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 Micheal P. Hennessy DDS, MS Periodontist in Boca Raton

Dr Hennessy, is a highly skilled Periodontist with specialty training in Dental Implants, Periodontics, and Periodontal Related Surgeries.  Originally from Long Island, he moved to Florida after graduating from New York University School of Dental Medicine.  He lives locally with his family.

Our Boca Raton Periodontist and Implantologist is a New York and Florida trained Periodontist, who is caring, very skilled, gentle, and is sure to exceed your expectations.  He is available at East Boca Implant & Specialty Care Center to care for your Dental Implant and Periodontal needs.

It is not a given that we must lose teeth as we age. If we maintain good oral hygiene and have regular professional cleanings and oral examinations, chances are we can keep our natural teeth for life. That involves not only caring for the teeth themselves, but also the structures that surround them: the gums and tooth-supporting bone. Gum disease, which is a bacterial infection, threatens these supporting tissues. That is why dental professionals are always on the lookout for early signs that patients may not notice. When signs of trouble become apparent, periodontal therapy may be suggested.

periodontal therapy procedure

Periodontal therapy can take various forms, from minimal preventative care, to complex osseous surgical protocols.  The goal is to restore diseased tissues to health.  Gum (periodontal) disease can spread from the gums to the bone that supports the teeth, and may even cause tooth loss in many cases.  There are very effective therapies to combat this, ranging from scalings (deep cleanings) that remove plaque and calculus (tartar) from beneath the gum line, to surgical repair of lost gum and bone tissue.

Periodontal Therapy Procedures

Periodontal therapy includes both surgical and non-surgical techniques to restore health to the tissues that support the teeth (gums and bone) and prevent tooth loss. They include:

  • Scaling and Root Planing.  These deep-cleaning techniques are the best starting point to control gum disease.  Plaque and calculus (tartar) are removed from beneath the gum tissues, using hand scalers and/or ultrasonic instruments.
  • Gum Grafting.  Sometimes it's necessary to replace areas of lost gum tissue so that tooth roots are adequately protected.  This can be accomplished by using laboratory-processed matrix tissue, although other periodontal gtrafting options are also available.
  • Periodontal Plastic Surgery.   When used to describe surgery, the word “plastic” refers to any reshaping procedure that creates a more pleasing appearance of the gum tissues.
  • Periodontal Laser Treatment.  Removing diseased gum tissue with lasers can offer advantages over conventional surgery, such as less discomfort and gum shrinkage.
  • Crown Lengthening Surgery.  This is a surgical procedure in which tooth structure that is covered by gum and bone tissue may need to be exposed either for cosmetic reasons (too make the teeth look longer and the smile less gummy), or to aid in securing a new dental crown.
  • Dental Implants.  Today's preferred method of tooth replacement is a titanium dental implant, which is placed beneath the gum, during a minor surgical procedure.  The implant is then attached to a realistic-looking dental crown that is visible above the gum line and can look and feel like a natural tooth.

 

Gum disease can affect your heart and body.

Recent scientific evidence suggests that it may have an even greater benefit to your overall health: Specifically, it could potentially reduce your risk for a number of systemic (whole-body) diseases, including cardiovascular disease (CVD), diabetes, and rheumatoid arthritis — even premature birth.

Periodontal (gum) disease, or Periodontitis is estimated to affect nearly half of all Americans, and is a major cause of adult tooth loss.  Numerous studies have shown that patients with severe periodontal disease are at increased risk for developing cardiovascular disease.  Periodontitis may also increase the chance that diabetes will develop or progress, and research suggests an association between gum disease and adverse pregnancy outcomes as well.

 

What You Can Do

There are a number of effective treatments for periodontal disease, including nonsurgical procedures such as root cleaning and the local application of antimicrobials, such as Arestin.  For more serious conditions, conventional or laser gum surgery is an option.  Finally, to keep your gums healthy between office visits, good oral hygiene is important.

Related Article on the Link Between Heart and Gum Disease:

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The Link Between Heart & Gum Diseases Inflammation has emerged as a factor that is involved in the process of Cardiovascular Disease (CVD), which commonly results in heart attacks and strokes.  While the precise role inflammation plays in causing chronic CVD remains an area of intense current investigation, much more is now known... Read Article

Gum disease.

Periodontal (gum) disease rarely hurts, but it is an infection caused by bacterial plaque, a thin, sticky layer of microorganisms  that collects at the gum line in the absence of effective daily oral hygiene.  Over time, this turns into Gingivitis, then later Periodontitis that can gradually separate the gums from the teeth — forming little spaces that are referred to as “periodontal pockets.”  The pockets offer a sheltered environment for the disease-causing (pathogenic) bacteria to reproduce.  If the infection remains untreated, it can spread from the gum tissues into the bone that supports the teeth.  Eventually it moves deeper into the bone, and teeth may loosen and eventually be lost if untreated.

At East Boca Dental Implant and Specialty Care, our Boca Raton Periodontist will examine you, diagnose, and discuss your concerns and options.  With Gum Disease, the earlier it is found the easier it is to control.  When treating gum disease, it is often best to begin with a non-surgical approach consisting of one or more of the following:

  • Scaling and Root Planing.  An important goal in the treatment of gum disease is to rid the teeth and gums of pathogenic bacteria and the toxins they produce, which may become incorporated into the root surface of the teeth. This is done with a deep-cleaning procedure called scaling and root planing (or root debridement).  Scaling involves removing plaque and hard deposits (calculus or tartar) from the surface of the teeth, both above and below the gum line.  Root planing is the smoothing of the tooth-root surfaces, making them more difficult for bacteria to adhere to.
  • Antibiotics/Antimicrobials.  As gum disease progresses, periodontal pockets and bone loss can result in the formation of tiny, hard to reach areas that are difficult to clean with handheld instruments.  Sometimes it's best to try to disinfect these relatively inaccessible places with a prescription antimicrobial rinse, or even a topical antibiotic (such as Arestin) applied directly to the affected areas. 
  • Oral Hygiene.  Since dental plaque is the main cause of periodontal disease, it's essential to remove it on a daily basis.  That means you will play a large role in keeping your mouth disease-free.  You will be instructed in the most effective brushing and flossing techniques, and other home care.

Often, nonsurgical treatment is enough to control a periodontal infection, restore oral tissues to good health, and help maintain the health of your teeth and gums.  Regular checkups and Hygienist cleanings at our Boca Raton Dental Office will give you a good chance to remain disease-free.

 

Tooth Wear. When advanced gum disease (periodontitis) develops, your teeth are in danger: At this stage, the ligaments and bone tissue that surround them are being destroyed, and you could even begin losing teeth!  If the disease can't be controlled by non-surgical treatments like cleaning and scaling, then periodontal surgery may be an option.

Periodontal surgery is a leading method for treating and repairing periodontal pockets. What are these “pockets?” They are areas below the gum line where gum tissue has detached from the teeth, resulting in an uncleansable space where harmful bacteria can proliferate.  These bacteria cause inflammation of the tissues, resulting in sensitivity, bleeding, and pain. Left untreated, they can cause a host of problems including gum disease, loss of the tooth-supporting bone structure, and possibly even systemic (whole-body) problems.

When periodontal pockets develop, the first step in treating them is usually via cleaning and scaling with a manual or ultrasonic instrument.  If this isn't effective, then periodontal surgery is considered.  Flap surgery isn't a cure for periodontal disease — but it helps create an environment that makes it easier to maintain your periodontal health. And even if you're prone to gum disease, proper professional treatment and regular care at home can help keep your teeth healthy for as long as possible.

 

The Goals of Surgery

One major objective of Periodontal surgery is to eliminate or reduce the pocket itself.  To access it, a flap-like incision is made in the gum tissue.  This allows diseased tissue to be removed from inside the pocket, and provides access to the teeth's root surfaces for a thorough cleaning, which helps to eliminate harmful plaque and calculus (tartar).  Afterward, the “flap” is closed, sealing the area. This begins the healing process, which takes place rapidly.

Another goal is the regeneration of periodontal ligament and bone tissue which may have been lost to the disease.  A variety of techniques may be used to accomplish this, including high-tech methods of bone grafting and chemicals referred to as growth factors.  These approaches help restore the gums to their normal form and function, and promote the healthy and secure anchoring of teeth.

The Flap Surgery Procedure

Periodontal flap surgery.

Flap surgery is typically done under local anesthesia, sometimes accompanied by oral anti-anxiety medications; alternatively, it may be performed under intravenous conscious sedation.  After anesthesia has taken effect, a small incision is made to separate the gums from the teeth.  The outer gum tissue is gently folded back to give access to the roots and the supporting ligament and bone tissue.

Next, the inflamed gum tissue can be removed, and the tooth roots can be cleaned; if needed, the area may also be treated with antibiotics or other medications.  Bone defects can be repaired with grafting material, and proper regeneration of the periodontal ligament can be encouraged by physical (barrier membranes) and chemical (growth factors) methods.  Finally, the incision is closed and the procedure is completed.

Performed by an experienced hand, state-of-the-art flap surgery has an excellent track record and offers well-established benefits.  It's often the treatment of choice for relieving periodontal disease and helping to maintain your oral health — and preserve your teeth.

Cosmetic Gum Grafting:

Gum Grafting before and after.

If gum recession is affecting your health or your appearance, a procedure called gingival (gum) grafting may be recommended.  Although it might sound scary, a variety of gum grafting procedures are routinely performed by periodontists (specialists in the area of gingival tissue),  with specialized training in this field.

Gum grafting involves carefully placing a small amount of new tissue in an area where little or no gum tissue currently exists — typically recommended to prevent further gum recession or to cover root surfaces of your teeth that have become exposed. The tissue used in this procedure may come from a variety of sources but usually is taken from the palate (roof of the mouth), after the area has been numbed for your comfort. Then it is delicately sutured (stitched) in place where it's needed, using suturing material which may be finer than a human hair.

Your body's natural recovery process takes over after the grafting procedure is complete. During this time, new blood vessels grow into the graft and help it to become integrated with the surrounding tissue. A successful graft can reduce or eliminate problems like tooth sensitivity and further gum recession, as well as improve the aesthetics of your smile.

How do you know if you need a gum graft?  Often, you can clearly see or feel the problem. Exposed tooth roots can make your teeth look overly “long,” and they also generally appear somewhat darker than your pearly white crowns.  Gum recession is a condition that can increase with age, as we recognize when we hear the phrase “long in the tooth.” But the potential problems of gum recession aren't just cosmetic — they can also seriously impact your oral health.  Our Experienced Boca Raton Periodontist can evaluate your condition and advise ou here at East Boca Dental Implant and Specialty Care. 

A Closer Look at Your Gums

Inside your mouth, gum tissue forms a barrier that resists the mechanical (and microbial) effects of eating, chewing and biting.  Gums may begin to recede, or shrink down, for several reasons which can be assessed by our Boca Raton Periodontist.

When the tooth's roots lose the protection of healthy gum tissue, they can become extremely sensitive to hot or cold temperatures, causing pain when you consume many foods and drinks.  Worse, missing gum tissue makes it easier for bacteria to penetrate the roots and cause decay — or for minor trauma to result in rapid gum recession.  In either case, the eventual result may be tooth loss.  That's why proper treatment of gum recession is so important.

Treating Gum Recession With Gingival Grafting

After a thorough examination and assessment of your teeth by our Boca Raton Periodontist, gums and overall health, the gingival grafting procedure may be recommended.  

There are several different methods of grafting.  For example, if you have lost gum tissue in an area of your mouth that's not highly visible when you talk or smile, additional gum tissue can be placed there to prevent further recession without trying to cover the tooth-root surface completely.  This procedure is referred to as a free gingival graft, and takes about 45 minutes.  It is very predictable with a very high success rate.  If the objective is to cover root surfaces, the procedure becomes a bit more complicated and may take longer, but is still very successful.

Grafting procedures are typically carried out under local anesthesia, and are generally pain-free.  You should experience very little discomfort after the surgery.  Fortunately, any discomfort that you do have can be alleviated with over-the-counter or prescription anti-inflammatory medication, and it is generally short-lived.  A soft diet (and an antibiotic) may also be recommended for a week or so thereafter, enabling the tissues to heal fully; otherwise, your normal activities will not be limited.

Bone grafting for dental implants.

Bone Grafting at East Boca Dental Implant and Specialty Care:  Replacement teeth supported by dental implants function well and last a long time because, like natural teeth, they are securely anchored in the jawbone for maximum support.  In order to benefit from this remarkable technology, however, you need to have enough tooth-supporting bone in your jaw to hold a dental implant in place.  Unfortunately, after tooth loss, the surrounding bone deteriorates — decreasing in width, height and density — and this process starts immediately.  The longer a tooth has been missing, the more the bone that used to surround it resorbs (melts away).  If you want a dental implant but don't have enough bone to support it, can anything be done?  Yes. Very often you can still get the replacement tooth you want, thanks to routine bone grafting procedures.

How It Works

Bone grafting, normally a minor surgical procedure done in the dental office, is used to build up new bone in the area of your jaw that used to hold teeth.  A small incision is made in your gum to expose the bone beneath it, and then grafting material is added.  Most often, the grafting material is processed bone that serves as a scaffold, around which your body will actually deposit new bone cells.  The grafting material will eventually be absorbed by your body and replaced by your own new bone.

What to Expect

The procedure for placing a bone graft usually requires only local anesthesia, though oral or IV sedatives can also be used to achieve a higher state of relaxation.  Because a small incision in your gum tissue needs to be made to access the underlying bone that will receive the graft, you may experience some soreness in the area after the surgery; this can usually be managed by over-the-counter anti-inflammatory medication and/or pain relievers as well as ice therapy after the procedure.  Though you will soon feel completely back to normal, it may take your body up to seven months for bone maturation to take place to receive your dental implant.  The waiting time allows the healing process enough time to achieve the desired result: ideal support for replacement teeth that look great and will last a lifetime.

Consequences of Tooth Loss.If you have lost any of your teeth, you no doubt realize there are consequences to living without them: Your smile may not look the way you want it to; eating, speaking and intimacy may be more difficult; and your self-confidence may fade.  Though serious, these are not the only impacts.  There are hidden consequences of losing teeth that affect not only your appearance but also your health.

Importantly, a loss of jawbone inevitably follows tooth loss. Bone needs stimulation to maintain its form and density.  In the case of the jawbone, that stimulation comes from the teeth, which make hundreds of fleeting contacts with each other throughout the day.  The small stresses produced by these contacts are transmitted to the bone, prompting it to regenerate constantly.  When a tooth is lost, the stimulation it provided disappears.  In just the first year of tooth loss, there is a 25% decrease in bone width.  This is followed over the next few years by an overall 4 millimeters decrease in height.  If enough teeth are lost, and as bone loss continues, the distance from nose to chin can decrease and the lower third of the face partially collapses.  With a lack of structural support, the lips sag; that's why toothless people often appear unhappy.  Also, extreme loss of bone can make an individual more prone to jaw fractures.

You may also find that some of your remaining teeth actually shift into the spaces left open by your missing teeth.  This in turn can cause additional bite problems and even jaw joint (TMJ) pain.  Finally, compromised nutrition and poor general health can result if eating healthy foods like raw fruits and vegetables becomes too difficult without teeth.

Now here's the good news: Dental implants - the state-of-the-art tooth-replacement method  - can prevent all this.

How Dental Implants Prevent Bone Loss

Dental Implants 101.Besides helping a person without teeth look and feel great again, dental implants actually prevent bone loss.  That's because they are made of titanium, which has a unique ability to fuse.  By actually becoming a permanent part of the jawbone, dental implants stabilize and stimulate the bone to maintain its volume and density.

Dental implants are placed during a minor surgical procedure using local anesthetic and then, after a healing period, topped with a lifelike dental crown.  Together, these precision components look, feel and function exactly like your natural teeth.  Dental implant success rates exceed 95% — the highest of any tooth-replacement option.

Other Options for Tooth Replacement

Other than dental implants, your tooth-replacement options include fixed bridgework that incorporates or uses the adjacent teeth, and removable dentures.  You should be aware, however, that the disadvantage of both of these options is that they may damage the anatomical structures on which they rest.  For example, fixed bridges rely on support from two adjacent, possibly healthy teeth, which must be filed down and capped; this can make them susceptible to decay and root canal problems.  Removable partial dentures hook onto existing teeth, which may become loose over time. And full dentures press on the bony ridges that used to support the teeth, accelerating the bone loss that began when the teeth were lost in the first place.

The above tooth-replacement options are all less expensive than dental implants, but only when viewed in the short term.  Since bridgework and dentures may cause new problems and will likely need replacement themselves, they don't offer the same long-term value.  When viewed as an enduring investment in your comfort, health and well-being, implants offer the best return by far.

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The dental implant is today's state-of-the-art tooth replacement method.  It consists of a very small titanium post (the actual implant), which is attached to a lifelike dental crown.  The crown is the only part of this tooth-replacement system that is visible in your mouth.  The implant itself rests beneath your gum line in the bony socket that used to hold your missing tooth.  Two, four or more implants can be used to support multiple crowns, or even an entire arch of upper or lower replacement teeth.  Whether you are missing one tooth, several teeth or all your teeth, dental implants are preferred by doctors and patients alike.  That's because dental implants are:

1. Dental Implants are most like natural teeth

Your natural teeth have roots that keep them securely anchored to your jawbone. In a similar way, implant teeth form a solid attachment with the bone in your jaw.  This is possible because dental implants are made of titanium, a metal that has a unique ability to fuse to living bone.  After an implant is inserted during a minor procedure done in the dental office, it will become solidly fused to your bone over a period of several months.  Once that happens, your implant-supported replacement tooth (or teeth) will feel completely natural. It will also be visually indistinguishable from your natural teeth.  Implant teeth allow you to eat, speak and smile with complete confidence because they will never slip or shift like removable dentures often do.

2. Dental Implants are long lasting tooth replacements

Because dental implants actually become part of your jawbone, they provide a very long-term solution to tooth loss.  Whereas other methods of tooth replacement, including removable dentures and bridgework, may need to be replaced or remade over time, properly cared-for dental implants should last a lifetime.  That's what makes this choice of tooth replacement the best long-term value.

3. Dental Implants help prevent bone loss

You may not know it, but bone loss inevitably follows tooth loss.   Bone is a living tissue that needs constant stimulation to rebuild itself and stay healthy.  In the case of your jawbone, that stimulation comes from the teeth.  When even one tooth is lost, the bone beneath it begins to resorb, or melt away.  This can give your face a prematurely aged appearance and even leave your jaw more vulnerable to fractures if left untreated long enough.  Dental implants help halt this process by fusing to the jawbone and stabilizing it.  No other tooth replacement method can offer this advantage.

4. Safe for adjacent natural teeth

Dental implants have no effect on the health of adjacent natural teeth; other tooth-replacement systems, however, can weaken adjacent teeth.  With bridgework, for example, the natural teeth on either side of a gap left by a missing tooth must provide support for the dental bridge.  This can stress those adjacent teeth and leave them more susceptible to decay.  Likewise, a partial denture relies on adjacent natural teeth for support and may cause those teeth to loosen over time. Dental implants are stand-alone tooth replacements that don't rely on support from adjacent natural teeth.

5. And lastly, Are Dental Implants easy to have, and maintain?

Yes! Caring for implant teeth is no different than caring for your natural teeth.  You must brush them and floss them daily.  But you'll never have to apply special creams and adhesives, or soak them in a glass overnight, as you would with dentures.  They'll also never need a filling or a root canal, as the natural teeth supporting bridgework might.  While implants never decay, they can be compromised by gum disease.  Good oral hygiene and regular visits to the dental office for professional cleanings and exams is the best way to prevent gum disease, and to ensure your dental implants last a lifetime.

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Implant supported fixed dentures vs removable dentures.

If you have lost an entire arch of teeth (top and/or bottom), or are soon to have your remaining teeth removed because they are too unhealthy to save, you may be able to replace them with fixed dentures supported by dental implants.  Doctors and patients alike prefer fixed over removable dentures because they:

  • Look, feel and function like natural teeth
  • Don't slip or move when you eat or talk
  • Help prevent bone loss in the jaw
  • Can last a lifetime

How It Works

Dental implants serve the same purpose as the roots of natural teeth: anchoring the replacement teeth to your jawbone. Just like natural tooth roots, they lie under the gum line and therefore are not visible in the mouth.  Only the lifelike prosthetic teeth attached to them (the fixed denture) can be seen by you or anyone else. Because dental implants are made of titanium, a metal that has the unique ability to fuse to living bone, they are extremely stable and reliable.  How many implants are needed?  The number varies because each individual has unique conditions: Depending on the volume and density of the bone in your jaw, you will need as few as four implants or as many as six for your new teeth to function as well as a set of healthy, natural teeth.

What to Expect

All-on-Four.The surgery to place dental implants that support a fixed denture is a simple, routine procedure carried out in an office setting, under local anesthesia in most cases (If you need to have failing teeth removed, that will be done first, often the same day your implants are placed).  After numbing the area, the appropriate number of implants will be placed in your jaw at precisely planned angles and positions to maximize support and avoid anatomical structures such as nerves and sinuses.  Most people who have dental implants placed find that any post-operative discomfort can be managed with over-the-counter anti-inflammatory medication such as ibuprofen or acetaminophen.  Some don't even need to take that.

What happens immediately after surgery will depend on what's best to promote healing in your individual situation.  Sometimes a set of temporary teeth can be attached immediately, so that you can leave the office with new teeth, such as with the modern All-on-4 dental implant procedure done here at East Boca Dental Implant & Specialty Care Center.    In other cases, the implants will be left to heal for several months before any teeth are attached.  Sometimes that is the best way to insure that the implants remain undisturbed as they go through the process of fusing to your jawbone, which is known as osseointegration.

In either case, you will need to go easy on your newly placed implants during the crucial healing phase following surgery.  You will be advised to eat a softer diet and avoid hard, chewy foods until the process of osseointegration is complete — about three months.  While this may seem like a long time, keep in mind that people who wear removable dentures often avoid these foods permanently.  The good news is that once your implants have fused to your jawbone and your new permanent teeth are attached, you will be able to eat anything you want.  In fact, you are likely to forget you even have dental implants!

 

Please choose a topic below for more information, or call us at (561) 226-0100.  We look forward to meeting and talking with you.

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(561) 226-0100