Oral surgery and periodontology

Oral surgery and periodontology

Surgical teeth and roots extraction

The times when tooth extraction was associated with a lot of pain and stress are already gone. Now, even the extraction of third molars, called „the eights“ or „the wisdom teeth“, or removal of the retained broken roots is done in perfect local anaesthesia. Therefore, any discomfort during this procedure is reduced to a minimum, and the patient recovers quickly after the extraction wound has been secured.

Indications to tooth extractions - including the third molars, are the following:

  • massive damage of a tooth due to caries requiring root canal treatment when root canal treatment cannot be performed
  • difficult eruption of third molars resulting in a chronic inflammation around them
  • third molar impaction – when its proper eruption is unlikely due to insufficient room in a dental arch; such teeth are extracted to avoid serious complications such as cyst formation
  • for orthodontic reasons – when an erupting wisdom tooth causes other teeth to shift and disturbs aesthetics in the anterior zone.

Frequently asked questions:

  • How long does the pain last after extraction? The pain usually goes away a few hours after extraction; a doctor prescribes painkillers to relieve it.
  • Can a gap after extraction be filled immediately? Yes, it is possible thanks to immediate prostheses insertion right after extraction.
  • Is an antibiotic always administered after tooth extraction? No, an antibiotic is administered only in case of difficult extraction to prevent complications in the extraction wound healing.
  • Does tobacco smoking interfere with wound healing? Yes, tobacco smoking significantly increases the risk of complicated wound healing; when healing process is painful and difficult an additional appointment to secure the wound with appropriate medication may be required – such visit is free of charge in our practice.

Ultrasonic scaling
Tartar consists of calcified layers of dental plaque. Initially, its deposition is asymptomatic but with its growth many diseases are more likely, including gums inflammation and bleeding, caries, and teeth mobility. To avoid them, a patient should brush their teeth thoroughly to remove plaque and do in-office scaling regularly. There is supra-gingival tartar (located above the gum line) and sub-gingival tartar (under the gum line). How does healing look like? Here is a simplified scheme:

Supra-gingival tartar removal:

  • The first visit: a dentist removes tartar with an ultrasonic scaler, then brushes and polishes cleaned surfaces and protects them with a fluoride varnish to reduce teeth hypersensitivity after scaling.

Sub-gingival tartar removal:

  • The first visit: before scaling a dentists applies local anaesthesia to ensure painless treatment, then removes tartar with an ultrasonic scaler; after scaling a dentist places a dressing on the gums and prescribes mouth rinses to a patient.

Frequently asked questions:

  • Is scaling harmful to the enamel? Properly performed scaling of tartar deposits is not harmful to the enamel.
  • How often should tartar be removed? Tartar removal rate depends on the level of oral hygiene and saliva composition – the more minerals in saliva, the greater tartar deposition; on average, tartar should be removed every 1-3 years.

Oral surgery - a field of dentistry dealing with surgical treatment of the mouth and adjacent areas. It is a subspecialty of general surgery. Frequent diseases it deals with are odontogenic inflammations, including purulent (with pus) and periapical (around the root tip) inflammations.
Oral surgery is more than tooth extraction. Within this specialty a range of medical procedures is performed on the mouth, including procedures supporting other dental specialties, for instance endodontics (root tip resection), periodontology (periodontal surgery), prosthetics (preprosthetic surgery), or the most modern field of dentistry – implantology. Oral surgery deals with all bloody procedures performed in the mouth to eliminate inflammations and improve anatomical conditions of the jaw bones and soft tissues.

Fields of surgery:

Hard surgery - tooth extraction, tooth cutting (hemisection, resection), bone edge correction, and implants.

Soft surgery - advanced periodontal procedures (curettage and flap surgeries), gum and oral mucosa plastic surgeries, removal of cysts and tooth germs.

Reconstructive surgery (restoring proper anatomy): sinus lift, bone augmentation, closure of bone defects (including bone clefts), and nerve repositioning.

Trauma surgery (traumatology) tooth transposition after accidents, splinting and stabilising the teeth and bones.

For a typical patient oral surgery means fear and pain. However, modern methods of treatment are two-folded and include:
Fear management – pharmacological and psychological premedication (administering sedatives, thorough explanation of surgical treatment, etc.)
Pain management - in recent years a great progress has been made in this field, so today we have a range of modern anaesthetics at our disposal (needle-free anaesthetics, traditional systems of fast-acting anaesthetics, general anaesthesia).

Oral surgery is a field of dentistry where medical specialists deal with surgical treatment of the mouth and adjacent areas. For the patients, the most common surgical procedure is tooth extraction. However, there are many more reasons for which surgery is necessary:

  • difficult endodontic cases e.g. root tip resection
  • periodontal diseases requiring specific procedures like curettage, flap surgery, or gingivectomy (gum tissue resection)
  • preprosthetic surgery when the mouth is prepared to prosthetic treatment
  • preorthodontic surgeries
  • mplantology.

The most frequent procedures in oral surgery are:

  • extractions, including extractions of impacted and unerupted teeth
  • exposure of teeth retained in the dental arch, wisdom teeth extractions
  • plastic surgery of an opening into the maxillary sinus (oro-antral fistula)
  • complicated abscesses and treatment of oro-facial fistulas
  • root tip resections, hemisections
  • removal of fibromas, epulis (mucosal nodules), mucoceles, pappilomas and other oral mucosa inflammatory lesions
  • preparing the oral cavity to prosthetic procedures – frenulectomy
  • treatment of mouth and lips benign and malignant neoplasms and neoplasm-like tumours
  • orthognathic therapy of mandibular, maxillary and alveolar processes fractures
  • treatment of salivary glands and temporo-mandibular joints (TMJ).

Successful treatment and the choice of optimal strategy always go hand in hand with our care to provide maximum mental comfort of a patient. Any surgery may evoke fears of pain and complications. Therefore, each patient is prepared to treatment individually. A doctor explains the treatment plan thoroughly, its stages and possible consequences. Sedatives and painkillers individually chosen to suit the purpose in every case are administered to a patient before treatment. All surgeries are performed under anaesthesia, and aseptics of the operating field is maintained. After treatment ends, a patient is given special care and attention to ensure complete success and patient’s quick and uncomplicated recovery.

Hemisection - literally a „half-cut“, or cutting out half of the tooth. The purpose is to remove one of the roots and a corresponding part of the crown from a multi-rooted tooth.

The procedure is performed in lower molars and multi-rooted premolars. The separated portion of the tooth is removed. Thanks to this simple procedure part of a tooth can be saved to serve as an abutment for a prosthetic restoration. Without such a procedure a whole tooth would need to be removed because periapical inflammation around one of the roots, if left in place, is a potential source of infection for the body. A procedure is performed in local anaesthesia. A dentist uses a drill to cut and excise part of the tooth. After preparing the socket, the wound is closed with sutures.

What are the indications?

  • deep caries penetrating towards the roots furcation (branching)
  • inflammatory changes in the root hardly reachable with endodontic instrumentation
  • canal perforation or an instrument broken and left in the canal
  • massive jaw bone loss around one of the tooth roots
  • deep bony pocket
  • vertical fracture of the root or crown.