Tomographic and Periodontal Clinical Parameters Two Years After Surgical Exposition of Maxillary Impacted Canines. Case Series

Abstract

Introduction: This report on clinical cases presents the evaluation of periodontal parameters that should be assessed in patients with impacted maxillary canines as predictors of post-operative results. Objective: To evaluate the surgical follow-up after two years, analyzing the tomographic and clinical periodontal parameters of the impacted maxillary canines that underwent an orthodontic traction procedure after exposure by using apical and lateral reposition flaps from existing keratinized tissue. Case presentation: Clinical parameters were evaluated: plaque index, gingival index, pocket depth, keratinized tissue width, and Cairo esthetic score. Tomographic parameters were also evaluated: bone height, bone support, and bone thickness. After two years of post-operative follow-up, clinical parameters showed the absence of plaque in the gingival area, absence of inflammation, bleeding, color change, and absence of periodontal pockets. The width of keratinized tissue obtained was 4.3 mm and it always kept up with the tooth ́s movement. Its aesthetics and quality are comparable to the adjacent tooth. Cone-beam computed tomography showed that the bone height was greater in the labial region and lesser in the palatal region and the percentage of bone support was related to the height of the alveolar crests. The thickness of the labial bone plate was smaller compared to the thickness of the palatal bone plate. Conclusion: The apical-positioned flap and the lateral-positioned flap have been demonstrated as periodontal plastic surgery techniques to maintain an appropriate width of keratinized tissue around natural teeth. In the literature, there are not sufficient reports showing the joint evaluation of clinical and tomographic periodontal parameters, so they must continue to be reported to create an evaluation protocol before canine exposure surgery in the future.