Dentoalveolar Surgery

The alveolus is that part of the bone of the jaw which supports the teeth and may be involved in any disease process affecting the teeth, jaws and surrounding structures. Dentoalveolar surgery, therefore, is the surgical management of diseases of the teeth and their supporting hard and soft tissues. It does not include dental surgery, (ie. the restoration of teeth and provision of crowns, bridges and other prostheses).

Impacted and ectopic (misplaced) teeth may result in a number of irreversible hard and soft tissue pathological conditions which can reach an advanced stage with minor or no symptoms, demanding a carefully balanced decision as to the timing of surgery.

The removal of impacted wisdom teeth is one of the commonest of all surgical procedures and guidance in management of the third molars has been subject of several reports, including the Faculty of Dental Surgery at The Royal College of Surgeons of England, and the National Institute of Clinical Excellence. Indications for removal of third molars include recurrent history of infection, including pericoronitis, un-restorable caries, non-treatable pulpal and/or periapical pathology, cellulitis, abscess and osteomyelitis, periodontal disease, prophylactic removal in the presence of specific medical and surgical conditions, facilitation of restorative treatment, including provision of prosthesis, internal and/or external resorption of tooth or adjacent teeth, pain directly related to the third molar, tooth in the line of fracture of the mandible, fracture of the tooth, disease of the dental follicle, including cyst and tumour, tooth or teeth impeding orthognathic or reconstructive jaw surgery, teeth involved in the field of tumour resection and by being a satisfactory tooth for use as donor for transplantation.

In addition, there are some orthodontic abnormalities, where there may be an indication for removal of unerupted upper third molars before the commencement of maxillary retraction. There is little rationale, based on present evidence, for excision of lower third molars solely to minimise present or future crowding of lower anterior teeth.

The removal of impacted teeth, in most circumstances, can be carried out on a day stay basis, either under local anaesthesia with or without intravenous sedation, or in designated Day Surgical Units under general anaesthesia.

Difficult impactions can be one of the most demanding procedures in maxillofacial surgery, carrying a significant risk of nerve injury and, without question, removal is most safely carried out by an experienced surgeon. In addition to the third molar, many other teeth have the potential for impaction, including pre-molar and canines and the expertise required to manage a full range of dentoalveolar presentations is considerable and remains a core activity of the speciality of oral & maxillofacial surgery.

There is a very large range of benign and cystic lesions of the mouth and jaws, including benign tumours, metabolic disorders of bone, many cystic lesions which are all progressive and can cause pain, infection, weakness and deformity of bone.

With increased specialisation, more and more patients will be referred to oral & maxillofacial surgeons and their colleagues in oral surgery and surgical dentistry working in Maxillofacial Units.