Dental Surgical Procedures
A wisdom tooth, in humans, is any of the usual four third molars. Wisdom teeth usually appear between the ages of 16 and 25. Most adults have four wisdom teeth, but it is possible to have fewer (hypodontia), or more, in which case they are called supernumerary teeth. Wisdom teeth commonly affect other teeth as they develop, becoming impacted or "coming in sideways." They are often extracted when this occurs. The oldest known impacted wisdom tooth belonged to a European woman of the Magdalenian period (18,000–10,000 BC).
Sometimes the wisdom tooth fails to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap or lid around the tooth called an operculum. Teeth covered by an operculum can be difficult to clean with a toothbrush. However, debris and bacteria can easily accumulate under an operculum, which may cause pericoronitis, a common infection problem in young adults with partial impactions that is often exacerbated by occlusion with opposing third or second molars. Common symptoms include a swelling and redness of the gum around the eruption site, difficulty in opening the mouth, a bad odor or taste in the mouth, and pain in the general area which may also run down the entire lower jaw or possibly the neck. Untreated pericoronitis can progress to a much more severe infection. If the operculum does not disappear, recommended treatment is extraction of the wisdom tooth. An alternative treatment involving removal of the operculum, called operculectomy, has been advocated. Chronic inflammation in the gingival tissue of the partially erupted third-molar, i.e. chronic pericoronitis, may be the etiology for the development of paradental cyst, an inflammatory odentogenic cyst.
Impacted wisdom teeth (i.e., those that have failed to erupt through the gum line) fall into one of several categories:
1) Mesioangular impaction is the most common form (44%), and means the tooth is angled forward, towards the front of the mouth.
2) Vertical impaction (38%) occurs when the formed tooth does not erupt fully through the gum line.
3) Distoangular impaction (6%) means the tooth is angled backward, towards the rear of the mouth.
4) Horizontal impaction (3%) is the least common form, which occurs when the tooth is angled fully 90 degrees sideways, growing into the roots of the second molar.
Impacted wisdom teeth may also be categorized on whether they are still completely encased in the jawbone. If it is completely encased in the jawbone, it is a bony impaction. If the wisdom tooth has erupted out of the jawbone but not through the gumline, it is called a soft tissue impaction. In a small portion of patients, cysts and tumors occur around impacted wisdom teeth, requiring surgical extraction. Estimates of the incidence of cysts around impacted teeth vary from 0.001% to 11%, with a higher incidence in older patients, suggesting that the chance of a cyst or tumor increases the longer an impaction exists. A retrospective review of approximately 10,000 impacted teeth, suggested that the incidence of malignant tumours was 0.02% (2 cases in 9,994 teeth).
A dental implant is a "root" device, usually made of titanium, used in dentistry to support restorations that resemble a tooth or group of teeth to replace missing teeth. Virtually all dental implants placed today are root-form endosseous implants, i.e., they appear similar to an actual tooth root (and thus possess a "root-form") and are placed within the bone (endo- being the Greek prefix for "in" and osseous referring to "bone"). The bone of the jaw accepts and osseointegrates with the titanium post. Osseointegration refers to the fusion of the implant surface with the surrounding bone. Dental implants will fuse with bone; however, they lack the periodontal ligament, so they will feel slightly different than natural teeth during chewing. Prior to the advent of root-form endosseous implants, most implants were either blade endosseous implants, in that the shape of the metal piece placed within the bone resembled a flat blade, or subperiosteal implants, in which a framework was constructed to lie upon and was attached with screws to the exposed bone of the jaws. Dental implants can be used to support a number of dental prostheses, including crowns, implant-supported bridges or dentures. They can also be used as anchorage for orthodontic tooth movement. The use of dental implants permits undirectional tooth movement without reciprocal action.
When an implant is placed either a 'healing abutment', which comes through the mucosa, is placed or a 'cover screw' which is flush with the surface of the dental implant is placed. When a cover screw is placed the mucosa covers the implant while it integrates then a second surgery is completed to place the healing abutment.
Two-stage surgery is sometimes chosen when a concurrent bone graft is placed or surgery on the mucosa may be required for esthetic reasons. The latter is usually important where an implant is placed in the "esthetic zone". This allows more control over the healing and as a result the predictability of the final result.Some implants are one piece so that no healing abutment is required. In carefully selected cases, patients can be implanted and restored in a single surgery, in a procedure labeled "Immediate Loading". In such cases a provisional prosthetic tooth or crown is shaped to avoid the force of the bite transferring to the implant while it integrates with the bone. There are different approaches to place dental implants after tooth extraction. The approaches are:
1) Immediate post-extraction implant placement.
2) Delayed immediate post-extraction implant placement (2 weeks to 3 months after extraction).
3) Late implantation (3 months or more after tooth extraction).
An increasingly common strategy to preserve bone and reduce treatment times includes the placement of a dental implant into a recent extraction site. In addition, immediate loading is becoming more common as success rates for this procedure are now acceptable. This can cut months off the treatment time and in some cases a prosthetic tooth can be attached to the implants at the same time as the surgery to place the dental implants. Because one of three implants requires a minimum addition of bone tissue, surgical techniques for underlying bone augmentation are currently under a large scale development.
Sinus Lift Procedure For Dental Implant
A sinus lift is a bone-grafting procedure that's sometimes required in instances where the quantity of bone found in a patient's upper jaw (in the region originally occupied by their bicuspid or molar teeth) is inadequate to accommodate the length of a dental implant.There can be several reasons why the amount of bone found in a patient's upper jawbone might be insufficient to accommodate a dental implant.One naturally occurring problem simply involves the situation where the size and shape of their maxillary sinus is relatively large in comparison to the size of their upper jawbone. When this combination exists, there may not be enough bone thickness in which to embed a dental implant. During the sinus-lift procedure, a portion of the maxillary sinus is filled in with bone (grafting material). The result is a thicker sinus floor into which a tooth implant can then be placed.
Dentofacial osteotomy
A Dentofacial Osteotomy (also known as corrective jaw surgery) is an oral surgery where bone is cut, moved, modified, and realigned to correct a dentofacial deformity. The word "osteotomy" means the division, or excision of bone. The dental osteotomy allows surgeons to visualize the jawbone, and work accordingly.The operation is used to correct jaw problems and dentofacial deformities like maxillary prognathisms, mandibular prognathisms, open bites, difficulty chewing, difficulty swallowing, temporomandibular joint disorder pains, excessive wear of the teeth, and receding chins. Many surgeons prefer this procedure for the correction of a dentofacial deformity due to its effectiveness. All dentofacial osteotomies are performed under general anesthesia, causing total unconsciousness. General anesthesia allows surgeons to perform dentofacial osteotomies effectively without involuntary muscle movement or complaints about minor pain. Prior to any Osteotomy, third molars (wisdom teeth) should be extracted to reduce the chance of infection.
Types of Osteotomy
1) Maxilla Osteotomy (Upper Jaw)
2) Mandible Osteotomy (Lower Jaw)
3) Sagittal Split Osteotomy
4) Genioplasty Osteotomy (Intra-oral)
5) Rapid Palatal Expansion Osteotomy