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Procedures

Dental Implants

The loss of a tooth can sometimes be an emotional event. The loss of even one tooth can drastically change the way the mouth functions. Each tooth in the mouth has a specific and important function. The incisor and canine teeth are in the front part of the mouth. These teeth function to grasp and tear food such as when one bites into a piece of fruit. These teeth obviously are important in ones smile. The premolar and molar teeth are in the back part of the mouth and function to grind food into pieces that are small enough to swallow.

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Dental implants are a predictable method of replacing a missing tooth or even several teeth. Dental implants are made from titanium, a metal which has been shown to be compatible with the human body. In fact, when implanted into the jaw titanium dental implants actually fuse to the bone, a process called osseointegration. This makes them permanent and allows them to function much like the natural tooth roots. Titanium dental implants typically require three to six months to undergo the osseointegration process. Once the dental implant has fused to the jaw bone your dentist will perform a series of steps that will lead to the placement of a porcelain crown onto the implant. This porcelain crown will look and function like the rest of your natural teeth.

Dental implants may be used to replace teeth anywhere in the mouth. In most cases the process of surgically placing and restoring dental implants is routine and straightforward. In some cases minor or major bone or gum tissue grafting may be necessary. Dr. Ferdowsmakan will discuss the need for bone or tissue grafting at the time of your initial consultation.

The success rate for dental implants is typically greater than 95%. In rare cases dental implants may fail for a variety of reasons. If this occurs Dr. Ferdowsmakan will remove the implant and allow healing prior to the placement of another implant.

Bone Grafting

Bone grafting is typically performed when there is inadequate bone in the jaw for dental implant placement. Not every patient will need bone grafting. In fact the majority of patients will not need bone grafting prior to dental implant placement. The jaw bone naturally resorbs or “shrinks” to some extent after the loss of one or more teeth. Typically this occurs after several years but in some cases can occur much sooner after the loss of a tooth. Sometimes infection or traumatic injuries can result in significant bone resorption. Fortunately most defects in the jaw bone can be reconstructed with minor or major bone grafting techniques. These grafting procedures can be performed in our office surgical suite.

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Minor Bone Grafting

Minor bone grafting is typically performed to reconstruct small defects in the jaw bone prior to dental implant placement. In some cases minor bone grafting is performed at the time of dental extraction to prevent future bone resorption. This makes subsequent dental implant placement much more predictable. Most minor bone grafting procedures are performed using synthetic or bovine bone. This prevents the need for harvesting the patient’s own bone resulting in less discomfort to the patient.

Major Bone Grafting

Major bone grafting is required when there are large defects in the jaw bone usually due to traumatic injuries, removal of cysts or tumors and in some cases after teeth have been missing for many years. In some cases the maxillary sinus floor may need grafting after the removal of molar teeth. Major bone grafts utilize natural bone harvested from the patient. Usual sources of bone include the mandible (lower jaw), iliac crest (hip bone), tibia (lower leg bone) and sometimes the cranium (skull bone). Dr. Ferdowsmakan will discuss the benefits and indications of the different major bone grafting sources and techniques at your consultation appointment.

Sinus Floor Augmentation

Sinus floor augmentation sometimes referred to as “sinus lift” is a predictable method of increasing bone volume in the maxilla (upper jaw) for the placement of dental implants. The maxillary sinus is a normal air-filled cavity in the upper jaw that sometimes expands after the removal of molar teeth. This expansion decreases the amount of bone available for dental implant placement. If this occurs a sinus floor augmentation procedure is performed. During the procedure the thin membrane of the maxillary sinus is gently elevated and bone graft material is placed under this membrane. Depending on the amount of existing bone in the upper jaw dental implants can sometimes be placed concomitantly with the grafting procedure. The bone graft usually requires several months for maturation and eventually will become a part of your own jaw.

Onlay Grafting

Onlay or veneer grafting is employed when the jaw bone is inadequate in width to accommodate dental implants. Bone is typically harvested from either the lower jaw or hip bone and secured to any part of the jaw which requires grafting to increase the width. Once the bone graft has incorporated into the jaw, dental implants may be placed. This usually takes about four to six months to occur.

Wisdom Teeth

Wisdom teeth or third molars are the last teeth to develop and to erupt into the mouth. When erupted and properly functioning there usually is no need to remove these teeth. Often there is inadequate space in the jaw for the proper eruption of these teeth. This results in impaction which means the teeth have been unable to erupt into a proper position. When this happens the impacted wisdom teeth can cause problems with the other healthy teeth in the mouth. Impacted wisdom teeth can result in gum disease and eventual bone loss with the molar teeth adjacent to them. This can result in eventual loss of these healthy functioning molar teeth. Impacted wisdom teeth can sometimes result in cavity formation in the adjacent molar teeth necessitating extensive repair of these teeth including the need for root canal treatment and the placement of a porcelain crown. Partially impacted wisdom teeth allow food and bacteria to become lodged in the gap between the tooth and gum tissue often resulting in a painful infection called pericoronitis. In some cases cysts and tumors can develop around impacted wisdom teeth resulting in the need for more extensive surgery to treat these pathologic conditions.

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Wisdom teeth are often removed in the teen years or early twenties to prevent some of these problems. They can be removed later in life; however, there may be more risks and complications associated with the later removal of wisdom teeth. The removal of wisdom teeth is a safe and predictable procedure, especially when performed earlier in life. Some of the complications that may arise are sensory nerve injury, sinus exposure and dry socket. The incidence of complications is extremely low and most conditions typically return to normal with little or no treatment.

Surgery typically is performed under general anesthesia; however, some patients elect to undergo the procedure with the use of nitrous oxide sedation also known as “laughing gas”. Nitrous oxide sedation usually works well for the mildly anxious patient who desires not to be under general anesthesia.

The procedure is performed in our state of the art surgical suite. Patients are monitored during and after the procedure. Once the surgery is completed patients are monitored in our recovery area where family members can join them until they are ready to be escorted home. A prescription for pain medications can be phoned to the pharmacy if desired; otherwise a written prescription is given which can be taken to any pharmacy. A follow-up appointment is usually scheduled for one week after surgery so that the extraction sites can be checked for proper healing.

Corrective Jaw Surgery

Corrective jaw surgery, also known as orthognathic surgery, is used to correct a significant discrepancy between the upper and lower jaw. Common conditions that are treated with jaw surgery include facial asymmetry, underbite, overbite, open bite, gummy smile, obstructive sleep apnea and mouth breathing. Certain craniofacial disorders such as hemifacial microsomia and cleft palate may require corrective jaw surgery as part of overall treatment. Jaw surgery is indicated when orthodontic treatment is not enough to correct misalignment of the teeth and jaws.

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Corrective jaw surgery is meant to enhance your facial appearance naturally without resulting in an artificially produced look that cosmetic surgery procedures often create. Jaw surgery not only improves the esthetic appearance of your face but there are many functional benefits as well. Many patients with jaw discomfort will have reduced pain after surgery. Some speech difficulties will improve significantly with surgery. The ability to properly chew food is also drastically improved.

Jaw surgery is typically performed in the hospital operating room. Some patients may be able to go home the same day. However, most patients will spend the night in the hospital and go home the next day. Recovery typically takes at least 2 weeks prior to returning to work or school. Patients are encouraged to be up and about, usually the same day as surgery, without overexertion. There is some facial swelling expected, the majority of which resolves in 2 weeks. Surprisingly there is relatively little pain associated with the surgery and most patients require minimal amounts of pain medication. The jaws are almost never wired shut with the advent of titanium plate and screw technology that holds the jaw bones together during healing. Patients will be on a liquid and puree diet for the first week after surgery and then will be allowed to eat very soft foods for the next several weeks until the jaw bones are fully healed.

Dr. Ferdowsmakan regularly performs corrective jaw surgery and has extensive experience treating patients with jaw discrepancies and facial asymmetries. He has a true passion for helping patients that require corrective jaw surgery. Dr. Ferdowsmakan has found tremendous fulfillment by performing this life-changing treatment for his patients. He can help you achieve a natural smile and healthy jaw function with corrective jaw surgery.

Dr. Ferdowsmakan uses the latest medical imaging technology to evaluate your face and jaw structure prior to surgery. This allows him to plan your corrective jaw surgery with the highest precision while at the same time giving you the harmonious facial balance you desire. If you think you may benefit from corrective jaw surgery please contact our office to schedule your consultation today. We look forward to meeting with you soon!

Cleft Palate

Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy. Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly. A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

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Repair of a cleft palate often requires multiple surgeries over the course of 18 years. The cleft hard palate is generally repaired between the ages of 6 and 12 when the incisors and cuspid teeth begin to develop. The procedure involves placement of bone from the hip into the bony defect, and closure of the communication from the nose to the gum tissue in three layers. It may also be performed in teenagers and adults as an individual procedure or combined with corrective jaw surgery.

Children with a cleft palate may also need a bone graft when they are about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. About 20% of children with a cleft palate require further surgeries to help improve their speech.

Although treatment for a cleft lip and/or cleft palate may extend over several years and require several surgeries depending upon the involvement, most children affected by this condition can achieve normal appearance, speech, and eating.

Trauma Reconstruction

Traumatic facial injuries can occur as a result of sports accidents, motor vehicle accidents, work-related accidents or altercations. The facial structures are some of the most frequently injured parts of the body. Injuries can range from minor dental injuries to facial lacerations to fracture of one or more of the facial bones. Oral and Maxillofacial Surgeons are uniquely qualified to diagnose and treat facial injuries.

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Dentoalveolar Trauma

Dentoalveolar trauma occurs when there is sufficient force to disrupt not only the tooth and tooth socket but the surrounding jaw bone. This type of injury requires care from an Oral and Maxillofacial Surgeon to stabilize the teeth and bone to allow for proper healing. Failure to seek prompt care can result in improper healing of the bone or improper positioning of the teeth.

Facial and Oral Lacerations

Lacerations of the facial skin, lips and oral tissues is not uncommon in traumatic injuries. Lacerations should be repaired as soon as possible after they occur to minimize scarring and to ensure the most cosmetic result. Oral and Maxillofacial Surgeons are well-trained in the cosmetic repair of facial and oral lacerations. Laceration scars can often be lessened with the use of dermabrasion or laser resurfacing after a period of healing.

Facial Bone Fractures

The nasal bones are the most commonly fractured facial bones followed by the cheek bones. This occurs because these bones protrude furthest from the rest of the face. The lower jaw, upper jaw, eye socket and forehead are other areas of the facial skeleton that are sometimes fractured or injured. The proper and timely repair of facial bone injuries is crucial to proper function and optimal esthetics. Late repair of facial injuries can result in poor function and unsightly deformities which may be difficult and sometimes impossible to repair.

Dr. Ferdowsmakan treats all facial injuries. Some injuries can be treated in our office surgical suite at Torrey Hills Oral & Maxillofacial Surgery. More severe or complex injuries usually need to be treated in a hospital setting. Dr. Ferdowsmakan maintains active hospital privileges at Scripps Memorial Hospital, La Jolla, Rady Children’s Hospital and Sharp Memorial Hospital.

Sleep Apnea

Patients with obstructive sleep apnea syndrome (commonly referred to as sleep apnea) have disrupted sleep usually due to anatomic variations in the upper airways. These obstructions typically occur at the base of the tongue and at the soft palate. When obstruction occurs the upper airway becomes blocked and air flow stops or is significantly reduced temporarily. When the oxygen level in the brain becomes low enough, the obstructed sleeper partially awakens, the obstruction in the throat clears and the flow of air starts again, usually with a loud gasp. Patients with sleep apnea may have up to 100 episodes of apnea or lack of breathing each night. Repeated cycles of decreased oxygenation may lead to very serious cardiovascular problems including high blood pressure, stroke and heart attack.

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Symptoms of sleep apnea typically include daytime sleepiness, extreme tiredness, lack of concentration, memory loss, short attention span, poor judgement, rapid weight gain and may even result in depression and personality changes.

The first step in treatment of sleep apnea is recognition of the symptoms and seeking appropriate consultation. Oral and Maxillofacial Surgeons offer consultation and treatment options. In addition to a detailed history, Dr. Ferdowsmakan will assess the anatomic relationships in the maxillofacial region. This involves a thorough clinical examination and the use of specialized imaging. To assess the degree of obstructive sleep apnea, a formal sleep study (known as a polysomnogram) is performed in order to monitor individuals overnight in a controlled laboratory setting.

Continuous positive airway pressure (CPAP) devices are often used as the first line treatment. These devices are highly effective when properly used. Unfortunately the devices are very often not tolerated and compliance rates are poor.

Mandibular anterior positioning devices have been shown in studies to be equally effective in the treatment of sleep apnea when compared to CPAP devices. The mandibular devices are custom-made appliances fabricated in a laboratory. These devices are well tolerated and have been shown to have excellent results.

In more severe cases, the bones of the upper and lower jaw may be surgically repositioned forward to dramatically increase the size of the airway and thus to decrease symptoms and the harmful sequelae of sleep apnea.

Sleep apnea is a serious medical condition that requires proper diagnosis and treatment. There are many surgical and non-surgical treatment options available. If you have sleep apnea or suspect that you may have sleep apnea, please contact our office for an evaluation.