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Maxillofacial Surgery
Many developmental or acquired cystic lesions are seen in the jaws. A cyst is a fluid-filled balloon-like structure surrounded by epithelial tissue. Cysts, which tend to grow with the ingress of fluid from the surrounding tissues into the cyst, grow by slowly destroying the jaw bones. They usually do not cause symptoms until they reach certain sizes. The majority of cysts seen in the jaw are radicular cysts caused by chronic infections of the roots of the teeth.
Diagnosis of cysts can usually be made by routine radiographic examinations. Cystic lesions should be suspected in cases of persistent pain, swelling, and pus drainage in the jaw areas despite dental treatments. It is important to do check ups by taking radiographs at least once a year for the early diagnosis and treatment of possible cystic lesions.
Cyst treatments are divided into two. In large developmental cysts, in order not to damage important anatomical structures, the first step is to reduce the cyst (marsupialization). With the help of a drain that is surgically placed in the area, the cystic lesion is washed daily with serum to reduce it. When it reaches an appropriate size, the cyst is completely removed and cleaned with a second operation. Another treatment method is the complete removal of the cyst (enucleation). However, this method is not recommended for very large cysts due to the possibility of jaw fractures and possible damage to important anatomical structures. In such cases, it is a more reliable method to shrink the cyst with the first treatment option and completely clean the area after a few months.
Extraction of teeth with excessive crown destruction or remaining root fragments cannot be done by normal ways. In this case, the soft tissue is removed and if necessary the roots are surgically divided and removed by an open surgery. This procedure is defined as complicated tooth extraction. Since such teeth are difficult to extract, after careless extractions, there is a lot of loss in the bone tissue surrounding the tooth in the area, making advanced implant surgeries difficult. For this reason, extraction of such teeth by an experienced specialist is important for the preservation of tissues.
Wisdom teeth begin to erupt after the age of 18 and continue to erupt until the age of 25. However, their position, pathological conditions in the eruption tract (cyst, excess teeth, etc.) cannot protrude and remain buried in cases where the thickness of the soft tissue is excessive, and there is not enough space to protrude in the mouth. It is not essential for every impacted tooth to be extracted, but it is beneficial to have it extracted as it may cause cystic formations due to the developmental sheaths (malesless epithelial remnants) around the impacted teeth. Extractions may be considered for those aged 20 and over. The presence of pain, swelling and radiolucency around the impacted tooth on panoramic x-ray should be evaluated well. If one of the above-mentioned symptoms is present, extraction of the tooth may be considered. Apart from these, the positions of the wisdom teeth are also important in terms of extraction. Some temporary or permanent complications can be seen following extraction in impacted teeth that are closely related to the nerve. Some of these include partial or total loss of sensation, tingling, or decreased sensation in the area where the nerve is dispersed and in some parts of the lips (right or left). However, most of the time, these complications are seen as temporary and improve within 2 weeks to 6 months with additional medical treatments. It is important to be less traumatic in impacted teeth, which are in close contact with the nerve, to be very careful and not to put too much pressure on the nerve, so that the teeth are divided into pieces to minimize nerve damage.
As in the figure, teeth in the mesioangular position tend to erupt towards the anterior teeth, which can cause decay in the roots of the second molars and cause the loss of these teeth. For this reason, the extraction of these teeth is also important in terms of the longer life of the teeth in front of them.