Italian guidelines for the prevention and management of dental trauma in children.

Dental trauma is a frequent occurrence in children and adolescent and a correct diagnosis and treatment are essential for a favourable long-term prognosis. The present Guidelines aim to formulate evidence-based recommendations to assist dentists, paediatricians, surgeons, teachers, school and sport staff, parents in the prevention and first aid of dental trauma in children and to provide a careful assessment of the medico-legal implications, reviewing the first draft of the guidelines published in 2012. A multidisciplinary panel on the behalf of the Italian Ministry of Health and in collaboration with the WHO Collaborating Centre for Epidemiology and Community Dentistry of Milan, developed this document. The following four queries were postulated: 1) Which kind of precautions the health personnel, parents, sports and educational personnel must activate in order to prevent the dental trauma damage? 2) How an orofacial trauma in paediatric patients should be managed either in the Emergency Care Unit and/or in private dental office? 3) What criteria should be adopted by a dentist private practitioner to fill in a certificate in cases of dental and/or tempomandibular joint trauma occurring in children and adolescents? 4) What are the elements that should lead clinicians to suspect a non-accidental dental trauma? A systematic review and analysis of the scientific literature published in English, Italian and French from 2007 to 2017 regarding dental trauma in children and adolescents aged 0-18 years was performed, and about 100 papers were analysed and included. The following four domains were analysed and discussed: Dental Trauma Prevention Strategies and Health Education, First aid in orofacial and dental trauma, Certificate of the dental trauma, Oral and dental signs of child abuse and neglect. Twenty-eight recommendations were draw up and codified by the panel according to the Methodological handbook, produced by the Istituto Superiore di Sanità, in order to guide physicians in the prevention and first aid of dental trauma in children and adolescents. In addition, a careful assessment of the medico-legal implications is reported in this document.

Some inconsistencies in Demirjian's method.

Nowadays, given the massive migration movements toward and across EU countries, age assessment can be highly useful for estimating the real age of asylum seekers or in medico-legal assessments of age-disputed children charged with criminal acts. Demirjian et al.'s dental maturity score is currently a dental scoring system universally adopted for age assessment of unidentified children. Here we explore the biological compatibility of Demirjian's scores with respect to the estimation of certain chronological ages of forensic interest through an algorithm based on the theory of constrained graphs integrated with combinatory analysis. Rather than simply respect Demirjian's indications (direct method) on a sample of children, we followed a reverse procedure (indirect method) as follows: i. chronological age selection and identification of the corresponding maturity score (MS); ii. determination of all the possible combinations of dental maturity stages whose sum of the scores is equal to the MS under consideration; iii. checking for all such possible combinations the biological congruity of the state of maturity of each tooth compared to the chronological age initially chosen. By evidencing dental development inconsistencies, our mathematical approach explains why Demirjian's method typically overestimates age. Therefore, even if the method in question remains the recommended way to assess individual dental maturity, it should definitely be considered unsuitable for application in certain forensic scenarios, particularly as regards the most disputed age range 14-16 years.

Three-Dimensional Anthropometric Database of Attractive Caucasian Women: Standards and Comparisons.

The aim of this paper is to develop a database to determine a new biomorphometric standard of attractiveness. Sampling was carried out using noninvasive three-dimensional relief methods to measure the soft tissues of the face. These anthropometric measurements were analyzed to verify the existence of any canons with respect to shape, size, and measurement proportions which proved to be significant with regard to the aesthetics of the face. Finally, the anthropometric parameters obtained were compared with findings described in the international literature.The study sample was made up competitors in the Miss Italy 2010 and 2009 beauty contest. The three-dimensional (3D) scanning of soft tissue surfaces allowed 3D digital models of the faces and the spatial 3D coordinates of 25 anthropometric landmarks to be obtained and used to calculate linear and angular measurements. A paired Student t test for the analysis of the means allowed 3 key questions in the study of biomorphometric parameters of the face to be addressed through comparison with the data available in the literature.The question of statistical evidence for the samples analyzed being members of the populations samples reported in literature was also addressed.The critical analysis of the data helped to identify the anthropometric measurements of the upper, middle, and lower thirds of the face, variations in which have a major influence on the attractiveness of the face. These changes involve facial width, height, and depth. Changes in measurements of length, angles, and proportions found in the sample considered were also analyzed.

Comparison of soft-tissue orbital morphometry in attractive and normal Italian subjects.

OBJECTIVE: To identify esthetic characteristics of the orbital soft tissues of attractive Italian adult women and men. MATERIALS AND METHODS: Three-dimensional computerized digitizers were used to collect the coordinates of facial landmarks in 199 healthy, normal subjects aged 18 to 30 years (71 women, 128 men; mean age, 22 years) and in 126 coetaneous attractive subjects (92 women, 34 men; mean age, 20 years) selected during beauty competitions. From the landmarks, six linear distances, two ratios, six angles, and two areas were calculated. Attractive subjects were compared with normal ones by computing z-scores. RESULTS: Intercanthal width was reduced while eye fissure lengths were increased in both genders. Orbital heights (os-or) were increased only in attractive women, with a significant gender-related difference. The inclinations of the eye fissure were increased in attractive subjects, while the inclinations of the orbit were reduced. For several of the analyzed measurements, similar patterns of z-scores were observed for attractive men and women (r  =  .883). CONCLUSION: Attractive women and men had several specific esthetic characteristics in their orbital soft tissues; esthetic reference values can be used to determine optimal goals in surgical treatment.

Three-dimensional methodology for photogrammetric acquisition of the soft tissues of the face: a new clinical-instrumental protocol.

BACKGROUND: The objective of this study is to define an acquisition protocol that is clear, precise, repeatable, simple, fast and that is useful for analysis of the anthropometric characteristics of the soft tissue of the face. METHODS: The analysis was carried out according to a new clinical-instrumental protocol that comprises four distinct phases: (1) setup of portable equipment in the space in which field analysis will be performed, (2) preparation of the subject and spatial positioning, (3) scanning of the subject with different facial expressions, and (4) treatment and processing of data. The protocol was tested on a sample comprising 66 female subjects (64 Caucasian, 1 Ethiopian, and 1 Brazilian) who were the finalists of an Italian national beauty contest in 2010. To illustrate the potential of the method, we report here the measurements and full analysis that were carried out on the facial model of one of the subjects who was scanned. RESULTS: This new protocol for the acquisition of faces is shown to be fast (phase 1, about 1 h; phase 2, about 1.5 min; phase 3, about 1.5 min; phase 4, about 15 min), simple (phases 1 to 3 requiring a short operator training period; only phase 4 requires expert operators), repeatable (with direct palpation of anatomical landmarks and marking of their positions on the face, the problem of identification of these same landmarks on the digital model is solved), reliable and precise (average precision of measurements, 0.5 to 0.6 mm over the entire surface of the face). CONCLUSIONS: This standardization allows the mapping of the subjects to be carried out following the same conditions in a reliable and fast process for all of the subjects scanned.

Calorimetric and thermomechanical properties of titanium-based orthodontic wires: DSC-DMA relationship to predict the elastic modulus.

Orthodontic treatment is strongly dependent on the loads developed by metal wires, and the choice of an orthodontic archwire should be based on its mechanical performance. The desire of both orthodontists and engineers would be to predict the mechanical behavior of archwires. To this aim, Gum Metal (Toyota Central R&L Labs., Inc.), TMA (ORMCO), 35°C Copper NiTi (SDS ORMCO), Thermalloy Plus (Rocky Mountain), Nitinol SE (3M Unitek), and NiTi (SDS ORMCO) were tested according to dynamic mechanical analysis and differential scanning calorimetry. A model was also developed to predict the elastic modulus of superelastic wires. Results from experimental tests have highlighted that superelastic wires are very sensitive to temperature variations occurring in the oral environment, while the proposed model seems to be reliable to predict the Young's modulus allowing to correlate calorimetric and mechanical data. Furthermore, Gum Metal wire behaves as an elastic material with a very low Young's modulus, and it can be particularly useful for the initial stage of orthodontic treatments.

Soft-tissue facial characteristics of attractive Italian women as compared to normal women.

OBJECTIVE: To compare the facial characteristics of two different groups of attractive women with those of reference women. MATERIALS AND METHODS: The three-dimensional coordinates of 50 facial landmarks were collected in 71 healthy reference women (18-30 years old) and in 24 coetaneous "attractive" women selected during two different beauty competitions; soft tissue facial angles, distances, areas, and volumes were computed and compared using analysis of variance. RESULTS: When compared with reference women, both groups of attractive women shared several similar facial characteristics: relatively large forehead (P < .001), reduced mandible (P = .008), and rounded face (reduced surface-to-volume ratio, P = .002). They had a more acute soft tissue profile, an increased upper facial width (P < .001) and middle facial depth, larger mouth, and more voluminous lips (P = .005) than reference women. CONCLUSIONS: Both groups of attractive women had several facial characteristics suggesting babyness. Nonetheless, each group of women was characterized by a different development of these features. Esthetic reference values can be a useful tool for clinicians, but should always consider the characteristics of individual faces.

Soft-tissue facial characteristics of attractive and normal adolescent boys and girls.

OBJECTIVES: To identify possible esthetic canons in facial size and shape of Italian adolescent boys and girls. MATERIALS AND METHODS: The three-dimensional coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw, ears) were collected in 231 healthy, reference adolescents (10- 17 years old) and in 93 similar age group "attractive" adolescents selected by a commercial casting organization. Soft-tissue facial angles, distances, areas, and volumes were computed. Comparisons were made with analysis of variance. RESULTS: Attractive adolescents had wider, shorter, and less deep faces than reference adolescents, with a relatively larger forehead and maxilla, and a reduced mandible relative to the maxilla. Lips were larger and more prominent, and the nasolabial angle was reduced, but in older boys the effect was reversed. The prominence of the soft-tissue profile, and of the maxilla relative to the mandible, were larger in attractive boys, but smaller in attractive girls than in their reference peers. In the horizontal plane, attractive "young" adolescents had a flatter face, while the opposite pattern was observed in the "old" adolescents, with a relatively more prominent chin. Attractive adolescents had smaller noses than reference subjects of the same age and sex. CONCLUSIONS: Overall, all the measurements appeared sufficiently homogenous, and the quantitative characteristics of an "attractive" face well defined. Esthetic reference values can be used to determine optimal timing and goals in orthodontic treatment.

Three-dimensional facial morphometry of attractive children and normal children in the deciduous and early mixed dentition.

OBJECTIVES: To identify possible esthetic canons in facial size and shape of Italian children. MATERIALS AND METHODS: The three-dimensional coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw, ears) were collected in 220 healthy reference children (4-9 years old) and in 89 "attractive" children of a similar age group selected by a commercial casting organization. Soft-tissue facial angles, distances, and volumes were computed. Comparisons were made with the Student's t-test. RESULTS: Attractive children had a larger face than the reference children, with a larger maxilla and forehead; overall, their faces were wider and deeper, but less vertically developed. Lips were more voluminous in attractive children, with a higher mouth. The nose was larger in attractive children than in reference children. The soft-tissue facial profile was more convex in attractive children, with a more prominent maxilla relative to the mandible. CONCLUSIONS: Overall, considering that in the analyzed ages body growth and dental changes are very fast and individually determined, all the measurements appeared sufficiently homogenous, and the quantitative characteristics of an "attractive" face well defined. Esthetic reference values can be used to determine optimal timing and goals in orthodontic treatment.

Three-dimensional facial morphometry of attractive adolescent boys and girls.

OBJECTIVES: To identify reference standards and possible esthetic features of facial size and form of Italian adolescent boys and girls. METHODS AND SUBJECTS: A three-dimensional electromagnetic digitizer was used to collect the coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw, ears) in 231 healthy, reference adolescents (10-17 years old) and in 93 "attractive" adolescents selected by a commercial casting; soft tissue facial angles, distances and volumes were computed. RESULTS: Attractive adolescents had wider and shorter faces than reference subjects of the same age and sex, with relatively larger upper and middle facial thirds, and a reduced mandible relative to the maxilla. Lips were larger and more prominent, and the nasolabial angle was reduced, but in older boys the effect was reversed. The prominence of the soft-tissue profile, and of the maxilla relative to the mandible, were larger in attractive boys, but smaller in attractive girls than in their reference peers. Attractive adolescents had a relatively less prominent chin relative to the lower lip, with increased values of the mentolabial angle. In the horizontal plane, attractive "young" adolescents had a more obtuse mandibular convexity angle, while the opposite pattern was observed in the "old" adolescent subjects, with a relatively more prominent chin. Attractive adolescents had smaller noses than reference subjects of the same age and sex. CONCLUSION: Esthetic reference values have been identified which could be used to determine optimal timing and goals in orthodontic treatment.

Three-dimensional facial morphometry of attractive Italian women.

OBJECTIVES: To identify reference standards and possible esthetic features in facial proportion and form of Italian adult women. METHODS AND SUBJECTS: A three-dimensional electromagnetic digitizer was used to collect the coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw, ears) in 71 healthy, reference women (18-30 years old) and in 48 "attractive" women selected during a beauty competition; soft tissue facial angles, distances and volumes were computed. RESULTS: Attractive women had wider faces with a relatively larger upper facial third (forehead); a larger facial width relative to facial height. The mouth was larger, and lips were more prominent; the interlabial angle was reduced. Overall, the soft-tissue profile was more prominent, with a larger maxillary prominence relative to the mandible. Faces in the attractive women were more flat in the horizontal plane. For several of the analyzed measurements, similar patterns were observed for the 36 women participants to the semi-final stage of the beauty competition, the 12 finalists, and the winner. The winner of the beauty competition deviated from the reference women more than the other two groups of attractive women. CONCLUSION: Esthetic reference values were determined for a population of 18-30 year olds that reflect contemporary society.

Prevalence of tooth-size discrepancy among different malocclusion groups.

This study was designed to estimate the prevalence of tooth-size discrepancy as a factor of skeletal malocclusion in the orthodontic patient population of the Campania region. The study employed the pretreatment models of 94 patients. The mesiodistal diameters of teeth were measured by digital electronic calipers (accurate to 0.01 mm) and Bolton's indices were calculated. The sample was grouped into three malocclusion groups based on the values of Steiner cephalometric analysis. Multiple regression analysis data indicated a significant linear relationship (r2 = 0.99, P = 0.0000) for Bolton's posterior, anterior and total indices. The discriminant multivariate analysis, based on stepwise Wilke's lambda, revealed five variables capable of classifying 88.6% of the sample in the four malocclusion groups. As no relationship between the four groups identified by the discriminant analysis and the types of skeletal malocclusions exists, it was unequivocally concluded that there is no evidence of any predisposition for a tooth-size discrepancy in any of the malocclusion groups.