In a combined orthodontic-jaw surgery, the position of the teeth is corrected with fixed braces and the misaligned jaw is treated with a surgical procedure. In the case of serious jaw misalignments, a combined orthodontic and maxillofacial surgical treatment is necessary.
If orthodontic therapy begins in childhood, subsequent surgical intervention is rarely necessary. Removable braces usually have a sufficient effect on the growth of the jaws. Only in the case of very pronounced misalignments, for example if the lower jaw is extremely large in relation to the upper jaw (overbite – mandibular prognathism), oral surgery may be unavoidable. It is not performed until adulthood, when the jawbone has grown.
In adults, a combined orthodontic and maxillofacial surgical treatment is almost always carried out in order to correct jaw misalignments in the long term. Because the jawbone is fully grown, it can no longer be influenced by braces.
PROCESS OF THE TREATMENT
The combined orthodontic and maxillofacial surgical treatment in adults usually lasts about three to four years. Jaw growth must be complete. In younger patients, this is checked with a wrist radiograph if necessary.
A palatal expansion is performed when the upper jaw is too narrow. To do this, the upper jaw is carefully divided in the middle and on the sides and an expansion device is used. It has to be adjusted regularly by the patient and gradually moves the two jaw halves apart in the upper jaw. The body automatically fills the resulting small gap in the upper jaw with new bone substance.
The appliance usually remains in the jaw for about six months. During this time, the teeth in the upper jaw are continuously getting more space. This can be recognized by the fact that a gap forms between the incisors, which is then closed orthodontically.
Diseases of the jaw joints can primarily occur as inflammation, such as arthritis. Temporomandibular joint diseases are secondary to functional disorders in the masticatory system. Malfunctions in the masticatory system can trigger various types of pain and discomfort in the head and jaw joint, but also in the neck, shoulder and back. One speaks of craniomandibular dysfunction CMD.
The pairs of temporomandibular joints, consisting of the lower jaw head, cartilage disc and joint cavity in the upper jaw, are constantly in action: chewing, biting, laughing, yawning. A closely networked system of muscles, tendons, nerves and the two temporomandibular discs enable complex three-dimensional movement sequences.
In a healthy chewing apparatus, the teeth of the upper and lower jaw, the chewing muscles and the two jaw joints work together harmoniously. The teeth mesh like a cogwheel, each tooth finds a suitable opponent, the tooth contacts – one speaks of the occlusion – are even. At the same time, the muscles are relaxed and the temporomandibular joints are in a physiological position that is symmetrical to one another: the bite is correct.
However, if the harmony in the chewing system is disturbed, i.e. the bite is no longer correct, pain and discomfort occur, which often necessitate treatment of the jaw joint.
There are many causes of the “wrong bite”: misaligned teeth, such as a crossbite, tooth gaps, wear and tear of the teeth due to bruxism/teeth grinding, but also poor dentures, unsuitable tooth fillings or inadequate orthodontic measures can lead to incorrect loading with compression of the jaw joints and tension in the jaw chewing, face and head muscles.
When you clench and grind your teeth at night, enormous unconscious chewing forces act on the jaw joints and can damage them directly. Emotional stress can also trigger muscle tension in the chewing apparatus and thus strain the jaw joints. Genetic factors play a rather subordinate role in the course of the disease.
Jaw cysts are usually round cavities in the jaw that contain liquid, pulpy or gaseous contents. Jaw cysts grow very slowly and are usually symptom-free for a long time. Therefore, many patients do not know that they are affected. Cysts are often only discovered by chance during an X-ray in the dental practice when dental treatment is due. Complaints such as a feeling of pressure or dull pain only appear when the cysts enlarge and thus press on nerves or strain the jaw by displacing healthy tissue.
Basically, cysts are among the most common pathological processes in the mouth, face and jaw region, with the upper jaw being more frequently affected by radicular cysts at the root of the tooth than the lower jaw. Developmental cysts, on the other hand, more commonly affect the mandible. In addition, cysts form more frequently in men from a young age to middle age than in women.
If a patient has unclear pain such as a feeling of pressure or dull pain, the dentist will of course look specifically for the cause of the pain and take three-dimensional X-rays of the jaw and teeth. Otherwise, cysts are often only accidentally discovered on the X-ray in the dental practice.
Since cysts are constantly increasing in volume and spreading, neighboring areas can be affected – up to and including jaw bone loss. Therefore, it is advisable to have the cyst removed as soon as its presence is known.
To do this, the oral surgeon opens the mucous membrane and the bone and completely removes the cyst. Attempts are made to protect the surrounding tissue and neighboring teeth. Sometimes, however, z. B. in the case of a tooth root cyst, the root tip is cut, which can also be done as a laser treatment and is therefore considered a very gentle surgical method.
Oral surgery can be performed under local anesthesia. At the request of the patient or in the case of anxious patients, general anesthesia is also possible in the oral surgery specialist practice or in a dental clinic.
The prognosis for complete healing after the complete removal of the cyst on a tooth or the jaw is good, so that the cyst is not expected to reappear at the operated site.
Wisdom teeth that have erupted and are correctly integrated into the dentition usually do not have to be removed. However, this case is the exception. In many cases, a wisdom tooth is a tooth that is embedded in the jaw and cannot erupt due to the limited space available.
Partial or complete displacement can lead to cyst formation or even abscesses. Injury to adjacent teeth, nerves or soft tissue is also possible. In this case, the only right decision is: the wisdom teeth must be removed! This is also the case if the orthodontic treatment is to be successful.