Matthew Bronk

This depends on the location of the stones and whether or not you are symptomatic (ie swelling etc). IF the stones are close to the entrance of the ducts, they may be able to be removed with a procedure called lithotripsy (think of a tiny jackhammer) that can break up the large stones so that they can pass. IF the stones (which are causing swelling) are right next to the gland, especially the submandibular gland, then the treatment is usually removal of that gland in the OR. Wharton's is the duct from the submandibular gland which is located just medial to the angle of the mandible and the duct exits just under the tongue in the anterior floor of the mouth. Stenson's is the duct from the parotid gland which is located anterior and deep to the tragus of the ear at its superior border and runs down almost to the angle of the mandible. SO, if your swelling is on the* side* of your face, that stone/obstruction is likely in the parotid duct. IF your swelling is *under your jaw* and medial, then the stone is likely in your submandibular duct. IF YOU ARE ASYMPTOMATIC, and the stones are simply a finding on a CBCT or CT scan, then you may not require treatment. If, however, you have had swelling, I would recommend going to see an OMS or an ENT surgeon. Hope this helps, Dr Bronk

The one placed by a board certified Oral Surgeon or Periodontist.

It depends on your specific situation, but usually between 3-6 months. If it's in the lower jaw, and you're a healthy non-smoker, 3-4 months is likely fine (CBCT scan will give more information on the bone consolidation after the graft). If you're talking about the upper jaw, usually 5-6 months before the implant can be placed.

This is more dependant on whether or not you received a bone graft at the time of implant surgery. If so, I'd avoid very hot and abrasive foods for the first 2 weeks....ie stock with a soft diet that is not more than lukewarm. But, if no graft was placed I tell my patients they can eat what they want as soon as 24 hours after surgery (soft cool diet until then) Hope this helps, Dr Bronk

It can't necessarily fix the height of tissue loss, but a soft tissue graft can help the width of the thin tissue overlying the roots of the teeth. The attached gingival graft is taken from the hard palate and placed/attached to the attached gingival tissue in an overlay fashion. So, it will thicken the current tissue, thereby slowing the recession. I would speak to a periodontist as this is their specialty and although it's performed by some OMS's, I don't do them. Hope this helps, Dr Bronk

Antibiotics during (IV or start them 2 days before surgery, if not doing IV sedation) and for a short period after a bone graft (I prescribe abx for 5 days following grafts), is prudent in my opinion. There is some debate as to whether or not to give them, but I think that it's prudent to prevent graft failure due to infection. Also, it's best to give a narrow spectrum (ie penicillin or Clindamycin) rather than something that covers bugs outside the mouth. Amoxicillin is not necessary. Dr Bronk Board Certified OMS

In most cases, you can return to normal chewing 6 weeks after your surgery. Until that time, a strict, SOFT, NON-CHEW diet is recommended. I would recommend speaking to your Oral Surgeon as he/she may want you to go longer or MAYBE even shorted depending on your case. The standard I use is 6 weeks, Dr Bronk

Ice for the first few days as well as staying on top of your pain meds. I truly believe that the combination (COMBO) of Ibuprofen (600mg) AND Tylenol (650mg) taken every 6 hours works amazingly well. In some cases I will also prescribe a very small amount (12 tabs) of Norco (10/325) for BREAKTHROUGH pain ONLY. For example: let's say your surgery is this Monday and your surgeon discharges you on Tuesday morning around 9 am, but you got some pain meds (a COMBO perhaps) around 6 am. You could then take another combo at noon, 6 pm and midnight. If you are young with good kidney function, you could take that last dose around 11 pm. For Breakthrough pain, you would take a Norco at 3 pm and 9 pm and one more if you wake up in the middle of the night in pain (but this is rare), say at about 2 am or so. Keep in mind that if you plan to drive a motor vehicle or operate ANY heavy machinery, you cannot take Norco within 6 hours of operation (ie if driving before 8 am, you can't take that 2 am dose). I hope this helps answer your question and my apologies for not getting to this question sooner. Dr Bronk

I think I already answered this question but if not, here is what I do in my practice: IF the patient has adequate bone quality and quantity, I will place 2 implants to set up the patient's general dentist to do a 3 unit bridge, provided the span isn't too long (ie replacing 1 or MAYBE 2 teeth). What I have NEVER done in 26 years, is to place an implant as ONE abutment of a 3-unit bridge where the other abutment is a tooth. Here's why: the implant is going to be very much like an ankylosed tooth...it does NOT move (or at least it shouldn't :). A tooth, even one that's been root canal treated, will have some movement due to the PDL (periodontal ligament) that acts like a shock absorber. This will, in most instances, result in failure within 5 years. There may be SOME cases out there that have been successful with treatment like this, but not a majority and therefore, "not on my watch". Hope this helps. Have a great week,

I recommend that you see your dentist who will then likely refer you to an OMS (Oral Surgeon) for the removal of the cyst. He/She will then send that cyst to an Oral Pathologist who will look at it under a microscope. This is important because you want to know what type of cyst you're talking about. If it's a repeat cyst, like a mucocele that has already been diagnosed previously, then you don't HAVE to send it to pathology, but in all other scenarios, the biopsy report is recommended. Good luck with your surgery. Hope you find an excellent surgeon to take care of you.

How old are you? Are you on any anticoagulation medication? If you're young and fairly healthy and can take ibuprofen and Tylenol, then I recommend a combination of the two. Two (200 mg each) ibuprofen and ONE extra strength Tylenol (500 mg) every four hours. You don't have to set an alarm at night to wake up to take the next dose and it's best to have something in your stomach (i.e., food) before to taking them. But, if you wake up in pain and it's been 4+ hours, you may certainly take the next dose.

Hope this helps,

Dr. Bronk

TMD, or Temporomandibular Disorder, is generally a clinical diagnosis, but the diagnosis can be aided by diagnostic X-rays, CT scan, or an MRI.

Good Morning,

As a surgeon who has performed hundreds of orthognathic surgeries, I can tell you that it's unlikely for a screw to come loose, but is always a possibility. This is true moreso in the maxilla (top jaw) following a LeFort. This is because the screws used in a maxillary surgery are smaller, the bones are thinner and the bone quality is less dense. If you are truly compliant and eat a soft, non-chew diet for at least 6 weeks, then it is far less likely as well. If one of the screws does come loose, say 6 months later, a year later, 2 years later, it can usually be removed with IV sedation in the office setting, and the bones are usually healed enough by then that no additional surgery is needed. In mandibular surgery (bottom jaw), I usually will utilize bicortical screws that are quite a bit longer. Bicortical means that they engage both sides of the mandible where the bone is VERY hard. Over many years of doing
these cases, I have yet to see a mandibular screw work it's way out. I'm sure it has happened in the long history (about 70 years) of this procedure (BSSO), but it's extremely rare. Again, you must still follow the NON-CHEW diet protocol for 6 weeks following your surgery. Usually, my patients are very compliant for the first 2-3 weeks ( I do short weekly follow-ups for 6 weeks after surgery). Then they will ask the following question: "Do I REALLY need to not chew for 3-4 more weeks?" YES!!! This is the difficult timeframe because the patient is feeling much better and really feels that it will be okay to chew. This is simply not true. I had one patient that did have hardware that had loosened on the maxilla and it was about weeks 4 post-op. When I asked if he'd been chewing, he admitted that he'd had a hamburger, the weekend after the 3-week follow-up. I also saw that he had brought in a motorcycle helmet. I asked him what he rode and he told me a that it was a Harley Davidson. Since his maxilla was "loose," I said, no more chewing, SOFT BLENDED, NON-CHEW diet ONLY and NO HARLEY for the next 6 weeks! Wouldn't you know it, he came back 2 weeks later and the jaw had tightened up. This was a close call as we almost had to return to the OR to re-fixate him (new plates and screws). Fortunately, that wasn't required. I now tell all of my patients that in addition to 6 weeks of soft, non-chew diet, no motorcycle riding or anything similar that might cause jarring/vibration of the maxilla. See there, even crusty old surgeons can learn a few things.
I hope this answer helps you out. Good luck with your surgery and remember to keep hydrated afterwards and use a soft, blenderized diet. There are lots of good things that you can blend and still taste suprisingly well.

Dr. Matt Bronk

Good Morning,

I assume that you are referring to Orthognathic Jaw Surgery. In that case, I recommend that my patients sleep at a 30-45 degree angle using a pillow made for reading or (if that's not available) using three pillows to prop you up at night, for the first week following surgery. If you have a bed that adjusts, that works great, too. As a 27-year-old, you will heal enough by then that you can (probably) go back to your regular sleep pattern after that. We are trying to avoid pooling of blood on either or both sides (so NO side sleeping the first week).