Plastic surgery in the oral cavity has different indications – orthodontic (occlusal problems), speech therapy (disorders of pronunciation of sounds) and even associated with a violation of sucking reflex in newborn. However, most often such operations are performed by specialists in the field of periodontology for the treatment and prevention of periodontal disease.
Plastic Surgery Of The Oral Vestibul
Plastic surgery of the oral vestibule is most often recommended for people with a small vestibule to prevent gum recession and treat periodontitis. The oral vestibule (anterior part of the oral cavity) is a space bounded on the outside by the lips, cheeks and alveolar processes of the upper and lower jaw from the inside. Approximately 20% of people have a small vestibule of the mouth, so the distance from the transition fold to the bottom of the gingival papillae of the front teeth is less than 5 mm.
Too high attachment of tissues to the alveolar processes leads to significant tension of the gums in the front teeth, which can cause not only a cosmetic defect, but also a recession (displacement of the gums in the apical direction with the exposure of tooth roots), gum atrophy, other signs of periodontal disease (gingivitis, bad breath, bleeding gums, etc.).
Plastic surgery of the oral vestibule is performed to eliminate a cosmetic defect, as well as to treat gingivitis, recession, treatment of periodontitis, which are caused by the small vestibule of the oral cavity.
Currently, there are several methods of the plastic surgery of the oral vestibule , but mostly open techniques are used (as a result of deepening the vestibule of the mouth on the alveolar process and the mucous membrane of the lip, wound surfaces remain open and heal by secondary tension), closed (after deepening the anterior cavity , the wound surface is closed with local tissues and sutured with resorbable suture material), as well as using autografts of free skin or mucous flaps to close the wound surface. In some cases, a special plate (a plate made of soft material with a vestibular pelvis) is used to form the oral vestibule , which patients use for 2-3 months after surgery.
Plastic Frenulum Of The Tongue, Lips
In addition to the plastic surgery of the oral vestibule, the plastic surgery of bridle of the tongue and lips are often used in modern dentistry.
Anomalies of the bridles of the upper or lower lip and tongue can lead to diastema (gaps between the upper incisors), occlusion and temporomandibular disorders, local recession of the gums (exposure of the neck and root of the tooth), local periodontitis, impaired articulation of the tongue, and difficulty fixing orthodontic appliances. In infants, abnormalities of the bridle of the tongue can lead to a violation of the act of sucking.
Plastic frenulum of the tongue is to lengthen it by dissecting and stratifying the edges of the wound in the horizontal plane, followed by suturing the edges of the wound, again in the vertical plane (in infants sutures may not overlap), as well as changing its attachment to the alveolar process of the mandible (dissection of soft tissues from the periosteum to the alveolar process and the free edge of the mucosa is fixed to the periosteum at the site of attachment of the sublingual muscle).
Plastics of the bridle of the upper or lower lip is performed by a V-shaped incision around the bridle, displacement and separation of muscle fibers from the bone, followed by suturing.
Tooth Extractions
Modern surgical dentistry allows in most cases to avoid tooth extraction, but still tooth extraction is sometimes necessary. Tooth extraction surgery should be performed only as a last resort, when other methods to save the tooth are no longer possible or when the tooth may be the cause of other, more serious complications.
The Endications For Tooth Extraction
Quite a frequent indication for tooth extraction is the need to rehabilitate the oral cavity in the presence of chronic periodontitis in the acute stage, when it is impossible to eliminate the inflammatory process at the apex of the tooth. In some cases, tooth extraction is performed to avoid more serious complications. For example, in the presence of teeth that can cause cysts, inflammation or neuritis of the trigeminal nerve. If the tooth constantly injures the tongue or the mucous membrane of the cheek, as well as interferes with normal occlusion, this tooth is also better to remove.
Tooth extraction surgeries are performed under effective anesthesia, taking into account all contraindications. Teeth are removed when they are severely damaged by caries, affected by advanced periodontal disease (“gum disease”), have been broken so that they can no longer be restored, incorrectly located in the mouth (eg, a submerged wisdom tooth) or in preparation for orthodontic treatment. Before you start removing teeth, the dentist examines the oral cavity, takes X-rays of diseased teeth, assesses their condition.
After the tooth is removed, the adjacent teeth begin to gradually shift, sometimes quite significantly, and this can greatly affect the overall condition of the teeth. Removing even a single tooth can create serious problems with chewing. To avoid these complications, the dentist will recommend replacing the removed tooth with an artificial one.
Given all the advances in surgical surgery to date, most patients prefer to replace an existing dentition defect by placing a dental implant (benefits of using dental implants), dental bridge, or removable partial dentures.
Wisdom Tooth Extraction
If the problem tooth is a wisdom tooth, then its extraction belongs to the category of complex. Tooth extraction is performed in cases when they are incorrectly located in the dentition, it is not possible to preserve them due to significant destruction or the threat of complications such as trigeminal neuritis, cysts, periodontitis, odontogenic osteomyelitis and others.
Wisdom teeth extraction is perfomed to slightly different reasons. Of course, the above reasons for tooth extraction are related to the wisdom teeth extraction, but in this case there are some peculiarities. Problems with wisdom teeth often occur when they erupt. They erupt at the age of 18-25 years (sometimes much later), when the dentition is formed by 28 teeth, which leads to incorrect placement of wisdom teeth in the dentition (often displaced lower wisdom teeth), immersion (incomplete eruption with a slope in the vertical, horizontal, distal or medial direction). In addition, incorrect placement of wisdom teeth can damage neighboring teeth, putting pressure on them and leading to damage to their roots and resorption, as well as their displacement and occlusion.
There are no rules that determine the most acceptable age for wisdom tooth extraction. However, practice shows that the sooner you extract these teeth, the less complications can be expected from them in the future. If there are a very serious reasons to extract a wisdom tooth, it should be extracted as soon as possible. It is best to extract these teeth when their roots have not yet formed, and the bone around the wisdom tooth is not yet very dense – it is late adolescence or early adolescence.
Wisdom teeth extraction, in violation of their eruption or location in the dentition, is recommended to carry out as soon as possible, until the above complications and finally formed the roots of wisdom teeth. If complications occur, we recommend wisdom teeth extraction.