Biological Oral Surgery

Die Biologische Oralchirurgie ist aus der Lehre der Biologischen Zahnmedizin und der klassischen Oralchirurgie entsprungen. Dabei liegt das Augenmerk auf die gesundheitliche Verbesserung des Patienten, wobei die bewährten oralchirurgischen Techniken und Methoden berücksichtig werden.

In der Biologischen Oralchirurgie werden die Materialien so ausgewählt, dass der Körper nicht belastet wird, z.B. Keramikimplantate anstatt Titanimplantate. Die Operationstechniken, sind so modifiziert, dass postoperative Schwellung so gering wie möglich ausfällt, z.B. minimalinvasive und atraumatische Techniken der Schnitt- und Nahtführung.

Die vollständige Reinigung aller entzündlichen Prozesse und die gründliche Desinfektion mit Ozon, sind essentiell für eine optimale Wundheilung. Zusätzliche Massnahmen zur Unterstützung der Regeneration, wie z.B. die A-PRF-Technik, sind ebenfalls ein Teil des Konzeptes.

Alle Massnahmen und Techniken dieses Konzeptes greifen Hand in Hand und verbessern den Ausgang der Operation signifikant. So können Schmerzen, postoperative Schwellungen und Entzündungen auf ein Minimum reduziert werden.

Durch langjährige Erfahrung in der Biologischen Oralchirurgie, die modifizierten OP-Techniken und zusätzlichen Massnahmen, können wir grosse Sanierungen, unkompliziert, in ein bis zwei Sitzungen, lösen.

Preparing for surgery

The preparation for surgery aims to bring the patient to a state where wound and bone healing is optimal. For this purpose, we use our own measures and also work closely with experts from various medical disciplines.

It is important to supply the body with the necessary vitamins, minerals and trace elements. Vitamin D3 and Vitamin K2 levels in particular should be in the higher range, as they are of great importance for wound healing and especially for bone healing. Minerals such as magnesium, calcium, and silica are necessary building blocks and can be supplied through a balanced diet and supplements.

The permanent improvement of the oral bacterial flora is also an important point. It is important that only the pathogenic bacteria are eliminated. Healthy and beneficial bacterial strains stay alive and are strengthened.

Before an operation, the oral flora should be optimized so that pathological and aggressive bacteria are less likely to infect the fresh wounds.

Preoperative 3D X-ray diagnostics

Before major surgical interventions and placement of ceramic implants, it is important that the dentist gets a precise overview of the patient’s anatomy. A three-dimensional X-ray image (digital volume tomography, DVT, also known as cone beam CT, CBCT) is the method of choice and provides imaging that corresponds to the exact anatomical dimensions.

In our dental practice we use the Planmeca ProMax 3D Mid. This features the Planmeca Ultra Low Dose protocol and is able to guarantee high resolution with low radiation exposure simultaneously.

With a digital volume tomography, the dentist can determine the ideal, three-dimensional position of the ceramic implants and therefore place them in the exact position. Important anatomical structures such as the nerves of the lower jaw or maxillary sinuses can be precisely localized and protected accordingly.

A DVT is also very helpful before the removing shifted wisdom teeth or jaw inflammation. This way, the removal can be carried out in a minimally invasive and gentle manner and the surrounding anatomical structures are protected as best as possible.

All In One Concept

The all-in-one concept has proven to be very effective in large and complex cases. A complete dental surgical treatment can be carried out in one session with little risk.

With this concept, all diseased and inflamed teeth can be extracted, ceramic implants can be placed immediately and as well as long-term provisionals. This saves patients from inconvenient and less effective intermediate steps.

Advantages

• After a tooth has been removed, there is no need to wait for the implantation. Immediate implants ensure that the jawbone remains stable in height and width – bone loss is prevented.
• Since there is no bone loss, bone grafts are not necessary in most cases.
• Immediate implant placement and long-term temporaries made of high-quality composites can prevent unaesthetic gaps.
• Frequent operations and long waiting times in between treatments can be avoided. The goal of having fixed teeth is achieved in a relatively short time.
• Through to our experience in the field of immediate implant placement/implantology with the all-in-one concept, we offer our patients an implant healing guarantee.

Our goal is to ensure that the patient receives the fixed restoration of choice quickly and without complications and that wound healing can proceed in the best possible way. The corresponding techniques of biological oral surgery and biological dentistry are essential for this.

Cutting and suturing techniques

When performing surgery on the jaw, it is often necessary to make an incision of the gum. This allows the surgeon to more easily remove a broken tooth, foreign body, and inflammation, or get a better sight of the bone supply. The direction of the incision and length of the incision can have a major impact on the healing and regeneration of the wound. If an incision is made too long or incorrectly, it can increaase the duration of wound healing, swelling and pain.

In general, the cutting technique should be as atraumatic and minimally invasive as possible. As a result, the wound conditions are kept small and wound regeneration is optimized.

After each incision into the tissue, edges of the wound should be closed tightly by suturing. This allows incisions in the gum to grow back together quickly and the risk of wound infection is greatly reduced.

Suturing techniques are also of great importance and should meet various requirements.

• The suture should be able to absorb the pull of the cheek and lips on the wound. Since every movement of the mouth creates a pull on the tissue, it can have a negative effect on the wound.
• The gums should be supported and stabilized in place. Exposed tooth necks and recession of the gum papilla are thereby minimized.
• Minimally invasive and atraumatic suturing without creating tension and traction in the soft tissue.

Removal of teeth / tooth extractions

A tooth is removed when the tooth can no longer be saved because it is so badly damaged. This can be caused by of caries, periodontitis or trauma to the tooth.

In the case of inflammation of the bone surrounding the tooth, removing the tooth is often the only option. Bone inflammation of this kind often occurs around dead, root canal-treated teeth and can be detected both radiologically and histologically.

When removing teeth, being very careful and gentle has proven to be beneficial. Unnecessary tissue damage should be avoided as much as possible. Ideally, the extracted tooth should be replaced immediately with a ceramic implant. For this purpose, it is important that the healthy surrounding bone is not removed under any circumstances.

After tooth extraction, all inflammation of the bone and soft tissue should be completely removed. The empty tooth socket is completely curetted so that no fibers of the periodontium are left.

The wound is disinfected, A-PRF membranes are inserted and the edges of the wound are closed with a high-quality suture.

Removal of wisdom teeth

Wisdom teeth often do not have enough space in the jawbone, creating an unclean area that can easily become inflamed. Recurrent, painful inflammation of the adjacent gums is a common symptom.

Surrounding bone can also show radiological and histological inflammation. Such inflammation can be acute and painful, or chronic and asymptomatic.

Wisdom teeth can be erupted, partially erupted, or not erupted (retained). There are also frequent cases where there are no wisdom teeth at all.

Erupted wisdom teeth can usually be extracted in one piece, like normal teeth.

Impacted wisdom teeth, on the other hand, are still completely in the jawbone, which is why a gum incision and access to the bone are necessary. They should be as small as possible, without making it difficult to see or operate. When the wisdom teeth are then exposed, they are separated strategically and the pieces are then carefully removed. In this case the bone and soft tissue should be traumatized as little as possible.

All surrounding inflammation in the bone and gums is completely removed so that only healthy bone and tissue remains. This process is extremely important to ensure wound healing without any complications.

As with the extraction of other teeth, remaining fibers are removed, the wound is disinfected, A-PRF membranes are inserted and the wound is sutured without tension.

Removal of inflammation

Inflammation in the bone and soft tissue can cause pain and has a major impact on health. It is therefore important to treat such inflammation.

Bone inflammation in particular often requires surgical intervention. Inflammatory processes at the tip of the tooth root or around wisdom teeth can often only be eliminated surgically.

It is very important to throughly remove all inflammed tissue, so that there is no remaining inflammation in that area. To ensure this, the technique of piezo surgery can be used, which allows precise surgeons to work precicely and mportant anatomical structures, e.g. the mandibular nerve or maxillary sinuses, are protected as much as possible.

Complete removal of all foreign materials

Often there are various forein materials present in the jaw bone and mucous membrane, which have been inserted inadvertently during previous dental treatments.

These include e.g.:

• Overpressed root filling material
• Splinters of amalgam or other metals
• Broken tooth root tips and other tooth fragments

These foreign bodies/materials can be critical for the body from both a toxicological and an allergological point of view. The risk and benefit should always be considered before removing these particles. When removing these particles, they should always be removed completely.

As well as this, a lot of care should be taken during operations to avoid inserting new foreign bodies into the jaw bone. This includes preventing adjacent fillings from splintering and settling into the wound, or tooth root residues remaining in the jaw.

Piezo Surgery

Piezo surgery (ultrasonic surgery) is a minimally invasive method of bone surgery that uses ultrasound to oscillate the surgical instruments.

The frequency of the oscillating instruments is selected to treat only hard and mineralized tissue. Soft tissue such as gums, the mucous membrane of the maxillary sinus, nerves or blood vessels are spared, which practically eliminates the risk of injury.

The use of common, rotating dental drills and dental milling cutters, on the other hand, involves an increased risk of injury/trauma and should ideally be replaced by piezo surgery technology.

Piezo surgery is ideal for:

• Removal of wisdom teeth
• Bone grafting/bone augmenttation (with one’s own bone)
• Widening/expansion of the jaw ridge (bone splitting/ridge splitting)
• Precise application of the bone window technique for access
• Removal of foreign material/particles from the jaw bone/oral cavity

With the help of ultrasound surgery, dental work can be carried out gently and precisely. Accordingly, there is less trauma and wound healing is improved.

Disinfection with ozone

Ozone is a small, gaseous molecule made up of three oxygen atoms (O3). The positive properties of ozone on health have long been known and the applications are diverse.

In dentistry, ozone can be used very effectively for caries and problems with the gums. Ozone is beneficial for oral and maxillofacial surgery.

During dental operations, the wound is treated with ozone. The small, oxygen-containing molecules penetrate deep into the tissue and show a variety of effects there:

• Disinfection of the wound. Anaerobic, pathological bacteria, viruses and fungi are eliminated. Consequently, the probability of postoperative wound infection decreases significantly.
• Ozone breaks down into oxygen in the tissue and increases the oxygen supply in and to the surrounding tissue.
• Blood circulation in the wound region improves. As a result, more stem cells and important building blocks can reach the surgical area.

To avoid postoperative complications, ozone can be effectively combined with the use of A-PRF.

Endogenous wound dressing – A-PRF

A-PRF (Advanced Platelet Rich Fibrin) is a method for producing endogenous wound dressings to protect and regenerate wounds after surgical interventions.

Right before dental surgery, a small amount of blood is taken from the patient, which is then centrifuged. This is done with a special centrifuge in which the speed and duration of rotation is set precisely.

Through the centrifugation process, the blood is separated into different components, with the heavy red blood cells being pushed outwards. The yellowish part of the blood, which has a high concentration of platelets (for coagulation) and blood cells (for the immune system), forms the cellular basis of the plasma membranes produced. In addition, the membranes have high concentrations of the body’s own minerals, nutrients, hormones and proteins.

This composition of important cells and building blocks forms an ideal basis for a stable fibrin framework, which adheres tightly to the wound edges and helps avoid infections.

The wound framework determines how the early healing phase will proceed. If it detaches from the edges of the wound, wound infection is likely. The fibrin membrane adheres firmly and securely to the wound edges, providing maximum protection.

Stem cells now enter the fibrin framework via the wound edges and convert the membrane into jawbone.

Advantages of the A-PRF method:

• Complications after operations, e.g. pain, swelling, inflammation, occur much less frequently.
• Wound healing is accelerated.
• The bone is built up faster and it’s dimensions remain stable. Bone loss is avoided (socket preservation).
• Complete autologous process with no foreign material.

Keramikimplantate als Sofortimplantation

Keramikimplantate haben gegenüber Titanimplantaten viele weitreichende Vorteile. Lesen Sie dazu den

Hauptartikel → Keramikimplantate.

Sofern ein Zahn entfernt werden muss, ist es empfehlenswert, das Keramikimplantat, in der gleichen Sitzung zu inserieren. Dieses Vorgehen, also Zahn raus und Implantat rein, wird als Sofortimplantation bezeichnet.

Bei der Sofortimplantation ist ein sehr sauberes und präzises operieren eine absolute Voraussetzung.

Dazu gehören:

• Die vollständige Extraktion des Zahnes, ohne den angrenzenden Kieferknochen zu beschädigen
• Die komplette Entfernung aller Entzündungen und kollagenen Fasern.
• Gründliche Desinfektion des Zahnfaches
• Primärstabile Verankerung des Keramikimplantates im vorhandenen Knochen

Die Sofortimplantation hat gegenüber der Spätimplantation viele entscheidende Vorteile:

• Bestmögliche Ästhetik, da Knochen und Zahnfleisch sofort von dem Implantat stabilisiert werden. Unschöne Einziehungen im Knochen und Zahnfleisch werden verhindert.
• Nach einem Zahnverlust wird die Knochenheilung aktiviert. Entsprechend ist auch die Osseointegration bei der Sofortimplantation verbessert.
• Mehrere operative Eingriffe, mit wiederholten Spritzen, können vermieden werden. Der Patient kommt schneller ans Ziel.

In unserer Zahnarztpraxis haben wir das Konzept der Sofortimplantation perfektioniert und setzen dementsprechend fast alle Implantate sofort ein. Wegen der sehr guten Prognose, geben wir unseren Patienten eine Einheilgarantie.

Internal and external sinus lift

The term sinus lift comes from:

• Sinus maxillaris = maxillary sinus.
• Lift = to lift, to raise

This is a technique in which the maxillary sinus, which is located above the maxillary posterior teeth, is lifted. By raising/lifting the floor of the maxillary sinus, a cavity is created which is filled with new bone. This new bone is used to firmly stabilize an implant.

In most cases, an internal sinus lift is done. This procedure is carried out internally through the bone compartment of the freshly extracted tooth or via the drill hole. It is a very gentle and minimally invasive method of bone augmentation in the lateral upper jaw. The floor of the maxillary sinus is lifted by carefully tapping with osteotomes and enables excellent anchoring of the implant. The cavity formed is filled with blood and later with stable autologous bone. A bone gain of up to 5 mm is possible with this method.

The external sinus liftis also known as a lateral (side) sinus lift. The maxillary sinus is not lifted via the bone compartment or drill hole, but via a lateral bone window. The fenestration of the jawbone and the careful detachment of the mucous membrane of the maxillary sinus can be carried out with the help of piezo surgery, minimally invasive and atraumatic. The cavity formed (beneath the mucous membrane of the maxillary sinus) is filled with the patient’s own bone via lateral access. This technique is used when there is very little bone to stabilize the implant.

In the majority of cases, we can achieve high implant stability with the internal sinus lift and avoid bone augmentation. Both the internal and external sinus lifts can be combined with an immediate implantation. Despite having a small amount of bone, unpleasant multiple interventions can be avoided and the patient can reach their goal quickly and easily.

Bone grafting / bone augmentation (with one’s own bone)

If jaw bone height and width are not sufficient for implant placement, bone grafting/bone augmentation is necessary. From a health point of view, using autologous bone has advantages, since foreign bone materials can cause local inflammatory processes.

Bone chips or a bone block can be used as autologous bone.

The bone chips are preferably collected in a sterile bone collector (e.g. Safescraper) and inserted into the bone defect without contamination.

A bone block is carefully and precisely removed with the help of piezo surgery and is then placed in the correct area. This heals in with the existing bone and improves the bone supply both horizontally and vertially.

The use of foreign bone material should be avoided if possible. However, if there is no other option, the material should be chosen accordingly. It should have the best biological properties and a complete bone transformation should occur.

Post treatment / procedure

During and after the operation, care must be taken to ensure that the area of the wound is adequately cooled. Wounds can stop various areas of tissue from an ideal blood supply and cause a a lack of oxygen. Cooling ensures that the metabolic rate of the tissue is reduced and therefore oxygen requirement of that area decreases. Consequently, the amount of oxygen is sufficient for the tissue to be able to heal and regenerate properly.

It is essential to ensure that the temperature soft tissue does not fall below 15°C,

otherwise there will be lymphatic congestion. As a result, the lymphatic flow is decreased and regeneration slows down. Permanent and precise cooling at approx. 18°C can be carried out with the Hilotherm cooling device.

After surgery, it takes 2-3 months for strong and stable bone to form. During this time and afterwards, the body should be supplied with important vitamins, minerals and building blocks. These include vitamin D3, K2, magnesium, calcium, silica (silicon) and boron.

These are supplied via supplements and a balanced diet with high-quality foods.

The bacterial flora in the oral cavity should also remain permanently stable and not cause any pathological processes. This way, the ceramic implants placed can remain firmly stabilized in the jaw bone for a lifetime.

FAQ zum Thema: Biologische Oralchirurgie

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