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admin | What Cures Bv | 05.03.2014
Our goal is to provide you with the highest quality of care in a compassionate and safe environment. If you have a broken or badly decayed tooth, your dentist or periodontist may recommend crown lengthening in order to make getting a filling, crown or bridge possible.
Procedure: The periodontist administers a local anesthetic and recontours excess gum and bone tissue to expose more of your natural teeth. The left photo shows the lower 2nd molar (bottom back tooth) is badly broken on both the cheek and tongue side. The left photo shows a molar decayed and broken extending under the gum line, making it impossible to restore.
This is a teenage orthodontic patient who developed excessive gum overgrowth as a result of ineffective oral hygiene during braces.
This is a teenage orthodontic patient who developed excessive gum overgrowth as a result of ineffective oral hygiene during braces. This is a Before photo of a teenager that has some gingival overgrowth, making it harder to clean her teeth leading to reduced oral hygiene, as well as an esthetic issue.
Procedure: The periodontist administers a local anesthetic, prepares the area, and then places a gum tissue graft. The main purpose of a soft tissue graft is to reduce the likelihood of further recession and bone loss. One is the Free Gingival Graft (FGG), which has been a common gum surgery since the 1940’s.
The 2nd type of soft tissue graft is a Sub-epithelial Connective Tissue Graft, commonly shortened to Connective Tissue Graft or a CTG.
Sometimes when you lose one or more teeth, an indentation can occur in your gums and jawbone where the tooth used to be.
Not only is this indentation unnatural looking, it can cause the replacement tooth to look long compared with the adjacent teeth. Procedure: The periodontist administers a local anesthetic and then fills the sunken area with grafting material, securing the tissue into place.
The before photos above show a benign lesion of the gum tissue in between the teeth called a pyogenic granuloma. The left photo shows a thin resorbable collagen barrier to hold the bone graft in place inside the void.
Above left shows the upper anterior prominent frenum just before excision (frenectomy) and the right photo was taken 10 weeks later. Sometimes teeth do not erupt through the gum tissue on their own and they need to be exposed as part of orthodontic treatment.
The above photos show an impacted mandibular 2nd molar in a teenager undergoing orthodontics.
Using local anesthetic (commonly called novocaine) the gum was reflected, trimmed and sutured lower so that the impacted tooth was exposed . This photo was taken 7 weeks later and shows the tooth with the orthodontic bracket and wires in place beginning to move the tooth.
The above photos show an impacted lower right cuspid in a patient undergoing orthodontics. Above is an example of pericoronal gingiva that was removed with a combination of surgical excision and laser. Our practice is easily accessible from the following surrounding areas: Auburn, Kent, Puyallup, Tacoma and Seattle, WA. Periodontists are dental specialists who treat gum disease, place dental implants, do gum treatments and perform a number of other procedures. Dr Brijesh Patel is one of the best dental surgeon ahmedabad, Gujarat providing all dental surgeries under one roof.
It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. Upon first glance, many parents are understandably concerned that their child has a serious problem in their mouth. The next photo shows an eruption cyst where the upper left six-year molar is preparing to come into the mouth. Fact: Since many eruption cysts occur on the back teeth and only last a few weeks, they often go undetected. You can click the following link to check out a picture of a tooth after its eruption cyst has been opened. You can find more photos of eruption cysts in this article that appeared in the Indian Journal of Dental Research. If you have any questions or concerns on eruption cysts, feel free to leave a comment in the comments section below. Many times, 6 year old molars erupt a bit under the last baby tooth, causing some resorption (or dissolving) of the baby molar’s roots. This can be a big problem resulting in space loss, and need for orthodontia or permanent tooth extractions later.
If you are truly concerned emergently, seek a consult with an oral surgeon or oral medicine specialist. I have had what you are describing and had an endodontist clean it out with a minor oral surgery procedure called an apioectomy it is essentially an infection that can continue to grow and cause bone loss. Teething aids (dry crackers, teething rings etc) may help a bit while you’re waiting.
Hi, my six year old has this on the right side of his mouth right where I believe his molar is coming in. I started this site to help you have a better understanding of dentistry so that you can make informed decisions regarding your dental treatment.
Pulpitis: What’s the Difference Between Reversible Pulpitis and Irreversible Pulpitis? Although most people develop and grow 32 permanent adult teeth, many times their jaws are too small to accommodate the four wisdom teeth. We will need to see you for a consultation to determine if you will benefit from wisdom tooth removal. Soft Tissue Impaction: There is not enough room to allow the gum tissue to retract for adequate cleaning of the tooth. Partial Bony Impaction: There is enough space to allow the wisdom tooth to partially erupt. As wisdom teeth develop, the roots become longer and the jawbone more dense.When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative course can be prolonged and there is a higher complication rate. Most people prefer to be unaware of the experience when they have their wisdom teeth removed and usually decide to be sedated. On the day of your procedure, you will take medications to help minimize post-operative pain and swelling. On the morning or afternoon of your surgery, it is essential that you have nothing to eat or drink (excluding prescription medications with a sip of water) for at least 6 hours (preferably longer).
If your surgery requires stitches, these are usually the type that dissolve in 3 to 5 days and do not require removal.
We do not recommend using dairy products such as yogurt, ice cream or milkshakes on the day of surgery, as nausea and vomiting may develop in conjunction with the anesthetic and pain medication. Wisdom Teeth Presentation To provide you with a better understanding of wisdom teeth, we have provided the following multimedia presentation. After the procedure, our assistants will review your post-operative instructions with your escort. A primary concern is a nerve within the lower jawbone that supplies feeling to the lower lip, chin, and tongue.
The upper wisdom teeth are situated close to your sinuses, and their removal can result in an opening between your mouth and the sinus. Dry sockets continue to be the most common problem people experience following dental surgery. The symptoms frequently begin in the middle of the night, and your pain medication regimen may not help. At the time of your consultation, your specific situation will be discussed in greater detail. All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Wisdom Tooth Removal Overview For a brief narrated overview of the wisdom tooth removal process, please click the image below. If you do not have enough room in your mouth for your third molars to fully erupt, a number of problems can happen. Impacted wisdom teeth should be removed before their root structure is fully developed. As wisdom teeth develop, the roots become longer and the jaw bone more dense.When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative course can be prolonged and there is a higher complication rate. In order to do this, we use the most current periodontal procedures, instruments, medications, and sterilization techniques. When getting a new crown or bridge, your dentist must prepare your tooth to receive the crown.
Your teeth may actually be the proper lengths, but they are covered with too much gum tissue. This can be done to either prepare your teeth for a crown or bridge or to improve the esthetics of your smile. The gums overgrowth subsided somewhat after the braces were removed, but would not improve any more than this.

Sebastian has done advanced training in soft tissue grafting to ensure that he can offer you the highest standard of care. As you can see in the before photos several of the lower front teeth had paper thin gum that was starting to recede. Note that the lower cuspid was prominently positioned in the arch, leaving very thin existing gum that eventually started to recede away.
When the crown was originally placed several years before, it was made to the then existing gum line. The after photo is 15 months after the CT graft was done, showing the root remaining covered. It can also make the new tooth that replaces the lost tooth easier to clean, as well as making it look more natural. Using local anesthesia, the lesion was excised and sent for a definitive diagnosis to a pathology laboratory that specializes in oral lesions (University of Washington Oral Pathology Department).
The above right x-ray was taken 17 months later, showing resolution of the cyst and re-growth of the previously destroyed bone.
In the above case,  before orthodontics was started, the 2 upper front incisors had a diastema (separated front teeth like David Letterman) with the frenum extending between the teeth. Frenum removal surgery, Biopsy of Suspected precancerous lesion and soft tissue lesion, Oral Cancer Surgery, Cyst And Tumor Removal, Mouth opening Surgery for Oral Submucuous Fibrosis Treatment, Maxillofacial Fractures Wiring And Plating and Gum surgery.
I was planning on taking him to an urgent care tomorrow until my mother shared this article with me. While I read that it usually resolved itself, this one is under a capped, lower canine tooth that doesn’t seem wiggly. I would say they have been there for 3 months the purple was further up and now has moved down. They are usually the last teeth to develop and are located in the back of your mouth, behind your second molars. A special x-ray of your mouth and jaws (panorex) will be taken to determine if your wisdom teeth are impacted, if there is room for them to erupt, and how difficult it will be to have them removed. However, the tooth cannot function properly in the chewing process, and creates cleaning problems, among others. It remains embedded in the jawbone or if even partially visible requires complex surgical techniques for removal.The impacted wisdom tooth may also be in an unusual position and difficult to remove. In some patients it is as early as 12 or 13, and in others it may not be until the early twenties. This is most noticeable with the front teeth, primarily the lower front teeth and is most commonly seen after a patient has had braces. Treating these complications is often more difficult and less predictable than with a younger patient. We ask that a parent or responsible adult accompanies you to the office and plans to stay with you the rest of the day.
Make plans to have a parent or responsible adult stay with you for the rest of the day, following wisdom tooth removal.
You may also notice a sensation of your gums feeling swollen and pulling away from your teeth. Please try non-narcotic anti-inflammatory medications such as ibuprofen (Advil®) first, to see if that adequately treats your pain. If you are given antibiotics and you take birth control pills, please be aware that the birth control pills might become ineffective and take appropriate precautions.
You should cover your pillowcase with something so that you don’t get any blood on it. Some complications that patients undergoing Wisdom Tooth Extraction may experience include: Damage to the sensory nerve that supplies sensation to the lips and tongue, sinus communication, infections and dry sockets. We ask that you follow these instructions closely, as they will make you most comfortable following your procedure.
Once again, if the teeth are removed at an early age, the root formation is minimal, and this complication is very unlikely. These may include the difficulty involved in removing your teeth and which type of anesthesia is best for you. Having anything in your stomach can increase the risk for serious anesthetic complications.
Singla and Yoo can evaluate the position of the wisdom teeth and predict if there are present or future potential problems.
It will launch our flash educational MiniModule in a separate window that may answer some of your questions about wisdom teeth. We utilize modern monitoring equipment and our staff are experienced in anesthesia techniques.
Gilbert can evaluate the position of the wisdom teeth and predict if there are present or future potential problems. Our doctors are trained, licensed, and highly experienced in providing various types of anesthesia for patients.
Cysts are fluid-filled “balloons” inside the jaw bone that develop as a result of impacted teeth and slowly expand destroying adjacent jaw bone and occasionally teeth. This does not mean you should try to fit in one “last meal” exactly six hours before your surgery.
Please try non-narcotic anti-inflammatory medications such as ibuprofen (Advil®) first, to see if that adequately treats your pain. We want you to be completely informed of your condition and encourage you to ask any questions you may have regarding your treatment and care. It can also make some dental procedures, like crowns or bridges, possible by providing more tooth structure for the crown or bridge to rest upon. The dentist could not restore it adequately with a new crown without having more solid tooth structure exposed. The right photo shows the tooth with a new crown placed 3 months after the crown lengthening surgery. 4 months later this woman's family dentist was able to make a crown, saving a tooth that she thought had to be extracted. Note the decay and break are now above the new gum line, making it possible for the dentist to remove all the tooth decay and prepare the tooth for a crown. It can also improve ability to eat, as well as allow better oral hygiene and result in less gum irritation. Your gums may have receded for a variety of reasons, including aggressive tooth brushing, the alignment of the teeth, orthodontics, heredity or periodontal disease. Donor tissue from the palate was used as the graft tissue to reinforce the gum with a tightly adhering gum tissue that should resist any further recession (and subsequent underlying bone loss) from occurring.
A CT graft was done to place a thicker amount of firmly adhering gum taken from the palate that should prevent further significant recession from occurring in the future. A definitive diagnosis is obtained through a biopsy specimen being sent to a pathology laboratory that specializes in oral lesions for analysis. When orthodontics pulls the 2 teeth together, the frenum bunches up and will re-separate the teeth once the braces are removed, unless it is excised away.
Their development is usually completed between the middle teenage years and early twenties, a time traditionally associated with the onset of maturity and the attainment of wisdom. This situation can also arise when the shape or size of the jawbone and other facial structures make removal of this tooth significantly more complex.
They can be very difficult to treat if your wisdom teeth are not removed in your teenage years.
There are a number of factors that cause teeth to crowd after braces or in early adulthood. The procedure will take about 30 to 60 minutes and you will probably be in the office for 90 minutes. Having anything in your stomach can increase the risk for serious anesthetic complications, including nausea and vomiting.
Each individual’s reaction to surgery varies, and the sensation of pain can range from mild discomfort to severe pain.
Having these teeth out between the ages of 12 and 18 usually provides shorter roots so that the nerve is not so close to the roots of these teeth. However, if it does occur, it will usually close spontaneously, but we may give you special instructions to follow, such as avoid blowing your nose for two or three days following the surgery.
This seems to occur with greater frequency in people who smoke or are taking birth control pills.
Many times, just placing you on an antibiotic for one week will take care of the infection.
During your consultation appointment, the surgeon will need to review your x-rays, complete an examination and determine the best option for anesthesia, before an accurate estimate can be provided.
If new questions arise after your consultation, please call the doctor’s office to speak to one of the patient care coordinators.
Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Singla and Yoo is trained, licensed, and highly experienced in providing various types of anesthesia for patients.
If new questions arise after your consultation, please call our office at 909-982-8888 to speak to one of our patient care coordinators. When crown lengthening is recommended for a large cavity or broken tooth, it usually means the tooth can not be restored or saved with out more tooth being exposed, so the bone and gumline is reduced to expose more solid tooth structure.

The after picture is with the new crown in place 3 months after the restorative crown lengthening surgery was done.
In both these cases, your periodontist can perform crown lengthening to enhance your smile. Local anesthetic was given and the gums were reshaped using both a surgical blade and our Luxar LX20 carbon dioxide laser. 2 month later, the restorative dentist placed veneers, obtaining an excellent esthetic result. You may not be in control of what caused the recession, but your periodontist can help you identify the factors contributing to the problem.
CT grafts take longer to do and are much more technique sensitive, requiring more advanced surgical skills. There was not pain associated with this growing lesion, and it was identified on an x-ray as part of a routine check-up. The norm is to do the orthodontics until near completion, then excise the frenum away (frenectomy) and is very successful. If the tissue overlying the tooth is small, it is called an operculum, and its removal is referred to as an operculectomy. The actual tooth didn’t appear for another 3 months, but shortly thereafter her second molar next to it became very loose and the surrounding tissue swollen and was extracted by her dentist. And the procedure if done by a great endontist will heal nicely and the bone will regenerate and no need to extract the tooth. If your impacted wisdom teeth are not removed in your teenage years or early in your twenties and they are completely impacted in bone, it may be advisable to wait until a localized problem (such as cyst formation or localized gum disease and bone loss) develops.
Our office staff has the training, licensing, and experience to provide the various types of anesthesia. Recent advances in medicine and technology allow patients to undergo wisdom tooth removal in a manner, which promotes rapid healing and minimal post-operative discomfort. The local anesthesia may last until the following day, and should not be confused with an injury to your nerve. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a few days. Occasionally, when the teeth are removed, and especially in older patients, the nerve can become injured. While both jaws can be affected, they usually occur in the lower jaw on the third to fifth day.
Following removal of the dressing, an irrigation device may be provided to help you to keep food particles from lodging in the extraction site. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist, or by an oral and maxillofacial surgeon. Crown lengthening can also result in less gum irritation from an existing filling or crown that is too deep under the gum line. The restorative crown lengthening procedure made it possible for the dentist to save the tooth.
A soft tissue graft procedure can repair the missing gum and help to prevent additional recession. In many instances soft tissue grafts, called Connective Tissue grafts (CT grafts) can attempt to cover these exposed roots and reduce the sensitivity to heat, cold and sweets and may improve the esthetics of your smile, as exposed tooth roots may look unsightly.
The after photo was taken 4 months post-op and 1 month after refinement with a carbon dioxide laser. Doing the frenectomy initially before orthodontics will create a scar that will also tend to spread the teeth apart. If the tissue is large, it is referred to as pericoronal gingiva, and its removal is referred to as excision of pericoronal gingiva. He seemed stymied by the loss of the tooth, but I’m wondering if the eruptive hematoma possibly had anything to do with it? As I was having my tooth prepped for a crown , I involuntarily swallowed and they did not move the drill. It is in a fluid-filled sac that sometimes gets a bit of blood as well, so it looks purple until it pops through the gum.
My question is whether she will develop a permanent tooth at this extracted tooth’s place. Unless you have an active problem when you see the oral surgeon, the reason for removal is primarily to prevent long-term damage to your teeth, gums and jawbone. In general, you will heal faster, more predictably and have fewer complications if treated in your teens or early twenties. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and a well trained experienced staff. We may provide you with a prescription for pain medication at your consultation appointment, which for your convenience, can be filled in advance. We recommend starting your post-operative diet with clear liquids such as jello and broths, gradually increasing in substance as your body permits. Please make sure you have the Adobe Flash Player plugin installed in order to correctly view this presentation.
When local anesthesia wears off, you may experience a tingling or numbing sensation in the lower lip, chin, or tongue. The effectiveness in alleviating the pain lasts for 24-48 hours and may require dressing changes every day or two, for five to seven days. Other temporary problems you may experience in the post-operative period include stiffness of the jaws, chafing around the corners of your lips, facial bruising, and blood oozing from the extraction sites. The oral surgeon’s office staff will help you obtain maximum insurance coverage for your treatment.
Unless you have an active problem when you see the oral surgeon, the reason for removal is primarily to prevent long-term damage to your teeth, gums and jaw bone.
The oral surgeon’s office staff will help you obtain maximum insurance coverage for your treatment.
The Surgical Care Team, the office facilities, and the doctors are inspected on behalf of the Board of Dental Examiners on a regular basis.
When you are seated in the surgical room, we will make every effort to make you as comfortable as possible. These can include delayed healing, infection and post-operative numbness or tingling in your lip, chin, or tongue. Should this occur, it is usually temporary and will resolve gradually over a period of weeks or months. Pressure should not be created in the sinus area, which may dislodge the healing blood clot. The post-operative instruction sheet we will provide should answer many of the questions related to these more common concerns. Upon discharge your postoperative kit will include postoperative instructions, a prescription for pain medication, antibiotics, and a follow-up appointment in one week for suture removal. The more ice you use the first day, the less swelling you are likely to have on the second day. The oral surgeon will review relevant post-operative events with you and answer any questions during your office visit.
On rare occasions it can result in a permanent alteration of sensation similar to having local anesthesia. In addition, while total root coverage is the ideal outcome, sometimes only partial root coverage can be achieved. This is a quick and nearly painless procedure that ensures optimal delivery of your medication. Please remember to put ice on the first day even if it is somewhat uncomfortable to have the cold next to your skin.
We refine the majority of our CT grafts about 3 to 4 months post-op with our Luxar LX20 carbon dioxide laser to reshape them for achieving the best esthetic result.
Local anesthesia is given to you afterwards to ensure comfort, and allow adequate time to travel home and rest. On the third day, you will notice that your jaw muscles are stiff, and it is difficult to open your mouth normally. You can apply moist heat to your face on the second and third day allowing your muscles to relax more and open wider. Doing so will make you as comfortable as possible during the first few days following your procedure.
Please allow time for your body to begin healing before resuming an active social, academic, or athletic schedule. Most patients feel like they are over the hump and on their way to recovery in 3 to 5 days.

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