Medium-term effects of rapid maxillary expansion on nasal cavity and pharyngeal airway volumes considering age as a factor: A retrospective study.

OBJECTIVES: The medium-term effects of rapid maxillary expansion (RME) on nasal cavity (NC) and upper airway (UA) dimensions based on chronological age are still unclear. This retrospective study evaluated the medium-term changes occurring in the NC and pharyngeal airways (PA) after RME in two distinct age-based cohorts of patients. METHODS: This retrospective study included 48 subjects who underwent RME grouped in two cohorts: a 6-9-year-old group (EEG group: early expansion group - 25 subjects) and an 11-14-year-old group (LEG group: late expansion group - 23 subjects). NC and PA volumes were analyzed from CBCT imaging segmentation before RME (T0) and twelve months after RME (T1). The amount of maxillary expansion (PW) and minimal cross-sectional area (CSmin) were also considered. RESULTS: All PAs' volumetric sub-regions, CSmin and PW showed a significant volumetric increment (p < 0.05). Inter-group comparisons showed significant differences (p < 0.05) for nasopharynx and CSmin parameters (p < 0.05), while no significant changes were recorded for the other UA's sub-regions and PW (p > 0.05). According to a deviation analysis, part of the UA increase (more marked for the nasopharynx area) may have occurred due to reduced adenotonsillar tissues, which were larger in the EEG group. CONCLUSIONS: Twelve months after treatment, clinicians should not expect changes in the UAs dimensions to be solely related to treatment effects of RME; instead, normal craniofacial growth changes and spontaneous regression of the adenotonsillar tissue could represent the most significant factors influencing UAs changes. CLINICAL SIGNIFICANCE: From the clinical perspective, the results of the present study encourage caution when considering the therapeutic effects of RME on airways dimensions.

Chemopreventive and Biological Strategies in the Management of Oral Potentially Malignant and Malignant Disorders.

Oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC) represent a significant global health burden due to their potential for malignant transformation and the challenges associated with their diagnosis and treatment. Chemoprevention, an innovative approach aimed at halting or reversing the neoplastic process before full malignancy, has emerged as a promising avenue for mitigating the impact of OPMD and OSCC. The pivotal role of chemopreventive strategies is underscored by the need for effective interventions that go beyond traditional therapies. In this regard, chemopreventive agents offer a unique opportunity to intercept disease progression by targeting the molecular pathways implicated in carcinogenesis. Natural compounds, such as curcumin, green tea polyphenols, and resveratrol, exhibit anti-inflammatory, antioxidant, and anti-cancer properties that could make them potential candidates for curtailing the transformation of OPMD to OSCC. Moreover, targeted therapies directed at specific molecular alterations hold promise in disrupting the signaling cascades driving OSCC growth. Immunomodulatory agents, like immune checkpoint inhibitors, are gaining attention for their potential to harness the body's immune response against early malignancies, thus impeding OSCC advancement. Additionally, nutritional interventions and topical formulations of chemopreventive agents offer localized strategies for preventing carcinogenesis in the oral cavity. The challenge lies in optimizing these strategies for efficacy, safety, and patient compliance. This review presents an up to date on the dynamic interplay between molecular insights, clinical interventions, and the broader goal of reducing the burden of oral malignancies. As research progresses, the synergy between early diagnosis, non-invasive biomarker identification, and chemopreventive therapy is poised to reshape the landscape of OPMD and OSCC management, offering a glimpse of a future where these diseases are no longer insurmountable challenges but rather preventable and manageable conditions.

Orthodontic patients and the information found on the web: a cross-sectional study.

BACKGROUND: In recent years, the Web has become a source of medical information for patients, even though the information available online may be incorrect or qualitatively inadequate. Younger generations, immersed in a digital environment since a very tender age, are more likely to get informed online. This study aims to understand the relevance of online information for prospective orthodontic patients and to investigate the effects of digital research on patients' decision-making process, and it also aims to investigate potential generational differences between digital natives and digital immigrants. MATERIALS AND METHODS: An anonymous questionnaire was developed to investigate patients' orthodontic-themed Web searches as well as the effects digital material had on their decision-making process. Before submitting the newly designed survey to patients, it was validated in a pilot study. Univariate analysis was applied to analyze the relationship between the demographic characteristics of respondents and their answers on the use of digital research for the decision-making process. RESULTS: 64.6% of the study population searched the Web for orthodontic information prior to their visit. Google was the most used platform regardless of patients' age. The perceived reliability of online sources varied significantly with age. Men displayed more trusting behavior towards their doctor than women. Prospective patients' satisfaction with affected patients' decision-making processes, and the perceived reliability of online sources of information had repercussions on the doctor-patient relationship. CONCLUSIONS: Orthodontists should be aware that the majority of patients use the Internet as a source for orthodontic information, and that patients who are digital immigrants are more prone to trust the information found online. Patients who perceive the information found on the Web as either useful or reliable don't easily discard it, even if it is inconsistent with the orthodontist's opinion.

The Use of a CAD/CAM Thermoformed Splints System in Closed Reduction of Condylar Fractures.

(1) Background: Mandibular fractures are very common. Common indications of closed treatment for mandibular fractures are non-displaced or minimally displaced simple fractures in adult compliant patients with good dentition, the absence of occlusal disruption, and fractures in growing children. In closed treatment, the mandible is maintained in centric occlusion with a maxillomandibular fixation (MMF) with orthodontic elastics. Many methods of MMF have been described, often using orthodontic appliances. In recent years, CAD-CAM technology has improved many procedures used in maxillofacial surgery and orthodontics. The device we present is manufactured following a digital workflow, and was designed specifically for MMF. (2) Materials: Two patients with mandibular fractures were treated with an MMF method whose procedure comprised scanning of the dental arches, followed by construction of thermoformed splints on which buttons for the elastics and retention holes are made. The splints were fixed on the dental arches with composite resin at the level of the holes, and were kept in place for the period of healing of the fracture, with the intermaxillary elastics hooked to the buttons. (3) Results: The application time of the splints was very quick. The splints remained stable for the necessary time, without causing particular discomfort to the patients. (4) Conclusions: From our experience, this technique has proved to be reliable and reproducible and could represent a valid tool in the closed treatment of mandibular fractures.

Accuracy Of Imaging Software for 3d Rendering of Tooth Structures, Usable in Clinical Settings.

AIM: The aim of this study was to evaluate the segmentation accuracy of dentition testing four free-source semi-automatic software. MATERIALS AND METHODS: A total of 20 cone-beam computed tomography (CBCT) were selected to perform semi-automatic segmentation of maxillary and mandibular dentition. The software tested were Invesalius, ITK-Snap, 3D Slicer and Seg3D. Each tooth model was also manually segmented (Mimics software) and set as the gold standard (GS) reference of the investigation. A specific 3D imaging technology was used to perform the superimposition between the teeth models obtained with semi-automatic software and the GS model, and to perform the surface-to-surface matching analysis. The accuracy of semi-automatic segmentation was evaluated calculating the volumetric mean differences (mean bias and limits of agreement) and the percentage of matching of the tooth models compared to the manual segmentation (GS). Qualitative assessments were performed using color-coded maps. All data were statistically analysed to perform software comparisons. RESULT: Statistically significant differences were found in the volumetric and matching percentage data (p < 0,05). Invesalius was the most accurate software for 3D rendering of the dentition with a volumetric bias (Mimics) ranging from 4,59 mm3 to 85,79 mm3; instead, ITK-SNAP showed the higher volumetric bias, ranging from 30,22 mm3 to 319,83 mm3. The dis-matched area was mainly located at the radicular region of the teeth. Volumetric data showed excellent inter-software reliability with coefficient values ranging from 0,951 to 0,997. CONCLUSIO: Different semi-automatic software algorithms could generate different patterns of inaccuracy error in the segmentation of teeth.

Local Delivery and Controlled Release Drugs Systems: A New Approach for the Clinical Treatment of Periodontitis Therapy.

Periodontitis is an inflammatory disease of the gums characterized by the degeneration of periodontal ligaments, the formation of periodontal pockets, and the resorption of the alveolar bone, which results in the destruction of the teeth's supporting structure. Periodontitis is caused by the growth of diverse microflora (particularly anaerobes) in the pockets, releasing toxins and enzymes and stimulating the immune system. Various approaches, both local and systemic, have been used to treat periodontitis effectively. Successful treatment depends on reducing bacterial biofilm, bleeding on probing (BOP), and reducing or eliminating pockets. Currently, the use of local drug delivery systems (LDDSs) as an adjunctive therapy to scaling and root planing (SRP) in periodontitis is a promising strategy, resulting in greater efficacy and fewer adverse effects by controlling drug release. Selecting an appropriate bioactive agent and route of administration is the cornerstone of a successful periodontitis treatment plan. In this context, this review focuses on applications of LDDSs with varying properties in treating periodontitis with or without systemic diseases to identify current challenges and future research directions.

Exfoliative Cytology and Genetic Analysis for a Non-Invasive Approach to the Diagnosis of White Sponge Nevus: Case Series.

BACKGROUND: White Sponge Nevus (WSN) is a rare benign disorder associated with mutations in genes coding for cytokeratin 4 (KRT4) and 13 (KRT13) characterized by dyskeratotic hyperplasia of mucous membranes. This study was aimed at examining different approaches (cytology, pathology and genetic analysis) to WSN diagnosis. METHODS: A series of four patients with asymptomatic white diffuse oral lesions were evaluated and, before performing an incisional biopsy for pathology, an oral brush Thin Prep was collected for exfoliative liquid-based cytology (LBC). DNA for genetic analysis was also obtained from patients and both their parents, using buccal swabs. RESULTS: Pathology and cytology showed similar results, leading to the same diagnosis of hyperkeratotic epithelium with acanthosis and spongiosis, without atypia, demonstrating the efficiency of LBC for the differential diagnosis. Sequencing analysis revealed at least 6 rare variants in the KRT4 and KRT13 genes in each patient, contributed in part by both unaffected parents. CONCLUSIONS: Thin Prep for oral exfoliative cytology and genetic analysis are sufficient for an accurate diagnosis of WSN. The combination of cytological and genetic analyses could substitute the histologic exam, providing a non-invasive alternative for incisional biopsy.

Mother and Daughter Carrying of the Same Pathogenic Variant in FGFR2 with Discordant Phenotype.

Craniosynostosis are a heterogeneous group of genetic conditions characterized by the premature fusion of the skull bones. The most common forms of craniosynostosis are Crouzon, Apert and Pfeiffer syndromes. They differ from each other in various additional clinical manifestations, e.g., syndactyly is typical of Apert and rare in Pfeiffer syndrome. Their inheritance is autosomal dominant with incomplete penetrance and one of the main genes responsible for these syndromes is FGFR2, mapped on chromosome 10, encoding fibroblast growth factor receptor 2. We report an FGFR2 gene variant in a mother and daughter who present with different clinical features of Crouzon syndrome. The daughter is more severely affected than her mother, as also verified by a careful study of the face and oral cavity. The c.1032G>A transition in exon 8, already reported as a synonymous p.Ala344 = variant in Crouzon patients, also activates a new donor splice site leading to the loss of 51 nucleotides and the in-frame removal of 17 amino acids. We observed lower FGFR2 transcriptional and translational levels in the daughter compared to the mother and healthy controls. A preliminary functional assay and a molecular modeling added further details to explain the discordant phenotype of the two patients.

Association between Vitamin D Receptor Gene Polymorphisms and Periodontal Bacteria: A Clinical Pilot Study.

Background: Periodontitis is an inflammatory disease caused by microorganisms involving the supporting tissues of the teeth. Gene variants may influence both the composition of the biofilm in the oral cavity and the host response. The objective of the study was to investigate the potential correlations between the disease susceptibility, the presence and the quantity of periodontopathogenic oral bacterial composition and the VDR gene polymorphisms. Methods: Fifty (50) unrelated periodontal patients and forty-one (41) healthy controls were selected for genomic DNA extraction. DNA concentration was measured and analyzed. The periodontopathogenic bacterial species were identified and quantified using a Real Time PCR performed with species-specific primers and probes. Results: Genotype distribution showed a different distribution between the groups for BsmI rs1544410 genotypes (p = 0.0001) with a prevalence of the G(b) allele in periodontal patients (p = 0.0003). Statistical significance was also found for VDR TaqI rs731236 (p ≤ 0.00001) with a prevalence of the T(T) allele in periodontal patients (p ≤ 0.00001). The average bacterial copy count for the periodontitis group was significantly higher than that of control group. Dividing patients into two groups based on high or low bacterial load, FokI rs2228570 T allele (f) was statistically more represented in patients with high bacterial load. Conclusions: The findings of the study suggest the involvement of the VDR gene BsmI and TaqI polymorphisms in periodontal disease, while FokI and BsmI may be involved in determining an increased presence of periodontopathogens.

Asymmetry index for the photogrammetric assessment of facial asymmetry.

INTRODUCTION: Facial asymmetry is common and can be clinically related to dental malocclusion, facial bone development, muscular imbalance, and soft tissues thickness, which should be assessed during diagnosis to choose proper treatment options. This study aimed to quantify the amount of symmetry/asymmetry in previously defined symmetrical and asymmetrical subjects, analyzing full-face 3-dimensional images. METHODS: Seventy-six orthodontic patients' 3-dimensional face images were obtained with the 3dMD Trio-system (Atlanta, Ga) and processed with the Geomagic Control (64-bit; 3D Systems, Rock Hill, SC) software. Patients were divided into symmetrical and asymmetrical groups through a surface-based technique. Sixteen facial landmarks were positioned, an asymmetry index was calculated for each landmark, and an evaluation diagram of facial asymmetry was created through the asymmetry index mean and standard deviation of symmetrical and asymmetrical landmarks. RESULTS: The asymmetry index mean varied from 0.05 to 1.51 in the symmetrical group and from 0.05 to 2.84 in the asymmetrical group. This study suggests that landmarks located in the lower third of the face have a greater asymmetry index than other landmarks. CONCLUSIONS: The landmark-based technique does not exhibit statistically significant differences among asymmetrical and symmetrical patients for some landmarks. This approach provides useful information about the localization and the extension of asymmetry, in which bilateral landmarks showed a higher amount of asymmetry than median landmarks.

A comparison between stereophotogrammetry and smartphone structured light technology for three-dimensional face scanning.

OBJECTIVES: To compare three-dimensional facial scans obtained by stereophotogrammetry with two different applications for smartphone supporting the TrueDepth system, a structured light technology. MATERIALS AND METHODS: Facial scans of 40 different subjects were acquired with three different systems. The 3dMDtrio Stereophotogrammetry System (3dMD, Atlanta, Ga) was compared with a smartphone (iPhone Xs; Apple, Cupertino, Calif) equipped with the Bellus3D Face Application (version 1.6.11; Bellus3D Inc, Campbell, Calif) or Capture (version 1.2.5; Standard Cyborg Inc, San Francisco, Calif). Times of image acquisition and elaboration were recorded. The surface-to-surface deviation and the distance between 18 landmarks from 3dMD reference images to those acquired with Bellus3D or Capture were measured. RESULTS: Capturing and processing times with the smartphone applications were considerably longer than with the 3dMD system. The surface-to-surface deviation analysis between the Bellus3D and 3dMD showed an overlap percentage of 80.01% ± 5.92% and 56.62% ± 7.65% within the ranges of 1 mm and 0.5 mm discrepancy, respectively. Images from Capture showed an overlap percentage of 81.40% ± 9.59% and 56.45% ± 11.62% within the ranges of 1 mm and 0.5 mm, respectively. CONCLUSIONS: The face image acquisition with the 3dMD device is fast and accurate, but bulky and expensive. The new smartphone applications combined with the TrueDepth sensors show promising results. They need more accuracy from the operator and more compliance from the patient because of the increased acquisition time. Their greatest advantages are related to cost and portability.

Validating clinical characteristic of primary failure of eruption (PFE) associated with PTH1R variants.

BACKGROUND: Primary failure of eruption (PFE) is a hereditary condition, and linkage with variants in the PTH1R gene has been demonstrated in many cases. The clinical severity and expression of PFE is variable, and the genotype-phenotype correlation remains elusive. Further, the similarity between some eruption disorders that are not associated with PTH1R alterations is striking. To better understand the genotype-phenotype correlation, we examined the relationship between the eruption phenotype and PTH1R genotype in 44 patients with suspected PFE and 27 unaffected relatives. Sanger sequencing was employed to analyze carefully selected PFE patients. Potential pathogenicity of variants was evaluated against multiple genetic databases for function prediction and frequency information. RESULTS: Mutational analysis of the PTH1R coding sequence revealed 14 different variants in 38 individuals (30 patients and 8 first-degree relatives), 9 exonic and 5 intronic. Their pathogenicity has been reported and compared with the number and severity of clinical signs. In 72.7% of patients with pathogenic variants, five clinical and radiographic criteria have been found: involvement of posterior teeth, involvement of the distal teeth to the most mesial affected, supracrestal presentation, altered vertical growth of the alveolar process and posterior open-bite. In cases with mixed dentition (3), the deciduous molars of the affected quadrant were infraoccluded. DISCUSSION: The probability of an affected patient having a PTH1R variant is greater when five specific clinical characteristics are present. The likelihood of an eruption defect in the absence of specific clinical characteristics is rarely associated with a PTH1R mutation. CONCLUSIONS: We report here that systematic clinical and radiographic observation using a diagnostic rubric is highly valuable in confirming PFE and offers a reliable alternative for accurate diagnosis.

The Effects of Wearing a Removable-Partial-Denture on the Bite Forces: A Cross-Sectional Study.

BACKGROUND: Removable partial dentures are a frequently used prosthetic treatment in the elderly population, but different types or RPDs might guarantee different chewing capabilities. In many studies, the relationship between chewing and aging has been reported and it has been shown that efficient chewing can improve the overall quality of life. OBJECTIVES: In the present study, the relationship between maximum bite force (MBF) and RPDs was studied. A relationship between the body mass index (BMI) and the type of prosthesis was also analyzed. METHODS: 240 elderly patients, 120 males and 120 females, with bilateral posterior edentulism (class 1 of Kennedy classification) who had been wearing an RPD for at least a year, were recruited. Patients were divided into two groups: Group 1: male (n = 60) and female (n = 60) patients with bilateral edentulous areas located posterior to the remaining natural teeth and natural teeth in the opposite dental arch. Group 2: male (n = 60) and female (n = 60) patients with maxillary and mandibular bilateral edentulous areas located posterior to the remaining natural teeth. Their Body Mass Index (BMI) and Maximum bite force (MBF) were measured and compared according to the material and design of their RPD. RESULTS: In both Groups, patients wearing cobalt-chrome alloy RPDs (Co-Cr-RPD) (Group 1: 20.25 ± 6.7 MBF, p < 0.001; Group 2: 16.0 ± 5.7 MBF, p < 0.001) had an increased MBF when compared to polymethylmethacrylate RPD (PMMA-RPD) (Group 1: 12.9 ± 3.36 MBF; Group 2: 10.4 + 2.8 MBF), and Valplast RPD (V-RPD) (Group 1: 14.3 ± 4.7 MBF; Group 2: 11.3 ± 3.4 MBF) users. There were no significant differences in bite force between patients wearing PMMA-RPD and V- RPD in both Groups. Patients in Group 2 showed a lower MBF than those in Group 1 (Group 1: 16.05 ± 6.13 MBF; Group 2: 12.6 ± 4.84 MBF; p < 0.001). CONCLUSIONS: A reduction in chewing force can lead to choosing softer foods for nutrition, which can lead to an increase in BMI. Our results show that only CoCr-RPD wearers were able to chew consistent food, whereas PMMA- RPD and V-RPD, due to the properties of the materials, their instability, and the possibility of causing pain during mastication, determined a limitation in the choice of food for many of the participants.

Clinical Evidence in the Treatment of Obstructive Sleep Apnoea with Oral Appliances: A Systematic Review.

BACKGROUND: Recent clinical guidelines have extended indications for oral appliances to subjects affected by moderate-to-severe obstructive sleep apnoea (OSA). The aim of this systematic review covering this important issue for public health is twofold: updating and summarizing the best available scientific evidence by selecting RCTs of quality only, and identifying the therapeutic pathways that can be transferred to the current clinical practice. METHODS: All the abstracts which were published before February 18, 2019, have been identified in three electronic databases (PubMed, Web of Science, and Cochrane). The Cochrane Collaboration's tool for assessing risk of bias was used as an assessment tool in order to evaluate the quality of the selected studies. RESULTS: The search strategy yielded 2,260 studies. After removing duplicates and studies that did not comply with the inclusion criteria, 32 full-text articles were assessed for eligibility, and 17 RCTs were finally included in the qualitative synthesis. The 17 selected studies were very heterogeneous in the type of included RCTs in terms of patient inclusion criteria, sample size, distribution of the two genders in the various groups, duration of treatment, and definition of primary and secondary outcomes, without any restriction on the definition of the control group. A common finding was the positive responsiveness of oral appliance treatment in subjects affected by mild-to-moderate OSA with some evidence for cases of severe OSA. CONCLUSION: Higher-quality studies are needed in order to provide additional useful guidelines for dental clinicians for OSA management.

Patient Satisfaction with Implant-Supported Monolithic and Partially Veneered Zirconia Restorations.

The digital workflow and the application of Computer-Aided Manufacturing (CAM) to prosthodontics present the clinician with the possibility of adopting new materials that confer several advantages. Especially in the case of zirconia, these innovations have profoundly changed daily practice. This paper compares the satisfaction and perception of patients who received implant-supported single crowns (SC) and fixed partial dentures (FPD) made from zirconia, either monolithic or partially veneered, after 3 years of follow-up; the success and survival rate of these restorations were also measured. Forty patients, who had been previously treated with implant-supported SC or FPD, either monolithic or partially veneered, and submitted to a yearly maintenance program, were recalled 3 years after their treatment and requested to complete an 8-question questionnaire regarding their perceptions of the treatment. Any mechanical or biological complication that had occurred from the time of delivery was also recorded. Patients that experienced ≥1 complication were less likely to be prone to repeat the treatment. The 3-year success rate was 92.6% for monolithic restoration and 92.3% for partially veneered restoration, while the survival rate was 100% for both restorations. The 3-year follow-up found that monolithic and partially veneered zirconia restorations are both well-accepted treatment options, and patients preferred the veneered restorations (0.76, p < 0.05) from an aesthetic point of view. According to our results, monolithic and veneered zirconia restorations are both reliable treatment options and are both equally accepted by patients.

Orthodontic debonding and tooth sensitivity of anterior and posterior teeth.

OBJECTIVES: To assess whether orthodontic debonding and onset of tooth sensitivity were related and if anterior and posterior teeth showed different sensitivity. MATERIALS AND METHODS: 40 patients were divided into a trial group (group 1, at the end of the multibracket treatment) and a control group (group 2, not under treatment). After the application of compressed air and cold water to mandibular incisors and first molars, participants were asked to report the pain felt for each tooth using a 100-mm visual analogue scale. In group 1, assessment was performed just before debonding (T0), immediately after completion of debonding (T1) and 7 days after (T2). In group 2, values were assessed at the beginning of a follow-up visit (T0), at the end of the same visit (T1) and 7 days after (T2). RESULTS: Considering overall teeth, statistical analyses showed significantly higher values in the trial group at T1 after both stimuli, especially after cold water, besides a significant difference between T0 and T2 values in the same group. Anterior teeth showed significantly higher VAS scores than posterior after the two thermal stimuli, except after air stimulation in group 1 at T2 and in group 2. CONCLUSIONS: Orthodontic debonding leads to sensitivity to thermal stimuli especially in the anterior teeth, however pain level is restored within 7 days.

Evaluation of structural skeletal asymmetry of the glenoid fossa in adult patients with unilateral posterior crossbite using surface-to-surface matching on CBCT images.

OBJECTIVES: To compare, using surface-to-surface (StS) matching, any shape differences between the crossbite and noncrossbite side of the glenoid fossa and articular eminence in adult patients affected by posterior unilateral crossbite (PUXB) and compare them with unaffected controls. MATERIALS AND METHODS: 32 cone beam computed tomography (CBCT) scans of patients (mean age: 23.72 ± 3.74 years) undergoing surgical maxillary expansion were analyzed to obtain three-dimensional models of the left and right glenoid fossae that were superimposed using stable anatomical reference points and then compared using StS matching to evaluate the presence of any shape differences. These findings were compared with those obtained from 16 CBCT scans of unaffected controls (mean age: 23.72 ± 3.73 years). RESULTS: A mean difference of >11% was found between the study group and controls when comparing the matching percentages of the two sides of the glenoid fossa and articular eminence at all three levels of tolerance selected for this study. These differences were found to be highly statistically significant (P ≤ .0001). CONCLUSIONS: According to the shape analysis findings, adult PUXB patients exhibit a higher degree of glenoid fossa and articular eminence shape differences compared to unaffected controls.

Evaluation of the changes of orbital cavity volume and shape after tooth-borne and bone-borne rapid maxillary expansion (RME).

OBJECTIVE: To assess and compare volumetric and shape changes of the orbital cavity in patients treated with tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME). STUDY DESIGN: Forty adolescents with bilateral maxillary cross-bite received tooth-borne (TB group = 20; mean age 14.27 ± 1.36 years) or bone-borne (BB group = 20; mean age of 14.62 ± 1.45 years) maxillary expander. Cone-beam computed tomography (CBCT) were taken before treatment (T1) and 6-month after the expander activation (T2). Volumetric and shape changes of orbital cavities were detected by referring to a specific 3D digital technology involving deviation analysis of T1/T2 CBCT-derived models of pulp chamber. Student's t tests were used to 1) compare T1 and T2 volumes of orbital cavities in TB and BB groups, 2) compare volumetric changes and the percentage of matching of 3D orbital models (T1-T2) between the two groups. RESULTS: Both TB and BB groups showed a slight increase of the orbital volume (0.64 cm3 and 0.77 cm3) (p < 0.0001). This increment were significant between the two groups (p < 0.05) while no differences were found in the percentage of matching of T1/T2 orbital 3D models (p > 0.05). The areas of greater changes were detected in the proximity of the frontozygomatic and frontomaxillary sutures. CONCLUSION: TB-RME and BB-RME would not seem to considerably affect the anatomy or the volume of the orbital cavity in adolescents.

Patient and Operator Centered Outcomes in Implant Dentistry: Comparison between Fully Digital and Conventional Workflow for Single Crown and Three-Unit Fixed-Bridge.

BACKGROUND: Scientific information about the effects of implant therapy following a precise workflow and patient and operators' preferences should be considered to choose which implant treatment protocol to use, and to achieve patient's satisfaction and functional results. The aim of this study was to analyze implant rehabilitations with a fully digital workflow and compare this approach with a conventional one. METHODS: This study comprises 64 patients treated with a fully digital approach and 58 patients treated using a conventional protocol. Patient and operator centered outcomes were assessed through two visual analogue scale (VAS) questionnaires. RESULTS: The VAS questionnaire demonstrated better results for the digital workflow concerning anxiety, convenience, taste, nausea sensation, pain and breathing difficulties (p < 0.0001). The VAS questionnaire administered to the operators showed better scores for the digital approach in relation to anxiety, convenience, difficulties of the impression procedure and the workflow (p < 0.0001). A significant reduced mean time for the digital workflow as well as a reduced number of required visits were recorded. CONCLUSION: The analysis of a fully digital and a conventional protocol showed better results according to patient and operators' preferences when a fully digital approach was used.

One Step before 3D Printing-Evaluation of Imaging Software Accuracy for 3-Dimensional Analysis of the Mandible: A Comparative Study Using a Surface-to-Surface Matching Technique.

The accuracy of 3D reconstructions of the craniomaxillofacial region using cone beam computed tomography (CBCT) is important for the morphological evaluation of specific anatomical structures. Moreover, an accurate segmentation process is fundamental for the physical reconstruction of the anatomy (3D printing) when a preliminary simulation of the therapy is required. In this regard, the objective of this study is to evaluate the accuracy of four different types of software for the semiautomatic segmentation of the mandibular jaw compared to manual segmentation, used as a gold standard. Twenty cone beam computed tomography (CBCT) with a manual approach (Mimics) and a semi-automatic approach (Invesalius, ITK-Snap, Dolphin 3D, Slicer 3D) were selected for the segmentation of the mandible in the present study. The accuracy of semi-automatic segmentation was evaluated: (1) by comparing the mandibular volumes obtained with semi-automatic 3D rendering and manual segmentation and (2) by deviation analysis between the two mandibular models. An analysis of variance (ANOVA) was used to evaluate differences in mandibular volumetric recordings and for a deviation analysis among the different software types used. Linear regression was also performed between manual and semi-automatic methods. No significant differences were found in the total volumes among the obtained 3D mandibular models (Mimics = 40.85 cm3, ITK-Snap = 40.81 cm3, Invesalius = 40.04 cm3, Dolphin 3D = 42.03 cm3, Slicer 3D = 40.58 cm3). High correlations were found between the semi-automatic segmentation and manual segmentation approach, with R coefficients ranging from 0,960 to 0,992. According to the deviation analysis, the mandibular models obtained with ITK-Snap showed the highest matching percentage (Tolerance A = 88.44%, Tolerance B = 97.30%), while those obtained with Dolphin 3D showed the lowest matching percentage (Tolerance A = 60.01%, Tolerance B = 87.76%) (p < 0.05). Colour-coded maps showed that the area of greatest mismatch between semi-automatic and manual segmentation was the condylar region and the region proximate to the dental roots. Despite the fact that the semi-automatic segmentation of the mandible showed, in general, high reliability and high correlation with the manual segmentation, caution should be taken when evaluating the morphological and dimensional characteristics of the condyles either on CBCT-derived digital models or physical models (3D printing).