Pre-prosthetic surgery refers to surgery that is meant to help improve a patient’s oral health or prepare a patient to wear a denture. This includes the exposure of an impacted tooth, alveoplasty, removal of maxillary tori (torus palatinus), removal of mandibular tori (large bone lumps in the jaw), removal of hypermobile or hyperplastic tissue, and vestibuloplasty.
Impacted Canines and Their Management for Orthodontic Therapy
The canines, or cuspids, are typically some of the last teeth to fully develop. They are crucial components of a healthy bite and should be monitored for normalcy throughout their development. One or more impacted canines can lead to a number of potentially complex issues and abnormalities in the dental arch, affecting all teeth adjacent to the unerupted tooth.
Canine impaction can be defined in more than one way and its specific definition varies from patient to patient. The tooth may be prevented from erupting by adjacent teeth that have grown too close together or may be embedded in the bone of the jaw. The tooth may simply fail to emerge after the root has formed completely. Approximately one to two percent of the general population suffers from impaction of one or more permanent canines.
Complications of Impacted Canines
In most cases of impacted canine teeth, the problem is first discovered during a routine visit to the dentist. Impaction of these vital teeth can be detected by a dentist or oral surgeon as early as the age of eight using a combination of physical and radiographic examination. If, however, the patient is not seen by a dental professional regularly and the impaction is not detected in a timely manner, there is an increased likelihood that the patient will experience some undesirable complications. These include:
- Pain and pressure in the gum at the expected eruption site
- Uneven spacing and malocclusion of adjacent teeth
- Gum recession and periodontal disease
- Dull ache or sharp pain in the teeth surrounding the affected area
- Decay of partially erupted or impacted tooth due to inability to clean properly
- Spread of decay from affected canine to healthy adjacent teeth
- Tumor or cyst formation potentially leading to alveolar bone and pathologic fracture
Canine Impaction Management for Orthodontic Therapy
Proper management of impacted canines must involve the work and cooperation of both an oral surgeon and an orthodontist. Though each individual and each case will prove unique, treatment typically consists of the placement of orthodontic braces first and then a referral to the oral surgeon. The oral surgeon will make an incision along the gum above the empty cuspid’s space and lift a flap of tissue to reveal the impacted tooth beneath. When a primary tooth is present and impacted as well, it is removed to make room for the permanent tooth.
The oral surgeon then places an orthodontic bracket to the tooth, attaching the bonded and bracketed tooth with a small chain to the arch wire of the braces. In some cases, the gum tissue is repositioned over the impacted canine, leaving the chain visible. In others, the surgeon sutures the gum tissue higher up above the once hidden tooth. The oral surgeon and orthodontist will continue to work together as necessary throughout the full development and proper growth of the canine tooth or teeth treated. The ultimate result of this type of therapy is a complete set of teeth that function properly and are aesthetically pleasing.
Ankyloglossia and Its Release: Correcting Tongue Tie (Frenuloplasty)
Ankyloglossia, more commonly known as “tongue tie,” is a relatively common abnormality of the corded tissue structure beneath the tongue. This band of oral mucosa is called the lingual frenum or c and derives its name from the Latin “little bridle of the tongue.” The translation of the name is particularly apt in cases of ankyloglossia. When a patient is tongue tied, the lingual frenum actually does serve as a restricting bridle, preventing the tongue from extending as far out as it should.
Correcting Tongue Tie
Though most infants’ frena recede naturally over the course of their first year, up to two percent of babies experience ankyloglossia that affects their ability to develop normally in the areas of speech and feeding. In severe cases, the extended frenum may even contribute to the formation of a visible gap between the two bottom teeth.
To correct ankyloglossia in babies, the simple frenectomy is performed with or without anesthesia, depending on the severity of the tongue tie itself, the parents’ preferences and the informed recommendation of the attending doctor. Because there are very few nerve endings in the lingual frenum, pain is minimal and most children recover from the rapid snip very quickly. In fact, in the majority of cases, a baby can begin breastfeeding immediately after the procedure is completed. The tongue is free from its excessive attachment to the floor of the mouth and is capable of forming a proper latch, allowing the child to receive sufficient sustenance and preventing maternal discomfort.
Alveoplasty is the reshaping of the bone underneath the gums. Sometimes the bone may be too sharp causing irritation from a denture. The oral surgeon would simply smooth the bone for better comfort.
Tori are bone bumps which may interfere with the seating of a denture. They can be present on the top or bottom jaw. Their removal may become necessary for a better denture fit.
If a patient’s jaw bone is too short for a denture, a vestibuloplasty may be the appropriate procedure for you. This procedure lowers the floor of the mouth and muscle attachments to allow for more room for a denture.