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Introduction: Besides the mid-palatal suture maturation stage, the morphology of the palate might also play a role in the effectiveness of miniscrew insertion planning or effectiveness of palatal expansion., Objectives: The aim was to assess the mid-palate length, height and surface area according to the mid-palatal suture maturation stage and its correlation to the maturity of the transverse palatine suture on cone-beam computed tomography (CBCT) maxillary images in a consequently selected group of subjects., Material and Methods: High-resolution CBCT images of 100 subjects (56 females, 44 males), aged 33.9±22.7 years, were selected. The images were clustered according to the mid-palatal suture maturation stage (stages B, C, D, and E) and 25 images per stage group were retrieved. The length, heights (at 2mm intervals) and surface area of the mid-palate were measured from the posterior border of the incisal foramen to the posterior nasal spine, and the maturity of the transverse palatine suture was recorded., Results: No between-stage-group differences were seen for mid-palate length, while heights and surface areas were significantly different between maturational stages. The mid-palate height was significantly smaller in maturational stages D and E groups (5.65±1.55mm and 5.77±1.70mm, respectively) than in groups B and C (6.97±1.82mm and 7.00±1.53mm, respectively). However, differences were significant only distally to the sixth mm measurement point. The surface area was significantly different among groups, denoting higher values for stage B and C (1.82±0.55cm 2 and 1.86±0.41cm 2 , respectively), compared to stage D and E groups (1.53±0.38cm 2 and 1.57±0.54cm 2 , respectively). A significant negative but poor correlation was seen between mid-palate total average height, surface area and mid-palatal suture stage (rho=-0.278, P=0.005 and rho=-0.222, P=0.027, respectively). Moreover, a very strong to moderate positive correlation (rho=0.847, P<0.001, rho=0.739, P<0.001) was seen between age and the maturational stage of the mid-palatal and transverse palatine sutures, respectively. Both the mid-palatal and transverse palatine sutures maturity stages were positively and very strongly correlated (rho=0.839, P<0.001)., Conclusions: The height and surface area of the mid-palate were significantly different among the maturational stage groups, while no differences were observed regarding the mid-palate length. Less mature sutures exhibit greater height and surface area values than more mature sutures. Although further research is needed in this regard, the mid-palatal suture maturational stage C showed greater distribution variability in terms of the transverse palatal maturation stages, which might be a discriminating factor between successful and unsuccessful skeletal palatal expansion, even with the use of skeletal anchorage devices., (Copyright © 2024 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background/objectives: Recently, lateral cephalograms have been proposed for guided miniscrew insertion planning. Therefore, the aim was to assess the reliability and safety of such planning on corresponding cone-beam computer tomography (CBCT) images., Materials/methods: Intraoral scans, lateral cephalograms, and CBCT images of 52 subjects (even sexes distribution), aged 15.1 ± 2.5 years, were included. Miniscrew (n = 104) insertion planning was performed using lateral cephalograms superimposed on the maxillary intraoral scans, while the assessment of their bicortical placement, length in bone, contact with adjacent teeth, incisive canal, and nasal floor perforation was done on corresponding superimposed CBCT images. Moreover, maxillary incisor inclination, crowding, and the maxillary intercanine width were measured., Results: The overall miniscrew length in bone was 7.2 ± 1.3mm. Bicortical placement was seen in 58.7% of the sample (38.5% of subjects). Incisive canal and nasal floor perforation was seen in 25% and 21.2% of subjects, respectively. No contact of the miniscrew with adjacent teeth was recorded. A negative significant interaction was seen between the miniscrew length in bone, the percentage of total miniscrew length and maxillary anterior teeth crowding (β, -0.10, P = .047 and β, -0.90, P = .006, respectively). Moreover, a positive significant interaction was seen between the incisive canal perforation and maxillary anterior teeth crowding (OR = 1.32, P = .021)., Limitations: Exclusion of subjects with impacted teeth., Conclusions: Miniscrew insertion planning using lateral cephalograms, despite being safe in preventing contact with adjacent teeth, is limited in achieving bicortical placement and insufficient in completely avoiding incisive canal and nasal floor perforation., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Orthodontic Society.)

Objectives: The study aimed to compare severe crowding treatment's skeletal and dental effects by serial extractions or maxillary expansion and serial extractions in the mixed dentition phase., Setting and Sample Population: The retrospective controlled study included lateral cephalograms of 78 subjects aged 8.5 ± 1.4 years, 52 consecutively treated because of severe crowding, and 26 untreated controls matched for baseline age and observational period., Methods: Subjects were clustered according to the treatment modality, either serial extraction (EX) or expansion and extraction (EXP-EX) group. Sagittal and vertical skeletal as well as dental cephalometric parameters were assessed at baseline and after the eruption of all permanent posterior teeth, and group comparisons were performed., Results: Both treatment modalities significantly affected the vertical skeletal parameters in terms of decreasing the mandibular and occlusal plane inclination and increasing the facial height index. A distinct treatment effect on the gonial angle was observed, with a significant decrease in its superior part observed in both extraction groups. The annualized changes in the superior part of the gonial angle significantly differ (P = .036) between the Control (-0.04 ± 0.6), EX (-0.44 ± 0.6) and EXP-EX (-0.34 ± 0.5) groups. Upper and lower incisor inclination did not change significantly in any of the groups; however, the interincisal angle at follow-up was significantly smaller in the Control compared with both treated groups., Conclusions: Serial extractions and a combination of maxillary expansion and serial extractions have similar significant skeletal effects, mainly affecting vertical cephalometric parameters if performed during the pre-pubertal growth phase., (© 2023 The Authors. Orthodontics & Craniofacial Research published by John Wiley & Sons Ltd.)

Aim: The aim was to compare the degree of back symmetry in two groups of subjects with and without pathologic facial asymmetry and to assess any possible associations between face and back asymmetry evaluated on three-dimensional surface face and back scans., Materials and Methods: The study design consisted of allocation of 70 subjects (35 females, 35 males) aged 6.4±0.5 years, according to the percentage of whole face symmetry assessed on three-dimensional (3D) facial scans into a 'symmetric' (symG; symmetry ≥70%) and 'asymmetric'(asymG; symmetry <70%). The 3D face and back scans were analysed using colour deviation maps and percentages of symmetry of the whole face and back surfaces as well as their three separate areas: forehead, maxillary and mandibular areas for the face and neck, upper and middle trunk areas for the back, were calculated. Non-parametric statistical tests were used for between-group comparisons (Mann-Whitney U test). Within each group, differences between each face or back area were tested with the Friedman test. Correlations between face and back symmetry were assessed with the Spearman rho coefficient., Results: The symG exhibited a significantly higher symmetry in each facial area than the asymG. The mandibular area was the least symmetric area of the face within each group, with significantly smaller values than the maxillary area in the symG and significantly smaller values than the forehead and maxillary area in the asymG. The percentage of whole back symmetry did not significantly differ (p>0.05) between the symG ( 82.00% [67.4;88.00]) and asymG (74.3% [66.1;79.6]). The only significant between-group difference was observed for the symmetry of the upper trunk area (p=0.021), with lower symmetry values in the asymG. No significant associations were detected between face and back parameters., Conclusion: The percentages of symmetry in each facial area were significantly higher among subjects without pathologic facial asymmetry. The most asymmetric area of the face, regardless of the degree of whole face symmetry, was its mandibular area. No significant differences were detected within different back areas; however, subjects with asymmetric faces showed significantly smaller symmetry of their upper trunk area.

Introduction: Despite the substantial prevalence of skeletal Class II Division 1 malocclusion, only a few studies analyzed the maxillomandibular growth changes in these subjects with contrasting results. This study compared the longitudinal maxillomandibular growth changes in growing subjects with Class I and II skeletal relationships, specifically during the circumpubertal growth phase assessed by the modified third finger middle phalanx maturation (MPM) method. An attempt to uncover any maxillomandibular growth peak in subjects with Class II relationship has been followed., Methods: From the files of the Burlington Growth Study, a total of 32 subjects (13 males, 19 females) with at least 7 annual lateral cephalograms taken at 9 and 16 years old were included and equally distributed between Class II and Class I groups matched for sex. Overall changes in 12 cephalometric parameters were calculated, and maxillomandibular growth peak was also identified individually and used to register subjects according to the year of growth peak ± 2 years. According to this procedure, annualized changes (trends) were analyzed along with the corresponding prepubertal, pubertal, and postpubertal MPM stages., Results: No significant differences were seen between subjects with Class I and II skeletal relationships at 9 and 16 years, except for the parameters of the sagittal maxillomandibular relationship, such as ANB angle. Overall, changes for all the cephalometric parameters were similar between the groups, except for the CoGn distance increment that was significantly lower in the subjects with a Class II relationship. In both groups, the annual changes in CoA, CoGn, and CoGo distances showed a clear peak at the time point corresponding to a median MPM stage 3., Conclusions: In subjects with a skeletal Class II relationship, mandibular deficiency appears to be mostly established during the prepubertal growth stage and further aggravated during puberty. However, the maxillomandibular growth trend in subjects with Class II relationship is generally similar to that of subjects with a Class I relationship, including the existence of a pubertal peak., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

To evaluate the effect of long-term in-vivo aging on orthodontic archwires, we aimed to assess the triboelectrochemical and mechanical characteristics of as-received and in-vivo aged nickel-titanium (NiTi) and stainless-steel (SS) orthodontic archwires. Four consecutive tribocorrosion cycles on six NiTi and six SS archwires, as-received and in-vivo aged, were performed on a reciprocal tribometer. Electrochemical noise and friction coefficient measurements, three-dimensional surface profiling, and hardness measurements were performed. Repassivation times of as-received archwires were longer than of the in-vivo aged; however, were shorter for NiTi. Friction coefficients were higher for NiTi than for SS archwires. Sudden major current drops concomitant with inverse potential shifts and friction coefficients' fluctuations, were seen for as-received (last cycle) and in-vivo aged (last three cycles) NiTi archwires. More pronounced tribocorrosion damage was observed on in-vivo aged NiTi than on other archwires. Hardness was generally higher inside the wear track of archwires. Long-term in-vivo exposure decreases the corrosion susceptibility of archwires, more evidently for the NiTi ones. Sudden major fluctuations in electrochemical current, potential, and friction coefficient detected for NiTi archwires, might be related to localized residual parts of the oxide layer persisting due to increased surface roughness or to phase transformations of the alloy's crystal structure.

Objectives: The aim was to assess the diagnostic ability of the crown-to-root length ratio of the primary second molar and the position of the corresponding underlying premolar in estimating future anchoring teeth exfoliation during maxillary expansion., Setting and Sample Population: Fifty-four subjects (30 females, 24 males; 108 teeth) aged 8.2 ± 1.0 years that underwent palatal expansion., Methods: The upper second premolar position of the corresponding expander anchoring primary molar was determined in relation to the ipsilateral first permanent molar half-pulp chamber (HPC) line on panoramic radiographs. Subjective and objective (based on measurements) assessments of the crown-to-root length ratio of anchoring primary molars were performed. Exfoliation after the expansion was recorded over a retention period of 12 months. All the assessments were performed individually by three examiners at two 3-week-apart sessions, trained and calibrated before enrolment. The intra-/inter-examiner agreements were evaluated, and the diagnostic accuracy of the methods was calculated., Results: All methods exhibited almost perfect intra- and at least substantial inter-examiner agreement (Kappa >0.8 and ≥0.63, respectively). Good diagnostic accuracy was seen for the premolar position to the HPC line (0.7-0.8), while the crown-to-root length ratio methods exhibited hardly sufficient accuracy. The diagnostic agreement of the methods was fair., Conclusions: When primary molars are considered as anchoring teeth for maxillary expansion, the premolar position in relation to the HPC line appears to be the most valid and reliable method for predicting their stability. Despite high repeatability values, the crown-to-root length ratio needs a cut-off point re-definition to increase its predicting ability., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The aim was to identify factors associated with maxillary expander loss due to anchoring deciduous molars exfoliation and assess the diagnostic accuracy of the upper second premolar cusp position as a prognostic factor for the exfoliation of its corresponding deciduous molar., Materials/methods: Ninety-two subjects aged 8.4 ± 1.1 years, treated with a Haas or hyrax expander, and using the same expansion protocol and deciduous teeth as anchorage were included. The position of the upper second premolar cusp, according to the half pulp chamber (HPC) line of the ipsilateral upper first permanent molar, was assessed on pre-treatment panoramic radiographs., Results: A significant association between anchoring deciduous molar exfoliation and the position of the upper second premolar cusp according to the HPC line (P = 0.002; odds ratio = 5.7) was seen, while there was no association with gender, age, treatment duration, and type of expander. The median survival time for an anchoring deciduous molar, when the underlying premolar cusp was touching/crossing the HPC line, was 13.0 (11.7; 14.2) months. The upper second premolar cusp position to the HPC line showed high accuracy (at least 76.11 per cent) and substantial repeatability (at least 0.7) as a prognostic factor for the corresponding second deciduous molar exfoliation., Limitations: Applicability in the mixed dentition phase with fully erupted upper first permanent molars., Conclusions: The probability of a second deciduous molar to be successfully used as maxillary expander anchorage for at least 16 months is above 94 per cent; when at baseline, the corresponding premolar cusp is apical to the HPC line., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: The cervical vertebral maturation (CVM) method comprises 6 stages reported to be prepubertal (1 and 2), pubertal (3 and 4) and postpubertal (5 and 6), and its use has been recommended for planning treatment timing in orthodontics. Reliable use of the method implies that pubertal stages have to mature into postpubertal as soon as the growth peak is terminated. The present study was aimed at determining whether postpubertal CVM stages 5 or 6 are attained in all subjects., Methods: A total of 450 adult subjects (270 females and 180 males; mean age, 30.4 ± 27.3 years; range, 20-45 years) seeking orthodontic treatment and having a lateral head film were included in the study. Customized cephalometric analysis was used, and each recording was converted into an individual CVM code according to the concavities of the C2 to C4 and shapes of C3 and C4. The retrieved CVM codes, either falling within the reported norms (regular cases) or not (exception cases), were also converted into the CVM stages and a newly introduced CVM score (0-9) capable of defining intermediate stage., Results: The most frequent CVM stage was 5, while the CVM stage 6 was attained in only one third of the sample. Up to about 11% of adult subjects showed the pubertal CVM stage 4. Irrespective of the CVM stage or CVM score, no significant differences were seen between the sexes or across ages. The C4 showed a rectangular vertical shape in only 16.4% of the cases., Conclusions: The percentage of adult population maintaining a pubertal CVM stage 4 is not high, but still relevant from a clinical standpoint. In light of this finding, planning treatment timing-based only on CVM appears not fully reliable., (Copyright © 2019 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background/objectives: Since a high prevalence of back anomalies has been reported among subjects with crossbite, the aim was to assess the degree of back symmetry among subjects with (crossbite) and without (control) unilateral functional crossbite during the pre-pubertal growth phase., Methods: A group of 70 subjects (36 boys, 34 girls; 6.8 ± 1.2 years) in the primary or mixed dentition phase were included. Clinical assessment of head posture, shoulder, scapula and hip height were performed with the subject standing, and differences between the left and right side greater than 5 mm recorded. Asymmetry of the scapula and trunk prominence greater than 8 mm was recorded along with the prominence of thoracic and lumbar paravertebral musculature during the forward-bending test. Back symmetry was assessed qualitatively and quantitatively on colour deviation maps of superimposed mirrored three-dimensional back scans at a tolerance level of 2 mm., Results: No significant differences were observed between the groups regarding the frequency of clinically assessed back anomalies. The percentage of back symmetry was slightly lower in the crossbite than that in the control group (71.4 ± 13.3% and 79.2 ± 12.1%, respectively). A significant association (P < 0.05) was seen between scapula plane inclination (OR = 3.41) and scapula prominence inequalities (OR = 3.29) and unilateral functional crossbite, while hip height inequalities (OR = 0.94) were more frequent in the control group. No associations were detected between the side of crossbite and side of prominence of back parameters., Limitations: The use of different thresholds for clinical (5-8 mm) and three-dimensional (2 mm) symmetry assessment., Conclusions: Although some degree of back asymmetry was detected in the crossbite group during the pre-pubertal growth phase, this asymmetry does not appear to be clinically relevant., (© The Author(s) 2018. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The aim of the study was to assess the level of selected systemic oxidative stress parameters during the first week of orthodontic treatment with fixed appliances. Fifty-four males with malocclusion and having a similar lifestyle were randomized using a computer based procedure and allocated to either the treatment group (TG; n=27;24.6 ± 1.7 years) or control group (CG; n=27;24.7 ± 1.7 years). Capillary blood was collected at baseline and 6 hours, 24 hours, and 7 days after archwire insertion. At the same time points, capillary blood was retrieved in the CG. In order to determine the oxidative stress, both the reactive oxygen species (ROS) formation and the antioxidative defense (AD) potential were measured using the ROS testing and oxygen free radicals defense (equivalent to antioxidant defense) testing, respectively, by a blinded operator. The ratio between ROS and AD (ROS/AD) was calculated and data were analyzed using nonparametric tests. No drop-outs or harms were detected. At baseline, neither ROS (1.54 [1.22; 2.12] and 1.74 [1.40; 2.01] for the TG and CG, respectively), AD (1.19 [0.66; 1.50] and 1.19 [0.57; 1.42] for the TG and CG, respectively), nor ROS/AD levels were significantly different (p>0.05). After 24 hours, the ROS level significantly increased in the TG (2.05 [1.71; 2.26]) and was higher compared to the CG ROS level (1.67 [1.29; 1.95]; p=0.025), while for the AD level, no marked between and within group differences were detected. A notable change of ROS/AD ratio was observed over time only within the TG (p=0.026). Moreover, a significantly higher ROS/AD ratio was detected 24 hours after archwire insertion in the TG compared to the CG (2.69 [1.44; 3.89] and 1.79 [1.45; 2.35], respectively), followed by a decrease. Orthodontic treatment with fixed appliances might induce systemic oxidative stress in the short-term, since ROS levels and ROS/AD levels are normalized within 7 days after archwire insertion.

Objective: This study investigated the prevalence of the signs and symptoms of temporomandibular disorders (TMD) among Italian adolescents., Methods: The data were recorded from 567 subjects (246 males and 321 females; age range 11-19 years), grouped according to age and molar class relationship., Results: Forty-four point one percent of subjects showed at least one sign or symptom of TMD, which were significantly more frequent in the 16-19 year-old group (52.9%) in respect to the 11-15 year-old group (39.8%) (χ 2  = 8.78; p = 0.003). Signs and/or symptoms were about 1.6 times more frequent in subjects with Class II/1 malocclusion (χ 2  = 13.3, p = 0.0003), mostly for TMJ sounds (χ 2  = 1.444; p = 0.036). Myalgia was more frequent in females than in males (χ 2  = 3.882; p = 0.049)., Conclusion: TMD signs and/or symptoms among Italian adolescents seem diffused (44.1%). Therefore, all adolescents should be screened thorough medical history and clinical examination.

Background/objectives: The capability of the cervical vertebral maturation (CVM) method in the identification of the mandibular growth peak on an individual basis remains undetermined. The diagnostic reliability of the six-stage CVM method in the identification of the mandibular growth peak was thus investigated., Subjects/methods: From the files of the Oregon and Burlington Growth Studies (data obtained between early 1950s and middle 1970s), 50 subjects (26 females, 24 males) with at least seven annual lateral cephalograms taken from 9 to 16 years were identified. Cervical vertebral maturation was assessed according to the CVM code staging system, and mandibular growth was defined as annual increments in Co-Gn distance. A diagnostic reliability analysis was carried out to establish the capability of the circumpubertal CVM stages 2, 3, and 4 in the identification of the imminent mandibular growth peak., Results: Variable durations of each of the CVM stages 2, 3, and 4 were seen. The overall diagnostic accuracy values for the CVM stages 2, 3, and 4 were 0.70, 0.76, and 0.77, respectively. These low values appeared to be due to false positive cases., Limitations: Secular trends in conjunction with the use of a discrete staging system. In most of the Burlington Growth Study sample, the lateral head film at age 15 was missing., Conclusions/implications: None of the CVM stages 2, 3, and 4 reached a satisfactorily diagnostic reliability in the identification of imminent mandibular growth peak.

Objectives: To assess arch width, palatal surface area, and volume in surgically treated unilateral cleft lip and palate (UCLP) in mixed dentition children in comparison with non-cleft lip and palate (NCLP) children using a 3D laser scanning., Materials and Methods: 38 subjects (Caucasian origin), 5.63-11.9 years of age (mean, 9.33 ± 1.67 years), were included. 19 in each group (UCLP and NCLP). Digital dental casts were obtained using a 3 Shape R700 laser scanner. Intercanine and intermolar widths (cusp and gingival levels), palatal surface area and volume were measured. An independent sample Student's t-test and an ANOVA were undertaken with significance level set as P < 0.05., Results: Intercanine widths at the cusp (5.60 mm; P < 0.001) and at the gingival level (3.11 mm; P = 0.014), palatal area (141.5 mm2; P = 0.009) and volume (890.7 mm3; P = 0.029) were significantly lower in the UCLP compared to the control group., Limitations: A smaller part of the subjects was in late mixed dentition phase. To overcome this limitation a matched control group was used. In seven subjects with UCLP, some teeth were missing, which might have had an influence on the dental measurements. However, these subjects could not be excluded because eliminating more severely affected subjects, would have introduced bias., Conclusions: Three-dimensional evaluation of the maxillary arch and palate highlighted significant differences between UCLP and non-UCLP subjects in mixed dentition phase, suggesting that orthopaedic maxillary expansion is advisable in UCLP., (© The Author 2017. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com)

Objective: To investigate the diagnostic reliability of mandibular second molar maturation in assessing the mandibular growth peak using a longitudinal design., Materials and Methods: From the files of the Burlington and Oregon growth studies, 40 subjects (20 from each collection, 20 males and 20 females) with at least seven annual lateral cephalograms taken from 9 to 16 years were included. Mandibular second molar maturation was assessed according to Demirjian et al., and mandibular growth was defined as annual increments of Co-Gn distance. A full diagnostic reliability analysis (including positive likelihood ratio) was performed to establish the diagnostic reliability of dental stages E, F, and (pooled) GH in identifying the imminent mandibular growth peak., Results: None of the dental maturation stages reliably identified the mandibular growth peak with greatest overall mean accuracy and positive likelihood ratio of 0.77 (stage F) and 2.7 (stage E), respectively., Conclusions: Use of the mandibular second molar maturation is not recommended for planning treatment requiring identification of the mandibular growth peak.

Background/objectives: Facial soft tissues changes during growth roughly tend to mimic the underlying hard tissues, but not completely. The aim of this mixed longitudinal study was to assess facial growth among pre-pubertal and pubertal subjects without malocclusion using a non-invasive three-dimensional laser scanning system., Subjects/methods: Fifty-nine subjects (30 females and 29 males) aged at baseline 5.4-8.9 years with normal occlusion were clustered into the younger, older pre-pubertal, and pubertal groups according to age and the absence/presence of a standing height growth spurt. Three-dimensional facial images were obtained using laser scanners for five consecutive years. Several transversal, sagittal, and vertical parameters were assessed for between and within group comparisons., Results: Significant overall changes of almost all parameters were seen within each group (P < 0.05) without any group differences (P > 0.05). The younger pre-pubertal group showed greater annual growth rates of lip prominence; both pre-pubertal groups showed greater rates in facial middle third height. The pubertal group showed greater annual rates in facial profile angle changes during the growth peak., Limitations: A high standing height increment (7cm) was used as the threshold for subject allocation in the pubertal group., Conclusions: Soft tissue facial growth has generally similar amounts and rates irrespective of the pubertal growth spurt. Pre-pubertal subjects show greater annual rates of facial middle third height changes while pubertal subjects show greater annual rates of chin protrusion., (© The Author 2016. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: The aim of this study was to monitor the alveolar bone formation at the tension sites of teeth supporting the appliances for rapid maxillary expansion (RME) during the retention phase according to the local gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity., Methods: This split-mouth prospective study included 23 prepubertal subjects (15 girls, 8 boys; mean age, 9.0 ± 1.4 years) who had a constricted maxillary arch and were undergoing RME. Periodontal parameters, including probing depth, were recorded at 3 and 6 months after RME. Furthermore, the GCF ALP activity was measured at the tension sites of the supporting test teeth (TT) and at the antagonist control teeth (CT) sites., Results: Periodontal parameters were generally similar between the TT and CT sites during the study, with the exception that probing depth underwent a slight increase at the TT sites. At baseline, the GCF ALP activity was similar between the TT and CT sites; however, at both 3 and 6 months, significantly greater enzymatic activity was seen at the TT sites. The overall probing depth changes were not significantly correlated with the corresponding GCF ALP activity changes for either the TT or the CT sites., Conclusions: Alveolar bone formation at the tension sites would last up to 6 months of retention after RME. These results warrant more comprehensive studies to assess whether the GCF ALP activity has potential as a diagnostic tool for bone formation during the retention phase of RME., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the anatomical characteristics of the maxillary arch, identified as palatal surface area and volume, between mouth-breathing and nose-breathing subjects using a three-dimensional (3D) analysis of digital dental casts., Methods: Twenty-one Caucasian subjects (14 females and 7 males) with a mean age of 8.5 years [standard deviation (SD) 1.6 years] were selected according to the following criteria: mouth-breathing pattern due to allergic rhinitis, early mixed dentition, skeletal Class I relationship, and pre-pubertal stage of cervical vertebral maturation. This study group (SG) was compared with a control group (CG) of 17 nose-breathing subjects (9 females and 8 males, mean age: 8.5 years; SD: 1.7 years). For each subject, initial dental casts were taken and the upper arch was scanned using a 3D laser scanner. On each digital model, 3D measurements were performed to analyse maxillary arch morphology. Between-group differences were tested with the independent sample Student's t-test (P < 0.05)., Results: In mouth-breathing subjects, changes in physiological function of the upper respiratory tract resulted in skeletal adaptations of the maxillary arch. In the SG, both palatal surface area and volume were significantly smaller when compared with values of the CG. In particular, the palatal surface area and palatal volume were, respectively, 13.5 and 27.1 per cent smaller in the SG when compared to the CG., Conclusions: Subjects with prolonged mouth breathing showed a significant reduction of the palatal surface area and volume leading to a different development of the palatal morphology when compared with subjects with normal breathing pattern., (© The Author 2014. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background/objective: Facial asymmetry is very common in adult class III patients; however, the degree of facial asymmetry in growing class III subjects has been poorly investigated. Therefore, the aim was to assess the degree of facial asymmetry of growing class III subjects and to compare it with a sample of growing subjects without malocclusion, recorded using a three-dimensional laser scanning method and classified according to the dentition phase., Subjects/methods: A group of 156 Caucasian subjects, 52 with class III malocclusion (28 females and 24 males) and 104 without malocclusion (control, 51 females and 53 males), with an overall mean age 6.7±1.4 years (range 4.3-10.3 years), were included. The subjects were further subdivided according to the presence of either primary or early/intermediate mixed dentitions. Facial asymmetry was assessed on three-dimensional surface facial images obtained using a laser scanning device in terms of mirrored face distances and percentages of asymmetry. Multivariate analyses were used to assess the differences among class III and control groups., Results: Complete facial symmetry was not seen in any subject. No significant differences of facial asymmetry were observed between the class III and control groups, neither in the primary nor in the early/intermediate mixed dentition phases., Limitations: No conclusions about longitudinal changes in the degree of facial asymmetry among class III subjects could be drawn from the present cross-sectional study., Conclusions: Based on three-dimensional facial asymmetry analysis, class III subjects do not show clinically relevant facial asymmetry, at least during the pre-pubertal growth period., (© The Author 2013. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background/objectives: Prematurely born children show significant delay in many areas of physical development, including the orofacial structures. The aim of the present study was to evaluate the influence of premature birth on the prevalence of functional and morphological characteristics of malocclusion in the deciduous dentition phase, considering also confounding variables, such as type of feeding and oral habits., Material/methods: Through questionnaires and clinical examinations of 80 prematurely born subjects (42 females, 38 males, aged 24.46 ± 1.77 months; PBG) and 113 controls (50 females, 63 males, aged 25.42 ± 2.64 months; CG) in the deciduous dentition phase, data about feeding modalities, sucking habits, and functional and morphological characteristics of malocclusion were collected, and the two groups were compared for differences (chi-square test). Logistic regression analysis was used for risk assessment., Results: The prevalence of functional and morphological characteristics was not significantly different (P > 0.05) in PBG compared with the CG, and premature birth was not a risk indicator for any characteristics of malocclusion. The main significant risk indicators for class II/1 malocclusion were dummy (OR = 3.13; P < 0.01) and thumb sucking (OR = 4.41; P < 0.05), while dummy sucking alone was a risk indicator for anterior open bite (OR = 12.19; P < 0.001)., Limitations: In the present study, the PBG and CG were close in mean gestational age and birth weight, which might have influenced the results., Conclusions: Prevalence of malocclusion among prematurely born subjects is not significantly different compared with controls, and premature birth is not a risk indicator for any functional or morphological characteristics of malocclusion.

Conflicting data have been reported in dentistry regarding the diagnostic potential of monitoring body sway while in a static standing bipedalic position. This systematic review reappraises previously reported effects of mandibular position, asymmetric occlusion, and temporomandibular disorders (TMDs) on body sway to determine whether there is sufficient evidence for such correlations and to define the potential diagnostic applications in orthodontics. A literature survey was performed using the Medline, LILACS, and SciELO databases, and the Cochrane Library, covering the period from January 1980 to December 2011. Twelve articles qualified for the final analysis. All of these studies investigated the effects of mandibular position, two focussed also on asymmetrical occlusion, and three on TMDs. Only two studies were judged to be of medium or medium/high quality, with all of the rest classified as low-quality design; no study included follow-up. According to the conclusions of these reports, four studies saw significant correlations between body sway and mandibular position or TMDs. After a reappraisal of the full data set, generally no clinically relevant correlations were uncovered in the comparisons. While more investigations with improved levels of scientific evidence are needed, according to current evidence, the static monitoring of body sway as a diagnostic aid in orthodontics may not be indicated.

Background: Major surgery suppresses the cell-mediated immune response in children and adults. Data on preoperative and postoperative T-cell counts in pediatric surgical patients and their relationship to health-care-associated infection (HAI) are not yet known., Methods: A prospective observational study was carried out in a level III multidisciplinary neonatal and pediatric intensive care unit. Before and after, and in the first 3 days after surgery, lymphocyte subsets in peripheral blood were measured in 28 neonates and infants on flow cytometry. HAI were classified according to CDC/NHSN criteria., Results: Six out of 28 neonates and infants (21.4%) developed HAI (group I-HAI), while 22 out of 28 (78.6%) remained infection free (group II-non-HAI). In group I with HAI, the preoperative median cytotoxic T-lymphocyte (CD8-T-cell) level was found to be below normal, and remained very low throughout the study period. In addition, the median and interquartile CD8 T-cell range (358 cells/μL; 304-424 cells/μL) were twice as low compared to group II without HAI (822 cells/μL; 522-933 cells/μL; P = 0.013). No differences were found between the two groups with regard to patient demographics and clinical data., Conclusion: Neonates and infants who underwent a major surgical procedure and who had a very low preoperative CD8 T-cell level, developed HAI postoperatively., (© 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.)

The aim of the present study was to evaluate the association of tongue posture with the dentoalveolar maxillary and mandibular morphology in a group of Class III subjects in comparison to a group of Class I subjects. Twenty Class III subjects (9 males, 11 females, 19.2 ± 4.6 years) and 20 Class I subjects (6 males, 14 females, 17.4 ± 1.7 years) were included in the present study. Maxillary and mandibular morphology was defined by the intermolar and intercanine distances, at both the cusps and gingival levels, and by measuring surface area and volume of the palatal vault and mouth floor assessed on three-dimensional digital models. Tongue-to-palate distances were measured on lateral cephalograms. The groups were compared using the Mann-Whitney U-test and correlations between each morphological parameter and the tongue-to-palate distances were calculated using the Spearman correlation coefficient. The mandibular intermolar width at the gingival level was significantly greater in the Class III group (P < 0.01), while the maxillary intercanine widths were significantly smaller in the Class III group (P < 0.05). The mouth floor area and volume and the respective ratios between the mouth floor and palate were significantly greater in the Class III group (P = 0.01). The tongue-to-palate distances were generally greater, i.e. lower tongue posture, for the Class III subjects. Significant correlations were seen between tongue-to-palate distances in the posterior region with the area ratio (rho = 0.44, P < 0.05). Tongue posture is significantly lower in Class III subjects and is associated with the dentoalveolar characteristics of the maxilla and mandible.