Oral Surgery is, in patients’ conception, one of the most feared dental procedures. Precisely due to this feeling of fear, with no specialised consultation, teeth that could be restored end up the situation where they need to be extracted.
Surgical intervention should not be a source of fear and pain for you. Therefore, all interventions, from the simplest to the most complex, will be completed in minimal stress conditions, with adequate anaesthesia, which may be accompanied by conscious inhalation anaesthesia with nitrogen protoxide, so you will be relieved of any anxiety or fear.
Which are the situations where we turn to dentoalveolar surgery?
Extraction is required for:
- Teeth that do not have any alternative prosthetic restoration (high destruction of dental tissue, root fractures, teeth presenting periapical granulomas or cysts, accompanied by large coronary destructions)
- Teeth with very high mobility (traumas, periodontal disease)
- Intraosseous or submucosal impacted wisdom teeth
- Other included teeth (canines or premolars)
When there is not enough space in the dental arch so allow them to erupt or due to the existence of a very dense bone and a hard, thickened mucous, maxillary wisdom teeth, but more commonly the mandibular ones, remain included intraosseous (total inclusion) or submucosal (semiinclusion). Abnormal placing inside the bone may cause pressure on erupted teeth and changes in their position, molar 2 root damage or sometimes even fractures of the jaw bone, in the case of a deepened position in the body of the jaw bone.
Thus, through a minimally invasive surgery on the bone, they will be removed.
Uncovering included teeth
Through collaboration between the orthodontist and the surgeon, another surgical manoeuvre which is practiced in the case of included teeth (canines or premolars) to maintain them on the dental arch is uncovering the tooth, followed his orthodontic anchorage, bringing it gradually to its normal position in the natural arrangement of the dental arch.
When a tooth (most commonly the wisdom molar) is in the process of eruption, the gum around it becomes very swollen and painful, due to accumulation of bacteria at that level. Removing this gum lining allows freeing tooth and facilitates its cleaning.
This surgical intervention is less invasive, conservative and is done in the case of:
Teeth for which a canal treatment cannot be done correctly (unfavourable root anatomy)
Teeth that present inflammatory processes (infection) at the tip of the root and cannot be treated by endodontics conservative means
Teeth that show fractures in their deepest third part of the root
Thus, it is necessary to remove the root tip, along with the affected tissue around it. This intervention is performed on the bone from above:
- anaesthesia in the maxillary area where the intervention will be conducted
- performing an incision in the gum to create a bone window that will eventually lead to uncovering the root of the tooth
- removing the root tip and infected tissue surrounding the root
- retrograde obturation of the remaining tooth
- repositioning and suturing of the gums
After surgery, you may feel severe pain or inflammatory oedema may occur.
In this case, the dentist will prescribe anti-inflammatory and pain relievers.
It is performed for lower molars, which have two roots, and one of them is compromised (root fracture, infection at the tip of the root, periodontal pocket). Thus, the affected root will be extracted, along with corresponding coronal portion and the remainder root will be obturated along the root canal, followed by the restoration of the tooth crown.
Closure of oro-sinusal communication
Sometimes, due to the relation between tooth roots and maxillary sinusal floor, during extraction of these teeth, an oro-sinusal communication will be made. This communication is extremely harmful if left untreated. Besides the dysfunctional effects it may have, this communication may be complicated by sinusal disease, of the maxillary sinusitis type. Whether occurring during extraction, whether being discovered late (the dentist who performed the extraction did not notice this incident), the surgeon can close this communication by creating a flap of mucosa which will be expanded and sutured to produce the obstruction of this defect.
Bone crest regularization
Sometimes, due to trauma or incorrectly performed extractions, the edentulous bone crest (with missing teeth) may become riddled with bumps which are very painful pressure, sharp, covered by a thin adhering mucosa. In most cases this makes it impossible to wear total or partial acrylic dentures because of the pain and the damage that they produce.
Thus, it is necessary to perform the regularization of the bone crest. This consists of levelling these bony protrusions.
This manoeuvre is very easy, being performed under local anaesthesia. A muco-periosteal flap is performed, the exostoses are flattened with the bone bur and the mucosa is then sutured.