surgical procedures that are commonly carried out in orthodontics

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Surgery in Orthodontics
Ujwal Gautam
Roll no. 431
BDS 4th year (2009 batch)
BPKIHS

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Major procedures
• Orthognathic surgeries
• Cosmetic surgeries
Minor procedures
• Extractions
– therapeutic extraction
– serial extraction
– carious teeth
– malformed teeth
– supernumerary teeth
– impacted teeth
• Surgical uncovering of teeth
• Frenectomy
• Pericision
• Corticotomy

3.  Orthognathic surgeries
corrects dento-facial disproportions involving the maxilla, the
mandible or both in all three planes of space
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4. Indication
If neither growth modification procedures nor orthodontic
camouflage provides solution
NOT a substitute but adjunct to or in conjunction with orthodontic
treatment.
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Camouflage v/s Surgery
Decision for camouflage or surgery must be made before
treatment begins
Greater emphasis on soft tissue consideration essential
when camouflage versus surgery is considered

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Envelope of Discrepancy

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Surgery preferred over Orthodontic Camouflage for;
o Long Vertical Facial pattern
o Moderate or severe antero-posterior jaw discrepancy
o Crowding >4-6 mm
o Exaggerated features
o Transverse Skeletal problem

8. Contemporary Surgical Techniques:
– Mandibular Surgery
– Maxillary Surgery
– Dentoalveolar Surgery
– Distraction Osteogenesis
– Adjunctive Facial
procedures
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LeFort I osteotomy
Segmental osteotomies
Sagital Split osteotomy
Oblique sub condylar
osteotomy
Rhinoplasty
Genioplasty
Sub mental procedures
Lip procedures
Surgically assisted rapid
Palatal Expansion
(SARPE)

9. Class III mandibular excess
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10. Class II mandibular deficiency
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11. Horizontal deficiency and vertical chin excess
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12. Class II maxillary protrusion
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13. Excess vertical growth of maxilla and down and back rotation of mandible
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14. Class III maxillary deficiency and mandibular excess
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15. Distraction Osteogenesis
• based on manipulation of a healing bone
• osteotomized area is stretched before calcification has
occurred in order to generate the formation of additional bone
formation and investing soft tissue
• Patients with craniofacial syndrome are the prime candidates
• Advantages of distraction are that
– Larger distances of movement are possible than with
conventional orthognathic surgery, and
– Deficient jaws can be increased in size at an earlier age
• Disadvantage is that precise movements are not possible
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17.  Adjunctive Facial procedures
• improve the esthetics of the patient
• to improve the soft tissue contours beyond what is available
from repositioning the jaws
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18. Rhinoplasty
 cosmetic surgery of the nose focused on the contour of the nasal
dorsum, the shape of the nasal tip and the width of the alar base
 particularly effective when nose is deviated to one side, has a
prominent dorsal hump, or has a bulbous or distorted tip.
 Usually follows LeFort I osteotomy which compromises the
appearance of nose
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20. Chin Augmentation or Reduction
 most frequently used adjunct to orthodontics
 Improves the stability of the lower incisors as well as enhancing
facial appearance tightens the suprahyoid musculature and
produces desirable changes in chin-neck contour
 Reduction of the chin with osteotomy can be a possibility to
camouflage a skeletal Class III problem
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22.  Extractions
Most commonly undertaken minor surgical procedures in conjunction
with orthodontic therapy.
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23. Therapeutic extraction
– for gaining space
– Choice of teeth extraction is based on number of factors including the
amount of arch length-tooth material discrepancy, the direction and
amount of jaw growth, the facial profile, the state and position of
teeth in particular and the entire dentition and finally the age of the
patient.
– Integrity of alveolus should be maintained
– Permanent 1st premolars are the most commonly extracted teeth
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24. Serial extractions
– interceptive orthodontic procedure
– usually initiated in the early mixed dentition when severe arch
length discrepancy exists
– includes planned extraction of certain deciduous teeth and later
specific permanent teeth in an orderly sequence and predetermined
pattern to guide the erupting permanent teeth into normal
alignment
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25. Procedures
Dewels method
Tweeds method
Nance method
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26. Extraction of supernumerary, impacted and ankylosed teeth
• Involves removal of local cause of malocclusion
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27. Surgical extraction of bilateral unerupted supernumerary teeth in
maxillary central incisor region
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28. • Impacted teeth can be guided into normal position by removal of
overlying soft tissue and removal of bone covering
• orthodontic guidance can be required using attachments to guide
erupting tooth into arch
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 Surgical uncovering of impacted teeth

29.  Frenectomy
• surgery to remove the interdental fibrous tissue and reposition the
frenum
• Generally performed for Midline Diastema
• maxillary midline diastema is often accompanied by the insertion of a
thick, fleshy fibrous labial frenum into a notch in the alveolar bone.
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30. frenectomy performed prior to space closure
Merit-
 removal of etiology
 Space closure can be easily attained orthodontically
Demerit-
 scar tissue that could prevent orthodontic space closure.
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31. frenectomy should be performed after space closure
Merit-
 reduces the risk of scar tissue formation that can prevent closure of
midline diastema.
 post surgical scar tissue stabilizes the teeth together.
Demerit-
 during closure, soft tissue may be enlarged and sore preventing
complete space closure.
 if the space is large and frenal attachment is thick, it may not be possible
to completely close the space before surgical intervention, requiring
multiple stages of treatment.
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32. Frenectomy and midline diastema
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33.  Corticotomy
• undertaken in patients having dental proclination with spacing
• Involves sectioning of dento-alveolar region into multiple small
units to hasten orthodontic tooth movement
• Although the nerve supply to the teeth is interrupted, sensation
usually returns and endodontic treatment almost never required
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34.  Pericision
• Also known as circumferential supracrestal fibrotomy
• Adjunct to an retention procedure after corrrection of rotations
• performed to counter the relapse tendency of the stretched gingival
fibres – trans-septal and alveolar crest group in derotated tooth
• Surgical sectioning of gingival fibres
• performed a few weeks before removal of orthodontic appliance or
if it is performed at the same time the appliance is removed, a
retainer must be inserted almost immediately.
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35. References
Proffit W. R.; Contemporary Orthodontics; Mosby Inc; 4/e; 2007
Bhalajhi S. I.; Orthodontics The Art and Science; Arya(MEDI) Publishing House; 4/e;
2009
Proffit, White, Sarver; Contemporary Treatment of Dentofacial Deformity; St. Louis,
Mosby,2003
Singh G.; Textbook of Orthodontics; Jaypee Brothers Medical Publishers Ltd; 2/e; 2007
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