Understanding racial/ethnic disparities in COVID-19 mortality using a novel metric: COVID excess mortality percentage.

Prior research on racial/ethnic disparities in COVID-19 mortality has often not considered to what extent they reflect COVID-19-specific factors, versus preexisting health differences. This study examines how racial/ethnic disparities in COVID-19 mortality vary with age, sex, and time period over April-December 2020 in the United States, using mortality from other natural causes as a proxy for underlying health. We study a novel measure, the COVID excess mortality percentage (CEMP), defined as the COVID-19 mortality rate divided by the non-COVID natural mortality rate, converted to a percentage, where the CEMP denominator controls (albeit imperfectly) for differences in population health. Disparities measured using CEMP deviate substantially from those in prior research. In particular, we find very high disparities (up to 12:1) in CEMP rates for Hispanics versus Whites, particularly for nonelderly men. Asians also have elevated CEMP rates versus Whites, which were obscured in prior work by lower overall Asian mortality. Native Americans and Blacks have significant disparities compared with White populations, but CEMP ratios to Whites are lower than ratios reported in other work. This is because the higher COVID-19 mortality for Blacks and Native Americans comes partly from higher general mortality risk and partly from COVID-specific risk.

Long-term effects produced by early treatment of Class III malocclusion with rapid maxillary expansion and facemask followed by fixed appliances: A multicentre retro-prospective controlled study.

OBJECTIVE: To assess the short- and long-term dentoskeletal effects of early Class III treatment with rapid maxillary expansion and facemask (RME/FM) followed by fixed appliances. MATERIALS AND METHODS: A total of 44 patients (27 females, 17 males) treated consecutively with RME/FM were included from the archives of 3 centres. Three lateral cephalograms were available: T0 (before the start of RME/FM therapy, mean age 8.1 ± 1.8 years), T1 (immediately after RME/FM, mean age 9.8 ± 1.6 years), and T2 (long-term observation, mean age 19.5 ± 1.6 years). A control group of 17 untreated Class III subjects (12 females and 5 males) also was selected. Between-group statistical comparisons were performed with ANCOVA. RESULTS: No statistically significant differences for any of the cephalometric variables were found at T0. In the short term, the treated group showed significant improvements in ANB (+2.9°), Wits appraisal (+2.7 mm), SNA (+1.8°) and SNB (-1.1°). A significant closure of CoGoMe angle (-1.3°) associated with smaller increments along Co-Gn (-2.4 mm) also was found together with a significant increase in intermaxillary divergence (+1.3°). In the long-term, significant improvements in ANB (+2.6°), Wits appraisal (+2.7 mm) and SNB (-1.7°) were recorded together with a significant closure of the CoGoMe angle (-2.9°). No significant long-term changes in vertical skeletal relationships were found. CONCLUSIONS: RME/FM therapy was effective in improving Class III dentoskeletal relationships in the short term. These changes remained stable in the long-term due mainly to favourable mandibular changes.

Cephalometric changes of pushing splints 3 compared to rapid maxillary expansion and facemask therapy on the airway space in class III growing patients: A randomized clinical trial.

BACKGROUND: Early orthopaedic treatment with rapid maxillary expansion (RME) associated with facemask (FM) has been shown to be effective in correcting Class III malocclusions in children. Treatment with pushing splints 3 (PS3) has shown to correct skeletal discrepancies in Class III growing patients. However, the effects of orthopaedic treatment on the upper airways in children with Class III malocclusion is controversial. OBJECTIVES: The aim of this study was to evaluate the cephalometric changes in the airways of PS3 compared to the RME/FM protocol. MATERIALS AND METHODS: In this study, 48 patients with Class III malocclusion (age range 5.5-8.5 years old) were selected for this study, and 24 were treated with PS3 appliance and 24 with RME/FM therapy. Lateral cephalograms before (T0) and at the end of the treatment (T1) were analysed to compare pharyngeal spaces. Paired and unpaired t tests were used for data analysis (P < .05). RESULTS: A total of 41 patients (21 patients for the PS3 group, 11 males and 10 females, mean age 7.0 ± 1.2 years; 20 patients for the RME/FM group, 10 males and 10 females, mean age 7.2 ± 1.3 years) were included. The results showed a statistically significant (P < .05) increase in the nasopharyngeal space after both therapies. However, the effects were similar considering that there were no differences between groups for the assessed variables at T0-T1. CONCLUSIONS: Early treatment of Class III malocclusion with PS3 does not induce a statistically significant increase in the sagittal airway space compared to RME/FM. The absence of untreated group could not define the role of growth in the increase of space.

Efficacy of an automatic electric toothbrush with nylon bristles in dental plaque removal: a cross-over randomized controlled trial.

OBJECTIVES: The objective of this single-use, five-treatment, five-period, cross-over randomized controlled trial (RCT) was to compare the efficacy in dental plaque removal of a new Y-shaped automatic electric toothbrush (Y-brush) compared to a U-shaped automatic electric toothbrush (U-brush), a manual toothbrushing procedure (for 45 and 120 s), and no brushing (negative control). MATERIALS AND METHODS: Eligible participants were volunteer students randomized to the treatments in the five periods of the study. The primary outcome measure was the reduction in full-mouth plaque score (FMPS) after brushing while the secondary outcome variable was a visual analogic scale (VAS) on subjective clean mouth sensation. Mixed models were performed for difference in FMPS and VAS. RESULTS: After brushing procedures, manual toothbrushing (120 s) showed a statistically significant reduction in FMPS than Y-brush (difference 36.9; 95%CI 29.6 to 44.1, p < 0.0001), U-brush (difference 42.3; 95%CI 35.1 to 49.6, p < 0.0001), manual brushing (45 s) (difference 13.8; 95%CI 6.5 to 21.1, p < 0.0001), and No brushing (difference 46.6; 95%CI 39.3 to 53.9, p < 0.0001). Y-brush was significantly more effective than No brushing (difference 9.8; 95%CI 2.5 to 17.0, p = 0.0030), while there was no significant difference compared to U- brush. Similar results were obtained for the differences in the Clean Mouth VAS. CONCLUSIONS: Y-brush was significantly more effective than no brushing (negative control) in removing dental plaque. When compared to manual toothbrushing for both 45 and 120 s, however, Y-brush was less effective in dental plaque removal. CLINICAL RELEVANCE: Modified design of automatic toothbrushing devices could improve plaque reduction, especially in patients with intellectual disabilities or motor difficulties.

Comparison between digital and conventional impression techniques in children on preference, time and comfort: A crossover randomized controlled trial.

OBJECTIVE: To compare the conventional alginate impression and the digital impression taken with an intraoral scanner of both dental arches in children, using a randomized crossover design. TRIAL DESIGN: This is a monocentric, controlled, superiority, randomized, crossover, open study. METHODS: Twenty-four orthodontic patients between 6 and 11 years of age underwent intraoral scanning (TRIOS 3; 3Shape) and alginate impression of both dental arches with an interval of 1 week between the two procedures. Participants were recruited from September 2021 to March 2022 and the study was completed in April 2022. Impression time for the two procedures was compared. Patients were asked which one of the two impression procedures they preferred. A questionnaire including Visual Analogue Scale (VAS) for comfort, pain, gag reflex and difficulty in breathing, was administered to the patients. RESULTS: Eighteen out of 24 patients preferred digital impression (75%, 95% confidence interval [CI]: 55% to 88%; P = .014). Scanning time was significantly shorter than alginate impression time (difference -118 seconds; 95% CI: -138 to -99; P < .001). Comfort was significantly higher for digital impression (difference 1.7; 95% CI: 0.5 to 2.8; P = .007). There was no difference in pain (difference -0.2; 95% CI: -1.5 to 1.0; P = .686) while gag reflex and breathing difficulties were smaller for digital impression (gag reflex difference -2.5; 95% CI: -4.0 to -0.9; P = .004 and breathing difficulties difference -1.5; 95% CI: -2.5 to -0.5; P = -.004). CONCLUSIONS: Digital impression is preferred by children aged 6-11 years and it is significantly faster in acquisition time than conventional alginate impression. REGISTRATION: The study was registered on ClinicalTrials.gov with registration number NCT04220957 on January 7th, 2020 (https://clinicaltrials.gov/ct2/show/NCT04220957).

Three-dimensional comparison of bone-borne and tooth-bone-borne maxillary expansion in young adults with maxillary skeletal deficiency.

OBJECTIVE: To compare the transverse dental and skeletal changes in patients treated with bone-anchored palatal expander (bone-borne, BB) compared to patients treated with tooth and bone-anchored palatal expanders (tooth-bone-borne, TBB) using cone-beam computer tomography (CBCT) and 3D image analysis. METHODS: The sample comprised 30 patients with transverse maxillary discrepancy treated with two different types of appliances: bone-borne (Group BB) and tooth-bone-borne (Group TBB) expanders. CBCT scans were acquired before (T1) and after completion of maxillary expansion (T2); the interval was 5.4 ± 3.4 and 6.2 ± 2.1 months between the T1 and the T2 scans of Group TBB (tooth-bone-borne) and Group BB (bone-borne), respectively. Transverse, anteroposterior and vertical linear and angular three-dimensional dentoskeletal changes were assessed after cranial base superimposition. RESULTS: Both groups displayed marked transverse skeletal expansion with a greater ratio of skeletal to dental changes. Greater changes at the nasal cavity, zygoma and orbital levels were found in Group BB. A relatively parallel sutural opening in an anterior-posterior direction was observed in Group TBB; however, the Group BB presented a somewhat triangular (V-shaped) opening of the suture that was wider anteriorly. Small downward-forward displacements were observed in both groups. Asymmetric expansion occurred in approximately 50% of the patients in both groups. CONCLUSION: Greater skeletal vs dental expansion ratio and expansion of the circummaxillary regions were found in Group BB, the group in which a bone-borne expander was used. Both groups presented skeletal and dental changes, with a similar amount of posterior palate expansion. Asymmetric expansion was observed in both groups.

Effects produced by the facemask with and without skeletal anchorage for the orthopaedic treatment of Class III malocclusion in growing patients: a systematic review and meta-analysis of RCTs.

BACKGROUND: Skeletally anchored facemask has been proposed to maximize skeletal effects and minimize dental effects in the treatment of Class III malocclusion in growing patients. OBJECTIVE: To compare the dento-skeletal effects produced by the facemask with or without skeletal anchorage for the treatment of Class III malocclusion in growing patients. MATERIALS AND METHODS: PubMed, Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey were used for the electronic search without language, publication status, and year restrictions. Only RCTs were included. Inclusion criteria were: growing patients (age under 18 years) with Class III malocclusion, with indications for treatment with the facemask. Data were extracted by two independent reviewers. GRADE statement was executed. The mean of differences (MD) and the risk ratio (RR) were used. RESULTS: Three articles with a total of 123 patients were included. One article was at low risk of bias while two were at high risk of bias. There were no significant differences between the two groups in ANB angle, Wits appraisal, SNB angle, and SN-MP angle. SNA angle was significantly increased in the skeletally anchored facemask (pooled MD = 0.80 favouring skeletal anchorage, 95% CI from 0.29 to 1.31, P = 0.002, I2 = 12 per cent, three studies, GRADE moderate). The U1-SN angle was significantly reduced in the skeletally anchored facemask (pooled MD = -5.91 favouring skeletal anchorage, 95% CI from -7.64 to -4.27, P < 0.00001, I2 = 0 per cent, two studies, GRADE moderate). There were significantly less complications in tooth-anchored facemask (pooled RR = 7.98 favouring dental anchorage, 95 per cent CI from 1.04 to 61.27, P = 0.05, I2 = 0 per cent, two studies, GRADE low). LIMITATIONS: Few RCTs (three) were included, and two studies were at high risk of bias. There were no long-term RCTs comparing skeletally anchored facemask with dental-anchored facemask. Only Asiatic patients were included in this systematic review. CONCLUSIONS: Skeletally anchored facemask was associated to a greater increase of SNA angle at the end of treatment though clinically not significant. Facemask with skeletal anchorage determined a reduced inclination of maxillary incisors compared to dental-anchored facemask with greater risks of complications. REGISTRATION: PROSPERO register (CRD42020221982).

Clinical decision-making and management of stage IV periodontitis: A survey.

OBJECTIVE: To investigate the clinical management of stage IV periodontitis patients among clinicians within the Italian Society of Periodontology and Implantology. METHODS: A cross-sectional study was designed on a web-based anonymous survey. Comparison between ordinary members (OMs) versus active and certified members (ACMs) and comparison between members with at least 10 years of experience in periodontology (Ov10) and members with less than 10 years of experience in periodontology (Un10) were performed. RESULTS: A total of 324 out of 1362 members (response rate of 24%) responded to the questionnaire. ACMs and Ov10 more often reported their teams hold adequate skills to manage cases. Step I and II periodontal therapy took more time in the ACMs and Ov10 groups. ACMs used different strategies to perform step I-II therapy, and antibiotics were used less frequently than OMs. Unresponsive sites were treated more often with surgery by ACMs compared to OMs. ACMs adopted different treatment sequences compared to OMs. Ov10 group used more often CBCT, lateral cephalogram, and wax-up while Un10 group tend to avoid orthodontic therapy. CONCLUSIONS: More experienced members spent more time in step I and II of periodontal therapy, used more diagnostic tools, and performed more often surgery and orthodontics in the treatment of stage IV periodontitis patients.

Treatment of mild Class II malocclusion in growing patients with clear aligners versus fixed multibracket therapy: A retrospective study.

OBJECTIVE: To compare the dental and skeletal effects of intermaxillary elastics on the correction of mild Angle's Class II division 1 malocclusion with clear aligner treatment (CA) versus fixed multibracket (FMB) in growing patients. SETTINGS AND SAMPLE POPULATION: The study sample consisted of 49 consecutively patients (mean age ± SD 12.9 ± 1.7 years), 32 females and 17 males referred from the School of Orthodontics of the University of Bratislava Comenius (Slovakia). All patients were treated with a non-extraction orthodontic treatment, 25 with FMB and 24 with CA. METHODS: The cephalometric analysis was performed at the beginning (T0) and the end of the treatment (T1). The t test for unpaired data was carried out to compare cephalometric values at T0 and changes at T1-T0 between the two groups. The level of significance was set as P < .0035. RESULTS: The two groups showed no statistically significant differences (ANPg = -0.1°; P = .762) in the correction of the sagittal intermaxillary relation. The analysis of vertical skeletal changes showed no statistically significant effects on mandibular inclination (SN/MP = 0.1°; P = .840). The two treatments had a statistically significant and clinically relevant difference in controlling the inclination of the lower incisors (L1/GoGn = 4.8°, CAG = -0.5°± 3.9°; FMB = 4.3°± 5.8°; P < .001). CONCLUSIONS: Class II elastics combined with CA and FMB produce a similar correction on sagittal discrepancies in growing patients. CA presented a better control in the proclination of the lower incisors. CA and elastics might be a good alternative in the correction of mild Class II malocclusion in cases where a proclination of lower incisors is unwanted.

Variations in maxillary second molar position of untreated subjects with normal occlusions: A long-term observational study.

INTRODUCTION: The purpose of the present study was to evaluate the long-term variations in maxillary second molar position in untreated subjects with normal occlusion. SETTING AND SAMPLE POPULATION: A sample of 39 subjects (18 females and 21 males) selected from the University of Michigan Growth Study (UMGS) was followed longitudinally with digital dental casts at 3 observation times: T1, when the maxillary permanent second molars were fully erupted, T2, last observation available in the longitudinal series (38 subjects), and T3, at least 20 years after T2 (12 subjects). MATERIALS AND METHODS: Digital measurements were recorded with an open-source software. Outcome variables were sagittal and transverse inclinations of the upper second molars. Two mixed-effect models were performed. RESULTS: The maxillary second molars had a distolingual inclination at T1, T2 and T3. Sagittal and transverse inclination showed progressive significant uprighting from T1 through T3 (P < .001). From T1 to T2, the adjusted difference in sagittal crown inclination was 8.0° (95% CI from 6.5° to 9.6°; P < .001). From T2 to T3, the adjusted difference was 5.5° (95% CI from 3.0° to 8.1°; P < .001). From T1 to T2, the adjusted difference in transverse crown inclination was 1.9° (95% CI from 0.4° to 3.5°; P = .011). From T2 to T3, the adjusted difference was 6.0° (95% CI from 3.4° to 8.5°; P < .001). CONCLUSIONS: Along with age, maxillary second molars showed a progressive significant uprighting with a decrease in the distal and lingual inclinations.

Three-dimensional evaluation of skeletal and dental effects of treatment with maxillary skeletal expansion.

INTRODUCTION: The objective was to determine the skeletal and dental changes with microimplant assisted rapid palatal expansion (MARPE) appliances in growing (GR) and nongrowing (NG) patients using cone-beam computed tomography and 3-dimensional imaging analysis. METHODS: The sample consisted of 25 patients with transverse maxillary discrepancy treated with a maxillary skeletal expander, a type of MARPE appliance. Cone-beam computed tomography scans were taken before and after maxillary expansion; the interval was 6.0 ± 4.3 months. The sample was divided into GR and NG groups using cervical vertebral and midpalatal suture maturation. Linear and angular 3-dimensional dentoskeletal changes were assessed after cranial base superimposition. Groups were compared with independent-samples t test (P <0.05). RESULTS: Both groups displayed marked transverse changes with a similar ratio of skeletal to dental transverse changes and parallel sutural opening from the posterior nasal spine-anterior nasal spine; a similar amount of expansion occurred in the anterior and the posterior regions of the maxilla. The maxilla expanded skeletally without rotational displacements in both groups. The small downward-forward displacements were similar in both groups, except that the GR group had a significantly greater vertical displacement of the canines (GR, 1.7 ±1.0 mm; NG, 0.6 ± 0.8 mm; P = 0.02) and anterior nasal spine (GR, 1.1 ± 0.6 mm; NG, 0.5 ± 0.5 mm; P = 0.004). CONCLUSIONS: Treatment of patients with MARPE appliance is effective in GR and NG patients. Although greater skeletal and dental changes were observed in GR patients, a similar ratio of skeletal to dental transverse changes was observed in both groups.

Soft tissue evaluation of functional therapy in growing patients with Class II malocclusion: a long-term study.

OBJECTIVE: The objective of this study was to analyse the soft tissue changes produced by the functional treatment of mandibular advancement in growing Class II patients. MATERIALS: The treated group consisted of 25 Caucasian patients (12 females and 13 males) with dento-skeletal Class II malocclusion treated with functional therapy (Activator). All patients were evaluated before treatment (T1; mean age, 9.9 years), at the end of functional treatment phase (T2; mean age, 11.9 years), and at a post-pubertal follow-up observation (T3; mean age, 18.5 years). The treated group was compared with a matched control group of 25 untreated subjects (13 females, 12 males) with untreated Class II division 1 malocclusion. Statistical comparisons between the two groups were performed with independent samples t-tests (P < 0.05). RESULTS: Significant improvements were found during the long-term interval for mandibular sulcus (9.9°) and the profile facial angle (9.8°) in the treated group. No significant effects were found in terms of lower face percentage between the two groups. CONCLUSION: Removable functional appliances induced positive effects on the soft tissue profile in Class II growing subjects with good stability in the long-term.

Post-pubertal effects of the Alt-RAMEC/FM and RME/FM protocols for the early treatment of Class III malocclusion: a retrospective controlled study.

OBJECTIVE: To assess the stability of the effects of the modified Alt-RAMEC and facial mask (FM) protocol at a post-pubertal observation. METHODS: Twenty-one Class III patients (11 males and 10 females, 6.5 ± 0.7 years) treated consecutively with the Alt-RAMEC/FM approach and presenting with lateral cephalograms taken before treatment (T1), after treatment (T2), and at post-pubertal observations (T3) were compared with 22 Class III patients (9 males and 13 females, 6.9 ± 1.2 years) treated with the rapid maxillary expansion (RME) and FM protocol and with 15 Class III untreated subjects (7 males and 8 females, 6.2 ± 2.2 years). At T3, all patients showed a post-pubertal skeletal maturation stage (CS4-CS6). Descriptive statistics and statistical comparisons between the three groups at T1 and for the T3-T1, T2-T1, and T3-T2 changes were assessed by means of the ANOVA or Kruskal-Wallis test. RESULTS: During the overall observation period, Alt-RAMEC/FM and RME/FM protocols produced statistically significant favourable effects when compared with the Control group (ANB + 2.8° and +2.2°, respectively; Wits appraisal +4.4 mm and +2.7 mm, respectively). No statistically significant differences were found between the outcomes of the Alt-RAMEC/FM and RME/FM protocols neither at the post-pubertal or short-term observations. LIMITATIONS: Retrospective study and the comparison with an historical control sample of subjects with untreated Class III malocclusion. CONCLUSIONS: The Alt-RAMEC/FM protocol cannot be recommended as the approach of choice for the therapy of Class III dentoskeletal disharmony in very young subjects compared to the conventional RME/FM protocol.

Comparison of the dento-skeletal effects produced by Leaf expander versus rapid maxillary expander in prepubertal patients: a two-center randomized controlled trial.

OBJECTIVE: This study aimed to compare the skeletal and dentoalveolar effects produced by slow maxillary expansion (SME) with the Leaf expander versus the conventional rapid maxillary expansion (RME) on digital dental casts, lateral and postero-anterior cephalometric radiographs. TRIAL DESIGN: This is a superiority, two-center, two arms parallel balanced randomization trial. METHODS: Patients in the mixed dentition were included with a transverse interarch discrepancy of at least 3 mm. An expansion screw using moderate continuous forces (Leaf group) was compared to a conventional RME screw (RME group). The primary response variable was the difference in maxillary intermolar width (U6-U6) measured at baseline (T0) and one-year follow-up (T1) on the digital dental casts. Other dento-skeletal variables were also measured on digital dental casts and cephalograms. Computer-generated block randomization was used with allocation concealed in sequentially numbered opaque sealed envelopes. The examiner was blinded on the type of expander used. Linear models were used for statistical analysis. RESULTS: Twenty-eight patients in the Leaf group and 28 patients in the RME group were randomized and included in the study. There were no dropouts. U6-U6 did not show a statistically significant difference between the two groups (-0.4 mm in favor of the RME group, 95% CI from -1.2 to 0.5, P = 0.365). As for the other secondary variables no statistically significant differences were found between the two groups except maxillary intercanine width (U3-U3, -0.9 mm in favor of the RME group, 95%CI from -1.5 to -0.3, P = 0.005) and maxillary skeletal width (Mx-Mx, -1.4 mm in favor of the RME group, 95%CI from -2.4 to -0.3, P = 0.013). CONCLUSIONS: No significant differences between the RME and Leaf groups were detected for any of the analyzed dento-skeletal variables except the T1-T0 differences in U3-U3 and Mx-Mx that were significantly greater in the RME group. REGISTRATION: The study was registered in the ISRCTN register on 08/11/2016 with the number ISRCTN18263886. FUNDING: No funding or conflict of interest to be declared.

Predicting mandibular growth based on CVM stage and gender and with chronological age as a curvilinear variable.

OBJECTIVE: The aim of this study was to develop a prediction model that combines the information derived from chronological age (analysed as a curvilinear variable), gender and the CVM method to predict mandibular growth. SETTINGS AND SAMPLE POPULATION: 50 participants (29 females, 21 males) were selected from the AAOF Craniofacial Growth Legacy Collection, the Michigan Growth Study and the Denver Child Growth study. MATERIALS AND METHODS: In this investigation, 456 lateral cephalograms were analysed by applying a mixed effect model. The outcome variable was the annualized increment in total mandibular length (Co-Gn) during the year following the lateral cephalogram on which the cervical stage and chronological age were evaluated. The predictive variables were chronological age up to the fifth order, gender, stage of cervical vertebral maturation, as well as interactions between age and gender, age and cervical stage, and gender and cervical stage. RESULTS: Cervical stage, chronological age up to the fourth order, gender, and the interaction between age and gender were significant predictors of annualized increments in mandibular length. The annualized increment in Co-Gn was significantly greater for CS 3 when compared to all other cervical stages. Further, annualized increments in Co-Gn for CS 1 and CS 2 were significantly greater when compared to CS 5. CONCLUSIONS: Cervical stage, chronological age and gender can be used jointly to predict the annualized increment in mandibular growth. Cervical stage 3 exhibited the greatest annualized increase in mandibular length.

Prognostic approach to Class III malocclusion through case-based reasoning.

OBJECTIVE: This investigation evaluates the evidence of case-based reasoning (CBR) in providing additional information on the prediction of future Class III craniofacial growth. SETTINGS AND SAMPLE POPULATION: The craniofacial characteristics of 104 untreated Class III subjects (7-17 years of age), monitored with two lateral cephalograms obtained during the growth process, were evaluated. MATERIALS AND METHODS: Data were compared with the skeletal characteristics of subjects who showed a high degree of skeletal imbalance ('prototypes') obtained from a large data set of 1263 Class III cross-sectional subjects (7-17 years of age). RESULTS: The degree of similarity of longitudinal subjects with the most unbalanced prototypes allowed the identification of subjects who would develop a subsequent unfavourable skeletal growth (accuracy: 81%). The angle between the palatal plane and the sella-nasion line (PP-SN angle) and the Wits appraisal were two additional craniofacial features involved in the early prediction of the adverse progression of the Class III skeletal imbalance. CONCLUSIONS: Case-based reasoning methodology, which uses a personalized inference method, may bring additional information to approximate the skeletal progression of Class III malocclusion.

Comparison of two protocols for early treatment of dentoskeletal Class III malocclusion: Modified SEC III versus RME/FM.

OBJECTIVE: To compare the short-term cephalometric outcomes of the protocols modified splints, Class III elastics, chincup (SEC III) and rapid maxillary expansion and facial mask (RME/FM) for the early treatment of growing subjects with Class III dentoskeletal malocclusion. SETTINGS AND SAMPLE POPULATION: This retrospective observational study included 20 patients (11 males, nine females) treated with the modified SEC III protocol and 31 patients (16 males, 15 females) treated with the RME/FM one. The sample was evaluated before (T1, mean age 7.9 ± 1.0 years) and at the end of treatment (T2, mean age 9.0 ± 1.0 years). Statistical comparisons between the two groups were performed with independent sample t tests. RESULTS: Both the modified SEC III and the RME/FM sample groups showed significantly favourable effects in terms of maxillary advancement (SNA +1.3° and +1.5°, respectively), control of mandibular projection (SNB -0.5° and -0.8°, respectively), and intermaxillary relationships (ANB +1.8° and +2.3°, respectively; Wits +3.4 and +1.9 mm, respectively). The modified SEC III group showed a statistically significant greater control in the intermaxillary divergency considering the SN to Pal. Pl. (P < 0.006) and Pal. Pl. to Mand. Pl. angle (P < 0.002) with a difference of 2.3 mm between the two groups. LIMITATIONS: The main limitations of this study are its retrospective nature and the short-term outcomes. CONCLUSION: Early treatment of growing patients with dentoskeletal Class III disharmonies is efficient using either modified SEC III or RME/FM protocols. However, a higher vertical control is achieved with the modified SEC III.

Cephalometric effects of Pushing Splints 3 compared with rapid maxillary expansion and facemask therapy in Class III malocclusion children: a randomized controlled trial.

BACKGROUND: Pushing Splints 3 (PS3) device was recently introduced for the treatment of Class III malocclusion in children. OBJECTIVES: To assess the effect on the sagittal maxillary position (SNA, primary outcome) of PS3 therapy compared with rapid maxillary expansion and facemask therapy (RME/FM) and to compare skeletal and dento-alveolar effects in growing Class III patients. TRIAL DESIGN: This trial was a single-centre randomized controlled trial with two groups randomly allocated in a 1:1 ratio of equal size by sealed-envelope randomization, conducted at the Dentistry Unit of Bambino Gesù Children's Hospital, IRCCS (Rome, Italy). METHODS: A total of 48 patients with Class III malocclusion were included in the study and randomly allocated to the two groups: PS3 therapy and RME/FM therapy. Only the RME/FM group underwent palatal expansion, and both groups were instructed to wear the appliances 14 hours/day. Pre- (T0) and post-treatment (T1) cephalograms were taken. An independent sample t-test and regression analysis were used to analyse the data (P value <0.05). Researchers involved in statistics and tracings were blinded to the treatment allocation. RESULTS: A total of 42 patients (21 for each group) completed the study. The maxillary sagittal position improved similarly in both groups (SNA = 0.4°; P = 0.547). A statistically significant decrease of SNPg angle (-1.6°; P < 0.001) and increase of ANPg angle (1.4°; P = 0.018) were found in the RME/FM group compared with PS3 group. CoGoMe angle significantly decreased in RME/FM group compared with PS3 group (-1.7°; P = 0.042). The regression analysis showed an association between SN/MP angle at T0 and the differences between T1 and T0 of SNPg (B = 0.13; P = 0.005) and SN/MP (B = -0.19; P = 0.034). Only three patients (PS3 = 2; RME/FM = 1) had breakages of the devices. LIMITATIONS: Results are limited to short-term effects. CONCLUSION: RME/FM therapy and PS3 are both effective therapies for the early correction of Class III malocclusion. The PS3 controlled better mandibular divergency reducing the clockwise rotation in patients with higher mandibular inclination. REGISTRATION: This study was not registered in a clinical trial registry.

Modified SEC III protocol: vertical control related to patients' compliance with the chincup.

OBJECTIVES: To compare the short-term outcomes of modified SEC III protocol in growing patients in relation to their compliance with the chincup, matching them with an untreated Class III control group (CG). MATERIALS AND METHODS: Thirty-four patients (mean age of 8.6 ± 1.2 years) with Class III dentoskeletal malocclusion treated with the modified SEC III protocol and divided into group 1 (G1, 18 subjects), reporting good compliance and group 2 (G2, 16 subjects) not compliant with the chincup. The records were analysed before treatment (T1) and after the orthopaedic phase (T2), with an interval period of about 1.3 ± 0.5 years. The CG consisted of 16 untreated subjects with Class III dentoskeletal malocclusion (mean age of 8.3 ± 1.4 years). The statistical comparisons among the three groups were performed with ANOVA with Tukey's post hoc tests. RESULTS: Both G1 and G2, compared with CG, presented significant improvements in the sagittal skeletal relationships (ANB +2.5° and +2.5°, Wits +4.2° and +3.0°, respectively). G1 exhibited a significant more favourable control of vertical skeletal relationships when compared to G2 (Palatal Pl.-Mandibular Pl. -2.0°) that were associated with a statistically significant reduction of the gonial angle (ArGoMe -1.7°). Limitations of the study were its retrospective nature and the lack of evaluation of the long-term outcomes. CONCLUSIONS: Both groups of treated patients showed favourable sagittal skeletal improvement compared with controls. The use of chincup in patients with good compliance produced significantly greater control of the skeletal vertical dimensions compared with patients not compliant with the chincup.

Dento-skeletal effects produced by rapid versus slow maxillary expansion using fixed jackscrew expanders: a systematic review and meta-analysis.

BACKGROUND: No systematic review and meta-analysis of dento-skeletal effects following rapid maxillary expansion (RME) and slow maxillary expansion (SME) using the same jackscrew expander with different activation protocols is available. OBJECTIVE: To compare dento-skeletal effects produced by RME with those induced by SME using the same fixed jackscrew expanders in growing patients. SEARCH METHODS: PubMed (MEDLINE), Cochrane Library, Scopus, Embase, and OpenGrey were searched with no language or publication date restrictions. SELECTION CRITERIA: Only randomized controlled trials (RCTs) were selected and the following inclusion criteria were used: growing patients in mixed or permanent dentition, with maxillary transverse discrepancy, dental crowding, and treated with fixed jackscrew maxillary expander (e.g. Hyrax, Haas) activated to achieve either RME or SME. DATA COLLECTION AND ANALYSIS: Data were extracted by two independent reviewers. The quality of the included RCTs was assessed according to the Cochrane risk-of-bias tool for randomized trials (RoB 2.0). For the aggregation of continuous data, the mean of the differences (MD) between treatments was used. A random effect model was applied. RESULTS: From 4855 retrieved articles, 3 studies were selected, 1 at unclear risk and 2 at high risk of bias. Maxillary intermolar distance showed no significant differences between the two modalities of expansion [pooled MD = 0.99 mm favouring RME, with 95% confidence interval (CI) = -2.09 to 4.06, P = 0.53, I2 = 90%]. As for maxillary molar inclination measured as the angle formed by the axes passing through the disto-buccal cusps and the apexes of the palatine root of the first upper molars, it was significantly smaller in the SME group (MD = -11.51°, with 95% CI = -15.23 to -7.79, P < 0.0001). Posterior maxillary expansion was significantly greater in RME than SME (pooled MD = 0.75 mm, with 95% CI = 0.27-1.23, P = 0.002, I2 = 0%). CONCLUSIONS: Both RME and SME produce an effective dento-skeletal expansion of the maxilla. RME is slightly more effective in increasing the posterior transverse skeletal width of the maxilla while SME induces smaller molar inclination. REGISTRATION: PROSPERO CDR42018105530.