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Background: The permanent maxillary canine is the most impacted tooth after third molars. There are many possible surgical techniques to approach impacted canines. The literature reports that high-intensity laser therapies (HILTs) can be used for opercolectomy of an impacted tooth. The aim of this study is to propose a new orthodontic-surgical approach using a laser for the disinclusion of palatally impacted canines. Methods: Nine patients presented maxillary primary canine persistence in the dental arch. Orthopanoramic X-ray and cone beam computed tomography (CBCT) showed the impaction of permanent maxillary canines. Surgical exposure was performed using a diode laser (Raffaello, DMT, Lissone, Italy, 980 nm + 645 nm). No orthodontic devices were applied for impacted tooth traction. Canine movement was monitored at 1, 8, 16 weeks post-surgery with photos and a CS3500 intraoral scanner (Carestream Dental, Atlanta USA) to evaluate their autonomous eruption. Results: No complications were observed. In all the cases, complete disimpaction of the treated canines was obtained in only four months. Conclusions: Impacted canine exposure with a diode laser has many advantages if compared with traditional surgery. The pre-orthodontic exposure and autonomous eruption of impacted canines provided simplified and predictable outcomes. The absence of traction and the reduced time for orthodontic treatment increased compliance during the orthodontic alignment. [ABSTRACT FROM AUTHOR]

The impaction of permanent maxillary canine is a common clinical occurrence, and it is observed in 2% of patients who require orthodontic treatment. This case report describes a new orthodontic-surgical approach through the use of CO2 laser, for the exposure of the palatally impacted 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. Orthopanoramic X-ray showed impaction of both permanent maxillary canines. The family history revealed that the patient's mother had the same orthodontic problem. Cone Beam Computer Tomography (CBCT) was requested to plan the surgical-orthodontic treatment. Surgical exposure of the impacted canines was performed using a CO2 laser and subsequent periodontal pack application. No orthodontic devices were applied for impacted teeth traction on dental arch. Canines' movement was monitored at 1, 8 and 16 weeks post-surgery with photo and intraoral scanner CS3500 (CS3500®, Carestream Health, Atlanta, GA, USA). When canine crowns were completely erupted on palatal side, the alignment in the arch with indirect bonding technique was performed. Complete disimpaction of canine crowns was obtained in only four months. As reported in the literature, this case confirms that impacted canines' exposure to CO2 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. Conclusions: The pre-orthodontic uncovering and autonomous eruption of palatally impacted maxillary canines provides simplified, predictable, and more aesthetic outcomes. 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. [ABSTRACT FROM AUTHOR]