Oct 31, 2020

Dental implants are successfully used in patients who do not have sufficient bone due to new technology that enhances bone growth and healing.

It was not that many years ago that some patients were told that they were not good candidates for dental implants because they did not have sufficient bone. During my 32 years in practice, the technology has advanced so that I am now able to treat patients with dental implants that I was not able to treat 10 to 15 years ago. There are a number of growth factors that we routinely use in our practice today to enhance bone growth. One is platelet-rich plasma or PRP, which is prepared from blood drawn from the patients prior to surgery.

We use the patient’s own blood and we have the technology in the office to separate the platelets that are in that blood sample from the rest of the blood and to prepare a solution called platelet-rich plasma or PRP. These platelets have growth factors that enhance the healing of bone. The platelet-rich plasma is added to freeze-dried bone that is from a bone bank to reconstitute this bone.

This bone is then grafted into the bone defect in the jaw. In my experience the bone/platelet-rich plasma mix tends to dramatically increase bone volume and the healing of the bone. I routinely use platelet-rich plasma in cases with large defects in the bone, to wrap around the dental implants, and in sinus grafting procedures in which we can add bone to the flora of the sinus to gain height in the back part of the upper jaw to prepare the sites of dental implants.

Another way to build bone is to use the synthetic bone protein called bone morphogenetic protein. This protein is also mixed with bone. I use the bone morphogenetic protein in cases where we may need larger areas of bone growth in a more predictable way.

These growth factors are very beneficial to patients, and today many patients can benefit from dental implants who could not have taken advantage of implants in the past due to our ability to enhance bone.

Dr. Leonard Spector
www.chesapeakeimplants.dentist

Oct 24, 2020

Orthognathic or corrective jaw surgery performed by Dr. Leonard Spector is used to correct skeletal problems that cannot be addressed by orthodontic treatment alone.

Orthognathic surgery is also called corrective jaw surgery and it is performed by oral and maxillofacial surgeons. There are jaw deformities or discrepancies that are not amenable to orthodontic treatment alone and require corrective jaw surgery as part of their final and definitive treatment.

Corrective jaw surgery is used to correct a wide range of minor and major skeletal and dental problems, including misalignment of the jaws and the teeth. The surgery can improve chewing, speaking, and breathing. Jaw surgery can be used to correct gross jaw deformities in all dimensions of the jaws, both front to back, side to side, or vertical jaw problems. These procedures are also used to address facial discrepancies associated with people who have documented sleep apnea and airway problems.

In addition, certain facial discrepancies associated with temporomandibular joint (TMJ) problems can be corrected with orthognathic surgery. This treatment is a coordinated effort between the orthodontist and the oral surgeon.

The great benefit for the patient is that not only can we restore the function of their teeth but we also restore proper facial balance and proportions to the face.

Many times, these procedures are performed in an outpatient hospital setting, under general anesthesia. Orthognathic surgery procedures are performed through incisions inside the mouth so there is no visible scarring. The patient is able to open and close their mouth right after surgery has been completed and today the recovery time is very fast compared to the way these procedures were performed in the past. Patients do not have to have their jaws wired together for five to six weeks, as was the case in conventional orthognathic post-op procedures.

There is much higher patient acceptance when patients do not need to have to have their jaws wired together after the surgery, and the results can be dramatic from both an esthetic and functional perspective.

Dr. Leonard Spector
www.chesapeakeimplants.dentist

Oct 17, 2020

Dental implants are a conservative, cost-effective option for replacing missing teeth according to Havre de Grace oral surgeon Dr. Leonard Spector.

There are a number of disadvantages to having a single missing tooth replaced with an old-fashioned three-unit bridge:

  1. The dentist must cut down natural teeth to support a bridge.
  2. These natural teeth, once they are prepared and cut down, may require root canal therapy.
  3. The patient may have to wear a removable appliance that most people find unacceptable.
  4. It is extremely difficult for the patient to clean under a bridge. As a result, the patient is more susceptible to tooth decay and periodontal disease.
  5. Bridges need to be replaced every seven to ten years.
  6. Bridges often look like false teeth.
  7. Patients tend to get bone loss in the area around bridges.

The advantages of replacing a single missing tooth with a one dental implant are many:

  1. I regard an implant-supported tooth as a permanent tooth replacement With proper home care and regular dental visits, a dental implant can last for decades or even a lifetime.
  2. They are easy for the patient to maintain with good daily dental hygiene habits.
  3. Dental implants stimulate bone and prevent bone loss.
  4. Dental implants look, feel, and function just like natural teeth.
  5. There is a great benefit of improved appearance. A conventional bridge often looks artificial but dental implants look very natural.
  6. A person’s quality of life is enhanced because implant supported teeth are like new, natural teeth. People can eat, smile, laugh—basically go about their daily lives with complete confidence.
  7. Dental implants are a great investment in one’s health. Because they are natural looking, long-lasting, and can be easily maintained with daily hygiene and regular visits to the dentists, dental implants are much more cost-effective in the long run than bridges that cause problems and need to be replaced when they wear out.

For all these reasons, I tell my patients that dental implants are now the modern standard of care for replacing missing teeth.

Dr. Leonard Spector
www.chesapeakeimplants.dentist

Oct 10, 2020

Dental implant treatment has progressed to the point that patients often have functional and esthetic temporary restorations placed on the day of surgery.

When dental implants were first made available to the public, the entire process was very time consuming. Patients would leave the office and have to wear an unsatisfactory temporary restoration such as a flipper or temporary bonded bridge.

The great benefit for many patients today is that we are able to have them leave the office with a very good temporary restoration or go to their dentist’s office immediately after the dental implant is placed to have the implant restored with a natural looking tooth.

Specifically, in regard to single teeth, we are able to place an implant and also place a temporary post in that implant. Then your general dentist – your referring dentist – will see you that day and place a temporary crown on that implant.

The benefit here is that you basically have a restoration – a tooth in your mouth the day of the surgery. Most patients find this protocol to be very acceptable. This new protocol also significantly reduces treatment time because it allows you to have the final restoration in half the amount of time. In was not that many years ago, with what was then the conventional method of implant treatment, that the patient had to wait an additional three months before the implant was restored.

With regard to teeth in a day procedures, these are procedures where we use dental implants to replace all the teeth in one dental arch. The implants are placed and a restoration is securely placed on the implants that day.

These time savings are very important for the patient. They always ask about the cost of dental implants, but they also want to know how many appointments will be required to finish the entire course of treatment. I am now able to tell patients, very predictably, that there are minimal appointments—and that means there is greater value to the patient for these implant dentistry procedures.

Dr. Leonard Spector
www.chesapeakeimplants.dentist

Oct 3, 2020

Replacing missing teeth promptly – even those in the back of the mouth—has many benefits, because one missing tooth can affect many teeth and cause numerous problems.

When I tell patients that they need to have a back tooth replaced, they will often say, “Well, it’s a back tooth. You can’t see it. So why do I really need to have it replaced?” The answer is that each tooth in your mouth has a specific function.

The back broad molar teeth are used to grind your food. The molar teeth are designed to work with an opposing molar—the tooth in the other arch that makes contact with that tooth when you bite. So if you’re missing either an upper or a lower molar, there is no corresponding opposing tooth in the other arch. The result is that you cannot, therefore, grind your food.

Another problem is that when you are missing a tooth, the opposing tooth in the other dental arch, over time, will super-erupt into that space which may prevent you from having a dental implant because there may not be enough space to place the restoration on the implant. This problem can be corrected, but the point is that replacing a missing tooth promptly is the best course of action.

Also, if you lose a molar tooth, bone loss will tend to occur in that area, with the potential of the adjacent teeth shifting into that space where the molar used to be. This situation can lead to additional tooth and bone loss over time. Also, as you lose your back teeth, there is more pressure applied to the front teeth. Your front teeth are not designed to take these forces and the result could be tooth fracture or loss of bone around the front teeth. When teeth are subjected to too much force they also tend to shift, which alters the bite and makes it more difficult to clean around these teeth. As a result, the patient could experience problems with tooth decay and gum disease.

The bottom line is that it is not just a simple matter of losing one tooth, because when you lose one tooth, there is a cascading effect on the other teeth.

Dr. Leonard Spector
www.chesapeakeimplants.dentist

Sep 19, 2020

Lutherville oral surgeon Dr. Leonard Spector explains that many replacement teeth can often be supported by relatively few dental implants.

Many times several implants can be used to replace many teeth. It really depends on the quality and the quantity of the available bone and the design of the final restoration. For instance, if we are only replacing one tooth, of course, one tooth is replaced with one dental implant. A single-tooth implant is a single tooth replacement for a single missing tooth. There are also cases where two or three teeth will require individual implants to replace each tooth. However, if there is good quality and quantity of bone, we can often use two implants to support a three-unit bridge or four implants to help anchor a five-unit bridge.

In cases where the patient is missing all their teeth, we may use four or five implants to support a full-arch restoration.

With the three-dimensional technology we have in our office and our ability to evaluate the quality and quantity of bone in three dimensions, we plan the case with the referring dentist. We can decide in advance for instance, if two or three implants can be used to support a multiple unit bridge. This decision would depend not only on the quality of the bone and how much bone there is, but also on the size of the dental implants we would be using.

These decisions really depend a lot on my own experience based on what I have seen over the years and of course close collaboration with the restorative dentist. The final result is that we want to provide the most predictable long-term solution to that patient’s dental needs with the use of the dental implants. We always try to use the fewest number of implants and be as conservative as possible, but at the same time our goal is to create a result that is very stable and long-lasting for the patient.

Dr. Leonard Spector
www.chesapeakeimplants.dentist

Sep 12, 2020

Dental implants are used to replace a single tooth, multiple teeth or an entire arch of teeth, according to Maryland oral surgeon Dr. Leonard Spector.

The great advantage of using dental implant – as opposed to conventional crown and bridgework over natural teeth—is the number of ways that dental implants can be used to replace missing teeth. They can be used to replace missing front teeth with very predictable cosmetic results, to replace a number of teeth with single crowns and bridges, or replace both the upper and lower teeth.

Many times the patients can receive their teeth the same day as the implants are placed. In regards to single teeth in the esthetic zone – the front teeth, I will frequently remove the non-restorable tooth, place the dental implant immediately, and have the patient seen by the dentist that day. The dentist will place a very natural-looking temporary crown on the implant so the patient has a new tooth the same day. At the appropriate time, the patient returns to the dentist’s office and the final restoration is placed.

In other cases where we are replacing all of the upper or lower teeth, we can place four to six implants in the jaw and have what we can an “immediate fixed hybrid restoration” placed immediately after the implants are placed. An immediate fixed hybrid restoration is a temporary restoration that is secured to the implants. It is actually screwed into the implant and supported by the implant at the time of surgery.

The advantage to the patient is that they may come to the office with conventional dentures and few if any natural teeth remaining in an arch. They leave the office with four to six permanent dental implants and an immediate restoration, which is a securely affixed denture.

We like to evaluate the patient’s smile, bite and speech so we can make any minor changes to the temporary restoration. Typically the patient will wear the temporary fixed hybrid restoration for approximately six months to a year before they receive their final restoration.

Dr. Leonard Spector
www.chesapeakeimplants.dentist

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
www.chesapeakeimplants.dentist

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
www.chesapeakeimplants.dentist

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
www.chesapeakeimplants.dentist