Immediate multivessel revascularization after myocardial infarction: change of strategy?

Multivessel coronary artery disease (MVD) is a frequently encountered condition in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) of the culprit vessel. Several studies have demonstrated the benefit of complete coronary revascularization compared with the treatment of the culprit lesion only in patients with STEMI. Based on this evidence, the current European guidelines recommend that in haemodynamically stable patients with STEMI and MVD, routine complete revascularization should be achieved either during the same procedure in concomitance with the treatment of the culprit lesion (immediate multivessel PCI) or with a subsequent intervention within 45 days from the index PCI of the culprit lesion (deferred multivessel PCI). However, the guidelines do not express a preference for immediate vs. delayed multivessel PCI. Therefore, the optimal timing of the treatment of non-culprit lesions in patients with STEMI and haemodynamic stability is still debated and has been evaluated in recent studies that showed the non-inferiority of immediate vs. delayed multivessel PCI. The article discusses the results and clinical implications of these studies on the timing of complete revascularization of non-culprit lesions in haemodynamically stable patients with STEMI.

Evaluation of effects of brackets and orthodontic wires on intraoral scans: A prospective in-vivo study.

OBJECTIVE: To evaluate any distortion produced by multibracket fixed orthodontic appliances on digital models obtained from intraoral scans (IOS), considering the presence of both brackets only and brackets/archwire combination. SETTING/SAMPLE: The IOS data of the arches of 20 patients (12 females and 8 males; mean age = 15.55 ± 2.84 years) were acquired using the CS3600 intraoral scanner (Carestream Dental, Atlanta, USA), without any appliances (model A), with vestibular brackets alone (model B) and then with brackets and orthodontic archwire fitted (model C). MATERIALS AND METHODS: Data were acquired between the months of January and October 2021 at the moment of indirect bonding phase. On each model, five intra-arch linear measurements were obtained (inter-canine, inter-premolar 1 and 2, inter-molar and arch depth), and after digital matching between model A and B (match 1) and A and C (match 2), the linear discrepancies were evaluated at 20 points (10 occlusal and 10 gingivolingual) previous identified on the reference model A. All measurements were performed using Geomagic Control X software (3D Systems, Morrisville, USA), and any dimensional variations and distortions were evaluated by the linear regression analysis and two-sample t-test (P ≤ .05). RESULTS: The results show an almost perfect correlation between both models B and C and the reference model A, both as regards the intra-arch linear measurements and the linear discrepancies found at the 20 identified points. CONCLUSIONS: Multibracket fixed orthodontic appliances do not produce any relevant distortions in digital models obtained via intraoral scanning. Therefore, the removal of archwire is not mandatory before IOS.

Soft-tissue profile changes in adult patients treated with premolar extractions.

INTRODUCTION: The objective of this study was to identify the soft-tissue profile changes and the potential pretreatment cephalometric parameters that clinicians could use to predict the lip response after premolar extraction treatment in adult patients. METHODS: Pretreatment and posttreatment lateral cephalograms of 75 white patients treated with premolar extractions were analyzed. The following initial cephalometric measurements were recorded: upper and lower lip to E-plane, vermilion thickness, lip length, maxillary and mandibular incisor inclination, and mentolabial and nasolabial angle. Pretreatment and posttreatment radiographs were superimposed using the Björk structural method to record lip retraction and incisor/lip retraction ratio. Pearson correlation and Kruskal-Wallis tests were used to compare lip retraction and incisor/lip retraction ratio with the cephalometric variables. The sample was divided according to different extraction patterns. RESULTS: The mean upper and lower lip retraction values were 1.4 mm and 1.7 mm, respectively. Vermilion thickness showed a negative and statistically significant correlation (P <0.05) with lip retraction and incisor/lip retraction ratio. In addition, the mean incisor/lip retraction ratio was 61% and 98% for the upper and lower thin lip, respectively, whereas the mean incisor/lip retraction ratio was 17% and 44% for the upper and lower thick lip, respectively. The comparison among extraction patterns did not highlight any noticeable difference. CONCLUSIONS: The choice of a specific extraction pattern did not impact lip response. The vermilion thickness was the key factor influencing lip retraction: an increase in this parameter was related to a decrease in lip retraction and vice versa.

CAD/CAM-based 3D-printed and PVS indirect bonding jig system accuracy: a systematic review, meta-analysis, and comparative analysis of hard and soft CAD/CAM transfer trays.

BACKGROUND: The widespread use of CAD/CAM transfer trays warrants evaluation of their accuracy as compared to PVS transfer trays. OBJECTIVES: To quantify the accuracy of CAD/CAM and PVS transfer trays, investigating any differences between soft and hard trays CAD/CAM transfer trays. SEARCH METHODS: Eight different databases (Scopus, Web of Science, PubMed, Google Scholar, ProQuest, Embase, Cochrane Library, ClinicalTrials.gov) were searched, without restrictions, up to an end date of February 2023. SELECTION CRITERIA: Clinical trials (randomized and non-randomized) and in vitro studies reporting average imprecision values for bracket positioning obtained by digital superimpositions of digitally planned and real positions. DATA COLLECTION AND ANALYSIS: Data eligibility, data extraction, and risk of bias (RoB-2 and ROBINS-I) were conducted independently. The data, where possible, were synthesized and quantitatively analysed (meta-analysis of mean differences with 95% confidence intervals). The Grade of Recommendation, Assessment, Development and Evaluation (GRADE) analysis of the quality of evidence was performed. The t-test for independent samples was used to compare the transfer accuracy of hard and soft CAD/CAM transfer trays. RESULTS: Thirteen studies were synthesized in this systematic review, and then eight studies were included in the quantitative meta-analysis. As regards linear measurements, there was a mean transfer error of 0.0752 mm (95%CI: 0.0428, 0.1076) for mesiodistal measures, 0.0943 mm (95%CI: 0.0402, 0.1484) for vertical, and 0.0815 mm (95%CI: 0.0469, 0.1160) for buccolingual. As for angular measurements, there was an average transfer error of 1.2279° (95% CI: 0.6011, 1.8548) for inclination, 0.9397° (95%CI: 0.4672, 1.4123) for angulation, and 0.8721° (95%CI: 0.4257, 1.3185) for rotation. CAD/CAM transfer trays were less accurate than polyvinylsiloxane (PVS) transfer trays, with those made of soft material being more accurate than the hard ones, except for vertical dimension. The GRADE quality of evidence ranged from very low to moderate. CONCLUSIONS AND IMPLICATIONS: CAD/CAM transfer trays provide high bracket positioning accuracy, with soft transfer trays offering greater precision than rigid ones. Future randomized prospective trials are required to enhance the strength of the available evidence. REGISTRATION: Prospero (CRD42023401278 number).

Accuracy of indirect bracket placement with medium-soft, transparent, broad-coverage transfer trays fabricated using computer-aided design and manufacturing: An in-vivo study.

INTRODUCTION: The objective of this study was to test the precision of in-vivo indirect bracket placement via medium-soft, transparent, broad-coverage, computer-aided designed and manufactured transfer trays using an automated digital method. METHODS: Seventeen patients requiring vestibular fixed appliances were consecutively recruited, and bonding accuracy was measured at each bracket, evaluating 3 linear (mesiodistal, buccolingual, and vertical) and 3 angular measurements (torque, tip, and rotation) with an automated method involving digital superimposition of individual teeth. Mean and standard deviation values were calculated for both arches, single arch, and tooth type, and the percentages of single deviations over the thresholds of 0.25 mm and 1° were calculated, as well as maximum and minimum values for each deviation and directional bias. Correlations between each variable (arch, tooth type, and single tooth) and deviations were investigated through classification and regression trees (CART) predictive models. RESULTS: Neither mean nor single linear deviations ever exceeded the set cutoff value of 0.25 mm. Mean angular deviations never exceeded 1°, but some individual angular deviations did, specifically 8.31% of torque, 13.16% of tip, and 7.16% of rotation deviations. The highest percentage of deviation was recorded for rotation of the maxillary incisors (18.11%). No evident trend in directional deviation bias was found. Tooth type appears to influence mesiodistal and torque deviations, whereas the single tooth variable influenced the percentage of rotation deviations exceeding 1° (P <0.05). CONCLUSIONS: This computer-aided designed and manufactured medium-soft, transparent transfer tray provides accurate bracket placement and could be recommended for routine fixed appliance treatment.

Combined use of F22 aligners and intermaxillary elastics in mild skeletal Class II: Two case reports.

INTRODUCTION: The aim of these two case-reports is to illustrate and compare the therapeutic effects of Class II elastics in combination with F22 aligners in an adult and an adolescent patient, respectively. CASE PRESENTATION: Two patients with a mild skeletal Class II malocclusion, associated with mild-to-moderate crowding, presented for orthodontic treatment. The first patient was 12 years old, while the second was 40 years old. In both cases, the goal was to obtain bilateral molar and canine Class I with ideal overjet and overbite, and Class II skeletal relationship improvement in the young patient as well. Both treatments were approached without extractions and using clear aligners (CAs) in combination with Class II elastics, giving the patient the opportunity to take advantage of a therapy that is both comfortable and aesthetic. DISCUSSION: Final records of both cases demonstrate how appropriate analysis and diagnosis enable CAs in conjunction with Class II elastics to be used with considerable efficiency and efficacy for Class II treatment. In the first case, the key to success was exploiting residual jaw growth, while in the second case it was careful orthodontic digital planning. CONCLUSION: In the presence of good patient compliance, CAs associated with Class II elastics provide satisfactory occlusal outcomes if biomechanics and digital set-up are carefully evaluated and executed and if diagnosis is appropriate.

A non-invasive system to manage impacted teeth associated with a large dentigerous cyst.

A male patient aged 11 years presented a large dentigerous cyst in the lower left quadrant associated with retained deciduous lower lateral incisor and canine and impacted, unerupted corresponding permanent ones. The treatment consisted in marsupialisation and placement of a modified lingual arch that held a tube for decompression used for irrigation of the cystic cavity in a comfortable way for the patient and for the clinician.The same lingual arch was later used as an anchorage method for traction of the retained teeth. The final records showed complete resolution of the cyst and retained teeth were successfully Aligned into the oral cavity.

Temporal relationship between sleep-time masseter muscle activity and apnea-hypopnea events: A pilot study.

BACKGROUND: Obstructive sleep apnea (OSA) is the most common sleep disorder due mainly to peripheral causes, characterized by repeated episodes of obstruction of the upper airways, associated with arousals and snoring. Sleep bruxism (SB) is a masticatory muscle activity during sleep that is characterized as rhythmic (phasic) or nonrhythmic (tonic) and is not a movement disorder or a sleep disorder in otherwise healthy individuals. Given the potentially severe consequences and complications of apnea, the concurrent high prevalence of SB in daily dental practice, getting deeper into the correlation between these phenomena is worthy of interest.. STUDY OBJECTIVES: The aim of this study was to investigate the correlation between SB-related masseter muscle activity (MMA) and apnea-hypopnea events as well as to assess their temporal sequence. METHODS: Thirty (N = 30) patients with sleep respiratory disorders and clinical suspicion of sleep bruxism (SB) were recruited. Ambulatory polygraphic recording was performed to detect apnea-hypopnea events (AHEs) and sleep bruxism episodes (SBEs). Pearson test was used to assess the correlation between apnea-hypopnea index (AHI) and SB index (SBI). A 5-s time window with respect to the respiratory events was considered to describe the temporal distribution of SBEs. Furthermore, SBI was compared between groups of patients with different AHI severity (i.e., mild, moderate and severe) using ANOVA. RESULTS: On average, AHI was 27.1 ± 21.8 and SBI 9.1 ± 7.5. No correlation was shown between AHI and SBI. Most of SBEs (66.8%) occurred without a temporal relationship with respiratory events. Considering OSA, 65.7% of SBEs occurred within 5 s after AHEs, while in the case of central apnea (CA) 83.8% of SBEs occurred before the respiratory event. The participants with severe apnea (N = 9) show a tendency to have higher bruxism indexes when compared to patients with mild (N = 11) and moderate apnea (N = 10). CONCLUSIONS: Findings suggest that: 1. At the study population level, there is no correlation between AHI and SBI, as well as any temporal relationship between SBEs and respiratory events. 2. Specific patterns of temporal relationship might be identified with future studies focusing on the different types of apnea-hypopnea events and bruxism activities.

Short-term variation in the subgingival microbiota in two groups of patients treated with clear aligners and vestibular fixed appliances: A longitudinal study.

OBJECTIVE: To evaluate the subgingival microbiological changes during the first six months of therapy with clear aligners (CAs) and fixed appliances (FAs). The null hypothesis was that there would be no microbiological differences between the two. SETTING/SAMPLE: Two groups of patients to be treated, respectively, with CAs (14 patients; 9 females and 5 males; mean age 21 years ± 0.25) and FAs (13 patients; 8 females and 5 males; mean 14 years ± 0.75) were consecutively recruited. MATERIALS AND METHODS: Subgingival microbiological samples were obtained at the right upper central incisor and right first molar at four different time points: before appliance fitting (T0), and at 1 month (T1), 3 months (T3) and 6 months (T6) thereafter. Total bacterial load (TBL) and counts of the bacteria Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Fusobacterium nucleatum, Campylobacter rectus, Treponema denticola and Tannerella forsythia were determined using real-time PCR. RESULTS: Total bacterial load did not vary in the CA group, while a significant increase was detected after 3 and 6 months of treatment in the FA group. Unlike red complex species, C rectus and F nucleatum were often detected: levels remained stable in the CA group but increased progressively in the FA group. CONCLUSION: The type of orthodontic appliance influences the subgingival microbiota. TBL increased in the FA group but not in the CA group, although the levels of the individual periodontal pathogenic bacteria species did not significantly increase during the observation period.

Dual-section versus conventional archwire for en-masse retraction of anterior teeth with direct skeletal anchorage: a finite element analysis.

BACKGROUND: The aim of this study is to compare the biomechanical effects of the conventional 0.019 × 0.025-in stainless steel archwire with the dual-section archwire when en-masse retraction is performed with sliding mechanics and skeletal anchorage. METHODS: Models of maxillary dentition equipped with the 0.019 × 0.025-in archwire and the dual-section archwire, whose anterior portion is 0.021 × 0.025-in and posterior portion is 0.018 × 0.025-in were constructed. Then, long-term tooth movement during en-masse retraction was simulated using the finite element method. Power arms of 8, 10, 12 and 14 mm length were employed to control anterior torque, and retraction forces of 2 N were applied with a direct skeletal anchorage. RESULTS: For achieving bodily movement of the incisors, power arms longer than 14 mm were required for the 0.019 × 0.025-in archwire, while between 8 and 10 mm for the dual-section archwire. The longer the power arms, the greater the counter-clockwise rotation of the occlusal plane was produced. Frictional resistance generated between the archwire and brackets and tubes on the posterior teeth was smaller than 5% of the retraction force of 2 N. CONCLUSIONS: The use of dual-section archwire might bring some biomechanical advantages as it allows to apply retraction force at a considerable lower height, and with a reduced occlusal plane rotation, compared to the conventional archwire. Clinical studies are needed to confirm the present results.

Smartphone-based application for EMA assessment of awake bruxism: compliance evaluation in a sample of healthy young adults.

OBJECTIVE: A smartphone-based ecological momentary assessment (EMA) strategy to collect real time data on awake bruxism (AB) has been recently introduced. The aim of this study was to assess the compliance with its use over 1 week in a sample of healthy young adults. METHOD: Sixty (N = 60) healthy young adults (mean age 24.2 ± 4.1 years) used a dedicated smartphone application that sent 20 alerts at random times throughout the day. Upon alert receipt, the subjects had to report in real time their condition among five possible options: relaxed jaw muscles, teeth contact, teeth clenching, teeth grinding, and mandible bracing. Compliance rate with the app was assessed at the individual and group level in terms of percentage of answered alerts as well as number of days that were needed to reach the targeted observation period of 7 days with a compliance of at least 60%. RESULTS: The mean compliance recorded with the smartphone application was 67.8% of the total alerts. On average, 9.8 ± 3.2 days (range 7-19) have been necessary to achieve the targeted goal of 7 days with a minimum of 60% alerts/day. No gender differences were detected in any compliance data. Response rate was not different during weekdays or weekends. CONCLUSIONS: This investigation is the first attempt to assess individual compliance with EMA for reporting awake bruxism. Results suggest that a smartphone-based strategy can have interesting potential. The compliance rate reported in this study will serve as a comparison standpoint for future investigations. CLINICAL SIGNIFICANCE: Based on the recent multidisciplinary focus on the study of awake bruxism, EMA has emerged as a potential approach for use in the clinical and research settings. This investigation suggests that compliance with such strategy is good, thus making it worthy of adoption for the assessment of AB and its clinical implications.

Fluorescence-aided composite removal during lingual bracket debonding.

OBJECTIVE: This report describes the fluorescence-aided composite removal during lingual bracket debonding with an ultraviolet light emitting diode flashlight. The purpose of this technique is to help clinicians in composite removal without enamel surface damage. CLINICAL CONSIDERATIONS: The bracket debonding requires clinical attention in order to remove all composites and resins without enamel surface damage. Different protocols can be used in order to minimize the enamel damages and the excess bonding remnants. The fluorescence-aided composite removal permits to have an immediate visualization of the composites and adhesives, especially for the uneven lingual surfaces, of which the interindividual morphological variability is greater than the buccal surfaces. CONCLUSIONS: The fluorescence-aided composite removal during lingual brackets debonding minimizes the risks described in literature and it is an easier, more accurate, reliable, noninvasive, inexpensive, and time-saving method. CLINICAL SIGNIFICANCE: The application of this technique allows, with inexpensive flashlights, to remove all the composite on the lingual surfaces during debonding, without damaging the tooth and saving time.

Analysis of tooth anatomy in adults with ideal occlusion: A preliminary study.

INTRODUCTION: The aim of this study was to investigate the vestibular anatomy of teeth in samples of adult Italian and Mozambican subjects in ideal occlusion and permanent dentition and identify any anatomic characteristics that may influence bonding in the straight-wire technique. METHODS: Linear measurements and coordinates of each curve representing the clinical crown height and width of each tooth were acquired from digital models of each subject categorized to 1 of 2 groups: Italian (18 males, 22 females; mean age, 29.6 ± 5.7 years) or Mozambican (14 males, 15 females; mean age, 23.4 ± 5.9 years). All subjects had normal dentition and no previous orthodontic treatment, fillings, or prostheses. Method error and systematic error were calculated according to the Dahlberg formula (S2 = ∑ d2/2n) and dependent Student t test (P <0.05), respectively. Tooth symmetry was investigated through a paired-samples t test (P <0.05) and sex difference via an independent-samples t test (P <0.05). After neither asymmetry nor sexual dimorphism was found, all data were pooled, inverting the signs of the X coordinates and then mirroring data. Subsequently, a 2-samples t test (P <0.05) and a multivariate cluster analysis were performed on the mirrored data to compare the 2 groups and to identify any within-group diversity for number of clusters for each tooth. Means of all linear measurements and coordinates (crown height and width) calculated for each cluster were reported and compared using a standard 2-samples t test (P <0.05). RESULTS: Two clusters were identified for the maxillary second premolars and molars in Italian subjects, whereas in the Mozambican subjects, there were 2 clusters for the maxillary first premolars and lateral incisors and 3 clusters for the maxillary canines and central incisors. The mandibular arch was remarkably homogeneous, with only 1 cluster per tooth in each group. In the mandibular arch, statistical differences were recorded between ethnic groups in crown height at the central incisors and second molars and in crown width in the sector from the second premolar to the second molar. CONCLUSIONS: There were considerable differences both between and within racial groups in crown height, crown width, and numbers of clusters, which should be taken into account during bonding. Although single-bracket placement guides specific for ethnicity may be feasible for the mandibular arch, the significant diversity in number of clusters in the maxillary arch indicates that more accurate bracket placement guides that take into account such heterogeneity are required.

Does low-frequency vibration have an effect on aligner treatment? A single-centre, randomized controlled trial.

BACKGROUND: Low-frequency vibrations have been proposed as a means of accelerating tooth movement and reducing orthodontic treatment times. OBJECTIVE: To determine any differences in the accuracy of dental movement in patients treated with a low-frequency vibration aligner protocol and/or by reducing the aligner replacement interval with respect to a conventional protocol. DESIGN: This trial was designed as a single-centre, randomized controlled clinical trial. METHODS: Participants: Patients (aged 27.1 ± 9.0 years) who required orthodontic treatment with aligners. Randomization: Patients were randomly allocated to three arms as determined by a computer-randomization scheme. Group A were assigned a conventional protocol (aligners replaced every 14 days); group B also used a low-frequency vibration device for 20 minutes per day; group C followed the same vibration protocol but replaced their aligners every 7 days. Blinding: The operator who performed the set-up and the one who analysed the data were blinded to the group of the patients. Outcome: Pre- and post-treatment digital models were analysed using VAM software to identify the accuracy/imprecision of dental movements. One-way analysis of variance (P < 0.05) and the Bonferroni post hoc test were used to identify any statistically significant differences between the three arms in terms of the accuracy of tooth movement versus the prescription. RESULTS: Numbers analysed: A total of 45 patients (15 for group) were analysed (i.e. 2286 dental movements). Outcome: No statistically significant differences emerged between groups A and C in the upper arch, or among groups A, B, and C in the lower. Group B displayed significantly greater accuracy with respect to group A in upper incisor rotation (P = 0.016), and to group C in vestibulolingual (P = 0.007) and mesiodistal tipping (P = 0.029) of the upper canines, and vestibulolingual tipping of the upper molars (P = 0.0001). Harms: No adverse events or side-effects were registered. CONCLUSIONS: Considering all tooth and movement types of the 45 participants, the mean total imprecision was 2.1 ± 0.9 degrees, with respect to a mean prescription of 5.7 ± 2.2 degrees. There was no difference in accuracy between replacing the aligners accompanied by low-frequency vibration every 7 days and replacing them every 14 days without vibration. Moreover, low-frequency vibration seemed to improve the accuracy of a conventional protocol in terms of upper incisor rotation. TRIAL REGISTRATION: The German Clinical Trials Register (DRK00015613).

Skeletal and dentoalveolar effects of hybrid rapid palatal expansion and facemask treatment in growing skeletal Class III patients.

INTRODUCTION: The purpose of this study was to describe the skeletal and dentoalveolar changes in a group of growing skeletal Class III patients treated with hybrid rapid palatal expansion and facemask. METHODS: Twenty-eight growing patients with skeletal Class III malocclusion were treated using a rapid maxillary expander with hybrid anchorage according to the ALT-Ramec protocol (SKAR III; E.P.), followed by 4 months of facemask therapy. Palatal miniscrew placement was accomplished via digital planning and the construction of a high-precision, individualized surgical guide. Pretreatment and posttreatment cephalometric tracings were analyzed, comparing dental and skeletal measurements. RESULTS: Point A advanced by a mean of 3.4 mm with respect to the reference plane Vert-T. The mandibular plane rotated clockwise, improving the ANB (+3.41°) and the Wits appraisal (+4.92 mm). The maxillary molar had slight extrusion (0.42 mm) and mesialization (0.87 mm). CONCLUSIONS: The use of a hybrid-anchorage expander followed by 4 months of facemask treatment improves the skeletal Class III relationship with minimal dental effects, even in older patients (mean age, 11 years 4 months, ± 2.5 years).