Frequently Asked Questions
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Dr. Thomas S. Weil is a diplomate of the American Board of Oral and Maxillofacial Surgery and a fellow in the American Association of Oral and Maxillofacial Surgeons. After receiving his Bachelor of Arts degree from Tulane University in New Orleans, Weil began his professional education at Baylor College of Dentistry, where he graduated at the top of his class.He then attended the University of Texas Health Science Center at San Antonio, where he earned his medical degree, also graduating with honors. He remained in San Antonio to complete a general-surgery internship, his anesthesia training and the remainder of his specialty training in oral and maxillofacial surgery.
All dentists attend a four-year dental school prior to receiving their dental degree. Oral and maxillofacial surgeons then spend an additional four to six years intensively training in medicine, surgery, anesthesia and implant dentistry. Some receive medical degrees in the process but all get the same intensive core training in expert third-molar removal, complex-implant placement, jaw surgery, temporomandibular joint and trauma surgery. Following this training, most then submit for written and oral examinations to achieve board certification.
Oral surgery offices are built from the ground up for outpatient surgery and anesthesia rather than general dental care. From anesthesia and safety equipment to patient flow and recovery, the facility is designed for outpatient surgery. All oral-surgery offices undergo onsite examination and certification to ensure office-based anesthesia standards are met. All general dental offices are different, but most necessitate that the traveling dentist bring anesthesia, surgery and safety equipment with each visit. Additionally, while complications are rare, often, patients want the reassurance of a quick unscheduled visit to check in or confirm healing is going well. With most surgeons’ offices staffed full time, there is always an expert available to provide that follow-up care and reassurance. Such accessibility is often not available with traveling providers.
Almost all who can be seen in an office environment can have some form of anesthesia. The type of anesthesia and ideal treatment environment are best discussed with your surgeon at the time of a consultation visit, when your medical history can be discussed in detail.
Austin Oral and Maxillofacial Surgery has cared for Austinites for more than 50 years. We have 15 board-certified surgeons in 12 locations, so we can provide service in a safe, convenient, caring environment for most of Austin and the surrounding areas. Additionally, we always have someone available to see you, as there’s flexibility in scheduling with so many doctors and locations. The most important thing that sets us apart, however, is our people. Our surgeons, clinical assistants and front-office teams are all focused on caring for patients in a safe, pleasant and compassionate environment.
While we are indeed the wisdom-tooth experts, there are many other areas in which oral surgeons have expertise. Sophisticated implant placement and the various hard- and soft-tissue grafting procedures that are done to optimize implant results are routine for us. Orthognathic or jaw surgery for developmental bite problems and the treatment of traumatic facial injuries are in our areas of expertise as well. The primary surgical procedure that cures sleep apnea is one our specialty developed procedures. Some of our surgeons treat temporomandibular joint disorders and we offer minimally invasive joint surgery for the most common temporomandibular joint issues when surgery is necessary.
Wisdom teeth or third molars are the last teeth to develop. Eons ago when our diet was much different and dental crowding was common, the third molars came in or “erupted” and provided another set of functional teeth. With today’s softer non-abrasive diet and the relative rarity of dental crowding, most often there is not enough room for the wisdom teeth to erupt into place and be functional teeth which can be maintained by the patient. This is what is meant by “impacted”, simply that the tooth is not able to come into a functional position. There are patients who have the space for wisdom teeth and in these cases the teeth may be functional and beneficial.
In cases where the wisdom teeth came in appropriately it is common later in life to develop decay or gum disease around these teeth first. They are difficult for some to maintain and your dentist may suggest removal rather than a filling or crown when or if this happens.
While your family dentist may remove erupted or exposed wisdom teeth, many regular dentists do not. Furthermore, impacted wisdom teeth, more complex teeth or higher risk teeth will likely result in referral to an oral surgeon. A visit with your dentist or a look at your x ray would likely answer that question best. Most patients having multiple wisdom teeth removed at the same time will prefer sedation rather than being awake. Oral surgeons have extensive, hospital based training in anesthesia to make this procedure pleasant and astonishingly safe. The facility is almost as important as the surgeon and board certified oral surgery offices are inspected and certified for anesthesia safety by both the State of Texas and their surgery certifying board. Certification ensures that the monitoring and safety equipment mirrors that in the hospital environment.
In general, younger patients are very low risk as the teeth are typically less difficult to remove. For this reason, the recovery is commonly smoother and faster. The best approach is to image and consult at a young age, typically teenage years, and make an assessment on whether the wisdom teeth will likely ever need to be removed. If it is likely that removal will be necessary, earlier surgery generally is easier and more predictable. This assessment might happen with your family dentist, orthodontist or directly with an oral surgeon.
Most insurance plans cover wisdom tooth removal. At consultation, each wisdom tooth will be evaluated and coded depending on how it is positioned within the mouth and whether it is exposed or impacted. Likewise, anesthesia choices are usually discussed, and the level of sedation agreed upon. The costs will vary depending on these factors and your insurance can generally be explored prior to the procedure. The best way to discover costs and insurance coverage, as well as discuss the procedure, is to set up a consultation visit with your provider.
A dental implant is a device made of titanium or ceramic alloy which is placed where a tooth or teeth used to be, sometimes at the same time as a tooth is removed. It will essentially function as a tooth root and at some point a prosthetic device such as a crown or bridgework is fabricated and attached to the implant or implants to restore the function and esthetics of the natural teeth. The current style implant, which is shaped similarly to a tooth root, has been in use for over 40 years so there is a strong track record of success.
In a growing patient, the position of the natural teeth is changing as growth continues. If implants are placed before growth is complete, their position relative to the natural teeth may change as well leaving them poorly positioned. For this reason, implant placement is deferred until jaw growth is complete, typically around age 18.
There is no upper age limit for implant placement and success rates are similar for all age groups.
While one could replace every tooth with an implant, more commonly the design of the replacement teeth may use implants with multiple teeth supported. This is similar in concept to bridges resting on natural teeth and can be a more efficient use of fewer implants.
In the great majority of even young patients, most implants will last the life of the patient.
While every insurance plan is unique, many plans do provide coverage for dental implants.
There is a broad spectrum of procedural complexity when placing implants from an individual tooth replacement to replacing all of the upper and lower teeth. When a single or even several teeth are replaced, the procedure is quick with very minimal recovery. Most patients could expect to go back to work the next day and have some slight modifications to their diet for a brief time.
When full arches are done, the procedure is more time consuming and recovery will take longer. It would be rare, even in complex cases, for recovery to extend beyond a week. Your surgeon can give you personalized advice on what to expect with recovery.
With a full arch restoration such as the widely advertised “All-on-4” solution, once the teeth are removed and the implants placed, an immediate temporary restoration is placed. This is sometimes advertised as “teeth in a day” and specifically refers to that process of replacing all of teeth in either the upper or lower arch with that technique. In these cases the patient will indeed get immediately restored.
When dealing with a single tooth or less than all the teeth, most surgeons will want to defer tooth/crown placement to enhance healing and ensure implant success. It some cases, some anterior (front) implants may have a temporary tooth placed immediately. This is a process to discuss with your surgeon to understand more fully.
While many patients are tolerant of a complete upper denture, assuming they can live with the roof of the mouth being covered in plastic, most are unsatisfied with their lowers. This is due to mobility and functional issues with lower dentures. For those who want reliable function and retention and/or want to eliminate the coverage of the palate, adding implants under the denture makes a world of difference. The volume of the denture can be streamlined, and it can be removed for easy cleaning yet retained in place with excellent stability.
As a specialty, surgeons started the implant revolution 40 years ago and have been at the forefront of innovation and progress ever since. While technically any dentist may place implants, oral surgeons have 4 to 6 years of additional specialty training in surgical and implant care. Implant patients may need more than just the implant and additional procedures such as bone grafting or soft tissue (gum) refinement may be necessary to get an ideal result. These procedures are rarely part of the training for generalists but are a routine part of implant care for your surgeon. Oral surgeons will typically place hundreds of implants each year gaining experience and expertise along the way.
In the context of the dental or oral surgery fields, it generally means that you may need a procedure to facilitate dental implant placement or to prepare you for dental implant placement. Bone grafting typically involves making a small incision in the gum tissue and placing something within that incision to encourage your own new bone to form over time. The choice of material to facilitate bone growth is highly variable and, in many cases, could be chosen in collaboration with your surgeon. While your own bone from another site in the mouth may be recommended, more commonly a synthetic material, cadaver bone or xenograft (a calcium material made from sterile bovine bone) is suggested. Each material has advantages and a discussion with your surgeon would be the best way to explore those choices. Although it may be possible to place your graft at the same time a dental implant is placed, sometimes the graft must be performed first and allowed to heal for several months with implant placement to follow.
Tooth removal may be recommended for many reasons but typically it implies that the tooth in question cannot be reliably restored. Not infrequently the source of the problem may have caused bone loss surrounding the tooth itself. In these cases, it may be recommended that at the time the tooth is removed, grafting material is placed in the extraction site to encourage adequate healing and allow dental implant placement when healing is complete. This is also known as “socket preservation”. All dental extraction sites will remodel and lose volume and contour during healing, with or without bone grafting. If there is healthy, normal bone surrounding the tooth to be removed, generally healing will occur better and faster without placing a grafting material in the site. However, if bone loss around the tooth is present, grafting material will retain the dimension and bulk of bone where the tooth was and simplify the future placement of an implant. The need for grafting should be discussed with your doctor before the procedure but may be best evaluated at the time the tooth is removed.
The unfortunately named sinus lift is actually the most predictable of all the grafting procedures. When we are born, our sinuses are just barely formed. They continue to expand throughout life and in many adults have expanded to surround the roots of the upper back teeth. When these teeth are removed and a dental implant is contemplated, there may not be enough bone to allow an appropriately long implant to be placed. In these cases, a sinus lift would be indicated. Done appropriately, the sinus is avoided entirely. The procedure involves meticulously moving the sinus floor out of harms way so that a grafting material and/or dental implant can be placed underneath it. This is most commonly done in conjunction with implant placement in a single procedure but it may be necessary to perform first, with implant placement to follow several months later. While it sounds complex, the complication rate is astonishingly low. In some cases it may even be done with no incisions. Discuss the options with your surgeon to fully understand the procedure and what to expect.