Three-dimensional facial swelling evaluation of piezo-electric vs conventional drilling bur surgery of impacted lower third molar: a randomized clinical trial.

BACKGROUND: Among the post-surgical complications of lower wisdom teeth surgery, swelling is considered by patients one of the most impairing, with both social and biological influences and impacting patients' quality of life. Aim of the study was to evaluate the swelling following the osteotomy when performed with drilling burs versus piezo-electric instruments in the mandibular impacted third molar extraction, using a facial reconstruction software. MATERIALS AND METHODS: A randomized, split-mouth, single-blind study was conducted on patients, ranging between 18 and 40 years of age, requiring lower third molars extraction and referred at the Oral Surgery Unit of the School of Dentistry of the University of Messina. Twenty-two patients were recruited during an 8 months period according to the following criteria: good general health conditions; bilateral, symmetrical, impacted third molars; no use of medication that would influence or alter wound healing; no temporomandibular joint disorder history; no smoking. All patients underwent bilateral surgical removal. For each patient, a facial scan was obtained prior to the surgical procedures. The two extractions were conducted performing, in a randomized way, osteotomy with rotatory burs or use of piezo surgical instruments. Facial scans were repeated at 3 and 7 days after the surgical procedures. Volumetric differences were calculated via superimposition using a dedicated software. The data obtained were processed using paired t-test. RESULTS: The results obtained from our study showed no significant differences between two groups regarding post-operative swelling. To the best of our knowledge, this study represents the first experience of using an objective method that can be reproducible on the collection of patients' clinical parameters. CONCLUSIONS: The 3D digital analysis, in the evaluation of facial swelling, is a technique of simple application, objective, reproducible, reliable, decreasing the variables of error. Based on these data, it is possible to conclude that piezo surgery is a safe way for performing the osteotomies during third molar surgery. However, regarding the post-operative swelling, it does not show an advantage over classical rotary instruments. TRIAL REGISTRATION: Registered on ClinicalTrials.gov (ID: NCT05488028, on 04/08/2022). Approved by Ethical Committee of Messina: (ID 01-2020, on 27/04/2020).

Evaluation of mandibular symmetry and morphology in adult patients with unilateral posterior crossbite: a CBCT study using a surface-to-surface matching technique.

OBJECTIVES: To investigate mandibular morphology in adults affected by posterior unilateral crossbite (PUXB) and to evaluate the hemi mandibular volumes from the crossbite (CB) and non-CB sides of the same patients. METHODS: Thirty-eight cone beam computed tomography (CBCT) images were consecutively recruited and the Digital Imaging and Communications in Medicine (DICOM)-formatted scans were volume rendered into a surface three-dimensional (3D) mesh model and volumes to obtain the 3D model of the mandibular bone. To achieve the surface point-to-point analysis of the mandibular models, a reverse engineering software was used. The same procedure was performed for an age-matched control group (19 CBCT images). RESULTS: Total mandibular volume showed a difference of 2.46 cm3 between patients and controls, which was not statistically significant. A mean difference of 1.53 cm3 was found comparing the hemi mandibular volumes from the CB and non-CB sides of PUXB patients, this difference was statistically significant (P ≤ 0.01). Findings for the surface-to-surface deviation analysis, demonstrated a higher percentage of mismatch in patients PUXB, over 10% at 0.5 mm tolerance level. LIMITATIONS: Limitations are related to the intrinsic surfaces matching methodology, that make difficult to evaluate discrepancies among different mandibular anatomical units. CONCLUSION: Adult patients affected by PUXB show a greater mandibular structural asymmetry compared to controls because of a lower matching percentage obtained from the surface-to-surface matching technique. IMPLICATIONS: Treatment of adult patients affected by PUXB should take into consideration the possibility of a mild mandibular asymmetry mainly localized at the condyle and gonial angle levels.

Is static friction affected by aging and amount of elastomeric ligatures in orthodontic sliding mechanics? An in-vitro investigation.

In straight-wire mechanics, friction can significantly influence the forces expressed by wires. The aim of this study is to assess whether the aging and the sum of elastomeric ligatures affect the static friction during orthodontic space closure. A 0.017x 0.025-in SS was drawn throughout a 3-bracket experimental model and engaged with elastomeric ligatures. Before performing the test, the ligatures were soaked in artificial saliva for 48 hours (Group 1), 2 weeks (Group 2) and 4 weeks (Group 3); brand-new ligatures were also tested as control group (Group 4). The resistance to sliding (RS) was recorded at 3 different numerical configurations of ligatures using a customized testing machine and tests were repeated for ten times. Data of RS were statistically analysed by using two way analysis of variance (ANOVA) and Tukey's multiple comparison tests. RS was found to increase systematically when more elastomeric ligatures were included in the wire engaging system. At two weeks of immersion in artificial saliva elastomeric ligatures showed the lowest values of RS while they became significantly more frictional after immersion for 4 weeks. The results of this study showed that in multi-bracket orthodontic therapy, the RS increases with the number of elastomeric ligatures involved for arch-wire engagement. Differently from the frictional behavior of elastomeric modules, the aging of these ligatures does not influence their incremental effect of frictional forces.

Standard and low-dose cone beam computer tomography protocol for orthognatodontic diagnosis: a comparative evaluation.

Considering the diagnostic capability offered by cone-beam computed tomography (CBCT), nowadays orthodontists often use this exam for treatment planning, especially in cases of impacted teeth, maxillary ipoplasia, orthognathic surgery etc. The aim of this study was to compare the radiation doses related to a conventional CBCT setting and that of a low dose protocol, usable in orthodontic practice. The absorbed organ doses were measured using an anthropomorphic phantom loaded with thermo-luminescent dosimeters related to sensitive organs (brain, bone marrow, salivary glands, thyroid, esophagus, oral mucosa, extrathoracic airways, lymph nodes). The device used was a MyRay Hyperion X9-11x5. The standard setting of the apparatus was 90 Kv, 36 mAs, CTDI/Vol 4.09 mGy, instead the low dose one was 90 Kv, 27 mAs, CTDI/Vol 2.89 mGy. Equivalent and effective doses have been calculated; the measurement of the effective doses was based on the ICRP recommendations. For the assessment of image quality, five readers, independent and experienced orthodontists, were asked to state if the images were sufficient enough to perform an orthodontic diagnosis. The lowest organ dose (5.01 microSv) was received by the esophagus during low dose CBCT acquisition. The highest mean organ dose instead (1227.67 microSv) was received by the salivary glands during conventional setting CBCT acquisition. Image quality has been considered sufficient for orthodontic diagnostic needs for both CBCT protocols. CBCT low dose setting should be preferred over the standard one in orthodontic practice, because it provides a significant lower radiation dose to the patients ensuring a good image quality. However, further studies are necessary to evaluate the opportunity of CBCT exams in orthodontic treatment planning.

Effects of rapid vs slow maxillary expansion on nasal cavity dimensions in growing subjects: a methodological and reproducibility study.

AIM: To evaluate the methodological feasibility of a RCT comparing skeletal changes of nasal cavity size obtained with RME and SME, assessed via CBCT. MATERIALS AND METHODS: Twenty Caucasian children with a mean age of 10.4 years were recruited and allocated to receive RME (10 subjects, mean age 10.4 years) or SME (10 subjects, mean age 10.5 years). INCLUSION CRITERIA: constricted maxillary arch, upper and lower first molars erupted, unilateral or bilateral posterior crossbite. EXCLUSION CRITERIA: age above 15 years, history of previous orthodontic treatment, periodontal disease, systemic disease affecting craniofacial growth, or craniofacial congenital syndrome. CBCT examinations were performed before treatment (T0) and 7 months after expander removal (T1). Changes of nasal width (NW), palatal width (PW) and total nasal volume (TNV) were assessed; palatal and nasal expansion was also calculated as a percentage of the increase of intermolar width IMW (PW% and NW%). RESULTS: The correlation between the first and the second readings ranged from 0.991 to 0.995 for linear measurements and was of 0.915 for volumetric measurements. The method error, as described by the value of ?, was in general less than 0.3 mm for linear measurements and 0.372 cm³ for volumetric measurements. All linear transverse skeletal and dental measurements and the nasal volume increased with both RME and SME protocols. CONCLUSION: The reported methodology can be reasonably used to investigate the transverse dimension of nasal cavity. The PW% and NW% parameters more accurately described the efficacy of the two expansion protocols as compared to their corresponding absolute measurement (PW and NW).

Multimodal airway evaluation in growing patients after rapid maxillary expansion.

AIM: The objective of this study was to evaluate the airway volume of growing patients combining a morphological approach using cone beam computed tomography associated with functional data obtained by polysomnography examination after rapid maxillary expansion treatment. STUDY DESIGN: 22 Caucasian patients (mean age 8.3±0.9 years) undergoing rapid maxillary expansion with Haas type expander banded on second deciduous upper molars were enrolled for this prospective study. Cone beam computed tomography scans and polysomnography exams were collected before placing the appliance (T0) and after 12 months (T1). METHODS: Image processing with airway volume computing and analyses of oxygen saturation and apnoea/hypopnoea index were performed. RESULTS: Airway volume, oxygen saturation and apnea/hypopnea index underwent significant increase over time. However, no significant correlation was seen between their increases. CONCLUSION: The rapid maxillary expansion treatment induced significant increases in the total airway volume and respiratory performance. Functional respiratory parameters should be included in studies evaluating the RME treatment effects on the respiratory performance.

Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta-analysis.

The objective of this systematic review was to estimate the efficacy of protraction facemask on the correction of Class III malocclusion in the short term. A systematic review of articles was performed using different electronic databases (PubMed, Ovid, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, and Google Scholar). Search terms comprised 'orthopedic treatment' and 'Class III malocclusion'. The selection criteria were set in order to include in this review only randomized clinical trials (RCTs) performed treating with facemask Class III growing patients. Studies' selection, data extraction, and risk of bias's assessment were executed independently by two authors using pre-defined data forms. All pooled analyses of data were based on random effects models. A pre-specified subgroup analysis was planned to evaluate the effect of preliminary rapid palatal expansion on facemask efficacy. Three RCTs met our inclusion criteria. In total, data from 155 patients (92 treated and 63 controls) were collected. The treated group showed the following significant changes: ANB° +3.66° [95%CI (2.58, 4.74)]; SNA° +2.10 [95%CI (1.14, 3.06)]; SNB° -1.54 [95%CI (-2.13, -0.95)]; SN-palatal plane -0.82° [95%CI (-1.62, -0.02)]; and SN-mandibular plane +1.51 [95%CI (0.61, 2.41)]. Heterogeneity varied from low to moderate (mean I(2) value: 41.4 ± 20.8). Facemask is effective correcting Class III malocclusion in the short term. The skeletal modifications induced by facemask are forward displacement of maxilla, backward displacement of mandible, clockwise rotation of the mandibular plane, and counterclockwise rotation of the maxillary plane.

Temporomandibular joint involvement in a cohort of patients with Juvenile Idiopatic Arthritis and evaluation of the effect induced by functional orthodontic appliance: clinical and radiographic investigation.

AIM: The aim of the study was to assess possible correlations between the clinical parameters of temporomandibular joint (TMJ) arthritis and pathologic MRI findings of the TMJ in patients affected by juvenile idiopathic arthritis (JIA), and the effect of a functional orthodontic therapy on the evolution of TMJ disorders. MATERIALS AND METHODS: A prospective clinical and nuclear magnetic resonance (NMR) investigation was conducted on a sample of 53 patients (41 female, 12 male) with JIA, treated for 24 months with an Andresen appliance. The involvement of TMJ was defined by clinical and radiological signs. NMR assessments were performed in closed and maximum opening mouth position before (T0) and at the end of functional orthodontic therapy (T1). RESULTS: Fifteen patients showed physical and radiologic TMJ abnormalities. Changes were not uniformly distributed among the different JIA subtypes. Patients with poliarticular JIA (≥5 peripheral joints affected) showed more destructive bony changes. No correlation existed between clinical symptoms and NMR alterations. Approximately one half of the patients experienced significant improvement of the TMJ and muscular pain using the Andresen appliance. CONCLUSION: The prevalence of TMJ involvement in patients suffering of JIA, and the improvement of TMJ and muscular pain associated with the use of functional appliance found in the present study, suggest an alert for TMJ dysfunction in patients with JIA and demonstrate the utility of functional orthodontic therapy in preventing the morbidities associated with TMJ arthritis in JIA.

Transverse changes determined by rapid and slow maxillary expansion--a low-dose CT-based randomized controlled trial.

OBJECTIVES: To compare transverse skeletal changes produced by rapid (RME) and slow (SME) maxillary expansion using low-dose computed tomography. The null hypothesis was that SME and RME are equally effective in producing skeletal maxillary expansion in patients with posterior crossbite. SETTING AND SAMPLE POPULATION: This study was carried out at the Department of Oral Sciences, University of Naples Federico II, Italy. Twelve patients (seven males, five females, mean age ± SD: 10.3 ± 2.5 years) were allocated to the SME group and 14 patients (six males, eight females, mean age ± SD: 9.7 ± 1.5 years) to the RME group. MATERIALS AND METHODS: All patients received a two-band palatal expander and were randomly allocated to either RME or SME. Low-dose computed tomography was used to identify skeletal and dental landmarks and to measure transverse maxillary changes with treatment. RESULTS: A significant increase in skeletal transverse diameters was found in both SME and RME groups (anterior expansion = 2.2 ± 1.4 mm, posterior expansion = 2.2 ± 0.9 mm, pterygoid expansion = 0.9 ± 0.8 mm). No significant differences were found between groups at anterior (SME = 1.9 ± 1.3 mm; RME = 2.5 ± 1.5 mm) or posterior (SME = 1.9 ± 1.0 mm; RME = 2.4 ± 0.9 mm) locations, while a statistically significant difference was measured at the pterygoid processes (SME = 0.6 ± 0.6 mm; RME = 1.2 ± 0.9 mm, p = 0.04), which was not clinically relevant. CONCLUSION: Rapid maxillary expansion is not more effective than SME in expanding the maxilla in patients with posterior crossbite.

Enhancing the diagnosis of maxillary transverse discrepancy through 3-D technology and surface-to-surface superimposition. Description of the digital workflow with a documented case report.

BACKGROUND: Maxillary transverse discrepancy is often diagnosed in childhood. The evaluation of morphological characteristics of the maxilla is crucial for appropriate treatment of this condition, however conventional diagnostic method is based on visual inspection and transversal linear parameters. In this paper, we described a user-friendly diagnostic digital workflow based on the surface-to-surface analysis. We also described a case report. CASE REPORT: A 6-year-old female patient presenting mild transversal maxillary deficiency associated with functional posterior crossbite was treated by using maxillary removable appliance. In this respect, the appliance was designed in accordance to the morphological characteristics of the maxilla obtained by using the diagnostic digital work-flow and the maxillary surface-to-surface analysis. CONCLUSION: The present user-friendly diagnostic digital workflow based on surface-to-surface analysis helps clinicians to detect specific morphological characteristics of the maxilla, such as shape and area of asymmetry, in order to reach a comprehensive diagnosis and choose the correct biomechanics for treating the condition.

Myotonic dystrophy and craniofacial morphology: clinical and instrumental study.

AIM: The aim of this study is to assess if, and to what extent, myotonic dystrophy can affect the craniofacial growth pattern. MATERIALS AND METHODS: The research was conducted on a sample of 27 patients with Steinert's myotonic dystrophy (study group). Each subject underwent a clinical examination with impression-taking and intra- and extraoral photographs. A latero-lateral projection teleradiography in the mirror position was also taken and a cephalometric examination was performed. The assessed values were compared with those obtained from a group of healthy subjects (control group). RESULTS: Statistical analysis of the data obtained from the myotonic patients who developed the disease during the growth phase revealed alterations in the transversal plane and, to an even greater extent, the vertical one, with a high frequency of anterior open bite. Discussion and conclusions Regarding the pathogenesis of these types of skeletal dysplasias, the authors hypothesise a posterior rotation growth pattern, resulting from gravitational force prevailing over the deficit of the elevator muscles.

No Compliance Correction of Class II Malocclusion in Growing Patients Whit HERBST Appliance: A Case Report.

BACKGROUND: Class II malocclusion is the most common sagittal skeletal discrepancy, with a prevalent skeletal pattern of mandibular retrusion. The correction of mandibular retrusion with functional removable appliance needs a good patient's compliance; for this reason, some clinicians prefer to use no compliance apparatus. OBJECTIVE: Objective of the present therapy note is to demonstrate that the use of no compliance apparatus can provide a good correction of skeletal class II malocclusion. METHODS: In the present study, authors report a therapy note referred to a 10 years old patient, woman, affected by Class II, with mandibular retrusion and deep bite, treated in 2013 at the Dep. of Orthodontics of Messina University. An orthodontic treatment has been planned with the aim of stimulating mandibular growth; an Herbst appliance with a cantilever design, bonded on first maxillary and mandibular molars, has been used. After eleven months of functional therapy a bilateral molar class I have been obtained. RESULTS: In the therapy note proposed, authors obtained a resolution of mandibular retrusion, a correction of overjet, overbite and dental crowding in both arches, and a bilateral molar and canine class I has been achieved. CONCLUSION: Herbst appliance seems to be efficient in the correction of II Class Malocclusion, independently from patient's cooperation; moreover , early correction of Class II malocclusion with functional appliances produces several clinical advantages.

Correlations between cephalic posture and facial type in patients suffering from breathing obstructive syndrome.

AIM: In this teleradiographic study, the authors investigate the correlations between facial kind, breathing pattern and cephalic posture. METHODS The research was conducted on a 94 schoolchildren sample. For each patient teleradiographic analysis in-L-L projection and rhinomanometric examination were performed. On the basis of clinical evidences, rhinomanometric results and nasopharyngeal space evaluation, the sample was divided into two groups: the first one included 36 oral breather patients (OB), the second one 58 nasal breathers (NB). RESULTS: The two groups do not differ significantly, with the exception of divergence values, frequently higher in OB than NB. The comparison of craniofacial features and cephalic posture among the groups points out to correlations between large craniocervical angle and skeletal Class II, mandibular retrognathia and increased gonial angle, respectively, not related to breathing patterns. CONCLUSION: According to the authors' results, it can be stated that morphological characteristics classically associated with breathing obstructive syndrome could be induced by altered cephalic posture instead.

Evaluation of skin dose in a low dose spiral CT protocol.

AIM: The authors evaluated radiation and skin doses absorbed by the eye lens, as well as the parotid and thyroid glands, during a low dose maxillary spiral computed tomography (CT). METHODS: Three spiral CTs were carried out, one after the other, changing from time to time MAS, pitch factor, Kv and consequently, CTDI/Vol, until the minimum values detectable by the equipment were reached (MAS 28, Kv 80, CTDI/Vol 2.5, Pitch 1). The quality of the images was evaluated on the grounds of being able to visualise the anatomic structures considered. The amount of radiation effectively absorbed by the soft tissue (skin doses) can be measured with the help of dosimeters placed at the level of eye lens, parotid and thyroid glands. The spiral CTs were performed with a Siemens 16 CT sensation machine, using a tissue equivalent Head-Neck RT Humanoid phantom. RESULTS: From the results of this study, it appears possible to obtain high quality images, useful for diagnosing numerous skeletal pathologies in orthodontics, reducing of about 90% the radiation dose per unit of volume and, at the same time, reducing the soft tissue (skin) dose of about 85% when compared to pre-established settings. CONCLUSION: The authors conclude their research emphasizing the possibility of applying low dose protocols, not only in orthodontics but in any dental field, whenever a spiral CT is needed for a more detailed diagnosis.

[The effect of the administration of an amino acid solution containing acetate on the calcium balance in surgical patients]. / Effetto della somministrazione di una soluzione di aminoacidi contenente acetato sul bilancio del calcio in pazienti chirurgici.

A frequent trouble in total parenteral nutrition is the occurrence of a negative calcium balance, due to reduction of calcium tubular reabsorption in acidosis. This condition could depend on acid metabolites raise, coming from degradation of nutritional amino acid mixtures. Authors have evaluated the effect of acetates addition to amino acid solutions on calcium balance. In fact the bicarbonate excess could reduce calcium urinary excretion. Thirty surgical patients have been treated. They were randomized according to acetates presence or absence in the administered solutions. In the acetate-treated group authors noted a raise in plasma bicarbonate and pH and a reduction in urinary calcium excretion. Adding acetates to amino acidic mixtures could reduce in total parenteral nutrition the risk of hypercalciuria and its related complications.

Kinesiographic investigations in children with increased nasal airways resistance.

The aim of this study is to evaluate by means of the kinesiographic test, how the muscular alteration, linked with mouth breathing, modifies mandibular dynamics. From a sample of children aged between 8-11 years, on the basis of increased nasal airways resistance measured with the forced oscillation technique, we selected a group of 14 subjects. These children underwent kinesiographic examination (K-System Biotronic) and they were compared to a control group. Certainly, the speeds reduction in the pathological group emerged as the most significant data. The mastication tracings on the frontal plane, in the group with increased nasal airways resistance, moreover appeared to be reduced in width, elongated in shape and sometimes irregularly square, compared to the bell shape typical of subjects without any dysfunctional pathologies. Considering that each subject responds in a personal manner to an increase of the nasal resistances, due to the extremely variable individual adaptability, the kinesiographic test, together with the electromyographic one, in our opinion, can assist anamnesis, clinical examination and other instrumental investigations, in the identification of those subjects in which the increase of the nasal airways resistance interferes with muscular function, laying the basis for possible modifications in the craniofacial growth.