minor surgical procedures are performed as an adjunct to or in conjunction vth orthodontic treatment.

1. Minor Surgical
Procedures in
Orthodontics
PRESENTED BY-
V.V.Priyanka
B.D.S final year,
RKDF Dental College & Research
Centre,Bhopal
A SEMINAR FOR DEPT. OF
ORTHODONTICS

2. 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 factor
2. As a part of treatment plan
3. Facilitate correction of malocclusion by orthodontic
techniques
4. Stabilize orthodontic treatment results & prevent
relapse
5. To correct severe skeletal discrepancies

3. 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

4. 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

5. 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

6. THERAPEUTIC EXTRACTION
Extractions When to extract
undertaken as a part of (and when not to)
comprehensive Permanent teeth
orthodontic treatment Central Incisors = Don’t!
mainly to gain space are Lateral Incisors
• When to extract (and= Rarely to)
when not
called Therapeutic Canines
• Permanent teeth = Rarely
extractions. 1st premolars Don’t!
• Central Incisors == 4+mm space
oPremolars most required
• Lateral Incisors = Rarely
commonly extracted 2nd premolars = 2-4mm space
• Canines = Rarely
oExtraction should be required
• 1st premolars = 4+mm space required
atraumatic as any break in 1nd molars = Compromised = only
st
• 2 premolars = 2-4mm space required
continuity of alveolar plate 4-5mm space
• 1st molars = Compromised = only 4-5mm
may hinder the smooth 2nd molars = To aid distal
progression of intended space
nd
movement
orthodontic tooth • 2 molars = To aid distal movement
movement.

7. 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

8. 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

9. 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

10. 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

11. 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

16. 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.

17. 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.

18. THANKS
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