Services

Oral Surgery, Implants,
Bone Graph & Biopsy in Greater Toronto Area

Oral surgery encompasses a wide assortment of procedures. It can help treat many different types of conditions, including tooth impaction, dental extractions, implants, and even bone grafting.

Patient Information

All patients require a consultation with the doctor before any diagnosis and treatment options can be discussed. Minor and emergency surgery can sometimes be scheduled the same day as the consultation.

Please bring with you on your first visit:

  • The referral slips from your dentist or physician.
  • Any x-rays if applicable.
  • A list of medications you are presently taking.
  • The name and telephone number of your dentist, family doctor and medical specialists.
  • Information about your dental insurance company including primary policy number, membership ID number and date of birth of the pimary holder.
  • Photo identification such as healthcard, driver’s license, birth certificate or citizenship card.
  • For patients on social services, a copy of your dental eligibility card for the current month. Method of payment: Our office accepts visa, mastercard, debit or cash.

IMPORTANT:

  •  All patients under the age of 16 must be accompanied by a parent or guardian at the consultation visit.
  • If necessary, an alternate decision maker should be present.
  • If necessary, an interpreter should be present.
  • A preoperative consultation and physical examination is necessary for patients who wish to have surgery done under general anesthesia.             

ON ARRIVAL AT OUR OFFICE:
Please check in with the front desk receptionist.

You will be asked to complete a medical questionnaire on arrival. Please list all medical conditions you may have and any prescriptions and over the counter medications you are taking. Please read the details of how our office collects, uses and discloses patients’ personal information.

X-RAYS
Once your appointment is booked we will require any recent x-rays that your dentist or physician has taken. Please bring the x-rays with you, either on film or x-rays printed on a photo paper or have them forwarded by mail or email to our office.

Our office is able to take the following digital x-rays: Computed Tomography, panoramic and periapical if they are not available.

Our email address for the Sheppard office is: 143@metropolitanoms.com.
  
Our email address for the Danforth office is: 815@metropolitanoms.com.

ANAESTHESIA:
Oral and maxillofacial surgery procedures can be accomplished free of pain using a combination of nitrous oxide, intravenous sedation, general anaesthesia and local anaesthesia.

The use of new narcotics, tranquilizers and ultra-short acting anaesthetic drugs, combined with local anaesthesia, allow patients to experience a state of sleep or sedation in comfort and safety.

A pleasant environment with skilled, attentive and congenial staff in a fully equipped outpatient setting provides this optimal care.

Payment and Insurance Options

FEES AND INSURANCE
The doctors and staff will be pleased to discuss fees and payment arrangements with patients.

Patients are directly responsible to our office for the cost of treatment.  Payment is due on the day of treatment.

Method of Payment: Our office accepts visa, mastercard, debit or cash.
If you have a new “chip” credit card, you need to know your PIN number to make payment on your account.

O.H.I.P.

  1. O.H.I.P. does not cover office procedures.
  2. O.H.I.P. does cover some surgical procedures performed in a hospital.  The doctor will discuss these fees with patients.
  3. O.H.I.P. no longer pays the biopsy laboratory fee for processing and diagnosing pathological tissue.

DENTAL INSURANCE:
Your dental insurance plan is a contract between you and your insurance company, not between the insurance company and your doctor. You are financially responsible for your account with our office. Our office does not receive payment from your insurance company, but we are able to submit your claims electronically.

  1. We will be pleased to fill out your dental insurance forms or we will provide you with a standard form that you can submit to your insurance company for reimbursement. Please make sure you have all insurance details with you. We will require the name of your insurance company, policy number, membership or ID number and the name and date of birth of the primary holder.
  2. Some insurance companies have restrictions on how much they will reimburse patients for surgery.
    • Some companies do not base their coverage on the current year's fee guide.
    • Some companies use a general practitioner's fee guide.
    • Some companies provide only partial coverage of services.
    •  Some companies do not cover specified services.

Some insurance companies require that patients submit fees and codes before treatment. Our office will be pleased to provide you with these forms or we will email them to the insurance company for you. Your insurance company will contact you directly.

It is customary to pay for professional services when rendered. Any other arrangements for payment must be made in advance.

Pre-Operative Instructions for Patient Having Sedation or General Anesthesia
  • Please bring photo identification with you. e.g., health card, driver's licence, birth certificate, citizenship card.
  • If you are having IV sedation or general anaesthesia you should not have anything to eat or drink (including water) or undertake the vigorous exercise for eight hours before surgery.
  • If you are taking any prescribed medicine, these must be taken as usual with a minimal amount of water unless advised otherwise.
  • Patients should not take any recreational drugs (including marijuana), controlled substances, or alcohol before their surgery as severe adverse reactions could occur. Patients must report to their surgeon if they have taken any recreational drugs or controlled substances for a period of up to 48hours before having general anaesthesia or sedation.
  • Patients should wear loose or short-sleeved comfortable clothing to the surgical appointment. Wear flat enclosed shoes, no high heels or flip-flops.
  • Patients should leave contact lenses at home or bring a suitable container in which to store them while in the office.
  • Patients must bring an English speaking, responsible adult with them to their appointment. This person must stay in the office during the appointment to accompany the patient home in a personal automobile or taxi.
  • A responsible adult must stay with the patient at home for at least 4 hours after surgery.
  • Patients must not drive a vehicle, operate hazardous machinery, take recreational drugs (for example, marijuana) or consume alcohol for a minimum of 24 hours following the anaesthetic, or longer if drowsiness or dizziness persists.
  • Have soft foods and possibly an ice pack (or packet of frozen peas) at home for after surgery.
  • Patients must bring I.D. with them to the office at the time of their appointments for prescriptions, I.D. can be health card, birth certificate, or driver’s license.
  • Advise staff of any medicine or latex allergies.
Post-Operative Instructions for Patients (After Surgery Instructions)

We can provide post-operative instructions in Chinese, French, Korean, Persian, Russian, and Spanish on request.

Swelling, Bruising & Discomfort
Swelling, bruising, and discomfort usually occur following surgery. Considerable swelling of the face and neck may occur. Swelling may increase for 48 hours, then gradually subside over approximately one week. Bruising of the neck and chest may occur. Do not apply heat to the face. Ice packs may be utilized at intervals of 15 minutes for the first 8 hours. If symptoms have not improved by the fourth day, please contact our office.

Limited Mouth Opening
This standard protective mechanism usually occurs following oral and maxillofacial surgery.

Temperature Elevation
A temperature increase to 102°F or 39°C is common for 1 to 2 days after surgery. If your temperature goes higher than this, please call our office.

Stitches
Stitches are used to control bleeding. They will dissolve over 5 to 10 days. After five days, if a small piece of suture is hanging, you can try to remove it or cut it shorter.

Bleeding
A small amount of redness mixed with saliva is normal after surgery. If you have a flow of blood or if bleeding persists, look in the mirror to determine the source of the bleeding, then place a gauze pad or a fresh, moist tea bag wrapped in gauze over the bleeding spot. Bite on this and, at the same time, apply light pressure to the side of the face with the palm for half an hour. Repeat if necessary. If there is still a flow of blood, please notify our office. Once bleeding has stopped, remove the gauze and do not replace it.

Spitting and Smoking
Do not spit, smoke, or use a straw. Smoking should be avoided as it can complicate the healing process. There is a much higher incidence of dry socket in patients who smoke post-operatively. Dry socket is extremely painful. The #1 cause of dry sockets is smoking, even if only a few cigarettes are smoked daily.

General Anaesthesia & Sedation
After general anaesthesia or sedation, it is normal to be drowsy and poorly coordinated for several hours. Stay home and rest for the remainder of the day. Do not drive, sign any legal documents, or drink alcohol for 24 hours.

Nausea
Nausea may occur after an anaesthetic or from some medicines. If this happens, Gravol may be purchased without a prescription. Follow the instructions on the bottle. Rat cola may also alleviate nausea. You must keep up with your fluid intake despite nausea, or you may get dehydrated quickly. Drink small amounts at a time frequently.

Oral Hygiene
Rinsing of the mouth should be started very gently on the day after surgery, as vigorous rinsing can disturb the healing process. Rinsing can become more robust as healing progresses. Rinse with either ¼ teaspoon of salt or baking soda in ½ glass of warm water, 5 to 6 times per day for one week. Begin brushing your teeth 24 hours after surgery and when comfortable to do so. Lubricate your lips with Vaseline or any bland ointment.

Diet
After surgery, your jaw may be stiff, or your throat could be sore, so it will be difficult to eat. It is, however, essential to have something to eat and drink after surgery. You will feel better, have more strength, less discomfort, and heal faster if you eat and drink regularly.

You will be able to eat soft foods such as scrambled eggs, mashed potatoes, custard, chowder, apple sauce, yogurt, ice cream, and Jello. You may also drink soups such as chicken or beef broth. Consume water, fruit and vegetable juices, liquid nutritional supplements (i.e., Ensure). Drink as much as you can prevent dehydration. Avoid hot temperature food and drinks after surgery until the local anaesthesia has worn off, as this may cause you to bum your tongue and the inside of your mouth.

Medications
Take the pills prescribed as directed on the bottle. Your pain medicine should keep you reasonably comfortable and is best taken with fluid or food in your stomach. For mild pain, Aspirin, Advil, or Tylenol may be used. Narcotic or prescription pain medicine may cause some dizziness. Do not drive or use hazardous machineries while taking narcotics. Antibiotics should be taken until the full prescription is used. For nausea or stomach upset Gravol can be taken with your medication. Flat cola may also alleviate nausea. If a rash, severe stomach cramps, or diarrhea occur, stop taking your medicine and call our office.

Females who are taking birth control pills and antibiotics at the same time should know that the combination of these two drugs may cause birth control pills to become ineffective as a contraceptive method. Pregnancy may occur if alternative methods of birth control are not used for the remainder of that menstrual cycle.

Constipation
The Codeine in pain medicine can be constipating. If this occurs, a mild laxative such as Milk of Magnesia may be taken.

Patients will be given as many post-operative appointments as necessary to ensure that healing proceeds normally.

Extractions

Carious teeth 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.

Impacted Teeth

Third molars (wisdom teeth) are the last teeth to develop and frequently become trapped under the bone 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 initiate the development of cysts and tumours, 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

Dental implants allow the replacement of one or more teeth without compromising the health of the adjacent natural teeth. Implants can replace partial or complete dentures and can be utilized to support loose dentures solidly.

Implants are inserted into prepared openings in the jawbone. Small titanium cylinders are attached to each implant with a screw. These small post cylinders protrude through the gum. 

Your dentist can then construct teeth that will be attached to the cylinders. 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.

Bone Grafts

Occasionally, there is not sufficient bone present to allow the insertion of implants. Bone grafts are also occasionally necessary to fill in gaps during facial reconstruction surgery. Several techniques can be utilized. Bone can be removed from an alternate location in the jaw and moved to the deficient area. Alternately, mineralized bone, or other bone substitutes can be utilized. These products are specially treated and sterilized so that they can be utilized in the human body. 

Mineralized bone is an inert calcified matrix into which your bone can grow. 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.
                                                                               
Patients who have difficulty wearing dentures do not have enough bone for implant placement or have other jaw defects, can benefit from jaw reconstruction surgery. Bone and soft tissue can usually be added to the jaws so that dentures can be worn successfully, implants can be inserted and aesthetics restored.

Minor bone grafting can be done in the office under local or general anaesthesia. Larger bone grafts are 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. Platelet-rich plasma is a solution derived from a small amount of your own blood. The blood is centrifuged to concentrate blood cells, which are called platelets. Platelets contain growth factors that aid in healing. The solution containing the growth factors is mixed into the bone graft.

General anaesthesia is often recommended for bone graft procedures.

Sinus Lift Surgery

A sinus lift procedure 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, mineralized or demineralised bone and platelet-rich plasma. The use of platelet-rich plasma involves harvesting a small amount of the patient’s own blood. Platelets are removed from the blood and concentrated in a solution which is mixed with the graft material. This promotes the success of bone grafts. In our experience, the success rate of bone graft is about 80-85%.

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

Cysts and tumours occasionally develop in the jawbones and the surrounding soft tissues such as the cheeks and lips. Cysts and tumours should always be removed promptly.
        
Biopsies are performed to remove any abnormal tissue growths. A biopsy should be considered for any growth 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.

Uncovering Buried Teeth

Occasionally teeth become trapped due to lack of space in the jaw. To correct this, an opening can be made in the bone and gum through which the tooth can erupt.  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.

Root Resection And Retrograde Fillings

In some cases, teeth can be saved by utilizing root canal therapy. Root canal therapy or endodontic therapy can be done by the patient’s dentist, or if the procedure is complicated by a root canal specialist. 

Occasionally it is necessary to supplement endodontic therapy with a root resection. Root resection is a surgical procedure in which an incision is made through the tissue over the root of the tooth so the underlying area can be cleaned and the end of the root smoothed off. 

Sometimes it is necessary to place a filling at the end of the root to further seal off the root canal. Root resection surgery is not always successful in saving teeth.

Corrective Jaw Surgery

The goal of corrective jaw surgery is to establish a stable, functional balance of the teeth, jaws, and surrounding facial structures.

In conjunction with orthodontic treatment, corrective jaw surgery is used to assist in the correction of crooked teeth and to enhance aesthetics. Depending on the extent of the patient’s problem, corrective jaw surgery may range from the minor movement of a single part of a dental arch to repositioning an entire jaw or repositioning both jaws and adjoining facial bones.

We provide a comprehensive program for the treatment of patients with skeletal facial problems. For instance, we make large jaws smaller and small jaws larger. Procedures are done to correct gummy smiles or to shorten and lengthen faces. Most dental-facial deformities can be corrected.

Advances in surgery and anaesthesia have enabled patients to undergo these procedures safely with minimal discomfort and swelling and to achieve predictable results.

Surgical techniques allow almost all corrective jaw surgery procedures to be done from inside the mouth, so no incision on the face is necessary.

Techniques have now been developed so most patients can have surgery with the upper teeth wired to the lower teeth. New techniques and anaesthetics have led to shortened hospital stays and rapid recovery. Patients obtain important functional and psychological benefits.

Prognathism: Horizontal overgrowth in the upper or lower jaw.

Microgenia: A chin that is too small. A small chin may occur as an isolated deformity or may accompany another abnormality, such as a retrognathic mandible.

Retrognathism: A small jaw that does not match the opposing jaw. Both upper and lower jaws can be affected.

Open Bite: A deformity that occurs when the front upper teeth do not contact the front lower teeth.

Vertical Facial Excess: A face that is too long. This may be an overgrowth of the mid-face alone or may appear in combination with other abnormalities. Patients with this problem often complain of showing too much gum tissue when smiling and frequently demonstrate lip strain as they try to mask the abnormality by forcing their lips together over their front teeth.
Vertical Facial Deficiency refers to the opposite of vertical facial excess. With this problem, the face is too short. 

Temporomandibular (Tmj) Arthroscopic Surgery

Arthroscopic surgery is a surgical technique recommended for patients with structural damage inside the temporomandibular joint (TMJ). This damage may include displaced cartilage, damage to the cartilage that lines the skull bone or jawbone (chondromalacia), inflammation of the capsular ligaments of the joint (capsulitis), inflammation of the joint lining (synovitis) or breakdown of the bony components of the joint osteoarthritis). 

Other disease conditions like rheumatoid arthritis may also affect the TMJ.
Diagnosis of these and other conditions can usually be made from the assessment of the history of the condition and clinical examination. Confirmation may be gained through special tests, including TMJ arthrograms, MRI scans, or CT scans.

These conditions are generally initially treated with conservative measures, including physiotherapy, anti-inflammatory drugs, bite splint therapy, and arthrocentesis (washing out of the joint space). The vast majority of patients with painful temporomandibular joint problems respond well to conservative therapy. However, some patients will continue to have pain despite excellent conservative therapy.

Patients who have persistent TMJ pain following conservative therapy may be candidates for arthroscopic surgery. Arthroscopic surgery is an operation performed by trained oral and maxillofacial surgeons. The operation is performed in the hospital under general anaesthesia. Most patients can have this surgery done on an out-patient basis.

Cone Beam Ct (Cbct)

We are pleased to offer a state-of-the-art 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 one of our surgeons or a licensed oral and maxillofacial radiologist.

Platelet Rich Plasma (Prp)

Platelet-rich plasma (PRP) is a by-product of blood (plasma) that is rich in platelets. Until now, its use has been confined to the hospital setting. New technology allows us to harvest and produce a sufficient quantity of platelets from a small amount of blood which is drawn from the patient while they are having surgery either at the hospital or in the office. The blood is then centrifuged to create the platelet-rich plasma solution. The PRP is then mixed with thrombin and calcium chloride that stimulate the aggregation of platelets.

PRP permits 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 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 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 in conjunction with our bone grafting procedures, including block grafts, particulate grafting, sinus lifts, and ridge augmentation procedures.

Advantages

  • Safety
  • Convenience
  • Faster healing
  • Cost-effectiveness
  • Ease of use

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.
Advantages

  • More precise implant placement
  • Reduction in treatment time
  • Increased patient safety
  • Minimally invasive surgery
  • Faster recovery
  • Less post-operative discomfort

Cone Beam CT scanning is also used to aid the planning and to perform corrective jaw surgery. By utilizing this technology, we are not only able to plan your surgery virtually ahead of time, but also able to fabricate precise surgical splints to aid the repositioning of the jaws during surgery and to maximize the final results in terms of the functional and esthetic outcome.

We are also able to utilize this technology to communicate more effectively with you and your orthodontist about what to expect from the surgical procedure.

As a result, the quality of treatment provided is enhanced, total surgical time is reduced, there will be lesser post-operative discomfort, faster recovery, and fewer complications.