Orthodontic Exposure of Impacted Permanent Tooth using Soft Tissue Diode Laser

Introduction-An impacted tooth simply means that it is “stuck” and cannot erupt into function. The most commonly impacted or un-erupted tooth is the permanent maxillary canine. Primarily the impaction is due to arch length deficiency. Since the canine is usually the last tooth to erupt anterior to the first molar in the maxillary arch, shortage of space may result in ectopic eruption or impaction of this tooth. There has been numerous hypotheses developed regarding the etiology of canine impaction, the issue remains controversial. Impacted canine can cause complications without such as internal or external resorption, loss in arch length, infection associated with partial eruption, and resorption of the roots of lateral incisors.  

Treatment modality- Various treatment modalities have been proposed to avoid the complications associated with impacted canines such as use of scalpel, caustic agents, electrocautery and diode laser. However, Diode laser therapy is an effective and noninvasive treatment option for exposure of impacted canine without bone covering the tooth. But in most of the cases, it first requires orthodontic preparation of the maxillary arch in order to create adequate space between the lateral incisor and first premolar prior to surgical exposure. PIOON Laser offers different wavelengths like 450nm/810nm or 980nm. Out of which 450nm can be used in non-contact/contact mode whereas 810nm and 980nm are used in contact mode to perform the procedure.

In this case after obtaining the informed consent surgical exposure of the tooth with diode laser at wavelength of 450nm was used in non-contact mode under topical anesthesia and the soft tissue over the impacted tooth was exposed. The impacted tooth was cleaned and scaled to permit bonding and an orthodontic bracket was bonded to position immediately in the same siting after the exposure of the tooth. The patient was given postoperative oral hygiene instructions that included chlorhexidine rinses, gentle tooth-brushing.

Sana F et al. in 2018 and Deepa D et al used 940nm and 980nm wavelength respectively. They concluded that use of diode laser in the surgical intervention of submerged tooth exposure gives many intraoperative and postoperative advantages along with excellent results. Fornaini C et al. in 2016 also proved that wavelength 450 nm proved to be very effective and safe for soft tissue procedures with no side effects for the patients.

Rationale behind Use of Lasers Diode laser offers advantages like patient compliance, reduced pain and discomfort, faster healing process, absence of bleeding and less chair side time. The greatest advantage is the complete absence of bleeding, which gives the possibility to immediately bond the bracket in dry enamel, so preventing the possibility of detach and reducing the risk of a further re-intervention

Conclusion- The use of lasers in orthodontics, and in particular diode lasers, has made it possible for orthodontic clinicians to more easily address the challenges faced on a daily basis in an orthodontic practice.

References -

Sana F, Rizwan G, Shanin F, Dimple V and Nikhil M. Management of Impacted Canine with Surgical Exposure using Soft Tissue Diode Laser and Alignment by Orthodontic Treatment: A Case Report. JORDMIMS, 2017, 4(1), Page 50-52

Deepa D, Gazal J , Shivangi A. Diode laser excision of the soft tissue around submerged permanent canine - A case report. International Journal of Periodontology and Implantology, April-June 2017;2(2):64-66

Fornaini C, Rocca JP, Merigo E. 450 nm diode laser: a new help in oral surgery. World J Clin Cases 2016; 4:253–257.

Preoperative View (Courtesy- Dr. Sana Farista)  

Postoperative View  (Courtesy- Dr.Sana Farista)