Surgery for Impacted Teeth, Infections, and Jaw: Dentoalveolar Procedures

Dentoalveolar surgery encompasses a spectrum of surgical interventions targeting the teeth, the alveolar bone (which houses the tooth sockets), and adjacent supportive tissues within the oral cavity. These structures form the functional and structural core of the dental arch, and their integrity is essential for proper chewing, speech, and facial aesthetics.

The role of dentoalveolar surgery is critical in addressing conditions that compromise the stability, alignment, or health of the dental and bony architecture. Through precise surgical techniques, these procedures aim to restore or maintain oral function, reduce or eliminate pain, and prevent the progression of localized disease that could otherwise lead to broader systemic complications. In pediatric, adult, and geriatric patients alike, dentoalveolar surgery contributes significantly to maintaining long-term oral health, facilitating rehabilitation, and supporting the success of restorative and prosthetic dental interventions.

Beyond functional benefits, dentoalveolar interventions often play a key role in improving quality of life, particularly in patients suffering from chronic oral discomfort, structural deformities, or post-traumatic conditions.

Why Cuba

Dentoalveolar procedures and surgeries in Cuba are primarily performed by oral and maxillofacial surgeons, who undergo rigorous training in both dentistry and surgical management of complex conditions involving the oral cavity, jaws, and facial structures. These specialists possess the clinical expertise required to manage a wide spectrum of cases—from routine extractions to more intricate interventions involving the alveolar bone, soft tissues, and facial framework. In Cuba, the practice of dentoalveolar surgery is well-integrated into the national healthcare system, supported by a strong foundation in preventive dental care and community-based treatment models.

These procedures and surgeries are routinely incorporated into multidisciplinary treatment plans that may involve periodontists, prosthodontists, orthodontists, and rehabilitation specialists. This collaborative approach ensures that patients receive comprehensive care that addresses not only the immediate surgical need but also the broader functional, aesthetic, and restorative goals of treatment.

Cuban surgical teams place a strong emphasis on functional restoration and long-term outcomes, aligning each surgical intervention with the patient’s overall oral health objectives and quality of life improvements.

Diseases and Conditions Affecting the Dentoalveolar Region

The dentoalveolar complex includes the teeth, alveolar bone (the part of the jaw that supports teeth), periodontal ligament, and surrounding soft tissues.

Conditions that affect this area and may require surgical intervention include:

• Impacted teeth (especially third molars or wisdom teeth)
  Impacted teeth are those that fail to erupt properly through the gums, often due to lack of space or abnormal positioning.

• Severe dental infections or abscesses
  Infections that originate in the tooth pulp or surrounding tissues can lead to the formation of abscesses—pockets of pus caused by bacterial activity. If not surgically drained or treated, these infections can spread to the jawbone or bloodstream, posing serious health risks.

• Advanced periodontal disease
  When gum disease progresses beyond gingivitis, it can destroy the supporting structures of the teeth, including the alveolar bone.

• Tooth and bone trauma
  Trauma from accidents or sports injuries can result in fractured teeth, dislocated tooth roots, or damage to the alveolar bone. Prompt surgical management is essential to preserve dental function and prevent long-term complications.

• Benign cysts or tumors of the jaw
  Non-cancerous growths such as odontogenic cysts or tumours can displace teeth, erode bone, and cause facial asymmetry. Surgical removal is often necessary to prevent structural damage and to confirm the diagnosis through biopsy.

• Congenital or developmental anomalies
  Some individuals are born with structural abnormalities affecting the teeth or jaw. Surgical correction may be required to enable normal function and facilitate future orthodontic or prosthetic treatment.

• Retained roots or supernumerary teeth
  Roots left behind after incomplete extractions or extra (supernumerary) teeth that crowd the dental arch can interfere with normal tooth alignment or cause impaction. These require surgical removal to prevent complications and support orthodontic planning.

• Severe tooth decay that cannot be treated conservatively
  In cases where decay has extensively damaged the tooth structure, conventional fillings or crowns are no longer viable. Surgical extraction becomes necessary to eliminate pain and infection and to prepare for possible replacement options such as implants or bridges.

Types and Classification of Dentoalveolar Surgical Procedures

Dentoalveolar surgeries can be categorized based on their purpose and complexity:

• Tooth-Related Procedures
  • Surgical extractions (e.g., impacted or broken teeth)
  • Exposure of unerupted teeth for orthodontic reasons
  • Apicoectomy (removal of infected root

• Bone and Soft Tissue Procedures
  • Alveoloplasty (reshaping of the alveolar bone)
  • Bone grafting in preparation for implants
  • Removal of cysts, granulomas, or benign lesions
  • Treatment of traumatic injuries to teeth or jawbone

• Reconstructive or Pre-Prosthetic Procedures
  • Ridge preservation or augmentation
  • Sinus lifts (for implant support)
  • Frenectomy (removal of restrictive oral soft tissue attachments)

Causes of Dentoalveolar Disorders

Dentoalveolar conditions can arise from a variety of factors, including:

• Poor oral hygiene and plaque buildup
• Chronic untreated dental caries
• Genetic or developmental abnormalities
• Trauma from accidents or sports injuries
• Failed previous dental treatments
• Infections that extend beyond the tooth into the bone
• Orthodontic treatment complications

Symptoms of Dentoalveolar Conditions

Patients may present with one or more of the following symptoms:

• Persistent or severe toothache
• Swelling of the gums or jaw
• Painful chewing or biting
• Difficulty opening the mouth fully
• Loose teeth or mobility in the jaw
• Pus discharge or bad taste in the mouth
• Visible deformities in the dental arch or jaw

Pre-Surgical Diagnosis and Evaluation

Before performing any dentoalveolar surgical procedure, a thorough presurgical diagnosis is essential to ensure patient safety, guide treatment planning, and optimize surgical outcomes. The following steps provide a structured approach to evaluating the patient’s condition and readiness for surgery:

• Medical and Dental History Review
  • Comprehensive medical history to identify chronic conditions (e.g., diabetes, cardiovascular disease, bleeding disorders) that may impact surgical risk or healing.
  • Medication review, especially anticoagulants, immunosuppressants, or bisphosphonates.
  • Dental history including past extractions, trauma, orthodontic treatment, or periodontal disease.

• Clinical Examination
  • Intraoral assessment to evaluate the teeth, gingiva, alveolar ridges, mucosa, and occlusion.
  • Extraoral evaluation to check for swelling, asymmetry, lymphadenopathy, or signs of infection.
  • Mobility testing and percussion sensitivity of the teeth to assess vitality and stability.

• Radiographic Imaging
  • Periapical and panoramic X-rays (OPG) to visualize root structure, alveolar bone, and impacted teeth.
  • Cone Beam CT (CBCT) for three-dimensional assessment of bone volume, lesion extent, or proximity to critical structures like the inferior alveolar nerve or maxillary sinus.
  • Imaging helps identify cysts, tumors, root fractures, or retained roots.

• Diagnostic Tests (When Indicated)
  • Pulp vitality testing (thermal or electric) to assess tooth health.
  • Sinus tracing or dye testing if oroantral communication is suspected.
  • Laboratory tests (CBC, INR, glucose levels) in medically complex patients or when systemic conditions are present.

• Diagnosis Confirmation and Classification
  • Establish a working diagnosis based on clinical and radiographic findings.
  • Classify the case as routine or complex, which determines the surgical approach and anesthesia type.

• Risk Assessment and Surgical Planning
  • Evaluate:
    • Bleeding risk
    • Infection risk
    • Anatomic complications (nerve damage, sinus perforation, etc.)
  • Decide on surgical approach (minimally invasive vs. open surgery) and anesthesia plan (local, sedation, or general).

Surgical Treatment for Dentoalveolar Conditions

Most dentoalveolar procedures use one of the following methods:

• Local anesthesia: For minor surgical extractions and simple procedures
• Conscious sedation or general anesthesia: For more extensive interventions or anxious patients

The surgical process involves:

• Creating an incision to access the affected area
• Removal or reshaping of tissue or bone
• Irrigation and decontamination of the surgical site
• Suturing (if needed) and postoperative care instructions

Surgeons use specialized tools to ensure precision and minimize trauma to surrounding structures.

Minimally Invasive vs. Open Surgical Approaches

Most dentoalveolar surgery often utilizes minimally invasive techniques, which offer:

• Smaller incisions
• Less bleeding and swelling
• Reduced postoperative pain
• Faster healing times

However, open surgery may still be necessary in more complex cases, such as removal of large cysts or reconstructive bone procedures. The choice of approach depends on the condition’s complexity, location, and the patient’s specific needs.