Surgical orthodontics may be as simple as the surgical exposure of unerupted teeth to allow disimpaction or the use of Temporary Anchorage Devices (TADS). TADS are self-tapping micro-screws which are implanted into the inter-alveolar bone of the jaw and are used as skeletal anchors. This skeletal anchorage is used to pull the teeth towards the TAD via elastic or spring traction to achieve dental corrections that could not have been achieved with conventional orthodontics alone. When the tooth movement needs are greater, Skeletal Anchor Plates can be secured to the jaw bones.
When the malalignment of the teeth is a result of an imbalance of the underlying bony structures and there is disharmony of the face, the orthodontic correction will need to be conducted in conjunction with orthognathic or facial re-proportion surgery. This form of treatment involves a close collaboration between the orthodontist and a highly skilled and trained maxillofacial surgeon. The surgery usually involves the repositioning of the facial bones in patients beyond the age of 16. With the aid of Cone Beam CT, facial volumetric imaging allows for precise analysis and treatment planning to achieve accurate, predictable outcomes.
Normally braces need to be worn to best place the teeth before the surgical procedure is undertaken, as well as to stabilise the dentition following the surgery. Recently, however, there has been an increase in the use of a surgery first technique where the stabilisation of the facial bones is achieved with the help of Skeletal Anchor Plates.
Recent advances in surgical orthodontics has allowed bone lengthening to be achieved by osteogenic distraction in patients as young as 12. For the lower jaw, a technique known as Inter Molar Distraction Osteogenesis (IMDO) is used to generate new bone by progressive stretching where the mandible has recently been surgically divided. Final alignment of the teeth with braces is delayed until bone remodelling has occurred.
In the case of the underdeveloped upper jaw width, where treatment is undertaken after the two halves of the maxilla have fused, it may be necessary to surgically remobilise the halves before expanding with a Mid Palate Distractor. This procedure is known as Surgically Assisted Rapid Palatal Expansion.
The functional and aesthetic benefits achieved by facial skeletal correction surgery can be cosmetically outstanding and have a profound, life changing effect for the patient.
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