Implant Surgery

We have to bear in mind that our teeth are not only enable us to chew foods, but also help us to speak while affecting our appearance and personal charisma.

Therefore, loss of a tooth will have a psychological as well as physiological effect on us. Implant, a special technique which replaces natural tooth with an implant material, provides the healthiest and most definite solution to all the problems arising from tooth loss.

What is Oral Implantology?
 
Implants are screw, pin, and plates made of porcelain which have no side effect on the host and function as natural teeth following the completion of their fusion with the bone tissue. Implants appear just like your natural teeth and display a natural function.

Implants have a history as old as humanity. In various levels of human development, people have mounted pieces onto their jaw bones in order to compensate for their lost teeth. Currently, titanium is the most commonly used implant material. It has a perfect compliance with the living tissues which has been used successfully for centuries in service of many fields of medicine. Titanium, shaped as a root, cylinder, or a screw, is prepared by being processed with special procedures.

What is the aim of implant use?

Maxillofacial osteoporosis, physiologically occurring as a result of tooth loss or resulting traumas, causes a reduction in the elevation and volume of the jaw bone. As a result, the prosthesis to be applied can not function completely and leads to inevitable problems in mastication and speech.

Main target of implant procedures is to provide a solution for missing teeth and functional problems of dentures and prostheses.

In which cases implants can be applied?

 In cases involving missing of a single tooth, missing of several teeth, and complete edentulism, implants can be inserted.

Can I receive an implant treatment?
 
Everyone who:

• has a normal wound healing capacity,
• can maintain oral hygiene,
• has a bone potential that is either enough or can be made enough,
• has no disease that could present a problem for implant production, can receive implant treatment. If you consider yourself as a candidate, then your doctor can decide whether implant treatment is suitable for you or not.

What are the benefits of implants?

Implant is a strong, comfortable, and reliable practice. Prosthetics built on the implants replace original teeth and present a natural appearance. While replacing the missing teeth with implants, healthy ones can be preserved. They last for much longer than other types of prostheses.

Maxillofacial Surgery

Candidates complete a 5-year Oral and Maxillofacial Surgery PhD program following 5-year undergraduate dentistry education, and earn the title of Maxillofacial Surgeon. During the doctoral training, candidates actively participate in all the treatments realized in their departments as well as involving in rotation programs in other departments such as General Anesthesia, Intensive Care, Ear-nose-throat, and General Surgery.  

Maxillofacial Deformities

The development of jaws is a complex process which lasts until puberty and is influenced from many factors. Negative factors that might occur in this period are:

• Disproportionate jaw development
• Crowding of teeth
• Speech disorders
• Chewing, swallowing, and biting problems
• Breathing problems

Treatment

The preferred treatment method for jaw deformities is the repair of jaws by surgical intervention. Orthodontic treatment is required prior to correction of crowding in teeth and preparation of jaws to the operation.  
 
 During the operation, one of the jaws, or both, are positioned in the most appropriate position regarding cosmetic and functional concerns, and then fixated.

Presence of jaw or face deformities can be easily perceived from the appearance of the face. If you complain about your chin as being receding or prominent, feeling that your teeth do not close on each other normally, or an asymmetry in your face annoys you, then you should visit an oral and maxillofacial surgeon.

The preferred treatment method for jaw deformities is the repair of jaws by surgical intervention. Orthodontic treatment is required prior to correction of crowding in teeth and preparation of jaws to the operation.
 
 During the operation, one of the jaws, or both, are positioned in the most appropriate position regarding cosmetic and functional concerns, and then fixated (two images below).
 
 Presence of jaw or face deformities can be easily perceived from the appearance of the face. If you complain about your chin as being receding or prominent, feeling that your teeth do not close on each other normally, or an asymmetry in your face annoys you, then you should visit an oral and maxillofacial surgeon.

Dental Implant

According to a survey performed among maxillofacial surgeons in USA across the whole country, patients were found to show an increasing interest and demand towards dental implants. The comparison of the current number of dental implant procedures, with the number in 1986, shows a 3-fold increase in the implant procedures carried out today. The reason why patients prefer dental implants can be summarized as follows:

• Normal nutrition and establishment of a better speech function
• Better facial esthetics
• Inconveniences caused by removable prostheses

Another reason underlying the increase in demand for implants, is the appreciation of the high rate of success in the long-term results by the public.  
 
 Implants can be used in conditions varying from single missing tooth to partial and complete missing teeth. In order to learn if you are an eligible candidate for implant treatment, visiting a maxillofacial surgeon and a dentist specialized in prosthetics, will suffice. Clinical and radiological examination will reveal your overall health status, oral health, and eligibility of the structure of your jaws for implant treatment.  

How is it applied?

As a result of the recent studies, screw implants have become the most preferred implant types because they can be easily applied and they provide long-term success.

Generally, implants are inserted into the proper sites on jaws with an easy surgical procedure under local anesthesia and left there for 2 months in order to wait for their fusion with the bone.

In the next stage, connecting pieces that will carry the prostheses are placed onto the implants and routine prosthetic procedures are performed.

This treatment process takes 2.5-3 months between the beginning and end of the examination.

Multidisciplinary Approach

Although implant procedures are generally considered as a simple surgical intervention, successful results can be more easily achieved by the combined work of a maxillofacial surgeon and prosthetic specialist. After the teeth are inserted in the mouth, tissues bordering the implant should be checked for any problem by a gingival diseases specialist every 3 months.

Bone Repairs  

• Sinus Lifting

In the upper jaw, anatomical spaces just above the teeth are called as maxillary sinuses. Maxillary sinuses exhibit a life-long growing pattern. The increase in volume of the sinuses, leads to a reduction in the bone volume of upper jaws. While those bone losses are physiologically acceptable, they might reach levels that can hamper implant procedures. In such cases, if implant treatment is planned, a special surgical procedure called as “sinus lifting” should be conducted in order to reduce the volume of sinuses and increase bone volume. In this operation which can be performed under either general or local anesthesia depending on the patient’s wish, bone particles are placed between the jaw bone and sinus mucosa and bone development is waited for the following 6 months. For this procedure, auto grafts (from hip or lower jaw) or bones that can be obtained from bone banks, or inorganic materials, can be used. After the completion of the bone formation, routine implant procedures are performed.
 

• Alveolar Bone Augmentation (Enlargement)

Osteoporosis of the jaw bones is one of the most important problems encountered in the long-term following tooth extractions. If treatment of tooth losses will be carried out with implants, bone height and volume, gain extra importance. Implant procedure requires presence of bones with certain height and volume. Reductions in bone volume at early ages due to tooth losses or severe gingival inflammation can be repaired with bone repairs. Those repairs can be conducted with auto grafts as well as inorganic materials. If auto graft will be used, than hip bone is the most ideal donator site. Skull can be used, as well.

Wisdom teeth

Wisdom teeth generally erupt at age 15-20 years. However, in cases where there is no space in the jaws for those teeth, they can not complete eruption process and stay under the gingiva or within the jaw bone (impaction).

Why should they be extracted?

A partially erupted wisdom tooth usually causes infection and crowding in the adjacent teeth. In more advanced cases, the capsule surrounding the impacted tooth may turn into a cystic formation and dissolve jaw bone.


If it is left untreated at this stage too, tumoral lesions originating from the cyst that will require more complicated procedures can be encountered.  

Should the nonproblematic wisdom teeth extracted as well?

You can not predict if an impacted wisdom tooth would later cause trouble or not. However, the treatment might be more complicated after the occurrence of the problem. Most common problems caused by the infection of an impacted wisdom tooth are pain, swelling in the jaw angle, restriction in the mouth opening, and difficulty in swallowing.  
   
Maxillofacial Fractures

Jaw fractures are generally associated with facial injuries. Due to fractures in the upper jaw, mandible, palate, cheek bones, and eye socket; difficulties in visual, respiratory, speech, and swallowing functions as well as trauma-related facial deformities, may develop.
 
Treatment

The principles of the treatment of maxillofacial fractures are the same as in other fractures of the body; broken bone is repositioned and fixated until complete fusion is established. In repositioning and fixation, open method (surgical approach), or closed method (conservative treatment) can be employed depending on the condition of the patient.

Temporomandibular Joint

Temporomandibular joint (TMJ) is a small joint that enables lower jaw to move and function, and is located where skull and mandible articulate with each other anterior to the ears.

Most common complaints associated with TMJ are earache (otalgia) and headache alongside limited mouth opening, pain and unusual sounds during jaw movement.
 
What are the causes behind joint problems?

One of the most frequent causes of TMJ disorders is involuntary practice of nonphysiological behavior that are called as “parafunction” such as grinding of the teeth and clenching of the jaw.

 Such parafunctions, if not prevented at early period, can lead to pathologies such as meniscus degenerations. Other than parafunctions; trauma, rheumatoid arthritis, and degenerative joint diseases can lead to painful or painless various symptoms in the TMJ as well.
 
Available treatment methods

Treatment of TMJ varies from conservative tooth and drug treatment to surgery. Depending on the diagnosis, in short term, pain may be attempted to be treated with a painkiller and muscle relaxants, bite guard or splint treatment, and therapies aimed to reduce stress.

 Overall, if nonsurgical approach fails or all the examinations indicate an irreversible damage that decreases patient’s quality of life, surgery may be required.

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