oral surgery

Dental Implants

  1. What is Implant Dentistry?
  2. What are dental implants?
  3. Is everyone a candidate for dental implants?
  4. How do you care for dental implants?
  5. Are these dental implant procedures painful?
  6. Am I a candidate for a single tooth immediate implant?
  7. If I loose a tooth in the back of the mouth, is it a big deal, because no one sees it anyway?

Extraction

  1. What does an Oral and Maxillofacial surgeon do?
  2. What does it mean to have an impacted wisdom tooth (third molar)?
  3. When is it recommended to remove the wisdom teeth?
  4. Can wisdom teeth cause your teeth to crowd as they grow in?
  5. My wisdom teeth aren’t bothering me, so do I still need to have them removed?

Periodontal Surgery

  1. What is a sinus lift procedure, and when is it necessary?
  2. What is bone grafting, and where does the bone come from?
  3. What would happen if I just left the space after the Oral Surgeon extracts my posterior tooth?
  4. How soon can one exercise after minor dental surgery like a tooth extraction, gum surgery, apicoectomy, root canal, etc.?

Dental Implantstop

Question:
What is Implant Dentistry?
Answer:
The introduction of implant dentistry has laid the foundation for a new level of care and service that accomplishes today what was thought impossible only a few years ago. It is the most advanced therapy available to replace missing or lost teeth. Dental implants not only enable one to regain their confidence and psychologically be able to enjoy an active lifestyle, but they can improve your smile, help you to once again enjoy chewing all the foods you like, and help to restore your facial structure and youthful appearance. Implant dentistry and bone regeneration are among the recent miracles of modern medicine. Their impact on the field of dentistry ranks up there with the introduction of the local anesthetic Novocain (developed in 1904), and the air-driven turbine drill (introduced in 1957). With adequate time and proper planning great things can now be accomplished.


Question:
What are dental implants?
Answer:
Implants are metal posts (usually titanium) that are surgically placed beneath your gums to act as artificial tooth roots once they have become integrated with the surrounding bone. These implants offer stable support to artificial teeth, whether in the form of a single crown, a fixed bridge or beneath a removable denture. A conventional fixed bridge still remains an excellent treatment option. However, many individuals who have lost or who will be losing a single tooth may be hesitant to grind down their intact adjacent teeth, especially when the adjacent teeth are free of cavities or restorations. For these individuals, a single tooth dental implant may be the ideal option.

Question:
Is everyone a candidate for dental implants?
Answer:
As with any medical or dental procedure, the placement of implants may have a compromised success rate in certain individuals. Some of the reasons to exclude dental implants as a treatment option include: insufficient bone quantity, poor bone quality, inadequate amounts of space between your upper and lower teeth, vital anatomical structure in close proximity to the proposed implant site, unrealistic expectations about the esthetic outcome, or a still growing mouth and face. Certain chronic diseases such as diabetes, osteoporosis or chronic sinus troubles can have the potential to interfere with the integration of bone to these implants. Individuals who smoke regularly will usually have a poorer prognosis for the implants in the long run. However with proper treatment planning, placement selection, and by utilizing the appropriate style of implant, the level of success has been tremendous. To find out if implants are the right choice for you, your dentist will need to evaluate your health history, take impressions of your mouth for planning models, and take the necessary dental x-rays. Your dentist will most likely refer you to have a CAT scan performed to help establish the quality and quantity of your bone, along with determining the best placement and the number of implants that will be required for long term success.


Question:
Are dental implants more successful in different areas of the mouth?
Answer:
Yes. Different areas of the mouth typically have different qualities of bone. For example, the front segment of the lower jaw has the densest bone, while the back portion of the upper jaw usually has bone that is softer and more porous. Implants will have a better chance of success in an area of denser bone. If it is discovered that you do not have enough bone in certain areas, do not yet give up hope. Recent studies have proven that implants can be quite successful in bone that has been augmented by either natural or synthetic bone grafts. The degree to which new bone will form within the grafted site differs from one individual to another depending on the type of graft used and the overall health of the patient.

Question:
How do you care for dental implants?
Answer:
The long term success of implants is, in part, determined by meticulous oral hygiene and regular dental visits. Although you cannot get cavities in implants or periodontal disease, it is possible to develop what is called peri-implantitis, which is inflammation of the tissues around the implants. To prevent this, keep brushing and flossing as you normally would your own teeth, and don't forget to schedule your regular check-ups.

Question:
Are these dental implant procedures painful?
Answer:
These procedures are performed without discomfort, under the utilization of local anesthesia or local anesthesia with I.V. Sedation. Occasionally general anesthesia may be used depending on the individual and their medical history. Post-operatively there may be mild to moderate discomfort and some swelling, but nothing that can't be controlled with the assistance of an oral analgesic that your doctor will prescribe.


Question:
Am I a candidate for a single tooth immediate implant?
Answer:
Another topic to be of considerable interest for discussion is whether or not one is a candidate for placing a single tooth implant in a fresh extraction site (tooth socket). Dentists regularly wait for a period of 6 months after extracting a tooth before they place an implant. However, this delays treatment and may leave the residual bony ridge too thin for implant placement. A thin or resorbed bony ridge is of primary concern in areas where the esthetics of one's smile is in jeopardy of being compromised. This compromised quantity of bone could lead to cosmetic defects such as the loss of the surrounding gum tissue. It is believed that bone growth may actually be greatest after a tooth is removed. Single tooth immediate implant placement (according to a 1997 regeneration report in the Journal of Practical Periodontics and Aesthetic Dentistry) is indicated in the following cases: (1) teeth that are lost by trauma, (2) teeth that are condemned due to fracture, (3) residual baby teeth with root resorption, and (4) teeth with root canal failure. The disadvantage of immediate placement is that placing an implant in a fresh extraction site does not provide optimum initial bone-to-implant contact. As a result, the usual waiting period for the implant to integrate with the bone may have to be extended by about 2 months. Depending on what implant system is used, this usual waiting period generally take anywhere from 2 to 6 months before the implant can be restored with a crown. The immediate implant procedure has survived 10 years of clinical scrutiny and has a proven success rate that is close to those experienced in an intact toothless site. Keep in mind, however, that this procedure is not generic; it is only presently indicated for those individuals who satisfy the aforementioned criteria.

Question:
If I loose a tooth in the back of the mouth, is it a big deal, because no one sees it anyway?
Answer:
Many people prioritize their dental health by taking care of the teeth they can see when they smile and put off care for the teeth they do not see. A number of patients will choose to spend their money whitening their front teeth, instead of putting those funds towards restoring a compromised back tooth. When that back tooth fails, and needs to be removed, the space often gets left there without a bridge or an implant to help fill in the space. Empty spaces in the back are a big deal! When you have an empty space, the adjacent teeth can drift and tilt, causing spacing, gum pockets, and loss of bone. Opposing teeth will tend to slowly erupt out of its socket in attempt to meet up with another tooth. Additionally, if multiple teeth are lost in the back of the mouth, it causes an additional stress on the other teeth, resulting in the enamel to wear faster. In the case of heavy grinders, missing teeth in the back can cause front teeth to wear, chip and break, causing their bite to collapse, and slowly break down what is seen when smiling.top

Extraction

Question:
What does an Oral and Maxillofacial surgeon do?
Answer:
An Oral and Maxillofacial surgeon (Oral Surgeon) is someone who is well trained to correct a wide variety of diseases, defects and injuries in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. Oral surgeons have attended four years of dental school and at least four years of a hospital surgical residency program. They are specially trained to place dental implants, address TMJ (temporomandibular joint) disorders, handle various types of facial pain, and perform restorative surgical procedures such as bone grafting, sinus lifts, apicoectomies and wisdom teeth removal (both erupted and impacted). Oral surgeons specialize in addressing facial injuries, such as broken jaws, and are trained to treat oral cancers. An oral surgeon also has advanced training in anesthesia, so they can make your experience as painless and comfortable as possible. If your general dentist feels that a tooth extraction or other oral surgical procedure is more complicated or outside of their comfort zone, they will refer their patient to an Oral Surgeon.

Question:
What does it mean to have an impacted wisdom tooth (third molar)?
Answer:
Wisdom teeth usually erupt into the mouth between the ages of 17-21. Even when the wisdom teeth are fully formed, not everyone’s wisdom teeth grow in (impacted), and some only grow in partially (partially impacted). Sometimes a person’s jaw doesn’t grow large enough to accommodate the growth of the wisdom tooth (third molar from the midline of the face), and other times the tooth develops on its side and will not erupt.

Question:
When is it recommended to remove the wisdom teeth?
Answer:
It is generally recommended to remove the wisdom teeth when:

  • wisdom teeth are partially erupted, as this can leave an open communication for bacteria to enter and cause an infection
  • wisdom teeth are growing in such a way that they can damage adjacent teeth
  • If a cyst (fluid-filled sac) forms, destroying surrounding structures such as bone or tooth roots

Question:
Can wisdom teeth cause your teeth to crowd as they grow in?
Answer:
People who notice that their teeth are crowding as their wisdom teeth are growing in, may be blaming the wrong culprit. This crowding tends to happen at this age (late teens to early 20’s) whether or not the patient has wisdom teeth. This crowding may also occur whether or not that individual had braces too. Often times teeth tend to crowd because of a late growth of the lower jaw coupled with a flattening of the profile of the face. Of course, the lack of compliance with wearing their retainer after orthodontic treatment may also be the source of this crowding, resulting in a relapse of the original crowding.

Question:
My wisdom teeth aren’t bothering me, so do I still need to have them removed?
Answer:
Wisdom teeth don’t always need to be removed. Some people’s mouths are large enough to accommodate their growth, and others have wisdom teeth that don’t come close to erupting. However, there are many times when wisdom teeth should be evaluated for removal even in the absence of any form of discomfort, in order to prevent possible cysts, infections or impact on the adjacent teeth.

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Periodontal Surgery

Question:
What is a sinus lift procedure, and when is it necessary?
Answer:
In order for an implant to be successful and predictable, it needs to be placed in an area with adequate bone surrounding it. Surgeons prefer the minimum height of bone to be 7mm and the width to be at least 5mm, in order to have successful integration of bone and adequate support and strength. When the patient doesn’t have enough bone; certain procedures can be performed in order to make that patient a better candidate, such as bone grafting and sinus lifts (sinus augmentation). For patients who need to have teeth replace in the back part of the upper jaw, many times the floor of the sinus is in the way, preventing the placement of an implant in that area. The oral surgeon can augment the sinus by lifting the sinus membrane and filling in the base of the sinus with bone grafting material to give more vertical height. For example, if an 8 mm implant needed to be placed, but there was only 4mm of bone beneath the floor of the sinus, after the sinus is lifted and bone is placed, we can now get at least 4mm of extra bone for its successful placement. This procedure takes place at the oral surgeon’s office and begins with a local anesthesia to the area being worked on.

Question:
What is bone grafting, and where does the bone come from?
Answer:
Bone grafting is the placement of bone within and around certain areas that are deficient in bone or have some defects that could compromise the placement of implants and affect function and esthetics in the mouth. The best source of bone for your graft is your own bone tissue from elsewhere in your body, because it is the most biocompatible and offers faster healing times when compared to other methods. However, it is not always the most practical or desired, since this bone would usually involve a procedure that takes some bone from your chin, the back of your lower jaw, the hip or your tibia. In many cases, a combination of artificial bone substitutes and freeze dried, demineralized, sterilized cadaver bone is used. The grafted bone provides an anchor and allows the existing bone to integrate with it, providing an environment suitable for the placement of implants.

Question:
What would happen if I just left the space after the Oral Surgeon extracts my posterior tooth?
Answer:
The loss of a back tooth can affect your dental health, your physical appearance and the way you chew, speak, sing and smile. When a tooth is lost, the adjacent teeth may tilt towards that empty space, or the teeth in the opposing jaw may drift up or down towards that space. Tipped teeth are more difficult to maintain, and are therefore more prone to decay. In addition, the surrounding bone and gum tissues may break down, resulting in an increased risk for gum disease. You may find yourself favoring the opposite side of your mouth when you chew, causing additional stress to your teeth and gum tissues. The loss of a tooth may also result in the failure to maintain the natural shape of your face, due to the lack of lip and cheek support in that area. The outcome may be an older appearance due to a sinking of your mouth in the region where the tooth was lost. Missing teeth can and should be replaced. Speak to your dentist to explore the many options you have, including implants and fixed bridges, which come very close to duplicating the function and appearance of your natural teeth.

Question:
How soon can one exercise after minor dental surgery like a tooth extraction, gum surgery, apicoectomy, root canal, etc.?
Answer:
There is no definite answer for everyone. As a general rule do not perform heavy exercise for at least one or two days from after your swelling has subsided. This may wind up being a week or until your stitches come out, but use common sense or ask your dentist if you have any questions. Exercising too early after surgery will make bleeding more likely. Rest, sleep, proper care and attention at home are important for the wound to heal properly. You have to listen to your body before you re-start your exercise regimen. You may resume your normal activities the next day, but just do not engage in vigorous exercise such as heavy lifting, competitive sports, running, biking, etc.top