Phillip Geoffrey Cary, DDS

A dental bridge can be placed on two or more dental implants. On occasion one implant can be used to replace two missing teeth. The process that undergoes the decision to do so is too complicated to address here. Bone volume, bite dynamics, bone quality, general state of dental health, general health, ability to perform necessary oral hygiene and comply with requried professional dental evaluation and treatment, and cost of care are just a few of the items that go into the decision process. I have said it before, and always stand by this: Implant dentistry is not as simple as some want to make it seem.

Always see a Board-Certified Oral and Maxillofacial Surgeon or Board- Certified Periodontist for surgery. Almost always see a Prosthodontist for restorative care if more than one tooth in an otherwise healthy dentition is being considered for replacement, and certainly see a Prosthodontist if your dentition is compromised with extensive fillings, missing teeth, gum problems, or previously placed failing dentistry. Always look at the forest, and not just the missing or ailing tree. You are best armed for decisions such as this when you have ample information to work with.

Happy Holidays.

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Fixed, implant supported bridges (also referred to as implant supported fixed partial dentures) are subject to the same types of problems that can be associated with natural teeth supported bridges. Oral hygiene is one of the keys to long term success. Although implants cannot develop structure decay (cavities) like natural teeth, they are subject to local inflammation, soft tissue problems due to inflammation, and progressive bone loss that is also due to inflammation. This inflammation problem is often due to a hygiene problem, but can be the result of unfavorable implant positioning, unfavorable soft tissue(gum tissue) immediately adjacent the supporting implants, unfavorable design or fit of the bridge, and to patient variables such as general health/cigarette smoking/diabetes/clenching and tooth grinding to name a few. One cannot floss between teeth that are part of the bridge, and will need to develop hygiene skills that allow the patient to reach the areas under the bridge. Implant placement and distribution of bite load in the bridge design are also both critical to long term prosthetic success.

Your dentist and your implant surgeon (preferably an Oral and Maxillofacial Surgeon) should address these issues with you completely and answer all your questions fully and to your satisfaction prior to embarking on such treatment. Do not be fooled, dental implants are not always the right answer and are not always a "permanent" solution, regardless of the marketing of dentistry that is so commonplace today.

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Although any patient undergoing orthognathic (corrective repositioning jaw surgery) should be prepared for the possibility of requiring wiring the teeth together (maxillomandibular fixation) for a period of time after surgery (3-6 weeks), the majority of procedures of this kind performed today utilize placement of small titanium plates and screws to hold the repositioned jaw(s) in place without requiring wiring the teeth together with other than during the surgical procedure. The use of these pieces of titanium hardware is known as rigid fixation of the sectioned bone. Rigid fixation has alleviated many of the postoperative difficulties of our jaw surgery patients. Your Oral and Maxillofacial Surgeon should be able to provide you with a clear understanding of what you should expect as far as indications for, risks of, benefits of, and alternatives to orthognathic surgery. If you have concerns with your facial appearance and not strictly with the alignment of your teeth, one should always seek consultation with an Oral and Maxillofacial Surgeon prior to beginning orthodontic treatment, as coordination of care between the surgeon and the orthodontist and general dentist is critical for success.

Corrective jaw surgery (orthognathic surgery) is considered in cases where the skeletal base of the upper and lower jaws do not grow in a coordinated fashion. The jaws may not coordinate in the profile of the face, the length of the face, or the symmetry of the face. That is to say, there are dental overbite problems with good alignment of the jaws (normal lip support, nasal projection, chin position, and facial proportions), and there are cases where overbite is associated with abnormal jaw positions that would be best managed with a combination of orthodontic treatment and corrective jaw surgery. See an Oral and Maxillofacial Surgeon for evaluation if you believe your case is more than just a teeth problem.

PC

All surgery carries the possibility of postoperative pain or discomfort. Corrective jaw surgery is a pretty broad term, as surgery such as this may involve movement of the upper jaw, movement of the lower jaw, movement of both jaws, chin repositioning, bone grafting. Pretty tough to give you a simple answer. Fortunately, pain is not a big problem for our patients, as they will typically have a period of "numbness" following surgery.

Talk with your Oral and Maxillofacial Surgeon, he or she should be able to give you a much better answer as relates to the specifics of your surgical treatment plan. Corrective jaw surgery can change people's lives in a number of positive ways. Fear and anxiety about surgery is normal. Your surgeon and surgical team should be committed to your physical and emotional well being.

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Hospitalization following orthognathic surgery is a variable matter. Jaw surgery to "fix my jaw" might only involve one jaw, or might require repositioning of both jaws, and sometimes the chin. Some patients have more complicated general health considerations that affect hospital stay time. Some patients can be sent home on day of surgery after suitable anesthesia recovery. Many patients have an overnight stay. Surgical or anesthesia complications can result in longer hospital stays, but that is a very rare matter. This question should be more accurately answered by your Oral and Maxillofacial surgeon, as he or she knows the specifics of your case.

Phillip Cary, DDS

Orthognathic surgery is performed to align skeletal components of the mid and lower face that have resulted in malocclusion that cannot be corrected with stability or appropriate cosmetic results with orthodontic treatment alone. Mild cases of jaw misalignment can be treated with what is considered orthodontic camouflage mechanics to correct the malocclusion without surgery. Jaw growth can be modified in a growing child in some cases using orthodontic appliances. Each case is unique, and each patient should be evaluated by a board certified/eligible orthodontist and oral and maxillofacial surgeon prior to arriving upon a final treatment plan.

Complications can occur with any surgery. As the saying goes, the only minor surgery is someone else's. Extraction of third molars (wisdom teeth) is considered a routine procedure that is performed every day for Oral and Maxillofacial Surgeons. This cannot be said for the average general/restorative dentist. You should generally expect less possibility for complications when treated by a specialist who does this type of surgery daily. In other words, see an Oral and Maxillofacial surgeon for third molar surgery. Prior to surgery, all patients are carefully evaluated and should be informed as to the risks, benefits, possible complications, and expected postoperative course.

A urinary catheter (Foley) is generally not required in routine jaw surgery. In cases where procedures are expected to be lengthy (to avoid bladder distension), or when there is significant concerns with bleeding or management of blood pressure and cardiovascular status, a catheter may be used to document renal perfusion via urinary output. This is a decision that is made by the operating surgeon and anesthesia provider.

Jaw surgery can be a pretty routine procedure and the patient can often be discharged to home within 24 hours of completion. In some cases, the procedures are much more complex, require longer exposures to anesthesia, and may be more concerning as relates to control of bleeding, maintenance of patient comfort, maintenance of an adequate airway, and establishing adequate oral intake just to name of few parameters measured when considering discharging a patient from the hospital. This question can only be specifically answered by the Oral and Maxillofacial Surgeon performing the surgery. An experienced surgeon can generally give you a pretty accurate estimate.

An Oral Surgeon cannot provide basic dental services, and as such a patient should have a general dentist for examinations/cleanings/restorative care. If certain the care one requires is surgical, a patient can always see an Oral Surgeon first. Just always remember, Oral Surgeons only provide surgical services and should always be considered when mouth surgery is being considered. We work closely with the general dental care provider to assure the patient gets the benefit of advanced training and experience.

Hello 26-year-old male,

A dental implant can be used for replacement of a missing tooth, replacement of multiple teeth, or for stabilization of a denture. What "goes on top" of the implant is dependent on how the implant is being used. A dental implant is most commonly used to replace a missing tooth, and in that case will have a tooth form constructed (crown) that is custom made for the patient and attaches to the dental implant. Most Oral and Maxillofacial Surgeons have websites. Visit one or more sites; I think you will find helpful information.

PC

A sinus lift bone graft is done to create adequate bone volume in the posterior upper jaw for placement of dental implants. The amount of bone in the area of interest can be augmented so that a dental implant, or multiple dental implants, of appropriate dimensions can be placed using this surgical procedure. There are times where only minor increase in bone volume is required, and in those cases it is possible to do the sinus lift bone graft and place the dental implant in one surgery. Other times there is not enough native bone to secure the implant in place as the bone graft heals, which requires staging the grafting procedure and implant placement. If this is the case, one should expect anywhere between three and six months of healing time for the graft to incorporate and heal before implant(s) can be placed. These are very technique sensitive procedures.

Gingival grafts (gum grafts) can be done as free gingival grafts, meaning a layer of tissue from the roof of the mouth is harvested and transplanted at the intended site. At times, gum grafts are done with a layer of tissue directly under the surface (connective tissue graft), and also harvested from the palate or sometimes from other areas of the mouth. There is nothing you can do to "speed up" the healing process. Just try to keep your oral hygiene at optimal levels, maintain a soft diet, and follow the directions of your surgeon.
Good luck.

Phillip Cary, DDS

A "bad" tooth can mean a lot of things. The physical condition of the tooth, the tooth's position in the mouth, the health of the adjacent bone and gum support, the vitality of the tooth, the general condition of the mouth, the patient's ability or commitment to maintaining good oral hygiene and regular dental examinations, and the financial implications of addressing these conditions impact the decision of a dentist with their patient to extract. Sometimes there is no other option, and most other times all these factors weigh in. You have to find a dentist you are confident with and trust, and always see an Oral and Maxillofacial Surgeon if in need of oral surgery or sedation or general anesthesia services.

The amount and length of time one has pain/discomfort following tooth extraction with or without bone grafting can be quite variable. The reason for extraction, the difficulty of the procedure, the overall patient health, the experience of the surgeon, the type and size of bone graft if performed, presence or absence of infection at the time of surgery, and the patient's individual capacity to manage pain will influence the process. In most uncomplicated cases, pain/discomfort should not linger beyond a few days if the healing process is going along properly. Always see an Oral and Maxilofacial surgery when tooth extraction and bone grafting is being considered.

Upper jaw surgery is generally done in a hospital OR. The goal of treatment (moving the jaw forward/downward/upward) will determine the specifics of the procedure. All procedures are done from inside the mouth (intraoral approach). An incision is made to access the bone, followed by bone cuts (osteotomies) that free the upper jaw from the facial bones and the nasal septum. The upper jaw can then be moved to the desired position and secured there with titanium plates and screws. The incision is then closed with sutures that dissolve over time. This is a general overview. You should visit an Oral and Maxillofacial Surgeon to discuss the specifics of your case.

Depends on the location of pain, the severity, any associated oral or facial/neck swelling. Many sources dental pain can be readily managed by a conscientious and well trained DDS. One can always start with an Oral Surgeon, but may be advised at that visit the best course of action for that individual would be a visit to a general dentist. If the pain is severe, or associated with any oral or facial/neck swelling you should consider a visit with an Oral and Maxillofacial Surgeon first. Don't be mislead by corporate dentistry or by those general dentists who can "do it all." An Oral and Maxillofacial Surgeon has been specifically trained to manage the more severe matters.
Good luck.

Open bite may refer to either a condition known as anterior open bite (vertical space between upper and lower anterior teeth such that there is difficulty with biting through food), or posterior open bite (some or all back teeth do not come into contact with full mouth closure such that chewing with the back teeth is difficult). Open bite can get worse over time, depending on the cause, the age of the patient, the type of open bite, presence of nonfunctional jaw movements, presence of bone support problems for the teeth. You should see an Oral and Maxillofacial Surgeon for an evaluation to arrive at a diagnosis, cause of the condition, and to get a specific answer to your question.

PG CARY, DDS

Massage of muscles that are tender/sore can be helpful for patients who have myofascial pain (muscle pain) that is one of the more common symptoms of temporomandibular joint disorders. Joint specific disorders (arthritis, degenerative joint disease, disc malposition) require more joint specific intervention, although massage may assist with the associated muscle pain, limited opening. There are a myriad of interventions that are applied to TMJ disorders, and a clear diagnosis and determination of causes is essential if treatment is to be tailored to the patient specifically. See an Oral and Maxillofacial surgeon.

P. Cary