Oral-maxillofacial surgery

Oral-maxilofacial surgery involves two types of dental procedures.

• Dental Office in-house procedures.
• OT procedures.

Dental office procedures are the the minor dental surgical procedures normally performed in the dental clinic under the influence of Local Anaesthesia.

OT surgical procedures are the ones which involve the more complex surgeries involving either or both the jaws, parts of nose, etc. These are normally performed under  General Anaesthesia inside a registered operation theatre.

The minor oral surgeries are;-

• Extractions
• Impaction Removal
• Abscess or Cyst removal
• Implant surgeries
• Maxillary Sinus Augmentation

Here we would only talk about these type of procedures. More complex cases are undertaken by the Oral-maxillofacial Surgeons on recommendation.

Extraction of teeth is the most undesirable treatment in dentistry today. With the advanced techniques to save the broken, decayed or loose teeth, the number of extractions in a dental office has considerably come down. Though the extractions are carried out for unsalvageable teeth, impacted wisdom teeth or for orthodontic purposes.

So the extraction of teeth could be a simple extraction for a loose tooth, a socket preservation extraction for planning a dental implant or a surgical extraction for impacted teeth.

It is a routinely done extraction procedure with the help of standard tools. The tooth socket collapses after the extraction thereby causing the decreased bone height and width. A good bone height and width is required for replacing teeth with a bridge or a dental implant. This is by far inexpensive.

This extraction is planned with the type of tooth replacement in mind. Special extraction tools (periotomes) are used to cut the supporting fibers slowly and slip the tooth out of the socket without damaging the bone. In some cases, the socket is filled with a bone graft and a membrane to achieve a good quality bone for placing a dental implant later. In other cases, the dental implant is placed immediately to achieve the twin purpose of bone preservation and immediate function. This procedure involves the higher cost. 

Due to the deficiency in the jaw size as a result of the evolutionary changes, wisdom teeth do not erupt in a desirable position thus getting stuck at different bone levels and varied directions. Depending upon their position, they can give rise to different problems like 

· Pain in the overlying soft tissue, 

· Decay in itself or the molar next to it, 

· Root resorption of the adjacent molar, 

all contributing to pain at some point or the other.

The impaction could be a bony impaction (when the tooth is totally within the bone) or a soft tissue impaction (when the tooth is partially out of the bone and covered with soft tissue). 

The only treatment of choice is extraction. 

Procedure:- A flap is raised; the tooth is loosened in total or in pieces and is removed. The flap is sutured and patient is given an ice pack to avoid the swelling. Anti-biotic regime is prescribed. The sutures are removed after a week.