Class II division 1 malocclusions: comparisons between one- and two-step treatment.

AIM: The aim of this study consists in comparing the two-step treatment with that performed in a single-step in adolescent patients. MATERIALS AND METHODS: Study design: This paper is a critical review of the literature with a systematic approach. The search for scientific articles was performed on the US National Library of Medicine database using the PubMed service. Keywords set: "Early treatment Class II OR 1-phase orthodontics OR orthodontic timing Class II". From the initial screening 20 articles were selected of which the full text has been researched and evaluated. RESULTS: The selected articles were reviewed and evaluated by two independent operators, who both excluded two papers. Ultimately 13 articles were selected that refer to four major working groups, respectively from Manchester, North Carolina, Florida and Queen Mary University of London. CONCLUSION: We can assume that both the one- and two-step treatment are effective in correcting Class II malocclusion, with no significant difference of outcome, except for the incidence of incisor trauma, which was significantly lower for the early treatment group.

Titanium TSME appliance for patients allergic to nickel.

AIM: The aim of this article is to describe the use of a titanium TSME appliance for patients with allergy to resin and nickel. We aim to highlight the optimal way to avoid problems such as stomatitis and peri-labial dermatitis, which generally appear in patients who use traditional orthodontic appliances made in acrylic resin and steel. MATERIALS AND METHODS: The construction of a titanium appliance is described and a case treated with it is reported. RESULTS: The titanium TSME presented in this paper has excellent biocompatibility due to its ability to form superficial oxides, which prevent oxidation and thus corrosion. CONCLUSION: The non-allergic properties of titanium allow to propose it as an alternative in patients with a long-term history of allergic reactions to nichel.

Modified transversal sagittal maxillary expander for correction of upper midline deviation associated with maxillary arch deficiency.

The transversal sagittal maxillary expander (TSME) is a fixed device designed to develop arch form in patients with constricted dental arches. The present article describes a modified TSME appliance, the activation method, the therapeutic benefits as well as clinical advantages. The appliance has two molar bands, a Hyrax-type transverse expansion screw, one 0.045-inch wire extending from the molar band to the palatal surface of the central incisor in the emiarch crossbite and an 8 mm-Hyrax-type screw attached to this wire between the molar band and the incisor. A buccal arm with a terminal loop is welded to the band in the emiarch and it is extended to the labial surface on the central incisor on the side opposite to the crossbite and the maxillary midline deviation. The modified TSME appliance described in this paper are specifically designed for anteroposterior and transverse development. It has a sagittal effect on the maxillary alveolar process and at the same time allow to restore the correct transverse maxillary diameters.

Obstructive sleep apnea syndrome: a literature review.

Obstructive sleep apnea syndrome (OSAS) is a complete or partial airway obstruction that can cause significant physiologic disturbance with various clinical impacts. The etiology is multifactorial and its clinical manifestations are night snoring, headache when patient wakes up, day-time sleepiness and degrease of cognitive performance. Some recent international studies suggest that the OSAS prevalence is 2-4% in men and 1-2% in women of average age. The aim of this work was presenting a literature review in Medline concerning Obstructive sleep apnea syndrome. A review of the articles ranging from 1980 to 2014 has been done. Over 2000 articles were found and those which give useful information about etiology, diagnosis, therapy and found results after the study were selected and evaluated. In literature there is no unanimous opinion on the treatment of OSAS. According to the majority of the authors it should be multidisciplinary. The choice of therapy is predicated on the etiology, severity and natural history of the increased upper airway resistance. The importance of a praecox diagnosis and orthodontic therapy in order to re-establish normal function is underlined, since OSAS is linked with high risk of hypertension, cardiovascular diseases, daytime sleepiness, home and work-related accidents, with consequent worsening of life quality.

Upper midline deviation: modified Hyrax expander.

BACKGROUND: The Hyrax rapid palatal expander is useful for patients in mixed dentition with premature exfoliation of some deciduous teeth and maxillary hypoplasia. This appliance, which is provided of a vestibular arm for correcting maxillary asymmetric transverse discrepancies, represents an interceptive treatment able to reduce the duration of the orthodontic therapy with fixed appliances. CASE REPORT: In this case report the modified version of the Hyrax rapid palatal expander is described. The activation method, the therapeutic benefits as well as the clinical advantages are described.

Atypical swallowing: a review.

AIM: Atypical swallowing is a myofunctional problem consisting of an altered tongue position during the act of swallowing. High incidence in population, multifactorial etiology and the recurring connection with the presence of malocclusions made it a topic of strong interest and discussion in science. The purpose of this review is to illustrate the current orientation on the topic of atypical swallowing, trying in particular to answer two questions: 1) what kind of connection is there between atypical swallowing and malocclusion; 2) what kind of therapy should be used to solve it. METHODS: This review was conducted on the Medline database [www.ncbi.nim.nih.gov/pubmed] searching for the keywords "atypical swallowing" and "tongue thrust". We examined all the documents from the year 1990 onwards, excluding the ones about syndromic cases of the central motor system. RESULTS: The causal relation between the two problems seems to be biunique: some authors affirm that this oral habit starts as a compensation mechanism for a preexisting malocclusion (especially in case of open-bite); other texts show that it has a tendency to exacerbate cases of malocclusion; it is also proven that a non-physiological tongue thrust can negatively influence the progress of an ongoing orthodontic therapy. Thereby, the best therapeutic approach seems to be a multidisciplinary one: beside orthodontics, which is necessary to correct the malocclusion, it is essential to set up a myofunctional rehabilitation procedure to correct the oral habit, therefore granting long time permanent results. There is also proof of a substantial difference between the results obtained from early (deciduous or primary mixed dentition) or later treatments. CONCLUSION: The biunique causal relation between atypical swallowing and malocclusion suggests a multidisciplinary therapeutic approach, orthodontic and myofunctional, to temporarily solve both problems. An early diagnosis and a prompt intervention have a significantly positive influence on the therapy outcome.

Cleft lip and/or palate: review.

AIM: Aim of the review was to provide a literature overview of the birth defects of cleft lip and/or cleft palate (CL/P). METHODS: Through the use of the PubMed database items were collected that would provide information about the condition, leading to the discussion of the following topics: epidemiology, anatomical features, genetics, environmental factors, diagnosis and treatment. RESULTS: According to these data, the CL/P are the most common congenital malformations of the craniofacial region. There are different phenotypes and clinical features of this malformation, which differ according to the anatomical structures involved: cleft lip, cleft lip and cleft palate. The etiology is multifactorial and includes both genetic factors and environmental factors. For proper diagnosis and treatment it is important to complete a multidisciplinary approach to guide the patient from birth to the end of growth. Among the outstanding figures for the care of the anomaly are: the gynecologist, the pediatrician, the maxillofacial surgeon and orthodontist. Individuals with a cleft lip and/or cleft palate may experience problems in feeding, pronunciation, hearing and social integration, which can be corrected to a different extent by surgery, dental treatment, speech therapy and psychosocial interventions. CONCLUSION: Today the optimal treatment is difficult to find, because of the large variability of malformations and the subjective response of each patient to therapy.

Premature loss of primary molars in children: space recovery through molar distalisation. A literature review.

AIM: The integrity of primary dentition is essential in the development of the jaws and permanent occlusion. The consequences of a premature loss of primary molars are: space loss, crowding, risk of impaction of the permanent teeth, ectopic eruption, anomalous inclination of the teeth adjacent to the loss molar, reduction of arch length. The mesial displacement of the posterior permanent teeth during eruption can cause a loss of space, which can be regained with orthodontic appliances. Therefore, a careful diagnosis is of great importance to be able to decide what appliance is indicated to recover from this situation. Molar distalisation consists in displacing permanent molars distally, allowing them to reach class I relationship and to recover the correct space for the second bicuspids when the second deciduous molar has been lost early. METHODS: The aim of this study is to carry out a narrative literature review regarding the different appliances and their effectiveness in regaining space after premature loss of the upper primary molars. CONCLUSION: The paediatric dentist should be aware of the advantages and disadvantages related to each device and select the most appropriate distalisation appliance based on an individual plan of diagnosis and a careful treatment. The distalisation of the upper molar must be adequately stabilised and so it is important to consider also some retainers such as Nance's appliance, the Palatal Plate, the extraoral traction, the utility arch, or II Class elastic bands.

Impacted maxillary canine on the position of the central incisor: surgical-orthodontic repositioning.

The aim of this article is to describe a case of a young orthodontic patient in which an impacted maxillary canine was repositioned in the central incisor position. A severe resorption of the root of the central right maxillary incisor by ectopic eruption of the impacted right maxillary canine is described. The canine was repositioned in the incisor's position to avoid resorption of the roots of the adjacent teeth during the disinclusion. The central incisor was extracted and the canine was extruded by a closed eruption technique. When the canine eruption was complete, the tip, the torque and the morphology of the canine were modified in order to make it look like an incisor. Nowadays the therapy with dental implants is the best choice, if the position of impacted teeth is difficult to reach. This case report describes a successful management of an impacted upper right canine aligned in the upper right central incisor position. Accurate diagnosis, conservative management of the soft tissues, anchorage unit and the direction of the orthodontic traction are important factors for the success treatment.

Oral tissues and orthodontic treatment: common side effects.

The aim of this paper was to provide a literature review about the problems that can occur during orthodontic treatment. Using the PubMed database we collected items that would provide information regarding the direct consequences of the placement of an orthodontic appliance: coming to the discussion of the following topics: candida infections, the effects on the soft tissues, the effects on periodontal tissues and effects on hard tissues. The presence of appliances in the oral cavity increases the prevalence of people with candida, specifically the species Candida Albicans is the most frequently isolated. The balance between the clearance of the microorganism, the colonization and the state of candidiasis depends both on the virulence of the fungus, and the competence of the host immune system. On soft tissues, cases of ulceration of the upper jaw by a rapid palatal expander and pyogenic granuloma due to quad helix appliance have been reported. The second one is mostly observed on vestibular gingiva. The first one was found, however, in patients suffering from diabetes mellitus type 1 because of the tissue modifications induced by this pathological condition. The more severe periodontic effects are those caused by incorrect use of orthodontic elastic separators. Finally, the White Spot Lesions are the direct consequences of a wrong conditioning of enamel when attaching the bracket. They represent a first stage of caries in the positioning area of the bracket. The orthodontist is required to intercept these issues not to affect the success of the treatment.

Correlations between malocclusions and dyslalias.

AIM: This was to evaluate the relationship between malocclusions and dyslalias and to plan a multidisciplinary approach between orthodontics and speech therapy. STUDY DESIGN: 880 children (448 males and 432 females) ranging in age from 6 to 10 years were examined at the Department of Orthodontics at Milan University to determine if a relationship between malocclusions and dyslalia exists and their correlations. METHODS: The children were examined by a speech therapist and an orthodontist. An examination of the occlusion and phonetics was conducted and compared with an age-matched control group. RESULTS: Correlations between malocclusion and dyslalia were found. The presence of Class III occlusion, diastema, increase in overjet, presence of open and deep bite, asymmetry have high tendency to be associated with speech disorders such as dyslalias. The presence of crowding and anterior cross bites have moderate tendency to be associated with such disorders; on the contrary Class II occlusion, upper incisors protrusion, posterior cross bite and TMD have low tendency to be associated with dyslalias. CONCLUSION: The effect of dyslalia on the speech organs is not constant. On the other hand, the effect of malocclusion on dyslalia seems to be more relevant and more frequent and to increase proportionally, depending on the severity of the malocclusion.

Orthopaedic treatment efficiency in skeletal Class III malocclusions in young patients: RME-face mask versus TSME.

AIM: To cephalometrically compare the skeletal vertical and sagittal effects of TSME with those of RME protraction facemask therapy in Class III patients. MATERIALS AND METHODS: The sample of this retrospective study included 104 patients (53 females, 51 males) with age ranging from 5 to 9 years, presenting a skeletal Class III relationship: 52 were treated with transverse sagittal maxillary expander (TSME) appliance (Group 1) and 52 with Hyrax rapid maxillary expander/facemask (RME/FM, Group 2). For each patient a lateral cephalogram was obtained before treatment (T0) and at the end of the retention period (T1). Changes in the two groups during the observation period were calculated, compared and statistically analysed with t-test. RESULTS: TSME can produce skeletal changes and dento-alveolar modifications. RME in association with protraction facemask showed that after treatment the maxilla was moved significantly forward. The correction of the ANB angle was due to a change in mandibular position during treatment which showed a backward and downward rotation. CONCLUSION: Both devices were effective in the treatment of subjects with skeletal Class III due to maxillary retrusion.

RME: influences on the nasal septum.

AIM: The aim of this work consists in analyzing the consequences of RME on the nasal septum. METHODS: The sample included 140 patients presenting a skeletal maxillary transverse constriction. Two groups were constructed. The first group containing 100 patients presenting a septal deviation more than 1 mm was treated by a Hyrax expander, to correct the transverse dimension. The second group containing 40 patients was not treated because the patients were under pharmacological treatment for neurovascular headache. The protocol of activation in group 1 consisted by activation of the transverse screw one-quarter turn twice a day for 15 days. Then the appliance was left in place for passive retention. The skeletal variations induced by RME have been made through cephalometric evaluations obtained before therapy (T0), at the removal of the appliance (T1) and after 6 months of manteinance (T2). A lapse of time of six months passed between T0 and T1. RESULTS: This study demonstrates how RME can increase the length of the septum, improving its possible deviations and growth disturbance. CONCLUSION: Palatal expansion technique is a valid therapeutic option, which allows to increase nasal cavity volume and it can also have a favorable effects on the growth of the maxillary complex.

Comparison of the dental and skeletal effects of two different rapid palatal expansion appliances for the correction of the maxillary asymmetric transverse discrepancies.

AIM: The aim was to compare the skeletal and dental effects of a new type of a modified Hyrax rapid palatal expander with vestibular arm with the Hyrax expander in patients with maxillary asymmetric deficiencies. METHODS: This study includes 50 growing patients in early mixed dentition, suffering from a maxillary narrowness combined with the exfoliation of one or more deciduous teeth, a monolateral or bilateral crossbite and a deviation of the upper midline. Twenty-five patients were treated with a modified Hyrax expander and 25 patients with a Hyrax expander (RME). Dental casts and posteroanterior radiographs were obtained before treatment [T0] and six months after maxillary expansion [T1]. Measurements of intermolar width, intercanine width, arch length, arch perimeter, space between lateral incisor and I deciduous molar, and midline discrepancy were made with a digital calliper on photocopies taken from the dental casts. Cephalometric tracing on frontal teleradiographies were evaluated. RESULTS: Results showed no statistically significant differences between T0 and T1 in the modified RME appliance and the RME except lateral drift of incisor and space between lateral incisor and first deciduous molar. The modified RME permitted to obtain the restoration of the coincidence of the midlines of almost 5/6 mm and to create 7 to 9 mm of space in the canine area. CONCLUSION: both the appliances are effective in correcting maxillary narrowness but the modified hyrax expander represents the best choice for the correction of upper midline deviations, and to restore the correct symmetry of dental midlines.

Long term results of open reduction management of condylar fracture: a 20 years follow-up. Case report.

Management of condylar fracture may be surgical (open reduction) or non surgical (closed treatment). The age of the patient is a key factor in the choice of treatment. Condylar fracture requires early treatment to avoid ankylosis, to reduce facial deformity, aesthetic problems and functional disturbances. The protocol described in this case report showed excellent results and achieved all the treatment objectives. Early mobilization is the key in treating condylar fractures and to allow functional remodelling. It is important that every specialist should be able to suspect condylar fracture when facial asymmetry, joint problems, muscles pain, occlusion or nerve disorders develop after an injury. An early diagnosis can permit an early treatment that prevents esthetic and functional complications. The purpose of this article is to describe the long term clinical and radiological evaluation of unilateral condylar fracture in a teenager patient treated by condylectomy, physiotherapy and fixed appliance therapy. Twenty years follow-up records are presented.

Modified Hyrax expander for the correction of upper midline deviation: a case report.

This article describes a case report of a patient treated by the modified version of the Hyrax rapid palatal expander described by Farronato et al. in 2009. This device can be utilized for the treatment of patients in mixed dentition who, due to the maxillary hypoplasia and to the premature exfoliation of some deciduous teeth, manifest a migration of the permanent incisors with a reduction or closure of the space for the permanent teeth substituting those previously exfoliated. This expander presents a vestibular arm for correcting maxillary asymmetric transverse discrepancies. The activation method, the therapeutic benefits as well as the clinical advantages are described. The use of this appliance allows to restore the correct transverse maxillary diameters, to regain space and at the same time to restore the symmetry of the midlines up to 5-6 mm. Moreover, a recovery of the arch length can be obtained, as demonstrated by the case report presented. The expander with vestibular arm represents an interceptive treatment which can reduce the duration of the orthodontic therapy with fixed appliances.

Bilirubin, a physiological antioxidant, can improve cryopreservation of human hepatocytes.

The availability of cryopreserved hepatocytes is required for a more widespread use of hepatocyte transplantation, but human hepatocytes are easily damaged during freezing-thawing. Here, preincubation with unconjugated bilirubin, a physiological antioxidant, resulted in increased viability and function of hepatocytes (as determined by trypan blue exclusion, mitochondrial succinate dehydrogenases activity, urea synthesis, and cytochrome P450 1A/2) compared with cells incubated without the pigment. These findings suggest that unconjugated bilirubin may be used as cryoprotectant in clinical hepatocyte transplantation.

Hyrax versus transverse sagittal maxillary expander: An assessment of arch changes on dental casts. A retrospective study.

OBJECTIVE: The aim of this study was to compare arch changes before and after maxillary expansion with Transverse Maxillary Sagittal Expander (TSME) and Hyrax Palatal Expander (HPE), in growing patients with diagnosis of maxillary hypoplasia. MATERIALS AND METHODS: The sample consisted of 40 patients' records (20 males 20 females mean age 9.2 ±â€¯2.6 years) were selected from the archive of the Orthodontic Department of the University of Milan, Italy. Patients were randomly divided in two groups: patients in group 1 were treated with HPE as they presented only transverse deficiency of the maxilla and in group 2 were treated with TSME. Plaster models have been measured with a Verniere caliper to evaluate the differences in maxillary expansion of the two devices. Measurements were performed on casts poured from impressions taken before appliance bonding (T0), immediately after appliance debonding (T1) and at 6 months follow-up (T2). The variations in the following distances have been considered: inter-molar distance, inter-canine distance, palatal depth, palatal length and arch circumference. Shapiro-Wilk test was performed to assess normality distribution. ANOVA for repeated measures with multiple paired t-test for pairwise comparisons and its non-parametric equivalent Friedman's test with multiple Wilcoxon tests for pairwise comparisons were performed to evaluate changes in time of each variable in each group. Between groups comparisons were performed for each variable at each observing time using independent t-test or Mann-Whitney test. Significance level was set at p < 0,05. RESULTS: Both the Friedman test and the rm-ANOVA test and their respective post-hoc show that within both groups the respective variables have a statistically significant increase between T0 and T1 (p < 0,05) and a slight decrease between T1 and T2 (p < 0,05) that is not clinically relevant remaining always T2 greater than T0 in a statistically and clinically relevant way (p < 0,05). The analysis between the differences of the measurements at different timing measured by the Mann-Whitney test shows that for all the variables there is no statistically significant difference between the 2 devices (p < 0,05), except for the perimeter of the arch and the length of the palate; in this case it appeared that the TSME is better statistically (p < 0,05). CONCLUSIONS: The study has shown that RPE and TSME can achieve similar results in transversal palatal expansion. Differences have been found in the palatal length and in the arch perimeter where TSME seems to be more efficient.