Oral & Maxillofacial Procedures

Dental Implants

Dental implants are changing the way people live. They are designed to provide a foundation for replacement teeth that look, feel, and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything, knowing that the new teeth appear natural and that natural facial contours are restored. Patients with dental implants can smile with confidence.

What Are Dental Implants?

The implants themselves are titanium posts that are surgically placed into the jawbone where teeth are missing. These are most appropriately placed by a surgeon specifically trained in jaw and implant surgery. These metal anchors act as tooth root substitutes. The bone bonds with the titanium, creating a strong foundation for artificial teeth. Small posts that protrude through the gums are then attached to the implant. These posts provide stable anchors for artificial replacement teeth.

Implants also help preserve facial structure, preventing bone deterioration that occurs when teeth are missing.

The Surgical Procedure

For most patients, the placement of dental implants involves two surgical procedures. First, implants are placed within your jawbone by a qualified surgeon. For the first three to six months following surgery, the implants are beneath the surface of the gums gradually bonding with the jawbone. You should be able to wear temporary dentures or temporary partial dentures and eat a soft diet during this time. At the same time, your dentist is fabricating new replacement teeth.

After the implant has bonded to the jawbone, the second phase begins. Dr. Viehweg will uncover the implants and attach small posts that protrude through the gums and will act as anchors for the artificial teeth. When the artificial teeth are placed, these posts will not be seen. The entire procedure usually takes less than six months. Most patients experience minimal disruption in their daily life.

Surgical Advances

With the use of state-of-the-art advances in facial bone imaging, Dr. Viehweg can use CT technology to obtain a 3-dimensional image of the area where an implant is to be placed. This technology helps identify the location of structures such and nerves and adjacent teeth, and can predict the best location to place the implant based upon the amount and quality of bone present. This technology helps increase the chance for success of the implant, and takes much of the guesswork out of the surgery itself.

In some cases, an area intended for implant placement will require a bone graft to appropriately support the implant. Often times, the implant and associated bone grafting can be done simultaneously, eliminating the need for a second surgery. However, if the amount of bone present is insufficient initially, a bone graft will need to be performed independently to ensure the proper amount of bone to maximize the success of the implant.

Using the most recent advances in dental implant technology, Dr. Viehweg is able to place single stage implants. These implants do not require a second procedure to uncover them, but do require a minimum of six weeks of healing time before artificial teeth are placed. There are even situations where the implants can be placed at the same time as a tooth extraction – further minimizing the number of surgical procedures. Advances in dental implant technology have made it possible, in select cases, to extract teeth and place implants with crowns at one visit. This procedure, called “immediate loading”, can be done in select cases when the bone is plentiful and healthy.

Implants are a team effort between an Oral and Maxillofacial surgeon and a restorative dentist. While Dr. Viehweg performs the actual implant surgery, initial tooth extractions, and bone grafting if necessary, the restorative dentist (your dentist) fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.

What Types Of Prosthesis Are Available?

A single prosthesis (crown) is used to replace one missing tooth – each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis (over denture) attaches to a bar or ball-in-socket attachments, whereas a fixed prosthesis is permanent and removable only by the dentist.

Dr. Viehweg performs office-based implant surgery in a hospital-style operating suite, optimizing the level of sterility. Inpatient hospital implant surgery is for patients who have special medical or anesthetic needs, or for those who need extensive bone grafting from the jaw, hip or tibia.

Why Dental Implants?

Once you learn about dental implants, you finally realize there is a way to improve your life. When you lose several teeth – whether it’s a new situation or something you have lived with for years – chances are you have never become fully accustomed to losing such a vital part of yourself.

Dental implants can be your doorway to renewed self-confidence and peace of mind.

Why Select Dental Implants Over More Traditional Types Of Restorations?

There are several reasons: Why sacrifice the structure of surrounding good teeth to bridge a space? In addition, removing a denture or a “partial” at night may be inconvenient, not to mention that dentures can slip, can be uncomfortable, and can be embarrassing.

Are You A Candidate For Implants?

If you are considering implants, your mouth must be examined thoroughly and your medical and dental history reviewed. If you mouth is not ideal for implants, ways of improving outcome, such as bone grafting, may be recommended.

What Type Of Anesthesia Is Used?

The majority of dental implants and bone grafts are placed in an office setting using local anesthesia under intravenous (IV) sedation with nitrous oxide/oxygen (laughing gas) or general anesthesia.

Do Implants Need Special Care?

Once the implants are in place, they will serve you well for many years if you take care of them and keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing) and keeping regular appointments with your dental specialists.

Teeth-In-An-Hour™

TEETH-IN-AN-HOUR™ is a revolutionary concept providing patients with fully functioning teeth on dental implants in one single procedure that lasts about an hour. This technology was recently developed by Nobel Biocare and allows for collaboration between both the restorative doctor and the surgeon. This merging of knowledge and experience achieves not only increased safety, but also a more precise implant placement. In addition, the fabrication of a final prosthesis is completed prior to the surgery. The computer-guided implant surgery is done in an arthroscopic fashion without requiring any flap reflection. This benefits the patient in that there is less postoperative discomfort, less swelling and less bruising. Patients can often resume their normal activities the next day.

The process starts when a CAT scan is taken of the patient's jawbone. This CAT scan allows for the generation of a three-dimensional model of the jawbone that can then be used in virtual reality software to plan the implant placement without the presence of the patient. The results are more accurate implant placement, and less chair time for the patient at the surgery office.

Wisdom Teeth

By the age of 18, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine, and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth (molar teeth) are used to grind food up into a consistency suitable for swallowing.

The average jawbones can only accomodate 28 teeth. It can be painful when 32 teeth try to fit into jaws that holds only 28 teeth. These four other teeth are your third molars, also known as "wisdom teeth."

Why Should I Have My Wisdom Teeth Removed?

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt.

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the teeth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain, and illness. The most serious problem occurs when tumors or cysts form around the impacted wisdom teeth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Facial and Oral Examination

With a facial and oral examination and x-rays of the jaws, Dr. Viehweg can evaluate the position of the wisdom teeth and determine if there are any problems present, or predict the possibility of future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist or by an Oral and Maxillofacial surgeon.

All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Viehweg has the training, license, credentials, and experience to provide various types of anesthesia. He will help you select the best alternative.

Removal

In most cases, the removal of wisdom teeth is performed with local anesthesia under intravenous (IV) sedation with nitrous oxide/oxygen (laughing gas) or general anesthesia, by a well qualified Oral and Maxillofacial surgeon. These options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is often sutured. To help control bleeding, bite down on the moist gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your postoperative kit will include postoperative instructions, a prescription for pain medication, and a packet of gauze for future use. You may also have a prescription for antibiotics, as well as an appointment for a follow-up visit. If you have any questions, please do not hesitate to call us at (801) 766-4834.

Our services are provided in an environment of optimum safety that utilizes modern, state-of –the-art monitoring equipment, and staff who are experienced in providing excellent patient care and anesthetic techniques.

Orthognathic Surgery

Orthognathic surgery is needed when upper and lower jaws don't meet correctly and/or teeth don't seem to fit with jaws. Teeth are straightened with orthodontics and corrective jaw surgery repositions a misaligned jaw. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.

Who Needs Orthognathic Surgery?

People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and in some instances, the upper and lower jaws may grow at different rates. The result can be a combination of problems that can affect chewing function, speech, long-term oral health and appearance. Injury to the jaw, growth abnormalities, and birth defects can also affect jaw alignment. Orthodontics alone can correct bite problems when only the teeth are involved. Orthognathic surgery may be required for the jaws when bone repositioning in necessary. This is best done by a well trained Oral and Maxillofacial Surgeon.

Difficulty in the following areas should be evaluated:

Difficulty in chewing, biting or swallowing
Speech problems
Chronic jaw or TMJ (joint) pain
Open bite
Protruding jaw
Breathing problems

Any of these symptoms can exist at birth, be acquired after birth as a result of hereditary or environmental influences, or as a result of trauma to the face. Before any treatment begins, a consultation with your orthodontist and your Oral and Maxillofacial surgeon will be held to formulate a complete and extensive treatment plan to ensure proper diagnosis and surgical planning. This will be after a complete examination with x-rays, photographs, and stone models of your teeth and jaws. During the pre-treatment consultation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your surgical and orthodontic team can make the decision to proceed with treatment together.

Technology & Orthognathic Surgery

Dr. Viehweg uses modern computer techniques and three-dimensional models to show you exactly how your surgery will be approached. Using comprehensive facial x-rays and computer imaging, Dr. Viehweg can show you how your bite will be improved and even give you an idea of how you'll look after surgery. This helps you understand the surgical process and the extent of the treatment prescribed. Our goal is to help you understand the benefits of orthognathic surgery.

If you are a candidate for corrective jaw surgery, Dr. Viehweg will work closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional, and healthy dental-facial relationship.

Facial Trauma

An Oral and Maxillofacial Surgeon performs the proper treatment of facial injuries. These specialists must be well versed in emergency care, acute treatment and long-term reconstruction and rehabilitation – not just for physical reasons but emotional as well. Oral and Maxillofacial surgeons are trained, skilled and uniquely qualified to manage and treat facial trauma. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.

Dr. Viehweg’s training and abilities exceeds these modern standards. He is well trained, highly skilled, and uniquely qualified to manage and treat facial trauma. He is on staff at several local hospitals to provide emergency room coverage for facial injuries, including the following:

Facial lacerations
Fractured facial bones (cheek, nose or eye socket)
Fractured jaws (upper and lower jaw)
Intra-oral lacerations
Avulsed (knocked out) teeth

The Nature Of Maxillofacial Trauma

There are a number of possible causes of facial trauma such as motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. Types of facial injuries can range from extremely severe injuries of the skin and bones of the face, to injuries of the teeth and gums. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).

Soft Tissue Injuries Of The Maxillofacial Region

When soft tissue injuries such as lacerations occur on the face, they are repaired by suturing. In addition to the obvious concern of providing a repair that yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands, and salivary ducts (or outflow channels). Dr. Viehweg is a well-trained and highly experienced Oral and Maxillofacial surgeon and is proficient at diagnosing and treating all types of facial lacerations.

Bone Injuries Of The Maxillofacial Region

Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, the age, and general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.

One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique of treatment can often allow for healing, and obviates the necessity of having the jaws wired together. This technique is called "rigid fixation" of a fracture. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly.

The treatment of facial fractures should be accomplished in a thorough and predictable manner. More importantly, the patient's facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest and smallest incisions necessary is always made. At the same time, the incisions that become necessary, are designed to be small, and whenever possible, are placed so that the resultant scar is hidden.

Injuries To The Teeth & Surrounding Dental Structures

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral and Maxillofacial surgeons are often involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see an Oral and Maxillofacial surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon, such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.

The proper treatment of facial injuries is best done in the realm of specialists who are well versed in emergency care, acute treatment, long-term reconstruction, and rehabilitation of the patient.

Bone Grafting

Major & Minor Bone Grafting

Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.

Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and aesthetic appearance.

Major Bone Grafting

Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either your own bone taken from the jaw, hip or tibia (below the knee) or obtained from a tissue bank. Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.

Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an office setting, or in the hospital, depending on the need for an overnight hospital stay.

Sinus Lift Procedure

The maxillary sinuses are behind your cheeks and above the upper teeth. Sinuses are hollow spaces in the facial bones. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.

The solution is a sinus graft or sinus lift. The oral & maxillofacial surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.

The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.

If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.

Ridge Expansion

In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.

Nerve Repositioning

The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants in the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and second premolar. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which generally dissipates over time), a thorough evaluation with 3-dimensional radiography is completed to ensure the most appropriate surgical plan.

Typically, an outer section of the cheek side of the lower jawbone is removed in order to expose the nerve and vessel canal. The nerve and vessel bundle in that area is carefully identified and isolated, and gently repositioned to the side to allow room for implants in the jaw bone. At this time, the implants are placed. The nerve is then allowed to rest passively next to the bone graft material that is placed around the implants and in the bony defect. The area is then closed and allowed to heal.

These procedures may be performed separately or together, depending upon the individual's condition. As stated earlier, there are several areas of the body that are suitable for obtaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region, or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be obtained from the hip or the outer aspect of the tibia, below the knee. The best results with bone grafting occur when the patient’s own bone is used to graft the defect.

In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to promote the patient’s own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation.

These surgeries are performed in the office surgical suite under intravenous (IV) sedation or general anesthesia. After discharge, limited physical activity is recommended for several days.

Pre-Prosthetic Surgery

The preparation of your mouth before the placement of a prosthesis is referred to as pre-prosthetic surgery.

Some patients require minor oral surgical procedures before receiving a partial or complete denture, in order to ensure the maximum level of comfort. A denture sits on the bone ridge, so it is very important that the bone is the proper shape and size. If a tooth needs to be extracted, the underlying bone might be left sharp and uneven. For the best fit of a denture, the bone might need to be smoothed out or reshaped. Occasionally, excess bone would need to be removed prior to denture insertion.

One or more of the following procedures might need to be performed in order to prepare your mouth for a denture:

Bone smoothing and reshaping
Removal of excess bone
Bone ridge reduction
Removal of excess gum tissue
Exposure of impacted teeth

We will review your particular needs with you during your appointment.

Distraction Osteogenesis

Distraction osteogenesis (DO) is a relatively new method of treatment for selected deformities and defects of the oral and facial skeleton. It was first used in 1903. In the 1950s, the Russian orthopedic surgeon, Dr. Gabriel Ilizarov slowly perfected the surgical and postoperative management of distraction osteogenesis treatment to correct deformities and repair defects of the arms and legs. His work went mostly unnoticed until he presented to the Western Medical Society in the mid-1960s.

Distraction osteogenesis was initially used to treat defects of the oral and facial region in 1990. Since then, the surgical and technological advances made in the field of distraction osteogenesis have provided the oral and maxillofacial surgeons with a safe and predictable method to treat selected deformities of the oral and facial skeleton.

Dr. Viehweg uses distraction osteogenesis to treat selected deformities and defects of the oral and facial skeleton. Dr. Viehweg has many years of experience performing distraction osteogenesis procedures. If you have questions about distraction osteogenesis, please call our office and schedule an appointment with Dr. Viehweg.

Frequently Asked Questions About Distraction Osteogenesis

What does the term distraction osteogenesis mean? Simply stated, distraction osteogenesis means the slow movement apart (distraction) of two bony segments in a manner such that new bone is allowed to fill in the gap created by the separating bony segments.

Is the surgery for distraction osteogenesis more involved than "traditional surgery" for a similar procedure? No. Distraction osteogenesis surgery is usually done on an outpatient basis with most of the patients going home the same day of surgery. The surgical procedure itself is less invasive so there is usually less pain and swelling.

Will my insurance company cover the cost of osteogenesis surgical procedure? Most insurance companies will cover the cost of the distraction osteogenesis surgical procedure provided that there is adequate and accurate documentation of the patient’s condition. Of course, individual benefits within the insurance company policy vary. After you are seen for your consultation at our office, we will assist you in determining whether or not your insurance company will cover a particular surgical procedure.

Is distraction osteogenesis painful? Since all distraction osteogenesis surgical procedures are done while the patient is under general anesthesia, pain during the surgical procedure is not an issue. Postoperatively, you will be supplied with appropriate analgesics (pain killers) to keep you comfortable, and antibiotics to fight off infection. Activation of the distraction device to slowly separate the bones may cause some patients mild discomfort. In general, the slow movement of bony segments produces discomfort roughly analogous to having braces tightened.

What are the benefits of distraction osteogenesis vs. traditional surgery for a similar condition? Distraction osteogenesis surgical procedures typically produce less pain and swelling than the traditional surgical procedure for a similar condition. Distraction osteogenesis eliminates the need for bone grafts, and therefore, another surgical site. Lastly, distraction osteogenesis has been shown to have increased stability when used in major cases where significant movement of bony segments are involved.

What are the disadvantages of distraction osteogenesis? Distraction osteogenesis requires the patient to return to the surgeon's office frequently during the initial two weeks after surgery. This is necessary because in this time frame the surgeon will need to closely monitor the patient for any infection and teach the patient how to activate the appliance.

In some cases, a second minor office surgical procedure is necessary to remove the distraction appliance.

Can distraction osteogenesis be used instead of bone grafts to add bone to my jaws? Yes. Recent advances in technology have provided the oral and maxillofacial surgeon with an easy to place and use distraction device that can be used to slowly grow bone in selected areas of bone loss that has occurred in the upper and lower jaws. The newly formed bone can then serve as an excellent foundation for dental implants.

Does distraction osteogenesis leave scars on the face? Depending on the surgery, the entire surgery is performed within the mouth and the distraction devices used by Dr. Viehweg remain inside the mouth. In most cases, there are no facial surgical incisions made, so no facial scars result.

Are there any age limitations for patients who can receive osteogenesis? No. distraction osteogenesis works well on patients of all ages. In general, the younger the patient, the shorter the distraction time, and the faster the consolidation phase. Adults require slightly longer period of distraction and consolidation because the bone regenerative capabilities are slightly slower than those of adolescence or infants.

Impacted Canines

An impacted tooth simply means that it is “stuck” and cannot erupt into proper position and function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get “stuck” in the back of the jaw and can develop painful infections or other problems (see Impacted Wisdom Teeth under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary canine (upper eyetooth) is the second most common tooth to become impacted. The canine tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The canine teeth are very strong biting teeth and have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.

Normally, the maxillary canine teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a canine tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary canine (upper eye) teeth. Sixty percent of these impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are found in the middle of the supporting bone but stuck in an elevated position above the roots of the adjacent teeth or out to the facial side of the dental arch.

Early Recognition Of Impacted Canines Is The Key To Successful Treatment

The older the patient, the more likely an impacted canine will not erupt by nature’s forces alone, even if the space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panoramic screening x-ray, along with a dental examination, be performed on all dental patients at around the age of seven years to count the teeth and determine if there are problems with eruption of the adult teeth. It is important to determine whether all the adult teeth are present or missing. Are there extra teeth present or unusual growths that are blocking the eruption of the canine? Is there extreme crowding or too little space available causing an eruption problem with the canine? This exam is usually performed by your general dentist or hygienist who will refer you to an orthodontist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to open space to allow for proper eruption of the adult teeth. Treatment may also require a referral to an Oral and Maxillofacial surgeon for extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the important canine teeth. The Oral and Maxillofacial surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking eruption of the adult teeth. If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance the impacted canine will erupt with nature’s help alone. If the canine is allowed to progress in development (age 13-14), the impacted canine will not erupt by itself, even with the space cleared for its eruption. If the canine has fully developed in an adult patient, there is a much higher chance the tooth will be fused in position. In many of these cases the tooth will not move despite all the efforts of the orthodontist and Oral and Maxillofacial surgeon to erupt it into place. Sadly, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (crown on a dental implant or a fixed bridge).

What Happens If The Canine Will Not Erupt When Proper Space Is Available?

In cases where a canine will not erupt spontaneously, the orthodontist and Oral and Maxillofacial surgeon work together to help the unerupted canine erupt. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and the Oral and Maxillofacial surgeon. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted canine to be moved into its proper position in the dental arch. If the baby eyetooth has not fallen out already, it is usually left in place until the space for the adult eyetooth is ready. Once the space is ready, the orthodontist will refer the patient to the Oral and Maxillofacial surgeon to have the impacted canine exposed and bracketed.

In a simple surgical procedure performed in the surgeon’s office, the gum on top of the impacted tooth will be lifted up to expose the tooth underneath. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, the surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. The surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed impacted tooth completely uncovered by suturing the gum up high above the tooth or making a window in the gum covering the tooth (on selected cases located on the roof of the mouth). Most of the time, the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.

Shortly after surgery (1-14 days) the patient will return to the orthodontist. A rubber band will be attached to the chain to put a light eruptive pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take up to a full year to complete. Remember, the goal is to erupt the impacted tooth and not to extract it! Once the tooth is moved into the arch in its final position, the gum around it will be evaluated to make sure it is sufficiently strong and healthy to last for a lifetime of chewing and tooth brushing. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor “gum surgery” required to add bulk to the gum tissue over the relocated tooth so it remains healthy during normal function. This can be done by the Oral and Maxillofacial surgeon. Your dentist or orthodontist will explain this situation to you if it applies to your specific situation.

These basic principals can be adapted to apply to any impacted tooth in the mouth. It is not that uncommon for both of the maxillary canines to be impacted. In these cases, the space in the dental arch form will be prepared on both sides at once. When the orthodontist is ready, the surgeon will expose and bracket both teeth in the same visit so the patient only has to heal from one surgery. Because the anterior teeth (incisors and canines) and the bicuspid teeth are small and have single roots, they are easier to erupt, if they get impacted, than the posterior molar teeth. The molar teeth are much bigger teeth and have multiple roots making them more difficult to move. The orthodontic maneuvers needed to manipulate an impacted molar tooth can be more complicated because of their location in the back of the dental arch.

Recent studies have revealed that with early identification of impacted canines (or any impacted tooth other than wisdom teeth), treatment should be initiated at a younger age. Once the general dentist or hygienist identifies a potential eruption problem, the patient should be referred to the orthodontist for early evaluation. In some cases the patient will be sent to the Oral and Maxillofacial surgeon before braces are even applied to the teeth. As mentioned earlier, the surgeon will be asked to remove over-retained baby teeth and/or selected adult teeth. He will also remove any extra teeth or growths that are blocking eruption of the developing adult teeth. Finally, he may be asked to simply expose an impacted eyetooth without attaching a bracket and chain to it. In reality, this is an easier surgical procedure to perform than having to expose and bracket the impacted tooth. This will encourage some eruption to occur before the tooth becomes totally impacted (stuck). By the time the patient is at the proper age for the orthodontist to apply braces to the dental arch, the canine will have erupted enough that the orthodontist can bond a bracket to it and move it into place without needing to force its eruption. In the long run, this saves time for the patient and means less time in braces (always a plus for any patient!).

What To Expect From Surgery To Expose & Bracket An Impacted Tooth?

The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure that is performed in the Oral and Maxillofacial surgeon’s office. For most patients, it is performed using intravenous (IV) sedation with local anesthesia. In selected cases it will be performed under general anesthesia if the patient desires to be completely asleep. The procedure is generally scheduled for 30 minutes if one tooth is being exposed and bracketed and 45 minutes if both sides require treatment. If the procedure only requires exposing the tooth with no bracketing, the time required will be shortened by about half. These issues will be discussed in detail at your preoperative consultation with your doctor. You can also refer to Preoperative Instructions under Surgical Instructions on this website for a review of any details.

You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within two to three days after surgery there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site; it can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is not a common finding after these cases. A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items like crackers and chips as they will irritate the surgical site if they jab the wound during initial healing. Your doctor will see you seven to ten days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process by applying the proper rubber band to the chain on your tooth. As always your doctor is available at the office or can be beeped after hours if any problems should arise after surgery. Simply call Alpine Surgical Arts at (801) 766-4834, if you have any questions.

Oral Pathology

The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth:

Reddish patches (erythroplakia) or whitish patches (leukoplakia) in the mouth.
A sore that fails to heal and bleeds easily.
A lump or thickening on the skin lining the inside of the mouth.
Chronic sore throat or hoarseness.
Difficulty in chewing or swallowing.

These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology, and curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.

We would recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body's most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we may help.

TMJ Disorders

TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a "clicking" sound, you'll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles (muscles of mastication) do not work together correctly. TMJ stands for temporomandibular joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.

No single treatment can resolve TMJ disorders completely and treatment takes time to become effective. Dr. Viehweg can help you have a healthier and more comfortable jaw.

Trouble With Your Jaw?

TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking, popping or grating noise when you open your mouth, or trouble opening your mouth wide.

Do You Have A TMJ Disorder?

Do you grind or clench your teeth?
Do you wake up with sore, stiff muscles around your jaws?
Do you have frequent headaches or neck aches?
Does the pain get worse when you clench your teeth?
Does stress make your clenching and pain worse?
Does your jaw click, pop, grate, catch, or lock when you open your mouth?
Is it difficult or painful to open your mouth, eat, or yawn?
Have you ever injured your neck, head, or jaws?
Have you had problems (such as arthritis) with other joints?
Do you have teeth that no longer touch when you bite?
Do your teeth meet differently from time to time?
Is it hard to use your front teeth to bite or tear food?
Are your teeth sensitive, loose, broken or worn?

The more times you answered "yes", the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.

Treatment

There are various treatment options that Dr. Viehweg can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Viehweg will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care joined with professional care.

The initial goals are to relieve the muscle spasm and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory, or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include:

Resting your jaw
Keeping your teeth apart when you are not swallowing or eating
Eating soft foods
Applying ice and heat
Exercising your jaw
Practicing good posture

Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. A splint (or nightguard) fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night and helps to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw forward, relives pressure on parts of your jaw and aids in disk repositioning. It may be worn 24 hours/day to help your jaw heal. An orthotic stabilization appliance is worn 24 hours/day or just at night to move your jaw into proper position. Appliances also help to protect from tooth wear.

What About Bite Correction Or Surgery?

If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair or restructuring are sometimes needed, but are reserved for severe cases. Dr. Viehweg does not consider TMJ surgery unless the jaw can’t open, is dislocated and nonreducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully.

Sleep Apnea

People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue and soft palate fall against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Oral and Maxillofacial surgeons offer consultation and treatment options.

In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometric (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.

There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures are usually performed under light IV sedation in the office.

In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.

Dr. Viehweg and his staff have the training and experience to perform many of the procedures describe help alleviate the anatomical abnormalities associated with obstructive sleep apnea.

Cleft Lip & Palate

During early pregnancy, separate areas of the face develop individually and then join together, including the left and right sides of the roof of the mouth and lips. However, if some parts do not join properly, sections don’t meet and the result is a cleft. If the separation occurs in the upper lip, the child is said to have a cleft lip.

A completely formed lip is important not only for a normal facial appearance but also for sucking and to form certain sounds made during speech. A cleft lip is a condition that creates an opening in the upper lip between the mouth and nose. It looks as though there is a split in the lip. It can range from a slight notch in the colored portion of the lip to complete separation in one or both sides of the lip extending up and into the nose. A cleft on one side is called a unilateral cleft. If a cleft occurs on both sides, it is called a bilateral cleft.

A cleft in the gum may occur in association with a cleft lip. This may range from a small notch in the gum to a complete division of the gum into separate parts. A similar defect in the roof of the mouth is called a cleft palate.

Cleft Palate

The palate is the roof of your mouth. It is made of bone and muscle and is covered by mucosa that forms the red covering inside the mouth. You can feel your own palate by running your tongue over the top of your mouth. Its purpose is to separate your nose from your mouth. The palate has an extremely important role during speech because when you talk, it prevents air from blowing out of your nose instead of your mouth. The palate is also very important when eating. It prevents food and liquids from going up into the nose.

As in cleft lip, a cleft palate occurs in early pregnancy when separate areas of the face that develope individually do not join together properly. A cleft palate occurs when there is an opening in the roof of the mouth. The back of the palate is called the soft palate and the front is known as the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).

Sometimes a baby with a cleft palate may have a small chin and a few babies with this combination may have difficulties with breathing easily. This condition is called Pierre Robin sequence.

Since the lip and palate develop separately, it is possible for a child to be born with a cleft lip, palate or both. Cleft defects occur in about one out of every 700 babies.

Children born with either or both of these conditions usually need the skills of several professionals to manage the problems associated with the defect such as feeding, speech, hearing and psychological development. In most cases, surgery is recommended. When surgery is done by an experienced, qualified Oral and Maxillofacial surgeon such as Dr. Viehweg, the results can be quite positive.

Cleft Lip Treatment

Cleft lip surgery is usually performed when the child is about ten weeks old. The goal of surgery is to close the separation, restore muscle function, and provide a normal shape to the mouth. The nostril deformity may be improved as a result of the procedure or may require a subsequent surgery.

Cleft Palate Treatment

A cleft palate is initially treated with surgery safely when the child is between 12-18 months old. This depends upon the individual child and his/her own situation. For example, if the child has other associated health problems, it is likely that the surgery will be delayed.

The major goals of surgery are to:

Close the gap or hole between the roof of the mouth and the nose.
Reconnect the muscles that make the palate work.
Make the repaired palate long enough so that the palate can perform its function properly.

There are many different techniques that surgeons will use to accomplish these goals. The choice of techniques may vary between surgeons and should be discussed between the parents and the surgeon prior to surgery.

The clefted anterior hard palate is generally repaired between the ages of 8 and 12 years when the cuspid teeth begin to develop. The procedure involves placement of bone from the hip into the bony defect, and closure of the communication from the nose to the gum tissue in three layers. It may also be performed in teenagers and adults as an individual procedure or combined with corrective jaw surgery.

What Can Be Expected After The Surgery?

After the palate has been fixed, children will immediately have an easier time in swallowing food and liquids. However, in about one out of every five children following cleft palate repair, a portion of the repair will split, causing a new hole to form between the nose and mouth. If small, this hole may result in only an occasional minor leakage of fluids into the nose. If large however, it can cause significant eating problems, and most importantly, can even affect how the child speaks. This hole is referred to as a "fistula," and may need further surgery to correct.

Facelift

Many factors cause the skin to wrinkle and sag (i.e., exposure to the sun, genetics as well as the natural aging process). Children and young adults have smooth, round faces due to fatty tissue that is evenly distributed throughout the contours of the face. As you age, the skin sags and fits more loosely. These folds become prominent, especially around the chin, the jaw line, and along the neck.

Dr. Viehweg performs rhytidectomies, or facelifts, to enhance your appearance and correct these conditions. A facelift involves tightening of the facial and neck muscles as well as the removal of any excess skin. The procedure is often performed in conjunction with additional cosmetic surgeries such as blepharoplasty (eyelid surgery), forehead lift, chin augmentation, liposuction, and/or rhinoplasty (nasal surgery). These procedures can be performed any time after signs of aging appear in order to attain a more youthful appearance.

Before Surgery

Dr. Viehweg will evaluate your medical history in order to determine your overall health. He will discuss with you how your face can look and what you can expect from surgery. Our objective is to create a natural appearance that is pleasing to you. Photographs and computer imaging are performed to determine the amount of improvement after surgery.

We will provide you with preoperative instructions that may include the elimination of specific drugs containing aspirin several weeks before surgery to minimize excess bleeding. Antibiotics may also be prescribed to prevent infection. You may be instructed to shampoo your hair the night before surgery. A small amount of hair may be shaved around your ears and temples.

Surgery

A rhytidectomy can be performed under IV sedation or general anesthesia in our state-of-the-art surgical facility. These options will be discussed in detail with you. Premedication is administered for relaxation. Incisions are made inside the hairline at the temple, running in front of the ear then around the earlobe and behind the ear, ending in the hair of the scalp. The loose skin is separated from underlying tissue and is pulled up and back. Excess skin is removed. Sagging muscles and connective tissues are tightened. In some cases, fatty deposits are removed from beneath the chin and neck. Small sutures are used to close the incisions. The procedure may take up to five hours depending on whether any other procedures are performed at the same time.

Postoperative Care

It is recommended that you avoid strenuous activity for several days to weeks following surgery. Generally, you can spend the night of surgery at home. Bandages are applied to the area of surgery and are removed within a few days. Pain is moderate and controlled with oral medications. Your sutures are removed within the first five to ten days. In order to minimize scarring, the doctor may remove the sutures in stages. Scarring fades quickly. Swelling and discoloration decrease within two weeks. Tightness in your face will be present for several weeks and there may be slight changes in your hair pattern around the incisions.

It is recommended that you avoid the sun for several weeks after surgery. Healing is gradual so you will not appreciate the final results for up to six months. Improvement varies, depending on the your initial condition. In most cases, a single procedure achieves the desired results. In some instances, minor revisions can be made to maximize the benefit and optimize the result. Most patients who have had facelifts are pleased with their new, more youthful appearance.

Laser Skin Resurfacing

As one of the most exciting and innovative scientific achievements to date, laser technology is being utilized throughout the health care community. Dr. Viehweg uses one of the newest lasers, the ultrapulse carbon dioxide laser, to treat sun-damaged skin, facial wrinkles, and scars in a procedure called laser skin resurfacing.

What Is A Laser?

The word "laser" is an acronym, which stands for light amplification by the stimulated emission of radiation. A surgical laser, such as the CO2 laser, is a beam of light capable of removing unwanted tissue, such as scarred, lined, wrinkled, and otherwise imperfect skin. The laser vaporizes skin cells by emitting bursts of radiation that are absorbed by water in these cells. Laser light penetrates to a very precise, controlled depth, making the procedure safe and predictable, while reducing the risk of scarring or pigmentation problems. Laser skin resurfacing is bloodless, and is performed in the office under intravenous (IV) sedation. As a result of this treatment, you are left with more youthful looking skin.

What Areas Can Be Treated Through Laser Resurfacing?

The laser is used to reduce tiny wrinkles, acne scars, and other minor skin imperfections, especially around the mouth and eyes. It can improve sun-damaged and acne-scarred skin problems that often cause concern to both men and women.

Benefits of Treatment

Laser resurfacing can be used as an alternative to chemical peel and dermabrasion. The benefits of using this technique are less pain and a faster recovery time. In most cases, it is less costly.

Before Surgery

Prior to surgery, Dr. Viehweg will discuss with you your goals for facial improvement. After determining the most appropriate procedure, he will fully describe the procedure, what results to expect, and the costs. The skin is usually pretreated prior to surgery to improve the healing time.

The Procedure

Once you are comfortabley sedated, a local anesthetic is administered to ensure that you are comfortable throughout the procedure. The area is cleansed and draped. Dr. Viehweg directs the laser beam toward your skin’s imperfections. The laser quickly and accurately vaporizes just four or five cells in thickness of the outermost layer of skin.

What Can Be Expected?

In most cases, only one treatment is needed. The initial redness fades in a few weeks to a light pink, which can be camouflaged with cosmetics. The discoloration usually disappears in one to three months. The goal of laser resurfacing is to enhance facial appearance. Expectations by the patient must be realistic and results should be anticipated as improvements rather than total corrections. Results of the surgery depend on many factors such as the size, shape, and location of the imperfection, and the patient's heredity, age, and general skin condition.

Chemical Peels

A chemical peel is helpful for wrinkles, light acne scarring, and irregular pigmentation such as freckles and age spots. Pre-cancerous conditions such as keratoses (thick, rough, reddish growths) also respond well to this procedure.

There are several types of chemical peels: light peels remove superficial wrinkles, medium, and deep peels are for more severe conditions.

After a thoroughly cleansing of the skin, a small applicator is used to apply the chemical solution to an area of the face. Excess solution is removed and the procedure is repeated on other areas.

The amount of improvement varies and depends upon the initial condition of the patient's skin. Significant improvement of damaged skin has been achieved, which can produce dramatic results.

Skin Rejuvenation

A skin rejuvenation program is often used in conjunction with either chemical peels or laser wrinkle removal to reduce the fine wrinkles of the face, lighten areas of hyper-pigmentation, and produce a softer texture to the skin. The program can be accomplished separately or in conjunction with the other procedures listed here. It is followed at home by the patient after a consultation and a treatment plan is established for the patient's cosmetic needs. Our staff is dedicated to providing you with the latest and most effective skin treatments available.

We invite you to inquire about laser skin resurfacing or chemical peels, and hope it can help you achieve smoother, fresher, younger-looking skin.

Rhinoplasty

Dr. Viehweg performs rhinoplasty in order to reshape the nose. Appearance can be improved for those people who are dissatisfied with the shape and size of their nose. Nasal reconstruction was one of the first cosmetic procedures ever developed and is among those most frequently performed today. Rhinoplasty is a surgical procedure in which deformities of the nose are corrected by removing, rearranging, or reshaping bone or cartilage.

Reasons for Surgery

Indications for rhinoplasty include reducing the size of the nose, removal of bumps as well as improving the angle of a nose. Conditions may be natural or due to external trauma to the face. This operation will also help patients who have difficulty breathing. The operation can be performed on all age groups, including teens and the elderly.

Before Surgery

A medical history along with a careful examination is conducted in order to evaluate your general health. We will discuss with you the way your nose can look in relation to your other facial features. Digital photographs and computer imaging allow Dr. Viehweg to evaluate the appropriate procedure to achieve the desired results. Preoperative instructions may include eliminating certain drugs that contain aspirin to minimize the possibility of excess bleeding. Antibiotics may be prescribed before surgery to prevent infection.

Method of Surgery

Surgery is usually performed under intravenous (IV) sedation or general anesthesia, which are both extremely safe and comfortable. In most cases involving a reduction in shape or size of the nose, angle, or removal of a hump, the skin of the nose is separated from the underlying skeleton of bone and cartilage. The bone and cartilage are then reshaped and the skin redraped over the surface. Patients who have a deviated septum may benefit by correction of this problem. The incisions are placed inside the nose, unless the surgeon uses an open approach, in which case the incisions are made across the columella (the tissue between the nostrils). In cases where the nostrils flare, the surgeon may make an incision at the junction between the nose and the skin of the upper lip to narrow the flared appearance. It is not unusual to combine rhinoplasty with chin augmentation (grafting) to improve the profile.

Postoperative Information

Recovery from rhinoplasty takes one to two weeks. Most people resume their normal activities within a week or two. Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is removed within 7-10 days. Nasal splints may be inserted at the time of surgery to protect the septum. These are removed within 7-10 days. There is always some stuffiness of the nose, especially when work has been done on the nasal septum.

Pain is minimal and is controlled with medications. Bruising occurs around the eyes and begins to fade within a few days. Discoloration usually disappears in two weeks.

Insurance

Your insurance company may pay for all or part of the costs associated with your surgery if it is performed as a result of nasal obstruction. It is recommended that you check with your carrier to determine if there is coverage.

Browlift

Dr. Viehweg performs brow and forehead lifts to raise eyebrows and reduce ridges and furrows on the forehead, creating a smoother, more youthful appearance. This procedure can be performed in conjunction with other surgeries.

Newer techniques now allow us to perform forehead lifting through small incisions in the scalp hidden within the hairline, by using an endoscope and specialized instruments such as a laser. This accelerates the healing process.

Postoperative Information

Antibiotics may be prescribed for several days following surgery. Sutures are generally removed within one week. Swelling and some bruising may occur which should subside within a few weeks. Our doctors will prescribe ice compresses and eye exercises to reduce swelling and regain mobility. Women will be allowed to use eye cosmetics two weeks after surgery. You can proceed with your normal daily activities within one to two weeks. A final evaluation may occur within several months from the initial surgical procedure.

Insurance

Your insurance company may pay for part or all of the cost of surgery if the procedure is performed as a result of visual impairment. Because every insurance carrier is different, it is recommended that you check with your own insurance company to determine the level of coverage.

Eyelid Surgery

The eyes are a prominent facial feature. Although the eyes are expressionless structures, the surrounding skin conveys emotion. The tissue, muscle, fat, hair, and lashes all contribute to the wide array of expressions. Unfortunately, wrinkles and deep lines as well as puffiness under the lids develop with age. In addition, exposure to the sun, as well as hereditary factors contribute to the aging process, all resulting in changes of expression. In many cases, people may look fatigued, worn out, and older than their true age. Beyond possible visual impairment, these changes in your appearance can cause stress and anxiety.

Dr. Viehweg is trained in several surgical procedures, such as blepharoplasty, forehead lift, and brow lift in order to eliminate the majority of these problems.

Before Surgery

To better understand your overall health, Dr. Viehweg will evaluate your medical history prior to surgery. In addition, a complete examination of your eyes and face is made in order to take the most effective surgical approach. The amount, distribution, and type of excess skin to be removed are carefully reviewed.

Dr. Viehweg will provide you with preoperative instructions that may include the elimination of specific drugs containing aspirin several weeks before surgery to minimize excess bleeding. Antibiotics may also be prescribed to prevent infection.

The areas that will be excised are marked and digital photographs and computer imaging are performed in order to determine the amount of improvement after surgery.

Blepharoplasty

Dr. Viehweg can perform blepharoplasty to correct sagging eyelids, bags or pouches beneath the eyes, as well as excess folds around the eyes. This surgical procedure involves the removal of excess skin and fat on upper and lower eyelids and is often performed in conjunction with other surgical procedures including facelifts, eyebrow, and forehead lifts. Blepharoplasty can be done under general anesthesia (with you asleep) or with intravenous IV sedation. Both are very comfortable options. Premedication is utilized prior to surgery to decrease swelling after the operation.

Dr. Viehweg will trace the natural lines and creases of your face and make incredibly fine incisions from the inner to the outer edge of the eyelid. Surgery on the upper eyelid is performed first with the incision made in the fold of the lid. The incision is made below the eyelash on the lower eyelid. Any excess fat and skin are removed from the underlying compartments. The amount of fat excised is determined by the degree of protrusion of fat when pressure is applied to the area. Small sutures are used to close the incision and special ointments and dressings may be applied. The surgery can take up to two hours. In certain cases, lower eyelid incisions are made inside the lid. A laser may be used at the same time to reduce wrinkles.

Postoperative Information

Initially, drying of the eyes can occur after blepharoplasty. This condition can be alleviated with medication. In addition, you may be sensitive to bright light and wind for a period of time. Numbness and itching may also occur during the healing process. A final evaluation may occur within several months from the initial surgical procedure.

Insurance

Your insurance company may pay for part of the cost of surgery if the procedure is performed as a result of visual impairment. Because every insurance carrier is different, it is recommended that you check with your own insurance company to determine the level of coverage.

BOTOX® Cosmetic

BOTOX® Cosmetic treatment is a revolutionary approach to reversing the affects of facial wrinkles. Crow’s feet, worry lines, and laugh lines can all be a thing of the past. These are referred to as dynamic wrinkle lines and are treatable with this procedure. Cosmetic denervation is the process of injecting BOTOX® Cosmetic into the tiny facial muscles that create the wrinkles.

Before Surgery

To better understand your overall health, Dr. Viehweg will evaluate your medical history prior to surgery. In addition, a complete examination of your eyes is made in order to decide the most effective injection sites. All issues and concerns will be discussed.

The areas that will be treated are marked and digital photographs are taken in order to determine the amount of improvement after surgery.

The BOTOX® Cosmetic Procedure

BOTOX® Cosmetic injections are usually performed without anesthesia because they are virtually painless. However, intravenous (IV) sedation can be utilized if desired. Only a very small sting is felt when the injections are made. The effects are not permanent and may need to be repeated two to three times per year to retain the effects. Research has suggested, however, that long-term use of the injections leads to a longer duration of each treatment's effect. Patients over the age of 65 may not experience such dramatic results. BOTOX® Cosmetic is only useful in treating expression lines and cannot be used to repair sagging skin caused by aging.

Postoperative Information

After the operation patients may experience slight bruising around the area of injection. This bruising fades quickly. Normal activities can be performed immediately. Possible side effects of treatment are temporary weakness of nearby muscles. In rare cases an eyelid may droop. BOTOX® Cosmetic is completely reversible so any side effect is only a temporary condition. The doctor will explain all risks associated at the time of your consultation.

Facial Liposuction

Facial liposuction is a very common and popular procedure. It is designed for the permanent removal of fatty tissue from your cheeks, chin, and neck. It is an elective procedure that allows the surgeon to remove undesirable, subcutaneous fat in specific areas that do not respond to diet and exercise.

Patients with good skin tone who have fatty deposits receive the best results from facial liposuction. It is not a treatment for obesity. If weight gain occurs following liposuction, the fat will be deposited in areas that have not been treated. The procedure can be repeated, if necessary. To maintain the safety of the procedure, there is a limit on how much can be done at one time. A variety of factors can affect the results: physical condition, genetic makeup, diet, exercise, smoking, alcohol intake, and skin elasticity.

The Procedure

Facial liposuction is performed under general anesthesia on an outpatient basis in a hospital or surgical center. The surgeon makes small (less than 1/2 inch), discreet incisions in the face or neck. A cannula is inserted in a small incision and attached to a suction machine. The procedure may take up to 30 minute or more.

The results of liposuction are permanent. If you were to gain a large amount of weight, you might note rippling in the treated areas, depending on your skin elasticity.

Following liposuction, the scars will go through a maturation process. During the first eight to twelve weeks, they may be red and possibly raised. The scars will mature over six to twelve months and become pale, flat, and soft. You may experience numbness, burning, and/or tingling around the incision site. These symptoms are almost always temporary. Please let us know if you are prone to keloid formation or hypertrophic scarring.

Otoplasty

In cases of protruding or over-developed ears, the procedure of otoplasty may be an option. Otoplasty is commonly referred to as "pinning back" the ears. It is available for children once their ears have stopped developing around the age of five or six. Over-developed ears can be the cause of psychological stress and trauma and should be treated at a young age before it becomes a serious issue. Dr. Viehweg is trained in several surgical procedures that eliminate the majority of the problems related to protruding ears.

Before Surgery

To better understand your overall health, we will evaluate your medical history prior to surgery. In addition, a complete examination including digital photographs of your face and ears is made in order to take the most effective surgical approach. All issues such as shape and types of anesthesia used will be discussed.

The areas that will be excised are marked and digital photographs are taken in order to document the amount of improvement after surgery.

Ostoplasty

The procedure can be performed under intravenous (IV) sedation or general anesthesia. The doctor will discuss these options with you. Dr. Viehweg has the option of either folding the cartilage located on the back of the ear or removing excess cartilage. Sutures are placed and bandages applied to speed the healing process. The procedure typically takes only one to two hours.

Postoperative Information

After the operation patients should expect bruising around the area that fades in two to three weeks. Pain associated with the operation is minimal and can be easily treated with oral medication. The bandages are only needed for a few days and should be replaced with a lighter dressing. Refraining from sleeping on the ears is required and patients are advised to use a very soft pillow. A light headband should be worn at night for several months after the surgery. Showering and shampooing may begin after a few days. Expect two to three days of recovery before normal activities can be performed. Consult with Dr. Viehweg before attempting any athletic or precarious activities that may affect the healing process.