Exciting and innovative treatment options are available for patients in need of orthognatic surgery or other orthodontic treatment, thanks to new developments in interdisciplinary dentistry according to Dr. Rebecca Bockow.
By Rebecca Bockow, DDS
Have you ever had a patient decline orthognathic surgery? Or had a patient who needed orthodontics, but did not pursue it because the projected treatment time was too long? Have you ever seen a patient with significant gingival recession who would also benefit from orthodontic treatment?
Thanks to new developments in interdisciplinary dentistry, we can now offer exciting and innovative treatment options for these patients.
Patients seeking orthodontic care may present dental crowding and/or skeletal discrepancies. When the etiology for a malocclusion is skeletally-based, a patient’s treatment options include either a combination of orthodontics and orthognathic surgery or orthodontic “camouflage” treatment, including extractions, interproximal reduction, and pushing teeth to their biologic extremes. The biologic limits of orthodontic tooth movement are defined by the pre-treatment alveolar bone and the surrounding soft tissues. Moving teeth outside of the alveolus can result in bony dehiscences, fenestrations and gingival recession.
Traditionally, the only treatment option for patients requiring tooth movement beyond the scope of orthodontic camouflage was a combination of orthodontics and orthognathic surgery. Some patients decline orthognathic surgery due to fear, cost, lifestyle or underlying health issues. We now have an effective treatment option to offer borderline surgical orthodontic patients.
In implant dentistry, when the alveolar ridge is deficient to support the placement of an implant, we perform a localized bone graft, or a “guided bone regeneration.” The same principles can be applied to orthodontic tooth movement: If there is insufficient bone to support traditional tooth movement, we can now ask our surgical colleagues to graft the alveolus. Advantages to this procedure include greater breadth of tooth movements, potentially less gingival recession, greater long-term orthodontic stability and a faster total treatment time for the patient. Studies show that tooth movement can be twice as fast in the presence of a localized injury compared to traditional orthodontic tooth movement. If a patient declines orthognathic surgery, we can now expand the alveolar ridge and safely move teeth a greater distance in order to mask an underlying skeletal discrepancy.
Diagnosis and treatment planning from all team members is essential for a favorable treatment outcome. The ideal position of the teeth should be determined in three planes of space. The final restorative treatment plan may influence the ideal tooth position. Once the team knows the tooth movement goals, the surgeon and orthodontist assess whether or not the available bone can support such movement. If the answer is no, a localized bone augmentation is necessary in the direction of the proposed tooth movement. Brackets and wires are placed a few weeks to a few months prior to the surgery.
Immediately following bone augmentation, the teeth are rapidly moved into the grafted bone. The new bone heals around the teeth as they move into the new position, creating increased post-orthodontic tooth and soft-tissue stability.
Join me at AO’s 2017 Annual Meeting in Orlando, FL to learn more during my presentation titled, “Expanding Alveolar Contours with Surgically Facilitated Orthodontics.” It will be part of a new session grouping called, “New Concepts and Materials for Site Development” on March 17 from 3:30 – 5:00 pm. REGISTER TODAY.
* Dr. Bockow’s article originally appeared in Spear Digest