Evaluation of palate morphology in patients treated with leaf expander and hyrax expander: A geometric morphometric analysis.

OBJECTIVE: The aim of this study was to evaluate changes in shape of the palatal vault after maxillary expansion with hyrax expander (HE) and leaf expander (LE), using 3D Geometric Morphometric Analysis. SETTING AND SAMPLE POPULATION: Overall, 250 patients (110 M, 140 F) with maxillary transverse deficiency were selected for this study. In this study, 127 subjects were treated with HE, 123 with LE. MATERIALS AND METHODS: Digital dental models were obtained pre-treatment (T0) and after 12 months from the cementation of the device (T1) and processed by means of a digital scanner. Linear and morphometric analyses were conducted to determine the effects of each appliance on dental measurements and palatal shape, and a multiple linear regression was performed to analyse the influence of anchorage and appliance type on final shape. RESULTS: Morphometric analysis showed that there was a lowering of the palatal vault in the HE group, while in the LE group it remained unchanged: the difference in palatal shape at time T0 and T1 was statistically significant in both treatments (HE vs. LE). In the HE group, the change in shape also included the upper part of the palatal vault in the vertical dimension, while in the LE group the change in shape interested mainly palatal shelves and the lower portion of the palate. CONCLUSIONS: Both LE and HE produce clinically significant changes in the morphology of the palatal vault.

Effectiveness of dental monitoring system in orthodontics: A systematic review.

BACKGROUND: Dental monitoring (DM) constitutes a recent technological advance for the remote monitoring of patients undergoing an orthodontic therapy. Especially in times of health emergency crisis, the possibility of relying on remote monitoring could be particularly useful. OBJECTIVES: To assess the effectiveness of DM in orthodontic care. ELIGIBILITY: Studies conducted on healthy patients undergoing orthodontic care where DM was applied, assessing a change in treatment duration, emergency appointments, in-office visits, orthodontic relapse, early detection of orthodontic emergencies and improvement of oral health status. INFORMATION SOURCES: PubMed, Web of Science and Scopus were searched for publications until November 2022. RISK OF BIAS: Quality assessment was performed with the STROBE Checklist. DATA EXTRACTION: Data were extracted independently by two reviewers, and discrepancies were resolved with a third reviewer. INCLUDED STUDIES: Out of 6887 records screened, 11 studies were included. SYNTHESIS OF RESULTS: DM implemented to the standard orthodontic care was found to significantly decrease the number of in-office visits by 1.68-3.5 visits and showed a possible trend towards improvement of aligner fit. Conversely, evidence does not support a reduction of treatment duration and emergency appointments. The assessment of the remaining variables did not allow any qualitative synthesis. CONCLUSIONS: This review highlighted that DM implemented to standard orthodontic care can significantly decrease the number of in-office visits and may potentially result in an improved aligner fit. Due to the low quality of most of the included studies and the heterogeneity of the orthodontic system where DM was applied, studies with different investigation team and rigorous methodology are advocated.

Impact of Periodontitis on Glycemic Control and Metabolic Status in Diabetes Patients: Current Knowledge on Early Disease Markers and Therapeutic Perspectives.

Diabetes mellitus and periodontitis are two of the most common chronic diseases affecting the world's population, and they are intimately linked. For several years, in fact, it has been known that there is an interdependent relationship between the two diseases: Diabetes promotes the destruction of periodontal tissues, and periodontal disease negatively affects glycemic control. In relation to the control of dental plaque and oral dysbiosis responsible for periodontal disease, both nonsurgical and surgical therapy associated with proper home hygiene procedures have emerged as essential for good glycemic control. Moreover, several evidences suggest the essential role played by the control of periodontal disease in preventing the onset of the most common complications of diabetes: cardiovascular diseases, retinopathies, and other systemic diseases. The aim of this study is to update the current knowledge on the bi-univocal relationship between diabetes and periodontitis and the impact of therapy in the optimal management of these two disorders. From the information found in the literature, it has emerged that the correct treatment of periodontal disease in diabetic patients represents one of the main mechanisms and means currently established and valid to control periodontal disease and glucose metabolism and prevent the onset or development of diabetic complications.

Online videos: The hidden curriculum.

INTRODUCTION: Dental undergraduates will access the Internet searching for learning materials to complement their training; however, open access content is not generally recommended by dental schools. This study aimed to evaluate how dental students are using online video content. MATERIALS AND METHODS: Students from eight Universities (Athens, Birmingham, Brescia, Cardiff, Melbourne, Paris, Sao Paulo and Valdivia) representing three continents were invited to complete a survey on their access and learning from online videos. RESULTS: International students behave similarly when studying dental content online. Of 515 respondents, 94.6% use the Internet as a learning tool. It was observed that videos are not frequently recommended during didactic lectures (9.6%). But many students (79.9%) will use YouTube for their learning which includes clinical procedures. Students will check online content before performing procedures for the first time (74.8%), to understand what was explained in class (65.9%) or read in books (59.5%), to relearn clinical techniques (64.7%) and to visualise rare procedures (49.8%). More than half of the students do not fully trust the accuracy or the reliability of online content. This does not prevent students from watching and sharing dental videos with classmates (64.4%). The content watched is not shared with teachers (23.3%) even when it contradicts what was learnt in the school (38.2%). CONCLUSION: This study concludes that students regularly integrate open access digital resources into learning portfolios but are hesitant to inform their teachers about their viewing habits. Students wish to receive critical skills on how to evaluate the material they encounter outside their traditional learning space.

Effects of remote digital monitoring on oral hygiene of orthodontic patients: a prospective study.

BACKGROUND: Remote digital monitoring during orthodontic treatment can help patients in improving their oral hygiene performance and reducing the number of appointments due to emergency reasons, especially in time of COVID-19 pandemic where non-urgent appointments might be discouraged. METHODS: Thirty patients scheduled to start an orthodontic treatment were divided into two groups of fifteen. Compared to controls, study group patients were provided with scan box and cheek retractor (Dental Monitoring®) and were instructed to take monthly intra-oral scans. Plaque Index (PI), Gingival Index (GI), and White Spot Lesions (WSL) were recorded for both groups at baseline (t0), every month for the first 3 months (t1, t2, t3), and at 6 months (t4). Carious Lesions Onset (CLO) and Emergency Appointments (EA) were also recorded during the observation period. Inter-group differences were assessed with Student's t test and Chi-square test, intra-group differences were assessed with Cochran's Q-test (significance α = 0.05). RESULTS: Study group patients showed a significant improvement in plaque control at t3 (p = 0.010) and t4 (p = 0.039), compared to control group. No significant difference was observed in the number of WSL between the two groups. No cavities were detected in the study group, while five CLO were diagnosed in the control group (p = 0.049). A decreased number of EA was observed in the study group, but the difference was not significant. CONCLUSIONS: Integration of a remote monitoring system during orthodontic treatment was effective in improving plaque control and reducing carious lesions onset. The present findings encourage orthodontists to consider this technology to help maintaining optimal oral health of patients, especially in times of health emergency crisis.

Palatal changes in crossbite patients treated with rapid maxillary expansion vs untreated ones: A geometric morphometric study.

OBJECTIVE: The present study aimed to analyse palatal changes due to rapid maxillary expansion (RME) by using modern geometric morphometric analysis (GMA) on 3D models. SETTINGS AND SAMPLE POPULATION: Forty children with posterior crossbite and maxillary deficiency were selected for this study. Twenty children were treated with RME (mean age 7.4 ± 0.8 years), whereas 20 children were not treated (mean age 7.2 ± 1.1 years). MATERIALS AND METHODS: In the treated group, RME screw was activated until overcorrection was achieved and the RME appliance remained in place for 11 months. Digital dental casts were recorded before treatment and 1 year after the end of active treatment. GMA was performed to compare shape and dimensional variations among groups (between-group principal component analysis). RESULTS: All children in the treated group achieved crossbite correction. None of the control group children achieved crossbite self-correction. No significant shape and dimensional changes were noted in the control group after 1 year. On the other hand, significant shape and dimensional changes were noted in the treated group after 1 year (P < .05). Most of the shape changes in the treated group were similar but more pronounced compared to those observed in the control group. All major changes in palatal morphology occurred on the lateral sides of the palatal vault (widening) and at the height (shortening). Some shape changes were observed in the treated group alone. CONCLUSIONS: Application of GMA to evaluate the effects of RME in crossbite patients revealed significant changes in palatal morphology compared with the absence of changes in the control group.

The impact of temporomandibular joint arthritis on functional disability and global health in patients with juvenile idiopathic arthritis.

OBJECTIVES: The objective of the study was to evaluate the impact of temporomandibular joint (TMJ) arthritis on the functional disability and quality of life in patients affected by juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS: Sixty-two consecutive patients with JIA with or without TMJ arthritis and 35 healthy control subjects were enrolled in the study. The demographic data, disease activity and clinical characteristics were obtained from all patients. The functional disability was assessed using the Italian version of the Childhood Health Assessment Questionnaire (C-HAQ). The oral health-related quality of life (OHRQoL) was assessed using the Child Perception Questionnaire (CPQ11-14). Possible determining factors of TMJ arthritis comprised demographic, disease characteristics and scores derived from questionnaires that were assessed by a uni and multivariable logistic regression analysis. RESULTS: Compared with patients without TMJs arthritis, JIA patients with TMJ arthritis presented higher functional disability. The multivariable logistic regression analysis performed showed that female subjects (OR = 1.5, P = 0.041), with a JIA duration over 3.9 years (OR = 2.7, P = 0.033) and presenting higher C-HAQ and CPQ11-14 scores (OR = 2.7, P = 0.012 and OR = 2.9, P = 0.015, respectively) were the greatest determining factors for TMJ arthritis. CONCLUSIONS: JIA patients with TMJ arthritis presented higher functional disability and lower OHRQoL scores compared with JIA patients without TMJ arthritis. TMJ arthritis was strongly associated with JIA duration and activity, especially in female patients.

Treatment of recurrent aphthous stomatitis (RAS; aphthae; canker sores) with a barrier forming mouth rinse or topical gel formulation containing hyaluronic acid: a retrospective clinical study.

BACKGROUND: Use of hyaluronic acid-based products has become a valuable alternative to drug-based approaches in the treatment of recurrent aphthous stomatitis (RAS). The presented study aimed to investigate the effect of a barrier forming hyaluronic acid containing mouth wash or a topical gel formulation on the healing of RAS and patient's quality of life. METHODS: For this single-center retrospective study, medical records of the Dental School of the University of Brescia were screened for adult and systemically health patients suffering from minor recurrent aphthous stomatitis (RAS) and treated with either a barrier forming, hyaluronic acid containing mouth wash (GUM® AftaClear® rinse) or a topical gel (GUM® AftaClear® gel) in 2015. All patients fulfilling the in-/exclusion criteria and presenting full data sets on lesion diameter, lesion color, as well as pain perception for baseline (day 0) and 4 and 7 days after treatment were enrolled into the presented study. RESULTS: Out of 60 screened patients, a total of 20 patients treated with the Rinse formulation and 25 treated with the Gel formulation were eligible for the enrollment into this study. Both groups showed equal distribution in patient's age, sex and presented a similar mean lesion size (3.0 ± 1.0 mm), lesion color distribution as well as pain perception at baseline. All patients showed significant normalization of lesion color, reduction of pain, and lesion dimension within the course of their treatment. After 7 days, the mean percentage of lesion reduction was highly significant for both groups attaining 77.4 ± 30.1% in the Rinse group and 81.2 ± 23.1% in the Gel group with a complete lesion closure obtained in 60 and 56% of the cases, respectively. However, a significant (p < 0.05) higher percentage of lesions in the Gel group (72%) compared to the Rinse group (40%) showed an improvement in lesion size already after 3 days. CONCLUSIONS: Within the limitation of retrospective design, it can be concluded that both the barrier forming hyaluronic acid containing mouth rinse as well as the topical gel formulation are effective in the treatment of minor recurrent aphthous stomatitis (RAS), with a trend for an earlier healing onset for the topical Gel formulation.

Impacted and transmigrant mandibular canines incidence, aetiology, and treatment: a systematic review.

Background: The incidence of impacted and transmigrant mandibular canines in the mandible is not as high as that in the maxilla; consequently, it is more difficult to find clinical guidelines derived from sound studies based on large patient samples. Objectives: The aim of this systematic review was to summarize currently available data pertaining to the incidence and aetiology of impacted and transmigrant mandibular canines and the success rates of different treatment strategies. Methods: This review was registered with PROSPERO (CRD42014006175) and was conducted using PRISMA and CRD (Centre for Reviews and Dissemination, University of York) statement. A computerized search of studies published up to February 2016 was conducted using the following databases: PubMed, Cochrane Central Register of Controlled Clinical trials, ISI Web of Knowledge, and Scopus. To identify any relevant publications not included in this list, we manually searched the references lists of the selected articles. The Newcastle-Ottawa Scale quality assessment tool was utilized to classify the included articles. Results: In total, 630 articles were identified after the removal of duplicates. A total of 13 studies published between 2001 and 2015 met all the eligibility criteria and were included for the final analysis. The sample size in these studies ranged from 14 to 112873 teeth, while their methodological quality ranged from low to medium. Conclusions: According to the findings from our review, the incidence of canine impaction in the mandible ranges from 0.92 to 5.1 per cent, while that of canine transmigration ranges from 0.1 to 0.31 per cent. Various etiologies may play a role, including odontomes (up to 20 per cent) and lateral incisor anomalies (16 per cent). Surgical extraction (89 per cent in some studies) and orthodontic traction (20-32 per cent) are the most commonly used treatment strategies, with the latter showing a failure rate of 17 per cent in two studies.

Asymmetric molars' mesial rotation and mesialization in unilateral functional posterior crossbite and implications for interceptive treatment in the mixed dentition.

INTRODUCTION: Symmetric transverse expansion is the main outcome of the early treatment in subjects with unilateral functional posterior crossbite. The aim of this study was to analyse mesial rotation and mesialization of upper first molars as sagittal parameters to be corrected in the treatment of these patients during the mixed dentition. METHODS: Digital dental cast measurements (rotation and mesialization) were performed in a sample of 48 subjects with unilateral posterior crossbite (UPXB; 19 males and 29 females, mean age 10.2 ± 1.2 years) and in a control group of 35 subjects with normal Class I occlusion (17 males and 18 females, mean age 9.9 ± 1.3 years). An independent sample t-test, the Mann-Whitney test, Fisher's exact test, and Pearson correlation were used for statistical comparison. RESULTS: The amount of upper molar rotation was significantly greater in the experimental group when compared with the control group. A clinically significant 'upper molar rotation' (UMR) was present in 66.7 per cent of the subjects with UPXB versus 5.7 per cent of the control group. The UMR group presented also a significant mesialization of upper first molars when compared with the control group. In the experimental group, there was a significant difference between rotation and mesialization in the right and left side and a correlation has been found between these two variables and the amount of Class II molar relationship at the crossbite side. LIMITATIONS: This is an epidemiological case-control study and the discussed effects of an early correction of the asymmetric upper molars' migration are only speculations based on an association relationship. CONCLUSIONS: The findings of this study show an asymmetric upper first molars' migration (rotation and mesialization) in unilateral functional posterior crossbite versus a control group. An early evaluation and correction of the molars' migration during the mixed dentition should be considered in order to obtain a correct inter-occlusal sagittal molar relationship, space for an adequate eruption of permanent teeth, and perhaps reduce the need of a following fixed appliance treatment in the permanent dentition.

Immediate versus delayed loading: comparison of primary stability loss after miniscrew placement in orthodontic patients-a single-centre blinded randomized clinical trial.

INTRODUCTION: The aim of this randomized clinical trial was to compare torque recordings at insertion time and 1 week post-placement between immediately loaded orthodontic miniscrews and an unloaded control group. TRIAL DESIGN: This RCT was designed as parallel with an allocation ratio of 1:1. METHODS: Eligibility criteria to enroll patients were: needs of fixed orthodontic treatment, no systemic disease, absence of using drugs altering bone metabolism. All patients were consecutively treated in a private practice and the miniscrews were placed by the same author. Patients received ORTHOImplant (3M Unitek) miniscrews and they were blindly divided in two groups: group 1 screws were unloaded between T0 and T1, group 2 received immediately loaded screws with NiTi coil. For each patient, maximum insertion torque (MIT) was evaluated at T0. After 1 week, without loading, the screw torque was measured again (T1) and at the end of the treatment maximal removal torque was evaluated (T2). Torque variation in the first week was considered as the primary outcome. RANDOMIZATION: A randomization list was created for the group assignment, with an allocation ratio of 1:1. BLINDING: The study was single blinded in regard of the statistical analysis. RESULTS: Patients enrolled in the clinical trial were 51 for a total of 81 miniscrews. The recruitment started in November 2012 and the observation period ended in August 2014. Twenty-six and twenty-five patients were analysed in group 1 and 2, respectively. The MIT mean in each placement time was 18.25 Ncm (SD = 3.00), 11.41 Ncm (SD = 3.51) and 10.52 Ncm (SD = 5.14) at T0, T1, and T2 time, respectively. In group 1, the torque decrease between T1 and T0 was statistically higher compared to group 2 (P value = 0.003). Statistically significant effects of the placement times on MIT were found (P value <0.0001). No serious harm was observed. LIMITATIONS: This study was performed using only direct force on the miniscrew and not using the miniscrew as an indirect anchorage. It was not possible to obtain quantitative data on bone quality or root proximity to miniscrews. CONCLUSIONS: A significant stability loss was observed in the first week in both groups; Group 1 showed a statistically higher torque loss in the first week when compared to the immediately loaded group. There were statistically significant effects of the measurement times on MIT and of the miniscrew location on MIT. The overall failure rate was 7.4%. TRIAL REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement.

Efficacy of professional hygiene and prophylaxis on preventing plaque increase in orthodontic patients with multibracket appliances: a systematic review.

BACKGROUND: Plaque increase is a troubling side-effect of fixed orthodontic therapy. This generally arise as a consequence of long-term difficulty in maintaining adequate oral hygiene while wearing multibracket appliances. Demineralization, also known as white spot, causes particular concern as it spoils the aesthetic outcome of the treatment itself, not to mention the integrity of the enamel. OBJECTIVES: To collate the existing literature by evaluating the efficacy of dental hygienist intervention on plaque increase in fixed orthodontics patients. MATERIALS AND METHODS: A targeted search of the Medline database (Entrez PubMed), EMBASE, and CENTRAL using relevant Medical Subject Headings was performed. The articles selected were all published before June 2013 and comprised randomized clinical trials, prospective longitudinal controlled clinical trials, and before/after studies onto the plaque increase of fixed appliances. RESULTS: The search strategy yielded 630 articles. Following the application of inclusion and exclusion criteria, 10 articles qualified for the final review. CONCLUSION: The quality of the retrieved researches ranged from low (one study) to high (one study). Six controlled trials were considered at unknown risk of bias. Data showed that regular patient motivation sessions and mechanical tooth cleaning by a professional dental hygienist help maintaining good oral hygiene during fixed orthodontics.

Determinants for success rates of temporary anchorage devices in orthodontics: a meta-analysis (n > 50).

INTRODUCTION: The aim of this study was to review the literature and evaluate the failure rates and factors that affect the stability and success of temporary anchorage devices (TADs) used as orthodontic anchorage. METHODS: Data were collected from electronic databases: MEDLINE database, Scopus, and Web of Knowledge. Four combinations of term were used as keywords: screw orthodontic failure, screw orthodontic success, implant orthodontic failure, and implant orthodontic success. The following selection criteria were used to select appropriate articles: articles on implants and screws used as orthodontic anchorage, data only from human subjects, studies published in English, studies with more than 50 implants/screws, and both prospective and retrospective clinical studies. RESULTS: The search provided 209 abstracts about TADs used as anchorage. After reading and applying the selection criteria, 26 articles were included in the study. The data obtained were divided into two topics: which factors affected TAD success and to what degree and in how many articles they were quoted. Clinical factors were divided into three main groups: patient-related, implant-related, and management-related factors. CONCLUSIONS: Although all articles included in this meta-analysis reported success rates of greater than 80 per cent, the factors determining success rates were inconsistent between the studies analysed and this made conclusions difficult.

Reliability of a novel CBCT-based 3D classification system for maxillary canine impactions in orthodontics: the KPG index.

The aim of this study was to evaluate both intra- and interoperator reliability of a radiological three-dimensional classification system (KPG index) for the assessment of degree of difficulty for orthodontic treatment of maxillary canine impactions. Cone beam computed tomography (CBCT) scans of fifty impacted canines, obtained using three different scanners (NewTom, Kodak, and Planmeca), were classified using the KPG index by three independent orthodontists. Measurements were repeated one month later. Based on these two sessions, several recommendations on KPG Index scoring were elaborated. After a joint calibration session, these recommendations were explained to nine orthodontists and the two measurement sessions were repeated. There was a moderate intrarater agreement in the precalibration measurement sessions. After the calibration session, both intra- and interrater agreement were almost perfect. Indexes assessed with Kodak Dental Imaging 3D module software showed a better reliability in z-axis values, whereas indexes assessed with Planmeca Romexis software showed a better reliability in x- and y-axis values. No differences were found between the CBCT scanners used. Taken together, these findings indicate that the application of the instructions elaborated during this study improved KPG index reliability, which was nevertheless variously influenced by the use of different software for images evaluation.

Self-ligating fully customized lingual appliance and chair-time reduction: a typodont study followed by a randomized clinical trial.

In this study, we tested the hypothesis that self-ligation can reduce the chair time necessary for inserting and removing the archwire in a fully customized, multi-bracket, orthodontic, lingual appliance. A permuted-block, randomized trial design was employed to treat seven patients, each with Incognito(®) lingual appliances and Harmony(®) self-ligating lingual appliances. Three operators (a third year resident in orthodontics, an orthodontic specialist, and an experienced lingual orthodontist) were instructed, and they were allowed to familiarize themselves with two typodonts. Next, the operators were asked to insert and remove a.014 NiTi customized archwire for each patient, and they were timed. The time required for removing and inserting archwires decreased proportionally with operator experience: it was shorter with self-ligating appliances (114.82±18.06 seconds versus 595.83±289.09 seconds, P < 0.001) and when testing the typodonts' performances (480.61±285.74 seconds versus 518.65±296.97 seconds, P < 0.001). However, differences between operators were smaller when using typodonts (31.77±21.19 seconds versus 43.87±27.06 seconds, P < 0.001) and with self-ligation (15.17±9.29 seconds versus 45.37±25.44 seconds, P < 0.001). In vivo performance improved after typodont training, allowing for difference reductions between operators. Lingual self-ligation appears to require less hands-on ability and training of the orthodontist, for reduction of chair time.

A Semi-Automatic Method on a Small Italian Sample for Estimating Sex Based on the Shape of the Crown of the Maxillary Posterior Teeth.

Teeth are known to be reliable substrates for human identification and are endowed with significant sexual dimorphism not only in the size but also in the shape of the crowns. In the preliminary phase of our study (already published in 2021), a novel sex estimation method based on dental morphometric geometric (GMA) analysis combined with the artificial neural network (ANN) was developed and validated on a single dental element (first upper premolar) with an accuracy rate of 80%. This study aims to experiment and validate the combination of GMA-ANN on the upper first and second left premolars and the upper left first molar to obtain a reliable classification model based on the sexual dimorphic traits of multiple maxillary teeth of Caucasian Italian adults (115 males and 115 females). A general procrustes superimposition (GPS) and principal component analysis (PCA) were performed to study the shape variance between the sexes and to reduce the data variations. The "set-aside" approach was used to validate the accuracy of the proposed ANN. As the main findings, the proposed method correctly classified 94% of females and 68% of males from the test sample and the overall accuracy gained was 82%, higher than the odontometric methods that similarly consider multiple teeth. The shape variation between male and female premolars represents the best dimorphic feature compared with the first upper molar. Future research could overcome some limitations by considering a larger sample of subjects and experimenting with the use of computer vision for automatic landmark positioning and should verify the present evidence in samples with different ancestry.

Proposed parameters of optimal central incisor positioning in orthodontic treatment planning: A systematic review.

OBJECTIVE: Planning of incisal position is crucial for optimal orthodontic treatment outcomes due to its consequences on facial esthetics and occlusion. A systematic summary of the proposed parameters is presented. METHODS: Studies on Google Scholar©, PubMed©, and Cochrane Library, providing quantitative information on optimal central incisor position were included. RESULTS: Upper incisors supero-inferior position (4-5 mm to upper lip, 67-73 mm to axial plane through pupils), antero-posterior position (3-4 mm to Nasion-A, 3-6 mm to A-Pogonion, 9-12 mm to true vertical line, 5 mm to A-projection, 9-10 mm to coronal plane through pupils), bucco-lingual angulation (4-7° to occlusal plane perpendicular on models, 20-22° to Nasion-A, 57-58° to upper occlusal plane, 16-20° to coronal plane through pupils, 108-110° to anterior-posterior nasal spine), mesio-distal angulation (5° to occlusal plane perpendicular on models). Lower incisors supero-inferior position (41-48 mm to soft-tissue mandibular plane), antero-posterior position (3-4 mm to Nasion-B, 1-3 mm to A-Pogonion, 12-15 mm to true vertical line, 6-8 mm to coronal plane through pupils), bucco-lingual angulation (1-4° to occlusal plane perpendicular on models, 87-94° to mandibular plane, 68° to Frankfurt plane, 22-25° to Nasion-B, 105° to occlusal plane, 64° to lower occlusal plane, 21° to A-Pogonion), mesio-distal angulation (2° to occlusal plane perpendicular on models). CONCLUSIONS: Although these findings can provide clinical guideline, they derive from heterogeneous studies in terms of subject characteristics and reference methods. Therefore, the optimal incisal position remains debatable.

Clinical effects of different prescriptions on the inclination of maxillary and mandibular incisors by using passive self-ligating brackets.

Objective: Controlling the incisal inclination is fundamental in orthodontics. However, the relationship between the inclination prescription and its clinical outcome is not obvious, and the incisal inclination changes generated by different bracket prescriptions were investigated. Methods: Twenty-eight non-extraction dental Class II patients (15 females, 13 males; mean age = 12.9) were retrospectively analyzed. Patients were treated using passive self-ligating fixed appliances with three inclination prescriptions for maxillary incisors (high, standard, low), and two for mandibular incisors (standard, low). Clinical outcomes were compared among different prescriptions, and regression analysis was used to explain the effects of bracket prescriptions and to understand the prescription selection criteria (α = 0.05). Results: For maxillary central incisors, low and high prescriptions were related to linguoversion (p = 0.046) and labioversion (p = 0.005), respectively, while standard prescription maintained the initial dental inclination. Maxillary lateral incisors did not show significant changes. For mandibular incisors, low prescription led to linguoversion (p = 0.005 for central incisors, p = 0.010 for lateral incisors), while standard prescription led to labioversion (p = 0.045 for central incisors, p = 0.005 for lateral incisors). The factors affecting inclination changes were the imposed change and selected prescription, while prescription selection was influenced by the initial dental inclination and initial intercanine distance. Conclusions: The direction of correction of incisal inclination can be controlled by choosing a certain prescription, but the final inclination may show limited consistency with it. The amount of imposed inclination change was the most relevant predictor of the clinical outcome.