Wagner Oral Surgeon & Dental Implant Specialists

There is no question, having seen the effects of lack of fluoride in water supplies in certain areas here in the states and in our mission travels around the world, that fluoridation is a significant health care aid for the people we serve. Anyone who has practiced dentistry has seen the benefits first-hand. There are genetic factors which can come into play, but for the vast majority of people, application of fluoride can reduce and in some cases reverse the early cavity process. (JADA 2016:147(2):84-91).

The article I reference is addressing the use of fluoride to reverse early decay in children. Fluoride in our drinking water is an important adjunct. Fluoride toothpaste clearly helps to reduce caries incidence on teeth. In my oral surgery practice, I tend to see a greater need in the aging population (who are the ones who are often losing teeth to decay and dental disease) where fluoride can help to reduce caries incidence under restorations such as crowns, or along the gum line. These are classic areas where we can see decay progress leading to tooth loss.

The problem we are seeing now that was not as great a concern 10-15 years ago is that adults tend to not consume tap water, an important fluoride source. Bottled water, bottled and canned beverages, etc. typically do not have fluoride.

I am an advocate for the use of topical fluoride for home use as an adjunct to professionally applied treatments for older adults. I like the fluoride gel. Apply it after brushing your teeth before bedtime and just leave it on the teeth. Typically you can get fluoride gel OTC from your pharmacist. Just ask. In some regions/states a prescription from your dentist is needed. I would recommend using this about three times per month if there is no other specific need. A nice side effect is that fluoride will also reduce tooth/root sensitivity such as may occur with age and gum recession.

An example of a specific need would be if there was another metabolic or physical problem such as immune disease, cancer chemotherapy, radiation therapy, etc. These are areas where you want to have your dentist and hygienist as a comprehensive team guiding you. For the average, otherwise healthy aging adult, fluoride can be very helpful to maintain strong teeth that are more resistant to decay.

Make Your Appointment Today

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

My daughter Kim Bollmeier is now practicing in Southeast Wisconsin with Ascend Dermatology. I couldn’t be more proud!  Click here to read more

As an OMS, I have been referred patients through the years with various “foreign bodies” to remove from the face and jaws. (J Oral Maxillofac Surg 73:1911-1916, 2015) These “foreign bodies” have included glass, metal fragments, bullets, dental needles, teeth, and road debris to name a few. The most memorable are several patients who have had bullets in their facial tissues and had no idea how they got there.

Cone Beam Scanner Available in Our Office

Surgeons tend to be very good at visualizing things in three dimensions and of course we are very familiar and comfortable with navigating the anatomy of the face, jaws, throat, and neck. To the uninitiated or inexperienced it can be easy to get lost in these tissues and it can actually be quite risky to try to navigate in unfamiliar tissues. In my era, CT imaging has always been available and has been essential in evaluating such cases. Now with the cone beam scan at our fingertips, we can get real time localization in more difficult cases. We have a cone beam scanner right in our office and we use it to help with planning as well as directly with care when needed.  

Make an Appointment Today

Learn more about the removal of foreign objects from the face and jaw at Dr. Wagner Oral Surgery & Dental Implant Specialists. Give us a call at (262) 634-4646 today in Milwaukee.

I have been using pedicled buccal fat flaps for closure of oral–sinus (oral-antral) openings (fistulae) as well as for treatment of areas of bone exposure for many years. This has been a reliable procedure with a high success rate. Patients who have undergone cancer treatment including radiation to the jaws and/or chemotherapy are often the individuals who develop such healing problems. This may be the result of tissue injury from the therapy such as radiation, or it may be due to the medications that they are on as part of their treatments such as bisphosphonate drugs which can cause healing problems in the jaw bones (J Oral Maxillofac Surg 73:2080-2086, 2015).

A Procedure with Great Results

One observation I have after performing many of these surgeries over time is that the condition of the fat flap is also affected by the patients’ overall health, nutrition, and the extent of their therapy. Often the result is a connective tissue (fat) tissue flap that does not have very good integrity. This often manifests itself as tissue that has a poor fibrous component. This type of tissue tears or fragments easily. Even in such cases I am usually able to carefully move tissue from one place to another and perform the repair. The realistic expectation is that as the tissue and bone condition is more compromised the success rate goes down. Overall, this is a great procedure that has worked well in our practice.

Call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more about our procedures.

This blog entry sounds self serving, but my reason for writing this blog is that I saw another patient in the last several days with a dramatic healing problem with loss of jaw bone structure relating to previous implant treatment that was done poorly. We are seeing a trend toward “every dentist” placing dental implants. Contrary to what I hear is taught in many courses and dental schools, placing dental implants well is not “easy” to do. In particular, it is not easy to do well. I am seeing more and more patients enter my practice to try and recover from poorly done implant care or to try to recover lost bone resulting from a surgical fiasco provided by an inexperienced, but maybe with well-intentions, practitioner who was practicing outside of their skill set.

Trust a Surgeon With Proper Training and Experience

To me this is malpractice, but since it is “just teeth” or “just jawbone” we do not place a high value on the fact that a patient has a poor result or loss of structure. “At least no one died” is a common statement. I do not see it like that. Surgeons with the proper training and experience will not put their patient at risk in the first place and these surgeons as well are able to deal with complications effectively when they do occur.

Make Your Appointment Today

If you are going to pursue implant treatment, find a surgeon with experience and training. You want excellent outcomes, so look for excellence in your surgeon and dentist.  Call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more about our dental implant procedures.

I do not think that there are too many people out there who would argue that smoking is a good and/or healthy habit. There is a wealth of research showing that smoking cigarettes in particular is deleterious to your health and contributes to many diseases and conditions. The oral (mouth) tissues are particularly affected by the irritants and carcinogens in cigarette smoke.

There have been a number of tissue factors that have been identified as being directly affected causing both direct tissue changes as well as genetic changes (J Oral Maxillofac Surg 73:2123-2131, 2015). The genetic predisposition to these problems is an area of considerable research as scientists look at individual gene expression and map the gene variations to predict disease. From a purely anecdotal standpoint, surgeons will tell you that there is a relationship between cigarette use and tissue/healing problems. Certainly anesthesia concerns relating to cigarette use is another whole subject and discussion.

If you are a smoker, please realize how destructive the habit is and seek help in trying to quit. To learn more about oral tissue damage from smoking, contact Dr. Wagner Oral Surgery & Dental Implant Specialists at (262) 634-4646 today.

What Is The Standard of Care For X-Rays For Impacted Wisdom Teeth?

The standard of care based on the most recent white papers by the ADA and AAOMS for pre-treatment x-rays for third molar teeth (“wisdom teeth”) is the panoramic scan. The truth is that technology continues to march forward and the Cone Beam Scan gives a far better view of the related anatomy in three dimensions. With this scan we are able to manipulate the images to see those relationships in great detail.

Cone Beam Scan Gives Greater Details

The cone beam scan (CBCT) images are helpful in most all cases as they give so much more detail and much greater detail. If it is affordable to you I would recommend the CBCT for all cases. Having said that, I feel that most third molar treatments can be provided safely with just the panoramic view. That is the only imaging that we had for the first twenty years of my practice life and we had an excellent technique – result quotient. We rarely have complications. We have always been careful and gentle no matter. It is when there are specific findings clinically that we may be directed toward additional imaging. It is when the panoramic scan points us toward those clinical risks that I specifically urge patients to let us take the cone beam scan.

The relationship of the lower wisdom teeth to the nerve bundle in the jaw is the most common “risk reason” for me to advise a cone beam scan. The inferior alveolar nerve (IAN) is a branch of the mandibular division of the trigeminal nerve. The trigeminal nerve carries sensory information such as touch, pressure, temperature, and pain from the facial structures to the brain. The IAN does not control any muscles, but it affects both feeling and proprioception (awareness of the structure in space) to the lip, chin, teeth, and gums in the lower jaw. Injury to the nerve can result in diminished or loss of feeling in part or all of these areas. Having the cone beam scan does not eliminate the risk, but it can reduce it significantly by giving us more specific information about the nerve location. Basically, it tells me which areas to avoid in the surgical procedure. To the date of the writing, I have had no problems with injury to the nerve in all third molar cases where we have had the cone beam scan.

Powerful and Helpful Imaging Tool

Again, I would recommend considering the scan for anyone having a procedure done on their jaws, but more specific indicators would include; wisdom teeth, lesions (growths, cysts, tumors), tooth position abnormalities, orthodontic concerns, TMJ problems, dental implant planning, and evaluation of growth abnormalities, to name a few. Once you see a cone beam scan and experience the visual manipulation of the images you quickly realize what a powerful and helpful imaging tool that it is. You also realize how much value it can have toward your proper diagnosis and treatment.  

Learn more about cone beam scans for wisdom teeth treatment at Dr. Wagner Oral Surgery & Dental Implant Specialists. Give us a call at (262) 634-4646 today in Milwaukee.

I was trained in dental implants in the mid-80s when they first came to the United States. Those were all titanium Branemark implants. Shortly after that, a number of other implants came to market with titanium alloy taking the place of pure titanium. We started using ceramic coated implants in the 1990s for certain applications and we had generally good luck with them. The advancements including sand blasted roughened titanium surface and improvements in the thread and surface configuration of the implants brought us back toward titanium alloy as being an ideal material.

The ceramic implants have always been out there and frankly, I have not seen any particular long term problems with any of the implant types that I have placed ceramic or titanium. There is an intuitive feeling that any implant surface that might be exposed even with some minor bone loss would be a harbor for microorganisms and cause progressive problems (and that would be the thought with a material like ceramic). Frankly, we just have not seen that. Overall, the long term success rate with all of implants has been excellent.

That brings us full circle around to the use of Ceramic Zirconia as an implant material instead of titanium. The beauty of it is that it is a white material and it does not show any dark area either through the bone or along the gingival margin, even if there is some bone loss.

I have not seen this technique yet, but I imagine that in the near future we will extract a tooth, take a cone beam scan of the socket, and then immediately mill a one piece dental implant and crown or dental implant with a prep using a CAD-CAM technique that would insert tight into a tooth socket that has been otherwise prepared to receive an implant, probably with some freshening of the surface or use of a healing interface such as PRGF. We could certainly even build in a roughened surface or retention grooves on the ceramic which would create a friction grip into the socket for secure placement.

We have tried contoured implants in the past which were designed to help maintain the papilla bone (bone and tissue spikes between the teeth). This was not successful, but I would imagine that a precision computer generated ideally contoured implant using ceramic material would have great promise. I am an innovator, but I am not a researcher or developer. I am an experienced surgeon who looks forward to this technology catching up with our dreams.

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.

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.

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.

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.

WHERE?

Wagner Oral Surgery and Dental Implant Specialists.

WHEN?

I suggest having wisdom teeth removed at a younger age for several reasons. When patients are younger the roots of wisdom teeth are shorter, basically less “grown in” so less resistant to removal. They are typically “looser” in the bone making it a less painful and less risky process. Lastly, removing them early means better and faster healing and an easier recovery.WHY?

WHY?

Most people do not have room for their third molars. Even when there is space in the jaw there is typically poor attached gum tissue contours. As time progresses they develop problems which often damage the adjacent teeth adversely as well. Risks of treatment increase with age.

Gum disease.

Germs and debris can make their way in behind the tooth in front of the wisdom tooth site. This can lead to inflammation of the gums over the wisdom tooth, but more importantly can lead to permanent bone loss on the adjacent second molar.

Crowding.

The presence of the wisdom teeth signals the teeth around it to shift to “make room”. This can complicate orthodontic problems.

Decay.

Bacteria tend to be harbored by impacted teeth. Because you are often not able to clean it, decay can progress and damage the
adjacent second molar.

Poor position.

Wisdom teeth often develop at abnormal positions and angles. This magnifies the other issues such as risks and infections.

Cysts.

The developing tissues around wisdom teeth can develop growths and tumors. These can be very destructive and can be avoided by early removal.

Learn more about wisdom tooth at Dr. Wagner Oral Surgery & Dental Implant Specialists, call (262) 634-4646 today.