Post on 07-May-2015
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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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