Wagner Oral Surgeon & Dental Implant Specialists

Successful Treatment Rarely Used

Orthognathic surgery used to advance the upper and lower jaws is a highly successful surgical treatment in many cases of obstructive sleep apnea (OSA). (J Oral Maxillofac Surg 73:1133-1142, 2015). Either in spite of this or maybe out of some level of ignorance, I have found that regionally we rarely use this technique in treatment of OSA. As a surgeon who has extensive background, training, and experience in orthognathic surgery I often wonder why we do not pursue this further.

Improving Health Standards for All Patients

Frankly, from my point of view, these are typically difficult patients to manage from a health standpoint, and they are often “unhappy” patients frustrated with their condition and situation. This fact causes me not to pursue these patients in terms of any type of marketing or public awareness. Having said that – I do care deeply about improving health standards for our patients and OSA is a serious condition with many troubling side effects for the patient. If I had OSA, I would want to pursue all reasonable avenues of care including orthognathic surgery.

For many people, the phrase wisdom teeth removal inspires anxiety. While tooth extraction is not a walk in the park, it is often necessary to ensure oral health.

Dr.  Wagner Oral Surgery and Dental Implant Specialists of Racine, WI can provide more information on wisdom teeth removal to help ease your mind. 

Here are the pertinent facts about wisdom teeth removal that you should know.

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An article in the May 2015 issue of JOMS looks at the likelihood that wisdom teeth will need to be removed. (J Oral Maxillofac Surg 73:806-811, 2015). The conclusion is that in most cases the wisdom teeth do need to be removed. What the article does not show specifically and what we know from practice experience is that price of retaining the teeth is high both in real cost as well as the cost of complications, disability, and increased risks.

When it comes to wisdom teeth extraction, in general, the risks associated with leaving the teeth are enough to necessitate their removal.

Here are some of the issues that can arise when wisdom teeth are left and not extracted.

Wisdom Teeth Risk #1: Permanent Damage to Nerves

To me, the most important of these are the risks such as ending up with permanent nerve injury. To the patient, the most important of these are probably the complication of loss of adjacent teeth due to decay or periodontal disease brought on by the wisdom teeth. The reason I say it this way is that in a high percentage of cases we are able to control the nerve injury by careful diagnostics and surgery.

Wisdom Teeth Risk #2: Irreversible Decay or Periodontal Problems

We cannot typically reverse periodontal or decay problems after they have started. The bottom line is that it is easy and it is best to evaluate wisdom teeth/third molars at an early age. I recommend seeing your oral and maxillofacial surgeon at about age 15. Need for care, prediction of problems, and proper timing of treatment can be determined with a panoramic x-ray and/or a cone beam scan.

We can assess your wisdom teeth and determine if extraction is needed.

If you’ve got questions about wisdom teeth removal for your children, and when the teeth should be removed call Wagner Oral Surgery at (262) 634-4646 today.

Cutting Edge Technique

When you have small lesions or small tissue areas for biopsy, we have historically used an incisional or excisional technique using a blade such as a #15 blade. Tissue punches are a nice alternative and give a clean, round tissue cut. You control the depth of the excision as you use the biopsy punch. The technique is to tense up the tissue area and then rotate the punch on the surface of the tissue watching the depth of cut on the blade of the punch. You can then hold the central portion of the specimen with a tissue forceps and either excise it with a tissue scissors or a blade removing it at the desired level.

Round Punches Through Medical Suppliers or Online

Biopsy punches can be purchased through your medical supplier or online. I use a 5 or 8 mm round punch. If I am getting larger than that then I would use a blade for excision. You can Google Miltex Sterile Disposable Biopsy Punches; 8 mm typically come in a box of 50. After excision on unattached mucosa, I would usually place one or two 4-0 plain gut sutures to approximate the tissue although this is not necessary.

Mucosal Grafts from the Palate

I also use these to harvest attached mucosal grafts from the palate, especially if I am performing a single site extraction and graft. In those cases, I would oversew the graft with 5-0 or 6-0 nylon to try to keep firm pressure over the graft at the site. I have also used this technique to regain a bib of attached mucosa along the facial aspect of the crest of the ridge in an area such as where we have placed an implant and there are poor tissue contours or a thin tissue biotype. My preferred technique for the thin tissue biotype however, is still an interpositional graft with a partial thickness attached mucosal graft which usually can be taken nicely from the tuberosity area.

Dr. Wagner is an expert in all things tissue biopsy punches. For more information, call (262) 634-4646 today.

Last year we saw the passing of one of the great pioneers in dental care, Dr. Per-Ingvar Branemark. His research and innovations were not only a great service to dentistry, oral and maxillofacial surgery, and the progression of dental research, but these innovations have blossomed to wonderful treatments that have improved the lives of millions of patients. Throughout his career, it was the well being of patients and appropriate patient care that motivated him and guided his protocols. In his own words, his work was, “to bring basic science and biology to improving the quality of life of human beings.”

A Titanium Pioneer

I had the great pleasure of meeting Dr. Branemark several times during my career. He was an unassuming, humble man who took the time to make all of his admirers feel important. It was his study on the relationship of titanium and its response in bone that has led to countless offshoots in all areas of medicine. Most all implants placed in the body now utilize the titanium technology. The fact that bone grows up to and engages tightly to the surface of titanium enables us to support everything from a tooth to a hip joint.

Invaluable Research

Dr. Branemark carried out a decades-long journey with continuous research which included the placement of the first titanium dental implant in 1965. Widespread acceptance of this treatment took place in the early 1980s. In 1984 the program that I was associated with became one of the first in this country to be placing dental implants and helped validate this research to a skeptical dental community and public. Dr. Branemark always stressed the importance of widely available implant therapy to “reach as many patients as possible by having simple, safe procedures.” One of his famous lines was that “no one should die with their teeth in a glass of water.” Thanks to his efforts, implant treatment today continues to grow and advance. I am indebted and grateful to him for his life of service and research.  

Wisdom Teeth Need to Be Removed Most of the Time

An article in the May 2015 issue of JOMS looks at the likelihood that wisdom teeth will need to be removed. (J Oral Maxillofac Surg 73:806-811, 2015). The conclusion is that in most cases the wisdom teeth do need to be removed. What the article does not show specifically and what we know from practice experience is that price of retaining the teeth is high both in real cost as well as the cost of complications, disability, and increased risks.

Preventative Measures to Avoid Permanent Damage

To me, the most important of these are the risks such as ending up with permanent nerve injury. To the patient, the most important of these are probably the complication of loss of adjacent teeth due to decay or periodontal disease brought on by the wisdom teeth. The reason I say it this way is that in a high percentage of cases we are able to control the nerve injury by careful diagnostics and surgery. We cannot typically reverse periodontal or decay problems after they have started.

Early Evaluations

The bottom line is that it is easy and it is best to evaluate wisdom teeth/third molars at an early age. I recommend seeing your oral and maxillofacial surgeon at about age 15. Need for care, prediction of problems, and proper timing of treatment can be determined with a panoramic X-ray and/or a cone beam scan.

Call (262) 634-4646  to schedule a consultation or evaluation for wisdom teeth removal.

The May 2015 Journal of the AAOMS (American Association of Oral and Maxillofacial Surgeons) contained an article delineating the recent care guidelines for Finland as it relates to third molar/wisdom teeth removal. (J Oral and Maxillofac Surg 73:804-805, 2015). Europe has, in general, been behind in the promotion of preventive dental procedures such as the early removal of wisdom teeth. That is a broad statement and there are certainly exceptions. This article shows some advancement in those philosophies.

Wisdom Teeth: A Stitch in Time Saves Nine

My opinion is that socialized medicine generally wants to limit any procedures and tends to parse out treatments carefully to restrain costs. My further opinion is that this is done at the peril of those citizens because as we age the problems associated with wisdom teeth retention increase, the complications associated with treatment increase, and the social cost (lost time, lost wages, ultimate cost of treatment) also increase. Where they save money, is that for many patients decay and periodontal disease lead to the loss of the dentition and lower maintenance costs. This, however, leaves the patient partially crippled dentally. Our ideal here in the States is to maintain the dentition in a healthy state for the lifetime of the patient. This includes more attention shown to wisdom teeth removal.

Preventative Wisdom Teeth Removal

The good news is that their study relating to Finland supports the idea of early removal of wisdom teeth as a preventive measure. Any oral and maxillofacial surgeon with experience can tell you that this makes sense.

Wisdom Teeth Removal Equals Wise Medicine

If our goal is to maintain healthy teeth and mouths for a lifetime and lower risk of treatment – the early removal of wisdom teeth is wise medicine.

Call on the Jaw Doc for expert wisdom teeth removal services at (262) 634-4646.

During my training, I had the privilege of also going through a one year anesthesia residency which was on top of the typical intensive anesthesia training that goes along with becoming an oral and maxillofacial surgeon. With this residency, I was able to work for the Department of Anesthesiology at Metro Health Center in Cleveland for most of my three years as a surgery resident. This was moonlighting as an anesthetist, most typically doing nighttime cases such as burns, heart procedures, and trauma. This was an unbelievably great opportunity in that these are highly challenging cases in terms of management which helped to greatly sharpen my skills and knowledge of anesthesia and medicine. I came into practice with a very healthy respect for anesthesia and in particular the importance of patient assessment and management of medical concerns.

Experience and Care With Dental Anesthesia

Over the years, we have seen a continued erosion in training standards and care standards for anesthesia with many practitioners entering into this treatment realm with little training and experience. Dental anesthesia is a good example of this, but marginal anesthesia training has been around in multiple medical specialties for some time. The idea has been to bring the cost of care down, but they have seen more cases of complications and problems. My observation is that drug selection and inadequate emergency preparedness are the main shortcomings leading to complications.

Attention to Detail

I am proud to say that in over 30 years of practice we have never had any serious anesthesia complications. I believe this is mainly due to our attention to detail (with monitoring and dealing with concerns before they become problems) along with a very conservative technique (titrated dose anesthesia). We have performed thousands of anesthesia procedures on patients of all ages.

Having said that, I am well aware that a serious problem could happen tomorrow. Maybe the important point is that we are prepared, trained, and follow safety protocols in this care.

Ask Questions About Your Doctor’s Background

Be aware that there are many doctors out there who may perform office based anesthesia, many with a minimum of training. Check you doctor’s background and training. Residency based training is most ideal. A board certified oral and maxillofacial surgeon should have excellent training. A specific anesthesia residency is even better. Then look at their office, staff, and equipment. Does it look up-to-date? Are they ACLS certified? Is their facility set up as a surgical care center with easy access for emergency medical service? Ask questions.

RICHARD M. WAGNER, D.D.S.
Board Certified Oral and Maxillofacial Surgeon<br />© 2015 Wagner Oral Surgery and Dental Implant Specialists

Proudly serving Racine, Milwaukee, Kenosha, Franklin, Oak Creek and all of South East Wisconsin.

Wagner Oral Surgery | 1925 S Green Bay Rd. | Racine, WI 53406 |(262)634-4646

We have been using Piezosurgery for our office-based surgeries for many years. This is an advanced technology which uses ultrasonic frequencies to perform bone surgery. We have found it to be a cleaner, easier, less painful, and lower-risk way to perform many of our procedures involving bone and soft tissue treatment such as grafting, bone widening, and dental implant care.

Different Patients Mean Different Challenges

 The truth is that any tool is only as good as the hands it is placed in, and a talented surgeon can have great results with a variety of approaches. That is what allows us to deal with the variety of challenges that we encounter with different patients.

A Better Approach to Difficult Treatments

I have found the piezotome to be a great adjunct to our surgical care. It selectively cuts bone and not soft tissues such as nerves or blood vessels, so we are able to better approach difficult treatments with confidence that we were not able to treat in the past.

Call (262) 634-4646  to schedule a consultation for Piezosurgery.

Ref: J Oral Maxillofac Surg 72:1168-1172, 2014