Paedodontic preformed crowns in primary teeth and relative degree of dental wear.

AIM: Prosthetic rehabilitation of deciduous teeth in paediatric age using pre-formed crowns has been considered one of the best methods of dental restoration since their introduction. Their main advantages are related to durability, longevity and a low rate of recurrent cavities. Since stainless steel crowns do not coincide with aesthetic needs of parents and patients, preformed paedodontic crowns made of zirconia and nano-hybrid composite was introduced. The aim of the study is to evaluate the degree of wear on the enamel and on themselves of the different paedodontic crowns. MATERIALS: Nine bovine teeth and nine paedodontic crowns for deciduous molars were selected for the study, three of which in zirconia, three in nano-hybrid composite and three in stainless steel. Wear test was carried out on the Rtech™ Instruments tribometer applying a force of 50 N. After that, both the bovine teeth and the paedodontic crowns were observed using a stereo microscope (Zeiss Stemi C-500) and a scanning electron microscope (SEM, Cambridge Stereoscan 440). The areas of wear were calculated with a software [ImageJ, version 1x, Wayne Rasband, Maryland, USA]. CONCLUSION: Pre-formed paediatric crowns in zirconia, nano-hybrid composite and stainless steel are a valid aid for the restoration of deciduous teeth and do not compromise the physiological wear characteristic of the phases of the dental exchange. The stainless steel crown is preferable for the restorations in the posterior sectors as its behaviour is the most similar to that of a natural tooth. Zirconia and nano-hybrid composite crowns showed an inversely proportional behaviour between their wear volume and that of the opposing tooth.

Analysis of sleep and symptoms related to OSAS in a group of paediatric patients with Down syndrome.

AIM: Good sleep is fundamental for development, particularly in children. Sleep can be fragmented by obstructive sleep apnoea syndrome (OSAS). Children with Down syndrome (DS) are more likely to have obstructive sleep apnoea, due to their craniofacial characteristics. The diagnosis can be made through the administration of specific questionnaires. The purpose of the study is to analyse the results obtained from the administration of a questionnaire for the screening of OSAS in the paediatric population with DS. MATERIALS: The questionnaire chosen is a questionnaire validated in Italian and administered to 139 parents of children with DS. This questionnaire investigates the diurnal and nocturnal symptoms related to OSAS and their frequency. CONCLUSION: This study wants to state the importance of the administration of questionnaires for the screening of OSAS in children with Down syndrome and the role of the dentist in the early diagnosis.

Linguistic validation of a questionnaire for the screening of OSAS in a paediatric population with Down Syndrome.

AIM: Obstructive sleep apnoea syndrome (OSAS) is a common clinical condition in which the throat narrows or collapses repeatedly during sleep, causing obstructive sleep apnoea events. This disorder is present in the paediatric population with a prevalence estimated between 1.2% and 5.8%. Down Syndrome (DS) is the most common chromosomal alteration associated with mental disability and characterised by other clinical manifestations, and its incidence is estimated at 1/800 births worldwide. Most of the craniofacial features typical of DS represent a risk factor for the development of OSAS. Routine screening has been recommended in some countries but it is still not a standard practice. The aim of this study is the Italian linguistic validation of a questionnaire for the diagnosis of OSAS in children with Down Syndrome. METHODS: After careful review of the existing scientific literature, a specific questionnaire was selected for the diagnosis of OSAS in children with DS. The questionnaire was then translated into Italian and administered to 111 parents of children with Down syndrome, for online completion. The last part of the questionnaire was dedicated to the comprehension of the questionnaire itself, with a specific focus on its clarity, accuracy and difficulty in completing it. CONCLUSION: The positive feedback registered in the comprehension part of the questionnaire, certified the good quality of the Italian translation and confirmed the questionnaire as a useful screening method to identify the comorbidity of OSAS and DS.

Preventive oral hygiene and ventilator-associated pneumonia in paediatric intensive care unit.

AIM: Data indicate a tendency towards an increased incidence through the last decades of various forms of pneumonia. Among these, nosocomial pneumonia in patients who have been on mechanical ventilation support (increased after the Covid-19 pandemic) is a condition that must be addressed as soon as possible to avoid complications. Current literature lacks an in-depth analysis of the potential correlation between ventilator-associated pneumonia and poor oral hygiene, especially in children. The aim of this literature review is to investigate if improving oral hygiene could affect the onset of nosocomial pneumonia in children. METHODS: A search was performed in Pubmed, Medline, and Scopus for the keywords: oral care, children, neonates, ventilator-associated pneumonia, combined with 'AND' or 'OR' Boolean Operators. CONCLUSION: The relevant papers retrieved in the scientific literature emphasised the importante of good oral care bundles to mitigate the bacteria proliferation in the bloodstream, and to prevent the development of ventilator-associated pneumonia.

Incidental findings of the nose and paranasal sinuses in orthodontic patients in the age of development: a retrospective study on CBCTs.

AIM: Nowadays, the use of CBCT in orthodontics and paediatric dentistry is constantly increasing. Since it allows a precise 3D visualisation of the entire head, CBCT can be used to identify alterations and pathologies of the jaws, but also of the sinonasal complex. Despite that, literature lacks studies focusing on the sinonasal complex of healthy orthodontic paediatric patients. Therefore, the aim of this cross-sectional retrospective study is to analyse the prevalence of incidental findings and anatomic variations of the nose and paranasal sinuses in orthodontic patients in the age of development. METHODS: The 61 CBCTs that respected all inclusion criteria (patient's age under 15 years old and CBCT scans showing the entire sinonasal complex, data in DICOM format) were searched for: nasal septum deviation, Onodi cells, Haller cells, concha bullosa, sinus underdevelopment, sinus mucosal thickening, sinus cysts or polypoid formations. CBCTs were evaluated by two different orthodontists and their findings were then compared and statistically analysed. CONCLUSION: Considered the high prevalence of incidental findings, prescription of a CBCT to paediatric patiens seems crucial in order to to detect conditions that would require referral to a specialist.

Pain perception in paediatric patients: evaluation of computerised anaesthesia delivery system vs conventional infiltration anaesthesia in paediatric patients.

Aim: The aim of the present study is to compare the effectiveness of a computerised system (QuickSleeper) compared to traditional syringe in injection of local anaesthetic focusing on the perception of anxiety and pain in paediatric patients. Methods: Study design: 100 children aged between 3 and 15 years in need of two dental treatments that required local anaesthesia were selected and treated randomly but alternately with computerised and traditional local anaesthesia. After each anaesthetic injection, patient's anxiety was measured using the Venham test. Results: Electronic anaesthesia showed statistically significant better results than traditional anaesthesia according to the Venham pain scale, in both mandibular and maxillary sites. Statistics: Data were analysed using the paired Wilcoxon test. Conclusion: The computer-assisted anaesthesia system resulted in a significantly lower pain perception score and yielded to helpful, cooperative behaviour. For this reason, it is an advantageous alternative to traditional injection anaesthesia and can avoid invasive treatments and trauma for young patients.

Proposal of use of the autotransplantation of the third molar as space maintainer in growing patients: a review of literature and a clinical case.

The review of literature shows that 48,22% of the autotranspated teeth were orthodontically treated. A 13-year-old male patient presented a destructive decay in the element 3.6, which was underoccluded. To maintain the arch space and the quantity of bone necessary for a potential implant, it was decided to perform an autotransplantation of the impacted element 3.8. Tooth autotransplantation is a valid and durable alternative to the prosthetic and the implant solutions with high success rate.

Rapid maxillary expansion for interceptive orthodontic treatment of palatally displaced canine: A systematic review.

AIM: The present systematic review aims to summarise the relevant randomised clinical trials and estimate the efficacy of interceptive orthodontic intervention, in particular if an interceptive treatment with rapid maxillary expansion could be successful in managing of palatally displaced canines (PDCs). MATERIALS AND METHODS: A search strategy was developed on electronic databases including Medline, Web of Science, Scopus and Cochrane Collaboration Trial from 1925 to 2019. Two reviewers independently reviewed the sources deciding for a full reading according to the inclusion and exclusion criteria. Methodological quality criteria were applied to the selected articles. RESULTS: Three randomised clinical trials (RCTs) and one prospective longitudinal study were included in the systematic review. Generally, the intervention groups showed a higher incidence of successful eruption of PDCs (45.1% - 65.7%) compared with the control groups (13.1% - 13.6%). CONCLUSIONS: Based on the literature published, authors reached a reasonable conclusion that rapid maxillary expansion can facilitate the eruption of PDCs. Authors suggest to associate maxillary expansion with deciduous canine extraction or prevention of mesial movement of the upper first molars.

Evaluation of tooth size in non-syndromic cleft lip and palate patients: A retrospective Italian study.

AIM: This study aims to evaluate the dental dimension in cleft lip and palate patients presenting agenesis of at least an upper lateral incisor and to compare the results with those of two control groups. A control group consisted of general orthodontic patients without agenesis, while the other group consisted of orthodontic patients with agenesis of at least one upper lateral incisor. METHODS: Records of 40 (30 male, 10 female) cleft lip and palate patients (Group A), 40 (17 male, 23 female) patients representing the control group of general orthodontic patients (Group B) and 40 patients (14 male, 26 female) with at least one missing lateral incisor (Group C) were collected and analysed. Mesiodistal tooth size of all teeth (except second and third molars) was measured on digital or plaster dental casts. RESULTS: Tooth size in cleft lip and palate patients (Group A) was similar to that of the control group (Group B) of general orthodontic patients without tooth agenesis, except for the upper central incisors and the second upper left bicuspids that presented a significant reduction in the mesiodistal dental width. Non-syndromic patients with at least one missing upper lateral incisor showed a significant reduction of mesiodistal tooth size compared to Group A and to Group B. CONCLUSION: Dental width of cleft lip and palate patients is similar to that of a normal orthodontic population, with the exception of the upper central incisor and upper premolars on one side.

Oral health-related quality of life in children using the child perception questionnaire CPQ11-14: a review.

OBJECTIVES: The Child Perceptions Questionnaire 11-14 (CPQ11-14) is the most common and effective indicator of paediatric oral health-related quality of life. The aim of this review was to verify if CPQ11-14 can be considered a valid instrument for assessing the impact of oral health on the quality of life of adolescents for the paediatric population aged between 11 and 14 years old and which dental conditions mainly affect it. STUDY DESIGN: A literature research from Pubmed Medline database was adopted to identify the eligible studies among the published articles related to CPQ 11-14 using keyword search strategy. From 170 initial articles, a total of 128 articles were included for the full text reading. RESULTS: Conditions that mainly interest the oral health-related quality of life are untreated dental caries, dental trauma, increased dental protrusion, wearing orthodontic appliances, and severe periodontal disease. CONCLUSION: CPQ 11-14 seems to be a solid and valid indicator to measure oral health-related quality of life, because it has been widely tested and validated in several states including developed, developing and underdeveloped countries.

In vitro comparison of the bond strength to the enamel of conventional and self-etching dental fissure sealants.

AIM: Dental caries in pits and fissures of molars is still very common in young people, despite a gradual reduction in their incidence and prevalence. Prevention with the aid of dental fissure sealants can help to reduce the onset of decay. In vitro tests were conducted to compare the bond strength to enamel of self-etching sealants versus those applied using the conventional procedure. METHODS: The lingual surface of 40 extracted, caries-free, mandibular third molars was milled to make them flat. The prepared teeth were randomly divided into two groups of 20 teeth each: those in Group A were treated with Clinpro (3M ESPE, St. Paul, MN, USA); those in Group B with Quick Seal (BJM Laboratories Ltd, Or-Yehuda, Israel). Cylinders of sealant were attached to the enamel of the flat surfaces of the samples using a polymerisation process treating the surfaces involved according to the type of material. All samples underwent load testing by means of a universal test machine. RESULTS: The results of the load testing, measured in MPa, were analysed using the Student's t-test for independent samples and the differences proved significant, indicating that the traditionally- applied sealant (mean strength 21.06 MPa) assured a significantly stronger bond (p <.05) than the self-etching sealant (mean strength 10.43 MPa) under our experimental conditions. CONCLUSION Conventional sealants generally provide a considerably higher bond strength than self-etching sealants.

The impact of a multidisciplinary approach on response rate of mandibular advancing device therapy in patients with obstructive sleep apnoea syndrome.

The aim of the present study was to evaluate the importance of a multidisciplinary approach on increasing the response ratio expectation to mandibular advancing device (MAD) therapy in patients with obstructive sleep apnoea syndrome, especially in severe cases. Forty-two mild-to-severe OSAS patients were selected, after comprehensive evaluation by neurologists, otorhinolaryngologists and orthodontists, and treated with a Somnodent® device. Six months later, a polysomnographic exam with the MAD in situ was performed. The paired t-test evaluated the effectiveness of therapy and the results were compared with data from systematic reviews. The average treatment response was statistically significant for the apnoea/hypopnea index (AHI) and oxygen desaturation index and was higher than the outcomes presented in literature. An optimum therapy response (AHI < 5) was observed in 53% of patients (40% in severe OSAS) and a good response (AHI < 10) in 73% of patients (50% in severe OSAS). The Somnodent® device was effective and the multidisciplinary patient selection improved the response ratio compared to that reported by previous systematic reviews.

Reliability of different methods for measuring the inclination of the maxillary canines on panoramic radiographs.

OBJECTIVES: To test the reliability of 4 different methods of measuring maxillary canine inclination (CI) on panoramic radiographs, and to determine whether examiner experience level influenced these measurements under ideal experimental conditions. SETTING AND SAMPLE POPULATION: The sample consisted of 20 high-quality panoramic radiographs obtained under standardized conditions using the same radiological apparatus. MATERIAL AND METHODS: Canine inclination (CI) was measured as either the angle formed by the canine long axis and the midline (method A), a line passing through the suborbitary points (method B), the most superior points of condyles (method C) or the mesiobuccal cusp tip of the first molars (method D). Measurements were made at initial observation (T1) and after 3 months (T2) by 5 experienced orthodontists and 5 undergraduate dental students. RESULTS: Mean T1-T2 differences for the measurements were close to zero, with no relationship between their magnitude or direction for each method. Intra-rater reliability was excellent, with the lowest values being observed for method B and the highest for method C. No influence of the examiner experience level was detected. CONCLUSION: The four methods used in this study to measure CI showed excellent intra-rater and inter-rater reliability, irrespective of examiner experience level. Method B was the least reliable and method C the most reliable, if compared with the others.

Numerical/experimental analysis of the stress field around miniscrews for orthodontic anchorage.

The aims of this study were to analyse the stress distribution developing around an orthodontic miniscrew (OM) inserted into the maxilla and to determine the stress field changes for different screw lengths and for different levels of osseointegration occurring at the bone/screw interface. An integrated experimental/numerical approach was adopted. Using the photoelastic technique, the stress field arising in the bone after screw insertion and the application of the initial orthodontic load was assessed. The finite element (FE) method was used to determine the stress acting in the bony tissue after a given time following screw application, when, for the viscoelastic relaxation effects, the only stress field remaining was that due to the application of the orthodontic load. Different levels of osseointegration were hypothesized. Photoelastic analyses showed that stress distribution does not change significantly for moderate initial orthodontic loads. From the FE simulations, it was found that critical conditions occur for screws 14 mm long with an orthodontic load of 2 N. The optimal screw length seems to be 9 mm. For such a dimension, small stress values were found as well as low risk of lesion to the anatomical structures.