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4. 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.
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5. Limitations of Orthodontics – Several
conditions which cannot be corrected by
Orthodontics alone.
Limitations of Surgery
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10. The spectrum of surgeries
a. Osteotomies –
• Le fort I, (Le fort II, or III in some cases)
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11. The spectrum of surgeries
a. Osteotomies –
• Sagittal split osteotomy and osteotomy of
the ramus (trans-oral or extra oral, vertical
or inverted L)
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12. The spectrum of surgeries
Surgically assisted expansion or contraction of
the maxilla
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13. The spectrum of surgeries
Subapical surgeries
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14. The spectrum of surgeries
Chin Surgeries
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15. The spectrum of surgeries
Cosmetic surgeries
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16. The spectrum of surgeries
Distraction osteogenesis
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17. DIAGNOSIS
a. Deciding the need for Surgery
b. Deciding where the fault lies.
c. Quantifying the extent of the fault
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18. 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
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19. Deciding the need for surgery:
d. Orthognathic surgery in most instances is
elective.
Patient’s opinion plays a decisive role.
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20. Deciding the need for surgery:
Excess mandibular growth is considered more
obnoxious in our society.
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21. Deciding the need for surgery:
Persons with mild prognathism often seek
treatment, while those with moderate
mandibular deficiency may refuse surgical
correction.
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22. Deciding the need for surgery:
e. Age considerations.
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23. Deciding the need for surgery:
f. Patient’s self image.
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24. How to locate the fault?
• History
• Clinical examination
• Study models
• Photographs
• radiographs
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25. The advantages and shortcomings of both
orthodontics and cephalometrics should be
thoroughly understood.
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27. Visual Esthetic Appraisal
Relationship of facial structures with respect
to their balance, symmetry, and proportions
in all the three planes of space.
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30. Visual Esthetic Appraisal - Frontal
3. Canting of bilateral structues, specially the
lips and the dentition
4.Lip Competence, exposure of upper incisors
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31. Visual Esthetic Appraisal - Profile
1. Assessment of angles such as the facial
angle of convexity, nasolabial angle, etc.
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32. Visual Esthetic Appraisal - Profile
2. Lips in relation to various esthetic lines
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33. Visual Esthetic Appraisal - Profile
3.Perpendicular
distance
subnasale and the chin.
4. Cheek – Bone contour.
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between
the
34. Cephalometric Analysis
Precautions while taking cephalograms
1. Condyles properly seated in the fossae.
2. Lips fully relaxed.
3. Recording in the ‘Natural Head Position’
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35. Cephalometric Analysis
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.
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36. Cephalometric Analysis
Precautions while doing analysis
2. Norms based on hard tissues alone also not
appropriate due to the varying thickness of
the soft tissues.
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37. Cephalometric Analysis
Precautions while doing analysis
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
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38. Cephalometric Analysis
Precautions while doing analysis
4.
Instead of relying on absolute linear
measurements, projected values are more
meaningful.
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40. Cephalometric Analysis
Precautions while doing analysis
6. Effect of vertical displacements on the
sagittal relationship must be taken into
account.
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41. Cephalometric Analysis
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.
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42. Cephalometric Analysis
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.
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43. Cephalometric Analysis
Useful readings - Vertical
a) Jarabak ratio
b) Mandibular plane wrt SN and FH
c) Linear measurements of the incisors to their
corresponding jaw bases
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45. Cephalometric Analysis
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.
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46. 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
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47. Quantification of the fault
Cephalometric Assessment
a) Comparison with normative values
b) Assessment using certain established ratios
c) Surgical VTO
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48. Quantification of the fault
Cephalometric Assessment
a) Comparison with normative values.
Burstone and Legan’s analysis
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49. Quantification of the fault
Cephalometric Assessment
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.
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50. Quantification of the fault
Cephalometric Assessment
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 )
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54. Pre-Surgical Orthodontics
C. Incisor intrusion done pre-surgically if an
increase in the anterior face height is not
desirable
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55. Pre-Surgical Orthodontics
D. Arch forms are corrected so that the arches
are compatible with each other when
surgically repositioned.
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56. Pre-Surgical Orthodontics
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.
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59. 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
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60. Post-Surgical Orthodontics
a) Closure of remaining spaces
b) Acheivement of proper interdigitation
c) Finishing and detailing to
functional occlusal criteria.
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satisfy
the
61. Preparation of Surgical Splints
Surgical splints
Intermediate
Final
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62. Thank you
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