Why should the most challenging cases in dentistry be performed by an oral surgeon?

An oral surgeon is a dentist who has specialized in the field of oral surgery, which is one of the branches of dentistry. Due to their narrow specialization, they are best suited to:

• perform all procedures that are part of oral surgery
• place dental implants.

What is oral surgery?

Oral surgery is a specialized branch of dentistry that deals with surgical procedures involving:

• the mouth
• teeth
• jaws.

It experienced significant growth after the discovery of nitrous oxide, followed by ether. The field saw its greatest advancements in the 20th century, thanks to rapid technological development and the invention of dental implants.

Which procedures are most commonly performed by an oral surgeon?

○ Tooth extraction
○ Alveotomy
○ Cystectomy
○ Apicoectomy
○ Gingivectomy
○ Frenulectomy
○ Implant placement
○ Dental traumatology
○ Removal of various soft tissue and bone changes

Oral surgeon – dentoalveolar surgery

The oral surgeon most commonly performs the following two procedures:

• Tooth extraction
• Alveotomy.

Both fall under the category of dentoalveolar surgery. Extracting wisdom teeth can often pose significant challenges to dentists. In such cases, an oral surgeon, who is educated, experienced in the procedure, equipped with all the necessary tools and prepared for unexpected situations, needs to step in with a calm and steady hand.

Alveotomy is a surgical procedure used to remove impacted or retained teeth, most commonly wisdom teeth and canines. Postoperative complications often occur and can be physiologically caused:

• Infection
• Dry socket
• Edema
• Trismus
• Hemorrhage
• Injury to neighboring teeth
• Fracture of the mandible
• Nerve injuries.

To minimize or completely avoid such consequences, it is advisable to entrust the alveotomy procedure into the skilled hands of an oral surgeon who will protect the surrounding tissue from injury.

Local anaesthesia or sedation

Depending on the complexity of the case and the patient’s anxiety, the oral surgeon decides on the anaesthesia method for the surgical procedure:

• Local anesthesia
• Conscious sedation.

Thanks to increasingly sophisticated technology that provides simpler procedures and less painful experiences for patients, most oral surgery procedures can be performed with local anaesthesia alone.

Oral surgeon’s knowledge of orofacial anatomy

Since the human face consists of several areas, including sensory organs, the nose, paranasal sinuses and the stomatognathic system, it is evident that it is a very small area with a very specific structure.

The stomatognathic or masticatory system is a complex entity composed of teeth and supporting tissues, which can be divided into clinical and morphological systems.

The basis of the orofacial system consists of a framework formed by immovable bones and one movable bone – the mandible (lower jaw). The mentioned immovable bones together with the neural part of the skull form a whole. They are characterized by complex structure. The upper jaw or maxilla is a paired bone consisting of a body and four processes:

• Frontal
• Palatine
• Dental
• Zygomatic.

Paranasal sinuses, or air-filled cavities, are also found in this area. In cases of tooth loss, the sinuses can descend, interfering with the secure placement of dental implants. In such cases, the oral surgeon may perform a procedure known as sinus lift, which elevates the sinus floor. Depending on the case, the oral surgeon may perform either a minor or major sinus lift.

Oral surgeon and implantology

The oral surgeon places:

• standard dental implants in the jawbone
• zygomatic implants in the cheekbone.

The placement of zygomatic implants is an extremely demanding and often risky operation. Implant placement, in general, has become a routine procedure for oral surgeons due to its high success rate, durability and the potential to provide fixed teeth in the end.

What are dental implants exactly? They are alloplastic materials (usually titanium) implanted into the bone to replace lost teeth or their roots.

Since an incision must be made, followed by the elevation of the mucoperiosteal flap, it is recommended that the procedure be performed by an oral surgeon. After opening the flap, the bone canal is first drilled with a pilot drill and then the direction and depth of drilling must be determined. The oral surgeon drills the bone with drills marked to indicate the maximum drilling depth, then places the implant and finally sutures the wound with atraumatic needles.

Facial traumatology

Individuals involved in traffic accidents often suffer facial bone trauma. This can lead to:

• Airway obstruction due to profuse bleeding
• Foreign bodies in the oral cavity
• Vomiting
• Posteriorly impacted fractures of the upper jaw
• Fractures of the lower jaw where the tongue is no longer anchored to the bone.

In these cases, surgical procedures are exclusively performed by a specialist in oral surgery, i.e. an oral surgeon.

Specialist in oral surgery at Miličić Dent Polyclinic

We proudly highlight that the founder and director of our polyclinic is the renowned specialist in oral surgery, Dr. Marko Miličić, univ. mag. med. dent., who has extensive experience in oral surgery and implantology. For patients with the most challenging cases, we offer the services of the most competent specialist – an oral surgeon.