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Commonly referred to as wisdom teeth, 3rd molars are typically the last teeth to erupt, and are located furthest back in your upper and lower jaws. You typically develop four wisdom teeth, though the number may vary. These teeth generally erupt into your mouth during the late teenage years, but they may remain impacted due to spacing issues. Though every case is different, general reasons for removal for wisdom teeth are for prevention of future problems, or to treat problems they are already causing. Problems these teeth may cause in the future include: pathology (cyst formation), infections, periodontal issues (bone loss), decay. Sometimes, they are also removed in cases of dental crowding, or in preparation of orthognathic (jaw repositioning) surgery. Additionally, sometimes hygiene is difficult and they are removed so that proper oral hygiene may be maintained. This is a very common procedure to have done!
Dental implants have now been around for several decades. They provide excellent esthetics and function. Generally speaking, success rates are very high. Reasons for dental implants may include: loss of teeth due to decay or caries, missing congenital teeth, failure of other previous treatments, or to help anchor dentures that otherwise are unstable. If your remaining teeth are unhealthy and need to be removed, sometimes we can offer removal of teeth, implants, and restoration during the same day. Typically you can expect to have the unhealthy tooth removed, and the site bone grafted the same day. Sometimes, we are able to place the implant at the same time as the extraction. This is referred to as an immediate implant. Other times, the area may be grafted with bone and allowed to heal for some time prior to implant placement. Your surgeon will discuss your specific case with you during your consultation. Usually, the implant is given several months to heal in your bone before a crown can be placed to allow you to return to function.
There are other benefits to having an implant as well. As you may expect, if a tooth is removed, over time, the bone in the area starts to decrease in volume, or atrophy. Did you know that placing an implant can halt the process of bone loss? If properly cared for, an implant is certainly a long-lasting solution for missing teeth.
There may be several reasons we may offer bone grafting, and there are several types of bone grafts in general. Bone grafting may be used in an initial reconstructive procedure to build bone in different areas prior to or during implant placement, to ensure that the implant has sufficient bone support. Alternatively, after removal of pathology from the jaws, a bone graft may be used as a filler to allow bone to grow back into the defect. If you may be considering an implant in the future, a bone graft may be used after the extraction to help maintain the bony contours of the extraction socket for future implant placement. The different types of bone graft may each have different indications, and based on your individual case, your doctor will make recommendations to you.
Many times, you may be referred for evaluation of a lesion, either inside your mouth, or visible on radiographs from your dental office. A clinical examination will be done during your consultation, and records will be gathered. Often times, we may be able to provide you a differential diagnosis, or a range of clinical possibilities. A more definitive diagnosis will be made after the lesion (either a piece of the lesion, or the full lesion) is removed and sent for the pathologist to look at the cell types under microscope. After review of all information, your doctor will discuss with you if a biopsy should be considered. If so, your doctor will discuss the steps. Many times, after removal of the lesion being biopsied, no additional steps are required. If additional treatment is required, your doctor will discuss this with you.
Expose and bond/tooth exposure:
Your orthodontist may have referred you for a procedure to assist with an impacted tooth to erupt into it's proper position in the dental arch. Your doctor will evaluate you with a clinical examination, and together with the orthontist, come up with a plan. This may include a simple exposure, or removal of gums and bone to gain access to the impacted tooth. At other times, a chain may be attached to the impacted tooth, which will then be used by the orthodontist to pull the tooth into it's proper position in the arch.
There are different reasons for why a tooth may need to be removed. These may include infection, bone loss, or if a treatment plan is made that requires the tooth to be removed. This is generally a routine procedure that can be done with local anesthetic. If you are generally healhty, and anxious, other options for removal may be with "laughing gas," or with IV sedation. During your consultation, your doctor will discuss with you different options to help rebuild the area after the tooth is removed.
Your orthodontist may have referred you for orthognathic, or jaw repositioning, surgery. Sometimes, we are able to correct malocclusion by simply moving teeth around. However, if the problem lies with your skeletal structure, we may not be able to correct the problem with orthodontic treatment alone. In this case, we will work closely with your orthodontist to first move the teeth properly. Once ready, we will gather many records to plan your surgery. Surgery may involve repositioning either just the upper or lower jaw, or repositioning of both jaws. A genioplasty, or chin repositioning, may also be recommended depending on your case. Recovery generally involves a 1-2 day hospital stay, usually to make sure you are comfortable at discharge. The hospital stay also depends on how much is done during your case. 6 weeks after your surgery, your orthodontist will start putting the finishing touches on your bite. With this procedure, we are able to get you functioning again and provide a better jaw structure with improved esthetics.
Sometimes we are caught with unforunte circumstance. If you suffer from a fracture of bones of the faces, or have a soft tissue injury, surgery can help to place the bones and soft tissue back into proper form and function. Usually, we these procedures will be performed in the hospital, but may be performed in an outpatient setting depending on several factors. After surgery, if appropriate, imaging will be done to ensure proper reduction, or orientation of bones. Sometimes, post operative physical therapy may be needed. We will work with you to get you back to your daily life!
There are many ways your temporomandibular joint may start causing bothersome symptoms. During your consultation, we will listen to your symptoms, and ask about progression of symptom. We will perform an examination and will likely perform imaging. We will determine whether your problems are largely muscular, from the disc, or from the bone. We will determine whether your are a surgical candidate, and offer you the best treatment choice. Generally speaking, we like to start with the most conservative treatment available first, if possible. Once decided upon, we will discuss treatment and recovery with you in detail.
Major Reconstructive Surgery:
During your consultation, your doctor will gather a full history. Facial asymmetry may result from genetic or developmental problems, or perhaps after previous surgeries for tumor or pathology removal. Records will be gathered, and depending on your case, major bone grafting can be considered. Sources of bone grafting may include the hip bone, ribs, or your facial bones. Other options, depending on your case, may include facial implants. Your doctor will make recommendations in your case to return you to form and function.
Sleep apnea can cause many health problems, ranging from cardiovascular issues to neurologic issues and pulmonary issues. At times, if the case is not severe, your dentist may try sleep applicances. Alternatively, once diagnosed, you may be given a CPAP or BiPAP to wear at night.
If your case is severe or if you are unable to tolerate your CPAP or BiPAP, a genial advancement or a maxillo-mandibular advancement may be considered in your case. Patients with the most severe cases will typically present with a tracheostomy. Depending on your case, and what procedure is done, you may require some time in the ICU after the sugery to allow swelling to decrease so we can make sure you are breathing well before stepping down your care. In many circumstances, surgical procedures to open up the airway may result in a significant improvement.
If you have frown lines, or deep fissures, or simply desire more volume in your lips, our doctors can help you with minimally invasive techniques. We will discuss your desires with you, and recommend whether a filler or a toxin like Botox is best for your case. Typically, this is a quick procedure with minimal down time. Though this is generally a very safe procedure, certian priniciples must be followed to prevent adverse outcomes. You can rest assured at Mountain View Oral Surgery, you will have a trained physician performing your procedure!
If you have a cleft/lip palate, you are likely being managed by a craniofacial team, that consists of surgeons, speech pathologists, dentists, and social workers. You will need a variety of procedures done by different members of team as you grow and hit different milestones.
We can help work with your team in bone grafting your alveolus. Though there are different times to do this, most commonly it is done when the root of your impacted canine is 1/2 to 2/3 formed. Before you are ready for surgery, any baby teeth in the area will be removed and the gums will be allowed to heal. Your orthodontist will have expanded your arch, and ensured there is enough space for your canine to erupt. Your dentist may provide you with a plate to use after the bone grafting is done, especially if you have a bilateral cleft. This will allow for some stability. Generally, the grafting is done with some bone chips harvested from hip bone. You may stay overnight in the hospital for comfort measures, but are able to go home in most circumstances by the next day. Your doctor will talk to you about why this surgery is important during your consultation.
Due to scarring, some patients may also have restricted growth of skeletal structure and may require orthognathic sugery once growth has stopped. Our team can also help you during this surgery.
At times when an implant may be desired at the posterior maxilla, a sinus lift procedure may be recommended by your surgeon. The maxillary sinus is an air-filled cavity that lies inside your upper jaw bone, above your upper teeth. Sometimes, the sinus drops low between the roots of your upper teeth. If a tooth is removed, or if you don't have teeth in the area, and the position of the sinus is particularly low, your surgeon may recommend a sinus lift procedure. During this procedure, the sinus membrane will be superiorly lifted, and bone graft will be placed so that the future implant will be surrounded by bone. This is important for the health and longevity of the implant.
Sinus lifting can be done either with direct access, or indirectly, by tapping bone up from the inferior aspect while placing the implant. What is done specifically in your case will depend on how much bone you have. It may or may not be possible to place the implant simultaneously. Your surgeon may recommend a CBCT 3 D scan, and discuss our specific options with you during your consultation!
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