Minor Surgical Proceduresin

OrthodonticsDr.Sundus AljazaeriOMFS Department

Basrah Dental CollegeUniversity of Basrah

Surgical Orthodontics: Introduction

• DEFINITION: Surgical orthodontics refers to the various surgical procedures carried out as a part of overall orthodontic treatment plan.

• Can be carried out before, during or after completion of orthodontic treatment

• Surgical procedures are usually carried out:1. To eliminate the existing etiologic factor2. As a part of treatment plan3. Facilitate correction of malocclusion by orthodontic

techniques4. Stabilize orthodontic treatment results & prevent relapse5. To correct severe skeletal discrepancies

A- panoramic B- lateral cephalometricC- 3D CS [CBCT scan}D- lateral

RADIOLOGICAL EXAMINATIONS

C

Minor Surgical Procedures

The main aim is to remove the etiological factors

facilitate correction of malocclusion by orthodontic appliances help stabilize post-orthodontic results & to prevent relapse

ExtractionsThe various extraction procedures carried out as a part of

orthodontic treatment are:a. Therapeutic extractionb. Serial extractionc. Extraction of carious teethd. Extraction of malformed/ankylosed teethe. Extraction of Supernumerary teethf. Extraction of impacted teeth

THERAPEUTIC EXTRACTION

• When to extract (and when not to)• Permanent teeth• Central Incisors = Don’t!• Lateral Incisors = Rarely• Canines = Rarely• 1st premolars = 4+mm space required• 2nd premolars = 2-4mm space required• 1st molars = Compromised = only 4-5mm space• 2nd molars = To aid distal movement

Extractions undertaken as a part of comprehensive orthodontic treatment mainly to gain space are called Therapeutic extractions.--Premolars most commonly extracted--Extraction should be atraumatic as any break in continuity of alveolar plate may hinder the smooth progression of intended orthodontic tooth movement.

serial extraction

•Serial extraction is a form of interceptive orthodontic treatment which aims to relieve crowding at an early stage so that the permanent teeth can erupt into good alignment, thus reducing or avoiding the need for later appliance therapy

Different procedures has been described by different authors such as;Tweed’s method 1966; 8years [DC4].Dewel’s ,, 1978; 8 1/2yrs[CD4]Nance’s ,, 1940; D4C

Extraction of Supernumery,Impacted & Ankylosed Teeth

Post surgical removal of impacted maxillary right canine

•The presence of Supernumerary, impacted & ankylosed teeth impede the normal development of occlusion & are important local causes of malocclusion.•Common Supernumerary teeth- mesiodens, lower premolar area, upper-canine areaExtraction of impacted canine-i. prior to extraction, a thorough radiographic

examination must be done.ii. Depending on position approach by a well-

designed buccal or palatal flap.iii. Elevate flap. After reflecting flap, remove bone

around tooth. iv. Remove tooth a traumatically & irrigate

extraction socket. v. Reposition flap & suture. vi. Remove suture after a week

Surgical Exposure of Impacted Teeth

• Canines- frequently impacted teeth that required surgical exposure.

• Favorably located impacted canines can be guided to their normal positions in the dental arch by a combined surgical-orthodontic treatment referred to as surgical eruption

Surgical Techniques for exposing Impacted Canines:1. Window approach (gingivectomy)2. Apically repositioned flap (ARF)3. Flap closed eruption technique (FCET)4. Tunnel traction (TT)

Steps in the management of an Impacted Tooth:

a. Determination of the positionb. Evaluation of favorabilityc. Surgical exposure & bone removald. Fixing orthodontic attachments or direct

ligation

Frenectomy• Frenum Problems-Midline diastema between two maxillary central incisors

(low frenum attachment/thick labial frenum)• The frenum that is inserted palatally into the incisive papilla & balances on

eversion of lip is the main etiological factor of diastema. Such frenum has to be excised.

• A frenectomy in this case should be followed with orthodontic treatment.• The RULE!!!- The presence of a maxillary diastema does not prompt

early frenectomy-WAIT UNTIL THE CANINES AND LATERALS ERUPT

Corticotomy• Corticotomy is an adjunct surgery for

malocclusion with wide generalized spacing.

• The buccal palatal flaps are raised.• The vertical cuts are placed in the

cortical bone parallel to the roots. These vertical cuts on both palatal & buccal side are joined by horizontal bone cuts that extend the depth of cortical bone.

• The sutures are placed & orthodontic appliance is placed after 2-3weeks.

• Now the tooth move within the cancellous bone and the treatment time is appreciably reduced.

PERICISION or CIRCUMFERENTIAL SUPRACRESTAL FIBROTOMY (CSF)

•It is an adjunctive procedure to prevent relapse following orthodontic treatment particularly rotational correction.

•The supracrestal fibers are responsible for the relapse tendencies.

•Pericision involves surgical transection of these supracrestal fibers.

Surgical Procedures

MINOR PROCEDURES

• Extractions• Surgical exposure

(uncovering) of unerupted teeth

• Frenectomy• Corticotomy• Supracrestal fibrotomy/

Pericision

MAJOR PROCEDURES

• Orthognathic surgeries-surgical correction of jaws

• Facial esthetic surgeries like rhinoplasty, blepharoplasty

• Facial reconstruction like cleft palate & lip repair surgery