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Oral Surgery

During the periodontal treatment Dr. Hoffmeyer may identify infections requiring surgery or hopeless teeth requiring removal. This may be due to pain, infection or severe bone loss.

Dr. Hoffmeyer may find it necessary to perform one of the following surgeries for you. This can be done at the same time of your periodontal and implant treatment, or at any occuring incident:

Lateral Abscess

A lateral abscess is located along the side (lateral) surface of the tooth's root.

The infection comes usually from outside the tooth not from within. A lateral abscess can either be gingival (located near the gum line) or periodontal (located further in the bone).
Most cases are due to periodontal disease and can be treated.


Periapical abscess

A periapical abscess is an infection at the tip of the root.

This occurs after the pulp (nerve) of the tooth becomes infected. It is usually caused by deep decay or an accident (nerve damage). This tooth requires root canal therapy, apicoectomy or extraction and possibly antibiotics.
An abscessed tooth is usually sensitive or painful and can be seen on an x-ray.
Left untreated, an abscess may compromise the immune system.

Apicoectomy root tip surgery

During root canal (endodontic) treatment, infected nerve tissue is removed from inside the tooth (canals). Sometimes infection may remain in the side branches causing re-infection.
Apicoectomy is a surgical procedure that attempts to remove infection from the tip of the tooth.
This surgery is more difficult to perform in the back (molar) teeth because of difficulty in surgical access and complexity of multi-rooted teeth.
Sometimes this procedure is not indicated, the infected tooth may need to be extracted and maybe replaced by an implant.

Periapical abscess around left tooth is speading towards right tooth.

Root tip surgery is performed by cleaning the infection away and placing a filling (white spot).
In some cases it is indicated to place a bone graft and a membrane.

 (This part is still under development - please come back later)


The need for tooth removal may be due to:

  • Severe gum disease, affecting the supporting bone structure and tissues.

  • Tooth decay, infection or fracture beyond repair.

  • Referral by your orthodontist. Teeth may be growing in crooked because there is not enough space. Tooth extraction allows room for teeth to grow straight and proper.

  • Lack of space for your wisdom teeth at the back of your mouth.

Antibiotics may offer temporary relief from symptoms (like pain and swelling) but tooth removal is often the only solution for permanent relief of symptoms.
If your tooth is severely damaged, a surgical extraction may be required.

Dr. Hoffmeyer prefers to remove the diseased tooth in an atraumatic surgical procedure in order to minimize loss of bone, and ensuring the possibility of placing implants immediately or later on.

Black and dark gray areas represent root cavity and boneloss


As a periodontist, Dr. Hoffmeyer is very concerned about preserving and creating bone and soft tissue to adequately retain your beautiful smile.

Extracting a hopeless tooth leaves a damaged empty hole (socket). The bony ridge around the socket tends to erode away (resorb) and the gum shrinks. Eventually the bony (alveolar) ridge can narrow to a knife edge and can cause severe problems if you want implants, bridges or dentures.

You can develop sunken cheeks, excessive wrinkling around your lips and your chin and nose appear to become pointed and closer together. Your bite collapses.

If immediate implants are not an option, these deformities can be prevented and repaired by a procedure called socket or ridge preservation.

Socket preservation (bone grafting), can stop ridge erosion before it begins. It is done by filling the extraction site with a bone grafting material and covering with a biocompatible barrier and/or treating with tissue stimulating proteins to encourage your body’s natural ability to repair itself by regenerating lost bone and gum tissue. This bone graft protects the blood clot of the extraction site, promotes the growth of new bone and is gradually resorbed and replaced as your new bone grows in. The bone usually will develop for about 4-12 months before your implant placement or restorative treatment can be completed. Often temporary restorative teeth can be provided at the time of tooth extraction and function during the healing period.


  • The procedure takes a few minutes

  • The bone on the neighboring tooth is preserved

  • The bone (ridge) does not collapse

  • The esthetics is improved with a more natural smile appearance

  • The regenerated bone allows placement of an implant to replace the missing tooth later on.

  • The cosmetic outcome of future treatments such as dental implants, fixed bridges, removable dentures, or gum-line reshaping will most likely be more successful.

Dr. Hoffmeyer will advise you if socket preservation is necessary to help you achieve your treatment goals and create the foundation for dental implants.

Normal jaw bone at the time of extraction.

Insuficient amount of jaw bone to support dentures and bridges several years after extraction.

Bone grafting can assist in ridge preservation.


Bone loss and defects due to e.g. periodontal disease, root tip cysts and around implants can be treated with bone graft and membranes.



BioOss bone graft and BioGuide membrane placed after extraction


Ridge augmentation • JAW Bone re-growth

Once the tooth is lost the jaw bone continues to disappear. Today, some simple, predictable techniques are available to re-grow your lost bone, to provide support for implants or dentures or to improve esthetics around bridges. The bone does not need to be taken from your own body. Specially prepared bone-grafts and membranes are used to rebuild your lost bone. This procedure is highly predictable in healthy patients.


  • Improves esthetics, function, oral hygiene and maybe speech problems (front area)

  • Regeneration of sufficient bone to place implants in the proper positions for your new teeth.

  • Gives greater stability for full dentures

  • Corrects depressions in your gum line that look unnatural, e.g. where the gum and bone has “fallen in” and is missing under crowns and bridges

  • Helps reduce “dark spaces” between teeth in your bridge


  • Patient age and the length of time that bone has been missing are not negative factors

  • Medical conditions may cause delayed healing and complications

Impacted canine teeth

These unerupted or partially erupted teeth cannot fully erupt due to lack of space (crowding), conflicting position (another tooth has erupted over that position) or ankylosis (roots of the impacted tooth fuse to the bone and can not move).

If indicated Dr. Hoffmeyer can remove the tooth and perform bone grafting.

Another option is to uncover the tooth and glue an orthodontic bracket on for movement.


Wisdom teeth (third molars) usually erupt at the age of 15 to 25. Wisdom teeth are not removed when they are healthy and properly positioned. However, most mouths are too small for these four additional molars and problems develop that require their removal.

Why are impacted wisdom teeth removed?

  • The tooth is unable to break through the gum since your jaw may be too small

  • The tooth breaks partially through the gum. A flap of gum tissue grows over the tooth, food and germs are trapped under the flap and cause infection (pain and red, swollen gums).

  • The tooth may grow at an akward angle and can damage the adjacent tooth' root and bone structure (periodontal defect).

  • The tooth may possibly contribute to crowding of your teeth.

  • The tooth may lead to more serious problems, such as infections, cysts, tooth decay and gum disease to the adjacent tooth.

  • The longer the extraction is postponed in young people, the longer the tooth roots grow. The risk of complication during extraction increases because the tooth roots may grow close to sensitive facial nerves.

When the wisdom tooth causes periodontal disease, the lost bone and periodontal defect on the remaining adjacent tooth will be assessed by Dr. Hoffmeyer and if possible the defect can be treated by a bone regeneration procedure.

After all surgeries a thorough postoperative instruction will be given verbally and in writing.
In addition the most commonly needed medications, mouth rinse, icepack and gauze are handed out.

Panoramic x-ray of impacted teeth

(This part is still under development - please come back later)


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