Periodontists receive three years of additional experience beyond dental school where they obtain extensive training in implant treatment, periodontal reconstruction, as well as preventing, diagnosing and treating all forms of periodontal (gum) diseases. Post Falls Periodontics and Implant Dentistry offers the highest expertise in implant and periodontal therapy throughout the Coeur d’Alene area. Let Post Falls Periodontics show you how implant treatment and periodontal health can dramatically improve your well-being.

DENTAL IMPLANT THERAPY

As a highly trained specialist in treating gum tissue and the underlying bone in the mouth, Dr. Joseph McCombs at Post Falls Periodontics is uniquely qualified to place and maintain dental implants. Periodontists receive three additional years of training after regular dental school to master the surgical skills needed to provide predictable and successful dental implant treatment.

A dental implant is an artificial tooth root placed into the jaw to hold a replacement tooth. Dental implants look and feel like natural teeth, and with proper care, they can be a long-term solution to tooth replacement.

ADVANTAGES OF DENTAL IMPLANTS 
Appearance: The replacement teeth that dental implants are built to hold will appear identical to your surrounding teeth. No one will know you have a replacement tooth.

Reliability: The success rates of dental implants are highly predictable. When placed by an experienced surgeon and with diligent at-home maintenance, a dental implant can last for many years.  

Confidence: Because they are secured into the jaw, dental implants function like natural teeth, allowing you to confidently smile, speak, and eat.  

Comfort: Dental implants fuse into your jawbone, becoming permanent. Unlike dentures, they will stay comfortably in place and do not require messy adhesives.

Improved Oral Health: Because the adjacent teeth are not affected by dental implants, your long-term oral health is not compromised.  

DENTAL IMPLANT TREATMENT
While collaborating with your general dentist, your team at Post Falls Periodontics will develop a treatment plan unique to your specific needs. A dental implant, a small titanium post, is first placed into the jawbone where the missing tooth is. The bone in your jaw, over time, will grow around the dental implant through a process called osseointegration. Once your jawbone has fused with the dental implant, an abutment, which attaches to the replacement tooth, will be attached. The replacement tooth can be affixed by your general dentist. The entire dental implant process—including extraction, integration of the implant, and periods of healing—can take up to several months depending on what treatment plan is best for you. 

FULL MOUTH IMPLANT REHABILITATION
When gum disease or tooth decay becomes extensive, the remaining teeth may need to be removed. When this occurs, dental implants provide a valuable treatment option which will facilitate retention of a fixed or removable prosthesis. Following removal of the teeth and possible re-contouring of the jaw bone, immediate implants are placed strategically in the remaining bone. Depending on the bone density and the stability of the implants, a natural looking temporary appliance may then be attached to the implants at the time of placement. Following bone healing of approximately 4-6 months around the implants, the final appliance will be secured by your general dentist. Dr. McCombs at Post Falls Periodontics received three years of additional training and has attended many continuing education courses focused on complex implant rehabilitation.

DENTAL IMPLANT CARE 
Because dental implants look and function like natural teeth, they require the same care. The American Academy of Periodontology (AAP) recommends brushing twice a day, flossing at least once a day, and receiving regular dentist check-ups and an annual comprehensive periodontal evaluation. 

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BONE GRAFTING/RIDGE AUGMENTATION

Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. This defect may have been caused by periodontal disease, wearing dentures, developmental defects, injury or trauma. Not only does this bone deformity cause problems in placing the implant, it can also cause an unattractive indentation in the jaw line near the missing teeth that may be difficult to clean and maintain.

To correct the problem, Post Falls Periodontics will lift the gum away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. We can tell you about your options for graft materials, which can help to regenerate lost bone and tissue.

Finally, the incision is closed and healing is allowed to take place. Depending on your individual needs, the bone usually will be allowed to develop for about four to 12 months before implants can be placed. In some cases, the implant can be placed at the same time the ridge is modified.

Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come. Ridge modification can enhance your restorative success both aesthetically and functionally.

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SINUS LIFTS

A key to implant success is the quantity and quality of the bone where the dental implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus. If you've lost bone in that area due to reasons such as periodontal disease or tooth loss, you may be left without enough bone to place dental implants.

Sinus lift surgery can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants. Dr. McCombs at Post Falls Periodontics offers several techniques that can be used to raise the sinus and allow for new bone to form. In one common technique, an incision is made to expose the bone. Then a small circle is cut into the bone. This bony piece is lifted into the sinus cavity, much like a trap door, and the space underneath is filled with bone graft material. Dr. McCombs can explain your options for bone graft materials, which can regenerate lost bone and tissue in order to prepare you for dental implants.

For the last step, the incision is closed and healing is allowed to take place. Depending on your individual needs, the bone usually will be allowed to develop for about four to 12 months before dental implants can be placed. After the dental implants are placed, an additional healing period is required. In some cases, the dental implant can be placed at the same time the sinus is augmented.

Undergoing sinus lift surgery has been shown to greatly increase your chances for successful implants that can last for years to come. Most Post Falls Periodontics patients experience minimal discomfort during this procedure.

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PERIODONTAL PLASTIC SURGERY/GUM GRAFTS

Just as cosmetic surgery can help people improve their looks, several periodontal plastic surgery procedures are available to help enhance the aesthetics of your smile. The following are some common treatments.

GUM GRAFTS TO ADDRESS SOFT TISSUE RECESSION

ROOT COVERAGE
Root coverage procedures are often used to treat gums that have receded to the point that the roots of a tooth are exposed. During a root coverage procedure, Dr. Joseph McCombs will take gum tissue from the roof of your mouth (known as the palate) to cover roots, develop gum tissue where needed, or make dental implants look more natural. In some instances, other graft materials may be utilized avoiding the need for a second surgical site in the palate. Root coverage periodontal procedures improve the appearance of your teeth, reduces sensitivity, and reduces the risk of root decay. This procedure may also be utilized to prepare your teeth for orthodontic treatment or as part of implant therapy.  

CROWN LENGTHENING 
Many young adults express an interest in ways to improve a "gummy" smile since the upper teeth appear short. Your teeth may actually be the proper lengths, but they're covered with too much gum tissue. To correct this, Post Falls Periodontics is able to perform a dental crown lengthening procedure.

During the dental crown lengthening procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.

A gummy smile may also be due to excessive lip movement which occurs while smiling. To address this, the lip can be repositioned to reduce the distance it moves when talking and smiling.

Your general family dentist may refer you to Post Falls Periodontics for dental crown lengthening to make a restorative or cosmetic dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a tooth restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.

RIDGE AUGMENTATION
Ridge augmentation periodontics procedures are often performed to correct irregularities in the gums and jaw after a tooth extraction. Post Falls Perio may also perform a ridge augmentation to prevent the jawbone from collapsing after a tooth extraction. A ridge augmentation may be needed to allow the placement of a properly sized dental implant.

POCKET-DEPTH REDUCTION
Bone and gum tissue should fit snugly around the teeth. In cases of advanced periodontal disease, deep pockets can form in the spaces between the gum and tooth, providing a space for additional bacteria to grow and possibly cause further damage to gum tissue and bone. During a pocket depth reduction, Dr. McCombs will clear the pocket of any bacteria and infection and retighten the gum tissue around the tooth.

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DIAGNOSIS AND TREATMENT OF PERIODONTAL DISEASE

Periodontal disease (also known as gum disease) occurs when plaque bacteria below the gum line irritate the gums and trigger an inflammatory response characterized by reddened tissue, swelling, and bleeding. In severe cases of periodontal disease, bacteria erode gum and supporting bone tissue, causing gum recession, spaces between the teeth and gums, loosening and shifting teeth, and eventually tooth loss.

TYPES OF PERIODONTAL DISEASE

Gingivitis: The mildest form of periodontal disease, gingivitis causes redness, swelling, and bleeding of the gums. It usually can be reversed by daily brushing, flossing, and regular cleanings by a general family dentist. If left untreated, gingivitis can advance into periodontitis, which is more severe.  

Periodontitis: As plaque accumulates below the gum line, gums can separate from teeth, creating gaps (known as pockets) that may become infected. These pockets can deepen, often resulting in destroyed gum tissue and bone as well as loosening teeth that may have to be removed.  

Types of periodontitis include the following: 

• Chronic periodontitis, which often progresses slowly, is the most common form and is most prevalent in adults.
• Aggressive periodontitis, which is characterized by rapid detachment of gums to teeth and rapid bone loss. This form is likely to appear in smokers and in those with a family history of periodontitis.
• Necrotizing periodontal disease, in which necrosis (the death of tissue) affects gums, bone tissue, and the fiber connecting teeth to the bone. This extremely rare form of periodontitis is prevalent in those who suffer from human immunodeficiency virus (HIV), immunosuppression, or malnutrition. In some cases, periodontitis is associated with systemic disease affecting other parts of the body. Conditions like diabetes are associated with this form of periodontal disease  

PREVENTION
The first step in preventing periodontal disease is to brush at least twice a day and floss once a day. The AAP also recommends that all adults receive a comprehensive periodontal evaluation annually which can be performed by your general family dentist or by Dr. McCombs at Post Falls Periodontics.  

RISK FACTORS

• Poor Oral Health Habits: Without twice-daily brushing and regular flossing, there is an increased likelihood of plaque buildup.
• Age: Adults age 65 and over have higher incidences of periodontal disease, according to data from the Centers for Disease Control and Prevention.
• Medications: Certain drugs can reduce the flow of saliva. Without adequate saliva production, the mouth can become a breeding ground for bacteria.
• Tobacco Use: Users of cigarettes and chewing tobacco are at an increased risk of periodontal disease. Tobacco use is said to be one of the most significant risk factors in the development and progression of periodontal disease.
• Genetic Predisposition: Research has found some individuals may be genetically susceptible to periodontal disease.  

TREATMENT
If periodontal disease is suspected, the next best step is to seek the counsel of a periodontist, a dental specialist uniquely trained in the treatment of periodontal disease. Depending on the severity of disease, Post Falls Periodontics may recommend a number of treatments ranging from deep cleaning, medication, or surgery. There are also a number of procedures to restore aesthetics and function in the event of tooth loss. Treatment may also include a care routine and the avoidance of certain habits like smoking.

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DEEP CLEANING/SCALING AND ROOT PLANING

A deep cleaning, also known as scaling and root planing, is a non-invasive measure of preventing the progression of periodontal disease. A deep cleaning goes beneath the gum line to remove plaque, bacteria, calculus (tartar) and other toxins from areas that brushing and flossing cannot reach, reducing the risk of disease advancement. A routine cleaning does not require your general family dentist or dental hygienist to go below the gum line; therefore, the procedure does not eliminate the cause of disease if it is present.

After scaling and root planing, many patients do not require any further active treatment. However, the majority of patients will require ongoing maintenance therapy to sustain healthy roots.

MEDICATION
Oral antibiotics as well as anti-microbial mouth rinses can be prescribed short-term to control bacteria and treat acute periodontal infection. Other medicinal treatments include antibiotic gels, slow-release antiseptic chips, microspheres, and enzyme suppressants used after scaling and root planing procedures. 

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POCKET REDUCTION SURGERY

Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth.

Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted. 

As part of your therapy we will measure the depth of your pocket(s). A periodontal pocket reduction procedure is recommended when you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine.

During this procedure, Post Falls Periodontics will fold back the gum tissue and remove the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.

Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your general family dentist to clean, so it's important for you to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth – and decrease the chance of serious health problems associated with periodontal disease.  

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PERIODONTAL REGENERATIVE SURGERY

Procedures that regenerate lost bone and tissue supporting your teeth can reverse some of the damage caused by periodontal disease.

We may recommend a regenerative procedure when the bone supporting your teeth has been destroyed due to periodontal disease. These procedures can reverse some of the damage by regenerating lost bone and tissue.

During this procedure, we fold back the gum tissue and remove the disease-causing bacteria. Membranes (filters), bone grafts or tissue-stimulating proteins can be used to encourage your body's natural ability to regenerate bone and tissue.

Eliminating existing bacteria and regenerating bone and tissue helps to reduce pocket depth and repair damage caused by the progression of periodontal disease. With a combination of daily oral hygiene and professional maintenance care, you'll increase the chances of keeping your natural teeth – and decrease the chances of other health problems associated with periodontal disease  

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SURGICALLY FACILITATED ORTHODONTIC THERAPY

Patients in active orthodontic treatment may benefit from this surgical procedure. This involves gently reflecting the gum tissue away from the bone, re-shaping the bone and adding a bone substitute. This thickened bone supports additional tooth movement which may not have been possible otherwise. It also reduces the risk of post treatment soft tissue recession during orthodontic treatment. Additionally, recontouring the bone may reduce orthodontic treatment time by up to 50%.

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EXPOSURE OF IMPACTED TEETH

During development, permanent teeth normally grow into the mouth as the baby teeth are lost. Sometimes the path of movement is blocked and the tooth remains submerged in the jaw bone. To address this, the gums are folded back away from the submerged tooth. A small amount of bone is then removed from the tooth and an orthodontic bracket is attached and forces are applied to the tooth. Over time the tooth is moved into the correct position as the orthodontic therapy progresses.

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MANAGEMENT OF DENTAL IMPLANT COMPLICATIONS

PERI-IMPLANT DISEASES
Peri-implant diseases are inflammatory conditions affecting the soft and hard gum tissues around dental implants. Similar to a natural tooth, bacteria can build up on the base of the implant, below the gum line. Over time, the bacteria irritate the gum tissue, causing it to become inflamed, damaging the tissue and if not caught early, causing the bone structure below the implant to deteriorate. 

Peri-implant diseases are classified into two categories. 

In peri-implant mucositis, gum inflammation is found only around the soft tissues of the dental implant, with no signs of bone loss. Generally, peri-implant mucositis is a precursor to peri-implantitis. Evidence suggests that peri-implant mucositis may be successfully treated and is reversible if caught early. 

In peri-implantitis, gum inflammation is found around the soft tissue and there is deterioration in the bone supporting the dental implant. Peri-implantitis usually requires surgical treatment.  

Signs of peri-implant diseases are similar to symptoms of gum disease: red or tender gums around the implants, or bleeding when brushing. And just like your natural teeth, implants require regular tooth brushing and flossing and regular check-ups from your general family dentist. Risks factors for developing peri-implant disease include previous periodontal disease diagnosis, poor plaque control, smoking, and diabetes. It is essential to routinely monitor dental implants as part of a comprehensive periodontal evaluation.  

Treating peri-implantitis involves carefully folding back the gum tissue to expose the underlying contaminated implant. Bacteria and toxins are then meticulously removed from the implant surface using a mechanical and chemical means. If bone grafting is indicated, growth factors and graft material will be placed around the implant and secured with a rigid or semi-rigid membrane. If the bone cannot be re-grown, the implant surface itself may need to be modified to make it smoother and easier to clean. In some instances of severe bone loss, pain, infection or implant movement, the implant may require removal and complex bone augmentation. 

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ORAL BIOPSY SERVICES AND MANAGEMENT OF ORAL DISEASES

Numerous conditions are first evident inside your mouth including some autoimmune disorders, viral/fungal/bacterial infections and even cancer. Oral cancer is responsible for over 9,000 deaths every year. When you visit our Post Falls Perio office, a meticulous head and neck examination will be completed to detect any abnormal areas which could suggest oral cancer. If an area of concern is detected, a biopsy may be necessary. This involves removing a small specimen of tissue from your mouth and submitting it to a pathology center for evaluation and diagnosis. Conditions such as erosive lichen planus may require long-term medical management and periodic re-evaluation.

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602 North Calgary Ct. Suite 102
Post Falls, ID 83854

208.777.1796

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