ORAL SURGERY

SINUS AUGMENTATION

 What is a Sinus Lift?

Maxillary sinus floor augmentation (also termed sinus lift, sinus graft,) is a surgical procedure which aims to increase the amount of bone in the posterior maxilla (upper jaw bone), in the area of the premolar and molar teeth, by lifting the lower sinus membrane  and placing a bone graft.
It's typically performed in advance of implant placement surgery, so to allow time for bone healing. But with some cases, both procedures may be done at the same time.
While the need for this procedure is not uncommon, not all implants placed in this region will require it.
When a natural tooth is lost the alveolar process begins to reshape. The vacant tooth socket collapses as it heals leaving an edentulous (toothless) area, termed a ridge. This collapse causes a loss in both height and width of the surrounding bone. In addition, when a maxillary molar or premolar is lost, the floor of the maxillary sinus expands, which further diminishes the thickness of the underlying bone.Overall, this leads to a loss in volume of bone that is available for implantation of dental implants, which rely on osseointegration (bone integration), to replace missing teeth. The goal of the sinus lift is to graft extra bone into the maxillary sinus, so more bone is available to support a dental implant.

 

What does the sinus lift procedure do?

When this procedure is performed, a portion of the maxillary sinus is filled in with bone (grafting material). The result is a thicker sinus floor into which a tooth implant can then be placed. (See illustration below.)
Indication

While there may be a number of reasons for wanting a greater volume of bone in the posterior maxilla, the most common reason in contemporary dental treatment planning is to prepare the site for the future placement of dental implants.

Sinus augmentation (sinus lift) is performed when the floor of the sinus is too close to an area where dental implants are to be placed. This procedure is performed to ensure a secure place for the implants while protecting the sinus. Lowering of the sinus can be caused by: Long-term tooth loss without the required treatment, periodontal disease, trauma.

How is the sinus lift procedure performed?

The specific technique that a dentist uses can vary. But traditionally this surgery has been performed as follows:

A sinus lift in preparation for a dental implant.
A sinus lift increases the thickness of bone.
The dentist will make an incision in the patient's gum tissue on the cheek side of their upper jaw in the region where the placement of the dental implant is planned. (This will be an area originally occupied by one of their upper bicuspid or molar teeth.)
After making the incision, the dentist will flap back the patient's gum tissue and expose the surface of the jawbone that lies underneath.

The exposed bone is cut in a fashion where a "trap door" of bone (hinged at the top) is created. This movable section of bone is then pushed gently inward and upward into the sinus cavity.
The bone movement will carry the sinus membrane (which is attached to it) along with it, thus "lifting" the membrane (and hence the sinus floor) to a new, higher level.
The empty space underneath the lifted sinus membrane is then packed with bone-grafting material (see below), thus providing the new bone into which a tooth implant can be placed.


Once the bone-graft material has been positioned, the gum tissue flap is stitched back in place.

In some instances, it can be possible that the dentist will place the dental implant at the same time that the sinus lift is performed.
In most cases, however, a dentist will allow a healing period of six to nine months before the dental implant is placed. The specific time frame allowed for healing is dependent upon the type of bone-graft material that has been used.

 

What types of bone-graft materials are used with the sinus lift procedure?
Several different types of bone-grafting materials can be utilized with sinus lift surgery.In some cases, the patient's own bone will be used, such as that taken from another location in their mouth or else from other bones [including the hip (iliac crest) or shin bone (tibia)].In other instances, prepared bone (frozen bone, freeze-dried bone, demineralized freeze-dried bone), either human or from another species (i.e. bovine), can be purchased from a tissue bank for use.Another alternative involves the use of synthetically derived graft material such as hydroxyapatite.

 

WISDOM TEETH

Why do we have wisdom teeth?

 

A Adults can have up to 32 teeth.  The wisdom teeth are the last to come through, right at the back.

They usually appear when you are between 17 and 25, although sometimes they appear many years later.

 

Nowadays people often have jaws that are too small for all 32 teeth – 28 is often the most we have room for. 

So if all the other teeth are present and healthy there may not be enough space for the wisdom teeth to

come through properly.

Do they always cause problems?

 

A No.  If there is enough room they will usually come through into a useful position and cause

no more problems than any other tooth.

 

Often there will be some slight discomfort as they come through, but this is only temporary and

will disappear once the tooth is fully in position.

What is an impacted wisdom tooth?

 

A  If there is not enough room, the wisdom tooth may try to come through,

but will get stuck against the tooth in front of it.  The wisdom tooth will be at an angle,and will be described by the dentist as ‘impacted’.

 

What problems should I be prepared for?

 

A If part of the wisdom tooth has appeared through the gum and part of it is still covered, the gum may become sore and perhaps swollen.  Food particles and bacteria can collect under the gum edge, and it will be difficult to clean the area effectively.

 

Your dentist will tell you whether this is a temporary problem that can be dealt with by using

mouthwashes and special cleaning methods (and possibly antibiotics), or whether it is better to

have the tooth removed.

What can I do to help myself?

A  If your gums are sore and swollen, use a mouthwash of medium hot water with a teaspoonful of salt.

(Check that it is not too hot before using it.)  Swish the salt water around the tooth, trying to get into the

areas your toothbrush cannot reach.  An antibacterial mouthwash such as Corsodyl can also reduce the

inflammation.  Pain-relieving tablets such as paracetamol or aspirin can also be useful in the short term,

but see your dentist if the pain continues.

But if it does not help?

 

A If the pain does not go away or if you find it difficult to open your mouth, you should see a dentist. 

They will be able to see the cause of the problem, and tell you what to do. It may help to clean around

the tooth very thoroughly, and the dentist may give you a prescription for an antibiotic.

Are x-rays needed?

 

A  The dentist will usually take x-rays to see the position of the root, and to see whether there is room for the tooth to come through into a useful position. 

                                           

                                               DENTAL CYSTS 

What are dental cysts?

A cyst is a sac of tissue that has either fluid or soft material inside it.

Cysts can form in a wide range of tissues including in the face and mouth (including the jaws). Some can form next to or around teeth, which are called dental cysts.

Cysts are a reaction of the body to a condition and are usually relatively slow growing. They can be sterile or become infected.

Why do dental cysts form?

Dental cysts can form at the tip of the roots of dead teeth. They can also form around the crowns

(and roots) of buried teeth. Most cysts form because the teeth they are associated with have died

(infection or trauma). Others form because of a mistake in the way the teeth have developed

(including being unable to grow into the mouth properly). Rarely, dental cysts are part of a genetic

syndrome that has other symptoms (eg Gorlin's syndrome). Your dentist or oral and maxillofacial

surgeon will explain to you more about the cause of your cyst.

Can I develop more than one dental cyst?

Any teeth can develop dental cysts. Mostly people will only have one at a time, but some people are more susceptible to developing them either because of the condition of their teeth or because they have an inherited condition that has dental cysts as part of its features.

What problems can dental cysts cause?

Dental cysts can cause several problems but some remain undetected for months or even years. Many cause problems when:

  • They become infected (causing pain and/or swelling);

  • They slowly replace some bony tissue (they can weaken the jaws),

  • They press against other teeth and structures;

  • They prevent the normal function of the teeth and mouth tissues.

How would I know if I have a dental cyst?

You might find out that you have a dental cyst when it becomes infected (an abscess).

Your dentist might tell you that you have a dental cyst after looking at a dental or jaw

X-ray: cysts can be seen as darker areas ('holes').

Some people only find out they have a dental cyst when their jaw breaks after trauma

(because the jaw is weakened by the cyst).

How are dental cysts treated?

The treatment your dentist or oral and maxillofacial surgeon will recommend for a dental cyst depends on the location, type and size of cyst. Ideally, dentists or oral and maxillofacial surgeons want to remove the cyst tissue to:

  • Examine it;

  • Help the tissues to repair themselves

  • To prevent another cyst from forming.

This is often done in combination with other treatment of the tooth (or teeth) associated with the cyst.