Oral Surgery/Orthodontics

Question 1

What are the soft tissue procedures that can be done for orthodontics

Answer 1

• frenoplasty
• impacted canine exposure
• impacted premolar exposure

Question 2

What is a frenoplasty

Answer 2

modifying the frenum
can be a V-Y frenoplasty or a Z-plasty
nowadays its done to move the frenum to allow for diastema closure

Question 3

When is a soft tissue exposure done for impacted canines

Answer 3

o Sometimes impacted canines only have soft tissue covering them therefore no bone removal is required, classifying them as a soft tissue procedure

Question 4

If the canine is impacted bucally then what type of flap would be done

soft tissue procedures

Answer 4

apically repositioned flap

Question 5

If the impacted canine is palatal then what type of exposure would be done

soft tissue

Answer 5

open exposure

Question 6

What are the hard tissue procedures done for ortho

Answer 6

impacted canine exposure
impacted premolar exposure
other rextractions
submerged retained decidious teeth
implants (anchorage)
mini implants (anchorage)
orthognathic surgery

Question 7

What is the procedure for exposing impacted canines

hard tissue

Answer 7

• flap raised
• bone removal

Question 8

What is the flap used for bucally positioend canines

Answer 8

• apically repositioned flap

Question 9

What is an apically respositioned flap

Answer 9

 3 sided flap raised preserving attached mucosa
 Flap repositioned apically and sutured

Question 10

What is the benefit of an apically repositioned flap

Answer 10

 This preserves attached mucosa and results in a thicker biotype of gingiva which is easier to maintain

Question 11

What type of flap is used for palatally placed canines

Answer 11

an open exposure with bone removal

Question 12

What are buccal/palatal closed exposures with gold chain attatchment

Answer 12

 Tooth should be isolated to the best of our ability
 Button of gold bonded to the tooth with composite and mesh present to help light cure get to composite better
 Chain is left for orthodontist to attach to brace
 Can do open or closed exposure with gold chain technique, closed is most common

Question 13

How do implants provide anchorage

Answer 13

Implants provide the qualities of an ideal orthodontic anchor
 Patient compliance unnecessary
 Absolute anchorage as no PDL
 Easily used under a variety of tx modalities
 Easily placed
 Removable if necessary

Question 14

Why are the implants used in ortho made of stianless steel

Answer 14

as we don’t want them to osseointegrate as it is only temporary, usually they are made out of stainless steel (does mean that it will eventually fall out but ideally we shouldn’t need it for that long anyway)

Question 15

What are the tx options for impacted canines

Answer 15

• leave alone + monitor
• extract canine
• surgical exposure + orthodontic alignment
• transplant

Question 16

When do we leave the impacted canines alone and monitor

Answer 16

o If reasonable aesthetics and patient happy

Question 17

What are the risks of leaving an impacted canine

Answer 17

o Future risk of infection, radicular cyst, damage to adjacent teeth

Question 18

When do we extract the impacted canine

Answer 18

o Canine is too far gone
o Don’t want it to further damage adjacent teeth
o Easier orthodontic tooth movement
o May be dilacerated

Question 19

When do we do surgical exposure and orthodontic alignment for impacted canines

Answer 19

mini-implants for anchorage
corticotomy

Question 20

What is corticotomy

Answer 20

 Used to speed up tooth movements

Question 21

How does a corticotomy speed up tooth movement

Answer 21

 Teeth have to move in dense cortical bone which is responsible for the slow movement of teeth
 However we cannot push the teeth too hard as it will result in root resorption
 If we weaken the buccal bone, this will help move the teeth quicker
 Create grooves in the bone

Question 22

What are the indications for transplanting an impacted canine

Answer 22

 When 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 23

Why is it important to prevent PDL damage when transplanting the impacted canine

Answer 23

o There should be minimal damage to the PDL when extracting the tooth to be transplanted as otherwise you will get ankylosis

Question 24

What should be done after the canine is transplanted

Answer 24

splinted

Question 25

What is the procedure for an impacted canine in the line of the arch

Answer 25

minimal exposure and starting with the least invasive option, you want to remove the deciduous tooth, excise the overlying mucosa and follicle (using a 15 blade) and then remove overlying bone with bone nibblers, dress it and suture it and hopefully canine will come through. Don’t want to just ‘cut a hole’ as attachment will be lost.

Question 26

What is the procedure for buccally placed canines

Answer 26

Buccally placed canines can be moved back with a removable appliance, however buccally placed canines when they are brought down often bring down unattached mucosa when them and these result in poor aesthetics as this gingiva is more prone to receding easily as well as this gingiva being more red. We want to encourage them to erupt into attached issue

Question 27

What is the procedure for palatally placed canines

Answer 27

Palatally placed canines may be expose using an open surgical exposure, it is unlikely they will erupt where they are supposed to, will require realignment

Question 28

What are kissing canines

Answer 28

Palatally placed canines may be expose using an open surgical exposure, it is unlikely they will erupt where they are supposed to, will require realignment