Decayed or fractured teeth that cannot be restored by the dentist must be removed because they will frequently give rise to severe infections and pain. The removal of teeth can vary from simple extractions to complicated surgical procedures.
Loss of teeth can be a traumatic psychological experience that can lead to an inability to chew food properly, deterioration of dental alignment, difficulty with speech, and changes that make a face look older. In most instances, teeth can be replaced with implants or bridges. Please discuss replacement options with your oral and maxillofacial surgeon.
General anaesthesia is often recommended for the removal of complicated teeth and multiple extractions.
Third molars (wisdom teeth) are the last teeth to develop and frequently become trapped under the bone or gums (impacted) because of lack of space in the jaw or blockage by other teeth. Other teeth can also occasionally become similarly trapped. These unerupted teeth are called “impacted teeth.” Impacted teeth should be removed because they can cause severe infections and pain. Impacted teeth may also cause the development of cysts and/or tumors, which may cause crowding and damage to other teeth. Infections from impacted teeth can spread to the cheeks, throat, neck, and become severe enough to warrant hospitalization.
The amount of surgery necessary to remove impacted teeth varies according to the position of the teeth. General anaesthesia is often recommended for the removal of impacted teeth.
Dental implants allow the replacement of one or more teeth without compromising the health of the adjacent natural teeth. Implants can be used to replace a single tooth or multiple teeth. Implants can assist with the retention and support for dentures.
Implants are inserted into prepared openings in the jawbone. Small titanium cylinders or healing abutments are attached to each implant with a screw. These small abutments protrude through the gum.
Your dentist will then fabricate a crown, bridge or dentures which will attach to the implants. Occasionally, additional soft tissue surgery or bone grafting may be required to establish sufficient bone and soft tissue before insertion of implants. The long term success of implants depends on excellent oral hygiene similar to that required for caring for natural teeth. General anaesthesia or sedation is often recommended for implant surgery.
Occasionally, there is not sufficient bone present to allow the insertion of implants. Several techniques can be utilized. Bone can be harvested from an alternate location in the jaw or elsewhere in the body and moved to the deficient area. Alternately, allogeneic (cadaver) and xenogeneic (animal) bone is used with excellent success. These products are specially treated and sterilized so that they can be utilized in the human body.
If a large volume of bone is required for grafting, it may be necessary to obtain bone from an area other than the jaw. If a remote bone graft site is required, we will discuss this with you in detail. If it is necessary to harvest bone from a remote site, we will usually utilize hip bone to obtain the graft material.
Minor bone grafting can be done in the office under local anesthesia, intravenous sedation or general anaesthesia. Larger bone grafts may be done in the hospital under general anaesthesia and are covered by OHIP.
The success of bone grafts is enhanced with the utilization of Platelet Rich Plasma (PRP) or Platelet Rich Fibrin (PRF). These are solutions that are derived from a small amount of your own blood. The blood is centrifuged to concentrate blood cells, which are called platelets. Platelets contain and release growth factors that aid in healing. The solution containing the growth factors is mixed into the bone graft.
SINUS LIFT SURGERY
A sinus lift is a bone grafting procedure that is done to increase the vertical height of bone available in the upper jaw beneath the sinus to place implants. The surgery involves entering into the lateral side of the sinus, elevating the membrane, and grafting the space with bone harvested from the side of the jaw, allogeneic (cadaver) and xenogeneic (animal) bone and Platelet Rich Plasma (PRP) or Platelet Rich Fibrin (PRF). The use of PRP or PRF involves harvesting a small amount of the patient’s own blood which is then centrifuged to separate out and concentrate the Platelets. The platelet are cells in the blood which are involved clotting and release growth fractures. This platlet rich solution is mixed with the graft material to help increase the success of the graft and promote the healing.
Four to six months are required for bone grafting to consolidate before implants can be placed. With the sinus lift procedure, you will experience swelling, pain, and bruising in and around the tissues where the surgery has been performed. You may also have transient sinusitis, which should clear up within ten days after surgery. Following bone graft procedures, patients can expect to experience some swelling, discomfort, and bruising over the surgical site. Most patients tolerate bone grafting procedures easily.
Oral pathology can affect both the hard and soft tissue of the mouth and jaws. Oral pathology can include benign soft tissue growths, ulcerations, red or white discolorations, pigmented lesions, precancerous lesions, cancerous lesions, salivary gland lesions, traumatic lesions, and cysts or tumors.
Cysts and tumors occasionally develop in the jawbones and the surrounding soft tissues such as the cheeks and lips. Cysts and tumors should be removed due to their potential to cause pain and/or infections, displace teeth or other anatomical structures, and/or result in pathological jaw fractures.
Biopsies are performed to obtain a diagnosis or to remove any abnormal tissue growths. A biopsy should be considered for any abnormal appearing tissue that is present for more than two weeks. The tissue will be submitted for analysis, and we will notify the patient with the results. Further treatment may be necessary, depending on the result of the analysis.
Government funding, including OHIP, no longer pays for the fee that the pathologist charges for processing and diagnosing the pathological tissue.
EXPOSURE OF IMPACTED TEETH
Occasionally teeth become trapped under the gums and bone due to lack of space in the jaw. To correct this, an opening can be made in the bone and gum to expose the tooth. The tooth can then be guided into its proper position in the dental arch by orthodontic treatment. Following surgery, in rare cases, uncovered teeth may not erupt and may require removal.
General anaesthesia is often recommended for uncovering buried teeth.
TEMPOROMANDIBULAR JOINT (TMJ) MANAGEMENT
TMJ jaw problems can involve the muscles that control the jaw and/or the joint complex itself. We can help assess and diagnose the actual nature and cause of your TMJ problem with a thorough clinical examination and obtaining the appropriate radiographs. These conditions are generally initially treated with conservative measures, including physiotherapy, anti-inflammatory drugs, bite splint therapy, warm compresses, and/or muscle relaxants. The vast majority of patients with painful temporomandibular joint problems respond well to conservative therapy. However, some patients will continue to have pain or functional impairment.
Patients who have persistent TMJ pain following conservative therapy may be candidates for Botox therapy or other minimally invasive procedures.
CONE BEAM CT (CBCT) and 3D Imaging
We are pleased to offer the 3D imaging modality known as cone beam computed tomography (CBCT). Similar to traditional CT imaging but much lower radiation dose, the CBCT allows highly accurate 3-D radiographic images for the diagnosis and treatment related to oral surgery. This technology allows us to provide the best possible assessment and treatment for areas such as dental implants, impacted teeth, TMJ, corrective jaw surgery, trauma, and pathologic conditions. The 3-D images enable a level of anatomical accuracy and patient care not possible with traditional 2-D technologies.
While we do not obtain a CBCT on every patient, we do evaluate each of our patients on an individual basis to see if a CBCT will provide the information that would improve your care, and we will discuss our recommendation with you accordingly. Every CBCT that is done in our office is interpreted by a licensed oral and maxillofacial radiologist.
PLATELET RICH PLASMA (PRP) or PLATELET RICH FIBRIN (PRF)
PRP and PRF are by-products of blood that is rich in platelets. Blood is withdrawn drawn from the patient while they are having surgery which is then centrifuged to create the platelet rich solution.
PRP and PRF permit the body to take advantage of the normal healing pathways at a greatly accelerated rate. During the healing process, the body rushes many cells and cell-types to the wound to initiate the healing process. One of those cell types is platelets. When platelets arrive at a wound or surgical site, they aggregate or stick together, releasing growth factors. These growth factors assist the body in repairing itself by stimulating cells to regenerate new tissue, including blood vessels, soft tissue, and bone. The more growth factors released and sequestered into the wound, the more cells are stimulated to produce new tissue. Therefore, the use of PRP or PRF provides a greater quantity of platelets that would otherwise be present, thereby providing a rich source of growth factor factors amplifying the normal healing response. Additionally, through the aggregation of the platelets, the PRP or PRF provides for a bone graft mixture that congeals together, improving handling and the ability to pack and place the bone graft in the desired location and contour.
We use PRP/PRF in conjunction with our bone grafting procedures, including block grafts, particulate grafting, sinus lifts, and ridge augmentation procedures. It can also be used to help in other situations where enhanced healing may be desired including sinus perforations during extractions, osteomyelitis, smokers, and/or diabetic patients.
- Faster healing
- Ease of use
CT GUIDED IMPLANT SURGERY
The Cone Beam CT has revolutionized dental implant surgery. The 3-D imaging technology can be used to fabricate a surgical guide to plan the exact position of the implants in your jawbone according to the future crown or denture to be made. This eliminates all the guesswork involved in determining what parts of the jawbone offer the best sites for implant placement.
We utilize state-of-the-art implant planning software in conjunction with our CBCT to visualize the placement of dental implants in three dimensions. It can virtually create your exact future crown or denture on the computer software according to your exact bone and soft tissue anatomy.
From this, we can then determine precisely in three dimensions how and where the implant will be placed. The software data is then sent to the lab, and a surgical guide is generated to be used during the implant surgery.
- More precise implant placement
- Reduction in treatment time
- Increased patient safety
- Minimally invasive surgery
- Faster recovery
- Less post-operative discomfort