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Oral Surgery

Oral Surgery for Children | Oral Surgery for Adolescents | Oral Surgery for Adults

Oral Surgery for Children - Extraction

Primary (Baby)  Teeth
Removing baby teeth on a 6-10 year old facilitates the eruption of the developing permanent teeth. This does not necessarily mean permanent teeth will need to be extracted later.  Developing crowding and irregularly aligned teeth can often be handled by an interceptive early procedure called serial extraction. This is the progressive removal of selected teeth as the child matures both dentally and skeletally. By removing deciduous teeth  "extra" space will aid in the natural alignment of the remaining teeth. Since the remaining teeth are somewhat likely to straighten or align naturally on their own as the child is maturing, these changes are often more stable and future orthodontic therapy is often facilitated.

In order to attain the maximum benefit from the serial extraction program, it will be necessary for us to monitor your child at regular intervals to assess the developmental changes in order to assess the appropriate time for future extractions. We will either schedule the next visit while you are in the office or send a reminder in the mail. Failure to maintain the periodic recall visits as scheduled may nullify the program and result in longer and more difficult treatment in the future.

Adult Teeth
The decision to remove permanent teeth is a function of the expressed jaw-tooth size relationship. If the full complement of adult teeth cannot be positioned in a stable, periodontally healthy, functionally sound, esthetic manner, tooth removal is indicated. The removal of permanent teeth (usually the first bicuspids) is elected when the crowding is so severe that treating via expansion would compromise dental health, cosmetics, and stability.

Often there are indications that the jaw size of a child will not be large enough to accommodate the permanent teeth that are developing. Dental crowding and irregularities with regard to the positioning of the newly erupted teeth are the major indicators of a discrepancy in the relationship between the size of the jaws and the size of the teeth. The tendency for crowded teeth will usually become increasingly more apparent as the larger permanent front teeth erupt and replace the deciduous "baby" teeth.

Any combination of removing one to four teeth is utilized to gain space. Typically for dental crowding in the front of the mouth, mid-arch bicuspids are removed. Full orthodontic treatment is then required. Between 15-18 years of age, the back of the mouth may experience crowding or "impaction" of the developing third molars, or "wisdom" teeth. Typically, these teeth are removed with no accompanying orthodontic treatment. Serial Extraction

Before removing any teeth, it is often advised that we obtain orthodontic records (photographs, models, dental x-rays, cephalometric analysis) to evaluate and diagnose the necessary treatment. We may wish to discuss our findings with you at a second consultation appointment.



Oral Surgery for Adolescents

Did You Know? Humans have two upper (maxillary) canines and two lower (mandibular) canines. Canine teeth are sometimes referred to as cuspids, fangs, or "eye teeth" because of their direct positioning beneath the eyes. The canines are critical teeth that play an important role in the mouth, including:

Closing Gaps - Canines are the last of the front teeth to fall into place and help close any unsightly gaps between the other upper teeth.

First Touch - Canines play a vital role in your bite. They touch first when you close your jaw, and guide the other teeth into position.

Proper Alignment & Function - Canine teeth are essential to the correct alignment and function of the other teeth. If they are missing or impacted it can greatly affect the function and aesthetic appearance of your smile.

Exposure and Bracketing of an Impacted Tooth
After wisdom teeth, the upper canines are the most common teeth to become impacted.   An impacted tooth simply means that it is blocked, stuck, or unable to fully erupt and function properly. If a canine tooth gets impacted, every effort is made to save the tooth and bring it into a normal position in the mouth.  Early recognition of impaction is the key to successful treatment.

The primary reasons why canine teeth become impacted include; the presence of extra teeth or unusual growths that blocks or restrict the eruption path of the canine tooth, and overcrowding do to extra teeth or the misalignment of the front teeth. That's why the American Association of Orthodontists recommends that a panorex screening x-ray and an orthodontic examination be performed on all dental patients at age 7 to count the teeth and determine if any of these problems exist.

Treating these types of problems may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also require a surgical extraction of baby teeth and/or selected adult teeth that are blocking the path of the canine. Your oral surgeon will also need to remove any extra teeth or growths that are in the way.  If the eruption path is cleared and the space is opened up by age 11 or 12, there is a good chance the impacted canine will erupt on its own. If the impacted tooth is allowed to develop too long (age 13-14), it will not erupt by itself even with the space cleared. If the patient is too old (over 40), there is a much higher chance the tooth will be fused in position. When fused, the only option is to extract the impacted tooth and replace it with a dental implant or a fixed bridge.

Exposure & Bracketing Procedure
Once your orthodontist has placed braces to open a space for the impacted tooth, the oral surgeon will expose and bracket the tooth in a simple surgical procedure performed under local anesthesia. A small incision is made in the gum to expose the impacted tooth.  An orthodontic bracket is bonded to the tooth and a gold chain is attached to the bracket, sutures are then placed to reposition the gum tissue.

Shortly after surgery (7-10 days) the patient will return to the orthodontist who will attach the chain to the existing orthodontic wire and will intermittently tighten it to guide the impacted tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take up to a year to complete. Recovery from this procedure is usually uneventful with only mild discomfort and swelling. 

The Wisdom behind Pulling Teeth!
An impacted tooth simply means that it is blocked, stuck, or unable to fully erupt and function properly. Wisdom teeth are the most common teeth to suffer impaction, but since they serve no important function, the typical treatment is to have them removed before they cause many problems.

By the age of eighteen, the average adult has 32 teeth - 16 on the top and 16 on the bottom. The only problem is that the average mouth can only comfortably accommodate 28 teeth. The four extra teeth, your "wisdom teeth" can cause a lot of pain and problems if left to grow without sufficient space.

Why Should You Have Your Wisdom Teeth Removed?
Wisdom teeth are the last teeth to erupt in the mouth. If they align properly and the gum tissue is healthy, they may not need to be removed. Unfortunately, this rarely happens. They may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone (impacted).

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection with swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the natural alignment.  This is why retainer wear until these teeth are removed is crucial.  More serious problems can occur when tumors or cysts form around the impacted tooth, resulting in the destruction of the jawbone and healthy teeth.

Early removal is recommended to avoid these problems and to decrease the surgical risk involved with the procedure.   We strongly encourage everyone to be evaluated in their mid-teenage years. Studies have shown that early evaluation and treatment yields better results for the patient.

Oral Surgery: Four-Bicuspid Extraction
Impacted Cuspid (Palatal) Treated



Oral Surgery for Adults

For severe conditions that cannot  be treat by orthodontic appliances alone, corrective jaw surgery (orthognathic surgery) treats and corrects abnormalities of the facial bones, Specifically, the jaws and the teeth. These abnormalities could be esthetic and/or functional in nature.  Often, these abnormalities can cause difficulty associated with chewing, talking, sleeping and other routine activities. Orthognathic surgery corrects these functional problems and, in conjunction with orthodontic treatment, will improve the overall appearance of the facial profile.

Using the latest in digital imaging technology, we will demonstrate the overall functional and aesthetic benefits of orthognathic surgery. Computerized treatment planning minimizes treatment times, recovery periods and the overall efficacy of your surgery. State-of-the-art materials such as titanium plates and miniature screws provide stability, strength and predictability to your treatment. These advances in technology, procedures and equipment reduce post-surgical recovery time.  Often, patients will experience healing within 7-10 days thus allowing patients to return to their normal routines soon after the surgery.   Hard and soft tissue healing will usually be completed within a 6 week period allowing you to resume normal function and enjoying the esthetic outcome of your procedure.

Orthognathic surgery may be unnecessary if orthodontic treatment can correct the problem. With the latest advances in orthodontics, this is sometimes the case. We will determine if orthognathic surgery is the correct treatment option for you.  Thanks to modern medical advances, corrective jaw surgery is now a very precise and predictable procedure. Not only can we show patients exactly how the surgery will be approached, we also can show how your bite will be improved and even give you an idea of what you'll look like after surgery.

There are several classifications of malocclusion that may require surgery:

Class I Malocclusion “Openbite” - The bite is normal in the back, but the upper teeth do not overlap the lower teeth.
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Class II Malocclusion "Overjet"
- When the upper teeth significantly protrude outwards relative to the lower teeth.  This may be caused by the upper jaw being too far forward, or the lower jaw being too far back.
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Class III Malocclusion "Underbite" - Occurs when the lower teeth are positioned beyond the upper teeth, making the lower jaw much more prominent than the upper jaw. This can be caused by the lower jaw being too far forward or the upper jaw being too far back.
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Related Videos:

Oral Surgery Scenario: Maxillary Impaction (Skeletal Open Bite)
Oral Surgery for Mandibular Advancement

Oral Surgery for Mandibular Setback
Oral Surgery for Maxillary Impaction (Gummy Smile)
Oral Surgery Scenario: Maxillary Posterior Impaction with Mandibular Advancement