Vertical mandibular asymmetry and hand measurements in patients in growth: cross-sectional study

Objectives

The aim of this study was to determine the relationship between the vertical mandibular ramus asymmetry and the hand measurements asymmetry in growing patients.

Material and Methods

Panoramic radiographs and comparative radiographs of the right and left hands of 40 patients (14 males and 26 females) between 6 and 16 years old (mean age of 11.35±1.99 years) were evaluated. The total height of the mandibular ramus was measured, and the asymmetry index was calculated. The lengths of the proximal, middle and distal phalanges and the metacarpals of the five digits of both hands were measured and the absolute differences R-L were calculated for each one.

Results

A statistically significant association between the presence of vertical mandibular ramus asymmetry and the presence of phalanges asymmetry FPII (p=0.016), FPIII (p=0.016), FPIV (p=0.033), FMIII (p=0.031) and FMIV (p=0.016) was observed.

Conclusions

Mandibular asymmetry appears not to be isolated but also present in other body districts such as the phalanx bones. The total vertical asymmetry of the mandibular ramus showed an association with the asymmetry of the lengths of the FPIII, FMIII, FPIV, FMIV and FPII in growing individuals, with association between the side of mandibular asymmetry and the side of the phalanx's asymmetry. The asymmetry of this phalanges increases with increasing index of vertical mandibular ramus asymmetry.

'Study of the maxillary yaw on cone beam computed tomography: A preliminary report and comparison between two different dento-skeletal malocclusions'

OBJECTIVES

To assess the skeletal and dental maxillary transverse compensation (yaw) on the cone beam computed tomography (CBCT) three-dimensional reconstructed image of the skull in two groups of patients, both clinically affected by a class III malocclusion with deviation of the lower midline.

MATERIALS AND METHODS

An observational retrospective study was designed to analyse differences in two groups of patients, the first one was composed by patients affected by horizontal condylar hyperplasia, the second one by patients affected by dento-skeletal asymmetric class III malocclusion. Each group was composed by 15 patients. Transverse analysis was performed by measuring five landmarks (three bilateral and two uneven) with respect to a mid-sagittal plane; sagittal analysis was performed by measuring the sagittal distance on the mid-sagittal plane between bilateral points. Means were compared through inferential analysis.

RESULTS

In the condylar hyperplasia group, all differences between the two sides were not statistically significant, nor for canines' difference (P = .0817), for molars (P = .1105) or for jugular points (.05871). In the class III group, the differences between the two sides were statistically significant for molars (P = .0019) and jugular points (P = .0031) but not for canines (P = .1158). Comparing the two groups, significant differences were found only for incisors' midline deviation (P = .0343) and canine (P = .0177).

CONCLUSION

The study of the yaw on CBCT should be integrated into three-dimensional cephalometry and could help in differentiating the various malocclusion patterns.

Abdominal Acupuncture for Non-Responding TMD Patients: a Retrospective Observational Study in General Practice

Background

Pain related to Temporomandibular Disorders (TMD) is severe, negatively affecting patients' quality of life, and often resistant to conventional treatments. Abdominal Acupuncture (AA) is known to be particularly effective for pain, especially chronic and musculoskeletal pain, but it is still poorly studied and never investigated in TMD patients.

Objectives

To analyze the efficacy of AA for the treatment of patients with subacute and chronic pain related to TMD and non-responding to previous conventional therapies (occlusal splint, medications, physical therapy).

Methods

Twenty-eight patients, 24 F and four M (mean age 49.36 years), were recruited from January 2019-February 2021. All patients underwent AA treatment: two sessions per week for four weeks, for a total of eight sessions. At the beginning of therapy (T0) and at the end of the cycle (T1) the following data were evaluated: maximum mouth opening (MMO); cranio-facial pain related to TMD (verbal numeric scale, VNS); pain interference with normal activities and quality of life of patients (Brief Pain Inventory, BPI); oral functioning (Oral Behavior Checklist, OBC); impression of treatment effectiveness (Patients' Global Impression of Improvement, PGI-I Scale). Statistical comparison of data before and after the AA treatment was performed by Wilcoxon's signed-rank test (significance level p < 0.05).

Results

The MMO values were significantly improved after one cycle of AA (p = 0.0002). In addition, TMD-related pain had a statistically significant decline following AA treatment (all p < 0.001). Patients' general activity and quality of life (BPI) were described as improved following a course of AA, with statistically significant values for all aspects considered (all p < 0.05).

Conclusion

Abdominal acupuncture resulted in effective treatment of subacute/chronic-resistant pain related to TMD, capable of improving mandibular function and facial pain, and reduced the interference of pain affecting patients' quality of life.

Dental and skeletal features in subjects with missing maxillary lateral incisors: a case control retrospective study

BACKGROUND

The aim of this study was to investigate the relationship between missing maxillary lateral incisors and the mesio-distal (MD) diameters of the teeth. Occlusal and skeletal characteristics of the patients have been analyzed.

METHODS

Seventy-nine patients were included in the study (permanent dentition, mean age: 13.7): 30 subjects with uni- or bilateral maxillary lateral incisors agenesis (study group, SG) and 49 patients with no maxillary lateral incisors agenesis (control group, CG). Orthopanoramics, plaster models and cephalometric analysis were used to perform the evaluations.

RESULTS

Compared to the CG, in the SG, most of the teeth had smaller MD diameter. In the bilateral agenesis subgroup, the average differences between teeth diameters were lower than those found by comparing them to the unilateral agenesis subgroup and to the SG. Overjet was reduced on average in the SG. In the SG were found less cases of cross-bite and scissor-bite, less frequency of impaction of at least one tooth and agenesis of other teeth, crowding only in the lower arch, square or ovoid arch shape in the upper arch and square in the lower arch, increased interincisal angle and decreased SN^GoMe.

CONCLUSIONS

Upper lateral incisors agenesis, especially in cases of unilateral agenesis, is associated with MD teeth reduction. The agenesis of the upper lateral incisors is associated with a greater probability of agenesis affecting other teeth, molar and canine class II, reduced overjet and overbite, square or ovoid upper arch shapes, increased interincisal angle and reduced total divergence.

Efficacy and Accuracy of Maxillary Arch Expansion with Clear Aligner Treatment

The aim of this work was to evaluate the efficacy and accuracy of maxillary arch transverse expansion using the Invisalign^® clear aligner system without auxiliaries other than Invisalign attachments. Knowing the accuracy of a movement through a clear aligner system allows the clinician to plan the treatment with greater precision and to achieve the expected result faster. The study group included 28 patients with a mean age of 17 ± 3.2 years. The treatment protocol for all the selected patients included the application of the Invisalign^® clear aligner system without auxiliaries, except for the Invisalign^® attachments; in no case were tooth extraction or interproximal enamel reduction (IPR) performed. Linear measurements of the expansion were assessed before treatment (T0), at the end of treatment (T1), and on final virtual models by ClinCheck^® (TC). A paired t-test was used to compare T0-T1 and T1-TC differences. A paired t-test was applied, and one normality was validated with the Shapiro-Wilks test. If normality was not met, the nonparametric test (Mann-Whitney U test) was applied. The level of significance was set at 5%. Statistically significant differences were found for all measurements at T0-T1. The results showed an average accuracy of efficacy of 70.88%. The differences in predictability between the various vestibular measurements (intercanine, inter-premolar, and intermolar) were not statistically significant, while they were for gingival measurements. The overall accuracy of the expansion treatment was 70%, regardless of tooth type.

Correlation between generalised joint hypermobility and temporomandibular joint disc displacement in adolescent patients: Magnetic Resonance Imaging study

AIM

Temporomandibular disorders (TMD), in particular disc displacement, are recognised to have a multifactorial aetiology. Ligamentous laxity has been suggested as a potential risk factor for TMD. Ligamentous laxity can lead to generalised joint hypermobility (GJH) involving multiple joints, including the temporomandibular joint (TMJ). The aim of this work is to evaluate the correlation between GJH and disc displacement (DD) assessed on magnetic resonance images (MRI) of the TMJ in adolescent patients.

MATERIALS

The study was included 40 adolescent patients (10-16 years), divided into two groups, a Study Group (SG), composed of 20 subjects with GJH, and a Control Group (CG), composed of 20 subjects without GJH. The GJH was assessed by the Beighton test with a threshold value of ≥ 4. The severity of the TMD was determined using the Fonseca Questionnaire and a clinical evaluation of the type of TMD. The condylar-discal relationship and the condylar mobility of the TMJ were evaluated by MRI. Pearson's χ2 Test was performed for the analysis of the statistical correlation.

CONCLUSION

This study suggests that adolescents with GJH have a greater risk of developing TMJ disc displacement, especially disc displacement without reduction.

The cornea as a reference point in orthodontic diagnosing, a retrospective study

BACKGROUND

The aim of the study is to provide scientific evidence on the possibility of using the Corneal point a skin point for measu-rements that can be made on both standard and three-dimensional photographs. Also, we want to demonstrate the stability of corneal point during the growth, to use it as a reference point.

METHODS

A sample of 105 radiographs was reached. A descriptive and longitudinal statistical analysis was performed.

RESULTS

By data analysis we obtained more variability inter-subject of the millimetrically value of the SC plan. For this reason, we consi-dered the relationship between the SN and SC values and not a single value. In the cross-sectional study the T- test analysis did not show a different significant result of variations between SC and SN in both sexes; therefore, we considered these as unique sample.

CONCLUSION

Longitudinal study has a major importance for to esta-blishing the age-related changes. By cross-selection and longitudinal analysis we obtained an overlapping trend of the SN and SC plan. As the SN plan has always been used as a reference plan for cephalometric measurements, although its variations in growth, it can be concluded that the SC plan can be considered equally a reference plan.

Auriculotherapy used to manage orthodontic pain: a randomized controlled pilot study

INTRODUCTION

Several methods are commonly used to decrease orthodontic pain, but versatile tools and standardized protocols are still lacking.

OBJECTIVE

In response to the need for alternatives to conventional analgesic methods, this study evaluates the analgesic effects of auriculotherapy (AT) during the first three months of fixed orthodontic treatment.

METHODS

A sample of 36 subjects was selected, with patients randomly allocated into two homogeneous groups, Study Group (SG) and Control Group (CG), depending on the application/non-application of AT. Patients rated their pain scores monthly from 0 to 10, on visual analogue scales (VAS) at the time of bonding (T0) and again at two appliance adjustments (T1 and T2). At each of these treatment phases, VAS was applied in six different time moments (TM): immediately before, immediately after, after 4 hours, after 8 hours, after 24 hours, and after 72h hours. Descriptive statistical analysis, a Student's t-test, and a Chi-square test were applied to the collected data (statistical significance for p< 0.05).

RESULTS

SG patients reported lower pain levels than CG patients, both at T0, T1 and T2. Moreover, average pain intensity values were lower in the SG for all TM analyzed, with the t-test significant (p< 0.05) for most TMs.

CONCLUSION

AT was effective in the pain treatment of patients with fixed orthodontic appliances. Further studies are needed with a sham control group to confirm the validity of these results.

Effects of laser photobiomodulation in the management of oral lichen planus: a literature review

Objectives

This review aims to understand whether Photobio-modulation (PBM) therapy is a valid aid in the management of Oral Lichen Planus (OLP) and its symptoms. Moreover, an analysis to determine whether it is a valid replacement for conventional therapies and whether standardized protocols can be used in PBM sessions or whether these should be changed depending on the type of injury has been made. Finally, an evaluation to determine whether PBM may induce transformation of dysplastic oral keratinocytes into squamous cell carcinoma has been made.

Materials and Methods

Searches were conducted on two search databases for relevant publications released between 1992 and 2019. The databases used were: Pubmed "Medline", and Google Scholar. Forty-four articles complied with the inclusion criteria and were included for quality assessment and data extraction.

Results

All the studies reported positive effects of PBM; how-ever, there was wide heterogeneity in the laser parameters used in the management of the OLP. The effective dose ranges from 2 to 3 J/cm2, in order to see the desired biological effects.

Conclusions

PBM is useful in controlling algal sensation and can be used in cases of OLP lesions that are not responsive to conventional therapies or when corticosteroid doses are too high for the patient, resulting in possible side effects. Standardized biostimulation protocols with further scientific insights are therefore required.

Uncovering and Autonomous Eruption of Palatally Impacted Canines-A Case Report

The impaction of permanent maxillary canine is a common clinical occurrence, and it is observed in 2% of patients who require orthodontic treatment. This case report describes a new orthodontic-surgical approach through the use of CO₂ laser, for the exposure of the palatally impacted canines. A 13-year-old female referred to our observation to make an orthodontic examination because of the maxillary primary canines’ persistence in upper arch. Orthopanoramic X-ray showed impaction of both permanent maxillary canines. The family history revealed that the patient’s mother had the same orthodontic problem. Cone Beam Computer Tomography (CBCT) was requested to plan the surgical-orthodontic treatment. Surgical exposure of the impacted canines was performed using a CO₂ laser and subsequent periodontal pack application. No orthodontic devices were applied for impacted teeth traction on dental arch. Canines’ movement was monitored at 1, 8 and 16 weeks post-surgery with photo and intraoral scanner CS3500 (CS3500^®, Carestream Health, Atlanta, GA, USA). When canine crowns were completely erupted on palatal side, the alignment in the arch with indirect bonding technique was performed. Complete disimpaction of canine crowns was obtained in only four months. As reported in the literature, this case confirms that impacted canines’ exposure to CO₂ laser has advantages if compared with traditional surgery: no bleeding during and after the procedure, decontaminant effect on the surgical area, no suture, and a fast spontaneous eruption. Conclusions: The pre-orthodontic uncovering and autonomous eruption of palatally impacted maxillary canines provides simplified, predictable, and more aesthetic outcomes. Furthermore, a significant positive factor is that there is no need to carry out the orthodontic traction of the impacted element, undoubtedly better compliance by the patient during the next alignment phase with the fix orthodontic appliance.

Assessment of maxillary canting on cone beam computed tomography and digital models: A retrospective study and proposal of a method

OBJECTIVES

The mounting of the plaster casts on articulator procedure is routinely performed in orthognathic surgery to assess canting of the maxillary occlusal plane, but the currently used protocols and reference plane could be source of errors which affect reliability. Nowadays the assessment of canting of the maxillary occlusal plane could be also performed with an entirely digital protocol. Aim of the study was to propose a method to evaluate canting in patients affected by Unilateral Condylar Hyperplasia, comparing the measurements performed on digital models matched on CBCT with those made on traditional articulator.

MATERIALS AND METHODS

A retrospective cross-sectional study was designed on 20 patients affected by vertical Unilateral Condylar Hyperplasia treated in the Units of Orthodontics and Maxillo-Facial Surgery. The canting of the maxillary occlusal plane was measured on plaster casts mounted on the conventional articulator and the measures were compared with those made on digital models matched on CBCT, according the protocol developed in our Unit. Molar, canine and basal difference were measured. To compare the two protocols and to test the agreement, we performed descriptive statistics, comparison between means and Bland Altman analysis. P value was set at 0.05.

RESULTS

Statistic comparison demonstrated agreement between measurements performed with the digital protocol and conventional physical method.

CONCLUSION

Measurements of canting with digital protocol are comparable to the physical standard method. A total digital protocol allows faster availability and storage of patient's data and better communication between orthodontist and maxillo-facial surgeon, especially in patients affected by three-dimensional malocclusions.

Is the use of clear aligners a real critical change in oral health prevention and treatment?

ABSTRACT

The introduction, in the late years of the last century, of clear aligners therapy (CAT) has drastically changed the approach' perspective to orthodontic treatment. Both patients and clinicians' expectations appear to be addressed with clear aligner therapy achieving an aesthetic appearance and fewer side effects, mainly due to the difficult maintenance of proper oral hygiene in the conventional fixed approach. Research has partially confirmed these key points of CAT but similarly revealed several limitations to the overall benefit of this treatment. Both the aforementioned key points of the CAT are currently under discussion: the aesthetic appearance is not uniform, due to the presence in some cases of extensive need for attachments, and the better periodontal conditions are certainly present in the CAT but mainly limited to the short term. This critical review of the state of the art clarifies the gray areas, such as to inform the researcher with the aim of elaborating an adequate study design in order to evaluate the advantages and limitations of this orthodontic approach.

Clear Aligners: Between Evolution and Efficiency-A Scoping Review

In recent years, clear aligners have diversified and evolved in their primary characteristics (material, gingival margin design, attachments, divots, auxiliaries), increasing their indications and efficiency. We overviewed the brands of aligners used in Italy and reviewed the literature on the evolution of clear aligners based on their characteristics mentioned above by consulting the main scientific databases (PubMed, Scopus, Lilacs, Google Scholar, Cochrane Library). Inclusion and exclusion criteria were established. The data were collected on a purpose-made data collection form and analyzed descriptively. From the initial 580 records, 527 were excluded because they were not related to the subject of the review or because they did not meet the eligibility criteria. The remaining 31 studies were deemed comprehensive for the purpose of the review, although the “gingival margin design” feature and “auxiliaries” tool are not well represented in the more recent literature. Current knowledge on invisible aligners allows us to have a much clearer idea of the basic characteristics of aligner systems. There remains a need to deepen the use of systems other than Invisalign™ to give greater evidence to aligners that are very different based on the characteristics analyzed here and that are very widespread on the market.

Perceived Preparedness of Dental Academic Institutions to Cope with the COVID-19 Pandemic: A Multi-Country Survey

Dental academic institutions are affected by COVID-19. We assessed the perceived COVID-19 preparedness of these institutions and the characteristics of institutions with greater perceived preparedness. An international cross-sectional survey of dental academics was conducted from March to August 2020 to assess academics’ and institutional attributes, perceived preparedness, and availability of infection prevention and control (IPC) equipment. Principal component analysis (PCA) identified perceived preparedness components. Multilevel linear regression analysis assessed the association between perceived preparedness and fixed effect factors (academics’ and institutions’ attributes) with countries as random effect variable. Of the 1820 dental academics from 28 countries, 78.4% worked in public institutions and 75.2% reported temporary closure. PCA showed five components: clinic apparel, measures before and after patient care, institutional policies, and availability of IPC equipment. Significantly less perceived preparedness was reported in lower-middle income (LMICs) (B = −1.31, p = 0.006) and upper-middle income (UMICs) (B = −0.98, p = 0.02) countries than in high-income countries (HICs), in teaching only (B = −0.55, p < 0.0001) and in research only (B = −1.22, p = 0.003) than teaching and research institutions and in institutions receiving ≤100 patients daily than those receiving >100 patients (B = −0.38, p < 0.0001). More perceived preparedness was reported by academics with administrative roles (B = 0.59, p < 0.0001). Academics from low-income countries (LICs) and LMICs reported less availability of clinic apparel, IPC equipment, measures before patient care, and institutional policies but more measures during patient care. There was greater perceived preparedness in HICs and institutions with greater involvement in teaching, research, and patient care.

Association between the temporomandibular joint disc position on magnetic resonance imaging and the mandibular deviation on posteroanterior cephalogram: a cross-sectional study in adolescents

OBJECTIVE

The aim of this cross-sectional research was to analyze the association between the disc position of the temporomandibular joint (TMJ) evaluated by magnetic resonance imaging (MRI) and the mandibular deviation evaluated by posteroanterior cephalometric (PA) in adolescents.

MATERIALS AND METHODS

The sample was 53 adolescents aged 11-18 years. This cross-sectional study was based on the analysis of PA and bilateral TMJ MRI images retrospectively selected. The mandibular deviation was evaluated by PA and defined by the amount of menton (Me) deviation from the midsagittal reference line. The temporomandibular disc position was evaluated by MRI: normal (N), disc displacement with reduction (DDR) and disc displacement without reduction (DDNR). The DDNR was considered more severe than the DDR. The patients were classified into three groups based on the bilateral disc position: group I, the same bilateral disc position; group II, disc displacement more severe on the ipsilateral side of the menton deviation; group III, disc displacement more severe on the contralateral side of the menton deviation. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between the menton deviation and the bilateral disc position.

RESULTS

There was an association statistically significant between the bilateral disc position and the Me deviation (p<0.05). There were significant differences in the mean of the menton deviation between group II (4,40 ±2,26), and group I (2,17±1,93) and III (2,10±1,70).

CONCLUSIONS

The menton deviation was significantly correlated with the disc position in the TMJ exhibit more deflection to the side more affected.

Comparison of the Effectiveness of Three Different Acupuncture Methods for TMD-Related Pain: A Randomized Clinical Study

PURPOSE

This study aimed to compare the effectiveness of three acupuncture methods for temporomandibular disorders- (TMDs-) related pain.

MATERIALS AND METHODS

Different locations of pain, according to DC/TMD clinical assessment, were considered: temporomandibular joint (TMJ), masticatory muscles, head, and neck. Sixty patients were assigned randomly to one of three treatment groups (20 patients in each): group BA received body acupuncture, group EA received electroacupuncture, and group CA received acupuncture + cupping. The groups were compared in terms of pain (verbal numeric scale), pain-related disability (Brief Inventory Pain, BPI), and impression of the treatment's effectiveness (Patients' Global Impression of Improvement Scale, PGI-I). These were recorded before sessions of acupuncture treatment (T0), after 8 sessions of acupuncture treatment (T1), and after 4 weeks of follow-up after treatment (T2). The between-group and within-group differences in the data were analyzed statistically. The baseline characteristics were similar in all groups (p > 0.05).

RESULTS

Significant improvements were noted in all types of pain compared to baseline values in all groups (all p < 0.05). No significant differences were noted in the improvement of TMDs-related pain according to the different acupuncture techniques (all p > 0.05). All acupuncture methods used resulted to be significantly effective in improving the pain-related interference in the patient's common activities and quality of life. EA resulted to be significantly more effective than BA and CA in improving the interference of pain with patients' mood (p=0.015) and quality of sleep (p=0.014).

CONCLUSION

BA, EA, and CA are all effective acupuncture methods in reducing pain and pain interference with common activities and quality of life in patients affected by TMD.

CBCT and Intra-Oral Scanner: The Advantages of 3D Technologies in Orthodontic Treatment

BACKGROUND

The aim is to demonstrate the validity of the monitoring through intraoral scanner of the dental movements and the real impact, advantages, and convenience, in terms of treatment time and efficiency gain, to frequently monitor a patient with the scanner application.

METHODS

A movement control of palatally impacted canines was performed, surgically treated with laser opercolectomy. Three-dimensional models of the patient's dental arch were obtained with intraoral scanner during a monitoring time of 4 months. The STL (Standard Triangle Language) files were superimposed with the 3D models extrapolated from the pre-operative CT (Computerized Tomography). The measurements of eruption, exposed palatal and vestibular areas, and distances between the canines and the incisors were performed, using digital technologies and with a digital caliber.

RESULTS

Descriptive and inferential statistical analysis of the data obtained from both conventional and digital monitoring has been realized and performing the T Student Test for paired data.

CONCLUSION

The advantages of digital monitoring are numerous, like the possibility to reduce the error of method caused by manual measurement on plaster casts and the possibility to compare the pattern and amount of eruption of the canine in the same patient overtime.

Familiar occurrence of facial asymmetry: a pilot study

BACKGROUND

The point at which "normal" asymmetry becomes "abnormal" can be defined by an aesthetic limit and a functional limit. The underlying causes are still not fully discovered; the etiology includes congenital disorders, acquired diseases, and traumatic and developmental deformities. Our purpose was to investigate the possible genetic liability in the transmissibility of the asymmetric traits, through an analysis developed by twofold approach: 1) exploring and recording the family history through the use of a specific questionnaire; and 2) examining differences in laterality between the patients and their corresponding parent by a facial analysis.

METHODS

A total of 52 Italian subjects (57% females, 43% males; mean age: 11.7 years), showing a clinically detectable asymmetry, were selected. Individuals in the sample were selected according to the diagnosis of facial asymmetry, non-syndromic patients, participation by informed consent, and negative medical history of the maxillo-facial complex. A specifically designed questionnaire was used to investigate the presence of the asymmetric trait in the family. Differences in length between distance from the anthropometric points to the facial midline and to horizontal reference were measured on a frontal facial photograph. For all the subjects recruited the same analysis was performed on the frontal facial photographs of both the parents. A descriptive and interferential statistical analysis was performed on the data.

RESULTS

Concerning the linear measurement, in a high percentage of parent-child pairs there is a correspondence of laterality of asymmetry traits, with a more common relation with the maternal trait. Sixty-five percent of parents with correspondence of laterality reported a positive family history of asymmetry.

CONCLUSIONS

The analysis of the obtained data shows that the mother is the parent most involved in the correspondence of laterality. Further analysis would be appropriate to investigate this result.