Non-surgical retreatment versus papillary preservation flap surgery for residual pockets: A randomized controlled trial with clinical and patient-reported outcomes.

AIM: To compare the efficacy of non-surgical re-instrumentation (NSR) and papillary preservation flap (PPF) surgery at single-rooted teeth with residual pockets. MATERIALS AND METHODS: Patients with at least a residual pocket depth (PD ≥ 5 mm) after Steps I and II were enrolled and randomly assigned to receive NSR or PPF surgery. The primary outcome was PD reduction, and secondary outcomes were clinical attachment level (CAL) change and patient-reported outcome measures (PROMs). Outcome variables were measured at baseline, 3 and 6 months. The examiner was blinded. Statistical analysis, one site for each patient, included descriptive statistics and analysis of covariance. RESULTS: Forty-six participants were enrolled, and one patient dropped out in the PPF group. After 6 months, both treatments resulted in significant PD reduction (1.3 ± 1.2 mm, p = .009 NSR; 2.0 ± 0.7 mm, p < .001 PPF) and CAL gain (1.0 ± 2.4 mm, p = .031 NSR; 1.4 ± 0.8 mm, p < .001 PPF). PD reduction between groups was not statistically significant (diff: 0.6 mm; 95% confidence interval [CI] [-0.3 to 1.5]; p = .167). Pocket closure was 61% NSR versus 86% PPF (p = .091). Smoking was associated with less PD reduction of almost 1 mm in both treatments. Treatment time was longer for PPF surgery, but PROMs and post-operative pain were similar between groups. CONCLUSIONS: Both NSR and PPF reduced PD without significant difference between treatments at 6 months. PPF surgery may offer faster PD reduction, but smoking habits reduce treatment efficacy.

Long-term effects produced by early treatment of Class III malocclusion with rapid maxillary expansion and facemask followed by fixed appliances: A multicentre retro-prospective controlled study.

OBJECTIVE: To assess the short- and long-term dentoskeletal effects of early Class III treatment with rapid maxillary expansion and facemask (RME/FM) followed by fixed appliances. MATERIALS AND METHODS: A total of 44 patients (27 females, 17 males) treated consecutively with RME/FM were included from the archives of 3 centres. Three lateral cephalograms were available: T0 (before the start of RME/FM therapy, mean age 8.1 ± 1.8 years), T1 (immediately after RME/FM, mean age 9.8 ± 1.6 years), and T2 (long-term observation, mean age 19.5 ± 1.6 years). A control group of 17 untreated Class III subjects (12 females and 5 males) also was selected. Between-group statistical comparisons were performed with ANCOVA. RESULTS: No statistically significant differences for any of the cephalometric variables were found at T0. In the short term, the treated group showed significant improvements in ANB (+2.9°), Wits appraisal (+2.7 mm), SNA (+1.8°) and SNB (-1.1°). A significant closure of CoGoMe angle (-1.3°) associated with smaller increments along Co-Gn (-2.4 mm) also was found together with a significant increase in intermaxillary divergence (+1.3°). In the long-term, significant improvements in ANB (+2.6°), Wits appraisal (+2.7 mm) and SNB (-1.7°) were recorded together with a significant closure of the CoGoMe angle (-2.9°). No significant long-term changes in vertical skeletal relationships were found. CONCLUSIONS: RME/FM therapy was effective in improving Class III dentoskeletal relationships in the short term. These changes remained stable in the long-term due mainly to favourable mandibular changes.

Efficacy of an automatic electric toothbrush with nylon bristles in dental plaque removal: a cross-over randomized controlled trial.

OBJECTIVES: The objective of this single-use, five-treatment, five-period, cross-over randomized controlled trial (RCT) was to compare the efficacy in dental plaque removal of a new Y-shaped automatic electric toothbrush (Y-brush) compared to a U-shaped automatic electric toothbrush (U-brush), a manual toothbrushing procedure (for 45 and 120 s), and no brushing (negative control). MATERIALS AND METHODS: Eligible participants were volunteer students randomized to the treatments in the five periods of the study. The primary outcome measure was the reduction in full-mouth plaque score (FMPS) after brushing while the secondary outcome variable was a visual analogic scale (VAS) on subjective clean mouth sensation. Mixed models were performed for difference in FMPS and VAS. RESULTS: After brushing procedures, manual toothbrushing (120 s) showed a statistically significant reduction in FMPS than Y-brush (difference 36.9; 95%CI 29.6 to 44.1, p < 0.0001), U-brush (difference 42.3; 95%CI 35.1 to 49.6, p < 0.0001), manual brushing (45 s) (difference 13.8; 95%CI 6.5 to 21.1, p < 0.0001), and No brushing (difference 46.6; 95%CI 39.3 to 53.9, p < 0.0001). Y-brush was significantly more effective than No brushing (difference 9.8; 95%CI 2.5 to 17.0, p = 0.0030), while there was no significant difference compared to U- brush. Similar results were obtained for the differences in the Clean Mouth VAS. CONCLUSIONS: Y-brush was significantly more effective than no brushing (negative control) in removing dental plaque. When compared to manual toothbrushing for both 45 and 120 s, however, Y-brush was less effective in dental plaque removal. CLINICAL RELEVANCE: Modified design of automatic toothbrushing devices could improve plaque reduction, especially in patients with intellectual disabilities or motor difficulties.

Long-term comparison of root coverage procedures at single RT2 maxillary gingival recessions: Ten-year extension results from a randomized, controlled clinical trial.

AIM: The purpose of the present study was to assess root coverage outcomes 10 years after connective tissue graft plus coronally advanced flap (CTG + CAF) or CAF alone, at single RT2 maxillary gingival recession. MATERIALS AND METHODS: Twenty-one of the original 29 patients (11 treated with CAF + CTG and 10 with CAF alone) were available for the 10-year follow-up. A blinded and calibrated examiner performed all the measurements. Outcome measures included complete root coverage (CRC), recession reduction (RecRed), root coverage aesthetic score (RES), and keratinized tissue (KT) gain. A visual analogue scale was used to evaluate patient satisfaction. RESULTS: CRC was maintained in 63% of the test group and 20% of the control group after 10 years, with a significant difference favouring CAF + CTG (p = .030). Furthermore, the addition of CTG was associated with greater KT gain (p = .0002) and greater papilla tip recession (p = .023) than with CAF at the last follow-up. No difference was detected regarding RecRed, RES, and patient satisfaction. CONCLUSIONS: Adding CTG under CAF improved the probability of maintaining complete root coverage 10 years after single maxillary RT2 recession treatment.

Association between chronic kidney disease and periodontitis. A systematic review and metanalysis.

OBJECTIVES: Aims of this SR were to assess the association of Periodontitis (PD) with Chronic Kidney Disease (CKD) and with different CKD stages. MATERIALS AND METHODS: MEDLINE, Cochrane Central Register of Trials and EMBASE, up to April 4, 2021 were searched. RCTs, prospective and retrospective cohort studies, case-control studies and cross-sectional studies were considered. JBI's Critical Appraisal Tool for risk of bias assessment was used. The risk of PD was calculated using the Mantel-Haenszel odds ratios (MH-OR); weighted mean difference for clinical attachment level (CAL) and periodontal probing depth (PPD) were also evaluated. RESULTS: Out of 1949 titles screened, 142 full texts were evaluated and 17 studies were included. CKD was associated to higher risk of PD (MH-OR = 2.36, [95% C.I. 1.25, 4.44]; p = 0.008), higher mean CAL (WMD = 0.41 mm [95% C.I. 0.22, 0.60]; p < 0.0001) and mean PPD (WMD = 0.25 mm [95% C.I. 0.03, 0.47]; p = 0.02) compared to healthy individuals. Severe CKD (stages 4-5 vs 2-3) resulted at higher risk of PD (MH-OR = 2.21, [95% C.I. 1.07, 4.54]; p = 0.03). Heterogeneity and risk of bias were high. CONCLUSIONS: An association between PD and CKD was found. It could be appropriate to consider PD a frequent CKD comorbidity.

Comparison between digital and conventional impression techniques in children on preference, time and comfort: A crossover randomized controlled trial.

OBJECTIVE: To compare the conventional alginate impression and the digital impression taken with an intraoral scanner of both dental arches in children, using a randomized crossover design. TRIAL DESIGN: This is a monocentric, controlled, superiority, randomized, crossover, open study. METHODS: Twenty-four orthodontic patients between 6 and 11 years of age underwent intraoral scanning (TRIOS 3; 3Shape) and alginate impression of both dental arches with an interval of 1 week between the two procedures. Participants were recruited from September 2021 to March 2022 and the study was completed in April 2022. Impression time for the two procedures was compared. Patients were asked which one of the two impression procedures they preferred. A questionnaire including Visual Analogue Scale (VAS) for comfort, pain, gag reflex and difficulty in breathing, was administered to the patients. RESULTS: Eighteen out of 24 patients preferred digital impression (75%, 95% confidence interval [CI]: 55% to 88%; P = .014). Scanning time was significantly shorter than alginate impression time (difference -118 seconds; 95% CI: -138 to -99; P < .001). Comfort was significantly higher for digital impression (difference 1.7; 95% CI: 0.5 to 2.8; P = .007). There was no difference in pain (difference -0.2; 95% CI: -1.5 to 1.0; P = .686) while gag reflex and breathing difficulties were smaller for digital impression (gag reflex difference -2.5; 95% CI: -4.0 to -0.9; P = .004 and breathing difficulties difference -1.5; 95% CI: -2.5 to -0.5; P = -.004). CONCLUSIONS: Digital impression is preferred by children aged 6-11 years and it is significantly faster in acquisition time than conventional alginate impression. REGISTRATION: The study was registered on ClinicalTrials.gov with registration number NCT04220957 on January 7th, 2020 (https://clinicaltrials.gov/ct2/show/NCT04220957).

Immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser: a retrospective cohort study.

Dental implants placed in fresh extraction alveoli provide several advantages, including shorter treatment periods and improved patient comfort. After a compromised tooth extraction, the Er,Cr:YSGG laser can considerably reduce bacterial concentration. The objective of this controlled study conducted after at least 1 year of follow-up was to compare the use of immediate post-extraction implants in infected sites treated with laser (test group) versus conventional implants in edentulous sites (control group) through an analysis of pre- and post-operative radiographs. The study was based on a series of patients treated between 2014 and 2019, with a 1-year minimum follow-up, and up to over 4 years. An analysis of the clinical history of the treated patients and pre- and post-operative radiographs was performed to evaluate the implant success and to measure the marginal bone level (MBL). Overall, 149 implants were studied. There was only one failure in the test group (1%) and no failures in the control group. The test group gained 0.1 mm of the MBL compared to the baseline, while the control group lost 0.1 mm of the MBL. The difference between the two groups of only 0.2 mm was not statistically significant (P = 0.058). Immediate dental implants in infected sockets debrided and decontaminated using Er,Cr:YSGG laser do not appear to enhance the likelihood of failure; however, peri-implantitis and associated problems must be avoided by following a certain set of protocols and procedures.

Effects produced by the facemask with and without skeletal anchorage for the orthopaedic treatment of Class III malocclusion in growing patients: a systematic review and meta-analysis of RCTs.

BACKGROUND: Skeletally anchored facemask has been proposed to maximize skeletal effects and minimize dental effects in the treatment of Class III malocclusion in growing patients. OBJECTIVE: To compare the dento-skeletal effects produced by the facemask with or without skeletal anchorage for the treatment of Class III malocclusion in growing patients. MATERIALS AND METHODS: PubMed, Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey were used for the electronic search without language, publication status, and year restrictions. Only RCTs were included. Inclusion criteria were: growing patients (age under 18 years) with Class III malocclusion, with indications for treatment with the facemask. Data were extracted by two independent reviewers. GRADE statement was executed. The mean of differences (MD) and the risk ratio (RR) were used. RESULTS: Three articles with a total of 123 patients were included. One article was at low risk of bias while two were at high risk of bias. There were no significant differences between the two groups in ANB angle, Wits appraisal, SNB angle, and SN-MP angle. SNA angle was significantly increased in the skeletally anchored facemask (pooled MD = 0.80 favouring skeletal anchorage, 95% CI from 0.29 to 1.31, P = 0.002, I2 = 12 per cent, three studies, GRADE moderate). The U1-SN angle was significantly reduced in the skeletally anchored facemask (pooled MD = -5.91 favouring skeletal anchorage, 95% CI from -7.64 to -4.27, P < 0.00001, I2 = 0 per cent, two studies, GRADE moderate). There were significantly less complications in tooth-anchored facemask (pooled RR = 7.98 favouring dental anchorage, 95 per cent CI from 1.04 to 61.27, P = 0.05, I2 = 0 per cent, two studies, GRADE low). LIMITATIONS: Few RCTs (three) were included, and two studies were at high risk of bias. There were no long-term RCTs comparing skeletally anchored facemask with dental-anchored facemask. Only Asiatic patients were included in this systematic review. CONCLUSIONS: Skeletally anchored facemask was associated to a greater increase of SNA angle at the end of treatment though clinically not significant. Facemask with skeletal anchorage determined a reduced inclination of maxillary incisors compared to dental-anchored facemask with greater risks of complications. REGISTRATION: PROSPERO register (CRD42020221982).

Clinical decision-making and management of stage IV periodontitis: A survey.

OBJECTIVE: To investigate the clinical management of stage IV periodontitis patients among clinicians within the Italian Society of Periodontology and Implantology. METHODS: A cross-sectional study was designed on a web-based anonymous survey. Comparison between ordinary members (OMs) versus active and certified members (ACMs) and comparison between members with at least 10 years of experience in periodontology (Ov10) and members with less than 10 years of experience in periodontology (Un10) were performed. RESULTS: A total of 324 out of 1362 members (response rate of 24%) responded to the questionnaire. ACMs and Ov10 more often reported their teams hold adequate skills to manage cases. Step I and II periodontal therapy took more time in the ACMs and Ov10 groups. ACMs used different strategies to perform step I-II therapy, and antibiotics were used less frequently than OMs. Unresponsive sites were treated more often with surgery by ACMs compared to OMs. ACMs adopted different treatment sequences compared to OMs. Ov10 group used more often CBCT, lateral cephalogram, and wax-up while Un10 group tend to avoid orthodontic therapy. CONCLUSIONS: More experienced members spent more time in step I and II of periodontal therapy, used more diagnostic tools, and performed more often surgery and orthodontics in the treatment of stage IV periodontitis patients.

Variations in maxillary second molar position of untreated subjects with normal occlusions: A long-term observational study.

INTRODUCTION: The purpose of the present study was to evaluate the long-term variations in maxillary second molar position in untreated subjects with normal occlusion. SETTING AND SAMPLE POPULATION: A sample of 39 subjects (18 females and 21 males) selected from the University of Michigan Growth Study (UMGS) was followed longitudinally with digital dental casts at 3 observation times: T1, when the maxillary permanent second molars were fully erupted, T2, last observation available in the longitudinal series (38 subjects), and T3, at least 20 years after T2 (12 subjects). MATERIALS AND METHODS: Digital measurements were recorded with an open-source software. Outcome variables were sagittal and transverse inclinations of the upper second molars. Two mixed-effect models were performed. RESULTS: The maxillary second molars had a distolingual inclination at T1, T2 and T3. Sagittal and transverse inclination showed progressive significant uprighting from T1 through T3 (P < .001). From T1 to T2, the adjusted difference in sagittal crown inclination was 8.0° (95% CI from 6.5° to 9.6°; P < .001). From T2 to T3, the adjusted difference was 5.5° (95% CI from 3.0° to 8.1°; P < .001). From T1 to T2, the adjusted difference in transverse crown inclination was 1.9° (95% CI from 0.4° to 3.5°; P = .011). From T2 to T3, the adjusted difference was 6.0° (95% CI from 3.4° to 8.5°; P < .001). CONCLUSIONS: Along with age, maxillary second molars showed a progressive significant uprighting with a decrease in the distal and lingual inclinations.

Periodontitis predicts HbA1c levels and glucose variability in type 1 diabetic patients: the PARODIA Florence Project study.

OBJECTIVE: The aim of the present study was to assess the extent and severity of periodontal disease among type 1 diabetic patients (T1DM) and to investigate the possible association with systemic markers of glucose control and variability. MATERIAL AND METHODS: Patients were consecutively enrolled in a Diabetic Unit. A full-mouth periodontal evaluation was performed, and data on systemic markers of diabetes were collected. Descriptive statistics and logistic and linear models were performed. RESULTS: A total of 136 T1DM patients (mean age: 45.5 ± 14.6 years) were examined. Periodontitis was detected in 62% of cases (mean CAL: 3.0 ± 0.9 mm): stage III periodontitis was diagnosed in 32% of patients while stage IV in 8%. Mean level of glycated hemoglobin (HbA1c) was 7.5% ± 1.4. Among the investigated factors, mean CAL (p=0.040) was associated with HbA1c ≥ 7%; 93% of patients with mean CAL > 6 mm showed HbA1c ≥ 7%. Mean CAL (p=0.004), mean PPD (p=0.005), mean FMPS (p=0.030), and stage III/IV periodontitis (p=0.018) predict glucose coefficient of variation (CV). CONCLUSIONS: Periodontitis showed a relevant prevalence in the present, well-controlled T1DM population and predicts poor glycemic control (HbA1c ≥7%) and higher glucose variability. The present findings suggest that periodontal infection may have systemic effects also in T1DM patients. CLINICAL RELEVANCE: The extent and severity of periodontitis and its possible systemic effects in T1DM patients could be underestimated.

Comparison of the dento-skeletal effects produced by Leaf expander versus rapid maxillary expander in prepubertal patients: a two-center randomized controlled trial.

OBJECTIVE: This study aimed to compare the skeletal and dentoalveolar effects produced by slow maxillary expansion (SME) with the Leaf expander versus the conventional rapid maxillary expansion (RME) on digital dental casts, lateral and postero-anterior cephalometric radiographs. TRIAL DESIGN: This is a superiority, two-center, two arms parallel balanced randomization trial. METHODS: Patients in the mixed dentition were included with a transverse interarch discrepancy of at least 3 mm. An expansion screw using moderate continuous forces (Leaf group) was compared to a conventional RME screw (RME group). The primary response variable was the difference in maxillary intermolar width (U6-U6) measured at baseline (T0) and one-year follow-up (T1) on the digital dental casts. Other dento-skeletal variables were also measured on digital dental casts and cephalograms. Computer-generated block randomization was used with allocation concealed in sequentially numbered opaque sealed envelopes. The examiner was blinded on the type of expander used. Linear models were used for statistical analysis. RESULTS: Twenty-eight patients in the Leaf group and 28 patients in the RME group were randomized and included in the study. There were no dropouts. U6-U6 did not show a statistically significant difference between the two groups (-0.4 mm in favor of the RME group, 95% CI from -1.2 to 0.5, P = 0.365). As for the other secondary variables no statistically significant differences were found between the two groups except maxillary intercanine width (U3-U3, -0.9 mm in favor of the RME group, 95%CI from -1.5 to -0.3, P = 0.005) and maxillary skeletal width (Mx-Mx, -1.4 mm in favor of the RME group, 95%CI from -2.4 to -0.3, P = 0.013). CONCLUSIONS: No significant differences between the RME and Leaf groups were detected for any of the analyzed dento-skeletal variables except the T1-T0 differences in U3-U3 and Mx-Mx that were significantly greater in the RME group. REGISTRATION: The study was registered in the ISRCTN register on 08/11/2016 with the number ISRCTN18263886. FUNDING: No funding or conflict of interest to be declared.

Factors influencing the aesthetics of smile: An observational study on clinical assessment and patient's perception.

AIM: To clinically assess the aesthetics of smile and the possible influencing factors. MATERIALS AND METHODS: In this explorative study, an initial questionnaire on demographic variables and perception of own quality of smile (Visual Analogue Scale) was administered by a first examiner. A second blinded assessor examined all patients and recorded clinical data. In addition, for each patient, the Smile Aesthetic Index (SEI) was calculated. Descriptive statistics and multilevel logistic models were performed. RESULTS: One hundred consecutive subjects were enrolled. The mean SEI was 8.4 ± 1.2, while the mean patient's perception of smile was 7.1 ± 2.0. However, they did not correlate (r = 0.16 from -0.04 to 0.34; p = .12). Gingival recessions were perceived by 21.9% of subjects, tooth alignment by 38.6%, tooth dyschromia by 34.3%, and missing papilla/diastema by 26.7%. In particular, gingival recessions were perceived when they were deeper (p = .0342), located in the upper jaw (p = .0223), and corresponding to incisors (p < .0001) and canines (p = .0159) with respect to molars. CONCLUSIONS: Clinical assessment and patient perception represent two important diagnostic phases. However, there is no correlation between them. Attention should be given to specific variables to provide the most comprehensive aesthetic analysis of smile.

Predicting mandibular growth based on CVM stage and gender and with chronological age as a curvilinear variable.

OBJECTIVE: The aim of this study was to develop a prediction model that combines the information derived from chronological age (analysed as a curvilinear variable), gender and the CVM method to predict mandibular growth. SETTINGS AND SAMPLE POPULATION: 50 participants (29 females, 21 males) were selected from the AAOF Craniofacial Growth Legacy Collection, the Michigan Growth Study and the Denver Child Growth study. MATERIALS AND METHODS: In this investigation, 456 lateral cephalograms were analysed by applying a mixed effect model. The outcome variable was the annualized increment in total mandibular length (Co-Gn) during the year following the lateral cephalogram on which the cervical stage and chronological age were evaluated. The predictive variables were chronological age up to the fifth order, gender, stage of cervical vertebral maturation, as well as interactions between age and gender, age and cervical stage, and gender and cervical stage. RESULTS: Cervical stage, chronological age up to the fourth order, gender, and the interaction between age and gender were significant predictors of annualized increments in mandibular length. The annualized increment in Co-Gn was significantly greater for CS 3 when compared to all other cervical stages. Further, annualized increments in Co-Gn for CS 1 and CS 2 were significantly greater when compared to CS 5. CONCLUSIONS: Cervical stage, chronological age and gender can be used jointly to predict the annualized increment in mandibular growth. Cervical stage 3 exhibited the greatest annualized increase in mandibular length.

Smile esthetic evaluation of mucogingival reconstructive surgery.

To assess the difference in smile esthetic impact of Coronally Advanced Flap (CAF) with or without the adjunct of a collagen matrix (CMX) used as root coverage procedures. Subjects with esthetic demands showing multiple upper gingival recessions of at least 2 mm, without interproximal attachment loss and cervical abrasion no more than 1 mm were recruited and randomized to CAF plus CMX or CAF alone. The Smile Esthetic Index (SEI) was adopted to quantify the quality of the smile recorded at baseline and 12 months after treatment for each treatment group. In addition, between group difference in the SEI was calculated. 24 Patients were treated and analysed. At baseline, mean gingival recession depths were 2.3 ± 0.7 mm for Test group and 2.6 ± 1.0 mm for Control group. After 1 year, the residual recession depth was 0.3 ± 0.4 mm in the CAF + CMX group and 0.6 ± 0.3 mm in the control group. The SEI at baseline was 8.1 ± 1.0 and 7.9 ± 0.7 for Test and Control group, respectively. The between groups difference at 12 months in SEI was 0.4 (95% C.I. - 0.0 to 0.8, P = 0.0697). Twelve months after treatment, CAF + CMX provided a similar SEI compared to CAF alone and the adjunct of a collagen matrix did not show a different impact on the smile esthetic appearance.

Dento-skeletal effects produced by rapid versus slow maxillary expansion using fixed jackscrew expanders: a systematic review and meta-analysis.

BACKGROUND: No systematic review and meta-analysis of dento-skeletal effects following rapid maxillary expansion (RME) and slow maxillary expansion (SME) using the same jackscrew expander with different activation protocols is available. OBJECTIVE: To compare dento-skeletal effects produced by RME with those induced by SME using the same fixed jackscrew expanders in growing patients. SEARCH METHODS: PubMed (MEDLINE), Cochrane Library, Scopus, Embase, and OpenGrey were searched with no language or publication date restrictions. SELECTION CRITERIA: Only randomized controlled trials (RCTs) were selected and the following inclusion criteria were used: growing patients in mixed or permanent dentition, with maxillary transverse discrepancy, dental crowding, and treated with fixed jackscrew maxillary expander (e.g. Hyrax, Haas) activated to achieve either RME or SME. DATA COLLECTION AND ANALYSIS: Data were extracted by two independent reviewers. The quality of the included RCTs was assessed according to the Cochrane risk-of-bias tool for randomized trials (RoB 2.0). For the aggregation of continuous data, the mean of the differences (MD) between treatments was used. A random effect model was applied. RESULTS: From 4855 retrieved articles, 3 studies were selected, 1 at unclear risk and 2 at high risk of bias. Maxillary intermolar distance showed no significant differences between the two modalities of expansion [pooled MD = 0.99 mm favouring RME, with 95% confidence interval (CI) = -2.09 to 4.06, P = 0.53, I2 = 90%]. As for maxillary molar inclination measured as the angle formed by the axes passing through the disto-buccal cusps and the apexes of the palatine root of the first upper molars, it was significantly smaller in the SME group (MD = -11.51°, with 95% CI = -15.23 to -7.79, P < 0.0001). Posterior maxillary expansion was significantly greater in RME than SME (pooled MD = 0.75 mm, with 95% CI = 0.27-1.23, P = 0.002, I2 = 0%). CONCLUSIONS: Both RME and SME produce an effective dento-skeletal expansion of the maxilla. RME is slightly more effective in increasing the posterior transverse skeletal width of the maxilla while SME induces smaller molar inclination. REGISTRATION: PROSPERO CDR42018105530.

Comparison between two screws for maxillary expansion: a multicenter randomized controlled trial on patient's reported outcome measures.

OBJECTIVE: The objective of this study was to compare an expansion screw of the maxilla that generates moderate and continuous forces versus a conventional screw for rapid maxillary expansion (RME) on patient-reported outcome measure during the first 12 weeks of treatment. TRIAL DESIGN: This is a superiority, multicenter, two-arm parallel balanced randomization trial. METHODS: Patients in the mixed dentition were included with a transverse discrepancy between the two arches of at least 3 mm. An expansion screw using moderate continuous forces (Leaf group, treated with an expansion screw with Ni-Ti springs) was compared to a conventional RME screw that generates intermittent heavy forces (RME group). The primary response variable was the visual analogue scale (VAS) on pain calculated in the first 12 weeks of therapy. The VAS on difficulty on speaking and oral hygiene, patient satisfaction, and complications were also evaluated. A computer-generated block randomization was used with allocation concealed in sequentially numbered opaque-sealed envelopes. Blinding was not applicable. Linear models were used for statistical analysis. RESULTS: Twenty-eight patients in the Leaf group and 28 patients in the RME group were randomized and included in the study. There were no dropouts. The mean of the VAS for pain was 0.3 ± 0.4 in the Leaf group and 0.6 ± 0.5 in the RME group. The difference was -0.3 (95 per cent CI from -0.5 to -0.0; P = 0.017) in favour of the Leaf group. The difference in pain was marked in the first week (Leaf group 2.2 ± 2.3; RME group 3.7 ± 2.6; difference -1.5; 95 per cent CI from -2.7 to -0.3; P = 0.019). CONCLUSIONS: Patients in the Leaf group experienced a lower degree of pain, especially during the first week following the application of the expander. For the other variables, no significant differences were reported between the two treatments. REGISTRATION: The study was registered in the ISRCTN register on 8 November 2016 with the number ISRCTN18263886.

Immediate versus early non-occlusal loading of dental implants placed flapless in partially edentulous patients: A 10-year randomized clinical trial.

AIM: To compare immediate versus early non-occlusal loading of dental implants placed flapless in a 10-year, parallel group, randomized clinical trial. MATERIALS AND METHODS: Patients were randomized to receive implants for fixed partial dentures. The immediate group was represented by immediate non-occlusal implant loading, whereas the early group was represented by early non-occlusal implant loading. The outcome variables were implant failure, complications, subjective satisfaction and radiographic bone level at implant sites 10 years after loading. RESULTS: Sixty patients were randomized: 30 to the immediately loaded group and 30 to the early loaded group. Three patients dropped out in the immediate group, and three patients dropped out in the early group. One implant failure occurred in the early group (p = 1.0). Three complications occurred in the immediate group and four in the early group (RR = 0.75, 95% CI 0.19 to 3.04, p = 1.0). The difference in bone level was 0.1 mm (95% CI -0.2 to 0.5, p = .3752) favouring the early group. Difference in subjective functional satisfaction was 0.2 (95% CI -0.2 to 0.7; p = .3271). Difference in subjective aesthetic satisfaction was 0.0 (95% CI -0.4 to 0.4; p = .9656). CONCLUSION: At 10-year follow-up, no differences between implants loaded immediately and early were detected in this randomized clinical trial.

Coronally advanced flap and composite restoration of the enamel with or without connective tissue graft for the treatment of single maxillary gingival recession with non-carious cervical lesion. A randomized controlled clinical trial.

BACKGROUND: Aim of this study was to compare coronally advanced flap (CAF) and composite restoration of the cement-enamel junction (CEJ) with or without connective tissue graft (CTG) for treatment of single maxillary gingival recession with non-carious cervical lesion (NCCL). MATERIAL AND METHODS: Thirty patients with single gingival recessions and previously restored NCCL were randomly allocated to the two groups. A masked examiner evaluated recession reduction (RecRed), complete root coverage (CRC), keratinized tissue (KT) gain, increase in gingival thickness (GT), patient satisfaction and Root coverage Esthetic Score (RES). RESULTS: No significant difference for RecRed and CRC was detected at 12 months. CAF + CTG resulted in greater increase of KT width and thickness (p < .001). An interaction between baseline GT and type of treatment was reported, suggesting that when baseline GT was ≤0.84 mm adding CTG led to higher RecRed, while for values >0.84 mm the use of CAF was associated with better outcomes. Similarly, CAF alone provided better final RES score for baseline GT > 0.82 mm. CONCLUSION: Both procedures were effective for root coverage at single RT1 recession with previously restored CEJ. Adding a CTG under CAF should be considered for Rec with thin gingival phenotype.

Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects: A systematic review and meta-analysis.

BACKGROUND: The aim of this systematic review was to compare clinical, radiographic and patient-reported outcomes (PROMs) in intra-bony defects treated with regenerative surgery or access flap. MATERIALS AND METHODS: A systematic review protocol was written following the PRISMA checklist. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) on regenerative treatment of deep intra-bony defects (≥3 mm) with a follow-up of at least 12 months. Primary outcome variables were probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain and tooth loss. Secondary outcome variables were Rec, radiographic bone gain, pocket "closure," PROMs and adverse events. Meta-analysis was carried out when possible. To evaluate treatment effect, odds ratios were combined for dichotomous data and mean differences for continuous data using a random-effect model. RESULTS: A total of 79 RCTs (88 articles) published from 1990 to 2019 and accounting for 3,042 patients and 3,612 intra-bony defects were included in this systematic review. Only 10 of included studies were rated at low risk of bias. A total of 13 meta-analyses were performed. All regenerative procedures provided adjunctive benefit in terms of CAL gain (1.34 mm; 0.95-1.73) compared with open flap debridement alone. Both enamel matrix derivative (EMD) and guided tissue regeneration (GTR) were superior to OFD alone in improving CAL (1.27 mm; 0.79-1.74 mm and 1.43 mm; 0.76-2.22, respectively), although with moderate-high heterogeneity. Among biomaterials, the addition of deproteinized bovine bone mineral (DBBM) improved the clinical outcomes of both GTR with resorbable barriers and EMD. Papillary preservation flaps enhanced the clinical outcomes. The strength of evidence was low to moderate. CONCLUSION: EMD or GTR in combination with papillary preservation flaps should be considered the treatment of choice for residual pockets with deep (≥3 mm) intra-bony defects.