Dental surgery

Tooth extraction

Surgical tooth extraction

Removal of inflammatory lesions and root-end resection

Treatment of tooth injuries - Pre-prosthetic surgery

Periodontal surgery

Course of treatment

Dental surgery involves much more than tooth extraction procedures. The speciality includes a series or procedures within the whole oral cavity, including procedures supporting other fields of dentistry, e.g. endodontics - root-end resertion, periodontics - periodontal surgery, prosthetics - pre-prosthetic surgery, and in particular the most modern one - dental implatology.

Medyk Dental and Medical Centre offers all procedures that do not require hospital treatment. All the procedures are performed under local anaesthesia applied by means of specialised equipment for local anaesthesia. It ensures a unique painless technique of anaesthesia and manufactured-guaranteed sterility during the application of anaesthesia.

TOOTH EXTRACTION

Tooth extraction consists of the separation of the tooth from adjacent tissues and its removal from the alveolus (tooth socket). The dentist's skill and co-operation of the patient ensure the appropriate course of the procedures and prevent complications. However , note that tooth extraction is not the ultimate measure and we use our best efforts and the most recent dental development to avoid it.

SURGICAL TOOTH EXTRACTION

This way of extraction is designed mostly for roots of tooth remaining in the gum and for impacted teeth. An impacted tooth is a tooth that remains embedded in the gums or jaw bone despite its development being completed (it may be completely invisible or only partialy visible in the mouth). The problem usually refers to wisdom teeth. Surgical tooth extraction is a more complex pocedure and requires more time than simple extraction; however thanks to the skills of our specialist, it does not result in particular discomfort for our patients, and appropriate wound dressing promote and accelerate healing.

REMOVAL OF INFLAMMATORY LESIONS AND ROOT-END RESECTION

Root-end resection (apicoectomy) consists of cutting off the end of the root of tooth with concomitant removal of any inflammatory lesion and protection of the root against re-occurrence of the inflammation. This type or treatment creates appropriate conditions of regular bone re-build in the place of the removed lesions; the process may by improved by the use of material promoting bone re-building. In the most the cases (approx. 95%) the procedure allows the tooth involved to be saved from extraction. Due to enormous progress in the endodontic treatment (endodontic microscopes, modern canal treatment tools), the procedure is used less and less frequently.

The root-end resection is indicated if:

the treatment applied failed to remove inflammatory lesions;

it is impossible to apply root canal treatment up to the very and of canal (abnormal anatomical structure, closure of the canal lumen);

there is a need for repeated endodontic treatment, while the canal is filled with hard material, e.g. cement;

aesthetic and functional prosthetic restoration in the form of a root-crown inlay and a prosthetic crown has been made;

The resection is usually made on single-root teeth (incisors, canine teeth); however, the procedure may be performed on any tooth requiring it.

TREATMENT OF TOOTH INJURIES

Tooth injuries usually affect children, but they may also occur in adults, e.g. during sport activities (skating, roller skating, bicycling) or accidents (falls, traffic accidents, physical assaults). Tooth damages may be of various kinds but it is of great importance to visit a dental surgery as soon as possible to seek care and advice. Depending of the type of trauma, usually the injured tooth may be saved with conservative or prosthetic treatment; however, sometimes the removal of part of the whole tooth is necessary.

PRE-PROSTHETIC SURGERY

The aim of pre-prosthetic surgery is to prepare the oral cavity for prosthetic treatment in a way which enable possibility the most functional, convenient and aesthetic prosthetic restoration to be performed. This field of dentistry includes in particular tooth extraction for prosthetic indications, the levelling of deformation and removal of pathological lesions of bone and soft tissues. A separate branch includes procedures aimed at the preparation of the site of dental implant placement, such as bone reconstruction procedures (augmentation of the alveoar process) or elevation of the bottom of the maxillary sinus, if the sinus is in low position. Special materials stimulating and promoting formation of the bone tissue are used in this procedures. The implantation procedure itself is usually performed approximately six month after the above-mentioned procedures.

PERIODONTAL SURGERY

Periodontal surgery is concerned with supporting conservative treatment of the diseases of tissues adjacent to the teeth, i.e. the periodontium, and involves prophylactic and therapeutic procedures. Prophylactic treatment consists of the removal of all the soft (e.g. abnormal fraenum - a small fold of tissue under the tongue) and hard tissues (bone, teeth) which promote periodontal diseases, while therapeutic treatment is aimed at the elimination of inflammation and reconstruction of tissues damaged in the course of disease. One of the most common procedures is open curettage, i.e. cleaning of gingival pouches that are inaccesible to the patient. In this branch of dentistry, numerous materials stimulating and promoting reconstrucion of the bone and other periodontal tissues are frequently used.

COURSE OF TREATMENT

The first visit is designed for diagnostic examinations. The general medical history is of particular importance for the success of surgical treatment, as the dentists has to know the condition of the patient's health and the drugs being taken before choosing the appropriate anaesthetic agent(s), procedure technique or preparatory actions (e.g. administration of an antibiotic). For more sophisticated procedures it may be necessary for the patient to bring the current results of lab tests (blood count, ESR) or to undergo such tests. The next step is physical examination of the patient , commonly followed by X-ray (either panoramic or of selected teeth).

The next step, when the treatment plan is developed and accepted by the patient, is the performance of planed procedure(s) and then providing the patient with recommendation and advice.

FAQ

1. How should I prepare myself for the surgical procedure?
2. What is allowed or what is forbidden after tooth extraction?
3. Is it necessary to remove all wisdom teeth?
4. Is it advisable for teeth to be removed in pregnant woman?
5. How long may a wound bleed after a surgical procedure?
6. What is the dry socket?
7. Can a knocked-out tooth be saved?

1. How should I prepare myself for the surgical procedure?

To be prepared for the surgical procedure you should:

take a rest;

have a light but calorific meal;

take your regular medicines unless the dentist recomendes otherwise;

relax and trust your dentist!

2. What is allowed or what is forbidden after tooth extraction?

After the tooth extraction procedure:

remove the dressing approximately 40 minutes after the procedure;

do not eat or drink anything for 2 hours after the procedure;

eat only light, semi-liquid food for the whole day after the procedure;

do not rinse your mouth;

put the cold compress on the face for 2-3 hours after the procedure (recommended);

do not warm your face on the side of extracted tooth;

avoid smoking on extraction day would be of benefit;

in case of pain you may use any OTC painkiller available, except products containing acetylsalicylic acid, e.g. Aspirin(R).

3. Is it necessary to remove all wisdom teeth?

If the wisdom teeth are healthy, regularly positioned in the dental arch, do not pose difficulties in cleaning and do not cause pain, there is no need to remove them unless for other reasons, e.g. orthodontic indications. The following are indications for the extraction of wisdom teeth (including impacted ones):

uselessness in biting;

lack of space in the dental arch;

certain diseases of dental pulp, such as purulent inflammation or gangrene;

bone pouch outside the tooth crown;

pressure on the neighbouring tooth;

cyst around the crown of the impacted tooth (visible on the X-ray);

neuralgia caused by the pressure of the tooth on a nerve.

4. Is it advisable for teeth to be removed in pregnant woman?

The pregnancy itself is not a contra-indication for tooth extraction. However, the procedure should be appropriately scheduled, the patient should be appropriately prepared and the tooth should be removed quickly and efficiently. The best period for such procedures is the second trimester of the pregnancy. In the first trimester most procedures in the oral cavity to be performed are postponed, unless such delay would be a threat for the patient's health or life. The most important element of the preparation of the patient for such a procedure is calming her explaining the need for her tooth extraction. Only the most safe and efficient agent may be used for the anaesthesia of pregnant women.

5. How long may a wound bleed after a surgical procedure?

Each surgical procedure is associated with a bleeding. The regular bleeding duration varies from several to some dozen minutes (until the cloth is formed). An apparently longer bleeding period is considered abnormal and there may be various underlying general (bleeding tendency, effect of medicines) or local (extra wound, bone injury) causes for such abnormality. Irrespective of the cause of such bleeding, the patient should visit the surgery immediately to seek help.

6. What is the dry socket?

The dry socked of a complication following tooth extraction consisting of the lack of blood clot in the alveolus (a clot has not been formed or has been washed out), commonly associated with bacterial infection. The symptoms, involving severe sharp pain, radiating to the ears ot temples and commonly occuring during the night, as well as general weakness, usually occur 2-3 days after the procedure.

Such ailments may perisist up to two weeks. The exact case for such disease is unknown; possible causes include compromised immunity, vitamin deficiencies, smoking, etc. Should similar symptoms occur, the patient should seek help from dental surgery.

The treatment applied will accelerate the wound healing and relieve the pain.

7. Can a knocked-out tooth be saved?

If a tooth has been knocked-out, it may be reimplanted, i.e. placed again in its alveolus. The success of such procedure depends on three factors:

the stage of development of the tooth; the best chance of successful reimplantation is with young teeth, whose roots have not developed completely;

the duration when the tooth was outside the alveolus (preferably not longer than 20-30 minutes);

the condition in which the tooth was kept (it is recommended to keep the tooth in the patient's mouth or in a container with milk or water.

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