Objectives: Tooth mobilization is a challenging orthodontic treatment. Inadequate interdisciplinary communication between surgery and orthodontics, as well as limited knowledge of the topography of the surgical field, can lead to unfavorable positioning of the appliance. This can result in dangerous force vectors for tooth movement. Comprehensive digital planning and customized tools could reduce these sources of error. Two cases of impacted canines were treated using cutting guides (CG) and customized attachments (CA).
Methods and Materials: A CBCT and intraoral scan were taken for planning. A CAD process was used to design a CG and a CA according to the required force vectors (OnyxCeph3™, Image Instruments GmbH, Chemnitz, Germany). Using various CAM processes, the CG (Biomed Clear Resin, Formlabs GmbH, Berlin, Germany) and a CA dummy (Permanent Crown Resin, Formlabs GmbH, Berlin, Germany) were fabricated in a 3D printer (Form 3b, Formlabs GmbH, Berlin, Germany). The CA was fabricated from titanium using the SLM process (OrthoLIZE GmbH, Nienhagen, Germany). The teeth were surgically exposed using the CG and CA dummies. The CA was conventionally cemented using Transbond XT (3M Unitek, Monrovia, CA, USA).
Results: All teeth were successfully exposed with the CG. The CA could only be placed in the predetermined position according to the digital planning.
Conclusion: The 3D planned CG can help to shorten the surgical procedure and keep the surgical field as small as possible. The 3D planned CA allows precise positioning. The digitally planned force vectors should prevent side effects on adjacent teeth and allow targeted mobilization. However, studies are needed for further validation.