Procedures

Sedation analgesia or “Twilight sedation” is a safe and effective way for patients with high dental anxiety to undergo dental procedures in a relaxed, calm and comfortable fashion. Common methods include Nitrous oxide, Oral sedation, and intravenous options, each providing various levels of sedation. Combined with Local anesthesia, patients can relax without experiencing any discomfort. This is an option we discuss with all patients and is especially helpful for those who have a phobia of dental treatments or have difficulty sitting for long periods of time during surgery.

Dental Implants Procedure
A dental implant procedure can take about 30 to 60 minutes to place one implant or two to three hours to complete multiple implants. Depending on a patient's unique situation, the time and number of appointments to complete the procedure will vary from person to person. In any case, you will receive professional and compassionate care from our team throughout the process. Before your procedure, we will discuss the use of antibiotics and IV sedation or nitrous oxide to help provide the most comfort. In all cases, we will use a local anesthetic to numb the area where the implant will be placed. Once the area has been numbed, and you are comfortable, we make a small incision in the gum to expose the bone. Our specialized tools allow us to create space to gently place a titanium implant. This is just the first step in the process.

The Healing Phase
As the healing process begins, we will advise you on your follow-up care and additional appointments. The next step will be to place an abutment or healing cap on the implant to allow the gum tissue to mature. Healing time varies from patient to patient. You may require anywhere from one to four follow-up appointments to monitor the healing process. Sometimes patients may require a soft tissue graft to strengthen the gum area around the implant. The final step is placing a crown, which is the visible replacement tooth, onto the dental implant.

When Are Dental Implants Placed?
The timing of dental implants will depend on the patient. In most cases, dental implants aren't placed until months after tooth extraction. Less often, it may be possible to place an implant immediately after an extraction. However, if there is an infection or other bone problems, it is best to wait until the mouth is healthier to place an implant.
In cases where the tooth has been missing for quite some time, there may be bone loss. Natural teeth must be present to stimulate bone growth, and bones stop growing when teeth are missing. A patient missing a tooth for a year can lose as much as one-third of their bone growth. We perform bone grafting procedures to build up bone in the area to support an implant adequately.

How Many Implants Do I Need?
Patients usually require one implant per missing tooth. More prominent teeth in the back of the mouth have two or three roots, so missing teeth in those areas are usually filled with larger implants.

Do I Need a Tooth Extraction?
Tooth extractions are necessary for various reasons. Teeth that are severely decayed, impacted, or broken beyond repair are reasons for extraction. Sometimes extraction is required to prepare for orthodontic treatment or to treat advanced periodontal disease. We will discuss alternatives to extraction. However, if an extraction is the best solution, we will also talk about options for replacement.

The Extraction Process
We use a local anesthetic to numb the tooth, jaw bone, and gums surrounding the tooth that will be extracted. Patients will feel a bit of pressure during the process but will not feel pain due to the anesthetic numbing the nerves in the area. We constantly monitor our patients' comfort levels and take steps to provide additional comfort when required.

Sectioning a Tooth
A tooth that is fractured or decayed may require sectioning instead of a straight extraction. This is common and means we cut the tooth into sections to remove it correctly from the mouth.

After Tooth Extractions
As with all of our procedures, we give patients detailed instructions on caring for their extraction when they return home after the surgery. It's essential to let the wound form a blood clot so that it can heal faster. This is accomplished by placing gauze on the wound and biting down for 30 minutes. Patients should avoid rinsing vigorously, using a straw with liquids, or brushing the wound within the first 24 hours of the surgery. It's important not to do anything to dislodge the clot. If it happens, biting on a new piece of gauze for 30 minutes can stop the bleeding and reform a clot. More details on post-operative care instructions, including managing pain and swelling, are available on the After Extractions page.

What Is Bone Grafting?
Over time, after the loss of a tooth, the jaw bone will begin to shrink, resulting in insufficient bone for dental implant placement. It can also lead to movement of the remaining teeth and changes to the facial structure. Most patients in this situation are not candidates for dental implants to correct these issues. However, with today's modern techniques, we have the ability to stimulate bone growth where we need to, allowing us to restore patients' physical health and mental well-being.

Bone Grafting Process
Bone loss can result from various dental complications, including previous extractions, gum disease, or an injury. There are three types of bone grafting materials available to repair this: autologous, allogenic, or xenogenic. Each of these materials has advantages and disadvantages for patients and can be used independently or in conjunction with another. The method used will depend on the surgery required to achieve the desired results.

We categorize bone grafts as either major or minor:

• Major bone grafts – These procedures are usually performed to repair jaw defects caused by facial trauma, tumor surgery, or a birth defect. These larger procedures use the patient's own bone, which is commonly taken from the cranium, hip, or lateral knee. Even though these are categorized as major surgeries, we can still perform the majority of these here in our office in an operating room.
• Minor bone grafts – Minor bone grafts are procedures performed to reconstruct and add bone to smaller facial, jaw, or tooth areas. These are routine and performed right here in our office using local or general anesthesia. When using autologous bone for these minor procedures, we can take bone from the same sites noted above as well as the upper or lower jaw.

Allogenic Bone
Using allogenic bone has become increasingly popular among surgeons due to its impressive life-enhancing benefits. Allogenic tissue is taken from living or cadaver donors and can either be spongy-like cancellous or denser cortical tissue. Both allow the same results of promoting the ingrowth of blood vessels and the influx of bone remodeling cells into the tissues. It is the framework to form new bone. All donors are carefully screened, and the grafting material is highly processed, so there is no risk of transmitting disease during the procedure. One of the great benefits of these allografts is that they don't require a second surgical procedure on a patient to mine autologous bone while still providing excellent results.

Xenogenic Bone
Xenogenic bone is taken from a non-living species other than a human, most commonly a cow. This type of bone is also highly processed and at a very high temperature to avoid potential immune rejection and contamination. They serve the same framework to form new bone as allogenic bone. While both allogenic and xenogenic bones provide the same results and don't require the additional surgery of an autograft to acquire the patient's own bone, they don't contain the properties to form bone structure as easily as autologous bone. Because of this, bone growth with allogenic and xenogenic grafts can take longer to develop.

It's not uncommon for people to experience changes inside their mouths, such as inflammation, redness, or lesions. We perform a medical test known as a biopsy to determine the cause and condition patients are experiencing. Biopsies are routine procedures performed right here in our office. We take a small tissue sample from the affected area and send it to a lab for further testing and proper identification. Once we receive the biopsy results, we thoroughly educate the patient on what the results mean, the type of issue they are experiencing, and the process we will take to help them achieve optimal health.

What are wisdom teeth?
Wisdom teeth are the third molars located in the back of the mouth behind the second molars. They are usually the last teeth to grow in and are fully developed sometime between the middle teenage years and early twenties. Since they grow in during the age of maturity and wisdom, they are known as wisdom teeth.

What Is an Impacted Tooth?
Most people don’t have jaws large enough to accommodate the last four teeth to grow in, which are the upper and lower wisdom teeth. Teeth that grow into an area that doesn’t have enough room to allow for normal growth are called impacted. These are teeth that aren’t functional for eating and can’t be cleaned easily.

Wisdom Teeth Examination
Oral examination and x-rays of the mouth are routine parts of a dental exam where we evaluate the growth and position of wisdom teeth. We look for current or potential problems they might cause. The earlier we monitor wisdom teeth, the best chance we have at limiting issues on other teeth. Wisdom teeth examinations start in the early teen years.

After Extraction of Wisdom Teeth
If you’re having your wisdom teeth extracted by us, the procedure takes place here in the comfort of our office under local anesthesia, nitrous oxide, or general anesthesia. We will go over everything you need to do to prepare for the extraction with detailed instructions on caring for your mouth when you return home after the operation. We use self-dissolving stitches to help the wound heal. You can learn more by visiting our After Wisdom Teeth Removal page.

Many dental procedures require healthy bone to support the treatment or implants used in oral surgeries. Patients who lack the proper amount of healthy upper jaw bone to complete implants or treat periodontal disease might need to have a sinus lift. In a sinus lift or augmentation, we move the sinus membrane upward to create space to add new bone through the bone grafting process.
 
We make a small incision in the molar region to gain access to the jawbone. From there, we can push the sinus membrane upward to create space to add bone grafting material. A sinus lift may be necessary for patients who are: missing more than one tooth in the back of the jaw, missing a significant amount of bone at the back of the jaw, missing teeth due to a birth complication or condition, or missing most of the maxillary teeth and require support for dental implants.

An apicoectomy is an oral surgery performed to treat infected tissues inside the tooth. A root canal is a standard procedure to achieve the same results. However, re-infection is a concern if a root canal can't adequately address all infected areas and dead nerves. In this case, an apicoectomy, performed at the root of the tooth through a small incision in the gum, is performed instead.
 
We make a small incision in the gum to access the inflamed tissue in the jawbone. We remove the damaged tissue along with a portion of the root tip. A filling is placed at the end of the root tip where the piece was removed to prevent re-infection. After suturing the gum, the bone will naturally heal to regain full function over the next few months.

With the latest technology, such as cone beam computed tomography (CBCT) 3D technology, we perform panoramic CT scans to get a wraparound view of patients' faces and teeth. This equipment allows us to accurately diagnose issues and provide treatment with complete confidence. The benefits of this technology enable our team to obtain crystal clear three-dimensional images while reducing patients' exposure to radiation. Such precise imaging and clear photos allow your team of doctors to share, analyze, and confer on the same group of images to provide the absolute best treatment.

Our office is available for dental emergencies caused by traumatic injuries, accidents, or sudden dental complications. If you experience any of these that cause severe pain or excessive bleeding, contact us right away.

The inside of your mouth is covered with skin that is typically smooth and pinkish in color. Any change in this appearance could signal a pathological process that includes serious diseases such as oral cancer. These changes aren't always accompanied by pain, so we recommend performing a self-exam of the lips, cheeks, palate, gum tissue, and around the teeth, tongue, face, and neck once a month to look for:

• Reddish or whitish patches in the mouth
• Sores that don't heal on their own and bleed easily
• Lumpy or thickening skin inside the mouth
• Chronic sore throat
• Difficulty chewing or swallowing

It’s important not to ignore any signs of warning in these areas.