Aug 5, 2020

Havre de Grace Oral and Maxillofacial Surgeon Dr. Leonard Spector explains what to expect before, during, and after wisdom teeth removal.

A typical patient who has been referred to our office for wisdom teeth removal is a teenager whose wisdom teeth are beginning to erupt into the mouth or have not erupted and may be impacted and indicated for removal.

Prior to Surgery

Prior to treatment, we schedule a 30-minute pre-surgical consultation with the patient (and parent or guardian if the patient is a minor). I go over all the risks, benefits, and concerns related to the removal of the wisdom teeth. I review with them the dental x-ray and their medical history.

We discuss the means of how the wisdom teeth will be removed as well as the type of anesthesia to be used. Will it be just local anesthesia or IV sedation or local anesthesia with laughing gas?  My goal is always to keep the patient comfortable during procedures.

At the consultation appointment, we review all their pre-op instructions with them. If  they will be going to sleep, the patient is instructed not to have anything to eat or drink after midnight and to have someone who is at least 18 years old accompany them to the office and drive them home.

Day of Surgery

We typically do wisdom teeth extractions in our office for the convenience of the patient. The procedures usually last between 30 and 45 minutes. After the procedure, we allow the patient some recovery time in our office, but the anesthesia wears off quickly. The patient wakes up and we review follow-up instructions.

After Surgery

There tends to be minimal post-op discomfort or swelling after these procedures. Due to my advanced training in wisdom tooth removal, we can keep the incisions extremely small and the procedure times short.

Any post-op discomfort can be managed with prescription medication. Patients who have some difficulty opening their mouth widely will be on a soft diet. There may be some swelling of the jaw, particularly the lower jaw, after surgery, and we give the patient medicine and instructions to keep swelling to a minimum. Most people take a few days off from work or school to rest and recover after surgery.

Dr. Leonard Spector

Aug 5, 2020

Dr. Leonard Spector explains his extensive training and experience in anesthesia that he uses to keep patients comfortable during in-office oral surgery procedures.

I have delivered approximately 50,000 general anesthetics during my 32 years in private practice. Our private practice facility has to be certified to provide general anesthesia in our office setting. In our office, we have the most advanced equipment, including monitoring of blood pressure, EKG, pulse oximetry, and capnography, which is a way to measure carbon dioxide. My staff and I are trained in advanced cardiac life support and we regularly renew this training to stay current.

It is a great convenience for the patient to come to an oral and maxillofacial surgery office to have their procedure done. Patients understand that their surgery and anesthesia are being taken care of by individuals with an impressive amount of formal training and many years of experience. They also know that we do everything possible to make the procedures safe and we also have all the necessary equipment on site to perform procedures using different types of anesthesia, including general anesthesia if necessary.

I received extensive formal training in anesthesia during my residency program. This extensive training included a six-month rotation in the anesthesia department. I have been intensively trained in providing IV sedation and general anesthesia.

We closely screen all of our patients prior to anesthesia, and we have an excellent safety record for providing anesthesia in our office. In regard to the monitoring, we are using all the most advanced, state of the art monitoring equipment to provide the safest type of general anesthetic that can be provided in an office setting.

The drugs we use are all ultra short-acting drugs, and many of these drugs have a reversal agent. With our advanced training, we are able to provide a level of anesthesia in which the patients are extremely comfortable and sedated during the procedure, but also recover very quickly following the procedure.

Dr. Leonard Spector

Aug 5, 2020

Orthodontic treatment often involves close cooperation with an oral surgeon to expose impacted canines and remove other teeth to create proper space.

The canine teeth, also called eye teeth, are longer and pointier than other teeth. A common procedure is to expose and place a bracket on impacted canine teeth when these teeth are impacted. As an oral and maxillofacial surgeon, I perform this procedure when it is requested by an orthodontist. Once there are brackets placed on these teeth, the orthodontist can guide the teeth into position as part of overall orthodontic treatment.

Orthodontists also like to refer to our office because we have advanced cone beam technology, which means three-dimensional imaging technology. We are able to evaluate the position of the teeth in relation to other teeth and roots in the mouth so we can safely and very efficiently expose these teeth knowing exactly where they are located in the anatomy of the jaws.

Other common things we do in concert with orthodontists is to remove teeth in patients where there is dental crowding and teeth have to be removed in order for the orthodontist to straighten and place all the teeth correctly and functionally in the mouth.

Many times the teeth are just too large to be accommodated in the space that nature provides. For example, wisdom teeth can sometimes block the second molars from erupting. Once the wisdom teeth are removed, then there is space for the second molars to come in.

Removing wisdom teeth solves problems and no one misses having them. Even when wisdom teeth come in properly, we usually do not chew that far back in our mouth and so wisdom teeth are not functional.

Additionally, in younger patients, we are often asked by the orthodontist to remove some of the primary teeth to accelerate the eruption of the permanent teeth.

The key to proper treatment is close collaboration between the orthodontist and the oral and maxillofacial surgeon.

Dr. Leonard Spector

Aug 5, 2020

Dental implants have many benefits, including looking and functioning like natural teeth, according to Chesapeake oral surgeon Dr. Leonard Spector.

Dental implants are permanent tooth replacements. They are artificial teeth that look and function just like your natural teeth. One of the many other benefits of dental implants is that implants prevent bone loss over time, thereby preserving the integrity of the jawbone and enhancing one’s appearance.

Dental implants treatment is a conservative procedure. The adjacent teeth are not compromised to replace the missing teeth. If you have a single missing tooth, it is not necessary to cut down the teeth on either side of the missing tooth in order to place a bridge.

Implants can also anchor dentures and provide a very secure fit. They are also much easier to clean than a bridge.

Patients are so pleased with dental implants that are placed in the front of the mouth, the area that we call the esthetic zone. After they are placed and restored, dental implants can look just like one’s natural teeth. The long-term esthetics are usually so much better with an implant-supported tooth than with the traditional tooth-supported bridge. This is very important because particularly in the front of the mouth you do not want any visible bone defect, which could be critical in how the teeth will appear.

Paying close attention to esthetic issues is always a part of dental implant treatment. In addition to minimizing or preventing bone loss with a dental implant, we are also able to maintain the gingival contours, which essentially means how the gums are shaped around the implant tooth.

For example, the size, shape, and color of an implant tooth can closely mimic a natural tooth, but with a bridge, the contours of the gums around the false teeth often make the teeth look false. With a well-placed implant, however, the gingival or gum contours can be maintained and the implant-supported tooth looks very natural.

It is difficult for anyone to tell that one or more teeth are dental implants because they look so natural.

Dr. Leonard Spector

Aug 5, 2020

Dental implants success rate is now 95% or higher, according to Chesapeake oral and maxillofacial surgeon Dr. Leonard Spector.

Dental implants became approved for placement in the United States in 1984, and that is the year that I began to practice. After 32 years of experience in my practice, I regard dental implants as permanent tooth replacements. Dental implants are now the standard of care in replacing missing teeth.

I have had a greater than 95 percent success rate in my practice in the placement of dental implants over the years. This includes placing implants to replace single teeth, multiple implants, and full mouth replacement of teeth using dental implants to secure a permanent denture.

Over the years, we have seen the procedure evolve. There is now more exact, precise, predictable placement of the implants due to advanced technologies such as using computerized three-dimensional imaging. We use these high-tech images to produce computerized surgical guides that allow us to place implants much more precisely. When implants are placed very carefully with regard to bone and the anatomy of the jaw and at the right angle, the probability of long-term success is even higher.

The reason that dental implants remain so secure in the jaw is that the implant fixtures themselves are titanium cylinders that replace your natural tooth root. Titanium has the unique ability to bond and fuse to bone. In essence, the molecules of titanium become fused or integrated with the molecules of your jawbone. The word “osseous” means “bone” and the process is called osseointegration.

Over a period of time, the bone will fuse extremely tightly, tenaciously, to the surface of the implant.

Another exciting development is that now in many cases we are able to place an implant and immediately “load” the implant if there is sufficient initial stability when the implant is placed. When we speak of “loading” an implant, we mean that a crown is attached to the implant immediately so that the patient leaves the office with a functioning tooth that also looks very natural. The patient also has the peace of mind of knowing that most implants will last for decades if not a lifetime.

Dr. Leonard Spector

Aug 5, 2020

Dental Implants have no age limit. According to Maryland oral surgeon Dr. Leonard Spector, implants can help patients of any age who are in good health.

We treat many patients over the age of 80 who are referred to us by their general dentist to place the dental implants. I always tell my patients that there is no arbitrary age cut-off for dental implants. We do not disqualify patients for implant dentistry just because they have reached a certain age. It is not uncommon for patients in their 70’s, 80’s, or even their 90’s to have successful dental implant treatment.

As long as these patients are medically healthy, they tend to be excellent candidates for implants. Even in cases with minimal amounts of bone and years without teeth, implants can still be used to support new teeth because we have procedures to build up bone when necessary. Older patients routinely say that the implants feel, look, and function just like their natural teeth.

Most of these procedures can be performed under local anesthesia and are usually performed in our office setting. Older patients, just like any other patients, are able to tolerate this procedure extremely well with minimal post-op pain and swelling. Most patients, when they come back for their post-op visit, report that they are very surprised by how little discomfort they experienced during and after the procedure. I tell most patients that the day after the implant surgery that they can maintain most of their regular schedule.

In this older age group, we see many patients who have lost all their teeth. We are able to use these implants to help retain their dentures and therefore eliminate the use of denture adhesives. Patients like being free from dentures adhesives, because even the best of these products cannot hold dentures in place perfectly at all times. With their conventional dentures there is also often a compromise regarding appearance, but with dental implants patients can laugh, eat, smile—really go through a full range of facial expressions quite naturally because the dentures are so securely fixed in place by the implants.

Dr. Leonard Spector

Sep 5, 2020

Dental implant treatment in Dr. Spector’s office requires close collaboration between the oral and maxillofacial surgeon and the patient’s dentist.

Dental implant treatment is a true collaborative effort between the restorative dentist and me, the oral surgeon. My philosophy on placing dental implants is to use a prosthetically-based approach. The prosthesis is the artificial tooth or crown that is securely affixed to the implant, which is an artificial tooth root. We like to know before we place the dental implant what the final result will be, because the patient is ultimately interested in the new tooth, not the artificial tooth root that supports the tooth.

For any implant case, whether it a single tooth or multiple teeth or full mouth reconstruction, I will discuss the case and meet with the referring dentist prior to the surgery. At that time, we review x-rays and a dental model of the patient’s mouth. We decide ahead of time exactly where the dental implants will be placed to get to that final result. The referring dentist and I determine the type and position of the final replacement of the teeth.

In many occasions, after I place the implants, the restorative dentist is able to place an immediate temporary restoration on the implant, and then the final restoration a few months later. This treatment is all planned prior to the actual surgery.

In cases where we are doing procedures in which the implants are placed and we are replacing a full arch of teeth – upper or lower – many times the final restoration can be placed in the office the same day of the surgery.

Patients may be surprised to learn that in these situations the restorative dentist will be working with me in my office as the implants are being placed. In coordination with the dental laboratory, we will place the final restorations immediately after the implants are placed.

In this way, the patient leaves the office with teeth due to the close collaboration between the oral surgeon and the patient’s dentist.

Dr. Leonard Spector