- Dental implant use has nearly tripled since 1986 and is expected to continueto rise
   rapidly
 - People of all ages are turning to dental implants to replace a single tooth, several    teeth or a full set of dentures
 - Leading reasons cited for choosing dental implants are:
      - to restore normal eating and speaking abilities
      - to enhance facial appearance and confidence
      - to increase denture retention

According to the survey, the reasons for the increased demand are:
  - Growing public awareness of the significant functional and esthetic advantages of      dental implants over conventional dentures and bridges
  - The availability of data on the long-term success of dental implants

Experts predict that the demand for the procedure will continue to grow as people become more familiar with the benefits of dental implants.

AN ALTERNATIVE TO NATURAL TEETH
Dental implants are a great option for patients missing natural teeth, because they act as a secure anchor for artificial replacement teeth and eliminate the instability associated with surface adhesives and removable bridges. Your natural teeth absorb biting pressure of up to 540 lbs. per square inch. Long-time denture-wearers can often absorb no more than 50 lbs. per square inch. Dental implants, when properly placed, can withstand 450 lbs. per square inch of biting pressure.

Dental implants are made of materials that are compatible with human bone and tissue. The sub periosteal implants are surgically placed directly into the jawbone. Small posts are then attached to the implants which protrude through the gums. These posts provide stable anchors for artificial replacement teeth.
Dental Implants Fit Patient Needs.
Based on patient needs, a single tooth, a partial bridge or a full set of replacement teeth are fitted to the implants and locked in place over the protruding posts. In appearance and in function, implants are the closest thing to natural teeth and a good alternative to conventional dentures.

Implants eliminate the day-to-day frustrations and pain of ill-fitting dentures. They allow people to enjoy a healthy and varied diet without the restrictions many denture wearers face. With a sense of renewed self-confidence, many people rediscover the excitement of an active lifestyle shared with family and friends and the chance to speak clearly and comfortably with co-workers.  For all these reasons, people with dental implants often say they feel better . . . they look better . . .they live better.

WHAT TO EXPECT
An oral and maxillofacial surgeon can determine if you are a candidate for dental implants. You will be evaluated based upon a number of things including dental health, life-style, jawbone quality and oral hygiene habits. In close consultation with your own dentist, the oral and maxillofacial surgeon can plan your dental implant treatment program. Dental implant surgery is often done in an oral and maxillofacial surgeon’s office. In some cases, the procedure is done in a hospital or ambulatory surgery center. In any event, an oral and maxillofacial surgeon can determine the most appropriate setting based on your individual needs.

A Two-Phase Procedure
For most patients, the placement of dental implants involves two surgical procedures. First, the implants are surgically placed into your jawbone. These small devices make up the framework needed to securely hold replacement teeth. For the first three to six months following surgery, the implants are beneath the surface of the gums, gradually bonding with the jawbone. During this time, you should be able to wear temporary dentures and eat a soft diet. Some patients do report minor pain and swelling immediately after the procedure but most experience no change in their daily routines. While the implants are bonding with the jawbone, new replacement teeth are fashioned by your dentist. The replacement teeth must clip onto the implants, fit securely in the mouth and withstand the day-to-day movement and pressure created by chewing and speaking. So, it is important that they are created by a dentist with proper training in restorative techniques.

Once the implants have bonded to the jawbone, the second phase of the procedure begins. At this time, the oral and maxillofacial surgeon uncovers the implants and attaches small posts which will act as anchors for the artificial teeth. The posts protrude through the gumline but are not visible when artificial teeth are attached. The entire process, from evaluation to completion, generally takes six to eight months. During this time, most patients do not experience any disruption in their normal business and social activities. Because dental implants are made of materials that are compatible with human bone, there is little chance for an allergic reaction in the body. However, implants can fail when proper oral hygiene techniques are not used. Dental implants require special individual care. Proper brushing, flossing, rinsing and regular check-ups are critical to the long-term success of your implants.

A TEAM EFFORT
Though dental implants are a relatively simple procedure, they generally warrant the expertise of two dental professionals—an oral and maxillofacial surgeon and a restorative dentist.

Working as a team, the oral and maxillofacial surgeon and restorative dentist can determine if you are a candidate for implants and design an appropriate treatment plan. A restorative dentist, with training in dental implants, creates the replacement teeth. The doctor prepares the necessary molds and works with a dental laboratory to make sure that the denture or bridge will meet the particular needs of each patient. Additionally, dental implant patients should see a dentist for routine follow-up care and maintenance.

START A NEW WAY OF LIVING TODAY
If you are among the millions of Americans who suffer from permanent tooth loss, you can eliminate the problems and pain caused by dentures, bridges or missing teeth. You can begin to rediscover the joy of eating healthy, speaking clearly and laughing comfortably. Take the first step. Get the facts about dental implants. See your dentist or a member of the American Association of Oral and Maxillofacial Surgeons. With their training and expertise, they can determine if dental implants are right for you.

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Cosmetic Maxillofacial Surgery
Cosmetic maxillofacial surgery is used to repair physical malformations resulting from disease, injury, burns, birth defects or aging. It may also serve to restore normal function and improve individual appearance. Cosmetic maxillofacial surgery can be performed using a variety of techniques, and several different procedures are available to correct specific conditions. Because of their surgical and dental background, oral and maxillofacial surgeons are uniquely qualified in the treatment of the face, mouth, teeth and jaws. Extensive education and training in surgical procedures involving both the soft tissue (skin and muscle) and hard tissue (bone and cartilage) of the maxillofacial area make the oral and maxillofacial surgeon finely attuned to the importance of harmony between facial appearance and function.

IS COSMETIC SURGERY FOR YOU?
Individuals elect to pursue cosmetic surgery for a variety of reasons. For some, the decision is prompted by the need to repair damage caused by accidents or birth defects. In many instances, however, individuals choose cosmetic surgery to improve their personal appearance.

Before any procedure is performed, your surgeon will request a thorough medical history to evaluate your overall general health. A careful physical examination also will be conducted. You will discuss the procedure to be performed, the anticipated results, expected changes in your appearance, type of anesthesia to be used, and possible risks and complications.

Cosmetic maxillofacial surgery may be performed on an outpatient basis in your oral and maxillofacial surgeon’s office, surgical facility, or surgery center, or on an inpatient basis in the hospital, depending upon your surgeon’s and your preference. Surgery may be performed under general anesthesia, IV sedation, or local anesthesia.

FACING THE FACTS
While a majority of patients report enhanced self-confidence and self-esteem after their surgeries it is important to understand that the goal of surgery is to improve appearance. Cosmetic maxillofacial surgery will refine and enhance features that already exist, it will not give you a new face or a new life. How much or how little change is realized depends on the individual and the extent of surgery. Your age, health, skin texture, bone structure and healing capacity are all factors that can affect the results of your surgery. Your expectations and attitude also will play a major role in your recovery. It is important that you discuss the procedure thoroughly with your surgeon and proceed with realistic expectations. Cosmetic maxillofacial surgery will require patience on your part. The final result of your surgery may not be immediately apparent. Each procedure outlined in this brochure entails a reasonable recovery period during which you may experience some swelling, bruising and discomfort which are part of the normal healing process Cosmetic maxillofacial surgical procedures are relatively common, but as with any surgery, cosmetic surgery entails a measure of risk. You should discuss with your surgeon the possible risks and complications of the procedure under consideration. Costs vary depending on the geographic area and the complexity of the procedure to be performed. Cosmetic maxillofacial surgery is often considered “elective” rather than medically necessary and, as such, it is normally not covered by insurance. Because insurance companies and policies vary, you should check with your agent to determine if your surgery is covered.

COMMON PROCEDURES
Facelift (Rhytidectomy)
The natural aging process, genetic influences, exposure to sun and other factors cause the skin to wrinkle and sag as it fits the body more loosely. Skin folds become
more prominent, especially around the chin, jaw line and neck. A rhytidectomy, or facelift, can give you a more youthful appearance by tightening facial skin and muscles and removing excess skin. When a facelift is performed, connective tissue and sagging muscles are tightened. In some cases, fat deposits are reduced from beneath the chin and neck, allowing the skin to reposition in a more ideal manner.

Nasal Reconstruction (Rhinoplasty)
Those displeased with the size and/or shape of their nose can improve their appearance through nasal reconstruction, or rhinoplasty. Rhinoplasty is one of the most commonly performed cosmetic procedures today. During rhinoplasty, corrections are made by removing, rearranging or reshaping bone or cartilage. The procedure can straighten crooked noses, narrow or widen noses or remove humps. Rhinoplasty is usually not performed until a person has reached their mid-teens, when growth is nearly complete.

Cosmetic Surgery of the Eyes (Blepharoplasty, Forehead/Brow Lift)
Blepharoplasty can correct sagging eyelids, pouches beneath the eyes and excess folds around the eyes. Brow and forehead lifts raise eyebrows and reduce ridges and furrows on the forehead, creating a smoother, younger appearance. A blepharoplasty may be performed on either the upper or lower eyelids, or both during the same operation. Excess fat, muscle and skin is removed to eliminate sagging eyelids. Incisions are made in the natural skin creases around the eyelids, making scars inconspicuous.

A forehead and brow lift is often done in conjunction with blepharoplasty to improve brow positioning and reduce forehead wrinkles. During a forehead and brow lift, an incision is made across the top of the head behind the hairline. The forehead and brows are elevated and excess skin is removed from behind the hairline to hide the resulting scar. the cheekbone.

Facial Liposuction
Even people who are not overweight may be plagued by a double chin, saggy jowls or a very round face. Fat deposits in these locations may be hereditary or due to the natural aging process. These areas are often resistant to exercise and weight loss. Facial liposuction can benefit those who want to remove unsightly fat deposits from localized areas of the face. Individuals who are in good physical condition with good skin elasticity are the best candidates for this surgery. The surgeon makes small incisions along the jawline, in the cheeks or below the chin, depending upon which fat deposits are to be removed. A tube attached to a high pressure suction device is inserted deep in the fat. The surgeon moves the tube back and forth to loosen excess fat from surrounding tissue and then “vacuums” the loose fat from the face with the suction device.

Treatment of Facial Scarring (Dermabrasion)
Dermabrasion is a surgical procedure in which skin that has been scarred from trauma, acne, pox or other causes, is “sanded” with a rotary abrasive instrument. This “sanding” evens out the skin to give it a smoother texture. Dermabrasion also may be used to treat tattoos, age (liver) spots, wrinkles and certain skin lesions.

TAKE A CLOSER LOOK
Remember, the decision to have cosmetic maxillofacial surgery is not one to be entered into lightly. If you are interested in learning more about these procedures and determining if you are a candidate for cosmetic surgery, please contact our office. We will be happy to answer your questions and arrange for an initial consultation.

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Corrective Jaw Surgery (Orthognathic Surgery)
Jaw growth is a slow and gradual process. Occasionally, something may go wrong with this process and the upper and lower jaws may grow at different rates.

UNEQUAL JAW GROWTH—A CAUSE FOR CONCERN
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 malrelationship. 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 malrelationship. In addition, jaws of different sizes—that don’t match—can affect appearance.

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.

TAKE A CLOSER LOOK
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, have your oral and maxillofacial surgeon examine your face and bite.

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Anesthesia

EXTENSIVE SCHOOLING AND EXPERIENCE IN THE CONTROL OF PAIN AND ANXIETY
Your oral and maxillofacial surgeon not only is a specialist in dealing with problems of the mouth, teeth and jaws, but also is experienced in dealing with the control of pain and anxiety. During years of hospital training, the oral and maxillofacial surgeon receives extensive schooling in medical and dental aspects of anesthesia. Your oral and maxillofacial surgeon is thoroughly knowledgeable in pain and anxiety control and possesses extensive clinical experience in anesthesia techniques, from local anesthesia to sedation to general anesthesia.

PUTTING YOUR MIND AT EASE
One of the things your oral and maxillofacial surgeon has been taught in terms of reducing anxiety is the importance of making the patient aware of what to expect during surgery. It’s usually true; the more you know, the less you have to be anxious about. That’s why beforehand, you’ll review with your surgeon the type of anesthetic to be used, as well as the way you’re likely to feel during the operation. Your oral and maxillofacial surgeon will answer any questions you may have about any facet of the operation. During surgery, one or more of the following can be used in controlling pain and anxiety: local anesthesia, nitrous oxide-oxygen, intravenous sedation and general anesthesia. Commonly, patients describe their feelings during surgery as surprisingly pleasant, without a care in the world. After surgery, your oral and maxillofacial surgeon can prescribe a number of medications to make you as comfortable as possible when you get home. Suffice it to say that before, during and after surgery, your oral and maxillofacial surgeon truly shares your concern for your well being. Beyond that, though, your oral and maxillofacial surgeon also has the training, the knowledge and the experience to make your visit as pleasant and comfortable as it possibly can be.

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Wisdom Teeth

Most people start getting their third molars (also called wisdom teeth) when they reach their late teens or early twenties. In many cases, the jaws are not large enough to accommodate these teeth and they remain under the gum (impacted).

WHAT IS AN IMPACTED TOOTH?
When a tooth develops, it travels to its appropriate position in the dental arch. If the path to eruption through the gum is prevented due to the size of the jaw, the tooth will become partially or totally blocked (impacted).

HOW SERIOUS IS AN IMPACTED TOOTH?
Serious problems can develop from partially blocked teeth such as infection, and possible crowding of and damage to adjacent teeth. More serious complications can develop when the sac that surrounds the impacted tooth fills with fluid and enlarges to form a cyst, causing an enlargement that hollows out the jaw and results in permanent damage to the adjacent teeth, jawbone and nerves. Left untreated, a tumor may develop from the walls of these cysts and a more complicated surgical procedure would be required for removal.

MUST THE TOOTH COME OUT IF IT HASN’T CAUSED ANY PROBLEMS YET?
No one can tell you when your impacted molar will cause trouble, but trouble will probably arise. When it does, the circumstances can be much more painful and the teeth can be more complicated to treat.

WHEN SHOULD I HAVE MY IMPACTED TEETH REMOVED?
The key to timely attention to third molars is regular x-rays of the mouth. With the help of these pictures the oral and maxillofacial surgeon can frequently predict if the wisdom teeth are going to cause trouble, either in the near future or later in life. If so, chances are the oral and maxillofacial surgeon will recommend their removal rather than wait for trouble to occur. Removal is easier in younger patients. Roots are not yet fully developed and the bone is less dense. In older patients, removal before complications develop is key to shorter recovery and healing time and minimizing discomfort after surgery.

WHAT HAPPENS AFTER SURGERY?
Generally after surgery the patient experiences some swelling and discomfort. However, with personalized postoperative instructions and medications, the oral and maxillofacial surgeon can reduce the possible discomfort following surgery.

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Facial Trauma

There are people specially trained to deal with injuries to the mouth, face, and jaw: oral and maxillofacial surgeons. Their training and experience uniquely qualify them to deal with these types of injuries. These can include a wide range of injuries, from facial cuts and lacerations to more serious problems, like broken teeth and fractured facial bones.

THE SERIOUS SIDE OF FACIAL INJURY
One of the most common types of serious injury to the face occurs when bones are broken. Fractures can involve the lower jaw, upper jaw, palate, cheekbones, eyesocket, and combinations of these bones. These injuries can affect sight, and the ability to breathe, speak and swallow. Treatment often requires hospitalization.

SPECIALIZED TREATMENT
The principles of treatment for facial fractures are the same as for a broken arm or leg. The parts of the bone must be lined up (reduced) and held in position long enough to permit them time to heal. This may require six or more weeks depending on the patient’s age and the fracture’s complexity. When fractures are extensive, multiple incisions to expose the bones and a combination of wiring or plating techniques may be needed. The repositioning technique used by the oral and maxillofacial surgeon depends upon the location and severity of the fracture. In the case of a break of the upper or lower jaw, metal braces may be fastened to the teeth and rubber bands or wires used to hold the jaws together. Patients with few or no teeth may need dentures or specially constructed splints to align and secure the fracture. What’s more, many individuals who sustain facial fractures have other medical problems and the oral and maxillofacial surgeon is trained to coordinate his or her treatment with that of other doctors. During the healing period, when jaws are wired shut, the oral and maxillofacial surgeon prescribes a nutritional diet. This helps the injury heal as quickly as possible by keeping the patient in good health. After discharge from the hospital,
the doctor gives the patient instructions dealing with continued facial and oral care.

DON’T TREAT ANY FACIAL INJURY LIGHTLY
Of course, not all facial injuries are extensive. The thing you should remember, though, is that they are all complex. Even in the case of a moderately cut lip, the expertise of the oral and maxillofacial surgeon is indispensable. If sutures are needed, placement must be precise to bring about the desired cosmetic result. So a good rule of thumb is that you shouldn’t take any facial injury lightly. Not only that, but facial injuries are in a critical area of the body. after all, the functions of breathing, eating, speaking and seeing are located there.

PREVENTION—THE BEST POLICY
Because avoiding injury is always best, the oral and maxillofacial surgeon is a staunch advocate of the use of automobile seat belts. For the same reason, the use of protective mouth guards, and appropriate masks and helmets for athletes is recommended. The oral and maxillofacial surgeon maintains a constant vigilance, warning the public of hidden everyday hazards to their health. Now, as always, your oral and maxillofacial surgeon’s concern is not just with oral health, but extends to the total health of the individual.

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Temporomandibular Joint Disorders (TMJ, TMD)

The temporomandibular joint (TMJ) is a small joint located in front of the ear where the skull and lower jaw meet, which allows the lower jaw (mandible) to move and function.
TMJ disorders have a variety of symptoms. Patients may complain of earaches,
headaches and limited ability to open the mouth. They may also complain of clicking or grating sounds in the joint and feel pain when opening and closing the mouth. What must be determined, of course, is the cause.

WHAT CAUSES TMJ DISORDERS?
Arthritis is one cause of TMJ symptoms. It can result from an injury or from grinding of the teeth at night. Another common cause involves displacement or dislocation of the disc that is located between the jawbone and the socket. A displaced disc may produce clicking or popping sounds, limit jaw movement, and cause pain during opening and closing of the mouth. There are also conditions such as trauma or rheumatoid arthritis that can cause the parts of the TMJ to fuse, preventing jaw movement altogether.

SOMETIMES THE JOINT ITSELF IS THE PROBLEM
Stress may trigger pain in the jaw muscles that is very similar to that caused by TMJ problems. Such patients frequently clench or grind their teeth at night causing painful spasms in the muscles and difficulty in jaw movement. Patients may also have a
combination of muscle and joint problems. That is why diagnosing TMJ disorders can be complex and may require different diagnostic procedures. Determining the cause of a TMJ problem is important, because it is the cause that guides the treatment.

THE ROLE OF THE ORAL AND MAXILLOFACIAL SURGEON
When symptoms of TMJ trouble appear, an oral and maxillofacial surgeon should be consulted. A specialist in the areas of the mouth, teeth and jaws, the oral and maxillofacial surgeon is in a good position to correctly diagnose the problem. Special imaging studies of the joints may be ordered and appropriate referral to other dental or medical specialists or a physical therapist may be made.

RANGE OF POSSIBLE TREATMENT
The oral and maxillofacial surgeon’s treatment may range from conservative dental and medical care to complex surgery. Depending on the diagnosis, treatment may include short-term medications for pain and muscle relaxation, bite plate or splint therapy, and even stress management counseling. Generally, if nonsurgical treatment is unsuccessful or if there is clear joint damage, surgery may be indicated. Surgery can involve either arthroscopy (the method identical to the orthopaedic procedures used to inspect and treat larger joints such as the knee) or repair of damaged tissue by a direct surgical approach. Once TMJ disorders are correctly diagnosed, appropriate treatment can be provided.

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Oral Cancer

Because the mouth is a region where changes can be easily seen, oral cancer can be detected in the early stages. Performing a self-examination regularly will help in early recognition. Oral and maxillofacial surgeons recommend that everyone do an oral cancer self-exam once a month. If you are at a high risk for oral cancer—smoker, consumer of alcohol, user of smokeless tobacco—you should also see your oral and maxillofacial surgeon for an exam yearly.

The things to look for when performing an oral lesion self-examination are:
  _ reddish patches - erythroplasia
  _ whitish patches - leukoplakia
  _ a sore that fails to heal and bleeds easily
  _ a lump or thickening of the tissues
  _ chronic sore throat or hoarseness
  _ difficulty in chewing or swallowing

To complete an oral examination, using a bright light and a mirror:
  _ remove any dentures
  _ look and feel inside of lips, the front of gums
  _ tilt head back to look at and feel the roof of your mouth
  _ pull the cheek out to see the inside and also to see the back gums
  _ put out your tongue, look at all surfaces
  _ feel for lumps or enlarged lymph nodes (glands) in both sides of the neck and under the lower jaw.

EARLY DETECTION AND TREATMENT MEAN A BETTER CHANCE OF CURE
If you have any of the aforementioned signs, see your oral and maxillofacial
surgeon. Should the oral and maxillofacial surgeon agree that something looks suspicious, a biopsy may be recommended. This is a procedure that involves the removal of a piece of the suspicious tissue. The piece is then sent to a pathology laboratory for microscopic examination in order to make an accurate diagnosis of the problem. The biopsy report not only helps in establishing a diagnosis, but enables the doctor to make a treatment plan specifically designed for the type of lesion diagnosed.

FACTORS THAT MAY CAUSE CANCER
Research has determined a number of factors that may contribute to the development
of oral cancer. The most common are the use of tobacco and alcohol. Others include poor oral hygiene, irritation caused by ill-fitting dentures and rough surfaces on teeth, poor nutrition and combinations of these factors. Studies have shown that the death rate from oral cancer is about four times higher for cigarette smokers than for
nonsmokers. It is also widely believed in the medical field that the heat generated
by smoking pipes and cigars irritates the mouth and can lead to lip cancer.
Those at an especially high risk of contracting oral cancer are males over 40
years of age who are combination heavy drinkers and smokers, or users of smokeless tobacco.

Keep in mind that your mouth is one of your body’s most important early
warning systems. Don’t ignore any suspicious lumps or sores. Should you discover something, make an appointment for a prompt examination. Early treatment may well be the key to complete recovery.

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