ZeroExpander® effectiveness assessment in PEEK or PA12 in a group of paediatric patients with transverse maxillary deficiency.

AIM: The aim of this article is to compare the performance of ZeroExpander® realised using PEEK or PA12 for the expansion of the maxilla in paediatric patients, exploring a new concept for approaching maxillary expansion with a metal-free fixed automatic appliance, based on pre-programmed set-up and anchored on deciduous teeth. MATERIALS: It is a retrospective comparative study with a sample of 40 children in early or mixed deciduous dentition and transversal maxillary deficit, 20 treated with ZeroExpander® in PEEK and 20 treated with ZeroExpander® in PA12 with a mean age of 7.3 years old. The intraoral scans at T0 and at the end of the expansion were all performed by the same operator to obtain digital models on which were performed measurements by two other different operators. A descriptive analysis was conducted using frequencies and percentages for nominal variables and means and standard deviations for continuous variables. CONCLUSION: In cases of allergy or hypersensitivity to metals or to specific chronic or acute pathological conditions, which may require periodic magnetic resonance imaging (MRI), it may not be possible to use traditional and metal fixed expansion devices. Moreover the concept of autonomous driving in paediatric orthodontics is not only possible, but it is and will be more real and very useful in the future. The "ortho-paediatric dentistry concept" will increase the range of benefits for children and their families which, in addition to care and thanks to technology, demand well-being, safety, comfort and quality of life beyond clinics.

Orthodontic management of patient with Silver-Russell Syndrome (SRS). A case report.

BACKGROUND: SRS is classified as a rare syndrome with an estimated incidence of 1 in 30.000/100.000 [Christoforidis A. et al., 2005]. It's a clinically and genetically heterogeneous disorder that presents a very wide phenotypic range. Due to its heterogeneity, SRS diagnosis is difficult, and the disease is probably underdiagnosed [Eggermann T. et al., 2009]. CASE REPORT: M., a 7-year-old patient affected by SRS syndrome, comes to the first visit with a history of pain in the upper retroincisive gum due to the deep bite (gingival impingement). The pain prevents the correct chewing during meals and makes the orthodontic treatment necessary. CONCLUSION: The elaboration of a personal orthodontic treatment plan allows the patient to recover the correct masticatory function and improve her facial aesthetic.

Otodental Syndrome.

BACKGROUND: Otodental syndrome is a rare autosomal dominant condition characterised by a dental phenotype known as globodontia often associated with high-frequency hearing loss. Globodontia occurs both in the decidous and permanent dentition and affects canine and molar teeth.

New 3D printed polymers in orthodontics: a scoping review.

AIM: The aim of this scoping review is to assess the application of new 3D printed polymeric materials in orthodontics, including polyamide-12 (PA-12) and Shape Memory Polymers (SMPs). METHODS: A search for articles published until January 2023 was carried out using PubMed, Scopus, Web of Knowledge, Lilacs, Opengrey, Embase and Cochrane Library databases and by applying the search terms (orthodontic* OR paediatric* OR paedodontic*) AND ("3D printed" OR "three-dimensional printed") AND (polymer* OR material* OR resin* OR technopolymer*). Additional records were also screened through hand or electronic search. No restriction in terms of language or publication period was applied. CONCLUSION: Due to their mechanical, aesthetic and biocompatibility characteristics, PA12 and SMPs can be used in orthodontic practice. However, additional studies should be performed to evaluate the clinical efficiency of these recent materials.

Aarskog-scott syndrome (AAS): a case report.

BACKGROUND: Aarskog-Scott syndrome (AAS) is a rare developmental disorder characterised by facial dysmorphism, genital and limb anomalies as well as disproportionate acromelic short stature. Clinical diagnosis is based on physical examination and the presence of the most characteristic clinical signs. The diagnosis can be finally confirmed by molecular tests, which identify mutations in the FGD1 gene. CASE REPORT: The report outlines the orthodontic treatment of a 6-year-old male patient, who was diagnosed with AAS syndrome. He presents all facial and oral clinical signs of this syndrome. The extent of maxillary hypoplasia and early dental crowding are so significant that immediate expansion therapy is required. CONCLUSION: Dental management of patients with AAS syndrome represents a challenge for paediatric dentists. The key to improving a patient's aesthetic, functional and psychological condition is making the correct orthodontic decision.

PEEK polymer in orthodontics: a scoping review.

AIM: The aim of this scoping review was to evaluate the application of polyether-ether-ketone (PEEK) in orthodontics. METHODS: Search strategies were executed for electronic databases through PubMed, Scopus, Web of Science, Lilacs, Opengrey, Embase, Cochrane Library and records identified through hand or electronic search. The keywords used were: "PEEK" OR "Polyether-ether-ketone" AND "orthodontics". The period selected of article publication was from January 2015 to June 2021. CONCLUSION: Due to excellent physical, mechanical, aesthetic properties and biocompatibility, its low plaque affinity and flexural modulus close to enamel and dentin, PEEK can be used also in orthodontics. However, more clinical research should be done to find out all the advantages and disadvantages of this material.

Otodental syndrome: Case report and differential diagnosis with Treacher Collins syndrome.

BACKGROUND: Otodental syndrome and Treacher Collins syndrome are rare diseases that have similar clinical features, which can complicate the diagnostic process. These syndromes cause skeletal and dental abnormalities, the differential diagnosis can be based on clinical signs but only the genetic analysis can confirm it. The aim of this case report is to describe and compare clinical signs of these syndromes. CASE REPORT: A 7-year-old patient came to our department: he presented abnormal tooth shapes and sizes, delayed teeth replacement and micrognathia. After extra- and intra-oral examination and radiographic exams, a clinical diagnosis of otodental syndrome was made, and a genetic testing was requested to confirm the diagnosis. CONCLUSION: Dental management of patients with otodental syndrome is challenging due to agenesis, teeth malformation, lack of space for permanent dentition. Proper treatment decision is crucial to obtain the best result for the patient.

ZeroExpander: Metal-free automatic palatal expansion for special-needs patients.

AIM: The aim of this paper is to illustrate a new concept for approaching maxillary expansion in paediatric orthodontics with a metal-free fixed automatic appliance in special-needs patients. CASE REPORTS: The ZeroExpander is a complete CAD-CAT full digital and automatic metal-free fixed device. It is designed to expand the maxilla in a pre-programmed automatic way using deciduous teeth as anchorage. Two cases of growing patients with a narrow upper arch are illustrated to present this innovative system, one in complete deciduous dentition and the second in mixed dentition. Both patients were successfully treated with palatal expansion. In the first case we present the use of PEEK, and in the second one the use of PA12. CONCLUSION: The ZeroExpander, fabricated using metal-free technopolymers and anchored on deciduous teeth, proved to be comfortable and efficient in treating palatal transverse deficiency, without the need of any compliance, even in young patients who must periodically undergo MRI.

Complex odontoma at the upper right maxilla: Surgical management and histomorphological profile.

BACKGROUND: Odontomas are hamartomatous developmental malformations of the dental tissues. Usually asymptomatic, their presence is often revealed on routine radiographs. The study aimed to establish the efficacy of this conventional approach in treating odontomas, analysing clinical outcome, follow-up, and histomorphological profile. CASE REPORT: A case is presented with a review of the international literature. The patient, aged 8 years, had a complex odontoma localised on the front upper jaw. She was treated following the conventional surgical procedure. Post-operative course and healing were uneventful. Orthodontic treatment was necessary to realign the teeth. At the 12-month follow-up there was no recurrence or failure. Healing was excellent. CONCLUSION: Variations in normal tooth eruption are a common finding, but significant deviations from established norms should alert the clinician to further investigate the patient's health and development.

Prevalence and determinants of early childhood caries in Italy.

AIM: Still limited data from representative surveys are available on the prevalence of Early Childhood Caries (ECC; i.e., the presence of one or more decayed, missing, or filled tooth surfaces in any primary tooth in a child aged 71 months or younger), particularly for infant. We conducted a survey in Italian children aged 0 to 71 months. MATERIALS AND METHODS: A cross-sectional study on ECC was conducted in Italy in 2018 on a sample of parents who were members of an online panel. Using an online questionnaire, 2,522 parents provided information on a total sample of 3,000 children, representative of the Italian population aged 0-71 months. RESULTS: ECC prevalence was 8.2% overall, 2.9% in children aged 0-23 months, 6.2% in children aged 24-47 and 14.7% in children aged 48-71 months (p for trend<0.001). ECC was more frequently observed among children using baby bottle with milk to fall asleep (multivariate odds ratio, OR, 1.36, 95% confidence interval, CI: 1.03-1.78), baby bottle with sugary beverages (OR 2.87, 95% CI: 2.05-4.03) and pacifier with sugary substances (OR 2.49, 95% CI: 1.79-3.47), consuming beverages other than water (OR for ?1/day vs never 2.29, 95% CI: 1.35-3.90), a higher number of snacks between meals (OR for ?3 vs <2 meals 2.05, 95% CI: 1-38-3.06), a lower frequency of tooth brushing (OR for <1 vs ?2 times/day 2.26, 95% CI: 1.42-3.58) and a high number of siblings (compared to 0, OR for ?2 siblings 2.28, 95% CI: 1.56-3.34). ECC increased with parents' mean age (p for trend=0.048), parents' smoking habit (OR for at least one smoker 1.54, 95% CI: 1.17-2.03), parents' poor oral hygiene (OR for ?1 vs >1 time/day of tooth brushing 1.42, 95% CI: 1.03-1.96) and high number of caries (OR for ?7 vs 0 caries was 2.38, 95% CI: 1.35-4.20). CONCLUSION: The present large and representative survey for the first time shows that ECC might be frequent also among infants. We confirm that ECC might be prevented if parents follow simple good practices. Information campaign and intervention programmes are needed to inform parents about unfavourable habits that favour the onset of ECC.

Sub-ablative laser irradiation to prevent acid demineralisation of dental enamel. A systematic review of literature reporting in vitro studies.

AIM: Caries lesions begin with enamel acid demineralisation mediated by microorganisms. Lasers with sub-ablative energy might act as a prophylactic intervention to reinforce enamel against lesions caused by acid. MATERIALS AND METHODS: A systematic review of the literature was performed evaluating only in vitro studies published from 2010 to 2018. The research was performed using the following databases: Medline, Embase and the Web Of Science. A further search was performed consulting the list of references of the included studies as well as book chapters which dealt with this topic. RESULTS: A total of 347 records were retrieved and, after their evaluation, 36 studies were included. CO2 lasers were the most described and effective device in preventing acid demineralisation. This type of laser was unique in improving the already positive results obtained with fluoride-based interventions. Er,Cr:YSGG (with fluencies > 8.5J/cm2), diode and argon lasers also improved enamel acid resistance (p-values ranging from 0.05 to 0.001) producing similar effects with fluoride-based interventions. Regarding the sealant retention outcome, the Er:YAG laser was able to perform an enamel etching which was as effective as the traditional acid etching with the advantage of being easier and usually well accepted by low-compliant patients (i.e. younger children). Nd:YAG presented the worst results. The most common structural changes after the laser irradiation were water and carbonate reduction in the enamel combined with a phosphate and calcium enamel content increase. Moreover, the calcium/phosphate ratio was found to reach the 1.67 ideal ratio. CONCLUSION: The in vitro studies that examined the prophylactic use of lasers for increasing enamel acid resistance presented interesting results that are enough to support a further in vivo experiment. This would entail the use of a clinical laser as an alternative or in combination with fluoride-based interventions.

The effect of added sugars on children's health outcomes: Obesity, Obstructive Sleep Apnea Syndrome (OSAS), Attention-Deficit/Hyperactivity Disorder (ADHD) and Chronic Diseases.

Increasing attention has been paid to how dietary sugars affect not only tooth decay, but also obesity, Type 2 diabetes mellitus, and cardiometabolic and kidney diseases. Therefore, possible connections of these diseases with oral health and diet are analysed. Healthy approaches to beverage and dietary consumption should be recommended and hopefully established in infancy, with the aim of preventing negative effects on general health in later childhood and adulthood.

Clinical evaluation of TRCReady M.TB for rapid automated detection of M. tuberculosis complex in respiratory samples.

SETTING: Timely diagnosis of tuberculosis (TB) is essential for effectively controlling and managing the disease. Although international guidelines recommend acid-fast bacilli staining and culture as the 'gold standard', new molecular methods are available to safely and rapidly identify positive samples. OBJECTIVE: To evaluate the performance of the newer and fully automated version of a molecular assay for rRNA amplification (TRCReady® M.TB) on 1028 respiratory samples collected from 378 patients for its possible use as a reliable screening method. Results were evaluated using culture as the reference test. RESULTS: Of four diagnostic protocols employed, best results were obtained when TRCReady M.TB was used together with microscopy on the first respiratory sample, followed by microscopy alone on a second one. The sensitivity and specificity were respectively 97% and 100%, with a turnaround time of 24 h. We propose a possible laboratory algorithm for rapid identification of patients with TB. CONCLUSIONS: TRCReady offers the advantages of full automation and avoidance of cross-contamination. As such, it should be considered as a more economical option for TB screening than other commercial assays that are currently available.

Clinical, histomorphological and therapeutic features of the Van der Woude Syndrome: literature review and presentation of an unusual case.

BACKGROUND: Van der Woude syndrome (VWS), an autosomal dominant condition associated with lower lip pits and/or cleft palate, is caused by mutations in the interferon regulatory factor 6 gene (lRF6 gene). The genetic alterations identified to date that contribute to expression of the syndrome are chiefly mutations located on chromosome 1 (the largest of our chromosomes), mutations at p36 that codifies the gene GRHL (grainy-head transcriptor factor) and mutations involving IRF6 (interferon regulatory factor). With frequency ranging from 1:35,000 to 1:100,000, depending on ethnicity, gender, and socio-economic status, the syndrome accounts for about 2% of orofacial clefts. The clinical and histomorphological aspects of VWS are studied, and a case of heterozygous female twins of whom only one was affected with VWS is reported. CONCLUSION: This very rare case (no similar case has been reported to date) contributes further evidence on modifying factors in the expression of this condition.

Tongue-tie assessment: clinical aspects and a new diode laser technique for its management.

BACKGROUND Often breastfeeding problems experienced by mothers and their babies may be attributed to the abnormal attachment of the infant's tongue (ankyloglossia) and/or maxillary lip-tie. Proper breastfeeding depends upon an infant's ability to correctly latch onto its mother's breast. If born with oral soft tissue abnormalities such as tongue-tie or lip-tie, it may be almost impossible for the infant to breastfeed. During the oral evaluation of an infant presenting with breastfeeding problems, one factor that is often overlooked and undiagnosed - and thus untreated - is the attachment of the upper lip to the maxillary gingival tissue. CASE REPORT: The case is reported of tongue-tie and breastfeeding difficulties, treated with a novel technique: the diode laser (980 nm).

Oral manifestations of gastrointestinal diseases in children. Part 4: Coeliac disease.

Alterations within the oral cavity can be the first sign of systemic diseases and may thus allow for an early diagnosis and treatment. In particular, being the oral cavity part of the gastrointestinal system, oral alterations can be an expression of a gastrointestinal disease. Dental enamel hypoplasia and aphthous ulcers have been found to be more common in children with coeliac disease compared with the general population and to regress after the patient is started on a gluten free-diet. A prompt recognition of systemic diseases through a careful examination of the oral cavity could allow the child to have appropriate investigations and to be treated in a timely fashion.

Mucocele of the minor salivary glands in an infant: treatment with diode laser.

BACKGROUND: Mucoceles are benign lesions that develop as a result of retention or extravasation of mucous material from minor salivary glands. Very uncommon in newborns and infants, they rarely may interfere with breastfeeding and compromise the respiratory function. CASE REPORT: We report a case of mucocele in a three-month-old infant in the right labial commissure excised by diode laser of different wavelengths (635-980 nm), with an average power of 1.8 W, in continuous wave mode, using 300 to 320 micron optical fibers. The healing occurred in 10 days. There were no adverse effects and the patient was carefully followed-up until complete healing. CONCLUSION: T he diode laser is not only a valuable tool for mucocele eradication but it also reduces relapses, thanks to the characteristics of the laser light.