INTERDISCIPLINARY ASPECTS OF ORTHODONTIC...

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




Dentoalveolar surgery




Dentoalveolar surgery

1. Extraction of 3rd molars or premolars for ortho treatment

2. Treatment of impacted teeth




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




Diagnosis and planning • Most frequently

affected teeth: upper canines – Guidance theory

• Diagnosis and Prognosis




Space opening

• Extraction or expansion

• Lateral incisor should be moved with caution




Surgical exposure and bonding

• Open or closed surgery

• Bonding




Guided eruption

• Elastic traction

• Overlays

• Cantilevers

• Ballista spring




Maxillofacial Surgery




Maxillofacial surgery • SARME

• Le Fort I Osseotomy

• BSSO/ Obwegeser-Dal Pont surgery

• Genioplasty




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.




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




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




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




Orthodontic treatment with orthognathic surgery I.

1. Diagnosis: dento-skeletal discrepancy

2. Treatment plan: surgery (not camouflage)

3. Presurgical orthodontics: decompensation

„make it worse”




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




Orthognathic (and other) surgery results




Periodontology




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




Forced eruption

• Alternative to crown-lengthening

– more aesthetic gingival margin

• Reduction of pocket depth




Alveolar augmentation

•

Lindhe J. Lang N. P. Karring T. Orthodontics and periodontics, Clinical Periodontology and Implant Dentistry, Blackwell, Munksgaard, 5th edition

2008.




Gingival recessions

• Can arise as a complication of orthodontic treatment (overexpansion)

• Gingival grafting should be done before orthodontic treatment




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




Gingivotomy

Graber L W, Vanarsdall R L JR, Vig K W L: Orthodontics, Current Principles and Techniques-5th ed. Elsevier, 2012 S.845




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




Sleep medicine and the orthotontis

Obstructive sleep apnea

• RPE/SARME

• Mandibular advancement splint

• Mandibular advancment surgery




Pediatrist and the orthodontist

• Syndromes

– Down

– Cleft patients

• Otolaryngologist

– Sleep medicine

– Tonsils

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