The effectiveness of non-surgical interventions for common ...
surgical interventions in orthodontics
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Transcript of surgical interventions in orthodontics
Surgical Techniques in
Orthodontics
Techniques
• Minor Surgical Procedures
– Circumferential Supracrestal Fibrotomy (CSF)
– Frenectomy
– Papilla Split Procedure
• Orthognathic Surgery
• Distraction Osteogenesis
• Adjunctive Surgical Procedures
Papilla Split Procedure
Common Surgical Techniques
Transverse
• Maxilla
• Single Step Expansion
• Surgical Assisted Rapid Palatal Expansion
• Mandible
• Symphysial Distraction
Vertical
• Maxilla
• Lefort I maxillary Impaction
• Lefort I maxillary downfracture
• Mandible
• No recommended Surgical Technique available
• Tripod landing with BSSO mandibular advancement
Sagittal
• Maxilla
• Lefort I maxillary Advancement
• Lefort I maxillary setback
• Anterior Segmental Maxillary setback
• Wassmund
• Wunderer
• Mandible
• BSSO Mandibular Advancement
• BSSO Mandibular Setback
DISTRACTION
OSTEOGENESIS
Distraction Osteogenesis
“A biological process of new bone formation between
the surfaces of osteotomized bone segments that are
separated gradually by incremental traction”
Distraction Histogenesis :
– Adaptive regenerative changes in surrounding soft tissues
Historical Overview
Alessandro Codiwilla (1905)
– First report of surgical limb lengthening
– Oblique osteotomy and external traction pins
– Complications: infections, overstretching, poor blood
supply and inadequate fixation
Historical Overview
G.A. Ilizarov (1950’s)
– Lengthening limbs through gradual distraction of fracture
callus
– Rhythm and rate of distraction
– Minimal complications
Historical Overview
McCarthy (1992)
– DO to lengthen congenitally hypoplastic mandible
Historical Overview
• Rachmiel et al (1993) and Blocks et al (1995)
– Maxillary distraction
• Polley et al (1995) – Midface distraction with externally fixed cranial halo frame
Biology of Distraction
1. Osteotomy/Corticotomy phase
2. Latency phase
3. Distraction phase
4. Consolidation phase
5. Remodeling phase
Osteotomy Phase
• Divides the bone into two segments
• Triggers process of bone repair
– Angiogenesis
– Fibrogenesis
– Osteogenesis
Latency Phase
• Period from bone division to onset of distraction
• Inflammation and soft callus formation of the fractured bone
• Soft callus formation begins 3-7 days and lasts 2-3 weeks
• Latency period = 5-7 days
Distraction Phase
• Characterized by the application of traction forces to osteotomized
segments
• Rate : 1 mm/day
• Rhythm : 0.25 mm every 6 hours
0.5 mm twice a day
• Duration : 1-3 weeks
Consolidation Phase
Cessation of traction forces to removal of distractor
• Newly formed bone mineralizes and increases in bone density
and strength
Duration: 3- 4 months
Remodeling Phase
• Removal of distractor to application of functional
loading
• Formation of lamellar bone
Symphesial Distraction
• For V shape mandible
• Severe mandibular crowding
• Brodie’s syndrome
• To avoid inderdental stripping or extractions
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Symphesial Distraction
• Osteotomy Cuts
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Symphesial Distraction
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Cosmetic Surgeries
• Rhinoplasty
• Cheiloplasty
• Genioplasty
• Submental Liposuction
• Malar Implants
• Mandibular Angle/Ramal Implants
Sagittal Augmentation Genioplasty
Rhinoplasty
Gonial Angle Implants
Lip Augmentation
Lip Lengthening
Cheiloplasty
Submental Liposuction
Thanks You!