Wagner Oral Surgeon & Dental Implant Specialists

A “corticotomy” refers to a procedure where we make cuts in the bone to disrupt the outer (cortical) bone layer in the area of the tooth roots to cause the release of reparative factors from the bone and tissues. These factors signal the bone and surrounding teeth to heal, but it has been found that these factors also act as signals to the body to be very open to change. That is, the healing or reparative process is also a process that accelerates changes like tooth movements. It is for this response that we perform this procedure. Once stimulated in this way, the surrounding bone and teeth are much more “open” to orthodontic and orthopedic treatments and this can result in tooth movements much more quickly and even tooth movements that were previously not possible. This procedure must be differentiated from corticectomy, which is a much more invasive procedure, and involves removal of the top layer of the bone in the area of the teeth.

I prefer the corticotomy procedure and most recently we have applied this technique in a case of adult orthodontics in a patient who has also undergone orthognathic surgery (corrective jaw surgery for a developmental jaw/bite abnormality).

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

Studies have shown that telemedicine consultations (consultations with a doctor or nurse over an electronic video link such as the internet) are as effective as traditional face-to-face consultations. (J Oral Maxillofac Surg 74:262-268, 2016). We have not yet gone to this method at our office, but it seems that it would make us more efficient and would be friendly for most patients’ busy lives and for those who have routine oral surgery needs. It would certainly be more convenient for most patients with basic needs – it could be done virtually anywhere with your phone. The problems I see are that in most examination and consultation visits, there may be need for more imagining, or other/different concerns may arise that may not be picked up in the telemedicine consult.

I do think that in the near future we will be able to handle most simple consults for wisdom teeth and routine extractions this way. There is some basic infrastructure which has to take place such as making consultation and consent videos, but the web makes that pretty easy and accessible. I will look forward to progress in this area.

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

Truly one of the most poorly understood professions, Oral and Maxillofacial Surgeons have done a poor job of promoting and providing public awareness of our profession. (J Oral and Maxillofac Surg 74:1109-1110, 2016). The basic definition is that we provide “comprehensive surgical care and treatment of the face, jaws, mouth and teeth.” We are the highest trained and most comprehensively trained in all aspects of dental surgery – moreso than any other dental specialty; and we have the highest medical and general surgical training of any of the dental specialties. Most of us have advanced training in head and neck surgery with overlaps to areas of otolaryngology, facial plastic surgery, and panfacial trauma. We are the highest trained as it relates to dental implants and related surgeries. We are arguably the highest trained subspecialty in anesthesiology. These statements are not cockiness or egocentrism. It is just the truth and I’m proud of it.
If there is a shortcoming in this, it is that the specialty may be so broad that one needs to limit their practice to certain areas of subspecialty in order to “have a life”. I absolutely love being an OMS. I look back on the path to being here and I am so grateful to God and so grateful to so many people who have supported, trained, guided, and loved me through this journey. My specialty is planning a media outreach to do just that – explain and define what it is that we are and do. I hope that campaign is informational and helpful.  

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

I first saw Dr. Istvan Urban present on the “sausage grafting technique” several years ago at the Pikos Institute course in Orlando. The grafting technique uses PRGF and bone product in a tube shaped absorbable mesh material. This technique uses materials and methods that are familiar to us, but like many things in dentistry, he applied innovative logical thinking and came up with a new application. I have subsequently used this method to graft bone to areas of the jaws where there was not enough bone for implant care. We were subsequently able to place dental implants successfully in the new bone that was created.

The shortcomings of the procedure are that it takes time – often 6-8 months to complete the process – and it is a tedious, involved surgery. On the positive note, it is not a particularly painful process and our results have been very good. Contraindications would be significant health issues that may affect healing (such as radiation and chemotherapy in the past, vegetarian diet, and cigarette smoking).

The assessment for the procedure would include a comprehensive dental plan, a cone beam scan, and clinical examination. This technique can also be used to best prepare the jaws for comprehensive implant care such as the All on Four/Teeth in a Day technique.

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

Just this morning we performed a surgery where we rebuilt the dental ridge and used Transalveolar Suturing to help preserve the attached gum tissue around our dental implant sites. I first saw this presented at the Pikos Institute bone grafting course a number of years ago and we have used it ever since. The idea is simple; a hole is made through the dental ridge at the surgical sites and a suture is passed through the bone to tack down the tissues to hold them in place during initial healing so swelling and muscle movements do not cause the tissue to heal in the incorrect place.
I remember back in the 80s using a denture or other prosthesis and wiring it or suturing it in place to hold the tissue or a graft. That was a good technique at the time, but now it looks barbaric. Bone tacks and Transalveolar Sutures will soon be replaced by resorbable bone anchors (which already exist, but are still a little costly). The suturing technique is tedious to do, but it gives great results and is not painful nor does it create any disability. To the contrary, it results in great tissue contours and the increased tissue stability during healing gives increased comfort.

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

Here is a listing of articles regarding the successful use of orthognathic surgery – MMA (maxillomandibular advancement) to help in the treatment of OSA (obstructive sleep apnea). The expected success with these procedures can be evaluated with a cone beam scan and clinical examination. This is a big surgery and carries a number of risks and limitations, however the reported results are good.

I would still consider the UPPP (uvulopalatopharyngoplasty) if there is a significant secondary tonsilar drape. That procedure removes excess tissue from around the soft palate and throat to better open the airway. This needs to be done conservatively so as not to cause a “rigid palate”. Done well, it is an excellent procedure. The UPPP has been shown to improve breathing, but is again not a cure.  Read the rest of this entry »

I have blogged on several occasions about the risks that go along with providing care for our general population who are living longer and living with greater medical problems. One area we do not speak of much is that of patients who have congenital problems such as congenital disabilities or congenital heart defects as examples. These patients are also surviving much longer and are found in our patient populations on a regular basis, even for more complicated procedures. (J Oral Maxillofac Surg 74:601-609, 2016). Experience has taught me (along with many of my teachers and mentors) – and now I pass on to others – is that when you see one congenital problem, expect more. It is especially common for patients who have branchial arch or cleft deformities to have other defects that may not be diagnosed. A common example might be a person with a birth defect with a deformed ear or jaw structure who may have never had a heart problem diagnosed. This can show up for the first time when we anesthetize them for an oral surgery procedure. If you have a congenital growth abnormality, make sure to let your surgeon know about this and make sure they are following through with proper presurgical testing. Lastly, make sure they are experienced and well trained. It can make all the difference.

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

An article in the October 2016 issue of the JADA addresses this question. It is commonplace for women of childbearing age (full range) to be on oral contraceptives (OC). It is anecdotal, but I do not feel that there is any difference in the rate of “dry socket” (DS) in women who are on or not on OC. But it does seem logical that hormonal changes, especially during menses, would cause body tissues to show increased fragility. The same process that allows the uterine lining to slough also can cause other lining tissues in the body to be fragile and separate. We certainly see this in oral tissues with the increased susceptibility to autoimmune reactions such as aphthous sores during these times. It may follow that healing tissues, such as an extraction socket which depends upon the stability of a bone – fibrin – endothelial interface, may be prone to breakdown/interruption in the healing process for certain individuals.  

We do not see many problems with osteitis or dry socket in our patient population as a whole. When we do I will ask questions about care and habits. I will also look at surgical risk factors such as infection, periodontal concerns, and difficulty of the treatment. Frankly, the only two things that I have found any consistency as to an increased incidence of osteitis (DS) is smoking in both men and women, and onset of menses in females. Smoking is far and away the greater risk and again, overall the incidence even in these groups is low.

The bottom line is that we do see a correlation with DS and the onset of menses. We do not see a correlation with just the use of oral contraceptives. Unless a patient has a specific concern or health issue I would not delay treatment because of the presence of these risks. I alert patients to the risks as is appropriate.

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

There are privacy issues that one gives up when using electronic media and coIn the November 2016 ADA News there was an article about a dentist who has created a prototype app for cell phones to report dental emergencies. The idea is good, but it is unnecessary to have a specific app.

If a patient has a concern all they need to do is use their smart phone to create a video or photo series where they can show us their problem area. For instance, facial swelling or an abnormal area such as on their gums or teeth and they can email this to us right from their smart phone for us to view and evaluate. Patients have even sent us pictures of x-ray scans so that we can give them an estimate such as for removal of their wisdom teeth.

Tmmunications of this nature needs to be understood as being unsecure. It does not seem that this would be a great issue for most patients. Secure sharing sites such as Drop Box could be used when there is a concern.

We are happy to communicate with patients in these ways using electronic media and it does help in assessing the risks and concerns that you may have. If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.  You can also email us at [email protected], in some cases it could even help to avoid an unnecessary trip to the doctor.

A gentleman came to our office recently for evaluation for dental implants. He had undergone radiation and chemotherapy for head and neck cancer a number of years ago. He had been to another surgeon recently and had a consult regarding dental implants and was told that he would need HBO (hyperbaric oxygen) treatment prior to his dental implant care. Since this had been presented to him as a treatment option, it almost becomes a mandatory treatment from a medical legal standpoint, but in my heart I feel it is unnecessary.

It has been my experience that most patients who have undergone treatment for head and neck cancer, including high dose radiation and chemotherapy, can have dental implants with an expected high success rate (J Oral Maxillofac Surg 74:1965-1973, 2016). Read the rest of this entry »