In Vitro Study of Tooth Surfaces After Interproximal Enamel Reduction: Extraoral Scanner and SEM Analysis

ABSTRACT Objective To perform a morphological evaluation concerning the extent of interproximal enamel reduction (IPR) with different manual instruments in different types of teeth and a qualitative analysis of enamel surface characteristics at the contact point before and after IPR. Material and Methods 40 freshly extracted, caries-free, and intact human teeth were used for the study (20 bicuspids and 20 incisors) and performed IPR just on the mesial surface. The morphological variation of contact point was evaluated by superimposed the stl file, obtained thanks to an extraoral scanner, at T0 and T1 for each tooth. Two types of strip were used, Intensiv Manual Ortho Strips Coarse/Medium and Steelcarbo Horico Strips. Teeth were then cut lengthwise, removed the most apical root portion and the mesial and distal halves were gilded and observed at different magnifications. Results The morphological variation following stripping mainly depends on the extent of the stripping, while the diameter, the type of strip and the shape of the tooth itself do not appear to be relevant. The 500X and 1500X magnifications allowed to appreciate better the characteristics of the surface of the stripped enamel and the differences with the intact enamel. All teeth treated, independently from the kind of strip used, shows deep marks and grooves in the direction of stripping. In both cases, the enamel appears significantly damaged at great magnifications. Conclusion Stripping always and inevitably leads to a change in the shape of the contact point and is directly correlated to the amount of stripping performed. The use of polishing after the removal of enamel interproximal is necessary in all cases.

Effectiveness of Fully Customized Lingual Orthodontic Treatment: A Retrospective Pilot Study

ABSTRACT Objective: To investigate the effectiveness of Suresmile® lingual therapy on torque, tip, and rotations measures through digital evaluation of planning and post-treatment digital models. Material and Methods: A sample of 12 Caucasian adult patients (4 men; mean age 30.6 years ± 3.9 and 8 women; mean age 31.4 years ± 4.5) treated with the Suresmile® lingual orthodontic technique was retrospectively selected, regardless of the type of malocclusion. Digital planning was performed with Suresmile® software, while lingual therapy was accomplished with interactive self-ligating lingual brackets and customized Suresmile® arches. First, digital models of planning and post-treatment digital models were compared using VAM software (and the discrepancies were analyzed through MANOVA and four multivariate. Then, Tukey and Bonferroni's post-hoc tests are performed. Results: The accuracy average values are 60.11 ± 27.67% for torque, 53.52 ± 27.37% for tip and 59.19 ± 26.42% for rotation, while for inaccuracy values are 2.72° ± 2.23° for torque, 2.98° ± 2.16°for tip and 3.58° ± 3.29° for rotation. No significant differences have been recorded evaluating different sectors of both arches. Conclusion: This retrospective preliminary study highlight how overcorrections, especially in the Suresmile lingual technique, should be performed during orthodontic planning. Moreover, the study gets bases for further, more structured future studies that should involve larger and more homogeneous samples.

Comparison of Bracket Position Accuracy with Different CAD/CAM Indirect Bonding Systems

ABSTRACT Objective To evaluate the accuracy of three different digital bracket positioning systems, comparing vertical, mesiodistal and buccolingual accuracy. Material and Methods The same case was sent to Orapix, Insignia, and Orthocad systems and the brackets were bonded to the malocclusion models.Damon 3 MX brackets were used with all systems and the brackets were bonded to the models with the same bonding protocol and materials. The comparison of the position of each single bracket was made with digital photography, and ImageJ software was used to find the length in pixels and then convert it to hundredths of a mm for vertical, mesiodistal and buccolingual displacement, compared to the setup. Results Insignia System reported the average higher vertical displacement (0.28 mm), compared with the other two appliances (0.22-0.23 mm), and showed the lowest average displacement for the mesiodistal and buccolingual positioning (0.14 and 0.07 mm, respectively).However, these slight bracket positioning variations between these bonding systems were not statistically different (p>0.05). Conclusion The three systems analyzed were shown to be accurate in positioning the brackets, and none of them was statistically better.

Effect of Conventional Versus Passive Self-Ligating Vestibular Appliances on Torque, Tip and Transverse Dental Changes in Patients Affected by Class I Malocclusion: A Retrospective Study

ABSTRACT Objective: To evaluate the effects of passive self-ligating appliances (PSLAs) and conventional ligating appliances (CLAs) during orthodontic treatment regarding torque, tip, and transversal dental changes. Material and Methods: Dental parameters were digitally acquired from pre- and post-treatment models of each subject belonging to two groups of patients treated with PSLAs (23 patients; 11 females and 12 males with a mean age of 14.2 ± 1.6 years) and CLAs (18 patients; 10 females and 8 males with a mean age of 14.3 ± 1.9 years), respectively. All subjects had Class I or slight Class II malocclusion (= 2mm), permanent dentition and no previous orthodontic treatment. After normality of data was assumed, a paired sample t-test rejected any side differences at T0 and, therefore, the data were grouped by tooth group. Statistical analyses were performed using a linear mixed-effect framework, assuming the appliance, time, and interactions as fixed effects and the tooth type as random effects. Finally, post-hoc effect analysis was used to contrast modeled marginal effects (p<0.05). Results: For both appliances, there is a general increase of both torque and transverse values at T1, especially for PSLAs. Tip shows a general reduction in the lateral sectors for both appliances is registered. The only significant statistical difference referred to appliances' efficacy is located to mandibular intermolar width. Conclusion: Both appliances have an expansive potential for both torque and transverse dental changes. No evident differences are detectable between appliances except for the rate of the mandibular intermolar width increase.

Dentoalveolar Effects Following Maxillary Expansion: Comparison Between Dental and Skeletal Anchorage

ABSTRACT Objective: To compare the dento-alveolar effects between dental and skeletal anchored expansion devices to achieve maxillary expansion in different groups of patients: pure dental anchorage was used in growing patients and skeletal anchorage in adult patients. Linear, angular and volumetric parameters have been analysed. Material and Methods: 22 patients has been selected from the total archive of patients treated in the Orthodontics Department of the University of Ferrara, Italy, divided into 3 groups according to the appliance used to obtain the transversal maxillary correction. Digital files of the upper arch were obtained from scans performed using an intro-oral scanner before treatment (T0) and at the end of expansion (T1). Therefore, linear, angular and volumetric measurements have been performed. Results: There is a highly significant statistic variation of the 3-3, 4-4 and 6-6 diameter as a function of time. There was a statistically significant variation of the palatal vault angle and of the 6-6 distance at the cusp level as a function of time. Moreover, it appears that these parameters are reduced in the group with skeletal anchored expander. No tooth considered have encountered a statistically significant change in tip and torque values, no matter the type of RPE and the treatment time. For all patients, we have recorded the superimposition of the maxillary dental cast before and after treatment. Conclusion: In all patients, we obtained a resolution of the maxillary transverse deficit. Patients treated by pure skeletal anchored devices have recorded a less variations of palatal vault angle and the distance between first molar cusps, as if the expansion was gained more parallel. The expansion obtained showed reduced dental side effects, as tip and torque values haven't changed in a statistically significant way.

Phonetic Alterations Caused by Different Lingual Appliances

ABSTRACT Objective: To evaluate the differences in phonetic alterations caused by three different lingual appliances, all bonded in sequence on the same patients. Material and Methods: Lingual brackets (STb, Incognito and Harmony) were bonded from 1.3 to 2.3 with a 0.013 CuNiTi archwire. The text was formulated to evaluate the phonetic variations in a controlled context (logatomi) and more casual sentences. The recording of the text was performed at time t0 (before positioning the brackets), t1 (after positioning the brackets) and t2 (60 minutes after positioning the brackets). An ANOVA-type analysis was performed. Results: A significant correlation was confirmed between the effects of all the linguistic methods used compared to the absence of the same. The most influenced acoustic variables were the center of gravity of the acoustic spectrum of the analyzed sounds (CoG) and the number of zero crossings of the instantaneous amplitude curve of the considered signal. Conclusion: The effects deriving from the positioning of the various brackets were relatively contained: in some cases, for some subjects, for some consonants and in specific contexts, some brackets may occasionally be less invasive than others. However, no lingual system was systematically better than others regarding phonetic alterations.

Correlation Between Mesio-Distal Teeth Diameters and Arch Width

ABSTRACT Objective: To verify the existence of a correlation between the mesio-distal size of teeth and the arch width by analyzing the data separately for maxillary and mandibular arch in patients with ideal occlusion Material and Methods: 58 patients with ideal occlusion were studied, for a total of 276 files analyzed. Dental casts were then scanned using a professional scanner (Epson Perfection v 330) and images were obtained in TIFF format at 600 dpi. All single teeth measurements were carried out for all teeth of both arches using the VAM software (Vectra, Canfield Scientific, Fairfield, NJ, USA). The repeatability and reproducibility of the measurement method were evaluated using the Gauge R&R method. In case a correlation between tooth size and arch size is found to be significant, a linear regression analysis can be applied through the following statistical relationship: y=a+b*x, where y is the result (inter-molar distance "AvgB66" or inter-canine distance "Cusp 33"), and x the specific tooth. The a and b respectively represent the intercept (point of intersection between the line and the y axis) and the slope of the line that describes the regression ratio. Results: The statistical analysis highlights a significant correlation (p<1%) between the results of the mesio-distal measurements of each tooth and the two variables considered to define the size of each arch ("AvgB66" and "Cusp 33"). Based on these results, a numerical relationship "y=a+b*x" has been extrapolated. Thus, it is possible to calculate the estimated inter-molar or inter canine distance necessary to have the teeth aligned. Conclusion: The inter-canine and inter-molar distances can be estimated starting from measuring the mesio-distal diameter of a single tooth.

Comparative Analysis of Stiffness of Lingual Appliances: An in Vitro Study

ABSTRACT Objective: To analyze and compare the stiffness of different lingual appliances with different archwires. Material and Methods: The three-point bending test was used to analyze the stiffness of the lingual archwires for the different lingual systems: eBrace, Harmony, Incognito, and STb. The deflection load curve of each archwire was obtained to evaluate how the section, the material and the manufacturer affect the elasticity and stiffness characteristics of the wires. The comparison of the stiffness between different systems was carried out through a factor variance analysis with three factors (manufacturer, cross-section, and material), followed by the post-hoc Tuckey test. Results: An increase in the system's rigidity was reported as the wire section increases, regardless of the manufacturer. The stainless steel archwires have ever higher stiffness values than NiTi and TMA. The STb wires of CuNiTi material, by virtue of the characteristics of the thermal wires, have flatter and lower load-deflection curves than the NiTi wires of other manufacturers. Conclusion: Archwires section and material showed a significant influence on the stiffness of the lingual systems. Archwires of the same section and material but different manufacturers show different load-deflection curves of stiffness.

Spontaneous Transversal Changes of Lower Arch Following Palatal Skeletal Expansion

ABSTRACT Objective: To evaluate how the lower arch spontaneously change after upper rapid palatal expansion in a group of patients with transversal skeletal deficit. Material and Methods: Twenty-four patients treated by the same orthodontist with a rapid palatal expander (RPE) bounded on a deciduous molar have been selected. The sample was divided into two groups: no treatment was provided for group one, while group two was treated using a lip bumper or Schwarz appliance. For each patient, dental casts were collected when the RPE was bounded (T0) and at the end of treatment, 9 months ± 3 months later (T1). Each outcome was analyzed, providing descriptive statistics, main effects significance tests and post-hoc analyses with the objective to evaluate the variations between pre-treatment (TO) and post-treatment (T1) of each of them. Results: If the linear measurements are considered, a significant beneficial effect on both arches is observed. However, the upper arch always shows a major increase of all values at T1 with respect to the lower arch. Even though the post-hoc tables indicate that time differences are all statistically significant across considered partitions, the lower arch's increase is more pronounced in group two, where patients were treated in both arches. If the angular measurements are concerned, the increase of lingual crown inclination was found in all patients, independently from the type of treatment in lower arch. Conclusion: All patients show normalization of upper diameters, regardless of whether the lower arch was treated or not.

Thermographic Control of Pediatric Dental Patients During the SARS-CoV-2 Pandemics Using Smartphones

Abstract Objective: To evaluate the reliability of infrared (IR) thermal camera connected to smartphones, already used in medicine for diagnostic purposes, as an easy tool for access screening to pediatric dentistry services. Material and Methods: After the preventive telephone triage, thirty orthodontic patients (7-13 years) underwent temperature measurement in the office with two no-contact IR devices: forehead digital thermometer and thermal-camera connected to a smartphone (reference areas: forehead, inner canthi, ears). Measurements were compared and differences were statistically investigated with T student's test (p<0.01). Results: Forehead digital thermometer temperatures were superimposable to those recorded in ear areas and inner canthi with the thermal camera connected to a smartphone. Differences were not statistically significant even in comparison between the sexes. Forehead temperature values detected with a thermal camera are lower than those detected with a digital forehead thermometer. Conclusion: Thermal camera on a smartphone could be reliable in measuring body temperature. Mobile thermographic values of ears and inner canthi areas can be used as an alternative to forehead digital thermometer measurements. Further applications in pediatric dentistry of thermography on smartphones should be examined.

Direct and Indirect Bonding Techniques: A Systematic Review

ABSTRACT Objective: To assess the scientific evidence on direct and indirect bonding techniques to analyse the differences related to treatment time, number of appointments and number of bracket detachments. Material and Methods: The MEDLINE and Cochrane Library databases were searched through to March 2021. Reference lists from the retrieved publications were also examined. The following article types that described data on the different types of direct and indirect bonding techniques in orthodontics were included: prospective and retrospective cohort studies, case-control studies and randomized controlled clinical trials (RCCTs). Two review authors independently assessed eligibility, extracted data, and ascertained the quality of the studies. Results: The search strategy initially resulted in 824 articles, and after a careful selection comprising the inclusion criteria, 12 articles were picked for the final review, specifically 2 cohort studies, 4 case-control studies and 6 RCCTs. The methodological quality was low in 4 studies, medium in 2, and high in 6 articles. Conclusion: The evidence currently available suggests that the use of computer-aided bonding is related to a reduction in treatment time and the number of appointments compared to direct and manual indirect bonding. However, the total bonding time for computer-aided bonding technique, including digital bracket placement, was longer than for direct bonding. Further high-quality RCTs on the differences between direct and indirect bonding are necessary to determine more precise data, as well as additional advantages and disadvantages.

Accuracy Assessment of Virtual Surgical Planning Comparing 3D Virtual Surgical Planning and Post-Operative CBCTs in Surgical Skeletal Class III Cases: A Retrospective Study

ABSTRACT Objective: To evaluate the accuracy of Virtual Surgical Planning (VSP) comparing VSPs and post-operative CBCT scans in patients undergoing bimaxillary orthognathic surgery of severe Skeletal Class III malocclusion. Material and Methods: Twenty-three patients (9 males and 14 females, mean age 24.1 ± 7.0 years) were selected and submitted to bimaxillary orthognathic surgery. Pre-operative VSPs and post-operative CBCTs were compared using both linear (taking into account four skeletal and six dental landmarks, each one described by the respective coordinates) and angular measures (seven planes in total). The threshold discrepancies for post-operative clinical acceptable results were set at ≤2 mm for liner and ≤4° for angular discrepancies. The mean difference values and its 95% confidence interval were identified, comparing which planned and which obtained in absolute value. Results: There were significant statistical differences for all absolute linear measures investigated, although only two overcome the linear threshold value of 2mm in both X and Y-linear dimensions. Linear deviations in Z-linear dimension do not reach statistical significance. All 12 angular measures reach the statistical significance, although none overcome the threshold angular value of 4°. Angular deviation for roll register the higher accuracy in contrast to pitch and yaw. Conclusion: Virtual surgical planning is a reliable planning method to be used in orthognathic surgery field; as a matter of fact, although some discrepancies between the planned on the obtained are evident, most of them meet the tolerability range.

Digital Assessment of Dental Parameters in Italian and Mozambican Subjects with Ideal Occlusion and Permanent Dentition

ABSTRACT Objective: To obtain reference values for tip, torque and in-out from digital models of Italian and Mozambican subjects in ideal occlusion using a repeatable and validated method and to compare these measurements with previously reported values. Material and Methods: Dental parameters were acquired from digital models of each subject, categorized to one of two groups: Italians (23 males, 27 females; mean age 28.3 years, ±5.7 years) and Mozambicans (14 males, 15 females; mean age, 23.4 years, ±5.9), using VAM software. All subjects had ideal occlusion, permanent dentition and no previous orthodontic treatment, fillings or prostheses. After normality of data was assumed (p<0.05), a paired t-test was performed to detect any statistical differences between the two groups (p<0.05). Then, classical inference (t-test and power analysis) was used to compare our data to those reported by other authors. Results: Mozambicans' incisors were more proclined, while their upper molars appeared to be more prominent regarding Italians'. Italians shown greater tip values, especially at the upper first premolars and lower first molars. In-out values were comparable between the two groups, except for the upper molars (more prominent in Mozambicans) and lower first molar (more prominent in Italians). Unlike other reports, upper second molars displayed negative tip in our samples. Conclusion: Pre-adjusted appliances with standard prescription should not be expected to guarantee optimal outcomes. Prescriptions specific for ethnicities are recommended and reference values should be reconsidered.

3D Assessment of the Correlation between Neonatal Morphology and Occlusal Outcomes in 5-Year-Old Patients with Complete Unilateral Cleft Lip and Palate

ABSTRACT Objective: To exploit 3D measurement technology to determine any correlation between neonatal palate morphology and occlusal outcomes at five years in patients receiving surgery for unilateral cleft lip and palate (CLP). Material and Methods: Twenty-nine neonatal and 5-year models treated by the same surgeon using the same protocol for CLP correction were scanned using a high-resolution structured-light scanner and stored in stl format. Dedicated software was used to make linear and surface area measurements on the neonatal models, and each digitized 5-year model was assigned a Five-Year-Old (5YO) index score on three separate occasions by the same investigator. Results: Minimum, maximum, mean, standard deviation and standard error were calculated for each variable considered, and the Pearson coefficient was used to identify any correlations between neonatal variables and 5YO scores. Linear regression analysis showed that the only variable to approach significance was the posterior width of the cleft, which showed an R2 equal to 0.111, indicating that it accounts for 11% of the variability of the 5YO index. There was no other appreciable correlation between linear measurements, surface areas, or their inter-relationships. Conclusion: There is no correlation between neonatal morphological characteristics and occlusal outcomes at 5 years in CLP patients treated via the surgical protocol considered.

Orthodontic Emergencies and Perspectives During and After the COVID-19 Pandemic: The Italian Experience

ABSTRACT Objective: To investigate the types of dental emergencies that occurred during the lockdown period in Italy (12th March-4th May) and to investigate future therapeutic preferences related to the use of different types of appliances. Material and Methods: A questionnaire dedicated to assessing dental emergencies during the lockdown period and surveying the resumption of orthodontic practice was submitted to clinicians in digital form. The first part of the questionnaire, focused on the orthodontic emergencies that were encountered in relation to the different types of orthodontic appliances and how these were resolved. The second part of the questionnaire was devoted to the resumption of clinical practice; in particular, it was designed to assess whether and what percentage of clinicians are willing to change the duration of appointments in relation to the different types of appliance used, asking them whether their approach to orthodontic treatment would change in the coming months as compared to the pre-COVID-19 era. Results: Results show that in most cases (82%), the percentage of patients who experienced a dental emergency was less than 5% and that far fewer emergencies were attributable to removable (5.7%) than to fixed appliances (94.3%). Looking ahead, clinicians expressed a greater preference for using removable (60.8%) rather than fixed appliances (39.2%). Conclusion: During the lockdown, there relatively few orthodontic emergencies, many of which were handled by telephone consultation. However, a far lower percentage of emergencies were generated by removable (e.g., clear aligners) as opposed to fixed appliances (e.g., multibracket equipment), likely influencing the decision of the majority of clinicians to opt for removable appliances in the wake of the COVID-19 pandemic.

Surgical Management of Frenula: Laser Therapy Compared with Z-Frenuloplasty Technique

Abstract Objective: To compare intra- and post-operative consequences associated with Z-frenuloplasty and laser therapy for both upper labial and lingual frenulectomies. Material and Methods: Clinical data of 120 consecutive patients with a mean age of 11 years and 2 months (age range from 9 years and 1 month to 14 years and 3 months) with hypertrophic labial and lingual frenula were assembled. Of the 70 labial frenula, 35 were removed through Z-frenuloplasty (Group 1) and 35 with laser (Group 2); of 50 lingual frenula, instead, 25 were extracted through Z-frenuloplasty (Group 1A) and 25 with laser (Group 2A). The cutting device was Laser Diode Handy 10 in continuous mode. Finally, the time of the surgery, pain and swelling were measured 24-48 hours after the removal. VAS scale was used. Results: The time of the surgery, VAS score after the removal and the swelling were lesser in Group 2 and 2A. Conclusion: Both Z-frenuloplasty and Laser therapy are valid instruments to remove frenula. Moreover, laser offers more advantages like less use of anesthesia, no bleeding in the operating phase, no need for suturing, a faster tissue healing and minor limitations in speech and nutrition.

Torsional Resistance of Two New Heat Treated Nickel Titanium Rotary Instruments: An in Vitro Evaluation

Abstract Objective: To evaluate the difference in torsional resistance, angular deflection and fragment length between two new rotary instruments: AF Blue S4 and S-One. These files share all features except cross-sectional design. Material and Methods: A total of 40 new Nickel-Titanium instruments of 25 mm in length were tested in this study and divided in two groups: 20 AF Blue S4, tip 25 and constant 6% taper and 20 AF-Blue S4 tip 25 and constant 6% taper. The torsional test was performed by the use of a torque recording endodontic motor (KaVo, Biberac, Germany). Torque to Fracture (TtF), Angular Deflection (AD) and Fragment Length (FL) was recorded for each instrument. To ensure an immovable block at 3mm of the instrument tip, an auto-polymerizing resin (DuraLay; Reliance Dental Mfg Co, Worth, IL) was used. Each file was rotated clockwise at a speed of 300 rpm until fracture occurred. Results: Group A (AF Blue S4) showed higher TtF and AD than Group B (S-One), and statistical analysis found significant differences between the two instruments (p<0.05). The mean values for FL showed no significant differences (p>0.05) between the two instruments. Conclusion: The AF Blue S4 seems to have a higher resistance to torsional stress in vitro. Clinically, the use of AF Blue S4 could be safer in narrow canals.

Impact of the SARS-Cov2 Pandemic on Orthodontic Therapies: An Italian Experience of Teleorthodontics

Abstract Objective: To assess the possibility of controlling patients at a distance according to principles of teleorthodontics to understand its possible usefulness in the future routine activity and the impact pandemic may have had on different types of orthodontic treatments. Material and Methods: One hundred orthodontic patients (57 F, 43 M, age 7-46) during quarantine were checked through videocalls and photos sent by patients following proper instructions. Three groups have been distinguished based on the type of therapy: A-fixed appliances; B-removable appliances; C-clear aligners. Relevant events about dental and gingival health, integrity of appliances, orthodontic therapies related symptoms and overall progress of treatments were recorded. Results: A and B groups reported higher percentages of gingival inflammation (27 and 22%), dental plaque (16 and 13%), deciduous tooth loss (8 and 16%). Bracket and attachment detachment were the most frequent events in A and C groups (22 and 23%). Pain and discomfort were reported in A and B groups (35 and 32%). Therapies continued to progress better in C (51% improved dental alignment) and B (31% improved malocclusions) groups. Conclusion: Orthodontics is safe and allows during emergencies to postpone checks. Everyday mobile-technology is useful in managing orthodontic patients unable to carry out in-person control. When their effectiveness equals other systems, treatments with clear aligners without attachments should be preferred in patients unavailable for regular checks.

Three-Dimensional Soft-Tissue Facial Morphometry in Caucasian Obese Adults

Objective: To evaluate the facial morphology of Caucasian obese adults in relation to normal weight peers, and to study the association between three-dimensional soft-tissue facial measurements and cardiometabolic risk factors. Material and Methods: Nineteen Caucasian obese subjects aged 25 to 73 years underwent anthropometric measurements, blood samples and a stereophotogrammetric facial scan. Soft-tissue facial linear distances, angles, and volumes were obtained and compared to those collected on normal weight subjects by computing z-scores. Spearman correlation was used to assess the associations between facial measurements and metabolic parameters. Logistic regression analysis adjusted for sex and age was used to assess the risk of metabolic syndrome associated to the facial measurements. Results: Overall, when compared to normal weight persons, obese adults had a wider face in the horizontal dimension, with a middle face (maxilla) that was larger both in absolute value and relatively to the lower face (mandible), and a larger right side gonial angle (Wilcoxon test, p < 0.01). Only the mean (left and right) gonial angle was positively associated to serum triglycerides level, while the other facial measurements were associated with none of the cardiometabolic parameters. Moreover, none of the facial measurements was associated with the risk of metabolic syndrome. Conclusion: Despite larger facial dimensions and altered mandible/maxilla volume ratio, three-dimensional soft-tissue facial morphometry in Caucasian obese adults is not related to cardiometabolic risk factors. The actual association between morphological facial characteristics and clinical information on the health conditions of patients is still to be investigated.

Distribution of depression, somatization and pain-related impairment in patients with chronic temporomandibular disorders

Abstract Objective the aim of this study was to describe the frequency of psychosocial diagnoses in a large sample of patients attending a tertiary clinic for treatment of temporomandibular disorders (TMD). Material and Methods six hundred and ninety-one patients who sought treatment for pain-related TMD were selected. Chronic pain-related disability (Graded Chronic Pain Scale, GCPS), depression [Symptoms Checklist-90 (SCL-90) scale for depression, DEP] and somatization levels (SCL-90 scale for non-specific physical symptoms, SOM) were evaluated through the Research Diagnostic Criteria for TMD (RDC/TMD) Axis II psychosocial assessment; TMD diagnoses were based on the Axis I criteria. Results the majority of patients presented a low disability or no disability at all, with only a small portion of individuals showing a severely limiting, high disability pain-related impairment (4.3%). On the other hand, abnormal scores of depression and somatization were high, with almost half of the individuals having moderate-to-severe levels of depression and three-fourths presenting moderate-to-severe levels of somatization. The prevalence of high pain-related disability (GCPS grades III or IV), severe/moderate depression and somatization was 14.3%, 44% and 74.1% respectively. Gender differences in scores of SCL-DEP (p=0.031) and SCL-SOM (p=0.001) scales were signficant, with females presenting the highest percentage of abnormal values. Conclusion patients with TMD frequently present an emotional profile with low disability, high intensity pain-related impairment, and high to moderate levels of somatization and depression. Therefore, given the importance of psychosocial issues at the prognostic level, it is recommended that clinical trials on TMD treatment include an evaluation of patients' psychosocial profiles.