ortho - the international C.E. magazine of orthodontics

ortho1_2013 I 15 C.E. article_ orthognathic surgery I You’ll need to know how to do pre-treatment setups and surgical setups. You need to apply all of these techniques on all patients (mixed dentition, adoles- cent or adult). Iftheteetharen’tinthecorrectpositioninthejaw, then there’s no way the surgeon can place the parts correctly, resulting in surgical failure. Most surgical failures happen because of orthodontics. One of the things you need to keep in mind in yourpre-treatmentsurgicalorthodonticsisthatyou established the correct arch form. Without the cor- rect arch form, it’s difficult to put the parts together. The other thing to keep in mind is the actual 3-D position of the teeth. If you have up-righted the up- per anterior teeth, the surgeon will have a difficult time fitting the mandible to this. If you have tipped the lower anterior teeth back too far — such as in a Class III — then you cannot obtainagoodmaximuminter-cusptationbecauseof the incorrect torque of the anteriors. The setup part of the procedure will give you this information. _Age If it’s an adolescent patient, you can do the pre- surgical orthodontic and establish the correct axial positionoftheteethineachjaw.However,donottry to fix the occlusion. That means the teeth will be in theproperpositionswhenyouapproachthesurgery. As a rule, I won’t get into a surgical case before a femaleisinherearly20s,andwithmalesintheirmid 20s.I’veseencaseswheretheyweredoneearlierand actually grew out of the correction. _Learning these techniques We all need to be taught to do these things, and it needs to be from someone who has done them for a number of years so you can be certain that the methods you are learning will work. They are taught in the Advanced Education in Orthodontics (AEO) course, and we do practice them. That includes surgical setup, orthodontic setup, soft-tissue cephalometric analysis and surgical treatment objective. They need to be practiced a numberoftimes.It’snotsomethingyoucanlearnon your own. You need a mentor who will teach you all the characteristics you’ll need. In the lab phase of the AEO class, we do get into mountingcasesonthetruehingeaxis.Youwilllearn how to establish these on patients. They are not time consuming.Normally,establishingahingeaxisinthe axio-path tracing and transfer takes no more than six or seven minutes, so the clinician is not using a lotofhisorhertimetoestablishacorrecthinge-axis mounting. The instructors will demonstrate how it’s done, and then have you perform the procedures. Under the proper guidance, you can learn these techniques and apply them in an office setting in an economical manner. Without the coaching, these procedures can feel like too much of a chore. Moreover, without coach- ing, there’s no way to do a surgical workup for the benefit of the patient, which of course, is the main reason you need to know these procedures. It also helps if you work with the surgeon and the restorativedentistbecauseit’stherestorativedentist who obtains the final outcome, and he or she needs to finish the case from where you left it. Ittakessometimeandittakessomeefforttolearn theseprotocols.Butonceyoudolearnthem,andyou have the technique, your surgical cases will be more stable, and you’ll cut down the instances of surgical relapse that you see. Above all, remember this is all for the benefit of thepatient.Youneedtospendtimelearningandyou needtospendtimeintheoperatingroomtoknowthe problems the surgeon encounters. Then you need to spend time in the diagnoses and workup. However,thebenefitisforthepatient,whowinds up with a functioning occlusion and improved face, andthegingivaltissuesarehealthyandthejawfunc- tions correctly._ Theodore D. Freeland, DDS, MS, is a board-certified orthodontist in Gaylord, Mich. After graduating from Albion College in 1967, he attended the University of Detroit Mercy, earn- ing a dental degree in 1971 and his master’s of science in orthodontics in 1978. Freeland has completed Dr. Gene Williamson’s course in occlusion and TMJ and the Roth/Williams course in advanced orthodontics. In addition, Freeland has served as an adjunct professor in orthodontics at the University of Detroit Mercy, and held appointments at the University of Detroitinfixedprostheticsandorthodontics;theRoth/WilliamsCenterasaclinicalinstructor; andtheAdvancedEducationinOrthodonticsGroupasdirectorandinstructor.Freelandisan accomplished author who lectures nationally and internationally. _about the author