Advanced Dentistry provides an oral surgery/extractionsservice to patients throughout Glasgow, Edinburgh and Central Scotland.
From time to time, presenting conditions will require those small operations are carried out in the mouth. These procedures fall into the category of oral surgery and a number of the most commonly encountered are listed below. These procedures are commonly carried out with the use of local anaesthesia only, however, depending upon the complexity of the procedure or the specific patient requirements, sedation techniques can also be used. All surgery is planned and carried out on a case-specific basis and this planning may involve special investigations such as X-ray or CT scan to provide as much information as required before the procedure, ensuring a predictable outcome.
Virtually all of the oral surgical procedures are carried out by our team, but we also work closely with consultant surgeons for the more extreme cases.
Routine extraction
If a tooth is deemed unrestorable in the mouth or has a poor long term prognosis, extraction may be advised. The tooth is removed as gently as possible and the area allowed to heal before replacement of the tooth is considered.
Atraumatic extraction
If a tooth is deemed unrestorable in the mouth or has a poor long term prognosis, extraction may be advised. Depending upon the options for the restoration of the area after extraction, and especially if an implant is the treatment of choice, an atraumatic extraction technique may be advised. This procedure uses a periotome to gently loosen the tooth in the socket allowing it to be lifted out with as little trauma as possible. Following the atraumatic extraction technique, the area may be considered for a socket grafting procedure (see bone grafting section) and some small stitches may be placed to allow the area to heal.
Surgical extraction
If a tooth is deemed unrestorable in the mouth or has a poor long term prognosis, extraction may be advised. In some cases, the position of a tooth or its roots, the amount of decay in a tooth, or the decreased volume of tooth tissue may mean that conventional or atraumatic extraction is not possible. In cases such as this, a surgical extraction would be carried out. This would involve a small incision to access and remove the tooth or tooth portions from beneath the gum. In some surgical cases, bone removal may be required to facilitate tooth removal. Bone removal is carried out using either a bur or piezosurgery which is considered one of the safest and most atraumatic techniques available for bone removal. Following the removal of the tooth or tooth fragments, the area is likely to be closed with some small stitches to allow the area to heal.
One of the most common surgical extractions would be the removal of impacted (stuck or jammed) lower wisdom teeth stuck within the bone or against the remaining teeth. This prevents the teeth from erupting as normal into the arch. In the clinic, we closely follow the Scottish Intercollegiate Guidelines Network (SIGN) guidelines for wisdom tooth extraction, ensuring that teeth are extracted as safely and predictably as possible. Impacted or buried wisdom tooth removal requires careful planning and may involve the use of CT scanning to determine the exact tooth position in three dimensions to ensure its safe removal without damage to adjacent structures.
Impacted canines
On occasion, the upper canine teeth can become impacted (stuck or jammed) within the bone or against the remaining teeth. This prevents the teeth from erupting as normal into the arch. These cases are generally planned following assessment by and discussion with our orthodontist. Impacted canines can either be:
Exposed – the canine is accessed and a channel made between it and the mouth to allow the orthodontic eruption of the tooth into a more favourable position in the arch.
Extracted – The canine position is such that eruption or forced eruption after exposure is not possible. In these cases, the impacted canine tooth would be accessed and extracted. In some cases, bone grafting would be placed in the area to retain/augment the bone volume of the area meaning that implant placement in the future would be possible.
Following the death of the nerve of a tooth, the standard treatment would be the removal of this nerve using standard root treatment or endodontic techniques. On occasion, when the end of the root canal is thin, branched or tortuous, simple root canal treatment may not be enough to allow the tooth to be treated to resolution. This means that there can be a persistent or chronic infection (abscess) associated with the end of the tooth root which may or may not be symptomatic. In cases such as this, surgical intervention is required to remove this small end piece or apex of the root. This procedure is known as an apicectomy and following the removal of the root end (apex), a small filling is placed at the end of the root (retrograde root filling). This procedure should remove the infection or granulation tissue, together with the source of this infected tissue (root apex) allowing resolution and the restoration of health to the area.
Cysts
Small cysts can grow within the bone around teeth or areas where teeth have been extracted. These cysts can grow and in doing so will decrease the bone volume in the jaws and can affect remaining teeth and the restorative options. These cysts, on detection, can be treated or removed using several techniques depending upon the specifics of each case.
Bone grafting, socket grafting and sinus elevation work together with all of the implant work we carry out in the clinic are classed as oral surgery. Given the vast amount of information on each of these topics, we have grouped them under the Dental Implants section. Please see the information on each of these topics in that section.
Soft tissue surgery
The soft tissue throughout the mouth is generally healthy, pink, soft and moist. Many and varied conditions or diseases can change this tissue, hence, it is extremely important to have the oral tissue checked regularly to ensure it is healthy. Small swellings in the minor salivary glands (mucoceles) can be dealt with surgically, as can small soft tissue swellings known as polyps. We have a close relationship with Oral Medicine colleagues and regularly assist in the management and review of Lichen Planus and Sjogren’s Syndrome patients (dry mouth). Also, for any lesions which require specific consultant assessment, referral via this route can be made.
The prevalence of oral cancer has increased in recent years and can affect anyone from young to elderly patients and all age groups in between. Commonly, oral cancers are associated with patients who smoke, drink alcohol, or do both – however, this is not always the case. If you notice any changes within the mouth such as white patches, red patches, or mixed red/white patches, painful areas, persistent painful or ulcerated areas, persistent hoarseness or changes in the sound of the voice, you must have these areas examined or investigated by a dentist for appropriate, quick referral for further investigation if required.
With all soft tissue or biopsy surgery, any excised samples are sent for microscopy or histopathological examination as appropriate for the supposed diagnosis to be confirmed as definitive and the most appropriate treatment be confirmed.
