Obstructive sleep apnea syndrome in the pediatric age: the role of the dentist.

OBJECTIVE: Sleep disordered breathing in children designates a wide spectrum of respiratory disorders characterized by partial or complete obstruction of the upper airways. It ranges from primary snoring, its mildest clinical manifestation, to obstructive sleep apnea syndrome (OSAS): complete obstruction of the upper airways with cessation of airflow. The aim of this paper is to highlight the roles of the pediatric dentist and the orthodontist in the therapeutic approach to pediatric OSAS as a "sentinel" who can detect early signs of the disease for immediate referral to the otolaryngologist and as an active participant in therapy. MATERIALS AND METHODS: A literature review has been performed on the following topics: pediatric OSAS, orthodontic clinical aspects of pediatric OSAS, orthodontic therapy of pediatric OSAS, mandibular advancement devices and functional orthodontic devices in OSAS treatment. RESULTS: The role of the dentist in pediatric OSAS is essential to correct orthodontic alterations that may favor the development of the condition. Orthodontic treatment aims at reducing the severity of OSAS by increasing the airspace and improving airflow through orthopedic expansion of the upper jaw and mandibular advancement. Rapid palatal expanders and mandibular advancement devices are successfully used in the treatment of OSAS. CONCLUSIONS: Scientific evidence of a strong association between craniofacial growth and OSAS; the pediatric dentist and the orthodontist participate as sentinels, observing and identifying conditions requiring referral to the otolaryngologist and playing a pivotal role in the orthodontic treatment phase.

Craniofacial morphology and airflow in children with primary snoring.

OBJECTIVE: Sleep-disordered breathing (SDB) is among the most common diseases and includes a group of pathological conditions that form a severity continuum from primary snoring (PS) to obstructive sleep apnea (OSA). SDB presents a multifactorial etiology and in children, it is often linked to adenotonsillar hypertrophy, which may lead to an alteration of the breathing pattern. Therefore, several studies hinted at the existence of a correlation between SDB and the alteration of craniofacial growth. However, these studies concentrated on the most severe forms of SDB and little evidence still exists for the mildest form of SDB, namely PS. This preliminary study investigates the association between nasal airflow, measured through rhinomanometry, and cephalometric parameters in a sample of young children with PS. PATIENTS AND METHODS: A sample of 30 children with habitual snoring aged between 5 and 8 years was selected by a SDB validated questionnaire at the Pediatric Allergology and Immunology Center of "Sapienza" University of Rome, Italy. To assess the degree of nasal obstruction, all children underwent anterior active rhinomanometry while nocturnal pulse oximetry and polysomnography were used to characterize the SDB. Cephalometric analysis was used to evaluate relevant orthodontic parameters associated to the sagittal and vertical craniofacial development and to the position of the hyoid bone. RESULTS: We found a statistically significant association between the Frankfurt mandibular angle (FMA), which measures the total facial vertical divergence, and the severity of the airflow's obstruction (p = 0.014). CONCLUSIONS: The present study supports the association between the level of nasal obstruction in children with PS and the alteration of cephalometric parameters associated with the vertical craniofacial growth, thus placing the evaluation of craniofacial parameters in the growth period in a privileged position to determine an early diagnosis of a possible insurgence of sleep disorders.

Gender assessment through three-dimensional analysis of maxillary sinuses by means of cone beam computed tomography.

OBJECTIVE: The availability of a low dose radiation technology such as Cone Beam Computed Tomography (CBCT) in dental practice has increased the number of scans available for forensic purposes. Moreover, specific software allows for three-dimensional (3D) characterization of the maxillary sinuses. This study was performed to determine whether sinus maxillary volumes can be useful to identify gender after validating the use of the Dolphin software as a tool for volumetric estimation of maxillary sinus volumes. PATIENTS AND METHODS: The validation was performed by four different operators measuring the volume of six phantoms, where the real volume was already known. The maxillary sinus volumes of 52 patients (26 males and 26 females) mean age 24.3 were calculated and compared between genders and sagittal skeletal class subdivision. The measurements for patients and phantoms were based on CBCT scans (ILUMA™) processed by Dolphin 3D software. RESULTS: No statistical difference was observed between the real volume and the volume measurements performed by the operators. No statistical difference was found in patient's maxillary sinus volumes between gender. CONCLUSIONS: Based on our results, it is not possible to support the use of maxillary sinuses to discern sexual difference in corpse identification.

Second Class Resolver: a retrospective analysis.

AIM: To evaluate the use of Second Class Resolver (SCR), a new fixed orthopaedic appliance, for the treatment of skeletal Class II malocclusion in growing subjects. MATERIALS AND METHODS: Design Retrospective analysis. Forty subjects were treated with Second Class Resolver (SCR). The mean age was 8 years at the beginning of treatment and 10 years at the end of treatment. Digital cephalometric superimpositions on lateral radiographs taken at start and end of treatment were assessed. The cephalometric values were statistically analysed. RESULTS: Cephalometric analysis of changes during treatment shows reduction of ANB angle (mean 2°); reduction of Witts Index (mean 3 mm); reduction of Maxillo-Mandibular angle (MM) (mean 1°); reduction of SNA (angle mean 3°); reduction of gonial angle (mean 1.8°); increase of the mandibular branch length (mean 5 mm); increase of mandibular body (mean 2.9°). CONCLUSION: The Second Class Resolver can be beneficially used for the treatment of Class II malocclusion.

Marsupialization of radicular cyst in a 9-year-old child: report of a case and review of the literature.

The following report describes the treatment of a 9-year-old child affected by a radicular cyst. The case was treated through the extraction of the impacted primary tooth followed by marsupialization. The residual cystic cavity was filled with a removable device in order to speed the healing process, facilitate the eruption of the permanent teeth and avoid orthodontic treatment. This technique is suitable as conservative treatment for patients affected by radicular cyst.

A new aid in temporomandibular joint disorders' therapy: the universal neuromuscular immediate relaxing appliance.

Among the various treatment options currently indicated to deal with temporomandibular joint disorders (TMD) an important role is played by occlusal devices, which can be used in an individualized or universal manner. A new universal occlusal appliance device was designed and patented at the Clinical Gnathology Service of the Sapienza University of Rome. To assess its validity and efficacy a preliminary study on a sample of 50 patients was carried out. Patients were selected from a cohort of 158 according to the RDC-TMD (SPEC) criteria and randomly assigned to two groups, the patient group (PG), treated with the device, and a control group (CG) without any treatment. The two groups were evaluated by comparing four VAS pain scores: muscular, migraine, cervical and temporomandibular joint (TMJ). On the whole, all VAS pain scores in the PG showed a marked and statistically significant improvement after treatment, decreasing to about 50-80 percent, while the control group remained stable. The best improvement was achieved in muscular pain. Age did not affect neither the initial scores, nor the pain response to the treatment. The pain scores tended to slightly increase with time of application (one, two or three months), but this trend was significant only for cervical pain. Overall the results are favourable to the application of this new occlusion device. However, the data should be considered preliminary and require further verification in time and on a higher sample of patients of both sexes.

Effects of bisphosphonates in orthodontic therapy:systematic review.

BACKGROUND: Currently, the use of oral and systemic bisphosphonates, in the form of anti-osteoporosis medications or as a part of a chemotherapeutic regimen for several malignant diseases, is increasing dramatically in a large group of orthodontic patients. Animal studies have reported adverse dental effects from bisphosphonates, including decreased tooth movement, impaired bone healing, and osteonecrosis in the mandible and the maxilla. OBJECTIVE: The objective of this paper was to analyze the effects of bisphosphonates on orthodontic therapy in humans. STRATEGY: The literature was systematically reviewed using PubMed, LILACS and OvidMedline up to December 31, 2011. Handsearching included several dental journals. STUDY SELECTION: All RCT’s, controlled trials and case reports-series about the effects of bisphosphonates on orthodontic therapy were analyzed and selected independently by two different researchers based on previously established inclusion and exclusion criteria. The main search terms were: bisphosphonates, orthodontic treatment and tooth movement. RESULTS: The search strategy yielded 136 titles/abstracts: 134 from PubMed and 2 from LILIACS; no articles from OvidMedline, Chocrane Library and manual search. Eighty three records were screened, after removal of duplicates. After applying the inclusion/exclusion criteria, 135 papers were removed: 43 studies on animals, 4 French and Portuguese articles, 17 reviews and letters, 18 unrelated to orthodontic therapy or to the topic of this review. CONCLUSIONS: Further studies are required to assess possible adverse effects of bisphosphonate on orthodontic treatment in humans.

Características histológicas del epidídimo de Baba (Caiman crocodilus crocodilus) sexualmente maduro / Histological characteristics of the epididymis of the sexually mature spectacled Caiman (Caiman crocodilus crocodilus)

El epidídimo es un órgano que forma parte del aparato reproductivo masculino en todas las especies vertebradas, y que posee características histológicas que permiten lograr su identificación. Se realizó el estudio histológico del órgano reproductor de las babas Caiman crocodilus crocodilus en diferentes meses del año, incluyendo las épocas de gran actividad sexual o apareamiento y la época de no apareamiento, para conocer si las características histológicas de este órgano son similares durante todo el año. Se extrajeron 11 ejemplares sexualmente maduros de su medio ambiente natural, obteniéndose por necropsia, las muestras del epidídimo. Las muestras se fijaron con formol buferado al 10%, y se incluyeron en parafina. Posteriormente, se realizaron cortes de 5µm de grosor y fueron teñidos con Hematoxilina - Eosina. Como característica histológica común durante todo el año, se observó la presencia de unos conductillos epididimarios que confluyen en un conducto principal o conducto del epidídimo con un epitelio que varió de cúbico simple en la porción anterior a cilíndrico simple en los segmentos medio y posterior. De igual manera, se apreció un aumento de la capa muscular a medida que se avanzaba hacia las porciones media y posterior. En época de apareamiento resalta la característica del epitelio visiblemente festoneado, el aumento en la altura del mismo, la presencia de un gran número de células claras sin estereocilios y el aumento del diámetro de los conductos, así como gránulos de secreción eosinofílicos y un gran número de espermatozoides en el lumen, detalle que no es observado en la época de no apareamiento, durante la cual no se observa el epitelio de forma festoneado y su diámetro es mucho menor.

The epididymis is an organ which forms part of the male reproductive tract in all vertebrate species, and it possesses histological characteristics which allow its identification. A study was conducted to verify if the histological characteristics of the epididymis of the spectacled caiman (Caiman crocodilus crocodilus) are similar during different seasons of the year, including seasons of high and low mating activity. A total of 11 mature animals were selected from their natural environment. Samples of the epididymis were obtained from necropsy, fixed with 10% buffered formaldehyde and embedded in paraffin. Subsequently, they were stained with hematoxilin-eosin. The results show a common histological characteristic: the presence of some epididymis tiny ducts that converge into a main duct or the epididymis duct, with an epithelium which varies from a simple cubic in the anterior portion to a cylindrical one in the medial and posterior segments. In a similar way, as one moves forward to the medial and posterior portions, an increase in the muscular layer is observed. During mating time, the visibly festooning of the epithelium, the increase in height, the presence of a large amount of clear cells without stereocilium, an increase in the diameter of the ducts, as well as eosinophillic secretion granules and a great quantity of sperms in the lumen, stand out, a detail which is not seen during non-mating season, where the presence of a festooned epithelium is not observed, and its diameter is much smaller.

Effects of interceptive orthodontics on orbicular muscle activity: a surface electromyographic study in children.

The purpose of this study was to assess by surface electromyography (sEMG) the changes in upper and lower orbicular oris (OO) muscles produced by a preformed functional device in subjects with Class II, division 1 malocclusion, deep bite, and labial incompetence. Twenty-eight subjects were selected: 13 subjects (mean age 9 ± 1.5 years) with Class II malocclusion, deep bite, and labial incompetence were treated with a preformed functional device, while 15 subjects (mean age 9.5 ± 0.8 years) with normal occlusion were used as control. Inclusion criteria for both groups were: presence of mixed dentition, no previous orthodontic treatment, and absence of speech disturbance. sEMG recordings were taken at the time of the first visit (T0), and after 3 (T1) and 6 months (T2) for the treated group, and at T0 and T2 for the control group. The sEMG recording was performed at rest, and while kissing, swallowing, opening the mouth, clenching the teeth, and during protrusion of the mandible, by placing electrodes at the area of muscle contraction. At T0, except during swallowing, the treated group always showed a lower sEMG activity of the lower OO muscle with respect to the control group, with significant differences at rest and during mandibular protrusion (p<0.05). In the treated group, a significant increase in muscle tone was observed for the lower OO muscle from T0 to T1, but only at rest. The upper OO muscle showed a significant increase during the protrusion of the mandible from T1 to T2. No significant change was observed in the control group during the follow-up. Muscular contractility of treated patients at T2 reached the same values as that of the control group at T2. Interceptive orthodontics seems to improve the form and function of the orofacial muscle structure. Improvement in muscle contraction after treatment was demonstrated by sEMG.

A follow-up study of ethnic and gender differences in cardiac rehabilitation.

In a 1991 study, Romeo and Saccucci used the Sickness Impact Profile (SIP) to measure the perceived health status of individuals enrolled in a cardiac rehabilitation program and the perceived health status of those who received routine care. The participants were further classified by ethnic group and gender to enable the researchers to focus on the differential effects of cardiac rehabilitation on these groups. The present study was initiated to determine if the earlier results would remain consistent over time. The SIP was used to measure the health status of many of the same subjects within 3 years of the original measurement. The results of this study show fewer differences among the participants over the long term, which suggests that the time required for improvements may differ for various ethnic groups and for men and women.