Bony impactionoccurs when the tooth is
blocked by both bone and soft tissue. The soft tissue
must be removed to gain access to the tooth before it can
be extracted. The oral surgeon removes the alveolar
bone over the impaction using a bur or chisel and mallet.
Removal of the bone provides access for elevators or
extraction forceps to extract the tooth. A surgical
handpiece with a bur may also be used to section the
tooth into four pieces and then each piece is removed
separately. A commonly performed impacted
extraction is the removal of unerupted third molars.
Alveoloplasty involves contouring the alveolar
structures. It may be done in conjunction with multiple
surgical extractions to eliminate sharp bone edges that
could cause discomfort to the patient, and to provide
suitably contoured bone structure for denture
fabrication and insertion. An alveoloplasty may also
be performed to contour the bone without being in
conjunction with extractions.
Osteotomy literally means cutting away of bone.
Osteotomies include maxillofacial surgery performed
to modify or correct facial abnormalities, such as
protrusion of the mandible or maxilla where the bone is
placed as far forward as possible, or retrusion of the
mandible or maxilla where the bone is placed as far
back as possible. The oral surgeon may also perform
an osteotomy on a patient who has a fractured
mandible or maxilla. The patient's teeth are splinted to
bind them together into one unit using arch bars, elastic
bands, and interdental sutures using wire. This keeps
the bones in place, while they heal into the correct
position. After healing takes places, the splint and
wiring are removed.
Exostosis is the surgical removal of bony growths
projecting past the normal contour of a bony surface. It
includes torus mandibularis often found on the
lingual surfaces of the body of the mandible, and torus
palantinus located on the center of the hard palate.
Usually, tori removals are performed to permit
fabrication and insertion of dentures, or to improve
speaking or eating functions.
A frenectomy is a surgical procedure used to
remove a malattached facial or lingual frenum. A
frenum is the tissue that attaches the tongue, cheeks,
and lips to the alveolar process of the upper and lower
jaw. The malattached tissue restricts movement of the
tongue (lingual frenum) or lips (labial frenum). The
frenum may be removed, loosened, or repositioned.
The excision of the lingual frenum is done to help
correct a condition known as tongue-tie. The labial
frenum may require surgery to enable better lip
movement, and to help prevent large diastemas
(spaces) between erupting central incisors.
Frenectomies are commonly performed on children.
A localized area of abnormal tissue is referred to as
a lesion. A biopsy is a surgical procedure to remove a
piece of tissue from the lesion for diagnostic and
microscopic examination. The information obtained
from a biopsy procedure assists the dentist in arriving
at a diagnosis and predicting the prognosis of the
disease. It is common in dentistry to remove both
normal and abnormal tissue from the surgical site for
The tissue specimen should be handled carefully to
prevent crushing or tearing. Immediately place it into a
specimen bottle containing a sufficient amount of 10
percent of buffered formalin to preserve it. Before
submitting the specimen, ensure that the bottle is
tightly closed and labeled properly. At a minimum, the
label should include the patient's name, age, sex, and
the dentist's name, your commands name, and the date
of the biopsy. The dentist will include a Tissue
Examination, SF-515 Form, with the specimen along
with a tentative diagnosis that is sent to an oral
histopathology center. If the histopathology report of
an oral biopsy has a premalignant or malignant
diagnosis, the dentist must notify the patient of the
results. Two common biopsy methods used in
dentistry are incision and excision methods.
The incision method involves the removal of a
sample of the lesion for examination. A wedge-shaped
section of the tissue from the lesion along with
adjacent normal tissue is removed for comparison.
The biopsy site is sutured and the patient is dismissed.
The incision method generally is used when the
lesion is large or in a strategic area where complete
removal of the lesion would create significant esthetic
or functional impairment. Complete surgical removal
of the lesion is not indicated until a final diagnosis is