Maxillofacial Surgery and Implantology

Maxillofacial surgery is used to treat different diseases, fix injuries, and correct defects in the face, jaw, and mouth. The surgery reduces facial pain, restores function and fixes deformities. Maxillofacial surgeons are specialists who diagnose and treat oral problems related to jaw bones, lip, and palate (roof of the mouth). Maxillofacial surgery is a surgical procedure performed by a qualified maxillofacial surgeon.

Implantology is a field of dentistry that specializes in dental implants. In this procedure, a dental implant (artificial tooth root) is placed into the jawbone (in the maxilla or mandible). The implant is in the form of a screw made of titanium or titanium alloy.

Types of Maxillofacial Surgery

Maxillofacial surgery is performed on the face, jaw, and mouth conditions. The different types of surgeries used to treat them are as follows:

• Wisdom tooth removal: Wisdom tooth removal is a surgical procedure to remove one or more wisdom teeth. Wisdom teeth are the four permanent adult teeth, grown at a later stage and located at the back of the mouth on the top and bottom. The surgery is performed when the wisdom tooth does not have enough room to grow, causing pain, infection, or other major dental problems.
• Tooth extraction: Tooth extraction surgery is needed to remove teeth or if there is tooth decay, crowding, or infection. The surgery can be simple or surgical, depending on the visibility or impact of the infection. This surgery is commonly performed when any infection or decay penetrates the gums. The complete tooth extraction procedure fully removes the infected tooth.
• Apicoectomy: Apicoectomy, sometimes called root-end resection, is a dental procedure to remove inflamed gum tissue and the root of the tooth while keeping the top of the tooth intact. This minor surgery is performed to fix a tooth's root or tissues and prevent infections. Apicoectomy is commonly performed after a root canal surgery when the tooth issue remains unsolved.
• Temporomandibular Joint Surgery: The Temporomandibular Joint (TMJ) is a small joint that joins the skull and the lower jawbone, located in front of the ear. Patients with temporomandibular joint disease may experience headaches, jaw pain, earaches, difficulty opening and closing the mouth, and clicking sounds. In this surgery, the joint disc is repaired or replaced depending on the damage. This helps to restore normal jaw functioning.
• Cleft palate or lip surgery: Cleft palate is a condition in which there is an opening in the roof of the mouth. A baby is born with a cleft palate that needs surgical treatment. A cleft palate makes it hard for a baby to eat and speak. Cleft surgery is used to seal the palette and close the opening in the roof.
• Jaw reconstruction/ Reconstructive surgery: Jaw reconstruction or orthognathic surgery is a treatment to correct irregular jaw bones and realign the jaw bones and teeth to improve facial appearance & function. Jaw surgery is considered when there is no alternate treatment. In most cases, the patient will have braces before and after the surgery to keep the teeth aligned. This surgery is performed to help the patient to eat and chew easily, correct swallowing or speech problems, jaw closure problems, and facial imbalance, and repair birth defects or facial injuries.

Types of implantology

Implantology is a branch of dentistry that specializes in implants. The different types of implant techniques include:

• Bone augmentation: Bone augmentation is a procedure to restore or regenerate the jawbone when the jaw is unable to support the implants. This procedure is performed when a patient does not have enough bone to anchor the screw or implant.
• Ridge Expansion: A ridge expansion is performed when the jaw is narrow or not wide enough to support the implants. In this procedure, the ridge bone is divided into two parts (inner and outer bone segments) and stretched apart. The space between the two segments is then filled with bone graft.
• Sinus Lift: A sinus lift, also called sinus augmentation or sinus elevation, is a procedure to add a bone below the sinus when the natural bone deteriorates. This technique is used when there is not enough jaw bone to hold and secure the implant.
• Endosteal Implants: Endosteal implants are placed in the jawbone. They are commonly made of titanium in the shape of small screws, cylinders, or blades. The implants are surgically placed in the jawbone to hold the artificial teeth.
• Subperiosteal Implants: Subperiosteal implants are used when a person does not have healthy jawbones to support the dental implants. They are placed under the gum and on or about the jawbone. These implants are also used on patients who cannot undergo bone augmentation surgery.

Symptoms

A person needs maxillofacial surgery to correct facial, jaw, and mouth defects. The following symptoms may indicate any facial, jaw, or mouth problems.

• Changes in facial appearance
• Deformed on even facial bones
• Double vision
• Missing teeth
• Swelling and bruising around the face
• Bleeding gums
• Gums oozing pus
• Facial or oral trauma
• Swollen jaw
• Severe tooth pain or sores
• Dry mouth
• Spots on the tongue
• Coloured tooth (pink or greyish)
• Tooth Sensitivity
• Broken jaw
• Pain in jaw joints and muscles

When to see a Maxillofacial Surgeon?

Maxillofacial surgery deals with facial defects and problems. A maxillofacial surgeon is a specialist who diagnoses and treats these facial problems. A person needs to visit a maxillofacial surgeon if they have the following:

• Severe pain
• Abnormal jaw functioning
• Bone loss in your jaw
• Missing or broken teeth
• Oral diseases
• Extensive tooth decay
• Gum disease.
• Impacted teeth
• Benign oral pathology

Diseases that Maxillofacial Surgeon treats

Maxillofacial surgeons perform maximum facial surgery to treat several head, neck, and face conditions. They treat the following conditions:

• Dental implants to replace missing tooth/teeth
• Misaligned jaws
• Head and neck cancer
• Oral reconstructive surgery
• Cysts
• Cleft lip and palate
• TMJ disorders- Facial Trauma (Jaw Bones/Facial Bones)

Diagnosis

The diagnostic procedures to identify any maxillofacial conditions are as follows:

• Physical examination: A doctor may conduct a physical exam and check for signs and symptoms. The examination can be followed by various tests to confirm the diagnosis.
• X-ray: A facial X-ray is performed to identify tumours, infections, bone fractures, changes in bone structure, and abnormal growth. In one image, a dental x-ray is performed to capture the mouth (teeth, upper and lower jaw with surrounding tissues). This x-ray helps to diagnose and plan treatment for dentures, teeth extraction, braces, and implants. It also helps to evaluate oral cancer, cyst in jaw bones, jaw disorders, sinusitis, and periodontal disease.
• MRI: A maxillofacial MRI is performed to evaluate facial fractures and trauma. MRI is used to diagnose temporomandibular joint disorders. Jaw MRI helps to evaluate the disc position, extent of joint degenerative joint, and inflammation.
• Oral biopsy: An oral biopsy is a procedure to collect tissues from the oral cavity to check under a microscope. The test is performed to diagnose inflammatory changes in the mouth, oral lesions, and head and neck cancer.

Review

Reviewed by Dr. Anurag Singh, Principal Consultant, Dental Care, Maxillofacial Surgery and Implantology on 13-Dec-2022