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Kent Oral & Maxillofacial Surgery
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Dental Implants
Dental implants are changing the way people live! They are designed to provide a foundation for replacement teeth that look, feel, and function like natural teeth. A person who has lost their teeth regains the ability to eat virtually anything. Their teeth appear natural and their facial contours are preserved. Patients with dental implants can smile once again with confidence. -
What Are Dental Implants?The implants themselves are tiny titanium posts that are surgically placed into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes. The bone bonds with the titanium, creating a strong foundation for artificial teeth. Small posts that protrude through the gums are then attached to the implant. These posts provide stable anchors for artificial replacement teeth. Implants also help preserve facial structure, preventing the bone deterioration that occurs when teeth are missing.
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The Surgical ProcedureFor most patients, the placement of dental implants involves two surgical procedures: First, implants are placed within your jawbone. For the first three to six months following surgery the implants are beneath the surface of the gums, gradually bonding with the jawbone. You should be able to wear temporary dentures and eat a soft diet during this period. While this integration in occuring, your dentist is forming your new replacement teeth. After the implant has bonded to the jawbone, the second phase begins. Dr. Patterson will uncover the implants and attach small posts that protrude through the gums that will act as anchors for the artificial teeth. These posts will be covered and hidden from view by the artificial teeth that are placed. The entire procedure usually takes six to eight months. Most patients experience minimal disruption in their daily life.
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Surgical AdvancesUsing the most recent advances in dental implant technology, Dr. Patterson is able to place single stage implants. These implants do not require a second procedure to uncover them, but do require a minimum of six weeks of healing time before artificial teeth are placed. There are even situations where the implant can be placed at the same time as the tooth extraction – further minimizing your number of surgical procedures. Dental implant placement is a team effort between an oral and maxillofacial surgeon and a restorative dentist. Dr. Patterson performs the actual implant surgery, initial tooth extractions, and bone grafting if necessary. The restorative dentist (your dentist) fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.
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What Types Of Prosthesis Are Available?A single prosthesis (crown) is used to replace one missing tooth – each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon a variety of factors. A removable prosthesis (over denture) attaches to a bar or ball-in-socket attachments, whereas a fixed prosthesis is permanent and removable only by the dentist. Dr. Patterson performs in-office implant surgery in a hospital-style operating suite. Inpatient hospital implant surgery is for patients who have special medical or anesthetic needs, or for those who need extensive bone grafting.
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Why Dental Implants?Dental implants can vastly improve your life. When you lose several teeth – whether it’s a new situation or something that you have lived with for years – chances are you’ve never become fully accustomed to missing such a vital part of yourself. Dental implants can be your doorway to renewed self-confidence and peace of mind. A Swedish scientist and orthopedic surgeon, Dr. Per-Ingvar Branemark, developed this concept for oral rehabilitation more than 35 years ago. With his pioneering research, Dr. Branemark opened the door to a lifetime of renewed comfort and self-confidence for millions of individuals facing the frustration and embarrassment of tooth loss.
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Why Select Dental Implants Over More Traditional Types Of Restorations?There are several reasons: A dental bridge can sacrifice the structure of surrounding good teeth to bridge the space of the missing tooth/teeth. In addition, removing a denture or a “partial” at night may be inconvenient, not to mention dentures that slip can be uncomfortable and rather embarrassing.
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Are You A Candidate For Implants?If you are considering implants your mouth must be examined thoroughly and your medical and dental history reviewed. If your mouth is not ideal for implants there are ways of improving the outcome, such as bone grafting, which may be recommended.
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What Type Of Anesthesia Is Used?The majority of dental implants and bone grafting can be performed in our office under local anesthesia, with or without general anesthesia.
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Do Implants Need Special Care?Once the implants are in place they will serve you well for many years if you take good care of them and keep your mouth healthy. Good oral hygiene (brushing and flossing) and keeping regular appointments with your dental specialists is key to the long term success of dental implants.
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Teeth-in-an-Hour
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TEETH-IN-AN-HOUR™ is a revolutionary concept providing patients with fully functioning teeth on dental implants in a single procedure that takes about an hour.This technology was developed by Nobel Biocare and utilizes collaboration between both the restorative doctor and the oral surgeon. This merging of knowledge and experience achieves not only increased safety, but also a more precise implant placement. In addition, the fabrication of a final prosthesis is completed prior to the surgery. The computer-guided implant surgery is done in an arthroscopic fashion without requiring any flap reflection. This benefits the patient in that there is less postoperative discomfort, less swelling, and less bruising. Patients can often resume their normal activities the next day.
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The process begins when a CAT scan is taken of the patient’s jawbone.This CAT scan allows for the generation of a three-dimensional model of the jawbone that can then be used with virtual reality software to plan the implant placement without the presence of the patient. The results are a more accurate implant placement and less chair time for the patient.
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All-on-4
Scientifically proven and documented. All-on-4 is supported by good clinical outcomes from studies over a decade with favorable results. -
All-on-Four 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.
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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 solution also ensures greater stability in the bone, reducing the need for bone graft surgery to increase bone volume.
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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.
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The All-on-4 offers you many advantages
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A cost effective solution.Your new replacement teeth require only 4 implants for each jaw. With fewer implants required, the cost is lowered.
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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.
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Faster treatment and healing time.Your replacement arch can be attached to your implants immediately after insertion.
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Bone Grafting
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Major & Minor Bone GraftingMissing teeth over a period of time can cause your jawbone to atrophy, or resorb. This often results in poor quality and quantity of bone suitable for the placement of dental implants as well as long term shifting of remaining teeth and changes to facial structure. Most patients, in these situations, are not candidates for dental implants. Fortunately, today we have the ability to grow bone where it is needed. This not only gives us the opportunity to place implants of proper length and width, but it also gives us a chance to restore functionality and aesthetic appearance.
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Major Bone GraftingBone 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 to protect the bone graft, as well as 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 areas depending on the size needed. 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.
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The Importance of Teeth for Jawbone Health
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When one or more teeth are missing it can lead to bone loss at the site of the gap.This loss of jawbone can develop into additional problems, both with your appearance and your overall health. You may experience pain, problems with your remaining teeth, altered facial appearance, and eventually even the inability to speak and/or eat normally.
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In the same way that muscles are maintained through exercise, bone tissue is maintained by use.Natural teeth are embedded in the jawbone and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth into the mouth, no longer receives the necessary stimulation it needs and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates.
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Potential Consequences of Tooth and Jawbone Loss
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Problems with remaining teeth, including misalignment, drifting, loosening, and loss
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Collapsed facial profile
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Limited lip support
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Skin wrinkling around the mouth
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Distortion of other facial features
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Jaw (TMJ or temporomandibular joint) pain, facial pain, and headaches
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Difficulty speaking and communicating
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Inadequate nutrition as a result of the inability to chew properly and painlessly
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Sinus expansion
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Reasons for Jawbone Loss and Deterioration
The following are the most common causes for jawbone deterioration and loss that may require a bone grafting procedure: -
Tooth ExtractionsWhen an adult tooth is removed and not replaced jawbone deterioration may occur. Natural teeth are embedded in the jawbone and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates and goes away. The rate that the bone deteriorates, as well as the amount of bone loss that occurs, varies greatly among individuals. However, most loss occurs within the first eighteen months following the extraction and will continue gradually throughout your life.
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Periodontal DiseasePeriodontal diseases are ongoing infections of the gums that gradually destroy the support of your natural teeth. Periodontal disease affects one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, or gingiva. While there are many diseases that affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues and are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the diseases, may never progress into periodontitis, it always precedes periodontitis. Dental plaque is the primary cause of gingivitis in genetically-susceptible individuals. Plaque is a sticky colorless film, composed primarily of food particles and various types of bacteria, that adheres to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. Bacteria found in plaque produces toxins, or poisons, that irritate the gums. Gums may become inflamed, red, swollen, and bleed easily. If this irritation is prolonged, the gums will separate from the teeth causing pockets (spaces) to form. If daily brushing and flossing is neglected, plaque can harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line. Periodontitis is affected by bacteria that adheres to the tooth’s surface, along with an overly aggressive immune response to these bacteria. If gingivitis progresses into periodontitis, the supporting gum tissue and bone that hold teeth in place deteriorates. The progressive loss of this bone, the alveolar, can lead to the loosening and subsequent loss of teeth.
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Dentures/BridgeworkUnanchored dentures are placed on top of the gum line, but they do not provide any direct stimulation to the underlying alveolar bone. Over time the lack of stimulation causes the bone to resorb and deteriorate. Because this type of denture relies on the bone to hold them in place, people often experience loosening of their dentures and problems eating and speaking. Eventually, bone loss may become so severe that dentures cannot be held in place with strong adhesives, and a new set of dentures may be required. Proper denture care, repair, and refitting are essential to maintaining oral health. Some dentures are supported by anchors, which do help adequately stimulate, and therefore preserve bone. With bridgework, the teeth on either side of the appliance provide sufficient stimulation to the bone, but the portion of the bridge that spans the gap where the teeth are missing receives no direct stimulation. Bone loss can occur in this area. By completing a bone graft procedure, Dr. Patterson is now able to restore bone function and growth, thereby halting the effects of poor denture care.
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TraumaWhen a tooth is knocked out or broken to the extent that no biting surface is left below the gum line, bone stimulation stops, which results in jawbone loss. Some common forms of tooth and jaw trauma include: teeth knocked out from injury or accident, jaw fractures, or teeth with a history of trauma that may die and lead to bone loss years after the initial trauma. A bone grafting procedure would be necessary to reverse the effects of bone deterioration, restoring function and promoting new bone growth in traumatized areas.
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MisalignmentMisalignment issues can create a situation in the mouth where some teeth no longer have an opposing tooth structure. The unopposed tooth can over-erupt, causing deterioration of the underlying bone. Issues such as TMJ problems, normal wear-and-tear, and lack of treatment can also create abnormal physical forces that interfere with the teeth’s ability to grind and chew properly. Over time, bone deterioration can occur where the bone is losing stimulation.
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OsteomyelitisOsteomyelitis is a type of bacterial infection in the bone and bone marrow of the jaw. This infection leads to inflammation, which can cause a reduction of blood supply to the bone. Treatment for osteomyelitis generally requires antibiotics and the removal of the affected bone. A bone graft procedure may be required to restore bone function and growth lost during removal.
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TumorsBenign facial tumors, though generally non-threatening, may grow large and require the removal of a portion of the jaw. Malignant mouth tumors almost always spread into the jaw, requiring the removal of the affected section of the jaw. In both cases, reconstructive bone grafting is usually required to help restore normal function to the jaw. Grafting in patients with malignant tumors may be more challenging because treatment of the cancerous tumor generally requires removal of the surrounding soft tissues as well.
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Developmental DeformitiesSome conditions or syndromes are characterized by missing portions of the teeth, facial bones, jaw or skull. Dr. Patterson may be able to perform a bone graft procedure to restore bone function and growth where it may be absent.
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Sinus DeficienciesWhen molars are removed from the upper jaw, air pressure from the air cavity in the maxilla (maxillary sinus) causes resorption of the bone that formerly helped keep the teeth in place. As a result, the sinuses become enlarged, a condition called hyperneumatized sinus. This condition usually develops over several years and may result in insufficient bone from the placement of dental implants. Dr. Patterson can perform a procedure called a “sinus lift” that can treat enlarged sinuses.
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About Bone Grafting
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What is Bone Grafting?Over a period of time, the jawbone associated with missing teeth atrophies and is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for the placement of dental implants. In these situations, most patients are not candidates for the placement of dental implants. With bone grafting we now have the opportunity to not only replace bone where it is missing, but we also have the ability to promote new bone growth in that location. 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 aesthetic appearance.
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Types of Bone Grafts
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Autogenous Bone GraftsAutogenous bone grafts, also known as autografts, are made from your own bone, taken from somewhere else in the body. The bone is typically harvested from the chin, jaw, lower leg bone, hip, or the skull. Autogenous bone grafts are advantageous in that the graft material is your own live bone, meaning it contains living cellular elements that enhances bone growth, also eliminating the risk of your body rejecting the graft material since it comes from you. However, one downside to the autograft is that it requires a second procedure to harvest bone from elsewhere in the body. Depending on your condition, a second procedure may not be recommended.
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Allogenic BoneAllogenic bone, or allograft, is dead bone harvested from a cadaver, then processed using a freeze-dry method to extract the water via a vacuum. Unlike autogenous bone, allogenic bone cannot produce new bone on it’s own. Rather, it serves as a framework, or scaffold, over which bone from the surrounding bony walls can grow to fill the defect or void.
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Xenogenic BoneXenogenic bone is derived from non-living bone of another species, usually a cow. The bone is processed at very high temperatures to avoid the potential for immune rejection and contamination. Like allogenic grafts, xenogenic grafts serve as a framework for bone from the surrounding area to grow and fill the void. Both allogenic and xenogenic bone grafting have an advantage of not requiring a second procedure to harvest your own bone, as with autografts. However, because these options lack autograft’s bone-forming properties, bone regeneration may take longer than with autografts, and have a less predictable outcome.
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Bone Graft Substitutes
As a substitute to using real bone many synthetic materials are available as safe and proven alternatives, including: -
Demineralized Bone Matrix (DBM)/Demineralized Freeze-Dried Bone Allograft (DFDBA)This product is processed allograft bone, containing collagen, proteins, and growth factors that are extracted from the allograft bone. It is available in the form of powder, putty, chips, or as a gel that can be injected through a syringe.
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Graft CompositesGraft composites consist of other bone graft materials and growth factors to achieve the benefits of a variety of substances. Some combinations may include: collagen/ceramic composite, which closely resembles the composition of natural bone, DBM combined with bone marrow cells, which aid in the growth of new bone, or a collagen/ceramic/autograft composite.
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Bone Morphogenetic ProteinsBone morphogenetic proteins (BMPs) are proteins naturally produced in the body that promote and regulate bone formation and healing. Synthetic materials also have the advantage of not requiring a second procedure to harvest bone, reducing risk and pain. Each bone grafting option has its own risks and benefits. Dr. Patterson will determine which type of bone graft material best suited to your particular needs.
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Ridge Augmentation
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What is a Ridge Augmentation?A ridge augmentation is a common dental procedure often performed following a tooth extraction. This procedure helps recreate the natural contour of the gums and jaw that may have been lost due to bone loss from a tooth extraction, or for another reason. The alveolar ridge of the jaw is the bone that surrounds the roots of teeth. When a tooth is removed an empty socket is left in the alveolar ridge bone. Usually this empty socket will heal on its own, filling with bone and tissue. Sometimes when a tooth is removed the bone surrounding the socket breaks and is unable to heal on its own. The previous height and width of the socket will continue to deteriorate. Rebuilding the original height and width of the alveolar ridge is not always medically necessary, but may be required for dental implant placement or for aesthetic purposes. Dental implants require bone to support their structure and a ridge augmentation can help rebuild this bone to accommodate the implant.
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How is the procedure Accomplished?A ridge augmentation is accomplished by placing bone graft material in the tooth socket. It is often done immediately after the tooth is removed to avoid the need for a second procedure later. Next, the gum tissue is placed over the socket and secured with sutures. Dr. Patterson may choose to use a space-maintaining product over the top of the graft to facilitate new bone should growth. Once the socket has healed, the alveolar ridge can be prepared for dental implant placement. A ridge augmentation procedure is typically performed in Dr. Patterson’s office under local anesthesia. Some patients may also request sedative medication.
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Sinus Lift
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What is a Sinus Lift?The maxillary sinuses are behind your cheeks and on top of the upper teeth. These sinuses are empty, air-filled spaces. 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. The key to a successful and long-lasting dental implant is the quality and quantity of jawbone to which the implant will be attached. If bone loss has occurred due to injury or periodontal disease, a sinus augmentation can raise the sinus floor and allow for new bone formation. A sinus lift is one of the most common bone grafting procedures for patients with bone loss in the upper jaw. The procedure seeks to grow bone in the floor of the maxillary sinus above the bony ridge of the gum line that anchors the teeth in the upper jaw. This enables dental implants to be placed and secured in the new bone growth.
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How is this procedure Accomplished?Most commonly, a small incision is made on the premolar or molar region to expose the jawbone. A small opening is cut into the bone, and the membrane lining the sinus is pushed upward. The underlying space is filled with bone grafting material, either from your own body or from a other sources. Sometimes, synthetic materials that imitate bone formation are used. After the bone is implanted, the incision is sutured and the healing process begins. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in the newly formed sinus bone. If enough bone between the upper jaw ridge and the bottom of the sinus is available to sufficiently stabilize the implant, 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 up to several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed. The sinus graft makes it possible for many patients to have dental implants that previously had no other option besides wearing loose dentures. A sinus augmentation is generally performed at Dr. Patterson‘s office, under local anesthesia. Some patients may request oral or intravenous sedative medication as well.
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Am I a Candidate for a Sinus Lift Procedure?
A sinus lift may be necessary if you: -
Are missing more than one tooth in the back of your jaw
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Are missing a significant amount of bone in the back of your jaw
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Are missing teeth due to a birth defect or condition
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Are missing most of the maxillary teeth and require support for dental implants
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Socket Preservation Procedure
Preserving Your Jaw Bone after Extraction -
Removal of teeth is sometimes necessary because of pain, infection, bone loss, or due to a fracture in the tooth.The bone that holds the tooth in place (the socket) is often damaged by disease and/or infection, resulting in a deformity of the jaw after the tooth is extracted. In addition, when teeth are extracted the surrounding bone and gums can shrink and recede very quickly, resulting in unsightly defects and a collapse of the lips and cheeks.
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These jaw defects can create major problems in performing restorative dentistry whether your treatment involves dental implants, bridges, or dentures.Jaw deformities from tooth removal can be prevented and repaired by a procedure called socket preservation. Socket preservation can greatly improve your smile’s appearance and increase your chances for successful dental implants.
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Several techniques can be used to preserve the bone and minimize bone loss after an extraction.In one common method, the tooth is removed and the socket is filled with bone or bone substitute. It is then covered with gum, artificial membrane, or tissue, which encourages your body’s natural ability to repair the socket. With this method, the socket heals, eliminating shrinkage and collapse of the surrounding gum and facial tissues. The newly formed bone in the socket also provides a foundation for an implant to replace the tooth. If your dentist has recommended tooth removal, be sure to ask if socket preservation is necessary. This is particularly important if you are planning on replacing the front teeth.
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Wisdom Teeth
By the age of 18 the average adult has 32 teeth: 16 teeth on top and 16 teeth on bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine, and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth (molar teeth) are used to grind food into a consistency suitable for swallowing. 0:03 Click here for high-res version The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that is meant to hold only 28 teeth. These four other teeth are your third molars, also known as “wisdom teeth”. Our services are provided in an environment of optimum safety. We utilize modern monitoring equipment and our staff are experienced in anesthesia techniques. -
Why Should I Have My Wisdom Teeth Removed?Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this is not what generally happens. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, only partially emerge from the gum, or can even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt. An impacted tooth simply means that it is “stuck”. These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the teeth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain, and illness. The pressure from the erupting wisdom teeth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom teeth, resulting in the destruction of the jawbone and healthy teeth. Removal of the impacted teeth usually resolves these problems. Early removal is recommended to avoid complications.
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Oral ExaminationWith an oral examination and x-rays of the mouth, Dr. Patterson can evaluate the position of the wisdom teeth and predict if there are present or future potential problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist, or by an oral and maxillofacial surgeon. All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Patterson is trained, licensed, and highly experienced in providing various types of anesthesia for patients.
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RemovalIn most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia), or general anesthesia. These options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge your postoperative kit will include postoperative instructions, a prescription for pain medication, antibiotics, and a follow-up appointment in one week for suture removal. If you have any questions, please do not hesitate to call us at 336-812-3104.
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Facial Trauma
An oral and maxillofacial specialist is thoroughly qualified to repair facial injuries. These professionals are well versed in emergency care, acute treatment, and long-term reconstruction and rehabilitation – not just for physical reasons, but for emotional ones as well. Injuries to the face, by their very nature, impart a high degree of emotional as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long-term function and appearance. Dr. Patterson meets and exceeds these modern standards. They are trained, skilled, and uniquely qualified to manage and treat facial trauma. They are on staff at local hospitals and deliver emergency room coverage for facial injuries, which include the following conditions: Facial lacerations; Intraoral lacerations; Avulsed (knocked out) teeth; Fractured facial bones (cheek, nose, or eye socket); Fractured jaws (upper and lower jaw). -
The Nature of Maxillofacial TraumaThere are a number of possible causes of facial trauma, such as motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. Types of facial injuries can range from injuries to teeth to extremely severe injuries to the skin and bones of the face. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves, or the salivary glands).
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Soft Tissue Injuries of the Maxillofacial RegionWhen soft tissue injuries, such as lacerations, occur on the face they are repaired by suturing. In addition to the obvious concern of providing a repair that yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands, and salivary ducts (or outflow channels). Dr. Patterson is a well-trained oral and maxillofacial surgeon and is proficient at diagnosing and treating all types of facial lacerations.
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Bone Injuries of the Maxillofacial RegionFractures to the bones in the face are treated in a similar manner to fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, and the age and general health of the patient. When an arm or leg is fractured a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures. One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique of treatment can often allow for healing and eliminates the necessity of having the jaws wired together. This technique is called “rigid fixation” of a fracture. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly. The treatment of facial fractures should be accomplished in a thorough and predictable manner. More importantly, the patient’s facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is hidden.
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Injuries to the Teeth & Surrounding Dental StructuresIsolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone, or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon, such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists, who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth. The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long-term reconstruction, and rehabilitation of the patient.
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Pre-prosthetic Surgery
The preparation of your mouth before the placement of a prosthesis is referred to as pre-prosthetic surgery. Some patients require minor oral surgical procedures before receiving a partial or complete denture in order to ensure the maximum level of comfort. A denture sits on the bone ridge, so it is very important that the bone is the proper shape and size. If a tooth needs to be extracted, the underlying bone might be sharp and uneven. For the best fit of a denture, the bone might need to be smoothed or reshaped. Occasionally, excess bone may need to be removed prior to denture insertion. One or more of the following procedures might need to be performed in order to prepare your mouth for a denture: -
Bone smoothing and reshaping
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Removal of excess bone
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Bone ridge reduction
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Removal of excess gum tissue
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Exposure of impacted teeth
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Distraction Osteogenesis
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Distraction osteogenesis (DO) is a relatively new method of treatment for selected deformities and defects of the jaw and skull.Although it was first used in 1903, in the 1950's the Russian orthopedic surgeon, Dr. Gabriel Ilizarov, slowly perfected the surgical and postoperative management of distraction osteogenesis treatment to correct deformities and repair defects in the arms and legs. His work went mostly unnoticed until he presented to the Western Medical Society in the mid-1960s.
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Distraction osteogenesis was first used to treat defects of the oral and facial region in 1990.Since then, the surgical and technological advances made in the field of distraction osteogenesis have provided oral and maxillofacial surgeons with a safe and predictable method to treat selected deformities.
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If you have questions about distraction osteogenesis, please call our office and schedule an appointment with Dr. Patterson.
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Frequently Asked Questions About Distraction Osteogenesis
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What does the term distraction osteogenesis mean?Simply stated, distraction osteogenesis means the slow movement apart (distraction) of two bony segments in a manner such that new bone is allowed to grow and fill in the gap created by the separating bony segments.
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Is the surgery for distraction osteogenesis more involved than “traditional surgery” for a similar procedure?No. Distraction osteogenesis surgery is usually done on an outpatient basis with most of the patients going home the same day of surgery. The surgical procedure itself is less invasive so there is usually less pain and swelling.
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Will my insurance company cover the cost of osteogenesis surgical procedure?Most insurance companies will cover the cost of the osteogenesis surgical procedure provided that there is adequate and accurate documentation of the patient’s condition. Of course, individual benefits within the insurance company policy vary. After you are seen for your consultation at our office, we will assist you in determining whether or not your insurance company will cover a particular surgical procedure.
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Is distraction osteogenesis painful?Since all distraction osteogenesis surgical procedures are done while the patient is under general anesthesia, pain during the surgical procedure is not an issue. Postoperatively, you will be supplied with appropriate analgesics (pain killers) to keep you comfortable, and antibiotics to fight off infection. Activation of the distraction device to slowly separate the bones may cause mild discomfort. In general, the slow movement of bony segments produces discomfort roughly similar to having braces tightened.
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What are the benefits of distraction osteogenesis vs. traditional surgery for a similar condition?Distraction osteogenesis surgical procedures typically produce less pain and swelling than the traditional surgical procedure for a similar condition. Distraction osteogenesis eliminates the need for a second surgical site to harvest bone graft material. Lastly, distraction osteogenesis is associated with greater stability when used in major cases where significant movement of bony segments are involved.
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What are the disadvantages of distraction osteogenesis?Distraction osteogenesis requires the patient to return to the surgeon’s office frequently during the initial two weeks after surgery. This is necessary because in this time frame the surgeon will need to closely monitor the patient for any infection and teach the patient how to activate the appliance. In some cases, a second minor office surgical procedure is necessary to remove the distraction appliance.
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Can distraction osteogenesis be used instead of bone grafts to add bone to my jaws?Yes. Recent advances in technology have provided the oral and maxillofacial surgeon with a distraction device that can be used to slowly grow bone in selected areas of bone loss that has occurred in the upper and lower jaws. The newly formed bone can then serve as an excellent foundation for dental implants.
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Does distraction osteogenesis leave scars on the face?No. The entire surgery is performed within the mouth and the distraction devices used by Dr. Patterson remain inside the mouth. There are no facial surgical incisions made, therefore, no facial scars result.
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Are there any age limitations for patients who can receive osteogenesis?No. Distraction osteogenesis works well on patients of all ages. In general, the younger the patient the shorter the distraction time and the faster the consolidation phase. Adults require slightly longer period of distraction and consolidation because the bone regenerative capabilities are slightly slower than those of adolescence or infants.
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Oral Pathology
These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face, and/or neck. Pain does not always occur with pathology, and curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer. We would recommend performing an oral cancer self-examination monthly. Remember that your mouth is one of your body’s most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we can assist you with any questions or concerns. The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathological process or cancerous growth: -
Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
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A sore that fails to heal and bleeds easily
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A lump or thickening on the skin lining the inside of the mouth
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Chronic sore throat or hoarseness and/or difficulty in chewing or swallowing
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TMJ Disorders
TMJ (temporomandibular joint) disorders are a family of problems related to your jaw joint. If you have had symptoms like pain or a “clicking” sound, you’ll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles do not work together correctly. TMJ stands for temporomandibular joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important. No one treatment can resolve TMJ disorders completely and treatment takes time to become effective. Dr. Patterson can help you have a healthier, more comfortable jaw. -
Trouble With Your Jaw?TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking, or grating noise when you open your mouth, or trouble opening your mouth wide.
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What About Bite Correction or Surgery?If your TMJ disorder has caused problems with how your teeth fit together you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options, such as arthroscopy and open joint repair restructuring, are sometimes needed, but are reserved for severe cases. Dr. Patterson does not consider TMJ surgery unless the jaw can’t open, is dislocated and non-reducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully.
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Do You Have a TMJ Disorder?
The more times you answered “yes”, the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated. -
Are you aware of grinding or clenching your teeth?
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Do you wake up with sore, stiff muscles around your jaws?
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Do you have frequent headaches or neck aches?
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Does the pain get worse when you clench your teeth?
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Does stress make your clenching and pain worse?
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Does your jaw click, pop, grate, catch, or lock when you open your mouth?
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Is it difficult or painful to open your mouth, eat, or yawn?
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Have you ever injured your neck, head, or jaws?
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Have you had problems (such as arthritis) with other joints?
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Do you have teeth that no longer touch when you bite?
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Do your teeth meet differently from time to time?
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Is it hard to use your front teeth to bite or tear food?
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Are your teeth sensitive, loose, broken or worn?
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Treatment
Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. A splint (or nightguard) fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night. It also helps to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw forward, relives pressure on parts of your jaw, and aids in disk repositioning. It may be worn 24 hours/day to help your jaw heal. An orthotic stabilization appliance is worn 24 hours/day, or just at night, to move your jaw into proper position. Appliances also help protect tooth wear. There are various treatment options that Dr. Patterson can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Patterson will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care combined with professional care. The initial goals are to relieve the muscle spasms and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory, or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include: -
Resting your jaw
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Keeping your teeth apart when you are not swallowing or eating
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Eating soft foods
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Applying ice and heat
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Exercising your jaw
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Practicing good posture
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Impacted Canines
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An impacted tooth simply means that it is “stuck” and cannot erupt into function.Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get “stuck” in the back of the jaw and can develop painful infections, among a host of other problems (see Wisdom Teeth under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary cuspid (upper eyetooth) is the second most common tooth to become impacted. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The cuspid teeth are very strong biting teeth and have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.
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Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place.They usually come into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary cuspid (upper eye) teeth. Sixty percent of these impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are found in the middle of the supporting bone, but are stuck in an elevated position above the roots of the adjacent teeth, or are out to the facial side of the dental arch.
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Early Recognition Of Impacted Eyeteeth Is The Key To Successful Treatment
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The older the patient the more likely an impacted eyetooth will not erupt by natural forces alone, even if the space is available for the tooth to fit in the dental arch.The American Association of Orthodontists recommends that a panoramic x-ray, along with a dental examination, be performed on all dental patients at the age of seven to count the teeth and determine if there are problems with eruption of the adult teeth. It is important to determine whether all the adult teeth are present or if some adult teeth missing.
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This exam is usually performed by your general dentist or hygienist who will refer you to an orthodontist if a problem is identified.Treating such a problem may involve an orthodontist placing braces to open spaces allowing for proper eruption of the adult teeth. Treatment may also require referral to an oral surgeon for extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important eyeteeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking the eruption of any adult teeth.
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If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance that the impacted eyetooth will erupt with nature’s help.If the eyetooth is allowed to develop too much under the surface (by age 13-14), the impacted eyetooth will not erupt by itself, even with the space cleared for its eruption. If the patient is older (over 40), there is a much higher chance that the tooth will be fused in position. In these cases, the tooth will not budge despite all the efforts of the orthodontist and oral surgeon to erupt it into place. Sadly, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (crown on a dental implant or a fixed bridge).
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What Happens If The Eyetooth Will Not Erupt When Proper Space Is Available?
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In cases where the eyeteeth will not erupt spontaneously, the orthodontist and oral surgeon will work together to get these teeth to erupt.Each case must be evaluated on an individual basis, but treatment will usually involve a combined effort between the orthodontist and the oral surgeon. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby eyetooth has not fallen out already, it is usually left in place until the space for the adult eyetooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted eyetooth exposed and bracketed.
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In a simple surgical procedure performed in the surgeon’s office, the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath.If there is a baby tooth present it will be removed at the same time. Once the tooth is exposed, the oral surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. The oral surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed and impacted tooth completely uncovered by suturing the gum up high above the tooth, or making a window in the gum covering the tooth. Most of the time the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.
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Shortly after surgery (1-14 days) the patient will return to the orthodontist.A rubber band will be attached to the chain to put a light eruptive pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take up to a full year to complete. Remember, the goal is to erupt the impacted tooth and not to extract it. Once the tooth has moved into the arch in its final position, the gum around it will be evaluated to make sure it is sufficiently strong and healthy to last for a lifetime of chewing and tooth brushing. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor “gum surgery” required to add bulk to the gum tissue over the relocated tooth so that it remains healthy during normal function. Your dentist or orthodontist will explain this procedure to you if it applies to your specific situation.
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These basic principals can be adapted to apply to any impacted tooth in the mouth.It is not that uncommon for both of the maxillary cuspids to be impacted. In these cases, the space in the dental arch will be prepared on both sides at once. When the orthodontist is ready, the surgeon will expose and bracket both teeth in the same visit so that the patient only has to heal from one surgery. Because the anterior teeth (incisors and cuspids) and the bicuspid teeth are small and have single roots they are easier to erupt if they get impacted than the posterior molar teeth. The molar teeth are much bigger teeth and have multiple roots making them more difficult to move. The orthodontic maneuvers needed to manipulate an impacted molar tooth can be more complicated because of their location in the back of the dental arch.
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Recent studies have revealed that with early identification of impacted eyeteeth (or any other impacted tooth other than the wisdom teeth), treatment should be initiated at a younger age.Once the general dentist or hygienist identifies a potential eruption problem, the patient should be referred to the orthodontist for early evaluation. In some cases the patient will be sent to the oral surgeon before braces are even applied to the teeth. As mentioned earlier, the surgeon will be asked to remove over-retained baby teeth and/or selected adult teeth. He will also remove any extra teeth or growths that are blocking the eruption of the developing adult teeth. Finally, he may be asked to simply expose an impacted eyetooth without attaching a bracket and chain to it. In reality, this is an easier surgical procedure to perform than having to expose and bracket the impacted tooth. This will encourage some eruption to occur before the tooth becomes totally impacted (stuck). By the time the patient is at the proper age for the orthodontist to apply braces to the dental arch, the eyetooth will have erupted enough so that the orthodontist can bond a bracket to it and move it into place without needing to force its eruption. This saves time for the patient and means less time in braces (always a plus for any patient)!
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What To Expect From Surgery To Expose & Bracket An Impacted Tooth
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The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure that is performed in the oral surgeon’s office.For most patients, it is performed using laughing gas and local anesthesia. In selected cases it will be performed under IV sedation if the patient desires to be asleep, but this is generally not necessary for this procedure. The procedure is scheduled for approximately 75 minutes if one tooth is being exposed and bracketed, and 105 minutes if both sides require treatment. If the procedure only requires exposing the tooth with no bracketing, the time required will be shortened by about one half. These issues will be discussed in detail at your preoperative consultation with your doctor. (You can also refer to Preoperative Instructions under Surgical Instructions on this website for a review of any details).
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You can expect a limited amount of bleeding from the surgical sites after surgery.Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within two to three days after surgery there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site; it can be minimized by applying ice packs to the lip for the afternoon after surgery. A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items, like crackers and chips, as they will irritate the surgical site if they jab the wound during initial healing. Your doctor will see you seven to ten days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process (applying the proper rubber band to the chain on your tooth). As always, your doctor is available at the office and can be contacted after hours if any problems should arise after surgery. Simply call Patterson Oral & Maxillofacial Surgery at 336-812-3104 if you have any questions.
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