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Summary Background The minimally important difference (MID, the smallest difference that patients perceive as beneficial) has been proposed to assess whether study results are clinically meaningful, reducing the shortcoming of P-values-based approaches in the assessment of clinical outcomes. The post-treatment changes and the MID in Oral Health-Related Quality of Life (OHRQoL) among adults undergoing fixed orthodontic treatment were investigated. Methods Ninety-two patients (29.1 ± 6.3 years old, 18 males and 74 females) were prospectively included. Oral Health Impact Profile (OHIP-14) and United Kingdom Oral Health-related Quality of Life (OHQoL-UK) were used to assess OHRQoL at baseline and post-treatment (50.8 ± 15.7 months). Global Transition Rating (GTR) was used to assess oral health/well-being, Peer Assessment Review (PAR), and Index of Complexity, Outcome and Need (ICON) were used to assess occlusion. Wilcoxon signed-rank test was used to assess changes in OHRQoL and occlusion, Kruskal–Wallis one-way ANOVA and Mann–Whitney U-test were used to assess associations between OHRQoL and oral health/well-being or occlusion. MID for OHIP-14 and OHQoL-UK was estimated via anchor-based (PAR, ICON, GTR) and distribution-based approach (effect size, standardized response mean, standard error of measurement). Results The median OHIP-14 and OHQoL-UK post-treatment scores were significantly changed, indicating improved OHRQoL. Based on the agreement between different methods, the MID of OHIP-14 and OHQoL-UK were at least 15 and 6 scale points, corresponding to a large effect size (1.5–1.7). Conclusions Orthodontic treatment had a positive long-term impact on OHRQoL. MID for the OHIP-14 and OHQoL-UK provide guidance to interpreting the impact of orthodontic treatment on the OHRQoL of patients.

Objectives: The proportionality between anatomical characteristics and disease severity in children and adolescents with obstructive sleep apnea (OSA) has not been well characterized. The present study investigated the relationship between the dentoskeletal and oropharyngeal features of young patients with OSA and either the apnea–hypopnea index (AHI) or the amount of upper airway obstruction. Methods: MRI of 25 patients (8- to 18-year-old) with OSA (mean AHI = 4.3 events/h) was retrospectively analyzed. Sleep kinetic MRI (kMRI) was used to assess airway obstruction, and static MRI (sMRI) was used to assess dentoskeletal, soft tissue, and airway parameters. Factors related to AHI and obstruction severity were identified with multiple linear regression (significance level α = 0.05). Results: As evidenced by kMRI, circumferential obstruction was present in 44% of patients, while laterolateral and anteroposterior was present in 28%; as evidenced by kMRI, obstructions were retropalatal in 64% of cases and retroglossal in 36% (no nasopharyngeal obstructions); kMRI showed a higher prevalence of retroglossal obstructions compared to sMRI(p = 0.037); the main obstruction airway area was not related to AHI; the maxillary skeletal width was related to AHI (β = −0.512, p = 0.007) and obstruction severity (β = 0.625, p = 0.002); and the retropalatal width was related to AHI (β = −0.384, p = 0.024) and obstruction severity (β = 0.519, p = 0.006). Conclusions: In children and adolescents, the severity of OSA and obstruction were inversely proportional to the maxillary basal width and retropalatal airway width. Further studies are needed to assess the benefits of targeted clinical treatments widening the transverse dimension of these structures.

Objective Planning of incisal position is crucial for optimal orthodontic treatment outcomes due to its consequences on facial esthetics and occlusion. A systematic summary of the proposed parameters is presented. Methods Studies on Google Scholar©, PubMed©, and Cochrane Library, providing quantitative information on optimal central incisor position were included. Results Upper incisors supero-inferior position (4–5 mm to upper lip, 67–73 mm to axial plane through pupils), antero-posterior position (3–4 mm to Nasion-A, 3–6 mm to A-Pogonion, 9–12 mm to true vertical line, 5 mm to A-projection, 9–10 mm to coronal plane through pupils), bucco-lingual angulation (4–7° to occlusal plane perpendicular on models, 20–22° to Nasion-A, 57–58° to upper occlusal plane, 16–20° to coronal plane through pupils, 108–110° to anterior-posterior nasal spine), mesio-distal angulation (5° to occlusal plane perpendicular on models). Lower incisors supero-inferior position (41–48 mm to soft-tissue mandibular plane), antero-posterior position (3–4 mm to Nasion-B, 1–3 mm to A-Pogonion, 12–15 mm to true vertical line, 6–8 mm to coronal plane through pupils), bucco-lingual angulation (1-4° to occlusal plane perpendicular on models, 87–94° to mandibular plane, 68° to Frankfurt plane, 22–25° to Nasion-B, 105° to occlusal plane, 64° to lower occlusal plane, 21° to A-Pogonion), mesio-distal angulation (2° to occlusal plane perpendicular on models). Conclusions Although these findings can provide clinical guideline, they derive from heterogeneous studies in terms of subject characteristics and reference methods. Therefore, the optimal incisal position remains debatable.

Objectives: Cleidocranial dysplasia (CCD) is a rare skeletal syndrome affecting craniofacial and dental development. As a consequence, conventional cephalometric landmarks may not be valid for CCD patients, and the appropriateness of norms used for the general population should be critically discussed. Methods: Five patients 9- to 22-year-old (three females, two males) with CCD were included. Lateral-cephalograms, orthopantomographies, and intra-oral photos were retrospectively analysed. Lateral-cephalograms of 50 normal controls (ten for each CCD patient) matched for age and sex were selected from an online database. Cephalometric measurements of each CCD patients were compared with average values of matched controls using Wilcoxon signed-rank test for paired values (α = 0.05). Results: In CCD patients, a shortening of the cranial base was present (ΔSN = −17.1 mm, p = 0.043). Thus, the mandible (ΔSNPg = +9.5°, p = 0.043) and the maxilla (ΔSNA = +11.2°, p = 0.043) showed protrusion compared to the cranial base, despite a reduced maxillary (ΔCo-A = −15.1 mm, p = 0.043) and mandibular (ΔCo-Gn = −15.2 mm, p = 0.080) length. The mandibular divergence was reduced (ΔSN/GoGn = −6.4°, p = 0.043), a reduced overbite was present (ΔOverbite = −2.9 mm, p = 0.043), and the interincisal angle was increased (ΔInterincisalAngle = +13.7°, p = 0.043), mainly due to retro-inclination of lower incisors. Conclusions: Standard cephalometric norms for the assessment of horizontal jaw position may not be applicable to CCD patients because of a reduced anterior cranial base length compared to normal subjects. Vertical relationships may not be affected, and mandibular hypodivergency was confirmed.

The present dry-mandible study evaluated the presence of the mental (MF), lingual (LF), and retromolar (RMF) foramina to assess the accuracy of CBCT in detecting these anatomical structures. In total, 38 human dry mandibles were analyzed (30 men, 8 women; mean age: 61.9 ± 13.7 years). CBCT scans were taken using low-dose parameters, and LF, MF, and RMF were assessed visually and radiographically. Both the presence (yes/no) and the count (n) of each foramen were compared between CBCTs and visual assessment. For the presence assessment, only RMF exhibited a significant difference between CBCT and visual inspection (P = .035). For count, the RMF (P = .049) and paramedian LF (P = .003) exhibited differences between the two methods. The agreement between CBCT and visual inspection was excellent for the MF, moderate-excellent for the LF, and low-moderate for the RMF. Intra- and interassessor agreement varied from excellent (MF), to moderate-excellent (LF), and low-moderate (RMF). The LF and RMF represent challenging structures to identify on CBCT images due to their limited dimension. False negative findings in CBCTs in the assessment of foramina, especially LF, might lead to surgical complications during implant surgery.

Finite Element models (FEM) are developed for the analysis of the contact pressures exerted by a Continuous Positive Airway Pressure (CPAP) mask applied to a dummy head. This is seen as a preliminary step in the analysis of the mechanical effects of CPAP masks applied to human faces, such as recently employed for the care of COVID-19 patients, or other purposes. These mechanical effects can range from negligible, in the case of correct positioning, sufficiently light tension in the headgear, correct mask design, etc., to the possible development of device-related pressure ulcers and/or dentofacial deformations, especially in children. The results of Finite Element analyses are compared, for their validation, with experimental ones. The numerical analysis tool appears able to predict, at an acceptable cost, both the intensity and the area distribution of the contact pressures, as well as the force-displacement relationship occurring in the headgear. This might help the design and the production of more effective and tolerable CPAP masks.

OBJECTIVES The present work describes the status and contents of The Human Bone Collection of the Faculty of Dentistry at the University of Hong Kong. MATERIALS AND METHODS The Collection originates from the 1980s and became officially established in 2017 for teaching and research purposes. Most of the Collection consists of unclaimed human remains of southern Chinese individuals exhumed from local cemeteries and donated to the Faculty in the last few decades. The demographic information was provided largely from burial records and forensic estimations. Since 2016, the Collection has undergone a process of reorganization into cranial and postcranial remains, followed by preservation procedures that included cleaning and classification. RESULTS The Collection currently consists of remains belonging to about 368 individuals (243 males, 54 females, 71 unknown), with ages ranging from 0.8 to 90 years (mean 57.4 years). It comprises cranial remains belonging to 260 individuals (169 males, 39 females, 52 unknown), and postcranial remains belonging to 248 individuals (180 males, 42 females, 26 unknown). The preservation status ranges from poor to good, with the cranial remains better preserved than the postcranial elements. For a large number of individuals, ear ossicles, soil samples, and other materials are also available. DISCUSSION The Collection is accessible to local and international institutions for teaching and research.

Objectives To use both absolute anteroposterior maxillary complex length (APMCL) and relative APMCL to investigate the relationship between the maxillary complex, its individual bony segments, and their association to the anterior cranial base. In addition, the relationship between length and position of the maxillary complex was analyzed. Materials and Methods Sixty human skulls were analyzed using cone beam computed tomography. The maxillary complex length was measured between anterior and posterior nasal spine (ans-pns), and the average was used as the cut-off to identify a high- and a low-length group based on absolute APMCL. The length ratio between the maxillary complex and the anterior cranial base (ans-pns/SN) was used to identify the two groups based on relative APMCL. The anterior cranial base length and the lengths of the maxillary complex bones were compared between the high- and low-length groups. Results Based on absolute APMCL, individuals with shorter maxillary complex had shorter anterior cranial base (P = .003), representing normal proportions. Based on relative APMCL, individuals with shorter maxillary complex had longer anterior cranial base and vice versa (P = .014), indicating disproportions. Individuals with shorter maxillary complex exhibited shorter maxilla (Δ = −1.5 mm, P = .014). Conclusions When skeletal deformity of the midface is suspected, individual disproportions in the anteroposterior length of the maxillary complex in relation to the anterior cranial base (relative measurements) should be assessed through radiological imaging. A shorter maxillary complex may be associated with a shorter maxilla, and not with a shorter premaxilla or palatine bone.

The aim of this systematic review was to provide guidelines for decision-making during orthodontic treatment planning of infra-occluded deciduous molars with or without their successors in children and adolescents.Computerized search was conducted on Medline via PubMed, and Cochrane Library. Articles published until 2020 in English language were analyzed following the Preferred Reporting Items for Systematic Reviews (PRISMA) Checklist. Observational and interventional longitudinal studies reporting the treatment of ankylosed deciduous molars with or without successor tooth in 3 to 15-year-old patients were included.In case of ankylosis with presence of successor, exfoliation took place in 77% of teeth, while extraction involved 23%. Infra-occlusion happened in 53% of teeth (worsening in 52%), alveolar bone loss in 37%, mesial tipping of first permanent molar in 5%, and over-eruption of antagonist in no cases (after exfoliation and eruption of successor). In case of ankylosis without successor, exfoliation took place in 1% of teeth, progression of infra-occlusion in 42%, progression of root resorption in 58%, development of mesial tipping of first permanent molars in 25%, while no case of antagonist over-eruption was reported.When the permanent tooth is present and the ankylosed tooth is slightly or moderately infra-occluded, observation is appropriate. In case of severe infra-occlusion or absence of successor, tooth extraction may be considered together with orthodontic space closure, transplantation, or prosthetic replacement. Alternatively, nonextraction and a prosthetic build-up may be considered.

Controlling the incisal inclination is fundamental in orthodontics. However, the relationship between the inclination prescription and its clinical outcome is not obvious, and the incisal inclination changes generated by different bracket prescriptions were investigated.Twenty-eight non-extraction dental Class II patients (15 females, 13 males; mean age = 12.9) were retrospectively analyzed. Patients were treated using passive self-ligating fixed appliances with three inclination prescriptions for maxillary incisors (For maxillary central incisors,The direction of correction of incisal inclination can be controlled by choosing a certain prescription, but the final inclination may show limited consistency with it. The amount of imposed inclination change was the most relevant predictor of the clinical outcome.

A continuous positive airway pressure (CPAP) mask is a respiratory ventilation method used for treating breathing disorders including respiratory failure and obstructive sleep apnoea (OSA). The forces applied by a CPAP mask may affect facial development and lead to pressure ulcers. In an experimental setting, the magnitude and the distribution of the contact pressures developed by a CPAP mask on the face were investigated for providing information aiming at optimizing the design of the device.A nasal CPAP mask with forehead support was placed via its headgear straps on a rigid phantom head and then a controlled load was incrementally applied via a mechanical testing system (5848 Micro Tester, Instron), up to 4 maximum levels of exerted force, namely 5 N, 10 N, 15 N, and 20 N. Real-time pressure mapping was realized by means of sensor matrixes (I-Scan System, Tekscan) applied on the facial surface in four regions (forehead, nasal bridge, zygoma, and maxilla). The data were then transferred on a virtual model created by 3D scans of both the CPAP mask and the phantom head used in the experiments.At increasing applied force, increases in average contact pressure were present at the zygomatic region (1-8 kPa), nasal bridge (12-14 kPa), and forehead (13-29 kPa), while the maxillary region showed relatively stable values (9 kPa). Despite the overall increase in average contact pressure with increasing applied force, no direct proportionality was present. Contact areas did not show clear increments, despite force may redistribute on a larger area, as sensors did not cover the entire mask perimeter. Peak contact pressure values were somehow affected by pressure concentrations that led to saturation in some areas of the sensors (up to 2% of the sensels).The CPAP mask exerts pressures that may be not uniformly distributed on the face of a subject. This information underlines the clinical importance of assessing both the pressure exerted and the areas that are interested by the mask contact, so as to optimise the CPAP masks design for obtaining a good compromise between ventilation performance and reduction of possible side effects on living tissues.

Recent studies have shown that global variation in body proportions is more complex than previously thought as some traits formerly associated with climate adaptation are better explained by geographic proximity and neutral evolutionary forces. While the recent incorporation of quantitative genetic methodologies has improved understanding of patterns related to climate in Africa, Europe, and the Americas, Asia remains underrepresented in recent and historic studies of body form. As ecogeographic studies tend to focus on male morphology, potential sex differences in features influenced by climate remain largely unexplored. Skeletal measurements encompassing the dimensions of the skull, pelvis, limbs, hands, and feet were collected from male (n = 459) and female (n = 442) remains curated in 13 collections across seven countries in East Asia (n = 901). Osteological data were analyzed with sex and minimum temperature as covariates adjusted by autosomal single-nucleotide polymorphism population genetic distance using univariate Bayesian linear mixed models, and credible intervals were calculated for each trait. Analysis supports a relationship between specific traits and climate as well as providing the magnitude of response in both sexes. After accounting for genetic distance between populations, greater association between climate and morphology was found in postcranial traits, with the relationship between climate and the skull limited primarily to breadth measurements. Larger body size is associated with colder climates with most measurements increasing with decreased temperature. The same traits were not always associated with climate for males and females nor correlated with the same intensity for both sexes. The varied directional association with climate for different regions of the skeleton and between the sexes underscores the necessity of future ecogeographic research to holistically evaluate body form and to look for sex-specific patterns to better understand population responses to environmental stresses.

Background Remote digital monitoring during orthodontic treatment can help patients in improving their oral hygiene performance and reducing the number of appointments due to emergency reasons, especially in time of COVID-19 pandemic where non-urgent appointments might be discouraged. Methods Thirty patients scheduled to start an orthodontic treatment were divided into two groups of fifteen. Compared to controls, study group patients were provided with scan box and cheek retractor (Dental Monitoring®) and were instructed to take monthly intra-oral scans. Plaque Index (PI), Gingival Index (GI), and White Spot Lesions (WSL) were recorded for both groups at baseline (t0), every month for the first 3 months (t1, t2, t3), and at 6 months (t4). Carious Lesions Onset (CLO) and Emergency Appointments (EA) were also recorded during the observation period. Inter-group differences were assessed with Student's t test and Chi-square test, intra-group differences were assessed with Cochran’s Q-test (significance α = 0.05). Results Study group patients showed a significant improvement in plaque control at t3 (p = 0.010) and t4 (p = 0.039), compared to control group. No significant difference was observed in the number of WSL between the two groups. No cavities were detected in the study group, while five CLO were diagnosed in the control group (p = 0.049). A decreased number of EA was observed in the study group, but the difference was not significant. Conclusions Integration of a remote monitoring system during orthodontic treatment was effective in improving plaque control and reducing carious lesions onset. The present findings encourage orthodontists to consider this technology to help maintaining optimal oral health of patients, especially in times of health emergency crisis.

To evaluate if a remote digital monitoring system added at the end of orthodontic treatment could positively influence the retention phase by reducing the occurrence of misfit of removable appliances, number of emergency appointments (EA), and orthodontic relapse.Twenty-seven patients who completed active orthodontic treatment were divided into the study and control groups. In addition to the standard chairside follow-up appointments at month 1 (T1), month 3 (T2), month 6 (T3), the study group patients were monitored using Dental MonitoringThe study group showed a significantly lower occurrence of misfit of removable retainers (Integrating remote monitoring systems, such as Dental Monitoring

Sutures are greatly involved in both normal craniofacial growth and developmental anomalies. Having clear parameters for defining their morphology is fundamental to properly investigate their physiological or pathological development. However, the current literature is lacking of well-defined methods for the assessment of these structures. This study performed a comprehensive microcomputed tomography (μCT) analysis of a swine model evaluating morphological variation of sutures in different skull regions. Seventy-two suture samples were removed from one swine (Sus scrofa), approximately 9-12-month-old. Each sample was analyzed with μCT in the parallel (PAR) and perpendicular (PER) plane with respect to the bone surface. Suture width (S w ), linear obliteration index (LOI), and linear interdigitation index (LII) were calculated in each of the two reference planes, and sutures were categorized in four types (S t ). Parameters were compared among the facial, craniofacial, and cranial region. Description of the main morphological parameters was provided, and differences were found between the parallel and perpendicular planes. S t varied depending on the skull region, with simple sutures more represented in the cranial region. LII in the perpendicular plane decreased from facial to craniofacial and cranial region. S w in the parallel plane decreased from facial and craniofacial to cranial region. In the swine model, the sutural width, linear interdigitation, and suture type were related to distinct skull regions. The suture type was introduced to allow a better morphological characterization of sutures as 3D structures. Clear definition of sutural parameters is important for appropriate description of these complex structures. Anat Rec, 302:2156-2163, 2019. © 2019 American Association for Anatomy.

Objective. The present study compared the changes in the upper airway dimensions and sleep-related breathing disorder (SRBD) condition between functional treatment with the headgear Herbst (HG-Herbst) and headgear Twin Block (HG-TB) appliance. Soft tissues were assessed on lateral cephalometric X-ray and magnetic resonance imaging (MRI). Materials and Methods. Consecutive patients who sought orthodontic treatment at the Faculty of Dentistry of The University of Hong Kong were screened. Adolescents (12-17 year sold for boys and 10-15 years old for girls), with class II molar relationship and overjet >5 mm, with no severe transverse maxillary deficiency, were recruited. Patients were assigned either to the HG-Herbst or to the HG-TB treatment by stratified block randomisation, with sex as the stratification factor. Lateral cephalograms, magnetic resonance imaging (MRI), and the Paediatric Sleep Questionnaire (PSQ) were obtained at baseline and after treatment. Results. 28 patients were enrolled, and 26 patients (13 in each group) completed the treatment. Following 1 year of functional appliance treatment, a significantly lower increase of the lower anterior facial height was observed in the HG-Herbst group compared to the HG-TB group (p = 0.024). However, no significant differences were observed in the upper airway structures or SRBD between the two groups. Conclusion. The changes in upper airway dimensions and SRBD condition were not significantly different between the HG-Herbst and the HG-TB appliance treatment. Additional studies with larger sample size are warranted.

Background The present study compared the treatment changes in the upper airway, hyoid bone position, and craniofacial morphology between two groups of children with skeletal class II malocclusion treated with the headgear activator (HGA) and Herbst appliance (Herbst). Setting and Sample Population Orthodontic population from the Faculty of Dentistry of the University of Hong Kong. Methods Thirty-four skeletal class II patients treated with the HGA (17 patients, mean age 10.6±1.5 years) and Herbst (17 patients, mean age 11.0±1.4 years) were matched for sex, age, overjet, skeletal class, and mandibular divergence. The patients received lateral cephalometric radiographs (LCRs) at the beginning of treatment (T1 ), after treatment (T2 ), and at follow-up (T3 ). In the HGA group, patients underwent LCRs seven months before the beginning of treatment (T0 ), which were used as growth reference for intra-group comparison. Paired Student's t-tests were used for intra- and inter-group comparisons (α=0.05). Results Treatment changes (T2 -T1 ) did not differ significantly between the groups. However, at follow-up (T3 -T1 ) the Herbst group showed a smaller increase than the HGA group in the vertical position of the hyoid bone relative to the Frankfort plane (p=0.013) and mandibular plane (p=0.013). Conclusions There were no significant differences in the upper airway, hyoid bone position, and craniofacial morphology between the groups at the end of treatment. However, the Herbst may provide better long-term control of the vertical position of the hyoid bone than the HGA in children with skeletal class II malocclusion.

Structured AbstractIntroduction Of the variables used by in vitro studies of resistance to sliding (RS) in orthodontics, sliding velocity (SV) of the wire is often the one farthest from its clinical counterpart. We investigated whether velocity influences the RS at values approximating the orthodontic movement. Methods A SS self-ligating bracket with a NiTi clip was fixed onto a custom-made model. Different shaped orthodontic SS wires of four sizes and two types (round, 0.020″ and 0.022″; rectangular, 0.016″×0.022″ and 0.017″×0.025″) were tested using an Instron® testing machine. Wires were pulled at four velocities (1×10−2 mm/s, 1×10−3 mm/s, 1×10−4 mm/s, 1×10−5 mm/s). Shapiro-Wilk test was used to evaluate the normal distribution of the data; two-way ANOVA was performed to compare means in the RS with wire characteristics and SV. Significance level was set at P

Acoustic emission (AE) is a non-destructive test to detect energy release. This technique was applied during rapid maxillary expansion (RME) to evaluate the reaction of the craniofacial skeleton.A swine model was analysed. Soft tissues were removed from two heads, while other two were preserved intact. A palatal expander (PE) was positioned and AE sensors were placed on the intermaxillary, fronto-nasal, and maxillo-lacrimal sutures. The PE was activated and AE recorded during RME. Differences between parameters were analysed with Mann-Whitney U test and Kruskal-Wallis test, and correlations with Spearman-Rho test (significance p0.05).PE activations were accompanied by clusters of AE hits. In the presence of soft tissues, amplitudes were generally lower (p0.001) and durations were higher (p0.001). No differences were found in the respective energy values. Differences were found in the AE (p0.05) among the four channels, with AE characterised by higher values in proximity of the maxillo-lacrimal sutures. High-energy hits were represented by burst-type waves, and low-energy ones by continuous-type.Although soft tissues create possible attenuation of the signal, AE can be detected during RME with sensors on the skin. AE provided further information of energy release, on top of the mechanical parameters. Source location was one of the main limitations.

Objectives To test the reliability of Lateral cephalometric radiographs (LCRs) for use in the assessment of the upper airway, hyoid bone, soft palate, and tongue. Materials and Methods The records of 57 healthy Chinese children from a nonhospital population (mean age = 12.6 years, SD = 0.5, 28 males and 29 females) who received two consecutive LCRs in the natural head posture were retrospectively analyzed. Fifteen linear, angular, and area measurements were used to describe the airway, hyoid bone, soft palate, and tongue. The reliability between the two LCRs was assessed with the intraclass correlation coefficient (ICC) and F-test. Errors were estimated with the Dahlberg and Bland-Altman method, and intra- and inter-assessor agreements were determined. Results Measurements of upper airway and hyoid bone had excellent method reliability, intra-assessor reliability, and inter-assessor reliability (ICC > 0.8). However, the method reliability and the inter-assessor reliability for soft palate and tongue was less favorable (ICC from 0.60 to 0.96). Soft palate area and thickness were the most critical parameters. Intra-assessor reliability was greater than both method reliability and inter-assessor reliability (which were similar). Conclusions The measurement of upper airway morphology, defined as the intramural space, and of the hyoid bone position were highly reliable on LCRs of children. However, the limited reliability in the assessment of tongue and soft palate area may compromise the diagnostic application of LCRs to these structures.

Learning bone anatomy of the skull is a complex topic involving three-dimensional information. The impact of the use of human dry skulls and cone beam computed tomography (CBCT) imaging was investigated in the teaching of undergraduate dental students. Sixty-four first-year students in the University of Hong Kong were randomly divided into eight groups. Four teaching methods were tested: (1) CBCT followed by standard lecture, (2) CBCT followed by lecture with skulls, (3) standard lecture followed by CBCT, and (4) lecture with skulls followed by CBCT. After each, students were given a multiple-choice questionnaire to assess their objective learning outcome (20 questions) and a questionnaire for their subjective satisfaction (10 statements). Surveys were assessed with Cronbach's alpha, Kendall's tau-b, and principal components analysis. Data were analyzed with Student's t-test and a one-way ANOVA (significance α = 0.05). Standard lecture followed by CBCT showed the highest learning outcome score (81.6% ± 14.1%), but no significant difference was present among four teaching methods. Cone beam computed tomography followed by lecture with skulls scored the highest overall subjective satisfaction (4.9 ± 0.8 out of 6), but no significant difference was present among teaching methods. Nevertheless, students' perception of learning was positively influenced by the use of skulls (P = 0.018). The timing of administration of the CBCT did not affect students' subjective satisfaction or objective learning outcome. Students perceived to learn more by using skulls, but their objective learning outcomes were not significantly affected. A discrepancy seems to exist between students' perception of learning and their effective performance.

Bone marrow and adipose tissue human mesenchymal stem cells were seeded in highly performing 3D gelatin–chitosan hybrid hydrogels of varying chitosan content in the presence of human platelet lysate and evaluated for their proliferation and osteogenic differentiation. Both bone marrow and adipose tissue human mesenchymal stem cells in gelatin–chitosan hybrid hydrogel 1 (chitosan content 8.1%) or gelatin–chitosan hybrid hydrogel 2 (chitosan 14.9%) showed high levels of viability (80%–90%), and their proliferation and osteogenic differentiation was significantly higher with human platelet lysate compared to fetal bovine serum, particularly in gelatin–chitosan hybrid hydrogel 1. Mineralization was detected early, after 21 days of culture, when human platelet lysate was used in the presence of osteogenic stimuli. Proteomic characterization of human platelet lysate highlighted 59 proteins mainly involved in functions related to cell adhesion, cellular repairing mechanisms, and regulation of cell differentiation. In conclusion, the combination of our gelatin–chitosan hybrid hydrogels with hPL represents a promising strategy for bone regenerative medicine using human mesenchymal stem cells.

The mechanical properties of the midpalatal suture and their relationship with anatomical parameters are relevant for both tissue engineering and clinical treatments, such as in sutural distraction osteogenesis. Soft tissues were dissected from ten swine heads and the hard palate was sliced perpendicularly to the midpalatal suture. Thirteen specimens were collected from each animal and analysed with micro-computed tomography and 4-point-bending for sutural width (Sw), interdigitation (LII), obliteration (LOI), failure stress (σ f ), elastic modulus (E), and bone mineral density (BMD). Values of the premaxillary, maxillary, and palatine region were compared with Kruskal-Wallis one-way ANOVA and Spearman’s rank coefficient was used to analyse the correlation between parameters and their position along the suture (α = 0.05). LII had values of 1.0, 2.9, and 4.3, LOI had values of 0.0%, 2.5%, and 4.5%, and E had values of 12.5 MPa, 31.3 MPa, and 98.5 MPa, in the premaxillary, maxillary, and palatine region, respectively (p

Sutures are synarthroses connecting the bones of the head with each other through a fibrous sutural ligament. The knowledge of their biomechanical properties is relevant in the application of regenerative techniques for the treatment of craniofacial conditions, such as the sutural distraction osteogenesis (SDO). However, their mechanical characterization has not received a systematic approach, and both clinical treatments and virtual simulations lack clear mechanical parameters. Online databases (PubMed©, Cochrane Library©, Google Scholar©), references of full-text articles, and previous reviews of the literature were searched. Articles quantifying the biomechanical properties of human sutures were included without date, language, or publication restrictions. A qualitative analysis was carried out based on source, sample, load, and measurement characteristics. Subsequently, mechanical parameters were discussed for each suture analyzed. No previous review was found debating the topic. Seven studies were included, only six sutures were analyzed among the about 39 existing ones, and important situations such as compressive and static loading were not considered. Only three studies analyzing the coronal, sagittal, and metopic sutures provided a clear description of the methods and determined parameters of sutures of infants and children. Although a selective load application on sutures is capable of modifying the craniofacial development, little is known about the optimal forces to be applied. The present findings may help to estimate the forces transferred to the sutural ligament during SDO when the strain is measured, and to advance the rationale of the application of certain parameters to optimize the clinical outcome.

Objective Sutures are fibrous joints connecting the bones of the head. Despite the fundamental role played by sutures in dentofacial orthopaedics, their biomechanical properties are not completely understood. This study evaluated anatomy, biomechanics, and acoustic emission (AE) during distraction of the sutural ligament (SL). Methods Seventy-two suture samples were removed from a twelve-months-old swine ( Sus scrofa ) head. Each volume was acquired using micro-computed tomography (μCT), and the linear interdigitation index was calculated on both planes ( LII COR and LII SAG ). Mechanical testing till failure was carried at 1 mm/min, and four piezoelectric sensors were used for recording of amplitude ( A ), duration ( D ), and energy ( E ) of AE. The relationships between interdigitation, fracture types, tensile stress ( σ 0 ), and AE were statistically analysed with non-parametric tests ( α = 0.05). Results σ 0 of the SL had median values of 4.0 MPa, and AE were characterised by A of 49.3 dB (IQR = 2.2), D of 826.3 μs (IQR = 533.4), and E of 57,715.8 eu (IQR = 439,613.5). Most of the fractures happened in the SL (46%), some within the bone (34%), and fewer were combined (19%). LII COR had correlation with A (0.383, p = 0.028), D (0.348, p = 0.048), and E (0.437, p = 0.011) of the AE, and σ 0 had similar relationship with A (0.500, p = 0.003), D (0.495, p = 0.003), and E (0.579, p Significance Biomechanical properties under tension of most of the sutures of the craniofacial skeleton were reported. AE provided information about the sequence of events during SL distraction, and had significant relationship with its mechanical properties. Further studies are necessary to confirm these preliminary findings, and to identify their relationship with biological processes and dentofacial treatments.

The use of elastics to close a diastema or correct tooth malpositions can create unintended consequences if not properly controlled. The American Association of Orthodontists recently issued a consumer alert, warning of "a substantial risk for irreparable damage" from a new trend called "do-it-yourself" orthodontics, consisting of patients autonomously using elastics to correct tooth position. The elastics can work their way below the gums and around the roots of the teeth, causing damage to the periodontium and even resulting in tooth loss. The cost of implants to replace these teeth would well exceed the cost of proper orthodontic care. This damage could also occur in a dental office, when a general dentist tries to perform a simplified orthodontic correction of a minor tooth malposition. The present case report describes a case of tooth loss caused by a displaced intraoral elastic, which occurred during a simple preprosthetic orthodontic treatment.

Resistance to sliding (RS) between the bracket, wire, and ligature has been largely debated in orthodontics. Despite the extensive number of published studies, the lack of discussion of the methods used has led to little understanding of this phenomenon. The aim of this study was to discuss variables affecting RS in orthodontics and to suggest an operative protocol. The search included PubMed©, Medline©, and the Cochrane Library©. References of full-text articles were manually analyzed. English-language articles published between January 2007 and January 2017 that performed an in vitro analysis of RS between the bracket, wire, and ligature were included. Study methods were analyzed based on the study design, description of materials, and experimental setup, and a protocol to standardize the testing methods was proposed. From 404 articles identified from the database search and 242 records selected from published references, 101 were eligible for the qualitative analysis, and six for the quantitative synthesis. One or more experimental parameters were incompatible and a meta-analysis was not performed. Major factors regarding the study design, materials, and experimental setup were not clearly described by most studies. The normal force, that is the force perpendicular to the sliding of the wire and one of the most relevant variable in RS, was not considered by most studies. Different variables were introduced, often acting as confounding factors. A protocol was suggested to standardize testing procedures and enhance the understanding of in vitro findings.

Background: Root resorption shall be taken into consideration during every orthodontic treatment, and it can be effected by the use of different techniques, such as the application of low friction mechanics. However, its routinely assessment on orthopantomography has limitations related to distortions and changes in dental inclination. Aim: The aim of this investigation was to evaluate the severity of apical root resorption of maxillary and mandibular incisors after low-friction orthodontic treatment, using the combination of panoramic and lateral radiographs, and applying a trigonometric correction. Settings and Design: A hospital based Retrospective study at the orthodontic Department (Dental School, University of Brescia, Spedali Civili di Brescia, Brescia, Italy). Materials and Methods: Ninety-three subjects (53 females and 40 males; mean age, 14 years) with mild teeth crowding were treated without extractions by the same operator using a low-friction fixed appliance following an integrated straight wire (ISW) protocol. The pre- and post-treatment tooth lengths of the maxillary and mandibular incisors were measured on panoramic radiographs. A trigonometric factor of correction for the pre-treatment length was calculated based on the difference between the pre and post-treatment incisal inclination on lateral cephalograms. Statistical Analysis: The changes in lengths were investigated using the Student’s t-test for paired values (p

Purpose: To evaluate some aspects of the experimental determination of the mechanical behavior of the periodontal ligament on porcine samples. The focus was on the mechanical properties of the periodontal ligament related to the presence/absence of fluid, and to the different position of the sample along the tooth root length. The application of these results could be used to develop computerized virtual models of the tooth-periodontium system. Methods and materials: Porcine mandibles were obtained from pigs (8–12 months old). From each one four blocks were cut, containing one complete inferior incisor and surrounding bone, then six sections were cut (each 2mm thick). Twelve samples were obtained from animals just suppressed and once sliced, put into a plastic container and immersed in physiologic solution. A testing chamber was built to apply tensile/compressive/shear displacements to samples in pressurized liquid. Inside the chamber a ±100N load cell was placed and a 100 cm long vertical tube allowing the application of a pressure when filled with liquid. The displacements were obtained through an endless screw activated by a servo-controlled motor. Preliminary tests were performed to determine the correct clamping method and the minimum non-slipping force of the grips. Tests were done at a constant displacement of 1mm/min. Experiments were done at room temperature (23 ◦C). Monotonic tension, compression, and shear tests, up to failure, have been performed and standard one-way ANOVA analyses was used (a=0.05). Results: Typical tension/compression and shear stress–strain curves were shown. Results in tension were substantially undisturbed by the presence/absence of liquid in the testing chamber. On the contrary, compression tests revealed a quite notable stiffness increase associated to the presence of pressurized liquid. It appears that only the shear mechanical parameters were correlated to the position of the sample along the tooth root. Conclusion: It is important to perform tests keeping the samples immersed in pressurized fluid. The most coronal sections seem to provide slightly higher strength values, as could be expected considering their proximity to the cementenamel junction.