SURGICAL

ORTHODONTICS
DR CHAITANYA
LECTURER
DEPARTMENT OF ORTHODONTICS &
DENTOFACIAL ORTHOPEDICS
 Surgical procedures carried out
as an adjunct to or in
conjunction with orthodontic
treatment are termed as
surgical orthodontics.
 These surgical procedures are usually carried out

- to eliminate an etiologic factor

eg:- Frenectomy, surgical exposure and removal of
impacted teeth

- to correct severe dentofacial abnormalities that

cannot be satisfactorily treated by growth
modification procedures or orthodontic
camouflage.

- As a part of treatment plan

eg:-Therapeutic extractions, serial extractions

- Stabilize orthodontic treatment results and prevent relapse

eg:- supracrestal fibrotomy or pericision
 Surgical orthodontic procedures are
broadly classified as

a) minor surgical procedures

b) major surgical procedures .

 Most minor surgical procedures are an integral part of

orthodontic therapy
 CLASSIFICATION OF SURGICAL
PROCEDURES
MINOR SURGICAL MAJOR SURGICAL PROCEDURES
PROCEDURES
1. Extractions 1. Surgical correction of jaws

2. Surgical exposure 2. Facial esthetic surgeries like

(uncovering) of Rhinoplasty, Blepharoplasty.
unerupted teeth.

3. Frenectomy 3. Facial reconstruction surgeries

like cleft palate and lip repair
surgeries.

4. Circumferential supracrestal 4. SARPE – Surgical assisted rapid

fibrotomy (Pericision) palatal expansion
5. Transplantation of teeth 5. Distraction Osteogenesis
6. Corticotomy
 The major procedures are aimed at treatment of
severe skeletal malocclusion or dentofacial
deformities that cannot be satisfactorily treated
by orthodontic treatment alone.

 There should be good co-ordination between oral

surgeon and orthodontist when undertaking such
procedures
MINOR SURGICAL PROCEDURES
• Extraction
• Surgical uncovering/exposure of
teeth
• Frenectomy
• Pericision/ supracrestal fibrotomy
• Transplantation of teeth
• Corticotomy
 EXTRACTION

Extractions are the most commonly

undertaken minor surgical procedures in
conjunction with orthodontic therapy.
Extraction procedures carried out are :

 Therapeutic extraction
 Serial extraction
 Extraction of carious teeth
 Extraction of malformed teeth
 Extraction of supernumerary teeth
 Extraction of impacted teeth
 Therapeutic extraction is undertaken as a part of full fledged
orthodontic treatment mainly to gain space.

• Prior to therapeutic extraction a thorough diagnostic exercise

is essential.

• Preoperative radiographs are a valuable aid in planning and

execution of extraction.
Features
➢ Extraction should be as atraumatic as possible

➢ Care should be taken to preserve the integrity of the alveolus.

➢ Any break or loss of either buccal or lingual bony plates may

prevent ideal positioning of the teeth during orthodontic
therapy
 Serial extraction is an interceptive orthodontic procedure

 Usually initiated in the early mixed dentition period

 Corrected by a procedure that includes the planned
extraction of certain deciduous teeth and later
specific permanent teeth in an orderly sequence and
pre determined pattern to guide the erupting
permanent teeth in to a , more favorable position.
EXTRACTION OF SUPERNUMERARY TEETH, IMPACTED AND
ANKYLOSED TEETH

 Impede the normal development of occlusion

 Important local causes of malocclusion

 The most commonly seen supernumerary teeth are the

mesiodens
 can also occur in the lower premolar area followed by
incisor and molar region
EXTRACTION OF IMPACTED TEETH

 The most common teeth to be

impacted other than third molars are
maxillary canine followed by
premolars, and maxillary second
molars
 The presence of impacted teeth in dental arch can cause minor
dental irregularities due to deflection of adjacent teeth.

 Impaction of teeth usually occur as a result of arch length

discrepancy or presence of mucosal and bony barriers that
prevent their eruption
 INDICATIONS FOR EXTRACTION
OFINDICATIONS FOR EXTRACTION OF
IMPACTED TEETH TEETH

 Ectopically erupted and cannot be aligned

 Adjacent teeth are in good contact

 Any pathology associated with it

 Causing pressure on root of standing tooth

 Radiographic location of tooth should be undertaken.

 During extraction care should be taken not to

damage adjacent teeth or roots.

 The tooth is approached by a buccal or palatal flap

depending up on its location.
 The most commonly impacted tooth is the maxillary
permanent canine.

 In many cases it is possible for the orthodontist to guide the

impacted canine in to normal location in the dental arch after
adequate surgical exposure.
An un erupted canine may be a candidate for surgical
exposure if :
 No sign of tooth even after 12 years of age

 Adequate room in the arch or can be created by the

orthodontist

 Un obstructed path of eruption

 Radio graphically root is not dilacerated

 Location of the tooth

 Evaluation of favorability

 Evaluation of space adequacy

 Surgical excision and bone removal

 Fixing orthodontic attachments

 Exact location of impacted tooth has to be determined .

 This can be done using tube shift or right angle technique.

 Most impacted teeth present as a bulge corresponding to their

location which should be examined clinically by inspection
and palpation
 In many cases the orientation of impacted teeth may be such
that surgical orthodontic guidance of tooth in to the arch
may not be possible.

 The favorability should be examined prior to the procedure, it

is considered favorable whenever the apex of canine is closer
to its normal position.
 When impacted tooth is guided in to dental arch adequate space
should be present for their normal alignment .
 In many cases involving the impaction of permanent canine the
deciduous canines are over retained .

 These teeth have to be extracted to accommodate the permanent

canine.
 The crown of impacted tooth is exposed by excision of the
overlying soft tissue and removal of bone covering .

 The bone should be removed up to maximum height of

contour.
 In most cases of favorably impacted canines, once the soft
tissue and bony tissue is removed , the canine erupt on its
own.

 In some cases orthodontic guidance for eruption of the

teeth in to the arch may be required.

 Attachments are placed on the impacted tooth to guide

the erupting tooth in to the arch
- Standard bondable orthodontic bracket or
lingual buttons
- A celluloid crown with an attachment
prebonded to it
- A metal crown with a soldered hook
- Lasso wires
- Threaded pins
- Orthodontic bands
- A simple eyelet
- Elastic ties and modules
- Magnets
 - ligature wire or elastic module or chain is secured around
the attachment and the other end tied to a removable or fixed
orthodontic appliance.

 The wire or module is gradually tightened at regular

intervals to guide the erupting tooth.
 Frenectomy is a surgical procedure
performed to excise the frenum and
remove the deeply embedded fibrous tissue.
 It may be a labial frenectomy and lingual
frenectomy.
 Two school of thoughts are :
i. it should be performed before orthodontic treatment
ii. It should be done after orthodontic treatment as it reduces
risk of scar tissue that prevents the closure of diastema

 Frenectomy should not be attempted before the

eruption of permanent lateral incisors and canines
 The band of tissue connecting the tongue to the floor of the
mouth is called the lingual frenum or frenulum.

 Occasionally this frenum might be congenitally short, thick,

or tight , or may extend too far down along the tongue or the
gum.
 Anunusually thick , large, or tight lingual frenum
can seriously constrict the movement of the
tongue and this condition called
“ tongue tie” or ankyloglossia.
 A frenectomy is performed using either scalpel or a carbon
dioxide laser .
 The surgeon excises the frenum or performs a

Z – plasty in order to
mobilize the tongue.
 Pericision or circumferential supracrestal fibrotomy is a
minor surgical procedure that is undertaken to
counter the relapse tendency of the stretched gingival
fibers.

 The transseptal and alveolar

crestal (supracrestal) group of
gingival fibres are responsible
for relapse tendencies after
correction of rotations
 Pericision involves surgical sectioning of these fibers by
passing a sharp narrow scalpel through the gingival sulcus
around the tooth to a depth of 2 mm apical to the alveolar
crest .

 Pericision is generally undertaken as an adjunctive retention

procedure after the correction of rotations.
 EDWARDS TECHNIQUE

 Under LA a no 11 knife is passed through gingival

sulcus up to crest alveolar bone
 Cuts are made inter proximally on each side of
a rotate tooth and along the labial or lingual
gingival margin
 surgical sectioning of these fibers by passing a
sharp narrow scalpel through the gingival sulcus
around the tooth to a depth of 2 mm apical to the
alveolar crest.
 Transplantation of teeth has been advocated as an alternative
to other methods of treatment of impacted teeth.

 It may be a good alternative for the adult patient who cannot

undergo conventional orthodontic movement of an impacted
tooth.

 The advocated technique is a careful wide exposure of the

impacted tooth. .
 The tooth is then moved in to its position with in the dental
arch and is stabilized with a segmental orthodontic
appliance.

 Endodontic treatment ,if necessary is rendered 6 to 8 weeks

after the surgical procedure initially using a calcium
hydroxide paste.
 Then a conventional root canal filling is done 1 year later.
 Corticotomy is a surgical procedure usually undertaken in
patients having dental proclination with spacing in
anterior region.

 This technique involves the sectioning of the thick

interdental dento-alveolar region in to multiple small units
to fasten orthodontic tooth movement.

 Labial flaps are raised and interdental bony cuts are made
parallel to the long axis of teeth
 Labial and palatal mucoperiosteal flaps are raised to
expose both the labial and palatal cortices of the teeth
to be moved

 Vertical interdental bony cuts of predetermined width

are made with a bur on either side of each tooth
through both the cortices parallel to the long axes of
the teeth and away from the roots.
 These cuts may be joined together by a horizontal bony cut
above the apices of the roots.

 Care should be taken not to totally separates the individual

units.

 Following the surgery ; orthodontic tooth movement is

initiated using fixed appliance after 2-3 days
 Wilckodontics

 Also known as Accelerated Osteogenic

Orthodontics (AOO)

 Shorten orthodontic treatment time

 Developedby Drs.Thomas and WilliamWilcko,

of Erie, PA, in 1995
 Decortication the bone i.e., some of the bone's external
surface is removed.
 The bone then goes through a phase known as
osteopenia, where its mineral content is temporarily
decreased

 In state of remineralisation of bone, there is accelerated tooth

movement, because the bone offers less resistance to the
orthodontic force