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Pre-Surgery preparation includes reviewing patient treatment plans... always keeping the patient informed. |
Dr. DeFrancesco is equipped to handle your oral surgery procedures (as listed below) with a gentle touch and expert skills while he listens attentively to all your concerns. To help you understand your options we've included descriptions of some of our leading services on this page.
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“Checking Out” with Nadine and scheduling a surgery time... |
In most cases, as a new patient your first visit will be a 15- 30 minute consultation at which time Dr DeFrancesco will review your health history, examine your mouth at the area of your concern and read your x-rays that were sent by your refering dentist. A new or original Xray may also be taken at this time if needed. The doctor will discuss all your options. If your procedure is relatively simple and you are in good health the surgery may be performed at that visit as well. However in most cases the surgery is scheduled as soon as possible with our patient care coordinator either under local anesthetic or with IV Sedation.
Wisdom Teeth
Wisdom teeth or third molars, are the last teeth to develop. They are referred to as “wisdom teeth” because they usually appear during the late teens, or early twenties, i.e. “the age of wisdom”. In a majority of cases, the jaws of modern humans are smaller than their ancestors.
As a result, there is insufficient room for the third molars to erupt into proper alignment. These third molars are blocked and remain embedded in the jaw bone. This is why wisdom teeth cause more problems than any other teeth in the mouth. In fact, for nine out of ten people at least one wisdom tooth remains underneath the gum due to lack of space in the mouth.
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New “Digital” Radiography, with instant viewing and very low radiation exposure |
WHY REMOVE WISDOM TEETH ?
A tooth may just initially break through the gum tissue, a partial bone impaction, or it may fail to erupt at all and thus remain totally impacted. Wisdom teeth that are not causing pain may seem harmless enough. But if not removed early [16-21 years of age], they often will cause the following problems:
A. Infection - the mouth is full of bacteria that normally does not get past the protective layer of the gums. When an impacted tooth breaks through the gum's surface, bacteria can enter, causing decay of the impacted tooth or the gum tissue surrounding the tooth
[pericoronitis]. This infection can cause severe pain, swelling, stiffness of the jaws, and possibly a systemic illness with involvement of the lymph nodes of the neck accompanied by high fever.
B. Pain - Infection in a decayed wisdom tooth or the gum tissues surrounding an impacted tooth can cause pain. If the decayed wisdom tooth is not situated in a healthy position, or if it is not restorable, your dentist may recommend its removal. Headaches and sinus problems may improve following the removal of impacted teeth.
C. Crowding - An impacted wisdom tooth can crowd adjacent teeth out of proper alignment
If you are undergoing orthodontic treatment, your orthodontist will most likely recommend that your impacted wisdom teeth be removed during or shortly after your therapy is completed.
D. Cysts - When a tooth remains impacted, the formative sac remains in bone. Occasionally, the sac fills with fluid, forming an expanding cyst that can erode bone and endanger surrounding structures.
Conclusion - The removal of wisdom teeth is performed in our office or, in rare instances, in a hospital setting if the patient's medical condition warrants it.
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A gentle approach to surgery with local anesthesia |
If the tooth is impacted, an incision is made in the gum tissue and the tissue is trimmed back so the tooth can be seen. If bone is covering the tooth, it is removed in order to expose and extract the tooth. The tooth is removed in whole, or in some cases, it is sectioned and the segments are removed individually. Usually the procedure will take up to an hour, although the time can vary depending upon the complexity of the case.
POST-OPERATIVE CARE INSTRUCTIONS
In most cases normal activities can be resumed within a few days depending upon the degree of impaction and the patient's response to healing, medical history etc. Avoid exertive activities such as most athletics which could reactivate bleeding during this time. The recovery process will go more smoothly if the post operative instructions are followed strictly, such as; 1) no smoking for at least 4 or 5 days and 2) no use of straws when drinking to prevent the pressure of suction as these can result in creating a dry socket (an open pocket that becomes an invitation for infection and sensitivity to air); 3) a soft food diet should be adhered to for at least 2-3 days (puddings, jello, ice cream (not too cold ) mashed potatoes, soups at room temperature as the healing sites will be sensitive to extreme hot or cold, or any other “soft” foods are recommended); 4) avoid carbonated beverages and acidic foods such as oranges, tomatoes etc; and 5) apply ice packs for the first 24 hours (20 minutes on - 20 minutes off) followed by moist heat for the next day or two to prevent the discomfort of swelling; and 6) keep the excision sites clean with gentle swishing of warm salt water and gentle brushing. Read More...
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Post Op Exam "Patient healing well" |
Dental Implants
WHAT ARE DENTAL IMPLANTS ?
Dental implants are metal (titanium) anchors placed in the jaw bone to anchor artificial teeth where natural teeth are missing. Unlike other tooth replacements, such as removable dentures or fixed bridges that are cemented to your own teeth, dental implants are placed (“implanted”) into the jaw bone under the gum tissue. The implant “osseointegrates” meaning that the bone actually attaches itself to the implant.
If you want a dental restoration that looks and feels as though it's really part of your mouth, dental implants would definitely be worth your consideration.
ARE DENTAL IMPLANTS FOR YOU ?
Anyone who is missing teeth and can benefit from increased chewing efficiency, and improved appearance or speech is a candidate for dental implants.
You are a candidate for dental implants if :
- You have enough bone and dense enough bone, to secure dental implants
- You do not have a disease or condition that interferes with proper healing after
implant surgery.
We will design the treatment with your general dentist that will provide the optimum result for your dental needs. An examination and tests [if needed] help determine where the implants should be anchored in your jaw. New technology [3D Imaging] allows us to acquire detailed images of the surgical site for precise placement and comfort. Read More...
Special Surgical Procedures
If your mouth is not ideal for dental implants because of extensive bone loss, there are reconstructive procedures that can be performed to accommodate implant placement. They include:
- Bone Graft
Bone grafting can increase the jaw height and width. The bone needed can be taken
from other donor sites in your mouth. Alternatively, allogenic bone can be used.
- Tissue Regeneration
To encourage proper healing after a bone graft, an artificial membrane may be placed
along the bone edge. This membrane slows soft-tissue growth, giving the new bone
time to fuse with your jaw.
- Sinus Lift
If your upper jaw ridge is deficient in height because of sinus cavity enlargement,
bone can be added to the floor of the sinus to increase the height and thereby provide
anchorage for the implants.
- Advanced Extraction Therapy
Immediately after an extraction, the socket is filled with synthetic bone. This graft
enhances new bone growth in this area thereby preserving the integrity of the site
for potential future implant placement.
IV SEDATION AVAILABLE
All procedures can be accomplished with local anesthesia or IV Sedation. Because the patient's comfort is of utmost importance to the doctor, he generally recommends in office IV Sedation as the preferred anesthetic for more difficult surgery procedures. When the patient's health history is rather extensive and warrants special precautions be taken for anesthesia, the hospital setting is recommended (generally as an out-patient procedure). Dr. DeFrancesco is on staff at Allegheny General Hospital, so these surgeries would be performed at their out-patient surgery center.
For all in office IV Sedation cases, the anesthesia is administered by a group of certified Anesthesiologists who carefully monitor the administration of all sleep medications.
