Surgical orthodontics-minor surgical procedures

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minor surgical procedures are performed as an adjunct to or in conjunction vth orthodontic treatment.

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  • 1.Minor SurgicalProcedures inOrthodontics PRESENTED BY-V.V.PriyankaB.D.S final year,RKDF Dental College & ResearchCentre,BhopalA SEMINAR FOR DEPT. OFORTHODONTICS

2. Surgical Orthodontics: IntroductionDEFINITION: Surgical orthodontics refers to the various surgical procedures carried out as a part of overall orthodontic treatment plan.Used as an adjunct or in conjugation with orthodontic treatmentCan be carried out before, during or after completion of orthodontic treatmentSurgical procedures are usually carried out:1.To eliminate the existing etiologic factor2.As a part of treatment plan3.Facilitate correction of malocclusion by orthodontictechniques4.Stabilize orthodontic treatment results & preventrelapse5.To correct severe skeletal discrepancies 3. Surgical Procedures MINOR PROCEDURESMAJOR PROCEDURES Extractions Orthognathic Surgical exposure surgeries- surgical(uncovering) of correction of jawsunerupted teeth Facial esthetic Frenectomysurgeries likerhinoplasty, blephar Supracrestaloplastyfibrotomy/Pericision Facialreconstruction like Corticotomy cleft palate & liprepair surgery 4. Minor Surgical ProceduresThe main aim is to remove the etiological factors & facilitate correction of malocclusion byorthodontic appliances, helpstabilize post-orthodontic results &to prevent relapse 5. ExtractionsThe various extraction procedures carried out as a part of orthodontic treatment are: a. Therapeutic extractionb. Serial extraction c. Extraction of carious teethd. Extraction of malformed/ankylosed teeth e. Extraction of supernumery teeth f. Extraction of impacted teeth 6. THERAPEUTIC EXTRACTIONExtractionsWhen to extractundertaken as a part of (and when not to)comprehensivePermanent teethorthodontic treatment Central Incisors = Dont!mainly to gain space areLateral Incisors When to extract (and= Rarely to) when notcalled TherapeuticCanines Permanent teeth = Rarelyextractions.1st premolars Dont! Central Incisors == 4+mm spaceoPremolars most required Lateral Incisors = Rarelycommonly extracted 2nd premolars = 2-4mm space Canines = RarelyoExtraction should be required 1st premolars = 4+mm space requiredatraumatic as any break in1nd molars = Compromised = only st 2 premolars = 2-4mm space requiredcontinuity of alveolar plate 4-5mm space 1st molars = Compromised = only 4-5mmmay hinder the smooth 2nd molars = To aid distalprogression of intendedspace nd movementorthodontic tooth 2 molars = To aid distal movementmovement. 7. serialextractionSerial extraction is a form ofinterceptive orthodontic treatmentwhich aims to relieve crowding atan early stage so that the permanentteeth can erupt into goodalignment, thus reducing oravoiding the need for laterappliance therapyDifferent procedures has beendescribed by different authors suchas;Tweeds method 1966; 8years [DC4].Dewels ,, 1978; 81/2yrs[CD4]Nances ,, 1940; D4C 8. Extraction of Supernumery,Impacted & Ankylosed TeethThe presence of supernumery,impacted &ankylosed teeth impede the normaldevelopment of occlusion & are important localcauses of malocclusion.Common supernumery teeth-mesiodens, lower -pmarea>incisor>molar, upper-canine areaExtraction of impacted canine-i. prior to extraction, a thorough radiographic examination must be done.ii. Depending on position approach by a well- designed buccal or palatal flap.iii. Elevate flap. After reflecting flap, remove bone around tooth.iv. Remove tooth atraumatically & irrigate extraction socket.v. Reposition flap & suture.remove suturePost surgical removal of after a weekimpacted maxillary right canine 9. Surgical Exposure of Impacted Teeth Canines- freq impactedteeth that req surgicalexposure. Favourably locatedimpacted canines can beguided to their normalpositions in the dentalarch by a combinedsurgical-orthodontictreatment referred to assurgical eruption 10. Surgical Techniques forexposing Impacted Canines:1. Window approach (gingivectomy)2. Apically repositioned flap (ARF)3. Flap closed eruption technique (FCET)4. Tunnel traction (TT)Steps in the management of an Impacted Tooth:a. Determination of the positionb. Evaluation of favourabilityc. Surgical exposure & bone removald. Fixing orthodontic attachments or direct ligation 11. Frenectomy Frenum Problems-Midline diastema between twomaxillary central incisors (low frenumattachment/thick labial frenum) The frenum that is inserted palatally into theincisive papilla & balances on eversion of lip is themain etiological factor of diastema. Such frenumhas to be exised. A frenectomy in this case should be followed withorthodontic treatment. The RULE!!!- The presence of a maxillary diastemadoes not prompt early frenectomy-WAIT UNTILTHE CANINES AND LATERALS ERUPT 12. Corticotomy Corticotomy is an adjunct surgery formalocclusion with wide generalisedspacings. The buccal palatal flaps are raised. The vertical cuts are placed in thecortical bone parallel to the roots. Thesevertical cuts on both palatal & buccalside are joined by horizontal bone cutsthat extend the depth of cortical bone. The sutures are placed & orthodonticappliance is placed after 2-3weeks. Now the tooth move within thecancellous bone and the treatment timeis appreciably reduced. 13. PERICISION or CIRCUMFERENTIAL SUPRACRESTAL FIBROTOMY(CSF) It is an adjunctive procedure to prevent relapse following orthodontic treatment particularly rotational correction. The supracrestal fibres are responsible for the relapse tendencies. Pericision involves surgical transection of these supracrestal fibres. 14. THANKS FORLISTENING!