treatment

Wisdom teeth
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Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. This generally occurs between the ages of 17 and 25, a time of life that has been called the "Age of Wisdom."

Anthropologists note that the rough diet of early humans resulted in the excessive wear of their teeth. Normal drifting of the teeth to compensate for this wear ensured that space was available for most wisdom teeth to erupt by adolescence. The modern diet, which is much softer, and the popularity of orthodontic tooth straightening procedures produce a fuller dental arch, which quite commonly doesn't leave room for the wisdom teeth to erupt, thereby setting the stage for problems when the final four molars enter the mouth.

More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows it may hollow out the jaw and permanently damage adjacent teeth, the surrounding bone and nerves. Rarely, if a cyst is not treated, a tumor may develop from its walls and a more serious surgical procedure may be required to remove it.

More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows it may hollow out the jaw and permanently damage adjacent teeth, the surrounding bone and nerves. Rarely, if a cyst is not treated, a tumor may develop from its walls and a more serious surgical procedure may be required to remove it.

These are the most common complications of leaving malpositioned or impacted wisdom tooth in place:

  • Infection of the surrounding gum tissue. This condition,pericoronitis, is most likely to occur if the tooth is partly erupted or very close to the surface.
  • Fluid filled cysts. These can form from remnants of tissue around the crown of the tooth, becoming large and painful.
  • Decay, or dental caries. The positioning of wisdom teeth makes them hard to clean and hard to repair. 

 How an impacted wisdom tooth is removed ?


1. The surgeon will take the x-ray to check the position and anatomy of the impacted wisdom tooth.


2. In general cases, the surgery can be carried out under local anesthesia. This completely blocks feeling from the wisdom tooth and surrounding area. You will stay awake during the operation. Or alternatively for one who needs to get several wisdom teeth removed all at once or one who has dental fear, then General anesthesia maybe need.


3. Depending on the position of the wisdom tooth, the surgeon may need to make a small cut in the gum over the tooth.



4. And then remove any bone that is covering it. 


5. The surgeon mayneed to cut the tooth into poeces,to make it easier to remove.


6. The stitches are placed to reduce bleeding and immobilize the flap in order to enhance healing.

 



7. The surgeon will ask you to keep biting on gauze pad firmly for few hours until bleeding will stop and inform you about post-operative care.

Sinus lifting surgery
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 Sinus lifting surgery is a procedure to add bone mass into the upper jawbone to ensure successful implantation of dental implants to replace back molars. Sinus augmentation involves lifting the sinus membrane into the sinus cavity to make room for a bone graft in the jawbone. Sinus lift surgery is performed by a maxillofacial surgeon.

The Right Candidates

Patients who require dental implants if there is not enough jawbone or if the sinuses are too close to the jawbone for the implants to be inserted. The jawbone may be insufficient to support implants due to bone re-absorption following tooth loss or tooth extraction, the structure of the jawbone or bone loss caused by gum disease.

Risks and Side Effects

Sinus augmentation surgeries carry the risk of puncturing the sinus membrane. If the sinus membrane is thin and tears during the procedure the surgeon will seal the puncture and the sinus augmentation procedure may be postponed until the tear heals. All dental surgeries carry the risk of infection and antibiotics may be prescribed to prevent this. A rare complication of sinus augmentation is failure of the bone graft.

Surgery

Sinus lift procedures involve lifting the sinus membranes and inserting a bone graft into the upper jaw to increase the depth of the jawbone. The surgeon make an incision in the gum line of the upper jaw and pull the gum back to reveal the jawbone near the back molars. A section of this bone is cut to make a hinge that is used to push the sinus membrane into the sinus cavity. The empty space remaining where the sinus membrane was is then filled with a bone graft. The dental implant can then be placed into the extra bone mass.

Sinus augmentation procedures are completed in 1-2 hours depending on the amount of grafted bone that is added.



Flap opening


Making the access to the sinus


Lifting the sinus membrane

Applying bone graft materials

Fillings the empty cavities with bone graft materials

Applying the artificial membrane

The membrane will hold bone graft materials inplace

Closing the flap

Waiting for the graft to heal

 

It takes up to 6 months for healing

The graft become solid to support the implant

Implant placement


Recovery

Patients are anaesthetized for sinus augmentation procedures. Following the procedure the nose and upper jaw may be sore as the swelling subsides.

Immediately following surgery there may be some bleeding slight swelling along the upper gum line and nose. This will stop a few hours after surgery and swelling will reduce within a week. The sutures used to seal the incisions will be removed 7 days post-surgery.

The surgeon will occasionally insert dental implants into the jaw bone at the same time as the sinus lifting procedure, depending on the condition of individual jawbone. However, it is usually recommended that dental patients wait for the bone graft to fuse to the original jawbone before the implants are inserted. Fusion of the bone graft and the jaw bone can take up to 6 months.

Ridge augmentation or Bone grafting
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idge augmentation or Bone grafting is a surgical procedure to improve the shape and size of the alveolar ridge(s) in preparation to receive and retain a dental prosthesis.
If you have lost one or more teeth and would like to receive dental implants, time is of the essence. If you do not receive dental implants shortly after the tooth or teeth are lost, your jawbone will begin to deteriorate and lose its shape. When this happens, ridge augmentation can be used to reshape the jawbone.
There are several different procedures that can be used for ridge augmentation. The surgeon will select a procedure depending on the type, location and number of implants to be used. For example :
 * Mild to moderate bone lost : Bone graft together with implant placement (Allograft)


Duration of treatment until completion of a crown on the implant for mild to moderate bone lost

1st step

  • Implant placement together with Allograft
  • Healing time at least 4 months

2nd step

  • Crown on the implant

*Severe bone lost : Block bone graft (Autogenous bone grafting)

 


Overtime significantly bone lost may occurs, resulting in the thin ridge. It may be impossible to place dental implants.

There are several bone grafting techniques that use your body own bone to rebuilt deficient area.

One procedure involves extracting the bone from an area of the jaw refer to us as the ramus

The bone is shaped in small blocks and secured to the thin ridge

 

A bone substitute product is used to adequately fill the surrounding area

And specialize covering are placed over the site to accelerate and improve healing

 

After the bone matures

Implants can be placed

 

After the jawbone bonds with the implants

The crowns can then be fabricated and installed on the implants


Duration of treatment until completion of a crown on the implant for severe bone lost

1st step

  • Block bone grafting
  • Healing time at least 6 months

2nd step

  • Implant placement
  • Healing time at least 2 months

3rd step

  • Crown on the implant
Nerve repositioning
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Nerve repositioning or Nerve Lateralization is a technique that is performed when a patient has missing teeth in the posterior area of the lower jawbone and requires dental Implants. This technique is only necessary in the case that has lost significant amounts of lower jawbone since it is not possible to place implants without damaging the nerve. To address this problem, an oral surgeon can drill a small window in the bone and move the nerve to one side. The implants then can be placed through the bony canal previously filled by the nerve.


 

  • The surgeon will reflect the tissue and make a small window to gain access to the neurovascular bundle inside the jawbone. 
  • The surgeon will reflect the tissue and make a small window to gain access to the neurovascular bundle inside the jawbone. 
  • The implant is inserted into the bone,while the neurovascular bundle is kept out of its path.
  • Once placed, the bundle is released and the access site is refilled with bone graft materials. 

 


Lateralization of the inferior alveolar nerve offers the following advantages

  • Implants of greater length can be placed in the same surgical step. 
  • Greater primary implant stability is afforded thanks to the possibility of bicortical mandibular fixation. 
  • Only a physical examination and simple radiological study (e.g., panoramic X-rays) are needed. 
  • Increased protection of the dental neurovascular bundle is afforded during implant placement .
  • No advance bone grafting is needed, and donor site morbidity is avoided.

 

Before

You can notice

After

lower right side inferior alveolar nerve repositioning, the implants can be placed through the bony canal previously filled by the nerve.

Ridge preservation
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Ridge preservation or Socket preservation is a procedure in which graft material or scaffold is placed in the socket of an extracted tooth at the time of extraction to preserve the alveolar ridge. After extraction, jaw bones have to be preserved to keep sockets in its original shape. Without socket preservation, the bone quickly resorbs. The jaw bone will never revert to its original shape once bone is lost and tissue contour has changed.Socket Preservation differs from Ridge Augmentation; in Socket Preservation, the graft or scaffold is placed inside the tooth socket immediately after extraction, whereas the Ridge Augmentation grafting procedure is done to bring back the lost bone after the bone has resorbed and there is insufficient ridge height or width for further treatment procedure.


1. When natural teeth are removed and missing, the natural healing and resorption of the bone occurs causing the ridge to deform. 

2. An alternative procedure is a Ridge preservation technique. When the teeth are removed the flap is prepared to expose the bone.

3. The teeth socket is then filled with the bone substitute. The type substitute used is determined on case by case basis. Maybe a synthetic material or another that will stimulate bone graft .The material of choice is used to fill all the voids including the tooth sockets as long as any bone defects. 

4. This area can be covered with the dissolvable membrane to enhance healing process. 

5. The flap is then repositioned and sutures are placed.The area is then allowed to heal over a period of time.Sutures will be removed or dissolve themselves.With time the membrane underneath the gum will be dissolvedand the the bone substitue will be replaced with the patient's own bone by the body. 

6. This treatment often creates an ideal ridge and the edentulous area.We can now place implants in an ideal bone.

7. Or we can have the bone supported-sof tissues under other prosthetic options.

 

 


Socket Preservation procedure prevents immediate bone resorption after extraction thus keeping the contour and integrity of the socket with successful and natural looking appearance for tooth restorative procedures. All dental prosthesis requires good jaw bone support for it to be successful in the long run. Without socket preservation, residual bones could lose volume resulting in loss of facial vertical and horizontal dimension and changes in facial soft tissues aesthetics.