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Dentoalveolar Surgery

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Patients present to a Maxillofacial Surgeon with a variety of problems

with their teeth, gums, jaw bone and other soft tissues or bony areas in the mouth. When surgery is performed on these areas, it is called dentoalveolar surgery.

These surgeries can include:

- Extraction of a tooth or retained root

- Removal of an odontome

- Exposure of a tooth

- Frenectomy

- Oral Pathology

- Removal of cysts of the lower and upper jaw

- Vestibuloplasty to aid fitting of a partial or complete denture

- Supernumery teeth extractions

Extraction of a Tooth or Retained Root

 Teeth may require extraction:

- If the nerve in the tooth is dead or not viable to restore due to deep        

  decay or fracture.

- If the tooth is impacted (pushing against other tissues or teeth) or

   misplaced (not in a functional position).

- Gum disease

- Supernumerary teeth

Usually a referral is made to an Oral and Maxillofacial Surgeon for an extraction when:

- A tooth in an abnormal position is affecting neighbouring teeth

- Adjacent teeth need protecting or could be compromised

- There is a major nerve near the tooth to be extracted

- The tooth roots are curved, or travel deep into the bone, or the tooth 

   roots have been filled

- Teeth are unerupted and fused into the tooth bone (ankylosed)

- There are medical conditions that can complicate a tooth extraction

Still need more information? Just call for an appointment.

Removal of an Odontome

An odontome is a malformed tooth that did not develop properly.  An odentome can often cause: 

- swelling

- a delayed eruption of nearby teeth

- abnormal occlusion (or biting)

Some symptoms that may indicate presence of an odontome include:

  • Absent tooth

  • Delayed primary tooth loss

  • Delayed tooth eruption

  • Dysphagia

  • Increased bone size under tooth

  • Lump on gums

Once this is diagnosed, the usual procedure is to remove the odontome as soon as is practical, but this does depend on the age and development of the patient.

Exposure of a Tooth

Teeth fail to erupt for several reasons. The tooth may not have enough space caused by an overcrowded dentition. Another common reason is that a baby tooth has not yet been lost and it prevents the adult tooth coming through. If that baby tooth stays in this position for long enough, the roots of the adult tooth will finish growing, leaving nothing to 'push' that tooth through the gum.

Why not just leave the baby and adult tooth alone?

Baby teeth typically fall out because their roots are reabsorbed, leaving nothing for them to hold onto the gum with; thus falling out. This may eventually happen at any time. The impacted adult tooth, sitting above it, to develop a cyst around it, become infected, eroding itself or the teeth around it.


What does the surgery do?

Exposure of a tooth uncovers the buried tooth so that it can move into functional position naturally, or sometimes it requires the aid of braces or an orthodontic plate to aid in its movement.

The procedure is typically done under a general anaesthetic, unless the tooth is very shallow. This will be discussed with your surgeon to determine the best solution for each person.

Frenectomy / Tongue Tie

A Frenectomy deals with the fleshy bit of skin between the two front teeth which can cause a gap between these teeth. Really though, it is only under very specific conditions that the frenulum needs surgical intervention. These include:

- It makes it difficult to keep teeth clean

- It causes pain

- Interferes with eating or speech

- It pulls on the gums causing them to recede.

Usually though, the gap will close without any intervention. If you are concerned about the frenulum, it is worth the conversation to determine your specific case with your surgeon.

Tongue Tie occurs when the lingual frenulum (or fleshy tissue) beneath the tongue restricts the movement of the tongue. Parents often come in with their babies and children with tongue tie, concerned about feeding, eating or speech. 

In babies, some indicators of tongue tie difficulties revolve around: 

- A frustrated baby at the breast

- Continuous snacking at the breast

- Gumming or chewing at the breast rather than sucking

In children, some indictors of tongue tie that needs intervention include:

- Difficulty chewing foods because the tongue does not move

- Difficulty licking their lips / cleaning their mouth

- Messier eating or dribbling a bit more.

- Speech sounds may be impeded, although a full speech pathology

   assessment is recommended prior to surgery.

Ultimately it is the parents decision about clipping or cutting tongue tie, and is case by case dependent. Talk to your surgeon for more information.

Oral Pathology

For abnormal lesions, ulcers, growths and  tissue in the oral cavity, temperomandibular joint area and neck, you may be referred to see a Maxillofacial Surgeon. In Australia, this is a combined dental and medical specialty area. It is important with oral disease for a diagnosis to be obtained. If a microscopic diagnosis is required, a biopsy of the tissue will be required. Diagnosis comes from a combined approach between the maxillofacial surgeon and an oral pathologist. 


It will depend on the type and size of the lesion as to how it is excised. A small lesion can be completely excised in a local anaesthetic procedure if it is seemingly benign and accessible surgically. If the lesion is in deeper tissue such as the throat and neck, it may be required to remove this in a surgical procedure under general anaesthetic.

Many oral pathologies are first noticed in their early stages of development and it is important to have an assessment from your dentist or General Practitioner to evaluate these. They will be able to inform you as to whether further intervention is required from a Maxillofacial Surgeon.

Emergency and

Chronic Pain Management

Sometimes dental procedures do not have the outcome expected, despite best efforts of the dentist or other specialist. Sometimes the human body does not respond in an expected way to a procedure, and sometimes, oral and tooth pain can be exceptionally difficult to manage.

We see a range of unusual cases where the patient is 'beyond' uncomfortable. A few of these cases may include:

- Nerve damage in the jaw after root canal treatment

- Remaining tooth fragments from incomplete tooth removal

- Abscess or infection in a deep tooth root

- Temperomandibular Jaw (TMJ)  pain

- Damage from teeth extractions

A Maxillofacial Surgeon is continually exposed in their work line to more complex cases. It is the experience with a range of these cases that make it possible to have an approach to dealing with your problem.

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