The greatest inconvenience of the closed eruption technique is that it is preferable that the Orthodontists Baton Rouge be present in the operating room for bonding of the attachment before the flap is sutured back to its former place. It is true that many oral surgeons bond the attachments themselves. However, since the surgeon bonds orthodontic attachments far less frequently than docs the orthodontist, the chances of bond failure are relatively increased - the more so since the surgeon, when working with only chair-side nursing assistance, will need to undertake both the task of maintaining a dry and uncontaminated tooth surface in a very hemorrhagic field and, at the same time, that of performing the bonding procedure. It should be emphasized that in the case of the closed eruption technique, bond failure will dictate the need for a second surgical intervention. If the attachment is to be bonded at a later visit, the orthodontist does not need to be present at the surgeon’s side for an open exposure case. However, this means that the surgeon must expose the tooth much more widely, place surgical packs and aim for healing by 'secondary intention' only, with attendant negative periodontal implications.
Of far greater importance and directly related to ensuring successful resolution of the impaction, the orthodontist is able to see the exact position of the crown, the direction of the long axis and the deduced location of the root apex, by being present. The height of the tooth and its relation to adjacent roots may all be noted, and the orthodontist may confirm or change the original plan for the strategy of its resolution, by direct vision, in the light of what lie/she now sees ‘in the flesh. The orthodontist will be in a position to decide exactly where the attachment should be placed from a mechanotherapeutic point of view and will bond it there. The orthodontist is also the best person to fabricate and place a suitable and efficient auxiliary to apply a directional force of optimal magnitude and a wide range of movement, and to do so at the time of or, preferably, immediately prior to surgery.
It is not fair to expect the oral surgeon to be aware of how different attachment positions may affect the orthodontic or periodontic prognosis; nor should it be expected that Orthodontists Baton Rouge will be sufficiently experienced with the bonding technique to do this. Indeed, without the presence of the orthodontist, the surgeon may carry out the exposure of the tooth and place a bracket in the most convenient location that may seem to him/her to be entirely appropriate. At a subsequent visit, the application of traction by the orthodontist may need to be made in a particular direction which, because of an incorrectly placed attachment, is impossible to attain, and the tooth may cause damage to adjacent structures by being drawn in an unfavorable direction. It becomes evident that the inconvenience caused to the orthodontist by his/her being present at the exposure is handsomely rewarded in the long run by far greater control of the destiny of the impacted tooth, including efficacy and predictability of treatment and the quality of outcome.
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