Effects of minimally invasive non-surgical therapy on C-reactive protein, lipoprotein-associated phospholipase A2, and clinical outcomes in periodontitis patients: A 1-year randomized, controlled clinical trial.

BACKGROUND: Growing evidence suggests the type of periodontal treatment could differentially influence the reduction of key cardiovascular risk mediators in periodontitis patients. This randomized, controlled clinical trial compared the impact of minimally invasive non-surgical therapy (MINST) with quadrant-wise subgingival instrumentation (Q-SI) on C-reactive protein (CRP) together with lipoprotein-associated phospholipase A2 (Lp-PLA2) levels, and clinical periodontal outcomes in patients with periodontitis. Moreover, it was evaluated if baseline CRP levels impacted the efficacy of non-surgical periodontal therapy protocols. METHODS: Forty-two periodontitis patients were enrolled and randomly treated by means of MINST (n = 21) or Q-SI (n = 21). The outcomes assessed were serum CRP and Lp-PLA2, and periodontal parameters (probing depth [PD], clinical attachment level [CAL], full-mouth bleeding score [FMBS]), at baseline and at follow-ups at 1, 3, and 6 months and at 1 year after treatment. RESULTS: At 1 year, MINST significantly reduced, among others, mean PD (p = 0.007), mean CAL (p = 0.007), the number of pockets >4 mm (p = 0.011) and ≥6 mm (p = 0.005), and FMBS (p = 0.048) compared to Q-SI. Generalized multivariate analysis evidenced that high baseline CRP (p = 0.039) and FMBS (p = 0.046) levels, together with MINST treatment (p = 0.007) were significant predictors of PD reduction at 1-year follow-up. Moreover, the Jonckheere-Terpstra test showed that patients with high baseline CRP levels gained more benefits from MINST treatment at 1-year follow-up than they did from Q-SI. CONCLUSION: Patients receiving MINST showed a greater reduction in CRP levels than patients with Q-SI after 1 year of follow-up. Moreover, patients with high baseline levels of CRP and Lp-PLA2 gained more benefits from the MINST approach at 1-year follow-up.

Indications for Dental Specialists for Treating Obstructive Sleep Apnea with Mandibular Advancement Devices: A Narrative Review.

Obstructive sleep apnea (OSA) syndrome is characterized by repeated airway collapse during sleep. It determines cardiovascular, pulmonary, and neurocognitive consequences and is associated with several daytime and nighttime symptoms that influence the patient's quality of life. The contribution of the dental specialist in the clinical management of OSA patients entails participating in the screening process as diagnostic sentinels and providing adequate treatment using mandibular advancement devices (MADs). Since the treatment of OSA requires a multidisciplinary approach, including different medical specialists, dentists should have a comprehensive understanding of medical and dental factors that influence the strategy and effectiveness of OSA treatment with MAD. Such expertise is crucial in determining the appropriate treatment indications and helps clinicians establish a consolidated position within the multidisciplinary OSA team. In this regard, this review summarizes the evidence of the clinical indications for MAD treatment and provides the dental specialist with helpful information about medical, functional, and other relevant factors that should be considered during diagnosis, treatment plan, and follow-up stages. Information retrieved was organized and discussed, generating specific domains/queries oriented to the clinical management of OSA patients from the clinical perspective of dental specialists.

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.

Up regulation of serum L fucose glycoprotein as a diagnostic biomarker for dysplasia in oral sub mucous fibrosis patients.

Glycoproteins, essential for cellular functions, contain monosaccharides like Levo-fucose, crucial for cell communication. Recent research highlights serum L-fucose as a potential biomarker for early detection of malignancies. Typically, serum L-fucose levels are low but rise with malignancy. This study evaluates serum L-fucose as an early biomarker in oral submucous fibrosis (OSMF) patients. Aim: Assess serum L-fucose's diagnostic potential for dysplasia in OSMF patients. Objectives: Determine the Association between Serum L Fucose Glycoprotein Levels and Dysplasia in OSF Patients.Evaluate the Diagnostic Accuracy of Serum L Fucose Glycoprotein as a Biomarker for OSF-Related Dysplasia. Methodology: Over a span of two years, this study encompassed 80 subjects, aged between 18 and 60 years, who were clinically and histopathologically identified as OSMF patients, with or without dysplastic alterations. From each participant, 5 ml of blood was collected. Following centrifugation to separate the serum, the samples were analyzed to determine the levels of Levo-fucose. Statistical analysis: Using SPSS (version 17.0), serum L-Fucose levels of the case group were compared to the control group using ANOVA. Frequencies were analyzed with the chi-square test, and Tukey's Test was used for multiple comparisons. Significance was set at p < 0.01. Results: The analysis revealed a statistically significant disparity in the mean serum L-Fucose levels between the two groups (p < 0.01). Notably, Group II patients (those with OSMF and dysplasia) exhibited markedly elevated mean serum L-fucose levels. Conclusion: Elevated serum L-Fucose levels were observed in OSMF patients with dysplasia. Harmful habits, especially gutkha chewing, were linked to Oral Squamous Cell Carcinoma onset. Serum L-fucose can be a reliable marker for evaluating precancerous conditions.

Dental implant survival in epidermolysis bullosa patients: A systematic review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions.

Background: Epidermolysis bullosa (EB) is a genetic syndrome afflicting skin and mucous membranes. The manifestation depends on the form: in mild conditions, occasionally, vesicular-bullous lesions of the oral cavity may be present, which heal spontaneously without leaving scars. Patients following joint rupture have scars that limit food intake and restrict quality of life. This study aims to evaluate the possibility of carrying out an implant therapy and the success rate of this therapy. Methods: Until January 3, 2000, PubMed, Web of Science, and Lilacs were searched. Clinical studies were selected that considered implant therapy in patients with epidermolysis bullosa. Articles were therefore selected that addressed oral health and implant survival in patients with epidermolysis, with no differentiation between the various subtypes. A risk of bias assessment was performed through Cochrane. Results: Twenty-one studies were found after the investigation. Only five were chosen to create the current systematic study; 16 articles were skipped over. 10 papers were disregarded because they had been reviewed; 4 were ignored because they contained case studies; and two were omitted because they were not written in English. The results show that implant survival is at around 97%. Conclusions: Patients with epidermolysis bullosa can be treated with implant therapy without the risk of an increased implant failure rate. Indicate the main conclusions or interpretations.

Applications of artificial intelligence in the utilisation of imaging modalities in dentistry: A systematic review and meta-analysis of in-vitro studies.

Background: In the past, dentistry heavily relied on manual image analysis and diagnostic procedures, which could be time-consuming and prone to human error. The advent of artificial intelligence (AI) has brought transformative potential to the field, promising enhanced accuracy and efficiency in various dental imaging tasks. This systematic review and meta-analysis aimed to comprehensively evaluate the applications of AI in dental imaging modalities, focusing on in-vitro studies. Methods: A systematic literature search was conducted, in accordance with the PRISMA guidelines. The following databases were systematically searched: PubMed/MEDLINE, Embase, Web of Science, Scopus, IEEE Xplore, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar. The meta-analysis employed fixed-effects models to assess AI accuracy, calculating odds ratios (OR) for true positive rate (TPR), true negative rate (TNR), positive predictive value (PPV), and negative predictive value (NPV) with 95 % confidence intervals (CI). Heterogeneity and overall effect tests were applied to ensure the reliability of the findings. Results: 9 studies were selected that encompassed various objectives, such as tooth segmentation and classification, caries detection, maxillofacial bone segmentation, and 3D surface model creation. AI techniques included convolutional neural networks (CNNs), deep learning algorithms, and AI-driven tools. Imaging parameters assessed in these studies were specific to the respective dental tasks. The analysis of combined ORs indicated higher odds of accurate dental image assessments, highlighting the potential for AI to improve TPR, TNR, PPV, and NPV. The studies collectively revealed a statistically significant overall effect in favor of AI in dental imaging applications. Conclusion: In summary, this systematic review and meta-analysis underscore the transformative impact of AI on dental imaging. AI has the potential to revolutionize the field by enhancing accuracy, efficiency, and time savings in various dental tasks. While further research in clinical settings is needed to validate these findings and address study limitations, the future implications of integrating AI into dental practice hold great promise for advancing patient care and the field of dentistry.

Analysis of maxillary asymmetry before and after treatment of functional posterior cross-bite: a retrospective study using 3D imaging system and deviation analysis.

BACKGROUND: Previous evidence would suggest that subjects affected by functional posterior cross-bite (FPXB) present an asymmetric morphology of the maxilla. However, no evidence is available concerning the morphology (symmetry/asymmetry) of the maxilla after treatment of FPXB. This study aimed to investigate the volumetric and morphological changes of the palate in FPXB subjects treated with maxillary expansion and to compare these data with an untreated control group. The study sample included 20 FPXB subjects (mean age 8.1 ± 0.9 years) who underwent maxillary expansion (MEG group) and 21 FPXB subjects (mean age 7.7 ± 1.2 years) as controls (CG group). Digital models were recorded at T0 (first observation) and T1 (12-18 months after first observation) and analyzed to assess palatal volume and symmetry. Deviation analysis and percentage matching calculation were also performed between original and mirrored palatal models for each patient. All data were statistically analyzed for intra-timing, inter-timing and inter-groups assessments. RESULTS: At T0, the cross-bite side (CBS) was significantly smaller than non-cross-bite side (non-CBS) in both groups (p < 0.05). At T1, the CBS/non-CBS difference reduced significantly in the MEG group (p < 0.05) while slightly worsened in the CG, however without statistical significance (p > 0.05). The matching percentage of the palatal models improved significantly at T1 in the MEG group (T0 = 74.02% ± 9.8; T1 = 89.95% ± 7.12) (p < 0.05) while no significant differences were recorded in the CG (T0 = 76.36 ± 8.64; 72.18% ± 9.65) (p > 0.05). LIMITATIONS: The small sample size and the retrospective design of the study represent two limitations that should be overcome with further clinical trials. CONCLUSIONS: Subjects with FPXB present an asymmetric development of the maxillary vault that improves after reestablishment of normal occlusion following maxillary expansion.

The Potential of Nano-Based Photodynamic Treatment as a Therapy against Oral Leukoplakia: A Narrative Review.

Oral leukoplakia is a predominantly white lesion of the oral mucosa that cannot be classified as any other definable lesion with the risk of progressing into malignancy. Despite the advancements in conventional therapy, the rates of malignant transformation remain notably high, affecting 4.11% of adults, due to the difficulty of accurate diagnosis and indistinct treatment. Photodynamic therapy (PDT), being a minimally invasive surgical intervention, employs a variety of factors, including light, nano-photosensitizers (PSs) and oxygen in the management of precancerous lesions. PDT faces limitations in administering photosensitizers (PSs) because of their low water solubility. However, these challenges could be effectively resolved through the incorporation of PSs in nanostructured drug delivery systems, such as gold nanoparticles, micelles, liposomes, metal nanoparticles, dendrimers and quantum dots. This review will give an overview of the different innovative PS approaches in the management of premalignant lesions, highlighting the most recent advancements. From a clinical perspective, it is expected that nanotechnology will overcome barriers faced by traditional therapeutics and will address critical gaps in clinical cancer care.

Advanced Applications in Pediatric Dentistry: A Worldwide Perspective of the Last 13 Years.

The enhancement of the clinical management of growing patients has always been a great challenge for orthodontists and pediatric dentists [...].

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.

Growth differentiation factor-15 and circulating biomarkers as predictors of periodontal treatment effects in patients with periodontitis: a randomized-controlled clinical trial.

BACKGROUND: During the last decades, in patients with periodontitis, periodontal treatment has been shown to reduce the potential release of local and systemic biomarkers linked to an early risk of systemic inflammatory disorders. This study evaluated the efficacy of non-surgical-periodontal treatment (NSPT) on growth differentiation factor 15 (GDF-15) and related circulating biomarkers such as glutathione peroxidase 1 (GPx-1), c-reactive protein (hs-CRP), and surfactant protein D (SP-D) in periodontal patients and explored whether subjects who had high GDF-15 levels at baseline showed increased clinical benefits following NSPT at 6-months follow-up. METHODS: For this two-arm, parallel randomized clinical trial, patients with periodontitis were randomly allocated to receive quadrant scaling and root-planing (Q-SRP, n = 23, median age 51 years old) or full-mouth disinfection (FMD, n = 23, median age 50 years old) treatment. Clinical and periodontal parameters were recorded in all enrolled patients. The primary outcome was to analyse serum concentrations changes of GDF-15 and of GPx-1, hs-CRP, and SP-D at baseline and at 30, 90, and 180-days follow-up after NSPT through enzyme-linked immunosorbent assay (ELISA) and nephelometric assay techniques. RESULTS: In comparison with FMD, patients of the Q-SRP group showed a significant improvement in clinical periodontal parameters (p < 0.05) and a reduction in the mean levels of GDF-15 (p = 0.005), hs-CRP (p < 0.001), and SP-D (p = 0.042) and an increase of GPx-1 (p = 0.025) concentrations after 6 months of treatment. At 6 months of treatment, there was a significant association between several periodontal parameters and the mean concentrations of GDF-15, GPx-1, hs-CRP, and SP-D (p < 0.05 for all parameters). Finally, the ANOVA analysis revealed that, at 6 months after treatment, the Q-SRP treatment significantly impacted the reduction of GDF-15 (p = 0.015), SP-D (p = 0.026) and the upregulation of GPx-1 (p = 0.045). CONCLUSION: The results evidenced that, after 6 months of treatment, both NSPT protocols improved the periodontal parameters and analyzed biomarkers, but Q-SRP was more efficacious than the FMD approach. Moreover, patients who presented high baseline GDF-15 and SP-D levels benefited more from NSPT at 6-month follow-up. TRIAL REGISTRATION: NCT05720481.

External root resorption and rapid maxillary expansion in the short-term: a CBCT comparative study between tooth-borne and bone-borne appliances, using 3D imaging digital technology.

BACKGROUND: The aim of the study was to analyze and compare external root resorption (ERR) in patients treated with tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME). METHODS: The sample included 40 subjects who received tooth-borne RME (TB group, average age: 13.1 ± 1.08 years) or bone-borne RME (BB group, average age: 14.5 ± 1.11 years) and Cone-beam computed tomography (CBCT) scans before treatment (T0) and after 3-month of retention (T1). A specific 3D Imaging technology was used to generate 3D models of posterior dentition (M1 = maxillary first molars, P2 = second premolars, P1 = first premolar) and calculate volumetric data (mean and percentage values) and shape changes, the latter obtained from deviation analysis between the radicular models at different time points. Evaluation of radicular length changes was performed for each tooth. Data were statistically analysed to perform intra-timing and inter-groups comparisons. RESULTS: A significant reduction of radicular volume and length was found in posterior dentition in both groups (p < 0.05), and the M1 (volume) and its palatal root (length) were mostly involved in this response. No differences were found between M1, P1 and P2 (p > 0.05) when volumetric changes were calculated as percentage of the total volume. Deviation analysis revealed that the radicular areas mostly affected by shape change were the apex and bucco-medial side. The amount of ERR was significantly greater in TB group compared to BB group. CONCLUSIONS: BB-RME treatment could reduce the amount of ERR at the post-expansion stage.

Comparative Analysis of Skeletal Changes, Occlusal Changes, and Palatal Morphology in Children with Mild Class III Malocclusion Treated with Elastodontic Appliances and Bimaxillary Plates.

BACKGROUND: The aim of the present study was to compare the changes observed in children after the early treatment of mild class III malocclusion using bimaxillary removable plates supported by class III elastics and elastodontic devices. METHODS: Twenty children (mean age 7.6 ± 1.1 years) with signs of class III malocclusion were treated using by-maxillary plates (PG group) with class III elastics (10 subjects = mean age 7.9 ± 1.3 years) or using class III elastodontic devices (EG group) (10 subjects = mean age 7.4 ± 0.8 years). Digital models and lateral cephalograms were obtained before treatment (T0) and at the end of treatment (T1). The digital models were analyzed to assess occlusal changes and maxillary morphology using the surface-to-surface matching technique. Changes in cephalometric parameters were also analyzed. The data outcomes were statistically analyzed using the paired Student's t test for inter-timing assessments and the independent Student's t test for inter-group assessments. RESULTS: Both groups showed correction of class III malocclusions, with a significant increase in the ANB angle and the overjet (p < 0.05). Subjects in the PG group exhibited a greater reduction in the inter-incisal angle compared to the EG group (p < 0.05). The children in the EG group had a significantly lower percentage of palatal morphology matching between T0 and T1 compared to the PG group (p < 0.05), suggesting greater morphological changes in the palate. CONCLUSIONS: Elastodontic appliances (EAs) and bi-maxillary plates successfully correct class III malocclusions in children. However, elastodontic devices significantly improved the morphology of the palate, both in the transverse and anteroposterior directions.

The Use of Diode Low-Power Laser Therapy before In-Office Bleaching to Prevent Bleaching-Induced Tooth Sensitivity: A Clinical Double-Blind Randomized Study.

INTRODUCTION: The present study aimed to investigate the effectiveness of low-level laser therapy (LLLT) use before in-office bleaching to prevent an increase in the risk and intensity of tooth sensitivity. METHODS: Thirty patients were selected. Before bleaching with 38% hydrogen peroxide, the participants were randomly divided into two groups of 15 subjects. Test group: the patients' teeth were subjected to a preliminary LLLT procedure by an 810 nm diode laser with 0.5 W for 30 s for an energy density of 15 J/cm2 and a group placebo. All patients were instructed to report their cold sensitivity experiences immediately, 1 h, 24 h, and 48 h after the end of bleaching via a VAS score. RESULTS: The results obtained show an increase in VAS values for both groups (290 and 490 vs. 224 and 234 of baseline time of test and placebo group, respectively); afterward, the VAS value seemingly decreases at 1 h after the end of bleaching, approaching the baseline VAS for the test group (274) in comparison to the placebo group. CONCLUSIONS: The use of preliminary diode LLLT could represent a valid possibility to reduce the occurrence of tooth sensitivity post-whitening and shorten recovery time in cases where tooth sensitivity occurs.

Three-dimensional analysis of miniscrew position changes during bone-borne expansion in young and late adolescent patients.

INTRODUCTION: Maxillary expansion in patients at the end of their growth relies on the possibility to use miniscrew supported expanders to apply expansion forces directly to the midpalatal suture. Although miniscrews provide a stable anchorage unit, several studies have reported that they do not remain in exactly the same position during treatment. The aim of the present study was to analyze miniscrew position changes after the expansion using bone-borne appliances in late adolescent patients. METHODS: Nineteen patients (13 females, 6 males), with a mean age of 17.81 (SD = 4.66), were treated with a Bone-Borne Expander Device. The appliance was designed with 4 miniscrews: 2 in the anterior palatal area, at the third rugae level; 2 in the posterior area. A CBCT and an intraoral scan were obtained before treatment (T0), and then, a second CBCT was obtained after the expansion (T1). Data on peri-suture bone thickness were collected at T0, then the CBCTs were superimposed, and changes between mini-screws position on T0 and T1 were evaluated, both by linear and angular displacements. RESULTS: Significant longitudinal differences were found in the distance of the head and the tip of miniscrews measured at the occlusal plane, as well as angular changes. Correlations between displacement measurements and peri-suture bone thickness and height measurements were found as well. CONCLUSIONS: While acting as bone anchor units, miniscrews do not remain in the same position during bone-borne expansion. The amount of displacement was related to peri-sutural total bone height and cortical thickness, especially in the anterior area of the naso-frontal maxillary complex.

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.

Accuracy (trueness and precision) of 3D printed orthodontic models finalized to clear aligners production, testing crowded and spaced dentition.

BACKGROUND: The study's objective was to assess the accuracy (trueness and precision) of orthodontic models obtained from crowded and spaced dentition finalized for the production of clear aligners. Four 3D printers featuring different technologies and market segments were used for this purpose. METHODS: Two digital master models were obtained from two patients featuring respectively crowded dentition (CM group) and diastema/edentulous spaces (DEM group). The 3D printers tested were: Form 3B (SLA technology, medium-professional segment), Vector 3SP (SLA technology, industrial segment), Asiga Pro 4K65 (DLP technology, high-professional segment), and Anycubic Photon M3 (LCD technology, entry-level segment). Each 3D printed model was scanned and superimposed onto the reference master model and digital deviation analysis was performed to assess the trueness and precision calculated as root mean square (RMS). All data were statistically examined to obtain intra-group and inter-groups comparisons(p 0.05). RESULTS: In both CM and DEM groups, SLA 3D printers (Vector 3SP and Form 3B) showed lower trueness error compared to DLP/LCD technologies (Asiga Pro 4K65, Anycubic Photon M3) (p < 0.001). In general, the entry-level printer (Anycubic Photon M3) showed the greatest trueness error (p < 0.001). Comparing CM and DEM models generated with the same 3D printer, statistically significant differences were found only for Asiga Pro 4k65 and Anycubic Photon M3 printers (p > 0.05). Concerning data of precision, the DLP technology (Asiga Pro 4k65) showed lower error compared to the other 3D printers tested. The trueness and precision errors were within the accepted clinical error for clear aligner manufacturing (< 0.25 mm), with the entry-level 3D printer nearly reaching this value. CONCLUSIONS: The accuracy of orthodontic models generated for clear aligners can be affected by different 3D printer technologies and anatomical characteristics of dental arches.

Tooth automatic segmentation from CBCT images: a systematic review.

OBJECTIVES: To describe the current state of the art regarding technological advances in full-automatic tooth segmentation approaches from 3D cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: In March 2023, a search strategy without a timeline setting was carried out through a combination of MeSH terms and free text words pooled through Boolean operators ('AND', 'OR') on the following databases: PubMed, Scopus, Web of Science and IEEE Explore. Randomized and non-randomized controlled trials, cohort, case-control, cross-sectional and retrospective studies in the English language only were included. RESULTS: The search strategy identified 541 articles, of which 23 have been selected. The most employed segmentation methods were based on deep learning approaches. One article exposed an automatic approach for tooth segmentation based on a watershed algorithm and another article used an improved level set method. Four studies presented classical machine learning and thresholding approaches. The most employed metric for evaluating segmentation performance was the Dice similarity index which ranged from 90 ± 3% to 97.9 ± 1.5%. CONCLUSIONS: Thresholding appeared not reliable for tooth segmentation from CBCT images, whereas convolutional neural networks (CNNs) have been demonstrated as the most promising approach. CNNs could help overcome tooth segmentation's main limitations from CBCT images related to root anatomy, heavy scattering, immature teeth, metal artifacts and time consumption. New studies with uniform protocols and evaluation metrics with random sampling and blinding for data analysis are encouraged to objectively compare the different deep learning architectures' reliability. CLINICAL RELEVANCE: Automatic tooth segmentation's best performance has been obtained through CNNs for the different ambits of digital dentistry.

Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review.

Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: "what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures" and "the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars"? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.

Geometric Morphometric Analysis of Mandibular Symphysis Growth between 12 and 15 Years of Age in Class II Malocclusion Subjects.

The aim of the present paper was to evaluate the morphology changes of the mandibular symphysis (MS) in a longitudinal retrospective cohort of class II untreated subjects. The study sample included 120 subjects followed during normal growth and examined at the age of 12 (T0) and 15 (T1) years. MS was traced using two landmarks and ten sliding semi-landmarks. The acquired morphological data were processed via Procrustes superimposition that allowed to study variation and covariation in MS'form according to specific variables such as age, gender, and skeletal pattern. The first two principal components (PCs) described more than 90 % of the total morphological variation. Both types of form changes of the symphysis could be associated with the different skeletal vertical growth patterns. Age and sex did not interfere with the form of chin symphysis. Moreover, there was no significant covariation between initial MS morphology and form modifications. Clinicians should not expect to be faced with spontaneous changes of the form of the symphysis during the orthodontic treatment of adolescents.