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surgical interventions in orthodontics

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Orthognathic Surgery, Papilla Split Procedure, Other adjunctive cosmetic procedures

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surgical interventions in orthodontics

  1. 1. Surgical Techniques in Orthodontics
  2. 2. Techniques • Minor Surgical Procedures – Circumferential Supracrestal Fibrotomy (CSF) – Frenectomy – Papilla Split Procedure • Orthognathic Surgery • Distraction Osteogenesis • Adjunctive Surgical Procedures
  3. 3. Papilla Split Procedure
  4. 4. Common Surgical Techniques Transverse • Maxilla • Single Step Expansion • Surgical Assisted Rapid Palatal Expansion • Mandible • Symphysial Distraction Vertical • Maxilla • Lefort I maxillary Impaction • Lefort I maxillary downfracture • Mandible • No recommended Surgical Technique available • Tripod landing with BSSO mandibular advancement Sagittal • Maxilla • Lefort I maxillary Advancement • Lefort I maxillary setback • Anterior Segmental Maxillary setback • Wassmund • Wunderer • Mandible • BSSO Mandibular Advancement • BSSO Mandibular Setback
  5. 5. DISTRACTION OSTEOGENESIS
  6. 6. Distraction Osteogenesis “A biological process of new bone formation between the surfaces of osteotomized bone segments that are separated gradually by incremental traction” Distraction Histogenesis : – Adaptive regenerative changes in surrounding soft tissues
  7. 7. Historical Overview Alessandro Codiwilla (1905) – First report of surgical limb lengthening – Oblique osteotomy and external traction pins – Complications: infections, overstretching, poor blood supply and inadequate fixation
  8. 8. Historical Overview G.A. Ilizarov (1950’s) – Lengthening limbs through gradual distraction of fracture callus – Rhythm and rate of distraction – Minimal complications
  9. 9. Historical Overview McCarthy (1992) – DO to lengthen congenitally hypoplastic mandible
  10. 10. Historical Overview • Rachmiel et al (1993) and Blocks et al (1995) – Maxillary distraction • Polley et al (1995) – Midface distraction with externally fixed cranial halo frame
  11. 11. Biology of Distraction 1. Osteotomy/Corticotomy phase 2. Latency phase 3. Distraction phase 4. Consolidation phase 5. Remodeling phase
  12. 12. Osteotomy Phase • Divides the bone into two segments • Triggers process of bone repair – Angiogenesis – Fibrogenesis – Osteogenesis
  13. 13. Latency Phase • Period from bone division to onset of distraction • Inflammation and soft callus formation of the fractured bone • Soft callus formation begins 3-7 days and lasts 2-3 weeks • Latency period = 5-7 days
  14. 14. Distraction Phase • Characterized by the application of traction forces to osteotomized segments • Rate : 1 mm/day • Rhythm : 0.25 mm every 6 hours 0.5 mm twice a day • Duration : 1-3 weeks
  15. 15. Consolidation Phase Cessation of traction forces to removal of distractor • Newly formed bone mineralizes and increases in bone density and strength Duration: 3- 4 months
  16. 16. Remodeling Phase • Removal of distractor to application of functional loading • Formation of lamellar bone
  17. 17. Symphesial Distraction • For V shape mandible • Severe mandibular crowding • Brodie’s syndrome • To avoid inderdental stripping or extractions 19
  18. 18. Symphesial Distraction • Osteotomy Cuts 20
  19. 19. Symphesial Distraction 21
  20. 20. Cosmetic Surgeries • Rhinoplasty • Cheiloplasty • Genioplasty • Submental Liposuction • Malar Implants • Mandibular Angle/Ramal Implants
  21. 21. Sagittal Augmentation Genioplasty
  22. 22. Rhinoplasty
  23. 23. Gonial Angle Implants
  24. 24. Lip Augmentation
  25. 25. Lip Lengthening
  26. 26. Cheiloplasty
  27. 27. Submental Liposuction
  28. 28. Thanks You!

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