Full mouth reconstruction typically involves general or restorative dentists to provide procedures like dental implants, crowns, bridges and veneers, but it can often include dental specialists like periodontists, who specialize in the prevention, diagnosis, and treatment of the gums when there is gum disease like gingivitis and periodontitis, and they are also experts in the treatment of oral inflammation.  Some of those treatments are scaling, root planning, and periodontal surgery.

If you have gum disease, you have calculus and tartar below the gum line, and that means you’ve not had a cleaning frequently enough.  Gums are not attached at the gum line, but rather below the point that you see in the mouth. That creates a little moat or a little crevice around each tooth where bacteria can find a place to hide and grow.

There are a variety of surgical and non-surgical treatments that Periodontists use to treat patients with gum disease, such as:

  • Sinus Lift Surgery
  • Ridge Modification
  • Dental implants
  • Pocket Reduction
  • Laser treatment for gum disease
  • Cosmetic: Gummy smiles, uneven gum line, gum graft, ridge augmentation

In a typical first visit, the periodontist will want to see the patient’s complete medical and dental history.  It is extremely important for the patient to disclose if any medications are being taken or if there are any medical conditions such as heart disease, diabetes, or pregnancy that can affect periodontal care.

In a preliminary examination of the gums, the periodontist will look for any gum line recession, and will determine how the teeth fit together when biting.  The teeth will be checked to see if any are loose. The periodontist might use a small measuring instrument called a probe to determine the depth between the teeth and gums, called periodontal pockets, which helps to determine how healthy the gums are. X-rays are usually taken to observe the health of the bone below the gum line.




When plaque and calculus [tartar] in deep periodontal pockets needs to be removed, scaling and root planing are used to do a careful deep cleaning and disinfecting of the root surfaces to remove bacterial toxins and to smooth the tooth root to remove tiny crevices or protrusions where bacteria can lodge, and help the gums reattach to the tooth. This is sometimes followed by supplementary therapies such as local delivery antimicrobials, systemic antibiotics, and host modulation (HMT) to balance inflammatory response, as needed on a case-by-case basis.

Bacteria found in plaque initiate the periodontal disease, and possibly subsequent tissue invasion, by producing harmful by-products and enzymes that break down tissues such as collagen and cell membranes, in order to produce nutrients for their growth.  This results in an immune-system inflammatory response.

If your dentist says that you need a root planning, believe it!   It’s an important procedure that needs to be done.  If you don’t get it done, then you’re going to be at risk for all sorts of much worse health problems like heart disease, cancer, bacterial pneumonia, infections in the blood, and the like. If the inflammatory index (CRP) rises and stays high, other parts of your body will become inflamed. And of course, that’s not a good thing…. So much easier and less expensive to have the procedure, not to mention saving your health!

Following a scaling and root planing treatment, most patients do not require any additional treatment.  However, ongoing maintenance therapy to sustain health is a good idea.



Sinus Lift Surgery

When upper back teeth are missing, there may not be enough bone depth to place a dental implant without compromising the sinus cavity.  That makes this is one of the most difficult areas to place implants, especially if there is periodontal disease that has created bone loss.  A periodontist can help correct this problem by using bone grafts to raise the sinus floor, providing more bone depth, and this has proven to increase the success rate of implants.

Ridge Modification & Augmentation

There can be deformities in the bone of the upper or lower jaw, causing inadequate bone in which to place dental implants.  If teeth are missing, the jawbone recedes when it no longer is holding a tooth in place.  These conditions can cause an unattractive indentation in the jaw line near the missing teeth that may be difficult to clean and maintain, and can make the replacement tooth look too long compared to adjacent teeth.  This can be caused for a variety of reasons:

  • Periodontal disease
  • Tooth loss
  • Wearing dentures
  • Developmental defects
  • Injury or trauma

Ridge augmentation can fill the depression with bone or bone substitute to build up the ridge to regenerate lost bone and tissue, recapturing the natural contour of the gums and jaw. A new tooth can then be created that is natural looking, easy to clean and beautiful.  Also, this can greatly improve function and appearance, and increase your chances for successful implant placement that can last a lifetime.

Periodontal Pocket Reduction

Pocket reduction surgery (aka gingivectomy, osseous surgery, and flap surgery) is a collective term for a series of several different procedures with the objective to gain access to the root of the tooth in order to remove bacteria and tartar (calculus).  It’s done when root planning and scaling are not enough.

Your bone and gum tissue should fit snugly around your teeth, but if you have gum disease (periodontitis), this supporting tissue and bone can be destroyed by inflammation and swelling due to plaque, creating deep spaces around the teeth called periodontal pockets.  A periodontal pocket reduction is recommended when pockets are too deep to clean with daily at-home oral hygiene and professional teeth cleanings.

As these pockets become deeper, a larger space for bacteria to live is created. The bacteria accumulates and penetrates under the gum tissue.  In turn, these deep pockets collect even more bacteria, resulting in further bone and tissue loss.  If left untreated, and bone loss becomes excessive, abscesses can form, and the teeth may need to be extracted.

The treatment involves folding back the gum tissue to remove the disease-causing bacteria before stitching the tissue back into place. In some cases, irregular or rough surfaces of the damaged bone are smoothed (planed) to limit areas where disease-causing bacteria can hide, aiding the gum tissue to better reattach to healthy bone.

By having the pocket reduction procedure, and together with a combination of daily oral hygiene and professional maintenance care, you can increase your chances of keeping your natural teeth – and decrease the chance of serious health problems associated with periodontal disease.

Periodontal Cosmetic Procedures

Periodontists may be thought of as the plastic surgeons of dentistry. If you are looking to improve your smile, a periodontist may be able to help with some of these procedures:

Gummy Smile or Uneven Gum Line:  Also called dental crown lengthening, usually targeting the upper front teeth — As the name suggests, crown lengthening usually involves reducing the amount of gum and increasing the area of teeth that your smile exposes, and/or to improve symmetry of the gum line.

Gum Graft Surgery:  If teeth look too long, it’s usually due to gum recession that causes the tooth root to become exposed, and that can make you look older than you are. This may result from a variety of causes, including periodontal diseases as the jawbone loses volume.  During gum graft surgery, gum tissue is taken from your palate or another donor source to cover the exposed root.  This also protects vulnerable roots from decay.

If you are interested in periodontics in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.