Wagner Oral Surgeon & Dental Implant Specialists

MINI DENTAL IMPLANTS: ARE THEY OK?

We have used Mini Dental Implants (implant diameter less than or equal to 2.9 mm) over the years for a variety of applications. The most common use has been to use them for orthodontic anchorage – that is where the implant is placed and used to secure braces in order to move teeth. The implant is essentially immovable and the orthodontist can anchor their braces to this and move the teeth relative to the implant. I have also used Mini Dental Implants (MDI’s) as temporary support for dental applications such as to attach a denture during a period of healing such as after grafting. I have found them to work consistently well in these types of applications. (Compendium of Dentistry April 2019, Vol. 40, #4, pg. 238-241)

Where we have seen problems – and this was apparent to us from the start – is when the expectation is that this would be a long-term or permanent functioning device. Mini Implants fail at this.

I see advertisements for them all over and they are being done for “low cost implant care”. We get to see many of these cases after several years when they are failing. What we end up with is discouraged, unhappy patients trying to find the “fly by night” practitioner who provided this care and it often costs much more to recover this situation than it would have to do it the correct way in the beginning. In spite of this, I see patients continually going to that well expecting that they are going to get pure water at a cheap price. There is no substitute for excellence. And excellence does cost something.

I have seen very few Mini Implant cases that I would expect to be long-term. If you are going to pursue that care, I would recommend that you find a doctor who has been around and who will be around to stand by his or her work. I would advise a minimum of 2.5 mm diameter and a roughened surface implant. Make sure you get several opinions.

My basic recommendation is to not get Mini Implants in the first place unless you are in a particularly unique situation where the implant will not be called on to carry much load.

ELECTRONIC MEDICAL RECORD AND PRIVATE PRACTICE

Computerization has been present since the start of my practice life, about 30 years ago. We have always transcribed our notes and so we have always utilized computer based systems to organize our data including patient registration. The use of this information to file insurance came on the scene a number of years ago and has been useful and helpful in expediting a still cumbersome process as it relates to oral surgical-insurance ease. The true use of Electronic Medical Record – as it exists in the hospital setting may seem like it is up and running strong. But the truth is that these systems are not readily accessible to practitioners and especially when you cross boundaries from one corporate entity to another. (J Oral and Maxillofac Surg 77:896-897, 2019). When you get to the level of a clinical application such as an oral surgery group or a dental group it becomes even more narrow.

It is only beneficial in that the members of our group are able to share and access information on shared patients. It is my opinion that the data we can access through hospital based systems to evaluate and treat our patients is extremely helpful. The problem for us – as private practitioners – is that our information is not easily shared on their (the hospital or medical group’s) system without either functioning in their system, or by spending a great amount of time inputting data into their system.

Frankly, as a small group practice, I have found it easiest and best to maintain our own records and in our case that includes a combination of electronic documentation and paper charts. I am actually hopeful that shared systems will not become mandated by the government. It seems that we do not have very much privacy as it is.

Flossing: Absolutely Necessary!

Yes, You Still Have to Floss. No, the dance move “flossing” does not count. The AP recently released an article making the claim that “there’s little proof that flossing works”. Their review cited a series of studies that found flossing does little or nothing to improve oral health. Here’s the problem: the studies were flawed. The AP concluded that floss does little for oral health, but it’s important to note that the evidence they cited was very weak at best. In fact, they said so themselves.

As acknowledged by the AP, many of these studies were extremely short. “Some lasted only two weeks, far too brief for a cavity or dental disease to develop” (Associated Press). They also say that “One tested 25 people after only a single use of floss” (Associated Press).

Of course, the evidence is unreliable. You don’t simply develop gum disease because you forgot to floss yesterday. Cavities and gum disease do not happen overnight. Gum disease is preventable by maintain great oral health habits for a long period of time. Lets put it this way: If a study claims drinking milk does nothing for bone health, but draws conclusions after only three glasses of milk, is it a reliable study?

The fact of the matter is floss removes gunk from teeth. You can see it. Gunk feeds bacteria which leads to plaque, cavities, poor gum health, and eventually gum disease. Floss has the ability to reach the food particles that your brush can’t get to. Using a sawing motion instead of moving up and around the teeth to clean the cracks. Positive results come from correct use and it’s critical that people learn to use a tool properly before discarding it as useless.

That’s just what floss is: a tool. Just like your toothbrush, it is designed to keep your mouth clean, and therefore keep your body safe from infection. Both your toothbrush and floss are designed to do what the other can’t, and both successfully remove bacteria from your mouth. Just like proper brushing technique, it is important that you know how to use floss properly, so that you can reap the long-term health benefits of good oral hygiene.

Oral hygiene is a long-term process and requires long term observations to make worthwhile conclusions. In the meantime, it’s obvious that you should continue to do everything you can to protect your well-being, and floss is one of many tools that can help you do that. If you would like a refresher on the best, most efficient techniques for floss use feel free to call our office today

Wisdom Teeth: Questions Answered

Wisdom-Teeth--Questions-Answered

If you or your child are getting your wisdom teeth removed, you must have questions! We are here to make you feel as comfortable as possible. As always, if you have other questions feel free to contact us. We are more than happy to help you understand more on your upcoming procedure. Read on for some frequently asked questions:

1. Why do we have Wisdom Teeth?
Centuries ago our human ancestors used wisdom teeth to help them grind up tough food, like leaves and roots. Their jaws were larger and had more room for extra molars. As we evolved, our diets changed to include softer foods. The third molars became unnecessary as our jaws became smaller.

2. Why do I need to have my wisdom teeth removed?
There are several reasons why you would need your wisdom teeth extracted, as they can cause a variety of complications.
• Impaction: If there is not enough room in your mouth, your wisdom teeth will become impacted and grow at an angle. This can cause problems such as pain and discomfort while eating.
• Damage to other teeth: Your impacted tooth can begin pushing against your second molars, causing potential tooth decay.
• Disease: Spaces between the impacted tooth and your molars allows room for bacteria to grow, putting you at risk for inflammation, cysts, and periodontal (gum) disease.

3. When should I get my wisdom teeth removed?
Wisdom teeth usually come out between the ages of 17- 25, and are typically removed during your high school years. The longer you wait, the more complications that may arise. The root will continue growing and can cause potential permanent nerve damage.

4. When are wisdom teeth okay to keep?
If there is enough room for them to erupt correctly without causing any damage, then they are safe to keep. It is also important to note that not everyone is born with all four wisdom teeth, as evolution has been removing them for generations.

We hope this article has helped you, and if you have any other questions please contact us. Everyone’s teeth are different, and we want to make sure we take the right course of action for your wisdom teeth.

When Should You Consider Dental Implants?

consider implants

Dental implants typically consist of three components: the post, the abutment, and the restoration. The post is a screw which is inserted into the bone. The abutment is attached to the post and the restoration is placed on top, giving the finished product a beautiful, realistic look.

Dental implants are an effective way to replace missing or damaged teeth, but when is getting a dental implant the best option for you? There are a few circumstances where receiving an implant might be the best option for improving your smile.

To restore and preserve your appearance
One of the main functions of dental implants is to restore a smile back to its original glory. They are built to last a lifetime, and last much longer than dental bridges. If you are looking for a permanent solution to damaged or missing teeth, dental implants are your best option.

To protect and preserve a healthy jawbone
Missing spaces in your smile can lead your jawbone to deterioration. Dental implants are the only option which will protect and save your natural bone. Waiting to get a dental implant can continue to increase the chances of your jawbone not being able to support dental implants in the future.

To stop your teeth from shifting
Losing a tooth can cause the surrounding teeth to shift and look unnatural. These teeth can become crowded or can be shifted unevenly. This can cause your teeth to become harder to clean and can also cause your face to sag and appear sunken.

These are just a few of the instances in which you should consider getting dental implants. Dental implants are one of the most useful and successful restoration options available today. For more information on how we can restore your smile with dental implants, contact our practice today at Racine Office Phone Number 262-634-4646 !

ROOT RESORPTION (ROOT ABSORPTION) FROM THIRD MOLAR TEETH (WISDOM TEETH)

It is fairly common to see abnormalities on the second molar teeth caused by the presence of the third molar impactions (wisdom teeth). (J Oral Maxillofac Surg 77:11-17, 2019). These are developmental and are caused by the developing tooth structures of the second molar sharing the same space during development causing them to form in “unusual shapes”. For the most part this does not cause failure of the teeth such as infection or decay. More likely this becomes a problem when the teeth have to be removed and/or if gum disease (periodontal disease) becomes an additive issue. The point is that an abnormally shaped tooth may be more prone to disease.

The easy solution to this is early diagnosis and early removal of the offending teeth – often the wisdom teeth or third molars. I recommend early treatment – about age 15 for best results. In some rare cases the second molars may be considered for removal if they have a more–abnormal shape or position and if the third molars can then be guided in either naturally or orthodontically to achieve the second molar positions. If this is the thought – an even earlier age should be considered.

ROOT CANAL INFECTIONS SPREADING TO THE SINUSES

It is common for dental infections to spread to other areas outside of the jaw bone such as the upper jaw, sinuses, or the facial structures. When there is a more serious infection the danger is that the spread can extend to the brain or chest where it can kill you. I am often amazed at how quickly this spread can occur and frankly how often people will ignore danger signs and leave a problem untreated until it has caused significant damage. Fortunately, it is rare to die from dental infections, but we have seen it happen. The take home lesson is “don’t take dental infections casually” – they can easily become serious matters. (Decisions in Dentistry January 2019, pgs. 7-11).

The cited article indicated above shows several cases of spread of infection from upper back teeth to the sinuses. This is a common situation for us to deal with, both from the standpoint of diagnosis and treatment, as well as dealing with the sequelae of poor treatment or lack of treatment. The anatomy of teeth for most patients has the teeth/dental structures located in what is fairly thin bone. This allows for easy spread of infection from abscessed teeth to the surrounding structures such as drainage to the mouth (most common), as well as drainage to structures such as the sinuses or fascial spaces (the tissue planes between the muscles and “skin” layers of the face).

We have such wonderful access to advanced surgical procedures as well as antibiotics/medications here in the United States that these problems are very treatable. We are able to even graft and place implants often at the same procedure as we are cleaning up a site. Again, the take home message is do not take dental infections for granted.

3 Tips to Keep Your Gums Healthy and Happy

3 tips for happy gums

Keeping your gums healthy is vital to ensuring that your mouth stays clean and your teeth stay intact and in pristine condition. Incorporating a few simple steps into your daily oral hygiene routine will keep your teeth and gums healthy, happy and your smile shining bright for years to come.

Floss Like a Boss
Flossing is one of the easiest and most effective steps you can take to fight against gum disease and keep your gums healthy. Flossing once to twice a day helps to clean the hard to reach areas in-between your teeth that your toothbrush cannot reach.

Keep ‘em Clean
Brushing twice a day is the most commonly preached method of keeping your mouth clean and cavities at bay. Be sure to brush with a fluoride based toothpaste to help to give you the best results when brushing. Next time you are shopping for toothpaste, look for the ADA seal of acceptance in order to ensure your toothpaste is backed by experts!

It is also beneficial to rinse your mouth with an antiseptic mouthwash twice a day in order to protect your gums. Rinsing with mouthwash is a great way to finish off thoroughly cleaning your mouth, because it reaches areas that your toothbrush and floss can’t reach.

Stay Regular
Visiting your dentist twice a year is extremely important in preventing oral diseases and guaranteeing that your teeth stay in tip top shape.
Your dentist will perform a thorough cleaning and will show you the proper way to brush and floss if you need a bit of help!

These three steps can help you significantly improve the health of your gums and reduce your risk of developing gum disease. If you have any questions about how to keep your gums healthy and happy, give our office a call, today!

WHICH IS BETTER; PRGF OR PRF?

 I have written on this in the past, and was reintroduced to the subject in a recent article in our journal (J Oral Maxillofac Surg 76:1823.e1-1823.e12, 2018).

PRGF (platelets rich in growth factors) and PRF (platelet rich fibrin – also called L-PRF) are terms used to describe products of blood fractionation used in surgical procedures. Unfortunately they do not have a specific definition from a procedure standpoint medically/surgically. The original descriptor for PRGF was “plasma rich in growth factors” which is also an appropriate term, but I feel falls short of showing that we are using a platelet concentrate, not just plasma. There is an importance in that some techniques that other practitioners use to separate the component parts include additional cells which may adversely affect the desired result. Some include the white blood cells (leukocytes) and others include some red cells (erythrocytes) and/or additional plasma and components. I feel strongly that there is a difference in results and in our practice we stick to using primarily the platelet–growth factor portion where we can, which is the vast majority of cases.

Historically we used the patient’s own bone harvested locally, from the jaw, or from a distant area such as the hip or rib as examples. This works well especially for large defects and especially with vascularized grafts (bone grafts including the grafting of associated blood vessels and tissue such as muscle). The problem with your own bone is the necessity of a donor surgical site and also that our bodies absorb our own bone easily – so a graft such as an onlay graft using your own bone, which might be performed for implant reconstruction, will absorb easily during the healing process resulting in the loss of the graft.

In comes materials such as ceramics, animal bone products, and human bone products. Of these the human bone product (deproteinated and irradiated for sterilization) has shown to be the best received and very stable for grafting of smaller defects as might be used in typical oral surgical procedures. The ceramics and animal bone products have their uses and we find them to be excellent for certain applications, however they may show a more difficult “take” or acceptance and they tend to stay on forever in their present state (which is technically not usually a problem – but can be). The human bone product is essentially completely reabsorbed and replaced by your own native bone during the healing process. This result is more desirable to me.

When you mix PRGF and the human bone product (and in some cases the other bone substitutes) I call it a “super-charged” graft with not only a bony scaffold (the bone graft material), but also a very cellular accelerant which “induces” bone growth (the PRGF). This has been a quantum leap for our grafting procedures and gives great results. The cited article backs up the idea that the PRGF works better than just PRF to induce tissue regeneration and growth.

We have been using these techniques for about 10 years. Again, we have been performing implants and grafting procedures for over 30 years and we have trained in and tried all of the reasonable techniques. We stick with what works best and keep looking for new and better materials and methods.

In our hands, PRGF works better than PRF for grafting techniques.

DIRECT ORAL ANTICOAGULANTS AND MEDICAL COMORBIDITIES

Patients who are taking oral anticoagulant drugs such as Coumadin or Plavix (as examples) can be divided into about 10,000 groups based on their medication, age, medical problems, history, genetics, dosage, the treatment needed (to name a few). In other words there is no simple one-size-fits-all answer to this question/problem of how do you manage a patient on oral anticoagulants who needs an oral surgery procedure. (J Oral Maxillofac Surg 77:463-470, 2019).

There are some simple rules-of-thumb that we follow and they all boil down to the idea that we need to “know” our patient as much as possible and then use good judgement and tried surgical techniques to control bleeding as much as possible. Along with that, a well-informed patient and family/support personnel as to how to deal with problems as they arise, goes a long way to head off problems. Some very basic fact-finding with the patient, patient’s family, and patient’s primary care doctor will usually answer the questions required to make good decisions for an experienced, well-trained surgeon.

The article that I site discusses the effect of comorbidities such as diabetes as predictors. Frankly, I have found that trying to predict based on comorbidities has a limited use. Clearly, a patients’ other medical problems as a list is good to have – but these need to be assessed as they relate to how they are affecting “this” patient. We see patients with multiple serious medical concerns who know their own health well and have good control. They will have a much lower risk than someone who does not understand their own disease such as hypertension and who has poor control.

Again, these are complicated issues and proper discernment, follow through, and responsible surgical care work best to save us from having problems.