Oral Surgery Procedures

Dental Implants

Dental implants are used to replace tooth roots. Implants provide a strong foundation for fixed or removable replacement teeth. Dental implants are small anchors made of biocompatible metal, called titanium, placed in the jawbone. The anchors begin to fuse with the bone over a few months. After the fusing process, known as osseointegration, abutment posts are inserted into the anchors to allow for the attachment of the replacement teeth. To fabricate the replacement teeth, an impression is taken and a model of the bite is created. The replacement teeth are based on this model. Replacement teeth can either be crowns, bridges or dentures.

Wisdom Tooth Removal (3rd Molars)

Wisdom teeth often do not have enough space to erupt into a functional and cleanable position in the mouth. A wisdom tooth that is deemed problematic is normally extracted to avoid any oral complications. To have a wisdom tooth removed, a small incision is made to open up the gum tissue over the tooth and remove any bone that is covering the tooth. Sometimes the tooth may need to be cut into smaller pieces to make it easier for removal. Stitches may be necessary after the removal of a wisdom tooth.

Impacted Tooth & Tooth Exposure

Impacted Tooth & Tooth Exposure

An impacted tooth is a tooth that fails to fully pass through the gum tissue (erupt) at the expected time.

Impacted wisdom and cuspid (or canine) teeth are very common. To correct impacted teeth, there are a few treatment options. For impacted wisdom teeth, the most common procedure is extraction. For impacted canine teeth, several treatment modalities are available. Orthodontic braces can be used to open space for proper eruption or primary (baby) teeth can be extracted. Alternatively, the impacted tooth can be surgically exposed to allow for the placement of an orthodontic bracket to help align the teeth.

Bone Grafting

Bone Grafting

Oral and Maxillofacial Surgeons are the only specialists trained to provide the full range of bone grafting options. Bone grafting is the replacement or enhancement of bone in the upper and lower jaws. When a tooth is lost, the surrounding bone collapses over time. Bone grafting is performed to reverse bone loss or enhance existing bone and most procedures can be performed in the office. The grafting material can be taken from parts of the body or from other sources that have been specifically prepared for dental use. Bone grafting allows for proper support of dental implants or prostheses.

Sinus Lift

Sinus Lift

A sinus lift is a surgery that adds bone to your upper jaw in the premolar and molar areas of your mouth in order to placed dental implants. To add bone, an incision is made where the premolar and molar teeth were previously located. Once the bone is exposed, a small window is made to access the sinus. Once the sinus is accessed, the sinus membrane is gently pushed up and away from the upper jaw. Bone graft material is then placed into the sinus space to increase the amount of available bone and provide support for dental implants. We are often able to place dental implants at the same time that the sinus lift bone graft is performed. Once the bone is in place, the incision is closed and the healing process begins.

Orthognathic Surgery

Orthognathic Surgery

Orthognathic surgery is done to correct misalignments or other abnormalities in the upper and/or lower jaw.

Orthognathic surgical correction of the jaws is conducted in stages, and the course of treatment can last from a few months to a year or more. The procedures are performed in coordination with your orthodontist who will use orthodontic braces to make appropriate changes in tooth position.

In order to perform the procedure successfully, the jawbones will be repositioned in accordance with one’s specific needs. Inconspicuous incisions are usually made inside and, if needed, outside the mouth to allow for placement of small surgical plates and screws to hold your jaws in their new positions.

Labial or Lingual Frenectomies

Labial or Lingual Frenectomies

A frenectomy is a simple surgical procedure performed to release the connection of the “frenum,” a connective muscle between two tissues. There are two types of oral frenectomies that are frequently performed on both adults and children for a variety of reasons. Most frenectomies are performed in the office with our surgical laser.

A Labial Frenectomy is performed on the tissue that connects the lip to the gums. This may be performed on children or adults to aid with orthodontic treatment or even help with the proper fitting for a denture or appliance.

A Lingual Frenectomy may also be referred to as the release of tongue-ties (ankyloglossia). This procedure is performed on the connective tissue under the tongue. The procedure is often performed on neonatal patients to assist with nursing or on toddlers or older patients who need the surgery to help correct speech issues caused by limited movement due the the frenum.

Additional Procedures

Facial trauma involves injuries to the bone, teeth, skin, gums or other soft tissues.

Depending on the type and severity of facial trauma sustained, there are many different treatment options available. Drs. Lieblich, Fletcher, and Gill are members of the Hartford Hospital and Connecticut Children’s Medical Center (CCMC) maxillofacial trauma team and perform surgery on numerous trauma patients throughout the year. As Oral and Maxillofacial Surgeons, they are the only medical specialty able to provide complete reconstruction of the maxillofacial skeleton and continue this treatment through the replacement of lost teeth with dental implants.

The smooth, pink skin lining the mouth is called mucosa. Abnormalities in the color or texture of this mucosa can sometimes indicate pathology. Any concerns with the mucosa in the mouth, a sore that is not healing properly or a lump on the inside of the cheeks, palate, gums or lips, may merit a biopsy so that the tissue sample can be tested for oral cancer. Please do not ignore these warning signs and be sure to mention any concerns you may have during your visit.

There are numerous types of cysts, tumors, or other lesions that can occur in and around the jaw bones and oral cavity. Many of these lesions are noted on routine dental exams or x-rays and referred to our office for further evaluation and treatment. Most biopsies can be performed in the office with a simple procedure. Further treatment will depend on the results of the biopsy. Drs. Lieblich, Fletcher, and Gill all maintain active privileges for and a particular interest in the surgical removal of these lesions and any reconstruction that may be required.

The temporomandibular joint (TMJ) is similar to a sliding hinge that connects your jawbone to your skull. TMJ disorders can cause pain in the jaw joint and in the muscles that control jaw movement.

To treat TMJ disorders, first the cause has to be identified. In less severe cases TMJ disorders can be treated with self-managed care (eating soft foods, using ice packs, avoiding extreme jaw movement) or nonsurgical treatments (anti-inflammatory medications, Botox injections, or stabilization splints). In severe cases surgical treatments (jaw joint replacements) may be necessary.

TMJ conditions fall into three main categories:

  • Myofascial pain – discomfort or pain in the muscles that control jaw function.
  • Internal derangement of the joint – a possible indicator of a displaced disc, dislocated jaw, or injury to the condyle.
  • Arthritis – a degenerative inflammatory disorder.
Sleep apnea is a disorder in which one experiences pauses in breathing while sleeping that lead to disruption of the normal sleep cycle. When breathing is paused or becomes shallow, one will often move out of deep sleep and into light sleep to allow for the exchange of air, but resulting in a poor quality of sleep. Snoring can be a sign of possible sleep apnea but also may occur without episodes of reduced breathing. Both snoring and sleep apnea can be treated with a variety of surgical and nonsurgical options.

The most common treatment for Obstructive Sleep Apnea is a breathing device called CPAP (continuous positive airway pressure). These devices are typically prescribed by your primary care physician. A CPAP machine uses a mask that fits over your mouth and/or nose and blows a continuous stream of air pressure that helps keep your airway open while you sleep. Many patients have difficulty tolerating this device leading to poor compliance with treatment.

There are numerous alternatives that we can provide to help overcome issues with sleep apnea and snoring. Treatment is tailored to each patient’s needs but may include the following:

  • Sleep appliance (mandibular repositioning device)
  • Radiofrequency Coblation of the Palate/Uvula
  • Maxillo-mandibular advancement (orthognathic surgery to advance and reposition the jaws)
A tooth that can not be saved with restorative materials may need to be removed. First, the area will be numbed with anesthesia. The tooth is then loosened with a special dental instrument known as an elevator. After the tooth is loosened from the socket, it is removed. Stitches may be necessary after the removal of a tooth.
An apicoectomy is a surgery to remove a tooth’s root tip and seal off the remaining portion of root to prevent further infection. These procedures are performed on teeth that have had previous root canal therapy (endodontics) but continue to have active infection around the root.

A small incision is made in the gum tissue and bone over the tooth’s root. After the root tip is accessed, it is partly removed, cleaned and sealed with a small filling. The gum tissue is then stitched back into place. These procedures can be performed under local anesthesia or with sedation, if desired and appropriate.

Socket preservation is a procedure performed after an extraction to reduce bone loss. Bone grafting material or bone growth enhancing elements are placed in the socket where the extracted tooth was to prevent resorption of bone.
Pre-prosthetic surgery is performed to prepare the mouth for a dental prosthesis, such as a denture.Surgical modification of the bone involves reshaping and smoothing edges so that a well-fitting, well-functioning dental prosthesis can be created. Dental implants can also be placed into the jaw bone in select patients to help retain a denture and provide for a significant improvement in comfort and function.

Specialized Techniques

Drs. Lieblich, Fletcher, and Gill are able to treat snoring problems through minimally invasive surgery known as coblation assisted palate channeling. The doctors utilize radiofrequency technology to reduce the size of enlarged palatal soft tissue and reduce upper airway obstruction that can lead to snoring. The palatal coblation procedure is office based and well tolerated by patients. This procedure is often performed in conjunction with uvulectomy (removal of enlarged tissue in the back of the palate). Coblation surgery provides an excellent adjunct to non-surgical treatment in selected patients.
Laser surgery uses a beam of intense light to vaporize the tissue it is concentrated on. Laser surgery often means less bleeding and discomfort, an easier and quicker recovery time, and fewer appointments.
BMP is a growth factor used to stimulate bone growth. It can be used to combat jaw bone resorption or supplement bone to accommodate an implant.