Oral Surgery Procedures
Wisdom Tooth Removal (3rd Molars)
Wisdom teeth, also known as third molars, are the molars that the furthest back in the upper and lower jaws. The last to develop, if they grow in at all, wisdom teeth usually erupt when you are “older and wiser,” between 16 and 20 years of age. Many times these teeth become “impacted” or trapped in the jaw and will not fully erupt, potentially causing more serious problems.
What problems can wisdom teeth cause?
- Damage to Adjacent Teeth
- Periodontal Bone Loss and Pockets
- Cysts and Tumors
- Jaw Joint (TMJ) Problems
- Crowding or Shifting of Teeth
Not all wisdom teeth have to be removed. Wisdom teeth that have grown fully into the mouth, are surrounding by normal health gum tissues and can be easily cleaned and maintained may not require removal. However, any wisdom teeth, including fully erupted ones, that cannot be maintained should be removed.
At your first appointment, Dr. Johnson will complete a thorough oral examination and review of your current panoramic x-rays (less than one year old) which will allow us to determine if the wisdom teeth should be removed and the timing of their removal. In most cases, In most cases, if wisdom teeth are ready for removal, all should be done at one surgical appointment. If it is determined that surgery is indicated, the procedure will be discussed with you, along with anesthesia choices that are available. After meeting with Dr. Johnson, you will be able to discuss appointments and insurance benefits with a trained staff member.
For more information on wisdom teeth, please visit our page on Wisdom Teeth.
It is estimated by the American Association of Oral and Maxillofacial Surgeons that more than 40 Million American over the age of 55 have lost some or all of their teeth due to decay or periodontal disease. As Americans live longer, many will face years or decades of complete or partial toothlessness. Others, often younger, will lose teeth for the same reasons, or due to traumatic injuries where teeth are knocked out and the surrounding bone is damaged and lost.
Dental implants are metallic devices that replace the roots of missing teeth, so that dental implant crowns or bridges can be placed, or are placed as anchors to support and stabilize loose dentures.
Dental implants are usually manufactured from a medical grade space-age metal called titanium, which heals very well when placed in human tissues. In addition to being used in dental implants, titanium is used in the manufacture of such devices as hip, knee and other joint replacements, bone plates, and some artificial heart valves. There are many types and brands of dental implants available, so it is important to choose an implant that is manufactured by a reputable company, and that has a design and surface quality that encourages healing.
After being placed in the jaw bones in a very precise, implants heal by a process called OSSEOINTEGRATION. This means that the specially designed porous surface of the implant and the nature of titanium allow it to actually attract bone forming cells to shift from the jaw bone into the implant itself, forming bone that anchors the implant in place. In most cases, this requires several months of healing prior to placement of crowns, bridges or dentures.
For more information, please visit our Dental Implants page.
Impacted Tooth & Tooth Exposure
An impacted tooth is a tooth that is growing in the jaw in such a way that it is trapped and can not grow in and be a functional tooth. The most commonly impacted tooth is the wisdom tooth, but any other tooth in the mouth can develop as an impacted one, including eye teeth (cuspids), bicuspids and lower 12 year molars are the next most common.
To correct impacted teeth, there are a few treatment options. For impacted wisdom teeth, the most common procedure is extraction. For impacted canine teeth, several treatment modalities are available. Orthodontics (braces) can be used to open space for proper eruption. Primary (baby) teeth can either be extracted or surgically exposed to allow for the placement of an orthodontic bracket to help align the teeth.
- Impacted teeth are classified according to the position of the crown in the bone and into 4 main categories:
- Soft Tissue: A tooth covered by gum tissue, and positioned so that they can not grow in.
- Partial Bony: A portion of the crown is trapped in or covered by bone.
- Full Bony: Most or all of the crown is covered by bone.
Impacted teeth are further classified as to their angulation in the bone and positions relative to the roots of adjacent teeth. Each of these factors affects the potential difficulty and what must be done to remove the teeth.
In our office bone grafts are most commonly used to preserve or lost bone in preparation for placement of dental implants. After the extraction of teeth, the bone (called alveolar bone) forming the sockets has no further function, and immediately begins a shrinkage process call resorption.
The area will heal, the bone left behind may be too thin for dental implants in the future.Also, at the time of tooth removal, bone may have to be removed in order to remove the tooth. This can accelerate and worsen the shrinkage process. If left to heal without bone replacement or preservation procedures, the healing time after extractions before implant placement is much longer and there may not be adequate bone width for implants.
Generally, bone grafts are placed in one of 3 ways to prepare for future implant placement:
Socket Preservation or Bone Replacement Grafts: These grafts are placed into an extraction site at the time of tooth removal to preserve bone width and height. These grafts are also used to restore the bone that may have been removed during an extraction. After a healing period, implants may often be placed into these sites.
Augmentation Graft: These grafts are used to build up the width or height of shrunken extraction sites to recreate lost bone. Generally, a healing time of 6 months or more is required before implants.
Sinus Lift Graft: By creating a “window” into the sinus cavities, a bone graft can placed to increase the bone height to allow for a implants of proper length to be placed. Sometimes, implants can be placed simultaneously, but, if there is not sufficient for stabilization of implants, the grafts are allowed to heal for as much as 6 months before implants are subsequently placed.
There is a wide variety of bone grafting materials available but in our office we most commonly use grafts of human freeze-dried bone mixed with some of the patients own blood. Freeze-dried bone is human bone from healthy donors that has been laboratory processed, purified, and freeze-dried into a powder, made up of many particles. It is mixed with a component of your own blood., platelet-rich fibrin (PRF). The advantage of this combination is that PRF accelerates and improves the healing process, and over a period of time, the freeze-dried bone is replaced by the patient’s own bone.
In our office, we most commonly use grafts of human freeze-dried bone mixed with some of the patients own blood. Freeze-dried bone is human bone from healthy donors that has been laboratory processed, purified, and freeze-dried into a powder, made up of many particles. It is mixed with a component of your own blood, platelet-rich fibrin (PRF). The advantage of this combination is that PRF accelerates and improves the healing process, and over a period of time, the freeze-dried bone is replaced by the patient’s own bone.
Laser Assisted Surgery
The use of lasers in dentistry and in oral surgery, specifically, is becoming more and more common. In general dentistry, these devices may be used in preparing teeth for fillings and in certain soft tissue procedures. There are multiple types and sizes of medical lasers depending on the area of the body being treated and the tissue type (bone, soft tissue, eyes, etc.) Research is ongoing to develop lasers that can be routinely used in procedures on the jaws themselves, such as removal of impacted wisdom teeth, but these devices are not yet available for general use.
Our office utilizes the diode laser for certain soft tissue procedures. It is particularly helpful in biopsies, the removal of lesions (growths) of the tongue, the roof of the mouth and the inside of the cheeks and lips. It is also helpful in performing frenectomies for the treatment of tongue-tie or persistent or recurrent spacing between upper front teeth, as well as soft-tissue procedures around implants.
Use of the laser for these procedures can reduce post-operative pain, speed healing, and reduce the need for sutures.