Trusted. Expert. Confident. Caring. For 35 years, these have been the remarks from Dr. Michael Eklund’s patients and peers. He has paved the way for many in the field, and been a part of some innovative breakthroughs  in oral surgery. And now again Dr. Eklund has received top recognition!

The staff at Southwest Oral & Implant Surgery is proud to announce that for the sixth consecutive year, Dr. Eklund was voted by dental peers to be included in Texas Monthly Magazine’s list of Texas Super Oral Surgeons for five years in a row (2005 – 2010).  Dr. Eklund was also named H Texas Magazine’s Top Oral Surgeon for the sixth year in a row (2005 – 2010).

At Southwest Oral & Implant Surgery, we celebrate and take pride in a long tradition of excellent service. When your patients have oral surgery needs, you want to refer them to a highly-qualified oral surgeon. Dr. Eklund has received many accolades for his commitment to quality care.  Visit our Awards & Recognition page to find out more.

From dental implants and wisdom teeth extraction, to complex facial traumas and corrective jaw surgeries, you can be assured that Dr. Eklund can quickly and expertly handle your most complex cases and then return your patients to you for their long-term care.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is found in patients who have received intravenous and oral forms of bisphosphonate therapy for various bone-related conditions including bone cancer, osteoporosis, osteopenia, Paget’s disease of bone, and osteogenesis imperfecta of childhood.  Bisphosphonate is marketed under the brand names Boniva (Ibandronate), Fosamax (Alendronate), and Actonel (Risendronate), Zometa (Zolendronic acid) and Aredia (Pamidronate).

BRONJ is a condition in which the maxillofacial bones, in particular the tooth areas, become exposed and necrotic.  Bisphosphonate slows the body’s ability to remove and replace bone, specifically in the jawbone area.  BRONJ can appear spontaneously or can be a result of trauma to the dentoalveolar structures from periodontal (gum) disease, dental surgery, implants, root canals, abscessed teeth, or tooth extraction.

BRONJ patients normally present with pain, swelling, halitosis, cellulitis, and trismus.  Physical findings include clinical infection, mandibular and or maxillary bone exposure, oral-cutaneous fistula, or pathologic fracture.  Upon examination, a varied amount of exposed and painful alveolar, maxillary, and/or mandibular  bone is revealed.  Clinical detection involves sloughing of pieces of bone, spicules of bone protruding through the gums, and drainage.  A patient with this condition should be referred to an oral and maxillofacial surgeon who is then responsible for counseling, managing and treating the patient.

BRONJ Diagnosis

The American Association of Oral and Maxillofacial Surgeons outlines the following parameters to distinguish BRONJ from other delayed healing conditions. Patients may be considered to have BRONJ if all of the following three characteristics are present:

  1. Current or previous treatment with a bisphosphonate;
  2. Exposed, necrotic bone in the maxillofacial region that has persisted for more than eight weeks; and
  3. No history of radiation therapy to the jaws.

To make a definitive diagnosis, laboratory studies should be conducted to rule out a primary malignancy.  Additionally, a CT scan, MRI, panoramic or plain-film imaging, and/or area biopsy may be conducted (if warranted.)

It is important to understand that patients at risk for BRONJ or with established BRONJ can also present with other common clinical conditions not to be confused with BRONJ. Commonly misdiagnosed conditions may include, but are not limited to, alveolar osteitis, sinusitis, gingivitis / periodontitis, caries, periapical pathology and TMJ disorders.

Treatment of BRONJ

The treatment objectives for patients with an established diagnosis of BRONJ are to eliminate pain, control infection of the soft and hard tissue and minimize the progression or occurrence of bone necrosis. There are two ways to manage and treat patients with BRONJ – non-surgical and surgical.

Non-surgical management includes antibiotics, systemic or topical antifungals, antimicrobial rinses, ceasing bisphosphonate therapy, and stopping dental therapy or changing strategy to minimally invasive dental therapy.

Surgical solutions for BRONJ are limited due to the patient’s impaired healing ability.  Again deferring to the American Association of Oral and Maxillofacial Surgeons’ guidelines, the suggested treatment of BRONJ patients is determined by which stage the patient presents in:

  • Stage I
    • Antimicrobial rinses
    • No surgical intervention
  • Stage II
    • Antimicrobial rinses
    • Systemic antibiotics or antifungals
    • Analgesics
  • Stage III
    • Antimicrobial rinses
    • Systemic antibiotics or antifungals
    • Analgesics
    • Surgical debridement or resection

Management and Prevention of BRONJ

Although a small percentage of patients receiving bisphosphonates develop osteonecrosis of the jaw spontaneously, the majority of affected patients experience this complication following dental surgery.   The use of oral bisphosphonates and their role in BRONJ have yet to be completely determined. Long-term studies identifying the patients who are at risk for this disease process are still pending.  Currently, the best solution to the problem is prevention.

Prior to treatment with an IV bisphosphonate, the patient should have a thorough oral examination, any unsalvageable teeth should be removed, all invasive dental procedures should be completed and optimal periodontal health should be achieved. Patients with full or partial dentures should be examined for areas of mucosal trauma, especially along the lingual flange region. It is critical that patients are educated as to the importance of dental hygiene and regular dental evaluations, and specifically instructed to report any pain, swelling, or exposed bone.

For individuals who have taken an oral bisphosphonate for less than three years and have no clinical risk factors, no alteration or delay in dental surgery is necessary. The risk of developing BRONJ associated with oral bisphosphonates, while exceedingly small, appears to increase when the duration of therapy exceeds three years.  For patients who have taken an oral bisphosphonate for less than three years with or without corticosteroids concomitantly, the prescribing provider should be contacted to consider discontinuation of the oral bisphosphonate for at least three months prior to oral surgery, if systemic conditions permit. The bisphosphonate should not be restarted until healing has occurred.

If you have a patient who is presenting with BRONJ symptoms, or at risk of contracting BRONJ, we would be happy to evaluate them and work together with you on a treatment plan.  If you have any questions for us or would like to discuss a patient situation with us, please contact us at 713-439-7575 or 281-277-6622.  We look forward to partnering in your patient’s care.

Resources:
American Association of Oral and Maxillofacial Surgeons Position Paper

Wikipedia – BRONJ
Journal of Oral and Maxillofacial Surgery Abstract

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You can’t open a newspaper or magazine lately and not run across advertising touting “DENTAL IMPLANTS IN A DAY!”  Considering the traditional dental implant process can take anywhere from two months to two years to complete, it’s easy to understand how patients would be interested in walking out with a new set of dental implants in just one day.  But is this just marketing hype?  And more importantly, would it work for your patients?

First, let’s take a look at the traditional two-stage dental implant process that involves both an oral surgeon and a general dentist.  During the first surgery, an oral surgeon places the implant and it is left for the bone to heal and grow around it.  Once the dental implant is stable in the jawbone, a second surgery is completed to surgically uncover the implant.  The patient is then sent back to his or her general dentist for crown placement.

Single Stage Surgery
Technological advances have allowed for single stage surgery, which requires only one surgical procedure. The patient comes in to have the implant placed and a tall cover screw is used to keep the implant from submerging.  After a four month healing period for the bone to grow onto the implant, the abutment post is placed and the patient is ready for the dental crown – no additional surgery is required. The Single Stage Surgery procedure offers a quicker recovery, less time off of work and in the oral surgeon’s office, and minimal pain and overall discomfort.

Dental Implants in Day
The latest evolution in dental implants shortens the process even more.  During the “dental implants in a day” procedure, an oral surgeon extracts the tooth, places the implant and coordinates with the patient’s general dentist for fabrication of a temporary crown all in the same day. This procedure still warrants several months of healing before fabrication of the permanent crown.  On the day of implant surgery, a patient will leave the office with a temporary crown attached to his or her implant. Once the patient has healed, usually four months, the permanent crown can be attached.  The same-day dental implant process offers improved aesthetics, faster results, and the peace of mind of not having to wear a removable replacement tooth.

Dental Implants in a Day – Not for Everyone
Certain conditions must be met in order to receive dental implants in a day.  Patients who require significant bone grafting due to bone loss, have uncontrolled diabetes, are post-irradiation for cancer and are extremely heavy smokers are not candidates for the dental implant in a day procedure.  But for many patients, the same day dental implant procedure is a viable option.

When your patients require dental implants, referring them to me is the best choice.  I have successfully placed over 6,000 dental implants.  Additionally, I placed the first temporary anchorage device (TAD) in the world in 1983. This procedure generated a profound paradigm shift in how skeletal anchorage could be used for dental implantology and was the basis for many of the procedures used today.

When you refer your patients to me I can assess their unique situations to determine which dental implant procedure is the best for them.  Contact Southwest Oral & Implant Surgery today to schedule a consultation and use our online referral form to speed the process.

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Researchers at Case Western Reserve University have discovered that inflammation levels in prostatitis patients is linked to a loosening of the attachment level between gums and teeth.  Read More.

Researchers at North Carolina State University have developed a “smart coating” that helps surgical implants bond more closely with bone and ward off infection.  Read more.

I am happy to announce that I’m incorporating something new into my oral surgery practice – aesthetics. This is the third part of my new logo – cosmetics. Medical aesthetician Debra Havelka, R.N. has joined our team. Debra has been a practicing nurse for over 25 years.  She will be providing BOTOX® Cosmetic and Juvederm™ XC injections.

BOTOX Cosmetic improves the appearance of moderate to severe frown lines between your brows, crows feet and in your forehead. The treatment requires no downtime and results can last up to four months.

Juvéderm XC is a smooth consistency gel made of hyaluronic acid, a naturally occurring substance in your skin that helps to add volume and hydration. Juvéderm XC injectable gel is eased under the skin to instantly restore your skin’s volume and smooth away facial wrinkles and folds. Smoothes your “smile lines” or “parentheses” (nasolabial folds – the creases that run from the bottom of your nose to the corners of your mouth) as well as restored fullness and youthfulness to your lips.

To help introduce these new services, we will be offering an introductory special of $50 off your first BOTOX or Juvederm treatment.  Limited to one discount per patient and must be redeemed prior to September 30, 2010.

Debra will be seeing patients at our Greenway Plaza office on Thursdays and at our Sugar Land office on Wednesdays. Patients can schedule appointments between noon and 6:00 p.m.

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One of the most exciting new medical advances in recent years is the introduction of Platelet Rich Plasma (PRP). Platelet Rich Plasma uses the body’s own cells to help it heal. When PRP is injected directly into an injured area, it accelerates the body’s instincts to repair muscle, bone, and other tissue. I have been successfully using Platelet Rich Plasma to speed healing in my oral surgery patients.

For dental implant patients, Platelet Rich Plasma invigorates and enhances bone growth around titanium dental implants, as well as other areas requiring additional bone.

PRP Can Be Used for the Following:

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

Advantages of PRP:

  • Safety – Because PRP is a by-product of the patient’s own blood, disease transmission, allergic reaction, and rejection are not concerns.
  • Convenience – PRP can easily be gathered from a simple IV blood draw during an oral surgery procedure.
  • Rapid healing – PRP can speed up bone and tissue growth and wound healing.
  • Faster bone growth – Adding PRP to a bone graft will increase the final amount of bone present.
  • Ease of application – PRP makes it easier to apply bone substitute materials and bone grafting products by making them more gel-like.

For more information on PRP, including how it is derived and used to help patients, see the Platelet Rich Plasma page on the Southwest Oral and Implant Surgery website.

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