Around 4-6 weeks after your first scaling and root
planing, your re-evaluation exam will determine the outcome
of initial treatment.
If there are still pathological (deep)
pockets that need further treatment, local surgery can
remove any remaining infection and decrease pocket depths to
reduce your risk for disease in the future.
Flap surgery • Pocket Depth Reduction
This is advised when a gum pocket is too deep to clean
with daily oral hygiene and professional care routine. The
gum tissue is folded back and allows for visible and
instrumental access to the root for removal of calculus,
plaque, diseased tissue and smoothing of irregular damaged
bone. The gum is then secured back into place.
pockets increase your chances of keeping you natural teeth
and avoiding disease progression.
Bone regeneration • Bone grafting • Guided tissue
Examples of tooth and jaw bone defects are: defects from
periodontal disease, abscesses, tooth extraction, trauma,
cysts and bone loss around implants.
Bone loss and defects due to e.g. periodontal
disease, root tip cysts and around implants can
be treated with bone graft and membranes.
There are bone grafts (from your own mouth, from
deceased human organ donors, from bovine or synthetic
polymers or calcium), membranes (porcine or
synthetic) and growth factors, chemically similar to
your body, which stimulate your bone to grow back. Over time
your own newly formed bone will replace much of the graft
material. This procedure will give your teeth better
Bone graft is similar to your human bone and is
accepted by our defense mechanism and not rejected. It
acts as a framework so your bone forming cells, blood
vessels migrate into it and form your own new bone and the
defect is repaired. Bone graft is safe. The bone is highly
controlled in processing and sterilization which removes all
impurities. It is highly purified with no allergic reactions
or infections observed. The new bone begins to form within
the first few weeks after grafting but will take 3-12 months
(depending on size) to achieve the quantity and density of
bone needed for further dental or surgical procedures to be
Membranes can be used over tooth surfaces to guide bone to
heal along the tooth. Membranes can also be used over bone
grafts to hold them in place, protect in case of gum tissue
opening during healing and prevent the growth of gum tissue
into the surgical area. Membranes are either made of
non-resorbable GoreTex material or made of a thin resorbable
(melts away) natural fiber material (porcine collagen or
synthetic). Porcine derived collagen is also used for many
artificial heart valves. This product is not indicated for
patients with a known history of allergic response to
collagen or porcine derived products. Depending on the
chosen resorbable membrane, it resorbs in 1-4 months and
does not need to be removed by your dentist.
Growth factors (text will be added soon)
levels before and after bone regeneration.
dark areas show that bone loss due to periodontal
disease is very clear prior to surgery.
graft and membrane assists in the regeneration of
Bone Grafting Procedure
The first step is to remove the periodontal disease and
stop the bone loss during the initial deep cleaning phase
During surgery Dr. Hoffmeyer gives you
a local anesthetic, gently opens the area, filling in the
missing section with bone grafting material.
1-2 years all follow-up of periodontal care with cleanings
(not dental exams) will be with Dr. Hoffmeyer who observes
the healing results.
It is very important that the grafted
areas are not probed with any instruments as this may
destroy the healing process and result.
Area of bone loss (dark gray /
black areas) between roots and teeth was treated
with bone graft and membrane to regenerate new bone
(light gray areas).