Category Archives: Periodontic


Dr. Al Manesh Periodontist & Implantologist

With over 20 years of experience, Dr. Manesh brings a wealth of knowledge and expertise to his patients. He has placed over 7,000 implants and is one of the only implant specialist in the Houston area using all-ceramic zirconia implants. In addition, he takes regenerative periodontal care and periodontal cosmetic surgery to a whole new level through the use of progressive treatment options, including plasma rich in growth factors (RGF), bone grafts (synthetic, animal, or patient’s own bone), and tissue grafts to regenerate and reconstruct jawbone and gum tissue in the oral cavity. Dr. Manesh also performs bite analysis, full mouth rehabilitation, and All-on-4 implant-supported fixed dentures.

Dr. Manesh takes each patient’s health concerns seriously and customizes a treatment plan just for you. He is always willing to answer any questions you have so that you are completely comfortable with the entire process. Dr. Manesh earned his Bachelor of Science degree from California Polytechnic University, Pomona. He continued his dental studies at Oregon Health Sciences University where he earned his doctorate in dentistry. He decided to become a periodontist and went on to obtain his postgraduate degree in Periodontics at Louisiana State University. He is also a published author, noted lecturer, and Fellow of the International Congress of Oral Implantologists (FICOI). He is actively involved in the professional dental community and is a member of the American Dental Association, the American Academy of Implant Dentistry, the American Academy of Periodontology, and the Academy of Osseointegration. Dr. Manesh has also spent the past 10 years training other dentists in implantology and periodontal surgeries. He currently teaches professional training courses on the placement of ceramic zirconia dental implants and implant-related procedures for the Ceramic Implant Institute :

When he is not busy working with patients, teaching, or learning about the latest dental technology, Dr. Manesh enjoys spending time with his wife and three children. His hobbies include water sports, reading, and traveling. Dr. Manesh speaks English and Farsi.



Gum Plastic Surgery

Gum recession is one of the most widespread forms of gum disease and is common among many adults. The shape, thickness and general health of your gums is often hereditary, but gum recession may also result from the use of certain drugs, poor oral hygiene, bad dental habits, or from certain diseases.

Gum recession involves the loss or recession of gum tissue, which starts to fall away from teeth and make them appear much longer than normal. More than just causing an abnormal appearance in your smile, gum recession also exposes the tooth root, which can cause sensitivity and negatively impact the proper function and health of your teeth and gums.

In the beginning, someone who suffers from gum recession may notice a slight sensitivity in their teeth. If the condition gets worse, however, teeth can become unstable and tooth loss can occur, so it is important to identify and correct gum recession before it is too late.

There are a number of ways to correct gum recession, including gum plastic surgery procedures like gingival grafts. A gingival graft is a procedure that uses live soft tissue to cover the exposed root surfaces and prevent the tooth root from further exposure. Not only does this enhance one’s appearance, but it also eliminates sensitivity and prevents further gum recession down the road.

Gum tissue grafts can be sourced from a number of areas in the mouth, including the palate on the roof of one’s mouth or from soft tissue areas around the teeth. Your dentist will determine the best area to source your gum graft based on your unique situation. The tissue graft is stitched into place and left to absorb into and stimulate the existing soft tissue.

Often gum plastic surgery procedures are done for aesthetic reasons; however, they can be beneficial for the health of your teeth as well. From covering unsightly fillings or a yellowed tooth root beneath the gum line to reducing exposure to sensitive areas of one’s teeth, gum plastic surgery is useful for a number of reasons. Most importantly, however, a gingival graft can prevent the loss of teeth in the future.

Many people suffer from gum recession and they don’t even know it. It is important to spot gum recession as early as possible to prevent further damage to your teeth and gums. If you are in need of a dental checkup, suffer from sensitive teeth or gums, or suspect that your gums might be receding, contact our office to schedule your next appointment with us to see what can be done to correct

Gum Grafting

If you suffer from receding gums, not only does your appearance change, but your dental health can be impacted as well. When gums recede, more tooth root becomes exposed, which can cause heightened sensitivity and damage to your teeth. Gum grafting is a simple dental procedure that can effectively rebuild your gum line and protect your teeth from further damage.

Gum recession is a condition in which your soft tissue gradually separates from surrounding teeth. This leaves more of the tooth root exposed, which results in the appearance of longer teeth. Long teeth might not be a problem; however, this may damage the supporting bone beneath, causing your teeth to become less secure and perhaps fall out.

It is important not to ignore gum recession until it is too late. Regular dental checkups are necessary to determine whether or not your gum recession poses a problem to your overall dental health. Gum recession is a gradual process and one that is often difficult for patients to spot themselves. If left untreated, however, gum recession can lead to sensitivity and tooth loss. In order to prevent such damage, gum tissue grafts may be needed.

There are basically three different kinds of gum tissue grafts available: pedicle grafts, free gingival grafts and connective tissue grafts.

Connective tissue grafts are the most common type of gum graft. For this graft procedure, connective tissue is sourced from beneath the palate at the roof of the mouth. This procedure involves cutting a flap of tissue at the roof of one’s mouth and removing the connective tissue from under the flap to be used for the gum graft. This tissue is stitched over the area of the gum line in need of tissue growth.

Pedicle grafts use tissue from around the tooth that needs to be repaired. For this procedure, your dentist will partially cut your gum and pull excess gum tissue over the tooth root that has been exposed. The flap is then sewn into place and left to heal over time. This type of gum graft can only be performed on individuals with ample gum tissue near the affected area.

Free gingival grafts are similar to the connective tissue grafts in that they also use tissue from the roof of one’s mouth; however the tissue sourced for this type of graft is located on the top layer of flesh instead of underneath.

If you suffer from receding gums, a gum graft procedure may be needed to protect your teeth from further damage. Contact our office to schedule a dental exam with us today to see if gum grafting may be needed to correct your gum recession.

Dental Bone Regeneration

Bone loss is a common problem among older adults, particularly those who have missing or decaying teeth. Guided Bone Regeneration is a surgical dental procedure that directs the growth of new bone tissue in areas of the jaw that are lacking in bone density or thickness.

Dental bone regeneration procedures are mainly focused on developing the hard tissues along one’s jaw so a dental appliance, such as dental implants, can be successfully attached. Other procedures, such as bone grafting, may also be used in conjunction with Guided Bone Regeneration to promote hard tissue growth along the jaw.

When is bone regeneration needed?

Dental bone regeneration is often used in preparation for periodontal procedures, such as dental implants. Often, a patient needs dental implants but does not have adequate bone tissue to support them. Bone regeneration helps build up bone around the implants after a tooth extraction to provide a solid foundation upon which to place dental implants securely. The procedure may also be used to fill bone defects after a tooth is removed or to preserve sockets in preparation for the future implantation of false teeth or other dental prosthetics.

How does the process work?

Before a Guided Bone Regeneration procedure takes place, your dentist will determine if you are a qualified candidate who can withstand hard tissue growth in the jaw. If you are found to be a good candidate for the procedure, a surgical appointment will be scheduled.

During your procedure, your gum pockets will be cleaned and a biocompatible membrane will be inserted between the pockets and gum tissue to guide the bone tissue growth within the gum pockets. A graft material – sourced from a human or animal donor or produced synthetically in a lab – will be placed into areas of the jaw in need of augmentation. This graft material will become absorbed into the natural tissues and stimulate growth over time.

Depending on the size of your graft, recovery may take anywhere from two to three weeks; however the graft material will undergo a process called osseointegration over the next 3 or more months.

What are the benefits of dental bone regeneration?

Regenerative methods like these are vital to the success of one’s dental implant or dental bridge or to correct defects in the bone. In addition to helping restore one’s smile, regenerative procedures can actually improve a patient’s dental health by preventing the further decay of tissues beneath the gum line.

At The Texas Dental Implant Center, we are experts in periodontal procedures like these and are committed to providing our patients with the quality care and comprehensive service they need to permanently restore their smile. Bone regeneration is just one such procedure that can help you achieve the smile you have always wanted in a healthy and natural way. If you are interested in learning more about procedures like these, contact our office today to schedule a consultation with us.


Dental Bone Graft

In order to have a successful dental implant, you must have a sufficient amount of bone in the jawbone to support the implant or implants. If the bone under the gum is not wide, dense or long enough, then a bone graft may have to be performed before a dental implant is placed.

A bone graft is a procedure that enhances the bone tissue in the jaw to ensure there is a strong foundation upon which to successfully anchor dental implants. Grafts can vary in complication from simply enhancing the bone alongside one implant to making important deviations to the figure, dimensions and magnitude of the entire dental ridge.

Bone loss can be occur as a result of decay, swelling, shock or from periodontal disease. Over time, bone deterioration accelerates, so individuals who have been missing teeth for a long period of time tend to require more extensive bone grafting procedures that someone who has recently had a tooth extracted.

The materials used for bone grafts can be found from a variety of sources, including your own bone, a human cadaver bone, animal bone or synthetic bone substitute. Bone grafts sourced from your own bone tends to be the safest and most effective source of graft material. This is because it can easily be integrated into your existing bone without any risk of an infection or contamination, and it is not likely that your natural tissue will reject the graft material.

Usually, the bone graft material is taken from one’s chin area or jaw; however, you can also opt for the shin or hip bone to be used instead. Some of the disadvantages of using bone from the hip or shin is that you will have to undergo two forms of surgeries.

A human cadaver bone or animal bone tissue can also be used for dental bone grafts. Animal bone tissue is typically sourced from either cows or horses, are sterilized and safe for use in human bone tissue. The graft material naturally absorbs well in the body and these bone grafts pose little risk of infection as long as the bone is sterilized properly.

Lastly, a synthetic mineral bone can also be used for your dental bone graft procedure. Synthetic bone graft material has been known to be less effective as the body absorbs this material more slowly than the alternatives, but it may be a good option for some depending on their circumstance.

If you have been told that you are not a candidate for dental implants because you have insufficient bone left in the jaw, bone grafting procedures can help you augment the jawbone to sufficient levels to get the dental implants you need and restore your smile. Contact our office today to see what bone grafting options are available to you and to schedule a consultation with us.

Gum Regeneration

When gums have receded past the tooth root, you may be required to undergo a type of gum surgery known as gum regeneration to correct it. Gum recession can cause a number of problems, including sensitive teeth and the appearance of elongated teeth. Gum regeneration helps resolve these problems, giving you a beautiful, functional and healthy smile that you can be proud to show off.

There are two types of gum tissue in the mouth: gingiva and gingival mucosa. Gingiva is a tissue that resembles an orange peel and is resolutely attached to the underlying bone. The main function of the gingiva is to form a firm seal around the tooth and act as a barrier from forces, such as chewing and tooth brushing. Gingival mucosa is a more delicate, red, shiny and loose tissue that is not firmly attached to the underlying bone. You can easily see this type of tissue when gently pulling out the lower lip. Here, both types of tissues meet.

Gum recession is when the gingiva is pulled away from the tooth, exposing the tooth root. The result of this is the appearance of elongated teeth and increased sensitivity of the tooth to hot and cold temperatures.

Gum regeneration procedures, such as gingival grafts, are popular procedures that can enhance the amount of tissue around receding gums in order to protect the underlying bone. The gum regeneration process involves taking donor gum tissue – often from the roof of the mouth – and relocating it to the site in need of restoration. Over time the graft integrates with the existing tissue, bolstering the area and stimulating natural tissue growth.

A connective tissue graft is another type of gum regeneration procedure that is similar to gingival graft; however, the difference lies in the fact that a different type of tissue layer is used. The donor tissue is taken from the tissue layer beneath the palate. The incision may be the same, but the type of tissue used is different. This is a much thicker tissue and it contains stronger connective tissues and more blood vessels as compared to the top layer. After taking out the required tissue, the surface is folded back to its original position for the wound to heal.

If you suffer from gum recession, there are a number of gum regeneration procedures that might be beneficial in helping you restore your smile. Contact our office to schedule a consultation with us and get started on your comprehensive treatment plan today!

Crown Lengthening

Some people’s gums appear to rest too low on their teeth, causing what is commonly known as a gummy smile. Gummy smiles can be heredity or they can result from disease or use of certain prescription drugs. One cosmetic dental solution to solve this problem is a gum contouring procedure known as dental crown lengthening. Crown lengthening is a minor surgical procedure that is completed by a periodontist to expose more tooth structure in one’s mouth. This is done by cutting the gingival tissue around the tooth and removing any excess tissue that extends above the tooth. The result of a crown lengthening procedure is the appearance of longer, more even looking teeth.

Most people who have gummy smiles tend to ignore it, and sometimes it may not be medically necessary to correct. Others, however, simply are not satisfied with the look of their smile and choose to undergo cosmetic dental procedures to correct it. Gum contouring procedures, like crown lengthening, can help those with gummy smiles achieve a beautiful, more even-looking smile.

Crown lengthening is a procedure that exposes a larger amount of tooth structure by cutting away excess gum tissue around the tooth. Often, this procedure is purely cosmetic for the purposes of enhancing the look of one’s smile. Ancillary gum contouring procedures, such as gum grafting may also be used in conjunction with crown lengthening procedures to reshape the gum line.

Those with gummy smiles or should always go to an experienced periodontist, who is a specialist at procedures such as gum contouring and crown lengthening procedures. It is important to make sure that your dentist has successfully completed these procedures before. Ask your dentist for his or her experience, client testimonials or before and after pictures to make sure you are completely comfortable with your procedure.

Gum contouring procedures are completed in the dentist’s office. The recovery period for this type of procedure ranges from a few days to weeks before your gums can heal completely and you are free to eat the foods you want and brush your teeth normally. Over-the-counter painkillers and ice packs can be taken to reduce pain and swelling after your surgery.

If you have a gummy smile and are interested in learning more about what crown lengthening can do for you, contact our office today to schedule your initial consultation with us.

Cosmetic surgery

If you feel like your teeth are too small or gums look too large, you may have what is commonly known as a “gummy smile” or “excessive gingival display.” At The Texas Dental Implant Center, we are happy to help explore all options available to you to correct this condition and give you a smile you will love.

Gummy smiles are caused by excessive gum tissue on your upper teeth or jaw, which can result in the abnormal eruption of teeth. This may cause your teeth to appear smaller than their actual length. In addition, your upper lip might be slightly inflamed and will rise higher than it should. This is because the muscles that control the upper lip tend to become hyperactive and expose more gum tissue. Gummy smiles are also caused by the way in which your upper jaw tends to develop. For example, if there is an excessive bulging or protrusion of your upper jaw, then it is obvious that there is a problem within the gum tissue, which can lead to a gummy smile.

Treatments to Correct Gummy Smiles

There are several procedures that are used to correct gummy smiles, including:

Crown lengthening:

A gummy smile is typically fixed through cosmetic dental surgery, specifically through a procedure called the dental crown lengthening. The crown lengthening procedure involves the removal and re-sculpting of your gums to expose more of your natural tooth structure beneath.

Gum grafting

: In some cases, where the tooth roots are exposed, your teeth look longer than they should. This can also be fixed through a cosmetic dental procedure, known as gum grafting. Gum graft surgery is a procedure in which soft tissue, typically from the roof of your mouth, is patched onto the gum and allowed to integrate, stimulating gum tissue growth in the area. Gum grafting is effective at not only covering exposed tooth roots, but also in preventing further decay.

Gingivoplasty and gingivectomy:

Gingivoplasty and gingivectomy procedures are permanent solutions to correct gum tissue overgrowth. A gingivectomy involves the surgical removal of gum tissue, while a gingivoplasty reshapes healthy gum tissue surrounding one’s teeth. Both of these surgical procedures can help you achieve a permanent solution to a gummy smile and should be completed by an experienced dental professional.

If you suffer from a gummy smile or exposed tooth roots, there are a number of cosmetic surgery options available for you to correct these problems and get you the smile you have always wanted. Contact our office today to schedule a consultation with us to see what options are available to you.



Periodontics is a specialty dental practice that involves the prevention, diagnosis and treatment of periodontal, or gum, disease. These practices are vast, ranging from treating minor forms of the disease, such as gingivitis and its symptoms, to completely restoring one’s smile after tooth loss with restorations like dental implants. Periodontal disease should be treated by a board-certified periodontist with the extensive training and expertise needed to diagnose and treat periodontal disease completely and effectively.

Here are a few of the many periodontics treatments offered by our board-certified periodontist, Dr. Al Manesh, at Texas Dental Center:

Periodontal disease prevention:

Prevention of periodontal disease starts at home with proper oral hygiene and maintenance of one’s teeth. We encourage twice-daily brushing and flossing and avoidance of sugary sweets and tobacco to prevent the onset of gum disease. It is also important to visit us at least twice a year for exams and deep cleanings so we can remove any plaque or tartar that might have built up in hard-to-reach places – even if you do practice proper oral hygiene at home.

Minor periodontics treatments:

Non-surgical treatments for gingivitis and minor forms of gum disease include professional deep dental cleanings, removal of damaged or infected tissue, and scaling and root planing – a process by which the infected surface of a tooth root is cleaned and smoothed out. Often these treatments are sufficient in reversing the progression of gum disease if they are treated early. If gum disease is allowed to progress to more advanced stages, however, more robust surgical procedures may be required.

Surgical periodontics treatments:

More extensive or surgical periodontics treatments may be needed to treat advanced stages of gum disease. These treatments may include gum pocket reduction surgery, bone and soft tissue grafting, guided tissue regeneration or bone surgery. These treatments tend to require multiple appointments and at least one surgical procedure.

Dental implants:

When periodontal disease reaches its most advanced stages, the gum and bone tissue holding teeth in place weaken and deteriorate, causing teeth to shift, loosen and fall out. In cases where teeth cannot be salvaged, dental implants may be required to replace lost teeth.

All of our periodontics procedures are completed by our expert periodontist Dr. Al Manesh here at Texas Dental Center. To learn more about our periodontal treatments, contact our office today.



Periodontal Disease Treatment

Periodontal disease, or gum disease, can be a problematic dental and overall health problem that can lead to infection, tooth loss and destruction of vital tissues in the mouth. The disease starts with a mild form of the disease, known as gingivitis, which is a build-up of plaque between the teeth and gums. This plaque build-up causes inflammation, redness and irritation around the gums.

If treated early, gingivitis is easily reversed with professional care from your dentist. If allowed to progress, however, gingivitis leads to a more advanced state of the disease, which begins to damage the inner layer of the gums and bone around the infected area. The body’s natural response to fight the infection is to break down the tissues that are affected, causing bone and soft tissues to deteriorate.

There are a number of causes of periodontal disease, including hormonal changes, illness, poor dental hygiene, family history, smoking or tobacco use or use of certain medications that are known to affect one’s oral health. The treatments too are vast, ranging from minor, non-surgical treatments to more robust, surgical procedures. The type of treatment needed will depend on the severity of your disease.

Here are a few of the periodontal disease treatments we offer:

Non-surgical treatments

For minor or less advanced stages of periodontal disease, such as gingivitis, non-surgical treatments can treat the disease, sometimes within a single visit. Here are some non-surgical treatments for periodontal disease:

Professional teeth cleaning:

For milder cases of periodontal disease, plaque and tartar can be removed during a routine or scheduled professional teeth cleaning. During this cleaning, your dentist will use special tools to scrape and clean all traces of plaque and tartar from hard-to-reach places in your mouth.

Scaling and root planing:

This non-surgical procedure, which is completed under a local anesthetic, involves scraping away rough spots on the tooth’s root below the gum line, and smoothing out its surface to prevent bacterial buildup in the gum pocket.

Surgical treatment options

When periodontal disease is allowed to progress, surgical treatments may be necessary. Here are some of the surgical treatment options to treat periodontal disease:

Pocket reduction surgery:

When gum pockets are deep, disease-causing bacteria is given an easy place to reside and fester. To reduce these pockets, your dentist may complete a surgical procedure that involves removing the tartar from these gum pockets, then replacing your gums more snugly around the tooth, eliminating the spaces where bacteria likes to grow.

Bone and tissues grafts:

Bone and tissue grafts are surgical procedures that stimulate the regeneration of bone and soft tissue in one’s mouth by taking tissue from another place on a person’s body, such as the soft tissue from the roof of one’s mouth or fragments of real or synthetic bone tissue, to add tissue to the affected area.

Guided tissue regeneration:

This surgical procedure is often done in conjunction with pocket reduction, or gum flap, surgery to stimulate tissue growth around the gum pocket. During this procedure, a medical mesh-like material is inserted between the bone and gum tissue to guide tissue growth and limit it to a specific area.

Bone surgery:

Bone surgery for periodontal disease involves smoothing out shallow craters on the bone that have formed from bone loss. After flap surgery, the bone is reshaped to decrease the craters, making it more difficult for bacteria to gather and multiply.

If you suffer from periodontal disease and are in need of treatment, contact our office today to schedule your initial consultation with us, where we will go over your options and come up with the best treatment plan for your distinct situation.