Dentoalveolar Surgery

Our practice specializes in a wide variety of surgery involving the teeth and surrounding structures. A few of the more common procedures are listed below.

Tooth Removal

The most common procedure performed in our practice is the removal of teeth in the adult and pediatric population. Teeth are removed for many reasons such as decay, impaction, periodontal disease, infection, or part of an orthodontic plan.

Can’t the general dentist remove my tooth?

All dentists have at least basic training in the removal of teeth. Fortunately, with the advances in modern dentistry and prevention, far fewer teeth need removal compared with the past. This has allowed state of the art dental practices to concentrate on more advanced restorative and esthetic techniques. While some dentists still perform simple dental extractions, a great many refer patients to our practice to ensure the best possible surgical care. Some extractions can also be quite complex and beyond the scope of the general dentist. Our extensive surgical experience allows us to often perform procedures more quickly with less surgical trauma to adjacent bone or soft tissues. We are also able to provide a variety of anesthetic options for your safety and comfort. Our goal is to work with your dentist to provide you with the highest quality of modern dental care.

What is involved in removing a tooth?

Dental extractions can vary in complexity greatly. Our doctors will discuss your specific situation with you at the consultation appointment. Simple extractions can often be performed with local anesthesia while the patient is awake. Local anesthesia is similar to what is experienced at a general dentist office with several injections in the oral cavity. Although the sensation of pain is blocked, you would still be aware of deep pressure, vibration, and some noise. For more involved extractions or patients who desire to sleep through the procedure, intravenous anesthesia is a very comfortable option. With this method, patients are unaware of the local anesthetic injections or the procedure performed. You awake after the procedure without any memory of the surgery.

Post-operative care instructions will be reviewed in detail during your consultation and prior to discharge from our office. Our doctors are always on call if you have questions or concerns after your surgery.

Exposure and Bonding of Impacted Canine

The problem

The maxillary (upper jaw) canine, or eye tooth, normally erupts into the mouth between the ages of 11 and 13. Since these are among the last teeth to erupt, they can occasionally be crowded out of the dental arch and stay impacted in the upper jaw. Sometimes one or both canines simply develop in the wrong position. Often they lie across the roof of the mouth behind the front teeth. After orthodontic evaluation, you may be informed that these teeth may require surgical treatment at our office to facilitate orthodontic care.

Why do I need treatment?

If left alone, impacted canines will usually remain impacted in the upper jaw. These teeth can also damage the roots or affect the alignment of the adjacent teeth. By bringing these teeth into the dental arch, a nicer and faster orthodontic result is usually possible without the need to “replace” the impacted tooth with adjacent teeth or artificial replacements (bridge, implant etc.). These teeth are important in the alignment of the upper teeth and the esthetics of a beautiful smile.

What does the treatment involve?

Helping the tooth erupt into your mouth involves a relatively minor surgical procedure. This procedure is usually performed while the patient sleeps (intravenous anesthesia), although some patients may prefer only local anesthetic for more simple cases. While you are asleep, the gum lying over the canine will be pushed back to reveal the impacted tooth. Occasionally some of the bone surrounding the crown of the tooth also needs to be removed. If the tooth is near the surface, we often use a surgical laser to remove overlying tissue.

A small orthodontic bracket is then glued to the tooth. Attached to this is a small gold chain that your orthodontist can then use to gradually pull the tooth into the right position. The chain is usually attached to the orthodontic archwire at the completion of surgery. The chain is quite delicate and therefore it is important to be careful when eating and brushing. Sometimes it is necessary to hold the gum back in the right position with stitches at the end of the operation. These are usually dissolvable and take about a week to disappear. Depending upon the position of the tooth, it is sometimes possible to see the tooth after surgery and during orthodontic therapy.

What do I expect after surgery?

There is usually minimal post-operative pain following this procedure. There is also usually very little swelling or bleeding. We recommend a soft diet for several days following the procedure. You should appoint with your orthodontist in a timely fashion to begin traction on the tooth. The position of the tooth often dictates orthodontic treatment time. Your orthodontist will be able to provide you with updates during treatment.

Are there any complications with this procedure?

Fortunately, this is usually a very minor procedure and well tolerated by most patients. The success rate for this procedure is very good. Since the bracket is attached to the tooth with a form of cement, it can occasionally become dislodged during treatment. If the tooth is visible, the orthodontist can replace it. If not, we will replace the bracket in our office.

Drs. Englehardt and Vande Berg will discuss your individual situation during the consultation appointment.