Search Results (15)

This study aimed to describe the changes produced on the occlusal plane (OP), the mandibular position and the dentoalveolar compensations of patients with distalization of the maxillary/mandibular arch assisted by mini-screws (MS). A descriptive case–series study was performed using the digital lateral cephalograms (DLC) of nine patients who underwent orthodontic treatment and required the use of MS for a complete distalization of the maxillary/mandibular arch. Records were collected at three different times (T1–T2–T3) and digitally analyzed (variables: Skeletal diagnosis; maxillary occlusal plane; position of the maxilla/mandible; and dentoalveolar changes of the distalization arch tracing the longitudinal axis of incisors/molars regarding the palatal/mandibular plane). Findings show that the OP varied from T1–T2–T3 in all cases, indicating its stepping or flattening. ODI, APDI, SNA, SNB, and ANB changed minimally in all cases, without variations in the mandibular position or in the skeletal diagnosis. Dentoalveolar measurements also showed differences between T1–T2–T3. In summary, conventional orthodontic treatment modified the OP during the first phase of treatment. Moreover, the distalization mechanics with MS changed the OP and produced dentoalveolar changes, mainly in the inclination of incisors and molars. Other measures considered in the study did not change substantially. Full article

Distal occlusion is one of the most common dentoalveolar anomalies and can be the reason for the obstructive sleep apnea (OSA) syndrome development among children. The aim of the study was to investigate the relationship between cephalometric and OSA parameters in the pediatric population. Methods: The cohort study included 39 children with OSA symptoms. Orthodontic examination consisted of a cephalometric analysis of 39 linear and angular variables. Patients underwent a sleep diagnostic study. Statistical analysis was performed using SPSS 19.0.0. Results: Of the general sample, 53.8% were mouth breathers and 46.2% had a mixed type of breathing. Moreover, 30.8% of patients had bruxism. The mean apnea-hypopnea index and oxygen desaturation index were 4.6/h and 3.9/h, respectively. A 1.06 times increase in the SNA index indicated the anterior position of the upper jaw. The MnPLSN° exceeded the norm by 1.3 times, which indicated the posterior position of the lower jaw and vertical type of the growth. An increase in ANSPNSSPT° by 1.1 times indicated an inclination of the upper jaw in the posterior position and a narrowing of the nasal passages. Patients with pediatric OSA had a significantly smaller lower airway space and MPH parameter. Conclusion: Systematic orthodontic monitoring of children with pediatric OSA is important for diagnosis and timely treatment. Full article

Background: The prognosis of orthodontic treatment for a patient with impacted canine teeth can be affected by many factors and understanding some of the characteristics of impacted teeth can increase the effectiveness and reduce the duration of treatment. This study aims to explore the effects of positions and dentoalveolar morphological characteristics of impacted maxillary canines on the prognosis of orthodontic treatment. Methods: In this study, forty-six adolescent individuals who applied for treatment of impacted teeth were divided into three groups: CC (no impacted maxillary canine group), BC (unilateral buccally positioned impacted maxillary canine group), and PC (unilateral palatally positioned impacted maxillary canine group). The impacted canine and adjacent teeth were evaluated in terms of position, angulation, inclination, mesiodistal and buccolingual widths, root length, dilaceration angle, and root resorption. Results: The mean values of U3 Ang (angulation of the maxillary impacted canine) and U3/U2 angles (maxillary impacted canine and lateral incisor angle) were statistically significantly higher in the BC and PC groups (p < 0.001). The mean values of U2 RL (lateral incisor root length) and U3 RD (canine root dilaceration angle) were statistically significantly lower in the BC and PC groups. Conclusions: The results of this study suggest that shorter root lengths and increased angulation values may lead to the ectopic eruption of canines. The higher canine angulations in the PC group increase the degree of root resorption. Full article

Background: Perioral muscle function, which influences maxillofacial growth and tooth position, can be affected in patients with oral clefts due to their inherent anatomical characteristics and the multiple surgical corrections performed. This research aims to (1) compare the maximum oral muscle pressure of subjects with and without isolated cleft palate (CP) or unilateral cleft lip and palate (UCLP), (2) investigate its influence on their dentoalveolar characteristics, and (3) investigate the influence of functional habits on the maximum oral muscle pressure in patients with and without cleft. Material and methods: Subjects with and without CP and UCLP seeking treatment at the Department of Orthodontics of University Hospitals Leuven between January 2021 and August 2022 were invited to participate. The Iowa Oral Performance Instrument (IOPI) was used to measure their maximum tongue, lip, and cheek pressure. An imbalance score was calculated to express the relationship between tongue and lip pressure. Upper and lower intercanine (ICD) and intermolar distance (IMD) were measured on 3D digital dental casts, and the presence of functional habits was reported by the patients. The data were analyzed with multivariable linear models, correcting for age and gender. Results: 44 subjects with CP or UCLP (mean age: 12.00 years) and 104 non-affected patients (mean age: 11.13 years) were included. No significant differences in maximum oral muscle pressure or imbalance score were detected between controls and clefts or between cleft types. Significantly smaller upper ICDs and larger upper and lower IMDs were found in patients with clefts. A significant difference between controls and clefts was found in the relationship between oral muscle pressure and transversal jaw width. In cleft patients, the higher the maximum tongue pressure, the wider the upper and lower IMD, the higher the lip pressure, the smaller the upper and lower ICD and IMD, and the higher the imbalance score, the larger the upper and lower IMD and lower ICD. An imbalance favoring the tongue was found in cleft patients. The influence of functional habits on the maximum oral muscle pressure was not statistically different between clefts and controls. Conclusion: Patients with CP or UCLP did not present reduced maximum oral muscle pressure compared with patients without a cleft. In cleft patients, tongue pressure was consistently greater than lip pressure, and those who presented a larger maxillary width presented systematically higher imbalance scores (favoring the tongue) than those with narrow maxillae. Therefore, the influence of slow maxillary expansion on maximum oral muscle pressure in cleft patients should not be underestimated. Full article

Nowadays, many people use clear aligners to address their dental issues. The efficacy of transparent dental aligners must be investigated even though they are more aesthetically pleasing, easy to use, and tidy than permanent tools. Thirty-five patients in this study’s sample group who used Nuvola^® clear aligners for their orthodontic therapy were prospectively observed. Initial, simulated, and final digital scans were analysed with a digital calliper. The actual results were compared with the prescribed ending position to evaluate the efficacy of transversal dentoalveolar expansion. Aligner treatments in Groups A (12) and B (24), particularly in the dental tip measures, demonstrated high adherence to the prescription. On the other hand, the gingival measures exhibited a greater level of bias, and the differences were statistically significant. However, there was no difference in the outcomes between the two groups (12 vs. 24). Within specific parameters, the evaluated aligners were shown to be helpful in predicting movements in the transverse plane, particularly when considering movements linked to the vestibular–palatal inclination of the dental elements. This article compares the expansion effectiveness of Nuvola^® aligners compared with other work in the literature using competitor companies. Full article

Background: Excessive gingival display or “gummy smile” is a clinical condition where a maxillary gum shows between the inferior line of the superior lip and the gingival line of the incisive superior during a spontaneous smile. The aim of this research was to understand the various skeletal and dentoalveolar components contributing to a gummy smile in a sample of 120 patients. Material and Methods: This retrospective case-control study had the primary objectives of analyzing the existence of a correlation between the presence of gingival exposure and the alteration of the inclination of the upper incisors with respect to the Frankfurt plane, the Palatine plane (bi-spinal) and to the NA line in a sample of orthodontic patients, and also evaluating the association with skeletal, dental, and aesthetic cephalometric parameters. Result and Conclusions: In our study, it’s emerged a correlation between the gingival exposure and the presence of alterations to incisal torque in the vestibular direction and the quantity of maxillary gingiva evident during the smile, which is correlated in particular to the Is–Sts distance, overjet and overbite. The major indicative data, therefore, are related to the vertical position of the upper incisors, in particular with respect to the upper lip and to the sagittal position. Full article

Background: The objective of the study was to ascertain whether the alveolar bone and root of the mandibular central incisor measured from cephalograms can represent the same measurements of both mandibular central and lateral incisors from CBCT. Methods: A total of 38 sets of CBCT images and cephalograms before treatment were selected for this study. Thicknesses included alveolar bone, cortical bone, and cancellous bone at the labial and lingual sides. Root diameter and total root-bone thickness were also evaluated. The measurements were performed at 3, 6, and 9 mm from the cemento-enamel junction. Heights included labial bone height and lingual bone height. All measurements were performed on cephalograms and CBCT images of the mandibular central incisor (L1CT) and mandibular lateral incisor (L2CT). The data were statistically analyzed using one-way ANOVA and Bonferroni tests (p < 0.01) to compare the cephalograms, L1CT, and L2CT. Results: The cephalograms presented thicker alveolar bone and cortical bone (labial: 0.16–0.31 mm, lingual: 0.14–0.29 mm; p < 0.001) as well as higher alveolar crest (labial: 0.46–0.48 mm, lingual: 0.38–0.39 mm; p < 0.001) than the CBCT images on both the labial and lingual sides, whereas lingual cancellous thicknesses were not significantly different (p = 0.257). The cephalograms presented greater total root-bone thicknesses than L1CT (0.19–0.30 mm; p < 0.001), whereas the cephalograms traced thinner roots than L1CT (0.18–0.23 mm; p < 0.001) and L2CT (0.39–0.59 mm; p < 0.001). Conclusion: Lateral cephalograms cannot represent both mandibular central and lateral incisor dentoalveolar thicknesses, heights, and root diameters the same as CBCT. However, the differences were less than 0.5 mm. Full article

Background and Objectives: The long face type is associated with excessive vertical facial growth and most often with anterior open bite. In many cases of anterior open bite of high severity associated with bimaxillary dento-alveolar protrusion, lips are unable to form an adequate seal at rest. This leads to many issues, including facial dysmorphism. The aim of this study was to describe the case of a 15 year old girl who addressed the orthodontist in November 2015, having complaints related to the skeletal and dental open bite. Case Description: A 15.7 year old patient required a consultation with the orthodontic service for impaired dento-facial aesthetics at rest, smile and speech due to an exaggerated superior protrusion of the upper frontal teeth, labial incompetence with excessive gingival exposure at rest and smile associated with upper and lower anterior teeth crowding. The orthodontic diagnostic consisted of skeletal open bite with a hyperleptoprosop morphological facial type, high degree of hyperdivergence, bimaxillary dento-alveolar protrusion, 7 mm skeletal open-bite, 3 mm vertical inocclusion of the anterior teeth, skeletal class II relationships, bilateral half cusp class II molar and canine relationships, labial incompetence, highly increased interlabial gap, facial asymmetry, excessive gingival exposure of 7 mm at smiling and bimaxillary anterior crowding. Because the patient initially refused orthognathic surgery, prior to starting the orthodontic treatment, the patient was recommended to receive a bilateral extraction of the first upper premolars. Key objectives of pre-surgical orthodontic treatment were to achieve a retroclined position of the upper incisors under their normal inclination for the planned upward maxillary rotation, to maintain slightly lower incisor proclination. The orthognathic surgery consisted of Le Fort I impaction osteotomy with 8 mm anterior impactation, bilateral sagittal split osteotomy, and mandibular repositioning using occlusal splint. Conclusions: At the end of the orthodontic-surgical treatment, the patient presented significant improvement in dento-facial aesthetics, and optimal skeletal, muscular and dental balance. Full article

Background: To evaluate the dentoalveolar position and root diameters of the maxillary incisors from cone beam computed tomograms (CBCT) compared with cephalometric tracings. Methods: A total of 64 sets of initial lateral cephalograms and CBCT images were enrolled. Measurements of dentoalveolar position included bone thicknesses and heights of alveolar, cortical, and cancellous bone. Root diameter and total root-bone thickness were also evaluated. All measurements were performed on cephalograms and CBCT images of the maxillary central incisor (U1CT) and maxillary lateral incisor (U2CT). The data were statistically analyzed using one-way ANOVA and Bonferroni tests (p < 0.01) to compare the cephalograms, U1CT, and U2CT. Results: The cephalograms presented thicker alveolar bone (labial: 0.20–0.67 mm, palatal: 0.41–0.60 mm; p < 0.001) and cortical bone (labial: 0.20–0.67 mm, palatal: 0.41–0.52 mm; p < 0.001) as well as higher alveolar crest (labial: 0.23–0.27 mm, palatal: 0.15–0.17 mm; p < 0.001) and cortical height (labial: 0.35–0.47 mm; p = 0.051, palatal: 0.14–0.18 mm; p < 0.001) than the CBCT images on both the labial and palatal sides, whereas palatal cancellous thickness was not significantly greater (p > 0.01). The cephalograms presented a greater total root-bone thicknesses (0.80–1.08 mm; p < 0.001), whereas the cephalograms traced thinner roots than the CBCT images (0.36–0.52 mm; p < 0.01). Conclusion: Routine lateral cephalograms are not suitable for alveolar bone evaluation in orthodontic treatment due to errors in representing dentoalveolar thicknesses and heights. Full article

Objective: The purpose of this retrospective preliminary study was to analyze the skeletal and dentoalveolar effects of a new clear functional appliance in a sample of patients close to growth spurt with class II malocclusion attributable to mandibular retrusion. Materials and methods: A sample of growing patients underwent functional Class II correction using F22^® (Sweden and Martina, Due Carrare (PD), Italy) Young, realized combining the aesthetic characteristics of the F22^® clear aligner with the structural features of a functional appliance. For each patient, a digital setup was performed by a single operator to plan a mandibular advancement to the therapeutic position. Cephalometric analysis before and after treatment was performed. The purpose of the statistical analysis was to evaluate dental and skeletal changes associated with F22^® Young device, and whether there were statistically significant differences in anatomical measurements between the beginning and end of treatment. Results: 15 patients, 7 females and 8 males of average age 10.3, were treated with the F22^® Young appliance for an average period of 10 months ± 0.5 (maximum 11.5 months, minimum 10.5 months). The data showed that the SNB angle increase was statistically significant from T0 to T1, leading to a reduction in the ANB angle. Values for the mandible length, both total (Co-Gn) and at the base (Go-Pg), significantly increased. Conclusions: According to this preliminary study, F22^® Young appliance is effective in promoting mandibular advancement when used near the pubertal growth peak. The device is comfortable and aesthetic, which certainly promoted patient compliance, a key factor for treatment success. Full article

Aim. To investigate the effect of changes in incisor tip, apex movement, and inclination on skeletal points A and B and characterize changes in skeletal points A and B to the soft tissue points A and B after incisor retraction in Angle Class I bimaxillary dentoalveolar protrusion. Methods. Twenty-two patients with Angle Class I bimaxillary dentoalveolar protrusion treated with four first premolar extractions were included in this study. The displacement of skeletal and soft tissue points A and B was measured using cone-beam computed tomography (CBCT) using a three-dimensional coordinate system. The movement of the upper and lower incisors was also measured using CBCT-synthesized lateral cephalograms. Results. Changes in the incisal tip, apex, and inclination after retraction did not significantly affect the position of points A and B in any direction (x, y, z). Linear regression analysis showed a statistically significant relationship between skeletal point A and soft tissue point A on the anteroposterior axis (z). Skeletal point A moved forward by 0.07 mm, and soft tissue point A moved forward by 0.38 mm, establishing a ratio of 0.18: 1 (r = 0.554, p < 0.01). Conclusion. The positional complexion of the skeletal points A and B was not directly influenced by changes in the incisor tip, apex, and inclination. Although the results suggest that soft tissue point A follows the anteroposterior position of skeletal point A, its clinical significance is suspected. Thus, hard and soft tissue analysis should be considered in treatment planning. Full article

Reduced periodontal support, deriving from chronic inflammatory conditions, such as periodontitis, is one of the main causes of tooth loss. The use of dental implants for the replacement of missing teeth has attracted growing interest as a standard procedure in clinical practice. However, adequate bone volume and soft tissue augmentation at the site of the implant are important prerequisites for successful implant positioning as well as proper functional and aesthetic reconstruction of patients. Three-dimensional (3D) scaffolds have greatly contributed to solve most of the challenges that traditional solutions (i.e., autografts, allografts and xenografts) posed. Nevertheless, mimicking the complex architecture and functionality of the periodontal tissue represents still a great challenge. In this study, a porous poly(ε-caprolactone) (PCL) and Sr-doped nano hydroxyapatite (Sr-nHA) with a multi-layer structure was produced via a single-step additive manufacturing (AM) process, as a potential strategy for hard periodontal tissue regeneration. Physicochemical characterization was conducted in order to evaluate the overall scaffold architecture, topography, as well as porosity with respect to the original CAD model. Furthermore, compressive tests were performed to assess the mechanical properties of the resulting multi-layer structure. Finally, in vitro biological performance, in terms of biocompatibility and osteogenic potential, was evaluated by using human osteosarcoma cells. The manufacturing route used in this work revealed a highly versatile method to fabricate 3D multi-layer scaffolds with porosity levels as well as mechanical properties within the range of dentoalveolar bone tissue. Moreover, the single step process allowed the achievement of an excellent integrity among the different layers of the scaffold. In vitro tests suggested the promising role of the ceramic phase within the polymeric matrix towards bone mineralization processes. Overall, the results of this study demonstrate that the approach undertaken may serve as a platform for future advances in 3D multi-layer and patient-specific strategies that may better address complex periodontal tissue defects. Full article

Adult orthodontic patients with skeletal Class III malocclusion, open bite and bimaxillary dentoalveolar protrusion are complex problems that normally require surgical intervention to correct. This is a report of an adult female with a skeletal Class III jaw relationship; in addition, the patient had anterior open bite and bimaxillary dentoalveolar protrusion. The patient also had three premolars in the lower left quadrant. Treatment involved extracting the extra premolar distal to lower left canine, retraction of lower anterior teeth, closing extraction space and anterior open bite utilizing Invisalign clear aligners. The patient initially changed aligners every week before this was changed to 3–5 days after starting to use a high frequency vibration (HFV = 120 Hz) device. Satisfactory results were achieved in a relatively shorter period. Comparing before and after treatment cone beam computed tomography revealed that new bone has been formed labial to the lower incisors after their retraction/correction of their initial proclined position and the use of HFV and myofunctional therapy without gingival graft. The present case report shows the comprehensive multidisciplinary team approach in treatment for such cases and the advantage of using HFV to improve bone formation. Full article

An accurate estimation of both facial growth and the dentoalveolar dimension is key to successful treatment. The aim of this study was to analyze the relation between the Condylion–Gonion–Menton angle (CoGoMe^) and dentoalveolar heights in a population of patients from southern Italy. This retrospective study analyzed 270 cephalograms of 115 males (42.1%, mean age 15.5 ± 5.2 years) and 155 females (57.9%, mean age 15.6 ± 5.9 years). The facial divergency was evaluated with the Sella–Nasion and Gonion–Gnation angle (SN^GoGn), mandibular structure with the CoGoMe^, and dentoalveolar heights were assessed in four measurements: upper anterior (UADH), lower anterior (LADH), upper posterior (UPDH), and lower posterior (LPDH). Data were analyzed by means of Pearson’s correlation and linear regression model (p < 0.05). All the dentoalveolar heights were strongly correlated among them (p < 0.001). The UADH was correlated with the SN^GoGn (r = 0.145; p = 0.017), while the LPDH was correlated with the CoGoMe^ (r = −0.183; p = 0.003). Moreover, there was a positive association between the UADH and the SN^GoGn (B = 0.08; 95% CI: 0.014–0.144; p = 0.017), and a negative association between the CoGoMe^ and the LPDH (B = −0.098; 95% CI: −0.161–0.035; p = 0.003). Facial divergency and mandibular structure are associated with dentoalveolar heights. Full article

Introduction: Wind instrumentalists like clarinetists, may present a muscular hyperactivity on certain groups of the cranio-cervico-mandibular complex, due to their musical activity. Therefore, the use of infrared thermography can be used to assess and characterize the orofacial structures involved in clarinet performance. Aim: The objective of this study was to analyze and record the thermal patterns using the thermographic camera Flir^® E60sc to evaluate anatomically and physiologically certain orofacial structures of the cranio-cervical-mandibular complex, such as the masticatory muscles and the region of the temporomandibular joint. Methodology: A sample of 30 clarinetists completed an individual questionnaire composed of two components (musical and clinical history of the participant), and were subjected to a clinical examination. Four thermographic images were taken of the cranio-cervical-mandibular complex at a rest position with frontal, right lateral, left lateral and anterior dentoalveolar components views. Each musician performed a piece of music for an uninterrupted period of 10 min. New thermographic images were captured with the same incidences, after the performance, respecting the same protocol. Results: There were statistically significant differences in the areas corresponding to the left temporal muscle, the orbicularis muscle (labial component), the left and right perioral teguments, as well as in the upper central incisors. There was also statistical evidence regarding the initial and final temperature asymmetries regarding temporal muscle and orbicular muscles (labial and marginal components). Conclusion: Infrared thermography has been shown to be an effective complementary diagnostic tool in the monitorization of the cranio-cervical-mandibular complex of clarinetists. Full article