Wisdom tooth last erupted in the mouth; They are called third molars. Although it usually differs according to racial, genetic characteristics and diet, these teeth that erupt at the end of both sides of the jaw in the 18-24 age range, sometimes do not erupt or remain impacted until late ages. Although all teeth in the jaw are likely to be impacted, the most impacted teeth are wisdom teeth due to the lack of sufficient space in the mouth.

Why Does a Wisdom Tooth Remain Impacted?

• Having a genetically small jaw structure,
• Jaw stenosis,
• Displacement of adjacent teeth,

Although there are many reasons such as underlying infections due to untreated caries of milk teeth, historical research also gives us other clues about the change of the jawbone.

According to the researches of anthropologists, there has been a change and shrinkage in the structure of the jawbone as a result of factors such as the change in the diet of people over time and the continuation of the evolution process. The fact that wisdom teeth were found in 80% of the skeletons of young people from the Chalcolithic and Copper Ages during excavations in Anatolia confirms this view.

Wisdom teeth, which cannot find enough space in the mouth to come out, usually remain buried or partially erupted and cause complaints such as pain around the tooth, earache, and restriction in mouth opening. Because of their location, they are often not cleaned well, which can lead to cavities, inflammation and sometimes cysts.

Why Should Wisdom Teeth Be Extracted?

Wisdom teeth should be extracted as early as possible. Because the jawbone loses its flexibility in advanced ages, complaints such as swelling, pain and numbness may be encountered after extraction. At young ages, the probability of such complaints is low, since the root development of the tooth is not yet completed.

Although some of the problems related to wisdom teeth can be resolved with antibiotic treatment, extraction should be performed by a maxillofacial surgeon in the following cases;

• If there is an infection in the soft tissues around the impacted or semi-impacted teeth that cannot find a place in the jaw curve, or they can be removed before it occurs,
• If there is a place in the jaw curve and the teeth are fully erupted, if it shows decay and gum disease as a result of insufficient cleaning,
• If pain occurs as a result of the pressure of the erupting wisdom tooth on the adjacent tooth,
• If there are cysts and tumors around the wisdom tooth
• If root problems and caries are detected as a result of the pressure exerted on the roots of the teeth next to the wisdom teeth,
• If wisdom teeth trying to erupt cause crowding in the front teeth,
• Prevention of recurrence after orthodontic treatment

How is Wisdom Teeth Extracted?

Extraction of wisdom teeth is a procedure performed under local anesthesia.
After the soft tissue is removed, the bone tissue around the tooth is removed. Sometimes the tooth is broken into pieces and removed in smaller pieces. Sometimes, the bone around the tooth is removed from the jaw with special tools. Then the extraction cavity is cleaned and closed with soft tissue sutures. After these procedures, antibiotics or painkillers are recommended to the patient.

In Which Situations Is Apical Resection Surgery Performed?

• Incomplete root canal treatment due to excessive curvature, perforation (perforation) or calcification in the root canal
• In teeth where root canal cleaning and filling material application cannot be performed successfully in teeth whose root tip is not completely closed, that is, in teeth that cannot complete their development.
• In cases where root canal treatment cannot be performed when the root canal cannot be reached over the tooth (in the presence of crowns or bridge prostheses, that is, veneers).
• If the instrument is broken during root canal treatment, the broken instrument must be removed, when it is necessary to remove the instrument.
• In cases where cystic formations occur at the root tip of the tooth.
• In cases where the 1/3 end of the tooth root is broken in the bone.

In order to see and treat the bone and root surface under the soft tissue, the process of removing the soft tissue and gingiva by cutting is called flap operation.
In the mouth, dental plaque and tartar enter the gingival pocket and cause inflammation. It is difficult for patients to physically clean the microorganisms that enter the gingival pocket. After a certain period of time, tooth brushing will not work. Dentists apply gingival treatment in these cases. However, in cases such as deep pockets and bone retraction, it is difficult to clean the gingival pockets clinically and the infection recurs constantly. In these cases, dentists apply periodontal flap surgery to remove the soft tissue and clean the dental plaque and microorganisms on the underlying tooth root. In this way, the effects of the infection and its recurrence are eliminated.
Flap operations are the basis of all kinds of surgical procedures, not only for cleaning dental plaque and microorganisms on the root surface. It is used in root tooth extractions, implant surgery, wisdom tooth extraction, orthognathic surgery and many surgical fields.

How is Flap Operation Performed?

There are many flap techniques in periodontal flap surgery. These are chosen according to their intended use. Flap surgery is performed when:

• If the root surface needs to be seen for calculus and dental plaque.
• Gum cutting and removal.
• Excision of the bone.
• Flap surgeries are used to restore the health of the gums and surrounding tissues.
• Or, it is applied in aesthetic smile designs, which we call gumysmile.

There are spaces called sinuses in the right and left parts of the upper jawbone (maxilla). The main task of these cavities is to reduce the weight of the skull bones. These spaces can expand in volume with the effect of air pressure, especially after tooth extraction. This volumetric enlargement and decrease in bone volume are more common in areas that have not been treated for a long time and are edentulous. This may prevent implantation in edentulous areas under the sinus.

edentulousness or tooth extraction in the upper jaws. It leads to a decrease in bone volume. In order to overcome this difficulty, the technique of filling the sinus cavities with bone or materials that turn into bone, also called sinus lift. Sinus lifting operations have been developed over the years. A special surgical intervention called Sinus Lifting should be applied to decrease the volume of the sinuses and increase the bone volume. With this operation, which can be performed under local or general anesthesia according to the patient’s request, bone particles are placed between the jawbone and the sinus mucosa and it is waited for at least 4-6 months for bone formation.

In sinus lifting operations, the patient’s own bone (autogenous graft) or materials that can turn into bone (biomaterials) can be used. Biomaterials show a wide variety of sources, including synthetically produced calcium-phosphate compounds (Hydroxylapatite, Tricalcium Phosphate), corals, glass-based, animal (bovine-pig) or human origin. In response to the question of which of these materials is the best, it is possible to say that the human’s own tissue (autogenous graft) is always the most efficient among grafts. However, studies have shown that all materials give similar results when the operation technique is applied correctly.
Today; The general approach is that the graft volume required for sinus lifting is approximately 2-3 cm3 for each sinus, so instead of taking bone from another part of the patient’s body, bovine deproteinized-mineral graft (which does not have the risk of carrying disease because it is free from protein, and the mineral part is calcium and mineral part of human bone). It is in the direction of using the mineral component consisting of phosphate). A mixture of the patient’s own bone and synthetic graft is also widely used.

As a result, sinus lifting is applied in cases where the sinus floor is drooping and the bone height is below 4mm, with tooth deficiencies in the maxilla, posterior region of the premolars and molars, which we use most for chewing. It is a surgical method that involves filling the sinus cavity with materials that turn into bone in order to make a fixed implant-supported prosthesis. The application has a simple surgical technique. The post-operative period is smooth and comfortable for the patients. Although the surgical method is simple, it requires very sensitive work.