Minor Oral Surgery

CYST ENUCLEATION

A cyst is a pathological cavity, a closed sac, having a distinct membrane and division, compared to the nearby tissues. It is a cluster of cells that have grouped together to form a sac. It may contain air, fluids or semi-solid materials. Once formed, it may resolve on its own or may have to be surgically treated by a process called as enucleation, which involves the removal of the entire cystic contents along with the lining. If any remnants are left behind, it can lead to recurrence of the cyst. Commonly occurring cysts are Dentigerous, Radicular ,Odontogenic cysts etc.

VESTIBULOPLASTY

This is a procedure done to increase the height of the vestibule (the space between the lips and the gums). If it is too shallow, there can be several mucogingival problems, difficulty in positioning the tooth brush for oral hygiene maintenance, a pull or tension on the gum margins leading to pocket formation, gingival recession etc. Vestibuloplasty is also performed prior to fabrication of removable or fixed dentures so as to form a sound base for retention of the dentures, as the flanges or extensions of the dentures rest in the vestibule.
Techniques

  • Periosteal Fenestration
  • EdlanMejchar
  • Kazangian technique
  • Laser assisted vestibuloplasty- can be performed with CO2, Diode, Nd:YAG, and Er:YAG lasers.

MAXILLARY SINUS LIFT PROCEDURES

It is a procedure performed generally before placement of dental implants in the posterior or molar region of the maxilla or the upper jaw. The maxillary sinus or antrum is a hollow cavity lined by epithelium(schneiderian membrane).It is present on both sides of the face extending from the canine region till the molar areas. The roots of these teeth sometimes project into the sinus. For placement of dental implants in the molar region, if there is less height of bone, the maxillary sinus is is in close proximity, and chances of perdoration are very high during the procedure. This can lead to post-operative infection of the sins or an or-antral communication, which can be dangerous. Thus in such cases , either an implant is not placed or a procedure called as sinus –lift is performed, where a window is created in the lateral wall of the sinus through the bone and the epithelium is lifted off, and raised higher, and the space filled with a bone graft material. This increases the height of the ridge, and enables safe placemnt of dental implants.
In direct sinus lift, the above mentioned procedure is performed first and then after 3-6 months dental implants are placed.This is an open surgery, which involves slightly more risk, and is done under antibiotic coverage.
In indirect sinus lift, the membrane is lifted through the osteotomy site for implant, simultaneously at the time of implant.This is a closed procedure and involves less risk.

BIOPSY PROCEDURES

A biopsy is a part of the tissue or complete excision of a lesion , swelling or growth in the oral cavity, which is sent for histopathological testing to the laboratory. This is generally performed in order to find out the exact nature of the lesion, especially in suspected cases of malignancy. It is also done when there is a differential opinion in the clinical presentation of a certain condition. Most common procedure is done with scalpel and blade. Nowadays lasers are being used for this purpose. There are other methods such as brush biopsy, use of dyes, exfoliative cytology, etc, to detect any changes in the initial stages of the lesions. Indications:

  • Red and white patches on the gingiva, tongue, cheek, lips, palate etc.
  • Fibrous growth or swelling of the soft tissue
  • Bony swellings
  • Dark patches of pigmentation in the oral cavity, etc.

Extraction of teeth

Extraction of teeth is the most common form of minor oral surgical procedure performed in the clinic. There are many indications for extraction of teeth. The most common indications are describd below:1. Fractured /carious/broken down teeth2. Impacted painful third molars(wisdom teeth)-these are generally stuck in the jaw bone as they have inadequate space to erupt since they erupt at a later stage of life, generally 18-25 years. If a wisdom tooth does not have an opposing tooth or is embedded in bone, it generally is extracted surgically. (Disimpaction). If the tooth is partially erupted, has an opposing tooth, and has adequate space behind it for complete eruption, yet has a soft tissue or gum covering, a minor procedure called operculectomy is performed to remove the soft tissue and facilate eruption. At times, food and bacteria may get lodged beneath this gum tissue, or pouch called operculum, leading to pus formation , swelling(abscess) called pericoronalabscesss, which may be very painful and sometimes may lead to fever and swollen lymph nodes. In this case an abscess drainage is performed and antibiotics may have to be prescribed , following which a decision is made whether to save the tooth or to extract it.
iii)Extraction of teeth for orthodontic reasons: Sometimes healthy teeth especially first or second premolars have to be extracted in cases of overcrowding, so as to make space and facilitate tooth movement.3. Extraction of impacted canines/overetained teeth: Teeth which are overretained, like deciduous teeth which do not exfoliate , or impacted(stuck in the jaw bones) canines have to be extracted, if they interfere with the normal occlusion .4. Atrauamtic extraction and socket preservation : Teeth which are diificult to retain, due to above mentioned reasons need to be extracted atraumatically using special instruments called periotomes, inorder to maintain the tooth socket intact.This is especially important when a dental implant is postulated as the line of treatment for replacement of the tooth after extraction. An adequate height, width and volume of bone of the ridge is required for a successful implant placement.