Wagner Oral Surgeon & Dental Implant Specialists

We perform many procedures that have discomfort as a possible side effect so we prescribe pain medication regularly. I have always taken this responsibility seriously and we have genuine concern for the potential for individuals to abuse this. (J Oral Maxillofac Surg 74:1291-1293, 2016). Although it is a very real responsibility for surgeons to prescribe responsibly, it is also the responsibility of individuals to use the privilege of prescription medications responsibly. This includes the responsible curation, storage, and/or disposal of these medications. Unfortunately, our society has become somewhat naïve and casual as it relates to the possibility that family, friends, or even casual visitors to our homes may be using our prescription drugs. Pain medications are an obvious one, but abuse of many types of medications or illicit use of them is widespread. Read the rest of this entry »

Upper back teeth often have roots that extend up into the sinuses. When these teeth need to be removed, healing with a persistent sinus opening can occur. there are a number of factors that can contribute to this and these include cigarette smoking, healing problems such as autoimmune disease, presence of sinus disease, periodontal issues, and ankylosis to name a few. Cigarette smoking has been the one greatest risk factor in my experience.

We have used many different procedures over the years for treatment of an oral sinus fistula and the closure using native fat tissue derived from the cheek fat (buccal fat pad) has been the best and most reliable procedure for this. (J Oral Maxillofac Surg 74:1718-1722, 2016). Read the rest of this entry »

The article in the September issue of JADA regarding Periodontal Therapy as a preventive measure for Third Molar sites was very interesting on several fronts. First and foremost is prevention. We can predict early on with a panoramic scan the expected arch length concerns and pathology concerns there may be with third molar (wisdom) teeth. Early treatment, if appropriate, essentially eliminates the pathological concerns — eliminating the cause preventatively before it occurs — and minimizes the risk with treatment. Prevention is the key! Read the rest of this entry »

We Have Added the Nobel Biocare Parallel CC Implant to Our Armamentarium

I have added the Parallel CC Implant to our Nobel line. For you, this is the same platforms, connections, and instrumentation as the Active implant. No changes! For our patients, this implant brings the “biologic width” and “platform shift” technology. This implant has significant advances which help maintain crestal bone. The “CC” stands for “Conical Connection”. Again, this is the same internal connections and platform sizes as we are familiar with using the Active implant. These include the narrow, regular, and wide platform applications that we have used in the past. These also come in ultra short sizes. Read more here. 

We continue to use the Nobel Active implant, especially for All-on-4, immediate placement, and immediate load cases. We also continue to use the Astra and Straumann implant systems as always.

The Parallel CC implant is a significant move forward in ideal treatment results. We have already been using this implant on a regular basis and have found it to be excellent from a surgical standpoint. I expect prosthetic excellence will follow.

We have been practicing oral and maxillofacial surgery for over 25 years. I was specially trained in anesthesia with an additional anesthesia residency beyond the typical OMS. Even with basic training I feel that OMS’s to be the most comprehensively trained subspecialty in anesthesia, but all of the training that exists does not reduce the importance of proper care, and the truth is that each day you enter into practice realizing that any patient can have an abnormal reaction or complication. (J Oral Maxillofac Surg 74:474-479, 2016).  When we discuss light sedation, moderate sedation, deep sedation, and general anesthesia – these are all on a continuum of the same process. That is where proper training, continuing education, and preparedness play a crucial role in patient safely. We have delivered thousands of safe anesthetic procedures without complications. I feel very fortunate to say that we have never had an anesthetic complication in our office. We are, however prepared and trained to deal with the possibility.

The biggest and most important part of this is knowing anesthesia well and providing a conservative, titrated dose technique. We are thorough in our preparation and approach and I trust that you, as our patient, feel confident that we are providing excellent care for you. Oral surgery can be scary, it can be uncomfortable, and it can be tedious. We want to give you an excellent experience from all standpoints.

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

I do not have a 3D printer in my office yet. Many of my dental colleagues are using CAD-CAM milling of crowns which is the opposite, but similar technology. We have used off-site manufacturers of 3D molds for various applications. Our guided surgery templates up to this point are largely made of acrylic, but not printed. The place where this technology seems to have significant application will be printing prosthetic replacements for body parts in trauma and cancer reconstruction cases. (2016 American Association of Oral and Maxillofacial Surgeons 0278-2391/15/0141 6-0).

Many times we do not know what the contours will be until we are in surgery and have removed diseased, injured, or pathologic tissues. The ability to print a replacement out of a bone replacement material such as a biological ceramic is very exciting. Another great clinical application that we could use today would be the printing a semi rigid absorbable mesh material to hold a bone graft for dentofacial reconstruction. This could replace titanium mesh which, in our present procedures, has to be removed after a period of bone healing.

The challenge is to grow these technologies in a way that delivers the best care and without it costing too much. I applaud the continued work that is being done in these areas.

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

A “critical summary” in the March 2016 Journal of the American Dental Association addressed the positive effects of grafting at the time of dental extraction. (JADA 2016:147:204-206). I have been doing this type of grafting for about 30 years and as the technology and materials have improved, the results continue to be even better. The technology is going faster than the critical peer-reviewed literature so in my practice I am performing successful procedures that we learn about at our meetings but possibly have not been reported on yet. The articles in our present day journals are often talking about techniques that we were using several years ago. This is normal, and in a big way medical and surgical practices are where ideas and techniques are refined.

Like so many things, individuals with better structure to start with, do better with these procedures. The opposing experience has taught me to be realistic and appropriately cautious when treatment planning for someone who has poor tissue and bone structure to start with or patients with an “immune deficient profile”. It is not that we cannot do it – it just may require additional procedures or different techniques. As a patient you must be realistic: as a doctor you must be observant and wise.

The techniques we have now using bioactive materials like PRGF and PRF along with bone and bone substitutes (allografts, alloplasts, xenografts, etc.) have made this much more successful. Again, you must have realistic expectations and competent care. There is no question that we have better results with bone retention in the long run when we graft rather than when we do not graft. In fact, bone loss without grafting is common at extraction sites. As this technology improves and as the cost of materials have come down these have become standards of care in my practice.

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

I am not sure that this is such a big debate from a treatment standpoint. The question is; “what should we do when root canal treatment has failed”. (JADA 2016:147(3):214-220). The truth is that every case is unique and the person who did the root canal treatment in the first place probably has the best idea about the logic of trying a retreatment procedure (doing the root canal over again). In some cases this may be a dollars and cents decision. In other cases this may be a “treatment desire” decision.

In most cases I am presented with, there is a logical thought process based on the clinical picture (what we can see is involved / what are the particulars for this patient) and what options are available to us. As a surgeon, even though we continue to perform surgical root canal treatments such as apicoectomy and retrofill, I have been moving away from these procedures in favor of implant treatment which in many cases is much more reliable and has a much higher success rate. So if I am presented with a failing root canal treatment, my prejudice is toward looking to another option.

I work closely with my endodontist colleagues and have found that there are obvious warning signs that would tend to guide us away from further root canal care (retreatment). To name a few; periodontally compromised teeth, suspicion of a periodontal communication, abscess along or close to the gum margin, fractured teeth, larger lesions such as odontogenic cysts, and a history of trauma. I would always encourage an opinion from the endodontist (root canal specialist) if there is any doubt.

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

There are literally hundreds of dental implant types, brands, sizes, and treatment protocols. Actually combined, there are probably thousands. Understanding these and deciding what is best for you in your specific case is the duty of your surgeon. In the dental community there is tremendous pressure for just about every practitioner to place dental implants. This is unfortunate in that I see so many cases where doctors with inadequate training or experience are placing implants of the incorrect size or type are being placed, implants being placed in an incorrect location in the bone, or in the presence of pathology.

One of the more common “rookie mistakes” made by the inexperienced is placing too small of an implant. (J Oral Maxillofac Surg 74:489-496, 2016). This usually comes as a result of not enough bone at the site and a desire to “just get an implant in there”. Do not fall prey to this. First, make sure your implant surgeon is experienced. Next, ask questions about the amount of bone you have and what size and type of implant that is going to be replaced. Is it big enough to support the tooth or teeth? What might happen if it is not? What are my options? Do not be satisfied with an “adequate” bone preparation. Proper long term success can be delivered consistently with excellent site preparation and proper implant selection.

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

Surgical exposure of palatally and facially impacted canine teeth as well as other impacted teeth is a common procedure for us. (J Oral Maxillofac Surg 73:2273-2281, 2015). The most typical is a palatally impacted canine tooth that is not descending normally. The typical procedure involves opening up the tissues, removing bone and tissue to expose part of the crown, and placement of an orthodontic button and chain to use for the orthodontist to bring the tooth into proper position. If you wait too long, the impacted tooth may fuse in the bone (ankylosis/ankylosed) and then will not come in normally. It has been my experience that you usually have up to about age 30 to perform this treatment.

The health of the gum tissue on the younger population is typically very good and so the procedure is tolerated well and the gum tissues will typically heal well around the adjacent teeth. There are occasions where the impacted tooth comes up in less healthy tissue (this is common on lower impactions). In these cases we try to modify our procedure or we may need to augment these tissues at a later date with a gingival graft. All of these procedures have been around for a long time and have shown to be reliable and reproducible. This recent article did a study that followed patients undergoing this procedure and found as well that this is a reliable and safe procedure.

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