Services

Dentoalveloar Surgery and Ambulatory Anesthesia
Implants
Pathology and Maxillofacial Infections
Orthognathic and Reconstuctive Surgery
Tempormandibular Joint Disorders
Maxillofacial Trauma

Dentoalveolar Surgery and Ambulatory Anesthesia

At the heart of any full scope private practice is the performance of dentoalveolar surgery and ambulatory anesthesia. Oral and maxillofacial surgeons have in-depth training in general anesthesia. These skills and the knowledge base are founded on training at the residency level in operation room anesthesia.

Modern practice parameters have compelled surgeons to use monitoring devices similar to operating rooms including continuous EKG, blood pressure monitoring, pulse oximetry and recording respiration. Continuing education insures that your surgeon will be certified in Basic as well as Advanced Cardiac Life Support. Education of the auxiliary staff is the management of the anesthetized patient. The safety record for general anesthesia in the OMS office is one that we can be proud of.

This ability to perform anesthesia has allowed surgeons to comfortably and safely remove difficult impacted and nonrestorable teeth and to perform surgery on the anxious or uncooperative patient in an ambulatory setting. Teeth can be exposed for orthodontic guidance or even transplanted. Bone and soft tissue can be removed, recontoured and biopsied if needed. Abnormalities of tongue function, muscular attachments (“tongue tie”), and others are frequently performed. Minor surgery in preparation for dentures or other dental appliances are part of the usual scope of practice. In short, virtually any minor surgical procedure, whether it involves a tooth (teeth), soft or hard tissue, can be performed in comfort and safety with either local or general anesthesia in an ambulatory setting.

Implants

Few revelations of improvements in dental care have achieved the accolades that the development and advancement created by implant surgery and reconstructive dentistry. Oral and maxillofacial surgeons have participated in this development extensively over the years. Modern implant surgery ranges from the placement of commercially pure titanium fixtures (endosseous implants or anchors) to more “exotic” devices such as the mandibular staple implant or the transmandibular implant.

As part of the implant team, the surgeon and the reconstructive dentist work together to develop a surgically stable, bone integrated, implant system that can function well within the anatomical constraints of each patient’s mouth. Single teeth to entire dentitions can be successfully and predictably restored.

Great advances in implant surgery have occurred in the last 10 years. Improvements in the implant systems have created a more “user friendly” atmosphere for their use in general practice. Surgical improvements in bone grafting have allowed surgeons greater freedom in the placement of implants in the areas not previously accessible such as the posterior upper jaw due to sinus proximity. Nerve “relocation” can even be performed when implant placement in the lower jaw demands it.

The area of implant surgery holds much promise for those patients who have lost teeth prematurely in areas of high visibility or find denture wear either too uncomfortable or impossible to manage well without greater stability.

Pathology and Maxillofacial Infections

The recognition of various pathological entities continues to be one of the more challenging and rewarding aspects of the practice of oral and maxillofacial surgery. Almost on a daily basis the oral surgeon is called upon for opinions regarding various hard and soft tissue lesions of the oral cavity and associated structures. With the oral manifestations of patients with AIDS, “pre-malignant” oral lesions, and other disease entities come the need for a more astute awareness of the earliest signs of tissue change so the appropriate diagnosis, biopsy and treatment can be rendered. The oral surgeon is in a unique position to provide such care.

Odontogenic (tooth) related infections are also very common problems that the oral surgeon is regularly called upon to diagnose and treat. These can range from the very simple to the very complex medical/surgical management that may require the expertise of other specialists (e.g. internists, infectious disease).

Both pathologic and infectious problems often require hospitalization, with a need for extensive surgery and/or management with antibiotics. Modern practice parameters help to insure that management of the problem and recovery will be nothing short of excellent.

Orthognathic and Reconstructive Surgery

The area of orthognathic and reconstructive surgery has been and continues to be a source of extreme gratification for the OMS. Reconstructive surgery for cancer patients has been advanced by research in bone grafting and improvement in metallic, and other “artificial” prostheses. Patients with jaw resections are now being rehabilitated with bone grafts and implants so their function is as optimal as possible.

Orthognathic surgery for skeletal facial deformities including patient with jaw clefts has progressed dramatically. New data on stability and relapse of these procedures has continued to support their use in this important area of surgery. Rigid fixation with screws and plates have in large part, been responsible for more predictable post operative results. Their use has facilitated an earlier return to normal diet and improved temporomandibular stability. Aside from the obvious functional restoration of normal jaw relations, many patients have improvement in speech, airway function (especially for patients with some forms of sleep apnea) and tempormandibular disorders. Patients with more severe skeletal facial deformities have also had dramatic improvement in their concept of self image and self esteem.

Optimal results continue to be produced when the OMS, orthodontist and dentist participate in the treatment planning and care before and after surgery for these patients. The OMS continues to be on the forefront of research, education and the surgical management of these complex problems.

Tempormandibular Joint Disorders/Facial Pain

One of the most controversial and debated subjects that continues to spawn research and progress in care, is that of the treatment of tempormandibular disorders. Oral and maxillofacial surgeons, along with those individual practitioners/researchers who have limited their practice to the treatment and study of TMD, orthodontists, prosthodontists and dental radiographers have diligently advanced the diagnosis of these problems.

Arthoscopic surgery and magnetic resonance imagining (MRI) have done much to improve diagnostic accuracy of TMD. Acceptance of TMD, not as a “dental” problem, but as an orthopedic one, unique in location and function has been helped tremendously by these two developments. Insurance coverage continues to be a source of problems for the TMD patient because of prevailing attitudes as to whether the disorder is “dental or medical” in nature.

Surgical techniques now employed include arthoscopic lysis, debridment, and lavage of the diseased joint. Advanced arthoscopic procedures such as the use of laser have been used on a limited basis with some success. Open joint procedures (arthotomy/arthoplasty) have included surgical repair and repositioning of displaced or malformed discs. Disc removal procedures have utilized replacement with muscle grafts, ear cartilage, etc., or in some cases artificial (metal) protheses. When total joint replacement becomes necessary due to metabolic disease, trauma, or failed surgical procedures, reconstruction of the entire joint complex becomes necessary. Rib grafts or an artificial joint replacement then became the only surgical alternative.

Post operative management continues to be one of the keys to successful TMJ surgery. This management scheme is often orchestrated by the OMS for the surgical recovery and rehabilitation of these patients with a referral base consisting of dentists, physical therapists, psychologists, anesthesiologists and other “rehab” specialists.

Maxillofacial Trauma

Maxillofacial and dentoalveolar trauma have been consistently treated by the OMS over the years. Oral and maxillofacial surgeons, because of their unique training in dentistry and surgery have been directly responsible for many aspect of current treatment and management of maxillofacial injuries. Knowledge of the teeth and normal jaw relationships have placed the oral surgeon in a unique position to treat fractures of facial skeleton in general and the upper and low jaw in particular. “Turf battles” still exist among both specialty areas e.g. plastic and ENT surgeons for the major facial injuries. In many institutions across the country the adversarial relationships have given way to a more collaborative effort between the specialists.

The training of the OMS to treat major facial injuries is in-depth and generally encompasses the management of both soft and hard tissue trauma. Significant surgical advances in the area of ridged skeletal fixation have greatly improved the treatment and post operative comfort of the facially injured patient.

The OMS treats the minor injuries as well. Bicycle, sporting injuries, and inter-personal violence still account for the vast majority of teeth that get fractured or completely avulsed (knocked out). These injuries can be treated in the OMS office safely and predictably with a variety of techniques that can insure stability of the injured teeth and bone. Those trauma patients in whom significant injury has resulted in tooth, bone or soft tissue loss can/will benefit from the reconstructive talents the oral surgeon possesses in the other areas of implant and reconstructive surgery.