Oral & Maxillofacial Surgery

Tooth extraction

In line with the scientific and technological developments in dentistry, as a result of the principle of keeping the teeth in the mouth as much as possible, the indications for tooth extraction have been limited. On the other hand, teeth that have excessive destruction in the tissues surrounding the tooth, which are thought to be untreatable as a result of advanced caries or trauma, should be extracted considering the patient's health.

Situations Where Tooth Extraction Is Necessary

· Teeth where treatment is not possible due to excessive substance loss

· Teeth that do not respond to root canal treatment and apical resection

· Teeth that wobble as a result of excessive damage to the supporting tissues

· Teeth that cannot be treated as a result of trauma

· Milk teeth that do not fall out when the time comes

· Teeth accompanying pathologies such as cysts and tumors

· Teeth that are mechanically damaged as a result of the placement of restorative appliances.

· Roots in the mouth without function

· Teeth that hinder or complicate prosthetic treatment. (Inverted, rotated teeth)

· Supernumerary teeth (Plus teeth)

· Teeth that wobble at the fracture line or have the potential for infection in trauma cases.

· Impacted teeth

· For orthodontic purposes, teeth can be extracted to save space.

Things to do before extraction

Before the procedure, you must inform your doctor about your existing systemic diseases (health problems), if any, your allergic status (against antibiotics, local anesthetics, etc.) and all the medications you use. If there is a drug (antibiotic, etc.) recommended by your doctor before shooting, you should definitely use it as your doctor recommends. If you have a problem with previous tooth extractions (allergic reaction, fainting, excessive tension, etc.), please inform your doctor. A few hours before coming to the shooting session, you should have a snack and should not come on an empty stomach unless your doctor tells you otherwise. Brush your teeth well and, if possible, rinse your mouth with mouthwash. Thus, you can reduce the bacterial population in the mouth and the risk of infection.

Recommendations After Tooth Extraction

· Bite the gauze that has been placed on it for 30 minutes. If the bleeding has stopped, there is no need to put any tampons. It is not recommended to change the placed tampon frequently as it will adversely affect the clot formation.

· After the tampon is removed, a slight leakage of bleeding may continue for the first 24 hours. No action is required for this. If bleeding has resumed, bite a moist gauze pad by placing pressure on the extraction wound. Continue this process for 30 minutes.

· Do not drink alcohol or smoke for the first 24 hours. Smoking can cause bleeding and wound healing can be adversely affected.

· Do not suck or spit for 24 hours to avoid bleeding.

· Do not eat or drink anything for at least 2 hours.

· If there is numbness in the lips, do not bite them until they pass.

· A slight pain may occur after the effectiveness of local anesthesia wears off. In this case, painkillers recommended by your doctor can be used.

· Avoid hot and grainy foods (rice etc.) for the first 24 hours. On the first day, warm soup, juice, milk, yogurt, ice cream, mashed potatoes, etc. Eat soft foods.

· On the day of shooting, lie down with your head elevated.

· Consult your doctor in case of excessive bleeding and pain that does not stop for a long time.

· The shooting area must be kept clean. Filling the extraction socket with food residue should be prevented. 24 hours after extraction, the area should be brushed gently with a soft toothbrush. Mouthwashes or warm salt water gargles can also be used at this time.

Treatment planning after tooth extraction

The place where the tooth was extracted must be filled with a bridge, removable prosthesis or implant as soon as possible. If it is not filled, digestive disorders, elongation of the upper teeth, position disorders in the adjacent teeth (tilting, rotation), jaw joint problems, and destruction of other teeth due to overload may occur due to incomplete chewing.

Impacted Teeth

Teeth that have not taken their place in the dental arch even though the eruption time is complete, and remain completely in the bone and soft tissue are defined as “Embedded Teeth”. Teeth, some of which have erupted into the mouth, are referred to as "Semi-Embedded Teeth". Although each tooth in the jaws has the potential to be impacted, the wisdom teeth are the teeth with the highest probability of being impacted. The eruption time of the wisdom teeth, genetic characteristics of the individuals, diet, participation of the teeth in the function, racial changes, etc. Although it varies under such parameters, it is usually between the ages of 20-23 in men and 21-22 in women.

Pathologies Due to Impacted Teeth

In cases where no surgical procedure is applied to the impacted teeth;

Pericoronitis (local gum inflammation)

Crowding in the teeth

Dental abscess

Pain

Caries formation in adjacent teeth

Adjacent tooth roots resorption (melting)

Focal infection

TMJ (Jaw joint) disorders

Cyst or tumor formation arising from the tissues attached to the tooth

Jaw fractures may occur.

Treatment Approach to Impacted Teeth

There are different opinions among physicians about the surgical approach to impacted lower wisdom teeth. Although some physicians recommend not removing the tooth and following the patient in the absence of any complaints, it is generally believed that impacted teeth should be removed unless they are a risk factor and are not contraindicated. As long as impacted upper wisdom teeth or canines (canine teeth) remain impacted, the risk of problems is low. However, the risk of pathological formation is higher in impacted lower wisdom teeth and they are recommended to be extracted.

Removal Time of Impacted Teeth

In cases where there is an indication for extraction of impacted teeth, it is advantageous to perform the surgical procedure at an early age. Because the jaw bones are more flexible and softer at younger ages; therefore, teeth may be easier to extract. In addition, due to the increase in general health problems (diabetes, heart, blood pressure, etc.) in advancing ages, the procedure may become more complicated. In advancing age, the risk of complications such as root fractures, maxillary sinus and nerve injuries due to surgical intervention may increase.

How to Remove Impacted Teeth

Impacted teeth are usually extracted under local anesthesia. However, it can also be withdrawn by applying sedative agents or under general anesthesia in patients who are overly stressed, anxious or unable to cooperate. Although the duration of the procedure may vary from patient to patient and case to case, it usually takes between 10-20 minutes.

Dental Implant

As a word meaning, implant is defined as the placement of inanimate materials in living tissues for treatment purposes. A dental implant, on the other hand, is an artificial tooth root made of material compatible with biological structures that replaces missing teeth in the jaw bones for treatment and function purposes, and supports removable and fixed prostheses. Dental implants, which have been successfully applied for nearly 50 years, have become an indispensable treatment option today.

Benefits of implant application

• Implant treatment is an application with proven success and reliability. It is the closest form of treatment to obtain the aesthetics and function provided by the patient's natural teeth.
• In the treatment of missing teeth, the adjacent teeth are cut and a bridge is applied. Since there is no need for support tooth support in implant treatment, adjacent teeth are preserved.
• There is no need for removable prostheses used in total or partial missing teeth. It increases the quality of life by providing the patient with fixed prosthesis.
• It increases the self-confidence of patients by eliminating the negative psychological effects of missing teeth.
• In the early and late periods after tooth extraction, bone resorption (melting) occurs in that area over time. It significantly prevents bone loss in the area where the implant is applied.
• In the absence of teeth, the remaining teeth in the mouth are exposed to additional chewing force. These forces can cause problems enough to cause the loss of remaining teeth. It can also cause jaw joint problems. Therefore, implant treatment prevents joint problems due to missing teeth and prolongs the life of the teeth.

What are the disadvantages of implant treatment?

Implant applications are more expensive than routine dental treatments. It also requires correct and regular oral care.

Lifespan of Dental Implants

Properly placed dental implants by specialist physicians can be used by patients for many years if good oral hygiene and regular control sessions are provided. Factors can affect implant life. For this reason, your doctor will be able to give you more detailed information as a result of the necessary intraoral and radiological examination.

Situations where the implant can be applied

In every case with missing teeth, if there is no obstacle to the application of the implant, implant treatment can be applied in the presence of appropriate bone and space. Implants can be applied to any suitable patient, from a single missing tooth to total edentulism (losing all teeth). In addition, in orthodontic applications, implant application can be made to ensure the movement of the teeth and to support the maxillofacial prosthesis.

Situations where Implant Application is Not Suitable

• Uncontrolled health problems (such as heart, blood pressure, diabetes, etc.). In such diseases, after the health problems are taken under control, implant application can be successfully performed under the consultation of a doctor.

• Patients with alcohol and drug addiction

• Those with blood clotting problems

• Have a jawbone that does not have sufficient bone length and width patients without p. Today, implants can be successfully applied to patients with bone deficiency by means of grafts obtained from the patient himself (autogenous bone graft), cadavers, animals or synthetically.

• Situations where the patient's financial situation is insufficient

• Implant treatment is not considered in cases where the patient's oral hygiene situation is not good and it is thought that he will not be able to provide complete oral hygiene afterwards.

Is implant treatment a painful procedure?

Implant treatment is usually performed under local anesthesia. After successful anesthesia, the patient does not feel any pain during the procedure. After the procedure, if you follow the recommendations of your doctor and use the prescribed drugs, you usually do not experience serious pain. After a successful implantation, patients are so comfortable that they do not even feel the presence of the implant.

Treatment time

The duration of implant operations can vary from 10 minutes to several hours, depending on the patient's mouth-jaw structure and factors such as the number of implants. However, in the presence of appropriate patient and bone structure, an implant operation takes approximately 10-15 minutes at most. After implantation, a period of 2-3 months is required for the osseointegration of the dental implant with the bone. Osseointegration time can be up to 6-8 months in unsuitable bone situations (soft bone, etc.) or in cases that require additional procedures (graft operation, sinus lift applications, etc.). is placed.

Apical Resection

Apical resection means removing the affected end of the tooth root from the area by cutting and removing the necrotic and inflamed tissue or small diameter radicular cyst in that area by curettage. This procedure is generally applied in cases where conventional root canal treatments are unsuccessful or insufficient in curing inflammation and infection at the root tip, or in the presence of chronic pathologies (cyst, etc.) associated with the root tip, in order to restore a healthy structure to the teeth and surrounding tissues.

Conditions Requiring Apical Resection (Indications)

• Persistent cases that do not respond to root canal treatment

• Presence of soft tissue lesions at the root tip (such as granulation tissue around the root, cysts originating from teeth, etc.)

• Physician-induced errors (canal perforations, irregularities, instrument breaks or overflow of canal filling materials from the root tip)

• Anatomical variations (canal curvatures (curvatures), lateral canals, apical bifurcations (root-tip bifurcations) or canal calcifications)

• Root tip fractures that may occur due to trauma or various reasons.

• Cases requiring biopsy due to apical pathology

• Situations where the patient cannot attend root canal treatment sessions regularly due to socioeconomic or job status.

Situations in which Apical Resection should not be performed (Contraindications)

• Presence of uncontrolled general health problems (heart, blood pressure, diabetes, leukemia, rheumatism with fever, bleeding problems, etc.)

• Situations where most of the root tip needs to be cut

• Root canal treatment failures of undetermined cause

• Excessive destruction of the tissues surrounding the tooth and the presence of abnormal mobility (shaking) in the teeth

• Cases where the crown/root ratio is insufficient

• Anatomical obstructions (where roots are close to vital tissues such as nerves, sinuses, etc.)

Can Apical Resection Be Done To Every Tooth?

Apical resection is generally applied to anterior teeth and premolars. However, it can also be successfully applied in cases where maxillary sinus and nerve relations with tooth roots are suitable and in posterior group teeth where it is easy to reach the root tip.

Operation time

Although the duration of the apical resection procedure varies depending on the experience of the physician, the condition of the patient and the characteristics of the tooth to be made, it takes an average of half an hour.

POST-OPERATIVE CARE

A. WOUND CARE

1. Bite the gauze that has been placed on it for 30 minutes.

2. Do not smoke for the first 24 hours. Drinking can cause bleeding and wound healing can be adversely affected.

3. Do not try to stretch your lip and cheek to see the operation area.

B. BLEEDING

1. It is normal to have bleeding in the form of leakage in the surgical area. You may see a blood stain on your pillow in the morning.

2. Do not suck or spit to avoid bleeding.

3. If bleeding has started again, bite a moist gauze pad by placing pressure on the extraction wound. Continue this process for 30 minutes.

4. Keep your head elevated. You can use several pillows while sleeping.

C. DISCOMFORT, DIFFICULTY

1. A little discomfort after surgery is normal. This discomfort can be controlled with medications prescribed by your doctor, but it may not be completely eliminated.

2. If pain relievers cause nausea, take them with a glass of water and some food.

D. DIET

1.2 hours duration Do not eat or drink anything with it.

2. It is important to drink lots of fluids. Do not use a straw as it may cause bleeding.

3. Return to your normal eating habits as soon as possible after surgery.

4. Soft and cold foods such as ice cream and yogurt are recommended on the first day.

E. ORAL CARE

1. Do not rinse your mouth and do not brush your teeth during the first 8 hours.

2. If a mouthwash has been given by your doctor afterwards, use it as directed. If a special mouthwash is not given, rinse your mouth with salt water (a glass of warm water, a teaspoon of salt) every 4 hours.

3. Start brushing your teeth, except for the wound area.

4. In the meantime, you can clean the operation area by using a cotton swab without putting too much pressure on the tissues.

5. You can start brushing all your teeth, including the wound area, with a soft brush in about 3 days.

F. SWELLING

1. It is normal to see swelling after surgery. The swelling reaches its greatest extent about 48 hours after surgery and usually resolves within 4 to 6 days.

2. During the first 24 hours, cold application with an external ice pack (applied for 15 minutes and interrupted for 30 minutes) to the surgical area helps to reduce swelling and may help to pass the post-surgical period more comfortably.

3. After the first 48 hours, applying heat from the outside to the surgical area (15-20 minutes 3-4 times a day) will reduce the swelling that has occurred more quickly.

G. REST

Avoid excessive talking and strenuous activities for 12 hours after surgery.

H. BRUISING

A slight bruising may be seen in the surgical area.

I. HARDNESS

After surgery, stiffness in the jaw muscles and restriction in the opening of the mouth can be seen. This is normal and will resolve in 5 to 10 days.

J. SUTURES

If there are sutures in the surgical area, they should be removed by your doctor after about a week.

K. CONSULT YOUR DOCTOR IN THE FOLLOWING CASES.

1. In the presence of excessive pain that you cannot control with painkillers,

2. If your bleeding continues despite biting the gauze as mentioned,

3. If there is a swelling that is growing even on the third day after surgery,

4. If you have a fever,

5. If you have any problem.