Wagner Oral Surgeon & Dental Implant Specialists


In the United States, most oral surgeons remove wisdom teeth through the lateral and distal approach – rather than from the tongue or lingual aspect which is the case in certain European and European influenced locations. As far as I know, I have never had a case of diminished taste sensation after third molar/wisdom tooth removal. A recent article in the Journal of Oral and Maxillofacial Surgery (J Oral Maxillofac Surg 76:258-266, 2018) addresses the question and reports a certain level of prevalence as a problem after removal of more difficult types of third molar teeth. This study comes out of a dental college in India; I might expect that they approach wisdom teeth from the lingual aspect (tongue side approach) to account for these results.

The anatomy of the “taste” nerve (chorda tympani) is different than the “feeling” nerve (trigeminal nerve); although both of them run along the tongue side of the lower jaw on each side along the third molar/wisdom tooth areas. Injury to this nerve is rare, but possible.

Clearly this is a risk that increases with age/difficulty of the extraction and represents another reason why it is wise to have the wisdom teeth evaluated at an early age (about 15 years old) and removed if there are risk concerns. At the younger age the risks are essentially zero.

No matter your age, the risk is almost always less when you are younger. Make sure to go to a competent, gentile, careful OMS for this care, especially if there are increased risks.


Over the years we have vacillated as to whether it is acceptable to perform periodontal probing around dental implants. We have generally advocated for checking periodontal health this way, but recommended plastic probes and avoiding deep probing. There are some common sense ideas I will share here, but as a general answer, there is no problem with gentile (less than 0.25 Ncm = gentile touch pressure) periodontal probing around the neck of an implant to evaluate pocket depth. 1) Risk of damaging the tissue around the implant. As long as the tissues are healthy this should not be a problem. I feel that the general health of the patient is most important here. If there is immune disease, decreased resistance to infective diseases, or the presence of chronic generalized gingival conditions such as might appear with a diabetic or a mouth breather, it would be wise to minimize probing. Use of a softer probe such as a flexing plastic probe may be helpful. 2) Risk of damage to the implant surface by the probe. I feel that this concern is unfounded. Studies have shown the opposite; that any roughening of the surface actually makes it more “sticky”. Also, the contamination by dissimilar metals has been shown to be a false idea or at least very rarely a problem. 3) Risk of bacterial inoculation (introduction of bacteria). Again, this is an individual case and individual health/resistance to disease concern. If you know that the implant is buried deeper than normal – such as may be the case with an anterior tooth – deeper probing should be avoided. Let me explain this again. When we place implants in the “esthetic zone” – front tooth area – especially if there is a lot of tooth and gums showing in the smile – we have to place them deeper in the gum tissue to have them “emerge naturally” or look natural as the crown appears to come out of the gums. These tissues are often naturally thinner and more fragile. I would avoid regular or “routine” probing unless there are clinical signs that warrant the check. The gum tissues around implants “like” the titanium surface and will adhere to it if they are not disturbed. The act of probing deeper tissues also places germs in the deeper tissues. If this is going to be done I would suggest irrigating the area with a dilute 1-to-100 povidone iodine irrigation before and after probing to help reduce the germ counts.

Overall, for otherwise healthy individuals it is fine to check periodontal health around implants with a careful, gentile technique.


Facts About Bone Grafting

know the facts

Modern bone grafts can be used to fix a number of dental and facial issues and are often required. Dental implants often cannot be placed without first getting a bone graft. If you are considering getting dental implants or think you’re in need of a bone graft, here are some things you may want to know!

Bone grafting is a routine procedure!

Over the years, bone grafting has become a standard and highly-practiced procedure. The procedure is typically performed in the office, depending on each individual case and a local anesthesia or conscience sedation is available if needed in order to block the pain and calm any anxiety you may be feeling!

A number of materials can be used!

The bone grafting material that we use may come from a variety of sources. If we are able, we generally like to use bone from your own body, which decreases the chance of your body rejecting the graft. If possible, we will take this bone from your hip, jaw, or lower knee. If this is not an option, we are able to obtain bone from a tissue bank.

Bone grafting allows for your body to rebuild itself!

Your body will use your new bone graft as a sort of frame to grow new bone. Over time, the graft will be replaced with new bone that your body has grown during its own regeneration process. Keeping a healthy amount of bone tissue around your teeth is crucial in maintaining great oral health.

If you are in need of a dental implant, have a congenital defect, or have suffered a traumatic facial injury, and you’re wondering if you might need a bone graft, give our practice a call! We can assess your case, answer your questions and come up with the best possible treatment option for you! Racine Phone Number 262-634-4646


We use capnography for every one of our procedures that involve intravenous anesthesia. (JADA 149(1) pages 38-50, January 2018). We have extensive training and background in anesthesia and we are experts in these areas of care along with many years of experience. I can say without hesitation that the use of capnography (monitoring of CO2) provides little value for increased safety for procedures such as ours where the patient is not intubated and managed with a titrated dose of anesthetic agents. We also monitor EKG, pulse oximetry (P02), blood pressure, pulse and respirations, and I feel all of these are appropriate and necessary.

Clearly the C02 monitoring works and we get a wave reading of the CO2 level. But in an open system (just sampling the exhaled air as is done for non-intubated patients) this monitoring does not give me additional valuable information compared to the cost to the patient of the additional monitoring and equipment. I understand the argument that any safety that we can provide is good, but the blind “following the crowd” in order to sell more and more complicated monitoring equipment that I see from legislators and researchers seems silly. The use of this equipment has been legislated and we conform accordingly, but my opinion remains the same that it is unfortunate that patients have to bear the additional expense of monitoring that may not be necessary.



It has been shown time and time again in scientific studies that leaving impacted wisdom teeth in place leads to problems on the other teeth (J Oral Maxillofac Surg 75:2048-2057, 2017). We see this everyday in OMS practice. The big concern to me is that these problems increase with age, in scope, and in severity. The sad part is that this can be easily cared for by evaluating and treating them at an early age before it even becomes a concern.

Too often individuals choose to “wait and see” what happens and end up with much greater dental problems and increased risks of treatment. Please, if you still have impacted wisdom teeth, even if they are not symptomatic, get in to your board certified oral and maxillofacial surgeon (preferably us J) and have them evaluated. This is a basic, preventative health concern which will result in a healthier mouth.


This is a question that I get a lot and it really makes me crazy. The answer is Yes you still usually need to have your wisdom teeth removed even if you have had braces.

As a general rule, orthodontists will guide their patients to put off removal of their third molar teeth “until they cause a problem”. This is not malicious, they are just thinking of this from the patients’ perspective and an “orthodontic perspective” rather than from the standpoint of surgical risks and problems. If there is an arch length concern the orthodontist may guide the patient to have a bicuspid tooth removal in each quadrant to gain arch length to straighten the teeth. This may result in some additional arch length where they might suggest keeping the third molars. (JADA 148 (12) December, 2017; Pages 903-912).

The truth is that the condition that leads to the bicuspid tooth extractions in the first place (arch length deficiency) is only partially improved by those extractions and as the wisdom teeth try to come in they are in a poor position (poor tissue contours – a lack of attached mucosa) which will lead to problems with cleansing and possible periodontal disease as you age.

Again, the recommendation from the orthodontist relates to their orthodontic care and whether keeping the third molars will adversely affect their care. The whole idea is frustrating to me in that the person that is hurt is the patient as wisdom tooth problems are often progressive and once the damage is done you cannot go back. Again, as I have preached so often – if you still have your wisdom teeth and you want a long term healthy mouth, get them evaluated by a competent OMS. In cases where there are risks get them out. It is much easier, safer, lower risk and less expensive the younger you are.


There is no question that laser use for periodontal surgery has shown great promise for this care. Laser treatment of gum pockets to influence resolution of periodontal disease has brought on the idea that this treatment might be applied to other areas such as surgical removal of impacted teeth. The idea is to use the dental laser to “clean up” and “sterilize” the extraction socket after removal of the impacted teeth. (JADA 148 (12) December 2017; pages 881-902).

When I first saw the data for use of the laser for periodontal surgery I bought into the idea that this could work for other types of surgical sites. What I found is in agreement with the sited article. That is, the use of lasers in third molar sites does not improve healing outcomes. I have found the same thing with use of Chlorhexidine rinses – no effect on outcome. The one modality that seems to have had the greatest result as far as recently applied therapies go is the use of dilute Povidone iodine irrigation. Still the main treatment protocols for best results are atraumatic technique (gentile care), experienced practitioner (expeditious treatment), and appropriate home care (thorough after care/instructions and follow through).


During the late 1980s and during the 1990s we were introduced to various ceramic coated dental implants. I embraced this technology because it made sense. And it did. We placed many of these and many of you have been functioning on them for years. In fact, I have been placing dental implants for over 30 years and failure of these implants, as with all implants, has been rare. As technological advances progressed, it was discovered that a roughened surface on titanium improved the bond-interface between the implant and the bone. At that time, I switched over to the all titanium implant-because it made sense. And it did!

Over the years, we rarely see failures and with the titanium surface, different from the ceramic implants, we have actually found that the maintenance of the bone height and tissue interface remains more stable on the roughened surface implants. Based on the history I do not believe that the ceramic implants do this as well. We are now seeing a return of the ceramic coated implants and I welcome this new application of an “older” technology.

Recently, I had to remove two implants from a patient’s lower jaw. These had been placed by another surgeon and the angulation was poor. It was encouraging to find how completely solid and bonded in the bone they were, even with bone loss and inflammation. And there were original machined surface implants which were the first type of implants that we used in the 1980s. The importance of this is that even though these implants were placed poorly, they were very solid and stable in the bone. I see dental implants as a permanent, very strong, and biologically very compatible replacement for teeth as well as an effective attachment for devices such as dentures and facial prostheses.

Ref: J Oral Maxillofac Surg 72:1928-1936, 2014-10-16
Keywords: Dental implants, ceramic coated dental implants, titanium, hydroxyapatite

What Teeth Grinding Means for Your Dental Health

Teeth grindingTeeth grinding has become one of the most common health concerns worldwide, as there is a very high number of people who encounter it every night. Usually, the teeth grinding, which is also known as bruxism, can appear as a result of high stress and tension, as many studies revealed that most of the people who experience stress during the day confront with teeth grinding during the night.

Teeth Grinding & Your Dental Health

The teeth grinding might represent a symptom of obstructive sleep apnea, which does not allow you to rest appropriately and it determines the appearance of other major affections, that will provoke discomfort as well. Teeth grinding has been well analyzed by researchers and the final conclusion is that this issue may affect mostly people who are very stressed and who do not manage to cope with certain situations appropriately.

However, this affection can be easily treated if the person in question pays a visit to the dentist and asks for proper advice and indications regarding this issue. If the problem is cured before it worsens, people can prevent numerous diseases and other affections which can disrupt their normal lifestyle and provoke discomfort. Many people do not realize whether they experience teeth grinding or not during the night and this is why they do not take the necessary precautions in order to stop it.

How To Stop Teeth Grinding

There are many symptoms which signal a teeth grinding problem and the most common ones are earaches, sensitive teeth, constant headaches and jaw soreness. It is very important to mention these symptoms to your dentist, as they are the most appropriate person who can offer you appropriate advice and indications regarding this issue.

There is no way for your dentist to show you how to stop grinding teeth, as it is a result of the stress and stress is provoked by nerves. However, you can prevent the harmful action of this affection over your general health state and use mouth guards for teeth grinding while you sleep. Usually, the mouth guard is made of plastic and it will stop the teeth from grinding. You can also opt for relaxation methods, which will help you relieve the stress and stop the teeth grinding. Starting from breathing techniques to meditation, the methods to relieve stress are numerous and they can help you a great deal.

As long as you pay a visit to th



We have been using the cone beam scanner for a number of years and it has been an unbelievable adjunct in terms of basic diagnosis and aiding in surgery. The ability to virtually perform procedures such as dental implants as well as looking “into” and around structures such as third molar teeth or the jaw structures in orthognathic surgery. The pictures and the ability to manipulate the structures on the computer screen provide a great teaching instrument to help patients understand treatment needs and treatment plans.

Predictive Scanning

The virtual placement of dental implants using the scanner software includes specific brand and size variations so that we know specifically what can fit into a site and what the proper angulation, position, and trajectory is for best prosthetic treatment. One of the benefits as we look at a scan of a region is a detailed assessment on the adjacent teeth including possible dental concerns. One of the more common things that I note is the decreased density of tooth structure on teeth that otherwise appear in good condition. This at least gives us an anticipation of problems and possible need for additional care such as fluoride treatments.

Eight Types of Scans for Spectacular Detail

The cone beam scanner has eight types of scans which are four sizes ranging from a single site scan to a quadrant, to an arch, to a full face scan and then two levels of resolution. Alike to a digital camera, the highest resolution is gained from the smallest field. The single site scan gives a high level of detail for an individual tooth which is particularly useful for looking at individual tooth fractures or trauma. The manipulation and slicing of images is quite incredible.

Lesions in 3D

One area that has been particularly helpful for an oral surgeon is with lesions. We are now able to see considerable detail about the extent of lesions and involvement of adjacent teeth and bone. The vital structures including the teeth, sinus, and neurovascular bundles are visualized in three dimensional space letting you enter into the site virtually and plan a treatment before you have ever made an incision. Again, in terms of patient education it can be a very helpful instrument.

One of the joys of dentistry is the constant improvement and innovation with materials and methods. The cone beam scanner certainly helps us in the way we practice, but it provides valuable improvement in our patient’s lives through the services that we deliver.

For more information on how a cone beam scanner can benefit your oral and overall health, call Wagner Oral Surgery at (262) 634-4646 today.

Tags: ,