New Jersey Oral & Maxillofacial Surgery Associates - Hackensack

We generally recommend an evaluation in the mid to late teen years. This evaluation should consist of an oral examination and x-rays of the mouth.

A wisdom tooth that is deemed problematic is normally extracted to avoid any oral complications. To have a wisdom tooth removed, a small incision is made to open up the gum tissue over the tooth and remove any bone that is covering the tooth. Once the tooth is in view, it is gently grasped with a dental instrument, known as a forcep, and gently rocked back and forth to loosen it from the jaw bone and surrounding ligaments. Sometimes the tooth may need to be cut into smaller pieces to make it easier or removal. Stitches may be necessary after the removal of a wisdom tooth.

Oral and Maxillofacial surgeons are uniquely trained to manage pain and anxiety in an outpatient surgical setting. Our anesthesia training includes 9-12 months of full time, comprehensive exposure to multiple anesthetic techniques in an operating room environment. As oral surgeons we have routinely provided outpatient intravenous anesthesia for over 50 years.

Local anesthesia is the most common technique used in dental offices for pain control. Based on the patient and clinical situation, we may utilize any one of a number different local anesthetic agents for your surgical procedure. In addition, our offices are equipped for the administration of inhalation anesthetic agents that range from nitrous oxide (laughing gas) to full inhalation general anesthetics. For many patients, intravenous medication may be required and these drugs may be used to provide conscious sedation or general anesthesia. All of our anesthetized patients are fully monitored utilizing state of the art anesthesia monitors. The doctors and staff are trained in the management of medical and anesthetic emergencies. Emergency equipment and associated drugs are regularly maintained and readily available.

We also have the ability to manage most pediatric cases in a safe, comfortable and non-threatening environment. We are aware that pediatric problems often surface without notice and these cases are given a priority during our busy day. As always, we ask for your cooperation and understanding in emergency situations.

Orthognathic surgery may be considered when the upper (maxilla) and lower (mandible) jaws meet incorrectly and/or teeth do not seem to fit within the jaws. Your teeth and facial bones can be repositioned to create a more balanced appearance with jaws that work well together.

Our office will work closely with your orthodontist and restorative dentist to assess your teeth and facial bones. This will enable us to determine what we can do to achieve your intended goal. The pre-treatment consultation process will include a series of specific facial x-rays with x-ray analysis, clinical photographs, dental stone models (reproductions of your teeth) and coordination with your entire dental team (orthodontist and restorative dentist).

We are trained, skilled and uniquely qualified to manage and treat acute injuries to the facial skeleton. We are very fortunate to be an integral part of the trauma team at Hackensack University Medical Center. The Medical Center is recognized nationally for its emergency services and is a state designated Level II Trauma center.

Our emergency room coverage for facial injuries includes:

• Facial lacerations
• Intra oral lacerations
• Avulsed (knocked out) teeth
• Fractured facial bones (cheek, nose, or eye socket)
• Fractured jaws (upper and lower jaw)

Depending on the type of facial trauma sustained there are many different treatment options available. However, the goal of treatment is to stop any bleeding from occurring, create a clear airway, repair any broken or fractured bone, and or suture any damaged soft tissue. Treatment is immediate, as long as there are no neck fractures or life-threatening injuries.

Dental implants are changing the way people live. Modern implants (Osseointegrated Implants- implants bonding to directly to bone) are designed to provide a firm foundation for the replacement of teeth.

Osseointegrated implants look, feel and function like natural teeth. The person who has lost teeth may lose the ability to eat comfortably and speak confidently, which can have a profound effect on their entire personality. We will work closely as part of your dental implant team with your restorative dentist to prepare your jaw for placement of the appropriate implant prosthesis. We are confident that your restoration will look and feel natural and preserve your facial contours.

The placement of dental implants is a surgical procedure that can predictably replace missing teeth and roots. The “new generation” of osseointegrated implants are small titanium cylinders that are surgically placed into the jawbone where the teeth are missing. For most patients, the placement of dental implants will involve two surgical procedures. First stage surgery, consists of implants being surgically placed within your jawbone. During the healing phase (osseointegration) bone bonds directly with the titanium cylinder. The second stage, typically two to six months following your first stage surgery, involves exposing the implant surface and attaching a post, which now will allow for a wide range of dental prosthetic attachments.

A jaw bone (maxilla/mandible) that is without teeth for an extended period of time will gradually resorb and atrophy (disintegrate or wash away). This often results in a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In most cases where osseointegrated implants are being considered the limiting factor is the amount of bone available to place the implants. The amount of bone may be deficient in either a vertical or horizontal dimension. This lack of viable bone will necessitate a bone grafting procedure to restore the anatomy and allow for proper prosthetic treatment.

We now have the ability to graft autogenous (bone harvested form the same patient) bone when indicated. This gives us the opportunity to place implants of proper length and width, but more importantly it provides the ability to restore proper function and aesthetics.

There are many types of bone grafting techniques and the following is a brief list of some of the procedures that we perform. These techniques are all case specific depending on the many variables that go into to coordinating your case.

Sinus Lift:
This procedure involves surgery above the maxillary posterior teeth. During this procedure we elevate the maxillary sinus membrane and place a bone graft that is harvested from another site in the mouth, onto the sinus floor. This will increase the amount of bone available for implants in a vertical direction and allow implants to be placed in the back part of the upper jaw.

Ridge Augmentation:
In severe cases the alveolar ridge (the alveolar ridge is the portion of bone in our mouths that generally supports the teeth) is reabsorbed and a bone graft is necessary to increase the ridge height and/or width to accommodate an osseointegrated implant. This procedure involves grafting autogenous bone (bone from the same person’s body) to the desired location in the mouth.

Nerve Repositioning:
When considering implants in the lower jaw, the inferior alveolar nerve, which gives feeling to the lower lip and chin, may restrict the quantity of bone available to place implants in the posterior aspect of the mandible. We now have the ability to reposition this rather large sensory nerve in order to make room for placement of dental implants to the lower jaw.

Immediate Extraction Socket Graft:
Often times an osseointegrated implant is considered as the replacement of choice for an extracted tooth. It may be advantageous to immediately fill the missing tooth socket with an artificial bone substitute to properly prepare the extraction site for ideal implant placement.

Platelet Rich Plasma (PRP), a growth factor, is a “cutting edge” technology that accelerates the healing process. Platelet Rich Plasma is a mixed gel that can be applied directly into tooth sockets and other sites. The use of PRP in tooth sockets after tooth extractions is capable of improving soft tissue healing and positively influencing bone regeneration.

Clinical Applications of PRP:

• Bone grafts for dental implants, sinus lift procedures, ridge augmentation procedures, and closure of cleft lip and palate defects.
• Repair of bone defects created by removal of teeth or small cysts
• Repair of fistulas between the sinus cavity and mouth

Advantages of PRP:

• Safety: PRP is a by-product of our patient’s own blood; therefore, disease transmission is not an issue.
• Convenience: PRP is processed in our office, under strict sterile conditions, simultaneously while the patient is undergoing an outpatient surgical procedure, such as placement of dental implants. The patients own blood is removed at the time of preparation of the IV site for general anesthesia.
• Faster healing: The super saturation of the wound with PRP, and the described growth factors, produces an increase of tissue synthesis and thus faster tissue regeneration.
• Cost effectiveness: Since PRP harvesting is performed with only a small portion of blood in the doctor’s office, the patient need not incur the expense of the harvesting procedure in the hospital or at the blood bank.

The lining of the mouth is normally lined with smooth, coral colored skin (mucosa). Any differentiation in this appearance could be a warning sign for a pathological process. Any change in color or thickness of any of the oral tissues should be investigated. If you experience difficulty swallowing, have a chronic sore throat or hoarseness or a sore that will not heal, you should see an oral surgeon for an evaluation.

TMJ (temporomandibular joint) disorders represent a family of problems related to your complex jaw joint. If you have experienced symptoms like pain or a “clicking” sound in the area of your “jaw hinge”, you will be glad to know that these problems are now more easily diagnosed and treated than they were in the past. TMJ can develop from clenching or grinding your teeth, an injury to your temporomandibular joint or even disease.  Whatever the cause, the results could include clicking upon movement, a grating noise, a misaligned bite or difficulty opening your mouth wide.

Diagnosis of TMJ disorders generally involves obtaining a comprehensive medical history, review of complaints and clinical examination. Generally x-rays of the jaws and jaw joints are obtained in the office. If more advanced imaging studies such as CT scans or MRI studies are required, appropriate referrals will be made directly through our office.

To treat TMJ disorders, first the cause has to be identified. In less severe cases, TMJ disorders can be treated with self-managed care (easting soft foods, using ice packs, avoiding extreme jaw movement) or nonsurgical treatments (anti-inflammatory medications, Botox injections, stabilization splints). In severe cases, surgical treatments (jaw joint replacements) may be necessary.

Sleep apnea is a disorder in which one experiences one or more pauses in breathing or shallow breaths while you sleep.

Sleep apnea is an ongoing condition that disrupts sleep and often goes undiagnosed. It is estimated that at least ten million Americans have unrecognized sleep apnea.

Sleep Apnea is a medical condition that is usually diagnosed utilizing a comprehensive history, clinical examination and a sleep study. A sleep study is usually performed at a sleep center. Our office is affiliated with the Institute for Sleep-Wake Disorders at Hackensack University Medical Center in Hackensack, New Jersey.

Sleep apnea can be treated with lifestyle changes, mouthpieces, breathing devices, and/or surgery. All treatment is focused on opening the airway passage in the back of the throat.

For mild sleep apnea, a custom fitted mouth piece or some lifestyle changes (weight loss, smoking cessation, clearing nasal passages) may be helpful.

For moderate to severe sleep apnea, a breathing device called CPAP (continuous positive airway pressure) or surgery to widen the breathing passages by shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw may be helpful. A CPAP machine uses a mask that fits over your mouth and/or nose and gently blows air into your throat. This air pressure helps keep your airway open while you sleep.

Distraction Osteogenesis is the creation of new bone by slowly separating two pieces of bone in such a way that new bone fills in the gap. This procedure is commomly performed on an outpatient basis with most patients going home the same day of surgery. The surgical procedure itself is less invasive so there is usually less pain and swelling, eliminates the need for bone grafts, thus reducing the number of surgical sites and can provide greater stability in cases where large areas of bone are involved.