The success of an implant is largely dependent upon the quantity and quality of the bone where the implant needs to be placed. A big issue when placing implants in the back of the mouth in the upper jaw is the location of the sinus. Implants need to be placed in bone and they cannot be placed into the sinus cavity. Since the sinus is a membrane, it can be lifted and displaced by bone in a procedure called a sinus lift or sinus augmentation. This decreases the volume of the sinus cavity, but this rarely causes problems.
Oral and maxillofacial surgeries are special areas of dentistry concerned with the diagnosis and surgical treatment of congenital or acquired diseases; dysfunction, defects, or injuries of the mouth, jaws, face, neck, and associated regions.
Some of these issues are:
When Teeth Are Lost
When a tooth must be extracted due to trauma, bone loss, or other reasons, implants may be placed in the bone if your dentist determines that you are a good candidate for implants. Please see our tooth fractures page view different types of fractures that occur in teeth.
The wisdom teeth, or third molars, are the most frequently impacted teeth due to lack of space in the jaw. In most cases, wisdom teeth that do not erupt into proper alignment should be extracted. Please visit our wisdom teeth page to see the different types of impactions.
Oral surgery can correct cases where the jaw bones are under- or overdeveloped. Cases where the upper jaw grows either too much or too little and/or the lower jaw grows too much or too little can be surgically corrected and realigned.
TMJ – Temporomandibular Joint
Otherwise known as the TMJ, this joint in front of the ear where the lower jaw pivots is a common problem area. Problems with this joint can cause headache and continuous pain. Lesser cases can be corrected with medication, therapy, and splints. However, more serious cases may require reconstruction of the joint.
When there is a suspicious growth or changed appearance of a section of tissue in the mouth, a biopsy will be performed to determine the origin of the lesion.
Oral surgery can help in cases of facial trauma that results from accidents or facial genetic malformation of the jaw and face.
Fractured cuspThis is the most common type of tooth fracture and has the best long term prognosis. In this type of fracture, a part of the tooth can completely break off and, occasionally, no pain is felt after the tooth fractures.
Treatment for this type of fracture is to place a crown on the tooth. If the fracture extends into the middle part of the tooth, root canal therapy would be required in addition to a crown.
Vertical Furcation Fracture
Vertical furcation fractureThis tooth has a vertical crack that extends vertically into or toward the furcation. The furcation, which is where the arrow is pointing, is the place where the tooth splits into two or more separate roots. The nerve is almost always involved in a vertical furcation crack. The tooth rarely separates into two pieces because the tooth is held in position by the surrounding bone.
The prognosis for this type of crack is fair but it depends on how deep the crack extends into the internal aspect of the tooth. The options are to treat the tooth with a root canal followed by a build up, post and crown or to extract the tooth.
Split Root Fracture
Split root fractureA split root fracture, also known as a subgingival oblique fracture, can be restorable depending upon where the fracture ends. The term subgingival means below the gumline. If the fracture is not too far below the gumline, the tooth can be restored with a procedure called crown lengthening, followed by adding a crown. The tooth may also require root canal treatment. If the fracture is too far below the gumline, it is unrestorable and requires extraction.
These types of fractures occur for various reasons, such as biting down on very hard foods or foreign objects, the presence of a previous filling in the tooth, or a tooth that had root canal therapy that was not treated with a crown.
Vertical Root Fracture
Vertical root fractureVertical root fractures are not a very common type of fracture and usually occur in teeth that have had root canal therapy. If the fracture is very short in length, the tooth may be saved by performing an apicoectomy. This involves gaining access to the root tip within the bone and removing the part of the root that is fractured. The only other option is an extraction.
Oblique Root Fractures
Oblique root fractureOblique Root Fractures are fractures that are limited to the roots of teeth with the crown portion intact. The fractured root is generally entirely below the gumline and usually completely within the bone.
If the fracture is close to the crown as shown by number 1 in the diagram to the right, the tooth is usually unrestorable. The tooth might be able to be treated with endodontic therapy and root amputation if the remaining roots are strong and healthy, but the overall prognosis is poor.
If the fracture is close to the tip of the root as shown by number 2 in the diagram, the tooth may be restored with root canal therapy. A root canal cannot be performed on a fractured root tip and the body tends to resorb the untreated piece. The prognosis for this procedure is fair to good, and regular exams are recommended to check how the body responds to the treatment.
See also: Dental Implants