For palatally impacted canines, various surgical approaches and various orthodontic traction techniques have been described in the literature. The therapeutic approach involves surgical exposure of the included tooth, followed by orthodontic traction to guide and align the tooth to the dental arch. Orthodontic treatment of the impacted upper canine is still considered a difficult challenge for clinicians, and it requires a multidisciplinary therapeutic approach. Erikson and Kurol found that the more mesially located the crown of the canine in the panoramic film, the more reduced the likelihood of canine eruption. The early diagnosis of canine displacement in relation to the surrounding structures is based primarily on radiographic examination. One of the fundamental aspects in the diagnosis and treatment planning of a complex tooth anomaly such as the impaction of the permanent maxillary canine is the ability to recognize the tooth displacement early and to predict the subsequent failure of eruption. The cause of impacted maxillary canines is not exactly known it is commonly thought that palatally impacted canines are associated with hypoplastic or missing lateral incisors (“the guidance theory”) or with aplasia of premolars and third molars and supernumerary teeth (“the genetic theory”). Of all patients who have impacted maxillary canines, 8% have bilateral impactions, and they are twice more common in females than males. The incidence of maxillary canine impaction is more than double that in the jaw, and the ratio of palatal inclusion to buccal one is 8 to 1. The upper canine is one of the teeth that mostly undergoes impaction, second only to third molars, with a prevalence range ranging from 0.8% to 5.2% depending on the population examined. The impaction of a permanent maxillary canine is a common clinical occurrence, and it is observed in 2% of patients who require orthodontic treatment. Furthermore, a significant positive factor is that there is no need to carry out the orthodontic traction of the impacted element, undoubtedly better compliance by the patient during the next alignment phase with the fix orthodontic appliance. Conclusions: The pre-orthodontic uncovering and autonomous eruption of palatally impacted maxillary canines provides simplified, predictable, and more aesthetic outcomes. As reported in the literature, this case confirms that impacted canines’ exposure to CO 2 laser has advantages if compared with traditional surgery: no bleeding during and after the procedure, decontaminant effect on the surgical area, no suture, and a fast spontaneous eruption. Complete disimpaction of canine crowns was obtained in only four months. When canine crowns were completely erupted on palatal side, the alignment in the arch with indirect bonding technique was performed. Canines’ movement was monitored at 1, 8 and 16 weeks post-surgery with photo and intraoral scanner CS3500 (CS3500 ®, Carestream Health, Atlanta, GA, USA). No orthodontic devices were applied for impacted teeth traction on dental arch. Surgical exposure of the impacted canines was performed using a CO 2 laser and subsequent periodontal pack application. Cone Beam Computer Tomography (CBCT) was requested to plan the surgical-orthodontic treatment. The family history revealed that the patient’s mother had the same orthodontic problem. Orthopanoramic X-ray showed impaction of both permanent maxillary canines. A 13-year-old female referred to our observation to make an orthodontic examination because of the maxillary primary canines’ persistence in upper arch. This case report describes a new orthodontic-surgical approach through the use of CO 2 laser, for the exposure of the palatally impacted canines. The impaction of permanent maxillary canine is a common clinical occurrence, and it is observed in 2% of patients who require orthodontic treatment.
0 kommentar(er)
