Premature loss of primary molars in children: space recovery through molar distalisation. A literature review.

AIM: The integrity of primary dentition is essential in the development of the jaws and permanent occlusion. The consequences of a premature loss of primary molars are: space loss, crowding, risk of impaction of the permanent teeth, ectopic eruption, anomalous inclination of the teeth adjacent to the loss molar, reduction of arch length. The mesial displacement of the posterior permanent teeth during eruption can cause a loss of space, which can be regained with orthodontic appliances. Therefore, a careful diagnosis is of great importance to be able to decide what appliance is indicated to recover from this situation. Molar distalisation consists in displacing permanent molars distally, allowing them to reach class I relationship and to recover the correct space for the second bicuspids when the second deciduous molar has been lost early. METHODS: The aim of this study is to carry out a narrative literature review regarding the different appliances and their effectiveness in regaining space after premature loss of the upper primary molars. CONCLUSION: The paediatric dentist should be aware of the advantages and disadvantages related to each device and select the most appropriate distalisation appliance based on an individual plan of diagnosis and a careful treatment. The distalisation of the upper molar must be adequately stabilised and so it is important to consider also some retainers such as Nance's appliance, the Palatal Plate, the extraoral traction, the utility arch, or II Class elastic bands.

Extended nodal radiotherapy for prostate cancer relapse guided with [11C]-choline PET/CT: ten-year results in patients enrolled in a prospective trial.

AIMS: To report long-term outcomes of relapsed prostate cancer (PC) patients treated in a prospective single-arm study with extended-nodal radiotherapy (ENRT) and [11C]-choline positron emission tomography (PET)/computed tomography (CT)-guided simultaneous integrated boost (SIB) to positive lymph nodes (LNs). METHODS: From 12/2009 to 04/2015, 60 PC patients with biochemical relapse and positive LNs only were treated in this study. ENRT at a median total dose (TD) = 51.8 Gy/28 fr and PET/CT-guided SIB to positive LNs at a median TD = 65.5 Gy was prescribed. Median PSA at relapse was 2.3 (interquartile range, IQR:1.3-4.0) ng/ml. Median number of positive LNs: 2 (range: 1-18). Androgen deprivation therapy (ADT) was prescribed for 48 patients for a median of 30.7 (IQR: 18.5-43.1) months. RESULTS: Median follow-up from the end of salvage treatment was 121.8 (IQR: 116.1, 130.9) months; 3-, 5-, and 10-year BRFS were 45.0%, 36.0%, and 24.0%, respectively; DMFS: 67.9%, 57.2%, and 45.2%; CRFS: 62.9%, 53.9%, and 42.0%; and OS: 88.2%, 76.3%, and 47.9%, respectively. Castration resistance (p < 0.0001) and ≥ 6 positive LN (p = 0.0024) significantly influenced OS at multivariate analysis. Castration resistance (p < 0.0001 for both) influenced DMFS and CRFS in multivariate analysis. CONCLUSIONS: In PC relapsed patients treated with ENRT and [11C]-choline-PET/CT-guided SIB for positive LNs, with 10-year follow-up, a median Kaplan-Meier estimate CRFS of 67 months and OS of 110 months were obtained. These highly favorable results should be confirmed in a prospective, randomized trial.

Continuous and near real-time measurements of gaseous elemental mercury (GEM) from an Unmanned Aerial Vehicle: A new approach to investigate the 3D distribution of GEM in the lower atmosphere.

We present the first real attempt to directly and continuously measure GEM through a Lumex RA-915 M, designed for real-time detection of mercury vapor, mounted on an UAV (Unmanned Aerial Vehicle, namely a heavy-lift octocopter), inside and outside the former Hg-mining area of Abbadia San Salvatore (Mt. Amiata, Italy), known as a GEM source. We tested the effectiveness of the UAV-Lumex combination at different heights in selected sites pertaining to both mining facilities and surrounding urban zones, shedding light on the GEM spatial distribution and concentration variability. The Lumex great sensitivity and the octocopter optimal versatility and maneuverability, both horizontally and vertically, allowed to depict the GEM distribution in the atmosphere up to 60 m above the ground. The acquisition system was further optimized by: i) synchronizing Lumex and UAV GPS data by means of a stand-alone GPS that was previously synchronized with Lumex; ii) using a vertical sampling tube (1.20 m high) connected to the Lumex inlet to overcome the rotors strong airflows and turbulence that would have affected GEM measurements; iii) supplying the octocopter with batteries for power supply to avoid the release of exhaust gases; iv) taking the advantage of the UAV ability to land in small spaces and stop at selected altitudes. The resulting dot-map graphical representations, providing a realistic 3D picture of GEM vertical profiling during the flights in near real-time, were useful to verify whether the guideline concentrations indicated by competent authorities were exceeded. The results showed that the GEM concentrations in the urban area, located a few hundred meters from the mining structures, and close to already reclaimed areas remained at relatively low values. Contrarily, GEM contents showed significant variations and the highest concentrations above the facilities containing the old furnaces, where increasing GEM concentrations were recorded at decreasing heights or downwind.

Hyrax versus transverse sagittal maxillary expander: An assessment of arch changes on dental casts. A retrospective study.

OBJECTIVE: The aim of this study was to compare arch changes before and after maxillary expansion with Transverse Maxillary Sagittal Expander (TSME) and Hyrax Palatal Expander (HPE), in growing patients with diagnosis of maxillary hypoplasia. MATERIALS AND METHODS: The sample consisted of 40 patients' records (20 males 20 females mean age 9.2 ±â€¯2.6 years) were selected from the archive of the Orthodontic Department of the University of Milan, Italy. Patients were randomly divided in two groups: patients in group 1 were treated with HPE as they presented only transverse deficiency of the maxilla and in group 2 were treated with TSME. Plaster models have been measured with a Verniere caliper to evaluate the differences in maxillary expansion of the two devices. Measurements were performed on casts poured from impressions taken before appliance bonding (T0), immediately after appliance debonding (T1) and at 6 months follow-up (T2). The variations in the following distances have been considered: inter-molar distance, inter-canine distance, palatal depth, palatal length and arch circumference. Shapiro-Wilk test was performed to assess normality distribution. ANOVA for repeated measures with multiple paired t-test for pairwise comparisons and its non-parametric equivalent Friedman's test with multiple Wilcoxon tests for pairwise comparisons were performed to evaluate changes in time of each variable in each group. Between groups comparisons were performed for each variable at each observing time using independent t-test or Mann-Whitney test. Significance level was set at p < 0,05. RESULTS: Both the Friedman test and the rm-ANOVA test and their respective post-hoc show that within both groups the respective variables have a statistically significant increase between T0 and T1 (p < 0,05) and a slight decrease between T1 and T2 (p < 0,05) that is not clinically relevant remaining always T2 greater than T0 in a statistically and clinically relevant way (p < 0,05). The analysis between the differences of the measurements at different timing measured by the Mann-Whitney test shows that for all the variables there is no statistically significant difference between the 2 devices (p < 0,05), except for the perimeter of the arch and the length of the palate; in this case it appeared that the TSME is better statistically (p < 0,05). CONCLUSIONS: The study has shown that RPE and TSME can achieve similar results in transversal palatal expansion. Differences have been found in the palatal length and in the arch perimeter where TSME seems to be more efficient.

RME: effects on the nasal septum. A CBCT evaluation.

AIM: Three-dimensional images have been evaluated to study the changes that occur on the maxillary complex and the nasal septum, following rapid maxillary expansion (RME) in growing children. METHODS: The records of 39 consecutively treated patients (20 male, 19 female), aged between 6.2 and 12.3 years (mean 8.6 years, S.D. 1.5), presenting a septal deviation of more than 1 mm, were analysed. Each patient was scanned at two distinct periods. The first image (T0) was obtained before treatment and hence represented the patient's baseline condition prior to expansion. The second time point (T1) was set after removal of the expander. The skeletal modifications induced by RME have been evaluated via cephalometric tracings obtained at T0 and at T1. The time lapse between T0 and T1 was 12 months. RESULTS: The nasal septum has been modified in its length more significantly in its lower rather than its upper tract. The width of the piriform aperture increased of 1.58 mm with an increase in the lateral walls and a downward movement of the nasal floor (consequent to an increase in septal length). There was also a reduction of septal deviation. The control group measurements did not vary during the considered period. CONCLUSION: Evidences of this study suggest that RME procedures can result in: a potentially positive effect on the nasal septum asymmetry during childhood; an increase of the nasal cavity volume due to a downward and forward movement; a lateral inclination of the nasal cavity reducing air resistance and improving breathing pattern; an increase of the length of the septum in its lower third improving its possible deviations and growth disturbances; favourable effects on the growth of the entire maxillary complex.

DNA methylation of genes regulating appetite and prediction of weight loss after bariatric surgery in obese individuals.

PURPOSE: Epigenetic traits are influenced by clinical variables; interaction between DNA methylation (DNAmeth) and bariatric surgery-induced weight loss has been scarcely explored. We investigated whether DNAmeth of genes encoding for molecules/hormones regulating appetite, food intake or obesity could predict successful weight outcome following Roux-en-Y gastric bypass (RYGB). METHODS: Forty-five obese individuals with no known comorbidities were stratified accordingly to weight decrease one-year after RYGB (excess weight loss, EWL ≥ 50%: good responders, GR; EWL < 50%: worse responders, WR). DNAmeth of leptin (LEP), ghrelin (GHRL), ghrelin receptor (GHSR) and insulin-growth factor-2 (IGF2) was assessed before intervention. Single nucleotide polymorphisms of genes affecting DNAmeth, DNMT3A and DNMT3B, were also determined. RESULTS: At baseline, type 2 diabetes was diagnosed by OGTT in 13 patients. Post-operatively, GR (n = 23) and WR (n = 22) achieved an EWL of 67.7 ± 9.6 vs 38.2 ± 9.0%, respectively. Baseline DNAmeth did not differ between GR and WR for any tested genes, even when the analysis was restricted to subjects with no diabetes. A relationship between GHRL and LEP methylation profiles emerged (r = 0.47, p = 0.001). Searching for correlation between DNAmeth of the studied genes with demographic characteristics and baseline biochemical parameters of the studied population, we observed a correlation between IGF2 methylation and folate (r = 0.44, p = 0.003). Rs11683424 for DNMT3A and rs2424913 for DNMT3B did not correlate with DNAmeth of the studied genes. CONCLUSIONS: In severely obese subjects, the degree of DNAmeth of some genes affecting obesity and related conditions does not work as predictor of successful response to RYGB.

Class II division 1 malocclusions: comparisons between one- and two-step treatment.

AIM: The aim of this study consists in comparing the two-step treatment with that performed in a single-step in adolescent patients. MATERIALS AND METHODS: Study design: This paper is a critical review of the literature with a systematic approach. The search for scientific articles was performed on the US National Library of Medicine database using the PubMed service. Keywords set: "Early treatment Class II OR 1-phase orthodontics OR orthodontic timing Class II". From the initial screening 20 articles were selected of which the full text has been researched and evaluated. RESULTS: The selected articles were reviewed and evaluated by two independent operators, who both excluded two papers. Ultimately 13 articles were selected that refer to four major working groups, respectively from Manchester, North Carolina, Florida and Queen Mary University of London. CONCLUSION: We can assume that both the one- and two-step treatment are effective in correcting Class II malocclusion, with no significant difference of outcome, except for the incidence of incisor trauma, which was significantly lower for the early treatment group.

Titanium TSME appliance for patients allergic to nickel.

AIM: The aim of this article is to describe the use of a titanium TSME appliance for patients with allergy to resin and nickel. We aim to highlight the optimal way to avoid problems such as stomatitis and peri-labial dermatitis, which generally appear in patients who use traditional orthodontic appliances made in acrylic resin and steel. MATERIALS AND METHODS: The construction of a titanium appliance is described and a case treated with it is reported. RESULTS: The titanium TSME presented in this paper has excellent biocompatibility due to its ability to form superficial oxides, which prevent oxidation and thus corrosion. CONCLUSION: The non-allergic properties of titanium allow to propose it as an alternative in patients with a long-term history of allergic reactions to nichel.

Modified transversal sagittal maxillary expander for correction of upper midline deviation associated with maxillary arch deficiency.

The transversal sagittal maxillary expander (TSME) is a fixed device designed to develop arch form in patients with constricted dental arches. The present article describes a modified TSME appliance, the activation method, the therapeutic benefits as well as clinical advantages. The appliance has two molar bands, a Hyrax-type transverse expansion screw, one 0.045-inch wire extending from the molar band to the palatal surface of the central incisor in the emiarch crossbite and an 8 mm-Hyrax-type screw attached to this wire between the molar band and the incisor. A buccal arm with a terminal loop is welded to the band in the emiarch and it is extended to the labial surface on the central incisor on the side opposite to the crossbite and the maxillary midline deviation. The modified TSME appliance described in this paper are specifically designed for anteroposterior and transverse development. It has a sagittal effect on the maxillary alveolar process and at the same time allow to restore the correct transverse maxillary diameters.

Obstructive sleep apnea syndrome: a literature review.

Obstructive sleep apnea syndrome (OSAS) is a complete or partial airway obstruction that can cause significant physiologic disturbance with various clinical impacts. The etiology is multifactorial and its clinical manifestations are night snoring, headache when patient wakes up, day-time sleepiness and degrease of cognitive performance. Some recent international studies suggest that the OSAS prevalence is 2-4% in men and 1-2% in women of average age. The aim of this work was presenting a literature review in Medline concerning Obstructive sleep apnea syndrome. A review of the articles ranging from 1980 to 2014 has been done. Over 2000 articles were found and those which give useful information about etiology, diagnosis, therapy and found results after the study were selected and evaluated. In literature there is no unanimous opinion on the treatment of OSAS. According to the majority of the authors it should be multidisciplinary. The choice of therapy is predicated on the etiology, severity and natural history of the increased upper airway resistance. The importance of a praecox diagnosis and orthodontic therapy in order to re-establish normal function is underlined, since OSAS is linked with high risk of hypertension, cardiovascular diseases, daytime sleepiness, home and work-related accidents, with consequent worsening of life quality.

Titanium orthodontic appliances for allergic patients.

AIM: The aim of our study was to assess the use of orthodontic appliances made in titanium for patients with an allergy to resin and nickel. We aim to highlight the resolution of problems such as stomatitis and peri-labial dermatitis, which generally manifest in patients who use traditional orthodontic appliances in acrylic resin and steel. METHODS: A total of 120 patients of ages between ten and fifteen undergoing orthodontic treatment requiring a rapid palatal expander or a mobile appliance were evaluated and two patch sensitivity tests were done to assess the presence of allergies. RESULTS: The biocompatibility of a material is directly dependent on its corrosion effect. If a metal does not allow the release of ions it will not have a damaging action or cause destruction on the cellular DNA. The oxidation status of an ion is related to the reactivity of the ion itself and thus may give the latter a carcinogenic effect. Titanium appliances used for this study have obtained excellent results due to their ability to form superficial oxides, which block the oxidation phenomenon and thus corrosion. CONCLUSION: We have noticed a total regression of the symptoms after the use of titanium appliances in patients who had a sensitivity reaction.

Atypical swallowing: a review.

AIM: Atypical swallowing is a myofunctional problem consisting of an altered tongue position during the act of swallowing. High incidence in population, multifactorial etiology and the recurring connection with the presence of malocclusions made it a topic of strong interest and discussion in science. The purpose of this review is to illustrate the current orientation on the topic of atypical swallowing, trying in particular to answer two questions: 1) what kind of connection is there between atypical swallowing and malocclusion; 2) what kind of therapy should be used to solve it. METHODS: This review was conducted on the Medline database [www.ncbi.nim.nih.gov/pubmed] searching for the keywords "atypical swallowing" and "tongue thrust". We examined all the documents from the year 1990 onwards, excluding the ones about syndromic cases of the central motor system. RESULTS: The causal relation between the two problems seems to be biunique: some authors affirm that this oral habit starts as a compensation mechanism for a preexisting malocclusion (especially in case of open-bite); other texts show that it has a tendency to exacerbate cases of malocclusion; it is also proven that a non-physiological tongue thrust can negatively influence the progress of an ongoing orthodontic therapy. Thereby, the best therapeutic approach seems to be a multidisciplinary one: beside orthodontics, which is necessary to correct the malocclusion, it is essential to set up a myofunctional rehabilitation procedure to correct the oral habit, therefore granting long time permanent results. There is also proof of a substantial difference between the results obtained from early (deciduous or primary mixed dentition) or later treatments. CONCLUSION: The biunique causal relation between atypical swallowing and malocclusion suggests a multidisciplinary therapeutic approach, orthodontic and myofunctional, to temporarily solve both problems. An early diagnosis and a prompt intervention have a significantly positive influence on the therapy outcome.

Upper midline deviation: modified Hyrax expander.

BACKGROUND: The Hyrax rapid palatal expander is useful for patients in mixed dentition with premature exfoliation of some deciduous teeth and maxillary hypoplasia. This appliance, which is provided of a vestibular arm for correcting maxillary asymmetric transverse discrepancies, represents an interceptive treatment able to reduce the duration of the orthodontic therapy with fixed appliances. CASE REPORT: In this case report the modified version of the Hyrax rapid palatal expander is described. The activation method, the therapeutic benefits as well as the clinical advantages are described.

Qualitative and quantitative assessment of plaque bacteria in pediatric patients, patients undergoing orthodontic treatment, combined orthdontic-surgical treatment and implant-prosthetic rehabilitation.

AIM: The aim of this paper was to describe the qualitative and quantitative changes occurring within the oral bacterial flora of several groups of patients following oral prevention protocols during the stages of the dental treatment they required. METHODS: Three hundred patients were enrolled in the study. The selected patients were categorized into different groups to receive preventive strategies according to their needs and treatment required. Plaque samples from each patient were collected at different intervals according to the treatment they were undergoing. These were then assessed under a microscope to carry out a quantitative and qualitative assessment of the plaque. RESULTS: The Mean Plaque Index Score of most patients generally decreased during the various treatment phases and hence the overall bacterial count. However, we noticed a slight increase in the plaque index in patients undergoing orthodontic surgery after placement of the orthodontic appliance and patients undergoing combined orthodontic-surgical treatment during the intermaxillary fixation phase. We generally found that the coccoidal bacterial form was the most prevalent. CONCLUSION: Patients who were adequately instructed and motivated through oral hygiene prevention strategies, showed a significant decrease in the plaque levels and in the overall bacterial components between the first visit and the successive sample taking. Even though we noticed a slight increase in the plaque index in patients undergoing the intermaxillary fixation phase, this decreased immediately once the phase ended and the patients managed to return to the routine oral hygiene care. This highlights the importance of constant motivation and oral hygiene instruction reinforcement.

Cleft lip and/or palate: review.

AIM: Aim of the review was to provide a literature overview of the birth defects of cleft lip and/or cleft palate (CL/P). METHODS: Through the use of the PubMed database items were collected that would provide information about the condition, leading to the discussion of the following topics: epidemiology, anatomical features, genetics, environmental factors, diagnosis and treatment. RESULTS: According to these data, the CL/P are the most common congenital malformations of the craniofacial region. There are different phenotypes and clinical features of this malformation, which differ according to the anatomical structures involved: cleft lip, cleft lip and cleft palate. The etiology is multifactorial and includes both genetic factors and environmental factors. For proper diagnosis and treatment it is important to complete a multidisciplinary approach to guide the patient from birth to the end of growth. Among the outstanding figures for the care of the anomaly are: the gynecologist, the pediatrician, the maxillofacial surgeon and orthodontist. Individuals with a cleft lip and/or cleft palate may experience problems in feeding, pronunciation, hearing and social integration, which can be corrected to a different extent by surgery, dental treatment, speech therapy and psychosocial interventions. CONCLUSION: Today the optimal treatment is difficult to find, because of the large variability of malformations and the subjective response of each patient to therapy.

Oral tissues and orthodontic treatment: common side effects.

The aim of this paper was to provide a literature review about the problems that can occur during orthodontic treatment. Using the PubMed database we collected items that would provide information regarding the direct consequences of the placement of an orthodontic appliance: coming to the discussion of the following topics: candida infections, the effects on the soft tissues, the effects on periodontal tissues and effects on hard tissues. The presence of appliances in the oral cavity increases the prevalence of people with candida, specifically the species Candida Albicans is the most frequently isolated. The balance between the clearance of the microorganism, the colonization and the state of candidiasis depends both on the virulence of the fungus, and the competence of the host immune system. On soft tissues, cases of ulceration of the upper jaw by a rapid palatal expander and pyogenic granuloma due to quad helix appliance have been reported. The second one is mostly observed on vestibular gingiva. The first one was found, however, in patients suffering from diabetes mellitus type 1 because of the tissue modifications induced by this pathological condition. The more severe periodontic effects are those caused by incorrect use of orthodontic elastic separators. Finally, the White Spot Lesions are the direct consequences of a wrong conditioning of enamel when attaching the bracket. They represent a first stage of caries in the positioning area of the bracket. The orthodontist is required to intercept these issues not to affect the success of the treatment.

Volatile organic compounds (VOCs) in air from Nisyros Island (Dodecanese Archipelago, Greece): Natural versus anthropogenic sources.

This study presents the chemical composition of VOCs in air and gas discharges collected at Nisyros Island (Dodecanese Archipelago, Greece). The main goals are i) to discriminate between natural and anthropogenic VOC sources and ii) to evaluate their impact on local air quality. Up to 63 different VOCs were recognized and quantitatively determined in 6 fumaroles and 19 air samples collected in the Lakki caldera, where fumarolic emissions are located, and the outer ring of the island, including the Mandraki village and the main harbor. Air samples from the crater area show significant concentrations of alkanes, alkenes, cyclic, aromatics, and S- and O-bearing heterocycles directly deriving from the hydrothermal system, as well as secondary O-bearing compounds from oxidation of primary VOCs. At Mandraki village, C6H6/Σ(methylated aromatics) and Σ(linear)/Σ(branched) alkanes ratios <1 allow to distinguish an anthropogenic source related to emissions from outlet pipes of touristic and private boats and buses.

Impacted maxillary canine on the position of the central incisor: surgical-orthodontic repositioning.

The aim of this article is to describe a case of a young orthodontic patient in which an impacted maxillary canine was repositioned in the central incisor position. A severe resorption of the root of the central right maxillary incisor by ectopic eruption of the impacted right maxillary canine is described. The canine was repositioned in the incisor's position to avoid resorption of the roots of the adjacent teeth during the disinclusion. The central incisor was extracted and the canine was extruded by a closed eruption technique. When the canine eruption was complete, the tip, the torque and the morphology of the canine were modified in order to make it look like an incisor. Nowadays the therapy with dental implants is the best choice, if the position of impacted teeth is difficult to reach. This case report describes a successful management of an impacted upper right canine aligned in the upper right central incisor position. Accurate diagnosis, conservative management of the soft tissues, anchorage unit and the direction of the orthodontic traction are important factors for the success treatment.