Oral and Maxillofacial Surgery

Oral and maxillofacial surgeons diagnose, surgically treat and manage injuries and disorders of the jaws and face. Some basic vocabulary is helpful in understanding more about this specialty.

Maxillofacial refers to the bones and tissues of the face and jaws.

  •  orthognathic refers to the jaws.
  •  maxilla = upper jaw
  • mandible = lower jaw

Oral and maxillofacial surgeons’ training begins with four years of dental school. This is followed by another four years or more of a residency program, usually at a hospital. They train alongside residents in general surgery, internal medicine and anesthesiology. Their practice includes extracting wisdom teeth, corrective jaw surgery, dental implant surgery, bone grafting, and removing of complex tumors, among others. Most oral and maxillofacial surgery treatments can be done comfortably with local anesthesia. Occasionally, a complicated and lengthy surgical procedure may require general anesthesia and may need to be performed in a hospital or specialized clinic.

Oral and maxillofacial surgery treatments:

  •  Extraction of impacted and non-restorable teeth
  •  Tooth replacement using dental implants
  •  Tooth root surgeries: apicoectomy; hemisection; root amputation
  •  Soft tissue surgeries such as gingivectomy and crown lengthening
  •  Bone grafting to address jaw deformities or degeneration prior to implant surgery
  • Alignment or repair of the jaw through orthognathic surgery
  • Biopsies of cysts or tumors in the facial, oral or jaw region
  • Malignant tumor removal
  •  Facial and jaw reconstruction following cancer surgery

Descriptions of some common Oral and Maxillofacial Surgeries

(Please note that more details can be found in linked pages found at the bottom of this page)

Wisdom tooth extractions

Wisdom teeth, or third molars, usually appear between the ages of 17 to 25. As they grow in later than other permanent teeth, there is often no adequate space in the mouth for them. In such cases, the wisdom teeth remain completely or partially impacted within the gum tissue. When left untreated, impacted teeth cause damage to nearby teeth, infection, and even cysts or tumors. Even fully erupted wisdom teeth may have these problems, with symptoms of persistent swelling and pain.

To minimize the risks associated with extraction, it is greatly recommended that impacted or symptomatic wisdom teeth be taken out as early as possible. In some cases, these molars are removed to prevent teeth overcrowding. The procedure is usually performed under local anesthesia.

Implants

Dental implants are artificial tooth roots which hold replacements for teeth. The initial stage of implanting the titanium post into the jaw is often done by an oral surgeon. The subsequent steps of affixing the abutment and the crown may be done by the same surgeon or the patient’s general dentist.

Tooth root surgeries

Apicoectomy, or root-end resection, is occasionally needed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure. The endodontist or oral surgeon opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling is placed to seal the end of the root canal and few stitches are placed to help the tissue heal. Hemisection refers to cutting a double-rooted tooth in half when only one of the roots is infected but treatable. The root canal is treated and then the tooth is restored. Root amputation, the surgical removal of one root in a multi-rooted molar, is performed when only one root is severely infected, while the rest of the tooth structure is healthy.

Soft tissue surgery

Most soft tissue surgery involves removing or adding and reshaping gum tissue. Chronically diseased gums and deep bacterial pockets may need to be removed (gingivectomy) in order to prevent damage to the teeth and bones supporting them. Removal and reshaping of the gums in the procedure called crown lengthening ensures that a sufficient portion of the tooth’s structure is exposed to securely hold a crown and also improves the patient’s appearance. Sometimes soft tissue must be grafted on to cover an exposed root and prevent further gum recession.

Bone grafting

Bone grafting is the process of surgically adding either natural bone or synthetic bone material to specific areas of the jaw. The added material grows together with the natural bone over time. It is often done prior to implant surgery when a patient does not have sufficient bone to safely support the implant. Those with bone loss in the upper jaw may undergo a surgical procedure called sinus lift, wherein part of the sinus membrane is moved to make room for the bone graft. Another procedure that may be done to address deformities or injuries to either upper or lower jaws is called ridge modification.

Orthognathic surgery and post-trauma facial reconstruction

Orthognathic surgery, also called corrective jaw surgery is done to correct irregularities characterized my a misaligned jaw or improper bite which cannot be corrected by orthodontic procedures. Misaligned jaws can cause difficulty with eating, speech and breathing, as well as esthetic concerns such as receding chin. It is often a factor in sleep apnea. The diagnosis and treatment plan is likely to involve the collaboration of a dentist, orthodontist and oral and maxillofacial surgeon.

Trauma injuries to the face usually include soft tissue damage, bone damage, and damage to the teeth and surrounding structures. So reconstructive surgery is likely to include grafting and suturing, and, often, small plates and screws to stabilize fractured bones. Each case is individual. Our 7 Day Dental oral and maxillofacial surgeons have the expertise to devise and execute the best treatment plan for each patient.

Oral pathology treatment

Oral cancer lesions in the cheeks, tongue and jaw tissues are generally treatable when detected early. During an oral cancer screening, an irregularity may be detected which requires a biopsy – the removal of a small amount of tissue for laboratory analysis. Malignant lesions or tumors that are highly localized can usually be removed by the oral and maxillofacial surgeon in the office, with the patient under local anesthetic. Non-cancerous cysts and benign tumors also pose a health risk and are often surgically removed.