Dottorato in TECNOLOGIE INNOVATIVE NELLE MALATTIE DELLO SCHELETRO,
DELLA CUTE E DEL DISTRETTO ORO-CRANIO-FACCIALE

Titolo della tesi: NEW APPROACHS IN ORTHO-SURGICAL TREATMENTS WITH STIMULATE & INNOVATIVE TECHNOLOGY

INTRODUCTION: Impaction is defined as the failure of tooth eruption at its appropriate site in the dental arch, within its normal period of growth. After the third molars, the permanent maxillary canine is most commonly impacted tooth with an incidence of 1% to 3%. It shows a predilection for the palatal over the labial side, it is more common in female patients than in male patients and it has a definite tendency toward being unilateral rather than bilateral. 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 (guidance theory) or with aplasia of premolars and third molars and supernumerary teeth (genetic theory). Several methods are proposed in the literature to manage and treat palatally impacted canines. The standard procedure is surgical exposure and forced orthodontic eruption (combined surgical-orthodontic treatment). There are two basic surgical methods for the exposure of a palatally impacted canine, the open and the closed technique. The open technique includes the surgical exposure of the crown by either complete removal of bone and soft tissue. The canine can be either left to spontaneously erupt or an orthodontic attachment is directly bonded on the canine in order to directly apply traction. The closed technique on the other side involves exposing the canine crown, and bonding an attachment on it; orthodontic traction is applied after initial healing, until the canine erupts in the oral cavity and is subsequently guided to the dental arch. To date, laser technology got a more important role in modern dentistry and also in orthodontics was proposed the utilization of laser devices. According to the literature, the use of the laser related to orthodontic treatment offers several advantages when compared with conventional methods. AIM: 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. The hypothesis is that palatally impacted canines, after the laser surgery, will suffer a “spontaneous” eruption for reactivation of the physiological eruption, without any orthodontic traction (traditional method). Furthermore, this “spontaneous” eruption will be monitored through DENTAL MONITORING and INTRAORAL SCANNER. We will monitor 31 patients with unilateral or bilateral impacted canines in the palatal side, male and female, from the time of the laser surgery to the crown eruption. At this time, we will perform the alignment in the arch with direct/indirect bonding technique. Study can moreover analyze the effectiveness of monitoring through the intraoral scanner CS3500 (Carestream Dental), which allows to acquire precise dental coloured impressions. Monitoring will be carried out as follows: T0: Laser surgery T1: 1 week T2: 8 weeks T3: 16 weeks The result that we will expect, it’s the gradual disimpaction of canines in 4-6 months, rather than 12 months with traditional method, during which we will monitor the movements with pictures and scans. After that we will proceed to direct bonding of the full dental arch for the alignment. Scans of the arches will be overlapped to measure the spontaneous eruption movement of the canines. The results will be compared with the data obtained with the traditional surgery, underlining the advantages and disadvantages of this experimental technique.