20/Feb/2011

What is bone graft in dentistry?

Bone graft is a material that used to replace missing bone or bone defect in the face and mouth region, particularly in jaw area for support of implant during implant placement. Bone graft can also be use support the cheek or the chin area for aesthetic reasons.
Usage of bone graft in dentistry:

Orthognathic (Corrective jaw surgery) Surgery
Alveolar Bone Grafting (ABG) procedure in cleft patient
Periodontal surgery (eg. Guided Bone Regeneration)
In implant dentistry, bone grafts are widely used in:
- Sinus augmentation
- To preserve the socket after dental extraction of implant placement later
- To repair defect after dental extraction
- To cover exposed implant fixture during implant placement

Bone augmentation is a term that describes a variety of procedures used to “build” bone so that dental implants can be placed.

Bone graft was use during open sinus augmentation

When do we use bone graft in implant surgery?

Bone graft is used when there is not enough of bone at the site where implant is intended to be placed. Usually, when the width or the height of the jaw bone is not enough to support the placement of implant.
Bone graft can be obtain from outside or from patient’s own bone (autologous bone). Autologous bone is the best bone to substitute missing bone due to its high survival rate and its capability of attract new bone formation.

Bone-graft-procedure — Xenograft material was used to graft bone defect after implant placement

Bone graft sources

Autograft (Autogenous Bone)

Autologous bone grafting involve taking bone graft from patient’s bone of the same individual who is receiving the graft. Bone can be harvested from intra-oral (in mouth) or extra-oral (outside the mouth); example iliac crest, rib, cavarium.

In oral and maxillofacial surgery, bones are harvested extra-oral under general anaesthesia to repair alveolus in cleft patient, reconstruct mandible or maxilla after tumor resection, condyle reconstruction etc.

In implant dentistry, the usual site in the mouth that used to get bone graft (Donor site) usually depends on surgeon preference, the quality and quantity required:

External oblique ridge (bone behind the lower last molar)
Chin area
Tuberosity (bone behind the upper last molar)

Advantages of autograft:

Less rejection because graft originated from the patient’s own body
The graft doesn’t carry any disease
Using autograft bone as grafting material produce the highest successful outcome and predictability because the graft is a vital (living) bone which has the property of osteoinductive and osteogenic, as well as osteoconductive to regenerate new bone.

Disadvantages:

Additional surgical site is required (2 site surgery)
Post-operative pain and complications

Allografts

Allograft bone, like autogenous bone, is derived from humans; the difference is that allograft is harvested from an individual other than the one receiving the graft. Allograft bone can be taken from cadavers that have donated their bone so that it can be used for living people who are in need of it.

puros-from-zimmer — Puros from Zimmer is allograft bone particles

There are three types of bone allograft available:

Fresh or fresh-frozen bone
Freeze-dried bone allograft (FDBA)
Demineralized freeze-dried bone allograft (DFDBA)

Allograft bone used in dentistry uses bone from cadaver that undergo process of removal of unwanted material such as fats, cells, antigens, and inactivates pathogens, while preserving the valuable minerals and collagen matrix. This material is than freeze-dried before package.
Advantages of allograft:

Less antigenic rejection because allogaft bone originated from the same species
No need additional surgical site is required (2 site surgery)
The success of grafting using allograft will be lesser than autograft as the material used is basically a dead tissues
However, this material still carry property of osteoinductive and osteoconductive to regenerate new bone

Disadvantages:

Allograft bone might carry certain unknown diseases that resist the cleaning process during preparation of the graft
The graft usually resorb faster than xenograft material
Additional cost to the surgery

Xenografts

Xenograft bone substitute has its origin from a species other than human, such as bovine bone (or recently porcine bone) which can be freeze dried or demineralized and deproteinized. This material still has the property of osteoinductive and osteoconductive to regenerate new bone.

Bio-oss — Bio-Oss from Geislich contains xenograft material

Advantages of xenograft:

No need additional surgical site is required (2 site surgery)
This material still carry bone regeneration property of osteoinductive and osteoconductive.
However, success of grafting using xenograft will be lesser than autograft as the material used is basically a dead tissues
Xenograft material last longer in the mouth therefore, it with maintain the bone thickness for years

Disadvantages:

Just like allograft, xenograft material might carry certain unknown diseases that resist the cleaning process during preparation of the graft
Additional cost to the surgery

Alloplastic grafts

Alloplastic grafts may be made from hydroxylapatite, a naturally occurring mineral that is also the main mineral component of bone. They may be made from bioactive glass. Hydroxylapatite is a Synthetic Bone Graft, which is the most used now among other synthetic due to its osteoconduction, hardness and acceptability by bone.

boneceramic — BoneCeramic isone of the example of alloplastic graft

Some synthetic bone graft are made of calcium carbonate, which start to decrease in usage because it is completely resorbable in short time which make the bone easy to break again.
Tricalcium phosphate which now used in combination with hydroxylapatite thus give both effect osteoconduction and resorbability.
Polymers such as some microporous grades of PMMA and various other acrylates (such as polyhydroxylethylmethacrylate aka PHEMA), coated with calcium hydroxide for adhesion, are also used as alloplastic grafts for their inhibition of infection and their mechanical resilience and biocompatibility. Calcifying marine algae such as Corallina officinalis have a fluorohydroxyapatitic composition whose structure is similar to human bone and offers gradual resorption, thus it is treated and standardized as “FHA (Fluoro-hydroxy-apatitic) biomaterial” alloplastic bone grafts.

Biological mechanism

Properties of various types of bone graft sources.
	Osteoconductive	Osteoinductive	Osteogenic
Alloplast	+	–	–
Xenograft	+	–	–
Allograft	+	+/–	–
Autograft	+	+	+

Bone grafting is possible because bone tissue, unlike most other tissues, has the ability to regenerate completely if provided the space into which to grow. As native bone grows, it will generally replace the graft material completely, resulting in a fully integrated region of new bone. The biologic mechanisms that provide a rationale for bone grafting are osteoconduction, osteoinduction and osteogenesis.^[1]

Osteoconduction

Osteoconduction occurs when the bone graft material serves as a scaffold for new bone growth that is perpetuated by the native bone. Osteoblasts from the margin of the defect that is being grafted utilize the bone graft material as a framework upon which to spread and generate new bone. In the very least, a bone graft material should be osteoconductive.

Osteoinduction

Osteoinduction involves the stimulation of osteoprogenitor cells to differentiate into osteoblasts that then begin new bone formation. The most widely studied type of osteoinductive cell mediators are bone morphogenetic proteins (BMPs). A bone graft material that is osteoconductive and osteoinductive will not only serve as a scaffold for currently existing osteoblasts but will also trigger the formation of new osteoblasts, theoretically promoting faster integration of the graft.

Osteopromotion

Osteopromotion involves the enhancement of osteoinduction without the possession of osteoinductive properties. For example, enamel matrix derivative has been shown to enhance the osteoinductive effect of demineralized freeze dried bone allograft (DFDBA), but will not stimulate de novo bone growth alone.

Osteogenesis

Osteogenesis occurs when vital osteoblasts originating from the bone graft material contribute to new bone growth along with bone growth generated via the other two mechanisms.

More Info

…

Dr. Ng HW

20/Feb/2011

An articulator is a mechanical device used in dentistry which represents the anatomy of temporomandibular joint (the joint connecting lower jaw to the skull), upper jaw and lower jaw of patient to which upper teeth cast and lower teeth cast are fixed to the articulator in order to reproduce patient’s jaw movements. By nature, the purpose of these articulators can only be achieved when the position of the maxilla is duplicated with respect to the skull. The upper teeth cast should be mounted on a semi-adjustable articulator using a face bow. The closer the articulator matches the patient’s anatomy, the better the treatment outcome will be, hence shorter dental treatment time is required. It is a complex articulator which almost imitates the anatomy of the temporomandibular joint and follows the movement of your lower jaw. Therefore, it can be used in the fabrication of complex crowns, long span bridges and full mouth rehabilitation. This articulator is also used for jaw surgery (orthognathic) planning. Semi-adjustable articulator is adjustable in certain areas but not all. They have adjustable horizontal condylar paths, adjustable lateral condylar paths, adjustable incisal guide tables, and adjustable intercondylar distances. Nevertheless, this articulator is adequate for most of the cases. Uses of articulators

Educate to patient their jaw relation
Reproduce patient’s jaw movement like opening and closing of mouth
To diagnosis the state of patient’s occlusion
To help in treatment planning
To help in fabrication and modifying of dental restoration (dental crown and bridge)
To obtain good occlusion for dental restoration
For jaw surgery planning
Allows teeth arrangement for denture

Advantages of articulator

Dentist allows to adjust patient’s dental restoration on the articulator (outside patient’s mouth) without the disturbance of patient’s tongue, cheek, and saliva.
Reduce dental visits and treatment time because articulator helps to resemble patient’s jaw relation.
Adjustment and correction of dental restoration can be done in the absence of patient
With the help of articulator, your dentist allows to visualize the inner side of your teeth easily

…

Dr. Ng HW

20/Feb/2011

In Malaysia, 2 persons are diagnosed with oral cancer every day where 75% seek treatment at the later stages and only half of them survives. According to the National Cancer Registry, Ministry of Health, mouth cancer is the third most common cancer among Malaysian Indian community. If cancer is detected earlier, the treatment outcome is more favorable and the chance of survival is definitely much higher. And of course, prevention is better than cure. Biopsy can be performed to detect the abnormalities of the swelling whether it is benign (good) or cancerous.

What is biopsy?

A biopsy is a procedure where a small part of tissue is removed so that it can be looked closely under microscope.

When is it indicated?

A sore or lesion on any area of your mouth which lasts for more than 2 weeks.
A white or red patch on your mouth.
An non-healing ulcer for more than 2 weeks.

What is the purpose of a biopsy?

a. For definitive diagnosis so that correct treatment can be initiated as soon as possible

b. To establish prognosis of a pre-cancerous or cancerous lesion

Types of biopsy

There are few types of biopsy but most commonly used are:

a. Incisional biopsy

A small portion of suspicious swelling will be removed and sent to the laboratory for diagnosis purpose.
Pathologists will determine the nature of the swelling and staging of swelling if it is found to be cancerous.
Often indicated when the swelling is large and has differing charecteristics, so it may need investigation on several areas.

b. Excisional biopsy

Whole swelling will be removed for both diagnosis and treatment purpose.
Often indicated when the swelling is small, usually less than 2cm.

How is it performed?

The procedure is painless as it is done under local anesthetic (numbing injection). Dentist will take small piece of the tissue and stitching is often required afterwards. The tissue specimen will then be labeled and stored into container with special solution inside. It will be sent to the laboratory for investigation. The procedure usually takes 15 minutes from start to finish.

So, if you have a persistent swelling inside your mouth, do seek a dentist for consultation. Don’t be panic, not all the swelling are cancerous but it is better to get it check as soon as possible.

Different Types of Gum Surgery

There are certain types of gum surgery that usually the dentist will perform depend on the condition of the patient’s gum:

Pocket reduction (Gingiva Flap Surgery) This procedure is indicated for patient with deep pocketing on his gum as the result of gum disease (periodontitist). In this procedure, dentist or periodontist (gum specialist) will reflect the gum to expose the root of deep cleaning and then reposition the gum slightly lower in order to reduce pocket. Thus, this allows the patient to clean his teeth more efficiently.

Regeneration (Guided bone regeneration GBR) When there is excessive bone lost to a single or few teeth in the mouth, the dentist/periodontist might try to ‘re-grow’ the bone back around the tooth. The procedure can be done only after the gum disease ceased. Dentist/periodontist folds back the gums and removes disease-causing bacteria, then inserts bone grafts, membranes, or tissue-stimulating proteins (or any combination of the three) to encourage your gum tissues to regenerate and fit snugly around the teeth again.

Crown lengthening This procedure is done to lengthen the crown of the tooth for restoration later (Example: porcelain crowns or fillings). In cases where the tooth breaks down badly, sometimes, up to the gum level; crown lengthening is performed before restoration. The gum around the tooth will be removed to expose the root. This can be done with laser or electrocautery under local anesthetic. Once the gum healed, the tooth finally will be restore with filling or porcelain crown.

Removing excessive gum (Gingivectomy) In certain conditions where overgrowth of gum covering the teeth (gingiva hyperplasia), gingivectomy can be performed to reduce it. Gingiva hyperplasia usually cause be irritation to the gum, or certain medication patient taking causing the gum grows excessively or can be unknown reason. Basically, gingivectomy improves the teeth aesthetically and reduce plaque accumulation around them.

Soft tissue graft (Gingivoplasty)This procedure is performed on the gum that is thin and receded due to over-brushing. Dentist will take a tissue from elsewhere in your mouth (usually on the palate) and attaches it to your gums to replace gum tissue that has receded or has been removed due to gum disease. This procedure is often used for cosmetic purposes as well as to treat gum disease because it covers areas where the root is becoming exposed and improves the appearance of the teeth.

Is Gum Surgery Painful?

Most people will have only mild to moderate pain after surgery that can be managed with pain relievers. If the is moderate swelling on the gum, cold pack can be used to reduce it. Usually the dentist will give instructions on managing the wound after surgery.

More info

Treatments of gum disease:

Scaling and polishing
Air Polishing – A way to eliminate staining due to smoking, coffee or tea
Root Planing
Gum Surgery
Cosmetic Gum Surgery
Gingivoplasty
Gingivectomy
Fear of Dental Treatment? How to overcome it..?

Dr. Ng HW

20/Feb/2011

Complex Extraction

Unfortunately, not all extractions can be done by simply grasping the tooth with forceps and rocking it out. What if there is nothing left above the gum line to grasp? Or what if the crown breaks off leaving the roots still in the bone? These things can and do happen, and any dentist that extracts teeth will have to deal with them routinely.

In these cases, it becomes necessary to surgically remove the tooth. This is frequently accomplished by prying the root out using a sharp instrument that can be forced between the root and the bone surrounding it. This technique is called “luxation“. In the case of multiple rooted teeth, the roots are first separated so they can be removed individually. Unfortunately, not all roots or root fragments may be removed in this fashion. This means that the dentist must make an incision into the gums around the tooth and raise a flap of tissue exposing the tooth and its surrounding bone.

Surgical-Extraction — Surgical Extraction – a. Gum flap is raised and surrounding bone is removed. b. The roots of the molar are split with a drill and removed. c. The flap is held back in place with sutures

Sometimes, after the flap is raised, there is enough tooth exposed to grab and remove it as in a simple extraction. Sometimes, the technique described above as luxation may successfully remove the tooth. If luxation fails, the dentist must take a handpiece (drill) and cut away some of the surrounding bone in order to gain a purchase on the tooth. After the tooth has been pried out of the artificially enlarged socket, the dentist then sutures (sews) the flap of tissue back in place so that healing can proceed normally.

Introduction

Cosmetic gum surgery – It is a type of surgery used to reshape healthy gum tissue around the teeth to make them look better. If a person has tooth recession where the gum is pushed away from the tooth, a gingivoplasty surgery can be done. Basically to ‘bring’ back the gum to cover the expose root surface of a tooth:

Before cosmetic gum surgery (gingivoplasty surgery) – receding gum especially on patient’s left side

After cosmetic gum surgery *(gingivoplasty surgery)*

To read more on the gingivoplasty procedure click here.

On the other hand, if there is excessive gum covering the teeth, then the procedure is to remove some part of the gum covering the teeth (gingivectomy surgery) to show more of the tooth thus reduce gummy smile and improve smile line.

To read more on the gingivectomy procedure click here.

After gum surgery, it is important that the periodontist or dental hygienist inform you how to clean the teeth and gum tissue with a toothbrush and an antimicrobial fluoride toothpaste, floss and antibacterial mouth rinse. Please consult your periodontal specialist or dentist for more information of how to care for your gum tissue and teeth after gum surgery.

Surgical procedures

Treatments may be performed on the craniomaxillofacial complex: mouth, jaws, neck, face, skull, and include:

Dentoalveolar surgery (surgery to remove impacted teeth, difficult tooth extractions, extractions on medically compromised patients, bone grafting or preprosthetic surgery to provide better anatomy for the placement of implants, dentures, or other dental prostheses)
Diagnosis and treatment of benign pathology (cysts, tumors etc.)
Diagnosis and treatment (ablative and reconstructive surgery, microsurgery) of malignant pathology (oral & head and neck cancer).
Diagnosis and treatment of cutaneous malignancy (skin cancer), lip reconstruction
Diagnosis and treatment of congenital craniofacial malformations such as cleft lip and palate and cranial vault malformations such as craniosynostosis, (craniofacial surgery)
Diagnosis and treatment of chronic facial pain disorders
Diagnosis and treatment of temporomandibular joint (TMJ) disorders
Diagnosis and treatment of dysgnathia (incorrect bite), and orthognathic (literally “straight bite”) reconstructive surgery, orthognathic surgery, maxillomandibular advancement, surgical correction of facial asymmetry.
Diagnosis and treatment of soft and hard tissue trauma of the oral and maxillofacial region (jaw fractures, cheek bone fractures, nasal fractures, LeFort fracture, skull fractures and eye socket fractures).
Splint and surgical treatment of sleep apnea, maxillomandibular advancement, genioplasty (in conjunction with sleep labs or physicians)
Surgery to insert osseointegrated (bone fused) dental implants and Maxillofacial implants for attaching craniofacial prostheses and bone anchored hearing aids.
Cosmetic surgery limited to the head and neck: (rhytidectomy/facelift, browlift, blepharoplasty/Asian blepharoplasty, otoplasty, rhinoplasty, septoplasty, cheek augmentation, chin augmentation, genioplasty, oculoplastics, neck liposuction, lip enhancement, injectable cosmetic treatments, botox, chemical peel etc.)

Taken from Wikipedia

22/Jan/2011

10/Jan/2011

BEST THING TO NATURAL TEETH

What is Dental Implant?

A dental implant is a small “anchor” made of titanium. It is inserted into the jawbone to take the place of your missing tooth root. After Osseointegration, or when the surrounding bone has attached to the implant, a replacement tooth is secured to the top of the implant. The new tooth looks, feels, and performs just like your natural teeth.

Dental implants can be used in a variety of situations, whether you need to replace a single missing tooth or many teeth. They can even be used to replace a full denture. As anchor points, implants can also securely attach a partial denture or bridge.

What are the benifits of dental implant?

Choosing implants offers you a number of significant advantages including:

More healthful and beautiful: When teeth are missing, the surrounding bone begins to shrink. This unhealthy bone loss can make your jawline recede. Dental implants can help prevent deterioration of the jawbone caused by loss of teeth, so your face retains its natural shape.
As an alternative to bridgework, dental implants eliminate the need to grind down healthy teeth when replacing one or more adjacent teeth.
More comfortable: Because dental implants are securely anchored, there is no slipping or movement as there is with dentures. This eliminates some of the key worries of dentures, including poor fit, gum irritation, and pain from exposed nerves.
More confident: With dental implants, you will never need to cover your mouth when laughing, smiling, or speaking. You can eat your favorite foods without pain or fear of embarrassment – and taste every bite. You will look better, feel better, and live more confidently.

Are you the candidate for dental implants?

If you’re healthy enough to have a tooth extracted, you’re probably healthy enough to have an implant – whether your missing teeth are the result of injury, disease, or decay. General good health and adequate bone in the jaw are the key requirements. Your doctor can tell you if implants are right for you.

What is involved in implant procedure?

The dental implant process involves several steps that take place over a time period that averages from four to nine months. The typical process will include:

Initial implant placement: This procedure is typically performed in your dentist’s office under either a local or a general anesthesia. Your doctor places the implant into your jaw. Over the next several months, bone will attach to the surface of the implant anchoring it into position. Depending on your particular case, an additional minor procedure creates an opening through which your artificial tooth will emerge.
Implant prosthetic attachment: During this phase, your dentist painlessly attaches a prosthetic “post” from Zimmer Dental to the implant. A simple impression will be taken and over the next few days an artificial tooth will be created for a functional natural restoration.

Implants can improve your appearance, confidence and freedom

Since dental implants look and feel like natural teeth, they naturally enhance your appearance. More importantly, the securely attached implant gives you the confidence of eating what you like, speaking easily and clearly, and freedom from embarrassment. And, by following a regular routine of careful oral hygiene and regular checkups, your implants can last for many years.

To find out if implants are a solution for you, ask your doctor to evaluate you today.

More Info

Dr. Ng HW

02/Jan/2011

Topics

What is wisdom teeth?
Impacted Wisdom Teeth
Signs and Symptoms of Impacted Wisdom Tooth
Consequence of impacted wisdom teeth
Treatment Options
Indication of Wisdom teeth Extraction
Surgery or Not Surgery?
Surgical Removal of Wisdom Tooth
For Anxiety Patient…
What Do I Need to Do During Recovery?
Complication of Wisdom Tooth Surgery

What is wisdom teeth?

They are the last molar (or third molar) that usually erupt at the age of 18 to 25 years old (and sometimes older). The eruption of the tooth may cause pain in some of the cases. There are usually 4 wisdom teeth in each person. However, in some cases not every tooth will erupt into the oral cavity.

Impacted Wisdom Teeth

When a wisdom tooth cannot erupted properly either it tilt to the front or back or half-way jammed it is consider as impacted. The impaction cause severe pain especially when the tooth is erupting. This prevents the patient from open his mouth wide or eat properly. Sometimes it interferes with his daily activities. Impaction of wisdom tooth also will cause food trap easily (between the second last molar and wisdom teeth) which will result in decay at the second molar.
Impacted wisdom teeth can be divided into one of several categories. Mesioangular impaction is the most common form (44%), and means the tooth is angled forward, towards the front of the mouth. Vertical impaction (38%) occurs when the formed tooth does not erupt fully through the gum line. Distoangular impaction (6%) means the tooth is angled backward, towards the rear of the mouth. And finally, Horizontal impaction (3%) is the least common form, which occurs when the tooth is angled fully ninety degrees sideways, growing into the roots of the second molar.
Impacted wisdom teeth may also be categorized on whether they are still completely encased in the jawbone. If it is completely encased in the jawbone, it is a bony impaction. If the wisdom tooth has erupted out of the jawbone but not through the gumline, it is called a soft tissue impaction. Sometimes the wisdom tooth fails to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap or lid around the tooth called an operculum. Teeth covered by an operculum can be difficult to clean with a toothbrush.

Signs and Symptoms of Impacted Wisdom Tooth

Usually impacted wisdom teeth are presented with:

pain (may disturb sleep and may extend to the back, neck and head)
unable to open the mouth big due to pain
infection of the gum around the wisdom tooth
swelling on the gum
swelling on the cheek of the affected side
fever

Consequence of impacted wisdom teeth

Impacted wisdom tooth can lead to:

Acute gum infection or pericoronitis that happens around the wisdom tooth (Most common).
Infection on the pulp or pulpitis in the wisdom teeth due to decay
Infection on the pulp or pulpitis in the second molar due to prolong food trap that causes dental caries.
Infection on the bone or osteomylitis which occur if infection spread into the bone.
Infection around the facial tissue or cellulitis. This happens when the infection spread into the soft tissue around the facial region (Below).
Facial cellulitis
Gum abcess – if pus present in the gum or facial abcess if it’s in the face region
Gum problem or periodontitis around wisdom tooth and second molar.

Treatment Options

1. Leave it – If the symptoms are very mild, usually with some mouth rinse and the pain will subside. However, sometimes the pain may come back due to re-infection.
2. Take antibiotic and pain killer – Again the symptoms will subside however re-infection still can occur.

3. Incisional and Drainage – Removing of the pus accumulated either in the gum or facial region then followed by removing of the wisdom tooth.
4. Operculectomy – Removing the gum that cover the wisdom tooth for easy cleaning. However, sometimes the gum might grow back and infection can re-occur

5. Extraction – Removing the wisdom tooth (surgery or without surgery)

6. Root canal treatment – On the second molar if the pulp is infected and the wisdom tooth required to be removed.

Indication of Wisdom teeth Extraction

Wisdom teeth are extracted for two general reasons: either the wisdom teeth have already become impacted, or the wisdom teeth could potentially become problematic if not extracted. Potential problems caused by the presence of properly grown-in wisdom teeth include infections caused by food particles easily trapped in the jaw area behind the wisdom teeth where regular brushing and flossing is difficult and ineffective. Such infections may be frequent, and cause considerable pain and medical danger.
According to NICE (The National Institute for Clinical Excellence – UK), the routine practice of prophylactic removal of pathology-free impacted third molar should be discontinued. Third molar should be removed if there is evidence of pathology includes unrestorable caries, non-treatable pulpal and/or periapical pathology, cellulitis, abcess and osteomyelitis, internal/external resorption of the tooth or adjacent teeth, fracture of tooth, disease of follicle including cyst/tumour, tooth/teeth impeding surgery or reconstructive jaw surgery, and when a tooth is involved in or within the field of tumour resection.

The degree to which the severity or recurrence rate of pericoronitis should influence the decision for surgical removal of a third molar remains unclear. The evidence suggests that a first episode of pericoronitis, unless particularly severe, should not be considered an indication for surgery. Second or subsequent episodes should be considered the appropriate indication for surgery.

Surgery or Not Surgery?

When a wisdom tooth erupts vertically just like the second molar and the access is easily, then extraction of the tooth will be straight forward case. Usually the surgeon will loosen the tooth and grip the tooth with a forceps to remove it.

Horizontal Impaction — Horizontal impaction of wisdom tooth

However, most of the impacted wisdom tooth is embedded in the bone, tilted either forward or backward. Sometimes the tooth is in a horizontal position instead of vertical. This will make extraction with forceps impossible. Therefore, surgery is required.

Surgical Removal of Wisdom Tooth

Usually done by a oral surgeon (Specialist) or an experience dentist and it should be done in a sterile manner. After injections are given, a small cut will be made on the gum to expose the wisdom tooth and bone surrounding it. Then some bone near to the tooth will be removed to allow instrument to engage with the tooth. Next, the tooth will be sectioned into half or more and the fragment of tooth will be removed.
After the whole tooth was removed completely, the socket will be cleaned and the surgeon will inspect the wound to make it is clean and bleeding stop. Finally, the gum will be held together by stitches and the patient will be allowed to go home with gauze, pain killer and antibiotic. Usually the whole process takes about an hour or less.

For Anxiety Patient…

If in a case of an anxious patient come for wisdom tooth surgery, usually, we will prescribe some medication of reduce anxiety before the surgery or patient will have to inhale nitrous oxide during the procedure so that he/she will feel relax and calm all the time during surgery. If the patient is extremely phobia of surgery, then he can opt for surgery done under general anaesthesia which required hospitalization.

What Do I Need to Do During Recovery?

After your wisdom teeth are removed you may experience some swelling and mild discomfort, which are normal symptoms and are part of the healing process. Here is what to expect after the procedure.
1) The First 24 Hours:
Bleeding: This may occur for several hours after your wisdom teeth are removed. To control it, place a piece of clean moist gauze or moistened tea bag over the empty tooth socket and bite down firmly. This needs to be done for about 45 minutes. You should avoid rinsing, spitting or sucking actions for 24 hours after your wisdom teeth are removed. For example, don’t drink beverages through straws or smoke, and avoid hot liquids (such as soup or tea). You should also avoid carbonated and alcoholic drinks. These activities can cause the clot to dislodge, which will cause dry socket.
Facial Swelling: This can occur where the wisdom tooth was extracted. You can apply a cold compress to ease the swelling and pain. Cold compress(ice packs) should be used 20 minutes on 20 minutes off. Repeat as necessary during this first 24-hour period. Avoid taking aspirin, ibuprofen (e.g. Motrin, Advil, etc.) if you have a stomach ulcer.
Pain: Medications such as Mefenamic Acid (Ponstan) or Etoricoxib (Arcoxia) can be taken to manage your pain. We may prescribe more potent pain relievers, such as narcotics, if necessary.
Antibiotics: Antibiotics may be prescribed post-treatment and should be taken until you have finished the prescription.
Food: Avoid hot liquids and alcoholic beverages for at least 24 hours. When the extraction is more difficult, you will need to consume a soft or liquid diet for at least 24 hours after removal of your wisdom teeth.
Brush your Teeth: You need to continue to brush your teeth, but avoid the teeth adjacent to the extracted tooth during the first 24 hours. On day two, you can resume the gentle brushing of your teeth. However, do not use commercial mouth rinses because these can irritate the area of extraction.
2) After 24 Hours:
Facial Swelling: Facial Swelling in the area of your wisdom tooth extraction needs to be man aged with heat after the first 24 hours of ice. Use a moist warm towel and apply it to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary.
Rinse Your Mouth with Warm Salt Water: Use 1/2 teaspoon of salt in a cup of warm water after before bed and after meals. Do not use commercial mouth rinses.
Complete Healing: This will not occur for a few weeks to a few months following the removal of your wisdom teeth. However, usually within the first week or two, you will feel reasonably comfortable because enough healing has taken place. We will explain what to expect regarding your healing process.

Complication of Wisdom Tooth Surgery

1) The usual problem the patient will experience after surgery

Pain on surgical site
Limited mouth opening
Swelling around the cheek
Bruise over the cheek (not usual)

2) Complication (Rare!!)

Infection on surgical site (Higher risk for smoker and diabetic patient)
Lower jaw fracture (Will only happens in very thin jaw or a rough surgery)
Bleeding (Can be from arteries which usually can be controlled with compression)
Injury to nerve (Damage to the nerve will happens when the wisdom tooth is very near to the nerve and the event of removing it cause injury to the nerve. This will result in numbness on the lower lipand usually it takes 6-12 months to recover.)

What is bone graft in dentistry?

When do we use bone graft in implant surgery?

Bone graft sources

Autograft (Autogenous Bone)

Allografts

Xenografts

Alloplastic grafts

Biological mechanism

Osteoconduction

Osteoinduction

Osteopromotion

Osteogenesis

More Info

What is biopsy?

When is it indicated?

What is the purpose of a biopsy?

Types of biopsy

a. Incisional biopsy

b. Excisional biopsy

How is it performed?

Read More…

Different Types of Gum Surgery

Is Gum Surgery Painful?

More info

Treatments of gum disease:

Complex Extraction

Read more….

Introduction

Read More…

Surgical procedures

BEST THING TO NATURAL TEETH

What is Dental Implant?

What are the benifits of dental implant?

Are you the candidate for dental implants?

What is involved in implant procedure?

Implants can improve your appearance, confidence and freedom

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What is wisdom teeth?

Impacted Wisdom Teeth

Signs and Symptoms of Impacted Wisdom Tooth

Consequence of impacted wisdom teeth

Treatment Options

Indication of Wisdom teeth Extraction

Surgery or Not Surgery?

Surgical Removal of Wisdom Tooth

For Anxiety Patient…

What Do I Need to Do During Recovery?

Complication of Wisdom Tooth Surgery

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