Face & Tooth Trauma
Danoff Dental & Associates, LLP in NYC, two dental offices located in Great Neck and the Little Neck dental office serving Queens and surrounding neighborhoods.
Distraction Osteogenesis (DO) is a treatment for some deformities and defects of the oral and facial skeleton. Distraction Osteogenesis, first used in 1903 became popular in western medicine in the 1960's, has provided Danoff Dental & Associates, LLP with a safe and predictable method to treat selected deformities of the oral and facial skeleton. Distraction Osteogenesis means the slow movement apart (distraction) of two bony segments in a manner such that new bone is allowed to fill in the gap created by the separating bony segments. Distraction Osteogenesis Surgery is usually done on an outpatient basis with most of the patients going home the same day of surgery. The surgical procedure itself is less invasive so there is usually less pain and swelling.
Distraction Osteogenesis works well on patients of all ages. In general, the younger the patient the shorter the distraction time and the faster the consolidation phase. Adults require slightly longer period of distraction and consolidation because the bone regenerative capabilities are slightly slower than those of adolescence or infants.
Frequently Asked Questions
Q: Will my insurance company cover the cost of Osteogenesis surgical procedure?
A: Most insurance companies will cover the cost of the Osteogenesis surgical procedure provided that there is adequate and accurate documentation of the patient's condition. Of course, individual benefits within the insurance company policy vary. After you are seen for your consultation at our office, we will assist you in determining whether or not your insurance company will cover a particular surgical procedure.
Q: Is Distraction Osteogenesis a painful procedure?
A: Since all Distraction Osteogenesis surgical procedures are done while the patient is under general anesthesia, pain during the surgical procedure is not an issue. Post-operatively, you will be supplied with appropriate analgesics (pain killers) to keep you comfortable, and antibiotics to fight off infection. After surgery there is no more discomfort that having braces tightened.
Q: What are the advantages of Distraction Osteogenesis versus traditional surgery for a similar condition?
A: Distraction Osteogenesis surgical procedures typically produce less pain and swelling than the traditional surgical procedure for a similar condition. Distraction Osteogenesis eliminates the need for bone grafts and provides greater stability in cases where significant movement of bony segments are involved.
Q: What are the disadvantages of Distraction Osteogenesis?
A: Distraction Osteogenesis requires the patient to return to the surgeon's office frequently during the initial two weeks after surgery. This is necessary because in this time frame the surgeon will need to closely monitor the patient for any infection and teach the patient how to activate the appliance. In some cases, a second minor office surgical procedure is necessary to remove the distraction appliance.
Q: Can Distraction Osteogenesis be used instead of bone grafts to add bone to my jaws?
A: Yes. It has become an easy process to place and use a distraction device to slowly grow bone in selected areas of bone loss in the upper and lower jaws. The newly formed bone can then serve as an excellent foundation for dental implants.
Q: Does Distraction Osteogenesis leave scars on the face?
A: No. The entire surgery is done within the mouth and the distraction devices used by Danoff Dental & Associates, LLP remain inside the mouth. There are no facial surgical incisions are made so no unsightly facial scars result.
Orthognathic surgery is needed when jaws don't meet correctly and/or teeth don't seem to fit with jaws. Teeth are straightened with orthodontics and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly. People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing function, speech, long-term oral health and appearance. Injury to the jaw and birth defects can also affect jaw alignment. Orthodontics alone can correct bite problems when only the teeth are involved. Orthognathic surgery may be required for the jaws when needing repositioning.
Difficulty in the following areas should be evaluated:
- difficulty in chewing, biting or swallowing
- speech problems
- chronic jaw or TMJ pain
- open bite
- protruding jaw
- breathing problems
Any of these can exist at birth or may be acquired after birth as a result of hereditary or environmental influences or the result of trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination with x-rays. Feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team will make the decision to proceed with treatment together.
Orthognathic Surgery Technology
Danoff Dental & Associates, LLP uses comprehensive facial X-rays and computer video imaging, to show you how your bite will be improved and even give you an idea of how you will look after surgery. Danoff Dental & Associates, LLP wants you understand the surgical process and the extent of the treatment prescribed and to see the benefits of orthognathic surgery.
If you are a candidate for Corrective Jaw Surgery, Danoff Dental & Associates, LLP will work closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional and healthy dental-facial relationship.
Bone grafting is commonly performed by an oral and maxillofacial surgeon to replace or augment bone in areas of tooth loss. Bone grafting to the jaws and facial structures may be necessary in a wide variety of scenarios. The most common bone grafts are facial skeleton and jaw procedures. Other common procedures include tooth extraction site graft, bone graft reconstruction and for a sinus lift. Shrinkage of bone often occurs when a tooth is lost due to trauma, severe caries, or periodontal disease. Additionally, bone loss may have already occurred due to infection or pathology around a tooth. There are many artificial biocompatible bone substitutes available; however, the best material for a bone graft is your own bone, which most likely will come from your chin, the back part of your lower jaw or your hip bone. The hip is considered to be a better source because the hip bone has a lot of marrow, which contains bone-forming cells. There are also synthetic materials that can be used for bone grafting. Most bone grafts use a person's own bone, possibly in combination with other materials.
To place the removed bone in the recipient site, little holes are drilled in the existing bone to cause bleeding. This is done because blood provides cells that help the bone heal. The block of bone that was removed will be anchored in place with titanium screws. A mixture of the patient's bone marrow and some other bone-graft material will then be placed around the edges of bone block. Finally, a membrane is placed over the area and the incision closed.
The bone graft will take about 6 to 12 months to heal before dental implants can be placed. At that time, the titanium screws used to anchor the bone block in place will be removed before the implant is placed.
Oral and maxillofacial surgeons are trained, skilled and uniquely qualified to manage and treat facial trauma. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bone injuries and fractures, or injuries to special regions such as the eyes, facial nerves or the salivary glands. Oral and maxillofacial surgeons are well versed in emergency care, acute treatment and long-term reconstruction and rehabilitation both physical and emotional.
This refers to a tooth or teeth (primary or permanent) that have become 'fused' to the bone, preventing it or them from moving 'down' with the bone as the jaws grow. This process can affect any teeth in the mouth, but it is more common on primary first molars and teeth that have suffered trauma (typically the incisors). Treatment can vary depending on the degree of severity of the ankylosis (how 'sunken into the gums' a tooth may appear). The degree of severity usually will vary depending on how early the process started, and as a general rule, the earlier it starts, the more severe the ankylosis becomes with age. Several considerations must be taken before any treatment is provided, and your dentist will discuss all the risks and benefits of each treatment option.
Impacted canines may be retrieved with braces, using a surgical approach via a gold chain or straight wire. Tissue covering the tooth is uncovered. A chain or wire is attached to the tooth crown. Tissue is placed back over the tooth leaving the chain or wire coming out of the gum. For the purpose of this illustration a gold chain is used to retrieve the canines. The chain is attached to the tooth crown and the link is attached to a flexible archwire so that the wire is active (bent). Once a month, the wire is reactivated by using the next link up on the chain until the impacted canine erupts enough to attach a regular bracket on the canine. With the regular bracket in place, a more flexible wire is added directly to the bracketed canine. This process will bring the canine into position within the arch by forcing the canine to conform to the straight archwire form. This is a long process taking anywhere from 8-12 months.