Surgical Orthodontic Assistance

Frenectomy

These procedures are traditionally performed to improve the stability of the orthodontic positions of the teeth during and after the braces are removed. However, it is also indicated for patients who are tongue tied, which can improve their annunciation of words. It is usually associated with a considerable diastema or space between the two upper front teeth. The frenum is the soft movable tissue that can connect your upper lip to in between your two upper/lower front center teeth. When this tissue get squished between the two front teeth from orthodontics the pressure may be so great that either the teeth won’t come together with the braces on, or after the braces are removed, the space between the teeth will open up. This can be very frustrating and will require the braces to be placed on again and the tissue relieved in the area.

The procedure itself can take very little time and can be performed using local anesthetic to numb the area. After the patient is comfortable, the soft tissue frenum attachment is surgically removed from between the teeth and requires a few dissolvable stitches. Traditionally, this procedure causes slight discomfort and can be easily managed with ibuprofen. A one week follow-up appointment is performed and possibly one more at a later date.

Circumferential Fibrotomy / Edwards Procedure

This procedure is commonly performed for the patient when a significantly rotated tooth has been brought back into alignment orthodontically and is used to avoid rotation relapse after the braces are removed. The procedure itself can take very little time and can be performed using local anesthetic to numb the area. The fibers that have been stretched from the straightening of the teeth are in a lot of tension. Studies have shown that after the braces are removed, the likelihood that these rotated teeth may turn back towards their original position because of these tensioned fibers. The surgical procedure releases the attachment of these fibers on the tooth and allows them to reattach is a more passive position, therefore, relieving this fiber tension after orthodontics. Traditionally, this procedure causes slight discomfort and can be easily managed with ibuprofen. A single one week follow-up appointment is necessary.

Orthodontic Tooth Exposure

This procedure is indicated for teeth that have failed to erupt within a reasonable time frame. The procedure can be performed using local anesthetic to numb the area. The impacted tooth is surgically exposed and may have a bracket placed on it to assist the orthodontic movement into the arch. Traditionally, this procedure causes slight discomfort that can be easily managed with ibuprofen. The orthodontist may begin actively pulling the tooth after 10 days post surgery.

Free Gingival Graft

This procedure is indicated when there is inadequate attached tissue (pink firm fixed tissue) around the tooth/teeth. If recession occurs and results in red, movable mucosal tissue surrounding the tooth/teeth, significant recession at a much quicker rate can occur. The reason for this is that the mucosal tissue is not resistant to toothbrush wear and can be very tender to brushing. Also, the mucosal tissue is not firmly bound down on the tooth and bone, resulting in food getting trapped under the tissue, resulting in a possible abscess. This can cause significant bone loss in a very short period of time. Another concern from an orthodontic standpoint is that if orthodontic movement is performed on these particular teeth significantly more recession and bone loss can and does occur. All of this results in possible loss of teeth. If the ultimate goal of treatment includes covering the recession root surface with gum tissue, then a connective tissue graft is the more appropriate soft tissue grafting procedure (see Connective Tissue Graft).

A free gingival graft is a very effective way of preventing significant progression of recession causing bone loss problem. The procedure requires local anesthetic and a small incision releasing the mucosal tissue away from the tooth. A small, thin piece of attached tissue is removed from the patient’s palate and inserted into the mucosal released area using dissolvable sutures. A putty type dressing may be placed over the site initially. This putty has no medication in it, so if it becomes loose and is removed earlier then 4 days, this should not be a problem. The procedure can take can take less than a half hour and usually only requires a one and four-six week follow-up to verify the healing progress of the area. The orthodontics can be performed as soon as 6 weeks after the surgery. Traditionally, this procedure causes slight discomfort and can be easily managed with ibuprofen.