the periodontal treatment Dr. Hoffmeyer may identify
infections requiring surgery or hopeless teeth requiring
removal. This may be due to pain, infection or severe bone
Dr. Hoffmeyer may find it
necessary to perform one of the following surgeries for you.
This can be done at the same time of your periodontal and
implant treatment, or at any occuring incident:
A lateral abscess is located along the side (lateral)
surface of the tooth's root.
The infection comes usually from outside the tooth not from
within. A lateral abscess can either be gingival
(located near the gum line) or periodontal (located
further in the bone).
Most cases are due to periodontal
disease and can be treated.
periapical abscess is an infection at the tip of the root.
This occurs after the pulp (nerve) of the tooth becomes
infected. It is usually caused by deep decay or an accident
(nerve damage). This tooth requires root canal therapy,
apicoectomy or extraction and possibly antibiotics.
abscessed tooth is usually sensitive or painful and can be
seen on an x-ray.
Left untreated, an abscess may compromise
the immune system.
root tip surgery
During root canal (endodontic) treatment, infected nerve
tissue is removed from inside the tooth (canals). Sometimes
infection may remain in the side branches causing
Apicoectomy is a surgical procedure that
attempts to remove infection from the tip of the tooth.
surgery is more difficult to perform in the back (molar)
teeth because of difficulty in surgical access and
complexity of multi-rooted teeth.
Sometimes this procedure
is not indicated, the infected tooth may need to be
extracted and maybe replaced by an implant.
Periapical abscess around left tooth is speading
towards right tooth.
tip surgery is performed by cleaning the infection
away and placing a filling (white spot).
In some cases it is indicated to place a
bone graft and a membrane.
part is still under development - please come
TOOTH EXTRACTION • SURGICAL REMOVAL
need for tooth removal may be due to:
Severe gum disease, affecting the supporting bone
structure and tissues.
Tooth decay, infection or fracture beyond repair.
Referral by your orthodontist. Teeth may be growing in
crooked because there is not enough space. Tooth
extraction allows room for teeth to grow straight and
Lack of space for your wisdom teeth at the back of your
Antibiotics may offer temporary relief from symptoms (like
pain and swelling) but tooth removal is often the only
solution for permanent relief of symptoms.
If your tooth is
severely damaged, a surgical extraction may be required.
Dr. Hoffmeyer prefers to remove the diseased tooth in an
atraumatic surgical procedure in order to minimize loss of
bone, and ensuring the possibility of placing implants
immediately or later on.
and dark gray areas represent root cavity and
SOCKET PRESERVATION • RIDGE PRESERVATION • BONE GRAFTING
As a periodontist, Dr. Hoffmeyer is very concerned about
preserving and creating bone and soft tissue to adequately
retain your beautiful smile.
Extracting a hopeless tooth leaves a damaged empty hole
(socket). The bony ridge around the socket tends to erode
away (resorb) and the gum shrinks. Eventually the bony
(alveolar) ridge can narrow to a knife edge and can cause
severe problems if you want implants, bridges or dentures.
You can develop sunken cheeks, excessive wrinkling around
your lips and your chin and nose appear to become pointed and
closer together. Your bite collapses.
If immediate implants are not an option, these deformities
can be prevented and repaired by a procedure called
socket or ridge preservation.
Socket preservation (bone grafting), can stop ridge erosion
before it begins. It is done by filling the extraction site
with a bone grafting material and covering with a
biocompatible barrier and/or treating with tissue
stimulating proteins to encourage your body’s natural
ability to repair itself by regenerating lost bone and gum
tissue. This bone graft protects the blood clot of the
extraction site, promotes the growth of new bone and is
gradually resorbed and replaced as your new bone grows in.
The bone usually will develop for about 4-12 months before
your implant placement or restorative treatment can be
completed. Often temporary restorative teeth can be
provided at the time of tooth extraction and function
during the healing period.
The procedure takes a
The bone on the neighboring tooth is preserved
The bone (ridge) does not collapse
The esthetics is improved with a more natural smile
The regenerated bone allows placement of an implant to
replace the missing tooth later on.
The cosmetic outcome of future treatments such as dental
implants, fixed bridges, removable dentures, or gum-line
reshaping will most likely be more successful.
Dr. Hoffmeyer will advise you if socket preservation is
necessary to help you achieve your treatment goals and
create the foundation for dental implants.
Normal jaw bone at the time of extraction.
Insuficient amount of jaw bone to support
dentures and bridges several years after
Bone grafting can assist in ridge preservation.
Bone loss and defects due to e.g. periodontal
disease, root tip cysts and around implants can
be treated with bone graft and membranes.
BioOss bone graft and BioGuide membrane placed
Once the tooth is lost the jaw bone continues to
disappear. Today, some simple, predictable techniques are
available to re-grow your lost bone, to provide support for
implants or dentures or to improve esthetics around bridges.
The bone does not need to be taken from your own body.
Specially prepared bone-grafts and membranes are used to
rebuild your lost bone. This procedure is highly predictable
in healthy patients.
Improves esthetics, function, oral hygiene and maybe
speech problems (front area)
Regeneration of sufficient bone to place implants in
the proper positions for your new teeth.
Gives greater stability for full dentures
Corrects depressions in your gum line that look
unnatural, e.g. where the gum and bone has “fallen in”
and is missing under crowns and bridges
Helps reduce “dark spaces” between teeth in your
Impacted canine teeth
unerupted or partially erupted teeth cannot fully erupt due
to lack of space (crowding), conflicting position (another
tooth has erupted over that position) or ankylosis (roots of
the impacted tooth fuse to the bone and can not move).
If indicated Dr. Hoffmeyer can remove the tooth and perform
Another option is to uncover the tooth and glue an
orthodontic bracket on for movement.
teeth (third molars) usually erupt at the age of 15 to 25.
Wisdom teeth are not removed when they are healthy and
properly positioned. However, most mouths are too small for
these four additional molars and problems develop that
require their removal.
Why are impacted wisdom teeth removed?
The tooth is unable to break through the gum since your
jaw may be too small
The tooth breaks partially through the gum. A flap of
gum tissue grows over the tooth, food and germs are
trapped under the flap and cause infection (pain and
red, swollen gums).
The tooth may grow at an akward angle and can damage the
adjacent tooth' root and bone structure (periodontal
The tooth may
possibly contribute to crowding of your teeth.
The tooth may lead to more serious problems, such as
infections, cysts, tooth decay and gum disease to the
The longer the extraction is postponed in young people,
the longer the tooth roots grow. The risk of
complication during extraction increases because the
tooth roots may grow close to sensitive facial nerves.
the wisdom tooth causes periodontal disease, the lost bone
and periodontal defect on the remaining adjacent tooth will
be assessed by Dr. Hoffmeyer and if possible the defect can
be treated by a bone regeneration procedure.
After all surgeries a thorough
postoperative instruction will be given
verbally and in writing.
In addition the
most commonly needed medications, mouth
rinse, icepack and gauze are handed out.
(This part is still under development - please come back