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AIM To systematically review the effects of surgical mandibular advancement (SMA) regarding changes of the upper airways in adult patients with skeletal Class II malocclusion. MATERIALS AND METHODS Five electronic databases were searched up to April 2020. Human studies focusing on the morphology and dimension of the upper airways after SMA were included. 'Quality assessment for Before-After (Pre-Post) Studies' was used to assess the risk of bias of the individual studies. Standard mean differences (SMD) with 95% confidence intervals (CI) were calculated for random effect model meta-analysis. The certainty of evidence was assessed using the GRADE tool. RESULTS Twenty cohort studies of only treated patients without control group were eligible for qualitative synthesis, of which 17 were used for quantitative synthesis. Very low certainty of evidence indicated that SMA resulted in significant increase of the volume and of the smallest cross-sectional area (SMC) of the nasopharynx (volume SMD: 1.43, CI: 0.62, 2.24, P = .001, I2 = 87.8%; SMC SMD: 1.53, CI: 0.59, 2.47, P = .001, I2 = 90.5%) and oropharynx (volume SMD: 1.36, CI: 0.37,2.35, P = .007, I2 = 92.1%; SMC SMD: 1.21, CI: 0.11,2.32, P = .032, I2 = 93.1%). Significant augmentation of the distances between the posterior pharynx wall and the uvala (SMD: 0.73, CI: 0.46,0.98, P

The purpose of this study is to describe the management of 2 dimorphic patients affected by Hemimandibular Hypoplasia with Condylar-Coronoid Collapse (HH-CCC), also called Pseudo Hemifacial Microsomia, where the orthopedic treatment gave an excellent long-term follow-up. The patients were a 7-year-old female and a 6-year-old male with a HH-CCC on the left side, an asymmetrical face with chin deviation, class II dental malocclusion and canting of the occlusal plane. An X-ray evaluation and clinical observation confirmed the unilateral mandibular deficiency and the collapse of the condyle on the coronoid process on the affected side. The treatment plan consisted of the use of an asymmetrical functional appliance with a vertical screw. The appliance was gradually activated on the vertical plane on one side by a screw incorporated on an acrylic plate. It was used for 22 hours/day, including sleep time but not during meals. This treatment improved the patient' s facial appearance. HH-CCC showed a positive response to functional therapy.

SummaryBackground/ObjectivesTo assess intra- and inter-observer reproducibility of the evaluation of the Frӓnkel Manoeuvre (FM) on three-dimensional (3D) scans and to compare it to the assessment on two-dimensional (2D) pictures.Materials/MethodsThis study included 44 individuals with a skeletal Class II malocclusion [9–16-years old mean age ± standard deviation: 13.5 ± 2.01 years]. All patients had a full Class II molar relationship, overjet ≥6 mm and point A, Nasion, point B angle (ANB) ≥5 degrees. During the FM, each patient was invited to bite in centric occlusion and then to posture the mandible forward to reach a Class I molar relationship. The FM was recorded both by a normal camera and a 3D scanner (3dMD system). Six examiners divided into two groups according to their orthodontic clinical experience (10 years), and one gold standard in the evaluation of FM, commented twice (every 15 days) on both 2D photographs (T0 and T2) and 3D scans (T1 and T3). The intra-observer agreement and the inter-observer agreement compared to the gold standard were evaluated by computing the Cohen’s K.ResultsThe agreement between observations for each examiner ranged from 0.36 to 1 on 2D pictures (T0 versus T2), and from 0.22 to 0.69 on 3D scans (T1 versus T3). The overall agreement was 0.63 (95 per cent CI = 0.35–0.91) in 2D analysis and 0.5 (95 per cent CI = 0.35–0.64) in 3D analysis.Conclusions/ImplicationsThe FM was less reproducible when performed on 3D records than on 2D pictures.

Regenerative medicine has recently improved the principal therapies in several medical fields. In the past ten years, the continuous search for novel approaches to treat the most common dental pathologies has developed a new branch called regenerative dentistry. The main research fields of translational dentistry involve biomimetic materials, orally derived stem cells, and tissue engineering to populate scaffolds with autologous stem cells and bioactive growth factors. The scientific literature has reported two main research trends in regenerative dentistry: scaffold-based and scaffold-free approaches. This article aims to critically review the main biological properties of scaffold-free regenerative procedures in dentistry. The most impactful pros and cons of the exosomes, the leading role of hypoxia-based mesenchymal stem cells (MSCs), and the strategic use of heat shock proteins in regenerative dentistry will be highlighted and discussed in terms of the use of such tools in dental regeneration and repair.

This study aimed to evaluate the periodontal health of orthodontic patients with supportive periodontal therapy in a 3 month follow-up. The sample comprised 20 patients (mean age 20.6 &plusmn, 8.1 years) in treatment with multibracket fixed appliances (fixed group&mdash, FG) and 20 patients (mean age 34.7 &plusmn, 12.5 years) in treatment with clear aligners (clear aligners group&mdash, CAG). At baseline (T0) and after 3 months (T1), probing depth (PD), plaque index (PI), bleeding on probing (BOP), and gingival recession (REC) were measured. Patients were trained to perform an individualized tooth brushing technique, and every 2 weeks they were re-called to reinforce the oral hygiene instructions. The intra-group comparisons (T1 vs. T0) were calculated with the Wilcoxon signed-rank test, while a linear regression model was used for the inter-group comparisons (FG vs. CAG). The significance level was set at p &lt, 0.05. Statistically significant decrease in both groups was found for PD (FG: &Delta, &minus, 9.2 inter-quartile range (IQR), &minus, 22.5, &minus, 5.5, CAG: &Delta, 12.6 IQR, &minus, 25.4, &minus, 4.8), BOP (FG: &Delta, 53.5 IQR, &minus, 70.5, &minus, 37, 37.5 IQR, &minus, 54.5, &minus, 23), and PI (FG: &Delta, 17.5 IQR, &minus, 62.5, 14.5, 24 IQR, &minus, 49.5, &minus, 5). The result of the linear regression models suggested that the type of appliance did not have any effects on the improvement of periodontal variables. Therefore, patients undergoing orthodontic treatment with fixed appliances and clear aligners did not show differences in gingival health when followed by a dental hygienist.

Background: To evaluate the profile changes following orthopedic/orthodontic treatment with the Herbst Miniscope&reg, appliance in subjects affected with Class II malocclusion with mandibular retrusion. Methods: A total of 44 patients presenting a skeletal Angle Class II malocclusion (ANB &gt, 4&deg, ) due to mandibular retrusion and a cervical maturation stage between CS2 and CS3 were included in the study. Of these 44 patients, 22 (mean age 11.9 &plusmn, 1.3, HBT group) were treated using the Herbst appliance, while 22 (mean age 10.6 &plusmn, 1.3, CTR group) were followed for a 12-month observational period. A cephalometric tracing was performed at the beginning of treatment (T0) and after 12 months (T1). Results: In both groups there was a significant advancement of soft tissue pogonion (HBT = 3.5 &plusmn, 3.0 mm, p &lt, 0.001, CTR = 2.2 &plusmn, 2.9 mm, p &lt, 0.001), but the difference between the two groups was not significant (p = 0.172). On the contrary, both groups had a significant advancement of the mandibular sulcus (HBT = 3.7 &plusmn, 2.8 mm, p &lt, CTR = 1.2 &plusmn, 2.2 mm, p &lt, 0.001) and a lower lip protrusion (HBT = 3.45 &plusmn, 2.51 mm, p &lt, CTR = 1.7 &plusmn, 2.7 mm, p = 0.008), but in both cases the HBT group showed a statistically significant greater increase in sulcus protrusion (p = 0.002) and lower lip protrusion (p = 0.029) than controls. There were no statistically significant effects on the upper jaw. Conclusions: The Herbst appliance advanced the lower jaw soft tissues.

The goal of fracture treatment that includes the dentoalveolar process is to obtain the anatomic bone healing and the pre-injury occlusion restoration with functional and aesthetic recovery, avoiding dental or periodontal lesions. Fractures activates, in the damaged tissue, the Regional Acceleratory Phenomenon, a physiological healing process that can also be activated during orthodontic overloads. Orthodontic treatment in the traumatized area could exploit this phenomenon in order to sustain the cellular activity. The aim of this study is to propose a treatment protocol for dentoalveolar fractures based on the use of orthodontics in order to sustain the physiological healing process known as Regional Acceleratory Phenomenon. The authors present 2 cases of an 18 year old woman and 23 year old man affected by dentoalveolar fracture. The operative protocol the authors applied foresaw three steps of treatment: orthodontic brackets application, surgery, orthodontic treatment. The patients showed complete healing at the 3 months follow-up and were treated up to 18 months for further orthodontic treatment. The operative protocol proposed by the Authors appears to be a rational choice since it allows a single orthodontic device to be an ''active splinting system'', with fast application time, good acceptance by the patient, low complications rate; moreover, it produces any planned dental movements for further orthodontic treatments.

Background The prevalence of malocclusion, temporomandibular disorders (TMD) and oral parafunctions is highly debated in children population. Objectives To investigate the prevalence of malocclusion, self-reported oral parafunctions and TMD-pain in Italian schoolchildren and to assess the association between the examined factors. Methods A total of 700 children aged 9-11 years were selected among six public schools in Campania region (Italy). Molar relationship, overjet, overbite and cross-bite were assessed through a clinical examination. Furthermore, the subjects were demanded to fill in a validated questionnaire for TMD-pain screening and the short form of the Oral Behaviours Checklist. Descriptive statistics were used to report the frequencies. The associations between occlusal traits, oral parafunctions and TMD-pain were analysed with a Pearson chi-square test, as expressed by odds ratio and 95% confidence intervals. The significance level was set at P < 0.05. Results Molar Class I was the most frequently encountered molar relationship, followed by molar Class II, subdivision and molar Class III. Increased overjet was more common than negative overjet. Posterior cross-bite was observed in 12% of children. TMD-pain was recorded in 14.7% of subjects. High frequency of oral parafunctions was reported in 21.3% of subjects. A significant association was found between TMD-pain and negative overbite. Cross-bite and high frequency of oral parafunctions were associated with TMD-pain. Conclusion The current results show that malocclusion, self-reported oral parafunctions and TMD-pain are frequent findings among Italian schoolchildren and that some occlusal factors and high frequency of oral parafunctions might be associated with TMD-pain.

Abnormal elongation of mandibular coronoid process, often defined as coronoid hyperplasia, is a rare condition, which is frequently associated with limited mouth opening. In some cases, the enlarged coronoid pushes the zygoma forward causing facial asymmetry. This case report describes a 16-year-old boy whose chief complaint was a progressive difficulty and deviation in mouth opening, together with a deformity appearing at maximum opening at the zygomatic area. The diagnosis was Unilateral Accessory Mandibular Condyle at coronoid process, without reduction of the mouth opening capacity. A coronoidectomy was carried out by means of piezoelectric surgery, instead of a coronoidotomy which is usually performed in these cases, due to a suspect of ramus neoplasm. Keywords: Coronoid hyperplasia, Accessory condyle, Temporomandibular disorder, Piezoelectric surgery, Adolescent

Objectives: To detect changes in mandibular growth between a historical group (HG) from the American Association of Orthodontics Foundation Craniofacial Growth Legacy Collection (AAOF Legacy) and a contemporary group (CG) of normodivergent or hypodivergent Class II untreated subjects. Setting and Sample Population.: The sample included radiographs from the AAOF Legacy and from the University of Naples ‘Federico II’ collected during a previous RCT. Materials & Methods: The HG was composed of 26 individuals (around 1960) from the AAOF Legacy (15 from theBurlington Growth Study, nine from the Oregon Growth Study and two from the Michigan Growth Study) who were matched by sex, age and race with the 26 individuals of the CG (around 2010). Two lateral cephalograms obtained at T0 and T1 (12 months) were selected, and one examiner performed the cephalometric measure‐ ments according to Pancherz's method. The normal distribution of data was confirmed by the Shapiro‐Wilk test, MANOVA analysis and t test for paired and unpaired data were performed. The level of significance was set according to Bonferroni's correction. Results: At T0 and T1, the between‐group comparisons revealed greater linear di‐ mensions for Maxillary base, Maxillary incisor and Mandibular incisor in the CG than in the HG (P ≤ 0.002). No significant difference was found in the growth rate for linear skeletal measurement between the HG and the CG. Conclusions: In this study, the cephalometric analysis showed larger maxillary dimen‐ sions for the CG than the HG, while no differences were shown between the growth rate and direction of the two groups.

Several orthopedic procedures have been used in early treatment to reduce the need for orthognathic surgery in skeletal Class III. The most used treatment is Rapid Maxillary Expansion and Facemask. This procedure also determines a clockwise rotation of the mandible, increasing the vertical dimensions of the lower third of the face. Therefore, the control of vertical dimension appears to be a key objective in Class III hyperdivergent patients. This article shows two skeletal Class III patients treated with a new appliance (Pushing Splints 3), that is able to correct sagittal discrepancy with a good control of the vertical growth. In both cases, Class I relationship with a proper Overjet and Overbite was achieved with improvement of profile. The final cephalometric values demonstrated a stable sagittal relationship and a good control of the vertical growth. The specific biomechanic features of the PS3 appliance permit the improvement of the sagittal jaw relationship, delivering at the same time vertical vectors that are able to control the alveolar and skeletal components of the vertical growth. This could be useful in the treatment of Class III hyperdivergent patients.

Background Constricted maxilla is frequently associated with reduced nasal airway dimensions. Wheatear skeletal maxillary expansion (ME) is effective on the dimension of the upper airways is still a debated issue. Objectives This overview aimed to report the evidence provided by systematic reviews (SRs) on the effect of ME on the upper airways and to assess the methodological quality of the included SRs. Methods Six electronic databases have been explored up to November 2017. After title and abstract screening, SRs addressing the effects of fixed palatal expanders on the dimension and function of the nasal airways were included. The methodological quality of the included SRs was assessed using the updated version of A Measurement Tool to Assess Systematic Review (AMSTAR-2). Results Eight SRs were included. The methodological quality of most of the included SRs ranged between low and critically low. One SR was rated of high quality. A significant increase in nasal linear dimensions was reported both in the short and long term, but supported by low-/critically low-quality SRs. The significant increase in nasal cavity volume was the only outcome supported by a high-quality SR Controversial results were found with regards to nasal function. Conclusion Whenever a constricted maxilla is present general dentists, paediatricians and ENTs should be familiar with the potential improvement provided by ME. However, due to the low/critically low quality of SRs supporting these results, ME cannot be indicated only for upper airways enhancement, but should be supported by an orthodontic indication.