Cosmetic Surgical Procedures
Gum Grafting
Gum grafting involves adding gum tissue next to the affected tooth or teeth to prevent gum recession or irritation. This is often necessary in conjunction with a tooth to be capped, orthodontic treatment (braces), or following periodontal treatment.
Root Coverage
Root Coverage is performed to cover exposed root surfaces, which are more vulnerable to cavities and more sensitive to cold. Root Coverage, rather than cervical fillings, restores proper proportion and esthetics to roots exhibiting decay.
When there is gum recession, the root of the tooth often shows and is unsightly. Gum grafting is needed to restore health, but root coverage may also be desired to improve appearance. This is generally accomplished with a connective tissue graft, which provides new attached gingiva while covering the root surface. These delicate procedures are done with microsurgical instrucments that are used in eye surgery. Small instruments means greater patient comfort.
Recession of canine gum producing a "fang-like" appearance.
Complete root coverage with normal gum contour.
Front tooth with unsightly root exposed.
Improved cosmetics after root coverage.
Root coverage of upper premolars, left and right.
Root coverage of upper premolars, left and right.
Root coverage of upper premolars, left and right.
Root coverage of upper premolars, left and right.
Unsightly anterior recession.
Unsightly anterior recession.
Recession corrected with root coverage procedure.
Recession corrected with root coverage procedure.
Full View.
Soft Tissue (Gum) Augmentation
Bone shrinkage following tooth extraction can create cosmetic and functional deformities. This most often results in a poorly shaped replacement tooth, subsequent food impaction, and an inability to maintain effective oral hygiene. The addition of gum tissue can effectively restore proper tooth appearance and function.
Periodontal Plastic Surgery
Periodontal procedures are available today that dramatically improve esthetics and provide adequate gum tissue to help prevent gum recession and tooth loss. These plastic surgery procedures create a natural, harmonious smile. Treatment options include specialized tissue grafting to cover exposed roots. This prevents further gum recession and root cavities and allows for regeneration of new gum tissue, affording excellent esthetics. Crown lengthenings and recontourings are performed to remove excessive tissue, thus eliminating a gummy smile. Our clinical team is available to meet with you to evaluate your unique needs.
Cosmetic Crown Lengthening
Cosmetic crown lengthening is performed to improve the appearance of your smile. This is accomplished with the use of microsurgery to revise the gum line position and improve symmetry. Metal free restorations such as veneers may be necessary as part of the treatment.
Short Clinical crown is cosmetically unpleasing.
After crown lengthening, a new crown results in a beautiful smile.
Most crown lengthening procedures are very straightforward, and there is little or no post-operative discomfort. Sutures and dressing are removed after about 2 weeks, and in many cases a 5-minute "touch-up" surgery is done after 4-6 weeks to establish ideal tissue form. This secondary procedure requires no sutures or dressing, and has no post-operative discomfort.
If a crown is to be placed in a cosmetic area, the restorative dentist should wait 8 weeks following crown lengthening before taking final impressions. This ensures that the gum, which shrinks slightly as it re-attaches to the tooth during healing, is in its final position. If the margin of the crown is placed at the gum level before final healing, and additional shrinkage occurs, the results may be unsightly. A temporary crown can be placed two weeks after surgery if the patient desires to cover the exposed root during this healing period.
Correcting the Gummy Smile
The gummy smile makes the teeth look short and not in proportion with the patient's face. By sculpting the gum to make the teeth appear more natural, the smile can be greatly enhanced.
Gummy smile results in short teeth with irregular gum margins.
After tissue sculpting and veneers, a beautiful smile with teeth the proper size for the patient's face.
Overgrowth of gum tissue during orthodontics.
Tissue surgically trimmed to normal contour.
Healed tissue with a pleasing appearance
Irregular Gum Levels
Irregular gum levels detract from an attractive smile. Even with new crowns, the results can never be satisfactory unless the gum has a natural contour. This may be as simple as changing a single tooth, or may involve all the upper front teeth.
Short lateral tooth, with low gum.
Gum made level with adjacent teeth so normal crown could be placed.
Irregular gum levels with short, chipped teeth.
Following gum recontouring and crowns.
Microsurgery
Magnification makes it possible to use ophthalmic (tiny) instruments to make surgical treatment more comfortable, heal faster and produce more predictable results.
Ridge Augmentation
When teeth are extracted, the bone often resorbs during healing and leaves an indentation in the gum. When a bridge is placed, this concavity prevents the artificial tooth from looking real - it looks like it is just lying on the gum. By repairing the ridge defect with a ridge augmentation, the artificial tooth now looks like it is growing out of the gum, and cannot be distinguished from the natural teeth.
Severe ridge defect after extraction.
Ridge augmented to return normal shape.
Deficient ridge making artificial tooth look unnatural.
Ridge augmented and expanded so artificial tooth appears to emerge from gum.
The best way to treat a ridge deficiency is to prevent it from occurring. The amount of bone loss from an extraction can be minimized by performing a ridge augmentation at the time of extraction.
Treating Extraction Sites
After a tooth extraction, the gum heals down in the socket before the bone has time to completely reform, leaving a resorbed ridge. To prevent bone resorption after extraction, we suggest the socket be filled with a material (bone graft) that reduces gum shrinkage or the socket be isolated with a membrane that prevents gum downgrowth. Preparing the extraction site with bone graft material prevents bone loss and soft tissue deformities.
Socket after extraction.
Membrane sutured in place.
At 6 months, bone healed without shrinkage.
Patient Comfort Options
Your well being is extremely important to me, and I will do everything I can to provide for a comfortable experience.
Local Anesthetic
Many procedures are performed with local anesthesia. Special medications are applied topically to numb the area prior to receiving the anesthetic.
Intravenous Sedation
Dr. Mecall is fully qualified and licensed by the state of Nevada to deliver intravenous sedation for your comfort.
Conscious sedation, which includes a twilight sleep, allows you to breathe on your own and comply with the doctor's instructions, while feeling completely relaxed. You will remember very little of the procedure once the sedation has lifted. Special monitoring equipment is used to enhance patient safety and comfort during all sedation procedures. The American Heart Association certifies Dr. Mecall in Basic and Advanced Cardiac Life Support.
Because your family dentist plays a crucial role in preventing and minimizing periodontal disease, I strongly urge you to continue to visit him or her regularly.