One of the newest types of surgery with advanced benefits for patients is piezo surgery. The dental surgeon uses a piezo device to have a level of control and predictability that did not exist in traditional dentistry. The expert performs reactive operations in which he is active on the bone, but completely protects the soft parts or adjacent anatomical formations, so the patient has no risks and receives a personalized 100% treatment depending on his offer of hard tissue (bone) or soft tissue (gum).
- Safe work that does not damage sinus membranes or nerves
- Safe work that does not damage sinus membranes or nerves
- Minimally invasive maneuvers, with an extremely low degree of trauma compared to classic maneuvers
- Possibility to perform extractions without affecting the bone supply
- No pain
- Reduced edema
- Minimal post-intervention symptoms
- Safe 100% sinus lifting maneuvers
Using piezo surgery, the dental surgeon has access to settings and calibrations depending on the work performed, depending on the bone density and the general condition of the patient.
Mental extraction of the mind
One of the most common dental surgery treatments is the extraction of the wisdom tooth. In Clinic 32, the dental surgeon performs each operation based on the digital infrastructure, through which he has access to 2D and 3D investigations. The radiology department is included in the clinic, as are all the dental departments, and each treatment plan has a multidisciplinary approach.
Mental molars often do not resemble the morphology of other teeth and are very difficult to treat, so they are often extracted. Small surgeries are often required to remove them. Mental molars should only be removed when they cause various problems (crowding of the front teeth, pain at the rash) or decay and can no longer be treated. For included or semi-included wisdom teeth, surgery is performed in a sterile field, under cooling with saline or with the help of piezosurgery.
Mental molars or the third set of molars are the last permanent teeth to erupt on the arch and are four in number, one for each hemiarcade. They usually erupt between the ages of 18 and 30, but may erupt later. The wisdom teeth are radiologically visible, starting at the age of 8, at the age of 12 the crown is already formed, and at the age of 17-18 the roots are already developed, which corresponds to the average age of the rash.
Currently, we can investigate the problems given by the wisdom tooth with the help of CBCT computed tomography, respectively 3D investigations and thus we can avoid accidents and complications that may occur during extractions or if these molars are kept on the arch.
The most efficient method of extracting the included and semi-included molars is with the help of piezo surgery which has a superior advantage in that there are no swellings and pains after extraction.
Oral and mucogingival surgery
Mucogingival surgery is associated with dental implantology and periodontology. Traditionally, the patient wanted to give up the mobile prosthesis and have the opportunity to have fixed teeth. At present, we can offer each patient the chance to have fixed teeth that perfectly simulate the initial situation, respectively to offer a perfectly natural look.
The benefits of oral and mucogingival surgery in periodontology
The patient who is experiencing gingival retraction and aesthetic or physiognomic problems, as well as pain that occurs as a result of gingival retraction due to the fact that the tooth root is present in the oral cavity, receives a safe and final solution for the health and special appearance of the teeth.
The connective tissue graft and partially repositioned coronary flap help us to restore the ideal position of the gum, the position of the papillae or the pseudo-papillae and in this way the patient has a harmonious smile, and the symptoms that appear associated with periodontal diseases disappear.
The benefits of mucogingival surgery in implantology
The most important aspect refers to the long-term stability of the dental implant, to the fact that this type of dense keratinized fixed tissue added by mucogingival surgery can bring trophicity, stability to the area and thus the patient has teeth that resemble natural ones. . The patient receives as final result teeth that have papillae, respectively pseudo papillae. It is the maximum physiognomy that implantology can offer today.
APRF - Advanced Plasma Rich Factor
PRF and A-PRF (Advanced Plasma Rich Factor) membranes are frequently used in oral surgery, being very effective in the regeneration and healing of soft and hard tissues, reduce the risk of infection, reduce postoperative edema, these containing a platelet concentrate and fibrin, an essential source of growth factors that will be released gradually for a few days after surgery.
Their preparation is done quickly, directly in the office, just before surgery, by collecting their own blood, then by a special centrifugation technique, without the addition of other chemicals and a biocompatible and risk-free 100% preparation is obtained for patients. .
The use of these APRF membranes is very wide, being indicated in most surgical procedures in the oral cavity: tooth extractions, sinus-lift, bone additions, treatment of periodontitis, implantology.
- Bone addition is a surgical procedure that restores the volume of bone that is lost as a result of tooth extractions, dental infections, periodontal disease, trauma or due to prolonged wearing of dentures.
- The new volume of bone created will allow the insertion of dental implants in the correct prosthetic position, and the crowns or bridges that will be made on these implants will be much more durable and will withstand the masticatory forces much better.
- The resorption of the bone can be vertical, horizontal or combined, each time resulting in a bone in which an implant cannot be inserted in the correct position, of appropriate dimensions or the crown to be applied on that implant will not be able to satisfy the patient's physiognomic desires.
The addition of bone can be recommended by the dentist in several situations. These include:
When a tooth extraction takes place, the bone that supported the extracted tooth begins to gradually reduce its volume, this process is called resorption. Thus, after the first year of extraction, on average the bone is resorbed in proportion of 25% from the initial volume. At 3 years after extraction, the bone is resorbed in a proportion of 40-50%. In order to avoid bone loss, in the post-extraction stage it is sometimes necessary to perform bone augmentation (bone addition) or to insert a dental implant.
Bone addition is the surgical procedure that allows optimal results in implantology. Therefore, after the bone has been added, the volume of bone available increases and a longer implant can be inserted, giving it greater stability. Bone augmentation surgery is a surgical procedure that can be performed at the same time as the dental implant insertion operation.
Another operation in which bone addition is used is sinus lift surgery. As the name implies, the operation of sinus lift (sinus lift) is a surgery that aims to lift the membrane of the maxillary sinus in order to add a quantity of bone, which is necessary to insert the dental implant.
Bone augmentation (bone augmentation) is also used in the case of flap surgery, when the patient suffers from periodontal disease, situations in which the teeth have lost part of the bone support. Flap surgery is done when there are deep periodontal pockets filled with pus that need to be cleaned. If the situation allows, bone addition material can be added to restore the lost bone support. Flap surgery is also performed in the case of periimplantitis (infection of the bone around the implant).
Addition of bone is also recommended in the case of a surgical procedure called apical resection. Apical resection is a surgical procedure in which the granuloma is removed from the tip of a tooth root along with part of the tip of the root.
It is good to put a bone addition material in place of the bone defect in the bone defect to help the bone recover and prevent recurrences. Apical resection is a helpful procedure in the case of canal treatments that cannot be performed correctly. Retrograde filling of the dental canals can also be done with the apical resection.
- It is good to put a bone addition material in place of the bone defect in the bone defect to help the bone recover and prevent recurrences.
- Apical resection is a helpful procedure in the case of canal treatments that cannot be performed correctly.
- Retrograde filling of the dental canals can also be done with the apical resection.
Bone replacement materials fall into four categories:
1. autogenous bone - the bone harvested directly from the patient, either with the help of milling cutters when the place for the new implant is made, or with the help of bone-scrapers from the neighboring areas, or is harvested in the form of bone block with the help of the piezotome at the level retromolar area or chin symphysis - this type of bone is the "Golden Standard", there are no compatibility issues, it integrates perfectly, the only disadvantage being that it resorbs fairly quickly if not combined with a substitute of bone with slow resorption.
2. allogeneic bone - bone of human origin, its use is quite limited although it is very close as a result of autogenic bone.
3. xenogeneic bone - is represented by bone of animal, bovine or equine origin. This bone is deproteinized by various methods, either by heat or by enzymes, so that only the mineral matrix remains that will be used as a "scaffold" for the bone regeneration that is needed.
4. alloplastic bone - it is a bone synthesized in the laboratory, it helps to maintain the space so that in time it can be replaced by the patient's bone.
In addition to these bone substitutes, there is a category of materials needed to make bone additions - membranes. They are necessary because, during healing, the bone heals much more slowly than the soft, connective tissue heals, so that the latter can seep into the bone that we want to rebuild and we will not get a hard tissue for to insert an implant. Therefore, these membranes create real barriers between bone and connective tissue and each can be healed separately. These membranes can be resorbable, ie disappear in two to four or six months, or they can be non-resorbable, which means that they will be removed by the surgeon in a post-application session. Resorbable membranes are usually made of animal collagen, and non-absorbable membranes are either Teflon or titanium.
The last category of materials used in various types of bone additions is represented by screws for fixing bone blocks and supporting membranes or pins for fixing the membranes as best as possible over the regenerated bone.
Innovations used for bone addition
In Clinic 32, a device is used that applies the pins for fixing the membranes by pneumatic force, a device that provides greater safety in the correct application of the pins as well as the membranes.
Another technological aid in limiting inflammation (swelling) after surgery and which helps in faster healing is represented by Protein Rich Fibrine (fibrin rich in protein). This technology involves collecting blood from the patient before surgery, a few tubes - 30-40 ml, centrifuging it so that the red blood cells separate from the plasma. This high-growth plasma is applied to the wound along with the bone or above the membrane and helps to heal faster, without complications of the intervention.
Sinus lifting surgery
A special type of bone addition is the sinus lift.
Maxillary sinus is a cavity filled with air inside the maxillary bone, with a role in heating, humidifying and filtering the inspired air. It develops over a lifetime and ends with the eruption of the last permanent teeth. The floor of the maxillary sinus has close relationships with the roots of the maxillary teeth, relationships that vary depending on the particularities of each group of teeth. For example, molars and premolars often have close relationships with the floor of the maxillary sinus, while canines rarely have them, only in cases where the sinus is highly pneumatized.
Usually, after extraction and during the healing of the bone under the floor of the sinus, it extends into the space left free by the dental roots. Thus, the bone left under the sinus floor will no longer have a proper vertical size when the decision is made to replace the lost tooth with an implant. Here, the surgeon will tell you about the "sinus lift" operation, which consists in increasing the height of the bone below the maxillary sinus, so that we can insert an implant of a size corresponding to the lateral area, where the masticatory forces are greater.
Types of sinus lift intervention
Depending on the surgical approach, the sinus lift intervention can be of two types: internal sinus lift (closed), with crestal approach or external sinus lift (open) with lateral approach.
The first type of sinus lift, the internal one, also called the Summers technique, assumes that the approach is made at the level of the alveolar ridge, by milling a neo-alveolus to the floor of the maxillary sinus. After this, with the help of some instruments and by applying repeated pressure, the controlled fracture of the maxillary sinus floor is performed and its lifting together with the sinus mucosa. In the newly created space, under the mucosa of the sinus that has been elevated, artificial bone is inserted, and in the neo-alveolus through which the access was made, a dental implant is inserted. The healing period after this procedure is usually around 5-6 months, after which the discovery of the inserted implant and the application of a healing abutment will be made.
Another minimally invasive method of approaching the crest of the maxillary sinus is with pressure exerted by saline. The pressure of the saline solution on the sinus mucosa is equal at any point and thus pushes the mucosa of the sinus constantly and without breaking it. A bone substitute is inserted into the crate space. The technique is minimally invasive because it is made without wide flaps, without swelling or other hematomas. Recovery is fast in 2 days.
The second variant of this intervention is the external or open sinus lift. This involves accessing through a window in the lateral bony wall of the maxillary sinus, lifting this window and exposing the sinus membrane, followed by very careful detachment from the maxillary bone until there is space to insert sufficient addition material. In this addition material, after six or eight months, after it will be integrated and strengthened, the necessary dental implants will be inserted.
This method is especially applicable when the maxillary sinus is very large and highly pneumatized and the existing bone is less than 4 mm thick.
Piezo surgery and Sinus Lift
Depending on the initial height of the bone below the maxillary sinus, it is possible to choose to insert the implants at the same time as performing the sinus lift operation. The use of piezo-surgery, both in harvesting the bone blocks needed for various additions, and in performing external sinus-lift, greatly supports the surgeon's work through the superior visibility provided, but at the same time helps a much easier healing, reducing postoperative inflammation.
Scarlătescu Dental Clinic
3 Scarlatescu Street
Sector 1, Bucharest
+40 31 620 30 30
Banu Manta Dental Clinic
Banu Manu Blvd., 79A
Sector 1, Bucharest
+40 31 620 30 30
Clinica UNU - partner Clinica 32
Middle Street, no. 1
+4 0268 418 969
Scarlatescu Dental Clinic
Str. Scarlatescu, no. 3 ,
sector 1, Bucharest
Monday - Friday 09: 00-20: 00
Banu dul Banta Manta, no. 79 A,
sector 1, Bucharest
Monday - Friday 09:00 - 20:00
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