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Frequently Asked Questions About Distraction Osteogenesis

Glenview Oral Surgeon, Jeffrey Bressman, DDS of Glenbrook Oral and Maxillofacial Surgery, answers some FAQs on Distraction Osteogenesis.

What does the term distraction osteogenesis mean?

Simply stated, 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.

Is the surgery for distraction osteogenesis more involved than “traditional surgery” for a similar procedure?

No. 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.

Will my insurance company cover the cost of osteogenesis surgical procedure?

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.

Is distraction osteogenesis painful?

Since all distraction osteogenesis surgical procedures are done while the patient is under general anesthesia, pain during the surgical procedure is not an issue. Postoperatively, you will be supplied with appropriate analgesics (pain killers) to keep you comfortable, and antibiotics to fight off infection. Activation of the distraction device to slowly separate the bones may cause some patients mild discomfort. In general, the slow movement of bony segments produces discomfort roughly analogous to having braces tightened.

What are the benefits of distraction osteogenesis vs. traditional surgery for a similar condition?

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 therefore, another surgical site. Lastly, distraction osteogenesis is associated with greater stability when used in major cases where significant movement of bony segments are involved.

What are the disadvantages of distraction osteogenesis?

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.

Can distraction osteogenesis be used instead of bone grafts to add bone to my jaws?

Yes. Recent advances in technology have provided the oral and maxillofacial surgeon with an easy to place and use distraction device that can be used to slowly grow bone in selected areas of bone loss that has occurred in the upper and lower jaws. The newly formed bone can then serve as an excellent foundation for dental implants.

Does distraction osteogenesis leave scars on the face?

No. The entire surgery is performed within the mouth and the distraction devices used by Dr. Bressman remain inside the mouth. There are no facial surgical incisions are made so no facial scars result.

Are there any age limitations for patients who can receive osteogenesis?

No. 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.

Distraction Osteogenesis (DO) Offered at Glenbrook Oral Surgery

Glenview Oral Surgeon, Jeffery Bressman, DDS of Glenbrook Oral and Maxillofacial Surgery, offers Distraction Osteogenesis (DO).

Distraction osteogenesis (DO) is a relatively new method of treatment for selected deformities and defects of the oral and facial skeleton. It was first used in 1903. In the 1950s, the Russian orthopedic surgeon, Dr. Gabriel Ilizarov slowly perfected the surgical and postoperative management of distraction osteogenesis treatment to correct deformities and repair defects of the arms and legs. His work went mostly unnoticed until he presented to the Western Medical Society in the mid-1960s.

Distraction osteogenesis was initially used to treat defects of the oral and facial region in 1990. Since then, the surgical and technological advances made in the field of distraction osteogenesis have provided the oral and maxillofacial surgeons with a safe and predictable method to treat selected deformities of the oral and facial skeleton.

Sleep Apnea Help from Glenbrook Oral & Maxillofacial Surgery

Glenview-based Oral Surgery, Glenbrook Oral and Maxillofacial Surgery, offers help for Obstructive Sleep Apnea. Below are additional details:

People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Oral and maxillofacial surgeons offer consultation and treatment options.

In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.

There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures usually performed under light IV sedation in the office.

In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.

Oral Pathology at Glenbrook Oral and Maxillofacial Surgery

Glenview Oral Surgery, Glenbrook Oral and Maxillofacial Surgery, offers Oral Pathology services, below are more details:

The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth:

• Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth.
• A sore that fails to heal and bleeds easily.
• A lump or thickening on the skin lining the inside of the mouth.
• Chronic sore throat or hoarseness.
• Difficulty in chewing or swallowing.

These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology, and curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.

Early diagnosis and management are the keys to properly dealing with areas of oral pathology.  Our office is committed to the early diagnosis and treatment of all types of oral pathology.  We have a tremendous amount of clinical experience in identifying potentially problematic areas.  In addition to this, we utilize the most up to date technology for earlier and more accurate diagnosis.  These include:

1. Velscope – the only FDA approved system designed to identify the potential presence of malignant or pre-malignant lesions that are not visible to the naked eye. 
2. Brush Biopsy – a non-invasive method of assessing the presence of abnormal cells in a particular area of the oral mucosa.

Using these adjuncts, we feel that we are uniquely qualified to identify and manage any areas of abnormality in your mouth in the earliest possible time frame.

 

Dr. Bressman of Glenbrook Oral and Maxillofacial Surgery on AllExperts.com

Glenview Oral Surgeon, Jeffery Bressman, DDS of Glenbrook Oral and Maxillofacial Surgery, is a member of the expert panel of AllExperts.com. View his profile here: http://www.allexperts.com/ep/3405-109188/Oral-Surgery/Jeff-Bressman-DDS.htm

Apicoectomy at Glenbrook Oral Surgery

Glenview Oral Surgery, Glenbrook Oral and Maxillofacial Surgery excels at apicoectomy. Read more below:

Periapical surgery, also known as apicoectomy, is a dental procedure performed at the tip of a tooth’s root to stop leakage of diseased tissue or bacteria into the surrounding area. The procedure is most frequently indicated when a patient has had endodontic (root canal) therapy on a tooth but continues to have pain or infection.

 The diagram illustrates this simple procedure. An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with a small amount of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function. If a fracture of the root or other evidence of a hopeless prognosis is found during surgery, the tooth can either be removed at that time or at a later date when adequate plans have been made to replace the tooth.

There is usually mild to moderate post-operative discomfort. Swelling will occur and reach its peak on the second or third day. To alleviate any discomfort, an appropriate pain medication will be recommended. If you have pain that does not respond to medication, please call our office.

Overall, periapical surgery is often a good approach to save a tooth that has not responded well to root canal therapy. Feel free to contact our office to schedule a consultation to determine if you are a good candidate for this procedure.

Bone Grafting at Glenbrook Oral Surgery

Major & Minor Bone Grafting

Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.

Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and aesthetic appearance.

Major Bone Grafting

Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee). Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.

Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.

Sinus Lift Procedure

The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.

There is a solution and it’s called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.

The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.

If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.

Ridge Expansion

In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.

Glenbrook Oral and Maxillofacial Surgery

Glenbrook Oral and Maxillofacial Surgery

Glenbrook Oral + Maxillofacial Surgery, Glenview IL

Glenbrook Oral and Maxillofacial Surgery provides the finest personal service and facilities for their patients who always enjoy a warm, relaxed and comfortable environment. They deliver quality care to their patients through the pursuit of excellence in all areas of Oral + Maxillofacial Surgery treatment, including dental implants, wisdom teeth extractions, TMJ disorders, the exposure of impacted teeth, bone grafting and treatment of sleep apnea. They also diagnose and treat facial pain, facial injuries, and fractures.

The team members possess a commitment to be the best they can be in all areas of patient service. Contact the office to schedule your first consultation.

Dr. Jeffery Bressman, Oral Surgeon, Glenview IL

Dr. Bressman has devoted his professional career to all aspects of oral and maxillofacial surgery practice with special interests in office based treatment including dental implants, oral pathology and removal of wisdom teeth. To keep abreast of the latest developments in Oral Surgery, Dr. Bressman has always exceeded the continuing education requirements of Illinois.

Dental Implants, Glenview IL

Dental Implants are tiny titanium posts that are surgically placed into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes. The posts provide stable anchors for artificial replacement teeth. The person who has lost teeth regains the ability to eat virtually anything, knowing that teeth appear natural and that facial contours will be preserved. Patients with dental implants can smile with confidence.