Can computer-guided surgery help orthodontics in miniscrew insertion and corticotomies? A narrative review.

Orthodontics has considerably increased the use of technology combined with surgery as a tool to improve dental movements in terms of predictability, acceleration of movement, and fewer side effects. To achieve these goals miniscrews and corticotomy were introduced. The digital workflow permits an increase in the accuracy of surgical and orthodontic setups. The tool that transfers the information is the CAD/CAM (Computer-Aided Design/ Computer-Aided Manufacturing) template. The aim of this review is to illustrate the use of computer-guided surgery in orthodontics regarding miniscrews and piezocision. The search strategy was a combination of Medical Subject Headings (Mesh) and free text words for PubMed. A total of 27 articles were included in this review: 16 concerned miniscrews and 11 concerned corticotomy. The current need for faster treatments, the improved systems of anchorage, and the evolution of imaging technologies require operators to be knowledgeable of the digital workflow. CAD/CAM templates allow greater precision and predictability of miniscrew insertion even if in the hands of less experienced clinicians and permit a better orientation and depth of the cortical incision. In conclusion, digital planning makes surgery faster and easier and allows for the identification and correction of any potential problem before the procedure.

Condylar remodelling in a severe class II deep bite dento-skeletal malocclusion treated with an ortho-surgical approach: A five-year follow-up case report.

Condylar displacement and remodelling are phenomena closely related to orthognathic surgery and critically involved in occlusal and skeletal stability. The aim of the present case report is to describe over time condylar displacement and surface remodelling after bilateral split sagittal osteotomy (BSSO) in an adult patient with severe class II skeletal malocclusion treated with ortho-surgical approach. A male of 21years comes to our observation. The extraoral examination shows a symmetrical square-shaped face, a convex profile, an acute nasolabial angle and a deep labiomental fold. Intraoral examination reveals a class II division 2 with a 2mm deviation of the mandibular midline to the left and the presence of a scissor bite of the bicuspids between quadrants II and III. The Spee curve and overbite are extremely accentuated (OV 14.3mm) as the overjet (11.1mm). Axiographic reconstructions of CBCT show a normal shape and position of both condyles. The cephalometric analysis shows a reduced lower facial height, a normal upper jaw position, a mandibular underdevelopment masked by a very developed symphysis and an extremely low divergence (FMA 11.2°). BSSO for mandibular setback was performed in the 13th month of orthodontic therapy. Original CBCT data before surgery (T0), at the end of treatment (T1), 2years postoperatively (T2) and 5years postoperatively (T3) were collected and reconstructed for 3-dimensional (3D) qualitative analyse. At the end of the surgical-orthodontic treatment (26months), good function and good aesthetics were achieved. The qualitative and comparative analysis of the superimpositions and the cuts made on the CBCT at T0, T1, T2, T3 showed a physiological remodelling and adaptation of the condyles.

Predictive Analysis of Maxillary Canine Impaction through Sella Turcica Bridging, Ponticulus Posticus Calcification, and Lateral Incisor Anomalies: A Retrospective Observational Study.

Maxillary canine impaction is an increasing dental anomaly and is often related to other dento-skeletal anomalies. The aim of this work is to support the clinician in evaluating the relationship between a displaced maxillary canine and clinical (the features of lateral incisors)/skeletal (ponticulus posticus and sella turcica bridging) anomalies through orthopanoramic radiographs, lateral cephalograms, and plaster casts to identify the parameters that best predict maxillary canine impaction. A retrospective observational study was carried out on the analysis of the medical records, radiographic findings (panoramic radiographs and lateral cephalograms), and plaster casts of 203 orthodontic patients divided into a case group, with at least one impacted maxillary canine, and a control group, without an impaction. A chi-square test and logistic regression analysis were used to analyze the data. A statistically significant association was found between the impaction of the maxillary canine and the female sex, the bridging of the sella turcica, the ponticulus posticus calcification, and the anomaly of the lateral incisor; a logistic regression revealed that these significant variables were found to be positive predictors of impacted maxillary canines, particularly in reference to the impaction in the palatal area. Finding one of these clinical and radiographic elements can represent a predictive sign of the possible impaction of the maxillary canine.

Condylar reshaping in a TMD patient after ortho-prosthetic treatment: A 20-year follow-up case report.

Temporomandibular disorders (TMDs) involve different conditions with similar symptoms and signs affecting the temporomandibular joints (TMJs), the muscles of mastication, or both. The symptoms and signs of TMDs are several: pain and tenderness in and around the TMJs and muscles of mastication, limitation and lack of coordination in jaw movement, joint sounds - clicking and/or crepitus, episodes of closed lock or open lock, headaches. In the TMD, degenerative joint disease (DJD), also called osteoarthritis (OA), may be a local condition or part of a systemic disease. According to the Research Diagnostic Criteria for Temporomandibular Disorders RDC/TMD, OA involves the presence of reported symptoms and clinical signs. As regards the possible causes, the literature indicates that mechanical load may act as a trigger factor for a various degenerative modification resulting in con-dylar resorption when host remodeling capacity is lost. Although the role of occlusion in the etiology of TMD is not absolutely assessed, occlusal interferences could affect TMD. The aim of this case report is to present the history over time (20 years follow-up) of a female adult patient with osteoarthritis of TMJs, who showed an adaptative reshaping of the condyles and to consider the possible relation with orthodontic treatment and occlusal rehabilitation. Key words:TMD, osteoarthritis, condylar reshaping, adult treatment.

Periodontal results of different therapeutic approaches (open vs. closed technique) and timing evaluation (< 2 year vs. > 2 year) of palatal impacted canines: a systematic review.

BACKGROUND: This review evaluates, as a primary outcome, which surgical technique (open vs. closed) and which type of material used for the auxiliaries (elastic vs. metallic) were preferable in terms of periodontal results during the treatment of palatal-impacted canines. The timing of the evaluation of the results was also assessed as a secondary outcome. METHODS: An electronic search of the literature up to March 2021 was performed on Pubmed, MEDLINE (via Pubmed), EMBASE (via Ovid), Cochrane Reviews and Cochrane Register of Controlled Trials (RCTs) (CENTRAL). The risk of bias evaluation was performed using version 2 of the Cochrane risk of bias tool (RoB 2) for RCTs and the ACROBAT NRSI tool of Cochrane for non-RCTs. RESULTS: 11 articles met the inclusion criteria. Only one RCT was assessed as having a low risk of bias and all the non-RCTs were assessed as having a serious risk of bias. This review revealed better periodontal results for the closed technique and metallic auxiliaries. In addition, it revealed that the timing of the evaluation of the results affects the periodontal results with better results obtained 2 years after the end of treatment. CONCLUSION: In the treatment of a palatal-impacted canine, the closed technique and metallic auxiliaries should be preferred in terms of better periodontal results. The timing of the evaluation of the results affects the periodontal results.

Periodontal evaluation of palatally impacted maxillary canines treated by closed approach with ultrasonic surgery and orthodontic treatment: a retrospective pilot study.

Aim of this study is the evaluation of the periodontal status of impacted canines treated by closed approach with ultrasonic surgery and orthodontic treatment compared with contralateral spontaneously erupted teeth. The periodontal conditions of the teeth adjacent to the canines (lateral incisors and first premolar) were also considered. 17 patients (9 females and 8 males; mean age: 15.2 years) with unilateral palatal impaction of maxillary canine were selected. All patients were treated by closed-flap surgery with ultrasonic instruments. Periodontal status was evaluated by assessing probing depth (PD), gingival recession and width of keratinized tissue (KT) 4.6 months after the end of the orthodontic treatment, on average. Test group was composed by impacted elements and adjacent teeth and control group by contralateral spontaneously erupted canines and adjacent teeth. Student's t-test was used to compare test and control group values of PD and width of KT. Significance threshold for Student's t-test was set at p < 0.05. The average probing depth values show no significant clinical differences between the test and control groups. Probing depths recorded at the mesiovestibular and distopalatal sides of the impacted canine were statistically significant compared to the control elements (p < 0.05). No gingival recession was detected on the treated canines. The measurement of KT did not differ significantly between the test and the control groups. In conclusion, the ultrasonic surgery for disinclusion associated with a closed approach and orthodontic traction allows the alignment of an impacted palatal canine without damaging the periodontium.