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- Introduction to Oral & Maxillofacial Surgery
- Wisdom Teeth Removal
- Dental Implants
- Bone Grafting
- Orthognathic (Jaw) Surgery
Introduction to Oral & Maxillofacial Surgery
Oral and Maxillofacial Surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region.
Dr. Yarmand provides surgery services for the mouth such as tooth extraction, bone grafting, and the removal of pathological lesions. Oral surgery might be recommended by your general dentist for a particularly complex tooth extraction or for the placement of dental implants.
Dr. Yarmand also provides treatment for maxillofacial problems such as deformities of the jaw. Maxillofacial procedures might be recommended for a range of difficulties due to problems of congenital, developmental, and traumatic origin.
A treatment plan for oral surgery frequently requires collaboration between Dr. Yarmand and your general dentist. A consultation and an evaluation of your needs will help Dr. Yarmand to create a treatment plan that will have you smiling again in no time.
The treatment goal for maxillofacial problems is the proper form and function of the mouth, upper and lower jaw. Patients undergo maxillofacial treatment in order to speak and eat without pain or difficulty.
Wisdom Teeth Removal
The educational material provided in this section gives you important information about your Wisdom Teeth (also known as Third Molars) reasons for their removal, possible problems associated with their removal and expectations about the post-removal experience.
- What are Wisdom Teeth?
- What Detrimental Effects can Wisdom Teeth Have?
- So, Do I Really Have To Have Them Removed?
- What is The Best Age To Have Them Removed?
- What If I Don't Have Them Removed Now?
- If I Decide to Do It, When Should I Have Them Removed?
- What Happens On The Day They're Removed?
- What Happens Afterwards and What Will I Feel Like?
- Can There Be Any Problems?
- What are Dry Sockets?
- What Does It Cost and Will My Insurance Cover It?
- What If I Have Questions Before Surgery?
What are Wisdom Teeth?
What Detrimental Effects can Wisdom Teeth Have?
If you do not have enough room in your mouth for your third molars to erupt and they become impacted, several detrimental results can occur:
Infection - Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and swallowing.
Damage - If there is inadequate room to clean around the wisdom tooth, the tooth directly in front, the Second Molar, can be adversely affected resulting in gum disease (bone loss).
Disease - Non-infectious diseases can also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jawbone which are associated with impacted wisdom teeth and slowly expand destroying adjacent jawbone and occasionally, other teeth. They can be very difficult to treat if your wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with the delayed removal of wisdom teeth.
Crowding - Although controversial, many feel that impacted wisdom teeth directly contribute to crowding of your teeth which is most noticeable in the front teeth, usually the lower front teeth. This is most commonly seen after a patient has had braces. There are most likely a number of factors that cause teeth to crowd after braces or in early adulthood and retained, impacted wisdom teeth may possibly play a contributory role. However, wisdom tooth removal cannot be recommended solely to avoid crowding.
Unless you have an active problem at the time of your consultation, the reason for removal is primarily preventative to avoid long-term problems.
We will need to see you for a consultation before it is determined IF you will benefit from Wisdom tooth removal. We will need to take a special x-ray of your mouth and jaws to determine how much room you have, if any, for your Wisdom teeth to erupt.
So, Do I Really Have To Have Them Removed?
In most cases the absolute answer is “no” You don’t have to do anything, until or unless, YOU chose to do so. This is not critical, life-saving, emergency medical treatment. It is elective. However, we understand, however, that we can identify problematic patients early in their teens and treat them when the impact of the surgery is minimal and their ability to recover is at its maximum.
What is The Best Age To Have Them Removed?
If it is recognized that you do not have enough room in your mouth for your third molars to erupt, it is advisable to have them removed as soon as it is recognized. In some patients it is as early as 14 whereas in others it may not be until 17 or 18 years of age. You will heal faster, with more predictable final healing and have fewer complications than an older patient.
What If I Don’t Have Them Removed Now?
Many people, especially in years past, were told to take a “wait and see” approach to wisdom teeth. Many who did not have adequate room developed localized problems previously mentioned. The problem with this approach is that if it is necessary to remove impacted wisdom teeth in your thirties, forties, fifties, or beyond, it is clearly more difficult for you as the patient. The post-operative course is usually prolonged and there is a higher complication rate. Treating these complications is more difficult than with a younger patient. If you do not have your impacted wisdom teeth removed in your teenage years or early in your twenties, it may be advisable to wait until a localized problem (such as cyst formation or localized gum disease and bone loss) develops and then treat the affected area only. This is because the predictability of healing decreases with age and the likelihood of infection and delayed healing increase.
If I Decide to Do It, When Should I Have Them Removed?
There is probably never a good time to undergo an elective procedure such as wisdom teeth removal. The most “popular” times for wisdom teeth removal is during the summer and school vacations. The bottom line is that with adequate preparation, any time will work for most people if they have planned accordingly in advance.
What Happens On The Day They’re Removed?
First of all, you need to decide if you will be sedated (“go to sleep”). Most people clearly prefer to be unaware of the experience when they have their wisdom teeth removed. You will be provided with appropriate anesthesia options for you at your consultation.
We ask that a parent or responsible adult accompanies you to the office, where they must remain during the entire procedure and they should plan on staying with you the rest of the day. Your procedure will take about an hour and you will probably be in the office for 1 1/2 -2 hours. Our surgical assistants will review your post-operative instructions. When you leave the office you will be comfortable and drowsy. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a few days.
All outpatient surgery is performed under appropriate anesthesia to maximize your comfort. We have the training, license, and experience to provide various types of anesthesia to allow patients to select the most appropriate alternative. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and staff experienced in anesthesia techniques.
What Happens Afterwards and What Will I Feel Like?
Most of the times you will want to maintain a low profile for a few days.
We ask that you follow your post-operative instructions closely as they will make you most comfortable during the first few days following your procedure. Please allow the time to let your body begin healing before resuming an active social, academic, or athletic schedule. Most patients feel like they are over the hump in 3-5 days.
Can There Be Any Problems?
As with any medical procedure, there can be complications or an unanticipated result that you should be aware of:
There is a nerve, which supplies feeling to the lower lip, chin, and tongue which is frequently very close to the roots of the lower wisdom teeth. Having these teeth out between the ages of 14 and 18 usually provides shorter roots so that the nerve is not so close to the roots of these teeth. Occasionally, when the teeth are removed, especially in older patients, the roots have grown longer and become closer to the nerve itself. This nerve can become irritated in the process of removing the tooth. When local anesthesia wears off, you may experience a tingling or numb sensation in the lower lip, chin, or tongue. Should this occur, it is usually temporary and will resolve gradually over a period of weeks or months. RARELY, it can result in a permanent alteration of sensation similar to the feeling of Novocaine, although to a much lesser degree. We feel that you should be aware of this before consenting to surgery.
The upper wisdom teeth are situated close to your sinuses and their removal can result in a communication between your mouth and the sinus. Once again, if the teeth are removed at an early age, the root formation is minimal and this complication is very unlikely to occur. Should this occur, it will usually close spontaneously. We may give you special instructions to follow if this is apparent at the time of surgery. We prefer that you don’t blow your nose for two or three days following the surgery. You can wipe your nose, but don’t blow your nose. If you have to sneeze, you should sneeze with an open mouth into a tissue. You should not create any pressure in the sinus area, which may dislodge the healing blood clot. If you sense a communication occurring after the surgery, please contact the office. RARELY, an additional procedure may be necessary to close the communication.
The most common problem encountered following surgery of any kind is infection. This usually requires an office visit and clinical examination. Many times, just placing you on an antibiotic for one week will take care of the infection. It will occasionally require drainage of the infected area, which may have accumulated near the surgical site, and even more rarely do the patients need to be admitted to the hospital for intravenous antibiotics and further surgical drainage.
Other temporary problems you may experience in the postoperative period include stiffness of the jaws, chafing around the corners of your lips, facial bruising, and blood oozing from the extraction sites. The postoperative instruction sheet we will provide should answer many of the questions related to these more common concerns. If not, don’t hesitate to call the office.
What Are Dry Sockets?
Dry sockets continue to be the most common problem people experience following wisdom tooth surgery. They arise due to premature loss of a blood clot in the empty tooth socket and affect approximately one out of five patients. This seems to occur with greater frequency in people who smoke or are taking birth control pills. While both jaws can be affected, they usually occur in the lower jaw on the third to fifth day. They cause a deep, dull, continuous aching on the affected side(s). Patients may first notice the pain starting in the ear radiating down towards the chin. It frequently begins in the middle of the night, and the Ibuprofen medication usually doesn’t help. Treatment involves placing a medicated dressing in the “empty” tooth socket. This will help decrease the pain and protect the socket from food particles. The effectiveness in alleviating the pain lasts for 24-48 hours and usually will require dressing changes every two or three days for approximately one week. Dressings are usually removed when you have been pain free for 2-3 days. The dressing doesn’t aid in healing. The only reason to place a dressing is for pain control. If ibuprofen is controlling the pain, the socket will heal without a dressing. An irrigation device can be given to you to help keep food particles from lodging in the extraction site following removal of the dressing.
What Does It Cost and Will My Insurance Cover It?
Because of the different types of impacted wisdom teeth, along with different anesthesia options, it is impossible to give you a realistic estimate of what our services will cost until we have reviewed your x-rays. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure. We will provide you with an estimate and obtain a predetermination of your coverage prior to the procedure. We do however, encourage you to check your dental insurance carrier to determine your coverage and out of pocket liability.
What If I Have Questions Before Surgery?
We recognize that having your Wisdom teeth out is NOT something you really want to do. We also realize that with an active schedule there is never a really good time to have this done. If this information, combined with information you receive at your consultation appointment doesn’t answer all of your questions, please call our offices to speak to one of our Patient Care Coordinators.
Dental Implants
Dental implants are changing the way people live. They are designed to provide a foundation for replacement teeth which look, feel and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything, knowing that teeth appear natural and that facial contours will be preserved. Patients with dental implants can smile with confidence.
- What types of prostheses are available?
- What are Dental Implants?
- Why dental implants?
- Are you a candidate for dental implants?
- Why would you select dental implants over more traditional types of restorations?
- What does the surgery involve?
- Who actually performs the dental implant placement?
- Do dental implants need special care?
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Bone Grafting
Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants. Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.
Major Bone Grafting
Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee.) Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.
Major bone grafts are typically performed to repair defects of the jaws.
These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.
Sinus Lift Procedure
The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.
These procedures may be performed separately or together, depending upon the individual’s condition. As stated earlier, there are several areas of the body that are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. When we use the patient’s own bone for repairs, we generally get the best results.
In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to promote the patient’s own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. These surgeries are performed in the out-office surgical suite under IV sedation. After discharge, bed rest is recommended for one day and limited physical activity for one week.
There is a solution and it’s called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.
The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.
If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the Sinus Augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.
Nerve-repositioning
The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants to the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and 2nd premolar, with the above-mentioned secondary condition. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever), usually other, less aggressive options are considered first.
Typically, we remove an outer section of the cheek side of the lower jawbone in order to expose the nerve and vessel canal. Then we isolate the nerve and vessel bundle in that area, and slightly pull it out to the side. At the same time, we will place the implants. Then the bundle is released and placed back over the implants.
The surgical access is refilled with bone graft material of the surgeon’s choice and the area is closed.
These procedures may be performed separately or together, depending upon the individual’s condition. As stated earlier, there are several areas of the body that are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. When we use the patient’s own bone for repairs, we generally get the best results.
In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to promote the patient’s own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. These surgeries are performed in the out-office surgical suite under IV sedation. After discharge, bed rest is recommended for one day and limited physical activity for one week.
Orthognathic (Jaw) Surgery
Orthognathic surgery is needed when jaws don’t meet correctly and/or teeth don’t seem to fit with jaws. Teeth are straightened with orthodontics and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.
