Interdisciplinary management of dental problems

The restoration of existing teeth, or the replacement of those that are missing, is occasionally preceded by periodontal treatment to modify the appearance or location of the gums around the teeth. Orthodontic treatment may require special procedures in order to yield a stable position of the teeth and the gums around the teeth. The Periodontist is often called upon to assist other dentists in achieving healthy, functional, and esthetic results:

Clinical Crown Lengthening:

The presence of tooth decay, old fillings that are located under the gum line, (See Exhibit 1 Before & After) or defects in the teeth often requires dental crowns, or caps (See Exhibit 2 Before & After). A change in the position of the gum tissue is occasionally needed before these restorations are placed. This joint effort between the Periodontist and the restorative dentist can produce a long term result that is pleasing to the eye and is at less risk for development of future disease.

Night guards are often used in the management of tooth grinding or clenching. These are custom-made appliances, usually made of clear hard acrylic from molds made of the patients top and bottom teeth. Depending on the situation, they may be made to fit on either the upper or lower teeth, and may be worn during the day and/or night.

Biopsies may be indicated in order to establish a diagnosis for areas of concern located in the mouth. These simple procedures involve removal of all or a portion of a lesion, which is then sent to the pathology lab for evaluation under a microscope. Once the nature of the condition is determined, further management is provided as indicated.

Periodontal therapy associated with orthodontic treatment

Frenectomy:

A Frenectomy involves a minor surgery to remove a small portion of the dense tissue that may separate the upper front teeth. Not only can the teeth be moved together quicker, but the procedure can prevent them from separating again once the orthodontic appliances are removed. (See Exhibit 3 Before & After).

Fiberotomy:

The fibers that anchor the tooth root to the gum tissue can often prevent a rotated tooth from being straightened. This procedure minimizes the chance for relapse to the original position.

Soft Tissue Graft:

Movement of teeth that are surrounded by very thin gum tissue introduces a risk of recession and exposure of the root surface. A gum graft to increase tissue thickness can prevent this undesirable side effect of orthodontic treatment. (See Exhibit 4 Before & After)

Management of tissue overgrowth:

Occasionally while braces are being worn, the gum tissue can become overgrown. This creates problems properly cleaning the teeth, which may have become very short and stubby looking. Minor surgery allows more effective cleaning and can dramatically improve the smile. (See Exhibit 5 Before & After).

Exhibit 1 – Before Crown lengthening	Exhibit 1 – After Crown Lengthening
Exhibit 2 –Before Crown Lengthening	Exhibit 2 – After Crown Lengthening
Exhibit 3 – Before Frenectomy	Exhibit 3 – After Frenectomy
Exhibit 4 – Before Graft	Exhibit 4 – After Graft
Exhibit 5 – Before Surgery	Exhibit 5 – After Surgery