Preformed Elastodontic Appliances: Awareness and Attitude of Orthodontists and General Dental Practitioners

BACKGROUND

Preformed elastodontic appliances (EAs) have been described as safe, cost-effective, and easy-to-use devices for interceptive orthodontic treatment in growing patients. This study aimed to assess the knowledge and the attitude of dentists toward the use of EAs and to compare the behaviors of orthodontists (Os) with those of general dental practitioners (GDPs).

METHODS

An anonymous survey was distributed among dentists through social media. Twenty-two items were divided as follows: characteristics of respondents; general knowledge about EAs; section for EA-users; and section for EA non-users. Chi-squared tests were used to analyze differences in responses between groups.

RESULTS

Participants included 226 Os and 168 GDPs. The majority in both groups reported having adequate knowledge about EAs and utilizing them in their practice. GDPs usually use EAs to treat children during the early phase of growth, while Os also use EAs to address orthodontic problems in different stages of dentition, experiencing a chair time reduction compared with traditional appliances. Regarding EA non-users, GDPs seem not to find an application among their patients, whereas Os reported not having enough patient compliance during treatment.

CONCLUSIONS

Although treatment with EAs is common among all dentists, differences exist between Os and GDPs in the awareness and application, as well as in the reasons provided for not using EAs.

Cephalometric changes of pushing splints 3 compared to rapid maxillary expansion and facemask therapy on the airway space in class III growing patients: A randomized clinical trial

BACKGROUND

Early orthopaedic treatment with rapid maxillary expansion (RME) associated with facemask (FM) has been shown to be effective in correcting Class III malocclusions in children. Treatment with pushing splints 3 (PS3) has shown to correct skeletal discrepancies in Class III growing patients. However, the effects of orthopaedic treatment on the upper airways in children with Class III malocclusion is controversial.

OBJECTIVES

The aim of this study was to evaluate the cephalometric changes in the airways of PS3 compared to the RME/FM protocol.

MATERIALS AND METHODS

In this study, 48 patients with Class III malocclusion (age range 5.5-8.5 years old) were selected for this study, and 24 were treated with PS3 appliance and 24 with RME/FM therapy. Lateral cephalograms before (T0) and at the end of the treatment (T1) were analysed to compare pharyngeal spaces. Paired and unpaired t tests were used for data analysis (P < .05).

RESULTS

A total of 41 patients (21 patients for the PS3 group, 11 males and 10 females, mean age 7.0 ± 1.2 years; 20 patients for the RME/FM group, 10 males and 10 females, mean age 7.2 ± 1.3 years) were included. The results showed a statistically significant (P < .05) increase in the nasopharyngeal space after both therapies. However, the effects were similar considering that there were no differences between groups for the assessed variables at T0-T1.

CONCLUSIONS

Early treatment of Class III malocclusion with PS3 does not induce a statistically significant increase in the sagittal airway space compared to RME/FM. The absence of untreated group could not define the role of growth in the increase of space.

Management of temporomandibular joint arthritis in children and adolescents: An introduction for orthodontists

Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease of childhood. JIA can affect any joint and the temporomandibular joint (TMJ) is one of the joints most frequently involved. TMJ arthritis impacts mandibular growth and development and can result in skeletal deformity (convex profile and facial asymmetry), and malocclusion. Furthermore, when TMJs are affected, patients may present with pain at joint and masticatory muscles and dysfunction with crepitus and limited jaw movement. This review aims to describe the role of orthodontists in the management of patients with JIA and TMJ involvement. This article is an overview of evidence for the diagnosis and treatment of patients with JIA and TMJ involvement. Screening for the orofacial manifestation of JIA is important for orthodontists to identify TMJ involvement and related dentofacial deformity. The treatment protocol of JIA with TMJ involvement requires an interdisciplinary collaboration including orthopaedic/orthodontic treatment and surgical interventions for the management of growth disturbances. Orthodontists are also involved in the management of orofacial signs and symptoms; behavioural therapy, physiotherapy and occlusal splints are the suggested treatments. Patients with TMJ arthritis require specific expertise from an interdisciplinary team with members knowledgeable in JIA care. Since disorders of mandibular growth often appear during childhood, the orthodontist could be the first clinician to see the patient and can play a crucial role in the diagnosis and management of JIA patients with TMJ involvement.

Lower Incisor-Pg: A New Cephalometric Parameter to Evaluate the Anterior Limit of Dentition

Background: This present retrospective study aimed to introduce Lower Incisor-Pg and to assess how this new parameter varies with the skeletal sagittal and vertical relationships. Methods: A total of 1256 cephalometric analyses were performed using lateral cephalometric radiographs of a sample of subjects divided according to SN^Go-Gn, ANPg^, and IMPA measurements. The differences in Lower Incisor-Pg between the groups were assessed through ANOVA tests and posthoc analyses, while Pearson's correlation analysis was used to assess the correlations between the measurements. Results: The mesofacial growth pattern (61.0%) was more common than dolichofacial (30.0%) and brachyfacial (8.6%) ones in the sampled population. Regarding skeletal sagittal relationships, Class I was more frequent (70.9%) than Class II (19.3%) and Class III (9.8%). The mean value of the Lower Incisor-Pg was 3.2 ± 4.0 mm. Linear regression showed that the β coefficient was 0.45 and 0.36 for ANPg^ and SnGoGn^, respectively. Conclusions: Lower Incisor-Pg is a linear cephalometric measurement to evaluate the lower incisor sagittal position. For each degree of increase in ANPg^ and SNGoGn^, the Lower Incisor-Pg increased 0.45 mm and 0.36 mm, respectively.

Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for adolescents

BACKGROUND

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for use in adults is in use worldwide. Until now, no version of this instrument for use in adolescents has been proposed.

OBJECTIVE

To present comprehensive and short-form adaptations of the adult version of DC/TMD that are appropriate for use with adolescents in clinical and research settings.

METHODS

International experts in TMDs and experts in pain psychology participated in a Delphi process to identify ways of adapting the DC/TMD protocol for physical and psychosocial assessment of adolescents.

RESULTS

The proposed adaptation defines adolescence as ages 10-19 years. Changes in the physical diagnosis (Axis I) include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for adolescents, (ii) adding two general health questionnaires, one for the adolescent patient and one for their caregivers and (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire. Changes in the psychosocial assessment (Axis II) include (i) adapting the language of the Graded Chronic Pain Scale to be developmentally appropriate for adolescents, (ii) adding anxiety and depression assessment that have been validated for adolescents and (iii) adding three constructs (stress, catastrophizing and sleep disorders) to assess psychosocial functioning in adolescents.

CONCLUSION

The recommended DC/TMD, including Axis I and Axis II for adolescents, is appropriate to use in clinical and research settings. This adapted first version for adolescents includes changes in Axis I and Axis II requiring reliability and validity testing in international settings. Official translations of the comprehensive and short-form to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Changes in COVID-19 Perception and in TMD Prevalence after 1 Year of Pandemic in Italy

OBJECTIVES

 The study aims to report the perception of dental practices and assess the individual's psychological stress level and related temporomandibular disorders (TMD) symptoms by evaluating the changes that occurred during the year following the first lockdown (May 2020).

MATERIALS AND METHODS

 An online questionnaire was submitted to the Italian population between 20 March and 20 April 2021. It was sent via online platforms and included 14 questions.

STATISTICAL ANALYSIS

 The data were analyzed using a chi-squared test and a comparison of the current data with the May 2020 survey data was performed using independent samples t-tests. The level of significance was set at p < 0.05.

RESULTS

 Forty-three percent of subjects (872) considered the dental practice to be a place with a high risk of infection. Temporomandibular pain and joint sounds were reported by 35.7% (724) of the population; of these more frequently were women (71.8%, 520/724, p < 0.001). About 31% of the participants had moderate/severe psychological distress and, among them, it was found that 46.4% (294/634) reported TMD pain (p < 0.001) and 34.9% (221/634) complained of temporomandibular joint sounds (p < 0.001).

CONCLUSIONS

 Most participants did not consider dental practices as a place with a higher risk of coronavirus disease 2019 transmission and, in contrast to the data from a previous study, people were less afraid to go to dental practices. After the first year of the pandemic, the level of stress and depression increased and the prevalence of TMD pain and joint sounds increased, in association with gender, age, and level of distress.

The Predictability of Transverse Changes in Patients Treated with Clear Aligners

Arch expansion might be used to correct buccal corridors, improve smile aesthetics, resolve dental cross bite, and gain space to resolve crowding. In clear aligner treatment, the predictability of the expansion is still unclear. The purpose of this study was to evaluate the predictability of dentoalveolar expansion and molar inclination with clear aligners. In the study, 30 adult patients (27 ± 6.1 years old) treated with clear aligners were selected (treatment time: 8.8 ± 2.2 months). The upper and lower arch transverse diameters were measured for canines, first and second premolars, and first molars on two different sides (gingival margins and cusp tips); moreover, molar inclination was measured. A paired t-test and Wilcoxon test were used to compare prescription (planned movement) and achieved movement. In all cases, except for molar inclination, a statistically significant difference was found between achieved movement and prescription (p < 0.05). Our findings showed a total accuracy of 64% for the lower arch, 67% at the cusp level, and 59% at the gingival level, with a total accuracy of 67% for the upper arch, 71% at the cusp level, and 60% at the gingival level. The mean accuracy for molar inclination was 40%. Average expansion was greater at cusps of canines than for premolars, and it was lowest for molars. The expansion achieved with aligners is mainly due to the tipping of the crown rather than bodily movement of the tooth. The virtual plan overestimates the expansion of the teeth; thus, it is reasonable to plan an overcorrection when the arches are highly contracted.

Predictability of Maxillary Molar Distalization and Derotation with Clear Aligners: A Prospective Study

Clear aligners are employed daily for the treatment of Class II malocclusions, when a valid option involves distalization and derotation of the upper first and second molars. Evidence regarding the predictability of these movements is slight, and the treatment outcome that clinicians plan may not be achieved. Therefore, the purpose of this study is to assess the accuracy of distalization and derotation with clear aligners. Geomagic Control X, a 3D quality control software, was used to superimpose digital models of the pre-treatment, post-treatment, and virtual plan (ideal post-treatment) measurements of 16 patients (4 M, 12 F; mean age 25.7 ± 8.8 years). Linear and angular measurement tools were used to calculate the amount of tooth movement prescribed and achieved. Distal displacement of the buccal cusps had an overall accuracy of 69% for the first molar and 75% for the second molar. The accuracy of molar derotation was higher for the first molar (77.5%) than for the second molar (62.7%). The aligners were not able to achieve 100% of the ideal post-treatment result; thus, planning of refinements is often needed. However, clear aligners can be regarded as a valuable option for the distalization of first and second molars.

Effect of orthopedic and functional orthodontic treatment in children with obstructive sleep apnea: A systematic review and meta-analysis

Orthodontic treatment is suggested in growing individuals to correct transverse maxillary deficiency and mandibular retrusion. Since, as a secondary effect, these orthodontic procedures may improve pediatric obstructive sleep apnea (OSA), this systematic review assessed their effects on apnea-hypopnea index (AHI) and oxygen saturation (SaO2). Twenty-five (25) manuscripts were included for qualitative synthesis, 19 were selected for quantitative synthesis. Five interventions were analyzed: rapid maxillary expansion (RME, 15 studies), mandibular advancement (MAA, five studies), myofunctional therapy (MT, four studies), and RME combined with MAA (one study). RME produced a significant AHI reduction and minimum SaO2 increase immediately after active treatment, at six and 12 months from baseline. A significant AHI reduction was also observed six and 12 months after the beginning of MAA treatment. MT showed positive effects, with different protocols. In this systematic review and meta-analysis of data from mainly uncontrolled studies, interceptive orthodontic treatments showed overall favorable effects on respiratory outcomes in pediatric OSA. However, due to the low to very low level of the body evidence, this treatment cannot be suggested as elective for OSA treatment. An orthodontic indication is needed to support this therapy and a careful monitoring is required to ensure positive improvement in OSA parameters.

Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for children

BACKGROUND

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed.

OBJECTIVE

The aim of this study was to present comprehensive and short-form adaptations of Axis I and Axis II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings.

METHODS

Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children.

RESULTS

The proposed adaptation is suitable for children aged 6-9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, (ii) adding anxiety and depression assessments that have been validated in children and (iii) adding three constructs (stress, catastrophising and sleep disorders) to assess psychosocial functioning in children.

CONCLUSION

The recommended DC/TMD, including Axis I and Axis II, for children aged 6-9 years, is appropriate for use in clinical and research settings. This adapted the first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Obstructive Sleep Apnoea in Children with Down Syndrome: A Multidisciplinary Approach

A comprehensive evaluation of obstructive sleep apnoea (OSA) may allow for the development of more efficient management of Down syndrome (DS). We aimed to evaluate the effect of a multidisciplinary approach to DS with OSA. A total of 48 DS children aged 4−12 years were prospectively investigated with nasal endoscopy, orthodontic examination, and overnight polygraphy (PG); the Italian Child Sleep Habits Questionnaire (CSHQ-IT) was filled out by the mothers. The total CSHQ-IT score was 63 (96% of children reporting sleep problems). The major ear, nose, and throat characteristics were enlarged palatine tonsils (62%), adenoid tonsils (85%), and chronic rhinosinusitis (85%). DS children showed orthognathic profile in 68% of cases, class I relationship in 63%, and cross-bite in 51%. PG revealed OSA in 67% of cases (37% mild, 63% moderate−severe). The oxygen desaturation index (ODI) was higher in the group with OSA (5.2) than with non-OSA (1.3; p < 0.001). The ODI was higher (p = 0.001) and SpO2 lower (p = 0.03) in children with moderate−severe OSA than with mild OSA. The apnoea−hypopnea index (AHI) and percentage time with SpO2 < 90% were higher in DS children with grade III than with grade I or II adenoids (5 vs. 1, p = 0.04, and 1.2 vs. 0.1, p = 0.01, respectively). No significant correlations were found between PG and the total CSHQ-IT score or orthodontic data. However, children showing associated cross-bite, grade III adenoids and size 3 or 4 palatine tonsils showed higher AHI and ODI than those without (p = 0.01 and p = 0.04, respectively). A coordinated multidisciplinary approach with overnight PG is a valuable tool when developing diagnostic protocols for OSA in DS.

Evaluation of Tooth Movement Accuracy with Aligners: A Prospective Study

Background. Clear aligners treatment (CAT) is a common solution in orthodontics to treat both simple and complex malocclusions. This study aimed to evaluate the predictability of CAT, comparing the virtually planned and the achieved tooth movement at the end of stage 15, which is often the time of first refinement. Methods. Seventeen patients (mean age: 28.3 years) were enrolled in the study. Torque, tip and rotation were analyzed in 238 maxillary teeth on digital models at Pre-treatment (T0), at the end of stage 15 (T15) and at virtually planned stage 15 (T15i). Prescription, Achieved movement and performance values were calculated to compare the virtually planned and the clinical tooth position. Data were analyzed by means of Student’s t test with a level of significance set at p < 0.05. Results. The largest iper-performance was the torque correction of the second molars (+2.3° ± 3.1°), the greatest under-performance was the tip correction of the first molars (−2.3° ± 3.3°), while rotation corrections of all the teeth showed more accurate performance. No significant differences were found between mean Prescription and mean Achieved movement for all the assessed movements (p < 0.05). Conclusions. An accurate evaluation of CAT after the 15th aligner is fundamental in order to individuate the movements that are not matching the digital set-up.

Diagnostic criteria for temporomandibular disorders (DC/TMD) in children and adolescents: an international Delphi study-Part 2-Development of Axis II

BACKGROUND

Unlike the psychosocial assessment established for adults in the diagnostic criteria for temporomandibular disorders (DC/TMD), a standardized psychosocial assessment for children and adolescents with TMD complaints has not yet been established.

OBJECTIVES

To develop a new standardized instrument set to assess the psychosocial functioning in children and adolescents by adapting the psychosocial status and pain-related disability (Axis II) of the adult DC/TMD and by including new instruments.

METHODS

A modified Delphi method was used to survey 23 international TMD experts and four international experts in pain-related psychological factors for consensus regarding assessment tools for psychosocial functioning and pain-related disability in children and adolescents. The TMD experts reviewed 29 Axis II statements at round 1, 13 at round 2, and 2 at round 3. Agreement was set at 80% for first-round consensus level and 70% for each of the second and third rounds. The psychological experts completed a complementary Delphi survey to reach a consensus on tools to use to assess more complex psychological domains in children and adolescents. For the psychological experts, the first round included 10 open-ended questions on preferred screening tools for depression, anxiety, catastrophizing, sleep problems, and stress in children (ages 6-9 years old) and adolescents (ages 10-19 years old) as well as on other domains suggested for investigation. In the second round, the psychological experts received a 9-item questionnaire to prioritize the suggested instruments from most to least recommended.

RESULTS

The TMD experts, after three Delphi rounds, reached consensus on the changes of DC/TMD to create a form to evaluate Axis II in children and adolescents with TMD complaints. The psychological experts added tools to assess depression and anxiety, sleep disorders, catastrophizing, stress, and resilience.

CONCLUSION

Through international expert consensus, this study adapted Axis II of the adult DC/TMD to assess psychosocial functioning and pain-related disability in children and adolescents. The adapted Axis II protocols will be validated in the target populations.

Cephalometric effects of Pushing Splints 3 compared with rapid maxillary expansion and facemask therapy in Class III malocclusion children: a randomized controlled trial

Background

Pushing Splints 3 (PS3) device was recently introduced for the treatment of Class III malocclusion in children.

Objectives

To assess the effect on the sagittal maxillary position (SNA, primary outcome) of PS3 therapy compared with rapid maxillary expansion and facemask therapy (RME/FM) and to compare skeletal and dento-alveolar effects in growing Class III patients.

Trial design

This trial was a single-centre randomized controlled trial with two groups randomly allocated in a 1:1 ratio of equal size by sealed-envelope randomization, conducted at the Dentistry Unit of Bambino Gesù Children’s Hospital, IRCCS (Rome, Italy).

Methods

A total of 48 patients with Class III malocclusion were included in the study and randomly allocated to the two groups: PS3 therapy and RME/FM therapy. Only the RME/FM group underwent palatal expansion, and both groups were instructed to wear the appliances 14 hours/day. Pre- (T0) and post-treatment (T1) cephalograms were taken. An independent sample t-test and regression analysis were used to analyse the data (P value <0.05). Researchers involved in statistics and tracings were blinded to the treatment allocation.

Results

A total of 42 patients (21 for each group) completed the study. The maxillary sagittal position improved similarly in both groups (SNA = 0.4°; P = 0.547). A statistically significant decrease of SNPg angle (−1.6°; P < 0.001) and increase of ANPg angle (1.4°; P = 0.018) were found in the RME/FM group compared with PS3 group. CoGoMe angle significantly decreased in RME/FM group compared with PS3 group (−1.7°; P = 0.042). The regression analysis showed an association between SN/MP angle at T0 and the differences between T1 and T0 of SNPg (B = 0.13; P = 0.005) and SN/MP (B = −0.19; P = 0.034). Only three patients (PS3 = 2; RME/FM = 1) had breakages of the devices.

Limitations

Results are limited to short-term effects.

Conclusion

RME/FM therapy and PS3 are both effective therapies for the early correction of Class III malocclusion. The PS3 controlled better mandibular divergency reducing the clockwise rotation in patients with higher mandibular inclination.

Registration

This study was not registered in a clinical trial registry.

Three-dimensional soft tissue changes in orthodontic extraction and non-extraction patients: A prospective study

OBJECTIVES

To assess the soft tissue changes in orthodontic extraction and non-extraction patients on 3D stereophotogrammetric images.

SETTING AND SAMPLE

23 extraction (22.2 ± 9.2 years) and 23 non-extraction (20.3 ± 11.1 years) consecutive patients were enrolled at the Sections of Orthodontics at Aarhus University and at University of Naples Federico II.

METHODS

All patients had a first 3D image taken after bonding of brackets on the upper incisors (T0), and a second 3D image (T1) after space closure in the extraction group or at insertion of the first SS or TMA rectangular wire in the non-extraction group. The 3D images were captured with 3dMDFace System and analysed with 3dMDVultus Software. After placing 19 landmarks, 15 measurements were obtained. Intragroup changes were analysed with paired t-test and intergroup changes with unpaired t-test (P < .05).

RESULTS

Superimpositions of the 3D images at T0 and T1 visualized with colour-coded maps showed that soft tissue changes primarily happened in the perioral area in both groups. The Nasolabial angle increased significantly in the extraction group (3°± 4.1, P = .002), while it decreased in the non-extraction group (-1.5°± 5.5°, P = .002). There was a significant difference between the two groups (4.4°, P = .004).

CONCLUSIONS

3D comparison of the soft tissues in the extraction and non-extraction groups showed statistically significant, but clinically limited differences in the perioral area. The Nasolabial angle was significantly larger at T1 in the extraction group compared with the non-extraction group.

Treatment of mild Class II malocclusion in growing patients with clear aligners versus fixed multibracket therapy: A retrospective study

Objective

To compare the dental and skeletal effects of intermaxillary elastics on the correction of mild Angle's Class II division 1 malocclusion with clear aligner treatment (CA) versus fixed multibracket (FMB) in growing patients.

Settings and sample population

The study sample consisted of 49 consecutively patients (mean age ± SD 12.9 ± 1.7 years), 32 females and 17 males referred from the School of Orthodontics of the University of Bratislava Comenius (Slovakia). All patients were treated with a non‐extraction orthodontic treatment, 25 with FMB and 24 with CA.

Methods

The cephalometric analysis was performed at the beginning (T0) and the end of the treatment (T1). The t test for unpaired data was carried out to compare cephalometric values at T0 and changes at T1‐T0 between the two groups. The level of significance was set as P < .0035.

Results

The two groups showed no statistically significant differences (ANPg = −0.1°; P = .762) in the correction of the sagittal intermaxillary relation. The analysis of vertical skeletal changes showed no statistically significant effects on mandibular inclination (SN/MP = 0.1°; P = .840). The two treatments had a statistically significant and clinically relevant difference in controlling the inclination of the lower incisors (L1/GoGn = 4.8°, CAG = −0.5°± 3.9°; FMB = 4.3°± 5.8°; P < .001).

Conclusions

Class II elastics combined with CA and FMB produce a similar correction on sagittal discrepancies in growing patients. CA presented a better control in the proclination of the lower incisors. CA and elastics might be a good alternative in the correction of mild Class II malocclusion in cases where a proclination of lower incisors is unwanted.

Diagnostic criteria for temporomandibular disorders (DC/TMD) for children and adolescents: An international Delphi study-Part 1-Development of Axis I

Background

Since in children and adolescence prevalence is assessed mainly on self‐reported or proxy‐reported signs and symptoms; there is a need to develop a more comprehensive standardised process for the collection of clinical information and the diagnosis of TMD in these populations.

Objective

To develop new instruments and to adapt the diagnostic criteria for temporomandibular disorders (DC/TMD) for the evaluation of TMD in children and adolescents.

Method

A modified Delphi method was used to seek international consensus among TMD experts. Fourteen clinicians and researchers in the field of oro‐facial pain and TMD worldwide were invited to participate in a workshop initiated by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM scientific network) at the General Session of the International Association for Dental Research (IADR, London 2018), as the first step in the Delphi process. Participants discussed the protocols required to make physical diagnoses included in the Axis I of the DC/TMD. Thereafter, nine experts in the field were added, and the first Delphi round was created. This survey included 60 statements for Axis I, and the experts were asked to respond to each statement on a five‐item Likert scale ranging from ‘Strongly disagree’ to ‘Strongly agree’. Consensus level was set at 80% agreement for the first round, and at 70% for the next.

Results

After three rounds of the Delphi process, a consensus among TMD experts was achieved and two adapted DC/TMD protocols for Axis I physical diagnoses for children and adolescents were developed.

Conclusion

Through international consensus among TMD experts, this study adapted the Axis I of the DC/TMD for use in evaluating TMD in children and adolescents.

The perception of COVID-19 among Italian dental patients: an orthodontic point of view

BACKGROUND

The present study aimed to investigate the patients' perception of the dental practice during the COVID-19 outbreak, and whether the pandemic will affect the attendance of orthodontic patients at the dental practice. An online questionnaire, including the Patient Health Questionnaire-4 (PHQ-4), was submitted to Italian dental patients with items about their perceived risks when going to the dentist, concerns about continuing orthodontic treatment, and the onset of temporomandibular disorders (TMD). Data were analyzed with a chi-square test and logistic regression analysis. The level of significance was set at P < 0.05.

RESULTS

A total of 1566 subjects completed the survey, including 486 who were under orthodontic treatment or who had a child in orthodontic treatment. A total of 866 participants (55.3%) thought the risk of contracting the COVID-19 infection was higher in a dental practice; this perception was associated with gender (women more than man), age (over 60 years old) and high levels of distress (P<0.001). However, 894 patients (57.1%) felt comfortable going back to the dentist. Most of the orthodontic patients (84%) would continue their treatment. After the lockdown, there was a slight increase in the frequency of TMD pain (356 versus 334).

CONCLUSIONS

Most of the participants believed that the dental practice is a place at greater risk of contracting COVID-19, even if they continue to go to the dentist. Gender, age, and the level of distress were associated with the increase in the fear of going to the dentist due to COVID-19. Because of the pandemic, 16% of patients undergoing orthodontic treatment would not return to the dental practice to continue their orthodontic treatment after the lockdown. The prevalence of TMD pain in the population increased due to the pandemic.

Cephalometric outcomes of a new orthopaedic appliance for Class III malocclusion treatment

OBJECTIVE

To evaluate dental and skeletal effects of a new orthopaedic appliance for the treatment of Class III malocclusion in growing patients.

MATERIAL AND METHODS

This retrospective cephalometric study was performed on a sample of 18 patients with a skeletal Class III malocclusion (4 males; 14 females; mean age 8.8 ± 1.5 years) treated with the Pushing Splints 3 (PS3) protocol. The control group consisted of 18 subjects (5 males; 13 females; mean age 9.1 ± 1.8 years) selected from a database of subjects with untreated Class III malocclusion. The cephalometric analysis was performed at the beginning (T0) and the end of the orthopaedic therapy (T1). Significant differences between the treated and control groups were assessed with independent samples t-test (P < 0.05).

RESULTS

In the PS3 group, the post-treatment cephalometric values showed a forward displacement of the maxilla, resulting in a statistically significant increase of the SNA angle. ANPg and Wits appraisal improved significantly compared with the control group. Lingual inclination of mandibular incisors and buccal inclination of the upper incisors were significantly increased in comparison with the control group. No significant differences were recorded for backward mandibular rotation.

LIMITATIONS

This study presents a short-term evaluation of the treatment and the use of a historical control group.

CONCLUSIONS

The PS3 was effective for the treatment of Class III malocclusion in growing patients, with favourable maxillary advancement and control of the vertical skeletal relationships.

Short-term effects of the Sander bite-jumping appliance on the pharyngeal airways in subjects with skeletal Class II malocclusion: A retrospective case-control study

BACKGROUND

Skeletal Class II subjects present often a retruded mandible that might increase the probability of breathing disorders.

OBJECTIVE

To evaluate the effects of functional treatment by means of the Sander bite-jumping appliance (BJA) on the upper airways of growing subjects.

METHODS

Thirty-four subjects (21 males, 13 females; mean age 11.1 ± 1.2 years) with skeletal Class II malocclusion due to mandibular retrusion were treated with the Sander BJA (BJA group). The control group consisted of thirty-four untreated subjects with skeletal Class II malocclusion (25 males, 9 females; 10.4 ± 1.2 years; CTR group). The effect of the Sander BJA appliance on the airway dimensions was evaluated by comparing lateral cephalograms recorded before (T0) and after (T1) the period of observation/treatment. Within- and between-group comparisons were statistically evaluated according to the distribution of the data (P < .05).

RESULTS

The oropharyngeal region (ph_pph) increased in the BJA group (1.8 ± 3.2; P = .001) but the difference respect to the CTR group was not statistically significant (0.73 ± 4.0; P = .314; P = .077). The tongue height (th) increased in the BJA group (2.8 ± 3.7; P < .001), and this increase was statistically significant respect to the CTR group (0.6 ± 4.7; P = .461; P = .038). In the BJA, the Ans_Pns_P angle showed a statistically significant decrease (-3.8 ± 7.8; P = .007) compared to the CTR group (-0.1 ± 5.4; P = .705; P = .026).

CONCLUSIONS

The airway dimensions increased for both control subjects and Class II patients treated with Sander BJA due to physiological growth. The Sander BJA induced a statistically significant change in the tongue and soft palate position, but the clinically relevant of these changes is questionable.

Two-dimensional versus three-dimensional Frӓnkel Manoeuvre: a reproducibility study

Background/Objectives

To assess intra- and inter-observer reproducibility of the evaluation of the Frӓnkel Manoeuvre (FM) on three-dimensional (3D) scans and to compare it to the assessment on two-dimensional (2D) pictures.

Materials/Methods

This study included 44 individuals with a skeletal Class II malocclusion [9–16-years old mean age ± standard deviation: 13.5 ± 2.01 years]. All patients had a full Class II molar relationship, overjet ≥6 mm and point A, Nasion, point B angle (ANB) ≥5 degrees. During the FM, each patient was invited to bite in centric occlusion and then to posture the mandible forward to reach a Class I molar relationship. The FM was recorded both by a normal camera and a 3D scanner (3dMD system). Six examiners divided into two groups according to their orthodontic clinical experience (&lt;5 and &gt;10 years), and one gold standard in the evaluation of FM, commented twice (every 15 days) on both 2D photographs (T0 and T2) and 3D scans (T1 and T3). The intra-observer agreement and the inter-observer agreement compared to the gold standard were evaluated by computing the Cohen’s K.

Results

The agreement between observations for each examiner ranged from 0.36 to 1 on 2D pictures (T0 versus T2), and from 0.22 to 0.69 on 3D scans (T1 versus T3). The overall agreement was 0.63 (95 per cent CI = 0.35–0.91) in 2D analysis and 0.5 (95 per cent CI = 0.35–0.64) in 3D analysis.

Conclusions/Implications

The FM was less reproducible when performed on 3D records than on 2D pictures.

Impact of functional orthodontic treatment on facial attractiveness of children with Class II division 1 malocclusion

Background/objectives

Whether orthodontic treatment with functional appliances improves facial aesthetics is still under debate. This study aimed to determine whether functional orthodontic treatment improves the facial attractiveness of patients with Class II division 1 malocclusion.

Materials/method

Extraoral lateral photographs of 20 children with Class I (CLI, 11.7 ± 0.8 years), and before (T1) and after treatment (T2) photographs of patients with Class II division 1 (CLII T1 and CLII T2; mean age ± SD = 11.1 ± 0.6 years) treated with functional appliances, were transformed into black silhouettes. Three panels of examiners including 30 orthodontists (39.0 ± 10.1 years), 30 dentists (40.0 ± 9.7) and 30 laypersons (39.0 ± 9.2) evaluated the attractiveness of patients’ silhouettes using a 100-mm visual analogue scale, and the sagittal position of patients’ upper lip, lower lip, and chin using a 3-point Likert scale. Two-way ANOVA and a chi-square test were used to test differences among groups. Statistically significance was set as P  &lt;  0.05.

Results

The silhouettes of CLII T2 individuals were more attractive than those of the other groups (all Ps &lt; 0.001). The upper lip, lower lip, and the chin of these individuals were judged to be normally positioned in 69.5 per cent, 74.9 per cent, and 72.3 per cent of the assessments, respectively (all Ps &lt; 0.05).

Limitations

This study did not account for the psychological profile of the examiners, which may have affected the ratings.

Conclusions/implications

Orthodontic treatment with functional appliances is associated with a superior facial profile attractiveness. Functional treatment should be considered as a treatment option to improve the facial appearance of children with Class II division 1 malocclusion.

The Psychological Impact of Dental Aesthetics in Patients with Juvenile Idiopathic Arthritis Compared with Healthy Peers: A Cross-Sectional Study

This study aimed to assess whether dental aesthetics had a different impact on the psychosocial domains of adolescents with juvenile idiopathic arthritis (JIA) as compared with healthy peers. Fifty JIA patients and eighty controls aged between 13 and 17 years were enrolled. The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was administered along with tools for the self-assessment of malocclusion and self-esteem. An objective evaluation of malocclusion severity was performed through a clinical evaluation with the Dental Aesthetic Index (DAI). The sample was divided according to the DAI stages of malocclusion severity; a two-way analysis of variance (ANOVA) was performed to assess whether there was a difference in the studied variables according to the malocclusion and the presence of JIA. The results showed no interaction between the malocclusion severity and the presence of JIA in all analyzed variables (all p > 0.05). According to the DAI stages, the Dental Self-Confidence domain of the PIDAQ and the Perception of Occlusion Scale showed statistically significant differences only within the controls (p = 0.027 and p = 0.014, respectively). Therefore, JIA adolescents seem to be less concerned about their dental aesthetics compared with healthy peers, and clinicians should take particular care when proposing orthodontic treatments aiming only to improve dental aesthetics.

Is there an association between various aspects of oral health in Southern Italy children? An epidemiological study assessing dental decays, periodontal status, malocclusions and temporomandibular joint function

AIM

To describe the current oral health status of primary school children in Southern Italy, to investigate if there is an association between malocclusions and temporomandibular disorders (TMDs), and to investigate if there is an association between dental caries and periodontal disease.

MATERIALS AND METHODS

Study design: Transversal epidemiological study. We examined 1086 children, considering them of the same socioeconomic status (medium). The Decayed, Missing, Filled (DMF) index and the Community Periodontal Index (CPI) were used to assess decay and periodontal status. Moreover, orthodontic and gnathologic evaluations were performed.

RESULTS

Children had a mean age of 10.3±0.72 yrs, 41.6% had active dental caries in permanent teeth and 54.8% experienced periodontal problems. The 54.3% of patients had Angle Class I, 40.1% Class II and 5.5% Class III. The 13.8% of children had a deviated opening pattern of the mandible, and 2.2% of them had TMJ pain. DMF indices greater than 0 were associated with positive CPI. Males were more susceptible to periodontal disease, compared to females. TMJ pain was found associated with a decreased overbite.

STATISTICS

Descriptive statistics for continuous data, and frequencies and percentages for categorical and ordinal data were calculated. Univariate linear and logistic regression model, with ? calculations, was used to assess associations between dental caries status and CPI, and between malocclusions and gnathologic aspects.

CONCLUSIONS

This study found a noticeable prevalence of oral diseases among children of Southern Italy and an association between malocclusions and TMDs, periodontal disease and dental decay. Thus, a higher number of preventive interventions are recommended in the area.

Thickness of orthodontic clear aligners after thermoforming and after 10 days of intraoral exposure: a prospective clinical study

Background

Clear aligners (CA) are among the most chosen orthodontic therapies for patients who require an invisible treatment. Previous studies showed that the thermoforming process and the complexity of the intraoral environment might alter the properties of these devices. The aim of the current prospective clinical study was to assess the thickness changes of the CA after 10 days of intraoral use. The secondary aim was to assess the reproducibility of the thermoforming process, in terms of aligner thickness.

Materials and methods

CA from 18 consecutive patients (13 women, 5 men, mean age 28.8 ± 9.6 years) were investigated. Before intraoral exposure (T0), the thickness of the unused CA was measured at different occlusal points on a 3D model with a dedicated software (Geomagic Qualify 2013; 3D Systems, Rock Hill, SC, USA). Two CA configurations were studied: passive maxillary aligner (P—no tooth movement; no shape for attachments) and active maxillary aligner (A—tooth movement; shape for attachments and divot). The used aligners were returned after 10 days (T1) and the thickness measurements were repeated. A Student’s t test for paired data (T1 vs. T0) was applied to compare the thicknesses of used and unused devices (significance level after Bonferroni correction for multiple comparison was set at p < 0.0014). Furthermore, to study the reproducibility of the thermoforming process, P and A aligners were thermoformed twice, and the thicknesses of the two unused thermoformed devices were compared by means of Student’s t test for paired data (significance level after Bonferroni correction for multiple comparison was set at p < 0.0014) and Dahlberg’s error.

Results

The thermoforming process showed good reproducibility for both aligner configurations, with a maximum Dahlberg’s error of 0.13 mm. After intraoral use, the thickness of P showed some statistically significant, but not clinically relevant, thickness changes as compared to the unused aligners, while A did not show any significant changes.

Conclusion

Considering the thickness changes, the thermoforming process is reliable both with active and passive aligner configurations. Also, the CA examined show good thickness stability after physiological intraoral ageing in a population of healthy adults.

Translation and validation of the italian version of the Psychosocial Impact of Dental Aesthetics Questionnaire (pidaq) among adolescents

AIM

The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is a valid tool aiming to evaluate the self-reported influence of dental aesthetics on quality of life. This questionnaire was developed in English for young adults, and later translated and validated with an Italian population. A new version of the questionnaire was recently introduced to be used in adolescents (11-17 years- old), but it had not been translated in Italian yet. Hence, the purpose of this study was to translate, cross-culturally adapt and validate the PIDAQ for adolescents, for its use among Italian subjects.

METHODS

To develop the Italian PIDAQ, the original version was translated, back-translated, cross-culturally adapted and pre-tested. Afterwards, the Italian PIDAQ was administered to a convenience sample of 677 subjects, aged 11-17 years, together with two other written questionnaires: the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) and the Perception of Occlusion Scale (POS), which are instruments dedicated to assess the self-reported degree of malocclusion. A one-way ANOVA was performed to assess the difference between groups, within each PIDAQ factor, according to POS and IOTN-AC scores. The correlation between PIDAQ factors and POS/IOTN-AC scores was measured as Spearman's rank correlation. The internal consistency was assessed as Cronbach's alpha coef?cient (&#945;), and the test-retest reproducibility as Intra-Class Correlation Coef?cient (ICC).

RESULTS

The one-way ANOVA showed that all the factors of the self- reported impact of dental aesthetics on quality of life significantly increased as the degree of malocclusion worsened (P<0.001). Furthermore, all the factors showed statistically significant correlations with both IOTN-AC and POS scores. The &#945; ranged between 0.79 and 0.90, and the ICC ranged between 0.93-0.97.

CONCLUSION

The Italian adolescent PIDAQ showed good reliability and validity. The psychometric properties of this version of the questionnaire support its use for the assessment of the psychosocial impact of dental aesthetics among Italian adolescents.

Evaluation of the relationship between obesity, dental caries and periodontal disease in adolescents

AIM

To assess the prevalence of caries, oral hygiene quality and periodontal disease in a cohort of obese adolescents compared to a control group.

MATERIALS AND METHODS

Study Design: cross-sectional study conducted on 204 subjects (age range 10-16 years). Ninety obese subjects (BMI >90) and 114 normal-weight subjects (BMI <75) were visited at the Bambino Gesù Children's Hospital and in a junior high school in Rome, respectively. An ad hoc questionnaire (investigating demographic and oral health behaviour data) was filled in by patients and their caregivers. Accurate oral examinations were conducted. The Decayed-Missing-Filled Teeth/Surfaces Index in both permanent (DMFT/DMFS) and primary dentition (dmft/dmfs), Gingival Bleeding Index (GBI), Visible Plaque Index (VPI), and Probing Depth (PD) were recorded.

STATISTICS

data analysis was carried out using the Statistical Package for the Social Sciences (SPSS 21.0; SPSS IBM, New York, NY). The data of the two groups were compared by means of Student's t Test or the Mann-Whitney test for numerical data and the Chi-square test for categorical data.

RESULTS

Patients affected by obesity, compared with controls, presented less compromised teeth in the primary dentition (dmft obese: 0.30 &#177;± 1.12; normal-weight: 1.00 &#177; 1.90; P<0.001) and less compromised dental surfaces (dmfs obese: 0.51 &#177; 2.14; normal-weight: 1.61 &#177; 3.10; P<0.001). Furthermore obese patients showed minor gingival inflammation with less bleeding on probing (GBI) (obese: 23.95 &#177; 21.43; normal-weight: 38.17&#177; 24.37; P<0.001), and less probing depth in a greater number of sites (PPD &#8804; 3) (obese: 101.92 &#177; 9.27; normal-weight: 97.28 &#177; 12.13; P<0.001). Moreover, the obese group showed a better oral hygiene (VPI) (obese: 25.69 &#177;25.83; normal-weight: 37.72 &#177;24.34; P<0.001).

CONCLUSION

In our study, obese adolescents showed a better oral hygiene, fewer compromised teeth and better periodontal health when compared with normal-weight patients.

In vitro cytotoxicity of different thermoplastic materials for clear aligners

OBJECTIVES

To investigate the in vitro cytotoxicity of different thermoplastic materials for clear aligners on human primary gingival fibroblasts (HGFs).

MATERIALS AND METHODS

Four materials for clear aligners were considered in this study: Duran (Scheu-Dental GmbH, Iserlohn, Germany), Biolon (Dreve Dentamid GmbH, Unna, Germany), Zendura (Bay Materials LLC, Fremont, CA, USA), and SmartTrack (Align Technology, San Jose, CA, USA). Three out of four materials (Duran, Biolon, Zendura) were assessed as thermoformed and nonthermoformed, whereas the SmartTrack was assessed only as thermoformed. The samples were placed at 37°C in airtight test tubes containing Dulbecco's Modified Eagle's Medium (DMEM; 0.1 mg/mL) for 14 days. The cell viability of HGFs cultured with this medium was assessed by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Data were analyzed by means of one-way and two-way analysis of variance and post hoc tests (α = 0.05).

RESULTS

Each material exhibited a slight cytotoxic effect after 14 days. The highest cytotoxicity level on HGFs was achieved by Biolon (64.6% ± 3.3 of cell viability), followed by Zendura (74.4% ± 2.3 of cell viability), SmartTrack (78.8% ± 6.3 of cell viability), and finally Duran (84.6% ± 4 of cell viability), which was the least cytotoxic. In the comparison between nonthermoformed and thermoformed materials for Duran, Biolon, and Zendura, the thermoformed materials showed the highest level of cytotoxicity (P < .001).

CONCLUSIONS

Under the experimental conditions of this study, all the materials for clear aligners presented a slight cytotoxicity. Biolon was the most cytotoxic and the thermoforming process increased the cytotoxicity of the materials.

Temporomandibular joint damage in juvenile idiopathic arthritis: Diagnostic validity of diagnostic criteria for temporomandibular disorders

BACKGROUND

Diagnostic criteria reported in the expanded taxonomy for temporomandibular disorders include a standardised clinical examination and diagnosis (DC/TMD 3.B) of temporomandibular joint (TMJ) damage in patients with juvenile idiopathic arthritis (JIA); however, their validity is unknown.

OBJECTIVES

To assess the validity of DC/TMD 3.B for the identification of TMJ damage in JIA-patients, using magnetic resonance imaging (MRI) as gold standard, and to investigate the relation between clinical findings and TMJ damage.

METHODS

Fifty consecutive JIA patients (9-16 years) were recruited. DC/TMD 3.B were compared with TMJs MRI (100 TMJs) performed maximum at 1 month from the visit. The severity of TMJ damage was scored in four grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), logistic regression models with odds ratio of DC/TMD 3.B and clinical findings respect to MRI were calculated.

RESULTS

The DC/TMD 3.B were inadequate in the identification of TMJ damage (sensitivity = 0.15, specificity = 0.92, PPV = 0.85, NPV = 0.28, P = 0.350). Chin deviation and TMJ crepitus were associated with worse TMJ damage (P = 0.006; P = 0.034). Reduced mouth opening (OR = 3.91, P = 0.039) and chin deviation (OR = 13.7, P = 0.014) were associated with the presence of TMJ damage. Combining "pain" (history of pain, TMJ pain, pain during movements) and "function" (TMJ crepitus, reduced mouth opening, chin deviation) clinical findings, the sensitivity and the specificity were 0.88 and 0.54.

CONCLUSION

DC/TMD 3.B present a low sensitivity to diagnose TMJ damage. Chin deviation, reduced mouth opening and TMJ crepitus are associated with TMJ damage. We suggest combining "pain" and "function" findings for the evaluation of TMJ damage in JIA patients.

Effects of maxillary expansion on the upper airways: Evidence from systematic reviews and meta-analyses

BACKGROUND

Constricted maxilla is frequently associated with reduced nasal airway dimensions. Wheatear skeletal maxillary expansion (ME) is effective on the dimension of the upper airways is still a debated issue.

OBJECTIVES

This overview aimed to report the evidence provided by systematic reviews (SRs) on the effect of ME on the upper airways and to assess the methodological quality of the included SRs.

METHODS

Six electronic databases have been explored up to November 2017. After title and abstract screening, SRs addressing the effects of fixed palatal expanders on the dimension and function of the nasal airways were included. The methodological quality of the included SRs was assessed using the updated version of A Measurement Tool to Assess Systematic Review (AMSTAR-2).

RESULTS

Eight SRs were included. The methodological quality of most of the included SRs ranged between low and critically low. One SR was rated of high quality. A significant increase in nasal linear dimensions was reported both in the short and long term, but supported by low-/critically low-quality SRs. The significant increase in nasal cavity volume was the only outcome supported by a high-quality SR Controversial results were found with regards to nasal function.

CONCLUSION

Whenever a constricted maxilla is present general dentists, paediatricians and ENTs should be familiar with the potential improvement provided by ME. However, due to the low/critically low quality of SRs supporting these results, ME cannot be indicated only for upper airways enhancement, but should be supported by an orthodontic indication.

Evaluation of masticatory muscle activity in patients with unilateral posterior crossbite before and after rapid maxillary expansion

Objectives

The relationship between unilateral posterior crossbite (UPCB) and the possible asymmetric activation of the jaw muscles in children is still under debate. This study aimed at evaluating the jaw muscle activity of children with UPCB before and after rapid maxillary expansion (RME) by means of surface electromyography and a standardized sampling protocol.

Subjects and methods

Twenty-nine children with UPCB (UPCB-group, mean age 9.6 ± 1.6 years) and 40 UPCB-free controls (Control-group, 10.5 ± 1.1) were recruited. The activity of the left and right anterior temporalis (AT) and superficial masseter muscles (MM) was recorded during maximum voluntary clenching and a chewing task (T0). In the UPCB-group, data were collected, also, after the correction of the UPCB with RME (T1) and 6 months later (T2), without any further treatment. Electromyographic indices comparing the activity of paired muscle were computed via software to estimate the extent of asymmetric AT and MM activity. Paired and unpaired t-test or Wilcoxon-signed rank and Mann-Whitney U test, ANOVA or Friedman test and chi-squared test were used in the statistical analysis.

Results

Both groups presented with asymmetric activity of the muscles, which did not differ between groups (T0, all P > 0.05). The treatment determined a decrease in muscular activity (T1, P = 0.040), and a more asymmetric pattern of muscle activation during chewing (T1, P = 0.040), which returned similar to baseline values at T2 (all P > 0.05).

Conclusions

UPCB does not contribute to an asymmetric activation of AT and MM during functional tasks. The treatment of UPCB by RME did not determine a more symmetric activity of the assessed muscles.

Prevalence of temporomandibular disorders and oral parafunctions in adolescents from public schools in Southern Italy

Objective: The aim of this cross-sectional epidemiologic study was to estimate the prevalence of temporomandibular disorders (TMDs) and oral parafunctions in Italian adolescents and to assess the associations between age, gender, oral habits, and TMD. Methods: Three hundred sixty-one adolescents, aged 14-18 years, were examined for TMDs according to the Research Diagnostic Criteria for TMD. Furthermore, oral habits were explored by means of a written questionnaire. Results: Almost one-third of the sample (27.4%) showed at least one TMD diagnosis, with myofascial pain being the most prevalent. Gum chewing was the most prevalent oral habit. The female gender and oral habits were significantly associated with TMD. Conclusion: TMD in adolescents, although lower than in adults, are significantly prevalent. General practitioners should include TMD screening methods in their routine dental examinations of adolescent patients. Adolescents should be instructed on how to avoid incorrect oral behaviors that might predispose them to the onset of TMD.

Dentoskeletal effects of oral appliance wear in obstructive sleep apnoea and snoring patients

Objectives

To evaluate the dentoskeletal changes associated with long-term and continuous mandibular advancement device (MAD) use in sleep-related breathing disorder patients.

Methods

Cephalometric measurements and three-dimensional model analysis were performed at baseline and after 3.5 ± 1.1 years in 20 snoring and obstructive sleep apnoea patients treated with the Silensor® appliance. Intra-group differences were compared using paired t-test or Wilcoxon signed-rank test. A regression analysis was performed for variables that showed a statistically significant difference between time points to evaluate the influence of treatment time and patient's initial characteristics on their variations. The statistical significance was set at P < 0.05.

Results

At cephalometric assessment, the maxilla revealed a significant decrease in horizontal position (SNA: -0.4 ± 0.72 degree, P = 0.021) and a significant retroclination of the upper incisor (-1.59 ± 1.07 degree, P < 0.001), while the mandible displayed a significant downward rotation (0.88 ± 1.28 degree, P = 0.006) and a proclination of the lower incisor (2.27 ± 1.38 degree, P < 0.001). Model analysis showed a decrease in upper total space discrepancy (-0.66 ± 0.72 mm, P < 0.002), overjet (OJ; -0.34 ± 0.47 mm, P < 0.011), and overbite (-0.4 ± 0.52 mm, P < 0.004). In the regression analysis, treatment time influenced the lower incisor inclination (Beta = -0.713, P = 0.018) and OJ (Beta = -0.218, P = 0.018); patients' initial characteristics had an effect on OJ (Beta = -0.195, P = 0.011).

Limitations

A larger sample size could increase the generalizability of the findings.

Conclusion

MAD wear after a mean of 3.5 years determines statistically significant but clinically irrelevant dentoskeletal changes. Their potential occurrence should be thoroughly discussed with patients; regular follow-up visits by a specialist experienced in dental sleep medicine are also mandatory during treatment in addition to polysomnographic examinations.

Impact of skeletal divergence on oral health-related quality of life and self-reported jaw function

OBJECTIVE

To investigate the differences in oral health-related quality of life (OHRQoL) and self-reported jaw function between patients with hyperdivergent and normodivergent facial types.

METHODS

Eighty patients with a distinctively hyperdivergent facial type (mandibular plane angle greater than 2 standard deviations, or 42°) and 80 controls were individually matched according to age, sex, ethnicity, and treatment stage. Data were collected using self-report questionnaires such as the Oral Health Impact Profile (OHIP-14) and Jaw Functional Limitation Scale (JFLS-8).

RESULTS

The mean age of the patients was 17.2 ± 4.6 years (range, 12-9 years), with most (65.0%) being female and of New Zealand European origin (91.3%). Individuals with hyperdivergent facial types had higher overall and social domain scores on the OHIP-14 (p < 0.05) than did the ones with normodivergent facial types. However, the intergroup differences in JFLS-8 scores were not significant (p > 0.05).

CONCLUSIONS

Jaw function appears to be similar in individuals with hyperdivergent and normodivergent facial morphologies. However, those with hyperdivergent facial types are more likely to self-report poorer OHRQoL than are those with normal faces, especially in relation to social aspects.

Dental and skeletal effects of palatal expansion techniques: a systematic review of the current evidence from systematic reviews and meta-analyses

The aim was to assess the quality and to summarise the findings of the Systematic Reviews (SRs) and Meta-Analyses (MAs) on the dental and skeletal effects of maxillary expansion. Electronic and manual searches have been independently conducted by two investigators, up to February 2015. SRs and MAs on the dentoalveolar and skeletal effects of fixed expanders were included. The methodological quality was assessed using the AMSTAR (A Measurement Tool to Assess Systematic Reviews). The design of the primary studies included in each SR/MA was assessed with the LRD (Level of Research Design scoring). The evidence for each outcome was rated applying a pre-determined scale. Twelve SRs/MAs were included. The AMSTAR scores ranged from 4 to 10. Two SRs/MAs included only RCTs. The current findings from SRs/MAs support with high evidence a significant increase in the short-term of maxillary dentoalveolar transversal dimensions after Rapid Maxillary Expansion (RME). The same effect is reported with moderate evidence after Slow Maxillary Expansion (SME). However, there is moderate evidence of a non-significant difference between the two expansion modalities concerning the short-term dentoalveolar effects. With both RME and SME, significant increase of skeletal transversal dimension in the short-term is reported, and the skeletal expansion is always smaller than the dentoalveolar. Even though dental relapse to some extent is present, long-term results of the dentoalveolar effects show an increase of the transversal dimension, supported by moderate evidence for RME and low evidence for SME. Skeletal long-term effects are reported only with RME, supported by very low evidence.

In vitro biocompatibility of nickel-titanium esthetic orthodontic archwires

OBJECTIVE

To investigate the cytotoxicity of nickel-titanium (NiTi) esthetic orthodontic archwires with different surface coatings.

MATERIALS AND METHODS

Three fully coated, tooth-colored NiTi wires (BioCosmetic, Titanol Cosmetic, EverWhite), two ion-implanted wires (TMA Purple, Sentalloy High Aesthetic), five uncoated NiTi wires (BioStarter, BioTorque, Titanol Superelastic, Memory Wire Superelastic, and Sentalloy), one β-titanium wire (TMA), and one stainless steel wire (Stainless Steel) were considered for this study. The wire samples were placed at 37°C in airtight test tubes containing Dulbecco's Modified Eagle's Medium (0.1 mg/mL) for 1, 7, 14, and 30 days. The cell viability of human gingival fibroblasts (HGFs) cultured with this medium was assessed by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Data were analyzed by a two-way analysis of variance (α  =  .05).

RESULTS

The highest cytotoxic effect was reached on day 30 for all samples. The archwires exhibited a cytotoxicity on HGFs ranging from "none" to "slight," with the exception of the BioTorque, which resulted in moderate cytotoxicity on day 30. Significant differences were found between esthetic archwires and their uncoated pairs only for BioCosmetic (P  =  .001) and EverWhite (P < .001).

CONCLUSIONS

Under the experimental conditions, all of the NiTi esthetic archwires resulted in slight cytotoxicity, as did the respective uncoated wires. For this reason their clinical use may be considered to have similar risks to the uncoated archwires.

Does clinical experience affect the reproducibility of cervical vertebrae maturation method?

Objective: 

To assess interobserver and intraobserver reproducibility of the cervical vertebrae maturation method (CVMM) among three panels of judges with different levels of orthodontic experience (OE).

Materials and Methods: 

Fifty individual lateral cephalograms of good quality with complete visualization of cervical vertebrae 1 to 4 were selected. Thirty clinicians, divided according to their OE into three groups (junior group, JU, OE ≤ 1 year; postgraduate group, PG, 2 ≤ OE ≤ 4 years; specialist group, SP, OE ≥ 7 years), evaluated the cephalograms in two sessions (T1 and T2) at 3 weeks apart. Kendall's W and weighted Cohen's kappa (κ) coefficients were performed to assess interobserver and intraobserver agreement. The level of significance was set as P &lt; .05. For both the interobserver and the intraobserver datasets, the percentage of perfect agreement (PPA) and the number of stages apart for each disagreement were calculated.

Results: 

Kendall's W at T1 was SP  =  0.61, PG  =  0.70, and JU  =  0.87; at T2 it was SP  =  0.78, PG  =  0.85, and JU  =  0.86. The percentage of total interobserver perfect agreement (Inter-PPA) was 42.3% at T1 and 46.3% at T2. The JU group had the highest Cohen's κ coefficient at 0.78, while the PG and SP had coefficients of 0.64 each. The percentage of total intraobserver perfect agreement (Intra-PPA) was 54.2%.

Conclusions: 

The reproducibility of the method was not improved by the level of orthodontic experience. The group with the lowest level of orthodontic experience had the best performance.

A three-dimensional evaluation of Māori and New Zealand European faces

OBJECTIVE

Māori patients are often inappropriately treated using Caucasian norms, despite obvious differences in facial morphology. There is currently very little data concerning the nature and/or magnitude of these differences in facial features. The objective of the present study was therefore to evaluate the facial features of Māori and New Zealand (NZ) Europeans.

METHODS

Two convenience samples of 30 Māori and 30 NZ Europeans, evenly matched for age and gender, were recruited from amongst students of the University of Otago, New Zealand. Using a 3D white-light scanner, 12 facial scans were taken of each participant, which were then merged to form a single 3D image of the face. Prior to scanning, round markers were fixed to the skin in order to facilitate the localisation of facial anthropometric points and from which vertical, sagittal, and transverse measurements were assessed from the 3D facial image. Univariate and multivariate analyses of variance were used to test for differences between the two groups before and after adjusting for body mass index (BMI).

RESULTS

Significant differences were found in vertical, sagittal, and transverse facial dimensions, before and after adjusting for BMI. The overall face of Māori was significantly larger than that of NZ Europeans, although the facial proportions were generally similar. However, Māori had a broader face, more anterior position of the chin and reduced facial convexity in comparison with NZ Europeans (p < 0.01).

CONCLUSION

Māori have markedly different sagittal facial features compared with NZ Europeans. These distinctive features may reflect important differences in environmental and genetic influences between the two populations. The findings from the present study may assist the clinician in the treatment planning and assessment of facial dysmorphology in these ethnic groups.

Cross-cultural adaptation and validation of the Italian Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ)

PURPOSE

To validate and cross-culturally adapt the Italian version of the Psychological Impact of Dental Aesthetics Questionnaire (PIDAQ) among Italian young adults.

METHODS

After translation, back translation, and cross-cultural adaptation of the English PIDAQ, a first version of the Italian questionnaire was pretested. The final Italian PIDAQ was administered to 598 subjects aged 18-30 years, along with two other instruments: the aesthetic component of the index of orthodontic treatment need (IOTN-AC) and the perception of occlusion scale (POS), which identified the self-reporting grade of malocclusion. Structural validity was assessed by means of factorial analysis, internal consistency was measured with Cronbach's alpha coefficient (α), convergent validity was assessed by means of Spearman correlation, and test-retest reliability was calculated with intra-class correlation coefficient (ICC) and standard measurement error. Criterion validity was evaluated by multivariate and univariate analysis of variance with Bonferroni post hoc tests.

RESULTS

The α of the Italian PIDAQ domains ranged between 0.79 and 0.92. The ICC was between 0.81 and 0.90. The mean scores of each PIDAQ domain showed a statistically significant difference when analysed according to the IOTN-AC and POS scores.

CONCLUSION

The satisfactory psychometric properties make PIDAQ a usable tool for future studies on oral health-related quality of life among Italian young adults.

Effects of muscle pain induced by glutamate injections during sustained clenching on the contraction pattern of masticatory muscles

AIMS

To evaluate the contraction pattern of masticatory muscles during sustained clenching tasks with or without experimental pain induced by glutamate injection into the masseter muscle. It was hypothesized that acute muscle pain could induce compensatory changes in the electromyographic (EMG) activity of the masticatory muscles.

METHODS

Fifteen volunteers (seven males, mean age ± SD = 29.7 ± 1.1 years; eight females, mean age ± SD = 23.5 ± 1.2 years) were recruited in a crossover experimental study. All subjects participated in two randomized 20-minute experimental sessions. Each subject was asked to clench at 25% of the maximum voluntary contraction (MVC). After 10 minutes, isotonic saline or glutamate was injected in random order into the right masseter. EMG activity (root mean square [RMS] and mean power frequency [MPF]) was assessed in the masseter and anterior temporalis muscles on both sides. Pain and fatigue were assessed by 0-10 numeric rating scales (NRS) every minute. Differences between conditions (isotonic saline vs glutamate) for all the outcome parameters were analyzed by using a mixed effect model.

RESULTS

The EMG activity of the masticatory muscles and pain and fatigue scores were not dependent on isotonic saline/glutamate injection (all P > .05). The RMS in the temporalis and masseter muscles increased with time (right masseter P = 0.001, left masseter P = .004, right temporalis P = .22, left temporalis P = .006), whereas the MPF decreased (right masseter P = .0001, left masseter P < .0001, right temporalis P = .51, left temporalis P = .0005). Scores for fatigue and pain increased during the experimental sessions (all P < .05).

CONCLUSION

Intramuscular injection of glutamate caused more pain than isotonic saline but did not affect the contraction pattern of the masticatory muscles during a sustained clenching task. This finding strongly suggests the adaptive capacity of the stomatognathic system in the presence of acute nociceptive inputs.

Three-dimensional evaluation of the relationship between jaw divergence and facial soft tissue dimensions

OBJECTIVE

To evaluate the relationship between mandibular divergence and vertical and transverse dimensions of the face.

MATERIALS AND METHODS

A sample was recruited from the orthodontic clinic of the University of Otago, New Zealand. The recruited participants (N  =  60) were assigned to three different groups based on the mandibular plane angle (hyperdivergent, n  =  20; normodivergent, n  =  20; and hypodivergent, n  =  20). The sample consisted of 31 females and 29 males, with a mean age of 21.1 years (SD ± 5.0). Facial scans were recorded for each participant using a three-dimensional (3D) white-light scanner and then merged to form a single 3D image of the face. Vertical and transverse measurements of the face were assessed from the 3D facial image.

RESULTS

The hyperdivergent sample had a significantly larger total and lower anterior facial height than the other two groups (P < .05), although no difference was found for the middle facial height (P > .05). Similarly, there were no significant differences in the transverse measurements of the three study groups (P > .05). Both gender and body mass index (BMI) had a greater influence on the transverse dimension.

CONCLUSIONS

Hyperdivergent facial types are associated with a long face but not necessarily a narrow face. Variations in facial soft tissue vertical and transversal dimensions are more likely to be due to gender. Body mass index has a role in mandibular width (GoGo) assessment.

Effects of intraoral aging on surface properties of coated nickel-titanium archwires

OBJECTIVE

To evaluate the effects of intraoral aging on surface properties of esthetic and conventional nickel-titanium (NiTi) archwires.

MATERIALS AND METHODS

Five NiTi wires were considered for this study (Sentalloy, Sentalloy High Aesthetic, Superelastic Titanium Memory Wire, Esthetic Superelastic Titanium Memory Wire, and EverWhite). For each type of wire, four samples were analyzed as received and after 1 month of clinical use by an atomic force microscope (AFM) and a scanning electronic microscope (SEM). To evaluate sliding resistance, two stainless steel plates with three metallic or three monocrystalline brackets, bonded in passive configuration, were manufactured; four as-received and retrieved samples for every wire were pulled five times at 5 mm/min for 1 minute by means of an Instron 5566, recording the greatest friction value (N). Data were analyzed by one-way analysis of variance and by Student's t-test.

RESULTS

After clinical use, surface roughness increased considerably. The SEM images showed homogeneity for the as-received control wires; however, after clinical use esthetic wires exhibited a heterogeneous surface with craters and bumps. The lowest levels of friction were observed with the as-received Superelastic Titanium Memory Wire on metallic brackets. When tested on ceramic brackets, all the wires exhibited an increase in friction (t-test; P < .05). Furthermore, all the wires, except Sentalloy, showed a statistically significant increase in friction between the as-received and retrieved groups (t-test; P < .05).

CONCLUSION

Clinical use of the orthodontic wires increases their surface roughness and the level of friction.

Evaluation of surface roughness of orthodontic wires by means of atomic force microscopy

OBJECTIVE

To compare the surface roughness of different orthodontic archwires.

MATERIALS AND METHODS

Four nickel-titanium wires (Sentalloy(®), Sentalloy(®) High Aesthetic, Titanium Memory ThermaTi Lite(®), and Titanium Memory Esthetic(®)), three β-titanium wires (TMA(®), Colored TMA(®), and Beta Titanium(®)), and one stainless-steel wire (Stainless Steel(®)) were considered for this study. Three samples for each wire were analyzed by atomic force microscopy (AFM). Three-dimensional images were processed using Gwiddion software, and the roughness average (Ra), the root mean square (Rms), and the maximum height (Mh) values of the scanned surface profile were recorded. Statistical analysis was performed by one-way analysis of variance (ANOVA) followed by Tukey's post hoc test (P < .05).

RESULTS

The Ra, Rms, and Mh values were expressed as the mean ± standard deviation. Among as-received archwires, the Stainless Steel (Ra  =  36.6 ± 5.8; Rms  =  48 ± 7.7; Mh  =  328.1 ± 64) archwire was less rough than the others (ANOVA, P < .05). The Sentalloy High Aesthetic was the roughest (Ra  =  133.5 ± 10.8; Rms  =  165.8 ± 9.8; Mh  =  949.6 ± 192.1) of the archwires.

CONCLUSIONS

The surface quality of the wires investigated differed significantly. Ion implantation effectively reduced the roughness of TMA. Moreover, Teflon(®)-coated Titanium Memory Esthetic was less rough than was ion-implanted Sentalloy High Aesthetic.