Fletcher Hills Dental Implants and Oral Surgery Center are dental health partners with the Ocotillo community, about 26 miles west of El Centro in Imperial Valley.

Ocotillo began as a retirement community in 1976. Ocotillo was devastated by floods from Hurricane Kathleen in 1976; 3 people died. A documentary about the Ocotillo disaster can be seen on YouTube, search “Hurricane Kathleen” or “The Ocotillo Flood of 1976”.

We here at Fletcher Hills Dental Implants and Oral Surgery are pleased to welcome the residents of the Ocotillo community as partners in promoting the best possible dental health here.

We provide the following services to the Ocotillo community:

• Dental Implants
• Wisdom Teeth
• Bone Grafting
• Impacted Canines
• Oral Pathology
• Platelet Rich Plasma (PRP)
• Facial Trauma
• Orthognathic (Jaw) Surgery

Dental Implants

Dental implants are changing the way El Cajon people live. They are designed to provide a foundation for replacement teeth which look, feel and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything, knowing that teeth appear natural and that facial contours will be preserved. Patients with dental implants can smile with confidence. For more information regarding dental implants in our El Cajon, California office, please give us a call at 619-334-8880.

What are Dental Implants?

For most patients, the placement of dental implants involves one surgical procedure. Usually, the implant can be placed along with the healing abutment at the same time. This saves time and requires only one surgical procedure. Occasionally two surgical procedures are required. First, implants are placed within your jawbone. 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 and eat a soft diet during this time. At the same time, your dentist is forming new replacement teeth.

After the jawbone has bonded to the implant, the second phase begins. If a two-stage procedure was done, Dr. Gadler will uncover the implants and attach healing abutments which will then require one month for maturation of the gum tissue around the healing abutments. Next, small posts known as final abutments are placed, which will act as anchors for the artificial teeth. These posts protrude through the gums.

Usually, Dr. Gadler will seat the final abutment and send your general dentist everything he/she will need to complete the process (impression cap, lab analog, & 2nd impression cap to be ground down & used as a temporary cap by your general dentist). Your General dentist will then fabricate and seat the final restoration (crown, bridge, or removable prosthesis). When the artificial teeth are placed, these posts will not be seen. The entire procedure usually takes six to eight months. Most patients experience minimal disruption in their daily life.

Surgical Advances

Using the most recent advances in dental implant technology, Dr. Gadler is able to place single stage implants, usually without the need for cutting open the gums (making a “flap”), and without the need for sutures. These implants do not require a second procedure to uncover them, but do require a minimum of twelve 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 very select cases, to extract teeth and place implants with crowns at one visit. This procedure, called “immediate loading,” greatly simplifies the surgical process, but has a lower overall success rate.

Who actually performs the implant placement?

Placing implants is a team effort between an Oral and Maxillofacial Surgeon, a Restorative Dentist or Prosthodontist. While Dr. Gadler performs the initial tooth extractions, implant placement and bone grafting (if necessary), your Restorative Dentist (your Dentist or Prosthodontist) fits and makes the permanent prosthesis. Your Restorative Dentist will also make any temporary prosthesis needed during the implant process. It may be worn 24 hours each day to help your jaw heal.

What types of prostheses 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. Gadler performs in-office implant surgery in a hospital-style operating suite, thus 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. In most cases Dr. Gadler prefers to use readily available particulated or “synthetic” bone grafting materials thereby eliminating the need for a second potentially painful surgery and extra surgical site.

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 avital part of yourself.

Dental implants can be your doorway to renewed self-confidence and peace of mind. A Swedish scientist and orthopedic surgeon, Dr. Per-Ingvar Branemark, developed this concept for oral rehabilitation more than thirty-five years ago. With his pioneering research, Dr. Branemark opened the door to a lifetime of renewed comfort and self-confidence for millions of individuals facing the frustration and embarrassment of tooth loss.

Why would you 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 that slip can be uncomfortable and rather embarrassing.

What type of anesthesia is used?

The majority of dental implants and bone graft can be performed in the office under local anesthesia, with or without general anesthesia.

Do Implants need special care?

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

Working together here in El Cajon to be healthy, stay healthy, and look our best is just being good neighbors.

Wisdom Teeth

Here are a few reasons why wisdom teeth can pose problems for the younger members of El Cajon families and why you will want a dental professional to monitor the development of your children’s teeth.

By the age of eighteen, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth 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 or molar teeth are used to grind food up into a consistency suitable for swallowing.

The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your Third Molars, also known as “wisdom teeth.” For more information regarding wisdom teeth removal in our El Cajon, California office, please give us a call at 619-334-8880.

Why Should I Remove My Wisdom Teeth?

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 erupt successfully.

These poorly-positioned, impacted teeth can cause many problems. When they are partiallyerupted, 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. A serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. A major new study was recently completed which showed that retaining wisdom teeth leads to a whole host of other very serious medical problems including heart disease. 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.

Oral Examination

With an oral examination and x-rays of the mouth, Dr. Gadler can evaluate the position of the wisdom teeth and predict if there may be present or 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. Gadler has the training, license and experience to provide a variety of different types of anesthesia for his patients. Dr. Gadler and his staff work closely with dental professionals in the El Cajon valley and beyond.

Removal

In many cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia) or general anesthesia. 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 usually sutured.

Dr. Gadler prefers to use resorbable (disolving) sutures. To help control bleeding, bite down on the 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 post-operative kit will include postoperative instructions, a prescription for pain medication, antibiotics and a follow-up appointment in one to 2 weeks for evaluation. If you have any questions, please do not hesitate to call us if needed at 619-334-8880.

Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and a staff that is experienced in the safe delivery of everything from local anesthesia to general anesthesia.

Bone Grafting

Huge advances continue to be made in healthcare science and technology and dental procedures have become increasingly specialized. In the El Cajon valley, solutions to dental health issues that heretofore were disfiguring or untreatable now often involve coordination between a number of professionals with amazing results. It is important that each step in a treatment is performed by the professional with the most training and experience in that segment of the process, for best results and for the safety of the patient. Nowhere is this more true than with bone grafting.

Major and 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 the past, under these conditions, most patients were 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 esthetic appearance. For more information regarding bone grafting in our El Cajon, California office, please give us a call at 619-334-8880.

Major Bone Grafting

Bone grafting can repair sites in the jaws with inadequate bone structure caused by previous extractions. The bone can be obtained from a tissue bank, a synthetic source, or your own bone is taken from the jaw, hip or tibia (below the knee.) 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 jaw defects caused by traumatic injuries, tumor surgery or congenital defects. Sometimes the patient’s own bone is used.

The 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 operating room and require a hospital stay.

Sinus Lift Procedure

The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. 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.

There is a solution and it’s called a sinus graft or sinus lift graft. The dental implant 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, a sinus augmentation will be performed first, then the graft may have to mature for several months. 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 expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant. In some situations, the implant(s) can be placed immediately.

In many cases, allograft material is used 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. Factors from the patient’s blood can be used to accelerate and promote bone formation in graft areas.

Larger surgeries are performed in a hospital surgical suite under I.V. sedation or general anesthesia. After being discharged, bed rest is recommended for one day and limited physical activity for one week.

We are pleased to be able to offer such important solutions to the residents of the greater El Cajon area.

Impacted Canines

Impacted canines are an example of an ounce of prevention is worth a pound of cure. Nowhere in dental health is being proactive more important than with impacted canines, and our El Cajon parents know that going to the dentist is far more than cleaning the teeth and checking for cavities, as important as those are with a developing child.

An impacted tooth simply means that it is “stuck” and cannot erupt into 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 among a host of 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 cuspid (upper eye tooth) is the second most common tooth to become impacted. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”.

The cuspid teeth are very strong biting teeth which 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. For more information regarding impacted canines in our El Cajon, California office, please give us a call at 619-334-8880.

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. 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 cuspid (upper eye) teeth. 60% 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 eyeteeth is the key to successful treatment. The older the patient, the more likely an impacted eye tooth 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 panorex screening x-ray along with a dental examination be performed on all dental patients at around the age of 7 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 if some adult teeth are missing. Are there extra teeth present or unusual growths that are blocking the eruption of the eyetooth? Is there extreme crowding or too little space available causing an eruption problem with the eyetooth? 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 spaces to allow for proper eruption of the adult teeth. Treatment may also require a referral to an oral surgeon for extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important eyeteeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking eruption of any of the adult teeth. If the eruption path is cleared and the space is opened up by age 11 or 12, there is a good chance the impacted eyetooth will erupt with nature’s help alone. If the eyetooth is allowed to develop too much (age 13-14), the impacted eyetooth will not erupt by itself even with the space cleared for its eruption. If the patient is too old (over 40), there is a much higher chance the tooth will be fused in position. In these cases the tooth will not budge despite all the efforts of the orthodontist and oral 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 eyetooth will not erupt when proper space is available?

In cases where the eyeteeth will not erupt spontaneously, the orthodontist and oral surgeon work together to get these unerupted eyeteeth to erupt. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and the oral 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 tooth 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 surgeon to have the impacted eyetooth exposed & 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 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 (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. Your dentist or orthodontist will address this if it applies to your specific situation.

These basic principles can be adapted to apply to any impacted tooth in the mouth. It is not uncommon for both of the maxillary cuspids 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 surgery once. Because the anterior teeth (incisors and cuspids) 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 eye teeth (or any other impacted tooth other than wisdom teeth), treatment should be initiated at an early 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 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 eyetooth 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 and 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 surgeon’s office. For most patients, it is performed using laughing gas (Nitrous Oxide) and local anesthesia. In some cases it will be performed under I.V. sedation if the patient desires to be asleep, but this depends on the complexity of the case, and the anxiety of the patient. The procedure is generally scheduled for 30 minutes if one tooth is being exposed and bracketed and 60 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 web site for a review of any details.

After surgery, you can expect a limited amount of bleeding from the surgical sites. 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 2-3 days after surgery, there is usually little need for any medication at all. There may be some swelling due to holding the lip up to visualize the surgical site. The swelling can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising typically 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 7-10 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 paged after hours if any problems should arise after surgery. Simply call Fletcher Hills Dental Implant & Oral Surgery Center at 619-334-8880 if you have any questions.

There is some risk in all medical procedures, and optimal results are best achieved by close collaboration between health professionals, be they hygienists, general dentists, orthodontists, or oral surgeons, and of course, the patients, for whom dental care is a lifetime investment.

Oral Pathology

The first line of defense in the oral health of our El Cajon public is the patient’s own awareness. The information on this website is intended to promote patient education and patient participation in their own health.

The inside of the mouth is 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. Some possible signs and symptoms of a pathologic process or cancerous growth are:

Reddish patches (erythroplasia) 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, gum tissue around the teeth, tongue, face and 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 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 immediately so we can address your questions and concerns. We are, or want to be your oral health partners. For more information regarding oral pathology, diagnosis, or treatment in our El Cajon, California office, please give us a call at 619-334-8880.

Platelet Rich Plasma

Platelet Rich Plasma (PRP) is exactly what its name suggests. The substance is a by-product of blood (plasma) that is rich in platelets. Until now, its use has been confined to the hospital setting. This was due mainly to the cost of separating the platelets from the blood (thousands) and the large amount of blood needed (one unit) to produce a suitable quantity of platelets. New technology permits the doctor to harvest and produce a sufficient quantity of platelets from as little as only 20 cc of blood drawn from the patient while they are having outpatient surgery. For more information regarding platelet rich plasma procedure in our El Cajon, California office, please give us a call at 619-334-8880.

Why all the excitement about PRP?

PRP permits the body to take advantage of the normal healing pathways at a greatly accelerated rate. During the healing process, the body rushes many cells and cell types to the wound in order to initiate the healing process. One of those cell types is platelets.

Platelets perform many functions, including formation of a blood clot and release of growth factors (GF) into the wound. These GF (Platelet-Derived Growth Factors, PDGF, Transforming Growth Factor Beta, TGF-beta, and Insulin-Like Growth Factor, ILGF) function to assist the body in repairing itself by stimulating stem cells to regenerate new tissue. The more GF released and sequestered into the wound, the more stem cells stimulated. Thus, one can easily see that PRP permits the body to heal faster and more efficiently.

A subfamily of TGF is Bone Morphogenic Protein, BMP. In research studies, BMP has been shown to induce he formation of new bone in animals and humans. This is of great significance to the surgeon who places dental implants. By adding PRP, and thus BMP, to the implant site with bone substitute particles, the implant surgeon can now grow bone more predictably and faster than ever before.

PRP has many clinical applications:

Bone grafting for dental implants. This includes onlay and inlay grafts, sinus lift procedures, ridge augmentation procedures and closure of cleft lip and palate defects.
Repair of bone defects created by removal of teeth or small cysts.
Repair of fistulas between the sinus cavity and mouth.

PRP also has many advantages:

Safety: PRP is a by-product of the patient’s own blood, therefore, disease transmission is not an issue.
Convenience: PRP can be generated in the doctor’s office while the patient is undergoing an outpatient surgical procedure, such as placement of dental implants.
Faster healing: The super-saturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and thus faster tissue regeneration.
Cost effectiveness: Since PRP harvesting is done with approximately 20 cc of blood in the doctor’s office, the patient need not incur the expense of the harvesting procedure in a hospital or at the blood bank.
Ease of use: PRP improves the ease of application of bone substitute materials and bone grafting products by making them more gel-like.

Frequently asked questions about PRP:

Is PRP safe?

Yes. During the outpatient surgical procedure a small amount of your own blood is drawn out via the I.V. This blood is then placed in the PRP centrifuge and spun down. In less than fifteen minutes, the PRP is formed and ready to use.

Should PRP be used in all bone-grafting cases?

Not always. In some cases, there is no need for PRP. However, in the majority of cases, application of PRP to the graft will increase the final amount of bone present in addition to making the wound heal faster and more efficiently.

Will my insurance cover the costs?

Unfortunately not. The cost of the PRP application (approximately $500) is paid by the patient.

Can PRP be used alone to stimulate bone formation?

No. PRP must be mixed with either the patient’s own bone, a bone substitute material such as demineralized freeze-dried bone, or a synthetic bone product, such as PepGen.

Are there any contraindications to PRP?

Very few. Obviously, patients with bleeding disorders or hematologic diseases do not qualify for this in-office procedure. Check with your surgeon and/or primary care physician to determine if PRP is right for you. We are pleased that Dr. Gadler and his staff are able to provide this advanced technology to the greater El Cajon area.

Facial Trauma

The dental specialist performs the proper treatment of facial injuries. These professionals 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. For more information regarding facial trauma treatments in our El Cajon, California office, please give us a call at 619-334-8880.

Dr. Gadler meets and exceeds these modern standards. He is trained, skilled and uniquely qualified to manage and treat facial trauma. Dr. Gadler is on staff at local hospitals and delivers emergency room coverage for facial injuries, which include the following conditions:

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

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 injuries of teeth to extremely severe injuries of the skin and bones of the face. 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. Gadler is a well-trained 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 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 and Surrounding Dental Structures

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are 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 salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral 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 now the realm of specialists who are well versed in emergency care, acute treatment, long term reconstruction and rehabilitation of the patient.

If something unexpected were to happen to any of the residents and neighbors in the greater El Cajon area, isn’t it great that we know a specialist to call who is qualified and experienced to deal with it? In the event of facial trauma, ask for Dr. Gadler at Fletcher Hills Dental Implants and Oral Surgery Center.

Orthognathic (Jaw) Surgery

We in the greater El Cajon area are fortunate that there are excellent choices for highly qualified specialists when teamwork is required.

Orthognathic surgery is needed when 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 misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly. For more information regarding corrective jaw surgery in our El Cajon, California office, please give us a call at 619-334-8880.

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 host of problems that can affect chewing function, speech, long-term oral health and appearance.

Injury to the jaw 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 repositioning in necessary.

Difficulty in the following areas should be evaluated:

Difficulty in chewing, biting or swallowing
Speech problems
Chronic jaw or TMJ 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 will be held including complete examination with x-rays. 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 dental team will make the decision to proceed with treatment together.

Technology and Orthognathic Surgery

Dr. Gadler 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 video imaging, we 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. Gadler 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.