Management of patients with cancer during the COVID-19 pandemic: The Italian perspective on the second wave.

The novel coronavirus disease 2019 (COVID-19) pandemic has been an overwhelming challenge for worldwide health systems. Since the beginning of year 2020, COVID-19 has represented a potential harm for cancer patients and has often hindered oncology care. The Collegio Italiano dei Primari Oncologi Medici (CIPOMO) is an Italian association of head physicians in oncology departments, which promotes working and research activities in oncology on a national basis. During the second wave of COVID-19 pandemic, the CIPOMO promoted a national survey aiming to evaluate the impact of COVID-19 on oncologists' clinical activity and what changes have been made compared with the Italian situation during the first wave of the pandemic. Overall, 138 heads of medical oncology departments participated in this survey: 75 (54%) from the North, 24 (17%) from the Centre and 39 (28%) from the South of Italy and islands. This survey provides an overview of Italian oncologists facing the second wave of COVID-19 pandemic. The lesson learned during the first wave of COVID-19 pandemic has led to a better organisation of clinical activities, and regular testing among healthcare practitioners, with better chances to grant patients' protection. However, the lack of standardised informatic platforms results in serious challenges in replacing frontal visits, often making a concrete reduction of patients' hospital accesses unfeasible. Oncologists need to keep preserving the continuum of care of patients. Standardisation of safety measures, together with the implementation of informatic platforms, can significantly improve oncology pathways during this second wave of COVID-19 pandemic.

Three-dimensional evaluation of the maxillary effects of two orthopaedic protocols for the treatment of Class III malocclusion: A prospective study.

OBJECTIVES: To compare the three-dimensional maxillary dentoskeletal effects of a modified alternate rapid maxillary expansion and constriction facemask protocol (Alt-RAMEC/FM) with the traditional rapid maxillary expansion facemask protocol (RME/FM) performed in deciduous or early mixed dentition Class III patients. SETTING AND SAMPLE POPULATION: Orthodontic Clinic of the Section of Dentistry of the Department of Surgery and Translational Medicine of the University of Florence. Thirty-four Class III patients were enrolled and allocated by alternating assignment to either Alt-RAMEC/FM or RME/FM therapy. MATERIALS AND METHODS: Prior to treatment, all patients were evaluated, and a cone beam computed tomography (CBCT) scan was acquired. After completion of the orthopaedic therapy (average interval 1.2 years), a follow-up CBCT scan was obtained. Anatomic landmark identification on the CBCTs and subsequent quantification of the changes were performed. The primary outcome variable was the anteroposterior displacement of the anterior nasal spine (ANS AP). The treatment groups were compared with independent samples t tests. RESULTS: The patients in the two treatment groups showed a similar degree of compliance. No statistically significant differences were recorded for any variable when comparing the Alt-RAMEC/FM and RME/FM groups. In particular, the between-group difference for ANS AP was 0.0 mm (95%CI: -0.6;0.7, P = 0.933). CONCLUSIONS: Both Alt-RAMEC/FM and RME/FM produced favourable orthopaedic changes in Class III growing patients. Neither protocol was superior to the other in terms of maxillary protraction effectiveness.

Enamel defects and aphthous stomatitis in celiac and healthy subjects: Systematic review and meta-analysis of controlled studies.

OBJECTIVES: The aim of this systematic review was to compare the presence of enamel defects and aphthous stomatitis between celiac patients and healthy controls. DATA SOURCES: A systematic review of articles selected from MEDLINE, EMBASE and Google Scholar was performed by two independent operators. Additional studies hand-searched and found in the principal dental and gastroenterology journals were included. STUDY SELECTION: Only controlled studies on celiac patients compared to healthy subjects were included. DATA EXTRACTION: Independent extraction of articles by 2 authors using predefined data fields, including study quality indicators. DATA SYNTHESIS: In total, the celiac patients had greater frequency of enamel defects (odds ratio=5.69, 95%CI from 3.47 to 9.33, P<0.00001, I2=90%, 30 studies). Considering only the children, the odds ratio was 5.63 (95%CI from 3.95 to 8.01, P<0.00001, I2=65%, 24 studies), while in the adults the odds ratio was not significant (odds ratio=2.16, 95%CI from 0.95 to 4.88, P=0.06, I2=40%, 3 studies). In total, the celiac patients had greater frequency of aphthous stomatitis (odds ratio=3.79, 95%CI from 2.67 to 5.39, P<0.00001, I2=49%, 21 studies). Considering only the children, the odds ratio was 4.31 (95%CI from 3.03 to 6.13, P<0.00001, I2=29%, 13 studies), while in the adults the odds ratio was 47.90 (95%CI from 6.29 to 364.57, P=0.0002, 1 study). CONCLUSIONS: In children, celiac disease was associated with both enamel defects and aphthous stomatitis. The odds ratio estimates, however, should be interpreted with caution due to the high risk of bias showed by all the studies. In adults, the association between celiac disease and enamel defects or aphthous stomatitis was unclear because very few studies were performed on this population. CLINICAL SIGNIFICANCE: The presence of enamel defects and/or aphthous stomatitis in a child affected by other typical or atypical symptoms of celiac disease represents an indication for further diagnostic exams for celiac disease.

Italian, Multicenter, Phase III, Randomized Study of Cisplatin Plus Etoposide With or Without Bevacizumab as First-Line Treatment in Extensive-Disease Small-Cell Lung Cancer: The GOIRC-AIFA FARM6PMFJM Trial.

Purpose Considering promising results in phase II studies, a randomized phase III trial was designed to assess the efficacy of adding bevacizumab to first-line cisplatin plus etoposide for treatment of extensive-disease (ED) small-cell lung cancer (SCLC). Patients and Methods Treatment-naive patients with ED-SCLC were randomly assigned to receive either cisplatin plus etoposide (arm A) or the same regimen with bevacizumab (arm B) for a maximum of six courses. In the absence of progression, patients in arm B continued bevacizumab alone until disease progression or for a maximum of 18 courses. The primary end point was overall survival (OS). Results Two hundred four patients were randomly assigned and considered in intent-to-treat analyses (103 patients in arm A and 101 patients in arm B). At a median follow-up of 34.9 months in arm A and arm B, median OS times were 8.9 and 9.8 months, and 1-year survival rates were 25% and 37% (hazard ratio, 0.78; 95% CI, 0.58 to 1.06; P = .113), respectively. A statistically significant effect of bevacizumab on OS in patients who received maintenance was seen (hazard ratio, 0.60; 95% CI, 0.40 to 0.91; P = .011). Median progression-free survival times were 5.7 and 6.7 months in arm A and arm B, respectively ( P = .030). Regarding hematologic toxicity, no statistically significant differences were observed; for nonhematologic toxicity, only hypertension was more frequent in arm B (grade 3 or 4, 1.0% v 6.3% in arms A v B, respectively; P = .057). Conclusion The addition of bevacizumab to cisplatin and etoposide in the first-line treatment of ED-SCLC had an acceptable toxicity profile and led to a statistically significant improvement in progression-free survival, which, however, did not translate into a statistically significant increase in OS. Further research with novel antiangiogenic agents, particularly in the maintenance setting, is warranted.

Transverse relationship of permanent molars after crossbite correction in deciduous dentition.

OBJECTIVE: To evaluate the transverse relationships of the first permanent molars after the correction of posterior crossbite performed during the deciduous dentition with two different treatment protocols. MATERIALS/METHODS: Ninety patients (40 males and 50 females) with posterior crossbite were treated during the deciduous dentition with either a removable expansion plate (RP group, 60 patients) or rapid maxillary expander (RME group, 30 patients). The dental casts before treatment (T0, mean age 5.1 ± 0.7 years) and after treatment, when the first permanent molars were fully erupted, (T1, mean age 7.7 ± 1.0 years) were analysed. The prevalence rates for posterior crossbite on the first permanent molars in the two groups were compared by means of chi-squared test with Yates correction. A logistic regression was performed to evaluate the factors that could influence the presence/absence of posterior crossbite on the first permanent molars. RESULTS: Prevalence rate of posterior crossbite on the first permanent molars at T1 was 34.4 per cent in the total sample, 28.3 per cent for the RP group and 46.6 per cent for the RME group. No significant predictors for the 'presence/absence of posterior crossbite on the first permanent molars' at T1 were found. LIMITATIONS: Retrospective study. CONCLUSIONS: After treatment of posterior crossbite during the deciduous dentition phase, the first permanent molars erupted in crossbite in the 34.4 per cent of the cases. The type of treatment is not a significant predictor for the presence of posterior crossbite on the first permanent molars.

Prognostic impact of KRAS, NRAS, BRAF, and PIK3CA mutations in primary colorectal carcinomas: a population-based study.

BACKGROUND: Activation of oncogenes downstream the EGFR gene contributes to colorectal tumorigenesis and determines the sensitivity to anti-EGFR treatments. The aim of this study was to evaluate the prognostic value of KRAS, BRAF, NRAS and PIK3CA mutations in a large collection of CRC patients from genetically-homogeneous Sardinian population. METHODS: A total of 1284 Sardinian patients with histologically-proven diagnosis of colorectal carcinoma (CRC) and presenting with metastatic disease were included into the study. Genomic DNA was isolated from formalin-fixed, paraffin-embedded primary tumour tissue samples of CRC patients and screened for mutations in RAS and BRAF genes, using pyrosequencing assays, and in PIK3CA gene, using automated DNA sequencing assays. RESULTS: Overall, mutation rates were 35.6 % for KRAS, 4.1 % for NRAS, and 2.1 % for BRAF. Among available DNA samples, 114/796 (14.3 %) primary CRCs were found to carry a mutation in the PIK3CA gene. In this subset of patients analysed in all four genes, a pathogenetic mutation of at least one gene was discovered in about half (378/796; 47.5 %) of CRC cases. A mutated BRAF gene was found to steadily act as a negative prognostic factor for either time to progression as metastatic disease (from detection of primary CRC to diagnosis of first distant metastasis; p = 0.009) or partial survival (from diagnosis of advanced disease to the time of death or last control; p = 0.006) or overall survival (p < 0.001). No significant impact on prognosis was observed for mutated KRAS, NRAS, and PIK3CA genes or combined RAS mutations (all RAS). CONCLUSIONS: Our study defines both prevalence and prognostic role of main activated oncogenes in a population-based large collection of CRC patients.

Ceramic brackets and low friction : A possible synergy in patients requiring multiple MRI scanning.

AIM: To investigate any advantages of low friction biomechanics in orthodontic patients with fixed appliances without producing metal artifacts during magnetic resonance imaging (MRI). MATERIALS AND METHODS: Frictional resistance generated by bracket-wire-ligature systems was analyzed via an experimental model that reproduced upper canine misalignment. Each sample was tested 10 consecutive times in a dry state; a total of 160 tests were carried out. We documented the frictional forces generated by a 0.012- and 0.014-inch superelastic nickel-titanium wire (SENT) with ceramic self-ligating brackets (SLB) with metal insert and ceramic monocrystalline brackets with nonconventional elastic ligatures (NCEL) in conjunction with various degrees of canine misalignment (1.5, 3.0, 4.5, and 6.0 mm). Comparisons between the frictional forces released by the two different bracket-wire-ligature systems were made by conducting 3-way analysis of variance (ANOVA) with Tukey HSD pairwise test (P < 0.005). RESULTS: We observed no clinically relevant difference between the frictional forces released by ceramic SLB and ceramic brackets in conjunction with a 0.012- and 0.014-inch SENT. Statistically significant differences were apparent with a 0.012-inch SENT at 4.5 and 6.0 mm of canine misalignment, where the SLB revealed higher frictional forces. CONCLUSIONS: Ceramic brackets with NCEL revealed frictional forces similar to those generated in conjunction with ceramic SLB, thereby helping to avoid metal artifacts in case of expected necessary MRI during orthodontic treatment with fixed appliances.

Dentoskeletal effects produced by a Jasper Jumper with an anterior bite plane.

OBJECTIVE: The aim of this retrospective study was to evaluate the dentoskeletal effects produced by a modified Jasper Jumper with an anterior bite plane for the correction of Class II division 1 malocclusion. MATERIALS AND METHODS: A sample of 32 growing patients (mean age  =  11.9 ± 1.4 years) with Class II division 1 malocclusion and increased overbite were treated with a modified Jasper Jumper (JJ) and anterior bite plane protocol and compared with a matched control group of 30 subjects with untreated Class II malocclusion (mean age 12.2 ± 0.8 years). Lateral cephalograms were taken before treatment (T1) and at the end of comprehensive treatment (T2). Mean treatment duration was 2.1 ± 0.4 years. The T1-T2 changes in the two groups were compared with Student's t-tests for independent samples. RESULTS: The JJ group was successfully treated to a Class I occlusal relationship with a significant reduction in overjet (-3.9 mm, P < .001) and overbite (-3.1 mm, P < .001). The JJ group exhibited a significant increase in mandibular length and a significant improvement in maxillomandibular sagittal skeletal relationships. The lower incisors were significantly proclined, while the lower first molars demonstrated significant movement in a mesial direction. CONCLUSIONS: Use of a modified JJ appliance and anterior bite plane is an effective protocol for the treatment of Class II malocclusion with increased overbite and greater skeletal (75%) than dentoalveolar (25%) effects mainly at the mandibular level.

Bonded versus banded rapid palatal expander followed by facial mask therapy: analysis on digital dental casts.

OBJECTIVES: To compare the dental effects produced by a bonded versus a banded expander combined with facial mask (FM) in patients with Class III malocclusion by means of digital dental casts. MATERIALS AND METHODS: Two groups of patients with Class III malocclusion and maxillary transverse deficiency in the deciduous or early mixed dentition were selected. The first group consisted of 25 subjects (12 females; 13 males) with a mean age of 7.4 years (SD 1.2 years) treated with a bonded expander and FM. The second group consisted of 25 subjects (13 females; 12 males) with a mean age of 8.1 years (SD 1.3 years) treated with a banded expander and FM. For each subject of the two groups, initial (pre-treatment, T1) and final (post-treatment, T2) dental casts were taken and scanned. Maxillary digital models of T1 and T2 were superimposed on the palatal rugae in order to analyse the maxillary anchorage loss. Significant between-group differences were tested with independent sample t-test (P < 0.05). RESULTS: No statistical differences were found for any of the variables observed. CONCLUSION: Orthopaedic treatment of Class III malocclusion with either a bonded or a banded expander and FM during the deciduous or early mixed dentition induced a significant expansion of the maxillary arch and a slight mesialization of the posterior anchoring teeth with no difference between the two intraoral appliance designs.

Treatment of Periodontitis for the Prevention of Endothelial Dysfunction: A Narrative Review.

Endothelial dysfunction (ED) is the initial step in the development of atherosclerosis, leading to cardiovascular disease (CVD). It has been suggested that periodontal disease (PD) could be associated to pathogenesis of atherosclerosis, since it is able to trigger a host response with systemic inflammation. Although a number of epidemiological studies have shown that periodontitis could be associated with ED, it is still unclear whether periodontal treatment could improve ED and therefore cardiovascular outcomes. In this narrative review we analysed the literature in the databases of Medline under ''endothelial function OR dysfunction OR vasodilatation'', AND ''periodontal disease" OR periodontal treatment" AND "cardiovascular disease" OR atherosclerosis AND "endothelial biomarker". Research articles, systematic reviews and clinical trials were screened. ED could be related to periodontitis as well as to CVD. Periodontal treatment reduces the risk of teeth loss and may improve ED and the risk of CVD. Since controversial results exist, there is an urgent need for well-designed clinical trials to find and validate novel biomarkers of endothelial function, such as circulating endothelial progenitors, which may be crucial for further investigation of the association of PD with endothelial function and CVD.

Treatment effects produced by the Twin-block appliance vs the Forsus Fatigue Resistant Device in growing Class II patients.

OBJECTIVE: To compare the dentoskeletal changes produced by the Twin-block appliance (TB) followed by fixed appliances vs the Forsus Fatigue Resistant Device (FRD) in combination with fixed appliances in growing patients having Class II division 1 malocclusion. MATERIALS AND METHODS: Twenty-eight Class II patients (19 females and 9 males; mean age, 12.4 years) treated consecutively with the TB followed by fixed appliances were compared with a group of 36 patients (16 females and 20 males; mean age, 12.3 years) treated consecutively with the FRD in combination with fixed appliances and with a sample of 27 subjects having untreated Class II malocclusion (13 females and 14 males; mean age, 12.2 years). Mean observation interval was 2.3 years in all groups. Cephalometric changes were compared among the three groups by means of ANOVA and Tukey's post hoc tests. RESULTS: The FRD produced a significant restraint of the maxilla compared with the TB and control samples (SNA, -1.1° and -1.8°, respectively). The TB sample exhibited significantly greater mandibular advancement and greater increments in total mandibular length than either the FRD or control groups (SNB, 1.9° and 1.5°, respectively; and Co-Gn, 2.0 mm and 3.4 mm, respectively). The FRD produced a significantly greater amount of proclination of the mandibular incisors than what occurred with the TB or the control samples (2.9° and 5.6°, respectively). CONCLUSION: The TB appliance produced greater skeletal effects in terms of mandibular advancement and growth stimulation while the Forsus caused significant proclination of the mandibular incisors.

Impact of tissue type and content of neoplastic cells of samples on the quality of epidermal growth factor receptor mutation analysis among patients with lung adenocarcinoma.

Assessment of the epidermal growth factor receptor (EGFR) mutational status has become crucial in recent years in the molecular classification of patients with lung cancer. The impact of the type and quantity of malignant cells of the neoplastic specimen on the quality of mutation analysis remains to be elucidated, and only empirical and sporadic data are available. The aim of the present study was to investigate the impact of tissue type and content of neoplastic cells in the specimen on the quality of EGFR mutation analysis among patients with lung adenocarcinoma. A total of 515 patients with histologically-confirmed disease were included in the present study. Formalin-fixed paraffin embedded tissue samples were used for the mutation analysis and the content of the neoplastic cells was evaluated using light microscopy. Genomic DNA was isolated using a standard protocol. The coding sequences and splice junctions of exons 18, 19 and 21 in the EGFR gene were then screened for mutations by direct automated sequencing. The mean age of the patients examined was 64.9 years and 357 (69.3%) were male. A total of 429 tissue samples (83.3%) were obtained by biopsy and the remaining samples were obtained by surgery. A total of 456 samples (88.5%) were observed from primary lung adenocarcinomas, while 59 (11.5%) were from metastatic lesions. EGFR mutations occurred in 59 cases (11.5%); exon 18 mutations were detected in one case (1.7%), whereas exon 19 and 21 mutations were detected in 30 (51%) and 28 (47.3%) cases, respectively. EGFR mutations were more frequent in females and patients that had never smoked. The distribution of the mutations among primary and metastatic tissues exhibited no significant differences in the proportions of EGFR mutations detected. However, a statistically significant difference in the number of mutations detected was found between samples with at least 50% of neoplastic cells (450 cases-57 mutations; 12.7%) and those with <50% of neoplastic cells (65 cases-2 mutations; 3.1%).

Italian multicenter phase III randomized study of cisplatin-etoposide with or without bevacizumab as first-line treatment in extensive stage small cell lung cancer: treatment rationale and protocol design of the GOIRC-AIFA FARM6PMFJM trial.

BACKGROUND: Neoangiogenesis is particularly abundant in small-cell lung cancer (SCLC) and is associated with poor prognosis. As a result of the promising nature of phase II studies, a randomized phase III trial was designed to assess the efficacy of adding bevacizumab to first-line chemotherapy with cisplatin-etoposide for treatment of extensive disease SCLC. We present the treatment rationale and study design of GOIRC trial (FARM6PMFJM study), a multicenter randomized phase III study, supported by AIFA (Agenzia Italiana del Farmaco). PATIENTS AND METHODS: Patients are randomized to receive either cisplatin 25 mg/m(2) and etoposide 100 mg/m(2) intravenously on days 1 to 3 (control arm) or the same chemotherapy combined with bevacizumab 7.5 mg/kg intravenously on day 1 (experimental arm). Treatment is repeated every 3 weeks and for a maximum of 6 courses. Patients randomized to the experimental arm in the absence of disease progression after 6 cycles continue bevacizumab alone until progression or for a maximum of 18 courses. Tumor assessment is done every 3 cycles. Major eligibility criteria are: age ≥ 18 years; histologically or cytologically documented extensive disease SCLC; Eastern Cooperative Oncology Group performance status ≤ 2; adequate hematological, hepatic and renal functions; no history of grade 2 or higher hemoptysis; and no evidence of tumor cavitation. The primary end point of this study is overall survival. Secondary end points include response rate, time to progression, and toxicity. CONCLUSION: An interim futility analysis was performed by an Independent Data Monitoring Committee in September 2013 and the trial obtained approval to continue. As of July 31, 2014, 171 patients of 206 planned have been randomized.

Functional approach to a Class II patient with upper first molar impaction.

The lack of the left first molar maxillary and the left second molar maxillary, caused respectively by impaction and agenesis is a very rare case, which determines an important occlusal imbalance and asymmetrical mandible movement. A gnatologic and functional orthodontic approach were planned to improve the retrognathic mandible and the muscular activity using kinesiograph and electromyography.

Active-treatment effects of the Forsus fatigue resistant device during comprehensive Class II correction in growing patients.

OBJECTIVE: To evaluate the active-treatment effects of the Forsus fatigue resistant device (Forsus) during comprehensive correction of Class II malocclusion in growing patients. METHODS: Fifty-four patients (mean age, 12.5 ± 1.2 years) with Class II division 1 malocclusion were consecutively treated with fixed app-liances in combination with Forsus. Lateral cephalograms were analyzed at the beginning of the fixed treatment (T1), Forsus insertion (T2), its removal (T3), and end of the comprehensive therapy (T4). Statistical comparisons were carried out by repeated-measures ANOVA with Tukey's post-hoc test (p < 0.05). RESULTS: The overall therapeutic effects were mainly dentoalveolar and occurred mostly during the active treatment with Forsus (T2-T3, mean duration = 0.5 ± 0.1 years). The overjet and overbite decreased significantly (-3.5 and -1.5 mm, respectively) and the molar relationship improved by 4.3 mm. These changes were associated with significant retroclination of the maxillary incisors (-3.1°), proclination and intrusion of the mandibular incisors (+5.0° and -1.5 mm, respectively), and mesialization of the mandibular molars (+2.0 mm). CONCLUSIONS: Forsus had mainly dentoalveolar effects and contributed largely to the overall therapeutic outcome.

Surgical treatment of single gingival recessions: clinical guidelines.

PURPOSE: The purpose of this clinical guidelines project was to determine the most appropriate surgical techniques, in terms of efficacy, complications, and patient opinions, for the treatment of buccal single gingival recessions without loss of interproximal soft and hard tissues. METHODS: Literature searches were performed (electronically and manually) for entries up to 28 February, 2013 concerning the surgical approaches for the treatment of gingival recessions. Systematic reviews (SRs) of randomised controlled trials (RCTs) and individual RCTs that reported at least 6 months of follow-up of surgical treatment of single gingival recessions were included. The full texts of the selected SRs and RCTs were analysed using checklists for qualitative evaluation according to the Scottish Intercollegiate Guidelines Network (SIGN) method. The following variables were evaluated: Complete Root Coverage (CRC); Recession Reduction (RecRed); complications; functional and aesthetic satisfaction of the patients; and costs of therapies. RESULTS: Out of 30 systematic reviews, 3 SRs and 16 out of 313 RCTs were judged to have a low risk for bias (SIGN code: 1+). At a short-term evaluation, the coronally advanced flap plus connective tissue graft method (CAF+CTG) resulted in the best treatment in terms of CRC and/or RecRed; in case of cervical abrasion and presence of root sensitivity CAF + CTG + Restoration caused less sensitivity than CAF+CTG. CAF produced less postoperative discomfort for patients. Limited information is available regarding postoperative dental hypersensitivity and aesthetic satisfaction of the patients. CONCLUSION: In presence of aesthetic demands or tooth hypersensitivity, the best way to surgically treat single gingival recessions without loss of interproximal tissues is achieved using the CAF procedure associated with CTG. Considering postoperative discomfort, the CAF procedure is the less painful surgical approach, while the level of aesthetic satisfaction resulted higher after CAF either alone or with CTG. It is unclear how much tooth hypersensitivity is reduced by surgically covering buccal recessions. It is important to note that the present recommendations are based on short-term data (less than 1 year). SOURCE OF FUNDING: The guidelines project was made possible through self-financing by the authors.

Forecasting craniofacial growth in individuals with class III malocclusion by computational modelling.

AIM: To develop a mathematical model that adequately represented the pattern of craniofacial growth in class III subject consistently, with the goal of using this information to make growth predictions that could be amenable to longitudinal verification and clinical use. MATERIALS AND METHODS: A combination of computational techniques (i.e. Fuzzy clustering and Network analysis) was applied to cephalometric data derived from 429 untreated growing female patients with class III malocclusion to visualize craniofacial growth dynamics and correlations. Four age groups of subjects were examined individually: from 7 to 9 years of age, from 10 to 12 years, from 13 to 14 years, and from 15 to 17 years. RESULTS: The connections between pathway components of class III craniofacial growth can be visualized from Network profiles. Fuzzy clustering analysis was able to define further growth patterns and coherences of the traditionally reported dentoskeletal characteristics of this structural imbalance. Craniofacial growth can be visualized as a biological, space-constraint-based optimization process; the prediction of individual growth trajectories depends on the rate of membership to a specific 'winner' cluster, i.e. on a specific individual growth strategy. The reliability of the information thus gained was tested to forecast craniofacial growth of 28 untreated female class III subjects followed longitudinally. CONCLUSION: The combination of Fuzzy clustering and Network algorithms allowed the development of principles for combining multiple auxological cephalometric features into a joint global model and to predict the individual risk of the facial pattern imbalance during growth.

Evaluation of mechanical properties of three different screws for rapid maxillary expansion.

BACKGROUND: The aim of this in vitro study was the evaluation of the mechanical properties the screws for rapid maxillary expansion (RME). METHODS: Three commercially available screws for RME were tested: Leone A2620; Dentaurum Hyrax; Forestadent Palatal Split Screw. All expansion screws were 10 mm in size. For the evaluation of mechanical properties, the screws for RME were adjusted using the same maxillary dental model. An Instron 3365 testing machine with a load cell of 5 kN recorded the forces released by the screws at different amounts of activation (1, 5, 10, 15 and 20 quarters of a turn). Each type of screw was tested 10 times. Comparisons between the forces released by the different types of screws at different amounts of activation were carried out by means of analysis of Kruskal-Wallis test with post-hoc test di Tukey (P < 0.05). RESULTS: The results of this study showed that all 3 expansion devices were able to develop forces that could produce a separation of the palatine processes. The Hyrax and A2620 expanders developed force values over 20 kg and the Palatal Split screws about 16 kg. Both the A2620 and Hyrax expanders showed significantly greater amounts of forces at all the different amounts of activations with respect to the Palatal Split screw. CONCLUSIONS: All tested devices showed the capability of developing expansion forces (16-20 kg) adequate for RME. The A2620 and Hyrax expanders showed a greater level of rigidity than the Palatal Split screw.

Frictional resistance in monocrystalline ceramic brackets with conventional and nonconventional elastomeric ligatures.

BACKGROUND: The objective of this study was to compare the frictional forces generated by three types of monocrystalline ceramic brackets coupled with conventional elastomeric ligatures (CEL) and nonconventional elastomeric ligatures (NCEL) during the alignment of apically displaced teeth at the maxillary arch. METHODS: All tests (a total of 480 tests) were carried out in a dry state on a universal testing machine with a testing model consisting of three 0.022-in. monocrystalline ceramic preadjusted brackets (from the maxillary right second premolar through the right central incisor). The canine bracket was bonded to a sliding bar that allowed for different vertical positions. The frictional forces generated by a 0.012- and 0.014-in. superelastic nickel titanium wire (SENT) with conventional and nonconventional ligatures at various amounts of canine misalignment (1.5, 3.0, 4.5, and 6.0 mm) were recorded. Comparisons between the different types of bracket-wire-ligature systems were carried out by means of analysis of variance on ranks with Tukey's post hoc test (P<0.05). RESULTS: No significant differences were assessed among the three types of monocrystalline brackets with NCEL when coupled with 0.012-in. SENT. Radiance brackets with NCEL coupled with 0.014-in. SENT showed significantly greater frictional force than Inspire Ice brackets and Pure brackets with NCEL. A significantly greater amount of frictional force was generated with CEL when compared with NCEL for all the tested variables, with the exception of the Pure brackets with 0.012-in. SENT at 1.5 and 3.0 mm of canine misalignment where similar frictional forces were found. CONCLUSIONS: Nonconventional elastomeric ligatures are able to reduce friction in monocrystalline ceramic brackets.