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cone beam international magazine of cone beam dentistry

I opinion _ oral surgery 06 I cone beam2_2014 _The term “surgery” is derived from the Greek words“chir”(hand)and“ergos”(work).Accordingto this etymology, surgery should include any clinical work implemented with our hands. In daily clinical practice, however, the use of this word is often limited to practical therapeutic acts, such as those involvingcuttingsofttissue(incisions),flapraising, osteotomiesandreconstruction,aswellasrepairing and dressing living tissue. The term “oral” pertains to the mouth (or oral cavity), and oral surgery would consequently encompass maxillary sinus membrane lifts, onlay and inlay bone grafts, the placement of dental osseointegrated implants, exodontia (including surgical extraction of impacted teeth and tooth- like structures), as well as the incision and drai- nage of cellulitis, just to name a few. Despite these different fields of use, the limits of oral surgery are not yet well defined and may reach maxillofacial surgery, a term that implies a greater scope of surgical interest, such as temporomandibular joint surgery, orthognathic surgery, the treatment of head and neck trauma, as well as cancer surgery. General dental practitioners are only required to undertake surgical treatment of teeth, tooth- like structures, and soft tissue surrounding teeth. Inthisregard,theUKGeneralDentalCouncildefines “surgical dentistry” as “those surgical procedures within the mouth which would normally be ac- complished for a cooperative patient under local anaesthesia,withorwithoutsedation,inatolerably short operating time.” In the past 30 years, oral surgery has progressed significantly in the diagnosis and treatment of dental and jaw pathology. Dentistry, particularly surgical dentistry, is rapidly changing and evolving, and dentists worldwide are attempting to adapt to the revolutionary changes and new opportunities resulting from globalisation of dental and medical surgical specialties. New insights and discoveries related to oral surgery are indeed astonishing and many of them have already been applied in every- day practice, and addressed in textbooks and at international conventions. The near future will probably witness Er:YAG laser bone ablation replacing surgical drill os- teotomy in oral surgical practice. Indeed, scanning electron microscope observations have deter- mined that Er:YAG laser treatment produces well- definededges.Meltingandcarbonisationassociated with carbon dioxide lasers could not be observed on sites irradiated with Er:YAG lasers. In addition, F T I R spectroscopy revealed that the chemical composition of bony surfaces after ablation with an Er:YAG laser was almost the same as that after conventional drilling with a bur, proving that the use of Er:YAG laser ablation can be an alternative to traditional bur ablation in oral and periodontal osseoussurgeries,particularlyinmandibularramus onlay block harvesting, apicectomy, cysts and benign jaw tumour surgery, or the irradiation of bisphosphonate-associated jaw osteonecrosis. Dental pulp stem cells (DPSCs) can nowadays be cryopreserved and stored for years, while still retaining their multipotency and bone-producing capacity. These highly specialised cells show very lowmorbidityandareeasytocollectfromextracted wisdom teeth or buds, for example. They also inter- act with bone biomaterials and substitutes, which makes them an ideal cell population for jaw re- construction. In addition, stromal bone-producing DPSCs, a multipotent stem cell subpopulation of DPSCs, are capable of differentiating into osteo- blasts, and they are claimed to possess immune Dr Ziad Noujeim, Lebanon Current perspectives on oral surgery How to improve consistency and implementation of contemporary treatment recommendations and options in general dental practice Author_Dr Ziad Noujeim, Lebanon