Oro-maxillofacial and Plastic Surgery

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Dental Surgery

The field of dental surgery encompasses all surgical measures in the mouth required from a medical point of view. Amongst these are the extraction of impacted wisdom teeth, the surgical exposure of impacted teeth, tooth transplants, root end surgery, the removal of mandibular cysts and benign tumours, plastic closure or restoration of maxillary sinuses, plastic correction of the gums and mucous membranes, and biopsies of the mucous membranes and bones as a diagnostic measure.

These measures are briefly described in the following:

Impacted teeth are teeth that have not or not completely broken through, that is to say they lie completely or partially in the jaw bone. Wisdom teeth are most often impacted (approx. 10 – 25 % of all cases). Wisdom tooth extraction is usually indicated here, due to pain and inflammation in the region around the emerging wisdom tooth (Dentitio difficilis). Wisdom teeth are also extracted after caries, parodontosis, root resorption and the formation of cysts. A prophylactic indication is also the extraction of wisdom teeth within the framework of orthodontic treatment. In most cases the wisdom teeth can be extracted ambulantly, with a local anaesthetic. With a cut into the gum, the impacted wisdom tooth is lifted from the bone. Using special bone drills, the bone surrounding the tooth crown of the impacted tooth is removed. In order to be able to remove the tooth it is often also necessary to cut it into several parts.

If it is possible from an orthodontic point of view to realign an impacted tooth, the gum is raised from the jaw bone, and the bone covering the tooth crown is removed. An orthodontic bracket is placed on the tooth crown, on to which the impacted tooth can be realigned with the row of teeth, using orthodontic apparatus.

Tooth transplants are advisable at a young age, in order to avoid later graft therapy, if permanent teeth have been lost at an early stage due to caries or trauma. For this, a tooth socket is prepared in the new tooth position. The transplant tooth is placed in this new socket, and secured to its neighbouring teeth for 4 weeks with an elastic splint.

Root apex resection is a procedure during which the last millimeters of a root are surgically removed. This procedure is necessary when conservative root canal treatment is unsuccessful. The gum above the root is raised from the bone, the tooth root is shortened and inflammatory soft tissue is removed. The root filling in the area of the remaining root apex is renewed and the root stump is smoothed. As the amount of space available here is at a premium, the use of visual aids (magnifying glasses, surgical microscope) is often necessary.

Jaw cysts are empty spaces in the jaw bone which are lined with soft tissue (epithelium) and filled with liquid. These are often inflamed or caused by abnormal development. They can be up to several centimetres in size. Benign jaw tumours are mutations which grow and cause local displacement. In most cases the diagnosis of a jaw cyst and/or jaw tumour is made as the result of a coincidental x-ray find within the framework of a routine examination. Jaw cysts and tumours can usually be removed ambulantly with a local anaesthetic. These are bluntly pared from the bone, without removing healthy surrounding bone. After removal of the cyst/tumour, the remaining bone cavity usually heals up completely.

A plastic maxillary sinus occlusion is necessary when there is a connection between mouth and maxillary sinuses after tooth extraction in the upper jaw. Using a mucosal flap the connecting area is covered and carefully sutured. It is important that after the procedure, no air pressure is applied to this area (that is to say, avoiding nose blowing or pressing during bowel movements).

Mucous membrane and bone biopsies are some of the most frequent interventions. As described with the previous procedures, once the bone has been exposed from the region deemed conspicuous in x-ray, a piece of bone is removed and passed on for histo-pathological examination. The same applies in the case of unclear soft tissue biopsies.

After the procedure, the effect of the local anaesthetic gradually wears off. On the day of the operation and during the next two days, the cheek on the side of the operation should be cooled without any long interruptions. Mushy food and milk products must be avoided. Carrying out appropriate oral hygiene measures (cleaning teeth) can prevent infections in the area. It is advisable in some cases to take antibiotics. Generally, apart from moderate pain and inflammation, serious complications are rare. In given cases, the doctor on duty is available for exact evaluation. Further information is available at: www.dgzmk.de