Francesca Germanò

This report describes an innovative dynamic computer‐guided piezocision technique that integrates preoperative digital planning with real‐time intraoperative navigation to accelerate orthodontic treatment while minimizing complications. A 24‐year‐old female patient who requested short‐term orthodontic treatment underwent a minimally invasive, flapless corticotomy using a dynamic system. Preoperative optical scanning and cone‐beam computed tomography were performed for comprehensive three‐dimensional surgical planning. Intraoperatively, reference trackers were fixed and calibration was performed, enabling precise guidance. A conventional scalpel, adapted with a drill‐tag, was employed to execute fully guided soft tissue incisions, and a piezoelectric cutting insert was calibrated for corticotomy cuts. The dynamic navigation system provided continuous real‐time feedback on instrument position during the surgical procedure, guiding the surgeon regarding location, depth, and angulation, while ensuring optimal irrigation to reduce thermal risks. The fully guided dynamic piezocision technique enabled the execution of corticotomies following the planned cuts without surgical complications such as damage to dental roots or periodontal tissues. The dynamic approach allowed intraoperative adjustments and improved irrigation, reducing the risk of thermal injury. Fully guided dynamic piezocision may enhance surgical accuracy and safety compared to traditional methods by combining preoperative digital planning with real‐time dynamic navigation.

This case report of an 11-year-old subject shows the digital workflow for the management of an impacted mandibular canine using Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) technology along with Temporary Anchorage Devices (TADs). The miniscrew insertion site was planned using software, and a surgical guide was digitally designed and 3D printed. Orthodontic traction was performed using a 3D-designed and -printed device. In a single sitting, the miniscrew was inserted and the disimpaction device was also delivered. The primary objective of recovery and the repositioning of the impacted mandibular canine in the axis with its eruptive path was achieved. The space available and the subject’s early stage of mixed dentition was considered favourable to a spontaneous eruption. This case report shows how CAD/CAM digital technology, combined with 3D printing, enables the creation of a surgical guide to position the miniscrew and the customized devices used for mandibular canine disimpaction. CAD/CAM surgical guides can help clinicians to position TADs with more accuracy and predictability, ensuring high quality bone support offering primary stability. Although orthodontic traction is the most complex therapeutic choice to implement, with the aid of CAD/CAM technology it is possible to proceed with accurate and minimally invasive orthodontic traction in order to recover a mandibular canine.

Maxillary canine impaction is an increasing dental anomaly and is often related to other dento-skeletal anomalies. The aim of this work is to support the clinician in evaluating the relationship between a displaced maxillary canine and clinical (the features of lateral incisors)/skeletal (ponticulus posticus and sella turcica bridging) anomalies through orthopanoramic radiographs, lateral cephalograms, and plaster casts to identify the parameters that best predict maxillary canine impaction. A retrospective observational study was carried out on the analysis of the medical records, radiographic findings (panoramic radiographs and lateral cephalograms), and plaster casts of 203 orthodontic patients divided into a case group, with at least one impacted maxillary canine, and a control group, without an impaction. A chi-square test and logistic regression analysis were used to analyze the data. A statistically significant association was found between the impaction of the maxillary canine and the female sex, the bridging of the sella turcica, the ponticulus posticus calcification, and the anomaly of the lateral incisor; a logistic regression revealed that these significant variables were found to be positive predictors of impacted maxillary canines, particularly in reference to the impaction in the palatal area. Finding one of these clinical and radiographic elements can represent a predictive sign of the possible impaction of the maxillary canine.