Maxillofacial Surgery

What is Oral, Dental and Maxillofacial Surgery?

It is a branch of dentistry that is specialized in the diagnosis and treatment of soft tissues in the oral cavity (cheek, lip, tongue, palate), pathologies and joint disorders in the teeth and jaw bone. Buried tooth removal, wisdom teeth removal, implant surgery, fracture treatment, prostheses, and soft and rigid tissue provisions in preparation for orthodontic treatment, root-end resection (apical resection) cyst operations, graft operations, and arthrosynthesis are included in the duties of this branch of surgery.

Wisdom Teeth

Soft and cooked foods are consumed more often nowadays, due to changes in the nutritional routines of individuals. As a result of this, inidividuals’ jawbones started to shrink with wisdom teeth being embedded in the bones.

Embedded wisdom teeth can cause compression and pain as well as carrying the risk of developing a cyst and infection. An infected wisdom tooth may cause pain in the throat, ear, neck, and head area while also leading to limitations in the mouth opening. To prevent such problems, routine follow-up should be done every six months and any existing problems should be solved before further progression.

In cases where wisdom teeth should be withdrawn:

Caries: The wisdom teeth are located in a very rear region of the mouth and usually lie flat against the cheek or the tongue as they do not grow properly. Since this corresponds to a challenging area to reach, it is very difficult to maintain and clean these teeth. Therefore, decay is very common. Due to their location in the mouth, the canal or caries treatment of wisdom teeth is also difficult. Removal is a more appropriate option for the treatment of wisdom teeth that can be considered difficult to treat and maintain.

Caries risk for the neighbouring teeth: When wisdom teeth are half-buried or slanted, they may cause caries on the near large molars due to accumulation of food. When the risk of decay in healthy molars becomes likely, the removal of wisdom teeth would be suitable.

Pericoronitis (inflammation of the surrounding gum and soft tissues): For wisdom teeth that are half embedded, inflammation may occur due to the accumulation of microorganisms between the embedded part and the overlying gum tissue. As a result of this, swelling, bad taste and smell in the mouth, pain, redness and limitations in opening the mouth, swollen lymph glands and fever may be observed. This infection process may relapse with similar complaints via acute inflammations. For recurrent infectious conditions, the primary method of treatment would be the removal of the teeth.

Malocclusion (Misaligned teeth): When tilted wisdom teeth force to grow, they may pressure the front teeth and cause misalignment in the area.

Pain: Fully or half-buried wisdom teeth may apply pressure to the neighbouring teeth and cause a painful sensation of jamming to all surrounding teeth.

Cyst formation in the bone: Cyst formation can be seen in epithelial tissue surrounding the wisdom teeth. Although cysts are benign pathologies, they cause osteolysis following treatment. Larger cysts may even result in bone fractures, due to thinning of the bones. For treatment purposes, wisdom teeth and cyst tissue should be removed together, with the epithelium surrounding the region.

Chronic trauma: When the wisdom teeth cannot grow in a normal position, they may lay towards the side of the cheek. In such cases, the mucosa of the gum and the buccal mucosa, that were unable to form properly on top of the tooth, may cause wounds between the teeth during biting. Inflammation in the gum and buccal mucosa may occur due to exposure to this chronic trauma. The patient would experience pain during biting and eating.

Should the wisdom teeth be removed even when no pain or complaint is present?

Teeth develop in follicles during formation. When wisdom teeth cannot grow properly and remain buried, the follicle surrounding the teeth may cause the formation of cysts. During formation, cysts may not demonstrate any noticeable symptoms and may even keep growing/spreading without any observed symptoms at all. As they grow, cysts would cause thinning of the surrounding jawbone. Cysts are surrounded by a membrane of epithelial cells, which also contains the cyst fluid. Based on the level of pressure applied by the cyst fluid, jawbone may melt, and the melting would result in increased spread of the cyst. This spread may push the roots of the neighbouring teeth and cause the teeth to swing. In cases where the cyst is too wide, the anatomical points may be reached and symptoms such as tingling, and numbness may occur around the jaw nerves. In addition, abnormal growth of the follicle cells surrounding the teeth may lead to malignant pathologies. In order to keep these conditions under control, routine 6-month check-ups should not be neglected.

Sinus Lifting

The maxillary sinuses are the anatomical spaces located on the upper side of the teeth, where the maxillary small molar and large molar teeth can be found. The sinuses serve to dampen the air we inhale. If, after losing the molar teeth in the upper jaw, the area is left without teeth for an extended period of time, the sinuses start to droop and cause a decrease in the height of the bone level. Depending on the amount of bone remaining, sinus lifting (sinus elevation) can be performed and the bone level can be elevated.

How many different lifting ways are there?

Two different sinus lifting exercises are performed, either open or closed.

Closed lifting: The closed method can be used in cases where an addition of 2-3 mm bone is needed in the respective area. This method is performed during the session in which the implant is performed. It is a simpler and shorter operation compared to other sinus methods. As the healing is fast, the duration of the procedure for post-implant prosthesis is reduced.

Open lifting: It is applied in cases where there is too much sag in the sinus, and when more than 2-3 mm bone addition is needed. An oval window is opened surgically in the area close to the base of the sinus. New bone formation would occur by elevating the sinus base via this opening.

Apical Resection

We prefer to always go for the treatment of chronically inflamed teeth and the teeth that seem to have lost their vitality. If teeth with chronic inflammation are not treated for a long time, tooth loss becomes inevitable. It is our primary goal to try to treat these teeth instead of removing them. Teeth with chronic rheumatic rhinoplasty have become highly treatable with the use of improved treatment procedures. However, even after successful canal treatment, there may be cases where treatment remains insufficient. In such cases, inflammation can continue to spread to the surrounding teeth, tissues, and become cystic. It is possible to reach the root end with a simple surgical intervention called apical resection and remove the inflamed tissue from there.

How is apical resection performed?

The tooth mucosa is removed by incision from the root end of the tooth where it is inflamed. The infected tissue is removed. After removing the infected part, the canal filling at the root end of the tooth is re-covered with a sealed tissue material. The unsealed gum mucosa will be closed again, and the full recovery will then be anticipated. If the infected tissues are removed completely, a great level of success would be attained. Thus, the tooth can remain in the mouth for many years without the need for removal.

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