Oral Surgery & Orthodontics

Treatments
Oral Surgery & Orthodontics

Occasionally minor oral surgery procedures are necessary in conjunction with orthodontic treatment. Often the more simple procedures such as removal of erupted teeth because of decay or crowding can be comfortably managed by your Dentist using local anaesthetic (injection) at the Dental Surgery. More complex surgical procedures such as removal of impacted or unerupted teeth are often arranged to be done under a short general anaesthetic (day surgery) by either your Dentist or a specialist Oral & Maxillofacial Surgeon at a private hospital. These arrangements are made according to individual patient preferences and recommendations from the Orthodontist and Dentist. Oral surgery procedures include:

Extraction of teeth: As mentioned above, erupted teeth might need to be removed because of decay, poor long term prognosis (stability), over-retention of deciduous (baby) teeth or very occasionally to correct crowding.

Extraction of impacted teeth: Wisdom teeth are the most likely teeth to become impacted which is where they remain completely or partially unerupted because of inadequate space for eruption or ectopic (abnormal) position. Surgical extraction of wisdom teeth is generally recommended due to concern regarding recurrent infection of surrounding gum, not because they cause crowding.

Extraction of ankylosed teeth: Permanent or deciduous teeth can become ankylosed which is where they are fused to surrounding bone and either remain unerupted or don’t continue to erupt to maturity alongside adjacent teeth. Ankylosis can be idiopathic (no apparent cause) or due to trauma, and ankylosed teeth cannot be orthodontically repositioned or aligned.

Ligation of impacted teeth: If we decide to orthodontically erupt impacted teeth into normal alignment, most commonly the upper canines, the unerupted impacted tooth can be surgically ligated, which usually involves attachment of a short length of fine gold chain to the tooth so that the tooth can be guided into alignment using braces.

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Crowding

Crowding is a common orthodontic problem that compromises appearance, confidence and oral health. Difficulty cleaning crowded teeth can lead to gum disease (periodontal disease), resulting in gum recession, reduced bone support of the teeth and loss of teeth.

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Protruded Teeth

Protruded teeth (excessive overjet) are vulnerable to trauma and often associated with excessive gum display when smiling and talking. Speech is usually adversely affected and protrusion will also prevent the lips resting together, resulting in habitual mouth breathing, snoring and restless sleep.

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Anterior Cross Bite

Normally the upper teeth bite closely against the outer surface of the corresponding lower teeth. Anterior cross bite is where the upper front teeth bite inside the lower front teeth which can result in worn teeth and gum recession if in close contact, or loss of chewing function, compromised appearance and speech problems if there is a gap with the lower front teeth forward of the upper teeth.

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Open Bite

An open bite is where some teeth don’t contact when unaffected teeth are biting together. Most open bite problems affect the front teeth and can be due to simple causes such as finger or thumb sucking habits, or more complex causes such as habitual mouth breathing due to nasal airway/allergy problems resulting in vertical (downward) lower jaw growth. Open bite affecting the side teeth can be due to abnormal tongue posture and function or ankylosed teeth (teeth fused to supporting bone).

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Deep Bite

A deep over bite is where there is too much overlap of the upper front teeth over the lower front teeth when biting together. A deep bite will cause excessive wear of the front teeth and can result in palatal impingement of the lower front teeth where they bite into the gum behind the upper front teeth. Deep bites can also result in jaw joint (TMJ) problems such as muscle pain, TMJ pain, headaches, clicking and locking.

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Missing Teeth

Teeth are sometimes missing from birth (congenitally missing) or lost because of gum disease or decay. With orthodontic treatment we can either close space where teeth are missing, sometimes with the assistance of TADs (temporary implant anchorage), or alternatively, space can be co-ordinated for replacement teeth, usually involving dental implants.

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Surgery/Orthodontic treatment

Some bite discrepancies are due to an imbalance between upper and lower jaw development or position, particularly severe overjet, open bite and cross bite, that can’t be satisfactorily corrected by orthodontic treatment alone. For these more severe malocclusions we co-ordinate orthodontic treatment with orthognathic (jaw) surgery in conjunction with our Maxillo-Facial Surgery colleagues.

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Crowding