The Use of CAD/CAM Technology in Mandibular Canine Disimpaction: A Case Report.

This case report of an 11-year-old subject shows the digital workflow for the management of an impacted mandibular canine using Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) technology along with Temporary Anchorage Devices (TADs). The miniscrew insertion site was planned using software, and a surgical guide was digitally designed and 3D printed. Orthodontic traction was performed using a 3D-designed and -printed device. In a single sitting, the miniscrew was inserted and the disimpaction device was also delivered. The primary objective of recovery and the repositioning of the impacted mandibular canine in the axis with its eruptive path was achieved. The space available and the subject's early stage of mixed dentition was considered favourable to a spontaneous eruption. This case report shows how CAD/CAM digital technology, combined with 3D printing, enables the creation of a surgical guide to position the miniscrew and the customized devices used for mandibular canine disimpaction. CAD/CAM surgical guides can help clinicians to position TADs with more accuracy and predictability, ensuring high quality bone support offering primary stability. Although orthodontic traction is the most complex therapeutic choice to implement, with the aid of CAD/CAM technology it is possible to proceed with accurate and minimally invasive orthodontic traction in order to recover a mandibular canine.

Local factors relating to mandibular canine impaction: A retrospective study.

INTRODUCTION: This study aimed to investigate the characteristics of impacted and transmigrated mandibular canines and the association existing between them and some local factors, such as degrees of axial inclination of mandibular incisors, skeletal Class, and mandibular symphysis width. METHODS: A retrospective observational study was performed on the medical records and radiographic examination (panoramic radiographs and lateral cephalograms) of 102 orthodontic patients divided into a study group, with at least 1 impacted mandibular canine (51 subjects) and a control group, without mandibular impaction (51 subjects). A chi-square test, t test, and analysis of variance test analysis were used to analyze the data. RESULTS: Unilateral and buccal impaction and the presence of the deciduous canine were the more prevalent characteristics of impacted canines, whereas 39.2% presented transmigration. Furthermore, the persistence of the deciduous canine on the impaction side (P <0.0001) and the mesial axial inclination of the impacted canine (P <0.0001) were found to be statistically significant characteristics. A statistically significant association was found between the impaction of the mandibular canine and mandibular incisor to the mandibular plane angle (IMPA) (IMPA, 95.8°; P = 0.009). An additional statistically significant association was found with transmigrated canines (IMPA, 96.8°; P = 0.024). CONCLUSIONS: The mesialization of the canine cusp and the persistence of the mandibular deciduous canine are characteristics frequently found in the impaction of the mandibular canine. An accentuated vestibular inclination of the mandibular incisors is significantly associated with mandibular canine impaction.

Pure and Sc-doped diopside (CaMgSi2O6) vibrational spectra: modelling and experiments.

We investigated the structure of pure and Sc-doped synthetic diopside (a monoclinic single-chain silicate nominally CaMgSi2O6); in Sc-doped diopside, Sc3+ substitutes Mg2+ in the structure and, to achieve charge balance, vacancies form at the expense of Ca2+. We compared the structure obtained from ab initio modelling techniques at the density functional theory (DFT) level with the structure solved by employing single crystal X-ray diffraction. Furthermore, we compared IR and Raman spectroscopy experiments with vibrational density of states (VDOS) calculated from the Fourier transform of the velocity autocorrelation function obtained using ab initio (DFT) molecular dynamics simulations. In this framework, we developed a computational tool to assign the vibrational mode associated with a specific frequency. This method consists of projecting velocities along a specific set of internal coordinates such as stretching or bending, in cases involving defects or vacancies, to calculate a partial VDOS (pVDOS) that takes into account only the vibrations associated with selected internal modes, aiding the interpretation of the total VDOS and the experimental spectra in a relevant way. The computed data were validated with the experiments and we observed that doping the diopside structure with Sc produces peak broadening and the occurrence of new peaks in the Raman spectra and that site vacancies are associated with the nearby Sc site. The present work constitutes an interesting starting point to exploit the calculated VDOS/pVDOS to characterize experimental vibrational spectra of complex systems containing local vacancies, substitutions or defects as the Sc-doped diopside.

Computer-guided miniscrew insertion in the paramedian and parapalatal area of the palatal vault: low failure rate and no learning curve required to obtain predictable results?

AIM: To evaluate the failure rate of palatal computer-guided miniscrews, placed in paramedian and parapalatal regions for orthodontic purposes. In addition, to investigate the presence of a learning curve using computer guided miniscrew insertion, and to evaluate the peri-implant soft tissues response at 2-, 6- and 12- month follow-ups. MATERIALS AND METHODS: 202 palatal computer-guided miniscrews were inserted in 78 subjects for orthodontic purposes. A surgical guide was designed after planning the appropriate insertion sites on three-dimensional images created by the fusion of cone-beam computed tomography (CBCT) and digital dental model images. The devices were disassembled monthly to perform the percussion test and to evaluate the mobility of each miniscrew. To determine the presence of a learning curve, the time of miniscrew failures and the number of surgeries were evaluated. Bleeding on probing (BOP) and probing pocket depth (PPD) were recorded for each miniscrew, at 2- (T0), 6- (T1), and 12-month follow ups (T2). RESULTS: An immediate failure rate of 4.95%, due to lack of primary stability immediately following miniscrew insertion, was recorded, with statistically significant higher failure rate of parapalatal miniscrews (P= 0.00). Miniscrew failure occurred at random time, with an absence of a learning curve. The BOP (mean: 3.13%) and PPD (mean: 1.68mm) measurements remained stable over time. CONCLUSIONS: Computer-guided miniscrew insertion in the palatal vault showed a low failure rate without a determined learning curve to obtain predictable results and with long-term stability of peri-implant soft tissues indexes.

Can computer-guided surgery help orthodontics in miniscrew insertion and corticotomies? A narrative review.

Orthodontics has considerably increased the use of technology combined with surgery as a tool to improve dental movements in terms of predictability, acceleration of movement, and fewer side effects. To achieve these goals miniscrews and corticotomy were introduced. The digital workflow permits an increase in the accuracy of surgical and orthodontic setups. The tool that transfers the information is the CAD/CAM (Computer-Aided Design/ Computer-Aided Manufacturing) template. The aim of this review is to illustrate the use of computer-guided surgery in orthodontics regarding miniscrews and piezocision. The search strategy was a combination of Medical Subject Headings (Mesh) and free text words for PubMed. A total of 27 articles were included in this review: 16 concerned miniscrews and 11 concerned corticotomy. The current need for faster treatments, the improved systems of anchorage, and the evolution of imaging technologies require operators to be knowledgeable of the digital workflow. CAD/CAM templates allow greater precision and predictability of miniscrew insertion even if in the hands of less experienced clinicians and permit a better orientation and depth of the cortical incision. In conclusion, digital planning makes surgery faster and easier and allows for the identification and correction of any potential problem before the procedure.

The effects of biochar on soil organic matter pools are not influenced by climate change.

The sustainability of Mediterranean croplands is threatened by climate warming and rainfall reduction. The use of biochar as an amendment represents a tool to store organic carbon (C) in soil. The vulnerability of soil organic C (SOC) to the joint effects of climate change and biochar application needs to be better understood by investigating its main pools. Here, we evaluated the effects of partial rain exclusion (∼30%) and temperature increase (∼2 °C), combined with biochar amendment, on the distribution of soil organic matter (SOM) into particulate organic matter (POM) and the mineral-associated organic matter (MAOM). A set of indices suggested an increase in thermal stability in response to biochar addition in both POM and MAOM fractions. The MAOM fraction, compared to the POM, was particularly enriched in labile substances. Data from micro-Raman spectroscopy suggested that the POM fraction contained biochar particles with a more ordered structure, whereas the structural order decreased in the MAOM fraction, especially after climate manipulation. Crystalline Fe oxides (hematite) and a mix of ferrihydrite and hematite were detected in the POM and in the MAOM fraction, respectively, of the unamended plots under climate manipulation, but not under ambient conditions. Conversely, in the amended soil, climate manipulation did not induce changes in Fe speciation. Our work underlines the importance of discretely taking into account responses of both MAOM and POM to better understand the mechanistic drivers of SOC storage and dynamics.

Effect of the alkali vs iron ratio on glass transition temperature and vibrational properties of synthetic basalt-like glasses.

Volcanic eruptions generate huge amounts of material with a wide range of compositions and therefore different physicochemical properties. We present a combined Raman and calorimetric study carried out on four synthetic basaltic glasses with different alkali vs iron ratio which spans the typical compositions of basalts on Earth. Differential scanning calorimetry shows that changes of this ratio modify the glass transition interval whereas Raman spectra allow to gain insight about the structure of the glass in the microscopic and macroscopic range. Indeed, our Raman analysis is extended from the high frequency region, characterized by the molecular peaks, to the very low frequency region where glasses exhibit the boson peak. Spectra show a variation of the non-bridging oxygens number that affects the medium range order of the glass and the network interconnections. In the considered substitution interval, the boson peak shape is conserved while its position shift upwards. This means that increasing the alkali vs iron content, the elastic medium hardens but it does not change nature. This study emphasizes the importance of considering the full-range spectra when analysing multicomponent or natural systems with small chemical variations.

Dental and skeletal features in subjects with missing maxillary lateral incisors: a case control retrospective study.

BACKGROUND: The aim of this study was to investigate the relationship between missing maxillary lateral incisors and the mesio-distal (MD) diameters of the teeth. Occlusal and skeletal characteristics of the patients have been analyzed. METHODS: Seventy-nine patients were included in the study (permanent dentition, mean age: 13.7): 30 subjects with uni- or bilateral maxillary lateral incisors agenesis (study group, SG) and 49 patients with no maxillary lateral incisors agenesis (control group, CG). Orthopanoramics, plaster models and cephalometric analysis were used to perform the evaluations. RESULTS: Compared to the CG, in the SG, most of the teeth had smaller MD diameter. In the bilateral agenesis subgroup, the average differences between teeth diameters were lower than those found by comparing them to the unilateral agenesis subgroup and to the SG. Overjet was reduced on average in the SG. In the SG were found less cases of cross-bite and scissor-bite, less frequency of impaction of at least one tooth and agenesis of other teeth, crowding only in the lower arch, square or ovoid arch shape in the upper arch and square in the lower arch, increased interincisal angle and decreased SN^GoMe. CONCLUSIONS: Upper lateral incisors agenesis, especially in cases of unilateral agenesis, is associated with MD teeth reduction. The agenesis of the upper lateral incisors is associated with a greater probability of agenesis affecting other teeth, molar and canine class II, reduced overjet and overbite, square or ovoid upper arch shapes, increased interincisal angle and reduced total divergence.

Smile esthetic: comparison of perception amongst orthodontists, dental students, orthodontic patients and surgical orthodontic patients

Most patients require orthodontic treatment to improve the esthetics of their smile. Orthodontists must consider how some parameters of mini-esthetics can influence the patient's esthetic perception. Methods: A photograph of the smile of a young female was taken and some modifications were made to the buccal corridor, gingival exposure, smile arc and midline position to assess the influence of these variables on smile attractiveness. Two hundred examiners were selected from four groups: orthodontists (O), dental students (DS), orthodontic patients (OP) and surgical-orthodontic patients (SOP). Each examiner was asked to complete the questionnaire with an approval rating from 1 to 10. Significant level was set at P ≤ 0.05. Results: Only orthodontists considered buccal corridors of 4mm and midline deviation of 1mm as non-esthetic; all other examiners considered gingival exposures ≥3 mm and midline angulation as non-esthetic. All examiners assigned higher satisfaction values to the photo with the concordant smile arc and defined as non-esthetic the covered smile and the reverse smile arc. Patients perceived as non-esthetic only midline deviations of 4mm. The surgical orthodontic patients assigned lower values to the photos and showed greater attention to evaluating the esthetics of the smile than the orthodontic patients. Conclusion: Smile arc, gingival exposure and midline angulation influence smile esthetics; the role of buccal corridors and midline deviation is dependent on the type of examiner

Predictive Analysis of Maxillary Canine Impaction through Sella Turcica Bridging, Ponticulus Posticus Calcification, and Lateral Incisor Anomalies: A Retrospective Observational Study.

Maxillary canine impaction is an increasing dental anomaly and is often related to other dento-skeletal anomalies. The aim of this work is to support the clinician in evaluating the relationship between a displaced maxillary canine and clinical (the features of lateral incisors)/skeletal (ponticulus posticus and sella turcica bridging) anomalies through orthopanoramic radiographs, lateral cephalograms, and plaster casts to identify the parameters that best predict maxillary canine impaction. A retrospective observational study was carried out on the analysis of the medical records, radiographic findings (panoramic radiographs and lateral cephalograms), and plaster casts of 203 orthodontic patients divided into a case group, with at least one impacted maxillary canine, and a control group, without an impaction. A chi-square test and logistic regression analysis were used to analyze the data. A statistically significant association was found between the impaction of the maxillary canine and the female sex, the bridging of the sella turcica, the ponticulus posticus calcification, and the anomaly of the lateral incisor; a logistic regression revealed that these significant variables were found to be positive predictors of impacted maxillary canines, particularly in reference to the impaction in the palatal area. Finding one of these clinical and radiographic elements can represent a predictive sign of the possible impaction of the maxillary canine.

Comparing Distal-Jet with Dental Anchorage to Distal-Jet with Skeletal Anchorage: A Prospective Parallel Cohort Study.

The use of traditional intra-oral devices in maxillary molar distalization is not without undesirable consequences. The aim of the present study was to compare the miniscrew-supported distal-jet appliance to a traditional distal-jet appliance by evaluating the amount of upper first molar distalization and the dentoalveolar side effects. Data of 600 subjects visited at the orthodontic unit of Sapienza University of Rom were analyzed. Only 46 patients met the inclusion criteria and were selected and treated. Subjects were assigned randomly to receive treatment either with miniscrew-supported distal-jet appliance (Group A) or with a traditional distal-jet appliance (Group B). In Group A, miniscrews were inserted using a computer-guided surgical guide. The amount of upper first molar distalization and the dentoalveolar side effects were assessed both on the digital casts and on the lateral cephalometric radiograph at the end of the distalization phase. A descriptive statistical analysis that included the mean values and the standard deviation was conducted to evaluate the molar distalization and the dentoalveolar effects in two groups. Intergroup differences were determined using the Student's t-test. The significance was set at p ≤ 0.05. In Group A, greater maxillary first molar distalization and a spontaneous distalization of the first premolars and a palatal inclination of central incisors were observed. By contrast, in Group B, the first premolars tipped mesially and a proclination of the maxillary central incisors was observed. In both groups, the transverse widths of the dental arch increased while a greater tendency of first premolar extrusion and of maxillary first molar rotation was observed in Group B. The skeletal anchorage device achieved greater first molar distalization and did not cause dento-alveolar side effects.

Are the Insertion Torque Value and Implant Stability Quotient Correlated, and If So, Can Insertion Torque Values Predict Secondary Implant Stability? A Prospective Parallel Cohort Study.

PURPOSE: Primary stability is the most important prognostic index for predicting osseointegration. It is generally thought that to achieve high primary stability, it is necessary to insert an implant with a high insertion torque (IT). To date, it has not yet been determined whether IT and implant stability quotient (ISQ) values are correlated. The primary aim of the study was to determine the correlation between IT and ISQ values at the time of implant insertion (T0); at 2 months, the time of healing (T1); and at 6 (T2) and 12 months (T3) after loading. The secondary aims were to determine the influence of different macroscopic implant designs and of a different insertion arch on this correlation; and to assess whether implants inserted with a high IT, that is, > 50 Ncm, had higher levels of implant stability at 2-, 6-, and 12-month follow-ups. MATERIALS AND METHODS: STROBE guidelines were followed. Partially or monoedentulous patients were randomly assigned to receive taper thread on straight-body implants with microthreads (group A) or without microthreads (group B). At implant insertion, IT and ISQ values were recorded. At 2-, 6-, and 12-month follow-ups, the ISQ values were recorded. A spring-style torque wrench was used to assess the IT. The Osstell device was used to determine the ISQ values. Descriptive statistics, Pearson correlation, and t test were used. P was set at ≤ .005. RESULTS: Two hundred fifty subjects were assessed; 142 were included. Two hundred sixty-eight implants were inserted (group A, 137 implants; group B, 131 implants). No subject dropped out, and no implant failed. A statistically significant correlation between ISQ and IT was determined at the time of implant insertion (T0; P = .000). The implant morphology and arch did not influence the correlation. An IT > 50 did not determine a higher secondary stability. CONCLUSION: There is a strong correlation between IT and primary stability, but IT is not correlated with the secondary stability. A different implant macroscopic design and a different arch of insertion did not influence this correlation. Moreover, implants inserted with IT > 50 Ncm do not result in greater secondary stability.

Comparison of changes in skeletal, dentoalveolar, periodontal, and nasal structures after tooth-borne or bone-borne rapid maxillary expansion: A parallel cohort study.

INTRODUCTION: This parallel cohort study aimed to assess the dentoalveolar, skeletal, periodontal, and airway effects of tooth-borne (hyrax) and computer-guided miniscrew-supported rapid palatal expansion appliances. METHODS: Thirty-six subjects were randomly allocated into 2 groups. Eighteen subjects (mean age, 12.2 years; male-to-female ratio, 10:8) were assigned to receive treatment with the hyrax appliance (group A), and 18 subjects were treated with the computer-guided miniscrew-supported appliance (group B). The same type of expansion screw and expansion protocol was used in both groups. Linear and angular measurements of skeletal, dentoalveolar, periodontal, and nasal floor changes were performed on the pretreatment and posttreatment cone-beam computed tomography images (6-month follow-up). Descriptive statistics and the independent Student t test were used for the statistical analysis. Intraoperator reliability was evaluated using a 2 sample t test. The level of significance was P ≤0.05. RESULTS: Ten subjects were censured because posttreatment cone-beam computed tomography imaging was not performed because of the coronavirus disease 2019 pandemic. In the remaining 26 subjects, increases in linear measurements were observed in both groups. The transversal skeletal increase was greater and statistically significant in the group treated with the bone-borne expander (P ≤0.05). The dentoalveolar transverse diameters were greater in the tooth-supported expander group, with no statistically significant difference between the groups. The buccal inclination of the maxillary first molar was observed in the group with the tooth-borne expander, with a statistically significant difference between the 2 groups. A slight reduction of buccal and palatal thicknesses at the level of the maxillary first molars was observed in both groups, smaller in the skeletal expander group, with a statistically significant difference between the 2 groups only on the right buccal cortical plate. The width of the nasal floor increased more in the group with skeletal expander with a statistically significant difference of 2 mm. CONCLUSIONS: Computer-guided miniscrew-supported maxillary expanders allowed a greater transversal increase of the nasal-maxillary skeletal structures by reducing the dentoalveolar side effects of the tooth-supported devices.

Computer-Guided Bone Biopsy: A Technical Note with the Description of a Clinical Case.

AIM: The aim of this technical note is to present a computer-aided design-computer-aided manufacturing (CAD-CAM) surgical guide to perform a computer-guided bone biopsy. Traditionally, to diagnose abnormal conditions affecting jawbone, a bone biopsy is performed with the use of a trephine bur. The positioning of the bur, during the biopsy, is based on the skill of the surgeon; therefore, an inaccurate placement of a trephine bur may occur. The use of a guide, however, can minimize this risk and achieve a better result. MATERIALS AND METHODS: To determine the site and the extension of bone sampling, the stereolithography file (STL) file of cone-beam computed tomography (CBCT) images is acquired using a specific planning software and superimposed with the STL file of a dental cast; a virtual surgical guide is designed, using the same software that allows a 3D (three-dimensional) view of the guide from different perspectives and planes. The number and site of guide tubes are determined on the basis of the width and the extension of the sampling; thanks to a 3D printer, the surgical guide is manufactured. RESULTS: The use of a customized surgical guide realized with CAD-CAM technology allows a precise and minimally invasive approach, with an accurate three-dimensional localization of the biopsy site. CONCLUSIONS: The high precision, great predictability, time-effectiveness and versatility of the present guide should encourage the clinician to use this minimally invasive surgical approach, but controlled clinical trials should be conducted to evaluate the advantages as well as any possible complications.

Periodontal results of different therapeutic approaches (open vs. closed technique) and timing evaluation (< 2 year vs. > 2 year) of palatal impacted canines: a systematic review.

BACKGROUND: This review evaluates, as a primary outcome, which surgical technique (open vs. closed) and which type of material used for the auxiliaries (elastic vs. metallic) were preferable in terms of periodontal results during the treatment of palatal-impacted canines. The timing of the evaluation of the results was also assessed as a secondary outcome. METHODS: An electronic search of the literature up to March 2021 was performed on Pubmed, MEDLINE (via Pubmed), EMBASE (via Ovid), Cochrane Reviews and Cochrane Register of Controlled Trials (RCTs) (CENTRAL). The risk of bias evaluation was performed using version 2 of the Cochrane risk of bias tool (RoB 2) for RCTs and the ACROBAT NRSI tool of Cochrane for non-RCTs. RESULTS: 11 articles met the inclusion criteria. Only one RCT was assessed as having a low risk of bias and all the non-RCTs were assessed as having a serious risk of bias. This review revealed better periodontal results for the closed technique and metallic auxiliaries. In addition, it revealed that the timing of the evaluation of the results affects the periodontal results with better results obtained 2 years after the end of treatment. CONCLUSION: In the treatment of a palatal-impacted canine, the closed technique and metallic auxiliaries should be preferred in terms of better periodontal results. The timing of the evaluation of the results affects the periodontal results.

Estimating the viscosity of volcanic melts from the vibrational properties of their parental glasses.

The numerical modelling of magma transport and volcanic eruptions requires accurate knowledge of the viscosity of magmatic liquids as a function of temperature and melt composition. However, there is growing evidence that volcanic melts can be prone to nanoscale modification and crystallization before and during viscosity measurements. This challenges the possibility of being able to quantify the crystal-free melt phase contribution to the measured viscosity. In an effort to establish an alternative route to derive the viscosity of volcanic melts based on the vibrational properties of their parental glasses, we have subjected volcanologically relevant anhydrous glasses to Brillouin and Raman spectroscopic analyses at ambient conditions. Here, we find that the ratio between bulk and shear moduli and the boson peak position embed the melt fragility. We show that these quantities allow an accurate estimation of volcanic melts at eruptive conditions, without the need for viscosity measurements. An extensive review of the literature data confirms that our result also holds for hydrous systems; this study thus provides fertile ground on which to develop new studies of the nanoscale dynamics of natural melts and its impact on the style of volcanic eruptions.

Comparision of profile macro-estethic perception among orthodontists, dentistry students, orthodontic patients and surgical orthodontic patients.

BACKGROUND: The patient's needs should guide the orthodontist in choosing the most appropriate therapy. The purpose of the present survey was to compare the esthetic perception of the facial profile by orthodontists (O), dentistry students (DS), orthodontic patients (OP) and surgical-orthodontic patients (SOP) and to evaluate the influence of gender, age and level of study. MATERIAL AND METHODS: A facial profile photograph of a young female was taken and twelve modified images were made, altering the position of the jaws in protrusion and in retrusion. Two hundred caucasian examiners, divided into four groups (O, DS, OP, SOP), were selected. Each examiner was asked to complete the questionnaire with an approval rating from 1 to 10. An ordinary least square OLS model was applied. Significant levels were set at P ≤ 0.05. RESULTS: All examiners considered a straight profile or a slight retrusion of the maxilla as the most attractive profile. Slight discrepancies (up to 2 mm) in jaw protrusion were barely perceived by patients. Mandibular retrusion (2 and 4 mm) was one of the least appreciated condition by all examiners. Surgical-orthodontic patients assigned lower ratings compared to orthodontic patients. Female subjects assigned lower ratings than males. Patients with secondary school education assigned higher statistically significant values compared to other levels of study. The lowest values were attributed by the sample of age > = 17 years. CONCLUSIONS: The choice of the most appropriate therapy is based not only on a correct diagnosis, but on the evaluation of esthetic and psychological aspects. Key words:Estethic, profile, orthodontic, surgical orthodontic patients.

Uprighting Impacted Mandibular Second Molar Using a Skeletal Anchorage: A Case Report.

The aim of this case report is to present an innovative combined orthodontic-surgical technique to disimpact mandibular second molar (MM2) using an orthodontic miniscrew and an elastic chain. The impact on the Oral health-related quality of life (OHRQoL) was also evaluated. Using the present techinique, it is possible to expose the impacted tooth, insert a self-drilling miniscrew in the retromolar area, and remove the bud of third mandibular molar. At the same time the orthodontic force is applied with the use of an elastomeric chain that connects the head of miniscrew and vestibular and oral buttons bonded on MM2. A close traction is performed for the whole treatment time without the reactivation of the elastic force. The use of skeletal anchorage allowed the disimpaction of impacted MM2 in a short treatment time (about three months) avoiding the typical biomechanical side effects of traditional orthodontic appliance and increasing the effectiveness of the treatment. Further studies are necessary to evaluate the real advantages and disadvantages of this combined orthodontic-surgical approach.

The impact of tooth-borne vs computer-guided bone-borne rapid maxillary expansion on pain and oral health-related quality of life: A parallel cohort study.

INTRODUCTION: The primary aim of this study was to investigate and compare perceived pain intensity and oral health-related quality of life (OHRQOL) results during the activation phase of rapid maxillary expansion (RME), with tooth-borne and bone-borne devices. In addition, a secondary aim of this study was to evaluate the correlation between pain scales and the shortened Oral Health Impact Profile (OHIP-14) questionnaire. METHODS: Thirty-six subjects (16 girls and 20 boys) with a mean age of 12.3 years (standard deviation, 0.82 years) were randomized into 2 groups. Group A received treatment with hyrax appliance, and group B received a computer-guided skeletal RME appliance. The same type of expansion screw and screw activation or expansion protocol were used. Two rating scales were used to assess the subject's pain during the activation phase of RME: a Graphic Rating Scale for Pain (GRS) and the Wong-Baker Faces Pain Scale (FPS). The OHIP-14 was used to evaluate the impact of RME on OHRQOL before the beginning of the treatment at day 3 and day 7 follow-ups. Painkillers were forbidden during the active phase of RME. Descriptive statistics, Student t test, and Pearson correlation were used. Significance was set at P ≤0.05. RESULTS: A total of 36 subjects, divided into 2 groups, were treated in the study. Regarding the level of pain, the Student t test showed statistically significant higher pain in group B-although only on the first day of screw activation (GRS, P = 0.01; FPS, P  <0.01). For the following days, there were no significant differences in pain levels between groups. The OHIP-14 showed no statistically significant difference at baseline (P = 0.32) and day 3 (P = 0.88) and day 7 (P = 0.85) follow-ups between the 2 groups. The Pearson correlation coefficient showed a statistically significant association between the 2 different scales of pain (GRS and FPS) but not a statistically significant correlation between GRS and FPS scales and OHIP-14. CONCLUSIONS: A higher perceived pain intensity in the patients treated using a bone-borne computer-guided skeletal RME appliance was limited to the first day of screw activation. There were no statistically significant differences between the 2 types of treatment in terms of their impact on OHRQOL and no statistically significant correlation between pain scales and the OHIP-14 questionnaire.

Split crest technique for implant treatment of agenesis of the upper lateral incisors: results of a randomized pilot histological and clinical study at 24-month follow-up.

Agenesis of lateral incisors, besides the functional issues, represents a great esthetic drawback. The selection of an appropriate treatment is a complex decision, which should consider the stability of the clinical outcomes over time. The aim of the present study was a histological and clinical comparison of two-stage split crest technique (SCT), with bone chips alone or mixed with porcine bone in patients affected by unilateral and bilateral agenesis of the upper lateral incisors. Eleven patients were enrolled, and randomly assigned to receive a treatment with autologous bone chips (group 1) or autologous bone chips mixed 1:1 to porcine-derived xenogenic bone (group 2). After a 2-month healing period, implants were placed and biopsies harvested for histomorphometrical evaluation. Clinical assessment, according to ICOI PISA health scale, and radiographic marginal bone loss evaluation at 12- and 24-month follow-ups were conducted. The histomorphometry showed significantly greater new bone formation (p > 0.0229) in group 2. At 12- and 24-month follow-ups, all the evaluated implants, regardless of the group they were allocated, could be categorized as "success" in the ICOI Pisa Health Scale for Dental Implants, and did not show significant difference in crestal bone loss. To the best of our knowledge, these are the first histological and clinical outcomes indicating that the use of bone chips mixed 1:1 to porcine bone in SCT could be a promising technique for the rehabilitation of patients with agenesis of the upper lateral incisors, although studies with a larger number of patients and implants, and a longer follow up are needed.