Conventional Crown Lengthening

Conventional Crown Lengthening

First things first, what is crown lengthening?

 Often when a tooth fractures or has a very large filling and your dentist has recommended a crown to restore the tooth to its normal function and appearance, a crown lengthening procedure is required.

This procedure involves the removal and re-contouring of the gum and bone surrounding the tooth.  This provides your dentist with sufficient tooth area to work with in order to place the crown so that it will have the best chance of being retained on the tooth.  Having a proper fitting crown ensures the gum tissues remain as healthy and stable as possible.

Nearly everyone who has cracked or damaged a healthy tooth and is in general good health is a candidate for surgical crown lengthening.  However, if a tooth has been fractured beyond repair, extraction of the tooth and replacement with a dental implant may be another option for treatment.

To determine if you are a candidate for surgical crown lengthening, a consultation with your periodontist is needed to develop your individualized treatment plan of action.

Aesthetic Crown Lengthening

Aesthetic Crown Lengthening

First things first, what is aesthetic crown lengthening?

It is possible that during normal growth and development, too much gum tissue forms around the teeth.  This if often referred to as a “gummy smile.”

Teeth will appear shortened and the gum margin where the gum contacts the tooth may appear to have a ledge as opposed to a fine contour line.

Aesthetic crown lengthening is a procedure similar to conventional crown lengthening with the goal of establishing proper gingival contours while exposing the complete crown of the tooth, ultimately performing a “Smile Makeover.”

In all makeover cases, gum tissue provides not only the aesthetic framework but also the foundation that will hold the teeth.

Fundamental to the smile makeover is the assessment of the gum tissue.  Nearly everyone who has excess gum tissue and is in general good health is a candidate for aesthetic crown lengthening.  Make an appointment with your periodontist to determine if removal of excess tissue, building up of minimal gum tissue or re-contouring of existing tissues is a possible procedure for your new smile.

Post-Dental Surgery Meal Planning

Post-Dental Surgery Meal Planning

Proper care after your periodontal surgery will help your mouth to heal quickly.  This includes a healthy, soft food diet.

At first, your temporary soft food diet may seem challenging, but with some planning you can ensure that you have all of the nutrients you’ll need for your body to heal quickly.

As soon as you are able (after your local anesthetic has worn off), start drinking nutritious fluids such as real fruit juices, milk, milkshakes, and fruit and vegetable smoothies.

REMEMBER: Do not drink from a straw for at least two weeks.  The suction and force created when using a straw will be disruptive to the sutures and the delicate healing tissues.

A general rule of thumb for the first two weeks following periodontal surgery is to avoid any foods that take more than 3 chews to swallow.

Avoid hot food or drink for the first two weeks.  The heat of your food can increase the flow of blood to the area and can cause your surgical site to bleed.

Just because your diet is of a soft consistency, it is still important to eat a variety of nutritious foods.  Below are some general guidelines according to Health Canada’s Food Guide and some examples of food choices.

Fruit & Vegetables

Consume at least 7 servings of soft fruit and well-cooked vegetables per day:

  • apple sauce
  • stewed or canned fruit
  • peas
  • smoothies
  • soups
  • well cooked or pureed vegetables (potatoes, broccoli, cauliflower, carrots, turnip, other root vegetables)

Protein

Two servings of tender protein:

  • tuna
  • salmon
  • flakey fish served without a crispy coating
  • well-cooked poultry cut into small, bite-sized pieces
  • eggs
  • baked beans
  • lentils
  • Greek yogurt

Milk & Dairy

Two servings of milk or dairy products:

  • milk
  • calcium-fortified soy or almond milk
  • ice cream/frozen yogurt
  • yogurt
  • fruit sorbet
  • puddings
  • soft cheeses such as cottage cheese

Whole Grains

Chose whole grain foods over processed, simple carbohydrates:

  • porridge
  • oatmeal
  • cream of wheat
  • cereals without nuts or dried fruit
  • whole-grain pastas or noodles
  • soft bread without hard crust

Beverages

Make water your drink of choice.  It is important to stay hydrated.

Avoid alcohol and tobacco as much as possible during the healing period.

How much is my dental surgery going to hurt?

How much is my dental surgery going to hurt?

Many of our patients experience fear and extreme anxiety at the dentist and while we do our best to create a calm and tranquil environment, the fear of pain associated with periodontal treatment may still be a deterrent for some.

Therefore, to answer one of the most commonly asked questions “Is this going to hurt?”, we conducted a study that was published in the Journal of Clinical Periodontology.

Over a period of two years, we enrolled 213 patients requiring either dental implant or grafting surgery.  The average age of the patients that were recruited was 51 years, but ranged from 19-80 years.  Prior to their surgery, patients were asked to rate the amount of pain that they anticipated feeling from No Pain to Worst Pain Imaginable.  For 7 days following their surgery, patients were asked to rate the amount of pain they experienced on the same scale.

When all of the data was analyzed, we found that the actual pain that patients experienced after periodontal surgery was lower than the pain they anticipated feeling.

With these findings, we are now able to provide our patients with an evidence-based answer when they ask us “Is this going to hurt?”  Happily, we are able to put them at ease by sharing with them that in fact, periodontal surgery hurts less than they expect!

Some factors that we found did predict the amount of pain a patient would feel are:

  1. Anticipated Pain – if you expect it to hurt, you’ll report it hurting more
  2. Age – older individuals reported it hurting less
  3. Sedation – those who had their periodontal surgery under sedation with one of our Registered Nurses reported experiencing less pain

Some factors that we found did not predict the amount of pain a patient would feel are:

  1. Nervousness
  2. Gender
  3. Surgery Type (dental implant vs. soft tissue grafting)
  4. Smoking Status

Also collected as part of the study, we found that patients needed only 600mg of Ibuprofen for relief of their post-operative pain and discomfort.  This reinforces Dr. Fritz’s mandate of never prescribing narcotics to any of this patients.

This study was conducted by Jennifer Beaudette as part of her Master’s of Science research through the Faculty of Applied Health Sciences at Brock University.  Jen has since completed her M.Sc. and is currently pursuing a Ph.D at Brock University.

Tooth Anatomy

Tooth Anatomy

The structure and function of a teeth all play an important role in how we eat, drink, speak, and smile.

The root is the part of the tooth anchors it into place in the jaw bone.  Like an iceberg, most of our tooth is located below the surface.

The root is made up of several parts, the root canal, cementum, periodontal ligament, nerves, and blood vessels.

The crown is the part of the tooth that is visible when we smile.

The crown is layered with enamel and dentin.  Enamel is the outermost layer and protects the crown both from bacteria and from pressure when chewing.  Enamel is the hardest tissue in the body.  Dentin is the layer of mineralized tissue below the enamel. 

The gingiva divides the root and the crown.  A healthy gingival margin forms the link between where the root meets the crown.

Each of the different aspects of the tooth are susceptible to different conditions.

The crowns can be susceptible to cavities, grinding or clenching (causing the crown to wear down), tooth erosion (caused acidic foods, chronic dry mouth, or some medications).

The roots and gingiva can be susceptible to periodontal disease and other bacterial infection (i.e., tooth abscess).  Left untreated, periodontal disease can cause tooth loss.

To keep all aspects of the tooth healthy, it is important to take good care by:

– brushing twice daily for at least 2 minutes using a power toothbrush
– daily use of floss and interdental brushes
– visiting your dentist for regular supportive periodontal therapy and maintenance
– limiting your intake of sugary foods and drinks
– quitting smoking
– controlling your diabetes and blood sugar