Dr. Herrera’s practice provides a variety of non surgical and surgical services for the treatment of periodontal issues. We pride ourselves on the fact that we are very conservative in our treatment recommendations and limit surgery to the areas where it is absolutely necessary. We are committed to providing extensive education which speeds & maintains healing.
Many times, the early stages of periodontal disease are best treated with non-surgical periodontal therapy. Even in severe cases, non-surgical periodontal therapy often precedes surgical therapy. This is done to improve the overall tissue quality prior to surgery and also to help limit the areas requiring surgery. We are passionate about providing care with the least amount of discomfort. Dr. Herrera does not start any treatment until patients are profoundly numb. With every surgery long acting anesthetic is given to keep you numb 6-8 hours, so that you can take pain medications in advance of the anesthetic wearing off. We give detailed instructions and will answer all questions at a pre op appointment which is done one week prior to the surgery date. Our efforts pay off as most patients have none or very little discomfort after surgery and are very surprised that it is much easier than anticipated.
Scaling and Root Planing
Guided Bone and Tissue Regeneration
Enamel Matrix Proteins
Cosmetic Periodontal Surgery
Oral Cancer Examination
Bruxism is an oral parafunctional activity that commonly occurs in most people at some point in their lives. The two main characteristics of this condition are grinding of the teeth and clenching of the jaw. These actions usually occur during a person’s sleeping hours, but occasionally they occur during the day.
Chewing is a neuromuscular activity controlled by a subconscious process, but more highly controlled by the brain. During sleep, the subconscious process may become active, while the higher control is inactive (asleep), resulting in bruxism. The most common symptoms are earaches and headaches, depression, eating disorders and anxiety, and chronic stress.
If Dr. Herrera observes the effects of clenching or grinding she will recommend a night time appliance be made by your general dentist.
Diagnostic Microbiology in Periodontics
Dr. Herrera administers a molecular test that provides supplemental information about a patient's periodontal disease.. Periodontitis is a multifactorial infectious disease - the most important risk factors can be determined rapidly and easily by molecularbiological testing. (www.hain-diagnostics.com)
This information can be used to develop patient-specific treatment plans for periodontal disease therapy and to help establish the therapy endpoint. Effective management of periodontal disease requires early diagnosis and appropriate therapeutic intervention.
Unfortunately, actively destructive periodontitis and periodontitis in remission can be difficult to distinguish on purely clinical grounds. Therefore, some periodontitis patients may not receive the most optimal treatment. Dr. Herrera most commonly uses DNA testing In patients who have received periodontal treatment and who are still not stable or those who are young and have aggressive periodontal disease.
There are specific oral bacteria that cause Periodontitis. Potential periodontal pathogens include:
Monitoring these bacteria may aid in distinguishing non-progressing and progressing periodontitis, in assessing treatment success or failure, and in selecting appropriate antimicrobial therapy which will be administered in conjunction with conventional therapy. This test is simple, painless and the results are sent by the laboratory quickly. This allows us to significantly increase the success rate of the therapy while the relapse rate is dramatically reduced. This test can also be done around failing implants in conjunction with periodontal surgery.
Now that your course of periodontal treatment is complete, we have your periodontal disease under control. To keep your gums healthy and avoid any recurrence of disease the next step is a regular periodontal maintenance appointment, formerly referred to as supportive periodontal therapy or periodontal recall.
It provides the careful, ongoing monitoring, and treatment necessary to prevent the recurrence of periodontal disease.
Like diabetes and cardiovascular disease, periodontal disease is a "silent disease," meaning that the person is not aware of the existence-of the disease. Just as cardiovascular patients must eat well and exercise to prevent future cardiovascular problems, patients who have undergone periodontal treatment must maintain their oral health by diligent oral hygiene practices and with timely periodontal maintenance appointments to prevent recurrence of disease.
It is a procedure that removes all the bacterial plaque that causes this chronic infection.
A prophylaxis, the standard cleaning done at a dental office, involves scaling done above the gumline. A periodontal maintenance appointment involves removal of bacterial plaque and calculus below the gumline. A prophylaxis is performed in patients with no bone loss or pockets. When the dental team uses a probe to measure the pockets of these patients, the probe goes 2-3 mm below the gum line and this is considered "normal." Patients, such as yourself, with disease beyond minor redness and bleeding and normal pocket depths are scheduled for a more in depth periodontal maintenance appointment.
At every periodontal maintenance appointment, the following is done:
Your dentist and Dr. Herrera work as a team to devise the best course of treatment for you. They keep each other and you informed of your progress.
Dr. Herrera, a specialist attuned to your periodontal needs, helps monitor progress and prevent the onset of new periodontal problems.
Your general dentist manages your overall dental health by taking x-rays, performing complete exams as well as diagnosing cavities and providing fillings, crowns, and bridges.
Seeing both doctors provides you with the highest level of care possible.
Alternating periodontal maintenance appointments between offices (your dentist and specialist) every 3-4 months is the standard of care and is a very effective way to manage periodontal disease. Studies show that removing the harmful bacteria every 90 days is critical to maintaining health. When this is not done, the pockets can deepen and more bone loss can occur.
The initial stage of treatment for periodontal disease is usually a thorough cleaning that may include scaling or root planing. The objective of these non-surgical procedures is to remove etiologic agents such as dental plaque and tartar, or calculus, which cause gingival inflammation and disease. Scaling and root planing can be used as a stand-alone treatment, or a preventative measure. They are commonly performed on cases of gingivitis and moderate to severe periodontal disease.
Dr. Herrera will only perform scaling and root planing after a thorough examination of the mouth, which may include taking X-rays and visually examining the mouth. Depending on the condition of the gums, the amount of tartar present, the depth of the pockets, and the progression of periodontitis, Dr. Herrera may recommend scaling and root planing. In all cases, a local anesthesia will be used during the procedure. In addition if you are very anxious, a short term anti anxiety medication can be prescribed. If you take this medication it is mandatory that you have someone drive you to and from your appointment.
When scaling is performed, calculus and plaque that attaches to the tooth surfaces is removed. The process especially targets the area below the gum line, along the root. Scaling is performed with a special dental tool called an ultrasonic scaling tool. The scaling tool usually includes an irrigation process that can be used to deliver an antimicrobial agent below the gums to help reduce oral bacteria.
Root planing is performed in order to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar. The root of the tooth is literally smoothed, which promotes healing, and also helps prevent bacteria from easily colonizing in the future.
Antibiotics or irrigation with anti-microbials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, an antibiotic will be placed in the periodontal pockets after scaling and planing. This may be done to control infection and to encourage normal healing.
When deep pockets between teeth and gums are present, it is difficult for our hygienist to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health. The more you do at home in terms of oral care that she prescribes, the better you will heal.
If treatment is successful, scaling and planing may have many periodontal benefits. One is that it can help prevent disease. Research has proven that bacteria from periodontal infections can travel through the blood stream and affect other areas of the body, sometimes causing heart and respiratory diseases. Scaling and root planing removes bacteria that causes these conditions.
Another benefit of treatment is protecting teeth against tooth loss. When gum pockets exceed 3mm in depth, the risk for periodontal disease increases. As pockets deepen, more bacteria are able to colonize, eventually causing a chronic inflammatory response by the body to destroy gingival and bone tissue. This leads to tooth loss.
Finally, scaling and root planing may make the mouth more aesthetically pleasing, and should reduce bad breath caused from food particles and bacteria in the oral cavity. Superficial stains on the teeth will be removed during scaling and planing, adding an extra bonus to the procedures.
A bite is considered to be healthy when all or most of the teeth are present and not destroyed by normal daily usage.
It is destructive when teeth show wear, looseness or when TMJ (jaw joint) damage is seen. Bite therapy helps restore a bite that can function without damage and destruction. The therapy may include:
Osseous surgery, sometimes referred to as pocket reduction surgery or gingivectomy, refers to a number of different surgeries aimed at gaining access to the tooth roots to remove tartar and disease-causing bacteria.
Osseous Surgery is used to reshape deformities and remove pockets in the alveolar bone surrounding the teeth. It is a common necessity in effective treatment of more advanced periodontal diseases. The ultimate goal of osseous surgery is to reduce or eliminate the periodontal pockets that cause periodontal disease. Despite the word “surgery” the procedure is reported to feel more like a thorough cleaning. The specific goals of surgery include:
Bacteria from the mouth can spread throughout the body and cause other life-threatening conditions such as heart disease and respiratory disease. Removing deep tartar and thereby bacteria can help reduce the risk of bacteria spreading.
The immune system’s inflammatory response prompted by periodontal bacteria can lead to bone loss in the jaw region, and cause teeth to fall out. Osseous surgery seeks to stop periodontal disease before it progresses to this level.
Mouths plagued with periodontal disease are often unsightly. Brown gums, rotting teeth, and ridge indentations can leave a person feeling depressed and too self-conscious to smile. Fortunately, osseous surgery can help reduce bacteria and disease and thereby restore your mouth to its former radiance, while restoring confidence at the same time.
As the gum pocket deepens, it can become nearly impossible to brush and floss adequately. Osseous surgery reduces pocket size, making it easier to brush and floss, and thereby preventing further periodontal disease.
A local anesthetic will be used to numb the area prior to surgery. First, Dr. Herrera will cut around each tooth of the affected area to release the gum tissue from the bone. This allows access to the bone and roots of the teeth. After the roots have been thoroughly cleaned through scaling, a handpiece and hand tools will be used to reshape the bone around the teeth. Bone is removed in some areas to restore the normal rise and fall of the bone, but at a lower level. Bone grafting may also be necessary to fill in large defects.
Next, the gums will be placed back over the remaining bone and sutured in place. The site will also be covered with a bandage (periodontal pack) or dressing. Pain medicine and mouth rinses containing chlorhexidine are generally prescribed following the surgery.
Do not be alarmed if bleeding and swelling occur after the surgery. This can be controlled easily by placing an ice pack on the outside of the affected area. In cases where the bleeding and swelling is in excess, it is advised that you call to notify our office. Several follow up visits may be necessary and you must fulfill a meticulous maintenance program especially during the initial phases of healing to avoid post-operative infection. You will be delighted to experience how mild the discomfort is when you follow our directions and take the prescribed medications.
When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession is a problem, gum reconstruction using grafting techniques is an option.
When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the mucosa, the first line of defense against bacterial penetration is lost.
In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unpleasant appearance of the gum and tooth. When significant, gum recession can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries and root gouging.
A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth or gently moved over from adjacent areas to provide a stable band of attached gingiva around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root.
The gingival graft procedure is highly predictable and results in a stable, healthy band of attached tissue around the tooth.
|Recession, NAG, & High Frenum||CTG #24 & 25|
|Severe Recession, NAG, & Root Fillings||CTG on #3 & 4 with Emdogain|
|Recession, Decay, NAG, & Esthetic Concern||Connective Tissue Grafts “CTG” on #8 & 9|
|Recession, Decay, & NAG||CTG on #28 & 29|
|Recession, NAG, & Filling Removal||CTG #10 & 11|
|Recession, NAG, Dark Roots above Bridge & Crowns||CTG #6 & 8|
|Recession, NAG, Severe Root Wear, & Sensitivity||CTG on #3-4 & 5-6|
|Recession, NAG, Shallow Vestibule & High Frenum||Free Gingival Grafts “FGG”
#22 & 26
A frenum is a naturally occurring muscle attachment, normally seen between the front teeth (either upper or lower). It connects the inner aspect of the lip with the gum. A lack of attached gingiva, in conjunction with a high (closer to the biting surface) frenum attachment, which exaggerates the pull on the gum margin, can result in recession. Additionally, an excessively large frenum can prevent the teeth from coming together resulting in a gap between the front teeth. If pulling is seen or the frenum is too large to allow the teeth to come together, the frenum is surgically released from the gum with a frenectomy. A frenectomy is simply the surgical removal of a frenum.
When Orthodontic treatment is planned or initiated, the removal of an abnormal frenum, with or without a gingival graft, can increase stability and improve success of the final orthodontic result.
Crown lengthening is usually performed to improve the health of the gum tissue, prepare the mouth for a procedure, or correct a “gummy smile”. A “gummy smile” is used to describe an instance where teeth are covered with excess gum tissue resulting in a less esthetically-pleasing smile. The procedure involves reshaping or recontouring the gum tissue and bone around the tooth in question to create a new gum-to–tooth relationship. Crown lengthening can be performed on a single tooth, many teeth or the entire gum line.
Crown lengthening is often required when your tooth needs a new crown or other restoration. The edge of that restoration is deep below the gum tissue and not immediately accessible. It is also usually too close to the bone or below the bone.
Crown lengthening allows us to reach the edge of the restoration, ensuring a proper fit to the tooth. It should also provide enough tooth structure so the new restoration will not come loose in the future. This allows you to clean the edge of the restoration when you brush and floss to prevent decay and gum disease.
Crown lengthening takes approximately one hour but will largely depend on the amount of teeth involved and if any amount of bone will need to be removed. The procedure is usually performed under local anesthetic and involves a series of small incisions around the tissue to separate the gums from the teeth. Even if only one tooth requires the procedure, it will probably be necessary to adjust the surrounding teeth to enable a more even reshaping. In some cases, extraction of a small amount of bone will be necessary as well.
When Dr. Herrera is satisfied that the teeth have sufficient exposure and the procedure is completed, the incisions will be cleaned with sterile water. Sutures and a protective bandage are then placed to help secure the new gum-to-tooth relationship. Your teeth will look noticeably longer immediately after surgery because the gums have now been repositioned. You will need to be seen in one or two weeks to remove the sutures and evaluate your healing. The surgical site should be completely healed in approximately two to three months following the procedure.
Over a period of time, the jawbone associated with missing teeth atrophies, or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implant of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.
Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease, or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip, or tibia (below the knee.) Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.
Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia) are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay. If you require this type of bone grafting, Dr. Herrera and your general dentist will advise you who you can see for this.
When one or more teeth are missing, it can lead to jawbone loss at the site of the gap. This loss of jawbone can develop into additional problems, both with your appearance and your overall health. You may experience pain, problems with your remaining teeth, and altered facial appearance, and eventually even the inability to speak and eat normally.
In that same way that muscles are maintained through exercise, bone tissue is maintained by use. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates and goes away.
The following are the most common causes for jawbone deterioration and loss that may require a bone grafting procedure:
When an adult tooth is removed and not replaced, jawbone deterioration may occur. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates and goes away.
The rate at which the bone deteriorates, as well as the amount of bone loss that occurs, varies greatly among individuals. However, most of the bone loss occurs within the first eighteen months following the extraction, and continues throughout life.
Periodontal diseases are ongoing infections of the gums that gradually destroy the support of your natural teeth. Periodontal disease affects one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, or gingiva. While there are many diseases which affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues, and are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the diseases, may never progress into periodontitis, it always precedes periodontitis.
Dental plaque is the primary cause of gingivitis in genetically-susceptible individuals. Plaque is a sticky colorless film, composed primarily of food particles and various types of bacteria, which adhere to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. Bacteria found in plaque produce toxins or poisons that irritate the gums. Gums may become inflamed, red, swollen, and bleed easily. If this irritation is prolonged, the gums separate from the teeth causing pockets (spaces) to form. If daily brushing and flossing is neglected, plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.
Periodontitis is affected by bacteria that adhere to the tooth’s surface, along with an overly aggressive immune response to these bacteria. If gingivitis progresses into periodontitis, the supporting gum tissue and bone that holds teeth in place deteriorates. The progressive loss of this bone, the alveolar, can lead to loosening and subsequent loss of teeth.
Unanchored dentures are placed on top of the gum line, and therefore do not provide any direct stimulation to the underlying alveolar bone. Over time, the lack of stimulation causes the bone to resorb and deteriorate. Because this type of denture relies on the bone to hold them in place, people often experience loosening of their dentures and problems eating and speaking. Eventually, bone loss may become so severe that dentures cannot be held in place even with strong adhesives, and a new set may be required. Proper denture care, repair, and refitting are essential to maintaining oral health.
Some dentures are supported by anchors, which do help adequately stimulate, and therefore preserve bone.
With bridgework, the teeth on either side of the appliance provide sufficient stimulation to the bone, but the portion of the bridge that spans the gap where the teeth are missing receives no direct stimulation. Bone loss can occur in this area.
By completing a bone graft procedure, Dr. Herrera is now able to restore bone function and growth, thereby halting the effects of poor denture care.
When a tooth is knocked out or broken to the extent that no biting surface is left below the gum line, bone stimulation stops, which results in jaw bone loss. Some common forms of tooth and jaw trauma include: teeth knocked out from injury or accident, jaw fractures, or teeth with a history of trauma that may die and lead to bone loss years after the initial trauma.
A bone grafting procedure would be necessary to reverse the effects of bone deterioration, restoring function and promoting new bone growth in traumatized areas.
Misalignment issues can create a situation in the mouth where some teeth no longer have an opposing tooth structure. The unopposed tooth can over-erupt, causing deterioration of the underlying bone.
Issues such as TMJ problems, normal wear-and-tear, and lack of treatment can also create abnormal physical forces that interfere with the teeth’s ability to grind and chew properly. Over time, bone deterioration can occur where bone is losing stimulation.
Osteomyelitis is a type of bacterial infection in the bone and bone marrow of the jaw. The infection leads to inflammation, which can cause a reduction of blood supply to the bone. Treatment for osteomyelitis generally requires antibiotics and removal of the affected bone. A bone graft procedure may then be required to restore bone function and growth lost during removal.
Benign facial tumors, though generally non-threateningly, may grow large and require removal of a portion of the jaw. Malignant mouth tumors almost always spread into the jaw, requiring removal of a section of the jaw. In both cases, reconstructive bone grafting is usually required to help restore function to the jaw. Grafting in patients with malignant tumors may be more challenging because treatment of the cancerous tumor generally requires removal of surrounding soft tissue as well.
When molars are removed from the upper jaw, air pressure from the air cavity in the maxilla (maxillary sinus), causes resorption of the bone that formerly helped the teeth in place. As a result, the sinuses become enlarged, a condition called hyperneumatized sinus.
This condition usually develops over several years, and may result in insufficient bone for the placement of dental implants.
Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
With bone grafting, we now have the opportunity to not only replace bone where it is missing, but also the ability to promote new bone growth in that location! This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.
Autogenous bone grafts, also known as autografts, are made from your own bone, taken from somewhere else in the body. The bone is typically harvested from the chin, jaw, lower leg bone, hip, or the skull. Autogenous bone grafts are advantageous in that the graft material is live bone, meaning it contains living cellular elements that enhance bone growth.
However, one downside to the autograft is that it requires a second procedure to harvest bone from elsewhere in the body. Depending on your condition, a second procedure may not be in your best interest.
Allogenic bone, or allograft, is dead bone harvested from a cadaver, then processed using a freeze-dry method to extract the water via a vacuum. Unlike autogenous bone, allogenic bone cannot produce new bone on its own. Rather, it serves as a framework or scaffold over which bone from the surrounding bony walls can grow to fill the defect or void.
Xenogenic bone is derived from non-living bone of another species, usually a cow. The bone is processed at very high temperatures to avoid the potential for immune rejection and contamination. Like allogenic grafts, xenogenic grafts serve as a framework for bone from the surrounding area to grow and fill the void.
Both allogenic and xenogenic bone grafting are advantageous in that they do not require a second procedure to harvest your own bone, as with autografts. However, because these options lack autograft’s bone-forming properties, bone regeneration may take longer than with autografts, with a less predictable outcome.
This product is processed allograft bone, containing collagen, proteins, and growth factors that are extracted from the allograft bone. It is available in the form of powder, putty, chips, or as a gel that can be injected through a syringe.
As a substitute to using real bone, many synthetic materials are available as a safe and proven alternative, including:
Graft composites consist of other bone graft materials and growth factors to achieve the benefits of a variety of substances. Some combinations may include: collagen/ceramic composite, which closely resembles the composition of natural bone, DBM combined with bone marrow cells, which aid in the growth of new bone, or a collagen/ceramic/autograft composite.
Bone morphogenetic proteins (BMPs) are proteins naturally produced in the body that promote and regulate bone formation and healing.
Synthetic materials also have the advantage of not requiring a second procedure to harvest bone, reducing risk and pain. Each bone grafting option has its own risks and benefits. Dr. Herrera will determine which type of bone graft material is right for you.
Site preservation is a common dental procedure often performed following a tooth extraction to help retain the natural contour of the gums and jaw that may otherwise have been lost.
When a tooth is removed, an empty socket is left in the alveolar ridge bone. When a tooth is removed, the bone surrounding the socket may resorb if a bone graft is not placed in the socket. If the previous height and width of the socket deteriorates, an implant may not be feasible due to inadequate bone.
Rebuilding the original height and width of the alveolar ridge is not medically necessary, but may be required for dental implant placement, or for aesthetic purposes. Dental implants require bone to support their structure, and site development can help maintain this bone to accommodate the implant.
A ridge augmentation is accomplished by placing bone graft material in the tooth socket. It is often done immediately after the tooth is removed, to avoid the need for a second procedure later. Next, the gum tissue is placed over the socket and secured with sutures. Dr. Herrera may choose to use a space-maintaining product over the top of the graft to help restore the height and width of the space created by the tooth and bone loss, and into which new bone should grow. Once the socket has healed, the alveolar ridge can be prepared for dental implant placement.
Site development procedure is typically performed in Dr. Herrera’s office under local anesthesia. Some patients may also request sedative medication which is a pill you take prior to the appointment.
You are a good candidate for this procedure if:
Gum disease has traditionally been treated by eliminating the gum pockets by trimming away the infected gum tissue and by re-contouring the uneven bone tissue. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are used routinely today. One of these advancements is guided bone regeneration, also referred to as guided tissue regeneration. This procedure is used to stabilize compromised teeth or to prepare the jaw for dental implants.
As periodontal disease progresses, pockets of degenerated bone develop in the jaw. These pockets can promote the growth of bacteria and the spread of infection. To address these pockets, Dr. Herrera may recommend tissue regeneration. During this surgical procedure, the pockets are cleaned thoroughly, and a membrane is placed between the soft tissue and the pocket in the bone. Some of these membranes are bio-absorbable and some require removal. The membrane covers the pocket so that fast-growing soft tissue is blocked, and slower-growing bone can begin to grow, or “regenerate” itself.
The effectiveness of the procedure generally depends on the patient’s willingness to follow a strict postoperative diet and careful oral care. Dr. Herrera will help you determine if bone regeneration surgery is right for you.
EmdogainGel is a resorbable, implantable material intended as an adjunct to periodontal surgery for topical application onto exposed root surfaces to treat intrabony, furcations, and recession type defects due to moderate or severe periodontitis. After a single gel application, EmdogainGel leaves only a resorbable protein matrix on the root surface that has been proven to regain attachment on the root surface.
EmdogainGel has been carefully designed to fit easily into established treatment regimens. As an adjunct to periodontal surgery, EmdogainGel requires no additional site preparation and adds little time to the procedure.
Dental implants are designed to provide a foundation for replacement teeth that look, feel, and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours will be preserved. The implants themselves are tiny titanium posts that are surgically placed into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes.
The bone bonds with the titanium, creating a strong foundation for artificial teeth. Small posts that protrude through the gums are then attached to the implant. These posts provide stable anchors for artificial replacement teeth. Dental Implants also help preserve facial structure, preventing the bone deterioration that occurs when teeth are missing.
If, like many others, you feel implant dentistry is the choice for you, we ask that you undergo a dental/radiographic examination and health history. During these consultation visits, Dr. Herrera will address your specific needs and considerations. Your questions and concerns are important to us and our team will work with you very closely to help make your procedure a success.
We will also discuss fees and insurance at this time. There are many types of insurance plans, and coverage for implants is varied. We will be happy to assist you in obtaining any benefits to which you may be entitled.
For most patients, the placement of dental implants involves two surgical procedures. First, implants are placed within your jawbone. Healing time following surgery varies from person to person and is based on a variety of factors, such as hardness of bone. In some cases, implants may be restored immediately after they are placed.
For the first three to six months following the surgery, dental implants are beneath the surface of the gums gradually bonding with the jawbone. You should be able to wear temporary dentures and eat a soft diet at this time. At the same time, your restorative dentist designs the final crown, bridgework or denture that will ultimately improve both function and aesthetics.
After the implant has bonded to the jawbone, the second phase begins. Either Dr. Herrera or your general dentist will attach an extension to your implant. The teeth replacements are then made over the posts or attachments. The entire procedure usually takes six to eight months. Most patients do not experience any disruption in their daily life. You then see your general dentist for an impression and fabrication of your crown or bridge.
A single prosthesis (crown) is used to replace one missing tooth – each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis (over denture) attaches to a bar or ball in socket attachments, whereas a fixed prosthesis is permanent and removable only by a professional.
Dr. Herrera performs in-office dental implant surgery in a hospital-style operating suite, thus optimizing the level of sterility. Inpatient hospital implant surgery is for patients who have special medical or anesthetic needs or for those who need extensive bone grafting from the jaw, hip or tibia.
Dr. Herrera has received extensive training in Dental Implantology. She has been successfully placing implants since 2008. Through continuing education, Dr. Herrera is abreast of the most current information on implant dentistry.
The maxillary sinuses are behind your cheeks and on top of the upper teeth. These sinuses are empty, air-filled spaces. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.
The key to a successful and long-lasting dental implant is the quality and quantity of jawbone to which the implant will be attached. If bone loss has occurred due to injury or periodontal disease, a sinus augmentation can raise the sinus floor and allow for new bone formation.
In the most common sinus augmentation procedure, a small incision is made on the premolar or molar region to expose the jawbone. A small opening is cut into the bone, and the membrane lining the sinus is pushed upward. The underlying space is filled with bone grafting material, either from your own body or from a cadaver. Sometimes, synthetic materials that can imitate bone formation are used. After the bone is implanted, the incision is stitched up and the healing process begins. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.
If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.
The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option besides wearing loose dentures.
Cosmetic periodontal procedures are a conventional way to cover unpleasant, sensitive, or exposed root surfaces and to prevent future gum recession. If you are unhappy with the appearance of short, unsightly teeth this can be greatly improved by a combination of periodontal procedures by Dr. Herrera and cosmetic dentistry by your dentist.
Although your teeth appear short, they may actually be the proper length. The teeth may be covered with too much gum tissue. We can correct this by performing the periodontal plastic surgery procedure, crown lengthening. During this procedure, excess gum and bone tissue are reshaped to expose more of the natural tooth. This can be done to more than one tooth, to even your gum line, and to create a beautiful smile.
Another cosmetic procedure is the soft tissue graft. It is used to cover unattractive tooth roots, reduce gum recession, and protect the roots from decay and eventual loss.
Tooth loss causes the jawbone to recede and can lead to an unnatural looking indentation in your gums and jaw, and appearance of a general aging. The original look of your mouth may not be recaptured because of spaces remaining under and between replacement teeth. They may appear too long compared to nearby teeth.
Bone grafting following tooth loss can preserve the socket/ridge and minimize gum and bone collapse. There is less shrinkage and a more aesthetic tooth replacement for either an implant crown or fixed bridge around the replacement teeth.
For more information about crown lengthening, gum grafting, and bone grafting, please refer to the treatment section of our website, and click on each individual procedure for an in-depth description.
Gummy SmileCrown Lengthening
Recession and Exposed RootsGingival Grafting and Porcelain Crowns
Recession and Exposed RootsGingival Grafting and Porcelain Crowns
Tooth LossFixed Bridge
Gingival Defects Connective Tissue Grafting & Crowns
Gingival Asymetry Connective Tissue Grafting, CL & Crowns
According to the American Cancer Society, over 30,000 cases of oral cancer are diagnosed each year, with over 7000 of these cases resulting in the death of the patient. Fortunately, oral cancer can be diagnosed with an annual cancer exam provided by Dr. Herrera. If caught early, oral cancer can be effectively treated.
Oral cancer is a pathologic process, which begins by producing no symptoms making it hard to recognize without an exam. There are many types of oral cancer, including teratoma, adenocarcinoma and melanoma. The most common form of oral cancer is malignant squamous cell carcinoma, which typically originates in the lip and mouth tissue. There are many other places in which oral cancers occur, including: the tongue, salivary glands, throat, gums, and face.
The oral cancer examination is completely painless. Dr. Herreraa will look for abnormalities and feel the face, glands, and neck for unusual bumps. Some of the signs that will be investigated are red patches and sores. Red patches on the floor of the mouth, or the front of the tongue, and bleeding sores which fail to heal easier, can be indicative of cancerous changes. Leukoplakia is a hardened white or gray, slightly raised lesion that can appear inside the mouth, and may be cancerous. Signs of these will be examined as well. Finally, soreness, lumps or the general thickening of tissue anywhere in the throat or mouth can signal pathologic signs, and will be examined.
If abnormalities, lesions, lumps, or leukoplakia are apparent, Dr. Herrera will implement a treatment plan that is right for you. Treatment options vary according to the precise diagnosis, but may include: excision, radiation therapy, and chemotherapy.
Dr Herrera will work with your primary care physician to implement a treatment plan that is right for you. Dr. Herrera does biopsy simple lesions of the gingiva but more advanced cases are refered to UCSF. The biopsies Dr. Herrera does are sent to UCSF oral pathology laboratory.
It is also important to note that over 75% of oral cancers are linked with avoidable behaviors such as smoking, tobacco use, and excessive alcohol consumption. Dr. Herrera can provide you with literature and options about quitting dangerous behaviors such as tobacco use.
Toothbrush selection is a process that should be undertaken with advice from the periodontist. As part of your treatment, Dr. Herrera assesses your periodontal status along with the thickness of your gum tissue and bone. She will then recommend a specific toothbrush and a hygiene regimen for you. Some periodontal problems such as recession and notching of the root surface are caused by over brushing with a firm brush and excessive amounts of toothpaste . Conversely, some patients build up large amounts of bacterial biofilm and benefit from instructions on how to remove it better which requires more focused efforts at the gum line. With treatment we place a dye on the teeth to stain the plaque so that patients can be instructed how to brush properly. It is critical to have specific instructions for each individual patient to improve treatment outcomes and ensure stability of the teeth, gums and bone over time. Dr. Herrera recommends the Sonicare Flexcare Platinum as an electric toothbrush . (www.Sonicare.com). The Sonicare is available for purchase in our office. For those with thin gums and recession a sensitive brush head is available. The Nimbus micro fine manual brush is also an excellent option and is available in our office as well as online (www.Nimbusdental.com).
Dr. Herrera has used Emdogain for about 15 years. This product contains Amelogenins which are growth factors that assist the body to form bone,connective tissue and the covering of the root called cementum. When used in combination with bone grafting material this product can help regenerate bone around teeth in patients with chronic bacterial periodontitis. She also recommends and uses this product in conjunction with connective tissue grafts or coronally repositioned grafts around the teeth. This gel is placed during surgery. It also speeds healing and helps with post-ope rative discomfort. If you would like more information please access their website at http://www.straumann.us/en/professionals/products-and-solutions/regeneration-solutions/tissue-regeneration.html
Perio Science Pro Advantage gel is a relatively new product that is all natural. It is an antioxidant and antibacterial agent. It comes in gel form and has a pleasant taste. In our practice doctor currently recommends this to be used after periodontal surgeries as well as for patients who need to eliminate inflammation. Patients can purchase this product in our office or through our website. If you have any additional questions please access their website at www.Periosciences.com