Periodontal Plastic Surgery

Where the smile reveals too much of the gums (a gummy smile), or where the gums have receded following trauma or periodontal disease (gingival recession), a procedure can be carried out to restore their appearance. Coverage of the recession is achieved with grafts taken either from the patient themselves (a graft is harvested from the palate) or from ready-made grafts available commercially.

Extraction of an impacted or partially impacted wisdom tooth

Because of changes in dietary habits, the human stomatognathic system today develops less, and there is usually not enough room in the mouth for the third molars (wisdom teeth) to erupt, so they often remain impacted or partially impacted. Problems associated with wisdom teeth are:

1. Pericoronitis: this is inflammation of the gum surrounding a partially impacted wisdom tooth, accompanied by intense pain radiating to the ear, redness and swelling in the area, discharge of pus, and inability to open the mouth fully.
2. Periodontitis or caries, because of the difficulty of cleaning and removing dental plaque.
3. Damage to the adjacent tooth
4. Dental or periodontal abscess, or cysts
5. Soft tissue injuries, when the wisdom tooth has erupted at an angle and traumatises the cheek or the tongue.
6. Orthodontic irregularities, because of the pressure exerted on the remaining teeth.

Whether to preserve the orthodontic result, or to prevent or treat the problems above, extraction of the third molars is required.

Apicectomy

An apicectomy is a minor surgical procedure aimed at removing a cystic lesion located at the tip of the root of a tooth and sealing that root tip hermetically.

An apicectomy is the treatment of choice when

• there is a periapical cyst that has not healed with endodontic treatment
• an endodontic instrument has fractured inside the root of the tooth
• obturation material has extruded beyond the root
• the apical foramen cannot be reached because of narrowing of the root canal

Surgical exposure of impacted canines for orthodontic reasons

Often, as part of orthodontic treatment, teeth that remain impacted (most commonly the canines) need to be surgically exposed, so that the tooth appears in the mouth and the orthodontist can bond the «brace» to it. Choosing the appropriate surgical technique is important, as it contributes to creating a more favourable anatomical environment and to preserving all the periodontal tissues, so that future gingival recession on that particular tooth is prevented.