For extensive jaw restorations or special conditions such as a tumor in the oral cavity, it makes sense to consult a specialist dentist for oral surgery, as their range of treatments goes beyond that of a dentist.
Oral surgery can be divided into three areas: Treatments in the oral cavity, procedures on the jaw and in dentistry. In dentistry, oral surgery is not only required when patients want dental implants, doctors also remove wisdom teeth surgically or help when a root canal filling has not brought the desired success. In such cases, a dentist specializing in oral surgery can remove the root tip.
Hemisection is also part of oral surgery. In simple terms, a molar tooth is divided into two halves in order to preserve the healthy area and use it as a bridge abutment for dental implants, for example.
Oral surgery is also used to correct misalignments of the jaw and to treat dislocations or fractures of the jawbone. In the context of implantology, jaw bone augmentation is often necessary, which is also part of the treatment spectrum of oral surgery.
An accident involving bone fractures and tooth loss is therefore also treated by oral surgery specialists. They coordinate the treatment of the jawbone and any implantology measures so that dental implants can be inserted at the optimum time.
Oral surgery is particularly important in the oral cavity when cavities form in the tissue(cysts), which can also put painful pressure on the roots of the teeth. Another area of oral surgery is surgical periodontology, in which, among other things, pockets in which bacteria become lodged are removed.
The correction of lip and tongue frenulum as well as orthodontic treatments are also part of oral surgery. One example is palatal expansion, which is used in oral surgery when the upper jaw is too small. It is slightly pushed apart at the natural growth plate and thus widened. This oral surgery procedure replaces or supplements braces for misaligned teeth.
Last but not least, oral surgery is also used when swellings (tumors) in the mouth need to be surgically removed.
An oral surgeon performs surgical procedures in the oral cavity, such as the jaw, jawbone around the tooth root, teeth and gums @ andrey_orlov /AdobeStock
Many dentists specializing in oral surgery now mention implantology separately when listing their range of services. The use of dental implants has become increasingly important, which is mainly due to medical progress.
Implantology as a branch of oral surgery has developed considerably since the mid-1980s. Today, the insertion of dental implants can be considered a routine procedure.
In a long-term study, Swiss researchers from the Dental Clinics (ZMK) in Bern were able to show that the loss rate of dental implants is low and that complications rarely occur with this form of oral surgery.
Such results mean that implantology is gaining increasing acceptance, despite the associated costs. While most areas of oral surgery are medically necessary procedures that are fully covered by statutory health insurance, the situation is different for dental implants. Tooth replacement can also be carried out using other methods such as bridges.
The health insurance funds therefore only pay a fixed subsidy. The amount depends, among other things, on the position of the tooth to be replaced. The difference is paid by the implantology patient themselves or covered by supplementary dental insurance. In most cases, a higher co-payment is therefore due for dental implants.
A bridge closes a tooth gap, which can include one or more teeth @ piyaset /AdobeStock
In oral surgery and implantology in particular, careful planning is crucial for the success of the treatment. Dental implants can only be implanted if the jaw meets certain requirements. In addition, oral surgery specialists and other implantology specialists must decide on the exact methods and work very precisely.
Before dental implants are used in oral surgery, careful diagnostics are therefore always carried out.
Orthopantomogram (OPG)
The standard procedure in implantology is the orthopantomogram (OPG). This is an X-ray device that provides two-dimensional images of the oral region in oral surgery. Before placing the dental implants, the doctor can use this image to measure the height of the jawbone, but not its width. In implantology, this diagnosis is sufficient in most cases.
An orthopantomogram, or OPG for short, is a two-dimensional X-ray image of the upper and lower jaw @ Евгений Панов /AdobeStock
Computer tomography (CT)
Other imaging procedures are available in oral surgery for more complicated cases. Computed tomography (CT) is very well established in implantology. This three-dimensional imaging technique is superior to OPG because the anatomical structures are shown in every spatial direction and the doctor knows the details of the bone structures before inserting dental implants.
However, even dentists specializing in oral surgery rarely have the relevant equipment themselves and must first refer the patient to a specialist colleague or clinic as part of the preliminary examinations for implantology. Computed tomography is only used in oral surgery if the OPG is not sufficient, as this examination is associated with a higher radiation exposure.
Dental volume tomography (DVT)
In recent years, dental volume tomography (DVT) has become increasingly popular in implantology and is now also used in other areas of oral surgery. It is again a three-dimensional imaging procedure that enables a very precise representation of the oral cavity before dental implants are implanted.
The decisive factor here is the processing of the data for implantology: the device generates very vivid 3D images, which help oral surgeons to better assess the conditions for dental implants.
However, even with CBCT, the radiation exposure for patients who want dental implants is higher than with a two-dimensional image. Experts point out that in oral surgery, the procedure that offers sufficient results with the lowest possible radiation exposure should be selected.
3D procedures are therefore primarily recommended for implantology in the following special cases:
- Unusual anatomical deviations that could complicate the placement of dental implants
- Unclear success of bone augmentation
- The 2D image did not provide sufficient results and, for example, did not delineate the neighboring teeth well enough
- Pathological changes have become apparent that affect the implantology area
- Previous operations or previous diseases of the maxillary sinus are present that could affect the dental implants, such as sinusitis
- Previous oral surgery procedures have led to complications, such as injury to nerves or the roots of neighboring teeth
- The doctor is planning special implantology procedures, e.g. an immediate restoration
In implantology, many specialists now advertise CBCT devices. To date, however, there is no study in the field of oral surgery that proves that CBCT is qualitatively superior to CT. However, it is recommended if the planning of dental implants is to be computer-assisted.
This is because for more complicated oral surgery procedures, a specialist often plans the treatment on the computer. In implantology, this means simulating the exact position of the dental implants, as well as any bone augmentation or soft tissue transplantation.
In this case, a DVT is the better procedure for oral surgery because it facilitates computer simulation. For this virtual planning of implantology, the doctor has access to databases of dental implants from various manufacturers. They can therefore select the type and size and position the dental implants in the image to check the result of the planned measures.
This procedure in turn opens up new possibilities for oral surgery: static or dynamic navigation when inserting dental implants.
Dental volume tomography (DVT) is one of the modern methods of X-ray diagnostics that produces 3D X-ray images @ coldwaterman /AdobeStock
3D drilling template
In oral surgery, static navigation is also referred to as a 3D drilling template. In simple terms, implantology planning is used to mill computer-aided templates. The doctor places these on the jaw in order to find the exact position of the dental implants during the operation. It is ideal if the templates can rest on the remaining teeth or on temporary dental implants, for example. The results are then even more precise than if they are supported by the mucous membrane or the jawbone.
For the actual implantology procedure, the expert drills through thin metal guide tubes.
In oral surgery, specialists make use of this option, for example, if the jaw reconstruction is very complex or implantology could be associated with greater risks for the patient, for example because they suffer from diabetes mellitus or an increased tendency to bleed.
3D navigation
Dental implants can also be implanted using dynamic or 3D navigation. The patient wears a rigid splint in the mouth on which reference points are marked. During the procedure, live X-ray images are taken so that the specialist can follow the position of his instruments on the screen in real time and compare it with the implantology planning.
However, the radiation exposure is higher when 3D navigation is used for dental implants. In implantology, it is therefore only recommended for particularly complicated procedures.
Oral surgery experts have not yet been able to determine any significant differences in accuracy between static and dynamic navigation. With these implantology options, patients must bear in mind that such procedures are associated with higher costs for their dental implants.
Implantology is a special case. The placement of dental implants is anatomically part of oral surgery. However, implantology is not a protected term and is therefore not subject to any special requirements. In principle, therefore, any dentist can practise implantology, even without special experience in placing dental implants.
It is therefore all the more important for patients to inquire about the qualifications of their dentist in the field of implantology if they want dental implants. Responsible dentists work together with appropriate specialist colleagues if they do not specialize in implantology themselves.
If the dentist is not a specialist in oral surgery, the addition of "Specialization in Implantology (TSP)" is an important indicator of the doctor's experience in performing operations with dental implants. This designation is verified by the Federal Association of Dentists Working in Implantology (BDIZ). It is only awarded if the doctor in question
- has completed a comprehensive training program (implantology curriculum),
- has placed or treated at least 200 dental implants and
- has at least three years of experience with dental implants.
In addition, the designation of specialization in implantology is limited to five years. An extension is only possible if evidence of further training is provided. This ensures that the dentists or oral surgery specialists in question are up to date in implantology.
The designation "Implantology Specialist of the EDA" goes one step further. In cooperation with the BDIZ, the European Dental Association (EDA) conducts examinations several times a year in which participants must document, among other things, dental implants they have placed themselves.
In addition to dentists and dentists specializing in oral surgery, specialists in oral and maxillofacial surgery can also offer dental implants. They also have the opportunity to acquire the described specialization in implantology.
The diagnostic possibilities in oral surgery are also used to determine the timing of treatment. With regard to implantology, the question of when exactly the dental implants should be inserted is answered.
Immediate implantation
Immediate implantation is possible. In this form of implantology, doctors remove the existing teeth and place the dental implants during the same treatment.
The dentist specializing in oral surgery or another doctor specializing in implantology must decide in advance whether there is enough bone material for this method. In addition, there must be no inflammation if dental implants are to be inserted immediately.
Early implantation
In oral surgery, the term early implantation means waiting until the soft tissue has healed before inserting the dental implants. Late implantation is the most common procedure in implantology. The wound and the bone are then completely healed. If necessary, the doctor will have carried out bone augmentation. Only now will the dental implants be placed.
Construction of dental implants
The actual construction of dental implants is always the same. The specialist places a post in the jawbone. There are different shapes for this post. In addition, different types of threads are used in oral surgery for dental implants when the post, also known as the body, is screwed into the bone.
In implantology, the same material is normally used as for prostheses inside the body: titanium or titanium alloys. An alternative for dental implants are models made of zirconium oxide ceramics. They are also considered to be well tolerated, which is an important factor.
The so-called neck is placed on the body. In the case of dental implants, this is the area that is later surrounded by the gums and serves as a base for the crown. In oral surgery, the crown in turn visually closes the gap in the row of teeth.
Again, implantology has variations in terms of material. Full cast crowns made of gold are hardly ever used anymore. Dental implants made of all-ceramic are considered the best, but also the most expensive option.
With a ceramic veneered crown, on the other hand, a metal framework is covered with a ceramic layer, which significantly reduces the price of this oral surgery option.
A porcelain veneered crown is the most affordable option for a dental implant. Instead of ceramic, the metal cap is covered with plastic. In principle, a specialist will always match the color and shape of the dental implants very closely to the natural teeth.
