Oral Surgery Procedures Overview

Facial trauma involves injuries to the bone, teeth, skin, gums or other soft tissues.

Depending on the type of facial trauma sustained, there are many different treatment options available. The primary goals of treatment are to stop any bleeding from occurring, create a clear airway, repair any broken or fractured bone, and or suture any damaged soft tissue. Treatment is immediate, as long as there are no neck fractures or life-threatening injuries.

Oral and maxillofacial pathology refers to diseases of the mouth and the jaw. Treatment options vary based on the patient’s specific needs.

The smooth, pink skin lining the mouth is called mucosa. Abnormalities in the color or texture of this skin can sometimes indicate pathology. Any concerns with the skin in the mouth, a sore that is not healing properly or a lump on the inside of the cheeks, palate, gums or lips, may merit a biopsy so that the tissue sample can be tested for oral cancer. Please do not ignore these warning signs and be sure to mention any concerns you may have during your visit.

Cleft lip is an opening/split in the upper lip, and cleft palate is an opening/split in the roof of the mouth (palate). Cleft lip and cleft palate result when these developing facial structures in an unborn baby do not close completely.

A series of surgeries can restore normal function and achieve a more normal appearance with minimal scarring.

A cleft lip is usually repaired between the ages of 3 to 6 months. Some children require a lip adhesion or a device such as a molding plate to bring the parts closer together before the full lip repair. A child with a repaired cleft lip will have a scar on the lip under the nose.

A cleft palate is usually repaired between 9 and 12 months of age. To repair the palate, the soft palate muscles from each side are connected to each other and the normal barrier between the mouth and nose is created.

Additional surgeries are needed to improve the appearance of the lip and nose, close the opening between the mouth and nose, help breathing, and stabilize and realign the jaw. Once the permanent teeth grow in, braces are often needed to straighten the teeth.

Ridge Expansion
Adequate bone volume of the jawbone is necessary for the secure placement, stability, function, aesthetics and longevity of implants.  Because tooth loss can result in diminished bone volume in the jawbone, a bone expansion procedure may be necessary prior to implant placement.  This procedure can increase the height and/or width of the jaw ridge through the use of mechanical manipulation combined with a bone graft.  The Ridge Expansion takes several months to mature and be sufficiently strong for the placement of implants.  Ridge Expansion not only improves the function of implants, but is also a key contributor to the enhanced aesthetics, filling in the face around the gums and jaw and thus minimizing the appearance of aging.

The temporomandibular joint (TMJ) is similar to a sliding hinge that connects your jawbone to your skull. TMJ disorders can cause pain in the jaw joint and in the muscles that control jaw movement. 

To treat TMJ disorders, first the cause has to be identified. Improper alignment due to genetics or injury, arthritis affecting the cartilage in the joint, malocclusion, and trauma can all cause TMJ disorders.

Sleep apnea is a disorder in which one experiences one or more pauses in breathing or shallow breaths while you sleep.

Sleep apnea is an ongoing condition that disrupts sleep. When breathing is paused or becomes shallow, one will often move out of deep sleep and into light sleep, making the quality of sleep poor.

Sleep apnea can be treated with lifestyle changes, mouthpieces, breathing devices, and/or surgery.

For mild sleep apnea, a custom fitted mouthpiece or some lifestyle changes (weight loss, smoking cessation, clearing nasal passages) may be helpful.

For moderate to severe sleep apnea, a breathing device called CPAP (continuous positive airway pressure) or surgery to widen the breathing passages by shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw may be helpful. A CPAP machine uses a mask that fits over your mouth and/or nose and gently blows air into your throat. This air pressure helps keep your airway open while you sleep. Surgery to shrink the tissue involves a small shot into the breathing passages. Surgery to stiffen excess tissue requires a small incision in the tissue and the insertion of a piece of stiff plastic.

Facial cosmetic surgery is performed to correct physical malformations of the face.

The following are some of the facial cosmetic surgeries performed:

• Cheekbone Implants
• Chin Surgery
• Ear Surgery
• Eyelid Surgery
• Facelift
• Facial and Neck
• Liposuction
• Forehead/Brow Lift
• Lip Enhancement
• Nasal Reconstruction

A tooth that can not be saved with restorative materials may need to be removed. First, the area will be numbed with anesthesia. The tooth is then loosened with a special dental instrument known as an elevator. After the tooth is loosened from the socket, it is removed. Stitches may be necessary after the removal of a tooth.

An apicoectomy is a root tip surgery. This procedure is performed to remove a tooth’s root tip to prevent further infection of the root. First, a small incision is made in the gum and bone over the tooth’s root. After the root tip is accessed, it is cleaned and sealed with a small filling. The gum is then stitched back into place.

Gum reshaping or contouring is a procedure performed to reshape the gums if they rest too low or too high on your teeth. In order to reshape the gum tissue, a line is drawn to mark the new gum line. Once approved, anesthesia is applied to the area and the contouring begins. A dental instrument (typically a scalpel or laser) is used to reshape the gum tissue and trim away any extra tissue overhanging the tooth.

Nerve repositioning may be an option for patients whose inferior alveolar nerves, located near the lower molars, are in the path of a potential implant. Nerve repositioning is most frequently needed when there is insufficient bone height at the desired implant site. This procedure moves the nerve out of the way of the potential implant, allowing for optimal positioning of the implant.

Socket preservation is a procedure performed after an extraction to reduce bone loss. Bone grafting material or bone growth enhancing elements are placed in the socket where the extracted tooth was to prevent resorption of bone.

Pre-prosthetic surgery is performed to prepare a mouth for a dental prosthesis. Surgical modification of the bone involves redesigning and smoothing edges so that a well-fitting, well-functioning dental prosthesis can be created.

Distraction osteogenesis is a procedure performed in reconstructive surgeries to correct skeletal deformities that could result in health problems. Distraction osteogenesis is the process by which bone is surgically cut and then slowly separated at a controlled rate over the course of several days. This slow separation combined with the bone healing process allows new bone to fill in the gap created by the cut.

Platelet Rich Growth Factors and Platelet Rich Fibrin are new techniques used to assist with tissue regeneration using the patient’s own tissues and centrifugation to minimize healing time and maximize healing potential following procedures.

These growth factors are in the form of a mixed gel that can be applied directly into tooth sockets and other sites. Placing this material in tooth sockets after tooth extractions can improve soft tissue healing and positively influence bone regeneration.

These techniques offer a new approach to tissue regeneration. PRP derives from the centrifugation of a patient’s own blood and contains growth factors that influence wound healing. This is important in tissue repairing mechanisms. The use of PRP in surgical practice could have beneficial outcomes, reducing bleeding and enhancing soft tissue healing and bone regeneration.

Dental laser surgery uses a beam of intense light to correct dental problems. The energy produced by the laser cuts or vaporizes the tissue it is concentrated on. Laser surgery often means less discomfort, an easier and quicker recovery time and fewer, shorter appointments.

Lasers have several uses for dental surgery. Some common types of dental laser surgery include but are not limited to: dental cavities, root canals, gum surgery, dental abscess, biopsy, and treatment of lesions.

BMP is a growth factor used to stimulate bone growth. It can be used to combat jaw bone resorption or supplement bone to accommodate an implant.