Digital analysis of the occlusal changes and palatal morphology using elastodontic devices. A prospective clinical study including Class II subjects in mixed dentition.

AIM: The aim of the present prospective study was to evaluate the effectiveness of elastodontic appliance (EAs) in the treatment of subjects presenting Class II sagittal discrepancy in mixed dentition, and to evaluate palatal morphological development during treatment. MATERIALS: The study group, composed of 19 subjects, received treatment with EA for 1 year. The control group consisted of 17 untreated subjects. INCLUSION CRITERIA: age between 6 and 11 years, mixed deciduous dentition and skeletal and/or dental Class II malocclusion. EXCLUSION CRITERIA: previous orthodontic therapy, systemic diseases and signs of temporal dysfunction. Skeletal and dentoalveolar parameters were compared between T0 and T1. A 3D imaging technology was used to compare palatal morphology obtained from intra-oral digital scans between T0 (pre-treatment) and T1 (post-treatment). CONCLUSION: EAs can successfully mitigate early signs of malocclusion in Class II subjects as well as contribute to the harmonious development of the palate.

Molecular evaluation of tissue proteins in vivo during controlled orthodontic movement.

Orthodontic tooth movement determines a biological response of all the tissues surrounding the teeth to which force is applied. The aim of this study is to evaluate which ideal orthodontic force, at the biological level, arouses an acute inflammatory response on periodontal tissues, and the duration of the force in order to establish an ideal experimental model of dental movement. The periodontal ligament and the alveolar bone change abruptly due to the biochemical adaptive response, resulting in a re-organization of the intracellular and the extracellular matrix. There is a modification of the local vascularization which stimulates a cascade production, synthesis and the release of arachidonic acid, metabolites, proteins, such as cytokines, and growth factors. Every dentist can control and should know the above-mentioned mechanism. Moreover, the production of proteins by modulating the direction and the intensity of the force can be changed but, above all, the duration.

Efficacy of the Andresen activator before peak growth in class II patients.

Andresen activator (AA) is a functional appliance used to correct Class II malocclusion in growing patients. It corrects the malocclusion stimulating mandibular growth and determining a palatoversion of the upper incisors and a vestibularization of the lower incisors. The aim of this study was to analyze the treatment efficacy of class II malocclusion due to mandibular hypodevelopment before peak growth. Fourteen subjects with class II relationship of the skeletal bases and cervical vertebrae maturation stage 1 or 2 were enrolled in the study. Cephalometric analyses were carried out using landmarks derived from the analyses of Pancherz, Ricketts, Tweed and Steiner. A significant decrease (P less than 0.05) in ANB angle was found (-2.29±3.05°) after treatment, which was expression of an improvement in maxillo-mandibular sagittal skeletal relationships. There was also a significant reduction of OJ after treatment (-4.44±2.36 mm; P less than 0.001), indicating a vestibularization of the mandibular incisors and a palatoversion of the maxillary incisors, and a correction of the molar relationship. The favorable effects of the Andresen activator for the correction of the mandibular defect can be found even prior to peak growth; the achieved class I relationship maintains a correct mandible position in time, ensuring a proper skeletal growth. .

Evaluation of pain, swelling and trismus after extraction of impacted third molars relative to the use of betamethasone in submucusal infiltration.

The aim of this study was to evaluate the anti-inflammatory effect of a single 4 mg injection of submucosal betamethasone after extraction of impacted third molars. Single-centre, single-blinded, parallel group study; Forty-three patients were submitted to impacted third molar extraction. In this study, 4 mg single-dose submucosal betamethasone was injected in the interventional group, while in the control group nothing was injected. Postoperative measurement included pain via the VAS scale, swelling and trismus with facial measurements and maximum mouth openings, and finally nerve sensitivity. There was a significant difference between the two groups regarding trismic pain and edema. The use of a single 4 mg submucosal betamethasone injection leads to a reduction of oedema, trismus and pain in patients undergoing impacted third molar extraction. .

Tooth agenesis: part 2. Orthodontic treatment and prosthetic possibilities.

Dental agenesis has a great clinical significance due to its frequency during daily practice and the therapeutic problems that can arise from it. This paper will explore all the aspects to consider in order creating a proper multidisciplinary treatment plan: in particular, orthodontic, prosthetic and implantologic therapeutic alternatives are described for the rehabilitation of the different areas of the dental arches. In fact, dental agenesis is a problem that often requires the intervention of specialists from the different fields of dentistry and its treatment must meet aesthetics needs, stomatognathic function and patient satisfaction.

Tooth agenesis: part 1. Incidence and diagnosis in orthodontics.

Dental agenesis has a great clinical significance due to its frequency during daily practice and the therapeutic problems that can arise from it. This paper will explore the incidence of dental agenesis, its diagnosis and how this anomaly affects the teeth differently. The second subsequent paper will look at its treatment and management.

Comparison of conventional orthognathic surgery and "surgery-first" protocol: a new weapon against time.

The aim of this literature review article is to evaluate the new surgical technique "Surgery-First" and compare it with the conventional orthognathic surgery in terms of treatment length, patient satisfaction and post-surgical stability. The goal is to compare the pro and cons of the two techniques and to determine which technique can offer more efficient results.

Neoadjuvant chemotherapy response influences outcomes in non-colorectal, non-neuroendocrine liver metastases.

BACKGROUND: Indications for surgical resection of non-colorectal, non-neuroendocrine (NCNNE) liver metastases are unclear. This study analysed the influence of response to neoadjuvant chemotherapy and the presence of extrahepatic disease (EHD) on outcomes. METHODS: Patients who underwent hepatic resection for NCNNE liver metastases and who received neoadjuvant chemotherapy at a single centre between 1982 and 2016 were analysed retrospectively. Patients were classified as having no EHD, controlled EHD or non-controlled EHD. RESULTS: Hepatic resection was performed in 199 patients (81·2 per cent) after partial or complete response to chemotherapy or disease stabilization, and 46 patients (18·8 per cent) after tumour progression. Patients with progressive disease after chemotherapy had worse overall survival than those without (23 versus 50·4 per cent at 5 years; P = 0·004). Median survival was 63·6 (range 31·1-94·8) months for patients without EHD, 34·8 (19·2-49·2) months for those with controlled EHD and 7·2 (1·2-13·2) months for patients with non-controlled EHD (P = 0·004). In multivariable analysis, EHD (P = 0·004), response to chemotherapy (P = 0·004) and resection margins (P = 0·002) were all independent predictors of overall survival, regardless of primary tumour site. CONCLUSION: The prognosis of patients with NCNNE liver metastases is influenced by preoperative chemotherapy and resectability.

Effects of stannous fluoride on eroded enamel permeability.

This study aimed to evaluate the effect in vitro of a single application of a stannous fluoride- (SnF2-) containing toothpaste on eroded enamel. Forty-eight teeth were subjected to three acid treatments: 15% hydrochloric acid for 120 s (HA group); 1% citric acid (pH=4) for 180 s (CA group); 37% phosphoric acid for 30 s (PA group). They were brushed with an electric toothbrush with pressure control and 1 g of SnF2 (1100 ppm) toothpaste for 2 min. Polyether replicas of buccal enamel surfaces were obtained at baseline, after acid exposure and after brushing, gold sputtered and inspected by SEM for fluid droplets presence. Hydrochloric and citric acid treatments increased enamel permeability while, on the contrary, phosphoric acid reduced enamel fluid release. SnF2 application of ameliorated acid induced permeability in citric and hydrochloric treated samples. Permeability in phosphoric treated enamel was unchanged after topical application of SnF2. Our data show specific acid-dependent effects on enamel permeability and demonstrate that SnF2 application can reverse acid-induced permeability.

Piezoelectric surgery inserts vs conventional burst: a clinical investigation.

Piezosurgery is a new technique that can be used to cut mineralized structures without damaging adjacent soft tissues. This device has a lot of advantages: reduced surgical time, blood loss, and inferior alveolar nerve injury in bimaxillary osteotomy. Fifty patients underwent different surgical operations (orthognathic surgery, traumatic surgery, reconstructive surgery, aesthetic procedures) with 7 different kind of piezosurgery inserts in a period of 8 months. The same two surgeons performed all the procedures. All the procedures were carried out in order to improve the precision of the osteotomy and the comfort of the surgeon. Piezoelectric devices provide an innovative ultrasonic technique for safe and effective osteotomy compared with methods that use rotating instruments. Different inserts have been developed in order to achieve the utmost advantages.

Effects of clear aligners on sleep bruxism: randomized controlled trial.

The possible effects on sleep bruxism (SB) of clear aligners in orthodontics are unknown. This study was conducted to analyze the effects of clear aligners on SB. Sixty subjects needing orthodontic treatment and affected by SB (33 m, 27 f, 20±;5 years) were enrolled in the study and randomly assigned to one of the following three groups: 20 were given clear aligners (CAT) (12 m, 8 f, 19±5 years), 20 occlusal splint (MOS) (9 m, 11 f, 22±5 years) and 20 a placebo splint (PMS) (12 m, 8 f, 24±3 years). All groups were followed for 6 consecutive months and monitored for SB with a portable electromyographic-electrocardiographic (EMG-ECG) device (Bruxoff®, OT Bioelettronica, Torino, Italy). MOS subjects reduced masseter contractions after 6 months of treatment (t3) (MD=-29.11, std. error 11.74, p=0.017) but increased phasic contractions related to SB after 3 months of treatment (t2) (MD=4.73, std. error 2.36, p=0.048) and tonic contractions related to SB during all the six months of treatment (t1, t2, t3) when compared to PMS. CAT subjects increased phasic contractions related to SB during the first (t1) (MD=3.94, std. error 2.27, p=0.04) and the third month (t2) of treatment (MD=4.62, std. error 2.36, p=0.046) when compared to PMS. No significant differences were found for SB index at any time for all the three groups. Although MOS and CAT affected EMG signals during sleep time differently, they did not influence the overall SB index.

Effect of dental care on the oral health of Sjögren’s syndrome patients.

Sjögren’s syndrome (SS) is a chronic, systemic autoimmune disease affecting the exocrine glands, particularly the salivary and lacrimal glands. Xerostomia is a major feature of this syndrome and greatly affects patient quality of life. The most typical clinical signs associated with hyposalivation are dysgeusia and dysosmia, dental caries, candidiasis, periodontal disease, gland inflammation, mucositis and oral ulcers. The aims are to investigate on Plaque Index (PI) and Gingival Index (GI) before and after dental care of SS patients. Fifty-two consecutive patients (mean age 48.9±2 years) were analysed. At T0, (baseline) T1 (3 months after T0) and T2 (6 months after T0), a Plaque Index and a Gingival Index were calculated. The statistical analysis was performed using one-way ANOVA test. If distribution was not normal, Friedman test was chosen instead of ANOVA. Dunn’s multiple comparison procedure was performed as post-hoc (IBM SPSS Statistics 21 software). A statistically significant decrease was observed both in PI and in GI between T0 and T1, T1 and T2, T0 and T2 (P less than 0.05).

Cervical vertebrae maturation: a blinded trial study.

This blinded trial was conducted to analyze possible correlations between the cervical vertebrae maturation method (CVM) and the mineralization of mandibular teeth as described by Demirjian et al. (TMS). Panoramic and cephalometric radiographs of 500 orthodontic patients were analyzed by two blinded operators. TMS was utilized to analyze mineralization of second molar, second and first premolar and canine on the left side of the mandible; CVM stage was also evaluated. A blinded statistician performed statistical correlations and multiple regression analysis. Significant relations between CVM and TMS stages were identified for each tooth. Significant age differences resulted for CVM, second molar and second premolar (p<0.05). Significant correlations for second molar were observed between TMS D and CVM I-II, TMS G and CVM III, TMS H and CVM V-VI (p less than 0.01). Second molar stage G for both sexes indicates the ongoing of growth spurt. Stage G for boys and stage H for girls correlate significantly with the late part of PGS.

Standard and low-dose cone beam computer tomography protocol for orthognatodontic diagnosis: a comparative evaluation.

Considering the diagnostic capability offered by cone-beam computed tomography (CBCT), nowadays orthodontists often use this exam for treatment planning, especially in cases of impacted teeth, maxillary ipoplasia, orthognathic surgery etc. The aim of this study was to compare the radiation doses related to a conventional CBCT setting and that of a low dose protocol, usable in orthodontic practice. The absorbed organ doses were measured using an anthropomorphic phantom loaded with thermo-luminescent dosimeters related to sensitive organs (brain, bone marrow, salivary glands, thyroid, esophagus, oral mucosa, extrathoracic airways, lymph nodes). The device used was a MyRay Hyperion X9-11x5. The standard setting of the apparatus was 90 Kv, 36 mAs, CTDI/Vol 4.09 mGy, instead the low dose one was 90 Kv, 27 mAs, CTDI/Vol 2.89 mGy. Equivalent and effective doses have been calculated; the measurement of the effective doses was based on the ICRP recommendations. For the assessment of image quality, five readers, independent and experienced orthodontists, were asked to state if the images were sufficient enough to perform an orthodontic diagnosis. The lowest organ dose (5.01 microSv) was received by the esophagus during low dose CBCT acquisition. The highest mean organ dose instead (1227.67 microSv) was received by the salivary glands during conventional setting CBCT acquisition. Image quality has been considered sufficient for orthodontic diagnostic needs for both CBCT protocols. CBCT low dose setting should be preferred over the standard one in orthodontic practice, because it provides a significant lower radiation dose to the patients ensuring a good image quality. However, further studies are necessary to evaluate the opportunity of CBCT exams in orthodontic treatment planning.

In vitro effects of fluoride-based and desensitizing toothpastes on dentine permeability.

This study aims to evaluate the effectiveness in reducing dentine permeability of three different toothpastes comparing with a sodium fluoride one. Dentine permeability was measured by a fluid filtration system. Dentin discs were randomized in four experimental groups and treated with different commercial toothpastes, as it follows. Group A: Sensodyne® Rapid, with strontium acetate; group B: Elmex Sensitive ProfessionalTM, with arginine and 450 ppm monofluoro-phosphate; group C: Colgate Total Advanced®, with 1450 ppm NaF; group D: AZ Pro-Expert®, with 1100 ppm SnF2. After brushing specimens of each groups were assigned to two subgroups and: 1) stored in artificial saliva (2 h) and treated with 6% citric acid for 1 min; 2) stored in artificial saliva for 24 h. SEM analysis was performed to investigate dentinal tubules occlusion of acid treated and stored in artificial saliva samples. Dentin permeability proved affected by dentifrice treatments. The toothpastes specifically formulated for hypersensitivity showed significant effects concerning decrease of dentine permeability. SEM observations demonstrated the presence of dentifrice particles on dentin surface and inside dentin tubules. Stannous fluoride treated samples exhibited the greater tubules occlusion.

Comparison of linear transverse measures between plaster and resin printed digital models.

The aim of this study was to test for dimensional variations between plaster models recorded with alginate impression and printed 3D physical replicas from an .stl file digitized with an intra-oral scanner. Eighty arches (maxillary and mandibular) from 40 different patients were analyzed. Classic alginate impressions and digital recordings with an intraoral scanner were taken on the same day, for both arches of each patient. Digital recordings were then printed into resin models. The linear intercanine (IC) and intermolar (IM) distances were measured with a manual electronic caliper and then compared. The measurements were repeated twice for each distance to verify repeatability with the intraclass correlation coefficient (ICC). The Student’s t test for paired data was used to compare the two sets of impressions. The repeatability of the measures was assessed as ICC values were higher than 0.98. The values of the IC and IM lengths showed a statistically significant difference, but not clinically significant as it was less than 0.1 mm, between the two techniques.

Is static friction affected by aging and amount of elastomeric ligatures in orthodontic sliding mechanics? An in-vitro investigation.

In straight-wire mechanics, friction can significantly influence the forces expressed by wires. The aim of this study is to assess whether the aging and the sum of elastomeric ligatures affect the static friction during orthodontic space closure. A 0.017x 0.025-in SS was drawn throughout a 3-bracket experimental model and engaged with elastomeric ligatures. Before performing the test, the ligatures were soaked in artificial saliva for 48 hours (Group 1), 2 weeks (Group 2) and 4 weeks (Group 3); brand-new ligatures were also tested as control group (Group 4). The resistance to sliding (RS) was recorded at 3 different numerical configurations of ligatures using a customized testing machine and tests were repeated for ten times. Data of RS were statistically analysed by using two way analysis of variance (ANOVA) and Tukey's multiple comparison tests. RS was found to increase systematically when more elastomeric ligatures were included in the wire engaging system. At two weeks of immersion in artificial saliva elastomeric ligatures showed the lowest values of RS while they became significantly more frictional after immersion for 4 weeks. The results of this study showed that in multi-bracket orthodontic therapy, the RS increases with the number of elastomeric ligatures involved for arch-wire engagement. Differently from the frictional behavior of elastomeric modules, the aging of these ligatures does not influence their incremental effect of frictional forces.

Depression and distress in burning mouth syndrome: A case control study.

To compare the results of psychometric tests in patients with BMS and controls, participants were tested for depression, anxiety, fatigue and distress. Patients with BMS had noticeably higher scores for depression, fatigue and distress, compared to controls. Depression and distress were significantly correlated with the burning symptom. Moreover, distress and burning symptoms proved to be interdependent. Depression seems to play a specific role in BMS. Burning symptoms affect quality of life of patients and they could be a predictor of distress.

Analysis of saliva samples in patients with Prader-Willi syndrome.

Patients affected by Prader-Willi Syndrome (PWS) usually show orofacial dysfunction, poor oral hygiene, severe tooth wear, generalized caries and thick sticky saliva. The aim of this study was to evaluate molecular/ionic changings in PWS patients compared to controls, as well as unstimulated salivary flow rate (SFR); 7 patients with a mean age of 20.0±5.45 years were enrolled in the study group (PWS group) and 5 patients with a mean age of 22.6±3.05 years, in the control group. Results showed a greater Na+ (p=0.003), Cl+ (p=0.004) and P (p=0.001) concentration in saliva of PWS group as well as a greater concentration of secretory IgA (p=0.003) with a reduction of SFR (p=0.004) compared to controls. A Spearman’s analysis (based on the SFR of both groups) revealed an inverse correlation with Na (rho=-0.747), Cl (rho=-0.723), P (rho=-0.637) and sIgA (rho=-0.707) concentration and SFR, when linear regression model was performed only P and SFR were interdependent (ß=-0.748; p=0.005).