Minor SurgicalProcedures inOrthodontics PRESENTED BY-V.V.PriyankaB.D.S final year,RKDF Dental College & ResearchCentre,BhopalA SEMINAR FOR DEPT. OFORTHODONTICS
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 Procedures MINOR PROCEDURES MAJOR PROCEDURES• Extractions • Orthognathic• Surgical exposure surgeries- surgical (uncovering) of correction of jaws unerupted teeth • Facial esthetic• Frenectomy surgeries like rhinoplasty, blephar• Supracrestal oplasty fibrotomy/ Pericision • Facial reconstruction like• Corticotomy cleft palate & lip repair surgery
Minor Surgical Procedures The main aim is to remove the etiological factors & facilitate correction of malocclusion by orthodontic appliances, helpstabilize post-orthodontic results & to prevent relapse
ExtractionsThe various extraction procedures carried out as a part of orthodontic treatment are: a. Therapeutic extraction b. Serial extraction c. Extraction of carious teethd. Extraction of malformed/ankylosed teeth e. Extraction of supernumery teeth f. Extraction of impacted teeth
THERAPEUTIC EXTRACTIONExtractions When to extractundertaken as a part of (and when not to)comprehensive Permanent teethorthodontic treatment Central Incisors = Don’t!mainly to gain space are Lateral Incisors • When to extract (and= Rarely to) when notcalled Therapeutic Canines • Permanent teeth = Rarelyextractions. 1st premolars Don’t! • Central Incisors == 4+mm spaceoPremolars most required • Lateral Incisors = Rarelycommonly extracted 2nd premolars = 2-4mm space • Canines = RarelyoExtraction should be required • 1st premolars = 4+mm space requiredatraumatic as any break in 1nd molars = Compromised = only st • 2 premolars = 2-4mm space requiredcontinuity of alveolar plate 4-5mm space • 1st molars = Compromised = only 4-5mmmay hinder the smooth 2nd molars = To aid distalprogression of intended space nd movementorthodontic tooth • 2 molars = To aid distal movementmovement.
serialextraction•Serial extraction is a form ofinterceptive orthodontic treatmentwhich aims to relieve crowding atan early stage so that the permanentteeth can erupt into goodalignment, thus reducing oravoiding the need for laterappliance therapyDifferent procedures has beendescribed by different authors suchas;Tweed’s method 1966; 8years [DC4].Dewel’s ,, 1978; 81/2yrs[CD4]Nance’s ,, 1940; D4C
Extraction of Supernumery,Impacted & Ankylosed Teeth •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 Post surgical removal of after a week impacted maxillary right canine
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 forexposing 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 favourabilityc. 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 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.