ORAL SURGERY
A dental crown is a tooth-shaped “cap” that is placed over a tooth – to cover the tooth to restore its shape and size, strength, and improve its appearance.
The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.
A dental crown may be needed in the following situations:
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To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth
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To restore an already broken tooth or a tooth that has been severely worn down
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To cover and support a tooth with a large filling when there isn’t a lot of tooth left
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To hold a dental bridge in place
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To cover misshapened or severely discolored teeth
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To cover a dental implant
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To make a cosmetic modification
Dental bridges literally bridge the gap created by one or more missing teeth.
A bridge is made up of two or more crowns for the teeth on either side of the gap — these two or more anchoring teeth are called abutment teeth — and a false tooth/teeth in between. These false teeth are called pontics. Dental bridges are supported by natural teeth or implants. A bridge helps to strengthen the prepared teeth and makes chewing and eating easier because they are fixed and can’t come out.
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Bridges can:
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Restore your smile
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Restore the ability to properly chew and speak
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Maintain the shape of your face
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Distribute the forces in your bite properly by replacing missing teeth
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Prevent remaining teeth from drifting out of position
Oral surgery includes a large number of surgical interventions carried out in local anesthesia and in ambulatory environments, for the treatment of numerous clinical situations such as jaw cysts and granulomas, impacted teeth, apicotomy or implant placement.
An impacted tooth is a tooth that gets blocked as it is pushing through the gum into your mouth (erupting). Most commonly impacted teeth are wisdom teeth. Wisdom teeth usually begin to come in between the ages of 17 and 21. If there is no enough room for wisdom tooth until age of 25, this tooth is considered impacted. Impacted wisdom teeth can lead to infectious problems, situations of periodontal disease caused by neighboring teeth, dental caries, root resorption or the forming of cystic lesions. It is therefore essential to visit the specialist in oral surgery to insure these issues are not present and to intervene surgically to remove the wisdom tooth, in case there is a risk or presence of these diseases.
An apical resection i.e. apicoectomy may be needed when an infection develops or persists after root canal treatment or retreatment. During root canal treatment, the canals are cleaned, and inflamed or infected tissue is removed. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches and possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root. In time, if the problem is ignored, the infection may embrace other teeth or even perforate the bone tissue.
There’s one single alternative to apicoectomy, and that is extraction. So the main purpose of apical resection is to save your tooth. Your dentist chooses apical resection if the bone tissue around tip of the root gets infected and if the classical procedure can’t be followed due to various reasons: faulty root canal treatment, specific anatomic morphology (atypical root canals), when the infection doesn’t step back with medication, when accessing the root canal may compromise a dental bridge etc.
First, you will be given a local anesthetic. The oral surgeon will cut and lift the gum away from the tooth so the root is easily accessible. The infected tissue will be removed along with the last few millimeters of the root tip. He or she will use a dye that highlights cracks and fractures in the tooth. If the tooth is cracked or fractured, it may have to be extracted, and the apicoectomy will not continue.
To complete the apicoectomy, 3 to 4 millimeters of the tooth’s canal are cleaned and sealed. The cleaning usually is done under a microscope using ultrasonic instruments. Use of a surgical microscope increases the chances for success because the light and magnification allow the oral surgeon to see the area better. Your oral surgeon then will take an X-ray of the area before suturing the tissue back in place.
You will be given a (approximately) one-week prescription to follow home. Then, your stitches will be removed. Post-surgery advice is similar to that of a difficult extraction and your dentist will inform you on the specifics of it. After an amount of time which can vary from six to twelve months, a check is necessary to make sure the bone tissue is properly healed.
Most apicoectomies take between 30 to 90 minutes, depending on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.
A jaw cyst is a cavity full of fluid which forms inside your jaw bone. They can form around
the roots of your teeth or around teeth that are buried. Most cysts are initially harmless (mostly non-malignant, not malignant), yet jaw cysts can eventually lead to inflamed tooth roots, malpositions, chronic pain and even tooth loss. Therefore, the timely removal is recommended.
There are different types of jaw cysts. The most common is the so-called tooth root cyst, which is inflammatory and usually starts from a dead tooth.
Another type of cyst forms in the cover found around the hidden teeth. Less often, folicular cysts are discovered
from the cells that originally formed your teeth. Jaw cysts can have a variety of causes: inflamed tooth root tip (radicular cyst, usually in the upper jaw), disorders during tooth development, for example, during training and breakthrough of the wisdom tooth (follicular cyst, usually in the lower jaw), pressure of a tooth root on nerve tracts, smaller Injuries to the gums and dead tooth components.
Jaw cysts usually grow very slowly and without noticeable symptoms. . After some time, the patient may feel uncomfortable pressure at the affected site, such as when the jaw cyst presses on tooth roots, nerve tracts or adjacent tissue. Only with further growth, the cyst becomes visible through the increasing swelling. You may not know that you have one until your dentist takes an x-‐ray, very often for some other reason. Once the diagnosis is established, the cyst must be removed. Without therapy it can even cause bone deformation and disfigurement of the face. Damage to nearby nerves can lead to paralysis or loss of sensibility. Due to the loss of substance of the bone it loses stability and threatens a jaw fracture. Infections and abscesses can form and pose a risk of sepsis or meningitis. As the cyst grows, the nearby teeth may become damaged or loose. If the cyst is very large, it is noticeable as a swelling in the jaw.
The cyst can be indentified on the x-ray. The type of procedure depends on the size and type of cyst. As a therapy, only operative measures, which are often made under local anesthesia, are used. Either the complete removal of the cyst (cystectomy) or only the incision of the cyst (cystostomy) can be considered. Cystectomy can be used on smaller cysts (less than 2 cm), if their location allows it. After removal, in the case of larger defects in the bone, the cavity can be filled with bone substitute material, which dissolves over time and is replaced by the body's own bone. The fact that after the removal of the cyst first a cavity in the bone is present, the surrounded bone may not be too thin, otherwise the risk of breakage would be too large. Also, no tooth root (a living tooth) should be directly in contact with the cyst because it could die off. The teeth, which are hidden, broken or bad, must be removed at the same time.
In these cases, and with larger cysts, the method of cystostomy is rather chosen: in this case, an incision of the cyst creates an artificial outflow for the cystic fluid. The fluid can flow outwards which causes the pressure drop in the cyst. As a result, the cyst does not continue to grow and even shrinks over time. At best, it heals completely. One advantage is that the procedure is relatively small compared to cystectomy, limiting the pain and swelling of the face after surgery. A disadvantage is that an antibiotic must be given for a relatively long time so that no bacteria migrate into the cyst residue through the opening and cause inflammation. This is the method of choice for large cysts, inflamed cysts or when the location of the cyst does not allow complete removal.
If the jaw cyst is surgically removed, there is always a risk of recurrence, ie the jaw cyst will form again at the site. This can happen because small tissue remnant remain in the bone cavity, from which a new cyst can develop. This would then have to be removed again. Therefore, sufferers should regularly go to the follow-up to notice the recurrence in time. Many patients are afraid of the large hole left in the bone after cyst removal. The body needs approx. 2-5 years to fix the substance defect again with new bone. After that you do not see anything anymore.
Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.
When wisdom teeth cause problems, or X-rays show they might down the line, they need to come out. Other good reasons to take them out include:
Damage to other teeth: That extra set of molars can push your other teeth around, causing mouth pain and bite problems.
Jaw damage: Cysts can form around the new teeth. If they aren’t treated, they can hollow out your jaw and damage nerves.
Sinus Issues: Problems with wisdom teeth can lead to sinus pain, pressure, and congestion.
Difficult cleaning: In particular, incompletely outgrown wisdom teeth are difficult to reach with the toothbrush and cleaned. As a result, bacterial deposits can accumulate, which can lead to tooth decay and inflammation of the adjacent teeth and the entire mouth.
Inflamed Gums: During late breakthrough, wisdom teeth are often partially covered by gums. Mucous pockets (narrow gaps between the tooth and the gums), in which food particles and bacteria accumulate, develop at these points. This can lead to frequent inflammations, which can develop into abscesses in extreme cases.
Cavities: Swollen gums can create pockets between teeth that help bacteria grow and cavities form.
Alignment: Impacted wisdom teeth can cause problems with crowding of other teeth and even make treatment to straighten other teeth necessary.
Your dentist will look at the shape of your mouth and the position of your teeth to make a decision. Your age plays a role, too.
After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). In general, here’s what to expect.
During the first 24 hours
Bleeding may occur for several hours after tooth extraction. To control it, If possible, use an upright upper body posture, the head should not lie flat. Make cold cheek and neck compresses. Position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps healing blood clots to form (blood clots function similarly to scab over an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid “sucking” actions (for example, don’t drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing a dry socket (see below) to develop.
Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10 minutes on, followed by 20 minutes off. Repeat as necessary during this first 24-hour period.
Pain medications, such as ibuprofen, can be taken for minor pain. Your oral surgeon may prescribe more potent pain relievers, if necessary.
Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription is gone.
Foods should be restricted to a liquid diet until all the numbness from anesthesia has worn off. Eat soft foods for a few days. Also avoid alcohol if you’re also taking narcotic pain medication.
Continue to brush your teeth, but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses — these can irritate the extraction site.
After 24 hours
Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses.
Stitches, if used and if not of the self-dissolving type, need to be removed by your oral health care provider in about 1 week. If you do require stitches, ask what type you have been given.
Watch for signs of dry socket (described below). This condition requires treatment by your oral health care provider.
Complete healing takes up to few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Your dentist will explain what to expect in your specific case.
After removing your wisdom teeth, you may experience two common complications: dry tooth and paresthesia.Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain (ranging from “dull” to moderate to severe) and a foul mouth odor. Your dentist or oral surgeon will treat the dry socket by placing medication in the socket.
Paresthesia is a rarer complication of wisdom teeth extraction. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness (called a paresthesia) of the tongue, lip, or chin that can last a few days, weeks, months, or may even be permanent.