Wagner Oral Surgeon & Dental Implant Specialists

Oral Surgeon in Racine

Burning mouth syndrome (BMS) is defined by oral surgeons as a burning sensation of the lining of the mouth in the absence of specific oral sores or lesions. There are a number of theories thought of by oral surgeons as to the underlying causes, but a specific cause and effect, or a specific cure is not known. As oral surgeons, we do see this disorder more in individuals with autoimmune complex disorders. The nerve “endings” or receptors in the oral tissues are likely altered in density (increased numbers) or reactive capacity (sensitivity). Risk factors for BMS include stress, anxiety, female gender, menopause, and advanced age.

Burning Mouth Syndrome by the Oral Surgeon

The disorder is characterized by a burning or itching sensation typically involving the more forward structures in the mouth including the inside of the lips, tongue tip and sides, and the front of the palate. No clinical changes in the tissues are seen. Sometimes there are alterations in taste and a sensation of a dry mouth. Most cases involve both sides of the mouth. Most patients are female between the ages of 40 and 60. The burning sensation is continuous and it may show some increase in intensity as the day goes on. It rarely causes sleep disturbances and is typically relieved by eating or drinking.

There may be metabolic changes due to psychogenic processes, but local causes have been identified, in particular anti-hypertensive drugs. In an article from 2008, anti-hypertensives as well as certain anti-depressants, anxiolytic, and anti-retroviral drugs are implicated. (Med Oral Patol Oral Cir Bucal, 2008 Mar 1;13(3):E167-70). Drug sensitivity and drug allergy remains my main suspect when I see cases. Oral surgeons have been able to solve some problems by changing medications. It does take some detective work and cooperation of the prescribing doctors.

Certain preservatives and food additives have been implicated and as an oral surgeon, I do see a crossover between BMS and certain types of allergic responses. Sensitivity to food additives has been reported as being the most common cause when the pain is intermittent and in unusual locations such as under the tongue.

A sedative mouth rinse made up of equal parts Benadryl, Maalox, and Viscous Xylocaine can be used for temporary relief, however this is not a satisfactory treatment or solution. Again, good detective work as an oral surgeon to the underlying problem, sensitivity, or psychogenic concern is needed. As patients, we do need to take initiative with vague problems like this and try to identity when it occurs and possible causes. Make sure to work with your physician if you are going to alter your medications or if you want to try some alternative medications. The above mentioned article may be a good starting point.

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.

Oral Surgeon in Racine

Marsupialization is a technique for treating oral and facial cysts (odontogenic cysts) that we have used successfully in many cases to avoid losing involved teeth. The procedure involves entering into the involved jawbone cyst by making a window, typically removing a portion of the cyst for further biopsy, and creating an opening from the outside tissue into the cyst space – creating a pouch, – thus marsupialization. It is not always a “more conservative” procedure as it does increase the risk for complications during the healing process. It can heal shut, it can get infected, it can require other or different treatment depending on the healing, so it is not a perfect science.

Oral Surgeon Perspective on Marsupialization

Having said that, an an oral surgeon, I do recommend and use it for many procedures. The goal is to get the cyst space to heal in without tooth loss. This can be especially important when there are one or more permanent teeth associated with the cyst, which is common.

We have performed this procedure many times with good success, but you must be selective and frankly, most cases of jaw cysts do not meet the criterion for this procedure, performed by an oral surgeon. Treatment of jaw cysts and tumors (odontogenic cysts and tumors) are a common procedure for us and we are expert in this. When we evaluate such a problem, the oral surgeon will consider all of the options for care and discuss these options to make up a proper, excellent surgical plan.

Ref: J Oral Maxillofac Surg 71:1825-1832, 2013

Affordable Oral Surgeon

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

Dental Implants in Racine

One of the great challenges with care of dental implants is having excellent gingival esthetics around the site. Dental implants, at this time, are flat, in a biologically contoured area. Attempts have been made to make contoured dental implants. I do picture a time where we will take a scan of the extraction socket and mill a custom implant for that socket right at the time of extraction and it will have matching contours. For the time being, we do have to compensate for this.

Papilla Forms and Dental Implants

Papilla forms are dependent upon bony projections extending above the CEJ to support the tissue position and health. This is a special problem when we are dealing with multiple dental implants next to each other. We can mask this by trying to make the gingiva thicker and this can be done by grafting dense or thickened mucosa in these areas.

Esthetics of Dental Implants

In the esthetic zone, we tend to submerge dental implants slightly so that we get a minimum of 3 mm of gingival height facially. In the posterior regions, the tissues are often thin and firm and so we will often have 2 mm tissue heights on the facial aspect of an implant site. This is great for cleansing, but makes esthetic restoration challenging.

We can help this through building up these tissues either at the time of extraction and bone grafting or subsequently as an interpositional mucosal graft. Again, the desire would be to get 3 or 4 mm of thickened tissue especially to the facial aspect which gives some cosmetic coverage to the abutment and the base of the crown. The tissues can be simultaneously thickened interproximally to improve the papilla forms.

What’s the Trade Off?

The trade off is that this leaves some increased pocketing. The good news is that the newer designs of dental implants do have a roughened titanium surface at the level of the biologic width and it has been found that the gingival fibers like to cinch down and “attach” around this area when the tissues are healthy.

My challenge, at the time, regarding treatment for dental implants, is to effectively teach patients the benefits of thickened tissue contours and get them to accept the possibility of additional cost and treatment. The tissue grafting procedures can always be done down the line after they have the teeth, but they are certainly best done prior to restoration.

As a team, our goal is to be looking at these tissue contours and expected tissue height, and to anticipate these cosmetic challenges. This will allow us to encourage patients toward appropriate care.

Affordable Dental Implants

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

Conservative in Approach of Immediate Dental Implants

Historically, the immediate placement of dental implants into extraction sockets has given us variable results. Certainly, when we try to place dental implants into poor sites where the bones are of poor quality, we should expect bone loss. In most cases, dental implants will still be a success in that it will heal solid in the bones, however I do not consider significant bone loss on dental implants to be a successful case. Because of this, we have been very conservative in our approach toward immediate dental implants.

For about the past three years,we have been using PRGF (plasma rich in growth factors) as an adjunct to our bone grafting procedures and we have also used this in conjunction with immediate dental implants with and without grafting. This article from the Journal of Oral and Maxillofacial Surgeons (J Oral Maxillofac Surg 67:2476-2484, 2009), studies the effect of the use of PRGF along with immediate dental implants into sites that have infection present. Their studies showed this to be an effective and predictable treatment method. This reinforces my experience with immediate dental implants and PRGF. We also have been using bone graft material along with this care which has given us even better results for bone maintenance.

I still believe that you should have as close to an ideal a site as possible and for those patients who can tolerate staged procedures, I truly believe this gives the best result. However, I find more and more people want immediate care and that is pushing us into providing treatments that we might feel are otherwise risky. The use of PRGF and grafting materials along with these procedures does improve our outcomes.

Affordable Dental Implants

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

Dental Implants Outside of the Mouth

I was first introduced to the use of dental implants outside of the mouth in the middle 1980s. This was recognized early on as a great use for this technology. The method of dental implants has been shown to be a safe and predictable method to restore facial defects. (J Oral Maxillofac Surg 70:1551-1557, 2012). Dental and facial implants are basically cylindrical anchors made of titanium alloy which heals in the bone and we attach teeth or prostheses to them.

Most of the time, in the mouth, it is a tooth crown that is attached to the dental implant. We do, however, use them regularly in the mouth for other types of attachments such as snap attachments to hold dentures in place. If you were a missing a portion of your facial structure, such as if lost in an accident or from disease (like cancer); dental implants can be placed in the facial skeleton and used to secure a prosthetic device which fills out the defect. The dental implants have snap-like attachments on them which the prosthetic facial part attaches to. Makeup is often used to blend from the natural structure to the artificial structure. I have even seen them used on the skull to secure a toupee.

Implants For the Future

I envision the use of titanium implants, such as dental implants, in the skull to house electronic devices such as implanted hearing devices. I even imagine the placement of an implant disc behind the ear to contain communication devices such as our phone or phone receiver. Sound transmission would come from the device right to the ear. Wireless monitoring devices such as continuous heart monitoring or blood sugar monitoring (as examples) could be housed in skeletal implant devices. Sounds crazy, but I am certain it will be here sooner than we think.

Affordable Dental Implants

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

Titanium in Dental Implants: The Beginning

Titanium! What a material. The whole titanium technology in medicine started by accident. The researchers were looking for a metal that would be very strong for its size to use as on a research project to microscopically look into bone marrow. They made lenses with titanium housings that screwed into the bone. At the end of the experiment, they found that the bone had bonded to the metal. The researcher told his dental friend about it and they made a titanium tooth screw and it worked. The rest is history.

Common Use of Titanium in Dental Implants

Now, most every implant used in bone placement such as artificial hips, knees, bone plates, dental etc., are all titanium. Ceramics also work for dental implants, but the titanium is still the standard and has been consistently the best material.

The Future of Titanium in Dental Implants

I believe the future will be in a composite titanium/ceramic material that we will be able to produce (3D printing) immediately to place in a desired spot such as a tooth socket for dental implants. Work is being done on this with special materials and coatings. It is a new twist on an idea we had tried in the past. I am excited about these new applications and material combinations that will likely make a great technology used for dental implants even greater.

Ref: J Oral Maxillofac Surg 72 : 53-60, 2014

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.

Concerns with Cleaning Dental Implants

Cleaning around dental implants is as important as cleaning around our natural teeth. There are some concerns as it relates to the materials we use around them and the possible injury to the dental implants, so we’re going to visit those today! 

In an ideal situation with dental implants, the top of the dental implants between the crown and the bone actually attracts attachment of the gingival fibrous tissue similar to the way that the titanium surface in the bone attracts bone growth and maturation. This is an intimate bond, not a biological bond.

The Process of Cleaning Dental Implants

When cleaning around dental implants, it is important not to be stripping that tight tissue attachment from around each of the dental implants. The newer dental implants that we use which take advantage of biologic-width should be maintaining a healthy level in the bone and also should maintain this healthy tissue attachment. Obviously, when there is periodontal bone loss on one of the dental implants, then hygiene will need to be addressing those areas. The use of instruments made for dental implants such as the Hu-Friedy Implant Care II scalers, Color-Vue probes, and Perioprobes are good ideas. We use titanium surgical instrumentation whenever we are working around dental implants. This avoids the metallic contamination which can adversely effect integration.

As we continue to communicate about care of dental implants, we ensure the best outcomes for our patients.

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.

Treatment of cysts and tumors of the jaws and facial skeleton (also called Odontogenic Cysts and Tumors) are a common part of my practice (J Oral Maxillofac Surg 70:2118-2123, 2013).

When and Where we see Cysts and Tumors

We see odontogenic cysts and tumors most commonly associated with impacted teeth such as third molars/wisdom teeth. In many cases, these cysts or tumors are found on a routine dental examination and were otherwise not symptomatic. They typically are confined to the jawbones and will spread in the marrow space. Many become quite extensive and can involve large areas of the jaws if left untreated. In some rare cases, cysts and tumors will extend outside of the jawbone into the facial and oral tissues.

In most cases, we intercept cysts and tumors early and are able to treat them conservatively with removal and repair of the area. Certain types of these lesions are more prone to spread and/or reoccur, and therefore require more extensive treatment. It is rare for odontogenic lesions to be or become cancerous. A biopsy is performed when needed.

Seek Treatment When you Find a Growth

Early treatment is important. I am surprised at how many cases I see where the “growth” was discovered on a routine examination and was then just “watched” for a year or two. At that point it is much more extensive and the treatment can be much more debilitating. However rare, odontogenic lesions can even transform into more serious types of growths or tumors and even cancer.

What to do if you Find a Growth

If you have a suspicious area noted on a dental exam, or if you have symptoms of swelling, bone expansion, or a feeling of “fullness” or other unusual symptoms such as dull pain, make sure to get it evaluated. We are here to help you. Schedule a visit to our Racine oral surgery office by calling (262) 634-4646.

Historically, the immediate placement of dental implants into extraction sockets has given us variable results. Certainly, when we try to place a dental implant into a poor site where the bone is of poor quality, we should expect bone loss. In most cases, our implant will still be a success in that it will heal solid in the bone. However, I do not consider significant bone loss on an implant to be a successful case. Because of this, we have been very conservative in our approach toward immediate implants.

Approaching Immediate Implants With Care

For about the past three years,we have been using plasma rich in growth factors (PRGF) as an adjunct to our bone grafting procedures and we have also used this in conjunction with immediate implants with and without grafting.

This article from the Journal of Oral and Maxillofacial Surgeons (J Oral Maxillofac Surg 67:2476-2484, 2009), studies the effect of the use of PRGF along with immediate implants into sites that have infection present. Their studies showed this to be an effective and predictable treatment method.

This reinforces my experience with immediate implants and PRGF. We also have been using bone graft material along with this care which has given us even better results for bone maintenance.

Immediate Implants and Care at Wagner Oral Surgery

I still believe that you should have as close to an ideal a site as possible and for those patients who can tolerate staged procedures, I truly believe this gives the best result. However, I find more and more people want immediate care and that is pushing us into providing treatments that we might feel are otherwise risky. The use of PRGF and grafting materials along with these procedures improves our outcomes.

Do you have questions about immediate implants and PRGF? We are always ready to answer questions and share our practices with the communities in Racine, Kenosha and Milwaukee. Call us at (262) 634-4646 to learn more. 

 “Wisdom comes with age.”

This is a common saying. Wisdom is usually a welcome effect of aging. Wisdom teeth usually start causing problems at about the time that we “come of age,” thus the name.

Learn more about the problems that necessitate wisdom tooth extraction.

Why Do We Have Wisdom Teeth?

The third molars, or wisdom teeth, are the last teeth to erupt into the mouth. By the time they come along the other teeth have typically taken up all the space in the jaws. If we look at our cave man relatives from thousands of years ago, we see that they had much larger jaws with room to hold all 32 teeth. It is speculated that the larger jaws were necessary because their diet required more powerful and muscular jaws for chewing.

In modern man, we have much smaller jaws but we still have the same 32 teeth. I do feel that before we had good dental care, the extra set of molars may very well have served a purpose as people would have likely lost molar teeth to dental disease by the time they were in their late teens. As other teeth were lost, the wisdom teeth might erupt into that space. We still see this in some cases today.

What is “Impacted?”

The word impacted means to be “wedged in or tightly packed.” When you have too many teeth for the length of your dental arch, the space is often inadequate for the teeth to come in, and your dentist or oral surgeon may recommend wisdom tooth extraction. The term impacted is sometimes used to refer to the relationship of the wisdom tooth to the bone or gums. In other cases, the term is used as part of a definition of what may be involved in the removal of the tooth.

What kinds of problems might I have if I delay wisdom tooth extraction?

• Decay on the adjacent teeth.
• Formation of cysts or tumors in the jaws
• Periodontal bone loss and periodontal pockets on the second molar tooth with premature loss of the second molar.
• Localized inflammation, pain, and infection

What is the Best Time for Wisdom Tooth Extraction?

The best time for impacted wisdom tooth extraction is when the crown is well-developed, but the roots are minimally developed. This usually occurs at about age 15. Sometimes we will treat patients earlier if they are well-developed or if it is part of a comprehensive treatment plan such as orthodontic care. Of course we remove wisdom teeth on people of all ages. My oldest patient for wisdom teeth so far was 104 years old. It is actually fairly common for us to treat elderly patients, as wisdom teeth that may have sat silently for years become problems as health diminishes.

Again, the best time for wisdom tooth extraction is in the mid-teen years. During this time, the roots are not well developed and the removal of these teeth is performed with much less risk. As you age, the roots more fully develop and the teeth become more bonded in the bone. Many patients tell us that they have been told to just “wait until they are bothering you.” This is bad advice as considerable damage can be done by the wisdom teeth before the patient experiences any traces of pain. Also, by the time many of these problems arise the patient may be older, have a diminished healing capacity, additional medical concerns, and a possible greater risk of complications.

Should I Pursue Wisdom Tooth Extraction?

At any age, if you still have your wisdom teeth, I would recommend considering having them removed from a preventative standpoint. It is a lot easier. Younger patients are generally healthier; they heal more rapidly with less postoperative discomfort and swelling, and with a lower risk of complications than older patients. From a social standpoint, life is also simpler at an early age, so it is normally advisable to remove these teeth early on.

If you want to decide if now is the right time to remove your wisdom teeth, request a consultation with Dr. Wagner. Call us at (262) 634-4646 to learn more.