The VISTA Approach in Canine Disimpaction

Canine disimpaction is always a challenging orthodontic treatment overall, even when the impacted permanent canine is in a high position, especially when in tight relation with the upper incisors' roots. Conventional treatment methods are usually not capable of performing the correct force direction, consisting of the contemporary movement in the distal and vestibular directions of the canine crown, often provoking, as side effects, the presence of decubitus on the mucous of the lips and cheeks or a poor final appearance of the periodontal support of the disimpacted canine. Among the different approaches, the vertical incision subperiosteal tunnel access (VISTA) technique shows good performance with regard to the direction of the forces and the canine's periodontal conditions when erupted; it is usually realized through an elastic chain connected to a temporary anchorage device (TAD) in the posterior area. In this paper, a different protocol for the VISTA method is also presented, to be resorted to in cases of difficult miniscrew positioning due to the anatomic conditions or stage of dentitions. The new protocol also considers the use of nickel-titanium coil springs in order to avoid the need of frequent reactivation of the device and consequent patient discomfort, highlighting its advantages and indications with respect to the traditional approach.