Surgical-orthodontic approach of two palatally impacted canines with maxillary lateral incisor anomalies in a growing class II patient: A case report.

Introduction: After the mandibular third molars, the maxillary canines are the most displaced or impacted teeth in permanent dentition. Surgical-orthodontic disimpaction of impacted canines, followed by aesthetic reconstructions, can be a successful treatment choice.
Aim: The aim of this case report was to describe the smile restoration through simultaneous surgical disimpaction of the two upper permanent canines in a 13-year-old patient who also presented with agenesis of the right upper lateral incisor and a conoid-shaped left upper lateral incisor.
Treatment Protocol: The present case report followed the Care Checklist For Case Reports. After having completed the multibrackets fixed orthodontic therapy phase necessary for the preparation of the anchorage, avulsions of the upper deciduous canines were carried out, followed by the making of surgical full thickness palatal flap in order to perform traction of the permanent canines, and an orthodontic eyelet with passive metal looped ligatures was applied. One week after the surgery, traction was started with Crescini-double arch technique. Subsequently, the avulsion of elements 2.2 and 5.2 were executed. At the end of orthodontic treatment, in order to optimise the aesthetics and function of the canines, a restorative treatment was carried out.
Results and Conclusions: After the surgical creation of a palatal flap, the disimpaction of the two upper canines, using the double arch technique, allowed the teeth to be moved into the desired position on the upper arch.
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