Our Expertise

 

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Dr. Hakim (left) after successfully repairing a mandible fracture with his former residents at the University of Michigan

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Extractions

 

Teeth are removed due to severe cavitation, gum disease, or being impacted and non-functional.  Through a variety of anesthesia and sedation techniques, Dr. Hakim aims to minimize stress.

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Wisdom Teeth Removal

 

"Wisdom teeth" (aka 3rd Molars) are removed when they're impacted, difficult to clean or  simply problematic.  While Dr. Hakim does not recommend removal of all wisdom teeth, he does recommend everyone have them evaluated by an Oral and Maxillofacial Surgeon before age 18, because the older people get, the more challenging removal may be due to poor healing capacity and increased risk of complications.

 

Whenever Dr. Hakim receives high complication risk referrals of elderly patients from other Oral Surgeons for extraction of problematic wisdom teeth, he wishes for them “If only this patient had had them evaluated at age 18.”

 

Interestingly, wisdom teeth evaluation does not actually require a referral from a dentist or an orthodontist.  Patients are encouraged to directly reach out to our office for a consultation.

 

 

Wisdom Teeth Removal Video in English:

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Wisdom Teeth Removal Video in Spanish:

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Expose and Bond

 

Sometimes when teeth are impacted, instead of removing them, we expose them and attach an orthodontic device so the orthodontist can bring them into the mouth.

 

Expose and Bond Video in English:

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Expose and Bond Video in Spanish:

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Dental Implants

 

Dental implants are the standard of care for replacing missing dentition and can vary from replacing one missing tooth to more sophisticated advanced procedures like replacing multiple teeth or the entire dentition.

 

Implants Video in English:

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Implants Video in Spanish:

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Bone Grafting and Jaw Reconstruction

 

After losing teeth (perhaps due to extractions, trauma, or tumors) it is common that jaw bones resorb.  Bone grafting and reconstruction are meant to restore the jaw bone to allow for normal appearance and to provide bone for dental implants’ placement.

 

Bone grafts can range from:

 

• a simple procedure where we place bone graft following the extraction of a tooth,
• to more advanced grafts to widen or increase the height of a jaw bone
• to major reconstruction of the entire jaw due to severe atrophy.

 

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Bone Graft After Tooth Extraction.

 

 

Full Arch Implants

 

Also known as all-on-four or all-on-six. The most sophisticated level of dental implants in which the teeth of an entire jaw are replaced by dental implants in collaboration with a restorative dentist or prosthodontist so the new prosthetic is fixed and can only be removed by the dentist.  Precision is needed for implant position for ideal function.  The result?  A major quality of life improvement.

 

 

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A panoramic radiograph of a severely atrophic lower jaw. The patient was referred to Dr. Hakim by another oral surgeon for management because her jaw was so atrophic that doing dental implants was going to be very challenging, if not impossible.

 

 

 

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A CT scan redemonstrating how narrow the jaw bone was before surgery.

 

 

 

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Dr. Hakim performed advanced total jaw reconstruction and here is the immediate result.

 

 

 

 

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8 months later the patient had adequate bone and received 5 dental implants for full arch treatment.

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Orthognathic (Corrective Jaw) Surgery

 

Dr. Hakim loves this surgery because it is life changing with predictable results.  It brings him joy to have such a positive and profound impact on someone’s life.

 

Some people have discrepancies in their jaw bones.

- The upper jaw may be small relative to the bottom jaw; it can be narrow; it can be long.

- The bottom jaw may be too large or too small relative to the top.

These discrepancies can result in bite problems including:

- crossbite,

- underbite

- and overbite.

 

They can also result in esthetic problems like:

- gummy smile,

- small chin,

- very large chin,

- small smile,

- and mid-face deficiency (sunken face).

 

Some people have both small upper and lower jaws and that puts them at risk for obstructive sleep apnea.

 

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This patient had an enlarged lower jaw and a deficient upper jaw resulting in esthetic concerns and an underbite that could not be corrected with braces alone.

 

 

 

 

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Surgery was performed to bring the upper jaw forward and the lower jaw backwards, while performing a separate surgery to move the chin forward and maintain a masculine look, resulting in facial harmony and correction of the bite.

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Obstructive Sleep Apnea (OSA)

 

Sleep apnea can be:

- central, where the brain does not adequately activate breathing muscles in our sleep or

- obstructive, where the airway becomes obstructed during sleep.

Living with sleep apnea can be morbid and cause problems like high blood pressure, daytime sleepiness, diabetes and heart disease.

 

Corrective jaw surgery can increase the airway's opening and improve symptoms of Sleep Apnea.  Patients with OSA that fail CPAP, are encouraged to seek consultation to see if they are candidates for jaw advancement surgery.

 

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This is an example of how some people’s airway muscles relax in their sleep resulting in airway obstruction. Jaw advancement surgery increases the size of the airway and can improve or sometimes cure OSA.

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Oral Pathology

 

Benign jaw cysts and tumors can affect the upper or lower jaws; they may be associated with impacted teeth or appear independently.

 

Dr. Hakim uses his minimally invasive surgical techniques to treat these conditions resolving the problem with as little surgery as possible.

 

Dr. Hakim does not treat malignant or premalignant tumors (like oral cancer) but he has helped patients find the specialized care they need so feel free to contact us and we can guide you.

 

 

 

​RLCyst

A large cyst in the left lower jaw that developed over the years in association with an impacted wisdom tooth that was never addressed earlier in the patient's life. The size of the cyst placed the patient at a high risk for nerve injury and mandible fracture.

 

 

 

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Instead of immediately removing the cyst and risking mandible fracture, a minimally invasive decompression technique was used to drain the cyst and reduce its size, so it could be removed safely. Notice the increase in the density of this xray compared to the first one. This is an indication that the cyst was shrinking and the bone was healing.

 

 

 

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After the cyst shrank completely, removing the cyst was easier and the jaw bone fully healed, except for the contour discrepancy that was esthetically not detectable. Notice how the bone density is the same on both sides of the mandible.

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TMJ Disorders

 

Most Oral and Maxillofacial Surgeons agree that TMJ is one of the most challenging fields in our specialty, which is why there are only a few expert TMJ surgeons in the world, most of whom focus on open surgery.  In addition to proficiency in open surgery and joint replacement, Dr. Hakim is one of the best TMJ arthroscopists in the world.

 

[Arthroscopy is a minimally invasive procedure that reduces the need for open surgery and reduces recovery time.]

 

A TMJ consultation does not necessarily mean surgery would be recommended; it's needed to assess the patient’s candidacy for surgery and to ensure that they are getting the appropriate non-surgical management to reduce the chances of needing surgery.

 

 

TMJ Case One

 

 

 

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This patient had unexplained severely limited mouth opening, which affected her quality of life because it is very difficult to eat with such a small opening.

 

 

 

 

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Instead of jumping to open surgery like joint replacement, Dr. Hakim followed his principle of attempting minimally invasive techniques first to see if he could spare the patient the open procedure.  He performed advanced TMJ arthroscopy. The picture on the left shows a severely scarred down joint which prevented the patient from movement. With advanced arthroscopic technique, he was able to open the joint space (on the right) and improve the patient's range of motion. The patient went home the same day.

 

 

 

 

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After postoperative physical therapy, the patient returned for follow-up opening twice as wide. It's a great feeling to be able to help patients with a minimally; invasive technique sensitive procedure.

 

 

 

 

TMJ Case Two

 

 

 

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Sometimes arthroscopy fails or the disease process is too advanced that arthroscopy is no longer an option.  This patient had arthritis of the left TMJ that resulted in ankylosis (jaw fusion). It also shifted the lower jaw to the left side causing a midline shift and premature biting on the left side. Her teeth on the right side and in the front did not touch.

 

 

 

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Dr. Hakim performed total joint replacement with a custom made prosthesis, while simultaneously doing corrective jaw surgery on the right side. This allowed him to move the jaw back to the right side without putting excessive strain on the right TMJ. The result was improved mouth opening and stable bite correction. Notice how the both sides were now touching and how the midlines aligned after surgery.