Capital Center for Oral and Maxillofacial Surgery's Blog

Piezosurgery is a relatively new yet well established surgical technique used in dentistry to section hard tissues without damaging adjacent soft tissues. Piezosurgery, by definition, is a process that utilizes piezoelectric vibrations in the application of cutting bone tissue.  It is indicated for use in oral, maxillofacial, cranial and spinal procedures. By adjusting the ultra-sonic frequency of the device, it is possible to cut hard tissue while leaving soft tissue untouched by the process.

The main advantages of Piezosurgery include soft tissue protection, decreased blood loss, less vibration and noise, increased comfort for the patient and protection of tooth structure. The main indications in oral surgery are sinus lift, bone graft harvesting, osteogenic distraction, ridge expansion, endodontic surgery, periodontal surgery, inferior alveolar nerve decompression, cyst removal, dental extraction and impacted tooth removal. It also reduces damage to osteocytes and permits good survival of bony cells during harvesting of bone.

Bimaxillary osteotomy, including bilateral sagittal split osteotomy (BSSO), is the most commonly performed orthognathic surgical intervention in Europe and the United States. Neurosensory perturbation in the territory of the inferior alveolar nerve is a reported adverse effect of bilateral sagittal split osteotomy. Performing BSSO utilizing Piezosurgery allows us to cut the bone while preserving surrounding soft tissue, including surrounding nerves, vessels and mucosa. In fact, studies have shown a significant improvement in retention of alveolar inferior nerve sensitivity, reduced nerve injury, and reduced blood loss at no extra surgical time utilizing Piezosurgery vs. traditional techniques for BSSO.*

The Capital Center for Oral and Maxillofacial Surgery in Washington, DC utilizes piezoelectric surgery because it is a minimally invasive technique that lessens the risk of damage to surrounding soft tissues and important structures such as nerves, vessels, and mucosa. This enables us to provide better care and comfort for our patients and help them to a speedy recovery.

*Critical Evaluation of Piezoelectric Osteotomy in Orthognathic Surgery: Operative Technique, Blood Loss, Time Requirement, Nerve and Vessel Integrity. Journal of Oral and Maxillofacial Surgery Volume 66, Issue 4, April 2008, Pages 657–674. Constantin A. Landes, MD, DMD, PhD, , , Stefan Stübinger, DMD, Jörg Rieger, DMD, MD, Babett Williger, DMD, MD, Thi Khanh Linh Ha, DMD, MD, Robert Sader, MD, DMD, PhD

When considering dental implants in the Washington, DC area there are several choices in regards to clinician and surgical technique.  One technique, image guided surgery, may provide unique advantages and should garner particular attention. What is Image Guided Surgery? Image guided surgery uses virtual x-ray vision, our low radiation dose three dimensional x-ray machine, to implement our virtual surgical plans in real time. This makes surgery less painful and safer because we can make our incisions smaller and more accurately. Accuracy equals safety. A small incision equals less pain.

Image guided surgery enables oral/maxillofacial surgeons to precisely install a dental implant in the exact location where there is adequate bone to support the implant and to do so using a smaller more precise incision than ever before.  Image guiding replaces outmoded and imprecise technology that is not as effective in guiding the surgeon to the exact location for implant placement. Other technologies required the manufacturing of physical guides that were often inaccurate, possibly leading to them being useless or in need of being replaced. This could force the surgeon to estimate the placement of the implant without proper guidance or to postpone surgery until a new guide could be manufactured by a dental laboratory, adding to the time and cost of the procedure.

With image guided surgery, the oral surgeon uses an interactive, real-time guide that precisely indicates the most advantageous point to insert each implant. The surgical system software takes into account all necessary factors when directing the surgeon to choose a particular point to drill into the jawbone and prepare the site for insertion of an implant. The surgeon is not restricted by a physical guide that forces surgical equipment into a static position, as the system virtually instructs rather than restricts the surgeon and his or her equipment. The system transmits an accurate and easy-to-interpret picture of the surface of the bone, and the surgeon then sets up a drilling path based on accurate, real-time images of the bone and tissue as they appear during the surgery itself. This results in increased accuracy versus the previous system, which relied on a CT scan taken prior to the surgery to create the physical guides that were used during the operative process.

Image guided dental implantation surgery ensures a more positive outcome as it enables surgeons to prepare the implantation surface in a way that lets them install each implant in the position that is best suited for ensuring proper and comfortable placement of the crown.

The Capital Center for Oral and Maxillofacial Surgery is the first and only Dental Image Guided Surgical Center in the Washington DC area that offers all types of Image Guided Surgery: image guided implant placement. (IGI™), image guided third molar extractions and image guided removal of cysts and tumors.

To hear more about Image Guided Surgery in Washington, DC please call us at 202-386-7100.

TMJ, or temporomandibular joint disorder, is a painful disorder of the jaw. It can be referrred to as Consten’s syndrome or myofascial pain dysfunction as well. TMJ is a complex disorder with stiffness of the jaw, bite issues, clicking and locking of the jaw joint, and headache/ear pain. If you believe you have TMJ disorder, The Capital Center for Oral and Maxillofacial Surgery in Washington, DC may be able to help.

Symptoms of TMJ

There are several signs and symptoms of temporomandibular joint disorder, including headache, ear pain, grinding or popping, dizziness, ringing in ear, and fullness or pressure in ears. Approximately 80 percent of those with TMJ disorder will have headache and 50 percent will have ear pain. Some factors that can make the pain worse are cold weather and being around stressful environments. Approximately 40 percent of TMJ disorder sufferers become dizzy and approximately 33 percent report having a fullness or clogged-feeling in the ears.

Diagnosis of TMJ Disorder

With a dental and medical exam, doctors are able to check for damaged jaw joints or wearing on the teeth from grinding. There may be CT, or computerized tomography, scans performed to check the bone’s detail, along with other dental x-rays. MRIs, or magnetic resonance imaging, may be able to help in diagnosing the condition by showing the soft tissues.

TMJ Disorder Treatment

The most common therapies used to treat TMJ disorder include jaw rest and pain management, soft diets, and medications. Jaw rest, including the use of a soft diet, helps lower the amount of jaw grinding, while heat and ice can help in pain relief. Applying ice or heat can reduce the spasms and the jaw tension, helping the pain dissipate. Medications can include steroids, muscle relaxants, cortisone shots, and anti-inflammatory products.

Lowering the amount of stress in one’s life is helpful as well, as tension is created in stressful situations and can lead to an increase in the amount of grinding and jaw locking. Physical therapy, including a bite guard and biofeedback may be recommended the pain persists.

Surgical options such as arthroscopy and open joint repair restructuring are sometimes needed, but are reserved for severe cases. The Capital Center for Oral and Maxillofacial Surgery does not consider TMJ surgery unless the jaw can’t open, is dislocated and nonreducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully. TMJ disorder can be a complex jaw disorder that may require several different modes of treatment to find the correct fit for the patient and ensure a pain free outcome.

As always, if you have any questions please call our office at 202-386-7100.

OHANCAW is a weeklong series of events to promote education and awareness organized through the Head and Neck Cancer Alliance, formerly known as the Yul Brynner Head and Neck Cancer Foundation.

Our very own Dr. Ryan is featured in this video about the remarkable recovery of DC United player Charlie Davies. Dr. Ryan described the experience as, “An incredible feeling. I’m excited to see him back on his feet again playing at a world class level. It gives a lot of validation to what we do. It makes us feel really great to have participated in his care.”

We feel really great to have Dr. Ryan at CCOMFS! Here’s hoping for continued success for Charlie Davies!

Recovery from a wisdom tooth extraction is often accompanied by varying degrees of pain and swelling. However, if you take certain precautions, you can prevent and alleviate the pain and swelling that occurs after this oral surgery. It’s important to take time to relax after undergoing a wisdom tooth extraction procedure. Take a few days off from work or school and don’t overexert yourself.  By resting, you’ll allow your body to heal more effectively and quickly.

If your doctor prescribes anti-inflammatory drugs or painkillers, it is a good idea to take them as soon as possible to prevent the onset of pain. If you do not receive a prescription, ask your doctor for recommendations on what kinds of over-the-counter medicines you can take.

For the first 24 hours after wisdom tooth extraction, you may find relief by placing an ice pack on your jaw and alternating sides every 15 minutes. This will prevent your jaw and cheeks from swelling up and may even help to numb the pain. After the first 24 hours, try soaking a washcloth in hot water and pressing it against your jaw and cheeks. You can also gently bite down on a moistened tea bag. This may alleviate pain and swelling by allowing the muscles around your jaw to relax. You can also try swishing warm salt water around in your mouth several times a day. This helps to stop swelling and will also clean your mouth to prevent infection in the extraction site.

Avoid solid foods for the first 24 hours following the oral surgery. Instead, opt for soft foods, such as yogurt, smoothies, broth, and gelatin. Introduce solid foods back into your diet gradually. You should also avoid any activities that may cause you to overstretch your jaw. Do not spit, whistle, or use a straw for a few days following your wisdom tooth removal procedure. These activities will strain the jaw muscles, causing pain and swelling.

Keep your head elevated for several days following wisdom tooth extraction. When you sleep, prop up your head with a stack of pillows. This will not only prevent swelling, it will also help prevent excessive blood flow in your mouth. Recovery from wisdom tooth extraction can be painful. However, if you take the proper steps to alleviate pain and swelling, you can recover and be back to normal within a few days.

As always, if you have any questions or concerns, please call our office at 202-386-7100.