Bony impaction - occurs 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

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

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

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.

FRENECTOMY

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.

BIOPSY

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 comparison.

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 command’s 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.

Incision Method

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