Beyond the Clinic: why new bioactive restorative materials have really changed Paediatric Dentistry.

BACKGROUND: The aim of this paper is to remind how evidence-based paediatric dentistry should not only consider the best available scientific evidence relating to the patient's oral conditions but it should also consider the patient's needs beyond the clinic. In a child-family-oriented approach, the best restorative treatment for a primary tooth could not be the proper one for the child as a whole. Preservation of dental tissues as much as possible, without involving the pulp, is called minimal intervention dentistry (MID) and it is closely related to "selective caries removal" and "bioactive restorative materials". To preserve the vitality of a tooth as much as possible, many tools are available on the market (i.e. silver diamine fluoride, ozone) and this could play an important role in a "tailored fit treatment plan" mindset. CONCLUSION: Minimally invasive direct restorative strategies in paediatric dentistry, is a predictable evidence-based-restorative option for the treatment of vital primary teeth with no need of local anaesthesia and absolute isolation. Beyond the clinical aspect, the clinician expertise is crucial to evaluate the required materials and tools, not only to perform a minimal invasive paediatric dentistry in a safe, efficient and child-friendly way, but for the wellness of all parties involved. In this life-related paradigm new bioactive restorative materials are among the main protagonists.

New 3D printed polymers in orthodontics: a scoping review.

AIM: The aim of this scoping review is to assess the application of new 3D printed polymeric materials in orthodontics, including polyamide-12 (PA-12) and Shape Memory Polymers (SMPs). METHODS: A search for articles published until January 2023 was carried out using PubMed, Scopus, Web of Knowledge, Lilacs, Opengrey, Embase and Cochrane Library databases and by applying the search terms (orthodontic* OR paediatric* OR paedodontic*) AND ("3D printed" OR "three-dimensional printed") AND (polymer* OR material* OR resin* OR technopolymer*). Additional records were also screened through hand or electronic search. No restriction in terms of language or publication period was applied. CONCLUSION: Due to their mechanical, aesthetic and biocompatibility characteristics, PA12 and SMPs can be used in orthodontic practice. However, additional studies should be performed to evaluate the clinical efficiency of these recent materials.

Child/family-oriented approach: the teeth come after.

BACKGROUND: The aim of this paper is to promote reflection on the dentist's approach to the dental care of young patients, considering not only their oral care needs, but also the management of their behaviour, that is intrinsic to their life needs and to those of their families. CASE REPORT: This approach to dental care management stems from a thorough evaluation of the patient, the reason for dental visit, whether the child had previous dental visit(s), which might not have been positive, the family involvement and the emotional characteristics of the child and their parents. We should design a progressive customized path, sometimes starting only from secondary prevention in order to "comfortably" avoid the worsening of a given clinical condition, stimulate a concomitant positive behavioural response of all parties involved, until the child and their family are ready to take the next step, in terms of integrated restorative dentistry and/or paediatric orthodontics, where and when needed. CONCLUSION: "The teeth come after" means that dental and oral care of the children may not be achievable goals unless we first address their wellbeing and that of their families, and that sometimes "the perfect is the enemy of the good", especially when we incorrectly consider only the clinical outcome. In this scenario, psychological skills and clinical feelings, comfort techniques, technologies, new materials and a more "medical less" surgical approaches are the bases for a child/family-oriented approach.

DOP Dentistry: digitally embracing orthodontics and paediatric dentistry.

AIM: The aim of this paper is to illustrate the concept of DOP Dentistry (Digital Ortho Paediatric Dentistry) in daily practice. CASE REPORT: DOP Dentistry is a new concept introduced by the authors to express the perfect integration between two disciplines that for a long time have been separated: paediatric dentistry and paediatric orthodontics. In modern dentistry it is increasingly important for the paediatric dentist to have skills and abilities that embrace both of these disciplines. To these we have to add a third element, represented by new digital technologies, as well as new bioactive ionic resin composites and biocompatible technopolymers to perform fully digital, integrated paediatric orthodontic treatments. CONCLUSION: Based on the DOP Dentistry concept, that definitely changes the paradigm of taking care of children, new and fascinating scenarios open up, that will lead us to a more integrated management of our little patients, their needs and those of their family with a new, more ergonomic, efficient and tailor-made approach.

Face Scan for Ceph 3D: a green way for diagnosis in children.

BACKGROUND: The aim of this paper is to illustrate how new opportunities offered by technology and diagnostic imaging can more easily create a 3D integration of soft tissue Face Scan and IOS (intra oral scan) for orthodontic evaluation in children. CASE REPORT: Through TrueDepth technology, a software commonly used for digital devices such as smartphones and tablets, the authors illustrate the acquisition of facial scans by means of different applications, and their integration with IOS to perform diagnostic evaluations and treatment planning at zero biological cost for patients. CONCLUSION: TrueDepth technology is both accurate and easy to use for all clinicians, even those less accustomed to digital innovations. In the past, stereophotogrammetric systems and devices were used, and they are the gold standard for three-dimensional acquisitions. However, there is a major drawback associated with this technology as it is expensive and non-portable. Truedepth technology is an effective substitute, as smartphone applications are portable, cheaper, and more accessible, giving each orthodontist the ability to take advantage of the benefits of facial scanning in their daily practice.

Spa-Inspired Oral Care: A new approach in paediatric dentistry.

BACKGROUND: The aim of this paper is to illustrate a different way to take care of our little patients, starting from creating child-oriented environmental conditions and proceeding using a specific comfort technique in paediatric dentistry. CASE REPORT: This concept of treatment arises from the inseparable relationship between body and psyche. It starts with instructions aimed at informing parents or caregivers not to prepare the child for the visit but to explain the child that he/she will be taken care in new ways. This is accomplished by approaching the child in an original setting without the traditional dental chair, and that can be the same dedicated room in which we will be able to provide the first care, as a part of a customised treatment, which does not consider only the clinical outcomes. CONCLUSION: Spa-inspired oral care is the name we chose to describe this new way to treat our little patients, putting them at ease with a dedicated environment, characterised not only by drawings hung on the walls, but also by lights, music, videos and scents. Importance is also given to the choice of words, the dental team appearance, and instruments that allow the application of treatment and comfort techniques tailored to them, where 'how' can be more important than 'what'.

Fully digital fixed orthodontic prosthesis: use of PEEK technopolymer in cases of early loss of primary incisors.

BACKGROUND: The aim of this paper is to illustrate a new, fully digital approach to temporary rehabilitation in the case of premature loss of deciduous incisors, using a metal-free fixed orthodontic prosthesis made of polyether ether ketone (PEEK). CASE REPORT: Clinical report: Technopolymer Orthodontic Prosthesis (TOP) is a complete CAD-CAT (Computer Aided Design-Computed Aided Technofacturing) fixed device that can be used to rehabilitate the mouth of very young patients, both from an aesthetic and functional point of view as well as maintaining space and controlling growth. The appliance is customised, designed to be cemented with adhesive technique, using deciduous teeth as anchorage. Two cases of patients in deciduous dentition with early loss of incisors are illustrated to present this procedure. In the first case the patient lost 2 central incisors and in the second one 3 lower incisors were lost due to trauma. CONCLUSION: TOP, made by metal-free technopolymer and cemented on deciduous teeth, proved to be comfortable, aesthetic, easy to apply and efficient in rehabilitating smile and mastication in case of trauma or premature loss of deciduous incisors.

ZeroExpander: Metal-free automatic palatal expansion for special-needs patients.

AIM: The aim of this paper is to illustrate a new concept for approaching maxillary expansion in paediatric orthodontics with a metal-free fixed automatic appliance in special-needs patients. CASE REPORTS: The ZeroExpander is a complete CAD-CAT full digital and automatic metal-free fixed device. It is designed to expand the maxilla in a pre-programmed automatic way using deciduous teeth as anchorage. Two cases of growing patients with a narrow upper arch are illustrated to present this innovative system, one in complete deciduous dentition and the second in mixed dentition. Both patients were successfully treated with palatal expansion. In the first case we present the use of PEEK, and in the second one the use of PA12. CONCLUSION: The ZeroExpander, fabricated using metal-free technopolymers and anchored on deciduous teeth, proved to be comfortable and efficient in treating palatal transverse deficiency, without the need of any compliance, even in young patients who must periodically undergo MRI.

Comparison between RME, SME and Leaf Expander in growing patients: a retrospective postero-anterior cephalometric study.

AIM: The aim of this study is to compare the dental and orthopaedic effects of the Leaf Expander with rapid and slow maxillary expanders. MATERIALS AND METHODS: The sample comprised 30 patients with a posterior crossbite divided into three groups: the rapid maxillary expander (RME) group (3 m, 7 f), average age 8.9 years; the slow maxillary expander (SME) group (7 m, 3 f) average age 12.2 years; the Leaf Expander (LE) group (7 m, 3 f), average age 7.9 years. Postero-anterior cephalometric studies have been obtained at the beginning of the therapy (T1) and after 9 months (T2). Nasal width, maxillary width, mandibular width, upper permanent molars width have been measured by a calibrated examiner. RESULTS: All the measurements increased significantly after the treatment (paired t-test P=0.05). Maxillary average width increased of 4.2 mm (SD 3.6 mm) in RME; + 2.8 mm (SD 2.8 mm) in RSE and +3.6 mm (SD 2.2 mm) in LE group. Upper permanent molars width increased: + 5.4 mm (SD 3.31 mm) in RME; + 5.4 mm (SD 3.3 mm) in SME and + 3.8 mm (SD 2.1 mm) in LE group. No statistical differencesbetween the groups have been found (t-student test P=.05). CONCLUSIONS: The effectiveness of the LE in transversal deficiency correction has been confirmed.

Maxillary tridimensional changes after slow expansion with leaf expander in a sample of growing patients: a pilot study.

AIM: The aim of this study is to evaluate the dento-alveolar effects of slow maxillary expansion using the Leaf Expander in a sample of growing patients with maxillary transverse deficiency, unilateral cross bite and mandibular shift. MATERIALS AND METHODS: The study included 10 patients, 3 male and 7 female (mean age 7.5 + 7 months), treated with Leaf Expander anchored on the upper deciduous teeth. Digital models were obtained by a lab scan of the pvs impressions at the beginning of the therapy (T1) and at the removal of the palatal expander (T2). Five parameters were measured: 1) the distance between the first upper permanent molars; 2) the distance between the upper second deciduous molars; 3) the distance between the upper canine cusps 4) the distance between the first lower permanent molars; 5) the distance of the lower canine cusps. RESULTS: In all patients complete correction of posterior crossbite was achieved on average in 4 months, with a spontaneous expansion of the upper first permanent molars. Significant increases in the dento-alveolar transversal diameters were obtained. Increases were also observed in the anterior mandibular arch diameter (+ 1 mm). CONCLUSIONS: These findings suggest that slow maxillary expansion using Leaf Expander appliance could be a reasonable alternative to conventional maxillary expansion therapy in the early mixed dentition.

Rapid and slow maxillary expansion: a posteroanterior cephalometric study.

AIM: The purpose of this study was to evaluate and compare the dental and orthopaedic effects of rapid and slow maxillary expansion in a sample of young patients with transversal maxillary deficiency by using a postero-anterior cephalometric analysis. MATERIALS AND METHODS: Two groups of patients were considered: 10 patients (3 males, 7 females) with an average age of 8.9 years were treated with a rapid maxillary expansor (RME); 10 patients (7 males, 3 females) with an average age of 12.2 years were treated with a new slow maxillary expansion appliance (ELA). Postero-anterior cephalometric analyses were made at the beginning of the therapy (T0) and at the end of expansion (T1) using a computerised cephalometric programme. Four parameters were measured: Nasal width, maxillary width, mandibular width, upper molars width. RESULTS: Transversal average width increased 5.435 mm (SD 3.31 mm) between the upper molars in the RME group and 5.547 mm (SD 3.49 mm) in the SME group. Maxillary average width increased 4.254 mm in the first group and 2.845 mm in SME group. Discussion An orthopaedic result was reached with both treatments. These results are in agreement with the orthodontic literature. CONCLUSION: This work confirms the effectiveness, efficiency and usefulness of this new ELA appliance in the correction of transversal deficiency with orthopaedic results, if used in growing patients.