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Socket Preservation
JAWBONE AND EXTRACTION SITE PRESERVATION
When you need to have a tooth or teeth extracted—whether it be due to decay, abscess, gum disease or injury—it is usually in your best interest to do so in a manner which preserves as much of your underlying jawbone as possible. From the time the teeth are removed, significant degeneration of the surrounding bone begins to take place. You have many options to prevent this, and it is important that you consider them BEFORE any teeth are removed. Some of these procedures are best performed at the time the tooth is removed. Drs. Snyder, Dugan and Sweeney are oral and maxillofacial surgeons who specializes in tooth removal, jawbone preservation and dental implant placement.
WHAT HAPPENS WHEN A TOOTH IS REMOVED?
There is a special type of bone surrounding your teeth. This bone is called alveolar “ridge” bone, and exists solely to support your teeth. As soon as the tooth is removed, this bone begins to degenerate and “melt away.” This occurs in two dimensions. The first is loss of horizontal width caused by the collapse of the bone surrounding the socket. This makes the remaining ridge narrower than when the tooth was present. The second is a loss of vertical height. This makes the remaining bone less “tall.” This process is faster in areas where you wear a partial or complete denture.

WHY IS IT IMPORTANT TO PRESERVE THE BONE?
You will have several choices of how you can replace the newly missing teeth. All of the options rely on bone support and bone contour for the best function and esthetics. Here is a list of the possible options:
You may choose to replace your missing teeth with dental implants. These are root-shaped supports that hold your replacement teeth. The more bone support you have, the stronger the implant replacements will be. In some cases, the bone can degenerate to a point where implants can no longer be placed without having more complex bone grafting procedures to create the necessary support. Obviously, preventing bone loss is much easier than recreating the bone later.
You may choose to replace the missing teeth with a “fixed bridge.” This is a restoration that is supported by the teeth adjacent to the missing tooth space. The replacement tooth (or pontic) spans across the space. If the bone is deficient, there will be an unsightly space under the pontic that will trap food and affect your speech.
Other replacement alternatives include removable partial or full dentures. These often perform better with more supporting bone.
HOW CAN THE BONE BE PRESERVED?
There are two important phases in retaining your alveolar ridge during and after the tooth extraction. Not all extractions are the same — Drs. Snyder, Dugan and Sweeney will use the most careful techniques to extract the teeth while preserving as much bone as possible. Second—and key to preventing the collapse of the socket—is the addition of bone replacement material to the extraction socket.
There are several types of bone grafting materials and techniques — Drs. Snyder, Dugan and Sweeney will discuss the most appropriate one with you. After the tooth is extracted, the socket will be packed with a bone-like material and covered with a small absorbable plug or suture. Early on, the grafting material will support the tissue surrounding the socket, and in time will be replaced by new alveolar bone. This bone will be an excellent support should you choose later to have dental implant-supported replacement teeth.
Although the bone created by socket grafting supports and preserves the socket, it will not do so indefinitely. Placing dental implants four to twelve months after the extraction and socket grafting will provide the best long-lasting support for preserving your jawbone and allow you to function as before. Otherwise the graft may “melt away” or resorb over time.
IMMEDIATE DENTAL IMPLANT PLACEMENT
In some selected cases it is possible to actually extract the tooth and place the dental implant at the same time. We call that immediate implantation. If you are interested in replacing your tooth with an implant and want to be considered for immediate implantation, please call Drs. Snyder, Dugan and Sweeney's office for a consultation prior to your extraction.

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Socket Preservation Procedure
Preserving Your Jaw Bone after Extraction
Removal of teeth is sometimes necessary because of pain, infection, bone loss or fracture of the tooth. The bone that holds the tooth in place (the socket) is often damaged by disease and/or infection resulting in deformity of the jaw after the tooth is extracted. In addition, when teeth are extracted, the surrounding bone and gums can shrink and recede very quickly after the extraction resulting in unsightly defects and collapse of the lips, and cheeks.
These jaw defects can create major problems in performing restorative dentistry whether your treatment involves dental implants, bridges or dentures. Jaw deformities from tooth removal can be prevented and repaired by a procedure called socket preservation. Socket preservation can greatly improve your smiles appearance and increase your chances for successful dental implants for years to come.
Several techniques can be used to preserve the bone and minimize bone loss after an extraction. In one common method, the tooth is removed and the socket is filled with bone or bone substitute. It is then covered with gum, artificial membrane, or tissue stimulating proteins to encourage your bodys natural ability to repair the socket. With this method, the socket heals eliminating shrinkage and collapse of surrounding gum and facial tissues. The newly formed bone in the socket also provides a foundation for an implant to replace the tooth. If your dentist has recommended tooth removal, be sure to ask if socket preservation is necessary. This is particularly important if you are planning on replacing the front teeth.

Socket Preservation


What is socket preservation?

Socket preservation is a procedure often recommended after tooth extraction in order to prevent bone loss. When a tooth is removed, the bone at that site begins to shrink and deteriorate almost immediately. The jawbone may also be deformed or compromised because of the infection or disease that necessitated the tooth extraction. If the jawbone resorbs or is deformed, it may lead to the unsightly collapse of the lips and cheeks. Jawbone deterioration also causes problems when performing restorative dentistry, whether your treatment involves dental implants, bridges, or dentures.

In socket preservation, our oral surgeon is able to preserve the jawbone and minimize bone loss after tooth extraction. One common type of socket preservation in Tulsa, Oklahoma, involves filling the socket with bone or bone substitute after the tooth is removed. The extraction site is then covered with gum tissue, an artificial membrane, or tissue-stimulating proteins to encourage your body’s natural ability to repair the socket. As the socket heals, it helps to minimize or eliminate shrinkage and collapse of the surrounding gum and facial tissues. The new bone in the socket also provides a stable foundation for dental implants to replace the missing tooth. If you have a tooth extracted, be certain to ask your dentist whether socket preservation is needed, especially if you are planning on replacing front teeth.




Frenectomy Oral Surgery
A frenectomy is an oral surgical procedure performed to correct the unhealthy shape, size or position of the frenum muscle tissue which connects the tongue, lips and cheeks to the jaw bone. When the frenum is abnormally formed and positioned, such as along the gums or tongue, it may impact teeth alignment and restrict tongue and lip movement for communication.
Defining the Frenum
Frenum is the medical term used to describe the soft muscle connective tissue found in the mouth, digestive tract, external genitalia and brain.
Frenectomy Oral Surgery Procedures in Dentistry
Frenectomy surgery serves varied purposes in dentistry to restore frenum condition for healthy oral function. Typical dentistry treatments requiring a frenectomy include:
  • Dentures
  • Tongue Clipping
  • Orthodontics
Dentures
Frenectomy surgery secures dentures for better retention if the frenum is the cause of loose fitting dentures. A prominent frenum dislodges dentures with lip movement. Frenectomy surgery reshapes and repositions the frenum to prevent denture pulling and shifting.
Tongue Clipping
The frenum tissue or lingual frenum is found under the tongue, and if attached too close to the tongue tip, may impede speech and impact healthy dental development. Sometimes referred to as being 'tongue tied', the condition may be identified early in children. A Lingual Frenectomy or 'tongue clipping' removes this frenum tissue from below the tongue for unrestricted tongue movement, proper dental development and normal speech.
Orthodontics
An abnormal oral frenum may be attached and extend above the gums, causing the gums to recede and irregular teeth spacing to develop. Commonly seen between the two top front teeth, a prominent frenum or labial frenum may be removed through labial frenectomy before orthodontic treatment such as Invisalign is used to return teeth spacing and alignment to normal.
Frenectomy Surgical Procedures
Prior to Frenectomy surgery the oral surgeon will explains the procedures involved, including risks, benefits and price. Patients may have their questions answered for understanding of frenectomy surgery before consenting to treatment.
Preparatory procedures include provision of local anaesthetic for pain-free surgery and Intravenous (IV) Sedation treatment where necessary, such as for dental phobia to provide the patient with greater relaxation during surgery.
Frenectomy procedures used to remove or alter the frenum may be with soft tissue laser or a dental scalpel. Laser frenectomy eliminates the need for stitches, reduces bleeding and allows for faster recovery. Frenectomy surgery duration is approximately half an hour and patients soon recover within a fortnight.
Post-Frenectomy Surgery Care
Patients usually recover from frenectomy surgery within an approximate period of two weeks. This depends on the patient's health condition and healing rate.
The dentist may prescribe non-steroidal anti-inflammatory (NSAID) medication or advise patients to use over-the-counter NSAIDs, such as Ibuprofen. Rinsing the mouth with an antibacterial mouthwash is recommended to clean the treatment site gently and prevent infection. Salt water may be used as an alternative mouth rinse.
Careful cleaning around the frenum treatment site is advised. However, patients are encouraged to continue healthy oral hygiene such as teeth brushing and flossing.
If frenectomy surgery procedures are performed by dental scalpel, sutures should self-dissolve within a two-week period or may need to be removed by the dentist.
Risks and Benefits of Frenectomy Surgery
All surgical procedures have inherent risks such as bleeding, bruising, infection, nerve damage, swelling, scarring, pain and discomfort. Frenectomy surgery may include these risks. Oral Surgeons are qualified and experienced to reduce such risks.
In some cases, the frenum tissue may redevelop requiring repeated surgery. Repeated labial frenectomy is less common than repeated lingual frenectomy. Laser frenectomy requires no sutures and patients usually experience less bleeding and discomfort with quicker recovery time.
Tingling or numb sensations may be experienced at and around the treatment site should accidental nerve damage occur. Patients should immediately inform their oral surgeon or dentist.
While risks are posed by frenectomy surgery the benefits patients receive vastly enhance their quality of life. Having stable dentures reduces oral discomfort, allows for better chewing ability and facilitates normal communication.
'Tongue tied' conditions can affect an individual's communication, how they express themselves and others' perceptions. Lingual frenectomy enables individuals to experience better communication and life opportunities.
Frenectomy surgery corrects orthodontic conditions for improved bite function, nutritional choices, communication and facial expression. Patients experience enhanced oral and overall health from frenectomy surgery for better quality of life.

Oral Surgery Group provides several options for sedation and anesthesia.  Your doctor will discuss which of the following is best for you:

LOCAL ANESTHESIA- consisting of injections in the mouth to numb or anesthetize the area where treatment is to be rendered.

LOCAL ANESTHESIA + NITROUS OXIDE “LAUGHING GAS
a combination that allays apprehension and reduces pain.

INTRAVENOUS ANESTHESIA – injection of drugs that establish either a state of conscious or deep sedation in order to accomplish the intended surgery.  Local anesthesia is frequently used in conjunction with this type of anesthesia in order to reduce the requirement of the injected drug.


ANESTHESIA for Oral Surgery
WHAT YOU SHOULD KNOW ABOUT ANESTHESIA FOR ORAL SURGERY
Our Oral and Maxillofacial Surgery practice offers comprehensive surgical services including extraction, removal of impacted wisdom teeth and dental implants, with or without intravenous anesthetic techniques.

WHO CAN BENEFIT FROM
ANESTHESIA SERVICES?
Nearly half of the people with dental insurance still avoid dental care because of their fears and anxiety.  Modern safe anesthesia techniques allow the fearful patient to have dental procedures without the anxiety associated with dentistry. 
  • LOW PAIN THRESHOLD
Many people perceive pain differently than others, or at a much smaller stimulus.  With general anesthesia and sedation techniques, these patients will have the perception of pain altered and will be pain free.  Recollection of the procedure is usually absent.
  • ACTIVE GAG REFLEXES
Some patients will gag before the smallest X-ray film is even place in their mouth, or before they have a simple impression taken.  Using anesthesia services or exclusively extra-oral X-rays (dental x-rays taken without anything in the mouth) even for the simplest procedures can eliminate the problems caused by gagging.
  • SPECIAL NEEDS
For physically and mentally challenged patients, and individuals emotionally uncomfortable in the traditional office setting, anesthesia service can provide a way to accomplish oral surgery as a pleasant experience

WILL I KNOW WHAT IS GOING ON?
The patient may sometimes have a vague awareness that the dental treatment is being performed, but due to the medications, no fear or anxiety is present.  Memory and recollection of the procedure is usually absent.

HOW IS THE ANESTHESIA MONITORED?
Patients are monitored using the most modern equipment, the same found in hospital operating rooms and ICUs. Our anesthesia team includes medical anesthesiologists and certified registered nurses.  All aspects of vital signs including blood pressure, heart rate, ECG, pulse oximetry, end-tidal CO2 breathing monitoring, and temperature are continuously monitored.  Emergency drugs and medical equipment are immediately available if they should become necessary.   Due to new anesthetics available, safety is enhanced and recovery time is reduced. Each anesthesia or sedation is tailored to you specific needs, always keeping your safety in mind.

TYPES OF ANESTHESIA AVAILABLE
Almost all oral surgery can be performed painlessly with local anesthesia (“novacaine”) only.  Our technique includes using a topical anesthetic (a gel which is painted on the area) which allows the injection to be less uncomfortable.  For those who find the prolonged numb sensation uncomfortable, a different anesthetic can be used which will wear off more quickly.
Sedation (laughing gas or nitrous oxide) can be used to relieve the anxiety and nervousness of any procedure without the necessity of intravenous medications.  The desired effect of the gas can be regulated to relieve the nervousness only, alleviate the “pinch” of the injection, or result in sleepiness and amnesia.  Local anesthetics are always used as well.
Intravenous sedation is a technique of using medications to provide relief of all anxiety and produce a state of amnesia so there will not be recollection of the procedure.  Supplemental oxygen as well as all monitoring devices are always utilized.
General anesthesia is an intravenous technique removing any sense of stimulation from anesthetic injections or surgical procedure.  The same level of monitoring as in hospitals and ICU’s is utilized.  Due to new anesthetics safety is enhanced and recovery time is reduced.

Each anesthesia or sedation is tailored to your specific needs, always keeping your safety in mind. 

Discussing your anesthesia alternatives with Dr. Kimelman will result in the best technique to meet your desires and needs while minimizing the financial costs.

             BENEFITS FOR PATIENTS
·      You will no longer fear treatment
·      You will no longer feel any needles
·      You will sleep in comfort and safety
·      You will become pain free
·      We eliminate stress of dental visits
·      No lost work or vacation time
·      Less medication
·      We will assist in insurance reimbursement

The apprehensive patient is sedated and
relaxed or asleep to allow the necessary procedures to be performed.


Types of anesthesia offered at Florida Oral Surgery
Please review the different types of anesthesia offered at Florida Oral Surgery, and kindly let us know which one you would prefer.
Local Anesthesia
With local anesthesia you will remain conscious throughout the procedure, however the area of surgery will be numb.

Nitrous Oxide-Oxygen
With the nitrous oxide-oxygen, also known as "laughing gas", you will remain conscious throughout the procedure, and the N2O will help to keep you feeling relaxed and comfortable. You may feel fuzzy for a short time right after the procedure, however it will help to make your overall experience a positive one.

Intravenous Sedation
Intravenous sedation will put you in a safe, relaxed and comfortable state for your surgery. You will be in a controlled state of unconsciousness, so it will reduce your fear and anxiety tremendously.

Orthognathic Surgery

Orthognathic surgery is a surgical correction of the skeletal anomalies or malformations involving the mandible (lower jaw) or the maxilla (upper jaw). These malformations may be present at birth or they become evident as the patient grows and develops. These jaw malformations will manifest themselves by your teeth not properly occluding against each other.

Surgical Orthodontic treatment is comprised of two phases:

1- Your orthodontist in consultation with your surgeon will apply braces and straighten your teeth. During this phase your occlusion may actually worsen as your teeth are being positioned to perfectly fit against the opposite dentition following surgery.

2- Once your teeth have straightened then corrective jaw surgery repositions misaligned jaws and assures correct occlusion of teeth. This procedure not only improves facial appearance, but also ensures that teeth meet correctly and function properly.

Who Needs Orthognathic Surgery?

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 function, speech, long-term oral health and appearance. Injury to the jaw and birth defects can also affect jaw alignment. Orthodontics alone can correct bite problems when only the teeth are involved. However, teeth can only be moved a certain amount. Orthognathic surgery may be required for correction of larger discrepancies. If you are a candidate for Corrective Jaw Surgery, our surgeons will work closely with your physician, dentist and orthodontist during your treatment. The actual surgery will move your teeth and jaws into a new position that results in a more attractive, functional and healthy dental-facial relationship.

Difficulty in the following areas should be evaluated:

  • Difficulty in chewing, biting or swallowing
  • Speech problems
  • Chronic jaw or TMJ pain
  • Open bite
  • Protruding jaw
  • Breathing problems

Any of these symptoms can exist at birth, be acquired after birth as a result of hereditary or environmental influences or as a result of trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination with radiographs. During the pre-treatment consultation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team will make the decision to proceed with treatment together.


Facial Trauma

An oral and maxillofacial specialist is thoroughly qualified to repair facial injuries. These professionals are well versed in emergency care, acute treatment, and long-term reconstruction and rehabilitation – not just for physical reasons, but for emotional ones as well. Injuries to the face, by their very nature, impart a high degree of emotional as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long-term function and appearance.

Our surgeons meet and exceed these modern standards. They are trained, skilled, and uniquely qualified to manage and treat facial trauma. They are on staff at local hospitals and deliver emergency room coverage for facial injuries, which include the following conditions:

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

The Nature of Maxillofacial Trauma

There are a number of possible causes of facial trauma, such as motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. Types of facial injuries can range from injuries to teeth to extremely severe injuries to the skin and bones of the face. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves, or the salivary glands).

Soft Tissue Injuries of the Maxillofacial Region

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 that 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 (or outflow channels). Our surgeons are well-trained oral and maxillofacial surgeons and are proficient at diagnosing and treating all types of facial lacerations.

Bone Injuries of the Maxillofacial Region

Fractures to the bones in the face are treated in a similar manner to 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, and 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 of treatment can often allow for healing and eliminates the necessity of having the jaws wired together. 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 many patients, allowing them to return to normal function more quickly.

The treatment of facial fractures should be accomplished in a thorough and predictable manner. More importantly, the patient’s facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is hidden.

Injuries to the Teeth & Surrounding Dental Structures

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone, or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon, such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists, who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.

The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long-term reconstruction, and rehabilitation of the patient.