Re-Infection Concern

I stopped using drains for severe odontogenic infections about 15 years ago. I am concerned that drains may actually act as a path for re-infection.  (J Oral Maxillofac Surg 71:42-46, 2013). Perhaps, with an under-educated or less cooperative patient population it may be appropriate, but I think that the population I serve tends to be healthier and cooperative.

Results that Matter: Thorough Work

I have never had an infection case resistant to wide surgical dissection, irrigation, and appropriate antibiotic usage. I imagine that if I had a patient who was showing a resistance to treatment I would consider it.

We are always excited to be able to keep on top of the latest in technology and technique when it comes to fighting infection. If you are ready to obtain innovative and patient-oriented infection fighting services, we can help. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our oral surgery team is excited to help you achieve a happier, healthier smile.

Nerve Repair: An Inexact Science

Nerve repair technology has continued to improve over the years, particularly with the use of nerve grafts and guided tissue regeneration. (J Oral Maxillocaf Surg 70:1978-1999, 2012). It is still an inexact science and although we can get a return of sensation to an area where it may have been lost, it is usually imperfect sensation. The patients are happy to have feeling back, but it is rarely perfect.

I have been very fortunate during my career that I have rarely had this complication. I like to believe that I am careful and methodical in my treatments and I use reliable techniques. I am sure there is something to that, but I also think there is a certain amount of good fortune. One of my mentors told me years ago, “The more careful and studied you are in surgery, the luckier you will be.” That is good advice no matter what you do.

Early Nerve Repair to Restore Function

In terms of nerve repair, my experience is that the most important factor in restoration of nerve function is performing a repair as early as possible. This often means trying to make a decision whether the reported problem (let’s say numbness) is likely to resolve. Sometimes the decision is obvious, such as a traumatically cut nerve. Most of the time it is not so obvious. A good rule of thumb is that I would like to decompress or repair a nerve within four months if the problem is expected to be permanent. This is a little simplistic as a statement, but I put it here just for discussion.

Evolving Nerve Repair Tools

Three dimensional cone beam imaging is a relatively new tool which helps us tremendously in qualifying that assessment and decision. Proper testing and assessment is critical and it is a weighted decision as to whether it is worth it to try to get a return of sensation to an affected area.

Nerve Repair from Your Milwaukee Oral Surgeon

Let our experienced and professional oral surgeon help repair your tooth’s nerves before it’s too late. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today!

Surgical root tip surgery (apicoectomy and retrofill) has been a common procedure for us my entire career. Although it is a tedious and meticulous procedure, I actually enjoy it. In many cases, it is a last-ditch effort to save a failing tooth. Because of this, and with the advancement of implant treatment, it is often a better decision to just lose the tooth and put the resources toward a new implant tooth.

Excellent Results with Your Root Canal

My material of choice when I perform retrofill is Super-EBA. It handles well and has given consistently good results (J Oral Maxillofac Surg 70:2041-2047, 2012). In this article, Super-EBA is compared to MTA in a study of regional tissue response in a dog model.

Typically, we are performing this procedure in cases where conventional root canal fill is failing or is not possible. In some cases, retreatment of the root canal fill can be tried.

New Technology

We can now use cone beam imaging to look at a very high resolution 3-D image of a tooth root and root apex to look for root fractures or incomplete fills. These are the most common problems that I find with failed root canal. With the cone beam study, we can make an excellent diagnosis and decide the best treatment course moving forward.

Thorough Surgical Root Canal Procedures

If you’re in need of a retrofill for your failed root canal, we can help. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our caring and professional oral surgeon will take wonderful care of you.

With the use of better and better sensors for our radiographic scans, we are now able to take a 3D Cone Beam Scan with less radiation exposure than we used to use for a panoramic film. Certainly, all radiation exposure is a concern and we continue to strive to provide the best care with a minimal exposure. There is however, a lot of debate and flawed information circling around regarding the appropriateness of dental x-rays and the risks associated with this. The bottom line is that, where needed as part of an oral surgery treatment, dental x-rays are appropriate and carry a minimal risk with a benefit that far exceeds that risk. In the following pages, I have put down a few definitions and details that may be of interest about x-rays and radiation as they relate to oral surgery.

X-Rays for Oral Surgery Patients in Milwaukee

Exposure to gamma radiation (x-rays) is part of everyday life. By far the largest exposure is by natural sources, especially Radon which is present in the earth and given off as a gas. Electronics such as televisions, microwaves, cell phones, etc., give off radiation. Again, these sources present a much greater risk than dental x-rays. Positioning one’s self too close to these appliances can be a concern.

Studies show that we are able to heal cell damage from x-ray sources and rid of many abnormal cells naturally. This helps with low level exposure and even periodic exposure such as with x-rays. The state of the science right now is still to approach all exposure with caution, but that the amount or dose at one time is much more important than the cumulative dose – which used to be thought of as more important. This again is because of the natural healing that can take place in our bodies to counter the harmful effects.

Medical and dental x-rays help us to diagnose and treat oral and facial disease and have contributed immensely to the science of oral surgery with great benefit at a low risk. The addition of Cone Beam Scanning has allowed us to easily see anatomy and pathology in three dimensions, greatly enhancing our ability to evaluate, treatment plan, reduce risk, and care for conditions and diseases of the oral/facial region. As you may know, digital x-ray units such as we use have significantly brought down the dose of radiation our patients receive.

Here are several important terms used to describe x-ray radiation:

DENTAL X-RAY DOSAGE

• Here are some typical x-ray studies and the average dose in millisieverts (mSv)

RADIATION

• Visible light is an example from a larger array of electromagnetic waves that we call radiation. Light, as well as other types of radiation, is made up of particles of different sizes and energies. These sizes and energies give the different types of radiation their characteristics. For instance, ultraviolet waves can cause sunburn. Infrared waves can cause a heat burn. Microwaves excite and disrupt water molecules which can cook our food. Radio, television and other types of microwaves can carry patterns of signals that can be transformed into sound, data, and light images. Visible light is absorbed in different ways by different objects giving us the sensation of color.

The spectrum of radiation is divided into parts and named based on the characteristics of the type of radiation. These include Black Body Radiation, extremely low frequency (ELF) radiation, very low frequency (VLF) radiation, radio waves, microwaves, infrared, visible light, ultraviolet light, cosmic radiation, and ionizing radiation. Ionizing radiation is dividing into x-ray and gamma radiation, alpha radiation, beta radiation, and neutron radiation.

IONIZING RADIATION

• Ionizing radiation is radiation composed of particles that individually carry enough kinetic energy to liberate an electron from an atom or molecule causing that atom or molecule to become ionized. X-rays/gamma radiation are a type of ionizing radiation. Although we cannot see these particles we can “read” the effects that these particles have on films and screens, thus allowing us to form x-ray (radiographic) images that we can see visually and interpret.

• We usually measure x-ray dose in sieverts (Sv).

SIEVERT

• A commonly used measurement used to define the effects of radiation from different sources. The sievert is a derived unit of ionizing radiation dose in the International System of Units. It is the unit of measurement used to assess the risks of low levels of ionizing radiation on the human body.

• One sievert of effective dose, which would be a massive dose, carries with it a 4 percent chance of developing a fatal cancer in an average adult, and a 0.8 percent chance of a hereditary defect in future offspring.

• When we talk about x-ray output from our machines, we are talking in millisieverts (1000^th) and microsieverts (1,000,000^th).

GRAY

• The gray is a derived unit of ionizing radiation dose in the International System of Units. It is a measure of the absorbed dose and is defined as the absorption of one joule of energy in the form of ionizing radiation by one kilogram of matter.

• An absorbed dose of one gray (Gy) by alpha particles will lead to an equivalent dose of twenty sieverts (Sv).

• Dose equivalent is expressed numerically in rems or sieverts (Sv).

RAD (Roentgen Absorbed Dose)

• The rad is a deprecated unit of absorbed radiation dose defined as 1 rad equals 0.01 Gy equals 0.01 J/kg. It was originally defined in CGS units in 1953, as causing 100 ergs of energy to be absorbed by one gram of matter. In talking about the radiation environment, the discussion is dominated by terms applying gamma or x-rays applied uniformly to the whole body. In this case, one rad of absorbed dose gives one rem of effective dose. One sievert is generally defined as the amount of radiation roughly equivalent in biological effectiveness to one gray (or 100 rads) of gamma radiation.

• The definition of these terms is very difficult because of the numbers of variables and the application of x-ray dose to a specific area rather than the whole body. For instance, certain parts of the body such as the gonads or eyes may be more susceptible or have a greater relative susceptibility than other parts of the body. The way the x-rays are applied, the energy of the dose, the amount, the focus of the beam, the density of the target tissue, location relative to the source, etc. all can have an effect. This has certainly been studied as it relates to various organ systems, but absolute data and absolute effects information does not exist and cannot be calculated for each case.

• Wilhelm Roentgen was a German physicist (1845-1923) who discovered x-rays or roentgen-rays for which he received the Nobel Prize for Physics in 1901.

REM (Roentgen Equivalent Man)

• The rem is a unit of effect absorbed dose of ionizing radiation on the human tissue equivalent to one roentgen of x-rays. This term was developed in the 1940s as an acronym for roentgen equivalent man.

• It is a unit of radiation dosage (such as from x-rays) applied to humans. The rem is now defined as the dosage in rads that will cause the same amount of biological injury as one rad of x-rays or gamma rays.

• Formerly poorly defined, the rem was redefined in 1962 to clarify the usage of the term relative biological effectiveness (RBE) in both radio biology and radiation protection.

• A rem is equivalent to 0.01 seiverts in the International System of Units (SI).

Experienced Oral Surgery Team for Milwaukee Residents

We are always excited to be able to keep on top of the latest in technology and technique when it comes to oral surgery. If you are ready to obtain innovative and patient-oriented oral surgery services, we can help. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our oral surgery team is excited to help you achieve a happier, healthier smile.

Why Cone Beam Scans Can Be Beneficial

Third molar or wisdom tooth impaction is a common clinical issue for us as oral surgeons to deal with. We are experts in it and we are able to assess, plan, and appropriately treat these concerns. In the past several years, the cone beam scan has been a part of our assessment and examination for more difficult extractions. The panoramic x-ray is still the “standard of care,” but the Cone Beam Scan gives so much more information that it can be helpful in most all cases.

Technology-Driven Oral Surgery Services in Milwaukee

The big benefit of the Cone Beam Scan is in determining risks by being able to see the relationship of these teeth to the surrounding structures such as the other teeth, the sinuses in the upper jaw, and the nerve bundles in the lower jaw. We typically recommend the Cone Beam Scan in cases where the risk appears higher. We can do it for anyone who wishes the best information about their teeth and surgery.

Insurance companies typically will not cover this expense, so it is often a choice based on finances. One of our goals is to provide care safely and with excellence. The Cone Beam Scan is another instrument that helps us to achieve that goal.

Gentle Oral Surgery Services for Milwaukee Residents

It is important to us to use the most advanced oral surgery equipment and techniques available in order to give each of our patients the best possible experience and results. If you’re looking for oral surgery services or wisdom tooth extraction in a comfortable, positive environment, we can help. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced oral surgeon will provide gentle and experienced care to you and your family.

Ref: J Oral Maxillofac Surg 72:1444-1455, 2014

When we perform tooth extraction in patients who may have an immune compromised state such as diabetes (IDDM) or patients on chemotherapy, there is an increased risk of poor healing, poor bone fill, and infection.

Tooth Extraction for Patients with Compromised Immune Systems

We are experts at dealing with this situation in tooth extraction and with proper technique and care the risks are low. We also have a new technology called platelets rich in growth factors (PRGF) which we use along with bone grafting to enhance grafting and “take” of the graft. This is a very exciting technology which has caused a remarkable improvement in the success with grafting and tooth extraction.

Improving Tooth Extraction

This same technology can be used to improve healing at any site for any patient. It can be a particular help when you have a tooth extraction patient who may likely show poor healing such as a diabetic or other immune compromised patient. It is easy to perform and we do it right in our office at the time of your procedure. This does involve additional expense so we do not perform it as a routine.

If you have concerns about tooth extraction healing or if you just want the best possible result, ask us about PRGF. It is a great technology.

Gentle Tooth Extraction Services in Milwaukee

If you’re looking for tooth extraction in a comfortable, positive environment, we can help. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced oral surgeon will take excellent care of you.

Ref: J Oral Maxillofac Surg 72:456-462, 2014

We have been using Piezosurgery (ultrasonic frequency bone cutting technology) for a number of years. It is clean, precise, and has the advantage that it helps to minimize injury to soft tissue structures as the cutting mechanism with this technology selectively cuts hard tissue and tends to spare soft tissue.

Cutting Edge Jaw Surgery in Milwaukee

The shortcoming of the technology is that it is slow and it does produce heat, so it has to be water cooled and we tend to use it for smaller procedures. We are experts in its use.

Because of limitations in the technology, we are not using it for large procedures such as trauma surgery or facial reconstructive (orthognathic) procedures. As the technology advances, I am sure we will use it for these as well. For now, we use it in the office for most of our smaller bone procedures and it works very well and gives us more exacting results.

Jaw Surgery Experts in Milwaukee

If you think you’re in need of jaw surgery, partner with a team with the experience and equipment to get you the best results. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced jaw surgery team will take excellent care of you.

Ref: J Oral Maxillofac Surg 72:481-484, 2014

Root tip (periapical) surgery has been a standard procedure for oral and maxillofacial surgeons for many years and has been an area of expertise for me throughout my practice life. Basically, the procedure is used as the “ultimate root canal.” We approach the root tip surgically and seal off the root canals at the point where the pulp of the tooth would communicate with the jaw. This effectively seals off inflammation and infection and in many cases, saves a failing tooth. It is a nice procedure and easy in most cases.

How Root Tip Oral Surgery Can Help

The shortcomings of the procedure are that there are many variables that we do not control and so the risk of failure is greater than many of the other procedures that we perform. With the advent of dental implants, we now have a very safe and effective way to replace a failing tooth, so in many cases we choose the implant path rather than investing more in a failing tooth.

Root tip (periapical) surgery is still a viable treatment and less expensive than implant treatment and should be considered in many cases. The introduction of cone beam scanning has also greatly improved our ability to diagnose and assess success expectations.

If you have a tooth that is failing, you might want to check and see if periapical surgery would be an opportunity to save your tooth.

Oral Surgery for Patients in Milwaukee

If you think that you have a problem with a tooth, you shouldn’t wait to consult an oral surgery expert. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! 

(Periapical surgery, peri-apical surgery, apicoectomy, retrofill)

Ref: J Oral Maxillofac Surg 72:1049-1061, 2014

Much of what we do in bone and soft tissue grafting has come out of a combination of research along with clinical trials and clinical usage. Many great advancements come out of a simple idea – to apply something in a new way, to try to enhance a result. Contrarily, we also find that through trial and error we often discover circumstances to avoid or problems which point to a need for more research.

Oral Surgery with Dietary Restrictions in Mind

One of those findings is the problems with bone graft failure in individuals who adhere to a vegetarian lifestyle. The vegetarian lifestyle has gained considerable popularity and following. It has been my experience that most individuals who follow a vegetarian lifestyle do so based on a belief that this is a healthier way to live. Paradoxically, I have found that when we perform bone grafting procedures on vegetarians we see an almost total absorption of the graft, including synthetics, allografts, and xenografts. I have not been able to find any specific research on this subject, but based on my experience it appears that it deserves some special attention.

Bone Grafting: Complications for Vegetarians

The impression is that there is a nutritional deficit in these individuals that calls on the body to reabsorb the available bone material, possibly to be used in other places. From a research perspective, we may wish to look at this issue from the opposite end. If we can determine the problem that leads to poor take of the graft for these individuals, maybe we will be able to find the key to enhance bone graft reception from a nutritional standpoint.

For right now, I recommend that my vegetarian patients work aggressively at taking in dietary amino acids, both essential and non-essential in the time leading up to and during the grafting process.

High Quality Oral Surgery Services in Milwaukee

No matter what lifestyle choices you make, you deserve to work with an oral surgeon who has the knowledge to make sure that you get optimal results. For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced oral surgeon will take excellent care of you and your family members.

In the years during which I have been in practice as an oral surgeon, we have experienced quantum leaps in bone grafting techniques, materials, and methods. The use of various bone products, PRGF, PRP, and titanium mesh, to name a few, have greatly enhanced our ability as oral surgeons to gain bone height in areas where it has been lost due to processes such as atrophy and trauma.

Oral Surgery Techniques for Saving Bone Tissue

We may not have an ideal oral surgery technique yet, but we are able to regain lost bone in many circumstances. The main problem that I run into is time. It often takes many months and sometimes more than a year to perform the necessary procedures to rebuild the bone and tissue bed to a level where the site is satisfactory for standard dental implant placement.

Most bone restoration cases are very straightforward and we can build the bone and place implants in one procedure. There are, however, many variables which can affect the outcome and we look at theses as part of your evaluation. We do have mini implants, but these may not be a long term solution for many individuals.

These oral surgery techniques and related technologies are extremely exciting and I count myself very lucky to be at the cutting edge of these advancements.

Oral Surgery Experts in Milwaukee

For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced oral surgeon will take excellent care of you.

(Vertical Ridge Augmentation =building up the ridge, PRGF=Platelets Rich in Growth

Factors, PRP=Platelet Rich Plasma)

Ref: J Oral Maxillofac Surg 72:286-291, 2014 and J Oral Maxillofac Surg 72:292-303,

2014