Oral Surgeon

Oral and Maxillofacial Surgery encompasses a variety of procedures that involve surgery of the mouth
(oral), jaw (maxilla), and face (facial). Oral and Maxillofacial surgery requires additional years of hospital-
based surgical and anesthesia training after graduation from dental school. As an oral and maxillofacial
surgeon, our doctors manage a wide variety of problems relating to the mouth, teeth, and facial regions.
Our doctors practice a full scope of oral and maxillofacial surgery with expertise ranging from dental
implants, wisdom teeth, corrective jaw surgery and facial cosmetic surgery. Our office can also diagnose
and treat facial pain, facial injuries, and fractures.

Keep in mind that oral surgeons undergo many additional years of advanced medical training and hands-
on experience outside of regular dental school and are qualified to perform these procedures and more.
The best way to find out the treatment plan that is right for you is to contact one of our offices and set
up a consultation. Our staff are trained in assisting with Intravenous (IV) sedation and outpatient general
anesthesia in our state-of-the-art office setting.


While every case is different, so are the many options we have to make your procedure relaxing, comfortable and as pain-free as possible. As Board Certified Oral and Maxillofacial surgeons, Dr.’s Vigliante, Gocke, and Bowler have not only completed four years of dental school, but additionally at least four years of hospital surgical residency completing advanced training in anesthsia. We encourage you to discuss your best options for pain management during your procedure, including local anesthesia, “laughing gas” (No2), IV sedation or general anesthesia for more extensive procedures and surgeries.

Exparel, a non-narcotic injection at the time of surgery, is a fantastic alternative to opioids for your child’s pain-management post wisdom teeth extraction.

Almost all of our Oral and Cosmetic surgeries are completed on an outpatient basis, and in almost all cases, patients can resume work or normal activities with a few days.

Wisdom Teeth

Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth, generally between
the ages of 17 and 25. It is estimated that greater than 85% of third molars will eventually need to be
removed. This is why a focused consultation for wisdom teeth removal with the surgeons at Reston Oral
and Cosmetic Facial surgery who, is crucial and of great oral health benefit. Wisdom teeth removal cost
depends greatly on the type of extraction that is being performed.

Several different types of tooth extraction related to third molars are: surgical extractions, soft tissue
impacted extractions, partial bony impacted extractions, and full bony impacted extractions. Each of
these increases in complexity and, as such, there is an increase in fee. Not tending to issues with these
teeth can lead to infected wisdom teeth, or even shifting or crowding of your other teeth due to the
impacted wisdom teeth pushing against adjacent teeth. This can undo all your orthodontist’s efforts to
give you your beautiful straight smile.

Dental Implants

A natural tooth consists of a root and a crown. If you compare natural teeth to implant-supported
replacement teeth, you’ll see they have the same basic parts. Both have a crown (the visible part used to
chew food). Both have a root that holds the tooth securely under the gum and is anchored into the jaw.
The difference is that the implant is made of titanium – the same time-tested material used by surgeons
for artificial joints. When you lose a tooth, you lose both the root and the crown. To replace the tooth,
the surgeon first replaces the root with a small dental implant. After the implant has bonded to the
jawbone, the second phase begins. The surgeon will uncover the implants and attach a small healing
collar, and then refer you back to your General Dentist to complete the process.

The cost of dental implants varies, based on the complexity of each case. Your Doctor at Reston Oral
and Cosmetic Facial Surgery will go over all options with you at your consultation, including temporary
retainers with prosthetic tooth or multiple teeth to give you a full smile while you are going through the
implant process.

Bone Grafting

A bone graft is used to promote bone growth in the area where an implant is to be placed, ensuring a
healthy and stable implant site that will last. When a tooth is removed or a permanent tooth fails to
develop in the appropriate position, the tooth-supporting bone of the jaw begins to atrophy, or melt
away. This leads to the bone in your jaw being unstable, weakened, and often unable to support a
dental implant. The bone graft is placed in the area of your jaw where it is needed. Then, it acts as a
platform for the nearby bone to grow upon and new bone will eventually replace the graft material. A
bone graft is designed to maintain and regrow bone so that you can be a qualified candidate for dental
implants.

All on 4

All on 4 dental implants are an easy to care for solution that amazingly simulates the look and feel of
natural teeth and stay fixed in place with 4 implants acting as anchors. Patients will not experience the
typical rocking and movement or gum irritation associated with dentures. A major benefit of All-on-4 is
the cost savings. Traditional dental implants required many implants, but with All-on-4, you will only
need 4-5 specifically placed implants, drastically reducing the price and time of the procedure.

  • All on 4 implants allow you to have
  • Beautiful natural looking new teeth that are permanently supported into place — they never
    come out
  • A denture that conforms to the natural contour of your arch, instead of a bulky plate covering
    the roof of your mouth
  • Freedom to enjoy all of your favorite foods
  • Speaking clearly, without a denture getting in the way
  • The closest thing to natural teeth all over again
  • A new smile that can last for the rest of your life

We will be happy answer all your questions about All on 4 dental implants at the time of your virtual or in-person consultation.

Sleep Apnea

Sleep apnea refers to non-breathing episodes during sleep, occurring as frequently as several hundred
times per night. Although the individual may have had a full night’s sleep, he or she still feels tired
during the day. Sleep apnea is surprisingly common and can progress in severity and become life-
threatening if not detected and properly treated.

According to the American Sleep Disorder Association, oral appliance therapy is an endorsed form of
Sleep Apnea Treatment for snoring and mild cases of sleep apnea. Most sleep apnea sufferers fall into
the mild to moderate categories. For these patients, oral appliance therapy is often the best option.
For more severe cases with obstructive sleep apnea (OSA) Maxillomandibular advancement surgery
(MMA) can be an effective treatment. In MMA, the bones of the upper and lower jaw are repositioned
to relieve airway obstruction. The procedure also suspends the attached pharyngeal airway muscles in
an anterior position and simultaneously increases pharyngeal soft tissue tension.

After reviewing the results of your Sleep Apnea test, we will come up with a comprehensive plan and
discuss all your treatment options with you.

TMJ Treatment

TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If
you have had symptoms like pain or a “clicking” sound, you’ll be glad to know that these problems are
more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of
the jaw and the chewing muscles (muscles of mastication) do not work together correctly. TMJ stands
for temporomandibular joint, which is the name for each joint (right and left) that connects your jaw to
your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and
treatment are important.

Today’s in office treatment options for TMJ pain are amazingly advanced and easily tolerated. They
range from simple Botox injections to Arthrocentesis, a flushing out of the jaw joint for TMJ relief.