Drs. Buchholz and colleagues
Oral Surgery Specialists
Areas of expertise: endodontics
out-patient surgery

Extraction of non-conservable teeth

There are a number of situations that make tooth extraction necessary:

  • the tooth is extremely loose;
  • the crown is destroyed far below the gingival margin, impeding the application of a crown;
  • chronic inflammation in the root tips that cannot be remedied with endodontic or surgical therapy;
  • the tooth has grown up or is tilted severely due to a missing neighboring tooth or antagonist;
  • the tooth must be extracted as part of orthodontic therapy.

Surgery:
In general, teeth are extracted under local anesthesia or analgosedation. The gingiva is detached from the tooth and the tooth then is extracted from the bone slowly with a forceps or a lever. Infected tissue is removed and the lesion is stitched closed.

Extraction of wisdom teeth

If the jaw does not provide sufficient space, the wisdom teeth cannot break through the gums to align themselves with the other teeth. As a result, they remain in the jaw covered by bone (referred to as impaction) or break through only partially (partial impaction).

Surgical extraction of wisdom teeth is indicated in these cases:

  • inflammation of the bone and mucous membrane around the affected wisdom tooth, in particular if the tooth has broken through only partially;
  • a cyst in the area of an impacted wisdom tooth based on the soft tissue of the crown;
  • damage to a neighboring tooth due to pressure from the wisdom teeth that cannot break through;
  • to avoid inaccessible gaps between the last teeth and the wisdom teeth to prevent caries and gingival diseases;
  • displacement of the row of teeth due the direction of growth of the wisdom teeth prior to prosthetic restoration.

Surgery:
Under local anesthesia, analgosedation or general anesthesia, the mucous membrane is removed from the bone and the tooth is exposed through bone removal using a burr and, if required, divided in half. The tooth then is extracted with a lever or a forceps.

Extraction of displaced teeth
Surgical extraction of displaced teeth is indicated in these cases:

  • inflammation of the bone and soft tissue around the crown;
  • a cyst around the crown of the impacted tooth starting from the surrounding tooth sac;
  • to prevent damage to the roots or displacement of neighboring teeth;
  • prior to prosthetic restoration;
  • if the displaced tooth causes diseases or trigeminal neuralgia (facial pain).

Surgery:
Under local anesthesia, analgosedation or general anesthesia, the mucous membrane is removed from the bone and the tooth is exposed by removing the bone with a burr.  If required, the tooth is cut in half and then extracted with a lever or a forceps.

Exposure of displaced teeth
If the jaw does not provide sufficient space, teeth cannot break through the gums and must be aligned with the other teeth. They remain in the jaw covered by bone (referred to as impaction) or break through only partially (partial impaction).

Impacted or partially impacted teeth can assume various positions and must be exposed to facilitate orthodontic alignment. During exposure, a bracket is generally glued to the individual tooth. The tooth then can be moved into the desired position.
Surgery:
Under local anesthesia, analgosedation or general anesthesia, the mucous membrane is removed from the bone and the crown is exposed by removing the surrounding bone. A bracket then is glued to the exposed crown.
Surgery of jaw cysts
In general, jaw cysts are cavities in the jaw bone that are filled with liquid or a pasty material and lined with skin that is referred to as a cyst sac.
Jaw cysts can be caused by a dead tooth or a sac around a tooth embedded in the bone (impacted or partially impacted tooth). Some cysts do not originate in a tooth but grow in the course of embryonic development.
Left untreated, cysts can grow and cause the bone to enlarge and displace the neighboring teeth and/or the walls of the maxillary sinus or the nasal cavity. Enlarged cysts in the mandible can cause fractures; infected cysts cause acute pain.
Surgery:
Depending on the size of the cyst, two surgical methods are possible, both of which are conducted under local anesthesia, analgosedation or general anesthesia:
Cystectomy
The gingiva is cut open to expose the bone over the affected area. The mucous membrane then is detached from the bone, the bone over the cyst is ablated and the entire cyst sac is removed and sent for patho-histological analysis. The lesion then is stitched closed. If the cyst was caused by a tooth, the root canal of the tooth typically is filled prior to the surgery. If the root canal has been treated already, the filling must be renewed or a root tip resection with retrograde filling procedure must be completed. If the cyst cavity is very large and the tooth moves because it is no longer attached firmly to the bone, the tooth may have to be extracted.
Cystostomy
If cysts are very large, it is not possible to remove the entire cyst sac. In this case, the cyst is opened by removing the bone wall that borders the oral cavity. This is to ensure that the cyst no longer grows, the bone can regenerate and the cavity decreases in size with time. This surgical method typically is used only in the mandible.

Maxillary sinus surgery
The maxillary sinuses are located in the maxilla bone to the right and left of the nose to which they are connected via a narrow duct. The maxillary sinuses border on the eye sockets and the maxillary teeth.

Maxillary sinus surgery is indicated in these cases:

  • chronic purulent inflammation that cannot be remedied by medication;
  • cysts;
  • an open connection between the mouth and the maxillary sinus.

Surgery:
Under local anesthesia, analgosedation or general anesthesia, the infected or mutated tissue is removed from the maxillary sinus. Under local anesthesia, the connection between the maxillary sinus and the oral mucosa is covered. To do so, the mucosa is detached from the bone using a special technique, then displaced and re-attached with stitches.

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