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Orthodontic surgeries:

 

  Your orthodontist wants what's best for you.  So do we.  At Bayside OMS, we want to help you along your journey toward functional, aesthetic and healthy dentition.  

 

  At Bayside we have the experience and the understanding to aid you and your orthodontist accomplishing your goals in as short of a time period as possible.  We also want you to be comfortable and confident in your decisions with us.  Rest assured the procedure that you are going to have done has been performed successfully by your surgeon to the satisfaction of patients and orthodontists.  

 

  Click on the below links for more information regarding: 

Canine exposures:

 

The incidence of impacted canines is second only to the incidence of impacted wisdom teeth.  It isn't fully-understood why this happens though it is believed it may be due to a malformation in the lateral incisor in front of the canine or some other genetic disturbance as this phenomenon seems to run in families.  

 

Canines serve as the cornerstone tooth of the upper jaw arch and are typically the last tooth to be removed; they have long, strong roots and guide the movement of the lower jaw.  To that end, it is wise to allow this tooth to erupt whenever possible -even if this requires a little help from the surgeon.

 

 

 

 

A consultation will be done to determine a number of factors:

  • the health of the patient and their ability to undergo the procedure while being relaxed and comfortable;

  • the position of the impacted tooth (most are toward the palate though some are in the direction of the lip;

  • the degree of impaction of the tooth which helps to determine the amount of surgical time to be planned.

 

Most of the time the orthodontist will request a small gold chain be bonded to the tooth during the surgical procedure.  This will allow the orthodontist to apply forces to guide the tooth along an appropriate eruption path.  

 

In the typical instance, the patient is under IV sedation.  The tooth is uncovered surgically, via reflection of a surgical flap of gum.  The tooth then has the requested gold chain bonded to it with a composite adhesive.  The gold chain is attached to the orthodontic arch wire, the gums are sutured.  

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Frenectomies:

A frenum is a fold of tissue that limits the movement of another anatomical structure - in a sense, a tether.  In the mouth there are two predominant frenula (plural for frenum or frenulum) that can be a problem.

 

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Lingual frenum:

The lingual frenum is a remnant of the development of the tongue.  It typically will retract away largely by birth.  The tip of the tongue also grows past birth. The combination of this typically results in the tongue establishing adequate mobility.  In some, the frenum is too short ("tongue-tie") and restrictive leading to problems with feeding and speech.  There can be a social impairment with cases that continue in life.  

 

Labial frenum:

The labial frenum partially anchors the lip to the gums/mouth.  If this attachment is too "high" (as in high on the tooth area), it can result in the propogation and perpetuation of a gap between the front teeth known as a diastema.

The removal of the frenum is a procedure known as a frenulectomy.  There are many ways to remove the frenum such as scalpel excision, electrocautery, laser.  Each of these methods proclaim various advantages and disadvantages in the literature.  In the instance of a frenum/diastema scenario, it is felt to be important to remove not only the 'skin' of the frenum but also the muscle fibers underneath. Typically - even children six or even younger - can have this done with a few drops of local anesthetic in the area and some TLC (yes, this still exists).  The results are typically permanent.  

Extractions:

There are a number of circumstances that may require your orthodontist to recommend or require the removal of teeth in the context of an orthodontic treatment plan:

 

1)  Supernumerary teeth:  Literally extra teeth; this occurs relatively frequently and certainly has a hereditary influence.  

  • Wisdom teeth are the most common "supernumerary teeth" to have and can be removed along with the remaining wisdom teeth.  

  • There can be an extra "tooth" between (mesiodens) or around the two upper front teeth, leading to the failure of the incisors erupting.  Not uncommonly, a child will have one incisor erupt normally and have no signs of the other one.  Radiography of the area often reveals and extra tooth blocking eruption.  

  • Other supernumerary teeth may prevent the useful or proper eruption of the permanent teeth and should be removed.

 

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Supernumerary wisdom tooth:

Arrow is pointing to the "extra" wisdom tooth (S/N).  The "normal" wisdom tooth (#1.8) lies directly above.

Mesiodens:

The extra "incisor" (S/N) is blocking the eruption of the permanent central incisor (#2.1).

Supernumerary premolar:

Arrow is pointing to the "extra" premolar tooth (S/N).  In this case the "normal" premolar was able to erupt.

2)  Impacted wisdom teeth: 

  • Often at the inception of orthodontics in late adolescents and adults, orthodontists will request the removal of any remaining wisdom teeth.  This may be necessary to give room for the orthodontist to spread the teeth around as needed. 

  • At the end of orthodontics done on younger patients or a short while after braces come off, the orthodontist will frequently request the removal of the wisdom teeth.  The rationale for this is that: there isn't enough room in the arch to accomodate those teeth and maintaining them may result in the relapse of crowding/malalignment. 

 

3)  Dental crowding: 

  • For a number of reasons, there may be a mismatch between the size of the jaws and the "amount" of tooth it can hold in correct alignment. If your orthodontist recommends the removal of teeth, typically four premolars will be removed to balance the top, left and right sides.  

  • If there is an excessive protrusion of the lower or upper jaw, the orthodontist may request removal of that jaw's respective premolars to bring the jaw into alignment with the opposing jaw.

  • Occasionally, there is just "not quite" enough room (typically the lower arch) to align the teeth, in this case one of the anterior incisors may be removed.  This is imperceptible to most people.

 

Palatal expansion:

 

If you start your orthodontics later in life - once growth is over - the correction of a narrow upper jaw (maxilla) may only be possible by re-opening the areas where bones have already fused.  Surgery can be used to re-create precise cuts in the maxilla to allow the orthodontist and patient to widen the maxilla over a very brief period.  The procedure is known as Surgically-Assisted Rapid Palatal Expansion.  The procedure can be performed on an outpatient basis in the hospital and is relatively brief.  

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  • Before the surgery, your orthodontist will make impressions (moulds) of the teeth in the constricted maxilla (Illustration #1) and have the lab fabricate an expansion appliance (e.g. Hyrax) that sits in the palate but is held in by the teeth. This will be cemented in before the surgery.

 

  • At the surgery the cuts in Illustration #2 will be made and the appliance will be activated while in the surgery to verify the maxilla is widening properly as in Illustration #3.  The appliance is de-activated and returned to it's pre-operative state.  

 

  • After a week of latency, where the bones just start to heal, the appliance will be activated by the orthodontist just a slight amount.

 

  • Each day thereafter, the patient will activate the appliance per the orthodontist's / surgeon's instructions (typically two to four turns per day).  Each turn is 0.25 mm of expansion.

    • So, if 6 mm of overall expansion is desired and the patient uses two turns per day then after 12 days expansion is complete.

 

  • After this period the patient no longer activates the appliance and the appliance is left in an additional period of time (longer for wider expansions).  Three additional weeks is typical.  This is to allow the bones to heal - the consolidation phase.

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