Oral & Maxillofacial Surgery

Oral and maxillofacial surgeons are specialists with advanced training and expertise in the diagnosis and treatment of various head and neck conditions and injuries.  After four years of dental school, an oral and maxillofacial surgeon completes four to six years of additional formal training in treating the craniomaxillofacial complex.  This specialty is one of 9 dental specialties recognized internationally and by the American Dental Association (ADA).

An oral and maxillofacial surgeon can diagnose and treat a wide variety conditions.

The following are just some of the many conditions, treatments and procedures oral and maxillofacial surgeon deal with on a daily basis:
  • TMJ, Facial Pain, & Facial Reconstruction
  • Dental Implants
  • Tooth Extractions & Impacted Teeth
  • Wisdom Teeth
  • Misaligned Jaws
  • Cleft Lip & Palate
  • Apicoectomy
  • Oral Cancers , Tumors, Cysts, & Biopsies
  • Sleep Apnea
  • Facial Cosmetic Surgery

Whether your dentist refers you to our office, you have pain or symptoms causing you concern, or you simply have questions you would like answered, please contact our office today to schedule an appointment. We are here to answer your questions and provide the treatment you deserve!

Simple Tooth Extractions

If you are experiencing extreme sensitivity or are suffering from advanced periodontal disease, you may be required to have a tooth extracted.  With a simple extraction, the dentist can safely remove the affected tooth without the need for major surgery.

Reasons for a tooth extraction There are numerous situations in which a simple extraction can help alleviate pain or prepare you for another cosmetic or restorative procedure.

Some common reasons for extraction include:
  • Advanced periodontal disease that has loosened the tooth roots
  • Extra teeth or baby teeth that impede adult teeth
  • Preparing a patient for orthodontic treatment
  • Removing a fractured or malformed tooth
  • Severe tooth decay which cannot be remedied with root canal therapy

How is a tooth extracted?

As a precaution, the dentist will first take X-rays of the tooth or teeth in question, to help plan the procedure.  After preparing a method of extraction, you will be given a local anesthetic that will prevent you from feeling pain during the procedure.  Next, the dentist will use a tool called an elevator to lift the tooth and loosen ligaments and gum tissue around the base of the tooth.  Finally, the dentist will use a pair of forceps, to gently rock the tooth back and forth until it breaks free of the ligaments holding it in the gum tissue.  Occasionally, a stubborn tooth will resist the dentist’s soft tug, refusing to come out.  In these and more complex cases, the tooth may need to be broken up into smaller pieces for removal.

Once removed, we will pack gauze into the socket and have you place pressure on the area by biting down.  If necessary, the dentist will place stitches to close the socket.

If you are sick the week prior to your scheduled extraction or on the day of, please contact our office, as alternative arrangements may need to be made.  Please contact us if you have any questions or concerns.

Apicoectomy

The teeth are held firmly in place by strong roots that extend into the jawbone. Molars and premolars tend to have several roots, whereas the front incisors only have a single root. The end or tip of each root is termed the apex. The apex is where the nerves and blood vessels enter the tooth and aids in the delivery of blood to the crown (the part of the tooth you can see in your mouth).

A root canal treatment refers to the cleaning of the canals and the removal of infected and inflamed tissue within the root. When the inflammation or infection persists after the root canal treatment, an apicoectomy may be required. An apicoectomy is essentially the removal of the apex (or root tip), followed by a filling procedure to seal the root from further infection. When left untreated, infected roots can damage other teeth, spread infection, and cause regression of the jawbone.

Reasons for an apicoectomy

Infected and inflamed soft tissue around the root of a tooth can be exceptionally painful and debilitating. The purpose of an apicoectomy is to eliminate the infection in the tissue and to ultimately preserve the function of the tooth and save it from extraction. An apicoectomy will rarely be considered by the surgeon unless a prior root canal treatment has failed.

There are several reasons why an apicoectomy may be necessary:
  • Small Adjoining Root Branches – Roots are extremely complex and can contain many tiny branches. If these tiny branches cannot be cleaned and sealed when the root canal treatment is performed, inflammation can persist.
  • Blocked Root Canal – In some cases, the surgeon is unable to effectively clean a root canal because it is blocked by a fractured file left behind from prior root canal treatment. Infection and debris can quickly affect adjacent teeth.
  • Narrow or Curved Root Canals – When the root canal is poorly shaped, the endodontic files cannot reach the root tip. Continuing infection or re-infection can then occur.

What does getting an apicoectomy involve?

Prior to the surgery, the surgeon will generally prescribe an antibiotic or anti-inflammatory medication to treat the underlying infection. Panoramic X-rays will then be taken to enable the surgeon to plan the apicoectomy, which will be performed under local anesthesia.

The surgeon will make a small incision in the gum and expose the root by lifting away the gum. In some cases, a tiny fraction of the jawbone may be removed to properly expose the root. The edge of the root tip and any infected connective tissue will be removed using ultrasonic instruments. The root will be sealed using a retrofill (filling material), and the surgeon will suture the gum with several stitches.

This surgery does not require an overnight stay, and full aftercare instructions and pain medications will be provided as needed. After several days, the surgeon will remove the stitches, and the connective tissues will fully heal several months after the procedure.

If you are experiencing any symptoms, such as pain or swelling associated with a tooth that has had a root canal, we encourage you to contact our office immediately.

Bone Grafting

Bone grafting is often closely associated with dental restorations such as bridge work and dental implants. In the majority of cases, the success of a restoration procedure can hinge on the height, depth, and width of the jawbone at the implant site. When the jawbone has receded or sustained significant damage, the implant(s) cannot be supported on this unstable foundation and bone grafting is usually recommended for the ensuing restoration.

There are several major factors that affect jaw bone volume:
  • Periodontal Disease – Periodontal disease can affect and permanently damage the jaw bone that supports the teeth. Affected areas progressively worsen until the teeth become unstable.
  • Tooth Extraction – Studies have shown that patients who have experienced a tooth extraction subsequently lose 40-60% of the bone surrounding the extraction site during the following three years. Loss of bone results in what is called a “bone defect”.
  • Injuries and Infections – Dental injuries and other physical injuries resulting from a blow to the jaw can cause the bone to recede. Infections can also cause the jaw bone to recede in a similar way.

Reasons for bone grafts

Bone grafting is a highly successful procedure in most cases. It is also a preferable alternative to having missing teeth, diseased teeth, or tooth deformities. Bone grafting can increase the height or width of the jawbone and fill in voids and defects in the bone.

There are essentially two basic ways in which bone grafting can positively impact the health and stability of the teeth:

Jaw Stabilization – Bone grafting stabilizes and helps restore the jaw foundation for restorative or implant surgery. Deformities can also be corrected and the restructuring of the bone can provide added support.

Preservation – Bone grafting can be used to limit or prevent bone recession following a tooth extraction, periodontal disease, or other invasive processes.

Oral Examination

Initially, the dentist will thoroughly examine the affected area in order to assess the general condition of the teeth and gums. If periodontal disease is present or the adjacent teeth are in poor condition, these factors will be fully addressed before the bone grafting procedure can begin. The dentist will also recommend panoramic x-rays in order to assess the precise depth and width of the existing bone. On occasion, a CAT scan may be recommended to determine the bone condition. Depending on these results, the dentist may also anesthetize the area and explore into the gum in order to determine what kind and how much bone is required.

What Does Bone Grafting Involve?

There are several types of bone grafts. Your dentist will determine the best type for your particular condition.

Autogenous Bone Graft – Harvested from the patient’s own body (usually from the posterior part of the lower jaw or the chin). This method is usually preferred because it produces the most predictable results.

Allograft Bone Graft – Cadaver or synthetic bone is used in this type of graft.

Xenograft – Cow bone is used in this type of graft.

The bone grafting procedure can often take several months to complete. Bone is typically harvested from your own body (or on rare occasions obtained from a “bone bank”) and added to the affected site. This bone will fuse with the existing bone and the migration of cells will cause firm adhesion and cell growth. Supplementing the jaw with bone will result in greater bone mass to help support and anchor the implant(s).

During the surgery, the dentist will numb the grafting and extraction sites using local anesthetic. A small incision will be made to prepare the site for the new bone and it will be anchored into place. On occasion, a synthetic membrane may be used to cover the new bone. This membrane prevents soft tissue and bacterial invasions, and encourages new bone growth. The surgery does not require an overnight stay, and you will be provided with comprehensive instructions for your post-operative care. The dentist will prescribe medications to help manage infection, discomfort and swelling.

Dental Implants

Dental implants are a great way to replace missing teeth and also provide a fixed solution to having removable partial or complete dentures. Implants provide excellent support and stability for these dental appliances.

Dental implants are artificial roots and teeth (usually titanium) that are surgically placed into the upper or lower jaw bone by a dentist or Periodontist – a specialist of the gums and supporting bone.  The teeth attached to implants are very natural looking and often enhance or restore a patient’s smile!

Dental implants are strong and durable and will last many years.  On occasion, they will have to be re-tightened or replaced due to normal wear.

Reasons for dental implants:
  • Replace one or more missing teeth without affecting adjacent teeth.
  • Resolve joint pain or bite problems caused by teeth shifting into missing tooth space.
  • Restore a patient’s confident smile.
  • Restore chewing, speech, and digestion.
  • Restore or enhance facial tissues.
  • Support a bridge or denture, making it more secure and comfortable.

What does getting dental implants involve?

The process of getting implants requires a number of visits over several months.

X-rays and impressions (molds) are taken of the jaw and teeth to determine bone, gum tissue, and spacing available for an implant.  While the area is numb, the implant will be surgically placed into the bone and allowed to heal and integrate itself for up to six months.   Depending on the type of implant, a second surgery may be required in order to place the “post” that will hold the artificial tooth in place.  With other implants the post and anchor are already attached and placed at the same time.

After several weeks of healing the artificial teeth are made and fitted to the post portion of the anchor.  Because several fittings may be required, this step may take one to two months to complete.  After a healing period, the artificial teeth are securely attached to the implant, providing excellent stability and comfort to the patient.

You will receive care instructions when your treatment is completed.  Good oral hygiene and eating habits, alongside regular dental visits, will aid in the life of your new implant.

If you have questions about dental implants or would like to schedule a consultation, please contact our office.

Mini Dental Implants

Mini Dental Implants (MDIs) have changed the face of implant placement.  Unlike full implant placement where multiple dental visits are required, MDIs eliminate the need for surgery.  The development of long term MDIs now allows the dentist to place anchors in the jaw during one non-invasive treatment.  The most common use for MDIs is the stabilization of dentures and overdentures.  MDIs firmly anchor the dental prosthesis, which means there is no longer any need to suffer with ill-fitting, loose dentures.

MDIs are designed to eliminate bone grafting and expedite treatment.  Full implants require significant bone grafting and a recovery period.  The latent period allowed the anchor of the implant to properly embed itself into the jawbone.  The smaller size of MDIs means that no recovery period is necessary, and the denture can be fitted the same day.

What is the configuration of mini dental implants?

An MDI is a tiny dental implant (similar to a screw) that is designed to act in place of a natural tooth root.  MDIs are generally constructed from titanium and are either sprayed with calcium phosphate, or contain it along the length of the screw portion.  The design and structure of MDIs promotes quick healing and long lasting results.  The head portion of the implant looks very much like a ball.  This ball fits firmly into the retaining mechanism and together these structures hold the dentures at a designated level.  The dentures sit comfortably on the gum tissue and are able to withstand significant amounts of pressure and natural force.

What are the advantages of MDI placement?

MDIs are a true innovation for people who are reluctant to have invasive dental surgery and for denture wearers.  One significant advantage MDIs have over full implants is that they offer a viable treatment choice for patients who have experienced extensive bone loss.  Depending on the quality and density of jawbone available at the implant site, four of these mini implants may be implanted at one time.  Unlike full implants, MDIs don’t require invasive surgery, which makes MDIs a gentler option.  MDIs also minimize cost. Full-sized implants can be expensive to place, especially if many visits are required.  The most common use for MDIs is to stabilize a lower denture, however they can be placed anywhere in the mouth.

Here are some of the other advantages associated with MDIs:
  • Better smelling breath.
  • Clearer speech.
  • Easier chewing and biting.
  • Easier cleaning.
  • Firmer denture fit.
  • High success rate. Less discomfort.
  • No cutting or sutures.
  • No need for adhesives or messy bonding agents.
  • No rotting food beneath the denture.
  • No slipping, wobbling or discomfort.
  • Permanent results.
  • Quick treatment time.
  • Reduced costs.

How are mini dental implants placed?

The whole mini dental implant placement procedure takes approximately one hour.  Generally, in the case of lower jaw implants, four MDIs will be placed about 5mm apart.  Prior to inserting MDIs, the dentist will use many diagnostic and planning tools to find the optimal place to implant them.

Here is a brief overview of the MDI placement procedure:
  1. A mild anesthetic is administered.
  2. A small hole is drilled in the jawbone to situate each MDI.
  3. Each implant is screwed into place and tightened with a winged wrench.
  4. Finally, a ratchet wrench is used to fully stabilize the MDIs.
  5. The denture is measured against the mini implants and marks are made to indicate where the MDIs will fit.
  6. The denture is sent to the laboratory to have holes drilled to accommodate the MDIs.

Once the denture has been fully modified, it can be affixed to the MDIs.  The rubber O-ring on each MDI snaps into the designated spot on the denture, and the denture then rests snugly on the gum tissue.  MDIs hold the denture comfortably in a tight-fitting way for a lifetime.

In almost all cases, no stitching is required and no real discomfort is felt after the procedure.  After the denture placement procedure is complete, light eating can be resumed.  The denture can be removed and cleaned at will. MDIs enhance the natural beauty of the smile and restore full functionality to the teeth.

If you have any questions or concerns about mini dental implants, please ask your dentist.

Platelet Rich Plasma (PRP)

Platelet Rich Plasma or PRP is a by-product of blood that is exceptionally rich in platelets. PRP has long been used in hospitals to accelerate the body’s own healing process, but it is only fairly recently that advances in technology have allowed this same technique to be used in the dental office.

The blood platelets perform several essential functions in the body, including blood clot formation and the release of growth factors that help to heal wounds. These growth factors stimulate the stem cells to produce new host tissue as quickly as possible, which is why platelet rich plasma is so effective in the post-treatment healing process.

There are several ways in which PRP can be used in clinical dentistry:

Bone Grafting For Implants – This includes closure of a cleft lip and cleft palate deformities, sinus lifts, ridge augmentation, and both inlay and onlay grafts.

Bone Repair – PRP can be used in facial trauma reconstruction, repairing of defects due to tooth removal, or the removal of growths and cysts.

Fistula Repair – This includes the repair of fistulas between the mouth and the sinus cavity.

Reasons for platelet rich plasma treatment

Platelet rich plasma application is now widely used to expedite the post-procedure healing process and is completely safe. Since the blood used will come from the patient’s own body, disease transmission is not a factor. Almost all patients report a much greater degree of comfort immediately after their procedure. There are also several more distinct advantages of PRP:

  • Lower Infection Risk – PRP is smeared thickly on the wound after the procedure by the dentist and actually seals the wound away from infectious agents, lowering the risk of problems.
  • Accelerated Healing – The saturation of the wound with PRP helps increase tissue synthesis due to its growth factors, and this in turn results in faster tissue regeneration. Speedier healing decreases the risk of later infections, complications, and discomfort.
  • Safety and Convenience – Disease transmission is non-issue since the blood is harvested from the patient’s own blood supply. The amount of blood needed is small and can be collected during a routine outpatient procedure.

What does platelet rich plasma treatment involve?

The dentist will assess if you’re a candidate for PRP treatment.  Patients with blood clotting disorders will be unable to take advantage of this treatment. A small (about 2 oz) sample of your blood will be collected during a scheduled outpatient treatment. The blood will be placed into a centrifuge to separate the plasma from the red blood cells. A second centrifuge will be used to concentrate the platelets which contain the growth factor.

Immediately after suturing the wound, the dentist will apply the PRP to the surgical area in a high concentration. This will expedite your healing and decrease the amount of discomfort following the surgery. The dentist will provide aftercare instructions pertaining to the surgery and a prescription for pain medication as required.

If you have any questions about treatment with platelet rich plasma or would like to find out if you are a candidate and can benefit from this treatment, please contact our office today to schedule an appointment.

Wisdom Teeth Extractions

Third molars, commonly referred to as wisdom teeth, are usually the last four of 32 teeth to erupt (surface) in the mouth, generally making their appearance between the ages of 17 to 25. They are located at the back of the mouth (top and bottom), near the entrance to the throat. The term “wisdom” stems from the idea that the molars surface at a time typically associated with increased maturity or “wisdom”.

In most cases, inadequate space in the mouth does not allow the wisdom teeth to erupt properly and become fully functional. When this happens, the tooth can become impacted (stuck) in an undesirable or potentially harmful position. If left untreated, impacted wisdom teeth can contribute to infection, damage to other teeth, and possibly cysts or tumors.

There are several types, or degrees, of impaction based on the actual depth of the teeth within the jaw:

Soft Tissue Impaction: The upper portion of the tooth (the crown) has penetrated through the bone, but the gingiva (gum) is covering part or all of the tooth’s crown and has not positioned properly around the tooth. Because it is difficult to keep the area clean, food can become trapped below the gum and cause an infection and/or tooth decay, resulting in pain and swelling.

Partial Bony Impaction: The tooth has partially erupted, but a portion of the crown remains submerged below the gum and surrounding jawbone. Again, because it is difficult to keep the area clean, infection will commonly occur.

Complete Bony Impaction: The tooth is completely encased by jawbone. This will require more complex removal techniques.

Reasons to remove wisdom teeth

While not all wisdom teeth require removal, wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or as a preventative measure to avoid serious problems in the future.

If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:
  • Damage to nearby teeth: Second molars (the teeth directly in front of the wisdom teeth) can be adversely affected by impacted wisdom teeth, resulting in tooth decay (cavities), periodontal disease (gum disease) and possible bone loss.
  • Disease: Although uncommon, cysts and tumors can occur in the areas surrounding impacted wisdom teeth.
  • Infection: Bacteria and food can become trapped under the gum tissue, resulting in an infection. The infection can cause considerable pain and danger.
  • Tooth Crowding: It has been theorized that impacted wisdom teeth can put pressure on other teeth and cause them to become misaligned (crowded or twisted). This theory isn’t universally accepted by all dental professionals, and it has never been validated by any scientific studies.

Wisdom teeth examination

As with any dental procedure, your dentist will want to initially conduct a thorough examination of the wisdom and surrounding teeth. Panoramic or digital X-rays will be taken in order for your dentist to evaluate the position of the wisdom teeth and determine if a current problem exists, or the likelihood of any potential future problems.  The X-rays can also expose additional risk factors, such as deterioration or decay of nearby teeth. Early evaluation and treatment (typically in the mid-teen years) is recommended in order to identify potential problems and to improve the results for patients requiring wisdom teeth extractions. Only after a thorough examination can your dentist provide you with the best options for your particular case.

What does the removal of wisdom teeth involve?

Wisdom teeth removal is a common procedure, generally performed under local anesthesia, intravenous (IV) sedation, or general anesthesia by a specially trained dentist in an office surgery suite. The surgery does not require an overnight stay, and you will be released with post-operative instructions and medication (if necessary), to help manage any swelling or discomfort.