High prevalence of orofacial pain in juvenile fibromyalgia as detected by a novel tool specifically devised for children and adolescents.

OBJECTIVES: To examine the prevalence of temporomandibular disorders (TMD) in patients with juvenile fibromyalgia syndrome (JFS) and identify TMD characteristics specifically associated to JFS. METHODS: Signs and symptoms of TMD were assessed using a novel clinical tool specifically devised for children that consists of: 1. a self-report multiple-choice questionnaire; 2. a protocol for the clinical examination of the orofacial region. Multivariate logistic regression model was used to identify TMD features associated with JFS. RESULTS: Thirty JFS patients (median age 15.5 years) and 45 healthy controls (median age 15.0 years) were included in this cross-sectional study. Orofacial pain was reported by 26 of 30 JFS patients (86.7%) and by 3 of 45 controls (6.7%; p<0.001). Pain on TMJ palpation was present in 18 of 30 JFS patients (60%) and in 5 of 45 controls (11.1%; p<0.001). Median values of maximum spontaneous mouth opening, voluntary active opening and assisted passive opening were significantly higher in JFS patients than in controls. On multiple regression analysis spontaneous orofacial pain (OR: 21.0; p=0.005), diffuse tenderness on palpation of the masticatory muscles (OR: 14.9; p=0.026) and TMJ hypermobility (OR 1.42; p=0.008) were independently associated with JFS. CONCLUSIONS: The high prevalence of TMD in JFS highlights the need for a broader interdisciplinary evaluation of JFS patients. TMJ hypermobility, in addition to orofacial and masticatory muscle pain, is an important clue for the diagnosis of TMD in adolescents with JFS. Elucidating the link between these disorders will advance individualised management and improve treatment efficacy.

Timing considerations on the shear bond strength of orthodontic brackets after topical fluoride varnish applications.

OBJECTIVES: To assess the best temporal association between the application of a fluoride varnish on enamel and bonding procedures. MATERIALS AND METHODS: Eighty mandibular bovine incisors were used. Teeth were divided into 4 groups (20 per group); Groups 1-3 were treated with fluoride varnish (Fluor Protector, Ivoclar Vivadent, Schaan, Liechtenstein), and Group 4 served as control with no pretreatment. Tooth were stored in deionized water (37°C) and subjected to thermal cycling for 400 (Group 1), 800 (Group 2), and 2500 (Group 3) cycles corresponding, respectively, to 15, 30, and 90 days in order to simulate the three different timing of bracket bonding. Shear bond strength (SBS) was measured using an Instron Universal Testing machine. Tooth surfaces were examined under a stereomicroscope at 10× magnification to assess the amount of adhesive remnant index (ARI). One-way analysis of variance (ANOVA) and Tukey's honestly significant difference post-hoc test were used for the comparison of SBS values between groups (P < 0.05). The Chi-square test was used to examine differences among ARI scores. (P < 0.05). RESULTS: One-way ANOVA and Tukey post-hoc test showed that the SBS of different groups were significantly different and was impacted by different timing of bonding (P < 0.05). The main differences were between the control group (17.02 ± 6.38 MPa) and Group 1 (6.93 ± 4.3 MPa). The ARI scores showed that there were no significant differences between the four tested groups. CONCLUSIONS: The SBS of the brackets bonded 15 days after the application of the fluoride was set back to an optimal value.

Reconstruction and rehabilitation of severe mandibular atrophy using distraction osteogenesis technique: a case report.

PURPOSE: The purpose of this article is to describe a rehabilitation technique for patients with severe anterior atrophy using a combination of distraction osteogenesis and implants to support fixed or removable prostheses. MATERIALS AND METHODS: The surgical technique involves the use of an extraosseous distraction device followed by more than 14 mm of distraction of the mandibular symphysis. RESULTS: The patient was successfully treated by the application of 4 implants in the region of the mandibular symphysis, stabilized by an Ackerman bar, and a removable prosthesis. CONCLUSION: Osseous distraction techniques, when possible, are preferable to block bone grafting techniques because they present considerable advantages for patients and surgeons. The combination of distraction and implant placement can rehabilitate patients with severe defects.

Early diagnostic evaluation of mandibular symmetry using orthopantomogram.

AIMS: The aim of this research was to complete Habets's method on orthopantomogram, in order to measure mandibular symmetry horizontally and diagonally in mixed dentition as the first diagnostic evaluation. SETTINGS AND DESIGN: Mixed dentition subjects were consecutively selected according to skeletal maturity. MATERIALS AND METHODS: Inclusion criteria were: Mixed dentition, cervical vertebral stages 1-2, Class II or Class III malocclusions, with or without unilateral posterior cross-bite. Fourteen subjects with cross-bite (mean age 8 y, 9 m) cross group (CG) and 14 subjects with normal transverse occlusion (mean age 8 y, 6m) non-cross group (NCG) were selected. Nine measurements were determined. An asymmetry index was performed for all linear variables. STATISTICAL ANALYSIS USED: NCG patients' data were compared with CG data using parametric t-tests. Probabilities of <0.05 were accepted as significant. RESULTS: In CG, comparing right and left side, single values showed no significant differences up to 6% (twice if compared to the 3% threshold value). T-tests showed statistically significant differences between the groups for ramus + condyle height (index 2.5% vs 4.5%, P = 0.04), condylar height (index 3.7% vs 6.6%, P = 0.02) and mandibular length (index 1.4% vs 2.3%, P = 0.04). Overall CG group was more asymmetrical than NCG. CONCLUSIONS: In mixed dentition (CS1-2), a first appraisal of mandibular symmetry may be performed on orthopantomogram utilizing this modified Habets's method. This tracing method provides an early evaluation about mandibular symmetry and is able to show slight asymmetries in mixed dentition thereby reducing the number of cone beam computed tomograms performed.

Surgical orthodontic treatment of an impacted canine in the presence of dens invaginatus and follicular cyst.

Introduction. "Dens invaginatus" is a dental anomaly which originates from the invagination of the ameloblastic epithelium into the lingual surface of the dental crown during the odontogenesis. It can cause early pulpal necrosis, abscesses, retention or dislocation of contiguous elements, cysts, and internal resorptions. It normally affects the upper lateral incisors. In the following study the authors will discuss the etiology, the physiopathology, and the surgical-orthodontic management of a rare case of impacted canine associated with dens invaginatus and follicular cyst, with the aim of highlighting the importance of taking any therapeutic decision based on the data available in the literature. Case Report. The present study describes a combined surgical-orthodontic treatment of an impacted canine associated with a lateral incisor (2.2) suffering from type III dens invaginatus with radicular cyst, in a 15-year-old patient. Discussion. When treating a dens invaginatus there are different therapeutic solutions: they depend on the gravity of the anomaly and on the association with the retention of a permanent tooth. The aesthetic and functional restoration becomes extremely important when performing a surgical-orthodontic repositioning.

Microcomputed tomographic analysis of bone reaction at insertion of orthodontic mini-implants in sheep.

PURPOSE: To evaluate the effects on bone of forced insertion of self-tapping orthodontic mini-implants and thus obtain biomechanical data to develop insertion protocols and optimize drills for implant site preparation. MATERIALS AND METHODS: After implant site preparation, 39 orthodontic mini-implants (OMI), 1.6 x 7.5 mm each, were inserted into the hard bone of sheep mandible; 24 were placed with a 1-mm bone drill and 15 were placed with a standard-diameter (1.2-mm) drill. Removal torque was measured immediately (group A) and 8 weeks after insertion (group B). Eight OMIs (group C) were removed from the mandible in block sections of appropriate size for microcomputed tomographic morphometric and morphologic analyses. RESULTS: All OMIs were placed without complications, with mean insertion torque of 17.625 (± 1.71) Ncm (test groups) and 17.70 (± 1.41) (control groups) and were stable at reentry. Group A implants showed a reduction in removal torque of 5.66%, while in group B, removal torque was reduced by 43.25%. In the control groups (ie, OMIs placed with a 1.2-mm drill), removal torque immediately after placement was reduced by 5.64%, and 8 weeks after insertion, removal torque had declined by 18.2%. Microcomputed tomographic bone morphometric analysis for both test and control groups showed that bone-implant contact was lower than expected in cortical bone 8 weeks after insertion. Morphologic analysis revealed cavities in the cortical bone close to the surface and microcalli in soft bone. Cavities in the cortical bone may have been caused by bone trauma during insertion. CONCLUSIONS: The use of a narrow drill for site preparation increased orthodontic screw insertion torque, but it also damaged the bone and decreased removal torque. Standard histologic examination may clarify whether cavities in hard bone are actually signs of bone resorption that results from the activation of remodeling.