Effectiveness of Mandibular Advancement Devices in Positional OSA Patients: A Retrospective Analysis of Predictive Variables in a Sample of Adult Patients.

Objectives To evaluate the efficacy of mandibular advancement devices (MADs) in improving apnea-hypopnea index (AHI) in positional obstructive sleep apnea (POSA), compared with a control group of nonpositional OSA (NPOSA) patients, from mild to very severe degree, in order to to find the main variables characterizing the examined group as potential predictors of treatment success. Materials and Methods In the present observational study, we retrospectively collected polysomnographic records of 39 positional adult patients, divided into 30 supine isolated OSA (siOSA) and 9 supine predominant OSA (spOSA) undergoing MADs from 2003 to 2019, and compared with those of a control group of 47 NPOSA patients. Demographics and anthropometrical data, home sleep apnea test (HSAT) records, drug-induced sleep endoscopy (DISE) results, and dental casts evaluation were analyzed pre- and post-treatment with MADs. Results A prevalence of the male sex (86%), mean age of 49,4 ± 14.98 years, and mean body mass index (BMI) of 26.74 ± 4.29 kg/m 2 were found among the OSA patients with significant differences between the three groups for sex and BMI. After MADs, the HSAT revealed significant reduction of AHI in all of the groups, with greater reduction of the supine AHI in POSA and significant reduction of the snore index for NPOSA. The hypopharynx section (H) of the NOHL Index, a fourth degree of hypopharyngeal collapse and an anteroposterior pattern was the most frequent to occur (19.9%) from DISE exam. No significant correlation between the initial total AHI and the dental variables was found, except for a reduced maxillary intermolar distance. Conclusion MADs are effective in reducing AHI in POSA and NPOSA patients from mild to very severe degree. Supine AHI decreased after treatment with MADs mainly in siOSA and spOSA patients compared with the NPOSA group. The snore index decreased significantly after treatment with MADs in all groups, showing the greater reduction in the NPOSA group. The tongue base (H) represented the most frequent anatomic area of collapse and there was a high prevalence of upper maxillary constriction.

CAD/CAM-based 3D-printed and PVS indirect bonding jig system accuracy: a systematic review, meta-analysis, and comparative analysis of hard and soft CAD/CAM transfer trays.

BACKGROUND: The widespread use of CAD/CAM transfer trays warrants evaluation of their accuracy as compared to PVS transfer trays. OBJECTIVES: To quantify the accuracy of CAD/CAM and PVS transfer trays, investigating any differences between soft and hard trays CAD/CAM transfer trays. SEARCH METHODS: Eight different databases (Scopus, Web of Science, PubMed, Google Scholar, ProQuest, Embase, Cochrane Library, ClinicalTrials.gov) were searched, without restrictions, up to an end date of February 2023. SELECTION CRITERIA: Clinical trials (randomized and non-randomized) and in vitro studies reporting average imprecision values for bracket positioning obtained by digital superimpositions of digitally planned and real positions. DATA COLLECTION AND ANALYSIS: Data eligibility, data extraction, and risk of bias (RoB-2 and ROBINS-I) were conducted independently. The data, where possible, were synthesized and quantitatively analysed (meta-analysis of mean differences with 95% confidence intervals). The Grade of Recommendation, Assessment, Development and Evaluation (GRADE) analysis of the quality of evidence was performed. The t-test for independent samples was used to compare the transfer accuracy of hard and soft CAD/CAM transfer trays. RESULTS: Thirteen studies were synthesized in this systematic review, and then eight studies were included in the quantitative meta-analysis. As regards linear measurements, there was a mean transfer error of 0.0752 mm (95%CI: 0.0428, 0.1076) for mesiodistal measures, 0.0943 mm (95%CI: 0.0402, 0.1484) for vertical, and 0.0815 mm (95%CI: 0.0469, 0.1160) for buccolingual. As for angular measurements, there was an average transfer error of 1.2279° (95% CI: 0.6011, 1.8548) for inclination, 0.9397° (95%CI: 0.4672, 1.4123) for angulation, and 0.8721° (95%CI: 0.4257, 1.3185) for rotation. CAD/CAM transfer trays were less accurate than polyvinylsiloxane (PVS) transfer trays, with those made of soft material being more accurate than the hard ones, except for vertical dimension. The GRADE quality of evidence ranged from very low to moderate. CONCLUSIONS AND IMPLICATIONS: CAD/CAM transfer trays provide high bracket positioning accuracy, with soft transfer trays offering greater precision than rigid ones. Future randomized prospective trials are required to enhance the strength of the available evidence. REGISTRATION: Prospero (CRD42023401278 number).

Evaluation of effects of brackets and orthodontic wires on intraoral scans: A prospective in-vivo study.

OBJECTIVE: To evaluate any distortion produced by multibracket fixed orthodontic appliances on digital models obtained from intraoral scans (IOS), considering the presence of both brackets only and brackets/archwire combination. SETTING/SAMPLE: The IOS data of the arches of 20 patients (12 females and 8 males; mean age = 15.55 ± 2.84 years) were acquired using the CS3600 intraoral scanner (Carestream Dental, Atlanta, USA), without any appliances (model A), with vestibular brackets alone (model B) and then with brackets and orthodontic archwire fitted (model C). MATERIALS AND METHODS: Data were acquired between the months of January and October 2021 at the moment of indirect bonding phase. On each model, five intra-arch linear measurements were obtained (inter-canine, inter-premolar 1 and 2, inter-molar and arch depth), and after digital matching between model A and B (match 1) and A and C (match 2), the linear discrepancies were evaluated at 20 points (10 occlusal and 10 gingivolingual) previous identified on the reference model A. All measurements were performed using Geomagic Control X software (3D Systems, Morrisville, USA), and any dimensional variations and distortions were evaluated by the linear regression analysis and two-sample t-test (P ≤ .05). RESULTS: The results show an almost perfect correlation between both models B and C and the reference model A, both as regards the intra-arch linear measurements and the linear discrepancies found at the 20 identified points. CONCLUSIONS: Multibracket fixed orthodontic appliances do not produce any relevant distortions in digital models obtained via intraoral scanning. Therefore, the removal of archwire is not mandatory before IOS.

Accuracy of 3D facial scans: a comparison of three different scanning system in an in vivo study.

BACKGROUND: The aim of the study was to compare the accuracy and reproducibility of three different 3D facial scanning systems, relying, respectively, on stereophotogrammetry, structured light and a smartphone app and camera. METHODS: Thirty subjects have been scanned with three different facial scanning systems, stereophotogrammetry, structured light and a smartphone app and camera. Linear measurements were compared with direct anthropometries measured on the patient's face, while the study of areas (forehead, tip of the nose, chin, right and left cheek) was evaluated by overlapping scans using the Geomagic Control X program. Statistical analyses were conducted using IBM SPSS v28 software. RESULTS: The ANOVA test was used to compare linear distances and direct anthropometry measurements, revealing statically significant values for all distances investigated, especially for the Face Hunter scanner, except for the Prn-Pog' distance (p = 0.092). The three facial scans were superimposed pairwise almost the 100 per cent of the overlapping areas fell within the tolerance limits for all three comparisons analysed. The chin was the most accurately reproduced, with no differences among scanners, while the forehead proved to be the least accurately reproduced by all scanners. CONCLUSIONS: All three acquisition systems proved to be effective in capturing 3D images of the face, with the exception of the Face Hunter scanner, that produced statistically significant differences in linear measurements for the distances Tr-Na' and Zyg-Zyg with respect to direct anthropometric measurements.

Gut Microbiota and Endometriosis: Exploring the Relationship and Therapeutic Implications.

Endometriosis is a common inflammatory disease affecting women of reproductive age, characterized by the growth of endometrial tissue beyond the uterus. In addition to gynecological manifestations, many endometriosis patients experience gastrointestinal symptoms, indicating a potential association between gut health and the disease. Recent studies have revealed alterations in the gut microbiota of individuals with endometriosis, including reduced diversity, microbial composition imbalances, and pathogenic bacteria. These changes can disrupt immune function, increase inflammation, and contribute to the chronic inflammatory state observed in endometriosis. Moreover, dysregulation of intestinal permeability may further exacerbate gastrointestinal symptoms in affected individuals. Understanding the role of the gut microbiota and intestinal permeability in endometriosis can provide valuable insights into disease pathogenesis, aid in non-invasive diagnostic approaches, and open new avenues for therapeutic interventions. Probiotics, in particular, have shown promise in improving endometriosis-associated pain symptoms and reducing endometriotic lesions in animal models. This review suggests that additional research and well-designed clinical trials are necessary to validate the potential diagnostic and therapeutic benefits of manipulating the gut microbiota in managing endometriosis and its gastrointestinal symptoms, thereby improving the quality of life for those affected.

Survival rate of indirectly bonded brackets using single vs. two-component orthodontic adhesive: A 12-month split-mouth clinical trial.

Objective: Compare the bonding survival rate of two distinct bonding materials: Ortho Solo + Gradia LoFlo Resin and single component GC Ortho Connect. Materials and Methods: Indirect bonding fixed appliance treatment was required for 26 consecutive patients, 8 males and 18 females, with a mean age of 22.1 +/- 4.2 years. All patients were treated with SWM (Straight-Wire Mirabella) technique (Sweden and Martina, Due Carrare, Padova, Italy). Each patient's bonding process followed a contralateral pattern. Firstly, a 37 % orthophosphoric acid etching gel was used for 20 s, subsequently the single or two components light-cured adhesives were applied through a split-mouth cross-arch procedure. The patients underwent a 12-month follow-up period and brackets failures were rebounded, but not further included in the study. Statistical analysis was performed to analyse the survival rate of the bonding materials and the influence of the variables, with a significant level of α = 0,05. Results: The GC Connect group was used on 349 teeth, while the Ortho Solo + Gradia group was used on 351 teeth, and the indirect debonding rate was respectively 17.5% and 12.8%. With respect to the total sample, statistically significant values were found for both sex and dental arch. The bracket's survival rate for incisors, canines, premolars and molars was not significant. However, a higher debonding rate was clinically appreciable in upper and lower molars. Conclusion: In a 12-months observation period, considering all maxillary and mandibular teeth the indirect survival rate for the group GC Ortho Connect and Ortho Solo + Gradia was respectively 82.5% and 87.2%. Although the difference was not significant, a pronounced tendency to debonding for the single component group was appreciable from a clinically point of view.

Evaluation of effectiveness and efficiency of fixed orthodontic treatment comparing standard and computer-aided design and manufacturing conventional bracket systems using indirect bonding for both: A retrospective study.

BACKGROUND: To compare the effectiveness and efficiency of orthodontic treatment (OT) with standard versus computer-aided design and computer-aided manufacturing (CAD/CAM) indirect bonding of conventional brackets. METHODS: This retrospective study examined two groups: standard indirect bonding group (12 males, 13 females; mean age 12.21 ± 0.52 years), and digital indirect bonding group (11 males, 14 females; mean age 12.76 ± 1.32 years), treated via a CAD/CAM indirect bonding system. Conventional brackets were used in both groups. Pretreatment and post-treatment records were acquired for all subjects. Weighted Peer Assessment Rating (W-PAR) index was used to assess the effectiveness of OT, in conjunction with five angular cephalometric measurements (ANB°, Sn-GoGn°, U1-PP°, IMPA° and FMA°) and comparatively analyzed using generalized mixed-effects models and post hoc test. Treatment efficiency was assessed in terms of the numbers of bracket repositionings, archwire bends, accidental bracket debondings, appointments and treatment months. Comparative analysis of efficiency was performed using the asymptotic Wilcoxon-Mann-Witney test. Statistical significance was set at 5%. RESULTS: Total W-PAR and W-PAR component scores decreased significantly during treatment for both groups and in a similar way. Cephalometric measures ANB° and IMPA° significantly decreased and increased, respectively. Significantly fewer bracket repositionings, number of appointments and treatment months were recorded in group digital indirect bonding. CONCLUSIONS: Although both methods investigated were effective to achieve good outcomes, CAD/CAM indirect bonding method increased the efficiency of OT, when conventional brackets are used.

Obstructive Sleep Apnea in Developmental Age: 22-Item Pediatric Sleep Questionnaire for an Observational Descriptive Investigation.

The aim of this paper is to perform an observational descriptive study of the Obstructive Sleep Apnea Syndrome (OSAS) in a population of children by evaluating the prevalence and role of sex and age variables. The 22-item Pediatric Sleep Questionnaire (PSQ) was administered to parents of children aged 3 to 12 years. The questionnaire is a very simple tool since it allows for the indication of patients with possible OSAS diagnosis through a cut-off of 0.33. The anonymous diagnostic questionnaire, available in digital format, was administered to the population under study by a link or QR code. Only the questionnaires completed in all their parts were recorded and analyzed. Eight hundred and thirty-two questionnaires were collected. One hundred and fifty-four subjects obtained a PSQ score > 0.33 and the prevalence of OSAS was 18.51%. The Chi-square test showed a statistically significant association between the PSQ score > 0.33 and male sex. The higher prevalence of subjects with a value of PSQ > 0.33 (n = 277) are aged 3-4-5 years, followed by the 6-7-8 range in the group with PSQ score > 0.33, p < 0.05. The prevalence of OSAS was 18.51% in children aged 3 to 12 years. The variables male biological sex and the age group 3-8 year were statistically significant for subjects with OSAS diagnosis. This study underlines the use of the 22-item Pediatric Sleep Questionnaire as a first screening tool to identify children at risk of OSAS.

Is a non-radiological-assisted method valid for establishing crown-root relationships in an orthodontic set-up incorporating the roots? A retrospective study.

INTRODUCTION: This study aimed to obtain information on the relationship between crown and root in terms of morphology - dimensions and crown-root angles -to be used for orthodontic set-ups without the use of radiological examinations. MATERIAL AND METHODS: All the good quality CBCTs of patients obeying the eligibility criteria, from 2000 to 2015, were analysed. All teeth were analysed except for third molars. Six variables were evaluated: crown (CL) and root length (RL), crown width (CW), root width (RW), crown-root angles in both the frontal (CR-frontal) and sagittal plane (CR-sagittal). All teeth were divided into 3 groups according to number of root (single, two, three-rooted). The measurements were assessed with the Invivo professional software and then, subjected to correlation matrices and linear regression statistical analysis in order to find any significant correlations between crown and root measurements (α≤0.05). RESULTS: Seventy-three out of 247 good quality CBCTs were assessed. Correlation matrices statistical analysis showed linear correlations for some variables investigated, especially for CW/RW pairing in all subgroups (r=0.81, r=0.70 and r=0.58 respectively for single-, two- and three-rooted) and CL/RL in the single-rooted subgroup (r=0.29). Subsequent linear regression analysis allowed to obtain information about roots starting from crown measurements by means of equations [RW=0.76+(0.73×CW) and RL=10.94+(0.25×CL) for single-rooted teeth; RL=1.11+(0.73×CW) and RW=0.99+(0.76×CW), respectively for single- and two-rooted teeth]. No linear correlation was found between crown measurements and C-R angular values. CONCLUSION: It is possible to obtain root information starting from some crown measurements but these do not fulfil the need of minimal information to guarantee a perfect root position starting from that of crown.

Class III treatment with mini-implants anchorage in young adult patients: short and long-term results.

INTRODUCTION: Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. OBJECTIVE: To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. CONCLUSION: The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.

Combined use of F22 aligners and intermaxillary elastics in mild skeletal Class II: Two case reports.

INTRODUCTION: The aim of these two case-reports is to illustrate and compare the therapeutic effects of Class II elastics in combination with F22 aligners in an adult and an adolescent patient, respectively. CASE PRESENTATION: Two patients with a mild skeletal Class II malocclusion, associated with mild-to-moderate crowding, presented for orthodontic treatment. The first patient was 12 years old, while the second was 40 years old. In both cases, the goal was to obtain bilateral molar and canine Class I with ideal overjet and overbite, and Class II skeletal relationship improvement in the young patient as well. Both treatments were approached without extractions and using clear aligners (CAs) in combination with Class II elastics, giving the patient the opportunity to take advantage of a therapy that is both comfortable and aesthetic. DISCUSSION: Final records of both cases demonstrate how appropriate analysis and diagnosis enable CAs in conjunction with Class II elastics to be used with considerable efficiency and efficacy for Class II treatment. In the first case, the key to success was exploiting residual jaw growth, while in the second case it was careful orthodontic digital planning. CONCLUSION: In the presence of good patient compliance, CAs associated with Class II elastics provide satisfactory occlusal outcomes if biomechanics and digital set-up are carefully evaluated and executed and if diagnosis is appropriate.

A non-invasive system to manage impacted teeth associated with a large dentigerous cyst.

A male patient aged 11 years presented a large dentigerous cyst in the lower left quadrant associated with retained deciduous lower lateral incisor and canine and impacted, unerupted corresponding permanent ones. The treatment consisted in marsupialisation and placement of a modified lingual arch that held a tube for decompression used for irrigation of the cystic cavity in a comfortable way for the patient and for the clinician.The same lingual arch was later used as an anchorage method for traction of the retained teeth. The final records showed complete resolution of the cyst and retained teeth were successfully Aligned into the oral cavity.

Analysis of overcorrection to be included for planning clear aligner therapy: a retrospective study.

OBJECTIVES: To provide clinical information on overcorrection to be included in the initial digital setup to make clear aligner therapy (CAT) more efficient. MATERIALS AND METHODS: Prescription data for 150 patients (80 women and 70 men; mean age 33.7 ± 12.7 years) treated successfully with CAT (F22 Aligners, Sweden & Martina, Due Carrare, Italy) and requiring only a single, minimal finishing phase were acquired retrospectively. The inclusion criteria were Class I dental malocclusion with only minimal crowding (≤3 mm), 12-20 aligner steps per arch, no use of auxiliaries or interarch elastics, and rotations ≤25° for round-shaped teeth. The prescribed and corrective movements to be achieved in the main and finishing treatment phases, respectively, were quantified by the dedicated clear aligner setup software. The magnitudes of inclination (buccal-lingual crown tipping), angulation (mesial-distal crown tipping), rotation, intrusion, and extrusion were extracted and analyzed by tooth type, maxilla and mandible, and both arches. Descriptive statistics, that is, mean, standard deviation, and percentage, were calculated for each movement investigated. Classification and regression trees (CART) were generated using the model-based recursive partitioning approach, and the corrective movements were correlated with respect to both the amount of the movements prescribed and the tooth type. Statistical significance was set at 5%. RESULTS: Inclination and rotation required the greatest correction, whereas angulation, intrusion, and extrusion required only minimal correction. Expressed as a percentage of prescribed movement, mean corrective movements were 20.5% for inclination, 14.5% angulation, 28.4% rotation, 11.7% extrusion, and 22% intrusion. According to CART, all corrective movements except extrusion depended on both tooth type and the magnitude of prescribed movement. CONCLUSIONS: To achieve more efficient CAT, approximately 20% overcorrection should be added to the initial planning phase when planning challenging movements such as inclination and rotation.

Class I and Class II Patients Treated with Damon System: A Study of Transversal, Sagittal and Torque Values Variations

ABSTRACT Objective: To analyze the transversal and anterior-posterior changes obtained in patients treated only with the Damon system. Material and Methods: 51 patients with either class I or class II division 1 sagittal relationship treated with the Damon system and the same archwire sequence were retrospectively selected. Dental casts of each patient before (T0) and after treatment (T1) were scanned and analyzed using NEMOCAST 3D software. Inter-molar, inter first-premolar, inter-second premolar and inter-canine distances were measured in both upper and lower arches. Initial and final lateral cephalograms were traced using the OrisCeph program. Pre and post-treatment measurements were compared using the t-test for repeated measurements. The Pearson Correlation Index and Linear Regression Analysis were used to determine the dependence between continuous variables. The significance level was set at 0.05. Results: Transversal diameters in the upper arch increase statistically significantly, especially in the bicuspid area. Initial intra-arch diameter was the only statistically significant variable correlated with the final expansion obtained. A linear negative correlation between the initial latero-posterior torque and the final expansion was observed in both arches. Conclusion: Using identical arches in patients with very different initial characteristics, the changes in bicuspids' diameters remain the most predominant. Patients with initial more negative torque in the posterior region had a higher expansion amount.

Class III treatment with mini-implants anchorage in young adult patients: short and long-term results

ABSTRACT Introduction: Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. Objective: To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. Conclusion: The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.

RESUMO Introdução: A má oclusão de Classe III deve ser interceptada e tratada em idade precoce, a fim de evitar uma futura necessidade de procedimentos complexos e invasivos. O tratamento com máscara facial ortopédica tem o objetivo de obter alterações esqueléticas, minimizando os efeitos colaterais na dentição. O uso de ancoragem óssea em mini-implantes, associada ao protocolo Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) pode ser eficaz no tratamento de um grande número de pacientes Classe III em crescimento. Objetivo: Realizar uma síntese da literatura baseada em evidência sobre o tratamento da má oclusão de Classe III em pacientes adultos jovens, e ilustrar sua aplicação e eficácia por meio do relato de um caso emblemático. Conclusão: A resolução e o acompanhamento em longo prazo do caso apresentado, juntamente com estudos conduzidos em uma amostra maior, demonstram a eficácia da combinação estratégica dos tratamentos ortopédico e ortodôntico usando um expansor palatal híbrido e o protocolo Alt-RAMEC para corrigir a má oclusão de Classe III em pacientes adultos.