Distance education during COVID 19: an Italian survey on the university teachers' perspectives and their emotional conditions.

BACKGROUND: Following the COVID-19 pandemic, distance education (DE) replaced traditional "face-to-face" teaching and has become the main method of teaching. The aim of this study was to 1) evaluate the impact of DE by teachers in our department during the second semester of the 2019-20 academic year following the March-May 2020 Italian national lockdown and 2) evaluate the relationship between DE and the emotional well-being of teachers during the period of home confinement. METHODS: Ninety-seven university teachers (51.5% women; most represented age group 60-69 years range, 40.2%) responded to an anonymous online cross-sectional survey between July 15 - September 30, 2020, on the advantages and disadvantages of DE, developed by one online teacher focus group. The emotional conditions were assessed by a short version of the Beck Depression Inventory-II (BDI-II). The internal consistency reliability survey and the 10-item BDI-II were measured by Cronbach's alpha. A correlation analysis (r-Pearson) was conducted between the overall evaluation of the experience of DE and the variables included in the study. RESULTS: Teachers reported difficulties in technical aspects, and in psychological factors, as the discomfort of "speaking in the void" (64.7%). The absence of "face-to-face" eye contact with the students was complained by 81% of teachers. Significant impairments in sleep patterns and loss of energy were reported, with female teachers having greater difficulty concentrating than their male colleagues. A quarter of teachers showed depressive symptoms of varying severity. The most satisfied teachers were those most stimulated by DE (r = 0.752, p < 0.000), who showed a lower impact of depressive symptoms (r = - 0.289, p = 0.005). The teaching load in hours influenced the perception of disadvantages (r = 0.214, p = 0.035) and contributed to a lower appreciation of the challenges of DE. The more significant the manifestation of depressive symptoms during the lockdown was, the greater the subjective recovery of a good emotional condition once the domestic confinement was over (r = 0.344, p = 0.001), despite maintaining DE. CONCLUSIONS: Our study highlights the impact of technical, didactic, and psychological difficulties of DE, reported by our teachers. The appreciation of their new learning promoted by DE seemed related to better emotional well-being of university teachers accepting this "challenge" in their important role in the high-education system, influencing good learning and promoting students' professional success.

Short-Term Effect of Orthodontic Treatment with Clear Aligners on Pain and sEMG Activity of Masticatory Muscles.

Background and objectives: The aim of this study is to evaluate mandibular elevator muscles activity and pain on palpation in the early stages of orthodontic treatment with clear aligners using surface electromyography (sEMG). Materials and methods: Surface electromyography (sEMG) activity and pain level on muscle palpation of masseter and anterior temporalis muscles were recorded in a sample of 16 adult subjects (aged 18-32 years; mean 22.5 +/- 3.5 SD) undergoing orthodontic treatment with clear aligners before the treatment (T0), after 1 month of treatment (two clear aligners) (T1), and after 3 months of treatment (T2) (six clear aligners). A chi-square test for nominal data, a Friedman test, and a Wilcoxon-signed rank test as post hoc analysis were applied. Results: No statistically significant differences in muscular pain were observed. At T1, the sEMG activity of masseter muscles at mandibular rest position showed a statistically significant reduction, but after 3 months (T2), the data appeared similar to T0 (p = 0.03 and p = 0.02). Conclusions: During the treatment with clear aligners, subjects could experience an initial reduction in the masseter basal activity after 1 month of treatment. This effect tends to decrease to baseline levels after 3 months of therapy.

Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3-5 years old children.

BACKGROUND: Pacifier sucking habit has been associated in the literature with alterations of dental occlusion, and it could be a predisposing factor for other poor oral habits among children. Orthodontic pacifiers have been introduced in the market aiming to reduce these disadvantages caused by the conventional type of pacifiers. The aim of this study was to evaluate the prevalence of poor oral habits and malocclusions, after usage of orthodontic pacifiers in children with primary dentition. METHODS: A sample of 198 pre-school children, aged 3-5 years, (96 males and 102 females) who had exclusively used an orthodontic pacifier were included in order to assess the level of poor oral habits and the absence/presence of dental malocclusion. Firstly, children's parents/legal guardians were given a validated questionnaire, then the children were clinically examined at a dental clinic. RESULTS: Most of the children (79.79%) had started using the orthodontic pacifier within the first 3 months of life, and the 43.49% of them continued using it over a period of 2 years. The recorded percentage for those who had used it throughout sleep was 89.39%. Mouth breathing during the night was reported for 36.04% of the children. Tongue thrust swallow affected 16.16% of the sample. The 5.56% of the data indicated the presence of fingersucking/thumbsucking habit. The noted percentages for children with lip biting, lingual interposition between teeth at rest and those with nail biting, were 5.56, 12.63 and 15.15%, respectively. The regression revealed a significant contribution between early start of using an orthodontic pacifier with the prevalence of fingersucking/thumbsucking (OR 0.13, 95% CI 0.04-0.47, p = 0.0004). This also reported a noticeable increase of the malocclusion prevalence among the female gender (OR 2.74, 95% CI 1.42-5.31), as well as those who were not exclusively breastfed (OR 2.26, 95% CI 1.17-4.37). CONCLUSIONS: Orthodontic pacifiers does not favor the development of poor oral habits, even if it has been used for a period of 2 years in children with primary dentition. Children who begin to use orthodontic pacifier between 0 and 3 months, are less likely to acquire fingersucking/thumbsucking habit. The use of an orthodontic pacifier appears not to be correlated with the prevalence of malocclusion in primary dentition, differently from what stated in literature about the conventional type of pacifier.

Short Versus Longer Implants in Mandibular Alveolar Ridge Augmented Using Osteogenic Distraction: One-Year Follow-up of a Randomized Split-Mouth Trial.

The aim of this study was to evaluate the reliability of 6-mm-long implants compared with normal-length implants placed in a vertical augmented atrophic posterior mandible, supporting cemented single crowns. Thirty-six patients with bilateral posterior edentulous mandible and presenting a bone availability height less than 9 mm from the mandibular canal were enrolled in this study. Patient hemiarches were randomized to receive both 6-mm-long and normal-length implants (10 mm). The technique used for the vertical bone augmentation was the "sandwich" technique, using a bone substitute block as graft. The data outcomes at 1 year postloading follow-up were the loss of implants and complications. Eighty-six 6-mm-long implants and 84 normal implants were inserted. Five short implants and 13 normal implants were lost. In 28 patients, complications occurred, and in 21 cases, the complication was present on the side of the ridge vertical augmentation. From the statistical analysis, the association between the side of the ridge augmentation and the side of occurrence of the complication was statistically significant ( P < .05). The results from this trial suggest short implants can be preferred over vertical bone augmentation for the placement of longer implants in the rehabilitation of edentulous posterior mandibles. These initial results must be confirmed by larger and longer follow-ups of 5 years or more.

Clinical and radiographic evaluation of biodentine versus calcium hydroxide in primary teeth pulpotomies: a retrospective study.

BACKGROUND: Pulpotomy is the surgical removal of the entire coronal pulp with preservation of the radicular pulp vitality. The purpose of this retrospective study was to evaluate the clinical and radiographic success of pulpotomy of primary molars using two materials, biodentine and calcium hydroxide. METHODS: Records of 400 primary molars in 360 paediatric participants (mean age: 7.5 ± 1.6 years, ranging from 5 to 9 years) with dental caries who required pulp therapy were included in this study. Biodentine was used on 200 teeth, and calcium hydroxide (CH) was used on another 200 teeth, as a pulpotomy material. Clinical and radiographic evaluation was performed after 9 and 18 months. Statistical analysis was evaluated with the chi-squared test, and the level of significance was set at p < 0.05. RESULTS: The treatment success with CH was 85.5% after 9 months and 79.5% after 18 months, while the success rate of biodentine was 94% after 9 months and 89.5% after 18 months. The statistical analysis with the Chi-squared test showed that the clinical and radiographic success rate with biodentine was significantly higher than CH (p < 0.05). CONCLUSIONS: Biodentine exhibited a higher clinical and radiographic success rate compared to CH. However, besides the clinical results, biodentine has some disadvantages, such as higher costs, compared to CH.

Difference of Success Rates of Mineral Trioxide Aggregate Pulpotomies Performed Both by Undergraduate Dental Students and by an Expert Operator: A Retrospective Study.

AIM: The aim of this retrospective study was to evaluate the clinical and radiographic success of pulpotomy on primary molars performed by dental students compared to that performed by an expert operator. METHODS: The study was conducted on 142 second primary molars in 102 children. The patients were randomly selected from the available records. The test group (treated by dental students) included 51 subjects (28 males and 23 females, mean age: 7.2 ± 1) and the control group included 51 children (29 males and 22 females, mean age: 7.4 ± 1.2 years). After pulpotomy, a clinical and radiographic evaluation after 12 months was performed. Chi-square test and odds ratio were calculated and significance level was set at p < 0.05. RESULTS: The success rate was significantly lower, 81.6% (p < 0.05), in the test group than in the control group (93%). The test group showed less clinical and radiographic success (86% and 80%, resp.) compared to the control group (97.2% for clinical success and 93% for radiographic success). CONCLUSIONS: Pulpotomy with MTA is an effective method that ensures a good percentage of success. The clinical experience of the operator is a contributing factor.

Smoking and the risk of peri-implantitis. A systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis was to assess the role of smoking as a risk factor for peri-implantitis. MATERIAL AND METHODS: Six electronic databases and a manual search resulted in 5876 unique publications. After selection, only seven studies were included in the systematic review. Dichotomous data were expressed as risk ratios (RRs) and 95% confidence intervals (CIs). A generic inverse variance statistical model was used. Due to the expected interstudy heterogeneity, a random effect model was used for both data types. Heterogeneity was assessed with the Cochrane χ(2) and I(2) tests. The pooled effect was considered significant for a P-value <0.05. RESULTS: The implant-based meta-analysis revealed a higher and significant risk of peri-implantitis in smokers (RR: 2.1, 95% CI: 1.34-3.29, P = 0.001) compared with nonsmokers, but the patient-based meta-analysis did not reveal any significant differences for risk of peri-implantitis in smokers (RR: 1.17, 95% CI: 0.78-1.75, P = 0.46). No evidence of significant heterogeneity was detected for the two analyses (χ(2) = 0.64, P = 0.89; I(2) = 0% and χ(2) = 2.44, P = 0.30; I(2) = 18%, respectively, for implant- and patient-based meta-analyses). CONCLUSION: There is little evidence that smoking is a risk factor for peri-implantitis. However, given the low number of included studies, future studies are needed to confirm these results.

Nd:YAG laser as an adjunctive treatment to nonsurgical periodontal therapy: a meta-analysis.

A meta-analysis was conducted to investigate whether the use of Nd:YAG laser adjunctive to scaling root planing (SRP) could provide additional benefits compared to SRP alone in patients with chronic periodontitis. The meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement and the recommendations of the Cochrane Collaboration. A literature search was performed on seven databases, followed by a manual search. Weighted mean differences and 95% confidence intervals were calculated for the clinical attachment level (CAL), probing depth (PD), and changes in plaque index (PI) and gingival crevicular fluid (GCF). Inter-study heterogeneity was assessed by the I (2) test, and publication bias was analyzed by the visual inspection of the funnel plot for asymmetry, Egger's regression test, and trim-and-fill method. All outcomes were evaluated from baseline to the end of follow-up. Significant differences in PD and GCF reduction were observed in favor of SRP + Nd:YAG; no significant differences were observed in CAL gain or PI change. The findings of this meta-analysis suggest that use of the Nd:YAG laser as an adjunctive therapy to conventional nonsurgical periodontal therapy could potentially provide additional benefits. However, all included studies were not at low risk of bias, and only three studies were included in the meta-analysis. As a result, the evidence is insufficient to support the effectiveness of adjunctive Nd:YAG to SRP. Future long-term well-designed parallel randomized clinical trials are required to assess the effectiveness of the adjunctive use of Nd:YAG laser. These trials should also include microbiological and adverse events analyses.

Upper Midline Correction Using the Mesial-Distalslider.

AIM: The purpose of the present study is the three-dimensional (3D) analysis of molar and incisor movements that occur during the correction of the upper midline deviation by using the Mesial-Distalslider appliance. MATERIALS AND METHODS: A total of 20 consecutive patients (12 women and 8 men; mean age 19.6 ± 11.1 years) were selected from the Orthodontic Department of Heinrich-Heine University of Düsseldorf. To correct the upper midline deviation (>2 mm), the patients were treated with asymmetric mechanics (mesialization on one side and distalization on the contralateral side) with the aid of Mesial-Distalslider. Dental casts were taken for each patient before (T0) and after the treatment (T1). The casts were 3D digitized and the models were superimposed on the palatal anterior region. Three-dimensional molar movements and sagittal incisor movements (proclination and retroclination) were assessed for T0 and T1. RESULTS: At the end of the treatment, the total movements of the molars resulted in 4.5 ± 2.2 mm (antero-posterior direction), -0.4 ± 2.4 mm (transverse direction) and 0.3 ± 0.9 mm (vertical direction) on the mesialization side, and -2.4 ± 1.7 mm (antero-posterior direction), -0.5 ± 1.5 mm (transverse direction) and 0.2 ± 1.4 mm (vertical direction) on the distalization side. Incisor displacement was 0.9 mm ± 1.7 (mesialization side) and 0.6 mm ± 0.7 (distalization side). CONCLUSION: The Mesial-Distalslider appliance could be considered a valuable tool in orthodontic treatment for upper midline correction. Within the limits of a retrospective study, asymmetric molar movements appeared possible without clinically relevant anchorage loss.

Clinical Efficacy and Tolerability of a New Experimental Mucoadhesive Patch for Topical Anesthesia of Oral Mucosa in Pediatric Dentistry.

Background: The injection of local anesthetics is the procedure that still causes the most fear and anxiety in a dental session; to minimize this problem, we can use topical anesthesia. The aim of this study is to analyze the tolerability and the clinical efficacy in the control of pain, during the subsequent injection of the local anesthetic, of an experimental anesthetic patch with a new formulation, which was previously tested in gel formula. Methods: A total of 150 children, aged 4 to 9 years, were included in the study. Each patient was treated using three different pre-anesthesia methods (placebo gel, experimental gel, and experimental patch), according to a split-mouth procedure, within a week of each other. The injection pain was analyzed using the WBFPRS and FLACC scales. Patients' caregivers' satisfaction was recorded at the end of the procedures. The data were analyzed using one-way ANOVA-RM, Wilcoxon-Mann-Whitney, Mann-Whitney U, and χ2 tests. Results: In this study, significantly higher pain ratings were observed with the topical placebo gel and lower pain ratings were observed with the experimental patch. Conclusion: The use of the patch proved to be very effective in reducing pain both subjectively and objectively, in the absence of both local and systemic side effects, validating its use in the oral mucosa.

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.

An evaluation of the Invisalign® Aligner Technique and consideration of the force system: a systematic review.

OBJECTIVE: Since its introduction 25 years ago, the Invisalign® system has undergone multiple digital and biomechanical evolutions and its effectiveness is often compared to traditional systems without considering the many differences which characterize them. The main aim of this systematic review is to look at the literature dealing with studies on teeth movements using the Invisalign® system and the management of these movements through digital planning and artificial intelligence. MATERIALS AND METHODS: The following electronic databases were searched: MEDLINE, Embase, the Cochrane Oral Health Group's Trials Register, and CENTRAL. Unpublished studies were searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. RESULTS: Twenty-four studies (15 retrospective, 5 prospective, 2 pilot, and 2 case-control) were included. The results of the analysis carried out on the available literature show that the Invisalign® system is recognized to be a valid alternative to conventional orthodontic treatment in no-extraction cases. The results are influenced by the methods for assessing the effectiveness of this technique and by the comparison bias of the traditional system with the innovative digital system. CONCLUSIONS: Since the introduction of SmartForce and SmartTrack material, the efficacy of the treatment has improved. There is still a shortage of high-quality evidence concerning the treatment modality. In order to make the treatment with the aligners more efficient, a correct management of the ClinCheck® software and a proper use of the biomechanics are necessary. The aligned force-driven system should be taken into account when developing the digital planning.

Adjunctive photodynamic therapy to non-surgical treatment of chronic periodontitis: a systematic review and meta-analysis.

AIM: To investigate the efficacy of antimicrobial photodynamic therapy (aPDT) adjunctive to scaling root planing (SRP) in patients with chronic periodontitis. METHODS: A meta-analysis was conducted according to the PRISMA statement and Cochrane Collaboration recommendations. Two independent reviewers performed an extensive literature search and manual search on seven databases. Mean differences (MD) and 95% confidence intervals (CI) were calculated for clinical attachment level (CAL) gain and probing depth (PD) reduction. The I(2) test was used for inter-study heterogeneity. Publication bias was examined by Egger's regression test and the trim-and-fill method. RESULTS: Sensitivity analysis of 14 randomized clinical trials (RCTs) revealed differences in PD reduction (MD 0.19, 95% CI 0.07-0.31, p = 0.002) and CAL gain (MD 0.37, 95% CI 0.26-0.47, p < 0.0001) in favour of SRP + aPDT, with no evidence of heterogeneity. Subgroup analysis revealed the absence of heterogeneity in RCTs, with high risk of bias for PD reduction and CAL gain. No evidence of publication bias was detected. CONCLUSIONS: The use of adjunctive aPDT to conventional SRP provides short-term benefits. The evidence to support its clinical medium/long-term efficacy is insufficient. Further high-quality RCTs are needed to investigate the influence of potential confounders on the efficacy of adjunctive aPDT.

Effectiveness of diode laser as adjunctive therapy to scaling root planning in the treatment of chronic periodontitis: a meta-analysis.

To investigate whether the adjunctive use of diode laser provides additional benefits to scaling root planning alone in patients with chronic periodontitis, a meta-analysis was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement and the Cochrane Collaboration. A literature search was performed on seven databases, followed by a manual search. Weighted mean differences and 95 % confidence intervals were calculated for the clinical attachment level, probing depth, and changes in the plaque and gingival indices. The I (2) test was used for interstudy heterogeneity. Visual asymmetry inspection of the funnel plot, Egger's regression test, and the trim-and-fill method were used to investigate publication bias. All outcomes were evaluated at 6 months. No significant differences were observed for any investigated outcome of interest. No evidence of heterogeneity or publication bias was detected. These findings suggested that the use of diode laser as an adjunctive therapy to conventional nonsurgical periodontal therapy did not provide additional clinical benefit. However, given that few studies were included in the analysis, and that three of the five included studies had a high risk of bias, the results should be interpreted with caution. Important issues that remain to be clarified include the influence of smoking on clinical outcomes, the effectiveness of adjunctive diode laser on microbiological outcomes, and the occurrence of adverse events. Future long-term well-designed parallel randomized clinical trials are required to assess the effectiveness of the adjunctive use of diode laser, as well as the appropriate dosimetry and laser settings.

Photodynamic therapy in the treatment of chronic periodontitis: a systematic review and meta-analysis.

This meta-analysis was conducted to investigate the efficacy and safety of antimicrobial photodynamic therapy used alone or adjunctive to scaling root planing in patients with chronic periodontitis. The meta-analysis was conducted according to the QUOROM statement and recommendations of the Cochrane Collaboration. An extensive literature search was performed on seven databases, followed by a manual search. Weighted mean differences and 95% confidence intervals were calculated for clinical attachment level, probing depth and gingival recession. The I(2) test was used for inter-study heterogeneity; visual asymmetry inspection of the funnel plot, Egger's regression test and the trim-and-fill method were used to investigate publication bias. At 3 months, significant differences in clinical attachment level (p = 0.006) and probing depth reduction (p = 0.02) were observed for scaling root planing with antimicrobial photodynamic therapy, while no significant differences were retrieved for antimicrobial photodynamic therapy used alone; at 6 months no significant differences were observed for any investigated outcome. Neither heterogeneity nor publication bias was detected. The use of antimicrobial photodynamic therapy adjunctive to conventional treatment provides short-term benefits, but microbiological outcomes are contradictory. There is no evidence of effectiveness for the use of antimicrobial photodynamic therapy as alternative to scaling root planing. Long-term randomized controlled clinical trials reporting data on microbiological changes and costs are needed to support the long-term efficacy of adjunctive antimicrobial photodynamic therapy and the reliability of antimicrobial photodynamic therapy as alternative treatment to scaling root planing.

Bioactive Peptides Derived from Edible Insects: Effects on Human Health and Possible Applications in Dentistry.

Novel foods, including edible insects, are emerging because of their nutritional characteristics and low environmental impacts and could represent a valid alternative source of food in a more sustainable way. Edible insects have been shown to have beneficial effects on human health. Insect-derived bioactive peptides exert antihypertensive, antioxidant, anti-inflammatory, and antimicrobial properties and have protective effects against common metabolic conditions. In this review, the roles of edible insects in human health are reported, and the possible applications of these peptides in clinical practice are discussed. A special mention is given to the role of antimicrobial peptides and their potential applications in controlling infections in orthodontic procedures. In this context, insects' antimicrobial peptides might represent a potential tool to face the onset of infective endocarditis, with a low chance to develop resistances, and could be manipulated and optimized to replace common antibiotics used in clinical practice so far. Although some safety concerns must be taken into consideration, and the isolation and production of insect-derived proteins are far from easy, edible insects represent an interesting source of peptides, with beneficial effects that may be, in the future, integrated into clinical and orthodontic practice.

Effectiveness and Tolerability of a New Formulation of a Topical Anesthetic in Reduction of Pain and Parents' Satisfaction in Pediatric Dentistry.

The aim of the present study was to test a new topical anesthetic gel with a different formulation (10% lidocaine, 10% prilocaine) to analyze its effectiveness in pain control, during the subsequent injection of local anesthetic, and the presence of any side effects. METHODS: The study's research design was a randomized controlled clinical trial on 300 children, aged 5-8 years, divided into two groups, each of 150 patients, according to pre-injection procedures (presence or absence of topical anesthesia). The injection pain was analyzed using the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability Scale (FLACC). At the end of the procedures, patients' parents' satisfaction was recorded. The data were analyzed using the Student's T test, Mann-Whitney U test and Chi-square test. RESULTS: There were statistically significant differences between the two groups both in the PRS and FLACC ratings. Both in subjective and objective pain evaluations, significantly higher pain ratings were observed in the group without topical anesthesia. There was also a statistically significant difference in terms of patients' parents' judgment, as in the group with the use of topical anesthetic the level of parental satisfaction is statistically higher. CONCLUSION: The experimental anesthetic has proved very effective in its use as a topical gel in both pain measurement scales, thus validating its use on the oral mucosa, for its pharmacological and psychological effect, in the total absence of local and systemic side effects.

Effects of Rapid Palatal Expansion on the Upper Airway Space in Children with Obstructive Sleep Apnea (OSA): A Case-Control Study.

Obstructive Sleep Apnea (OSA) in children needs a multidisciplinary approach. Even if the first-line treatment of pediatric OSA is adenotonsillectomy, nowadays rapid palatal expansion (RPE) is considered a valid additional treatment. The aim of this study is to evaluate cephalometric changes in upper airways dimensions after rapid palatal expansion (RPE) in children suffering from Obstructive Sleep Apnea (OSA). A total of 37 children (range age 4-10 years) with diagnosis of OSA referred to Dentistry Unit of Bambino Gesù Children's Research Hospital IRCCS (Rome, Italy) were included in this pre-post study and underwent lateral radiographs at the start (T0) and at the end (T1) of a RPE treatment. Inclusion criteria were: diagnosis of OSA confirmed by cardiorespiratory polygraphy (AHI > 1) or pulse oximetry (McGill = >2), skeletal maxillary contraction evaluated by presence of posterior crossbite. A control group of 39 untreated patients (range age 4-11 years), in good general health, was set up. A paired T-test was used to investigate the statistical differences between T0 and T1 values in both groups. The results showed a statistically significant increase of nasopharyngeal width in the treated group after RPE treatment. Moreover, the angle that identifies mandibular divergence compared to palatal plane (PP-MP°) was significantly reduced. In the control group, no statistically significant differences were observed. The present study showed that RPE treatment determines a significant sagittal space increase in the upper airways space and a counterclockwise mandibular growth in children with OSA compared to a control group. These results suggest that a widening of the nasal cavities induced by RPE may support a return to physiological nasal breathing and promote a counterclockwise mandibular growth in children. This evidence confirms the crucial role of the orthodontist in the management of OSA in pediatric patients.

RA.DI.CA. Splint Therapy in the Management of Temporomandibular Joint Displacement without Reduction.

BACKGROUND: The purpose of this study is to report clinical and instrumental changes after RA.DI.CA splint therapy for temporomandibular joint disc displacement without reduction. METHODS: Subjects affected by disc dislocation without reduction were recruited between July 2020 and May 2022 based on inclusion and exclusion criteria and treated with RA.DI.CA. splints over a period of 6 months. Clinical data were collected at each phase of the study (T0, T1, T2). Magnetic resonance imaging and electrognathography data were recorded at the beginning (T0) and at the end (T2) of the study. ANOVA with post-hoc contrasts was performed to assess differences in outcome measures over time. The Wilcoxon test was used to evaluate changes in disc-condyle angle between before- and after-treatment MRI. A two-tailed value of p < 0.05 was regarded as significant. METHODS: Ten patients completed the study. There were statistically significant differences over time for arthralgia, headache, neck pain, and mouth opening. Disc recapture and an improved quality of mandibular movement were recorded in 70% of subjects. The clinical and instrumental improvements are probably due to the orthopedic action of RA.DI.CA splint treatment, which allows for a greater degree of joint mobilization. CONCLUSIONS: The purpose of this therapy is to recover the disc position if possible and achieve an adequate joint functional adaptation that avoids the progression of the structural damage and the recurrence of symptoms.