Dental, Skeletal, and Soft Tissue Changes after Bone-Borne Surgically Assisted Rapid Maxillary Expansion: A Systematic Review and Meta-Analysis.

(1) Background: For non-growing patients with marked transverse maxillary deficiency, bone-borne surgically assisted rapid maxillary expansion (SARME) has been proposed as an effective treatment option. Objective: To evaluate the dental, skeletal, and soft tissue changes following bone-borne SARME. (2) Methods: An unrestricted systematic electronic search of six databases, supplemented by manual searches, was performed up to April 2023. The eligibility criteria included prospective/retrospective clinical studies with outcomes pertaining to objective measurements of dental/skeletal/soft tissue effects of bone-borne SARME in healthy patients. (3) Results: Overall, 27 studies satisfied the inclusion criteria. The risk of bias of the non-randomized trials ranged between moderate (20) and serious (4). For the two RCTs, there were some concerns of bias. Trials with outcomes measured at the same landmarks within the scope of the prespecified timeframe were deemed eligible for quantitative synthesis. Eventually, five trials were included in the meta-analysis. SARME was associated with a statistically significant lengthening of the dental arch perimeter immediately after expansion, along with a marginally significant decrease in palatal depth during the post-SARME retention period. Post-treatment SNA values exhibited no statistically significant change. (4) Conclusion: Current evidence indicates that bone-borne SARME constitutes an effective treatment option for adult patients with maxillary transverse deficiency. Further long-term randomized clinical trials with robust methodology, large sample sizes, and 3D evaluation of the outcomes are needed.

Dental treatment of a Seven-Year-Old Child with Mastocytosis.

AIM: Mastocytosis is a rare disorder characterized by pathologic mast cell degranulation. This paper aims to present the dental management of a seven-year-old girl diagnosed with mastocytosis, in a hospital setting, yet without general anesthesia. CASE REPORT: A seven-year-old girl, diagnosed with urticaria pigmentosa, was referred to a dental practice. Her parents' main concern was a possible allergic reaction to local anesthetics and antibiotics. It was decided to perform treatment in the operating theatre of a clinic without general anesthesia. Eight primary teeth were restored. The patient was monitored, and no complications occurred throughout the procedure. Follow-ups performed every three months for two years after treatment. Patient's oral hygiene was improved significantly. CONCLUSION: Collaboration between medical experts, patient's family and the pediatric dentist was crucial. The dentist must be aware of the medical history and potential triggering factors. Due to high probability for life-threatening emergencies, dental treatment in a hospital setting is recommended.

Comparative investigation of fully customized lingual bracket systems and conventional labial appliances: Analysis of forces/moments and final tooth positions.

INTRODUCTION: The assessment of forces and moments generated by fully customized lingual appliances and their effectiveness in tooth movement were compared with conventional labial bracket systems, applied to a specific malocclusion model. METHODS: Two fully customized lingual appliances (Incognito [3M Unitek, Monrovia, Calif] and WiN [DW Lingual Systems, Bad Essen, Germany]) and 2 labial bracket systems (Discovery classic and Discovery smart [Dentaurum, Ispringen, Germany]) were examined with nickel-titanium wires of different cross-sections (0.012, 0.014, 0.016, and 0.016 × 0.022-in) and 3 tooth types (canine, lateral incisor, and second premolar). Simulated movement was performed with a wire replacement as soon as forces or moments were no longer effective. RESULTS: Lingual and labial appliances showed statistically significant differences in initial forces and moments when tested with the same cross-section wires. Statistically significant differences between the 2 lingual bracket systems were also registered. Both lingual appliances rotated the premolar less than the conventional labial appliances. CONCLUSIONS: In areas of smaller lingual interbracket distance and higher lingual slot misalignment, the tested lingual multibracket appliances showed higher forces than the labial appliances. The force difference was particularly prominent with vertically oriented lingual slots and rectangular wires. The tested lingual appliances presented difficulties in rotating the premolar.

Investigation of salivary biomarkers as indicators of skeletal and dental maturity in children.

OBJECTIVE: Estimation of patient's skeletal maturity in orthodontics is essential for the diagnosis and treatment planning. The aim of the study was to investigate the potential use of metabolic fingerprint of saliva for bone growth and tooth development estimation. MATERIALS AND METHODS: Saliva samples from 54 young patients were analysed by an untargeted gas chromatography-mass spectrometry metabolomics-based method. The skeletal maturity was calculated with the cervical vertebrae maturation method, and the dental age was estimated with the Demirjian method. Multivariate analysis and univariate analysis were performed to investigate differences within skeletal, dental and chronological age groups. RESULTS: Metabolomic analysis identified 61 endogenous compounds. Mannose, glucose, glycerol, glyceric acid and pyroglutamic acid levels differentiated significantly with skeletal age (P = .02 to .043), while mannose, lactic acid, glycolic acid, proline, norleucine, 3-aminoisobutyric acid, threonine, cadaverine and hydrocinnamic acid levels differed within the dental age groups (P = .018 to .04); according to the chronological age, only the levels of mannose and 3-hydroxyphenylacetic acid showed variation (P = .029 and .048). The principal component analysis did not manage to highlight differences between the groups of the studied parameters. CONCLUSION: Differentiated levels of mannose, glucose, glycerol, glyceric acid and pyroglutamic acid related to skeletal maturation were identified. According to dental development, the levels of mannose, lactic acid, glycolic acid, proline, norleucine, 3-aminoisobutyric acid, threonine, cadaverine and hydrocinnamic acid differed within the groups, while regarding chronological age, only the levels of mannose and 3-hydroxyphenylacetic acid showed variations. Further studies are required to prove their relation to skeletal and dental development pathway by applying complementary analytical techniques to wider cover the metabolome.

Vertical and Orovestibular Forces Generated by Beta-Titanium and Stainless-Steel Rectangular Wires in Labial and Fully Customized Lingual Bracket Systems.

This study aimed to investigate the force values exerted from rectangular wires when combined with conventional labial and fully customized lingual appliances under predefined, idealized activation. Fully customized lingual brackets of two brands Incognito™ (3M Unitek, Monrovia, CA, USA) and WIN (DW Lingual Systems, Bad Essen, Germany) and labial brackets of another brand, discovery® MIM and discovery® smart systems (Dentaurum, Ispringen, Germany), were chosen. Stainless-steel and beta-titanium wires of 0.018" × 0.025" were examined. For IncognitoTM, 0.0182" × 0.025" beta-titanium wires were tested. Intrusion/extrusion and orovestibular movements were performed in a range of 0.2 mm, and the forces were recorded for each 0.1 mm of the movement. Mean values and standard deviations were calculated for all measurements, and ANOVA was performed for statistical analysis. Slight differences were observed between the forces generated from beta-titanium and stainless-steel wires. The same wire generated in some cases 5-53% higher forces with the lingual appliance due to the vertical orientation of the long walls during intrusion/extrusion and increased wire stiffness at the anterior region. Beta-titanium and stainless-steel 0.018" × 0.025" wires can generate similar force values during the final stages of the orthodontic therapy; thus, possibly only one of the two alloys could be used in each orthodontic wire sequence.

Upper airway volumetric changes of obstructive sleep apnoea patients treated with oral appliances: a systematic review and meta-analysis.

BACKGROUND: Obstructive sleep apnoea (OSA) is a common sleep-related breathing disorder, attributed to the collapse of the pharyngeal walls and the subsequent complete or partial upper airway obstruction. Among different treatment options for OSA, Continuous Positive Airway Pressure, and oral appliances (OAs) have been used, with various outcomes and side effects. OBJECTIVE: The aim of this study was to summarize current knowledge in an evidence-based manner regarding the upper airway volume increase of OSA patients while treated with OAs. SEARCH METHODS: Electronic search was conducted in Pubmed, Cochrane Library, and Scopus, up to May 2020. SELECTION CRITERIA: Studies were selected after the application of predetermined eligibility criteria. DATA COLLECTION AND ANALYSIS: Mean airway volume differences and the corresponding 95% confidence intervals were calculated, using the random effects model. Sensitivity, exploratory, and meta-regression analyses were also implemented. RESULTS: Eleven studies filled the inclusion criteria and were included in the systematic review, while 10 of them were suitable for meta-analysis. In total, 291 patients were included, with mean upper airway volume increase of 1.95 cm3 (95% CI, 1.37-2.53; P < 0.001) with Mandibular Advancement Devices in place. In all studies, post-treatment Apnea Hypopnea Index (AHI) was either <10 events/hour or was reduced by more than 50% from baseline levels. A greater increase of the velopharynx volume was observed, regarding airway compartments. CONCLUSIONS: Treatment with OAs in OSA may lead to a significant increase of the upper airway volume with a subsequent decrease of AHI. The velopharynx seems to be affected the most from OA therapy.

NAM Therapy-Evidence-Based Results.

Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

Dentoalveolar characteristics in children with juvenile idiopathic arthritis.

PURPOSE: Juvenile idiopathic arthritis (JIA) is an autoimmune disease with multiple potential causal factors. In case of temporomandibular joint (TMJ) affection, the inflammatory reaction can result in restricted mandibular growth with implied skeletal and facial deformities. Aim of the present study was to examine dentoalveolar and occlusion characteristics in children with JIA. PATIENTS AND METHODS: The sample consisted of 66 children (27 boys, 39 girls) with JIA. Thirty-three of them showed unilateral or bilateral condylar destruction, while the other half did not manifest any TMJ involvement. Corresponding dental casts of these patients were evaluated and Angle classification, overjet, overbite, crossbite, crowding, and ectopic teeth were registered. All dental casts were subsequently scanned and digitized to analyze 26 additional variables. Subgroups according to sex and condylar affection were formed. Statistical analysis was performed using Fisher's least significant difference (LSD) post hoc test of analysis of variance (ANOVA). RESULTS: The prevalence of Class II, division 1 malocclusion in this JIA sample was high (28.8%). Compared to girls, boys had significantly greater dental arch widths and lengths. The group with bilateral condylar affection had significantly decreased lower arch length and increased irregularity index (p < 0.035) compared to the non-affected group. CONCLUSIONS: Bilateral condylar involvement in children with JIA seems to reduce the lower arch length, while increasing the irregularity index of the lower front teeth.

Craniofacial morphology and dental maturity in children with reduced somatic growth of different aetiology and the effect of growth hormone treatment.

Children with reduced somatic growth may present various endocrinal diseases, especially growth hormone deficiency (GHD), idiopathic short stature (ISS), chromosomal aberrations, or genetic disorders. In an attempt to normalize the short stature, growth hormone (GH) is administered to these children. The aim of this literature review was to collect information about the craniofacial morphology and dental maturity in these children and to present the existing knowledge on the effect of GH treatment on the above structures.This review demonstrated that regardless of the origin of the somatic growth retardation, these children show similar craniofacial features, such as short length of the cranial base and the mandible, increased lower facial height, retropositioned mandible, and obtuse gonion angle. On the other hand, dental maturation does not demonstrate a specific pattern. Except for the above findings, muscle alterations seem to be present in individuals with short stature, who present low body muscle mass and strength, while studies on their craniofacial muscles seem to be lacking. After GH administration, the exact amount and pattern of craniofacial growth is unpredictable; however, the facial convexity decreases, mandibular length increases, and posterior facial height increases, while tooth eruption remains unaffected. Thus, it is of great importance to gain more insight into the craniofacial growth of treated and untreated children with reduced somatic growth so that the influence of GH therapy on the various craniofacial structures could be ascertained and proper orthodontic treatment could be selected.

The'SOS activator:'A Novel Functional Device Combined with Fixed Appliances for the Correction of Class II Malocclusion.

The aim of this paper is to present a new functional appliance named 'SOS activator. 'It is a modified removable headgear-activator type of appliance, which is indicated in growing skeletal Class II cases with mandibular retrusion and can be combined with banded (Quad-Helix, Hyrax, TPA) and bonded fixed appliances in the upper arch. This device can concurrently correct sagittal, vertical, and transversal discrepancies allowing the active expansion of the upper dental arch and the alignment of the upper teeth, while providing maximum anchorage or even distal movement of the upper first molars and exerting a restraining effect on the maxilla. The use of this appliance eliminates the need for a first phase of therapy and shortens treatment duration. In clinicalpraxis the 'SOS activator' has been used until now for the treatment of hundreds ofpatients and seems to be a reliable method of choice for the correction of Class II malocclusions with a retrognathic mandible, while presenting many advantages compared to other functional appliances. In this paper, the technical characteristics, the construction details, and the method of action of the new device are analyzed Furthermore, a treated case with this method is presented.

Comparative analysis of numerical and experimental data of orthodontic mini-implants.

The purpose of this study was to compare numerical simulation data derived from finite element analysis (FEA) to experimental data on mini-implant loading. Nine finite element (FE) models of mini-implants and surrounding bone were derived from corresponding experimental specimens. The animal bone in the experiment consisted of bovine rib. The experimental groups were based on implant type, length, diameter, and angle of insertion. One experimental specimen was randomly selected from each group and was digitized in a microCT scanner. The FE models consisted of bone pieces containing Aarhus mini-implants with dimensions 1.5 × 7 mm and 1.5 × 9 mm or LOMAS mini-implants (dimensions 1.5 × 7 mm, 1.5 × 9 mm, and 2 × 7 mm). Mini-implants were inserted in two different ways, perpendicular to the bone surface or at 45 degrees to the direction of the applied load. Loading and boundary conditions in the FE models were adjusted to match the experimental situation, with the force applied on the neck of the mini-implants, along the mesio-distal direction up to a maximum of 0.5 N. Displacement and rotation of mini-implants after force application calculated by FEA were compared to previously recorded experimental deflections of the same mini-implants. Analysis of data with the Altman-Bland test and the Youden plot demonstrated good agreement between numerical and experimental findings (P = not significant) for the models selected. This study provides further evidence of the appropriateness of the FEA as an investigational tool in relevant research.

Effect of mini-implant length and diameter on primary stability under loading with two force levels.

Mini-implants are widely utilized as anchorage units in orthodontic treatment. Nevertheless, there are factors that interfere with their clinical performance. The aim of this study was to examine the impact of length and diameter on the primary stability of two different types of orthodontic mini-implants loaded with two force levels. A total of 90 self-drilling mini-implants were inserted in bovine ribs in vitro, 62 of which were used in data analysis. The mini-implants were of two types, Aarhus (n=29) and Lomas (n=33), of two lengths (7 and 9 mm, n=26 and n=28, respectively), and of two diameters (1.5 and 2 mm, Lomas only, n=6 and n=8, respectively). A closed nickel-titanium (NiTi) coil spring was attached to each mini-implant. Half of the preparations were loaded with a low force of 0.5 N and the other half with a force of 2.5 N. Mini-implant deflections during force application were non-invasively registered using a three-dimensional (3D) laser-optical system. The results were analysed with analysis of variance for the effects of implant type, implant length, and force level, and with a t-test for the study of the effect of diameter in two different diameter variants of the same (Lomas) implant. In the low-force group, implant displacements were not statistically significant difference according to the investigated parameters. In the high-force group, the 9 mm long mini-implants displaced significantly less (10.5±7.5 µm) than the 7 mm long (22.3±11.3 µm, P<0.01) and the 2 mm wide significantly less (8.8±2.2 µm) than the 1.5 mm implants (21.9±1.5 µm, P<0.001). The force level at which significance occurred was 1 N. The rotation of the Lomas mini-implants in the form of tipping was significantly higher than that of the Aarhus mini-implants at all force levels. Implant length and diameter become statistically significant influencing parameters on implant stability only when a high force level is applied.

Geometric morphometric evaluation of cervical vertebrae shape and its relationship to skeletal maturation.

INTRODUCTION: Cervical vertebrae shape has been proposed as a diagnostic factor for assessing skeletal maturation in orthodontic patients. However, evaluation of vertebral shape is mainly based on qualitative criteria. Comprehensive quantitative measurements of shape and assessments of its predictive power have not been reported. Our aims were to measure vertebral shape by using the tools of geometric morphometrics and to evaluate the correlation and predictive power of vertebral shape on skeletal maturation. METHODS: Pretreatment lateral cephalograms and corresponding hand-wrist radiographs of 98 patients (40 boys, 58 girls; ages, 8.1-17.7 years) were used. Skeletal age was estimated from the hand-wrist radiographs. The first 4 vertebrae were traced, and 187 landmarks (34 fixed and 153 sliding semilandmarks) were used. Sliding semilandmarks were adjusted to minimize bending energy against the average of the sample. Principal components analysis in shape and form spaces was used for evaluating shape patterns. Shape measures, alone and combined with centroid size and age, were assessed as predictors of skeletal maturation. RESULTS: Shape alone could not predict skeletal maturation better than chronologic age. The best prediction was achieved with the combination of form space principal components and age, giving 90% prediction intervals of approximately 200 maturation units in the girls and 300 units in the boys. Similar predictive power could be obtained by using centroid size and age. Vertebrae C2, C3, and C4 gave similar results when examined individually or combined. C1 showed lower correlations, signifying lower integration with hand-wrist maturation. CONCLUSIONS: Vertebral shape is strongly correlated to skeletal age but does not offer better predictive value than chronologic age.

Nasolabial appearance in unilateral cleft lip, alveolus and palate: a comparison with Eurocleft.

OBJECTIVE: To evaluate nasolabial appearance of patients with UCLAP treated in Nijmegen and to compare them with those from six other individual centers from the Eurocleft study. Relationships between nasolabial aesthetics, dental arch relationships and cleft width at birth were also investigated. PATIENTS: Children of Caucasian origin with complete UCLAP (n=42 consecutive cases) from the Nijmegen Cleft Palate Unit, The Netherlands. METHODS: Nasolabial appearance was assessed by applying an aesthetic index and subsequently compared with the six-centre Eurocleft study. Cleft width at birth was measured on maxillary plaster casts. RESULTS: The 90% central range for the overall aesthetic rating of the 42 Nijmegen patients is 2.0-3.7 on a scale from 1 to 5 (1=very good nasolabial appearance, 5=very poor nasolabial appearance). With regard to the overall aesthetic rating, Nijmegen showed similar treatment outcomes with Eurocleft centres A, D, E and F. Nijmegen scored significantly better than Eurocleft centre C and significantly worse than Eurocleft centre B (p