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The objective of this study was to evaluate the accuracy of dental models prototyped via entry-level liquid crystal display (LCD) 3D printers.Identical prototyped models were generated from a master digital file testing two entry-level LCD-based 3D printers and using one professional-grade 3D printer as gold standard (GS), with 50-µm and 100-µm layer thickness. Each 3D-printed model was scanned, and a specific 3D technology was used to perform surface-based superimposition and deviation analysis to evaluate trueness and precision. The distances between surface points of two superimposed models were converted to root mean square (RMS) and statistically analyzed.The RMS values detected were significantly higher in dental models prototyped with entry-level compared to the SLA printer (p 0.001), in terms of trueness (50 µm: GS 0.075 mm, LCD1 0.192 mm, LCD2 0.179 mm; 100 µm: GS 0.066 mm, LCD1 0.209 mm, LCD2 0.199 mm) and precision (50 µm: GS 0.028 mm, LCD1 0.075 mm, LCD2 0.085 mm; 100 µm: GS 0.039 mm, LCD1 0.096 mm, LCD2 0.101 mm). No significant differences were found between the values of RMS of both entry-level 3D printers (p 0.05). Layer thickness did not affect either the trueness or precision of the 3D-printed models (p 0.05).Entry-level LCD-based 3D printers are not as accurate as professional-grade 3D printer, but still close to orthodontics clinical threshold values.Clinicians should evaluate the intended application of 3D-printed orthodontic models before using entry-level 3D printers.

Objective The aim of this systematic review was to evaluate the complications and side effects associated with the clinical use of orthodontic miniscrews by systematically reviewing the best available evidence. Methods A survey of articles published up to March 2020 investigating the complications associated with miniscrew insertion, in both the maxilla and mandible, was performed using 7 electronic databases. Clinical studies, case reports, and case series reporting complications associated with the use of orthodontic miniscrew implants were included. Two authors independently performed study selection, data extraction, and risk-of-bias assessment. Results The database survey yielded 24 articles. The risk-of-bias assessment revealed low methodological quality for the included studies. The most frequent adverse event reported was root injury with an associated periradicular lesion, vitality loss, pink discoloration of the tooth, and transitory loss of pulp sensitivity. Chronic inflammation of the soft tissue surrounding the miniscrew with mucosal overgrowth was also reported. The other adverse events reported were lesion of the buccal mucosa at the insertion site, soft-tissue necrosis, and perforation of the floor of the nasal cavity and maxillary sinus. Adverse events were also reported after miniscrew removal and included secondary bleeding, miniscrew fracture, scars, and exostosis. Conclusions These findings highlight the need for clinicians to preliminarily assess generic and specific insertion site complications and side effects.

This study aimed to evaluate the accuracy of orthodontic models for the production of clear aligners generated with four 3D printers featuring different technologies and belonging to different market segments.Eighty identical dental models were generated from two master digital files (.stl), respectively with aligned (AM group) and crowded dentition (CM group), and prototyped via four different 3D printers, i.e., Asiga Pro 4K65 (DLP technology, high-professional segment), Elegoo Mars Pro (LCD technology, entry-level segment), Form 3B (SLA technology, medium-professional segment) and Vector 3SP (SLA technology, industrial segment). Each 3D printed model was scanned and superimposed with the master file, and deviation analysis was used to evaluate trueness and precision (root mean square values). All data were statistically analyzed (p0.05).The trueness error was lower in models prototyped with SLA printers compared to the LCD/DLP printers (p0.001); models prototyped with Elegoo Mars Pro-showed higher precision error compared to the other printers (P0.001). The models in the CM group showed higher trueness error compared to AM group when prototyped with LCD/DLP printers (p0.001). Accuracy error values were within the accepted clinical error for producing clear aligners (0.25 mm), with the entry-level 3D printer almost reaching this value.The accuracy of orthodontic models generated for clear aligners can be influenced by different technologies/market segments of the 3D printers used.Caution should be taken with entry-level 3D printers for producing clear aligners.

Objective To assess and compare volumetric and shape changes of the orbital cavity in patients treated with tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME). Study design Forty adolescents with bilateral maxillary cross-bite received tooth-borne (TB group = 20; mean age 14.27 ± 1.36 years) or bone-borne (BB group = 20; mean age of 14.62 ± 1.45 years) maxillary expander. Cone-beam computed tomography (CBCT) were taken before treatment (T1) and 6-month after the expander activation (T2). Volumetric and shape changes of orbital cavities were detected by referring to a specific 3D digital technology involving deviation analysis of T1/T2 CBCT-derived models of pulp chamber. Student’s t tests were used to 1) compare T1 and T2 volumes of orbital cavities in TB and BB groups, 2) compare volumetric changes and the percentage of matching of 3D orbital models (T1-T2) between the two groups. Results Both TB and BB groups showed a slight increase of the orbital volume (0.64 cm3 and 0.77 cm3) (p p p > 0.05). The areas of greater changes were detected in the proximity of the frontozygomatic and frontomaxillary sutures. Conclusion TB-RME and BB-RME would not seem to considerably affect the anatomy or the volume of the orbital cavity in adolescents.

Objective To identify the available evidence on the effects of rapid maxillary expansion (RME) with three-dimensional imaging and provide meta-analytic data from studies assessing the outcomes using computed tomography. Methods Eleven electronic databases were searched, and prospective case series were selected. Two authors screened all titles and abstracts and assessed full texts of the remaining articles. Seventeen case series were included in the quantitative synthesis. Seven outcomes were investigated nasal cavity width, maxillary basal bone width, alveolar buccal crest width, alveolar palatal crest width, inter-molar crown width, inter-molar root apex width, and buccopalatal molar inclination. The outcomes were investigated at two-time points post-expansion (2–6 weeks) and post-retention (4–8 months). Mean differences and 95% confidence intervals were used to summarize and combine the data. Results All the investigated outcomes showed significant differences post-expansion (maxillary basal bone width, +2.46 mm; nasal cavity width, +1.95 mm; alveolar buccal crest width, +3.90 mm; alveolar palatal crest width, +3.09 mm; intermolar crown width, +5.69 mm; inter-molar root apex width, +2.85 mm; and dental tipping, +3.75°) and post-retention (maxillary basal bone width, +2.21 mm; nasal cavity width, +1.55 mm; alveolar buccal crest width, +3.57 mm; alveolar palatal crest width, +3.32 mm; inter-molar crown width, +5.43 mm; inter-molar root apex width, +4.75 mm; and dental tipping, 2.22°) compared to pre-expansion. Conclusions After RME, skeletal expansion of the nasomaxillary complex was greater in most caudal structures. Maxillary basal bone showed 10% post-retention relapse. During retention period, uprighting of maxillary molars occurred.

Background: To investigate the accuracy and reproducibility of digital measurements of Little&rsquo, s Irregularity Index and to evaluate if different degrees of dental crowding could influence these measurements. Methods: The study included 40 dental models and 5 sub-groups were created according to the severity of the crowding. In both the digital models and the study cast, Little&rsquo, s Irregularity Index was recorded by measuring (1) the mesiodistal width of each tooth and (2) the arch lengths in both the maxillary and mandibular jaw. Two operators performed measurements on plaster and digital models using, respectively, a digital caliper and OrthoAnalyzerTM 3D software (3Shape A/S, Copenhagen, Denmark). Statistical analysis was performed to assess intra- and inter-operator variability, the accuracy between manual and digital measurements and if the amount of crowding could affect the accuracy of the digital measurements. Results: Concerning intra-examiner reliability, no statistically significant differences were detected (p &gt, 0.05). In the maxillary and mandibular arch, the Intraclass Correlation Coefficient (ICC) value was 0.996 and 0.997 for the analogic measurements and 0.998 and 0.978 for the digital measurements. For the maxillary arch, the mean difference between the analogic and digital Little&rsquo, s Irregularity Index (LII) measurements was 0.43 mm while for the mandibular arch the mean difference was 0.24 mm, showing some overestimation of the digital measurements (p &lt, 0.05). No differences were found according to crowding subgroups (p &gt, 0.05). Conclusions: Digital measurements of LII could be considered as a valid substitute of the gold standard analogical measurement.

The aim of this study is to evaluate through computed tomography differences in cortical plate thickness of condyle in patients with a different facial vertical skeletal pattern. The final sample of this retrospective study included CBCT exams of 60 adult subjects (mean age 33.2 ± 5.6), selected from the digital archive of a private practice. The subjects were assigned to 3 different groups according to the values of the Frankfurt-mandibular plane angle: hyper-, normo-, and hypodivergent groups. The volume rendering of the mandible was obtained and three condylar points were marked on it: median pole, lateral pole and the most cranial point. For each considered reference point, the minimum distance between external and internal cortical surface was measured, obtaining three different outcomes: condylar cortical bone thickness of median pole (CCBToMP), lateral pole (CCBToLP) and cranial pole (CCBToCP). The measurements were executed by means of Mimics software by the same expert operator in specific scan views. The cortical bone thickness of hyperdivergent patients was found to be statistically thicker than normodivergent patients and hypodivergent patients. Cortical bone thickness of normodivergent patients was found thicker than hypodivergent patients. All the differences were statistically significant (p

Background The aim of this study is to evaluate through computed tomography differences in cortical plate thickness of condyle in patients with different facial vertical skeletal pattern.Methods The final sample of this retrospective study included CBCT exams of 60 adult subjects (mean age 33.2 ± 5.6), selected from the digital archive of a private practice. The subjects were assigned to 3 different groups according to the values of the Frankfurt-mandibular plane angle: hyper- normo- and hypodivergent group. The volume rendering of the mandible was obtained and three condylar points were marked on it: median pole, lateral pole and the most cranial point. For each considered reference point the minimum distance between external and internal cortical surface was measured, obtaining three different outcomes: median pole, lateral pole and cranial point cortical bone thickness. The measurement was executed by means of Mimics software by the same expert operator in specific scan views.Results The cortical bone thickness of hyperdivergent patients was found to be statistically thicker than normodivergent patients and hypodivergent patients. Cortical bone thickness of normodivergent patients was found thicker than hypodivergent patients. All the differences were statistically significant (p

Background: Cone beam computed tomography (CBCT) is often used in different fields of dental science, especially in complex anatomical districts like the endodontic one. The aim of this study is to propose a low-dose CBCT protocol useful in cases of endodontic lesions. Methods: The device used was a MyRay Hyperion X9-11x5, the low dose setting of the machine was 90 Kv, 27 mAs, CTDI/Vol 2.89 mGy. The absorbed organ doses have been evaluated with an anthropomorphic phantom loaded with thermoluminescent dosimeters positioned at the level of sensitive organs like brain, bone marrow, salivary glands, thyroid, esophagus, oral mucosa, extrathoracic airways, and lymph nodes. Equivalent and effective doses have been calculated, the last one has been calculated using the recommendations approved by the Main Commission of ICRP (International Commission Radiological Protection) in March 2007. For the assessment of image quality, five senior clinicians, independent and experienced clinicians, were asked to state if CBCT scans were accurate enough to assess endodontic lesions. Results: The use of a low-dose CBCT acquisition produced the lowest organ dose (5.01 microSv) at the level of the esophagus. Image quality has been considered accurate enough for endodontic diagnostic needs. Conclusions: CBCT low-dose protocol can be used over the standard one in endodontic special cases because it provides a significantly lower radiation dose to the patients while ensuring good image quality. However, further studies are necessary to evaluate the opportunity of low-dose CBCT exams in endodontic clinical practice.

The purpose of this article is to evaluate the amount of the relapse of anterior crowding and the efficacy of retention appliances by reviewing the best available scientific evidence. A survey of articles published up to November 2019 about the stability of dental alignment and retention after fixed orthodontic treatment was performed using seven electronic databases. Study Selection: Only randomized clinical trials investigating patients previously treated with multi-bracket appliances with a follow-up period longer than 6 months were included. Data Extraction: Two authors independently performed the study selection, data extraction, and risk of bias assessment. All pooled data analyses were performed using a random-effects model. Statistical heterogeneity was evaluated. In total, eight randomized clinical trials (RCTs) were included, grouping data from 987 patients. The ages of the patients varied across the studies, ranging between 13 and 17 years. The observation period ranged between 6 and 24 months. The data showed no significant intercanine width modifications during the retention period with both fixed and removable retainers. A significant modification of Little’s Index was found for the mandibular removable retainers with a mean difference of 0.72 mm (95% Cl, 0.47 to 0.98) and for the maxillary removable retainers with a mean difference of 0.48 mm (95% Cl, 0.27 to 0.68). No significant changes were found by evaluating Little’s Index modification for the mandibular fixed retainers. The results of this meta-analysis showed that all the considered retainers were effective in maintaining dental alignment after fixed orthodontic treatment. However, fixed retainers showed greater efficacy compared to removable retainers.

The objective of this systematic review was to estimate the efficacy of protraction facemask on the correction of Class III malocclusion in the short term. A systematic review of articles was performed using different electronic databases (PubMed, Ovid, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, and Google Scholar). Search terms comprised 'orthopedic treatment' and 'Class III malocclusion'. The selection criteria were set in order to include in this review only randomized clinical trials (RCTs) performed treating with facemask Class III growing patients. Studies' selection, data extraction, and risk of bias's assessment were executed independently by two authors using pre-defined data forms. All pooled analyses of data were based on random effects models. A pre-specified subgroup analysis was planned to evaluate the effect of preliminary rapid palatal expansion on facemask efficacy. Three RCTs met our inclusion criteria. In total, data from 155 patients (92 treated and 63 controls) were collected. The treated group showed the following significant changes: ANB° +3.66° [95%CI (2.58, 4.74)]; SNA° +2.10 [95%CI (1.14, 3.06)]; SNB° -1.54 [95%CI (-2.13, -0.95)]; SN-palatal plane -0.82° [95%CI (-1.62, -0.02)]; and SN-mandibular plane +1.51 [95%CI (0.61, 2.41)]. Heterogeneity varied from low to moderate (mean I(2) value: 41.4 ± 20.8). Facemask is effective correcting Class III malocclusion in the short term. The skeletal modifications induced by facemask are forward displacement of maxilla, backward displacement of mandible, clockwise rotation of the mandibular plane, and counterclockwise rotation of the maxillary plane.

Introduction The aim of this systematic review was to evaluate the treatment effects on maxillary growth of removable functional appliances that advance the mandible to a more forward position in patients with Class II malocclusion. Methods Sixteen electronic databases and reference lists of studies were searched up to April 2015. Only randomized clinical trials and prospective controlled clinical trials investigating Class II growing patients treated with removable functional appliances were included. Two authors independently accomplished study selection, data extraction, and risk of bias assessment. All pooled analyses of data were based on random-effects models. Statistical heterogeneity was evaluated. Results In total, 14 studies were included (5 randomized clinical trials, 9 prospective controlled clinical trials) that collected data from 765 patients (405 treated, 360 untreated controls). The mean differences in treatment effect of functional appliances, relative to the untreated controls, were −0.61° per year (95% CI, −0.69° to −0.25°) for SNA angle, −0.61 mm per year (95% CI, −0.90 to −0.32 mm) for anterior maxillary displacement, and +0.07° per year (95% CI, −0.17° to +0.32°) for maxillary plane rotation. Conclusions Removable functional appliances in Class II growing patients have a slight inhibitory effect on the sagittal growth of the maxilla in the short term, but they do not seem to affect rotation of the maxillary plane.