Wagner Oral Surgeon & Dental Implant Specialists

What to Expect When Expecting (..A Bone Graft)

bone graft..what to expect

Need a dental implant but don’t have sufficient jaw bone? Dental implants are the most effective option when it comes to replacing a tooth. However, if in order to successfully get an implant, you need to have an adequate amount of jawbone. If you don’t, then you will need a bone graft before getting the actual implant. Bone grafting is when an oral surgeon will either harvest bone from another part of your body, a cadaver, a deceased animal, or in most cases, use a special bone grafting material to anchor it onto your jaw bone, thus increasing its’ strength and density. Although the procedure may sound pretty scary, we can promise you it’s nothing of the sort. Below are some things to expect when getting a bone graft!
First, it’s important to keep in mind that dental implant surgeries are most often performed in stages. The first stage is the removal of the damaged tooth. After the removal of the tooth is when the actual bone grafting takes place; which, as explained previously, is when an oral surgeon replaces lost bone, therefore creating a base for a dental implant. Once the jawbone heals, you’ll be able to move on to the next stage, which is setting up the base for the dental implant using a titanium post. After this heals, the prosthetic tooth will then be inserted. To summarize, this process is often very long, spanning over months. A successful bone graft and implant won’t just happen overnight.
Recovery time is often based on the size of the bone graft and implant. This can take anywhere from a short two weeks to more than a year. We recommend avoiding intense physical activity for the first six weeks. Swelling is expected (as it always is after most surgical procedures); it’s your body’s reaction to the surgery. Most swelling won’t be apparent until the day following your surgery. To help aid your swelling, Ice packs can be applied to the outside of mouth where the surgery was performed.
As always, if you have any questions regarding the procedure, or simply want to discuss the details further, simply call our office @ Racine office of Wagner Oral Surgery & Dental Implant Specialists Phone Number 262-634-4646.

AGE AS A RISK FACTOR FOR THIRD MOLAR SURGERY COMPLICATIONS

 No matter what your age, if you still have your wisdom teeth (third molar teeth, “eight” teeth) and especially if they are impacted (below the surface), I strongly urge you to have the evaluation by an OMS for concerns and risks. Absolutely, for my family members, friends, and patients; I strongly urge that earlier removal be considered as part of a long term oral health plan.

I hear many patients and even dentists who recommend a “wait and see” approach. Something like “we will deal with them when they become a problem”.  Or “they are not causing any problems so we can wait”. Wait for what? For infection, bone loss, decay, cysts? I get to deal with these types of problems everyday and there is no question in my mind that “waiting” for the most part is a bad choice and early removal, no matter what your age, is usually the best choice.

At mid teen years, the risks with third molar removal are close to zero. By 20 years old the third molars are well formed in the jaw and this starts the greater risk process. As decades go by, there are increased risks from many standpoints. The advent of the cone beam scan to assess the position and risks in three dimensions has made the process even safer. We use careful and gentle surgical techniques.

If you still have your wisdom teeth, especially if they are impacted, please get an evaluation for care. In most cases, younger is better. (J Oral Maxillofac Surg 65:1685-1692, 2007).

Healthy Foods for Healthy Smiles!

healthy foods for healthy smiles

A healthy school lunch will not only give your child the energy they need throughout their school day, it will keep their teeth healthy too! Below are some examples of healthy foods that will keep your kid smiling all day long!

PB&J’s! While a popular choice, often times sugary jellies and nut butters are not great for kid’s teeth. Try switching to a natural peanut butter, and a preserve or fruit jam (aim for 5grams or sugar or less per serving). Use whole wheat bread as a healthy alternative too!

Cheese Please! Cheese is high in calcium which is probably one of the most important nutrients for your teeth. It is absorbed by tooth enamel and help block bacteria growth. Without calcium, your kid’s teeth could be in big trouble! Cheese also has protein, which is not only important for the growth and development of children, it also keeps their muscles strong and healthy making for a stronger smile.

Snack-Attack! Apples are great to munch on, they are high in water which help to dilute the sugars they contain. When you are chewing, the saliva production helps protect against tooth decay, pairing this with a low sugar nut butter makes an excellent snack! Edamame beans are also a great option, they are rich in calcium and are fun to eat too! Just make sure to get a salt free version to avoid too much sodium.

We want water! Although it seems simple, water is MUST. Often times we give our kids way to much juice and not enough water, and studies have shown that juice is just as bad for you as soda! Kids should be drinking 5-10 glasses of water each day, so encourage them to hydrate by sending them to school with a reusable water bottle they can keep filling up.

If you have any questions about what types of smile friendly foods your child should be eating, feel free to call our office today!

When do You Need a Bone Graft?

when do you need a bone graft

Bone grafts are essential for replacing missing or damaged bone in your jaw. Whether a cavity has reduced your tooth to an empty, gummy space after an extraction, or gum disease has caused loose teeth, a bone graft can repair and rebuild the damaged bone needed to support a dental implant. Surrounding teeth can also become loose and eventually fall out without healthy bone regeneration, which may cause future complications. Without bone grafting, a dental implant would not have enough mass to securely latch onto.

So, when do you need a bone graft?

• Once a tooth is lost, 25% of bone width is reduced within the first year. If left untreated for an extended period, there would not be enough surrounding jawbone to support a dental implant to replace a missing tooth. Once bone mass is gone, it cannot be reversed which is why a bone graft may be needed.

• Periodontal disease can also cause bone to disintegrate, which can lead to tooth loss. The bacteria slowly eat away at the jawbone and periodontal ligament, which connect teeth to bone.

• Dental trauma, including the persistence of grinding and clenching teeth, can cause excess wear on the tissue supporting tooth structure. The constant pressure can also lead to fractured or cracked teeth, which do not heal. Aside from grinding and clenching, trauma can also include a tooth getting knocked out from an accident or a fall. In this case, a bone graft may be needed as well.

Bone loss can be caused by several different circumstances, but one thing is for sure- a bone graft is a great alternative for repairing and building new bone. So, what are you waiting for? Call today for a consultation to see what our office can do for you! Racine 262-634-4646 Kenosha 262-654-4222

COMBINED PERIODONTAL ENDODONTIC INFECTIONS

When a tooth is involved in a Combined Periodontal-Endodontic Infection (CPEI) there is a communication between an infected tooth pulp (the internal soft tissue structure of a tooth) and the space along the side of a tooth, or periodontium (the soft tissue support structure of the tooth roots).

A tooth is a naturally enclosed structure with an internal soft tissue component that we call the pulp which is made up basically of connective tissue, blood vessels and nerves. The pulp communicates with the body through small openings in the roots – most typically in the root tips – that we call the root canal openings. Root canal treatment is designed to remove any dead tissue from the diseased root canal space and seal off the openings in the roots. Periodontal disease involves bone loss and communications along the sides of the roots of the teeth. Periodontal problems are typically treated with cleaning up the diseased tissue, controlling the bacterial environment, and grafting the tissues and/or bone if there is significant loss.

When there is a communication between an endodontic/root canal problem, and a periodontal/gum-disease problem, I would evaluate the severity, treatability, and the relative importance of the tooth in the dental scheme. Treatment may be recommended to try to save the tooth if reasonable for the individual patient.

I am absolutely not opposed to trying to save teeth – even if treatment may be considered heroic. However, it is my prejudice as a dental implant practitioner, that in many cases we are much better off replacing such a tooth with a dental implant early on. Treatment of advanced CPEI has shown low success rates and the very action of treatment often results in further bone loss and can ultimately compromise a dental implant plan. Built into my prejudice is the knowledge that dental implants have a comparatively excellent long term success rate and long term treatment stability.

If you have a tooth that has a diagnosis of a Combined Periodontal-Endodontic Infection – seek out several opinions. Read up on the success rates and make your best educated decision moving forward.

(Reference: Inside Dentistry April 2018 Pg. 38)

 

SURGICALLY FACILITATED ORTHODONTIC THERAPY

Surgically facilitated orthodontic therapy (SFOT) uses corticotomies (bone cuts made through the outer bone layer) and dentoalveolar bone decortication (removal of some of the surface bone) to stimulate the regional healing processes and increase bone remodeling and tooth movement as part of orthodontic treatment. It also generally includes guided tissue periodontal tissue regeneration (helping periodontal/gum health) and/or dentoalveolar augmentation (adding bone in areas of loss). (Compendium, March 2018: Pg 146-149)

We have been providing these treatments proactively for about 10 years. Prior to that we had learned through experience that when we performed jaw surgeries (orthognathic surgery), that it was easier to move the teeth for a period of time after the jaw surgery was performed. At the time, we theorized that this was due to the physiologic and chemical changes in the tissue/bone/teeth as a result of the healing processes that resulted from our making bone cuts to perform these surgeries. Subsequently, this was shown to be true through research. During the healing processes, because of the release of these healing/regeneration factors, the teeth are particularly open to the suggestion of orthodontic movement. There is a limit to this and a properly trained surgeon/orthodontist team is best to carry this treatment out.

The procedure typically involves making small vertical incisions in the gum tissue between the roots of the teeth that are to be moved. Through these small incisions an ultrasonic bone cutting instrument called a piezotome is used to make small cuts just through the outer layer of bone. It is fairly simple as long as you know what you are doing. It is not a painful procedure either. Some slight soreness for a few days, but most people would be back to school or work the next day.

In combination with computer generated orthodontic tooth movement, this procedure can greatly reduce treatment time and effectiveness. Ask you orthodontist if you would benefit form SFOT.

National Ice Cream Month: Fun Facts About Your Favorite Summer Treat!

I scream, you scream, we all scream for ice cream! Flashback to when you were a child on a hot summer day, when all of the sudden you hear that magical jingle that captivated all of our hearts; the ice cream truck! In the year 1984, President Ronald Reagan decided that from then on out, the Month of July would be recognized as National Ice Cream Month! Because really, what’s better than a big, cold, scoop of ice cream on a hot summer day? That was a trick question—there is nothing better. Whether it’s vanilla, chocolate, mint chip, or pistachio, there’s a flavor for everyone. Ice cream has that ability to brighten anybody’s day and for that, we’re eternally grateful. With that being said, let’s celebrate this month by highlighting some of the most fun facts about ICE CREAM!

#1: The best way to eat ice cream? In a waffle cone of course! However, it wasn’t until 1904 when an American ice cream vendor at World’s Fair in Missouri ran out of cups due to the high demand of guests, so he quickly rushed on over to a local waffle vendor and asked him to roll up his waffles so that they could hold the ice cream. The rest is history!

#2: Do us a favor really quick. Open your Freezer. Is there at least one form of ice cream in there? There should be! In fact, approximately 98% of all U.S families have ice cream in their homes at ALL TIMES! So, if your freezer is lacking, run to your local grocery store and pick up a pint so you’re not the odd one out!

#3: Brain freezes…. Ice cream’s arch nemesis. A brain freezes is a short-lasting sensation, normally lasting for about ten seconds, that often occurs when you eat or drink cold items in a short amount of time. The most tried and true way to get rid of a brain freeze? Place your tongue on the roof of your mouth and wait it out!

#4: Did you know one that one of the biggest ingredients in ice cream is AIR? That’s right, air. Air is added cream to make the consistency lighter, while also improving the texture. It’s often said that the amount of air added to the batch will determine the overall quality (the more air, the cheaper the quality).

#5: Throwback to the year 1665, when the first documented ice cream recipe was handwritten in a recipe book. The ingredients? Orange flower water, mace, and ambergris, also known as whale barf. Let’s just say we sure are grateful for how far the flavors have evolved….

This month, we want you to enjoy all that ice cream has to offer. We challenge you to try a new flavor that may be out of your comfort zone; who knows…maybe it’ll be your new favorite. Give us a call at Racine office of Wagner Oral Surgery & Dental Implant Specialists Phone Number 262-634-4646 if you have any questions or concerns regarding your oral health!

Common Dental Implant Myths

common dental implant myths

Insecure about a missing tooth? Don’t be. With dental implants, you can get your smile back to looking perfect. For many, dental implants provide the feeling of having their natural teeth back again. This is because instead of being a removable type of device, such as a dental flipper, dental implants are permanently embedded into the jaw, which then allows a dental crown to take the place of the missing tooth. We understand that this procedure may seem intimidating, but we’re here to reassure you it’s not as bad as it sounds. Below are the top three common misconceptions when it comes to getting dental implants.

Myth #1: Dental Implants are painful

This is a common fear. Many people hold back from pursuing a dental implant, simply because they’re afraid the procedure might be too painful. However, this is not true. The procedure itself is pain-free. As always after surgery, there may be some temporary discomfort, but your doctor will work very closely with you to ensure your comfort and ease.

Myth #2: Dental Implants are expensive

Although dental implants aren’t cheap, they’re a much better investment than dental bridges, which need replacing every 7-15 years. Dental Implants cost may be high initially, but it’s a better financial decision in the long run.

Myth #3: Dental Implants cause headaches

It’s a fairly common myth that dental implants can cause migraines or headaches. However, we’re here to let you know that this is not true. There is absolutely no scientific evidence to support this. After the dental implant has successfully bonded with the jaw/gums, you should experience zero pain.

If you have any questions or concerns regarding dental implants, give our office a call at Racine 262-634-4646 Kenosha 262-654-4222 so we can discuss the next steps.

MANAGEMENT OF THE MAXILLARY DIASTEMA IN YOUNG CHILDREN

I read with interest an article in our recent journal about how various dental specialties treat maxillary diastemas in children. (J Oral Maxillofac Surg 76:709-715, 2018) According to this article pediatric dentists and orthodontists generally agreed that frenectomy should not be performed before the permanent canines are erupted and that the operation should follow orthodontic closure of the space. I could not disagree more. I have seen this treatment sequence carried out for 30 years and I often get to see these patients in their 20s and 30s where there diastema has relapsed or they are having gingival problems between the central incisors. It is simple to understand and simple to manage. I have successfully treated many of these patients on referral by their general dentists who understand the logic of my method.

The maxillary midline diastema, a space between the upper front teeth, is typically caused by a thickened band of tissue under the upper lip that is abnormally attaching through to the palatal aspect rather than inserting in the more normal position on the front side of the upper jaw. The diastema and abnormal frenum attachment are easily seen in the pediatric patient as a thickened tissue band extending between the upper front teeth holding the primary/baby teeth apart. I recommend treatment at about age 5 or 6. I find it best to treat it before the primary teeth are lost, but at a time where the permanent teeth are close to coming into the arch.

This is not a simple snipping or cutting of the muscle attachment under the lip. That will not resolve the problem. It is important to excise the fibrous attachment between the central incisors as well (frenuloplasty and fiberotomoy). In most cases, we have found that the primary central incisors will drift into a more normal position and permanent central incisors will erupt into a completely normal position. Without the procedure, the adult incisors come in with the same diastema space.

It is a no-brainer to me that you would take care of this as a preventative treatment even if it requires a surgical procedure. I have had several of my dental colleagues, dental assistants, and even orthodontist’s assistants come to me for this procedure for their childrens’ care and with consistently good results. There is no question that I would recommend this for a child with a maxillary midline diastema.

MAGNETIC RESONANCE NEUROGRAPHY FOR TRIGEMINAL NEUROPATHIES

This article brings up an important point in the proper diagnosis of nerve injuries involving branches of the trigeminal nerves. That point is that MRI (magnetic resonance imaging) can be very helpful in diagnosing the problem and verifying the potential location of the problem. (J Oral Maxillofac Surg 76:725-736, 2018)

This article brought out a specific area of interest for me and that is the diagnosis and treatment of neuropathies of the lingual nerve after third molar surgery. I have been fortunate that this has been an extremely rare complication in our practice and, at the time of this writing, when it has occurred, we have never had a problem with a permanent injury such as permanent pain or numbness. I recognize that it could happen tomorrow – but we use a technique in how we approach teeth, and with the use of cone beam scanning as a pre-op study for more complicated cases, we have experienced a low complication rate.

We do however, get referred cases for treatment where other practitioners have treated a patient with a resultant nerve injury and they come to us for evaluation for repair. The first point is that early diagnosis and treatment give the best chance at resolving a nerve injury – so do not put off care waiting for the problem to resolve. There are definitely exceptions to this – such as a partial numbness or a light “tingling”. But if there is a complete numbness on the side of the tongue and it is getting past 3 months post-treatment, an MRI and surgical evaluation should be considered.

The second point is that the approach to the lingual nerve is critical. Many surgeons will make an incision back by the third molar region to access that area. There is a much easier and much better way and that is to approach the area much like one would approach the removal of exostoses – that is an incision along the back teeth and a releasing incision extending across the third molar area to the lateral aspect. A full thickness flap is then made to expose the tongue side of the jaw bone. In most cases, you will find an area where the bone is disrupted in the area of the previous surgery and the tissues along with the nerve are “pulled into” the third molar healing defect. Teasing these tissues out, and “releasing” scare tissue bands, and placing a surgical barrier graft over the bone defect will often times relieve the problem. If it is found that the nerve is severed you can try to approximate the ends, however it has never been my experience that the nerve has been cut and it is my opinion that the prognosis for repair in that case would be poor.

The third point is that if at the time of MRI and evaluation that the nerve is noted to be cut, then a microneurosurgical consult should be sought out. Going back to the beginning of this discussion, the MRI can be helpful in determining the location and the extent of these types of injuries.