Oral Surgery/Orthodontics Flashcards
What are the soft tissue procedures that can be done for orthodontics
- frenoplasty
- impacted canine exposure
- impacted premolar exposure
What is a frenoplasty
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
When is a soft tissue exposure done for impacted canines
o Sometimes impacted canines only have soft tissue covering them therefore no bone removal is required, classifying them as a soft tissue procedure
If the canine is impacted bucally then what type of flap would be done
soft tissue procedures
apically repositioned flap
If the impacted canine is palatal then what type of exposure would be done
soft tissue
open exposure
What are the hard tissue procedures done for ortho
impacted canine exposure
impacted premolar exposure
other rextractions
submerged retained decidious teeth
implants (anchorage)
mini implants (anchorage)
orthognathic surgery
What is the procedure for exposing impacted canines
hard tissue
- flap raised
- bone removal
What is the flap used for bucally positioend canines
- apically repositioned flap
What is an apically respositioned flap
3 sided flap raised preserving attached mucosa
Flap repositioned apically and sutured
What is the benefit of an apically repositioned flap
This preserves attached mucosa and results in a thicker biotype of gingiva which is easier to maintain
What type of flap is used for palatally placed canines
an open exposure with bone removal
What are buccal/palatal closed exposures with gold chain attatchment
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
How do implants provide anchorage
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
Why are the implants used in ortho made of stianless steel
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)
What are the tx options for impacted canines
- leave alone + monitor
- extract canine
- surgical exposure + orthodontic alignment
- transplant
When do we leave the impacted canines alone and monitor
o If reasonable aesthetics and patient happy
What are the risks of leaving an impacted canine
o Future risk of infection, radicular cyst, damage to adjacent teeth
When do we extract the impacted canine
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
When do we do surgical exposure and orthodontic alignment for impacted canines
mini-implants for anchorage
corticotomy
What is corticotomy
Used to speed up tooth movements
How does a corticotomy speed up tooth movement
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
What are the indications for transplanting an impacted canine
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
Why is it important to prevent PDL damage when transplanting the impacted canine
o There should be minimal damage to the PDL when extracting the tooth to be transplanted as otherwise you will get ankylosis
What should be done after the canine is transplanted
splinted
What is the procedure for an impacted canine in the line of the arch
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.
What is the procedure for buccally placed canines
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
What is the procedure for palatally placed canines
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
What are kissing canines
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
