'Study of the maxillary yaw on cone beam computed tomography: A preliminary report and comparison between two different dento-skeletal malocclusions'.

OBJECTIVES: To assess the skeletal and dental maxillary transverse compensation (yaw) on the cone beam computed tomography (CBCT) three-dimensional reconstructed image of the skull in two groups of patients, both clinically affected by a class III malocclusion with deviation of the lower midline. MATERIALS AND METHODS: An observational retrospective study was designed to analyse differences in two groups of patients, the first one was composed by patients affected by horizontal condylar hyperplasia, the second one by patients affected by dento-skeletal asymmetric class III malocclusion. Each group was composed by 15 patients. Transverse analysis was performed by measuring five landmarks (three bilateral and two uneven) with respect to a mid-sagittal plane; sagittal analysis was performed by measuring the sagittal distance on the mid-sagittal plane between bilateral points. Means were compared through inferential analysis. RESULTS: In the condylar hyperplasia group, all differences between the two sides were not statistically significant, nor for canines' difference (P = .0817), for molars (P = .1105) or for jugular points (.05871). In the class III group, the differences between the two sides were statistically significant for molars (P = .0019) and jugular points (P = .0031) but not for canines (P = .1158). Comparing the two groups, significant differences were found only for incisors' midline deviation (P = .0343) and canine (P = .0177). CONCLUSION: The study of the yaw on CBCT should be integrated into three-dimensional cephalometry and could help in differentiating the various malocclusion patterns.

Epidemiological characteristic of Orofacial clefts and its associated congenital anomalies: retrospective study.

BACKGROUND: To evaluate the relationship between gender, ethnicity/citizenship, clinical phenotype, total prevalence, and the various congenital malformations associated with oral clefts (OC) in Italy across the period 2001-2014. METHODS: A retrospective analysis (2001-2014) was conducted based on the National Congenital Malformation Registries network of Italy (Emilia-Romagna Registry of Birth Defects [IMER] and Registro Toscano Difetti Congeniti [RTDC]), which were analyzed to investigate time trends, geographical/ethnic clusters, topography, sex ratio, and associated congenital anomalies of OC phenotypes. RESULTS: Among 739 registered cases, 29.8% were syndromic or had multi-malformed associated anomalies, compared with 70.2% having isolated orofacial cleft. Cleft lip (CL) was observed in 22%, cleft palate (CP) in 40%, and cleft lip and palate (CLP) in 38% of live births, stillbirths, and terminations of pregnancy for fetal anomaly cases. Other associated conditions were major anomalies of cardiovascular defects (39%), followed by defects of the limbs (28%), neuroectodermal defects (23%), and urogenital malformations (10%). Male-to-female sex ratio was 1:1.14 in CP, 1.22:1 in CL, and 1.9:1 in CLP. Foreigners were represented by 29% from Southeast Asia, 25% from Balkans, 25% from North-Central Africa, 9% from the East, 7% from Western Europe, and 5% from South America. Total prevalence of OC cases ranged from 0.9 (RTDC) to 1.1 (IMER) of 1000 births. CONCLUSIONS: This retrospective study provides a population-based, clinical-epidemiological description of the orofacial cleft phenomenon. As a relatively frequent congenital malformation, its social and economic impact is worthy of further study. These abnormalities can cause significant problems that may be solved or minimized by early diagnosis and treatment.

Prevalence of craniomandibular disorders in orthodontic pediatric population and possible interactions with anxiety and stress.

AIM: To analyse the presence and prevalence of gnathologic problems in a sample of children, candidate for orthodontic treatment, and evaluate the relationship between psychological factors and gnathological problems. The purpose of this study was also to evaluate a simple protocol with specific psychological test and a questionnaire for the rapid diagnosis of gnathologic problems, useful for possible screening studies on a wider population. MATERIALS AND METHODS: Study Design: Observational, cross-sectional study. Among the patients coming for a first orthodontic evaluation 106 children, aged between 8 and 16 years, were examined. A complete orthodontic evaluation was performed in all patients; the RCMAS (Revised Children's Manifest Anxiety Scale) was used in the study to test the psychological condition, while the selected test for the diagnosis of gnathologic problems was the Fonseca Test. The prevalence of temporomandibular disorders (TMD) was evaluated with descriptive statistical analysis, and the eventually present correlation with a positive psycological test for anxiety has been evaluated with correlation parameters: c2 test of Pearson, and Cramer's V index. RESULTS: The mean age of the children was 10.74 years. Females accounted for 55.66% of the total compared to 44.34% males. Signs and symptoms of TMD were present on average in 82% and 32% respectively. A remarkable amount of children also showed signs of psychological problems, mostly represented by anxiety. Positive correlation resulted between TMD (Fonseca scores) and increased overbite. Cross-correlations have been obtained, tested with Pearson c2 test and Cramer's V index, between level of anxiety, muscle pain on palpation, bad habits, and headache. The Class II subdivision molar class and altered canine relationship have been related to the presence of articular noise. CONCLUSION: The protocol largely respected the need for speed of administration, comprehensiveness and reliability that we set out to achieve. Limited correlations have been assessed between occlusal conditions and positivity to the administrated tests. Further studies are desirable to increase the sample population.

The mandibular permanent second molars and their risk of impaction: a retrospective study.

AIM: The aim of this retrospective study is promote a better understanding of the impaction of teeth 37 and 47 by means of clinical and statistical data from the point of view of early interceptive treatment. STUDY DESIGN: 478 patients of the Orthodontic School of "La Sapienza" University of Rome (Italy) were studied to assess the eruption of teeth 37 and 47 on at least two good-quality panorex using angular measurements and Nolla's index from January 2008 to December 2013. Data were analysed using ANOVA and Tukey HSD test (P < 0.05). RESULTS: The data obtained on the possible correlations between the examined teeth and the four reference angles show that at t0, the angular variation of teeth 36 or 46 is constant when the teeth are at the end of their eruptive process, while for teeth 37 and 47, this variation is always constant. At t0, the first and the second molars of both quadrants, during eruption showed a similar behaviour. At t1, the four teeth examined in the patients sample showed a model of development analogous to that exhibited at t0. STATISTICS: a constant variation (t0-t1) is present among the differences in the development of the 36 and the two angular values, while difference in development of the 37 and that of the angular value is constant only in relationship to the difference in development of the mandibular first molar of the same quadrant. The variations between the difference in development of the 47 and in angular value (t0-t1) are constant only when related to the developing 46. The analytic variance of gradience (vargrad) data confirm peculiar behaviour of the first one, according to both mandibular molars, during their eruptive development. CONCLUSIONS: Adoption of universally recognised radiographic predictive methods allows assessment of the case and allows the specialist to plan a suitable treatment to prevent or intercept the molar impaction, with a perspective of a less invasive and shorter therapy. Although rare, impaction of teeth 37 and 47 often requires a complex, multidisciplinary approach.

Vertical mandibular asymmetry and hand measurements in patients in growth: cross-sectional study.

Objectives: The aim of this study was to determine the relationship between the vertical mandibular ramus asymmetry and the hand measurements asymmetry in growing patients. Material and Methods: Panoramic radiographs and comparative radiographs of the right and left hands of 40 patients (14 males and 26 females) between 6 and 16 years old (mean age of 11.35±1.99 years) were evaluated. The total height of the mandibular ramus was measured, and the asymmetry index was calculated. The lengths of the proximal, middle and distal phalanges and the metacarpals of the five digits of both hands were measured and the absolute differences R-L were calculated for each one. Results: A statistically significant association between the presence of vertical mandibular ramus asymmetry and the presence of phalanges asymmetry FPII (p=0.016), FPIII (p=0.016), FPIV (p=0.033), FMIII (p=0.031) and FMIV (p=0.016) was observed. Conclusions: Mandibular asymmetry appears not to be isolated but also present in other body districts such as the phalanx bones. The total vertical asymmetry of the mandibular ramus showed an association with the asymmetry of the lengths of the FPIII, FMIII, FPIV, FMIV and FPII in growing individuals, with association between the side of mandibular asymmetry and the side of the phalanx's asymmetry. The asymmetry of this phalanges increases with increasing index of vertical mandibular ramus asymmetry.

The role of MRI and CT in diagnosis and treatment planning of cherubism: a 13-year follow-up case report.

AIM: Cherubism is characterised by mesenchymal alterations during the development of the jaws secondary to perivascular fibrosis. According to the ALARA (As Low As Reasonably Achievable) principle, it is important to avoid conditions where the amount of radiation used is more than that needed for the procedure, because there is no benefit from unnecessary radiation. However, the use of MRI has been poorly studied in cherubism. MATERIALS AND METHODS: The patient underwent head and neck MRI and 3D CT for imaging assessment. RESULTS: MRI is necessary to evaluate the extension of dysplastic tissue and the cystic part of the lesions. Bone window CT only allows evaluation of strong densitometric alterations of cherubism lesions. Moreover, on radiographic film it is not always possible to distinguish fibrous tissue from mucous pseudocystic tissue. By contrast, these differences are readily evident on MRI. CONCLUSION: MRI, in addition to other traditional radiographs and CT, could be useful in helping the clinician in the diagnosis and treatment of cherubism.

Endoscopic palliative treatement of a post-radiation tracheoesophageal fistula.

Malignant Tracheoesophageal Fistula (TEF) is a life-threatening condition and conventional palliative surgical approach sometimes could be very dangerous or not suitable. We describe a case of a post-radiation TEF involving distal trachea and main carina treated by the placement of endotracheal silicon stent.

Correlation between generalised joint hypermobility and temporomandibular joint disc displacement in adolescent patients: Magnetic Resonance Imaging study.

AIM: Temporomandibular disorders (TMD), in particular disc displacement, are recognised to have a multifactorial aetiology. Ligamentous laxity has been suggested as a potential risk factor for TMD. Ligamentous laxity can lead to generalised joint hypermobility (GJH) involving multiple joints, including the temporomandibular joint (TMJ). The aim of this work is to evaluate the correlation between GJH and disc displacement (DD) assessed on magnetic resonance images (MRI) of the TMJ in adolescent patients. MATERIALS: The study was included 40 adolescent patients (10-16 years), divided into two groups, a Study Group (SG), composed of 20 subjects with GJH, and a Control Group (CG), composed of 20 subjects without GJH. The GJH was assessed by the Beighton test with a threshold value of ≥ 4. The severity of the TMD was determined using the Fonseca Questionnaire and a clinical evaluation of the type of TMD. The condylar-discal relationship and the condylar mobility of the TMJ were evaluated by MRI. Pearson's χ2 Test was performed for the analysis of the statistical correlation. CONCLUSION: This study suggests that adolescents with GJH have a greater risk of developing TMJ disc displacement, especially disc displacement without reduction.

The cornea as a reference point in orthodontic diagnosing, a retrospective study.

Background: The aim of the study is to provide scientific evidence on the possibility of using the Corneal point a skin point for measu-rements that can be made on both standard and three-dimensional photographs. Also, we want to demonstrate the stability of corneal point during the growth, to use it as a reference point. Methods: A sample of 105 radiographs was reached. A descriptive and longitudinal statistical analysis was performed. Results: By data analysis we obtained more variability inter-subject of the millimetrically value of the SC plan. For this reason, we consi-dered the relationship between the SN and SC values and not a single value. In the cross-sectional study the T- test analysis did not show a different significant result of variations between SC and SN in both sexes; therefore, we considered these as unique sample. Conclusion: Longitudinal study has a major importance for to esta-blishing the age-related changes. By cross-selection and longitudinal analysis we obtained an overlapping trend of the SN and SC plan. As the SN plan has always been used as a reference plan for cephalometric measurements, although its variations in growth, it can be concluded that the SC plan can be considered equally a reference plan.

Is the use of clear aligners a real critical change in oral health prevention and treatment?

ABSTRACT: The introduction, in the late years of the last century, of clear aligners therapy (CAT) has drastically changed the approach' perspective to orthodontic treatment. Both patients and clinicians' expectations appear to be addressed with clear aligner therapy achieving an aesthetic appearance and fewer side effects, mainly due to the difficult maintenance of proper oral hygiene in the conventional fixed approach. Research has partially confirmed these key points of CAT but similarly revealed several limitations to the overall benefit of this treatment. Both the aforementioned key points of the CAT are currently under discussion: the aesthetic appearance is not uniform, due to the presence in some cases of extensive need for attachments, and the better periodontal conditions are certainly present in the CAT but mainly limited to the short term. This critical review of the state of the art clarifies the gray areas, such as to inform the researcher with the aim of elaborating an adequate study design in order to evaluate the advantages and limitations of this orthodontic approach.

Effects of laser photobiomodulation in the management of oral lichen planus: a literature review.

Objectives: This review aims to understand whether Photobio-modulation (PBM) therapy is a valid aid in the management of Oral Lichen Planus (OLP) and its symptoms. Moreover, an analysis to determine whether it is a valid replacement for conventional therapies and whether standardized protocols can be used in PBM sessions or whether these should be changed depending on the type of injury has been made. Finally, an evaluation to determine whether PBM may induce transformation of dysplastic oral keratinocytes into squamous cell carcinoma has been made. Materials and Methods: Searches were conducted on two search databases for relevant publications released between 1992 and 2019. The databases used were: Pubmed "Medline", and Google Scholar. Forty-four articles complied with the inclusion criteria and were included for quality assessment and data extraction. Results: All the studies reported positive effects of PBM; how-ever, there was wide heterogeneity in the laser parameters used in the management of the OLP. The effective dose ranges from 2 to 3 J/cm2, in order to see the desired biological effects. Conclusions: PBM is useful in controlling algal sensation and can be used in cases of OLP lesions that are not responsive to conventional therapies or when corticosteroid doses are too high for the patient, resulting in possible side effects. Standardized biostimulation protocols with further scientific insights are therefore required.

Association between the temporomandibular joint disc position on magnetic resonance imaging and the mandibular deviation on posteroanterior cephalogram: a cross-sectional study in adolescents.

OBJECTIVE: The aim of this cross-sectional research was to analyze the association between the disc position of the temporomandibular joint (TMJ) evaluated by magnetic resonance imaging (MRI) and the mandibular deviation evaluated by posteroanterior cephalometric (PA) in adolescents. MATERIALS AND METHODS: The sample was 53 adolescents aged 11-18 years. This cross-sectional study was based on the analysis of PA and bilateral TMJ MRI images retrospectively selected. The mandibular deviation was evaluated by PA and defined by the amount of menton (Me) deviation from the midsagittal reference line. The temporomandibular disc position was evaluated by MRI: normal (N), disc displacement with reduction (DDR) and disc displacement without reduction (DDNR). The DDNR was considered more severe than the DDR. The patients were classified into three groups based on the bilateral disc position: group I, the same bilateral disc position; group II, disc displacement more severe on the ipsilateral side of the menton deviation; group III, disc displacement more severe on the contralateral side of the menton deviation. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between the menton deviation and the bilateral disc position. RESULTS: There was an association statistically significant between the bilateral disc position and the Me deviation (p<0.05). There were significant differences in the mean of the menton deviation between group II (4,40 ±2,26), and group I (2,17±1,93) and III (2,10±1,70). CONCLUSIONS: The menton deviation was significantly correlated with the disc position in the TMJ exhibit more deflection to the side more affected.

Dental Monitoring Application: it is a valid innovation in the Orthodontics Practice?

AIM: The aim of research is to show the effectiveness of 0.014X0.025 CuNiTi wires in self-ligating straight-wire appliance in the working time of 10 weeks, the treatments are monitored with the Dental Monitoring® Applications. A statistical significance analysis of the correspondence between the results of the first phase of fixed orthodontic treatment (alignment), according to the type of wires used, compared to the time (about 8 weeks) suggested by the manufactory house is therefore useful to fully understand the power of these arches in the orthodontic treatment. MATERIAL AND METHODS: The study provides for the recruitment of 35 cooperating patients with different degrees of crowding, all treated with Damon System(ORMCO), monitoring them through pictures, taken in the Dental Monitoring(DM®) sequence technique, as follows: Time0: Arch-Wire Insertion (0.014x0.025CuNiTi), Time1: Four Weeks, Time2: Eight Weeks, Time3: Ten Weeks. RESULT: The results obtained will be compared with records reported by manufactory house. Our results showed that the manufacture information does not correspond to the real efficiency of the device tested. Statistical Analyses performed by T test student. CONCLUSIONS: In Our experience, applying DM Application with self-ligating technique has reduced in term of number of appointments for each patient from 3 appointments in 10 weeks to 2 appointments, when the indirect bonding was effectuated and when we have inserted a 014X025 CuNiTi. This means that there is a reduction in the mean period of chair time, of material 'costs, number of visits; moreover, there is an increase in term of frequency of patient' s monitoring, resulting in a more precise evaluation of treatment by orthodontist. The limits of the present study are presented by the variable patient's compliance and by the small number of patients. This device is an instrument advantageous for the orthodontist's work. In literature, there are few articles inherent to Digital application Mobile, we will hope that this our experience represents a valid support to a major use of this application in the clinical practice.

Multiple Dental Inclusion in Monozygotic Twins with Congenital Visual Impairment.

The study presents two monozygotic twins (MZ) with multiple impacted teeth, affecting the upper canines and lower second molars, as well as congenital aniridia. The clinical aspect of the upper canines is peculiar because of the different positions-palatal in one and buccal in the other twin. Studies reporting different scenarios of impaction in monozygotic twins can contribute more data to the debate on tooth eruption aetiology and more so in this case because of the association with a genetic panocular disease. Patients' Concerns. The patients were referred by a general dentist, who diagnosed the presence of multiple inclusions. Diagnostic Study. Both patients showed severe malocclusion, classified as grade 5 of the Index of Orthodontic Treatment Need (IOTN). The MZ showed class I malocclusion, upper and lower crowding, and impacted lower right and left second molars. A Dentascan was prescribed for the canine impaction. The impaction of the upper canine was palatal of 2.3 in one of the MZ and buccal of 1.3 in the other one. The same altered pattern of eruption of the lower second molars was identified in both twins. The proposed treatment plan contemplated orthodontic surgical recovery of the impacted elements, followed by orthodontic treatment with multibracket appliance after the extraction of the first four premolars, given the crowding entity. The use of a retraction spring action was chosen for the recovery of the lower second molars. Many aspects of the possible genetic aetiology of tooth impaction are still under discussion. The study of diseases in twins offers decisive information. Finally, the possibility that alterations in the eruptive pattern of the dental elements may be associated with other congenital problems broadens the range of investigations related to the possible aetiological causes of the inclusions in humans.

Assessment of Masticatory and Cervical Muscles' Thickness by Ultrasonography in Patients with Facial Asymmetry.

OBJECTIVE: The aim of this study was to determine the relationship between the thickness of masticatory and cervical muscles (temporalis, masseter and sternocleidomastoid) and facial asymmetries in young patients. METHODS: 21 subjects were selected, through a detailed anamnesis and clinical examination, in order to assess the normality of oral tissues, the presence of normal occlusion, the absence of alteration in tooth dimensions and of congenital or developmental anomalies of lips, mouth or face. RESULTS: The present investigation showed that temporalis, masseter and sternocleidomastoid muscles in untreated and growing individuals with facial asymmetries are thinner on the omolateral side when compared with controlateral normal side, but in the untreated one this value is more statistically significantly. CONCLUSIONS: In conclusion, the cervical muscle's thickness resulted increased in young patients Ultrasound is beginning to be recognized to have potential use in dentistry as a safe, noninvasive, comfortable and cost-effective adjunct to diagnosis by producing high-resolution images more easily than magnetic resonance (MRI) and computed tomography (CT) (27-kubo).

General health & psychological distress in children with temporomandibular disorder.

INTRODUCTION: Temporomandibular disorders (TMD) are an heterogeneous group of disorders affecting temporomandibular joints (TMJ), masticatory muscles, or both. The aim of this study is to evaluate the relationship between general health and psychological distress variables and the clinical diagnosis of TMD in children between 8 - 13 years old. Moreover, it will be underlined the different perception of psychological distress existing between patients and their parents. MATERIALS AND METHODS: Patients were divided in two groups: the "case group", which includes patients with TMD, and the "control group", which included patients asymptomatic for TMD. The "case group" is composed by 29 patients, while the "control group" is composed by 22 patients. The patients were asked to fill in a questionnaire called Child Health Questionnaire (CHQ), to evaluate general health and psychological condition and, eventually, the presence of symptoms of stress, anxiety and/or depression. The CHQ is 87 - item questionnaire developed in USA specifically for children. RESULT: As widely reported during the present work, the link between TMD and psychological distress is existing and quite strong, because of lack of number of patients many aspects worth of attentions have not been analyzed as they deserved. CONCLUSION: That's way the conclusion must lead to the proposal of going on with the present study following, possibly, some aspects of research as an increase of the number of patients involved in the study; Individuate possible elements, internal and external, that could strongly influence differences between patient's results and parent's results, etc.

Delayed Eruption of Permanent Dentition and Maxillary Contraction in Patients with Cleidocranial Dysplasia: Review and Report of a Family.

INTRODUCTION: Cleidocranial dysplasia (CCD) is an inherited disease caused by mutations in the RUNX2 gene on chromosome 6p21. This pathology, autosomal dominant or caused by a spontaneous genetic mutation, is present in one in one million individuals, with complete penetrance and widely variable expressivity. AIM: To identify the incidence of these clinical findings in the report of the literature by means of PubMed interface from 2002 to 2015, with the related keywords. The report of local patients presents a clinical example, related to the therapeutic approach. RESULTS AND DISCUSSIONS: The PubMed research resulted in 122 articles. All the typical signs were reported in all presented cases. The maxilla was hypoplastic in 94% of the patients. Missing of permanent teeth was found in two cases: one case presented a class II jaw relationship, instead of class III malocclusion. Similar findings were present in our cohort. CONCLUSION: CCD is challenging for both the dental team and the patient. The treatment requires a multidisciplinary approach. Further studies are required to better understand the cause of this disease. According to this review, a multistep approach enhances the possibilities to achieve the recovery of the most possible number of teeth, as such to obtain a good occlusion and a better aesthetic.

Craniofacial asymmetry in non-syndromic orthodontic subjects: clinical and postural evaluation.

OBJECTIVE: The aim of this study was to evaluate the possible influence of a malocclusion pattern on a patient's posture. METHODS: Patients affected by symmetric malocclusion or malocclusion with mild to moderate non-syndromic craniofacial asymmetry were submitted to a clinical and X-ray evaluation. Subjects with symmetric skeletal class I were used as the control group. Evaluation of differences in postural pattern was performed using rasterstereography. RESULTS: Statistical analysis (t-test) was performed on 61 patients divided in homogeneous subgroups. The results show a pelvic torsion angle of 1.08° + 3.00° (P = 0.0023) (normal value (NV) = 0.0-1.9°) in subjects presenting skeletal class II z asymmetry (control group: 1.17° ± 1.25°, not significant (NS)). CONCLUSIONS: The present study shows evidence of a relationship between malocclusion and spinal posture. A better understanding of the relationship between malocclusion and posture may help in planning a multidisciplinary approach that could involve other specialists.