Oral Surgery

Tooth extractions, including difficult and wisdom teeth; dental implant placement and the crowns that restore them; pre-prosthetic surgery that prepares the jaw for dentures; and treatment of oral infections. All of it is done in the same familiar office by the team you already know, rather than through a referral to a stranger.

An implant replaces the root, not just the visible tooth. A small titanium post is placed into the jawbone, left to fuse with it over several months, then topped with an abutment and a custom crown. The result stands on its own, so neighboring teeth are never filed down to carry a bridge.

That fusing stage is what makes implants different from every other replacement. Bone grows directly onto the titanium surface in a process called osseointegration, and once it has, the post behaves like a root: it takes the force of chewing and passes it into the jaw. That matters more than most people expect, because the jawbone under a missing tooth shrinks away when nothing is loading it. A bridge or a denture sits on top of the gum and does nothing to stop that; an implant does.

The trade-off is time. From placement to final crown, a straightforward case usually runs three to six months, most of which is simply waiting for bone to do its work. If the bone has already thinned, a graft may be needed first, which adds months. We will tell you honestly at the consultation which of those paths you are on, because a plan that sounds quick on the phone and turns into a year of appointments helps nobody.

When keeping it would cost more than it gives you. A tooth split below the gumline, one destroyed by decay with too little structure left to hold a restoration, or one with advanced bone loss around it has usually reached that point. Infection that keeps returning after root canal treatment is another.

Our bias is toward keeping your own teeth. A natural tooth, even a repaired one, is better than anything we can make, and a root canal with a crown will often buy many more years of service. But there is a point where repeated repairs become a slow, expensive way of arriving at the same place, and we would rather be straight with you about that than take your money twice.

Three things decide it: how much sound tooth structure is left above the bone, how much bone is holding the root, and whether the tooth can be kept clean. We look at all three on a 3D scan before recommending anything, and if a tooth is borderline we will say so rather than pretending the answer is obvious.

An implant is the only option that replaces the root and protects the bone, and it leaves neighboring teeth untouched. A bridge is quicker but files down two healthy teeth. A partial denture is the cheapest and least invasive, but it is removable and does nothing to stop bone loss.

The honest summary is that an implant usually costs the most on the day and the least over twenty years, and a denture is the reverse. A bridge sits between the two and makes sense when the teeth on either side already need crowns anyway, because then nothing healthy is being sacrificed. Where none of that is obvious, we will lay out all three for your specific gap and let you decide without pressure.

You arrive, we confirm the plan and your medical history, then numb the area thoroughly and wait until you confirm it is numb. Most extractions take fifteen to forty minutes; implant placement is usually under an hour. You leave with written aftercare, gauze, and a phone number to call.

1. Before we start. We go through your medications and health history again, because blood thinners, bisphosphonates and uncontrolled diabetes all change how we plan.
2. Anesthesia. Local anesthetic is placed and given time to work. We test the area and do not begin until you tell us you feel only pressure.
3. The procedure itself. You will feel pushing and hear sounds; neither means pain. Tell us at any point and we will stop and add more anesthetic.
4. Closing up. Stitches are often dissolvable. We place gauze and watch you for a few minutes before you go.
5. Afterwards. You get written instructions and our number. Someone should drive you home if you have had sedation of any kind.

Most people feel noticeably better by day three and normal within a week. Swelling peaks around forty-eight hours, not immediately, so feeling worse on the second day is expected rather than a warning sign. Soft food for a few days, no smoking, no straws, and no vigorous rinsing on day one.

The one complication worth knowing about is a dry socket, where the clot protecting the bone is lost, usually three to five days after a lower extraction. It announces itself as a deep ache that starts getting worse instead of better, often spreading toward the ear. It is treatable in a single short visit, so call rather than waiting it out. Smoking and drinking through a straw are the two habits most likely to cause it.

Our full written guidance is on the post-extraction care page, and if you have had an implant crown placed, the implant crown instructions cover how to keep it clean for the long term.

The procedure itself should not hurt. Local anesthetic blocks the nerve completely, so what you feel is pressure and movement rather than pain. Afterwards, most extractions are managed with over-the-counter anti-inflammatories; stronger pain that ibuprofen will not touch is unusual and worth a phone call.

If dental anxiety is the real obstacle, say so when you book rather than when you are in the chair. Appointments can be scheduled early in the day when the office is quieter, and knowing in advance lets us slow the whole visit down, explain each step before it happens, and agree a hand signal to stop. Patients who have avoided treatment for years are a normal part of our week, not an awkward exception.

Bleeding, swelling, bruising and temporary jaw stiffness are common and settle. Less common are infection, dry socket, sinus communication on upper back teeth, and nerve irritation on lower wisdom teeth causing temporary numbness. Permanent nerve injury is rare, and 3D imaging beforehand is how we keep it that way.

Risk is also why we ask detailed medical questions. Blood thinners usually do not stop surgery but change how we manage bleeding. Some osteoporosis medications affect how jawbone heals and need discussion before anything is removed. Poorly controlled diabetes slows healing and raises infection risk. None of these rule treatment out; they change the plan, and knowing beforehand is the whole point.

Cost depends on the procedure, how complex the case is and what your plan covers, so we quote the full fee in writing before anything is scheduled. We verify your benefits first and file the claim for you, and the price we quote is the price you pay.

Two things are worth knowing. Extractions are usually treated as a basic or surgical benefit and are commonly covered in part, while implants are treated differently by different plans, some covering the crown but not the post. And medical insurance occasionally contributes where surgery follows an injury or a medical condition. We check all of this before you commit, not after.

Veterans in Glen Allen, Petersburg and Fort Lee: if VA has authorized dental care for you in the community, bring the authorization and we will tell you straight away whether we can treat you under it. Our veterans page explains how VA dental benefits and VADIP coverage work at a private practice.

Advanced imaging and careful planning make surgery safer and more predictable; we know where the nerves and sinuses are before we start. Treatment is pain-free, communication is plain, and you always know what is happening next and what it costs, because the fee is quoted in full before the procedure.

There is also a continuity argument. Surgery here is done by the practice that already has your records, took your X-rays and will see you for the follow-up and the cleaning six months later. Nothing is lost in a handover, and if something does not feel right at the weekend you are calling a team that knows your case rather than an answering service at an office you visited once.

Dr. Sean Sayyar has practiced in the Richmond area since 1998 and holds Mastership of the Academy of General Dentistry, a credential earned through more than a thousand hours of continuing education. The office is at 5231 Hickory Park Drive in Glen Allen, just off I-95, with free parking at the door.