Oral Surgery

Oral surgery is that branch of dentistry that aims to offer solutions to very complex diseases, which in some cases become  irreversible, which might undermine the health of the patient.

Oral surgery includes a wide range of operations almost always performed under local anesthesia (also with the use of peroxide). This includes:

  • tooth extractions
  • periodontology and implantology interventions
  • cysts removal
  • apicoectomies
  • reconstruction and regeneration of maxillary bone volumes

Nowadays oral surgery is increasingly oriented towards a minimally invasive and very conservative approach, aimed at minimizing post-operative outcomes.

 

Dental extractions 

An extraction or a dental avulsion is an intervention that is necessary when a tooth is no longer recoverable due to:

  • a fracture
  • very deep caries
  • irreversible mobility following periodontal a disease
  • other orthodontic purposes

 

In case of severe dental crowding the extraction of healthy teeth (such as the premolars) is used in order to guarantee sufficient space for the teeth to be realigned.

The extraction of teeth in total or partial osteomucosa is probably the highest expression of the difficulties that an extraction can imply.

In some cases, due to lack of sufficient space in the dental arch, some teeth (especially wisdom teeth) remain partially or completely submerged in the bone or gingiva, sometimes growing in an incorrect direction. If this happens, they are useless for chewing and can even cause several problems.

Often a simple panoramic X ray of the dental arches can reveal the presence of an impacted wisdom tooth. In the case of impacted canines it is almost always possible to avoid the extraction and manage to recover the tooth by bringing it back into the arch with orthodontic techniques.

 

Wisdom tooth extractions 

When a third molar does not have enough space to completely erupt or is placed in an abnormal position, an inflammation of the gum easily arises, which is called pericoronaritis also called “dysodontiasis of the third molar”.

Let us briefly remind you that the third molars, absent in a newborn teething, arise between 18 and 25 years (not surprisingly, they are called wisdom teeth), an age in which all the dental elements are placed in a precise position. The impetuosity with which wisdom teeth erupt from the gums could cause toothache, dental crowding and many other disorders, such as to make a dental extraction necessary.

Among the side effects caused by the eruption of wisdom teeth we find:

  • difficulty and discomfort in swallowing
  • earache
  • difficulty and annoyance in opening the mouth which remains more closed than usual
  • chronic toothache and inflammation

The wisdom teeth extraction is performed for preventive or curative purposes.

In the first case a wisdom tooth can be removed to safeguard the correct position and the right alignment of the other teeth, minimizing the risk of dental malocclusion and crooked teeth. Furthermore, an early extraction of the wisdom teeth (immediately after their extrusion from the gingiva) can be recommended by the dentist to limit any risks and complications that could instead arise by removing a third molar already fully formed during adulthood.

For therapeutic purposes, however, the extraction of wisdom teeth is inevitable when there is a dental crowding that can make daily dental cleaning very difficult, when there is a corrosion of the adjacent tooth that can cause inflammation and pain, when it is in a severe tooth infection (tooth decay, pulpitis abscess or wisdom tooth granuloma). A filling or devitalization are useless practices for a wisdom tooth because, if located in an abnormal position, it can cause difficulties in chewing as well as lesions to the mucous membrane of the cheeks. When to resort to extracting third molars?

Third molar surgery is generally an event feared by patients and therefore to be avoided or at least procrastinated over time.

When there are problems linked to the third molars we must remember that the aggravation of the pathology is progressive. It should also be pointed out that there is a general consensus that surgical complications are much less frequent if the patient is between 17 and 20 years old. At this age the roots are formed for two thirds, the bone is relatively elastic, so the surgery is simpler and the post-surgical healing is quite fast.

Remission with antibiotic-analgesic treatment is possible, but relapse is a frequent occurrence.

Impacted third molars located in close proximity to a second molar almost always result in damage to its tissues and  sometimes cause their loss. The later one intervenes with the avulsion of the impacted third molar, the more the lesions against the second molar can become irreversible.

 

Crown extension 

Clinical crown lengthening is a type of oral surgery that is necessary in cases where tooth pathologies develop, such as subgingival caries or fractures.

In fact, dental restorations (reconstructions or capsules) cannot be carried out in a qualitative way if they invade the gums.

The “gummy smile” or gum smile can also be experienced by the patient as a mere aesthetic problem. Also in this case, it is possible to use the crown lengthening solution, in order to  re-establish a new balance between the teeth and the gum surface.

A correct alignment of the gingival parables gives harmony to a smile; an aesthetic reconstruction of the prosthetic crowns with veneers cannot ignore the correct alignment of the gingival tissues. An anatomically “short” tooth near a long tooth causes an unsightly effect that cannot be improved by simply acting on the tooth element, for example with a ceramic veneer.

A realignment of the gingival parabolas becomes mandatory. This involves small programmed tissue removals called “lengthening of the clinical dental crown”.

The procedure involves lifting a surgical flap to expose the supporting bone of the affected teeth and removing a small amount of bone, to create a space between the dental lesion and the bone itself. The gingiva is then repositioned and sutured so as to leave the carious lesion exposed and visible. After 2 or 3 weeks, when healing is completed, decays can be treated with a filling.

Clinical crown lengthening is applicable to the single tooth or to the entire dental arch.

 

Cysts and benigne lesions removal 

At Neri Pinzuti’s dental practice, you can also get small benign lesions of the oral cavity and jaw bones removed, such as cysts, fibroids, papillomas, odontomas, etc.

It is important to undergo periodic checkups of the mucous membranes of the oral cavity in order to diagnose early injuries that can degenerate (precancerous).

Apicectomy

Teeth previously treated with incongruous and inaccurate root canal therapies are often characterized by peri-apical lesions, often asymptomatic, caused by residual germs and infections located within the channels of the dental elements.

Apicectomy is an operation that is performed by the endodontist with the use of a surgical microscope in order to resolve the infection, removing the infected portion of the root (apicectomy), blocking the part of the root that remains of the tooth (retrograde filling) and removing all the infected tissues located in the bone around the tooth apex.

 

Pre-posthetic surgery

This type of surgery allows the elimination and / or correction of abnormal conditions, both of the gum and of the maxillary bones, before rehabilitating the patient with a fixed or mobile prosthesis, thus preparing the oral cavity to better accommodate the patient to the new prosthesis.

Patient’s bone membranes and grafts or biocompatible synthetic material are used throughout the operation.