Oral and throat microbiological changes after orthodontic debonding.

As already known, orthodontic treatment presents a factor of plaque retention, promoting an increase of bacterial growth in the oral cavity. Nevertheless, after orthodontic debonding an alteration of the previous microbiological status may occur. The present study was designed to assess variations among six bacterial species in the oral cavity and the status of oral health after orthodontic debonding. At the end of the fixed orthodontic treatment, 30 patients were divided into three groups based on the type of retention: I - 10 patients were treated with upper and lower fixed retention devices, II - 10 with upper and lower removable retention devices, and III - 10 with lower fixed and upper removable retention devices. To assess the alterations of oral microbiota after orthodontic debonding, two salivary swabs were collected for each individual: the first immediately after debonding (T0) and the other one 6 weeks later (T1). Six species, the ones most correlated with the development of caries and periodontal disease, were selected for microbiological analysis with Real-time PCR: Streptococcus mutans, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Fusobacterium nucleatum. Furthermore, in order to correlate the microbiological outcomes with the clinical condition, oral health indexes at T0 and T1 were assessed for all patients. Six weeks after debonding, the salivary levels of the bacteria investigated tend to decrease and the values of the oral health indexes tend to improve with all types of treatment considered (p<.05). Salivary bacteria levels and oral health are similarly influenced by fixed and/or removable orthodontic retentions.

Cannabinoids Drugs and Oral Health-From Recreational Side-Effects to Medicinal Purposes: A Systematic Review.

BACKGROUND: marijuana, the common name for cannabis sativa preparations, is one of the most consumed drug all over the world, both at therapeutical and recreational levels. With the legalization of medical uses of cannabis in many countries, and even its recreational use in most of these, the prevalence of marijuana use has markedly risen over the last decade. At the same time, there is also a higher prevalence in the health concerns related to cannabis use and abuse. Thus, it is mandatory for oral healthcare operators to know and deal with the consequences and effects of cannabis use on oral cavity health. This review will briefly summarize the components of cannabis and the endocannabinoid system, as well as the cellular and molecular mechanisms of biological cannabis action in human cells and biologic activities on tissues. We will also look into oropharyngeal tissue expression of cannabinoid receptors, together with a putative association of cannabis to several oral diseases. Therefore, this review will elaborate the basic biology and physiology of cannabinoids in human oral tissues with the aim of providing a better comprehension of the effects of its use and abuse on oral health, in order to include cannabinoid usage into dental patient health records as well as good medicinal practice. METHODS: the paper selection was performed by PubMed/Medline and EMBASE electronic databases, and reported according to the PRISMA guidelines. The scientific products were included for qualitative analysis. RESULTS: the paper search screened a total of 276 papers. After the initial screening and the eligibility assessment, a total of 32 articles were considered for the qualitative analysis. CONCLUSIONS: today, cannabis consumption has been correlated to a higher risk of gingival and periodontal disease, oral infection and cancer of the oral cavity, while the physico-chemical activity has not been completely clarified. Further investigations are necessary to evaluate a therapeutic efficacy of this class of drugs for the promising treatment of several different diseases of the salivary glands and oral diseases.

3D cephalometry on reduced FOV CBCT: skeletal class assessment through AF-BF on Frankfurt plane-validity and reliability through comparison with 2D measurements.

OBJECTIVES: To test the validity of a novel protocol for 3D sagittal jaw discrepancy assessment (skeletal class determination) through comparison with common 2D indexes by the use of reduced FOV (10 × 10) CBCT which shows at least from the Frankfurt plane to the B point vertically, and from the most anterior between A and B point to Po point horizontally. METHODS: A sample of CBCT scans of 109 adult patients (46 females; 63 males; mean age 30 years ± 11.6) equally distributed between I, II and III class was selected. Skeletal class was evaluated with specific software using the distance of A and B point's projection (AF-BF) on FHp (Frankfurt horizontal plane) and compared to 2D common indexes (ANB and Witts appraisal). The validity and reliability of the aforementioned analyses were determined using intra-class correlation coefficients, quadratic weighted Cohen's K and sensitivity. RESULT: A selected range of values of 2.5 ± 2.5 AF-BF showed a solid correlation with the ANB angle (r = 0.846, K = 0.838, p < 0.001) and moderate with Wits appraisal (r = 0.723, K = 0.720, p < 0.001). CONCLUSIONS: AF-BF showed high reliability in skeletal class determination on reduced FOV CBCT without the use of S and N cephalometric landmarks. KEY POINTS: • Reduced FOV CT allows skeletal class determination for orthodontic purposes. • A new 3D-reduced FOV cephalometry is proposed. • AF-BF is a reliable alternative to ANB.

Assessment of condylar volume and ramus height in JIA patients with unilateral and bilateral TMJ involvement: retrospective case-control study.

OBJECTIVES: The objectives of the study are to analyze volumetric differences of condylar volumes in patients with unilateral and bilateral JIA and to compare results with control condylar volumes. MATERIALS AND METHODS: Forty-six CBCT images were analyzed for all patients affected by JIA, 37 females and 9 males (mean age 10.8 ± 4.2) with TMJ involvement (19 unilaterally, mean age 10.9 ± 4.5; 27 bilaterally, mean age 10.7 ± 4.5), and 25 CBCT of subjects without diagnosis of JIA were selected as controls (mean age 10.8 ± 4.2 years). In the case of unilateral JIA, condylar volumes and ramus lengths were compared with healthy condyle and with the compromised one. In the case of bilateral JIA, condyle volume and ramus lengths were compared with healthy one. The Shapiro-Wilk test was used to assess whether the data was normally distributed. Paired t test was applied to compare affected and non-affected condyle in the same patients (P < 0.05). Independent t test was used to evaluate whether the difference between the groups were comparable or significantly different (P < 0.05). RESULTS: For the unilateral JIA group, significant differences comparing affected and non-affected condyles were found. A statistically significant reduction of the volume of the head, neck, and ramus was found in the affected side (P < 0.01). For the bilateral JIA group, statistically significant differences have been found considering the condylar head and neck, the whole condylar volume, and the ramus length compared with the control group (P < 0.05). CONCLUSIONS: Subjects with unilateral JIA have condyles volumetrically smaller than those of the unaffected side and those found in healthy patients. A considerable decrease of the volume of all the anatomical structures considered in the patients with bilateral JIA was found compared with control group. CLINICAL RELEVANCE: The study presents the effects of JIA on different anatomical structures highlighting their dimensional changes, whose sequelae are irreversible if not diagnosed and treated early.

A multicenter, prospective, randomized trial of pain and discomfort during maxillary expansion: Leaf expander versus hyrax expander.

BACKGROUND: Pain suffered by the young patient is the most frequent symptom during orthodontic treatment and is the one that most frightens children and causes worry in their families. AIM: To investigate pain perception and function impairment during the first week of activation of two palatal expansion screws. DESIGN: A total of 101 subjects were randomly divided into two groups: RME group included patients treated with the standard hyrax expansion screw and LEAF group included patients treated with Leaf Expander appliance. Pain intensity was assessed via the Wong-Baker scale. A questionnaire on oral function impairments was also compiled by the patients. RESULTS: The Pain Scale analysis showed that patients in the RME group suffered from a significantly higher level of pain than those in the LEAF group (88.6% vs 25%, P < .01). RME group showed highest pain indexes from day 1 to day 4 (51.4% RME vs 9.7% LEAF suffered at least once from strong pain in the first 4 days, P < .01). Furthermore, oral functions were similarly affected in both groups. CONCLUSIONS: Pain reported during maxillary arch expansion is influenced by clinical activation protocol and by the screw type. Patients treated with Leaf Expander reported significantly lower pain level in the first 7 days of treatment.

Influence of Bone Quality, Drilling Protocol, Implant Diameter/Length on Primary Stability: An In Vitro Comparative Study on Insertion Torque and Resonance Frequency Analysis.

The aim of this study was to evaluate the influence of bone quality, drilling technique, implant diameter, and implant length on insertion torque (IT) and resonance frequency analysis (RFA) of a prototype-tapered implant with knife-edge threads. The investigators hypothesized that IT would be affected by variations in bone quality and drilling protocol, whereas RFA would be less influenced by such variables. The investigators implemented an in vitro experiment in which a prototype implant was inserted with different testing conditions into rigid polyurethane foam blocks. The independent variables were: bone quality, drilling protocol, implant diameter, and implant length. Group A implants were inserted with a conventional drilling protocol, whereas Group B implants were inserted with an undersized drilling protocol. Values of IT and RFA were measured at implant installation. IT and RFA values were significantly correlated (Pearson correlation coefficient: 0.54). A multivariable analysis showed a strong model. Higher IT values were associated with drilling protocol B vs A (mean difference: 71.7 Ncm), implant length (3.6 Ncm increase per mm in length), and substrate density (0.199 Ncm increase per mg/cm3 in density). Higher RFA values were associated with drilling protocol B vs A (mean difference: 3.9), implant length (1.0 increase per mm in length), and substrate density (0.032 increase per mg/cm3 in density). Implant diameter was not associated with RFA or IT. Within the limitations of an in vitro study, the results of this study suggest that the studied implant can achieve good level of primary stability in terms of IT and RFA. A strong correlation was found between values of IT and RFA. Both parameters are influenced by the drilling protocol, implant length, and substrate density. Further studies are required to investigate the clinical response in primary stability and marginal bone response.

Influence of the implant-abutment connection on the ratio between height and thickness of tissues at the buccal zenith: a randomized controlled trial on 188 implants placed in 104 patients.

BACKGROUND: To compare tissue response to two implant systems, featuring internal hexed connections with different designs. METHODS: Patients enrolled in this randomized controlled trial were assigned to two groups. In Group 1, patients were treated with implants with a 5° conical internal hexed connection (Anyridge®, MegaGen, South Korea). In Group 2, patients were treated with implants with an internal hexed connection (Core®, Kristal, Italy). After implant placement and a provisionalisation period of 12 months, impressions were taken, stone casts were poured and digitised with a desktop scanner (D700®, 3Shape, Copenhagen, Denmark). In a digital environment, for each fixture, two values were collected at the buccal zenith: the height of the peri-implant mucosa (mucosal height; MH), calculated from the vestibular shoulder of the implant analogue to the upper gingival margin of the supra-implant tissue; and the width of the peri-implant mucosa (mucosal thickness; MT), calculated from the vestibular shoulder of the analogue to the external mucosa point perpendicular to the implant major axis. The mean and standard deviation for MH and MT, as well as their ratios, were calculated for each group; the sectors in which the implants were placed were also considered. Finally, correlation between MH, MT, connection type and sector was assessed by Pearson's correlation coefficient, with significance level set at 0.05, and a confidence interval (CI) set at 95%. RESULTS: Data deriving from 188 implants placed in 104 patients were evaluated. The mean MH values were 3.32 (± 0.12) and 2.70 (± 0.16) mm for Groups 1 and 2, respectively. The mean MT values were 4.37 (± 0.16) and 3.93 (± 0.18) mm for Groups 1 and 2, respectively. Group 1 showed higher MH and MT values and a better ratio (1.50 ± 0.88) than Group 2 (1.81 ± 1.20). The MH, MT and MH/MT ratio were significantly influenced both by sector (p = 0.015) and group (p = 0.047). CONCLUSIONS: Within the limits of this study, the 5° connection implants supported a more extended tissue height and thickness at the buccal zenith, and a better ratio between them. TRIAL REGISTRATION: This study was retrospectively registered in Clinicaltrials.gov, with number NCT04160689, dated 13/11/2019.

The step further smile virtual planning: milled versus prototyped mock-ups for the evaluation of the designed smile characteristics.

BACKGROUND: Mock-up based approach allows the preview of the aesthetic rehabilitation, however, it is crucial that the mock-up does not differ from the expected aesthetic outcomes. With CAD-CAM technologies, it is possible to directly create mock-ups from virtual planned smile project, with greater accuracy and efficiency compared to the conventional moulded mock-ups. In this study, we investigated the trueness of mock-ups obtained with milling and 3D printing technology and a full digital work-flow system. METHODS: Ten adults subjects were included and digital smile design/digital wax-up were performed to enhance the aesthetic of maxillary anterior region. Ten milled mock-ups and 10 prototyped mock-ups were obtained from the original .stl file and a digital analysis of trueness was carried out by superimposing the scanned-milled mock-ups and the scanned-prototyped mock-ups to the digital wax-up, according to the surface-to-surface matching technique. Specific linear measurements were performed to investigate and compare the dimensional characteristics of the physical manufactures, the 3D project and the scanned mock-ups. All data were statistically analyzed. A clinical test was also performed to assess the fitting of the final manufacture. RESULTS: The prototyped mock-ups showed a significant increment of the transversal measurements (p < 0.001) while the milled mock-ups showed a significant increment of all vertical and transversal measurements (p < 0.001). The prototyped mock-ups showed good fitting after clinical tests while none of the milled mock-ups showed good adaptation (no fitting or significant clinical compensation required). Deviation analysis from the original 3D project reported a greater matching percentage for the scanned-milled mock-ups (80,31% ± 2.50) compared to the scanned-prototyped mock-ups (69,17% ± 2.64) (p < 0.001). This was in contrast with the findings from linear measurements as well as from the clinical test and may have been affected by a reductive algorithmic computation after digitization of physical mock-ups. CONCLUSION: Both prototype and milled mock-ups showed a slight dimensional increment comparing to the original 3D project, with milled-mock-ups showing less fitting after clinical tests. Caution must be taken when assessing the trueness of scanned manufacture since an intrinsic error in the system can underestimate the dimensions of the real object.

Bilateral Hyperplasia of the Coronoid Process in Pediatric Patients: What is the Gold Standard for Treatment?

OBJECTIVES: The aim of this systematic review of the literature is to describe treatment options for bilateral coronoid process hyperplasia in pediatric patients, to describe etiologic and diagnostic correlations with the treatment, and to evaluate long-term follow-up treatment outcomes. METHODS: A systematic revision of the literature was performed in the Medline, PubMed, Cochrane library, and Embase database up to December 5, 2017. Predetermined Medical Subject Heading keywords were used: "bilateral" or "monolateral" and "coronoid" or "coronoid process" and "hyperplasia" and "temporomandibular joint" or "tmj" and "ankylosis" or "trismus" and "treatment." Results were recorded following PRISMA guidelines. RESULTS: The systematic research produced 1459 results excluding duplicates. Two additional studies from "Grey literature" were also considered. After application of inclusion and exclusion criteria, 38 articles were selected for a qualitative synthesis. Data regarding sex and age of presentation were collected and summarized in a study flow diagram. CONCLUSION: It is possible to conclude that early diagnosis is fundamental to restore stomatognathic multifunction. There is lack of longitudinal studies presenting long-term follow-up to determine treatment stability. Coronoidectomy might be considered gold standard treatment for this pathologic condition.

Efficacy of ketoprofen lysine salt and paracetamol/acetaminophen to reduce pain during rapid maxillary expansion: A randomized controlled clinical trial.

BACKGROUND: Rapid maxillary expansion (RME) is an orthopaedic procedure indicated for a wide variety of clinical conditions. AIM: The aim of the study was to compare the effects of ketoprofen lysine salt (KLS) vs paracetamol/acetaminophen (P) on pain perception during RME. DESIGN: One hundred and fifty-one subjects (mean age 8.6 year) were enrolled in this prospective controlled clinical trial according to inclusion criteria: prepuberal stage of development, negative posterior transverse interarch discrepancy, non-concurrent use of other drugs. First phase: n.40 allocated to Group 1 used 40 mg of KLS, n.40 to Group 2 used 250 mg of P, n.36 to Group 3 as control group. Second phase: n.35 allocated to Group 4 used 40 mg ketoprofen lysine salt once a day for the first 3 days of activation. Pain experience was reported on a numeric rating scale (0-4) and a 100-mm visual analogue scale. Pain perception was tested with the Mann-Whitney test (P < 0.05). RESULTS: Pain perception was higher during the first 3 days of activation and it was described as mild to moderate. Group 1 experienced significantly less pain during the fourth, fifth, and sixth day (P < 0.05) compared with Group 2. Patients of the Group 4 reported significantly lower pain during the whole period of RME activation (P < 0.05). CONCLUSIONS: The perceived higher pain was reported during the second and third day of expansion. The analgesic effect of KLS is more effective than P during the fourth, fifth, and sixth day. The use of KLS during the first 3 days of activation seems to be able reducing pain during the whole active phase.

Current state of the art in the use of augmented reality in dentistry: a systematic review of the literature.

BACKGROUND: The aim of the present systematic review was to screen the literature and to describe current applications of augmented reality. MATERIALS AND METHODS: The protocol design was structured according to PRISMA-P guidelines and registered in PROSPERO. A review of the following databases was carried out: Medline, Ovid, Embase, Cochrane Library, Google Scholar and the Gray literature. Data was extracted, summarized and collected for qualitative analysis and evaluated for individual risk of bias (R.O.B.) assessment, by two independent examiners. Collected data included: year of publishing, journal with reviewing system and impact factor, study design, sample size, target of the study, hardware(s) and software(s) used or custom developed, primary outcomes, field of interest and quantification of the displacement error and timing measurements, when available. Qualitative evidence synthesis refers to SPIDER. RESULTS: From a primary research of 17,652 articles, 33 were considered in the review for qualitative synthesis. 16 among selected articles were eligible for quantitative synthesis of heterogenous data, 12 out of 13 judged the precision at least as acceptable, while 3 out of 6 described an increase in operation timing of about 1 h. 60% (n = 20) of selected studies refers to a camera-display augmented reality system while 21% (n = 7) refers to a head-mounted system. The software proposed in the articles were self-developed by 7 authors while the majority proposed commercially available ones. The applications proposed for augmented reality are: Oral and maxillo-facial surgery (OMS) in 21 studies, restorative dentistry in 5 studies, educational purposes in 4 studies and orthodontics in 1 study. The majority of the studies were carried on phantoms (51%) and those on patients were 11 (33%). CONCLUSIONS: On the base of literature the current development is still insufficient for full validation process, however independent sources of customized software for augmented reality seems promising to help routinely procedures, complicate or specific interventions, education and learning. Oral and maxillofacial area is predominant, the results in precision are promising, while timing is still very controversial since some authors describe longer preparation time when using augmented reality up to 60 min while others describe a reduced operating time of 50/100%. TRIAL REGISTRATION: The following systematic review was registered in PROSPERO with RN: CRD42019120058.

Implant-Supported Immediately Loaded Complete Arch Rehabilitations with a Mean Follow-up of 10 Years: A Prospective Clinical Study.

PURPOSE: To evaluate the complication-free and failure-free survival rates of porcelain fused to zirconia (PFZ) and all-resin complete arch fixed implant-supported prostheses over a mean follow-up of 10 years. MATERIAL AND METHODS: Subjects with either all-resin or PFZ complete arch fixed implant-supported prostheses on 4 or 6 implants were followed prospectively for 10 years. Cumulative survival rates of prostheses without any catastrophic mechanical complications (resolved without replacing the prosthesis) and free of prosthesis failure (requiring the replacement or removal of the prosthesis) were calculated using life table analysis for up to 10-year period. Additional descriptive variables for various prosthesis events were recorded, such as sex, smoking and drinking status of subjects. RESULTS: A total of 36 subjects with a total of 68 prostheses (53 all-resin and 15 PFZ) were available for evaluation with a mean follow-up of 10 years (SD 1.47; range: 8-13 years). The study registered an overall 90% prostheses survival rate-78% for males and 94% for females; 91% for PFZ and 87% for all-resin; and a 31% complication-free prosthesis survival rate-13% for males and 38% for females; 29% for PFZ and 31% for all-resin at 10 years. A slight decrease in survival rate was identified in the first 3 years since the initial treatment (from 100% to 93%). The number of complications increased with time, especially after the 6th year after the initial treatment. CONCLUSION: Despite the number of reparable mechanical complications, the results confirmed the long-lasting features of both PFZ and all-resin complete arch fixed implant-supported prostheses over a 10-year period. There was however an increased number of mechanical complications after 6 years which may entail additional treatment cost for patients.

Divergence between CBCT and Optical Scans for Soft Tissue Analysis and Cephalometry in Facial Imaging: A cross-sectional study on healthy adults.

BACKGROUND: Facial soft tissue analysis is becoming increasingly emphasized in orthodontic diagnosis and treatment planning. While traditional cephalometry primarily focuses on hard tissues, recent non-invasive imaging techniques offer the potential to comprehensively evaluate three-dimensional (3D) facial soft tissues. The aim of the study was to establish the geometrical 3D and cephalometric divergence between Cone Beam Computed Tomography (CBCT) derived images and scanned soft tissues. Crucial for enhancing orthodontic diagnosis, minimizing patient exposure to ionizing radiation and providing facial cephalometric parameters. MATERIAL AND METHODS: A cross-sectional study was conducted from January 2020 to May 2023. CBCT and 3D facial scans were obtained simultaneously using a specialized imaging system. Reproducible landmark points were selected for both cephalometric and soft tissue analysis. Angular and linear measurements were recorded, and correlations between CT and facial scans were statistically assessed. RESULTS: Comparisons between 10 CBCT-derived and 10 facial scan-based soft tissue representations resulted into 1.8mm mean root median square (RMS). Angular measurements, such as ANB, right gonial angle, and left gonial angle, exhibited a 0.9° of difference with their respective soft tissue variables. In contrast, linear measurements of total anterior facial height showed a lower correlation coefficient, equal to 0.51. The correlation between soft tissues and underlying hard tissues was more pronounced for gonial angles. CONCLUSION: Facial soft tissue analysis using either 3D facial scans or CBCT-derived offers similar results for orthodontic diagnosis and treatment planning. These findings support the use of non-invasive diagnostic tools in orthodontics, although further investigations are needed to comprehensively understand the complexity of hard and soft tissue relationships.

Novel method for augmented reality guided endodontics: An in vitro study.

OBJECTIVE: The aim of this study is to evaluate the accuracy in endodontics of a novel augmented reality (AR) method for guided access cavity preparation in 3D-printed jaws. METHODS: Two operators with different levels of experience in endodontics performed pre-planned virtually guided access cavities through a novel markerless AR system on three sets of 3D-printed jaw models (Objet Connex 350, Stratasys) mounted on a phantom. After the treatment, a post-operative high-resolution CBCT scan (NewTom VGI Evo, Cefla) was taken for each model and registered to the pre-operative model. All the access cavities were then digitally reconstructed by filling the cavity area using 3D medical software (3-Matic 15.0, materialize). For the anterior teeth and the premolars, the deviation at the coronal and apical entry points as well as the angular deviation of the access cavity were compared to the virtual plan. For the molars, the deviation at the coronal entry point was compared to the virtual plan. Additionally, the surface area of all access cavities at the entry point was measured and compared to the virtual plan. Descriptive statistics for each parameter were performed. A 95% confidence interval was calculated. RESULTS: A total of 90 access cavities were drilled up to a depth of 4 mm inside the tooth. The mean deviation in the frontal teeth and in the premolars at the entry point was 0.51 mm and 0.77 mm at the apical point, with a mean angular deviation of 8.5° and a mean surface overlap of 57%. The mean deviation for the molars at the entry point was 0.63 mm, with a mean surface overlap of 82%. CONCLUSION: The use of AR as a digital guide for endodontic access cavity drilling on different teeth showed promising results and might have potential for clinical use. However, further development and research might be needed before in vivo validation.

Are palatal rugae reliable markers for 3D superimposition and forensic human identification after palatal expansion? A systematic review.

OBJECTIVES: Palatal rugae are periodic structures situated in the palatal mucosa, often used as landmarks for human identification and superimposition of digital dental models. This review aims to collect the current evidence regarding whether orthodontic palatal expansion could affect the stability of the palatal rugae and to give preliminary guidelines. MATERIALS AND METHODS: A systematic review of the literature was performed in the scientific databases Pubmed; Embase; WoS; and Cochrane. Grey Literature was also sought (clinicaltrial.gov; ICTRP; AHRQ; INAHTA). The search protocol, was registered in PROSPERO (N*208722). Data extraction comprised: year of publication, journal, sample size, characteristics of the experimental and control group, type of expander, expansion protocol, rugae classification, measurement method on casts, time between casts, method error, rugae change, morphology change and overall outcome. Risk of bias of the included articles was evaluated with the Newcastle-Ottawa Scale. RESULTS: A total of 12394 manuscripts were retrieved after duplicate removal. From these, nine articles were finally included for data extraction. three studies scored as low risk of bias, two as medium and four as high. CONCLUSIONS: The morphology of the palatal rugae can be modified by palatal expansion techniques, especially by rapid maxillary expansion. The first rugae is the most stable along with the points close to the palatal midline, which should be used as a reference both for manual or semi-automatic superimpositions. Human identification and serial superimpositions based on palatal rugae should not be carried immediately post expansion and be taken in consideration with caution in patients who underwent prior palatal expansion.

A method based on 3D affine alignment for the quantification of palatal expansion.

INTRODUCTION: The current methodologies to quantify the palatal expansion are based on a preliminary rigid superimposition of 3D digital models representing the status of a given patient at different times. A new method based on affine alignment is proposed and compared to the gold standard, leading to the automatic analysis of 3-dimensional structural changes and to a simple numeric quantification of overall expansion vector and a better alignment of the digital models. MATERIALS AND METHODS: 40 digital models (timing span delta 25.8 ± 12.5 months) from young patients (mean age 10.7 ± 2.6) treated with two different palatal expansion techniques (20 subjects with RME-Rapid Maxillary Expander, and 20 subjects with NiTiSE, NiTi self-expander) were superimposed with the new affine alignment technique implemented as an extension package of the open-source MeshLab, from a golden standard starting point of rigid alignment. The results were then compared. RESULTS: The new measurement function indicates a mean expansion expressed in a single numeric value of 9.3%, 10.3% for the RME group and 8.4% for the NiTiSE group respectively. The comparison with the golden standard showed a decrease to the average error from 0.91 mm to 0.58 mm. CONCLUSIONS: Affine alignment improves the current perspective of structural change quantification in the specific group of growing patients treated with palatal expanders giving the clinician useful information on the 3-dimensional morphological changes.

Efficacy of the Cervical Vertebral Maturation Method: A Systematic Review.

OBJECTIVE: The present systematic review was carried out to evaluate both qualitatively and quantitatively the effectiveness of the cervical vertebral maturation (CVM) method in predicting the pubertal growth spurt. METHODS: PubMed, PMC, Scopus, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases were searched. The research included every article published from 1970 to June 2019, featuring the keywords: ("cervical vertebrae" OR ("cervical" AND "vertebrae") AND ("orthodontics" OR "growth and development" OR ("growth" AND "development") OR ("growth"). The Preferred Reporting Items for Reporting Systematic Reviews and Meta Analyses (PRISMA) protocol was adopted, and quality assessments modified from the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) and the "Standards for the Reporting of Diagnostic Accuracy Studies" (STARD) were performed to conduct this systematic review. RESULTS: Initially, 1284 articles were found. All the articles were then examined, and 43 studies met the inclusion criteria. Sixteen articles had low-quality scores, 25 had moderate scores, and 2 had high scores. The results showed a moderate to high statistically significant correlation between the CVM and other maturation methods. CONCLUSION: Overall, the CVM method can be considered an effective method and may be used with other skeletal indices for the radiographic assessment of skeletal maturity, and also to identify the growth peak in growing patients.

Effects on Muscular Activity after Surgically Assisted Rapid Palatal Expansion: A Prospective Observational Study.

The study aims to investigate the modifications in the temporalis and the masseter activity in adult patients before and after SARPE (Surgically Assisted Rapid Palatal Expansion) by measuring electromyographic and electrokinesographic activity. 24 adult patients with unilateral posterior crossbite on the right side were selected from the Orthodontic Department of the University of Milan. Three electromyographic and electrokinesographic surface readings were taken respectively before surgery (T0) and 8 months after surgery (T1). The electromyographic data of both right and left masseter and anterior temporalis muscles were recorded during multiple tests: standardized maximum voluntary contraction (MVC)s, after transcutaneous electrical nerve stimulation (TENS) and at rest. T0 and T1 values were compared with paired Student's t-test (p < 0.05). Results: Significant differences were found in the activity of right masseter (p = 0.03) and right temporalis (p = 0.02) during clench, in the evaluation of right masseter at rest (p = 0.03), also the muscular activity of masseters at rest after TENS from T0 to T1 (pr = 0.04, pl = 0.04). No significant differences were found in the activity of left masseter (p = 0.41) and left temporalis (p = 0.39) during clench and MVC, in the evaluation of left masseter at rest (p = 0.57) and in the activity during MVC of right masseter (p = 0.41), left masseter (p = 0.34), right temporalis (p = 0.51) and left temporalis (p = 0.77). Results showed that the activity of the masseter and temporalis muscles increased significantly after SARPE during rest and clenching on the side where the cross-bite was treated.

Clinical Performance Evaluation of a Hyaluronic Acid Dental Gel for the Treatment of Traumatic Ulcers in Patients with Fixed Orthodontic Appliances: A Randomized Controlled Trial.

BACKGROUND: A newly available gel containing hyaluronic acid (HA) and polyvinylpyrrolidone was tested for efficacy on traumatic oral ulcers (TOU) caused by fixed orthodontic appliances. METHODS: A double-blind RCT was conducted to test the new gel versus a placebo. According to the sample size calculation, a total of 60 patients were considered sufficient and randomly allocated to one of the two groups out of a pool of 100 total patients who initially agreed to participate in the study. A VAS scale test and lesion measurements at T0, T1, and T2 were performed on the patients. RESULTS: A total of 70 patients developed TOU, with 8 drop-outs; the intergroup comparison showed a statistically significant greater dimension of the lesion in the control group at T2 when compared to the test group. The pain experienced by the patients belonging to the test group was significantly lower than the pain in the patients in the control group Conclusions: Under the limitations of the study, the new formula might provide faster healing with less pain experienced by the patient when compared to a placebo.