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Combined Surgery and Orthodontic Treatment

On a regular basis orthodontists are required to work with other dental professionals and in particular, with Oral and Maxillofacial Surgeons. These combined orthodontic and surgical procedures are required to correct:

  1. Impacted teeth that are trapped below the gum and cannot erupt into the mouth, which can often come through on the palate.
  2. Atypical growth. The most common form of jaw surgery is lengthening of the lower jaw, but on occasions the upper jaw is repositioned or both jaws are reset.

Treatment of Impacted Teeth

Many teeth, most commonly the canine, may be impacted, meaning they are trapped below the gum and cannot erupt into the mouth. An Oral Surgeon or a Maxillofacial Surgeon can find these teeth in the gum and attach a gold chain to them. Braces are then fitted and the tooth is gently brought into its correct position. It is really amazing what can be achieved with excellent care.

Treatment of Atypical Growth

Some patients have discrepancies in the relationships between their jaws affecting the way their teeth bite together, and also discrepancies in the ways the jaws relate to the bones of the skull. Dr Peter Vaughan works with the local Maxillofacial Surgeons for combined orthodontic and surgical treatment of these patients. Dr Peter Vaughan has operated on people from all over Australia. Often from Sydney, patients seeking jaw surgery will often travel to Dr Vaughan's practice. Patients who have experienced atypical growth have three treatment options:

  1. Treatment with braces alone. Generally the patient has to accept a compromise in the orthodontic result if treated with braces alone.                                       
  2. Treatment with a functional appliance, usually also in conjunction with braces. Functional appliances can give very good results but need to be worn close to 24 hours a day for about 18 months. Unfortunately even with very good cooperation some patients do not gain the desired results. One inconvenience with functional appliances is they affect the speech, so most patients are reluctant to wear them as required. Find out more about functional appliances here.
  3. Combined surgical and orthodontic treatment. This gives us the best result. Unfortunately there is a lot of work and expense, but in situations where there has been atypical growth the results can be outstanding and patients are invariably thrilled with the results.

Dr Vaughan was the person who had the inspiration to change the traditional Distraction Surgical technique. Dr Vaughan understood why the traditional Distraction Surgical technique failed to achieve its objectives and he instructed a number of surgeons on how to perform a new surgical procedure now known as Intermolar Mandibular Distraction Osteogenesis (IMDO). The significant difference between IMDO and traditional Distraction Osteogenesis technique is the osteomtomoy cut through the bone, is made between the molars and not behind the molars. This has allowed the surgeon better access so a more accurate cut can be made, as well as allowing the distractors to be placed parallel to the chewing surfaces of the teeth. These changes have made IMDO a useful surgical technique.

After a number of years and a significant number of patients had been treaded with IMDO, Dr Vaughan enrolled at the University of Sydney and commenced a Master of Dental Surgery degree in order to evaluate the success of the IMDO technique. Unfortunately it was realised that the surgical procedure was not as successful as expected and a number of complications were identified. Following this Dr Vaughan is more selective when selecting the patients he treats with IMDO. While some surgeons & orthodontists are extremely enthusiastic about the results of the IMDO technique, Dr Vaughan expresses caution & that patients should obtain as much information as possible, & even second opinions, before they embark on surgery that otherwise it may not match their expectations.