When a tooth cannot be saved because of damage caused by decay, trauma, or periodontal disease, it must be removed. In most cases extractions are performed using only instruments to elevate the tooth from the socket and without a need for additional surgical techniques to section the tooth or provide access through soft tissue. This procedure is generally performed with local anesthesia and has quick healing.
When a tooth is severely broken down or fragile from decay or root canal therapy, a surgical extraction may be necessary. This procedure may include a surgical incision to separate the soft tissue from the tooth allow for better visualization of the remaining tooth structure. It some cases, it may involve removal of some bone from around the tooth or sectioning the tooth to allow for easier removal. Any surgical incisions are sutured back in place and allowed to heal after the tooth has been removed.
Bone Preservation Grafting
When a tooth is removed it may be advisable in some cases to preserve the jaw bone with a graft. This is a separate procedure from the extraction and may be treatment planned to allow for higher success for future work on the tooth, such as implant placement. It is important to provide a graft at time of extraction since it is much harder to graft at a later date due to the rapid changes that occur in the bone after a tooth has been lost.
Any suspicious area on the soft tissue of the oral cavity will require a biopsy. One of the least invasive biopsy techniques is a brush biopsy. Cells of the suspicious area are rubbed with a stiff brush and placed on a microscope slide to be stained and analyzed by a special laboratory. The slide is examined for pathology and a report is sent back to this office. A brush biopsy is usually only used for lesions that are likely to be very early pre-cancerous growths.
If a lesion is large, a small sample of the tissue may be removed to evaluate whether the tissue contains cancerous or pre-cancerous cells (called dysplasia). If the sample contains either cancerous or pre-cancerous cells, we refer the case to an oral surgeon or cancer specialist, depending on the findings of the pathologist.
If a lesion is small, an excisional biopsy may be performed where an entire lesion is removed. If there is concern that a lesion may be cancerous, the lesion plus surrounding tissue may be removed and examined for pathology and complete removal of diseased tissue.
Fibroma or Papilloma Removal
Certain oral growths have very distinct characteristics that are not consistent with cancer, but due to the location of the growth there is a potential to become cancerous. In these cases a growth can be removed and sent to a laboratory for a biopsy for verification of its non-cancerous diagnosis. An example of this type of biopsy would be the removal of a papilloma, a growth caused by one of the many papilloma viruses that exist in the human mouth.
Other Oral Surgeries
When the base of the tongue is bound down to the floor of the mouth by a tight lingual ligament, it can affect both speech and oral hygiene. If the tongue is not free to properly move about the mouth, particles of food may remain next to the teeth promoting decay. If the tongue cannot reach places in the mouth to form words easily, speech can be affected. With this condition, the Er:YAG laser can be used to release the tissue, allowing full tongue movements with very little bleeding or trauma to the tongue.
When the piece of tissue that extends from between the two front teeth to the upper lip is too tight, it can cause oral hygiene issues with trapped food, or can cause orthodontic problems if the band of tissue is so heavy that the front teeth cannot properly come together. In cases like these, the Er:YAG laser can be used to remove the tissue.
Crown Extension Surgery
When decay extends down one side of a tooth under the gums, it can cause an area of increased inflammation. In these cases a crown extension procedure is indicated to maintain gingival health around the restored area and prevent inflammation in the area.
Endosseous implants are placed to provide replacements of extracted teeth. An implant can be placed at the same time a tooth is extracted to minimize the number of surgeries the patient must undergo to replace the missing tooth. An implant is important to help preserve bone as the implant acts as a structure for bone to adhere to and to prevent bone loss in the future.
There are times when additional corrective surgery is necessary for successful placement of an implant. When there is insufficient bone between the sinus and the mouth in the upper jaw, a bone graft surgical procedure may be performed, which involves lifting the floor of the sinus and placing bone graft material to provide stabilization for an implant.