Analysis of Class II Intermaxillary Elastics Applied Forces: An in-vitro Study

Objectives

The aims of this study were: (1) to assess the average inter-arch distances characterizing Class II malocclusions, (2) to analyze the applied forces at those distances by different elastics, and (3) to compare measured forces with those declared by manufacturers, both in dry and wet environments.

Materials and Methods

Settings and sample population: Class II models of 167 adult subjects (96 women and 71 men, age: 28 ± 3 years) referred to the Orthodontic Department of the University of Turin, Turin, Italy, between January 2018 and January 2020, were collected. Distances between facial axes (FA) points of upper canines and lower first molars (A), upper first premolar and lower first molar (B), upper second premolar and lower first molar (C), upper canine and lower first premolar (D), and upper canine and lower second premolar (E), were measured using 3Shape Ortho® Viewer program. Different elastics' diameters and forces were tested at those distances. The MTS Insight® Electromechanical Testing System was used to measure the tensile forces of elastics. The applied forces were measured in dry (T0) and wet conditions, after 1 (T1), 6 (T2), and 12 h (T3).

Results

Average distances were calculated: A = 24.64 mm (SD 2.10), B = 16.3 mm (SD 1.94), C = 9.78 mm (SD 1.77), D = 9.8 mm (SD 1.88), and E = 15.99 mm (SD 2.06). Significant differences (p < 0.05) were highlighted between the measured force and the force declared by manufacturers, and all elastics had a significant force decay (p < 0.05).

Conclusion

The results showed that 3/16" 4.5 oz are the most reliable elastics in terms of applied force with respect to the declared one and in terms of force degradation.

A comparison between stereophotogrammetry and smartphone structured light technology for three-dimensional face scanning

OBJECTIVES

To compare three-dimensional facial scans obtained by stereophotogrammetry with two different applications for smartphone supporting the TrueDepth system, a structured light technology.

MATERIALS AND METHODS

Facial scans of 40 different subjects were acquired with three different systems. The 3dMDtrio Stereophotogrammetry System (3dMD, Atlanta, Ga) was compared with a smartphone (iPhone Xs; Apple, Cupertino, Calif) equipped with the Bellus3D Face Application (version 1.6.11; Bellus3D Inc, Campbell, Calif) or Capture (version 1.2.5; Standard Cyborg Inc, San Francisco, Calif). Times of image acquisition and elaboration were recorded. The surface-to-surface deviation and the distance between 18 landmarks from 3dMD reference images to those acquired with Bellus3D or Capture were measured.

RESULTS

Capturing and processing times with the smartphone applications were considerably longer than with the 3dMD system. The surface-to-surface deviation analysis between the Bellus3D and 3dMD showed an overlap percentage of 80.01% ± 5.92% and 56.62% ± 7.65% within the ranges of 1 mm and 0.5 mm discrepancy, respectively. Images from Capture showed an overlap percentage of 81.40% ± 9.59% and 56.45% ± 11.62% within the ranges of 1 mm and 0.5 mm, respectively.

CONCLUSIONS

The face image acquisition with the 3dMD device is fast and accurate, but bulky and expensive. The new smartphone applications combined with the TrueDepth sensors show promising results. They need more accuracy from the operator and more compliance from the patient because of the increased acquisition time. Their greatest advantages are related to cost and portability.

Maldevelopment of the cranio-facial-respiratory complex: A Darwinian perspective

AIM

The mammalian Cranio-Facial-Respiratory Complex (CFRC) comprises several different biological tissues that collectively function under coordination from the central nervous and cardiorespiratory systems, primarily to breathe, eat and drink as well as integrating the sensory and motor systems for speech, communication and protective mechanisms. Anthropologists have long recognised that lifelong exposure to modern feeding regimens of readily available and highly processed foods, changes in breastfeeding and weaning, can impact expression of various phenotypic traits affecting the CFRC quite differently than does lifelong exposure to more traditional ancestral feeding regimens, typical of hunter-gather/foraging in non-Western-exposed cultures. The aim of this study is to highlight the role of the paediatric dentist in a multidisciplinary approach in which professionals working in and around the CFRC can actively prevent tooth decay and skeletal-dental malocclusion in the light of evolutionary oral medicine.

RESULTS

As a result of changes in the environment, in the food quality, in eating and feeding practices starting from day one, two oral diseases of civilisation, tooth decay and skeletal-dental malocclusion, have both relatively recently reached worldwide epidemic proportions and afflict people of all ages.

CONCLUSION

A multidisciplinary approach in which professionals working in and around the CFRC can actively promote prevention or reversal of dento-skeletal and myofunctional disorders, diagnose them when present and coordinate the appropriate therapy and life long maintenance programme.

Myofunctional therapy Part 3: Tongue function and breastfeeding as precursor of oronasal functions

Breastfeeding is the best practice to ensure proper nutrition, correct growth of the craniofacial complex and overall health of the baby with optimal breathing, feeding and sleeping functions. Many mothers face breastfeeding problems due to the baby's difficulty in latching, especially if the lingual frenum is restricted. Early detection and understanding of some of the root causes of those difficulties will lead to an early intervention, thus getting the babies on the right tract of their full potential of growth and development.

Analysis of Earlier Temporomandibular Joint Disorders in JIA Patients: A Clinical Report

The aim of this study was to analyse the structural characteristics of the temporo-mandibular joint (TMJ) and the dysfunctional consequences induced by disease in subjects with juvenile idiopathic arthritis (JIA). The study was conducted in 25 patients with JIA (median age (IQR), 13.9 (10.9-15.3)) and 26 healthy controls (median age (IQR), 14.3 (11.6-17.2)) years. All enrolled patients were subjected to anamnestic evaluation, laboratory parameters, JIA subclass, and type of therapy for the disease. A clinical-gnathological evaluation, anamnestic and dysfunctional index (Ai and Di), and magnetic resonance imaging of TMJs were performed in all patients. The test group showed a significant reduction (p < 0.001) regarding the clinical findings such as maximal mouth opening, left and rightward laterotrusion and protrusion, and a significant difference in the reported symptoms (TMJ sounds, reduced mouth opening and pain), and Ai and Di (p < 0.001) compared to healthy patients. Correlation analysis showed a significant correlation between the median duration of disease and the maximum mouth opening and between visual analogue scale (VAS) score and maximum mouth opening, leftward laterotrusion, rightward laterotrusion, and protrusion. The results obtained in this study suggest that patients with JIA presented a cohort of symptoms in TMJs in comparison with healthy controls. Moreover, a careful TMJs evaluation and an early diagnosis of TMJs dysfunction and regular follow-ups are recommended in order to prevent and reduce functional and chewing problems in patients with JIA.

Myofunctional therapy Part 2: Prevention of dentofacial disorders

AirwayCentric approach to prevention of dentofacial disorders. The correct development of functions is important for the prevention of dentofacial disorders from the first days of life. The first and foremost function, to which all others are adapting, is nasal breathing. The AirwayCentric® method focuses on nasal breathing during early development and throughout childhood to promote: Neurobehavioural development and the brain, development of the craniofacial and respiratory complex, correct dental occlusion, proper and restful sleep and to improve performance and life overall. By working at the same time on orofacial functions and structures, many dentofacial disorders can be prevented.

Short term dentoskeletal effects of mandibular advancement clear aligners in Class II growing patients. A prospective controlled study according to STROBE Guidelines

AIM

To evaluate the dentoskeletal effects of the Invisalign® Mandibular Advancement (MA) (Align Technology, San José, CA, USA) feature in skeletal Class II growing patients with mandibular retrusion, at pre-pubertal and pubertal stages.

MATERIALS AND METHODS

Study design: Forty skeletal Class II patients were prospectively recruited and treated with Invisalign® MA. They were divided into two subgroups according to the CVM stage of growth (CVM2 and CVM3) at the beginning of treatment (T0). For each patient, lateral radiographs were collected at the beginning (T0) and at the end of the mandibular advancement treatment (T1) and their measurements were compared with those obtained by an untreated control group of 32 subjects, matched for growth stage and malocclusion.

RESULTS

Patients in CVM2 showed significant reduction of ANB angle, A:Po, Wits index, 11^Spp angle and significant increase of 11^41 and B Downs point. In CVM3 significant reduction of the Wits index and of 41^GoGn angle, and significant increase of the linear Co-Gn measurement, were revealed.

STATISTICS

The STROBE guidelines were followed. Linear regression analysis was performed to estimate the differences of ? (T1 - T0) means between group (control was used as reference) stratifying by CVM levels.

CONCLUSION

The use of Invisalign® MA is effective in treating Class II growing patient with retrognathic mandible in the short term period. While treatment at prepubertal stage of growth results in dentoalveolar rather than skeletal effects, treatment during the pubertal spurt produces skeletal effects with an annual rate of change of 5.8 mm.

Factors related to maxillary expander loss due to anchoring deciduous molars exfoliation during treatment in the mixed dentition phase

OBJECTIVES

The aim was to identify factors associated with maxillary expander loss due to anchoring deciduous molars exfoliation and assess the diagnostic accuracy of the upper second premolar cusp position as a prognostic factor for the exfoliation of its corresponding deciduous molar.

MATERIALS/METHODS

Ninety-two subjects aged 8.4 ± 1.1 years, treated with a Haas or hyrax expander, and using the same expansion protocol and deciduous teeth as anchorage were included. The position of the upper second premolar cusp, according to the half pulp chamber (HPC) line of the ipsilateral upper first permanent molar, was assessed on pre-treatment panoramic radiographs.

RESULTS

A significant association between anchoring deciduous molar exfoliation and the position of the upper second premolar cusp according to the HPC line (P = 0.002; odds ratio = 5.7) was seen, while there was no association with gender, age, treatment duration, and type of expander. The median survival time for an anchoring deciduous molar, when the underlying premolar cusp was touching/crossing the HPC line, was 13.0 (11.7; 14.2) months. The upper second premolar cusp position to the HPC line showed high accuracy (at least 76.11 per cent) and substantial repeatability (at least 0.7) as a prognostic factor for the corresponding second deciduous molar exfoliation.

LIMITATIONS

Applicability in the mixed dentition phase with fully erupted upper first permanent molars.

CONCLUSIONS

The probability of a second deciduous molar to be successfully used as maxillary expander anchorage for at least 16 months is above 94 per cent; when at baseline, the corresponding premolar cusp is apical to the HPC line.

3D Morphometric Analysis of Human Primary Second Molar Crowns and Its Implications on Interceptive Orthodontics

The second primary molar represents an anchorage element in interceptive orthodontics. The present study aims to analyze the 3D morphology of primary second molars in order to provide reference data and implications about the development of orthodontic bands for second primary molars. Digital models of dental arches from 150 subjects in primary or mixed dentition were analyzed. Six dimensional variables were digitally measured for each second primary molar, and the mean and standard error of the mean (SEM) were calculated and compared applying Student t-test statistical analysis. The mean value results show statistically significant dimensional differences between the upper and lower teeth, (mostly p < 0.0001), except for the variable h1, while only the variable h1 showed significant differences between the antimetric teeth (left and right). The dimensional variations between the right and left molars were considerably minor compared to those found by comparing the upper and lower arches. A significantly higher dimension of the lower molars and a more rectangular shape were observed.

Myofunctional therapy. Part 1: Culture, industrialisation and the shrinking human face

Culture, industrialisation and the shrinking human face: Why is it important? Over the past 300,000 years, not only has the way we consume food from birth through our lifetime changed, there have also been changes related to the methods of food preparation, availability, processing, and storage. These diet-related factors, along with other epigenetic factors, have led to a widespread increase in orofacial myofunctional disorders (OMDs) and resultant human malocclusion phenotypes (HMPs) worldwide. Currently there is an increasing need for resolution of HMPs in early childhood and associated OMDs. This review will include reports of cases and describe the nature of the problem and strategies for effective solutions.

Telemedicine for a Multidisciplinary Assessment of Orofacial Pain in a Patient Affected by Eagle’s Syndrome: A Clinical Case Report

Background:

Orofacial pain has a broad range of origins and a multidisciplinary approach occupies a relevant role.

Objective:

The aim of this study was to review the literature regarding the evolution of telemedicine and orofacial pain related to a case report of a patient affected by Eagle's syndrome.

Materials and Methods:

Two authors (RJM and SG) independently reviewed the literature up to March 2020. A case report was developed by including the interdisciplinary assessment and initial treatment of orofacial pain in a 38-year-old female patient affected by Eagle’s syndrome. The patient was interviewed by two different specialists (from Rome, Italy and Los Angeles, California) through an online meeting platform in order to evaluate her complex situation, demonstrating the possibilities that telemedicine offered during the COVID-19 pandemic.

Conclusion:

An interdisciplinary approach can be performed for future follow ups on patients as various advantages were found by the patient and by the clinicians themselves.

Mandibular Advancement Devices (MAD) as a Treatment Alternative for Obstructive Sleep Apnea Syndrome (OSAS)

Background:

Continuous Positive Airways Pressure therapy (CPAP) is the gold standard treatment of the Obstructive Sleep Apnea Syndrome (OSAS), however, the scarce adherence to the therapy requires the evaluation of other therapeutic alternatives.

Objective:

The aim of the present study was to assess the effectiveness of Mandibular Advancement Devices (MAD) in subjects affected by OSAS who had interrupted the treatment with CPAP and to make comparative evaluations.

Methods:

Eighteen subjects (15 males and 3 females), aged between 27 and 60 years, with a diagnosis of moderate to severe OSAS were included. Inclusion criteria: polysomnographic examination before treatment (T0) and after 1 month from the beginning of the therapy with CPAP(T1), interruption of the treatment due to loss of compliance, Epworth Sleepiness Scale (ESS) questionnaire filled out at T0 and T1. Subjects started the treatment with MAD and polysonnographic examination was prospectively executed after 3 months (T2) and 1 year (T3). One-way analysis of the variance (ANOVA) was used to compare data of polysonnographic examination performed at T0, T1, T2 and T3 as well as the differences of ESS scores recorded at different timing.

Results:

Compared to baseline (T0), all functional parameters tested showed statistically significant differences at T1, T2 and T3 (p < 0.001), meanwhile no differences were found between data recorded after therapy with MAD (T2 and T3) and with CPAP (T1). Similar results were also found with the score of ESS among different timelines (p < 0.001).

Conclusion:

These findings suggest that MAD could be a valid alternative for the treatment of OSAS in those patients with scarce adherence to the CPAP therapy.

The Digital Diagnostic Approach to Stafne’s Bone Cavity (SBC): From a Review of the Literature to the Description of a Clinical Case

Introduction:

Stafne’s Bone Cavity [SBC] is a rare, well-defined, mandibular bone lesion, which was first discovered by Edward C. Stafne in 1942.

Objective:

The purpose of this article is to evaluate a digital diagnostic approach to Stafne’s Bone Cavity (SBC) through a review and description of some clinical cases.

Methods:

The review was conducted through an analysis of the literature of all articles published on Stafne’s Bone Cavity.

We report the case of a 55-year-old male patient who needed tooth implant rehabilitation, and therefore, a panoramic radiograph was taken as part of the routine evaluation and plan of care. After the diagnosis, the focus was on more precise imaging and the merits of choosing Computerized Tomography or Magnetic Resonance Imaging were compared.

Results:

According to our review of the literature, the prevalence of these cavities was found to be 0.14%, while 8% of them were found in male patients and 72% of them were found in male patients older than 44 years of age.

The patient’s panoramic radiograph revealed the presence of an SBC in his left posterior side of the mandible. In order to confirm and improve the diagnosis, the patient underwent a Computer Tomography exam, chosen for its benefits outweighing those of an MRI.

Conclusion:

Stafne’s bone cavity (SBC) is indeed an uncommon finding as it is asymptomatic and is identified only through panoramic imaging, CT scans or MRIs. However, it can pose some logistical problems in the application of dental implants. The typology of this case study confirmed the findings of the systematic review; the patient, being a middle aged male, presented a mandibular SBC, which was discovered only during a routine panoramic x-ray to plan the fitting of dental implants. The use of tomography confirmed the diagnosis of SBC and detailed the anatomical structure, thus guiding the restoration process.

Diagnostic ability of the primary second molar crown-to-root length ratio and the corresponding underlying premolar position in estimating future expander anchoring teeth exfoliation

OBJECTIVES

The aim was to assess the diagnostic ability of the crown-to-root length ratio of the primary second molar and the position of the corresponding underlying premolar in estimating future anchoring teeth exfoliation during maxillary expansion.

SETTING AND SAMPLE POPULATION

Fifty-four subjects (30 females, 24 males; 108 teeth) aged 8.2 ± 1.0 years that underwent palatal expansion.

METHODS

The upper second premolar position of the corresponding expander anchoring primary molar was determined in relation to the ipsilateral first permanent molar half-pulp chamber (HPC) line on panoramic radiographs. Subjective and objective (based on measurements) assessments of the crown-to-root length ratio of anchoring primary molars were performed. Exfoliation after the expansion was recorded over a retention period of 12 months. All the assessments were performed individually by three examiners at two 3-week-apart sessions, trained and calibrated before enrolment. The intra-/inter-examiner agreements were evaluated, and the diagnostic accuracy of the methods was calculated.

RESULTS

All methods exhibited almost perfect intra- and at least substantial inter-examiner agreement (Kappa >0.8 and ≥0.63, respectively). Good diagnostic accuracy was seen for the premolar position to the HPC line (0.7-0.8), while the crown-to-root length ratio methods exhibited hardly sufficient accuracy. The diagnostic agreement of the methods was fair.

CONCLUSIONS

When primary molars are considered as anchoring teeth for maxillary expansion, the premolar position in relation to the HPC line appears to be the most valid and reliable method for predicting their stability. Despite high repeatability values, the crown-to-root length ratio needs a cut-off point re-definition to increase its predicting ability.

Platelet-Rich Fibrin in Single and Multiple Coronally Advanced Flap for Type 1 Recession: An Updated Systematic Review and Meta-Analysis

Background and Objectives: The aim of the present systematic review and meta-analysis was to investigate the efficacy of leukocyte–platelet-rich fibrin (L-PRF) in addition to coronally advanced flap (CAF) for the treatment of both single and multiple gingival recessions (GRs) compared to the CAF alone and to the adjunct of connective tissue graft (CTG). Root coverage outcomes using platelet concentrates have gained increased interest. In particular, it has been suggested that adding L-PRF to CAF may provide further benefits in the treatment of GRs. Materials and Methods: An electronic and manual literature search was conducted to identify randomized controlled trials (RTCs) investigating root coverage outcomes with CAF + L-PRF. The outcomes of interest included mean root coverage (mRC), recession reduction, keratinized tissue width (KTW) gain, gingival thickness (GT) gain, and patient-reported outcome measures (PROms) such as pain perception and discomfort. Results: A total of 275 patients and 611 surgical sites were analyzed. L-PRF in adjunct to single CAF seems to show statistically significant results regarding clinical attachment level (CAL) with a weighted means (WM) 0.43 95% CI (−0.04, 0.91), p < 0.0001, GT (WM 0.17 95% CI (−0.02, 0.36), p < 0.0001, and mRC (WM 13.95 95% CI (−1.99, 29.88) p < 0.0001, compared to single CAF alone. Interesting results were obtained from the adjunct of PRF to multiple CAF with respect to multiple CAF alone with an increase in the mRC WM 0.07 95% CI (−30.22, 30.35), p = 0.0001, and PPD change WM 0.26 95% CI (−0.06, 0.58), p < 00001. On the other hand, no statistically significant data were obtained when L-PRF was added to single or multiple CAF combined with CTG according to the included outcomes such as mRC (p = 0.03 overall). Conclusions: L-PRF is a valid alternative to CAF alone. L-PRF compared to CTG in single and multiple CAF showed statistically significant results regarding pain perception and discomfort PROms (p < 0.0001). However, CTG remains the gold standard for treating gingival recession.

Orthodontic treatment need and timing: Assessment of evolutive malocclusion conditions and associated risk factors

AIM

Orthodontic treatment need indexes are indispensable tools for collecting aepidemiological information, to define the need for clinical intervention on a graduated risk scale and to monitor the evolution of clinical conditions over time. The purpose of this research is to evaluate the prevalence of malocclusion and associated risk factors, and to compare the prevalence of malocclusion related to children's growth. Investigating the correlation between malocclusion and dental occlusion development is crucial to define orthodontic timing and the most suitable treatment modalities.

MATERIALS AND METHODS

A cross-sectional, multi-center, observational study was carried out throughout Italy: 4,422 patients aged between 2 and 13 years were visited. The patients were divided into two age groups: one composed of patients aged 2 -7 years, and one of children between 8 and 13 years of age. The prevalence data were classified according to the items of the Baby ROMA (first group, deciduous/early mixed dentition) and ROMA Index (second group, late mixed/permanent dentition). Pearson's Chi-square test was applied for the calculation of statistical significance in the comparison of prevalence data between the two age groups (P <0.05).

RESULTS

The need for orthodontic treatment among Italian children is high. In the sample aged between 2 and 7 years, the most frequent malocclusions are the moderate and severe open bite (23%), moderate and severe Class II (21.2%), deep bite (18.8%), cross bite (16.5%), Class III (7.7%), and crowding (5.1%). In the sample aged between 8 and 13 years the most frequent malocclusions are crowding (50.8 %), Class II (33.1%), deep bite (19.2%) crossbite (18.1%), Class III (9.1%), open bite (6.6%), facial or mandibular asymmetries (3.3%), and functional asymmetries (3.2%). It was found a statistically significant variation of the different malocclusion conditions according to age.

CONCLUSION

The study confirms that some risk factors occur during growth, and worsen the malocclusion. Therefore, it is important to reduce this risk of worsening by counteracting those factors with an early orthodontic intervention. Some malocclusions are less affected by environmental risk factors. In these case it would be better defer treatment until adolescence.

Enhancing the diagnosis of maxillary transverse discrepancy through 3-D technology and surface-to-surface superimposition. Description of the digital workflow with a documented case report

BACKGROUND

Maxillary transverse discrepancy is often diagnosed in childhood. The evaluation of morphological characteristics of the maxilla is crucial for appropriate treatment of this condition, however conventional diagnostic method is based on visual inspection and transversal linear parameters. In this paper, we described a user-friendly diagnostic digital workflow based on the surface-to-surface analysis. We also described a case report.

CASE REPORT

A 6-year-old female patient presenting mild transversal maxillary deficiency associated with functional posterior crossbite was treated by using maxillary removable appliance. In this respect, the appliance was designed in accordance to the morphological characteristics of the maxilla obtained by using the diagnostic digital work-flow and the maxillary surface-to-surface analysis.

CONCLUSION

The present user-friendly diagnostic digital workflow based on surface-to-surface analysis helps clinicians to detect specific morphological characteristics of the maxilla, such as shape and area of asymmetry, in order to reach a comprehensive diagnosis and choose the correct biomechanics for treating the condition.

Short-Term Effects of a Myofunctional Appliance on Atypical Swallowing and Lip Strength: A Prospective Study

Atypical swallowing needs treatment in order to eliminate harmful interferences of the tongue, which prevent the harmonious growth of the stomatognathic system. The purpose of this study was to assess the effects of a functional appliance on the presence of atypical swallowing, analyzing the lip strength and the altered facial mimics. The effects of a myofunctional appliance (the Froggy Mouth) were evaluated on 40 children (6 males; 24 females; mean age 9.6 ± 2.17) with atypical swallowing—with tongue thrust diagnosed by an expert orthodontist—before and during a 6 month treatment. Data were analyzed over time with a paired samples t-test for normally distributed data. After 6 months of treatment, 33 children out of 40 achieved clinical correction of atypical swallowing due to their good compliance, even at an early stage. Seven children showed low compliance and did not obtain any result. Lip strength in compliant subjects went from 190.30 ± 86.04 cN to 489.39 ± 123.36 cN (t = p < 0.001). Facial mimics improved in 28 out of 33 compliant subjects, and four children with the initial diagnosis of labial incompetence achieved correction. This observational study demonstrates the short-term efficacy of this myofunctional appliance in the treatment of atypical swallowing, achieving correction of the facial mimics and labial incompetence with a significant improvement of the lip strength.

Evaluation of Imaging Software Accuracy for 3-Dimensional Analysis of the Mandibular Condyle. A Comparative Study Using a Surface-to-Surface Matching Technique

The aim of this study was to assess the accuracy of 3D rendering of the mandibular condylar region obtained from different semi-automatic segmentation methodology. A total of 10 Cone beam computed tomography (CBCT) were selected to perform semi-automatic segmentation of the condyles by using three free-source software (Invesalius, version 3.0.0, Centro de Tecnologia da Informação Renato Archer, Campinas, SP, Brazil; ITK-Snap, version2.2.0; Slicer 3D, version 4.10.2) and one commercially available software Dolphin 3D (Dolphin Imaging, version 11.0, Chatsworth, CA, USA). The same models were also manually segmented (Mimics, version 17.01, Materialise, Leuven, Belgium) and set as ground truth. The accuracy of semi-automatic segmentation was evaluated by (1) comparing the volume of each semi-automatic 3D rendered condylar model with that obtained with manual segmentation, (2) deviation analysis of each 3D rendered mandibular models with those obtained from manual segmentation. No significant differences were found in the volumetric dimensions of the condylar models among the tested software (p > 0.05). However, the color-coded map showed underestimation of the condylar models obtained with ITK-Snap and Slicer 3D, and overestimation with Dolphin 3D and Invesalius. Excellent reliability was found for both intra-observer and inter-observer readings. Despite the excellent reliability, the present findings suggest that data of condylar morphology obtained with semi-automatic segmentation should be taken with caution when an accurate definition of condylar boundaries is required.

Perspectives of tele-orthodontics in the COVID-19 emergency and as a future tool in daily practice

AIM

The aim of our study was to explain how tele-orthodontics represents the only way to perform orthodontics during a period of restriction as the one subsequent to COVID-19 emergencies: To do this, we report a case study and explore the proposal of a model of tele-orthodontics, considering the advantages of this modality in the immediate post-emergency phase and in the future daily practice.

MATERIALS AND METHODS

Study design: Our study involves 30 patients, who had undergone different orthodontic therapies in a traditional way, and that the clinician continued to follow by means of tele-orthodontics. Given the obvious limitations of tele-practice, a comparison with patients who did not undergo any follow-up or underwent only in-office follow-ups could not be possible. The communication tools used in our study and proposed in our model of tele-orthodontics are videocalls, dedicated applications, intraoral and extraoral photos taken by the patients and instant messaging.

RESULTS

Tele-orthodontics allowed to perform some orthodontic follow-ups with less chairside time, reduced time spent by the patients in the dental office from up to 45 min, less risk of infection, fewer to no missed appointments, specific troubleshooting solutions, and more follow-ups with odontophobic patients. Overall, tele-orthodontics balanced the disadvantages of less personal contacts and in-office visits.

CONCLUSIONS

The need to respect safety distance and the fears patients have about the risk of infection make tele-orthodontics a fundamental tool during a pandemic lockdown and in its immediate post-emergency phase. Tele-orthodontics demonstrated to be a viable tool to continue at least some orthodontic care in times of emergency, but it may be considered an appropriate solution and addition even in normal times to ease therapy demands for both the orthodontist and the patient, while reducing time and money spent, without an excessive decrease in orthodontic quality.

Thermoplastic Disks Used for Commercial Orthodontic Aligners: Complete Physicochemical and Mechanical Characterization

Invisible orthodontic aligners (IOAs) have been introduced in the orthodontic field as an innovative alternative for fixed brackets, in relation to their ability to be easily inserted/removed from the oral cavity without affecting the chewing ability and the aesthetic of the patients. The paper provides a complete physicochemical and mechanical characterization of thermoplastic materials in the form of disks used for commercial IOAs. A wide palette of specific techniques is considered, from tensile tests and dynamic-mechanical analysis, to X-Ray diffraction (XRD), differential scanning calorimetry (DSC), Fourier transformation infrared spectroscopy (FTIR-ATR) analyses and water absorption tests. The disks are investigated before and after immersion into staining beverages (red wine, coffee, nicotine and artificial saliva), in terms of colour variations, transparency, and microscopic surface modifications by means of colorimetry, UV-VIS absorbance and scanning electron microscopy (SEM). Among all the samples, polyurethane (PU) exhibited the highest crystallinity and the highest values of mechanical and thermal resistance, while the poly(ethylene terephthalate)-glycol (PETG) samples presented better transparency and less ability to absorb water. Moreover, red wine and coffee give noticeable colour variations after 14 days of immersion, together with a slight reduction of transparency.

Bruma MAD: a new way of treating OSAS patients

The aim of this study was to introduce a new adjustable device in the treatment of obstructive sleep apnea syndrome (OSAS). The new appliance has a different way to regulate and move the mandible through the presence of two occlusal lifts, that can leave an open posterior space, and the complex system formed by the peduncle and the steel plate that can easily move forward the mandible. This system guarantees a posterior space for the tongue but mostly for the passage of air. The principal aim of Bruma MAD is to contrast the pharyngeal collapsing and to prevent hypopnea or apnea. Further clinical studies are needed to confirm and to evaluate the predictability of this new device.