Muhsin Yazıcıoğlu Caddesi No: 8/1, Çukurambar/Çankaya

Impacted Tooth Extraction

The extraction of teeth that are partially or completely embedded in the gums or jawbone (e.g. wisdom teeth) may become necessary for various reasons. Partially impacted teeth are frequently infected and may cause serious systemic disorders over time, or impacted teeth may locally cause pathologies in neighboring teeth, soft tissues, bone tissues, and may be effective in the decay of neighboring teeth. In very rare cases, cysts may develop in fully impacted teeth, and periodic radiographic control of impacted teeth is important for the early diagnosis of this condition. For this reason, extraction of the relevant impacted teeth may become necessary.

Partially or fully impacted tooth operations are performed under local anesthesia. A small incision is made in the soft tissue and the necessary amount of bone tissue is removed and the tooth is extracted. Teeth that do not erupt in this way may need to be divided. After the tooth is removed, the tooth follicle (growth sac) is removed from the area, whether it is infected or not. The area is washed with plenty of serum, sutured and a tampon is placed.

Abscess Drainage

When teeth become over-infected, they cause a reaction in neighboring tissues. This results in the formation of pus-filled swellings (abscesses), which may or may not be visible from the outside. The use of antibiotics temporarily suppresses the abscess formation and makes it chronic (relieves it). It is essential to drain the abscess from the area where it is located. Abscesses that are not drained can lead to serious problems that can be life-threatening. In some cases, these swellings may also resolve with the removal of the infected tooth. For abscesses that your doctor decides cannot be treated otherwise, a small incision is made in the mouth or on the skin and a drain is placed to provide drainage. The location of the drain is determined according to the location of the abscess and the area where it is most fluid. The day after the abscess is drained, the tooth that is the source of infection is extracted and the treatment is successfully completed. After drainage through the skin, more or less scarring may remain on the facial area and therefore, unless it is not necessary, drainage through the mouth is tried to be provided.

Grafting of Soft and Hard Tissues (Augmentation)

The meaning of the word grafting is to compensate/complete the missing tissue. As a result of age-related bone resorption, the jawbone may be affected and lose volume, as well as local bone loss due to trauma or inflammation. In addition, bone tissue loss is more common in edentulous areas where teeth have been extracted and have been out of chewing function for a long time. This is similar to the thinning of the casted arm/leg during the period of dysfunction, a condition called atrophy (shrinkage of non-functioning tissue).

For whatever reason, these areas with bone loss may require grafting in order to make prostheses and/or implants. There are alternatives for grafting bone tissues. The patient’s own bone can be taken from a suitable area and placed in the area in need. The ideal graft is the graft taken from the patient himself/herself. However, the patient and the physician may alternatively prefer bone grafts of human or animal origin or tissue-friendly graft materials that are synthetically manufactured and subjected to various sterilization methods.

Apical Resection (Root Tip Removal)

Teeth with inflammation at the root tip are treated with root canal treatment. If the desired improvement in the root tip cannot be achieved with root canal treatment, the inflamed root tip is surgically removed together with the inflammation or cyst tissue instead of pulling the tooth. This procedure is called apical resection. Single-rooted front group teeth and premolars with one or two roots are suitable teeth for this procedure. Exceptionally, this treatment can also be applied to molars by evaluating anatomical neighborhoods and risks.

The procedure is performed under local anesthesia. An incision is planned according to the size of the inflamed tissue observed on X-ray and the gum is removed. The inflamed root tip is removed together with the surrounding inflamed tissue. The surrounding bone tissue is shaved a little to reach the healthy area. The area is washed with plenty of serum, sutured and a tampon is placed. The stitches should be removed after one week. During this one-week period, the patient is given antibiotics and mouthwash to control the infection and keep the wound clean. An anti-inflammatory drug other than aspirin is also recommended to control pain and prevent or reduce possible swelling. For the first 72 hours, applying cold compresses on the operation site from the outside for 5-10 minutes at 5 minute intervals will minimize the possibility of swelling and hematoma (bruising) in the soft tissue.

Implantation (Implant Surgery)

Since tooth deficiencies cause unbalanced force transmission to the jaw joint bilaterally, they can lead to joint problems in the future as well as chewing loss. In addition, a non-functioning area deprived of chewing force is formed in the area of tooth loss, and the jawbone in this area continuously shrinks (atrophies) its own volume because it is out of use.

Implants are titanium screws that are placed into the jawbone under local anesthesia under sterile conditions and imitate tooth roots, produced from pure titanium with improved surface properties. Since titanium is not perceived as a foreign body in the body, there is no foreign body reaction around the implant. Implants are placed in one or two stages, and 1.5 to 3 months after placement in the bone, new bone tissue forms around the implant and fuses with the jawbone (osseointegration).

In some cases, if the amount of bone available for dental implant surgery is insufficient, additional surgical approaches such as the use of certain materials to support the jawbone before and/or during the procedure (grafting with autogenous bone or artificial bone alternatives, use of healing membranes and fixative devices, sinus floor elevation in the upper jaw, etc.) may be required. In this case, it is known that the duration of treatment will be prolonged by 3 to 6 months or more, taking into account the physiological healing time of the bone.

Healing potentials may differ between individuals. Smoking and alcohol use may limit the success of the procedures performed especially in graft applications. Smoking is known to reduce the vascularization of tissues and negatively affect healing. Some systemic disorders and deficiencies have also been reported to affect wound healing and postoperative success expectations. Diabetes, osteoporosis, radiotherapy, vitamin B and D deficiencies, and some blood diseases are among those reported.

A Fast and Fixed Treatment Method for Complete Edentulous Patients

There are implant systems and spacers that offer the possibility to make fixed prostheses for edentulous jaws in one day. These systems have different names, but their purpose is the same. It is to ensure that the newly placed implants heal together (fuse to the bone, osseointegrate) by passively connecting them to each other within 48 hours at the latest. In this way, patients who have no teeth or who have to have all their teeth extracted are provided with temporary teeth with fixed screws within 2 days at the latest. These systems show some differences from standard implant procedures. The implant lengths are chosen as long as possible, the most posterior implants are placed at an angle of approximately 35 to 45 degrees, which requires the use of additional interface parts. It is necessary to use extra interconnectors between all implants and the prosthesis. It is important to be able to passively connect the implants with the prosthesis and therefore it is essential to use system-specific abutments for each implant.

Advanced radiographic evaluation (volumetric dental tomography) will guide the selection of the ideal size of the implants and the most favorable areas of the jaw. Therefore, dental tomography is recommended. If the patient’s systemic and clinical condition is appropriate, it may also be possible to place the implants in the same session in which the teeth are extracted. The main feature of the system is that it allows all implants placed in one jaw to be fixed to each other with a temporary prosthesis. The protocol of these systems is to finish the prosthesis and passively fix it on the implants no later than 48 hours after the implants are placed in the jawbone. Therefore, as soon as the implants are placed and sutures are removed, impressions are taken for prosthesis construction. The next day, the ready temporary teeth are fixed by screwing on the implants. While the newly placed implants support each other, the patient can complete the healing process without being toothless. After waiting for the healing period, which varies between 2 and 6 months depending on the differences created by the clinical and systemic condition of the case, the construction of metal-supported porcelain teeth or metal-supported hybrid prostheses can be started.

Excision of Cysts and Tumors

Cyst/tumor excision is the removal of tissues that have been previously diagnosed as cysts/tumors by radiographic and clinical examination, with or without biopsy. The procedure can be performed with local anesthesia or sedation depending on its size. During or after this operation, complaints such as bleeding, swelling and numbness may occur depending on the location of the lesion. Failure to remove the lesion from the area where the lesion is located may lead to life-threatening consequences in the future, starting from simpler complications such as jaw fracture. During the removal of the cyst or tumor, it may be decided to extract some teeth. In some cases, unexpected damage to neighboring teeth such as root damage and fractures may occur during the procedure. Due to the bone loss caused by the size of the cyst, a fracture of the jawbone may occur even a few months after the procedure.

Sinus Lifting (Sinus Elevation Operation)

The maxillary sinuses are air-filled cavities lined with mucous membrane on either side of the skull, approximately under the cheekbones, between the eyes and the teeth. They are called “maxillary sinuses” because they are located in the upper jaw. The maxillary sinus is in close proximity to the upper jaw molars. After the loss of these teeth, sagging of the sinuses may occur over time. Over time, the sinuses can get closer to the oral cavity as a result of the increase in the volume of the sinus cavity with the effect of air pressure. This results in insufficient bone in the edentulous area to place an implant. There are case reports that approximately 1 mm of bone remains between the sinus cavity and the oral cavity. Cases of implants placed inside the sinus cavity have also been reported in the literature. It has been reported in the literature that sinusitis may occur in these cases, the natural structure of the sinus mucosa changes and the self-cleaning ability is lost. If the maxillary sinus needs to be elevated in accordance with the length of the implant planned to be placed to restore the lost bone tissue, closed or open sinus elevation is preferred depending on the needs of the case.

Closed Sinus Elevation (Lifting) Method

It has been reported that the standard closed sinus lifting method is suitable for sinus elevation up to an average of 2 mm. However, it has also been reported in the literature that 4-5 mm bone gain can be obtained with the use of some special equipment (such as balloon method). Closed sinus lifting operation is preferred in cases where there is not much bone loss in the extraction area and the sinus does not sag too much. It is recommended for cases where the dimensional difference between the implant planned to be placed and the existing bone is around 2 mm. While the implant slot is being prepared, the closed sinus lift operation is performed from the implant slot. The fact that it can be performed without the need for a new surgical area to be opened by the cheek as in the open sinus lifting operation and that the patient’s own bone is pushed upwards from the side wall of the prepared implant slot has been revealed as factors that positively affect the healing process.

Open Sinus Lift (Lifting) Method

In cases of excessive prolapse of the maxillary sinus, an open sinus elevation operation is indicated to create sufficient bone volume. This operation aims to regain hard bone tissue in which the implant or implants can rest. If the length of the implant planned to be applied is longer than the existing bone height and the difference between them cannot be eliminated with the closed sinus lifting method, the open sinus lifting method is preferred.

Usually, the maxillary sinus is also lifted during the placement of the implant or implants. It is the process of pushing the sinus mucosa (Schneider Membrane) upwards sufficiently and placing collagen membrane and bone grafts into the resulting space. In this way, it is aimed to restore the lost bone tissue and sinus to approximately its former position and to provide the appropriate bone volume. If the patient’s existing bone allows the implant to remain fixed, it is preferred to place the implant or implants in the same session. In the literature, it has been reported that with this approach, implants form a framework for the existing sinus elevation and allow a more predictable healing. In addition, the need for a second surgery is eliminated. In addition, in cases where the available bone is less than 2 mm and it is not possible to fix the implant to the patient’s jawbone, it may be necessary to perform a sinus lift without implant placement. As a result of excessive atrophy (shrinkage of the tissue) that may occur in areas that have long since tooth extraction, a large amount of bone graft may need to be placed, and cases requiring healing times of up to 9 months have been reported in the literature. After waiting for the necessary healing time, the bone that will allow the implant to be applied to that area will only be obtained.