Oral Surgery

Mark D. Breese, D.D.S.

Oral and Maxillofacial Surgeon

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Oral and Maxillofacial Surgeons care for patients with problem wisdom teeth, facial pain, and misaligned jaws. They treat accident victims suffering facial injuries, place dental implants, care for patients with oral cancer, tumors and cysts of the jaws, and perform facial cosmetic surgery.

Their advanced training in anesthesia allows them to provide quality care with maximum patient comfort and safety in the office setting. While many patients decide to have their procedures done under a local anesthetic, other people feel that it is less stressful to be put to sleep during the procedure.  As long as the patient can arrange for a ride home and has someone who can watch them for the evening, many patients report that they love waking up when "it's over."

Conditions & Symptoms

Oral and maxillofacial surgeons, the surgical specialists of the dental profession, complete four to six year surgical residencies that specifically train them to diagnose, treat and manage the conditions, defects, and injuries of the mouth, teeth, jaws and face. Among the conditions and symptoms treated by oral and maxillofacial surgeons are:

  • Diagnosis and management of impacted teeth, tooth extraction and dentoalveolar surgery;
  • Facial pain, including problems related to issues relating to temporomandibular joint disease;
  • Diagnosis and treatment of oral cancers. Patients are encouraged to perform routine oral exams and to see their general dentist or an oral and maxillofacial surgeon annually for a professional examination.
  • Pathologies in the maxillofacial region, including the performance of biopsies and other diagnostic tests and procedures required to diagnose the problem and develop an appropriate treatment plan;
  • Diagnosis and treatment of obstructive sleep apnea, a condition affecting approximately 45% of the US population in which breathing ceases for a brief period of time. Often characterized by loud and frequent snoring, obstructive sleep apnea can lead to excessive daytime sleepiness, poor work performance and such cardiovascular disorders as hypertension, arrhythmias and congestive heart failure.

Treatments & Procedures

OfOral and Maxillofacial Surgeryfice-based surgery is often the most efficient and cost effective way to perform many procedures while maintaining maximum patient comfort and safety. Oral and maxillofacial surgeons are trained to perform the following treatments and procedures:

 

 

  • Reconstructive surgery to address hard and soft tissue injuries in the upper and/or lower jaws resulting from injury or trauma, tumor surgery or long-term denture wear.
  • Dental implant placement to replace a single tooth, several teeth or an entire mouthful of teeth. Dental implants offer a long-lasting, comfortable and functional alternative to conventional dentures.
  • Diagnosis and treatment of infections in the maxillofacial region, which can develop into life-threatening emergencies if not treated promptly and effectively.
  • Treatment and repair of injuries to the face, jaws, mouth and teeth caused by trauma. Oral and maxillofacial surgeons are experts in treating trauma, including fractures of the upper and lower jaws and orbits, and the cosmetic management of facial lacerations.
  • Surgical correction of oral and facial deformities caused by differences in skeletal growth between the upper and lower jaws; and congenital deformities like cleft lip and palate, which occur when all or a portion of the oral-nasal cavity does not grow together during fetal development.
  • Their surgical and dental background and their ability to reconstruct facial structures damaged through trauma, enable oral and maxillofacial surgeons to perform facial cosmetic procedures on an outpatient basis in the oral and maxillofacial surgeon's office under local anesthesia, IV sedation or general anesthesia.

Dental Implants

Dental ImplantsDid you know that dental implants are frequently the best treatment option for replacing missing teeth? Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone.

A Solution of Choice for Replacing Missing Teeth

Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.

Dental Implant - Before Dental Implant - AfterBefore and after a dental implant is placed and restored

 

Today there is another option for patients who are missing permanent teeth. Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone. Composed of titanium metal that "fuses" with the jawbone through a process called "osseointegration," dental implants never slip or make embarrassing noises that advertise the fact that you have "false teeth," and never decay like teeth anchoring fixed bridges. Because dental implants fuse with the jawbone, bone loss is generally not a problem.

After more than 20 years of service, the vast majority of dental implants first placed by oral and maxillofacial surgeons in the United States continue to still function at peak performance. More importantly, the recipients of those early dental implants are still satisfied they made the right choice. If properly cared for, dental implants can last a lifetime.

Anatomy of a Dental Implant

Anatomy of a Dental ImplantA dental implant designed to replace a single tooth is composed of three parts: the titanium implant that fuses with the jawbone; the abutment, which fits over the portion of the implant that protrudes from the gum line; and the crown, which is created by a restorative dentist and fitted onto the abutment for a natural appearance.

Many people who are missing a single tooth opt for a fixed bridge; but a bridge may require the cutting down of healthy, adjacent teeth that may or may not need to be restored in the future. Then there is the additional cost of possibly having to replace the bridge once, twice or more over the course of a lifetime. Similarly, a removable partial denture may contribute to the loss of adjacent teeth. Studies show that within five to seven years there is a failure rate of up to 30% in teeth located next to a fixed bridge or removable partial denture.

Dental Implant - Fixed BridgeFixed bridges may require the shaping or cutting down of adjacent healthy teeth.


Dental Implant - Bone SupportBone is maintained by the presence of natural teeth or implants (a). Bone loss occurs with the loss of teeth (b).

 

Further, conventional dentures may contribute to the loss of bone in the area where teeth are missing. As illustration (a) indicates, the presence of natural teeth preserves the jawbone. When a tooth is missing, as in illustration (b), the bone may erode and weaken until it may be necessary for your oral and maxillofacial surgeon to graft bone to the area to strengthen it for placement of a dental implant. When a missing tooth is replaced by a dental implant, the fusion, or osseointegration, of the implant and bone provides stability, just as the natural tooth did.

If you are missing several teeth in the same area of your mouth, you may still enjoy the confidence and lifestyle benefits that come with dental implants. Your oral and maxillofacial surgeon will place two or more dental implants, depending on the number of teeth that are missing. Your replacement teeth will be attached to the implants to allow excellent function and prevent bone loss. The implants will serve as a stable support that tightly locks into your replacement teeth and dentures to prevent slipping and bone loss.

With an overall success rate of about 95% and almost 50 years of clinical research to back them up, dental implants are frequently the best treatment option for replacing missing teeth.

Dental Implants vs. Conventional Dentures

Dental Implants vs. Conventional DenturesImplants can be used to replace one missing tooth so that the replacement looks and feels natural (a). Also, two or more implants can serve as a stable support for the replacement of many teeth (b).

Many patients who have selected dental implants describe a quality of life that is much more comfortable and secure than the lifestyle endured by those with fixed bridges or removable dentures. Dentures often make a person feel and look older than they are, cause embarrassment in social situations when they slip and click, and restrict the everyday pleasure of eating comfortably.

 

When they count the benefits they enjoy as a result of their dental implants, patients say their implants eliminate the day-to-day frustrations and discomfort of ill-fitting dentures. They allow people to enjoy a healthy and varied diet without the restrictions many denture wearers face. With a sense of renewed self-confidence, many people rediscover the excitement of an active lifestyle shared with family and friends and the chance to speak clearly and comfortably with co-workers. For all these reasons, people with dental implants often say they feel better... they look better... they live better.

Dental Implants are a Team Effort

Dental implants combine the best of modern science and technology, including a team approach spanning several disciplines.

A successful implant requires that all parties involved — the patient; the restorative dentist, who makes the crown for the implant; and the oral and maxillofacial surgeon, who surgically places the implant, follow a careful plan of treatment. All members of the implant team stay in close contact with each other to make sure everyone clearly understands what needs to be done to meet the patient's expectations.

The team is organized as soon as the decision for placing a dental implant is reached. Following an evaluation that includes a comprehensive examination, x-rays and a consultation with the patient and members of the implant team, the oral and maxillofacial surgeon surgically places the posts, or implants, in the patient's jaw.

When the implants have stabilized in the jaw, the restorative dentist prepares an impression of the upper and lower jaws. This impression is used to make the model from which the dentures or crowns are created.

The teamwork continues long after the implant and crown have been placed. Follow-up examinations with the oral and maxillofacial surgeon and restorative dentist are critical, and progress is carefully charted. Both the oral and maxillofacial surgeon and the restorative dentist continue to work together to provide the highest level of aftercare.

Are You a Candidate for Dental Implants?

Whether you are a young, middle-aged or older adult; whether you need to replace one tooth, several teeth, or all your teeth, there is a dental implant solution for you. With the exception of growing children, dental implants are the solution of choice for people of all ages, even those with the following health concerns:

Existing Medical Conditions. If you can have routine dental treatment, you can generally have an implant placed. While precautions are advisable for certain conditions, patients with such chronic diseases as high blood pressure and diabetes are usually successful candidates for dental implant treatment.

Gum Disease or Problem Teeth. Almost all implants placed in patients who have lost their teeth to periodontal disease or decay have been successful.

Currently Wearing Partials or Dentures. Implants can replace removable bridges or dentures, or they can be used to stabilize and secure the denture, making it much more comfortable.

Smokers. Although smoking lowers the success rate of implants, it doesn't eliminate the possibility of getting them.

Bone Loss. Bone loss is not uncommon for people who have lost teeth or had periodontal disease. Oral and maxillofacial surgeons are trained and experienced in grafting bone to safely and permanently secure the implant.

Implant tooth replacement in children is usually deferred until their jaw growth is complete. There are, however, some instances when a dental implant may be appropriate, such as when it is part of the child's orthodontic treatment plan. Your family dentist or orthodontist can guide you in this instance.

Corrective Jaw Surgery

Corrective Jaw SurgeryCorrective jaw, or orthognathic, surgery is performed by Oral and Maxillofacial Surgeons to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth, which, in turn, can improve chewing, speaking and breathing. While the patient's appearance may be dramatically enhanced as a result of their surgery, orthognathic surgery is performed to correct functional problems.

Following are some of the conditions that may indicate the need for corrective jaw surgery:

  • difficulty chewing, or biting food
  • difficulty swallowing
  • chronic jaw or jaw joint (TMJ) pain and headache
  • excessive wear of the teeth
  • open bite (space between the upper and lower teeth when the mouth is closed)
  • unbalanced facial appearance from the front, or side
  • facial injury or birth defects
  • receding chin
  • protruding jaw
  • inability to make the lips meet without straining
  • chronic mouth breathing and dry mouth
  • sleep apnea (breathing problems when sleeping, including snoring)

Who Needs Corrective Jaw Surgery?

People who may benefit from corrective jaw surgery include those with an improper bite resulting from misaligned teeth and/or jaws. In some cases, the upper and lower jaws may grow at different rates. Injuries and birth defects may also affect jaw alignment. While orthodontics can usually correct bite, or "occlusion," problems when only the teeth are misaligned, corrective jaw surgery may be necessary to correct misalignment of the jaws.

Evaluating Your Need for Corrective Jaw Surgery

Your dentist, orthodontist and Oral and Maxillofacial Surgeon will work together to determine whether you are a candidate for corrective jaw, or orthognathic, surgery. The Oral and Maxillofacial Surgeon determines which corrective jaw surgical procedure is appropriate and performs the actual surgery. It is important to understand that your treatment, which will probably include orthodontics before and after surgery, may take several years to complete. Your Oral and Maxillofacial Surgeon and orthodontist understand that this is a long-term commitment for you and your family.They will try to realistically estimate the time required for your treatment.

Corrective jaw surgery may reposition all or part of the upper jaw, lower jaw and chin. When you are fully informed about your case and your treatment options, you and your dental team will determine the course of treatment that is best for you.

Correction of Common Dentofacial Deformities

Correcting an Open Bite 1 Correcting an Open Bite 2 Correcting an Open Bite 3 Correcting an Open Bite 4

Correcting an Open Bite: Some of the bone in the upper tooth-bearing portion of the jaw is removed. The upper jaw is then secured in position with plates and screws.

Correcting a Protruding Lower Jaw: 1 Correcting a Protruding Lower Jaw: 2 Correcting a Protruding Lower Jaw: 3 Correcting a Protruding Lower Jaw: 4

Correcting a Protruding Lower Jaw: The bone in the rear portion of the jaw is separated from the front portion and modified so that the tooth-bearing portion of the lower jaw can be moved back for proper alignment.

Correcting a Receding Lower Jaw or "Weak Chin": 1 Correcting a Receding Lower Jaw or "Weak Chin": 2 Correcting a Receding Lower Jaw or "Weak Chin": 3 Correcting a Receding Lower Jaw or "Weak Chin": 4

Correcting a Receding Lower Jaw or "Weak Chin": The bone in the lower portion of the jaw is separated from its base and modified. The tooth-bearing portion of the lower jaw and a portion of the chin are repositioned forward.

What Is Involved in Corrective Jaw Surgery?

Before your surgery, orthodontic braces move the teeth into a new position. Because your teeth are being moved into a position that will fit together after surgery, you may at first think your bite is getting worse rather than better. When your Oral and Maxillofacial Surgeon repositions your jaws during surgery, however, your teeth should fit together properly.

As your pre-surgical orthodontic treatment nears completion, additional or updated records, including x-rays, pictures and models of your teeth, may be taken to help guide your surgery.

Depending on the procedure, corrective jaw surgery may be performed under general anesthesia in a hospital, an ambulatory surgical center or in the oral and maxillofacial surgery office. Surgery may take from one to several hours to complete.

Your Oral and Maxillofacial Surgeon will reposition the jawbones in accordance with your specific needs. In some cases, bone may be added, taken away or reshaped. Surgical plates, screws, wires and rubber bands may be used to hold your jaws in their new positions. Incisions are usually made inside the mouth to reduce visible scarring; however, some cases do require small incisions outside of the mouth. When this is necessary, care is taken to minimize their appearance.

After surgery, your surgeon will provide instructions for a modified diet, which may include solids and liquids, as well as a schedule for transitioning to a normal diet. You may also be asked to refrain from using tobacco products and avoid strenuous physical activity.

Pain following corrective jaw surgery is easily controlled with medication and patients are generally able to return to work or school from one to three weeks after surgery, depending on how they are feeling. While the initial healing phase is about six weeks, complete healing of the jaws takes between nine and 12 months.

Enjoy the Benefits

Corrective jaw surgery moves your teeth and jaws into positions that are more balanced, functional and healthy. Although the goal of this surgery is to improve your bite and function, some patients also experience enhancements to their appearance and speech. The results of corrective jaw surgery can have a dramatic and positive effect on many aspects of your life. So make the most of the new you!

Anesthesia

Dental AnxietyA child wonders what the first day of school will be like. Someone is about to start a new job. A young couple is about to be married.

Each of these situations is a classic anxiety producer. What they have in common is that each involves the unknown. And that's what anxiety is: the fear of a specific upcoming event that, in all likelihood, you've never before experienced.

The Less You Worry, the Easier it Will Be

An upcoming visit to an Oral and Maxillofacial Surgeon is another potential anxiety producer. In this case, the patient is typically most concerned about possible pain — whether the procedure is going to hurt.

The good news is that whether your procedure requires local or intravenous anesthesia, today's technology makes it possible to perform complex surgery in the oral and maxillofacial surgery office with little or no discomfort for the patient. Knowing this should start to reduce your level of anxiety.

Extensive Training and Experience in the Control of Pain and Anxiety

The ability to provide patients with safe, effective outpatient anesthesia has distinguished the specialty of oral and maxillofacial surgery since its earliest days. As the surgical specialists of the dental profession, Oral and Maxillofacial Surgeons are trained in all aspects of anesthesia administration. Following dental school, Oral and Maxillofacial Surgeons complete at least four years of training in a hospital-based surgical residency program alongside medical residents in general surgery, anesthesia and other specialties. During this time, OMS residents must complete a rotation on the medical anesthesiology service, during which they become competent in evaluating patients for anesthesia, delivering the anesthetic and monitoring post-anesthetic patients.

As a result of this extensive training, Oral and Maxillofacial Surgeons are well-prepared to identify, diagnose and assess the source of pain and anxiety within the scope of their discipline, and to appropriately administer local anesthesia, all forms of sedation and general anesthesia. Further, they are experienced in airway management, endotracheal intubation, establishing and maintaining intravenous lines, and managing complications and emergencies that may arise during the administration of anesthesia.

Putting Your Mind at Ease

The best way to reduce anxiety is to make certain you know what to expect during and after surgery. As with most anxiety-producing situations, the more you know, the less you have to be anxious about. Prior to surgery, your Oral and Maxillofacial Surgeon will review with you the type of anesthetic to be used, as well as the way you're likely to feel during and after the operation.This is the time to discuss any concerns you may have about any facet of the operation.

During surgery, one or more of the following may be used to control your pain and anxiety: local anesthesia, nitrous oxide-oxygen, intravenous sedation and general anesthesia. Commonly, patients describe their feelings during surgery as comfortable and surprisingly pleasant.

After surgery, you may be prescribed a medication to make you as comfortable as possible when you get home.