Dental surgery

Dental surgery is any of a number of medical procedures that involve artificially modifying dentition.

Bone Grafting

Bone grafting is often closely associated with dental restorations such as bridge work and dental implants. In the majority of cases, the success of a restoration procedure can hinge on the height, depth, and width of the jawbone at the implant site. When the jawbone has receded or sustained significant damage, the implant(s) cannot be supported on this unstable foundation and bone grafting is usually recommended for the ensuing restoration. 

Dr. Salis, our periodontist specializes in this type of dental work.

There are several major factors that affect jaw bone volume:

  • Periodontal Disease - Periodontal disease can affect and permanently damage the jaw bone that supports the teeth. Affected areas progressively worsen until the teeth become unstable.
  • Tooth Extraction - Studies have shown that patients who have experienced a tooth extraction subsequently lose 40-60% of the bone surrounding the extraction site during the following three years. Loss of bone results in what is called a bone defect.
  • Injuries and Infections - Dental injuries and other physical injuries resulting from a blow to the jaw can cause the bone to recede. Infections can also cause the jaw bone to recede in a similar way.
Reasons for bone grafts

Bone grafting is a highly successful procedure in most cases. It is also a preferable alternative to having missing teeth, diseased teeth, or tooth deformities. Bone grafting can increase the height or width of the jawbone and fill in voids and defects in the bone.

There are essentially two basic ways in which bone grafting can positively impact the health and stability of the teeth:

Jaw Stabilization - Bone grafting stabilizes and helps restore the jaw foundation for restorative or implant surgery. Deformities can also be corrected and the restructuring of the bone can provide added support.

Preservation - Bone grafting can be used to limit or prevent bone recession following a tooth extraction, periodontal disease, or other invasive processes.

Oral Examination

Initially, the dentist will thoroughly examine the affected area in order to assess the general condition of the teeth and gums. If periodontal disease is present or the adjacent teeth are in poor condition, these factors will be fully addressed before the bone grafting procedure can begin. The dentist will also recommend panoramic x-rays in order to assess the precise depth and width of the existing bone. On occasion, a CAT scan may be recommended to determine the bone condition. Depending on these results, the dentist may also anesthetize the area and explore into the gum in order to determine what kind and how much bone is required.

What Does Bone Grafting Involve?

There are several types of bone grafts. Your dentist will determine the best type for your particular condition.

Autogenous Bone Graft - Harvested from the patient's own body (usually from the posterior part of the lower jaw or the chin). This method is usually preferred because it produces the most predictable results.

Allograft Bone Graft - Cadaver or synthetic bone is used in this type of graft.

Xenograft - Cow bone is used in this type of graft.

The bone grafting procedure can often take several months to complete. Bone is typically harvested from your own body (or on rare occasions obtained from a bone bank) and added to the affected site. This bone will fuse with the existing bone and the migration of cells will cause firm adhesion and cell growth. Supplementing the jaw with bone will result in greater bone mass to help support and anchor the implant(s).

Soft Tissue Grafting

A soft tissue graft or "gum graft" can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. This may reduce tooth sensitivity and improve aesthetics of your smile. Whether you have a gum graft to improve function or aesthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health - your keys to smiling, eating and speaking with comfort and confidence.


Reasons for a Gum Graft:
  • Sensitive teeth
  • Tender gums
  • Longer tooth line
  • Exposed roots
  • Loose teeth

Gum grafts can be used to cover roots or develop gum tissue where absent, due to excessive gingival recession. During gum graft surgery, your periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity. The soft tissue graft procedure is highly predictable and results in a stable, healthy band of attached tissue around the tooth.

If you are experiencing any sensitivity, do not hesitate to book a consultation with our periodontist: Dr. Salis

Root Amputation

Root amputation is a specialized dental procedure, whereby one root is removed from a multi-root tooth. The tooth is then stabilized and rendered fully functional with a crown or filling. The multi-root teeth best suited to the root amputation procedure are the molars at the back of the mouth. These large flat teeth have either two or three roots depending on whether they are situated on the upper or lower jaw.

The general purpose of root amputation is to save an injured or diseased tooth from extraction. Most dentists agree that there is no better alternative than retaining a healthy natural tooth, and the root amputation procedure makes this possible. Dental implants, extensive bridgework and custom-made tooth replacements can be expensive and time-consuming. Generally, root amputation and the necessary crown work are less expensive and can be completed in 1-3 short visits.

When is root amputation necessary?

It is important to note that root amputation can only be performed on an otherwise healthy tooth. Even in the case of a ?key? tooth, extraction will be performed if the tooth is diseased, badly fractured or otherwise injured. Suitable teeth for root amputation have a healthy tooth surface, strong bone support and healthy underlying gums.

There are several problems that may lead to root amputation including:


  • Broken, fractured or injured teeth and roots.
  • Embedded bacteria within the structure of the root.
  • Severe bone loss in a concentrated area due to periodontitis.
  • Tooth decay in a concentrated area of the tooth.

What does root amputation involve?

Prior to root amputation, it is necessary to perform root canal treatment. The amputation itself involves cutting deep into the tooth where blood vessels and nerves are located. For this reason, the pulp of the tooth including these vessels and nerves needs to be removed before resectioning the roots. The root canal and amputation treatments will be performed under local anesthetic.

During the root amputation procedure, a small incision will be created in the gum to fully expose the roots of the affected tooth. The root will be sectioned off from the rest of the tooth and then removed. To kill any remaining bacteria, the whole area will be cleansed with saline solution, and then sutures (stitches) will be applied to seal the incision.

Finally, a temporary crown or filling will be placed to secure the tooth. Depending on the specific situation, painkillers, antibiotics and a medicated anti-microbial mouthwash may be prescribed. In 7-10 days, the stitches will be removed and the gum will have healed. Arrangements can now be made to place the permanent crown or filling.

If you have any questions or concerns about root amputation, please ask your dentist.

Pocket Reduction Surgery

Pocket reduction surgery (also known as gingivectomy, osseous surgery and flap surgery) is a collective term for a series of several different surgeries aimed at gaining access to the roots of the teeth in order to remove bacteria and tartar (calculus).

The human mouth contains dozens of different bacteria at any given time. The bacteria found in plaque (the sticky substance on teeth) produce acids that lead to demineralization of the tooth surface, and ultimately contribute to periodontal disease.

Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area (below the gum line). Gum pockets form and deepen between the gums and teeth as the tissue continues to be destroyed.

Periodontal disease is a progressive condition which, if left untreated, causes massive bacteria colonization in gum pockets and can eventually cause teeth to fall out. Pocket reduction surgery is an attempt to alleviate this destructive cycle, and reduce the depth of the bacteria-harboring pockets.

Reasons for the pocket reduction surgery

Pocket reduction surgery is a common periodontal procedure which has been proven effective at eliminating bacteria, reducing inflammation and saving teeth. The goals of pocket reduction surgery are:


  • Reducing bacterial spread - Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize. It is important to decrease bacteria in the mouth in order to reduce the risk of secondary infection.
  • Halting bone loss - The chronic inflammatory response induced by oral bacteria leads the body to destroy bone tissue. As the jawbone becomes affected by periodontal disease, the teeth lose their rigid anchor. When the teeth become too loose, they may require extraction.
  • Facilitate home care - As the gum pockets become progressively deeper, they become incredibly difficult for the patient to clean. The toothbrush and dental floss cannot reach the bottom of the pockets, increasing the risk of further periodontal infections.
  • Enhancing the smile - An oral cavity that is affected by periodontal disease is not attractive to the eye. In fact, smiles may be marred by brown gums, rotting teeth and ridge indentations. Pocket reduction surgery halts the progression of gum disease and improves the aesthetics of the smile.
What does pocket reduction surgery involve?

Before recommending treatment or performing any procedure, the dentist will perform thorough visual and X-ray examinations in order to assess the condition of the teeth, gums, and underlying bone. Pocket reduction surgery can be performed under local or general anesthetic depending on patient preferences.

The gums will be gently pulled back from the teeth and bacteria and calculus (tartar) will be eliminated. Scaling and root planing will generally be required to fully remove the ossification (tartar) from the surface of the tooth root. If the root is not completely smooth, a planing procedure will be performed to ensure that when the gums do heal, they will not reattach to rough or uneven surfaces.

The final part of the surgery is usually the administration of an antimicrobial liquid to eliminate any remaining bacteria and promote healing. The gum is then sutured with tiny stitches that are left in place for 5-10 days.

Though the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.

If you have any questions about pocket reduction surgery or treatment for periodontal disease, please contact our practice.

Ridge Modification

Ridge modification is an effective procedure for treating deformities in the upper and lower jaws. These deformities can occur as a result of periodontal disease, trauma, injury, wearing dentures, or developmental problems. Such defects can leave insufficient bone for the placement of dental implants and an additional unattractive indentation in the jaw line adjacent to the missing teeth.

During the ridge modification procedure, the gum is lifted away from the ridge to fully expose the defect in the bone. The bony defect can be filled with bone graft material that can help regenerate lost bone or a bone substitute. Finally, the incision is closed and several months of healing will be required. Depending on the case and type of implant and procedure, the dental implant might be placed during the ridge modification procedure or when healing is complete; this all depends on the condition of the bone. Ridge modification improves the cosmetic appearance, functionality of the mouth, and the chance of enjoying dental implants for many years.