Accuracy of Artificial Intelligence Models in the Prediction of Periodontitis: A Systematic Review.

INTRODUCTION: Periodontitis is the main cause of tooth loss and is related to many systemic diseases. Artificial intelligence (AI) in periodontics has the potential to improve the accuracy of risk assessment and provide personalized treatment planning for patients with periodontitis. This systematic review aims to examine the actual evidence on the accuracy of various AI models in predicting periodontitis. METHODS: Using a mix of MeSH keywords and free text words pooled by Boolean operators ('AND', 'OR'), a search strategy without a time frame setting was conducted on the following databases: Web of Science, ProQuest, PubMed, Scopus, and IEEE Explore. The QUADAS-2 risk of bias assessment was then performed. RESULTS: From a total of 961 identified records screened, 8 articles were included for qualitative analysis: 4 studies showed an overall low risk of bias, 2 studies an unclear risk, and the remaining 2 studies a high risk. The most employed algorithms for periodontitis prediction were artificial neural networks, followed by support vector machines, decision trees, logistic regression, and random forest. The models showed good predictive performance for periodontitis according to different evaluation metrics, but the presented methods were heterogeneous. CONCLUSIONS: AI algorithms may improve in the future the accuracy and reliability of periodontitis prediction. However, to date, most of the studies had a retrospective design and did not consider the most modern deep learning networks. Although the available evidence is limited by a lack of standardized data collection and protocols, the potential benefits of using AI in periodontics are significant and warrant further research and development in this area. KNOWLEDGE TRANSFER STATEMENT: The use of AI in periodontics can lead to more accurate diagnosis and treatment planning, as well as improved patient education and engagement. Despite the current challenges and limitations of the available evidence, particularly the lack of standardized data collection and analysis protocols, the potential benefits of using AI in periodontics are significant and warrant further research and development in this area.

Comparative analysis of treatment outcomes between Bi-Maxillary Plates and Facemask for treating class III malocclusion in growing subjects. A retrospective study.

AIM: To comparatively analyse the skeletal and dento-alveolar changes after treatment with Class III Bi-Maxillary Plates (BMPs) and FM appliances in growing patients with Class III skeletal malocclusion. CONCLUSION: BMPs with class III elastics provided a similar pattern of skeletal and dento-alveolar changes compared to FMs, however supported by slightly greater dentoalveolar effects that contribute to the correction of the class III malocclusion in growing subjects.

Orthodontic management of patient with Silver-Russell Syndrome (SRS). A case report.

BACKGROUND: SRS is classified as a rare syndrome with an estimated incidence of 1 in 30.000/100.000 [Christoforidis A. et al., 2005]. It's a clinically and genetically heterogeneous disorder that presents a very wide phenotypic range. Due to its heterogeneity, SRS diagnosis is difficult, and the disease is probably underdiagnosed [Eggermann T. et al., 2009]. CASE REPORT: M., a 7-year-old patient affected by SRS syndrome, comes to the first visit with a history of pain in the upper retroincisive gum due to the deep bite (gingival impingement). The pain prevents the correct chewing during meals and makes the orthodontic treatment necessary. CONCLUSION: The elaboration of a personal orthodontic treatment plan allows the patient to recover the correct masticatory function and improve her facial aesthetic.

Unconventional use of Invisalign® in the treatment of ectopic palatal maxillary canines.

BACKGROUND: The proper development of the dental arches, including the eruption and correct positioning of the canines in the arch, is essential for the oral health of growing patients. Impacted canines not only give rise to functional challenges but also pose esthetic issues for patients. The aim of this article is to show if it is possible to benefit from the exclusive use of transparent aligners to guide the eruption of ectopic upper canines into the arch in the correct position. CASE REPORT: The subject of the study is the clinical case of a 13-year-old female growing patient who presented displaced upper permanent canines located in the palatal ectopic site. Following the surgical extraction of the retained deciduous elements, treatment with aligners for repositioning the ectopic canines in the arch was performed in two phases. At the end of the treatment, a Class I canine was achieved with satisfactory repositioning of the upper canines in the arch. CONCLUSION: The use of transparent aligners makes it possible, with some procedural precautions and in carefully selected cases, to reposition the ectopic palatal canines in the dental arch using a treatment that is both esthetic and effective.

First and second branchial arch involvement in mandibulofacial dysostosis Guion-Almeida type.

BACKGROUND: Mandibulofacial dysostosis Guion-Almeida Type (MFDGA; OMIM#610536) is a rare autosomal dominant genetic disorder caused by heterozygous pathogenic variants in the EFTUD2 gene. Mandibulofacial dysostoses are characterised by the core triad malar hypoplasia, maxillary hypoplasia and dysplastic ears, all derived by the impaired development of the first and second branchial arches. Differential diagnosis is often challenging. The early genetic diagnosis is extremely useful, not only for the correct management of cranial malformations, but also for the early diagnosis and treatment of the comorbidities associated to the disease, which greatly benefit from early treatment.

Are aligners effective and efficient in growing patients?

BACKGROUND: Proper development of deciduous and mixed dentition is essential to the oral health of growing patients, and early interceptive orthopedic or orthodontic treatments are indicated in specific clinical situations. Nowadays, orthodontists are subjected to a lot of pressure from growing patients and their parents about the orthodontic appliances that should be used. The aim of this article is to indicate how, when and why it is possible to effectively use aligners in growing patients. CASE REPORT: Two case reports are illustrated, one with a Cl.II subdivision, mono lateral cross-bite and vertical growth, and the other with a skeletal and dental Cl.II, vertical skeletal pattern, proclined and fractured upper incisors. The efficacy/efficiency ratio of aligners is analyzed in order to evaluate the suitability of this appliance for the treatment. Limits and advantages of aligners are widely discussed. CONCLUSION: Aligner treatment in growing patients shall be carefully studied to reach an optimal result. At present, a hybrid treatment strategy represents the best solution in growing patients with a complex clinical situation.

Analysis of maxillary arch expansion in growing patients treated with early Class III protocol versus RME.

Aim: To evaluate and compare the maxillary arch expansion obtained in growing patients treated with Class III early treatment protocol (the modified SEC III protocol), or rapid maxillary expansion (RME). Methods: This retrospective observational study included patients in the mixed dentition with maxillary constriction and/ or dental crowding. The first group consisted of 30 patients (11 males and 19 females, mean age 9.4 ±1.7 years) with dentoskeletal Class III malocclusion treated with the modified SEC III protocol. The second group of 30 patients (14 males and 16 females, mean age 9.3 ±1.5 years) with Class I or II malocclusion was treated with a Hyrax-type expander applied to bands on the first upper molars. For each subject, initial (T0) and post expansion (T1) digital dental casts were collected. The intermolar and intercanine widths, the arch lengths at both cusp and gingival levels, the anteroposterior length and the palatal depth were measured at T0 and T1. Results: At T1 there were statistically significant differences for 3-3 occlusal (OC) (P < 0.009), arch-length OC (P <0.030), anteroposterior arch-length (AP) (P <0.003), Depth (P <0.030) and Ap (P <0.000). No statistically significant T0-T1 changes were found between the modified SEC III and Hyrax groups except for Depth (P <0.011) with a mean difference of 2.3 mm between the two groups. Conclusions: Both bonded and banded expanders, used in the modified SEC III protocol and RME treatment respectively, produced similar changes in the upper arch. The different initial dentoskeletal malocclusions of the two sample groups were not relevant to the post-expansion arch changes.

Rare syndromes in dentistry Part 1: The Pierre Robin sequence: a focus on a rare congenital anomaly.

AIM: The aim of this paper was to enlighten the peculiar findings of the Pierre Robin sequence, a rare congenital anomaly with important afterbirth comorbidities. The management of this pathology requires highly specialised centers and highly qualified specialists in order to offer the best therapeutic strategy to the affected child. Early diagnosis and parental counseling play a key role in the managing of PRS: an earlier activation of the treatment path helps to yield better outcomes and to prevent complications. A case of a newborn affected by PRS is presented, showing the steps of the treatment strategy and the final outcome.

Class III malocclusions in deciduous or early mixed dentition: an early orthopaedic treatment.

BACKGROUND: An early approach to Class III malocclusions is crucial. From diagnosis to treatment, the aim is be to correct and harmonise maxillary and mandibular growth as quickly as possible. CASE REPORT: A new treatment protocol for the early treatment of Class III malocclusions to be used in children in deciduous teething and/or early mixed teething was proposed. Ten children, 6 females and 4 males, with an overall average age of 6.5 years (6 years and 6 months) at time T0 were included in this experimental study. Twelve months orthopaedic interceptive therapy using two protraction facemasks (Delaire and Petit mask) and two types of extraoral elastic bands (8 and 16 oz) were given. Parents/guardians were involved as much as possible to increase compliance with the treatment. CONCLUSION: The orthopaedic-interceptive treatment for Class III malocclusion intends to provide a potential improvement of the growth response so that significant results can be achieved quickly. The motivational role of the parent can positively influence the child's treatment cooperation. The clinician should then try to make parents understand the importance of early treatment of Class III malocclusion thus obtaining a full cooperation with the parent/ guardian and a good compliance from the child.

Digital analysis of the occlusal changes and palatal morphology using elastodontic devices. A prospective clinical study including Class II subjects in mixed dentition.

AIM: The aim of the present prospective study was to evaluate the effectiveness of elastodontic appliance (EAs) in the treatment of subjects presenting Class II sagittal discrepancy in mixed dentition, and to evaluate palatal morphological development during treatment. MATERIALS: The study group, composed of 19 subjects, received treatment with EA for 1 year. The control group consisted of 17 untreated subjects. INCLUSION CRITERIA: age between 6 and 11 years, mixed deciduous dentition and skeletal and/or dental Class II malocclusion. EXCLUSION CRITERIA: previous orthodontic therapy, systemic diseases and signs of temporal dysfunction. Skeletal and dentoalveolar parameters were compared between T0 and T1. A 3D imaging technology was used to compare palatal morphology obtained from intra-oral digital scans between T0 (pre-treatment) and T1 (post-treatment). CONCLUSION: EAs can successfully mitigate early signs of malocclusion in Class II subjects as well as contribute to the harmonious development of the palate.

Timing and treatment sequence in the management of odontomas associated with impacted teeth: A literature review and report of two cases.

AIM: This study aims to highlight the importance of early diagnosis, timing, optimal treatment sequence and multidisciplinary approach as key factors in the orthodontic management of impacted and retained teeth associated with odontomas. METHODS: Literature about classification, epidemiology, aetiopathogenesis, histopathology and therapeutic options about odontomas and impacted teeth in orthodontics was reviewed. Two case reports are presented, showing different timing in diagnosis and surgical removal of odontomas and some biomechanical approaches. CONCLUSION: An early removal of the odontoma is certainly a more effective and simpler procedure in the approach to this problem.

PEEK polymer in orthodontics: a scoping review.

AIM: The aim of this scoping review was to evaluate the application of polyether-ether-ketone (PEEK) in orthodontics. METHODS: Search strategies were executed for electronic databases through PubMed, Scopus, Web of Science, Lilacs, Opengrey, Embase, Cochrane Library and records identified through hand or electronic search. The keywords used were: "PEEK" OR "Polyether-ether-ketone" AND "orthodontics". The period selected of article publication was from January 2015 to June 2021. CONCLUSION: Due to excellent physical, mechanical, aesthetic properties and biocompatibility, its low plaque affinity and flexural modulus close to enamel and dentin, PEEK can be used also in orthodontics. However, more clinical research should be done to find out all the advantages and disadvantages of this material.

Maldevelopment of the cranio-facial-respiratory complex: A Darwinian perspective.

AIM: The mammalian Cranio-Facial-Respiratory Complex (CFRC) comprises several different biological tissues that collectively function under coordination from the central nervous and cardiorespiratory systems, primarily to breathe, eat and drink as well as integrating the sensory and motor systems for speech, communication and protective mechanisms. Anthropologists have long recognised that lifelong exposure to modern feeding regimens of readily available and highly processed foods, changes in breastfeeding and weaning, can impact expression of various phenotypic traits affecting the CFRC quite differently than does lifelong exposure to more traditional ancestral feeding regimens, typical of hunter-gather/foraging in non-Western-exposed cultures. The aim of this study is to highlight the role of the paediatric dentist in a multidisciplinary approach in which professionals working in and around the CFRC can actively prevent tooth decay and skeletal-dental malocclusion in the light of evolutionary oral medicine. RESULTS: As a result of changes in the environment, in the food quality, in eating and feeding practices starting from day one, two oral diseases of civilisation, tooth decay and skeletal-dental malocclusion, have both relatively recently reached worldwide epidemic proportions and afflict people of all ages. CONCLUSION: A multidisciplinary approach in which professionals working in and around the CFRC can actively promote prevention or reversal of dento-skeletal and myofunctional disorders, diagnose them when present and coordinate the appropriate therapy and life long maintenance programme.

Myofunctional therapy Part 3: Tongue function and breastfeeding as precursor of oronasal functions.

Breastfeeding is the best practice to ensure proper nutrition, correct growth of the craniofacial complex and overall health of the baby with optimal breathing, feeding and sleeping functions. Many mothers face breastfeeding problems due to the baby's difficulty in latching, especially if the lingual frenum is restricted. Early detection and understanding of some of the root causes of those difficulties will lead to an early intervention, thus getting the babies on the right tract of their full potential of growth and development.

Short term dentoskeletal effects of mandibular advancement clear aligners in Class II growing patients. A prospective controlled study according to STROBE Guidelines.

AIM: To evaluate the dentoskeletal effects of the Invisalign® Mandibular Advancement (MA) (Align Technology, San José, CA, USA) feature in skeletal Class II growing patients with mandibular retrusion, at pre-pubertal and pubertal stages. MATERIALS AND METHODS: Study design: Forty skeletal Class II patients were prospectively recruited and treated with Invisalign® MA. They were divided into two subgroups according to the CVM stage of growth (CVM2 and CVM3) at the beginning of treatment (T0). For each patient, lateral radiographs were collected at the beginning (T0) and at the end of the mandibular advancement treatment (T1) and their measurements were compared with those obtained by an untreated control group of 32 subjects, matched for growth stage and malocclusion. RESULTS: Patients in CVM2 showed significant reduction of ANB angle, A:Po, Wits index, 11^Spp angle and significant increase of 11^41 and B Downs point. In CVM3 significant reduction of the Wits index and of 41^GoGn angle, and significant increase of the linear Co-Gn measurement, were revealed. STATISTICS: The STROBE guidelines were followed. Linear regression analysis was performed to estimate the differences of ? (T1 - T0) means between group (control was used as reference) stratifying by CVM levels. CONCLUSION: The use of Invisalign® MA is effective in treating Class II growing patient with retrognathic mandible in the short term period. While treatment at prepubertal stage of growth results in dentoalveolar rather than skeletal effects, treatment during the pubertal spurt produces skeletal effects with an annual rate of change of 5.8 mm.

Myofunctional therapy Part 2: Prevention of dentofacial disorders.

AirwayCentric approach to prevention of dentofacial disorders. The correct development of functions is important for the prevention of dentofacial disorders from the first days of life. The first and foremost function, to which all others are adapting, is nasal breathing. The AirwayCentric® method focuses on nasal breathing during early development and throughout childhood to promote: Neurobehavioural development and the brain, development of the craniofacial and respiratory complex, correct dental occlusion, proper and restful sleep and to improve performance and life overall. By working at the same time on orofacial functions and structures, many dentofacial disorders can be prevented.

Myofunctional therapy. Part 1: Culture, industrialisation and the shrinking human face.

Culture, industrialisation and the shrinking human face: Why is it important? Over the past 300,000 years, not only has the way we consume food from birth through our lifetime changed, there have also been changes related to the methods of food preparation, availability, processing, and storage. These diet-related factors, along with other epigenetic factors, have led to a widespread increase in orofacial myofunctional disorders (OMDs) and resultant human malocclusion phenotypes (HMPs) worldwide. Currently there is an increasing need for resolution of HMPs in early childhood and associated OMDs. This review will include reports of cases and describe the nature of the problem and strategies for effective solutions.

Orthodontic treatment need and timing: Assessment of evolutive malocclusion conditions and associated risk factors.

AIM: Orthodontic treatment need indexes are indispensable tools for collecting aepidemiological information, to define the need for clinical intervention on a graduated risk scale and to monitor the evolution of clinical conditions over time. The purpose of this research is to evaluate the prevalence of malocclusion and associated risk factors, and to compare the prevalence of malocclusion related to children's growth. Investigating the correlation between malocclusion and dental occlusion development is crucial to define orthodontic timing and the most suitable treatment modalities. MATERIALS AND METHODS: A cross-sectional, multi-center, observational study was carried out throughout Italy: 4,422 patients aged between 2 and 13 years were visited. The patients were divided into two age groups: one composed of patients aged 2 -7 years, and one of children between 8 and 13 years of age. The prevalence data were classified according to the items of the Baby ROMA (first group, deciduous/early mixed dentition) and ROMA Index (second group, late mixed/permanent dentition). Pearson's Chi-square test was applied for the calculation of statistical significance in the comparison of prevalence data between the two age groups (P <0.05). RESULTS: The need for orthodontic treatment among Italian children is high. In the sample aged between 2 and 7 years, the most frequent malocclusions are the moderate and severe open bite (23%), moderate and severe Class II (21.2%), deep bite (18.8%), cross bite (16.5%), Class III (7.7%), and crowding (5.1%). In the sample aged between 8 and 13 years the most frequent malocclusions are crowding (50.8 %), Class II (33.1%), deep bite (19.2%) crossbite (18.1%), Class III (9.1%), open bite (6.6%), facial or mandibular asymmetries (3.3%), and functional asymmetries (3.2%). It was found a statistically significant variation of the different malocclusion conditions according to age. CONCLUSION: The study confirms that some risk factors occur during growth, and worsen the malocclusion. Therefore, it is important to reduce this risk of worsening by counteracting those factors with an early orthodontic intervention. Some malocclusions are less affected by environmental risk factors. In these case it would be better defer treatment until adolescence.