Introduction- Maxillary incisors are aesthetically important, parents often notices it first and are troubled. The children are bullied or teased due to delayed eruption resulting in psychological complications. It is necessary to bring the unerupted incisor into its correct position with proper monitoring and timely surgical orthodontic intervention so as no prosthetic solution is required as nothing is better than tooth itself. LASER have its advantages over conventional scalpel for the surgical exposure of the unerupted incisors.
Diagnosis of unerupted incisors-
A) Clinical evaluation-
B) Radiographic evaluation- The accurate location of the unerupted lateral incisor by the conventional two – dimensional radiographs is done. For the exact estimation of buccolingual position a second periodical film is obtained by using a) Clark’s rule b) Buccal-object rule. CBCT (Cone Beam Computed Tomography) can be used to avoid multiple exposure and to know the accurate position of the tooth.
In this case the patient’s chronological age was 9 years suggesting of delayed eruption of lateral incisor. Palpation of the painless incompressible labial fibromucosal protuberance or bulge is done to locate the crown. It is supported by the intraoral periapical radiograph. No bone is seen on the crown of the unerupted lateral incisor. The location and size of window to be made during surgical exposure is determined to be 1mm below the mucogingival junction.
Treatment- Pioon S1 blue dental LASER of 450 nm wavelength was used for the surgical exposure of lateral incisor.
This consist of following steps:
The complete safety protocols were followed for the patient, operating and assistant staff like using laser protective eye glasses and use of high vacuum suction. Highly reflective instruments were avoided while using lasers. (Fig 2)
Rationale for the use of LASER- LASER assisted surgical procedure has various advantages. Incision performance, hemostasis, reduced pre and post-operative oedema and pain hence the accelerated wound healing and reduced healing time resulting in less discomfort and reduced need of analgesics.
In paediatric patient behavioural guidance of children in the operative and perioperative period is a special challenge. Use of topical anaesthetic agent, no scalpel and less blood results in better cooperation from the children. It also aids in patient homecare and allows for better bracket repositioning and final detailing.
Conclusion – When unerupted tooth is not deeply placed, surgical exposure with Pioon LASER at 450 nm allows conservation of attached gingiva, no injection, less bleeding during surgery, less use of analgesic and anti-inflammatory drugs, minimal postoperative complication and also immediate placement of orthodontic brackets so less appointments as well. Hence LASER represents indispensable modality to treat paediatric patients with ease.
References-
1)HuBer K, Suri, Taneja P. Eruption disturbances of the maxillary incisors: a literature review. J Clin Pediatr Dent 2008; 32: 221-230.
