Personal identification of living people and corpses: usefulness and reliability of intraoral scanners and 3D technologies in modern forensic dentistry

Teeth and oral structures are considered valuable alternatives to DNA analysis and fingerprints for personal identification. Even if their reliability has been recognized, they’ve not been widely or at all tested with new technologies. This project had the aim to study the superimposability of dental and oral structures in radiographic examinations and 3D scans and stability of some of them, like palatal rugae, in patients undergoing to dental procedures and cadavers. The survey has been performed on the virtual and plastic reconstruction of the oral cavities developed from data collected from an innovative intraoral scanner and from orthopantomographs (in all patients and cadavers- if available -) and from full-mouth periapical films (in periodontal patients and cadavers only). In all the patients oral cavity scans started at the beginning of the therapeutic procedures and after one year. In cadavers oral cavity scans have been recorded on the first and the seventh or tenth day from the time of death, allowing a complete survey on how long the palatal rugae features and other oral structures remain stable after corruption of the body sets in their intraoral scans have been then superimposed on radiographs. Morphometric data collected from all the virtual and plastic reconstructions and radiographs, have been listed in an electronic paper. The statistical analysis estimated the differences in shape and length of palatal rugae and dental and other intraoral features in the groups. The results confirm the reliability and the superimposability of 2D radiographs with the reconstructions derived from 3D scans as tools for personal identification, allowing to develop a new protocol for personal identification overcomes the so traditional and so invasive oral autopsy

The association between Ponticulus Posticus and Dental Agenesis: a retrospective study

OBJECTIVE: Neural tube defects may increase the risk of an abnormal development of skull, vertebral column and teeth formation, including dental agenesis in non syndromic patients. The association between the presence of a congenital Dental Agenesis (DA) and the Atlantooccipital Ligament (AOL) calcification, known as "Ponticulus Posticus" (PP), as possible links can be investigated. DESIGN: After a systematic review of the scientific literature on this topic, two independent examiners assessed the AOL calcification in lateral cephalograms of 350 non syndromic patients(7-21 years old). The results were compared with a control group (non syndromic patients, without congenital missing teeth). RESULTS: The 16.3% of the population studied by cephalometric analysis revealed a prevalence rate of PP (both complete and partial) with a slight male predominance is seen, not statistically significant (χ square test = 0.09; p= 0.76). In both sexes complete PP is more observed. In the patients affected by DA the frequency of PP is the 66.6% (both complete than partial). The χ square test with Yates correction showed a significative difference(χ= 66.20; p value= 0.00) between PP in patients with DA compared to not affected by DA. CONCLUSIONS: PP is not an uncommon anomaly. Since orofacial pain like migraine and other symptoms are often associated to PP, during routine radiographic examination, if detected, it should be documented in patients' health record and with symptoms, further investigation should be sought for. These findings encourage to think there's an association between DA in non syndromic patients and neuro-crestal cells defects

Clear aligners with differentiated thickness and without attachments : a case report

Most clear aligner systems use straight or scalloped gingival margin aligners that are replaced weekly and that mainly use attachments to guide many movements. Yet in the literature some studies show the effectiveness of the aligner margin extended beyon

Thermographic Control of Pediatric Dental Patients During the SARS-CoV-2 Pandemics Using Smartphones

Objective: To evaluate the reliability of infrared (IR) thermal camera connected to smartphones, already used in medicine for diagnostic purposes, as an easy tool for access screening to pediatric dentistry services. Material and Methods: After the preventive telephone triage, thirty orthodontic patients (7-13 years) underwent temperature measurement in the office with two no-contact IR devices: forehead digital thermometer and thermal-camera connected to a smartphone (reference areas: forehead, inner canthi, ears). Measurements were compared and differences were statistically investigated with T student’s test (p<0.01). Results: Forehead digital thermometer temperatures were superimposable to those recorded in ear areas and inner canthi with the thermal camera connected to a smartphone. Differences were not statistically significant even in comparison between the sexes. Forehead temperature values detected with a thermal camera are lower than those detected with a digital forehead thermometer. Conclusion: Thermal camera on a smartphone could be reliable in measuring body temperature. Mobile thermographic values of ears and inner canthi areas can be used as an alternative to forehead digital thermometer measurements. Further applications in pediatric dentistry of thermography on smartphones should be examined

Clear Aligners and Smart Eye Tracking Technology as a New Communication Strategy between Ethical and Legal Issues

Smart eye-tracking technology (SEET) that determines visual attention using smartphones can be used to determine the aesthetic perception of different types of clear aligners. Its value as a communication and comprehension tool, in addition to the ethical and legal concerns which it entails, can be assessed. One hundred subjects (50 F, 50 M; age range 15–70) were equally distributed in non-orthodontic (A) and orthodontic (B) groups. A smartphone-based SEET app assessed their knowledge of and opinions on aligners. Subjects evaluated images of smiles not wearing aligners, with/without attachments and with straight/scalloped gingival margins, as a guided calibration step which formed the image control group. Subsequently, the subjects rated the same smiles, this time wearing aligners (experimental images group). Questionnaire data and average values for each group of patients, and images relating to fixation times and overall star scores, were analyzed using these tests: chi-square, t-test, Mann–Whitney U, Spearman’s rho, and Wilcoxon (p < 0.05). One-way ANOVA and related post-hoc tests were also applied. Orthodontic patients were found to be better informed than non-orthodontic patients. Aesthetic perception could be swayed by several factors. Attachments scored lower in aesthetic evaluation. Lips distracted attention from attachments and improved evaluations. Attachment-free aligners were better rated overall. A more thorough understanding as to the opinions, expectations and aesthetic perception of aligners can improve communication with patients. Mobile SEET is remarkably promising, although it does require a careful medicolegal risk–benefit assessments for responsible and professional use

Treatment efficiency of conventional vs. self-ligating braces: systematic review and meta-analysis

Objective: The aim of this study was to conduct a systematic search for eligible publications within the past 17 years and to conduct a meta-analysis on differences between conventional and self-ligating brackets regarding overall treatment time and number of appointments. Material & Methods: This review’s pre-de ned protocol was based on the Cochrane guidelines, and it is reported according to the PRISMA statement and its extension for abstracts. We included randomized controlled trials (RCTs) and quasi-RCTs, published in English between 1998 and 2015; we included human patients of any age or gender that received xed-appliance orthodontic treatment as well as comparable patients for age, gender, and malocclusion receiving therapy with conventional as well as self-ligating brackets. Results: After we performed the research, we analyzed the useful full-text publications. The total duration of the treatment was higher in the self-ligating brackets group than those of the conventional brackets in all the studies reviewed. The number of appointments were greater in the self-ligating group than in the conventional brackets group, while in other studies, the conventional brackets group shows a greater number of appointments. Conclusion: Results from our meta-analysis revealed weak and statistically not signi cant overall effects that failed to substantiate major advantages of self-ligating brackets over conventional brackets. Treatment time does not depend exclusively on the type of bracket. The number of appointments is of interest when considering treatment duration

The Power of Customized Clear Aligners in Closing Molar Edentulous Spaces: Clinical and Medico-Legal Considerations in a Scoping Review and Case Report

Successful closure of edentulous spaces with clear aligners (CAs) is influenced by many factors. CAs are tailored orthodontic devices whose predictability may have relevant medico-legal implications. This study presents a scoping review about missing molar space closure (MMSC) with CAs and a clinical case. This study aims to highlight the feasibility of molar space closure by mesialization with CAs without hybrid supports. Following PRISMA Sc-review guidelines, English-written randomized/non-randomized/observational clinical studies on PubMed, Scopus, Cochrane and Lilacs were searched. An 18-year-old patient, with upper and lower edentulous spaces due to the loss of two first molars, was rehabilitated with CAs (Sorridi®, Sorridi srl, Latina, Italy) without hybrid supports and attachments. The therapy was carried out over 10 months. Currently, there are no studies documenting MMSC by mesialization with only CAs. Existing articles document the closure of premolar or incisor spaces. The upper and lower left second molars replaced the missing first molars, and erupting third molars replaced adjacent teeth. The biomechanical effects in space closure with CAs related to extraction cases appear as priorities of clinical/medico-legal interest. Our case turns attention to this movement of CAs without attachments/hybrid supports, indicating that even such a complex treatment can be comfortable for patients and safely predictable for specialists

Efficiency of self-ligating vs conventional braces: systematic review and meta-analysis [Efficienza degli attacchi auto-leganti rispetto ai convenzionali: revisione sistematica e meta-analisi]

Lo scopo di questa pubblicazione è quello di rivedere gli effetti clini- camente significativi degli attacchi auto-leganti sul trattamento orto- dontico rispetto alle prove scienti- fiche disponibili e, infine, chiarire se e qual è il vantaggio di questi diversi brackets in termini di tem- po totale di trattamento e numero di visite. MATERIALI E METODI È stata eseguita un’analisi siste- matica della letteratura esistente usufruendo della banca dati di Pubmed e della ricerca manuale degli articoli presenti nelle biblio- grafie, utilizzando le parole chiave: Self-ligating* AND conventional AND bracket* AND conventional AND bracket* AND treatment time AND conventional AND bracket* AND time. Inoltre, sono stati cotrollati gli indi- ci di American Journal of Ortho- dontics and Dentofacial Orthope- dics, European Journal of Or- thodontics, Journal of Orofacial Orthopedics, Orthodontics and Craniofacial Research e The Angle Orthodontist. Infine, è stata effet- tuata una meta-analisi utilizzando il software MetaXL 2.2. Alle pub- blicazioni selezionate sono state aggiunte le linee guida Cochrane. Sono stati inclusi i processi di controllo randomizzati (RCTs) e i quasi-RTCs; l’analisi delle pubbli- cazioni è stata limitata a studi condotti sull’uomo, pubblicati tra il 1998 e il 2017 e in lingua inglese. Per essere inclusi nella revisione, le prove dovevano soddisfare i se- guenti criteri di selezione. - Progettazione dello studio: studi clinici randomizzati e controllati. - Partecipanti: pazienti con arcata completa, apparecchio orto- dontico fisso trattati con attac- chi auto-leganti (SLB) o attacchi convenzionali (CB). - Interventi: trattamento ortodon- tico dell’apparecchio fisso con SLB o CB. - Misure di outcome: le misure di outcome erano il tempo com- plessivo di trattamento e il nu- mero di appuntamenti, relative sia ai sistemi SLB che ai siste- mi CB. Un totale di 43 citazioni sono state identificate elettronicamente e al- tre 9 manualmente; dopo la pro- cedura di esclusione, solo tre stu- di hanno soddisfatto i criteri e so- no stati inclusi nella revisione si- stematica e nella meta-analisi (Fleming, DiBiase, Johansson). RISULTATI E CONCLUSIONI Durata complessiva del tratta- mento: anche se la durata totale del trattamento era più alta nel gruppo degli attacchi auto-leganti rispetto a quella degli attacchi convenzionali in tutti e tre gli studi, in nessuno dei lavori è stata rag- giunta la significatività statistica. Numero di appuntamenti: nel pri- mo e nel terzo studio (Fleming, Johansson), il numero di appunta- menti è risultato maggiore nel gruppo auto-legante rispetto a quello del gruppo di brackets con- venzionale, mentre nel secondo studio il gruppo di brackets con- venzionale mostra un numero maggiore di appuntamenti. Si può notare, tuttavia, che nessuno dei tre studi primari ha raggiunto si- gnificatività statistica. SIGNIFICATO CLINICO I risultati della meta-analisi hanno rivelato effetti generali deboli e statisticamente non significativi che non hanno dimostrato i prin- cipali vantaggi degli attacchi au- to-leganti rispetto a quelli con- venzionali. Gli autori si sono resi conto che il piccolo numero di prove incluse pone un grosso li- mite nel chiarire le differenze tra attacchi convenzionali e auto-le- ganti. L’applicazione di criteri me- no rigidi avrebbe, di contro, au- mentato la probabilità di bias nel- la meta-analisi.OBJECTIVES The purpose of this section is to review the clinically significant effects of self-ligating brackets on orthodontic treatment with respect to the quality of available scientific evidence, and, finally, clarify if and which is the advantage of these different brackets in terms of overall treatment time and number of visits. MATHERIALS AND METHODS A systematic analysis was made using the Pubmed Database and manual search in the references of articles identified; our search for relevant articles took place between September 2014 and January 2017 using the following terms: Self-ligating* AND conventional AND bracket* AND conventional AND bracket* AND treatment time AND conventional AND bracket* AND time. In addition, we checked the indices of American Journal of Orthodontics and Dentofacial Orthopedics, European Journal of Orthodontics, Journal of Orofacial Orthopedics, Orthodontics and Craniofacial Research, and The Angle Orthodontist. This review’s pre-defined protocol was based on the Cochrane guidelines. Five key methodological criteria were assessed: sample size calculation, random sequence generation, allocation concealment, reporting of dropouts, and blinding of measurement assessment. An overall assessment of risk of bias (high, medium, low) was undertaken for each included trial using the Cochrane collaboration criteria. To be included in the review, trials had to meet the following selection criteria. - Study design: randomized and controlled clinical trials. - Participants: patients with full arch, fixed orthodontic appliance(s) treated with self-ligating brackets (SLBs) or conventional brackets (CBs). - Interventions: fixed appliance orthodontic treatment involving SLBs or CBs. - Outcome measures: the outcome measures were overall treatment time and number of appointments, related to both SLB and CB systems. The meta-analysis was calculated using the software MetaXL 2.2, specifying standardized mean differences (SMD) and 95% confidence intervals (CI) in a random effects model. A total of 43 citations were identified electronically and 9 more manually, after exclusion procedure, only three studies met the criteria and were included in the systematic review and in the meta-analysis (Fleming, DiBiase, Johansson). RESULTS AND CONCLUSIONS Overall treatment time: even if the total duration of the treatment was higher in the self-ligating brackets group than in that of the conventional brackets in all the three studies, in none of the studies statistical significance was reached. Therefore, across studies, heterogeneity did not emerge in the presence of the effect of the type of treatment on the total duration. Number of appointment: in the first and third studies (Fleming, Johansson), the number of appointments resulted greater in the self-ligating group than in that of conventional brackets group, while in the second study the conventional brackets group shows a greater number of appointments. It can be noted however that none of the three primary studies reached significance. CLINICAL SIGNIFICANCE Results from our meta-analysis revealed weak and statistically not significant overall effects that failed to substantiate major advantages of self-ligating brackets over conventional brackets. We realized that the small number of included trials carries its own limitations in clarifying the differences between conventional and self-ligating brackets. The application of less strict criteria would have raised the probability of bias in the meta-analysis

Coronavirus (COVID-19) in Italy: knowledge, management of patients and clinical experience of Italian dentists during the spread of contagion

Background: The coronavirus infection that emerged in China in the last few months of 2019 has now spread globally. Italy registered its first case in the second half of February, and in a short time period, it became the top country in Europe in terms of the number of infected people and the first in the world in terms of deaths. The medical and scientific community has been called upon to manage the emergency and to take measures. Dentists also need to take new precautions during their clinical activity to protect themselves, coworkers and patients from the risks of contagion and to avoid further spread of infection. Methods: Following the data published in the international literature as well as the guidelines and directives constantly updated by the WHO and by the national health authorities, a questionnaire to be completed anonymously was submitted online to Italian dentists using social tools and online professional platforms. The collected data were processed statistically, providing descriptive data and analysis of correlations of the most significant parameters using the Pearson’s χ2, the Likelihood-Ratio χ2, Cramér’s V, Fisher’s exact test, Goodman and Kruskal’s γ, and Kendall’s τb (p < 0.05). Results: A total of 535 dentists from Italy participated in the survey. A good level of scientific knowledge about coronavirus and the extra precautionary measures needed to limit the spread was related to the age of respondents and their sex. Coming from areas with higher concentrations of cases affected knowledge, level of attention and perception of risk related to dental activity. Conclusions: At the moment, there are no therapies or vaccines to contain the infection with the new coronavirus that is causing many infections, many of which are fatal, worldwide. Dentists are one of the categories at highest risk of encountering diseases and infections because they work in close proximity with patients, and in their procedures, there is always contact with aerosols with high bacterial and viral potential. Therefore, during this COVID-19 emergency, it is important that dentists are properly informed and take the appropriate precautionary measures

New Perspectives in Third Molar Auto-Transplantation: Literature Review and a Case Report of Clinical, Financial and Forensic Implications

Third molar extraction is the most common procedure in oral and maxillofacial surgery. Third molars are considered less functional than other teeth and are often extracted. Sometimes, they are also used for auto-transplantation for the benefit of oral rehabilitation. Since many biological factors are involved in this surgical approach, herein, we outline a review of the biological characteristics of medico-legal/forensic interest, in addition to presenting a successful clinical case. A scoping review of currently available research data (following the principles of PRISMA-ScR or the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) on third molar auto-transplantation was conducted by drawing upon the main databases (Scopus, PubMed, Google Scholar and LILACS) to evaluate biological and clinical characteristics possibly relatable to forensic issues. All the collected data were summarized and elaborated on for the purpose of this article. A patient underwent extraction of the right upper first molar and auto-transplantation of the unerupted ipsilateral third molar. Many biologic and clinical factors are involved in the success of this clinical procedure. Knowledge of third molar anatomy, of its development and viable surgical approaches are all essential elements; just as important are the treatment of the tooth before and after transplantation and the integrity of the periodontal ligament. Follow-up of the clinical case for 5 years made it possible to verify the stability of the procedure over time. Third molar auto-transplantation is feasible and cost-effective. However, the use of third molars as donor teeth in auto-transplantation may have medico-legal implications. The lack of official protocols and consistent evidence-based guidelines for operators still prevent such a procedure from becoming mainstream; therefore, it is viewed with suspicion by clinicians and patients, even though the biological factors herein detected point to a reasonably high degree of safety. The understanding of many specific biological and clinical factors involved in the stability of third molar auto-transplantation allows for a thorough understanding of the forensic implications relevant to clinical practice. Effective communication and information provision are therefore of utmost importance, in the interest of both patients and doctors