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 such as canines which often come through on the inside of the mouth.                                                                                                       
2. Correcting 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 Atypical Growth

Some patients have discrepancies in the relationships between their jaws affecting the way the jaws 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. Patients who have experienced atypical growth have three treatment options. They are:

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. The problem with functional appliances is they affect the speech, so most patients are reluctant to wear them as required.                                                                         
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 Peter Vaughan has worked with Dr Paul Coceancig, Maxillofacial Surgeon to develop a new technique, Intermolar Mandibular Distraction Osteogenesis (IMDO), that has revolutionised the way the lower jaw is lengthened. The new surgical procedure is an amazing step forward from the previous surgical procedure. Patient satisfaction has been fantastic and we believe it will not be long before this is a common procedure for treating individuals with significantly shorter lower jaws.

The advantages of IMDO are:

1. There is less patient discomfort.
2. It is suited to treating patients from 13 to 18, and perhaps at other ages.
3. The patient is treated before dental and skeletal compensations develop that will prevent an ideal result being achieved if BSSO surgery is undertaken at a later stage.
4. Braces are not required and the surgical procedure is easier than the traditional BSSO technique. Most patients still benefit from braces, but a significant number are very happy with the result achieved and elect not to have braces. If they wish for braces they can still be placed many years later with no disadvantages.
5. We have yet to experience any complications with this procedure, whereas the traditional BSSO procedure has a significant incidence of complications.
6. This technique creates space that can be used to correct crowding in the lower jaw, thereby helping to treat patients without extracting teeth.

Unfortunately not all patients or problems are suitable for IMDO, and so the traditional BSSO or La Fort maxillary surgical procedure is indicated. Dr Vaughan treats many patients in conjunction with Maxillofacial Surgeons. The improvements in function and aesthetics that are produced by a combined surgical and orthodontic treatment is really amazing.

Treatment of Impacted Teeth

Many teeth, but most commonly the canine may be impacted, that means 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. Some examples of teeth I have corrected are:

• A canine tooth growing above the floor of the nose, actually it was growing into the nasal cavity xray no 1 link here 
• A central incisor (front tooth) that was laying along the floor of the nose. In this case two other orthodontists told the patient to have this teeth removed as it could not be corrected. Can you imagine the effect removing a front tooth in a 12 year old. This is a very happy patient who is thrilled she came to my practice for a third opinion (see x-ray).
• A premolar laying locked against another premolar in the jaw. Even the Oral Surgeon insisted this tooth could not be corrected but as the patient was missing so many other teeth I had no choice but to do my best, which was certainly good enough. xray no 3 link here