Category Archives: How-To

Surgical methods to uncover maxillary impacted canines

The following is a summary of an article done by Kokich that had shown the different techniques to uncover the maxillary impacted canines whether it was labially or palatally impacted.

Labial Impaction :

3 Techniques to uncover labial impactions  :

  • Excisional Uncovering.
  • Apical Repositioning Flap.
  • Closed Eruption technique.

Evaluate 4 criteria in labially impacted canines :

  1. Assess labiolingual position of canine :

    • If it is labially positioned use any of the 3 techniques because little bone pesent labially.
    • If it is in the center of the alveolous use Closed Eruption technique.
    • Other methods are difficult to perform because extensive bone might need to be removed occlusally.
  2. Assess vertical position relative to mucogingival junction.

    • Apical to Mucoginigival junction :
      • Deep to MGJ      :   Closed Eruption
      • Just above MGJ  : Apically repositioned flap mainly / Closed technique can be used too.
    • Coronal to Mucogingival Junction use Any of the 3 techniques.
  3. Evaluate amount of gingiva in the area of the impacted canine :

    • Insufficient ginigiva : Only Apically repositioned flap.
    • Sufficient to provide 2-3 mm of attached gingiva over canine :
      Any of the 3 techniques can be performed.
  4. Evaluate mesiodestal position of the crown of the impacted canine :

    • If mesially inclined and it is over the root of the upper lateral incisor use Apically repositioned flap.
    •  Excisional or Closed Eruption technique are not recommended.

Palatal Impaction :

  • If Not passed the mesial surface of lateral incisor Extraction of C will result in normal eruption
  • If passed beyond the lateral incisor : No Self Correction.
  • Uncovering usually is done within 6-9 months after alignment of maxillary dentition.
  • After Surgical exposure -> traction is initiated orthodontically . ( Ballista loop can be used or overlay wire ).
  • If the tooth was not uncovered properly, it could appear to the orthodontist that the tooth is not moving and perhaps could be ankylosed .The incidence of ankylosed maxillary canines is low.
  • If insufficient bone was removed -> less tooth movement will occur.
  • Sufficient bone removal down to the cementoenamel junction is recommended by Kokich.
  • Kokich recommends earlier timing for uncovering palatally impacted canine before orthodontic treatment. In some cases in late mixed dentition.
  • When dental follicle is removed while uncovering the impacted canine , tooth will move by pressure resorption.
  • a full-thickness mucoperiosteal flap is elevated in the area of the impacted canine. All bone over the crown is removed down to the cementoenamel junction. The flap is repositioned, and a hole is made through the gingival flap . Occasionally, if the tooth is positioned high in the palate, a dressing is placed over the exposed area in the flap. Once the bone and tissue have been removed, these palatally displaced canines will erupt on their own . In about 6 to 8 months, the canines generally have erupted to the level of the occlusal plane. At that point, a bracket can be placed on the tooth, and the root can be moved through the bone as the crown is gradually translated into the dental arch.

Labial

Assess labiolingual position

Labially Positioned

Any of the 3 methods

In the center of the alveolous use

Closed Eruption technique.

Assess vertical position relative to mucogingival junction

Apical to Mucoginigival junction

 

If it is so deep

Closed Eruption

If it is Just above MGJ

 Apically  repositioned flap mainly / Closed technique can be used.

Coronal to Mucogingival Junction

Any of the 3 techniques.

Evaluate amount of gingiva in the area of the impacted canine

Insufficient ginigiva

Only Apically repositioned flap.

Sufficient to provide 2-3 mm of attached gingiva over canine.

Any of the 3 techniques.

Evaluate mesiodestal position of the crown of the impacted canine

 

If mesially inclined and it is over the root of the upper lateral incisor       

Apically repositioned flap.

 

Excisional or Closed Eruption technique are not recommended.

 

Palatal

 

If Not passed the mesial surface of lateral incisor

Extraction of C will result in normal eruption

 

If passed beyond the lateral incisor

No Self Correction.

 

 

a full-thickness mucoperiosteal flap is elevated.

All bone is removed down to the cementoenamel junction.

The flap is repositioned, and a hole is made through the gingival flap .

if the tooth is positioned high in the palate, a dressing is placed over the exposed area in the flap.

 

Orthognathic Surgery : How to

Edited by : Dr. Hani Alhebshi

Orthognathic surgery is a type of surgery that is done to the jaws to correct a frank skeletal discrepancy.

The common steps in order are :

  • Pre-surgical orthodontic treatment (decompensation orthodontics).  This involves aligning the teeth on the jaws according to their basal bone , and may require extractions,  A few weeks before surgery when decompensation orthodontics is completed patient will undergo a surgical assessment and pre-planning.  This involves taking impressions, x-rays, pictures and models of the teeth as well as a face bow (jaw registration).  This will allow the surgeon to plan the movements of the jaw and the technician will be able to construct the splints required during surgery.
  • The surgery is usually performed under general anaesthetic and can take up to 3 or 5 hours to complete depending on how much jaw surgery is required.   The new position of the jaws is maintained with the use of plates and screws and on occasions these may be resorbable .  Most common surgical cuts involve : Maxillary LeFort I for maxillary impaction or advancement , Bilateral sagittal split osteotomy for mandibualr advancement or set back , and  genioplasty to either advance or set back the chin.
  • Post-surgical Orthodontic Treatment (following surgery) : Elastics are applied to the teeth to guide the new bite and the patient is put on a soft diet for 6 weeks.  During this time medications such as antibiotics, analgesics and nasal drops are often required in the first week or two after surgery.  Then elastics are removed after about six weeks and the final adjustments to teeth and bite are undertaken by the orthodontist in consultation with the surgeon.  The process can last a further three to six months depending on the complexity of the procedure.

Here are videos that shows the procedures done in different types of orthognathic surgery.

Lefort 1 Osteotomy HD

Bilateral Sagittal Split osteotomy

How Systematic reviews are conducted?

By : Dr. Hani Alhebshi.

A systematic review is simply a structured and organized way to review many articles on specific topic and collecting their results and analyzing them with or without statistical methods; to reach a better conclusion on that topic under investigation.
If statistical methods were used ; It is called “Meta-analysis“.

For example :
If we want to make a systematic review on whether there is a relation between third molar impaction and late lower arch crowding , we raise the question : Is there a relation between them ?
Then we determine inclusion and exclusion criteria of papers that we are going to collect. They must be relevant to our topic. If articles found during our search has not matched our inclusion criteria ; they are ignored to others that match.
Then we organize data in tabular forms and analyze their results.
Analysis can summerize the net conclusion of whether they support or refute presence of any relation between molar impaction and lower arch crowding. Continue reading How Systematic reviews are conducted?

Sequence of archwires of 2 bracket prescriptions (0.018 and 0.022 slots)

This is a general guideline of the sequence of archwires during treatment which can be modified according to the clinical situation.

( Summerized from a lecture of Dr. Zuhair Bakhsh ).

*For 0.018 x 0.025 slot brackets

Phase I (Alignment&Leveling):

1.0.014 Niti

2.0.016 Nitti
Continue reading Sequence of archwires of 2 bracket prescriptions (0.018 and 0.022 slots)

How to Critique an article ..

Your final personal opinion about any scientific paper can be based on the collective answers of the following questions :
1. Title : is it appropriate and clear ?
2. Abstract : is it representative of the article and in correct form?
3. Purpose of the article : is it clearly stated ?
4. Errors of established facts or errors of interpretation of other’s work.
5. Is all the discussion relevant?
6. Are references the auther cited relevant to the topic?
7. Have any ideas been overemphasized or under emphasized?

Continue reading How to Critique an article ..