Texas Oral Surgery Group

Can Oral Surgery Improve How Your Dentures Fit?

Can Oral Surgery Improve How Your Dentures Fit?

oral surgery dentures north txWith dentures, comfort and fit go hand-in-hand. Like pieces of a puzzle, the denture, gum and jaw must all fit together properly to ensure the most comfortable fit possible. For some patients, oral surgery is necessary to create the right alignment before being fitted for dentures. This is known a pre-prosthetic surgery.

When is pre-prosthetic oral surgery needed?

A denture sits on the bone ridge, so for maximum fit and function it is critical that the bone be the right shape and size. One of the most common reasons for pre-prosthetic surgery is to smooth out uneven bone ridge left behind after tooth extraction. Other reasons may include removal of excess bone or addition of a bone graft to create suitable support.

Common pre-prosthetic procedures include:

  • Bone smoothing and reshaping
  • Removal of excess bone
  • Bone or tissue grafting procedures
  • Bone ridge reduction
  • Removal of excess gum tissue
  • Extraction of impacted teeth

Generally, the dental practitioner who is fitting you for your dentures will discuss whether surgery is necessary. If you do need pre-prosthetic surgery, Doctors Stewart and Michael will perform the procedure on an outpatient basis using the most cutting-edge technology available today to ensure your comfort and safety.

Why do my dentures no longer fit?

Dentures are not a one and done treatment. Just like natural teeth, they require proper care and regular dental visits. Because the structure that supports dentures deteriorates over time, it is not uncommon for patients to undergo changes that create an improper fit. Gum ridges in our mouths often shrink as we age, which can cause dentures to become loose. Bone can also shrink, resulting in misaligned jaws. So even if a patient’s dentures initially fit properly, changes in gum and bone structure may require corrective oral surgery later on.

What are the symptoms of poor-fitting dentures?

Discomfort is the most obvious sign dentures do not fit correctly; however, other symptoms include:

  • Dentures that move
  • Difficulty speaking
  • Pain in the gums (sometimes with bleeding)
  • Difficulty eating and swallowing
  • A clicking noise when eating
  • Bad breath or strange taste

What are the dangers of poor-fitting dentures?

Beyond general discomfort, wearing poor-fitting or loose dentures for an extended period of time can cause much more than an inconvenience. Complications can include:

Swollen Gums – If dentures do not fit the contours of your mouth correctly, they rub against gum tissue causing them to swell.

Mouth Soreness – When gum tissue is irritated and inflamed, it creates sensitivity and soreness, which is exacerbated if a patient has other jaw disorders such as TMJ.

Trouble Speaking – Patients with loose or poor-fitting dentures may develop a lisp.

Blisters – When dentures do not fit properly, they rub against areas of the mouth creating blisters which not only cause extreme discomfort, but risk further tissue damage and infection.

Angular Cheilitis –  Poor-fitting dentures often lead to an uneven bite which can cause saliva to pool near the corners of the mouth. This creates a moist environment ripe for a painful bacterial infection.

Headaches – Headaches are a common side effect of poor-fitting dentures, as a sore jaw often creates head pain.

The ultimate goal of dentures is improved quality of life. To achieve this, dentures need to fit as comfortably as possible. With a combined 50 years of service, Doctors Stewart and Michael are committed to providing the right pre-prosthetic surgery for your needs. For additional information, please contact any Texas Oral Surgery Group location (Denton, Plano, Decatur, Gainesville ).


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Summertime is the Best Time … to Have Your Wisdom Teeth Removed!

Summertime is the best time…to have your wisdom teeth removed!

Wisdom Teeth ExtractionHaving one’s wisdom teeth removed is essentially a rite of passage, practically on par with high school graduation. Technically known as third molars, history suggests that the more common name – wisdom teeth – came about because they are the last four of our 32 teeth to appear, which generally happens between our late teens and early 20s.

While not everyone needs to have their wisdom teeth removed, the vast majority of us do because we simply don’t have space by the time these molars arrive. As a result, they become impacted in bone or gum tissue, causing crowding among current teeth which can lead to severe jaw pain, infection and damage to adjacent teeth. To reduce a patient’s risk, a surgical procedure is required to remove the impacted teeth. For specific information on the types of impactions, see our section dedicated to wisdom teeth.

Not sure if you or a loved one need wisdom teeth removed? There are several degrees of impacted wisdom teeth, based on where the teeth lie within the jaw. To evaluate the position of the wisdom teeth and determine if there are present or potential problems, patients should undergo an oral exam and x-rays of the mouth. Please note, even if you are not currently experiencing discomfort, you may still require extraction as some patients show no symptoms at all.

While the removal of wisdom teeth is common, it is still considered surgery and should be regarded as such. When performed by an oral surgeon versus a general dentist, a deeper level of sedation is provided for the patient’s maximum comfort. Oral surgeons are trained in a hospital-based residency to administer general anesthesia. The practice of office-based anesthesia is tightly regulated by the state, and oral surgeons in Texas undergo mandated office anesthesia evaluations and our staff is specifically trained in the office based anesthesia model.  We can administer outpatient IV sedation, which allows patients to literally sleep through the procedure with no recollection of surgery.  Drs. Stewart and Michael have over 40 years of combined experience, including extensive training in all types of wisdom teeth treatments and are well-equipped to manage any potential complications that arise.

For non-emergency cases where patients have the ability to schedule wisdom teeth extraction in advance, summer is the ideal time to have it done. The thought of summer vacation probably doesn’t bring images of a dental chair to mind, but you might think differently after reviewing the following reasons:

Recovery Time – Healing from oral surgery takes time. Typically, we recommend taking a few days off from work or school to rest after your wisdom teeth are removed. Given that we tend to have lighter schedules in the summer months, it’s generally one of the best times to be out of the office (and there’s no school to miss). As a bonus, when you return to work you may have a lighter load than you would during other times of the year.

Pain Management – Many patients are able to control pain after extraction with over-the-counter medications. However, some people require prescription pain medications that can cause nausea and / or interfere with their ability to focus and stay awake. With a lighter schedule, patients are better able to rest comfortably, with or without prescription medications, as there isn’t the usual rush to get back on schedule.

Be sure to ask Dr’s Stewart and Michael about non-narcotic pain management options- we have several excellent options available.

Special Diet – After this procedure a patient should expect a sore mouth and will need to stick to a modified diet for a few days. Soft foods, such as smoothies, ice cream and popsicles, will make recovery easier – especially when they’re enjoyed outside in the fresh air and sunshine!

Lifted Moods – Summer generally ushers in higher spirits and lifted moods. Even if you find yourself in recovery mode for a few days, being able to walk outside and feel the sunshine makes it much easier to handle than being cooped up inside during frigid temps.

We understand that no one wants to spend precious summer hours undergoing and recovering from oral surgery, but if it has to be done there’s no better time than summer. Before your calendar fills up with family and friends, contact any of our four locations (Denton, Plano, Decatur, Gainesville ) to schedule a consultation.

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Anticoagulants and Oral Surgery

Anticoagulants and Oral Surgery

Anticoagulants North TXWith the aging of the population, and their increased need for medications for cardiovascular and neurologic conditions, many older patients are on some form of anticoagulant therapy. You have probably heard these anticoagulant medications called “blood thinners”.  A new class of medications called Direct Acting Oral Anticoagulants (DAOC’s) are being commonly prescribed. They are used to treat certain blood vessel, heart and lung conditions, including: atrial fibrillation (AFib), peripheral artery disease (PAD) and venous thromboembolism (VTE). Anticoagulants help prevent blood clots from forming in an artery, a vein or the heart, and may prevent existing clots from getting larger.

AFib patients are commonly on one or more of these medications because of their irregular heartbeats, which can cause blood clots that can travel to the brain, restricting the blood supply to the area and causing a stroke. About one in five people who have a stroke has AFib!

These medications include:

  • Apixaban (Eliquis®)
  • Dabigatran (Pradaxa®)
  • Rivaroxaban (Xarelto®)
  • Edoxaban (Savaysa™)

The traditional anticoagulant  Warfarin  (Coumadin) requires continual monitoring in the form of a blood test called an INR. It is necessary to keep the INR within a therapeutic range as determined by your physician. This can be difficult to do and can be affected by many factors including other medications, and dietary issues.

The DAOC’s do not require this type of continual monitoring and for this reason along with others, have become very popular. DOACs have been shown to be highly effective, require less monitoring, and may reduce the risk of brain bleed when taken for stroke prevention. They also work more quickly and clear the system faster than warfarin.

Because we in oral surgery see many patients on these medications, this issue has been studied extensively. There are several scientific articles in the literature now that state that it is safe to remove one or 2 teeth, or perform minor oral surgery such as a soft tissue biopsy, while patients are on the DAOC’s. However, you must read these articles closely, because it does not say that 100% of the people do well 100% of the time! In fact, most authors agree that 83% of the people will do well. That means that 17% of the population will have some form of postoperative bleeding after minor oral surgery if the anticoagulant medication is not stopped prior to surgery.

How do we manage this? Consultation with your physician will be required prior to surgery in most cases. Stopping an anticoagulant medication has side effects itself- such as an increased risk for stroke or heart attack. We must weigh the “risk-benefit” of stopping versus continuing these medications during minor oral surgery. Understand that, if you have postoperative bleeding while on these medications, surgical measures such as suturing and packing (which will be done at time of surgery) may be of little benefit because you are unable to form a clot. If you cannot form a clot, you cannot stop bleeding!  Whether or not to stop your anticoagulant medication pre-surgically is not a simple decision.  The decision involves many factors that must be considered carefully.  If your prescribing physician deems the risk of stopping your anticoagulant medication to be minimal, then that is usually the safest course for surgical procedures (remember that 17% of people will have bleeding without holding the medication!).  If your physician deems your risk of stopping the medication to be moderate or high, and the procedure is a minor one, then stopping the medication is usually not the best course of action.  Ultimately, the decision whether or not to hold an anticoagulant medication for an oral surgical procedure will involve a combined decision between the surgeon and your prescribing physician.

This becomes a medical management issue and on occasion patients may have to be hospitalized or seen in the emergency room. Thankfully this is a rare phenomenon, however excessive bleeding is a risk for anyone on anticoagulants. The effects of warfarin usually can be reversed with vitamin K. One important concern of patients and physicians has been that there was no specific antidote for DOACs. This is no longer the case. In 2015 the FDA approved idarucizumab (Praxbind®) for reversal of dabigatran (Pradaxa®). On May 4th 2018, FDA approved andexanet alfa (AndexXa®) for the reversal of apixaban (Eliquis®) and rivaroxaban (Xarelto®). Ongoing studies are confirming its efficacy in reversing the other DOACs on the market betrixaban (BevyxXa®) and edoxaban (Savaysa®) as well as the low molecular weight heparin enoxaparin (Lovenox®) and fondaparinux (Arixtra®). Physicians can use prothrombin complex concentrate in emergency situations involving blood thinners that do not have a specific reversal agent yet approved by FDA. The good news is, these medications do a tremendous service to patients with cardiovascular, peripheral vascular, and neurologic issues. They save lives. Remember that any medication has side effects, and anticoagulants’ side effect (and intended effect!) is to prevent clot formation.

We will work closely with your physician to choose the best course of action for you if you are on one of these medications. Rest assured that our concern is for your health and safety and we want you to have a pleasant and positive experience.

If you have any questions regarding these medications or how we would manage your case, please feel free to consult with Dr. Stewart or Dr. Michael.






Texas Oral Surgery Group: LARRY R. STEWART, DDS, MS     WAYNE A. MICHAEL, DDS, MD

PLANO: 972-596-9242

DENTON: 940-387-9015

DECATUR: 940-627-2256

GAINESVILLE: 940-612-2040

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Teeth in a Day | All-on-4

Teeth in a Day / All-on-4

All On 4 ImplantsMore than 35 million Americans are missing all of the teeth in either the upper, lower, or both jaws, and over 3 million people in the United States have some form of dental implant[1]. Missing teeth can have a devastating effect on one’s self-confidence, negatively impacting them both personally and professionally. Though time is certainly of the essence in these situations, patients often need to go between 6 – 12 months with missing teeth depending on the procedure, especially if it requires bone grafting.

At Texas Oral Surgery Group, we understand the sensitive nature of our work and the far-reaching impact it has on patients. That’s why we’re committed to providing the best care possible via the latest technology and innovative procedures. One such procedure known as “teeth in a day” replaces a complete arch of teeth at once, restoring our patients’ smiles and confidence in a single procedure.

Teeth In A Day / All-on-4®

Teeth in a day or All-on-4®, has been around for over 35 years.  It replaces an entire arch of teeth by inserting four or more dental implants into the top, bottom, or both jaws. These four implants provide support which allows a prosthesis to be fixed into place.  The prosthesis does not have flanges or palate coverage (the most undesirable characteristics of a traditional denture).  Oral surgeons using this method can tilt some of the implants to provide the required support for the total rehabilitation of a dental arch. Positioning the implants in this manner overcomes bone deficiencies often found in these regions and generally eliminates the need for bone grafting (thus eliminating the need for graft healing time), which is why it is also referred to as “teeth in a day.”

Does the entire process really only take one day?

Almost. Patients who undergo the All-on-4 procedure are never without teeth due to the preparation involved in the days leading up to and following surgery. Prior to surgery, appointments are required for pre-surgical evaluation of the existing teeth and bone structure and fabrication of the initial design of the prosthesis that will be placed on the day of the procedure. Patients will also need to be seen for follow-up care and adjustments post-surgery. Additional appointments will also be needed to fabricate a final prosthesis. From beginning to end, the entire process can take nine months or more to complete the whole treatment. However, unlike other restorative procedures the All-on-4 method includes placement of a full arch prosthesis, which is fixed to the dental implants, on the day of surgery. This means patients leave with a full set of teeth (i.e. “teeth in a day”). The temporary prosthesis is later replaced with a permanent one after the implants have integrated with the bone (usually around 6 months after the initial procedure).

Are there any disadvantages?

Surgery of any type comes with inherent risks and should not be considered lightly. One of the greatest benefits of this procedure is the minimal disruption to a patient’s lifestyle, giving them fully functioning teeth with just one surgery. However, it is not without drawbacks. When considering All-on-4, it’s important to note these potential risks:

  • Patients are not able to test teeth for appearance, comfort, or bite prior to surgery because they are all placed at the same time.  However, patients get a real “test drive” of the teeth while wearing the provisional prosthesis for the first 6 months, and any changes in teeth size/shape/color can be incorporated into the final prosthesis.
  • In the unlikely case that one implant comes loose, a full replacement of the prosthesis would be necessary due to the specificity of the mold.
  • This method requires a sufficient level of bone density for implant placement, which can limit some patients’ eligibility or require more advanced surgical techniques.

There are a number of customizable dental implant options available today. If you or a loved one are in the process of considering which treatment is best, we encourage you to contact any of our four office locations to schedule a consultation.


[1] American Academy of Implant Dentistry. “Dental Implants Facts and Figures.” AAID,

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Oral Surgeons Role in the Management of Hospitalized Patients

Oral Surgeons Role in the Management of Hospitalized Patients

oral surgeon hospitalized patientsThe field of oral surgery is unique in that it combines the art and science of both dentistry and medicine. Oral and maxillofacial surgeons have a distinctive set of knowledge and skills that enables them to diagnose and treat a spectrum of conditions in the head and neck region.

In addition to advanced training that includes four years of dental school followed by a four or six-year, hospital-based residency program focused on the complexity of facial structures, oral surgeons also have access to the most cutting-edge technology available today. From 3D imaging to advanced computer guided surgeries, the Texas Oral Surgery Group uses the latest technology available to ensure the best results and patient experience possible. Additionally, Drs. Stewart and Michael maintain privileges at Medical City Plano, a Level I Trauma Center located in Plano, Texas.

Texas Oral Surgery Group has served the greater Dallas/Fort Worth community for over three decades. Our combination of cutting-edge technology and experienced and caring surgeons and staff make us the right choice for your oral and maxillofacial needs. From the removal of wisdom teeth to more severe cases such as those highlighted below, you can be confident in our ability to treat you and your loved ones.

Traumatic Facial Injuries

While all injuries have an element of trauma, facial injuries often add an emotional element. It is not uncommon for patients to be worried that their injuries will permanently affect their vision, hearing, taste, or sense of smell. Compounding the distress is the vital role the face plays in an individual’s personality and self-image. Given the sensitive nature of these injuries, it’s no surprise that one study reported one out of every four patients treated for facial trauma at an urban hospital met the criteria for post-traumatic stress disorder one-month post-injury .

Drs. Stewart and Michael’s extensive education and training not only make them well-versed in emergency care, acute treatment and long-term reconstruction and rehabilitation, but with over 40 years of combined experience they are adept at establishing the type of long-term patient relationships required to successfully treat and rehabilitate facial traumas.

Surgical correction of developmental and congenital facial deformities

According to the Center for Disease Control’s National Center on Birth Defects and Developmental Disabilities, approximately one in every 33 babies born in the United States has a congenital anomaly . Of these, birth defects of the face and mouth, specifically cleft palate and cleft lip, were most common.

A cleft lip is an abnormality in which the lip does not completely form. The degree of the cleft lip can vary greatly, from mild (presenting as a notching of the lip) to severe (large opening from the lip up through the nose). A cleft palate occurs when the roof of the mouth does not completely close, which leaves an opening that can extend into the nasal cavity. The cleft may involve either side of the palate and can extend from the front of the mouth (hard palate) to the throat (soft palate). In some cases, the cleft may also include the lip.

Children born with these conditions are faced with a range of associated problems that include issues with feeding, speech, hearing and psychological development. Care for children with a cleft lip and/or cleft palate often involves a team of doctors and experts, including Ear, Nose & Throat doctors, pediatricians, and oral surgeons. In most cases, surgery is recommended to repair and reconstruct the effected areas.

Oral surgeons use the same combination of surgical skills and patient rapport to treat other craniofacial abnormalities such as skeletal and maxillofacial deformities and hypodontia (the absence of teeth). In addition to the apparent cosmetic differences, these conditions often impede daily functioning, affecting the ability to breathe, eat and speak properly. Drs. Stewart and Michael understand the profound impact the treatment they provide has on their patients’ ability to lead productive lives.

Treatment and management of Head and Neck Cancer patients

Oral surgeons also play an important role in the treatment and management of head and neck cancers, which account for approximately 4% of all cancers in the United States . Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat). These cancers are further categorized by the area in which they begin – the oral cavity, pharynx, larynx, paranasal sinuses and nasal cavity, and salivary glands.

According to the American Cancer Society, 11.6% of all head and neck cancers begin in the area of the oral cavity/pharynx . The treatment plan for individual patients depends on a number of factors, including location of the tumor, stage of the cancer, as well as age and general health of the patient. Due to the complexity of these cases, head and neck cancers are best treated by multi-disciplinary cancer care teams that include oral surgeons and other specialists.

Oral Surgeons can also play a critical role in the early diagnosis of head and neck cancers by examining the oral cavity, oropharynx, facial and neck skin as a form of screening during routine visits. Some patients may present with pre-malignant lesions, which are likely to progress to established cancers; however, their removal may prevent the development of an established cancer.

At Texas Oral Surgery Group, we value the important role we play in patient care. From your first call and consultation with Drs. Stewart and Michael through the entire treatment process, our team is dedicated to providing the highest quality patient care possible. We invite you to contact any of our locations (Denton, Plano, Decatur, Gainesville) to schedule a consultation.

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Zygoma Implants

Zygoma Implants

Zygoma Implants North TXWhen exploring dental implants there are a number of factors to bear in mind, particularly if you’ve experienced bone loss. Why? Because regardless of technique, dental implants require healthy bone. This isn’t an issue if a patient is in good oral health and has sufficient bone to support implants; however, those with severe bone loss in the upper jaw may need an advanced option – Zygoma implants.

What are Zygoma implants and how are they different?

Traditional dental implants involve drilling directly into the upper jaw bone, which often requires a bone grafting procedure to ensure proper implant placement. Unfortunately, for those with severe bone loss in the upper jaw, such bone grafting techniques may not be suitable. Zygoma implants, however, offer an alternative. Instead of using the upper jaw bone as an implant anchor, Zygoma implants take advantage of the neighboring healthy cheek bone (i.e., zygomatic bone). Longer in size than conventional dental implants, Zygoma implants are designed to provide a secure foundation in situations where traditional dental implants may not be possible.

What are the benefits of using Zygoma implants?

Beyond giving patients with severe bone loss a viable implant option, Zygoma implants have a number of advantages over traditional dental implants. These include:

Immediate function (aka, “teeth-in-a-day”) – Zygoma implants are a “graft-less” procedure which expedites the entire experience allowing patients to leave with immediate aesthetic and functional improvements. When bone grafting is needed, patients may be required to wait up to 12 months for complete healing to occur before restorations can be placed. This is not necessary with Zygoma implants, as temporary restorations and zygoma bone implants can be put in place during the same appointment.

Faster recovery – Because the overall process is shorter, patients require fewer visits than are necessary with traditional implant treatments. In addition, they are able to return to work and resume normal routines faster because healing time is significantly shorter.

Improved bone strength – Zygoma dental implants are made of titanium which stimulates the surrounding bone to develop new bone structure via a process known as osseointegration. Not only does this help to secure the implant, it also strengthens the surrounding bone.

Minimally invasive – Unlike traditional implant techniques that require invasive bone grafting, Zygoma implants use 3D scanning for accuracy and are generally performed under IV sedation.

Am I a candidate for Zygoma implants?

Zygoma implants may be an option if you’ve previously been told you don’t have enough bone for traditional dental implants. Though the thought of anchoring implants to your cheek bones may be off-putting, the use of Zygoma implants reduces overall treatment time and is much less invasive than other dental treatments, making it a great option for those with severe upper jaw bone loss.

Where do I go from here?

Regardless of the method used, dental implant surgery is a subject that requires serious consideration. Contact any of our locations (Denton, Plano, Decatur, Gainesville ) to schedule a consultation. Drs. Stewart and Michael will assess your oral health and make a recommendation about the type of implants that are most appropriate for you.




Advanced Bone Grafting

Advanced Bone Grafting

Bone Grafting North Central TXThe unknown can be scary – especially when it involves you or a loved one undergoing surgery of any kind. At Texas Oral Surgery Group, we understand that our patients don’t live and breathe dental surgery – that’s our job!  We also know that surgical terms and medical jargon can be confusing, so we’ve provided an outline of some bone graft procedures to help eliminate some of the unknown.

What is bone grafting?

Bone grafting is a surgical procedure that replaces your missing jaw bone with material from either a patient′s own body or a substitute. The human body is an incredible thing, and bone tissue can regenerate if it’s provided the space in which to grow. And, as natural bone grows, it generally replaces the graft material resulting in a fully integrated area of new bone. The development of advanced bone grafting techniques has allowed us to be able to treat patients that were previously unable to receive optimal care.

When is bone grafting used?

Defects of the jaw caused by traumatic injuries, congenital defects or tumor surgery are generally treated with major bone grafts using the patient’s own bone – often taken from the skull, hip, or lateral knee. These types of bone graft procedures are performed in an operating room and require a hospital stay.  However, in the oral surgery office, bone grafting is more commonly used to allow for the proper placement of dental implants. In fact, anyone who has lost a tooth might need a bone graft before it’s possible to place a dental implant. Your body experiences bone loss every day a tooth is missing which, over time, leads to disuse atrophy in the jawbone. Disuse atrophy occurs when bone that is supposed to support teeth is reabsorbed resulting in poor quality and/ or quantity of bone suitable for placement of dental implants, or fixed or removable appliances.

Bone Grafting Procedures

Socket Preservation

Just as the name implies, the primary purpose of socket preservation is to prevent the atrophy, or preserve the health, of the alveolar bone (i.e. the socket that holds the tooth in place). This bone is often damaged by disease and/or infection, which necessitates a tooth extraction that can create a jaw deformity if preventative measures aren’t taken. These grafts are some of the most common and easiest bone grafts to perform and recovery is usually uncomplicated. Beyond cosmetic concerns, jaw defects also create major problems in performing restorative dentistry, which is why it’s important to speak with your dentist, about socket preservation if they recommend tooth removal.

Ridge Augmentation

Typically performed in Drs. Stewart and Michael‘s office under IV anesthesia, ridge augmentation helps recreate the natural contour of the gums and jaw which may have changed due to bone loss from a tooth extraction or traumatic injury. Ridge augmentation is achieved by placing bone graft material in the tooth socket. This procedure is often done immediately after a tooth is removed to avoid the need for a follow-up procedure, however it can be done on patients with long standing tooth loss.

Sinus Lift

This procedure is recommended when a patient needs an implant in the upper jaw but has a thin sinus floor that is unable to hold implants on its own. One of the most common bone grafting procedures for patients with bone loss in the upper jaw, a sinus lift grows bone in the floor of the maxillary sinus, increasing bone height and volume, to enable the secure placement of dental implants.

Types of Bone Grafts

Autogenous Bone Grafts

Autogenous bone grafts, or autografts, are made from your own bone and typically harvested from the chin, jaw, lower leg, hip or skull. Autogenous bone grafts are advantageous because the graft material is live bone containing living cellular elements that enhance bone growth. It also eliminates the risk of rejection, as it comes from your body. It’s important to note that this type of bone graft does require a second procedure to harvest bone from elsewhere in the body which, depending on your medical health, may not be in your best interest.


Allogenic bone grafts, or allograft, use dead bone that is harvested from a cadaver and processed using a freeze-dry method to extract the water and cellular components, via a vacuum. Unlike autogenous bone, allogenic bone cannot produce new bone on its own. Instead, it serves as a framework that bone from the surrounding bony walls can grow upon to fill the defect or void. This type of graft depends upon the patient having a good bone support structure in order to be effective.

Xenogenic Bone

This type of graft uses non-living bone from another species, usually bovine. To avoid contamination and the potential for rejection, the bone is processed at very high temperatures. Similar to allogenic grafts, xenogenic grafts serve as a framework for bone from the surrounding area to grow and fill the void. Both allogenic and xenogenic bone grafting have the benefit of not requiring a second procedure to harvest bone. However, since these options lack autograft’s bone-forming properties, bone regeneration may take longer and they tend to have a less-predictable outcome.

If Drs. Stewart or Michael determine that the best course of action is to use a real-bone substitute, there are a number of safe and proven synthetic alternatives, including:

Demineralized Bone Matrix (DBM)/Demineralized Freeze-Dried Bone Allograft (DFDBA)

This product is processed allograft bone (i.e. bone harvested from a donor). It contains collagen, proteins, and growth factors that have been extracted from the allograft bone. It’s available as powder, putty, chips, or a gel that can be injected through a syringe.

Graft Composites

Graft composites use other bone graft materials and growth factors to achieve the benefits of a variety of substances. Some combinations may include collagen/ceramic composite, which closely resembles the composition of natural bone; demineralized bone matrix combined with bone marrow cells, which aid in the growth of new bone; or a collagen/ceramic/autograft composite.

Bone Morphogenetic Proteins

Bone morphogenetic proteins (BMPs) are proteins naturally produced in the body that promote and regulate bone formation and healing. During surgery, BMP is soaked onto and binds with a collagen sponge. The sponge is then designed to resorb, or disappear, over time. As the sponge dissolves, the BMP stimulates the cells to produce new bone. The BMP also goes away once it has completed its task of jump starting the normal bone-healing process.

While synthetic materials have the advantage of not requiring a second procedure to harvest bone, each option has risks and benefits and Drs. Stewart and Michael will determine the type that best meets your particular needs.

Bone grafting, whether in preparation for restorative dentistry or for other reasons, is a technically sensitive procedure that requires a skilled professional. Texas Oral Surgery Group patients can feel confident knowing that in addition to Dr. Stewart’s extensive lecturing on the topic, he and Dr. Michael have a combined 50+ years of experience in the field.

We’re here to answer your questions. Please contact any of our four convenient office locations to schedule a consultation.

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What it Means to be a Diplomate of the American Board of Oral and Maxillofacial Surgery

What it means to be a Diplomate of the American Board of Oral and Maxillofacial Surgery

Diplomate of American Board of Oral Surgery LogoAt Texas Oral Surgery Group, we understand that choosing a surgeon – even under the best of circumstances – can be stressful. We also know that a doctor’s training and experience makes a difference. In addition to a combined 50 years of service, Doctors Stewart and Michael are Diplomates of the American Board of Oral and Maxillofacial Surgery, which means they are board-certified oral surgeons.

What is the American Board of Oral and Maxillofacial Surgery (ABOMS)?
ABOMS is the only certifying board in the United States recognized by the American Dental Association for the specialty of oral and maxillofacial surgery. Formed to elevate the standards of oral and maxillofacial surgery, ABOMS oversees certification and ongoing maintenance of that certification in an effort to promote the delivery of superior health care.

What goes into becoming board certified?
Board certification means that an oral and maxillofacial surgeon has met the highest requirements of competence within the field of oral and maxillofacial surgery. Achieving the status of board-certification demands an immense amount of dedication and hard work beyond the regular rigors of an oral surgeon’s education.

Following four years of dental school and a four or six-year, hospital-based residency program oral surgeons can elect to undergo an intense examination by the American Board of Oral & Maxillofacial Surgery. This process requires submission of cases that demonstrate a broad area of surgical expertise, an intensive written exam, and a lengthy oral exam.

Is board certification a one-time process?
Absolutely not! Beyond the initial certification diplomates must adhere to a certification maintenance process that ensures their commitment to lifelong learning, practicing in a safe and contemporary manner, and keeping current with the latest knowledge and skills. This includes maintaining active and unrestricted state licensure and continuous hospital privileges. Both Doctors Stewart and Michael maintain privileges at Medical City Plano, a Level I Trauma Center located in Plano, Texas.

Do I need to see a board-certified oral surgeon, isn’t a dental surgeon the same?
A dental surgeon is a regular or general dentist and while he or she likely performs procedures such as root canals, simple extractions, and some types of minor oral surgery the sole focus of their practice is not surgery. Conversely, oral surgeons are specialists who’ve undergone extensive surgical training and only perform surgery on a daily basis.

Beyond Doctors Stewart and Michael’s training, patients can feel confident knowing that the entire Texas Oral Surgery Group team across our four offices is as committed to patient care today as when we opened over 30 years ago.  We provide a full range of oral surgery services and invite you to contact any of our locations (Denton, Plano, Decatur, Gainesville ) if we can be of further assistance.

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Obstructive Sleep Apnea Treatment Options

Obstructive Sleep Apnea Treatment Options

Sleep Apnea North TexasDo you often experience fatigue or daytime sleepiness? Has a loved one expressed concern about how snoring could be impacting your health or, more likely, their ability to sleep?  Before you write these off, consider that the America Sleep Apnea Association estimates that 22 million Americans suffer from sleep apnea, and 80%  of moderate and severe obstructive sleep apnea cases go undiagnosed[1].

What Is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) occurs when something partly or completely blocks your upper airway while you sleep. This blockage causes your diaphragm and chest muscles to work harder to open the obstructed airway resulting in breathing that repeatedly starts and stops. Breathing commonly resumes with a loud gasp, snort, or body jerk. However, you might not be aware of what’s occurring because the apnea alerts the brain just enough to restart the breathing process.

What Are the Risks of Sleep Apnea?
Some symptoms associated with sleep apnea such as snoring, fatigue, awaking with a dry mouth or headache, may seem to be more of an inconvenience than a serious medical concern. However, untreated OSA can raise the risk of dangerous health issues such as Type 2 diabetes, irregular heart rhythms, and high blood pressure. In addition, sufferers often experience moodiness, depression, and obesity[2].

Treatment Options
Oral and Maxillofacial Surgeons are uniquely trained to recommend the appropriate course of action based on the severity of your OSA. Treatment options focus on preventing airway obstruction and span the spectrum from behavior modification to use of an oral appliance or air pressure machine, to surgery.

Non-surgical Options
For some, non-surgical behavior modifications such as weight loss, avoidance of alcohol before bed, and sleeping on one’s side rather than stomach or back, may provide relief. In many cases, the condition is treated with the use of a continuous positive air pressure (CPAP) machine or custom oral appliance. Custom-fitted oral appliances worn at night are designed to keep the lower jaw in a forward position. These appliances provide mandibular support which helps prevent oral tissues from collapsing and blocking the airway. Other patients may require a CPAP machine to maintain air pressure and keep the airway open.

Surgical Options
Surgery may become necessary if non-surgical treatments cannot provide relief. Oral and Maxillofacial Surgeons can refine or remove soft tissues that cause airway blockage and /or reposition the upper and lower jaw to keep the airways open during sleep. Depending on your specific needs, your oral surgeon may recommend one of the following procedures:

Somnoplasty –  Doctors use radiofrequency energy to tighten the soft palate at the back of the throat.

Uvulopalatopharyngoplasty (UPPP) –  Soft tissue in the back of the throat and palate is removed to increase the width of the airway at the throat opening.

Hyoid Suspension – This procedure secures the hyoid bone, located above the Adam’s apple, to the thyroid cartilage to help stabilize the airway.

Mandibular/maxillary Advancement Surgery – Jaw and face bones are moved forward to create more room in the back of the throat. This procedure is generally only used for people who have severe sleep apnea and problems with their head or face.

Nasal Surgery – These operations correct obstructions in the nose, such as a deviated septum.

While surgery is a good alternative for some patients, it’s important to remember that no surgical procedure is effective in all situations.

If you have been diagnosed with OSA or are experiencing symptoms, please contact one of our four convenient office locations at Texas Oral Surgery Group to schedule a consultation.

[1] “Sleep Apnea Information for Clinicians.” SleepApnea.org, www.sleepapnea.org/learn/sleep-apnea-information-clinicians/.

[2] “Sleep Apnea.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 July 2018, www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631.

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What You Need to Know About Office Based Anesthesia for an Oral Surgery Procedure

What You Need to Know About Office Based Anesthesia for an Oral Surgery Procedure

Anesthesia Texas Oral SurgeryWhether the procedure is removal of wisdom teeth, bone grafting, or placement of dental implants, one thing many people say is that they don’t want to be awake for the procedure.  We hear this from patients daily, and we understand!   The next most common concern that patients express to us is their fear of “being sedated”, and we understand that as well!

Much of the fear and anxiety associated with being sedated is a result of unanswered questions and unknowns.  We make a point of spending as much time with our patients as needed during our consultation appointments to attempt to answer all those questions.  We understand that consultation appointments often provide patients with an overwhelming amount of information.  So we hope that this will provide some insight into being sedated for an oral surgery procedure, and in doing so, help to alleviate some anxiety.

Other than “not being aware of the procedure”, what benefit exists from sedation/anesthesia?

The benefits of office-based anesthesia are numerous for both oral surgeons and patients alike.

As mentioned above, the elimination of patient anxiety with oral surgery procedures is the most significant benefit.  But there are other, less obvious benefits.

               Keeps you motionless during surgery

In many instances surgical procedures require delicate instrumentation and manipulation of bone and tissue and sudden movement (usually unintentional) can negatively impact the outcome.  Adequate sedation/anesthesia will allow a patient to remain very still during surgery.

               Makes procedure seem like it lasts for 2 seconds

Some surgical procedures can be lengthy, and it is difficult for anyone to remain calm and still for a prolonged period.  This is not an issue when a patient is under sedation/anesthesia.

               Even when you are numb, you still feel pressure

Local anesthesia (numbing medicine) does not eliminate noises, feelings of pressure, or vibration during a procedure, and this is not an issue with sedation/anesthesia.

Plan ahead for post-surgery

Someone must bring you, stay in the office, take you home, and stay with you a while afterwards
Oral surgery procedures may be “outpatient” in nature, but that doesn’t mean you can go about your day like normal afterwards.  Once the initial sedation has worn off, you’re still going to be impaired for some time as you recover.  The amount of time varies with each individual, but generally people are impaired for 4 – 8 hours after getting home.  The person that brings you to the appointment needs to plan on caring for you at home for at least 4-6 hours. You’ll likely be aware of your surroundings, but still somewhat disoriented from the anesthesia – having a caregiver for the day is generally a smart idea!|

Anesthesia affects everyone differently

Just because your cousin threw up after anesthesia, doesn’t mean that you will too

Anesthesia has wide ranging effects on different people.

Most patients emerge from sedation and feel a little groggy for several hours.

On occasion, patients may emerge from sedation feeling disoriented, possibly nauseous, fatigued or confused.  It is usually impossible to know how you will feel when emerging.  Fortunately, the side effects of anesthesia are well known and precautions are taken to prevent the most common ones.

Just because it took your sister 6 hours to be able to dance, doesn’t mean it will take you that long

Recovery periods differ for each patient, and how you feel in the 24 hours after your surgery will depend on how your body metabolizes the anesthetic drugs.

Medications, medical conditions, age, sex, etc. can affect the length of recovery from anesthesia.

The best predictor of how you will respond is a previous experience with anesthesia; if this is your first time with office-based anesthesia, then you should understand that your recovery length may be unpredictable.

You’re constantly and thoroughly monitored while sedated

Many people have a conscious anxiety or fear of anesthesia: usually associated with the “loss of control”. Know that while you are sedated, your heart electrical activity (EKG), heart rate, blood oxygen saturation (pulse oximetry), blood pressure, respiratory rate, and end-expiratory carbon dioxide level are being constantly monitored by our team.

For the science nerds like us:  the carbon dioxide levels measured at the end of an exhaled breath (called ETCO2 or End Tidal CO2) provides critical information that can tell us if your breaths are too deep or shallow (tidal volume) or too rapid or slow (tachypnea or bradypnea).

We use state of the art monitoring equipment and are very strict about performing frequent monitor checks and calibrations.

Our assistants of are DAANCE (Dental Anesthesia Assistant National Certifying Exam) certified.

Dr Stewart and Dr Michael are BLS, ACLS, and PALS certified.  In fact, Dr Michael is a BLS instructor!

What happens if there’s a complication with the sedation?

The key is keeping calm

The great thing about office-based sedation/anesthesia is that complications are very rare when appropriate training is in place and precautions are taken (as is the case in our office).

Nevertheless, some things are beyond our control and the best policy is to make sure that we are prepared to handle any possible situation that may arise.

We maintain state of the art emergency equipment and emergency medications on hand.
We-as a team-undergo frequent training drills where we practice our roles in various emergency scenarios.  While we always hope that urgency or emergency scenarios do not arise, we are proud of the fact that we place so much emphasis on being well-prepared in case such a situation occurs.

What kind of training is involved to be able to perform office-based general anesthesia?

Oral and Maxillofacial Surgeons are unique

If you’re receiving office-based sedation/general anesthesia for an oral surgery procedure by an Oral and Maxillofacial Surgeon, know that it’s being delivered by a highly qualified individual.

In the U.S., Oral and Maxillofacial Surgeons are required to undergo intensive general anesthesia training in a hospital-based residency training program working alongside Anesthesiology residents and being trained by Anesthesiologists.  Oral surgeons can provide IV general anesthesia (this is different than a simple IV sedation or conscious sedation) that can assure your adequate level of anxiolysis and comfort.   A simple IV sedation (which requires significantly less training and expertise) is usually not optimal for patients undergoing most oral surgical procedures.

In order to be allowed to perform IV general anesthesia, Oral and Maxillofacial Surgeons in Texas must undergo a rigorous anesthesia evaluation of their office (including office layout, equipment, medications, and surgeon knowledge) by a peer from the Texas Society of Oral and Maxillofacial Surgeons.

Make sure your Oral Surgeon is Board Certified

Board Certification (American Board of Oral and Maxillofacial Surgery) is important to consider when evaluating the training of the individual administering your anesthesia.  Oral and Maxillofacial Surgeons undergo a very rigorous written and oral exam to become Board Certified, and anesthesiology is a large part of that exam.  You can be assured that a Board Certified Oral and Maxillofacial Surgeon has proven adequate training and knowledge in anesthesiology.

Don’t be afraid to ask questions!

The more you know….

If you’ve scheduled an oral surgery procedure and are feeling uneasy about it, never be afraid to speak with the oral surgeon or staff. Asking questions about the procedure, including the anesthesia, is all part of the process and could provide you the comfort and peace of mind you need. Coordinating with a friend or family member to care for you, having trust in your oral surgeon, and understanding the nature of office-based anesthesia are all important.

If you have any questions about anesthesia, we encourage you to contact our experienced oral surgery team at the Texas Oral Surgery Group.

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