ORTHOGNATHIC SURGERY: The
word orthognathic is derived from "ortho" meaning correct
or straight and "gnathos" meaning jaw. Orthognathic surgery
is the type of surgery performed by Oral Surgeons to correct skeletal
mismatches. These situations involve a situation where one of the
jaws is too large, too small, too far forward or too far back in relation
to rest of the skull.
Situations that lend themselves to Orthognathia are:
1. Apertognathia is a situation when the back teeth meet but the
front teeth do not touch. This space causes difficulty in biting
with the front teeth.
2. Prognathia is a situation where the lower jaw is too large
and grows too far forward. Surgery can be used to slide the lower
jaw back.
3. Retrognathia is a situation where there is a "severe"
overbite. These situations are managed with surgery and orthodontics
together.
4. Vertical Maxillary Excess also known as the gummy smile. In this
case the upper jaw has grown too far down. Surgery can move the jaw
upward to create a much nicer looking smile.
Orthognathic Surgery is not intended to replace orthodontics for straightening
the teeth when the relationship to the jaws is within the normal range,
but cannot change the relationship of the jaw. Orthognathic surgery
is usually done in conjunction with orthodontics to provide the best
possible end result. If you believe you have any of these situations
discuss them with your dentist who will refer to specialists qualified
to carry out these procedures.
FRACTURES (BROKEN JAW): The lower jaw is a frequent site for fractures because
of:
• Accidents
• Assaults
• Some underlying disease
• Sports Injuries
There are 2 types of fractures:
• Open: The bone is exposed to air inside the mouth or outside
the facial skin • Closed: The bone is completely
covered by soft tissue.
Fractures can further be characterized as: • Complete:
The bone is broken completely into two or more pieces •
Incomplete: The bone is fractured only part way through
• Comminuted: The fracture is composed of many pieces
Three steps followed in the repair of most fractures:
1. Reduction of the fracture: Realigning the bony parts in their original
anatomic relationship.
2. Fixation of the fracture: Methods and materials are used to hold
the bony parts in their correct relationship while healing occurs.
• Maxillomandibular fixation is the wiring of the jaw shut.
Many fractures lend themselves to this treatment. When the upper dentition
is good and the upper jaw is stable this allows the upper jaw to act
as a cast for the lower jaw while it heals. • Internal fixation
is the use of wires and or screws and plates to hold the bony segments
in their correct relationship. This hardware may be applied inside
the mouth or outside the mouth depending upon the situation.
• External fixation is the use surgical pins that are placed
in the bony fragments and a external frame is placed between the pins
to fix the bony fragments in their proper orientation.
3.Healing and Rehabilitation: This is the time that is allowed for
healing and for physical therapy. Adequate nutrition and rest, avoiding
alcohol and, tobacco is very important.
CHIN RECONSTRUCTION: In situations where a person appears to have
little or no chin, and if there are no other skeletal abnormalities,
surgical procedures are available to change the chin. The chin point
can be augmented with materials from the patient's own body (autografting)
or with materials from outside the body (allografting) and each has
it's own advantages and disadvantages.
Autograft procedures involves sectioning the chin from the
remainder of the lower jaw, and moving it forward and reattaching
it to the lower jaw with plates, wires and/or screws. This surgery
is done from an incision inside the mouth so that there are no visible
scars
Allograft procedures also involve an incision made inside the mouth.
Prosthesis is placed in front of the bone of the chin, to give the
appearance of a more normal chin.
There are many new biocompatible materials being
developed all the time to create implants for the chin and for other
facial defects.
ORAL PATHOLOGY:
The inside of the mouth is normally lined with a special type of skin
(mucosa) that is smooth and coral pink in color. Any alteration in
this appearance could be a warning sign for a pathological process.
The most serious of these is oral cancer.
The following can be signs at the beginning of a pathologic process
or cancerous growth:
Reddish patches (erythroplasia) or whitish patches (leukoplakias)
in the mouth
A sore that fails to heal and bleeds easily
A lump or thickening on the skin lining the inside of the mouth
Chronic sore throat or hoarseness
Difficulty in chewing or swallowing
These changes can be detected on the lips, cheeks, palate, and gum
tissue around the teeth, tongue, face, and/or neck. Pain is not always
necessary to define pathology and, curiously, is not often associated
with oral cancer. However, any patient with facial and/or oral pain
without an obvious cause or reason may also be at risk for oral cancer.
Do not ignore suspicious lumps or sores, please contact us so we facilitate
advice from the oral surgeon on our panel.
EXTRACTION:
One of the main goals of modern dentistry is the prevention of tooth
loss. All possible measures should be taken to preserve and maintain
your teeth because the loss of a single tooth can have a major impact
upon your dental health and appearance. However, it is still sometimes
necessary to remove a tooth where there is severe decay, advanced
periodontal disease, infection or abscess, orthodontic correction,
malpositioned teeth, fractured teeth or roots Impacted
teeth.
If you've just had a Toothetracted
or your dentist has recommended that a tooth be extracted, the following
information will help you get through the first few days after your
extraction. Should anything occur that seems out of the normal, do
not hesitate to call your dentist.
Postoperative Instructions:
Bleeding: When you leave the office, you will be given verbal instructions
regarding the control of postoperative bleeding. A rolled up gauze
pad will be placed on the extraction site and you will be asked to
change this dressing every 20 minutes or so depending on the amount
of bleeding that is occurring. It is normal for some blood to ooze
from the area of surgery. If bleeding still continues, you may fold
a tea bag in half and bite down on it. Tea contains Tannic Acid, a
styptic, which may help to reduce the bleeding.
Pain: Some discomfort is normal after surgery. Analgesic
tablets (i.e. Aspirin, Tylenol etc.) may be taken under your dentist's
direction. Prescription medication, which may have been given to you,
should also be taken as directed. If pain continues, call your dentist.
Swelling: To prevent swelling, apply an ice pack
or a cold towel to the outside of your face in the area of the extraction
during the first 12 hours. Apply alternately, 20 minutes on then 20
minutes off, for an hour or longer if necessary.
Brushing: Do not brush your teeth for the first 8
hours after surgery. After, you may brush your teeth gently, but avoid
the area of surgery.
Mouthwash: Avoid all rinsing for 24 hours after extraction. This is
to insure the formation of a healing blood clot that is essential
to proper wound healing. Disturbance of this clot can lead to increased
bleeding or the loss of the blood clot. If the clot is lost, a painful
condition called dry socket may occur. You may use warm salt water
or mild antiseptic rinses after 24 hours, only if prescribed.
Do not disturb the wound: In doing so you may invite
irritation, infection and/or bleeding. Be sure to chew on the opposite
side for 24 hours and keep anything sharp from entering the wound. Do not smoke for 12 hours: Smoking will promote bleeding
and interfere with healing.
Do not spit or suck through a straw: This will promote bleeding and
may dislodge the blood clot causing a dry socket.
Diet: Eat normal regular meals as soon as you are able after surgery.
Cold, soft food such as ice cream or yogurt may be the most comfortable
for the first day. It is also important to drink plenty of fluids.
DENTURE SURGERY:
(Mouth preparation for Dentures)
After years of comfortably wearing dentures, it quite natural that
you may find your dentures don't fit the way they once did. Over time,
the shape and size of the jawbone changes due to shrinkage, beginning
at the time that a tooth is lost. These changes can result in dentures
that slip and click, and even cause pain. The irritation caused by
ill-fitting dentures can cause further changes in the bone or the
gum tissues.
Treatment Options Exist:
Advances in surgical procedures and materials now allow oral and maxillofacial
surgeons to help the patient without teeth to eat, speak and smile
without worrying about slipping or uncomfortable dentures. Oral and
maxillofacial surgeons have developed many procedures for treating
the patient without teeth who suffers with the social and physical
problems caused by ill-fitting dentures. Your oral surgeon will explore
these options with you before deciding on a treatment plan, like use
a bone substitute, hydroxylapatite, to build up the jawbone; in cases
of severe shrinkage, your oral surgeon may recommend a bone graft;
Vestibuloplasty grafting firm tissue over the bone to provide a larger
ridge; or dental implants to support dentures.
Maintenance is Important:
Many people stop going to their dentist after dentures are fitted.
Regular checkups are still the best insurance that your mouth is healthy.
Exploring your options with your dentist and oral maxillofacial surgeon
will allow you to function without worrying about your dentures and
will preserve the health of your mouth.
WISDOM TEETH: Wisdom teeth
that fail to emerge can damage the surrounding teeth, gums or bones,
or cause cysts or tumors in the jaw. If x-rays reveal problematic
wisdom teeth, an oral surgeon will extract the teeth. Click here for
more information in our section on wisdom teeth.
ALVEOLECTOMY:
It may be described as the reduction of bony sockets in which alveolar
trimming is done by removing of labio buccal plate of jawbones and
in which minimal amount of interdental and interradicular septum is
also removed.
Why it is done?
It is done in those patients in whom the alveolar bone is dense and
interbony pathology is present or in those whose teeth resist extraction
by forceps. Gross alveolectomy is indicated where the shape of the
alveolar bone is to be improved or where the alveolar bone prevents
the accurate sitting of a denture. It is also done where the patient
has severe protrusion and the periodontal health is very poor and
where orthodontic treatment is not possible for cosmetic reasons gross
alveolectomy is done and a new prosthesis is given. APICOECTOMY:
It may be defined as surgical amputation of the apex of the root of
a tooth and periapical curettage is the removal of pathological material
present in the periapical region by means of surgical curettage.
ANKYLOGLOSSIA (TONGUE TIE)
Treatment - Lingual
Frenectomy
LABIAL FRENECTOMY:
When a frenum has a high attachment on the alveolar ridge and this
may interfere in Orthodontic, Prosthodontic and normal oral hygiene
procedures. It may be necessary to excise the frenum. When the frenum
is excised for orthodontic procedures it is known as (FRENECTOMY)
and for prosthetic procedures, (FRENOPLASTY).
TMJ DISORDERS:
The temporomandibular joint (TMJ) is a joint that slides and rotates
just in front of your ear, consisting of the temporal bone (side and
base of the skull) and the mandible (lower jaw). The joint works properly
when the lower jaw (mandible) and its joint (both the right and left)
are synchronized during movement.
Mastication (chewing) muscles connect the lower jaw to the skull,
allowing you to move your jaw forward, sideways, and open and close.
Temporomandibular Disorder (TMD) may occur when the jaw twists during
opening, closing or side-motion movements. These movements affect
the jaw joint and the muscles that control chewing.
TMD symptoms:
An earache without an infection
Jaw pain or soreness that is more prevalent in the morning or late
afternoon
Jaw pain when you chew, bite or yawn
Clicking when opening and closing your jaw
Difficulty opening and closing your mouth
Locked or stiff jaw when you talk, yawns, or eat
Sensitive teeth when no dental problems can be found
For more information, please click our section TMD-TMJ Disorders.
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Statutory Warning: The information is intended
to help you better understand dental conditions and procedures and should
not be construed as specific medical advice or recommendation. The general
information provided here is not a substitute for a consultation with the
dentists. Only personal discussion of your individual needs with a professionally
qualified doctor / dentist will determine the best method of treatment suitable
for you.
ABOUT US 
The
word orthognathic is derived from "ortho" meaning correct
or straight and "gnathos" meaning jaw. Orthognathic surgery
is the type of surgery performed by Oral Surgeons to correct skeletal
mismatches. These situations involve a situation where one of the
jaws is too large, too small, too far forward or too far back in relation
to rest of the skull. 
