Oral Surgery

Overview

Oral surgery can be a simple tooth removal or a lengthy operating room procedure as pictured here.

Oral surgery can be a simple tooth removal or a lengthy operating room procedure as pictured here.

The phrase “oral surgery” is an umbrella term for a range of procedures to surgically treat a variety of mouth, head and/or neck issues. These surgeries may be performed by a specialist in oral surgery (Oral Surgeon), a dentist who specializes in gum disease (Periodontist), a root canal specialist (Endodontist), a specialist in treating children (Pedodontist), or a general dentist. Each specialist is licensed to work within of his or her area of expertise, training and experience.

Throughout this article keep in mind the main message is of tooth preservation. Our teeth begin the digestion process; without teeth doing their job, we cannot properly begin the digestion of fats and carbohydrates.

Common Oral Surgery Procedures

Extractions involve the removal of teeth. These could be teeth that have fractured, decayed, or impacted teeth. In simple extractions, the teeth can usually be removed without much effort. An exception would be if the tooth had become fused to the jaw bone or “ankylosed”  (ank-ill-ohst).

These extracted teeth are used in dental schools to study dental anatomy.

These extracted teeth are used in dental schools to study dental anatomy.

If the tooth to be extracted is severely decayed, it is considered weak and brittle and may require the gum tissue to be moved out of the way and a small portion of bone removed to ease tooth removal. Often, these teeth fracture and a portion remains attached in the bony socket. The broken piece should be retrieved and only left behind if it carries a greater risk vs. benefit; an example would be accidental pushing of the root tip from an upper molar into the sinus cavity. Any tooth part that enters the sinus should be removed. The patient should always be informed when needing to leave a fractured root tip in place.

Impactions are usually “wisdom teeth” that are completely covered by bone (full boney impaction), partially covered by bone (partial boney impaction), or covered only by soft tissue (soft tissue impaction). Oral surgeons are highly trained in the area of third molar (wisdom teeth) extractions, as it is one of the most common procedures they perform.

Implant placement for the replacement of missing teeth. (See Dental Implants)

Biopsy of suspicious oral lesions and diagnosis of Oral Cancer.

Bone grafting is the transplanting of bone tissue in areas where bone is not wide enough or thick enough; this bone grafting or addition would then permit completion of other dental procedures (such as implant placement).

Denture Preparation

  • Alveolpoplasty (al-vee’-lo-plas-tee)-  An alveoloplasty involves shaping of the jaw bone following tooth removal to prepare for the placement of dentures or partials. The gum tissue is laid back and the bone exposed for smoothing and shaping, removing any irregularities or undercuts. This allows a more comfortable fit to the dentures following healing.
  •  Vestibuloplasty (ves-tib’-u-low-plas-tee)- A vestibuloplasty involves increasing the “attached tissue”. If you pull your lower lip out, you can see where the pink tissue is loose and where it is attached firmly to bone. If the loose tissue is loose up onto the area where the denture sits, the denture will become unseated whenever the muscles in the face are used i.e. eating and talking.

A final stage to braces as a correction of a jaw problem called Protrusion or Retrusion of the upper and lower jaws. An orthodontist moves the teeth into a position that readies the patient for the jaw surgery; an oral surgeon performs the surgery only after all growth is complete.

Facial fractures due to accidents or physical trauma may require surgical intervention; these types of injuries usually require an oral surgeon as a member of a medical team.

Congenital defects such as cleft lip and cleft palate generally require a team approach which can consist of an oral surgeon and a team of medical professionals, including a plastic surgeon.

Gum Disease Treatment (periodontal pocket elimination) is a type of surgery performed by specialists (see Periodontist) to treat gum disease. This surgery is done when non-surgical procedures, such as scaling and root planning, have failed to provide the desired reduction in the pocket depths around the teeth. Periodontal treatment, whether surgical or non-surgical, is intended to make the cuff of gum tissue around the neck of the tooth shallow enough for the patient to keep it clean.

Soft tissue grafting is done to cover areas that have lost their gum tissue covering. The “donor site” is usually the roof of the mouth. A small piece of gum tissue is removed from the roof of the mouth and transferred to the area that lacks coverage.

Root Tip Treatment (Apicoectomy) is the surgery most performed when conventional root canal treatment has failed to bring about the desired results, a procedure called an apicoectomy is recommended. The word comes from apico (at the tip of the root) and ectomy (removal), or the removal of the tip of the root. Apicoectomies are typically performed by an Endodontist.

This procedure involves laying the gum tissue back and making a small window in the bone adjacent to the tip of the root in question. A portion of the root tip is removed by beveling the root tip and placing a filling material to close the opening at the root tip. The gum tissue is replaced and stitched closed.

Extraction of “baby teeth” in preparation for braces (see Braces (Orthodontics), is a common procedure performed by a children’s dentist (Pedodontist).