Scaling & Root Planning

The initial stage of treatment is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gum line.

The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment.

Antibiotics or irrigation with anti-microbials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis.

When deep pockets between teeth and gums are present, it is difficult for a dental professional to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health.


Crown Lengthening

 Periodontal Treatment - Crown Lengthening - Before 1  Periodontal Treatment - Crown Lengthening - Before 2
 Periodontal Treatment - Crown Lengthening - After 1  Periodontal Treatment - Crown Lengthening - After 2
 Periodontal Treatment - Crown Lengthening - Before 3
 Periodontal Treatment - Crown Lengthening - After 3

Crown lengthening (or crown exposure) is required when your tooth needs a new crown or other restoration.  The edge of that restoration is deep below the gum tissue and not accessible.  It is also usually too close to the bone or below the bone. The procedure involves adjusting the level of the gum tissue and bone around the tooth in question to create a new gum-to–tooth relationship. This allows us to reach the edge of the restoration, ensuring a proper fit to the tooth.  It should also provide enough tooth structure so the new restoration will not come loose in the future.  This allows you to clean the edge of the restoration when you brush and floss to prevent decay and gum disease.  The procedure takes approximately one hour.

When the procedure is completed, sutures and a protective bandage are placed to help secure the new gum-to-tooth relationship.  You will need to be seen in one or two weeks to remove the sutures and for an evaluation of your healing.


Osseous surgery

Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming “pockets” around the teeth.

Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss.

During this procedure, your Periodontist folds back the gum tissue and removes the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.


Guided Tissue Bone Regeneration

Traditionally, eliminating the gum pockets by trimming away the infected gum tissue and by re-contouring the uneven bone tissue treats gum disease. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are used routinely today.

Guided tissue bone regeneration regenerates the previously lost gum and bone tissue. Most techniques utilize various bone grafting materials and membranes that are inserted over the bone defects. Some of these membranes are bio-absorbable and some require removal.

 Periodontal Treatment - Guided Tissue Bone Regeneration - Before 1  Periodontal Treatment - Guided Tissue Bone Regeneration - After 1
 Periodontal Treatment - Guided Tissue Bone Regeneration - Before 2  Periodontal Treatment - Guided Tissue Bone Regeneration - After 2

Bone Grafting

Why does bone grafting help?
By including bone grafting in an overall procedure to restore the tooth’s attachment, dentists have found that they can regenerate lost bone and the ligaments that hold a tooth to that bone, restoring your tooth to its original state and insuring that you will have use of it for a good long time.

 Periodontal Treatment - Bone Grafting - Before  Periodontal Treatment - Bone Grafting - After

What is the procedure?
The doctor will cut and pull back the gum tissue around the tooth (called “flap surgery”) to gain access to the tooth root and surrounding bone. The tooth root is cleaned via a procedure called “scaling and planning” to remove all accumulated tartar and calculus so that the tooth will reattach to periodontal ligaments. The bone grafting material is placed in the area of missing bone and the gum tissues are replaced and sutured closed.


Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.



Sometimes, due to conditions beyond our control a permanent and primary (baby) teeth need to be removed.   This can be due to infections, large cavities, broken teeth and severe periodontal disease.   Also an extraction can be recommended as part of orthodontic treatment to create space for alignment.

Careful management of extraction sockets after tooth extraction prevents unsightly bone loss and provides a better cosmetic outcome for tooth replacement.  Bone grafts or other collagen materials may be necessary to preserve the height and width of the remaining bone after a tooth is removed.  This will allow for proper placement of future dental implants or bridges.  Dr. Ciniglio will help form a comprehensive treatment plan to replace your missing teeth to help restore your beautiful and functional smile.