the role of orthodontist in orthodontic preparation for surgery in different forms of malocclusion of teeth is obvious in this presentation

3. • Pre-surgical (Before surgery).
• Peri-operative (Just before and during surgery).
• Post-surgical (After surgery).

4. Pre-surgical orthodontics

6. Factors affecting incisor decompensation

8. The lower incisors are proclined and mildly crowded, with no space for retraction. Pre-molar extractions have
allowed lower incisor decompensation.

12. anchorage

13. overjet reverse overjet

14. • I.e., FMA+IMPA=120 °

16. Pre -red
Post- blue

18. Post surgical models

20. not

21. Control of incisor decompensation:

22. , the further forward the extractions
the more incisor retraction

24. class II

25. In addition, incisor inclinations can be adjusted by introducing third
order bends into stainless steel rectangular archwires.
For example, the torque values of the lower
incisor brackets can be changed from − 6° to + 6°
by inverting them, which will help to procline the
lower incisors in a class III case with minimal
crowding.

28. Occlusion during pre-surgical
orthodontics was not ideal, due to
inadequate decompensation
Inter-maxillary traction with class III elastics, aimed at retroclining the lower
incisors and proclining the uppers enabled class I buccal segments to be
achieved in the final result

29. • Limitations of orthodontic mechanics
• Stability
• Lower anterior face height

30. levelling
utility
arch wires
reverse-curve niti arch
wires

31. 1. Leave the curve unchanged during the pre-surgical
phase and then create posterior open bites through
posterior surgical impaction of the maxilla. These
open bites must then be closed post-surgically by
orthodontic extrusion of the molars.
2. Align the anterior and posterior segments at
different levels using sectional orthodontic
mechanics, and then level the arch through
segmental surgery.

32. • The curve of Spee:
• The risks associated with segmental surgery:

33. accentuated curve of Spee
• Leaving the vertical position of the lower incisors
unchanged throughout pre-surgical orthodontic
treatment. When placing stainless steel
archwires it is necessary to bend the curve into
the wire in order to avoid unwanted levelling.
• Surgery will create lateral open bites with
contact limited to the incisors and the terminal
molars. This is commonly known as a ‘three-point
landing’ and post-surgical orthodontics is then
required to close the open bites.
• The aim is increasing the lower anterior face
height.

34. limit
the increase in LAFH

37. inter-molar width
lower arch
• Occlusion.
• Limitations of orthodontic mechanics.

38. locked buccal segment occlusion
post-surgically

39. tipping
few
millimetres
Where the molars are upright over basal bone,
considerable expansion will be possible, but if
significant compensation is present, further
attempted expansion will produce excessive
flaring of the molars.

41. separating the
mid-palatal suture.

42. upper buccal segment roots
gingival attachment

44. • SARME involves surgically dividing the midpalatal
suture and the pterygo-maxillary sutures, as well as
making cuts in the lateral walls of the maxillary sinuses,
to remove as much of the bony resistance to maxillary
expansion as possible. A palatal expansion appliance is
then used in a similar way to conventional RME.
• If the appliance is placed at the time of
surgery, it can be a bone-borne design,
engaging the palatal vault for more direct
force application.

45. additional surgical intervention

47. For example, in a class III case, carrying out a unilateral lower arch
extraction to correct the lower centerline may lead to excessive
retraction of the incisors and a reduction in the reverse overjet.
Immediately post op.
3 weeks after using asymmetric elastics
to correct centerline discrepancy

48. Orthodontic preparation for segmental surgery

49. swapping the left and right canine brackets

50. Progress monitoring of pre-surgical prep. :
check models
• Check models should ideally first be taken following initial
alignment, so that subsequent tooth adjustments can be
planned in all three planes, and then repeated again in
rectangular wires until it is felt that the aims of treatment
have been accomplished.
• An up-to-date set of models should be available to take to
the final planning appointment. In addition to the occlusal
goals, the inter-molar and inter-canine width in the lower
arch should be monitored to ensure that the planned arch
dimensions are being achieved.

51. sectioned
the target overjet
reverse overjet

52. Peri-operative orthodontics
Fixed appliance preparation for surgery:
• It is advisable to under-tie the brackets in both
arches to prevent any spaces from re-opening, and
ensure that the archwires are passive for at least six
weeks, prior to the final planning appointment.

54. Inter-maxillary fixation
1. Orthodontic brackets with integral
traction hooks.
2. Hooks attached to the archwire, either by
crimping or soldering.

55. oral hygiene
overloading

56. • Conventional arch bars, ideally made in the
laboratory, can be attached using inter-dental
ligature wires and are very secure, but they
have a number of associated problems:
1. They must be applied in theatre because
of the need for ligature wires.
2. Ligature wires carry a risk of sharps
injury.
3. Post-operative removal can be
uncomfortable for the patient.
4. They can cause trauma to the
periodontal tissues.

57. bondable
arch bars
Bauermash® bondable arch bars

58. The occlusal wafer
‘best fit’
an erroneous wafer

59. A. First wafer after mandibular anterior sub-apical.
B. Left zygomatic advancement wafer indicating 10 mm
advancement.
C. Final occlusal wafer on articulated casts.
D. Final occlusal wafer on stereomodel.

62. Orthodontic procedures in theatre:

64. Post-surgical orthodontics
A. Post-surgical healing phase.
B. Post-surgical tooth movement.
C. Retention.

65. A. Post-surgical healing phase

68. elastic
traction

69. B. Post-surgical tooth movement

70. incisor decompensation
residual space closure

71. curve of Spee
anterior open bite
three-point landing

72. occlusal locking
the inter-cuspation

73. C. Retention
surgical
maxillary expansion

74. Surgery before orthodontics

78. • The informed consent

80. Surgery without orthodontics

81. Complications of orthodontic treatment
 Decalcification
• The risk of enamel decalcification associated with
fixed appliances should not generally be high for
orthognathic patients because they are mainly
adults.
• However, it can still occur, particularly where
treatment is protracted and there are problems with
oral hygiene or diet and a high previous caries
experience.
• Frequent hygienist support is invaluable in
minimizing this risk.

83. dehiscence