Wisdom Tooth Removal

Dental Surgical Services

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and the gum tissue is healthy, wisdom teeth do not have to be removed, unfortunately, this does not generally happen.

Wisdom teeth are extracted to prevent a problem that has occurred or to prevent a problem that may arise in the future. Your jaw may not be large enough for the wisdom teeth to come through the skin, or they may be impacted and unable to break through the gums. Food and germs can get caught under the partially erupted wisdom tooth, which can result in your gums becoming red, swollen and painful. Infections, damage to other teeth and bone or possible cysts can develop as a result of impacted teeth.


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

Dental Implants – Why Replace Missing Teeth

Many people feel self conscious about their smile if they have tooth loss. What many people do not realize is how missing teeth may have an impact on your health. When you no longer have a tooth there is a small area on your jaw bone that no longer needs to provide support. Because there is no longer a need for support, your jawbone begins to lose its strength. This process does not happen quickly, but it is a concern for people with missing teeth. The base of the dental implant acts as a replacement of the missing tooth. By having an implant, patients can rest assured that their dental health is safe. Dental implants are extremely strong because of the way they are placed, and dental implants are as natural looking as your natural teeth.

Dental implants will be coordinated with Dr. Cusumano and the general gentist. Dr. Cusumano will do the placement of the implant, and the general dentist will do the restorative portion of the implant.

Dr. Cusumano works with many general dentists in the area. If you do not have a general dentist we will be happy to assist you by making a recommendation.

Bone Grafting

Bone grafting is the replacement or augmentation of the portion of the jaw bone that anchors the teeth. It’s a surgical procedure that’s often done to reverse the loss or resorption of bone that may have occurred due to tooth loss, trauma, disease or ill-fitting dentures, and to rebuild the bone structure beneath the gums in preparation for the placement of dental implants or other tooth replacements.

When bone graft is implanted in the jaw, it doesn’t just simply fill a void in the bone; it may also help promote new bone growth in that location. When successful bone grafting can restore both the height and width of your jaw bone.

There are several bone graft options. Our office most often uses allogenic bone grafting.

Allogenic bone, also called allograft, is bone derived from a genetically unrelated member of the same species. It’s typically non-vital (dead) bone harvested from a cadaver, then processed using a freeze-drying method that extracts all the water via a vacuum. Allogenic bone cannot produce new bone on its own. Rather, its primary mechanism of action is that it is osteoconductive and serves as a framework or scaffold over which bone from the surrounding bony walls can grow to fill the defect or void.

Oral Pathology/Biopsy

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 of a pathological process. The most serious of these is oral cancer. The following is a list of changes that may represent the beginning of a pathologic process or cancerous growth:

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

When an abnormality is discovered, a referral is often made to an oral and maxillofacial surgeon. Often, he or she will feel a biopsy is necessary for a complete and accurate diagnosis.

A biopsy is a surgical procedure that involves the removal of a piece of suspicious tissue; usually part of the lining tissue (mucosa) of the mouth or the underlying bone that has demonstrated possible involvement through the examination process. Fortunately, most biopsies can be carried out in the office setting with local anesthesia.

The harvested piece of tissue, or specimen, is sent to a pathology laboratory for examination where the tissue is handled by a qualified specialist in oral pathology. They will process the tissue and examine the specimen under a microscope. After the examination is complete, the pathologist will send a report to your surgeon for review.

The report helps establish a diagnosis as well as enabling your surgeon to develop a treatment plan that addresses the type of lesion that was identified. Small lesions may have been removed in their entirety during the biopsy while the larger lesions may have had only a small portion removed thereby necessitating further surgery.

Canines / Orthodontic Exposure

Exposure and Bracketing of an Impacted Tooth

An impacted tooth simply means that it is “stuck” and can not erupt into function. Normally, the maxillary cuspid 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 tight together. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch.

In cases where the eye teeth will not erupt spontaneously, the orthodontist and oral surgeon work together to get these teeth to erupt. 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 hidden tooth underneath. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, the oral surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. The oral 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. 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 the patient will return to the orthodontist where 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 it’s proper place in the dental arch.

CT / Cone Beam Imagery

Cone beam computed tomography (commonly referred to by the acronym CBCT) is a medical imaging technique consisting of X-ray computed tomography where the X-rays are divergent, forming a cone. CBCT has become increasingly important in treatment planning and diagnosis in implant dentistry , among other things.

During a CBCT scan, the scanner rotates around the patient’s head, obtaining up to nearly 600 distinct images. The scanning software collects the data and reconstructs it, producing what is termed a digital volume composed of three dimensional voxels of anatomical data that can then be manipulated and visualized with specialized software.