How well does Invisalign ClinCheck predict actual results: A prospective study.

INTRODUCTION: This study aimed to compare achieved movements with predicted movements after 28-week use of Invisalign Lite aligners. SETTINGS AND SAMPLE POPULATION: The digital impressions of 21 subjects treated with Invisalign Lite at a private practice and in the dental clinic (Milan, Italy) were taken and analysed. Subjects were Caucasian with a mean age of 20.1 years. METHODS: Patients were analysed at two time points: at T0, before starting therapy, and at T1, after 28 weeks of treatment with Invisalign clear aligners, with a 2-week change interval. The changes that occurred between T0 and T1 were compared to the predicted changes between T0 and Ts (setup/ClinCheck). Tooth movement performance was estimated through variables calculated as the difference between obtained and planned movements. RESULTS: In both maxillary and mandibular arches, the teeth that exhibited the least accurate expression of torque were the central incisors. Tip was not accurate on maxillary central incisors and canines, mandibular central incisors, lateral incisors, first premolars, second premolars and first molars. Rotations were under-expressed on maxillary lateral incisors, canines and second premolars and on mandibular central incisors, canines, first premolars, second premolars and first molars. The overall angular changes showed a tendency to underperformance. Transverse linear changes were accurate with a significant overperformance on maxillary and mandibular first molars. CONCLUSIONS: Torque correction of maxillary central incisors, as well as rotational correction of most of the teeth, showed significant differences between what was planned and what was obtained.

Efficacy of the Cervical Vertebral Maturation Method: A Systematic Review.

OBJECTIVE: The present systematic review was carried out to evaluate both qualitatively and quantitatively the effectiveness of the cervical vertebral maturation (CVM) method in predicting the pubertal growth spurt. METHODS: PubMed, PMC, Scopus, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases were searched. The research included every article published from 1970 to June 2019, featuring the keywords: ("cervical vertebrae" OR ("cervical" AND "vertebrae") AND ("orthodontics" OR "growth and development" OR ("growth" AND "development") OR ("growth"). The Preferred Reporting Items for Reporting Systematic Reviews and Meta Analyses (PRISMA) protocol was adopted, and quality assessments modified from the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) and the "Standards for the Reporting of Diagnostic Accuracy Studies" (STARD) were performed to conduct this systematic review. RESULTS: Initially, 1284 articles were found. All the articles were then examined, and 43 studies met the inclusion criteria. Sixteen articles had low-quality scores, 25 had moderate scores, and 2 had high scores. The results showed a moderate to high statistically significant correlation between the CVM and other maturation methods. CONCLUSION: Overall, the CVM method can be considered an effective method and may be used with other skeletal indices for the radiographic assessment of skeletal maturity, and also to identify the growth peak in growing patients.

Wiskott-Aldrich syndrome: Oral findings and microbiota in children and review of the literature.

OBJECTIVE: Wiskott-Aldrich syndrome (WAS) is a rare X-linked primary immunodeficiency, characterized by micro-thrombocytopenia, recurrent infections, and eczema. This study aims to describe common oral manifestations and evaluate oral microbioma of WAS patients. MATERIAL AND METHODS: In this cohort study, 11 male WAS patients and 16 male healthy controls were evaluated in our Center between 2010 and 2018. Data about clinical history, oral examination, Gingival Index (GI) and Plaque Index (PI) were collected from both groups. Periodontal microbiological flora was evaluated on samples of the gingival sulcus. RESULTS: WAS subjects presented with premature loss of deciduous and permanent teeth, inclusions, eruption disturbance, and significantly worse GI and PI. They also showed a trend toward a higher total bacterial load. Fusobacterium nucleatum, reported to contribute to periodontitis onset, was the most prevalent bacteria, together with Porphyromonas gingivalis and Tannerella forsythia. CONCLUSIONS: Our data suggest that WAS patients are at greater risk of alterations in the oral cavity. The statistically higher incidence of periodontitis and the trend to higher prevalence of potentially pathological bacterial species in our small cohort, that should be confirmed in future in a larger population, underline the importance of dentistry monitoring as part of the multidisciplinary management of WAS patients.

Stannous Fluoride Preventive Effect on Enamel Erosion: An In Vitro Study.

The aim of this in vitro study was to evaluate the effects of a single dose application of two daily toothpastes on enamel exposed to acid attack. The research was conducted on human molars enamel fragments (n = 72). The two different toothpastes active ingredients were sodium fluoride (NaF) and stannous fluoride (SnF2). They were compared in protecting the surface of the enamel exposed to three acids: citric acid, lactic acid and hydrochloric acid. A spectrophotometer was used to measure the calcium ions and phosphate released in the solutions by the enamel specimens. Afterward, ionic concentrations were analyzed through the t-Student test, in order to estimate the significance level (p < 0.05) of the solubility differences obtained between the treatment and control groups. Finally, sample surfaces were analyzed with scanning electron microscopy and X-ray energy dispersive spectroscopy (SEM/EDX). The two analyzed toothpastes did not reveal any statistically significant variation in the release of calcium and phosphate (p > 0.05). Nevertheless, acid-resistant deposits were detected in samples treated with stannous fluoride and exposed to lactic acid, though the presence of tin ion deposits on samples treated with stannous fluoride was not shown. A single dose of a fluoride-based toothpaste before different acids attack, in simulated oral cavity conditions, did not show a significant preventive effect.

Invisalign appliance: aesthetic and efficiency.

BACKGROUND: The patients' request for treatment with clear aligners is constantly increasing. The aligners permit to the clinicians a valid way to solve a lot of orthodontic cases but the patients' compliance and the clinicians' capabilities and knowledge of the technique is fundamental for the outcome. METHODS: Seventy-two digital models of 18 consecutive patients treated with Invisalign and Smart Track aligners for 14 weeks were analyzed. The operator positioned 24 points on each model and were obtained the values of arch depth and perimeter of arch before and after the treatment. The variations of measurement were calculated with t student test. RESULTS: A decrease of arch depth and perimeter was found from t0 to t1 and the most relevant difference was observed in the upper arch depth with a decrease of 1.3 mm and in the upper arch perimeter with a difference of 1.1 mm. CONCLUSIONS: There was always a decrease of the values of arch depth and arch perimeter at the end of the treatment, especially in the upper arch. These changes must be considered by the clinicians to perform a better treatment to obtain the most predictable results and a patient's higher satisfaction.

Transverse and torque dental changes after passive self-ligating fixed therapy: A two-year follow-up study.

INTRODUCTION: Self-ligating appliances are purposed to expand the arches, but evidence on stability of the result is lacking. We measured the width of maxillary and mandibular arches and torque changes after treatment with the use of passive self-ligating appliances and assessed stability at the 2-year follow-up. METHODS: Maxillary and mandibular 3-dimensional (3D) models from 32 subjects (mean initial age 14.9 ± 0.9 years), consecutively treated with the use of self-ligating appliances, were obtained before, immediately after, and 2 years after treatment. Dental arches were examined with the use of 3D software to evaluate differences in transverse arch dimensions and torque values. RESULTS: An incremental increase of arch widths was recorded, especially regarding maxillary and mandibular premolars. The increase in the transverse diameters was associated with a significant positive torque gain. No significant changes in arch perimeter and depth were recorded. In the retention period, slight significant changes in transverse diameters were recorded, and a transverse diameter constriction detected. Torque values remained almost unchanged in the follow-up period. CONCLUSIONS: Transverse arch dimensions, along with torque values, increased significantly after treatment with the use of a passive self-ligating appliance. In the 2 years following treatment, a tendency to transverse diameter restriction, especially for the maxillary and mandibular premolars, was observed.

Oral mucosal complications in orthodontic treatment.

BACKGROUND: Orthodontic therapy is used to solve numerous oral problems, but the use of fixed oral devices can also impact negatively the oral cavity, if the treatment is not steadily under control. The aim of this study is to evaluate tooth, bone and soft tissues lesions due to the presence of fixed orthodontic appliances. METHODS: One hundred patients with fixed orthodontic appliances were included in the study. In particular, 20 patients with rapid palatal expander (RPE), 20 patients with Forsus appliance, 20 patients with a fixed multibracket appliance treatment, 20 patients with just the lower vestibular multibracket treatment and 20 patients with both upper and lower vestibular multibracket treatment. An accurate oral examination of the oral cavity, comprehending teeth, bone and soft tissues, was carried out thoroughly, in order to find possible lesions caused by the fixed orthodontic treatment. RESULTS: Concerning RPE, 35% patients had reversible palatal lesions, while 45% patients had the impression of the appliance on the tongue. Periodontal damages were observed in 5% of the patients, as well as tooth lesions (i.e. dental caries). 20% of the patients with Forsus appliance experienced the lesion on the cheek mucosa, while 10% individuals reported periodontal problems, and 15% of the subject suffered for WSL (white spot lesion) and dental caries. Upper vestibular multibracket appliance caused superior labial lesions (15%), cheek mucosal lesions (20%), gingivitis (55%), white spot lesions (WSL) of superior teeth (15%), while dental recessions and periodontitis due to the appliance were rarely observed (5%). Lower vestibular multibracket appliance was frequently the cause of inferior labial lesions (15%), cheek mucosal lesions (15%), gingivitis (50%), WSL of inferior teeth (20%) and also in lower arch dental recessions and periodontitis due to the appliance were rarely observed (5%). Patients with both superior and inferior multibracket appliance experienced upper and/or lower lip lesions (25%), lesions of cheek mucosa (25%), gingivitis (65%) and WSL (30%), and just in few cases periodontitis (10%). Data shows a more critical oral situation in patients with both superior and inferior appliances than people with one-arch therapy. CONCLUSIONS: Orthodontic therapy offers a considerable number of advantages, but it is important to underline what may be the adverse consequences also. This allows the orthodontist to inform the patient of all the possible effects of their therapeutic choice. In most cases, RPE can cause an impression of the device on the tongue and reversible lesions of the palate. On the other hand, the orthodontic fixed therapy can cause gingivitis, followed by mucosal lesions, labial lesions and WSL. For these reasons, an accurate assessment of the patients before the application of fixed orthodontic treatment is necessary. Oral hygiene instructions and motivation are very important, as well as periodic controls of the fixed oral device.

The skin rejuvenation associated treatment-Fraxel laser, Microbotox, and low G prime hyaluronic acid: preliminary results.

Minimally invasive facial rejuvenation procedures reached an all-time high in the 2016. This reveals a growing interest in a smoother, younger, and tighter look accessible using the esthetic medicine tools like botulinum toxin and dermal filler injections, laser, and microdermabrasion. Forty-five patients from 35 to 52 years old (medium age 43.8), 38 women and 7 men underwent 5 sessions of Fraxel laser, 1 session of very low G prime HA, and Microbotox injection treatments from January 2016 and January 2017, were included in this study. In this study, we demonstrated that the usage of three treatments together, like mBTX, Volite, and Fractional laser, have a better result despite every single technique alone. The clinical result showed 98% (44 patients, 6 males, 38 females) of the patients had a smoother skin surface, brighter, more hydrated, and elastic skin; 68% of our patients (31 patients, 5 males, 26 females) showed less skin defects and staining as well as less small wrinkles, thanks to Fraxel laser treatment; 98% (44 patients, 6 males, 38 females) showed tighter skin with less sebaceous gland secretion. The aim of this study was to demonstrate that the combination of three techniques acts better and faster than single treatment to contrast facial aging and to improve skin texture and quality.

Changes in oral microbiota due to orthodontic appliances: a systematic review.

Background: Oral microbiota has been at the center of cultural attention in recent years. In daily clinical practice, orthodontic appliances may be associated with an increased cariogenic risk and a worsening of preexisting periodontal diseases. Objective: The purpose of this review is to investigate the available evidence regarding the association between orthodontic appliances and changes in the quality and quantity of the oral microbiota. Design: The research included every article published up to October 2017 featuring the keywords 'Orthodontic appliance* AND (microbiological colonization OR periodontal pathogen* OR Streptococcus mutans OR Lactobacillus spp. OR Candida OR Tannerella forsythia OR Treponema denticola OR Fusobacterium nucleatum OR Aggregatibacter actinomycetemcomitans OR Prevotella intermedia OR Prevotella nigrescens OR Porphyromonas gingivalis)' and was conducted in the major medical databases. The methodological quality of selected papers was scored using the 'Swedish Council on Technology Assessment in Health Care Criteria for Grading Assessed Studies' (SBU) method. Results: Orthodontic appliances influence the oral microbiota with an increase in the counts of S. mutans and Lactobacillus spp. and in the percentage of potentially pathogenic gram-negative bacteria. Conclusions: There is moderate/high evidence regarding the association between orthodontic appliances and changes in the oral microbiota. PROSPERO registration number CRD42018091589.

Comparison between fiber-reinforced polymers and stainless steel orthodontic retainers.

OBJECTIVE: The aim of this study was to examine the properties of fiber-reinforced composite and stainless steel twisted retainers for orthodontic retention. METHODS: Three different span lengths (5.0, 8.0, and 14.0 mm) of fiber-reinforced composite were investigated. The three fiber-reinforced composite retainer groups were subdivided according to the storage condition (dry and wet), resulting in a total of six groups. Each stainless steel and fiber-reinforced composite group was comprised of six specimens. The three-point bending flexural test was conducted using a universal testing machine. ANOVA was used to assess differences in the maximum load and maximum stress according to the span length, material, and storage condition. Post-hoc comparisons were performed if necessary. RESULTS: The maximum stress and maximum load were significantly (p < 0.001) associated with the span length, material, and storage condition. The significant interaction between the material and span length (p < 0.001) indicated the differential effects of the material for each span length on the maximum stress and maximum load, with the difference between materials being the highest for the maximum span length. CONCLUSIONS: Our findings suggest that fiber-reinforced composite retainers may be an effective alternative for orthodontic retention in patients with esthetic concerns or allergy to conventional stainless steel wires.

Treatment of Severe Maxillary Hypoplasia With Combined Orthodontics and Distraction Osteogenesis.

Distraction osteogenesis (DO) is a technique that allows the generation of new bone in a gap between 2 vascularized bone surfaces in response to the application of graduated tensile stress across the bone gap.Distraction osteogenesis has become a routine treatment of choice to correct skeletal deformities and severe bone defects in the craniofacial complex over the past decade. Distraction osteogenesis has been successfully chosen in lengthening the maxilla and the mandible; in the maxilla and recently in the mandible, the jawbones have been distracted and widened transversely to relieve severe anterior dental crowding and transverse discrepancies between the dental arches.Distraction osteogenesis for maxillary advancement started in 1993 and is now widely used, especially in patients with skeletal Class III malocclusion caused by maxillary hypoplasia.The aim of this study was to present the efficiency of combined orthodontic and DO in the severe maxillary hypoplasia.A 35-year-old Italian man presented to our clinical practice with the chief complaint of esthetic and functionally problems because of skeletal Class III malocclusion with anterior crossbite.Considering that the severity of the skeletal discrepancy is remarkable but compensated by the DO potential, the combined orthodontic and DO treatment was considered adequate, like less invasive and equally effective.It was obtained a good alignment with the upper and lower arch dental alveolar maxillary advancement that allowed to correct the sagittal relationships.The patient was satisfied for the treatment results and had considerable improvement in his self-esteem.

Histomorphometric Evaluation of Two Different Bone Substitutes in Sinus Floor Augmentation Procedures.

The aim of this study is to compare the histomorphometric data of deproteinized bovine bone (DBB) and a fully synthetic bone substitute, poly (lactic-co-glycolic) acid/hydroxyapatite (PLGA/HA) applied for sinus floor augmentation technique. Twelve maxillary atrophic ridges of 8 patients requiring major maxillary sinus floor augmentation were studied; the sites were randomly assigned to the study groups and reexamined at 6 months after grafting using cone beam computed tomography scans and biopsy samples harvested during dental implant placement. Total bone volume, residual graft material volume, and new bone volume were assessed. Measurable biopsies were available from 67% of test sites and 100% of control sites. Poly (lactic-co-glycolic) acid/hydroxyapatite grafts showed no trace of graft material, whereas DBB grafts had a mean graft area of 16.60%. Mean percent of newly formed bone tended to be greater for PLGA/HA than for DBB group. Mean total bone volume percent did not differ significantly: PLGA/HA = 44.45% (CI, 16.42-72.48), DBB = 44.11% (CI, 36.61-51.60). Deproteinized bovine bone and PLGA/HA produced similar total bone volumes. Poly (lactic-co-glycolic) acid/hydroxyapatite appeared to be completely replaced by newly formed bone, whereas DBB presented significant amounts of residual graft material. Poly (lactic-co-glycolic) acid/hydroxyapatite necessitates of more clinical trials to be considered suitable for sinus floor augmentation.

Reliability and efficacy of palifermin in prevention and management of oral mucositis in patients with acute lymphoblastic leukemia: a randomized, double-blind controlled clinical trial.

BACKGROUND: Myeloablative and hematopoietic stem cells transplantation therapy (HSCT) often acts as side-effect to oral mucositis (OM) with no effective treatment. This randomized-controlled trial analyzed the efficacy of palifermin, administered as a dose during HSCT therapy, as primary prophylaxis on pediatric patients with acute lymphoblastic leukemia (ALL). METHODS: In this study forty-six patients (9-15 years) with B-cell acute lymphoblastic leukemia (B-ALL) were analyzed. The patients underwent allogenic HSCT conditioned by myeloablative regimen. Subsequently to randomization, patients in the palifermin group were assigned to receive palifermin, 60 mg/kg, intravenously as a single dose 3 days before and after transplant conditioning regimen cycle. The patients in the Control group received only a placebo treatment. Maximum severity of OM, incidence and duration of ulcerative OM, incidence and duration of severe OM limitations were evaluated. RESULTS: A statistically significant reduction in the incidence of OM up to grade 3 in the palifermin group compared to the control group was discovered. There was also a reduction, confirmed at 60 days, in the degree of severity of mucositis in the palifermin group, with an average of 1.54 grade in the palifermin group, and of 2.16 in the Control group and in the use of opioid analgesics. CONCLUSIONS: This study indicates that a single dose of palifermin used as primary prophylaxis during HSTC therapy can prevent severe OM in pediatric patients with ALL and used as secondary prophylaxis can prevent the recurrence of severe OM in high-risk patients with previous mucosal injury and improves the quality of life in pediatric patients with ALL.

Efficacy and effects of palifermin for the treatment of oral mucositis in patients affected by acute lymphoblastic leukemia.

This randomized-controlled trial studied the efficacy of palifermin, administered as a dose during hematopoietic stem cell transplant (HSCT) therapy, as primary prophylaxis on pediatric patients with acute lymphoblastic leukemia in order to reduce oral mucositis (OM). Patients in the palifermin group were randomly assigned to receive palifermin, 60 µg/kg, intravenously as a single dose 3 days before and 0, +1, and +2 post autologous HSCT infusion. The patients in the control group received only a placebo treatment. OM-related assessments were the WHO oral-toxicity scale and the patient-reported outcomes. There was a statistically significant reduction in the incidence of OM grade 3 and 4 in the palifermin group compared to the control group. There was also a reduction in the degree of severity of OM in the palifermin group (1.65 grade respect to 2.33 in the control group). Palifermin could prevent the recurrence of severe OM and improve the quality of life in patients with acute lymphoblastic leukemia (ALL).