Most contemporary dental treatments should be evaluated with an interdisciplinary work philosophy where all specialties are merged in order to rehabilitate the function of the stomatognathic system.
With today’s technology, there are specific orthodontic cases that can be solved in a simpler and faster way under orthosurgical interaction.
Dentofacial deformities
Dentofacial deformities are a group of alterations that occur in the upper and lower jaw and that establish between them an altered occlusal relationship, characterized by anomalies of size and position of these bones with respect to the base of the skull, affecting the facial harmony of our patients. Each type of dentofacial deformity (class I, II or III) is characterized by certain patterns that have skeletal, facial, dental and articular repercussions.
The treatment of dentofacial anomalies in their most severe cases is always surgical and is corrected with Orthognathic Surgery. In order to perform this type of major surgery it is necessary for the patient to undergo orthodontic treatment in two phases:
- Pre-surgical phase; we prepare the patient for surgery, moving the teeth with controlled forces exerted by orthodontic appliances to the ideal position within the maxillary or mandibular bone leaving them leveled and aligned to be able to undergo the surgical procedure. This consists of making cuts (controlled fractures) in the jaws to bring them to an ideal and stable position with respect to the base of the skull to provide a better aesthetic appearance and improve occlusal and articular function.
- Post-surgical phase, in which adjustments in the position of the teeth are completed to achieve the expected final result: stabilization of the ideal occlusion.
On the other hand, it is very convenient to emphasize that these specialties (Orthodontics – Oral and Maxillofacial Surgery) have more direct daily relations in our offices, which are the ones that will allow the Orthodontic specialist to solve and establish the idealization of the Stomatognathic System through a stable occlusal function. Therefore, a systematic and objective approach should be considered during the treatment in order to achieve healthy dental repositioning, proposing less invasive surgical procedures of hard tissues such as upper and lower third molar exodontia, selective alveolar corticotomies or flexicorticotomies, installation of anchorage attachments such as micro-implants or orthodontic micro-screws, dental implants, zygomatic implants, maxillary sinus elevations, subapical osteotomies or segmental osteotomies; and soft tissues such as labial and lingual frenilectomies, tissue excision and all types of muco-gingival surgeries.
The most important of all treatment is to establish a timely diagnosis of any of the three groups mentioned above that allows us to establish an individual treatment planning protocol for each case with clear objectives and adapted to the needs and requirements of the patient where the specialist can indicate major or minor surgical procedures that are effective, harmonious and long-lasting.
How and when is it performed? Can it be done with minimally invasive surgery?
With the initial establishment of a timely diagnosis, clear treatment objectives and interdisciplinary communication between specialists, it is possible to establish a working protocol where the patient has clear all the treatment planning, selecting the type of surgical procedure to be performed and the time of indication. Generally, orthodontic treatments require for their initiation a strict periodontal evaluation that will lead throughout the treatment, the maintenance of oral hygiene, installation of orthodontic appliances and conduct of treatment initially with minor movements, to be able to establish at an appropriate time the interconsultation for re-evaluation and scheduling of minor or major surgical procedure.
What is minimally invasive surgery?
The concept of minimally invasive surgery is currently very fashionable and comes mainly from cardiovascular surgery, from which it has been extended to other surgical specialties such as traumatology and orthopedic surgery, neurosurgery, plastic and oral-maxillofacial surgery, among others. In general terms, its foundation is based on the use of technology to perform computer-guided surgeries that are less morbid, very small, almost imperceptible approaches, tunneled techniques with special instrumentation that allow faster recovery and reintegration of our patients to their daily work, with stable and long-lasting functional aesthetic results over time.
Currently, minimally invasive surgery is widely used in dentistry in the field of oral implantology, achieving the installation of these devices in critical bone regions, avoiding or reducing the number of surgical procedures and facilitating implant-supported rehabilitation in less time and with excellent esthetic-functional results. We can also implement this technology in Ortho-surgical cases, planning digitally all movements and ambulatory surgeries with greater precision conceived in the printing of guided splints that, combined with special instrumentation, facilitate the resolution of cases that may have a greater complexity.
What complications are possible?
Every surgical procedure requires a complete pre-operative preparation where laboratory tests are performed in conjunction with evaluations by medical specialists who are fundamental in the treatment planning.
We often observe in our offices that patients show a certain degree of anxiety mixed with misinformation before a surgical procedure.
It is of utmost importance to let you know that currently the work protocols dictated by the different Scientific Societies are very clear, and with the creation of these and improvements of different consensuses the possibility of risks and complications is becoming less and less, as long as all the variables concerning the procedure are covered.
It is important that the patient clearly understands the act to which he/she will be submitted, mentioning and explaining to him/her all the cares concerning his/her surgery. It is not easy for any specialist to talk about failures, the natural or instinctive tendency of every human being is to present first the indications, the successes and try not to mention the possible complications or failures; these, however, must be considered as an evolution factor in our consultations to make a correct analysis of the frequency of appearance, probable origin and, above all, how to reduce their appearance.
Within the dentoalveolar surgery or minor oral surgery we can mention as the most frequent post-surgical complications: inflammatory conditions associated with pain, trismus (limitation of oral opening that is recovering with the evolutionary process), hematomas, infections associated with food intake or habits that are contraindicated (smoking), post-surgical bleeding that are increasingly less, since with the correct study of the pre-surgical routine we can evaluate or predict the behavior of our patients to the injury to which they will be subjected. Generally, all these complications are considered minor and easily solved by the treating specialist, however, we cannot rule them out when we give the information to our patients in the consultation.
What recovery will the patient need?
The responsibility of the treating specialist or his interdisciplinary team does not end with the completion of the surgical procedure, but must also ensure that the patient can achieve a satisfactory recovery as soon as possible. This satisfactory attention, for us, is key in the confidence in the treatment and resolution of all doubts in order to avoid complications after the surgical act. Therefore, we consider of utmost importance to establish a constant and clear communication between both parties, being willing to resolve doubts and possible complications.
In this recovery plays an important role rest, which is necessary for wound healing emphasizing that the post-operative inflammatory picture is normal and necessary to achieve the establishment of a physiological process with all the defense cells responsible for getting it to be established in a balanced way. Remind them by all possible means that oral surgery is a minor surgery, so it is natural that temporary changes occur in your mouth and in the areas near the surgical wound. You should not worry, you will return to your normal functions in a few days, but it is very important that you follow a series of detailed indications, including postoperative medication (antibiotic, analgesic), for your prompt recovery, to prevent complications and to make you feel more comfortable.
Finally, interdisciplinary work is one of the strengths to be considered when considering an integral management of our patients, and the integration with other health areas such as physiotherapy, in different phases of treatment, exponentially improves the comfort, adaptation and functional esthetic results of the patients.