Dentalnews (en)

Using an iliac crest bone transplant as an aid in jaw bone reconstruction is no longer a necessary procedure in dentistry, as there are excellent bone replacements available today.

Long periods of toothlessness and/or periodontitis can cause the  jaw bone to recede. Often there is not enough room to set an implant.

It was once a common practice to take piece of bone from the pelvis in order to replace bone in the jaw. You simply took a piece of bone and attached it to the jaw using screws – with varying degrees of success.

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Why larger pieces of bone were always absorbed is explained here!
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Although these kinds of operations are still performed, they are largely unnecessary, since there are bone replacement materials which work very well, and taking replacement bone from a patient’s own body entails opening another wound.
You can either use bone from a donor, for which the company Celtis has developed a special procedure, or you can use purified cattle bone .

Either way, if you do not have enough bone in your jaw, there are much better ways of getting a replacement than cutting yourself open!

What is the best type of bone to use in reconstruction?

If parodontitis goes untreated for a long time, or teeth are lost and not replaced, then bone starts to recede. And once it is time for a dental implant, there may not be enough bone matter available to support the implant.

Fortunately, there are various materials available to reconstruct bone, but which one of them is the best?

A rule of thumb is that the more similar replacement bone is to human bone, the better it heals. The best bone to use is the patient’s own – as long as the chunk of bone used does not exceed a specific size – you can find out more on that here.

From a certain size onwards it is better to use purified replacement bone, ideally human bone, or animal bone, for example from cattle. Bone substitutes can also be produced, e.g. from algae. Synthetic bone takes the longest to heal, although research is still being done on the subject.

It does not help to infuse bone from a donor with your own cells.

It is much more effective to mix replacement bone with your own blood – this is usually enough, and facilitates absorption during an operation, but it is unclear whether it helps healing.

There are many studies on this topic, but they are often poorly structured and do not observe evidence-based medical guidelines. Moreover, many of the materials used to replace bone are distributed by doctors themselves, and they all have their favorites, so it is hard to remain objective!

Dentists often forget to tell patients what to do after getting dental work!
So here are some advices after dental treatment.

What should you watch out for?
What rules are there to follow?

The suggestions below are general information. If your pharmacist gives you other instructions, then you should follow them!

The Dental News team wishes you a speedy recovery, these tips will help you smile again!

• Leave the swab in for another half hour after treatment, then you can spit it out, unless your dentist has given you other instructions
• Keep the area which has been operated cool, e.g. using a Cool Pack (ice), not directly on the skin, but wrapped in e.g. a towel
• Do not eat as long as the area is still numb, and remember to chew on the other side
• Avoid nicotine and alcohol, as well as spicy, crumbly or raw foods, and milk products for the first three days after the operation
• Do not pull on your lip/cheek, no „peeking in front of the mirror“
• Do not start cleaning your teeth again until two days later (do not use a toothbrush around the wound, but use a cotton swab dipped in 3% H2O2).
• Use mouthwash containing chlorhexidine (e.g. Chlorhexamed) twice a day (not longer than 2 weeks) and several times a day using 3% H2O2 dissolved in water. Rinsing out your mouth using chamomile tea also helps speed up healing.
• Do not point the oral irrigator at the area treated!
• Bruises or swelling in the face (intensifying up to 4 days after treatment), as well as difficulty opening the mouth and a temperature of up to 38.5° C are common after treatment and are no cause for concern
• Avoid sunlight and physical exertion the first couple of days after treatment (no sauna, no sports, no hiking …)
• For operations in the upper jaw and opening of the maxillary cavity no blowing your nose for 8 weeks; do not hold your nose shut when sneezing

Should wisdom teeth be removed ?

A note on terms . The eighth teeth, known as wisdom teeth often do not reach the chewing surface. They are located just below the gums and cause pain and /or a sickly sweet smell. Medical experts refer to them as „retained eights“, the term retention refers to a position of the wisdom teeth, in which after the root finishes growing the teeth do not reach the chewing surface.

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A tooth is referred to as partially retained when parts of the crown touch the oral cavity, or the teeth are connected to the oral cavity via the parodontal apparatus (gum pocket) of the neighboring 12-year molars (7s).

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Teeth which have absolutely no contact to the oral cavity are described as fully retained.
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The term impacted wisdom teeth means that the wisdom tooth is fully embedded in bone.

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A tooth is termed displaced if its axis or position diverges from the usual direction in which a tooth comes out.
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When should wisdom teeth be removed?

They should be removed:

• if there are acute or chronic infections in the area around the wisdom teeth (Dentitio difficilis)
• if there are severe cavities involving the dental nerve (if cavity damage is so severe that the teeth cannot be restored or the dental nerve is so inflammed as to be beyond treatment)
• if there are indications that a wisdom tooth is causing pain
• if x-rays show changes to the area around the wisdom tooth which cannot be treated (e.g. cysts)
• resorption of neighboring teeth
• to treat or contain the spread of parodontal diseases
• if they would get in the way of jaw or reconstructive surgery
• for teeth located in a crack, which would make it difficult to treat fractures of the jaw
• if the tooth is needed for a transplant
• if the elongated/tilted wisdom tooth keeps a patient from biting down properly

Removal may be a good idea

• for general reasons having to do with a patient’s living conditions (e.g. lack of access to medical care etc.)
• if other treatment is performed under general anaesthesia and anaesthesia would again have to be used to remove the tooth
• when inserting dentures, if the tooth is expected to come out due to bone atrophy or pressure from the denture
• to facilitate orthopedic work (braces)

Wisdom teeth do not need to be removed:

• if they are expected to take up their regular place in a row of teeth
• if extraction of other teeth and/or orthopedic treatment which would set the tooth right is planned
• if teeth are deeply impacted or displaced but not pathological, and there would be a high risk of complications when operating

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Ambulant treatment is usually sufficient.
Wisdom teeth can be removed individually or several/ all in one session.
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Treatment under general anasthesia/ sedation may be required if the patient is not expected to be cooperative, if the treatment is complex, if there are risk factors or at the patient’s request.
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Stationary treatment may be required if the patient has other illnesses or in connection with specific procedures.
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The necessity of antibiotics before and after an operation has not been scientifically established. A general recommendation is not possible at this time. Pain treatment may help to reduce swelling, but is not always necessary.

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Source: 2009_RZE_Indications

How much do dental implants cost? Implantation? Operations involving wisdom teeth?

These are topics often searched on the web, another good question is: how much does it cost to transplant wisdom teeth?

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Specifically: Wisdom teeth need not always be removed, they can be transplanted instead. The picture shows a 6-tooth in the upper jaw which has received faulty root treatment (highlighted in red). Hidden under the mucuous membrane is the 8 (highlighted in blue).
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The badly treated tooth has been removed and the 8 put in place of the 6. 2 months after the operation, the root is still in the process of growing (the blue lines in the first x-ray). Two years after the transplantation, the root has finished growing (the blue lines in the second x-ray). The mucuous membranes in the mouth of the patient have finished healing, the former 8 (blue arrow) is now where the 6 used to be.

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Bridges or implants are not always necessary, it is often possible to use one’s own teeth. Ask your dentist!

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