Assessment of Electromyographic Changes in a Patient with Masseter Hypertrophy and Muscle Pain after Botulinum Injections: A Case Report and 5 Months Follow-up.

AIM: To determine if botulinum injections in masseters could be an option to avoid surgery and prolonged treatment with occlusal splints and/or drugs to care for both painful bruxism and cosmetic improvement in a patient with a square jaw, bruxism, and orofacial pain. BACKGROUND: Masseter muscle hypertrophy (MMH) is a benign, unilateral, or bilateral, painless enlargement in the lower face. It presents as a symmetrical or asymmetrical increase in the masseter muscle. Masseter muscle hypertrophy (MMH) sometimes can be related to bruxism symptoms like muscle and/or temporomandibular joint (TMJ) pain. CASE DESCRIPTION: A 38-year-old woman complained of bilateral pain at palpation in the masseter body. She also complained about esthetics because of the prominent masseter muscle in the face and square face shape. A diagnosis of bruxism-related myalgia was performed, and treatment with botulinum injections into the masseter muscles was opted for. An oral electromyography was performed to detect the electrical muscular activity of masseter muscles over time. CONCLUSION: After a drastic reduction in the mean electrical activity immediately after the botulinum injections, a progressive increase in strength over time was noted, testifying about the decrease in the effect of botulinum over time. The pain disappeared for 5 months after the injections of botulinum. The reduction of the masseter muscle mass led to a softening of the face shape. CLINICAL SIGNIFICANCE: This case report shows that treatment with botulinum can lead, in the short term, to a reduction in orofacial pain due to a decrease in muscle electrical activity.

Immediate Autotransplantation of Molars with Closed Apex.

AIM: The aim of this study was to evaluate clinical features that might be related to success rates of autotransplantation of molars with complete root formation. MATERIALS AND METHODS: A group of 60 patients with completely formed third molars autotransplanted to a different molar socket was followed for a medium period of 5 years and 5 months. Extreme care was used in order to preserve the vitality of the periodontal ligament cells. The same technique was applied for all teeth despite different anatomies. Descriptive statistics was performed. The association of the various factors with failures was assessed by using the Fisher's exact test and a p-value of 0.05 was considered as significance threshold. RESULTS: Autotransplantation was found to be a reliable method to replace extracted molar teeth with closed apices. The two major factors that positively influenced the outcomes were fixation with splint and a periodontal probing pocket depth less than 4 mm after the initial healing period. The technique resulted in a suitable well-conserved socket and donor tooth, after the extraction. CONCLUSION: An accurate case evaluation was critically important in order to identify the risks prior to surgery and to select the right patients for this procedure. Autotransplantation of third molar teeth is a feasible approach to replace compromised mature molars. Proper stabilization of the transplanted tooth is strategical for the success of this procedure. A conservative approach to unerupted wisdom teeth is also recommended. CLINICAL SIGNIFICANCE: Dental implants and fixed prostheses have been utilized to replace missing teeth, and orthodontic space closure can be sometimes an effective treatment option. Tooth autotransplantation can be a reliable and less invasive clinical alternative when an appropriate donor site is available.

Vertical Bone Augmentation with GBR Pocket Technique: Surgical Procedure and Preliminary Results.

AIM: Nowadays, guided bone regeneration (GBR) is a predictable technique in both vertical and horizontal bone defects treatment. GBR Pocket Technique is an original surgical approach adopted in order to reduce the invasiveness of traditional procedures. The aim of this work is to describe the surgical procedure of GBR Pocket Technique in vertical bone augmentation and to compare the clinical outcomes of this technique with the results reported in literature of vertical bone augmentation and crestal bone remodeling achieved after 1 year after implants insertion. MATERIALS AND METHODS: Twenty-eight patients were recruited for this study and received 28 GBR procedures in the posterior region due to vertical and horizontal defects. A 50/50 mixture of autologous bone component and heterologous bone of equine origin was then made with the use of a bone scraper tunnel with internal reservoir. A PTFE-d membrane with titanium reinforcement was then fixed to the residual bone structure with screws in order to maintain the graft in place. Radiographic checks were made before graft procedures and implants insertion, then 6 months later and 1 year after implants placement. RESULTS: The average bone augmentation after surgery seems to be aligned, or even better, than the average reported in literature with alternative surgical approach; in addition, the mean crestal remodeling after 1 year and the rate of complications are aligned with other previous surgical techniques with a vertical bone augmentation of 8.78 mm ± SD 2.39 and a bone remodeling after 1 year of 0.59 mm ± SD 0.29. CONCLUSIONS: The advantages of this technique are preservation of blood circulation and consequently risk of flap necrosis, dehiscence, and graft exposure. This technique also reduces mucosal healing times even if it takes longer surgical time. CLINICAL SIGNIFICANCE: GBR Pocket Technique is the use of a minimal-invasive surgical wound to reduce patient morbidity and compliance.

Electromyographic Evaluation of Masticatory Muscles in a Young Patient with Crossbite Treated with Rapid Palatal Expander: A Case Report.

AIM AND OBJECTIVE: The purpose of this work is to investigate by electromyographic (EMG) surface analysis whether and how the variations in the occlusion due to the correction of the posterior crossbite using a rapid palatal expander (RPE) is accompanied by changes in the activity of the elevator muscles in the pediatric patients. BACKGROUND: Posterior crossbite is a disgnathic jaw relationship common in patients undergoing growth. In the last 10 years, several studies demonstrated the effectiveness and reproducibility of surface EMG in the objective evaluation of temporal muscle and masseter activity and how this evidence can be an interesting aid in dental clinical practice. CASE DESCRIPTION: The case subject BF is an 11-year-old boy with a right I class relationship and a left II class relationship treated with a rapid palatal expansion protocol with a turn of the transversal screw twice a day (0.25 mm each turn) for a week. In this case report, EMG was used to evaluate the temporal muscle and masseter activity immediately before, immediately after, and 4 months after the RPE protocol. CONCLUSION: Four months after the treatment, a condition of well-being and neuromuscular equilibrium such as that of starting was preserved. CLINICAL SIGNIFICANCE: Electromyography is a noninvasive exam which evaluates the masticatory muscle activity by facial application of electrodes on masseter and temporal muscles. It can be an interesting aid in orthodontic clinical practice to evaluate preservation of a good muscular balance following orthodontic and orthognathic movements.

Evaluation of the Oropharyngeal Airway Space in Class II Malocclusion Treated with Mandibular Activator: A Retrospective Study.

AIM: The development of a class II malocclusion is usually related to a reduced oropharyngeal airway space. In order to prevent airway obstruction, functional appliances are commonly used for orthodontic therapy. The aim of the article is to verify if these appliances could positively influence oropharyngeal diameters preventing the onset of future respiratory disorders. MATERIALS AND METHODS: A group of 10 patients treated at the Dental Clinic of San Gerardo Hospital in Monza with mandibular activator was selected. Ten similar untreated class II subjects with retrognathic mandible were used as control group. The cephalometric tracings were made on lateral teleradiographs of the skull before and after the active therapy with functional devices for the treated group and before and after growth peak for the control one. Descriptive statistical analysis was calculated for all the cephalometric values in both study cases and control group using Excel worksheet. The data distribution was evaluated with Shapiro-Wilk test and the in-between group discrepancies were evaluated with Mann-Whitney U test. RESULTS: At T1 period, both case and control groups showed a class II pattern. At T2 period, the study group shows an improvement in bones relationship with reduced ANB angles and OVJ measurements. The control group otherwise did not show any important changes in maxillo-mandibular discrepancies. The airway size increased in either group in most cases. No significant differences between the treated and control groups were detected for airway size neither in the upper, middle, nor lower level at the T1-T2 interval. CONCLUSION: The upper airway values did not show any significant discrepancies between the two groups during the observation period. CLINICAL SIGNIFICANCE: Functional devices were effective in solving class II relationships, but there is no evidence of successful breathing disorders prevention by using mandibular activators, probably due to the stability of airway tissues reached in pubertal age in both groups.

Minimal Invasive Flapless Piezotome Alveolar Crest Horizontal Split Technique: Preliminary Results.

INTRODUCTION: Alveolar split crest is an established surgical technique to enable implant insertion into narrow and atrophic alveolar crest. This surgical technique is adopted to position standard or large implants so that postextractive anatomy compromises with this attempt. The aim of this study was to evaluate the horizontal alveolar bone augmentation and its stability along time with a minimally invasive flapless technique. MATERIALS AND METHODS: Twenty-four implants were inserted in 10 patients during a 15-month period. Clinical parameters such as horizontal bone augmentation, intrasurgical complications, patient morbidity, implant loss, and vertical bone loss (VBL) were recorded in the first 3 years after surgery. Using cone-beam computed tomography (CBCT), alveolar bone width was measured for both implants position and bone reconstructions. 6 months later, at the time of implant integration, a new low-dose CBCT was performed. Implant survival (IS) and VBL were evaluated radiographically for 3 years. RESULTS: The initial bone thickness measured on the ridge is between 0.82 mm and 5.40 mm (average 2.43 mm), after the split crest the bone width is between 4.65 mm and 8.09 mm (average 6.39 mm). This leads to an increase in the alveolar bone width of between 0.80 mm and 6.01 mm (average 3.71 mm) on the ridge. No implant was lost at 3 years, and all implants are stable at the end of the study. Three years after the surgery, controls showed a VBL of between 0.0 mm and 1.2 mm (average 0.63 mm) around the inserted implants. These parameters suggest using a flapless technique to reduce bone resorption around the implant neck. CONCLUSION: A minimally invasive approach allows to reduce the surgical trauma and postsurgical discomfort. The complete vascular supply is maintained, the bone resorption is reduced, and the connective epithelium does not undergo postsurgical retraction, achieving the full maintenance of the residual keratinized gingiva. CLINICAL SIGNIFICANCE: A technique such as split crest can be a valid option to avoid autologous or heterologous bone grafts.

Evaluation with Micro-CT of the Canal Seal Made with Two Different Bioceramic Cements: GuttaFlow Bioseal and BioRoot RCS.

AIM: The aim of this work is to investigate the quality of root canal seals obtained by comparing two bioceramic cements, GuttaFlow bioseal and BioRoot RCS, focusing on the presence of voids created during the canal obturation procedure. MATERIALS AND METHODS: The voids are analyzed using a micro-computed tomography (micro-CT) device. The study will be performed using images of the endodontic space before and after filling of a selected group of elements. Furthermore, the average thickness of the cement, the average quantity of gutta-percha compared to the total shaped volume, and the average quantity of the two cements, GuttaFlow bioseal and BioRoot RCS, with respect to the total shaped volume were considered. The apical, middle, and coronal thirds have been investigated in a sectorial manner. Images have been analyzed using a CT-An™ software and visualized through a three-dimensional (3D) reconstruction of the slices by the software CT-Vol™. Shapiro-Wilk test/Test D'Agostino-Pearson/Kolmogorov-Smirnov test were used to ensure the reliability of results. RESULTS: No significant differences were observed in the amount of gutta-percha compared to the shaped volume between the GuttaFlow bioseal group and BioRoot RCS. No statistically significant difference was observed between the two groups in terms of voids. CONCLUSION: The data obtained from this study allowed to conclude that the samples filled with GuttaFlow bioseal and BioRoot RCS have a similar seal capacity since no statistically significant differences were observed between the two groups. No sample showed the absence of voids within the root canal obturation. CLINICAL SIGNIFICANCE: Even if the two cements tested showed differences in terms of void volume and ability to fill thin spaces, they should be considered both acceptable and equivalent in terms of clinical sealing ability.

Treatment of Temporomandibular Disorders of Muscular Origin with a Silicon Oral Device (Alifix®): Electromyographic Analysis.

AIM: The aim of this work was to evaluate if the use of a silicone device for muscular rebalancing (Alifix®) can be useful in treating of temporomandibular disorders (TMD) of muscular origin and improving the electromyographic indexes of the chewing muscles. MATERIALS AND METHODS: Thirteen patients (11 F and 2 M aged between 24 years and 65 years) with TMD of muscular origin according to diagnostic criteria (DC)/TMD were involved. At the first visit (T0), each patient reported the pain intensity of masseters and temporal muscles. A surface electromyography (EMG) was performed using Teethan® (Teethan S.p.A.) and then Alifix® was delivered instructing the patient on its use. Each subject was visited again after 1 month (T1) and 2 months (T2). New EMG had been made at T1 and T2, and patients were asked again to report the pain intensity. Statistical analysis was calculated between T0 and T1, T1 and T2, and T0 and T2 for all EMG, and muscle pain measurements by Wilcoxon test with statistical significance p < 0.05. RESULTS: Regarding the pain values between T0 and T1, T1 and T2, and T0 and T2, the difference is statistically significant, since the intensity of pain between T0 and T2 is decreased, if not disappeared, in 90% of cases. The use of Alifix® also determined a gradual improvement in the values of the EMG indexes, which, however, is not statistically significant. CONCLUSION: The effectiveness of Alifix® is demonstrated clinically but not at an instrumental level. Further studies involving a larger sample and taking longer therapy duration are needed. CLINICAL SIGNIFICANCE: Alifix® works by improving the blood circulation of the muscle, which allows the removal of catabolites with a consequent reduction of the algic symptomatology and promotes a greater supply of oxygen. It also encourages a conversion of IIA type muscle fibers into slow-twitch type I fibers that are more resistant to neuromuscular fatigue.

Treatment of Osteoradionecrosis of the Jaw with Ozone in the Form of Oil-based Gel: 1-year follow-up.

AIM: Osteoradionecrosis of the jaws (ORNJs) is aseptic bone necrosis that develops in post-irradiated bone tissue of patients who underwent radiotherapy for head-neck tumors. The present study aims to clinically assess the regenerative ability of the ozone in the form of oil-based gel applied to the exposed bone area in the treatment of ORNJ. MATERIALS AND METHODS: Eight patients who underwent radio- therapy for the treatment of cervical or neck cancer were diagnosed with ORN of the jaws at our Department, for a total of 11 sites of necrotic bone exposure (3 patients were diagnosed with more than one site of osteoradionecrosis). In the therapeutic protocol, the exposed bone lesion and osteomucosal margin were cleaned with manual debridement. Then the ORN lesion was treated with topical applications of ozone delivered as oil suspension (Ozosan® - Sanipan, Clivio, Italy) on the exposed bone for 10 minutes. The application was repeated each week until movement of the necrotic fragment was noted Results: In six patients on 8 (75%) lesions resolved with complete mucosal healing with 3 to 19 ozone applications. Total sequestration of the necrotic bone with spontaneous expulsion was observed. One patient improved his conditions shifting from a stage B2S1 to B1S1 according to He et al. classification. A patient only worsened his conditions with treatment. No toxicity was reported or observed. CONCLUSION: These results showed the efficacy of ozone oil suspensions in the non-invasive treatment of ORN, probably related to its properties of stimulation of local revascularization and antibacterial activity, and the good tolerability of the related protocol used. CLINICAL SIGNIFICANCE: The use of this kind of medication should be included in ORNJ treatments as effective, noninvasive and self-administered.

Digital Orthopantomography vs Cone Beam Computed Tomography-Part 2: A CBCT Analysis of Factors Influencing the Prevalence of Periapical Lesions.

AIM: Cone beam computed tomography (CBCT) is the most refined and affordable method available today for the examination of an incoming patient for different dental pathologies. The aim of this paper is to evaluate the significance of some factors influencing the prevalence of apical periodontitis. MATERIALS AND METHODS: An ortopantomography (OPT) and CBCT scan of the dental arches were examined for each of the selected 45 patients. The presence of apical periodontitis (AP) was compared for CBCT and OPT examination. Sensitivity, specificity, predictive values, and accuracy were calculated for CBCT, using OPT as a reference. The impact of protective/risk factors on the development of AP was examined. RESULTS: CBCT showed higher sensitivity (250%), predictive values (111%), accuracy (111%), and specificity (101%) than OPT. It was found to have higher sensitivity in all the dentition areas, especially where empty anatomical spaces or more radiotransparent structures have a strict relationship with the tooth apex and periapical structures like upper front area, premolar areas, and, especially, in the upper molar area. The prevalence of AP increased from 16 to 17% in the case of insufficient conservative restoration or 25% in the case of microleakage, 35-42% in the case of prosthetic restoration, 56-67% for posts, and 60 and 85%, respectively, for inadequate endodontic treatment and missed canals. CONCLUSION: CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between the apex and important anatomical structures exists. Different risk factors with different relevance are identified. CLINICAL SIGNIFICANCE: As CBCT-examined results show, coronal restorations are moderate-risk factors, while insufficient endodontic treatments and posts are high-risk factors for the development of AP.

Digital Orthopantomography vs Cone Beam Computed Tomography-Part 1: Detection of Periapical Lesions.

AIM: Digital orthopantomography (OPT) is usually the first examination step in supervising an incoming patient. Cone beam computed tomography (CBCT) is the most refined and affordable method to search for different dental lesions. The aim of this paper is to evaluate the effectiveness of OPT and CBCT in detecting periapical lesions in different dental groups. MATERIALS AND METHODS: An OPT and a CBCT scan of the dental arches of 45 patients were examined. The presence of AP was pointed out for OPT and CBCT. Sensitivity, specificity, predictive values, and accuracy were calculated for OPT, using CBCT as the reference standard. RESULTS: OPT showed low sensitivity (40.0), positive predictive value (90.4), negative predictive value (90.0), accuracy (90.0), and high specificity (99.2). It was found to have higher sensitivity in the lower front and premolar areas, while the lowest was found in the upper molar area. CONCLUSIONS: OPT can be used for endodontic diagnosis in the lower central and premolar sections, but CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between apex and important anatomical structures exists. CLINICAL SIGNIFICANCE: CBCT exposes the patient to higher doses of radiations when compared with OPT, but CBCT, with its more selective sensitivity and the possibility to offer a three-dimensional (3D) rendering of dental and periodontal structures, is an elective choice for uncertain cases and for specific dental areas.

Use of a Partial-thickness Flap for Guided Bone Regeneration in the Upper Jaw.

INTRODUCTION: Guided bone regeneration (GBR) aims to restore adequate bone volume for the placement of implants in an ideal location. In this article, we analyze different surgical techniques for tissue management during GBR and a modified partial-thickness surgical approach. MATERIALS AND METHODS: In a year's time span, five patients were enrolled in the study: Four women and one man (aged 44-59 years). In four patients, a GBR with simultaneous implant placement was adopted, whereas in another patient, a delayed implant placement was done. The flap was of full thickness and overturned on the side palatal with the aim of a retractor, thus exposing the bone crest. The graft material was covered and protected with a resorbable collagen membrane (Geistlich Bio-Gide®, Switzerland). The periosteal layer of the flap was then positioned above the resorbable membrane without traction. The sutures as vertical mattress were then positioned. Each patient received an intramuscular betamethasone dose (4 mg/50 kg) and antibiotic therapy for 7 days (amoxicillin + clavulanic acid 1 gm every 12 hours) and was instructed to maintain oral hygiene and appropriate wound cleaning. The patients were recalled at different times to monitor the healing. RESULTS: No cases of tissue dehiscence were observed during the period of wound healing. One patient, however, showed a delayed exposure 4 months after surgery. This occurrence was managed without complications for the patient. CONCLUSION: The design of proposed flap seems to be effective in controlling the risk of dehiscence during the healing time in the GBR. The vascular supply was rarely compromised. The results we obtained are encouraging even if further studies on this technique are needed. CLINICAL SIGNIFICANCE: Lateral partial-thickness flaps seem to be effective in controlling tissue tension and consequently the risk of dehiscence. The incision vestibularly performed should favor the soft tissue healing.

Osteoradionecrosis of the Posterior Maxilla: A New Approach Combining Erbium: Yttrium Aluminium Garnet Laser and Bichat Bulla Flap.

Osteoradionecrosis (ORN) of the jaw is a complication of radiation therapy for head and neck cancers. We report a case of ORN of the posterior maxilla treated with Er: YAG laser and a pedicled buccal fat pad (bichat bulla adipose) flap. A 69-year-old man presented complaining of pain on left maxilla. He had received high-dose radiotherapy (90 Gy) for squamous cell carcinoma of the left soft palate 2 years earlier. Clinical and radiographic examinations revealed ORN of the left maxillary molar region and maxillary sinusitis. Daily home care consisted of 0.9% saline irrigation and 0.8% H2O2 gel application. Sequestrectomy and tooth extraction were followed by debridement with Er: YAG laser and repair with a pedicled buccal fat pad flap. Complete resolution of ORN and maxillary sinusitis was established one year postsurgically. The excellent clinical outcome suggests that Er: YAG laser debridement and pedicled buccal fat pad flap are a viable option to treat ORN of the posterior maxilla.

Comparison between Two Methods of Skeletal Growth Evaluation: Cervical Vertebrae Maturations and Middle Phalanx Maturation.

Aim: Growth measurement has always been essential to identify the best time to employ orthopedic or orthodontic appliances. Optimal timing for orthodontic treatment is strictly linked to the identification of periods of craniofacial growth when treatment is more effective.The aim of this study was to compare two different methods, middle phalanx maturation (MPM) and cervical vertebrae maturation (CVM), used to evaluate the stage of facial growth. Materials and methods: The research data was collected from July 2018 to April 2019 at the Dental Clinic of the San Gerardo Hospital in Monza. The study included a sample of 98 patients-46 males and 52 females. For each patient, a latero-lateral teleradiography of the skull and an X-ray on the middle finger of the right hand were obtained.The statistical analysis of the comparison of the stages of skeletal maturation obtained by the MPM and CVM methods was performed using the correlation coefficient for ranks of Spearman. Results: A descriptive statistical analysis of the entire sample of 98 patients was performed (mean age of 12.2 years and median of 12.2 years). The average age of females in every single stage of MPM was significantly lower than the average age of males. Of the total sample, 87 patients (88.8%) showed complete agreement between the two methods. Conclusion: The results obtained from the statistical analysis of this study allowed us to confirm a satisfactory agreement between the two methods.The intermediate phalanx method is a valid and alternative indicator to CVM for the identification of the puberty growth peak. We can, therefore, consider the MPM method a valid indicator of skeletal maturity. How to cite this article: Mirabelli L, Bianco E, Pigato G, et al. Comparison between Two Methods of Skeletal Growth Evaluation: Cervical Vertebrae Maturations and Middle Phalanx Maturation. Int J Clin Pediatr Dent 2023;16(2):327-332.

Correlation between a Force-Sensing Oral Appliance and Electromyography in the Detection of Tooth Contact Bruxism Events.

BACKGROUND: Oral appliances embedding sensors can be interesting tools for monitoring tooth contact bruxism in a home environment, as they address some of the usability limitations of portable electromyography (EMG) systems. In this study, an oral appliance for sleep bruxism monitoring was compared to an electromyograph. METHODS: Simulated bruxism events with tooth contact, specifically clenching and grinding, and other occlusal activities unrelated to bruxism, were measured in 23 subjects with the two instruments simultaneously. The recordings were analyzed automatically by a computer program in order to compare the two techniques. RESULTS: The two instruments were found to be strongly correlated in terms of detecting events (r = 0.89), and estimating their duration (r = 0.88) and their intensity (r = 0.83). CONCLUSIONS: The two techniques were in agreement in measuring event frequency, duration and intensity in the studied group, suggesting that force-sensing oral appliances have the potential to be easy-to-use tools for home monitoring of bruxism, alone or as complements to portable EMGs.

sCD14 Level in Saliva of Children and Adolescents with and without Dental Caries, a Hurdle Model.

OBJECTIVE: Soluble CD14 (sCD14) plays an important role in the innate immune response of the oral cavity. The investigation of this biomarker for detection of carious lesions is an even more actual procedure due to its non-invasiveness and the ease of withdrawal. The purpose of the present observational case-control study was to evaluate whether the quantification of sCD14 in children and adolescent's saliva can discriminate healthy subjects from those suffering from tooth decay. MATERIALS AND METHODS: 164 subjects (6 to 17 years) were selected and divided into 2 groups: those with at least 1 decayed tooth were assigned to group Decayed (n = 82) and those free from dental caries to group Healthy (n = 82). The amount of salivary soluble CD14 was quantified. RESULTS: Mean salivary soluble CD14 was 28.3 ± 10.8 µg/mL in the Healthy group and 22 ± 9.6 µg/mL in the Decayed group. A hurdle model was applied to the data to estimate both the probability of having carious lesions and their number in relation to sCD14 levels. sCD14 was strongly associated (p < 0.01) with an inverse relation to both the probability of having caries and their number (falling rate of 5% per unit CD14 µg/mL). CONCLUSIONS: This data confirms the relationship between sCD14 and the presence of dental caries. However, there is no clear cut off level between healthy and unhealthy subjects, so it is currently not possible to use sCD14 as a biomarker to determine the risk of decays.

Second Class Functional Treatment: Andreasen Activator vs Twin Block.

AIM: The purpose of this research is to analyze and compare the dental and skeletal changes induced by two functional devices, Andreasen Activator and Clark's twin block, on the sagittal and vertical plane, by means of cephalometric analysis, of the lateral cephalograms prescribed at the beginning and at the end of the treatment for a second skeletal class, first division with normal or deep bite. MATERIALS AND METHODS: Twenty patients, 8 females and 12 males, fulfilling criteria for inclusion, were divided randomly into two groups: group I was treated with Andreasen activator, the second group with Clark's twin block. The duration of the therapy was about 18 months plus less 2 months. Pretreatment and posttreatment cephalometric radiographs were analyzed using angular (SNA, SNB, ANB, SnaSnp-GoGn angles), linear (Sna-Snp, Co-Gn, Co-Go, Go-Gn) skeletal parameters and dental one (U1-SnaSnp angle, L1-GoGn angle, Overjet and Overbite). To evaluate the posttreatment changes in the single groups and between them, paired and unpaired t-test was used. RESULTS: In both of the two groups analyzed, all the sagittal and vertical, angular and linear, skeletal measurements appear to be increased in a statistically significant way, except SNA angle and the distance Sna-Snp. Regarding the dental parameters, in the group treated with Andreasen activator, only Overjet and Overbite showed statistically significant differences. On the other hand, twin block induced statistical changes about Overjet, Overbite and also U1/SnaSnp, but not about L1/GoGn. The advancement of the mandible determines a greater prominence of the chin and lower lip, an increment of the labial mental angle and a reduction of the convexity of the profile. Also, the decrease of the overjet and, consequently, of the dental exposure improve the esthetic appearance of the patient's face. CONCLUSION: Both functional treatments showed a lower jaw advanced on the sagittal plane and increased in size. In the upper jaw no significant changes were observed. It was also evident a dental compensation both on sagittal and vertical planes. CLINICAL SIGNIFICANCE: The functional devices studied, Andreasen activator and twin block, seem to obtain more skeletal than dental results when the patients were treated at the peak of pubertal growth. HOW TO CITE THIS ARTICLE: Baccaglione G, Rota E, Ferrari M, et al. Second Class Functional Treatment: Andreasen Activator vs Twin Block. Int J Clin Pediatr Dent 2020;13(2):144-149.

Cone-beam computed tomography accuracy in pulp chamber size evaluation: An ex vivo study.

This study aimed to assess ex vivo the accuracy of cone-beam computed tomography (CBCT), as compared to operative microscope, for evaluating pulp chamber size. A total of forty teeth were extracted for periodontal reasons and a horizontal section was done at the most apical level of the cement-enamel junction. The pulp chamber was photographed using a digital camera connected to an optical microscope. Then, the tooth was scanned with CBCT and the horizontal slide matching the anatomical section of pulp chamber was digitally stored. The pulp chamber section area was measured through image analysis software. The two methods provided similar results, either for monoradicular (P = 0.14) or multiradicular teeth (P = 0.93). Correlation was statistically significant (P < 0.0001), being the coefficient r = 0.89 and 0.94 for monoradicular and multiradicular teeth, respectively. Conclusively, CBCT is suitable for pulp chamber morphology evaluation. However, it has limitations in detecting the anatomical variability of small branches in root canal system.

Dentofacial Effects of Modified Alt-RAMEC Protocol Combined with the Facial Mask for Treatment of Preadolescent Caucasian Class III Patients.

INTRODUCTION: In this study we analyzed dentoskeletal effects of orthopedic therapy with rapid palatal expander (RME), used according to modified Alt-RAMEC protocol, followed by facial mask in preadolescent patients with class III malocclusion. MATERIALS AND METHODS: The sample consisted of 10 patients treated consecutively with the alternate rapid maxillary expansions and constrictions (Alt-RAMEC) protocol and facial mask before the pubertal growth spur the patients were re-evaluated after about one year of treatment. We compared the cephalometric analyses at T0 (before the treatment) and T1 (just after the end of the treatment-about 1 year), evaluating 18 parameters. The normality of each distribution was assessed with D'Agostino-Pearson normality test and significative differences between T0 and T1 were assessed with paired t test (p < 0.05). RESULTS: Sagittal measurements of the maxilla (SNpSNa distance) showed significant improvements (p < 0.0001) with protraction effect at point A. Significant improvements were recorded also at Wits appraisal and overjet. Measures of the mandibular growth (Co-Gn) showed increased values at T1, as well as vertical dimension (SNpSNa-GoGn). No significant variations were recorded at the dental parameters. CONCLUSION: This protocol induces important skeletal effects, like advancement of the maxilla, also in preadolescent patients, while dental changes are minimal. Alt-RAMEC protocol seem to modulate maxillary development in patients near the pubertal growth spurt. HOW TO CITE THIS ARTICLE: Rota E, Ferrari M, et al. Dentofacial Effects of Modified Alt-RAMEC Protocol Combined with the Facial Mask for Treatment of Preadolescent Caucasian Class III Patients. Int J Clin Pediatr Dent 2019;12(3):222-228.

Relationship between the Position of the Incisors and the Thickness of the Soft Tissues in the Upper Jaw: Cephalometric Evaluation.

AIM: The aim of this study is to verify if the thickness of soft tissues and inclination of the incisors have some relation with profile, to analyze its relevance considering these two parameters separately and to screen how the combination of different inclinations and different thickness can generate different facial patterns. MATERIALS AND METHODS: The study was performed on 47 Caucasian patients aged between 6 years and 16 years of divided into 24 males and 23 females. None of the patients presented craniofacial changes of syndromic nature. All patients presented a value of SNA in between 80° and 84°. The inclination of the upper incisor related to the bispinal plane was between 104° and 116°. Each radiograph has been digitized or analyzed directly in digital format. To analyze the relationships between soft tissues and position of the incisors using various cephalometric measures and statistical methodology were used. RESULTS: Analysing the general correlation between all the cephalometric parameters considered, the results found show that the thickness of the tissues had an effect in modifying the aesthetic profile with respect to the position of the incisors. The cephalometric parameters related to the esthetic profile of the maxilla are all linked by strong correlations, especially correlation between SU, ULA and LS were very high. The differences between the means were statistically significant for different groups. Using the values of Mx1 and thickness of the lip as independent variables, while the LS, SU, ULA and NLA values as dependent variables all results are significant with respect to the prediction p < 0.05. CONCLUSION: Thickness of the soft tissues showed a significant influence on the profile with respect to the position of the incisors. CLINICAL SIGNIFICANCE: Data obtained highlighted that thickness of the soft tissues must be taken into account before starting an orthodontic treatment in order to obtain best aesthetic results. HOW TO CITE THIS ARTICLE: Maddalone M, Losi F, Rota E, et al. Relationship between the Position of the Incisors and the Thickness of the Soft Tissues in the Upper Jaw: Cephalometric Evaluation. Int J Clin Pediatr Dent 2019;12(5):391-397.