Surgical Procedures


Our mission is to provide the best possible care to all of our patients. On the following pages find literature and videos about the common oral surgery procedures provided at Manhattan Maxillofacial Surgery Group.

To achieve our goal, we rely on and utilize the most advanced techniques and latest technology available in our field. Our caring team of professionals make your visit a pleasant experience while providing you with the highest quality of care.



Implants

If you are suffering from tooth loss, take comfort in the fact that you are not alone. Nearly 178 million American adults are missing at least one tooth from their mouth, making this a problem that affects nearly 80 percent of all of us.

Learn more about dental implants


•  What Are Dental Implants?
•  Dental Implants Procedures
•  History of Dental Implants
•  Dental Implant Benefits
•  Bone Grafting
•  Dental Implant Solutions
•  Dental Implant FAQ


Tooth loss can cause a variety of complications in your mouth, not only blemishing your appearance, but it can also negatively affect your quality of life. You may start to develop pain in your mouth and jaw from your other teeth overcompensating for the missing tooth. You may also have a reduced bite force, and find yourself avoiding your favorite foods.

Even worse, you may even start to lose more teeth, as your remaining teeth will try to drift into the opening left behind by your lost tooth. If you are missing one or more teeth from your mouth, we here at Manhattan Maxillofacial Surgery Group may be able to fit you with a dental implant to give you a lasting and attractive restoration for your lost tooth.

What is a Dental Implant?


Manhattan woman please with her dental implants.In the past, before the introduction of dental implants, patients had very few options when they lost a tooth. They could choose from a partial denture, or they could elect to get a fixed dental bridge. While both of these options can temporarily serve as a replacement tooth, they simply could not compare to a real tooth.

Bone loss was always inevitable after tooth loss, and the face would start to appear haggard and prematurely aged due to the lack of structure in the jaw. Partial bridges and denture partials are also only temporary replacements for a lost tooth, even if the patient takes good care of them.

Dental implants, on the other hand, are a permanent restoration option for patients who are missing a tooth. They have a remarkably high success rate, at 98 percent. They can be taken care of just like a natural tooth, and in fact, can be cleaned and flossed just like you would clean your teeth.

Dental implants restore full function to the bite, unlike dentures, which restore only about 10 percent of function to the mouth. That means you do not have to worry about eating foods that may otherwise dislodge a denture. All in all, they are an excellent option for many patients!

Components of a Dental Implant


A dental implant is comprised of three main components. The first part of the dental implant is the titanium screw. This is the part that we place directly into your jawbone. We use titanium because instead of rejecting this metal, your body accepts it.

When we place the titanium screw, your bone material will build up around the screw in a process known as osseointegration. This keeps the implant durable and sturdy in your mouth and less likely to become compromised. The screw attaches to a connector piece, called the abutment. The abutment acts as a middle part between the screw and the actual restoration itself, called the crown. The crown is the part of the implant that resembles a real tooth.

Getting a dental implant placed is a straightforward procedure and typically can be completed under a combination of local and intravenous (IV) anesthesia. From the initial procedure to final restoration, it may take up to six months or longer, depending on how well the patient is healing. To learn more about dental implants or to set up a consultation with us to determine if you are a good candidate for them, please give us a call here at Manhattan Maxillofacial Surgery Group at (212) 287-2483 today!



Extractions

There are various reasons your doctor or orthodontist may have referred you to an oral surgeon for the extraction, or removal, of a tooth. Whether it is due to decay, poor placement, impaction, or more, our surgeons, Dr. Del Valle and Dr. Shahgoli, at Manhattan Maxillofacial Surgery Group can help. We ensure that the tooth is entirely removed with care in an atmosphere that is sterile. We can handle the difficult extraction cases and prepare the patient for the next step in their restoration process, including preparing the area for possible placement of a dental implant, or simultaneously placing a bone graft.

Types of Extraction


Extraction can be classified in two categories, simple and surgical. The differences between the two are as follows:
•  Simple Extraction: A simple extraction is a non-surgical extraction. In order to perform a simple extraction, the tooth must be fully erupted, or exposed. Our surgeon is able to fully place his tools around the tooth because it is not broken or impacted. He will then loosen the tooth using an instrument called an elevator. With the tooth loosened, he will then use forceps in order to lift and remove the tooth. In a simple extraction, the tooth lifts in one piece and is fully removed from the socket.
•  Surgical Extraction: A surgical extraction is more complex. This type of extraction needs to be performed if the tooth structure is compromised or if the tooth is not fully erupted, or if it is partially or completely impacted. Surgical means that the surgeon will need to make tissue cuts in order to retrieve the entire tooth. In some cases, we may need to quarter the tooth, break it into sections, and remove it section by section. A surgical extraction tends to take more time and the healing may take more time.

What may seem like a non-surgical extraction can quickly turn into a surgical one, as what may originally be thought of as easy proved to be more difficult.

Bone Graft

When a patient loses a tooth, from injury or extraction, it is important to their dental future to consider the placement of a bone graft as quickly as possible. Over the first year following the loss of a tooth, your jawbone will pull in, or atrophy, up to ⅓ of its natural size. This loss in density is what gives patients the appearance that we so commonly associate with old age. The process of a bone graft sounds more severe then it is. A tooth socket bone graft is simply placing miniscule particles of bone material from one of three sources, your own bone, donated bone, or synthetic bone in the spot and then suturing it closed to allow for healing.

Our surgeons, Antonio Del Valle, DMD, MD and Shahin Shahgoli, DDS, provide treatments, including both simple and surgical extractions, in an environment that places the safety of our patients first. We use the latest in modern equipment, along with a staff that is trained and experienced in anesthesia techniques to reduce or even eliminate your discomfort. For more information on some of our equipment, including the Cone Beam CT scanner, and the 3D images that we are able to produce here in our office, or for more information on dental extractions, contact our front office staff at: (212) 287-2483



Face & Jaw

An injury to the face and jaw can arise from many different things. Some of the more common causes of facial and jaw injuries include sports injuries, automobile accidents, fall injuries, and unfortunately, domestic concerns. When we here at Manhattan Maxillofacial Surgery Group meet a patient who has sustained an injury to their face or jaw, we understand how scary this can be for them.

Learn more about our face and jaw treatments


•  Facial Trauma
•  TMJ Disorders
•  Corrective Jaw Surgery
•  Oral Pathology


Facial injuries can be quite devastating and even disfiguring if not properly handled, leading to scars on the face and impaired oral function. When you need surgery on your face or jaw, regardless of the reason, then you need us to assess and treat the site to give you the best, most attractive outcome.

What Procedures Do We Perform on the Face and Jaw?


Trauma to the face resulting in lacerations or damage to the soft or bony tissue need extreme precision and care when they are being treated. That is not only because the area is quite delicate and prone to scarring, but also because there are so many vital nerves and structures (such as your salivary glands) in the area and we must maneuver around them carefully to avoid complications from arising.

Trauma to the mouth does not just result in cuts or abrasions to the soft tissue, either. Many times, if the impact that led to the injury was severe enough, there may be broken bones or teeth that need repair, too. It is vital that you do not delay treatment after an injury to the face, as you may sustain permanent damage and scars to the area.

We also treat non-emergency jaw issues in our office. We often see patients who are complaining about problems with their temporomandibular jaw (TMJ), which can result in pain in the joint that attaches the jaw to the rest of your face. TMJ dysfunction can cause popping and clicking in your mouth when you open and close it, discomfort when chewing or eating, a locked jaw when you try to close it, and tenderness and pain spreading from your jaw to your ear or neck. When other interventions do not relieve the symptoms of TMJ dysfunction, we can perform surgery to help improve it.

Keeping an Eye Out for Oral Cancer


Oral cancer is a highly lethal and devastating disease, one that will claim over 13,000 lives this year. If caught early, the prognosis is often favorable, but unfortunately, it often goes undetected for a long time. Signs of oral cancer can include white or red lesions in the mouth, an unexplained mass or swelling in the mouth or jaw, a bleeding sore that does not want to heal, and an ongoing sore throat.

Regular oral cancer screenings are essential to catching it early, and if you are a suspect for oral cancer, we can help diagnose and treat it. We may start with a biopsy to get a sample of the affected tissue. The sample will be sent to our lab and, depending on if we find any signs of cancer in the biopsied sample, we can treat it through surgical or other interventions.

As oral and maxillofacial surgeons, we cover a wide scope of diagnostic and treatment options to our patients. If you believe you may need oral surgery, or you are interested in learning more about what we do here at Manhattan Maxillofacial Surgery Group, please give us a call at (212) 287-2483 today!





Surgical Endodontics

An Apicoectomy is a surgical dental procedure that we perform when a standard endodontic procedure, known as a root canal, has been unsuccessful. We frequently are sent patients with failed endodontic therapy from their referring dentists. At Manhattan Maxillofacial Surgery Group, we specialize in these more difficult cases, removing the infection and restoring the patient’s oral health. Dr. Del Valle and Dr. Shahgoli can gain access to the source of infection that was missed in the original root canal therapy procedure and remove it.

Standard Endodontic Treatment


The most common endodontic treatment, the Root Canal, is a procedure that can be performed by your family dentist. This procedure is needed when the root of the tooth has become infected, generally from a deep cavity or tiny hairline fractures in a tooth that allowed passage for bacteria. Your dentist will remove the infected material by gaining access inside of your tooth and removing the pulp. The canal is then cleaned and filled with a medicated material. The tooth is then topped with a protective crown, allowing you to retain the original tooth structure, which is best for your overall dental health.

Apicoectomy Procedure


An apicoectomy is often needed when a tooth continues to rage with infection following your root canal treatment. This generally does not mean that your family dentist made an error, it is most often due to where the source of the infection is coming from. What patients may not understand is that root canal treatments can be very complex, there are many situations where the simple cleaning out of the canal removes the source of infection. Your root system is comprised of many small branches that extend from the main canal. If the source of infection has traveled into these tiny branches, even after your endodontic therapy treatment, there can still be infected debris that was missed in these branches. To remove the infected material, Dr. Del Valle or Dr. Shahgoli will then need to surgically remove the tooth’s root tip and prepare the root end cavity for filling.

Apicoectomy or Root Canal


Apicoectomy is commonly referred to as Root End surgery. We begin with a local anesthetic to thoroughly numb the patient ensuring that that they feel no discomfort. Dr. Del Valle or Dr. Shahgoli will then make a small incision directly through the gum tissues where the infected root is located. With access, we can then remove the infected material found near or around the tip of the root by removing the entire root tip, using endo-surgical procedures with microsurgical techniques, this includes a dental operating microscope, a range of micro instruments, ultrasonic preparation tips such as those used in removing plaque. Once we feel confidant that the infected material is gone, a root end cavity is prepared and filled with a biocompatible material, usually calcium-silicate based.

Once filled, Dr. Del Valle or Dr. Shahgoli are then ready to close the surgical site with a few sutures, this will help the gum tissue stay closed and assist while healing is occurring. Following the procedure, the patient can take an over the counter pain relief medication to assist with any discomfort. The healing should be a simple one, the patient needs only to be cautious of their sutures.



Facial Filler & Botox

As an Oral and Maxillofacial surgery, our area of work extends to the entire facial area, not just the mouth. Our doctors are trained in cosmetic procedures including the placement of facial fillers and Botox. Through aging, the skin loses elasticity, which then creates the frown lines and wrinkles between the eyebrows that are associated with an older appearance. At Manhattan Maxillofacial Surgery Group, Dr. Del Valle and Dr. Shahgoli, are able to remove these lines, and assist in providing a more youthful appearance with Botox. The only FDA-approved prescription treatment for moderate to severe frown lines between the brows in people ages 18 to 65 is Botox. The American Society for Aesthetic Plastic Surgery ranked Botox as the most popular physician-administered cosmetic procedure in the United States since 2008.

What is Botox?


Botox is a drug that is made from a neurotoxin produced by the bacterium Clostridium botulinum called botulinum toxin. Used in very tiny amounts, that is then mixed with saline, Botox is used for cosmetic and medical purposes. Cosmetically, Botox can assist in removing wrinkles by temporarily paralyzing the muscles where the wrinkle has occurred.

Botox is a neurotoxin. It is derived from Clostridium botulinum, which is an organism that is found naturally in soil and sediment where it is largely inactive and non-toxic. For most patients, when administered by a doctor, Botox is a safe and effective treatment. We do not recommend it for patients who are pregnant or nursing, or who are currently battling an infection anywhere in their body. Botox can spread throughout your body.

Botox Procedure


Botox procedures consists of several tiny injections and can be performed in under 10 minutes. No anesthesia is required; however your oral surgeons, Dr. Del Valle and Dr. Shahgoli, may numb the area with a cold pack or anesthetic cream prior to treatment. Minimal and brief discomfort is typical, in addition to slight, temporary bruising at the injection site. Results are typically seen in days and may continue to improve during the first week after treatment.


Though most often thought of as a cosmetic treatment, Botox is also used to treat medical conditions including migraines, excessive sweating, some muscular disorders, and even some bladder or bowel disorders. Currently, Botox is used to treat over twenty different medical conditions.
Botox is also used for therapeutic and rehabilitative reasons, such as a muscle relaxant to relieve pain associated with chronic clenching and grinding of teeth (TMJ disorders). For TMJ, a Botox injection is often required to relax the jaw muscles prior to surgery.


How long does Botox last?


For most patients, your Botox injections should begin to take effect within three days following injection and will then continue to last for 3 to 4 months. First time Botox users may find that their Botox results diminish in less than 3 months.

Dr. Del Valle and Dr. Shahgoli provide all of their surgical treatments in an environment that places safety first, using modern equipment, and where staff are experienced in anesthesia techniques. If you have any questions, please do not hesitate to call us at (212) 287-2483.



Surgical Orthodontics

Surgical orthodontics is commonly performed in preparation for the placement of orthodontics, this procedure will help correct severe misalignments. At Manhattan Maxillofacial Surgery Group we can make the preparations needed to then get the orthodontic work needed. This surgical prep is also referred to as orthognathic surgery. If you have been referred to our oral surgeons, Dr. Del Valle and Dr. Shahgoli for further examination of your alignment, we will evaluate the patient and make recommendations based on your situation.

What is orthognathic surgery?


The need for surgical orthodontics is to set jaws that are severely misaligned, and would not be able to line up correctly with orthodontics alone. We can help the patient achieve a proper bite. Orthognathic surgery is the initial step to allow the jaw to be properly aligned with the use of orthodontic braces to move the teeth into their proper position.

Orthognathic surgery is recommended for patients who suffer from bad bites, this may be due to jaw bone abnormalities or malocclusion, which is a misalignment of your jaw. Misaligned teeth can occur for a number of reasons including extra teeth, the jaw not being large enough to accommodate teeth, a severe jaw injury, or even from childhood habits, such as thumb sucking or the use of a pacifier after the age of 3. The most common cause of misalignment develops from the jaw being too small compared to the size of the patient’s teeth.

In order for Dr. Del Valle and Dr. Shahgoli to perform orthognathic surgery, it is best that the jaw is done growing, this generally happens by age 16 in females and 18 in males. Orthognathic surgery is often performed in a hospital and can take several hours to complete depending on each individual case. Healing from your procedure will take time, we often recommend resting the jaw for about two week post surgery. In many cases, patients find that they need to schedule time off of work and school during the healing process. After appropriate healing, your orthodontist will place braces to fine tune your bite.

Do I need orthognathic surgery?


In most cases, our patients are referred to us by your orthodontist. Once referred, we will examine the situation and help you determine if surgery is needed as part of your treatment. We will review the severity of your case and the alignment of your jaw, allowing you to decide if surgery is or is not needed.

Why do I want to correct my bite?


There are several reasons to correct your bite, some medical, some aesthetic. Patients with poorly aligned teeth can have TMJ problems, limited opening and closing of their mouth, limited chewing, and pain. Patients may also find that their smile is not as beautiful as it can be. They made have reduced confidence in smiling, we can help.

Our surgeons, Antonio Del Valle, DMD, MD and Shahin Shahgoli, DDS, provide treatments, including orthognathic surgery, in an environment that places your safety first. Our office uses the latest in modern equipment, and have a trained staff who are experienced in anesthesia techniques. For more information, contact our front office staff at: (212) 287-2483



Oral Pathology

This year, over 53,000 people will be diagnosed with oral cancer. Tragically, of these numbers, nearly one-fifth of them will perish. Every single hour, another person loses their fight with oral cancer. The prognosis for oral cancer is greatly improved if caught early, but unfortunately, it often remains undetected for a long time.

Oral cancer is often hard to detect on your own, which truly emphasizes the importance of routine dental checkups with an oral cancer screening. While everyone needs regular screenings for oral cancer, some demographics are more vulnerable to developing it. That is why we here at Manhattan Maxillofacial Surgery Group strongly stress that all of our patients stay on top of their oral health to prevent complications that could arise from oral cancer.

What You Need to Know About Oral Pathology


Because there are many structures in your mouth that can conceal the symptoms of oral cancer, getting checked for it frequently could quite literally save your life. Your oral mucosa (the skin inside your mouth) should be smooth and pink, and any deviations of that could be a clue that something is amiss in your mouth. Signs of oral cancer include white patches in your mouth (also known as leukoplakia), red ulcers or lesions in the mouth (called erythroplasia), thickening or masses that form in the mouth or throat, difficulty swallowing or eating, and ongoing hoarseness or sore throat.

Oral cancer screenings can give you the early detection that can make the difference between survival and succumb to oral cancer. Historically, it was believed that oral cancer was a disease that exclusively attacked smokers and those who use tobacco products, men, and those over the age of forty.

We now know that there is a rapidly growing group of people who are contracting oral cancer, and they do not fit the stereotype of the typical cancer patient. Instead, they are under the age of forty, do not use tobacco products or drink alcohol, and are in otherwise good health. The cause of this new group of oral cancer patients is caused by the human papillomavirus, which some 79 million Americans have. This means that nobody is truly immune to oral cancer.

We Will Also Help if Anything Looks Awry in Your Results


If we find something suspicious during your oral cancer screening, we want you to remain calm. Just because we are concerned does not automatically mean that you have oral cancer. We will start by taking a sample of the suspicious area and send it to our lab for a biopsy. This will help us determine if the cells are cancerous. If it does turn out that you have oral cancer, we can discuss your options with you to find the best course of treatment for you. Please know that we may need to address any underlying health issues before we can begin treatment, however. Treatment for oral cancer may include surgery to remove the suspicious mass or area, radiation treatment, or chemotherapy.

Do not let fear of a cancer diagnosis prevent you from getting the potentially life-saving screening and treatment for it. To learn more about oral pathology and how we here at Manhattan Maxillofacial Surgery Group diagnose and treat it, please give us a call today at (212) 287-2483!



MMSG News and EventsDr. Del Valle and Dr. Shahgoli offer this blog to our patients and the community. Our hope at Manhattan Maxillofacial Surgery Group is that our blog will cover the subjects that you and your family may be interested in.



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Manhattan Maxillofacial Surgery Group
16 E 52nd Street, Suite 1101
New York, NY 10022
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Phone: (212) 287-2483
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