An overview of the minor surgical procedures in Orthodontics for undergraduate students.

1. MINOR SURGICAL
PROCEDURES

2. CONTENTS
 INTRODUCTION
 CLASSIFICATION
 MINOR SURGICAL PROCEDURES
 EXTRACTION
 SURGICAL UNCOVERING OF IMPACTED TOOTH
 FRENECTOMY
 CORTICOTOMY
 PERICISON
 OTHER PROCEDURES
 CONCLUSION
 REFERENCES

3. INTRODUCTION
Surgical orthodontics is a term that refers to surgical procedures
carried out as an adjunct to or in conjunction with orthodontic
treatment.
The role of these surgical interventions is to:
 To eliminate an etiologic factor
 To improve the aesthetics and function of the patient
 To correct severe dento-facial abnormalities that cannot be
satisfactorily treated by growth modification procedures or
orthodontic camouflage.
 To facilitate and hasten orthodontic treatment
 Help stabilize post orthodontic results
 To prevent relapse
 To prevent or correct periodontal problems

4. CLASSIFICATION
Minor Surgery
Soft tissue
procedures
Hard tissue
procedures
Other
procedures
Dentoalveloar
procedures
Extractions

5. CLASSIFICATION
MINOR PROCEDURES
1. Extractions
A. Therapeutic extraction
B. Serial Extraction
C. Extraction of carious teeth
D. Extraction of malformed teeth
E. Extraction of supernumerary
teeth
F. Extraction of impacted teeth
2. Surgical uncovering of teeth
3. Frenectomy
4. Pericision
5. Transplantation of teeth
6. Corticotomy
7. Transpositioning of teeth
MAJOR PROCEDURES
1. Orthodontic/ Orthognathic
surgeries
2. Cosmetic surgeries
3. Surgical correction in cleft
lip and palate
4. Surgical assisted rapid
maxillary expansion (SARPE)
5. Distraction osteogenesis

6. CLASSIFICATION
SOFT TISSUE PROCEDURES
1. Pericision
2. Frenectomy
3. Gingivectomy/ Gingivoplasty
4. Removal of soft tissue barrier
Dentoalveolar procedures
1. Corticotomy
2. Wilckodontics
3. Orthodontic implants
4. Transplantation of teeth
5. Trans positioning of teeth
6. Removal of cysts and
odontomes
7. Surgical exposure of
impacted tooth
EXTRACTIONS
A. Therapeutic extraction
B. Serial Extraction
C. Extraction of carious teeth
D. Extraction of malformed teeth
E. Extraction of supernumerary
teeth
F. Extraction of impacted teeth
OTHER PROCEDURES
1. Lasers
2. Cryosurgery
3. Electocautery

7. MINOR
SURGICAL
PROCEDUR
ES

8. EXTRACTION
 Extractions are the most commonly undertaken minor surgical
procedures in conjunction with orthodontic therapy.
 Extraction performed as a part of orthodontic therapy includes :
Therapeuti
c
extraction
Serial
extraction
Extraction
of
supernum
erary or
carious
Extraction
of
malforme
d teeth

9. THERAPEUTIC
EXTRACTION
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.
THE NEED FOR EXTRACTION
 Arch Length – Tooth Material Discrepancy
 Correction of Sagittal interarch Relationship
 Extraction for the relief of crowding
 Abnormal size and form of teeth
 Skeletal jaw malrelations

10. CHOICE OF TEETH FOR
EXTRACTION
 Choices of teeth to be extracted depends on local
conditions which include:
• Direction and amount of jaw
growth
• Discrepancy between the
size of dental arches and
basal arches.
• State of position, eruption of
teeth
• Facial profile
• Degree of dentoalveolar
prognathism
• Age of patient

11. SERIAL EXTRACTIONS
 Serial extraction is an interceptive
orthodontic procedure usually
initiated in the early mixed
dentition when one can
recognize and anticipate
potential irregularities in the
dento-facial complex and is
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 into a
more favourable position.

12. EXTRACTION OF SUPERNUMERARY,
IMPACTED AND ANKYLOSED TEETH
 The presence of
supernumerary, impacted and
ankylosed teeth are important
local causes of malocclusion.
 The most commonly seen
supernumerary teeth are the
mesiodens.
 Supernumerary teeth are also
occur in the incisor, premolar
and molar region.
 Impactions in the maxilla
generally occur in the canine
region.

13. INDICATIONS
 In the anterior maxillary region, supernumeraries may
prevent eruption of permanent incisors.
 May cause pressure on the root and lead to
mispositioning of adjacent teeth.
 If erupted, can be the cause for crowding in the arch or
may cause periodontal complications.
 There may be a cyst associated with them.

14. TECHNIQUE
 Prior to the removal of these teeth their exact location and their
relationship with adjacent structures should be ascertained by
radiographs.
 The tooth is approached by a buccal or palatal flap depending
upon its location. After careful evaluation of the flap, adequate
amount of bone is removed using rotary instruments.
 During the extraction procedure, care should be taken not to
damage the adjacent teeth or roots.
 The impacted or supernumerary tooth is removed and the
extraction socket inspected for any pathological tissue. The flap is
repositioned and sutures placed for a week.

15. SURGICAL UNCOVERING OF
IMPACTED TEETH
 Impaction of teeth usually occurs as a result of arch length
discrepancy or presence of mucosal or bony barriers that prevent
their eruption.
 The most commonly impacted tooth is the maxillary permanent
canine.
Impaction of teeth usually occurs due to:
 Arch length discrepancy
 Presence of mucosal and bony barriers
 Abnormal developmental position of tooth germ
 Retained deciduous teeth
 Deflection of canine during eruption
 Genetic predisposition

16. INDICATIONS
An unerupted canine may be a candidate for surgical exposure if:
 There is no sign of the tooth even after 12 years of age.
 Adequate room in the arch is present or can be created
orthodontically or by extraction of some other tooth.
 Potential path of eruption is unobstructed by other teeth.
 The apex of canine comes as close to normal as possible after
eruption so that it does not look unsightly.
 Radiographically, the root is not dilacerated.
 Labial impaction of a maxillary canine is due either to ectopic
migration of the canine crown over the root of the lateral incisor or
shifting of the maxillary dental midline, causing insufficient space for

17. MANAGEMENT OF AN
IMPACTED TOOTHThe following steps are
undertaken in the
management of an impacted
tooth:
 Location of the tooth
 Evaluation of the
favourability
 Evaluation of space
adequacy
 Surgical excision and bone
removal
 Fixing orthodontic
attachments

18. RADIOGRAPHIC
EXAMINATION
 Presence of impacted canine/canines
 Judging the amount of root resorption of
remaining/ retained deciduous canines.
 Resorption of either permanent central or
lateral incisors.
 Cystic changes in the canine follicle
 Presence of apical dilaceration
 Displacement of adjacent teeth
 Axial inclination of the impacted tooth in
relation to the horizontal and vertical
planes.
 The position of apex of canine and its
relationship to the first premolar.

19. RADIOGRAPHIC
EXAMINATION
 Periapical radiographs taken by parallax method.
 Occlusal view of maxilla will also help us in locating the
position of the canines.
 P.A. view and lateral cephalograms will help us to know
about the degree of palatal or buccal displacement.
 CT can be suggested in specific cases of palatally
impacted canine.
 CBCT is the most preferred method to diagnose and
localize an impacted tooth.

20. LOCATION OF THE
TOOTH
 To determine the exact location of impacted tooth,
Clark’s tube shift technique or right angle technique
using two films.
 Clark’s tube shift technique – A radiographic procedure
used for localizing impacted teeth to determine their
relative antero-posterior position. If the two teeth or a
tooth and a foreign object are located in front of one
another relative to the x-ray beam, they will appear
superimposed on one another on a dental radiograph.

21. EVALUATION OF
FAVOURABILITY
 In many cases the orientation of the impacted teeth
may be such that surgical orthodontic guidance of the
tooth into the arch may not be possible. The
favourability should be examined prior to undertaking
the procedure. It is considered favourable whenever the
apex of the canine is close to its normal position.

22. EVALUATION OF SPACE
ADEQUACY
 When the impacted tooth is guided into the dental
arch, adequate space should be present for its normal
alignment.
 The deciduous canines are over-retained and have to
be extracted to accommodate the permanent canines.
 In certain patients, the space intended for the
permanent canine may be lost by migration of the
adjacent teeth. The space is created by consolidating
the rest of the teeth and possibly extracting a premolar.

23. SURGICAL EXPOSURE
 Correction of
unerupted tooth into
proper position
consist of 3 stages:
 Pre-surgical phase
 Surgical phase
 Post-surgical –
Method of
attachment and
mechanical
alignment

24. SURGICAL EXCISION AND BONE
REMOVAL
 The technique of surgical exposure is
combined with the placement of an
orthodontic attachment to the tooth,
allowing active guidance of the
impacted tooth into an ideal position.
 The crown of the 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.
 There are 4 techniques for
uncovering a labially impacted
maxillary canine
GINGIVECTOMY
FLAP/CLOSED ERUPTION
TECHNIQUE
APICALLY POSITIONED FLAP
TUNNEL TRACTION

25. GINGIVECTOMY Simple excision of the gingiva over the impacted teeth
can be accomplished with a sharp blade.
 Indicated when there is a wide zone of attached
gingiva.
 Bone removal is not needed, and one-half to two-thirds
of the crown can be exposed, leaving at least a 3 mm
gingival collar.
 The most common area where this technique may be
employed is over the labially impacted maxillary canine.
 This technique is simple and quick to carry out but
sacrifices healthy attached gingiva and may increase
the risk of detrimental changes in the periodontal

26. FLAP/CLOSED ERUPTION
TECHNIQUE
 This technique is best used with high labially impacted
teeth and teeth that are impacted in the mid-alveolar
area.
 TECHNIQUE:
 An incision is made on the crest of the gingiva and
buccal or lingual flaps are reflected. Appropriate bone
removal is accomplished, and a bracket or chain is
attached to the impacted tooth. The flaps are returned
to their original location for complete closure. The
chain passes under the flap, exits at the mid-crestal
incision area, and is attached to the archwire.

27. FLAP/CLOSED ERUPTION
TECHNIQUE
Disadvantages:
 Time consuming
 Once the flap has been replaced direct inspection of
the tooth cannot be made.
 Debonding of attachment may therefore take some
time to detect and rebonding the attachment is
difficult. The tooth may be difficult to isolate for acid
etching and bonding technique.

28. APICALLY POSITIONED
FLAP
Technique:
A split thickness flap is reflected
from the area adjacent to the
impacted tooth.
Appropriate bone removal is
accomplished, and the flap is
sutured apically, exposing about
two-thirds of the crown.
This technique is most often
employed on simple labially
impacted teeth.
Advantages:
 Accurate control of the amount
of keratinized gingivae
postoperatively and helps
maintenance of the
mucogingival complex, which
will help ensure a healthy long-
term prognosis for the tooth.
 Tooth can be easily inspected at
follow-up appointments.
 Debonding of the attachment is
readily detected and rebonding
attachments is relatively simple.

29. TUNNEL TRACTION
 This technique was introduced by Crescini et al in 1995.
 This technique is indicated when the permanent canine
is located very high and the deciduous canine is
retained.
 Technique:
 Reflecting a full thickness mucoperiosteal flap over the
impacted canine. The cortical bone over the impacted
canine is cut off to expose ½ to 2/3 of its crown.
 Care should be taken not to expose the cemento-
enamel junction.
 An orthodontic attachment is bonded over the exposed
canine and a ligature wire wrapped to it.

30. TUNNEL TRACTION
 Technique:
 The deciduous canine is now extracted and a tunnel is
created by cutting off any bone that covers the incisal
tip of the canine.
 The ligature wire that is attached to the bracket exits
through the tunnel and is ligated to the arch wire for
traction.
 The flap is sutured back in place. Therefore the tunnel
formed can be said to be an extension of the socket of
deciduous canine which provides a pathway for the
permanent canineto erupt.

31. FIXING ORTHODONTIC
ATTACHMENTS
 In most cases of favourably impacted canines, once the soft tissue
and bony tissue is removed, the canine erupts on its own.
 In some cases, orthodontic guidance for eruption of the teeth into
the arch may be required.
 Attachments are placed on the impacted tooth to guide the
erupting tooth into the arch. Some of the attachments that can be
placed on the impacted canine are:
 A metal crown with a hook
 A celluloid crown with an attachment bonded to it
 Bondable orthodontic brackets or buttons
 Gold chain with a mesh base

32. ALTERNATIVE METHODS OF
MANAGING IMPACTED MAXILLARY
CANINES
1. Leave it in situ/ Leave alone: (Ericson and Kurol, 1988)
 If the canine is asymptomatic without evidence of any
infection or pathology, the tooth is left as such in a
well-aligned arch.
 Periodic annual review is necessary.
2. Extraction:
 Tooth id unfavourably displaced and cannot erupt
normally or with orthodontic assistance.
 Tooth showing signs of pathology
 Tooth which causes resorption and displacement of
adjacent teeth.

33. ALTERNATIVE METHODS OF
MANAGING IMPACTED MAXILLARY
CANINES
3. Transplantation
In carefully selected cases, it is possible to transplant the
canines avoiding a prosthetic replacement.
Precautions to be taken while transplanting canines:
a. Adequate space must be available
b. Success of transplanted tooth is more likely, when the
apex is wide open.
c. Root should not be handled.
d. Ankylosis and resorption of the root may occur.

35. FRENECTOMY Frenectomy is a surgical
procedure to excise the frenum
and remove deeply embedded
fibrous tissue.
 Many cases of midline diastema
are believed to caused and
maintained by maxillary labial
frenum.
 The presence of a thick, fleshy
and fibrous frenum prevents the
two maxillary central incisors
from approximating each other.
In these patients, the frenal
tissue may cross over and et
attached in the inter-maxillary
suture area on the palatal aspect.

36. LABIAL FRENECTOMY The presence of median diastema may be associated with
a low attachment of the labial frenum.
 Labial frenum may sometimes merge with the incisive
papilla.
 A V-shaped radiographic appearance of the interproximal
bone or a bony interdental notch between the maxillary
central incisors is a diagnostic sign for high frenal
attachment as the cause for diastema.
 Abnormal frenal attachments are diagnosed by a blanch
test. When the upper lip and frenum are stretched, the
tissue between the central incisors moves and is
blanched.

37. LABIAL FRENECTOMY
 The timing of frenectomy is crucial. According to some,
frenectomy should be performed prior to orthodontic
closure of the midline diastema. According to another
school of thought, frenectomy should be performed
after space closure as it reduces the risk of scar tissue
formation that can prevent closure of the midline
space.

38. TECHNIQUE
The purpose of frenectomy is to eliminate the fibrous
tissue between the roots of the central incisors so that
there is no obstruction to approximation of these teeth
by appliance therapy.
 Region around the frenum is wiped with cotton or
gauze and excision margins are marked.
 Local anaesthetic is infiltrated on either side of frenum.
 The lip is held outwards and forwards using forefinger
and thumb on either side of frenum by an assistant.
 This not only produces traction, but also helps to
reduce the perfusion of surgical area resulting in less
intraoperative bleeding.

39. TECHNIQUE
 With a no. 15 blade, incisions down to the bone are
made on either side of the frenum, going-in between
the teeth and joined around the incisive papilla.
 With a periosteal elevator, the underlying fibrous tissue
is detached from the palatal bone and in-between the
teeth. This releases the base of frenum, which is left
attached to the lip at its anterior end. This is then
excised and the wound closed after clearing all fibrous
tissue from the bone.
 Residual defect on the gingiva is covered by a
periodontal pack.
 Sutures are removed on the 7th day. Healing is normally
uneventful.

40. PRECAUTIONS TO BE
UNDERTAKEN
 The frenum should not merely be clipped. It should be
totally excised to the bone level.
 Any palatally attached fibrous tissue should be
removed.
 Fibrous tissue attached to the inter-maxillary suture
area should be removed.
 The mucosa of the lip is undermined to prevent
reattachment of the fibrous tissue.
 Frenectomy should be done only after the eruption of
permanent lateral incisors and canines fails to close the
median diastema.

42. LINGUAL FRENECTOMY
 The band of tissue connecting the tongue to the floor of mouth is
called the lingual frenum or frenulum.
 Thick, large or tight lingual frenum can seriously constrict the
movement of tongue and this condition is called “tongue-tie” or
ankyloglossia which also contributes to diastema. This has to be
divided horizontally near the alveolar ridge and sutured vertically.
 An abnormally high attachment of the mandibular labial frenum
can cause recession of the gingiva in that area. It exerts a strong
pull on the free and attached gingiva leading to recession in the
lower anterior region.
 If gingival recession is present, reposition flap or free gingival graft
is recommended along with frenectomy.

43. CORTICOTOMY
 Corticotomy is a surgical procedure usually undertaken
in patients having dental proclination with spacing.
 This technique involves the sectioning of the dento-
alveolar region into multiple small units to hasten
orthodontic tooth movement.
 This procedure is usually carried out on the anterior
maxillary teeth in young adults when the duration of
appliance therapy needs to be shortened.
 It is indicated in patients with generalized spacing due
to macrognathia and in median diastema without any
other features of malocclusion.

44. TECHNIQUE:
 Large labial and palatal mucoperiosteal flaps are raised to expose
both the labial and palatal cortices of the teeth to be moved.
 Vertical unicortical cuts of predetermined width are made with a
thin bur (no.701) on either side of each tooth.
 The apical ends of these cuts are joined by horizontal cuts through
the compact bone alone thus leaving the teeth to be aligned
supported by cancellous bone.
 Care should be taken not to totally separate the individual units.
 The flaps are replaced and sutured.
 Following the surgery, orthodontic tooth movement is initiated
using fixed appliances.
 Retainers are required for a period of 6 months to stabilize the
result.

46. CORTICOTOMY-ASSISTED
ORTHODONTIC TREATMENT
(CAOT)
 The development of CAOT
overcame many limitations in
the orthodontic treatment of
adults.
ADVANTAGES:
 Reduced treatment time
 Enhanced expansion
 Differential tooth movement
 Increased traction of impacted
teeth
 Increased post-orthodontic
stability

47. APPLICATIONS OF CAOT
1. Corticotomy and osteotomy are used in orthodontics
to resolve crowding in a shorter period of time.
2. Accelerate canine retraction after premolar extraction.
3. Corticotomy –facilitated orthodontic treatment is
found to result in better post-treatment stability
compared to conventional orthodontic treatment. The
improved stability is attributed to the increased
turnover of tissues adjacent to the surgical site.

48. ACCELERATED OSTEOGENIC
ORTHODONTICS (AOO)/
WILKODONTICS Wilcko developed a technique called accelerated
osteogenic orthodontics (AOO) or periodontically
accelerated osteogenic orthodontics (PAOO).
 This technique is similar to conventional corticotomy
except that selective decortication in the form of lines
and points is performed over all the teeth that are to
be moved.
 In addition, a resorbable bone graft is placed over the
surgical sites to augment the confining bone during
tooth movement.
 After a healing period of one or two weeks, orthodontic
tooth movement is started and then followed up using
a faster rate of activation at two week intervals.

50. PERIODONTALLY ACCELERATED
OSTEOGENIC ORTHODONTICS
(PAOO)
 Indications:
 Class I with moderate to severe crowding
 Class II with extraction or expansion
 Mild class III cases
 To facilitate eruption of impacted teeth
 Molar intrusion and open bite correction
 Molar uprighting
 Molar distalization

51. PERIODONTALLY ACCELERATED
OSTEOGENIC ORTHODONTICS
(PAOO)
 Contraindications:
 Severe class III cases
 Active periodontal and gingival recession
 Abnormal skeletal relationship between the jaws
 Patients with uncontrolled DM, compromised immune
system and on long term use of medication such as
anti-inflammatory, immunosuppressive or steroids
 Uncontrolled osteoporosis or other bone disease
 Patients who are taking medication that slow down
bone metabolism such as bisphosphonate and NSAIDS

52. PERICISION
 Synonyms: Supracrestal
fibrotomy, Circumferential
Supracrestal fibrotomy
(CSF), Sulcus slice
procedure, Edwards
procedure
 This procedure is carried out
to minimize the extent of
rotational relapse of teeth.
This method was developed
by Edwards.

53. PRINCIPLE
 It is generally assumed that a stable position of the teeth in the
dental arch after orthodontic tooth movement can only be
established when the connective tissues of the gingiva have been
allowed to adapt to the newly created situation.
 Suprecrestal gingival fibers (Transseptal and alveolar crest group
of gingival fibers) of an orthodontically moved tooth get stretched
and undergo readaptation very slowly.
 The pull of these fibers is a major factor in relapse.
 Percision involves elimination of the pull of elastic Supracrestal
gingival fibers by sectioning these fibers.
 Teeth are held in the corrected position when the fibres heal,
thereby reducing the relapse caused by elasticity of the gingival
fibers.

54. TECHNIQUE Edward’s technique: Circumferential
Supracrestal fibrotomy (CSF)
 Under local anaesthesia, a No. 15 BP
blade is inserted into the gingival
sulcus upto the alveolar crest of the
bone.
 Blade is kept parallel to the tooth
surface and is passed around the
circumference of the tooth. This
severs the fibers connecting tooth to
the gingival soft tissues.
 Cuts are made interproximally on
each side of the rotated tooth and
along the labial or lingual gingival

55. ALTERNATIVE
TECHNIQUE
 Papilla dividing procedure:
 Vertical incisions are made in the centre of each
gingival papilla 1-2 mm below the margin. This reduces
the chance of reduction of height of gingival
attachment after the surgery.
 TIME OF SURGERY
 The teeth should be held in good alignment during the
gingival healing.
 Therefore surgery should be done few weeks before
the removal of active orthodontic appliance.
 Retainer must be given immediately after debonding of
the active appliance.

56. OTHER PROCEDURES
 TRANSPOSITIONING OF TEETH/
AUTOTRANSPOSITIONING/ SURGICAL REPOSITIONING
OF TEETH
 TRANSPLANTATION : Technique wherein a tooth is
reimplanted after being removed into a modified or
newly created socket.

57. OTHER PROCEDURES -
LASERS
 LASERS
LASER stands for Light
Amplification by Stimulated
Emission of Radiation.
 Laser applications in
orthodontics
Diagnosis :
1. To detect the caries
2. To assess the tooth mobility
 Soft tissue applications
1. For hemostasis
2. To excise the lesions
3. For incision and drainage of
abscess
4. For the removal of opercula on
third molar
5. For the removal of redundant
gingival tissue during the
orthodontic treatment
 Hard tissue applications
1. For caries removal
2. For enamel etching
3. For crown lengthening
procedure
 Non surgical procedures
1. For curing of materials
2. For instrument sterilization

58. OTHER PROCEDURES -
LASERS
 Surgical Procedures
1. For incisions
2. For the exposure of
impacted tooth
3. For frenectomy
 Other applications
1. Laser holography
2. Laser spectroscopy
3. 3D Laser scanning
4. Laser orthopaedics
5. Laser osseous surgery
6. Laser welding and micro
welding

59. OTHER PROCEDURES -
LASERS
ADVANTAGES DISADVANTAGES
• During the surgery
1. Less pain
2. Minimal bleeding
3. Better visualization
4. A more sterilized environment
5. Less damage to the adjacent tissues
6. Laser cut is more precise than the
surgical cut
7. Reduced risk of blood borne,
transmission of diseases
1. It is not economical
2. There may be chances of explosion
3. It requires specially trained
personnel
• After the surgery
1. Less scaring
2. Faster healing
3. Minimum postoperative pain
4. Reduced risk of postoperative
infection
• Hazards
1. Retinal burn if there is no
protection
2. Aerosols contamination and
respiratory hazards
3. Prolonged exposure to pulp causes

60. OTHER PROCEDURES -
ELECTROCAUTERY
 Electrocautery is a surgical technique which involves introducing
high frequency current (usually 100 kHz) to the specific area of the
body in order to remove unwanted tissue, seal off the blood
vessels or to create a surgical incision.
 Orthodontic Indications:
1. In case of long lingual frenum which can interfere with tongue
movement and speech.
2. In case of hyperplastic or low lying frenum which can disturb the
path of eruption and also may cause gingival stripping.
 Gingival problems:
1. In case of hyperplastic interdental gingiva which affects further
orthodontic progress
2. In case of fibrous gingiva which may interfere with normal
eruption.

61. OTHER PROCEDURES -
ELECTROCAUTERY
 Eruption problems
1. In case of partially erupting teeth, that is waiting for erupting
canine or other teeth in the oral cavity before it can be bonded
and incorporated in fixed appliances.
2. For clinical crown lengthening procedures
 Other uses
It can used to cut the soft tissue to get access for the surgical site. It
can also be used to seal off bleeding vessels during the surgery to
keep the surgical site clean and reduce the blood loss.

62. OTHER PROCEDURES -
ELECTROCAUTERY
 Advantages:
1. It is economical, requires less chair time, and minimal patient
discomfort.
2. Surgical recovery is more rapid than the conventional surgeries,
and there is reduced risk of infection.
 Limitations:
Depending on the voltage used, the electrocautery can have varying
effects on the patient’s body. Lower frequencies could cause
twitching and cramps, which would be a serious problem. If
electrocautery is not performed with safe equipment, the patient’s
body can be potentially burned elsewhere.

63. CONCLUSION
 Very good orthodontic alignment and stability can be
achieved by successfully combining orthodontics and
surgery.
 As important advances in surgical technique and
anaesthesia evolved for the surgical procedures, a
major contribution by orthodontists in collaboration
with surgeons was the creation of a common
diagnostic, planning, and treatment scheme for use by
both clinician groups in treatment of dentofacial
deformities and other skeletal and dental problems.

64. REFERENCES
 ORTHODONTICS – THE ART AND SCIENCE (7th Edition)
– S.I. Bhalajhi
 TEXTBOOK OF ORTHODONTICS (3rd Edition) –
Gurkeerat Singh
 ORTHODONTICS (2nd Edition) – Sridhar Premkumar
 TEXTBOOK OF ORTHODONTICS (3rd Edition) – M.S.
Rani