Effects produced by the facemask with and without skeletal anchorage for the orthopaedic treatment of Class III malocclusion in growing patients: a systematic review and meta-analysis of RCTs.

BACKGROUND: Skeletally anchored facemask has been proposed to maximize skeletal effects and minimize dental effects in the treatment of Class III malocclusion in growing patients. OBJECTIVE: To compare the dento-skeletal effects produced by the facemask with or without skeletal anchorage for the treatment of Class III malocclusion in growing patients. MATERIALS AND METHODS: PubMed, Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey were used for the electronic search without language, publication status, and year restrictions. Only RCTs were included. Inclusion criteria were: growing patients (age under 18 years) with Class III malocclusion, with indications for treatment with the facemask. Data were extracted by two independent reviewers. GRADE statement was executed. The mean of differences (MD) and the risk ratio (RR) were used. RESULTS: Three articles with a total of 123 patients were included. One article was at low risk of bias while two were at high risk of bias. There were no significant differences between the two groups in ANB angle, Wits appraisal, SNB angle, and SN-MP angle. SNA angle was significantly increased in the skeletally anchored facemask (pooled MD = 0.80 favouring skeletal anchorage, 95% CI from 0.29 to 1.31, P = 0.002, I2 = 12 per cent, three studies, GRADE moderate). The U1-SN angle was significantly reduced in the skeletally anchored facemask (pooled MD = -5.91 favouring skeletal anchorage, 95% CI from -7.64 to -4.27, P < 0.00001, I2 = 0 per cent, two studies, GRADE moderate). There were significantly less complications in tooth-anchored facemask (pooled RR = 7.98 favouring dental anchorage, 95 per cent CI from 1.04 to 61.27, P = 0.05, I2 = 0 per cent, two studies, GRADE low). LIMITATIONS: Few RCTs (three) were included, and two studies were at high risk of bias. There were no long-term RCTs comparing skeletally anchored facemask with dental-anchored facemask. Only Asiatic patients were included in this systematic review. CONCLUSIONS: Skeletally anchored facemask was associated to a greater increase of SNA angle at the end of treatment though clinically not significant. Facemask with skeletal anchorage determined a reduced inclination of maxillary incisors compared to dental-anchored facemask with greater risks of complications. REGISTRATION: PROSPERO register (CRD42020221982).

Post-pubertal effects of the Alt-RAMEC/FM and RME/FM protocols for the early treatment of Class III malocclusion: a retrospective controlled study.

OBJECTIVE: To assess the stability of the effects of the modified Alt-RAMEC and facial mask (FM) protocol at a post-pubertal observation. METHODS: Twenty-one Class III patients (11 males and 10 females, 6.5 ± 0.7 years) treated consecutively with the Alt-RAMEC/FM approach and presenting with lateral cephalograms taken before treatment (T1), after treatment (T2), and at post-pubertal observations (T3) were compared with 22 Class III patients (9 males and 13 females, 6.9 ± 1.2 years) treated with the rapid maxillary expansion (RME) and FM protocol and with 15 Class III untreated subjects (7 males and 8 females, 6.2 ± 2.2 years). At T3, all patients showed a post-pubertal skeletal maturation stage (CS4-CS6). Descriptive statistics and statistical comparisons between the three groups at T1 and for the T3-T1, T2-T1, and T3-T2 changes were assessed by means of the ANOVA or Kruskal-Wallis test. RESULTS: During the overall observation period, Alt-RAMEC/FM and RME/FM protocols produced statistically significant favourable effects when compared with the Control group (ANB + 2.8° and +2.2°, respectively; Wits appraisal +4.4 mm and +2.7 mm, respectively). No statistically significant differences were found between the outcomes of the Alt-RAMEC/FM and RME/FM protocols neither at the post-pubertal or short-term observations. LIMITATIONS: Retrospective study and the comparison with an historical control sample of subjects with untreated Class III malocclusion. CONCLUSIONS: The Alt-RAMEC/FM protocol cannot be recommended as the approach of choice for the therapy of Class III dentoskeletal disharmony in very young subjects compared to the conventional RME/FM protocol.

Dento-skeletal effects produced by rapid versus slow maxillary expansion using fixed jackscrew expanders: a systematic review and meta-analysis.

BACKGROUND: No systematic review and meta-analysis of dento-skeletal effects following rapid maxillary expansion (RME) and slow maxillary expansion (SME) using the same jackscrew expander with different activation protocols is available. OBJECTIVE: To compare dento-skeletal effects produced by RME with those induced by SME using the same fixed jackscrew expanders in growing patients. SEARCH METHODS: PubMed (MEDLINE), Cochrane Library, Scopus, Embase, and OpenGrey were searched with no language or publication date restrictions. SELECTION CRITERIA: Only randomized controlled trials (RCTs) were selected and the following inclusion criteria were used: growing patients in mixed or permanent dentition, with maxillary transverse discrepancy, dental crowding, and treated with fixed jackscrew maxillary expander (e.g. Hyrax, Haas) activated to achieve either RME or SME. DATA COLLECTION AND ANALYSIS: Data were extracted by two independent reviewers. The quality of the included RCTs was assessed according to the Cochrane risk-of-bias tool for randomized trials (RoB 2.0). For the aggregation of continuous data, the mean of the differences (MD) between treatments was used. A random effect model was applied. RESULTS: From 4855 retrieved articles, 3 studies were selected, 1 at unclear risk and 2 at high risk of bias. Maxillary intermolar distance showed no significant differences between the two modalities of expansion [pooled MD = 0.99 mm favouring RME, with 95% confidence interval (CI) = -2.09 to 4.06, P = 0.53, I2 = 90%]. As for maxillary molar inclination measured as the angle formed by the axes passing through the disto-buccal cusps and the apexes of the palatine root of the first upper molars, it was significantly smaller in the SME group (MD = -11.51°, with 95% CI = -15.23 to -7.79, P < 0.0001). Posterior maxillary expansion was significantly greater in RME than SME (pooled MD = 0.75 mm, with 95% CI = 0.27-1.23, P = 0.002, I2 = 0%). CONCLUSIONS: Both RME and SME produce an effective dento-skeletal expansion of the maxilla. RME is slightly more effective in increasing the posterior transverse skeletal width of the maxilla while SME induces smaller molar inclination. REGISTRATION: PROSPERO CDR42018105530.

In vitro comparison of bonding effectiveness of different adhesive strategies.

ABSTRACT: Purpose: To compare the bond strength to human dentin for a variety of adhesive materials, including self-adhesive resin composites, self-etch and etch-and-rinse adhesive systems and glass-ionomer cement by means of micro shear bond strength (µSBS) test and SEM observations. METHODS: Seventy-two human molars were sectioned to obtain a 2 mm-thick slab of mid-coronal dentin and were subsequently randomly divided into nine groups (n = 8). Nine conical frustum-shaped build-ups were constructed on the occlusal surface of each dentin slab using bonding agents (Group 1: OptiBond FL; Group 2: OptiBond XTR) combined with a resin composite (Premise Flow), self-adhesive resin composites (Group 3: RelyX Unicem; Group 4: RelyX Unicem 2; Group 5: SmartCem2; Group 6: SpeedCEM; Group 7: Maxcem Elite; Group 8: Vertise Flow) and a glass-ionomer cement (Group 9: Ketac-Fil). Specimens were subjected to µSBS test and observed with SEM. Data were analyzed by a mixed model and chi-square test. RESULTS: The bond strengths measured in Groups 3-9 were significantly lower than those recorded in Groups 1 and 2. There were no significant differences in bond strengths between Groups 1 and 2 or between Groups 4 through 8. The bond strength measured in Group 9 was significantly lower than those recorded in Groups 4, 5, and 6 but was not significantly different than those recorded in Groups 3, 7, and 8. Failures were mainly adhesive in all groups.

Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis.

BACKGROUND: No systematic review and meta-analysis are present in the literature comparing patient-reported outcome measures (PROMs) in rapid maxillary expansion (RME) versus slow maxillary expansion (SME) in growing patients. OBJECTIVE: The objective of this systematic review was to compare PROMs in RME versus SME in growing patients. MATERIALS AND METHODS: Electronic search in PubMed (MEDLINE), Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey was conducted. Only RCTs were included. Inclusion criteria were: growing patients in the mixed dentition or early permanent dentition, mild-to-moderate maxillary transverse deficiency, dental crowding, treatment with fixed expanders for rapid and slow maxillary expansion. Risk of bias was assessed using RoB 2. GRADE statement was performed. The mean of the differences (MD) and the risk ratio (RR) were used for the aggregation of data. A random effect model was applied. RESULTS: Two articles with a total of 157 patients were finally included in the systematic review and meta-analysis. One article was at low risk of bias, while one was at risk of bias with some concerns. Pain presence was less, though not statistically significant, in SME patients (RR = 2.02, 95%CI from 0.55 to 7.49, P = 0.29, I2 = 95%, 2 studies, GRADE very low). Pain intensity was significantly lower in SME appliance in the first week of treatment (pooled MD = 0.86 favoring SME, 95%CI from 0.47 to 1.26, P < 0.0001, I2 = 6%, 2 studies, GRADE moderate). There were no significant differences between the two groups in difficulty in speaking, difficulty in swallowing, hypersalivation, difficulty in hygiene, and patient and parent satisfaction. CONCLUSIONS: Pain intensity was significantly lower in SME compared to RME during the first week of treatment. For the following weeks, there were no differences in pain between the two protocols.

The influence of ULF-TENS on electroencephalographic tracings.

The purpose of this study was to evaluate and quantify the effects of Ultra-Low Frequency Transcutaneous Electrical Nerve Stimulation (ULF-TENS) on the Central Nervous System, using electroencephalography. The research was conducted on a study group of twelve patients, and a control group of six. Patients were chosen between the ages of twenty and thirty years old, and all had occlusal flags without pain. The electroencephalography patterns were registered, for each patient in the study group, before and after the application of 60' of the ULF-TENS. In nine of the twelve cases studied, a diminution of the cerebral rhythm was registered along with the appearance of a sedative effect caused by an increment in Alfa waves and a state of hypo-alertness caused by an increment in the theta rhythm. An identical effect was registered in one subject of the control group while another subject had an increased cerebral rhythm, and in the remaining four subjects, all values remained invariable. The study demonstrated two important points. First, it confirmed the utility of the EEG as a noninvasive useful method in order to study the central effects of the ULF-TENS, and second, also positive, it revealed the sedative effects on the central nervous system registered by the EEG.

Dental occlusion and body posture: a surface EMG study.

The influence between dental occlusion and body posture has been discussed in the past ten years by several authors with controversial conclusions. The objective of this study was to access, using surface electromyography (EMG), the rest activity of paired sternocleidomastoids, erectors spinae at L4 level, and soleus muscles in a group of 24 volunteer subjects (12 males, 12 females, aged 23-25 yrs) affected by sub-clinical dental malocclusions in different situations of dental occlusion. The subjects' occlusion was balanced (neuromuscularly) (registered on an acrylic wafer). Rest activity was assessed using the sEMG. The measurements were achieved on subjects while standing barefooted, before (Test 1), and 15 minutes after they wore the acrylic wafer (Test 2). The result was a significant reduction of the mean voltage for each muscle. Paired muscles were registered and the balancing rate between right and left muscles showed improvement for all the paired muscles (Wilcoxon test p < 0.05). No significant difference was noted in the relaxation and balancing rates between the muscles tested. The data confirmed a beneficial effect of balancing the occlusion with an acrylic wafer on the following paired postural muscles: sternocleidomostoid, erector spinae, and soleus.

Effect of operator skill in relation to microleakage of total-etch and self-etch bonding systems.

OBJECTIVES: To evaluate the influence of operator skill on microleakage in class V restorations using two-step bonding systems. METHODS: Two standardized box cavities were made on the buccal and lingual surfaces of 54 human bicuspid teeth, with the cervical margin in dentin. The teeth were randomly assigned to two groups according to the operator's skill. Students group: undergraduate students. Expert group: a dentist with 20 years of clinical experience in dental adhesion. The buccal cavities of each tooth were treated with Prime&Bond NT (two-step total-etch system); the lingual cavities were treated with AdheSE (two-step self-etch system). All cavities were restored by a single calibrated operator with one bulk increment of resin composite (InTens; Ivoclar Vivadent). Specimens were thermocycled, immersed in 2% methylene blue and sectioned in a bucco-lingual plane in the middle of the restorations. They were then examined under a stereomicroscope and scored according to microleakage by two operators who were blind to the specimen preparation. The data was subjected to a multilevel statistical model. RESULTS: The microleakage resulting from the self-etch adhesive was similar in the student and in the expert groups. On the other hand, the total-etch adhesive microleakage within the expert group resulted lower than that within the student group. However, the interaction term skill x adhesive resulted statistically significant at the dentin margin (p=0.0474) but not at the enamel margin (p=0.1267). CONCLUSION: While the total-etch adhesive used in this study showed to be skill-sensitive, the self-etch one proved to be less skill-sensitive in obtaining a reliable seal with dentin.

Influences of 432 Hz Music on the Perception of Anxiety during Endodontic Treatment: A Randomized Controlled Clinical Trial.

INTRODUCTION: Patients undergoing endodontic therapy often have severe perioperative and intraoperative anxiety, which may lead to increased perceptions of pain and vital sign instability throughout treatment. The purpose of this study was to test the influences of music, as a nonpharmacologic adjuvant, in terms of significant changes for systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) before, during, and after endodontic treatment in a population with different levels of anxiety assessed with the Corah Dental Anxiety Scale. METHODS: A total of 100 patients were recruited in the present study; before starting the endodontic treatment, the interviewer administered the Corah Dental Anxiety Scale to the participants to assess the baseline level of anxiety. Patients were randomly divided into 2 groups: the first one listened to the music and the second one did not. Before, during, and after the endodontic procedures, the vital signs (diastolic and systolic blood pressure and heart rate) were recorded. Results were collected and statistically analyzed. RESULTS: Direct contrasts between patients listening or not listening to music showed that all the measured vital signs decreased considering the overall period (during and after the canal therapy) in the group of patients listening to music (P < .05). CONCLUSIONS: This study shows the effects of music therapy on vital values and on subjective perception of anxiety during endodontic therapy. Music and medicine always work together; the soothing effects of sounds and musical frequencies make this union an extraordinary tool of synergistic care. Music therapy is a valid nonpharmacologic adjuvant to anxiety perception in endodontic therapies.

Functional approach to a Class II patient with upper first molar impaction.

The lack of the left first molar maxillary and the left second molar maxillary, caused respectively by impaction and agenesis is a very rare case, which determines an important occlusal imbalance and asymmetrical mandible movement. A gnatologic and functional orthodontic approach were planned to improve the retrognathic mandible and the muscular activity using kinesiograph and electromyography.

Retrognathic maxilla in "Habsburg jaw". Skeletofacial analysis of Joanna of Austria (1547-1578).

OBJECTIVE: To evaluate the dentoskeletal features of the "Habsburg jaw" by analyzing the skull of Joanna of Austria. MATERIALS AND METHODS: The skull, the panoramic radiograph, and the lateral cephalogram of Joanna of Austria were analyzed. The cephalometric values of Joanna were compared to cephalometric standards for adult female subjects. RESULTS: The analysis of the dentition on the dry skull and on the panoramic radiograph showed a generalized horizontal alveolar bone resorption with severe bone loss that was interpreted as a sign of severe periodontal disease with respect to the young age (31 years). The cephalometric analysis revealed the presence of a skeletal Class III disharmony associated with maxillary retrusion and normal sagittal position of the mandible. The maxilla exhibited a reduction in the sagittal dimension while the mandible presented with increased dimensions both in total mandibular length (Co-Gn) and in the mandibular body (Go-Gn). The skeletal open bite contributed to the lack of mandibular protrusion though in presence of increased mandibular sagittal dimensions. CONCLUSION: Joanna of Austria appeared to be affected by a peculiar type of "Habsburg jaw" as the Class III skeletal disharmony was due to a retrognathic maxilla rather than to a prognathic mandible.