Solutions

Click on the procedures below for photo's and descriptions.

When seeing Dr. Shuster for the first time it is important for him to perform a comprehensive evaluation of your oral health. This way he can properly diagnose any dental problems that need to be addressed. He will begin by taking a thorough health history including any medical conditions you have or any medications you may be taking.

It is very important for the doctor to know of any medications you are taking or health conditions you may have as modifications to treatment may need consideration. After reviewing your health history, Dr. Shuster will review your dental history to identify any problems you may be experiencing.

A thorough dental evaluation includes:

  • Oral cancer screening
  • TMJ evaluation
  • Periodontal screening
  • Hard tissue exam
  • Necessary Dental X-rays
  • Treatment plan

Oral Cancer Screening
It is very important to see your dentist regularly if only for oral cancer screenings. According to the Oral Cancer Foundation more than 34,000 Americans are disgnosed with oral cancer every year and 8,000 of those patient unfortunately will succumb to this disease.

TMJ Evaluation
Many patients suffer from misalignment of the teeth causing dysfunction and pain in the temporomandibular joints (TMJ). Many times this dysfunction is evidenced by an audible click or popping in the jaw. When our teeth are not aligned correctly there are forces at work that cause vibrations that are very damaging to the tendons and ligaments holding our jaws in position. Other cases involve clenching and grinding of the teeth during sleep which not only causes damage to tooth structure but inflammation in the jaw joints as well. Dr. Shuster will identify any problems that may be leading to potential damage to both the teeth and jaw joints.

Periodontal Screening
Periodontitis is an inflammatory disease that is a response to the presence of bacterial infection in the gums. Plaque is a conglomeration of bacteria, food debris, and a sticky substance called dextran the bacteria produce to allow adherance to tooth structure. If plaque is not removed within 24 hours it will soak up the minerals in our saliva and become hard like cement.

This is called calculus and cannot be removed by normal brushing and flossing. Even on a microscopic level calculus is porous, like swiss cheese, which gives bacteria a haven to live and multiply undisturbed. Bacteria eat the sugars we eat and excrete acid. This acid is what causes both inflammation in our gums as well as decay in our teeth. The acid is very caustic to the gums so the gums pull away from the root surface where the calculus resides. As the gum pulls away from the tooth it opens up areas where more calculus can form on the root.

Also, where the gum pulls away, the bone is affected and we will see bone loss in the area. This creates the viscious cycle by which periodontitis progresses. When we do a periodontal screening we measure between the tooth and gum with a periodontal probe to see if the patient has areas where the gum has pulled away from the root and check for the presence of calculus on the root.

Patients that exhibit signs of periodontitis must undergo periodontal therapy where the calculus is removed, scar tissue from the gum is removed, and the gum tissue can reattach to the root.

Hard Tissue Exam
Dr. Shuster will then evaluate the teeth themselves. He will closely look at each tooth checking for decay, failing restorations, fractures in the enamel, erosion from acids in foods and saliva, and general wear. Each tooth has its own story and we make a record of each individual tooths dental history and present condition.

Necessary Dental X-Rays
In order to make a complete and proper diagnosis a full mouth series of Dental X-rays is required. When we look at the patient clinically many underlying problems may go unnoticed without being able to see below the surface of the enamel and below the surface of the gums. A full mouth series of x-rays reveals decay of the teeth, abnormalities of the roots, bone loss, and tumors in the bone.

A full mouth series of x-rays is good for 3-5 years but the cavity detecting bite wing x-rays are taken annually. If you think you may have current x-rays from another office please let us know so we can have your records transferred. It is best for the doctor to have those Dental Xrays during your comprehensive oral exam.

Treatment Plan
After evaluating all of the data collected, Dr. Shuster will identify all problem areas. His goal for his patients is ideal oral health. He will develop a treatment plan that addresses all of the areas of concern while prioritizing the sequence of care to deal with the highest need areas first. The treatment plan is our roadmap to ideal oral health.

Periodontal Therapy
Periodontitis or periodontal disease is a bacterially induced chronic infection that destroys the bone and tissue that support teeth. If left untreated, periodontal disease can ultimately lead to tooth loss. According to the recent surveys by the National Institutes of Health (NIH), periodontitis is the leading cause of tooth loss in adults in the United States. An estimated 67 million adults suffer from some form of periodontal disease.

Healthy
Healthy gums are pink and firm and don’t bleed at all during brushing and flossing.

Gingivitis
Gums appear red and puffy around the teeth. They may bleed during brushing or flossing.

Early
The infection has moved under the gum line and inflammation has spread to the structures supporting the teeth. The gums bleed more easily and begin to separate from the teeth.

Moderate
Gums may recede as supporting fibers and bone continue to be destroyed. Teeth may be sensitive to hot and cold. Some teeth may be slightly loose.

Advanced
Significant amounts of supporting fibers and bone have been destroyed. Teeth may become extremely loose. Gums may bleed spontaneously and/or pus may ooze from under the gum line.

Periodontal disease is usually painless and patients seldom experience obvious symptoms or discomfort. This is one of the reasons so many people have undiagnosed periodontitis.

Root scaling and planing
Root scaling and planing is a non-surgical procedure for removing plaque and dental calculus from the mouth. These substances adhere to the teeth as sticky or hardened residues and are the result of bacterial colonies under the gums. If these plaques and bacteria are not removed frequently they can produce acids which promote tooth decay and gingivitis. Root scaling and planing is a most effective way to treat gum disease before it becomes severe and chronic. It is also a usual first step in treating more advanced periodontal disease.

Root scaling and planing provides a much deeper effort than a standard teeth cleaning and is very often performed by a dental hygienist.

The Procedure
Root scaling and root planing employ slightly different techniques and are usually used in combination. Both are of great value in combating periodontal disease from gingivitis to advanced periodontal disease.

Root scaling is generally performed with local anesthesia and involves cleaning the teeth below the gum line. The dental plaque (tartar) is carefully and firmly scraped away. In root planing the dentist or hygienist uses instruments to smooth the tooth's root surface which has become roughened from the disease process. This can help promote reattachment of the gum tissue and lead to a healthier mouth. In most cases the treatment will consist of four separate appointments to treat each quadrant of the mouth.

After scaling and root planing are completed the periodontist will re-evaluate the patient's gingival condition and together they will discuss and decide on any further treatment. Our team of professionals is highly qualified to guide our patients through the appropriate treatment planning for their individual situations.

Osseous Surgery
Osseous Surgery is designed to modify and reshape deformities in the alveolar bone surrounding the teeth. It is a common requirement in effective treatment of more involved periodontal diseases. In some instances, the bony support of the tooth assumes an unusual configuration as a result of uneven progression of the disease. When this occurs, modification of the altered bone support may be indicated.

Why do You Need Periodontal (Osseous) Surgery?
This surgical procedure is used by the Periodontist to smooth/correct defects and irregularities in the bone surrounding the diseased teeth with the ultimate goal of reducing or eliminating the periodontal pockets. Of course the areas to be treated are anesthetized with local anesthesia (Lidocaine or "Novocaine". Don’t let the word "surgery" scare you. Except in the most complex cases, it feels like a thorough cleaning. If you must worry about something, you can worry about possible post-surgical discomfort; I must say though I give less pain medication now than I ever have- perhaps it’s the experience!

This surgical procedure is used by the Periodontist to smooth/correct defects and irregularities in the bone surrounding the diseased teeth with the ultimate goal of reducing or eliminating the periodontal pockets. Of course the areas to be treated are anesthetized with local anesthesia (Lidocaine or "Novocaine". Don’t let the word "surgery" scare you. Except in the most complex cases, it feels like a thorough cleaning. If you must worry about something, you can worry about possible post-surgical discomfort; I must say though I give less pain medication now than I ever have- perhaps it’s the experience!

The average surgical procedure takes about 1 hour, including the time to get numb. We use an average of 3 anesthetic cartridges per quadrant. We use a combination of two types of local anesthetic: 1. Carbocaine and 2.Xylocaine with epinephrine; the "epi" is used to control bleeding and to make the anesthetic last longer. If you have problems getting numb, please tell Dr. Shuster at the beginning of the procedure, as Dr. Shuster can usually give it in a different location to make it work better and perhaps faster. Also, some patients have problems staying numb; in these cases Dr. Shuster must start the procedure immediately after the "shot" before it wears off. We aim to please!

What do we do exactly during surgery?

  1. First, after getting the area "numb" we FLAP the gum back so that we can visualize the amount and type of bone loss. We can also visualize tartar that may be attached to the roots.
  2. We then remove the tartar and clean out what we call granulation tissue from the bone defects or craters. This granulation tissue is basically infected/inflamed gum tissue that creeps into the craters and defects as the bone resorbs or disappears.
  3. Next, we use hand instruments or a special diamond bur on a high speed handpiece to smooth and recontour the bone so that the craters are reduced or eliminated. It’s difficult to explain, but by doing this, the pockets will be reduced or eliminated.
  4. At this time, in some cases where the craters or "holes" in the bone are too deep we will then use a bone graft to fill them in. As advances in periodontology have been made, additionally we now use a special membrane (Guided Tissue Regeneration procedure) to cover over the bone graft so that the gum does not grow down into the crater and "sabotage" the bone regeneration procedure. There are 2 types of membranes currently being used: A. Resorbable B. Non-resorbable
  5. After the bone is reshaped or augmented (bone graft), we then replace the original gum flap back over the bone and place sutures (stitches). The stitches are usually nylon and must be removed in about one week. Sometimes, however, if you can’t get back here within a week we place a different type of suture that won’t irritate or attach to your gums; it must still be removed, but you can wait as long as a month.

Esthetic Crown Lengthening
Esthetic crown lengthening, also know as gum recontouring or a “gum lift”, can instantly provide a new beautiful smile by exposing hidden tooth structure buried under excessive gum tissue. This allows patients to show off their new smile within minutes of the procedure. Dr. Shuster has a long and successful history of treating esthetically challenged smiles with esthetic crown lengthening.

Beautiful smiles are the result of several inter-related elements: the teeth, gums and the lips. This relationship is often described in terms of a theatrical production, with the lips acting as the curtain, the gums as the stage and the teeth as the players.

Using this analogy, beautiful smiles can only be achieced by setting the proper stage with well-suited players.

There are two instances in which altering the stage, gum recontouring, is necessary. First, teeth may appear short and square, often resulting from tooth structure being hidden beneath the gums. In these instances, Dr. Shuster will reshape the gums and underlying supporting structures, exposing the unseen tooth portion, creating a vibrant and healthy looking smile.

In the second instance, patients may want to alter the appearance of their teeth due to wear, poor shape, disproportionate size, or unattractive color. Under these circumstances, gum recontouring provides the restoring doctor with the proper frame or “stage” on to which new restorations such as veneers and caps can be placed.

Typically patients experience only mild discomfort and simply require over-the-counter analgesics following this treatment. Providing a balanced and properly designed stage allows the teeth to shine beautifully. Esthetic crown lengthening provides some of the most striking and immediate results to our patients.

If teeth are missing for a long time, a great deal of bone loss can occur. The air in the sinuses contributes to this loss by putting pressure on the jawbone. Therefore, there may not be enough bone under the upper sinus or air cavity to place a dental implant initially. To gain the necessary height for implants, a bone graft to raise the sinus and provide stability for an implant may be indicated. This is termed a "lateral wall sinus elevation" or "sinus lift." A sinus lift not only restores strong jawbone to place implants into but also may relieve some sinus drainage problems.

Ridge Augmentation
Ridge augmentation is often suggested when a patient has a large depression, cleft or crease in the gum which is ugly, distorts normal dental esthetics or traps food. The condition is often treated prior to fabrication of replacement teeth or a new dental bridge. The purpose of ridge augmentation is to “build up” the gum tissue, allowing the dentist to create tooth replacements that emerge naturally from the gum with normal cosmetic proportions.

Esthetically pleasing, natural-looking teeth depend not only on the form and shade of the teeth, but also on the shape and contour of the surrounding gums. In areas where teeth have been lost, the bone and gum tissue in the area, lacking the natural support of dental roots, will often recede and shrink over time. If the tooth or teeth were lost due to infection, fracture or trauma, the damage to the underlying jawbone and gum can be particularly severe. This can result in a concavity, or indentation of the gum in the area. If new teeth are fabricated to the level of the damaged gum, the result will be out of proportion to the adjacent teeth and look artificial or unnatural.

Traditionally, gum tissue (connective tissue) from another area in the mouth, usually the palate, has been used as donor tissue for ridge augmentation. In some cases, particularly where large defects are present, other materials may be used in conjunction with or instead of the gum graft.

Ridge augmentation is a predictable procedure that will correct the defects caused by bone loss and gum recession in areas with missing teeth. More importantly, this procedure allows the chance to return the harmonious contours of the gums that existed before loss of the tooth, creating the opportunity for a natural and esthetic new smile.

Extractions/Bone Preserving
Your tooth may need to be removed due to a fracture, pain, infection or bone loss. These problems may complicate the extraction procedure, resulting in jaw deformity. To prevent this deformity, we gently remove the tooth with state-of-the-art instruments and place bone material with growth factors to accelerate healing. The newly formed bone provides a foundation for implant placement. Our bone-preserving extraction will greatly improve your smile, and make implant placement more predictable.

As periodontists, we conserve as much bone as possible when removing a tooth. This promotes:

  • Faster healing
  • Retained bone volume
  • Ideal cosmetics

When your tooth requires removal by us, you may expect the following:

  • Use of state-of-the-art instruments to remove teeth as gently as possible
  • Bone graft materials to form new bone and preserve the jaw
  • Use of growth enhancers to accelerate healing
  • Our bone-preserving extraction will greatly improve your smile.

Dental implants are artificial tooth roots that hold crowns/caps or bridges. To replace failing or missing teeth, dental implants are very predictable (over 95% success), lifelong solutions. Dental implants have many advantages.

  • Prevent further bone atrophy (loss)
  • Preserve existing bone
  • Prevent the preparation of neighboring teeth for a bridge
  • Last for a long time
  • Are fixed (cannot be removed)
  • Look, feel and act like natural teeth
  • Improve your ability to chew
  • May retain dentures & subsequently improve function (i.e., speech, eating)
  • Make you feel whole again
  • Depending on your particular case, we may able to perform the following services:
  • Place implants on the day of tooth removal ("immediate implant")
  • Give you a temporary cap on the implant on the day of implant placement ("immediate temporization").

We utilize medical-grade CT scans to determine the exact quantity and quality of bone for placement of implants.

Single Tooth Implant

A missing tooth will alter the appearance, affect confidence and interfere with daily function.

Restoration of a missing tooth with dental implant is a predictable, long-term, non-decaying and natural-feeling solution. It is the best treatment available for most cases.

We understand that a dental implant must be placed with precision and your ideal look in mind. This is especially true for any tooth seen in a smile.

Our expertise will give the best possible result.

 

Multiple Implants

Missing several teeth significantly reduces chewing ability, speech, and quality of life.

Often, the only reliable or even feasible treatment is replacement by dental implants, which last for a long time, withstand force, feel natural, do not decay, and prevent loss of remaining teeth.

The doctors in our practice are very well-versed in the art and science of multiple implant therapy.

We will assist you with regaining your full function in the smoothest possible way.

Full Arch Implants

We specialize in helping patients without teeth recapture their self-esteem, attractiveness, comfort, speech, and chewing.

Both denture-wearers and those who need all their teeth removed gain so much from dental implant treatment.

With implant therapy, you will no longer be constantly embarrassed or frustrated by your situation.

Please let us tell you more about this predictable, long-lasting, natural-appearing, and cosmetic answer to your troubles.

Teeth in a Day
In certain situations, it is possible for you to walk into our office with your natural teeth and leave with non-removable, esthetic, and working implant teeth the same day.

Benefits:

  • Time-saving
  • Fixed teeth always present
  • Cosmetics always maintained

Whether you have one failing or an entire jaw of failing teeth, we may be able to coordinate such treatment with you and your restoring dentist.

Contact us to see if this treatment option is possible for you.