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CMS2 > Surgery and Ortho > Flashcards

Surgery and Ortho Flashcards

1
Q
  1. What are the surgical procedures that can be associated with orthodontics?
A
  • Extractions
  • Fraenectomy
  • Impactions (expose or extract)
  • Orthognathic surgery
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2
Q
  1. When extraction can be carried out in orthodontics? and which teeth are indicated to be extracted?
A
  • Extractions can be carried out where the space is needed
  • 4’s, 5’s, 6’s or a combination depending on (where + how much) space is needed
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3
Q
  1. True or false – wisdom teeth eruption causes anterior crowding
A
  • False
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4
Q
  1. True or false – anterior crowding can be as an effect of aging
A
  • True
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5
Q
  1. True or false – Anterior crowding is likely to get worse or occur despite the fact that wisdom teeth have been removed
A
  • True
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6
Q
  1. What we need to look for if we are going to undertake Fraenectomy?
A
  • Evidence of tight bundle of fibrous tissues is being inserted between the teeth
  • How big and bulky is the frenum
  • How close is it to the gap between the U1s
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7
Q
  1. How do we release the frenum?
A
  • hold the lip and making an incision across, that relieves the tension of the frenum
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8
Q
  1. what do you know about lingual frenum
A
  • It is common
  • Common to be treated by oral surgeons in combination with orthodontic treatment
  • Test – stick tongue out and if it appears like it is divided into 2 lobes that mean the frenum is significantly tight and that patient might benefit from frenectomy
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9
Q
  1. How to do frenectomy?
A
  • Put some tension on the tongue backwards
  • Make a cut across there (horizontal  turn into diamond)
  • In babies we wouldn’t think about having to suture those at all
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10
Q
  1. Reason for babies lingual frenectomy
A
  • Failure to latch on and failure to feed with breastfeeding is probably one of the most common reasons for babies to be referred for a lingual frenectomy
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11
Q
  1. Is the lingual frenum the main cause of the child not feeding?
A
  • No as babies can be challenging, and just because a baby doesn’t appear to be latching on and they’ve got lingual frenum, doesn’t mean that the frenum is the cause of that child’s problem
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12
Q
  1. Impacted teeth can be part of orthodontic treatment. If we have got impacted/ displaced teeth we always want to know where they are. Why?
A
  • They can develop cyst
  • If they develop cyst, that can move the tooth
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13
Q
  1. Problems with impacted teeth
A
  • Requires orthodontic treatment
  • Cyst formation
  • Damage to adjacent teeth
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14
Q
  1. How do we assess unerupted teeth?
A
  • Clinical assessment – Looking for the tooth + feeling it
    o If the tooth buccal you can feel it
    o If the tooth palatal, you cannot feel it
  • Radiographs – e.g., PAs, upper occlusal, OPG, CBCT
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15
Q
  1. Why we do assessment?
A
  • To assess impacted teeth position
  • To check if there has been damage to the adjacent teeth
  • to check if there has been cyst formation on the impacted teeth
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16
Q
  1. In the radiograph, how would you assess where is the canine in relation to other teeth according to the SLOB role?
A
  • Looking at the tooth in relation to fixed point in OPT (reference point). The beam in the OPT is horizontal
  • According to SLOB role – same lingual, opposite buccal
  • Compare the PA radiograph (beam is vertical) with the reference point.
    o if the tooth is going up the reference point, then it is in the same direction of the beam. So, the tooth is lingual
    o If the tooth comes down the reference point, then it is opposite the beam. So, the tooth is buccal
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17
Q
  1. How to treat supernumerary teeth?
A
  • Extraction
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18
Q
  1. What do you know about Mesiodens?
A
  • Sometimes doesn’t cause problems
  • Sometimes be found in relation to persistent upper midline diastema
  • Better to be removed as they can form cyst +and damage to adjacent teeth
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19
Q
  1. What is great thing about mesiodens?
A
  • tend to be short
  • have a short conical root
  • once exposed, straightforward to be removed
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20
Q
  1. what is a common kind of impaction that oral surgeons deal with apart from wisdom teeth and in relation to orthodontic treatment
A
  • upper canine impaction
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21
Q
  1. things need to be considered in canine impaction:
A
  • Exposure or removal
  • We have to assess:
    o Patient compliance
    o Other treatment the patient is going to be having e.g., orthognathic surgery etc…
    o Space – is there enough space
    o Angulation
    o Position of the apex
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22
Q
  1. Regarding to the impacted tooth, which angulation would be more favourable to move into space (90 or 15 degrees)?
A
  • 15 degrees is much more favourable as the minimum amount of tooth movement is easier to be achieved. 90 degrees is very hard to be achieved
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23
Q
  1. Why we need to consider the apex position? and what is the ideal position?
A
  • Apex needs to be roughly in the same position as what it would be in the ideal position.
  • If you had to move the apex a lot you probably won’t do that without having some damage the tooth
24
Q
  1. how do expose the tooth?
A
  • Start by making an incision in the gum whether it is:
    o buccal – make gingival incision around the gum with a relieving incision, anchor the tooth (usually the bone covering it is very elastic and quite thin especially in teenagers), you can scrape it away with sharp instrument
    o or palatal – trickier because of the access, make a palatal gingival incision around the upper teeth to expose the canine then, remove bone by scrape it away or by using a drill
25
Q
  1. how long does orthognathic surgery takes?
A
  • Complex and takes at least 3 years up to 5 years
26
Q
  1. Does orthognathic surgery on its own fix complex cases?
A
  • No, as orthognathic surgery is always as part of a combined orthodontic treatment plan
27
Q
  1. What we need to consider prior deciding to undertake orthognathic surgery?
A
  • Assess patient priorities, motivation, other priorities
  • Manage expectations
  • Timing
28
Q
  1. When is the ideal time to do this type of surgery?
A
  • The ideal time is just after finishing your growth spurt
29
Q
  1. How to treat narrow upper arch?
A
  • Treated by a combination of orthodontist and surgery with SARME
30
Q
  1. What is SARME? What does it involve when treating bilateral crossbites?
A
  • Surgically assisted rapid maxillary expansion
  • Involves GA
  • Cut the bone along the buttress (include buttress + anterior wall of the maxilla + lateral wall of the nose) in both sides
  • Cut through the midline of the maxilla
  • We don’t mobiles them fully but, make sure that cuts are complete and when you put some pressure on these fragments they start to move
  • Then attach SARME to the teeth (sometimes mini-implants can be used) but, traditionally they’ve been attached to the teeth
  • There is screw mechanism here so, patient is instructed to turn the screw once/ twice a day depending on the amount of movement that is required. Over couple of weeks, you will open this up by 5-6 mm
31
Q
  1. Can we use SARME to treat unilateral crossbites?
A
  • Yes
32
Q
  1. How do you know that SARME is working apart from the X-bite disappearing?
A
  • If patient develops during fortnight a huge midline diastema. Then this is all stabilised while the bone heals in new position. then the teeth are moved orthodontically through the bone in new position to close the midline diastema. Now cross-bite is corrected
33
Q
  1. What is Le Fort 1 fracture
A
  • fracture along the buttress, the anterior wall of the maxilla, up to the lateral wall of the nose
34
Q
  1. what does Le Fort 1 osteotomy involve?
A
  • GA
  • Incision in the mucosa above the upper teeth
  • Made bone cuts
  • Expand bone cuts to mobilise the fragments
35
Q
  1. What is the difference between SARMEN and is Le Fort 1 osteotomy
A
  • Same but, in Le Fort 1 osteotomy, we fully mobiles the fragments
36
Q
  1. There is only one direction that we cannot move the maxilla to, in Le Fort 1 osteotomy. Which direction is that? Why?
A
  • Backwards because of the pterygoid plate
37
Q
  1. What could be an indication of undertaking Le Fort 1 Osteotomy?
A
  • Vertical maxillary hypoplasia
38
Q
  1. What is occlusal cant?
A
  • When one side of the upper jaw is lower/ higher than the other side
39
Q
  1. How to treat occlusal cant
A
  • lift one side up or one side down or to do combination
  • Patient might have differential bone graft on the L or on R side
40
Q
  1. How would you treat vertical maxillary excess?
A
  • Upward movement of the maxilla to correct vertical maxillary excess
  • 2 bone cuts in each side and remove a section of bone to reposition the maxilla at higher level
41
Q
  1. How would you treat vertical maxillary hypoplasia?
A
  • Put a bone graft in
42
Q
  1. Does maxillary advancement only have an effect on the teeth
A
  • No as it can also, has an effect on facial profile
43
Q
  1. Mention one of the commonest procedures for the mandible
A
  • Mandible-sagittal split osteotomy
44
Q
  1. What does mandible-sagittal split osteotomy involve?
A
  • involves a cut in the buccal side and cut in the lingual side then join the cuts up
  • There is also a cut in the back, but we don’t do this cut. we do lingual cut take it to the buccal side and then you introduce an instrument and set it between the bone fragment and very gradually you open this up and it tears this bone apart
45
Q
  1. In mandible-sagittal split osteotomy, how the nerve would be affected?
A
  • Can be damaged
  • All patients will have temporarily numbness afterwards but, few will get permanent numbness
  • We aim to leave the nerve attached to the fragments of bone that has the teeth on it
46
Q
  1. What are the directions that you can move the tooth bearing fragment in mandible-sagittal split osteotomy
A
  • forward/ backward/ up/ down
47
Q
  1. what are the procedures that mandible-sagittal split osteotomy can be used in combination with?
A
  • Le fort 1 osteotomy
  • Genioplasty
48
Q
  1. Planning for orthognathic surgery is the most important part of the surgery. There are different of ways we can do this:
A
  • Old fashion – get the model set up on the articulator then, make the cuts + movements. Technician will do the wafer for you so, you can get the jaws + the occlusion in the right position
  • new way – use software which can model hard tissues movement and the impact of the hard tissues’ movements on the soft tissues. You can give the patient a picture of what they are likely to look like after the surgery
49
Q
  1. if you are planning to do surgery in both jaws, how would you plan that?
A
  • You normally do the maxilla first, make your cuts + plate them in the correct position by using intermediate wafer. After you plate the maxilla in the correct position you then do sagittal split osteotomy where you use final wafer to get the mandibular teeth in the correct position
50
Q
  1. Risks
A
  • Major Surgery
  • Swelling
  • Not being able to drink and eat easily
  • About 18 months pre-surgical orthodontics. The pre-surgical orthodontics very often makes the occlusion worse (decompensate before correction)
  • Potential of Airway risk as they might need their teeth to be wired together
  • Bleeding
  • Necrosis of the maxilla – very rarely
  • Lower lip numbness – both temporarily and permanent
  • Change in facial appearance
51
Q
  1. Why necrosis of the maxilla can be a risk of orthognathic surgery?
A
  • As we are cutting lots of blood supplies of the maxilla + the maxilla gets its blood supply from the soft tissues attachments + if had radiotherapy previously or previous surgery then the blood supply might be insufficient. Ending up with all/ part the maxilla dies off
52
Q
  1. What do you know about Distraction osteogenesis using Ilizarov technique in orthodontics? How does it work?
A
  • New development in orthognathic surgery
  • You take the diseased/ fractured section then put Ilizarov frame on  make an elective osteotomy at the top of this bone (the free bit of bone is attached through this wire to the frame, and if the circle on the frame moves up or down  the bit of bone move with it)
  • set this up so you can turn screws in the apparatus that move this disc of metal down. As the disc moves down it takes with it this piece of bone. As this piece of bone moves down, it is trying to heal and reconnect with the other piece of bone. But, before the piece of bone get the chance to mineralise and harden, the piece of osteotomised bone has moved on. Overtime you can move it down the entire length of the missing piece of bone
  • At the bottom there these pieces of bone will join up
53
Q
  1. In which cases can we use the distraction osteogenesis?
A
  • Used for trauma, but you can use it for oncology. We also, use it for managing malocclusions and facial disproportion
54
Q
  1. What is Hemifacial microsomia
A
  • branchial arch condition which affects everything developed from that branchial arch. First arch tends to affect structures around the face and the mouth including the ear and the mandible.
55
Q
  1. How can we treat hemifacial microsomia?
A
  • We can treat it by doing distraction osteogenesis
  • Then we might need to do other surgeries e.g., Le Fort osteotomy
  • Always multidisciplinary approach
56
Q
  1. Downsides of Distraction osteogenesis
A
  • Scaring marks (consent is taken) + overtime the scaring can settle down

CMS2 (29 decks)

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