About Our Oral and Maxillofacial Surgery

Oral and Maxillofacial surgery manages a wide variety of problems relating to the Mouth, Teeth and Facial Regions. The full scope of Oral and Maxillofacial Surgery ranges from Dental Implant Surgery, Corrective Jaw Surgery, Wisdom Tooth Removal and diagnosis and treatment of Facial Pain, and Facial Injuries.

Dental Implants

The implants themselves are tiny titanium posts which are inserted into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes. They are surgically placed into the jawbone. The bone bonds with the titanium, creating a strong foundation for artificial teeth. Small posts are then attached to the implant which protrude through the gums. These posts provide stable anchors for artificial replacement teeth. Implants also help preserve facial structure, preventing the bone deterioration that occurs when teeth are missing.

For most patients, the placement of dental implants involves two surgical procedures. First, implants are placed within your jawbone. For the first three to six months following surgery, the implants are beneath the surface of the gums gradually bonding with the jawbone. You should be able to wear a temporary prosthesis and eat a soft diet at this time.

After the implant has integrated with the jawbone, the second phase begins. Dr. Urig will uncover the implants and attach small posts which will act as anchors for the artificial teeth. These posts protrude though the gums. Once the artificial teeth are placed the posts will not be seen. The entire procedure usually takes three to six months. Most patients experience minimal disruption in their daily life.

Wisdom Teeth

The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your third molars, also known as 'wisdom teeth.'

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.

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. The result: is swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone, and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid future problems and to decrease the surgical risk.

Bone Grafting

Over a period of time, the jawbone associated with missing teeth atrophies. This often leaves a condition in which there is poor quality and quantity of bone for placement of dental implants. In these situations, patients will need bone grafting in order to become a candidate for dental implants.

Bone grafting allows bone to grow where it is needed. This not only gives the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance. In the posterior upper jaw when the bone is deficient it may be necessary to do a sinus floor graft. This procedure involves elevating the sinus membrane and placing the bone graft onto the sinus floor which regenerates vertical bone loss, allowing implants to be placed in the back part of the upper jaw.

The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be repositioned in order to make room for placement of dental implants to the lower jaw.

These procedures may be performed separately or together, depending upon the individual’s condition. There are several areas of the body which are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or tibia.

These surgeries are performed in the office surgical suite under IV sedation. After discharge, bed rest is recommended for one day and limited physical activity for one week.

Oral Pathology

The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The following can be signs at the beginning of a pathologic process or cancerous growth:

• Reddish patches or whitish patches in the mouth
• A sore that fails to heal and bleeds easily
• A lump or thickening on the skin lining the inside of the mouth
• Chronic sore throat or hoarseness
• Difficulty in chewing or swallowing

These changes can be detected on the lips, cheeks, palate and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology and is often associated with oral cancer. A patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer. Patients that smoke, chew tobacco and are heavy drinkers are at increased risk. We would recommend performing oral cancer self-examination monthly and remember that your mouth is one of your body's most important warning systems. Do not ignore suspicious lumps or sores. Please contact us for an evaluation or for more information on self examination.

Facial Trauma

Oral and Maxillofacial surgeons are trained, skilled and uniquely qualified to manage and treat facial trauma.

• Facial lacerations, Intra-oral lacerations, Avulsed (knocked out) teeth
• Fractured facial bones (cheek, nose or eye socket)
• Fractured jaws (upper and lower jaw)

Injuries to the face, by their very nature, impart a high degree of emotional and physical trauma to patients. The science and art of treating these injuries requires special training involving hands on experience and an understanding of how the treatment provided will influence the patient's long term function and appearance.

When soft tissue injuries such as lacerations occur on the face, they are repaired by suturing. In addition to the obvious concern of providing a repair which yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands and salivary ducts.

Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors which include the location of the fracture, the severity of the fracture, the age and general health of the patient. When an arm or leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.

One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique is called "rigid fixation" of a fracture. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for may patients, allowing them to return to normal function more quickly.

Orthognathic Surgery

Orthognathic surgery is needed when jaws don’t meet correctly and/or teeth don’t seem to fit with jaws. Teeth are straightened with orthodontics and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.

People who can benefit from Orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing, speech, breathing difficulty, snoring, long-term oral health and overall appearance. Injury to the jaw and birth defects can also affect jaw alignment. Orthodontics can correct bite problems when only the teeth are involved; however, Orthognathic surgery may be required when the jaws need to be repositioned. Some of these conditions exist at birth others are a result of hereditary or environmental influences or the result of trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination