New approaches in ortho-surgical treatments with stimulate & innovative technology

The aim of this study is to show the effectiveness of laser technology for the exposure of the palatally impacted canines, using a CO2 laser device (Smart US20D®, DEKA - Florence, Italy) and Diodi Laser device (Raffaello, DMT, Lissone, Italy, 980nm +645nm), which can stimulate the spontaneous eruption of the canine, without orthodontic traction application. Moreover, the purpose of this study is to monitor the movement of the impacted tooth after exposure with laser approach with digital technologies. Another aspect of this study is focused on the differences between digital monitoring through scanner and conventional monitoring which is based exclusively on the clinical evaluation of the photos and the study of the plaster casts. The final experimental sample was constituted of 18 patients, 9 females and 9 males; of these 8 patients showed a bilateral inclusion and 10 a mono-lateral inclusion of the canine, for a total of 26 canines. To demonstrate the validity of the technique applied to the study group, a CONTROL GROUP, which included 9 patients with unilateral and bilateral palatally impacted canines (in total 13 canines), treated by a traditional surgical-orthodontic approach, was observed. This experimental project was conducted in order to evaluate the effectiveness of laser surgery as an alternative approach to conventional surgical-orthodontic treatment. After laser exposure, no orthodontics treatment was initiated until the impacted tooth had erupted sufficiently into the palate and the autonomous eruption capacity was assessed. The spontaneous eruption was quantified by measuring the millimeter distance between the cusp of the canine one week after surgery (released from the overlying mucous and bone tissues) and the cusp of the same after 16 weeks from laser surgery. Of the 26 canines under study all of them performed a movement between 2,72 mm and 7,04 mm (mean value: 5,01 mm). Therefore, we can state that, at the end of the evaluation period of 16 weeks, a significant teeth movement was observed. Furthermore, the exposure of part of the dental crown, allowed, in all cases treated, to apply a bracket or a button to align the tooth in the dental arch. Our data suggests that the response of the dental element to the bio-stimulant action of the laser, applied to expose their crown, can be considered effective. Of the values obtained, the ones most distanced from the mean value were considered (the highest values 6,9 and 7,04 and the minimum values 2,72 and 3,12) and the type of inclusion of treated canines to which they refer was evaluated. The four values correspond to canines in bone inclusion; in particular, the millimetric value 7,04 corresponds to a deep inclusion canine. Therefore, from what emerges from our study, no significant correlation was found between the extent of spontaneous eruption (in mm) and the type of inclusion. A further purpose of this study was the evaluation of the possible different action between the CO2 laser (wavelength: 10600 nm; power: 4.5 Watts) used in super-pulsed emission mode (that no have bio-stimulation capacity) and the diode laser (wavelength: 980 nm + 645 nm; power: 4 Watts) used in continuous wave emission mode. Comparing the millimeters of eruption of the canines treated with the two different types of lasers and applying the Student’s T-Test, we found a super-imposable value. Moreover, the study groups (group A and group B) and the control group were compared in terms of mean eruption time, respectively spontaneous or forced by means of a Crozat orthodontic device, activated monthly to allow the displacement of the canines .I n the control group the duration of the orthodontic traction is, on average, 10 months. In the study groups the canine eruption was spontaneous and occurred in an average period of 4 months. It can be stated that, although a forced orthodontic traction was applied in the control group to allow tooth eruption, the eruption times in the study groups were significantly lower. The results obtained indicate the effectiveness of the new approach proposed by us, although performed on a small sample of patients. The results are significant from different points of view. The advantages found in this study are numerous. The main advantages of digital monitoring are the possibility of evaluating parameters that cannot be evaluated analogically and of making measurements of distances normally calculated on plaster casts with compass and rubber with the respective errors. Other advantages are represented by the reduction of work time, due to the abolishing of the need to request plaster casts to the dental technician. Which also means the reduction of the costs of the laboratory and it also means less costs for the patients. By eliminating the steps of the analogue impressions and of the plaster casts, the details are certainly represented with more precision and accuracy and there is a minimum error accumulated. This digital workflow that is created is also managed entirely by a single person, which represents a further saving of time. Moreover, we have clinical advantages, that are the less discomfort of the patient who does not tolerate the classic impressions in alginate and of the orthodontist, and the reduction of the chair time. The application of the digital technologies in the monitoring helps the orthodontist to make clinical decisions supported on measurable data and not just on clinical experience. The our ortho-surgical protocol with the use of different technologies set off to a new concept of work in dentistry, in particular, in the cases characterized by impacted teeth or cases that expect an orthodontic and surgical approach. Finally, a not indifferent aspect consists in the reduce of treatment time, which is an advantage for both the orthodontist and the patient. It is consequence of the reduction of the steps and work-time, and it is due to the real monitoring that can be performed on the patient.