Oral Surgery

Extractions are performed only when the dentist decides that removing a tooth may improve the oral health of the patient. Tooth decay, crowding and risk of dental infection are some of the common reasons for tooth extraction. Dentists carefully consider and review the medical condition of the patient before performing tooth extractions. It is a process often done with the help of local anesthesia as well as nitrous oxide, oral sedation, and/or IV moderate conscious sedation. Depending on the complexity of the extraction process, surgical removal of the tooth may be necessary. Your dentist or surgeon will provide post-operative care instructions that should be closely followed. These post-op instructions will help reduce the odds of getting a “dry socket.” Pain medications and ice bags can help reduce post operative discomfort and swelling. Some swelling and discomfort is expected because extractions are surgical procedures.

Through the modern miracles of sedation dentistry, specially trained dentists can now safely treat anxious patients and sometimes even accomplish all dental work in one visit that may have required many more visits without it!

Dental phobia, or fear of the dentist, is not uncommon. In fact, many people avoid dental treatments altogether, as the stress and anxiety can be overwhelming. As a result, dental health deteriorates. With sedation dentistry, you can get the smile you've always wanted without the stress and fear of the dental procedures!

There are several types of sedations. Your dentist will do an oral exam and review your medical history as well as perform a patient interview in order to assess which sedation is best for you.

• Nitrous oxide (offered in our office)
• Oral sedation (offered in our office)
• IV moderate conscious sedation (offered in our office)
• Deep sedation and general anesthesia (not offered in our office)
• Who is a candidate for sedation dentistry?

Nearly all patients are candidates for some form of sedation dentistry. Patients who have the following may benefit from our sedation services:

• High fear and anxiety for dental treatment
• Traumatic dental experiences in the past
• Difficulty getting numb
• A bad gag reflex
• Very sensitive teeth
• Complex dental problems
• Limited time to complete dental care

If you are one of those patients who hate needles, shots, the noises, smells and taste associated with dental care, call our office for a consultation with our doctor and see how you can benefit from sedation dentistry. Don't let anxiety and fears come in the way of your dental care!

For dental treatment under oral sedation, you will place a couple pills under your tongue an hour before treatment begins. Sometimes this is adjuncted by nitrous oxide or another medication that is swallowed. This will help you feel relaxed and sleepy. These medications have an amnesiotic effect which typically reduces or even eliminates the patient's memory of the dental treatment altogether! It is necessary to have a responsible adult accompany you to the office who will remain in the building for the entire treatment. During your dental treatment, a trained assistant will be with you monitoring vital signs. Our doctor and our experienced team will perform all necessary dental work and though you are in a deeply relaxed state, you will be responsive to any questions or requests. When the procedures are complete, you will be gently awakened and will typically have no memory of your treatment.

When a tooth is lost the specialized bony process that houses the tooth begins to reabsorb. This causes a decrease in width and height of the bone in the area the tooth is lost. Neighboring teeth and opposing teeth begin to move into the space. This causes food traps, subsequent decay, gum disease and abnormal forces being transmitted to teeth leading to possible fractures which may necessitate root canal treatment or extraction. Loss of teeth can also cause the cheek and lips to collapse giving an aged look. Simply extracting a tooth does not usually eliminate the problem. In fact, it usually creates several more problems down the road!

The consequences of tooth loss can be prevented by replacing the lost tooth in a timely manner. Although there are several options to replace a missing tooth, the number one choice for replacing lost teeth are dental implants. Implants are tiny titanium screws or posts that are surgically placed in the bone. Once integrated into bone, they act like roots onto which small posts are attached which protrude through the gums. These posts provide stable anchors for crowns, bridges, denture attachments, etc. Implants maintain the bone height by stimulation and prevents unnecessary mutilation of adjacent teeth for bridge placement. Sometimes this trauma to the teeth created during the bridge prep results in more root canals which further adds to the expense. Since implants are titanium posts and are highly bio-compatible, there is no chance for dental decay on implants. Diligent home care is still required, however, in order to maintain the health of the tissues surrounding the implant or an infection may cause implant failure. Implants can service you for several years with regular professional cleaning and proper home care. They're the next best thing to your natural tooth!

Many people who are missing a single tooth opt for a fixed bridge, but a bridge may require significant cutting down of healthy, adjacent teeth that may or may not need to be restored in the future. Then there is the additional cost of possibly having to replace the bridge once, twice or more over the course of a lifetime due to decay or gum problems affecting the anchor teeth. The long term costs of a bridge versus an implant may be three or four times the overall cost of the initial implant. Remember, if an implant crown has to be replaced, it is usually a single crown replacement since the implant body itself is almost always still good. Replacement of a bridge is at least the cost of three crowns every single time!

Another option to replace missing teeth is a removable partial denture or complete denture depending on the number of teeth missing. The chewing efficiency with a denture is significantly reduced to more than half of that of natural teeth and typically only about 30% as efficient. The teeth that support the partial denture are weakened due to the excessive loads acting on them and many times are eventually lost. The denture rests on the gum causing tissue abrasion and possibly bone loss. Removable dentures may slip or cause embarrassing clicking sounds while eating or speaking.

Studies show that within five to seven years there is a failure rate of up to 30% in teeth located next to a fixed bridge or removable partial denture! This leads to even more costs for the patient.

Anyone who is missing one or several teeth is a candidate for implants. With the exception of growing children, dental implants are the solution of choice for almost all people of all ages, even those with the following health concerns:

Existing Medical Conditions: If you can have routine dental treatment, you can generally have an implant placed. While precautions are advisable for certain conditions, patients with such chronic diseases as high blood pressure and diabetes are still usually successful candidates for dental implant treatment.

Gum Disease or Problem Teeth: Almost all implants placed in patients who have lost their teeth to periodontal disease or decay have been successful. Global studies consistently show a 97% 10 year success rate!

Currently Wearing Partials or Dentures: Implants can replace removable bridges or dentures, or they can be used to stabilize and secure the denture, making it much more comfortable as well as significantly more efficient.

Smokers: Although smoking lowers the success rate of implants, it doesn't eliminate the possibility of getting them.

Bone Loss: Bone loss is not uncommon for people who have lost teeth or had periodontal disease. Your surgeon is trained and experienced in grafting bone to safely and permanently secure the implant.

Implant tooth replacement in children is usually deferred until their jaw growth is complete. A general rule of thumb says that the patient needs to be at least 16 years old. There are, however, some instances when a dental implant may be appropriate, such as when it is part of the child's orthodontic treatment plan. Your family dentist or orthodontist can guide you in this instance.

Procedure

Dental implant placement usually takes two surgical appointments:

• During the first surgical appointment the implant site is prepared to receive the implant following strict aseptic procedures. The selected size of the implant is placed in the prepared site. The gum tissue is then sutured over the implant. The implant takes 4- 6 months to fuse with the bone.
• During the second surgical appointment the implant is uncovered and the appropriate post is attached which will serve as the anchor for the replacement crown. An impression of the post is taken and sent to the lab for the precise fabrication of the implant crown. During this time a temporary crown may placed but not every time. Once the final crown is back it is either cemented with permanent cement or torqued into place with a tiny screw.

This procedure involves elevating the sinus membrane which lines the floor of the maxillary sinus and placing bone grafting material onto the sinus floor. When the graft heals, it creates more bone height. This procedure is most commonly performed in preparation for implants to be placed in the back part of the upper jaw.

Extraction of a tooth causes resorption of the supporting bone. Bone resorption causes a 40-60% decrease in its width during the first three years following extraction. Bone resorption occurs at the expense of the outer plate of bone reducing the width of bone. Then, over time the height of bone is also reduced. This becomes critical for anterior implants where ideal esthetics, phonetics and function is desired. In the upper jaw following extraction the sinus floor also begins to expand further decreasing the available bone to place implants in the posterior maxilla. In the lower jaw, the mandibular nerve which runs in the jaw bone may limit the length of the implant placed especially in cases of moderate to severe atrophy of the jaw.

Bone grafting can be used as a socket preservation procedure when it is placed following extraction of a tooth or to augment an atrophied or reabsorbed site.

In severe cases of ridge resorption, bone grafting material is placed to increase the ridge height and or width. This may involve several different types of grafting materials, membranes, healing appliances, or other materials.

This procedure involves elevating the sinus membrane which lines the floor of the maxillary sinus and placing bone grafting material onto the sinus floor. When the graft heals, it creates more bone height. This procedure is most commonly performed in preparation for implants to be placed in the back part of the upper jaw.

The mandibular nerve may need to be moved by an oral surgeon in order to make room for placement of dental implants in the lower jaw.

These procedures may be performed separately or together, depending upon the individual's condition. There are several areas of the body which are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin, the third molar region, or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. Many times your surgeon will elect to place specially prepared grafting materials rather than having to harvest material from your body. These materials are proven to be effective and are much less traumatic since there is not a second or third surgical site.

Several bone augmentation materials are available to stimulate and encourage bone growth in areas where it is lost as a result of pathological or physiological processes.

Bone grafting materials can be derived from various sources:

• Allograft materials derived from cadaver bone of the same species
• Autogeneous material derived from the recipient's intra-oral or extra-oral site
• Alloplastic materials are exclusively derived from synthetic sources
• Xenografts derived from the inorganic portion of animal bone

Bone grafting can be used to help to place larger diameter implants in ideal locations that are stable and serviceable for a long time. It also helps to establish normal volume and dimensions of bone for ideal esthetics, lip support, and phonetics.