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OBJECTIVE: The aim of this study was to evaluate gingival tissue adaption induced by orthodontic tooth movement, in terms of clinical crown height (i.e., attachment loss), and thickness of the keratinized gingiva at the margin level. METHODS: Pre- and post-treatment intraoral models/scans of 100 orthodontically treated patients (50 treated with clear aligners and 50 treated with fixed appliance) were acquired. Models were digitally scanned. Each couple of pre- and post-treatment scans were superimposed using the Compare© software (Medit spa, Seoul, Republic of Korea) taking the same reference landmarks in all cases, that were the palatal rugae for the upper arch, and the labial median frenulum for the lower arch. Only teeth that had undergone vestibulo-palatal (or vice versa) movement, greater than 1 mm were included in the analyses. The change from pre-treatment to post-treatment, in the clinical crown height and thickness of the keratinized gingiva at the margin level were digitally measured and compared between the two groups. Statistical analysis included paired t-tests, and unpaired t-tests with significance set at p<0.05. RESULTS: There was a statistically significant change in clinical crown height and gingival thickness in both groups. However, a clinically relevant attachment loss was found only within the fixed appliance group. Whereas, regarding the change in gingival thickness, there was no clinically relevant changes between the two groups. CONCLUSIONS: Orthodontic tooth movement with fixed appliance is associated to a clinically relevant attachment loss. Clear aligners seem to be associated with a more discrete attachment loss than the one observed with fixed appliances. CLINICAL RELEVANCE: Orthodontists should pay attention and monitoring the clinical crown height (i.e., attachment loss) during orthodontic movement, mostly when using fixed appliances.
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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.
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Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea , Imagenología Tridimensional , Cirugía Asistida por Computador , Humanos , Cirugía Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Implantación Dental Endoósea/métodos , Programas Informáticos , Holografía/métodos , Prueba de Estudio Conceptual , Planificación de Atención al Paciente , Implantes Dentales de Diente Único , Masculino , FemeninoRESUMEN
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.
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Implantación Dental Endoósea , Implantes Dentales , Arcada Parcialmente Edéntula , Maxilar , Modelos Dentales , Cirugía Asistida por Computador , Humanos , Cirugía Asistida por Computador/métodos , Implantación Dental Endoósea/métodos , Maxilar/cirugía , Arcada Parcialmente Edéntula/cirugía , Imagenología Tridimensional/métodos , Estereolitografía , Planificación de Atención al Paciente , Tomografía Computarizada de Haz Cónico , Técnicas In VitroRESUMEN
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.
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Recubrimiento Dental Adhesivo , Soportes Ortodóncicos , Blanqueamiento de Dientes , Humanos , Animales , Bovinos , Blanqueamiento de Dientes/efectos adversos , Soportes Ortodóncicos/efectos adversos , Recubrimiento Dental Adhesivo/métodos , Peróxidos/uso terapéutico , Peróxidos/química , Urea/uso terapéutico , Urea/química , Resistencia al Corte , Análisis del Estrés Dental , Ensayo de MaterialesRESUMEN
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.
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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.
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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.
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Proyectos de Investigación , Trastornos de la Articulación Temporomandibular , Adulto Joven , Humanos , Rango del Movimiento Articular , Estado de Salud , ItaliaRESUMEN
The purpose of this study is to analyze the microbiota of patients undergoing orthodontic treatment with multibrackets and transparent aligners. The second goal is to evaluate the effectiveness of the oral irrigator on the oral hygiene and periodontal health of orthodontic patients. Fifty patients (27 F, 23 M; mean age 21.5 years) were recruited for the study, then divided into two groups. Group A underwent fixed orthodontic therapy with multibracket, and a home protocol that included manual orthodontic toothbrush, interdental brushes, and one-tuft brushes. Group B used transparent aligners for 22 h a day and a home protocol that included a manual brush with soft bristles and dental floss. After 3 months, all patients of the two groups, A and B, underwent plaque evaluation with a phase-contrast microscope. If the test result showed non-pathogenic bacterial flora, the subject continued with the traditional home oral-hygiene protocol. If the test detected pathogenic flora, the subject changed the home protocol, with a sonic toothbrush and oral irrigator, while the microbiological analysis continued to be performed after 3 months. After 3 months, 10 out of 25 patients treated with multibrackets (group A) and only 3 out of 25 patients with aligners (group B) passed from non-pathogenic flora to pathogenic flora. After 6 months, using the oral irrigator and a sonic toothbrush for 3 months, all subjects returned to non-pathogenic flora. This study confirms that in patients treated with multibrackets, the risk of developing unfavorable microbiota increases compared to those treated with clear aligners. The use of an oral irrigator combined with the sonic toothbrush seems to be able to restore good oral hygiene in subjects with pathogenic flora and therefore to be effective at reducing the risk of caries and gingivitis in orthodontic patients.
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Pregnancy causes physiological changes in the woman's body, which can also affect oral health. Therefore, pregnant women may manifest gingival inflammation that is favored by their hormonal increase. This clinical trial (ClinicalTrials.gov Identifier: NCT04140643) evaluated the variation in the plaque index (PI) or bleeding index (BOP) in pregnant women after daily use of an ozonated water irrigator and proper home oral hygiene, compared to a control group who only performed home oral hygiene. The inclusion criteria were the gestation period from the 14th week to the 30th week, a diagnosis of gingivitis, and a minimum number of teeth equal to 20. The PI and BOP index were evaluated at T0, fifteen days after T0 (T1), and two months after T1 (T2). The PI values systematically decreased over time (F (1.19) = 41.82) in both groups, with a systematic difference in PI values between the two groups (F (1.19) = 6.28, p = 0.021). A statistically significant difference was assessed in the BOP index at T2 between the two groups, with the control group suffering a higher BOP index. The results show that the patients in the study group showed a decrease in the BOP index over the three time points, in contrast to the control group, due to the beneficial properties of ozonated water.
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The purpose of the present study was to evaluate the mechanical resistance of elastodontic devices (ED): their maximum compression loads and plastic deformation under loading (percentage). An Instron universal machine (Model 3365, Instron, Industrial Product Group, Grove City, PA, USA) was employed with a 100 N load cell and with Bluehill software for loading analyses. Each device was submitted to a five-cycles test. The following ED were evaluated: A.M.C.O.P. (Micerium, Genova, Italy) in red color, in orange color, and in blue color; HealthyStart (Ortho-Tain, Winnetka, IL, USA), and T4K™ phase 1 (Myofunctional Research Co., Helensvale, Australia). During the five-cycles test, the Ortho-Tain device delivered the greatest compression load (7.56 N), with the lowest percentage of deformation (0.95%). For all devices, a slight plastic deformation of the material was registered, ranging from 0.95% to 1.75%. For the T4K device it was not possible to complete the five-cycles test. For all the analyzed ED, a slight plastic deformation under loading was registered, that in all cases can be considered clinically acceptable. Further studies are needed to test the appliances after clinical usage.
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Background: The purpose of this study was to introduce a new Oral Health Activities Questionnaire (OHAQ, hereinafter) that examines different activities and behaviours related to the oral hygiene regimen of each analysed subject. Methods: A sample of 658 students was analysed to determine the OHAQ scale's basic metric characteristics. To determine the construct validity of the OHAQ, descriptive statistics and correlation analysis, as well as differences testing, were applied to groups of subjects on the basis of self-reported oral status measures. Results: The dimensions of oral health activities were determined, and the scales for their measurement were constructed. Females and males differed in the OHAQ questionnaire measures. Significant but low intercorrelations were found among the measures. In the female and male subsample, four different oral health (OH, hereinafter) types of subjects were identified, exhibiting different characteristic behaviours regarding oral health. OHAQ scales showed good discriminant validity, revealing the differences related to specific self-reported oral status measures (e.g., frequency of toothache and the number of filled teeth). Conclusions: The OHAQ represents a satisfactory measurement instrument for determining the level of OH activities and for doing quick and reliable classifications of the participating subjects according to their OH activities and behaviours. The process of further validation and advancements of the OHAQ scales and measures should be continued through a clinical examination of subjects.
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Salud Bucal , Odontalgia , Femenino , Humanos , Masculino , Autoinforme , Estudiantes , Encuestas y CuestionariosRESUMEN
In orthodontics, post-treatment retention phase is crucial for maintaining the obtained clinical results. In cases of crowding, a bonded fixed retainer is often chosen to maintain teeth alignment in the anterior sector of the lower dental arch. A fixed retainer can remain in the mouth for years. Therefore, it is important that it is applied with harmless materials for the level of plaque control. The present study aimed to investigate the salivary concentrations of Streptococcus mutans (S. mutans) and Lactobacilli, and the Sillness and Loe plaque index, in patients wearing metal wire versus fiberglass orthodontic retainers. Forty post-orthodontic patients were included in the sample: in 20 subjects a metal wire retainer was applied (MR), while in the others a fiberglass retainer was applied (FR). The variables were recorded at baseline (T0), after 1 month (T1), and after 2 months (T2) of follow-up. The percentage of patients with a level of S. mutans and Lactobacilli colonization > 105 increased over time in the FR group (T0 = 0%, T1 = 5%, T2 = 35%), compared with the MR group. PI increased in the FR group (T0 = 0, T1 = 14, T2 = 27), and remained almost the same in the MR group (T0 = 3, T1 = 0, T2 = 2). From the present results it appears that the metal wire retainer is better than the fiberglass retainer for the level of plaque control performed by the patients.
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In complex dental treatments, a preliminary virtual plan (VP) can minimise the probability of errors and increase the predictability of the achieved result. Digital technologies and artificial intelligence open more opportunities for such planning, as they can be applied at the early stages of clinical examination to develop a simultaneous VP of all stages of treatment. The present clinical case describes a one-stage entire VP combining all the stages of treatment: gnathological, orthodontic, and prosthetic rehabilitation, until the final result. This approach avoids the accumulation errors associated with multistage VP, in which one stage of planning follows the end of a previous stage. One-step VP also allows demonstrating to the patients the expected results of the restoration, which increases their motivation to initiate the treatment.
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Ortodoncia , Prostodoncia/métodos , Inteligencia Artificial , HumanosRESUMEN
Bruxism and gastroesophageal reflux (GERD) can lead to wear of the dental tissues. Wear has a mechanical or chemical origin, and it is of extrinsic or intrinsic type. Bruxism and GERD are two etiological factors of dental wear. The intrinsic mechanical wear (abfraction) of Bruxism and intrinsic chemical wear (erosion) of GERD are both involved in sleep disorders; indeed, they could have associations and act in synergy in dental wear. The purpose of this review was to find out the possible associations between bruxism and GERD and their effects on tooth wear. The research was conducted on PubMed and the Cochrane Library using the following Keywords/Mesh Terms: Tooth wear, Bruxism, Sleep Bruxism, Sleep Disorders, or GERD. Only systematic reviews and clinical studies performed exclusively on human subjects were included in the review. Initially, the research gave more than 630 results on dental wear, bruxism and GERD and after application of the inclusion criteria irrelevant studies were excluded, and 5 studies were finally included in this review. It was possible to observe the presence of some associations between the two problems (reflux and GERD) and hypothesize negative effects on tooth wear. This research revealed the presence of an interconnection between these three problems (reflux, GERD and tooth wear) that can further act in synergy by attacking the hard dental tissues both from a chemical (reflux) and mechanical (bruxism) point of view. The dentist could play a role of "sentinel" in a multidisciplinary team, intercepting these problems early in order to treat them in the most appropriate way. PROSPERO Registration Number: CRD42021234209.
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Internal derangement (ID) in the temporomandibular joint (TMJ) is defined as a mechanical problem of the joint that interferes with its function. It is attributed to an abnormal interaction among the articular disc, condyle, and joint eminence. The aim of this study is to evaluate diagnostic efficacy of non-invasive hand-carried ultrasonography instrumentation (US) to provide high-level images for a correct diagnosis of ID. Twenty-eight ID patients, 15 female and 13 males, were examined both clinically and by MRI images in order to achieve a diagnosis of ID (using Helkimo index). Then, they were submitted to US examination with a 12 MHz transducer by using hand-carried instrumentation by a clinician that was blind to their diagnosis and clinical data. TMJ US examination was performed with the mouth closed and mouth open, with proper technique. Each position was then evaluated with two different orientations of the transducer. US showed acceptable results in identifying bone structures. Lower values of diagnostic efficacy were obtained for disc position during joint movements with respect to MRI images. MRI still represents the gold standard for the identification of joint structures. If not corroborated by clinical and anamnestic data, the diagnostic efficacy of US in identifying the position of the disc during opening and closing jaw movements appears limited than compared to MRI.
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BACKGROUND: The median solitary maxillary central incisor syndrome (SMMCI) is a rare malformative syndrome consisting of multiple defects, mainly found on the body midline. It can be correlated to the etiopathological and phenotypic pattern of panhypopituitarism. This case-report describes the rare case of a patient suffering from SMMCI and panhypopituitarism, showing an unusual craniofacial morphology. CASE PRESENTATION: From the cephalometric analysis, a skeletal class III was identified (despite the other cases described in literature described as skeletal class II), derived from hypomaxillia and mandibular protrusion. A convex lip profile, with tendency to mandibular hyper-divergency, airway patency, anterior and posterior cross-bite were observed. At the clinical examination, a maxillary cant was evident on the frontal plane that appeared asymmetric, with the prevalence of the third lower part of the face. There were some dysmorphic signs such as: small nose, rectilinear eyelid line and reduced interocular distance. CONCLUSIONS: The present clinical case shows how, despite the literature, SMMCI can be associated with a III skeletal class, with maxillary hypoplasia and mandibular protrusion. The interdisciplinary collaboration between dentist and pediatrician is therefore important for the early interception of the malocclusions associated with these syndromes.
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Anodoncia , Holoprosencefalia , Humanos , Hipopituitarismo , Incisivo/anomalías , Incisivo/diagnóstico por imagen , Maxilar/diagnóstico por imagenRESUMEN
The second primary molar represents an anchorage element in interceptive orthodontics. The present study aims to analyze the 3D morphology of primary second molars in order to provide reference data and implications about the development of orthodontic bands for second primary molars. Digital models of dental arches from 150 subjects in primary or mixed dentition were analyzed. Six dimensional variables were digitally measured for each second primary molar, and the mean and standard error of the mean (SEM) were calculated and compared applying Student t-test statistical analysis. The mean value results show statistically significant dimensional differences between the upper and lower teeth, (mostly p < 0.0001), except for the variable h1, while only the variable h1 showed significant differences between the antimetric teeth (left and right). The dimensional variations between the right and left molars were considerably minor compared to those found by comparing the upper and lower arches. A significantly higher dimension of the lower molars and a more rectangular shape were observed.
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Diente Molar , Ortodoncia Interceptiva , Coronas , Dentición Mixta , Humanos , Diente PrimarioRESUMEN
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.
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Inteligencia Artificial , Diseño de Aparato Ortodóncico , Programas Informáticos , Telemedicina , Técnicas de Movimiento Dental , Adulto , COVID-19 , Control de Enfermedades Transmisibles , Francia , Humanos , PandemiasRESUMEN
BACKGROUND: The purpose of this study is to evaluate the effect of an electromyography-guided adjustment of an occlusal appliance on the management of Temporomandibular disorder-related pain. METHODS: Data from 40 adult patients (20 males and 20 females), who underwent treatment with occlusal appliances, were recorded. A total of 20 appliances were adjusted according to electromyographic data (group 1), while the others were adjusted by a clinical conventional procedure (group 2). Muscle pain to palpation, pain during articular movements and headache were recorded by a VAS score (from 0 to 100) before the beginning of treatment (T0), at T1 (4 weeks) and T2 (8 weeks). RESULTS: Results showed a reduction of pain in both groups, with a better trend for group 1, where better results were achieved at T1 and maintained stability at T2, with an improved mean value regarding all parameters studied. After 8 weeks, only small recurrences started to occur in muscle pain to palpation in group 2. CONCLUSIONS: An occlusal appliance seems to be able to achieve a clinical improvement of Temporomandibular disorder (TMD)-related pain and headache, independently from the adjustment procedure adopted. However, the use of a surface electromyographic activity of masticatory muscles (sEMG) device as an aid in the calibration procedure seems to allow a better trend because the improvement of symptoms was obtained before, after the first four weeks, with an improvement in percentages of all the variables investigated. While the conventional procedure obtained later the improvement.
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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.