Questions of relevance for the patient:
– Are there any special preparations to be conducted before the surgery?
– Are there any risks and what are they?
– How long does a recovery period last?
– What is recommended to eat and drink?
– Which lifestyle habits are recommended and which are not?
– Will the surgery be performed in local or general anaesthesia?
– How long will the surgery last?
– When will they go home?
Surgical interventions are performed in the following cases:
– Teeth that did not erupt or that partially erupted (impacted and partially impacted teeth)
– Extraction of retained tooth root (radix relictae extraction)
– Inflammatory processes in root-end projection (resection or apicoectomy)
– Inflammatory processes in soft tissues (abscess incision)
– Cysts in hard and soft tissues (cystectomy)
– Removal of frenum (frenulum resection – frenectomy)
– Periodontal diseases (flap surgery)
– Orthodontic procedures (orthodontic surgery)
– Pre-prosthetic intervention
Pre-prosthetic interventions:
– Change of vertical bone dimension by lifting sinus floor and adding bone replacements (sinus lift)
– Artificial bone implant (bone augmentation and ridge levelling )
– Soft tissue graft (soft tissue augmentation)
– Implantation
Surgical extraction of impacted or partially impacted teeth
Impacted teeth are those which exist in the bone, but did not erupt on time.
Partially impacted teeth are those that erupted partially and do not perform their function.
Most common impacted teeth are: maxillary and mandibular wisdom teeth, maxillary canines and mandibular premolars.
Most often, their eruption is not complete due to the following reasons:
– Lack of space in dental arch
– Limited jaw growth in forward-backward direction
– Improper position of tooth germ that tooth develops from
– When tooth germ is positioned deeply in the bone
– Bone sclerosis or oral mucosa hypertrophy at places where teeth should erupt
– Presence of excess teeth
– Presence of pathological entities (cysts, odontomas, tumors)
– Genetic factor (disproportion between tooth size child inherits from one parent and jaw size they inherit from the other one).
Presence of impacted teeth is identified by an orthopan or 3D image.
Why is it important to extract impacted and partially impacted teeth?
Teeth that did not erupt put pressure and dislocate other teeth, causing pain, damaging other teeth, creating pockets, and, in some cases, leading to inflammatory processes, with fever, difficulty to swallow and bad breath.
These interventions are performed in local anaesthesia.
Replantation
Replantation is reinsertion of a patient’s own tooth in dental alveolus (socket), mainly as a consequence of an injury during tooth eruption.
In such situations, it is important to find the avulsed tooth, rinse it and put it in a physiological solution (if possible), or keep it in one’s own saliva (very carefully, in order not to swallow it) and immediately contact a dentist.
Surgical removal of tooth root-end (resection or apicoectomy)
This surgical procedure is applied for inflammatory processes on a tooth root-end and section of the bone that cannot be treated conservatively, due to:
– Inaccessibility of root-end for treatment with endodontic instruments
– Previous inadequate treatment
– “Fosse route” (false pathway) near root-end created during treatment
– Remaining needle parts in root-end that cannot be extracted.
This intervention is performed in local anaesthesia.
Abscess incision
Abscess is formed at the end of an inflammatory process on a tooth, when the inflammation from the tooth root and jaw bone progresses to soft tissues. Surgical intervention consists of incision, perforation in the lower part of the abscess, in order to drain pus and sanies.
The intervention is short and performed in local anaesthesia.
Surgical cyst removal
Any hard entity filled with liquid and lined with epithelium is a cyst.
Cysts are formed as a body reaction to a long-term infection. One type is formed by protruding from a tooth root to the jaw. Other type includes follicular cysts, formed around the crown of an impacted
(non-erupted) wisdom tooth or canine.
If a cyst is detected on a roentgen image or CBCT scan, it is necessary to remove it.
This intervention is performed in local anaesthesia.
Furthermore, after the cyst removal, it is necessary to send its content to a histopathological lab for an analysis to determinate whether those changes are benign or malign.
Frenulum resection – frenectomy
The frenum that connects internal tissue in the mouth, which can be too thick or too short, thus causing gum recession or other problems over time. There are two labial (located under both lips), four buccal (on the cheek sides of oral cavity) and one lingual frenum (under the tongue).
Frenulum resection is a routine procedure. It is performed in case of high and strained tie of the frenum with gums, in order to prevent gum recession and periodontitis.
Flap surgery
These surgical interventions are applied in case of periodontal diseases where it is not possible to improve status by using conservative methods. Those are mainly conditions complemented by chronic inflammatory processes, heavy gum bleeding, dull pain and sense of a foreign object between teeth, coupled with heavy and bad breath.
The intervention includes pulling of dental tissue to the exposed tooth neck or graft of soft tissue from the palate over the exposed section of the tooth.
Orthodontic surgery
These surgical procedures are performed when it is necessary to make room for tooth eruption, remove obstacles for tooth eruption and approach non-erupted teeth with orthodontic instruments.
Pre-prosthetic surgery
Maxillary sinus surgery
This surgical procedure is applied in case of pathological changes in the maxillary sinus, cysts or lifting of the maxillary sinus floor as preparation for prosthetic procedures.
This intervention is performed in local anaesthesia.
Artificial bone implant
Due to long-term periodontitis, as well as teeth loss, part of the alveolar bone is resorbed. This bone resorption has a negative impact on other teeth and the ridge, which collapses over time. Such bone does not have sufficient width and height for implant or other restorations, which anchor in the bone.
The surgery consists of separating the mucous membrane from the bone, where an artificial bone is added to a part of the alveolar ridge and then accreted with the existing bone. The artificial bone is protected with a membrane and stitched.
The full accretion process lasts between four and six months.
Soft tissue graft
Various surgical methods can be applied to improve a soft tissue status when adding implants and producing prosthetic restorations on implants, using palate grafts or artificial materials, which are then transplanted to the region around the tooth or implant. In these cases, connective tissue grafts (CTG) or FGA are used to cover the exposed section.
These procedures also include placing of caps – sulcus formers, when graft insertion is completed, in order to enable adequate gum healing.
Implantation
Implants are the latest and the longest-lasting solution for missing teeth. Implants are highly precise screws, made from the finest alloys, which are implanted in the bone. In case of a missing bone, the bone is augmented so that the implant can be anchored properly. For more information about implantation, please visit the Implantology subsection.
Implantation is performed in local anaesthesia.
