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AIM To systematically review the effects of surgical mandibular advancement (SMA) regarding changes of the upper airways in adult patients with skeletal Class II malocclusion. MATERIALS AND METHODS Five electronic databases were searched up to April 2020. Human studies focusing on the morphology and dimension of the upper airways after SMA were included. 'Quality assessment for Before-After (Pre-Post) Studies' was used to assess the risk of bias of the individual studies. Standard mean differences (SMD) with 95% confidence intervals (CI) were calculated for random effect model meta-analysis. The certainty of evidence was assessed using the GRADE tool. RESULTS Twenty cohort studies of only treated patients without control group were eligible for qualitative synthesis, of which 17 were used for quantitative synthesis. Very low certainty of evidence indicated that SMA resulted in significant increase of the volume and of the smallest cross-sectional area (SMC) of the nasopharynx (volume SMD: 1.43, CI: 0.62, 2.24, P = .001, I2 = 87.8%; SMC SMD: 1.53, CI: 0.59, 2.47, P = .001, I2 = 90.5%) and oropharynx (volume SMD: 1.36, CI: 0.37,2.35, P = .007, I2 = 92.1%; SMC SMD: 1.21, CI: 0.11,2.32, P = .032, I2 = 93.1%). Significant augmentation of the distances between the posterior pharynx wall and the uvala (SMD: 0.73, CI: 0.46,0.98, P

The aim of this study was to assess whether pain and strain of the periodontal ligament (PDL), induced by orthodontic separation, alter the somatosensory ability to perceive small thicknesses between occluding teeth (occlusal tactile acuity, OTA).The OTA was tested at baseline (T0), using 9 aluminum foils (range 8-72 μm), randomly placed between the molar teeth, and 1 sham test (without foil), asking the participants whether they felt the foil between their teeth. Afterwards, orthodontic separators were placed, and subjects were randomly assigned to one of the two experimental groups: Group Pain (GP: 18 males; 14 females mean age 25.22 ± 2.28 years) had separators removed after 24 h; Group Strain (GS: 14 males; 17 females, mean age 24.03 ± 3.06 years) had separators removed after 7 days. The OTA measurement was repeated in both groups immediately after orthodontic separators removal (T1). A within-group comparison (T1 vs T0) was performed for each testing thickness (ANOVA for repeated measurements, with Bonferroni correction for multiple testing) (p0.005).GP showed statistically significant reduction of the OTA at T1, as compared to T0, for the thicknesses 24 μm (p = 0.004) and 32 μm (p = 0.001). No significant reduction was observed in GS (all p0.005).Acute periodontal pain tends to disturb the tactile ability of the teeth, while strain of the PDL in absence of painful sensation determines a return to OTA baseline values.The reduction of OTA might explain the uncomfortable occlusal sensation referred by patients during acute periodontal pain.

Background: Systematic Reviews (SRs) and Meta-analyses (MAs) are the preferred research approaches to manage the growing number of clinical trials, since they bring together the results from multiple studies by applying rigorous methods, and provide summarized and critically appraised evidence on a given topic. Several orthodontic issues suffer from overwhelm of primary literature, and is frequent to find more than one SR on the same topic showing variable quality and scope. The diffusion of systematic approach made difficult to keep track of the number of SRs that are being published. Hence, SRs of SRs were introduced to integrate and to synthesise information from existing SRs. Objectives: The aims of this doctoral thesis were: (1) to assess the quality of SRs and MAs of debated issues in the orthodontic literature, (2) to collect the results provided by SRs and MAs and to critically appraise the evidence within reviews. More specifically, the current study focused on two issues: the functional orthopaedic treatment of Class II malocclusion and the dentoalveolar effects of palatal expansion. Materials and Methods: Two separate literature reviews were conducted. In the first review, SRs and MAs focusing on the effects of the functional orthopaedic treatment of Class II malocclusion in growing patients were included. In the second one, SRs and MAs focusing on the dentoalveolar and skeletal effects of palatal expansion were included. The methodological quality of each included SR or MA was assessed using the AMSTAR (A Measurement Tool to Assess Systematic Reviews). The level of evidence of the primary studies included in each SR or MA was assessed according to hierarchy of the evidence, and reported with the LRD scoring (Level of Research Design scoring). The main outcomes were summarized and the evidences retrieved were critically appraised applying pre-determined statements. Literature search, study selection, quality assessment and data extraction were independently conducted by two operators, and consensus was reached through discussion. Results: For the first SR fourteen studies on Class II treatment were included. The quality of SRs/MAs ranged between AMSTAR 2 and 10 (mean score: 6) and three SRs/MAs included only Randomized Clinical Trials (RCTs) (LRD II). The main outcomes analysed were: dentoalveolar effects, maxillary skeletal effects, mandibular effects and soft tissues effects. According to the current evidence provided by SRs and MAs there was still no sufficient evidence on the effects of Class II functional orthopaedic treatment, due to the small number of adequate MAs, the small number of primary studies for each outcome, and the low-medium quality of primary literature. However, we found some evidence of reduction of the overjet with different functional appliances, some evidence of maxillary growth control with Twin-Block and headgear and some evidence of mandibular length increasing with different functional appliances, even though the clinical relevance of the latter results was questionable. For the second SR twelve studies on dentoalveolar and skeletal effects of palatal expansion were included. The quality of SRs/MAs ranged between AMSTAR 4 and 10 (mean score: 6.8) and two SRs/MAs included only RCTs (LRD II). The main outcomes analysed were short- and long-term effects of rapid and slow maxillary expansion (RME/SME) on dentoalveolar and skeletal structures in the three directions (sagittal, vertical and transversal). According to our findings there was high level of evidence that RME determined a significant increase of transverse dentoalveolar maxillary dimensions in the short-term; however, long-term maintenance of this result seemed to be strongly influenced by the retention protocol and was supported by moderate evidence. Meanwhile, also SME showed similar results, but supported by moderate to low evidence. Maxillary skeletal expansion was mainly reported in the short-term with RME, but with low evidence. Conclusions: Due to the variable quality of SRs and MAs in orthodontics clinicians should be aware of the existent tools to assess strength and weakness of these studies, in order to adequately recognize whenever limited information are provided. SRs and MAs did not provide sufficient evidence to make a final decision about the effectiveness or ineffectiveness of Class II functional orthopaedic treatment, while RME was reported as an effective procedure for the short-term correction of dental transversal discrepancies.

Background The prevalence of malocclusion, temporomandibular disorders (TMD) and oral parafunctions is highly debated in children population. Objectives To investigate the prevalence of malocclusion, self-reported oral parafunctions and TMD-pain in Italian schoolchildren and to assess the association between the examined factors. Methods A total of 700 children aged 9-11 years were selected among six public schools in Campania region (Italy). Molar relationship, overjet, overbite and cross-bite were assessed through a clinical examination. Furthermore, the subjects were demanded to fill in a validated questionnaire for TMD-pain screening and the short form of the Oral Behaviours Checklist. Descriptive statistics were used to report the frequencies. The associations between occlusal traits, oral parafunctions and TMD-pain were analysed with a Pearson chi-square test, as expressed by odds ratio and 95% confidence intervals. The significance level was set at P < 0.05. Results Molar Class I was the most frequently encountered molar relationship, followed by molar Class II, subdivision and molar Class III. Increased overjet was more common than negative overjet. Posterior cross-bite was observed in 12% of children. TMD-pain was recorded in 14.7% of subjects. High frequency of oral parafunctions was reported in 21.3% of subjects. A significant association was found between TMD-pain and negative overbite. Cross-bite and high frequency of oral parafunctions were associated with TMD-pain. Conclusion The current results show that malocclusion, self-reported oral parafunctions and TMD-pain are frequent findings among Italian schoolchildren and that some occlusal factors and high frequency of oral parafunctions might be associated with TMD-pain.

Objective: To investigate the cytotoxicity of nickel-titanium (NiTi) esthetic orthodontic archwires with different surface coatings. Materials and Methods: Three fully coated, tooth-colored NiTi wires (BioCosmetic, Titanol Cosmetic, EverWhite), two ion-implanted wires (TMA Purple, Sentalloy High Aesthetic), five uncoated NiTi wires (BioStarter, BioTorque, Titanol Superelastic, Memory Wire Superelastic, and Sentalloy), one β-titanium wire (TMA), and one stainless steel wire (Stainless Steel) were considered for this study. The wire samples were placed at 37°C in airtight test tubes containing Dulbecco’s Modified Eagle’s Medium (0.1 mg/mL) for 1, 7, 14, and 30 days. The cell viability of human gingival fibroblasts (HGFs) cultured with this medium was assessed by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Data were analyzed by a two-way analysis of variance (α = .05). Results: The highest cytotoxic effect was reached on day 30 for all samples. The archwires exhibited a cytotoxicity on HGFs ranging from “none” to “slight,” with the exception of the BioTorque, which resulted in moderate cytotoxicity on day 30. Significant differences were found between esthetic archwires and their uncoated pairs only for BioCosmetic (P = .001) and EverWhite (P < .001). Conclusions: Under the experimental conditions, all of the NiTi esthetic archwires resulted in slight cytotoxicity, as did the respective uncoated wires. For this reason their clinical use may be considered to have similar risks to the uncoated archwires.

This Systematic Review (SR) aims to assess the quality of SRs and Meta-Analyses (MAs) on functional orthopaedic treatment of Class II malocclusion and to summarise and rate the reported effects. Electronic and manual searches were conducted until June 2014. SRs and MAs focusing on the effects of functional orthopaedic treatment of Class II malocclusion in growing patients were included. The methodological quality of the included papers was assessed using the AMSTAR (Assessment of Multiple Systematic Reviews). The design of the primary studies included in each SR was assessed with Level of Research Design scoring. The evidence of the main outcomes was summarised and rated according to a scale of statements. 14 SRs fulfilled the inclusion criteria. The appliances evaluated were as follows: Activator (2 studies), Twin Block (4 studies), headgear (3 studies), Herbst (2 studies), Jasper Jumper (1 study), Bionator (1 study) and Fränkel-2 (1 study). Four studies reviewed several functional appliances, as a group. The mean AMSTAR score was 6 (ranged 2-10). Six SRs included only controlled clinical trials (CCTs), three SRs included only randomised controlled trials (RCTs), four SRs included both CCTs and RCTs and one SR included also expert opinions. There was some evidence of reduction of the overjet, with different appliances except from headgear; there was some evidence of small maxillary growth restrain with Twin Block and headgear; there was some evidence of elongation of mandibular length, but the clinical relevance of this results is still questionable; there was insufficient evidence to determine an effect on soft tissues.

To summarise the skeletal, dental and soft tissue effects of orthopaedic treatment on growing skeletal class III patients compared with a concurrent untreated similar control group and to evaluate whether the design of the primary studies may affect the results. A literature search was performed up to the end of February 2016. No restrictions were applied concerning language and appliances. Once the quality score was assessed, a meta-analysis was performed for the appliances used in more than three studies. A moderator analysis for study design was performed. The level of evidence was evaluated by means of the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool. The search resulted in 21 papers. The quality of most of the studies was medium. Each study reported skeletal sagittal improvement and overjet correction. Fourteen studies reported a significant increase in lower facial height. Follow-up data showed slight relapses in about 15% of patients. Meta-analyses were performed for the facemask and chin cup. The two appliances were efficient for correcting the sagittal discrepancy, increasing the divergence. In the analysis for study design, the retrospective studies showed a more efficient appliance than RCTs for 6 of 13 variables. The level of evidence was between very low and moderate. There is very low to low evidence that orthopaedic treatment is effective in the correction of Class III skeletal discrepancies and moderate evidence for the correction of the overjet. A common side effect is mandibular clockwise rotation in older subjects.

The aim was to assess the quality and to summarise the findings of the Systematic Reviews (SRs) and Meta-Analyses (MAs) on the dental and skeletal effects of maxillary expansion. Electronic and manual searches have been independently conducted by two investigators, up to February 2015. SRs and MAs on the dentoalveolar and skeletal effects of fixed expanders were included. The methodological quality was assessed using the AMSTAR (A Measurement Tool to Assess Systematic Reviews). The design of the primary studies included in each SR/MA was assessed with the LRD (Level of Research Design scoring). The evidence for each outcome was rated applying a pre-determined scale. Twelve SRs/MAs were included. The AMSTAR scores ranged from 4 to 10. Two SRs/MAs included only RCTs. The current findings from SRs/MAs support with high evidence a significant increase in the short-term of maxillary dentoalveolar transversal dimensions after Rapid Maxillary Expansion (RME). The same effect is reported with moderate evidence after Slow Maxillary Expansion (SME). However, there is moderate evidence of a non-significant difference between the two expansion modalities concerning the short-term dentoalveolar effects. With both RME and SME, significant increase of skeletal transversal dimension in the short-term is reported, and the skeletal expansion is always smaller than the dentoalveolar. Even though dental relapse to some extent is present, long-term results of the dentoalveolar effects show an increase of the transversal dimension, supported by moderate evidence for RME and low evidence for SME. Skeletal long-term effects are reported only with RME, supported by very low evidence.

The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is a valid tool aiming to evaluate the self-reported influence of dental aesthetics on quality of life. This questionnaire was developed in English for young adults, and later translated and validated with an Italian population. A new version of the questionnaire was recently introduced to be used in adolescents (11-17 years- old), but it had not been translated in Italian yet. Hence, the purpose of this study was to translate, cross-culturally adapt and validate the PIDAQ for adolescents, for its use among Italian subjects.