Oral Surgery

Bone Grafting

Bone grafting is commonly performed by an oral and maxillofacial surgeon to replace or augment bone in areas of tooth loss. Bone grafting to the jaws and facial structures may be necessary in a wide variety of scenarios. The most common bone grafts are facial skeleton and jaw procedures. Other common procedures include tooth extraction site graft, bone graft reconstruction and for a sinus lift. Shrinkage of bone often occurs when a tooth is lost due to trauma, severe caries, or periodontal disease. Additionally, bone loss may have already occurred due to infection or pathology around a tooth. There are many artificial biocompatible bone substitutes available; however, the best material for a bone graft is your own bone, which most likely will come from your chin, the back part of your lower jaw or your hip bone. The hip is considered to be a better source because the hip bone has a lot of marrow, which contains bone-forming cells. There are also synthetic materials that can be used for bone grafting. Most bone grafts use a person's own bone, possibly in combination with other materials.

To place the removed bone in the recipient site, little holes are drilled in the existing bone to cause bleeding. This is done because blood provides cells that help the bone heal. The block of bone that was removed will be anchored in place with titanium screws. A mixture of the patient's bone marrow and some other bone-graft material will then be placed around the edges of bone block. Finally, a membrane is placed over the area and the incision closed.

The bone graft will take about 6 to 12 months to heal before dental implants can be placed. At that time, the titanium screws used to anchor the bone block in place will be removed before the implant is placed.

Crown Lengthening

Crown lengthening is a surgical procedure that re-contours the gum tissue and often the underlying bone of a tooth. Crown lengthening is often for a tooth to be fitted with a crown. It provides necessary space between the supporting bone and crown, which prevents the new crown from damaging bone and gum tissue.

Ankylosis

This refers to a tooth or teeth (primary or permanent) that have become "fused" to the bone, preventing it or them from moving "down" with the bone as the jaws grow. This process can affect any teeth in the mouth, but it is more common on primary first molars and teeth that have suffered trauma (typically the incisors). Treatment can vary depending on the degree of severity of the ankylosis (how "sunken into the gums" a tooth may appear). The degree of severity usually will vary depending on how early the process started, and as a general rule, the earlier it starts, the more severe the ankylosis becomes with age. Several considerations must be taken before any treatment is provided, and your dentist will discuss all the risks and benefits of each treatment option.

Distraction Osteogenesis

Distraction Osteogenesis (DO) is a treatment for some deformities and defects of the oral and facial skeleton. Distraction Osteogenesis, first used in 1903 became popular in western medicine in the 1960's, has provided Stanford Ranch Family Dentistry with a safe and predictable method to treat selected deformities of the oral and facial skeleton. Distraction Osteogenesis means the slow movement apart (distraction) of two bony segments in a manner such that new bone is allowed to fill in the gap created by the separating bony segments. Distraction Osteogenesis Surgery is usually done on an outpatient basis with most of the patients going home the same day of surgery. The surgical procedure itself is less invasive so there is usually less pain and swelling.

Distraction Osteogenesis works well on patients of all ages. In general, the younger the patient the shorter the distraction time and the faster the consolidation phase. Adults require slightly longer period of distraction and consolidation because the bone regenerative capabilities are slightly slower than those of adolescence or infants.

Frequently Asked Questions

Q: Will my insurance company cover the cost of Osteogenesis surgical procedure?
A: Most insurance companies will cover the cost of the Osteogenesis surgical procedure provided that there is adequate and accurate documentation of the patient's condition. Of course, individual benefits within the insurance company policy vary. After you are seen for your consultation at our office, we will assist you in determining whether or not your insurance company will cover a particular surgical procedure.

Q: Is Distraction Osteogenesis a painful procedure?
A: Since all Distraction Osteogenesis surgical procedures are done while the patient is under general anesthesia, pain during the surgical procedure is not an issue. Post-operatively, you will be supplied with appropriate analgesics (pain killers) to keep you comfortable, and antibiotics to fight off infection. After surgery there is no more discomfort that having braces tightened.

Q: What are the advantages of Distraction Osteogenesis versus traditional surgery for a similar condition?
A: Distraction Osteogenesis surgical procedures typically produce less pain and swelling than the traditional surgical procedure for a similar condition. Distraction Osteogenesis eliminates the need for bone grafts and provides greater stability in cases where significant movement of bony segments are involved.

Q: What are the disadvantages of Distraction Osteogenesis?
A: Distraction Osteogenesis requires the patient to return to the surgeon's office frequently during the initial two weeks after surgery. This is necessary because in this time frame the surgeon will need to closely monitor the patient for any infection and teach the patient how to activate the appliance. In some cases, a second minor office surgical procedure is necessary to remove the distraction appliance.

Q: Can Distraction Osteogenesis be used instead of bone grafts to add bone to my jaws?
A: Yes. It has become an easy process to place and use a distraction device to slowly grow bone in selected areas of bone loss in the upper and lower jaws. The newly formed bone can then serve as an excellent foundation for dental implants.

Q: Does Distraction Osteogenesis leave scars on the face?
A: No. The entire surgery is done within the mouth and the distraction devices used by Stanford Ranch Family Dentistry remain inside the mouth. There are no facial surgical incisions are made so no unsightly facial scars result.

Facial Trauma

Stanford Ranch Family Dentistry has Oral and Maxillofacial Surgeons on staff, who are trained, skilled and uniquely qualified to manage and treat facial trauma. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. Some of our doctors may also be on staff at local hospitals to deliver emergency room coverage for facial injuries, which include the following conditions:

  • Facial lacerations
  • Intra oral lacerations
  • Avulsed (knocked out) teeth
  • Fractured facial bones (cheek, nose or eye socket)
  • Fractured jaws (upper and lower jaw)

The Nature of Maxillofacial Trauma

There are a number of possible causes of facial trauma; e.g. Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries. Maxillofacial facial injuries can range from injuries of the teeth to severe injuries of the skin and bones of the face. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).

Soft Tissue Injuries of the Maxillofacial Region

When soft tissue injuries such as lacerations occur on the face, they are repaired by suturing. In addition to the obvious concern of providing a repair that yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands and salivary ducts (outflow channels). Dr. Scorza is proficient at diagnosing and treating all types of facial lacerations.

Bone Injuries of the Maxillofacial Region

Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, and the patients age and overall health. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.

One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique called "rigid fixation" of a fracture profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly. The treatment of facial fractures is accomplished in a thorough and predictable manner so the patient's facial appearance to be minimally affected.

Injuries to the Teeth and Surrounding Dental Structures

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.

Impacted Canine

Canine teeth are also commonly referred to as cusped or "eye teeth" since the teeth align under your eyes. You should have two canines in both your upper and lower jaw. They are the strongest teeth you have, used for tearing into your most meaty meals. Because of this need for strength, your canines have the longest roots of all your teeth. They are an essential part of your bite and balanced smile for two main reasons:

  • Your Bite
    Due to their length, the canines guide your other teeth together when chewing and biting. Canines are essential for maintaining a proper bite.
  • Your Appearance
    Without canines, large gaps appear in your smile. This can lead to your other front teeth becoming twisted or crooked.

Your canine teeth are generally some of the last teeth to erupt. Occasionally they do not erupt. The two most common reasons are:

  • Overcrowding in your mouth
    Extra teeth or a small jaw can cause the space where your canines are supposed to come in to be very small, resulting in impaction, or failure to erupt.
  • Abnormal growths
    Tissue may have developed in your jaw that prevented your canines from reaching the surface.

The fact that teeth don't always come in like they're supposed to highlights the need for regular dental visits when young teeth are developing. If you suspect your child has impacted canines, don't hesitate to make an appointment with Stanford Ranch Family Dentistry. With regular dental visits, x-rays and examinations, the problem of impacted canines can be found out early when treatment is easier. If you are an adult and your canines have not erupted Stanford Ranch Family Dentistry can help. Set an appoint today for an x-ray and consultation. Your smile is up there waiting for you.

Treatment for Impacted Canines

After assessing your situation, Stanford Ranch Family Dentistry will devise a plan to make room for your canines. Will a typical oral surgery and the assistance of an orthodontist your canine will find their way into their proper place over time.

After Extraction Care

  1. DO NOT RINSE MOUTH TODAY
    Tomorrow rinse mouth gently every 3 to 4 hours (especially after meals) using one quarter teaspoon of salt to a glass of warm water. Continue rinses for several days.
  2. BLEEDING
    Following extractions, some bleeding is to be expected. If persistent bleeding occurs, place gauze pads over bleeding area and bite down firmly for one-half hour. Repeat if necessary.
  3. SWELLING
    Ice bag or chopped ice wrapped in a towel should be applied to the operated area; one-half hour on, and one-half hour off for 4-5 hours.
  4. PAIN
    For mild to average pain, use any non-aspirin type of medication you like. If the doctor prescribes a specific pain medication, follow the instructions and do not mix with other medications unless approved by your doctor.
  5. FOOD
    Light diet is advisable during the first 24 hours.
  6. BONY EDGES
    Small sharp bone fragments may work up through the gums during healing. These are not roots; if annoying, return to our office for their simple removal.
  7. If any unusual symptoms occur, call the office at once.
  8. The proper care following oral surgical procedures will hasten recovery and prevent complications.

After Wisdom Tooth Removal

Post-operative care of the removal of impacted teeth is very important. Carefully follow instructions to minimize unnecessary pain and complications of infection and/or swelling.

  • BLEEDING. A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or slight blood traces in the saliva is not uncommon. To help minimize bleeding, avoid any sort of exercise or excitement. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. This action should create a blood clot and bleeding will stop; however, if bleeding does not stop repeat as necessary. As an alternative to the gauze gently bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. If bleeding does not subside, call the office at 916-435-4222 for additional instructions.
  • Standard After Surgery Instructions:
    • The gauze pad placed over the surgical area should be kept in place for a half hour prior to removal.
    • Vigorous mouth rinsing the surgical area following surgery should be avoided. Vigorous sucking through a straw should be avoided. Touching the surgical area should be avoided. These actions may cause the blood clot to become dislodged and cause excess bleeding.
    • Begin taking the prescribed pain medications as soon as you begin to feel discomfort.
    • Place ice packs to the sides of your face where surgery was performed.
    • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • SWELLING. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon as it is the body's normal process in repairing itself. Swelling does not always appear immediately. It may take 12 to 24 hours before swelling becomes apparent. Swelling may not reach its maximum until 2-3 days post-surgery. Swelling may be minimized by the immediate use of ice packs post-surgery. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
  • PAIN MEDICATION. For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours. For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive or operate machinery and avoid alcoholic beverages. Pain or discomfort should subside more every day. If pain persists, it may require attention and you should call the office for assistance.
  • DIET. After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. Nourishment and regular fluid intake is important to your recovery. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
  • HOME HYGIENE CARE. There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush. No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.
  • ANTIBIOTICS. If Stanford Ranch Family Dentistry has prescribed antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Call the office in the event of a rash or other unfavorable reaction at 916-435-4222.
  • NAUSEA. Occasionally, a prescribed pain medicine may induce nausea and/or vomiting following surgery. Do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period
  • Other Complications
    • NUMBNESS. As discussed in your pre-surgery consultation numbness of the lip, chin, or tongue can occur, but there is no cause for alarm. This is usually a temporary condition. If you do experience numbness be careful not to bite your lip of tongue as you will not feel the action. Call Stanford Ranch Family Dentistry if you have any questions.
    • TEMPERATURE. Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
    • DIZZINESS. Taking pain medications can make you dizzy. You can get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
    • SUTURES. Sutures may be placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture from your mouth and discard it. In about a week post surgery the sutures will be removed by Stanford Ranch Family Dentistry. It is a simple procedure that does not require any anesthesia or needles and only takes a few minutes.
    • SORE THROAT PAIN. Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
    • JAW STIFFNESS. Stiffness of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

Oral Pathology

The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer.

The following can be signs at the beginning of a pathologic process or cancerous growth:

  • Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth.
  • A sore that fails to heal and bleeds easily.
  • A lump or thickening on the skin lining the inside of the mouth.
  • Chronic sore throat or hoarseness.
  • Difficulty in chewing or swallowing.

These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology, and curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer. We would recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body's most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we may help.

Functional Crown Lengthening

Periodontal procedures are available to lay the groundwork for restorative and cosmetic dentistry and/or to improve the esthetics of your gum line. Your teeth may actually be the proper lengths, but they are covered with too much gum tissue. Crown lengthening is a procedure to correct this condition.

During this procedure, excess gum and bone tissue is re-shaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.

Crown lengthening can make a restorative or cosmetic dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.

Soft Tissue Grafting

Root exposure resulting from gingival tissue recession may pose multiple problems for patients:

  • Undesirable Aesthetics
  • Root Sensitivity
  • Impaired Oral Hygiene
  • Increased Caries Susceptibility
  • Teeth May Become Loose

A gingival tissue graft will restore the proper gum tissue structure around the tooth.

Sinus Lift

The human skull has several cavities or air spaces called sinuses. When the sinus is enlarged and intrudes on areas where we want to place dental implants, bone or bone growth stimulation material is placed into the sinus. This procedure only affects the maxillary sinuses, which are located just over the molar teeth in the upper jaw. The side of the maxillary sinus is opened and the bottom is raised so it will fill in with bone. Several months later, dental implants can be placed in solid bone.

An "Osteotome Lift" is a surgical procedure that raises the floor of the sinus directly over where the implant is placed. This can be done without actually opening the sinus.

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