Skeletal and dental effects of function-generating bite appliance compared to rapid palatal expander and untreated controls.

INTRODUCTION: Maxillary expansion is a fundamental interceptive orthodontic treatment, which can be achieved through either a rapid expansion protocol or functional devices. However, no data exist about the efficacy of functional devices in achieving skeletal expansion. Therefore, the aim of this study was to compare the effects of the rapid palatal expander (RPE) and the function-generating bite type M (FGB-M) on the transversal dimension of the maxilla, and on the maxillary and mandibular dental arch width. METHODS: One hundred eighty-one skeletal Class I patients, aged between 6 and 12 years and with a cervical vertebral maturation stage II or III, with maxillary transversal deficiency were retrospectively enrolled; among these 55 were treated with FGB-M, 73 were treated with RPE and 51 were untreated subjects retrieved from historical databases. The pre-treatment (T0) and post-treatment (T1) frontal cephalograms were retrieved, and the maxillary and mandibular widths, and the distance between upper and lower first molars were measured. T1-T0 interval was of 17.3 months (RPE), 24.6 months (FGB-M) and 18.2 months (controls). RESULTS: The statistical analysis showed that there were no statistically significant differences between the RPE and FGB-M groups regarding skeletal and dental expansion, while the untreated control group differed significantly from the other two groups. CONCLUSION: The comparison between patients treated with RPE and FGB-M showed that there were no statistically significant differences between the RPE and FGB-M groups regarding the amount of skeletal expansion and dental arch width, suggesting that both appliances can be used to achieve similar results.

Evaluation of occlusal force in Class II subdivision malocclusion.

BACKGROUND: Class II subdivision is a malocclusion characterized by dental and functional asymmetry that is difficult to manage. Impaired muscle function can result in asymmetrical growth, leading to occlusal instability. OBJECTIVE(S): The study aimed to assess occlusal force in patients with Class II subdivision malocclusion using Innobyte. Additionally, the discrepancies of force generated at the position of maximum intercuspidation between the left and right sides of the arches were evaluated. METHODS: The occlusal force of 66 patients with Class II subdivision malocclusion (group S) was measured and compared with that of 66 patients with Class I (group I) and 66 patients with Class II malocclusion (group II). The S group patients had a Class I molar on the right side and a Class II molar on the left side. ANOVA test, followed by the Games-Howell post hoc test, was performed to compare the mean of the total force among the groups. To assess the difference in force between the right and left arches, one-way ANOVA test followed by Tukey's post hoc comparison was performed. Finally, a boxplot was created to show the trend of occlusal force recorded in the three groups of patients. RESULTS: The occlusal force differed significantly among the groups (p < .001). Post hoc Games-Howell analysis showed significant differences as follows: the total force in group S was 165.24 N greater than in group II and in group I was 218.06 N greater than in group II. The difference (right-left) in total force between the groups was statistically significant (p < .001). Tukey's post hoc test showed following significant correlation: in group S was 53.51 N greater than in group II and 63.12 N greater than in group I. CONCLUSIONS: Among the analysed groups, patients with Class II malocclusion exhibited the lowest value of occlusal force. In patients with Class II subdivision malocclusion, force asymmetry, characterised by a higher value on the Class I side and a lower value on the Class II side was observed.

Evaluation of the relationship between incisor torque and profile aesthetics in patients having orthodontic extractions compared to non-extractions.

OBJECTIVE: The aim of the present study was to evaluate the relationship between soft tissues aesthetics and incisor torque, as well as the effect of crowding, anchorage, and extraction pattern, in adult patients treated without extraction or with two or four extractions. MATERIALS AND METHODS: Seventy-seven subjects with permanent dentition were selected retrospectively. Among these, 24 patients were treated with four extractions, 24 with two extractions and 29 without extractions. Lateral cephalograms and photographies taken before (T0) and after (T1) treatment were retrieved. The amount of crowding and the type of anchorage were recorded, and a cephalometric analysis was performed. A one-way ANOVA was used to compare the variables within and between groups. Linear regressions were performed to evaluate the effect of different predictors on soft tissues variables at T1. RESULTS: The statistical analysis showed no differences within and between groups for soft tissue aesthetics. A significant reduction of the angle obtained from the intersection of Frankfurt plane and mandibular plane was observed in the four-extractions group, and a significant proclination of the lower incisors was observed in the two-extraction group. Linear regressions revealed that the change in soft tissue profile aesthetics was affected by the type of anchorage and the two-extractions pattern. CONCLUSIONS: Similar soft tissue aesthetics were observed after treatment in the three groups, despite the presence of some skeletal and dental differences. CLINICAL RELEVANCE: A well-controlled incisor torque helps to preserve soft tissues aesthetics. The type of anchorage could influence soft tissues.

Short-term effect of orthodontic clear aligners on muscular activity and occlusal contacts: A cohort study.

INTRODUCTION: The simultaneous presence of maxillary and mandibular clear aligners alters the vertical dimension and the quantity and quality of occlusal contacts. Few data in the literature explain how this occurs and the effects on neuromuscular coordination. This study aimed to evaluate occlusal contacts and muscular balance during treatment with clear aligners over a short follow-up time. METHODS: Twenty-six female adult patients were enrolled in this study. The center of occlusal force (COF) was evaluated using a T-Scan II device, whereas muscular symmetry and balance were determined through surface electromyography using a standardized protocol that reduces anthropometric and electrode variations. Both evaluations were performed in centric occlusion and with aligners worn before treatment, after 3 months, and after 6 months. RESULTS: A statistically significant variation in COF position was reported in the sagittal plane but not in the transverse plane. The shift in the COF position was followed by a change in muscular balance evaluated through surface electromyography. CONCLUSIONS: Treatment with clear aligners resulted in an anterior shift of the COF when biting in centric occlusion and a posterior shift when the aligners were worn in healthy female patients after 6 months of observation. This change in occlusal contact was followed by an improvement in muscular function symmetry in the short term when aligners were worn, compared with the centric occlusion during treatment.

The Correlation between Mandibular Arch Shape and Vertical Skeletal Pattern.

Background and Objectives: The aim of this study was to evaluate the correlation between the mandibular arch shape and the vertical skeletal pattern in growing patients. Materials and Methods: A total of 73 Caucasian patients (33 males and 40 females; mean age 9.4) were retrospectively enrolled from a pool of patients treated in chronological order at the Department of Orthodontics, University of Foggia, Italy, from April 2018 to December 2021. Each patient received a laterolateral radiograph and a digital scan of the dental arch. Eight cephalometric parameters (lower gonial angle, intermaxillary angle, divergence angle, Wits index, Jarabak ratio, OP-MP angle, PP-OP angle, and ANB) and five dental measurements (posterior mandibular arch width, anterior mandibular arch width, mandibular occlusal angle, posterior width on distobuccal molar cusps, and molar angle) were analyzed and then compared. A Spearman's rho correlation test between the cephalometric measurements and the dental measurements was performed. Statistical significance was set at p < 0.05. Results: A negative statistically significant correlation was found between the Jarabak ratio and the intermolar angle; a statistically significant correlation was also observed between the Wits index, the posterior mandibular width, and the occlusal mandibular angle; the ANB angle and the occlusal mandibular angle; the intermaxillary angle (PP-PM) and the mandibular occlusal angle, posterior mandibular width on the disto-vestibular cusp, and the intermolar angle; and the OP-MP angle and mandibular occlusal angle and the posterior mandibular width on the disto-vestibular cusp. Conclusions: The mandibular arch form may be related to certain predisposing features in craniofacial morphology, such as jaw divergence, the Jarabak ratio, and the intermaxillary angle.

Treatment of Mandibular Impacted Canine in a Patient with Class II Division 1 Malocclusion with "Reverse Pin": A Case Report.

This case report presents an orthodontic treatment conducted on a 13-year-old girl with bilateral Class II malocclusion and a mandibular impacted canine. The presence of an impacted tooth necessitates careful consideration of the timing of orthodontic treatment, the appropriate surgical procedure to expose the tooth, the specific orthodontic mechanics involved, and the potential problems that may arise, all of which depend on the type and location of the canine impaction in the jaw. The treatment plan included a surgical procedure to expose the impacted tooth and orthodontic traction to guide it into position. Correction of the Class II Division 1 malocclusion utilized a specialized technique called the "reverse pin", reducing vertical side effects. The revised version maintains clarity and key information about the case report and treatment.

Treatment effect of bone-anchored maxillary protraction in growing patients compared to controls: a systematic review with meta-analysis.

OBJECTIVE: The aim of this systematic review was to determine which evidence level supports maxillary advancement after bone-anchored maxillary protraction (BAMP) in growing patients compared to controls. SEARCH METHODS: PubMed, Cochrane, Embase, Scopus, and Web-of-Science databases were searched with no restrictions on publication status or year. SELECTION CRITERIA: Prospective and retrospective human studies about BAMP, in at least three patients, were included. Authors were contacted when necessary, and reference lists of the included studies were screened. DATA COLLECTION AND ANALYSIS: Two authors undertook independent data extraction with conflict resolution by a third author. Risks of bias were assessed. A meta-analysis for estimates of changes for ANB angle, Wits appraisal, and incisor to mandibular plane angle (IMPA) angle of BAMP treatment compared to control groups was performed. RESULTS: A total of 449 articles were initially retrieved; 28 full-text articles met the inclusion criteria. Sample sizes ranged from 3 to 52 patients. There was heterogeneity in cephalometric outcomes reported, which prevented the comparison of certain outcomes. ANB angle improved more with BAMP in the maxilla combined with facemask (bone-anchored facemask, BAFM) compared to traditional facemask therapy: this was statistically but not clinically significant (0.2 degrees). No data are available for BAMP with skeletal anchorage in both jaws in combination with Class III elastics (bone-anchored Class III elastics, BAC3E). Likewise, no statistically significant differences in Wits appraisal were found (less than 1 mm). Lower incisor retroclination and facial height seemed to be better controlled with BAC3E compared to BAFM. CONCLUSIONS: The level of evidence available to support the maxillary advancement effect after BAMP was low. Publications reporting results based on identical samples tended to suggest overly positive results of BAMP. The differences in sagittal correction between BAMP and traditional facemask therapy were small and of questionable clinical significance. Long-term follow-up results are not available and, therefore, much needed. LIMITATIONS: Most articles had a low level of evidence and some included a historical control group. REGISTRATION: PROSPERO database number CRD42015023366.

Interradicular sites and cortical bone thickness for miniscrew insertion: A systematic review with meta-analysis.

INTRODUCTION: Safe zone maps are useful for the clinician to plan miniscrew insertion and possibly reduce radiation exposure. This study aimed to investigate the available evidence regarding the presence of sufficient interradicular space and adequate cortical bone thickness in patients with a complete permanent dentition, in the vestibular and palatal or lingual interradicular sites, mesial to the second molar. METHODS: PubMed, Scopus, Web of Science, Cochrane Library, and OpenGrey databases were searched up to January 2019 for observational studies involving patients with fully erupted second molars that investigated the amount of interradicular space and/or the cortical thickness of the alveolar processes using 3-dimensional data sets. A custom tool was prepared and used to assess the risk of bias in individual studies. A meta-analysis was performed when at least 4 different studies evaluated 1 identical parameter homogeneously. Publication bias was assessed with the Egger linear regression test. RESULTS: Twenty-seven observational articles were included in the qualitative synthesis. Only 11 articles were at low risk of bias. Fifteen articles were included in the meta-analysis. The results were graphically reported in "safe-zone" maps. CONCLUSIONS: In the maxilla, the most suitable insertion sites are those from mesial to the first molar to distal to the first premolar, and between the canine and the lateral incisor, all at 6 mm from the cementoenamel junction. In those areas, the cortical bone has adequate thickness, not requiring predrilling. In the mandible, the preferable vestibular interradicular spaces are those between first and second molars and between first and second premolars, both at 5 mm from the cementoenamel junction, and predrilling is suggested in these areas. TRIAL REGISTRATION NUMBER: PROSPERO CRD42016042081.

Biomarkers in the gingival crevicular fluid used to detect root resorption in patients undergoing orthodontic treatment: A systematic review.

OBJECTIVES: To evaluate whether changes in the concentration of different biomarkers in the gingival crevicular fluid (GCF) can be used to detect the root resorption process in adult or adolescent patients undergoing treatment with a fixed appliance, in comparison with untreated subjects or treated patients not showing signs of root resorption. MATERIAL AND METHODS: The following databases were analysed in the period between June 2017 and March 2018, without any language and initial date restrictions: PubMed, EMBASE, Scopus, Web of Science and Cochrane Library. A quality assessment instrument (QAI) was developed to establish the risk of bias. RESULTS: A total of 1127 articles were analysed. Based on the inclusion and exclusion criteria, seven studies qualified for the final review. The QAI tool revealed that five articles were at a moderate risk of bias and two articles were at a low risk of bias. CONCLUSION: Dentine phosphoprotein (DPP) may be considered a relatively useful marker for root resorption. Dentinal sialoprotein (DSP) could be a potential biomarker but is not highly helpful at detecting root shortening. Inflammatory cytokines (pro- and anti-resorption), osteopontin (OPN), osteoprotegerin (OPG), RANKL and alkaline phosphatase (ALP) are useful biomarkers to explain the biological mechanisms that occur during orthodontic movement but are not specific enough. Further studies are required to clarify the role of GM-CSF as a potential biomarker to distinguish subjects at a risk of severe root resorption in the early phase.

Correlation between body mass index and obstructive sleep apnea severity indexes - A retrospective study.

PURPOSE: To evaluate if Body Mass Index (BMI) is correlated to Apnea-Hypopnea Index (AHI), mean arterial oxygen saturation (SaO2) and Nadir SaO2, which are all indexes defining the severity of the respiratory stress associated with Obstructive Sleep Apnea (OSA). MATERIALS AND METHODS: Seventy-five adult patients (mean age 51.4) referred for polysomnography were retrospectively recruited. BMI was calculated for each patient, as well as AHI, SaO2, and Nadir SaO2 recorded during polysomnography. Spearman's Rho test was used to evaluate if OSA severity was correlated to BMI values. First type error was set as p < 0.025. RESULTS: No correlation was observed between BMI and AHI, and between BMI and SaO2. A statistically significant negative correlation (r2 = 0.424; p < 0.001) was found between the BMI index and the Nadir SaO2. CONCLUSIONS: Higher BMI values were correlated with lower Nadir SaO2 during overnight polysomnography. Since hypoxia stress is a risk factor for cardiovascular diseases and alters the lipid metabolism, dietary consulting should be recommended in association with other treatment modalities for OSA.

Swallowing and Temporomandibular Disorders in Adults.

INTRODUCTION: Temporomandibular disease (TMD) etiology is multifactorial and is related to many perpetuating, predisposing, and initiating factors. The daytime parafunctions may have an important role in TMD pathogenesis. The most frequent parafunctions analyzed were the static parafunction (ie, clenching) and the dynamic parafunction (ie, grinding). In the present paper, the authors evaluated the swallowing (an oral function/parafunction) with the surface electromyography in patients with TMD. MATERIALS AND METHODS: Twenty patients with TMD problems (nonhealthy patients, NHP) (mean age: 33 ±â€Š1.994; 8 men and 12 women) and 20 healthy matched subjects (HP) (34.4 ±â€Š2.782; 6 men and 14 women) were selected and examined. On each patient, an 8-channel surface electromyography was done during saliva swallowing. RESULTS: Nonhealthy patients presented higher masseter and temporalis activation (P < 0.05) and an unbalancing of temporalis and submental muscles activation (P < 0.05) than the HP. DISCUSSION: Nonhealthy patients presented a time of swallow higher than HP (P < 0.001). Nonhealthy patients presented a higher muscles activation and time of swallow than HP and a decrease of muscles balancing activation.

Retrospective evaluation of treatment time and efficiency of a predictable cantilever system for orthodontic extrusion of impacted maxillary canines.

INTRODUCTION: Orthodontic extrusion of impacted maxillary canines requires careful biomechanical planning and the use of physiologic force. The aim of this study was to evaluate the time needed for orthodontic extrusion of impactions of different severities, using a device that can predictably apply forces under 0.6 N. METHODS: Twenty-two patients who were consecutively treated were selected retrospectively, and a total of 30 impacted canines were studied. Indexes of impaction were used to measure severity on pretreatment panoramic radiographs. Statistical analysis was used to detect interactions between treatment time, complexity of impaction, age, and sex. RESULTS: Treatment time was highly dependent on the patient's age; the shortest treatment time was observed in 11- to 12-year old patients. On the other hand, the severity of impaction had no effect on treatment time. CONCLUSIONS: Applying physiologic force with the proposed device resulted in a short treatment time, which depended on the patient's age more than the impaction complexity. Few complications were associated with use of this device. Future prospective studies are needed to replicate these findings and confirm the recommended use of this device.

Predictable method to deliver physiologic force for extrusion of palatally impacted maxillary canines.

INTRODUCTION: Orthodontic treatment of palatally impacted maxillary canines raises many difficulties; to minimize complications, careful planning of orthodontic extrusion and the use of physiologic force are crucial. The aim of this study was to quantitatively evaluate a simple and reproducible system for orthodontic extrusion of impacted canines that can provide the correct amount of force. METHODS: Ten specimens were constructed, consisting of a cantilever made with a 0.6-mm or 0.7-mm stainless steel wire modeled around a transpalatal bar with 3, 5, or 7 loops in the shape of a helical torsion spring. A mechanical testing machine was used to measure the force produced by the cantilever at 3, 6, 9, 12, and 15 mm of activation. RESULTS: The force values ranged from 1.24 ± 0.13 N for the 0.7-mm wire with 3 loops to 0.48 ± 0.04 N for the 0.6-mm wire with 7 loops. The forces measured for the 0.6-mm wire with 3 loops and the 0.7-mm wire with 7 loops were similar at 15 mm of deflection. CONCLUSIONS: The proposed system has a simple and robust design, is easy to construct and manage, and can provide the desired amount of force by changing the wire diameter and number of loops.

Reliabilty of recording occlusal contacts by using intraoral scanner and articulating paper - A prospective study.

OBJECTIVE: The recording of occlusal contacts is a pivotal step in many dental procedures, yet the lack of a standardized method could introduce clinical errors. The aim of this study was to compare the occlusal contacts recorded using a intraoral scanner to the contacts recorded using articulating paper. As a secondary outcome, the subjective clinical assessment made using the two methods was compared between different observers. METHODS: Twenty-eight records were analysed for this study. Digital scan and intraoral photos of the coloured marks impressed by articulating paper were taken at the same time point for every patient. Using a standardized occlusal template, two operators recorded the number of occlusal contacts for every tooth provided by the two techniques. Then, 11 clinicians analysed the collected records and answered questions about the quality of the occlusions observed. RESULTS: The statistical analysis showed significant differences between the number of contacts recorded by digital scan and those recorded by the photographed articulation marks, except in the case of the upper central incisors and first premolars. The Kappa Fleiss showed slight and fair agreement between clinicians when judging the occlusions. CONCLUSION: The occlusal contacts recorded using the intraoral scanner and those recorded with the articulating paper did not match, and overall the clinicians showed low agreement when rating the recorded data. CLINICAL SIGNIFICANCE: Despite of the great clinical importance of occlusal contact there is a lack of a precise method for recording and collecting occlusal contacts.

Effects of Thermoforming on the Mechanical, Optical, Chemical, and Morphological Properties of PET-G: In Vitro Study.

The effectiveness of clear aligners in correcting malocclusions is closely linked to the properties of the materials used to make them. The polymers used in the manufacture of clear aligners have well-established properties. However, the process of manufacturing clear aligners, known as thermoforming, involves thermal and mechanical shocks that may alter these properties. The objective of this study was to evaluate the effects of thermoforming on the mechanical, optical, chemical, and morphological properties of sixty PET-G specimens. The study compared the thickness, weight, absorbance, chemical structure, surface roughness, elastic modulus, yield strength, and breaking load of thirty thermoformed specimens with thirty non-thermoformed specimens. The study introduces a new approach by using standardized samples to analyze both chemical and physical properties. The results showed statistically significant differences in thickness (-15%), weight (-11%), and surface roughness (+1233% in roughness average; +1129% in RMS roughness) of the material. Additionally, a correlation was found between reduction in thickness and increase in opalescence. There was no significant change in the functionality of the aligners after thermoforming, as no significant mechanical changes were found. However, the increase in surface roughness may lead to plaque and fluid accumulation and worsen the fit of the aligners.

Craniofacial morphology in patients with impacted canine: a case control-study.

BACKGROUND: The objective of this study was to evaluate the risk of maxillary canine impaction through cephalometric evaluation. METHODS: One hundred and eighty-two Caucasian patients (80 males and 102 females) with a mean age of 12.4±0.5 were retrospectively enrolled in the present study. Ninety patients with impacted canines were compared with ninety-two patients with physiologically erupted canines. The following cephalometric variables were analyzed: SNA, ANB, SN-GOME, GO-ME, SP-CL, SELLA TURCICA DEPHT, A-Pt LINE, B-Pt LINE, A-Pt LINE°, B-Pt LINE°, A1s-Pt, A1i-Pt, A1s-Pt°, A1i-PT°, A-SN, B-SN and SN-U1. When applicable, a paired sample t-test was performed to investigate the difference in means between the two sample groups, while the Mann-Whitney Test was used as a non-parametric test in the case of a non-normal distribution of data. Statistical significance was set at P<0.05. RESULTS: The group with impacted canines showed an increase in Go-Me distance, SNA angle and A1s-Pt angle compared with the control group. In addition, the same group showed a decrease in A-SN and SP-Cl distance compared with the control group. CONCLUSIONS: An increase in mandibular length (GO-ME) and SNA angle associated with a reduction in A-Sn distance and interclinoid distance (SP-Cl) were observed in patients with impacted canines.

Curve of Spee modification in different vertical skeletal patterns after clear aligner therapy: a 3D set-up retrospective study.

OBJECTIVE: The purpose of the present study was to evaluate: (1) changes in the curve of Spee (COS) after clear aligner therapy and (2) whether such changes correlated with the patient's skeletal patterns. MATERIALS AND METHODS: Three-dimensional mandibular models of 106 patients (47 males and 59 females; mean age 22.3 SD ± 3.4 years) treated with clear aligners were retrospectively analysed. The perpendicular distance between the occlusal reference plane and the buccal cusp tip of each lateral tooth was measured. Five angular cephalometric measurements (PP-MP, PP-OP, OP-MP, AFH, and PFH) were performed and correlated with the T1-T0 difference in linear distances. The patients were divided into three groups according to facial divergence. Variance analysis with Tukey post hoc correction was performed to evaluate the differences among groups. RESULTS: The one-way ANOVA test showed a statistically significant difference for all analysed variables, except for the change in the distance of the second molar from the occlusal reference plane. Tukey's HSD test showed the following differences: In normodivergents, the T1-T0 difference in the distance of the first molar from the occlusal plane was 1 mm greater than that observed in the hyperdivergent group (p < 0.05); in the normodivergent group, the T1-T0 difference in the distance of the second premolar from the occlusal plane was 1.23 mm greater than that observed in the hyperdivergent group (p < 0.05), while in the hypodivergent group, it was 1.08 mm greater than in the hyperdivergent group (p < 0.05); finally, in normodivergents, the T1-T0 difference in the distance of the first premolar from the occlusal plane was 0.97 mm greater than that observed in the hyperdivergent group (p < 0.05). CONCLUSION: Treatment with aligners did not lead to a clinically significant change in COS depth. However, when dividing the sample into groups based on craniofacial divergence, COS depth change differed significantly between the three groups.

Improvement in the transverse dimension of dental arches in mixed dentition patients with posterior crossbite treated with functional therapy.

OBJECTIVES: To evaluate the effects of treatment of posterior crossbite (PXB) in the mixed dentition with the Function Generating Bite (FGB) appliance on the transverse dimension of the dental arches. MATERIALS AND METHODS: This study included 84 PXB patients (female = 46; male = 38; mean age, 8.2 ± 1.8 years) and 69 control (C) patients (female = 31; male = 38; mean age, 8.9 ± 1.4 years). Measurements were taken with digital calipers on maxillary and mandibular study casts before (T0) and after (T1) treatment for the following measures: intermolar (IMD), intermolar gingival (IMGD), intercanine (ICD), and intercanine gingival distances (ICGD). RESULTS: At T0, there was a significant difference in all maxillary measurements between the PXB and C groups (P < .001), reflecting maxillary hypoplasia in PXB patients. At T1, there was no difference between the groups. In PXB patients, the mean increase between T0 and T1 for IMD was 4.34 ± 2.42 mm; this difference measured 3.51 ± 2.19 mm for IMGD, 2.78 ± 2.37 mm for ICS, and 1.89 ± 1.7 mm for ICGD. There was no significant difference in mandibular measurements between groups at T0 and T1. CONCLUSIONS: Functional therapy with FGB is effective in significantly increasing the transverse dimension of the maxillary dental arch in PXB patients. Considering its efficacy in treating masticatory dysfunction, FGB may be considered a good treatment option for the correction of PXB in growing children.

Correction of Midline Deviation and Unilateral Crossbite Treated with Fixed Appliance.

The following case report describes the treatment of a 20-year-old man with dental and facial asymmetry. Patient presented upper dental midline shifted 3 mm to right side and the lower one 1 mm to left side, skeletal class I, molar class I and canine class III on the right side, molar class I and canine class II on the left side, and upper and lower crowding on teeth #12, #15, #22, #24, #34, and #35 in crossbite. The treatment plan provided four extractions: in the superior arch the right second and the left first premolar and in the lower arch first premolars on the left and right sides. Wire-fixed orthodontic device was used in combinations with coils to correct the midline deviation and to close post-extractive spaces, avoiding miniscrew implants. At the end of the treatment, optimal functional and aesthetic results were obtained: realignment of the midline improved facial symmetry, correction of the crossbite on both sides, and a good occlusal relationship.

The efficacy of a modified mandibular advancement device for OSA treatment in a group of adult patients.

OBJECTIVE: The Mandibular Advancement Device (MAD) is actually recommended for the treatment of Obstructive Sleep Apnea (OSA) with mild or moderate severity. The present study evaluated the effects of a fully customizable MAD-type device (It Makes You Sleep, IMYS), in patients with moderate-to-severe OSA. METHODS: Twenty-nine patients (15 men and 14 women; mean age 62, SD ±10 years) were retrospectively enrolled. Home Sleep Apnea Testing ;(HSAT) was performed for all patients at baseline (T0) and after three months (T1) of IMYS therapy. The analyzed respiratory parameters were: Apnea-Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), Minimum Oxygen Saturation (minSO2) and Medium Oxygen Saturation (medSO2). RESULTS: From T0 to T1, a significant reduction of AHI and ODI was reported, as well as a significant increase of minSO2 and medSO2. CONCLUSION: The IMYS device could be an effective MAD appliance for treating moderate-to-severe OSA.