Procedures
Dental Implants are artificial teeth that replace missing or damaged teeth. Unlike removable dentures, which rest on the gum, or fixed bridges, which anchor to adjacent teeth, dental implants are surgically placed in the jawbone to provide a foundation for replacement teeth. Dental implants look and feel like real teeth. With good dental care they can last a lifetime.
Dental implant surgery typically involves threading a titanium support post into the jawbone in the location of the missing tooth, and attaching the new tooth onto the support. The bone fully heals and fuses around the newly implanted tooth support structure before the new artificial tooth can be attached. This is called osseointegration.
If multiple teeth need to be replaced the Center is has advanced experience in all dental implant technologies and techniques for fixed implant supported prostheses. Utilizing the office’s 3-D imaging technology, both TEETH-IN-A-DAY and All On Four revolutionary dental implant procedures significantly reduce the time needed for treatment. Both procedures involve implanting supports and the teeth prosthesis in one procedure.
The Center performs dental and oral implants, craniofacial implants, bone grafting for implants, sinus lifts, zygomatic implants and guided implant surgery. We encourage you to call with questions about the Faces of the Mission Oral & Maxillofacial Surgery’s expertise in the area of dental implants.
Wisdom teeth are usually the last four of 32 teeth to surface in the mouth, generally making their appearance between the ages of 17 and 25. In most cases, inadequate space in the mouth does not allow the wisdom teeth to come in properly. Wisdom teeth then can become impacted in a potentially harmful position. If left untreated, impacted wisdom teeth can contribute to infection, damage to other teeth and other problems.
There are several degrees of impaction based on the depth of the teeth within the jaw. These include soft tissue impaction, partial bony impaction and complete bony impaction.
Not all wisdom teeth require removal. Wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection. Some are removed as a preventative measure to avoid serious problems in the future.
Wisdom teeth or third molar removal is a common procedure at the Center, generally performed under local anesthesia, intravenous (IV) sedation, or general anesthesia.
Sleep apnea is serious condition that impacts a person’s breathing during sleep. People experience abnormally low breathing or pauses in breathing (called apnea). They are not typically aware of having any breathing difficulty when awake. The impact impaired breathing during sleep causes fatigue, vision or memory problems, and other effects associated with sleep deprivation, as well as low blood oxygen.
Obstructive sleep apnea, the most common form of sleep apnea, typically happens when the muscles in the throat relax and block the airway. Individuals with low muscle tone and soft tissue around the airway, and those who have oral structural features that give rise to a narrowed airway are at high risk for obstructive sleep apnea.
The Center has extensive experience in the obstructive sleep apnea surgery. For our patients with severe obstructive sleep apnea, we perform maxillomandibular advancement, orthognathic surgery, genioplasty, tongue reduction and tracheostomy.
Dr. Luque is a facial trauma expert. He has performed countless facial reconstructive surgeries in the aftermath of accidents, falls, automobile crashes and violence. Both at home in San Francisco and in his service abroad, Dr. Luque finds his work in facial trauma reconstruction to be a defining element of his practice.
Some of the main types of facial injuries are lacerations, fractured teeth, fractured jaws, fractured facial bones, knocked out teeth and intraoral lacerations.
No facial injury should be taken lightly. Aside from the obvious aesthetic reasons for repairing damage to the face, there are also a number of serious oral & maxillofacial health concerns that can arise from even a small amount of trauma. Depending on the exact location of the injury, respiration, speech, chewing and swallowing can be greatly impaired. If teeth become misaligned, this can lead to TMJ, uneven teeth wear and other complications.
Dr. Luque performs facial emergency surgery at the hospitals where he is on staff. He typically handles follow up procedures for facial trauma at the Center.
Jaw surgery, or orthognathic surgery, refers to surgical correction needed to fix substantial abnormalities of the maxilla (upper jaw), the mandible (lower jaw), or both. The abnormality may be a congenital malformation, a growth defect, or the result of traumatic injuries to the jaw area.
When the teeth come together improperly, such as an overbite or underbite, you have malocclusion. Orthognathic surgery is necessary when orthodontic treatment has not or will not be effective to treat malocclusion. Jaw surgeries performed at the Center include the reconstruction of the mandible or maxilla, mandibular ramus, maxilla osteotomy, and mandibular osteotomy, apertognathia, open-bite deformity and dentofacial deformities.
Left untreated, malocclusion of the teeth can cause uneven wear on teeth, chronic jaw, muscle pain, TMJ, headache, loose teeth, tooth sensitivity, and difficulty swallowing, chewing or biting food.
Temporomandibular joint (TMJ) disorders are a group of painful problems of the jaw. Temporomandibular problems are characterized by severe headaches, jaw pain, grinding teeth, and an intermittent ringing in the ears. TMJ pain can usually be relieved by noninvasive treatment such as medications, physical therapy, mouth or bite guards and arthrocentesis. Problems with jaw muscles and joints causing the TMJ pain also cause teeth grinding. The grinding teeth symptom is particularly common and usually occurs at night. The grinding eventually erodes the structure of the teeth and leads to severe dental problems. Untreated TMJ is one of the primary causes of eroded jawbones and loose teeth.
If noninvasive treatment does not relieve the TMJ, the Center performs partial or total join replacement, diskectomy, disk repair or repositioning.
Dr. Luque treats patients with benign and malignant cysts and tumors and infections of the oral cavity, salivary glands, jaws, and neck. During the course of a regular check up, Dr. Luque will thoroughly inspect the soft tissue of the mouth and take serious note of any changes or issues. Some conditions treated at the Center include:
- Odontogenic cysts.
- Odontogenic tumors.
- Amleoblastoma.
- Odontogenic keratocyst.
- Central Giant Cell Lesions.
- Cherubism.
- Fibrous Dysplasia.
- Tongue Cancer.
- Basal Cell Carcinoma.
- Sialolithiasis/Salivary gland stones.
- Pleomorphic adenoma.
- Warthins Tumor.
- Salivary gland tumors.
- Oral Cancer.
In the majority of cases, the pathological changes experienced in the oral region are uncomfortable and disfiguring, but not life threatening. However, oral cancer is on the rise (especially among men) and the chances of survival are around 80% if an early diagnosis is made.
Oral cancer refers to any type of cancer affecting the tongue, jaw, and lower cheek area. Since it is impossible for the dentist to decisively diagnose a pathological disease without taking a biopsy sample of the affected area, seeking immediate treatment when changes are first noticed is critical.
An oral cancer screening is usually performed during a comprehensive exam. Screening is painless and only takes a few minutes. Dr. Luque will use a laser light to assess the soft tissue for cell changes that might be indicative of oral cancer. If such cell changes are present, a small biopsy will be taken and sent to a laboratory for review. If the biopsy indicates that oral cancer is present, an excision (removal) will generally be performed.
When a tooth that has already had a root canal treatment becomes inflamed and infected, an apicoectomy or root end surgery may be required. An apicoectomy is the removal of the apex (or root tip), followed by a filling procedure to seal the root from further infection. When left untreated, infected roots can damage other teeth, spread infection, and cause regression of the jawbone.
Infected and inflamed soft tissue around the root of a tooth can be exceptionally painful. The purpose of an apicoectomy is to eliminate the infection in the tissue and to ultimately preserve the function of the tooth and save it from extraction.
This surgery does not require an overnight stay.
If you are experiencing any pain or swelling associated with a tooth that has had a root canal, we encourage you to contact our office to schedule an appointment.
Cleft lip and cleft palate are two common but markedly different birth defects that affect about one in every 700 newborns. These developmental deformities occur in the first trimester of a woman’s pregnancy; cleft lip in week seven, and cleft palate in week nine. A cleft lip is essentially a separation of the two sides of the lip. In many cases, this separation will include the bone and gum of the upper jaw. A cleft palate occurs when the sides of the palate fail to “fuse” as the fetus is developing, which results in an opening in the roof of the mouth.
The cleft can occur on one side of the mouth (unilateral) or both sides of the mouth (bilateral). Surgery will typically be performed in the child’s first six months to close the openings. Dental restoration caused by the deformity is handled later in the child’s life.
Dr. Luque and his team handle hundreds of cleft lip and palate surgeries annually. Cleft lip and palate surgeries performed at the Center include primary closure of cleft lip, secondary revision of cleft lip and hard and soft palate; repair of oral-nasal fistula, cleft orthognathic surgery, maxillary osteotomy, mandibular osteotomy and alveolar cleft grafting.
The gauze on the surgical area should be kept in place for 30 minutes after the procedure. After this time, the gauze pad can be discarded. Licking or touching of the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
Take the prescribed pain medications as soon as you begin to feel discomfort. This will coincide with the local anesthetic wearing off. Restrict your activities for the rest of the day after surgery and resume normal activity when you feel comfortable. Place ice packs to the sides of your face where the surgery was performed. Refer to the section on swelling for an explanation.
1. Bleeding
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping away old clots from your mouth, then placing a gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps form a blood clot by contracting bleeding vessels. To minimize further bleeding do not become exhausted, sit upright, and avoid exercise. If bleeding does not subside, call for further assistance.
2. Swelling
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until two or three days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Ice packs should be applied to side of the face where surgery was performed. The packs should be left on continuously while you are awake. After 24 hours, ice has no substantial beneficial effect. If swelling or jaw stiffness has persisted for several days, there is not cause for alarm. This is the normal reaction to surgery. Twenty four hours following surgery, the application of moist heat to the side of the face is beneficial in reducing the size of swelling.
3. Pain
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours. Alternatively, Ibuprofen (Motrin, or Advil) two to three 200 mg tablets may be taken every six to eight hours.
For severe pain, take the tablets prescribed as directed. The prescribed pain medication will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain and discomfort from surgery should subside more each day. If pain persists, it may require attention and you should call the office.
WARNING: Several medications regularly prescribed by our office such as Norco , and Tylenol #3 contain Tylenol or Acetaminophen. Do not exceed the dose prescribed by Dr. Luque. In addition, do not mix these prescription medications with any other over the counter medication that contains Tylenol or Acetaminophen. Acetaminophen in excessive amounts can have serious effects on your health.
4. Diet
Drink liquids after general anesthesia or IV sedation. Do not use straws when drinking from a glass. You may eat anything soft by chewing away from the surgical site. High calorie, high protein intake is very important. Try to maintain a normal diet. You should prevent dehydration by drinking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat.
BREAKFAST IDEAS
Milk
Fruit Juices
Cream of Wheat
Grits
Ensure/Boost Drinks Carnation/
Instant Breakfast Drink Oatmeal
Scrambled Eggs/Omelet
MEAL IDEAS
Any Vegetables (except corn)
well cooked, baked, scalloped,
pureed, scuffled, casseroles
Macaroni & Cheese Mashed Potatoes
MEATS AND FISH Deviled Ham
Tuna
Salads (Ham, Egg, Tuna, Chicken)
Any Flaky Fish
CAUTION: If you suddenly sit up from a lying position, you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.
5. Keep the mouth clean
No rinsing of any kind should be done until the day following surgery, unless otherwise instructed by Dr. Luque. You can gently brush your teeth the night of surgery.
6. Discoloration
In some cases, discoloration of the skin follows swelling. The development of black, blue, green or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may happen two or three days following surgery. Moist heat applied to the area may speed up the removal of the discoloration.
7. Antibiotics
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.
8. Nausea and vomiting
Post-operative nausea and vomiting are related to a combination of factors including having an empty stomach, swallowing blood during the procedure, and medication side effects. Right after surgery try to take milk derived liquids (yogurt, milk shake, etc) to counteract the acidity in your stomach. Once you can tolerate the liquid by mouth proceed taking the prescribed medications. Do not take pain medications on an empty stomach as this will increase the risk of developing nausea and vomiting.
9. Syringe Use: 3 days after surgery use Peridex rinse to clean up bottom sockets with syringe after every meal make sure tip of syringe is inside the socket. (For wisdom teeth extractions only)
Other Complications:
-If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. Be aware that if you are experiencing this numbness you are at greater risk for biting down and not feeling the sensation.
-A slight elevation of temperature immediately following the surgery is not uncommon. If the temperature persists, notify the office. Tylenol or Ibuprofen can reduce fever.
-Occasionally patients feel hard projections in the mouth with their tongue. They are not roots; they are bony walls which supported the tooth. These projections usually smooth out over time. If not, they can be removed by Dr. Luque.
-If the corners of your mouth are stretched, they may become dry or crack. Your lips should be kept moist with an ointment such as Vaseline.
-Sore throats and pain when swallowing are not uncommon. This should subside in 2-3 days.
-Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event that resolves with time.