Abdominal Acupuncture for Non-Responding TMD Patients: a Retrospective Observational Study in General Practice.

Background: Pain related to Temporomandibular Disorders (TMD) is severe, negatively affecting patients' quality of life, and often resistant to conventional treatments. Abdominal Acupuncture (AA) is known to be particularly effective for pain, especially chronic and musculoskeletal pain, but it is still poorly studied and never investigated in TMD patients. Objectives: To analyze the efficacy of AA for the treatment of patients with subacute and chronic pain related to TMD and non-responding to previous conventional therapies (occlusal splint, medications, physical therapy). Methods: Twenty-eight patients, 24 F and four M (mean age 49.36 years), were recruited from January 2019-February 2021. All patients underwent AA treatment: two sessions per week for four weeks, for a total of eight sessions. At the beginning of therapy (T0) and at the end of the cycle (T1) the following data were evaluated: maximum mouth opening (MMO); cranio-facial pain related to TMD (verbal numeric scale, VNS); pain interference with normal activities and quality of life of patients (Brief Pain Inventory, BPI); oral functioning (Oral Behavior Checklist, OBC); impression of treatment effectiveness (Patients' Global Impression of Improvement, PGI-I Scale). Statistical comparison of data before and after the AA treatment was performed by Wilcoxon's signed-rank test (significance level p < 0.05). Results: The MMO values were significantly improved after one cycle of AA (p = 0.0002). In addition, TMD-related pain had a statistically significant decline following AA treatment (all p < 0.001). Patients' general activity and quality of life (BPI) were described as improved following a course of AA, with statistically significant values for all aspects considered (all p < 0.05). Conclusion: Abdominal acupuncture resulted in effective treatment of subacute/chronic-resistant pain related to TMD, capable of improving mandibular function and facial pain, and reduced the interference of pain affecting patients' quality of life.

Efficacy and Accuracy of Maxillary Arch Expansion with Clear Aligner Treatment.

The aim of this work was to evaluate the efficacy and accuracy of maxillary arch transverse expansion using the Invisalign® clear aligner system without auxiliaries other than Invisalign attachments. Knowing the accuracy of a movement through a clear aligner system allows the clinician to plan the treatment with greater precision and to achieve the expected result faster. The study group included 28 patients with a mean age of 17 ± 3.2 years. The treatment protocol for all the selected patients included the application of the Invisalign® clear aligner system without auxiliaries, except for the Invisalign® attachments; in no case were tooth extraction or interproximal enamel reduction (IPR) performed. Linear measurements of the expansion were assessed before treatment (T0), at the end of treatment (T1), and on final virtual models by ClinCheck® (TC). A paired t-test was used to compare T0-T1 and T1-TC differences. A paired t-test was applied, and one normality was validated with the Shapiro-Wilks test. If normality was not met, the nonparametric test (Mann-Whitney U test) was applied. The level of significance was set at 5%. Statistically significant differences were found for all measurements at T0-T1. The results showed an average accuracy of efficacy of 70.88%. The differences in predictability between the various vestibular measurements (intercanine, inter-premolar, and intermolar) were not statistically significant, while they were for gingival measurements. The overall accuracy of the expansion treatment was 70%, regardless of tooth type.

Is There a Correlation between Gingival Display and Incisal Inclination in a Gummy Smile? Study on Cephalometric Parameters.

BACKGROUND: Excessive gingival display or "gummy smile" is a clinical condition where a maxillary gum shows between the inferior line of the superior lip and the gingival line of the incisive superior during a spontaneous smile. The aim of this research was to understand the various skeletal and dentoalveolar components contributing to a gummy smile in a sample of 120 patients. MATERIAL AND METHODS: This retrospective case-control study had the primary objectives of analyzing the existence of a correlation between the presence of gingival exposure and the alteration of the inclination of the upper incisors with respect to the Frankfurt plane, the Palatine plane (bi-spinal) and to the NA line in a sample of orthodontic patients, and also evaluating the association with skeletal, dental, and aesthetic cephalometric parameters. RESULT AND CONCLUSIONS: In our study, it's emerged a correlation between the gingival exposure and the presence of alterations to incisal torque in the vestibular direction and the quantity of maxillary gingiva evident during the smile, which is correlated in particular to the Is-Sts distance, overjet and overbite. The major indicative data, therefore, are related to the vertical position of the upper incisors, in particular with respect to the upper lip and to the sagittal position.

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.

Factors affecting duration of post-surgical orthodontics in the Surgery First/Early Approach: A retrospective study.

BACKGROUND: Surgery First Approach (SFA) and Surgery Early (SE) are considered promising alternatives, compared to the conventional three-stages orthodontic-surgical approach, for treatment of dento-maxillofacial deformities. However, many features need further study, like the role of the orthodontist. Aim of the study was to analyse the clinical characteristics of patients who underwent SFA and SE, and if differences in duration of orthodontics could be influenced by clinical features. METHODS: A retrospective research was performed on patients who met the inclusion criteria for SFA (31) and SE (12), of the total of patients affected by dento-facial deformities in our Unit (191) in the period 2012-2017. After collection of clinical data, duration of orthodontics, age, pre-treatment PAR Index, ANB angle, amount of the curve of Spee were compared. A regression analysis evaluated if these clinical parameters, together with type of bracket and type of intervention, could influence the duration of post-surgical orthodontics. RESULTS: All patients who performed the SFA/SE were affected by class III, II and active Unilateral Condylar Hyperplasia (22% of total population). Pre-treatment mean differences of age (p = 0.0518), PAR Index (p = 0.0916), curve of Spee (p = 0.1006) between groups were not statistically significant. A statically significant difference was found for the overall duration of therapy, for the significant shorter duration of pre-surgical orthodontics, while the difference of post-surgical orthodontics duration was not significant (p = 0.4753). Type of bracket (rho=-0.19039, p = 0.266) and intervention performed (rho=-0.11522, p = 0.5034) were not correlated with duration of post-surgical orthodontics, as well as pre-treatment PAR Index, ANB angle and depth of the curve of Spee. CONCLUSIONS: Surgery First/Early Approach is a therapeutic choice that could be performed only in patients affected by specific malocclusions and who exactly meet indications. Protocol and post-surgical occlusal stability are factors that should influence the duration of therapy more than clinical characteristics.

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

Correlation between condylar size on CT and position of the articular disc on MRI of the temporomandibular joint.

Objective: To analyze the relationship between the size of the mandibular condyle and the temporomandibular joint disc position using computed tomography and magnetic resonance imaging.Methods: One hundred joints were retrospectively analyzed. The measures analyzed included the condylar head height, the medio-lateral and antero-posterior dimensions of the condylar head, and the TMJ disc position. ANOVA correlation coefficient and Tukey's post hoc test were employed.Results: The mean age of the subjects was 20.3 years. There were no significant correlations between the disc position in closed-mouth and the condylar head sizes. There was no significant correlation between the position of the disc in open mouth and the height of the condylar head, but there were statistically significant associations between the position of the disc and the horizontal condylar dimensions, the medial-lateral (p < .014), and the anterior-posterior sizes (p < .020).Conclusion: The condylar head size was smaller in subjects with disc displacement without reduction.

Temporomandibular disorders in Venezuelan and Italian adolescents.

OBJECTIVE: The aim of this research was to compare the prevalence of temporomandibular disorders (TMDs) among Venezuelan and Italian adolescents. METHODS: One hundred-seventeen Venezuelan and 138 Italian adolescents aged 11-18 years were examined according to the Diagnostic Criteria for TMDs (DC/TMD). Signs and symptoms were registered. RESULTS: TMD prevalence among Venezuelan adolescents (17.9%) was lower than that among Italian adolescents (29.7%) and was higher in females and in the 15-18 age group. Intra-articular disorders were the most frequent in Venezuelan (8.5%) and Italian adolescents (13.0%). Pain-associated disorders were more frequent in the 11-14 age group, while intra-articular disorders were more frequent in the 15-18 age group in both samples. Italian adolescents presented greater muscle pain and joint noise than Venezuelan adolescents. CONCLUSION: TMD prevalence in Venezuelan adolescents was lower than that in Italian adolescents. This suggests the involvement of cultural and/or genetic factors in the etiology of these disorders.

Assessment of maxillary canting on cone beam computed tomography and digital models: A retrospective study and proposal of a method.

OBJECTIVES: The mounting of the plaster casts on articulator procedure is routinely performed in orthognathic surgery to assess canting of the maxillary occlusal plane, but the currently used protocols and reference plane could be source of errors which affect reliability. Nowadays the assessment of canting of the maxillary occlusal plane could be also performed with an entirely digital protocol. Aim of the study was to propose a method to evaluate canting in patients affected by Unilateral Condylar Hyperplasia, comparing the measurements performed on digital models matched on CBCT with those made on traditional articulator. MATERIALS AND METHODS: A retrospective cross-sectional study was designed on 20 patients affected by vertical Unilateral Condylar Hyperplasia treated in the Units of Orthodontics and Maxillo-Facial Surgery. The canting of the maxillary occlusal plane was measured on plaster casts mounted on the conventional articulator and the measures were compared with those made on digital models matched on CBCT, according the protocol developed in our Unit. Molar, canine and basal difference were measured. To compare the two protocols and to test the agreement, we performed descriptive statistics, comparison between means and Bland Altman analysis. P value was set at 0.05. RESULTS: Statistic comparison demonstrated agreement between measurements performed with the digital protocol and conventional physical method. CONCLUSION: Measurements of canting with digital protocol are comparable to the physical standard method. A total digital protocol allows faster availability and storage of patient's data and better communication between orthodontist and maxillo-facial surgeon, especially in patients affected by three-dimensional malocclusions.

Psychological and Physical Distress in Italian People during COVID-19 Pandemic: One Year Later.

The aim of this study was to evaluate the major life changes that Italian people experienced after one year of the COVID-19 pandemic. We assessed the psychological and physical impact of COVID-19 within one year of the pandemic situation, and its possible correlation with the positive COVID-19 trend in the Italian region. We invited Italian people to complete a cross-sectional, online survey within a three-week period from 14 March to 4 April 2021. The survey collected data on the participants' stress and physical levels, attitude, perceived control, norms, personal and professional backgrounds, and place of stay in the last year. We used Student's t-test and the software package GRETL for Windows to assess the association between the study outcome variables and the explanatory variables (stress, attitude, perceived control, and norms). All participants who declared a level of physical stress in their answer suffered from psychological stress, but not vice versa. The result to be highlighted is that this level of stress was found more in women and in the age range of 21-45 years.

Auriculotherapy used to manage orthodontic pain: a randomized controlled pilot study.

INTRODUCTION: Several methods are commonly used to decrease orthodontic pain, but versatile tools and standardized protocols are still lacking. OBJECTIVE: In response to the need for alternatives to conventional analgesic methods, this study evaluates the analgesic effects of auriculotherapy (AT) during the first three months of fixed orthodontic treatment. METHODS: A sample of 36 subjects was selected, with patients randomly allocated into two homogeneous groups, Study Group (SG) and Control Group (CG), depending on the application/non-application of AT. Patients rated their pain scores monthly from 0 to 10, on visual analogue scales (VAS) at the time of bonding (T0) and again at two appliance adjustments (T1 and T2). At each of these treatment phases, VAS was applied in six different time moments (TM): immediately before, immediately after, after 4 hours, after 8 hours, after 24 hours, and after 72h hours. Descriptive statistical analysis, a Student's t-test, and a Chi-square test were applied to the collected data (statistical significance for p< 0.05). RESULTS: SG patients reported lower pain levels than CG patients, both at T0, T1 and T2. Moreover, average pain intensity values were lower in the SG for all TM analyzed, with the t-test significant (p< 0.05) for most TMs. CONCLUSION: AT was effective in the pain treatment of patients with fixed orthodontic appliances. Further studies are needed with a sham control group to confirm the validity of these results.

Comparison of the Effectiveness of Three Different Acupuncture Methods for TMD-Related Pain: A Randomized Clinical Study.

PURPOSE: This study aimed to compare the effectiveness of three acupuncture methods for temporomandibular disorders- (TMDs-) related pain. MATERIALS AND METHODS: Different locations of pain, according to DC/TMD clinical assessment, were considered: temporomandibular joint (TMJ), masticatory muscles, head, and neck. Sixty patients were assigned randomly to one of three treatment groups (20 patients in each): group BA received body acupuncture, group EA received electroacupuncture, and group CA received acupuncture + cupping. The groups were compared in terms of pain (verbal numeric scale), pain-related disability (Brief Inventory Pain, BPI), and impression of the treatment's effectiveness (Patients' Global Impression of Improvement Scale, PGI-I). These were recorded before sessions of acupuncture treatment (T0), after 8 sessions of acupuncture treatment (T1), and after 4 weeks of follow-up after treatment (T2). The between-group and within-group differences in the data were analyzed statistically. The baseline characteristics were similar in all groups (p > 0.05). RESULTS: Significant improvements were noted in all types of pain compared to baseline values in all groups (all p < 0.05). No significant differences were noted in the improvement of TMDs-related pain according to the different acupuncture techniques (all p > 0.05). All acupuncture methods used resulted to be significantly effective in improving the pain-related interference in the patient's common activities and quality of life. EA resulted to be significantly more effective than BA and CA in improving the interference of pain with patients' mood (p=0.015) and quality of sleep (p=0.014). CONCLUSION: BA, EA, and CA are all effective acupuncture methods in reducing pain and pain interference with common activities and quality of life in patients affected by TMD.

The VISTA Approach in Canine Disimpaction.

Canine disimpaction is always a challenging orthodontic treatment overall, even when the impacted permanent canine is in a high position, especially when in tight relation with the upper incisors' roots. Conventional treatment methods are usually not capable of performing the correct force direction, consisting of the contemporary movement in the distal and vestibular directions of the canine crown, often provoking, as side effects, the presence of decubitus on the mucous of the lips and cheeks or a poor final appearance of the periodontal support of the disimpacted canine. Among the different approaches, the vertical incision subperiosteal tunnel access (VISTA) technique shows good performance with regard to the direction of the forces and the canine's periodontal conditions when erupted; it is usually realized through an elastic chain connected to a temporary anchorage device (TAD) in the posterior area. In this paper, a different protocol for the VISTA method is also presented, to be resorted to in cases of difficult miniscrew positioning due to the anatomic conditions or stage of dentitions. The new protocol also considers the use of nickel-titanium coil springs in order to avoid the need of frequent reactivation of the device and consequent patient discomfort, highlighting its advantages and indications with respect to the traditional approach.

Perceived Pain during Rapid Maxillary Expansion (RME): Trends, Anatomical Distinctions, and Age and Gender Correlations.

Objectives: To investigate pain trends and characteristics of different facial districts in patients undergoing rapid maxillary expansion (RME) and its possible correlations with age and gender. Materials and Methods: 85 subjects (45 males and 40 females) undergoing RME were selected and analyzed during first two weeks of treatment. Patients rated daily two types of pain perception: the general perceived pain (GPP), i.e., the pain overall perceived in the face, and the local perceived pain (LPP), i.e., the pain perceived locally in the following anatomical areas: anterior palate (APA), posterior palate (PPA), nasal (NA), joint (JA), and zygomatic (ZA). Patients were provided the Numeric Rating Scale (NRS) and Wong-Baker Faces Pain Rating Scale (FPS) to correctly assess their GPP and LPP. Pearson correlation coefficient and analysis of variance (ANOVA) were, respectively, used to define the linear relationship between all the variables considered and to verify whether the response variables (gender and age) were significantly different (α < 0.05). Results: Sample's mean age was 10.11 years. Average pain values of GPP and LPP progressively rise from day 1 to days 2-3 (pain peak) and tended to decrease until day 14, with a linear decrease for GPP and a not linear decrease for LPP. PPA and APA resulted the most painful areas, followed, respectively, by JA, ZA, and NA. Statistically significant differences resulted in average pain values according to patients' age and gender, both in GPP and LPP. Conclusion: RME causes perception of pain in several maxillofacial areas. Pain reported during RME resulted positively correlated with age and gender of patients.

Unilateral condylar hyperplasia: a thee-dimensional CBCT morphometric and volumetric evaluation of mandibular condyle by open-source softwares / Hiperplasia condilar unilateral: evaluación morfométrica y volumétrica en TCHC tridimensional del cóndilo mandibular mediante softwares de código abierto

SUMMARY: Unilateral condylar hyperplasia (UCH) is an alteration of the mandibular condyle growth. The aim of this study was to evaluate condyle volume, surface area, and Morphological Index (MI) differences between the affected condyle and an unaffected one in patients with UCH, evaluated through 3D reconstructions cone beam computed tomography (CBCT) images by two open-source softwares. A retrospective cross-sectional study of 16 patients with a certain UCH, 9 females and 7 males with mean age 25.13 ± 6.8 years was made. The image obtained from the CBCT of each condyle were reconstructed using the open-source software 3D SLICER 4.6 ®. The volumetric and area measurements of the 3D reconstruction of the mandibular condyle were made using the open-source soft- ware NETFABB basic 5.0 ®. The mean condylar volume of the hyperplastic condyles was 2.07 ± 1.51 cm3 and the non-hyperplastic condyles was 1.16 ± 0.82 cm3 (p<0.05). The mean area surface of the hyperplastic condyle was 11.77 ± 3.71 cm2 and the non-hyperplasic condyle mean was 8.05 ± 2.17 cm2 (p < 0.05). The mean area surface difference was 3.72 ± 3.57 cm2 (28.0 %). The MI of the hyperplastic condyle was 1.8 ± 0.3 mm and the non-affected condyle was 1.3 ± 0.6 mm (p < 0.05). The use of open-source software for 3D reconstruction with manual segmentation for evaluation of the volume and the condylar surface is a valid tool available to the clinic in the diagnosis and monitoring of patients with condylar hyperplasia.

RESUMEN: La hiperplasia condilar unilateral (HU) es una alteración del crecimiento del cóndilo mandibular. El objetivo de este estudio fue evaluar en pacientes el volumen del cóndilo, el área de superficie y las diferencias del índice morfológico (IM) entre el cóndilo afectado y el no afectado en pacientes, mediante tomografía computarizada de haz cónico (TCHC), por medio de dos softwares. Se realizó un estudio transversal retrospectivo de 16 pacientes con determinada HU, 9 mujeres y 7 hombres con edad media 25,13 ± 6,8 años. La imagen obtenida del TCHC de cada cóndilo se reconstruyó utilizando el software de código abierto 3D SLICER 4.6 ®. Las medidas volumétricas y de área de la reconstrucción 3D del cóndilo mandibular se realizaron utilizando el software de código abierto NETFABB basic 5.0 ®. El volumen condilar medio de los cóndilos hiperplásicos fue de 2,07 ± 1,51 cm3 y el de los cóndilos no hiperplásicos fue de 1,16 ± 0,82 cm3 (p <0,05). La superficie media del cóndilo hiperplásico fue de 11,77 ± 3,71 cm2 y la media del cóndilo no hiperplásico fue 8,05 ± 2,17 cm2 (p <0,05). La diferencia de superficie de área media fue 3,72 ± 3,57 cm2 (28,0 %). El IM del cóndilo hiperplásico fue de 1,8 ± 0,3 mm y el cóndilo no afectado fue de 1,3 ± 0,6 mm (p <0,05). Para el clínico, el uso de software de código abierto en la reconstrucción 3D con segmentación manual, para la evaluación del volumen y la superficie condilar, es una herramienta efectiva en el diagnóstico y tratamiento de pacientes con hiperplasia condilar.

Comparative Evaluation of Esthetic and Structural Aspects in Class II Functional Therapy. A Case-Control Retrospective Study.

Background: To compare the skeletal, dental, and esthetic changes produced by three functional devices, Fränkel-2 appliance (FR-2), Twin Block (TB), and Occlus-o-Guide® (O-o-G®), for the treatment of Class II malocclusion. Methods: Sixty-five patients with Class II Division 1 malocclusion were divided into three groups and were analyzed through cephalometric analysis of skeletal, dental, and esthetic variables before and after treatment. The first group of 23 patients (F: 9; M: 14; mean age: 10.3 ± 1.08 years) was treated with FR-2, the second group of 18 patients (F: 8; M: 10; mean age 10.7 ± 1.05 years) was treated with TB, the third group (F: 11; M: 13; mean age: 9.05 ± 0.39 years) of 24 patients was treated with O-o-G®. The structural effects of the three devices were compared with a control group generated by the growth variations reported in the cephalometric atlas of Bhatia and Leighton. Esthetic analysis was performed comparing the results of the patients treated with a control group of 20 subjects with mandibular retrognathia and Class II Division 1 malocclusion, not subjected to therapy. Results: The three devices resulted in a significant increase in mandibular length, with higher results obtained for FR-2 and TB. A statistically significant increase in the IMPA angle was found for the O-o-G® group, and a notable reduction of both overjet and overbite was detected in all three groups of treated patients. The esthetic evaluation showed overall more significant results in the TB group, especially with regard to the reduction of facial convexity. The retrusion of the upper lip was on average more significant in the O-o-G® group, followed by that in the TB. Conclusions: All three devices have proven to be effective overall in resolving skeletal changes and improving facial esthetics.

Uncovering and Autonomous Eruption of Palatally Impacted Canines-A Case Report.

The impaction of permanent maxillary canine is a common clinical occurrence, and it is observed in 2% of patients who require orthodontic treatment. This case report describes a new orthodontic-surgical approach through the use of CO2 laser, for the exposure of the palatally impacted canines. A 13-year-old female referred to our observation to make an orthodontic examination because of the maxillary primary canines' persistence in upper arch. Orthopanoramic X-ray showed impaction of both permanent maxillary canines. The family history revealed that the patient's mother had the same orthodontic problem. Cone Beam Computer Tomography (CBCT) was requested to plan the surgical-orthodontic treatment. Surgical exposure of the impacted canines was performed using a CO2 laser and subsequent periodontal pack application. No orthodontic devices were applied for impacted teeth traction on dental arch. Canines' movement was monitored at 1, 8 and 16 weeks post-surgery with photo and intraoral scanner CS3500 (CS3500®, Carestream Health, Atlanta, GA, USA). When canine crowns were completely erupted on palatal side, the alignment in the arch with indirect bonding technique was performed. Complete disimpaction of canine crowns was obtained in only four months. As reported in the literature, this case confirms that impacted canines' exposure to CO2 laser has advantages if compared with traditional surgery: no bleeding during and after the procedure, decontaminant effect on the surgical area, no suture, and a fast spontaneous eruption. Conclusions: The pre-orthodontic uncovering and autonomous eruption of palatally impacted maxillary canines provides simplified, predictable, and more aesthetic outcomes. Furthermore, a significant positive factor is that there is no need to carry out the orthodontic traction of the impacted element, undoubtedly better compliance by the patient during the next alignment phase with the fix orthodontic appliance.

Clear Aligners: Between Evolution and Efficiency-A Scoping Review.

In recent years, clear aligners have diversified and evolved in their primary characteristics (material, gingival margin design, attachments, divots, auxiliaries), increasing their indications and efficiency. We overviewed the brands of aligners used in Italy and reviewed the literature on the evolution of clear aligners based on their characteristics mentioned above by consulting the main scientific databases (PubMed, Scopus, Lilacs, Google Scholar, Cochrane Library). Inclusion and exclusion criteria were established. The data were collected on a purpose-made data collection form and analyzed descriptively. From the initial 580 records, 527 were excluded because they were not related to the subject of the review or because they did not meet the eligibility criteria. The remaining 31 studies were deemed comprehensive for the purpose of the review, although the "gingival margin design" feature and "auxiliaries" tool are not well represented in the more recent literature. Current knowledge on invisible aligners allows us to have a much clearer idea of the basic characteristics of aligner systems. There remains a need to deepen the use of systems other than Invisalign™ to give greater evidence to aligners that are very different based on the characteristics analyzed here and that are very widespread on the market.

Periodontal evaluation of palatally impacted maxillary canines treated by closed approach with ultrasonic surgery and orthodontic treatment: a retrospective pilot study.

Aim of this study is the evaluation of the periodontal status of impacted canines treated by closed approach with ultrasonic surgery and orthodontic treatment compared with contralateral spontaneously erupted teeth. The periodontal conditions of the teeth adjacent to the canines (lateral incisors and first premolar) were also considered. 17 patients (9 females and 8 males; mean age: 15.2 years) with unilateral palatal impaction of maxillary canine were selected. All patients were treated by closed-flap surgery with ultrasonic instruments. Periodontal status was evaluated by assessing probing depth (PD), gingival recession and width of keratinized tissue (KT) 4.6 months after the end of the orthodontic treatment, on average. Test group was composed by impacted elements and adjacent teeth and control group by contralateral spontaneously erupted canines and adjacent teeth. Student's t-test was used to compare test and control group values of PD and width of KT. Significance threshold for Student's t-test was set at p < 0.05. The average probing depth values show no significant clinical differences between the test and control groups. Probing depths recorded at the mesiovestibular and distopalatal sides of the impacted canine were statistically significant compared to the control elements (p < 0.05). No gingival recession was detected on the treated canines. The measurement of KT did not differ significantly between the test and the control groups. In conclusion, the ultrasonic surgery for disinclusion associated with a closed approach and orthodontic traction allows the alignment of an impacted palatal canine without damaging the periodontium.