The role of the dentist and orthodontist in recognizing oro-facial manifestations of acromegaly: a questionnaire-based study.

PURPOSE: Oro-facial manifestations of acromegaly are among the earliest signs of the disease and are reported by a significant number of patients at diagnosis. Despite this high prevalence of acromegaly oral manifestation, dentists do not play a pivotal role in acromegaly identification and diagnosis. The aim of our study was to evaluate the ability of dentists and orthodontists in the early recognition of the oro-facial manifestations of acromegaly. METHODS: A telematic questionnaire was administered to dentists and orthodontists. The questionnaire included photos with facial and oral-dental details and lateral teleradiography of acromegaly patients (ACRO). RESULTS: The study included 426 participants: 220 dentists and 206 orthodontists. Upon reviewing the photos, dentists most often observed mandibular prognathism and lips projection, while orthodontists also reported the impairment of relative soft tissue. Orthodontists, who usually use photos to document patients' oral-facial characteristics, paid more attention to oral-facial impairment than dentists. During dental assessment, 90% of the participants usually evaluated tongue size and appearance, diastemas presence, and signs of sleep impairment (mainly orthodontists). Orthodontists were also more able to identify sella turcica enlargement at teleradiography. A total of 10.8% of the participants had ACRO as patients and 11.3% referred at least one patient for acromegaly suspicion. CONCLUSION: The study highlighted dentists' strategic role in identifying ACRO. Increasing dentists' awareness about acromegaly clinical issues may improve early diagnosis, potentially resulting in an increased quality of life and decreased mortality among ACRO.

Effects of Rapid Palatal Expansion on Chewing Biomechanics in Children with Malocclusion: A Surface Electromyography Study.

Malocclusion during childhood may affect both morphology and masticatory function and could greatly affect the subsequent growth and development of the jaws and face. The purpose of this study was to evaluate the efficiency of surface electromyography in describing the effects of the rapid palatal expansion (RPE) on Masseter (M) and Temporalis Anterior (T) muscles' activity in 53 children with different types of malocclusion: bilateral posterior crossbite (BPcb), underdeveloped maxillary complex without crossbite (NOcb) and unilateral posterior crossbite on the right (UPCBr) and on the left (UPCBl). The muscular activities during chewing tasks were assessed bilaterally before and after RPE application and three months after removal. Both the envelope's peak (µV) and its occurrence (% of chewing task) were extracted from the surface electromyography signal. Our results showed the presence of statistically significant differences (p < 0.05) on temporomandibular joint muscles, across different assessments, in all the tested populations of subjects. Surface electromyography demonstrated a relationship between the correction of a maxillary transverse discrepancy and the restoration of a muscle's activation patterns comparable to healthy subjects for both T and M.

The use of the laser confocal scanning microscopy to measure resin remnants on customized lingual bracket.

BACKGROUND: The study aimed to evaluate the permanence of resin and enamel remains on lingual brackets at the end of orthodontic treatment and after the debonding procedure. The evaluation of resin remnants on customized lingual brackets bases has never done before in other studies because they are curved, and traditional techniques are not applicable. METHODS: The sample consisted of 100 lingual brackets (25 incisors, 25 canines, 25 premolars, 25 molars) scanned with a confocal laser microscope (OLS4000). We measured the brackets' surface and the area of resin remnants with the software of the microscope. Median and quartiles were presented to describe the data. ARI calculation was indirect for each tooth, measuring the resin remnants to the total surface of the bracket. The Kruskal-Wallis test and Fisher test were applied respectively to compare the percentages of remnants and the frequencies of the ARI between the four groups. RESULTS: After the analyses, 13 brackets had no adhesive remnants (ARI 0), 29 brackets had less than 50% of resin remnants (ARI 1), 50 brackets had more than 50% of resin remnants (ARI 2), and 8 brackets had 100% of adhesive (ARI 3). Canines brackets presented the lower amount of resin followed by premolars, incisors, and molars. CONCLUSION: Lingual brackets showed a high frequency of ARI = 2. The median percentage of the bracket surface covered by resin was 41%. We observed a slight tendency of more resin remnants on molar brackets, due to half-pad configuration. The authors suggest paying attention during the debonding procedure of molar brackets since a stronger connection between the adhesive and the bracket mesh means a higher risk of enamel damage.

Validity of the STOP-Bang Questionnaire in Identifying OSA in a Dental Patient Cohort.

Background and objectives: Obstructive Sleep Apnea represents a widespread problem in the population, but it is often not diagnosed and not considered a true pathology. Different diagnostic tools are available for the diagnosis of sleep apnea. This study aims to demonstrate the ability of the STOP-Bang (Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) questionnaire in identifying subjects with Obstructive Sleep Apnea (OSA) Syndrome, highlighting the role of dentists as epidemiological sentinels. Materials and methods: the STOP-Bang questionnaire was administered to a cohort of 1000 patients, assessing three private dental clinics in Italy. Excessive daytime sleepiness was measured using Epworth Sleepiness Scale (ESS) and defined as ≥ 10. Subjects were considered at risk of OSA if they had three or more positive items at STOP-Bang and were invited to undergo further examination with a type 3 polygraph. Presence of OSA was measured with the apnea-hypopnea index (AHI) and defined as AHI ≥ 5. Results: 482/1000 subjects (48.2%) had three or more positive items in the STOP-Bang questionnaire and were considered at risk for Obstructive Sleep Apnea Syndrome (OSAS). Excessive daytime sleepiness (EDS ≥ 10) was more frequent among subjects at risk for OSAS (73/482, 15.1%) vs. those not at risk for OSAS (30/518, 5.8%) (p < 0.0001). Moreover, 153/482 subjects at risk for OSAS (31.7%) accepted further examination with a type 3 polygraph. Presence of OSAS (AHI ≥ 5) was suggested in 121/153 subjects (79.1%, 95% CI 71.6% to 85.1%), with 76/121 subjects (62.8%) needing treatment (AHI ≥ 15). Conclusion: the high prevalence of OSAS highlights the role of dentists as "epidemiological sentinels". The STOP-Bang questionnaire is a simple and efficacious instrument for screening sleep apnea patients.

Multidisciplinary treatment with a customized lingual appliance for an adult patient with severe Class III malocclusion and multiple missing teeth.

A 24-year-old man presented with a severe skeletal class III malocclusion, associated with an anterior and posterior crossbite in the left side, upper and lower lip eversion, skeletal asymmetry, midline discrepancy, diastemas in the maxillary and mandibular dental arches, and agenesis of maxillary lateral incisors and canines with retained deciduous teeth. Treatment was performed with the use of the Win Lingual System. When the 0.016 × 0.022-inch NiTi archiwire was applied, the deciduous teeth were extracted and replaced with temporary crowns connected to the appliance. After the aligning, leveling, and diastema closure phases, a modified Le Fort II osteotomy, a mandibular setback with a bilateral sagittal split osteotomy and a genioplasty were performed. Implants were placed in the canine site through a flapless guided surgery, and cantilevered temporary bridges were delivered. Final prosthetic rehabilitation included veneers for the central incisors and zirconia-ceramic cantilevered bridges for the canine and lateral incisors. After 36 months of active treatment, the patient showed an Angle Class I molar and canine relationship and an ideal overbite and overjet. His profile had improved, lips were competent, and gingival levels were acceptable. The lateral radiograph and cephalometric analysis showed a good balance of the skeletal pattern, a good profile of the soft tissue, and proper inclinations of the maxillary and mandibular incisors in relation to maxilla and mandible. After 2 years of follow-up, the patient had a pleasant smile and no relapse, or joint or muscular pain.

Prevalence of Hypodontia in Unilateral and Bilateral Cleft Lip and Palate Patients Inside and Outside Cleft Area: A Case-Control Study.

OBJECTIVES: The aim of this study is to evaluate the prevalence and distribution of hypodontia, inside and outside the cleft area, in an Italian population with a non-syndromic unilateral (UCLP) and bilateral (BCLP) cleft lip and palate on panoramic radiographs and comparing it with a control sample. STUDY DESIGN: Case group was ethnically uniform and consisted in 233 patients. The control group was composed of 1000 subjects. Patients included were between seven and fifteen years old. Descriptive analysis, using absolute and relative frequencies, was performed to check out the prevalence of gender distribution, hypodontia and cleft formation. Statistical analysis was conducted with Chi-squared test, Yate's correction and the Fisher's exact test. The power was set higher than 0.8 for each test. RESULTS: 160 cleft patients (68.68%) presented at least one missing tooth, while 88 patients in the control groups presented agenesis (8.80%). A statistically significant difference was found in case and control groups for upper lateral incisors (37.34% and 48.07% in the case group against 2.50% and 2.60% in the control group), upper and lower second premolars (8.58%, 6.44%, 5.58% and 6.01% in the cleft group and 0.60%, 0.60%, 2.50% and 2.70% in the control group). CONCLUSION: Higher prevalence of dental agenesis in the maxillary dental arch is explained by the cleft defect. Higher prevalence of mandibular second premolars agenesis cannot be explained by the anatomical defect and suggests a multifactorial aetiology, including environmental and genetic factors, of the cleft condition.

Combined Orthodontic and Surgical Treatment in a 8-Years-Old Patient Affected By Severe Obstructive Sleep Apnea: A Case-Report.

An eight-years-old girl showed a restless sleep with snoring and severe apnea episodes, a mandibular retrognathia, mouth breathing, maxillary transverse discrepancy, mandibular transverse discrepancy, moderate crowding and anterior open-bite. The CBCT showed an anterior collapse of the epiglottis. The treatment consisted in a rapid palatal expansion, an epiglottoplasty and a reduction of the tongue base. Polysomnography revealed that apnea-hypopnea index improved from 21,8 episodes/hr at the baseline to 0,6 episodes/hr, average oxygen saturation from 96,5% to 98,1%, oxygen desaturation events from 23,4 episodes/hr to 1/hr.

Maturation of the Middle Phalanx of the Third Finger: A Comparative Study between Right and Left Hand.

OBJECTIVES: Recently a classification of patient's skeletal age based on the phalanx maturation, The Middle Phalanx Maturation of the third finger (MPM) method, was suggested. The aim of this study is to evaluate if there is a difference in MPM between the right and left hand. STUDY DESIGN: Two hundred fifty-four patients were obtained from the Complex Operating Unit of Orthodontics of Padua University Hospital. The total sample size has been selected by appropriate statistical calculations resulting in 130 patients. It was decided to further double the sample size of a previous study to ensure a robust statistical analysis. Radiographs of the right and left were obtained using the MPM method. Stages were compared using the right hand as a reference. The statistical analysis (Fisher exact test) was performed for the entire sample and related to gender in order to compare the right and the left hand stages. RESULTS: In MPS2, 6 out 49 (12.2%) males and 7 out 27 females (25.9%) showed MPS3 in the left hand (p-value < 0.05). In all other stages, a total agreement (100%) was found. CONCLUSION: The authors confirm the use of the right hand as reference. In patients with MPS2 an additional radiograph on the left hand can be taken in order to increase the diagnostic accuracy. In all other stages other radiographs are not needed as a total agreement between the right and left hand was found.

Periodontal status after surgical-orthodontic treatment of labially impacted canines with different surgical techniques: A systematic review.

INTRODUCTION: Good periodontal status is essential for a successful treatment outcome of impacted maxillary canines. Whereas the surgical technique used for tooth uncovering has been shown not to affect the final periodontal status of palatally impacted canines, its effect on labially impacted canines is still unclear. METHODS: Searches of electronic databases through January 2015 and reference lists of relevant publications were used to identify studies evaluating the periodontal status of labially impacted canines after combined surgical-orthodontic treatment. Two reviewers independently screened the articles, extracted data, and ascertained the quality of the studies. RESULTS: Ninety-one studies were identified; 3 were included in the review. No included study examined the periodontal outcome of the closed eruption technique. Excisional uncovering was reported to have a detrimental effect on the periodontium (bleeding of the gingival margin, 29% vs 7% in the control group; gingival recession, -0.5 mm [SD, 1.0] vs -1.5 mm [SD, 0.8] in the control group; and width of keratinized gingiva, 2.6 mm [SD, 1.4] vs 4.1 mm [SD, 1.5] in the control group). Impacted canines uncovered with an apically positioned flap had periodontal outcomes comparable with those of untreated teeth. CONCLUSIONS: The current literature is insufficient to determine which surgical procedure is better for periodontal health for uncovering labially impacted canines.

Customized orthodontics: The Insignia System.

Customized treatment systems offer both patient and clinician numerous advantages, first and foremost the possibility of viewing a computerized rendering of the dentition in three dimensions. This allows the orthodontist to perform accurate measurements, analyses and simulations, and for both to be able to view the end result on screen. Thus, computerized technology consents optimization of not only the diagnostic phase, by means of extremely accurate three-dimensional imaging systems, but also the operative phase, by supplying individualized appliances with little or no correction while the treatment is in progress. In this article we present a customized orthodontic system called Insignia and how it works through two different clinical cases.

Patients' perceptions of the importance of improvements and side effects from mandibular advancement device therapy for obstructive sleep apnea and snoring.

OBJECTIVE: To assess which improvements and side effects are considered most important by patients with OSA treated with a MAD. METHODS: A specific questionnaire consisting of 20 questions, including 10 questions on improvements and 10 on side effects, was developed and mailed to all subjects (54). RESULTS: 42 patients, participated in the survey by answering the questionnaire. The results showed that patients placed greater importance on the positive outcomes of treatment, with the most significant being the reduction in snoring and improvement in sleep quality. On the other hand, the side effects of difficulty speaking with the device, tooth mobility, and foreign body sensation were considered important. CONCLUSIONS: The advantages perceived by the patients appear to outweigh the disadvantages, especially the reduction of snoring, increased productivity, and improved social and intellectual life. Most significant side effects are reversible and short-term, while occlusal changes, is not considered important by patients.

Bulk-flow composites in paediatric dentistry: long term survival of posterior restorations. A retrospective study.

Dental decay is a prevalent bacterial disease affecting a significant percentage of children globally. In paediatric dentistry, various materials are available for restoring deciduous teeth, addressing both functional and aesthetic concerns. However, paediatric dentists encounter challenges related to patient compliance, limited working time, and material handling. This study aims to observe the survival rate of bulk-fill composite restorations in paediatric patients over a five-year follow-up. A total of 198 patients aged 0 to 12 years underwent 673 class II restorations on deciduous first molars (1M) and second molars (2M). All restorations were conducted performed by 1 Pediatric DDS resident students from the Paediatric Dentistry Department (Padova University), utilizing using different isolation techniques. Bulk-fill composite restorations were evaluated over a five-year follow-up, and data were collected by a single investigator. After five years, 177 patients and 611 restorations were assessed. The retention rate was higher in primary second molars than in first molars, with fewer marginal dyschromies and less formation of secondary caries. The overall failure rate was higher in primary first molars and primary lower second molars. Bulk-fill composites demonstrated significantly positive performance in terms of retention, maintenance, and marginal dyschromies. Bulk-fill composites are promising materials of choice in paediatric dentistry due to their easy handling and favorable properties. Further research is necessary to compare high and low viscosity bulk-fill composites and assess the impact of different variables on restoration success.

Influence of New Technology in Dental Care: A Public Health Perspective.

The advent of new technology has caused significant changes in the field of dentistry, enabling dentists and orthodontists to provide more efficient and effective treatments to their patients [...].

Assessment of Oral Health in a Child Cohort of a Rural Zone of Ethiopia.

Health conditions in a developing state such as Ethiopia are precarious; in addition to the extreme spread of infectious diseases such as AIDS, oral health is also affected by the scarce knowledge and possibility of treatment. This analysis considered 77 children aged 7 to 11 from a primary school in Guraghe in Ethiopia. The presence of plaque, calculus, and caries was evaluated. For each caries, the affected tooth and the site of onset were considered. Plaque was detected in 39% of the children, calculus in 22%, and dental caries in 48% of the patients. The cavities were found to be equally distributed between the two arches, with a prevalence of location in the deciduous teeth and in the occlusal area. The implementation of home oral hygiene education and the training of health professionals who successfully promote oral health is necessary.

Management of the Pediatric Patient with Suspected Diagnosis of Obstructive Sleep Apnea Syndrome.

AIM: The aim of this paper is to describe the multidisciplinary management pathway for pediatric patients with suspected obstructive sleep apnea syndrome (OSAS) conducted by the Pediatric and Orthodontic Department of the Dental Clinic of Padua. MATERIALS AND METHODS: All pediatric subjects undergo a comprehensive medical history, including the completion of the Pediatric Sleep Questionnaire (PSQ), and a physical examination. Patients with suspected OSAS are placed on a waiting list for home respiratory polygraphy testing. The respiratory polygraphy examination is conducted over two consecutive nights and interpreted by a neurologist. Additionally, patients diagnosed with OSAS undergo a case study involving intraoral and extraoral photography, as well as radiographic evaluation. RESULTS: Between September 2021 and May 2023, a total of 134 subjects (including 76 males), with an average age of 9.2 years, were identified as diagnostic suspects. Among these, 38 patients (28.3%) tested positive based on respiratory polygraphic results. Depending on the severity and etiopathogenetic characteristics of the disease, the positive cases were referred to various specialists. CONCLUSION: In the daily clinical practice of dentistry, particularly in orthodontics and pedodontics, the establishment of a defined management pathway for pediatric patients with OSAS is crucial. The collaboration of a multidisciplinary team with a shared objective of achieving accurate diagnosis and implementing targeted treatment in a timely manner is essential. Regular re-evaluation of patients through clinical and instrumental examinations is recommended.

Pain during Rapid Maxillary Expansion: A Systematic Review.

AIM: The aim of the present systematic review is to evaluate the pain perceived by patients during rapid maxillary expansion (RME) in relation to factors such as demographic characteristics, appliance type, activation protocol, and the eventual use of medication or pain management strategies. MATERIALS AND METHODS: An electronic search of available articles on the subject was conducted on three electronic databases, using predefined keywords. Sequential screenings based on pre-established eligibility criteria were performed. RESULTS: Ten studies were ultimately included in this systematic review. The main data of the reviewed studies were extracted according to the PICOS approach. CONCLUSIONS: Pain is a common effect of RME treatment that tends to decrease over time. Gender and age differences in pain perception are not clear. Perceived pain is influenced by the expander design and expansion protocol used. Some pain management strategies can be useful for reducing RME-associated pain.

Dental arch form and interdental widths evaluation in adult Caucasian patients with obstructive sleep apnea syndrome.

OBJECTIVE: To evaluate the hypothesis that dental arch form and inter-canine, inter-premolar, and inter-molar widths differ between OSAS patients and non-snoring, non-apneic controls. METHODS: Dental digital models from 64 OSAS patients and 64 control subjects were used to obtain dental arch forms and to compare them between the two groups. Arch forms were extracted from the lower arch models using a professional graphics program and an orthodontic digital template. Through an orthodontic software, inter-molar, inter-premolar, and inter-canine widths were measured for both upper and lower arches. RESULTS: The dental arch forms distribution differed between OSAS patients and controls. OSAS patients had reduced inter-canine, inter-premolar, and inter-molar widths for both arches compared to controls. DISCUSSION: These results suggest that OSAS patients have narrower and more tapered arches than controls. Dental arch morphology and interdental widths differ between OSAS and control groups, supporting the hypothesis that they are an etiological factor.

Antero-Posterior Mandibular Excursion in Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Device: A Retrospective Cohort Study.

Since obstructive sleep apnea (OSA) management with a mandibular advancement device (MAD) is likely to be life-long, potential changes in mandibular movements during therapy should be investigated. The purpose of this study was to use a method that has already been shown to be reliable in order to determine whether the range of antero-posterior mandibular excursion, the procedure upon which MAD titration is based, varies between baseline (T0) and at least 1 year of treatment (T1). The distance between maximal voluntary protrusion and maximal voluntary retrusion determined using the millimetric scale of the George Gauge was retrospectively collected from the medical records of 59 OSA patients treated with the MAD and compared between T0 and T1. A regression analysis was performed to evaluate the influence of treatment time, MAD therapeutic advancement and the patient's initial characteristics in excursion range variation. A statistically significant increase of 0.80 ± 1.52 mm (mean ± standard deviation, p < 0.001) was found for antero-posterior mandibular excursion. The longer the treatment time (p = 0.044) and the smaller the patient's mandibular excursion at T0 (p = 0.002), the greater the increase was. These findings could be explained by a muscle-tendon unit adaptation to the forward mandibular repositioning induced by the MAD. During MAD therapy, patients can develop a wider range of antero-posterior mandibular excursion, especially those with a smaller initial excursion capacity.

Correlation between Malocclusions, Tonsillar Grading and Mallampati Modified Scale: A Retrospective Observational Study.

AIM: to investigate the correlation between growth tendency and different patient malocclusion, tonsillar grading, and tongue size (Mallampati index). MATERIALS AND METHODS: The sample is composed of 64 males and 40 females; patients aged between 6 and 16 years (median age 11 years, IQR 9-13) were included. The final sample is therefore 104 patients. After the first orthodontic visit, all the children underwent a collection of documentation (photographs, digital arch models, and X-rays). Patients were classified according to their malocclusion, palatal conformation, tonsillar grading, and Mallampati index. Group comparisons were performed using Fisher's test. A p-value less than 0.05 was considered statistically significant. RESULTS: The narrow palate was more frequent in those with Angle class III (p = 0.04), while the other variables considered (tonsillar grading, Mallampati, and lingual frenulum) were not significantly associated with dental class (p > 0.05). Furthermore, a different distribution of tonsillar grading was observed between subjects with normal palate and subjects with narrow palate, while no statistically significant association was found between the palatal shape and Mallampati index (p = 0.88). CONCLUSIONS: This study found that children with higher tonsillar grading had a higher prevalence of crossbite or narrow palate compared to other children at the same developmental stage. However, we did not observe any association between tonsil hyperplasia and the prevalence of class II malocclusion, anterior open bite, or patient divergence in this sample. Furthermore, no correlation was found between the Mallampati index and patients' dental class, narrow palate, or divergence in this study.

Treatment of Ankyloglossia: A Review.

AIM: The aim of this narrative review is to analyze and compare the current scientific evidence regarding the diagnosis and treatment of hypertrophic lingual frenulum in preschool and school-age children. The treatments considered in this review are traditional surgical therapy, laser-assisted surgical therapy, and functional rehabilitation therapy. MATERIALS AND METHODS: A comprehensive literature review was conducted using the PubMed and PubMed Central search engines, considering articles published in the English language between 1 January 2000 and 30 June 2022. The bibliographic search was performed using the following keywords as search strings: "lingual", "frenulectomy", "frenulotomy", "frenulum", "ankyloglossia", and "laser." RESULTS: A total of 14 articles were included in this review, including four prospective observational studies, one case-control study, three cross-sectional studies, four retrospective studies, and one randomized controlled trial. The data extracted from each article are summarized in a table. CONCLUSIONS: In the literature, there are still limited studies regarding the treatment of hypertrophic frenulum. No common indications for the treatment of ankyloglossia and universally used classification for lingual frenulum were found. Currently, clinicians prefer the use of a diode laser for treatment. This method offers several advantages over the use of a scalpel blade. Many studies agree on the usefulness of providing patients with myofunctional rehabilitation to improve lingual mobility, both prior to surgical therapy and in the postoperative period.