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One of the most transformative advancements in dental restorations is the dental implant. Implants look just like natural teeth, they function just like natural teeth, and they help maintain jawbone health just like natural teeth. But the success of any implant procedure depends on the quality and quantity of the bone in which it’s placed. That’s why, before placing your implant, Dr. Theodotou might first suggest a common procedure known as ridge modification.

An implant consists of a metal post which is surgically placed in the jawbone. This post serves as the “root” of the dental implant. After several months, the post fuses with the bone surrounding it, as bone tissue grows around and attaches to the post surface. This process is called osseointegration, and it creates a strong, secure anchor for the abutment and crown which will be secured to the post when it heals.

Because of the strong pressures which biting, chewing, and clenching put on our teeth, the success of an implant depends on the strength of its integration into the jawbone. To make osseointegration possible, the bone must be healthy, with adequate size and density to hold the implant securely.

Ridge modification, also called ridge augmentation, is a kind of oral surgery. In this procedure, we use bone grafting to rebuild bone strength in the alveolar ridge (the part of the jawbone containing the tooth sockets) before placing a post. When is this procedure necessary?

Jawbone size and density can be compromised in several different ways, including:

• Resorption

When a tooth is missing, the bone ridge under the lost tooth gradually begins to shrink, a process called “resorption.” Over time, bone loss can lead to a noticeable indentation in the jawbone.

• Periodontitis

Serious gum disease is progressive. Without treatment, the gums begin to pull away from the teeth. This leaves bone and connective tissue exposed to destructive bacteria and infection, which can cause bone loss.

• Trauma

Bone damage caused by accident or injury might require bone replacement or recontouring.

• Bone structure and size

Sometimes the jaw ridge is too narrow or shallow to support an implant, especially in the back of the upper jaw near the sinus cavity, and will need added bone before an implant can be placed.  

Oral surgeons are specialists in bone grafting surgery, with years of medical and surgical training in the complex structure and interaction of bone, muscle, and nerve. We are experienced in providing patients with skillful, safe, and effective bone grafts, and will recommend this procedure when the success of your implant would be in jeopardy without it.

What will your surgery involve?

• Assessing bone quantity and quality

Using advanced imaging technology, we will evaluate your jaw’s condition, and map out any areas of bone loss.

• Designing your treatment plan

If a bone graft is your best option, we will recommend the best grafting materials for your needs. Bone grafting might use bone tissue taken from your own body, processed bone grafting material, or synthetic grafting material to replace and repair the damaged bone. We will also discuss your anesthesia and sedation options.

• Performing the Surgery

After anesthesia, an incision will be made in the gum tissue to reveal the damaged or missing bone. Grafting material will be shaped to restore the bone’s contours and secured to the affected area. The incision will then be closed. If you are here for an extraction, it may be possible to have augmentation done as part of the same procedure.

• Providing follow-up care

You’ll receive detailed careful instructions for after care and follow-up visits at our Pooler oral surgery office. The time it takes for you to heal completely will depend on the size and type of your graft.

• Placing your implant

Once the bone has healed, we can surgically place the post for a secure, long-lasting, and healthy implant.                  

If it’s been some time since you lost a tooth, if your jaw has been damaged by injury or trauma, if you have less-than-adequate bone size and density, it’s important to restore your bone before implant surgery can be successful. See us for an evaluation, and learn how a ridge modification procedure can help you improve your dental health and transform your smile.

Taking care of your oral health involves a daily regimen of brushing, flossing, and rinsing to prevent tooth decay and bacterial infections. Though you may have asked us which toothbrush to use, few patients at Oral and Maxillofacial Surgery of Coastal Georgia ask about mouthwash.

However, different mouthwashes you might choose will have varying effects on your oral health. So which type is best for you?

Gum Health

Antiseptic mouthwashes are designed to reduce the majority of bacteria on and near the gum line. Using an antiseptic mouthwash can help decrease your chances of developing gingivitis. If possible, look for a mouthwash with antibacterial or antimicrobial ingredients.

Fluoride

Fluoride is beneficial for oral health and can help prevent tooth decay. If you drink a lot of bottled water without fluoride, we may recommend that you purchase a rinse with fluoride in it.

Bad Breath

Although mouthwash is designed to prevent bacterial build-up within the mouth, many people use it to combat bad breath. Most mouthwashes will help eliminate the bacteria that cause bad breath, and some are specifically designed to do so.

However, if bad breath is a chronic problem that requires daily treatment with a mouth rinse, contact Oral and Maxillofacial Surgery of Coastal Georgia to discuss your symptoms.

American Dental Association Approval

The ADA reviews mouth rinses for safety and effectiveness. A mouthwash with the ADA Seal of Approval will meet strict criteria, and will have scientific evidence or clinical studies that support the claims of the manufacturer. If possible, select a mouthwash that bears the ADA Seal of Approval to ensure you are using a quality rinse.

Considerations

If you are unsure as to which mouthwash is right for you, contact our Pooler office or ask Dr. Theodotou during your next visit. Also, be sure to keep mouthwash out of the reach of children, as it contains alcohol and other substances that could be harmful to them. Avoid letting children under age six use a mouth rinse, and discontinue use if you experience a burning sensation in the soft tissues of your mouth.

No one really looks forward to a wisdom tooth extraction, even a straightforward one. Fortunately, you can be confident that your oral and maxillofacial surgeon has the experience and the skill to make your extraction experience as safe and comfortable as possible.

But what happens when your situation is not quite so straightforward? Dr. Theodotou and our team have the experience and the skill to diagnose and treat these more complex extractions as well.

One of the potential complications with an impacted wisdom tooth is its close proximity to the Inferior Alveolar Nerve (IAN) of the jaw.  When the roots of the impacted tooth are fully developed, they can rest very close to, put pressure on, or, in rare cases, even wrap around this nerve.

Why is this a problem? Because these nerves supply feeling to the lower lip, gums, chin, and teeth. If a nerve is damaged during extraction, a patient might be left with pain or numbness in these areas, which can affect sensation, speech, and eating. While this nerve damage is usually temporary, in rare cases it can be permanent.

But an impacted tooth, left alone, can also have serious consequences—pain, infection, and damage to neighboring teeth and bone. So what’s the answer in this complicated case?

Talk to Dr. Theodotou. We have the training and skill to detect any potential nerve involvement when you need a wisdom tooth extraction, and we have a procedure to help prevent damage to the nerve if it lies too close to the roots. The coronectomy is a specialized surgery used only to treat impacted teeth when the nerves of the lower jaw might be compromised.

What is a coronectomy, exactly? The tooth can be thought of in two distinct segments—the crown, which is the part of the tooth that rises above the gum when the tooth erupts, and the roots below, which anchor each tooth in the jaw. A “coronectomy” means the removal (“ectomy”) of the crown (“corona”) of the tooth.

In this procedure, we will divide the tooth into two parts. After making a small incision to expose the tooth, the crown will be removed, and the root section left in the jaw. When the procedure is completed, the incision in the gums will be closed with sutures. Recovery is much like recovery for any other tooth extraction.

Once the coronectomy is completed, you might be asking, “What happens to those roots that were left behind?” Another good question!

• Very rarely, the roots become infected or cause irritation to surrounding tissue and will need to be removed.
• Occasionally, root fragments can start to emerge through the gums, just as a whole tooth would. But since they must move away from the nerve in order to erupt, they can be extracted without endangering the nerve.
• The most common result? The remaining root segment becomes permanently encased by bone tissue within the jawbone, never to cause problems again.

Are there times when, even though a wisdom tooth is bordering on a nerve, this procedure might not be advisable? Yes. Infection and decay in the tooth, tooth mobility, periodontal disease near the tooth, a horizontal tooth (where sectioning the tooth could damage the nerve), and other conditions might mean that a coronectomy is not possible. In that case, Dr. Theodotou can discuss further options with you.

No one really looks forward to wisdom tooth extraction. Fortunately, even in complicated situations, your oral and maxillofacial surgeon has the experience and the skill to provide the answers you need for an extraction experience that is as safe and comfortable as possible.

Any more questions? Contact our Pooler office to see if a coronectomy is the answer for you.

If you’re feeling a bit nervous before you visit our office for a surgical procedure, we want to make your visit as worry-free as possible. We are happy to explain procedures, equipment, and sedation options so you know just how safe and comfortable your experience can be. And if X-rays are a concern, we can put your mind at ease here as well.

What Exactly Are X-rays?

Sometimes patients feel reluctant about the process of imaging because X-rays are a kind of radiation. But the fact is, radiation is all around us. We are exposed to radiation naturally from our soil and water, sun and air, as well as from modern inventions such as cell phones, WiFi, and air travel.

Why is radiation so common? Because matter throughout the universe constantly gives off energy, and the energy that is emitted is called radiation. This radiation takes two forms—as particles (which we don’t need to consider!) and as traveling rays. This second type is known as electromagnetic radiation, created by photons traveling in regular waves at the speed of light.

We are exposed to electromagnetic radiation every day, because, whether we can see them or not, these different wavelengths and frequencies create various forms of light. Radio waves, microwaves, infrared, visible, and ultraviolet light, X-rays, and gamma rays are all part of the electromagnetic light spectrum.

Different types of radiation on this spectrum have different wavelengths and different frequencies, and produce different amounts of energy. Longer wavelengths mean lower frequencies and less energy. Because X-rays have shorter wavelengths and higher frequencies than, for example, radio waves and visible light, they have more energy.

How Do Dental X-rays Work?

An X-ray machine produces a very narrow beam of X-ray photons. This beam passes through the body and captures images of our teeth and jaws on special film or digital sensors inside the mouth (intraoral X-rays), or on film or sensors located outside the mouth (extraoral X-rays). These X-ray images are also known as radiographs.

Why are X-rays able to take pictures inside our bodies? Remember that higher energy we talked about earlier? This energy enables X-rays to pass through the softer, less dense parts of our bodies, which are seen as gray background in a radiograph. But some substances in our bodies absorb X-rays, such as the calcium found in our bones and teeth. This is why they show up as sharp white images in radiographs. 

There are many medical and dental conditions which can be treated by oral surgeons. When the problem is primarily a dental one, we have several different X-ray options which can be used as necessary, including:

• Periapical X-rays, which allow us to look at one or two specific teeth from crown to root.
• Panoramic X-rays, which use a special machine to rotate around the head to create a complete two-dimensional picture of teeth and jaws.
• Cone Beam Computed Tomography, which uses an external machine to produce digital images creating a three-dimensional picture of the teeth and jaws.

Why Do We Need X-rays?

If all of our dental conditions were visible on the surface, there would be no need for X-rays. But since they are not, we use X-rays to discover such conditions as infection in a tooth’s root or bone, a decrease in bone density, and fractures or other injuries. And to properly plan treatment, we often require 3-D images, which show the spatial relationship of teeth, roots, bone, nerves, and sinuses.

Many dental procedures benefit from X-ray imaging for diagnosis and treatment planning, among them:

• Extraction of a seriously decayed or damaged tooth
• Wisdom tooth extraction
• Dental implant surgery
• Treatment of traumatic injuries
• Root surgeries such as apicoectomies and root amputations, which can save a tooth when infection recurs after a root canal
• Replacement of an avulsed, or knocked out, tooth

How Do Oral Surgeons Make Sure Your X-rays Are As Safe As They Can Be?

First of all, the amount of radiation you are exposed to with a dental X-ray is very small. In fact, a typical panoramic X-ray provides roughly the same amount of radiation we are exposed to through our natural surroundings in just one day. Even so, Dr. Theodotou and our team are committed to making sure patients are exposed to as little radiation as possible.

Radiologists, the physicians who specialize in imaging procedures and diagnoses, recommend that all dentists and doctors follow the safety principal known as ALARA: “As Low As Reasonably Achievable.” This means using the lowest X-ray exposure necessary to achieve precise diagnostic results for all dental and medical patients.

The guidelines recommended for X-rays and other imaging have been designed to make sure all patients have the safest experience possible whenever they visit the dentist or the doctor. We ensure that imaging is safe and effective in a number of ways:

• We take X-rays only when they are necessary.
• We provide protective gear, such as apron shields and thyroid collars, whenever needed.
• We make use of modern X-ray equipment, for both traditional X-rays and digital X-rays, which exposes patients to a lower amount of radiation than ever before.
• When treating children, we set exposure times based on each child’s size and age.

And now that we’ve talked about some things you might like to know,

Please Let Us Know If . . .

• You have X-rays from another doctor. We’ll let you know if your earlier X-rays might be useful, and how to transfer them. (With digital X-ray technology, this transfer can be accomplished electronically!)
• You’re pregnant, or think you might be pregnant. Even though radiation exposure is very low with dental radiographs, unless there is a dental emergency, dentists and doctors recommend against X-rays for pregnant patients.

X-rays play a vital part in helping us diagnose and treat our patients. If you have any concerns, contact our Pooler office. When it comes to making sure you’re comfortable with all of our procedures, including any X-rays that might be necessary, we’re happy to give you all the inside information!