Spontaneous Mandibular Dentoalveolar Changes after Rapid Maxillary Expansion (RME), Slow Maxillary Expansion (SME), and Leaf Expander-A Systematic Review

BACKGROUND

This systematic review aims to analyze the spontaneous dentoalveolar changes in the mandibular arch after maxillary expansion in growing patients obtained with different expansion protocols: Rapid Maxillary Expansion (RME), Slow Maxillary Expansion (SME), and Leaf Expander.

METHODS

The study adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria were established in the PICO format, involving patients who underwent slow, rapid, or leaf maxillary expansion during the mixed or early permanent dentitions. A comprehensive search of electronic databases and manual searches was conducted up to December 2023. The outcome measures included inter-mandibular first permanent molar width, inter-deciduous molar and canine width, arch perimeter, and arch length; both short- and long-term results were considered. The articles that met the inclusion criteria were included in this systematic review and were qualitatively evaluated using a methodological quality scoring system with a 13-point scale. To assess the inter-examiner agreement concerning the article selection and the qualitative assessment of the included studies, Kappa statistics were computed.

RESULTS

A total of 1184 articles were identified through electronic and manual searches. After the removal of duplicates and the initial examination of the titles and abstracts, 57 articles were considered for the full text analysis, and according to the eligibility and exclusion criteria, 22 studies were finally selected, composed of 8 randomized controlled trials (RCTs) and 14 retrospective/case-control studies. The qualitative assessment of the included studies showed the following scores: 6 papers have high research quality, 5 have moderate quality, and 11 have low quality. SME demonstrated negligible mandibular changes, with less than 1 mm variation on average (range 0.46-2.00 mm) in the selected parameters and relapses observed in the long term. RME induced more significant increases, particularly in intermolar width greater than 1 mm, which ranged between 0.93 and 3.3 mm, and good stability over the long term. Leaf Expander exhibited promising short-term lower intermolar width increases greater than 1 mm and ranged from 0.5 to 1.69 mm, but long-term stability was not thoroughly evaluated.

CONCLUSIONS

SME results in negligible short- and long-term effects, while RME, especially with Haas-type appliances, exhibits significant intermolar width increases that remain stable over the years. Leaf Expander shows short-term lower intermolar width increases, requiring further investigation into long-term stability.

Divergence between CBCT and Optical Scans for Soft Tissue Analysis and Cephalometry in Facial Imaging: A cross-sectional study on healthy adults

BACKGROUND

Facial soft tissue analysis is becoming increasingly emphasized in orthodontic diagnosis and treatment planning. While traditional cephalometry primarily focuses on hard tissues, recent non-invasive imaging techniques offer the potential to comprehensively evaluate three-dimensional (3D) facial soft tissues. The aim of the study was to establish the geometrical 3D and cephalometric divergence between Cone Beam Computed Tomography (CBCT) derived images and scanned soft tissues. Crucial for enhancing orthodontic diagnosis, minimizing patient exposure to ionizing radiation and providing facial cephalometric parameters.

MATERIAL AND METHODS

A cross-sectional study was conducted from January 2020 to May 2023. CBCT and 3D facial scans were obtained simultaneously using a specialized imaging system. Reproducible landmark points were selected for both cephalometric and soft tissue analysis. Angular and linear measurements were recorded, and correlations between CT and facial scans were statistically assessed.

RESULTS

Comparisons between 10 CBCT-derived and 10 facial scan-based soft tissue representations resulted into 1.8mm mean root median square (RMS). Angular measurements, such as ANB, right gonial angle, and left gonial angle, exhibited a 0.9° of difference with their respective soft tissue variables. In contrast, linear measurements of total anterior facial height showed a lower correlation coefficient, equal to 0.51. The correlation between soft tissues and underlying hard tissues was more pronounced for gonial angles.

CONCLUSION

Facial soft tissue analysis using either 3D facial scans or CBCT-derived offers similar results for orthodontic diagnosis and treatment planning. These findings support the use of non-invasive diagnostic tools in orthodontics, although further investigations are needed to comprehensively understand the complexity of hard and soft tissue relationships.

Premature loss of primary molars in children: space recovery through molar distalisation. A literature review

AIM

The integrity of primary dentition is essential in the development of the jaws and permanent occlusion. The consequences of a premature loss of primary molars are: space loss, crowding, risk of impaction of the permanent teeth, ectopic eruption, anomalous inclination of the teeth adjacent to the loss molar, reduction of arch length. The mesial displacement of the posterior permanent teeth during eruption can cause a loss of space, which can be regained with orthodontic appliances. Therefore, a careful diagnosis is of great importance to be able to decide what appliance is indicated to recover from this situation. Molar distalisation consists in displacing permanent molars distally, allowing them to reach class I relationship and to recover the correct space for the second bicuspids when the second deciduous molar has been lost early.

METHODS

The aim of this study is to carry out a narrative literature review regarding the different appliances and their effectiveness in regaining space after premature loss of the upper primary molars.

CONCLUSION

The paediatric dentist should be aware of the advantages and disadvantages related to each device and select the most appropriate distalisation appliance based on an individual plan of diagnosis and a careful treatment. The distalisation of the upper molar must be adequately stabilised and so it is important to consider also some retainers such as Nance's appliance, the Palatal Plate, the extraoral traction, the utility arch, or II Class elastic bands.

Comparison of Mechanical Behavior of Clear Aligner and Rapid Palatal Expander on Transverse Plane: An In Vitro Study

(1) Background: This study aims to investigate, within a controlled laboratory environment, the magnitude of the transversal load and the force decay over time produced by clear aligners in comparison to a Rapid Palatal Expander (RPE). (2) Methods: Resin models of a dental maxillary arch, additively manufactured from an intraoral scan, were inserted in a testing machine with uniaxial load cells to measure the force trend over time expressed by RPE and clear aligners. The mechanical load was recorded during a certain timeframe for both appliances. (3) Results: The force expressed by the RPE ranged from 30 to 50 N for each activation, decreasing with a nonlinear pattern over time. The force expressed by the clear aligner ranged from 3 to 5 N, decreasing with a linear pattern over time. In contrast, the force generated by the clear aligner fell within the range of 3 to 5 N, showing a linear reduction in force magnitude over the observed period of time. (4) Conclusions: The RPE exerted a force magnitude approximately ten times greater than that generated by clear aligners. Nevertheless, it is essential to acknowledge that the oral environment can significantly influence these results. These limitations underscore the need for caution when applying these findings to clinical settings.

SALIVA-based diagnostic approach for diabetes mellitus: a step towards non-invasive detection - a scoping review

OBJECTIVE

Diabetes mellitus (DM) is a chronic autoimmune disease whose main feature is chronic hyperglycemia. The causes of DM are impaired insulin secretion, impaired insulin action, or both. Saliva is a biofluid that can be considered as a "mirror" reflecting our body's health status; with the rapid advancement in salivaomics, saliva, being a non-invasive and safe source, could be a substitute for blood in the diagnosis and prognosis of diseases. As there are no precise guidelines about the salivary biomarkers correlated with the diagnosis of diabetes, a review was conducted to verify whether saliva analysis can be feasible and which biomarkers are more reliable, for the diagnosis of this disease.

MATERIALS AND METHODS

A literature search was performed through PubMed, Medline, Scopus, Web of Science, LILACS, Open Grey, and Cochrane Library databases. The "PRISMA" guidelines were used for the following review, and thirty-three studies were analyzed.

RESULTS

Almost all salivary glucose studies suggest that the estimation of this biomarker can be used as a potential indicator. Furthermore, studies that considered other biomarkers such as 1,5-anhydroglucitol, alpha-amylase, N-acetyl-β-D-hexosaminidase, asprosin, resistin, and fructosamine reported that these biomarkers resulted to be potentially useful for diabetes screening and diagnosis, with the exception of the cystatin SA.

CONCLUSIONS

In conclusion, several salivary biomarkers could be useful for monitoring DM, but it would be necessary to further expand the research and define precise values for each marker in order to predict with reasonable confidence if an individual is healthy or suffering from diabetes. Finally, standardized saliva collection and processing techniques are key to minimizing interindividual variability in saliva composition.

Influence of the type of breastfeeding as a risk or protective factor for the onset of malocclusions: a systematic review

AIM

The correlation between malocclusions in deciduous dentition and type of breastfeeding has been described by many authors in numerous articles. The aim of this article is to investigate the literature about this important topic.

MATERIALS

The research was conducted by querying the following databases: PubMed, EBMR, Cochrane Library, Web of Sciences, Medline, Web of Sciences, Ovid and Embase. The key words were: "infant" OR "baby", AND "breastfeeding" AND "malocclusion". As with similar literature review papers, the PRISMA-P (Preferred Reporting Items for Systematic Reviews Protocols) was used. The examined articles were of the following types: randomised controlled trials (RCTs), case-control studies and cohort studies. For the qualitative analysis of the selected studies, it was employed the NOS scale (Newcastle-Ottawa Quality Assessment Scale).

CONCLUSION

Two hundred and fifty articles were selected. After filtering out the articles deemed irrelevant or with obvious bias, only 16 articles were left. From our results, it can be concluded that breastfeeding seems to play a decisive role in preventing the onset of posterior cross-bites and Class II malocclusions, and that this protective effect appears to be time-dependent.

Skull Biomechanics and Simplified Cephalometric Lines for the Estimation of Muscular Lines of Action

Our study introduces a novel cephalometric analysis aimed at facilitating biomechanical simulations by elucidating the intricate relationship between craniofacial morphology and the size and inclination of the masseter muscle (MM) while incorporating muscle values. Our study analyzes the line of action of the MM drawn between the Gonion (Go) and Orbital (Or) points concerning dental and skeletal references (occlusal and Frankfort planes). A total of 510 pre-treatment lateral cephalometric tracings (217 males, 293 females, aged 6-50 years) and lateral Bolton standard tracings were examined. The key parameters investigated include (a) skeletal-cutaneous class (linear distance between projections of points A' and B' on the occlusal plane), (b) the angle between the perpendicular line to the occlusal plane and the Go-Or line at the molar occlusal point, and (c) the angle between the Go-Or line and the Frankfort plane. The assessment of anterior-posterior jaw discrepancy, measured as the skeletal-cutaneous class, ranged from -14.5 to 15.5 mm. Abnormal values were identified in two adolescents, showing no gender- or age-related patterns. The angle between the MM's line of action (Go-Or) and the normal to the occlusal plane averaged 39.3°, while the angle between Go-Or and Po-Or (Frankfort plane) averaged 41.99°. Age had an impact on these angles, with an average 3° decrease in adults and a 4° increase between ages 6 and 50. A weak relationship was observed between sagittal jaw discrepancy and the angle between Go-Or and the Frankfort plane, with about 20% of the variance explained by the anteroposterior maxillary-mandibular relationship. In conclusion, the study presents a cephalometric analysis of the relationship between craniofacial morphology and masseter muscle parameters. It finds that age influences the angles between key reference points, while the skeletal-cutaneous class does not exhibit age- or gender-specific trends. These findings can contribute to a better understanding of craniofacial biomechanics and aid in clinical orthodontic assessments and treatment planning.

Survey of Oral Hygiene Habits and Knowledge among School Children: a cross-sectional study from Italy

AIM

This study is aimed to investigate the oral hygiene practice, knowledge and attitude of young adults, assessing their awareness about the impact of a certain "risk" behaviour on their oral and dental health.

MATERIALS

This is a cross-sectional survey study conducted on 829 students (350 males and 479 females, mean age 13-20 years) attending high school in Milan and surrounding areas. They were asked to complete anonymous questionnaire during the first semester of the 2019-2020 school year, under the supervision of a teacher and/or an assigned interviewer. The questionnaire was created by "Laboratorio Adolescenza", in collaboration with the International Alliance of Responsible Drinking (IARD) Research Institute and the University of Milan. All of the data was compiled into table or graph form and analysed.

CONCLUSION

There is a general awareness among Italian school children about the risks of bad oral habits, however, there is a need to improve the oral health knowledge, attitude and practices in the target population with emphasis on improvement of oral hygiene practices.

Skeletal and dento-alveolar changes obtained with customised and preformed eruption guidance appliances after 1-year treatment in early mixed dentition

AIM

The aim of this study was to assess the skeletal and dento-alveolar changes produced by a customised eruption guidance appliance (EGA) and a preformed EGA in subjects presenting a skeletal class II pattern during early mixed dentition and to evaluate the differences between the two devices.

METHODS

All subjects included in the study were randomly selected from the record's archive according to the following inclusion criteria: (1) patients presenting upper central incisor and first permanent molars fully erupted; (2) early mixed dentition with age between 7 to 9 years old; (3) Angle class I or class II malocclusion; (4) increased overjet > 4 mm;(5) deep bite with at least 2/3 overlapping of the incisors; (6) no previous orthodontic treatment apart from maxillary expansion treatment. All children belonging to the case group received treatment with a 3D printed EGA whereas the other patients belonging to the control group were treated with preformed EGA. Records consisted in digital dental models and lateral cephalogram at the beginning (T0) and after 1 year of treatment (T1). Data collected on the digital models included the dentoalveolar changes in overbite, overjet, sagittal molar relationship, and dental crowding. Cephalometric tracings were computed by a single blinded observer using Dolphin Imaging software. Statistical analysis was performed with SPSS (version 25.00; IBM Corp, Armonk, NY). Comparison regarding the cephalometric changes between T1-T2 was carried out with paired t-test. Difference in distribution regarding sagittal molar and canine relationship and anterior crowding between groups at T1 and T2 has been computed with chi-square test. The independent sample t-test was used to perform the between group comparison.

CONCLUSION

In the short time, both the appliances showed to be effective in correcting class II malocclusion, anterior crowding, overjet and overbite. Custom-made appliance demonstrated to be significantly more effective in correcting anterior crowding, the dento-skeletal vertical relation and position of permanent incisor compared to the preformed appliance. Adopting a customised device, effects due to an average prescription appliance used to a specific patient can be reduced, resulting in more predictable results.

Comparison of the skeletal, dentoalveolar, and periodontal changes after Ni-Ti leaf spring expander and rapid maxillary expansion: a three-dimensional CBCT based evaluation

BACKGROUND

The aim of the present study was twofold:(1) three-dimensionally evaluate the quantitative skeletal and dentoalveolar changes after Ni-Ti leaf spring expander (leaf expander) and rapid maxillary expansion (RME) in mixed dentition patients;(2) analyze the modifications of the buccal alveolar bone plate of the maxillary first permanent molars.

METHODS

Patients who underwent CBCT scans before and after maxillary expansion were randomly selected from the records archived at the Department of Biomedical Surgical and Dental Sciences, University of Milan, Italy. Inclusion criteria were the following: no systemic disease or syndromes; maxillary transverse deficiencies (difference between the upper intermolar width and the lower intermolar width of at least 3 mm and/or clinical need based on radiographic evaluation), early mixed dentition with ages between 7 to 10 years old; cervical vertebra maturation stage (CVMS) 1 or 2; no pathologic periodontal status; skeletal class I or II; maxillary expander cemented on the upper second deciduous molars. Exclusion criteria were the following: patients with pubertal or post-pubertal stage of development (CVMS 3-6); late deciduous or late mixed dentition, impossibility to use the second primary molar as anchorage; skeletal class III malocclusion; craniofacial syndromes; patients unable to be followed during the treatment period. Twenty-three patients treated with Leaf Expander, 11 males (mean age 7.8 ± 0.6 years) and 12 females (mean age 8.1 ± 0.8 years), met the inclusion criteria and constituted the case group. Twenty-four (control group) treated with conventional RME, 12 males (mean age 8.4 ± 0.9 years) and 12 females (mean age 8.1 ± 0.7 years). The paired-sample T test was used for intra-group comparison to evaluate the difference between before (T1) and after (T2) maxillary expansion. Independent sample t-test was computed to perform between groups comparison of the skeletal, dentoalveolar, and periodontal changes.

RESULTS

The Leaf Expander and RME group showed a significant increase between T1 and T2 for most of the skeletal and dentoalveolar variables. Concerning the skeletal variables only the RME demonstrated a significant increase at the level of the posterior nasal (PNW) and apical base width (PABW) and maxillary mid-alveolar width (MMW). Despite this, when compare with the Leaf Expander, the RME group exhibited a statistically larger width increase for only two skeletal parameters: PNW (p = 0.03) and MMW (p = 0.02). No significant changes at the periodontal level were found in either group.

CONCLUSIONS

According to the current research, the authors confirm the effectiveness of the Leaf Expander and RME to produce similar skeletal and dentoalveolar effects in mixed dentition subjects. Moreover, the devices anchored to deciduous teeth did not reduce the thickness and height of the buccal bone at the level of the maxillary permanent first molars in either of the two groups.

Conscious Sedation for Dental Treatments in Subjects with Intellectual Disability: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis was aimed to investigate the conscious sedation efficiency in patients with intellectual disability undergoing dental treatment (PROSPERO CRD42022344292). Four scientific databases were searched by ad-hoc prepared strings. The literature search yielded 731 papers: 426 were selected, 42 were obtained in full-text format, and 4 more were added after hand searching. Fourteen studies were finally included, 11 of which were included in the meta-analysis (random effect model). A high heterogeneity in the drugs used and route of administration was retrieved. Success rate, occurrence of side effects, and deep sedation occurrence were combined to give an overall efficiency of each drug. N₂O/O₂ reported the highest efficiency (effect size = 0.90; p < 0.01) and proved to be more efficient when used alone. Nine papers reported a success rate of sedation of 80% or more. The prevalence of side effects (6 studies) ranged from 3% to 40%. Enteral and parenteral benzodiazepines showed the same overall efficiency (effect size = 0.86). No meta-analysis has yet been conducted to define the most effective and safest way to achieve conscious sedation in patients with intellectual disability; nitrous oxide appears to be the best choice to perform conscious sedation in patients with intellectual disability undergoing dental treatment.

Dentoskeletal effects of clear aligner vs twin block-a short-term study of functional appliances

PURPOSE

The twin block (TB) is one of the most widely used functional appliances for the correction of class II malocclusions. Align Technology (San Jose, CA, USA) developed the Invisalign® mandibular advancement (MA) that replicates the mechanism of action of a functional appliance. The aim of this study was to compare the changes produced by the TB versus those by MA.

METHODS

The records of 56 class II patients treated with the TB (TB group: n = 35) or the MA (MA group: n = 21) were compared to a control sample of 15 untreated class II subjects (UC2).

RESULTS

The TB and MA groups showed a significant reduction of the ANB angle, compared to the controls (TB group: -1.5°; MA group: -1.5°; UC2 group: +0.2°). For the Co-Gn values, the TB and MA groups showed significant differences when compared with the UC2 group with an increase of 8.4 mm in TB patients and of 8.3 mm in MA patients. The increase of the distance of Pg to the true vertical line (TVL) was the only measurement where significant differences between the three groups were found with a greater advancement of the soft tissue pogonion in the TB group compared with the MA group and the UC2 group (TB group: +3 mm; MA group: +0.9 mm; UC2 group: -1.6 mm). The angle between the palatal plane and mandibular plane revealed a more relevant reduction in the TB and MA groups. Both appliances were able to reduce overjet and vertical overbite values.

CONCLUSIONS

Treatment with the MA and TB appliances produced a significant elongation of the mandible with an improvement in sagittal relationship, overjet, and vertical overbite and with good control of the vertical relationship. TB subjects showed a greater advancement of the soft tissue chin.

Clinical Performance Evaluation of a Hyaluronic Acid Dental Gel for the Treatment of Traumatic Ulcers in Patients with Fixed Orthodontic Appliances: A Randomized Controlled Trial

BACKGROUND

A newly available gel containing hyaluronic acid (HA) and polyvinylpyrrolidone was tested for efficacy on traumatic oral ulcers (TOU) caused by fixed orthodontic appliances.

METHODS

A double-blind RCT was conducted to test the new gel versus a placebo. According to the sample size calculation, a total of 60 patients were considered sufficient and randomly allocated to one of the two groups out of a pool of 100 total patients who initially agreed to participate in the study. A VAS scale test and lesion measurements at T0, T1, and T2 were performed on the patients.

RESULTS

A total of 70 patients developed TOU, with 8 drop-outs; the intergroup comparison showed a statistically significant greater dimension of the lesion in the control group at T2 when compared to the test group. The pain experienced by the patients belonging to the test group was significantly lower than the pain in the patients in the control group Conclusions: Under the limitations of the study, the new formula might provide faster healing with less pain experienced by the patient when compared to a placebo.

Oral and throat microbiological changes after orthodontic debonding

As already known, orthodontic treatment presents a factor of plaque retention, promoting an increase of bacterial growth in the oral cavity. Nevertheless, after orthodontic debonding an alteration of the previous microbiological status may occur. The present study was designed to assess variations among six bacterial species in the oral cavity and the status of oral health after orthodontic debonding. At the end of the fixed orthodontic treatment, 30 patients were divided into three groups based on the type of retention: I - 10 patients were treated with upper and lower fixed retention devices, II - 10 with upper and lower removable retention devices, and III - 10 with lower fixed and upper removable retention devices. To assess the alterations of oral microbiota after orthodontic debonding, two salivary swabs were collected for each individual: the first immediately after debonding (T0) and the other one 6 weeks later (T1). Six species, the ones most correlated with the development of caries and periodontal disease, were selected for microbiological analysis with Real-time PCR: Streptococcus mutans, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Fusobacterium nucleatum. Furthermore, in order to correlate the microbiological outcomes with the clinical condition, oral health indexes at T0 and T1 were assessed for all patients. Six weeks after debonding, the salivary levels of the bacteria investigated tend to decrease and the values of the oral health indexes tend to improve with all types of treatment considered (p<.05). Salivary bacteria levels and oral health are similarly influenced by fixed and/or removable orthodontic retentions.

Method Presentation of a New Integrated Orthodontic-Conservative Approach for Minimally Invasive Full Mouth Rehabilitation: Speed Up Therapy

The materials available today allow for extensive oral rehabilitations in a non-invasive way, and often an orthodontic preparation is useful and, thanks to the use of clear aligners, is predictable and comfortable. A preliminary study of the wax-up, mock-up, and set-up allow the clinician to plan every aspect of the treatment in detail. Furthermore, the procedure offers the patient an intuitive and understandable view of the expected final result. The new proposed method, called “speed up therapy”, allows for the integration of the orthodontic set-up with the mock-up technique, simulating the occlusal and aesthetic components of the planned restoration, in all details. The clinical case presented, demonstrates step by step the predictability and clinical reliability of the proposed procedure. The final clinical result coincides exactly with the initial mock-up and demonstrates that the proposed method is predictable and reliable. The correct execution of the technique is rigorously customized, and its success is operator dependent, both for the clinical aspects and for the dental laboratory. Thus, the visualization of the objectives of the treatment constitutes a decisive support for the clinician and provides the patient with the possibility of benefiting from an immediate improvement by making it easier for them to accept a treatment plan. The visualization also includes an orthodontic phase that potentially lengthens the treatment but makes the realization more conservative and predictable.

Effects on Muscular Activity after Surgically Assisted Rapid Palatal Expansion: A Prospective Observational Study

The study aims to investigate the modifications in the temporalis and the masseter activity in adult patients before and after SARPE (Surgically Assisted Rapid Palatal Expansion) by measuring electromyographic and electrokinesographic activity. 24 adult patients with unilateral posterior crossbite on the right side were selected from the Orthodontic Department of the University of Milan. Three electromyographic and electrokinesographic surface readings were taken respectively before surgery (T0) and 8 months after surgery (T1). The electromyographic data of both right and left masseter and anterior temporalis muscles were recorded during multiple tests: standardized maximum voluntary contraction (MVC)s, after transcutaneous electrical nerve stimulation (TENS) and at rest. T0 and T1 values were compared with paired Student’s t-test (p < 0.05). Results: Significant differences were found in the activity of right masseter (p = 0.03) and right temporalis (p = 0.02) during clench, in the evaluation of right masseter at rest (p = 0.03), also the muscular activity of masseters at rest after TENS from T0 to T1 (pr = 0.04, pl = 0.04). No significant differences were found in the activity of left masseter (p = 0.41) and left temporalis (p = 0.39) during clench and MVC, in the evaluation of left masseter at rest (p = 0.57) and in the activity during MVC of right masseter (p = 0.41), left masseter (p = 0.34), right temporalis (p = 0.51) and left temporalis (p = 0.77). Results showed that the activity of the masseter and temporalis muscles increased significantly after SARPE during rest and clenching on the side where the cross-bite was treated.

Innovative Application of Diathermy in Orthodontics: A Case Report

Introduction: Several strategies have been proposed in the literature to accelerate tooth movement, many of which are invasive and have numerous side effects, such as surgical techniques (corticotomy and piezocision technique). This research investigates to what extent diathermy can accelerate the orthodontic alignment phase. Materials and Methods: A patient with lower teeth crowding index of the same magnitude was selected. The orthodontic treatment with Nickel–Titanium (NiTi) thermal arc 0.015 in the lower arch was performed, associated with a weekly application of diathermy using the intraoral handpiece. The total duration of treatment was three weeks. During each session, an intraoral transducer was employed to stimulate the hard and soft tissues of the left dental hemiarch, which was also orthodontically aligned like the right one. Results: Comparing the tooth movements of four elements of the two hemiarchies, it was found that, overall, the two teeth examined on the treated side underwent a more significant number of changes than on the untreated side, although not by a significant amount. Conclusions: The use of diathermy, according to the authors, is a non-invasive approach that may speed up the orthodontic alignment phase and reduce treatment duration, resulting in a lower risk of caries, gingival recessions, root resorptions, and patient compliance improvement, without side effects. Further studies and an adequate sample size will be needed to confirm the findings.

Evaluation of the effectiveness of a novel mouth rinse containing hyaluronic acid and hydrogen peroxide on gingivitis: A randomized pilot controlled trial

Objective

To evaluate and compare the effectiveness of a mouth rinse with hydrogen peroxide (H₂O₂) and hyaluronic acid (HA) versus a placebo mouth rinse on gingivitis.

Material and methods

This was a 21‐day, double blind, randomized, two‐arm parallel allocation placebo‐controlled trial of 50 study participants with a diagnosis of plaque‐induced gingivitis. Patients were randomly allocated to the test group or the placebo group and were assessed at three time points over the course of the study by the same operator, at baseline (T0), 7 days (T1), and 21 days follow‐up (T2). Primary outcomes of the trial were improvement in gingivitis and plaque accumulation.

Results

In both groups there was a decrease in gingival and plaque indices but the combination of the two actives (H₂O₂/HA) proved to be more effective against gingivitis (p = 0.001). Regarding plaque index, the differences between the test product and placebo were not statistically significant (p = 0.084). Besides, the new mouthwash was considered palatable, no adverse events were registered over the 21‐day period.

Conclusions

The H₂O₂ + HA product was more effective in reducing gingivitis when compared to a placebo while no differences were observed for plaque accumulation.

A CBCT based analysis of the correlation between volumetric morphology of the frontal sinuses and the facial growth pattern in caucasian subjects. A cross-sectional study

Background

The aim of this study was to evaluate the relationship between frontal sinus shape and facial growth pattern.

Methods

The three-dimensional examination was carried out by means of 80 CBCT scans selected from a sample of 1247 records of patients treated, for different reason, at the Department of Biomedical Surgical and Dental Sciences at University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico Milan. The sample (age ranges between 12 and 40 years) was divided according to gender and age in four groups (12-17, 18-20, 21-30, 31-40). Left and right frontal sinus volume (VOL), surface (SUP) and linear maximum width (XMAX), depth (ZMAX) and height (YMAX) were calculated using Mimics Research 17.0 (Materialise N.V., Leuven, Belgium). Cephalometric analysis has been performed for all subjects to categorize the patients depending on their facial growth pattern. Univariate and multivariate regression analysis were performed to investigate any association of frontal sinuses measurements (height, width, depth, volume and surface) and cephalometric variables. P value < 0.05 was considered statistically significant.

Results

A total of 160 frontal sinuses were measures in 80 patients: 40 men and 40 women, average age of 23.5 ±14.6. Globally the frontal sinuses had the following average dimensions: volumes of 9055.8 ± 6505 mm³ and surfaces of 3820.3 ± 2125 mm². The statistical analysis showed that frontal sinus volume was statistically significant (p=0.003) greater for male (11,425 mm³) than female (6597.5 mm³). Similarly, the surface showed to be greater in men than in women (p=0.005). No correlation between age and frontal sinuses characteristics has been found. A statistically significant (p<0.05) increase of frontal sinus depth, surface and volume was correlated with SNB angle. In addition, frontal sinus volume increased in subjects with greater anterior skeletal dimension values and with a superior length of the cranial base. Furthermore, a decrease of ANB has been found related to an increase in frontal sinus volume (p=0.04).

Conclusions

The present study showed a correlation between frontal sinuses dimensions and craniofacial aspects, despite the inter-individual variability of their morphology. The results suggested that young adults in whom the frontal sinuses have reached their maximum size, while vertical growth continues, a larger frontal sinus may be associated with future vertical growth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13005-022-00308-3.

Open bite and atypical swallowing: orthodontic treatment, speech therapy or both? A literature review

AIM

The cause-effect relationship between anterior open bite and atypical swallowing, two frequently associated conditions, is currently not completely understood. These conditions are often accompanied by speech disorders and represent a problem for both young patients and untreated adult patients. Treatment of these complex cases may be orthodontic, logopedic therapy or both. The purpose of this review is to compare the various types of treatment to determine their effectiveness in improving skeletal condition, normalisation of muscle activity, and temporal stability.

METHODS

The present systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyzes (PRISMA) guidelines. In order to find the most appropriate articles for inclusion, an electronic and manual search was performed using PubMed and The Cochrane Library on May 23, 2021. No language restrictions or time limits were applied. Only human studies describing cases of patients in the developmental stage of dentition, i.e., deciduous dentition or mixed dentition with an anterior open bite related to a type of swallowing with tongue interposition between the arches, undergoing three different types of treatment (orthodontic only, myofunctional/logopedic only, combined) were included.

CONCLUSION

The most effective treatment in cases of anterior open bite associated with atypical swallowing is a combination of the traditional orthodontic therapy and myofunctional therapy. Further studies are needed to devise an effective and universal logopaedic protocol to be followed in these cases.

Prevalence of Dental Malocclusions in Different Geographical Areas: Scoping Review

The World Health Organization (WHO) considers malocclusion one of the most important oral health problems, after caries and periodontal disease. Its prevalence is highly variable and is estimated to be between 39% and 93% in children and adolescents. Due to the importance of malocclusions in dentistry, the aim of our review is to assess the frequency of malocclusions among different geographical regions. A literature research was performed through the Pubmed, Medline, Scopus, Web of Science, LILACS, Open Grey and Cochrane Library databases. The “PRISMA” guidelines were used for the following review. Fourteen studies were analysed for this review. Class I was found most frequently, followed by class II and finally class III. Considering the other anomalies, crowding was one of the most frequent with a prevalence of up to 84%, followed by spacing, which reached a frequency of 60%. Prevalence of crossbite and openbite was quite variable, while the evaluation of deepbite revealed more uniform values. The prevalence varied widely for most of the types of malocclusion in relation to the different populations, which suggests a role of genetics and environmental influences, typical of each population in determining dental problems.

Three-dimensional volumetric evaluation of the different mandibular segments using CBCT in patients affected by juvenile idiopathic arthritis: a cross-sectional study

BACKGROUND

There is currently no information on how different mandibular segments are affected by juvenile idiopathic arthritis. The aim of this paper is to assess volumetric differences of different mandibular segments in subjects with unilateral and bilateral JIA and to compare them with non-JIA control volumes.

MATERIALS AND METHODS

Forty subjects with unilateral TMJ involvement and 48 with bilateral TMJ involvement were selected for the case group and 45 subjects with no known rheumatic comorbidities for the control group. The mandible of each subject was divided according to a validated method into different paired volumes (hemimandible, condyle, ramus and hemibody).

RESULTS

The ANOVA test revealed a statistically significant difference in all the groups for condylar and ramus volumes, and the pairwise comparison evidenced a statistically significant higher condylar and ramus volume in the control group (1444.47 mm³; 5715.44 mm³) than in the affected side in the unilateral JIA group (929.46 mm³; 4776.31 mm³) and the bilateral JIA group (1068.54 mm³; 5715.44 mm³). Moreover, there was also a higher condylar volume in the unaffected side in the unilateral JIA group (1419.39 mm³; 5566.24 mm³) than in the bilateral JIA group and the affected side in the unilateral JIA group.

CONCLUSIONS

The affected side of unilateral JIA patients showed statistically significant lower volumes in the hemimandible, in the condyle and in the ramus. The largest total mandibular volume was observed in the control group, followed by the unilateral JIA group and, lastly, by the bilateral JIA group.

Age- and Sex-Related Changes in Labial Dimensions of Sudanese Youngs of Arab Descent: A Three-Dimensional Cross-Sectional Study

Proper evaluation of facial features during growth and development requires the knowledge of anthropometric reference values validated for ethnicity, sex and age. In order to provide information concerning the normal sex-related size of the lips during childhood and young adulthood in Sudanese people of Arab descent, the three-dimensional coordinates of nine labial soft tissue landmarks were obtained by a laser scanner in 332 male and 386 female healthy Northern Sudanese subjects aged 3-30 years. Six labial linear distances, the vermilion height to mouth width ratio, vermilion areas and lip volumes were calculated and averaged for age and sex. Comparisons were performed by factorial analysis of variance (p < 0.01). All labial dimensions significantly increased with age. Significant effects of sex were found for four measurements only, with very small effect size; nonetheless, lips and their parts grew faster in females than in males at almost all ages. Philtrum width was the first linear distance that attained adult values. The vermilion height to mouth width ratio was nearly constant across the age groups. Data collected in this study contribute to information about ethnic-specific lip morphology during growth and development. As orolabial features change over time with their own pattern, the relevant age-related trends should be properly considered for clinical treatment planning.

Buccal Bone Changes Around First Permanent Molars and Second Primary Molars after Maxillary Expansion with a Low Compliance Ni-Ti Leaf Spring Expander

Background: Vestibular bone thickness changes and dento-alveolar buccal tipping of second primary molars and of first molars after maxillary expansion performed with a slow maxillary expansion protocol was investigated. Methods: Twenty patients (mean age 7.3 ± 0.9 years old; 9 male and 11 female) were treated according to the Leaf Expander protocol. Buccal alveolar bone thickness (BT), buccal alveolar bone height (BH), inter-dental angle (TIP), and inter-molar width (IW) regarding first molars and second primary molars were calculated before and after expansion on cone beam computed tomography (CBCT) images. Descriptive statistics and paired t-tests were used to assess changes between the pre-treatment and post-treatment measurements. Results: Bone thickness vestibular to second primary molars and intermolar width of both teeth were the only variables that showed statistically significant changes. Conclusions: It appears that buccal bone thickness vestibular to first molars was not significantly reduced after maxillary expansion with the Leaf Expander. The clinical use of a slow maxillary expander with Ni-Ti springs appears efficient and safe in in the correction of maxillary hypoplasia during mixed dentition.

Relationship between Breastfeeding and Malocclusion: A Systematic Review of the Literature

BACKGROUND

The purpose of this systematic review was to analyze the available literature about the influence of breastfeeding in primary and mixed dentition on different types of malocclusions.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines were used to perform the present review. The following electronic databases were searched: Pubmed, Evidence-Based Medicine Reviews (EBMR), Embase, Cochrane Library, Medline, Web of Science and Ovid.

RESULTS

A primary research found a total of 279 articles. Two more papers were also considered from the gray literature. Two hundred sixty-three articles were excluded as they were deemed irrelevant on the basis of: duplicates, title, abstract, methods and/or irrelevant contents. Eighteen papers were selected and included in the qualitative analysis.

CONCLUSIONS

breastfeeding is a positive factor that seems to reduce the incidence of posterior crossbite, skeletal class II and distoclusion in primary and mixed dentition. A sort of positive relationship between months of breastfeeding and risk reduction seems to exist. More longitudinal research is needed to avoid bias in the results, with data collected prospectively on the months of exclusive breastfeeding, by means of specific questionnaires and successive clinical evaluation of the occlusal condition at the primary dentition, mixed dentition and permanent dentition stages.

Correlation between Malocclusion and Allergic Rhinitis in Pediatric Patients: A Systematic Review

BACKGROUND

Oral breathing, nasal obstruction and airway space reduction are usually reported as associated to allergic rhinitis. They have been linked to altered facial patterns and dento-skeletal changes. However, no firm correlation based on the evidence has been established. This systematic review has been undertaken to evaluate the available evidence between malocclusion and allergic rhinitis in pediatric patients.

METHODS

The research refers to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines, databases (Medline, Cochrane Library, Pubmed, Embase and Google Scholar) were screened, the quality was evaluated through Quality Assessment of Diagnosfic Accuracy Studies (QUADAS-2).

RESULTS

The articles selected (6 out of initial 1782) were divided on the basis of the study design: two observational randomized study, three case-control study, one descriptive cross-sectional study, and one longitudinal study. A total of 2188 patients were considered. Different results were reported as related to allergic rhinitis ranging from a higher incidence of dental malocclusion, to an increase of palatal depth, and in posterior cross-bite about anterior open-bite and to longer faces and shorter maxillas.

CONCLUSIONS

Most of the studies selected found a rise in the prevalence of both malocclusion and allergic rhinitis in children. However, the level of bias is high, impaired by a poor design and no conclusive evidence can be drawn.

3D Printing of Clear Orthodontic Aligners: Where We Are and Where We Are Going

Clear orthodontic aligners were developed at the end of the 1990s [...].

A Call for Action to Safely Deliver Oral Health Care during and Post COVID-19 Pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak started just a couple of months ago and it grew rapidly causing several deaths and morbidities. The mechanism behind the transmission of the virus is still not completely understood despite a multitude of new specific manuscripts being published daily. This article highlights the oral cavity as a possible viral transmission route into the body via the Angiotensin converting enzyme 2 receptor. It also provides guidelines for routine protective measures in the dental office while delivering oral health care.

Assessing mandibular body changes in growing subjects: a comparison of CBCT and reconstructed lateral cephalogram measurements

The aim of this study is to compare cone-beam computed tomography (CBCT) and bi-dimensional reconstructed lateral cephalograms (RLCs) in assessing mandibular body length and growth and to evaluate how mandibular reshaping influences the error in measuring mandibular body growth in bi-dimensional radiographs. Twenty-five patients with two CBCT scans taken at a mean distance of 2.21 ± 0.5 years were selected. The following measurements were performed: right and left mandibular body length at each point in time, mandibular growth, inter-gonial distance and mandibular symphyseal angle. From each CBCT, an RLC was obtained, and mandibular body length and growth were measured. Data analysis revealed a statistically and clinically significant difference in CBCT and RLC regarding the mandibular length of each patient at each point in time. However, mandibular growth was almost identical. A linear regression was performed to predict growth distortion between RLCs and CBCT depending on the ratio between transverse and sagittal mandibular growth. The expected maximum and minimum distortion, however, appeared not to be significant. In fact, a second linear regression model and a Bland–Altman test revealed a strong correlation between measurements of average mandibular body growth by CBCT and RLCs. As the same distortion occurs in the first and second RLCs, bi-dimensional radiographs remain the method of choice in evaluating mandibular body growth.

Available Technologies, Applications and Benefits of Teleorthodontics. A Literature Review and Possible Applications during the COVID-19 Pandemic

Background: COVID-2019 spread rapidly throughout the world from China. This infection is highly contagiousness, has a high morbidity, and is capable of evolving into a potentially lethal form of interstitial pneumonia. Numerous countries shut-down various activities that were considered “not essential.” Dental treatment was in this category and, at the time of writing, only non-deferrable emergencies are still allowed in many countries. Therefore, follow-up visits of ongoing active therapies (e.g., orthodontic treatment) must be handled taking special precautions. This literature review aims at reducing in-office appointments by providing an overview of the technologies available and their reliability in the long-distance monitoring of patients, i.e., teledentistry. Methods: A literature review was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Randomized clinical trials, cross sectional, observational, and case-control studies were evaluated with the Mixed Methods Appraisal Tool for quality assessment and study limitations. Results: A primary search found 80 articles, 69/80 were excluded as non-relevant on the basis of: the abstract, title, study design, bias, and/or lack of relevance. Twelve articles were included in the qualitative analysis. Conclusions: Teleorthodontics can manage most emergencies, reassuring and following patients remotely. The aim set by dental teleassistance was met as it reduced patients’ office visits whilst maintaining regular monitoring, without compromising the results. Although our preliminary findings should be further investigated to objectively evaluate the efficacy, cost-effectiveness, and long-term results, we are confident that teleassistance in orthodontics will have a role to play in the near future.

Volumetric Changes in the Upper Airways after Rapid and Slow Maxillary Expansion in Growing Patients: A Case-Control Study

The aim is to evaluate changes in the volume of the upper airways before and after slow maxillary expansion (SME) obtained with the flexible properties of a nickel titanium leaf spring and rapid maxillary expansion (RME) with a conventional Hyrax appliance in growing patients. The records of 1200 orthodontic patients undergoing maxillary expansion from 2018 to 2019 were analyzed; among these pre and post treatment CBCT scans of 22 patients (mean age 8.2 ± 0.6 years old) treated by SME were compared with those obtained from 22 patients (mean age 8.1 ± 0.7 years old) treated by RME banded on the second primary molars. The following inclusion criteria were used: Maxillary transverse constriction, good general health, and no previous orthodontic treatment. Volumes of nasal cavity (NCavV), nasopharynx (NsPxV), and right and left maxillary sinuses (MSV) were calculated with ITK-SNAP. Shapiro–Wilk test revealed a normal distribution of data in each group. Paired t-test was used for within-group comparisons and independent t-test for between-group comparisons. Statistically significant increases occurred in NCavV, NsPxV, and MSVs after treatment with both appliances. No statistically significant difference between the appliances occurred in NCavV, NsPxV, and MSVs. Method error was considered negligible (mean intra-operator and inter-operator intraclass correlation coefficient were 0.928 and 0.911, respectively). It appears that both appliances produce similar effects on the different segments of the upper airway tract.

3D cephalometry on reduced FOV CBCT: skeletal class assessment through AF-BF on Frankfurt plane-validity and reliability through comparison with 2D measurements

OBJECTIVES

To test the validity of a novel protocol for 3D sagittal jaw discrepancy assessment (skeletal class determination) through comparison with common 2D indexes by the use of reduced FOV (10 × 10) CBCT which shows at least from the Frankfurt plane to the B point vertically, and from the most anterior between A and B point to Po point horizontally.

METHODS

A sample of CBCT scans of 109 adult patients (46 females; 63 males; mean age 30 years ± 11.6) equally distributed between I, II and III class was selected. Skeletal class was evaluated with specific software using the distance of A and B point's projection (AF-BF) on FHp (Frankfurt horizontal plane) and compared to 2D common indexes (ANB and Witts appraisal). The validity and reliability of the aforementioned analyses were determined using intra-class correlation coefficients, quadratic weighted Cohen's K and sensitivity.

RESULT

A selected range of values of 2.5 ± 2.5 AF-BF showed a solid correlation with the ANB angle (r = 0.846, K = 0.838, p < 0.001) and moderate with Wits appraisal (r = 0.723, K = 0.720, p < 0.001).

CONCLUSIONS

AF-BF showed high reliability in skeletal class determination on reduced FOV CBCT without the use of S and N cephalometric landmarks.

KEY POINTS

• Reduced FOV CT allows skeletal class determination for orthodontic purposes. • A new 3D-reduced FOV cephalometry is proposed. • AF-BF is a reliable alternative to ANB.

Effects on the Facial Growth of Rapid Palatal Expansion in Growing Patients Affected by Juvenile Idiopathic Arthritis with Monolateral Involvement of the Temporomandibular Joints: A Case-Control Study on Posteroanterior and Lateral Cephalograms

BACKGROUND

Juvenile idiopathic arthritis (JIA) affecting temporomandibular joints (TMJ) in growing patients results in maxillofacial deformities, especially if only one condyle has been affected by the rheumatic disease. Mandibular hypoplasia is the most common issue and it may be associated with maxillary hypoplasia. The aim of this retrospective case-control study is to evaluate the effects of rapid maxillary expansion (RME) in these patients.

METHODS

25 growing patients affected by maxillary hypoplasia, currently in a quiescent phase of JIA for at least one year and monolateral involvement of the TMJs, were treated with RME. Data gathered from posteroanterior and lateral cephalograms before and after 1 year from RME were compared to those of 25 non-JIA controls.

RESULTS

Nasal cavity width, maxillary width and upper and lower intermolar width statistically increased. Maxillary and mandibular symmetry indexes presented a statistically significant increase, so did the skeletal class. No signs or symptoms of TMJ activity of JIA occurred according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) criteria. No difference was found when comparing JIA and non-JIA patients apart from the better improvement of several mandibular symmetry indexes in the affected TMJ side of JIA patients. This event is allegedly due to a worse baseline asymmetry in JIA patients that underwent a bigger relative improvement after treatment.

CONCLUSIONS

Results suggest that solving maxillary hypoplasia and, therefore, premature contacts are likely to have allowed mandibular repositioning and condylar growth. RME is a safe and effective solution that can substantially improve maxillary and mandibular symmetry in growing patients affected by JIA with TMJ involvement.

Relationship between molar deciduous teeth infraocclusion and mandibular growth: A case-control study

AIM

As the effects of infraocclusion on mandibular growth could have a significant impact on the treatment planning made by the orthodontist, the aim of this study is to evaluate the correlation between infraocclusion and mandibular growth.

MATERIALS AND METHODS

Study design: A total of 42 healthy Caucasian patients with no history of dental trauma or orthodontic treatment were selected for this study from the same paediatric dentistry department. These patients were divided in two groups based on the presence or absence of infraocclusion: Group A, 22 patients (12 males and 10 females) suffering from infraocclusion of at least one inferior deciduous molar, and Group B, 20 patients (9 males and 11 females) who did not suffer from infraocclusion but had to be treated for dental overcrowding. Each patient was examined through an orthopantomography scan and lateral cephalogram. All measurements were made before the start of the treatment, and they were analysed in order to show cephalometric correlation between the skeletal class, the vertical dimension and cranio-maxillo-mandibular divergence.

RESULTS

According to Student's t-test, the only measurements which had a statistically significant difference between Group A and Group B were the SNB angle (p-value <0.01), the ANB angle (p-value <0.05) and the PC-GO-GN angle (p-value <0.05).

CONCLUSION

From the data collected in this study, it is possible to conclude that patients suffering from infraocclusion of the mandibular deciduous molars show mandibular post-rotation and an increased total Gonial angle, compared to patients who do not suffer from infraocclusion. Despite the absence of a longer-term evaluation of these patients, thanks to this data it is possible to state that early diagnosis of infraocclusion is fundamental in order to apply a well-planned and thought-out orthodontic treatment.

Three-Dimensional Evaluation of Maxillary Sinus Changes in Growing Subjects: A Retrospective Cross-Sectional Study

This study aims to evaluate changes of maxillary sinuses in growing subjects. Cone Beam Computed Tomography (CBCT) scans of 146 patients were divided according to gender and age (6–8, 9–11, 12–14 years old). Left, right and total maxillary sinus volume (MSV-R, MSV-L, MSV-Tot) and surface (MSS-R, MSS-L, MSS-Tot), left and right linear maximum width (LMW-L, LMW-R), depth (LMD-R, LMD-L) and height (LMH-R, LMH-R) were calculated using Mimics Research 22. Kruskal–Wallis Test and showed a statistically significant increase in both genders for all variables. Pairwise comparisons in females are always statistically significant in: LMH-R, LMH-R, MSS-Tot, MSV-Tot. All other variables showed a statistical significant increase between 9–11 and 12–14, and between 6–8 and 12–14 age groups, apart from LMSW-R, LMSW-L, LMSD-R, LMSD-L between 6–8 and 12–14 age groups. Pairwise comparisons in males are always and only statistically significant between 9–11 and 12–14, and between 6–8 and 12–14 groups. Symmetrical measurements (right and left) evaluated using Wilcoxon test retrieved no statistical significant difference. Comparisons between measurements on male and female subjects using Mann–Whitney test showed a statistical significant difference in 6–8 years group in MSV-R, MSV-L and MSV-Tot, and in 12–14 age group in MSV-R, MSV-L, MSV-Tot, MSS-r, MSS-l, MSS-Tot, MSW-R, MSW-L, MSD-R, MSD-L. Intraclass Correlation Coefficient (ICC) assessing inter-operator and intra-operator concordance retrieved excellent results for all variables. It appears that maxillary sinus growth resembles the differential peak of growth in male and female subjects. Sinuses starts to develop early in female subjects. However, in the first and last age group female sinuses are statistically significantly smaller compared to male ones. In male subjects, sinus growth occurs mainly between the second and third age group whilst in female subjects it starts between the first and second age group and continues between the second and the last. Sinus has a vertical development during the peak of growth, which is the main reason for its increase in volume.

Correlation between facial growth patterns and cortical bone thickness assessed with cone-beam computed tomography in young adult untreated patients

Background

The vertical facial growth pattern is one of the most important issue in the orthodontic diagnosis and treatment. Previous studies investigated the association between interdental bone thickness and facial divergence using mainly bidimensional analysis. When two-dimensional dental radiographic views are not sufficient for diagnosis and measurements, cone-beam computed tomography (CBCT) images should be used to assess the alveolar bone structure three-dimensionally and with high accuracy and reliability.

The aim of the present study was to evaluate the correlation between alveolar bone thickness and facial divergence in young adults untreated patients using a three-dimensional method analysis with CBCT images.

Methods

Records of 30 untreated patients (mean age 16 ± 2 years) with Angle Class I and mild to moderate crowding were analyzed. Subjects were classified as hypodivergent (<39˚), normodivergent (41 ± 2˚), and hyperdivergent (>43°). according to the inter-maxillary angle between the sagittal maxillary plane (ANS-PNS) and the mandibular plane (GN-ME). The alveolar bone thickness measurements were taken for the buccal and palatal/lingual surfaces of maxillary and mandibular anterior teeth. Axial-guided navigation (AGN) was used to locate all landmarks using a specific software (Horos 3.0).

Results

The statistical analysis showed a significant difference between the hypodivergent and hyperdivergent group regarding buccal bone height (P = 0.005), buccal apical bone thickness (P = 0.003) and palatal mid-root bone thickness (P = 0.006). Moreover, buccal bone height (P = 0.006) was found to be statistically significant different in normodivergent compared with hypodivergent individuals.

Conclusions

Facial types were found to be correlated with alveolar bone thickness. The hyperdivergent subjects presented thinner alveolus bone in the anterior maxilla and at almost all sites in the mandible. Clinicians should be aware of the possibility of thin cortical bone plates in hyperdivergent patients, reducing antero-posterior movements to avoid fenestration and dehiscence.

Rapid Maxillary Expander and Eruption Guidance Appliance therapy in skeletal Class II: cephalometric considerations

AIM

The use of rapid maxillary expander (RME) combined with eruption guidance appliances (EGA) represents a valid method in the treatment of skeletal Class II deep bite patients. In this paper a retrospective cephalometric study of the effects of RME and EGA therapy in Class II deep bite patients is described and compared with the treatment effects of patients with the same malocclusion treated only by RME.

MATERIALS AND METHODS

Pre and post treatment cephalometric radiographs of 47 Class II division 1 deep bite growing patients treated with RME followed by EGA (mean age 9.65 years) (Group 1) were compared with those obtained from a control group (Group 2) of 44 patients (mean age 9.34 years) treated with RME only. The following cephalometric values were analized: SNA; SNB; ANB; SN-PNS.ANS; SN-Go.GN; N-Me; S-Go.

RESULTS

Improvement in maxillo-mandibular relationship was observed in both groups with significantly higher decrease of SNA and ANB in group 1. The cranio-maxillary relation shows a tendency to grow downward and backward in both groups. Both anterior and posterior total facial heights showed a significant increase in group 1.

CONCLUSIONS

RME followed by EGA therapy in Class II skeletal deep bite patients has shown better results compared with RME therapy without functional appliance.

Correlation between Dental Vestibular-Palatal Inclination and Alveolar Bone Remodeling after Orthodontic Treatment: A CBCT Analysis

The aim of this study was to evaluate the correlation between dental vestibular-palatal inclination changes and the cortical bone remodeling after fixed orthodontic treatment using cone beam computed tomography (CBCT). Twenty-two patients with Angle Class I malocclusion, permanent dentition, and mild to moderate dental crowding were included in the present three-dimensional (3D) analysis. Bone dimensions were evaluated by CBCT scans obtained before and after orthodontic treatment, whereas the torque values were calculated by means of digital models using the 3D VistaDent software. A paired t-test was used to compare the changes between the pretreatment and post-treatment measurements. The correlations between variables were analyzed with linear regression analysis. A significant correlation between torque variations and bone thickness changes was observed for the apical buccal level of the anterior side (P < 0.05). Limited and not significant alveolar bone resorption for the apical thickness of anterior teeth occurred at ± 5 degrees of torque variation, while for tooth inclination exceeding +5 or -5 degrees, the bone remodeling was more evident. The present study demonstrated that anterior region was the most affected area by bone remodeling and that torque variation was highly related to apical bone thickness adaptation for maxillary and mandibular incisors and maxillary canines.

Lymphangioma of the tongue associated with open bite: case report

BACKGROUND

Lymphangioma of the tongue is a rare condition related to congenital malformations of the lymphatic system. It may have different implications such as macroglossia. This condition could exacerbate in aesthetic abnormalities and functional problems such as maxillofacial structural deformities, dysphagia, airway obstruction and speech difficulties. The aim of this paper is to describe this disease by means of a case report.

CASE REPORT

A 4-year-old patient was referred to our department presenting macroglossia, functional difficulty during swallowing and mastication, speech disturbances, airway obstruction, and deformities of the maxillofacial structures. Diagnosis of lymphangioma was confirmed by biopsy. After surgical removal of the lesion, the patient was treated with rapid palatal expansion, functional appliance with lingual grid and fixed multibracket appliance. After treatment, improvement in function, indicated by the gradual increase in occlusal force, could be taken as a positive sign of stability.

CONCLUSION

The 3-step treatment protocol described in this article proves to be effective in controlling the malocclusion in the three planes of the space in a patient affected by lymphangioma of the tongue.

RME: effects on the nasal septum. A CBCT evaluation

AIM

Three-dimensional images have been evaluated to study the changes that occur on the maxillary complex and the nasal septum, following rapid maxillary expansion (RME) in growing children.

METHODS

The records of 39 consecutively treated patients (20 male, 19 female), aged between 6.2 and 12.3 years (mean 8.6 years, S.D. 1.5), presenting a septal deviation of more than 1 mm, were analysed. Each patient was scanned at two distinct periods. The first image (T0) was obtained before treatment and hence represented the patient's baseline condition prior to expansion. The second time point (T1) was set after removal of the expander. The skeletal modifications induced by RME have been evaluated via cephalometric tracings obtained at T0 and at T1. The time lapse between T0 and T1 was 12 months.

RESULTS

The nasal septum has been modified in its length more significantly in its lower rather than its upper tract. The width of the piriform aperture increased of 1.58 mm with an increase in the lateral walls and a downward movement of the nasal floor (consequent to an increase in septal length). There was also a reduction of septal deviation. The control group measurements did not vary during the considered period.

CONCLUSION

Evidences of this study suggest that RME procedures can result in: a potentially positive effect on the nasal septum asymmetry during childhood; an increase of the nasal cavity volume due to a downward and forward movement; a lateral inclination of the nasal cavity reducing air resistance and improving breathing pattern; an increase of the length of the septum in its lower third improving its possible deviations and growth disturbances; favourable effects on the growth of the entire maxillary complex.

Comparison of a tridimensional cephalometric analysis performed on 3T-MRI compared with CBCT: a pilot study in adults

OBJECTIVE

Since the introduction of cone-beam computed tomography (CBCT) in dentistry, this technology has enabled distortion-free three-dimensional cephalometric analysis for orthodontic and orthognathic surgery diagnosis. However, CBCT is associated with significantly higher radiation exposure than traditional routine bidimensional examinations for orthodontic diagnosis, although low-dose protocols have markedly reduced radiation exposure over time. The objective of this preliminary feasibility study is to compare the accuracy and diagnostic capabilities of an already-validated three-dimensional cephalometric analysis on CBCT to those of an analysis on 3-T magnetic resonance imaging (3T-MRI) to assess whether the latter can deliver a comparable quality of information while avoiding radiation exposure.

MATERIALS AND METHODS

In order to test the feasibility of three-dimensional cephalometry on 3T-MRI, 18 subjects (4 male; 14 female) with mean age 37.8 ± SD 10.2, who had undergone both maxillofacial CBCT and maxillofacial 3T-MRI for various purposes within 1 month, were selected from the archive of the Department of Dentistry and Maxillofacial Surgery of Fondazione Ospedale Policlinico Maggiore, IRCCS, Milano, Italy. A three-dimensional cephalometric analysis composed of ten midsagittal and four bilateral landmarks and 24 measurements (11 angular, 13 linear) was performed on both scans using Mimics Research® v. 17.0 (NV, Technologielaan 15, 3001 Leuven, Belgium). Cephalometric analysis was performed twice by two independent orthodontists for each scan, and each orthodontist repeated the measurements 3 weeks later. Statistical analysis was performed with SPSS® 20.00 for Windows (IBM® Corporation, Sommers, NY, USA). A Bland-Altman test for each cephalometric value was performed to assess the agreement between the procedures. The intraclass correlation coefficient (ICC) was used to assess interobserver and intraobserver reliability. The coefficient of variation was used to evaluate precision.

RESULTS

Both procedures showed good reliability, with mean intraobserver ICCs of 0.977/0.971 for CBCT and 0.881/0.912 for MRI. The average interobserver ICCs were 0.965 for CBCT and 0.833 for MRI. A Bland-Altman analysis for the cephalometric tracing revealed a similar range of agreement between the two modalities; the bias range (mean ± SD) was - 0.25-0.66 mm (0.174 ± 0.31) for distances and - 0.41-0.54° (0.12 ± 0.33) for angles.

CONCLUSIONS

Within the main limitation of this pilot study, that is, the small sample, it is possible to state that cephalometric measurements on 3T-MRI seem to possess adequate reliability and repeatability and that they show satisfying agreement with values measured on CBCTs. An MRI examination does not expose patients to ionizing radiation and could provide an alternative to CBCT for three-dimensional cephalometrics in the future.

Hyrax versus transverse sagittal maxillary expander: An assessment of arch changes on dental casts. A retrospective study

Objective

The aim of this study was to compare arch changes before and after maxillary expansion with Transverse Maxillary Sagittal Expander (TSME) and Hyrax Palatal Expander (HPE), in growing patients with diagnosis of maxillary hypoplasia.

Materials and methods

The sample consisted of 40 patients' records (20 males 20 females mean age 9.2 ± 2.6 years) were selected from the archive of the Orthodontic Department of the University of Milan, Italy. Patients were randomly divided in two groups: patients in group 1 were treated with HPE as they presented only transverse deficiency of the maxilla and in group 2 were treated with TSME. Plaster models have been measured with a Verniere caliper to evaluate the differences in maxillary expansion of the two devices. Measurements were performed on casts poured from impressions taken before appliance bonding (T0), immediately after appliance debonding (T1) and at 6 months follow-up (T2). The variations in the following distances have been considered: inter-molar distance, inter-canine distance, palatal depth, palatal length and arch circumference. Shapiro-Wilk test was performed to assess normality distribution. ANOVA for repeated measures with multiple paired t-test for pairwise comparisons and its non-parametric equivalent Friedman's test with multiple Wilcoxon tests for pairwise comparisons were performed to evaluate changes in time of each variable in each group. Between groups comparisons were performed for each variable at each observing time using independent t-test or Mann-Whitney test. Significance level was set at p < 0,05.

Results

Both the Friedman test and the rm-ANOVA test and their respective post-hoc show that within both groups the respective variables have a statistically significant increase between T0 and T1 (p < 0,05) and a slight decrease between T1 and T2 (p < 0,05) that is not clinically relevant remaining always T2 greater than T0 in a statistically and clinically relevant way (p < 0,05). The analysis between the differences of the measurements at different timing measured by the Mann-Whitney test shows that for all the variables there is no statistically significant difference between the 2 devices (p < 0,05), except for the perimeter of the arch and the length of the palate; in this case it appeared that the TSME is better statistically (p < 0,05).

Conclusions

The study has shown that RPE and TSME can achieve similar results in transversal palatal expansion. Differences have been found in the palatal length and in the arch perimeter where TSME seems to be more efficient.

Class II division 1 malocclusions: comparisons between one- and two-step treatment

AIM

The aim of this study consists in comparing the two-step treatment with that performed in a single-step in adolescent patients.

MATERIALS AND METHODS

Study design: This paper is a critical review of the literature with a systematic approach. The search for scientific articles was performed on the US National Library of Medicine database using the PubMed service. Keywords set: "Early treatment Class II OR 1-phase orthodontics OR orthodontic timing Class II". From the initial screening 20 articles were selected of which the full text has been researched and evaluated.

RESULTS

The selected articles were reviewed and evaluated by two independent operators, who both excluded two papers. Ultimately 13 articles were selected that refer to four major working groups, respectively from Manchester, North Carolina, Florida and Queen Mary University of London.

CONCLUSION

We can assume that both the one- and two-step treatment are effective in correcting Class II malocclusion, with no significant difference of outcome, except for the incidence of incisor trauma, which was significantly lower for the early treatment group.

Bilateral Hyperplasia of the Coronoid Process in Pediatric Patients: What is the Gold Standard for Treatment?

OBJECTIVES

The aim of this systematic review of the literature is to describe treatment options for bilateral coronoid process hyperplasia in pediatric patients, to describe etiologic and diagnostic correlations with the treatment, and to evaluate long-term follow-up treatment outcomes.

METHODS

A systematic revision of the literature was performed in the Medline, PubMed, Cochrane library, and Embase database up to December 5, 2017. Predetermined Medical Subject Heading keywords were used: "bilateral" or "monolateral" and "coronoid" or "coronoid process" and "hyperplasia" and "temporomandibular joint" or "tmj" and "ankylosis" or "trismus" and "treatment." Results were recorded following PRISMA guidelines.

RESULTS

The systematic research produced 1459 results excluding duplicates. Two additional studies from "Grey literature" were also considered. After application of inclusion and exclusion criteria, 38 articles were selected for a qualitative synthesis. Data regarding sex and age of presentation were collected and summarized in a study flow diagram.

CONCLUSION

It is possible to conclude that early diagnosis is fundamental to restore stomatognathic multifunction. There is lack of longitudinal studies presenting long-term follow-up to determine treatment stability. Coronoidectomy might be considered gold standard treatment for this pathologic condition.