Stability prediction of early orthopedic treatment in Class III malocclusion: morphologic discriminant analysis.

BACKGROUND: To evaluate morphologic differences between class III malocclusion success and failure treatment subjects in order to identify which variables are more predictive for long-term stability in early orthopedic treatment. In this retrospective study, 31 patients were enrolled from the Department of Orthodontics (Rome Tor Vergata). Inclusion criteria were as follows: white ancestry, class III malocclusion, mixed dentition, cervical stage (CS) 1-2, no pseudo-class III. Pre-treatment radiographic and cast records were collected. Each patient underwent rapid maxillary expansion/facial mask/bite block (RME/FM/BB) orthopedic treatment until correction. At T1 (permanent dentition, CS4), records were recollected. According to treatment stability, relapse group (RG, 19) and success group (SG, 12) were identified. Sagittal and vertical cephalometric and digital cast measurements were performed. Student's t tests were used for statistically significant differences inter and intra groups. For discriminant analysis, relapse or success status was added to each patient's T0 data. RESULTS: At T0, RG showed larger upper anterior transversal width (p = 0.0266), while at T1 the upper anterior length was shorter than SG (p = 0.0028). Between T1 and T0, both groups showed larger upper anterior and posterior transversal widths. SG had greater upper anterior (p = 0.0066) and posterior (p = 0.449) sagittal length. RG presented larger lower anterior (p = 0.0012) and posterior (p = 0.0002) transversal widths, while there were no differences in SG lower arch. Discriminant analysis provided two predictive variables with an accuracy of 80.6%: upper anterior length and upper posterior length. CONCLUSION: A shorter and wider maxilla could be a predisposing factor for relapse and failure of the early orthopedic treatment of class III malocclusion patients. The absence of mandibular changes could be predictable for treatment success.

Evaluation of the morphometric covariation between palatal and craniofacial skeletal morphology in class III malocclusion growing subjects.

BACKGROUND: To study the covariation between palatal and craniofacial skeletal morphology in Class III growing patients through geometric morphometric analysis (GMM). METHODS: In this retrospective study, 54 Class III subjects (24F,30M;7.6 ± 0.8yy) were enrolled following these inclusion criteria: European ancestry, Class III skeletal and dental relationship, early mixed dentition, prepubertal skeletal maturation, familiarity for Class III malocclusion, no pseudo Class III malocclusion. Each patient provided upper digital cast and cephalogram before starting the therapy. Landmarks and semilandmarks were digitized (239 on the casts;121 on the lateral radiographs) and GMM was used. Procrustes analysis and principal component analysis (PCA) were applied to show the principal components of palatal and craniofacial skeletal shape variation. Two-block partial least squares analysis (PLS) was used to assess pattern of covariation between palatal and craniofacial morphology. RESULTS: Regarding palatal shape variation, PC with largest variance (PC1) described morphological changes in the three space dimensions, while, concerning the craniofacial complex components, PC1 revealed morphological differences along the vertical plane. A significant covariation was found between palatal and craniofacial shape. PLS1 accounted for more than 61,7% of the whole covariation, correlating the craniofacial divergence to palatal height and width. CONCLUSIONS: In Class III subjects increments of angle divergence are related to a narrow and high palate.

Obstructive sleep apnea in children with Marfan syndrome: Relationships between three-dimensional palatal morphology and apnea-hypopnea index.

OBJECTIVE: To evaluate the relationship between the severity degree of OSA (apnea/hypopnea index AHI>1) and palatal area and volume, measured by 3D analysis of digital casts in Marfan children. METHODS: Twenty children with a clinical diagnosis of MS were recruited from a tertiary medical center. All the subjects underwent standard nocturnal polygraphy testing. Sixteen Marfan patients (7F,9 M; mean age 8.8yy ±â€¯1.5yy) with AHI>1 were enrolled. Marfan Group (MG) was compared with a control group (CG) of 17 children without Marfan syndrome (9F,8 M; mean age 8.5yy ±â€¯1.7yy) presenting with nose-breathing pattern. For each subject maxillary digital casts were taken and palatal area and volume were measured. Unpaired t-test was used to test significant differences between MG and CG for area and volume measurements. Pearson correlation coefficient (PCC) was used to measure the linear correlation between the degree of OSA (AHI index) and palatal volume and palatal area. RESULTS: 80% of Marfan children presented an AHI>1 and a diagnosis of OSA. MG presented statistically significant lower values of palatal surface area (662.68 mm2; P < 0.0001) and palatal volume (2578.1 mm3; P < 0.0001) with respect to CG (923.0 mm2 and 3756.6 mm3, respectively). Correlation analysis showed that AHI index had no linear correlation with palatal area (r = - 0,07) and with palatal volume (r = - 0,11). CONCLUSION: OSA is highly prevalent in children with Marfan's syndrome (80%). Marfan children present a reduction of palatal area and volume when compared to healthy subjects. OSA in Marfan children is not linear correlated to the palatal morphology and it shows a multifactorial aetiology.

Titanium alloy vs. stainless steel miniscrews: an in vivo split-mouth study.

OBJECTIVE: To compare in vivo Titanium Alloy (TiA) with Stainless Steel (SS) miniscrews Temporary Anchorage Devices (TADs) using removal torque and Scanning Electron Microscopic (SEM) analysis. PATIENTS AND METHODS: 15 subjects (6 males and 9 females) who required maximum anchorage were recruited. For each patient, a TiA TAD and a SS TAD with same length and width were implanted following a randomized split-mouth study design. Retraction was carried out with nickel-titanium spring ligated directly from the anterior hooks of the archwire to the TADs to produce 90 to 100 g of force. When no further anchorage supplementation was needed, the TADs were removed. The removal torque values were registered with a digital screwdriver. After removal, the TADs were collected in a fixed solution and examined using SEM and X-ray microanalysis. RESULTS: All TADs remained intact, with a 100% success rate. There was no difference in removal torque between TiA and SS miniscrews (4.4 ± 1.3 N-cm and 5.1 ± 0.7 N-cm, respectively). All specimens' loss of gloss with signs of biological contaminations resulted in a dull implant surface. SEM photomicrographs of TiA miniscrews showed predominantly blood cells while SS miniscrews showed the precipitation of an amorphous layer with low cellular component. There was no difference in spectroscopic analysis between TiA and SS miniscrews. CONCLUSIONS: TiA and SS miniscrews had comparable removal torque values. SEM photomicrographs showed no evidence of osseointegration with both TADs having similar biological responses.

Sagittal dentoskeletal modifications associated with different activation protocols of rapid maxillary expansion.

AIM: The aim of this study is to compare the sagittal dentoskeletal changes associated with different activation protocols of maxillary expander. MATERIALS AND METHODS: A total of 101 subjects with constricted maxillary arches (49 males and 52 females; mean age 10.08 ± 1.57 years) were enrolled in the study. The study comprised also a control group of 20 subjects (11 females and 9 males, mean age 10.27 ± 1.24 years) who were not treated during the observation period. All the subjects underwent rapid maxillary expansion with a stainless steel banded expander cemented to the maxillary first molars. The expansion screw was randomly activated with two different rapid maxillary expansion protocols (one-quarter per day or two-quarters per day). A statistical comparison between the sagittal cephalometric variations obtained in the two expansion groups was made, and compared with the untreated control group. Data were then stratified for skeletal maturation of each subject. RESULTS: The Wilcoxon rank-sum test shows statistically significant differences between the two RME activation protocols only for overjet. Statistically significant differences were reported in comparison with the control group. CONCLUSIONS: This study suggests that the increase in overjet after RME could be associated with faster activation protocols especially in subjects with lower skeletal maturation.

A comparative assessment of changes in dental arches associated with different activation protocols of rapid maxillary expansion.

AIM: The aim of this study is to compare dental arch changes associated with different activation protocols of maxillary expander. MATERIALS AND METHODS: A sample of 101 subjects with constricted maxillary arches (49 males and 52 females; mean age 10.96 ± 1.91 years) was enrolled in the study. All subjects underwent RME with a stainless steel banded expander cemented to the maxillary first molars and the expansion screw was randomly activated with two different rapid maxillary expansion protocols (one- quarter per day or two quarters per day). The study also involved a control group of 22 subjects (10 females and 12 males, mean age 10.39 ± 1.32 years) who underwent no treatment. A statistical comparison between the dental arch measures obtained before and after treatment in the two groups was performed. RESULTS: The Wilcoxon rank-sum test shows statistically significant differences of the measurement increases between the two activation protocols (at least p=0.01). Statistically significant differences were also reported in comparison with the control group. CONCLUSIONS: A faster activation protocol could be able to determine a greater anterior opening of the mid-palatal suture. Moreover, it seems to yield a higher width increase in the molar area.

Correlations between dental malocclusions, ocular motility, and convergence disorders: a cross-sectional study in growing subjects.

OBJECTIVE: The purpose of the study was to analyze the association between dento-skeletal malocclusions, ocular motility, and convergence disorders in growing subjects. MATERIALS AND METHODS: 84 subjects (49 males, 35 females) with a mean age of 7.3±1.7 years were enrolled in a screening procedure for celiac disease at the Department of Gastroenterology of the University of Rome "Tor Vergata". Each child underwent an orthodontic, orthoptic, and ophtalmological examination. Pearson's Chi-Square test with Yates' correction and Fisher's exact test were conducted to assess the association between orthoptic defects and malocclusions (p<0.05). RESULTS: Ocular motility disorders were present in 44.9% of males and in 57.1% of females, while convergence defects were present in 10.2% of males and in 2.9% of females. Ocular motility disorders were more frequent in subjects with Angle Class III malocclusion (66.7%) than in subjects with Angle Class II (59.1%) and Class I (45.8%) malocclusion. Convergence defects were equally frequent in Angle Class I and Class II malocclusion (5.1%), while none subject presenting with Angle Class III malocclusion exhibited convergence defects. A statistically significant correlations was found between ocular motility disorders and unilateral cross-bite with midline deviation. CONCLUSION: Ocular motility defects had a significant greater prevalence in subjects presenting with unilateral cross-bite and midline deviation. The importance of role of orthodontic diagnosis among interdisciplinary treatment in growing children should be recognized.

Dental anomalies: prevalence and associations between them in a large sample of non-orthodontic subjects, a cross-sectional study.

BACKGROUND: To analyze the prevalence and associations between dental anomalies detectable on panoramic radiographs in a sample of non-orthodontic growing subjects. METHODS: For this cross-sectional study, digital panoramic radiographs of 5005 subjects were initially screened from a single radiographic center in Rome. Inclusion criteria were: subjects who were aged 8-12 years, Caucasian, and had good diagnostic quality radiographs. Syndromic subjects, those with craniofacial malformation, or orthodontic patients were excluded and this led to a sample of 4706 subjects [mean (SD) age = 9.6 (1.2) years, 2366 males and 2340 females]. Sample was subsequently divided into four subgroups (8, 9, 10, and 11-12 year-old groups). Two operators examined panoramic radiographs to observe the presence of common dental anomalies. The prevalence and associations between dental anomalies were also investigated. RESULTS: The overall prevalence of dental anomalies was 20.9%. Approximately, 17.9% showed only one anomaly, 2.7% two anomalies, while only 0.3% had more than two anomalies. The most frequent anomalies were the displacement of maxillary canine (7.5%), hypodontia (7.1%), impacted teeth (3.9%), tooth ankylosis (2.8%), and tooth transposition (1.4%). The lower right second premolar was the most frequent missing teeth; 3.7% had only one tooth agenesis, and 0.08% had six or more missing tooth (Oligodontia). Mesiodens was the most common type of supernumerary tooth (0.66%). Two subjects had taurodontic tooth (0.04%). Tooth transpositions and displacement of maxillary canine were seen in 1.4 and 7.5%, retrospectively (approximately 69 and 58% were in the 8 and 9 year-old groups, retrospectively). Significant associations were detected between the different dental anomalies (P < .05). CONCLUSIONS: The results of our study revealed significant associations among different dental anomalies and provide further evidences to support common etiological factors.

Orthopaedic treatment effects of functional therapy on the sagittal pharyngeal dimensions in subjects with sleep-disordered breathing and Class II malocclusion.

The purpose of this cephalometric study was to evaluate the craniofacial changes induced by functional treatment of mandibular advancement with special regard to pharyngeal sagittal airway dimensions, tongue and hyoid bone position in subjects with sleep-disordered breathing (SDB) and dentoskeletal Class II malocclusions compared with an untreated Class II control group. 51 subjects (24 female, 27 male; mean age 9.9 ± 1.3 years) with Class II malocclusion and SDB consecutively treated with a functional appliance (Modify Monobloc, MM) were compared with a control group of 31 subjects (15 males, 16 females; mean age 10.1 ± 1.1) with untreated Class II malocclusion. For the study group, mode of breathing was defined by an otorhinolaryngologist according to complete physical examination. The parents of all participants completed a modified version of the paediatric sleep questionnaire, PSQ-SRBD Scale, by Ronald Chervin (the Italian version in 22 items form) before and after the trial. Lateral cephalograms were available at the start and end of treatment with the MM. Descriptive statistics were used for all cephalometric measurements in the two groups for active treatment changes. Significant, favourable skeletal changes in the mandible were observed in the treated group after T2. Significant short-term changes in sagittal airway dimensions, hyoid position and tongue position were induced by functional therapy of mandibular advancement in subjects with Class II malocclusion and SDB compared with untreated controls. After orthodontic treatment, a significant reduction in diurnal symptoms was observed in 45 of the 51 participants who had received an oral appliance. Orthodontic treatment is considered to be a potential therapeutic approach for SDB in children. Orthodontists are playing an increasingly important role in managing snoring and respiratory problems by oral mandibular advancement devices and rapid maxillary expansion.

Young adult patient with two palatally maxillary impacted canines and forced traction on rigid arches of stabilization. Case report.

OBJECTIVE: Young adult patient treated for impaction of two maxillary canines. METHODS: C.S., 15 years, female. Diagnostic evaluation by clinical and radiographic examinations shows permanent dentition with persistence of 5.3 and 6.3, impaction of 1.3 and 2.3, dento-skeletal Cl I malocclusion, normodivergence of bone bases. Analysis of TC dentalscan confirms the palatal impaction of 1.3 and 2.3. The treatment plan provided an orthodontic-surgical approach for adequate space management in dental arch, evaluation of eruption movements, choice of anchorage device, surgical exposure and application of the brackets. RESULTS: Deciduous canines have been extracted and an edgewise appliance with rigid rectangular full thickness archwires has been used to align the arches and to obtain maximum anchorage during the forced traction. The surgical phase, for exposure of 1.3 and 2.3 respectively, performed an open technique by excisional uncovering and a close technique by a repositioned flap. The case has been finalized for the achievement of the right occlusal keys. CONCLUSION: The possibility to choose the surgical technique depending on the intraosseous position of impacted teeth in association to the edgewise therapy with full thickness arches allows to realize an effectiveness surgical-orthodontic approach for the forced traction of impacted teeth in a favourable position.

Human bocavirus in children with acute gastroenteritis in Albania.

Human Bocavirus (HBoV) has been recently identified in association with acute viral gastroenteritis (AGE). The objective of this work was to investigate the prevalence of HBoV in children with AGE in Albania. Stool specimens collected from 142 children were analyzed by amplification of partial NP1 and Vp1/Vp2 genes. HBoV was detected in 13 samples (9.1%), 12 HBoV-1 and one HBoV-2. All HBoV-positive patients were co-infected with rotavirus and/or adenovirus, a finding which might indicate that there is no clear causal association of this agent with diarrhea. Further investigation is needed to assess the pathogenic role of HBoV in childhood diarrhea.

Effect of cisplatin on proteasome activity.

Cisplatin is a widely used chemotherapy drug which exerts cytotoxic activity by affecting both nuclear and cytosolic pathways. Herewith, we report, for the first time, that cisplatin inhibits proteasome activity in vitro. Cisplatin induces a dose dependent inhibition of the three enzymatic activities of proteasome (i.e., the chymotrypsin-like activity, the trypsin-like activity and the caspase-like activity). Moreover, cisplatin administration to neuroblastoma cells brings about a fast loss of proteasome particle activity, which is followed by a de novo synthesis of proteasome. Lastly, we report that the simultaneous administration of lactacystin and cisplatin enhances the cytotoxicity of cisplatin alone. The overall bulk of data opens to an intriguing scenario, concerning the biological effects of cisplatin in the control of cellular life, which goes beyond the well established genotoxic effect.

Early treatment of Class III malocclusion with RME and facial mask: evaluation of dentoalveolar effects on digital dental casts.

AIM: To analyse the dental effects on digital dental casts in subjects with Class III malocclusion treated with bonded Rapid Maxillary Expansion and Facial Mask (RME/FM). MATERIALS AND METHODS: A study group sample (SG) of 29 subjects (13 females and 16 males) and mean age of 7.4 years (SD 1.2 years) was selected. A bonded RME was placed and activated 1/4 of a turn per day until overcorrection of the transverse width. At the end of expansion, patients were given FMs and treated at least to a positive overjet. The SG was compared with a control group (CG) of 21 prepubertal subjects (9 females; 12 males) presenting with normal occlusion and mean age of 7.9 years (SD 1.6 years). For each subject of the SG and CG initial (pretreatment, T1) and final (post-treatment, T2) digital dental casts were available. Significant in between-group differences were tested with the Student's t-test. RESULTS: The transverse dimension of the upper arch was significantly greater in SG vs. CG (IMAW: +2.6 mm; ICAW: +3.1 mm). Anterior arch length and arch depth were significantly smaller in SG when compared with CG (AAL: -3.2 mm, AD: -3.4 mm) at the end of therapy. CONCLUSION: The orthopaedic treatment with bonded RME/FM produced in subjects treated in the deciduous or early mixed dentition a significant expansion of the maxillary arch and mesialisation of the posterior teeth with a reduction of the arch depth.

Association between mesially displaced maxillary first premolars and early displaced maxillary canines.

AIM: To evaluate the association between the mesially displaced maxillary first premolar (MDP) and the early displacement of the adjacent permanent canine (EDC) before their eruption. MATERIALS AND METHODS: A sample of 1247 subjects in the intermediate mixed dentition stage was assessed for the presence of MDP and EDC. All subjects were divided into two groups: MDP group and noMDP group. For each subject two angular measurements (premolar-occlusal plane η and л premolar-midline angles) were analysed on panoramic radiographs. The chi-square test with Yates correction was performed to compare the prevalence rate of EDC in MDP (MDP-EDC) and noMDP groups. The statistical comparisons for the values of η and л angles between MDP vs noMDP, MDP vs MDP-EDC, and noMDP vs MDP-EDC groups were performed by means of ANOVA with Bonferroni correction. RESULTS: The prevalence rate of EDC in the MDP group was significantly greater than in the noMDP group (66% vs. 12.1%). MDP-EDC group showed a significantly larger л angle than in the MDP group resulting in an increased mesial inclination of displaced premolars. CONCLUSION: MDP can be considered a dental anomaly associated to maxillary canine displacement.

Analysis of rapid maxillary expansion effects on nasal soft tissues widths.

AIM: The aim of this study was to analyze the variations in nasal dimensions in prepubertal patients associated with RME therapy compared with an untreated age matched control group. METHODS: A group of 61 subjects (26 F, 35 M; mean age 10.5±1.8 years) was enrolled in the study to undergo a rapid maxillary expansion therapy; 41 subjects (26 F, 15 M; mean age 10.7±2.2 years) were enrolled as a control group. Both groups underwent nasal soft tissues width measurements using a caliper at three separate time points: T0 - prior to the placement of RME; T1 - after completion of active expansion phase; T2 - at the removal of the expander (nearly 6 months after T1). RESULTS: The ANOVA showed statistically significant increments (P<0.0001) of the greater alar cartilage (GAC) measurement (0.8±0.2 mm) in the study group, differences for the AB measurements were not statistically significant (P=0.0784). CONCLUSION: The treatment of rapid maxillary expansion can induce an increase in GAC soft tissues width of about 1 mm in prepubertal patients. This increase could not be considered of clinical impact. The alar base width increase less than GAC, this increase is without statistical significance.

Interceptive management for multiple eruption disturbances: a follow-up evaluation.

AIM: The aim of this report was to show the management of a case with an impacted central maxillary incisor caused by odontoma in a young patient with two mesiodentes in the region of the nasal floor. CASE REPORT: A 9-year-old girl was seen in the Department of Orthodontics of the University of Rome 'Tor Vergata'. Radiographic images showed intraosseous impaction of the maxillary right central incisor due to an odontoma. The treatment plan consisted of three stages: removal of the odontoma; rapid maxillary expansion (RME) in order to improve the intraosseous tooth position; surgical exposure and orthodontic traction of the impacted central incisor to its right position. At the end of the treatment the patient showed stable occlusal, functional, and periodontal results. In our therapeutic strategy the application of RME may improve the intraosseous position of incisor, minimizing space loss and surgical intervention to recover the impacted tooth. A three-year follow-up of the stability and periodontal health showed that the tooth placed in the occlusion maintained both esthetics and function.

Oral habits in a population of Albanian growing subjects.

AIM: The aim of this study was to assess the prevalence of oral habits in an Albanian population of schoolchildren. STUDY DESIGN: A sample of 2617 subjects, aged 7-15, was examined by clinical observation without radiograms. The sample comprised 1257 males and 1360 females, with no history of orthodontic treatment. Aestethical frontal and profile analysis, intraoral and functional analysis were performed. STATISTICS: Gender and age differences were compared by chi-square test. The relationship between malocclusions and oral habits was assessed by t-test and the level of significance was assessed at 0.01. RESULTS: The findings indicated that oral habits were present in 2225 subjects (85.0%), 1103 males (87.7%) and 1121 females (82.4%); the most frequent oral habit was pacifier sucking (30%) and it was mostly present in the 7-11 years group. It was observed a significant correlation between oral habits and dental malocclusions, open bite, altered overjet and maxillary contraction. CONCLUSION The high number of oral habits observed in the studied sample suggest that prevention strategies adopted in other countries could be successfully integrated in the development of an effective national programme in Albania aimed at reducing malocclusion risk factors.

Radiographic assessment of maxillary incisor position after rapid maxillary expansion in children with clinical signs of eruption disorder.

BACKGROUND AND OBJECTIVE: In this study we assessed the influence of rapid maxillary expansion (RME) on the intraosseous vertical position and inclination of the impacted incisors diagnosed at an early developmental stage on panoramic radiographs and subsequently treated by surgical removal of the obstacle. MATERIALS AND METHODS: Following surgical removal of the obstacles to incisor eruption (T1), a group of 34 subjects (mean age 8 years 11 months ± 11 months) underwent RME, while a group of 28 subjects (mean age 9 years 1 month ± 1 year) was monitored after surgery without further treatment. At T2 (on average 10 months after T1), the prevalence rate of subjects with erupted incisors was recorded. The measurements were taken on the panoramic radiographs at T1 and T2 to assess the vertical position and angulation of delayed unerupted incisors. RESULTS: At T2, impacted incisors erupted in 82.4% of the patients in the RME group versus 39.3% of those in the monitored group (χ(2) =8.45, p<0.001). All the patients treated with RME showed an improvement in the vertical and angular position of the unerupted teeth. Logistic regression revealed RME therapy as the only significant predictive variable (p<0.001) for successful eruption of the delayed incisors at T2. CONCLUSION: RME in early mixed dentition appears to be an effective procedure to increase the prevalence rate of impacted maxillary incisor eruption.