Before you book.

It depends on how many teeth, how deep they are, whether a CT scan is needed and whether we use sedation, so I don't publish surgery prices. A consultation is 60,000 colones at the office and 20,000 by video; with your imaging in front of me, I give you the cost for your case.

With local anesthesia the area is numb: you can expect to feel pressure and movement, not pain; if something hurts, tell me and I add more anesthetic. If you're very anxious or the surgery is longer, we consider sedation. Afterwards there is discomfort, mostly on the first day, which we manage with medication.

It depends on how many teeth, their position and your work: I tell you at the consultation. What holds is that the first day is usually the hardest.

Yes, in many cases, in a single surgery; it depends on the position of each tooth and your health. We decide at the consultation.

No. A panoramic X-ray is often enough; I order a CT scan if it shows a root near the nerve. If you have one, bring it.

Not always. For healthy teeth, the evidence doesn't show removal is preferable to keeping them: we monitor them. They come out for a specific problem, such as recurring infection, unfixable decay, damage to the neighboring molar, or a cyst.

It depends on the number of implants, whether a graft is needed and what imaging you already have, so I don't publish a surgery price. Your dentist quotes the crown. A consultation is ₡60,000 and a video consultation ₡20,000; once I see your imaging, I give you the surgical quote.

Months, not weeks: the bone has to integrate, and a graft beforehand adds time. Sometimes a provisional tooth goes in the same day, if the implant is firm and your bite allows it; I decide during surgery.

Local anesthesia is there so you don't feel pain during surgery; you will feel pressure. Afterwards there's discomfort for a few days, managed with medication.

Depending on the case, bone is rebuilt with grafts, the sinus lifted, or short implants used. If the upper jaw has lost a lot of bone, zygomatic implants, anchored in the cheekbone, are often indicated instead of major reconstructions.

In studies of 10 to 25 years, approximately 95% of implants were still in place. But staying in place isn't the same as being healthy: hygiene, check-ups and not smoking protect it. I don't promise a time frame.

In many cases, yes. Well-controlled type 2 diabetes was not linked to more disease around the implant. Smoking doesn't rule implants out by itself, but it raises the risk of failure and bone loss.

I confirm the brand and the terms of treatment at the consultation, with the quote. What no one can promise is how your bone will respond: that's why I plan, explain the risks and follow up with you.

I don't publish a single price: it depends on one arch or both, four or six implants, whether extractions or grafts are needed and the prosthesis material. A consultation is ₡60,000 and a video consultation ₡20,000. With your CT scan I give you the cost of each phase. You can pay by credit card, debit card or cash.

It depends on the bone, the arch and how strong your bite is. In the upper jaw, an overview of systematic reviews advises against using fewer than four. At 5 years or more, survival was high with both options.

If the implants are stable, a fixed provisional is screwed in within the first hours or days: the torque I measure decides it, not the calendar. If it isn't enough, we wait for the bone to integrate them.

There's no single material: it's chosen for your case. The provisional is replaced by the final one once the bone has integrated the implants. What studies show: in one review, the main prosthetic complication was fracture of the all-acrylic prosthesis, and according to a systematic review, zirconia may reduce mechanical complications.

It's screwed in: you don't take it out at home. You clean it daily, underneath too, with interdental brushes and a water flosser. The European Federation of Periodontology guideline recommends maintenance with periodic check-ups; the frequency depends on your case.

First it's measured on the CT scan. Tilting the back implants uses the bone in the front, and an overview of systematic reviews found no difference in failure between tilted and straight implants. If that isn't enough, we consider bone grafts or zygomatic implants.

No number predicts your case. Two long-term series from the center that created the technique report: in the lower jaw, with up to 18 years, 98.8% of prostheses and 93% of implants were still in place; in the upper jaw, with up to 13 years, 94.7% of implants. Some patients didn't complete follow-up. What depends most on you: not smoking, hygiene and check-ups.

Someone with a difference between the jaws that affects the bite, chewing, lip closure or breathing, and that orthodontics alone can't correct. Facial growth generally has to be complete and your health has to allow general anesthesia. Braces come before and after, coordinated with your orthodontist.

It depends on whether one or both jaws move, the hospital, the length of stay and the imaging; I give you an estimate after the consultation. A consultation is 60,000 colones and a video consultation 20,000 colones.

The CCSS has a network care protocol for orthognathic surgery, with its own criteria and timelines. In my private practice you can get an evaluation or a second opinion: bring your imaging.

It depends on whether one or both jaws are operated on. In a review of 18 studies (1,734 patients), two-jaw surgery took an average of 326.95 minutes, with an average stay of 3.25 days. I confirm your case in the plan.

In the vast majority of cases, no: the surgery is done from inside the mouth.

With titanium plates, prolonged rigid wiring is usually not needed; guiding elastics are used as needed.

In selected adults who can't tolerate CPAP, advancing both jaws is one of the surgeries considered. In reviews of operated sleep apnea patients, it achieved "surgical success" (lowering the apnea index by more than 50% to under 20 events per hour) in 79.6% to 85.5%, and "cure" (under 5 per hour) in 38.5% to 39%. If you have sleep apnea, bring your sleep study and I'll explain whether your jaws play a role.

When the bone below the sinus isn't enough for a standard-length implant. I measure it on the CT scan; sometimes a short implant avoids it.

Neither is superior overall: in the trials that compared them, neither reduced failures more than the other. I choose based on the millimeters of bone and the shape of the sinus.

It can be human donor bone, animal-derived, synthetic or your own bone. There's no evidence that your own bone is superior to substitutes, and taking it adds a second wound (from the chin it caused considerable discomfort). If you'd rather avoid animal or human materials, there are synthetic ones. I've given talks on bone biology (Tegucigalpa, 2018) and maxillo-mandibular reconstruction (AO CMF course, San José, 2014).

If there's stability, it goes in during the same surgery. If not, a few months: I don't give a fixed number because it depends on the bone and the technique, and I confirm it with an image.

It's uncommon: it was reported in 1.11% of patients, and I only operate on a healthy sinus.

During surgery, the anesthesia prevents pain. Afterward there's swelling and discomfort for a few days, managed with medication.

When I clear you at the follow-up. If you have a trip planned, tell me before we schedule.

It depends on the technique, the graft and how many implants are involved: I give you a quote after seeing your CT scan. A consultation is 60,000 colones and a video consultation 20,000, and in it we can review a CT scan you already have.

No. Surgery is reserved for a minority of cases, and most of those can be managed with minimally invasive techniques such as arthrocentesis.

It often improves over time, even without active treatment. If it hurts, limits your opening or gets worse, it's worth an assessment.

There isn't one for everyone. For pain lasting 3 months or more, the international guideline strongly recommends cognitive behavioral therapy, physical therapy, supervised exercises and home care. We combine them based on your diagnosis.

It protects your teeth from wear, but its effect on TMJ pain is uncertain: in 13 trials (1,076 participants) there was no evidence that splints reduce pain when all disorders are analyzed together. It must be reversible.

No. Clicking that doesn't hurt or lock usually doesn't need surgery. One assessment tells you which signs to watch for.

If it's stuck open and you can't close, contact the office or go to the emergency room. If it locked closed, message me soon: we start with conservative care and, if it doesn't improve, arthrocentesis is an option.

Arthrocentesis is an outpatient procedure and the discomfort is usually mild and temporary. Open surgery carries risks to the facial nerve and the bite, which is why, for disc problems, it doesn't come first.

Your dentist checks your teeth and bite; a physical therapist works on movement and muscle pain. See an oral and maxillofacial surgeon if your jaw locks or dislocates, if there's a change in the bone, or if it doesn't improve with initial treatment.

With warning signs (breathing, bleeding, a blow to the head, vision, neck), go to the emergency room. If not: cold packs, soft food, don't force your mouth, and get seen soon, especially with a cut in the gum or loose teeth.

The most sensitive signs are teeth that no longer meet the way they used to and numbness of the lower lip or chin. It is confirmed with a CT scan.

Not necessarily. With stable plates, the idea is to move your jaw early. Sometimes elastics are used afterwards; prolonged wiring is reserved for specific cases.

Usually yes: they are titanium. They are removed if a plate becomes infected, loosens or bothers you.

The bone heals over weeks. The soft diet and going back to work depend on the fracture and how it was fixed; I give you dates at the consultation and adjust them at every check-up.

It may be the tooth alone, but if several moved together as a block or your bite changed, the bone may be fractured. If a tooth was knocked out completely, get dental care right away and keep it in milk or your saliva, without touching the root.

The consultation is 60,000 colones and a video consultation is 20,000 colones, useful for reviewing a CT scan; the fracture is confirmed in person. I give you the cost of surgery after reviewing the CT scan. If it was an accident, ask your insurer first what they cover.

Often by chance, on an X-ray taken for another reason; other times because of a bump on the gum or a tooth that shifts. Many don't hurt.

Generally, no: keratocysts and ameloblastomas are benign, although they can grow and come back. The X-ray points the way; what confirms what it is — and rules out cancer — is the biopsy. In 2009 I took the oral and maxillofacial oncology course at Mexico's National Cancer Institute.

A diagnosed cyst is treated, because it usually keeps growing. What changes is how, depending on the type and size. What I don't recommend is watching a bone lesion without a biopsy.

A cyst that forms around the crown of a tooth that never came in, often a wisdom tooth or a canine. Depending on the case, it comes out with the tooth or is decompressed first.

A benign tumor that starts in the tissues that form teeth. It isn't cancer, but it comes back more often after conservative treatment than after bone resection; treatment is decided by the biopsy, the type and the size.

It depends on the type. In an analysis of 6427 keratocysts, overall recurrence was 21.1%: 14.7% in single-cavity lesions, 24.4% in multi-cavity ones and 35.4% in Gorlin syndrome. That's why X-ray check-ups go on for years.

Under local anesthesia, you usually feel pressure; if anything hurts, I add more anesthetic. Afterwards, mild discomfort for a few days. Results take from days to a few weeks; if easier, I can go over them by video consultation.

I don't publish a surgery price: it depends on what I find at the exam. A consultation is 60,000 colones, or 20,000 by video; that's where I give you the exact cost, or tell you you're not a candidate.

A good candidate has full cheeks from buccal fat, a stable weight, enough facial volume and realistic expectations. It doesn't suit a slim face, or one already losing fat with age: there the risk of looking gaunt goes up. In a small study, satisfaction dropped in patients over 25.

Yes: local, from inside the mouth. The time depends on your anatomy: I tell you at the consultation.

Not right away: there's swelling first. In a small study, facial measurements changed between 1 and 3 months.

Common: swelling, pain and difficulty opening your mouth, which pass. Less common: asymmetry, hematoma, infection, facial nerve or parotid duct injury and, long term, a gaunt-looking face.

It can, on the wrong face. There are almost no long-term studies; one reported a gaunt appearance in 1.6% of cases. Choosing the right patient is key, and when in doubt I'll recommend not operating.

I don't publish before-and-after photos here: someone else's result doesn't predict yours. At the consultation we look at your photos and I tell you what's realistic.

Get seen soon: it's resolved by removing the cause. Until then, don't pop it, don't use heat and don't take leftover antibiotics. With fever, swelling that spreads, or trouble swallowing, breathing or opening your mouth, go to the ER.

By getting the pus out and treating the cause. A cold pack on the outside may ease it until you're seen, but it doesn't cure the infection.

The pain may ease, but the cause is still there and the infection can come back or spread: still get seen.

Alone, that isn't proven. Guidelines call for removing the source first; antibiotics are reserved for an infection that spreads or causes fever or feeling unwell.

Often, yes: it depends on how much healthy tooth is left, the roots and the bone. If so, I refer you to your dentist or an endodontist.

A tooth broken at the gum line or trapped in the bone, or roots that are curved or near the nerve or sinus. You know this from the consultation.

It depends on whether it's simple or surgical, how many teeth, any infection, and whether a CT scan or graft is needed; I don't publish surgery prices. A consultation is 60,000 colones (20,000 by video), where I give you the cost of your case.

Without the tooth, the ridge shrinks, fastest in the first 3 to 6 months. Without a graft, 29% to 63% of the width and 11% to 22% of the height is lost in 6 months.

No. With enough bone, the implant goes in without a graft. If bone is short, sometimes a short implant works, sometimes the graft goes in during the implant surgery, and sometimes it's better to rebuild first: I decide with the CT scan.

When you'll want an implant there and it isn't going in the same day. Compared with healing on its own, it saved 1.18 to 1.99 mm of width on average, depending on the review; Cochrane rates that evidence as very uncertain and found no evidence of a difference in implant failure or appearance.

It can be your own bone (autograft), human donor bone (allograft), treated animal bone, usually bovine or porcine (xenograft), or synthetic. For socket preservation, Cochrane found none clearly better, though another review favored animal-derived or donor material. For sinus lifts and ridge augmentation, there's no evidence that your own bone is superior, and taking it adds a second wound.

Socket preservation studies measured the bone after 3 to 6 months of healing. Ridge augmentation usually takes longer. I don't give a fixed number: I confirm it with an image.

It depends on the defect, the material and whether it's done with the extraction or the implant, so I don't publish surgery prices. A consultation is 60,000 colones, or 20,000 by video; with your images, I give you the cost for your case.

Sources give two time frames that measure different things. With a likely cause, the cause is removed and, if the sore hasn't healed within 2 weeks, the WHO recommendation cited in a review is to biopsy it. With no explanation and more than 3 weeks, the UK's NICE guidance recommends considering an urgent suspected-cancer referral. When in doubt, don't wait.

The most common cause of painful mouth sores is canker sores, estimated to affect 10% to 25% of people, depending on the source. But a sore that doesn't heal shouldn't be written off as rubbing: other causes, including a tumor, need to be ruled out, and a biopsy is how you find out.

Per NICE, to get checked promptly: an unexplained sore lasting more than 3 weeks, a red or red-and-white patch, a lump on the lip or in the mouth, or one in the neck that persists. It's also worth getting checked for unexplained bleeding or pain, a numb area, or a tooth that loosens for no reason.

A white patch that doesn't rub off and has no other cause is called leukoplakia; a red one, erythroplakia. In follow-up studies, about 9.5% of leukoplakias became cancer; for red patches, 19.9% to 33.1%, depending on the review. That's why they need close follow-up, and a biopsy tells us what they are.

Under local anesthesia, in a few minutes and with a few stitches. You usually feel pressure; if anything hurts, I add more anesthetic. Afterwards, mild discomfort for a few days.

From days to a few weeks, and we go over them together. If they show dysplasia, its grade helps decide the next step. If they show cancer, I calmly explain the diagnosis and what comes next, with other specialists when needed.

It depends on the lesion's size and location, so I don't publish a price. A consultation is 60,000 colones, or 20,000 by video; after examining you, I give you the cost.

Ask for it to be measured on a CT scan: sometimes it means there isn't enough for a conventional implant without a graft, not that there is no option. Send me the CT scan and I'll tell you what I see.

It is a longer implant that anchors in the cheekbone, so it only works for the upper jaw. It is for someone with advanced bone loss there, measured on a CT scan, or whose grafts or implants have failed. Extra care is needed if you smoke, have untreated sinusitis, receive high-dose bone medications for cancer or have had radiation therapy.

No one can promise that. In studies with at least 3 years of follow-up, on average 96.2% of implants were still in place at 6 years; with 5 years or more, 96.5%, with no difference from conventional implants (95.8%). Hygiene, check-ups and not smoking all play a part.

It is a more complex surgery than a conventional implant, with its own risks —mainly sinusitis— and more maintenance. Compared with grafting, more complications but fewer failures.

It depends on how many implants your case needs, the temporary and final prostheses and the anesthesia: I give you the exact quote after evaluating your CT scan. A consultation is 60,000 colones at the office and 20,000 by video.

I plan and lead it myself. It's worth asking: according to the ITI consensus, success in this surgery depends heavily on the surgeon's skill and experience. I am a member of the IAOMS and was a speaker at the AO CMF course "Advances in maxillo-mandibular reconstruction" (San José, 2014).

Reviewing your imaging, giving you guidance and a second opinion: yes. Feeling the area, measuring your bite or scheduling surgery: no, that needs an exam.

Yes, if it has the complete DICOM files (or the imaging center's link); screenshots aren't enough. Add your panoramic X-ray, photos and your medication list.

It costs 20,000 colones. Book it from the booking page like any visit, noting that it's a video consultation. An in-person consultation, if needed afterwards, costs 60,000 colones.

At the end I tell you what we concluded, what can't be concluded on video and what the next step is. If you need something in writing, say so when you book and I'll confirm what's possible. A surgical plan is settled after I examine you.

Yes, to review your imaging and give you guidance before you travel. If surgery is needed, I examine you at Hospital CIMA before scheduling it.

Yes. Send me the plan, the report and the imaging: for implants, the CT scan; for jaw surgery, also the cephalometric X-ray and photos. I explain what I see, whether I agree and what the alternatives are, including not operating yet when valid.

It happens. In general radiology —not maxillofacial surgery—, when a second specialist reviewed already-reported imaging, the readings differed in 32.2% of cases and management changed in 18.6%. Disagreeing doesn't tell you who is right: I explain what I base my view on and which test would settle it. The decision is yours.