CO2 laser for surgical treatment of impacted canines

INTRODUCTION Impaction is defined as the failure of tooth eruption at its correct site in the dental arch, in its normal period of growth. The permanent maxillary canine is the most commonly impacted tooth after third molars, it has a predilection for the oral side with a tendency to be unilateral. It is more common in females. The etiology is unclear: orally impacted canines can be associated with hypoplastic or missing lateral incisors or with aplasia of premolars, presence of supernumerary teeth and malpositioned third molars. There are many possible surgical techniques to approach impacted canines: early interceptive intervention or late intervention, including extraction, autotransplantation, surgical exposure of the canine’s crown with open or closed technique and subsequent orthodontic alignment. The choice depends on canine position, associated malocclusion, skill and experience of orthodontist and surgeon, patient compliance. Literature reports that High-Intensity Laser Therapies (HILT) with cutting action on the soft tissues, can also be used for opercolectomy of impacted tooth. MATERIALS AND METHODS A 13-years-old male referred to the Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, for an orthodontic examination because of the maxillary primary canines persistence in dental arch. Orthopanoramic x-ray showed osteomucosal impaction of both permanent maxillary canines. The family history revealed that patient’s mother had the same orthodontic problem. Cone Beam CT was requested to plan the surgical-orthodontic treatment. Surgical exposure of the impacted canines was performed using a CO2 laser (Smart US20D®, DEKA-Florence, Italy) and subsequent periodontal wrap application. No orthodontic devices were applied for impacted teeth traction on dental arch. Canines movement towards the dental arch was monitored at 1, 8 and 16 weeks post-surgery with intraoral scanner CS3500 (Carestream Dental). When canines crowns were completely erupted on palatal side, the alignment in the arch with direct/indirect bonding technique was performed. RESULTS Complete disimpaction of canines crown was obtained in only four months. CONCLUSIONS As mentioned in Literature, this case confirms that impacted canines exposure with CO2 laser has advantages if compared with traditional surgery: no bleeding during and after procedure, no need to use sutures and laser biostimulating effect allow spontaneous eruption faster than with conventional treatments.