Index of orthodontic treatment need in obese adolescents

The skeletal and dental age advancements of children and adolescents with overweight and obesity: A systematic review and meta-analysis

INTRODUCTION

Over the past decades, a trend of increasing obesity among children has emerged. This study aimed to evaluate and summarize the impacts of overweight and obesity on children's and adolescents' skeletal and dental developmental advancement that may influence orthodontic management.

METHODS

Registered with the Prospective Register of Systematic Reviews (registration no. CRD42022347488), this study complies with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Particularly, relevant original studies on skeletal or dental age evaluation were screened from accessible electronic databases and supplemented by hand-searching. Meta-analysis was recruited to calculate differences (and their 95% confidence interval [CI]) between subjects with overweight or obese and normal-weight counterparts.

RESULTS

After applying the inclusion and exclusion criteria, 17 articles were selected for the final review. Two of the 17 selected studies were found to have a high risk of bias and moderate the other 15. A meta-analysis detected no statistically significant difference in skeletal age between children and adolescents with overweight and normal-weight counterparts (P = 0.24). However, the dental age of children and adolescents with overweight was found to be 0.49 years (95% CI, 0.29-0.70) advanced in comparison with normal-weight counterparts (P <0.00001). In contrast, children and adolescents with obesity were found to have advanced skeletal age by 1.17 (95% CI, 0.48-1.86) years (P = 0.0009) and dental age by 0.56 (95% CI, 0.37-0.76) years (P <0.00001) compared with their normal-weight counterparts.

CONCLUSION

Because the orthopedic outcomes of the orthodontic intervention are closely tied to the skeletal age of the patients, these results suggest that the orthodontic evaluation and treatment of children and adolescents with obesity might occur earlier than that of the normal-weight population.

Effects of Rapid Maxillary Expander and Delaire Mask Treatment on Airway Sagittal Dimensions in Pediatric Patients Affected by Class III Malocclusion and Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that is very common in pediatric patients. In the literature, there are very few studies concerning the association between OSAS and class III malocclusion in children. The use of a rapid maxillary expander (RME) in association with the Delaire mask is a common treatment protocol for class III malocclusion. The aim of this work was to evaluate the cephalometric variations of upper airway dimensions and OSA-related clinical conditions after orthodontic treatment with an RME and the Delaire mask, as recorded in pediatric patients with a class III malocclusion who were affected by OSAS. In this preliminary study, 14 pediatric patients with mixed dentition, aged between 6 and 10 years, were selected. All patients were treated with an RME and the Delaire mask. Pre- and post-treatment cephalometric radiographs were traced, analyzed, and compared. The results demonstrated a significant increase in the upper airway linear measurements and the nasopharyngeal and oropharyngeal dimensions (p ≤ 0.05). This increase creates an improvement in airway patency and in OSAS-related clinical conditions. The use of the RME in association with the Delaire mask can be effective in the treatment of pediatric patients with a class III malocclusion who are affected by OSAS.

Effectiveness and Tolerability of a New Formulation of a Topical Anesthetic in Reduction of Pain and Parents’ Satisfaction in Pediatric Dentistry

The aim of the present study was to test a new topical anesthetic gel with a different formulation (10% lidocaine, 10% prilocaine) to analyze its effectiveness in pain control, during the subsequent injection of local anesthetic, and the presence of any side effects. Methods: The study’s research design was a randomized controlled clinical trial on 300 children, aged 5–8 years, divided into two groups, each of 150 patients, according to pre-injection procedures (presence or absence of topical anesthesia). The injection pain was analyzed using the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability Scale (FLACC). At the end of the procedures, patients’ parents’ satisfaction was recorded. The data were analyzed using the Student’s T test, Mann–Whitney U test and Chi-square test. Results: There were statistically significant differences between the two groups both in the PRS and FLACC ratings. Both in subjective and objective pain evaluations, significantly higher pain ratings were observed in the group without topical anesthesia. There was also a statistically significant difference in terms of patients’ parents’ judgment, as in the group with the use of topical anesthetic the level of parental satisfaction is statistically higher. Conclusion: The experimental anesthetic has proved very effective in its use as a topical gel in both pain measurement scales, thus validating its use on the oral mucosa, for its pharmacological and psychological effect, in the total absence of local and systemic side effects.

Tooth movement, orofacial pain, and leptin, interleukin-1β, and tumor necrosis factor-α levels in obese adolescents

OBJECTIVES

To evaluate tooth movement, orofacial pain, and leptin, interleukin (IL)-1β, and tumor necrosis factor (TNF)-α cytokine levels in the gingival crevicular fluid (GCF) during orthodontic treatment in obese adolescents.

MATERIALS AND METHODS

Participants included adolescent patients aged 12-18 years: group 1, obese (n = 30), and group 2, nonobese controls (n = 30). They were evaluated before (T0) and after 1 hour (T1), 24 hours (T2), and 1 week (T3) of fixed appliance bonding. Periodontal examination (T0), collection of GCF (T1, T2, T3), and evaluation of Little's irregularity index (T0, T3) were performed, and a visual analog scale was used to measure pain (T1, T2, T3). Evaluation of IL-1β, TNF-α, and leptin cytokines was performed using a Luminex assay. Mann-Whitney and t-tests were used for intergroup comparisons, and a generalized estimating equation and cluster analyses were used for comparisons among observation times (P < .05).

RESULTS

The obese group had a higher prevalence of probing depth of ≥4 mm and bleeding on probing. Orthodontic tooth movement was similar in both groups. Peak of pain was at T2 in both groups and was higher in the obese patients. TNF-α showed a slight increase at T1, followed by a gradual decrease at T2 and T3 in both groups. The obese group had a higher concentration of IL-1β before and during orthodontic treatment. There was no difference in tooth movement between obese and control patients during the first week of orthodontic treatment.

CONCLUSIONS

Obese adolescents had a greater subjective report of orofacial pain after 24 hours of orthodontic treatment and higher concentrations of IL-1β proinflammatory cytokine before and during tooth movement as compared with nonobese control adolescents.

The assessment of the relationship between the severity of gingivitis and the glycosylated hemoglobin levels in adolescent and adult patients with type 1 diabetes

Background

Diabetes and periodontitis belong to the group of civilizational diseases, which are not associated with any specific bacterial or viral infection but with the rapid development of civilization and technological advances that affect comfort and quality of life. Civilizational diseases occur in highly developed and developing societies. Glycosylated hemoglobin A1c (HbA1c) is one of the standard indicators for the assessment of metabolic compensation in diabetes that reflects the risk of disease complications. One of the significant complications of diabetes that manifests in the oral cavity is gingival and periodontal inflammation, which is directly related to increased insulin resistance and worsened diabetes compensation. Factors influencing inflammation are the patient’s age, directly linked with fine motor skills when it comes to cleaning teeth, and patients’ awareness related to cause-and-effect relationship between dental hygiene, gingival and periodontal inflammation, and HbA1c testing during routine check-ups.

Objectives

To compare the relationship between gingival inflammation and metabolic compensation (HbA1c levels), depending on the patient’s age.

Materials and methods

The study involved 100 patients (50 adolescents and 50 adults, 42 M; 58 F) with type 1 diabetes. The study group was divided according to sex and age into 19 male adolescent patients (10–18 years old; mean age 15.5) and 23 male adult patients (19–45 years old; mean age 27.1). The mean duration of diabetes was 7 years in the group of adolescents and 11 years in the group of adults. The HbA1c levels and gingival index (GI) were measured in all patients. The obtained results were statistically analyzed.

Results

By comparing the study groups, higher HbA1c values were reported in the group of adolescents. HbA1c has been shown to correlate with the GI in adolescents and adults. Despite poorer compensation for diabetes (higher HbA1c), GI values were similar in adolescents and adults.

Clinical association between dental malocclusion and strabismus in adolescents: a retrospective dental cast analysis

BACKGROUND

The aim of this retrospective study was to evaluate the occlusion in adolescents with strabismus in comparison with healthy subjects without vision problems.

METHODS

The test group included 50 subjects (23 males and 27 females) with a diagnosis of strabismus and the control group included 50 healthy patients (23 males and 27 females) without any past or present disturbance of vision. Dental cast analysis was performed to evaluate antero-posterior, transversal and vertical malocclusion and dental crowding. Furthermore, oral habits (mouth breathing, atypical swallowing, finger sucking) were recorded. Mann-Whitney test was performed in order to evaluate significant differences between the groups regarding overbite, overjet and dental crowding; Kruskal-Wallis non-parametric test was adopted to compare the samples. Chi square test and Fisher test were adopted for the analysis of cross-bite, Angle Class, and oral habits.

RESULTS

No significant difference was found regarding the malocclusion and the unhealthy oral habits between the groups (P>0.05). The test group showed a slightly higher prevalence of cross-bite but the difference between the two groups was not significant (P>0.05).

CONCLUSIONS

A possible relationship between the stomatognathic system and strabismus was not confirmed by the results of this study.

A new surgical and technical approach in zygomatic implantology

Purpose

Different surgical approaches for zygomatic implantology using new designed implants are reported.

Material and methods

The surgical technique is described and two cases reported. The zygomatic fixture has a complete extrasinus path in order to preserve the sinus membrane and to avoid any post-surgical sinus sequelae.

Results

The surgical procedure allows an optimal position of the implant and consequently an ideal emergence of the fixture on the alveolar crest.

Conclusion

The surgical procedures and the zygomatic implant design reduce remarkably the serious post-operative sequelae due to the intrasinus path of the zygomatic fixtures.

Effects of light-emitting diode (led 640nm) on human gingival fibroblasts: a comparative in vitro study

Purpose

The light-emitting diodes (LEDs) have been applied in oral surgery for tissue stimulation and wound healing. Several Authors have highlighted that fibroblasts subjected to phototherapy have an increased viability, proliferation, biomodulation of inflammatory cytokines and genes expression. It remains to be determined which are the best irradiation parameters (energy, wavelength, power) for each type of cell in order to obtain the best bio-stimulation. The aim of this study was to investigate the effects of LED irradiation on primary human gingival fibroblast cells (HGF) on DSP, ELN, HAS1, ELANE, HYAL1, RPL13 genes activation using Real Time PCR. These genes activation is directly connected with elastin protein production and HGF functionality.

Materials and methods

Human gingival tissue biopsies were obtained from three healthy patients during extraction of teeth. The gingival pieces were fragmented with a scalpel and transferred in culture dishes for allow the cells growth. Human gingival fibroblasts at the second passage were seeded on multiple 6-well plates and were stimulated with three different light-emitting diodes (LEDs) fixture. After irradiation, the cells were trypsinized, harvested and lysed for RNA extraction. Genes expression was quantified using Real Time PCR.

Results

We didn't found significant differences in genes activation of HGF of the three different LEDs. The LED irradiation seems to be directly correlated with the elastin and hyaluronoglucosaminidase 1 genes activation that are directly connected with proteins production and HGF functionality.

Conclusions

HGF show an increased deposition of elastin as well as enhanced expression of collagen type I, which is the main protein related to the synthesis and of the collagen-rich matrix.

Post extractive implant: evaluation of the critical aspects

Purpose

Nowadays, implant supported prosthetic rehabilitation is a reliable procedure to replace compromised or untreatable teeth. The purpose of this review is to explore the concept of post extractive implant and the indications for clinical practice through an analysis of recent studies in the literature. All the main factors that could influence the outcome of this treatment will also be considered.

Materials and methods

Focusing on the extraction-socket healing time, three different implant insertion protocols have been defined: Immediate implant placement (IIP), Early implant placement (EIP), Delayed implant placement (DIP). The entity of bone remodeling can be associated with different factors: three dimensional implant position, presence/absence of platform switching, absence of facial bony wall, inter implant/tooth distance.

Results

All the studies in literature agreed that implant primary stability is the main condition for a successful osseointegration of dental implants. Primary implant stability is influenced by many factors including local bone quality and quantity, implant macro-design, soft tissue conditions and rehabilitation, surgical technique, prosthetic load timing, oral hygiene.

Conclusions

There is insufficient evidence in literature to determine possible advantages or disadvantages of IIP, EIP or DIP. Studies suggest that IIP and EIP may be at higher risks of implant failures and complications than delayed implants; on the other hand the aesthetic outcome might be better when placing implants just after teeth extraction.

Clinical and histomorphometric outcome in future site development performed with a nano-hydroxyapatite through hydraulic sinus lift technique

PURPOSE

The crestal sinus lifting by means of hydraulic technique associated with a nano-cristalline hydroxyapatite in an aqueous medium is investigated.

MATERIALS AND METHODS

A specific purpose-made instrument is used, consisting of a syringe with a micrometrically controlled piston connected to a dispenser used to inject, in a calibrated and precise manner, noted volumes of graft material into the sub-schneiderian space. Adopting such a technique the Authors performed 7 future site developments, on 7 patients (2 males; 5 females; mean age 49.29±8.08 years), using a nanocrystalline hydroxyapatite. In the second stage, performed at 5.71±1.52 months, 7 implants were placed, after harvesting bone biopsies from the regenerated sites. The samples underwent histological and histomorphometric analysis.

RESULTS

The average percentage of vital bone was of 33.27±5.98%, while the bone marrow and graft material were 60.84±5.93% and 5.87±3.05%, respectively.

CONCLUSIONS

The results confirm the effectiveness of this method in restoring bone volume in the sub-antral region. Furthermore nano-cristalline hydroxyapatite is a proper material for sinus floor augmentation.

Bone regeneration in aesthetic areas using titanium micromesh. Three case reports

PURPOSE

An adequate bone volume for complete circumferential coverage of the implants is very important for obtaining a long-term success of oral implants. To avoid these problems various membranes and biomaterials were used, but soft tissue pressure could cause a membrane collapse toward the defect. The present work describes a ridge augmentation with titanium mesh shaped by adapting it to a bone defect in aesthetic areas.

MATERIALS AND METHODS

Three patients with alveolar crest defects received three implants (Bone System, Milano, Italy) and the defects were filled with bone chips. The defects were covered with a titanium micromesh above which was positioned a resorbable membrane (Biogide, Geistlich, Wohlhusen, Switzerland).

RESULTS

At the re-entry procedure the titanium micromesh appeared to be surrounded by a dense connective tissue with no clinical signs of inflammation. Clinically in all patients, no residual bone defects were observed, and a significant increase of the alveolar width or height was found.

CONCLUSIONS

In conclusion the clinical results of the present study show that most certainly the space for the bone regeneration is one of the most critical factors in the success of the regenerative techniques.

Immediate loading implants: review of the critical aspects

Purpose

Modern dentistry have witnessed, a rapid and continuing evolution. Concerning the implant-rehabilitation protocols, they have been redefined in order to satisfy patient's increasing expectations in terms of comfort, aesthetic and shorter treatment period. The purpose of this review is to explore the concept of implant immediate loading and the indications for clinical practice. All the critical aspects that could influence the outcomes of this treatment will also be considered.

Materials and methods

Three protocols for implant load timing have been classified: immediate loading implants (ILI); early loading implants (ELI); and conventional loading implants (CLI). Two subclassifications point out the different loading modality: 1) Occlusal loading or Non-Occlusal loading, 2) Direct loading or Progressive loading. Micromovements have been considered, since the start of implant dentistry, one of the main risk for the success of osseointegration. The determinant and most accessible parameter to assess the primary stability is the implant insertion torque value. To achieve the necessary torque value to perform immediate loading, it is therefore important to evaluate the bone density at the implant site. Computerized tomography (CT) has been regarded as the best radiographic method to evaluate the residual bone.

Results

The clinical success of this technique is highly dependent on many factors: patient selection, bone quality and quantity, implant number and design, implant primary stability, occlusal loading and clinician's surgical ability. Among these, implant primary stability is undoubtedly the most important.

Conclusion

Studies on ILI show that successful outcome can be expected, if the previous criteria are fulfilled. It seems that ILI demonstrate a greater risk for implant failure when compared to CLI, although the survival rates were high for both the procedures. The use of different surgical procedures, type of prostheses, loading times and have very different study designs. This lack of homogeneity limits the relevance of the conclusions that can be drawn.

A new implant-abutment connection for bacterial microleakage prevention: an in vitro study

Purpose

The aim of our study is to evaluate the ability of a new type of implant (Konus Implant System®, Industrie biomediche e farmaceutiche, Italy) to isolate the internal of an implant-abutment connection from the external environment.

Materials and methods

To identify the capability of the implant to protect the internal space from the external environment, the passage of genetically modified Escherichia coli across implant-abutment interface was evaluated. Implants were immerged in a bacterial culture for twenty-four hours and then bacteria amount was measured inside implant-abutment interface with Real-time PCR.

Results

Bacteria were detected inside all studied implants, with a median percentage of 18% for Porphiromonas Gingivalis and 19% for Tannerella Forsythia.

Conclusion

The reported results are similar to previous work. Konus Implant System^® showed bacterial leakage similar respect others implant systems (18% Porphiromonas Gingivalis, 19% Tannerella Forsitya versus 20% of Bicon© and Ankylos ® systems). In spite of the limits of our study, none two-piece implant system has been demonstrated to perfectly close the gap between implant and abutment.

Pregnancy and periodontal disease: does exist a two-way relationship?

Periodontal disease (PD) is an inflammatory disease of the tissues supporting the teeth. PD affects 65 million adults over the age of 30 years in the USA, and worldwide 5 to 70% of adults. Women who develop PD during pregnancy, it's estimated 1 woman in 5, may have a higher risk of adverse pregnancy outcomes. PD during pregnancy starts by dental plaque and is increased by the action of pregnancy hormones. In order to study the effect of PD on adverse pregnancy outcomes, we have performed this narrative review summarising the current studies about the influence of PD on pregnancy. Periodontal pockets are a reservoir of oral microbiota. Modifications in oral microbiota may be considered as a potential mechanism for developing PD during pregnancy. PD is surely caused by bacteria, but the progression and worsening are due to a host immune response. The inflammation caused by PD is not limited to the oral cavity. It is hypothesized that episodes of bacteraemia and dissemination of endotoxins from periodontal pockets can induce the activation of the systemic immune response. In conclusion our narrative review shows that there's no relationship between PD and adverse pregnancy outcomes, and PD treatment during pregnancy does not confer a general protection against adverse pregnancy outcomes.

Delayed expansion of atrophic mandible (deam): a case report

Purpose

The present case report presents the clinical results of delayed expansion of mandibles by ultrasonic surgery in case of mono edentulous.

Materials and methods

The patients with a residual alveolar ridge thickness between 2,3 and 4,1 mm in the coronal area of posterior mandible was threated. In the first stage, four linear corticotomies were carried out by ultrasonic surgical device; bone expansion was not performed. After 4 weeks, in the second stage, adequate bone expansion, without compromising cortical vascularisation, by utilising a combination of scalpel, thin chisels and threaded osteotomes was achieved and one implant was placement, after filling the gaps with a cortico bovine biomaterial.

Results

The postoperative course was uneventful and final width ridge was 6,17±0,26mm.

Conclusions

The present case report showed that mandibular ridge expansion using a delayed split-crest technique by means of ultrasonic surgery and association with biomaterial clinically lead to a good horizontal bone gain with no fractures of the buccal plate and high implant success rate.

Positioning of a contextual implant along with a sinus lift anchored with a block of heterologous bone

During a sinus lift procedure the main requirement in order to position an implant is to have a maxillary sinus floor cortical bone thick enough to guarantee a primary stability in the implant inserted. In this way, the healing process is facilitated and osseointegration of the titanium surface may occur simultaneously, thus reducing the waiting time for the engraftment of the implant into the body. Unfortunately, these conditions are not always present. Hence, the need of developing an alternative approach that could simultaneously allow to perform sinus floor elevation along with an implant placement. Here we present the case of a 62-year-old patient that requires implant-prosthetic rehabilitation from 1.2 to 1.6 at diagnosis. In this study, we reported a novel application derived from the use of a heterologous bone scaffold (SmartBone@) in a sinus lift procedure. We showed the successful implant along with sinus lift with SmartBone@, both at the time of the surgery and after follow-up of the patient at 10 months from the implant. The possibility to perform simultaneously the contextual implant along with sinus lift dramatically reduced the waiting time for the patient of minimum 5-6 months required for osseointegration of the grafted biomaterials, before performing the implant procedure. This surgery represents an advance both in terms of medical technique and as life-benefit for the patient.

Cement layer thickness and shear stress resistance in cylindrical dowel spaces: pull-out test

Purpose

This study evaluated the effects of different dowel space (DS) diameters on pull-out bond strength of a cylindrical post, of threaded steel, to dentin.

Materials and methods

Forty-five extracted human teeth were divided in 3 groups with DSs, with the same depth (6 mm), differing for the diameter (i.e. 1.5 mm, Group 1; 1.75 mm, Group 2; 2.00 mm, Group 3). Both the diameter of the post (1.3 mm) and the composite resin cement (Panavia 21) were the same for all the samples. The samples were submitted to pull-out test by means an Universal Testing Machine (Mod. 1193, Instron) (1KN load cell, crosshead speed 0.5 mm/min).

Results

The mean values of the bond strength (BS) were: Group 1, 442±128.3N; Group 2, 411.3±111N; Group 3, 448.7±142.29N. While the calculated average shear bond strengths (SBSs) were: Group 1, 14.7±4.27MPa; Group 2, 11.6±3.14MPa; Group 3, 11±3.5MPa. ANOVA test showed not significative differences, among the groups, concerning the BS: Group 1 vs Group 2 (p = 0.490); Group 1 vs Group 3 (p = 0.894); Group 2 vs Group 3 (p = 0.431). Significative differences were observed, among the groups, concerning the SBS for Group 1 vs Group 2 (p = 0.032) and Group 1 vs Group 3 (p = 0.014). While a not significative difference was found, concerning this parameter, for Group 2 vs Group 3 (p = 0.641).

Conclusion

The cement thickness can influence the SBS of the adhesively luted posts, in our setting, the best values were obtained with a thickness of 100 μm.

An unusual, deceptive delayed of profuse haemorrhage after mandibular implant dentistry: risk planning and medico-legal instruction

Mandibular implant placement (MIP) has been accepted and widely used for decades all over the world, and has reached a very high level of therapeutic reliability. MIP is used mostly in elderly edentulous patients who lost their teeth when dentistry was not oriented to fixed or removable prosthetic. Notwithstanding this, every year cases of severe complications during MIP due to haemorrhage causing life-threatening airway's obstruction are reported. These severe complications of MIP need immediate therapy, usually with hospitalization, and may be potentially fatal. A 56-year-old man presented to the private practice requesting the placement of two dental implants at 41 and 31 previously lost for periodontal disease. Two implants of 3.3 mm of diameter, and 10 mm of length were inserted replacing teeth 31 and 41. Two hours after surgery and home delivery, the patient came to the emergency room complaining of dyspnoea and edema at the floor of the mouth. The maxillo-facial surgeon decided to perform tracheostomy and haemostasis under general anaesthesia. Two weeks after demission a complete healing was performed. This is important for dental practitioners to avoid severe bleeding complications during the MIP in the interforaminal region, especially on the midline. Moreover, when mandibles are severely atrophic, practitioners should be aware of this fact and the possible implications. The evaluation of these data is essential in the correct preoperative planning of implant procedures in the mandible, and with the increasing demand for MIP, the variations of the lingual foramen of the mandible should receive more attention.