Bony  impaction—occurs  when  the  tooth  is blocked by both bone and soft tissue. The soft tissue must be removed to gain access to the tooth before it can be  extracted.  The  oral  surgeon  removes  the  alveolar bone over the impaction using a bur or chisel and mallet. Removal of the bone provides access for elevators or extraction  forceps  to  extract  the  tooth.  A  surgical handpiece with a bur may also be used to section the tooth into four pieces and then each piece is removed separately.   A   commonly   performed   impacted extraction is the removal of unerupted third molars. ALVEOLOPLASTY Alveoloplasty   involves   contouring   the   alveolar structures.  It  may  be  done  in  conjunction  with  multiple surgical extractions to eliminate sharp bone edges that could cause discomfort to the patient, and to provide suitably  contoured  bone  structure  for  denture fabrication  and  insertion.  An  alveoloplasty  may  also be  performed  to  contour  the  bone  without  being  in conjunction with extractions. OSTEOTOMY Osteotomy  literally  means  cutting  away  of  bone. Osteotomies  include  maxillofacial  surgery  performed to  modify  or  correct  facial  abnormalities,  such  as protrusion of the mandible or maxilla where the bone is placed  as  far  forward  as  possible,  or  retrusion  of  the mandible  or  maxilla  where  the  bone  is  placed  as  far back as possible. The oral surgeon may also perform an   osteotomy   on   a   patient   who   has   a   fractured mandible or maxilla. The patient's teeth are splinted to bind them together into one unit using arch bars, elastic bands, and interdental sutures using wire. This keeps the  bones  in  place,  while  they  heal  into  the  correct position.  After  healing  takes  places,  the  splint  and wiring are removed. EXOSTOSIS Exostosis is the surgical removal of bony growths projecting past the normal contour of a bony surface. It includes  torus  mandibularis  often  found  on  the lingual surfaces of the body of the mandible, and torus palantinus  located  on  the  center  of  the  hard  palate. Usually,  tori  removals  are  performed  to  permit fabrication  and  insertion  of  dentures,  or  to  improve speaking or eating functions. FRENECTOMY A   frenectomy   is   a   surgical   procedure   used   to remove  a  malattached  facial  or  lingual  frenum.  A frenum is the tissue that attaches the tongue, cheeks, and lips to the alveolar process of the upper and lower jaw. The malattached tissue restricts movement of the tongue  (lingual  frenum)  or  lips  (labial  frenum).  The frenum  may  be  removed,  loosened,  or  repositioned. The  excision  of  the  lingual  frenum  is  done  to  help correct  a  condition  known  as  tongue-tie.  The  labial frenum  may  require  surgery  to  enable  better  lip movement,   and   to   help   prevent   large   diastemas (spaces)   between   erupting   central   incisors. Frenectomies are commonly performed on children. BIOPSY A localized area of abnormal tissue is referred to as a lesion. A biopsy is a surgical procedure to remove a piece  of  tissue  from  the  lesion  for  diagnostic  and microscopic  examination.  The  information  obtained from a biopsy procedure assists the dentist in arriving at  a  diagnosis  and  predicting  the  prognosis  of  the disease.  It  is  common  in  dentistry  to  remove  both normal and abnormal tissue from the surgical site for comparison. The tissue specimen should be handled carefully to prevent  crushing  or  tearing.  Immediately  place  it  into  a specimen bottle containing a sufficient amount of 10 percent  of  buffered  formalin  to  preserve  it.  Before submitting  the  specimen,  ensure  that  the  bottle  is tightly  closed  and  labeled  properly.  At  a  minimum,  the label should include the patient's name, age, sex, and the dentist's name, your command’s name, and the date of  the  biopsy.  The  dentist  will  include  a  Tissue Examination, SF-515 Form, with the specimen along with   a   tentative   diagnosis   that   is   sent   to   an   oral histopathology center. If the histopathology report of an  oral  biopsy  has  a  premalignant  or  malignant diagnosis,  the  dentist  must  notify  the  patient  of  the results.  Two  common  biopsy  methods  used  in dentistry are incision and excision methods. Incision  Method The  incision  method  involves  the  removal  of  a sample of the lesion for examination. A wedge-shaped section  of  the  tissue  from  the  lesion  along  with adjacent  normal  tissue  is  removed  for  comparison. The biopsy site is sutured and the patient is dismissed. The  incision  method  generally  is  used  when  the lesion  is  large  or  in  a  strategic  area  where  complete removal of the lesion would create significant esthetic or functional impairment. Complete surgical removal of the lesion is not indicated until a final diagnosis is 5-4