Maxillary Frenectomy

Maxillary midline diastemas are relatively simple to close during orthodontic treatment, but there are a number of factors that can contribute to the reopening of this space. The presence of “abnormal” maxillary labial frenum is the most frequently alleged etiologic agent in this relapse scenario. Most practitioners agree that this band of tissue must be surgically excised at some point in order to achieve a successful long-term result.

The questions surrounding this issue are:

• What constitutes an “abnormal” maxillary labial frenum?
• When should it be removed?
• What success rate should be expected to avoid relapse?

These questions are answered in a classic paper by Edwards. Most clinicians agree that three of four conditions exist in the presence of an abnormal frenum. First, the frenal attachment closely approximates the interdental margin and/or inserts palatally lingual to the incisors. Second, the attachment is wider than usual ant its insertion point. Third, there is movement and “blanching” of the interdental and/or palatal tissue upon stretching of the frenum and upper lip. The fourth condition that many clinicians agree upon is the presence of an invagination of the interseptal bone between the central incisors.

Almost all authors on the subject agree that an abnormal frenum should not be excised until the space is closed orthodontically because there is little evidence that spontaneous closure will result. Removing this tissue prior to space closure poses the risk of scar tissue formation, which can slow down subsequent attempts to space closure.

Edwards recommends a three-stage procedure when performing a frenectomy. The frenum is repositioned apical with denudation of the alveolar bone. The transept fibers are severed between the approximated central incisors, and the labial and/or palatal gingival papillae are recontoured in cases of excessive tissue accumulation.

Edwards’ study demonstrates that his procedure greatly increases the long-term stability of an orthodontically closed maxillary midline diastema.

Healthy Eating for Healthy Teeth

A healthy diet is essential to healthy teeth and gums. Developing teeth and the periodontal tissues especially need protein, vitamins A, C, and D, and calcium. It is also important to limit your intake of sweet foods like candy that will stick to your teeth and encourage bacterial growth that will lead to tooth decay. Vegetables, fruits and whole grain foods are great snacks because they are nutritious and won’t stick to your teeth. If you eat sweets at all, eat them after a meal when saliva levels are high and can fight the acids produced by sugar.

Article prepared by Diamond Braces Brooklyn Orthodontic Clinic.

Mini-Implants for Orthodontic Anchorage

Osseointegrated titanium implants have been successfully used to replace missing teeth, but their use for orthodontic anchorage has had certain limitations. Their use has been limited by space: conventional dental implants can only be placed in retromolar or edentulous areas. Another limitation has been the direction of force application: a dental implant is placed on the alveolar ridge and is too large for horizontal orthodontic traction.

Furthermore, dental implants are troublesome for patients because of the difficulty of oral hygiene, severity of the surgery, and the discomfort of initial healing.

Therefore, a mini-implant for orthodontic anchorage should be small enough to place in any area of alveolar bone, including apical bone. The surgical procedure should be simple enough for an orthodontist or general dentist to perform and minor enough for rapid healing. The implant needs to be easily removable after orthodontic traction. Such an implant can be made from a mini-bone screw used to fix bone plate for plastic reconstruction.

A 44-year old male patient had pain on the maxillary incisal papilla from biting with the mandibular incisors. Both mandibular second premolars and the maxillary right second molar were missing. Because of the severe curve of Spee and the deep bite, the treatment plan was to intrude the mandibular incisors.

The procedure was performed under local anesthesia. A mini-bone screw was implanted in the alveolar bone between the root apices of the mandibular central incisors.

Three additional screws were implanted, under the root alveolus of the maxillary central incisor and both sides of the missing mandibular second premolar, for future traction.

Each implant was placed 2-3mm from the root apex.

A mucoperiosteal flap was opened and the alveolar bone was denuded. A pit about 1.5mm in diameter was made by drilling into the cortical bone with a 2mm round bur, using water cooling After drilling into the bone with a 1 mm pilot drill as far as the length of the mini-implant, still using water cooling, the implant was inserted with the accompanying miniature screwdriver. The mini-implant was covered with the flap, and the wound was sutured. The position of the implant was documented with a periodical x-ray. After healing and osseointegration, the gingival tissue covering the mini-implant was removed. The soft tissue surrounding the head of the mini-implants was removed using a mucosal punch. A two-hole titanium bone plate was attached to the head of the mini-implant to act as a hook. A ligature wire was tied between this hook and the bracket on the mandibular central incisors to be intruded.

After four months the mandibular central incisors had been intruded 6mm. Neither periodontal pathology nor root resorption was evident. The patient had not complained of any discomfort during treatment and was satisfied with the overbite reduction.

Article prepared by Diamond Braces Brooklyn Orthodontic Clinic.