Pain, duration and safety of computer-assisted surgical exposure of palatally displaced canines: A case series

Abstract

Background: Surgical guides have recently been introduced in application to the open exposure of palatally displaced canines (PDCs). The present study assesses postoperative pain, fitting of the guide, surgery time and safety of the procedure. Material and methods: A prospective case-series was conducted from March 2023 to October 2024. Patients 12 to 20 years of age with at least one PDC requiring treatment with a combined orthodontic fixed appliances and surgical approach were included. Surgical templates were obtained after virtual planning. An intraoral scan was superimposed with cone-beam computed tomography to design the guide with a window according to the canine position. Flapless open exposure using the guide was performed, employing a scalpel and ostectomy with burs if needed. Surgery time (from the administration of local anesthesia to the start of the orthodontic attachment bonding or the placement of the protective pack), guide adjustment and intra-surgical complications were also reported. A questionnaire was given to the patient to record postoperative pain, analgesic consumption and any possible adverse event. Descriptive and bivariate analyses were performed.RESULTS: Ten patients (14 PDCs) were included. Computer-assisted PDC exposure lasted a median of 26 minutes (IQR = 18.00), and no complications were reported. All patients experienced mild post-operative pain (i.e., VAS < 40 mm). Pain intensity peaked between 2 and 24 hours post-surgery and gradually decreased over time. Surgical guides successfully fit in all cases. No fitting issues were noted that affected the accurate placement or functionality of the guide. Conclusions: Computer-guided exposure of PDCs is a feasible minimally invasive approach that reduces surgery time and postoperative pain. The use of an individualized guide is an easy tool for increasing the safety and efficacy of this procedure.