Three-dimensional evaluation of rapid maxillary expansion anchored to primary molars: direct effects on maxillary arch and spontaneous mandibular response.

AIM: The purpose of this study was to evaluate the effects of rapid maxillary expansion (RME) on maxillary and mandibular arch in the mixed dentition. MATERIALS AND METHODS: Forty-four consecutive patients with transverse maxillary deficiency were recruited. Test group: 21 patients (10 male, 11 female; 7.4 ± 1.2 years) who underwent RME (Haas type) therapy banded on the primary second molars. CONTROL GROUP: 17 patients (10 male, 7 female; 7.3 ± 1.1 years old) who did not receive any orthodontic treatment. Dental casts obtained pre-treatment and after appliance removal (11 months) were processed by means of a three-dimensional scanner (3Shape D250 laser, DK). Digital landmarks were traced using the VAM software (Canfield Scientific Inc., Fairfield-NJ, USA). Arch Length, interdental width and torque differences were measured before and after the removal of the appliance. The t-test (P<0.05) for paired data was applied to evaluate the measurements values before and after treatment. The linear regression model was employed to assess the correlations between treatment effects. RESULTS: The efficacy of the RME was confirmed both on maxillary and mandibular arch. Mandibular intermolar width (+2.02 mm) together with primary intermolar (+1.39 mm), intercanine width (+0.95mm) and torque variations significantly increased. The untreated control group showed no significant statistical differences between T0 and T1. The linear regression between maxillary and mandibular data showed correlations between the torque of the teeth 16/46 and 65/85 (P<0.05). CONCLUSIONS: RME anchored on primary molars is an effective treatment option to correct tranverse maxillary deficiencies. All the measurements increased significantly confirming the indirect effect of RME on the mandibular arch.

Comparison between RME, SME and Leaf Expander in growing patients: a retrospective postero-anterior cephalometric study.

AIM: The aim of this study is to compare the dental and orthopaedic effects of the Leaf Expander with rapid and slow maxillary expanders. MATERIALS AND METHODS: The sample comprised 30 patients with a posterior crossbite divided into three groups: the rapid maxillary expander (RME) group (3 m, 7 f), average age 8.9 years; the slow maxillary expander (SME) group (7 m, 3 f) average age 12.2 years; the Leaf Expander (LE) group (7 m, 3 f), average age 7.9 years. Postero-anterior cephalometric studies have been obtained at the beginning of the therapy (T1) and after 9 months (T2). Nasal width, maxillary width, mandibular width, upper permanent molars width have been measured by a calibrated examiner. RESULTS: All the measurements increased significantly after the treatment (paired t-test P=0.05). Maxillary average width increased of 4.2 mm (SD 3.6 mm) in RME; + 2.8 mm (SD 2.8 mm) in RSE and +3.6 mm (SD 2.2 mm) in LE group. Upper permanent molars width increased: + 5.4 mm (SD 3.31 mm) in RME; + 5.4 mm (SD 3.3 mm) in SME and + 3.8 mm (SD 2.1 mm) in LE group. No statistical differencesbetween the groups have been found (t-student test P=.05). CONCLUSIONS: The effectiveness of the LE in transversal deficiency correction has been confirmed.

Presence of Legionella spp. in human dental plaque.

AIMS: The aim of this research is to verify the presence of Legionella in human dental plaque. METHODS: 65 adult patients not treated with systemic or local antibiotics at least 2 months before the time of sample collection were enrolled for plaque collection between September 2015 and December 2016. A brief questionnaire about lifestyle and health risks was administered. Legionella spp. detection has been executed by semi- nested PCR. RESULTS: 8 out of 65 plaque samples (12.3%) were positive for Legionella spp. As regards health risks and lifestyle aspects, no relevant difference was observed between patients involved in our study, except for two positive patients who have reported a COPD ongoing and a pneumonia in the past. CONCLUSIONS: This study represents a step forward in the knowledge of reservoirs of the microorganism and richness of oral microbiota.

Space-maintaining management in maxillary sinus lifting: a novel technique using a resorbable polymeric thermo-reversible gel.

Several techniques have been proposed to achieve sinus floor elevation and the formation of new bone through the grafting of autologous, heterologous, or alloplastic materials. The grafted materials act as a scaffold for bone formation inside the maxillary sinus. This study investigated a non-graft sinus lifting procedure using a resorbable polymeric thermo-reversible gel. A space-maintaining approach to sinus lifting, using a resorbable polymeric thermo-reversible gel, was applied in 11 patients undergoing implant treatment in the atrophic posterior maxilla. After a healing period of 6 months, a total of 14 implants were placed; biopsies were taken and evaluated histologically and histomorphometrically. The parameters evaluated included the percentages of new bone formation, residual gel, and fibrous tissue. Histological examination showed the formation of new bone with no fibrous tissue or severe inflammatory cellular infiltration. The percentage of newly formed bone was in the range of 54-60%; this consisted of both lamellar and woven bone. No foreign-body reaction was observed. The mean quantities of both residual gel and connective tissue were small. This non-graft sinus lifting procedure using a space-maintaining gel appears to stimulate predictable bone formation; it is thus a useful technique for promoting bone formation in the sinus.

Transverse maxillary deficit and its influence on the cervical vertebrae maturation index.

AIM: The aim of this study is to evaluate whether a transverse maxillary deficit can cause an alteration of vertebral development and therefore of the skeletal maturation comparing the cervical maturation stages index with the hand-wrist index. MATERIALS AND METHODS: For the study were selected 200 patients aged 7-14 years, equally distributed by gender and divided into 100 study subjects with maxillary deficit and 100 controls without maxillary deficit. The skeletal maturation index (SM according to Fishman) was evaluated and compared with the hand-wrist x-rays and the cervical vertebrae maturation (CVM according to Hassel and Farmann). RESULTS: Forty-one per cent of the subjects in the test group show a discrepancy between CVM and SM. Among these 73% (30 subjects) present an advanced stage of CVM compared with the corresponding SM. Only 16% of the subjects in the control group show a discrepancy between CVM and SM. Among these 69% (11 subjects) appear in an advanced CVM stage. CONCLUSION: The analysis of the CVM stage in subjects with transverse maxillary deficit appears to be altered compared with the SM identified through a hand-wrist x-ray. In the case of individuals with transverse maxillary deficit it is advisable to use also a hand-wrist x-ray, thus not relying only on CVM for the evaluation of the skeletal growth stages.

Sphenofrontal distance on three-dimensional ultrasound in euploid and trisomy-21 fetuses at 16-24 weeks' gestation.

OBJECTIVE: To compare the distance between the sphenoid and frontal bones on three-dimensional (3D) ultrasound in euploid and trisomy-21 fetuses at 16-24 weeks' gestation. METHODS: We acquired 3D volumes of the fetal profile from 80 normal and 30 trisomy-21 fetuses at 16-24 weeks' gestation. We used the multiplanar mode to obtain the mid-sagittal plane and measured the sphenofrontal distance as the shortest distance between the most anterior edge of the sphenoid bone and the lowest edge of the frontal bone. RESULTS: In normal fetuses, the sphenofrontal distance increased linearly with gestational age, from 15.1 mm at 16 weeks to 18.2 mm at 24 weeks. In fetuses with trisomy 21, the mean sphenofrontal distance delta value was significantly smaller than in normal cases (-3.447 mm (95% CI, -5.684 to -1.211 mm); P < 0.01). The sphenofrontal distance was below the 5(th) and 1(st) percentiles of the normal range in 29 (96.7%) and 27 (90.0%) trisomy-21 fetuses, respectively. CONCLUSIONS: The sphenofrontal distance is shorter at 16-24 weeks' gestation in fetuses with trisomy 21 than in normal fetuses. A reduction in the growth of the anterior cranial base contributes to the mid-facial hypoplasia observed in fetuses with trisomy 21. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Correlation between salivary and serum oxidized LDL levels: a pilot study on overweight/obese subjects.

BACKGROUND: Saliva contains a variety of substances and could be functionally equivalent to serum in reflecting the physiological state of the body, including metabolic variations. Salivary samples are non-invasive, safe, and easier to handle than serum. Oxidized LDL cholesterol (oxLDL) is an additional cardiovascular risk factor playing an important role in atheromatous plaque formation; overweight/obese subjects present an increase in oxLDL concentrations. The aims of the study were to assess oxLDL salivary levels, if detectable, and to verify their possible correlation with serum in overweight/obese subjects. METHODS: Thirty-five consecutive overweight/obese subjects and 10 normal weight controls were enrolled. Serum and salivary oxLDL levels were measured by a commercial enzyme-linked-immunosorbent assay (ELISA method). RESULTS: oxLDL levels were detectable in salivary samples and correlated (P = 0.001) with serum levels. Overweight/obese subjects showed serum and salivary oxLDL levels higher than controls (P = 0.000 and P = 0.022, respectively). CONCLUSIONS: Our study showed the presence of oxLDL in salivary samples and highlighted a correlation between salivary oxLDL levels and their counterpart in serum. Moreover, salivary oxLDL levels were higher in overweight/obese subjects than in controls. Therefore, a salivary sample could be functionally equivalent to serum in monitoring cardiovascular risk in overweight/obese subjects.

Relationship between mandibular second molar calcification stages and cervical vertebrae maturity in Italian children and young adults.

AIM: The aim of this study was to investigate the relationship between the stages of calcification of the mandibular second molar and the stages of skeletal maturity among Italian children and young adults. MATERIALS AND METHODS: Cross-sectional descriptive study. The samples were derived from panoramic radiographs and lateral cephalograms of 500 Italian subjects aged from 10 to 20 years. Dental maturity index (DM) was assessed by calcification stages of the mandibular second molars according to the Demirjian method; skeletal maturity was evaluated with cervical vertebrae maturation index (CVM) according to Hassel and Farman. The Pearson r coefficient and Spearman rank correlation coefficient were estimated to determine the relationship between DM and CVM. RESULTS: Skeletal maturation stages occurred earlier in females (about 6 months). A highly significant correlation between CVM and DM (0.78-0.86 cor according to Pearson test and 0.81-0.85 rho according to Spearman test) was found. DM stage E corresponds to phase CVM 1 and 2 (the phase prior to the growth spurt), DM stage F corresponds to the phase of pubertal growth spurt, stages CVM 2 and CVM 3; DM stage G is indicator of the growth spurt underway (CVM 3-4), but it can still be found during CVM 5 in females. CONCLUSION: The second mandibular molars can be considered reliable indicators for the evaluation of the growth phases. In case of females the end of the growth spurt it is not clearly associated with a dental maturity stage and needs to be stated with further parameters such as CVM.

Tooth developmental anomalies in severe combined immunodeficiency disease and juvenile myelomonocytic leukemia: common clinical features and treatment outcomes.

AIM: Human Severe Combined Immunodeficiency (SCID) is a prenatal disorder of T lymphocyte development that depends on the expression of numerous genes. Juvenile myelomonocytic leukemia (JMML), previously known as juvenile chronic myeloid leukemia (JCML), is a rare, myelodysplastic/myeloproliferative disease typically presenting in early childhood. CASE REPORTS: Two cases are described of immunodeficiency disorders, both treated with chemotherapeutic drugs (Busulfan plus cyclophosphamide) before bone marrow transplantation. After treatment, these two different cases showed several similar oral lesions: microdontia, root alterations, numerous tooth ageneses, incomplete calcification, enamel hypoplasia, premature apexification and hypodontia. Both subjects underwent dental and orthodontic treatment. The first phase comprised orthopaedic treatment using a removable appliance (Interim-G®) followed by rapid palatal expansion; in the second phase patients underwent tooth extraction and were treated using fixed appliances for 19 and 26 months, respectively (mean 2 years) to obtain final alignment and maximum intercuspation. In the third and final phase, reconstruction of malformed teeth was completed, and implant-supported protheses were applied. CONCLUSION: The difficulties of managing and treating these diseases are discussed, with particular focus on tooth anomalies and malocclusion disorders. Collaboration between dentist and paediatrician in dealing with patients with a variety of oral lesions and tooth anomalies is important in order to prevent any other possible tooth lesions and ensure correct jaw development.

Three-dimensional changes of the upper airway in patients with obstructive sleep apnea syndrome after a non-adjustable oral appliance treatment.

The diagnosis, the therapy and the monitoring of the obstructive sleep apnea syndrome (OSAS) are to be considered as critical factors in order to prevent severe systemic complications that can be caused by this pathological condition. This work presents three cases of adult patients affected by OSAS, undergoing therapy with oral appliances (OAs), meant to remove the pharyngeal obstruction caused by mandibular retrusion and tongue collapse in nocturnal supine position. The aim of this work was to evaluate the effect of the OAs both through the comparison of the polysomnographic analysis, in the presence and absence of the appliance in situ, and also through the volumetric measurements of the pharingeal airway thanks to the cone beam computed tomography.