Balaji Dental & Craniofacial Hospital

Balaji Dental ISO 9001:2008
Balaji SM Dr

Dentoalveolar Surgery

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Dentoalveolar surgery refers to all surgical procedures involved with the teeth and associated structures i.e. bone and soft tissues. Dr. S.M. Balaji has extensive surgical experience and performs the surgical procedure(s) quickly and with less surgical trauma.

Commonly, dentoalveolar surgeries include:

1. Tooth extractions or exodontia: Teeth may need to be removed for many reasons including severe decay, advanced gum disease, infection or as part of an orthodontic treatment plan.  
Exodontia or tooth extraction    X-ray taken before extraction of upper right third molar tooth   During extraction- Accessing the tooth from the cheek side  
Exodontia or tooth extraction   X-ray taken before extraction of upper right third molar tooth   During extraction- Accessing the tooth from the cheek side  
During extraction- accessing the tooth from the tongue side   During extraction- Grasping the tooth with forceps   The extracted upper right third molar  
During extraction- accessing the tooth from the tongue side   During extraction- Grasping the tooth with forceps   The extracted upper right third molar  

2. Transalveolar extraction of impacted teeth: Sometimes a tooth may fail to emerge into proper alignment and remains “entrapped” in the gum tissue and jaw bone. Such tooth is referred to as impacted. Impactions may occur due to various reasons. For example, the jaw may be too small and there may be insufficient space for the teeth to erupt. Teeth may also become twisted, tilted, or displaced as they try to emerge, resulting in impacted teeth.

The most common impacted teeth are wisdom teeth or third molars. Impacted teeth may result in swelling, pain and infection of surrounding gum tissue. Also, impacted teeth may cause permanent damage to nearby teeth or lead to the formation of cysts or tumors that can destroy sections of the jaw. Therefore, it is often recommend that impacted teeth be promptly removed.

X-ray showing two impacted lower canine teeth   Surgical exposure of impacted teeth   Immediately after surgical removal of impacted lower canine teeth  
X-ray showing two impacted lower canine teeth   Surgical exposure of impacted teeth   Immediately after surgical removal of impacted lower canine teeth  
           
Severely decayed and impacted lower right wisdom tooth    Impacted wisdom tooth surgically removed atraumatically      
Severely decayed and impacted lower right wisdom tooth   Impacted wisdom tooth surgically removed atraumatically      
           
-ray showing 6 impacted teeth- upper right and left third molars and lower right and left third and second molars   Surgical exposure of lower right impacted teeth   Surgical exposure of lower left impacted teeth  
-ray showing 6 impacted teeth- upper right and left third molars and lower right and left third and second molars   Surgical exposure of lower right impacted teeth   Surgical exposure of lower left impacted teeth  
All impacted teeth removed          
All impacted teeth removed          
           hr>
 X-ray showing teeth impacted in the lower right jaw region   Impacted teeth surgically removed      
X-ray showing teeth impacted in the lower right jaw region   Impacted teeth surgically removed      
           
X-ray showing impacted upper right and left third molar teeth   Left tooth surgically exposed   Left tooth surgically exposed  
X-ray showing impacted upper right and left third molar teeth   Left tooth surgically exposed   Left tooth surgically exposed  
Right tooth surgically exposed   Right tooth surgically exposed   Impacted teeth surgically removed  
Right tooth surgically exposed   Right tooth surgically exposed   Impacted teeth surgically removed  
           
CT scan image showing impacted upper right canine in the right maxillary sinus   CT scan image showing impacted upper right canine in the right maxillary sinus   Impacted tooth accessed surgically  
CT scan image showing impacted upper right canine in the right maxillary sinus   CT scan image showing impacted upper right canine in the right maxillary sinus   Impacted tooth accessed surgically  
Impacted tooth exposed   Impacted tooth surgically removed      
Impacted tooth exposed   Impacted tooth surgically removed      
           
3D Cone Beam CT (CBCT)  image showing impacted teeth in the lower right jaw   X-ray showing impacted teeth in the right lower jaw   Clinically, impacted teeth not seen  
3D Cone Beam CT (CBCT) image showing impacted teeth in the lower right jaw   X-ray showing impacted teeth in the right lower jaw   Clinically, impacted teeth not seen  
Impacted teeth surgically exposed   Impacted teeth surgically removed      
Impacted teeth surgically exposed   Impacted teeth surgically removed      

3. Surgical Endodontic procedures: The most common of these is a surgical apicoectomy, which is usually performed on a root canal treated tooth that has become infected or painful. An apicoectomy is a procedure in which the gum tissue near the tooth is opened to see the underlying bone and infected tissue is removed. The very end of the root tip is also removed and the root canal filling is sealed.

During apicoectomy- infection at root tip exposed   Apicoectomy done   Apicoectomy done  
During apicoectomy- infection at root tip exposed   Apicoectomy done   Apicoectomy done  
Immediately after apicoectomy   Diagramatic illustration of infection in root apex   Diagrammatic illustration of apicoectomy procedure  
Immediately after apicoectomy   Diagramatic illustration of infection in root apex   Diagrammatic illustration of apicoectomy procedure  

4.trong>Pre-Prosthetic surgeryan>: Sometimes surgical modifications of the jaw bone and soft tissues are required to enable the placement of a well-fitting, comfortable and aesthetic dental prosthesis such as dentures or dental implants. This preparation is referred to as pre-prosthetic surgery.

It is important that the bony ridge and soft tissues be of proper size and shape before placing the prosthesis. To achieve this, one or more of the following procedures might be needed.
  • Bone smoothing and reshaping (alveoloplasty)- irregular or sharp bone ridges are smoothened off
  • Bone grafting – this is required to “fill in” the bony defects. When there is missing teeth, jaw bone tends to shrink over time. There may not be sufficient bone to place dental implants or prosthesis. Or bone defects may occur due to gum disease. Bone grafting is a procedure to rebuild bone in the bone deficient areas of the jaw. For this, bone may be harvested from other parts of the jaw, patient’s rib or bone substitutes may be used.
  • Removal of excess bone (exostoses)- large and irregular chunks of excess bone may need to be removed to allow denture to fit properly
  • Adding, removing or reshaping the soft tissues- the soft tissues inside the mouth may require to be surgically corrected to have a well-fitting, stable denture. Excess soft tissue may require to be removed or some tissues may need to be repositioned to ensure a successful prosthesis. Soft tissue grafting may sometimes be required.
3D Cone Beam CT (CBCT) image of the lower jaw showing mandibular tori (exostoses)   3D Cone Beam CT (CBCT) image of the lower jaw showing mandibular tori (exostoses)   Clinical photograph showing the tori  
3D Cone Beam CT (CBCT) image of the lower jaw showing mandibular tori (exostoses)   3D Cone Beam CT (CBCT) image of the lower jaw showing mandibular tori (exostoses)   Clinical photograph showing the tori  
Tori surgically excised from the lower left jaw region    Tori surgically excised from the lower right jaw region   A portion of the excised bone excess  
Tori surgically excised from the lower left jaw region   Tori surgically excised from the lower right jaw region   A portion of the excised bone excess  
Severely insufficient bone in missing teeth region of upper jaw and slanting bite   Deficient region surgically exposed   Mandibular segmental subapical osteotomy -  excess bone removal from left lower jaw to correct slanting bite  
Severely insufficient bone in missing teeth region of upper jaw and slanting bite   Deficient region surgically exposed   Mandibular segmental subapical osteotomy - excess bone removal from left lower jaw to correct slanting bite  
Implant placement in upper jaw after bone grafting with excess bone from lower jaw          
Implant placement in upper jaw after bone grafting with excess bone from lower jaw          
 Missing upper front teeth with insufficient bone and altered alignment of upper and lower jaw    Le Fort I maxillary osteotomy and upper jaw advancement   rhBMP-2 placed to stimulate new bone formation and implants placed  
Missing upper front teeth with insufficient bone and altered alignment of upper and lower jaw   Le Fort I maxillary osteotomy and upper jaw advancement   rhBMP-2 placed to stimulate new bone formation and implants placed  
rhBMP-2 will stimulate new bone formation reinforcing the bone deficient region   Upper jaw adequately advanced and brought into more favourable position in relation to lower jaw   After completeion of prosthetic rehabilitation with ceramic crowns and correct teeth alignment  
rhBMP-2 will stimulate new bone formation reinforcing the bone deficient region   Upper jaw adequately advanced and brought into more favourable position in relation to lower jaw   After completeion of prosthetic rehabilitation with ceramic crowns and correct teeth alignment  

5. Exposure and bonding of unerupted teeth for orthodontic purposes – some teeth do not erupt normally and remain buried in the jaw bone. Unlike impacted wisdom teeth which are often removed, these teeth (e.g. cuspid teeth in upper jaw) are important for good dental form and function. Such “hidden” teeth may need to be surgically “uncovered” by a procedure called operculectomy and an orthodontic appliance needs to be fixed to them that will gradually bring the tooth into normal position.

Photograph showing no clinical evidence of developing teeth   Photograph showing no clinical evidence of developing teeth   Developing teeth not visible  
Photograph showing no clinical evidence of developing teeth   Photograph showing no clinical evidence of developing teeth      
Operculectomy- surgical exposure of deeply embedded tooth assisting effective orthodontic treatment          
Operculectomy- surgical exposure of deeply embedded tooth assisting effective orthodontic treatment          

6. Biopsy and removal of simple cysts and other lesions of the mouth – Some lesions occurring in the mouth and maxillofacial region required to be examined for any disease. A tissue sample is taken from the lesion and sent for histopathological examination. This procedure is called a biopsy. Some simple lesions and infections including cysts have to be removed.
D Cone Beam CT image (CBCT) showing extensive cyst in lower jaw middle region and upper left jaw   Digital X-ray showing cyst lesions    Bony lesion surgically exposed in the upper jaw   Cyst lesion surgically removed in upper jaw  
3D Cone Beam CT image (CBCT) showing extensive cyst in lower jaw middle region and upper left jaw   Digital X-ray showing cyst lesions   Bony lesion surgically exposed in the upper jaw   Cyst lesion surgically removed in upper jaw  
Bony lesion surgically exposed in the lower jaw   Cyst lesion surgically removed in lower jaw   Excised lesions and extracted infected teeth   X-ray following surgery showing good bone healing  
Bony lesion surgically exposed in the lower jaw   Cyst lesion surgically removed in lower jaw   Excised lesions and extracted infected teeth   X-ray following surgery showing good bone healing  
               
               
3D Cone Beam CT (CBCT) image showing impacted tooth and cyst in lower jaw right side   X-ray showing right lower impacted tooth with cyst lesion and other multiple impacted teeth   Surgical exposure of impacted tooth   Impacted tooth surgically removed  
3D Cone Beam CT (CBCT) image showing impacted tooth and cyst in lower jaw right side   X-ray showing right lower impacted tooth with cyst lesion and other multiple impacted teeth   Surgical exposure of impacted tooth   Impacted tooth surgically removed  
Cyst lesion excised   Removed impacted teeth   X-ray showing good bone healing after surgery      
Cyst lesion excised   Removed impacted teeth   X-ray showing good bone healing after surgery      
               
               
3D Cone Beam CT (CBCT) image showing impacted lower right wisdom tooth, affected second molar and large cyst lesion in right lower jaw   Clinical exposure of the diseased portion of the right lower jaw   Surgical exposure of the impacted tooth and cyst   Impacted teeth and cyst excised surgically  
3D Cone Beam CT (CBCT) image showing impacted lower right wisdom tooth, affected second molar and large cyst lesion in right lower jaw   Clinical exposure of the diseased portion of the right lower jaw   Surgical exposure of the impacted tooth and cyst   Impacted teeth and cyst excised surgically  
Removed infected tooth and cyst   After cyst excision and surgical removal of affected teeth   Digital X-ray taken immediately after surgery   X-ray showing very good bone healing just three months following surgery  
Removed infected tooth and cyst   After cyst excision and surgical removal of affected teeth   Digital X-ray taken immediately after surgery   X-ray showing very good bone healing just three months following surgery  
               
               
X-ray showing cyst lesion in upper jaw right side   Radiovisuograph showing cyst lesion   Surgical exposure of cyst   Cyst lesion surgically excised  
X-ray showing cyst lesion in upper jaw right side   Radiovisuograph showing cyst lesion   Surgical exposure of cyst   Cyst lesion surgically excised  
Cyst lesion surgically excised   Cyst lesion surgically excised   The excised cyst pathology   Bone defect cleaned after cyst removal  
Cyst lesion surgically excised   Cyst lesion surgically excised   The excised cyst pathology   Bone defect cleaned after cyst removal