Wagner Oral Surgeon & Dental Implant Specialists
Do I Need Corrective Jaw Surgery?
If you are one of those people who have misaligned teeth and jaws that create an improper bite, you are very well someone who could benefit greatly from having corrective jaw surgery. The growth of the human jaw is a gradual process and it is common for both the upper and lower jaws to occasionally grow at different speeds. When this happens it can create many functional issues which include a difficulty in speaking, chewing foods, breathing, sleeping and your overall oral health condition. For those individuals who have developed a severe case of misalignment, the condition can even have an affect on the person’s physical appearance, producing emotional or psychological problems.
Aside from the rate of development, other factors such as birth defects and injuries to the jaw or head can also have a direct impact on your jaw alignment. While orthodontic braces will typically correct any bite problems which are caused by tooth misalignment, orthognathic surgery is required to correct a person’s jaw misalignment.
Conditions That May Indicate a Need for Corrective Jaw Surgery:
- Difficulty chewing or biting food
- Difficulty swallowing
- Excessive wear on the teeth
- Chronic headache or pain in the jaw or jaw joint
- Chronic mouth breathing and dry mouth
- An unbalanced appearance of the face from either the front or side
- Open bite – the space between the upper and lower teeth when your mouth is closed
- Facial injury and/or birth defects
- A protruding jaw or receding chin
- Inability to make your lips meet without straining
- Sleep apnea – breathing problems while sleeping, which includes snoring
Evaluating Your Need for Corrective Jaw Surgery
It is in your best interest to work closely with your dentist and orthodontist so that they can determine is corrective jaw surgery is recommended, and which procedure is deemed appropriate for you.
For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today — we’ll take excellent care of you.
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Jul 30th, 2014
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What are the benefits of dental implants?
Dental implants offer many benefits, including a great smile. Because this is a form of treatment that a person is not accustomed to having done on a regular basis, it can make the decision seem a bit more overwhelming. If you are struggling with the option of getting dental implants to correct any issues with your smile, take a look at some of the other benefits of dental implants.
What are the benefits of dental implants?
Improve Your Appearance
When a person loses teeth, continuous shrinkage of the jawbone take place. This can make your face appear to be older than your true age. This process can be slowed down or prevented with dental implants. You’ll also love the fact that dental implants look and feel like natural teeth, giving you an amazing smile.
Be Comfortable
Full or partial dentures sometimes come with a certain level of discomfort. As time goes by, shrinkage of the jawbone can cause the dentures to irritate the gums. One of the greatest benefits of dental implants is that you experience the comfort associated with natural and healthy teeth.
Improve Your Speech
With time dentures can begin to lose their original fit to your mouth due to shrinkage of the jaw bone. This can cause the dentures to move more freely inside the mouth, resulting in mumbling, slurred speech or clicking noises. Dental implants allow you to speak in a comfortable and natural tone.
Enjoy Eating Again
On average, even a person with a perfect fitting denture eats at only 15-20% efficiency compared to those with natural teeth. As the jawbone shrinks, this becomes even worse and you will find it extremely difficult to eat certain types of food. A benefit of dental implants is that they restore your chewing efficiency back to that of natural teeth.
Affordable Dental Implants
For a consultation, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today — we’ll take excellent care of you.
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Jul 30th, 2014
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WISDOM TEETH AND PERIODONTAL DISEASE
When wisdom teeth are removed at a younger age, the development of permanent periodontal problems is reduced significantly. It is easy to assess the potential problems with wisdom teeth at an early age – I recommend about age 15. It is an easier procedure all the way around and waiting increases the risks of irreversible pathology and problems.
What is the Right Age for Wisdom Tooth Extraction?
The second molars come in at about age 12. The wisdom teeth often have an impacted position up against the back of the second molar tooth. In this position, they can silently cause pocketing and bone loss on the second molar. We can also find decay on the second molar from the position of that tooth. Once the wisdom tooth becomes symptomatic, it is often too late and we are stuck with the effect (periodontal problem or decay) on the second molar for life.
Removal of wisdom teeth is a less complicated and less risky procedure on the younger patient. I recommend that patients come in for an evaluation as early as age 15. We can assess the risks and concerns and give appropriate recommendations for care. No matter your age – younger is better – come in and get them evaluated.
In our practice we can provide treatment easily and effectively under anesthesia, making it a painless procedure. We are careful and gentle as with all of our procedures. We take excellent care of you throughout your treatment.
Gentle Wisdom Tooth Extraction Experts
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 70:2732-2741, 2012)
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Jul 28th, 2014
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IMMEDIATE BONE GRAFTING OF WISDOM TOOTH SOCKETS
Should You Graft the Third Molar Socket at the Time of Extraction?
I have reported a number of times in the past how holding onto your third molar teeth leads to problems including periodontal disease on the adjacent teeth and can lead to bone loss on those teeth. In a recent article, the authors showed a procedure where they preemptively grafted the third molar sockets right at the time of extraction.
I feel this is a reasonable treatment and I might offer this treatment for select cases. The truth is that this procedure may not be necessary and would add expense to the procedure. The study showed that it did result in significant improvement in periodontal health on the adjacent second molar tooth. So if a patient wishes to afford this, it may help.
The last point is that periodontal conditions can be treated after the fact and there may be some argument that this may even be more effective. I have not yet seen a study on that specific idea; however periodontal surgery has had a very good success rate for many years. I will advise my patients of the options and proceed with appropriate care.
Talk to a Wisdom Teeth Removal Expert
For a consultation about wisdom teeth removal, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 today! Our professional, experienced oral surgeon will take excellent care of you.
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Jul 21st, 2014
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COMPLICATION WITH RETENTION OF THIRD MOLARS
Signs That You May Need Wisdom Tooth Extraction
As an oral surgeon, I know that many people some anxiety about the wisdom tooth extraction procedure. But the consequences of avoiding wisdom tooth extraction if you need it can be serious. Some of these consequences involve chronic pain and others can mean a dramatic reduction in your oral health.
• Infection
• Pain
• Crowding of the teeth
• Decay on the adjacent teeth
• Periodontal disease on the adjacent teeth
• Loss of otherwise normal teeth next to the site
• Nerve injury
• Periodontal concerns (poor tissue contours on the third molars)
• Injury to the sinus
• Sinus openings
• Fractured tooth roots
• Jaw fracture
• Complications of a more difficult surgical procedure
• Risk of infection spread to other parts of the body
• Fusion of the teeth in the bone (ankylosis)
• Diminished health of the patient with age (medical management concerns)
Don’t Wait to Act
The longer you wait to get your wisdom teeth removed, the greater the danger of running into these complications. 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.
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Jul 14th, 2014
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“DRY SOCKET” AND HORMONAL CHANGES
Smoking and Dry Sockets
As practicing Oral and Maxillofacial surgeons, we have known for years that a contributing factor for the development of alveolar osteitis-AO (colloquially called “dry socket”) is hormonal changes, such as the menstrual cycle. Since smoking has significantly reduced in my patient population, I have seen a significant reduction in the development of AO. The effect of proper oxygenation to the tissues is critical to proper healing. Nicotine is a vasoconstrictor (blood vessel constrictor) and can cause a decreased blood flow to the oral tissues. Carbon monoxide, a prominent component of cigarette smoke, is a potent oxygen depleter having 20 times the affinity to hemoglobin (part of your blood that carries oxygen) than oxygen-essentially depleting oxygen from the blood and tissues. So do not smoke!
Menstruation and Dry Sockets
During menstruation, the hormonal changes cause a fragility in the uterine lining allowing for these tissues to slough. Other lining tissues of the body may also be affected at the same time. Healing sites, such as extraction sockets, can show this during the menstrual cycle leading to the loss of the normal healing tissues. This results in the classic “open socket” with attendant discomfort and slow healing. The fact is, that we see this in very few patients and it is not clearly understood why it occurs in certain patients and not others. Obviously, there are other factors that contribute. I would not recommend putting off having wisdom teeth out just because of menstruation, but I would be aware of the risk especially if you have a history of tissue fragility such as oral sores during menstruation.
Affordable Oral Surgeon
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.
J Oral Maxillofac Surg 71:1484-1489, 2013
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Jul 9th, 2014
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HISTORY OF BONE GRAFTING
Introduction to Bone Grafting:
When I first came into oral and maxillofacial surgery, we were involved in a great amount of experimentation with many materials for bone grafting. Bone transfer grafts involved the use of ribs, hip bone, tibia and particulate bone grafts. We grafted blocks of ceramic (hydroxylapatite-solid and porous). We tried to get the body to induce bone healing, but only had marginal success. The problem was that our bodies are very good at absorbing bone that they feel does not belong. Also many of the areas we tried to build up have muscle pull and bite pressures that tell the body to absorb the bone.
Infection, contamination (foreign bodies), irritants (chemicals like alcohol, peroxide, menthol, etc), extremes in temperature, and mechanical displacement (to name a few) can also cause the body to reject a graft. We have been generally able to overcome these concerns with proper care and medications.
Past History of Bone Grafting:
Years ago, our initial attempts at bone grafting were largely failures. The area where the most progress was made with these bone grafting trials was in major reconstructions after accidents or cancer. The early researchers in bone grafting, were successful in transferring larger bone grafts using bone cribs (natural bones hollowed out to carry bone graft) and also vascularized grafts (major bone grafts transferred along with tissue and blood vessels to rebuild a jaw). These bone grafting surgeries are fabulous and needed, but are not practical for our day-to-day needs as it relates to the teeth and dental implants.
Synthetics in Bone Grafting:
Bone grafting took a big step with the introduction of synthetics (such as glass ionomers). These materials along with ceramics helped in providing some bridging and we were able to treat quite a few defects with these, but they were not adequate to build bone up. Generally we are able to use them in areas where there is some existing bone to widen or expand, but they do not work well to add bone thickness or adding bone onto a surface of a site.
Your Own Bone:
We have always used native (your own) bone for bone grafting material. Early on we would take bone from the hip or long bones. There were two main problems: the donor site surgery was extensive, and also the native bone is absorbed easily. The body can recognize it and absorb it. We do still use grafts like this in major reconstructions, but it is not practical or necessary for our day-to-day procedures.
Bone Grafting Products:
Human bone products started being introduced in the mid 1990s, but they were hard to get a hold of and these were prohibitively expensive. For us in oral surgery, the use of animal bone product (typically bovine and porcine bone) was introduced and again, expensive at first. The price did come down and it became our mainstay for grafting starting in about 2000. It was helpful with small defects, but it was only marginally helpful in larger grafts such as widening the dental ridge for implants. I used this a lot and some of you have had exceptional grafts with this and I have been successful with building up ridges and placing implants in this material and I say this in humble amazement. I was able to perform the bone grafting procedures, but it is quite a miracle of nature and frankly good genetics in some individuals who accepted this material enough to be successful.
BMP:
Over a number of years, the human bone product came down in price. It was certainly accepted by the body, but we found that by itself it would tend to absorb. It was still not ideal. BMP (bone morphogenetic protein) is a growth factor or “bone induction factor” our bodies produce which helps to stimulate the body to produce bone. This substance was isolated and we started using it in bone grafts in the 1990s. It was quite expensive when it first came out, but again, as the cost came down, we could use it in our practices. This was a big step in “turning bone on” to produce more bone. Mixed with human bone product, we saw enhanced bone healing. This worked well and again, I have treated a number of you out there with this material and have received successful grafts with this over the past 15 years or so. It was a step better, but still not ideal, especially in that it caused a large tissue response with swelling. It is also still quite expensive.
PRP:
In the meantime, individuals were experimenting with the use of PRP (platelet rich plasma) which was used in surgical sites along with grafts. This technology made a lot of sense and research seemed to support its use in bone grafting procedures, but we really did not see significant improvement. Some centers really believed in it. I did not find it to give any improved results.
More recently, it was found that blood can be further fractionated (separated) into its parts through centrifugation and pipetting. These are relatively easy techniques that can be done in our office setting and without great cost.
PRGF:
This was the advent of PRGF and this takes us up to our present technology. I have been using the PRGF technology since 2010 and I have used it on hundreds of grafting procedures. We typically use the PRGF along with human bone product as a mixture with great success. I call it a “supercharged bone graft.”
The interesting fact is that it actually works best with the human bone product (cataveric bone) rather than your own bone. When your own bone is used, your body recognizes it as your own and immediately starts to absorb it. The donated bone product is recognized by your body as “normal bone” and so you will grow bone around it. Ultimately, your body absorbs it and lays down your own bone, but it is more difficult for your body to absorb it. It actually takes months to completely absorb and during that extra time, it gives your body the chance to stabilize and mature the bone. It also gives us time to place dental and facial implants or other functional loads on the bone which stimulate it to stay and strengthen.
This is still not a perfect material in that we are still not able to easily graft large areas (areas bigger than your finger). However, that level of bone grafting is enough to be able to build up the ridges for dental implant placement or facial reconstructive surgery (orthognathic surgery).
Functional Load:
“Functional load” is a term that is used to describe a functional pressure that is placed on bone that tells it to be maintained. A tooth is an excellent example of a “functional load.” When a healthy tooth is in the jaw bone, it stimulates the bone to be present and strong in order to support the tooth – a functional load. A dental implant, once it is in place and accepted, performs the same stimulation on bone. So when we graft bone to the jaw, after a period of time without a load on it, the body will tend to absorb that bone. There are many factors that contribute, including genetic, functional and environmental.
Key Ingredients to Successful Bone Grafting:
Oxygen is one of the primary or key ingredients to the healing of any type of bone graft. In order to get bone to “take” or heal, your body has to recognize it as “acceptable” (not rejected) and then it needs to initially grow blood vessels into the graft from the surrounding bone and soft tissues. This actually takes place starting almost immediately, but can be accelerated or “induced” by properly preparing the site and with the use of natural graft enhancers such as PRGF.
Next to oxygen, there are “growth factors” which stimulate our bodies to lay down new bone and to grow blood vessels into the graft to nourish it. These growth factors are naturally present in our tissues and given off in areas of injury or where healing is going on, such as a surgical site. But we have discovered that these factors can be isolated and concentrated from our blood. What makes this even crazier is that the very part of the blood that is highest in these factors when the blood is centrifuged also contains the very cells (platelets) which produce the “stem cells” (multipotent fibroblasts) which have the ability to form into any type of tissue that they are “induced” to become. In our case, by mixing them with bone graft and placing them in a bone environment, separating them from the other tissues (barrier graft) – we are able to induce them to become bone development cells (osteoblasts) which will ultimately lay down mature bone in an area where the bone had been missing or deficient. Fantastic!
Maybe that is a little complicated, but suffice it to say: the ease of use of PRGF and human bone product has been a quantum leap for the reconstruction for the dental ridge in order to replace or secure the teeth. We can even use this technology along with block grafts (sections of bone that are taken from your own jaw structure) and build up or widen larger areas.
Soft Tissue Bone Grafting:
Soft tissue bone grafting is another separate subject, but worth mentioning here. When we rebuild up deficient areas of the jaw such as for dental implant treatment, we usually need to improve the tissue bed. Tissue along the dental ridge and along the teeth and implants needs to be thick, strong tissue. We call this tissue “attached gum tissue” and it is the tissue which naturally occurs around the necks of your teeth. It has the characteristic of producing and containing keratin which makes it tough (much the same way the keratin in the skin on the palm of your hand forms a callus). The tissue naturally occurs on the roof of the mouth (palate) and we are able to take tissue from the palate and transplant it to other areas to make them more healthy, such as bone grafted areas of the dental ridge. There are synthetic tissue graft materials which can help in this. The PRGF technology can also be used to enhance this kind of tissue grafting as well.
Success!
I am very excited about where our office is at with these procedures. We have stayed at the forefront of bone grafting technology and I continue my education on a regular basis. I look forward to new and even better technologies that will help my patients achieve a high quality of life. These are easy office procedures. If you would like to know how this bone grafting technology can help you, just call (262) 634-4646 and come in for a consult.
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Jun 29th, 2014
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SUCCESSFUL BONE GRAFTING – IT’S ALL ABOUT OXYGEN
When tissues are starved for oxygen (ischemia) there is increased pain. When tissues don’t receive oxygen, they die. Angiogenesis is a term that describes the formation of blood vessels. We use the term a lot when talking about healing after bone grafting. When we place a graft, such as a bone graft or a soft tissue graft into a living environment, such as the jaw, almost immediately the body begins to start to grow new, tiny, vascular channels (blood channels). As these extend into the graft, they provide the starting point for the development of blood vessels (angiogenesis). It is this process that gives life to the graft. The use of bone grafting enhancers, such as BMP and PRGF induce and promote this process. That is why we have increased success with grafting when we use these additives. It is the oxygen-carrying capacity of blood and the flow of oxygen and nutrients to the new forming tissues that is the key to success with bone grafting.
Skilled Bone Grafting Techniques in Racine, WI
Irritants and chemicals, such as nicotine and carbon monoxide, can block this process and so we try to eliminate these types of irritants when grafting. On a very basic level, it is all about getting oxygen to newly forming tissues to help them live and grow. (Ref: J Oral Maxillofac Surg 71:2048-2057, 2013)
If you are ready to talk to our team about our innovative bone grafting techniques, call our Racine, WI, office at (262) 634-4646.
Proudly serving Racine, WI and the surrounding Milwaukee-metro area.
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Jun 23rd, 2014
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PRFG AND OSTEOPOROSIS TREATMENT
We have been using PRGF as an adjunct to bone grafting for about three years. This has been a great leap in the success of bone grafting during oral surgery. Bisphosphonates and related drugs are used in the treatment of post menopausal osteoporosis and some related bone diseases. They are also used intravenously as part of treatment for certain types of cancers.
Cutting Edge Oral Surgery Solutions in Racine
When we perform oral surgery, including extractions on patients who are on these drugs, we see a certain percentage complicated with slow or poor healing which can include a type of bone breakdown that we call DRONJ (drug related osteonecrosis of the jaw). A recent study (J Oral Maxillofac Surg 71:994-999, 2013) showed significant healing improvement when PRGF was used in extraction sockets on patients who are on these drug regimens. There are many variables that can lead to poor healing, but adding PRGF to the treatment protocol for these patients is relatively easy and inexpensive. The inconvenience and the expense of treatment in cases where we have poor healing or bone break down can be significant.
If you are ready to talk to our team about our expert oral surgery services firsthand, call our Racine, WI, office at (262) 634-4646.
Proudly serving Racine, WI and the surrounding Milwaukee-metro area.
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Jun 16th, 2014
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What are PRP and PRGF?
We use PRP (platelet rich plasma) as an oral surgery tool. It works as a graft extender and as an architecture for bone and tissue healing. (J Maxoillofac Surg 70:2191-2197, 2012) We started using this technology years ago, and it was certainly helpful in surgical sites. The article shows improved blood vessel in growth with its use after oral surgery.
Oral Surgery Experts in Racine
We now use PRGF (platelets rich in growth factors) to enhance surgical sites and bone grafts. The literature has lagged a little in the reporting the results with PRGF, but from a surgeon’s hands-on experience PRGF has been a quantum leap in improved healing and “take” of bone grafts. I have no question that our use of this material on our grafts has improved not only the quantity and quality of our graft results, but has significantly decreased the time it takes to get bone healing.
We process the blood right in our office (using centrifugation and fractionation). In this process we isolate the PRGF. PRP is also a byproduct of this process (fractions 1 and 2). In many cases, such as a simple bone graft we just use the PRGF. In larger grafts, I will still use the PRP either to act as a coating over the graft or in the donor site when we are using a host bone graft.
Innovative Oral Surgery Techniques
I expect that in the future these growth factors will be synthesized and we will not have to separate them from the blood (such as with BMP). For the types of grafting that we do it is still an efficient and cost effective way of providing this care. The best part is that we have excellent results and we are now able to rebuild structure and place dental implants in places that were previously impossible or at least much more difficult.
If you are ready to learn more our quality oral surgery services firsthand, call our Racine, WI, office at (262) 634-4646.
Proudly serving Racine, WI and the surrounding Milwaukee-metro area.
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Jun 12th, 2014
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