Premature loss of primary molars in children: space recovery through molar distalisation. A literature review.

AIM: The integrity of primary dentition is essential in the development of the jaws and permanent occlusion. The consequences of a premature loss of primary molars are: space loss, crowding, risk of impaction of the permanent teeth, ectopic eruption, anomalous inclination of the teeth adjacent to the loss molar, reduction of arch length. The mesial displacement of the posterior permanent teeth during eruption can cause a loss of space, which can be regained with orthodontic appliances. Therefore, a careful diagnosis is of great importance to be able to decide what appliance is indicated to recover from this situation. Molar distalisation consists in displacing permanent molars distally, allowing them to reach class I relationship and to recover the correct space for the second bicuspids when the second deciduous molar has been lost early. METHODS: The aim of this study is to carry out a narrative literature review regarding the different appliances and their effectiveness in regaining space after premature loss of the upper primary molars. CONCLUSION: The paediatric dentist should be aware of the advantages and disadvantages related to each device and select the most appropriate distalisation appliance based on an individual plan of diagnosis and a careful treatment. The distalisation of the upper molar must be adequately stabilised and so it is important to consider also some retainers such as Nance's appliance, the Palatal Plate, the extraoral traction, the utility arch, or II Class elastic bands.

Influence of the type of breastfeeding as a risk or protective factor for the onset of malocclusions: a systematic review.

AIM: The correlation between malocclusions in deciduous dentition and type of breastfeeding has been described by many authors in numerous articles. The aim of this article is to investigate the literature about this important topic. MATERIALS: The research was conducted by querying the following databases: PubMed, EBMR, Cochrane Library, Web of Sciences, Medline, Web of Sciences, Ovid and Embase. The key words were: "infant" OR "baby", AND "breastfeeding" AND "malocclusion". As with similar literature review papers, the PRISMA-P (Preferred Reporting Items for Systematic Reviews Protocols) was used. The examined articles were of the following types: randomised controlled trials (RCTs), case-control studies and cohort studies. For the qualitative analysis of the selected studies, it was employed the NOS scale (Newcastle-Ottawa Quality Assessment Scale). CONCLUSION: Two hundred and fifty articles were selected. After filtering out the articles deemed irrelevant or with obvious bias, only 16 articles were left. From our results, it can be concluded that breastfeeding seems to play a decisive role in preventing the onset of posterior cross-bites and Class II malocclusions, and that this protective effect appears to be time-dependent.

Skeletal and dento-alveolar changes obtained with customised and preformed eruption guidance appliances after 1-year treatment in early mixed dentition.

AIM: The aim of this study was to assess the skeletal and dento-alveolar changes produced by a customised eruption guidance appliance (EGA) and a preformed EGA in subjects presenting a skeletal class II pattern during early mixed dentition and to evaluate the differences between the two devices. METHODS: All subjects included in the study were randomly selected from the record's archive according to the following inclusion criteria: (1) patients presenting upper central incisor and first permanent molars fully erupted; (2) early mixed dentition with age between 7 to 9 years old; (3) Angle class I or class II malocclusion; (4) increased overjet > 4 mm;(5) deep bite with at least 2/3 overlapping of the incisors; (6) no previous orthodontic treatment apart from maxillary expansion treatment. All children belonging to the case group received treatment with a 3D printed EGA whereas the other patients belonging to the control group were treated with preformed EGA. Records consisted in digital dental models and lateral cephalogram at the beginning (T0) and after 1 year of treatment (T1). Data collected on the digital models included the dentoalveolar changes in overbite, overjet, sagittal molar relationship, and dental crowding. Cephalometric tracings were computed by a single blinded observer using Dolphin Imaging software. Statistical analysis was performed with SPSS (version 25.00; IBM Corp, Armonk, NY). Comparison regarding the cephalometric changes between T1-T2 was carried out with paired t-test. Difference in distribution regarding sagittal molar and canine relationship and anterior crowding between groups at T1 and T2 has been computed with chi-square test. The independent sample t-test was used to perform the between group comparison. CONCLUSION: In the short time, both the appliances showed to be effective in correcting class II malocclusion, anterior crowding, overjet and overbite. Custom-made appliance demonstrated to be significantly more effective in correcting anterior crowding, the dento-skeletal vertical relation and position of permanent incisor compared to the preformed appliance. Adopting a customised device, effects due to an average prescription appliance used to a specific patient can be reduced, resulting in more predictable results.

Survey of Oral Hygiene Habits and Knowledge among School Children: a cross-sectional study from Italy.

AIM: This study is aimed to investigate the oral hygiene practice, knowledge and attitude of young adults, assessing their awareness about the impact of a certain "risk" behaviour on their oral and dental health. MATERIALS: This is a cross-sectional survey study conducted on 829 students (350 males and 479 females, mean age 13-20 years) attending high school in Milan and surrounding areas. They were asked to complete anonymous questionnaire during the first semester of the 2019-2020 school year, under the supervision of a teacher and/or an assigned interviewer. The questionnaire was created by "Laboratorio Adolescenza", in collaboration with the International Alliance of Responsible Drinking (IARD) Research Institute and the University of Milan. All of the data was compiled into table or graph form and analysed. CONCLUSION: There is a general awareness among Italian school children about the risks of bad oral habits, however, there is a need to improve the oral health knowledge, attitude and practices in the target population with emphasis on improvement of oral hygiene practices.

SALIVA-based diagnostic approach for diabetes mellitus: a step towards non-invasive detection - a scoping review.

OBJECTIVE: Diabetes mellitus (DM) is a chronic autoimmune disease whose main feature is chronic hyperglycemia. The causes of DM are impaired insulin secretion, impaired insulin action, or both. Saliva is a biofluid that can be considered as a "mirror" reflecting our body's health status; with the rapid advancement in salivaomics, saliva, being a non-invasive and safe source, could be a substitute for blood in the diagnosis and prognosis of diseases. As there are no precise guidelines about the salivary biomarkers correlated with the diagnosis of diabetes, a review was conducted to verify whether saliva analysis can be feasible and which biomarkers are more reliable, for the diagnosis of this disease. MATERIALS AND METHODS: A literature search was performed through PubMed, Medline, Scopus, Web of Science, LILACS, Open Grey, and Cochrane Library databases. The "PRISMA" guidelines were used for the following review, and thirty-three studies were analyzed. RESULTS: Almost all salivary glucose studies suggest that the estimation of this biomarker can be used as a potential indicator. Furthermore, studies that considered other biomarkers such as 1,5-anhydroglucitol, alpha-amylase, N-acetyl-ß-D-hexosaminidase, asprosin, resistin, and fructosamine reported that these biomarkers resulted to be potentially useful for diabetes screening and diagnosis, with the exception of the cystatin SA. CONCLUSIONS: In conclusion, several salivary biomarkers could be useful for monitoring DM, but it would be necessary to further expand the research and define precise values for each marker in order to predict with reasonable confidence if an individual is healthy or suffering from diabetes. Finally, standardized saliva collection and processing techniques are key to minimizing interindividual variability in saliva composition.

Open bite and atypical swallowing: orthodontic treatment, speech therapy or both? A literature review.

AIM: The cause-effect relationship between anterior open bite and atypical swallowing, two frequently associated conditions, is currently not completely understood. These conditions are often accompanied by speech disorders and represent a problem for both young patients and untreated adult patients. Treatment of these complex cases may be orthodontic, logopedic therapy or both. The purpose of this review is to compare the various types of treatment to determine their effectiveness in improving skeletal condition, normalisation of muscle activity, and temporal stability. METHODS: The present systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyzes (PRISMA) guidelines. In order to find the most appropriate articles for inclusion, an electronic and manual search was performed using PubMed and The Cochrane Library on May 23, 2021. No language restrictions or time limits were applied. Only human studies describing cases of patients in the developmental stage of dentition, i.e., deciduous dentition or mixed dentition with an anterior open bite related to a type of swallowing with tongue interposition between the arches, undergoing three different types of treatment (orthodontic only, myofunctional/logopedic only, combined) were included. CONCLUSION: The most effective treatment in cases of anterior open bite associated with atypical swallowing is a combination of the traditional orthodontic therapy and myofunctional therapy. Further studies are needed to devise an effective and universal logopaedic protocol to be followed in these cases.

Relationship between molar deciduous teeth infraocclusion and mandibular growth: A case-control study.

AIM: As the effects of infraocclusion on mandibular growth could have a significant impact on the treatment planning made by the orthodontist, the aim of this study is to evaluate the correlation between infraocclusion and mandibular growth. MATERIALS AND METHODS: Study design: A total of 42 healthy Caucasian patients with no history of dental trauma or orthodontic treatment were selected for this study from the same paediatric dentistry department. These patients were divided in two groups based on the presence or absence of infraocclusion: Group A, 22 patients (12 males and 10 females) suffering from infraocclusion of at least one inferior deciduous molar, and Group B, 20 patients (9 males and 11 females) who did not suffer from infraocclusion but had to be treated for dental overcrowding. Each patient was examined through an orthopantomography scan and lateral cephalogram. All measurements were made before the start of the treatment, and they were analysed in order to show cephalometric correlation between the skeletal class, the vertical dimension and cranio-maxillo-mandibular divergence. RESULTS: According to Student's t-test, the only measurements which had a statistically significant difference between Group A and Group B were the SNB angle (p-value <0.01), the ANB angle (p-value <0.05) and the PC-GO-GN angle (p-value <0.05). CONCLUSION: From the data collected in this study, it is possible to conclude that patients suffering from infraocclusion of the mandibular deciduous molars show mandibular post-rotation and an increased total Gonial angle, compared to patients who do not suffer from infraocclusion. Despite the absence of a longer-term evaluation of these patients, thanks to this data it is possible to state that early diagnosis of infraocclusion is fundamental in order to apply a well-planned and thought-out orthodontic treatment.

Hyrax versus transverse sagittal maxillary expander: An assessment of arch changes on dental casts. A retrospective study.

OBJECTIVE: The aim of this study was to compare arch changes before and after maxillary expansion with Transverse Maxillary Sagittal Expander (TSME) and Hyrax Palatal Expander (HPE), in growing patients with diagnosis of maxillary hypoplasia. MATERIALS AND METHODS: The sample consisted of 40 patients' records (20 males 20 females mean age 9.2 ±â€¯2.6 years) were selected from the archive of the Orthodontic Department of the University of Milan, Italy. Patients were randomly divided in two groups: patients in group 1 were treated with HPE as they presented only transverse deficiency of the maxilla and in group 2 were treated with TSME. Plaster models have been measured with a Verniere caliper to evaluate the differences in maxillary expansion of the two devices. Measurements were performed on casts poured from impressions taken before appliance bonding (T0), immediately after appliance debonding (T1) and at 6 months follow-up (T2). The variations in the following distances have been considered: inter-molar distance, inter-canine distance, palatal depth, palatal length and arch circumference. Shapiro-Wilk test was performed to assess normality distribution. ANOVA for repeated measures with multiple paired t-test for pairwise comparisons and its non-parametric equivalent Friedman's test with multiple Wilcoxon tests for pairwise comparisons were performed to evaluate changes in time of each variable in each group. Between groups comparisons were performed for each variable at each observing time using independent t-test or Mann-Whitney test. Significance level was set at p < 0,05. RESULTS: Both the Friedman test and the rm-ANOVA test and their respective post-hoc show that within both groups the respective variables have a statistically significant increase between T0 and T1 (p < 0,05) and a slight decrease between T1 and T2 (p < 0,05) that is not clinically relevant remaining always T2 greater than T0 in a statistically and clinically relevant way (p < 0,05). The analysis between the differences of the measurements at different timing measured by the Mann-Whitney test shows that for all the variables there is no statistically significant difference between the 2 devices (p < 0,05), except for the perimeter of the arch and the length of the palate; in this case it appeared that the TSME is better statistically (p < 0,05). CONCLUSIONS: The study has shown that RPE and TSME can achieve similar results in transversal palatal expansion. Differences have been found in the palatal length and in the arch perimeter where TSME seems to be more efficient.

Rapid Maxillary Expander and Eruption Guidance Appliance therapy in skeletal Class II: cephalometric considerations.

AIM: The use of rapid maxillary expander (RME) combined with eruption guidance appliances (EGA) represents a valid method in the treatment of skeletal Class II deep bite patients. In this paper a retrospective cephalometric study of the effects of RME and EGA therapy in Class II deep bite patients is described and compared with the treatment effects of patients with the same malocclusion treated only by RME. MATERIALS AND METHODS: Pre and post treatment cephalometric radiographs of 47 Class II division 1 deep bite growing patients treated with RME followed by EGA (mean age 9.65 years) (Group 1) were compared with those obtained from a control group (Group 2) of 44 patients (mean age 9.34 years) treated with RME only. The following cephalometric values were analized: SNA; SNB; ANB; SN-PNS.ANS; SN-Go.GN; N-Me; S-Go. RESULTS: Improvement in maxillo-mandibular relationship was observed in both groups with significantly higher decrease of SNA and ANB in group 1. The cranio-maxillary relation shows a tendency to grow downward and backward in both groups. Both anterior and posterior total facial heights showed a significant increase in group 1. CONCLUSIONS: RME followed by EGA therapy in Class II skeletal deep bite patients has shown better results compared with RME therapy without functional appliance.

Lymphangioma of the tongue associated with open bite: case report.

BACKGROUND: Lymphangioma of the tongue is a rare condition related to congenital malformations of the lymphatic system. It may have different implications such as macroglossia. This condition could exacerbate in aesthetic abnormalities and functional problems such as maxillofacial structural deformities, dysphagia, airway obstruction and speech difficulties. The aim of this paper is to describe this disease by means of a case report. CASE REPORT: A 4-year-old patient was referred to our department presenting macroglossia, functional difficulty during swallowing and mastication, speech disturbances, airway obstruction, and deformities of the maxillofacial structures. Diagnosis of lymphangioma was confirmed by biopsy. After surgical removal of the lesion, the patient was treated with rapid palatal expansion, functional appliance with lingual grid and fixed multibracket appliance. After treatment, improvement in function, indicated by the gradual increase in occlusal force, could be taken as a positive sign of stability. CONCLUSION: The 3-step treatment protocol described in this article proves to be effective in controlling the malocclusion in the three planes of the space in a patient affected by lymphangioma of the tongue.

RME: effects on the nasal septum. A CBCT evaluation.

AIM: Three-dimensional images have been evaluated to study the changes that occur on the maxillary complex and the nasal septum, following rapid maxillary expansion (RME) in growing children. METHODS: The records of 39 consecutively treated patients (20 male, 19 female), aged between 6.2 and 12.3 years (mean 8.6 years, S.D. 1.5), presenting a septal deviation of more than 1 mm, were analysed. Each patient was scanned at two distinct periods. The first image (T0) was obtained before treatment and hence represented the patient's baseline condition prior to expansion. The second time point (T1) was set after removal of the expander. The skeletal modifications induced by RME have been evaluated via cephalometric tracings obtained at T0 and at T1. The time lapse between T0 and T1 was 12 months. RESULTS: The nasal septum has been modified in its length more significantly in its lower rather than its upper tract. The width of the piriform aperture increased of 1.58 mm with an increase in the lateral walls and a downward movement of the nasal floor (consequent to an increase in septal length). There was also a reduction of septal deviation. The control group measurements did not vary during the considered period. CONCLUSION: Evidences of this study suggest that RME procedures can result in: a potentially positive effect on the nasal septum asymmetry during childhood; an increase of the nasal cavity volume due to a downward and forward movement; a lateral inclination of the nasal cavity reducing air resistance and improving breathing pattern; an increase of the length of the septum in its lower third improving its possible deviations and growth disturbances; favourable effects on the growth of the entire maxillary complex.

Class II division 1 malocclusions: comparisons between one- and two-step treatment.

AIM: The aim of this study consists in comparing the two-step treatment with that performed in a single-step in adolescent patients. MATERIALS AND METHODS: Study design: This paper is a critical review of the literature with a systematic approach. The search for scientific articles was performed on the US National Library of Medicine database using the PubMed service. Keywords set: "Early treatment Class II OR 1-phase orthodontics OR orthodontic timing Class II". From the initial screening 20 articles were selected of which the full text has been researched and evaluated. RESULTS: The selected articles were reviewed and evaluated by two independent operators, who both excluded two papers. Ultimately 13 articles were selected that refer to four major working groups, respectively from Manchester, North Carolina, Florida and Queen Mary University of London. CONCLUSION: We can assume that both the one- and two-step treatment are effective in correcting Class II malocclusion, with no significant difference of outcome, except for the incidence of incisor trauma, which was significantly lower for the early treatment group.

Titanium TSME appliance for patients allergic to nickel.

AIM: The aim of this article is to describe the use of a titanium TSME appliance for patients with allergy to resin and nickel. We aim to highlight the optimal way to avoid problems such as stomatitis and peri-labial dermatitis, which generally appear in patients who use traditional orthodontic appliances made in acrylic resin and steel. MATERIALS AND METHODS: The construction of a titanium appliance is described and a case treated with it is reported. RESULTS: The titanium TSME presented in this paper has excellent biocompatibility due to its ability to form superficial oxides, which prevent oxidation and thus corrosion. CONCLUSION: The non-allergic properties of titanium allow to propose it as an alternative in patients with a long-term history of allergic reactions to nichel.

Modified transversal sagittal maxillary expander for correction of upper midline deviation associated with maxillary arch deficiency.

The transversal sagittal maxillary expander (TSME) is a fixed device designed to develop arch form in patients with constricted dental arches. The present article describes a modified TSME appliance, the activation method, the therapeutic benefits as well as clinical advantages. The appliance has two molar bands, a Hyrax-type transverse expansion screw, one 0.045-inch wire extending from the molar band to the palatal surface of the central incisor in the emiarch crossbite and an 8 mm-Hyrax-type screw attached to this wire between the molar band and the incisor. A buccal arm with a terminal loop is welded to the band in the emiarch and it is extended to the labial surface on the central incisor on the side opposite to the crossbite and the maxillary midline deviation. The modified TSME appliance described in this paper are specifically designed for anteroposterior and transverse development. It has a sagittal effect on the maxillary alveolar process and at the same time allow to restore the correct transverse maxillary diameters.

Obstructive sleep apnea syndrome: a literature review.

Obstructive sleep apnea syndrome (OSAS) is a complete or partial airway obstruction that can cause significant physiologic disturbance with various clinical impacts. The etiology is multifactorial and its clinical manifestations are night snoring, headache when patient wakes up, day-time sleepiness and degrease of cognitive performance. Some recent international studies suggest that the OSAS prevalence is 2-4% in men and 1-2% in women of average age. The aim of this work was presenting a literature review in Medline concerning Obstructive sleep apnea syndrome. A review of the articles ranging from 1980 to 2014 has been done. Over 2000 articles were found and those which give useful information about etiology, diagnosis, therapy and found results after the study were selected and evaluated. In literature there is no unanimous opinion on the treatment of OSAS. According to the majority of the authors it should be multidisciplinary. The choice of therapy is predicated on the etiology, severity and natural history of the increased upper airway resistance. The importance of a praecox diagnosis and orthodontic therapy in order to re-establish normal function is underlined, since OSAS is linked with high risk of hypertension, cardiovascular diseases, daytime sleepiness, home and work-related accidents, with consequent worsening of life quality.

Titanium orthodontic appliances for allergic patients.

AIM: The aim of our study was to assess the use of orthodontic appliances made in titanium for patients with an allergy to resin and nickel. We aim to highlight the resolution of problems such as stomatitis and peri-labial dermatitis, which generally manifest in patients who use traditional orthodontic appliances in acrylic resin and steel. METHODS: A total of 120 patients of ages between ten and fifteen undergoing orthodontic treatment requiring a rapid palatal expander or a mobile appliance were evaluated and two patch sensitivity tests were done to assess the presence of allergies. RESULTS: The biocompatibility of a material is directly dependent on its corrosion effect. If a metal does not allow the release of ions it will not have a damaging action or cause destruction on the cellular DNA. The oxidation status of an ion is related to the reactivity of the ion itself and thus may give the latter a carcinogenic effect. Titanium appliances used for this study have obtained excellent results due to their ability to form superficial oxides, which block the oxidation phenomenon and thus corrosion. CONCLUSION: We have noticed a total regression of the symptoms after the use of titanium appliances in patients who had a sensitivity reaction.

Atypical swallowing: a review.

AIM: Atypical swallowing is a myofunctional problem consisting of an altered tongue position during the act of swallowing. High incidence in population, multifactorial etiology and the recurring connection with the presence of malocclusions made it a topic of strong interest and discussion in science. The purpose of this review is to illustrate the current orientation on the topic of atypical swallowing, trying in particular to answer two questions: 1) what kind of connection is there between atypical swallowing and malocclusion; 2) what kind of therapy should be used to solve it. METHODS: This review was conducted on the Medline database [www.ncbi.nim.nih.gov/pubmed] searching for the keywords "atypical swallowing" and "tongue thrust". We examined all the documents from the year 1990 onwards, excluding the ones about syndromic cases of the central motor system. RESULTS: The causal relation between the two problems seems to be biunique: some authors affirm that this oral habit starts as a compensation mechanism for a preexisting malocclusion (especially in case of open-bite); other texts show that it has a tendency to exacerbate cases of malocclusion; it is also proven that a non-physiological tongue thrust can negatively influence the progress of an ongoing orthodontic therapy. Thereby, the best therapeutic approach seems to be a multidisciplinary one: beside orthodontics, which is necessary to correct the malocclusion, it is essential to set up a myofunctional rehabilitation procedure to correct the oral habit, therefore granting long time permanent results. There is also proof of a substantial difference between the results obtained from early (deciduous or primary mixed dentition) or later treatments. CONCLUSION: The biunique causal relation between atypical swallowing and malocclusion suggests a multidisciplinary therapeutic approach, orthodontic and myofunctional, to temporarily solve both problems. An early diagnosis and a prompt intervention have a significantly positive influence on the therapy outcome.

Upper midline deviation: modified Hyrax expander.

BACKGROUND: The Hyrax rapid palatal expander is useful for patients in mixed dentition with premature exfoliation of some deciduous teeth and maxillary hypoplasia. This appliance, which is provided of a vestibular arm for correcting maxillary asymmetric transverse discrepancies, represents an interceptive treatment able to reduce the duration of the orthodontic therapy with fixed appliances. CASE REPORT: In this case report the modified version of the Hyrax rapid palatal expander is described. The activation method, the therapeutic benefits as well as the clinical advantages are described.