Areas ofExpertise

Summary

• The wisdom tooth is the last molar to start erupting, at the very back of the mouth. When the jaw lacks space, it stays under the gum or bone.
• Being impacted is not a reason for removal on its own. Removal is considered with recurring gum infection, decay in the tooth in front, a cyst or pain.
• In the lower jaw the roots may sit near the canal of the nerve that supplies feeling to the lip. If this is unclear on the X-ray, cross-sectional imaging helps planning.

What symptoms does it cause?

Recurring swelling at the back, pain on biting, a bad taste and limited mouth opening are common. They usually appear once part of the tooth has broken through the gum.

Some teeth cause no symptoms and are found on a routine X-ray.

How is the decision made?

The clinician looks at the angle of the tooth, how deep it lies, the condition of the neighbouring tooth and your symptoms. Regular monitoring is a valid option for a healthy, trouble-free tooth.

If orthodontic or prosthetic treatment is planned, the decision is made together with that clinician.

Imaging

Assessment usually starts with a panoramic X-ray. If the roots appear to overlap the nerve canal and this would change the approach, a cone beam CT may be requested.

The scan does not remove the risk. It lets the surgeon know in advance where the root lies relative to the canal.

How does the procedure go?

The area is numbed with local anaesthesia. If the tooth is in bone, a small flap is raised and the bone covering the tooth is thinned.

When needed, the tooth is divided and removed in sections, which can reduce the amount of bone removed. The wound is closed with a few stitches.

Recovery

Bite on gauze for the first hours. On the first day, avoid vigorous rinsing and spitting to protect the clot. Intermittent cold packs limit swelling. Swelling usually peaks on day two or three and then subsides.

Lukewarm, soft food is best at first. Avoiding smoking for at least three days helps protect the clot. Non-dissolving stitches are removed at the follow-up visit.

Known risks

Dry socket, infection and bleeding can occur. In the lower jaw, numbness of the lip, chin or tongue may develop. It usually improves over time and is rarely permanent.

Contact your clinician if pain keeps increasing or you notice fever or a bad smell. If swallowing or breathing becomes difficult, seek emergency care without waiting.

Frequently asked

Should I have a symptom-free wisdom tooth removed?

Not necessarily. A healthy tooth that harms nothing around it can be monitored. The decision follows the examination and X-ray.

How long does it take?

It depends on the angle and depth of the tooth. Some procedures are short, others take longer.

Why can numbness occur?

Because some lower roots lie next to the nerve that supplies the lip and chin. Numbness is usually temporary.

Summary

• Extraction is discussed when a tooth cannot be kept with a filling, root canal treatment or a crown.
• In a dental abscess the pus is released through an incision. The tooth causing it is treated or removed separately.
• Minor procedures include taking a tissue sample, removing small cysts and gum overgrowths, and releasing a tongue or lip tie.

When is extraction considered?

Teeth destroyed by deep decay, teeth with fractured roots and teeth that have lost bone support from advanced gum disease fall into this group. Options to keep the tooth are reviewed first.

How the gap will be restored is discussed from the start.

Simple and surgical extraction

Visible teeth with straight roots are usually removed simply. Teeth with curved, fractured or firmly held roots need the gum opened and the tooth sectioned.

If an implant is planned later, care is taken to preserve the bone walls. A graft may be placed in the socket if suitable.

Dental abscess

An abscess is a collection of pus formed by bacteria around the root or gum. Throbbing pain, swelling, sensitivity to heat and sometimes fever come with it.

The pus is released through a small cut in the gum or, if needed, the skin. This is called incision and drainage. The clinician decides on any medication. The tooth behind it is treated with root canal therapy or extracted.

Emergency signs

Rapidly growing facial swelling, difficulty swallowing or breathing, and swelling that closes the eye should be assessed in a hospital emergency department.

Minor procedures

A sore lasting more than two weeks, a white or red area or an unexplained swelling needs an examination. The clinician takes a tissue sample if needed. A suspicious appearance is not left for two weeks. The pathology report gives the diagnosis.

Small cysts and gum overgrowths can be removed under local anaesthesia. A tongue or lip tie can be released if it affects speech, denture fit or gum health.

Known risks

Oozing, swelling and pain are expected at first. Dry socket, infection and separation of the wound edges can occur.

Report bleeding that does not stop with pressure, pain that keeps increasing, fever or a bad smell.

Frequently asked

What can I eat after an extraction?

Once the numbness wears off, lukewarm and soft food is fine. Very hot, hard or spicy food can irritate the wound early on.

Is medication alone enough for an abscess?

It can ease symptoms. Without draining the pus and treating the tooth, the problem usually returns.

Does taking a tissue sample hurt?

It is done under local anaesthesia. Mild tenderness may follow for a few days.

Summary

• An implant is a small screw that replaces the root of a missing tooth and is placed in the jawbone. Once it bonds with the bone, a crown, bridge or denture is attached.
• Suitability depends on bone volume and quality, gum health and general health. Some conditions and medicines call for extra assessment.
• The plan starts from the tooth that will sit on top. The position, length and angle of the implant are chosen to suit that tooth.

What are the parts of an implant?

Treatment involves three main parts. The body that sits in the bone is usually made of titanium or a titanium alloy, and less often of zirconia. The connecting part that brings it into the mouth is called the abutment. The visible part on top is the crown, bridge or denture.

The surface of the body is roughened by special processes, which helps bone cells attach. Its length and width are chosen according to the bone and the tooth it will carry.

How does it bond with the bone?

After placement, the surrounding bone remodels towards the implant surface. This process is called osseointegration. A bonded implant sits firmly in the bone and passes chewing forces to it.

Bonding begins in the first weeks and usually takes a few months to complete. The implant should not be overloaded during this time. Avoiding hard food on that side and attending check-ups protect healing.

Who needs extra assessment?

If the jaw is still growing, treatment waits until growth is complete. If diabetes is poorly controlled, blood sugar may need to be brought under control first. Radiotherapy to the head and neck can reduce the bone's ability to heal, so timing and method are planned together with the relevant doctor.

Some medicines that slow bone turnover, such as bisphosphonates, can cause healing problems in the jawbone. The risk depends on the medicine, dose, duration of use and the condition it was prescribed for. Tell your clinician if you have ever taken one of these medicines.

Smoking harms the tissues around implants and raises the risk of implant loss. Active gum disease is treated first. People with a history of gum disease can also receive implants, but regular care and check-ups become even more important for them.

How many implants, which prosthesis?

A single missing tooth is replaced with a crown on one implant. When several neighbouring teeth are missing, a bridge on fewer implants may be planned.

For a jaw without teeth there are fixed options and removable dentures that clip onto implants. The choice is made together, based on bone volume, cleaning habits and expectations. For a fixed full bridge on a small number of implants, see All-on-4 and All-on-6.

When bone is lacking

After a tooth is removed, the jawbone gradually becomes thinner and shorter. If there is not enough width or height to surround an implant, there are several routes.

Missing bone can be rebuilt with bone grafting, sometimes in the same session as the implant and sometimes as a separate step. At the back of the upper jaw the sinus floor can be raised (sinus surgery). In some cases shorter or narrower implants can reduce the need for extra surgery.

When bone loss in the upper jaw is severe, zygomatic implants anchored in the cheekbone are among the options. The right route is discussed after measurements on a CT scan.

Digital planning and surgical guides

After the examination and a panoramic X-ray, a cone beam CT is usually requested. The nerve canal in the lower jaw and the sinus and nasal floor in the upper jaw are measured.

The CT can be merged with an intraoral scan on a computer. The future tooth is designed on screen first, and the implant position is chosen to suit it. When needed, a surgical guide made from this plan and seated on the teeth or gums is used. It helps place the implant at the planned position and angle. Careful examination and surgical experience are still required.

The surgical stage

The procedure is usually done under local anaesthesia. Sedation may be an option for anxious patients or longer procedures. The gum is lifted, a site matching the implant size is prepared in the bone and the implant is placed.

In some cases the work is done through a small opening without lifting the gum. This depends on the bone and gum condition.

Same-day implants and immediate loading

Placing an implant in the same session as an extraction is called immediate placement. It requires no active infection, socket walls that are sound enough and an implant that is held firmly in the bone. Otherwise the socket is left to heal for a few weeks or a few months.

Attaching a tooth that meets the opposing teeth within the first week is called immediate loading. If the temporary tooth is kept out of contact with the opposing teeth, it is called immediate restoration. In both cases the key measure is how stable the implant is at the moment it is placed. If stability is low or there is a strong clenching habit, the implant is usually left to heal without load.

How long does treatment take?

The total time depends on when the tooth was removed, whether extra bone work is needed and which jaw is involved. Without extra procedures, a few months usually pass between implant placement and the final tooth. It is often longer in the upper jaw.

Grafting or sinus surgery adds healing time. Your own timeline is discussed after the examination and scan.

Care and check-ups

The implant itself cannot decay, but the gum and bone around it can become diseased. Inflammation limited to the gum is called peri-implant mucositis. It shows as bleeding and redness and can be treated early. If inflammation reaches the bone, peri-implantitis develops and bone is lost around the implant.

Daily brushing, interdental brushes or floss and check-ups at the intervals your clinician recommends lower this risk. Check-ups examine the tissue around the implant and include X-rays when needed.

Known risks

Swelling, bruising and tenderness can occur early on. If an implant does not bond with the bone, it is removed and the site is reassessed after healing.

Altered sensation near the nerve in the lower jaw and sinus problems in the upper jaw can occur, though rarely. Over time a prosthetic screw may loosen or a crown may chip.

Frequently asked

Will an implant last a lifetime?

No such period can be given. Cleaning habits, smoking, gum health and regular check-ups all affect how long an implant stays in place.

Can an implant be placed on the day of extraction?

Sometimes. If there is no infection and the bone holds the implant firmly, it can be placed in the same session. Otherwise healing comes first.

I am older. Can I still have implants?

General health and bone condition matter more than age. Both are assessed at the examination.

Does it hurt during the procedure?

The area is numbed with local anaesthesia, so you should not feel pain, although pressure and vibration may be felt. Discomfort in the following days is usually controlled with the painkillers your clinician recommends.

I smoke. Can I have implants?

Implants can be placed in smokers. However, smoking raises the risk of implant loss and inflammation around implants. Stopping before and after surgery, and quitting if possible, is advised.

Can I have an MRI scan with implants?

Titanium and zirconia implants are not magnetic and in most cases do not prevent an MRI scan. The image may be distorted near the implant. Tell the radiology team about your implants and any magnetic denture attachments before the scan. They decide on suitability based on the components. Bring your implant card if you have one.

I have gum disease. Can I have implants?

Gum disease is treated and brought under control first. People with a history of gum disease have a higher risk of inflammation around implants, so regular care and check-ups are important.

Summary

• When a jaw has no teeth left, or the remaining teeth cannot be saved, a single fixed bridge carrying all the teeth can rest on a small number of implants. A plan with four implants is called All-on-4, and one with six is called All-on-6.
• In the four-implant plan the two back implants are usually placed at an angle. The angle keeps them away from structures such as the sinus and the nerve canal and extends the support for the bridge further back.
• In suitable patients, temporary fixed teeth can be fitted on the day of surgery. This depends on the implants being held firmly in the bone at the moment they are placed.
• Dr. Dt. Kıvanç Türkoğlu provides All-on-4 and All-on-6 treatment in suitable patients. Suitability is assessed with an examination and a CT scan.

Who is it considered for?

It is considered for people without teeth who struggle with a loose denture, speech or chewing. People about to lose many teeth to advanced gum disease, fractures or large cavities are also in this group.

When bone has shrunk at the back, placing one implant per tooth often needs extra bone surgery. In this plan the implants go into the front and middle of the jaw, where more bone usually remains. For some patients this can reduce the need for grafting.

Who may not be suitable?

Poorly controlled diabetes, radiotherapy to the head and neck and some medicines that slow bone turnover change the plan. These medicines may be taken as tablets or injections. Tell your clinician about every medicine you use.

Heavy smoking and an inability to clean every day harm the tissues around implants. If bone is also very thin at the front, grafting or another approach is discussed first. Night-time clenching and grinding are taken into account when designing the bridge.

Assessment and planning

The examination looks at lip support, how much gum shows when you smile and the teeth in the opposite jaw. After a panoramic X-ray, a cone beam CT measures bone height and width and locates the sinuses and the nerve canal.

The surgeon and the clinician who will make the bridge plan the treatment together. The position of the teeth is decided first. The implants are then placed to suit those teeth.

Four or six?

The number depends on bone volume, jaw width, the opposing teeth and biting force. Six implants spread the load over more points. Four implants can reduce extra surgery when bone is limited.

Some plans use five implants. The right number for you is discussed after the examination and the scan.

Surgery day and temporary teeth

The procedure can be done under local anaesthesia. Sedation is also an option when needed. Teeth that cannot be saved are removed in the same session, the bone edge is smoothed and the implants are placed.

As each implant is placed, its firmness in the bone is measured. If the values are adequate, screw-retained temporary teeth are fitted on the same day or within a few days. If not, the implants are left to heal without load and a removable temporary denture is worn in the meantime.

The final bridge

Implants usually need a few months to bond with the bone. This can take longer in the upper jaw. Soft food is advised with the temporary teeth during this period.

Once healing is complete, impressions are taken and the final bridge is made. It is screwed to the implants. You cannot remove it at home. The clinician takes it off at check-ups when needed.

Daily care

The underside of the bridge and the area around each implant need daily cleaning. Interdental brushes, a water flosser and thick-ended floss are used for this. Your clinician will show you which suits you.

Regular check-ups look at the tissue around the implants, screw tightness and how the teeth meet. The bridge is removed and cleaned when needed.

How it differs from removable dentures

A conventional full denture rests on the gums and palate. It gets no support from bone, so it may move when you speak or eat. A snap-on denture clips onto implants. In the lower jaw two implants are often enough, while the upper jaw usually needs more. The number is decided for each person. It is more stable but comes out for cleaning.

A fixed bridge on implants stays in the mouth and leaves the palate uncovered. In return it needs more implants and more careful cleaning. When bone loss is severe, a removable denture may restore lip and cheek support more easily. The choice is made together, based on bone, cleaning habits and expectations.

Known risks

Swelling, bruising and pain are expected in the first days. One of the implants may fail to bond with the bone. The plan is then reviewed and an extra implant may be needed.

The temporary bridge can break, screws can loosen and inflammation can develop around implants. Altered sensation in the lower jaw or sinus problems in the upper jaw can occur, though rarely. Some parts of the bridge may need renewing over the years.

Frequently asked

Will I definitely get fixed teeth on the same day?

This cannot be promised in advance. The decision is made during surgery, based on how firmly the implants sit in the bone.

Can I take the fixed bridge out myself?

No. It is screwed to the implants. The clinician removes and refits it at check-ups when needed.

I was told I have little bone. Is this still possible?

In some patients angled implants reduce the need for extra bone surgery. If bone in the upper jaw is very thin, options such as grafting or zygomatic implants may be discussed.

How long does treatment take?

The surgical stage is done in one session. The final bridge is made after the implants have bonded with the bone. The total time varies with the bone and the jaw.

Summary

• After tooth loss, bone becomes both thinner and shorter. A graft aims to regain the volume the implant will sit in.
• The material can be your own bone, processed bone or a synthetic material.
• A small defect can be grafted with the implant in one session. With larger defects the graft comes first and the implant follows later.

Why is bone lost?

After an extraction the bone around the socket remodels and loses volume. Long-term denture wear, gum disease and trauma add to the loss.

In the back of the upper jaw, downward expansion of the sinus causes extra height loss. This is covered under sinus surgery.

Types of graft

Your own bone carries living cells and is usually taken from another part of the jaw.

Processed human or animal bone and synthetic materials act as a scaffold for new bone. Granular graft is usually covered with a membrane. This is called guided bone regeneration.

Choosing the method

Whether the defect is in width or height, and how many teeth it spans, decides the method. This is measured on cross-sectional imaging.

For wide and vertical defects, blocks or thin plates prepared from your own bone may be preferred.

Waiting time

New bone formation and readiness for an implant depend on the material, the method and the site. A wait of several months is common.

A temporary tooth adjusted so that it does not press on the area can be worn meanwhile.

What affects success

Tension-free closure of the wound edges and a graft that does not move in the first weeks are needed for healing.

Smoking and poorly controlled diabetes make it harder for the graft to take. Avoid chewing on that side in the first weeks.

Known risks

Part or all of the graft may fail. Wound opening and infection are known problems.

The donor site may hurt for a few days. Altered sensation is usually temporary and rarely long-lasting or permanent.

Frequently asked

Where does graft material come from?

From your own bone, processed human or animal bone, or a synthetic material. The choice depends on the size and site of the defect.

Can I have an implant without a graft?

If there is enough bone, no graft is needed. With less bone, options such as shorter or narrower implants are also considered. Measurements decide.

How long is the wait after a graft?

It depends on the material and method. A few months is common. Follow-up X-rays guide the decision.

Summary

• After the upper molars are lost, the bone thins and the sinus expands downwards. The height needed for an implant may be gone.
• In a sinus floor elevation the membrane lining the sinus is gently lifted and graft is placed beneath it.
• With a small height deficit the lift is done through the implant site. With a large deficit a small window is opened in the side of the jaw.

Two approaches

If the remaining bone can hold the implant, the sinus floor is pushed up a few millimetres through the implant site. This is the transalveolar approach, and the implant is usually placed at the same time.

If the remaining bone is very thin, a window is made in the cheek-side bone wall. The membrane is lifted and the space is filled with graft. This is the lateral window approach. The implant goes in at the same session or after the graft matures.

Assessment beforehand

Remaining bone height, membrane thickness and bony septa inside the sinus are examined on cross-sectional imaging.

Active sinusitis, polyps or blockage call for an ear, nose and throat assessment first.

Healing

With the lateral window, a wait of six to nine months is usual for the grafted area to mature, depending on the material. With the transalveolar approach a few months are allowed for the implant to bond.

The first weeks

Not blowing your nose hard and sneezing with your mouth open protect the membrane. Straws and heavy lifting are postponed for a while. Discuss flights and diving with your clinician.

Known risks

The most common problem is a membrane tear. Small tears are usually repaired in the same session. With large tears the procedure may be postponed.

Nosebleed, facial bruising and swelling can occur temporarily. Rarely, graft infection or sinusitis develops.

Frequently asked

Can the sinus lift and implant be done on the same day?

Yes, if the remaining bone can stabilise the implant. Otherwise grafting comes first and the implant follows later.

I have chronic sinusitis. Is this suitable for me?

The sinus is first assessed by an ear, nose and throat specialist. The procedure is not done while untreated inflammation is present.

What if my nose bleeds afterwards?

A mild nosebleed can occur in the first days. Contact your clinician if bleeding persists or increases.

Summary

• A zygomatic implant is a long implant used when the upper jaw has lost a great deal of bone. It starts inside the mouth and its tip anchors in the cheekbone (zygoma).
• It is considered for some patients in whom bone grafting or a sinus lift cannot provide enough bone, or is not thought suitable.
• It is technically demanding surgery that calls for experience in the field. Dr. Dt. Kıvanç Türkoğlu performs zygomatic implant treatment in suitable patients. Suitability is assessed with an examination and a CT scan.

When does it come up?

After years without teeth, the upper jaw becomes both thinner and shorter. At the back, enlarging sinuses reduce the remaining bone further. When there is no room for a standard implant, a zygomatic implant becomes one of the options.

Loss of an earlier graft or of earlier implants, and bone defects after a tumour or injury, may also fall into this group.

Compared with grafting and sinus lift

With grafting, bone volume is built up first and standard implants are placed later. This route can take longer and sometimes needs bone taken from another part of the body.

A zygomatic implant takes its support from the cheekbone without adding bone. When conditions allow, temporary fixed teeth can be fitted soon after surgery. On the other hand, the limited studies comparing the two routes found complications more often with zygomatic implants. The choice is made after discussing benefits and risks together.

Planning with CT

Planning requires a cone beam CT. It measures the volume of the cheekbone, the state of the sinuses, the distance to the floor of the eye socket and the path the implant will follow.

If the sinuses are inflamed or blocked, an ear, nose and throat assessment may be requested first. If there is bone at the front, zygomatic implants are combined with standard implants there. If bone is very thin everywhere, two zygomatic implants may be planned on each side.

Anaesthesia and the procedure

Because the procedure is long and extensive, it is often done under general anaesthesia or deep sedation. A hospital setting may therefore be needed.

The path of the implant is chosen to suit the individual bone anatomy. In some patients it passes through the sinus, in others along a line close to its outer wall. In suitable cases a screw-retained temporary fixed bridge is fitted on the same day or within a few days.

Recovery

Swelling and bruising of the cheek and under the eye can occur. Mild nosebleeds may appear in the first days. Avoid blowing your nose hard and sneeze with your mouth open to protect the sinus.

Soft food is advised while the implants heal. The final bridge is made once healing is complete.

Known risks

Sinusitis is among the most frequently reported problems. An opening between the mouth and the sinus can form. Where the implant emerges into the mouth, gum recession, inflammation and other soft tissue problems can occur.

Altered sensation of the cheek or lip is possible. Because the work is close to the eye socket, rare cases of the implant entering the eye socket, injury to the eye muscles and double vision have been reported. Some problems may need further surgery or removal of the implant.

Experience and follow-up

With this technique the surgeon's training and how often they perform it matter. Feel free to ask your clinician about this.

Treatment is planned by the surgeon and the prosthetic clinician together. Regular check-ups and daily cleaning are needed for the long term.

Frequently asked

Can zygomatic implants be used in the lower jaw?

No. They anchor in the cheekbone, so they are used only in the upper jaw.

Is it possible for everyone?

No. The cheekbone must have enough bone and general health must allow it. Any sinus disease is dealt with first.

Should grafting be tried first?

It depends on the person. Your clinician explains the expected time, risks and recovery for both routes, and the decision is made together.

Will the implant show on my face?

The implant sits inside the bone and is not visible from outside. Swelling and bruising in the first days settle with time.

Summary

• Cone beam computed tomography (CBCT) shows the jawbone in three dimensions.
• A panoramic X-ray gives an overview. CBCT shows bone width and the position of canals and the sinus in cross-sections.
• Not every patient needs it. It is requested only when a question that would change treatment cannot be answered with 2D images.

Which questions does it answer?

Examples are bone height and width at an implant site, the position of the nerve canal in the lower jaw, and the distance to the sinus and nasal floor in the upper jaw.

The relation of an impacted root to the nerve canal, the borders of cysts and the direction of fracture lines are also examined.

What happens in the planning software?

The images are opened in dedicated software. The implant is placed virtually and its diameter, length and angle are chosen. A surgical guide that fits the mouth can be produced from the plan.

3D records are also used when planning new bone positions in jaw surgery.

Radiation

The CBCT dose is higher than a panoramic X-ray and usually lower than medical CT. It depends on the size of the area and the device settings.

The aim is to obtain the needed information from the smallest possible area at the lowest dose. Tell us beforehand if you might be pregnant.

On the day

No preparation is needed. Metal jewellery, glasses, hair clips and removable dentures are taken out. You will be asked to stay still during the scan.

Bring any earlier scan with you. Sometimes a new one is not needed.

Limitations

Metal fillings, crowns and existing implants create streak artefacts that can make nearby areas hard to read.

Movement causes blurring and may require a repeat scan.

Frequently asked

Is a panoramic X-ray not enough?

Often it is. CBCT is requested when bone width or closeness to the nerve canal or sinus is uncertain.

Is CBCT the same as medical CT?

No. CBCT was developed for the teeth and jaws. It usually images a smaller area at a lower dose.

Will it be repeated after treatment?

Not routinely. Follow-up is mostly done with 2D X-rays. It may be requested again if a problem is suspected.

Summary

• Orthognathic surgery corrects position problems of the upper or lower jaw that come from the skeleton.
• It is considered when the jaws sit too far forward or back relative to each other, the teeth do not meet and facial balance is affected.
• Treatment is carried out together with an orthodontist. Most patients need orthodontics before and after surgery.

When is it considered?

Examples are a Class III bite with the lower jaw forward, a Class II bite with it set back, an open bite where the front teeth do not touch, and marked facial asymmetry. Chewing and speech difficulties may accompany them.

If the problem comes only from tooth alignment, orthodontics is usually enough. The examination and records make this distinction.

How is the plan built?

The orthodontist first aligns the teeth to suit the new jaw position. This preparation usually takes months.

Before surgery, facial photographs, a cephalometric X-ray and, if needed, a 3D scan are taken. The planned jaw movements are measured on these records and guides for surgery are prepared.

The operation

Surgery is done under general anaesthesia in a hospital. Most incisions are inside the mouth.

Le Fort I osteotomy of the upper jaw and bilateral sagittal split osteotomy of the lower jaw are common techniques. The bones are fixed in their new position with small titanium plates and screws.

Recovery

Marked facial swelling appears in the first days, and most of it settles within a few weeks. A liquid and soft diet is followed early on.

After surgery, orthodontics continues until the teeth settle in the new position.

Known risks

Reduced feeling in the lower lip and chin is common. It usually improves over months but can be permanent in some patients.

Infection, bleeding, later removal of plates and screws and some shift of the jaw towards its old position are also known risks.

Academic work in this field

Dr. Dt. Kıvanç Türkoğlu's doctoral thesis evaluated hard and soft tissue changes after orthognathic surgery in Class III patients (Ankara University Institute of Health Sciences, 2011, YÖK thesis no. 281436).

Frequently asked

Does the operation leave facial scars?

Most incisions are inside the mouth, so a visible facial scar is usually not left.

How long is the hospital stay?

It depends on the extent of surgery and recovery. It is usually a few days.

Why does orthodontics start before surgery?

The teeth need to be aligned to fit the new jaw position. The sequence is decided with the orthodontist for each patient.

Summary

• Falls, assaults, sports and traffic accidents can fracture the jaw bones and injure the teeth.
• A change in how the teeth meet is an important sign of a jaw fracture. Pain, swelling, bruising and limited opening may accompany it.
• The goal is to return the bone fragments to the right position and let the teeth meet properly again.

Which signs suggest a fracture?

Teeth that no longer meet as before, a step felt along the jaw, a torn gum and numbness of the lower lip suggest a fracture. The jaw may also drift to one side on opening.

Assessment

The bite, facial sensation and tooth stability are checked. A panoramic X-ray gives the first information. Cross-sectional imaging clarifies the fracture direction and displacement.

For wounds that touched a dirty surface, tetanus vaccination status is checked.

Treatment options

Some undisplaced fractures heal with a soft diet and close follow-up. Displaced fractures are reduced and fixed with small titanium plates and screws.

In some cases the jaws are held together briefly with a system attached to the teeth. Injuries involving several facial bones are treated in hospital.

If a tooth is knocked out

Hold a permanent tooth by the crown, not the root. If it is dirty, rinse it for a few seconds under cold running water without scrubbing.

If the person is conscious and it is possible, put the tooth back in its socket and bite on a clean cloth on the way to the clinician. Otherwise carry it in milk or saline. Time matters, so see a dentist without delay. Never place a tooth in the mouth of an unconscious person. Baby teeth are not replanted.

Emergency first

Call emergency services for loss of consciousness, vomiting, severe headache, visual disturbance or shortness of breath. Dental and jaw treatment is planned once the general condition is secured.

Known risks

Infection, a lasting change in the bite, loss of a tooth in the fracture line and long-lasting altered sensation can occur. Plates and screws may need removal later.

The nerve of an injured tooth may lose vitality months later, so follow-up visits matter.

Frequently asked

How long does a broken jaw take to heal?

Bone union usually takes a few weeks. A soft diet and follow-up visits are important during this time.

What should I do with a broken piece of tooth?

Keep it in water or saline and bring it along. In suitable cases it can be bonded back.

My child's baby tooth was knocked out. Can it go back?

No. Baby teeth are not replanted because this can harm the permanent tooth beneath. The child should still see a dentist.