Maxillofacial surgery and implantology

Maxillofacial surgery and stomatology are a particular type of surgery which treat oral and facial pathologies.

Specialisations :

  • Facial traumatism
  • Mouth and oropharynx cancers
  • Facial dysmorphosia, for instance underbite (prognathism), or overbite (retrognathism)...,
  • Inborn anomalies (the most common one is the cleft palate or cleft lip), 
  • Facial infections, often with a dental origin
  • Mouth surgery (teeth extractions, benign tumors and maxillary cysts…)  
  • Facial reconstructive surgery by transplants and epithesis,
  • Facial plastic surgery
  • Implantology

 

Implantology

A dental implant is an artificial root, which basically is a screw generally made of titanium, used to replace one or many missing teeth. 

An X-ray examin on which anatomical structures can be analysed and iatrogenic intervention avoided is required so that the implantologist can adapt the length, diameter and shape to the patient.

Implementation

An implant setting involves a very rigourous protocol. The sterilization must be optimum to avoid postoperative infections. 

First of all, the dentist must access the bone by clearing up the gum. To do so, he incises the gum with a scalpel and peels it off to access his surgical space.
The dentist uses various drills with an increasing diameter to prepare the space inside the bone. The bone drilling is performed at a reduced speed and under irrigation to prevent the bone from overheating which would eventually generate a necrosis. The drilling progressively continues until the diameter is slightly inferior to the implant to be used. 
An implant has a diameter of about three to six millimeters and a length of about eight to eighteen millimeters. The implant must be stable.

After the implant is set, osteointegration takes place.
Contrary to a tooth, the implant is indeed permanent, as if it were screwed into the bone. 

The implant loading is generally differed to enable the osteointegration phase (from several weeks to several months).

Afterwards, a crown will be set into this implant.

The fill-in adjustment must be very accurate. Indeed, when the patient squeezes his teeth, they may sink into the bone (tenth of a millimeter) thanks to the periodontium ; nevertheless, the implant remains stable.

Other purposes

Another type of implant is temporarily set to serve as an anchor for orthodontic forces. 
In this case, the implant is much smaller. It looks like a small nail. It is set directly, without peeling off the gum. It will be removed once the orthodontic treatment is finished.

Contraindications

Implant techniques are not always feasible.

  • General contraindications related to the patient's health : unbalanced diabetes ; immunosuppression ; valvular disease carrier ; glomerulonephrity
  • Absolute local contraindications : radiation of the related (after a tumor)
  • Related contraindications : smoker ; pregnant woman.
  • Local contraindications related to the available bone volume (that can sometimes been compensated by bone a transplant).
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