Welcome to Heratsi N1 University Hospital Բարի գալուստ Հերացի թիվ 1 համալսարանական հիվանդանոց Добро пожаловать в университетскую больницу Гераци N1
+374 91 474169 [email protected]
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Overview

Oral and Maxillofacial Surgery is a specialty available at Heratsi Clinic. Maxillofacial surgeons diagnose and treat congenital and acquired diseases and deformities of the face, mouth, teeth and jaws. Patients of all ages are treated, including patients under 7 years old. Pathologic, functional, and cosmetic surgical procedures are available for patients. The surgeons in this group work closely with colleagues in both medicine and dentistry.

Contemporary training in both medicine and dentistry enables oral & maxillofacial surgeons to treat conditions requiring expertise in both fields. These include a range of common oral surgical problems (eg. impacted teeth, dental implants), jaw and congenital facial disproportion, facial trauma, oral cancer, salivary gland disease, temporomandibular joint disorders, and various benign pathologies (eg. cysts and tumours of the jaws).

The oral and maxillofacial rehabilitation specialists: prosthodontists, periodontists specialize in restoring and replacing teeth, mouth and facial structures. We use the latest, most advanced techniques including:

• Crowns and dentures

• Dental implants

• Periodontal therapies

• Teeth whitening

• Veneers

Our specialists are leaders in comprehensive facial surgery for many conditions. Our oral and maxillofacial surgeons diagnose, consult and provide treatment for:

• Congenital jaw deformities

• Cosmetic surgery

• Infections of the teeth and maxillofacial area

• Lesions and tumors

• Sleep disorders, such as sleep apnea and snoring

• Trauma

Our surgeons have special expertise in:

• Bone grafting

• Dental implants

• Evaluation and removal of wisdom teeth

• Orthognathic corrective surgery for jaw and face

• Reconstructive surgery

Wisdom Teeth & Dento-alveolar Surgery

Dento-alveolar surgery involves that part of the jaws (the alveolus) that contains or has contained teeth. This surgery is either undertaken under general anesthesia in a hospital, or in a clinic under local anesthesia, with or without sedation. Dento-alveolar surgery may include the following conditions:

Surgical Removal of (Erupted) Teeth

The removal of teeth is generally straightforward. However, there are many reasons why the surgical removal of a tooth may be necessary, prompting referral to an Oral and Maxillofacial Surgeon. Most teeth are removed because of extensive dental decay that destroys and weakens the remaining tooth crown thus requiring surgical removal. The pattern of root growth, for example a curved root, may increase the risk of complications in removal, if the tooth is not surgically removed.

 

Removal of Impacted Teeth

Impacted teeth have insufficient space to erupt into the mouth. The most common teeth to be impacted are the third molar teeth (‘wisdom teeth’) and canine (‘eye’) teeth. These teeth often require removal due to problems with pain and infection of the surrounding gum tissue and decay of adjacent teeth, necessitating referral to an Oral and Maxillofacial Surgeon for assessment and treatment.

 

Exposure of Impacted Teeth (surgery to assist Orthodontic Treatment)

Some impacted teeth may be orthodontically positioned by creating space by the extraction of other teeth such as, deciduous (‘baby’) teeth or premolar teeth. Surgery may be undertaken to remove some of the overlying soft tissue and bone to allow an orthodontic appliance to be glued to the surface of the tooth allowing the orthodontist to move the tooth into its correct position. This positioning of impacted teeth is best undertaken by a registered Specialist Orthodontist.

 

Apical Surgery

Some infections are related to teeth that have previously undergone root canal treatment. Surgery may sometimes be required to treat the residual infection around the apices of the roots of these teeth.

 

Management of Jaw Cysts

Cysts of the jaws are usually fluid-filled cavities replacing bone within the jaws. Many jaw cysts arise from infections around the apices of teeth, soft tissue around developing tooth crowns or from cells from which teeth and their surrounding structures develop. Benign jaw cysts are usually managed with surgery however treatment will depend upon the type of cyst present. Some cysts may require adjacent teeth to be removed as part of the treatment (also see below).

 

Preprosthetic Surgery

In order to have a denture constructed that is comfortable, with or without the use of dental implants, it may be necessary to alter the shape or size of the jaw or soft tissues that the denture will rest upon. Removal of excess mucosa (‘gum’) that has developed under an old, poorly fitting denture may be required, before the new denture is made. Similarly bony projections may need to be contoured to facilitate a new denture.

 

Tooth Transplantation

This procedure involves removing a tooth and placing it elsewhere in the jaws to replace a diseased or missing tooth. This procedure is very limited in its application but may be an option in an orthodontic treatment plan.

Corrective Jaw (Orthognathic) Surgery

Surgery to align the jaws, also known as Orthognathic surgery, is used to treat problems associated with overgrowth, undergrowth, disproportion and asymmetry of the jaws and facial skeleton.

Individuals with jaw and facial disproportion may seek corrective surgery. Facial asymmetry, jaw and tooth misalignment, difficulties with chewing and speech are indications for treatment. Orthognathic surgery is also used in the management of congenital craniofacial syndromes, such as cleft lip and palate and is also one of the treatment modalities for obstructive sleep apnoea, particularly in certain facial patterns.

Orthognathic surgery is generally conducted in conjunction with orthodontic treatment (braces) to optimally correct the bite and to provide good facial balance. Usually, treatment is undertaken in the teenage years and early adult life when facial growth is complete or nearing completion. However, corrective jaw surgery can be offered to adults of all ages.

The surgery is performed under general anesthesia and almost always through the mouth and only rarely are incisions made on the face. Precision bone cuts (osteotomies) enable repositioning of the jaw fragments that are held in position with bone screws and plates.

While most patients seek orthodontic treatment in combination with orthognathic surgery to straighten their teeth and to correct a bad bite, the treatment often has major positive changes in facial appearance.

Dental Implantology

Duration

15 min-2 hours

Dental implants are used to replace missing teeth in the jaws. The reasons for losing teeth can be varied, but no matter what the cause, their loss can impact on both appearance and function.

Implants are titanium “screws” that are place in the upper or lower jaws to act as supports to which individual or multiple teeth can be attached. They can also be used to connect to dentures to increase their stability.

The implants fuse to the bone, in a process called “osseointegration”, which can take 2-6 months to occur after placement. In some cases, teeth can be placed on the implants as soon as they are inserted, but often, a healing period is needed to allow osseointegration before the teeth are attached to the implant.

In most cases, the provision of implants is a team effort, with your Oral and Maxillofacial Surgeon placing the implant in the bone, and then a restorative dentist or specialist prosthodontist fitting the final teeth. In some cases, additional bone may be needed prior to or during the implant placement, and your surgeon will discuss this with you during the planning stages of the procedure.

Veneers

Lasting

many years

What is a veneer?

A veneer is a thin layer of porcelain made to fit over the front surface of a tooth, like a false fingernail fits over a nail. Sometimes a natural-colour ‘composite' material is used instead of porcelain.

When would I need a veneer?
Veneers can improve the colour, shape and position of your teeth. A precise shade of porcelain can be chosen to give the right colour to improve a single discoloured tooth or to lighten your front teeth. A veneer can make a chipped tooth look whole again.

The porcelain covers the whole of the front of the tooth, with a thicker section replacing the broken part. Veneers can also be used to close small gaps, when orthodontics (braces) are not suitable. If one tooth is slightly out of position, a veneer can sometimes be fitted to bring it into line with the others.

What are the advantages of veneers?
Veneers make teeth look natural and healthy. Because they are very thin and are held in place by a special, strong adhesive, very little preparation of the tooth is needed. Some types of veneers don't need any preparation at all.

How are teeth prepared for a veneer?

Some of the shiny, outer enamel surface of the tooth may be removed, to make sure that the veneer can be bonded permanently in place later. The amount of enamel removed is tiny and will be the same as the thickness of the veneer to be fitted, so that the tooth stays the same size.

A local anaesthetic (injection) may be used to make sure that there is no discomfort, but often this is not needed. Once the tooth has been prepared, the dental team will take an ‘impression' (mould). This will be given to the dental technician, along with any other information needed to make the veneer.

The colour of the surrounding teeth is matched on a shade guide to make sure that the veneer will look entirely natural.

a temporary veneer between visits?

Because the preparation of the tooth is so slight you will probably not need a temporary veneer. The tooth will look very much the same after preparation, but will feel slightly less smooth.

What happens after the veneer is fitted?

Only minor adjustments can be made to the veneer after it is fitted. It is usually best to wait a little while to get used to it before any changes are made. Your dental team will probably want to check and polish it a week or so after it is fitted, and make sure that you are happy with it.

How long will it take?

A veneer takes at least two visits. The first is to prepare the tooth and match the shade, and the second is to fit it. Before bonding it in place, your dentist will show you the veneer on your tooth to make sure you are happy with it. Bonding a veneer in place is done with a special adhesive, which holds it firmly on the tooth.

Will I need a temporary veneer between visits?

Because the preparation of the tooth is so slight you will probably not need a temporary veneer. The tooth will look very much the same after preparation, but will feel slightly less smooth.

What happens after the veneer is fitted?

Only minor adjustments can be made to the veneer after it is fitted. It is usually best to wait a little while to get used to it before any changes are made. Your dental team will probably want to check and polish it a week or so after it is fitted, and make sure that you are happy with it.

How much will it cost?

The costs for this treatment can vary from practice to practice so it is important to discuss charges and treatment options with your dental team before starting treatment.

How long will a veneer last?

Veneers should last for many years; but they can chip or break, just like your own teeth can. Your dental team will tell you how long each veneer should last. Small chips can be repaired, or a new veneer fitted if necessary.

Tooth whitening

Duration

30 min to 1 hour

Lasting

up to 3years

What is tooth whitening?

Tooth whitening can be a very effective way of lightening the natural colour of your teeth without removing any of the tooth surface. It cannot make a complete colour change, but it may lighten the existing shade.

Why would I need my teeth whitened?

There are a number of reasons why you might get your teeth whitened. Everyone is different; and just as our hair and skin colour vary, so do our teeth. Very few people have brilliant-white teeth, and our teeth can also become more discoloured as we get older.

Your teeth can also be stained on the surface by food and drinks such as tea, coffee, red wine and blackcurrant. Smoking can also stain teeth.

‘Calculus' or tartar can also affect the colour of your teeth. Some people may have staining under the surface, which can be caused by certain antibiotics or by tiny cracks in the teeth which take up stains.

What does tooth whitening involve?

Professional bleaching is the most usual method of tooth whitening. Your dental team will be able to tell you if you are suitable for the treatment, and will supervise it if you are. First the dental team will put a rubber shield or a gel on your gums to protect them. They will then apply the whitening product to your teeth, using a specially made tray which fits into your mouth like a mouthguard.

The ‘active ingredient' in the product is usually hydrogen peroxide or carbamide peroxide. As the active ingredient is broken down, oxygen gets into the enamel on the teeth and the tooth colour is made lighter.

How long does this take?

The total treatment can usually be done within three to four weeks. First, you will need two or three visits to the dentist. Your dental team will need to make a mouthguard and will take impressions for this at the first appointment. Once your dental team has started the treatment, you will need to continue the treatment at home. This means regularly applying the whitening product over two to four weeks, for 30 minutes to one hour at a time.

However, there are now some new products which can be applied for up to eight hours at a time. This means you can get a satisfactory result in as little as one week.

What other procedures are there?

There is now laser whitening or ‘power whitening'. During this procedure a rubber dam is put over your teeth to protect the gums, and a bleaching product is painted onto your teeth. Then a light or laser is shone on the teeth to activate the chemical. The light speeds up the reaction of the whitening product and the colour change can be achieved more quickly. Laser whitening is said to make teeth up to five or six shades lighter.

How long will my teeth stay whiter?

The effects of whitening are thought to last up to three years. However, this will vary from person to person. The effect is less likely to last as long if you smoke, or eat or drink products that can stain your teeth. Ask your dental team for their opinion before you start the treatment.

What are the side effects?

Some people may find that their teeth become sensitive to cold during or after the treatment. Others may have discomfort in the gums, a sore throat or white patches on the gum line. These symptoms are usually temporary and should disappear within a few days of the treatment finishing.

If any of these side effects continue you should go to your dentist.

What about home whitening kits?

There are many home whitening kits available, including paint-on whiteners and strips. How effective these are

depends on the amount of whitening agent they contain.

Home kits are cheaper but they are not always assessed for safety and tend to be more acidic. So there is a chance that these products could damage your teeth and gums. Because tooth whitening is a complicated procedure we advise that you always talk to your dentist before starting the treatment.

Regulations covering home kits vary from country to country. Kits sold in Europe cannot legally contain more than 0.1% peroxide and this is too little to be effective. In other countries where stronger peroxide is allowed, home whitening is more common. But you need to be careful as some kits sold over the internet may contain mild acids and abrasives.

What about whitening toothpastes?

There are several whitening toothpastes on the market. Although they do not affect the natural colour of your teeth, they may be effective at removing staining. Therefore, they may improve the overall appearance of your teeth. Whitening toothpastes may also help the effect to last, once your teeth have been professionally whitened.

Can a single tooth which has been root filled be whitened?

Yes. Sometimes dead teeth go discoloured after a root filling. If the tooth has been root treated, the canal (which contained the nerve) may be reopened. The whitening product is applied from the inside to whiten the tooth.

When might tooth whitening not work?

Tooth whitening can only lighten your existing tooth colour. Also it only works on natural teeth. It will not work on any types of ‘false' teeth such as dentures, crowns and veneers.

If your dentures are stained or discoloured visit your dental team and ask for them to be cleaned.

How can I look after my teeth once they have been whitened?

You can help to keep your teeth white by cutting down on the amount of food and drinks you have that can stain teeth. Don't forget, stopping smoking can also help prevent discolouration and staining.

We recommend the following tips to take care of your teeth:
  • Brush your teeth last thing at night and at least one other time during the day, with a fluoride toothpaste.
  • Cut down on how often you have sugary foods and drinks.
  • Visit your dental team regularly, as often as they recommend.

Address:  58, 60, 60/1 Abovyan, 0025, Yeravan, RA

Tel: +374 91 474169

E-mail:  [email protected]