oral surgery and ortho

Question 1

soft tissue surgeries for ortho

3

Answer 1

Frenectomy rare – more likely modify (-plasty), still not frequently done
* V to Y frenoplasty
* Z-plasty

Impacted canines
* Buccal apically repositioned flap

Palatal open exposure
* Impacted premolar exposures

Question 2

hard tissue surgeries for ortho

7 categories

Answer 2

Impacted canines
* Buccal apically repositioned flap with bone removal
* Palatal open exposure with bone removal
* Buccal or palatal closed exposure with gold chain attachment
* Extraction

Premolars
* Extraction
* Exposure of impacted premolars with bone removal

Other extractions

Submerged retained deciduous/primary teeth

Implants form of anchor for orthodontic appliance

Mini-implants form of anchor for orthodontic appliance

Orthognatic surgery

Question 2

hard tissue surgeries for ortho

7 categories

Answer 2

Impacted canines
* Buccal apically repositioned flap with bone removal
* Palatal open exposure with bone removal
* Buccal or palatal closed exposure with gold chain attachment
* Extraction

Premolars
* Extraction
* Exposure of impacted premolars with bone removal

Other extractions

Submerged retained deciduous/primary teeth

Implants

Mini-implants

Orthognatic surgery

Question 3

implants/mini-implants role in ortho

Answer 3

form of anchor for orthodontic appliance

Question 3

implants/mini-implants role in ortho

Answer 3

form of anchor for orthodontic appliance

Question 4

implants/mini-implants role in ortho

Answer 4

form of anchor for orthodontic appliance

Question 5

most frequent problematic tooth

Answer 5

canines (impacted)

Question 6

lines of approach for impacted canines

4

Answer 6

Leave alone and monitor
* aesthetic, no harm to other teeth, no apical pathology or bone/root resorption, warn pt possible future risk of infection or cyst

Extract the canine
* allows for easier ortho movement of other teeth, maybe too hard to bring in line

Surgical exposure and orthodontic alignment
* Mini-implants
* Corticotomy
* open exposure and attached orthodontic brackets

Transplant

Question 7

indicators for canine transplant

4

Answer 7

We cannot reasonably get a result by exposure and traction

There is a potential for damage to other teeth

Space is available or can be made available without premolar extraction

The older patient who is seeking a quick solution

Question 8

pros and con of transplant

Answer 8

Will eventually ankylose – no bone left after so implant not possible

Can last very long
At least natural tooth – not implant or bridge (but both are tx options)

Question 9

where do you want tooth to erupt into if surgically exposed

Answer 9

attached mucosa (pink) not higher up unattached highly vascularised mucosa – will caused red gingival margin

can use a 3 sided flap - preserving attached mucosa
Incisions more parallel than usual slightly more flared and reposition apically

Question 10

what to do here

Answer 10

Dilacerated 33
Some teeth not worth exposing – be realistic

Need full radiographic assessment before attempting surgical intervention

Question 11

describe issues in eruption here

Answer 11

Impacted 13, 23 and 45
Canines failed to erupt – follicles slightly enlarged
Other teeth – impacted premolar, needs management as not enough space (commonly due to early loss of second primary molar E)

Question 12

what is this phenomenon called

Answer 12

Kissing canines 33 and 43
One canine has crossed midline to touch other canine
Both fail to erupt

Question 13

where are the canines

options for management

Answer 13

Kissing canines 33 and 43

Parallax – canines are buccal – tube moved back but tooth moved forward (Same Lingual Opposite Buccal)

LL3 could be exposed and brought up
LR3 – cannot be used, so either transplant or extract

Question 14

how to manage submerged primary teeth

Answer 14

hard to remove but needs removed as impeding eruption permanent tooth

Cannot extract as no space for forceps so divided and flap raised.
Careful not to damage unerupted tooth or push into sinus

Question 15

what is issue here
management options

Answer 15

Submerged primary teeth
URE

hard to remove but needs removed as impeding eruption of 5.

Cannot extract as no space for forceps so needs divided and flap raised. Careful not to damage unerupted 5 or push into sinus

Question 16

frenectomies and frenoplasty

Answer 16

not done much now - if any woud be frenoplasty (V to Y or Z plasty)

surgical removal of some of the fleshy labial frenum
close with sutures
scar contraction after surgery - reduce the volume of frenum more

Question 17

where is impacted canine placed

Answer 17

Tube moved back
Canine moves to overlap lateral – so buccally placed

Question 18

what happens to teeth used for anchorage during ortho movement

Answer 18

During orthodontic treatment, the planned movement of one tooth or group of teeth causes reciprocal movement of the teeth used for anchorage

implants provide the quality of the ideal orthodontic anchor

Question 19

5 qualities of implants that make them ideal ortho anchor

Answer 19

1. Patient compliance unnecessary
2. Absolute anchorage as there is no periodontal ligament
3. Easily used under a variety of treatment modalities
4. Easily placed (buccal - no flap, palatal - surgical skill needed)
5. Removable, if necessary

prevents head gear too

Question 20

what is corticotomy

Answer 20

Developed to speed up tooth movement

Weaken buccal bone and palatal bone by drilling holes in bone
Can be option if teeth failing to move

Not really done