This is a broad area which encompasses wisdom tooth surgery, dental implant surgery, jaw surgery, trauma management, cleft lip and palate repair and oral cancer surgery.

Wisdom tooth extraction

Wisdom teeth also known as the third molars are situated at the back of the mouth. These teeth are normally the last teeth to erupt and appear from the late teens to early twenties, a period usually identified with the onset of maturity and the acquisition of wisdom. Most people usually have four wisdom teeth, two in the upper jaw and two in the lower jaw. Some may be congenitally missing.

These teeth are bonuses to the mouth if they are healthy and properly positioned. In most cases though, wisdom teeth are misaligned or impacted and thus require surgical removal. Poor alignment of wisdom teeth may affect or damage adjacent teeth, the jawbone or nerves in the jaw.

Wisdom teeth impaction occur when they are partially or entirely trapped under the gum and/or the jawbone. Partial eruption of the wisdom teeth may trap food and cause bacterial accumulation. This can lead to tooth decay and gum infection, known as pericoronitis, affecting both wisdom teeth and the neighbouring teeth. An impacted wisdom tooth may also grow into fluid-filled sacs, developing cysts and damaging the surrounding jawbone, teeth and nerves.

These associated conditions may require complex treatment if left unattended. They can develop silently without symptoms in the early stages. Therefore, it is advisable to schedule a dental visit pre-emptively to identify any wisdom teeth conditions and allow for timely treatment.

What are the options available to me?

During your visit, the dentist will examine and take an X-ray of your mouth to evaluate the position of your wisdom teeth and determine if removal is required.

A fully erupted wisdom tooth can be removed via simple extraction. However, an impacted wisdom tooth requires surgical extraction. Removal of a wisdom tooth can be performed under anaesthesia to numb the surrounding tissue. The type of anaesthesia, local or general, depends on your health condition, the number of wisdom teeth to be removed and the level of surgical complexity. After anaesthesia is administered, the buried wisdom tooth is surgically exposed and extracted as a whole, or sectioned and removed in multiple fragments.

After wisdom tooth extraction

After surgery, some minor bleeding from the wound is expected. Residual oozing may occur for a few hours. Mild swelling and bruising in the face and neck are common, this may increase over the first 72 hours. This should subside thereafter.

Ice packs and pain medication prescribed by the dentist or oral surgeon should help manage the pain. It is recommended to avoid excessive spitting or rinsing after surgery, to maintain satisfactory oral hygiene and to consume soft food for a few days following surgery.

Dental implant

A dental implant is a titanium screw that is surgically inserted into the jawbone to replace a missing tooth. It serves as a foundation for an implant crown, which restores the space created following the loss of a natural tooth. It improves function, appearance and likely speech. It may also be used to improve the retention of dentures.

For an implant to be successfully placed, there must be adequate remaining bone in the jaw to hold the implant. The amount of bone that is available for implant is often determined by the existing bone anatomy and vital structures in the vicinity such as maxillary sinuses, in the upper jaw, and nerve bundles, in the lower jaw. When the necessary factors have been considered, an implant of a suitable size may be selected, and you can be on your way to starting your implant treatment.

At TTSH, implants are managed by a team of specialists consisting of the oral surgeon, periodontist and prosthodontist. The treatment is carried out in three stages over a minimum period of four months. This may vary depending on the case complexity and the need for additional bone grafting.

Phase 1: Treatment Planning

During your initial dental implant consultation, the specialist will examine your overall oral condition and take several dental X-rays to determine the location of the vital structures and bone volume for an individualised treatment plan.

Phase 2: Surgical Treatment

The dental implant procedure involves making a small incision on the gums to place the titanium implant into the jawbone. If you had previously lost your tooth through chronic infection, the resultant bone loss will need to be replenished either with bone harvested from other parts of your jaw or with commercially prepared bone.

The surgical stage is performed under anaesthesia to numb the surrounding tissues. The type of anaesthesia, local or general, depends on your health condition and the level of surgical complexity.

Phase 3: Restorative Treatment

When the implant fixture is integrated with bone, the appropriate prosthesis will be fabricated for you.

Jaw Surgery

What is Jaw surgery?

Orthognathic surgery, also known as corrective jaw surgery, is a procedure that realigns the jaw bones and teeth to improve appearance and essential functions such as chewing, speaking and breathing.

When is orthognathic surgery recommended?

Orthognathic surgery may be considered if you have:
Severe malocclusion (including overbite, underbite, cross bite or open bite) that cannot be corrected with orthodontic treatment (braces) alone
Difficulty chewing or speaking due to to jaw malalignment
Obstructive sleep apnea related to jaw structure (e.g. a small and retruded jaw)
Cosmetic concerns such as facial asymmetry or a “gummy” smile

What to expect?

Consultation and Pre-operative Assessment

Your treatment journey begins with consultations with an Orthodontist (braces specialist) and an Oral and Maxillofacial Surgeon (OMS). Radiologic imaging (X-rays and CT scans) will be conducted as part of the pre-operative evaluation. Patients typically undergo braces treatment for 12 to 18 months to align their teeth in preparation for surgery.

Surgery

Surgery is performed under general anaesthesia. Depending on your treatment plan, one or both jaws may be operated on. Incisions are usually made inside the mouth, though external skin incisions may occasionally be necessary. Common orthognathic procedures include:

Le Fort I osteotomy (upper jaw surgery)

The maxilla or upper jaw is repositioned to a more optimal position and fixed in place with titanium plates and screws. This procedure is used to correct conditions such as a protruded or retruded jaw, vertical maxillary excess (“gummy smile”) or deficiency.

Bilateral sagittal split osteotomy (lower jaw surgery)

The mandible or lower jaw is split at both sides and moved forward, backward or rotated to the planned position to correct mandibular protrusion, retrusion or asymmetry. The bone segments are then fixed with titanium plates and screws.

Genioplasty (chin surgery)

The chin is repositioned or reshaped to achieve better projection and symmetry. Titanium plates and screws are used to secure to new chin position.

The titanium plates and screws used to secure the bone segments do not require removal unless they loosen, become exposed or infection develops around them. They do not trigger metal detectors or interfere with MRI scans.

Surgical Risks

All surgeries carry certain risks. These include, but are not limited to:
Excessive bleeding during or after surgery (may require blood transfusion or readmission)
Unfavourable jaw fractures
Nerve injury resulting in temporary or permanent altered sensation to cheeks, lips or tongue
Post-operative infection
Relapse (jaw returning to its original position)
General anaesthetic risks, including cardiorespiratory complications

Post-operative Recovery and Follow-up

Most patients spend 1 to 2 nights in the hospital after the operation. The upper and lower teeth may be tied together using elastic bands. Discomfort, swelling, numbness and bruising are expected after surgery which will gradually improve over the next few weeks. Patients will need to be on a liquid to soft diet for the first 6 weeks after surgery. It is important to maintain proper oral hygiene during this period of time to minimise the risk of postoperative infection and development of caries and gum disease. Full healing will take several months to a year but most patients are able to return to school or work after 2 to 3 weeks.

It is advised to avoid vigorous activities for at least 4 to 6 weeks after the operation and to avoid contact sports or activities for at least 6 months to prevent accidental fractures of the healing jaw bones.