Northwest Oral & Maxillofacial Surgical Procedures

One of the most common questions we hear is, "Do I really need my wisdom teeth out?" The answer is dependent upon several factors, so some people are able to keep their wisdom teeth while others should have them removed. Wisdom teeth (also referred to as third molars) develop in the back of the jaw, and typically try to come in by the time you turn 17 or 18 years of age. Most of the time, the wisdom teeth do not fully come in (or erupt), but if they do, they may erupt at an angle or location that will compromise the health of your mouth and teeth.

The next question we often hear is, "When do I need to have my wisdom teeth removed?" Timing is important when considering wisdom tooth removal. When a tooth is showing symptoms (pain, pressure, stiffness in the jaw, or redness in the gums around the tooth) it is because damage is already being done. If you ignore the symptoms, it can often lead to serious infections and even possible destruction of adjacent teeth or part of the jaw itself. The best situation is when we are able to catch it early, through examination and evaluation, and remove the teeth before serious symptoms begin. This usually provides for a faster, easier recovery, as well as more straightforward surgery.

Wisdom teeth can be removed under several different types of anesthesia, depending upon patient needs and overall health. Our highly trained staff will make you comfortable and help put you at ease, regardless of your treatment plan. 

Schedule an appointment today for a consultation about your wisdom teeth, and we will answer all your questions, help you understand your situation, and, if necessary, create a custom plan that will allow you to improve your oral health for years to come.

Dental implants are a wonderful technology that isn't all that new. They have actually been around for decades, but the technology is constantly improving. The concept is relatively simple: traditionally, once a tooth was lost, either a fixed bridge was placed to fill the empty space, or a removable partial denture was made to restore chewing ability, or the space was simply left empty. All these methods are still in use today, but each has certain drawbacks.

A fixed bridge will require the dentist to remove healthy tooth structure on at least two other teeth, just to create room to cement the bridge in place. Usually, the bridge functions well over time, but it does have a limited lifetime. A fixed bridge will also require more time for your daily oral hygiene. If proper, daily maintenance is not maintained, decay can form under the bridge, which can often mean loss of additional teeth.

Partial dentures are a less desirable solution for missing teeth. You must remove the denture every night, and often after meals, for thorough cleaning. They are larger than fixed bridges, which can affect your speech and is often difficult to get used to in your mouth. Their lifespan is also usually shorter than most fixed solutions.

Dental implants allow your dentist to replace teeth without negatively affecting other teeth in your mouth. A dental implant starts with a tiny titanium metal screw, and that is placed where the tooth root once was to serve as an anchor for a new tooth. When placed properly, the jawbone will attach to the implant surface, essentially integrating it as a part of the body. Once fully healed, you do not see or feel the implant, since it is now completely embedded in your jaw, just like the tooth root used to be. 

Once the implant has healed (the time-table varies because of a number of factors that differ from one person to another), the top of the implant is uncovered to reveal a screw attachment within the implant. The dentist will then use it to attach the new tooth, which has been created to match the rest of your natural teeth. You will then take care of this tooth just like you do with the rest of your natural teeth, and it will look and function like the rest of your smile.

While the implant placement surgery might sound very invasive, it is actually pretty straightforward. Most patients say that the procedure and associated recovery is easier than most tooth extractions. It can be performed with local anesthesia or IV sedation, depending on the needs of the patient and the overall treatment plan.

Not all people are good candidates for implants, although most people are. Surprisingly, age is not necessarily a limiting factor when considering an implant. Things that can carry additional risks are: certain medications, poorly controlled diabetes, radiation treatment to the jaws, and smoking. 

So if you're wondering if implants are right for you, just call us and schedule a consultation. We can evaluate your individual situation and discuss treatment options that are available to you.

Because they are the most common teeth to be impacted, many people are familiar with the idea of impacted wisdom teeth. However, the second most common teeth to become impacted are the upper canines, which are also known as eye teeth. And while impacted wisdom teeth are often removed to solve or prevent problems, canines serve several important purposes, so every attempt is made to preserve them.

Working to preserve your canines will likely involve collaborating with your orthodontist. Using braces, your orthodontist can open a space between the neighboring teeth, and this will allow us to surgically expose the impacted canine. A special bracket with a tiny gold chain can then be attached, and the orthodontist can use it to slowly move the tooth down to its proper position.

If your jawbone has suffered bone loss due to dental extractions, gum disease, or traumatic injuries, bone grafting is often a viable option for repairing the areas with insufficient bone structure. There are a number of different kinds of bone grafting that may be performed, as outlined here.

Socket Preservation Graft

Whenever a diseased or injured tooth has to be removed, a patient's first concern is often fear of having a gap in their smile. Fortunately, in today's world there are a number of solutions to solve the problem of a missing tooth. Dental implants provide a functional, esthetic, and long-term solution for missing teeth. Sometimes these implants can be placed at the same time the tooth is extracted, but in other situations, a solid foundation must be established before the implant can be placed securely. 

Once a tooth is extracted, the healing process can begin. Part of this healing process is a natural remodeling of the jawbone where the rotten tooth has caused bone decay. This remodeling causes the jawbone and gum tissue to shrink in this area, which creates a deficiency that often makes implant placement impossible without more extensive surgery. Thanks to significant advances, today we can typically control the remodeling process (to a certain extent) after tooth extraction by placing a bone graft within the empty tooth socket, covering it with a specialized membrane and stitching it shut. 

Depending on the amount of bone graft needed, the graft can be obtained from another part of the mouth, the hip, the leg bone just beneath the knee, or from a tissue bank. Banked human tissue (called an allograft) is a safe, economical, and pain-free alternative to performing surgery to utilize the patient's own bone.

Once the graft is placed in the socket, a specialized membrane is placed under the gums but over the grafted bone. This prevents the bone graft from coming out, but also prevents soft tissue from invading the socket during the healing process. These membranes can be bio-resorbable, which means that they dissolve slowly on their own, or non-resorbable, which means they will have to be surgically removed later.

This grafting will control the healing process, prevent shrinkage of the affected tissue, and provide a stable foundation for placing implants. Even if you're not sure that implants are right for you, grafting is still advisable. Deciding to place implants later in a space not previously grafted may prove to be impossible without more extensive, and now less predictable, grafting. Even if implants are not placed, grafting and preserving the jaw structure will provide better health for the rest of your teeth, and will naturally help maintain a more esthetically pleasing site for fixed bridges. In other words, your smile will look better.

Sinus Lift

The maxillary sinuses are located inside the cheek bones, just above the roots of the upper molars. They are empty air spaces that serve a very useful purpose. Unfortunately, the amount of jawbone between these sinuses and the mouth is often too thin to support dental implants. In these cases, a sinus lift procedure is used to increase the amount of usable bone. 

A sinus lift is performed by entering the sinus near where the molar teeth once were, so bone graft material can be placed along the floor of the sinus. The sinus is then closed with a specialized membrane and stitches, allowing a healing period of several months for the bone graft to grow into the jaw, so that implants can then be placed securely.

Depending on the amount of bone graft needed, the graft can be obtained from another part of the mouth, the hip, the leg bone just beneath the knee, or from a tissue bank. Banked human tissue (called an allograft) is a safe, economical, and pain-free alternative to performing surgery to utilize the patient's own bone.

Oral pathology refers to diseases of the mouth and jaws, as well as surrounding structures, including the salivary glands, lips, tongue, and upper throat. Many different diseases can show up in this region, alerting you to issues somewhere else in the body. Most oral lesions or sores are benign (non-cancerous), but they can still create a significant amount of tissue destruction. Whenever tissue  abnormalities are discovered, it is very important to follow-up with evaluation and treatment in a timely manner, in order to prevent the situation from worsening.

Every time you visit your general dentist, they should perform an oral pathology screening (often called an oral cancer screening, even though they are evaluating for any types of lesions). However, it is always a good idea to be aware of any changes with a simple self-exam on a monthly basis. Things to watch for include:

• Reddish and/or white patches in the mouth

• A sore or ulcer that fails to heal

• A sore that bleeds easily

• A bump, lump, or thickening of the gums, cheeks, lips, or tongue

• Difficulty swallowing, chronic sore throat, and voice changes

• Anything that seems unusual or out of the ordinary

It is interesting and important to note that oral cancer is often not painful, so pain should not be your only reason to have an oral cancer screening. When we see you for your exam, a complete evaluation and review of your medical history will be done. Then we will discuss any recommended treatments, which may include a biopsy. Biopsies are usually quite simple, and are typically done with local anesthesia. The tissue obtained from a biopsy is sent to an off-site lab that specializes in oral pathology. Once a diagnosis is made, we will, as necessary, work with you to determine the best plan going forward. Often the biopsy itself will remove the lesion completely, so once the lab results are back and reviewed, your treatment is complete.

Many surgical procedures can be comfortably performed with local anesthesia, which means simply numbing the affected area much like numbing a tooth for a filling. In situations where local anesthesia may not be sufficient, or even when there is a high level of anxiety, IV sedation or general anesthesia can be used to better treat the patient's needs. During your visit, we will discuss with you the safest and most comfortable methods of anesthesia available, in order to provide you with the best experience possible. Dr. Best and his staff are fully trained and licensed to recommend and administer various types of anesthesia.

X-Rays, Scans, and 3D Imaging

Northwest Oral & Maxillofacial Surgery features the Sirona Galileos ComfortPLUS 3D scanner. Unlike a traditional, multi-sensor spiral CT scanner found in major medical centers, this scanner uses cone-beam technology to create a 3D X-ray image of the jaws and teeth, but with a fraction of the radiation found in traditional scanning methods. These precise, high-resolution images give Dr. Best important information he can use to diagnose and treat a wide variety of conditions.

Some exams and procedures do not require the use of 3D imaging, and for those cases we use digital panoramic X-rays, as well as the Aribex Nomad Pro 2, which is also state-of-the-art technology and allows for further reductions in radiation exposure.

Northwest Oral & Maxillofacial Surgery features the Sirona Galileos ComfortPLUS 3D scanner. Unlike a traditional, multi-sensor spiral CT scanner found in major medical centers, this scanner uses cone-beam technology to create a 3D X-ray image of the jaws and teeth, but with a fraction of the radiation found in traditional scanning methods. These precise, high-resolution images give Dr. Best important information he can use to diagnose and treat a wide variety of conditions.

Some exams and procedures do not require the use of 3D imaging, and for those cases we use digital panoramic X-rays, as well as the Aribex Nomad Pro 2, which is also state-of-the-art technology and allows for further reductions in radiation exposure.