Many times, after the extractions of the teeth, the healing of the jaw bone does not take place smoothly and so the denture, although it has been adjusted by the dentist, cannot be applied properly. Thus, either in the same session with the extractions when the abnormalities are very marked or after the appropriate period of time for the bone regeneration to be completed, the abnormalities of the alveoli can be corrected (alveolar surgery).

The operation of extraction and alveolar surgery is simple, fast, painless and is performed in the doctor’s office under local anesthesia. After the anesthesia of the area, the extractions are performed and if it has been deemed necessary, the grinding of the bone abnormalities in the extraction areas (alveolar surgery).

Immediately after the end of the operation and the suturing, the immediate denture is placed and thus the patient is covered both functionally and aesthetically. Gradually there is a small internal and external swelling respectively in the area of ​​the operation, a slight discomfort, even a local hematoma (bruise). Normal postoperative development presupposes the patient’s compliance with the instructions given to him. The sutures, if not absorbable, are removed in 7-10 days. After the sutures are removed and the symptoms subside, the entire denture is modified by the general dentist for better fit.

The wisdom teeth are the last teeth to erupt in the mouth. When they are properly arranged and the gums that surround them are healthy, then they do not need to be removed. The extraction of a wisdom tooth is necessary when it is not erupting properly in the mouth. It can move sideways, remain partially under the gums or completely enclosed under the gums or even in the jaw bone.

Wisdom teeth in an incorrect position in the jaw can cause many problems. When they are semi-impacted (they have “partially” appeared in the mouth), the opening around the tooth allows bacteria to enter between the gums and the tooth and cause inflammation (pericoronitis). Inflammation results in swelling, narrowing of the opening of the mouth, pain and sometimes fever. The pressure exerted on the adjacent teeth can also damage the proper alignment of the other teeth or even that, which has been achieved after a successful orthodontic treatment.

The biggest problem occurs when cysts or tumors appear around impacted wisdom teeth, causing the gradual destruction of the jaw bone as well as the adjacent teeth. Recent research shows that the chances of developing cysts or tumors around impacted teeth are 32% -35%.

Extraction of the impacted wisdom teeth usually solves the above problems, while their extraction at a young age (<25) reduces the possible complications after the surgery. Clinical examination and radiographic evaluation of the wisdom teeth can be assessed and the possibility of immediate or future problems can be predicted. Early assessment and diagnosis in adolescence (15-18 years) leads to more effective treatment.

Cysts are cavities that grow in either the soft tissues or the hard tissues, are lined internally with tissues (epithelium) and contain fluid or semi-fluid. These are benign pathological entities. As they increase in size, they destroy the jaw bone and can take on large dimensions by shifting and pressing adjacent anatomical structures. In addition, they create problems such as infections and abscesses, loss of neighboring teeth that gradually lose their support and, in neglected cases, even fractures of the jaws.

There are different types of cysts. The development of cysts in most cases is associated with some inflammatory process in the mouth (decayed teeth, periodontitis) but can also occur without any obvious cause. Clinical symptoms include asymptomatic swelling of the area, redness of the mucosa and sometimes discharge of pus.

Treatment initially involves conservative treatment of the responsible tooth, if the cyst was caused by a damaged tooth. In larger cysts or in cysts that are not due to dental problems, the treatment includes either the complete removal of the cyst (nucleation) together with the responsible tooth, or the opening of the cyst (marsupialization) in order to reduce its size and totally remove the cyst in the future.

Tooth trauma usually occurs in accidents and sports-related injuries, especially in young children. Fracture is the most common occurrence in tooth injuries. Tooth displacement or avulsion (tooth totally out of bone) are less common but more serious events after an injury. Any dental injury, even if it seems simple, requires clinical examination by a specialized dentist in order to be treated in time.

– I fell down and the position of the tooth has changed, what should I do?

Tooth displacement can occur in 3 ways.

– I fell and my tooth came out completely, what should I do?

 

• If the tooth that came out is baby-tooth, it is not put back in the mouth as there is a risk of damage to the sperm of the permanent tooth but you should visit the dentist immediately to check the adjacent teeth, for any root residue, if it has affected the permanent ones and to replace the lost tooth in order to maintain the space for the normal eruption of the permanent tooth.
• If the missing tooth is permanent, it is important to move quickly:
  1. Βρίσκουμε το δόντι.
  2. Rinse the tooth with cold running water for up to 10 seconds, without touching the root.
  3. Put the tooth back in place in the mouth and hold it firmly with gauze. If we cannot do this, we keep it in milk. If there is no cold milk in the area you are in, it can be kept in the patient’s mouth under the tongue, as long as the patient is not a child as there is a risk of swallowing. In this case it is transferred to a container with the patient’s saliva.
  4. We visit the dentist immediately.

– What is the prognosis of an avulsed tooth?

The treatment and development of the extracted tooth depends on two important factors:

• Whether the formation of the tip has been completed and the condition of the periodontal cells, which depends on the time of stay of the tooth in a dry environment. 60 minutes later the periodontal cells are dead.
• A quick arrival in less than an hour to the dentists’ office can ensure that the tooth is kept in the mouth.

– Should other anatomical regions, besides the teeth be checked after a dental trauma?

In case of a serious injury, the priority is to ensure the patient’s life by providing first aid and immediate transport to the nearest hospital. After a strong impact there is a risk of injury to other tissues of the mouth, such as alveolar tissue fracture, jaw fracture, jaw dislocation – damage to the temporomandibular joint and soft tissue injuries (eg lips).

– How can dental injury be prevented?

In order to prevent dental injury, it is necessary to supervise young children, the appropriate configuration of the areas where infants play, the use of special protective mouthguards in sports and the timely orthodontic treatment in cases with big horizontal protrusion.

Sometimes,  permanent teeth remain in the bone resulting in delayed or even no eruption and orthodontic abnormality. The delay in the eruption of teeth is due to various reasons such as endocrine causes, supernumerary teeth, intraosseous lesions, etc. The teeth that usually show these problems are the canines of the upper jaw, the premolars of the lower jaw as well as the lateral incisors of the lower jaw. In these cases, a combination of surgical and orthodontic methods is necessary for a successful treatment.

The procedure usually involves incision in the gums, removal of the bone covering the top of the impacted tooth and the placement of orthodontic brackets in order to apply force on these teeth and pull them into their correct position in the mouth. If there are still baby teeth they should be removed simultaneously. The patient is then referred to the orthodontist for further treatment.

Bone Grafts

In the areas of the jaws where tooth extractions have been performed, a decrease in the height and width of the bone is observed over time. It is a normal process due to the absorption of bone in these areas. This results in less bone than is necessary for the proper placement of dental implants in the area.

Bone Regeneration

Quite often during the process of dental implants placement, a decrease in the amount of bone in the jaw area is observed. The main reason for bone loss, is the long-term loss of teeth in this area. Due to the lack of teeth, the bone atrophies and is absorbed.

However, there are cases where the bone has been lost from other causes such as pathological processes in the jaws, wounds, cysts, etc. In all the above cases, in order to place dental implants, we must proceed with bone regeneration by placing a bone graft.

Guided Bone Regeneration (GBR)

In cases where the bone deficit is small, the method of directed bone regeneration (GBR) can be applied. According to this method the bone defect is filled with a special material called “bone graft”. This bone graft can be obtained either from the patient himself or be an xenograft of animal or human origin, that has been properly treated and is biocompatible and safe to use.

The bone graft is then covered with a special membrane and gradually transformed into healthy bone. The time required for the bone graft to heal ranges from 3-6 months. The dental implant can be placed either at the same time as the bone graft or after the bone graft has totally healed, namely 3-6 months after the bone graft placement.

Reconstruction of a bone defect with a piece (block) of bone

If the bone defect is larger, then it is necessary to place a larger piece of bone in the area which is taken from the patient himself (autologous bone graft). The bone can be taken either from the oral cavity or extraorally. The block of bone is then fixed in place with special titanium screws and allowed to heal. After about 4 months, the screws are removed and the dental implant can be placed.

Orthognathic Surgery – Combination of Orthodontics and Maxillofacial Surgery

When there is important problem on the position the jaws, e.g. severe protrusion of the upper jaw and dental malocclusion, the usual orthodontic treatment with braces is not enough. In these cases, maxillofacial surgery is necessary for the correct and complete correction of the skeletal disharmony. Maxillofacial surgery is performed under general anesthesia in a hospital.

The correct diagnosis at the start of orthodontic treatment and the simulation of the final result allows us to be sure for the progress of treatment, but also allows us to have an estimation of the final image of the patient’s face. Thus it is necessary to take initial photos and x-rays, where with the help of special software the orthodontist can simulate the final result of the treatment.

The coordination of the whole process is undertaken by the orthodontist in collaboration with the surgeon who will perform the surgical operation. The procedure usually involves preparing the mouth for some time with orthodontic mechanisms, performing orthognathic surgery and completing the orthodontic treatment continuing with the orthodontic mechanisms.

Orthognathic orthodontic treatment is selected in adults whose skeletal growth has been completed and conventional orthodontic appliances do not allow us to improve their skeletal problems. If the appearance of the face is not a major concern, but the patient is only concerned about the correct positions of the teeth, we decide together what is the most appropriate treatment for him.

The dental implant is an artificial dental root.

It looks like a screw and is made of titanium, which is a biocompatible material. They are placed with a special technique in the jaw bone, to create the base on which the artificial tooth will be placed. The placement is performed under local anesthesia in the dental practice.

For most patients, the placement of dental implants take place in two phases. In the first, the implant is placed inside the bone (implanted). For the first 3-6 months, after the surgery, the dental implants are covered by the gums and gradually become one with the jaw bone (osseointegration process). After the osseointegration in the bone, the second phase follows, that of “revealing” the implants and the impression of the implant is taken. The impression with the locations of the implants but also with the teeth of the other jaw is sent to the laboratory to build the final restoration. The whole process from the first visit to the final placement of the work in the mouth takes about 4-5 months. During the above period the patient has been provided with temporary teeth, so that he is functional and there are no aesthetic concerns.

There are cases in which the implants (bases) are placed “immediately” after the extraction of a tooth and even cases where the teeth are placed on the implants directly, “immediate loading”, without having to wait for the above time (4-5 months).

Also, in some candidates for dental implants, especially in those whose natural teeth have been lost for a long time, there is a large absorption of bone and atrophy of the gums. In these cases, the addition of bone and/or soft tissues (gums) is required, ie placement of bone graft and/or gingival graft.

Frenum of the upper lip
If you pull the upper lip outwards you will notice a strip of mucus running high like a ligament from the middle of the upper lip to the middle of the upper jaw. In some patients this ligament reaches low between the two central teeth and causes aesthetic and functional problems.

Why and when should the frenum be removed
If the frenum reaches between the two central areas of the upper jaw, it is quite often blamed for creating a space (gap) between these teeth. At the end of the orthodontic treatment and after the gap between the teeth has been closed, the orthodontist usually requests the resection (removal) of the frenum in order to avoid the recurrence of the space later.

Removal of the frenum
The operation is extremely simple and is performed in the doctor’s office under local anesthesia. After the anesthesia of the area, follows the resection of the frenum, a procedure completely painless with little inconvenience for the patient, which is usually completed in less than half an hour. After the end of the operation, a small external swelling may appear on the upper lip and a slight discomfort. The normal postoperative development requires the patient’s compliance with the instructions that will be given to him after the completion of the frenum removal. The sutures are removed after 7-10 days.

The frenum of the tongue
If you try to lift the tongue towards the palate you will notice a strip of mucus running like a ligament from the middle of the ground of the mouth behind the lower central incisors, along the lower surface of the tongue towards the top. In some patients this connection is short and quite marked.

Why and when should the frenum be removed
If the frenum is short enough to hold the tongue stuck to the floor of the mouth restricting its movements, it should be cut. Limited tongue mobility often causes difficulty in chewing and speaking. The removal of the tongue frenum is usually done at a relatively young age so that the patient does not have difficulty in speaking and pronouncing some sounds.

Removal of the tongue frenum
The operation is extremely simple and is performed in the doctor’s office under local anesthesia. The anesthesia of the area is followed by the removal of the frenum, a procedure completely painless with little inconvenience for the patient, that is usually completed in less than half an hour. Immediately after the end of the operation, a small internal swelling under the tongue and a slight discomfort may appear. Normal postoperative development requires the patient’s compliance with the instructions given to him. The sutures are removed in 7-10 days.

The sinus is an air cavity located in the posterior region of the upper jaw. Its inner surface is lined with an elastic membrane. After extraction of the posterior teeth of the upper jaw, the sinus begins to grow at the expense of the bone of the upper jaw, with the result that there is not enough bone to place an implant and replace a missing tooth. In this case, in order to be able to place the right size implants, we can apply either the method of open sinus lift or closed sinus lift technique.

In the technique of open sinus lift, we create a “bone window” through the mouth in the area we want to regenerate and approach the membrane that covers the inside of the sinus. With careful handling, we lift it and fill the gap with a suitable bone graft (autogenous or xenograft). After a waiting period of 4-6 months, new bone is created in the area and the implants of our choice can be placed. In some cases, the implants are placed at the same time with the sinus lift.