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BACKGROUND: N-Cadherin (CDH2) is a calcium-dependent adhesion protein, whose de novo expression, re-expression, up-regulation and down-regulation in human tumors has been demonstrated. The aim of the present work was to define the prognostic role of N-Cadherin in a large series of oral squamous cell carcinomas (OSCCs). MATERIALS AND METHODS: A total of 94 selected OSCCs were quantitatively and qualitatively analyzed by immunohistochemistry for N-Cadherin. The association between protein expression and clinico-pathological parameters was assessed by statistical analysis. RESULTS: In neoplastic tissue, N-Cadherin levels were more evident than in normal peritumoral epithelium (p

Backgroundː Deep overbite or deep bite is common in the pediatric population. Although bite-raising splints are often a part of treatment programs for deep bite malocclusion, there are no reports in the literature regarding their effect on the human neuromuscular system, especially during developmental age. The current study aimed to use electromyographic and kinesiographic analysis to investigate if and how bite-raising splints applied during early stages of orthodontic treatment affect muscle tone, muscle activity, mandibular kinetics, and Freeway Space (FWS) in pediatric patients with dental and skeletal deep bite. Methodsː Thirty patients (17 males & 13 females, mixed dentition, ages 6 to 13; mean age 9.2 ± 2.05) with complete traumatic, skeletal, and dental deep overbite were fitted for bite-raising splints for 4 weeks and underwent electromyographic and kinesiographic examination before and 4 weeks after the application of bite-raising splints. Resultsː Evidence of general reduction in activity levels in the bilateral masseter and temporalis muscles was found. Although maximum mouth opening was narrower and mandibular deviation during mouth opening movements was slightly increased, neither variation was statistically significant. Nor was there a significant difference related to mean muscular tone values. Surprisingly, a statistical difference in the amount of FWS was found (p < 0.05); kinesiographic limitations linked to the intrusion of molars can be considered as explanation. Conclusionsː Study findings indicated that bite-raising splints were not associated to statistically significant effects on muscle tone, muscle activity, or on mandibular kinetics.

AIM: The aim of this study was to evaluate the dento-skeletal effects of mixed palatal expansion (MPE) on growing patients with a uni- or bilateral posterior crossbite and mild-to-moderate crowding as compared to untreated growing individuals using postero- anterior (PA) cephalometric analysis. MATERIALS AND METHODS: A group of 24 patients (18 girls and 6 boys) treated with a Hyrax- type device was compared to an untreated matched control group at T0 (8.6 yrs ± 2.01) and T1 (10 yrs ± 2.00) using PA cephalograms. The cephalometric analysis included eight bilateral skeletal and dental landmarks. The groups were compared using independent sample t-test to estimate dento-skeletal effects on PA cephalograms. RESULTS: The treated group showed significant changes for the maxillary width (P

PURPOSE: To evaluate the desensitizing efficacy of 2% sodium fluoride solution (NaF), diode laser (DL), a DL and NaF association and a solution of hydroxyl-ethyl-methacrylate and glutaraldehyde (HEMA-G: Gluma desensitizer) in cervical dentin hypersensitivity (CDH). METHODS: 262 teeth of 24 subjects (16 females and eight males; age 21 to 64 years, mean 38 years), each having at least two CHD teeth for each quadrant, were included in this prospective, split mouth, clinical study. Teeth of each oral quadrant were randomized in four groups (SG) to study the effectiveness of NaF (SG-1), of DL (SG-2) NaF-DL combination (SG-3) and HEMA-G (SG-4). The subjects were asked to rate the sensitivity experienced during air stimulation by placing a mark on a visual analogue scale (VAS) before treatment (baseline), immediately after treatment, and after 1, and 6 months. RESULTS: The outcomes showed a significant reduction of discomfort compared to baseline values for teeth of SG-3 immediately post treatment (82.6%) (P < 0.001), after 1 month (69.5%) (P < 0.001) and after 6 months (60.8%) (P < 0.001), respectively, compared with the reduction scores of 51.6% (P < 0.001), 29.7% (P < 0.05) and 4.7% (P > 0.05), recorded for SG-1; 72.2%, (P < 0.001), 62.5% (P < 0.001), and 47.2% (P < 0.05), recorded for SG-2; 77.4% (P < 0.001), 56.1% (P < 0.001), and 27.3% (P < 0.05), recorded for SG-4.

A novel explanation of pemphigus vulgaris (PV) pathogenesis suggests that serum autoantibodies may affect desmoglein 3 (Dsg3)-mediated adhesion by triggering depletion of Dsg3 from desmosomes. Furthermore, abrogation of Dsg3 from the cell seems to depend on anti-Dsg3 pemphigus IgG. In this study we sought to gain more insights into the role of PV IgG recognizing non-conformational epitopes of Dsg3 (anti-Dsg3-L IgG) by semi-quantitative living cell immunofluorescence (LCIF) microscopy, in-cell ELISA and morphometric analysis of acantholysis. Our data demonstrate that PV serum and PV IgG can induce acantholysis and reduce the total amount of Dsg3 in cultured keratinocytes, whereas anti- Dsg3-L IgG fail to do so when administered at concentrations comparable to those present in pathogenic PV sera. However, the Dsg3-depleting activity of such polyclonal anti-Dsg3 IgG was acquired when used at 1μg/ml. Interestingly, both PV sera and IgG, including anti-Dsg3-L IgG, caused early depletion of surface Dsg3 while slightly affecting the total cell content of Dsg3 until late acantholysis. This raises a possibility that depletion of Dsg3 from cell membrane and reduction of the total cellular levels of Dsg3 represent distinct phenomena in PV acantholysis. Taken together, our data demonstrate that anti-Dsg3 PV IgG against linear epitopes of Dsg3 can induce acantholytic changes of keratinocytes in a doseand time-dependent manner. Specifically, both morphological and biochemical changes suggestive of acantholysis are seen only at high concentrations. We conclude that anti-Dsg3L IgG play a minor role in PV under physiologic conditions.

AIM: The present cross-sectional survey was performed to determine cephalometric standards in a large sample (n. 1071) of children from Southern Italy (Naples). MATERIALS AND METHODS: 1071 lateral cephalograms of healthy children, between 8 to 12 years, with various types of occlusion, all with no history of orthodontic treatment before cephalometric analysis were examined. Seven angular and three linear length measurements (SNA, SNB, ANB, SN^GoMe, PN^Pal I^SN, i^GoMe), and three ratios were included. Descriptive statistics, including the mean, standard deviation, and maximum and minimum, values was computed for each cephalometric variable. RESULTS: Changes in angular and linear parameters during the observation period occurred mostly between the ages of 10 and 12 years. The three ratios varied from age and were not characterised by a progressive rise in mean values. Se-N/Go-Pg was greater in 11-year-old boys (p

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

Aim To analyse the prevalence and the distribution of displaced, buccal/palatal maxillary canines, and the association with sagittal and vertical skeletal relationships in a southern Italian population. Materials and methods Consecutive records of patients were examined. Inclusion criteria were: age 7-12 years, 1-2 cervical vertebral maturation (CVM) stage, initial dental casts, intraoral photographs, panoramic, lateral and periapical radiographs. Subjects with at least one canine in Lindauer II, III or IV sector and/or α angle > 31° were included in displaced maxillary canine (DMC) group, whereas those with both canines in sector I and α angle ≤31° were used as control group (CTR). According to canine bulges and/or x-ray examinations, DMC were then divided in palatal and buccal displaced canines (PDC/ BDC). Sagittal and vertical skeletal relationships were evaluated using ANB and SN/GoMe angles. Chi-square tests were performed to compare the prevalence rates of skeletal features.Results The sample consisted of 123 children, 40 DMC and 83 CTR. The DMC group included 11 PDC and 29 BDC subjects. The M:F ratio was 1:3 in PDC and BDC, 1:1 in CTR group. The unilateral-to-bilateral ratio was 1:1 and 3:1 in PDC and BDC subjects. The most common sector combination regarding unilateral and bilateral displacements was "II" and "II,II". PDC occurred more in Class I and in hyperdivergents, whereas BDC in Class I or II and in normodivergents. Conclusions DMC occurred more often in females than in males. BDC was more common than PDC and unilateral displacements occurred more frequently than bilateral ones. No significant correlation with skeletal features was observed. Aim To analyse the prevalence and the distribution of displaced, buccal/palatal maxillary canines, and the association with sagittal and vertical skeletal relationships in a southern Italian population. Materials and methods Consecutive records of patients were examined. Inclusion criteria were: age 7-12 years, 1-2 cervical vertebral maturation (CVM) stage, initial dental casts, intraoral photographs, panoramic, lateral and periapical radiographs. Subjects with at least one canine in Lindauer II, III or IV sector and/or α angle > 31° were included in displaced maxillary canine (DMC) group, whereas those with both canines in sector I and α angle ≤31° were used as control group (CTR). According to canine bulges and/or x-ray examinations, DMC were then divided in palatal and buccal displaced canines (PDC/ BDC). Sagittal and vertical skeletal relationships were evaluated using ANB and SN/GoMe angles. Chi-square tests were performed to compare the prevalence rates of skeletal features.Results The sample consisted of 123 children, 40 DMC and 83 CTR. The DMC group included 11 PDC and 29 BDC subjects. The M:F ratio was 1:3 in PDC and BDC, 1:1 in CTR group. The unilateral-to-bilateral ratio was 1:1 and 3:1 in PDC and BDC subjects. The most common sector combination regarding unilateral and bilateral displacements was "II" and "II,II". PDC occurred more in Class I and in hyperdivergents, whereas BDC in Class I or II and in normodivergents. Conclusions DMC occurred more often in females than in males. BDC was more common than PDC and unilateral displacements occurred more frequently than bilateral ones. No significant correlation with skeletal features was observed.

Purpose: To evaluate the margin quality of direct resin composite restorations comparing the enameldentin adhesive standard procedure with additional use of adhesive layer at the external outline. Methods: A total of 648 teeth with Class I occlusal lesions in molars and premolars were randomly selected and distributed into two groups of 324 each in order to compare the margin quality with two restoration strategies. Lesions were sealed with the standard adhesion procedure for direct resin composite restorations (Group 1) and with an additional procedure of enamel adhesive on the outer boundary of the finished restoration (Group 2). Evaluation of marginal quality at 6, 12, 24, 36 and 48 months was performed and described as good marginal adaption or as poor quality defined as Inadequacy A (IA): overhanging resin or change of color; Inadequacy B (IB): the presence of a gap at the enamel-composite interface that retained the probe tip; or Inadequacy C (IC) presence of gap at the enamel-composite interface with explorer tip penetration of more than 1 mm. Results: Data showed a higher number of Inadequacy A for restorations with the additional technique for marginal seal (Group 2): 16 of 24 total (57%) at 6 months; 28 of 37 total (76%) at 12 months; 36 of 44 total (82%) at 18 months; 22 of 33 total (67%) at 24 months; 14 of 21 total (70%) at 36 months and 16 of 25 total (64%) at 48 months. The Inadequacy B and C of marginal seal were more prevalent for restorations without the additional marginal seal (Group 1): 18 of 28 total (64%) at 12 months with inadequacy B; 19 of 25 total (76%) with inadequacy B and 16 total (100%) with inadequacy C at 18 months; 9 of 17 total (53%) with Inadequacy B and 13 total (100%) with Inadequacy C at 24 months; 12 of 17 total (70%) with Inadequacy B and 9 of 13 total (73%) with Inadequacy C at 36 months; 14 of 24 total (58%) with Inadequacy B and 7 of 11 total (63%) with Inadequacy C at 48 months.

Objective: The purpose of this research is to assess the analgesic efficiency of Photobiomodulation (PBM) in pain reduction in young patients during rapid maxillary expansion therapy. Materials and Methods: Thirty patients were included and allocated to an experimental group [Rapid Palatal Expansion (RPE) and PBM] and a control group (RPE only) at random. Inclusion criteria were skeletal age from CVS1 to CVS3, examined on the cephalometric lateral teleradiography, with cervical vertebra staging and completed eruption of upper first molar. Exclusion criteria were previous orthodontic treatment, bone disease, disability, or skeletal age from CVS4. Patients referred the pain they felt using a Numerical scale rate (NRS), ranging from 0 to 10, with specific intervals of time: 6 h, 12 h, 24 h, and from days 2 to 7. The Wilcoxon-Mann-Whitney test was used to evaluate differences in NRS reported values between the two groups. Results: The final sample included 30 patients, 14 males and 16 females, with a mean age of 7.8 ± 1.2 years. The pain that was felt at each time interval and the maximum score of pain were significantly lower in the experimental group (p < 0.05) and decreased faster in the experimental group, with a score test near to 0 after 2/3 days. Conclusions: PBM is efficient in reducing the intensity and the time of pain felt by young patients that undergo rapid maxillary expansion.

Objective The aim of this study is to assess if low-level laser therapy (LLLT) alleviates pain after the placement of orthodontic alignment archwire and if there could be a specific indication for the usage of LLLT according to the amount of dental crowding. Materials and Methods Ninety subjects were included and randomly assigned to the tested group (orthodontic treatment and LLLT), placebo group (orthodontic treatment and simulated LLLT), and control group (orthodontic treatment only). Inclusion criteria are age between 13 and 30 years, completely erupted mandibular teeth, and lower crowding of ≥3 mm. Exclusion criteria are spaces or diastema in the lower arch, ectopic teeth, treatment plan including extractions or the use of auxiliary devices, and previous orthodontic treatment. Patients reported the pain experienced by using a numeric rating scale, ranging from 0 to 10, at specific time intervals, that is, 2 hours, 6 hours, 24 hours, and from day 2 to 7. Kruskal–Wallis H Test was used to assess differences in the maximum pain and pain experienced at each time interval among the three groups and in the maximum pain reported among subjects with different degree of crowding. Results The final sample consisted of 84 patients, 41 male and 43 female patients, with a mean age of 16.5 ± 2.8 years. The pain experienced at each time interval and the maximum pain score were significantly lower in the tested group, whereas no differences were found between control and placebo groups. Moreover, no differences were found in the pain experienced among subjects with mild, moderate, and severe incisor crowding in all groups. Conclusions LLLT is effective in alleviating the intensity and duration of pain experienced by patients after the engagement of alignment archwire. However, there is no specific indication for the usage of LLLT according to the amount of crowding.

Background: The use of locally delivered antibacterials containing chlorhexidine (CHX) was proposed to improve the effectiveness of non-surgical periodontal treatment. The present multicenter randomized study investigated the effects of a xanthan-based chlorhexidine (Xan-CHX) gel used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. Methods: Ninety-eight systemically healthy subjects with moderate to advanced periodontitis were recruited in four centers (59 females and 39 males; aged 24 to 58 years). For each subject, two experimental sites located in two symmetric quadrants were chosen with probing depths (PD) ‡5 mm and positive for bleeding on probing (BOP). These two sites were randomized at the split-mouth level with one receiving a single SRP treatment and the other receiving a single SRP + Xan-CHX gel treatment. Supragingival plaque, modified gingival index, PD, clinical attachment level (CAL), and BOP were evaluated at baseline (prior to any treatment) and after 3 and 6 months. At the same times, subgingival microbiologic samples and gingival crevicular fluid (GCF) were collected for the analysis of total bacterial counts (TBCs), including the identification of eight putative periodontopathogens, and alkaline phosphatase (ALP) activity, respectively. Results: The Xan-CHX treatment group showed greater improvements compared to the SRP group for PD and CAL at 3a nd 6m onths (P

Background To detect the optimal timing of intervention based on different cervical vertebral maturation stage (CS1-2 vs. CS3-4) for the treatment of Class III malocclusion with early Class III protocol. Methods A total sample of 43 patients (23 females, 20 males) ranging between 7 and 13 years of age with dentoskeletal Class III malocclusion treated with the modified SEC III (Splints, Elastic and Chincup) protocol divided into two groups based on the cervical vertebral maturation stages (CS1-2 and CS3-4) was included in this retrospective observational longitudinal study. Patient compliance was assessed using a 2-point Likert scale. Statistical comparisons between the two groups were performed with independent sample t tests. Results No statistically significant differences for any of the cephalometric variables describing the baseline dentoskeletal features were found between the two groups except for the mandibular unit length that was significantly greater in the pubertal group (P = 0.005). The modified SEC III protocol produced favorable sagittal outcomes in both groups, whereas no statistically significant T1-T2 changes were found between the CS1-2 and CS3-4 groups for any of the angular and linear measurements. No significant differences were found in the prevalence rates of the degree of collaboration between the two groups (P = 1.000). Conclusions No significant differences between prepubertal and pubertal patients were found in the sagittal and vertical dentoskeletal changes with the modified SEC III protocol. Thus, this early Class III treatment produced similar favorable effects in growing subjects regardless of the cervical vertebral maturation stages from CS1 to CS4.

STUDY OBJECTIVES: To analyze differences in mandibular cortical width (MCW) among children diagnosed with obstructive sleep apnea (OSA) or at high- or low-risk for OSA. METHODS: A total of 161 children were assessed: 60 children with polysomnographically diagnosed OSA, 56 children presenting symptoms suggestive of high-risk for OSA, and 45 children at low risk for OSA. Children at high- and low-risk for OSA were evaluated through the Pediatric Sleep Questionnaire. MCW was calculated using ImageJ software from panoramic radiograph images available from all participants. Differences between MCW measurements in the 3 groups were evaluated using analysis of covariance and Bonferroni post-hoc tests, with age as a covariate. The association between MCW and specific cephalometric variables was assessed through regression analysis. RESULTS: The participants’ mean age was 9.6 ± 3.1 years (59% male and 41% female). The mean body mass index z-score was 0.62 ± 1.3. The polysomnographically diagnosed OSA group presented smaller MCW than the group at low-risk for OSA (mean difference = –0.385 mm, P = .001), but no difference with the group at high-risk for OSA (polysomnographically diagnosed OSA vs high-risk OSA: P = .085). In addition, the MCW in the group at high-risk for the OSA was significantly smaller than the group at low-risk for the OSA (mean difference = –0.301 mm, P = .014). The cephalometric variables (Sella-Nasion-A point angle (SNA) and Frankfort - Mandibular Plane angle (FMA)) explained only 8% of the variance in MCW. CONCLUSIONS: Reductions in MCW appear to be present among children with OSA or those at high-risk for OSA, suggesting potential interactions between mandibular bone development and/or homeostasis and pediatric OSA. CITATION: Fernandes Fagundes NC, d’Apuzzo F, Perillo L, et al. Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions. J Clin Sleep Med. 2021;17(8):1627–1634

Objective: The aim of this systematic review with meta-analysis was to evaluate the efficacy of conservative interventions in pain relief in patients with intracapsular temporomandibular disorders (TMD). Methods: PubMed, Scopus, and Web of Science were systematically searched until January 1st, 2022 to identify randomized controlled trials (RCTs) presenting patients with diagnosis of intracapsular TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), conservative approaches as interventions, and pain intensity as outcome. Results: Out of 3372 papers, 13 RCTs were included, with 844 study participants. Most of them (n=7) investigated the efficacy of splint appliance. Meta-analysis revealed that rehabilitative interventions had a significant overall effect size of 0.75 [0.17, 1.34], reporting splint appliance and laser therapy as significantly effective treatments. Conclusion: Findings of this systematic review with network meta-analysis suggested that conservative approaches might be effective in pain relief of intracapsular TMD patients.

Biologically active substances are expressed by cells within the periodontium in response to mechanical stimuli from orthodontic appliances. Several possible biomarkers representing biological modifications during specific phenomena as simile-inflammatory process, bone resorption and formation, periodontal ligament changes, and vascular and neural responses are proposed. Citations to potentially published trials were conducted by searching PubMed, Cochrane databases, and scientific textbooks. Additionally, hand searching and contact with experts in the area were undertaken to identify potentially relevant published and unpublished studies. Selection criteria were as follows: animal models involving only mice and rats undergoing orthodontic treatment; collection of gingival crevicular fluid (GCF) as a noninvasively procedure for humans; no other simultaneous treatment that could affect experimental orthodontic movement. The data suggest that knowledge of the remodeling process occurring in periodontal tissues during orthodontic and orthopedic therapies may be a clinical usefulness procedure leading to proper choice of mechanical stress to improve and to shorten the period of treatment, avoiding adverse consequences. The relevance for clinicians of evaluating the rate of some substances as valid biomarkers of periodontal effects during orthodontic movement, by means of two models of study,mice and men, is underlined.

Objective: To evaluate pain control in patients with joint and muscle pain in temporomandibular disorder (TMD) diagnosis treated with oral non-steroidal anti-inflammatory drugs (NSAIDs). Methods: The systematic research was conducted via Pubmed, Scopus, Web of Science, Google Scholar, and Cochrane databases. Results: Four full-text randomized-controlled trials (RCTs) were considered eligible. This systematic review included 164 patients whose VAS scores were assessed before and after therapy. In the selected studies, a strong heterogeneity in the diagnosis and in the use of different types and prescriptions of NSAIDs was highlighted. These limitations had to be considered to understand whether a clinical recommendation could be made. Eventually, all patients treated with NSAIDs showed an improvement in pain. Conclusion: The use of oral NSAIDs as the first approach to control joint and muscle pain is sustained by the current scientific literature, but further investigations on this topic are still needed.

Aim The aim of the present study was to compare the accuracy of the actual space obtained through interproximal enamel reduction (IPR) compared to the amount of IPR planned through the digital setup during clear aligner treatment (CAT). Materials and methods A total of 10 clinicians were randomly recruited using the Doctor Locator by Align Technology (California). For each clinician, four consecutive patients treated with CAT and manual stripping were selected for a total of 40 subjects and 80 dental arches. For each patient, the amount of planned IPR and the amount of actual IPR performed were recorded. Each arch was considered individually. For each arch, the mesio-distal tooth measurements were obtained from second to second premolars. Results No systematic measurement errors were identified. In 25 cases, stripping was planned and performed in both arches; in 4 cases only in the upper arch and in the remaining 7 cases only in the lower arch. The difference between planned IPR and performed IPR was on average 0.55 mm (SD, 0.67; P = 0.022) in the upper arch and 0.82 mm (SD, 0.84; P = 0.026) in the lower arch. The accuracy of IPR in the upper arch was estimated to be 44.95% for the upper arch and 37.02% for the lower arch. Conclusion Overall, this study showed that the amount of enamel removed in vivo did not correspond with the amount of IPR planned. In most cases, the performed IPR amount was lower than planned. When considering the actual amount in millimeter, these differences may not be considered clinically relevant.

The presence of a double-tooth requires specific complex management due to the need for differential diagnosis and following treatment choices. The aim of this report was to present a rare case of a geminated mandibular lateral incisor, treated with an orthodontic approach. A Caucasian 10.9-year-old girl presented a lower right double-tooth incisor, with a class 1 molar and a class 2 cuspid tendency on both sides. The upper arch was constricted as shown by bilaterally tendencies to cross-bite, a slightly lower midline deviation was reported and a lack of space for all four permanent cuspids was confirmed also by the panoramic X-ray. In the lower arch, there was a severe crowding of about 14 mm and a buccally ectopic left canine. Overbite was normal and Overjet minimally increased. The double-tooth was identified like a geminated tooth, for the presence of one root and one pulp canal of increased size, as shown by the radiographic examinations. The anomalous tooth was managed with an orthodontic approach associated with a progressive stripping to reshape the crown. A two-phase treatment plan was performed, based on first maxillary expansion and lip bumper and then fixed appliances, in order to achieve a proper occlusion and a better aesthetic.

Background To assess the predictability of crowding resolution and the efficacy of different strategies to gain space during clear aligners treatment. Methods A total of 10 clinicians were randomly recruited using the Doctor Locator by Align Technology (California). For each clinician, four consecutive patients treated with aligners and manual stripping were selected for a total of 40 subjects. Thus, 80 arches were collected and uploaded on the Orthoanalyzer software for arch measurements. The data were gained on the starting arch form (T0), on the virtual arch developed with digital planning (vT1), and on the arch form achieved at the end of the aligner sequences (T1). The following parameters were scored: Little's Irregularity Index, transversal arch diameters, (intercuspid, interpremolar, and intermolar width), incisor position/arch length, and enamel interproximal reduction (IPR). Results For all the measurements, statistically significant differences were found at different stages. The predictability of crowding resolution was very high, ranging from 87% in the upper arch and 81% in the lower one. Among the different strategies to gain space, variations in sagittal incisor position were predictable, with a value of 70% both in the upper and lower arch. Conversely, changes in arch diameters were less reliable varying between 49 and 67% in the lower arch and 59–83% in the upper one. Moreover, IPR was the least accurate procedure, wavering at 49% in the upper arch and 42% in the lower arch. Conclusions The predictability of crowding resolution during treatment with aligners was high. However, the virtual arch forms obtained at the end of digital planning (vT1) did not correspond with the arch forms at the end of the aligner sequences (T1). The IPR was the least predictable strategy to gain space, being, perhaps, an operator-dependent procedure.

Aim This prospective non-randomised case-control study analysed lip muscle activity after Lip Bumper (LB) treatment thought surface electromyography. Methods The study group was composed of 40 young patients with a mean age of 10 years and 1 month, treated with LB in the lower arch, while 40 children who did not undergo any treatment, matched for sex and age with the previous sample, constituted the control group. Measurements were performed at the beginning and after 1 year for both groups. Electromyographic recordings were obtained in rest position and during the swallowing of 50 ml of water. Results In the study group, after 1 year of LB treatment, a statistically significant decrease in values was found; specifically, in upper lip muscle activities at rest position with the appliance in situ (p

Coronoid process hypertrophy (CPH) consists of an abnormal volumetric increment of the mandibular coronoid process; as this process grows gradually, the infratemporal space needed for the rotation and translation of the mandible is reduced, which results in a reduction of the range of mouth opening and lateral excursion, limiting mouth opening. The purpose of this case report was to describe a rare case of hypertrophy of coronoid processes with associated temporomandibular ankylosis, monitored for over 20 years. The patient was first visited when he had a facial trauma at the age of 4. Then he was followed through clinical, functional, instrumental, bi-dimensional and three-dimensional radiological evaluations up to the age of 24. Physical therapy was initiated at the age of 10 to improve the condition of the masticatory muscles, while at the age of 14, Transcutaneous Electrical Nerve Stimulations were performed to reduce muscle tension and, a bite plane was delivered to control the parafunctional activity of the jaw in the night and self-control instruction was provided for daytime habits. The adult patient has not accepted surgical intervention; thus, the future objective is to continue monitoring over the years to avoid a detrimental progression of the medical condition through physical and functional therapies while waiting for patient consent to surgery if needed.

Bone-anchored appliances for the treatment of Class III malocclusions have recently been found to reduce the dentoalveolar effects caused by conventional tooth-borne devices while also improving orthopaedic outcomes in growing patients. The goal of this systematic review was to compare the outcomes of skeletal Class III interceptive treatment with dental anchoring devices to those achieved with mixed anchored palatal expanders. The inclusion criteria were as follows: patients who were treated with hybrid anchored palatal expanders and different maxillary advancement appliances. Study quality was estimated using the Newcastle–Ottawa scale. A search on the Pubmed, Scopus, Embase and Cochrane Library databases yielded 350 papers. Following the initial abstract selection, 65 potentially acceptable papers were thoroughly examined, resulting in a final selection of 9 articles. The results in the short-term showed that combined tooth-borne and bone-borne appliances for rapid maxillary expansion might be recommended in protocols of skeletal Class III treatment to obtain more skeletal effects and reduce side effects on the upper teeth.

Background: The aim of the retrospective observational study was to compare the precision of landmark identification and its reproducibility using cone beam computed tomography-derived 3D cephalograms and digital lateral cephalograms in unilateral cleft lip and palate patients. Methods: Cephalograms of thirty-one (31) North Indian children (18 boys and 13 girls) with a unilateral cleft lip and palate, who were recommended for orthodontic treatment, were selected. After a thorough analysis of peer-reviewed articles, 20 difficult-to-trace landmarks were selected, and their reliability and reproducibility were studied. These were subjected to landmark identification to evaluate interobserver variability, the coordinates for each point were traced separately by three different orthodontists (OBA, OBB, OBC). Statistical analysis was performed using descriptive and inferential statistics with paired t-tests to compare the differences measured by the two methods. Real-scale data are presented in mean ± SD. A p-value less than 0.05 was considered as significant at a 95% confidence level. Results: When comparing, the plotting of points posterior nasal spine (PNS) (p &lt, 0.05), anterior nasal spine (ANS) (p &lt, 0.01), upper 1 root tip (p &lt, 0.05), lower 1 root tip (p &lt, 0.05), malare (p &lt, 0.05), pyriforme (p &lt, 0.05), porion (p &lt, 0.01), and basion (p &lt, 0.05) was statistically significant. Conclusion: In patients with a cleft lip and palate, the interobserver identification of cephalometric landmarks was significantly more precise and reproducible with cone beam computed tomography -derived cephalograms vis-a-vis digital lateral cephalograms.

Machine Learning (ML) is an emerging subfield of artificial intelligence with significant resources being applied to connect computer science, statistics, and medical problems. Currently, and even more so in the future, ML algorithms applied to the orthodontic specialty will offer sophisticated and automatic models able to process and synthesize data in ways orthodontists could never do themselves, and ultimately convert data into intelligent treatment actions. This work focuses on the usefulness of two ML methodologies, LASSO networks (Ln), and Boruta selection (Ba), to simplify information from different types of pathogenic processes leading to the worsening of skeletal Class III malocclusion. Cephalometric analyses of 144 Class III untreated subjects followed longitudinally during the growth process (4–19 years) were performed. After separating subjects into two subgroups of 116 with mild (M) and 28 with very serious (VS) unfavorable growth, cephalometric features were processed using Ba and Ln algorithms for feature selection and regularization. The selection procedure revealed the unexpected predictive importance of the combination of two often overlooked craniofacial variables, SN-PP and L1-MP angles. Ln regularization highlighted additional feature interactions between M and VS growing subjects. Thus, the appropriate removal of redundant cephalometric features from the dataset contributed to the detection of subjects affected by serious unfavorable craniofacial progression and revealed the unexpected prognostic value of some skeletal feature interactions.

Aim Odontomas are odontogenic tumours of the jaws; they are generally asymptomatic with an unknown aetiology. This study was conducted on non-syndromic children aged 9 to 14 years to explore the side effects deriving from the presence of these benign tumours, as retention, transmigration, ectopic eruption of permanent teeth and the permanence of primary teeth in the affected area. Methods Two hundred panoramic (OPT) and 92 Cone Beam Computed Tomography radiographs (CBCT) of patients (130 males and 70 females) were analysed from February 2018 to December 2019. Two hundred odontomas (145 compound and 55 complex type) and 800 teeth (160 primary and 640 permanent) were included. Results The prevalence of these tumours in both male and female subjects was 65% and 35%, respectively; the prevalence of compound odontomas in maxillary and mandibular bones was respectively 27.58% and 72.41%. The prevalence of complex odontomas in maxillary bones in female and male subjects was 37.5% and 62.5% respectively. It was observed the presence of a primary tooth in 81% of cases, the presence of retained teeth in 16.5% and a dental transmigration in the remaining 2.5% of cases in the compound type. Gender (p =0.158) has no significant correlation. Conclusions An early diagnosis and removal of odontomas in primary dentition is crucial in order to prevent later dental complications. Since the detection of odontomas is mainly an accidental radiological finding, the need for routine radiographic analysis should be highlighted.

The objectives of this study were to assess gingival recessions (GR) and periodontal status in patients previously treated with non-extraction orthodontic treatment and retention at a follow-up of a minimum of two years after the end of treatment. Data from patients aged between 16 and 35 years with a previous non-extraction orthodontic treatment and at least 2 years of retention and full records before and after treatment were collected. The casts were digitalized using the 3Shape TRIOS® intraoral scanner and the Viewbox4 software was used for the measurements. The following parameters were scored: inclination of the lower and upper incisors (IMPA and I^SN) and anterior crowding (Little index). The included patients were recalled for a clinical periodontal follow-up examination and the following parameters were evaluated: buccal and lingual GR (mm) of incisors and canines, bleeding of probing score, plaque score, and gingival phenotype. The digital cast analysis showed a mean Little index of 7.78 (SD 5.83) and 1.39 (SD 0.79), respectively, before and after treatment. The initial and final cephalometric analyses showed an I^SN of 103.53° and 105.78° (SD 7.21) and IMPA of 91.3°and 95.1°, respectively. At the follow-up periodontal visits, the patients showed an overall low oral hygiene with bleeding at probing in 66.6% and plaque in the anterior area in 76.2% of patients. From the total examined 240 teeth of the frontal sextants, three patients had GR (from 1 to 6.5 mm): in the upper arch two at canines and one at central incisor, whereas in the lower arch two at central and one at lateral incisors. The gingival phenotype was thick in 55% of cases. The lingual-to-lingual retainers at follow-up were present in 61.9% of patients. A slight increased risk for buccal GR development was found only in correlation with the presence of fixed retainer and thin gingival phenotype mainly in patients with gingivitis. Thus, non-extraction orthodontic treatment performed with controlled forces and biomechanics seems to not affect the development of GR or the periodontal health after retention.

Introduction The purposes of this study were to characterize the 3-dimensional position of teeth adjacent to impacted canines and examine whether impaction affects canine development using cone-beam computed tomography. Methods Cone-beam computed tomography images of 34 unilateral maxillary impacted canines (12 males, 22 females; mean age, 16.5 years) were collected. Twenty-one canines were palatally impacted (PIC), and 13 were buccally impacted (BIC). Angular measurements of lateral incisors (LIs), first premolars, and the impacted canines positions relative to a 3-dimensional coordinate system and canines’ volume, length, and shape of the roots, were compared between the affected and contralateral control sides. The influence of canine position and severity of impaction was examined. Statistics included the paired t test, Wilcoxon signed rank test, and McNemar test. Results In the PIC group, LIs showed significant mesiobuccal rotation (−17.1°), mesial angulation (8.4°), and buccal root torque (5°) and first premolars mesiobuccal rotation (6.1°). In the BIC group, LIs displayed mesiobuccal rotation (−18°) and significant palatal root torque (−5°). The canine volumes were similar in BICs and slightly smaller in PICs. The lengths were shorter in both, but root hooks were more prevalent in BICs. The severity of impaction affected the measured variables. Conclusions The differential position of the adjacent teeth is pathognomonic for PIC vs BIC, and impaction seems to affect canine development. The findings provide evidence-based clinical and radiographical clues for early diagnosis of canine displacement and planning the most efficient treatment strategy. In addition, they support timely orthodontic eruption before the development of the apical third of the root.

Summary Objectives To compare the short-term outcomes of modified SEC III protocol in growing patients in relation to their compliance with the chincup, matching them with an untreated Class III control group (CG). Materials and Methods Thirty-four patients (mean age of 8.6 ± 1.2 years) with Class III dentoskeletal malocclusion treated with the modified SEC III protocol and divided into group 1 (G1, 18 subjects), reporting good compliance and group 2 (G2, 16 subjects) not compliant with the chincup. The records were analysed before treatment (T1) and after the orthopaedic phase (T2), with an interval period of about 1.3 ± 0.5 years. The CG consisted of 16 untreated subjects with Class III dentoskeletal malocclusion (mean age of 8.3 ± 1.4 years). The statistical comparisons among the three groups were performed with ANOVA with Tukey’s post hoc tests. Results Both G1 and G2, compared with CG, presented significant improvements in the sagittal skeletal relationships (ANB +2.5° and +2.5°, Wits +4.2° and +3.0°, respectively). G1 exhibited a significant more favourable control of vertical skeletal relationships when compared to G2 (Palatal Pl.–Mandibular Pl. −2.0°) that were associated with a statistically significant reduction of the gonial angle (ArGoMe −1.7°). Limitations of the study were its retrospective nature and the lack of evaluation of the long-term outcomes. Conclusions Both groups of treated patients showed favourable sagittal skeletal improvement compared with controls. The use of chincup in patients with good compliance produced significantly greater control of the skeletal vertical dimensions compared with patients not compliant with the chincup.

Background To assess if photobiostimulation (PBS) alleviates pain intensity/duration and swelling after implant surgery. Material and Methods Sixty subjects (27 male and 33 female, with a mean age of 47,13 8.05 years) were included and randomly assigned to experimental group (implant surgery and photobiostimulation), placebo group (implant surgery and simulated photobiostimulation) and control group (implant surgery only). Inclusion criteria: subjects older than 20 years, with a healthy oral mucosa and requiring implant surgery. Exclusion criteria: pregnancy, history of implant failure, light sensitivity, metabolic deseases, consumption of antibiotics or corticosteroids in the last two weeks, smokers and alcohol drinkers. Patients reported the pain experienced by using a numeric rating scale (NRS) at 2 hours, 6 hours, 12 hours, 24 hours and from day 2 to 7. Swelling score was assessed by linear measurements and type and number of analgesic drugs within each time-point were recorded on a spreadsheet. Data of pain and amount of swelling were compared among the three groups by using the Kruskal-Wallis H Test and post-hoc comparisons tests. Results Pain in the experimental group was less compared to controls and placebo group, at each time intervals (p < 0.001) as well as the maximum pain score (experimental group: median = 2, interquartile range 2-3; control group: median = 8, interquartile range 3,75-9; placebo group: median = 8, interquartile range 6,25-9). Swelling was almost insignificant in the experimental group (maximum value = 1, interquartile range 0-2,75, at 24 hours) compared with control (maximum value = 6, interquartile range 5-8,75, at 24 hours) and placebo (maximum value = 6, interquartile range 5-8, at 24 hours). Subjects in the experimental group assumed less analgesics compared to both controls and placebo groups. Conclusions Photobiostimulation is an effective method to reduce pain intensity/duration and swelling after implant surgery. Key words:LLLT, photobiostimulation, pain, implant surgery.

Objective. To describe a clinical case with a severe mandibular crowding treated without extraction and showing a long-term outcome. Methods. A 14-year-old boy in permanent dentition showed a class I molar and cuspid relationship, a severe deep bite of 8 mm, a constricted V-shaped upper arch with moderate crowding, and a severe crowding of about 12 mm in the lower arch. The panoramic X-ray showed an impacted upper right canine. The treatment started with the placement of a transpalatal bar and 0.022×0.028 in standard edgewise appliances in the upper arch and a lip bumper bonded on the second lower molars. Initial leveling of the teeth was accomplished with light Australian round wires. Finishing was then performed with rectangular wires. The phase with fixed appliances lasted 2 years and 9 months, and the patient was motivated and cooperative throughout the treatment, although with poor oral hygiene. The patient was treated without extractions. Results. The space was gained with the first and second upper molar derotations using the transpalatal bar and the gingival lip bumper in the lower arch. The upper right canine was well positioned, and the maxillary arch form was improved. The severe lower crowding was completely corrected, and a good overbite was achieved. Conclusion. A conservative, nonextraction treatment approach for this patient with class I malocclusion with severe mandibular crowding was effective, and the results have remained stable after a long-term follow-up (10 years).

Human periodontal ligament (PDL) is a membrane-like connective tissue interposed between the tooth root and the alveolar bone, the main component of which is represented by collagen fibers. During the early stage of application of orthodontic forces, different changes occur in PDL. For this reason, its characterization with conventional and non-conventional techniques can be extremely interesting. We investigated samples of PDL of orthodontic patients, aged between 13 and 21 years, using different experimental techniques. Morphological characterization of PDL samples was carried out by using a scanning electron microscope. Fourier-Transform Infrared (μ-FT-IR) and Raman (μ-RS) microspectroscopies were used for biochemical characterization of PDL samples. A biochemical characterization of PDL tissues with clear evidence of contributions from collagen, lipid and other protein was obtained. The analysis of Amide I and Amide III components was also performed, giving an indication of the protein secondary structure.

The aim of the study was to examine the biochemical and structural changes occurring in the periodontal ligament (PDL) during orthodontic-force application using micro-Raman spectroscopy ( &mu, RS). Adolescent and young patients who needed orthodontic treatment with first premolar extractions were recruited. Before extractions, orthodontic forces were applied using a closed-coil spring that was positioned between the molar and premolar. Patients were randomly divided into three groups, whose extractions were performed after 2, 7, and 14 days of force application. From the extracted premolars, PDL samples were obtained, and a fixation procedure with paraformaldehyde was adopted. Raman spectra were acquired for each PDL sample in the range of 1000&ndash, 3200 cm - 1 and the more relevant vibrational modes of proteins (Amide I and Amide III bands) and CH 2 and CH 3 modes were shown. Analysis indicated that the protein structure in the PDL samples after different time points of orthodontic-force application was modified. In addition, changes were observed in the CH 2 and CH 3 high wavenumber region due to local hypoxia and mechanical force transduction. The reported results indicated that &mu, RS provides a valuable tool for investigating molecular interchain interactions and conformational modifications in periodontal fibers after orthodontic tooth movement, providing quantitative insight of time occurring for PDL molecular readjustment.

OBJECTIVE To compare the short-term cephalometric outcomes of the protocols modified splints, Class III elastics, chincup (SEC III) and rapid maxillary expansion and facial mask (RME/FM) for the early treatment of growing subjects with Class III dentoskeletal malocclusion. SETTINGS AND SAMPLE POPULATION This retrospective observational study included 20 patients (11 males, nine females) treated with the modified SEC III protocol and 31 patients (16 males, 15 females) treated with the RME/FM one. The sample was evaluated before (T1, mean age 7.9 ± 1.0 years) and at the end of treatment (T2, mean age 9.0 ± 1.0 years). Statistical comparisons between the two groups were performed with independent sample t tests. RESULTS Both the modified SEC III and the RME/FM sample groups showed significantly favourable effects in terms of maxillary advancement (SNA +1.3° and +1.5°, respectively), control of mandibular projection (SNB -0.5° and -0.8°, respectively), and intermaxillary relationships (ANB +1.8° and +2.3°, respectively; Wits +3.4 and +1.9 mm, respectively). The modified SEC III group showed a statistically significant greater control in the intermaxillary divergency considering the SN to Pal. Pl. (P