Class II division 1 malocclusions: comparisons between one- and two-step treatment.

AIM: The aim of this study consists in comparing the two-step treatment with that performed in a single-step in adolescent patients. MATERIALS AND METHODS: Study design: This paper is a critical review of the literature with a systematic approach. The search for scientific articles was performed on the US National Library of Medicine database using the PubMed service. Keywords set: "Early treatment Class II OR 1-phase orthodontics OR orthodontic timing Class II". From the initial screening 20 articles were selected of which the full text has been researched and evaluated. RESULTS: The selected articles were reviewed and evaluated by two independent operators, who both excluded two papers. Ultimately 13 articles were selected that refer to four major working groups, respectively from Manchester, North Carolina, Florida and Queen Mary University of London. CONCLUSION: We can assume that both the one- and two-step treatment are effective in correcting Class II malocclusion, with no significant difference of outcome, except for the incidence of incisor trauma, which was significantly lower for the early treatment group.

Titanium TSME appliance for patients allergic to nickel.

AIM: The aim of this article is to describe the use of a titanium TSME appliance for patients with allergy to resin and nickel. We aim to highlight the optimal way to avoid problems such as stomatitis and peri-labial dermatitis, which generally appear in patients who use traditional orthodontic appliances made in acrylic resin and steel. MATERIALS AND METHODS: The construction of a titanium appliance is described and a case treated with it is reported. RESULTS: The titanium TSME presented in this paper has excellent biocompatibility due to its ability to form superficial oxides, which prevent oxidation and thus corrosion. CONCLUSION: The non-allergic properties of titanium allow to propose it as an alternative in patients with a long-term history of allergic reactions to nichel.

Modified transversal sagittal maxillary expander for correction of upper midline deviation associated with maxillary arch deficiency.

The transversal sagittal maxillary expander (TSME) is a fixed device designed to develop arch form in patients with constricted dental arches. The present article describes a modified TSME appliance, the activation method, the therapeutic benefits as well as clinical advantages. The appliance has two molar bands, a Hyrax-type transverse expansion screw, one 0.045-inch wire extending from the molar band to the palatal surface of the central incisor in the emiarch crossbite and an 8 mm-Hyrax-type screw attached to this wire between the molar band and the incisor. A buccal arm with a terminal loop is welded to the band in the emiarch and it is extended to the labial surface on the central incisor on the side opposite to the crossbite and the maxillary midline deviation. The modified TSME appliance described in this paper are specifically designed for anteroposterior and transverse development. It has a sagittal effect on the maxillary alveolar process and at the same time allow to restore the correct transverse maxillary diameters.

Obstructive sleep apnea syndrome: a literature review.

Obstructive sleep apnea syndrome (OSAS) is a complete or partial airway obstruction that can cause significant physiologic disturbance with various clinical impacts. The etiology is multifactorial and its clinical manifestations are night snoring, headache when patient wakes up, day-time sleepiness and degrease of cognitive performance. Some recent international studies suggest that the OSAS prevalence is 2-4% in men and 1-2% in women of average age. The aim of this work was presenting a literature review in Medline concerning Obstructive sleep apnea syndrome. A review of the articles ranging from 1980 to 2014 has been done. Over 2000 articles were found and those which give useful information about etiology, diagnosis, therapy and found results after the study were selected and evaluated. In literature there is no unanimous opinion on the treatment of OSAS. According to the majority of the authors it should be multidisciplinary. The choice of therapy is predicated on the etiology, severity and natural history of the increased upper airway resistance. The importance of a praecox diagnosis and orthodontic therapy in order to re-establish normal function is underlined, since OSAS is linked with high risk of hypertension, cardiovascular diseases, daytime sleepiness, home and work-related accidents, with consequent worsening of life quality.

Upper midline deviation: modified Hyrax expander.

BACKGROUND: The Hyrax rapid palatal expander is useful for patients in mixed dentition with premature exfoliation of some deciduous teeth and maxillary hypoplasia. This appliance, which is provided of a vestibular arm for correcting maxillary asymmetric transverse discrepancies, represents an interceptive treatment able to reduce the duration of the orthodontic therapy with fixed appliances. CASE REPORT: In this case report the modified version of the Hyrax rapid palatal expander is described. The activation method, the therapeutic benefits as well as the clinical advantages are described.

Atypical swallowing: a review.

AIM: Atypical swallowing is a myofunctional problem consisting of an altered tongue position during the act of swallowing. High incidence in population, multifactorial etiology and the recurring connection with the presence of malocclusions made it a topic of strong interest and discussion in science. The purpose of this review is to illustrate the current orientation on the topic of atypical swallowing, trying in particular to answer two questions: 1) what kind of connection is there between atypical swallowing and malocclusion; 2) what kind of therapy should be used to solve it. METHODS: This review was conducted on the Medline database [www.ncbi.nim.nih.gov/pubmed] searching for the keywords "atypical swallowing" and "tongue thrust". We examined all the documents from the year 1990 onwards, excluding the ones about syndromic cases of the central motor system. RESULTS: The causal relation between the two problems seems to be biunique: some authors affirm that this oral habit starts as a compensation mechanism for a preexisting malocclusion (especially in case of open-bite); other texts show that it has a tendency to exacerbate cases of malocclusion; it is also proven that a non-physiological tongue thrust can negatively influence the progress of an ongoing orthodontic therapy. Thereby, the best therapeutic approach seems to be a multidisciplinary one: beside orthodontics, which is necessary to correct the malocclusion, it is essential to set up a myofunctional rehabilitation procedure to correct the oral habit, therefore granting long time permanent results. There is also proof of a substantial difference between the results obtained from early (deciduous or primary mixed dentition) or later treatments. CONCLUSION: The biunique causal relation between atypical swallowing and malocclusion suggests a multidisciplinary therapeutic approach, orthodontic and myofunctional, to temporarily solve both problems. An early diagnosis and a prompt intervention have a significantly positive influence on the therapy outcome.

Cleft lip and/or palate: review.

AIM: Aim of the review was to provide a literature overview of the birth defects of cleft lip and/or cleft palate (CL/P). METHODS: Through the use of the PubMed database items were collected that would provide information about the condition, leading to the discussion of the following topics: epidemiology, anatomical features, genetics, environmental factors, diagnosis and treatment. RESULTS: According to these data, the CL/P are the most common congenital malformations of the craniofacial region. There are different phenotypes and clinical features of this malformation, which differ according to the anatomical structures involved: cleft lip, cleft lip and cleft palate. The etiology is multifactorial and includes both genetic factors and environmental factors. For proper diagnosis and treatment it is important to complete a multidisciplinary approach to guide the patient from birth to the end of growth. Among the outstanding figures for the care of the anomaly are: the gynecologist, the pediatrician, the maxillofacial surgeon and orthodontist. Individuals with a cleft lip and/or cleft palate may experience problems in feeding, pronunciation, hearing and social integration, which can be corrected to a different extent by surgery, dental treatment, speech therapy and psychosocial interventions. CONCLUSION: Today the optimal treatment is difficult to find, because of the large variability of malformations and the subjective response of each patient to therapy.

Primary Headache Relief in Paediatric Patients Following Rapid Maxillary Expansion: a Prospective Study and Cephalometric Changes Analysis.

BACKGROUND: Primary headaches (PH) are a group of disorders greatly impairing quality of life, highly prevalent in growing population. Previous studies suggested a rhinogenic involvement in PH episodes. Modifications of nasal cavities and septum take place during rapid maxillary expansion (RME). This study aims to investigate the role of skeletal modifications due to RME on PH episodes. METHODS: Sixty-eight growing patients (30/38 MF 7-12 y.o 9.2 ± 1.3 SD) were enrolled. All the selected sample patients reported at least 12 PH episodes in the previous year and were diagnosed with maxillary constriction to be treated with RME. Changes in PH episodes before and after this orthodontic procedure were analysed using paired t-tests. Correlations between age and PH episodes were assessed using Spearman correlation coefficients. Correlations between cephalometric changes and PH episodes were investigated using paired t-tests. CONCLUSION: RME produces significant modifications in maxillary and nasal width and lower nasal length and decreased monthly episodes of PH significantly. It can be supposed and inferred that RME has beneficial effects on PH in growing patients.

Comparison of facial features in fetuses and newborns following natural delivery with cephalic presentation: a pilot study

BACKGROUND: Malocclusions are usually diagnosed around 3-4 years of age according to specific criteria. The purpose of this protocol is to validate a method to understand how the type of delivery can influence the development of malocclusions. MATERIALS: This pilot study, conducted at the Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan, evaluated the relationship between the type of delivery, fetal presentation, and the presence of malocclusions in children. The sample included 5 healthy term newborns, all born to healthy mothers with uncomplicated pregnancies by vaginal delivery. Measurements were taken, via ultrasound, at the 37th week of gestation (T0) and on the second day of life (T1), using a craniometer, caliper and goniometer, including head circumference, lower facial angle, frontonasal angle, labial fissure length, and interpupillary distance. CONCLUSION: The results suggest that further research is necessary to better understand the influence of delivery mode and fetal presentation on the development of malocclusions. This study represents an important first step, highlighting the need for larger samples and more in-depth investigation methods to obtain more conclusive results.

Premature loss of primary molars in children: space recovery through molar distalisation. A literature review.

AIM: The integrity of primary dentition is essential in the development of the jaws and permanent occlusion. The consequences of a premature loss of primary molars are: space loss, crowding, risk of impaction of the permanent teeth, ectopic eruption, anomalous inclination of the teeth adjacent to the loss molar, reduction of arch length. The mesial displacement of the posterior permanent teeth during eruption can cause a loss of space, which can be regained with orthodontic appliances. Therefore, a careful diagnosis is of great importance to be able to decide what appliance is indicated to recover from this situation. Molar distalisation consists in displacing permanent molars distally, allowing them to reach class I relationship and to recover the correct space for the second bicuspids when the second deciduous molar has been lost early. METHODS: The aim of this study is to carry out a narrative literature review regarding the different appliances and their effectiveness in regaining space after premature loss of the upper primary molars. CONCLUSION: The paediatric dentist should be aware of the advantages and disadvantages related to each device and select the most appropriate distalisation appliance based on an individual plan of diagnosis and a careful treatment. The distalisation of the upper molar must be adequately stabilised and so it is important to consider also some retainers such as Nance's appliance, the Palatal Plate, the extraoral traction, the utility arch, or II Class elastic bands.

Impacted maxillary canine on the position of the central incisor: surgical-orthodontic repositioning.

The aim of this article is to describe a case of a young orthodontic patient in which an impacted maxillary canine was repositioned in the central incisor position. A severe resorption of the root of the central right maxillary incisor by ectopic eruption of the impacted right maxillary canine is described. The canine was repositioned in the incisor's position to avoid resorption of the roots of the adjacent teeth during the disinclusion. The central incisor was extracted and the canine was extruded by a closed eruption technique. When the canine eruption was complete, the tip, the torque and the morphology of the canine were modified in order to make it look like an incisor. Nowadays the therapy with dental implants is the best choice, if the position of impacted teeth is difficult to reach. This case report describes a successful management of an impacted upper right canine aligned in the upper right central incisor position. Accurate diagnosis, conservative management of the soft tissues, anchorage unit and the direction of the orthodontic traction are important factors for the success treatment.

Oral tissues and orthodontic treatment: common side effects.

The aim of this paper was to provide a literature review about the problems that can occur during orthodontic treatment. Using the PubMed database we collected items that would provide information regarding the direct consequences of the placement of an orthodontic appliance: coming to the discussion of the following topics: candida infections, the effects on the soft tissues, the effects on periodontal tissues and effects on hard tissues. The presence of appliances in the oral cavity increases the prevalence of people with candida, specifically the species Candida Albicans is the most frequently isolated. The balance between the clearance of the microorganism, the colonization and the state of candidiasis depends both on the virulence of the fungus, and the competence of the host immune system. On soft tissues, cases of ulceration of the upper jaw by a rapid palatal expander and pyogenic granuloma due to quad helix appliance have been reported. The second one is mostly observed on vestibular gingiva. The first one was found, however, in patients suffering from diabetes mellitus type 1 because of the tissue modifications induced by this pathological condition. The more severe periodontic effects are those caused by incorrect use of orthodontic elastic separators. Finally, the White Spot Lesions are the direct consequences of a wrong conditioning of enamel when attaching the bracket. They represent a first stage of caries in the positioning area of the bracket. The orthodontist is required to intercept these issues not to affect the success of the treatment.

SALIVA-based diagnostic approach for diabetes mellitus: a step towards non-invasive detection - a scoping review.

OBJECTIVE: Diabetes mellitus (DM) is a chronic autoimmune disease whose main feature is chronic hyperglycemia. The causes of DM are impaired insulin secretion, impaired insulin action, or both. Saliva is a biofluid that can be considered as a "mirror" reflecting our body's health status; with the rapid advancement in salivaomics, saliva, being a non-invasive and safe source, could be a substitute for blood in the diagnosis and prognosis of diseases. As there are no precise guidelines about the salivary biomarkers correlated with the diagnosis of diabetes, a review was conducted to verify whether saliva analysis can be feasible and which biomarkers are more reliable, for the diagnosis of this disease. MATERIALS AND METHODS: A literature search was performed through PubMed, Medline, Scopus, Web of Science, LILACS, Open Grey, and Cochrane Library databases. The "PRISMA" guidelines were used for the following review, and thirty-three studies were analyzed. RESULTS: Almost all salivary glucose studies suggest that the estimation of this biomarker can be used as a potential indicator. Furthermore, studies that considered other biomarkers such as 1,5-anhydroglucitol, alpha-amylase, N-acetyl-ß-D-hexosaminidase, asprosin, resistin, and fructosamine reported that these biomarkers resulted to be potentially useful for diabetes screening and diagnosis, with the exception of the cystatin SA. CONCLUSIONS: In conclusion, several salivary biomarkers could be useful for monitoring DM, but it would be necessary to further expand the research and define precise values for each marker in order to predict with reasonable confidence if an individual is healthy or suffering from diabetes. Finally, standardized saliva collection and processing techniques are key to minimizing interindividual variability in saliva composition.

Influence of the type of breastfeeding as a risk or protective factor for the onset of malocclusions: a systematic review.

AIM: The correlation between malocclusions in deciduous dentition and type of breastfeeding has been described by many authors in numerous articles. The aim of this article is to investigate the literature about this important topic. MATERIALS: The research was conducted by querying the following databases: PubMed, EBMR, Cochrane Library, Web of Sciences, Medline, Web of Sciences, Ovid and Embase. The key words were: "infant" OR "baby", AND "breastfeeding" AND "malocclusion". As with similar literature review papers, the PRISMA-P (Preferred Reporting Items for Systematic Reviews Protocols) was used. The examined articles were of the following types: randomised controlled trials (RCTs), case-control studies and cohort studies. For the qualitative analysis of the selected studies, it was employed the NOS scale (Newcastle-Ottawa Quality Assessment Scale). CONCLUSION: Two hundred and fifty articles were selected. After filtering out the articles deemed irrelevant or with obvious bias, only 16 articles were left. From our results, it can be concluded that breastfeeding seems to play a decisive role in preventing the onset of posterior cross-bites and Class II malocclusions, and that this protective effect appears to be time-dependent.

Skeletal and dento-alveolar changes obtained with customised and preformed eruption guidance appliances after 1-year treatment in early mixed dentition.

AIM: The aim of this study was to assess the skeletal and dento-alveolar changes produced by a customised eruption guidance appliance (EGA) and a preformed EGA in subjects presenting a skeletal class II pattern during early mixed dentition and to evaluate the differences between the two devices. METHODS: All subjects included in the study were randomly selected from the record's archive according to the following inclusion criteria: (1) patients presenting upper central incisor and first permanent molars fully erupted; (2) early mixed dentition with age between 7 to 9 years old; (3) Angle class I or class II malocclusion; (4) increased overjet > 4 mm;(5) deep bite with at least 2/3 overlapping of the incisors; (6) no previous orthodontic treatment apart from maxillary expansion treatment. All children belonging to the case group received treatment with a 3D printed EGA whereas the other patients belonging to the control group were treated with preformed EGA. Records consisted in digital dental models and lateral cephalogram at the beginning (T0) and after 1 year of treatment (T1). Data collected on the digital models included the dentoalveolar changes in overbite, overjet, sagittal molar relationship, and dental crowding. Cephalometric tracings were computed by a single blinded observer using Dolphin Imaging software. Statistical analysis was performed with SPSS (version 25.00; IBM Corp, Armonk, NY). Comparison regarding the cephalometric changes between T1-T2 was carried out with paired t-test. Difference in distribution regarding sagittal molar and canine relationship and anterior crowding between groups at T1 and T2 has been computed with chi-square test. The independent sample t-test was used to perform the between group comparison. CONCLUSION: In the short time, both the appliances showed to be effective in correcting class II malocclusion, anterior crowding, overjet and overbite. Custom-made appliance demonstrated to be significantly more effective in correcting anterior crowding, the dento-skeletal vertical relation and position of permanent incisor compared to the preformed appliance. Adopting a customised device, effects due to an average prescription appliance used to a specific patient can be reduced, resulting in more predictable results.

Survey of Oral Hygiene Habits and Knowledge among School Children: a cross-sectional study from Italy.

AIM: This study is aimed to investigate the oral hygiene practice, knowledge and attitude of young adults, assessing their awareness about the impact of a certain "risk" behaviour on their oral and dental health. MATERIALS: This is a cross-sectional survey study conducted on 829 students (350 males and 479 females, mean age 13-20 years) attending high school in Milan and surrounding areas. They were asked to complete anonymous questionnaire during the first semester of the 2019-2020 school year, under the supervision of a teacher and/or an assigned interviewer. The questionnaire was created by "Laboratorio Adolescenza", in collaboration with the International Alliance of Responsible Drinking (IARD) Research Institute and the University of Milan. All of the data was compiled into table or graph form and analysed. CONCLUSION: There is a general awareness among Italian school children about the risks of bad oral habits, however, there is a need to improve the oral health knowledge, attitude and practices in the target population with emphasis on improvement of oral hygiene practices.

Orthopaedic treatment efficiency in skeletal Class III malocclusions in young patients: RME-face mask versus TSME.

AIM: To cephalometrically compare the skeletal vertical and sagittal effects of TSME with those of RME protraction facemask therapy in Class III patients. MATERIALS AND METHODS: The sample of this retrospective study included 104 patients (53 females, 51 males) with age ranging from 5 to 9 years, presenting a skeletal Class III relationship: 52 were treated with transverse sagittal maxillary expander (TSME) appliance (Group 1) and 52 with Hyrax rapid maxillary expander/facemask (RME/FM, Group 2). For each patient a lateral cephalogram was obtained before treatment (T0) and at the end of the retention period (T1). Changes in the two groups during the observation period were calculated, compared and statistically analysed with t-test. RESULTS: TSME can produce skeletal changes and dento-alveolar modifications. RME in association with protraction facemask showed that after treatment the maxilla was moved significantly forward. The correction of the ANB angle was due to a change in mandibular position during treatment which showed a backward and downward rotation. CONCLUSION: Both devices were effective in the treatment of subjects with skeletal Class III due to maxillary retrusion.

Correlations between malocclusions and dyslalias.

AIM: This was to evaluate the relationship between malocclusions and dyslalias and to plan a multidisciplinary approach between orthodontics and speech therapy. STUDY DESIGN: 880 children (448 males and 432 females) ranging in age from 6 to 10 years were examined at the Department of Orthodontics at Milan University to determine if a relationship between malocclusions and dyslalia exists and their correlations. METHODS: The children were examined by a speech therapist and an orthodontist. An examination of the occlusion and phonetics was conducted and compared with an age-matched control group. RESULTS: Correlations between malocclusion and dyslalia were found. The presence of Class III occlusion, diastema, increase in overjet, presence of open and deep bite, asymmetry have high tendency to be associated with speech disorders such as dyslalias. The presence of crowding and anterior cross bites have moderate tendency to be associated with such disorders; on the contrary Class II occlusion, upper incisors protrusion, posterior cross bite and TMD have low tendency to be associated with dyslalias. CONCLUSION: The effect of dyslalia on the speech organs is not constant. On the other hand, the effect of malocclusion on dyslalia seems to be more relevant and more frequent and to increase proportionally, depending on the severity of the malocclusion.