Oral & Maxillofacial Surgery
• Orthognathic Surgery
• Facial Trauma
• Sinus Lift Procedure
• Wisdom Teeth
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.
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.
Sinus Lift Procedure
In order to successfully place implants you need sufficient bone. In certain situations dentist need to perform specific procedures in order to create bone volume. One such procedure is 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 egg shell 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 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 stabilized 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 loose denture
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 usually the last teeth to come through the gums.
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 builds up between the wisdom teeth and its neighboring molars, and decay and gum infection are very likely to occur. Crowded wisdom teeth in the upper jaw have a tendency 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. Ulceration can also be caused by wisdom teeth. 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.
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. Its advisable to have this x-ray prior to any wisdom teeth removal consultation
Traveling to foreign places and the wisdom teeth
Wisdom teeth removal may be advisable before traveling 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 over crowded, 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 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 advice 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
Wisdom teeth removal surgery is not something people look forward to, but modern surgical and anesthetic techniques as used recently have now combined to make wisdom teeth removal surgery a much more acceptable procedure tha