NRV Oral & Maxillofacial Surgery, Inc.

Little, Medium, Big Dental Bone Grafts

Bone grafting is a straightforward procedure that is immensely beneficial for numerous reasons. In the instance of a missing tooth (or teeth), the jaw bone can begin to slowly degrade. The jaw bone is holds teeth in place, and once a tooth is no longer present, the bone doesn’t have anything to support. There are different types of bone grafts, and depending on your situation. Outlined below are several different types of bone grafts:

 

'tooth with bone graft'Little Bone Graft

In the case of a simple, single lost tooth, the ideal course of action is to not lose excess bone. In this process, sterile, demineralized human bone granules are packed into the tooth socket immediately after tooth extraction. This procedure is very simple, and does not add anything to your recovery time. Over the next several weeks, your own bone will fill the tooth socket and preserve the bone height enough for you to have the area restored.

Medium Bone Grafts

If a tooth was removed a long time ago, there is likely to already be some bone loss impeding the restoration of the area. In this case, the area of the missing tooth is opened with a small incision, the bone surface is prepared, and demineralized bone graft granules are used to build up the area. Many surgeons prefer to use a little bit of the patient’s own bone in this procedure in order to ensure the best results possible. If your own bone is used, your surgeon will take it from another area of the jaw bone, usually near the wisdom tooth area, shaving off tiny granules and combining them with the demineralized bone. The bone graft will heal and integrate with the surrounding bone tissue. This type of graft can be used for one or multiple areas of missing teeth.

Big Bone Graft

Patients who have many missing teeth and who have been missing many teeth for many years, have often experienced advanced bone loss. In those who wear dentures, the lower jaw bone often recedes so severely that they can no longer wear them. Extensive bone grafting is necessary in order to consider restorative methods. A combination of demineralized, sterile human bone and the patient’s own bone is used to restore the jaw bone, creating enough width and height to consider dental implants. The patient’s bone is supplied by another part of the jaw, hip, or tibia. Bone granules are also used to enhance and strengthen the graft.

Bone grafting is a surgical procedure that takes time. However, it plays an essential role in making new teeth possible, and will ultimately be a positive process! For more information, call 540-951-8777 today for a consultation with NRV Oral & Maxillofacial Surgery, Ltd.

Dental Implants 101

Whether you are missing a tooth, or at risk of losing many, dental implants may be a great solution for you. Dental implants are an increasingly popular fix for missing or dying teeth, and have many benefits.

'Dental Implants 101'What is a Dental Implant?

Dental implants are high tech teeth. The root of your current tooth is removed, and replaced with a screw attached to a ‘cap’ that looks identical to a natural tooth. Many people report higher confidence and comfort after receiving their new tooth.

What’s so Great About Them?

The cool thing about implants is that if taken care of, they can last for life. Usually all that needs to be replaced, if anything, is the cap. The other great thing about implants is that they can’t die like natural teeth. You still have to clean and maintain them like your other teeth, but no roots are any longer at risk of causing that tooth to fail. In addition to that, many implants can last a lifetime!

What is the Surgical Process Like?

The process is done either all at once, or in steps. This depends on the recommendations for your particular case. The first step is to remove the root of your natural tooth, and place the implant in its place. If there is not enough bone to place the implant, we may encourage you to have bone grafting first. The gum is then stitched closed and allowed to heal. This can take five to six months. The next step is to reopen the gum and place an abutment on the implant, along with a temporary crown so you can heal while the permanent crown is made for you. You then return to get your permanent crown attached in a few weeks. In other cases, all of these steps can be done in a single visit, but it depends on your specific case.

If you have any questions, please call our office for more information, we would be glad to help!

Types of Jaw Surgery

Your jaw consists of two parts; the maxilla or upper jaw and the mandible or lower jaw . Sometimes these are misaligned and need to be put back into place for bite reasons, or for aesthetic purposes. Corrective jaw surgery straightens or aligns the jaw, and is often referred to as “orthognathic” surgery; “orthos” meaning to straighten and “gnathic” relating to the jaw.

There are a few different types of jaw surgery, depending on which part of your jaw requires correcting;

'side profile of man'Maxillary Osteotomy (Upper Jaw)
This type of surgery corrects a significantly receded upper jaw, cross bite, or when you have too many or too few teeth showing. It also can adjust an open bite.

Mandibular Osteotomy (Lower Jaw)
This surgery corrects a significantly receded lower jaw. The surgeon moves the jawbone forwards or backwards depending on the best adjustment and bite alignment.

Genioplasty (Chin)
A deficient chin often accompanies a severely receded lower jaw. Typically, surgeons can alter the jaw and restructure the chin during the same surgery.

Once your jaw is aligned, tiny screws and plates hold the bone into position. These screws and plates are osseo integrated and are specially formulated to be compatible with your body. They become integrated with your bone over time and do not have to be taken out.

Extra bone can also be added to your jaw if there is insufficient bone. This can be grafted from your hip, leg, or rib.

Often these types of jaw surgeries are performed entirely inside the mouth without any evidence on the skin surface as to what procedure has been performed. There are no facial scars on the chin, jaw or around the mouth.

Often with extensive jaw surgery, the process is carried out after you have had braces, so your teeth are aligned and ready for your jaw to be moved. Braces are placed anywhere from 9 to 18 months before jaw surgery.

Jaw surgery can take up to 2 years to complete, but the results are for life! Know your jaw facts; Talk to us today to discuss your options!

Learning the Lingo – Dental Implants

Dental implants are a safe and effective replacement for a missing tooth or teeth. The implant is placed in your jawbone and integrates with your natural bone. This implant then forms a stable, sturdy base for your new teeth.

What They Are

Implant: The implant itself is a rod that is screwed into the jawbone.

Abutment: This is the connection between the implant and the crown.

Crown: A tooth shaped cap that is attached to the abutment. It is the part of the tooth that is visible above the gum line.

What They’re Made Of

'tooth with dental implant vs regular tooth'Titanium: Most implants are typically made of titanium, a biocompatible metal.

Zirconia: Often used for crowns and bridges and can be used as a metal-free option. Zirconia is biocompatible just like titanium.

Where They Go

Endosteal Implants: Placed in the jawbone. These implants are typically shaped like small screws, cylinders or plates, and they are the most commonly used.

Subperiosteal Implants: Placed under the gum, but on or above the jawbone. These implants are mostly for people with smaller jaws or shallow jawbones.

What Happens To Them

Osseointegration: Creates strength and durability by fusing directly to the bone and is bio-compatible. Bone cells attach themselves directly to the titanium/zirconium surface, essentially locking the implant into the jaw bone. Osseointegrated implants can then be used to support prosthetic tooth replacements of various designs and functionality. Anything from a single tooth, to all teeth in the upper and lower jaws. The teeth/crowns are usually made to match the enamel color of the existing teeth to create a natural appearance.

Bone augmentation: Some people do not have enough healthy bone to support dental implants, so bone must be built. Procedures can include bone-grafting which means adding bone to the jaw.

Talk to us today at NRV Oral & Maxillofacial Surgery, Ltd. to discuss your options with an implant specialist!

Eating After Wisdom Tooth Extraction

We want your recovery to be as quick and painless as possible, so keep reading for an easy-to-follow guide to eating after your wisdom tooth removal!

DONT’S

  • 'woman with pain caused by wisdom teeth'Remember not to drink from a straw during your recovery. Using a straw could rip out your stitches or blood clots, causing dry socket.
  • The bubbles in carbonated drinks can also cause dry socket by loosening blood clots, so it’s best to avoid sodas.
  • Don’t eat crunchy foods like nuts, chips, and popcorn because they are hard to chew and can easily get stuck in your extraction sites.
  • Avoiding acidic foods and beverages can keep you from experiencing pain and stinging.

 

DO’S

  • Any liquids are fair game, like soups and broths. Lukewarm beverages are best, because you may experience temperature sensitivity.
  • Yogurt, pudding, applesauce and Jell-O are some go-to recovery foods: no chewing involved! Stick to these post-extraction staples for the first 24 hours after your surgery before moving on to soft foods that require chewing.
  • Mashed potatoes are great for the first few days because you can flavor them with gravy, butter, garlic, sour cream, cheese, the list goes on. Soft, starchy and filling, you won’t feel like you’re missing out on solid foods with these!
  • When you’re ready to move on to chewable foods, eggs are soft and can be eaten with just about anything.
  • You can even eat pancakes! They’re light, fluffy, and easy on your extraction sites (Tip: you can make breads even easier to chew by letting them sit in your mouth for a few seconds and softening them with your saliva).
  • Pasta is totally doable if you prepare it right. Macaroni and cheese is perfect because you can swallow the tiny noodles whole or chew them with your front teeth. You can also overcook your pasta noodles to make sure they are soft and easy to chew.

Your wisdom tooth extraction will be over with before you know it, and as long as you avoid difficult-to-chew foods you’ll be on your way to a speedy recovery!

Oral Cancer and Hepatitis C

The Journal of the National Cancer Institute (JNCI) recently found that individuals infected with the hepatitis C virus are two to five times more likely to develop head and neck cancers. The JNCI study found that the risk for hepatitis C patients of developing head and neck cancers more than doubled for oral cavity and oropharynx cancers, and increased nearly five times for larynx cancers. As well, patients that are hepatitis C virus-positive were also more likely to test positive for human papillomavirus (HPV).

The question remains, how does hepatitis C virus increase oral cancer risk?

'hepatitis c' 'oral cancer'Enhanced replication of hepatitis C virus in oropharyngeal tissues may in fact contribute to chronic inflammation, ultimately prompting cancer development. Human papillomavirus is known to suppress local immune response, which may accelerate the production of hepatitis C virus in oropharyngeal cells. The JNCI notes that human papillomavirus and hepatitis C virus may play a “synergistic role” in the development of oropharyngeal cancers by stimulating loss or destruction of tumor suppressor proteins p53 and retinoblastoma protein.

The JNCI notes that one of the study’s limitations is that it didn’t include individuals with hepatitis C virus who didn’t have oral cancer. All and all, it is important to take away from The Journal of the National Cancer Institute’s study that it is important to educate Hepatology (study of liver, gallbladder and pancreas health) and infectious disease specialists. These doctors who treat patients with hepatitis C virus need to understand that the hepatitis C virus not only drastically affect liver health, but it’s also a systemic infection that can drastically affect oral health.

Your oral health is important to us. If you suspect that your oral health is at risk, give NRV Oral & Maxillofacial Surgery, Ltd. a call today and schedule an oral cancer screening!

Pediatric Facial Trauma

We’ve all had our share of trips, bumps, and even broken bones in our childhood years! (If you haven’t, then you’re very lucky!)
As the saying goes, children are very resilient, and this is actually due to their biology. Children have “bendy bones” which are more likely to bend and crack under pressure rather than break.
The term is referred to as greenstick fractures; similar to when a green branch of a tree bends and cracks, but doesn’t break off.

'child with facial trauma holding soccer ball'The maxillofacial region is related to a number of vital functions, such as vision, smell, eating, breathing and talking. It also plays a significant role in appearance.
When treating children’s maxillofacial injuries, we take into consideration the difference anatomically between adults and children. Facial trauma can range between minor injury to disfigurement that lasts a lifetime if not treated correctly.

Children have much more flexibility in their facial bones, as well as smaller sinuses, multiple fat pads and unerupted teeth. In adolescents an increase in risk-taking behavior and the reduction of parental supervision results in an increase in facial fractures. Contact sports, physical play, riding bicycles, and even road traffic accidents all contribute to pediatric facial trauma.

A full treatment plan is always taken into consideration when we deal with facial trauma. The age of the patient, anatomic site of the trauma, complexity of the injury and how long since the injury occurred is taken into account. Ideally, don’t put off your incident for more than 4 days! This is prime healing time, and if any longer, could extend the healing and complicate the treatment process.

This is why it is very important to always wear protective gear! Remember to always have your children wear seatbelts, and invest in booster or car seats so your children can receive the full protection of seatbelt coverage.
During play, remember shin guards, mouth guards and helmets! Especially when riding a bike!

Play it safe, and if life throws a curve ball (at your face!) give NRV Oral & Maxillofacial Surgery, Ltd. a call at [PRACTICE_NUMBER]

Wisdom Tooth Removal – Aftercare

Having your impacted wisdom teeth removed is a serious surgical procedure, and post-operative care is extremely important! Read on for instructions on how to care for your sore mouth, and how to minimize unnecessary pain and complications.

Immediately Following Surgery

Keep a firm, yet gentle, bite on the gauze packs that have been placed in your mouth to keep them in place. You can remove them after an hour if the bleeding is controlled. If the surgical area continues to bleed, place new gauze for another 30 to 45 minutes.

Be careful!

'girl smiling after wisdom teeth removal'Do not:
• Rinse vigorously
• Probe the area
• Smoke (hopefully you don’t!!)
• Participate in strenuous activities
You can:
• Brush gently (but not the area)
• Begin saltwater rinses 24 hours after surgery (mix 1 tbs of salt with 1 cup of water). Make sure to swish gently. These rinses should be done 2-3 times a day, especially after eating.

Enjoy some down-time!

Keep activity level to a minimum! Enjoy a day of couch or bed-rest, as being active could result in increased bleeding. Avoid exercise for 3-4 days, and when you do begin exercising again, keep in mind your caloric intake has been reduced so you may feel weaker.

Bleeding

As you’ve just had surgery, some bleeding will occur and it’s not uncommon to ooze blood for 24-48 hours after your procedure. REMEMBER-the blood you see is actually a little blood mixed with saliva, so don’t panic!
If excessive bleeding persists:
1. Try repositioning the packs. They may not be putting enough pressure on the site.
2. Sit upright and avoid physical activity.
3. Use an ice pack and bite on gauze for one hour.
4. You can also try biting on a moistened tea bag for 30 minutes (the tannic acid in tea promotes blood clotting).
5. If bleeding persists, please call our office at 540-951-8777.

Pain

Unfortunately, some pain is to be expected after surgery. Try not to let the anesthetic wear off before taking your prescribed pain medication. Dr. Howard, Dr. Boyle or Dr. VanGilder will have discussed a plan to manage your pain, make sure you follow these instructions.

Diet

Eat nourishing food that takes little effort.
Avoid:
• Extremely hot foods
• Straws (for the first few days)
• Chewing (until tongue sensation has returned)
• Smaller foods that can become stuck in the socket area
• Skipping meals—while eating may seem like a lot of work, you need your nourishment to be able to heal and feel better!

Day 2 and 3 Following Surgery

Swelling

Swelling is a completely normal occurrence. Keep in mind, swelling will usually be at it’s worst in the 2-3 days after surgery. You can minimize swelling by applying a cold compress (covered with a towel) firmly to the cheek next to the surgical area. Apply the pack with 20 minutes on, and 20 minutes off for the first 24-48 hours. Also make sure to take the medication prescribed by Drs. Howard, Boyle or VanGilder. This helps with pain and swelling.

Keeping your mouth clean

Keeping your mouth clean is very important! Continue saltwater rinses as often as you’d like, but at least 2-3 times a day. Begin your normal oral hygiene (remember to brush softly and don’t do anything that hurts)!

Healing

Everyone heals differently, but your timeline should look similar to this:
1. Day 1-2 will be the most uncomfortable and you will experience some swelling.
2. Day 3 you should be more comfortable and while still swollen, you should be able to begin a more substantial diet.
3. Day 4 and on you should see a gradual and steady improvement.

Other Normal Things

• Discoloration. Bruising is a normal post-operative occurrence you may notice 2-3 days after surgery.
• Stiff jaw muscles. You may find it difficult to open your mouth wide in the days following your surgery. This is normal and usually resolves itself within a week after surgery. Stretching these muscles may help to speed up recovery.
Since no two mouths are alike, do not take advice from friends (even well-intended advice could cause a healing set-back). The advice given to you from Drs. Howard, Boyle or VanGilder and the NRV Oral & Maxillofacial Surgery, Ltd. team are tailored to fit your needs. Please call us at 540-951-8777 if you have any questions or concerns about your recovery. Happy healing!

Modern Options for Bone Grafting Technology

Bones, grafting, or any combination of the two are rarely the subject of casual conversation. Most of us, regardless of our profession, are happier discussing recent football scores, the price of gasoline, or the abnormally high number of Dunkin Donut franchise locations. Perhaps for it is for this very reason, however, that we should bring up this important topic–to raise awareness, maximize modern technology, and inform the public about the options offered in terms of dental implant surgery.

'bone grafting technology'Bone grafting for dental implants is the process by which bone tissue is placed (grafted) into the mouth to act as a placeholder for tissue that has been lost. In the modern medical landscape this is a safe, painless, and routine process: indeed, more than two million bone-grafting operations occur worldwide each year, making bone the second most transplanted organ (after blood!).

As well as natural bone tissue, synthetic tissue is an alternative for patients seeking the best results. Structured as a ‘biodegradable scaffold’ that can be implanted within the body and trigger bone regeneration, this strong, flexible material has been compared to tire rubber! Dr. Karin Hing, author of the study and reader in Biomedical Materials at Queen Mary’s University of London Institute of Bioengineering stated that the challenge being tackled currently is the development of a graft that is as clever as bone. By mechanically evaluating the way bone adapts to its environment and reacts to chemical and physical components, progress is taking place in leaps and bounds.

What does this mean for the average person who just wants to be happy with their mouth? Comfortable outpatient procedures complete with local anesthesia or intravenous sedation make bone grafting a sensible and worry-free choice. Browse our procedures page for more information on maximizing your resources!

The Benefits of Jaw Surgery

As doctors, we always weigh the risks and benefits of any procedure or medication therapy. One of the most significant procedures that we perform in our office is orthognathic surgery, more commonly known as “jaw surgery.”

'man holding mouth due to jaw pain'Orthognathic surgery has the ability to enhance a patient’s life, giving him or her the comfort needed to eat properly and, often, the freedom from pain. Because the decision to have jaw surgery is such a serious one, we would like to take a moment to look at the positive side of the procedure in this blog, focusing on the benefits of orthognathic surgery:

  • Pain Relief – There are several reasons that a person may experience jaw pain bad enough to warrant orthognathic surgery. They may have unnecessarily been causing excessive wear and tear in the joints over many years and living with constant inflammation. Correcting the alignment of the jaws through surgery is sometimes the only way to set the jaw back on the correct path, reducing strain and therefore pain. Another common scenario occurs with injury to the jaw, often from trauma caused by car and sports accidents. If the jaw is knocked too far out of place or suffers significant trauma, it may not heal on its own and may require resetting through a surgical procedure. These two situations represent occasions where the benefits of orthognathic surgery far outweigh the risks.
  • Regular Eating Patterns – A misaligned jaw can make it difficult to chew and swallow, particularly if your teeth do not line up correctly. Often, braces are not enough to correct the alignment issues with the teeth and the jaw itself must be altered. Sometimes, patients don’t even know that they are working too hard to chew because they are used to it always having been that way. Once their bite is corrected through surgery, they are pleasantly surprised to find a significant enhancement in their quality of life.
  • Better Overall Health – The health of your body starts in your mouth. Proper nutrition is key to everything from longevity to happiness. Whether your jaws are misaligned from injury or genetics – if your bite is significantly affected, your nutritional habits may be as well, and orthognathic surgery may be the best option for getting your health back on track.