Dr. Keller’s practice provides a variety of surgical services. He prides himself on the fact that he is very conservative in his treatment recommendations and limits surgery to the areas where it is absolutely necessary. Periodontal procedures are available to regenerate the bone and gum tissue to their original function and cosmetic appearance.
Flap Surgery is done when the doctor makes an incision on the gum tissue, lifting it to expose underlying tooth and bone structures for direct evaluation and better access for scaling and root planing.
Osseous Surgery – Traditionally, gum disease is treated by eliminating the gum pockets. The infected gum tissue is trimmed away, and the uneven bone tissue is re-contoured. Although this is still an effective way of treating gum disease new and more sophisticated procedures are used routinely today.
Frenectomy is done when the doctor needs to sever the loose muscle tissue that attaches the upper or lower lips to the gum or from the tongue to the floor of the mouth. This muscle attachment is called a frenum. When the frenum is positioned in such a way that it interferes with tooth alignment or causes the gum to pull away from the tooth resulting in gum recession a frenectomy is recommended.
Crown Lengthening is necessary when a tooth is damaged extensively due to fracture, decay, or other reasons there may be inadequate tooth exposed above the gum line for a dentist to attach a new restoration (crown or cap). By reshaping the remaining gum and bone support around the tooth, healthier tooth can be exposed that was hidden beneath the gum surface.
Tooth Extractions – Historically tooth extractions were avoided at all costs, but with today’s technology we are able to think and plan treatment differently. If a tooth becomes weak and cannot be saved, or leaving the tooth may cause an adjacent tooth to be lost from the enlargement of a periodontal pocket, extractions are recommended. It is also possible to have a situation where leaving the tooth will mean less bone support later for a partial or implants. At the time of extraction the doctor may perform socket augmentation, guided tissue regeneration or osseous (bone) recontouring.
Guided Tissue Regeneration / GTR - A more recently developed type of regenerative surgery depends on guiding the proper tissue to heal the periodontal lesions. Gum tissue heals very quickly, and after surgery migrates down into the bone pocket quickly. Unfortunately, this does not allow time for the bone to refill the pocket, so the defect persists. With guided tissue regeneration, the gum tissue is excluded from the bone defect with a resorbable membrane, allowing time for the bone to fill back in. This technique has been available for 18 years, and in certain areas is extremely predictable.
Cell Stimulation (Emdogain) – The most recent development in periodontal regeneration is the use of proteins to induce the formation of tooth supporting structures lost to periodontal disease. Available since 1999, the procedure calls for placing embryonic cells into the defect, which in turn stimulate production of new bone and tissue cells which reform the normal periodontal complex. These cells are porcine (pig), and carry no risk of disease transmission. While long-term studies are not yet available, the research to date warrants use of this approach under certain circumstance and periodontal regeneration is being used more and more.
Please review our Cosmetic Enhancement Procedures for an overview of cosmetic treatments performed by Dr. Keller.