Minor Surgical Procedures inOrthodontics

PRESENTED BY-V.V.PriyankaB.D.S final year,RKDF Dental College & Research Centre,Bhopal

A SEMINAR FOR DEPT. OF ORTHODONTICS

Surgical Orthodontics: Introduction

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

• Used as an adjunct or in conjugation with orthodontic treatment

• 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

Surgical ProceduresMINOR PROCEDURES

• Extractions• Surgical

exposure (uncovering) of unerupted teeth

• Frenectomy• Supracrestal

fibrotomy/ Pericision

• Corticotomy

MAJOR PROCEDURES• Orthognathic

surgeries- surgical correction of jaws

• Facial esthetic surgeries like rhinoplasty, blepharoplasty

• Facial reconstruction like cleft palate & lip repair surgery

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

Extractions

The various extraction procedures carried out as

a part of orthodontic treatment are:

a. Therapeutic extraction

b. Serial extraction

c. Extraction of carious teeth

d. Extraction of malformed/ankylosed teeth

e. Extraction of supernumery teeth

f. 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.oPremolars most commonly extractedoExtraction should be atraumatic as any break in continuity of alveolar plate may hinder the smooth progression of intended orthodontic tooth movement.

When to extract (and when not to)Permanent teeth

Central Incisors = Don’t!Lateral Incisors = Rarely

Canines = Rarely1st premolars = 4+mm space

required2nd premolars = 2-4mm space

required1st molars = Compromised = only

4-5mm space2nd molars = To aid distal

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; 81/2yrs[CD4]Nance’s ,, 1940; D4C

Extraction of Supernumery,Impacted & Ankylosed Teeth

Post surgical removal of impacted maxillary right canine

• The presence of supernumery,impacted & ankylosed teeth impede the normal development of occlusion & are important local causes of malocclusion.

• Common supernumery teeth- mesiodens, lower -pm area>incisor>molar, upper-canine area

Extraction 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 atraumatically & irrigate

extraction socket. v. Reposition flap & suture.remove suture

after a week

Surgical Exposure of Impacted Teeth

• Canines- freq impacted teeth that req surgical exposure.

• Favourably 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 position

b. Evaluation of favourability

c. Surgical exposure & bone removal

d. 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 exised.

• 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 generalised spacings.

• 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 fibres are responsible for the relapse tendencies. •Pericision involves surgical transection of these supracrestal fibres.

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