Surgical Dentistry

Wisdom Teeth Extraction

Wisdom teeth extraction is a common dental procedure to remove one or more of the third molars (wisdom teeth), typically located at the back of the mouth. These teeth often emerge between the ages of 17 and 25 and may cause problems if they don’t have enough space to grow properly.

Why Wisdom Teeth are Removed

1. Impaction: Wisdom teeth may become trapped in the jawbone or gums.

2. Crowding: They can push other teeth out of alignment.

3. Decay or Gum Disease: Difficult-to-clean areas can lead to cavities or infections.

4. Cysts or Damage: Impacted teeth may form cysts, damaging surrounding teeth and bone.

5. Pain or Discomfort: Emerging teeth can cause swelling, soreness, or jaw stiffness.

The Procedure

1. Preparation:

X-rays: To determine the position of the teeth and plan the procedure.

Anesthesia: Local, sedation, or general anesthesia is used based on complexity and patient preference.

2. Extraction Process:

The dentist or oral surgeon makes an incision in the gum to expose the tooth and bone.

The tooth may be divided into smaller pieces for easier removal.

The site is cleaned, and stitches may be applied if necessary.

3. Duration:

The procedure typically takes 30–60 minutes, depending on the number of teeth and complexity.

Recovery

1. Immediate Aftercare:

Bite down on gauze to control bleeding. Avoid rinsing your mouth vigorously for the first 24 hours. Use an ice pack to reduce swelling.

2. Pain Management:

Over-the-counter painkillers or prescribed medications. Saltwater rinses after 24 hours to keep the area clean.

3. Diet:

Stick to soft foods like yogurt, mashed potatoes, or smoothies.

Avoid hot, spicy, or crunchy foods for a few days.

4. Healing Time:

Swelling subsides within 3–5 days.

Full recovery takes about 1–2 weeks.

Potential Risks

Dry socket (painful condition due to a dislodged blood clot).

Infection or prolonged bleeding.

Temporary numbness (if nerves are close to the tooth).

Impacted Tooth Extraction

Impacted tooth extraction is a surgical procedure to remove a tooth that has not erupted properly or is blocked from coming out fully due to being stuck in the gum, jawbone, or against another tooth. This is common with wisdom teeth (third molars) but can affect other teeth as well.

Reasons for Extraction:

Pain or discomfort

Risk of infection or gum disease

Damage to neighboring teeth

Cysts or tumors forming around the tooth

Difficulty in cleaning and maintaining oral hygiene.

Procedure:

1. Consultation:

An oral surgeon or dentist evaluates the tooth using X-rays to determine its position and complexity.

2. Anesthesia:

Local anesthesia, sedation, or general anesthesia is administered based on the case and patient preference.

3. Surgical Removal:

A small incision is made in the gum to expose the tooth and bone.

In some cases, the tooth may need to be divided into smaller pieces for easier removal.

4. Closing:

The area is cleaned, and stitches may be used to close the incision.

5. Recovery:

A gauze pad is placed to control bleeding, and the patient is given instructions for aftercare.

Aftercare Tips:

Apply an ice pack to reduce swelling.

Take prescribed painkillers or anti-inflammatory medications.

Stick to soft foods for a few days.

Avoid using straws or spitting to prevent dry socket.

Maintain oral hygiene but avoid the extraction site during brushing.

Risks:

Dry socket (exposed bone due to clot loss)

Infection

Swelling or prolonged pain

Jaw stiffness or difficulty in opening the mouth

Rarely, nerve damage (in lower teeth).

Orthodontic Extraction

Orthodontic extraction refers to the removal of one or more teeth as part of an orthodontic treatment plan to help achieve proper alignment of teeth and create enough space in the jaw. This is typically recommended when there is severe crowding, malocclusion, or jaw size discrepancies that cannot be resolved through braces or aligners alone.

Common Reasons for Orthodontic Extraction:

1. Overcrowding: When the jaw is too small to accommodate all the teeth.

2. Protrusion: To reduce excessive forward positioning of the front teeth.

3. Improper Bite (Malocclusion): Such as overbite, underbite, or crossbite.

4. Impacted Teeth: Teeth that are blocked from erupting normally.

5. Aesthetic Concerns: To improve the overall appearance of the smile and facial profile.

Typical Teeth Extracted:

Premolars (bicuspids): Often removed because their location allows for easy realignment of front and back teeth.

Occasionally, canines, incisors, or molars are removed depending on the case.

Procedure:

1. Evaluation:

X-rays, dental impressions, and photographs are taken to assess the alignment and spacing. A detailed treatment plan is created by the orthodontist.

2. Extraction:

Performed by a general dentist or oral surgeon under local anesthesia. The tooth is loosened and removed carefully to avoid trauma to adjacent teeth or bone.

3. Orthodontic Treatment:

Braces or aligners are used shortly after the healing process begins (usually within 1-2 weeks). The orthodontist uses the space created by the extraction to align the remaining teeth.

Recovery and Care:

Mild pain, swelling, or bleeding is normal and can be managed with painkillers and cold compresses. Soft foods are recommended for the first 24-48 hours. Maintain oral hygiene but avoid the extraction site initially.

Advantages of Orthodontic Extraction:

Creates space for proper tooth alignment.

Improves bite function and dental aesthetics.

Prevents long-term dental issues caused by overcrowding.

Potential Risks:

Minor risks like infection or delayed healing.

Rare complications like shifting of other teeth if orthodontic treatment is delayed.

Dental Implant Placement

Dental implant placement is a surgical procedure to replace a missing tooth or teeth by inserting a titanium post (or other biocompatible material) into the jawbone, which acts as an artificial tooth root. A crown, bridge, or denture is then placed on top of the implant for a natural-looking and functional restoration.

Steps in the Procedure:

1. Initial Consultation:

The dentist evaluates the patient’s oral and overall health. X-rays or a CT scan are done to assess bone density and jaw structure. A treatment plan is developed.

2. Preparatory Procedures (if needed):

Bone Grafting: If the jawbone lacks sufficient density, bone grafting may be performed to strengthen the area.

Tooth Extraction: If a damaged or decayed tooth is present, it may be removed before the implant placement.

Sinus Lift: For upper jaw implants near the sinus cavity, a sinus lift may be performed to create more space.

3. Implant Placement:

Local anesthesia or sedation is administered. The gum is incised to expose the jawbone. A small hole is drilled in the bone, and the implant is inserted. The area is closed with stitches, and healing begins.

4. Osseointegration (Healing Phase):

Over the next 3-6 months, the implant fuses with the jawbone in a process called osseointegration, providing a stable foundation.

5. Abutment Placement:

Once healed, a small connector (abutment) is attached to the implant. The gum tissue around the abutment is allowed to heal.

6. Crown, Bridge, or Denture Placement:

A custom prosthetic tooth is designed and attached to the abutment for a natural and functional appearance.

Benefits of Dental Implants:

Restores chewing and speaking ability.

Prevents bone loss by stimulating the jawbone.

Long-lasting and durable (with proper care, implants can last decades).

Provides a natural look and feel.

Maintains facial structure by preventing sagging due to tooth loss.

Aftercare:

Practice good oral hygiene (brushing, flossing, and rinsing).

Avoid hard foods during the healing phase.

Regular dental check-ups to monitor the implant.

Quit smoking, as it can interfere with healing.

Potential Risks:

Infection at the implant site. Nerve damage,

Bone Grafting and Sinus Lifts

Bone grafting and sinus lifts are advanced dental procedures often performed to prepare the jaw for dental implants. They help restore lost bone structure or create adequate support in areas where natural bone is insufficient.

Bone Grafting

Bone grafting is the process of adding bone material to areas of the jaw that have experienced bone loss. This is commonly done before placing a dental implant to ensure the implant has enough support.

Reasons for Bone Grafting:

Bone resorption: After tooth loss, the jawbone shrinks over time.

Infection or trauma: Periodontal disease or injury can lead to bone loss.

Congenital defects: Some individuals naturally lack sufficient bone.

To support implant placement.

Types of Bone Grafts:

1. Autograft: Bone taken from the patient's own body (e.g., chin, hip).

2. Allograft: Bone from a human donor (usually from a bone bank).

3. Xenograft: Bone from an animal source (commonly bovine/cow).

4. Synthetic Grafts: Biocompatible materials like calcium phosphate or bio-glass.

Procedure:

1. Local anesthesia or sedation is administered.

2. The gum is opened, and the graft material is placed in the deficient area.

3. The area is secured with sutures and allowed to heal over 3-6 months as the graft integrates with the natural bone (osseointegration).

Sinus Lift

A sinus lift (sinus augmentation) is a specific type of bone grafting procedure performed in the upper jaw to add bone below the maxillary sinuses, creating space for implants in areas where natural bone is insufficient.

Reasons for Sinus Lift:

Tooth loss in the upper back jaw: This area often has less bone naturally and is close to the sinus. Bone resorption: Loss of bone after extractions.

Sinus expansion: With age or tooth loss, sinuses may enlarge and encroach into the jawbone.

Procedure:

1. Local or general anesthesia is administered.

2. An incision is made in the gum to access the jawbone.

3. A small window is created in the bone to gently lift the sinus membrane.

4. Bone graft material is placed in the space below the sinus membrane.

5. The area is sutured, and healing begins (takes 4-9 months for integration).

Recovery and Aftercare:

Expect swelling, minor bleeding, or discomfort for a few days.

Take prescribed painkillers and antibiotics to prevent infection.

Avoid blowing your nose or sneezing forcefully to prevent sinus complications.

Stick to soft foods and maintain good oral hygiene.

Benefits:

Restores bone volume, making dental implants possible.

Prevents further bone loss.

Enhances facial structure and stability.

Risks and Complications:

Infection or graft rejection (rare).

Sinus membrane perforation.

Delayed healing or insufficient bone growth.

Minor nasal or sinus congestion.