Dental surgery becomes necessary when teeth fail to emerge into the masticatory plane (where chewing takes place), or do so insufficiently, and also in cases where periodontal disorders can no longer be treated conservatively.
In cases where the placement of a tooth needs attention (wisdom teeth, canines etc.), tooth exposure is carried out as an alternative to removal if the tooth concerned is deemed to be worth preserving.
Another surgical measure that can be adopted for children and adolescents in appropriate cases is tooth bud transplantation.
In certain cases of localized inflammation in the area of the dental root tip, a resection operation (removal of the root tip) is carried out in cooperation with the family dentist.
Inflammation of parts of the jaw that provide support for the teeth are generally caused by widespread tooth decay that spreads to the bone via the dental nerve and causes swelling of the surrounding soft tissue. Less often, periodontal diseases play a role in the development of inflammatory changes. The most serious complication of such inflammations is a generalized affliction of major sections of the jaw with the danger that it may not be possible to save the affected sections.
Such cases are treated by opening up the inflamed section by surgical means and applying antibiotics in high doses. The patient remains in hospital for this and the original cause is treated separately once the acute phase has passed.
Introducing tooth implants into toothless jaw sections represents one of the most significant innovations in dental medicine of the last 30 years. In principle, any person can benefit from this effective technique, which can make a decisive difference to the patient's well-being and is independent of the person's age, the state of the jaw and ancillary disorders. The options for tooth implantation range from the replacement of individual teeth to comprehensive replacement of rows of teeth with the aid of permanent bridging structures. Tooth implants can also be used to anchor removable dentures, making them significantly more stable.
Generally, a tooth implant is first introduced into the jawbone. This is followed by a healing period from a few weeks up to four months (depending on the condition of the bone). After that, the replacement tooth can be supplied by the referring dentist. These days, an implant usually consists of titanium, although pressable ceramic implants may be used instead.
When the healing period after the implant procedure has elapsed, the replacement tooth or teeth are inserted by the referring dentist. This is common practice both in Germany as well as abroad (Europe, USA, United Arab Emirates etc.).
The jawbone is subject to a natural process of wear and renewal that itself is based on the principle of 'form follows function'. This means that the body quickly depletes bone which is not subjected to the stresses of chewing.
This process can only be prevented through the forces exerted by chewing being transmitted to the bone via natural teeth or implanted teeth. If large sections of the jaw have degraded on account of tooth loss, a variety of techniques and materials can be used to restore the hard material. These include synthetic bone replacement materials, and the patient can also donate his or her own bone from various sources. This bone can be taken from the rear section of the jaw, or in cases of very widespread loss, bone must be transplanted from the ilium, part of the pelvis. Whereas minor bone transplants can be carried out under local anaesthetic or outpatient general anaesthetic, if whole sections of the tooth-bearing jaw need replacement this requires a hospital stay.
Such an operation must be carefully planned, and this requires a three-dimensional survey of the jawbone by means of cone beam computed tomography (CBCT). When the transplants have settled in properly, tooth implants can then be introduced. By carefully selecting the specific reconstruction measures, the implants remain stable over many years or decades..
Under certain circumstances, this surgical technique, which gained awareness recently, can be used to increase the volume of bone substance. A special apparatus is used to distend, i.e. stretch the affected jaw or facial skeleton bone section slowly. Distraction osteogenesis is often used to raise restricted bone deficits in toothless jaw sections prior to implantation, as well as for the correction of complex malformations of the facial skeleton.
Injuries of the teeth and the dental holding apparatus are frequently consequences of falls or sports accidents, more rarely other impacts such as punching. This result in a loosening of the teeth, in the extreme case, the tooth is completely detached from the jaw. A rapid therapy is required to preserve the survival chances for the injured tooth. In this case all splinting and immobilization procedures will carried out on weekends and nights.
For more extensive fractures of facial skull bones, all modern techniques of stabilization using titanium plates and screws are performed to ensure correct restoration of shape and function of the face.
These days, most cases of malocclusion can successfully be treated by orthodontic treatment of patients while they are children or adolescents. However, severe cases of skeletal anomalies cannot be treated sufficiently by means of orthodontic measures alone. Malocclusion of this type is not caused by misaligned teeth, but by irregularities in the way the entire jaw has grown.
This means that this problem can only be dealt with by means of surgical correction of the affected jaw accompanied by orthodontic pre-treatment and post-treatment. Following careful surveying of the tooth-bearing jaw sections, an operation is carried out to realign the upper jaw, the lower jaw or in many cases both jaws. The whole course of treatment and its execution are planned in close cooperation with the orthodontic dentist concerned.
Whereas benign changes in the skin or mucous membrane of the oral cavity can be treated surgically or by laser, if there are grounds for suspicion that the change is malignant then surgical removal is essential. The removal must include a sufficient amount of healthy tissue, and the remaining tissue must be kept under observation.
Following the removal of malignant skin tumours, the reconstruction of the facial skin represents a challenging task. The surgeon must have command of all the techniques available for reconstructive plastic surgery to prevent disfiguring scars and misshaping.
If a tumour is found inside the oral cavity (tongue, oral mucous membrane, gums etc.), tissue reconstruction to allow essential functions such as swallowing, speaking and breathing is extremely important for patients.
In addition to local and regional tissue flap transplantations, all current tissue transplantation techniques including vascular pedicled, micro-surgical operations to replace large sections of soft tissue and/or bone following tumour operations are possible and carried out routinely.
Aesthetic facial surgery is one of the most difficult areas of oral and maxillofacial surgery, and also one in which the practitioner is under a special obligation to do his or her best. In addition to congenital departures from the norm relating to the form and size of nose and ears, there is increasing demand for aesthetic corrective surgery to counteract the natural aging process of soft facial and neck tissue.
The whole range of operative measures for modifying the shape of nose and ears, as well as the usual techniques for tautening the eyelids and the skin of the face and neck (lid-lifting, face-lifting, neck-lifting etc.) can be carried out. All such operations are possible using local anaesthetic with or without sedative medication, or using a general anaesthetic either without a hospital stay or with subsequent in-patient treatment.
Supplementary to the operative measures for tautening the facial and neck skin mentioned above, tissue-enhancing techniques can also be used to smooth smaller wrinkles and tissue deficits. Wrinkles can be filled out from below through the injection of ‘fillers’, i.e. industrially manufactured substances such as collagen. As an alternative to these substances, autologous fat (fat from the person's own body) can be injected. To this end, fat is removed from another part of the body (e.g. the buttocks) and then, after it has undergone special treatment, reintroduced to smooth wrinkles. In addition to these techniques, it is also possible to treat wrinkles that are caused by overactivity of the mimic musculature (e.g. so-called frown lines on the forehead) using a substance (botulinum toxin) that inhibits muscle activity and therefore allows the wrinkles to smooth out.