Dental anomalies in an Albanian orthodontic sample: a retrospective study.

BACKGROUND: To evaluate the prevalence and the distribution of dental anomalies in an Albanian orthodontic sample. METHODS: For this retrospective study, a sample of panoramic radiographs (PR) of n. 779 (456 F and 323 M, mean age of 15.1 ± 5.5 years) Albanian subjects with no genetic syndromes or craniofacial malformations (e.g., cleft lip/palate), history of extraction, trauma or previous orthodontic treatment drawn from the archives of the University Dental Clinic Our Lady of Good Counsel, was examined. The inclusion criteria were: subjects from 8 to 30 years of age, good quality of PRs in order to allow the assessment of crown and root development. For different dental anomalies, both the prevalence and the association were evaluated by using Chi-square test (p < 0.05). RESULTS: 24.4% of the sample had at least one dental anomaly and 4.6% had more than one. The following dental anomalies were most prevalent: hypodontia (9.8%), dental impaction (7.6%), and ectopic eruption (5.3%). No statistically significant correlation was found between males and females (p > 0.05). CONCLUSIONS: The most common anomalies in this group are found to be those of number and position, and only radiological investigations can reveal either of these anomalies. Early diagnosis of dental anomalies can contribute to prevent their complications and to establish the most suitable therapy to achieve a functional occlusion.

Mandibular morphometric analysis in open bite early treatment relapse subjects: a retrospective observational pilot study.

BACKGROUND: The purpose of this retrospective study was to evaluate the mandibular shape differences between a group of success and a group of failure Anterior Open Bite (AOB) malocclusion early orthodontic treatment in growing subjects, in order to identify mandibular features of relapse. METHODS: Twenty three patients (7 males, 16 females, 9.3 years ±1,5 years) were enrolled from the Department of Orthodontics at the University of Rome Tor Vergata. Inclusion criteria were: white ancestry, overbite < 0 mm, mixed dentition phase, end-to-end or Class I molar relationship, first skeletal class assessed on lateral cephalograms (0° < ANB < 4°), cervical skeletal maturation CS1-CS2, no previous orthodontic treatment, no congenital diseases. Pre-treatment (T1) lateral cephalograms were acquired. Each patient underwent early orthodontic treatment with Rapid Maxillary Expander (RME) and Bite Block (BB) or Quad-Helix Crib (QHC) until open bite correction. Radiographic records were recollected at T2 (permanent dentition, skeletal cervical maturation CS3-CS4). Mean interval time T2-T1 was 4.2 years ±6 months. According to treatment stability, a Relapse Group (RG 11 patients, 3 M, 8F; 13.7 years ±8 months, 7 subjects treated with RME/BB, 4 with QH/C) and a Success Group (SG, 12 patients, 4 M, 8F; 13.4 ± 10 months, 7 subjects treated with QH/C, 5 with RME/BB) were identified. On the lateral radiographs the mandibular length (Co-Gn), the inferior gonial angle (NGo^GoMe) and the antegonial notch depth (AND) were analyzed. Then the mandibular Geometric Morphometric analysis (GMM) was applied. Intergroup statistically significant differences were found using student's t-tests. Procrustes analysis and principal component analysis (PCA) were performed for the GMM. RESULTS: At T1 no statistically significant differences were found between RG and SG, however higher values of antegonial notch depth were found in RG. T2-T1 comparison showed in RG statistically significant increases in Co-Gn (p = 0.04), NGo^GoMe angle (p = 0.01) and antegonial notch depth (p = 0,04). PC1 confirmed the increase in the antegonial notch depth in RG when compared to SG at T2. CONCLUSIONS: The increased antegonial notch depth associated with the increased mandibular length and the increased gonial angle could be responsible of relapse of early orthodontic treatment in open bite growing subjects.

Gingival Margins' Modifications during Orthodontic Treatment with Invisalign First®: A Preliminary Study.

The aim of the study was to assess modifications of gingival morphology at the end of Phase I treatment with Invisalign First. Eighteen subjects (ten females, eight males, mean age nine years) treated with Invisalign First were selected. The following parameters were measured on intraoral photographs before treatment (T0) and after the first set of aligners (T1) at level of permanent incisors, deciduous canines and molars: gingival margin height (GMH) and deciduous canine inclination (DCI). A paired t-test was used to evaluate T1-T0 changes. The level of significance was established at 5%. Deciduous canines' GMH showed a major reduction between T1 and T0 accounting for 0.87 mm and 0.86 mm, respectively on the right and left sides. DCI increased for all patients in the interval T0-T1 on both sides, +7.11° on the right and +7.5° on the left. Tooth movement during Invisalign First induced significant modifications of gingival contour resulting in a more harmonious smile.

Saliva Analysis of pH and Antioxidant Capacity in Adult Obstructive Sleep Apnea Patients.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) may be associated with and activates the stress response system, and variation in the physiological antioxidant capacity of body fluids. Our aim was to evaluate the variation of pH and antioxidant capacity on the saliva of obstructive sleep apnea subjects (OG) compared to a control group (CG). METHOD: Fifty subjects with moderate/severe OSAS were recruited in Tor Vergata Hospital and compared with 20 healthy subjects CG. The buffer and the antioxidant capacity of the samples were quantified measuring the pH and the percentage of total salivary antioxidant capacity (%TAC), which refers to the reduced glutathione salivary concentration (GSH). Moreover, the protein concentration and the gelatinolytic activity of metalloproteinases were quantified. RESULTS: The data showed that the pH value is slightly more alkaline in OSAS subjects; however, it is not directly related to the severity of OSAS. The %TAC was found to be significantly reduced by 86.2% in the OG. Proteins of saliva from the OG were found 1.5 times more concentrated than in the healthy sample. The gelatinolytic activity of metalloproteinases of healthy and OSA did not show statistically significant changes. CONCLUSIONS: The salivary samples from OSAS compared to CG show an alteration of the oxidative state, the pH buffering power, and protein concentrations, inducing conditions that can easily evolve chronic gingivitis. Further investigations are necessary to evaluate the feasibility of using salivary fluid for the early diagnosis of oral or systemic problems in OSAS subjects.

Light-curing process for clear aligners' attachment reproduction: comparison between two nanocomposites cured by the auxiliary of a new tool.

BACKGROUND: Attachments' configuration play an important role during Clear Aligner Treatment (CAT) for aligner retention and control of movements planned. The aims were to compare the macroscopic morphology of attachments reproduced with flowable (FNC) and conventional (CNC) composites and the effects on them of two light-guide tips with different dimensions. METHODS: 4 resin casts derived from the initial scan of the same patient were obtained. 10 vestibular attachments were replaced on both upper and lower arches of each model with CNC (Models A, B) and FNC (Models C, D). Each composite was cured by means of the same LED lamp with both regular light-guide (Models A, B) and push and light tool® (Models C, D). The 80 attachments were qualitative analyzed by means of a digital stereo microscope. Surface roughness and waviness measurements were assessed by contact probe surface profiler (TalySurf CLI 2000; Taylor Hobson, Leicester, United Kingdom). Statistical analysis was performed with independent samples t-tests. Significance was established at the P < 0.05 level. RESULTS: Model A showed lower values of surface roughness (Ra - 1.41 µm, Rt - 3.46 µm) and waviness (Wa - 2.36 µm, Wt - 10.95 µm) when compared with Model C. Significant reduction of waviness (Wa - 3.85 µm, Wt - 4.90 µm) was observed on Model B when compared with Model D. Significant increase of roughness and waviness parameters (Ra 3.88 µm, Rt 21.07, Wa 2.89 µm, Wt 14.74 µm) was found when CNC sample (Model A) was cured with regular light-guide tip. Higher values (Ra 2.33 µm, Rt 24.07 µm, Wa 1.67 µm, Wt 20.79 µm) were observed after regular light-guide tips curing on FNC sample (Model C). CONCLUSIONS: CNC resins determine more regular surfaces of attachments profiles. The additional use of a smaller light- guide of the LED push and light tool® allows to improve the macroscopic morphology of the attachments and to maximize light irradiance delivering by enhancing the polymerization process and the integrity of the features during the treatment.

Enamel interproximal reduction during treatment with clear aligners: digital planning versus OrthoCAD analysis.

BACKGROUND: The aim of the study was to compare the amount of interproximal enamel reduction (IPR) provided on ClinCheck software with the amount of IPR carried out by the orthodontist during treatment with clear aligners. METHODS: 30 subjects (14 males, 16 females; mean age of 24.53 ± 13.41 years) randomly recruited from the Invisalign account of the Department of Orthodontics at the University of Rome "Tor Vergata" from November 2018 to October 2019, were collected according to the following inclusion criteria: mild to moderate dento-alveolar discrepancy (1.5-6.5 mm); Class I canine and molar relationship; full permanent dentition (excluding third molars); both arches treated only using Comprehensive Package by Invisalign system; treatment plan including IPR. Pre- (T0) and post-treatment (T1) digital models (.stl files), created from an iTero scan, were collected from all selected patients. The OrthoCAD digital software was used to measure tooth mesiodistal width in upper and lower arches before (T0) and at the end of treatment (T1) before any refinement. The widest mesio-distal diameter was measured for each tooth excluding molars by "Diagnostic" OrthoCAD tool. The total amount of IPR performed during treatment was obtained comparing the sum of mesio-distal widths of all measured teeth at T0 and T1. Significant T1-T0 differences were tested with dependent sample t-test (P < 0.05). RESULTS: In the upper arch, IPR was digitally planned on average for 0.62 mm while in the lower arch was on average for 1.92 mm. As for the amount of enamel actually removed after IPR performing, it was on average 0.62 mm in the maxillary arch. In the mandibular arch, the mean of IPR carried out was 1.93 mm. The difference between planned IPR and performed IPR is described: this difference was on average 0.00 mm in the upper arch and 0.01 in the lower arch. CONCLUSIONS: The amount of enamel removed in vivo corresponded with the amount of IPR planned by the Orthodontist using ClinCheck software.

Conventional versus laser gingivectomy in the management of gingival enlargement during orthodontic treatment: a randomized controlled trial.

OBJECTIVES: To compare the use of diode laser with conventional surgery evaluating the effectiveness of gingivectomy as an adjunct to non-surgical periodontal treatment in the management of gingival enlargement (GE) during orthodontic treatment. TRIAL DESIGN: Prospective three-arm parallel group randomized clinical trial with 1:1:1 allocation ratio. METHODS: Sixty subjects (33 males and 27 females), with a mean age of 14.4 ± 1.9 years, were selected according to inclusion criteria: overgrown gingivae on the labial side of the anterior teeth secondary to fixed appliance therapy, six maxillary anterior teeth present, and healthy non-smokers patients. Patients were enrolled in the study and randomly assigned to three groups by a computer-generated randomization list and by a block size of 4. The allocation information was concealed in opaque and sealed envelopes by the statistician. In the first group, all subjects underwent a conventional scalpel gingivectomy of the maxillary anterior sextant. In the second group, all subjects were treated using laser-assisted gingivectomy; while subjects assigned to the third group underwent only non-surgical periodontal treatment and served as control group (CG). The observer who performed all the measurements was blinded to the group assignment. Blinding was obtained by eliminating from the elaboration file every reference to patient group assignment. Intergroup comparisons of changes in the periodontal parameters were conducted at 1, 3, and 6 months using ANOVA with repeated measures and Tukey's post hoc tests. The significance level was set at P <0.05. RESULTS: After 1 month, the TGs showed a significant improvement of all periodontal parameters when compared with the CG. No statistically significant differences were observed between the two TGs. At the 3-month observation, a relapse occurred in the TGs, while the CG showed the greater improvement of soft tissue health. In the 6-month versus 3-month evaluation, no significant differences between the three groups were found for any periodontal measurements. In the long-term evaluation (6 months versus baseline), a significant greater reduction of pockets were found in the TGs when compared with the CG. CONCLUSIONS: The adjunct use of both scalpel gingivectomy and laser gingivectomy was more effective in controlling gingival inflammation than non-surgical periodontal treatment alone at 1, 3 and 6 months. In the control group, greater improvement in the periodontal parameters were observed within 3 months, depending on a self-care approach for the management of GE. LIMITATIONS: This study was a short-term study (6-month follow-up). TRIAL REGISTRATION: ClinicalTrials.gov (registration number: NCT03514316).

Morphometric analysis of the palatal shape and arch dimension in subjects with buccally displaced canine.

OBJECTIVES: To analyse morphological variations of the palate shape and maxillary arch dimension between a group of subjects with unilaterally or bilaterally buccally impacted maxillary canines and a control group (CG) by means of 3D geometric morphometric (GMM). MATERIALS: Pre-treatment records of 50 subjects (16 males and 34 females; mean age 13.9 years ± 1.8) with one or both canines buccally displaced were collected retrospectively. A CG of 50 subjects was selected from a list of orthodontic patients at the same dental hospital. The experimental group, buccally displaced canine (BDC) was divided in two groups: unilateral buccally displaced canine (UBDC) and bilateral buccally displaced canine (BBDC). To analyse the palate's shape and maxillary arch dimension, study casts were scanned. To study the entirety of the palatal shape, 3D GMM analysis was used. To analyse the maxillary arch dimension, the virtual three-dimensional models were measured with a specific software (VAM, Vectra, Canfield Scientific, Fairfield, New Jersey, USA). RESULTS: When comparing the groups with the GMM analysis, patients with BDC showed a statistically significant narrower and higher palatal vault. About the analysis of linear measurements, the intercanine width, the anterior and posterior segment length were significantly smaller in BDC, UBDC, and BBDC subjects when compared with the controls and there were no differences between UBDC versus BBDC groups. CONCLUSIONS: Patients with buccally displaced permanent canine tended to have maxillary transverse constriction and variation in palatal vault morphology. The morphometric variation of the palatine vault and arch dimensions can be considered a clinical factor associated with the presence of BDC.

Periodontal condition in growing subjects with Marfan Syndrome: a case-control study.

BACKGROUND: Marfan's syndrome (MFS) is a systemic disorder of connective tissue caused by mutations in the extracellular matrix protein fibrillin-1. Orofacial characteristics may be useful in identification of the syndrome. Severe periodontitis is sometimes observed in MFS patients, but no in-depth information has been reported in Italian groups of growing subjects with MFS. The aim of this study was to analyze the periodontal condition on a group of growing subjects affected by MFS, in comparison with a typically developed control group. METHODS: A group of 16 subjects with diagnosed MFS were recruited from the Centre for Rare Diseases for Marfan Syndrome and Related Disorders of Tor Vergata University Hospital. The Marfan Group (MG) was compared with a Control Group (CG) composed by 20 nonsyndromic subjects. The periodontal clinical parameters like Marginal Gingival Thickness (GT), Plaque Index (PI), Bleeding On Probing (BOP) and Modified Periodontal Screening and Recording (PSR) were assessed. RESULTS: The mean value of PI in MG was 59%, instead in CG it reached 21%. Analysis showed a significant difference between MG and CG also for the BOP. In MG the mean value of BOP attained 36% and in CG it reached 16%. A statistical significant difference of distribution of PSR index between the two groups was found for all sextant examined. DISCUSSION: Patients with Marfan syndrome reveal a higher presence of plaque and consequently a generalized inflammation in the oral cavity when compared with a control group.

Biologically guided flap stability: the role of flap thickness including periosteum retention on the performance of the coronally advanced flap-A double-blind randomized clinical trial.

AIM: To evaluate the possible benefit on wound healing and flap stability of periosteum inclusion, comparing a "split-full-split" thickness flap elevation versus a "split" thickness approach performed during CAF for the treatment of isolated-type gingival recessions in the upper jaw. MATERIAL AND METHODS: Forty patients were randomized, 20 were treated with "split-full-split" (test group) and 20 with a "split" approach (control group). Analysed parameters at 1 year were CRC, percentage of recession coverage (RC), keratinized tissue (KT) gain and patient-related outcome measurements. RESULTS: After 12 months, CRC was 80% in the test group and 35% in the control group. Percentages of RC and KT gain were higher in the test group, and a significant association between CRC and the thickness of the flap after elevation was found. Patient-related outcomes measurements were better for the test group. CONCLUSIONS: Flap thickness preservation and the presence of the periosteum in part of the flap may play a fundamental role in obtaining CRC.

Associations between tooth agenesis and displaced maxillary canines: a cross-sectional radiographic study.

BACKGROUND: The aim of present study was to test the association between hypodontia and displaced maxillary canine when compared with a control group. METHODS: The study group was composed of 336 subjects with a mean age of 10.7 ± 1.2 years, presenting with at least one missing tooth. Exclusion criteria included syndromes, craniofacial malformations, extractions and trauma history and previous orthodontic treatment. The control group consisted of 336 subjects with a mean age of 10.7 ± 1.2 years, without agenesis. Stepwise multiple logistic regression using the backwards elimination and the Wald test method was performed to identify the best combination of hypodontia and displaced maxillary canine (P < 0.05). RESULTS: The most represented category in study group consisted in mild agenesis (86.9%); moderate and severe agenesis groups respectively represented the 11.7 and 1.4% of study group. Agenesis was diagnosed in both arches in 46 subjects. Maxillary hypodontia and mandibular hypodontia was respectively detected in 156 and 134 subjects. The most frequent missing teeth were mandibular second premolars (45.8%), lateral incisors (41.7%) and maxillary second premolars (17.8%). A significant correlation between agenesis and displaced maxillary canine was observed in the study group (P < 0.05). Only the agenesis of maxillary lateral incisors remained in the final model during backward stepwise deletion. Significant association between the severity of dental agenesis and prevalence of displaced maxillary canine was not assessed. CONCLUSIONS: The outcomes revealed no difference related to the severity of dental agenesis and prevalence of displaced maxillary canine. Only the agenesis of maxillary lateral incisors should be considered directly connected with displaced maxillary canine.

Comparison and reproducibility of 2 regions of reference for maxillary regional registration with cone-beam computed tomography.

INTRODUCTION: The aims of this study were to evaluate the differences between 2 regions of maxillary voxel-based registration and to test the reproducibility of the registration. METHODS: Three-dimensional models were built for before-treatment (T1) and after-treatment (T2) based on cone-beam computed tomography images from 16 growing subjects. Landmarks were labeled in all T2 models of the maxilla, and voxel-based registrations were performed independently by 2 observers at 2 times using 2 reference regions. The first region, the maxillary region, included the maxillary bone clipped inferiorly at the dentoalveolar processes, superiorly at the plane passing through the right and left orbitale points, laterally at the zygomatic processes through the orbitale point, and posteriorly at a plane passing through the distal surface of the second molars. In the second region, the palate and infrazygomatic region had different posterior and anterior limits (at the plane passing through the distal aspects of the first molars and the canines, respectively). The differences between the registration regions were measured by comparing the distances between corresponding landmarks in the T2 registered models and comparing the corresponding x, y, and z coordinates from corresponding landmarks. Statistical analysis of the differences between the T2 surface models was performed by evaluating the means and standard deviations of the distances between landmarks and by testing the agreement between coordinates from corresponding landmarks (intraclass correlation coefficient and Bland-Altman method). RESULTS: The means of the differences between landmarks from the palate and infrazygomatic region to the maxillary region 3-dimensional surface models at T2 for all regions of reference, times of registrations, and observer combinations were smaller than 0.5 mm. The intraclass correlation coefficient and the Bland-Altman plots indicated adequate concordance. CONCLUSIONS: The 2 regions of regional maxillary registration showed similar results and adequate intraobserver and interobserver reproducibility values.