Effect of bleaching treatments on the adhesion of orthodontic brackets: a systematic review.

BACKGROUND: Nowadays bleaching procedures have gained popularity in orthodontic patients. Peroxide and Carbamide acids are the common agents which are used in in-office and at home bleaching techniques. Consequently, the Bonding adhesion to the enamel can be influenced by the orthodontic phase and the residual peroxide might interfere with the polymerization and the adhesion of the brackets. Frequent debonding of the brackets from teeth after the bleaching procedure could cause the lengthening of the therapy and promote irregularities on enamel surface derived from an additional bonding phase of the brackets. The aim of this systematic review is to appraise the influence regarding the effect of the bleaching procedure on the bond strength of orthodontic brackets. METHODS: An electronic database search was performed. Search terms included: bleaching, brackets, adhesion; data were extracted and summarized. Risk of bias was assessed using the Chocrane risk of bias tool, adapted for in vitro studies. RESULTS: A total of 8689 articles were screened and 11 studies met the inclusion criteria of this systematic review. 1000 teeth of human and bovine origin were analyzed for the shear bond strength (SBS) of stainless and ceramic brackets after the bleaching treatments. All the authors divided the groups in different subgroups with different bleaching agents and in different concentration. The SBS value allowed to demonstrate the necessity to delay the bonding of the brackets for two weeks after a bleaching treatment and its improvement when tooth mousse or antioxidants agents are used. CONCLUSIONS: The SBS values and the delay of the bonding procedure must be considered in dental practice and clinical strategies are necessary in order to avoid drawbacks which could cause the debonding of the brackets after bleaching due to the alterations of the dental substrate, thus interfering with the orthodontic treatments.

Analysis of Cervical Range of Motion in Subjects Affected by Temporomandibular Disorders: A Controlled Study.

Background and Objectives: The aim of this study were to compare the cervical ROM data obtained from accelerometer exams between patients suffering from TMDs (study group) and healthy patients (control group). Material and Methods: A sample of 43 young adult subjects (23 control subjects and 20 TMD patients) were included in this study and analyzed with the accelerometer (Baiobit™, BTS, Garbagnate Milanese, Milan, Italy) to assess cervical ROM using a standardized protocol, including the following occlusal conditions: mandibular rest position, clenching, clenching with cotton rolls, maximal intercuspation, and mandibular position with cotton rolls. The cervical ROM was measured in degrees and expressed as the mean and standard deviation. Results: TMD patients showed a reduced cervical extension compared to control subjects in all the conditions, with statistically significant relevance. Regarding the other movements, the differences were not statistically or clinically significant. Conclusions: Based on the results of the present study, it can be observed that temporomandibular disorders are associated with a decreased cervical extension range, while the remaining components of ROM do not seem to be significantly associated. The use of accelerometers in ROM analysis could be helpful in improving interdisciplinary communication between dentists and physiotherapists.

A Knowledge-Based Algorithm for Automatic Monitoring of Orthodontic Treatment: The Dental Monitoring System. Two Cases.

BACKGROUND: In the dental field, digital technology has created new opportunities for orthodontists to integrate their clinical practice, and for patients to collect information about orthodontics and their treatment, which is called "teledentistry." Dental monitoring (DM) is a recently introduced orthodontic application that combines safe teledentistry with artificial intelligence (AI) using a knowledge-based algorithm, allowing an accurate semi-automatic monitoring of the treatment. Dental Monitoring is the world's first SaaS (Software as a Service) application designed for remote monitoring of dental treatment, developed in Paris, France, with Philippe Salah as the Co-founder and CEO. CASES PRESENTATION: This report describes two cases in which DM system was essential to achieve the control of certain movements: it was possible to follow the movement, even if complex, such as the anterior cross of an adult patient and a lack of space in the canine of the growing patient. The software analyzed the fit and retention of the aligner, thus ensuring correct biomechanics. They were treated during the COVID-19 pandemic lockdown with aligners. The first case is a growing patient who was monitored during an interceptive orthodontic treatment to manage a retained upper canine. The second case is an adult patient forced to finalize his treatment of upper lateral incisor crossbite. The software analyzed the fit and retention of the aligner, thus ensuring correct biomechanics. CONCLUSIONS: DM system appears to be a promising method, useful for improving the interaction between doctor and patient, generally acceptable and useful to patients, even in critical clinical situations, at least in cases with optimal compliance and ability to use the tool properly.

Short-Term Effect of Orthodontic Treatment with Clear Aligners on Pain and sEMG Activity of Masticatory Muscles.

Background and objectives: The aim of this study is to evaluate mandibular elevator muscles activity and pain on palpation in the early stages of orthodontic treatment with clear aligners using surface electromyography (sEMG). Materials and methods: Surface electromyography (sEMG) activity and pain level on muscle palpation of masseter and anterior temporalis muscles were recorded in a sample of 16 adult subjects (aged 18-32 years; mean 22.5 +/- 3.5 SD) undergoing orthodontic treatment with clear aligners before the treatment (T0), after 1 month of treatment (two clear aligners) (T1), and after 3 months of treatment (T2) (six clear aligners). A chi-square test for nominal data, a Friedman test, and a Wilcoxon-signed rank test as post hoc analysis were applied. Results: No statistically significant differences in muscular pain were observed. At T1, the sEMG activity of masseter muscles at mandibular rest position showed a statistically significant reduction, but after 3 months (T2), the data appeared similar to T0 (p = 0.03 and p = 0.02). Conclusions: During the treatment with clear aligners, subjects could experience an initial reduction in the masseter basal activity after 1 month of treatment. This effect tends to decrease to baseline levels after 3 months of therapy.

Awake Bruxism Treated with Pregabaline in a Patient with Generalized Anxiety Disorder.

BACKGROUND: Bruxism is excessive teeth grinding or jaw clenching. Several symptoms are commonly associated with bruxism, including hypersensitive teeth, aching jaw muscles, headaches, tooth wear, and damage to dental restorations. There are two types of bruxism, awake bruxism and sleep bruxism. Awake bruxism is generally treated by dentists and maxilla-facial surgeons through several treatment modalities such as, counselling about triggers, relaxation, occlusal splints and botulinum toxin type A injections. METHODS: We will present the case of a 21-year-old woman presenting mood swings with a high level of anxiety and concentration difficulties since childhood. She also complained of awake bruxism. Intelligence was evaluated using The Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV). Attention-deficit hyperactivity disorder (ADHD) was investigated through a neuropsychology test. RESULTS: Intelligence evaluation showed normal intellectual function. Neuropsychology test showed a profile corresponding to ADHD. Bupropion XR 300 mg was initiated for ADHD. Pregabalin was prescribed for general anxiety syndrome. The patient reported a complete disappearance of awake bruxism at a daily dose of 375 mg, with no occlusal appliances. Following the improvement of the anxiety symptoms, the attempt to reduce the dose twice leading to the recurrence of bruxism. CONCLUSIONS: A 21 years old female treated with 375 mg daily doses of pregabalin for generalized anxiety disorder experienced a significant reduction of daytime bruxism. More studies are needed to determine whether pregabalin has a long term effect against awake bruxism.

Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3-5 years old children.

BACKGROUND: Pacifier sucking habit has been associated in the literature with alterations of dental occlusion, and it could be a predisposing factor for other poor oral habits among children. Orthodontic pacifiers have been introduced in the market aiming to reduce these disadvantages caused by the conventional type of pacifiers. The aim of this study was to evaluate the prevalence of poor oral habits and malocclusions, after usage of orthodontic pacifiers in children with primary dentition. METHODS: A sample of 198 pre-school children, aged 3-5 years, (96 males and 102 females) who had exclusively used an orthodontic pacifier were included in order to assess the level of poor oral habits and the absence/presence of dental malocclusion. Firstly, children's parents/legal guardians were given a validated questionnaire, then the children were clinically examined at a dental clinic. RESULTS: Most of the children (79.79%) had started using the orthodontic pacifier within the first 3 months of life, and the 43.49% of them continued using it over a period of 2 years. The recorded percentage for those who had used it throughout sleep was 89.39%. Mouth breathing during the night was reported for 36.04% of the children. Tongue thrust swallow affected 16.16% of the sample. The 5.56% of the data indicated the presence of fingersucking/thumbsucking habit. The noted percentages for children with lip biting, lingual interposition between teeth at rest and those with nail biting, were 5.56, 12.63 and 15.15%, respectively. The regression revealed a significant contribution between early start of using an orthodontic pacifier with the prevalence of fingersucking/thumbsucking (OR 0.13, 95% CI 0.04-0.47, p = 0.0004). This also reported a noticeable increase of the malocclusion prevalence among the female gender (OR 2.74, 95% CI 1.42-5.31), as well as those who were not exclusively breastfed (OR 2.26, 95% CI 1.17-4.37). CONCLUSIONS: Orthodontic pacifiers does not favor the development of poor oral habits, even if it has been used for a period of 2 years in children with primary dentition. Children who begin to use orthodontic pacifier between 0 and 3 months, are less likely to acquire fingersucking/thumbsucking habit. The use of an orthodontic pacifier appears not to be correlated with the prevalence of malocclusion in primary dentition, differently from what stated in literature about the conventional type of pacifier.

Point-of-care testing for hepatitis C virus infection at an Italian dental clinic: portrait of the pilot study population.

The dental clinic is an appropriate place to promote the prevention of hepatitis C virus (HCV) infection and fast access for care of HCV-positive subjects with new-generation anti-HCV drugs. This study aimed to determine the socio-demographic profile of subjects screened for HCV virus in a dental clinic to acquire useful information for future campaigns of prevention. An easy, free-of-charge, screen salivary test was offered to patients referred to the dental clinic of San Raffaele Scientific Research Hospital in Milan, Italy for dental procedures. These patients were also asked to complete an anonymous questionnaire on demographics and risk behaviours. A total of 1388 of 2097 (66.19%) questionnaires were evaluable. The demographics of the population responding to this initiative was primarily Italians citizen (96.47%), homogeneous gender distribution (55.55%), age over 50 (609 subjects; 43.88%), with high-level education and stable professional positions. 905 subjects (65.20%) were never tested for HCV before. The test showed positive reactivity in 22 cases (1.05%); of these, 21 subjects were known to be HCV-positive, and the test confirmed their status. One subject was newly diagnosed as HCV-positive. The percentage of subjects who were never tested for HCV infection appears too high (905 subjects, i.e., 65.20%), especially among subjects with high level of education and professions, and among adults over 40 or young people (18-25). The easy screening test in dental clinic can help raise awareness, promote early diagnosis and prevention, and provide a fast link to care for HCV infection.

Impact of molar teeth distalization with clear aligners on occlusal vertical dimension: a retrospective study.

BACKGROUND: A common strategy in the non-extraction treatment of Class II molar relationship is maxillary molar distalization, which could increase lower face height and cause clockwise mandibular rotation. The aim of this retrospective study was to analyse the effects on vertical dentoskeletal dimension of young adults treated with sequential distalization with orthodontic aligners. METHODS: Lateral cephalometric radiographs of 10 subjects (8 females 2 males; mean age 22.7 ± 5.3 years) treated with upper molars sequential distalization with orthodontic aligners (Invisalign, Align Technology, San Josè, California, USA) were analyzed. RESULTS: No statistically significant difference was observed for the primary outcome SN-GoGn between T0 and T1 and it was recorded a mean variation of 0.1 ± 2.0 degrees. Statistically significant differences were found in the linear position of the upper molars (6-PP, 7-PP) the molar class relationship parameter (MR) and the upper incisive inclination (1^PP) with at least p < 0.01. CONCLUSIONS: Upper molar distalization with orthodontic aligners guarantee an excellent control of the vertical dimension representing an ideal solution for the treatment of hyperdivergent or openbite subjects. It also allows an excellent control of the incisal torque without loss of anchorage during the orthodontic procedure.

Point-of-care testing for hepatitis C virus infection at alternative and high-risk sites: an Italian pilot study in a dental clinic.

The Infectious Diseases Department and the Department of Dentistry of San Raffaele Scientific Institute in Milan conducted a screening and prevention program, the "EASY HCV-test Program," at a dental clinic to increase the identification of unrecognized infections. Using a cross-sectional community-based study design, hygienists in the dental clinic offered patients a hepatitis C virus (HCV) rapid salivary test (OraQuick ADVANCE® Rapid HCV Antibody Test) with pre- and post-test counseling prior to initiation of their oral hygiene routine. From April 2015 to November 2015, the EASY HCV test was offered to 2650 patients visiting the Center of Oral Health and Prevention at the Department of Dentistry at San Raffaele Hospital in Milan. Among them, 2077 eligible volunteers were tested. The test showed positive reactivity in 22 cases; of these, 21 subjects were known to suffer from HCV, and the test confirmed their status. One subject was newly diagnosed with HCV infection. The results of this study suggest EASY HCV test screening conducted in dental clinics may constitute an effective strategy for increasing HCV testing among people at risk for infection.

Mechanical Reliability Evaluation of an Oral Implant-Abutment System According to UNI EN ISO 14801 Fatigue Test Protocol.

PURPOSE: The aim of this in vitro study was to evaluate the mechanical reliability of a dental implant system by testing its maximum fracture load and mechanical performance under cyclic fatigue stress. METHODS: An experimental study according to the international standards (UNI EN ISO 14801: 2008) was performed using 13 implants (3.80 mm in diameter and 12 mm in length) with straight titanium abutments tightened to 30 N. Five samples were subjected to compression stress at break. Based on the mean fracture load value obtained in this test, the levels of dynamic loading range were set and were carried on at a frequency of 15 Hz for 5 × 10 cycles. RESULTS: The compression stress at break mean value of the tested implants was 430 N (SD ± 35.66 N). In the mechanical fatigue stress test, the fatigue limit for 5 × 10 load cycles was 172 N. CONCLUSIONS: The evaluated implant system proved to withstand considerable mechanical loads under the "worst-case" loading situation performed according to UNI EN ISO 14801 standard. The reliability of this test protocol makes it suitable to be accomplished for understanding and comparing mechanical properties of implant systems.

Levels of salivary immunoglobulins and periodontal evaluation in smoking patients.

OBJECTIVE: The aim of this study was to assess the level of salivary immunoglobulins and periodontal status in smokers and non-smokers. MATERIALS AND METHODS: Unstimulated saliva of 30 subjects (mean age 24.2 ± 3.5 years) who were smokers (test group) and of 30 subjects (mean age 25.3 ± 3.8 years) who were non-smokers (control group) was collected and centrifugated; IgA, IgG, and IgM were measured with the colorimetric immunoenzymatic method. Moreover, the following periodontal clinical parameters were recorded for each subject: plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL). RESULTS: A significantly (p< 0.05) lower Ig level was observed in smoking patients (IgA: 20.0 ± 1.2 mg/dl; IgM: 19.5 ± 1.6 mg/dl; IgG: 8.1 ± 1.4 mg/dl) compared to levels in the non-smoking control group (IgA: 234.1 ± 65.2 mg/dl; IgM: 121.0 ± 31.7 mg/dl; IgG: 1049.4 ± 102 mg/dl). In the test group, PI (2.2 ± 0.3), GI (2.4 ± 0.5), PD (49.3 ± 9.2%), and CAL (49.3 ± 4.6%) were higher (p< 0.05) than those observed in the control group (PI: 0.8 ± 0.4; GI: 0.7 ± 0.3; PD: 10.6 ± 2.4%; CAL: 3.1 ± 0.8%). CONCLUSION: Smoking subjects showed lower levels of salivary IgA, IgG, and IgM and a worse periodontal condition than non-smoking subjects. On the base of our study, as smoking subjects also had lower levels of IgA, IgG, and IgM in their saliva than non-smoking subjects, despite the fact that there is little evidence that the salivary Igs have a protective action against periodontitis and that the whole saliva does not result in whole from the salivary glands, it can be concluded that the deteriorated periodontal health conditions of these patients can be attributed in part to a lowering of the host's defense due to a decrease in the quantity of Igs in salivary fluid.

Evaluation of an endosseous oral implant system according to UNI EN ISO 14801 fatigue test protocol.

PURPOSE: The aim of this in vitro study was to evaluate the maximum fracture load and the mechanical performance to cyclic fatigue stress of a dental implant system. METHODS: An experimental study according to the international standards (UNI EN ISO 14801: 2008) was carried out using 15 implants (3.80 mm of diameter and 13 mm of length) with applied straight titanium abutment tightened to 30 N. Five samples were subjected to compression stress at break. Based on the mean fracture load value obtained in this test, the levels of dynamic loading range were set that were carried on at a frequency of 15 Hz for 5 × 10 cycles. RESULTS: The compression stress at break mean value of the tested implants was 499.40 N (SD ±50.1 N). In the mechanical fatigue stress test, the fatigue limit for 5 × 10 load cycles for all tested samples was 250 N. CONCLUSIONS: The evaluated implant system proved to withstand considerable mechanical loads under the "worst-case" loading situation performed according to UNI EN ISO 14801 standard. The reliability of this test protocol makes it suitable to be accomplished for understanding and comparing mechanical properties of other implant systems.

Implant placement using mixed reality-based dynamic navigation: A proof of concept.

OBJECTIVES: To present the first clinical application of a novel mixed reality-based dynamic navigation (MR-DN) system in the rehabilitation of a single tooth gap. METHODS: The protocol consisted of the following: (1) three-dimensional patient data acquisition using intraoral scanning (IOS) and cone-beam computed tomography (CBCT), (2) implant planning using guided surgery software, (3) holography-guided implant placement using the novel MR-DN system (ANNA®, MARS Dental, Haifa, Israel) and (4) placement accuracy verification. RESULTS: The novel MR-DN system was safe and time-efficient, as the surgery took 30 min from anaesthesia to suturing. The accuracy of implant placement was high with minimal deviations recorded in the three planes of space compared to the presurgical planning: the error at the entry point planar distance (XY) was 0.381 mm, and the entry point planar distance (Z) was 0.173 mm, for a 3D entry point distance (En) of 0.417 mm. A 3D apex deviation (An) of 0.193 mm was registered, with an angle difference of 1.852° Conclusions: This proof-of-concept study demonstrated the clinical feasibility of MR-DN for guided implant placement in single tooth gaps. Further clinical studies on a large sample of patients are needed to confirm these positive preliminary results. Statement of clinical relevance: The use of MR-DN can change the perspectives of guided dental implant surgery as a possible alternative to the classic static and dynamic guided surgical techniques for the rehabilitation of single tooth gaps.

Accuracy of implant placement using a mixed reality-based dynamic navigation system versus static computer-assisted and freehand surgery: An in Vitro study.

PURPOSE: This in vitro study aimed to compare the accuracy of dental implant placement in partially edentulous maxillary models using a mixed reality-based dynamic navigation (MR-DN) system to conventional static computer-assisted implant surgery (s-CAIS) and a freehand (FH) method. METHODS: Forty-five partially edentulous models (with teeth missing in positions #15, #16 and #25) were assigned to three groups (15 per group). The same experienced operator performed the model surgeries using an MR-DN system (group 1), s-CAIS (group 2) and FH (group 3). In total, 135 dental implants were placed (45 per group). The primary outcomes were the linear coronal deviation (entry error; En), apical deviation (apex error; Ap), XY and Z deviations, and angular deviation (An) between the planned and actual (post-surgery) position of the implants in the models. These deviations were computed as the distances between the stereolithographic (STL) files for the planned implants and placed implants captured with an intraoral scanner. RESULTS: Across the three implant sites, the MR-DN system was significantly more accurate than the FH method (in XY, Z, En, Ap and An) and s-CAIS (in Z, Ap and An), respectively. However, S-CAIS was more accurate than MR-DN in XY, and no difference was found between MR-DN and s-CAIS in En. CONCLUSIONS: Within the limits of this study (in vitro design, only partially edentulous models), implant placement accuracy with MR-DN was superior to that of FH and similar to that of s-CAIS. STATEMENT OF CLINICAL RELEVANCE: In vitro, MR-DN showed greater accuracy in implant positioning than FH, and similar accuracy to s-CAIS: it could, therefore, represent a new option for the surgeon. However, clinical studies are needed to determine the feasibility of MR-DN.

Clinical association between teeth malocclusions, wrong posture and ocular convergence disorders: an epidemiological investigation on primary school children.

BACKGROUND: As the various systems in the body are inter-connected to form a single structural unit, a pathological condition in one area can also affect other areas. There are many known correlations between the visual and motor system. The importance of visual function, particularly the paracentral peripheral field of view, in motor coordination, ambulation and the maintenance of balance has been amply demonstrated.In line with current medical principles, which are moving towards a more holistic view of the human body, this study aims to investigate, in an interdisciplinary manner, the incidence of dental malocclusions together with posture and eye convergence disorders. METHODS: Six hundred and five children attending at the 3rd, 4th and 5th years of seven Genoa primary schools were examined. Each child underwent the following examinations: (i) dental/occlusal; (ii) orthoptic; and (iii) postural. Occlusal data concerned the presence of cross-bite, midline deviation with a mandibular shift, bad habits and deep or open bite.Postural assessment involved frontal and lateral inspection, investigation during trunk flexion and ambulation, and note of any asymmetry in the lower limbs. The recorded orthoptic data included those pertaining to ocular dominance, a cover test, convergence and the Brock string test. RESULTS: A prevalence of cases with an unphysiological gait was found in patients with overjet (14.70%) or overbite (14.87%), while the percentage of patients with normal occlusion that showed an unphysiological gait was 13.08%. Also, about 93.8%-94.2% of children showed normal legs without dysmetry, with no difference in respect to the type of occlusion. Subjects with an open bite or deep bite showed a slightly different distribution of right or left dominant eyes. CONCLUSION: About 13% of children showed a pathological gait and, among them, vertical anomalies of occlusion (deep bite or open bite) were prevalent with respect to the other occlusal defects. The vertical dimension of occlusion revealed a slight relationship with the proper dominant eye. Postural, orthoptic, osteopathic and occlusal variables were often clinically associated, and therefore these disorders appear to request a multidisciplinary medical approach for their treatment.

Full-Digital Workflow for TMDs Management: A Case Series.

Temporomandibular joint disorders (TMDs) have always been the subject of studies due to the difficult management of symptoms and the complex stabilization of the so-called therapeutic position. In this effort, digital technologies open new opportunities for such planning, allowing the clinician to digitally assess the situation and verify the stability of the new position from a functional point of view. The present case series shows examples of preliminary full-digital planning of treatment in TMDs patients made with the preliminary evaluation of the kinematic activity of the mandible through a digital device (Tech in motion™, ModJaw, Villeurbanne, France). Three TMD clinical cases are analyzed with full-digital techniques and workflow. A personalized treatment for each case was digitally planned on the base of proper kinematic tracings recorded for each patient, and intraoral appliances were digitally customized through a full-digital or semi-digital workflow. The digitalization of mandibular kinematic gave us the possibility of making a more "aware" diagnosis, especially in a dynamic key, and then it allowed a faster realization and execution of the intraoral appliance through a digital workflow, memorizing the therapeutic position and early checking the device, before its realization, on the real kinematics of the patient.

Cervical Range of Motion Analysis Performed with an Accelerometer: A Study of Intersession Reliability for Dental Practice.

During the clinical examination of subjects with temporomandibular disorders (TMDs), the dentist sometimes must evaluate the cervical spine, due to the anatomical and functional connections between the cervical portion of the spine and the stomatognathic apparatus. The accelerometer is a device that evaluates the Range of Motion (ROM) of the main movements of the head on the neck. To date, only a few studies have investigated the repeatability of the use of the accelerometer in the assessment of cervical ROM. Therefore, the present longitudinal observational study analyzed the repeatability of acquired cervical movements on a sample of volunteer subjects who underwent accelerometer testing. A sample of 32 subjects was tested twice within 14 days to assess cervical ROM using a standardized protocol based on a review of existing literature. The results show that the examination is reliable for all the positions of the jaw, except for the parameters regarding the asymmetries of rotation and bending. In conclusion, the accelerometer can be considered a reliable tool for evaluating the active cervical ROM. However, further studies will be necessary to make better evaluations.

Habitual snoring and atopic state: correlations with respiratory function and teeth occlusion.

BACKGROUND: Allergy represents a risk factor at the base of sleep-disordered breathing in pediatric age. Among allergic diseases, the atopy is characterized by a tendency to be "hyperallergic." Sleep-disordered breathing is also known in orthodontics as correlated with the morphology of craniofacial complex. The aim of this study was to investigate the relation between atopy and sleep-disordered breathing (oral breathers with habitual snoring), comparing atopic children with sleep-disordered breathing (test group) with nonatopic ones with sleep-disordered breathing (control group), in the prevalence of dento-skeletal alterations and other risk factors that trigger sleep-disordered breathing, such as adenotonsillar hypertrophy, turbinate hypertrophy, obesity, and alteration of oxygen arterial saturation. METHODS: In a group of 110 subjects with sleep-disordered breathing (6 to 12 years old), we grouped the subjects into atopic (test group, 60 subjects) and nonatopic (control group, 50 subjects) children and compared the data on the following: skin allergic tests, rhinoscopy, rhinomanometry, night home pulsoxymetry, body mass index, and dento-facial alterations. RESULTS: Even if our results suggest that atopy is not a direct risk factor for sleep-disordered breathing, the importance of a physiologic nasal respiration in the pathogenesis of sleep-disordered breathing seems to be demonstrated in our study by the higher prevalence of hypertrophy in the adenotonsillar lymphatic tissue, odontostomatological alterations, alterations of the oxygen saturation to pulsoxymetry, and higher prevalence of obesity observed in our children with sleep-disordered breathing, in percentages higher than that of the general pediatric population previously observed in the literature. CONCLUSIONS: The importance of a physiologic nasal respiration in the pathogenesis of sleep-disordered breathing is demonstrated in our study.

Gnatho-postural treatment in an air force pilot.

BACKGROUND: Due to the stresses of flight, air force pilots are more likely to experience oral parafunctions such as bruxism when compared to the general population. Further, their craniocervical mandibular system is subjected to particular stresses in the course of their duties. The aim of this study was to analyze an air force pilot who was undergoing gnatho-postural treatment in order to protect the masticatory system and achieve better occlusal balance. CASE REPORT: A 32-yr-old pilot from the Italian Air Force national aerobatic team P.A.N. Frecce Tricolori was chosen from the pilots analyzed and treated at the Istituto Medico Legale A. Mosso. A resin stabilization splint was designed for the pilot's lower arch, allowing for the unobstructed excursive glides of the mandible in the protrusive position, and laterality and occlusal balance in the centric position. DISCUSSION: The clinical gnatho-postural treatment involving a functional diagnostic instrument used on Italian Air Force pilots protects the masticatory system from dental abrasion and, in this particular case, seemed to improve the pilot's posture control system as analyzed by the stabilometric platform.

Skeletal maturation in obese patients.

INTRODUCTION: The objective of this study was to compare skeletal maturation in obese patients and in subjects of normal weight to evaluate the best timing for orthopedic and orthodontic treatment. The null hypothesis was that obese and normal-weight patients show similar degrees of skeletal maturation. METHODS: The sample for this retrospective study consisted of 50 white patients (28 boys, 22 girls) whose x-rays (hand-wrist and lateral cephalometric radiographs) were already available. The test group included 25 obese patients (11 girls, 14 boys; average age, 9.8 ± 2.11 years), and the control group included 25 subjects of normal weight (11 girls, 14 boys; average age, 9.9 ± 2.5 years). Skeletal maturation was determined by using the carpal analysis method and the cervical vertebral maturation method. RESULTS: According to the carpal analysis, there was a significant difference between skeletal and chronologic ages between the test group (11.8 ± 11.4 months) and the control group (-2.9 ± 3.1 months). Furthermore, the obese subjects exhibited a significantly higher mean cervical vertebral maturation score (2.8 ± 0.7) than did the control subjects (2 ± 0.6) (P <0.05). CONCLUSIONS: Compared with the normal-weight subjects, the obese subjects showed a higher mean discrepancy between skeletal and chronologic ages according to the carpal analysis and had a significantly higher cervical vertebral maturation score. Thus, to account for the growth in obese patients with skeletal discrepancies, it might be necessary to perform examinations and dentofacial and orthopedic treatments earlier than in normal-weight subjects.