PMC9560819_01
(a-c) Pretreatment intraoral and (d and e) radiographical recordings.
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Panoramic and lateral cephalometric radiographs were taken (Figures 1(d) and 1(e); Cranex  D, Soredex , Tuusula, Finland): the panoramic radiograph showed the presence of third molars' germs, lower deciduous canines' persistence, and upper left canine's impaction without apparent left maxillary incisors' radicular resorption. Intraoral pictures (Figures 1(a)-1(c); taken with Nikon Digital Camera D3500, Nikon Corporation, Tokyo, Japan) showed coincident dental midlines, deep bite, conservative treatments on upper central incisors, and upper lateral incisors' malposition.
Intraoral photo with the TPB cemented to the first molars and the orthodontic traction hook welded.
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Paul, MN, USA) and cement was light-cured (Starlight Pro, Power Output 1400 mW/cm2, Mectron S.p.A., Carasco, Italy; Figure 2).
(a and b) Intraoral photo during surgical procedure.
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After local anaesthesia (Septanest, articaine hydrochloride 4% with adrenaline 1/100,000), a diode laser (Fotona XD-2, Fotona d.o.o., Ljubljana, Slovenia) was used to perform surgical operculectomy, being an element in superficial palatal impaction, with the following parameters: 810 nm wavelength, continuous wave mode with a power output of 3 W and a 0.4 mm diameter optical fiber (Figures 3(a) and 3(b)).  Figure 4 shows how the surgical incision did not cause intra-operative bleeding, thus creating an ideal condition for the adhesion of the orthodontic bracket.
Surgical incision after laser surgery.
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After local anaesthesia (Septanest, articaine hydrochloride 4% with adrenaline 1/100,000), a diode laser (Fotona XD-2, Fotona d.o.o., Ljubljana, Slovenia) was used to perform surgical operculectomy, being an element in superficial palatal impaction, with the following parameters: 810 nm wavelength, continuous wave mode with a power output of 3 W and a 0.4 mm diameter optical fiber (Figures 3(a) and 3(b)).  Figure 4 shows how the surgical incision did not cause intra-operative bleeding, thus creating an ideal condition for the adhesion of the orthodontic bracket.
Orthodontic bracket positioned after surgical operculectomy, with a passive metal looped ligature and secured with composite.
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The orthodontic bracket was placed with a passive metal looped ligature, secured with composite (Figure 5).
Intraoral photo 1 month after surgery with active elastic traction on 2.3 and upper arch bonded.
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Ortodonzia e Implantologia, Sesto Fiorentino, Italy; Figure 6). After 2 weeks and 1 month follow-up, the intraoral wound healed without complications and no signs of infection (Figure 6); 3 months after surgery, the position of the upper canine can be appreciated and thanks to the orthodontic traction applied (Figure 7); 12 months after surgery, the upper canine 2.3, once included, is positioned at the level of the dental arch but a diastema remains between 2.2 and 2.3, for which orthodontic finalization is necessary to close it (Figures 8(a)-8(d)).
Position of 2.3 after 3 months of orthodontic traction and the extraction of deciduous 6.3.
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After 2 weeks and 1 month follow-up, the intraoral wound healed without complications and no signs of infection (Figure 6); 3 months after surgery, the position of the upper canine can be appreciated and thanks to the orthodontic traction applied (Figure 7); 12 months after surgery, the upper canine 2.3, once included, is positioned at the level of the dental arch but a diastema remains between 2.2 and 2.3, for which orthodontic finalization is necessary to close it (Figures 8(a)-8(d)).
(a-c) Intraoral photo and (d) panoramic radiograph 12 month after surgical-orthodontics disinclusion. Upper canine 2.3, once included, is positioned in the dental arch.
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After 2 weeks and 1 month follow-up, the intraoral wound healed without complications and no signs of infection (Figure 6); 3 months after surgery, the position of the upper canine can be appreciated and thanks to the orthodontic traction applied (Figure 7); 12 months after surgery, the upper canine 2.3, once included, is positioned at the level of the dental arch but a diastema remains between 2.2 and 2.3, for which orthodontic finalization is necessary to close it (Figures 8(a)-8(d)).