what is the medical necessity of a "expose and ligate" for the bicuspids.

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Request for Question Clarification by ericynot-ga on 18 Nov 2002 10:17 PST

Are you certain this is the exact term? There are various reasons to
expose bicuspids in oral surgical setttings, but "ligate", which means
to "tie a band around" something does not seem to fit in this context.

Where did you run across this expression?

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Clarification of Question by mrhook-ga on 18 Nov 2002 10:56 PST

the oral surgen is calling this treatment "expose and ligate #6" /
"expose and ligate #11".  i am trying to make my insurance company
ackowledge this procedure has to be done and without this procedure
her bicuspids will not ever come down one there own.  they are saying
this is strictly an orthodontia procedure and will not pay however the
surgens office says this is a medical necessity and in the future it
will cause her to have cyst, infection and her bite will move  making
her go thru braces again and i will be out another 4000.00. they will
go in and open her gum attach a chain then attach the chain to her
braces.  it will then be pulled down a bit monthly until the teeth
have come down. the procedure takes about 45 min and she will be under
while they are doing this.  hopes this helps

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Request for Question Clarification by easterangel-ga on 18 Nov 2002 19:02 PST

Hi! I found some information regarding the medical consequences that
you were looking for. But first, I would like to know what information
do you already possess so as not to charge you with knowledge you
already have. What info have you gotten from your physician at this
point? Furthermore, what level of explanation do you require? Just let
me know. :)

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Clarification of Question by mrhook-ga on 19 Nov 2002 08:52 PST

I LOOKED UPON ON THE INTERNET AND THE CLINICAL PROBLEMS INCLUDE
PERIODONTAL DISEASE, RISK OF INFECTION AND CYSTIC FOLLICULAR,
COMPROMISE LIFESPAN OF OTHER TEETH, INTERFERE WITH SINUS CAVITY,
IMPROPER FUNTIONING OF THE TEETH, CAUSE PREMATURE WEAR, PAIN AND
POSSIBLY CANCER.  IF YOU FOUND FUTHER INFO THAT WOULD BE GREAT. 
THANKS SHAWNA LEACH

This might be used as a precedent in which a state dental board
declared the procedure to be not an orthodontic one:

"...in May of 1996, the Board [Kentucky Board of Dentistry] determined
that exposure and ligation of impacted teeth is outside the scope of
orthodontics."

http://www.dental-implants.com/kentuckey_letter.html

Here is another precedent: North Carolina's Medicaid guidelines have a
code covering "surgical exposure and ligation of a soft tissue
impacted tooth." Medicaid programs routinely exclude payment for
orthodontia unless there is a medical necessity.

http://www.dhhs.state.nc.us/dma/bulletin/pdfbulletin/1297bulletin.pdf

Your description of the teeth involved is somewhat confusing, so I
will answer your question based upon the following assumptions.

1. The teeth involved are her second premolars (should be the fifth
teeth back from the central incisor) as these are the last bicuspids
to erupt and often are impacted (hitting other teeth due to lack of
room to erupt).
2. She is about 10-12 years old and about to udergo fixed bracket
orthodontic treatment.

The ideal treatment option is to expose these teeth and bond gold
brackets to them and apply traction via fixed ortho wires to ensure
these teeth end up in the arch. This is however based upon the
assumption that the ortho treatment is NOT extraction based (i.e.
crowding of upper and loweer arches would need teeth extracted to
provide adequate room for straightening the rest of her teeth) in
either the upper and lower arches.

The question of whether these teeth should be left in-situ more
difficult. Unerupted teeth can indeed cause the formation of a
dentigerous cyst (although rare) which in turn would cause movement of
the adjacent teeth by the slow expansion of the cyst in the bone.
(unerupted teeth in the palate do not generally cause other teeth to
move as their angle of impaction does not favour tooth movement- like
lower wisdom teeth for example). Teeth left in situ like this should
be radiographed every 2 years as a precaution.
There is no chance of cancer. Whoever told you this is talking
rubbish.

I can give you more detailed info if I have more knowledge of your
daughter's case. Things like photos of any radiographs (OPT, lateral
cephalogram, upper standard occlusal, periapical) and photos of her
ortho study casts.