Headgear therapy in children with Class II malocclusion and the role of compliance on treatment outcome: A nine-month randomized controlled trial.

OBJECTIVES: To evaluate three-dimensional movements of maxillary teeth during headgear treatment in Class II growing children, using digital analytical tools, and to determine the effects of compliance on these movements. MATERIALS AND METHODS: A 9-month parallel-group randomized controlled trial was carried out on 40 children with Class II malocclusion, aged 8-12 years, half assigned to receive a cervical headgear and half to a no-treatment group, using block randomization. Subjects in the treatment group were instructed to wear the headgear for 12 hours daily and monitored using an electronic module. After 9 months, the following dental outcomes were measured: first maxillary molar distalisation, rotation, tip and torque, arch depth, and interpremolar and intermolar distances. Caregivers and participants were not blinded to group assignments, but those assessing outcomes were. Linear regression models were used to detect differences between groups and correlation coefficients to find correlations between compliance and dental outcomes. RESULTS: All 40 included patients were analysed. A significant difference in molar distalisation was observed between the treatment (1.2 mm) and control groups (-0.2 mm). Arch depth change was also increased to a larger extent in the treatment groups (1.3 mm vs 0.1 mm), as was the interpremolar distance (1.9 mm vs 0.4 mm). In contrast, no significant differences in molar rotation or torque change were observed. With regard to compliance, average compliance was 55%. A significant correlation was found between molar distalisation and compliance in the treatment group. CONCLUSIONS: Headgear therapy has significant effects on molar distalisation, arch depth, and arch width. Compliance has a significant positive effect on molar distalisation.

How well does Invisalign ClinCheck predict actual results: A prospective study.

INTRODUCTION: This study aimed to compare achieved movements with predicted movements after 28-week use of Invisalign Lite aligners. SETTINGS AND SAMPLE POPULATION: The digital impressions of 21 subjects treated with Invisalign Lite at a private practice and in the dental clinic (Milan, Italy) were taken and analysed. Subjects were Caucasian with a mean age of 20.1 years. METHODS: Patients were analysed at two time points: at T0, before starting therapy, and at T1, after 28 weeks of treatment with Invisalign clear aligners, with a 2-week change interval. The changes that occurred between T0 and T1 were compared to the predicted changes between T0 and Ts (setup/ClinCheck). Tooth movement performance was estimated through variables calculated as the difference between obtained and planned movements. RESULTS: In both maxillary and mandibular arches, the teeth that exhibited the least accurate expression of torque were the central incisors. Tip was not accurate on maxillary central incisors and canines, mandibular central incisors, lateral incisors, first premolars, second premolars and first molars. Rotations were under-expressed on maxillary lateral incisors, canines and second premolars and on mandibular central incisors, canines, first premolars, second premolars and first molars. The overall angular changes showed a tendency to underperformance. Transverse linear changes were accurate with a significant overperformance on maxillary and mandibular first molars. CONCLUSIONS: Torque correction of maxillary central incisors, as well as rotational correction of most of the teeth, showed significant differences between what was planned and what was obtained.

Sella Turcica Bridging and Tooth Agenesis in Children With Unilateral Cleft Lip and Palate.

AIM: To investigate differences in sella turcica size and bridging in children with unilateral cleft lip and palate (UCLP) with or without concomitant dental anomalies. PATIENTS AND METHODS: A cross-sectional study was carried out looking at 56 children with nonsyndromic UCLP. Lateral cephalograms, taken before alveolar bone grafting, were used to assess sella turcica height, width, area, and bridging. Panoramic radiographs were used to evaluate the presence of dental anomalies in the cleft area including agenesis, supernumerary, and peg-shaped lateral incisors. Differences between sella turcica measurements in the presence or absence of dental anomalies were assessed using t tests. Differences between the prevalence of dental anomalies and sella turcica bridging were assessed using χ2 and Fisher exact tests. Multinomial logistic regression was used to investigate potential associations between sella measurements and dental anomalies. RESULTS: Twenty-six of the 56 children presented with agenesis of the cleft-side lateral incisor, while 7 had a supernumerary, and 19 had a peg-shaped lateral incisor. With regard to sella turcica bridging, 27 children had no calcification, 25 partial and 4 complete calcification. Children with agenesis of the cleft-side lateral incisor showed a shorter sella maximum height (P = .010) and a smaller area (P = .019). When looking at sella turcica bridging, 100% of children with complete calcification showed agenesis of the cleft-side lateral incisor, compared with 52% and 33% of children with partial calcification and no calcification, respectively (P = .034). CONCLUSIONS: Children with UCLP and sella turcica bridging are more likely to present with agenesis of the cleft-side maxillary lateral incisor.

Transverse and torque dental changes after passive self-ligating fixed therapy: A two-year follow-up study.

INTRODUCTION: Self-ligating appliances are purposed to expand the arches, but evidence on stability of the result is lacking. We measured the width of maxillary and mandibular arches and torque changes after treatment with the use of passive self-ligating appliances and assessed stability at the 2-year follow-up. METHODS: Maxillary and mandibular 3-dimensional (3D) models from 32 subjects (mean initial age 14.9 ± 0.9 years), consecutively treated with the use of self-ligating appliances, were obtained before, immediately after, and 2 years after treatment. Dental arches were examined with the use of 3D software to evaluate differences in transverse arch dimensions and torque values. RESULTS: An incremental increase of arch widths was recorded, especially regarding maxillary and mandibular premolars. The increase in the transverse diameters was associated with a significant positive torque gain. No significant changes in arch perimeter and depth were recorded. In the retention period, slight significant changes in transverse diameters were recorded, and a transverse diameter constriction detected. Torque values remained almost unchanged in the follow-up period. CONCLUSIONS: Transverse arch dimensions, along with torque values, increased significantly after treatment with the use of a passive self-ligating appliance. In the 2 years following treatment, a tendency to transverse diameter restriction, especially for the maxillary and mandibular premolars, was observed.

Accuracy of planned tooth movement with lingual straight wire technique.

OBJECTIVES: To analyze the accuracy of planned tooth movements of torque, tip, rotations, and transverse width values with lingual straight-wire technique. MATERIALS AND METHODS: 40 Caucasian subjects with mean age of 23.9 years, consecutively treated in private practice with a lingual straight-wire appliance (STb, Ormco, Glendora, Calif) were evaluated. Maxillary and mandibular dental casts were taken before treatment (T0), in the setup (T1), and at the end of treatment (T2) and scanned with an intraoral 3D scanner Carestream CS 3600 (Carestream Dental, Atlanta, GA). Virtual models at the three time points were superimposed on T1 using 3D software, and the coordinates were exported as a set of x, y, and z values. Angular and linear measurements were analyzed to measure torque, tip, rotation movements, and transverse intra-arch widths. Changes among the three time points were analyzed with Friedman's nonparametric test. RESULTS: A general increase in torque was recorded in the setup and in the final result, except for the maxillary molars. Torque, tip, and rotation movement mean accuracy was ≥84% for incisors, canines, and premolars. A general increase in transverse width was measured in the setup and in the final models, except for the upper second molars, which showed reduced transverse width during treatment. CONCLUSIONS: The movements planned in the setup to obtain the ideal torque, tip, and rotations actually occurred, except for second molars, which showed less accuracy. Planned expansion of the arches occurred only partially.

Efficacy and effects of palifermin for the treatment of oral mucositis in patients affected by acute lymphoblastic leukemia.

This randomized-controlled trial studied the efficacy of palifermin, administered as a dose during hematopoietic stem cell transplant (HSCT) therapy, as primary prophylaxis on pediatric patients with acute lymphoblastic leukemia in order to reduce oral mucositis (OM). Patients in the palifermin group were randomly assigned to receive palifermin, 60 µg/kg, intravenously as a single dose 3 days before and 0, +1, and +2 post autologous HSCT infusion. The patients in the control group received only a placebo treatment. OM-related assessments were the WHO oral-toxicity scale and the patient-reported outcomes. There was a statistically significant reduction in the incidence of OM grade 3 and 4 in the palifermin group compared to the control group. There was also a reduction in the degree of severity of OM in the palifermin group (1.65 grade respect to 2.33 in the control group). Palifermin could prevent the recurrence of severe OM and improve the quality of life in patients with acute lymphoblastic leukemia (ALL).

Dental arch response to Haas-type rapid maxillary expansion anchored to deciduous vs permanent molars: A multicentric randomized controlled trial.

OBJECTIVE: To assess maxilla and mandibular arch widths' response to Haas-type rapid maxillary expansion (RME) anchored to deciduous vs permanent molars on children with unilateral posterior crossbite. MATERIALS AND METHODS: Seventy patients with unilateral posterior crossbite recruited at the Universities of Genova, Siena, and Insubria (Varese) were randomly located into GrE (RME on second deciduous molars) or Gr6 (RME on first permanent molars) and compared. RESULTS: Upper intermolar distance and permanent molar angulation increased significantly in Gr6 vs GrE at T1. Upper intercanine distance increased significantly in GrE vs Gr6 at T1 and T2. GrE showed significant increases for upper intermolar and upper intercanine widths. Gr6 showed statistically significant increases for upper intermolar widths, for upper and lower intercanine widths, and for increases of angulation of upper and lower permanent molars. CONCLUSIONS: GrE showed reduced molar angulation increases at T1 and reduced molar angulation decreases at T2 when compared with Gr6. At T2, the net increase of the upper intercanine distance in GrE was still significant compared with Gr6, indicating a more stable expansion in the anterior area.