Surgical Procedures Associated with Orthodontic Treatment

Surgical exposure of Impacted Canines/Eye Teeth
An impacted tooth simply means that it is “stuck” and cannot erupt into function.
The maxillary canines/eye teeth are the second most common tooth to become impacted. The canine/eye tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The canine teeth are very strong biting teeth and have the longest roots of any human tooth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite. Normally, the maxillary canine teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a canine/eye tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. 60% of these impacted teeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are found in the middle
of the supporting bone but stuck in an elevated position above the roots of the adjacent teeth or out to the facial side of the dental arch.

In cases where the canine teeth will not erupt spontaneously, the Orthodontist and Maxillofacial and Oral Surgeon work together to get these unerupted eye teeth to erupt. In a surgical procedure performed preferable in hospital, the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath. Any bone covering the crown of the tooth will be removed. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, Dr. Viljoen will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature chain attached to it. He will then guide the chain back to the orthodontic arch wire or adjacent tooth if the arch wire hasn’t been placed yet, where it will be temporarily attached. Sometimes Dr. Viljoen will leave the exposed impacted tooth completely uncovered by suturing the gum up high above the tooth or making a window in the gum covering the tooth. Most of the time, the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.

Shortly after surgery the patient will return to the Orthodontist. A rubber band will be attached to the chain to put a light eruptive pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take up to a full year to complete.
You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find the prescribed pain medication to be more than adequate to manage any pain they may have. Within two to three days after surgery there is usually little need for
any medication at all. There may be some swelling but it can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is minimal after these cases. A soft diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items like crackers and chips as they will irritate the surgical site if they jab the wound during initial healing.

OSTEOTOMY

WHAT IS AN OSTEOTOMY?
Osteotomy is the cutting into your jawbone to change the structure of it. This occurs when it is not possible to correct your teeth and how they bite together with orthodontics alone. This is because the bones of your face and jaws are out of balance with one another. Surgery (under general anaesthetic) will correct the relationship of the upper jaw to the lower jaw and wil rectify these problems. One or more segments of the jaw can be simultaneously repositioned to treat various types of jaw deformities.

WHAT DOES THE OPERATION INVOLVE?
The operation is carried out almost entirely from the inside of your mouth so that there are minimal scars on the skin of your face. A cut is made through the gum to gain access to your jawbone. The jaw is then cut with a small saw to allow it to be broken in a controlled manner. It is then moved to its new position and held in place with small metal plates and screws. The gum is stitched back into place with dissolvable stitches that fall out on their own. Occasional y it is necessary to make a smal incision on the skin of the face to allow the screws to be inserted. This is very small and usually only requires one stitch to hold it in place.

WHAT CAN I EXPECTAFTER THE OPERATION?
Immediately after the operation your face wil be swollen and wil feel tight. Your jaws wil be stiff and you wil find that you cannot open your mouth widely. The swelling and bruising wil improve after about two days, as the second day is usually the worst. You wil only be able to have liquids for the first two days after surgery, but soon after that you should be able to progress to a soft diet. In a few weeks after surgery you wil be able to eat normal food again. The exact response to surgery is different in each particular case, but in general this is what you can expect.

Example of an Rethrognathic Mandible and An example of a Prognathic Mandible and correction thereof.