Bone anchors
What is a bone anchor?
If you are undergoing orthodontic treatment with braces, it may sometimes be necessary to have additional anchorage points in the jaw. In such cases, one or more bone anchors can be placed. These are activated by the orthodontist to a tooth or molar using elastics. A bone anchor is a titanium plate with a hook that is secured to the jawbone with small screws.
Placing a bone anchor
The oral surgeon usually places bone anchors under local anesthesia. A small incision is made in the gum, after which the bone anchor is screwed into place at the desired location. The gum is then closed again.
Is the placement of a bone anchor painful?
As with any surgical procedure on the jaw, you may experience some pain after the placement. However, this can be effectively managed with the pain medication prescribed or recommended by the oral surgeon.
After the bone anchor procedure
After the surgery, you may notice some swelling in your cheek. This is a normal reaction to the procedure. Usually, the swelling gradually subsides within a day or two. You can reduce the swelling by cooling your cheek with a cold pack.
You will receive an informational leaflet after the procedure with instructions and advice to help minimize discomfort following the surgery.
After the procedure, you will be referred back to your orthodontist to “activate” the bone anchors. This typically happens within two weeks of the placement.
When will the oral surgeon remove the bone anchor?
Once the orthodontic treatment is complete, your orthodontist will advise you to schedule another appointment with the oral surgeon to have the bone anchors removed. The removal process is carried out in the same way as the placement.
Bone augmentation
Are you missing one or more teeth and considering replacing them with implants?
It is essential to have sufficient bone volume in the jaw to successfully place implants. If there is a lack of bone, the oral surgeon can perform a bone augmentation procedure.
There are three possible scenarios regarding bone volume:
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Sufficient bone volume
An implant can be placed without any issues and will be fully surrounded by bone.
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Relative deficiency in bone volume
An implant can be stably placed in the jaw, but it is not entirely surrounded by bone. During the same procedure, additional bone material will need to be added around the exposed part of the implant. In most cases, synthetic bone is used for this purpose.
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Absolute deficiency in bone volume
An implant cannot be placed until the bone deficiency is reconstructed. Only after the bone has healed can the implant be placed in a second procedure. The extent of the bone deficiency determines the reconstruction method:
For minor deficiencies, bone from the jaw can be transplanted to the implant site. For significant deficiencies, bone must be harvested from elsewhere in the body, such as the hip or skull.
In addition to bone volume, the quality of the gum tissue is also crucial. The oral surgeon will assess this as part of the evaluation. The implant needs a firm gum collar to prevent potential problems or infections in the future. In some cases, it may be necessary to improve the gum tissue through a separate or combined procedure.
After bone augmentation
The level of discomfort after bone augmentation depends on the extent of the reconstruction. Pain is typically well-managed with prescribed pain medication. Swelling in the face is common following the procedure. Depending on the surgical method, swelling usually subsides gradually within 3 to 14 days.
How long before implants can be placed?
In most cases, after jawbone reconstruction, the bone requires approximately three to four months to heal sufficiently before implants can be placed. In certain situations, the oral surgeon may be able to place the implants during the bone augmentation procedure.
Perforation from the upper jaw to the sinus cavity
In the upper jaw, the roots of teeth and molars can extend into the maxillary sinus. When such a tooth or molar is extracted, a hole can form in the sinus membrane, creating an open connection between the mouth and the sinus. If such a hole forms, known as a sinus perforation, it must be closed to prevent problems with the sinus.
The oral surgeon will reposition the surrounding gum tissue to cover and close the hole. This procedure is performed under local anesthesia.
Once the open connection is closed, the gum and sinus membrane need time to heal. It is important to avoid putting pressure on the sinus. For the first one to two weeks, you should avoid blowing your nose. You may, however, sniff gently. If you need to sneeze, do so with your mouth open. You can also steam the sinus to keep it clean and well-ventilated, which helps prevent sinus infections.
After the procedure, the cheek may swell. This swelling usually subsides gradually after about three days. A follow-up appointment will be scheduled to check the healing process and remove any stitches if necessary.
Mandibular joint complaints
Complaints related to the mandibular joint and/or masticatory system can be bothersome and often long-lasting, varying in intensity. These complaints can have several causes, such as trauma, surgeries, or injections. However, in the majority of cases, the cause is overuse of the masticatory muscles (Bruxism). This frequently arises as a reaction to habitual clenching or grinding of the teeth, leading to pain.
The symptoms associated with these issues are often variable in nature, with periods of discomfort followed by periods of relative calm (a wave-like pattern). The key to managing these complaints effectively lies in a treatment approach that focuses on various pillars applied at the right time:
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Rest by avoiding hard or chewy foods
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Applying warmth and performing (self)massages
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Pain relief
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Treatment by an orofacial therapist (jaw physiotherapy)
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Using a mouth guard or splint to prevent grinding
In most cases, when these recommendations are carefully followed, symptoms will decrease quickly. It is important to continue adhering to these recommendations, especially during periods of discomfort. During periods of relative calm, the recommendations can be relaxed, guided by the severity of the symptoms.
If the complaints do not sufficiently improve despite conservative treatments, additional treatments can be considered:
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Botox treatment
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Medications to reduce or relax muscle tension
Mucosal abnormalities
Abnormalities of the mucous membrane in the mouth can appear in many different forms and colors. They may have a specific cause or be part of another (internal) condition or disorder. Each abnormality requires its own specific treatment. To make a diagnosis, a biopsy may sometimes be necessary. Please bring a list of your medications, as this might assist in the evaluation.
If the oral surgeon decides it is necessary to take a biopsy of the mucosal abnormality, an appointment will be scheduled. Under local anesthesia, a small representative tissue sample will be taken and sent to the laboratory for examination. The results of the analysis will be discussed with you, and subsequent treatment will be determined.
Treatment may involve medication in some cases, while in others, surgical intervention or laser treatment may be required.
The oral surgeon will provide detailed information about the various treatment options and recommend the most suitable treatment for your specific condition.
Salivary gland disorder
Humans have three pairs of major salivary glands: one near the ear, one under the jaw, and one beneath the tongue. Additionally, there are numerous minor salivary glands located in areas such as the lips and palate.
Disorders of the salivary glands are relatively rare. The known abnormalities can generally be categorized into three groups:
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Salivary gland abnormalities associated with other systemic diseases
One of the best-known examples is Sjögren's syndrome, a chronic rheumatic autoimmune disease. It causes inflammation of the moisture-secreting glands, leading to dry mucous membranes, manifesting as dry mouth and eyes.
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Obstructions in the flow of saliva from the salivary gland and its ducts
These are the most common salivary gland disorders. Blockages in the salivary gland or its ducts can cause symptoms such as gland infections, recurrent swelling in the gland, or along the duct pathway. The most common examples are:
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Salivary stones (obstructions in the gland's ducts)
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Mucous cysts (swelling of the minor salivary glands, particularly in the lower lip)
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Swelling of the salivary glands (tumors)
The majority (>80%) of salivary gland tumors are benign. However, removal is always necessary if a tumor is present.
Diagnosis and treatment of salivary gland disorders
Oral surgeons have several tools to investigate salivary gland abnormalities. For example:
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Laboratory testing to evaluate salivary gland function
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Imaging studies, such as X-rays or MRI scans
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In cases of a tumor, a biopsy or fine needle aspiration may be performed to analyze cells and establish a diagnosis.
Treatments vary depending on the type of condition:
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For blockages in the gland or its ducts, treatment may involve stimulating salivary flow combined with massages to clear the obstruction.
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If there is an infection, antibiotics may be prescribed.
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For benign tumors, surgical removal under general anesthesia is necessary.
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For malignant tumors, the patient will be referred to an oncological center (often a university hospital) for further evaluation and treatment.
Dental implants
What is an implant?
A dental implant is an artificial root placed in your jawbone to replace a lost tooth or molar. It is a titanium screw, one of the most biocompatible materials available, which bonds well with bone. Once the implant is placed in the jaw, it needs to integrate with the bone in a process called osseointegration, which takes approximately two to six months. After this process, a crown, bridge, or overdenture can be attached to the implant, allowing you to speak, smile, and eat normally again.
How does an implant procedure work?
Before starting treatment with implants, it is necessary to assess what is required to achieve a functional and aesthetically pleasing result. Therefore, a consultation is always scheduled first. During an oral examination, it will be determined if there is sufficient jawbone volume to place an implant. A radiograph or scan of your jaw will be taken for this purpose. The quality of the gum tissue and the space between the upper and lower jaws are also evaluated to ensure that a crown or bridge can be properly placed on the implant. Based on the information gathered, a treatment plan will be created and thoroughly discussed with you.
When can a crown, bridge, or overdenture be placed on the implants?
The implant must securely bond to the jawbone, which typically takes about two to six months, depending on the specific treatment and whether additional procedures, such as bone grafting, are required. The oral surgeon will provide detailed information about this process.
What are the costs of an implant treatment?
The cost of an implant treatment depends on any necessary additional procedures (e.g., bone augmentation) to ensure the implants are stable and optimally positioned in the jaw. During the initial consultation, a detailed cost estimate for the treatment will be provided.
If the implant treatment is intended to replace one or more missing teeth, the costs are generally not covered by basic health insurance. You will need supplemental dental insurance to have part or all of the costs reimbursed, or you will need to pay for the treatment yourself.
If the implant treatment is intended to place implants for an overdenture in a toothless jaw, you may qualify for reimbursement through your basic health insurance. In this case, the oral surgeon will submit a pre-authorization request to your health insurer for the estimated costs. Your health insurer must approve this authorization; only then will the costs be reimbursed, and your treatment can proceed.
Removal of a wisdom tooth or dental element
The removal of wisdom teeth and dental elements is the most common procedure performed by an oral surgeon. They are especially suited to surgically remove difficult-to-reach wisdom teeth, broken dental elements, or root remnants.
Why are wisdom teeth removed?
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Impaction
The wisdom tooth is impacted, meaning it doesn't have the space to properly emerge. This can lead to pain, swelling, and infection.
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Crowding
If there is insufficient space in the jaw, wisdom teeth can press against adjacent teeth, causing the alignment of the teeth to change.
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Caries and infections
Wisdom teeth are located at the back of the mouth, making them harder to keep clean. This can lead to cavities in the wisdom teeth and inflammation of the gums around them.
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Cysts
Impacted wisdom teeth can sometimes lead to the formation of cysts. These are usually developmental cysts that can grow and cause damage to the jawbone.
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Orthodontic reasons
If a person is undergoing orthodontic treatment, the orthodontist may request the removal of the wisdom teeth to maintain the results of the treatment and prevent relapse.
The removal of a wisdom tooth
Removal of one or more wisdom teeth is generally performed under local anesthesia. First, an X-ray of your jaw is taken so the wisdom teeth can be properly assessed. Particular attention is paid to any risks that may occur during the operation. An example of such a risk is damage to the nerve that runs through the lower jaw. The risks and consequences of any potential damage will be discussed with you. If there is a significant risk of complications from the removal of the wisdom teeth, the oral surgeon will allow you time to consider your options at home, so you can make a calm and well-informed decision about whether or not to undergo the treatment. If there are no risks, the oral surgeon will administer local anesthesia, and once it has taken effect, the wisdom tooth will be surgically removed. During the procedure, you will feel that work is being done on your jaw, but you should not feel any pain.
After the wisdom tooth is removed, the wound may be closed with a suture if necessary. These sutures dissolve on their own after 10-14 days. A suture is not always needed. Finally, a piece of gauze is placed on the wound, which you need to bite on for about 30 minutes. This stops the bleeding in the open tooth socket.
What aftercare is needed after removal of a wisdom tooth?
Proper aftercare is important to minimize discomfort after the procedure and to promote optimal healing. It's important that you do not rinse your mouth on the first day after the procedure to prevent bleeding. You should also be cautious when eating and drinking hot meals and beverages as long as the anesthesia is still effective. The day after the procedure, it's important to rinse the wound well to keep it clean. You can do this with a homemade salt solution or with a mouthwash prescribed to you. Do not use the mouthwash for longer than a week. To help reduce swelling after the procedure, you can apply slight pressure to the cheek and cool it with a cold pack.
What are normal symptoms after the removal of wisdom teeth?
Generally, some swelling of the cheek may occur after any wisdom tooth removal. The swelling usually reaches its maximum after two to three days, then gradually subsides on its own. The swelling may have a normal color but can also appear blue-yellow due to slight bruising. You may also experience some stiffness of the chewing muscles in the first few days after the procedure or find it difficult to open your mouth fully. The advice is to follow a soft diet for several days to rest the chewing muscles. You may also feel some pain at the wound or in the jaw. These symptoms are generally well-managed with the painkillers prescribed by the oral surgeon.
Exposure of dental elements
Exposure of dental elements
Teeth that fail to properly erupt can cause problems with the alignment of the teeth that have already emerged. In such cases, it may be necessary to expose these unerupted teeth so they can be guided into the dental arch. These issues are usually identified by the dentist, who will often refer the patient to an orthodontist. Subsequently, the patient is often referred to an oral surgeon for the surgical
The procedure for exposing dental elements
The procedure is performed under local anesthesia. An incision is made in the gum over the tooth in the jawbone. Using a drill, bone around the crown of the tooth is removed to fully expose it. A small bracket is then attached to the crown’s surface and connected to a small chain. The gum is closed with sutures, and the chain is secured to the orthodontic wire. The orthodontist or dentist can then gradually guide the tooth out of the bone and into the dental arch.
Post-treatment care at home
After the procedure, some swelling may occur. This typically subsides on its own after a few days. The sutures placed during the procedure will dissolve on their own within 10 to 14 days. You should be careful while brushing your teeth for a few days. The operated area can be kept clean with a disinfecting mouthwash. Additionally, the oral surgeon will prescribe pain relief medication to manage any discomfort.
Apical surgery (root tip treatment)
Inflammation of the root tip
An inflammation at the root tip of a tooth or molar often occurs after a previous root canal treatment. This typically happens when the canal filling during the root canal procedure was insufficient, allowing residual nerve tissue and bacteria to remain at the root tip. These can eventually flare up and cause symptoms, leading to a root tip inflammation.
In such cases, a retreatment of the root canal may be performed. However, it is often decided to refer the patient to an oral surgeon for a root tip treatment or apicoectomy.
Root tip treatment
The removal of the inflammation around the root tip is performed under local anesthesia. A small incision is made in the gum beside the affected tooth or molar to create an opening. A drill is then used to access the root tip. Once the root tip is reached, it is shortened, and the surrounding inflamed tissue is removed. The root canal is then filled and sealed with cement. Finally, the wound is closed with dissolvable stitches that will disappear after 10–14 days.
After the root tip treatment
In the first few days after the root tip treatment, swelling in the cheek may occur. This swelling typically subsides on its own after two to three days. Any discomfort or pain can be effectively managed with the pain relief medication prescribed by the oral surgeon. You may brush your teeth as usual but avoid brushing over the gum to prevent reopening the wound. To keep the gum clean, you will be prescribed a disinfecting mouthwash.
You can eat and drink as usual after the procedure, provided you avoid hot meals or beverages. A follow-up appointment will be scheduled 3–6 months after the treatment to monitor the healing process around the root tip.
