Computer-guided palatal canine disimpaction: a technical note

Aim: To present a minimally invasive approach to solve the impaction of palatal canines using computer-guided orthodontic miniscrews. Materials and methods: Miniscrew-supported appliances for palatal canine disimpaction are performed with CAD/CAM technology. With adequate software, it is possible to match the STL files of the dental arch with the DICOM images of the maxilla, previously transformed into STL files. The ideal points for miniscrew insertion can be identified on the STL 3D model file on the basis of the width and thickness of the palatal vault. A software application allows for the design of the surgical guide, which is printed using a 3D printer. The virtual position of the planned miniscrews is transferred onto a printed dental cast on which the orthodontic device is realized. On the day of surgery, both the surgical guide and the orthodontic appliance are ready for use. Results: Miniscrew insertion and palatal canine disimpaction can be achieved in one surgical procedure. Conclusion: The use of computer-guided skeletal anchorage allows for both the reduction of the biomechanical side effects typical of conventional treatment and the risk of damaging adjacent anatomical structures, increasing the effectiveness of treatment. Controlled clinical trials are necessary to evaluate more fully any advantages of this minimally invasive technique. Keywords: TADs, canine impaction, CAD/CAM, miniscrew, orthodontics, surgical template