It may sound like an extreme medical surgery, but bone grafting is frequently used in oral surgery for procedures like dental implants, ridge expansion and nerve repositioning.

When a tooth is missing, over time, the jawbone surrounding the missing tooth atrophies or is reabsorbed into the jaw, leaving a weakened bone structure that is likely unsuitable for dental implants.

Now, rather than going without the function or aesthetics of a tooth (or teeth), patients can see Dr. Ramsey Fanous of Texas Oral Surgery Group for a bone graft prior to implants. The bone graft is designed to strengthen the existing bone and grow new bone to serve as a base for implants, repairing sites that are currently too weak to securely hold dental implants. The goal of a bone graft is to provide patients with adequate bone structure for a successful implant.

Depending on the amount of bone needed, bone will be obtained from a tissue bank or an artificial source. If major bone grafting is needed, often the case following a traumatic injury or a congenital defect, bone will be taken from the patient’s own body from sites like the jaw, hip or tibia. Typically, major bone graft procedures are performed in an operating room and require a hospital stay.

Once the bone grafting procedure is completed, a day of bed rest is recommended, with limited physical activity for one week.

Dr. Fanous may supplement the bone graft procedure with platelet rich plasma (PRP) and bone morphogenetic protein (BMP), which research has shown to induce the formation of new bone in animals and humans. With the combination of bone grafting and BMP, bone has the ability to be grown more predictably and faster than ever before. 

If you would like to know more about bone grafting, dental implants, or PRP and BMP, call Dr. Fanous at 972-471-9596 to arrange an appointment or visit the website at

Texas Oral Surgery Group
Plano, Allen, Denton, Decatur, Gainesville, Texas



Surgical procedures aren't usually something patients look forward to, frequently due to the length of the recovery period. However, there is a way to speed up the dreaded recovery time.

Platelet rich plasma (PRP) is a by-product of blood (plasma) that is rich in platelets and quickens the body’s healing process in a safe, natural way.

Once confined to a hospital setting due to expense and the large amount of blood needed (one unit), new technology has allowed Dr. Ramsey Fanous to bring the PRP harvesting process in office, while requiring only 55 cc of blood drawn from the patient while they are having outpatient surgery.

Why All The Excitement About PRP?

PRP permits the body to take advantage of the normal healing pathways at a greatly accelerated rate. During the healing process, the body rushes many cells and cell-types to the wound in order to initiate the healing process. One of those cell types is platelets.

Platelets perform many functions, including formation of a blood clot and release of growth factors (GF) into the wound. These GF function to assist the body in repairing itself by stimulating stem cells to regenerate new tissue. The more growth factors released and sequestered into the wound, the more stem cells stimulated to produce new host tissue. PRP permits the body to heal faster and more efficiently.

In addition, bone morphogenetic protein (BMP) has been shown to induce the formation of new bone in research studies in animals and humans. This is of great significance for patients receiving dental implants. By adding PRP, and thus BMP, to the implant site with bone substitute particles, bone has the ability to be grown more predictably and faster than ever before.

PRP Has Many Clinical Applications

  • Bone grafting for dental implants. (This 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. 

PRP Also Has Many Advantages

  • Safety: PRP is a by-product of the patient's own blood, therefore, disease transmission is not an issue.
  • Convenience: PRP can be generated in Dr. Fanous’ office while the patient is undergoing an outpatient surgical procedure, such as placement of dental implants.
  • Faster healing: The supersaturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and thus faster tissue regeneration.
  • Cost effectiveness: Since PRP harvesting is done with only 55 cc of blood in Dr. Fanous’ office, the patient doesn't have to pay the expense of the harvesting procedure in hospital or at the blood bank. 
  • Ease of use: PRP is easy to handle and actually improves the ease of application of bone substitute materials and bone grafting products by making them more gel-like.

Frequently Asked Questions About PRP

Q: Is PRP safe?
A: Yes. During the outpatient surgical procedure a small amount of your own blood is drawn out via the IV. This blood is then placed in the PRP centrifuge machine and spun down. In less than 15 minutes, the PRP is formed and ready to use. 

Q: Should PRP be used in all bone-grafting cases?
A: Not always. In some cases, there is no need for PRP. However, in the majority of cases, application of PRP to the graft will increase the final amount of bone present in addition to making the wound heal faster and more efficiently.

Q: Will my insurance cover the costs?
A: No, the cost of the PRP application (approximately $400) is paid by the patient. 

Q: Are there any contraindications to PRP?
A: Very few. Obviously, patients with bleeding disorders or hematologic diseases do not qualify for this in-office procedure. Check with Dr. Fanous to determine if PRP is right for you. 

If you would like to know more about PRP and speeding up your recovery process, call Dr. Fanous at 972-471-9596 to arrange an appointment or visit the website at

Texas Oral Surgery Group
Plano, Allen, Denton, Decatur, Gainesville, Texas



Sleep is the time when the body takes a break. When we sleep, our brain and body recover and prepare for the stresses of the upcoming day. But if you have problems with snoring or obstructive sleep apnea (OSA), you may not only be prevented from getting a good night’s sleep, but you could also be at risk for a bevy of other health issues.

Snoring at night may be an annoyance to a spouse or others in the home, but snoring isn't inherently unhealthy. However, snoring could be a sign of something more serious — sleep apnea.

Obstructive sleep apnea is caused when the tongue is sucked against the back of the throat during sleep. The upper airway is blocked and airflow stops, causing depleted oxygen levels in the brain. When these levels become low enough, the sleeper partially awakens, causing the throat to clear and the flow of air to begin again.

Repeated cycles of decreased oxygenation can lead to serious cardiovascular problems, as well as excessive daytime sleepiness, loss of concentration and even depression.

First, it’s important to recognize the symptoms of sleep apnea, which include:

  • Waking up with a sore or dry throat
  • Snoring
  • Waking up to yourself gasping
  • Daytime sleepiness
  • Morning headaches
  • Depression
  • Waking up frequently throughout the night or insomnia

Though it’s hard to know exactly what’s happening while you sleep, if you recognize any symptoms or suspect that sleep apnea might be an issue for you, be sure to seek out a consultation to learn more about what treatment plan is right for you.

There are several treatment options available for snoring and sleep apnea. An initial treatment may consist of using a nasal continuous positive airway pressure (CPAP) machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night.

One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. The procedure increases the width of the airway in the throat by removing soft tissue. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP).

In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures are usually performed under light IV sedation in the office.

In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.

Every case is different and patients should contact an oral and maxillofacial surgeon to see what treatment option is best for them. If you snore and/or have symptoms of sleep apnea, call Texas Oral Surgery Group at 972-471-9596 to arrange an appointment or visit the website at

Texas Oral Surgery Group
Plano, Allen, Denton, Decatur, Gainesville, Texas



Over the past 18 years of oral maxillofacial surgery practice, Dr. Ramsey M. Fanous has developed a special interest in osseous (bone tissue) reconstruction. This article, written by Dr. Fanous, will focus on a simple and relatively atraumatic approach for lateral alveolar ridge augmentation, necessary to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. Having sound osseous and soft tissue architecture for implant placement results in consistently aesthetic, predictable and long-lasting implants.  

By Ramsey M. Fanous, DDS 

Although guided bone regeneration (GBR) and block grafting have been in use for well over two decades, clinical studies have shown that these procedures do have their deficiencies. Many alveolar ridges augmented with block grafts have shown significant resorption 10 years later in spite of implant placement in the site. GBR is excellent for small lateral defects, but does not provide predictable results in large defects especially with vertical gain. 

A simple technique that can be applied frequently is the alveolar split graft known as the book flap described by Ole Jensen, DDS*. We utilize this procedure for most lateral augmentations for maxillary and mandibular alveolar ridges with deficiencies. This technique differs from a traditional ridge splitting technique in that the mucoperiosteum (soft tissue attachment) is not dissected free from the facial/buccal alveolar plate to widen the ridge. Once the soft tissue is dissected free from the facial aspect of the alveolus and the ridge split occurs, the osseous site then essentially becomes a non-vitalized graft physiologically similar to a block graft. The book flap is used to increase alveolar width 2-5 mm and up to 6 mm in certain cases. This procedure can be used with immediate implant placement (2 mm of facial alveolar plate is required) or delayed implant placement. The relatively soft bone in the maxilla is amenable to this technique especially in the aesthetic zone. In the mandible, this procedure is more difficult due to the thickness of the cortical bone. From experience, a two-stage procedure is preferable in the mandible. 

In experienced surgical hands, the procedure is relatively simple. A crestal incision is created in the desired edentulous space. This incision is palatal to the crestal midline with minimal soft tissue reflection to visualize the alveolar crest. A sharp osteotome or a piezo electrical saw is used to create a crestal osteotomy extending to a depth of approximately 10 mm. This osteotomy must be 2 mm away from the adjacent periodontal ligament spaces of the adjacent teeth. Next, the vertical component of the osteotomy is completed within the alveolus and extended through the facial plate. The facial segment is then spread to the desired width. Allograft with or without the BMP (bone morphogenetic protein) can then be packed in the osteotomy site. A collagen membrane is then placed over the site with resorbable sutures. Physiologically, this will heal very similar to an extraction site with allograft placement. In a staged procedure, the implant placement can follow this initial procedure three to four months postoperatively. In the mandible, and inferior horizontal osteotomy is always necessary in order to be able to spread the bone to the desired thickness. This is due to the thickness of the cortical bone. From Dr. Fanous’ experience at Texas Oral Surgery Group, he believes the two-stage procedure is preferable. Stage one surgery requires a soft tissue dissection followed by the vertical and inferior horizontal osteotomies. Dr. Fanous makes the crestal osteotomy to the desired depth. There is no mobilization of the osseous segment at this stage. The tissue is then primarily closed. Stage two surgery occurs at a minimum of 28 days following the initial procedure. This allows for revascularization of the surgical site. A minimally invasive second procedure is completed as described above in the maxilla. The bone segment with attached tissue and blood supply is easily spread to the desired width. 

The book bone flap is simple and the complications are minimal. Potential complications can include infection or potential sequestration, however, these are rare. This procedure has great utility and versatility and can be used in all locations in the oral cavity. The advantage of this procedure is the ability to displace a solid plate of vital bone to restore a resorbed facial plate. This is a very important advantage when considering placement of implants in the aesthetic zone.                                      

* Jensen OT, Ellis E. The Book Flap; a technical note. j Oral Maxillofacial Surgery 2008;66(supple):43-61.  

If you would like to know more about ridge augmentation, possible complications or how to recover after surgery, call Texas Oral Surgery Group at 972-471-9596 to arrange an appointment or visit the website at

Texas Oral Surgery Group
Plano, Allen, Denton, Decatur, Gainesville, Texas



Since you are reading this story, you are probably well aware of the havoc wisdom teeth can play in a mouth. Rarely do they come in properly aligned and with healthy gum tissue. Often they come in sideways, only partially emerged from the gum or they even remain impacted underneath the gum.  Bacteria grow around them, which can cause painful infections. As they come in, they can push other teeth in the mouth out of alignment. Wisdom tooth pain drives a lot of people to their dentists. 

“Erupting wisdom teeth made a lot of sense from an evolutionary point of view when most people lost a few teeth by the time they were adults or had extensive wear, allowing more room for the wisdom teeth,” says Dr. Ramsey M. Fanous, DDS, an award winning oral surgeon in Plano and co-founder of Texas Oral Surgery Group. “Today, wisdom teeth have the potential to be a health problem waiting to happen.”

Once you are told your teeth need to come out, you need to decide if you should use an oral surgeon or a dentist to do the procedure. There are five factors to consider when making your decision:

  1. How often does my dentist extract wisdom teeth? For most dentists, wisdom tooth extractions are an occasional procedure, while oral surgeons perform extractions on a daily basis.  Oral surgeons perform thousands of wisdom tooth extractions every year. Quick, skillful extractions make for faster and less-painful recovery with less potential for complications

  2. Are there underlying complications with my teeth? Severely infected or very difficult-to-remove teeth should be handled by an oral surgeon.

  3. Do I have underlying health complications? “Diabetics, heart patients, those with high blood pressure and other underlying health issues should be treated by an oral surgeon,” adds Dr. Fanous. “The risk of complications is much higher and an oral surgeon can get a patient admitted to a hospital immediately if something goes wrong. Many surgeons are close to a hospital in addition to having surgical facilities equipped for emergencies.”

  4. Will I need anesthesia? Many dentists use local numbing agents, laughing gas or knock-out drugs to extract teeth. An oral surgeon will provide intravenous anesthesia, which makes the procedure much more comfortable and less traumatic.  If there are underlying complications requiring more work on the surgeon’s part, you won’t even know about it until you wake up later, which is a relief for most patients.

  5. Is there a plan to deal with emergencies? Be sure to ask this question of anyone who you want to perform the procedure. “An oral surgeon will have at least two other professional staff members in the room, responsible for monitoring a patient’s blood pressure, heart rate and breathing,” says Dr. Fanous. “While serious complications from wisdom tooth extraction are rare, they can happen and you want to make sure your provider is prepared for the worst.”

According to industry studies, 80 percent of dentists refer wisdom tooth extractions out to oral surgeons because they realize a surgeon has more experience and is in the best position to handle a tricky situation, like a tooth sitting on a nerve or a tooth still partially encased in bone.

If you would like to know more about wisdom tooth extraction, possible complications or how to recover after surgery, call Texas Oral Surgery Group at 972-471-9596 to arrange an appointment or visit the website at

Texas Oral Surgery Group
Plano, Allen, Denton, Decatur, Gainesville, Texas



As an Oral and Maxillofacial Surgeon who began his training with dental implants 21 years ago and has been board certified to perform dental implant surgery for 17 years, Dr. Ramsey M. Fanous has the pleasure of seeing patients’ self-confidence restored with dental implants in a single-day.  Dr. Fanous highlights a few reasons why dental implants are long-term choices, more beneficial than fixed-bridges, and why the “All-On-4” implant technique is much more desirable than dentures.

Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.  Patients who are current denture wearers, or in need of full upper and/or lower restorations, can greatly benefit from the “All-On-4” implant technique.

At Texas Oral Surgery Group, Dr. Fanous’ approach to successful dental implants includes a comprehensive patient evaluation including a 3-D Cone Beam CT Scan and an oral exam, as well as, a review of the patient’s medical and dental history to determine the patient’s needs for a single-tooth implant, multiple-tooth implants, or the “All-On-4” implant technique.

Dental implants are increasingly used, because rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that are surgically placed in the jawbone. Composed of titanium metal that "fuses" with the jawbone through a process called "osseointegration," dental implants never slip or make embarrassing noises that advertise the fact that a patient has "false teeth," and never decay, like teeth anchoring fixed bridges. Because dental implants fuse with the jawbone, bone loss is generally not a problem.  A single-tooth implant can be inserted the same day as the natural tooth extraction and the multiple-tooth implants, or “All-On-4” implant process can sometimes be completed in a single-day or can range from three to six months, depending upon if bone grafting is necessary.

Qualified patients can have a full-set of new replacement teeth in a single-day with the “All-On-4” Implant TechniqueHere are the major patient advantages of this technique over a technique using more than 4 implants:

  • This technique is a permanent, non-removable (fixed) replacement for teeth that can be maintained as natural teeth, following proper hygiene protocol.
  • Patients have a faster recovery time and greater comfort after surgery.
  • Patient can often avoid bone graft surgery, because there are only four upper implants and four lower implants.
  • These implants can last a lifetime, if cared for properly, and can prevent further bone loss.
  • The patient’s full set of teeth will fit comfortably with every contour of their mouth, for a more youthful appearance.
  • The patient’s ability to taste is not compromised, as no part of the roof of their mouth has to be covered (as with dentures, for example).
  • The patient will have an efficient bite once more and can once again enjoy a variety of nourishing foods, greatly enhancing overall health.

The majority of dental implant techniques and bone grafting can be performed in Dr. Fanous’ state-of-the-art office with the assistance of his expert surgical staff utilizing various options for anesthesia.  By working closely with a restorative dentist and a specialty dental technician, Dr. Fanous can offer a more personal, comprehensive, and affordable treatment plan than many of those seen on TV.

You may find more information at Feel free to contact Dr. Fanous’ staff with any questions at: or by calling 972-471-9596.

Texas Oral Surgery Group
Plano, Allen, Denton, Decatur, Gainesville TX


Click here to see before and after photos.


About Ramsey M. Fanous, D.D.S.

Board Certified by the American Board of Oral Maxillofacial Surgery: Dr. Fanous has been practicing oral and maxillofacial surgery since 1995, with an emphasis on soft and hard tissue facial trauma, implants, bone grafting and jaw surgery.  He received a BBA in finance and economics from Baylor University, and graduated with honors from the Baylor College of Dentistry in 1990.  Dr. Fanous completed his residency in Oral and Maxillofacial Surgery at the Medical College of Wisconsin in 1995.

 Dr. Fanous is a Fellow of the American Association of Oral and Maxillofacial Surgeons, where he has been involved on a national level.  Dr. Fanous is also a Fellow of the American College of Oral and Maxillofacial Surgeons and the North Texas Society of Oral and Maxillofacial Surgeons, where he served as president.  Dr. Fanous has served on the Board of the Texas Society of Oral and Maxillofacial Surgeons.  He has been listed consistently in D Magazine as a “Best Dentist” in Oral and Maxillofacial Surgery and in 2012 was selected as one of Texas’ Best Oral & Maxillofacial Surgeons by and TIME magazine. 

Dr. Fanous is an active staff member of the Medical Center of Plano; has lectured on soft and hard tissue trauma, orthognathic surgery, reconstructive surgery, and implants in Mexico City, Philippines, Chicago, Philadelphia, and Austin; and has volunteered his time to perform corrective cleft lip and palate surgeries for children in the Philippines.