Surgery for Orthodontics

In the process of undergoing orthodontic treatment, oral surgery procedures are occasionally required in order to help properly align your teeth into the dental arch and to allow your orthodontist to give you a beautiful smile!

The most commonly required oral surgery procedures necessary for optimal orthodontic treatment results include:

• Treatment of impacted teeth (typically canines)
• Removal of retained or ankylosed primary teeth
• Removal of extra or “supernumerary” teeth
• Removal of erupted and impacted permanent teeth
• Early removal of wisdom teeth interfering with proper eruption of second molar teeth
• Surgical repositioning of improperly positioned molar teeth
• Temporary anchorage device (TAD) placement

Early Recognition And Intervention Is The Key To Successful Treatment

Surgical procedures that are required for orthodontic purposes are unique in that for the majority of these procedures, time is of the essence. Early recognition of the disturbance in the natural tooth eruption pattern and prompt intervention are keys to successful treatment results.

Most oral surgery interventions for orthodontic purposes need to be performed at such a time when the roots of the problematic teeth are partially developed. Once the root development is complete, correcting malposition or impaction becomes much less predictable and success rates decrease.

Therefore, once the orthodontist refers you for any surgical procedures to assist with orthodontic treatment goals, the treatment typically should proceed without delay to optimize results.

Treatment of Impacted Canine Teeth

“Impacted” simply means that a tooth is “stuck” in bone and beneath the gums and cannot erupt into the proper position in the mouth. The most commonly impacted teeth are wisdom teeth, which can result in a host of problems (see “Wisdom Teeth” section under “Procedures” tab).

Since wisdom teeth rarely provide any functional benefit, they are usually extracted to prevent the problems that can arise from the impacted position. The second most common impacted tooth is the upper canine (cuspid or eyetooth).

The canine is a critical tooth in the dental arch and plays several important roles in your mouth. Not only are canine teeth very strong for chewing and an esthetic cornerstone of your smile, they are also designed to guide the rest of the teeth into the proper bite.

Normally, the upper canine teeth are the last of the front teeth to erupt into place and usually grow into the mouth around age 11-12, causing any space left between the upper front teeth to close tighter together. There are multiple reasons that a canine tooth can become impacted:

• Lack of space in the dental arch
• Blocking of the natural eruption path by a primary, permanent, supernumerary (extra) tooth, or a pathological lesion

If a canine tooth becomes impacted, every effort is made to assist its eruption into its proper position in the dental arch. The techniques used to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the upper canine teeth.

Again, early recognition of disturbance in the normal eruption pattern of teeth is key. The American Association of Orthodontists recommends that a thorough dental examination and special imaging be performed on all dental patients at the age of seven to count for the appropriate number of teeth and to determine if there are any problems with eruption of the adult teeth.

If lack of proper eruption of the adult canine teeth is noted early on a screening examination, simple interventions (such as placement of braces to open the space or removal of the overlying baby teeth or select permanent teeth) are oftentimes sufficient to allow for natural eruption of the tooth into the proper position.

Sometimes, if these interventions are not successful or if the patient is further developed, the impacted canine tooth will need to be surgically exposed and have an orthodontic chain attached, which the orthodontist can pull with rubber bands or springs attached to the braces to guide the tooth into the arch.

For select cases of canine teeth impacted in the roof of the mouth, a technique can be used where the tooth is surgically exposed and tooth-colored filling material is built upon the tooth to maintain the opening. With this technique, the tooth spontaneously grows into the roof of the mouth over a 6-9 months period, after which the orthodontist can attach an orthodontic bracket to pull it into the dental arch.

Regardless of the techniques used, treatment should not be delayed because once the root development of the canine tooth is complete, the difficulty with moving it into the arch can increase significantly. If surgical treatment is timed appropriately, the results of these techniques are very reliable and predictable to bring this very important tooth into your mouth to complete your beautiful smile!

Early Removal of Wisdom Teeth Interfering with Proper Eruption of Second Molar Teeth

If wisdom teeth are recommended for removal (please see Wisdom Teeth under Procedures section), they are typically removed anywhere from the mid-teens to the early twenties. However, wisdom teeth can occasionally develop and grow in such a way that they can actually obstruct the proper eruption of the adjacent second molar teeth into the mouth.

In these unique cases, your orthodontist or general dentist may refer you to Drs. Mynsberge and Ruggles for early removal of the wisdom teeth as early as age 11-14 so that the second molar tooth can naturally erupt into the proper position in the mouth. This phenomenon can occur both in the upper and lower jaws, though the lower jaw is more common.

Typically only the problematic wisdom teeth need to be removed early.

Surgical Repositioning of Improperly Positioned Molar Teeth

While it is very common for wisdom teeth or “third molar” teeth to become improperly positioned in the jawbones, the same can also occur with our other molar teeth, most commonly the lower second molars. Rather than growing normally into a vertical position in the mouth, some lower second molars get stuck leaning forward into the first molar tooth. In these unique cases, a surgical procedure can be performed that can reposition or upright the tooth into the correct position in the mouth.

After surgery or sometimes even during the surgery, an orthodontic bracket is placed on the repositioned tooth and an active orthodontic wire is attached to gradually complete the movement of the tooth into the ideal final position. Like most surgical orthodontic procedures, this technique is ideally performed when the roots of the tooth to be repositioned are partially developed (usually around ½ of ¾ of the way developed).

Temporary Anchorage Device (TAD) Placement

When an orthodontist puts braces on your teeth, some teeth attached to the braces act like “anchors” against which forces are placed on the misaligned or crooked teeth with wires, springs, and/or rubber bands in order to straighten them. For some special types of orthodontic tooth movement, your natural teeth cannot create the direction of force needed to achieve the desired movement.

In these unique situations, a temporary anchorage device (or TAD) may need to be placed so that the forces and direction needed for the orthodontic tooth movement can be achieved. TADs are usually small sterile and biologically compatible screws or plates that are placed with minimal surgical intervention and are similarly removed once the necessary orthodontic tooth movement is completed.