Orthodontic exposure of impacted canine

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August 15, 2003 at 9:29 am #3515 Reply

Glenn van As
Spectator

Well folks I have been saving a few of my cases since I got burned out and tonight I posted a few of them for you to view.

I do so not to suggest anything more than here is how one person tries to use his lasers to help patients get a better result. Its not that I know more than anyone else, just one persons perspective.

I did this case last week. Patient is 15 and we have been waiting patiently at moms request to get the tooth in but it wouldnt come in.

I raised a flap on the buccal with the chisel tip and found that I wasnt really far enough to the mesial with my releasing incision……..

Anyways, I couldnt do a window with the laser because I wouldnt have been in attached tissue and then I would for sure need a graft. I am trying to drag the tooth and the attached tissue down with the tooth.

I managed to coagulate and get a bracket on and suture the tissue with two large honking sutures ( I need to get some smaller sutures like 6.0 vicryl so that is my next endeavor) and I show you 5 day healing at the end. I like the healing in this case and will say that it might still need a graft and mom is aware of this but I loosened the tooth ever so slightly on the surgery day with an elevator to make sure it would come down.

I thought the tissue looked pretty good. I didnt like my flap design but hindsight is 20/20.

Have a good weekend and I will be thinking of you in Alaska, and I will shoot some non laser photos for you!!

Cya

Glenn

August 15, 2003 at 9:31 am #12048 Reply

Glenn van As
Spectator

Shoot so tired forgot photos……..

here they are.

Glenn

August 16, 2003 at 3:05 am #12047 Reply

vince
Spectator

Hi Glen,

I like to place 2 releasing incisions, one mesial and one distal to the cuspid, and connected at occlusal side with semi-lunar type design.
Make sure you have enough attached gingiva and apically reposition it and suture it down @ cuspid’s CEJ or as close as possible to it. It will come down with the crown and vary rarely requires a graft.

Nice case, thanks for sharing.

Vince

August 16, 2003 at 10:09 am #12049 Reply

Glenn van As
Spectator

Hi Vince: thanks for the comments. I infact did place two incisions and a semilunar inicison at the cervical of the teeth.

I was leary of the amount of attached tissue and had a heck of a time getting it to place where I did. The tooth is coming quickly so time will tell.

Thanks again………good points. Again surgery , flap design isnt really my strength so each and every time I am learning as I go. I know its pushing the envelope but thats how we all learn.

Glenn

September 24, 2003 at 4:46 am #12045 Reply

drannette
Spectator

Glenn,

No laser stuff, just a nifty exposure technique:

Recently my daughter had both #6 and 11 exposed. #11 had a dentigerous cyst and was overlying the root of #10 in the depth of the vestibule. #6 was also high up. The oral surgeon laid 2 sizeable flaps from the crest of the ridge, bracketed the teeth with chain attachments, then vertically troughed out the alveolar bone on the buccal to create a path of least resistance for eruption, and fully closed the flaps over the teeth and brackets and sutured at the crest. No windows in the soft tissue.

The sites healed very well and the teeth are moving nicely and should erupt fully into attached gingiva. Cool procedure. I took photos with the surgeon’s camera which should be ready this week. If you are interested I will post them.

Annette Skowronski

September 24, 2003 at 5:48 am #12050 Reply

Glenn van As
Spectator

Hey Annette……..I for one would love to see how he did this, it would be awesome. The flap is great to see how he did it.

Thanks again and take care , hope things are going great.

Cheers

Glenn

September 25, 2003 at 4:02 am #12046 Reply

drannette
Spectator

Glenn,
Glad you are interested. I’ll post the photos. Just because I felt guilty in not using the laser for the exposures, I removed a fibroma with the DELight today. All the patient and I could say was AWESOME! SHe is returning Saturday for a post op ck. I’ll take healing photos then.

Thanks SOO much to everyone who posts (and those that taught at the ConBio seminar) I feel guilty for having so much fun at the office and doing better dentistry to boot!

Annette SKowronski
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