Oral, Dental and Maxillofacial Surgery

TOOTH EXTRACTION

Tooth decay, gum disease, bone resorption, unsuccessful root canal treatment, large fractures, teeth that are the source of infection, conditions where cysts form at the root tip, and similar reasons may require tooth extraction. During local anesthesia during tooth extraction, patients do not feel pain, they only feel the applied pressure.

Before tooth extraction, post-extraction treatment planning is definitely made, and the patient is informed about treatment alternatives. Many factors such as the patient's desire, the medications he uses, his economic status, general health, oral care and anatomical structures affect treatment planning. Bone resorption occurs in cavities that remain untreated and toothless for a long time after tooth extraction, and neighboring teeth slide towards the extraction site. Tooth extraction should be performed after the patient's general health and treatment planning are well evaluated.

If an acute infection is involved, patients experience symptoms such as pain, swelling, fever. If the tooth causing these symptoms needs to be pulled out, it is necessary to control the acute infection first. During the extraction of infected teeth, anesthesia cannot be provided at a sufficient depth and there is a possibility that the infection will spread to other organs. For this reason, tooth extraction is performed after the infection is treated with antibiotic therapy or drainage.

Situations where teeth need to be pulled out:
» Caries that causes a lot of substance loss in the tooth and has progressed to the root
» Teeth that do not heal with root canal treatment and cysts form at the tip of the root
» Fractures that are too big to be restored
» There is a shortness of space before orthodontic treatment
» Teeth that will prevent the use of dentures before the construction of dentures
» Gum diseases that have not been treated for a long time
» Swinging teeth without bone support
» Teeth that may cause problems in the future in patients who will receive radiation therapy
» Milk teeth that do not fall out
» Cases where no other treatment can be applied to the tooth due to its general health

What are the things to be considered after tooth extraction?
The buffer placed in the shooting gap should be bitten for 30 minutes, then discarded and nothing should be replaced. If bleeding occurs in the form of leakage, the incoming blood should be swallowed, not spat out. Shaking vigorously and spitting should be avoided for 24 hours. On the first day, it should be applied at intervals of 5 minutes each between, cold food should be consumed. Hot, spicy and granular foods should not be consumed, cigarettes should not be used. The next day after tooth extraction, the extraction gap e other teeth should be gently brushed with a soft toothbrush. It usually takes 1-2 weeks for the shooting site to heal.

EMBEDDED TOOTH EXTRACTION

Teeth that have reached the age of riding but have not been replaced in the mouth, have remained completely or partially in bone or soft tissue, are called embedded teeth. While there may be a wide variety of reasons for teeth to remain embedded, nowadays it is often encountered with embedded 20-year-old teeth and embedded canine teeth. In the studies conducted, it has been shown that buried teeth are encountered in society at a rate of about 30% and they are seen more in women.

The teeth may remain embedded due to factors such as shortness of space caused by the inability of the jaws to complete their development, closure of the place where the permanent tooth will last due to long-term milk teeth failure or premature extraction, genetic characteristics, febrile disorders experienced as a child, developmental anomalies of the teeth, different direction of tooth eruption, and some systemic diseases.

Embedded teeth are diagnosed as a result of clinical and radiological examinations and can be removed if deemed necessary. Inflammation can occur often, especially in the soft tissue around buried 20-year-old teeth. This inflammation, which can occur acutely or chronically, should be treated with antibiotic support if necessary, and buried teeth should be removed to prevent recurrence and progression.

Buried or semi-buried teeth can be harmful to the teeth located next to them, depending on their position. They can create pressure for the side teeth, reduce bone support, create an area that cannot be cleaned. They can cause the side teeth to rot, resorb the root and even pull it out. In addition, cysts and tumors may occur around embedded teeth, may cause facial pain, may interfere with the use of prostheses and orthodontic treatment. Teeth driving into the cheek or tongue can cause a person to bite their cheek or tongue.

The problems that may be caused by embedded teeth should be evaluated specifically for the patient and the treatment plan should be shaped accordingly. Since the flexibility of the bone will decrease with age, it is generally preferred to leave it if the embedded tooth can be left in the mouth without causing problems. In young people, on the other hand, buried teeth, which are considered suitable to prevent damage to other teeth and complications, can be removed due to the fact that the surgical procedure is easier and tolerable.

Are there any situations where buried teeth cannot be pulled out?
In the case of an acute infection, it is necessary not to pull out the teeth, first of all, the infection should be controlled. Some embedded teeth are in close contact with various anatomical points, nerves. In such cases, patients are offered alternative treatment methods other than the shooting, or problems that may occur after the shooting (nerve damage, drowsiness, etc.) are informed about it in detail.

Is having a buried tooth pulled a painful procedure?
Patients do not feel any pain during the procedure, as drowsiness will be achieved with the applying of local anesthesia before the operation. They only feel the pressure needed for tooth extraction.

What are the stages of embedded tooth extraction?
Buried teeth can be removed in one piece or divided into 2-3 pieces. The embedded tooth is reached by removing the gum and bone as little as possible. After the tooth is extracted, the gum is restored and sutured.

What problems may occur during the operation?
There are complications that may occur during every surgical procedure. These conditions vary depending on the position of the tooth and the patient. After the necessary evaluation, the risks are explained to the patients in writing, and the operation is performed if their consent is obtained. In particular, problems such as damage to a side tooth with a large filling or coating, redness and cracks due to stretching at the corner of the mouth are evaluated and the patient is informed.

What can happen after the operation?
After the surgical procedure, it is quite normal for conditions such as pain, bleeding, swelling, difficulty swallowing, mouth opening restriction, fever to occur in patients. The severity, frequency and duration of these conditions differ in each patient. It is controlled with the recommendations of the physician and prescribed medications. We do not expect a severe picture to appear as long as what needs to be done after the operation is applied to embedded teeth removed with minimal surgical trauma. After the operation, an infection called alveolitis may develop in patients who do not follow what the doctor says. In addition, if long-term mouth opening restriction and joint pain occur due to jaw joint strain, the physician should be informed and the recommended treatment should be applied.

What is alveolitis and how is it treated?
An infection that occurs at the wound site is defined as alveolitis. The gum cannot close the attraction zone, patients feel pain and bad odor in the mouth. What needs to be applied after the operation is very rarely seen in cases where it is fully applied. When alveolitis develops, the dentist should definitely be informed. If necessary, the shooting cavity is cleaned under antibiotic treatment and the condition is brought under control.

What are the things to be considered after the operation?
The tampon placed after the operation should be bitten for 45 minutes, then it should not be thrown into the trash and replaced with anything. If bleeding occurs in the form of leakage, it should not be spat out, the blood coming to the mouth should be swallowed. In addition, in the first days, movements that may remove the clot in the gravity cavity, such as spitting, shaking, sucking vigorously on a straw, should be avoided. Ice applying should be made at intervals of 5 minutes each on the first day between in order to prevent edema. After surgery, hot, spicy and granular foods, cigarettes and alcohol should be avoided. 24 Hours after the operation, the shooting area should be cleaned with a soft toothbrush, and the mouthwash recommended by the dentist should be used.

ROOT FRAGMENT SHOOTING

During tooth extraction, curved or thin roots may break and remain in the jawbone. In this case, the size, position and condition of the remaining root part are evaluated by the physician. It is not always necessary to remove the root part. Small pieces of root that are not likely to develop an infection around them can be left in the bone by informing the patient.

The procedures to be performed for the removal of the broken root fragment vary depending on the size and location of the root. With the techniques used in normal tooth extraction, a part of the root can be removed, as well as embedded tooth extraction techniques can be applied.

As a result of the loss of the visible part of the teeth for various reasons, only the root part may remain in the bone. If a part of the tooth appears on the gum, the extraction of the root part can be performed by holding it from that part.

SINUS LIFTING

Sinuses are cavities located in the head bones in the area near the roots of the upper jaw molars. When the molars in the upper jaw are lost and a replacement prosthesis is not made, the sinuses expand under the influence of air pressure over time, causing the bone underneath to thin out. A certain bone volume is needed for an implant to be made in this area. In cases where the amount of bone is not sufficient, the surgical lifting of the sinus floor is called a sinus lifting (sinus lifting/raising) operation. The sinus lifting operation is performed in two ways: closed and open sinus lifting.
The amount of bone should be more for closed sinus lifting. The sinus base is raised by entering with special tools through the cavity where the implant will be made. Usually, the implant is placed in the same session as this surgery. It is a painless and painless procedure that extends the duration of the implant operation by about 15 minutes.

In the open sinus lifting technique, the sinus is reached by a small window opened through the gum. Bone powder appliyng is performed when necessary. After this procedure, an implant can be made in the same session, as well as there are cases where it is necessary to wait an average of 3-6 months for the bone powder to fuse with the bone.

What are the things to be considered after the sinus lifting operation?
Prescribed medications should be used regularly. Pressure such as nose cleaning should be avoided, and keep your mouth open when sneezing. Lips should not be twitched to see the place of the procedure. Spitting, shaking vigorously and using a straw for 24 hours should be avoided. Hot, spicy and grainy foods should be avoided. It is necessary to keep the operating area clean and clean with a soft toothbrush. You should stop smoking and drinking alcohol for at least 1 week. In the first week, you should not make air travel, so as not to be subjected to pressure. Applying ice intermittently on the first day will reduce the formation of edema.

Graft Applying (bone powder)
Bone loss, which eventually occurs in the area of the missing tooth, can interfere with the installation of implants. In this case, bone grafts are used to fill in the missing part of the bone. The grafts used can be obtained from a person's own bones or artificially.

The bone powders used are of the type that the patient's body can easily tolerate. The applied powders eventually integrate as if they were the patient's own bone. In order for bone powders to remain stable in the placed area, self-dissolvable bone membranes called membranes can also be used.

If it is not necessary to add too much bone powder in the bone graft applying, implant applying can be performed in the same session. With the addition of a high amount of bone powder, it can be expected for 3-6 months to ensure complete fusion. Implant treatment can be started when sufficient bone density is reached.