2. Removal of maxillary cysts (cystectomy)

Through the cystectomy intervention, the surgeon removes dental cysts, a type of pathological cavities newly formed at the level of the arch and covered by an epithelial membrane, which appear due to an infection or trauma to the tooth. Cysts take the form of a sac of fluid, often appearing at the tip of the dead root of a tooth or around the crowns and roots of included teeth. Since these formations are mostly asymptomatic, they are discovered after taking a dental x-ray. When symptoms appear, they manifest as swelling and redness of the gums, and when they become infected, pain occurs. To remove them, the intervention of the surgeon is necessary. After local anesthesia, an incision is made in the gum to remove both the infection and the cystic membrane so that the chances of recurrence are minimized.

3. Apical resection

Apical resection, as a dental surgery technique, involves cutting the apical portion of the tip of the root of monoradicular or multiradicular teeth. The objective of this intervention is to seal the apical canal when the procedure was not possible through endodontic treatments, such as coronal fillings, root canal treatments. If the devitalization procedure fails, there is a risk of the formation of chronic infections – granulomas, at the base of the tooth root.

In what situations is apical resection indicated?

• When there are anatomical difficulties that prevent proper cleaning and obturation of the root canal;
• When difficulties arise related to the prosthetic rehabilitation of the affected teeth;
• In case of horizontal radicular fractures with apical necrosis;
• When blockages occur along the length of the root canal, which cannot be solved by endodontic treatment;
• When endodontic treatment has failed

How is apical resection performed?

The apical resection procedure is performed in a single session. After loco-regional anesthesia, a mucoperiosteal incision is made, the mucosa and periosteum are detached, in order to reveal the bony plate. Then, trepanation of the bone is performed and the affected bone and tooth apex are removed. The root canal is mechanically cleaned, washed and then obturated, after which a visible calibrated obturation is performed. When permeabilization of the channel cannot be achieved, sealant is applied to the level of the remaining abutment. At the end, the wound is sutured and the threads will be removed approximately one week after the intervention.

4. Preprosthetic dental surgery

Pre-prosthetic dental surgery interventions aim to resolve lesions at the level of the periodontium, i.e. the dental support tissue. In some cases, for patients who need dental restorations (prosthetics, dental bridges or dental crowns), we recommend a series of particular periodontal therapies in advance.

Bone addition is a necessary surgical intervention in the situation where you are going to have a treatment with dental implants, but the amount of jawbone is insufficient, as a result of bone loss. Through this procedure, the missing bone tissue is replaced with one of human, animal or artificial origin, in order to obtain the width and thickness necessary for implantation, and implicitly, to ensure the stability of the future prosthetic work.

Bone addition can be done with one of four types of grafts:

• Autograft, from your own bone, being the most indicated option;
• Allograft, from human bone originating from another organism;
• Xenograft, from bone of animal origin;
• Alloplasty, from synthetic bone;

What causes bone loss?

• dental extractions;
• traumatic events;
• periodontal disease;
• osteoporosis;
• the aging process;

Bone addition. When is bone reconstruction recommended?

Following a specialist consultation, the dentist recommends the addition of bone to supplement the tissue that tends to atrophy in the absence of the natural tooth. The reconstructive procedure is necessary if one of the following circumstances is verified:

• Before the actual implantation, the amount of bone proves insufficient to be able to support the dental implant and thus, to guarantee the stability of the dental work, the addition of bone is necessary;
• Bone deficiencies can also affect the posterior portion of the arches, and this deficiency is corrected by the sinus lift procedure and/or bone reconstruction with autologous, heterologous bone graft or artificial tissue;
• Bone addition is a procedure also indicated in the case of periodontal disease, to maintain intact the healthy dental structures that have been left without a portion of the supporting tissue (periodontium);
• The presence of degenerative diseases, as well as bacterial inflammation of the periodontium (periodontal disease) results in the extension of the bone atrophy process, which can be compensated by bone regeneration (bone addition);
• The regenerative procedure is also indicated in the case of the removal of tumors or cysts located in the oral cavity, a solution concluded with the loss of part of the alveolar tissue;
• Following dental extractions, the absence of natural dental structures leads to the absorption of alveolar tissue and the preservation of the supporting infrastructure can be mediated by the addition of bone.

What is the bone grafting procedure?

In the situation where the autogenous technique is used for grafting, the specialist doctor will make a small incision in the donor area under local or general anesthesia, in order to collect the bone tissue necessary to correct the defect. The trauma in the case of this procedure is minimal, if one opts for its realization with the laser or with the help of piezo surgery. After the bone tissue is harvested, the doctor makes an incision in the gum, next to the defect, to expose the jawbone. Then, the bone graft is fixed, after which it is covered with membranes and, finally, the gum is sutured. We recommend the autogenous technique because, in this way, the risk of rejection by the body is minimal.

What are the disadvantages of the bone grafting procedure?

If you opt for a grafting technique other than the autogenous one, the risk of rejection is higher than when you choose the addition of your own bone tissue. Even though this method is considered to be the safest, fusion with the jawbone is not completely guaranteed. Therefore, for the body to accept the bone graft and the jaw bone to heal, to be ready for the implant, you will have to wait a period of three months to a year.

Sinus lift 

Sinus lift is the surgical procedure of bone addition, in which the donor bone is used to raise the area of the upper jaw bone, much too thin compared to the lower one, to support the future dental implant. In that portion, the bony structure of the jaw is not compact like the mandibular correspondence area, but is characterized by the presence of an air-filled cavity known as the maxillary sinus. Through the sinus lift procedure, the bone tissue grows volumetrically on the upper arch and the membrane of the maxillary sinus is elevated.

What is the sinus lift procedure?

The sinus lift procedure can be performed on the same day as the implantation, and it is sufficient to perform a local anesthesia or a general sedation, IV degree. After the anesthesia takes effect, the doctor makes an incision in the gum, which corresponds to the edentulous area, and makes a small hole, up to the membrane of the maxillary sinus. The doctor manages to raise the membrane covering the sinus, and the created space will be filled with an autologous, heterologous or artificial bone tissue graft with osteo-integrative properties. If the doctor determines that the patient’s bone tissue is thick enough to support a dental implant, the sinus lift procedure no longer needs to be supplemented with bone addition.

Gingivectomy – aesthetic remodeling of soft tissues

Gingivectomy is a surgical intervention that consists in the aesthetic remodeling of the gingival tissue, a procedure that was initially designed to treat periodontal disease, but now it is also considered an intervention with a cosmetic purpose. Through gingivectomy, the surgeon reduces the pathological gingival pockets, the spaces between the teeth, an effect caused by the loss of gingival tissue around the teeth, in periodontal disease. When these spaces, called pockets, become too deep to be cleaned with a brush, they are classified as pathological.

Another indication for gingivectomy is gingival hyperplasia, which has genetic or drug-induced causes. When undergoing orthodontic treatment, inflammation of the gums occurs when correcting the position of the teeth, and the combination of this process and bacterial plaque can trigger abnormal gum growth. Gingival hyperplasia contributes to the accumulation of food debris and favoring bacterial colonies, which makes daily dental hygiene difficult.

What types is gingival hyperplasia?

• Genetic;
• Idiopathic, appearing during orthodontic treatments or caused by certain drugs;

What are the contraindications of gingivectomy?

• The need for surgery on the bone or examination of the shape of the bone and its morphology;
• For aesthetic reasons, especially in the case of the anterior jaw;
• In situations where the distal end of the pocket is apical to the mucogingival junction;

What does gingivectomy involve?

After the doctor performs the local anesthesia, the excess tissue is resected with the help of a scalpel, electrocautery, laser or diamond burr. The intervention lasts between 10-15 minutes and an hour, depending on the amount of tissue to be excised. At the end, a dressing is placed on the surgical wound, which must be kept for 10 days.

What is postoperative care?

• To control the pain, the doctor will give you painkillers;
• Mouthwashes with chlorhexidine will be used to keep the oral cavity clean;
• Brushing the gums will be easy, without traumatizing the surgical wound;
• Avoid hot foods and drinks, as well as salty, spicy or crunchy ones;
• Soft foods will be consumed;
• Avoid chewing on the treated teeth for one week;
• Local bleeding, which will persist for 2-3 days, will be kept under control with locally applied sterile dressings;
• Avoid smoking in the first week after the intervention;
• Do not give medications such as aspirin or Condamine, which promote bleeding.

Don’t put off getting a healthy and beautiful smile! The dental clinic in sector 5, located on 89-91 Petre Ispirescu street, is here to offer you the best dental services. Whether you live in Bragadiru, Magurele, Jilava, Confort Urban Residence, Dream Residence, Ideal Residence, Calea Rahovei, Sebastian or Petre Ispirescu, 13 Septembrie, this office is close to you. Do not hesitate to contact us to schedule a consultation and have the smile you want!