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.

Buccal Alveolar Bone changes and upper first molar displacement after maxillary expansion with RME, Ni-Ti leaf springs expander and Tooth- Bone-borne Expander. A CBCT based analysis.

AIM: To evaluate the buccal alveolar bone changes and the upper first molar displacement in subjects treated with conventional rapid maxillary expansion (RME), Ni-Ti leaf springs expander (Leaf Expander) and Tooth-Bone-borne Expander (Hybrid Expander) using CBCT scans. METHODS: The sample consisted of 52 children treated with RME (n=18), Leaf Expander (n= 17) and Hybrid Expander (n= 17). CBCTs were taken before and after maxillary expansion and the Horos software was used for the analysis. Descriptive statistics and paired t-test were used to assess changes between the pre-treatment and post-treatment measurements. ANOVA test and Tukey's post hoc test with Bonferroni correction was used for between groups comparison. CONCLUSION: The Hybrid Expander during preadolescence showed few advantages over the use of tooth-anchored expanders. An expansion approach with mini-screws is not preferable during early mixed dentition to a conventional approach. The differences in dental tipping values were clinically insignificant and the reduction in cortical bone thickness remained less than 1 mm. When possible, the use of second primary molars as anchorage should be preferred.

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.

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.

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.

Three-dimensional evaluation of rapid maxillary expansion anchored to primary molars: direct effects on maxillary arch and spontaneous mandibular response.

AIM: The purpose of this study was to evaluate the effects of rapid maxillary expansion (RME) on maxillary and mandibular arch in the mixed dentition. MATERIALS AND METHODS: Forty-four consecutive patients with transverse maxillary deficiency were recruited. Test group: 21 patients (10 male, 11 female; 7.4 ± 1.2 years) who underwent RME (Haas type) therapy banded on the primary second molars. CONTROL GROUP: 17 patients (10 male, 7 female; 7.3 ± 1.1 years old) who did not receive any orthodontic treatment. Dental casts obtained pre-treatment and after appliance removal (11 months) were processed by means of a three-dimensional scanner (3Shape D250 laser, DK). Digital landmarks were traced using the VAM software (Canfield Scientific Inc., Fairfield-NJ, USA). Arch Length, interdental width and torque differences were measured before and after the removal of the appliance. The t-test (P<0.05) for paired data was applied to evaluate the measurements values before and after treatment. The linear regression model was employed to assess the correlations between treatment effects. RESULTS: The efficacy of the RME was confirmed both on maxillary and mandibular arch. Mandibular intermolar width (+2.02 mm) together with primary intermolar (+1.39 mm), intercanine width (+0.95mm) and torque variations significantly increased. The untreated control group showed no significant statistical differences between T0 and T1. The linear regression between maxillary and mandibular data showed correlations between the torque of the teeth 16/46 and 65/85 (P<0.05). CONCLUSIONS: RME anchored on primary molars is an effective treatment option to correct tranverse maxillary deficiencies. All the measurements increased significantly confirming the indirect effect of RME on the mandibular arch.

Comparison between RME, SME and Leaf Expander in growing patients: a retrospective postero-anterior cephalometric study.

AIM: The aim of this study is to compare the dental and orthopaedic effects of the Leaf Expander with rapid and slow maxillary expanders. MATERIALS AND METHODS: The sample comprised 30 patients with a posterior crossbite divided into three groups: the rapid maxillary expander (RME) group (3 m, 7 f), average age 8.9 years; the slow maxillary expander (SME) group (7 m, 3 f) average age 12.2 years; the Leaf Expander (LE) group (7 m, 3 f), average age 7.9 years. Postero-anterior cephalometric studies have been obtained at the beginning of the therapy (T1) and after 9 months (T2). Nasal width, maxillary width, mandibular width, upper permanent molars width have been measured by a calibrated examiner. RESULTS: All the measurements increased significantly after the treatment (paired t-test P=0.05). Maxillary average width increased of 4.2 mm (SD 3.6 mm) in RME; + 2.8 mm (SD 2.8 mm) in RSE and +3.6 mm (SD 2.2 mm) in LE group. Upper permanent molars width increased: + 5.4 mm (SD 3.31 mm) in RME; + 5.4 mm (SD 3.3 mm) in SME and + 3.8 mm (SD 2.1 mm) in LE group. No statistical differencesbetween the groups have been found (t-student test P=.05). CONCLUSIONS: The effectiveness of the LE in transversal deficiency correction has been confirmed.

Maxillary tridimensional changes after slow expansion with leaf expander in a sample of growing patients: a pilot study.

AIM: The aim of this study is to evaluate the dento-alveolar effects of slow maxillary expansion using the Leaf Expander in a sample of growing patients with maxillary transverse deficiency, unilateral cross bite and mandibular shift. MATERIALS AND METHODS: The study included 10 patients, 3 male and 7 female (mean age 7.5 + 7 months), treated with Leaf Expander anchored on the upper deciduous teeth. Digital models were obtained by a lab scan of the pvs impressions at the beginning of the therapy (T1) and at the removal of the palatal expander (T2). Five parameters were measured: 1) the distance between the first upper permanent molars; 2) the distance between the upper second deciduous molars; 3) the distance between the upper canine cusps 4) the distance between the first lower permanent molars; 5) the distance of the lower canine cusps. RESULTS: In all patients complete correction of posterior crossbite was achieved on average in 4 months, with a spontaneous expansion of the upper first permanent molars. Significant increases in the dento-alveolar transversal diameters were obtained. Increases were also observed in the anterior mandibular arch diameter (+ 1 mm). CONCLUSIONS: These findings suggest that slow maxillary expansion using Leaf Expander appliance could be a reasonable alternative to conventional maxillary expansion therapy in the early mixed dentition.

Rapid and slow maxillary expansion: a posteroanterior cephalometric study.

AIM: The purpose of this study was to evaluate and compare the dental and orthopaedic effects of rapid and slow maxillary expansion in a sample of young patients with transversal maxillary deficiency by using a postero-anterior cephalometric analysis. MATERIALS AND METHODS: Two groups of patients were considered: 10 patients (3 males, 7 females) with an average age of 8.9 years were treated with a rapid maxillary expansor (RME); 10 patients (7 males, 3 females) with an average age of 12.2 years were treated with a new slow maxillary expansion appliance (ELA). Postero-anterior cephalometric analyses were made at the beginning of the therapy (T0) and at the end of expansion (T1) using a computerised cephalometric programme. Four parameters were measured: Nasal width, maxillary width, mandibular width, upper molars width. RESULTS: Transversal average width increased 5.435 mm (SD 3.31 mm) between the upper molars in the RME group and 5.547 mm (SD 3.49 mm) in the SME group. Maxillary average width increased 4.254 mm in the first group and 2.845 mm in SME group. Discussion An orthopaedic result was reached with both treatments. These results are in agreement with the orthodontic literature. CONCLUSION: This work confirms the effectiveness, efficiency and usefulness of this new ELA appliance in the correction of transversal deficiency with orthopaedic results, if used in growing patients.

Treatment of sequential bilateral germ cell tumors of the testis following interval retroperitoneal lymph node dissection.

Modification in lymphatic drainage following retroperitoneal lymph node dissection, such as a collateral circulation or lymph node and lymphatic vessel regeneration, was observed in 2 patients in whom a second tumor developed in the remaining testicle. Such alterations of the lymphatic system are difficult to evaluate for the possible presence of metastatic disease. The presence of extensive collateral circulation rules out lymph node dissection or radiation therapy as an appropriate treatment in these patients. A short course of systemic chemotherapy, regardless of the histological type of the second malignancy, seems to be the safest adjunctive treatment in such cases.

High-dose tamoxifen in metastatic renal cell carcinoma.

The effectiveness of high-dose Tamoxifen in the treatment of metastatic renal cell carcinoma was evaluated. Fifteen patients were treated for eight weeks with 80 mg of Tamoxifen daily. Side effect were minimal. Results showed progression of disease in 47 per cent of the patients, no change in disease was seen in 40 per cent, and 13 per cent showed a partial objective response. Twenty per cent of patients showed deterioration of performance status. High-dose Tamoxifen does not appear to be useful in the treatment of advanced renal cell carcinoma.

Treatment of testicular tumors arising in patients with previous inguinal and/or scrotal surgery.

Of 20 patients with testicular tumors that occurred after previous inguinal and/or scrotal surgery 6 with seminomas were treated with traditional radiation therapy that included the ipsilateral groin, while 14 with nonseminomatous tumors were treated with retroperitoneal lymph node dissection with or without chemotherapy. No patient suffered inguinal lymph node metastases. Based on the satisfactory results in these patients to date and the lack of subsequent detectable recurrence of tumor we do not advocate additional treatment to the superficial inguinal lymph nodes and scrotum.

Iglesias articulated endoscopy teaching attachment.

A new articulated teaching attachment with a single joint is described. The attachment allows a 360-degree rotation in 3 planes (sagittal, horizontal and frontal) by the 3 rotary unions at the single joint with only 2 tubes. Simultaneous observation by 2 persons and the operator is achieved by combining 2 of these optical units. The attachment may be sterilized by soaking. It can be dismantled for cleaning and for replacement of any damaged parts. Finally, it facilitates taking still photographs, movies and television endoscopy without interference to the operator.