surgical interventions in orthodontics

Surgical Techniques in

Orthodontics

Techniques

• Minor Surgical Procedures

– Circumferential Supracrestal Fibrotomy (CSF)

– Frenectomy

– Papilla Split Procedure

• Orthognathic Surgery

• Distraction Osteogenesis

• Adjunctive Surgical Procedures

Papilla Split Procedure

Common Surgical Techniques

Transverse

• Maxilla

• Single Step Expansion

• Surgical Assisted Rapid Palatal Expansion

• Mandible

• Symphysial Distraction

Vertical

• Maxilla

• Lefort I maxillary Impaction

• Lefort I maxillary downfracture

• Mandible

• No recommended Surgical Technique available

• Tripod landing with BSSO mandibular advancement

Sagittal

• Maxilla

• Lefort I maxillary Advancement

• Lefort I maxillary setback

• Anterior Segmental Maxillary setback

• Wassmund

• Wunderer

• Mandible

• BSSO Mandibular Advancement

• BSSO Mandibular Setback

DISTRACTION

OSTEOGENESIS

Distraction Osteogenesis

“A biological process of new bone formation between

the surfaces of osteotomized bone segments that are

separated gradually by incremental traction”

Distraction Histogenesis :

– Adaptive regenerative changes in surrounding soft tissues

Historical Overview

Alessandro Codiwilla (1905)

– First report of surgical limb lengthening

– Oblique osteotomy and external traction pins

– Complications: infections, overstretching, poor blood

supply and inadequate fixation

Historical Overview

G.A. Ilizarov (1950’s)

– Lengthening limbs through gradual distraction of fracture

callus

– Rhythm and rate of distraction

– Minimal complications

Historical Overview

McCarthy (1992)

– DO to lengthen congenitally hypoplastic mandible

Historical Overview

• Rachmiel et al (1993) and Blocks et al (1995)

– Maxillary distraction

• Polley et al (1995) – Midface distraction with externally fixed cranial halo frame

Biology of Distraction

1. Osteotomy/Corticotomy phase

2. Latency phase

3. Distraction phase

4. Consolidation phase

5. Remodeling phase

Osteotomy Phase

• Divides the bone into two segments

• Triggers process of bone repair

– Angiogenesis

– Fibrogenesis

– Osteogenesis

Latency Phase

• Period from bone division to onset of distraction

• Inflammation and soft callus formation of the fractured bone

• Soft callus formation begins 3-7 days and lasts 2-3 weeks

• Latency period = 5-7 days

Distraction Phase

• Characterized by the application of traction forces to osteotomized

segments

• Rate : 1 mm/day

• Rhythm : 0.25 mm every 6 hours

0.5 mm twice a day

• Duration : 1-3 weeks

Consolidation Phase

Cessation of traction forces to removal of distractor

• Newly formed bone mineralizes and increases in bone density

and strength

Duration: 3- 4 months

Remodeling Phase

• Removal of distractor to application of functional

loading

• Formation of lamellar bone

Symphesial Distraction

• For V shape mandible

• Severe mandibular crowding

• Brodie’s syndrome

• To avoid inderdental stripping or extractions

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Symphesial Distraction

• Osteotomy Cuts

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Symphesial Distraction

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Cosmetic Surgeries

• Rhinoplasty

• Cheiloplasty

• Genioplasty

• Submental Liposuction

• Malar Implants

• Mandibular Angle/Ramal Implants

Sagittal Augmentation Genioplasty

Rhinoplasty

Gonial Angle Implants

Lip Augmentation

Lip Lengthening

Cheiloplasty

Submental Liposuction

Thanks You!