Biological oral surgery originates from the teaching of biological dentistry and classic oral surgery. The focus is on improving the health of the patient, taking into account the proven oral surgical techniques and methods.
In biological oral surgery, the materials are selected in such a way that the body is not stressed, e.g. the use of ceramic implants instead of titanium implants. The surgical techniques are modified in such a way that postoperative swelling is as low as possible, e.g. minimally invasive and atraumatic techniques for cutting and suturing.
Complete cleaning of all inflammatory processes and thorough disinfection with ozone are essential for optimal wound healing. Additional measures to support regeneration, such as the A-PRF technique, are also part of the concept.
All of the measures and techniques in this concept go hand in hand and significantly improve the outcome of the operation. In this way, pain, postoperative swelling and inflammation can be reduced to a minimum.
Thanks to many years of experience in biological oral surgery, the modified surgical techniques and additional measures, we are able to carry out oral reconstructions in one or two sessions in an uncomplicated manner.
Preparing for an Operation
The preparation for an operation aims to bring the patient into a state in which wounds and bone can heal optimally. To do this, we use our own measures and also work closely with experts from various medical disciplines.
Supplying the body with the necessary vitamins, minerals and trace elements is an important point. 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 silicon 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 not able 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) 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 at the same time/simultaneously.
With 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 removal of shifted wisdom teeth or jaw inflammation. In 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. The complete surgical treatment can be carried out in one session with little risk.
In this way, all diseased and inflamed teeth can be extracted ceramic implants can be interested immediately and long-term provisionals can be placed. This saves patients from inconvenient and less effective intermediate steps and offers the patient great added value.
- After the 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.
- Unesthetic gaps can be avoided by immediate implantation and long-term provisionals made of high quality composites.
- Frequent operations and long waiting times in between treatments are not needed. The goal of fixed teeth is achieved in record time.
- Thanks to our experience in the field of immediate implant placement/implantology with the all-in-one concept, we give our patients a guarantee that the ceramic implants will heal.
Our goal is that the patient gets the desired treatment of fixed teeth quickly and easily and that the wounds heal as best as possible. The corresponding techniques of biological oral surgery and biological dentistry are essential for this.
Cutting and Suturing Techniques
During an operation in the jaw area, it is often necessary to make an incision in the gums. In this way, the surgeon can more easily remove a broken tooth, foreign material and inflammation or get a better picture of the existing bone. The direction of the incision and length of the incision can have a major impact on the regeneration of the wound. Wound healing, wound swelling and wound pain can increase if the incision was made too long or incorrectly.
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 tissue is cut, the wound edges should be adapted with a suture. This allows the gum incision that has been made to grow back together quickly and the risk of wound infection is greatly reduced.
The suturing technique is 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 conditions.
- 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 / Teeth Extractions
A tooth is removed when it is so badly damaged that it is no longer possible to save the tooth. This can be caused by the influence 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 in 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 at all costs. Ideally, the extracted tooth should be replaced immediately with a ceramic implant. It is of great importance 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 adapted with a high-quality suture.
Removal of Wisdom Teeth
Wisdom teeth often do not have enough space in the jawbone, creating an unclean niche that can easily become inflamed. The symptoms are recurring, painful inflammation of the adjacent gums.
The 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). In addition, there are frequent cases where there are no wisdom teeth.
Erupted wisdom teeth can usually be removed in one piece, like normal teeth.
Impacted wisdom teeth, on the other hand, are completely in the jawbone, which is why a gum incision and bone access are necessary. Both should be as small as possible, without making it difficult to see or work. The exposed wisdom teeth are separated in strategically favorable places and carefully removed in pieces. Here, too, the bone and soft tissue should be injured as little as possible.
All surrounding inflammation in the bone and gums is completely eliminated until only healthy tissue remains. This process is extremely important for wound healing without any complications.
As with the tooth extraction, the retaining 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.
Care must be taken when removing the substance to ensure that there are no remains in the body. For this purpose, the technique of piezo surgery can be used, which allows precise work and important 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 in the bone and the mucous membrane, which have been inserted by previous treatments at the dentist.
These include e.g.:
- Overpressed root filling material
- Splinters of amalgam or other metal
- Broken tooth root tips and other tooth fragments
These foreign bodies/materials can be critical for the organism from both a toxicological and an allergological point of view. Removal should always be undertaken under strict risk-benefit considerations. The aim is always to remove it completely.
Of course, during operations, meticulous care must be taken to ensure that no new forein bodies are inserted into the jawbone. This should prevent adjacent fillings from splintering and settling in the wound, or tooth root residues from remaining in the jaw.
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 and should be replaced by piezo surgery technology.
Piezo surgery is ideal for:
- Removal of wisdom teeth
- Bone grafting (with one’s own bone)
- Widening/expansion of the jaw ridge (bone splitting/ridge splitting)
- Precise application of bone window for access
- Removal of foreign bodies from the jaw bone/oral cavity
With the help of ultrasound surgery, dental work can be carried out particularly 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 also offers great added value during 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.
- The 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 very 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.
Immediately before the operation, a small amount of blood is taken from the patient, which is then centrifuged. This takes place in a special centrifuge, with the speed and duration of rotation being precisely adjusted.
Through the centrifugation process, the blood is separated into its 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 offers no possibility of infections (avoids infection).
The wound framework determines how the early healing phase will proceed. If it detaches from the edges of the wound, wound infection is more than 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 remains stable in its dimension. Bone loss is avoided (socket preservation).
- Complete autologous process with no foreign material.
Ceramic Implants – Immediate Implantation
Ceramic implants have many far-reaching advantages over titanium implants. Please read the
Main article → Ceramic implants
If a tooth has to be removed, it is advisable to insert the ceramic implant during the same session. This procedure, i.e. tooth out and implant in, is called immediate implantation.
In the case of immediate implantation, a very clean and precise operation is an absolute prerequisite.
- A complete extraction of the tooth without damaging the adjacent jawbone
- Complete removal of all inflammation and collagen fibers
- Through disinfection of the tooth socket
- Primary stable anchoring of the ceramic implant in the existing bone
Immediate implant placement has many decisive advantages over late implant placement:
- Best possible aesthetics, as bone and gums are immediately stabilized by the implant. Unsightly retractions of the bones and gums are prevented.
- Bone healing is activated directly after tooth loss. Accordingly, the osseointegration is also improved with immediate implantation.
- Multiple surgeries with repeated injections can be avoided. The patient reaches his destination faster.
In our dental practice, we have perfected the concept of immediate implant placement and accordingly place almost all implants immediately. Because of the very good prognosis, we give our patients a healing guarantee.
Internal and external Sinus Lift
The term sinus lift stems 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 of our 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 provides 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 vast majority of cases, we can achieve high implant stability with the internal sinus lift and forgo a bone augmentation. Both the internal and external sinus lift can be combined with an immediate implantation. Despite the small amount of bone, unpleasant multiple interventions can be avoided and the patient can reach their goal quickly and easily.
Bone Grafting with one’s own bone
If jaw bone height and jaw bone width are not sufficient for an implantation, bone grafting 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 then placed in the correct area. This heals in with the existing bone and improves the bone supply in both the horizontal and vertical direction.
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 complete bone transformation should occur.
Post Treatment / Procedure
During and after the operation, care must be taken to ensure that the wound area is adequately cooled. Wounds cut off various areas of tissue from having an ideal blood supply and also have a lack of oxygen. The cooling ensures that the metabolic rate of the tissue is reduced and the oxygen requirement decreases. Consequently, the amount of oxygen is sufficient for the tissue to be able to regenerate well.
It is essential to ensure that the tissue temperature 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 high-quality, balanced diet.
The bacterial flora in the oral cavity should also remain permanently stable and not cause any pathological processes. In this way, the ceramic implants placed can remain firmly stabilized in the jaw bone for a lifetime.
Are there differences in procedures of the upper jaw and lower jaw?
In addition, the maxillary sinuses are located in the posterior region of the upper jaw and the lower jaw nerves are located in the lower jaw. Accordingly, there are slight differences in the operations.
Is cooling useful/important after the operation and for how long?
Cooling is very useful and should be done on the day of the operation as well as one to two days afterwards. In our practice, cooling is carried out with the Hilotherm cooling mask. If you also need such a cooling device at home, please contact us a few weeks before the operation.
Is the all-in-one concept also suitable for chronically ill and weakened patients?
We work closely with doctors and naturopaths. Depending on the patient’s condition and the urgency of the treatment, the therapy is always planned very individually. Appropriate preparation and follow-up work can be carried out on an interdisciplinary basis to strengthen the patient.
Can the operations also be performed under general anesthesia?
In our practice we work with a professional anesthesia team and can offer all treatments under general anesthesia. Please read the article – General Anesthesia Read the article → General anaesthesia.
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