3D occlusal changes of upper first molars after rapid maxillary expansion on permanent versus deciduous teeth: a retrospective multicenter CBCT study.

BACKGROUND: The purpose of this study was to compare the three-dimensional dental changes for the maxillary first molars and the overall skeletal effects achieved after expansion between the rapid maxillary expansion (RME) appliance attached to two different anchor units, the maxillary deciduous molars and the maxillary permanent first molars. METHODS: Patients were retrospectively selected according to the anchorage unit used for RME: deciduous upper second molars (RME-E group; 10 M, 10 F; mean age 8.4 ± 1.1 years) and first upper permanent molars (RME-6 group; 10 M, 10 F; mean age 12.6 ± 1.8 years). CBCT scans were obtained before treatment start (T1) and after retention and removal of the expander (T2). Images were analyzed using a new three-dimensional intra-hemi-maxillary reference system. 3D landmarks were marked to calculate all changes on maxillary first permanent molars; mesio-distal and buccal-lingual inclination and rotation, as well as intermolar and interforaminal distances were calculated. The Wilcoxon test was used to compare within-group changes, whereas the Mann-Whitney test was used to compare between-group differences, with the significance level set at 0.05. RESULTS: In the RME-E group, significant distorotation and lingual inclination of the first permanent molars at T2 were observed (p < 0.01); in the RME-6 group, only the buccolingual inclination of the crossbite side after RME was resulted statistically significant (p < 0.01). In both groups, intermolar and interforaminal values increased significantly (p < 0.01). Intergroup analysis showed a significantly higher distorotation and reduced buccal inclination of maxillary first permanent molars in the RME-E group after RME (p < 0.01). CONCLUSIONS: RME is effective in treating maxillary transverse hypoplasia; RME anchored too deciduous teeth spontaneously reduces buccal inclination and increases distorotation of maxillary first permanent molars, whereas anchorage to permanent molars is associated with increased buccal inclination, albeit with little clinical significance.

Treatment outcome of class II malocclusion therapy including extraction of maxillary first molars: a cephalometric comparison between normodivergent and hyperdivergent facial types.

Background: The dentoalveolar component of a Class II division 1 malocclusion can be orthodontically treated either with extractions or by distalization of the molars. This study aimed to compare skeletal, dentoalveolar and profile changes in normodivergent and hyperdivergent Class II Division I growing patients orthodontically treated with fixed appliances including maxillary first molar extraction. Methods: Sixty-four patients treated orthodontically with full fixed appliances including maxillary first molar extractions were retrospectively analyzed. Patients were divided into a normodivergent group (Group N; 30° ≤ SN^GoGn < 36°) consisting of 38 patients (17M, 21F; mean age 13.2 ± 1.3 years) and a hyperdivergent (Group H; SN^GoGn ≥ 36°) including 26 patients (12M, 14F; mean age 13.7 ± 1.1 years). Lateral cephalograms were available before (T0) and after treatment (T1) and cephalometric changes were calculated for 10 linear and 13 angular variables. The Shapiro-Wilk test confirmed a normal distribution of data, hence parametric tests were employed. The Student t-test was used to compare groups at baseline. The paired t-test was used to analyze intragroup changes between timepoints, and the Student t-test for intergroup comparisons. The level of significance was set at 0.05. Results: The Class II division 1 malocclusion was successfully corrected, and the facial profile improved both in normodivergent and hyperdivergent patients. Divergency increased by 0.76 ± 1.99° in Group N (p = 0.02) while it decreased -0.23 ± 2.25° (p = 0.60); These changes were not significant between groups after treatment (p = 0.680). Most dentoskeletal measurements changed significantly within groups but none of them showed statistically significant differences between groups after treatment. Dental and soft tissue changes were in accordance with the biomechanics used for this Class II orthodontic therapy. Discussion: The effect of orthodontic treatment of Class II division 1 malocclusion including extraction of the maxillary first molars in growing patients can be considered clinically equivalent in normodivergent and hyperdivergent patients. For this reason, this orthodontic treatment can be considered a viable option in the armamentarium of the Class II Division I therapy for both facial types.

CBCT Analysis of Dento-Skeletal Changes after Rapid versus Slow Maxillary Expansion on Deciduous Teeth: A Randomized Clinical Trial.

The aim of the present study was to compare skeletal and dental changes after rapid maxillary expansion (RME) and slow maxillary expansion (SME) performed by a Leaf Expander (LE) with upper deciduous teeth as anchorage and using 3D CBCT (Cone Beam Computed Tomography) analysis. Mixed dentition patients were randomly divided in two groups, according to the different expansion used anchored on maxillary primary second molars: the RME group (n = 16) was treated with a Hyrax type expander, whereas the SME group (n = 16) was treated with an LE expander. CBCT scans were performed before (T1) and after treatment (T2) and analyzed with a custom landmarks system. A paired t-test was used for intragroup analysis between T1 and T2, and a Student t-test was used for intergroup analysis; statistical significance was set at 0.05. Both RME and SME groups showed a statistically significant increase in dental and skeletal diameters. Group comparisons between T1 and T2 showed a significant expansion rate in the RME group for upper permanent molars (p = 0.025) but not for deciduous molars (p = 0.790). Moreover, RME showed higher increases for skeletal expansion evaluated at nasal walls (p = 0.041), whereas at pterygoid plates did not show any significant differences compared with the SME group (p = 0.849). A significant transverse expansion could be achieved with the expander anchored on deciduous teeth. RME and SME produced effective both skeletal and dentoalveolar transverse expansion; RME produced more anterior expansion than SME but less control regarding the permanent molar decompensation. SME by LE therefore could be an efficient and helpful alternative in the treatment of transverse maxillary deficiency in growing patients.

Skeletal, Dental and Soft Tissue Cephalometric Changes after Orthodontic Treatment of Dental Class II Malocclusion with Maxillary First Molar or First Premolar Extractions.

The aim of the present retrospective study was evaluating skeletal, dental and soft tissue changes of two groups of Class II patients orthodontically treated with extractions of upper first premolars (U4 group) and upper first molars (U6 group). In total, 21 patient records (9M and 12F; mean age 12.5 ± 1.2 years) were selected for the U4 group, and 38 patient records (17M and 21F; mean age 13.2 ± 1.3 years) were recruited for the U6 group. Twenty cephalometric variables were analysed on standardised lateral cephalograms at baseline (T0) and at the end of orthodontic treatment (T1). Means and standard deviations (SDs) were calculated for both groups and increments were calculated. After revealing the normal distribution of data with the Shapiro-Wilk test, Student's t-test was used to compare variables at T0 between groups. A paired t-test was used to analyse changes between time points within each group, and Student's t-test to compare differences between groups at T1. Both groups showed a significant increase in the distance among upper second molars and the vertical pterygoid line (PTV-maxillary second molar centroid U6 group: 6.66 ± 5.00 mm; U4 group: 3.66 ± 2.20 mm). Moreover, the distance of upper incisors to the palatal plane significantly increased (PP-maxillary incisor tip U6 group: 1.09 ± 1.52 mm; U4 group: 0.20 ± 2.00 mm; p = 0.061). Significant changes were found for overjet (U6 group: -4.86 ± 1.62 mm; U4 group: -3.27 ± 1.90 mm; p = 0.001). The distance between upper lip and esthetic plane showed a significantly reduction in both groups (ULip-E Plane U6 group: -2.98 ± 1.65 mm; U4 group: -1.93 ± 1.57 mm). No statistically significant changes were found in sagittal or vertical skeletal values. The significantly larger reduction of upper lip protrusion and overjet in the U6 group compared to the U4 group suggests preferring molar extraction treatment for severe Class II with protrusive soft tissues' profile and increased overjet. Since no differences on vertical values were found, an increased SN^GoGn angle should not be considered a discriminating factor for choosing molar extraction treatment.

Does Early Treatment Improve Clinical Outcome of Class II Patients? A Retrospective Study.

The present study was carried out to evaluate the benefits from one-phase Class II Early Treatment (ET) using extraoral forces and functional appliances but without intermaxillary forces and eventual lower leeway space preservation compared to two-phase Class II Late Treatment (LT) with the need for extractions and full fixed appliances as well as lower incisor proclination. The ET group (n = 239, 115 M, 124 F, mean age 10.6 ± 1.2 years), with first premolars not in contact and the second deciduous lower molars preserved, was compared to the LT group (n = 288, 137 M, 151 F, mean age 12.4 ± 1.5 years). The ET group was first treated with headgears, growth guide appliances, or Teuscher activators and, in borderline crowding cases, with lower space maintenance by a lingual arch, lip bumper, or fixed utility arch. The LT group and the second phase of ET were treated with full fixed appliances including intermaxillary forces such as Class II elastics or noncompliance devices; headgear and a growth guide appliance were also used. Cephalograms and plaster models were taken before (T1) and after treatment (T2) to calculate cephalometric changes and space balance discrepancies. The differences between T1 and T2 were analyzed by a t-test for normally distributed data and by the Mann-Whitney Test for nonnormally distributed data at a level of p < 0.05. The groups were defined as statistically homogeneous at T1. A statistical analysis showed that the ET group (mean treatment time 35.3 ± 13.3 months) was significantly associated with a 22.2% lower extraction rate, 15.9% less need for a full fixed appliance, and more than 5° less incisor proclination in the nonextraction cases compared to the LT group (mean treatment time 25.9 ± 8.1 months); treatment time significantly increased in the ET group compared to the LT group. Early Class II treatment resulted in a significant treatment effort reduction in more than one third of the patients and less lower incisor proclination, even if it clinically increased treatment time.

Influence of facial components in class III malocclusion esthetic perception of orthodontists, patients, and laypersons.

PURPOSE: The aim of the present study was to investigate the influence of different facial components (face length, lip volume, nose size, and cheekbone contour) on the perception of facial attractiveness of patients with Angle class III malocclusion in different categories of responders (orthodontists, laypersons, patients) with two-dimensional (2D) and three-dimensional (3D) simulations. METHODS: An ideal standard 3D face was manipulated to create a class III facial malocclusion. Four facial components were modified (face length, lip volume, nose size and cheekbone contour) and the resulting simulations were used to obtain 2D figures and 3D videos, which were evaluated in a survey by orthodontists, patients, and laypersons. RESULTS: No significant differences were detected between the 2D figures and 3D video simulations. Good correspondence was shown between the three categories of responders for the most and the least attractive faces. Smaller lips and bigger nose, regardless to the vertical dimension (short or long face), were found to be the least attractive features with agreement of all respondents. CONCLUSION: Regarding class III facial attractiveness perception, the sum of all facial features and not the alteration of a single component alone seems to play a key role in the perception of facial attractiveness. The 2D or 3D perspective did not play a significant role in perception and the analyzed categories of responders did not show significant differences when perceiving facial attractiveness of the utilized simulations.

Occlusal Plane Changes After Molar Distalization With a Pendulum Appliance in Growing Patients with Class II Malocclusion: A Retrospective Cephalometric Study.

OBJECTIVE: This study aimed to evaluate the skeletal and dental changes after distalization with a pendulum appliance in growing patients with Class II malocclusion, focusing on the occlusal plane (OP). METHODS: The sample included 24 patients with Class II malocclusion (10 boys, 14 girls); their mean age was 12.1 years. All patients underwent molar distalization and had 2 serial cephalograms traced at baseline (T1) and after distalization (T2). Angular and linear dental changes were calculated by taking the sella-nasion (SN), palatal plane (PP), and pterygoid vertical as reference. OP inclination was compared with SN, PP, and mandibular plane. The collected data were computed for all the tested variables, and one-way paired t-test was used to assess the significance of the differences between the time points. α was set at 0.05. Multiple linear regressions were used to predict the OP changes. RESULTS: The mean total treatment time was 8±2 months to obtain a super Class I molar relationship. In T1-T2 interval, statistically significant incisor buccal tipping of 5°±3.6° (p<0.05), first molar distal tipping of 8.9°±8.3° (p<0.001), and second molar tipping of 8.2°±8.1° (p<0.001) were observed. The maxillary first and second molars moved significantly backward by 2.8±3.2 mm (p<0.05) and 3.7±2.7 mm (p<0.001), respectively. Only the premolars showed a statistically significant anchorage loss of 2.7±3.3 mm (p<0.05); overjet increased significantly at 1.3±1.2 mm (p<0.05). Regarding the OP, none of the tested variables showed any statistically significant changes between T1-T2. CONCLUSION: The pendulum appliance showed efficacy in distalizing the maxillary first and second molars at the expense of anterior anchorage loss. The OP did not show statistically significant changes after molar distalization.

Condylar Changes in Children with Posterior Crossbite after Maxillary Expansion: Tridimensional Evaluation.

(1) Background: To investigate condylar position in subjects with functional posterior crossbite comparing findings before and after rapid maxillary expansion (RME) treatment through 3D analysis; (2) Methods: Thirty-two Caucasian patients (14 males, mean age 8 y 8 m ± 1 y 2 m; 18 females mean age 8 y 2 m ± 1 y 4 m) with functional posterior crossbite (FPXB) diagnosis underwent rapid palatal expansion with a Haas appliance banded on second deciduous upper molars. Patients' underwent CBCT scans before rapid palatal expansion (T0) and after 12 months (T1). The images were processed through 3D slicer software; (3) Results: The condylar position changes between T1 and T0 among the crossbite and non-crossbite sides were not statistically significant, except for the transversal axis. At T1, the condyles moved forward (y axis) and laterally (x axis), they also moved downward (z axis) but not significantly; (4) Conclusions: Condilar position in growing patients with functional posterior crossbite did not change significantly after rapid maxillary expansion.

Occlusal Plane and Skeletal Changes After Cervical Headgear Treatment With and Without Lower Utility Arch in Class II Growing Patients.

ABSTRACT: The purpose of this study was to investigate skeletal and dental changes affecting occlusal plane inclination after cervical headgear treatment with and without lower utility arch. In order to distinguish the orthodontic changes from natural growth a control group was employed.The sample of this study consisted by 20 Class II subjects (10 males, 10 females; mean age 8.54) treated by using cervical headgear, 19 class II children (19 males, 9 females; mean age 8.64) treated with cervical headgear and utility arch, and 21 Class II patients (11 males, 10 females; mean age 8.41) who had no therapy.Lateral head films were studied for all the patients before treatment (T1) and after therapy (T2) for all the treated groups and at the beginning and at the end of observational period for the control group; cephalometric analysis was carried out in order to seek for the modifications between time points and between groups.Means and standard deviation have been analyzed for all the groups. In order to compare the modification between the time points within the same group the ANOVA test was applied. The ANOVA test was used to compare the mean differences (T2-T1) of 3 groups.The study revealed that there were significant changes in occlusal plane inclination after the different treatment modalities employed instead control group. The treatment with cervical headgear and utility arch is more effective than cervical headgear alone in lowering occlusal plane posteriorly when it is compared with controls.

Correlation between Caries, Body Mass Index and Occlusion in an Italian Pediatric Patients Sample: A Transverse Observational Study.

BACKGROUND: The aim of this study was to evaluate the correlation between caries, body mass index (BMI) and occlusion in a sample of pediatric patients. METHODS: The study group included 127 patients (72 female, 55 male) aged between 6 and 16 years (mean age 10.2) and selected between January and June 2019 at the Department of Pediatric Dentistry, University of Messina. Caries incidence was evaluated using the decayed, missing and filled teeth (DMFT) index. On the basis of BMI values, using a table adjusted for age and gender, patients were grouped into four categories (underweight, normal weight, risk of overweight, overweight). RESULTS: There was no significant correlation between BMI and DMFT in the whole sample. The study of the correlation between BMI and DMFT in patients with different types of malocclusion showed a significant inverse correlation for patients affected by II class and deepbite malocclusion. CONCLUSIONS: The incidence of caries does not seem to be significantly related to BMI and occlusal patterns, but it decreases with increasing age.

3D Assessment of Endodontic Lesions with a Low-Dose CBCT Protocol.

Background: Cone beam computed tomography (CBCT) is often used in different fields of dental science, especially in complex anatomical districts like the endodontic one. The aim of this study is to propose a low-dose CBCT protocol useful in cases of endodontic lesions. Methods: The device used was a MyRay Hyperion X9-11x5; the low dose setting of the machine was 90 Kv, 27 mAs, CTDI/Vol 2.89 mGy. The absorbed organ doses have been evaluated with an anthropomorphic phantom loaded with thermoluminescent dosimeters positioned at the level of sensitive organs like brain, bone marrow, salivary glands, thyroid, esophagus, oral mucosa, extrathoracic airways, and lymph nodes. Equivalent and effective doses have been calculated; the last one has been calculated using the recommendations approved by the Main Commission of ICRP (International Commission Radiological Protection) in March 2007. For the assessment of image quality, five senior clinicians, independent and experienced clinicians, were asked to state if CBCT scans were accurate enough to assess endodontic lesions. Results: The use of a low-dose CBCT acquisition produced the lowest organ dose (5.01 microSv) at the level of the esophagus. Image quality has been considered accurate enough for endodontic diagnostic needs. Conclusions: CBCT low-dose protocol can be used over the standard one in endodontic special cases because it provides a significantly lower radiation dose to the patients while ensuring good image quality. However, further studies are necessary to evaluate the opportunity of low-dose CBCT exams in endodontic clinical practice.

Upper canine response to rapid maxillary expander anchored to deciduous vs. permanent molars.

PURPOSE: To understand whether two different designs of Haas-type rapid maxillary expander (H­RME) might have a different influence on canine eruption. PATIENTS AND METHODS: In all, 108 subjects seeking orthodontic treatment were selected and divided into two groups-H­RME with bands on the upper second deciduous molars (GrE), H­RME with bands on the upper first permanent molars (Gr6)-and were also compared to an historical untreated control group (CG) of 29 subjects. Panoramic x­rays (OPG) were performed before and after RME (T0-T1: 16 ± 7 months) and the upper canine angulation to the midline ("α" angle) was measured on both pre- and posttreatment OPG. RESULTS: A significant improvement of the canine position (decrease of the α angle) following RME in subjects with mixed dentition was reported in both treated groups, although the different design of the RME did not significantly affect canine angulation. Canine angulation in untreated subjects with transversal discrepancy did not improve significantly. CONCLUSION: Using RME in the early mixed dentition appears to be an effective procedure to increase the rate of eruption of maxillary canines, but the position of the bands on the upper second deciduous molars or on the upper first permanent molars and the significant different expansion of the upper dental arch at the canine level does not significantly influence the canine angulation following early treatment therapy.

Changes in canine inclination after rapid and slow maxillary expansion compared to untreated controls.

OBJECTS: Palatally displaced canines (PDC) might represent condition causing several clinical problems, such as roots resorption and malocclusion, and can develop palatal canine impaction. Some interceptive treatments such as rapid maxillary expansion were suggested in order to foster maxillary canine eruption. Among expansion protocols, no data are available about differences between rapid and slow maxillary expansion on maxillary canine eruption. The aim of this study was therefore to evaluate α-angle changes in palatally displaced canines using rapid and slow maxillary expansion compared to untreated control patients. SETTING AND SAMPLE POPULATION: The final sample comprised 19 patients treated with rapid maxillary expansion (RME group), 17 treated with slow maxillary expansion (SME group) and 22 control patients (Control group). MATERIALS AND METHODS: α-angle was measured on panoramic films to detect canine inclination at the beginning, and at the end of maxillary expansion treatment or observation, time and changes over time were compared. RESULTS: In the comparisons among groups, RME group was the only group showing a decrease in α-angle measurements that was statistically significant also when compared to the other groups, except for the left side when compared to SME group. CONCLUSION: RME treatment significantly and positively affected canine position when compared to SME treatment and control group.

Midpalatal Suture Density Evaluation after Rapid and Slow Maxillary Expansion with a Low-Dose CT Protocol: A Retrospective Study.

Background and objectives: The aim of the present paper is to use low-dose computed tomography (CT) to evaluate the changes in the midpalatal suture density in patients treated with rapid maxillary expansion (RME) and slow maxillary expansion (SME). Materials and Methods: Thirty patients (mean age 10.2 ± 1.2 years) were retrospectively selected from the existing sample of a previous study. For each patient, a low-dose computed tomography examination was performed before appliance placement (T0) and at the end of retention (T1), seven months later. Using the collected images, the midpalatal suture density was evaluated in six regions of interest. Results: No significant differences were found between the timepoints in the rapid maxillary expansion group. Three out of six regions of interest showed significant decreases between the timepoints in the slow maxillary expansion group. No significant differences were found in comparisons between the two groups. Conclusions: The midpalatal suture density showed no significant differences when rapid maxillary expansion groups were compared to slow maxillary expansion groups, suggesting that a similar rate of suture reorganization occurs despite different expansion protocols.

Changes of Occlusal Plane in Growing Patients With Increased Vertical Dimension During Class II Correction by Using Cervical Headgear.

This retrospective research aimed to highlight the changes of occlusal plane in Class II hyperdivergent subjects that received cervical headgear treatment and compared them to untreated controls in order to evaluate the occlusal changes that might be connected to a potential mandibular rotation.The sample of this investigation was represented by 20 hyperdivergent Class II subjects (10 males, 10 females; mean age 8.54) corrected by using cervical headgear (treated group) and 21 Class II patients (11 males, 10 females; mean age 8.41) hyperdivergent who had no therapy (control group). Lateral head films were studied for all the patients before treatment (T1) and after therapy (T2) for both groups; cephalometric analysis was used in order to seek the modifications between time points and between groups.Means and standard deviation have been computed for both groups. In order to confront the modification between the time points within the same group the Wilcoxon test was applied. The Mann-Whitney U test was applied to confront the dissimilarities between groups at T2.As a result of the Class II correction by using the cervical headgear treatment the occlusal plane was lowered and flattened compared to T1 and to the control group; the upper molars showed extrusion to the palatal plane, there was a significant forward rotation of mandible and the vertical dimension was not significantly modified. Downward and backward displacement of the upper jaw occurred.

Buccal bone plate thickness after rapid maxillary expansion in mixed and permanent dentitions.

INTRODUCTION: Rapid maxillary expansion (RME) might cause buccal displacement of anchor teeth. Dislocation of teeth outside their alveolar process can damage the periodontium; for this reason, maxillary expansion using deciduous teeth as anchorage in the mixed dentition might be suggested. The aim of this study was to compare changes of buccal bone plate thickness on the maxillary permanent first molars after RME in the mixed and permanent dentitions with different types of anchorage. METHODS: Two groups of patients were evaluated with cone-beam computed tomography before and after RME. Group E (21 patients) underwent RME using deciduous teeth as anchorage; group 6 (16 patients) underwent RME using permanent teeth as anchorage. The Wilcoxon test was used to compare changes between the time points in the same groups, and the Mann-Whitney U test was used to compare differences between the groups. RESULTS: In group E, generally, no statistically significant reduction was found in buccal bone plate thickness between the time points. In group 6, most measurements showed significant reductions in buccal bone plate thickness (P <0.05) between the time points, with a maximum decrease of 1.25 mm. CONCLUSIONS: RME in the mixed dentition with the appliance anchored to deciduous teeth did not reduce the buccal bone plate thickness of the maxillary permanent first molars, except for the mesial roots on both sides. RME in the permanent dentition caused a reduction of the buccal bone plate thickness of the maxillary permanent first molars when they were used as anchorage in the permanent dentition.

Effects of impaction severity of treated palatally displaced canines on periodontal outcomes: a retrospective study.

BACKGROUND: Even though periodontal health was suggested to be not related to the traction technique, some other variables might influence the esthetic outcome of palatally displaced canines (PDC) when aligned, such as the initial position and impaction rate of the canine before treatment. The purpose of the present study was therefore to evaluate the existing correlations between periodontal health outcome of PDC after their exposure and alignment and their initial position identified according to the different rates of impaction severity. MATERIALS AND METHODS: The final sample enrolled 293 PDC which satisfied inclusion and exclusion criteria. All the canines were exposed using CT by the same oral surgeon and orthodontic traction was applied using the easy cuspid device followed by fixed appliance treatment. Image analysis and periodontal status evaluation were performed for all PDCs. RESULTS: α-Angle and d-distance showed no significant differences in the periodontal outcome of PDCs after treatment. The only tested variable showing significant differences was S, since canines with CEJ visible at the end of the treatment presented sectors with a mean score of 1.67, which was significantly different (P < 0.05) when compared to the S-sector for the canines that showed PD < 2 mm at the end of the treatment. CONCLUSIONS: Radiographic variables as α-Angle and d-distance seem to not influence the periodontal outcome of the treated impacted canine regardless of the amount of gravity. On the contrary, S-sector might play a significant role when higher rates of gravity are present suggesting the possibility in few cases for periodontal damage at the end of treatment.

Metabolic effects of treatment in patients with obstructive sleep apnea: a systematic review.

INTRODUCTION: Growth retardation was frequently observed in obstructive sleep apnea (OSA) patients but the complex mechanisms causing this condition are still unclear. Several findings suggested growth catch-up after surgical treatment but other studies did not confirm the results, showing no improvement in OSA patients after tonsillectomy and adenoidectomy (T&A). The aim of the present study was to systematically review scientific literature of the relationships between OSA and metabolic changes involving growth hormone (GH) axis before and after treatment in patients. EVIDENCE ACQUISITION: Different databases were searched without limitations up to August 2017. Additionally, the bibliographies of the finally selected articles were hand searched to identify any relevant publications that were not previously identified. EVIDENCE SYNTHESIS: From the 37 studies collected from all the databases based on their title and abstract, only 12 studies actually fulfilled the selection criteria. From the twelve finally selected articles, eight focused on growth mediators, two evaluated endothelial mediators, one focused on neurocognitive function and mediators and one focused on local inflammation. CONCLUSIONS: OSA children present lower levels of growth mediators (IGF-I and IGFBP-3) thus indicating growth retardation, significantly higher cardiovascular disease risk and decreased cognitive functions when compared to controls. T&A seems to improve all the above mentioned functions with great impact on general health.

Osteo-regeneration personalized for children by rapid maxillary expansion: an imaging study based on synchrotron radiation microtomography.

BACKGROUND: Personalized maxillary expansion procedure has been proposed to correct maxillary transversal deficiency; different protocols of stem cell activation have been suggested and rapid maxillary expansion (RME) is the most commonly used among clinicians. The present study aimed to quantify in three-dimensions (3D) the osteo-regeneration of the midpalatal suture in children submitted to RME. METHODS: Three patients (mean age 8.3 ± 0.9 years) were enrolled in the study to preform biopsy of midpalatal suture. Two patients (subjects 1 and 2) were subjected to RME before biopsy. The third patient did not need maxillary expansion treatment and was enrolled as control (subject 3). Midpalatal suture samples were harvested 7 days after RME in subject 1, and 30 days after RME in subject 2. The samples were harvested with the clinical aim to remove bone for the supernumerary tooth extraction. When possible, maxillary suture and bone margins were both included in the sample. All the biopsies were evaluated by complementary imaging techniques, namely Synchrotron Radiation-based X-ray microtomography (microCT) and comparative light and electron microscopy. RESULTS: In agreement with microscopy, it was detected by microCT a relevant amount of newly formed bone both 7 days and 30 days after RME, with bone growth and a progressive mineralization, even if still immature respect to the control, also 30 days after RME. Interestingly, the microCT showed that the new bone was strongly connected and cross-linked, without a preferential orientation perpendicular to the suture's long axis (previously hypothesized by histology), but with well-organized and rather isotropic 3D trabeculae. CONCLUSIONS: The microCT imaging revealed, for the first time to the authors' knowledge, the 3D bone regeneration in children submitted to RME.