Until the last third of the 20th century, it was generally believed that it was impossible to surgically reconstruct deformities in the ridge of bone (alveolar ridge) that holds teeth, when many teeth were missing.  With new developments in periodontal plastic surgery procedures in the early 70s and forward, they now occupy a major place in reconstructive techniques to rebuild bone and gum tissue. Before that time, deformities were often filled with artificial materials in an effort to restore proper jaw contours.   Artificial (pontic) teeth were used, but they were frequently longer than original teeth, so artificial material to mimic gum tissue would be placed over them for aesthetic purposes.  They were acceptable for functional purposes, but frequently looked just as artificial as they were. The restorative dentist is now able to provide patients with fixed dental prostheses that look natural and enhance facial structure, with the use of modern techniques in reconstructive surgery procedures to restore bone and soft tissues of the jaw to their former dimensions.  Patients now realize that in addition to treating disease and restoring function, the dentist can also improve the position, shape, and color of teeth and gums to provide a beautiful new smile.

Now that dental implants are the gold standard for replacing missing teeth, these techniques aid in the reconstruction of the bone tissues of the jaw to augment the volume of bone necessary to permit the successful placement of dental implants. With this major breakthrough in the research and development of guided bone regeneration (GBR), and guided tissue regeneration (GTR), providing the development of new materials and technologies, the science and art of reconstructive oral surgery has made a major impact on extending the boundaries of restorative procedures in dentistry. Four stages are used to successfully regenerate bone and other tissues, abbreviated with the acronym PASS:

  1. Primary closure of the wound to promote undisturbed and uninterrupted healing
  2. Angiogenesis (formation of new blood vessels) to provide necessary blood supply and undifferentiated mesenchymal cells (stem cells found in connective tissue)
  3. Space creation and maintenance to facilitate space for bone in-growth
  4. Stability of the wound to induce blood clot formation and allow problem-free healing

There are many reasons for both soft tissue and hard tissue defects, such as periodontal disease, trauma, and congenital defects that can result in aesthetic problems. Various prosthodontic techniques can be used to improve gum/gingival aesthetics using contemporary materials such as dental composite or porcelain color matched to the patient’s gums, in addition to more traditional materials such as standard prosthetic acrylic. A patient may be concerned about “long” teeth, caused by gum recession that begins to expose tooth roots, or perhaps root sensitivity.  Untreated gum disease can lead to decay/cavities or other dental problems requiring treatment, the object of which would be to cover the root surfaces for starters, with gum grafts.  Some ways gums wear away from the teeth are overaggressive brushing and flossing, orthodontic movement of teeth, and tongue piercings that constantly rub on the gums.  This can happen because the gums don not have nerve endings that would alert you to the problem.  Because gum tissue does not grow back, tissue grafts are usually necessary to correct the problem. Dental reconstructive methods are now better than ever to restore your smile and self-confidence. If you are interested in alveolar or gingival reconstruction in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.