Often, general dentists, orthodontists, and oral surgeons work as a team to facilitate orthodontic surgery for patients. There are several scenarios in treatment where orthodontic surgery is required or may be used to facilitate or create the best results. In cases such as these, Dr. Tomlinson will work closely and communicate readily with patients’ general dentist and orthodontist to best serve the patient in a complete and timely manner.
Common Scenarios:
- Impacted Canines
- Temporary Anchorage Devices
- Surgical Uprighting
- Surgical Corticotomy
Impacted Canines
Impacted teeth refer to instances where teeth fail to erupt into the mouth appropriately. The most commonly impacted teeth are third molars or wisdom teeth. Canine teeth may also become impacted, but the incidence of impaction of canine teeth is approximately 2%, and it is far more common to occur in the upper jaw than the lower jaw.
There are several different approaches to treatment for impacted canine teeth. The most conservative of treatments is to observe the tooth normally accompanied by extraction of the overlying baby canine tooth. The most aggressive form of treatment for impacted canines is surgical extraction of the tooth and, in some cases, this is the only appropriate choice for treatment.
The most common decision regarding orthodontic surgery is to undergo a procedure called canine exposure and bonding of traction device to the tooth. The traction device will be bonded directly onto the tooth using typical dental composite materials. This device will normally incorporate a chain that will allow force to be applied to the tooth to help pull it into position in the jaw by attachment of the chain to the braces. Exposure and bonding procedures are normally done with the patient under sedation in the office setting.
Temporary Anchorage Devices (TADs)
The practice of orthodontics relies upon leverage and anchorage in order to move teeth into more appropriate positions. In many patients, this anchorage is provided via the teeth present and the braces that are applied by the orthodontist. There are situations, however, where anchorage necessary to appropriately reposition teeth is not present via the remaining teeth. In such cases, a TAD may be placed through orthodontic surgery in order to provide the anchorage necessary to facilitate tooth movement. The TAD is then later removed when no longer needed.
TADs have evolved a great deal over their somewhat short clinical history, and exist in several different forms. Some TADs are plates that are surgically inserted under the gum tissue with a hook or attachment arm that remains exposed outside of the gums to allow for connections. TADs also now exist as essentially screws that are surgically placed directly through the gum tissue, leaving the head of the screw exposed outside of the gum tissue to allow for anchorage. Surgical placement of TADs may be done in the office setting either under local anesthesia or with sedation.
Surgical Uprighting
There are many instances where adult teeth erupt in a position that is nonfunctional for the patient and may be detrimental to oral hygiene. One common example of such a situation is poor position or impaction of second molars. This occurs almost exclusively with the lower jaw second molars and requires orthodontic surgery.
Typically, this occurs in situations where the second molar was crowded during its eruption, leading to tipping of the molar and getting stuck under the crown of the first molar ahead of it. In these cases, treatment options include extraction of the poorly positioned tooth or surgical repositioning or surgical uprighting of the second molar.
The decision of whether to extract the second molar or to attempt repositioning is one that requires coordination and thorough communication among the surgeon, orthodontist, and general dentist. Surgical repositioning procedures are typically done with the patient under IV sedation in the office setting.
Surgical Corticotomy
Orthodontic tooth movement relies on slow, patient movement of teeth through bone into more appropriate positioning. Moving teeth too rapidly or aggressively may result in loss of supporting bone or gum tissue or both around the tooth being moved. Surgical corticotomy is a procedure that facilitates more rapid movement of teeth, while avoiding serious complications. Corticotomy is an orthodontic surgery that is completed through care, coordination, and communication with the patient’s orthodontist and general dentist.
Surgical Corticotomy Procedure:
- Gum tissue around the teeth that require significant movement is reflected, exposing the bone around these teeth
- Strategically, certain areas of bone reduction is completed that will reduce the resistance to movement
- Local anesthesia or IV sedation is used in the office