Advice about bone grafting

[Anonymous]

[Anonymous]

Hi there,

I saw your website, nice site. I’m looking for advice about periodontal treatment.

I have widespread gum recession and bone loss (5 to 6mm pockets, although my periodontist is putting me on extensive SRP to reduce pocket depth and to “seal up” the gums to keep bacteria out). I live in Vancouver, Canada and the periodontist I’m seeing says he is not able to do guided tissue regeneration (e.g. bone augmentation) for the widespread bone loss that I have.

Fortunately, I have large teeth and roots but the bone level is getting low. My teeth are not loose yet but I need to take action now.

I’m looking for a 2nd opinion and I’m looking for a better periodontist who can do the bone augmentation to provide more support for my teeth. I was wondering if you could point me to periodontists in western Canada or in the northwestern U.S. who are experts in bone augmentation, bone grafting for teeth, or even gum/bone regeneration in teeth. Ideally, I’d like to see such an expert who is close to Vancouver, e.g. Washington state, Oregon state, or western Canada.
But I could even fly out to other parts of Canada or the USA to see such an expert.

Do you have any suggestions about some experts or treatement in this field for my situation? Thanks for your help

[Jack Wasserstein, DDSMember]

If you are already seeing a Periodontist and he is advising you that you are not a good candidate for bone grafting, then that is probably the case. Specifically, and based on what you are describing this sounds like your situation, when your pattern of bone loss is horizontal it is difficult and very unpredictable to regain the bone height around teeth. You can think of horizontal bone loss as follows – when the bone recedes evenly around the tooth from the top towards the bottom of the roots. Typically it spans more than just one tooth. There can be gum recession in association with the bone loss as well. If indeed this is your situation, conventional periodontal treatment – scaling and root planing and periodontal surgery is the most predictable and cost effective approach.

Bone grafting is usually employed when the bone loss around the tooth is in a vertical pattern. In this scenario, the bone loss is in a v shaped pattern adjacent to the tooth – I hope to post some pictures soon. In these scenarios, you can attempt to regenerate the bone next to the tooth and as high as the preexisting level of the bone.

I would advise you to get a second opinion from another local periodontist, before traveling. If you need a referral I recommend http://www.perio.org which is the official website of the American Academy of Periodontology.

If you have any radiographs to send that would also be helpful in commenting about your specific situation.

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