Oral and maxillofacial surgery lecture

Oral & Maxillofacial SurgeryOral & Maxillofacial Surgery

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Education requirementsEducation requirements

After completing 4 years of dental school, After completing 4 years of dental school, students must then complete a 4 or 6 year surgical students must then complete a 4 or 6 year surgical hospital residency.hospital residency.

OMS programs may accept only 2 or 3 residents OMS programs may accept only 2 or 3 residents each year.each year.

Students who complete the 6 year residency are Students who complete the 6 year residency are eligible for a Medical Doctor degree upon completion of a eligible for a Medical Doctor degree upon completion of a medical internship. medical internship.


Common surgical procedures include:Common surgical procedures include:– Wisdom Teeth RemovalWisdom Teeth Removal– Orthognathic SurgeryOrthognathic Surgery– Facial Trauma ReconstructionFacial Trauma Reconstruction– ImplantsImplants– Bone GraftingBone Grafting– Oral PathologyOral Pathology– TMJ DisordersTMJ Disorders– Cosmetic SurgeryCosmetic Surgery


Wisdom Teeth RemovalWisdom Teeth Removal– The average adult has 32 teeth by age 18. The average adult has 32 teeth by age 18.

However, the average adult only has enough However, the average adult only has enough room for 28 teeth. This often results in room for 28 teeth. This often results in impaction of teeth.impaction of teeth.


Wisdom Teeth – impactionsWisdom Teeth – impactions

Soft Tissue Impaction:Soft Tissue Impaction: The tooth has erupted The tooth has erupted through the bone but not completely through the gum through the bone but not completely through the gum tissue. Result: Inadequate cleaning of the tooth.tissue. Result: Inadequate cleaning of the tooth.


Wisdom teeth – impactions cont.Wisdom teeth – impactions cont.– Partial Bony Impaction: The tooth erupted partially Partial Bony Impaction: The tooth erupted partially

through the bone, but part still remains embedded in through the bone, but part still remains embedded in the jaw. Results: Difficulty cleaning, damage to the jaw. Results: Difficulty cleaning, damage to surrounding teeth, possible crowding. surrounding teeth, possible crowding.


Wisdom teeth impaction, cont.Wisdom teeth impaction, cont.– Complete Bony Impaction: The tooth is completely Complete Bony Impaction: The tooth is completely

buried in the jaw, there is NO room for even a partial buried in the jaw, there is NO room for even a partial eruption. Results: Damage to surrounding teeth, eruption. Results: Damage to surrounding teeth, possible crowding, cyst formation.possible crowding, cyst formation.


Wisdom Teeth Removal:Wisdom Teeth Removal:– Wisdom teeth are ideally removed as Wisdom teeth are ideally removed as

soon as possible, preferably by the soon as possible, preferably by the age of 18. Why so early?age of 18. Why so early?

1. Younger patients heal faster than 1. Younger patients heal faster than older patients.older patients.

2. At a young age, the roots of the 2. At a young age, the roots of the wisdom teeth are not fully formed, wisdom teeth are not fully formed, making them easier to remove. making them easier to remove.

3. Wisdom teeth should be removed 3. Wisdom teeth should be removed BEFORE they have the chance to BEFORE they have the chance to become infected or damage become infected or damage surrounding teeth, etc.surrounding teeth, etc.

Surgical Removal of Impacted Wisdom Tooth


Orthognathic Surgery:Orthognathic Surgery:

Orthognathic surgery may be needed when upper and lower jaws do not meet correctly. The jaws, also referred to as the mid and lower face, may not be of the same size, parallel, symmetric or a combination of these problems.

Oral & Maxillofacial Surgery

Orthognathic Surgery, cont.Orthognathic Surgery, cont.

Reconstructive facial surgery is combined with orthodontics to reposition the misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.

Oral & Maxillofacial Surgery

Orthognathic Surgery, cont.Orthognathic Surgery, cont.– Problems that may occur when jaws are not Problems that may occur when jaws are not

parallel, symmetrical, and/or of the same size:parallel, symmetrical, and/or of the same size:Difficulty chewing, swallowing, and speakingDifficulty chewing, swallowing, and speaking

TMJ painTMJ pain

Open biteOpen bite

Breathing problemsBreathing problems

Poor estheticsPoor esthetics


Facial TraumaFacial Trauma– Reconstruction of the facial structures due to Reconstruction of the facial structures due to

injuries including:injuries including:Facial lacerationsFacial lacerations

Intra-oral lacerationsIntra-oral lacerations

Avulsed (knocked out) teethAvulsed (knocked out) teeth

Fractured facial bones (cheek, nose, eye sockets)Fractured facial bones (cheek, nose, eye sockets)

Fractured jawsFractured jaws


There are a number of possible causes of facial trauma: There are a number of possible causes of facial trauma: Motor vehicle accidents, accidental falls, sports injuries, Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries account interpersonal violence and work related injuries account for many. for many.


Typically, facial injuries Typically, facial injuries are classified as:are classified as:

– soft tissue injuries soft tissue injuries (skin and gums)(skin and gums)

– bony injuries bony injuries (fractures),(fractures),

– injuries to special injuries to special regions (such as the regions (such as the eyes, facial nerves or eyes, facial nerves or the salivary glands).the salivary glands).


Implants- what are they?Implants- what are they?Dental implants are titanium posts which are Dental implants are titanium posts which are surgically inserted into the jawbone where teeth surgically inserted into the jawbone where teeth are missing. These metal anchors act as tooth are missing. These metal anchors act as tooth root substitutes. The bone bonds with the root substitutes. The bone bonds with the titanium, creating a strong foundation for artificial titanium, creating a strong foundation for artificial teeth. teeth.


Implants – What are they?Implants – What are they?

Implant posts, called abutments, are then attached to Implant posts, called abutments, are then attached to

the implant and protrude through the gums. Abutments the implant and protrude through the gums. Abutments

provide stable anchors for prosthetic replacement teeth.provide stable anchors for prosthetic replacement teeth.


Implants - How are they placed?Implants - How are they placed?

1.1. An incision is made to reveal the bone.An incision is made to reveal the bone.

2.2. A socket for the implant is created in the bone.A socket for the implant is created in the bone.

3.3. The titanium post “root” is placed, the gums are The titanium post “root” is placed, the gums are sutured shut.sutured shut.


Implants – How are they placed?Implants – How are they placed?4.4. The implant is allowed to heal for six months. The implant is allowed to heal for six months. 5.5. During an “uncovering surgery”, a healing cap is During an “uncovering surgery”, a healing cap is

placed over the implant. placed over the implant. 6.6. 2 to 4 weeks later, the healing cap is removed and the 2 to 4 weeks later, the healing cap is removed and the

abutment is placed. Finally, a crown can be fitted to abutment is placed. Finally, a crown can be fitted to the abutment.the abutment.

Placement of a Dental ImplantPlacement of a Dental Implant


Bone GraftingBone GraftingOver time, the jawbone Over time, the jawbone

around missing teeth around missing teeth atrophies or is resorbed. atrophies or is resorbed. This results in poor This results in poor quality and quantity of quality and quantity of bone suitable for bone suitable for placement of dental placement of dental implants. implants.


Bone GraftBone Graft

We now have the We now have the ability to grow ability to grow bone where bone where needed, allowing needed, allowing for placement of for placement of implants and implants and restoring restoring functionality and functionality and esthetic esthetic appearance. appearance.


Oral PathologyOral Pathology

The inside of the mouth is normally lined with skin The inside of the mouth is normally lined with skin (mucosa) that is smooth and coral pink in color. Any (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral a pathological process. The most serious of these is oral cancer. Oral Surgeons perform biopsies for suspicious cancer. Oral Surgeons perform biopsies for suspicious lesions as well as the surgical removal of cancerous and lesions as well as the surgical removal of cancerous and non-cancerous lesions. non-cancerous lesions.

Removal of a MucoceleRemoval of a Mucocele(a benign fluid-filled sack stemming from salivary glands)(a benign fluid-filled sack stemming from salivary glands)

Oral & Maxillofacial SurgeryOral & Maxillofacial SurgeryOral PathologyOral Pathology

The following can be signs at the beginning of a pathologic process The following can be signs at the beginning of a pathologic process or cancerous growth:or cancerous growth:

*Reddish patches (erythroplakia) or whitish *Reddish patches (erythroplakia) or whitish

patches (leukoplakia) in the mouthpatches (leukoplakia) in the mouth

*A sore that fails to heal and bleeds easily*A sore that fails to heal and bleeds easily

*A lump or thickening on the skin lining the inside of the mouth*A lump or thickening on the skin lining the inside of the mouth

*Chronic sore throat or hoarseness*Chronic sore throat or hoarseness

*Difficulty in chewing or swallowing*Difficulty in chewing or swallowing


TMJ DisordersTMJ DisordersTMJ (temporomandibular joint) disorders are a family of problems related TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. to your complex jaw joint.

TMJ disorders develop for many reasons including: clenching your teeth, TMJ disorders develop for many reasons including: clenching your teeth, tightening your jaw muscles and stressing your TMJ joint, misaligned bite tightening your jaw muscles and stressing your TMJ joint, misaligned bite or missing teeth. TMJ disorders can also be due to injury or disease. or missing teeth. TMJ disorders can also be due to injury or disease.

Symptoms may include a misaligned bite, pain, clicking or grating noises Symptoms may include a misaligned bite, pain, clicking or grating noises when you open your mouth, or trouble opening your mouth wide.when you open your mouth, or trouble opening your mouth wide.


The Complex Temporomandibular JointThe Complex Temporomandibular Joint

Displaced disc

Arthritic Jaw Joint


Cosmetic SurgeryCosmetic SurgerySome Oral and Maxillofacial Surgery centers Some Oral and Maxillofacial Surgery centers also offer procedures such as:also offer procedures such as:

Brow LiftBrow LiftBotoxBotoxRhinoplastyRhinoplastyLip AugmentationLip AugmentationScar RevisitationScar RevisitationLaser Skin ResurfacingLaser Skin ResurfacingEye Lid SurgeryEye Lid Surgery

Oral and maxillofacial surgery lecture

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