Punch and Pull: A Modified Technique for Exposure and Bonding of Impacted Canines

Aim:
Exposure and bonding of impacted canines is a well-established procedure in orthodontic practice. Traditional closed-eruption techniques commonly involve bringing the gold chain through the surgical flap and securing it to the orthodontic archwire. This may result in increased tissue manipulation, soft tissue irritation, and difficulty maintaining the chain position. This case series describes a novel modification to the closed-eruption technique and its clinical outcomes in three patients with impacted maxillary canines.

Cases and Technique:
Three patients undergoing surgical exposure and bonding of impacted maxillary canines were treated using a modified closed-eruption approach. Following exposure of the impacted canine and bonding of an attachment with a gold chain, a soft tissue punch biopsy instrument was used to create a small circular opening in the overlying mucosa directly above the impacted tooth. Rather than exiting through the surgical flap margin, the gold chain was passed through this opening, allowing it to emerge in a more direct path towards the oral cavity. The chain was then loosely secured to the adjacent mucosa using a non-resorbable suture, avoiding attachment to the orthodontic appliance at the time of surgery. The flap was repositioned and closed in the conventional manner.

Results:
All three cases demonstrated uneventful healing with no postoperative complications. This method allowed straightforward access to the gold chain during orthodontic traction. The technique provided a predictable emergence point, minimised tension on the surgical flap, and reduced the risk of chain displacement.

Conclusion:
This modified exposure and bonding technique represents a simple modification to the conventional procedure. The clinical outcomes observed in these three cases are preliminary and do not permit comparison with conventional techniques. Comparative controlled studies with larger sample sizes are required to determine whether this technique offers advantages over traditional chain management and to assess its reproducibility and long-term clinical outcomes.