Oral and Maxillofacial Surgery


Oral and maxillofacial surgery is a specialty focused on the prevention, study, diagnosis and treatment of sicknesses of oral cavity and maxillofacial bone tissue, as well as cervical structures directly or indirectly links with the face and maxillofacial area. 

Craniofacial surgery is a sub-specialty of aesthetic and plastic surgery. It belongs to the extensive field of reconstructive and reparative surgery of this specialty. In Europe, this sub-specialty does not exist, but it is a specialty on its own: oral and maxillofacial surgery.

Since it works on a complex area, the specialty comprises a wide range of procedures. Maxillofacial surgeons do from wisdom teeth extractions or placement of dental implants to aesthetic, oncology and reconstructive surgery. This specialty is very much linked with plastic surgery, neurosurgery and otolaryngology, with which works closely and some aspects are treated for both specialties. It is also linked with some dentistry specialties, such as orthodontics and prosthodontics.

The scope of surgeries done by Maxillofacial surgeons varies depending on the access to this specialty (either medicine or dentistry), on the training program and the legislation on each country.

Maxillofacial surgeon examines facial traumatology problems, cleft lip and palate, head, cervical and oral oncology, skull´s base, reconstructive surgery, facial aesthetic surgery, pathology of salivary glands (benign and malign tumors, calculus, etc.), head deformities (minor deformities or big malformative syndromes) infectious pathology (phlegmons and facial and cervical abscesses), oral implants (placement and rehabilitation of osseo integrated dental implants), third molars (wisdom teeth) or cuspidate tooth, dentition cyst, pathology of oral mucosa and the temporo mandibular joint (dysfunction of jaws), etc.

Clínica Planas´s aim is to offer the best care, study and possibilities of treatment of the patient based on personalized treatment, high qualification of their knowledge and new technologies that allow surgeons to achieve the excellence on this specialty.

Implant Surgery

A dental implant is the same as the root of a tooth, like a stable pillar for the created crown. Dental implants are made of titanium or zirconium and its surface is usually treated with physicolchemical processes. Its placement usually just needs local anaesthesia. This titanium device fuses with the jawbone. This process is called osseointegration and it takes between 2 or 6 months. Since it is as a dental root, it is not necessary to lime the neighboring teeth for the placement of the definitive dental prosthesis.

There is one treatment called one day teeth, which consist on elaborating the prosthesis on the same moment as the surgery on few weeks after.

Up-to-date technology enables us to plan and program dental implants treatment with a computer program using a three-dimensional model, which provides a surgical guide that indicates exactly the position of the implants and crowns.

Some conditions are necessary in order to achieve the best results on the placement of implants:

  1. A professional with solid training and background on Oral and Maxillofacial Surgery, which provides the best treatment taking into account the individual needs of each patient, not only in the field of oral surgery, but also in general, taking into account other diseases and companion treatments.  
  2. Implants placement requires examination and correct diagnosis so the success percentage is on 96%. 
  3. A correct study including an orthopantomography, dental CAT and sometimes, surgical splint either by computer or traditional, depending on the case. 
  4. Implants surgery requires sterility and hygienic conditions to achieve the existing successful rates. 
  5. As in any other surgical treatment, dental implants is subject to possible complications and adverse effects, so the signature of prior informed consent is necessary.  
  6. Follow-up examinations with the oral and maxillofacial surgeon and restorative dentist are critical, in order that dental implants can perform correctly their function. It is also necessary the patient´s commitment to follow a strict oral hygiene. 

Oral Surgery

Dental inclusion

Milk teeth are changed for the definitive teeth at 7 and 12 years old, but sometimes there are problems of space, either because of traumatism or because of unknown causes and this change does not happen. These definitive teeth instead of being placed in their final location continue their normal development, both roots and crowns, inside the bone.

We called this process dental inclusion. Any teeth may suffer an inclusion process, although molars and wisdom teeth are more likely to suffer it, since they are the last ones to erupt and, thus, can have more space problems. The second more likely teeth to become inclusive are the superior cuspidate teeth, because of the same reasons.

Inclusive teeth have to be extracted when they cause inflammatory processes in neighboring tissues, caries in neighboring teeth as well as the reabsorption of their roots and early lost.

These teeth may originate dental cysts and tumors, as well as bone lost in neighboring teeth, favoring infections forming cavities.

So as to have more space for the orthodontic treatment, the extraction of the inclusive teeth is recommended.

This surgical operation is usually done under local anaesthesia, since soft and hard tissues of the mouth are manipulated. Swollenness may last some days, but complications and sequelae are usually minimal.

Dental cyst

Odontogenic cysts are one of main causes of destruction of maxillas, being a process relatively frequent. Most part of cases is related with neighboring tooth, being an infectious process originated on the teeth that expands to the closed bone. They can grow unnoticed. The first symptoms can be a dental phlegmon or the inflammation of soft tissue of face or neck, after years of development. A combined treatment will be necessary in most cases, for both the teeth and the cyst (since once formed, surgery will be necessary to excise it). These cysts may be due to other causes, such as alterations of development of maxillas, and sometimes, we may have to differentiate them from tumors with the same clinic and radiological appearance, so we should always have to do a microscopy study of the excised tissue to make a precise diagnosis that will allow us to determine the most complete treatment.

Confronted with any inflammatory process of dental origin, phlegmon, abscess, the visit to the odontologist is recommended. An orthompantomography will be necessary to discard cyst pathology in the maxillas.

Periodontal Surgery

Periodontal disease is the main cause of teeth extraction on patients older than 30 years old. This disease is caused by local agents such as bacterial plaque and scale, accumulation of food remaining, mouth breathing, nicotine, etc.

Defending themselves from these agents, gums reacted with a chronic inflammation, gingivitis (whose main characteristics are its red color, bleeding and pain on the gums). If not treated, this process continues and the infection grow to the root of teeth, causing an inflammatory reaction associated with the loss of the structures at periodontal level and the creation of permanent infectious focus at this level, periodontal pockets. Once these pockets formed, it is difficult for the patient to get rid of the amount of agents that are deposited on them. As the process advances, the loss of bone around the roots of teeth causes the mobility of them, in a first phase and the early fall, latter.

The treatment of this disease requires the coordination of several specialists. Maxillofacial surgeon will do the needed surgical procedures to get rid of the chronic focus of infection and reconstruction of the destroyed structures during the inflammatory process, suing new materials to substitute the bone. The periodontist will be in charge of the procedures de bite adjustment and rehabilitation of lost teeth and the patient will have a key role eradicating those habits that may cause the infection process.

Biopsy of oral mucosa

A biopsy on all new lesions on the oral cavity, with more than two weeks of evolution is advisable, especially for smokers. Biopsy consists of having a sample of the appropriate tissue under local anaesthetic, so as to make a microscopic study that will allow us to achieve a more precise diagnosis, especially whether the lesion is benign or malign. Once having the result, and taking it into account, we can follow up the patient or, if necessary, increase the surgical treatment.

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