Surgical orthodontics diagnosis /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


SURGICAL ORTHODONTICS –
DIAGNOSIS,
ORTHODONTIC MANAGEMENT
AND PREPARATION OF SURGICAL
SPLINT


Surgical Orthodontics
v/s
Orthognathic Surgery


Scope of the talk
1. A broad outline of the scope of Surgical
Orthodontics and the Orthodontist’s role in
it.
2. Suggestions to avoid the pitfalls in planning
the treatment and executing its orthodontic
management
3. Preparation of a surgical splint using a new
gadget.


Limitations of Orthodontics – Several
conditions which cannot be corrected by
Orthodontics alone.
Limitations of Surgery


Indications
1. Congenital anomalies


Indications
2. Excessively large or small jaw dimensions


Indications
3. Marked asymmetric jaw growth


Indications
4. Anatomic limitations, which hinder the
orthodontic tooth movement.


The spectrum of surgeries
a. Osteotomies –
• Le fort I, (Le fort II, or III in some cases)


a. Osteotomies –
• Sagittal split osteotomy and osteotomy of
the ramus (trans-oral or extra oral, vertical
or inverted L)


Surgically assisted expansion or contraction of
the maxilla


Subapical surgeries


Chin Surgeries


Cosmetic surgeries


Distraction osteogenesis


DIAGNOSIS
a. Deciding the need for Surgery
b. Deciding where the fault lies.
c. Quantifying the extent of the fault


Deciding the need for surgery:
a. Congenital or developmental craniofacial
anomalies.
b. Abnormal jaw growth causing marked
visible facial disfigurement.
c. Standard deviation as the yardstick


d. Orthognathic surgery in most instances is
elective.
Patient’s opinion plays a decisive role.


Excess mandibular growth is considered more
obnoxious in our society.


Persons with mild prognathism often seek
treatment, while those with moderate
mandibular deficiency may refuse surgical
correction.


e. Age considerations.


f. Patient’s self image.


How to locate the fault?
• History
• Clinical examination
• Study models
• Photographs
• radiographs


The advantages and shortcomings of both
orthodontics and cephalometrics should be
thoroughly understood.


Clinical examination
a. Visual esthetic appraisal .
b. Functional analysis.


Visual Esthetic Appraisal
Relationship of facial structures with respect
to their balance, symmetry, and proportions
in all the three planes of space.


Visual Esthetic Appraisal- Frontal
1. Assessment of facial proportions.


Visual Esthetic Appraisal - Frontal
2. Facial Symmetry


Visual Esthetic Appraisal - Frontal
3. Canting of bilateral structues, specially the
lips and the dentition
4.Lip Competence, exposure of upper incisors


Visual Esthetic Appraisal - Profile
1. Assessment of angles such as the facial
angle of convexity, nasolabial angle, etc.


2. Lips in relation to various esthetic lines


3.Perpendicular

distance

subnasale and the chin.
4. Cheek – Bone contour.


between

the

Cephalometric Analysis
Precautions while taking cephalograms
1. Condyles properly seated in the fossae.
2. Lips fully relaxed.
3. Recording in the ‘Natural Head Position’


Precautions while doing analysis
1. Use

of

normative

values

not

very

appropriate, since they cannot be accurately
applied to different ethnic groups, males and
females, persons with varying builds, etc.


2. Norms based on hard tissues alone also not
appropriate due to the varying thickness of
the soft tissues.


3.

It is better to consider as many
measurements related to a particular
structure. For ex: To evaluate the maxillomandibular relationship, measurements
such as LNAPog, Wits, projections of points
A and B on FH and palatal plane etc.
alongwith the customary LANB

4.

Instead of relying on absolute linear
measurements, projected values are more
meaningful.


a. Size
b. Placement
c. Orientation


6. Effect of vertical displacements on the
sagittal relationship must be taken into
account.


Useful readings - Sagittal
Maxilla: L SNA, A perpendicular to N perp.on
the true horizontal, Size of maxilla in relation
to the SN length, placement of its posterior
limit with respect to sella.


Useful readings - Sagittal
Mandible: L SNB, B perpendicular to N perp.on
the true horizontal, Size of corpus in relation
to the SN length, ratio of ramus to corpus
angle, placement of condyles, chin
placement with respect to point B and
Down’s facial angle.


Useful readings - Vertical
a) Jarabak ratio
b) Mandibular plane wrt SN and FH
c) Linear measurements of the incisors to their
corresponding jaw bases


Useful readings - Vertical
d) Basal plane angle.
e) Maxillary inclination angle
f) PNS-Ethmoid point and ANS-Nasion.


Transverse dimension
Grummon’s analysis is a useful analysis to
assess transverse dysplasia. Normative data
for the Indian population is being worked
out in our institution.


Quantification of the fault
This step involves the determination of the
precise magnitude of surgical alteration of
the jaw bases in a 3-dimensional
perspective.
Quantification

Clinical exam

Cephalometrics


Cephalometric Assessment
a) Comparison with normative values
b) Assessment using certain established ratios
c) Surgical VTO


a) Comparison with normative values.
Burstone and Legan’s analysis


Drawbacks of Burstone and Legan’s analysis:
1) Data was derived from a small sample
belonging to the Caucasian population.
2) The ‘surrogate’ horizontal plane may give
erroneous inferences.
3) Mean values applicable to the average size
individuals only.

B) Useful ratios:
1) SN: Maxilla: Mandible = 20:14:21
2)Corpus:Ramus = 7:5
3) Middle face : Lower face = 45 % : 55%
4) Postr : Antr face height(Jarabak)=62– 64%
5) Nasal : Labial = 1:4( Nasolabial angle )

Surgical VTO
Softwares
1) Dentofacial Planner
2) Vistadent


Pre-Surgical Orthodontics
A. Decompensating the incisor positions


B. Alignment of teeth by decrowding.
Extraction pattern differs from that in
camouflage.


C. Incisor intrusion done pre-surgically if an
increase in the anterior face height is not
desirable


D. Arch forms are corrected so that the arches
are compatible with each other when
surgically repositioned.


E. In case of segmental procedures, apices of
teeth on either side of the cut are divergent
or parallel.
F. Extraction spaces not closed completely.


Appliance Selection
1) Edgewise ( Standard or Pre-adjusted )
2) Tip-edge
3) Begg appliance ( Good quality brackets )


Other Considerations
A. Third molar extractions
B. Stabilizing wires
C. Model surgery and splint preparation


Post-Surgical Orthodontics
Correction of minor deficiencies can be tried
immediately after the surgery using elastic
forces.
Eg: Uneven midlines,
Minor canting of occlusal plane


Post-Surgical Orthodontics
a) Closure of remaining spaces
b) Acheivement of proper interdigitation
c) Finishing and detailing to
functional occlusal criteria.


satisfy

the

Preparation of Surgical Splints

Surgical splints

Intermediate
Final


Thank you
For more details please visit


Surgical orthodontics diagnosis /certified fixed orthodontic courses by Indian dental academy

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