Dental surgery

Dental surgery covers major surgery carried out in the inside of the mouth as well as operations that involve the teeth, the jaw (maxillofacial surgery) and the soft tissue inside the oral cavity. Dental surgery is normally carried out in our practices on an outpatients basis and using local anaesthesia. The most frequent surgery undertaken is the extraction of teeth as well as root end surgery.

A tooth extraction extraction is the most frequent type of dental surgery that we carry out. Our patients are given a gentle local anaesthetic after the careful clinical and radiological examinations have been completed. The actual surgery only takes a few minutes normally. If any of our patients suffer from a severe systemic disease or have to take blood-thinning medication, then the surgery might have to be carried out partially under inpatient conditions and be continually monitored by an anaesthetist. These patients can be hospitalized in the DIAKO hospital or be treated as outpatients in our practices in the Sternklinik and the Klinikum Nord (North Clinic).

We continually have to extract Wisdom teeth, which normally grow through during the 17th to 18th years. If there is insufficient space for them to grow through in the upper and lower jaws, then this will cause inflammations with abscesses or cysts, which might result in the lower jaw being broken in some cases. Impacted wisdom teeth are also renowned as the focal point of general illnesses such as myocardial inflammations or rheumatic complaints. The removal of wisdom teeth might become necessary for orthodontic reasons and the sooner this takes place the better. The removal of these teeth is normally carried out under a local anaesthetic, but a general anaesthetic might have to be used in the case of severely impacted and/or teeth that are still completely in the bone. This type of surgery takes longer than a simple tooth extraction and this normally means that you will be off work for a couple of days.

Root end surgery is the name of the surgery needed to preserve a tooth. If root canal treatment carried out by a dentist in the case of a dead (non-vital) tooth was unsuccessful or if large inflammations or cysts occur at the root end of a tooth, then orthodontic root end surgery will be necessary, in order to save the tooth. This type of operation is normally carried out using a local anaesthetic as a cut has to be made in the tooth’s root end area. The bone over the root end has to be drilled out afterwards, so that the root end as well as the surrounding inflamed tissue can be removed. The tooth’s root canal will be cleaned up and filled afterwards. This type of surgery can save many teeth, which would have to be removed otherwise, and prevent you having to have expensive tooth replacement solutions.

Hemisectioning might be necessary in the case of a molar tooth if root treatment and root end surgery is no longer possible on the root or if it proved to be unsuccessful. In this case the bone will also have to be removed from the area where the molar’s roots separate and this procedure might become necessary as a section of the root is not firmly anchored in place. A “hemisection” procedure is the separation of one or more roots together with half of the tooth crown in a multi-rooted tooth. The object here is to save the healthy part of the tooth. This type of surgery is carried out under a local anaesthetic as the tooth has to be separated using a drill and then one half of the crown together with its part of the root has to be removed. Afterwards the dentist will normally fit a crown or bridge on the remaining part of the tooth. Teeth can be saved by this type of treatment, without having to fit a removable replacement tooth, which is frequently necessary otherwise.

An incision might be necessary in the case of severe swelling or ulcerous processes, before the actual maxillofacial surgery takes place. In this case a small cut will be made, under local anaesthetisation, in the swelling to open it, so that the collected ichor or puss can flow out of the inflammation. The wound will be cleaned using a small gauze strip. The wound will be checked at regular intervals if the inflammation had to be completely cleaned away. The patient will nearly always be given a receipt for antibiotics as well.

Periodontal treatment (surgical procedures on the gums) also forms part of normal dental surgery. Professional teeth cleaning and oral hygiene training given by a specially trained dental assistant should always take place prior to a surgical procedure. A cut will be made in the periodontal pocket to open it when surgical periodontal treatment is required and the tooth and the root will be thoroughly cleaned and any deposits or inflamed tissue found inside the gum will be removed. If the bone tissue has already started to reform then either it can be regenerated using naturally produced bone substance or it can be replaced with a bone substitute material at this point in time. You will normally not be able to work for a few days after this type of operation. Optimum oral hygiene is especially important to help the operation wound to heal.

Teeth that have been lost as the result of an accident are not always completely lost. The teeth can be saved through re-implantation in many cases. It is important that the teeth are kept carefully here and using a special tooth saving box is the best option. It is possible to keep the tooth in a sterile and moist environment for up to 48 hours. However, you should visit a dentist as soon as possible in all cases. The missing tooth will be implanted under local anaesthetic and splinted to the adjacent teeth for a few weeks.

Surgical treatment can also be necessary even for our very small patients, usually caused by a fall or even by caries (tooth decay). Surgery on milk teeth problems is normally carried out under anaesthetic in our outpatients practice at the Bremen-Nord clinic and the damaged tooth will be removed without any pain in a single session. A filling will be made in the case of a carious tooth.

If a tooth transplant is needed then the damaged tooth will be replaced by an excessive tooth, which is normally a wisdom tooth. Implanting a tooth in a gap is only possible at a young age, as the root on the tooth that will be implanted has not finished growing. This method is a proven and sensible alternative to closing a gap using a bridge or an implant. You can choose to have the implant made straight after the bad tooth has been removed. The implanted tooth will have to be splinted for 2 - 3 weeks. The success of the transplant and the advance of the root growth and how the tooth has fixed itself into the bone can be determined in regular follow-up checks.

Pre-prosthetic surgery includes surgical procedures to improve the seating and the adhesion of a dental prosthesis in the upper and lower jawbones. The jawbone wanes after many years of tooth loss, so that troublesome lip and cheek ligaments as well as muscle strands restrict the suction capability of the prosthesis. Various surgical procedures to the roof of your mouth and the jawbone can improve the functional seating of the dentures and this is possible in many cases. Anchoring the dentures on implants has been given merit as the result of the increasing use of teeth implants in our specialised field. Pre-prosthetic surgery is a sensible alternative to implantology in individual cases.