SURGICAL AIDS TO

ORTHODONTICS
DR. SHAHEEN AHMED
ASSISTANT PROFESSOR
DEPARTMENT OF ORAL &
MAXILLOFACIAL SURGERY
 OUTLINE
• Therapeutic extractions

• Management of frenum

• Fiberotomy

• Management of un-erupted teeth

• Implants for anchorage

• Surgical assisted expansion

• Orthognathic surgery

• Distraction osteogenesis
MANAGEMENT
OF UN-ERUPTED
TEETH
MANAGEMENT OF
UNERUPTED
CANINE
 INCIDENCE

• Permanent maxillary canine is the 2nd most

frequently impacted tooth.
• Prevalence 0.9-2.8% in general population
• Frequency is 50 times > in maxilla
• Palatal impactions 85% (more common in
females)
• Labial impactions 15%
• Bilateral impactions less common
© J Can Dent Assoc 2000; 66:497-501
 DIAGNOSIS
Clinical Evaluation

• Inspection

• Palpation

Radiographic Evaluation
– Periapical radiograph
– Orthopantomogram
– Occlusal view

Cast analysis Biomechanics in clinical orthodontics by Nanda

RADIOGRAPHIC EVALUATION

LOCALIZATION OF
IMPACTED CANINE

– SLOB rule

– Vertex Occlusal
Radiographs

Biomechanics in clinical orthodontics by Nanda

 MANAGEMENT OF UN-ERUPTED
CANINE

• Treatment
– No active treatment

– Surgical exposure

– Surgical exposure with orthodontic treatment

– Transplantation

– Extraction

– Dental Implants
 SURGICAL
EXPOSURE
SURGICAL EXPOSURE AND BONDING OF IMPACTED CANINES
ALEXANDRA M. BIALY, DDS
University of Illinois at Chicago
Oral and Maxillofacial Surgery
February 18, 2001
 SURGICAL EXPOSURE

• Circular incision

• Apical repositioned flap

• Unrepositioned flap
 SURGICAL EXPOSURE

Window Technique

The orthodontic treatment of impacted teeth by Adrian Becker

 APICALLY REPOSITIONED FLAP
Vanarsdall & Corn 1977

Use of the apically repositioned flap in the management of

labially impacted maxillary central incisors. Singapore Dent J.
2004 Dec;26(1):55-9
 CASE
REPORT
PREOPERATIVE ORTHODONTICS
ANTERIOR (TOPOGRAPHIC ) OCCLUSAL VIEW
ORTHOPANTOMOGRAPH
(CROP IMAGE)
FULL THICKNESS (UNREPOSITIONED FLAP)

A modified flap design in exposing the palatally impacted canine

ASDC J Dent Child. 1988 Jul-Aug;55(4):285-7. .
 FULL FLAP CLOSURE
CLOSE ERUPTION TECHNIQUE
26 MONTHS FOLLOW UP
MANAGEMENT OF UN-ERUPTED
CANINE

Extraction
MALFORMED IMPACTED CANINE
EXTRACTION
MANAGEMENT OF
UN-ERUPTED
CENTRAL INCISOR
INTRA ORAL EXAMINATION
RADIOGRAPH
ORTHOPANTOMOGRAM
 TREATMENT PLAN
• Pre-surgical orthodontics
− Leveling / alignment
− Regaining space for 21

• Surgical exposure

• Post surgical orthodontics

 SURGICAL EXPOSURE

Esthetic management of an unerupted maxillary central incisor with a

closed eruption technique
AM J ORTHOD DENTOFACIAL ORTHOP. 2000 AUG;118(2):224-8 .
 SURGICAL EXPOSURE

Modified apically repositioned flap in the treatment of unerupted maxillary central

incisors.
Singapore Dent J. 2004 Dec;26(1):55-9
TRACTION CORD LIGATION
11 MONTHS FOLLOW UP
16 MONTHS FOLLOW UP
SURGICAL
ASSISTED
EXPANSION
 SURGICAL ASSISTED
EXPANSION

• Labial corticotomy

• Buccal corticotomy

• Buttress corticotomy

• Mid palate suture separation

 INDICATIONS

• Expansion required more 5mm

• Molar tipping could not be tolerated

• Failed Orthopedic expansion

• Orthognathic cases require more maxillary expansion

 BUTTRESS
CORTICOTOMY
 LATERAL OSTEOTOMY

Surgically Assisted Rapid Expansion; William Northway Oct.2,2001; PCSO Annual Session
LATERAL OSTEOTOMY
 LATERAL OSTEOTOMY

Maxillary sagittal and vertical displacement induced by surgically

assisted rapid palatal expansion.
Medscape Newslettersd Am J Orthod Dentofacial
Orthop.2001;120:144-8
MAXILLARY EXPANSION
PROGRESS
POST EXPANSION RADIOGRAPH
 CONSEQUENCE

3.3 degree relapse

Effect on anterior segment

Skeletal and dental changes following surgically assisted rapid palatal expansion
Friedrich K. Byloff and Claude F. Mossaz The European Journal of Orthodontics 2004
26(4):403-409
MID PALATAL
SEPARATION
ANTERIOR APPROACH
MIDPALATINE SUTURE
SEPARATION
PROGRESS
LABIAL CORTICOTOMY
INTER DENTAL VERTICAL OSTEOTOMY

Donald J, Ferguson
Accelerating orthodontics by altering alveolar bone dentistry
IMPLANTS FOR
ANCHORAGE
MID PALATE
IMPLANTS
The role of implants in orthodontics
S. F. H. Ismail and A. S. Johan Royal London Hospital, UK
Mr S. F. H. Ismail, Department of Orthodontics, Royal London
Hospital, New Road, London E1 1BB, UK. E-mail:
shamiqueismail@yahoo.com
MUCOSAL TREPHINATION
IMPLANT PLACED
ATTACHMENT
TRANS-PALATAL BAR
MINI IMPLANTS
NASAL PIN
MINI IMPLANTS
ORTHOGNATHIC
SURGERY
PRESENTATION
PROFILE
ORTHOPANTOMOGRAPH
LATERAL CEPHALOGRAPH
 TREATMENT PLANNING

• Maxillary impaction

• Mandibular advancement

• Advancement genioplasty
LEFORT 1 OSTEOTOMY
LEFORT 1 OSTEOTOMY
DOWN FRACTURE
BILATERAL SAGITTAL SPLIT OSTEOTOMY
BILATERAL SAGITTAL SPLIT OSTEOTOMY
GENIOPLASTY
2 WEEKS POST OPERATIVE FOLLOW UP
PROFILE
PRE-OP

POST-OP
THANKING
YOU