Procedures

Procedures Home | Extractions Including Wisdom Teeth | Dental Implants | Bone Grafting
Exposure and Orthodontic Bracketing of an Impacted Tooth | Oral Pathology

Home

FPO Image

Please click on a procedure that you would like more information about for an overview. You can ask Dr. Noren or the staff any questions you may still have.

Extractions Including Wisdom Teeth

Extractions Including Wisdom Teeth

Some General Dentists extract (remove) teeth, but Oral & Maxillofacial Surgeons are trained for 4 or more years after dental school to do this and much more complex surgical procedures. The goal is to remove the teeth as gently as possible and with the least amount of stress on the patient.

Ithaca Oral Surgery and Implant Center, our goal is also to restore the socket where the tooth was, or, if the patient does not have grafting or does not need grafting, to preserve as much bone as possible. In many situations, we use ultrasound or Piezosurgery to gently make space around the tooth to make the extraction less traumatic. Piezosurgery, similar to the ultrasound hygienists use to clean teeth, actually cuts bone by sound waves. We perform other surgeries with this as well.

Some teeth are completely showing in the mouth, or fully erupted. Others, are impacted, or covered by gum tissue or bone. In some cases, they are completely or mostly covered by bone. It is highly recommended to consult with an Oral Surgeon for most extractions. We will first see you on consultation and explain the risks and benefits of any surgery, as well as gather your medical and dental history. This is important for your surgery and you should try to be as thorough as possible in providing this information.

It is important to know that unlike a common cold that may resolve, decayed or infected teeth will generally cause increasing dental and medical problems if untreated. In some cases, by waiting too long, you may also lose valuable jawbone associated with the teeth if you do not have surgery in a timely fashion.

Our goal, as above, is to preserve as much bone so that it can be used to accommodate an implant, a denture or a bridge in the future. We frequently see patients that have had extractions in the past and have lost a great deal of bone without grafting.

As with any surgery, Dr. Noren will explain the risks and benefits of each surgical procedure so that you can understand your options. Feel free to call us anytime with questions.

If you are on osteoporosis medications or ever have been, you should definitely let us know so that we can inform you of any risks related to those medication

Dental Implants

Dental Implants

What are the advantages of dental implants?

There are many advantages to dental implants, including:

  • Improved appearance: Dental implants look and feel like your own teeth. And because they are designed to fuse with bone, they become permanent.
  • Improved speech: With poor-fitting dentures, the teeth can slip within the mouth, causing you to mumble or slur your words. Dental implants allow you to speak without the worry that your teeth might slip.
  • Improved comfort: Because they become part of you, implants eliminate the discomfort of removable dentures.
  • Easier eating: Sliding dentures can make chewing difficult. Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain.
  • Improved self-esteem: Dental implants can give you back your smile, and help you feel better about yourself.
  • Improved oral health: Dental implants don't require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your own teeth are left intact, improving your long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.
  • Durability: Implants are very durable and will last many years. They require the same care as real teeth, including brushing, flossing, and regular dental check-ups. With good care, many implants last a lifetime.
  • Convenience: Removable dentures are just that; removable. Dental implants eliminate the embarrassing inconvenience of removing your dentures in some cases. In most cases though, they snap into place eliminating the need for messy adhesives to keep your dentures in place.
Dental implant surgery is generally less physical than tooth extraction;

In some cases, there are no stitches and very little post-operative discomfort.

Cone Beam CT: What is it and why do we order it?

Cone Beam CT

Some patients require a closer look at the volume and quality of the bone available to place dental implants in the jaws. There are also anatomical considerations such as the sinuses in the upper jaw, and the nerves in the lower jaw. The cone beam imaging takes as long as a panorex (about 10-15 seconds) and has much less radiation than a hospital C.T. It provides a 3-D image of all the areas that we need to look at when planning a more complex dental implant case. It is not routinely used on all implant cases by most surgeons, and is reserved for those cases that warrant it's use. Ask us about this imaging and if it is appropriate for your case.

Bone Grafting

Bone Grafting

Bone grafting in the mouth is done for a variety of reasons, but overall, to restore the bone back to normal dimensions. It can be as simple as adding powdered bone to an extraction socket (a removed tooth space), or adding bone to a part of the jaw to help hold dental implants or support a denture where there has been bone loss. Dr. Noren will explain and also show you on dental models the basics of what he thinks you will need in your own particular situation. He will explain the alternatives and what the various surgical procedures entail. As always, the risks and benefits of any procedure will be explained.

For the most common of these procedures, socket grafting is the graft of choice. This is because the best time to preserve the bone is at the time the tooth is removed. It is less costly and is also less invasive than having to graft at a later time. For socket grafting, the tooth is gently removed and the site is cleansed and prepared briefly. Next, the granular bone and small amounts of mineral are placed and compacted gently into the socket. As a side effect, less discomfort is generally experienced in sockets that have been grafted vs. those that have not. This is not the main reason why we graft, but is helpful nevertheless.

In some cases where more reconstructive surgery is needed, larger portions of bone can be harvested from other areas of the mouth such as near where lower wisdom teeth are removed. This is called block grafting as they are small blocks of bone transplanted to an area that is deficient in bone. Frequently Piezosurgery, or ultrasound is used to obtain this bone in a very gentle fashion. Our goal is to do the least invasive approach to restore your jaw to function and appearance.

Exposure and Orthodontic Bracketing of an Impacted Tooth

Surgical Exposure of Teeth for Orthodontics

An impacted tooth means that it is "stuck" and can not erupt into function in the mouth. Some teenagers and even adults have impacted teeth other than their wisdom teeth. The maxillary canine (upper eye tooth) is the second most common tooth to become impacted. The canine is a critical tooth in the bite and plays an important role in your chewing and appearance. They are supposed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite. There are other teeth that can also be impacted and Dr. Noren can discuss this if it applies in your case.

The upper canine teeth are the last of the "front" teeth to move into place. They usually move into place around age 13 and cause any space left between the upper front teeth to close tight together. If a canine tooth gets impacted, every effort is made to get it to erupt into its proper position in the "bite" or arch. 60% of these impacted eye teeth are located on the palatal (roof of the mouth) side. The remaining impacted eye teeth are found in the middle of the bone but stuck in an elevated position above the roots of the adjacent teeth or out to the cheek side of the teeth.

As patients' get older, 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 bite. The American Association of Orthodontists recommends that a panorex screening x-ray along with a dental examination be performed on all dental patients at around the age of 7 years to count the teeth and determine if there are problems with eruption of the adult teeth. It is important to see whether all the adult teeth are present or if some adult teeth missing.

This exam is usually performed by your general dentist or hygienist who will refer you to an orthodontist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to open spaces to allow for normal eruption of teeth. Treatment may also require a referral to an oral surgeon for extraction of over retained baby teeth and/or selected adult teeth that are blocking the eruption of the all important eye teeth. Dr. Noren 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 will not erupt by itself even with the space cleared for its eruption. If the patient is older (not old; over 40!), there is a much higher chance the tooth will be stuck in position. Many times, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it with a crown on a dental implant or a fixed bridge).

The usual procedure performed in the oral surgeon's office involves exposing the hidden tooth underneath delicately. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, Dr. Noren will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. Dr. Noren will secure the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes we will leave the exposed impacted tooth completely uncovered by suturing the gum up high above the tooth or making a window in the gum covering the tooth (on selected cases located on the roof of the mouth). Most of the time, the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.

After surgery (1-14 days) the patient will return to the orthodontist. Often, a rubber band will be attached to the chain to put a light eruptive pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This can take up to a year in some cases, but also needs to be stabilized with time after that. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor "gum surgery" required to add bulk to the gum tissue over the relocated tooth so it remains healthy during normal function. Your dentist or orthodontist will explain this situation to you if it applies to your specific situation. Call us at (607) 273-0327 with any questions.

Oral Pathology

Oral Pathology Wisdom tooth with a cyst

Occasionally, a dentist may see something that doesn't appear to be normal and asks for the opinion of an oral surgeon. Many times, there is some idea what it may be and is not thought to be cancerous. Often, the lesion is benign and just may enlarge over time causing irritation or other problems.

Biopsy may involve a simple brush biopsy (similar to a pap smear where cells are brushed onto a slide and sent for microscopic study). It may also involve removing all or part of the lesion by Dr. Noren. Some biopsies are referred to Ear Nose and Throat doctors depending on the location of the lesion.

The first visit usually entails just looking at the area, doing a routine oral, head and neck exam, and making a decision on what to do next. Dr. Noren will explain these steps to you at this appointment. Most biopsies are painless and done with local anesthesia (numbing the area). For awkward areas or for patients who have anxiety, light IV sedation may be appropriate. This will also be discussed at the consultation appointment. We are here to make this as stress free as possible for you. If you have any questions, call us at (607) 273-0327.