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Introduction: This study aimed to analyze the variation of dentoskeletal effects after rapid maxillary expander therapy in subjects with different vertical growth patterns.Methods: The study sample consisted of 94 patients (32 males, 62 females; mean age 8.9 ± 1.5 years) treated with rapid maxillary expander (RME) anchored on first permanent molars. For each subject, lateral cephalograms and maxillary digital dental casts were available before RME, immediately after appliance removal, and 1 year after appliance removal. All the subjects were divided into 3 groups according to their vertical facial patterns (low-angle, normal-angle, and high-angle). Cephalometric analysis was conducted on lateral cephalograms. The virtual 3-dimensional models were used to analyze the torque of the first permanent molars and intercanine and intermolar width. The differences between the vertical facial subgroups were contrasted by analysis of variance multicomparison test (P <0.05).Results: In the short-term (from before to immediately after RME removal), high-angle subjects showed a mandibular clockwise rotation compared with other groups. No significant long-term vertical and sagittal skeletal changes (from before to 1 year after RME removal) were found between the groups. A greater increase in maxillary molar torque was observed in high-angle subjects than in the other groups. The low-angle patients showed a greater increase in the intercanine diameter.Conclusions: Hyperdivergent subjects showed increased buccal tipping of the anchor molars after the expansion. Hypodivergent and normodivergent subjects showed lower buccal tipping after the expansion and an increased expansion effect in the anterior region. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to evaluate and compare leveling of the curve of Spee (COS) achieved by traditional fixed appliances and Invisalign clear aligners (Align Technology, Santa Clara, Calif).Methods: This retrospective study involved 2 groups of subjects with an increased COS depth. Patients treated with the Invisalign system (I group) and patients treated with the standard edgewise full-fixed appliance (F group). The I group included 30 subjects (13 males, 17 females; mean age, 24 years 5 months ± 19 months). The F group included 32 subjects (12 males, 20 females; mean age, 22 years 4 months ± 21 months). The 2 groups were matched for sex, age, vertical pattern, and observation period. Pretreatment (T0) and posttreatment (T1) lateral cephalograms were analyzed. COS depth was measured on digital dental casts. The intragroup variation between T0 and T1 was analyzed with a paired t test. The intergroup variation was evaluated using an unpaired t test.Results: The leveling of COS was statistically significant, comparing T0 and T1 within the groups. The F group presented a statistically significant extrusion of posterior teeth, with a flaring of the mandibular incisors. The I group showed a statistically significant intrusion of the mandibular incisors, with excellent control in the proclination of incisors during the intrusion movement.Conclusions: Traditional continuous archwire treatment and the Invisalign system effectively level the COS. [ABSTRACT FROM AUTHOR]

Acute cholecystitis (AC) is a life-threatening emergency in elderly patients. To compare the commonly used management strategies for elderly patients with AC as well as resulting morbidity, mortality and length of hospital stay (LOS). All patients ≥ 65 years admitted to our emergency department for AC between January 1st, 2014 and December 31st, 2018 were included in the study. We compared patients that received medical treatment to patients who received operative procedures. In order to correct for baseline covariates and factors associated to clinical management, we used a 1:1 propensity score matching (PSM) analysis. The primary outcome was the overall in-hospital mortality. Secondary outcomes included occurrence of major complications and LOS. A total of 1075 patients were enrolled: 483 patients received a medical treatment and 592 patients underwent interventional procedures. After PSM, 770 patients (385 for each treatment group) were included in the analysis. The analysis revealed that both mortality and cumulative major complications were similar in medical and interventional group. We found that among comorbidities, Charlson comorbidity index and congestive heart failure were significantly higher in the medical treatment group (5 [4-6] vs. 4 [3-6] and 11.7% vs. 4.7%, respectively; p <0.001). LOS was slightly lower in the medical treatment group (7.0 days [4.9–11.1] vs. 7.9 [4.9–13.5]; p = 0.046). Medical management outcomes for AC in elderly patients were similar to operative treatments in terms of mortality and cumulative major complications. A conservative approach should always be considered. [ABSTRACT FROM AUTHOR]

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Introduction: The assessment of the volumetric changes of the airways after adenotonsillectomy has gained popularity among orthodontists, but the validity of such evaluation is not clear.Methods: Thirty patients with obstructive sleep apnea diagnosed with the use of polysomnography (PSG) were evaluated according to the Apnea and Hypopnea Index (AHI), the obstructive apnea index (OAI), the oxygen desaturation index (ODI), the lowest oxygen saturation (LSpO2), and the average oxygen saturation (ASpO2). The volume and the minimal cross-section of lower (oropharynx and velopharynx) and upper (nasopharynx) spaces of the airways were calculated. Patients were adenotonsillectomized; posttreatment data were collected after 12 months. Thirty comparison patients also had the volume of airways evaluated.Results: A statistically significant improvement (P < 0.05) of most PSG parameters was observed after adenotonsillectomy: AHI from 14.5 to 5.2, OAI from 9.4 to 5.5, ODI from 14.6 to 6.5, and LSpO2 from 77% to 94%). A significant increase in airway volume of the lower space (from 2571.5 mm3 to 5276.3 mm3) and the upper space (from 726 mm3 to 1056.9 mm3), as well as in the minimal cross-section of the airways (from 98.5 mm2 to 335.8 mm2) was found in adenotonsillectomy patients. No significant volumetric changes of the airways were observed in the comparison patients. No significant correlation was found between PSG parameters and the dimensions of the airways before adenotonsillectomy. No significant correlation was found between changes of the PSG parameters and changes of the dimensions of the airways 12 months after the adenotonsillectomy.Conclusions: Adenotonsillectomy contributed to the increase of the airway volume and minimal cross-section, and to the improvement of the PSG parameters, but there was no correlation between the magnitude of the anatomic changes and the improvement of the breathing mode. [ABSTRACT FROM AUTHOR]

• We introduce the concept of 'welfare technology practices' for understanding different constructions about future ageing. • We recognise the apparent lack of controversies as an indication of a dominant vision of the future. • We identify ethnicity and gender as two blind spots relevant to problematising welfare technology for older people. In this paper, we elaborate on how the future older person is characterised and what future ageing entails in relation to welfare technologies highlighting which actors, social and material, affect innovation governance and discussing who does not. Starting from a distinction between public, private, and academic perspectives we discuss how companies, public sector organisations, and research-oriented actors construct future ageing through sociomaterial practices in the welfare technology arena. We base our reasoning on an ethnographic study conducted during the 2017 edition of the yearly MVTe- Mötesplats Välfärdsteknologi och E-hälsa Swedish event (in English: Meeting place for Welfare Technology and e-Health). We use the concept 'welfare technology practices' to describe how actors perform future ageing by producing and reproducing a scenario where the positive effects of technology are assumed and the plurality of future older selves is overlooked. We problematise this view by reflecting on ageing as a complex sociomaterial process that calls for welfare technology practices and policies open to a pluralistic view of the future as futur es. This study may inspire research that further explore how future ageing is constructed as well as support the development of welfare technology practices for addressing current blind spots. [ABSTRACT FROM AUTHOR]

Graphical abstract The two main aspects investigated in the study are the performance assessment framework using a multi-criteria approach and the GWP-based energy management procedure. Highlights • A novel GWP-based energy management procedure for buildings is tested. • An hourly-based life-cycle performances assessments framework is developed. • Both have been tested on a building case study located in Switzerland. • The GWP-based EMP allows small GHG gains at the cost of huge primary energy hikes. Abstract Huge amount of energy resources greenhouse gas (GHG) emissions is devoted to the built environment. Therefore, an accurate assessment method of these indicators is compulsory. To take advantage of the temporal variation in the primary energy use and associated GHG emissions of the energy supply, we propose two ways of integrating hourly life-cycle conversion factors in building energy systems. First, to appraise the energy system design, we developed a versatile modelling and performance assessment framework using a multi-criteria approach. The simulated performances of possible energy systems are compared, and help designers systematically choose appropriate energy production and storage systems. Second, for the operation of the building, we propose an energy management procedure (EMP) that always feeds in the energy source with the least global warming potential (GWP). These two developments are tested on a case study consisting in an architectural project that should respect the 2000 W society targets. The running conditions of several energy systems are simulated and compared. The most promising scenario is identified. Compared to traditional methods, the assessment framework has a promising future but the GWP-based energy management procedure offers, in the context of the case study, limited GHG emissions mitigation at very high primary energy cost. [ABSTRACT FROM AUTHOR]

This study aims at unpacking the internal R&D determinants spurring a firm to invest in R&D abroad, that is owning R&D performing affiliates abroad. Differently from previous literature – mainly focusing on country level determinants as well as on motivations for the location choice of foreign R&D – we make a shift in the observation point. In particular, we dig deeper into the characteristics of firms' intra-mural R&D and the different types of R&D outsourcing to assess their association with R&D internationalisation. On the one hand, we account for the different types of R&D employees (share of researchers and technicians on R&D employees) and R&D performance (basic versus applied research; R&D performed in laboratories rather than in production facilities); on the other hand, we focus on a specific type of R&D outsourcing (to non-affiliated foreign partners, that is the “contract offshoring R&D”). The analysis is performed on an unbalanced panel of 33,476 observations referring to all Italian R&D performers over the 2003–2010 period. Our findings reveal that a more structured organisation of R&D at home (e.g. performing R&D in dedicated laboratories) and the propensity to outsource R&D to foreign non-affiliated partners are associated with a higher share of R&D internationalisation. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this prospective study was to evaluate the effects of posterior bite-blocks on masseter muscles and on facial growth in prepubertal dolichofacial subjects.Methods: The treatment group comprised 21 consecutive prepubertal dolichofacial patients treated with rapid maxillary expansion followed by mandibular removable bite-blocks. Lateral cephalograms and ultrasonographic scans of the masseter muscles were made before (T1) and after (T2) treatment with bite-blocks. The treatment group was compared with a control group of 21 subjects matched for sex, age, and skeletal vertical pattern. An independent samples t test was used to compare the T1 to T2 changes in ultrasonographic scan measurements between the treatment group and the control group, and the T1 to T2 cephalometric changes in the treatment group. Regression analysis was performed to investigate associations between masseter muscle thickness and cephalometric treatment outcomes.Results: Masseter muscle thickness showed a statistically significant decrease (-0.7 mm) in the treatment group compared with an increase (+0.6 mm) in the control group. A significant anterior rotation of the mandibular plane was observed in the treatment group as well as significant increases in overbite (1.8 mm) and total posterior facial height (1.5 mm). No significant associations were found between masseter muscle thickness and treatment outcomes apart from a tendency for overbite to increase more in subjects with thicker muscles.Conclusions: Treatment with removable bite-blocks produced a decrease in masseter muscle thickness and a reduction in vertical facial dimensions due to upward and forward rotation of the mandible. No significant correlation was found between the pretreatment masseter muscle thickness and the T1 to T2 cephalometric changes in the treatment group. [ABSTRACT FROM AUTHOR]

The aim of the present paper is to compare the results of the most commonly used extreme wave analysis methods applied to a 20 year (1994-2013) wave hindcast record at a grid point in the Gulf of Cagliari (South Sardinia, Italy). This analysis is a part of a large activity to support design, maintenance and repair of the jetty of the SARAS oil terminal in the inner part of the gulf. The paper shows some merits and hindrances of these methods. While conventional distributions recommended by Goda (e.g. the Gumbel and Weibull distribution) represent nowadays the most common methods in those engineering applications, accurate results in the paper indicate that the coastal engineering community should consider the Generalized Pareto Distribution (GPD) as one of the most performing credible candidates. Particular attention should be paid to the large uncertainty in the return level of extreme significant wave height when predicting a reference value for structures operating in a severe marine environment. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to determine the effects of the leveling of the curve of Spee in subjects treated with preadjusted appliances in different skeletal vertical patterns.Methods: The study sample consisted of 90 white patients (39 male, 51 female; age, 19 years 4 months ± 1 year 9 months), with a curve of Spee of 2 mm or greater before treatment. They were categorized into 3 groups: low-angle group (30 subjects; 12 male, 18 female; age, 19 years 1 month ± 1 year 4 months), normal-angle group (30 subjects; 14 male, 16 female; age, 19 years 6 months ± 2 years 1 month), and high-angle group (30 subjects; 13 male, 17 female; age, 19 years 7 months ± 1 year 5 months) by their vertical facial types. Cephalometric parameters were used to evaluate the different dental movements after treatment. The curve of Spee was measured on digital dental casts. Analysis of variance was used to determine any differences between the changes in the groups with time.Results: For the skeletal variables, no significant modifications were found in the 3 groups. For the dentoalveolar variables, the low-angle group showed significant buccal movements and intrusion of the mandibular incisors. The high-angle group had greater extrusion of the posterior teeth associated with uprighting of the first and second molars.Conclusions: In low-angle subjects, leveling of the curve of Spee occurs through buccal movement and intrusion of the mandibular incisors; in high-angle subjects, it occurs through extrusion and uprighting of the posterior teeth. [ABSTRACT FROM AUTHOR]

Introduction: Our aim in this prospective randomized clinical study was to assess the prevalence rate of eruption of palatally displaced canines, diagnosed at an early developmental stage with posteroanterior radiographs and consequently treated by rapid maxillary expansion. Methods: A sample of 60 subjects in the early mixed dentition with palatally displaced canines diagnosed on posteroanterior radiographs was enrolled in the trial. Their age range at the first observation (T1) was 7.6 to 9.6 years, with a prepubertal stage of skeletal maturity (CS1 or CS2). The 60 subjects were randomly allocated to the treatment group (TG, 35 subjects) or the no-treatment group (NTG, 25 subjects). The TG was treated with a banded rapid maxillary expander; after expansion, all patients were retained with the expander in place for 6 months. Thereafter, the expander was removed, and the patients wore a retention plate at night for a year. The NTG received no treatment. All subjects were reevaluated in the early permanent dentition (T2) (postpubertal CS4). The number of dropouts was recorded. The main outcome recorded at T2 was successful or unsuccessful eruption of the maxillary permanent canines. The starting forms at T1 for measurements on posteroanterior and panoramic films were compared in the 2 groups with the Mann-Whitney U test (P <0.05). The prevalence rates of successful and unsuccessful treatments in the TG were compared with those in NTG with chi-square tests (P <0.05). From T1 to T2, there were 3 dropouts in each group. Results: The final sample comprised 32 subjects in the TG and 22 subjects in the NTG. No statistically significant differences were found for any variable at T1. The prevalence rates of successful eruption of the maxillary canines were 65.7% (21 subjects) in the TG and 13.6% (3 subjects) in the NTG. The comparison was statistically significant (chi-square = 12.4; P <0.001). Subjects with palatally displaced canines in the early mixed dentition do not have transverse deficiency of the maxillary arch. Conclusions: The use of a rapid maxillary expander as an early interceptive approach is effective for increasing the rate of eruption of palatally displaced canines. [ABSTRACT FROM AUTHOR]

Introduction: The aims of this study were to evaluate the differences between 2 regions of maxillary voxel-based registration and to test the reproducibility of the registration.Methods: Three-dimensional models were built for before-treatment (T1) and after-treatment (T2) based on cone-beam computed tomography images from 16 growing subjects. Landmarks were labeled in all T2 models of the maxilla, and voxel-based registrations were performed independently by 2 observers at 2 times using 2 reference regions. The first region, the maxillary region, included the maxillary bone clipped inferiorly at the dentoalveolar processes, superiorly at the plane passing through the right and left orbitale points, laterally at the zygomatic processes through the orbitale point, and posteriorly at a plane passing through the distal surface of the second molars. In the second region, the palate and infrazygomatic region had different posterior and anterior limits (at the plane passing through the distal aspects of the first molars and the canines, respectively). The differences between the registration regions were measured by comparing the distances between corresponding landmarks in the T2 registered models and comparing the corresponding x, y, and z coordinates from corresponding landmarks. Statistical analysis of the differences between the T2 surface models was performed by evaluating the means and standard deviations of the distances between landmarks and by testing the agreement between coordinates from corresponding landmarks (intraclass correlation coefficient and Bland-Altman method).Results: The means of the differences between landmarks from the palate and infrazygomatic region to the maxillary region 3-dimensional surface models at T2 for all regions of reference, times of registrations, and observer combinations were smaller than 0.5 mm. The intraclass correlation coefficient and the Bland-Altman plots indicated adequate concordance.Conclusions: The 2 regions of regional maxillary registration showed similar results and adequate intraobserver and interobserver reproducibility values. [ABSTRACT FROM AUTHOR]

Aim The aim of this observational study was to assess mortality of patients with type 2 diabetes by type of healthcare delivery system, i.e. through specialist centers or generalist doctors, or integrated care. Methods The study was conducted at the “Vicentino Ovest” Local Health District in the Veneto Region (north-eastern Italy) from January 1, 2008 to December 31, 2010. Patients with diabetes (≥20 years old) were identified using different public health databases. They were grouped as: patients followed up by specialists at diabetes clinics (DS); patients seen only by their own general practitioner (GP); and patients receiving integrated care (DS-GP). Cox's regression analysis was used to estimate adjusted hazard ratios for available potential predictors of death by level of care. Results The crude mortality rate was highest in the GP group (26.1 per 1000 person-years), the difference being minimal when compared with the DS group (21.7 per 1000 person-years) and more marked when compared with the DS-GP group (8.8 per 1000 person-years). Patients followed up by their GPs had a 2.7 adjusted RR for mortality by comparison with the DS-GP group. Conclusions The findings of the present study could demonstrate that it is safe and cost-effective, after a first specialist assessment at a diabetes service, for low-risk diabetic patients to be managed by family physicians as part of a coordinated care approach, based on the specialist's clinical recommendations; GPs can subsequently refer patients to a specialist whenever warranted by their clinical condition. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to evaluate the long-term stability of quad-helix/crib treatment in subjects with dentoskeletal open bite. Methods: Twenty-eight subjects (11 boys, 17 girls; mean age, 8.2 ± 1.3 years) were treated consecutively with quad-helix/crib appliances. The patients were reevaluated at the end of active treatment with the quad-helix/crib (mean age, 9.7 ± 1.6 years) and at least 5 years after the completion of treatment (mean age, 14.6 ± 1.9 years). A control group of 20 untreated subjects with the same dentoskeletal disharmony was used for the statistical comparison (Mann-Whitney U test). Results: In the long term, the quad-helix/crib group showed a significant reduction in the ANB angle (−1.3°), a downward rotation of the palatal plane (1.8°), a greater increase in overbite (2.1 mm), and a decrease in overjet (−1.5 mm) when compared with the controls. Conclusions: In the long term, the use of the quad-helix/crib appliance led to successful outcomes in about 93% of the patients considered. Correction of dentoskeletal open bite was associated with a clinically significant downward rotation of the palatal plane. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this prospective controlled study was to evaluate the long-term effects of rapid maxillary expansion and facemask therapy in Class III subjects. Methods: Twenty-two subjects (9 boys, 13 girls; mean age, 9.2 years ± 1.6) with Class III disharmony were treated consecutively with rapid maxillary expansion and facemask therapy followed by fixed appliances. The patients were reevaluated at the end of the 2-phase treatment (mean age, 14.5 years ± 1.9) and then recalled about 8.5 years after the end of rapid maxillary expansion and facemask treatment (mean age, 18.7 years ± 2.1). Two groups of controls with untreated Class III malocclusion were used for statistical comparisons of the short-term and long-term intervals. Statistical comparisons were performed with the Mann-Whitney U test. Results: In the long term, no significant differences in maxillary changes were recorded, whereas the treatment group showed significantly smaller increases in mandibular protrusion. The sagittal maxillomandibular skeletal variables maintained significant improvements in the treatment group vs the control groups. Conclusions: In the long term, rapid maxillary expansion and facemask therapy led to successful outcomes in about 73% of the Class III patients. Favorable skeletal changes were mainly due to significant improvements in the sagittal position of the mandible. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to use low-dose coronal computed tomography (CT) scans to evaluate the treatment and postretention effects of rapid maxillary expansion (RME) on the maxillary central incisors, midpalatal suture, and nasal cavity. Methods: Multi-slice coronal CT scans of 17 subjects (7 boys, 10 girls; mean age, 11.2 years) were taken before RME (T0), at the end of active expansion phase (T1), and after the retention period of 6 months (T2). Measurements were made on 3 coronal scans perpendicular to the occlusal plane and passing through anterior nasal spine (anterior scan), the midpoint between anterior nasal spine and posterior nasal spine (middle scan), and posterior nasal spine (posterior scan). Statistical analyses were performed with analysis of variance (ANOVA) for repeated measures with post-hoc tests. Results: The transverse dimensions of the midpalatal suture and nasal cavity showed statistically significant T0 to T1 increments in all 3 coronal scans. The roots of the maxillary central incisors were more divergent than the crowns at both T1 and T2. All T0-to-T1 measurements at the sutural and nasal levels decreased from the anterior to the posterior measurements. Between T1 and T2, all measurements exhibited statistically significant decreases with the exception of nasal width on the middle scan. Conclusions: When analyzed on coronal CT scans, the maxillary halves were separated by RME in a parallel manner and not in a triangular shape. At T2 after RME therapy, the suture appeared reorganized, and the expansion of the nasal cavity was stable. [Copyright &y& Elsevier]

Introduction: In this cephalometric investigation, we analyzed the treatment and posttreatment effects of an orthopedic protocol for Class III malocclusion consisting of a facial mask combined with a removable bite-block appliance. Methods: The treated sample consisted of 22 Class III patients treated with the facial mask and bite-block protocol before the pubertal growth spurt (mean age, 8.9 ± 1.5 years). Treated subjects were evaluated after facial mask and bite-block therapy and at a posttreatment observation in absence of retention. The treated group was compared with a matched control group of 12 untreated Class III subjects. All treated and control subjects were postpubertal at the final observation. Significant differences between the treated and control groups were assessed with the Mann-Whitney U test (P <0.05). Results: Both angular and linear sagittal measurements of the maxilla showed significant improvements during active treatment. Significant improvements of SNA angle, ANB angle, overjet, and molar relationship remained stable during the posttreatment period. No significant effect was found in the mandibular skeletal measures. No significant protraction of the maxillary incisors or retraction of the mandibular incisors was observed. Conclusions: A bite-block appliance in the mandibular arch with a facial mask enabled effective control of mandibular rotation with progressive closure of the gonial angle. This added to the favorable maxillary outcomes of the treatment protocol. [Copyright &y& Elsevier]

Introduction: The aim of this cephalometric study was to analyze the effects of rapid maxillary expansion (RME) and facemask (FM), or FM combined with bite block (BB), on the sagittal pharyngeal dimensions in subjects with Class III malocclusion when compared with an untreated Class III control group. Methods: Thirty-nine subjects (22 girls, 17 boys) were divided into 2 groups: the FM/BB group (22 subjects; mean ages, 8.9 years ± 1.5 before treatment and 10.5 years ± 1.3 after treatment) and the RME/FM group (17 subjects; mean ages, 7.1 years ± 1.8 before treatment and 9.2 years ± 1.8 after treatment). The treated groups were compared with an untreated Class III control group of 20 subjects (mean ages, 8.1 years ± 1.2 at the first observation and 10 years ± 1.7 at the second observation). All subjects were at prepubertal stage of skeletal maturity at both times. Comparisons of these changes between the 3 groups were analyzed with the Kruskal-Wallis 1-way analysis of variance (ANOVA) on ranks with post-hoc tests. Results: The favorable skeletal maxillary and mandibular changes produced by maxillary protraction with or without RME were not associated with significant changes in the sagittal oropharygeal and nasopharyngeal airway dimensions. Conclusions: Orthopedic treatment of Class III malocclusion does not produce a significant increase in airway dimensions in the short term. [Copyright &y& Elsevier]

Introduction: The aim of this study was to apply low-dose computed tomography (CT) to evaluate treatment and posttreatment effects produced by rapid maxillary expansion (RME) at the levels of the midpalatal suture and the pterygoid processes. Methods: A sample of 17 subjects (7 boys, 10 girls; mean age, 11.2 years) was analyzed. Multi-slice CT scans were taken before RME, at the end of the active expansion phase, and after a retention period of 6 months. Statistical analysis was performed with ANOVA for repeated measures with post-hoc tests. Results: The amounts of opening of the midpalatal suture during the active phase of expansion were 3.01, 2.17, and 1.15 mm for the anterior, middle, and posterior suture widths, respectively. Pterygoid width also showed a statistically significant increase (1.49 mm). In the postretention period, all transverse measurements had significant decreases except for pterygoid width. Conclusions: At the end of the retention phase after RME therapy, the transverse width of the midpalatal suture was similar to the pretreatment width, whereas the width between the pterygoid processes was significantly increased. [Copyright &y& Elsevier]

Introduction: The aim of this study was to analyze the relationship between the circumpubertal phases of the dentition (early mixed, intermediate mixed, late mixed, early permanent) and skeletal maturity as assessed by means of the cervical vertebral maturation (CVM) method. Methods: The sample of 1000 subjects included 250 (125 boys, 125 girls) in each of the 4 dentition phases. Individual skeletal maturity was determined by using the CVM method. The relationship between the skeletal maturity (stages in CVM) and the phases of the dentition was evaluated statistically by means of indicators of diagnostic test performance. Results: Prepubertal stage 1 (CS1) was the variable diagnosed in the early mixed and intermediate mixed dentitions; pubertal stage 3 (CS3) was the variable diagnosed in the late mixed and early permanent dentitions. Conclusions: The early mixed dentition phase showed a strong diagnostic value for the identification of prepubertal skeletal maturity (CS1), whereas the intermediate mixed dentition phase had a low diagnostic value for the same prepubertal stage. Neither the late mixed dentition nor the early permanent dentition appeared to be a valid indicator for the onset of the pubertal growth spurt. [Copyright &y& Elsevier]

Introduction: The aim of this study was to compare the effects of the quad-helix/crib (Q-H/C) appliance and a removable plate with a crib (RP/C) in patients with dentoskeletal open bite. Methods: Both samples consisted of 20 subjects. Lateral cephalograms were analyzed before treatment (T1) and after active treatment (T2). The average age at T1 was 8.4 years, and the mean duration of treatment was 1.5 years in both groups. The T2-T1 changes in the 2 groups were compared with a nonparametric test for independent samples (Mann-Whitney U test). Results and Conclusions: Both the Q-H/C and the RP/C appliances induced favorable dental effects. However, a compliance-free appliance, such as the Q-H/C appliance, produced more favorable vertical skeletal changes. [Copyright &y& Elsevier]

Introduction: The aim of this study was to compare the effects of the quad-helix/crib (Q-H/C) appliance and the open-bite bionator (OBB) in patients with open-bite malocclusions. The Q-H/C sample included 21 subjects, 15 girls and 6 boys. The average age for the Q-H/C group before treatment (T1) was 8.4 ± 1.4 years, the mean age 1 year after active treatment (T2) was 10.9 ± 1.6 years, and the mean duration of treatment was 2.6 years ± 9 months. The OBB sample contained 20 subjects, 9 girls and 11 boys. The average ages were 8.3 years ± 10 months at T1 and 10.8 ± 1.5 years at T2. The mean duration of observation was 2.5 ± 1.2 years. Lateral cephalograms were analyzed at T1 and T2. The T2 to T1 changes in the 2 groups were compared with a nonparametric test for independent samples (Mann-Whitney U test). The comparison between the 2 treatment protocols for skeletal open-bite malocclusion showed that the Q-H/C appliance is significantly more effective than the OBB for the improvement of overbite (+1.9 mm) in association with extrusion (+1.5 mm) and palatal inclination (+2.9°) of the maxillary incisors. [Copyright &y& Elsevier]

Introduction: The aim of this study was to analyze the transverse characteristics of subjects with sucking habits and hyperdivergency in the mixed dentition. Methods: The test group consisted of 80 subjects with sucking habits and hyperdivergency in the intermediate mixed dentition, and it was compared with a control group of 185 subjects. The prevalence rate of posterior crossbite was recorded. Maxillary and mandibular intercanine and intermolar widths, and anterior and posterior transverse interarch discrepancies were measured on the dental casts. The statistical comparisons between the test and control groups were performed with independent sample t tests and chi-square tests (P <.05). Results: The prevalence rate of posterior crossbite in the test group was significantly greater (52%) than in the control group (14%) (P <.001). The test group had significantly smaller maxillary intermolar and intercanine widths and significantly greater posterior transverse discrepancy (P <.01). No significant differences were found for mandibular intermolar and intercanine widths or anterior transverse discrepancy. Conclusions: Prolonged sucking habits and hyperdivergency in the mixed dentition were associated with narrow maxillary intermolar and intercanine widths, increased posterior transverse discrepancies, and increased prevalence of posterior crossbites. [Copyright &y& Elsevier]

Introduction: The aim of this study was to investigate the effectiveness of a quad-helix/crib (Q-H/C) appliance in a group of growing subjects with thumb-sucking habits and both dental and skeletal open bites. Methods: The records of 23 subjects treated with Q-H/C appliances were compared with a control group of 23 untreated subjects with similar vertical relationships. Lateral cephalograms were analyzed before treatment (T1; mean age, 8.4 ± 1.4 years) and immediately after treatment (T2; mean age, 9.9 ± 1.5 years). Mean duration of treatment was 1.5 ± 7 months. The T2-T1 changes in the 2 groups were compared with a nonparametric test for independent samples (Mann-Whitney U test). Results: The average increase in overbite during Q-H/C therapy (3.6 mm more than the control group) overcorrected the amount of anterior open bite at T2. However, 4 of 23 subjects did not show positive overbites at T2. Both the maxillary and mandibular incisors had significantly greater lingual inclinations (about 4.0°) associated with greater extrusion (1.4 and 1.0 mm, respectively) in the Q-H/C group than in the control group. In addition, the treated group showed a greater downward rotation (1.2°) of the palatal plane than did the control group. This change was associated with a greater increase in upper anterior facial height (0.7 mm) and a clinically significant reduction in the palatal plane-mandibular plane angle (−1.7°) in the Q-H/C group with respect to the controls. The upper and lower lips showed significant tendencies toward retraction relative to the E-plane in the treated group (2.6 and 2.9 mm, respectively) compared with the controls. Conclusions: The Q-H/C appliance was effective in correcting the dental open bite in 90% of growing subjects with thumb-sucking habits and dentoskeletal open bites. The Q-H/C protocol produced a clinically significant improvement in the vertical skeletal relationships because of downward rotation of the palatal plane. [Copyright &y& Elsevier]

Introduction: The aim of this study was to evaluate the density of the midpalatal suture as assessed by low-dose computed tomography (CT) before rapid maxillary expansion (RME) (T0), at the end of active expansion (T1), and after a retention period of 6 months (T2). Methods: The study sample comprised 17 prepubertal subjects (mean age, 11.2 years) with constricted maxillary arches and unilateral or bilateral posterior crossbite. The total amount of expansion was 7 mm in all subjects. Multi-slice low-dose CT scans were taken at T0, T1, and T2. On axial CT scanned images, 4 regions of interest (ROIs) were placed along the midpalatal suture (anterior [AS ROI] and posterior [PS ROI]) and in 2 regions of palatal bone (anterior and posterior). Density was measured in Hounsfield units. The Mann-Whitney U test and Friedman analysis of variance (ANOVA) with post-hoc test were used (P <0.05). Results: The densities in the AS and PS ROIs were significantly smaller than the reference bone densities before RME therapy. Both AS and PS ROIs showed significant decreases in density from T0 to T1, significant increases from T1 to T2, and no significant differences from T0 to T2. Conclusions: The effective opening of the midpalatal suture by RME in prepubertal subjects was associated with a significant decrease in sutural density. The sutural density after 6 months of retention post-RME indicated reorganization of the midpalatal suture, since it showed values similar to the pretreatment ones. [Copyright &y& Elsevier]

COVID-19 gastrointestinal manifestations could be attributed to SARS-CoV-2-induced small vessel thrombosis. OA with NPT treatment may have a role in optimization of bowel microcirculation and in the reduction of the endothelial and the systemic cytokine-related damage, improving also respiratory function. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate sucking habits and hyperdivergency as risk factors for anterior open bite in mixed-dentition subjects. Methods: Anamnestic and pretreatment cephalometric records of 1710 mixed-dentition subjects were assessed for sucking habits, dental open bite, and facial hyperdivergency. Results: The rate of anterior open bite was 17.7%. Multiple logistic regression showed that both prolonged sucking habits and hyperdivergent vertical relationships significantly increased the probability of an anterior dentoalveolar open bite, with a prevalence rate of 36.3%. This was 4 times the prevalence of sucking habits and facial hyperdivergency in subjects without anterior open bite (9.1%). Conclusions: Prolonged sucking habits and hyperdivergent facial characteristics are significant risk factors for anterior open bite in the mixed dentition. [Copyright &y& Elsevier]

The aim of this systematic review of the literature was to assess the scientific evidence on the efficiency of functional appliances in enhancing mandibular growth in Class II subjects. A literature survey was performed by applying the Medline database (Entrez PubMed). The survey covered the period from January 1966 to January 2005 and used the medical subject headings (MeSH). The following study types that reported data on treatment effects were included: randomized clinical trials (RCTs), and prospective and retrospective longitudinal controlled clinical trials (CCTs) with untreated Class II controls. The search strategy resulted in 704 articles. After selection according to the inclusion/exclusion criteria, 22 articles qualified for the final analysis. Four RCTs and 18 CCTs were retrieved. The quality standards of these investigations ranged from low (3 studies) to medium/high (6 studies). Two-thirds of the samples in the 22 studies reported a clinically significant supplementary elongation in total mandibular length (a change greater than 2.0 mm in the treated group compared with the untreated group) as a result of overall active treatment with functional appliances. The amount of supplementary mandibular growth appears to be significantly larger if the functional treatment is performed at the pubertal peak in skeletal maturation. None of the 4 RCTs reported a clinically significant change in mandibular length induced by functional appliances; 3 of the 4 RCTs treated subjects at a prepubertal stage of skeletal maturity. The Herbst appliance showed the highest coefficient of efficiency (0.28 mm per month) followed by the Twin-block (0.23 mm per month). [Copyright &y& Elsevier]