When one of your teeth can no longer be saved, we will extract it gently and without pain.
Prior to your dental surgery you will have the opportunity to address any concerns you might have during your pre-op appointment. We encourage you to ask questions and make us aware of any fears you might have. Our main goal is to create a secure, comfortable environment for our patients on the day of surgery so the more you communicate with us, the easier we can accommodate your needs. The following guidelines are meant to serve as reminders in helping you prepare for your dental surgery. If you have any questions, feel free to contact our practice.
Leading Up to the Day of Surgery
- Fasting must begin at midnight the night before surgery for patients with a morning appointment. If you have an afternoon appointment, do not eat anything 8 hours prior to your scheduled dental surgery.
- While fasting, the patient may only drink clear fluids (Ex: water, apple juice, black coffee, and sports drinks). Beverages that are not allowed to be consumed are alcohol, orange juice, milk, creamer, and other opaque drinks. Patients should avoid drinking all fluids within 6 hours of their surgery. If you are unsure about what can and cannot be consumed, please ask during your pre-op appointment.
- Patients may continue taking the following medications with a small sip of water prior to surgery:
- Cardiac medications
- Pulmonary medications
- Anti-seizure medications
- Anti-Parkinson's medications
- Medications that patients are prohibited from taking are MAO inhibitors, anti-depressants, aspirins, anti-coagulants, and anti-inflammatory drugs. We request that patients stop taking these medications at least two days prior to surgery because they can create complications during dental surgery.
- Patients are not to consume alcoholic beverages or use tobacco products within 24 hours of their appointment and are asked to refrain from drinking or smoking for 24 hours after their surgery.
Day of Surgery
- If you are a minor, you must have a parent or guardian present for the extent of your surgery. All patients are required to have a licensed driver take them home after their appointment, and we prefer that you are accompanied by someone for at least 12 hours after your surgery.
- Brush your teeth as usual, but be sure not to swallow any water or toothpaste. Do not wear any make up or nail polish.
- If you regularly wear contact lenses, please remove them prior to surgery. Jewelry and dentures will also need to be removed before surgery.
- We prefer that you wear loose, comfortable clothing and flat soled shoes. Shirts that have ¾ sleeve or shorter are ideal.
- After surgery, you will not be fully aware, therefore cannot return to work or school, and cannot drive or operate other hazardous devices. Also, please make sure that you have assistance when climbing stairs or attempting other difficult tasks.
If you have any change in health the morning of you appointment, please contact the practice immediately. A cold or fever with chest and sinus congestion may dangerously affect surgery so it is imperative that our practice is made aware of the situation. If it is necessary to reschedule your appointment, we will notify you.
Orthognathic surgery refers to the surgical correction needed to fix substantial abnormalities of the maxilla (upper jaw), the mandible (lower jaw), or both. The abnormality may be a birth defect, a growth defect, or the result of traumatic injuries to the jaw area.
Orthognathic surgery is generally performed by an oral and maxillofacial surgeon to correct malocclusion (bad bite) in cases where routine orthodontic treatment has not or will not be effective. Orthognathic surgeries include the reconstruction of the mandible or maxilla, mandibular ramus, maxilla osteotomy, and mandibular osteotomy.
There are several classifications of malocclusion (the improper coming together of teeth) which may require orthognathic surgery:
Class I Occlusion - This malocclusion means that the lower anterior incisors sit directly behind the upper anterior incisors when the patient bites down. This is considered less destructive than Class II and Class III malocclusions.
Class II Malocclusion - This is identified when the lower incisors lie significantly behind the upper incisors during the biting process, in some cases hitting the soft tissue behind the upper incisors. This is commonly referred to as an overbite and can cause discomfort, bone damage, excessive wear of the front teeth, and tooth loss.
Class III Malocclusion - This is commonly known as an underbite and occurs when the lower anterior incisors and lower jaw are positioned beyond the upper teeth, making the lower jaw much more prominent than the upper jaw.
Reasons for orthognathic surgery
The malocclusion of the teeth can create greatly destructive forces among the five powerful muscles that control the closing and opening of the jaw. These muscles generate a tremendous force when clenching, grinding or chewing. Misalignment can seriously damage the function and aesthetic appearance of the teeth in many ways if left untreated, such as:
- Tooth Wear - In the case of an overbite, the pressure and wear on the teeth is not spread evenly. This can also lead to TMJ, migraine headaches, and tooth loss.
- Chronic Jaw, Muscle Pain & Headache - The misalignment of the teeth alters the way the facial muscles interact. In some cases, the meniscus cartilage, which acts as a buffer between the jawbones, can be painfully damaged.
- Loose Teeth - When uneven pressure is continually exerted in unintended places or soft tissue is damaged by an overbite, adjacent teeth may become loose in their sockets which causes pain and reduces proper function.
- Tooth Sensitivity - As teeth become damaged by constant use, the enamel becomes thinner and the nerves are less protected. This lack of protection can lead to sharp pains when hot or cold foods are eaten.
- Difficulty Swallowing, Chewing, or Biting Food - Each can be associated with muscle pain and/or poor alignment of the upper and lower jaws.
What does orthognathic surgery involve?
When the dentist identifies a patient as a candidate for orthognathic surgery, a complete photographic analysis is initially undertaken. This includes panorex x-rays, cephalometric x-rays, models, impressions, and radiographs. Your oral & maxillofacial surgeon, your orthodontist and your dentist will work together and consider how the corrective surgery will impact both proper jaw function and the aesthetic appearance of the entire face.
Generally, orthodontic braces are necessary to align the arches and straighten the teeth prior to the surgery, and additionally, retainers may be used after the surgery. During maxillary surgery, the upper jaw is moved and may be secured in position using tiny plates, wires, rubber bands and screws. Surgery on the mandible is performed using bone grafts to align the lower jaw into the correct position. Orthognathic surgery generally requires a general anesthesia and a good deal of aftercare. Pain medication will be prescribed as necessary, and you'll be given post treatment advice for your recovery. You may also be provided with a modified diet (if required).
Oral & Maxillofacial Surgeons are specialist trained to manage and treat facial trauma. There are an infinite number of ways in which the face can be damaged and thus need some type of reconstruction. Accidents, falls, automobile crashes, and interpersonal violence are among the most common causes. Some of the main types of facial injuries resulting from these instances are lacerations, fractured teeth, fractured jaws, fractured facial bones, knocked-out teeth, and intraoral lacerations.
There are three main classifications used by health professionals in their trauma assessment:
- Soft Tissue Injuries - Soft tissue trauma includes lacerations to the skin and any kind of intraoral (gum) damage.
- Avulsed (knocked out) Teeth - Injuries to the teeth are very common and must be dealt with immediately to insure success of reimplantation.
- Bony Injuries - This category encompasses the entire face including fractured cheekbones, jaw bones, eye sockets, palates, and noses.
- Special Regions - Special regions refers to the nerves in the face, the eyes, and the salivary glands.
Reasons for Facial Trauma Reconstruction
Aside from the obvious aesthetic reasons for repairing damage to the face, there are also a number of serious health and dental concerns that can arise from even a small amount of trauma. No facial injury should be taken lightly. Depending on the exact location of the injury, respiration, speech and swallowing can be greatly impaired.
Though broken facial bones are generally treated in the emergency room, damage to the teeth can be quickly dealt with by your dentist. Failure to treat facial and dental trauma can lead to the following longer term problems:
- Loss of Functionality: When teeth have fallen victim to trauma, they may become loose in their sockets and make eating and speaking much more difficult.
- Smile Aesthetics: Chipped, broken or missing teeth can be detrimental to a beautiful smile. Your dentist is able to repair chips, fractures and missing teeth easily.
- Bite/Jaw Irregularities: After trauma, it is possible that the teeth will become badly aligned. The poor alignment of the teeth can lead to TMJ, uneven teeth wear and other complications.
What does correcting facial trauma involve?
If facial bones have been fractured or broken, they will be treated in much the same way as any other broken bone. Of course, a plaster cast cannot be applied to a cheekbone, but the bones can be held firmly together by either wiring or the insertion of small plates and screws. Soft tissue lacerations will be treated immediately by way of suture (stitching).
In cases where a tooth has been knocked cleanly out of the mouth, there is still a possibility of reinserting it. The quicker a re-insertion can be performed by your dentist, the greater the likelihood that the natural tooth will survive. In the event that the tooth lacks the ligaments necessary for reinsertion, your dentist can implant a prosthetic tooth to restore both functionality and aesthetic appearance. Your dentist can also splint displaced teeth using structural support such as bonding or wiring with a good amount of success. Root canal therapy is also a possibility for loose or broken teeth.
Your dentist will conduct a thorough examination and take various x-rays in order to determine the precise condition of the afflicted area and plan a course of action. Pain medication will be prescribed as necessary, and you'll be given post treatment advice for your recovery.
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.
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.
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.
Root amputation is a specialized dental procedure, whereby one root is removed from a multi-root tooth. The tooth is then stabilized and rendered fully functional with a crown or filling. The multi-root teeth best suited to the root amputation procedure are the molars at the back of the mouth. These large flat teeth have either two or three roots depending on whether they are situated on the upper or lower jaw.
The general purpose of root amputation is to save an injured or diseased tooth from extraction. Most dentists agree that there is no better alternative than retaining a healthy natural tooth, and the root amputation procedure makes this possible. Dental implants, extensive bridgework and custom-made tooth replacements can be expensive and time-consuming. Generally, root amputation and the necessary crown work are less expensive and can be completed in 1-3 short visits.
When is root amputation necessary?
It is important to note that root amputation can only be performed on an otherwise healthy tooth. Even in the case of a key tooth, extraction will be performed if the tooth is diseased, badly fractured or otherwise injured. Suitable teeth for root amputation have a healthy tooth surface, strong bone support and healthy underlying gums.
There are several problems that may lead to root amputation including:
- Broken, fractured or injured teeth and roots.
- Embedded bacteria within the structure of the root.
- Severe bone loss in a concentrated area due to periodontitis.
- Tooth decay in a concentrated area of the tooth.
What does root amputation involve?
Prior to root amputation, it is necessary to perform root canal treatment. The amputation itself involves cutting deep into the tooth where blood vessels and nerves are located. For this reason, the pulp of the tooth including these vessels and nerves needs to be removed before resectioning the roots. The root canal and amputation treatments will be performed under local anesthetic.
During the root amputation procedure, a small incision will be created in the gum to fully expose the roots of the affected tooth. The root will be sectioned off from the rest of the tooth and then removed. To kill any remaining bacteria, the whole area will be cleansed with saline solution, and then sutures (stitches) will be applied to seal the incision.
Finally, a temporary crown or filling will be placed to secure the tooth. Depending on the specific situation, painkillers, antibiotics and a medicated anti-microbial mouthwash may be prescribed. In 7-10 days, the stitches will be removed and the gum will have healed. Arrangements can now be made to place the permanent crown or filling.
If you have any questions or concerns about root amputation, please ask your dentist.
Pocket reduction surgery (also known as gingivectomy, osseous surgery and flap surgery) is a collective term for a series of several different surgeries aimed at gaining access to the roots of the teeth in order to remove bacteria and tartar (calculus).
The human mouth contains dozens of different bacteria at any given time. The bacteria found in plaque (the sticky substance on teeth) produce acids that lead to demineralization of the tooth surface, and ultimately contribute to periodontal disease.
Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area (below the gum line). Gum pockets form and deepen between the gums and teeth as the tissue continues to be destroyed.
Periodontal disease is a progressive condition which, if left untreated, causes massive bacteria colonization in gum pockets and can eventually cause teeth to fall out. Pocket reduction surgery is an attempt to alleviate this destructive cycle, and reduce the depth of the bacteria-harboring pockets.
Reasons for the pocket reduction surgery
Pocket reduction surgery is a common periodontal procedure which has been proven effective at eliminating bacteria, reducing inflammation and saving teeth. The goals of pocket reduction surgery are:
Reducing bacterial spread - Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize. It is important to decrease bacteria in the mouth in order to reduce the risk of secondary infection.
Halting bone loss - The chronic inflammatory response induced by oral bacteria leads the body to destroy bone tissue. As the jawbone becomes affected by periodontal disease, the teeth lose their rigid anchor. When the teeth become too loose, they may require extraction.
Facilitate home care - As the gum pockets become progressively deeper, they become incredibly difficult for the patient to clean. The toothbrush and dental floss cannot reach the bottom of the pockets, increasing the risk of further periodontal infections.
Enhancing the smile - An oral cavity that is affected by periodontal disease is not attractive to the eye. In fact, smiles may be marred by brown gums, rotting teeth and ridge indentations. Pocket reduction surgery halts the progression of gum disease and improves the aesthetics of the smile.
Before recommending treatment or performing any procedure, the dentist will perform thorough visual and X-ray examinations in order to assess the condition of the teeth, gums, and underlying bone. Pocket reduction surgery can be performed under local or general anesthetic depending on patient preferences.
The gums will be gently pulled back from the teeth and bacteria and calculus (tartar) will be eliminated. Scaling and root planing will generally be required to fully remove the tartar from the surface of the tooth root. If the root is not completely smooth, a planing procedure will be performed to ensure that when the gums do heal, they will not reattach to rough or uneven surfaces.
The final part of the surgery is usually the administration of an antimicrobial liquid to eliminate any remaining bacteria and promote healing. The gum is then sutured with tiny stitches that are left in place for 5-10 days.
Though the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.
If you have any questions about pocket reduction surgery or treatment for periodontal disease, please contact our practice.
Ridge modification is an effective procedure for treating deformities in the upper and lower jaws. These deformities can occur as a result of periodontal disease, trauma, injury, wearing dentures, or developmental problems. Such defects can leave insufficient bone for the placement of dental implants and an additional unattractive indentation in the jaw line adjacent to the missing teeth.
During the ridge modification procedure, the gum is lifted away from the ridge to fully expose the defect in the bone. The bony defect can be filled with bone graft material that can help regenerate lost bone or a bone substitute. Finally, the incision is closed and several months of healing will be required. Depending on the case and type of implant and procedure, the dental implant might be placed during the ridge modification procedure or when healing is complete; this all depends on the condition of the bone. Ridge modification improves the cosmetic appearance, functionality of the mouth, and the chance of enjoying dental implants for many years.