TREATMENT

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.

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.  The bone graft type typically used by our office is cadaver bone from a bone bank that has gone through rigorous screening and treatment to remove potential antigens and pathogens.  This bone is usually mixed with Platelet Rich Plasma or saline and added to the extraction 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.

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.

A dental implant is essentially an artificial tooth root which is attached to the jaw bone.  Eventually, a replacement tooth or bridge will be firmly fixed to this root, restoring complete function to the tooth.  The key to a successful and long-lasting implant is the quality and quantity of jawbone to which the implant will be attached.  If bone has been lost due to injury or periodontal disease, a sinus augmentation can raise the sinus floor to allow for new bone formation.

In the most common sinus augmentation technique, a tiny incision is made near the upper premolar or molar region to expose the jawbone.  A small opening is cut into the bone and the membrane lining the sinus on the other side of the opening is gently pushed upward.  The underlying space is filled with bone graft material and the incision is closed.  The bone which is used for this procedure may be from your own body or from a cadaver.  Sometimes the dentist might use synthetic materials which can also stimulate bone formation.  The implants are placed after healing has occurred; this will depend on the individual case.  Sinus augmentation has been shown to increase the success of dental implant procedures.

The All-on-4^® treatment concept is a contemporary restoration that has revolutionized the way surgeons and dentists think of replacing a full set of teeth. Dentures are unsecured prostheses with very limited success. Most often, dentures are painful, inconvenient and unstable. Such dentures can make chewing foods difficult limiting the foods that you once enjoyed. Modern dentistry can help with the All-on-4^® treatment concept.

The All-on-4^® treatment concept replaces your missing teeth with a full dental bridge supported by only four dental implants. With less implants needed, overall treatment time and cost is reduced. The unique All-on-4^® treatment concept solution also ensures greater stability in the bone, reducing the need for bone graft surgery to increase bone volume.

Typically, a temporary set of teeth can be placed on the same day of surgery. The temporary teeth allow you to lead a normal life immediately after surgery. After a short healing period, your dentist will placed the final bridge. Your quality of life is improved, and you can start enjoying your favorite foods again with renewed confidence.

The All-on-4^® treatment concept offers you many advantages.

• A cost effective solution. Your new replacement teeth require only 4 implants for each jaw. With fewer implants required, the cost is lowered.
• Reduced need for bone grafting. The special tilting of two of the implants ensures a secure and stable anchorage for the replaced arch, typically making bone grafting unnecessary.
• Faster treatment and healing time. Your replacement arch can be attached to your implants immediately after insertion.

Scientifically proven and documented. All-on-4^® treatment concept is supported by good clinical outcomes from studies over a decade with favorable results.

Dental implants offer a natural looking replacement for adult teeth.  In addition, implants restore functionality to the jaw, making speaking, eating and chewing easier.  Most implants are comprised of a screw that is embedded into the bone, and a post, to which the prosthesis is attached.

Struamann implants are unique because the microsurface structure which is composed of sand blasted, large grit and acid etched surface which enhances the implant to bone interface and allow faster healing times.

Why should I choose Straumann dental implants?

There are a wide variety of dental implants in the marketplace, but Straumann have an almost unparalleled success rate.  Almost 98% of Straumann implants are fitted successfully and last for a lifetime.

Here are some of the other benefits associated with Straumann implants:

• Better oral health.
• Higher success rate.
• Improved self-esteem.
• Long-lasting results.
• Multiple Straumann implants can be placed during a visit.
• Natural-looking implants.
• No adhesives or mess.
• Prevention of bone loss and gum recession.
• Sturdy, functional prosthetic teeth.

How are Straumann dental implants placed?

The procedure for placing Straumann dental implants is similar to many other implant procedures.  It is usually performed in two short visits, the first visit being typically an hour in length and the second taking around thirty minutes.

After the dentist has analyzed the X-rays and diagnostic results, the implant root can be inserted.  This procedure will be performed under local anesthetic, unless another type of sedation is preferred.

Here is a step-by-step process for the first stage of a Straumann dental implant placement:

1. An incision will be made in the gum tissue to expose the jawbone.
2. A tiny hole will be drilled into the jawbone to insert the implant into.
3. The implant will be screwed or tapped into the designated position.
4. A small temporary stop-cap is placed to cover the implant, and the surgical site is sutured closed.
5. After approximately 10 days, the sutures will be removed or they will dissolve and the surgeon will assess the healing process.

Generally, Straumann dental implants enhance the healing process, which means that the second treatment phase can be completed around 10-12 weeks after the first.

When the healing process is complete, the new dental prosthesis (usually a crown) will be created from bite impressions.  A tiny screw will be used to secure the prosthesis onto the abutment.  Any necessary adjustments will be made to ensure the prosthesis is comfortable, and the Straumann dental implant will be secure for  potentially a lifetime.

If you have any questions about Straumann dental implants, please ask your surgeon or dentist.

An oral exam is routinely performed by the dentist during the course of an initial comprehensive exam and regular check-ups. An oral cancer exam refers to the identification and management of diseases pertaining to the maxillofacial and oral regions.

The soft tissue of the mouth is normally lined with mucosa, which is special type of skin that should appear smooth in texture and pink in color. Any alteration of the color or texture of the mucosa may signal the beginning of a pathologic process. These changes may occur on the face, neck, and areas of the mouth (e.g., gums, tongue, lips, etc.). The most serious of these pathologic changes (which may or may not be painful) is oral cancer, but there are also many other common pathologic problems.

Geographic Tongue – Also known as Benign Migratory Glossitis or Erythema Migrans, is a condition where the tongue is missing papillae (small bumps) in different areas, and a map-like appearance can develop. This condition is usually seen as red well defined areas on or around the sides of the tongue. The red patches (which can look like an unsightly rash) may come and go from hours to months at a time and cause increased sensitivity to certain substances.

Median Palatal Cyst – This cyst is of developmental origin and is essentially a fluid filled skin sac. It usually appears in the middle of the palate and may cause substantial discomfort.

Hairy Tongue – An overgrowth of bacteria or a yeast infection in the mouth which can cause the tongue to appear hairy and black. This condition is usually a result of poor oral hygiene, chronic or extensive use of antibiotics, or radiation treatments to the head or neck. It is often also seen in HIV positive patients and those who are intravenous drug users. Hairy Tongue may or may not require treatment.

Treatment of Pathological Diseases

In the majority of cases, the pathological changes experienced in the oral region are uncomfortable and disfiguring, but not life threatening. However, oral cancer is on the rise (especially among men) and the chances of survival are around 80% if an immediate diagnosis is made.

Oral cancer is a general term used when referring to any type of cancer affecting the tongue, jaw, and lower cheek area. Since it is impossible for the dentist to decisively diagnose a pathological disease without taking a biopsy sample of the affected area, seeking immediate treatment when changes are first noticed might be a life and death decision. For less serious problems, there are several options available, such as:

• Antibiotics – In the case of a bacterial infection or persistent soreness, the dentist may prescribe a dose of antibiotics to return the mucosa to its natural state. This will alleviate soreness and discomfort.
• Diluted Hydrogen Peroxide – When poor oral hygiene is causing changes to the soft tissue, the dentist may prescribe a diluted hydrogen peroxide mouthwash. This will kill more bacteria than regular mouthwash and improve halitosis (bad breath).
• Oral Surgery – If the patient has cysts or abnormal non-cancerous growths, the dentist may decide to completely remove them. This can improve comfort levels, alleviate breathing problems, and make speech substantially easier depending on the location of the cyst.

Oral Examinations

During the course of a regular check up, the dentist will thoroughly inspect the soft tissue of the mouth and take serious note of any changes. If there are cell changes present, the dentist will take a biopsy of the affected area and send it away to be analyzed by laboratory specialists. When definitive results are obtained, the dentist can decide on the best course of treatment.

Oral Cancer Screenings

An oral cancer screening is usually performed during a comprehensive or recall (check-up) exam. Screening is painless and only takes a few minutes. The dentist or hygienist will use a laser light to assess the soft tissue for cell changes that might be indicative of oral cancer. If such cell changes are present, a small biopsy will be taken and sent to a laboratory for review. If the biopsy indicates that oral cancer is present, an excision (removal) will generally be performed.

If you are experiencing any pain or symptoms that cause you concern, we encourage you to contact us today to schedule an appointment.

Humans have two upper (maxillary) canines and two lower (mandibular) canines. Canine teeth are sometimes referred to as cuspids, fangs, or “eye teeth” because of their direct positioning beneath the eyes. Canine teeth have thicker and more conical roots than incisors and thus have an especially firm connection to the jaw. Canine teeth often have the longest root of all teeth in the human mouth and are the last to fully erupt and fall into place, often around age 13.

An impacted tooth essentially means that it is blocked, stuck, or unable to fully erupt and function properly. Third molars (wisdom teeth) most commonly fall victim to impaction, but the upper canine is the second most common tooth to become impacted. Wisdom teeth serve no important function in the mouth and are frequently removed; however, impacted canines are a critical condition and require treatment for the following reasons:

• Closing Gaps – Canines are the last of the front teeth to fall into place and therefore close any unsightly gaps between the other upper teeth.
• First Touch – Canines play a vital role in the “biting” mechanism of the teeth. They touch first when the jaw closes, and guide the other teeth into position.
• Proper Alignment & Function – Canine teeth are essential to the correct alignment and function of the other teeth on the dental arch. Missing or impacted canines can greatly affect the function and aesthetic appearance of the smile.

What causes canine teeth to become impacted?

There are several main causes for impacted canine teeth:

Extra Teeth – If extra teeth are present, the natural eruption of the canine teeth may be inhibited. The eruption progress of the canine may be directly blocked by an extra tooth or the subsequent overcrowding might leave no room on the dental arch for the canine.

Overcrowding – In some cases, poor alignment of the front teeth can lead to overcrowding. The existing teeth compete for space which means that the canines do not have sufficient room to become functional.

Unusual Growths – On rare occasions, unusual growths on the soft tissue of the gums can restrict the progress of canine teeth, which leads to later impaction.

Early and thorough examination of the teeth can pre-empt problems with impacted canines. It is important for the dentist to document the number teeth present when the patient is around 7 years of age in order to record the presence or absence of canine teeth. The older the patient becomes, the less likely it is that an impacted canine tooth will erupt naturally. If canine teeth are missing or very slow in fully erupting, the dentist can make recommendations for proper treatment.

Oral Examination

The dentist initially conducts a thorough visual examination of the teeth, accompanied by a panorex x-ray and/or individual x-rays. Once the cause of the impaction has been determined, there will be several treatment options available depending upon the age of the patient. The objective is to aid the eruption of the impacted canines, and this can be skillfully done by the dentist, an oral surgeon, or an orthodontist.

What does the treatment of impacted canines involve?

If your mouth is overcrowded for any reason, the dentist may recommend extraction of teeth. The extraction will generally be performed under local anesthetic by an oral surgeon. The un-erupted canine will then be exposed by lifting the gum, and guided into place using a special bracket.

In the case of younger patients, an orthodontic brace may be fitted to create a space on the dental arch for the impacted canine. Surgery for impacted canines usually does not require an overnight stay. Pain medication will be prescribed as necessary, and you’ll be given post treatment advice for your recovery.

A frenum is a naturally occurring muscle attachment, normally seen between the front teeth (either upper or lower). It connects the inner aspect of the lip with the gum. A lack of attached gingiva (the pink gum tissue that is directly adjacent to teeth), in conjunction with a high (closer to the biting surface) frenum attachment, which exaggerates the pull on the gum margin, can result in recession. Additionally, an excessively large frenum can prevent the teeth from coming together, resulting in a gap between the front teeth. If pulling is seen or the frenum is too large to allow the teeth to come together, the frenum is surgically released from the gum with a frenectomy. A frenectomy is simply the surgical removal of a frenum.

When orthodontic treatment is planned or initiated, the removal of an abnormal frenum, with or without a gingival graft, can increase stability and improve success of the final orthodontic result.

Mandibular (lower jaw) and maxillary (upper jaw) tori are benign overgrowths of bone on the inner surface of the mandible or on the roof of the mouth. This normal anatomical feature is present in people for a lifetime without any indication for surgical removal. However, there are times when they have to be removed to facilitate the construction of complete of partial dentures. Many times the presence of these bony overgrowths makes adequate retention of dentures difficult or even impossible. The removal of tori is generally a procedure that is performed in the office with local anesthesia, IV sedation or general anesthesia.

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 anterior incisors lie significantly behind the upper anterior 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 dental and facial 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.