Oral and Maxillofacial Surgery

Dental implants are the replacement of tooth roots in the mouth. Implants provide a strong foundation for fixed or removable replacement teeth.  Dental implants are small anchors made of biocompatible metal called titanium, which are placed in the jawbone.  The anchors begin to fuse with the bone over a few months. After the fusing process, known as osseointegration, abutment posts are inserted into the anchors to allow for the permanent attachment of the replacement teeth.  To fabricate the replacement teeth, an impression is taken and a model of the bite is created.  The replacement teeth are based on this model. Replacement teeth can either be crowns or dentures.

A wisdom tooth that is deemed problematic is normally extracted to avoid any oral complications.  To have a wisdom tooth removed, a small incision is made to open up the gum tissue over the tooth and remove any bone that is covering the tooth.  Once the tooth is in view, it is gently grasped with a dental instrument, known as a forcep, and gently rocked back and forth to loosen it from the jaw bone and surrounding ligaments.  Sometimes the tooth may need to be cut into smaller pieces to make it easier or removal.  Stitches may be necessary after the removal of a wisdom tooth.

A tooth that can not be saved with restorative materials may need to be removed.  Before removing your tooth, the area will be numbed with anesthesia.  The tooth is then loosened using a special dental instrument known as an elevator.  After it is loosened from the socket, it is gently removed by a forcep, a dental instrument commonly used in dental extractions.  Stitches may be necessary after the removal of a tooth.

Bone grafting is the replacement or enhancement of bone around teeth.  When a tooth is lost, the surrounding bone collapses.  Bone grafting is performed to reverse bone loss or enhance bone.  The bone can be taken from parts of the body or from synthetic material.  Bone grafting allows for proper support of dental implants or prostheses.

An impacted tooth is a tooth that fails to fully pass through the gums for various reasons.

Impacted wisdom and cuspid (or canine) teeth are fairly common.  To correct impacted teeth, there are a few treatment options.  For impacted wisdom, the most common procedure is extraction.  For impacted canine teeth, several treatment modalities are available.  Treatment can involve orthodontics (braces) to allow open spaces for proper eruption, a visit to the oral surgeon to remove over retained primary (baby) teeth or to surgically expose the tooth and place an orthodontic bracket to help bring it down into proper alignment.

Facial trauma involves injuries to the bone, teeth, skin, gums or other soft tissues.

Depending on the type of facial trauma sustained there are many different treatment options available.  However, the goal of treatment is to stop any bleeding from occurring, create a clear airway, repair any broken or fractured bone, and or suture any damaged soft tissue.  Treatment is immediate, as long as there are no neck fractures or life-threatening injuries.

A sinus lift is a surgery that adds bone to your upper jaw in the premolar and molar areas of your mouth . To add bone, an incision is made where the premolar and molar teeth were previously.  Once the bone is exposed, a small circular shape is made in the bone to access the sinus.  Once the sinus is accessed, the sinus membrane is gently pushed up and away from the upper jaw.  Once this is done, bone graft material is filled into the space where the sinus was previously.  Once the bone is in place, the incision is closed and the healing process begins.

Oral and maxillofacial pathology refers to the diseases of the mouth and the jaw.  Treatment options vary based on the patient’s specific needs.

The temporomandibular joint (TMJ) is similar to a sliding hinge that connects your jawbone to your skull.  TMJ disorders can cause pain in the jaw joint and in the muscles that control jaw movement.

To treat TMJ disorders, first the cause has to be identified.  In less severe cases TMJ disorders can be treated with self-managed care (easting soft foods, using ice packs, avoiding extreme jaw movement) or nonsurgical treatments (anti-inflammatory medications, Botox injections, stabilization splints).  In severe cases surgical treatments (jaw joint replacements) may be necessary.

TMJ conditions fall into three main categories:

1. Myofascial pain which involves discomfort or pain in the muscles that control jaw function.
2. Internal derangement of the joint that can mean a displaced disc, dislocated jaw, or injury to the condyle.
3. Arthritis which is degenerative inflammatory disorder.

Orthognathic surgery is done to correct misalignments or other abnormalities in the upper jaw and lower jaws.

Orthognathic surgery can involve surgical procedures such as an osteotomy (bone cutting), bone grafts, or distraction osteogenesis (stretching of the bone) and orthodontic (braces) care.  Orthognathic correction is conducted in stages, and the course of treatment can last a few months up to one year or more.

In order to perform the procedure successfully, the jawbones will be repositioned in accordance with one’s specific needs.  Inconspicuous incisions are usually made inside, and if needed, outside the mouth to allow for surgical plates, screws, wires and rubber bands to be used to hold your jaws in their new positions.

Cleft lip is an opening/split in the upper lip and cleft palate is an opening/split in the roof of the mouth (palate).  Cleft lip and cleft palate result when these developing facial structures in an unborn baby do not close completely.

A series of surgeries can restore normal function and achieve a more normal appearance with minimal scarring.

A cleft lip is usually repaired between the ages of 3 to 6 months. Some children require a lip adhesion or a device such as a molding plate to bring the parts closer together before the full lip repair. A child with a cleft lip that is repaired will have a scar on the lip under the nose.

A cleft palate is usually repaired between 9 and 12 months of age. To repair the palate, the soft palate muscles from each side are connected to each other and the normal barrier between the mouth and nose is created.

Additional surgeries are needed to improve the appearance of the lip and nose, close the opening between the mouth and nose, help breathing, and stabilize and realign the jaw. Once the permanent teeth grow in, braces are often needed to straighten the teeth.

Sleep apnea is a disorder in which one experiences one or more pauses in breathing or shallow breaths while you sleep.

Sleep apnea is an ongoing condition that disrupts sleep.  When breathing is paused or becomes shallow, one will often move out of deep sleep and into light sleep, making the quality of sleep poor.

Sleep apnea can be treated with lifestyle changes, mouthpieces, breathing devices, and/or surgery.

For mild sleep apnea, a custom fitted mouth piece or some lifestyle changes (weight loss, smoking cessation, clearing nasal passages) may be helpful.

For moderate to severe sleep apnea, a breathing device called CPAP (continuous positive airway pressure) or surgery to widen the breathing passages by shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw may be helpful.  A CPAP machine uses a mask that fits over your mouth and/or nose and gently blows air into your throat.  This air pressure helps keep your airway open while you sleep.  Surgery to shrink the tissue involves a small shot into the breathing passages.  Surgery to stiffen excess tissue requires a small incision in the tissue and inserting a piece of stiff plastic.

Facial cosmetic surgery is performed to correct physical malformations of the face.

The following are some of the facial cosmetic surgeries performed:

• Cheekbone Implants
• Chin Surgery
• Ear Surgery
• Eyelid Surgery
• Facelift
• Facial and Neck Liposuction
• Forehead/Brow Lift
• Lip Enhancement
• Nasal Reconstruction

Platelet Rich Plasma (PRP), a growth factor, is a mixed gel that can be applied directly into tooth sockets and other sites.  The use of PRP in tooth sockets after tooth extractions is capable of improving soft tissue healing and positively influencing bone regeneration.

Platelet-rich plasma (PRP) is a new approach to tissue regeneration.  PRP derives from the centrifugation of a patient’s own blood and contains growth factors that influence wound healing.  This is important in tissue repairing mechanisms.  The use of PRP in surgical practice could have beneficial outcomes, reducing bleeding and enhancing soft tissue healing and bone regeneration.

Anatomage, the latest in dental virtual reality is a 3D imaging software used in dentistry to detect, diagnose, and treat all types of dental procedures.  Anatomage imaging software offers a variety of imaging detail in every area of dentistry, from 3D hard and soft tissue reconstruction to impression- less virtual models of teeth.

An apicoectomy is a root tip surgery.  This procedure removes a tooth’s root tip to prevent further infection of the root.  To perform an apicoectomy, a small incision is made in the gum and bone over the tooth’s root.  After the root tip is accessed, it is cleaned and sealed with a small filling.  The gum is then stitched back into place with stitches.

Dental laser surgery uses a beam of intense light to correct dental problems.  The energy produced by the laser cuts or vaporizes the tissue it is concentrated on.  Laser surgery often means less discomfort, an easier and quicker recovery time and fewer shorter appointments.

Lasers have several uses for dental surgery.  Some common types of dental laser surgery include but are not limited to: dental cavities, root canals, gum surgery, dental abscess, biopsy, and treatment of lesions.

Gum reshaping or contouring is a procedure performed to reshape the gums if they rest too low or too high on your teeth. In order to reshape the gum tissue, a line is drawn to mark the new gum line.  Once approved, anesthesia is applied to the area and the contouring begins.  Then, a dental instrument (typically a scalpel or laser) is used to reshape the gum tissue and trim away any extra tissue overhanging the tooth.