Extractions & Other Procedures

Wisdom Teeth Removal

Wisdom teeth also known as the 3rd molars and are the last teeth to form within the jaws. Wisdom teeth commonly attempt to erupt between the ages of 16-21. Frequently the wisdom teeth grow sideways and partially emerge through the gum and remain partially trapped beneath the soft tissues and bone. However, they still allow debris and bacteria to penetrate deeply beneath the surface causing chronic and, at times, severe infections. If a wisdom tooth has adequate room to fully erupt (so it is completely cleansable and in proper contact with an opposing tooth) and the gum tissue is healthy, the tooth may not need to be removed. Unfortunately, for the vast majority of individuals, this is not the case. Removal of wisdom teeth is strongly recommended when they are unable to erupt normally to prevent many potential problems.

Reasons to have your wisdom teeth removed

  • Infection / Bacteria (Chronic or Acute/Severe)
  • Wisdom Teeth can Cause Crowding / Shifting of Other Teeth & Orthodontic Relapse
  • Jaw Cysts / Tumors Can Develop Around Retained Impacted Teeth
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THERE ARE MANY BENEFITS TO HAVING YOUR WISDOM TEETH REMOVED

Tooth Extraction

Sometimes baby teeth do not exfoliate (come out) as they should, and the tooth must be removed to make room for the permanent tooth to erupt (come in). A tooth that decays puts the surrounding teeth and jaw at risk. A tooth may have advanced periodontal disease or have broken in a way that cannot be repaired. Infection/abscess, orthodontic treatment, problems associated with wisdom teeth, and other anomalies can all require tooth removal. If a permanent adult tooth needs removal, Dr. Catalano may recommend placing a dental implant to replace it.

YOU MAY NEED A TOOTH EXTRACTION FOR A VARIETY OF REASONS

Dental Implants

When a tooth is extracted, you lose both the root and the crown. To replace the missing tooth, Dr. Catalano may recommend a dental implant. Implants are a great option as their strength comes from their composition of titanium. Implant replacements are made of three components:

  • The Dental Implant (commonly known to the patient as a “post or screw”) which acts as a tooth “roof”.
  • The Tissue Former (or healing abutment), which helps to mold or shape the surrounding gum tissues.
  • Dental Crown (Prosthetic tooth) which is made and placed by the patient’s restoring dentist (not by Dr. Catalano).

The implant (titanium post) is surgically placed in the bone by Dr. Catalano. The restoring dentist (your general dentist) will create and secure the final crown typically several months later. Implants are anchored into the jaw securely. When adding a dental implant, time is allowed for bone to grow around and into the implant (osseointegration) and heal. The bone bonds with the titanium creating the foundation for a strong artificial tooth. The tissue former/abutment is placed on the implant shapes the gum tissue that will be around the final crown. Finally, the restoring general dentist will place/attach the new crown (tooth) to the implant and the artificial yet “life like” tooth is complete.

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DENTAL IMPLANTS CAN IMPROVE THE QUALITY OF YOUR LIFE

Pre-Prosthetic Surgery

On occasion, some patients require oral surgical procedures before receiving their full or partial denture to ensure maximum level of comfort and a proper fit. If a tooth needs to be extracted, or the bone needs to be reshaped, oral surgery may be required to make the prosthesis fit correctly. A denture sits on the bone ridge, so it is very important that the bone is the proper shape and size. In some situations, excess bone may need to be removed prior to denture insertion.

Type of Procedures Offered

  • Alveoplasty (Bone smoothing and reshaping)
  • Excess bone removal (or removal of bony “tori”-benign bony outgrowths)
  • Bone ridge reduction
  • Excess gum tissue removal
PREPARING THE MOUTH FOR TOOTH REPLACEMENTS

Expose and Bond

If a tooth fails to erupt on the expected timeline, an orthodontist will refer the patient to an oral surgeon for an “Expose-and-Bond” procedure. A tooth may not be erupting due to its position, and if so, is unlikely to every erupt on its own. The position of an un-erupted tooth could damage the roots of adjacent teeth if it is not relocated to its proper position. Cysts can form around un-erupted teeth and damage adjacent tooth roots and bone even if the tooth does eventually erupt, it will not likely be in a functional position.

During the Procedure

An un-erupted tooth is exposed, and an orthodontic bracket with a tiny gold chain may be attached to the newly exposed tooth and connected to the patient’s orthodontia.

WHY EXPOSE AN IMPACTED TOOTH?

Sedation

IV Sedation (Moderate Sedation)
IV (intravenous) sedation is an excellent choice for your future oral surgery procedure, and often is a covered benefit under your dental insurance plan. IV Sedation allows you to have your surgery while feeling or remembering virtually nothing at all. Dr. Catalano highly recommends IV Sedation for any of his patients that are candidates. Typically, patients have no memory of their procedure and feel nothing during that time. Dr. Catalano chooses to personally administer “start” his patient’s IV’s himself. He takes pride in making sure the patient is comfortable and feels safe. He treats his patients like family and has over 25 years of IV Anesthesia experience. Our staff have been told countless times by our patients how much easier receiving the IV was then they had expected.

The IV is placed usually in the wrist or forearm area. Anesthesia medications trickle through the IV that slowly and gently drift you off to sleep. The level of sedation can be monitored and adjusted as needed throughout the procedure to maintain optimal and consistent sedation. The level of sedation may at times be influenced/guided by a person’s age, body weight or health history. Requirements for IV Sedation include a totally empty stomach (nothing to eat or drink after midnight the night before). You will need a driver to and from the procedure, should you choose IV Sedation. Dr. Catalano wants your experience to be as easy for you as possible in the safest and most secure environment.

Nitrous (Inhaled Light Sedation)
A small nasal mask is placed over the nose and you breathe a carefully controlled mixture of oxygen and nitrous oxide (some people know this as “laughing gas”). The gas helps you to feel relaxed. Dr. Catalano will monitor and control the amount of sedation you receive custom to your needs. The affects wear off shortly after the procedure is completed. Nitrous is the only form of sedation where you can drive yourself home after the procedure. Nitrous Oxide can be used in both children and adults, usually for short procedures.

Oral sedation. (Conscious Light to Moderate Sedation Via Oral Pill)
This is a great option for patients undergoing relatively shorter procedures who do not need IV Sedation but would prefer something to help them feel relaxed prior to and during their procedure. Depending on the medication and dose chosen, oral sedation ranges from light to moderate sedation. Oral sedation is safe and effective for all ages. The medication is typically in pill form and prescribed preoperatively via a prescription to your pharmacy. It may also be given in liquid form in the office (usually for pediatric patients). Oral sedation can also be prescribed as a premedication for IV Sedation patients in order to help them feel comfortable prior to their procedure.

Local anesthesia. (Lidocaine, Septocaine, Marcaine and or Carbocaine)
Dr. Catalano administers local anesthesia himself (the most common ones he uses are listed above). Dr. Catalano has specialty training to administer a large variety of regional (nerve blocks) and local applications. Before you receive the local anesthesia, the surgical assistant will apply a topical anesthetic to your surgical area to reduce surface sensitivity. Local anesthesia is used for every procedure. Local is done in conjunction with the sedation of your choice, although it is perfectly acceptable to have a procedure with only local anesthesia if desired. Although you may feel some pressure and movement, you will not experience pain. If you have ever had an allergic reaction to any local anesthetic during a dental treatment, or other medical treatment, please let Dr. Catalano know during your consultation. He may request you have allergy testing done with an allergist prior to your procedure in our office.