Oral surgery
When and why is oral surgery necessary?
1. Removal of unerupted teeth: this procedure is necessary when a tooth fails to erupt and remains partially or completely under the gum or bone. It is common with wisdom teeth.
2. Wisdom tooth removal: wisdom teeth, or third molars, often need to be removed because there is not enough room for them in the mouth, which can cause pain, infection or displacement of the adjacent teeth.
3. Surgical tooth and root removal: if a tooth is inflamed, broken or the crown is too damaged, the tooth or just the part around the root is surgically removed.
4. Root-tip resection: this procedure is necessary when the end of the root canal is not healing properly. The procedure involves removing the root tip and the surrounding diseased tissue.
5. Removal of oral cysts: removal of cysts that form in the oral cavity and can lead to infection, pain or tooth movement. They are removed surgically, often with the surrounding tissue.
6. PRF (Platelet Rich Fibrin) therapy: this is a biological treatment that uses a plasma gel made from the patient’s own blood to help regenerate tissue and speed up the healing process after tooth extraction or dental surgery.
7. Gingivoplasty: This procedure involves modifying the shape or symmetry of the gums to achieve better aesthetic and functional results. It can be useful for increasing the length of teeth or treating gum atrophy.
Bone Grafting
Bone grafting may be necessary for several reasons, especially in different areas of dentistry.
Here are some common reasons:
- Preparing for dental implantation: when placing dental implants, the right amount and quality of bone is needed to ensure the stability of the implant. If the bone is too thin or not dense enough, bone grafting is required to provide a suitable base.
- Preventing bone loss after tooth extraction: after tooth extraction, the area of the jawbone where the root of the tooth was often atrophies. Bone grafting can preserve the volume and shape of the bone, which can be important for future tooth replacements.
- Treatment of periodontal disease: rehabilitation of bone loss caused by periodontal disease involves bone grafting to restore bone structure, improving the health and stability of the periodontium.
- Rehabilitation of facial and jaw injuries: bone lost due to injury or trauma can be replaced to restore function and aesthetic appearance.
- Aesthetic reasons: to improve facial aesthetics, bone grafting may sometimes be necessary, especially in the jawbone area, to restore the natural contour and shape.
Bone substitutes can be either natural or artificial (alloplastic materials) and are chosen according to the needs of the case.
The procedure of bone grafting and major oral surgeries
Bone grafting and related major oral surgery usually involve similar steps, although the exact process may vary depending on the case.
Here is a general timetable:
1. Consultation and diagnosis: the process starts with a thorough examination and consultation, where the dentist or oral surgeon examines the patient’s oral cavity, takes X-rays or even 3D CT scans. This will help determine the extent of bone loss and the need for intervention.
2. Planning: developing a precise management plan. The oral surgeon will recommend the appropriate bone substitute. This can be autologous bone (the patient’s own bone) or synthetic material, depending on what best suits the situation.
3. Pre-operative preparation: before the operation, the patient is given detailed information about the procedure and post-operative care. If necessary, antibiotics may be prescribed to prevent infections and anaesthesia will be discussed.
4. Performing the surgery: the procedure is performed under local anaesthesia. During the operation, the damaged or emaciated bone is prepared and bone grafting material is implanted or added.
5. Fixation and closure: if necessary, the newly implanted bone is fixed with fixation devices. Finally, the gum or soft tissue is closed, usually with sutures.
6. Recovery and follow-up phase: after the operation, the patient is informed about the necessary follow-up treatments and given lifestyle advice to help recovery. Regular check-ups are required to ensure the healing process is progressing as expected and to ensure that the bone graft is integrated into the jawbone as expected.
7. Final rehabilitation: after the healing period (3-9 months), the patient can return for further dental treatment or for the original purpose for which the bone replacement was performed for, such as implants.
This process is of course often individualised and depends on the patient’s specific health condition.
Frequently asked questions
What is the purpose of bone grafting in oral surgery?
The aim of bone grafting is to increase the amount of bone in the jaw to allow for the placement of dental implants or other tooth replacement solutions. This is essential in cases where the bone is not sufficiently thick or dense.
How can I find out if I need bone grafting before I have an implant?
This is determined by a thorough examination by a dentist or oral surgeon, or by X-rays or CT scans that reveal the quality and quantity of bone in the jaw.
What types of bone substitutes are available and what is the difference between them?
The most common materials are: autologous bone (the patient’s own bone), allograft (donor bone), xenograft (bone of animal origin), and synthetic grafts. The differences between them lie in their origin, their biocompatibility and their chances of integration.
How long does it take for the bone graft to fully heal?
The total recovery time usually takes 3-6 months, but this may vary depending on the characteristics of the case. During this time, the implanted material will fuse with the natural bone tissue.
What pain and symptoms can I expect after the procedure?
Pain, swelling and mild bleeding are natural after surgery. These are usually well managed with over-the-counter painkillers and ice packs. If these symptoms are severe or persist for a long time, it is worth consulting your doctor.
What preparations are necessary for bone replacement?
It is important to ensure the health of the area before surgery. You may be prescribed antibacterial irrigation or antibiotics, and avoiding smoking is also recommended.
Are there permanent restrictions after bone grafting?
Immediately after the operation, it may be necessary to reduce physical activity and to take care of the oropharyngeal system, for example by changing eating habits (e.g. eating soft food). In the long term, there are no permanent restrictions if healing is successful.
Could any complications happen during bone grafting?
As with any medical procedure, complications such as infection, inflammation, graft rejection or implantation problems can occur. These are rare but can be treated with proper follow-up and consultation with a doctor.
What are the best practices between bone grafting and implant placement?
It’s important to pay close attention to oral hygiene, avoid hard-to-chew foods, avoid smoking and follow your doctor’s instructions.
Does bone grafting increase the success rate of a dental procedure?
Yes, it can significantly increase the success rate of dental implants and other procedures by providing a good bone foundation for stable implant fixation. In this way, the stability and function of dental implants can be maintained over the long term.