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

A dental implant is an artificial tooth root replacement that is placed into the jaw bone and is used in prosthetic dentistry to support restorations that replace a tooth or group of teeth. Implant surgery is performed as an outpatient under general anesthesia (if several implants are to be placed) or with local anesthesia (for simple cases) by oral surgeons.

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

The most common treatment plan consists of several surgeries over a period of months, especially if bone augmentation (bone grafting) is needed to support implant placement. In simpler cases, implants can be placed and restored in a single surgery.

Manhattan woman please with her dental implants.A single implant procedure involves an incision of the gum or gingiva to expose the jawbone and takes approximately an hour, sometimes longer. Multiple implants can be placed in a single surgical session that can take several hours.

Healing and integration of the implant(s) within the jawbone occurs over three to six months in a process called osseointegration. At the appropriate time, the restorative dentist uses the implant(s) to anchor crowns or a bridge (a prosthetic restoration containing several crowns). Since the implants supporting the restoration are integrated, which means they are biomechanically stable and strong, the patient is immediately able to masticate (chew) normally.



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

Oral and maxillofacial surgeons work to treat a variety of facial injuries. These professionals need to be highly skilled in emergency care, treatment methods for acute injuries, and long-term rehabilitation and reconstruction.

While proper treatment is obviously critical for physical reasons, the emotional health of the patient is also at stake after an injury to the face. Facial injuries can lead to a high degree of physical and mental trauma to patients, and specialized, "hands on" experience is critical for the patient's long term appearance and health.

Learn more about our face and jaw treatments


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

Our surgeons work to meet and exceed modern surgical standards. They are highly-skilled, well-trained, and extremely qualified to treat and manage facial trauma.



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

In a healthy mouth, the inner lining will be covered with mucosa, a special type of skin that is smooth and pink. When changes to the appearance of the mucosa are noted, this could be a warning sign that something is going on with the pathology of your mouth, and the most serious concern is oral cancer. The following signs may indicate a cancerous growth or other pathological process:

•  White patches or leukoplakia in the mouth
•  Red patches or erythroplasia in the mouth
•  A thickening or lump in the skin that lines the inside of your mouth
•  Chronic hoarseness or sore throat
•  Difficulty swallowing or chewing

These changes can be detected in the gum tissue, palate, cheeks, lips, face, tongue, or neck. Pain might occur, but isn't always present, especially with oral cancer. However, if you do notice any oral or facial pain without an obvious reason or cause, you could be at risk for developing oral cancer.

Oral Cancer Screenings


Periodic oral cancer screenings are essential for detecting a problem while it is still treatable. Most dentists will perform an exam of your mouth during a routine dental visit in order to screen for oral cancer, and factors that can increase your risk include:

•  Heavy alcohol consumption
•  Significant sun exposure, as this can increase your lip cancer risk
•  Tobacco use
•  Previous diagnosis of oral cancer

In addition to looking for changes in the color of the inside of your mouth, we may also feel the tissues of the mouth to check for abnormalities or lumps. If you wear dentures that can be removed, we will likely ask you to take them out to better inspect the tissue located underneath them.

Treating Oral Cancer


If you have been diagnosed with oral cancer, you may need one of many treatment options, including: surgery, chemotherapy, or radiation. However, before commencing with the treatment, other oral health issues may need to be addressed. The reason for this is to reduce the likelihood of developing a post-therapeutic complication. Teeth that are in poor health due to cavities and periodontal disease may need to be extracted prior to oral cancer treatment in order to avoid post-radiotherapy surgery. This is essential because post-radiotherapy surgery can impact the blood supply to the jaw bone, and may lead to osteonecrosis, a condition in which the jaw bone loses its ability to repair itself.

We recommend that you perform monthly oral cancer self-exams to look for changes in the color and appearance of the inside of your mouth. Keep in mind that the mouth serves as one of the most important warning systems of the body, so you should always be on the lookout for signs of changes. Never ignore a suspicious sore or lump. If you've noticed a change that you feel could be a sign of a change in your oral pathology, don't hesitate to call us at (212) 287-2483. We'll set up a consultation to find out exactly what's going on in your mouth.



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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LOCATION
Manhattan Maxillofacial Surgery Group
16 E 52nd Street, Suite 1101
New York, NY 10022
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CONTACT
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Phone: (212) 287-2483
Fax: (646) 607-2957
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