Description

Oral Surgery and Implants

Which Operations Are Performed in Maxillofacial Surgery?

• Abscess and cyst operations
• Wisdom teeth extraction 
• Implant operations
• Jaw operations
• Tooth extraction

Under which circumstances are Cyst Operations (Apical Resection) performed?

• Situations in which the root of a tooth is too
  curved or blocked and root canal treatment cannot be performed,
• In cases where a canal tool is broken during
  treatment and must be removed,
• Where root canal treatment cannot be performed
  due to an irremovable restoration (such as porcelain) on the tooth,
• If there is a cyst or chronic abscess on the root
  tip of the teeth,
• In cases where the patient’s aches persist
  despite a canal treatment,
• Situations where 1/3 of the root tip is broken
  inside the bone,

Whyshould a badly positioned wisdom tooth be extracted even though it causes no discomfort?

Badly positioned wisdom teeth create a focal point for
infections.  These infections can present themselves in the form of aches
and swelling at any given time. 

• Wisdom teeth are difficult to clean with brushing
  and flossing.  Bacteria and food particles gather in this area and
  lead to tooth decay, which will promptly cause infections if not restored
  with fillings.
• Bacteria and food particles accumulated in this
  area cause bad breath.
• Abnormally positioned teeth buried under the gums
  cause other teeth to squeeze together and reposition, leading to deformity
  in the teeth.
• Furthermore, bacteria that collect beneath the
  gums covering a buried tooth lead to infections.

Can a wisdom tooth be extracted in cases where there is an acute infection?

No, generally not.  If an infected tooth is
extracted, the infection may spread in the region and prolong the recovery of
the wound.   The infection can be contained through local oral
hygiene, the use of antibiotics, and in some cases extraction of the opposing
wisdom tooth.

How should postoperative care be performed?

• The operated area should not be irritated;
  otherwise aching, infection, and/or bleeding may occur.
• No chewing should be done with the operated side
  for the first 24 hours. 
• No smoking for the first 24 hours. 
  Chemicals found inside cigarettes will increase bleeding and disrupt
  recovery.   
• No spitting for the first 24 hours. 
  Otherwise bleeding will increase and clots may be shifted.
• Wads should be kept in the mouth for half an hour
  in order for clotting to begin.
• After surgery, circulation may be slowed down and
  facial swelling prevented by applying a cold compress (ice) on the
  area.  Application should be as follows:  2-3 minutes of cold
  compress treatment – 2-3 minutes of resting – 2-3 minutes of cold
  compress, and so forth.  This should be applied for 48 hours.
• Gargling and brushing should be resumed after 24
  hours.
• If swelling has occurred after the first 48 hours,
  heat may be applied to the area to increase blood flow or circulation and
  bring down the swelling.
• Medication prescribed by the dentist should be
  used regularly.

Under which circumstances should wisdom teeth be extracted?

The last teeth in the mouth to erupt are third
molars.  They generally start erupting between the ages of 17 and 25;
because they erupt in the 20’s, they are commonly referred to as “wisdom
teeth”.  In some people, wisdom teeth may not form by birth and therefore
never erupt.  If they do erupt in the correct position and don’t harm
surrounding tissues, there are no adverse consequences to leaving the tooth
untouched. However, in some cases despite forming, these teeth fail to erupt
and stay buried.  Considering the damage that may be caused by a tooth
badly positioned and fused to the bone of the jaw, extraction may be decided
upon.  In cases with narrow tooth arches, eruption of wisdom teeth may be
impeded by gum-bone and other neighbouring teeth.

What are implants and under which circumstances should they be done?

When a tooth is lost, one way of replacing it is
through implant treatment.  An implant is a screw made from titanium which
is surgically rooted into the jaw bone of the toothless area, replacing the
tooth root.  Once it biologically fuses with the bone, it is capped with a
porcelain tooth.  In terms of appearance and chewing sensations, it is the
most natural prosthesis option.  Because of the advantages it provides the
patient, implants have become the most popular form of treatment in recent
years.  Ranging from single tooth absence to multiple teeth absences,
implants can be used as a fixed prosthesis without touching neighboring teeth,
as well as in the form of fixed or implant supported moveable prosthesis for patients
who use removable prosthesis.

What are the advantages of implant treatment?
  
Implant treatment is very user-friendly, comfortable, reliable, aesthetic, and
in terms of the patient a very acceptable treatment method.  Porcelain
prosthesis made on top of implants provide a natural and aesthetic look while
replacing actual teeth.  As missing teeth are filled in, the fact that the
other healthy teeth remain untouched is an advantage.  When compared to
all other prosthesis, they have a much longer lifespan.  To date, there
have been cases where a patient has undergone implant treatment and an implant
has remained successfully mounted for 41 years.  Furthermore as the
patient’s self-confidence is increased, the negative psychological effects
brought on by absent teeth are also eliminated.

Is implant treatment long-lasting?

The history of dental implants dates back to the early
1800’s.  Today, 35-40 year old near-perfect implants with clinic track
records still exist.  If appropriately chosen implants are correctly
mounted in a suitable situation, and the patient has shown the necessary care
to their oral hygiene, the implants will stay mounted in the mouth for a very
long time without causing any problems.

Can implants be used on all patients? 
 
Implants may be used on all patients with a good general state of health. 
As long as the patient’s general state of health is good, there is no upper age
limit to prevent implant treatment.  Only in patients whose bone
development has not been completed may implant treatment be unsuitable. 

Implant screws have a specific thickness and
wideness.  Therefore, the jaw bone where the implant will be mounted must
have a height and width suitable for the implants.  The quality of the
bone is also a determining factor; very tough or very soft bones may negatively
affect the success of the implant.  Aside from these, gums and neighboring
anatomical structures are also important factors in implant treatments. 

In which cases can implants be used?

Whether with a single tooth, or with multiple missing
teeth, an implant can be performed so long as there is sufficient bone on which
to mount the implant.  The important issue at this point is the width and
height of the bone, as well as its distance to neighboring teeth and anatomical
structures.  For this purpose, radiography or computed tomography can
accurately identify the condition of the bone. 

Is an implant procedure painful?

As is the case with all dental procedures, the patient
will feel no pain if the proper anaesthetic method has been applied prior to
the implant treatment.  In cases where patients may have a fear of local
anaesthetics or those who have extreme gag reflexes, implant treatment may also
be performed under general anaesthesia.  Following the procedure, slight
aches may be felt similar to that of having a tooth extracted.  This mild
discomfort, generally felt on the evening of the implant treatment, can be
treated with standard pain killers.

How long does the total treatment take?

Implant treatment is performed in two stages. 
The mounting of the implants stage, which varies depending on the number of
implants to be mounted, takes approximately ten minutes for each implant. 
This may vary depending on the tooth and bone structure of the patient. 
The second stage, the prosthesis stage, takes place approximately 2-3 months
after the implants have been mounted.  This time frame is also the total
duration of the treatment.  Temporary prosthesis utilized during this
period will not pose any problems in terms of aesthetics and
functionality. 

How long after the implants have been mounted can the prosthesis be fitted? 
  
The time needed for the implants to completely fuse with the bone
(osseointegration) is approximately 2-3 months.  During this time, the
amount of pressure placed on the implants should be kept at a minimum.  A
temporary prosthesis may be used for the duration of the recovery period,
provided excessive pressure is not placed on the implants.  Permanent
prosthesis may be introduced once the implants have completely fused with the
jaw bone. 

Does each missing tooth require an individual implant?

No, generally not.  In cases where more than 2
teeth are absent, planning may be done accordingly to accommodate bridge
prosthesis in the toothless area by leaving gaps between implants. 

What happens if the implant doesn’t fuse with the bone?

Provided the implants are properly mounted, the
chances of this happening are slim to none.  The odds of failure are
approximately 1-2%.  These types of failures generally present themselves
within the first 3 months following the mounting of the implant.  In such
cases, the implant is extracted by a procedure as simple as extracting a tooth,
and provided that the bone has not been damaged too severely, a slightly
thicker implant can be mounted.  If the bone has been too deteriorated, a
new implant may be mounted once the bone has healed, or as an alternative,
classic prosthesis options may also be considered. 

Where and how are implant treatments performed?

Implant treatments are carried out
through multidisciplinary work.  This consists of the maxillofacial
surgeon who will mount the implants to the jaw bone, the prosthesis specialist
who will make the prosthesis which will be placed on top of the implants and
the periodontist who will monitor the adaptability and health of the gums once
the treatment has been completed.  Having such a procedure performed in a
complex medical centre is especially important for the health of the
patient.  Throughout this treatment, a thorough examination of the
patient’s general health situation and/or inspection of the area receiving the
implant, along with certain findings may be required.  Aside from this,
panoramic film or dental cone beam computed tomography may be used to analyse
the condition of the bone.   
      
What are the advantages of implant treatment?

Patients who have no teeth on the lower jaw and use a
removable prosthesis often complain of aching and chewing difficulty caused by
constant movement of the prosthesis.  This complaint only gets worse with
time, as the bone tissue supporting the prosthesis is worn down.  In these
circumstances, implant treatment not only ends complaints but also ceases
wearing down of the bone. 

In patients who have lost portions of their teeth on
the lower or upper jaw, the absent teeth can be covered by use of a hooked and
moveable prosthesis or, if applicable, with a bridge prosthesis. 
Ultimately, the difficulty of use of removable prosthesis and the need to cut
healthy teeth when mounting bridge prosthesis are unfavourable circumstances
for patients.  In such situations, as the implant treatment will be done
with a fixed prosthesis, the aforementioned negative drawbacks are all
eliminated. 

In patients who have lost only one
tooth, the classic treatment method is having to cut at least two neighboring
teeth for the sole purpose of restoring one tooth.  In such situations, a
single implant will prevent the need to cut neighboring teeth.  As such, a
more aesthetic and functional prosthesis will have been applied.  
  
Is there a possibility that the implant will be unsuccessful?

The odds of failure in implants are approximately
1-2%.  It is important to learn the patient’s general state of health
prior to implant treatment.  With certain diseases (such as diabetes), it
is best to refrain from implant treatment.  Moreover, with patients who
smoke or those who do not take the necessary care in oral hygiene, the chances
of success for implants are lower. Notwithstanding, the area in which the
implant will be applied should be very carefully assessed.  Several
circumstances such as the amount of bone, the quality, its adjacency to
anatomic structures, all need to be taken into consideration.  If careful
work is done in the implant treatment and the patient has taken the necessary
care, the implants will stay mounted in the mouth for a very long time without
causing any problems. 

Do implants cause cancer?

Unfortunately there is a common such misconception
amongst the general public.  However, no scientific research to date has
suggested any evidence that implants may lead to cancer.