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Background: In the past, dentistry heavily relied on manual image analysis and diagnostic procedures, which could be time-consuming and prone to human error. The advent of artificial intelligence (AI) has brought transformative potential to the field, promising enhanced accuracy and efficiency in various dental imaging tasks. This systematic review and meta-analysis aimed to comprehensively evaluate the applications of AI in dental imaging modalities, focusing on in-vitro studies., Methods: A systematic literature search was conducted, in accordance with the PRISMA guidelines. The following databases were systematically searched: PubMed/MEDLINE, Embase, Web of Science, Scopus, IEEE Xplore, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar. The meta-analysis employed fixed-effects models to assess AI accuracy, calculating odds ratios (OR) for true positive rate (TPR), true negative rate (TNR), positive predictive value (PPV), and negative predictive value (NPV) with 95 % confidence intervals (CI). Heterogeneity and overall effect tests were applied to ensure the reliability of the findings., Results: 9 studies were selected that encompassed various objectives, such as tooth segmentation and classification, caries detection, maxillofacial bone segmentation, and 3D surface model creation. AI techniques included convolutional neural networks (CNNs), deep learning algorithms, and AI-driven tools. Imaging parameters assessed in these studies were specific to the respective dental tasks. The analysis of combined ORs indicated higher odds of accurate dental image assessments, highlighting the potential for AI to improve TPR, TNR, PPV, and NPV. The studies collectively revealed a statistically significant overall effect in favor of AI in dental imaging applications., Conclusion: In summary, this systematic review and meta-analysis underscore the transformative impact of AI on dental imaging. AI has the potential to revolutionize the field by enhancing accuracy, efficiency, and time savings in various dental tasks. While further research in clinical settings is needed to validate these findings and address study limitations, the future implications of integrating AI into dental practice hold great promise for advancing patient care and the field of dentistry., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background: Temporomandibular disorders (TMD) are manifested by soreness in the jaw joint area and jaw muscles, clicks or creaks when opening or closing the mouth. All these symptoms can be disabling and occur during chewing and when the patient yawns or speaks. Several classes of drugs are used to treat symptoms. This review aims to assess which drug suits the different signs., Methods: Pubmed, Web of Science and Lilacs were systematically searched until 01/02/2023. Clinical trials were selected that dealt with drugs used in temporomandibular dysfunction RESULTS: Out of 830 papers, eight studies were included. The Meta-Analysis with Continuous Outcomes with Pre-Calculated Effect Sizes resulted in the rejection that there is intergroup variability (p.0.74)., Conclusions: Treatment of orofacial pain is still a significant challenge for dentistry. We can conclude that there is no drug of first choice in the treatment of temporomandibular pain. However, the clinician must distinguish the type of pain and the aetioloic cause of the pain so that the patient can be treated and managed pharmacologically., (© 2024. The Author(s).)

Hemorrhage control is a crucial aspect of dental procedures, and achieving efficient hemostasis remains a key challenge. The advent of hemostatic dressings has revolutionized the field of dentistry by providing effective and convenient solutions for managing bleeding in vari-ous dental scenarios. This article aims to provide an overview of hemostatic dressings, their mechanisms of action, and their diverse applications in dentistry. We applied the following Pop-ulation, Exposure, Comparator, and Outcomes (PICO) model to assess the document eligibility. A literature search was performed on major search engines, using keywords. At the end of the search, 3 articles were selected that matched the PICO. Three items were selected after the screen-ing process, and bleeding times were analyzed between the control group and the study group. The overall effect showed a substantial and statistically significant difference with bleeding time in favour of HDD-treated patients, showing that this garrison is very useful in controlling bleed-ing for patients taking anticoagulants and antiplatelets (Mean difference - 5.61; C.I. -5.70, - 5.52); Overall, hemostatic dressings have revolutionized the management of bleeding in dentistry, offering a promising solution to achieve optimal hemostasis, improve treatment outcomes, and enhance patient care, particularly Hemcon., (© 2023. The Author(s).)

Background: In dentistry, there is a growing preference for computer-aided design and computer-aided manufacturing (CAD/CAM) systems over traditional laboratory procedures. However, there is not much literature comparing various CAD/CAM materials. Thus, this study aimed to assess and compare the color stability and hardness of gingival and tooth colored milled and 3D-printed acrylic resins., Materials and Methods: Four types of CAD/CAM materials were prepared: 3D-printed pink shade (PP), milled polymenthymethacrylate (PMMA) pink shade (MP), 3D-printed tooth shade (PT) and milled PMMA tooth shade (MT) (n = 6). For hardness, disc shaped samples of 15 mm × 2 mm and for color stability, bar shaped samples of 65mmx10mmx2.5 mm were prepared and polished. Vickers hardness test was performed in a microhardness tester. Color stability test was done by immersing in coffee solution and coca cola for 7 days. Day 0 and day 7 measurements were recorded using a digital spectrophotometer and the change in color was calculated. For statistical analysis, one-way ANOVA and Tukey's post hoc tests were done., Results: For color stability, milled PMMA was superior to 3D-printed resin samples. Milled pink and tooth shade samples had similar color stability, whereas 3D-printed tooth shade samples were more color stable as compared to pink shade 3D-printed samples. For hardness, milled tooth shade PMMA was the most superior one, followed by 3D-printed tooth shade, whereas pink shade milled PMMA and 3D-printed resin samples had similar hardness values and were inferior to the tooth shade CAD/CAM materials., Conclusion: Color stability of milled PMMA is superior to that of 3D-printed resins. Hardness of tooth shade milled and 3D-printed resins is more than that of pink shade milled and 3D-printed resins., (© 2024. The Author(s).)

Background: Epidermolysis bullosa (EB) is a genetic syndrome afflicting skin and mucous membranes. The manifestation depends on the form: in mild conditions, occasionally, vesicular-bullous lesions of the oral cavity may be present, which heal spontaneously without leaving scars. Patients following joint rupture have scars that limit food intake and restrict quality of life. This study aims to evaluate the possibility of carrying out an implant therapy and the success rate of this therapy., Methods: Until January 3, 2000, PubMed, Web of Science, and Lilacs were searched. Clinical studies were selected that considered implant therapy in patients with epidermolysis bullosa. Articles were therefore selected that addressed oral health and implant survival in patients with epidermolysis, with no differentiation between the various subtypes. A risk of bias assessment was performed through Cochrane., Results: Twenty-one studies were found after the investigation. Only five were chosen to create the current systematic study; 16 articles were skipped over. 10 papers were disregarded because they had been reviewed; 4 were ignored because they contained case studies; and two were omitted because they were not written in English. The results show that implant survival is at around 97%., Conclusions: Patients with epidermolysis bullosa can be treated with implant therapy without the risk of an increased implant failure rate. Indicate the main conclusions or interpretations., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Literature evidence describes various treatment protocols that have been employed for the effectiveness in improving survival and addressing associated symptoms of cracked teeth., Objective: This systematic review investigates the survivability of endodontically treated cracked teeth and associated assessments, focusing on various treatment protocols., Methods: The PRISMA guidelines were utilised for guiding the article selection framework of this review. A comprehensive search of relevant literature was conducted in May 2023 across various databases, and studies meeting the inclusion criteria were selected. Data extraction, guided by a standardized form, captured crucial details, including study characteristics, treatment protocols, and treatment outcomes, enhancing the consistency and accuracy of information collection. Data extraction and synthesis was done by two reviewers independently. The Newcastle Ottawa tool was used to measure the methodological quality of the study. Six observational studies were eventually included., Results: Mandibular molars are particularly prone to developing cracks, with research indicating a heightened susceptibility to this dental issue. Studies reveal that endodontically treated cracked teeth boast robust overall survival rates ranging from 75.8% to 100%. The risk of bias assessment, utilizing the Newcastle Ottawa scale, indicated a moderate risk across studies, highlighting the necessity for careful interpretation of findings., Conclusion: Endodontically treated cracked teeth show marked success in survival, with the incorporation of crowns post-endodontic treatment significantly enhancing longevity and resilience.

Background: Previous evidence would suggest that subjects affected by functional posterior cross-bite (FPXB) present an asymmetric morphology of the maxilla. However, no evidence is available concerning the morphology (symmetry/asymmetry) of the maxilla after treatment of FPXB. This study aimed to investigate the volumetric and morphological changes of the palate in FPXB subjects treated with maxillary expansion and to compare these data with an untreated control group. The study sample included 20 FPXB subjects (mean age 8.1 ± 0.9 years) who underwent maxillary expansion (MEG group) and 21 FPXB subjects (mean age 7.7 ± 1.2 years) as controls (CG group). Digital models were recorded at T0 (first observation) and T1 (12-18 months after first observation) and analyzed to assess palatal volume and symmetry. Deviation analysis and percentage matching calculation were also performed between original and mirrored palatal models for each patient. All data were statistically analyzed for intra-timing, inter-timing and inter-groups assessments., Results: At T0, the cross-bite side (CBS) was significantly smaller than non-cross-bite side (non-CBS) in both groups (p < 0.05). At T1, the CBS/non-CBS difference reduced significantly in the MEG group (p < 0.05) while slightly worsened in the CG, however without statistical significance (p > 0.05). The matching percentage of the palatal models improved significantly at T1 in the MEG group (T0 = 74.02% ± 9.8; T1 = 89.95% ± 7.12) (p < 0.05) while no significant differences were recorded in the CG (T0 = 76.36 ± 8.64; 72.18% ± 9.65) (p > 0.05)., Limitations: The small sample size and the retrospective design of the study represent two limitations that should be overcome with further clinical trials., Conclusions: Subjects with FPXB present an asymmetric development of the maxillary vault that improves after reestablishment of normal occlusion following maxillary expansion., (© 2023. The Author(s).)

Background: Haemophilia A, B and von Willebrand disease are the most common bleeding disorders. There is an increased tendency of spontaneous bleeding into joints resulting in intra-articular infection. It is believed that Temporomandibular Joint (TMJ) can be affected in a similar manner which can further lead to limited mouth opening and ankylosis. The association between bleeding disorders (BD) and development of temporomandibular disorders (TMD) is poorly understood. This systematic review intends to evaluate the association of TMD in individuals with inherited bleeding disorders as compared to healthy controls., Methods: PubMed, Ovid SP and Google Scholar were searched for articles published between the times of inception to 1 May 2023. All the articles were subjected to Population, Exposure, Comparison and Outcome model (PECO) based on which inclusion and exclusion criteria were applied. Participants (P) is children, adults or adolescents; Exposure (E) is children, adults or adolescents with a diagnosis of Haemophilia or bleeding disorder (BD); Comparator (C) is age and gender-matched healthy controls who do not have Haemophilia or bleeding disorder; Outcome (O) is prevalence of any signs or symptoms (clinical, radiographic) that is suggestive of temporomandibular disorder (TMD). Studies showing the prevalence of TMD are included for qualitative analysis. Only the studies which provided data of the prevalence of TMD in both the groups (BD and healthy controls) were included in the quantitative analysis. TMD diagnosis can be by clinical signs and symptoms, radiographic criteria, Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) or any other imaging criteria (MRI). We have set the exclusion criteria as articles without a control group, diagnostic sensitivity studies, case reports and systematic reviews and narrative reviews. The software Review Manager version 5.4 (Cochrane Collaboration) was used to perform the pooled analysis. We measured the risk ratio (RR) between the two groups (BD and healthy controls) for the outcome TMD., Results: A total of seven studies are included for qualitative analysis of data. The age of the population (BD and control) in the included studies ranged between 2 and 57 years. The prevalence of TMD in individual studies varied from 2% to 77%, and controls in the individual studies varied from 2% to 14%. Among the included studies, only clinical signs, symptoms and history were taken into consideration in four studies. Four studies were included for meta-analysis, the pooled result of the four studies suggests there is no significant difference in the prevalence of TMD in BD and control group (p value = .11, RR 2.19; 95% CI [0.84, 5.73])., Conclusion: This systematic review and meta-analysis elicits no association between bleeding disorders and increased prevalence of TMD., (© 2023 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Objective: Obesity is a growing epidemic in the world. It increases the risk for severe health conditions, including diabetes, heart disease and stroke. Recent research has found that obesity is associated with an increased risk for temporomandibular disorders (TMDs). The purpose of this literature review with meta-analysis is to analyse the possible association between obesity and temporomandibular disorders., Materials and Methods: Pubmed, Web of Science and Lilacs were systematically searched until 01/03/2000. Articles dealing with TMD and obesity were selected, and numbers that might be useful in the meta-analysis were extracted., Results: Fifty articles were chosen after using all three search engines. Thirty-five articles were considered during the initial screening step. Four papers were chosen for title and abstract screening based on the PECO model. A manual search of bibliographies and the Cochrane database was also carried out, but no publications that matched the inclusion criteria were located. The articles and meta-analysis did not show a clear association between obesity and temporomandibular disorders., Conclusion: There is no evidence regarding the reliability of either method. Both have superimposable results., (© 2023 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Background: Interceptive orthodontic treatment aims to eliminate factors that prevent the harmonious development of the maxillary and mandibular arches during childhood, and elastodontic appliances (EAs) represent a group of devices with an increasingly important role. This systematic narrative hybrid review (HR) aims to provide an overview of the clinical indications for the use of EAs according to the available evidence and to identify potential research areas for unexplored applications., Materials and Methods: To assess the available literature on the subject, selective database searches were performed between July 2023 and September 2023. With the assistance of a health sciences librarian, a search strategy that utilized terms related to elastodontic therapy was developed. Embase, Scopus, PubMed, and Web of Science were the databases used., Results: The current literature addressing the usability of EAs is scarce and mostly limited to case reports and case series. After 2168 citations were found through the searches, 13 studies were ultimately included. In this regard, information about the clinical use and effectiveness of EAs are reported in a narrative form, defining specific domains of the application that are clinically oriented, including sagittal and transversal discrepancies, atypical swallowing, teeth malposition, two-phase orthodontics and a lack of teeth retention., Conclusions: Within the intrinsic quality limitation of the available literature, it seems that EAs may represent a promising treatment alternative for managing mild-to-moderate malocclusion in children as an adjuvant therapy to the interruption of spoiled habits.

Objectives: The present study aims to assess the serum circulating cell-free (cfDNA) concentrations in patients with periodontitis and cardiovascular disease (CVD) and to evaluate the impact of periodontitis on circulating cfDNA levels and the confounding factors that might mediated the possible relationship., Materials and Methods: Healthy controls (n=30) and patients with CVD (n=31), periodontitis (n=31), and periodontitis + CVD (n=30) were enrolled in the present study. All subjects underwent regular periodontal examination and blood sampling and cfDNA evaluation. The analysis of the plasma cfDNA concentrations was performed using a dsDNA Assay Kit., Results: In comparison with healthy controls and CVD patients, periodontitis and periodontitis+CVD exhibited significantly higher expression of circulating cfDNA (p<0.05). There was a positive correlation among plasma cfDNA and clinical attachment loss (CAL) (p=0.019), high sensitivity C-reactive protein (hs-CRP) (p=0.027), and periodontal inflamed surface area (PISA) (p=0.003). Furthermore, the multivariate regression analysis evidenced that PISA (p<0.001), hs-CRP (p=0.014), and full-mouth bleeding score (FMBS) (p=0.004) were significant predictors of circulating cfDNA concentrations., Conclusions: The results of the study highlighted that the periodontitis and periodontitis + CVD group showed higher circulating cfDNA expression in comparison with healthy controls and CVD patients. Moreover, the extent of periodontitis was correlated with the increased cfDNA levels and represented a significant predictor of the increased circulating cfDNA concentrations., Clinical Relevance: Unbalanced circulating cfDNA concentrations have been indicated to represent a possible risk of CVD and endothelial dysfunction. Periodontitis and periodontitis + CVD patients showed higher circulating cfDNA expression; moreover, the extent of periodontitis significantly predicted higher circulating cfDNA concentrations, suggesting the potential increased risk of developing CVD in periodontitis patients., (© 2023. The Author(s).)

Introduction: Oral diseases are common and affect millions of people worldwide. They can range from mild and easily treatable conditions to more severe and serious diseases. Proper oral hygiene and regular dental monitoring are essential for maintaining good oral health. When it comes to children's health and well-being, parents' education level plays a critical role. Research has shown that parents' higher educational attainment is associated with better health outcomes for their children. Our aim is to evaluate whether parents' education level and employment influence children oral health and its impact on the family., Methods: We enrolled consecutively healthy subjects aged between 0-16 and their parents at the Dental Clinic of the University of Campania "L. Vanvitelli". The Italian version of the ECOHIS (I-ECOHIS) was administered to parents of the enrolled subjects referred to the Dental Clinic of the University of Campania "L. Vanvitelli". Linear regression models, adjusted for age and sex, were used to explore the association between parents' employment or education level and the ECOHIS scores. Statistical significance was accepted when p value < 0.05., Results: We found a significative association of a higher I-ECOHIS total score (coeff. 4.04244; CI 95%: 1.530855-6.554026; p = 0,002) and higher I-ECOHIS children section score (coeff. 3.2794; CI 95%: 1.29002-5.268; P = 0,002) and the father unemployed status. We also found that a higher education level of the father was associated with a lower ECOHIS total score (coeff. -1.388; IC 95%: -2.562115--0.214 p = 0.021) and a higher education level of the mother was associated with a lower ECOHIS in children section (coeff. -0.972; IC95%: -1.909356-0.034; p = 0.042)., Conclusions: Father unemployed status and a lower educational level for both parents may negatively affect oral health status., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Acquisition of psychomotor skills is of utmost importance for competent preclinical restorative dentistry. Recent advancements in haptic feedback technology have been incorporated into preclinical dental education to augment the conventional phantom head-based training., Objective: This systematic review aims to assess the effectiveness of haptic feedback device, Simodont, in improving the skill development and learning outcomes of dental students during their preclinical training., Materials and Methods: Electronic databases Web of Science, Scopus, PubMed were searched for relevant studies since inception up until March, 2023. Only English language studies that assessed the effectiveness of haptic feedback devices in preclinical dental education were included. We excluded studies that did not use Simodont as the haptic feedback device or did not involve preclinical restorative work. Study quality was assessed using the revised Cochrane risk of bias tool and ROBINS-I. The primary goal of the study is to evaluate the efficacy of Simodont as a complementary training modality for dentistry students., Results: Results from 9 high-quality studies were analyzed and synthesized to evaluate the overall impact of haptic feedback devices on various aspects of preclinical training. The studies were conducted on 826 undergraduate dental students enrolled in various years of their training across dental colleges and universities in different parts of the world. A majority of studies showed some concerns regarding risk of bias. Haptic feedback devices added a new layer to Virtual Reality (VR) through the perception of touch and force feedback. It assisted junior dental students improve their psychomotor skills and movement skills. Instantaneous feedback on the students' performance helped enhance their self-assessment and correction, and also eliminated the subjectivity of evaluation. Data derived from virtual simulators helped stratify dental students and predict their clinical performance, providing an opportunity to tailor the learning process to meet individual diversity in students' expertise., Conclusion: Based on the limited evidence available, Simodont was effective in preclinical training of dental students, offering advantages such as unlimited reproducibility, objective evaluation of preparation by computer assessment, and cost reduction. And further studies are warranted to explore the incorporation of patient's oral environment simulation for better skill training., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: While Temporomandibular disorders (TMDs) are not typically considered a primary symptom of Parkinson disease (PD), recent studies have documented a correlation between ageing and TMDs, a cluster of conditions affecting the temporomandibular joint and surrounding musculature, thereby underscoring the potential for an increased frequency of TMDs in the ageing PD population., Objective: The purpose of this review is to systematically evaluate the existing literature on the topic and provide a comprehensive overview of the prevalence of TMDs in patients with PD., Methods: To determine eligibility, we utilised the Population (human subjects), Exposure (PD), Comparator (PD vs non-PD subjects), and Outcomes (TMD) (PECO) model. To conduct this systematic review, we searched for articles published in PubMed, Web of Science and Lilacs from the beginning until April 15, 2023., Results: Three studies were selected. All together they comprised a total of 55 828 subjects, out of which 12 629 were affected by PD or Parkinsonism, and the remaining 43 199 were non-PD subjects matched for age and sex. The study aimed to evaluate the prevalence of TMDs in subjects affected by PD. The results showed that 193/12629 (1.53%) of PD individuals presented with TMD symptoms or were diagnosed with TMD, while 260/43199 (0.6%) of non-PD subjects were diagnosed with the same. The meta-analysis showed that there was a higher TMD prevalence in PD subjects compared to non-PD subjects (RR 1.57; 95% CI: 1.30-1.89)., Conclusion: The studies reviewed suggest a possible association between TMD and PD. Further research is needed to clarify the relationship between TMD and PD and to identify possible mechanisms and treatment strategies., (© 2023 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Introduction: The COVID-19 pandemic has had a significant impact on substance abuse patterns in recent times. Many people have experienced increased stress, anxiety, and social isolation, which has led to higher rates of substance abuse and addiction. It impacts on the orofacial region, particularly temporomandibular joint (TMJ). This review was undertaken to assess the association between substance abuse and temporomandibular disorders. (TMDs)., Materials and Methods: The databases of PubMed, Google Scholar, Web of Science and Cochrane were searched for articles based of set PECO criteria. A comprehensive search using keywords of "Psychoactive substances", "Illegal substances", "substance abuse", "narcotics", "temporomandibular joint" and "temporomandibular joint disorders" yielded a total of 1405 articles. Modified Newcastle-Ottawa Scale for observational studies assessed the risk of bias of included studies., Results: Two studies were reviewed. Samples recruited were either from rehabilitation centres or prisoners and fell in the second to fourth decade. A definite association was noted between psychoactive substance and TMDs. Moderate to low risk of bias was noted in all the studies evaluated., Conclusion: Further research is needed to better understand the nature of this relationship and the underlying mechanisms involved. It is important for healthcare providers to be aware of this potential association and to screen for substance abuse in patients with TMD symptoms., (© 2023 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Background: The aim of the study was to analyze and compare external root resorption (ERR) in patients treated with tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME)., Methods: The sample included 40 subjects who received tooth-borne RME (TB group, average age: 13.1 ± 1.08 years) or bone-borne RME (BB group, average age: 14.5 ± 1.11 years) and Cone-beam computed tomography (CBCT) scans before treatment (T0) and after 3-month of retention (T1). A specific 3D Imaging technology was used to generate 3D models of posterior dentition (M1 = maxillary first molars, P2 = second premolars, P1 = first premolar) and calculate volumetric data (mean and percentage values) and shape changes, the latter obtained from deviation analysis between the radicular models at different time points. Evaluation of radicular length changes was performed for each tooth. Data were statistically analysed to perform intra-timing and inter-groups comparisons., Results: A significant reduction of radicular volume and length was found in posterior dentition in both groups (p < 0.05), and the M1 (volume) and its palatal root (length) were mostly involved in this response. No differences were found between M1, P1 and P2 (p > 0.05) when volumetric changes were calculated as percentage of the total volume. Deviation analysis revealed that the radicular areas mostly affected by shape change were the apex and bucco-medial side. The amount of ERR was significantly greater in TB group compared to BB group., Conclusions: BB-RME treatment could reduce the amount of ERR at the post-expansion stage., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: The accuracy of surgical guides is a relevant factor in both surgical safety and prosthetic implications. The impact of widespread fabrication technologies (milling and 3D printing) was investigated., Methods: Surgical guides manufactured by means of two specific milling and 3D-printing systems were digitized and compared in a 3D analysis with the digital file of the designed guides. The surface mean 3D distance (at the surface where the teeth and mucosa made contact) and the axial and linear deviations of the sleeves' housings were measured by means of a metrological software program. Univariate and multivariate statistical analyses were used to investigate the effects of the fabrication technology, type of support, and arch type on the surgical guides' accuracy., Results: The median deviations of the intaglio surface in contact with the mucosa were significantly ( p < 0.001) lower for the milled surgical guides (0.05 mm) than for the 3D-printed guides (-0.07 mm), in comparison with the reference STL file. The generalized estimated equation models showed that the axial deviations of the sleeves' housings (a median of 0.82 degrees for the milling, and 1.37 degrees for the 3D printing) were significantly affected by the fabrication technology ( p = 0.011) (the milling exhibited better results), the type of support ( p < 0.001), and the combined effect of the fabrication technology and the sleeve-to-crest angle ( p = 0.003). The linear deviation (medians of 0.12 mm for the milling and 0.21 mm for the 3D printing) of their center points was significantly affected by the type of support ( p = 0.001), with the milling performing slightly better than the 3D printing., Conclusions: The magnitude of the difference might account for a limited clinical significance.

Background: This study aimed to assess the accuracy of digital workflow for guided insertion of miniscrews in the anterior palate using restorative implant dentistry software and licensed software for orthodontic applications., Methods: Twenty subjects (8 males, 12 females, mean age = 16.7 ± 2.1 years) were prospectively selected to receive guided insertion of bicortical palatal miniscrews. Virtual planning was performed using restorative implant dentistry software (Blue Sky Plan*, version 4.7) (group 1 = 10 subjects) and licensed orthodontic software (Dolphin Imaging Software, version 11.0) (group 2 = 10 subjects). A specific 3D Imaging technology was applied to permit the registration of the planned and achieved position of the miniscrews based on the superimposition of maxillary models. The angular deviation (accuracy error) between the planned and the achieved positions of the miniscrews were recorded. Independent Student's test was used with statistical significance set at p value < 0.05., Results: The mean accuracy error recorded in group 1 was 7.15° ± 1.09 (right side) and 6.19 ± 0.80 (left side) while the mean error in group 2 was 6.74° ± 1.23 (right side) and 5.79 ± 0.95 (left side). No significant differences were recorded between the two groups (p > 0.05); instead, miniscrews placed on the right side were almost one degree higher than the left side (p < 0.05) in both groups., Conclusions: The clinical accuracy error was similar when using generic and licensed orthodontic software for guided systems., (© 2023. The Author(s).)

Background: The aim of the present study was to compare the changes observed in children after the early treatment of mild class III malocclusion using bimaxillary removable plates supported by class III elastics and elastodontic devices., Methods: Twenty children (mean age 7.6 ± 1.1 years) with signs of class III malocclusion were treated using by-maxillary plates (PG group) with class III elastics (10 subjects = mean age 7.9 ± 1.3 years) or using class III elastodontic devices (EG group) (10 subjects = mean age 7.4 ± 0.8 years). Digital models and lateral cephalograms were obtained before treatment (T0) and at the end of treatment (T1). The digital models were analyzed to assess occlusal changes and maxillary morphology using the surface-to-surface matching technique. Changes in cephalometric parameters were also analyzed. The data outcomes were statistically analyzed using the paired Student's t test for inter-timing assessments and the independent Student's t test for inter-group assessments., Results: Both groups showed correction of class III malocclusions, with a significant increase in the ANB angle and the overjet ( p < 0.05). Subjects in the PG group exhibited a greater reduction in the inter-incisal angle compared to the EG group ( p < 0.05). The children in the EG group had a significantly lower percentage of palatal morphology matching between T0 and T1 compared to the PG group ( p < 0.05), suggesting greater morphological changes in the palate., Conclusions: Elastodontic appliances (EAs) and bi-maxillary plates successfully correct class III malocclusions in children. However, elastodontic devices significantly improved the morphology of the palate, both in the transverse and anteroposterior directions.

Objectives: To describe the current state of the art regarding technological advances in full-automatic tooth segmentation approaches from 3D cone-beam computed tomography (CBCT) images., Materials and Methods: In March 2023, a search strategy without a timeline setting was carried out through a combination of MeSH terms and free text words pooled through Boolean operators ('AND', 'OR') on the following databases: PubMed, Scopus, Web of Science and IEEE Explore. Randomized and non-randomized controlled trials, cohort, case-control, cross-sectional and retrospective studies in the English language only were included., Results: The search strategy identified 541 articles, of which 23 have been selected. The most employed segmentation methods were based on deep learning approaches. One article exposed an automatic approach for tooth segmentation based on a watershed algorithm and another article used an improved level set method. Four studies presented classical machine learning and thresholding approaches. The most employed metric for evaluating segmentation performance was the Dice similarity index which ranged from 90 ± 3% to 97.9 ± 1.5%., Conclusions: Thresholding appeared not reliable for tooth segmentation from CBCT images, whereas convolutional neural networks (CNNs) have been demonstrated as the most promising approach. CNNs could help overcome tooth segmentation's main limitations from CBCT images related to root anatomy, heavy scattering, immature teeth, metal artifacts and time consumption. New studies with uniform protocols and evaluation metrics with random sampling and blinding for data analysis are encouraged to objectively compare the different deep learning architectures' reliability., Clinical Relevance: Automatic tooth segmentation's best performance has been obtained through CNNs for the different ambits of digital dentistry., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The study's objective was to assess the accuracy (trueness and precision) of orthodontic models obtained from crowded and spaced dentition finalized for the production of clear aligners. Four 3D printers featuring different technologies and market segments were used for this purpose., Methods: Two digital master models were obtained from two patients featuring respectively crowded dentition (CM group) and diastema/edentulous spaces (DEM group). The 3D printers tested were: Form 3B (SLA technology, medium-professional segment), Vector 3SP (SLA technology, industrial segment), Asiga Pro 4K65 (DLP technology, high-professional segment), and Anycubic Photon M3 (LCD technology, entry-level segment). Each 3D printed model was scanned and superimposed onto the reference master model and digital deviation analysis was performed to assess the trueness and precision calculated as root mean square (RMS). All data were statistically examined to obtain intra-group and inter-groups comparisons(p 0.05)., Results: In both CM and DEM groups, SLA 3D printers (Vector 3SP and Form 3B) showed lower trueness error compared to DLP/LCD technologies (Asiga Pro 4K65, Anycubic Photon M3) (p < 0.001). In general, the entry-level printer (Anycubic Photon M3) showed the greatest trueness error (p < 0.001). Comparing CM and DEM models generated with the same 3D printer, statistically significant differences were found only for Asiga Pro 4k65 and Anycubic Photon M3 printers (p > 0.05). Concerning data of precision, the DLP technology (Asiga Pro 4k65) showed lower error compared to the other 3D printers tested. The trueness and precision errors were within the accepted clinical error for clear aligner manufacturing (< 0.25 mm), with the entry-level 3D printer nearly reaching this value., Conclusions: The accuracy of orthodontic models generated for clear aligners can be affected by different 3D printer technologies and anatomical characteristics of dental arches., (© 2023. The Author(s).)

Periodontitis is an inflammatory disease of the gums characterized by the degeneration of periodontal ligaments, the formation of periodontal pockets, and the resorption of the alveolar bone, which results in the destruction of the teeth's supporting structure. Periodontitis is caused by the growth of diverse microflora (particularly anaerobes) in the pockets, releasing toxins and enzymes and stimulating the immune system. Various approaches, both local and systemic, have been used to treat periodontitis effectively. Successful treatment depends on reducing bacterial biofilm, bleeding on probing (BOP), and reducing or eliminating pockets. Currently, the use of local drug delivery systems (LDDSs) as an adjunctive therapy to scaling and root planing (SRP) in periodontitis is a promising strategy, resulting in greater efficacy and fewer adverse effects by controlling drug release. Selecting an appropriate bioactive agent and route of administration is the cornerstone of a successful periodontitis treatment plan. In this context, this review focuses on applications of LDDSs with varying properties in treating periodontitis with or without systemic diseases to identify current challenges and future research directions.

Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: "what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures" and "the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars"? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.

The aim of the present paper was to evaluate the morphology changes of the mandibular symphysis (MS) in a longitudinal retrospective cohort of class II untreated subjects. The study sample included 120 subjects followed during normal growth and examined at the age of 12 (T0) and 15 (T1) years. MS was traced using two landmarks and ten sliding semi-landmarks. The acquired morphological data were processed via Procrustes superimposition that allowed to study variation and covariation in MS'form according to specific variables such as age, gender, and skeletal pattern. The first two principal components (PCs) described more than 90 % of the total morphological variation. Both types of form changes of the symphysis could be associated with the different skeletal vertical growth patterns. Age and sex did not interfere with the form of chin symphysis. Moreover, there was no significant covariation between initial MS morphology and form modifications. Clinicians should not expect to be faced with spontaneous changes of the form of the symphysis during the orthodontic treatment of adolescents.

Background: The present study aimed to evaluate the changes in palate dimension and morphology after treatment of functional posterior crossbite (FPXB) with elastodontic devices (EAs)., Methods: The treatment group (TG) consisted of 25 subjects (mean age 7.3 ± 0.9 years) who received treatment with EA for one year. The control group (CG) comprised 14 untreated subjects (mean age 6.8 ± 0.7 years)., Inclusion Criteria: intra-oral scan registered before (T0) and after treatment (T1), FPXB with a mandibular shift towards the crossbite site of ≥ 2 mm, class I molar relationship., Exclusion Criteria: missing teeth, anterior crossbite, temporomandibular disorders, previous orthodontic treatment, carious lesions, mobility of deciduous posterior teeth, craniofacial deformities. Digital models were analyzed to assess the inter-canine (ICW) and inter-molar widths (IMW) and the corresponding emi-lateral measurements (eICW and eIMW) using the median palatine plane as reference. According to a specific 3D imaging technology, the morphology and symmetry of the palate was investigated by analysing the 3D deviation between the two specular models of the palate., Results: At T0, both groups showed a significantly narrower dimension of eICW and eIMW at the crossbite side compared to the non-crossbite side (p < 0.05). Also, the 3D deviation analysis demonstrates a limited matching percentage of the original/mirrored models in both TG (81.12%) and CG (79.36%), confirming the asymmetry of the palate. The area of mis-matching was located at the alveolar bone level. At T1, subjects in the TG showed a significant increment of ICW and IMW (p < 0.05), a reduction of the differences of eICW and eIMW between both sides (p < 0.05) and an increment of the percentage matching (TG = 92.32%) (p < 0.05), suggesting a significant recovery of the palatal asymmetry. No significant changes were found between T0 and T1 in the CG (p > 0.05)., Conclusions: EAs could be successfully used to correct FPXB in mixed dentition and could restore the harmonious development of the palate in children., (© 2023. The Author(s).)

The Orthodontic Tooth Movement (OTM) is allowed through a mediated cell/tissue mechanism performed by applying a force or a pair of forces on the dental elements, and the tooth movement is a fundamental requirement during any orthodontic treatment. In this regard, it has been widely shown that each orthodontic treatment has a minimum duration required concerning numerous factors (age, patient compliance, type of technique used, etc.). In this regard, the aim of the following revision of the literature is to give readers a global vision of principal microRNAs (miRNAs) that are most frequently associated with OTM and their possible roles. Previously published studies of the last 15 years have been considered in the PubMed search using "OTM" and "miRNA" keywords for the present review article. In vitro and in vivo studies and clinical trials were mainly explored. Correlation between OTM and modulation of several miRNAs acting through post-transcriptional regulation on target genes was observed in the majority of previous studied. The expression analysis of miRNAs in biological samples, such as gingival crevicular fluid (GCF), can be considered a useful tool for novel diagnostic and/or prognostic approaches and for new personalized orthodontic treatments able to achieve a better clinical response rate. Although only a few studies have been published, the data obtained until now encourage further investigation of the role of miRNA modulation during orthodontic treatment. The aim of this study is to update the insights into the role and impact of principal micro-RNAs (miRNAs) that are most frequently associated during OTM.

Background: The study aimed to compare external root resorption (ERR) three-dimensionally in subjects treated with tooth-borne (TB) versus bone-borne (BB) rapid maxillary expansion (RME). Forty subjects who received tooth-borne RME (TB group, average age 13.3 years ± 1.10 years) or bone-borne RME (BB group, average age 14.7 ± 1.15 years) were assessed using CBCT imaging before treatment (T0) and after a 6-month retention period (T1). 3D reconstructions of the radicular anatomy of maxillary first molars (M1), first and second premolars (P1 and P2) were generated to calculate volumetric (mean and percentage values) and shape changes (deviation analysis of the radicular models) obtained at each time point. 2D assessment of radicular length changes was also performed for each tooth. Data were statistically analyzed to perform intra-group (different teeth) and inter-group comparisons., Results: In both groups, all the investigated teeth showed a significant reduction in radicular volume and length (p < 0.05), with the first molars being the teeth most affected by the resorption process (volume and palatal root length). When volumetric radicular changes were calculated as a percentage of the pre-treatment volumes, no differences were found among the investigated teeth (p > 0.05). Based on the deviation analysis from radicular models superimposition, the areas most affected by shape change were the apex and bucco-medial root surface. Overall, the amount of ERR was significantly greater in the TB group (mm 3 : M1 = 17.03, P1 = 6.42, P2 = 5.26) compared to the BB group (mm 3 : M1 = 3.11, P1 = 1.04, P2 = 1.24)., Conclusions: Despite the statistical significance, the difference in the amount of ERR of the posterior maxillary dentition between TB-RME and BB-RME remains clinically questionable., (© 2022. The Author(s).)

Background: Using three-dimensional (3D) images, this study evaluated the impact of Rapid Maxillary Expansion (RME) on changes in Nasal Septal Deviation (NSD). Methods: Cone-beam computed tomography (CBCT) scan of 40 children with transverse maxillary deficiency, who received tooth-borne (TB) RME or bone-borne (BB) RME, were included in this investigation. Two CBCT scans were performed: one before to appliance installation (T0) and one after a 6-month retention period (T1). The analysis was performed by dividing the actual length of the septum by the desired length in the mid-sagittal plane to measure NSD based on the tortuosity ratio (TR). Results: Subjects in the TB group showed a statistically significant reduction (p < 0.05) of the TR value from T0 to T1, according to the paired Student t test. Subjects in the BB group showed similar findings, with a statistically significant reduction (p < 0.05) of the TR value from T0. No statistically significant differences were found between the mean changes of TR between TB group and BB group. Conclusions: RME may have some effects in reducing the degree of NSD; however, no differences were found between RME performed with TB and BB anchorage systems.

The principles of periodontal therapy are based on the control of microbial pathogens and host factors that contribute to biofilm dysbiosis, with the aim of modulating the progression of periodontitis and periodontal tissue destruction. It is currently known how differently each individual responds to periodontal treatment, depending on both the bacterial subtypes that make up the dysbiotic biofilm and interindividual variations in the host inflammatory response. This has allowed the current variety of approaches for the management of periodontitis to be updated by defining the goals of target strategies, which consist of reducing the periodontopathogenic microbial flora and/or modulating the host-mediated response. Therefore, this review aims to update the current variety of approaches for the management of periodontitis based on recent target therapies. Recently, encouraging results have been obtained from several studies exploring the effects of some targeted therapies in the medium- and long-term. Among the most promising target therapies analyzed and explored in this review include: cell-based periodontal regeneration, mediators against bone resorption, emdogain (EMD), platelet-rich plasma, and growth factors. The reviewed evidence supports the hypothesis that the therapeutic combination of epigenetic modifications of periodontal tissues, interacting with the dysbiotic biofilm, is a key step in significantly reducing the development and progression of disease in periodontal patients and improving the therapeutic response of periodontal patients. However, although studies indicate promising results, these need to be further expanded and studied to truly realize the benefits that targeted therapies could bring in the treatment of periodontitis.

Conformative rehabilitation generally involves the treatment of partial dentate or the application of veneers. In this regard, conformative rehabilitation aims to generate an aesthetic prosthetic solution minimizing the amount of tissue removal without generating occlusal input interfering with the equilibrium of neuro-muscular function. In fact, pre-prosthetic orthodontics aims to re-establishing the correct position/inclination of the neighboring or antagonist teeth, providing appropriate space for the prosthetic crown. Clear aligners therapy (CAT) represents a valuable tool in the management of prosthetic cases with a conformative approach, as it allows clinicians to plan orthodontic movements that are guided by the prosthetic outcomes. In the present manuscript, we argue the concept of prosthetic guided orthodontics (PGO) by presenting and discussing three cases treated with the Invisalign GO system, which has been developed for the clinical management of multidisciplinary orthodontic-prosthetic cases with a conformative approach. In this regard, the rationale of this paper is to address the effectiveness and predictability of the digital set-up and CAT for aesthetic conformative rehabilitations.

The aim of the study was to systematically review and compare the accuracy of smartphone scanners versus stereophotogrammetry technology for facial digitization in children. A systematic literature search strategy of articles published from 1 January 2010 to 30 August 2022 was adopted through a combination of Mesh terms and free text words pooled through boolean operators on the following databases: PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and OpenGrey. Twenty-three articles met the inclusion criteria. Stationary stereophotogrammetry devices showed a mean accuracy that ranged from 0.087 to 0.860 mm, portable stereophotogrammetry scanners from 0.150 to 0.849 mm, and smartphones from 0.460 to 1.400 mm. Regarding the risk of bias assessment, fourteen papers showed an overall low risk, three articles had unclear risk and four articles had high risk. Although smartphones showed less performance on deep and irregular surfaces, all the analyzed devices were sufficiently accurate for clinical application. Internal depth-sensing cameras or external infrared structured-light depth-sensing cameras plugged into smartphones/tablets increased the accuracy. These devices are portable and inexpensive but require greater operator experience and patient compliance for the incremented time of acquisition. Stationary stereophotogrammetry is the gold standard for greater accuracy and shorter acquisition time, avoiding motion artifacts.

Objectives: This study aimed to evaluate the accuracy of orthodontic models for the production of clear aligners generated with four 3D printers featuring different technologies and belonging to different market segments., Materials and Methods: Eighty identical dental models were generated from two master digital files (.stl), respectively with aligned (AM group) and crowded dentition (CM group), and prototyped via four different 3D printers, i.e., Asiga Pro 4K65 (DLP technology, high-professional segment), Elegoo Mars Pro (LCD technology, entry-level segment), Form 3B (SLA technology, medium-professional segment) and Vector 3SP (SLA technology, industrial segment). Each 3D printed model was scanned and superimposed with the master file, and deviation analysis was used to evaluate trueness and precision (root mean square values). All data were statistically analyzed (p < 0.05)., Results: The trueness error was lower in models prototyped with SLA printers compared to the LCD/DLP printers (p < 0.001); models prototyped with Elegoo Mars Pro-showed higher precision error compared to the other printers (P < 0.001). The models in the CM group showed higher trueness error compared to AM group when prototyped with LCD/DLP printers (p < 0.001). Accuracy error values were within the accepted clinical error for producing clear aligners (< 0.25 mm), with the entry-level 3D printer almost reaching this value., Conclusion: The accuracy of orthodontic models generated for clear aligners can be influenced by different technologies/market segments of the 3D printers used., Clinical Relevance: Caution should be taken with entry-level 3D printers for producing clear aligners., (Copyright © 2022. Published by Elsevier Ltd.)

Introduction: Facial asymmetry is common and can be clinically related to dental malocclusion, facial bone development, muscular imbalance, and soft tissues thickness, which should be assessed during diagnosis to choose proper treatment options. This study aimed to quantify the amount of symmetry/asymmetry in previously defined symmetrical and asymmetrical subjects, analyzing full-face 3-dimensional images., Methods: Seventy-six orthodontic patients' 3-dimensional face images were obtained with the 3dMD Trio-system (Atlanta, Ga) and processed with the Geomagic Control (64-bit; 3D Systems, Rock Hill, SC) software. Patients were divided into symmetrical and asymmetrical groups through a surface-based technique. Sixteen facial landmarks were positioned, an asymmetry index was calculated for each landmark, and an evaluation diagram of facial asymmetry was created through the asymmetry index mean and standard deviation of symmetrical and asymmetrical landmarks., Results: The asymmetry index mean varied from 0.05 to 1.51 in the symmetrical group and from 0.05 to 2.84 in the asymmetrical group. This study suggests that landmarks located in the lower third of the face have a greater asymmetry index than other landmarks., Conclusions: The landmark-based technique does not exhibit statistically significant differences among asymmetrical and symmetrical patients for some landmarks. This approach provides useful information about the localization and the extension of asymmetry, in which bilateral landmarks showed a higher amount of asymmetry than median landmarks., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: In the last few decades, lasers in dentistry have encompassed all branches in dentistry, with more focus in periodontology. In recent years, the use of lasers against periodontitis and peri-implantitis has undergone a decisive development that has involved various operational areas. The broadest applications were probably found in the clinical approach to soft tissues. Methods: Laser therapy is a novel technique that may provide further beneficial effects to conventional periodontal and peri-implant therapies. However, clinical evidence for the improvement of periodontal wound healing and tissue regeneration through laser treatment is still limited. Results: This review is aimed at assessing the advantages and disadvantages of the use of lasers in dental procedures and pathologies, focusing more on protocols for the management of periodontal and peri-implant diseases. Conclusions: The adjuvant action of laser therapy, in addition to conventional therapies for the management of periodontal and peri-implant disease, could induce benefits, but further investigation would be necessary to standardize better the protocols applied and to understand the actual tissue response to laser therapy.

Background: Several semi-automatic software are available for the three-dimensional reconstruction of the airway from DICOM files. The aim of this study was to evaluate the accuracy of the segmentation of the upper airway testing four free source and one commercially available semi-automatic software. A total of 20 cone-beam computed tomography (CBCT) were selected to perform semi-automatic segmentation of the upper airway. The software tested were Invesalius, ITK-Snap, Dolphin 3D, 3D Slicer and Seg3D. The same upper airway models were manually segmented (Mimics software) and set as the gold standard (GS) reference of the investigation. A specific 3D imaging technology was used to perform the superimposition between the upper airway model obtained with semi-automatic software and the GS model, and to perform the surface-to-surface matching analysis. The accuracy of semi-automatic segmentation was evaluated calculating the volumetric mean differences (mean bias and limits of agreement) and the percentage of matching of the upper airway models compared to the manual segmentation (GS). Qualitative assessments were performed using color-coded maps. All data were statistically analyzed for software comparisons., Results: Statistically significant differences were found in the volumetric dimensions of the upper airway models and in the matching percentage among the tested software (p < 0.001). Invesalius was the most accurate software for 3D rendering of the upper airway (mean bias = 1.54 cm 3 ; matching = 90.05%) followed by ITK-Snap (mean bias =  - 2.52 cm 3 ; matching = 84.44%), Seg 3D (mean bias = 3.21 cm 3 , matching = 87.36%), 3D Slicer (mean bias =  - 4.77 cm 3 ; matching = 82.08%) and Dolphin 3D (difference mean =  - 6.06 cm 3 ; matching = 78.26%). According to the color-coded map, the dis-matched area was mainly located at the most anterior nasal region of the airway. Volumetric data showed excellent inter-software reliability (GS vs semi-automatic software), with coefficient values ranging from 0.904 to 0.993, confirming proportional equivalence with manual segmentation., Conclusion: Despite the excellent inter-software reliability, different semi-automatic segmentation algorithms could generate different patterns of inaccuracy error (underestimation/overestimation) of the upper airway models. Thus, is unreasonable to expect volumetric agreement among different software packages for the 3D rendering of the upper airway anatomy., (© 2022. The Author(s).)

The objective of the study was to assess the changes in nasal soft tissues after RME was performed with tooth-borne (TB) and bone-borne (BB) appliances. Methods. This study included 40 subjects with a diagnosis of posterior cross-bite who received tooth-borne RME (TB, average age: 11.75 ± 1.13 years) or bone-borne RME (BB, average age: 12.68 ± 1.31 years). Cone-beam computed tomography (CBCT) was taken before treatment (T0), after a 6-month retention period (T1), and one year after retention (T2). Specific linear measurements of the skeletal components and of the soft-tissue region of the nose were performed. All data were statistically analyzed. Results. Concerning skeletal measurements, the BB group showed a greater skeletal expansion of the anterior and posterior region of the nose compared to the TB group (p < 0.05) immediately after RME. Both TB and BB RME induce a small increment (>1 mm) of the alar base and alar width, without significant differences between the two expansion methods (p > 0.05). A high correlation was found between skeletal and soft-tissue expansion in the TB group; instead, a weaker correlation was found in the BB group. Conclusion. A similar slight increment of the alar width and alar base width was found in both TB and BB groups. However, the clinical relevance of these differences, in terms of facial appearance, remains questionable.

Teleorthodontics represents the orthodontic care system involving remote management of orthodontic treatment. Despite skepticism, there are several advantages of including teleorthodontics in the clinical orthodontic practice. In the present review, we discuss the lights and shadows of this new communication healthcare system and its applications in the field of orthodontics that is destined to change the future of our clinical practice. For this purpose, we have provided a point-to-point analysis based on data from the most valuable scientific evidence on this topic. The information and data discussed in the present paper were obtained from the most relevant studies evaluating the performance of teleorthodontics and remote monitoring systems in clinical practice., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Antonino Lo Giudice et al.)

Objectives: The objective of this study was to evaluate the accuracy of dental models prototyped via entry-level liquid crystal display (LCD) 3D printers., Materials and Methods: Identical prototyped models were generated from a master digital file testing two entry-level LCD-based 3D printers and using one professional-grade 3D printer as gold standard (GS), with 50-µm and 100-µm layer thickness. Each 3D-printed model was scanned, and a specific 3D technology was used to perform surface-based superimposition and deviation analysis to evaluate trueness and precision. The distances between surface points of two superimposed models were converted to root mean square (RMS) and statistically analyzed., Results: The RMS values detected were significantly higher in dental models prototyped with entry-level compared to the SLA printer (p < 0.001), in terms of trueness (50 µm: GS 0.075 mm, LCD1 0.192 mm, LCD2 0.179 mm; 100 µm: GS 0.066 mm, LCD1 0.209 mm, LCD2 0.199 mm) and precision (50 µm: GS 0.028 mm, LCD1 0.075 mm, LCD2 0.085 mm; 100 µm: GS 0.039 mm, LCD1 0.096 mm, LCD2 0.101 mm). No significant differences were found between the values of RMS of both entry-level 3D printers (p > 0.05). Layer thickness did not affect either the trueness or precision of the 3D-printed models (p > 0.05)., Conclusion: Entry-level LCD-based 3D printers are not as accurate as professional-grade 3D printer, but still close to orthodontics clinical threshold values., Clinical Relevance: Clinicians should evaluate the intended application of 3D-printed orthodontic models before using entry-level 3D printers., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To evaluate the accuracy of automatic deep learning-based method for fully automatic segmentation of the mandible from CBCTs., Setting and Sample Population: CBCT-derived mandible fully automatic segmentation., Methods: Forty CBCT scans from healthy patients (20 females and 20 males, mean age 23.37 ± 3.34) were collected, and a manual mandible segmentation was carried out by using Mimics software. Twenty CBCT scans were randomly selected and used for training the artificial intelligence model file. The remaining 20 CBCT segmentation masks were used to test the accuracy of the CNN automatic method by comparing the segmentation volumes of the 3D models obtained with automatic and manual segmentations. The accuracy of the CNN-based method was also assessed by using the DICE Score coefficient (DSC) and by the surface-to-surface matching technique. The intraclass correlation coefficient (ICC) and Dahlberg's formula were used respectively to test the intra-observer reliability and method error. Independent Student's t test was used for between-groups volumetric comparison., Results: Measurements were highly correlated with an ICC value of 0.937, while the method error was 0.24 mm 3 . A difference of 0.71 (±0.49) cm 3 was found between the methodologies, but it was not statistically significant (P > .05). The matching percentage detected was 90.35% (±1.88) (tolerance 0.5 mm) and 96.32% ± 1.97% (tolerance 1.0 mm). The differences, measured as DSC in percentage, between the assessments done with both methods were, respectively, 2.8% and 3.1%., Conclusion: The tested deep learning CNN-based technology is accurate and performs as well as an experienced image reader but at much higher speed, which is of significant clinical relevance., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To assess changes in spheno-occipital synchondrosis after rapid maxillary expansion (RME) performed with conventional tooth-borne (TB) and bone-borne (BB) appliances., Materials and Methods: This study included 40 subjects with transverse maxillary deficiency who received TB RME or BB RME. Cone-beam computed tomography images (CBCT) were taken before treatment (T0), and after a 6-month retention period (T1). Three-dimensional surface models of the spheno-occipital synchondrosis and basilar part of the occipital bone were generated. The CBCTs taken at T0 and T1 were registered at the anterior cranial fossa via voxel-based superimposition. Quantitative evaluation of Basion displacement was performed with linear measurements and Euclidean distances. The volume of the synchndrosis was also calculated for each time point as well as the Nasion-Sella-Basion angle (N-S-Ba°). All data were statistically analyzed to perform inter-timing and intergroup comparisons., Results: In both groups, there was a small increment of the volume of the synchondrosis and of N-S-Ba° (P < .05). Basion showed a posterosuperior pattern of displacement. However, no significant differences (P > .05) were found between the two groups., Conclusions: Although TB and BB RME seemed to have some effects on the spheno-occipital synchondrosis, differences were very small and clinically negligible., (© 2021 by the EH Angle Education and Research Foundation, Inc.)

The purpose of our work is to evaluate the correlation between skeletal Class II malocclusion and temporomandibular disorders, by assessing potential different frequency scores compared with Class I and Class III skeletal malocclusion, and to evaluate associated etiological and risk factors. Fifty-five subjects were examined, 35 females and 20 males, with a mean age of 18 ± 1.3 years, divided into two groups: those with TMD and those without TMD, and prevalence was evaluated in the two groups of Class II subjects. Symptoms and more frequent signs were also examined in the TMD group. Regarding Group A (subjects with the presence of TMD), we found that 48% have a Class II, 16% have Class I, and 28% have Class III. In the totality of the group A sample, only 8% were male subjects. In Group B (subjects without TMD), we found that 40% were females, with 26.7% in Class I, 10% in Class II, and 3.3% in Class III; the male subjects in this group (60%) were distributed with 33.3% in Class I, 16.7% in Class II, and 10% in Class III. Class II malocclusion is not a causal factor of TMD but may be considered a predisposing factor.

Introduction: This study aimed to test the accuracy of a new automatic deep learning-based approach on the basis of convolutional neural networks (CNN) for fully automatic segmentation of the sinonasal cavity and the pharyngeal airway from cone-beam computed tomography (CBCT) scans., Methods: Forty CBCT scans from healthy patients (20 women and 20 men; mean age, 23.37 ± 3.34 years) were collected, and manual segmentation of the sinonasal cavity and pharyngeal subregions were carried out by using Mimics software (version 20.0; Materialise, Leuven, Belgium). Twenty CBCT scans from the total sample were randomly selected and used for training the artificial intelligence model file. The remaining 20 CBCT segmentation masks were used to test the accuracy of the CNN fully automatic method by comparing the segmentation volumes of the 3-dimensional models obtained with automatic and manual segmentations. The accuracy of the CNN-based method was also assessed by using the Dice score coefficient and by the surface-to-surface matching technique. The intraclass correlation coefficient and Dahlberg's formula were used to test the intraobserver reliability and method error, respectively. Independent Student t test was used for between-groups volumetric comparison., Results: Measurements were highly correlated with an intraclass correlation coefficient value of 0.921, whereas the method error was 0.31 mm 3 . A mean difference of 1.93 ± 0.73 cm 3 was found between the methodologies, but it was not statistically significant (P >0.05). The mean matching percentage detected was 85.35 ± 2.59 (tolerance 0.5 mm) and 93.44 ± 2.54 (tolerance 1.0 mm). The differences, measured as the Dice score coefficient in percentage, between the assessments done with both methods were 3.3% and 5.8%, respectively., Conclusions: The new deep learning-based method for automated segmentation of the sinonasal cavity and the pharyngeal airway in CBCT scans is accurate and performs equally well as an experienced image reader., (Copyright © 2021. Published by Elsevier Inc.)

The purpose of this study was to assess the prevalence of Early Childhood Caries (ECC) and oral habits among preschool children from a southern Italian cohort. The survey population consisted of 300 subjects randomly selected among children attending two kindergartens in Catania, Italy. The prevalence of ECC and oral habits were clinically evaluated. During the clinical evaluation, the oral hygiene of children was also assessed. Parents were also interviewed using a brief and simple online questionnaire aimed at investigating eating and oral hygiene habits. The selected sample age ranged between 3 and 5 years. The prevalence of ECC was 9.34%, and the most affected teeth were primary molars. Moreover, the prevalence of oral habits was 44.66%. Only two-thirds of the sample brush their teeth at least once per day. The prevalence of ECC among Sicilian children (9.33%) seems suitable with the rest of the country. The results of the present study evidenced that oral habits showed a high prevalence among preschool children. The level of oral hygiene among preschool children is still not sufficient., Competing Interests: The authors declare that they have no competing interests with regard to authorship and/or publication of this paper., (Copyright © 2021 Grazia Fichera et al.)

Objectives: To compare volume and shape changes of pulp chamber of maxillary posterior teeth between tooth-borne and bone-borne maxillary expansions in adolescents., Materials and Methods: This study included 36 adolescents with bilateral maxillary crossbite who received tooth-borne rapid maxillary expansion (TB group, average age 14.4 years) or bone-borne rapid maxillary expansion (BB group, average age 14.7 years). Cone beam computed tomography (CBCT) was taken before treatment (T1) and after a 6-month retention period (T2). Volumetric and shape changes of pulp chamber of maxillary first molars and premolars were detected by referring to a specific 3D digital technology involving deviation analysis of T1/T2 CBCT-derived models of pulp chamber. Student's t tests were used to (1) compare T1 and T2 volumes of pulp chambers in TB and BB groups and (2) assess differences between the two groups in the post-treatment volumetric changes and in the percentage of matching of 3D pulp models., Results: All investigated teeth showed a reduction of pulp volume, being this difference significant in both TB (p < 0.0001) and BB (p < 0.0001) groups. The volumetric reduction was greater in the TB group; also, subjects in the TB group showed a lower percentage of matching between T1 and T2 pulp models (p < 0.0001). The area most affected by shape change was that of pulp horns., Conclusions: TB expander could induce a higher volumetric reduction of pulp chamber of posterior teeth compared with BB expander, in the short term., Clinical Relevance: The present findings add new information concerning the effects of RME protocols on pulp tissue.

Objectives: The purpose of this study was to evaluate mandibular asymmetry in youngsters with posterior unilateral crossbite (PUXB), through cone-beam computed tomography and reverse engineering technique, before and after rapid maxillary expansion (RME) treatment., Materials and Methods: Forty cone-beam computed tomography (CBCT) images were obtained from all patients at two time points, namely T0 acquired before the placement of a Hyrax expander and T1 after appliance removal. The CBCT scans were segmented and volume rendered into a surface there-dimensional (3D) mesh model. Thereafter, mandibular models were digitally registered by using a "best-fit" algorithm. Surface and volumetric changes, between T0 and T1, were compared by using Student's t tests., Results: A slight increase of 0.45 cm 3 of the total mandibular volume was found at T1 when compared with T0 (p < 0.001). The mandibular hemi-volume on the crossbite side (CB) was slightly smaller than the non-crossbite side both at T0 and T1. However, the mean differences of hemi-volume from the CB (crossbite) and non-CB side between T0 and T1 show a decrease of 0.26 cm 3 (p < 0.001). Findings for the surface-to-surface deviation analysis demonstrated a fine percentage of matching at T0 which slightly improved at T1 (p < 0.001)., Conclusions: Youngsters affected by PUXB showed a very slight and not statistically significant volumetric and morphological asymmetry between CB side and non-CB side at T0. However, the change in mean differences of 0.26 cm cannot be considered clinically relevant., Clinical Relevance: Mandibles in young PUXB patients exhibit only a very mild mandibular asymmetry. Although the statistically significant mean change found right after RME removal cannot be considered clinically relevant, a more consistent sample and a longer follow-up could be of interest in explaining the short-term findings.

Matrix metalloproteinase-9 (MMP-9) has been shown to play a key role in endothelial function and perhaps pivotal in the correlation between periodontal disease and cardiovascular disease (CVD). For the study, the impact of MMP-9 of periodontitis and CVD on serum and saliva concentrations was analyzed. For the study patients with periodontitis (n = 31), CVD (n = 31), periodontitis + CVD (n = 31), and healthy patients (n = 31) were enrolled. Clinical and demographic characteristics as well as serum and salivary MMP-9 were evaluated. MMP-9 concentrations in serum and saliva were statistically elevated in patients with CVD ( p < 0.01) and in patients with periodontitis plus CVD ( p < 0.001) compared to patients with periodontitis and healthy subjects. Multivariate regression analysis showed that c-reactive protein (hs-CRP) was the only significant predictor for MMP-9 serum ( p < 0.001), whereas hs-CRP ( p < 0.001) and total cholesterol ( p = 0.029) were the statistically significant salivary MMP-9 predictors. This study evidenced that patients with CVD and periodontitis + CVD presented elevated MMP-9 concentrations in serum and saliva compared to patients with periodontitis and healthy subjects. Furthermore, hs-CRP was a negative predictor of serum and salivary MMP-9.

Aim: Limited data are available on the fitting properties of prototyped occlusal appliances. The aim of the present study was to assess the fitting of prototyped splints digitally designed with different offset values and generated with two different biocompatible resins., Materials and Methods: Ten dental digital models were included, and occlusal splints were designed with different offset values (0.0, 0.05, 0.10, 0.15, 0.20, and 0.25 mm). Each splint was 3D printed using two different biocompatible resins, and the gap between the splint and the teeth was recorded by placing impression material. A specific 3D technology was used to assess the gap volume between the splint and the teeth and to calculate the Euclidean distance between the surface points of two digital models, with and without the gap volume., Results: The splints with a 0.20-mm offset value showed smaller gap volume and deviation analysis values compared with those with offset values of 0.15 and 0.25 mm (P < 0.05). These results were consistent with both types of biocompatible resins used. For each offset value tested, the gap volume and deviation value analysis did not significantly differ between the splints printed with the two different resins., Conclusion: According to the present findings, the 0.20-mm offset value would be the best choice when digitally designing occlusal appliances.

Oral lichen planus (OLP) is a chronic, inflammatory, immune-mediated disease, which can alter the quality of life of patients. The aim of this randomized clinical trial was to compare the therapeutic efficacy of clobetasol oral gel 0.05% versus an anti-inflammatory in oral solution (mouthwash) in the management of patients suffering from symptomatic OLP. The secondary objective was to analyze which one of the two treatments induced a greater risk of developing side effects. Forty patients were assigned (20 patients for group), through a randomized design, to receive clobetasol gel 0.05% or an anti-inflammatory mouthwash, which contains calcium hydroxide, hyaluronic acid, umbelliferone and oligomeric pro-anthocyanidins) for three months. At baseline (T0) and after 3 months (T1), patients underwent dental and dermatological examinations to assess their symptoms (Numerical Pain Scale (NRS) score) and signs (Thongprasom score). Data were calculated using T -test for the dependent variable, Wilcoxon test and Mann-Whitney u test. Both clobetasol and anti-inflammatory resulted in a statistically significant reduction of signs, ( p < 0.001 and p = 0.02, respectively) and symptoms ( p < 0.001 for clobetasol and p = 0.02 for anti-inflammatory). In conclusion, the results evidenced that, compared to clobetasol, the anti-inflammatory was less effective in determining the reduction of signs and symptom in OLP patients.