Patient Procedures performed at Pearlmax Oral Surgery

Wisdom Teeth

Wisdom teeth or third molars appear as the last tooth in the mouth and begin to erupt around the age of 16 years. Depending on the reference source, up to 90% of the population does not have enough room for wisdom teeth to erupt into a position which is accessible for good hygiene.

A commonly asked question is, "Why do we have wisdom teeth if there is no room in the jaws for them?". The answer has to do with diet. According to the British Journal of Oral and Maxillofacial surgery, in a article titled, Management of Asymptomatic Impacted Wisdom Teeth, Vol. 34 October 1996, the author notes that in Neolithic man the average, highly abrasive diet caused attrition of the teeth resulting in a reduction in the size of the molars from front to back. This decrease in size from the abrasive nature of the food ingested allowed for the forward migration of the teeth and adequate space for the eruption of the wisdom teeth. With the arrival of processed foods and a reduction in the amount of chewing necessary to reduce the food for swallowing, less wear occurs. This coupled with a decrease in the loss of teeth as a result of a decrease in cavities, requires modern generations to address impacted and partially impacted wisdom teeth.

When the wisdom teeth cannot be cleaned, infection may result. They have the potential for infection and the potential for this infection to spread to other teeth that usually motivates the patient to have the wisdom teeth removed. Other common reasons for the removal of wisdom teeth may be the potential for them to cause cysts, tumors, or cancer or the potential for them to cause crowding and shifting of the other teeth in the mouth are highly suspect. Although many believe that wisdom teeth cause crowding, this has never been definitively proven in any well controlled scientific study. Additionally, the possibility for them to cause cysts or tumors is very, very low. Although removing a wisdom tooth can weaken the jaw for a short period of time post-operatively, leaving a wisdom tooth in does not cause the jaw in the area to be inherently weak. Cancer occurring in wisdom teeth is a rare phenomenon.

Wisdom teeth are removed mainly to eliminate the potential for infection and damage to adjacent teeth. The jaws of most individuals are generally not large enough to accommodate the wisdom teeth and they remain either under the gum tissue where they have a three to five percent chance of becoming cystic or they become partially exposed where they will have much greater potential for becoming infected. Infection causes bone loss, damage to adjacent teeth and PAIN. When the dentist determines that no room exists for the wisdom teeth to erupt into a normal position, the decision then becomes, do you wait for the infection to occur or do you remove the tooth before infection and pain begins. Studies have shown that infection commonly occurs around malposed wisdom teeth. Study after study confirms that complications from the extraction of wisdom teeth increases dramatically as the patient enters their 30's. Once symptoms of pocketing, swelling, food impaction or pain begin, removal is the most prudent course since the symptoms will not subside until the teeth are removed. Should the patient have only symptomatic wisdom teeth removed and leave other asymptomatic wisdom teeth in the mouth until later? This depends on the relative position of the other wisdom teeth and whether or not the patient wants to be operated on more than once. Most dentists agree that one surgery is best and that multiple trips to the oral surgeon for the removal of wisdom teeth is not in the best interest of the patient and only raises the potential for complications from multiple anesthetics

Oral Examination

With an oral examination and x-rays of the mouth, Dr. Trujillo can evaluate the position of the wisdom teeth and predict if there may be present or future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid- teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon. Removal of the wisdom teeth could be performed while the patient is under anesthesia to maximize patient comfort. Dr. Trujillo has the training, licenses and experience to provide various types of anesthesia to allow patients to select the best alternative. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and staff trained and experienced in anesthesia techniques. Following surgery, you may experience some swelling and mild discomfort, which are part of the normal healing process. Cold compresses may help decrease the swelling, and prescribed medications can help manage the discomfort. You may be instructed to modify your diet following surgery and later progress to more normal foods. If you have any questions, please do not hesitate to contact us.

Dental Implants

One of the best ways to replace missing teeth is placing dental implants. Rather than resting on the gum line like removable dentures, or putting crowns on adjacent teeth and using them as anchors like fixed bridges, dental implants are long-term replacements placed by an oral and maxillofacial surgeon. An Adequate Choice for Replacing Missing Teeth

Years ago, patients would have had no alternative but to employ a fixed bridge or removable denture to restore their ability to eat, speak clearly and smile. Fixed bridges and removable dentures, however, are not the perfect solution and often bring with them other problems such as recurrent decay, fractures of the bridge structure or supporting tooth. Removable dentures may slip or cause embarrassing clicking sounds while eating or speaking. Fixed bridges often affect adjacent healthy teeth, and removable dentures often leads to bone loss in the area where the tooth or teeth are missing. Recurrent decay, periodontal (gum) disease and other factors often contribute to failure of fixed bridgework to early failure. For these reasons, fixed bridges and removable dentures usually need to be replaced every few years. Dental implants are another option for patients who are missing permanent teeth. Dental implants are long-term replacements. Composed of titanium metal that "fuses" with the jawbone, this process called "osseointegration," dental implants can 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.

Approximately 25 years have gone by since oral and maxillofacial surgeons in the United States starting placing dental implants, the vast majority of the first dental implants placed continue to still function well for patients. More importantly, the recipients of those early dental implants are still satisfied they made the optimal choice. When properly cared for, a dental implant can last a lifetime.

Anatomy of a Dental Implant

A dental implant 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 the actual tooth part created by a prosthodontist or 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 will 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 time. Also, a removable partial denture may contribute to the loss of adjacent teeth. Studies have shown that within five to seven years there is a failure rate of up to 30% in the teeth located next to a fixed bridge or removable partial denture.

Conventional dentures may lead to the loss of bone in the area where teeth are missing. When a tooth is missing, the bone may erode and weaken until it may be necessary for the oral and maxillofacial surgeon to do bone grafting in that area to strengthen it for placement of a dental implant. Dental implants, fuse to the bone (Process called osseointegration), and provide stability, just as a natural tooth does. If you are missing several teeth in the same area, you still can enjoy the confidence and benefits that come with dental implants. By placing two or more dental implants, depending on the number of teeth that are missing, the replacement teeth will be attached to the implants which allow excellent function and prevent bone loss. The implants will serve as a stable support that tightly locks into your replacement teeth or dentures to prevent slipping and bone loss.

Dental implants have 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

Patients who have selected dental implants are much more comfortable than 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.

Dental Implants are a Team Effort

A successful implant requires that all parties involved — the patient; the restorative dentist, who makes the crown (tooth) for the implant; and the oral and maxillofacial surgeon, who surgically places the implant.

Is necessary to have an evaluation including comprehensive examination, x-rays and a consultation with the patient and members of the implant team.

Are You a Candidate for Dental Implants?

Any adult, in need to replace one tooth, several teeth, or all your teeth, could be a candidate for implants.

Existing Medical Conditions: If you can have routine dental treatment, you generally can have an implant placed.

Gum Disease: Most implants placed in patients who have lost their teeth due to periodontal (gum) 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 functional and comfortable.

Smokers: Smoking may lower the success rate of implants, but still doesn't eliminate the possibility of getting them.

Tooth replacement with an implant in children is usually deferred until their jaw growth is complete (around 18 years of age). There may be some instances when a dental implant is appropriate, such as when it is part of the child's orthodontic treatment plan.

Impacted Teeth

Exposure and Bracketing of an Impacted tooth

An impacted tooth basically means that it is “stuck” and will not erupt into function. The maxillary canine or the upper eye tooth is a common tooth to become impacted. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The cuspid teeth are very strong and have the longest roots of all your dentition. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.

Early recognition of impacted eye teeth: key to successful treatment: The older the patient, the more likely an impacted eye tooth will not erupt by nature’s forces alone even if the space is available for the tooth to fit in the dental arch. It is important to determine whether all the adult teeth are present or are some adult teeth missing or if there are extra teeth present or possible growths that are blocking the eruption of the eye tooth. Extreme crowding or too little space available may cause an eruption problem with the eye tooth in the future. An exam is usually performed by a general dentist who will refer you to a dental specialist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also require an oral surgeon for extraction of teeth that are blocking the eruption of the important eye teeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking eruption of any of the adult teeth. If the eruption path is cleared and the space is opened up by age 11 or 12, there is a good chance the impacted eye tooth will erupt with nature’s help alone. If the eye tooth is allowed to develop too much (age 13-14), the impacted eye tooth may not erupt by itself even with the space cleared for its eruption. If the patient is too old (over 40), there is a much higher chance the tooth will be fused in position. In these cases the tooth will not budge despite all the efforts of the orthodontist and oral surgeon to erupt it into place. Unfortunately, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (crown on a dental implant or a fixed bridge).

What happens if the eye tooth will not erupt when proper space is available?

In some cases where the eye teeth have not erupted spontaneously, an orthodontist and oral surgeon can work together to get these eye teeth to erupt. Each case will be evaluated on a case by case basis. Treatment will usually involve a combined effort between the orthodontist and oral surgeon. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby eye tooth has not fallen out already, it is usually left in place until the space for the adult eye tooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted eye tooth exposed and bracketed.

In a simple surgical procedure performed by the oral surgeon, the impacted tooth will be exposed. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, an orthodontic bracket will be bonded to the exposed tooth. The bracket will have a miniature gold chain attached to it. The oral surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed impacted tooth completely uncovered. Within two weeks of surgery, the patient will return to the orthodontist to begin light traction forces on the impacted tooth. This will begin the process of moving the tooth/teeth into their proper place in the dental arch. This process can take up to a full year to complete. The goal is to erupt the impacted tooth and not to extract it. Once the tooth is moved into the arch in its final position, the gum around it will be evaluated to make sure it is strong and healthy. In some circumstances, especially those where the tooth had to be moved a long distance, there may be need of some minor gum surgery. Your dentist or orthodontist will explain this situation to you if it applies to your specific situation.

Recent studies have revealed that with early identification of impacted eye teeth (or any other impacted tooth other than wisdom teeth), treatment should be initiated at a younger age.

What to expect from surgery to expose and bracket an impacted tooth:

The surgery to expose and bracket an impacted tooth is a very straight forward surgical procedure. You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within 2-3 days after surgery there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site; it can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is not a common finding at all after these cases. A soft diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items like crackers and chips as they will irritate the surgical site. Your should have a follow up visit 7-10 days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process. Should you have any questions or concerns after surgery, simply call Pearlmax (619)-29 PEARL.

Orthognatic Jaw Surgery

Orthognathic surgery is sometimes needed when jaws don’t meet correctly and/or teeth don’t fit within the jaws. Teeth need to be straightened with orthodontics, then corrective jaw surgery repositions the misaligned jaws. This improves facial appearance, and ensures that the teeth meet correctly and function properly.

Who Needs Jaw Surgery?

People who can benefit from jaw surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth happens gradually up until the ages of 18 to 21 years of age, in some instances, the upper and lower jaws may grow at different rates. As a result, problems affecting chewing function, speech, long-term oral health, and appearance can happen. Injury to the jaw and birth defects can also affect jaw alignment. Sometimes orthodontics alone can correct bite problems if only the teeth are involved, but orthognathic surgery may be required in addition to the orthodontic treatment, if the jaws also need correct positioning. Areas that need attention:

• Speech problems
• Difficulty in chewing, biting or swallowing
• Chronic jaw pain
• Protruding jaw
• Open bite
• Breathing problems
• Obstructive sleep apnea
• Receded Jaw

These can exist at birth or may be acquired after birth as a result of hereditary or environmental influences or, trauma to the face. Before any treatment, a consultation with x-rays is necessary. During the consultation process, please ask any questions that you may have regarding any recommended treatment. When you are completely informed about the aspects of your care, you and your dental team will make the decision to proceed with treatment together.

Using modern computer techniques and three-dimensional models the surgery can be planned and the final results can be predicted.. Using digital X-rays and 3D imaging, we can show you how your bite will be improved and even give you an idea of how you'll look after surgery. This helps you understand the surgical process and the extent of the treatment prescribed, and to see the benefits of jaw surgery.

We will work closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional and healthy dental-facial relationship.

Oral Pathologies

Inside the mouth the special lining of skin (mucosa) is pink and smooth in color. Any alteration in this appearance could be a warning sign for a pathological process (involving disease). The most serious of these is oral cancer.

The following signs can be present at the beginning of a pathologic process or cancerous growth:

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

Some of these changes can be detected anywhere inside our mouth and tissue around the teeth, tongue, face, and/or neck. Pain does not always occur with disease and, curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.

Major and Minor Bone Grafting

Bone Grafting/Sinus Lift

Over time, the alveolar bone (portion of the jawbones that contain the teeth), can shrink when there are missing teeth (A process called reabsorbtion). This often leaves a condition in which there is low quality and quantity of bone needed for placement of dental implants. Making many patients bad candidates for placement of implants.

Now, we have the possibility to grow bone where needed, giving us the opportunity to place implants, it also gives us a chance to restore the functionality and esthetic appearance of the person. There are different types bone grafting procedures:

Sinus Lift Procedure

In this procedure the maxillary sinus membrane is elevated and the bone graft is placed onto the sinus floor, allowing implants to be placed in the back part of the upper jaw.

Ridge Augmentation

If teeth have been missing for an extended period of time, the respective alveolar ridge (bone which supports teeth) has been reabsorbed. In such cases a bone graft is needed to restore the height and the width on the alveolar ridge before an implant can be placed.

Traumatic injuries can lead to the loss of teeth as well as their supporting bone. This could possibly compromise the placement of implants in the injured site. The lost bone can be replaced with a bone graft, facilitating the esthetic and functional restoration of the injured site.

Nerve Repositioning

The inferior aveolar nerve (the nerve to the lower lip and chin), may need to be moved 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 or harvesting bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar (wisdom teeth) 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 (Largest bone in the lower part of the leg).

These surgeries are performed in our out-patient surgical suite under I.V. sedation or general anesthesia. The hip bone harvesting is performed in the operating room setting.

I.V. Sedation

For maximum patient comfort, we offer intravenous (I.V.) sedation for various procedures. I.V. is ideal if the patient is nervous and prefers a completely comfortable, stress-free surgery. We induce the patient into anesthesia at the beginning of the process and recovery happens shortly after the procedure has been completed.

I.V. sedation will require the patient to have nothing to eat or drink 8 hours prior to the operation, and someone must escort the person in and out of the office on the day of surgery, making sure the patient arrives home safely.

3D Cone Beam Radiography

KODAK 9000 3D Extraoral Imaging System

In an ongoing effort to provide you with the best care possible, we have invested in the KODAK 9000 3D Extraoral Imaging System to our practice, revolutionizing patient treatment. 

The KODAK 9000 3D System is an innovative two-in-one solution providing access to powerful, focused field 3D images.  The capabilities of 3D imaging offer a wide range of diagnostic possibilities such as implant placement, surgical planning, extractions, examination of oral pathologies, and third molar evaluations. 

Most importantly, the KODAK 9000 3D System was designed to acquire 3D images on a specific dental region of interest, so technicians are able to target the exact area for the 3D exposure.  This significantly reduces the amount of radiation, delivering 10-30 times less exposure than other dental radiography systems. 

Benefits include:

• High-resolution images: the doctor can view your teeth more clearly.
• Less radiation: more safety.
• Improved patient care: the doctor can perform a wider range of diagnoses, helping reduce multiple visits, saving you time and money.
• Comfortable positioning.

We are here to provide you with superb oral surgery care, every time.

If you have any questions regarding our technologies, feel free to send a message to our office, we'll be glad to answer any questions.

You can also see an image of our KODAK 9000 3D System in our Office Tour section.

Botox

Botox is the trade name for botulinum type A, a purified protein administered through a non-surgical procedure. When properly administered by a trained health professional, the very low doses of botox that are injected will cause stubborn frown lines to nearly disappear.

Botox is injected into the small muscles of the face and blocks the chemical pathways that cause those muscles to work, essentially paralyzing them, resulting in muscle relaxation. Lines on the forehead, frown lines, and crow’s feet can all be treated safely and effectively.

Results typically take 2-7 days to take effect and will last 3-4 months. For more information about Botox you can use our contact form to send us a message and we’ll be glad to help you and explain anything you want to know.

For more information on botox, you can visit: www.botoxcosmetic.com

Cosmetic Procedures

Dermal fillers

Dermal fillers are becoming increasingly popular as a means to help reverse the changes associated with aging. Because the goal is to return the dermis to its original youthful state, dermal fillers can give a more natural appearance than surgical face lifts. Dermal fillers are being used to reduce or eliminate wrinkles, raise scar depressions, enhance lips, and replace soft-tissue volume loss.

As our skin ages, the dermis gradually loses its major constituents: collagen, elastin and hyaluronic acid. Collagen acts as the major support protein for our skin, elastin allows our skin to stay firm and resist wrinkles, and hyaluronic acid helps to trap water and add volume and shape to our skin.

Dermal fillers are becoming increasingly popular as a means to help reverse the changes associated with aging. Because the goal is to return the dermis to its original youthful state, dermal fillers can give a more natural appearance than surgical face lifts. Dermal fillers are being used to reduce or eliminate wrinkles, raise scar depressions, enhance lips, and replace soft-tissue volume loss.

A variety of dermal fillers are available today. Some of the most popular include collagen based fillers (i.e. Evolence), hyaluronic acid based fillers (i.e. Restylane and Juvederm), poly lactic acid based fillers (i.e. Sculptra) and calcium hydroxylapatite fillers such as Radiesse.

All types of filler materials can all help improve the youthful appearance and fullness of facial skin, but there are differences in the way each behaves and the duration of time the results of each filler will last. An important element to achieving successful results with dermal fillers is realizing that no one filler is ideal for all areas of the face. For example, lips tolerate fillers differently than the cheek areas do, and not all fillers can be injected in the lips. At Pearlmax Oral Surgery we will evaluate your individual case, and will recommend the product that is most indicated for you.

Learn more at:

• www.juvederm.com
• www.radiesse.com
• www.restylane.com

Facial Implants

Cheek, Jaw and Chin Implants

Facial implants are used to enhance certain features of your face, including your cheeks or your jaw line. The surgery may be elective, or needed as the result of prior surgery on the face. Through a facial implant, you can aesthetically improve facial contours.

• Lower jaw implant. The implant is placed from the inside of the mouth. Incision site will be secured with sutures that will dissolve in about one week. The procedure takes one to two hours.
• Cheek implant. The implant is placed internally from the inside of the mouth. Sutures will be dissolved after a week or so. The procedure takes about an hour.
• Chin implant. To avoid scars on the face, the implant is placed from the inside of the lower lip. The procedure takes 30 minutes to an hour.