Surgical Dentistry

Extractions

A tooth extraction might be indicated if repairing a damaged tooth is not practical. There are a number of reasons why your dentist might recommend that you have a tooth, or even several teeth, extracted.

  • Broken, cracked, or extensively decayed teeth
    For teeth that have extensive decay (dental caries) or have broken/cracked in an extreme manner, extraction might be considered the best, or at least a reasonable, solution.
  • Teeth that are unsuitable candidates for root canal treatment
    Some teeth may require treatment of the nerve space that lies within them (root canal treatment) in order to save the tooth. While most teeth typically are candidates for root canal treatment, there can be complicating factors that eliminate this option.
  • Teeth associated with advanced periodontal disease (gum disease)
    In general, as periodontal disease worsens, a tooth is supported by less and less surrounding bone, often to the point where the tooth becomes loose. In those cases where significant bone loss has occurred and a tooth has become excessively mobile, extraction of the tooth may be the only option.

Wisdom Teeth Removal

Though we can deal with wisdom teeth removal at any stage of development, you would be wise to undergo wisdom teeth removal at the appropriate time in their development (age 13-18), prior to the complete formation of the roots. Our digital x-ray and CAT SCAN can assess the status of your wisdom teeth, allowing us to accurately advise you about the timing of the procedure.

Why do we have wisdom teeth?implant2

  • Evolution and genetics are the primary factors which have caused some 90% of the earth’s population to not have enough room in their mouths to allow the wisdom teeth, the third molars, to come in as normal healthy teeth.
  • Evolution over millions of years has been put forward as one cause, theoretically, and scientists speculate that as the human diet has changed, we have developed smaller jaws.
  • Genetics may also be a factor as we inherit large teeth from dad and a small jaw from mom.  The tooth size and jaw size discrepancy is what leads to both crooked teeth and inadequate room for the wisdom teeth.
  • Toward the end of high school, the last molars begin to erupt, pushing up through the soft gums.  Your teenager’s “Age of Wisdom” and the concurrent eruption of the last molars, has given them their popular name.

Why do we need wisdom teeth removal surgery?

  • Pain
    Pain is the great motivator that propels patients to seek removal of their wisdom teeth, and this pain is usually accompanied by jaw stiffness and swelling.  As the wisdom teeth begin to erupt, bacteria and food can accumulate under the gum and cause this problem. Undergoing wisdom teeth removal before the teeth start hurting is the best approach.  Even when there is enough room in your mouth for the wisdom teeth, they are difficult to get to with a tooth brush and frequently become decayed, infected, and painful later on. Your dentist can help to advise you of the correct timing for the removal of your wisdom teeth with an examination and x-ray.
  • Crooked Teeth
    If you have worn braces or need to wear braces, chances are you won’t have room for your wisdom teeth to come in as normal, healthy teeth. Even if you have straight teeth now, the eruption of the wisdom teeth in the back of your jaw can push and crowd the teeth in the front. Once this happens, braces are the only way to correct the problem.
  • Cysts and Tumors
    All teeth develop in a sack inside the jaw, and this fluid-filled sack disappears when a tooth breaks through the gum.  However, a trapped wisdom tooth sack can continue to grow and destroy bone in the jaw and can even cause the bone to fracture while under the stress of chewing.  Other tumors develop around the impacted teeth, such as keratocysts, ameloblastomas, and even rare cancers.  Treatment is then extensive and could have been avoided with early detection of impacted wisdom teeth.

What are impacted wisdom teeth?
When a wisdom tooth is blocked from erupting, it is termed “impacted.” Wisdom teeth impacted in the gum tissue overlying them are called soft tissue impactions. Occasionally, these impacted teeth (and even some fully erupted teeth) can be more difficult to remove than your dentist expects or predicts because of root curvatures that are not fully seen on x-rays or because of other anatomical conditions. Wisdom teeth are more commonly still encased in some bone, which is called a partial or full bony impaction. They are either only partially exposed in the mouth or completely under the gum surface and identifiable only on an x-ray.  These complicated issues make the extraction difficult, however, our doctors consider all factors, including age, jaw size, body type, gender and level of anxiety, to make your procedure as easy as possible for you.

How does the wisdom teeth removal process work?
Wisdom teeth removal begins by making a window in the gum so that the top of the tooth can be seen.  Most teeth are removed in pieces to avoid making a large and more painful incision. Usually only one-2 stitches are required to close the window in the gum. The stitches may fall out on their own, however you will be scheduled for a one week post-operative visit. It is recommended that IV anesthesia be used in most cases for the removal of wisdom teeth.  Local anesthesia is used after you are asleep so that you will be comfortable after you wake up.

What are the risks involved with wisdom teeth removal?
Wisdom teeth removal is a common procedure, but complications can occur.  The following are potential complications that the patient should understand:

  • Infection
    This is NOT a common complication, but can occur as late as 3-4 weeks following surgery.  Swelling and pain are indications of infection and should be reported to your doctor immediately.
  • Dry Socket
    There is a 5-10% risk of this complication.  Dry socket is a term used to describe a breakdown in the healing process following tooth removal, and the problem generally starts 3-4 days after oral surgery.  Dry sockets respond to treatment rapidly in most cases.
  • Nerve Injury
    There is less than a 1% chance of this complication.  Nerves that are in the jaw can become swollen or damaged during wisdom teeth removal, causing the loss of sensation in the lower lip, chin, or tongue.  Occasionally the ability to taste can be altered.  Your risk for this complication depends on the position of the tooth and your specific jaw and nerve anatomy.  Most patients are at a low risk for this complication.
  • Sinus Perforation
    This is NOT a common complication.  The roots of the upper wisdom teeth are close to the maxillary sinus, and perforation of the sinus can cause a sinus infection or a persistent fistula that may require closure with a second surgery at a later date.
  • Tooth Damage
    Adjacent tooth restorations may be damaged during the removal of a wisdom tooth, but this is usually due to dental decay that is already under the restorations, indicating that the teeth are already in a state of failure.
  • Incomplete Removal
    Occasionally, root tips remain after the removal of the wisdom teeth.  Sometimes it is prudent to leave a portion of the root if it is close to the sinus or the nerves in the jaw.  These roots can been seen on dental x-rays, but very seldom cause any problems afterward.

Wisdom Teeth Removal: Pre-Surgical Consultation
It is important for you to be comfortable and fully informed regarding your decision to have your wisdom teeth removed. We will schedule a Pre-Surgical Consultation with your doctor before your surgery appointment.

 

Bone Grafting Procedures

Replacement teeth supported by dental implants function so well and last so long because, like natural teeth, they are securely anchored in the jawbone for maximum support. In order to benefit from this remarkable technology, however, you need to have enough tooth-supporting bone in your jaw to hold a dental implant in place. Unfortunately, after tooth loss, the surrounding bone almost always deteriorates — decreasing in width, height and density — and this process starts immediately. The longer a tooth has been missing, the more the bone that used to surround it resorbs (melts away). If you want a dental implant but don’t have enough bone to support it, can anything be done? Yes. Very often you can still get the replacement tooth you want, thanks to routine bone grafting procedures.

How It Works
Bone grafting, normally a minor surgical procedure done in the dental office, is used to build up new bone in the area of your jaw that used to hold teeth. A small incision is made in your gum to expose the bone beneath it, and then grafting material is added. Most often, the grafting material is processed bone that serves as a scaffold, around which your body will actually deposit new bone cells. The grafting material will eventually be absorbed by your body and replaced by your own new bone.

The grafting material needed can come from a variety of sources. Sometimes it comes from your own body. Very often, however, it is bone from an animal or human donor that is processed by a laboratory to make it sterile and safe. Grafting material can even be synthetic. It comes in a variety of forms: powder, granules, putty or even a gel that can be injected through a syringe.

What to Expect
The procedure for placing a bone graft usually requires only local anesthesia, though oral or IV sedatives can also be used to achieve a higher state of relaxation. Because a small incision in your gum tissue needs to be made to access the underlying bone that will receive the graft, you may experience some soreness in the area after the surgery; this can usually be managed by over-the-counter anti-inflammatory medication and/or pain relievers as well as ice therapy after the procedure. Though you will soon feel completely back to normal, it may take your body up to seven months for bone maturation to take place to receive your dental implant. The waiting time allows the healing process enough time to achieve the desired result: ideal support for replacement teeth that look great and will last a lifetime.