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

BACKGROUND: The aim of the present study was twofold:(1) three-dimensionally evaluate the quantitative skeletal and dentoalveolar changes after Ni-Ti leaf spring expander (leaf expander) and rapid maxillary expansion (RME) in mixed dentition patients;(2) analyze the modifications of the buccal alveolar bone plate of the maxillary first permanent molars. METHODS: Patients who underwent CBCT scans before and after maxillary expansion were randomly selected from the records archived at the Department of Biomedical Surgical and Dental Sciences, University of Milan, Italy. Inclusion criteria were the following: no systemic disease or syndromes; maxillary transverse deficiencies (difference between the upper intermolar width and the lower intermolar width of at least 3 mm and/or clinical need based on radiographic evaluation), early mixed dentition with ages between 7 to 10 years old; cervical vertebra maturation stage (CVMS) 1 or 2; no pathologic periodontal status; skeletal class I or II; maxillary expander cemented on the upper second deciduous molars. Exclusion criteria were the following: patients with pubertal or post-pubertal stage of development (CVMS 3-6); late deciduous or late mixed dentition, impossibility to use the second primary molar as anchorage; skeletal class III malocclusion; craniofacial syndromes; patients unable to be followed during the treatment period. Twenty-three patients treated with Leaf Expander, 11 males (mean age 7.8 ± 0.6 years) and 12 females (mean age 8.1 ± 0.8 years), met the inclusion criteria and constituted the case group. Twenty-four (control group) treated with conventional RME, 12 males (mean age 8.4 ± 0.9 years) and 12 females (mean age 8.1 ± 0.7 years). The paired-sample T test was used for intra-group comparison to evaluate the difference between before (T1) and after (T2) maxillary expansion. Independent sample t-test was computed to perform between groups comparison of the skeletal, dentoalveolar, and periodontal changes. RESULTS: The Leaf Expander and RME group showed a significant increase between T1 and T2 for most of the skeletal and dentoalveolar variables. Concerning the skeletal variables only the RME demonstrated a significant increase at the level of the posterior nasal (PNW) and apical base width (PABW) and maxillary mid-alveolar width (MMW). Despite this, when compare with the Leaf Expander, the RME group exhibited a statistically larger width increase for only two skeletal parameters: PNW (p = 0.03) and MMW (p = 0.02). No significant changes at the periodontal level were found in either group. CONCLUSIONS: According to the current research, the authors confirm the effectiveness of the Leaf Expander and RME to produce similar skeletal and dentoalveolar effects in mixed dentition subjects. Moreover, the devices anchored to deciduous teeth did not reduce the thickness and height of the buccal bone at the level of the maxillary permanent first molars in either of the two groups.

Accuracy of automated 3D cephalometric landmarks by deep learning algorithms: systematic review and meta-analysis.

OBJECTIVES: The aim of the present systematic review and meta-analysis is to assess the accuracy of automated landmarking using deep learning in comparison with manual tracing for cephalometric analysis of 3D medical images. METHODS: PubMed/Medline, IEEE Xplore, Scopus and ArXiv electronic databases were searched. Selection criteria were: ex vivo and in vivo volumetric data images suitable for 3D landmarking (Problem), a minimum of five automated landmarking performed by deep learning method (Intervention), manual landmarking (Comparison), and mean accuracy, in mm, between manual and automated landmarking (Outcome). QUADAS-2 was adapted for quality analysis. Meta-analysis was performed on studies that reported as outcome mean values and standard deviation of the difference (error) between manual and automated landmarking. Linear regression plots were used to analyze correlations between mean accuracy and year of publication. RESULTS: The initial electronic screening yielded 252 papers published between 2020 and 2022. A total of 15 studies were included for the qualitative synthesis, whereas 11 studies were used for the meta-analysis. Overall random effect model revealed a mean value of 2.44 mm, with a high heterogeneity (I2 = 98.13%, τ2 = 1.018, p-value < 0.001); risk of bias was high due to the presence of issues for several domains per study. Meta-regression indicated a significant relation between mean error and year of publication (p value = 0.012). CONCLUSION: Deep learning algorithms showed an excellent accuracy for automated 3D cephalometric landmarking. In the last two years promising algorithms have been developed and improvements in landmarks annotation accuracy have been done.

Occlusal Plane and Skeletal Changes After Cervical Headgear Treatment With and Without Lower Utility Arch in Class II Growing Patients.

ABSTRACT: The purpose of this study was to investigate skeletal and dental changes affecting occlusal plane inclination after cervical headgear treatment with and without lower utility arch. In order to distinguish the orthodontic changes from natural growth a control group was employed.The sample of this study consisted by 20 Class II subjects (10 males, 10 females; mean age 8.54) treated by using cervical headgear, 19 class II children (19 males, 9 females; mean age 8.64) treated with cervical headgear and utility arch, and 21 Class II patients (11 males, 10 females; mean age 8.41) who had no therapy.Lateral head films were studied for all the patients before treatment (T1) and after therapy (T2) for all the treated groups and at the beginning and at the end of observational period for the control group; cephalometric analysis was carried out in order to seek for the modifications between time points and between groups.Means and standard deviation have been analyzed for all the groups. In order to compare the modification between the time points within the same group the ANOVA test was applied. The ANOVA test was used to compare the mean differences (T2-T1) of 3 groups.The study revealed that there were significant changes in occlusal plane inclination after the different treatment modalities employed instead control group. The treatment with cervical headgear and utility arch is more effective than cervical headgear alone in lowering occlusal plane posteriorly when it is compared with controls.

The Application of the Divine Proportion for the Construction of the Visualized Treatment Objective in Craniofacial Surgery.

ABSTRACT: Aesthetics and function of maxillofacial district are closely related and could interfere with patient psychological conditions. The aim of this paper is to describe and to analyze the procedures necessary for a proper surgical visualized treatment objective (VTO) realization through the use of the tracing on lateral head film, applying the divine proportion (or golden ratio) in certain steps. The method described is easy to realize, cheap and help both orthodontist and maxillo-facial surgeon to communicate each other and to the patients.For the following article, digital research and handheld research on surgical VTO planning for patients with skeletal or dentoalveolar severe deformities managed by surgeons and orthodontics were used. The research included articles in English published on dental and maxillofacial surgery journals.The surgical VTO consists of a "previsualization" of the objectives in order to make the desired changes for the individual patient. The result can thus be visualized and pre-evaluated rather than just imagined by the mind's eye. To simplify the procedure, the surgical VTO has been divided into 11 steps. The accurate model of the surgical result is fundamental in the treatment of dentofacial deformities. These predictions are intended to guide the treatment towards the desired result, to give the patient a reasonable preview of the outcome, and to ensure communication between the orthodontist and the surgeon.This technique proves to be effective in planning surgical treatment and it allows the clinician to view changes before, during, and after orthognathic surgery. The skeletal, dental, and aesthetic complete cephalometric evaluation is the key point to the long-term success of the results.

Changes in canine inclination after rapid and slow maxillary expansion compared to untreated controls.

OBJECTS: Palatally displaced canines (PDC) might represent condition causing several clinical problems, such as roots resorption and malocclusion, and can develop palatal canine impaction. Some interceptive treatments such as rapid maxillary expansion were suggested in order to foster maxillary canine eruption. Among expansion protocols, no data are available about differences between rapid and slow maxillary expansion on maxillary canine eruption. The aim of this study was therefore to evaluate α-angle changes in palatally displaced canines using rapid and slow maxillary expansion compared to untreated control patients. SETTING AND SAMPLE POPULATION: The final sample comprised 19 patients treated with rapid maxillary expansion (RME group), 17 treated with slow maxillary expansion (SME group) and 22 control patients (Control group). MATERIALS AND METHODS: α-angle was measured on panoramic films to detect canine inclination at the beginning, and at the end of maxillary expansion treatment or observation, time and changes over time were compared. RESULTS: In the comparisons among groups, RME group was the only group showing a decrease in α-angle measurements that was statistically significant also when compared to the other groups, except for the left side when compared to SME group. CONCLUSION: RME treatment significantly and positively affected canine position when compared to SME treatment and control group.

Changes of Occlusal Plane in Growing Patients With Increased Vertical Dimension During Class II Correction by Using Cervical Headgear.

This retrospective research aimed to highlight the changes of occlusal plane in Class II hyperdivergent subjects that received cervical headgear treatment and compared them to untreated controls in order to evaluate the occlusal changes that might be connected to a potential mandibular rotation.The sample of this investigation was represented by 20 hyperdivergent Class II subjects (10 males, 10 females; mean age 8.54) corrected by using cervical headgear (treated group) and 21 Class II patients (11 males, 10 females; mean age 8.41) hyperdivergent who had no therapy (control group). Lateral head films were studied for all the patients before treatment (T1) and after therapy (T2) for both groups; cephalometric analysis was used in order to seek the modifications between time points and between groups.Means and standard deviation have been computed for both groups. In order to confront the modification between the time points within the same group the Wilcoxon test was applied. The Mann-Whitney U test was applied to confront the dissimilarities between groups at T2.As a result of the Class II correction by using the cervical headgear treatment the occlusal plane was lowered and flattened compared to T1 and to the control group; the upper molars showed extrusion to the palatal plane, there was a significant forward rotation of mandible and the vertical dimension was not significantly modified. Downward and backward displacement of the upper jaw occurred.

Evaluation of condylar cortical bone thickness in patient groups with different vertical facial dimensions using cone-beam computed tomography.

The aim of this study is to evaluate through computed tomography differences in cortical plate thickness of condyle in patients with a different facial vertical skeletal pattern. The final sample of this retrospective study included CBCT exams of 60 adult subjects (mean age 33.2 ± 5.6), selected from the digital archive of a private practice. The subjects were assigned to 3 different groups according to the values of the Frankfurt-mandibular plane angle: hyper-, normo-, and hypodivergent groups. The volume rendering of the mandible was obtained and three condylar points were marked on it: median pole, lateral pole and the most cranial point. For each considered reference point, the minimum distance between external and internal cortical surface was measured, obtaining three different outcomes: condylar cortical bone thickness of median pole (CCBToMP), lateral pole (CCBToLP) and cranial pole (CCBToCP). The measurements were executed by means of Mimics software by the same expert operator in specific scan views. The cortical bone thickness of hyperdivergent patients was found to be statistically thicker than normodivergent patients and hypodivergent patients. Cortical bone thickness of normodivergent patients was found thicker than hypodivergent patients. All the differences were statistically significant (p < 0.05). The Pearson correlation coefficient showed a statistically significant correlation (p < 0.001) between the Frankfurt-mandibular plane angle and the evaluated cortical bone thickness outcomes. Facial biotype characteristics that define vertical facial skeletal pattern affect the cortical bone thickness of mandibular condyle.

Midpalatal Suture Density Evaluation after Rapid and Slow Maxillary Expansion with a Low-Dose CT Protocol: A Retrospective Study.

Background and objectives: The aim of the present paper is to use low-dose computed tomography (CT) to evaluate the changes in the midpalatal suture density in patients treated with rapid maxillary expansion (RME) and slow maxillary expansion (SME). Materials and Methods: Thirty patients (mean age 10.2 ± 1.2 years) were retrospectively selected from the existing sample of a previous study. For each patient, a low-dose computed tomography examination was performed before appliance placement (T0) and at the end of retention (T1), seven months later. Using the collected images, the midpalatal suture density was evaluated in six regions of interest. Results: No significant differences were found between the timepoints in the rapid maxillary expansion group. Three out of six regions of interest showed significant decreases between the timepoints in the slow maxillary expansion group. No significant differences were found in comparisons between the two groups. Conclusions: The midpalatal suture density showed no significant differences when rapid maxillary expansion groups were compared to slow maxillary expansion groups, suggesting that a similar rate of suture reorganization occurs despite different expansion protocols.

Buccal bone plate thickness after rapid maxillary expansion in mixed and permanent dentitions.

INTRODUCTION: Rapid maxillary expansion (RME) might cause buccal displacement of anchor teeth. Dislocation of teeth outside their alveolar process can damage the periodontium; for this reason, maxillary expansion using deciduous teeth as anchorage in the mixed dentition might be suggested. The aim of this study was to compare changes of buccal bone plate thickness on the maxillary permanent first molars after RME in the mixed and permanent dentitions with different types of anchorage. METHODS: Two groups of patients were evaluated with cone-beam computed tomography before and after RME. Group E (21 patients) underwent RME using deciduous teeth as anchorage; group 6 (16 patients) underwent RME using permanent teeth as anchorage. The Wilcoxon test was used to compare changes between the time points in the same groups, and the Mann-Whitney U test was used to compare differences between the groups. RESULTS: In group E, generally, no statistically significant reduction was found in buccal bone plate thickness between the time points. In group 6, most measurements showed significant reductions in buccal bone plate thickness (P <0.05) between the time points, with a maximum decrease of 1.25 mm. CONCLUSIONS: RME in the mixed dentition with the appliance anchored to deciduous teeth did not reduce the buccal bone plate thickness of the maxillary permanent first molars, except for the mesial roots on both sides. RME in the permanent dentition caused a reduction of the buccal bone plate thickness of the maxillary permanent first molars when they were used as anchorage in the permanent dentition.

Metabolic effects of treatment in patients with obstructive sleep apnea: a systematic review.

INTRODUCTION: Growth retardation was frequently observed in obstructive sleep apnea (OSA) patients but the complex mechanisms causing this condition are still unclear. Several findings suggested growth catch-up after surgical treatment but other studies did not confirm the results, showing no improvement in OSA patients after tonsillectomy and adenoidectomy (T&A). The aim of the present study was to systematically review scientific literature of the relationships between OSA and metabolic changes involving growth hormone (GH) axis before and after treatment in patients. EVIDENCE ACQUISITION: Different databases were searched without limitations up to August 2017. Additionally, the bibliographies of the finally selected articles were hand searched to identify any relevant publications that were not previously identified. EVIDENCE SYNTHESIS: From the 37 studies collected from all the databases based on their title and abstract, only 12 studies actually fulfilled the selection criteria. From the twelve finally selected articles, eight focused on growth mediators, two evaluated endothelial mediators, one focused on neurocognitive function and mediators and one focused on local inflammation. CONCLUSIONS: OSA children present lower levels of growth mediators (IGF-I and IGFBP-3) thus indicating growth retardation, significantly higher cardiovascular disease risk and decreased cognitive functions when compared to controls. T&A seems to improve all the above mentioned functions with great impact on general health.

Osteo-regeneration personalized for children by rapid maxillary expansion: an imaging study based on synchrotron radiation microtomography.

BACKGROUND: Personalized maxillary expansion procedure has been proposed to correct maxillary transversal deficiency; different protocols of stem cell activation have been suggested and rapid maxillary expansion (RME) is the most commonly used among clinicians. The present study aimed to quantify in three-dimensions (3D) the osteo-regeneration of the midpalatal suture in children submitted to RME. METHODS: Three patients (mean age 8.3 ± 0.9 years) were enrolled in the study to preform biopsy of midpalatal suture. Two patients (subjects 1 and 2) were subjected to RME before biopsy. The third patient did not need maxillary expansion treatment and was enrolled as control (subject 3). Midpalatal suture samples were harvested 7 days after RME in subject 1, and 30 days after RME in subject 2. The samples were harvested with the clinical aim to remove bone for the supernumerary tooth extraction. When possible, maxillary suture and bone margins were both included in the sample. All the biopsies were evaluated by complementary imaging techniques, namely Synchrotron Radiation-based X-ray microtomography (microCT) and comparative light and electron microscopy. RESULTS: In agreement with microscopy, it was detected by microCT a relevant amount of newly formed bone both 7 days and 30 days after RME, with bone growth and a progressive mineralization, even if still immature respect to the control, also 30 days after RME. Interestingly, the microCT showed that the new bone was strongly connected and cross-linked, without a preferential orientation perpendicular to the suture's long axis (previously hypothesized by histology), but with well-organized and rather isotropic 3D trabeculae. CONCLUSIONS: The microCT imaging revealed, for the first time to the authors' knowledge, the 3D bone regeneration in children submitted to RME.

Skeletal and Dental Effectiveness of Treatment of Class II Malocclusion With Headgear: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the skeletal and dental effects of headgear treatment by systematically reviewing the best available scientific evidence. MATERIALS AND METHODS: A survey of articles published up to February 2017 investigating the effects of headgear in the treatment of patients with class II malocclusion was performed using 19 electronic databases. Only randomized clinical trials and prospective controlled clinical trials investigating growing patients with class II malocclusion treated with headgear were included. Two authors performed independently study selection, data extraction, and risk of bias assessment. All pooled data analyses were performed using the random-effect model. Statistical heterogeneity was evaluated. RESULTS: In total, 6 trials were included (4 randomized clinical trials and 2 prospective controlled clinical trials), grouping data from 337 patients (170 treated patients and 167 untreated controls). The ages of the patients varied across the studies, but the majority of the trials had a sample with an age range between 8 and 9 years. The times of daily wear of the appliance varied across studies from 8 to 14 h/d. The significant mean differences in treatment effects compared with the untreated controls were -1.41° per year for SNA angle cephalometric parameter (95% confidence interval [CI]: -2.25° to -0.56°), -0.57 mm/y for anterior maxillary displacement (95% CI: -0.75 to -0.40 mm), -1.42° per year for ANB angle cephalometric parameter (95% CI: -2.12° to -0.72°), and -1.31 mm/y for the overjet cephalometric parameter (95% CI: -2.34 to -0.29 mm). CONCLUSION: Headgear treatment is effective in restricting sagittal maxillary growth and reducing the overjet in the short term.

Cellular Midpalatal Suture Changes after Rapid Maxillary Expansion in Growing Subjects: A Case Report.

The present case report aimed to investigate immediate histologic changes in midpalatal suture in humans following rapid maxillary expansion compared to control. Three patients (mean age 8.3 +/- 0.9 years) were enrolled in the case report and underwent midpalatal suture biopsy. Two patients underwent treatment before biopsy. The third patient did not show transversal maxillary deficiency and was enrolled as a control. Biopsy samples of midpalatal suture at 7 (subject 1) and 30 days (subject 2) after maxillary expansion as well as of one control (subject 3) were collected and processed for histology. In the control (subject 3) inter-digitations at the palatal suture gap were observed. At 7 days (subject 1) mature bone with small marrow spaces and trabecular bone with the peculiar storiform appearance inside the soft tissue and collagen fibers running parallel only in the central part were present. At 30 days (subject 2), a greater number of newly-formed bone trabeculae with a perpendicular orientation to the long axis of the suture could be seen. At 30 days the fibrous component of bone tissue was less represented compared to the sample at 7 days. Data from the preliminary histological results showed that bone formation was observed in the gap after rapid maxillary expansion, although the healing process was still ongoing.

Diagnostic concordance between skeletal cephalometrics, radiograph-based soft-tissue cephalometrics, and photograph-based soft-tissue cephalometrics.

OBJECTIVE: This study aims to investigate the diagnostic concordance between skeletal cephalometrics and soft-tissue cephalometrics in identifying facial lower third characteristics. MATERIALS AND METHODS: We compared a skeletal cephalometric analysis (SCA) to a soft-tissue analysis performed on cephalometric radiographs (rSTCA) and to one performed on profile photograph (pSTCA). Ninety-six pre-treatment digital lateral cephalometric radiographs and 96 digital profile photographs were randomly selected for this study (patients' mean age: 18.33, SD: 3.38, age range: 14-29). Inclusion criteria were as follows: no skeletal asymmetry, well-aligned upper and lower dental arches, no history of orthodontic treatment, prosthodontic treatment, facial surgery and trauma, patient's age between 14 and 30 years, high-resolution images, exams taken with natural head position. Kruskas-Wallis and post hoc pairwise comparisons tests were used to find differences among the considered cephalometric methods. The diagnostic performance of the three methods was also assessed using the receiver-operating characteristic (ROC) curve analysis. RESULTS: Significant differences were found between SCA and rSTCA and between SCA and pSTCA in defining sagittal and vertical facial lower third characteristics (P < 0.05). No differences were found between rSTCA and pSTCA (P > 0.05) for the same facial characteristics. For each parameters investigated, pSTCA showed an area under the curve much closer to the perfect value of 1.00. CONCLUSION: Poor diagnostic concordance was found between SCA and rSTCA and between SCA and pSTCA. pSTCA is a reliable method for evaluating the soft-tissue profile characteristics compared to that performed on cephalograms.

Digital evaluation of nasal changes induced by rapid maxillary expansion with different anchorage and appliance design.

BACKGROUND: Scientific evidence showed that rapid maxillary expansion (RME) affects naso-maxillary complex, increasing nasal width and volume. This study aimed to evaluate nasal changes induced by rapid maxillary expansion with different anchorage and appliance design by using low dose and cone beam computed tomography. METHODS: A total of 44 patients (20 males, mean age 8y 8 m ± 1y 2 m; 24 females mean age 8y 2 m ± 1y 4 m) were included in the investigation and divided into three groups according to the appliance: Hyrax-type expander anchored to permanent teeth, modified Hyrax-type expander anchored to deciduous teeth, modified Haas-type expander anchored to deciduous teeth. Maxillary expansion was performed until overcorrection and the expander was passively kept in situ for 7 months at least. All patients had three-dimensional imaging before expansion (T0) and after the retention period (T1). Nasal floor width, nasal wall width, maxillary inter-molar width were measured by means of Mimics software. The paired sample t-test was employed to assess the significance of the differences between the time points; the analysis of variance test (ANOVA) was used to compare differences between groups. RESULTS: The statistical analysis revealed significant differences between T0 and T1 for each recorded measurement in each group; no significant differences were found by comparing groups. CONCLUSIONS: Rapid maxillary expansion produces a significant skeletal transverse expansion of nasal region in growing patients. No significant differences in nasal effects are expected when the appliance is anchored onto deciduous teeth, with or without the palatal acrylic coverage.

Congenitally missing maxillary lateral incisors: Long-term periodontal and functional evaluation after orthodontic space closure with first premolar intrusion and canine extrusion.

INTRODUCTION: The aims of this investigation were to evaluate associations between orthodontic space closure (including first premolar intrusion and canine extrusion for esthetic reasons) and periodontal tissue deterioration over a 10-year period in subjects with one or both missing maxillary lateral incisors and to investigate the occurrence of signs or symptoms of temporomandibular disorder (TMD). METHODS: This was a retrospective cohort study comprising patients treated by the same orthodontist. The agenesis group included 26 consecutive adolescent and young adult patients (9 male, 17 female) treated with space closure. The control group consisted of 32 orthodontic patients (12 male, 20 female) with no missing teeth and no need for extractions. In the agenesis group, full-mouth probing pocket depths and bleeding on probing were recorded at 6 locations for each of 657 teeth (3942 periodontal sites). In the control group, comparative data were collected for the maxillary first molars, premolars, canines, and lateral incisors, a total of 264 teeth (1584 periodontal sites). Mobility and gingival recession were also evaluated. Patients in both groups completed questionnaires concerning symptoms related to TMD. RESULTS: The full-mouth assessments in the agenesis group generally demonstrated periodontally healthy conditions, with probing depths below 4 mm and few bleeding sites. Some slight recessions were found, mostly on molars and second premolars, and there was normal mobility of first premolars that substituted for canines. Comparisons between the agenesis and control groups showed no statistically significant differences for the maxillary teeth regarding increased pocket depth (≥4 mm) or increased mobility. Interproximal sites in the agenesis group showed less bleeding on probing than in the control group; this was statistically significant. Anterior teeth in the agenesis group did not show any more recession than in the controls. In addition, we observed no difference in signs or symptoms between the 2 groups; this might be due to the limited sample size or the drawbacks of the surveys of TMD through subjects' recall. Thus, the long-term periodontal tissue health and the incidence of dysfunction or TMD signs were similar in the space-closure agenesis group and in the control group of nonextraction orthodontic patients. CONCLUSIONS: Orthodontic space closure including first premolar intrusion and canine extrusion in patients with missing lateral incisors does not incur risks for periodontal tissue deterioration or TMD in the long term.

Measurements of orbital protrusion from childhood to young adulthood.

BACKGROUND: Ocular protrusion is usually measured as the deepest part of the lateral orbital rim to the apex of the cornea. Several studies have been carried out to propose normative data for ocular protrusion according to different age ranges. The protrusion of the eyeball seemed to increase during childhood and adolescence and become stable after the late teens during adulthood. Relationships of ocular protrusion with age are still not completely clarified. The purpose of the current retrospective study was to investigate ocular protrusion on lateral x-rays at different growth stages. METHODS: Ninety-five patients were retrospectively selected and divided into 5 different groups according to ages. Subjects were of both sexes with an age range from 5 to 20 years (mean 12.3 years). The cephalometric analysis proposed in the current study allowed to successfully evaluate sagittal relationships of the orbital-globe and the orbital-cavity in growing patients. All other sagittal and vertical measurements were successfully computed by one trained operator. RESULTS: Analysis of variance results with post hoc corrections showed for the orbital measurements indicating a significant increase of the orbital protrusion from childhood to pubertal stage. CONCLUSIONS: Ocular protrusion measurements showed significant increase from childhood (5-8 years) to teen age (13-15 years) and remained stable after the pubertal growth spurt (17-20 years) in the examined sample of patients.

Predictive variables derived from panoramic radiographs for impacted maxillary cuspids treated with easy cuspid system.

The aim of the current study was to find, by means of panoramic radiographs, a viable statistical method to forecast the duration of orthodontic traction of impacted maxillary cuspids. The treatment sample consisted of 51 palatal impacted cuspids (19 unilateral and 32 bilateral) in 35 patients (aged between 10.5 and 17.5 y) with a cervical vertebral maturation between cervical stage 1 and 4. Each patient underwent the same combined surgical-orthodontic technique. Anamnestic data as well as pretreatment panoramic radiograph and cephalogram with European Board of Orthodontics analysis were recorded for each case. Eight radiographic indicators were derived from panoramic films to define the reliable position of the impacted cuspid. Multiple regression analysis was used. All cuspids were successfully treated with an average traction time of 99 days (range, 33-188 d). The pretreatment radiographic features assessed on the panoramic radiographs did not significantly affect the duration of traction. The formula based on α angle, d1 distance, and S sector forecasted an average traction time of 123 days (range, 63-210 d), which is longer than the real time. No relevant correlations were found between orthodontic traction time and pretreatment radiograph parameters derived from panoramic film at the beginning of the treatment. The classic formula elaborated by Crescini could not be applied to the patients of this study, who were treated with the Easy Cuspid method.

Immediate, non-submerged, root-analogue direct laser metal sintering (DLMS) implants: a 1-year prospective study on 15 patients.

This study evaluated the 1-year survival and success rate of root-analogue direct laser metal sintering (DLMS) implants, placed into the extraction sockets of 15 patients. DLMS is a technology which allows solids with complex geometry to be fabricated by annealing metal powder microparticles in a focused laser beam, according to a computer-generated three-dimensional (3D) model; the fabrication process involves the laser-induced fusion of titanium microparticles, in order to build, layer-by-layer, the desired object. Cone-beam computed tomography (CBCT) acquisition and 3D image conversion, combined with the DLMS process, allow the fabrication of custom-made, root-analogue implants (RAIs). CBCT images of 15 non-restorable premolars (eight maxilla; seven mandible) were acquired and transformed into 3D models: from these, custom-made, root-analogue DLMS implants with integral abutment were fabricated. Immediately after tooth extraction, the RAIs were placed in the sockets and restored with a single crown. One year after implant placement, clinical and radiographic parameters were assessed: success criteria included absence of pain, suppuration, and exudation; absence of implant mobility and absence of continuous peri-implant radiolucency; distance between the implant shoulder and the first visible bone-to-implant contact <1.5 mm from initial surgery; and absence of prosthetic complications. At the 1-year follow-up, no implants were lost, for a survival rate of 100 %. All implants were stable, with no signs of infection. The good conditions of the peri-implant tissues were confirmed by the radiographic examination, with a mean DIB of 0.7 mm (±0.2). The possibility of fabricating custom-made, RAI DLMS implants opens new interesting horizons for immediate placement of dental implants.

Cephalometric evaluation of ocular protrusion at stages of growth.

The sagittal relationships between the orbital globe and the ocular orbit have great importance in aesthetic and functional evaluations. These relationships are useful in diagnosis and treatment of some malformations in which the orbital volume is reduced such as craniostenosis. The aim of the present study was the cephalometric evaluation of the ocular protrusion at different growth stages. Ninety-two patients with negative history of craniosynostosis, severe myopia, and skeletal class I were selected for the present study. Lateral teleradiography x-ray was performed for all the patients, and 5 groups were carried out based on the dentition phase. Cephalometric analyses were performed on the lateral teleradiography x-ray. Mean values of ocular protrusion (B-Or post) for females and males were found and digitized for the 5 groups tested. All other sagittal and vertical measurements were successfully computed by the trained operator. B-Or post showed values between -14.93 mm and -16.90 mm among the groups. The cephalometric analysis proposed in the present study allowed to successfully evaluate sagittal and vertical relationship of the orbital globe and the orbital cavity in growing patients. Moreover, the B-Or post maintained its value during growth in the present study.