The practice of modern dentistry encompasses specialized fields, each requiring extensive post-doctoral training. An Oral and Maxillofacial Surgeon (OMFS) represents the surgical arm of this profession, completing four to six years of hospital-based residency training following dental school. This specialized education focuses on the diagnosis and surgical management of injuries, defects, and diseases affecting the hard and soft tissues of the head and neck. The OMFS is fundamentally a surgical specialist, concentrating on complex procedures, and often serving as the bridge between medicine and dentistry.
The Primary Role of Oral and Maxillofacial Surgeons
The core scope of an Oral and Maxillofacial Surgeon’s practice centers on conditions demanding surgical intervention within the craniofacial region. This includes dentoalveolar surgery, such as complex wisdom tooth extractions and the removal of diseased or impacted teeth. They also manage severe odontogenic infections requiring surgical drainage.
OMFS specialists handle facial trauma, repairing fractures of the jawbone, cheekbones, and eye sockets, often requiring extensive reconstruction. They perform corrective jaw surgery (orthognathic surgery) to treat skeletal discrepancies affecting chewing, speaking, and facial aesthetics. This involves repositioning the upper or lower jaw for proper alignment.
Furthermore, Oral and Maxillofacial Surgeons manage pathology of the mouth and jaws, diagnosing and removing cysts, benign tumors, and malignant conditions. Their broad surgical training establishes them as experts in performing procedures under deep sedation or general anesthesia. Their primary function is strictly surgical, dealing with the anatomical structure of the facial skeleton and associated soft tissues.
Fabrication and Fitting of Dentures
Oral and Maxillofacial Surgeons do not fabricate or fit the final denture appliance; this non-surgical process falls under the domain of general dentists and prosthodontists. Denture fabrication requires precise measurements, impressions, and adjustments to ensure the prosthetic teeth function correctly and sit comfortably on the gums and underlying bone structure. These tasks are restorative, not surgical.
The specialist most qualified for this restorative work is the Prosthodontist, who completes an additional three years of advanced training focused entirely on replacing missing teeth and oral structures. A prosthodontist’s expertise includes designing, manufacturing, and fitting all types of dental prostheses, including crowns, bridges, and partial or complete dentures.
The process involves taking impressions of the patient’s mouth to capture the exact contours of the residual ridges and surrounding soft tissues. The denture is designed from these models and tested with a wax try-in to verify the fit, bite alignment, and aesthetic appearance before the final acrylic prosthetic is processed. The prosthodontist handles all adjustments and relines required to maintain the fit as the underlying bone naturally changes.
Surgical Procedures Supporting Denture Success
While Oral and Maxillofacial Surgeons do not create the denture itself, they perform necessary surgical preparations to ensure the success, comfort, and stability of the final prosthetic. This is known as pre-prosthetic surgery, which modifies the bone and soft tissue contours of the jaw ridges where the denture will rest. These procedures are required when the bony ridge is uneven, sharp, or has excessive growths that would interfere with the denture’s seal or cause painful sore spots.
A common pre-prosthetic procedure is alveoloplasty, which involves smoothing and recontouring the jawbone. This is often performed during tooth extraction to create a broad, uniform foundation. Other modifications include the removal of excessive bony protuberances, such as tori (large bone growths on the palate or under the tongue). Removing these allows the denture to seat securely without rocking or causing tissue injury.
Dental Implant Placement
The OMFS is also responsible for placing dental implants, which are titanium posts surgically integrated into the jawbone to serve as anchors for dentures. For an implant-supported overdenture, two to six implants are placed, offering significantly greater retention and stability than traditional dentures that rely solely on suction and adhesive. This precise surgical placement sometimes requires bone grafting beforehand to ensure sufficient bone volume for the implants to fuse successfully. The goal of this surgical support is to transform a problematic foundation into a stable, comfortable surface ready to receive the restorative appliance created by the prosthodontist.