oral surgery and ortho Flashcards
soft tissue surgeries for ortho
3
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
hard tissue surgeries for ortho
7 categories
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
hard tissue surgeries for ortho
7 categories
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
implants/mini-implants role in ortho
form of anchor for orthodontic appliance
implants/mini-implants role in ortho
form of anchor for orthodontic appliance
implants/mini-implants role in ortho
form of anchor for orthodontic appliance
most frequent problematic tooth
canines (impacted)
lines of approach for impacted canines
4
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
indicators for canine transplant
4
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
pros and con of transplant
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)
where do you want tooth to erupt into if surgically exposed
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
what to do here
Dilacerated 33
Some teeth not worth exposing – be realistic
Need full radiographic assessment before attempting surgical intervention
describe issues in eruption here
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)
what is this phenomenon called
Kissing canines 33 and 43
One canine has crossed midline to touch other canine
Both fail to erupt
where are the canines
options for management
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
how to manage submerged primary teeth
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
what is issue here
management options
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
frenectomies and frenoplasty
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
where is impacted canine placed
Tube moved back
Canine moves to overlap lateral – so buccally placed
what happens to teeth used for anchorage during ortho movement
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
5 qualities of implants that make them ideal ortho anchor
- Patient compliance unnecessary
- Absolute anchorage as there is no periodontal ligament
- Easily used under a variety of treatment modalities
- Easily placed (buccal - no flap, palatal - surgical skill needed)
- Removable, if necessary
prevents head gear too
what is corticotomy
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
