Oral & Maxillofacial Surgery

• Orthognathic Surgery
• Facial Trauma
• Sinus Lift Procedure
• Wisdom Teeth

A. Orthognathic Surgery

Orthognathic surgery is surgery performed on the bones of the jaws to change their positions. Orthognathic surgery is corrective facial surgery where deformities of the jaw exist. It may be indicated for functional, cosmetic, or health reasons. It is surgery commonly done on the jaws in conjunction with orthodontic treatment, which straightens the teeth.

B. Facial Trauma

Facial trauma, also known as maxillofacial trauma, is any injury to the face or jaw bone. Facial trauma may present with skin lacerations, obstruction to the nasal cavity or sinuses, damage to the orbital sockets, fracture to the jawbone and missing teeth.

Treatment for facial trauma often involves airway control, bleeding control, reduction of swelling, prevention of infection, and repair of bone fractures, repair of lacerations or soft tissue injury, and reconstruction. The most common causes of facial trauma are sports, accidents, penetrating injuries, and violence.

C. Sinus Lift Procedure

To successfully place implants, you need sufficient bone. In certain situations, the dentist needs to perform specific procedures to create bone volume. One such procedure is a sinus lift.

The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing at all in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just an eggshell thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place, so when the sinus wall is very thin, it is impossible to place dental implants in this bone.

There is a solution called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from the side above where the upper teeth used to be. The sinus membrane is then lifted upward, and donor’s bone is inserted into the floor of the sinus. After several months of healing, the bone becomes part of the patient’s jaw, and dental implants can be inserted and stabilised in this new sinus bone.

The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing a loose denture

D. Removal of Wisdom Tooth

The Wisdom tooth, (also called Third Molar) usually do not push through the gums until the late teens or twenties. Wisdom teeth are generally the last teeth to come through the gums.

Complications

In the majority of cases, there will not be enough room in the jaw for a wisdom tooth or all wisdom teeth to fully emerge. This can lead to several complications. If the exit of the wisdom teeth is stalled at the halfway point (soft impaction), this can make brushing and flossing the wisdom teeth extremely difficult. Food and bacteria build up between the wisdom teeth and its adjacent molars, and decay and gum infection are very likely to occur. Crowded wisdom teeth in the upper jaw tend to lean sideways and grate against the cheek. These wisdom teeth usually cause ulceration and chewing problems. A further problem is wisdom teeth crowding- the pressure from wisdom teeth may also force the other teeth closer together, and interfere with the bite. Gum disease and cyst formations are also complications of impacted wisdom teeth. Very rarely, tumours may also form from the wisdom teeth. Pressure from the wisdom teeth can also cause toothache on the tooth next to it. Wisdom teeth can also cause ulceration. Upper wisdom teeth may push sideways out of the gum and cause ulcers inside of the cheek.

Antibiotics are a short term solution for impacted wisdom teeth

Mouth infections such as pericoronitis caused by wisdom teeth can be treated with antibiotics, but the infection will reoccur unless the wisdom teeth removal is performed.

Wisdom teeth removal surgery is best done early

Toothache prompts patients to come to the dentist. However, wisdom teeth do not usually cause pain until damage has already been done! Wisdom teeth removal surgery is best performed sooner rather than later. X-rays taken earlier can indicate whether or not wisdom teeth will cause problems. The dental surgeon or oral surgeon will tell you when is the best time for the wisdom teeth removal.

The procedure, pre-surgical consultation and review of wisdom teeth removal

During a consultation involving x-rays or OPG (panoramic x-ray) and examination, the dental surgeon or the oral surgeon can determine which wisdom teeth or wisdom tooth will be, or are, functional, and which ones need to be removed. In many cases, all four wisdom teeth will need to be removed.

The wisdom teeth removal commonly involves an incision to open the gum, and sometimes a small portion of the bone may need to be removed to provide access for the wisdom teeth removal.

The wisdom teeth may also need to be divided into segments so it can be removed safely and easily.

Perfect wisdom teeth technique and a lot of experience is a must for these surgical procedures. The incision in the gum may then need to be closed with stitches.

Wisdom teeth X-ray

The most used radiograph to assess wisdom teeth is called OPG. This x-ray is most often required to show the end of the roots of wisdom teeth and its location in relation to important nerves and the sinus. It’s advisable to have this x-ray prior to any wisdom teeth removal consultation

Travelling to foreign places and the wisdom teeth

Wisdom teeth removal may be desirable before travelling to an area or country where dental services like wisdom teeth surgery are not readily available

Orthodontics and wisdom teeth

Many orthodontists believe that developing wisdom teeth can cause the front teeth to become overcrowded, and often recommend wisdom teeth removal before or immediately after orthodontic treatment

Wisdom teeth removal for prosthetic reasons

Wisdom teeth removal surgery or impacted tooth extraction may need to be considered before construction of dentures. Sometimes the wisdom teeth erupt beneath the denture, and that can cause severe irritation and infection

Wisdom teeth removal surgery when the acute infection is present

Generally speaking, wisdom teeth removal should be delayed in the presence of infection. Most of the time is preferable to control the infection with antibiotics and oral hygiene first. The tooth extraction of the opposing wisdom tooth is also sometimes advised, but that needs to be decided during the consultation with the dental surgeon or the oral surgeon.

Asymptomatic impacted wisdom teeth

There is always a risk that impacted wisdom teeth may cause problems. It may occur at inconvenient and unpredictable times. If the wisdom teeth appear to have a high chance of causing problems in the future, the dental surgeon and the oral surgeon may advise the removal of wisdom teeth

Impacted wisdom teeth categories

Impacted wisdom teeth fall into several categories. Mesioangular impaction is the most common and means the wisdom tooth is angled forward, towards the front of the mouth. Vertical impaction means the tooth is angled backwards, towards the rear of the mouth. Horizontal impaction means fully 90 degrees forward. Most of the time wisdom teeth with distoangulation are the easiest to extract in the maxilla and the most difficult in the mandible. The wisdom teeth with mesioangulation are easier to remove in the mandible and more difficult in the maxilla

General comment

Wisdom teeth removal surgery is not something people look forward to, but modern surgical and anaesthetic techniques as used recently have now combined to make wisdom teeth removal surgery a much more acceptable procedure than in the past.

Tooth Sensitivity

Tooth sensitivity is a common name for dentin hypersensitivity or root sensitivity. If hot, cold, sweet or very acidic foods and drinks, or breathing in cold air, makes your teeth or a tooth sensitive or painful then you have sensitive teeth.

Tooth sensitivity is very common, and it has been estimated that approximately half the population experiences tooth sensitivity1. Tooth sensitivity can come and go over time. Tooth sensitivity is usually caused by dentin on root areas exposed due to receded gums or periodontal disease. Receded gums are very common, and up to four-fifths of people2 have gum recession by the time they are 65.

Dentine hypersensitivity occurs most frequently on the buccal cervical regions of teeth, and most commonly affects the canines and first premolars above the incisors, second premolars and molars. Teeth with lower plaque scores are associated with the condition, suggesting a connection between regular (possibly over-zealous) tooth brushing and the onset of sensitivity.

The condition may be brought about by enamel loss as a result of tooth wear and by the concomitant exposure of dentine. Acid wear, abrasion and attrition are all associated with the loss of enamel, and so with the onset of dentine hypersensitivity. Acid wear, however, has been identified as the current primary cause of tooth wear, and as such a leading factor in the development of tooth sensitivity.

Gingival recession is also associated with the development of dentine hypersensitivity since the root surface exposure, which follows recession can result in a loss of cementum and subsequently in the exposure of the dentinal tubules.

There are a number of other conditions which cause similar pain to the patient, including:

• Chipped teeth
• Fractured restorations
• Cracked tooth syndrome
• Caries
• Tooth bleaching procedures
• Pulpal response to caries and restorative treatment

Crown lengthening procedure

It is no secret that dentists are committed to saving teeth. This is why we fill a cavity, instead of pulling the tooth.

Cavities can decay to tooth to the point where restoration is virtually impossible without a procedure called crown lengthening.

Crown lengthening is a routine surgical procedure, which remodels the contour of the gum line. The procedure does not lengthen the crown but rather lowers the gum line.

When there is not enough tooth structure to affix a crown, this is the only option. Sometimes a tooth has been broken below the gum line. In this instance, crown lengthening is very successful in exposing more of the tooth, so that the dentist has something to work with.

Frenectomy

A frenulum is a piece of tissue that prevents an organ from moving. There is a frenulum that attaches your upper lip to the gums, while another connects the lower lip to the gums.

A frenulum that is too short or thick will cause problems in speech patterns and tooth misalignment. In infants, a shortened frenulum underneath the tongue will inhibit breastfeeding. When the frenulum disrupts movement, growth, or development, corrective action is necessary to resolve the situation.

A frenectomy is a minor surgical procedure that is performed in your dentist’s office. It can be performed with either a scalpel or laser and takes less than 15 minutes. Using a laser causes very little bleeding and does not require stitches. A laser also results in less postoperative discomfort and shorter healing time. Young children and infants are put under general anaesthesia for the procedure, and adults have the procedure performed using local anaesthesia. If your child needs a frenectomy, there is nothing to worry about. The procedure is very successful and causes minimal discomfort.

Gum Depigmentation

A smile expresses a feeling of joy, success, sensuality, affection and courtesy and reveals self-confidence and kindness. The harmony of the smile is determined not only by the shape, position and colour of the teeth but also by the gingival tissues.

Gingival health and appearance are essential components of an attractive smile. Brown or dark pigmentation.

And discolouration of gingival tissue can be caused by a variety of local and systemic factors. Black gums may cause esthetic problems and embarrassment, particularly if the pigmentation is visible during speech and smiling.

Gingival depigmentation is a periodontal plastic surgical procedure whereby the gingival hyperpigmentation is removed or reduced by various techniques.