In some cases, if oral health problems have progressed to the point that you experience pain or problematic symptoms, there is a chance you may have to undergo dental surgery. This involves removing teeth, realigning the jaws or removing gum tissue from the mouth. Some have a procedure for cosmetic reasons, but the majority of people who get dental surgery need it to maintain a healthy mouth.
Most of us will experience some type of dental surgery in our lifetime. It’s critical to correct problems with tooth alignment, tooth decay or complications with our jaws. However, dental surgery doesn't have to be as scary as it sounds. Many routine procedures are done quickly and painlessly and will allow you to maintain a happy and healthy mouth. If your dentist recommends undergoing surgery, be sure to get all the facts so you can make the right decision. With a little bit of research, you will discover that dental surgery procedures are relatively simple thanks to modern technology, and can help you achieve a beautiful, healthy smile.
When a tooth is lost the specialized bony process that houses the tooth begins to resorb due to lack of stimulation. This causes a decrease in width and height of the bone in the area the tooth is lost. Neighboring teeth and opposing teeth begin to move into the space. This causes food lodgment, subsequent decay, gum disease and abnormal forces being transmitted to teeth leading to fracture of cusps which may necessitate root canal treatment or extraction. Loss of teeth can also cause the cheek and lips to collapse giving an aged look. The consequences of tooth loss can be prevented by replacing the lost tooth in a timely manner. Although there are several options to replace a missing tooth the number one choice for replacing lost teeth are dental implants.
Implants are tiny titanium screws or posts that are surgically placed in the bone. Once integrated into bone they act like roots onto which small posts are attached which protrude through the gums. These posts provide stable anchors to the replacement teeth. Implants maintain the bone height by stimulation and prevents unnecessary trimming of adjoining teeth for bridge placement. Since implants are titanium posts there is no chance for decay on implants. Implants can service you for several years with regular professional cleaning and proper home care.
Many people who are missing a single tooth opt for a fixed bridge; but a bridge may require the cutting down of healthy, adjacent teeth that may or may not need to be restored in the future. Then there is the additional cost of possibly having to replace the bridge once, twice or more over the course of a lifetime due to decay or gum problems affecting the anchor teeth.
Another option to replace missing teeth is a removable partial denture or complete denture depending on the number of teeth missing. The chewing efficiency with a denture is reduced to more than half of that of natural teeth. The teeth that support the partial denture are weakened due to the excessive loads acting on them and eventually are lost. The denture rests on the gum causing tissue abrasion and bone loss. Removable dentures may slip or cause embarrassing clicking sounds while eating or speaking.
Studies show that within five to seven years there is a failure rate of up to 30% in teeth located next to a fixed bridge or removable partial denture.
Who is a candidate for Implants?
Anyone who is missing one or several teeth is a candidate for implants. With the exception of growing children, dental implants are the solution of choice for people of all ages, even those with the following health concerns:
Existing Medical Conditions: If you can have routine dental treatment, you can generally have an implant placed. While precautions are advisable for certain conditions, patients with such chronic diseases as high blood pressure and diabetes are usually successful candidates for dental implant treatment.
Gum Disease or Problem Teeth: Almost all implants placed in patients who have lost their teeth to periodontal disease or decay has been successful.
Currently Wearing Partials or Dentures: Implants can replace removable bridges or dentures, or they can be used to stabilize and secure the denture, making it much more comfortable.
Smokers: Although smoking lowers the success rate of implants, it doesn’t eliminate the possibility of getting them.
Bone Loss: Bone loss is not uncommon for people who have lost teeth or had periodontal disease. Oral and maxillofacial surgeons are trained and experienced in grafting bone to safely and permanently secure the implant.
Implant tooth replacement in children is usually deferred until their jaw growth is complete. There are, however, some instances when a dental implant may be appropriate, such as when it is part of the child’s orthodontic treatment plan. Your family dentist or orthodontist can guide you in this instance.
Dental Implant placement usually takes two surgical appointments: During the first surgical appointment the implant site is prepared to receive the implant following strict aseptic procedures. The selected size of the implant is placed in the prepared site. The gum tissue is sutured over the implant. The implant takes 4- 6 months to fuse with the bone.
During the second surgical appointment the implant is uncovered and the appropriate post is attached to which the replacement tooth is anchored. An impression of the post is taken and sent to the lab for the fabrication of the implant crown. During this time a temporary crown is placed. Once the final crown is back it is cemented with permanent cement..
When a jawline has missing teeth, often the bone structure diminishes over time. Dental bone grafting procedures are done to restore your bone to its previous form following tooth loss, gum disease or trauma. Restoring and maintaining facial bone structure is important for several reasons. Many dental procedures, such as dental implant placement and tooth extraction, require that the bone be as close to its original dimension and position as possible for optimal results. Also, the jaw and other facial bones support the skin and muscle that are responsible for our outward cosmetic appearance. Without the support of the underlying bone, our faces can look prematurely aged.
During the body's normal maintenance cycle, specialized cells in the blood continually enter your tissue to remove damaged cells and replace them with new, healthy cells. Grafting procedures place a framework of material in the areas of missing bone into which these cells can enter and start the rebuilding process. Over time your cells will remodel the graft material into your own functioning bone.
Why consider bone grafting
Bone loss can occur in the upper and lower jaws for several reasons. Localized bone loss often occurs around diseased teeth due to periodontal (gum) disease, fractured teeth, traumatic injuries and dental infections. In addition, over a period of time the jawbone associated with missing teeth atrophies. This often leaves a condition in which there is poor quality and quantity of bone, unsuitable for placement of dental implants. In the past, patients with significant bone loss were not candidates for placement of dental implants.
With current bone graft techniques, we have the ability to grow bone where needed. Augmentation bone grafts can be accomplished virtually anywhere on the upper and lower jaws. This enables us to offer dental implants as a replacement for missing teeth to almost all patients, even if substantial bone loss has occurred.
The great majority of bone grafts required for implant placement are minor procedures which can easily be accomplished in the office under local anesthesia or intravenous sedation. Commonly used bone graft materials include autogenous bone (your own bone), cadaver bone (bank bone), bovine bone and synthetic bone. The selection of graft material and surgical technique are based on the location and severity of the bone loss. In most cases, specially prepared cadaver bone and/or autogenous bone are utilized. Autogenous bone is usually taken from other areas of the upper or lower jaw.
There are several reasons for extracting a tooth. These include:
Severe Tooth Damage/Trauma: Some teeth have such extensive decay and damage (broken or cracked) that repair is not possible. For example, teeth affected by advanced gum (periodontal) disease may need to be pulled. As gum disease worsens, the tooth — supported by less surrounding bone — often loosens to such an extent that tooth extraction is the only solution.
Malpositioned/Nonfunctioning Teeth: To avoid possible complications that may result in an eventual, negative impact on oral health, your dentist may recommend removing teeth that are malaligned and/or essentially useless (teeth that have no opposing teeth to bite against)
Orthodontic treatment, such as braces, may require tooth extraction to make needed space for improved teeth alignment.
Also referred to as supernumerary teeth, extra teeth may block other teeth from erupting.Radiation: Head and neck radiation therapy may require the extraction of teeth in the field of radiation in order to help avoid possible complications, such as infection.
Chemotherapy weakens the immune system, increasing the risk of tooth infections, heightening the risk of extraction.Organ Transplant: Immunosuppressive medications prescribed after organ transplantation can increase the likelihood of tooth infection. As such, some teeth require removal prior to an organ transplant.
Types of Tooth Extractions
These are performed on teeth that are visible in the mouth. General dentists commonly do simple extractions, and most are usually done under a local anesthetic, with or without anti-anxiety medications or sedation.
These involve teeth that cannot easily be seen or reached in the mouth, either because they have broken off at the gum line or they have not fully erupted. Performed by dentists or oral surgeons, surgical extractions require some type of surgical procedure, such as bone removal, removing and/or lifting and folding back all or part of the gum tissue to expose the tooth, or breaking the tooth into pieces (called tooth sectioning). Surgical extractions can be done with local anesthesia and/or conscious sedation. Patients with special medical conditions and young children may receive general anesthesia.
Commonly Extracted Teeth
Wisdom teeth removal is one of the more common categories of tooth extraction. Many dental professionals will recommend removing wisdom teeth (third molars) before they are fully developed — usually in the adolescent years — to help eliminate potential problems. One problem that could occur is development of an impacted tooth that has surfaced and has no room in the mouth to grow. Other problems associated with impacted teeth include infection, decay of adjacent teeth, bite interference and gum disease.
Extractions of some permanent teeth that have not erupted — such as the canines, which are also known as fangs or eye teeth — may be required in order to make space for orthodontic treatment.
Alveoloplasty refers to the shaping of alveolar process using surgical methods. It is done if a person has bony projections, sharp crestal bones or undercuts. Prior to the construction of any prosthetic appliance, attempts must be made to preserve the maximum possible amount of the alveolar bone. Primarily the alveolar ridge must be re-contoured for providing best tissue for denture support. This is done by maintaining and securing large amounts of the soft tissues and bone.
The final aim involves the patient’s rehabilitation, while also restoring best masticatory function, and further improving the facial as well as the dental esthetics. Alveoloplasty is referred for both single and the multiple teeth extractions. There is a minimal initial procedure for this type of Alveoloplasty that just involves the smoothening of the sharp edges. Rather than opting for a surgical removal, the remaining bone must be permitted to remodel. An extensive Alveoloplasty is recommended in the cases that require an urgent denture construction.
When one or more permanent teeth are lost due to extraction, injury or accident, each absent tooth leaves a hole in the jawbone. Although the gums will heal over the hole, the underlying jaw bone will inevitably have high and low points.causing restorations such as dentures to rub against high points, create sore spots, and fit poorly. Furthermore, over time, the edentulous (toothless) area of the jaw will also lose a significant amount of bone, causing thinning of the top ridge and again making proper denture fit a nightmare. Finally, some people simply have a little extra bone jutting out from the main jawbone, preventing correct denture fitting as well.
In such situations, we use alveoplasty to smooth out uneven areas, flatten and taper overly thin ridges, and prepare the jaw to receive dentures successfully. Not only does alveoplasty ensure a better fit for dentures, but it helps control bleeding and improves healing time following multiple extractions, since we actually suture the tooth sockets closed rather than leaving them open to fill with a blood clot as with general single tooth extractions. Fast healing is especially helpful for cancer patients preparing to receive head or neck radiation. For such patients, decayed teeth must be removed and the sockets completely healed prior to commencing therapy.
Prior to performing Alveoloplasty, it is always advisable to evaluate each patient individually for eliminating any future problems emanating at the time of extraction. Local anesthesia can be used for Alveoloplasty.