FIRST COAST ORAL SURGERY
Andrew Skigen, DMD, FACS • Anthony Massaro, MD, DMD
Sepideh Sabooree, MD, DMD • Stacey M. Nedrud, MD, DMD, FACS
Diplomates of the American Board of Oral and Maxillofacial Surgery
Fellows of the American Association of Oral and Maxillofacial Surgeons
Corrective Jaw Surgery
One or both jaws may grow too much or too little. The resulting abnormality may interfere with proper teeth alignment, speaking and chewing. The tongue and lips may be forced to move awkwardly during speech and swallowing in an attempt to compensate for the jaw mal relationship. There may be a speech defect or excessive mouth breathing. An improper bite may threaten the long-term health of the gums and teeth. The jaw joint (TMJ) can also be adversely affected by a jaw mal relationship. In addition, jaws of different sizes—that don’t match—can affect appearance.
When an individual’s jaw fails to grow properly, both functional and psychological difficulties may be experienced. Functionally, this abnormality may interfere with proper chewing, create difficulties swallowing, cause a speech defect, result in chronic mouth breathing and lead to jaw pain. Psychological difficulties that can accompany this kind of problem are also important considerations. Some abnormalities may involve only misaligned teeth and can be corrected orthodontically with braces or other appliances. More serious problems may require surgery to move all or part of the upper jaw, lower jaw or both into a more normal position. Surgical correction of jaw irregularities (orthognathic surgery) is undertaken after thorough study and consultation with an orthodontist and restorative dentist. Once the precise nature of the abnormality is determined, the surgical strategy is planned and the outcome may be reasonably predicted. Surgery can be performed in a hospital or ambulatory surgical center under general anesthesia. Corrective jaw surgery moves teeth and jaws into a new position that is more balanced, functional and healthy.
Before Surgery
After Surgery
Treatment
When unequal jaw growth is the source of the problem, corrective jaw surgery may be necessary. Orthodontic treatment (braces or other appliances) may also be needed to allow the teeth to align properly.
Corrective jaw surgery involves moving all or part of the upper and/or lower jaw into a more favorable position. For example, the entire jaw can be moved backward if it’s too large. The goal of treatment is to improve function and restore facial balance. Some people have facial abnormalities involving just the upper face, cheek bones and nose. These can also be surgically corrected. The bones are repositioned so the facial features are more symmetrical. This is usually accompanied by the return of normal breathing, speaking and eating patterns. After the jaws are moved into their new position, rubber bands or wires attached to the teeth may be used to fasten the jaws together during healing. Alternatively, rigid internal fixation with miniature screws and plates may be used to allow you to open and close your jaws sooner after corrective surgery.
The following are some of the conditions that may indicate the need for corrective jaw surgery:
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Difficulty chewing or biting food
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Difficulty swallowing
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Chronic jaw or jaw joint (TMJ) pain and headaches
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Excessive wear of the teeth
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Open bite (space between the upper and lower teeth when the mouth is closed)
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Unbalanced facial appearance from the front or side
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Facial injury
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Birth defects
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Receding lower jaw and chin
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Protruding jaw
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Inability to make the lips meet without straining
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Chronic mouth breathing
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Sleep apnea (breathing problems when sleeping, including snoring)
Enjoy the Benefits
Corrective jaw surgery moves your teeth and jaws into positions that are more balanced, functional and healthy. Although the goal of this surgery is to improve your bite and function, some patients also experience enhancements to their appearance and speech. The results of corrective jaw surgery can have a dramatic and positive effect on many aspects of your life. So make the most of the new you!
Jaw surgery
can have a
dramatic effect
on many aspects
of life.
Take a closer look at your bite and appearance. Does your chin stick out? Does it recede? Do your teeth fit together properly? Do you have “buck” teeth? Are your teeth straight? If you suspect there’s cause for concern, ask Dr. Skigen to examine your face and bite!
Contact our office today to schedule an appointment!
Lessing the Trauma of Facial Injury
Because of his dental background, Dr. Skigen is uniquely qualified to deal with any injury to the face, jaws, mouth or teeth. Cuts and lacerations anywhere on the face require meticulous attention. If stitches are needed, placement must be precise to ensure a proper cosmetic result. When facial bones are broken, the experience and training of Dr. Skigen is invaluable. For a fractured jaw, metal braces may be attached to the teeth and wires or strong rubber bands used to hold the jaws in place and allow the bones to heal. Patients with few or no teeth may need dentures or special dental splints to align and fix the fracture. Severe fractures can require surgery to wire together broken bones or secure them with metal plates.
SEEK HELP AT THE FIRST SIGN OF TROUBLE
Any suspicious lesion or growth on the face, neck or in or around the mouth, should be checked out by Dr. Skigen without delay. Lumps and sores or reddish or whitish patches can be signs of cancer. Dark, slowly healing or crusty lesions on the skin may also be signs of cancer. Upon examination, Dr. Skigen can diagnose potential problems. If needed, a biopsy is done; lab tests then determine if there is a malignancy. Remember, early detection and treatment of head and neck cancer greatly increases the chance of complete recovery. Don’t ignore suspicious lumps or sores. If you discover something, make an appointment for a prompt examination.
ALL YOU WILL FEEL IS RELIEF
Pain is a sure sign something is wrong. Unfortunately, fear of pain often prevents people from seeking needed oral care. Dr. Skigen is trained in the most advanced anesthetic and pain control procedures. During surgery, one or more of the following can be used in controlling pain and anxiety: local anesthesia, nitrous oxide, intravenous sedation and general anesthesia. Prior to any surgery Dr. Skigen can review the type of anesthetic to be used, as well as the way you’re likely to feel during the operation. The main goal is to ensure maximum patient comfort and safety.
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How Many Implants Do I Need?Most frequently, one implant per missing tooth is placed. Because many of the larger teeth in the back of your jaws have two or three roots, the most common approach is to replace missing back teeth with larger implants.
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What will I use for teeth while the Implants heal?Many options are available, and they are tailored to your specific requirements. If you need a replacement tooth while the implants are healing, temporary removable teeth or a temporary bridge can be made. If all of your teeth are missing, we can usually modify your present complete denture or make you a new temporary denture. If you would prefer non-removable teeth during the healing phase, temporary transitional implants usually can be placed along with the permanent implants, and temporary teeth may be made and inserted the same day. Depending on your particular situation, some implants can be placed and “loaded” immediately. This means a temporary or permanent replacement tooth can be placed on, or shortly after, the day the implant is placed.
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What are the potential problems with Implants?Although it is natural to be concerned about the pain that may be caused by these procedures, most patients do not experience severe or significant post-operative pain. Pain medication and antibiotics will be prescribed for you to make your recovery as easy as possible. Occasionally, some people develop post-operative infections that require additional antibiotic treatment. Even though great care is taken to place the implant precisely, occasionally adjacent teeth are injured in the placement process. In addition, there is a chance that the nerve in the lower jaw, which provides sensation to your lower lip and chin, may be affected. If you are missing quite a lot of bone, it might be difficult to place an implant without infringing on the nerve space. Although we take great care to avoid this nerve, occasionally it is irritated during the procedure, resulting in tingling, numbness or a complete lack of sensation in your lip, chin or tongue. Usually these altered sensations will resolve within time, but they can be permanent and/or painful. If you notify us of post-operative numbness as soon as possible, it will allow us to manage your care in the most appropriate way.
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How long will Implants last?Implants usually last a long time. When patients are missing all of their teeth, long-term studies (more than 30 years) show an 80 to 90 percent success rate. For patients missing one or several teeth, recent studies show a success rate of greater than 95 percent, which compares favorably with other areas in the body that receive implant replacement (such as hips or knees). However, if one of your dental implants either doesn’t heal properly or loosens after a period of time, you may need to have it removed. After the site heals (or on occasion at the time of removal), another implant usually can be placed.
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When are the replacement teeth attached to the Implant?The replacement teeth are usually attached to the implant when adequate healing has occurred and your jawbone is firmly fused to the implant. Depending on a variety of factors, it may be possible to begin this phase of your treatment immediately or shortly after implant placement. We will review the most appropriate treatment sequence and timing for your particular situation. The dental work required to complete your treatment is complex. Most of the work involves actually making the new teeth before they are placed. Your appointments are considered more comfortable and more pleasant than previous methods of tooth replacement. Frequently, this process can be performed without local anesthesia. Your restorative treatment begins with specialized impressions that allow us to produce a replica of your mouth and implants. We will also make “bite” records so that we see the relationship of your upper and lower jaws. With this information, we will make the abutments (support posts) that attach your replacement teeth to your implants. Various types of abutments exist. Frequently, we can use “off the shelf” abutments. Other times, custom abutments must be made of gold or a tooth-colored ceramic material. As you can imagine, these custom made abutments add to the cost and treatment time involved. Which abutment to use is a decision that often cannot be made until after healing is complete and impressions have been made.
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How do I clean my Implants?As with natural teeth, it is important that you clean implant-supported restorations regularly with toothbrushes, floss and any other recommended aids. You should also visit your dentist several times each year for hygiene and maintenance. As with regular dentures and other tooth replacements, your implants and their associated components are subject to wear and tear and eventually will need repair, including clip replacement, relines, screw tightening, and other adjustments.
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Will one Doctor do the entire Implant procedure?Usually, a dental surgeon places the implant(s) and performs other necessary surgical procedures – your general dentist provides the temporary and permanent replacement teeth. Both doctors are involved in planning your dental treatment. Also, depending upon a variety of factors, different dental specialists may help with your dental care.
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How much do Implants cost?Before treatment begins, every effort will be made to give you an accurate estimate of all the expenses involved in placing the implants and making your replacement teeth. In many cases, there is an initial charge for the diagnostic work-up, including study models, x-rays, and the fabrication of a surgical template to ensure the best possible result. In addition you will be charged for the abutment or support post(s), plus the crown, dentures, or anything else that will be placed over the implants, including temporary restorations. Periodic maintenance such as hygiene visits, tissue conditioners, denture relines and other repairs will also incur additional charges. When different doctors are involved in your treatment, you will be charged separately for their services. We will try to assist you in estimating what your actual payments will be after we evaluate your insurance coverage or other third party payments. Also, you should consider your personal financial investment in each treatment option as some insurance companies provide limited or no coverage. Each patient is unique, and it is not possible for us to discuss every option and every contingency for treatment outcome. This booklet is intended to help you understand the general treatment options available to you. If your specific treatment options are not clear, please contact us. We will be happy to answer any questions you have about your dental care.
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Why select Dental Implants over more traditional types of restorations?There are several reasons: A dental bridge can sacrifice the structure of surrounding good teeth to bridge the space of the missing tooth/teeth. In addition, removing a denture or a “partial” at night may be inconvenient, not to mention dentures that slip can be uncomfortable and rather embarrassing.