Dentoalvelar Surgery

Dentoalveolar surgery encompasses all procedures involved with the teeth and associated structures, including alveolar bone and adjacent soft tissue.

• Tooth extractions and associated bony surgery. This would include extraction of impacted wisdom teeth or other impactions.
• Surgical exposure of impacted teeth or extraction of teeth for orthodontic purposes. Many times your orthodontist will recommend extractions or surgical exposure of impacted teeth to help straighten your teeth.
• Surgical Endodontic procedures. The most common of these is a surgical apicoectomy, which is usually performed on a root canal treated tooth that has become infected or painful.
• Pre-Prosthetic surgery. Many surgical procedures (such as a vestibuloplasty or skin graft) can be performed to help improve the fit and retention of full or partial dentures. Other common procedures would include alveoloplasty (smoothing of bone) or exostosis removal (removal of abnormal or enlarged bone to allow dentures to fit properly).
• Surgical management of bone loss. The most common procedure is bone grafting. Many types of bone grafting can be performed to restore or “fill in” bony defects. Bone grafting materials used frequently are autologous bone (your own bone taken from a second site) or homologous bone (freeze dried human bone from a bone bank). If you wear dentures or partials, and bone loss is severe in your upper or lower jaws, placement of Implants for later use can also be performed with bone grafting procedures.

Historically, a number of methods have been described for exposure of impacted teeth:

• Celluloid crown
• Pack the wound area to maintain exposure
• Recommended gutta-percha packing
• Pins
• Orthodontic bands
• Wire ligature

The three most significant advances historically for exposure are:

• Palatal flap for exposure
• Direct-bonding brackets
• Soft tissue management

The palatal flap provided access and visibility. Direct bonding reduced morbidity by minimizing wound size and reduced tissue overgrowth and additional surgeries by having a bracket placed at the time of exposure.

Soft tissue management maintained and permitted an increase in keratinized gingiva, eliminating needless secondary surgery to treat mucogingival problems and prevent recession.

Localization and determination of a tooth’s exact position is the foremost step in surgical exposure of an impacted tooth. This can often be done by palpation in labial impactions. However, the use of periapical radiographs and occlusal radiographs plays a major role in palatal and middle alveolar impactions. Use of the buccal object rule is helpful in determining the location of impacted teeth.

Various surgical techniques can be employed to uncover impacted teeth. The vertical location of the permanent tooth position to deciduous tooth and the amount of gingiva available, will determine the selection of the appropriate technique. The goal of these mucogingival interceptive surgeries is to prevent the ectopic permanent tooth from developing periodontal lesions in its most incipient stage. In this paper, a case report is presented to discuss the validity of utilizing periodontal surgery to increase a band of keratinized tissue in a case of an impacted canine erupting from the alveolar mucosa.