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Ankylosed teeth: Orthodontic complications and surgical management
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028A - Orthognathic, cleft lip~palate and craniofacial surgery
fixation. Therefore, most surgeons have Consistently recommended against lingual appliances pre-operatively or recommend changing to labial appliances prior to surgery. Methods Of ten given patients with lingual orthodontic appliances who underwent orthognathic surgery, tile methods of stabilizing the osteomized segments and occlusion were as follows: 1. Two patients had labial arch bars applied to the maxilla and mandible intraoperatively. 2. Eight patients had labial orthodontic brackets or buttons placed preoperatively by the orthodontist. Four of these patients, in addition, had temporary maxillomandibular fixation screws placed in the maxilla and/or mandible intraoperatively. Results Rigid fixation was achieved in all 10 patients with no need for post-operative intermaxillary fixation. Lingual orthodontic appliances did not complicate the planned orthognathic surgery. There was a considerable amount of time added to the surgery in the patients who had arch bars placed intraoperatively, due to difficulty in passing wires. The temporary maxillomandibular fixation screws proved: to be quick in their application and were versatile in their position placement.
Results Ankylosed teeth identified included: Maxillary cuspid (7), lateral incisor (1), central incisor (1), maxillary molars (2), maxillary primary molar (1), mandibular second bicuspid (1), mandibular primary molar (1) and mandibular permanent first molar (1). Orthodontic treatment resulted in transverse cant in occlusion (7), maxillary hypoplasia (2), unilateral maxillary hyperplasia (1), vertical mandibular alveolar hyperplasia (1), posterior open bite (1), and failure to retract maxillary anterior teeth (2). Treatment of these 12 cases included: single tooth osteotomy to reposition the ankylosed tooth (2), segmental Le Fort I osteotomy (including a one tooth segment to reposition the ankylosed tooth) (6), mandibular body osteotomy and ramus oteotomy (1), multiple maxillary osteotomies indicated but not. yet completed (2), and disengage mandibular ankylosed tooth from arch wire and crown tooth (1). Conclusion UnreCognized ankylosis of teeth can create significant problems, particularly when the tooth is malaligned and attached to an orthodontic arch wire. Early recognition will minimize adverse affects on the jaws and occlusion. Surgical intervention may be required, including a single tooth segment to rep0sition the ankylosed tooth into proper position, or maxillary and mandibular osteotomies.
Conclusions Preoperative lingual orthodontic appliances should not be discouraged for patients undergoing orthognathic surgery. Bonded labial brackets and buttons are the preferred stabilization method, including the use of temporary maxillomandibular screws when needed for extra anchorage.
References 1. MEDEIROSP J, BEZERRAAR. Treatment of an ankylosed central incisor by single tooth dento osseous osteotomy. Am J Orthod Dentofacial Orthop 1 1997: 12(5): 496-501. 2. PATRIKIOU AK, KATSAVRIASEG. Repositioning ankylosed maxillary canines by segmental osteotomy. J Clin Orthod 1995: 29(10): 625-8.
6. Ankylosed Teeth: Orthodontic Complications and Surgical Management
7. Distraction Osteogenesis of the Severely Atrophic Mandible: A Pilot Study in Micropigs
Freitas, R., Wolford, L., Pitts, M., Hopkin, s
Lazar, F., Zoller, J., Hidding, s
Baylor College of Dentistry, Texas A&M University System
Department of Oral and Maxillofacial Surgery/ Plastic Surgery, University of Cologne, Cologne, Germany
Ankylosed teeth can cause significant problems with jaw growth and development and, if unrecognized, can create significant orthodontic problems when malaligned and tied into the orthodontic arch wire, with subsequentdevelopment of a facial deformity. An ankylosed tooth functions as an anchor, and in active orthodontics, will move adjacent teeth to align with its position. This study evaluated the effects of an ankylosed tooth on orthodontic outcomes, and the surgical treatment to manage the resultant condition. Patients and methods Twelve patients were evaluated with ankylosed teeth. Average age at diagnosis was 21.3 yrs (range 12 to 42). All patients were under active orthodontics at initial surgical evaluation. Pretreatment records were obtained to determine effect of the orthodontic forces tied to the ankylosed teeth. The ankylosed tooth (teeth) were identified and surgically managed in 9 of the 12 cases.
Statement of the problem Extreme atrophy of the mandibular alveolar ridge is a nonneglectable problem in our field. However, besides conventional surgical procedures like sandwich osteoplasty. We recently introduced a new surgical technique called vertical distraction osteogenesis which has been developed by our study group since 1997. Alveolar segments up to a width of 33 mm have been successfully moved vertically with new bone formation in the distraction gap. A new prototype distraction device has now been developed to move larger segments vertically. Material and methods The distraction device consists of a 2.3 mm Titanium plate, a distraction guide and a second microplate. In general anesthesia, three 8-10 year old micropigs underwent vertical distraction of a whole anterior alveolar ridge segment following
028A - Orthognathic, cleft lip~palate and craniofacial surgery
fixation. Therefore, most surgeons have Consistently recommended against lingual appliances pre-operatively or recommend changing to labial appliances prior to surgery. Methods Of ten given patients with lingual orthodontic appliances who underwent orthognathic surgery, tile methods of stabilizing the osteomized segments and occlusion were as follows: 1. Two patients had labial arch bars applied to the maxilla and mandible intraoperatively. 2. Eight patients had labial orthodontic brackets or buttons placed preoperatively by the orthodontist. Four of these patients, in addition, had temporary maxillomandibular fixation screws placed in the maxilla and/or mandible intraoperatively. Results Rigid fixation was achieved in all 10 patients with no need for post-operative intermaxillary fixation. Lingual orthodontic appliances did not complicate the planned orthognathic surgery. There was a considerable amount of time added to the surgery in the patients who had arch bars placed intraoperatively, due to difficulty in passing wires. The temporary maxillomandibular fixation screws proved: to be quick in their application and were versatile in their position placement.
Results Ankylosed teeth identified included: Maxillary cuspid (7), lateral incisor (1), central incisor (1), maxillary molars (2), maxillary primary molar (1), mandibular second bicuspid (1), mandibular primary molar (1) and mandibular permanent first molar (1). Orthodontic treatment resulted in transverse cant in occlusion (7), maxillary hypoplasia (2), unilateral maxillary hyperplasia (1), vertical mandibular alveolar hyperplasia (1), posterior open bite (1), and failure to retract maxillary anterior teeth (2). Treatment of these 12 cases included: single tooth osteotomy to reposition the ankylosed tooth (2), segmental Le Fort I osteotomy (including a one tooth segment to reposition the ankylosed tooth) (6), mandibular body osteotomy and ramus oteotomy (1), multiple maxillary osteotomies indicated but not. yet completed (2), and disengage mandibular ankylosed tooth from arch wire and crown tooth (1). Conclusion UnreCognized ankylosis of teeth can create significant problems, particularly when the tooth is malaligned and attached to an orthodontic arch wire. Early recognition will minimize adverse affects on the jaws and occlusion. Surgical intervention may be required, including a single tooth segment to rep0sition the ankylosed tooth into proper position, or maxillary and mandibular osteotomies.
Conclusions Preoperative lingual orthodontic appliances should not be discouraged for patients undergoing orthognathic surgery. Bonded labial brackets and buttons are the preferred stabilization method, including the use of temporary maxillomandibular screws when needed for extra anchorage.
References 1. MEDEIROSP J, BEZERRAAR. Treatment of an ankylosed central incisor by single tooth dento osseous osteotomy. Am J Orthod Dentofacial Orthop 1 1997: 12(5): 496-501. 2. PATRIKIOU AK, KATSAVRIASEG. Repositioning ankylosed maxillary canines by segmental osteotomy. J Clin Orthod 1995: 29(10): 625-8.
6. Ankylosed Teeth: Orthodontic Complications and Surgical Management
7. Distraction Osteogenesis of the Severely Atrophic Mandible: A Pilot Study in Micropigs
Freitas, R., Wolford, L., Pitts, M., Hopkin, s
Lazar, F., Zoller, J., Hidding, s
Baylor College of Dentistry, Texas A&M University System
Department of Oral and Maxillofacial Surgery/ Plastic Surgery, University of Cologne, Cologne, Germany
Ankylosed teeth can cause significant problems with jaw growth and development and, if unrecognized, can create significant orthodontic problems when malaligned and tied into the orthodontic arch wire, with subsequentdevelopment of a facial deformity. An ankylosed tooth functions as an anchor, and in active orthodontics, will move adjacent teeth to align with its position. This study evaluated the effects of an ankylosed tooth on orthodontic outcomes, and the surgical treatment to manage the resultant condition. Patients and methods Twelve patients were evaluated with ankylosed teeth. Average age at diagnosis was 21.3 yrs (range 12 to 42). All patients were under active orthodontics at initial surgical evaluation. Pretreatment records were obtained to determine effect of the orthodontic forces tied to the ankylosed teeth. The ankylosed tooth (teeth) were identified and surgically managed in 9 of the 12 cases.
Statement of the problem Extreme atrophy of the mandibular alveolar ridge is a nonneglectable problem in our field. However, besides conventional surgical procedures like sandwich osteoplasty. We recently introduced a new surgical technique called vertical distraction osteogenesis which has been developed by our study group since 1997. Alveolar segments up to a width of 33 mm have been successfully moved vertically with new bone formation in the distraction gap. A new prototype distraction device has now been developed to move larger segments vertically. Material and methods The distraction device consists of a 2.3 mm Titanium plate, a distraction guide and a second microplate. In general anesthesia, three 8-10 year old micropigs underwent vertical distraction of a whole anterior alveolar ridge segment following