Management of juvenile idiopathic arthritis in a 15-year-old patient: A digitally designed Herbst appliance combined with rapid maxillary expansion for transversal and sagittal correction

Juvenile idiopathic arthritis (JIA) is the most frequent systemic inflammatory disease involving temporomandibular joints in children. The reported prevalence of temporomandibular joint involvement in patients with juvenile idiopathic arthritis varies from 17% to 87% depending on the population studied, the subtypes, and the method for diagnosis. A 15-year-old girl was referred to the Department of Oral and Maxillofacial Surgery and the Department of Orthodontics of Parma University, Italy, for the evaluation and treatment of a three-dimensional facial deformity secondary to mandibular hypoplasia. The treatment strategy involved the use of a digitally designed Herbst appliance to promote mandibular growth and address facial asymmetry, occlusal plane deviation, and dental malocclusion. This phase was followed by fixed orthodontic therapy to finalize dental alignment and ensure occlusal stability. At the conclusion of the treatment, the patient demonstrated substantial functional and aesthetic improvements, with stability maintained during a three-year follow-up period. This case underscores the efficacy of combining functional therapeutic protocols with advanced digital technologies in the multidisciplinary management of JIA-associated dentofacial anomalies, offering a less invasive alternative to surgical interventions.

Imaging Software Programs for Reliable Mathematical Measurements in Orthodontics

AIM

To evaluate the reliability of linear and angular measurements taken using different software programs in orthodontics.

MATERIALS AND METHODS

A sample of four software programs from different manufacturers, namely MicroDicom viewer, Photoshop® CS3, AutoCAD®, and Image-Pro®, were used for measuring the geometric features of four types of miniscrews from different manufacturers. Each miniscrew type presented a group: Group I, Tomas® (Dentaurum, Ispringen, Germany); Group II, HUBIT® (HUBIT, Gyeonggi-do, Korea); Group III, AbsoAnchor® (Dentos, Daegu, Korea); and Group IV, Creative (Creative, Zhejiang, China). Measurements of apical face angle, thread angle, lead angle, flank, pitch depth, and width were taken on 45 × magnification scanning electron microscope images of the shafts of the miniscrews. One assessor measured the seven geometric features for the four types of miniscrews using the four software programs twice in two sessions separated by a three week interval.

RESULTS

Pairwise comparisons, for each of the four miniscrew groups, showed that the only common result observed was the significant difference (p < 0.001) between measurements of flank taken by the four software programs. When measurements of the four types of miniscrews were pooled into one group, a high degree of intra-rater reliability (ICC range from 0.9 to 1.0) for all the seven geometric features was found with all the four software programs. The paired t-test showed insignificant difference (at p ≤ 0.05) between the first and second measurements, except for a few measurements including pitch width measured by Image-Pro® (p = 0.012), MicroDicom (p = 0.023), and Photoshop® (p = 0.001).

CONCLUSIONS

Results did not give absolute superiority to one software program over the others and suggested an assessor effect. Assessor estimates could have been affected, among other factors, by the design of the miniscrews and the technical features of the software programs.

The Use of TADs in the Mandibular Arch to Prevent Proclination of the Lower Incisors during the Use of the Mini Scope Herbst Appliance

Class II malocclusions are the most frequent within the Italian population. Normally, these malocclusions are caused by a reduction in a mandibular component whose functional stimulus is still very much cause for debate. The negative effect of all types of Class II functional appliances is in the proclination of the lower incisors, which, in subjects whose incisors are already labially inclined, must be checked at all times to avoid serious consequences to these elements. In this case study, a girl aged 14 years and 5 months presented with Class II malocclusion, 2nd division with a convex profile and a visibly retruded chin. The lower incisors presented a marked proclination (-1/Go-Gn ini = 107.7°) in a brachyfacial patient. To avoid further inclination of the lower incisors a Herbst appliance was mounted in two separate sittings. The first part of the appliance including the tubes was mounted to the upper jaw allowing the vestibularisation of the upper incisors in order to increase the overjet. Once this was obtained the lower part of the appliance was mounted together with the telescopic arms associated with two temporary anchorage devices (TADs) in positions 36-37 and 46-47, and an anterior section 33-43 with distal loop to which two double metallic ligatures were anchored at the TADs to contrast the negative effect of the appliance. At the end of the first functional phase, the treatment was refined using MBK fixed therapy to finish the case. The orthodontic therapy led to a visible improvement of the profile and the achievement of a first-class dental-skeletal result on both sides. From the cephalometric evaluation carried out immediately after the Herbst appliance treatment at time T1 and at the end of the orthodontic therapy T2 it was possible to verify a slight increase in the inclination of the lower incisors (-1/Go-Gn fin = 108°). In conclusion, it can be said that the use of the skeletal anchorage avoided, in this case, the proclination effect in the lower incisors due to the use of a Herbst appliance.

3D Evaluation of Upper Airway Morphological Changes in Growing Patients with Class II Malocclusion Using Sander Bite Jumping Appliance

Class II malocclusion due to mandibular retrognathia is associated with a posterior positioning of the tongue and the hyoid bone, reducing the oropharyngeal volume. This could be a contributing factor to the development of respiratory and cardiovascular problems. This study evaluates the oropharyngeal volume variation in 13 patients with class II malocclusion undergoing functional orthopedic treatment with Sander Bite Jumping Appliance (SBJ). CBCT scans were performed before treatment (T0) and approximately after 12.5 months (T1): the retropalatal volume and retroglossal volume were quantified in mm3 using a segmentation software. At T1, the retropalatal volume increased in 2523 ± 2088 mm3, and the retroglossal volume increased in 2258 ± 1717 mm3. Both values were statistically significant (p < 0.05). This widening of the airways may allow prevention and treatment of sleep-disordered breathing, including obstructive sleep apnea syndrome.

Nerve Injury and Photobiomodulation, a Promising Opportunity: A Scoping Review on Laser Assisted Protocols for Lesions in the Oral Region

The currently available therapeutic options for restoring function and sensitivity in long-term nervous injuries pose challenges. Microsurgery interventions for direct nerve repair often lead to serious complications and limited success. Non-surgical methods, although somewhat effective, have limited benefits. These methods involve drug administration, such as with analgesics or corticosteroids. Photobiomodulation therapy (PBMT) has emerged as a promising approach based on clinical and laboratory studies. PBMT stimulates the migration and proliferation of neuronal fiber cellular aggregates, as reported in the literature. Experimental studies on animal models with peripheral nerve compression injuries have shown that PBMT can enhance the functionality of damaged nerves, preserving their activity and preventing scar tissue formation. The mechanism of action depends on the wavelength, which can positively or negatively affect photo acceptor resonances, influencing their conformation and activities. These findings suggest that photobiomodulation may accelerate and improve nerve regeneration. This review explores various methodologies used in photobiomodulation for regenerating nerve sensitivity after surgical trauma involving nerve structures, in the oral and peri-oral region. Research was conducted to evaluate which laser-assisted therapeutic protocols are used to improve the recovery of nervous sensitivity, using the JBI methodology for scoping reviews and following the PRISMA methodology.

Laser-assisted dentistry, safety, and cross-infection control: A narrative review

The rapidly expanding use of laser-assisted care in dentistry requires exploring all aspects of safety. The acronym laser stands for “light amplification by stimulated emission of radiation”. The laser produces a very narrow beam of electromagnetic radiation (light) and has been exploited for some innovative dental care technologies. So far, regulatory framework and laser safety issues mainly concern the prevention of some tissue damages (eye, non-target oral tissue, and non-target skin), and laser hazards (chemical, fire, and electric shock), but minimal on cross-infection prevention and control. Concerning infection prevention, it is important to remember that the outlook for infectious risk is alarming, dental patients are potentially infectious, and as with any other innovative oral-dental health technology, laser-assisted dentistry cannot claim to be free of healthcare-associated infections. The narrative review focuses on cross-infection prevention of laser-assisted dental care and includes 158 references. The search was adopted using some essential keywords from documents in databases (PubMed, Scopus) from 2010 to 2023. This study focuses on 10 important areas in results and discussion: a) international guidelines and recommendations; b) pre-procedural mouthwash before LD; c) indoor air quality during laser dentistry and recommendations for indoor air quality in dentistry; d) use of personal protective equipment; e) hand hygiene; g) reconditioning of laser safety eyewear; f) standards for the reconditioning of laser accessories; g) clinical contact surface disinfection and the use of transparent barriers; h) limitations; and i) perspectives. To ensure safety and cross-infection prevention, the study highlights the need for sound research and updated international guidelines, and better information for users with detailed recommendations for dental practitioners.

Exploring the Potential Clinical Applications of Salivary Cortisol in the Diagnosis and Management of Cushing’s Syndrome, Diabetes, Depression, and Periodontal Disease: A Systematic Review

Background

Current research primarily aims to investigate the potential of salivary cortisol for early diagnosis as well as clinical management and monitoring of disease progression. Its utility extends to a range of multidisciplinary settings, encompassing conditions, such as Cushing's syndrome, stress, and depression, pre-diabetes, type 2 diabetes, and periodontal disease, within dentistry. This systematic review aimed to analyze recent literature on the use of salivary cortisol as a biomarker for various clinical and pre-clinical conditions, including stress, depression, diabetes, Cushing's Syndrome (CS), and periodontal disease. Specifically, the review sought to evaluate its application in screening, diagnosis, clinical management, and monitoring disease progression.

Materials and Methods

Employing PubMed (MEDLINE) and Scopus databases, the search strategy utilized Medical Subject Heading (MeSH) terms, including “Cushing’s syndrome”, “diabetes mellitus type 2”, “hydrocortisone”, “saliva”, “biomarker”, “depression”, and “periodontal disease”, following the PICO model. The Cochrane Collaboration tool was used to assess bias risk for randomized clinical studies, while the ROBINS-I tool was used for observational studies.

Results

Adhering to PRISMA guidelines, 25 studies, comprising controlled interventions, pre-post studies, and observational/cohort or cross-sectional studies, were analyzed. We found a correlation between salivary cortisol levels and various health conditions. Elevated salivary cortisol was associated with increased disease severity in periodontitis, characterized by higher probing pocket depths and a greater plaque index. Patients with chronic periodontitis exhibited notably higher cortisol levels compared to healthy individuals, suggesting a link between stress and inflammatory responses in periodontal disease. Furthermore, salivary cortisol was identified as a valuable biomarker for detecting conditions, such as Cushing's syndrome and type 2 diabetes, with altered cortisol patterns indicative of disease progression. The findings highlighted the potential of salivary cortisol as a non-invasive diagnostic tool in assessing health status and managing related conditions.

Conclusion

Salivary cortisol serves as a crucial biomarker for the diagnosis and management of several health conditions, including Cushing's disease, diabetes, stress, depression, and periodontal disease. Its ease of measurement and reliability provide valuable insights into the Hypothalamic-pituitary-adrenal (HPA) axis, and the standardization of testing methods could enhance diagnostic accuracy. Continued research is essential to elucidate the interconnections among these conditions, which may inform future diagnostic and therapeutic strategies.

Effect of water contamination on the shear bond strength of self‐ligating brackets

Purpose: The aim of the present study is to evaluate the effect of water contamination on the shear bond strength (SBS) and adhesive remnant index (ARI) score of self‐ligating brackets.

Materials and methods: One conventional bracket and three different self‐ligating brackets were bonded onto 160 bovine permanent mandibular incisors, divided randomly into 8 groups. For each type of bracket, 20 samples were bonded on dry enamel and 20 after water contamination. After 24 h, all specimens were tested for SBS using an Instron Universal Testing Machine, and ARI scores were evaluated.

Results: All groups showed clinically adequate SBSs. Quick brackets bonded onto dry enamel showed significantly higher SBSs than all other groups tested, whereas the lowest shear strength values were recorded for Step, Quick, and Damon 3MX brackets bonded onto contaminated enamel and for Damon 3MX onto dry enamel. Frequency distribution of ARI Scores showed a prevalence of ARI “2” and “3” for all the groups tested.

Conclusions: Water contamination reduces the SBS of self‐ligating brackets, but significant differences have been found only for Quick brackets. All groups showed a significant higher frequency of ARI Score of “2” and “3”.