Are aligners effective and efficient in growing patients?

BACKGROUND: Proper development of deciduous and mixed dentition is essential to the oral health of growing patients, and early interceptive orthopedic or orthodontic treatments are indicated in specific clinical situations. Nowadays, orthodontists are subjected to a lot of pressure from growing patients and their parents about the orthodontic appliances that should be used. The aim of this article is to indicate how, when and why it is possible to effectively use aligners in growing patients. CASE REPORT: Two case reports are illustrated, one with a Cl.II subdivision, mono lateral cross-bite and vertical growth, and the other with a skeletal and dental Cl.II, vertical skeletal pattern, proclined and fractured upper incisors. The efficacy/efficiency ratio of aligners is analyzed in order to evaluate the suitability of this appliance for the treatment. Limits and advantages of aligners are widely discussed. CONCLUSION: Aligner treatment in growing patients shall be carefully studied to reach an optimal result. At present, a hybrid treatment strategy represents the best solution in growing patients with a complex clinical situation.

Guided endodontic microsurgery in apicoectomy: a review.

The purpose of this review was twofold. The first aim was to show predictable protocols of guided endodontic microsurgery (EMS) and to describe its clinical outcomes. The second aim was to verify the accuracy of this technique compared to the traditional pathway. An electronic search of publications was established from two electronic databases, Cochrane and PubMed, by two independent researchers. The search strategy used a combination of controlled vocabulary and free-text words. Inclusion and exclusion criteria were defined by the authors before the start of the study. Inclusion criteria were: all studies published in English language; studies in vivo on humans; human cadaver studies; studies analyzing guided surgery in apicoectomy. The initial search yielded 67 citations, of which 10 were included. The studies included in this review analysis have shown two different technique both for digitization of dental arch and for surgical procedures too. Guided endodontic micro-surgery is a more predictable technique with less intra-operative and post-operative complications compared to the "freehand" technique and this procedure has shown a greater accuracy.

Patient's perception of intraoral scanning: a comparison between traditional and digital dental impression.

The purpose of this work was to assess the discomfort perceived by the patient during the intraoral scan procedure using the iTero Scanner. A sample of 33 patients was selected on the basis of parameters that identify a complete dentition. All treated patients underwent a traditional polyvinylsiloxane impression with double procedure and an intraoral scan in the same session. Subsequently they were given a questionnaire concerning the discomfort perceived by both procedures. Once the completed questionnaires were obtained, preliminary statistical tests were carried out to check if the distribution of scores assigned by patients to the two procedures differed significantly from a Gaussian distribution. Furthermore, the discomfort/preference indexes for the two procedures were compared using the Wilcoxon test for paired data. Finally, the Spearman correlation test was used. From the results of the preliminary normality tests, it was decided to use nonparametric type tests that gives the intraoral scan procedure more favorable scores relative to a minor discomfort. The use of intraoral scanning and more specifically of the iTero 2.9 scanner (despite a not small wand), represents an option largely preferred by patients in terms of reduction of discomfort and classic discomfort related to relief systems traditional imprint.

Physical and chemical mechanisms involved in adhesion of orthodontic bonding composites: in vitro evaluations.

BACKGROUND: Bond strength of orthodontic composite is strongly influenced by molecular and structural mechanisms. Aim of this in vitro study was to compare bond strength of light-cure orthodontic composites by measuring debonding forces and evaluating locations of bond failure. Investigations on chemical compositions clarified adhesive behaviors and abilities, exploring effects of ageing processes in this junction materials. METHODS: Twelve enamel discs, from human premolars, were randomly coupled to one orthodontic adhesive system (Transbond XT™ 3 M UNITEK, USA, Light-Cure Orthodontic Paste, LEONE, Italy and Bisco Ortho Bracket Paste LC, BISCO, Illinois) and underwent to Shear Bond Strength test. Metallic brackets were bonded to twenty-seven human premolar, with one of the adhesive systems, to quantify, at FE-SEM magnifications, after debonding, the residual material on enamel and bracket base surfaces. Raman Spectroscopy analysis was performed on eight discs of each composites to investigate on chemical compositions, before and after accelerated aging procedures in human saliva and sugary drink. RESULTS: Orthodontic adhesive systems showed similar strength of adhesion to enamel. The breakage of adhesive-adherent bond occurs in TXT at enamel-adhesive interface while in Bisco and Leone at adhesive-bracket interface. Accelerated in vitro aging demonstrated good physical-chemical stability for all composites, Bisco only, was weakly contaminated with respect to the other materials. CONCLUSION: A similar, clinically adequate and acceptable bond strength to enamel for debonding maneuvers was recorded in all orthodontic adhesive systems under examination. No significant chemical alterations are recorded, even in highly critical situations, not altering the initial mechanical properties of materials.

Thermoformed Retainer: An Effective Option for Long-Term Stability.

INTRODUCTION: The concept of orthodontic retention is moving toward the idea that teeth will move unless retained indefinitely. However, permanent retention implies permanent supervision, and that is where reality clashes with stability. The cornerstone of Essix permanent retention is the complete delegation of responsibility to the patient. Essix retainers have nothing to adjust, but maximum collaboration of the patient is essential to achieve long-term stability. The purpose of this paper is to show the effectiveness of the thermoplastic appliance as a retainer, using a clinical case with a 10-year follow-up. Case Report. A 33-year-old male patient presented with a class II malocclusion division 2 and normal skeletal pattern. According to the patient's desire, a treatment plan was proposed to obtain the aesthetic result of the smile, maintaining the molar and canine class II relationship. The orthodontic therapy was performed by using the Invisalign System. In this case, it was possible to appreciate a posterior occlusal stability after 10 years. CONCLUSION: Currently, among orthodontists, the use of removable plastic devices is gaining popularity thanks to their capability to encapsulate and retain both posterior and anterior teeth. In this article, the technical features of thermoformed retainers will be described and one clinical case with a 10-year follow-up will be presented to emphasize the effectiveness of these retainers.

Long-term periodontal status of palatally and buccally impacted canines after closed surgical-orthodontic approach.

INTRODUCTION: The aim of this study is to evaluate the periodontal status of palatally and buccally impacted canines exposed with closed technique, and to compare them with the controlateral canines that served as control teeth as well as to compare them each other. METHODS: 28 patients, 14 with unilateral palatally impacted canines and 14 with unilateral buccally impacted canines comprised the subjects of the study. Mean recall observational period was 2 years 4 months ± 1 year 1 month. Closed eruption technique without the tunnel was performed to expose both the palatally and the buccally impacted canines. Six periodontal variables were considered: probing pocket depth (PPD); width of keratinized tissue (KT); gingival thickness (GT); plaque index (PI); gingival bleeding index (GBI); gingival recession (REC). RESULTS: Palatally impacted canines exhibited significant greater PPD on the mesiolingual site compared to their controlaterals (P<0.05). Buccally impacted canines had significant increased KT compared to their contralaterals (P<0.05). Palatally impacted canines had significant greater PPD on the midbuccal site and on all the palatal sites when compared to the buccally impacted canines (P<0.05). CONCLUSION: The changes observed in the periodontal status of impacted canines, although statistically significant, did not reach clinical significance.

An alternative technique in the treatment of anterior cross bite in a case of Nickel allergy: a case report.

AIM: The objective of this paper is to show an alternative use of an Essix based appliance in the treatment of anterior single-tooth crossbite malocclusion in a patient with Nickel allergy. MATERIALS AND METHODS: Anterior crossbite malocclusion of one or more teeth, without posterior crossbite association, is a relatively frequent condition both in the mixed and the permanent dentition. This kind of malocclusion is usually treated with either fixed or removable appliances. The use of preformed Essix appliances could be an alternative to traditional removable and fixed orthodontic devices in patients with Nickel allergy as well as in every patient. RESULTS: The treatment was successfully completed in 12 weeks, the anterior single tooth crossbite was corrected using three full arch Essix-based appliances planned on the set-up casting, providing a gradual vestibular movement. Patient compliance was requested in order to provide the planned dental movement. CONCLUSION: The Essix appliance can be successfully used to correct a single-tooth crossbite even in allergic subjects in a short time with patient cooperation.

Maxillary cyst: description of a clinical case.

AIM OF THE WORK: Aim of this work is to evaluate the efficacy of the Partsch I surgical technique which is considered to be first choice in the treatment of cystic lesions according to the international literature and also to evaluate the regeneration capacity of the bone tissue without any grafting procedure. MATERIALS AND METHODS: The patient reported pain in the second quadrant. The objective intraoral examination showed a swelling which was of a hard-elastic consistency and, the x-ray, opt and ct scan exams showed an osteolitic lesion which expanded from the element 2.3 to the elment 2.6 involving the maxillary sinus, too. The lesion was removed by the Partsch I method after disinfecting and shaping the radicular canals of the 2.3 element. It was assessed that the maxillary sinus requested no treatment for the presence of a thin cortical layer residue. The removed neoformation was then sent to the Anatomy and Histology Pathology Service. RESULTS: The histologic test confirmed the radicular origin of the odontogenic neoformation containing a necrotic-hemorrhage. Clinically the post-operative course showed no complications, with a good healing of the bone tissue and there was no oral-antral communications. CONCLUSIONS: The clinical results obtained confirmed the validity of the enucleation technique in the treatment of cystic neoformations. Such approach has always to be preferred because it presents no intraoperative risks, especially for what it concerns the post-operative course. It has also been confirmed the great capacity for the bone tissue to regenerate following the organization of the hematic coagulum.

Invisalign treatment in periodondal patient: case report.

SCOPE OF WORK.: To evaluate the results obtained from the use of removable orthodontic aligners in patients with periodontal and systemic issues to improve the aesthetics of the smile. MATERIALS AND METHODS.: Invisalign technique, a new technique based on the use of orthodontic removable transparent overlay representing the mechanotherapy. This technique through a dedicated software (Clin-Check) enables you to view the 3D resolution of the malocclusion. RESULTS.: In the case study examined the results support the Invisalign treatment in periodontal patients with a systemic disease, both for an easier home oral hygiene and also to maintain alignment and an aesthetic smile achieved without the use of invasive techniques. CONCLUSION.: The Invisalign orthodontic treatment is ideal for patients with periodontal problems. The removal of the masks ensures control of normal oral hygiene but also requires the cooperation of the patient during the treatment.

Immediate-loading post extractive implants: indications, advantages and limits.

The possibility of rehabilitating immediately an edentulous patient offers today remarkable advantages because it satisfies the patient's demands for comfort, aesthetics, and functionality and reduces the surgical stages for the professional.In the last years clinicians and companies have been concentrating their efforts in the development of new surgical techniques and biomaterials in order to speed up the osteointegration process, which fosters the functionality, that is the immediate-loading.This clinical report, based on the analysis of the literature and on the presentation of a case report, shows how satisfying results in functionality and aesthetic can be obtained by a careful diagnosis and an accurate therapeutic planning, reducing at the same time the stress for the patient and the surgical stages for the professional.In any case, it is necessary to have the rehabilitations with immediate-loaded implants directed by workers with a good knowledge and experience in surgery, periodontology, and prosthesis or by a work team able to face all the complications such advanced rehabilitations may cause.

The surgical treatment of the multiple gingival recessions.

The growing emphasis on aesthetics puts the dentist before new requests for intervention aimed at improving the smile not only in dental component but also in the gingival. Infact, even among patients is now widespread awareness that the beauty of the smile comes from balance existing, in the relations and proportions, between the dental and gum component.The development of plastic periodontal surgery techniques increasingly sophisticated allows the dentists to correct those deteriorations of the gingival tissues, such as multiple recessions, which are responsible for troublesome increases of the dental sensitivity and aesthetic worsening of the smile.The description of a case report of multiple recessions surgically treated with Zucchelli/De Santis' technique demonstrates that, having carefully selected patient, it's possible to resolve with a fine but not invasive surgery these smile's deteriorations.

Clinical management in extraction cases using palatal implant for anchorage.

This case report presents a Class I extraction treatment in an adult patient with bimaxillary crowding using a palatal implant for anchorage control. The implant (pure titanium 6 mm SLA) is inserted in the middle of the palate, after a careful radiological assessment on a lateral cephalogram. At the end of the healing period (13 weeks), an anchorage device, such as a squared trans-palatal bar connecting the maxillary molars to the palatal implant, is projected and placed in order to obtain the posterior anchorage control. The orthodontic treatment was performed according to the bidimensional technique.

Pseudo-Class III malocclusion treatment with Balters' Bionator.

The aim of this article is to show the use of the Balters' Bionator in pseudo-Class III treatment. The importance of differentiating between true Class III and pseudo-Class III is emphasized. The therapeutic results of a Balters' Bionator appliance are presented in three case reports of subjects in the mixed dentition. In this stage of development it is possible to correct an isolated problem. The use of the Bionator III in this kind of malocclusion enabled the correction of a dental malocclusion in a few months and therapeutic stability of a mesially-positioned mandible encouraging favourable skeletal growth.