Other Oral Surgery Procedures Virginia Beach, Chesapeake and Norfolk

Pre-Prosthetic Surgery

Oral Pathology

These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face, and/or neck. Pain does not always occur with pathology, 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.

We would recommend performing an oral cancer self-examination monthly. Remember that your mouth is one of your body’s most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we can assist you with any questions or concerns.

Bone Morphogenetic Proteins

Bone morphogenic protein is an isolated protein that induces specific cells in our body to form new cartilage and bone. During surgery, the BMP is soaked onto and binds with a collagen sponge. The sponge is then designed to resorb, or disappear, over time. As the sponge dissolves, the bone morphogenic protein stimulates the cells to produce new bone. The BMP also goes away once it has completed its task of jump starting the normal bone healing process.

Since there is no need to harvest bone from the patients’ hip for BMP, recipients were spared donor site pain. Complications from the graft harvest site are also eliminated with the use of bone morphogenic protein.

Dr. Beale, Dr. Yeh, Dr. Quigg, or Dr. Duncan would be happy to discuss all grafting options with you during the consultation.

Platelet Rich Plasma (PRP)

Platelet-rich plasma (PRP) is a by-product of blood (plasma) that is rich in platelets. Until now, its use has been confined to the hospital setting. This was due mainly to the cost of separating the platelets from the blood and the large amount of blood needed to produce a suitable quantity of platelets. New technology now permits doctors to harvest and produce a sufficient quantity of platelets from only 55 cc of blood, which is drawn from the patient while they are having outpatient surgery. Coastal Virginia Oral & Maxillofacial Surgery uses PRP as part of our oral surgery process.

PRP Also Has Many Advantages

Safety: PRP is a by-product of the patient’s own blood, therefore, disease transmission is not an issue.

Convenience: PRP can be generated in the doctor’s office while the patient is undergoing an outpatient surgical procedure such as the placement of dental implants.

Faster healing: The supersaturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and faster tissue regeneration.

Cost effectiveness: Since PRP harvesting is done with only 55 cc of blood in the doctor’s office, the patient need not incur the expense of the harvesting procedure in hospital or at a blood bank.

Ease of use: PRP is easy to handle and actually improves the ease of application of bone substitute materials and bone grafting products by making them more gel-like.

Frequently Asked Questions About PRP

Impacted Canines

An impacted tooth simply means that it is “stuck” and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get “stuck” in the back of the jaw and can develop painful infections, among a host of other problems (see Wisdom Teeth Removal under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary cuspid (upper eyetooth) is the second most 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 biting teeth and have the longest roots of any human teeth. 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.

Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary cuspid (upper eye) teeth. Sixty percent of these impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are found in the middle of the supporting bone, but are stuck in an elevated position above the roots of the adjacent teeth, or are out to the facial side of the dental arch.

3D Imaging

Doctors Beale, Yeh, Quigg, and Duncan are committed to uncompromising excellence. At Coastal Virginia Oral and Maxillofacial Surgery, we have state of art diagnostic imaging equipment available. Simply put, the 3-D digital imaging system is an in-office CAT scan, sometimes referred to as a cone beam scan. It provides highly accurate, high definition, 3-D images and information. The information obtained from these studies is more accurate than traditional X-rays. Although traditional X-rays can be used for the many surgical procedures, some anatomical structures can be distorted, overlapped or not visualized. A digital 3-D scan is similar to a medical CAT scan, but with less radiation and decreased cost. Cross sections of the jaws can be seen, and the distance to critical structures such as nerves can be measured. You can imagine the huge diagnostic advantage this technology offers the doctor of being able to see the teeth, jaws, and nerves in three dimensions.

For implant patients, a digital 3-D scan provides important diagnostic information for the surgeon to obtain optimal implant positioning in the jaws. It also assists in determining if bone grafting or a sinus lift procedure will be needed in areas of inadequate bone to support the implant.

Information obtained in a digital 3-D scan aids in the diagnosis and surgical planning for many procedures including dental implants, mouth and jaw reconstruction, impacted tooth removal, and treatment of cysts and tumors. Since the digital 3-D scan is an accurate anatomical representation, many times, a more conservative surgery can be planned based on the scan. The digital 3-D scan is accomplished right in our office in a comfortable open environment, and only takes a very short amount of time (less than 3 minutes). We will work closely with you and your dentist to ensure an outstanding result. At Coastal Virginia Oral and Maxillofacial Surgery, we are dedicated to quality patient care in a comfortable and pleasant setting.

Anesthesia

Several methods of anesthesia are available. The method of anesthesia that is chosen for or by a patient depends upon the nature of the surgical procedure and the patient’s level of apprehension. The following table illustrates the choices of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.

To administer general anesthesia in the office, an oral surgeon must have completed at least three months of hospital based anesthesia training. Qualified applicants will then undergo an in office evaluation by a state dental board appointed examiner. The examiner observes an actual surgical procedure during which general anesthesia is administered to the patient. The examiner also inspects all monitoring devices and emergency equipment and tests the doctor and the surgical staff on anesthesia related emergencies. If the examiner reports successful completion of the evaluation process, the state dental board will issue the doctor a license to perform general anesthesia. The license is renewable every two years if the doctor maintains the required amount of continuing education units related to anesthesia.

Again, when it comes to anesthesia, our first priority is the patient’s comfort and safety. If you have any concerns regarding the type of anesthesia that will be administered during your oral surgery procedure, please do not hesitate to discuss your concerns with your doctor at the time of your consultation.

Nitrous Oxide (Laughing Gas)

Nitrous Oxide is a sweet smelling, non irritating, colorless gas which you can breathe. Nitrous Oxide has been the primary means of sedation in dentistry for many years. Nitrous oxide is safe; the patient receives 50-70% oxygen with no less than 30% nitrous oxide. Patients are able to breathe on their own and remain in control of all bodily functions. The patient may experience mild amnesia and may fall asleep not remembering all of what happened during their appointment.

There are many advantages to using Nitrous Oxide

• The depth of sedation can be altered at any time to increase or decrease sedation.
• There is no after effect such as a “hangover”.
• Inhalation sedation is safe with no side effects on your heart and lungs, etc.
• Inhalation sedation is very effective in minimizing gagging.
• It works rapidly as it reaches the brain within 20 seconds. In as few as 2-3 minutes its relaxation and pain killing properties develop.

Reasons To Not Use Nitrous Oxide

Though there are no major contraindications to using nitrous oxide, you may not want to use it if you have emphysema, exotic chest problems, M.S., a cold or other difficulties with breathing. You may want to ask your dentist for a “5 minute trial” to see how you feel with this type of sedation method before proceeding.

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.

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 an ideal cosmetic result, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands, and salivary ducts (or outflow channels). Drs. Beale, Yeh, Quigg, and Duncan 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 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.