Drug induced sleep endoscopy and simultaneous polysomnography to predict the effectiveness of mandibular advancement device in obstructive sleep apnea treatment.

PURPOSES: To evaluate whether mandibular advancement device therapy is recommended in patients affected by obstructive sleep apnea. METHODS: In order to predict oral appliances therapy response, drug induced sleep endoscopy with cardio-respiratory polygraphy and mandibular advancement device simulator was carried out. Patients in which upper airway obstruction was resolved on all levels and AHI was normalized (< 5/h), were referred for oral appliance therapy. At 5 months follow up, a cardio-respiratory polygraphy with MAD was performed. RESULTS: 36 patients who have evidence of resolution of UA collapse and AHI below 5 events per hour, were referred for MAD therapy. At follow up, the mean AHI decreased from 29.1 ± 13.1 to 3.3/h ± 1.9 (p < 0.001). All the patients were responders. CONCLUSION: Combining the evaluation of drug induced sleep endoscopy and cardio-respiratory polygraphy data simultaneously during mandibular protrusion, has the potential to be a useful tool for prediction of MAD therapy response.

The use of the laser confocal scanning microscopy to measure resin remnants on customized lingual bracket.

BACKGROUND: The study aimed to evaluate the permanence of resin and enamel remains on lingual brackets at the end of orthodontic treatment and after the debonding procedure. The evaluation of resin remnants on customized lingual brackets bases has never done before in other studies because they are curved, and traditional techniques are not applicable. METHODS: The sample consisted of 100 lingual brackets (25 incisors, 25 canines, 25 premolars, 25 molars) scanned with a confocal laser microscope (OLS4000). We measured the brackets' surface and the area of resin remnants with the software of the microscope. Median and quartiles were presented to describe the data. ARI calculation was indirect for each tooth, measuring the resin remnants to the total surface of the bracket. The Kruskal-Wallis test and Fisher test were applied respectively to compare the percentages of remnants and the frequencies of the ARI between the four groups. RESULTS: After the analyses, 13 brackets had no adhesive remnants (ARI 0), 29 brackets had less than 50% of resin remnants (ARI 1), 50 brackets had more than 50% of resin remnants (ARI 2), and 8 brackets had 100% of adhesive (ARI 3). Canines brackets presented the lower amount of resin followed by premolars, incisors, and molars. CONCLUSION: Lingual brackets showed a high frequency of ARI = 2. The median percentage of the bracket surface covered by resin was 41%. We observed a slight tendency of more resin remnants on molar brackets, due to half-pad configuration. The authors suggest paying attention during the debonding procedure of molar brackets since a stronger connection between the adhesive and the bracket mesh means a higher risk of enamel damage.

Palmitoylethanolamide versus a nonsteroidal anti-inflammatory drug in the treatment of temporomandibular joint inflammatory pain.

AIMS: To carry out a randomized clinical trial to compare the effect of palmitoylethanolamide (PEA) versus ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), for pain relief in temporomandibular joint (TMJ) osteoarthritis or arthralgia. PEA acts as an endogenous agent with an autacoid local inflammation antagonism and modulates mast cell behavior controlling both acute and chronic inflammation. METHODS: A triple-blind randomized clinical trial was conducted on 24 patients (16 women and 8 men) aged 24 to 54 years and suffering from TMJ osteoarthritis or arthralgia. The patients were enrolled from a group of 120 consecutive patients referred to the University of Bologna's Department of Orthodontics. Patients were randomly divided into two groups: group A (12 subjects) received PEA 300 mg in the morning and 600 mg in the evening for 7 days and then 300 mg twice a day for 7 more days. Group B (12 subjects) received ibuprofen 600 mg three times a day for 2 weeks. Every patient recorded the intensity of spontaneous pain on a visual analog scale twice a day. Maximum mouth opening was recorded by a blind operator during the first visit and again after the 14th day of drug treatment. A t test was used for data comparisons. RESULTS: Pain decrease after 2 weeks of treatment was significantly higher in group A than in group B (P = .0001); maximum mouth opening improved more in group A than in group B (P = .022). CONCLUSION: These data suggest that PEA is effective in treating TMJ inflammatory pain.

Aging effect on pressure pain thresholds of head and neck muscles.

BACKGROUND AND AIMS: Aging implies a physiological decline in skeletal muscle mass and strength, pain perception, transmission and processing, causing pain thresholds to increase (presbyalgesia). This study compares the pressure pain thresholds (PPTs) of 18 head and neck muscles in groups of young and elderly subjects. METHODS: A cross-sectional study was conducted on 40 subjects, selected from a group of 97, referred for dental consultation. The inclusion criterion was subjects' age (from 20 to 30, and over 65 years). Exclusion criteria were all conditions which may alter PPTs. In two groups, A (young subjects; 10 men, 10 women) and B (elderly subjects; 11 men, 9 women) PPTs were evaluated by one calibrated examiner with a Fischer algometer. Data are described with mean values ± standard error and the 95% confidence interval. The Mann-Whitney test was used to compare PPT values between the two groups (α=0.05). RESULTS: There was a significant difference between the PPTs of group A and B, which were higher in the elderly group in all muscles except five. CONCLUSIONS: These preliminary data demonstrate that PPTs increase with aging in the muscles examined. Other confirmatory studies with a larger sample size are necessary.

Management of a deeply impacted mandibular third molar and associated large dentigerous cyst to avoid nerve injury and improve periodontal healing: case report.

As dentigerous cysts increase in size, the risk of postsurgical complications increases as well. Emphasis is usually placed on the risk of neurologic damage caused by trauma during and after surgical removal and of mandibular fracture resulting from the large residual bone defect. However, influence on the periodontal status of neighbouring teeth should also be taken into account. In this article, we present an interdisciplinary, safe, minimally invasive approach to treating large dentigerous cysts associated with deeply impacted third molars. A dentigerous cyst is an epithelial-lined pathologic cavity that develops in association with the crown of an unerupted tooth and appears radiographically as a well-circumscribed pericoronal radiolucency. The cyst not only inhibits the eruption of the associated tooth (usually, a mandibular third molar), but can also carry it to unusual positions in the jaw. Dentigerous cysts may enlarge causing extensive bone resorption and even pathologic fracture. The greater the size of the cyst, the higher the risk of neurologic damage caused by trauma during and after surgical removal and of mandibular fracture resulting from the postoperative bone defect.7,8 Moreover, the removal of large cysts can lead to a severe infrabony defect at the root surface of adjacent teeth, jeopardizing their long-term periodontal health. "Orthodontic extraction" is a combined orthodontic-surgical approach that decreases the risk of neurologic complications and facilitates the surgical extraction of impacted mandibular third molars that are in close contact with the mandibular canal, even when associated with cystic lesions.13 This case report shows that the interdisciplinary approach is also effective in preventing periodontal breakdown on the distal surface of the adjacent second molar.

Effect of soft drinks on the physical and chemical features of nickel-titanium-based orthodontic wires.

OBJECTIVE: The purpose of this study was to evaluate the effect of three popular soft drinks on the Young's modulus, hardness, surface topography and chemical composition of widely used nickel-titanium-based orthodontic wires. MATERIALS AND METHODS: Thirty-two specimens (20 mm in length) were cut from the straight portion of pre-formed 0.019 × 0.025 inch Nitinol Heat-Activated archwires and randomly divided into four groups of eight specimens each: Group A1 (Coca Cola(®) regular); Group A2 (Santal(®) orange juice); Group A3 (Gatorade(®)); Group B (distilled, deionized water; dH(2)O). Each specimen was immersed in 10 ml of one of the soft drinks or dH(2)O, control, for 60 min, at 37°C. At the end of the soaking time, the Young's modulus and hardness were determined using a nanoindenter. Scanning Electron Microscope-Energy Dispersive Spectroscopy (SEM-EDS) was used to characterize the effects on the topography and chemical composition of the wires. RESULTS: No statistically significant differences were found between the groups either in the Young's modulus or in hardness after the selected soaking protocol. Besides some surface colour changes, the topography and the chemical composition of the wires were not affected by the immersion in any of the chosen soft drinks. CONCLUSIONS: These in-vitro results suggest that the consumption of soft drinks cannot be acknowledged as one possible reason for the degradation of the physical and chemical properties of heat activated nickel titanium orthodontic wires in patients undergoing fixed orthodontic treatment.

Endogenous Enzymatic Activity of Primary and Permanent Dentine.

Matrix metalloproteinases (MMPs) play an important role in tooth development and influence caries development and hybrid layer degradation. Literature is scant on the differences in the activity of MMPs between primary and permanent dentine. Accordingly, the aim of the present study was to investigate endogenous gelatinolytic activity in primary and permanent dentine. Separate batches of dentine powder were obtained from intact human primary and permanent molars (n = 6). Each batch was divided in two subgroups: (1) mineralised; and (2) demineralised with 10% H3PO4. After protein extraction, gelatine zymography was performed. Furthermore, in situ zymography was performed on dentine sections of the same groups (n = 3). The slices were polished, covered with fluorescein-conjugated gelatine and evaluated using a confocal microscope. In situ zymography data were analysed using two-way analysis of variance and post hoc Holm-Sidák statistics (α = 0.05). Primary dentine showed poorly defined bands in the zymograms that vaguely corresponded to the pro-form and active form of MMP-2 and the pro-form of MMP-9. In permanent dentine, demineralised powder demonstrated stronger gelatinolytic activity than mineralised powder. In situ zymography identified stronger enzymatic activity in primary etched dentine (p < 0.05). Stronger enzymatic activity recorded in primary dentine may be related to the differences in morphology and composition between primary and permanent dentine.

A case report on the efficacy of transverse expansion in severe obstructive sleep apnea syndrome.

BACKGROUND: The recognition of the role of craniofacial abnormalities in the development of obstructive sleep apnea (OSAS) has led to several treatment strategies to correct or improve craniofacial structures. We report a case of severe OSAS [Apnea Hypopnea Index (AHI) = 80] in which an increase in the transverse dimensions by surgically assisted rapid maxillary expansion and mandibular symphyseal distraction osteogenesis dramatically decreased the OSAS index. DISCUSSION: Polysomnographic examen 6 months after surgery noticed normalization of the somnographic parameters (AHI = 9). This case report indicates that maxillomandibular transverse expansion can be a useful surgical procedure for treating severe OSAS with transverse deficiency. The results reported in the present case report are encouraging and emphasize the need for further critical evaluations of this potential new approach for the treatment of OSAS.

Orthodontic extraction of mandibular third molar to avoid nerve injury and promote periodontal healing.

AIM: Impacted mandibular third molar extraction is a common procedure in oral surgery, not without risk of nerve injury and periodontal defects on the distal aspect of the adjacent second molar. The "orthodontic extraction" is proposed as a method to avoid mandibular nerve injury during the extraction of a deeply embedded third molar and to prevent or limit such periodontal problems. MATERIAL AND METHODS: A 28-year-old man presented a deeply impacted left mandibular third molar that required extraction. Radiographs revealed a very slight quantity of bone at the distal surface of the adjacent second molar. The third molar was extruded according to the "orthodontic extraction" technique. A 3-month retention phase elapsed to ensure adequate bone maturation and the tooth was finally extracted. RESULTS: No neurological complications occurred. A minimal residual bone defect at the distal surface of the adjacent second molar was detected radiographically both post-operatively and at the 3-year follow-up. CONCLUSIONS: Orthodontic extraction makes third molar removal easier and has no neurological risk. This procedure, followed by a 3-month retention phase, appears to be effective in preventing or limiting the development of periodontal problems on the distal aspect of the adjacent second molar.

Obstruction of the eruption pathway by peripheral odontogenic fibroma: report of a patient.

The diagnostic process and interdisciplinary treatment of a healthy 12-year-old boy with impactions due to a localized peripheral odontogenic fibroma are presented. The treatment consisted of the surgical excision of the peripheral odontogenic fibroma and interceptive orthodontic treatment with an activator appliance to allow the passive eruption of the impacted teeth. Complete orthodontic treatment with fixed appliances was used later to level and coordinate the arches. This report illustrates the importance of early diagnosis and treatment of tooth impactions associated with diffuse gingival enlargement. The cooperation of various specialists in making a differential diagnosis, developing a comprehensive plan for conservative treatment, and delivering excellent care led to a successful result for this patient.

Does clinical experience affect the reproducibility of cervical vertebrae maturation method?

OBJECTIVE: To assess interobserver and intraobserver reproducibility of the cervical vertebrae maturation method (CVMM) among three panels of judges with different levels of orthodontic experience (OE). MATERIALS AND METHODS: Fifty individual lateral cephalograms of good quality with complete visualization of cervical vertebrae 1 to 4 were selected. Thirty clinicians, divided according to their OE into three groups (junior group, JU, OE ≤ 1 year; postgraduate group, PG, 2 ≤ OE ≤ 4 years; specialist group, SP, OE ≥ 7 years), evaluated the cephalograms in two sessions (T1 and T2) at 3 weeks apart. Kendall's W and weighted Cohen's kappa (κ) coefficients were performed to assess interobserver and intraobserver agreement. The level of significance was set as P < .05. For both the interobserver and the intraobserver datasets, the percentage of perfect agreement (PPA) and the number of stages apart for each disagreement were calculated. RESULTS: Kendall's W at T1 was SP  =  0.61, PG  =  0.70, and JU  =  0.87; at T2 it was SP  =  0.78, PG  =  0.85, and JU  =  0.86. The percentage of total interobserver perfect agreement (Inter-PPA) was 42.3% at T1 and 46.3% at T2. The JU group had the highest Cohen's κ coefficient at 0.78, while the PG and SP had coefficients of 0.64 each. The percentage of total intraobserver perfect agreement (Intra-PPA) was 54.2%. CONCLUSIONS: The reproducibility of the method was not improved by the level of orthodontic experience. The group with the lowest level of orthodontic experience had the best performance.

Multidisciplinary correction of anterior open bite relapse and upper airway obstruction.

A 27-year-old man presented an anterior open bite relapse. He had low tongue posture positioned anteriorly at rest and during swallowing and reported chronic difficulty in nose breathing. Head cone-beam computed tomography revealed nasal septum deviation, right turbinate hypertrophy, and left maxillary sinus congestion, which were thought to contribute to the breathing problem, encourage the improper tongue posture, and thereby cause the relapse. Multidisciplinary treatment involving an otorhinolaryngologist, an orthodontist, and a periodontist resolved the upper airway obstruction and corrected the malocclusion. The follow-up examination after 3 years 5 months demonstrated stable results.

Reliability of panoramic radiography in evaluating the topographic relationship between the mandibular canal and impacted third molars.

BACKGROUND: The authors conducted a study to evaluate the predictive value of five radiographic markers on the panoramic radiograph, or PR, to point out the relationship between the mandibular canal and the impacted third molar. METHODS: The authors evaluated the accuracy of the radiographic markers by comparing the PR with an axial computed tomographic, or CT, scan. They identified a sample of 73 third molars that showed a close relationship between the tooth roots and the mandibular canal on the PR, and then classified them on the basis of five radiographic markers. They also detected contact between the third molar and the mandibular canal on the CT scan. RESULTS: The distribution of the five radiographic markers was as follows: 37 teeth exhibited increased radiolucency, 13 exhibited superimposition, 14 exhibited interruption of the radiopaque border, 14 exhibited narrowing of the canal and seven exhibited diversion of the canal. In 11 cases, two or more markers were recognizable. The predictive values of a positive test result were as follows: increased radiolucency, 73 percent; superimposition, 38.5 percent; interruption of the radiopaque border, 71.4 percent; narrowing, 78.6 percent; and diversion, 100 percent. The authors detected contact in all of the cases that exhibited two or more markers. CONCLUSION: Increased radiolucency, narrowing and interruption of the radiopaque border, as well as the concomitant presence of two or more radiographic markers, on the PR were highly predictive of contact between the third molar and the mandibular canal. An axial CT scan probably is indicated in such cases. CLINICAL IMPLICATIONS: The results of this study may lead to some guidelines for oral surgeons evaluating whether to obtain an axial CT scan for further investigation after examining an impacted mandibular third molar via PR.

Orthodontic extraction: conservative treatment of impacted mandibular third molar associated with a dentigerous cyst. A case report.

A 53-year-old man exhibited a large dentigerous cyst associated with a deep vertical impaction of his left mandibular third molar where a close anatomic relationship existed between the root and the mandibular canal. After consultation, it was decided to perform marsupialization of the cyst, to extrude the third molar orthodontically, and then to extract it. This combined orthodontic-surgical approach was successful.

Combined effects of repeated oral hygiene motivation and type of toothbrush on orthodontic patients: a blind randomized clinical trial.

OBJECTIVE: To investigate the effects on plaque index (PI) scores of manual or electric toothbrush with or without repeated oral hygiene instructions (OHI) and motivation on patients wearing fixed orthodontic appliances. MATERIALS AND METHODS: One month after the orthodontic fixed appliance bonding on both arches, 60 patients were randomly assigned to four groups; groups E1 (n  =  15) and E2 (n  =  15) received a powered rotating-oscillating toothbrush, and groups M1 (n  =  15) and M2 (n  =  15) received a manual toothbrush. Groups E1 and M1 received OHI and motivation at baseline (T0) and after 4, 8, 12, 16, and 20 weeks (T4, T8, T12, T16, and T20, respectively) by a Registered Dental Hygienist; groups E2 and M2 received OHI and motivation only at baseline. At each time point a blinded examiner scored plaque of all teeth using the modified Quigley-Hein PI. RESULTS: In all groups the PI score decreased significantly over time, and there were differences among groups at T8, T12, T16, and T20. At T8, PI scores of group E1 were lower than those of group E2, and at T12, T16, and T20, PI scores of groups M1 and E1 were lower compared to those of groups M2 and E2. A linear mixed model showed that the effect of repeated OHI and motivation during time was statistically significant, independently from the use of manual or electric toothbrush. CONCLUSIONS: The present results showed that repeated OHI and motivation are crucial in reducing PI score in orthodontic patients, independent of the type of toothbrush used.

Individualized orthodontic treatment: The Insignia system.

This clinical report presents a case treated by a currently available customized orthodontic treatment system. The use of patient-specific brackets, indirect bonding transfer devices, and customized archwires decreases treatment and chairside time, making orthodontic cases more predictable, accurate, and efficient. The need for time-consuming adjustments is greatly reduced, and appliance customization further facilitates the achievement of the final desired occlusion from the first day of treatment.

Bracket base remnants after orthodontic debonding.

OBJECTIVE: To evaluate whether the debonding procedure leads to restitutio ad integrum of the enamel surface by investigating the presence of enamel within the bracket base remnants after debonding. MATERIALS AND METHODS: Sixty patients who completed orthodontic treatment with fixed appliances were included. A total of 1068 brackets were microphotographed; the brackets presenting some remnants on the base (n = 818) were selected and analyzed with ImageJ software to measure the remnant area. From this population a statistically significant sample (n = 100) was observed under a scanning electron microscope to check for the presence of enamel within the remnants. Energy dispersive x-ray spectrometry was also performed to obtain quantitative data. RESULTS: Statistically significant differences in the remnant percentage between arches were observed for incisor and canine brackets (P < .0001 and P = .022, respectively). From a morphologic analysis of the scanning electron micrographs the bracket bases were categorized in 3 groups: group A, bases presenting a thin enamel coat (83%); group B, bases showing sizable enamel fragments (7%); group C, bases with no morphologic evidence of enamel presence (10%). Calcium presence was noted on all evaluated brackets under energy dispersive x-ray spectrometry. No significant difference was observed in the Ca/Si ratio between group A (16.21%) and group B (18.77%), whereas the Ca/Si ratio in group C (5.40%) was significantly lower than that of the other groups (P < .323 and P = .0001, respectively). CONCLUSION: The objective of an atraumatic debonding is not achieved yet; in some cases the damage could be clinically relevant.

Combined orthodontic - mucogingival treatment of a deep post-orthodontic gingival recession.

In this article, the interdisciplinary management of an isolated-type recession defect in a severely compromised mandibular incisor of a young post-orthodontic patient is described. The prognosis of root coverage surgery was very questionable and unpredictable due to the severe root malposition (III Miller class gingival recession). The treatment plan consisted of: (1) interproximal enamel reduction to gain space within the dental arch, (2) orthodontic repositioning of the root of the affected tooth within the alveolar bone and (3) root coverage mucogingival surgery. Clinical re-evaluation 7 months after fixed orthodontic treatment revealed major improvements in the root coverage prognosis due to the resolution of root malposition and de novo formation of keratinized tissue apical to the root exposure (I Miller class gingival recession). A subepithelial connective tissue graft was performed as a root coverage surgical procedure. Clinical examination 1 year after surgery revealed complete root coverage, good color blending with adjacent soft tissue and an increase in facial gingival thickness. Successful periodontal and esthetic outcomes can be accomplished after the combined orthodontic-periodontal treatment of a severely mucogingivally compromised tooth.

Patients' self-perception of dentofacial attractiveness before and after exposure to facial photographs.

OBJECTIVE: To determine whether exposure to pretreatment photographs of themselves influenced patients' self-perception of dentofacial attractiveness and willingness to undergo treatment. MATERIALS AND METHODS: A total of 100 subjects of white ancestry aged 18 years or older (Study Group) and 100 sex- and age-matched controls (Control Group) were selected. Photographs of the frontal view of the face and the profile view of the face, both at rest and while smiling, were taken of each participant. Only Study Group subjects were given a printed copy of their own images to be examined at home between the initial observation (T0) and a set date an average of 30 days later (T1). Each of the 200 subjects in the study completed a questionnaire at T0 and T1 exploring happiness regarding their smiles and their facial profiles, as well as willingness to undergo treatment. RESULTS: At T1 in the Study Group, 50% of subjects responded with a lower opinion of their facial profiles than at T0; 11% and 45% were willing to undergo more comprehensive procedures to change the appearance of their smiles and profiles, respectively. No statistically significant change was seen in questionnaire answers between T0 and T1 for the Control Group. CONCLUSION: Laypeople generally are not aware of their facial profiles. Pretreatment photograph exposure can increase profile self-awareness, an important factor in reducing the discrepancy between orthodontists' and patients' visual emphasis on dentofacial esthetics.