Periodontal / Gum Disease Treatment

According to the American Academy of Periodontology, periodontal (gum) disease is a chronic inflammatory disease that affects the gums and bone supporting the teeth. It is the leading cause of tooth loss and has associations with systemic health issues such as diabetes and cardiovascular (heart) disease. The Center for Disease Control performed a study in 2012 and found that 47.2% or 64.7 million American adults have mild, moderate or severe periodontitis. In adults 75 and older, the rate increases to 70.1%.

The gums and bone are the foundation for the teeth. In periodontal disease, these supporting structures are destroyed, creating space between the teeth, gums and bone. This ultimately leads to pocketing, which houses harmful bacteria. As the bacteria multiply and invade the supporting gums and bone, they further destroy the foundation, making teeth loose, and eventually causing them to have to be extracted.

Types of Periodontal Disease


  • Gingivitis - initial stage of periodontal disease involving red, swollen, bleeding, gums. It is reversible with treatment; however, if left untreated, can lead to periodontal disease and potentially tooth loss and other health problems
  • Periodontitis - Plaque and disease causing bacteria can spread below the gum line and cause the body to be in a chronic state of inflammation. This ultimately causes the destruction of bone and soft tissues, creating space between the gums and teeth, which leads to the formation of infected periodontal pockets. As the disease advances, the pockets become deeper as more gum and bone tissue destructions occurs. This can lead to tooth mobility and potentially even loss.

Causes of Periodontal Disease


  • Plaque and pathogenic bacteria
  • Smoking
  • Genetics
  • Age
  • Stress
  • Medications
  • Grinding teeth
  • Systemic diseases (diabetes, heart disease, etc)


Non-Surgical Treatment of Periodontal Disease

The first approach to treating periodontal disease is via scaling and root planing (also known as a deep cleaning). This involves meticulously cleaning the diseased root surfaces and removing the plaque and disease causing bacteria. Non-surgical therapy is often sufficient to treat periodontal disease; however, it is crucial to maintain strict maintenance therapy (routine 3 month cleanings) in order to maintain health.

Surgical Treatment of Periodontal Disease

Periodontal Pocket Reduction
The gums and bone are the foundation for the teeth. In periodontal disease, these supporting structures are destroyed, creating space between the teeth, gums and bone. This ultimately leads to pocketing, which houses harmful bacteria. As the bacteria multiply and invade the supporting gums and bone, they further destroy the foundation, making teeth loose, and eventually causing them to have to be extracted.

Deep periodontal pockets are unable to be adequately cleaned by neither the patient nor the dental clinician. If deep pockets remain even after non-surgical therapy (scaling and root planing), surgical therapy is often the next step. Thus, periodontal procedures known as pocket reduction are performed in order to gain access, fold the gum tissues back, clean these deep pockets, remove the disease causing bacteria, create an environment that is amenable to cleaning by the patient and ultimately restore the gum and bone tissues to a state of health. These procedures are performed in order to prevent further damage caused by the disease process and to restore a healthy smile.

Deep pockets are very difficult to clean. Periodontal disease has many connections with the rest of the body and can lead to diabetes and heart disease. Thus, these procedures are necessary not only to maintain a beautiful, healthy smile but also to decrease the risk of serious health issues associated with periodontal disease.

Gingivectomies are procedures performed by the periodontist that involve removing and reshaping excess gum tissues that cause deep pocketing around the teeth. Gum tissue overgrowth can arise due to periodontal disease, genetics, or certain medications. Gingivectomies are usually performed when a patient has gum disease that has not responded well to scaling and root planing (deep periodontal cleaning) or other periodontal therapeutic measures. Deep pockets still remain due to excess gum tissue. Thus, gingivectomies are needed in order to restore a state of health and effectively treat gum disease.

The gums and bone are the foundation for the teeth. In periodontal disease, these supporting structures are destroyed. Procedures known as guided tissue regeneration regrow lost bone and tissue in order to provide support for the teeth and reverse some of the destruction caused by periodontal disease.


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Laser Periodontics


Laser technology can be used in several dental procedures. Lasers can be used for the following:

  • Surgical gum therapy
  • Crown Lengthening (“Gum Lift”)
  • Minimize discomfort
  • Expedite healing time
  • Curing restorative materials
  • Enhance effects of whitening
  • Remove tooth structure

When used on soft tissue for periodontal health maintenance, lasers provide reduced swelling, minimal bleeding and reduced need for local anesthesia.

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Gum / Tissue Recession Treatment

Treatment of Gum Recession

Often times, roots of teeth become exposed as a result of gum recession. Teeth begin to appear to look longer than normal as the gum tissues move towards the root. Gum graft surgery can help prevent the recession from getting worse, and in many cases, can even cover some of the exposed root surfaces to provide improved support for the teeth and a more esthetic smile.

Gum / Tissue grafting is an attempt to repair the gum line to a state of health and prevent further recession. Gum grafts can be taken from the patient's own tissues as well as from donor tissues, depending on the patient's initial presentation and symptoms. Free gingival grafts involve harvesting autogenous tissue (patient's own tissue) from the patient's roof of the mouth and transplanting it to the site that needs treatment. Connective tissue grafts also harvest autogenous tissue and are used to help obtain root coverage and thicken the tissues in order to provide additional support and an esthetic result. Autogenous tissues are often considered the gold standard.

A minimally invasive approach to gum grafting involves a procedure known as "tunneling". This procedure creates a small pouch beneath the gums and uses donor tissue to thicken the patient's gums and even can cover exposed root surfaces in certain indications. The benefit is that the grafted tissue does not need to be taken from the patient's roof of the mouth, thus reducing patient discomfort.

Gum grafts often provide a combined benefit of improving both function and health- crucial to chewing, speaking and smiling with comfort and confidence.

Causes of Gum Recession

  • Age
  • Gum disease
  • Genetics
  • Smoking
  • Plaque accumulation
  • Orthodontic treatment
  • Trauma to the gums

Indications for Gum Recession

  • Decay on root surfaces
  • Increased sensitivity- especially to hot and cold
  • Esthetic concerns
  • Prevention of tooth and bone loss

Benefits of Gum Grafting Surgery

  • Prevent further recession and bone loss
  • Improved tissue thickness
  • In some cases, obtain coverage on the exposed root surfaces
  • Improve the esthetics of the smile

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Esthetic Crown Lengthening / "Gummy" Smile Treatment

Do you feel like your teeth are too short or that you show too much gum tissue when you smile? This is called a "gummy smile" and can be treated with a procedure known as esthetic crown lengthening. This involves removing some of the excess gum tissues to expose more of the tooth crown and resculpting the gums so that they fit your teeth better. This ultimately will make the teeth longer and improve the esthetic appearance of the smile.

Often times due to large cavities or if a tooth is broken below the gum line, a crown is required. However, sometimes the crown is too close to the patient's gums and bones. In these cases, a procedure known as crown lengthening is needed in order to gain enough space for the crown or filling. Crown lengthening adjusts the levels of the bone and gums in order to expose more tooth structure and allow for a properly fitting crown to be made.

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Sinus Lift

A sinus lift is a surgical procedure, which increases the amount of bone in the upper jaw bone to allow for the placement of an upper dental implant. When a tooth is lost on the upper ridge, the floor of the sinus gradually becomes lower and leads to a loss of bone volume, which must be available for the successful placement of a dental implant.

Prior to receiving a sinus lift, the surgeons at Periodontal Specialists of Vinings will perform an extensive evaluation of your bone and soft tissue to provide a safe and successful procedure.

Sinus augmentation is “technique sensitive,” and should be performed only by an appropriately trained periodontist , oral surgeon, or maxillofacial surgeon.

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Bone Grafting and Buildup

Upon meeting Dr. Bezreh and the team of Periodontal Specialists of Vinings for a dental implant exam and consultation, you may learn that a bone or tissue graft is recommended prior to receiving a dental implant. This is often the case when tissue or bone has atrophied due to advanced periodontitis or tooth loss.

Dr. Bezreh is highly skilled and trained in providing bone grafts when necessary. With the use of modern technology, grafting is minimally invasive and provides permanent results. Through a process called “guided tissue regeneration,” your body will recognize the graft as natural bone and over time will replace the graft with your own native bone.

One of the following bone graft types may be recommended prior to placing a dental implant:

  • The Alveolar Ridge Preservation Graft or “Socket Graft” – May be used after a tooth is removed or extracted
  • The Autogenous Ramus/Chin Graft or “Block Bone Graft” – May be used after dental trauma related bone loss

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What is a gingivectomy?

A gingivectomy may be recommended when severe gum disease (periodontitis) cannot be fully treated with scaling and root planing. This procedure reshapes loose, diseased gum tissue to remove pockets between the gums and teeth. This allows for you to prevent plaque buildup and prevents progression of periodontal disease, by allowing for more thorough cleanings of teeth and gums.

Now a days, it is used mostly to enhance appearance and manage a “gummy smile.”

How is a gingivectomy performed?

After numbing your gums completely, a periodontal specialist may use a laser to remove loose gum tissue and pockets.

During healing, you can take ibuprofen or acetaminophen to reduce pain. You can return to normal activities after the anesthetic wears off.

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Surgical Tooth Extractions

There are several potential reasons for tooth extraction: periodontal disease, fractured teeth, decayed teeth, loose teeth, infected teeth, etc. Every attempt is made to save the natural teeth; however, when teeth can no longer be saved or restored, extractions are indicated. When teeth are removed, every precaution is taken to minimize patient discomfort and to preserve the surrounding bone in order to minimize the amount of bone loss that will occur naturally as a result of the tooth extraction.

Unfortunately, bone tends to atrophy (shrink) over time from tooth loss, similar to how muscles atrophy over time when they are not used. After a tooth is removed, the height and width of the tooth socket will shrink over time.

Bone grafts are often placed into the tooth sockets to prevent the gum tissue from having a concavity in the site where the tooth was removed. Socket bone grafting is not only for esthetics, but it is also crucial for providing a foundation of bone that could house a future dental implant. The bone grafts act as scaffolds to help support the tissues and to encourage your body to begin forming new bone cells to regenerate the bone during healing. Thus, a strong foundation of bone with sufficient width and height is needed to support a future implant.

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Pinhole Surgical Technique (PST) – Treat Receding Gums

Chao Pinhole Surgical Technique™ PST in Atlanta – A breakthrough treatment for gum recession and receding gums

The Chao Pinhole Surgical Technique (PST ®™), invented and patented by John Chao, D.D.S., is an incision-free, suture-free procedure for treating gum recession. Through a small pinhole made by a needle, Dr. Chao uses specially designed instruments to gently loosen the gum tissue and glide it over the receded part of the tooth. Since there is no incision or suturing, patients can expect minimal post-operative symptoms (pain, swelling and bleeding). Most patients also are pleasantly surprised by the instant cosmetic improvement.

A Breakthrough Treatment for Receding Gums

The unique features of the Chao Pinhole Surgical Technique®™ ( PST ) have aroused keen interest on the part of the media. So far news programs at 33 TV stations have featured this incision-free technique of treating a problem that is found in half of the U.S. population (JADA, 2003). Dr. Chao made a guest appearance on the Dr. Steve Show, which was, broadcasted nation-wide during the week of September 15-22, 2013.

Dr. Chao was granted a patent on the PST®™ method and another on the PST®™ instruments by the U.S. Patent and Trademark Office. For more information, please also see “The Pinhole Surgical Technique®™, A Novel Approach to Root Coverage,” as published in October, 2012 issue of The International Journal of Periodontics and Restorative Dentistry, a high-impact, peer-review journal. (Int J Periodontics Restorative Dent 2012;32:521-531.)

If you would like more information on the Chao Pinhole Surgical Technique®™, please contact us.

Video of Before and After Photos using the Chao Pinhole Surgical Technique®™ Performed by Dr. Bezreh


The Chao Pinhole Gum Rejuvenation™ and Chao Pinhole Surgical Technique™ was featured on the national TV Show, “The Doctors”. The segment was called, “The Lunchtime Gum Lift™” and featured a patient who had 10 recessions treated in under one hour by Dr. John Chao. You can view the segment below.


What is gum recession?

Gum recession refers to the loss of gum tissue along the gumline. This can occur as a result of periodontal disease (gingivitis, periodontitis, advanced periodontitis), the natural aging process, or abrasive habits when it comes to brushing the teeth.

Why should gum recession be taken seriously?

When gum recession occurs, the root structure of the tooth becomes exposed. This means that tooth decay and other problems can affect the teeth along the gumline and beneath it. Since healthy gums are essential for a healthy mouth, getting gum recession treated is important for lasting dental wellness.

What is the Pinhole Surgical Technique™ (PST™)?

The Pinhole Surgical Technique™ is a minimally invasive option for treating gum recession. Unlike traditional grafting techniques, PST™ is incision and suture free.

All of the tools and techniques used to perform the Pinhole Surgical Technique™ were created by Dr. John Chao, the same man who trained our doctor.

How does the Pinhole Surgical Technique™ (PST™) differ from traditional gum grafting?

Traditional gum recession treatments involve the use of donor tissue or soft tissue grafts in order to rebuild the gumline. This soft tissue would be sutured in place and would join with existing gum tissue as it healed.

While this traditional grafting treatment is effective, comparable results with better patient experience can be achieved through the Pinhole Surgical Technique™.

How is Pinhole Surgical Technique™ (PST™) performed?

During the Pinhole Surgical Technique™, a needle is used to make a small hole in the patient’s existing gum tissue. Through this pinhole, special instruments are used to gently loosen the gum tissue. These tools help expand and slide the gumline to cover the exposed root structure.

There are no grafts, no sutures, and no incisions needed with the Pinhole Surgical Technique™. It simply involves the adjustment of the existing tissue.

What are the benefits of Pinhole Surgical Technique™ (PST™)?

The benefits of the Pinhole Surgical Technique™ are many:

  • Less discomfort for the patient after treatment
  • Faster recovery for the patient than traditional grafting
  • No need for uncomfortable sutures
  • No need for scalpels or invasive surgical tools
  • No need to take donor tissue from the patient’s palate
  • Excellent, natural-looking, long-lasting results


Cancers can occur anywhere in the oral cavity and oropharyngeal region, but are mostly commonly found on the lateral border of the tongue and the floor of the mouth. The American Cancer Society estimates that 49,670 people will get oral cavity or oral pharyngeal cancer and an estimated 9,700 people will die from these in 2017. Thus, it is imperative to routinely perform oral cancer screenings when examining patients. While our surgeons are comprehensively examining the patients, they look for oral cancers, and if they find a suspicious area, can remove it and send it to a pathologist who can determine the proper diagnosis and if need be, further treatment. Our surgeons will discuss the pathology results and coordinate treatment in an efficient and timely manner.

Often times, prior to a patient getting braces, or even during the time that they have braces, the gum tissues are thin and need to be thickened. Soft tissue grafting can thicken the tissues so that recession does not develop as a result of orthodontic tooth movement.

In other instances, there is not enough resilient tissue (known as attached and keratinized gingiva), and this lack of tissue can lead to recession. Soft tissue grafting procedures can be performed in order to add more of this resilient gingiva and prevent recession. In cases where recession is already present, this grafting can help prevent the recession from getting worse.

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Sedation Options

Local Anesthesia

Local anesthesia is the use of local anesthesia or a numbing medication injected in the area of the mouth to be treated. This type of anesthesia blocks the sensation of pain during and after a surgical procedure.

Nitrous "Laughing Gas"

Are you nervous about going to the dentist? You don’t need to be nervous about coming to our practice. We offer oral surgery sedation to relax our patients.

Nitrous Dentistry

Nitrous Sedation is a controlled mixture of nitrous oxide and oxygen that you breath in with a nasal mask. This type of sedation will allow you to feel relaxed and less nervous during the procedure. An oral medication can be administered with nitrous oxide to produce a more relaxing experience.

Also known as laughing gas, Nitrous is beneficial in calming a patient’s anxiety before a procedure. It is a non-smelling, non-irritating, colorless gas which you can breathe.

It is used primarily for its anesthetic and analgesic properties. It is a safe and effective gas that is inhaled by the patient. It is a commonly used sedation technique in dentistry.

Oral Conscious Sedation

Are you extremely anxious about visiting the dentist? We can administer an oral sedative to relax you before performing any procedure. Safe and effective, Oral Sedation allows you to remain awake and aware, but your anxiety will be reduced for any dental procedure.

Oral Sedation can also be combined with a light amount of Nitrous Oxide gas to increase your relaxation.

Sedation Dentistry
Advantages to patients include:

  • Treatment is completed when you are in a more relaxed mood.
  • You will have less difficulty sitting through a lengthy procedure.
  • Multiple treatments and full mouth restorations can occur during the same visit.
  • Less discomfort after treatment.

IV Sedation

Comprehensive Conscious IV Sedation (moderate)
Conscious IV Sedation is also known as “twilight sleep”. Our doctors are specialty trained to offer this type of sedation. It is particularly good for patients with strong gag reflexes, high dental anxiety or for those patients requiring multi-visit procedures that can be done in the same visit such as multiple implants. IV Sedation is also used in most oral surgery. The patient will be groggy after the procedure and as such, will need a friend or family member to drive them home as well as monitor them for the next few hours.

General Sedation

General anesthesia is a combination of oral and IV (intravenous) medication that will sedate you to a level of unconsciousness. Depending on the amount and type of medication administered will determine the depth of unconsciousness. In your unconscious state, you will not have any fear and anxiety. General anesthesia is a very safe and effective way for patients to tolerate complex dental treatment.


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Have questions? Call us and speak to one of our friendly care coordinators.