Patrick C. Makins, DDS, Inc.
Periodontics & Dental Implants
San Angelo, TX
325-949-9505

Surgical Procedures

Dental Implants

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 titanium posts that are placed into the jawbone where teeth are missing. The bone bonds with the titanium, creating a strong foundation for artificial teeth. In addition, implants can help preserve facial structure, preventing the bone deterioration that occurs when teeth are missing.

Dental implants are changing the way people live! With them, people are rediscovering the comfort and confidence to eat, speak, laugh and enjoy life.

Dr. Makins has received extensive training in Implantology. He has been successfully placing implants since 1987. Through continuing education, Dr. Makins is abreast of the most current information on implant dentistry.

Evaluation

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, your doctor 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.

Procedures

Dental implants are metal screw-shaped anchors that act as tooth root substitutes. They are surgically placed into the jawbone. Small posts are attached to the implant to provide stable anchors in the gums for replacement teeth.

For most patients, the placement of dental implants involves a surgical procedure. First, implants are placed within your jawbone. Healing time following surgery varies from person to person and is based on a variety of factors that include hardness of bone.

For the first three to six months following surgery, the implants gradually bond with the jawbone. You should be able to wear temporary dentures if needed during this time. At the same time, your restorative dentist designs the final bridgework or denture that will ultimately improve both function and aesthetics.

After the implant has integrated to the jawbone, the second phase begins. An impression must be taken. Then posts or attachments can be connected to the implant. The teeth replacements are then made over the posts or attachments. The entire procedure varies from three to nine months. Most patients do not experience any disruption in their daily life.

Return to top

Cosmetic Periodontal Surgery

These procedures are a predictable way to cover unsightly, 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. Makins 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, an 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.

Return to top

Gum Graft

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 unsightly 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.

Return to top

Crown Lengthening

Crown lengthening (or crown exposure) is required when your tooth needs a new crown or other restoration. The edge of that restoration is deep below the gum tissue and not accessible. It is also usually too close to the bone or below the bone.

The procedure involves adjusting the level of the gum tissue and bone around the tooth in question to create a new gum-to–tooth relationship. This 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. The procedure takes approximately one hour.

When the procedure is completed, sutures, and a protective bandage may be placed to help secure the new gum-to-tooth relationship. You will need to be seen in one or two weeks to remove the sutures and evaluate your healing.

Return to top

Osseous Surgery

In this, one of the most common surgical procedures, incisions are made around the tooth, and the gum tissue is pulled back slightly. This provides access to thoroughly remove all plaque and calculus. Irregularities of the bone caused by the disease are smoothed over and the tissue placed at a higher level around the tooth, closer to the bone. When the procedure is completed, “dissolving” sutures are used. A protective dressing may be placed around the necks of the teeth to cover the surgical area and to help secure the new gum-to-tooth relationship. You will need to be seen in 10-14 days to remove any remaining sutures and evaluate your healing.

By moving the gum closer to the bone, the pockets will be reduced or eliminated. However, the tooth may appear longer and the spaces between the teeth may appear larger. In cosmetic areas, other treatment options may be considered depending on how much gum tissue is exposed (“Smile Line”).

Different surgical techniques can be utilized to minimize cosmetic changes.

Return to top

Bone Regeneration

Traditionally, eliminating the gum pockets by trimming away the infected gum tissue and by re-contouring the uneven bone tissue treats gum disease. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are used routinely today.

Guided tissue bone regeneration regenerates the previously lost gum and bone tissue. Most techniques utilize membranes that are inserted over the bone defects. Some of these membranes are bio-absorbable and some require removal. Other regenerative procedures involve the use of bioactive gels.

Return to top

Bone Grafting

Over a period of time, the jawbone associated with missing teeth atrophies or is resorbed. 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 an implant of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.

Bone grafting can repair potential 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. 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.

Sinus Lift Procedure

The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. 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.

There is a solution called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane can then be lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After six to nine months of healing, dental implants can be inserted.

The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.

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 six to nine months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.

Ridge Expansion / Augmentation

In severe cases, the ridge has atrophied and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for six months before placing the implant.

Return to top

Ridge Preservation

Careful management of extraction sockets after tooth extraction prevents unsightly bone loss and provides a better outcome for tooth replacement.

These procedures may be performed separately or together depending upon the individual's condition. As stated earlier, there are several areas that are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth.

In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from human donor bone and used to get the patient’s own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. We even use factors from your own blood to accelerate and promote bone formation in graft areas.

These surgeries are performed in the office surgical suite under IV sedation or local anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for 3 days.

Frenectomy

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. Often a Gingival Graft is added to re-establish an adequate amount of attached gingiva.

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.

Return to top