278 Lafayette Road, Bldg. E, Portsmouth, NH 03801 (603) 351-9125
278 Lafayette Road, Bldg. E
Portsmouth, NH 03801
(603) 351-9125

Periodontal Procedures

Gum Grafting

Gum (Gingival) grafting is done to correct recession. The procedure creates a seal of the gum to the tooth, minimizing the potential for further recession, infection and caries at the tooth root. It can also protect gum tissue from being irritated by fillings or crowns that are at the base of the teeth. Oftentimes people desire this surgery to correct their gumline, resulting in a more esthetically pleasing smile. The surgery takes about an hour and is most frequently done with local anesthesia.

Wilkodontics (AOO)

With the Accelerated Osteogenic Orthodontics (AOO) procedure most orthodontic cases in both adolescents and adults can be completed 2 to 3 times faster than would be possible with conventional orthodontics. This is accomplished by combining efficient orthodontic mechanics by an orthodontist and specialized periodontal surgery in our office. The end result is a beautiful smile in a much shorter amount of time than traditional braces. For more information please call our office at (603) 351-9125.

Guided Bone Regeneration

Guided bone regeneration is a dental procedure that is used for increasing bone mass in cases where vertical and/or horizontal defects in the jawbone exist. It is a reliable method for re-establishing hard tissue volume in areas of bone loss, which has taken place in the upper or lower jaw as the result of periodontal disease, trauma, cyst or tumor surgery, or subsequent to a dental extraction.

During a guided bone regeneration procedure a special membrane is positioned to cover a newly placed bone graft in the area of a bony defect. This membrane facilitates new growth of bone, while preventing any growth of unwanted soft tissue into the area.

Guided bone regeneration can enable the placement of dental implants in cases in which implants would otherwise not be possible.

Ridge Preservation

To preserve dental health as well as overall well being, it is sometimes necessary to have a tooth extracted. In many cases a tooth extraction is the result of dental disease or injury. However, without teeth in place the soft tissue and the supporting bone in the area may degenerate or shrink. This can complicate future efforts to fabricate a replacement tooth like a dental bridge or dental implant.

Ridge preservation is a procedure designed to retain the soft tissue and bone structure at the site of an extracted tooth. After a tooth is removed bone-grafting material is placed in the socket to promote healing and encourage new bone development. Maintaining adequate bone and supporting the soft tissues following a tooth extraction by means of a ridge preservation procedure, facilitates the successful placement of a dental implant.

Mini Implants

One of the dental solutions for the treatment of multiple lost or missing is a removable denture. While a removable denture is an effective prosthetic appliance for restoring one’s smile, there can be issues with its stability that affects both comfort and function. However, one way to address this problem is with the placement of mini dental implants.

Mini dental implants are narrower in diameter than traditional dental implants. This makes them an excellent option for providing added denture stability in cases where a grafting procedure to create enough bone would otherwise be needed for the placement of full size implants. Furthermore, mini implants can be placed in a less invasive manner, making them an easier procedure to tolerate for people with certain medical conditions.

An implant-supported denture is fitted with special housings that allow the denture to essentially snap on to the head of the mini implant thereby providing the needed denture stabilization.


The success of a dental implant procedure relies on the establishment of a structural and functional connection between the dental implant and the surrounding jawbone. Osstell technology and systems provide a non-invasive method for assessing the degree of osseointegration and measuring the stability of the dental implant. By providing objective and reliable data on the degree of osseointegration the healing process can be evaluated, thereby making treatment outcomes more predictable.


An advanced information gathering, treatment planning, and computer guided support platform that addresses the initial phases of the implant process all the way through the actual placement of the implants. The Simplant 3D system provides essential analysis and assistance to all facets of the dental implant process from acquiring the diagnostic records to the final restoration procedure. Simplant allows for the most efficient and effective dental implant treatment planning taking into account all of the cosmetic and functional requirements of the patient’s case.

Canine Exposure for Orthodontics

An impacted tooth is one that fails to erupt and remains covered to varying degrees by the soft tissue and bone. After the wisdom teeth, the most frequently impacted teeth are the maxillary canines. Since the canines play such an important role in the dental arch in terms of optimal function and facial support, it is important whenever possible to bring these teeth into alignment. In situations involving an impacted canine, an orthodontist will develop a treatment plan. This is typically followed by the placement of orthodontic appliances and the development of space as needed for the impacted tooth. At the appropriate juncture in treatment, the patient is referred for a surgical procedure to remove the necessary amount of bone and soft tissue covering the canine. During this surgical procedure an orthodontic attachment to facilitate moving the tooth into alignment will be placed on the tooth. Once sufficient healing has taken place, the orthodontist can proceed to gradually move the canine into its proper position.


A frenum (also known as a frenulum) in the oral cavity is a fold of tissue connecting moveable soft tissue such as the lips, cheeks or tongue to the fixed tissues next to the teeth and floor of the mouth. This fold of tissue can contain some muscle fibers as well.

The major frena in the mouth can be seen in three locations. The first is the maxillary labial frenum located on the underside of the middle of the upper lip connecting it to the gum tissue above and between the front two teeth on top. Another frenum is the mandibular labial frenum on underside of the lower lip connecting it to the gum tissue below and between the front two teeth on bottom. The third is the lingual frenum is on the underside of the tongue connecting it to the floor of the mouth.

In most cases these frena do not adversely limit tongue function or affect the teeth or their surrounding hard and soft tissues. However, there are situations where they do and a surgical procedure is required. A maxillary labial frenectomy is the most common one performed, and is considered when a large and ropey frenum is attached too close to the crowns of the teeth or extends too far towards the roof of the mouth. This causes space between the two front teeth, keeps the teeth apart, and can even affect the gums and bone between the front two teeth. A lingual frenectomy is considered when the lingual frenum attaches too far forward on the tongue and is impairing function including, speech, swallowing or eating.

When an abnormal frenal attachment is present certain surgical procedures like a frenectomy to remove a portion of the frenum can be performed. This prevents further tissue damage, allows for appropriate tooth movement and stability, and restores normal function.

Occlusal Adjustment

Every time that you close your mouth or bite down or bring your teeth together there should be a healthy distribution of forces. Furthermore, the top teeth should appropriately contact the bottom teeth during jaw movement in a functionally harmonious way. Having premature or uneven contact between the upper and lower teeth can lead you to experience unhealthy jaw deviations when biting as well as other symptoms of soreness or discomfort. An occlusal adjustment is a procedure to correct uneven contacts or bite interferences to restore the healthy distribution of forces to your teeth as they function. It involves the selective minor filing and reshaping of the occlusal or incisal surfaces (biting surfaces) of the teeth. An occlusal adjustment is a precise procedure that in most cases creates no discomfort. The adjustment may be performed on a single tooth, or on multiple teeth as needed.

Today, with advanced dental technology even the slightest bite discrepancies can be detected, allowing you to receive the most precise occlusal adjustments.

Periodontal Splinting

Periodontal splinting is a procedure whereby teeth that are mobile are connected to each other to improve their stability and comfort during jaw closure, biting, and chewing. By splinting teeth that have weakened support, the prognosis for maintaining these teeth in the mouth is better. The added stability provided by periodontal splinting also promotes optimal results with tissue regeneration procedures.

Cases that may require periodontal splinting include, teeth whose support has been compromised by periodontal disease or trauma. When multiple teeth are splinted together the biting force can be sustained by the entire joined unit, rather than the individual teeth. Periodontal splints can be fabricated in a number of ways including placing composite resin to secure a section of a reinforced ribbon applied to the involved teeth.

Osseous Grafting

In cases of periodontal disease, an osseous grafting procedure may be necessary to address the bony defects caused around a tooth by the progression of periodontal disease. An osseous grafting procedure, which involves guided tissue regeneration, rebuilds the bone and supporting tissues that have been lost. During the surgical procedure the roots of the involved teeth are thoroughly cleaned and the bony defects prepared and filled with a suitable bone graft material. The bone graft is then covered by special membrane and then the gums are then sutured back into place. With healing and time the osseous graft will fill in for the lost bone, thereby providing renewed support for the tooth.

Orthognathic Surgery

If a child’s facial growth and development does not proceed in a normal and harmonious manner then jaws may not achieve the proper relationship or alignment. This can present an individual with varying degrees of functional and cosmetic problems. When the jaws are not in the anatomically correct positions it can have a negative effect on the occlusion (the bite), facial symmetry and balance, as well as the temporomandibular joint. Problematic jaw relationships can even make eating, speaking, and normal breathing more difficult.

Orthodontic treatment alone is often insufficient to address all of the issues caused by these improper or disproportionate jaw relationships. Orthognathic surgery, more commonly known as corrective jaw surgery, is sometimes necessary to help address these skeletal and dental irregularities.

Orthognathic surgery involve a team approach with an orthodontist preparing and finalizing the alignment of the teeth along with an oral and maxillofacial surgeon to treatment plan and perform the corrective jaw procedures. If needed, other specialists may be involved in treating the patient to address any additional dental or medical issues necessary to achieve the best functional and cosmetic result.

Oral Pathology

The oral and maxillofacial region consists of hard and soft tissues that have many different and important functions. Oral pathology refers to the wide range of diseases and conditions manifesting themselves and affecting this area of the body. The signs and symptoms of these problems might be localized and have minor implications for an individual’s overall health, or may be a sign of larger systemic (throughout the body) medical conditions. However, suspicious lesions in the mouth and maxillofacial region can also be cancerous and can lead to far more serious consequences if not detected and treated promptly.

If tissue abnormalities or lesions are present in the oral and maxillofacial area it must be determined if they are the result of congenital or genetic conditions, infection, trauma, environmental causes, have developed for another medical reason or are idiopathic (without a known cause). A patient’s medical history, including lifestyle and habits in conjunction with a description of any signs and symptoms that a patient is experiencing can provide helpful information towards a diagnosis. Following a clinical exam, a biopsy as well as further diagnostic testing, is performed as needed to identify the source of the pathology.

If an individual on their own notices any suspicious growths, ulcerations, or unusual bumps anywhere in their mouth or in the head and neck region, it is important that they have them promptly evaluated.


Sedation dentistry offers individuals with general anxiety about going to the dentist or fears about a specific dental procedure the opportunity to have a stress free and more comfortable experience. Utilizing safe and controlled sedation techniques prior to the dental procedure the patient is eased into a state of complete relaxation.

Anxiolysis is considered the lightest level of sedation, reducing the stress and anxiety that may be associated with a dental visit or a particular procedure, while an individual maintains their ability to respond appropriately to verbal commands. The usual anxiolysis protocol consists of an oral medication given pre-operatively.

Ridge Augmentation

The bone that surrounds the roots of the teeth is referred to as the alveolar ridge. A ridge augmentation is a surgical procedure performed to restore the normal height and width of the alveolar ridge that may have been diminished as a consequence of having a tooth removed or for other reasons like denture wear or trauma. The main considerations when a reduced and narrowed alveolar ridge is present are how this lost tissue will effect the placement of a dental implant or other dental prosthesis.

A ridge augmentation procedure is performed by placing bone graft material into the tooth socket or immediately after a tooth has been removed or where there are deficient areas in order to rebuild the shape of the gums and jaw. While in certain situations dental implants can be placed at the time of a ridge augmentation procedure, they are more often placed after sufficient healing has occurred during which time the bone graft has successfully fused with the existing bone and new bone has formed. Bone graft materials can be collected from another area of the body, harvested from other natural sources, or can be made of synthetic materials. The choice depends upon the specific needs of the case.

Office Hours

8:00 AM - 5:00 PM
8:00 AM - 5:00 PM
8:00 AM - 5:00 PM
8:00 AM - 5:00 PM
By Appointment

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Dr. James D. Spivey, DDS, MS, PERIODONTIST
Dr. Juanita Fonseca, DDS, MS, ORTHODONTIST