FAQ

Wisdom teeth

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What are “wisdom teeth”?

The maxillary and mandibular third molars are often misshapen or distorted due to their placement. These molars are termed “wisdom teeth” because their eruption dates are late, from 17 to 21 years of age (presumably when wisdom is supposed to come). Most people have four wisdom teeth at the back of the mouth — two on the top, two on the bottom

Wisdom teeth — the third molars in the very back of your mouth — very often don’t have room to grow properly and can cause problems. Erupting wisdom teeth can grow at various angles in the jaw, sometimes even horizontally. Problems can include wisdom teeth that:

Remain completely hidden within the gums. If they aren’t able to emerge normally, wisdom teeth become trapped (impacted) within your jaw. Sometimes this can result in infection or can cause a cyst that can damage other teeth roots or bone support.
Emerge partially through the gums. Because this area is hard to see and clean, wisdom teeth that partially emerge create a passageway that can become a magnet for bacteria that cause gum disease and oral infection.
Crowd nearby teeth. If wisdom teeth don’t have enough room to come in properly, they may crowd or damage nearby teeth.

Impacted wisdom teeth can result in pain, damage to other teeth and other dental problems. In some cases, impacted wisdom teeth may cause no apparent or immediate problems. But because they’re hard to clean, they may be more vulnerable to tooth decay and gum disease than other teeth are.
Impacted wisdom teeth that cause pain or other dental complications are usually removed. Some dentists and oral surgeons also recommend removing impacted wisdom teeth that don’t cause symptoms to prevent future problems.

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Impacted wisdom teeth. Symptoms

Impacted wisdom teeth don’t always cause symptoms. However, when an impacted wisdom tooth becomes infected, damages other teeth or causes other dental problems, you may experience some of these signs or symptoms: red or swollen gums, tender or bleeding gums, jaw pain, swelling around the jaw, bad breath, an unpleasant taste in your mouth, difficulty opening your mouth. See your dentist if you experience symptoms in the area behind your last molar that may be associated with an impacted wisdom tooth.
You can’t keep an impaction from occurring, but keeping regular six-month dental appointments for cleaning and checkups enables your dentist to monitor the growth and emergence of your wisdom teeth. Regularly updated dental X-rays may indicate impacted wisdom teeth before any symptoms develop.

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Removing wisdom teeth

Some dentists recommend removing wisdom teeth if they don’t fully emerge. Many dentists believe it’s better to remove wisdom teeth at a younger age, before the roots and bone are fully formed, and when recovery is generally faster after surgery. This is why some young adults have their wisdom teeth pulled before the teeth cause problems.
According to the American Dental Association, wisdom teeth removal may be necessary if you experience changes in the area of those teeth, such as: pain, repeated infection of soft tissue behind the lower last tooth, fluid-filled sacs (cysts), tumors, damage to nearby teeth, gum disease, extensive tooth decay.
The decision to remove wisdom teeth isn’t always clear. Talk to your dentist or an oral surgeon about the position and health of your wisdom teeth and what’s best for your situation.

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Impacted wisdom teeth. Causes

Wisdom teeth become impacted because they don’t have enough room to come in (erupt) or develop normally. Wisdom teeth usually emerge sometime between the ages of 17 and 25. Some people have wisdom teeth that emerge without any problems and line up with the other teeth behind the second molars. In many cases, however, the mouth is too crowded for third molars to develop normally. These crowded third molars become trapped (impacted). An impacted wisdom tooth may partially emerge so that some of the crown is visible (partially impacted), or it may never break through the gums (fully impacted). Whether partially or fully impacted, the tooth may: grow at an angle toward the next tooth (second molar); grow at an angle toward the back of the mouth; grow at a right angle to the other teeth, as if the wisdom tooth is “lying down” within the jawbone; grow straight up or down like other teeth but stay trapped within the jawbone.

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Impacted wisdom teeth. Complications

Impacted wisdom teeth can cause several problems in the mouth:

Damage to other teeth. If the wisdom tooth pushes against the second molar, it may damage the second molar or increase the risk of infection in that area. This pressure can also cause problems with crowding of the other teeth or require orthodontic treatment to straighten other teeth.
Cysts. The wisdom tooth develops in a sac within the jawbone. The sac can fill with fluid, forming a cyst that can damage the jawbone, teeth and nerves. Rarely, a tumor — usually noncancerous (benign) — develops. This complication may require removal of tissue and bone.
Decay. Partially impacted wisdom teeth appear to be at higher risk of tooth decay (caries) than other teeth. This probably occurs because wisdom teeth are harder to clean and because food and bacteria get easily trapped between the gum and a partially erupted tooth.
Gum disease. The difficulty cleaning impacted, partially erupted wisdom teeth increases the risk of developing a painful, inflammatory gum condition called pericoronitis in that area.

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Atraumatic wisdom teeth extraction

Atraumatic extractions use vertical force to lift the tooth up, rather than wiggling it horizontally. Before the tooth is removed, your dentist carefully separates the tooth from the fibers that attach it to your mouth with a special instrument.
When a tooth is rocked back and forth during a traditional extraction, the force of the rocking damages the tissues in the tooth socket, which can cause pain for some time. Since atraumatic extraction is designed to minimize tissue damage, you’ll experience much less pain and bleeding after your tooth is removed, will recover faster and will have a lower risk of infection.
Tissue and small bits of the surrounding bone are often removed during a traditional extraction. With atraumatic tooth extraction, these structures remain undamaged. Atraumatic tooth extraction is often recommended if you plan to replace your tooth with a dental implant. Preserving as much bone as possible during the extraction provides a more stable foundation for your implant. If needed, bone grafts can be added to your jawbone immediately after an atraumatic extraction to build up the bone.

Dental implant surgery

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Overview

Dental implant surgery is a procedure that replaces tooth roots with metal, screwlike posts and replaces damaged or missing teeth with artificial teeth that look and function much like real ones. Dental implant surgery can offer a welcome alternative to dentures or bridgework that doesn’t fit well and can offer an option when a lack of natural teeth roots don’t allow building denture or bridgework tooth replacements.
How dental implant surgery is performed depends on the type of implant and the condition of your jawbone. Dental implant surgery may involve several procedures. The major benefit of implants is solid support for your new teeth — a process that requires the bone to heal tightly around the implant. Because this bone healing requires time, the process can take many months.

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Why is it better not to delay implantation?

lack of loading leads to gradual bone resorption
teeth shifting towards the gap
greater load on the remaining teeth causes inflammation of the tissues around and may lead to periodontitis
restoring teeth will be much harder, longer and more expensive over time

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Dental implant components

A dental implant consists of three separate parts: the body, the abutment, and the porcelain crown.

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Stages of dental implant surgery

Dental implant surgery is usually an outpatient surgery performed in stages, with healing time between procedures. The process of placing a dental implant involves multiple steps, including:

Damaged tooth removal
Jawbone preparation (grafting), when needed
Dental implant placement
Bone growth and healing
Abutment placement
Artificial tooth placement

The entire process can take many months from start to finish. Much of that time is devoted to healing and waiting for the growth of new bone in your jaw. Depending on your situation, the specific procedure done or the materials used, certain steps can sometimes be combined.

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Choosing your new artificial teeth

Once your gums heal, you’ll have more impressions made of your mouth and remaining teeth. These impressions are used to make the crown — your realistic-looking artificial tooth. The crown can’t be placed until your jawbone is strong enough to support use of the new tooth.
You and your dental specialist can choose artificial teeth that are removable, fixed or a combination of both:

Removable. This type is similar to a conventional removable denture and can be a partial or full denture. It contains artificial white teeth surrounded by pink plastic gum. It’s mounted on a metal frame that’s attached to the implant abutment, and it snaps securely into place. It can be easily removed for repair or daily cleaning.
Fixed. In this type, an artificial tooth is permanently screwed or cemented onto an individual implant abutment. You can’t remove the tooth for cleaning or during sleep. Most of the time, each crown is attached to its own dental implant. However, because implants are exceptionally strong, several teeth can be replaced by one implant if they’re bridged together.

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Advantages of dental implants

Improved appearance
Improved speech. With poor-fitting dentures, the teeth can slip within your mouth, causing you to mumble or slur your words. Dental implants allow you to speak without the worry that teeth might slip
Improved comfort
Easier eating. Dental implants allow you to eat your favorite foods
Improved self-esteem
Improved oral health
Durability
Convenience. Dental implants eliminate the embarrassing inconvenience of removing dentures

Maxillary sinus floor augmentation (sinus lift)

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Sinus lift and dental implant surgery

Maxillary sinus floor augmentation (also termed sinus lift, sinus graft, sinus augmentation or sinus procedure) is a surgical procedure which aims to increase the amount of bone in the posterior maxilla (upper jaw bone), in the area of the premolar and molar teeth, by lifting the lower Schneiderian membrane (sinus membrane) and placing a bone graft.
When a tooth is lost the alveolar process begins to remodel. The vacant tooth socket collapses as it heals leaving an edentulous (toothless) area, termed a ridge. This collapse causes a loss in both height and width of the surrounding bone. In addition, when a maxillary molar or premolar is lost, the maxillary sinus pneumatizes in this region which further diminishes the thickness of the underlying bone. Overall, this leads to a loss in volume of bone that is available for implantation of dental implants, which rely on osseointegration (bone integration), to replace missing teeth. The goal of the sinus lift is to graft extra bone into the maxillary sinus, so more bone is available to support a dental implant.

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Post-operative instructions

It takes about three to six months for the sinus augmentation bone to become part of the patient’s natural sinus floor bone.

For the next 4-6 weeks after the surgery you should avoid blowing your nose, sneezing through your nose, bending over: diving and flying by plane are prohibited for the next week after the surgery you should only be eating food that is soft, cool, and easy to chew. Do not eat anything spicy, hot, crunchy, tough to chew, or anything through a straw.

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Types of sinus lifts

Lateral Window Technique
Using the lateral window technique (in what is called a “direct sinus lift”), the sinus membrane is lifted to make room for the required amount of bone, which is taken from another part of the patient’s body or from a cadaver.
During the procedure, the gum tissue is reflected to expose the jawbone, where a window is created into the sinus cavity. By pushing against this now-moveable piece of the jawbone (window) and moving it inward and upward into the sinus cavity, the sinus membrane is raised higher up. A bone graft is then placed into the now-empty space left behind by the raised membrane, and the area is stitched shut. Dental implants are placed 4 to 9 months later, which gives the bone graft time to mesh with the bone already there.

Osteotome Technique
The least invasive type of sinus lift incorporates the osteotome approach, in which elevating the sinus is immediately followed by the placement of the dental implant. The procedure begins with a small hole made in the jaw bone. Bone-grafting material is placed between the jaw bone and the sinus floor, increasing the space between them. The implant is then inserted. This technique is only appropriate in cases in which there is not enough bone to secure the implant, but enough bone to lend it some stability.

BONE GRAFTING

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What is bone grafting?

Bone grafting is a surgical procedure that replaces missing bone with material from patient′s own body, an artificial, synthetic, or natural substitute. Bone grafting is possible because bone tissue has the ability to regenerate completely if provided the space into which it has to grow. As natural bone grows, it generally replaces the graft material completely, resulting in a fully integrated region of new bone.
Your surgeon may talk to you about undergoing a bone graft for dental implants if he believes that your jaw bone is too thin or soft to keep the implant in place in its current state. If the bone cannot support the implant, it may cause the implant surgery to fail.

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Types of bone grafts

There are four main types of bone grafts: alloplast (a graft composed of synthetic, non-human material), autograft (bone harvested from the patient’s own body, often from the iliac crest); allograft (cadaveric bone usually obtained from a bone bank), xenograft (bone grafts from animals).
While autografts are often considered the “gold standard” because using a patient’s own bone makes the regeneration process more seamless, they aren’t possible in every case. Your dental professional will work with you to determine which bone graft procedure is right for you and will have the proper training to perform the surgery safely and effectively.

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Dental implant surgery and bone grafting

In 80-90 percent of cases I perform bone grafting and placing dental implant simultaneously

Placing a dental implant and bone grafting can be performed simultaneously or using 2-stage technique with dental implants being placed in newly grafted bone tissue.
In 80-90 percent of cases I perform bone grafting and placing dental implant simultaneously.
The advantage of this approach is to save the patient’s time: bone grafting requires a long healing period (about 6 months). In case of simultaneous dental implantation and bone grafting, dental implant heals along with the bone. Thus, recovery from the surgery takes less time and, moreover, the patient DOES NOT REQUIRE a second surgery.

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