Comparison of cephalometric changes in Class II growing patients with increased vertical dimension after high-pull and cervical headgear treatment.

AIM: The aim of the present study was to evaluate the cephalometric changes in growing Class II patients with increased vertical dimension treated with cervical or high-pull headgear, by using an untreated control group with similar skeletal characteristics. MATERIALS: From the initial sample, 56 patients satisfied the inclusion and exclusion criteria; 20 patients were treated with cervical headgear (CHG), 15 with high-pull headgear (HHG), and 21 were not treated (CG). Cephalograms were available for each subject at baseline (T1) and after treatment/observation time (T2) for the three groups. A total of 17 measurements were taken on the lateral head films. Group comparison among CHG, HHG and CG was done using ANOVA test. CONCLUSION: In Class II high-angle growing patients, cervical headgear seems to be preferred in the correction of maxillary protrusion, molar relationship and increased anterior facial height. Extrusion of the upper molar may favour forward repositioning of the mandible and clockwise rotation in Class II patients with increased vertical dimension.

Maxillary expansion with clear aligners in the mixed dentition: A preliminary study with Invisalign® First system.

AIM: The aim of this study was to evaluate maxillary arch changes in patients treated with Invisalign® First system in the mixed dentition, focusing on arch width, arch perimeter, arch depth, molar inclination and alveolar expansion. MATERIALS AND METHODS: A retrospective study was carried out. The sample consisted of 20 patients, 12 females and 8 males, treated with clear aligners for maxillary expansion. Arch widths, arch perimeter, arch depth and molar inclination were measured on pre-treatment and post-treatment digital dental models. Superimposition of digital models was performed to evaluate alveolar expansion. RESULTS: There were significant increases in all measurements regarding arch width and arch perimeter, while arch depth and molar inclination significantly decreased. Alveolar expansion was recorded at all the reference points considered. Shapiro-Wilk test was used to check normal distribution. Average and standard deviations were calculated for all measurements. Paired t-test was run to report significant changes between T0 and T1. The statistical significance was set at p<0.05. Intraclass correlation coefficient was used to assess reliability. CONCLUSIONS: In case of mild crowding or limited transverse maxillary deficiency, Invisalign® First clear aligners could be a reasonable alternative to traditional slow maxillary expanders.

The Efficacy of a Dietary Supplement with Carnosine and Hibiscus Sabdariffa L. (AqualiefTM) in Patients with Xerostomia: a Randomized, Placebo-Controlled, Double-Blind Trial.

The purpose of this study was to test the safety and efficacy of AqualiefTM in patients affected by xerostomia. The main ingredients of AqualiefTM are carnosine and dried calyces of Hibiscus sabdariffa L. (karkadè) for their buffering effect at pH 7 as well as for their antioxidant, antimicrobial and lenitive properties. In a Randomized, Placebo-Controlled, Double-Blind Trial, sixty patients with xerostomia (RTOG/EORTC grade 1-2) were randomly assigned to receive either placebo, or AqualiefTM tablets (three times/day after meals) for 6 consecutive days. A questionnaire was used to evaluate dry mouth symptoms before and after 6 days of AqualiefTM or placebo application. Unstimulated and stimulated salivary flow rates and pH were measured before and after application. Treatment with AqualiefTM for 6 days induced a significant increase in saliva pH from 6.2 ± 0.5 to 6.4 ± 0.6 (P < 0.05) while placebo was ineffective (from 6.2 ± 0.5 to 6.3 ± 0.5). AqualiefTM also induced a significant increase in the pH of stimulated saliva from 6.3 ± 0.5 to 6.6 ± 0.5 (P < 0.01). Placebo was ineffective also in this setting (from 6.2 ± 0.5 to 6.3 ± 0.5). Besides an expected normalization of the saliva pH value, AqualiefTM treatment for 6 days greatly increased (56%, P < 0.0001) saliva production. Placebo induced a 19% increase (P < 0.05), which was likely due to mechanical stimulation. AqualiefTM also increased stimulated saliva production (27% increase with respect to day 0, P < 0.05), while placebo was ineffective. AqualiefTM was effective in regulating the saliva pH, in increasing saliva production and improving dry mouth symptoms in xerostomic patients.

Substance P expression in the gingival tissue after upper third molar extraction: effect of ketoprofen, a preliminary study.

The aim of this study was to evaluate substance P (SP) levels and the effect of a non-steroidal anti-inflammatory drug (NSAID), ketoprofen, on SP in the pericoronal gingival tissue after extraction of upper third molars. A sample of 20 young non-smoking systemically healthy adults of both sexes, with a healthy upper third molar to extract for orthodontic purposes, was selected. After extraction, a sample of the gingival tissue of the pericoronal region was collected with a sterile scalpel, placed into test tubes and kept frozen at -20°C until the SP determination. SP levels were determined by using a commercially available enzyme immunoassay (ELISA) kit. The subjects were randomly divided into two groups: group 1 received a single dose of ketoprofen 30 minutes prior to the experimental procedure. The subjects of group 2 did not receive any kind of drug administration before extraction. The patients were asked to complete a diary on the postoperative pain. A relevant amount of SP was measured in all the gingival samples. No statistically significant difference could be detected in SP expression between the two groups. In group 1 pain appearance was significantly delayed (6.2±0.13 hours) in comparison with group 2 (3.95±0.2 hours). In this small selected group of subjects and limited study design, preventive administration of ketoprofen did not significantly affect the gingival levels of SP, the clinical recommendation emerging is that of NSAID administration postoperatively but before pain appearance in order to optimize the management of pain of the patient.

Evaluation of masseter muscle in different vertical skeletal patterns in growing patients.

AIM: The present study aimed to evaluate the relationship between masseter size, maxillary intermolar width and craniofacial vertical skeletal pattern. STUDY DESIGN: The study followed a prospective longitudinal design and enrolled 61 subjects (30 males and 31 females), 9-14 years of age (mean age 11.5) at 2-3 CVM stage. The participants were divided into three groups based on their vertical skeletal pattern which was estimated using the Frankfurt-mandibular plane angle: low-angle group (L-A), normal-angle group (N-A), high-angle group (H-A). An additional gender-based distinction was made. Maxillary intermolar width was measured on the maxillary cast of each patient by means of an electronic caliper; masseter volume was estimated by using magnetic resonance (MR) and masseter thickness was measured by means of ultrasonography (US). The US registrations were performed during the relaxation state (RS) and the maximum voluntary contraction (MVC) of the muscle. The indipendent samples T- test was used for sex comparisons; the analysis of variance test (ANOVA) was used to evaluate the differences between the three groups in males and females, and the Pearson r correlation coefficient was employed to assess the correlation between maxillary intermolar width and masseter volume. RESULTS AND CONCLUSION: Maxillary intermolar width, masseter volume and thickness showed significant gender differences; all the tested variables decreased significantly according to the facial vertical pattern, with greater values in females, especially in low- and normal-angle subjects; maxillary intermolar width and masseter volume showed significant correlations, higher in females.

Correlation between unstimulated salivary flow, pH and streptococcus mutans, analysed with real time PCR, in caries-free and caries-active children.

AIM: Evaluate the correlations between unstimulated salivary flow, pH and level of S. mutans, analysed through real time PCR, in caries-free and caries-active children. MATERIALS AND METHODS: Thirty healthy children were divided into 2 groups: test group (DMFT/dmft ≥ 3 and at least 1 active caries lesion) and control group (DMFT/dmft=0). Un-stimulated saliva was collected, pH was measured and S. mutans and total bacterial amount were evaluated with real-time PCR analysis. RESULTS: Unstimulated salivary flow in the test group was significantly lower (p = 0.0269) compared to group control. The level of S. mutans was higher in the test group (p = 0.176), and an inverse correlation was recorded between total bacterial amount and un-stimulated salivary flow (p = 0.063). In the control group a positive relationship was found between total bacterial amount and S. mutans (p = 0.045) and an inverse correlation between pH and S. mutans (p = 0.088). A t-test and a linear regression analysis were performed. CONCLUSION: A higher salivary flow and an increased salivary pH seem to represent protective factors against caries in children, while high levels of S. mutans are correlated with caries active lesions. Caries risk assessment should be performed considering all parameters involved in the development of the disease.

Salivary pH after a glucose rinse: effect of a new mucoadhesive spray (Cariex) based on sodium bicarbonate and xylitol.

OBJECTIVE: This study evaluated whether sodium bicarbonate applied on the oral mucosa through a new mucoadhesive spray (Cariex) could control a drop in salivary pH after a glucose rinse, and therefore enhance the buffering potential of saliva. METHODS: A sample of 50 healthy adults was selected. At day 1, the measurement of salivary pH was performed in the lower fornix in correspondence with the lower molars. Each subject rinsed with 10 ml of a 10% glucose solution and then pH was monitored continually for 40 minutes. At day 2, the same experimental procedure was repeated and three shots of the spray were administered on the oral mucosa. The tested spray is composed of sodium bicarbonate, xylitol, and excipients. RESULTS: Without the mucoadhesive spray, salivary pH became significantly lower following the glucose rinse (p < 0.01). Following the spray, the time in which the pH remained lower than 6.0 was reduced statistically significantly (p < 0.01). A continual rise of salivary pH was observed for the 40 minutes in which the pH recording was performed. Conclusions: The use of a sodium bicarbonate spray on the mucosa was shown to control the lowering of salivary pH following carbohydrate consumption, and might therefore add to the prevention of caries and dental erosion.

Oral Signs and HLA-DQB1∗02 Haplotypes in the Celiac Paediatric Patient: A Preliminary Study.

Celiac disease (CD) diagnosis can be extremely challenging in the case of atypical patterns. In this context, oral signs seem to play a decisive role in arousing suspicion of these forms of the disease. At the same time, the different expressions of the HLA-DQB1∗02 allele apparently seem to facilitate the interpretation of signs and highlighted symptoms. The aim of this work was to verify whether it is possible to identify a correlation between the development of oral signs and different DQ2 haplotypes in celiac pediatric patients. 44 celiac patients with a medium age of 9.9 were studied. Oral examinations were performed in order to identify recurrent aphthous stomatitis (RAS) and dental enamel defects (DED). The diagnosis of DED resulted as being related to allele expression (P value = 0.042) while it was impossible to find a similar correlation with RAS. When both oral signs were considered, there was an increase in correlation with HLA-DQB1∗02 expression (P value = 0.018). The obtained results identified both the fundamental role that dentists can play in early diagnosis of CD, as well as the possible role of HLA haplotype analysis in arousing suspicion of atypical forms of the disease.

pH of tooth surface in healthy adolescents at rest and after a glucose rinse: effect of 72 hours of plaque accumulation.

AIM: This study was performed to evaluate the effect of a glucose rinse and of plaque accumulation on pH of tooth surface in healthy adolescents with a device used in gastroenterology and never tested in the oral cavity. MATERIALS AND METHODS: Values of pH were monitored in 12 adolescents using a portable device (pH-day 2® Menfis, bioMedica S.r.l., Bologna, Italy) with a disposable antimonium electrode kept in contact with the interproximal surface of the upper molars for 40 minutes respectively before and after a one-minute rinse with 10 ml of a 10% glucose solution. The same procedure was repeated in the same subjects after 72 hours of plaque accumulation. RESULTS: The device tested resulted difficult to use on the tooth surface because of the size of the active part of the probe. The glucose rinse caused a statistically significant decrease of the mean pH, restrained in basal conditions (d = -0.16, p <0.05), clinically relevant after plaque accumulation (d = -1.24, p <0.05). Time in minutes of pH < 6 grew considerably only in case of combination of plaque accumulation and glucose rinse (d = 20.90, p <0.05). A Stephan's curve of drop and recover of the pH values was not recorded. CONCLUSIONS: The continuous recording of pH of natural plaque present on the tooth could represent an alternative to other techniques found in literature. More studies are necessary to verify the suitability of this new device for the monitoring of pH in the oral cavity.

Invisalign teen for thumb-sucking management. A case report.

AIM: Currently and with increasing frequency, treatments with Invisalign orthodontic devices are aimed also to adolescent patients: this evolution involves the management of some atypical characteristics, and among them also thumb- sucking. CASE REPORT: A 13-year-old adolescent girl with protracted thumb sucking and dentoalveolar open bite is presented. Infantile neuropsychiatric assessment was required before and after treatment. Small areas of the aligners were occlusally flipped like a bite ramp, in particular on the palatal surface of the upper incisors, in order to discourage thumb sucking. The selection of an invisible orthodontic device was shown to be interesting because it does not impact on the fragile and complex neuropsychiatric situations. Moreover, the active daily application of the device further motivates young patients. The vertical attachments were fundamental in repositioning the front teeth and to close the dentoalveolar open bite. Treatment was ended in eight months with no behavioural or neuropsychiatric consequences in the short period. Invisalign was shown to be a useful device for orthodontic correction even in the complex management of adolescent thumb sucking.

Oral Squamous Cell Carcinoma in the paediatric patient: a literature review.

AIM: Paediatric Oral Squamous Cell Carcinoma (OSCC) is rare, but its incidence is increasing, bringing forward the issue of the common pathogenic factors. The aim of this study is to verify the actual incidence of oral carcinoma reported in paediatric patients up to the age of 15 by thoroughly reviewing the available literature. Setting this cut-off age has allowed us to emphasise possible risk factors other than those always associated with the onset of this neoplasia, which are not present in this age bracket yet. METHODS: In the first stage of the research, generic key words concerning OSCC in childhood were entered into two search engines. In the second stage, terms related to predisposing diseases connected to childhood oral carcinoma and those initially found were searched. RESULTS: The literature review consisted of 55 documented cases from 1894 to 2011, of which 15 were part of complete published case reports. CONCLUSION: Paediatric OSCC, though uncommon, is not rare. The review has strongly highlighted the need to carry out an objective, thorough and standardised examination of the child's oral cavity, especially when systemic predisposing diseases, such as Epidermolysis bullosa, Xeroderma pigmentosum, Juvenile papillomatosis and Fanconi's anaemia, are present.

Prevalence of malocclusion in preschool and primary school children with habitual snoring and sleep-disordered breathing.

AIM: Our research aimed to find out whether it was possible to establish a correlation between instrumental polysomnographic variables in children with Sleep Disordered Breathing (SDB) and their clinical dentofacial records. MATERIALS AND METHODS: 197 children, 116 (59%) male and 81 (41%) female, age range 0 to 12 years, with a clinical history highly suggestive for SDB were enrolled. All patients underwent full-night Poly-Mesam examination and a specific clinical orthodontic evaluation. A comparison between polysomnographic variables and clinical orthodontic variables was made. RESULTS AND CONCLUSION: OSAS can not be diagnosed by the paediatric dentist only by performing a single clinical orthodontic examination of oral cavity, but a polysomnography is essential and, if this should point out any pathology referring to SDB, a cranial lateral cephalometry will then be required.

Different geometric patterns of pacifiers compared on the basis of finite element analysis.

AIM: This study was carried out with the purpose to show on a virtual model of oral cavity the mechanical behaviour of different kinds of pacifiers with different pressure levels that can be likened to a condition of rest and deglutition. MATERIALS AND METHODS: Three different types of dummies, orthodontic- (A), cherry- (B) and drop- (C) shaped from an anatomical point of view, were inserted between the palate and the tongue in a virtual system by means of a finite element simulation. The palatal structure was recreated through tridimensional laser scanning, while the tongue structure was reconstructed by a software suitable for reproducing solids. Also the image of the pacifiers was developed by computer-aided scanning and reproduction. Suitable constraints were inserted and high and low pressure levels were exerted on these systems. FEA simulation allowed us to distribute the strain on the palate according to the different geometrical structures of the objects. RESULTS: Dummy A shows a more uniform and wider crosswise stress distribution with also a lesser load on the anterior palatal crest. Dummy B and C, on the contrary, show a more dot-like behaviour inducing a higher stress due to contact on restricted points. CONCLUSION: The characteristics of dummy A, although they have not been clinically investigated yet, seem to be the fittest ones to guarantee the maintenance of the transversal diameters of the premaxilla and reduce the risk of open bite.

Nickel ions release in patients with fixed orthodontic appliances.

AIM: The extent to which orthodontic appliances can cause contact allergies due to nickel release is a controversial matter. Since the data provided by literature are contrasting, the Authors think that it is important to analyse nickel ions released in organic tissues by means of a plasma spectrometer. METHODS: About 100 intact hairs were taken from 15 patients wearing fixed orthodontic appliances. The hairs had been washed 12 to 24 h before, in order to limit environmental contamination. The same procedure was carried out on a control group corresponding in sex, age and abode. The samples of hair were taken from at least 3 different scalp sites: frontal, vertex and occipital areas. RESULTS: According to the spectrophotometric analysis of the hair, there were no differences in nickel concentrations between the test group (0.50 mg/g on average) and control group (0.64 mg/g) (*P<0.005). The mean value was reduced even further if minimum and maximum values were excluded (test group 0.46 mg/g, control group 0.52 mg/g). Even though there was a slight difference (0.14 mg/g), it showed that more nickel concentration was found in the control sample (without orthodontic appliances) to a maximum of 2.20 mg/g. This suggests that environmental contamination, in particular diet, has an influence on ion concentration. Other studies also confirm that gut absorption of nickel released in the mouth by orthodontic appliances is much lower than the absorption of nickel release through diet. CONCLUSIONS: It can be assumed that orthodontic appliances do not release significant values of nickel to be a risk factor to the patient's health.

Scanning electron microscopy evaluation of the link between a new dentinal desensitizer and dentine.

AIM: The purpose of this study was to evaluate the interaction of a novel dentinal desensitizer Twin Pro with enamel-dentinal adhesive preparations or filling materials and dentine using scanning electron microscopy (SEM) technology. METHODS: Black's I class cavities were drilled extracted molar teeth free of caries or fissures, and the cavities disinfected. The specimens were divided into 4 groups of 2 teeth each treated as follows: Group A: Twin Pro, fluid (Tetric-Flow Vivadent) and micro-hybrid (Tetric-Ceram Vivadent) composites placed on the etched (Liner Bond 2V Clearfil) cavities. Group B: Twin Pro, PQ1-Ultradent loaded Primer-Bonding plus fluid and micro-hybrid composites applied to the acid-etched (37% orthophosphoric acid) cavities. Group C: Twin Pro plus Silver amalgam alloy (Phasealloy- Sybram Kerr). Group D (control group): self-etching primer plus fluid and micro-hybrid composite. Specimens were investigated by SEM. RESULTS: The results obtained in all groups show that the application of Twin Pro does not alter the adhesiveness of the restorative composite materials to the dental wall. In fact the desensitizer and the adhesive layers are indistinguishable at SEM observation, and well adherent to the dentinal surface of the cavities. CONCLUSION: The results of SEM investigations show that Twin Pro does not decrease the adhesion of restorative materials to the tooth surface, as it establishes an efficient interconnection with the different materials used, and it forms a uniform layer covering and occluding dentine tubules, and this might constitute an efficacious sealing of dentinal tubules which possibly contribute to decrease dentinal sensitivity to environmental nociceptive stimuli.

[Rehabilitation, using prosthetic implants, in patients with cancer of the oral cavity]. / Riabilitazione implanto protesica in pazienti trattati per neoplasia del cavo orale.

BACKGROUND: The number of patients treated for neoplasms of the oral cavity (by surgery and/or radiotherapy) requiring prosthesis rehabilitation using osteointegrated implants is increasing greatly. The objective of this research is to examine the correlation between prosthesis rehabilitation using osteointegrated implants, radiotherapy and the use of hyperbaric oxygen treatment in order to reduce the risk of osteoradionecrosis. METHODS: Research was carried out on 13 patients with 58 implants. The patients were divided into three sample groups: group A patients underwent radiotherapy (10 implants), group B patients did not undergo radiotherapy (29 implants) and group C patients first underwent radiotherapy and then hyperbaric oxygen treatment (19 implants). The group C patients first underwent hyperbaric oxygen treatment at 2.5 atmospheres. The osteointegrated implants were then applied and hyperbaric oxygen treatment was carried out again over 20-30 postoperative sittings without any other treatment between the sittings. The whole test period lasted 24 months. RESULTS: Only two implants were lost out of the 58 implants and they were in the group that had undergone radiotherapy. CONCLUSIONS: The results show how pre and postoperative hyperbaric oxygen treatment improves the success rate of osteointegrated implants in mandibular areas that had previously undergone radiotherapy. Moreover, the stability of the prostheses that are fixed to the implants is greatly improved compared to conventional methods.

Active mandibular protrusion in the rational treatment of skeletal Class II malocclusions.

BACKGROUND: Aim of the present study is to assess the ideal mandibular protrusion exercises, which should always be associated with functional treatment of skeletal Class II malocclusions, characterized by mandibular hypoplasia. METHODS: The study was carried out on a sample including 8 growing subjects (mean age 10.6 years +/- 0.6), similar in age and biotypology (mandibular hypoplasia; normodivergent growth pattern). The electromyography (EMG) activity of the superficial bundle of the masseter (considered as an accessory protrusive muscle) was bilaterally recorded at rest and, during voluntary contraction, at different degrees of protrusion (minimum, medium, maximum), condition dynamically analyzed at various times of contraction (initial, 5, 10, 30 seconds). The mean values of the recruitment pattern during the whole contraction, the number of turns/sec and the ratio turns/mean amplitude were evaluated. RESULTS: The data obtained by means of a precise electromyographic analysis suggest that the ideal exercise for an active mandibular protrusion should be a medium degree contraction lasting 10 seconds. These results are consistent with the linear relationship between muscle force and EMG amplitude, correlation effective only up to 60% of the exerted force, because of the muscular fatigue appearing beyond this threshold. During such a muscular fatigue, due to maximum contraction, it is possible to observe a progressive decrease in the EMG activity, owing in particular to the motor-neuron reduced discharge-frequency. CONCLUSIONS: This result suggests a small benefit of long-lasting muscular contractions, both in maximum and in medium protrusion movements, for re-educational purposes. Only during the medium-degree, 10 sec-lasting contraction it's possible to point out a turns-number variation significant of an active and constant contraction, which decreases if long-lasting (30 sec).