Post on 19-Jul-2018
SEMMELWEIS UNIVERSITY
Department of Paediatric Dentistry and Orthodontics http://semmelweis.hu
INTERDISCIPLINARY ASPECTS OF ORTHODONTIC TREATMENT
dr. Radó Zsuzsanna Stefánia
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Lecture overview
Areas of cooperation 1. Dentoalveolar
surgery 2. Maxillofacial
surgery 3. Periodontology 4. Prothetics 5. General Medicine
1. Otolaryngology 2. Pediatrics
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Dentoalveolar surgery
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Dentoalveolar surgery
1. Extraction of 3rd molars or premolars for ortho treatment
2. Treatment of impacted teeth
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Usual steps of forced /guided eruption
1. Diagnosis and plan
2. Creating adequate space for the tooth
3. Surgical exposure and bracket application
4. Guided/forced eruption by application of orthodontics forces
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Diagnosis and planning • Most frequently
affected teeth: upper canines – Guidance theory
• Diagnosis and Prognosis
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Space opening
• Extraction or expansion
• Lateral incisor should be moved with caution
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Surgical exposure and bonding
• Open or closed surgery
• Bonding
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Guided eruption
• Elastic traction
• Overlays
• Cantilevers
• Ballista spring
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Maxillofacial Surgery
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Maxillofacial surgery • SARME
• Le Fort I Osseotomy
• BSSO/ Obwegeser-Dal Pont surgery
• Genioplasty
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
SARME
Surcially assisted rapid maxillary expansion
Angelieri F, Cevidanes LH, Franchi L, Gonçalves JR,
Benavides E, McNamara JA Jr. Midpalatal suture
maturation: Classification method for individual
assessment before rapid maxillary expansion
Am J Orthod Dentofacial Orthop. 2013 November ;
144(5): 759–769.
Melsen B. Palatal growth studied on human autopsy material. A
histologic microradiographic study. Am J Orthod. 1975 Jul;68(1):42-
54. PubMed PMID: 1056143.
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
SARME
• Insertion of the device – A tooth borne expansion device is
fixed to at least two teeth on either side of the palatal osteotomy.
– A bone borne device is fixed to the palate on either side of the palatal osteotomy with screws or pins.
• Surgery – Palatal osseotomy – The expansion device is activated to
asure expansion occurs
• After a latency period, the palate is distracted at a rate of 0.5 -1.0 mm per day
Source: https://www2.aofoundation.org
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Le Fort I Osteotomy
• Fracture pattern originally described by Rene LeFort in 1901 that extends from the nasal septum, along the tooth apices, through the pterygomaxillary junction
• Correction of skeletal midface deformities
• It is indicated, often with mandibular surgery, for sceletal class II and III malocclusion and facial asymmetry
Source:
https://www2.aofoundation.org
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Obwegeser osteotomy
• Bilateral Saggital Splint Osteotomy (BSSO) of the ramus
• It is indicated for sceletal class II and III malocclusion and facial asymmetry
• Allows all correctional movement of the mandible Source:
https://www2.aofoundation.org
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Orthodontic treatment with orthognathic surgery I.
1. Diagnosis: dento-skeletal discrepancy
2. Treatment plan: surgery (not camouflage)
3. Presurgical orthodontics: decompensation
„make it worse”
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Orthodontic treatment with orthognathic surgery II.
4. Planning of the surgery
(One jaw or both) 1. „paper surgery” 2. „cast surgery”
5. Instructions for the surgeon and splint for the surgery
6. Surgery 7. Post-OP = finishing
orthodontic treatment
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Orthognathic (and other) surgery results
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Periodontology
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Periodontology
• Tx because of perio-problems (individually planned mechanics!!!)
– Forced eruption – Alveolar augmentation – (Uprighting) – Gingival recessions – Elimination of plaque-
harbouring surfaces (eg crowding)
• Tx to facilitate ortho – Corticotomy – Gingivotomy
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Forced eruption
• Alternative to crown-lengthening
– more aesthetic gingival margin
• Reduction of pocket depth
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Alveolar augmentation
•
Lindhe J. Lang N. P. Karring T. Orthodontics and periodontics, Clinical Periodontology and Implant Dentistry, Blackwell, Munksgaard, 5th edition
2008.
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Gingival recessions
• Can arise as a complication of orthodontic treatment (overexpansion)
• Gingival grafting should be done before orthodontic treatment
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Corticotomy
The alveolar corticotomy procedure increases orthodontic tooth movement for at least 2 weeks after the corticotomy and decreases the risk of root resorption. This process might be brought about by the rapid alveolar bone reaction in the bone marrow cavities, leading to less hyalinization of the PDL on the alveolar wall.
Shoichiro Iino et al. AJODO, 2007
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Gingivotomy
Graber L W, Vanarsdall R L JR, Vig K W L: Orthodontics, Current Principles and Techniques-5th ed. Elsevier, 2012 S.845
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Preprothetic orthodontics
• Create more ideal situation for prothetic work
• Open the bite
Graber L W, Vanarsdall R L JR, Vig K W L: Orthodontics, Current Principles and Techniques-5th ed. Elsevier, 2012 S.845
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Sleep medicine and the orthotontis
Obstructive sleep apnea
• RPE/SARME
• Mandibular advancement splint
• Mandibular advancment surgery
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Pediatrist and the orthodontist
• Syndromes
– Down
– Cleft patients
• Otolaryngologist
– Sleep medicine
– Tonsils
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu
Interdisciplinary aspects of orthodontic treatment 2018.04.23
dr. Radó Zsuzsanna Stefánia SEMMELWEIS UN IVERSITY ©
http://semmelweis.hu