Taxonomic Analysis of Oral Microbiome during Orthodontic Treatment

Background: Orthodontic appliances induce significant changes in the oral microbiome, but this shift in microbial composition has not been well established by the available evidence yet. Objectives: To perform a systematic review of existing literature in order to assess the taxonomic microbial changes in orthodontic patients during Fixed Appliance Treatment (FAT) and Clear Aligner Treatment (CAT), using next-generation sequencing (NGS) technique of the bacterial 16S rRNA gene. Search Methods and Selection Criteria. The search for articles was carried out in PubMed, including articles published in English until May 2021. They included every human study report potentially relevant to the review. Data Collection and Analysis. After duplicate study selection and data extraction procedures according to the PICOS scheme, the methodological quality of the included papers was assessed by the Swedish Council on Technology Assessment in Health Care Criteria for Grading Assessed Studies (SBU) method. Results: The initial search identified 393 articles, 74 of which were selected by title and abstract. After full-text reading, six articles were selected according to inclusion criteria. The evidence quality for all the studies was moderate. Conclusions: Orthodontic treatment seems to transiently affect the composition of subgingival microbiome, although not salivary, maintaining a stable microbial diversity. Different results were found in the shift of microbiome between plaque and saliva, depending on the type of orthodontic treatment. This review should be interpreted with some caution because of the number, quality, and heterogeneity of the included studies

Vertical effects of cervical headgear in growing patients with Class II malocclusion: a systematic review and meta-analysis

Background Cervical headgear (cHG) has been shown to be effective in Class II correction both with dental and orthopaedic effects but has traditionally been associated with vertical adverse effects in terms of posterior mandibular rotation. Objective To assess the treatment effects of cHG treatment in the vertical dimension. Search methods Unrestricted literature search of five databases up to May 2023. Randomized/non-randomized clinical studies comparing cHG to untreated controls, high-pull headgear (hp-HG), cHG adjuncts, or other Class II treatment alternatives (functional appliances or distalisers). Data collection and analysis After duplicate study selection, data extraction, and risk-of-bias assessment according to Cochrane, random-effects meta-analyses of mean differences (MD)/standardized mean diffences (SMD) and their 95% confidence intervals (CIs) were performed, followed by meta-regressions, sensitivity analyses, and assessment of certainty on existed evidence. Results Two randomized/16 non-randomized studies (12 retrospective/4 prospective) involving 1094 patients (mean age 10.9 years and 46% male) were included. Compared to natural growth, cHG treatment was not associated on average with increases in mandibular (eight studies; SMD 0.22; 95% CI −0.06, 0.49; P = 0.11) or maxillary plane angle (seven studies; SMD 0.81; 95% CI −0.34, 1.95; P=0.14). Observed changes translate to MDs of 0.48° (95% CI −0.13, 1.07°) and 1.22° (95% CI −0.51, 2.94°) in the SN-ML and SN-NL angles, respectively. No significant differences were seen in y-axis, facial axis angle, or posterior face height (P > 0.05). Similarly, no significant differences were found between cHG treatment and (i) addition of a lower utility arch, (ii) hp-HG treatment, and (iii) removable functional appliance treatment (P > 0.05 for all). Meta-regressions of patient age, sex, or duration and sensitivity analyses showed relative robustness, while our confidence in these estimates was low to very low due to the risk of bias, inconsistency, and imprecision. Conclusions cHG on average is not consistently associated with posterior rotation of the jaws or a consistent increase in vertical facial dimensions among Class II patients. PROSPERO registration (CRD42022374603)

The Virtual Patient in Daily Orthodontics: Matching Intraoral and Facial Scans without Cone Beam Computed Tomography

Aim: The authors provided an accurate, simple, and noninvasive method for matching the intraoral scan with facial scan of a patient, without the need of a cone beam computed tomography (CBCT). Materials and methods: Three different facial scans were acquired: the first one with the mouth closed, the second one with a voluntary “social smile”, and the last one scanned the face with a lip-and-cheek retractor with dental arches in occlusion. The base of this method is to superimpose the area of the dental arches acquired by a face scanner with the same area derived by an intraoral scanner. Result: An accurate matching of intraoral and facial scans can be achieved without the risks of radiation exposure. Conclusions: The virtual patient helps the orthodontist to improve both diagnosis and treatment planning: a three-dimensional digital smile design can be performed, the patient’s smile can then be analyzed in the context of the lips, and the teeth can be moved to achieve a consonant and balanced smile. All this information can be integrated in a clear aligner therapy or an indirect bonding procedure, enhancing outcomes in the facial esthetics

Cephalometric effects of the elastodontic appliance in managing skeletal Class II division 1 cases

Abstract Aim The aim of the study was to evaluate the cephalometric effects of the elastodontic appliance (EA) in the management of patients presenting with a skeletal Class II/1 malocclusion. Methods Twenty Class II patients treated using the EA (Group EA) were compared with 20 Class II untreated children (Group C). Cephalograms were compared at the start (T0) and after 24 months (T1) after which time, skeletal, dental, and aesthetic variables were evaluated. A statistical evaluation was conducted by applying an unpaired t-test for normally distributed variables. Results From T0 to T1, the EA group showed a significant increase in lower facial height (LFH), in mandibular length (Co-Gn), in the upper incisor and cranial plane angle (1 + SN) and in the distance between a true vertical line (TVL)-soft tissue B (B') and TVL-soft tissue Pogonion (Pog') points. From T0 to T1, group C showed a significant decrease in SN-occlusal plane (PO) (p < 0.01), of SN-mandibular plane (Go-Me) (p < 0.01) and of total gonial (N-Go-Me) angles (p < 0.05); a significant reduction of the distance between TVL-upper incisor (1+), TVL-lower lip (Li), and TVL-Pog' was shown. No statistical differences were observed between the groups in dental and aesthetic outcomes, except for a skeletal increase in LFH (p < 0.05) and in Co-Gn length (p < 0.05), which was statistically significant in the EA group. Conclusion In Class II growing patients, the EA induces minor skeletal effects, compared to untreated control patients

Comparison of the cytotoxicity of 3D-printed aligners using different post-curing procedures: an in vitro study

Three-dimensional (3D) printing technology represents a novel method for manufacturing aligners. The aim of the present study was to assess the in-vitro cytotoxicity of 3D-printed aligners using different post-polymerisation conditions

MUSIC THERAPY REDUCES ANXIETY AND PAIN AND IMPROVES SATISFACTION IN PATIENTS UNDERGOING PERCUTANEOUS RENAL BIOPSY

BACKGROUND AND AIMS Percutaneous kidney biopsy (PRB) is an invasive procedure performed under local anaesthesia that often creates anxiety, stress and pain in the patient before, during and after the procedure. Music therapy (MT), defined as the clinical- and evidence-based use of music, is administered by a trained professional to achieve individualized goals within a therapeutic relationship between patient, music and music therapist. MT can be used as a complementary non-drug intervention to prevent and treat emotional distress and pain. The main objectives of the study were 1. evaluate the effectiveness of MT in managing anxiety, pain and satisfaction in patients undergoing PRB. 2. investigate the effect of MTI on heart rate variability (HRV). METHOD This study was a two-arm, single-centre, parallel-group and pre–post PRB randomized controlled trial. Patients programmed for PRB were enrolled (n = 80) and assigned to the MT intervention group (MG, n = 40) or standard treatment [control group (CG), n = 40]. MG received, from a FAMI-certified music therapist, a personalized playlist administered during the PRB, adapted to the individual patient. Patient anxiety was assessed before and after PRB using the State Y-1 Trait Anxiety Inventory (STAI-Y1). A visual analog scale (VAS) was used for self-assessment of pain (VAS-P) and satisfaction (VAS-S). Physiological stress parameters (PRE–POST) were assessed using HRV (SDNN, RMSSD, LH/HF, SD1, SD2) from E4 wristbands—Empatica Inc.1. The bracelet was placed 5 min before the patient entered the operating room for the procedure and removed after the completion of the PRB. The data of each session were divided into two segments: (1) pre, before the administration of the local anesthetic and (2) post, after the conclusion of the biopsy. RESULTS A statistically significant difference in anxiety levels was observed between the MG and CG groups (35.35 ± 6.208 versus 42.83 ± 9.027; P &lt; 0.001, Fig. 1). The MG group showed significantly lower VAS-P values ​​(4.95 ± 1.377 versus 6.28 ± 1.281; P &lt; 0.001, Fig. 2) and higher VAS-S values ​​(7.75 ± 0.981 versus 6.03 ± 0.800; P &lt; 0.001) after PRB compared with the CG group (Fig. 3). The SDNN (P &lt; 0.034), RMSDD (P &lt; 0.04) and SD2 (P &lt; 0.027) measurements of HRV were significantly higher in MG than in CG, while LF/HF decreased (P &lt; 0.033). CONCLUSION This study supports the efficacy of MT in reducing anxiety and pain and improving satisfaction in patients undergoing PRB. MT modulates the autonomic nervous system, reducing sympathetic activity, increasing parasympathetic activity and inducing physiological relaxation

Curve of Spee modification in different vertical skeletal patterns after clear aligner therapy: a 3D set-up retrospective study

Abstract Objective The purpose of the present study was to evaluate: (1) changes in the curve of Spee (COS) after clear aligner therapy and (2) whether such changes correlated with the patient’s skeletal patterns. Materials and methods Three-dimensional mandibular models of 106 patients (47 males and 59 females; mean age 22.3 SD ± 3.4 years) treated with clear aligners were retrospectively analysed. The perpendicular distance between the occlusal reference plane and the buccal cusp tip of each lateral tooth was measured. Five angular cephalometric measurements (PP-MP, PP-OP, OP-MP, AFH, and PFH) were performed and correlated with the T1–T0 difference in linear distances. The patients were divided into three groups according to facial divergence. Variance analysis with Tukey post hoc correction was performed to evaluate the differences among groups. Results The one-way ANOVA test showed a statistically significant difference for all analysed variables, except for the change in the distance of the second molar from the occlusal reference plane. Tukey’s HSD test showed the following differences: In normodivergents, the T1–T0 difference in the distance of the first molar from the occlusal plane was 1 mm greater than that observed in the hyperdivergent group (p < 0.05); in the normodivergent group, the T1–T0 difference in the distance of the second premolar from the occlusal plane was 1.23 mm greater than that observed in the hyperdivergent group (p < 0.05), while in the hypodivergent group, it was 1.08 mm greater than in the hyperdivergent group (p < 0.05); finally, in normodivergents, the T1–T0 difference in the distance of the first premolar from the occlusal plane was 0.97 mm greater than that observed in the hyperdivergent group (p < 0.05). Conclusion Treatment with aligners did not lead to a clinically significant change in COS depth. However, when dividing the sample into groups based on craniofacial divergence, COS depth change differed significantly between the three groups

Occlusal Plane Modification in Clear Aligners Treatment: Three Dimensional Retrospective Longitudinal Study

The purpose of the present study was to evaluate: (i) maxillary occlusal plane changes after clear aligners therapy with a 3D measurement technique; and (ii) as a secondary outcome, if such changes were correlated to the patient’s 1axilla-mandibular divergence. 3D maxillary models of 32 patients (7 males and 25 females; mean age 22.3 +/− 3.4 year) treated with clear aligners were analyzed. The angle (α) between a reference palatine plane and a maxillary occlusal plane was measured. Five angular cephalometric measurements (NSL/MP; PP-OP; OP-MP; PP-MP; PFH/AFH%) were performed and related to Δα. The subjects were further divided into three groups according to facial divergence. After aligner treatment, Δα increased in hyperdivergent patients and decreased in hypodivergent patients (p < 0.05). Δα showed a significant positive correlation with NSL/MP (rho = 0.44) and negative correlation with PFH/AFH% (rho = −0.53). Aligners treatment produced a counterlockwise rotation of the maxillary occlusal plane, even if this rotation occurs differently depending on divergence

Correlation between dental arch form and OSA severity in adult patients: an observational study

Abstract Background The role of interdental widths and palatal morphology on the development of obstructive sleep apnea (OSA) has not been well investigated in adult patients yet. The aim of this paper was to assess the morphology of maxilla and mandibular dental arches on three-dimensional (3D) casts and to correlate these measurements with the severity of OSA. Methods Sixty-four patients (8 women and 56 men, mean age 52.4) with a diagnosis of mild-to-moderate OSA were retrospectively enrolled. On each patient, home sleep apnea test and 3D dental models were collected. Apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were recorded, as well as the dental measurements including inter-molar distance, anterior and posterior widths of maxillary and mandibular arches, upper and lower arch lengths, palatal height, and palatal surface area. The respiratory and dental variables were then correlated. Result A statistically inverse correlation was found between ODI and anterior width of lower arch, maxillary arch length, palatal height, and palatal area. AHI showed a significant inverse correlation with anterior width of mandibular arch and maxillary length. Conclusion A significant inverse correlation between maxillary and mandibular morphology and respiratory parameters was shown in the present paper