Low-level laser therapy and invisible removal aligners.

It seems that Low Level Laser Therapy (LLLT) stimulates orthodontic tooth movements, increasing the alveolar bone turnover. The aim of this study is to evaluate how LLLT can influence the orthodontic treatment with invisible removal aligner. A sample of 21 subjects was divided into two groups, a laser group (10 patients) and a control group (11 patients). All subjects were instructed to wear each aligner 12 hours a day for 2 weeks. Laser external bio-stimulation was given in the laser group every second week. The laser group successfully finished the treatment, while at 3rd – 5th aligner the control group did not finish the treatment. Laser treatment seemed to be better than treatment without laser. LLLT combined with aligners is able to favour, in 12 hours, the same tooth movement obtained by wearing the aligner 22 hours a day, according to the traditional protocol. This aspect could be useful for those patients who prefer not to use the aligners during the day. LLLT makes invisible removal aligner treatment more comfortable also because during the day the patients have to wear the aligners less hours than the treatment without laser.

Anticoagulant therapy in patients undergoing dental interventions: a critical review of the literature and current perspectives.

Patients treated with oral anticoagulant therapy (OAT) represent an issue to the dentist, as an increasing number of people are using anticoagulant drugs for cardiovascular disease. The choice of an eventual suspension or continuation of anticoagulant therapy is important when considering an efficient management of the patient. Patients in anticoagulant therapy and requiring dental procedures sometimes represent therapeutic concerns especially concerning the suspension of the anticoagulant treatment. At the moment there is no consensus among international experts of a possible discontinuation of therapy before invasive dental procedures. In this paper, the authors try to focus on this topic through a critical review of the literature. Most of the studies suggest the continuation of the anticoagulant treatment with heparin before invasive oral surgical interventions. Based on the data of the literature, two rules must be adopted in clinical practice: 1) maintenance of anticoagulation related to the international normalized ratio (INR); 2) local application of antifibrinolytic agents to ensure a proper hemostatic process. Given the widespread use of anticoagulant drugs in cardiovascular disease, dentists must often face the problem of the therapy and, since there is no consensus on the management of these patients, the authors propose, after a thorough critical review of the literature, the implementation of a multiphase protocol of surgical approach to be implemented with safety in daily clinical practice.

Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta-analysis.

The objective of this systematic review was to estimate the efficacy of protraction facemask on the correction of Class III malocclusion in the short term. A systematic review of articles was performed using different electronic databases (PubMed, Ovid, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, and Google Scholar). Search terms comprised 'orthopedic treatment' and 'Class III malocclusion'. The selection criteria were set in order to include in this review only randomized clinical trials (RCTs) performed treating with facemask Class III growing patients. Studies' selection, data extraction, and risk of bias's assessment were executed independently by two authors using pre-defined data forms. All pooled analyses of data were based on random effects models. A pre-specified subgroup analysis was planned to evaluate the effect of preliminary rapid palatal expansion on facemask efficacy. Three RCTs met our inclusion criteria. In total, data from 155 patients (92 treated and 63 controls) were collected. The treated group showed the following significant changes: ANB° +3.66° [95%CI (2.58, 4.74)]; SNA° +2.10 [95%CI (1.14, 3.06)]; SNB° -1.54 [95%CI (-2.13, -0.95)]; SN-palatal plane -0.82° [95%CI (-1.62, -0.02)]; and SN-mandibular plane +1.51 [95%CI (0.61, 2.41)]. Heterogeneity varied from low to moderate (mean I(2) value: 41.4 ± 20.8). Facemask is effective correcting Class III malocclusion in the short term. The skeletal modifications induced by facemask are forward displacement of maxilla, backward displacement of mandible, clockwise rotation of the mandibular plane, and counterclockwise rotation of the maxillary plane.

Differential expression of transglutaminase genes in patients with chronic periodontitis.

OBJECTIVE: Gingival epithelium plays a key role in the protection of oral tissues from microbial challenge, especially during the periodontal disease. This study was aimed to evaluate levels of mRNA transcripts of different forms of transglutaminase in the human gingival tissues from patients with chronic periodontitis and relative controls. SUBJECTS AND METHODS: This study included 22 patients with chronic periodontitis (CP) and 22 healthy controls. For each patient, the values of probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded. Gene expression of transglutaminase 1, transglutaminase 2, transglutaminase 3, and metalloprotease 2 was evaluated by real-time PCR, while that of Factor XIIIA and metalloprotease 9 by RT-PCR. RESULTS: The values of all the clinical parameters were significantly higher in the CP group than in the healthy control group (P < 0.05). In the CP group, the mRNA expression of transglutaminase 1 and transglutaminase 3 was significantly decreased in comparison with healthy control group. A slight nonsignificant changes of transglutaminase 2 gene expression were observed in samples from CP patients in comparison with controls. CONCLUSIONS: These observations suggest that transglutaminase gene expression may be modified in response to chronic injury in the damaged gingival and emphasizes the key role of these enzymes in gingival remodelling/healing and adaptive processes.

Transverse changes determined by rapid and slow maxillary expansion--a low-dose CT-based randomized controlled trial.

OBJECTIVES: To compare transverse skeletal changes produced by rapid (RME) and slow (SME) maxillary expansion using low-dose computed tomography. The null hypothesis was that SME and RME are equally effective in producing skeletal maxillary expansion in patients with posterior crossbite. SETTING AND SAMPLE POPULATION: This study was carried out at the Department of Oral Sciences, University of Naples Federico II, Italy. Twelve patients (seven males, five females, mean age ± SD: 10.3 ± 2.5 years) were allocated to the SME group and 14 patients (six males, eight females, mean age ± SD: 9.7 ± 1.5 years) to the RME group. MATERIALS AND METHODS: All patients received a two-band palatal expander and were randomly allocated to either RME or SME. Low-dose computed tomography was used to identify skeletal and dental landmarks and to measure transverse maxillary changes with treatment. RESULTS: A significant increase in skeletal transverse diameters was found in both SME and RME groups (anterior expansion = 2.2 ± 1.4 mm, posterior expansion = 2.2 ± 0.9 mm, pterygoid expansion = 0.9 ± 0.8 mm). No significant differences were found between groups at anterior (SME = 1.9 ± 1.3 mm; RME = 2.5 ± 1.5 mm) or posterior (SME = 1.9 ± 1.0 mm; RME = 2.4 ± 0.9 mm) locations, while a statistically significant difference was measured at the pterygoid processes (SME = 0.6 ± 0.6 mm; RME = 1.2 ± 0.9 mm, p = 0.04), which was not clinically relevant. CONCLUSION: Rapid maxillary expansion is not more effective than SME in expanding the maxilla in patients with posterior crossbite.

A proportional correlation index for space analysis in mixed dentition derived from an Italian population sample.

AIM: The aim of this study was to establish a specific proportional correlation method for space analysis in mixed dentition applicable to the Italian population. MATERIALS AND METHODS: A retrospective analysis was performed on 300 plaster models taken from Italian subjects, 156 females and 144 males, aged between 12 and 25 years, visited at the Department of Orthodontic and Paediatric Dentistry of the University of Messina. RESULTS: The variance analysis (ANOVA) showed a high correlation between the dimension of the mesio-distal diameters of the four mandibular incisor and those of the upper canine and premolars. The correlation coefficient showed the existence of a directly proportional, positive intra- dependence between the two groups. DISCUSSION: The correlation tables used in the present study appear to be much more accurate if applied to groups of patients with similar ethnic backgrounds, thus explaining the differences between the various prediction indexes found in previous publications. CONCLUSION: This study highlights the need to develop specific values to fit the features of the different ethnic groups.

Myotonic dystrophy and craniofacial morphology: clinical and instrumental study.

AIM: The aim of this study is to assess if, and to what extent, myotonic dystrophy can affect the craniofacial growth pattern. MATERIALS AND METHODS: The research was conducted on a sample of 27 patients with Steinert's myotonic dystrophy (study group). Each subject underwent a clinical examination with impression-taking and intra- and extraoral photographs. A latero-lateral projection teleradiography in the mirror position was also taken and a cephalometric examination was performed. The assessed values were compared with those obtained from a group of healthy subjects (control group). RESULTS: Statistical analysis of the data obtained from the myotonic patients who developed the disease during the growth phase revealed alterations in the transversal plane and, to an even greater extent, the vertical one, with a high frequency of anterior open bite. Discussion and conclusions Regarding the pathogenesis of these types of skeletal dysplasias, the authors hypothesise a posterior rotation growth pattern, resulting from gravitational force prevailing over the deficit of the elevator muscles.

Correlations between cephalic posture and facial type in patients suffering from breathing obstructive syndrome.

AIM: In this teleradiographic study, the authors investigate the correlations between facial kind, breathing pattern and cephalic posture. METHODS The research was conducted on a 94 schoolchildren sample. For each patient teleradiographic analysis in-L-L projection and rhinomanometric examination were performed. On the basis of clinical evidences, rhinomanometric results and nasopharyngeal space evaluation, the sample was divided into two groups: the first one included 36 oral breather patients (OB), the second one 58 nasal breathers (NB). RESULTS: The two groups do not differ significantly, with the exception of divergence values, frequently higher in OB than NB. The comparison of craniofacial features and cephalic posture among the groups points out to correlations between large craniocervical angle and skeletal Class II, mandibular retrognathia and increased gonial angle, respectively, not related to breathing patterns. CONCLUSION: According to the authors' results, it can be stated that morphological characteristics classically associated with breathing obstructive syndrome could be induced by altered cephalic posture instead.

Effects of etanercept, a tumour necrosis factor-alpha antagonist, in an experimental model of periodontitis in rats.

BACKGROUND AND PURPOSE: Etanercept is a tumour necrosis factor antagonist with anti-inflammatory effects. The aim of our study was to evaluate, for the first time, the therapeutic efficacy of in vivo inhibition of TNF-alpha in an experimental model of periodontitis. EXPERIMENTAL APPROACH: Periodontitis was induced in adult male Sprague-Dawley rats by placing a nylon thread ligature around the lower 1st molars. Etanercept was administered at a dose of 5 mg kg-1, s.c., after placement of the ligature. KEY RESULTS: Periodontitis in rats resulted in an inflammatory process characterized by oedema, neutrophil infiltration and cytokine production that was followed by the recruitment of other inflammatory cells, production of a range of inflammatory mediators, tissue damage, apoptosis and disease. Treatment of the rats with etanercept (5 mg kg-1, s.c., after placement of the ligature) significantly reduced the degree of (1) periodontitis inflammation and tissue injury (histological score), (2) infiltration of neutrophils (MPO evaluation), (3) iNOS (the expression of nitrotyrosine and cytokines (eg TNF-alpha)) and (4) apoptosis (Bax and Bcl-2 expression). CONCLUSIONS AND IMPLICATIONS: Taken together, our results clearly demonstrate that treatment with etanercept reduces the development of inflammation and tissue injury, events associated with periodontitis.

Evaluation of skin dose in a low dose spiral CT protocol.

AIM: The authors evaluated radiation and skin doses absorbed by the eye lens, as well as the parotid and thyroid glands, during a low dose maxillary spiral computed tomography (CT). METHODS: Three spiral CTs were carried out, one after the other, changing from time to time MAS, pitch factor, Kv and consequently, CTDI/Vol, until the minimum values detectable by the equipment were reached (MAS 28, Kv 80, CTDI/Vol 2.5, Pitch 1). The quality of the images was evaluated on the grounds of being able to visualise the anatomic structures considered. The amount of radiation effectively absorbed by the soft tissue (skin doses) can be measured with the help of dosimeters placed at the level of eye lens, parotid and thyroid glands. The spiral CTs were performed with a Siemens 16 CT sensation machine, using a tissue equivalent Head-Neck RT Humanoid phantom. RESULTS: From the results of this study, it appears possible to obtain high quality images, useful for diagnosing numerous skeletal pathologies in orthodontics, reducing of about 90% the radiation dose per unit of volume and, at the same time, reducing the soft tissue (skin) dose of about 85% when compared to pre-established settings. CONCLUSION: The authors conclude their research emphasizing the possibility of applying low dose protocols, not only in orthodontics but in any dental field, whenever a spiral CT is needed for a more detailed diagnosis.

Increased transglutaminase activity was associated with IL-6 release in cultured human gingival fibroblasts exposed to dental cast alloys.

Molecular mechanisms underlying gingival and periodontal inflammation caused by dental alloys are still poorly understood. Recently, it has been demonstrated that tissue transglutaminase can be involved in inflammatory cell response. The aim of this study was to evaluate effects of exposure to orthodontic materials on transglutaminase in cultured human gingival fibroblasts. The incubation with Ni-Ti heat-activated (T3) or Ni-Ti super-elastic (T4), and with Ni-Cr-Co (T2) alloys produced respectively 2.5-fold and 8-fold increases in IL-6 release compared with control cultures. Transglutaminase activity was significantly increased in cells exposed to T3 and T4 alloys (about 170% of control; p < 0.05), where it was mainly localized close to inner part of cell membrane. The exposure to T3 and T4 specimens significantly up-regulated also tTG expression compared with control cultures. These data first show an association between IL-6 release and tissue transglutaminase increases, suggesting that TGase-mediated reactions may play a major role in periodontal inflammation.

Kinesiographic investigations in children with increased nasal airways resistance.

The aim of this study is to evaluate by means of the kinesiographic test, how the muscular alteration, linked with mouth breathing, modifies mandibular dynamics. From a sample of children aged between 8-11 years, on the basis of increased nasal airways resistance measured with the forced oscillation technique, we selected a group of 14 subjects. These children underwent kinesiographic examination (K-System Biotronic) and they were compared to a control group. Certainly, the speeds reduction in the pathological group emerged as the most significant data. The mastication tracings on the frontal plane, in the group with increased nasal airways resistance, moreover appeared to be reduced in width, elongated in shape and sometimes irregularly square, compared to the bell shape typical of subjects without any dysfunctional pathologies. Considering that each subject responds in a personal manner to an increase of the nasal resistances, due to the extremely variable individual adaptability, the kinesiographic test, together with the electromyographic one, in our opinion, can assist anamnesis, clinical examination and other instrumental investigations, in the identification of those subjects in which the increase of the nasal airways resistance interferes with muscular function, laying the basis for possible modifications in the craniofacial growth.

[Restoration of dentoperiodontal unit in cervical carious lesions]. / Il ripristino dell'unita' dento parodontale nelle lesioni cariose cervicali.

The Authors study the issues of conservative periodontal treatment in therapy of carious lesions adjacent gingivae. They say again with one accord with others Authors the importance of the attainment of the extrasulcular cavity margins. They show the resolution of some cases.

[Bad habits and dysgnathia: epidemiological study]. / Abitudini viziate e disgnazie: indagine epidemiologica.

The authors refer about an epidemiological survey in 651 children in the school-age. The aim of study is to investigate about the frequency of the bad habits and the pathogenetic relations between these and the development of the dento-maxillo-facial deformities. They point out an incidence of these bad habits in the 35,48% with a predominance of mouth breathers (45,45%). After they discuss the necessity of an early detection of anomalous neuromuscular attitudes.

[Epidemiological study of the frequency of caries and malocclusion in school-age children]. / Studio epidemiologico sulla frequenza della carie e delle malocclusioni in eta' scolare.

The authors have made an epidemiological survey on a population in the school-age group, with the aim to evaluate the right incidence of the decay and dysgnathias and about the possible ethiopatogenetic relationship between these two pathologies. The results are very close to other similar researches.