Would you try the papilla tunneling procedure on other teeth besides the lower anteriors? In this case if the patient had a large labial frenum could you do the tunneling procedure combined with a frenectomy or would you have opted for a CTG from the palate and frenectomy?
@MrAwishart If you check out my youtube channel: periEau you can see AlloDerm used in all areas of the mouth. When the frenum is a factor with the need for root coverage then I do a laser frenectomy at least a month before some sort of root coverage grafting. I don't combine frenectomy with the grafting. But I'm not sure if anyone else does, or their particular technique.
I had this procedure done two weeks ago and my gums do not look covered. My peridontist said it is because the grafting is under the gum line. How does the alloderm grow to cover the exposed teeth?
@siciliansummer you have to loosen the gum (as noted in the video) and then you can move it up over the roots with the graft below. Sometimes you cannot get the gum to move over the exposed roots or sometimes it slides back. If the result is more "functional" then fine. IF you need a cosmetic result then a second procedure may need to be done.
Great surgery, very well. done. At the end of the surgery, a question was raised about using Arrestin in a pregnant patient. Would this not cause tetracycline staining of the unborn fetus?
@alanrw91311 I'm not sure that we would use Arestin in a pregnant patient but that said Arestin is 1mg of minocycline. It is a local antibiotic and even though trace amounts can get into circulation it would be extremely unlikely that it would effect the permanent dentition.
My dentist used to try lots of distraction techniques but the Lunar eclipse is a new one on me lol - Non of them ever worked very well though because i am too nosey for my own good and wanted to know every detail of what she was doing. I'm sure i was a total pain in the backside because of it to start with. But strangely it calmed me down more by been kept in the loop and knowing what was going on so i put myself in a calm place. If that makes sense.
I always see this surgery done for the visible front of the teeth. Can this surgery be done for the inner (non-visible) teeth?
I have recession on my outer and inner lower incisors. Last week, I was eating pretzel sticks, when I bit down, the pretzel posted in my mouth and pinched off a big chuck of my gum on my lower inner incisor. Can this surgery be done on my inner (non-visible) lower incisor?
my fixed bridge in the middle in that area are also like that , my dentist replaced my jackets 3 times im glad its getting better , ty for sharing this vid :)
Nice work!! I had bone loss and had bone replacement grafts in all quadrants. Lost my front teeth but have a very nice bridge. I also have very tight grouping in the bottom front. Is it possible to pull some teeth to straighten them? I look like a movie star on top and look like Shrek on the bottom.
Great surgery doc. I have a question. Freeze at 9:02. Notice the the gap between the two top front teeth, is there a treatment for something like that? My gums have receded and it looks very similar to the gentleman's in the video. Can that section be restore so there isn't a hole like that anymore? Thanks.
@perieau I use medium brushes cause the soft do not clean my teeth well enough, I feel...I do have good teeth and do not damage my gums, I am very careful as well as I keep up with my dentist apps.
Your comments are much appreciated! It is my blessing to be able to practice my passion. Getting paid for it is a nice bonus! AND you're right about the office. My staff is incredible!
So far there is no known way to get more tissue over a root with recession other than some sort of regenerative surgery. BUT who knows? Maybe this is something that can be done in the future!
wow!!! great surg!!! and great healing. is the alloderm grafting something thaz relatuvely mainstream or do most perio's still do the tear-up-da-roof-of-ur-mouth graft
Have not tried emdogain and alloderm together. Don't seem to need it but I'm sure it won't hurt the healing. It would increase the cost per procedure for the office as well as the patient.
I see AlloDerm as being stable. I have been doing AlloDerm grafting for over 15 years.
AlloDerm is an acellular donor product with no infection potential or rejection potential. It becomes part of the patient's tissue when it integrates.
But what about if the tooth or the tooth's root have a small restoration of resin? Is that possible to the gum attach to the resin? If not, is that possible remove the resin and replace with another material that will allow the gum to attach?
Does alloderm create some new tooth tissue in the small gap where the resin was removed, or the small gap is filled with gum tissue regenerated by alloderm ???
IF more root coverage is needed the connective tissue grafting is more predictable. In this case we have a very functional result with almost total root coverage.
from today and on im going to makesure that i floss everyday and brush as well.
i refuse to spend that amount of money on just 3 teeth! that should be my whole damn mouth. lol
im sorry but everyone should from now on spend special care on your teeth and put these dentist people out of business. give them a reason to lower the prices.
im going to makesure that i take care of my teeth from now on.
too much money, and especially in this economy, oh no!
Don't brush too hard and use a soft brush because those that over do it can end up needing some grafting. Us dental people will still be around to help those in need and also help prevent problems in the future.
I normally don't video crown lengthening because I typically do that with loupes. The microscope has a camcorder attached so video is easy to capture.
I can tell by this video you are a great at what you do. I have a relative who went through multiple allo grafts...literally all bottom front teeth and all top front. She has had problems with some and with the ones that did turn out, the results were not as good as your patients. Soon it will be my turn to get some allo grafts. So I was wondering how long is it on average before one can eat solid foods again or anything you have to say about the healing process would be helpfull.
We have patients chew softer foods after treatment on the non-surgical side. If both sides: "if you can't chew it with your tongue, it's too hard". Premed with NSAIDS and for 24 hrs is a good way to prevent discomfort.
We infiltrate the local area with articaine. Pt is numb for about 3 hrs. We premed with naproxen sodium 550mg (Anaprox, the same as Aleve but higher dose). We keep pts on this for 24 hrs and they can add some Vicodin in between as needed. Quite often they take "maybe" one vicodin that night.
Sir, my dentoalveolar cases have registered increased bleeding (enough to make it troublesome) when I use Articaine, I wonder if you have come across this phenomena, some o my friends have experienced the same.
OK, thanks, as complimentary information, the one we use is made by Septodont (France), it does contain epinephrine, congrats on your assistant, she sounds in the dialogue off camera as a cool, professional and wonderful person. cheers & good luck
your supposed to bounce the probe on the gum and wait for a blanching NOT slide it across and break the barrier of the epithelium tissue like WTF!!!!!!!
Why are you using a curette to elevate your flap? I mean, I'm sure the procedure turned out well-enough, as oral tissues are very forgiving. But I always use a thin 15 blade. With that curette, you are just needlessly fucking around with the tissues, and worse, you are almost certainly tearing them beneath the flap. A thin 15-blade gives you a nice, clean cut from which you can elevate a clean flap.
Gee, you are so tactful with your comments... First of all, that is not a curette it is a modified Orban knife. It was designed by Pat Allen and it works great to elevate a full thickness flap. A thin 15 blade is HUGE by comparison. Hard to mobilize a connected flap with a 15 blade but I look forward to checking out your video because that would be next wouldn't it??
the last part of the comment wasn't necesary, what this guy needs is manners, and those he should have gotten along with his mother's milk, as they say in Spain, this was a beautiful job, I must confess the intricate suturing left me scratching my head, but then again I am only an OMF surgeon, if you were so kind to explain the hows and the whys, what pulls what, again congrats, nice job.
Congratulations., So artistic..! Excellent Suture.
havakian 6 months ago
My teeth were messed up because my mom took tetracycline. Idk why she did, but it made my adult teeth not white. My baby teethe were ok though.:o Tc.
blacksheepgirl 1 year ago
@snoopdogsg1 more like recession from an anatomical issue.
perieau 1 year ago
Would you try the papilla tunneling procedure on other teeth besides the lower anteriors? In this case if the patient had a large labial frenum could you do the tunneling procedure combined with a frenectomy or would you have opted for a CTG from the palate and frenectomy?
MrAwishart 1 year ago
@MrAwishart If you check out my youtube channel: periEau you can see AlloDerm used in all areas of the mouth. When the frenum is a factor with the need for root coverage then I do a laser frenectomy at least a month before some sort of root coverage grafting. I don't combine frenectomy with the grafting. But I'm not sure if anyone else does, or their particular technique.
perieau 1 year ago
I had this procedure done two weeks ago and my gums do not look covered. My peridontist said it is because the grafting is under the gum line. How does the alloderm grow to cover the exposed teeth?
siciliansummer 1 year ago
@siciliansummer you have to loosen the gum (as noted in the video) and then you can move it up over the roots with the graft below. Sometimes you cannot get the gum to move over the exposed roots or sometimes it slides back. If the result is more "functional" then fine. IF you need a cosmetic result then a second procedure may need to be done.
perieau 1 year ago
Great surgery, very well. done. At the end of the surgery, a question was raised about using Arrestin in a pregnant patient. Would this not cause tetracycline staining of the unborn fetus?
alanrw91311 1 year ago
@alanrw91311 I'm not sure that we would use Arestin in a pregnant patient but that said Arestin is 1mg of minocycline. It is a local antibiotic and even though trace amounts can get into circulation it would be extremely unlikely that it would effect the permanent dentition.
perieau 1 year ago
My dentist used to try lots of distraction techniques but the Lunar eclipse is a new one on me lol - Non of them ever worked very well though because i am too nosey for my own good and wanted to know every detail of what she was doing. I'm sure i was a total pain in the backside because of it to start with. But strangely it calmed me down more by been kept in the loop and knowing what was going on so i put myself in a calm place. If that makes sense.
Peace
RumbleGuts2112 1 year ago
Soft brushes are much better than the medium ones because they will not cause abration.
fularpsarm0422 1 year ago
Soft brushes are much better than the medium ones because they will not cause abration.
fularpsarm0422 1 year ago
hi dr very nice work i want to know the name of the instrument used to move the gingiva
sho83osh 1 year ago
Hello,
I always see this surgery done for the visible front of the teeth. Can this surgery be done for the inner (non-visible) teeth?
I have recession on my outer and inner lower incisors. Last week, I was eating pretzel sticks, when I bit down, the pretzel posted in my mouth and pinched off a big chuck of my gum on my lower inner incisor. Can this surgery be done on my inner (non-visible) lower incisor?
youcantakeapunch 1 year ago
Nice work. Could you please tell give me the infos on the tissue pick-up used by your assistant.
Thanks
kajdent 1 year ago
my fixed bridge in the middle in that area are also like that , my dentist replaced my jackets 3 times im glad its getting better , ty for sharing this vid :)
SensualCoconuts07 1 year ago
Nice work!! I had bone loss and had bone replacement grafts in all quadrants. Lost my front teeth but have a very nice bridge. I also have very tight grouping in the bottom front. Is it possible to pull some teeth to straighten them? I look like a movie star on top and look like Shrek on the bottom.
vexviper 1 year ago
@vexviper You should check in with an orthrodontist.
perieau 1 year ago
oh my I'm afraid to go to the dentist, but i need to...my teeth are pain and my gum is flaming.
pedped 1 year ago
@pedped Go ahead, be brave. Dentist will not hurt you.
fularpsarm0422 1 year ago
Great surgery doc. I have a question. Freeze at 9:02. Notice the the gap between the two top front teeth, is there a treatment for something like that? My gums have receded and it looks very similar to the gentleman's in the video. Can that section be restore so there isn't a hole like that anymore? Thanks.
yousckk 1 year ago
The simple solution is some composite bonding. Grafting can regenerate some papilla but bonding is very simple and non-surgical.
perieau 1 year ago
very nice surgery Doc. What's the advantage of covering the recession besides cosmetics. Thanks
ckn711 1 year ago
Stabilization of the gumline to prevent further recession. Sometimes root sensitivity.
perieau 1 year ago
Okay...now i'm thoroughly convinced to brush my teeth more o_o
XxDarkInsanityxX 2 years ago
Don't be too aggressive as those who are tend to have MORE (o_O) recession. AND I'm not talkin' about the financial crisis in the US....
Soft Brushes RULE!
perieau 2 years ago
@perieau I use medium brushes cause the soft do not clean my teeth well enough, I feel...I do have good teeth and do not damage my gums, I am very careful as well as I keep up with my dentist apps.
briggs9187 1 year ago
@perieau soft brushes are being found to be more detrimental than good re: abrasion and efficacy of plaque removal subgingivally.
Medium brushes (with good instruction) rule!
joannet17 1 year ago
this s making my teeth hurt....
pizzaholic 2 years ago
wow great surgery your luike amazing :D
EmoPrincess12312 2 years ago
Your comments are much appreciated! It is my blessing to be able to practice my passion. Getting paid for it is a nice bonus! AND you're right about the office. My staff is incredible!
perieau 2 years ago
I know I have used Peroxide after getting my teeth cleaned and my gums are normal and the the doctor was asking me how I got my tissue back?
latinogott 2 years ago
Can a growth hormone be applied to recessed areas to rejuvenate gum tissue instead of surgery?
Dasdfjkl 2 years ago
So far there is no known way to get more tissue over a root with recession other than some sort of regenerative surgery. BUT who knows? Maybe this is something that can be done in the future!
perieau 2 years ago
wow!!! great surg!!! and great healing. is the alloderm grafting something thaz relatuvely mainstream or do most perio's still do the tear-up-da-roof-of-ur-mouth graft
kloud81 2 years ago
We have been using AlloDerm for about 15 years but not everyone uses it. Becoming more common now however.
perieau 2 years ago
Nice result.
Some periodontists used to cut off the pretty papillas when they did gum surgery.
Can Alloderm be used to build a new papilla between two upper teeth?
splashcat 2 years ago
See my channel: perieau
there is a video about rebuilding papillae
perieau 2 years ago
Have not tried emdogain and alloderm together. Don't seem to need it but I'm sure it won't hurt the healing. It would increase the cost per procedure for the office as well as the patient.
I see AlloDerm as being stable. I have been doing AlloDerm grafting for over 15 years.
perieau 2 years ago
Unbelievable work !!
Does the AlloDerm ever get rejected by the patient's system?
IncLogic 2 years ago
AlloDerm is an acellular donor product with no infection potential or rejection potential. It becomes part of the patient's tissue when it integrates.
perieau 2 years ago
thanks for the info !
IncLogic 2 years ago
With rare exceptions the gum does not grow back after recession. There are ways to correct recession and/or prevent further loss.
perieau 2 years ago
A dentist told me once that gum graft created a smallbag between the tooth and the gum. Is that true?
He said the gum do not adhere to the tooth.
Does it occur using aloderm?
jerryaltman 2 years ago
Grafting of all sorts creates an attachment to the tooth. And this type of grafting creates root coverage that is attached.
perieau 2 years ago
Thank you for your reply.
But what about if the tooth or the tooth's root have a small restoration of resin? Is that possible to the gum attach to the resin? If not, is that possible remove the resin and replace with another material that will allow the gum to attach?
jerryaltman 2 years ago
The resin is normally removed or most of it is removed. There is a hybrid resin that does get attachment sometimes.
perieau 2 years ago
Does alloderm create some new tooth tissue in the small gap where the resin was removed, or the small gap is filled with gum tissue regenerated by alloderm ???
Sorry so many questions :-)
jerryaltman 2 years ago
Seems pretty brutal. Aren't there any better ways to stimulate gum growth?
Individualism101 2 years ago
if your patient had asked for full root coverage would you have obliged? and would it have cost more?
cocolahtay 2 years ago
IF more root coverage is needed the connective tissue grafting is more predictable. In this case we have a very functional result with almost total root coverage.
perieau 2 years ago
connective tissue grafting and alloderm grafting are about the same fee for me
perieau 2 years ago
from today and on im going to makesure that i floss everyday and brush as well.
i refuse to spend that amount of money on just 3 teeth! that should be my whole damn mouth. lol
im sorry but everyone should from now on spend special care on your teeth and put these dentist people out of business. give them a reason to lower the prices.
im going to makesure that i take care of my teeth from now on.
too much money, and especially in this economy, oh no!
goldenismonica 2 years ago
Don't brush too hard and use a soft brush because those that over do it can end up needing some grafting. Us dental people will still be around to help those in need and also help prevent problems in the future.
perieau 2 years ago
this guy rocks good work man
albertobult 2 years ago
Good Job, John!
Please post the implant video on my #7 and some crown lengthening!
My patients were lucky being referred to you!
Your referring general dentist---Sam
DrWangCA 2 years ago
I normally don't video crown lengthening because I typically do that with loupes. The microscope has a camcorder attached so video is easy to capture.
perieau 2 years ago
im getting this done soon....it seems painful, good thing i'll be out of it during the procedure
alorena 2 years ago
where did u get the AlloDerm from ??
did u get it from the patient him self ??
yasootaha 2 years ago
why do you do this procedure?
Narzedie7001 2 years ago
How much does this thing cost per tooth?
monesv 3 years ago
We charge about $1500 per segment (2-3 teeth).
perieau 2 years ago
I can tell by this video you are a great at what you do. I have a relative who went through multiple allo grafts...literally all bottom front teeth and all top front. She has had problems with some and with the ones that did turn out, the results were not as good as your patients. Soon it will be my turn to get some allo grafts. So I was wondering how long is it on average before one can eat solid foods again or anything you have to say about the healing process would be helpfull.
BranVam 3 years ago
We have patients chew softer foods after treatment on the non-surgical side. If both sides: "if you can't chew it with your tongue, it's too hard". Premed with NSAIDS and for 24 hrs is a good way to prevent discomfort.
perieau 2 years ago
wow do they numb you when they do that?
i sure do hope so.
tiarabaranes 3 years ago
We infiltrate the local area with articaine. Pt is numb for about 3 hrs. We premed with naproxen sodium 550mg (Anaprox, the same as Aleve but higher dose). We keep pts on this for 24 hrs and they can add some Vicodin in between as needed. Quite often they take "maybe" one vicodin that night.
perieau 3 years ago
Sir, my dentoalveolar cases have registered increased bleeding (enough to make it troublesome) when I use Articaine, I wonder if you have come across this phenomena, some o my friends have experienced the same.
rmgj 2 years ago
I cannot say that I have noticed the same problem. Then again I have an awesome assistant. I have used Articaine for 6-7 years now.
perieau 2 years ago
OK, thanks, as complimentary information, the one we use is made by Septodont (France), it does contain epinephrine, congrats on your assistant, she sounds in the dialogue off camera as a cool, professional and wonderful person. cheers & good luck
rmgj 2 years ago
that is single handliy the sickest slash
COOLEST thing ever
that dentist is a beast!
cptjrkov 3 years ago
Check out more surgeries by the "beast" on YouTube channel: periEau. See "old guy pole vaults 12'". Now that's a beast!
perieau 3 years ago
gaahhhhhh i had the cleaning 2 but it hurts when the dentist outs in in ur gums and pokes it like woooo ouck ahaaaaaa
mileyneida1fanhannah 3 years ago
your supposed to bounce the probe on the gum and wait for a blanching NOT slide it across and break the barrier of the epithelium tissue like WTF!!!!!!!
kooshie3 3 years ago
Thanks for the expert advice. And I have no idea what you are talking about.
perieau 3 years ago
the sutures are sling sutures:
interpapillary to coronally position and hold the alloderm and then marginally to additionally coronally position the gingival margins
perieau 3 years ago
Thanks a lot , if a little late, the answer was placed in somebody else's thread, but I checked that today, again thanks, and good luck.
rmgj 2 years ago
Wow, it healed up beautifully. Can you send me your office location and info?
isisbenny404 3 years ago
Boy, you really suture the hell out of that graft! Nice result, though.
DrSandmann 3 years ago
Why are you using a curette to elevate your flap? I mean, I'm sure the procedure turned out well-enough, as oral tissues are very forgiving. But I always use a thin 15 blade. With that curette, you are just needlessly fucking around with the tissues, and worse, you are almost certainly tearing them beneath the flap. A thin 15-blade gives you a nice, clean cut from which you can elevate a clean flap.
DrSandmann 3 years ago
Gee, you are so tactful with your comments... First of all, that is not a curette it is a modified Orban knife. It was designed by Pat Allen and it works great to elevate a full thickness flap. A thin 15 blade is HUGE by comparison. Hard to mobilize a connected flap with a 15 blade but I look forward to checking out your video because that would be next wouldn't it??
perieau 3 years ago
the last part of the comment wasn't necesary, what this guy needs is manners, and those he should have gotten along with his mother's milk, as they say in Spain, this was a beautiful job, I must confess the intricate suturing left me scratching my head, but then again I am only an OMF surgeon, if you were so kind to explain the hows and the whys, what pulls what, again congrats, nice job.
rmgj 3 years ago
you're right, his videos are very helpful.
rubikbg 2 years ago
Why use foul language?, far from making emphasis on your sayings, it reveals something about you.
rmgj 2 years ago
Does anybody can tell me what is AlloDerm? Is this artificial?
samuelperu99 3 years ago
google it
It is freeze dried human dermis.
perieau 2 years ago
I just wish I could afford this - my teeth will only get worse with time, unfortunately.
zookr 3 years ago
sick. now i know what it looked like when i had my surgery
g4t0r5 4 years ago