Oral Maxillofacial Surgery

Wisdom Tooth

Wisdom tooth, as commonly known, is actually the third molar tooth. For most of us wisdom teeth are the last teeth in the mouth, usually erupted during the late teens or early 20's. For most of us wisdom teeth are either fully erupted, partially erupted or do not erupt at all. It is common to have some discomfort during eruption of wisdom teeth, especially the lowers. The most common complaint is pain and swelling. This is normally followed by fever, difficulties in mouth opening, and of course eating. These will normally subside after a few days, however some will require a visit to the dentist or Oral Surgeons for cleaning and a course of antibiotics and painkillers.

The reasons why wisdom teeth have to be removed:

Recurrent gum infection (pericoronitis)
Decay (caries)
Decay of the adjacent teeth
State of the art Bio-Ceramics
Other reasons deemed removal necessary (during consultation with Oral Surgeon)

Subsequently, the teeth might require removal. Since most of the wisdom teeth, mainly the lower ones are impacted, removal means a minor oral surgical procedure. It can be carried out under a local anesthesia, or if you prefer general anesthesia at a private hospital setting.

Dental / Jaw Cysts

A cyst is a pathological (disease) cavity in the bone, filled with fluid. One of the causes of cysts is infection from a dead tooth, while the majority is still unknown.

Cysts can be presented as:

Slow –growing swelling on the gums or jaws
In some instances it can get infected and causes pain
Sometimes cyst can stop the teeth from erupting. It is very important to go for routing dental check-up so that any delay of teeth eruption can be investigated
Growing cyst most of the time can be painless, and can ‘push’ existing teeth into abnormal position
Most of the time cysts are incidental finding during routine dental check up, mostly from dental xrays

Once a cyst is suspected, radiographs (Xray) such as OPG, or preferably dental CT scan (CBCT) should be carried out to identify the location, size of the cyst. It is very important to know the exact position, the proximity of the cyst to other important structures (such as nerve).Once full investigation is carried out, your surgeon will be able to advice on the best course of treatment. Small cysts can be surgically removed at the clinic under local anesthesia (injection to the gums). However bigger cysts might require surgery under general anaesthesia, which will be carried out at hospital.

Jaw Surgery (Orthognathic Surgery)

What is Orthognathic Surgery?

It is a procedure carried out to ‘correct’ misaligned jaws. In these cases, the discrepancies are very pronounced and not able to be corrected by using braces alone.

What are the problem needing Orthognathic Surgery?

There are mainly 4 conditions that might require Orthognathic surgery:

Class 2 skeletal base – Also commonly known as overbite, condition where the lower jaw fails to develop fully causing receding chin and the lower jaw further behind the upper teeth
Class 3 skeletal base – Commonly known as an underbite, due to less developed upper jaw, causing the lower jaw/teeth to be far ahead of the upper jaw
Gummy smile (vertical maxillary excess) – Increased height of the upper jaw, when smiling an excessive amount of upper gums visible
Anterior open bite - A gap between the upper and lower front teeth when teeth are in biting position. Usually due to thumb-sucking habit when younger, causing the narrowing of the upper jaw.

How would I know if surgery is required?

Usually, patients are assessed by the dentist before being referred to an orthodontist. Necessary investigations would be via clinical examinations and X-rays. The orthodontist may decide to take impressions or prints of your upper and lower teeth where plaster casts or study models are made for better assessment.

Once the orthodontist decides that braces alone would not be able to solve the problem, he/she may seek advice from an Oral and Maxillofacial Surgeon. A joint consultation is necessary so that you can be advised by both Orthodontist and Surgeon before making any decision. You may ask any questions or seek any clarifications before deciding what is the best treatment for you. Should you want to discuss further, a second joint consultation can also be arranged. Surgery will be carried out under full general anesthesia at a hospital.

What are the procedures involved in Orthognathic Surgery?

The Oral and Maxillofacial Surgeon will recommend the best choice of treatment for you after doing a full facial skeletal and oral assessment.

There are 2 types of approach:

Conventional approach – Orthodontics treatment (braces) to realign/rearrange the teeth prior to surgery. This will be followed by surgery, and continue with braces treatment post-operatively to complete the treatment. Time taken are usually 1-2 years of braces, followed by surgery and then another 6 months of braces treatment.
Surgery first – In this approach, braces are fitted, and surgery carried out soon after. Active orthodontics (braces) treatment only started a few weeks after surgery.

The procedures usually involves:

One jaw surgery in mild cases – Surgery involving either upper or lower jaw only
Double jaw surgery – Involving both upper and lower jaw, for example shortening the lower jaw and advancing/lengthening the upper jaw in severe Class 3 cases
Genioplasty – Shortening or lengthening of the chin to ‘harmonise’ the facial profile. All the procedures are carried out from inside of the patients mouth, so there won’t be any visible scarring on the face

Nowadays there are options of doing a computerised planning/ customised implants. CT scans are taken, followed by intra-oral scans. A 3D image is produced, surgery is simulated on the computer screen, planning is done and the necessary titanium bone implants are 3D-printed. This results in a faster, more precise surgery with fewer complications, shorter hospital stay, and faster recovery. Our Maxillofacial Surgeon is actively involved in this method with vast experience, in collaboration with Materialise, a medical device company from Belgium. Please enquire and we will be able to discuss in further detail.

Orthognathic Surgery (CASE 1)

This oung gentleman initially presented with mandibular prognathism, altered bite due to 'lower teeth in front of upper teeth'. He has had a course of orthodontic treatment to 're-arrange' the teeth before surgery was carried out for both upper and lower jaw. Below are a series of photos taken before and after surgery, showing how much difference orthognathic can make to improve the looks and alignment of teeth.