This technique is very similar to buccal advancement technique where the gingiva is close to the oroantral defect is mildly advanced to approximate it.
May be done for small sized defects.
It is not possible to get too much of advancement, as the palatal tissue is very rigid and thick.
In this,the palatal tissue surrounding the OAC, is reflected +may be advanced downwards and sutured to the buccal tissue to cover the detect.
Not a very successful procedure.
ROTATIONAL ADVANCEMENT FLAP or ASHLEY’S FLAP OPERATION:
• It is posteriorly based flap which gets its supply from the greater palatine artery. • Local anesthesia is infiltrated on the palatal aspect. Infilteration is also given on the buccal side of the oroantral defect. • Removal of fistula tract and clearing any signs pathology. • The flap is outlined with surgical marking an excess of what appears to be required to rotate the flap. • Incision is placed to the bone making sure the palatal pedicle is kept intact. • A full thickness mucoperiosteal flap is reflected with care taken to visualize the greater palatine vessels. • A small amount of tissue along the margin of the defect on the buccal aspect is also reflected to enable suturing. • The flap is reflected and rotated to fit the defect. There are chances of ending of the tissue when it is turned to cover the oroantral opening. • The flap is sutured to the buccal flap ensuring a good water tight seal. • The raw surface of the palate is left to granulate only. • A small gauze soaked in Whitehead’s varnish may be placed on that raw surface for a few days.
REFERENCES:
Textbook of Oral & Maxillofacial Surgery, Chitra Chakravarthy (2nd Edition)
Type of surgery depends on age of the patient & extent of deformity.
Treatment also varies if ankylosis is unilateral/bilateral.
SINGLE STAGE V/S 2-STAGE SURGICAL PROCEDURES:
Surgery can be done in two stages.
In the first operation, only a release of ankylosis is done.
It is believed that growth takes place after release of ankylosis.
Second stage procedure,an orthognathic surgery can be performed to restore esthetics.
Some, however prefer to it as a single stage procedure,where release of ankylosis + esthetic correction is done in a single stage operation in adults.
SURGICAL PROCEDURES:
There are 3 types:
Condylectomy.
Gap Arthroplasty.
Interpositional Arthroplasty.
TMJ APPROACHES:
SURGICAL APPROACHES TO THE TMJ: P1 and P2— preauricular approaches; PA-postauricular approach; I—inverted hockey stick approach; E -endaural approach. R-retromandibular approach.
1. CONDYLECTOMY:
CONDYLECTOMY
2. GAP ARTHROPLASTY:
GAP ARTHROPLASTY
3. INTERPOSITIONAL ARTHROPLASTY:
AUTOGENOUS COSTCHONDRAL GRAFT
KABAN’S PROTOCOL:
REFERENCES:
Textbook of Oral & Maxillofacial Surgery, Chitra Chakravarthy (2nd Edition)
• The Adams clasp was first described by Professor Phillip Adams. • It is also known as Liverpool clasp, universal clasp and modified arrowhead clasp. • When properly constructed this clasp offers maximum retention. • The clasp is constructed using 0.7mm hard round stainless steel wire.
The Adams clasp is made of the following parts: a) Two arrowheads b) Bridge c) Two retentive arms. The two arrowheads engage the mesial and the distal proximal undercuts. The arrow head are connected to each other by a bridge that is at 45° to the long axis of the tooth.
ADVANTAGES: • It is rigid and offers excellent retention. • It can be fabricated on deciduous as well as permanent teeth. • TheyThey can be used on partially or fully erupted teeth. • It can be used on molars, premolars and on incision. • No specialized instrument is needed to fabricate the clasp. • Young’s universal pliers that are used routinely for most wire bending can be used.
It is small and occupies minimum space.
The clasp can be modified in a number of ways.
MODIFICATIONS: • The Adams clasp can be modified in a number of ways. • These modification is permit additional uses or enhanced retention. • The following are some of the modifications of Adams clasp:
Adams with single arrowhead:
• The Adams clasp cam be modified to have a single arrowhead. • This type of clasp is indicated in a partially erupted tooth, which usually is the last erupted molar. • The single arrowhead is made to engage the mesio – proximal undercut of the list erupted molar. • The bridge is modified to encircle the tooth distally and ends on the palatal aspect as a retentive arrowhead.
Adams with J Hook:
• A Hook can be soldered on to the bridge of the Adams clasp. • These hooks are useful in engaging elastics. • Adams with incorporated helix: A helix can be inc porated into the bridge of the Adams clasp This helps in engaging elastics. Adams with additional arrowhead: • Adams clasp can be constructed with an additional arrowhead. • The additional arrowhead engages the proximal undercut of the adjacent tooth and is soldered on to the bridge of the Adams. • This type of clasp offers additional retention.
Adams with additional arrowhead:
Adams clasp can be constructed with an additional arrowhead.
The additional arrowhead engages the proximal undercut of the adjacent tooth and is soldered on to the bridge of the Adams.
This type of clasp offers additional retention.
Adams With Incorporated Helix:
A helix can be incor porated into the bridge of the Adams clasp.
This also helps in engaging elastics.
Adams with soldered buccal tube:
• A buccal tube can be soldered on to the bridge of the Adams clasp. • This modification permits use of extra-oral anchorage using face bow- headgear assembly . Adams with distal extension: • The Adams clasp can be modified so that the distal arrowhead has a small extension incorporated distally. • This distal extension helps in engaging elastics.
Adams With Distal Extension:
The Adams clasp can be modified so that the distal arrowhead has a small extension incorporated distally.
This distal extension helps in engaging elastics.
Adams on incisors and premolars:
• Adams clasp can be fabricated on the incisors and premolars when retention in those areas is required. • They can be constructed to span a single tooth or two teeth.
DISADVANTAGES: • Needs special arrowhead forming pliers the o fabricate. • Occupies a large amount of space on buccal side. • Arrowheads can injure interdental soft tissues. • Difficult & time consuming to fabricate.
REFERENCES: • Orthodontics: The Art & Science,SI Balajhi (7th Edition). • SlideShare
Derichsweiler type: • The first premolars and the first molars are banded. • Wire tags are soldered onto the palatal aspect of the bands. • These wire tags get inserted into a split palatal acrylic plate incorporating a screw at its centre.
Hass type • The first premolar and molar of either side are banded. • A thick stainless steel wire of 1.2 mm diameter is soldered on the buccal and lingual aspects connecting the premolar and molar bands. • The lingual wire is kept longer so as to extend past the bands both anteriorly and posteriorly. These extensions are bent palatally to get embedded in the palatal acrylic. • The split palatal acrylic has a midline screw. • The plural does not extend over the rugae area.
Isaacson type: • This is a tooth borne appliance without any acryl palatal covering. • This design makes use of a spring loaded screw called a MINNE expander (developed at the University of Minnesota, Dental School). • The first premolars and molars are banded. • Metal flanges are soldered onto the bands on the buccal and lingual sides. • The expander consists of a coil spring having a nut that can compress the spring. • This coil spring is made to extend between the lingual metal flanges that have been soldered. • The expander eactivated by closing the nut so that the spring gets compressed.
Hyrax type: • This type of appliance makes use of a special type of screw called HYRAX (Hygienic Rapid Expander). • The screws have heavy gauge wire extensions that are adapted to follow the palatal contour and are soldered to bands on premolars and molars.
REFERENCES:
Orthodontics: The Art & Science, SI Bhalajhi (7th Edition)
Dentowesome 