Effects of experimental insoles on body posture, mandibular kinematics and masticatory muscles activity. A pilot study in healthy volunteers

BACKGROUND: It has been hypothesized that different plantar sensory inputs could influence the whole body posture and dental occlusion but there is a lack of evidence on this possible association. OBJECTIVES: To investigate the effects of experimental insoles redistributing plantar pressure on body posture, mandibular kinematics and electromyographic (EMG) activity of masticatory muscles on healthy subjects. METHODS: A pilot study was conducted on 19 healthy volunteers that wore custom-made insoles normalizing the plantar pressure distribution for 2 weeks. Body posture parameters were measured by means of an optoelectronic stereophotogrammetric analysis; mandibular kinematics was analyzed by means of gothic arch tracings; superficial EMG activity of head and neck muscles was performed. Measurements were carried out 10 days before the insertion of the insoles, immediately before the insertion, the day after, 7 and 14 days after, in four different exteroceptive conditions. RESULTS: The outcomes of the present study show that insoles do not modify significantly over time the parameters of body posture, SEMG activity of head and neck muscles and mandibular kinematics. CONCLUSIONS: In this pilot study the experimental insoles did not significantly influence the body posture, the mandibular kinematics and the activity of masticatory muscles during a 14-day follow up perio

Awareness and Sources of Knowledge about Obstructive Sleep Apnea: A Cross Sectional Survey Study

Obstructive sleep apnea (OSA) is a multifactorial sleep breathing disorder, seriously impacting quality of life and involving approximately 1 billion of the world’s population. It is characterized by episodes of total cessation of breathing or decreases in airflow during sleep. Available data suggest that most cases of OSA remain undiagnosed even in developed countries. This is due to a lack of widespread knowledge about this pathology and the medical morbidities and mortality it brings about, among both laypeople and physicians. Moreover, despite receiving indications about the need to undergo specific evaluations for OSA signs and symptoms, sometimes patients do not pay sufficient attention to the problem. This is probably due to a lack of correct information on these issues. The present investigation analyzed the level of knowledge about OSA pathology and the sources through which a group of OSA patients gained information on their condition. A survey of 92 patients diagnosed with OSA (mean age 60.55 ± 10.10) and referred to the Unit of Orthodontics and Dental Sleep Medicine of the University of Bologna was conducted by means of a questionnaire investigating sociodemographic characteristics, the level of general knowledge on OSA pathology and its possible medical consequences. Despite about two third (67.38%) of the population demonstrating extensive knowledge, remarkably, a group of subjects (20.65%) had poor awareness of the OSA condition. A statistically significant correlation emerged between the level of knowledge about OSA and the level of education (p = 0.002). A great effort should be made to improve the quality of information and the communication modalities for OSA to enable a fully appropriate awareness of the condition among patients

Bracket base remnants after orthodontic debonding

Objective: To evaluate whether the debonding procedure leads to restitutio ad integrum of the enamel surface by investigating the presence of enamel within the bracket base remnants after debonding. Materials and Methods: Sixty patients who completed orthodontic treatment with fixed appliances were included. A total of 1068 brackets were microphotographed; the brackets presenting some remnants on the base (n \u200a=\u200a 818) were selected and analyzed with ImageJ software to measure the remnant area. From this population a statistically significant sample (n \u200a=\u200a 100) was observed under a scanning electron microscope to check for the presence of enamel within the remnants. Energy dispersive x-ray spectrometry was also performed to obtain quantitative data. Results: Statistically significant differences in the remnant percentage between arches were observed for incisor and canine brackets (P < .0001 and P \u200a=\u200a .022, respectively). From a morphologic analysis of the scanning electron micrographs the bracket bases were categorized in 3 groups: group A, bases presenting a thin enamel coat (83%); group B, bases showing sizable enamel fragments (7%); group C, bases with no morphologic evidence of enamel presence (10%). Calcium presence was noted on all evaluated brackets under energy dispersive x-ray spectrometry. No significant difference was observed in the Ca/Si ratio between group A (16.21%) and group B (18.77%), whereas the Ca/Si ratio in group C (5.40%) was significantly lower than that of the other groups (P < .323 and P \u200a=\u200a .0001, respectively). Conclusion: The objective of an atraumatic debonding is not achieved yet; in some cases the damage could be clinically relevant

Lax eyelid condition (LEC) and floppy eyelid syndrome (FES) prevalence in obstructive sleep apnea syndrome (OSA) patients: a systematic review and meta-analysis

Purpose: Lax eyelid condition (LEC) and floppy eyelid syndrome (FES) represent two distinct conditions which have been associated with several ocular and systemic comorbidities. The main aim of this systematic review and meta-analysis is to explore the available literature to estimate the prevalence rate of LEC and FES in obstructive sleep apnea (OSA). Methods: The protocol of this systematic review and meta-analysis has been registered in PROSPERO. Four electronic databases (PubMed/MEDLINE, Google Scholar, Cochrane Library, Web of Science) were searched from inception to December 24, 2021. A random intercept logistic regression model was carried out for the analysis of overall proportions. Odds ratio and mean difference were reported as measures of the effect size in the presence of binary and continuous outcomes, respectively. The estimated numbers of LEC/FES patients in OSA were calculated by multiplying the prevalence rate determined by our random-effects model and the corresponding Benjafield et al.’s population prospect. Results: We included 11 studies comprising 1225 OSA patients of whom 431 and 153 affected by LEC and FES, respectively. Our model estimated a pooled prevalence rate for LEC and FES in OSA patients of 40.2% (95%CI: 28.6–53.1%) and of 22.4% (95%CI: 13.8–34.2%), respectively. The number of LEC/FES affected individuals among OSA patients is expected to peak up to 376 and to 210 million, respectively. OSA patients appeared to have a 3.4 (95%CI: 2.2–5.2) and a 3.0 (95%CI: 1.7–5.5) increased risk of developing LEC and FES than the healthy counterpart. Conclusion: Prevalence of LEC and FES is higher in OSA-affected patients compared to controls. More studies are warranted to investigate the mechanisms leading to the development of LEC and/or FES in OSA patients, as well as the feasibility of the adoption of these clinical findings as screening tools for OSA

Effect of orthopedic and functional orthodontic treatment in children with obstructive sleep apnea: A systematic review and meta-analysis

Orthodontic treatment is suggested in growing individuals to correct transverse maxillary deficiency and mandibular retrusion. Since, as a secondary effect, these orthodontic procedures may improve pediatric obstructive sleep apnea (OSA), this systematic review assessed their effects on apnea-hypopnea index (AHI) and oxygen saturation (SaO2). Twenty-five (25) manuscripts were included for qualitative synthesis, 19 were selected for quantitative synthesis. Five interventions were analyzed: rapid maxillary expansion (RME, 15 studies), mandibular advancement (MAA, five studies), myofunctional therapy (MT, four studies), and RME combined with MAA (one study). RME produced a significant AHI reduction and minimum SaO2 increase immediately after active treatment, at six and 12 months from baseline. A significant AHI reduction was also observed six and 12 months after the beginning of MAA treatment. MT showed positive effects, with different protocols. In this systematic review and meta-analysis of data from mainly uncontrolled studies, interceptive orthodontic treatments showed overall favorable effects on respiratory outcomes in pediatric OSA. However, due to the low to very low level of the body evidence, this treatment cannot be suggested as elective for OSA treatment. An orthodontic indication is needed to support this therapy and a careful monitoring is required to ensure positive improvement in OSA parameters

Outcomes in Hybrid Breast Reconstruction: A Systematic Review

Background and Objectives: Lipofilling is a commonly performed procedure worldwide for breast augmentation and correction of breast contour deformities. In breast reconstruction, fat grafting has been used as a single reconstructive technique, as well as in combination with other procedures. The aim of the present study is to systematically review available studies in the literature describing the combination of implant-based breast reconstruction and fat grafting, focusing on safety, complications rate, surgical sessions needed to reach a satisfying reconstruction, and patient-reported outcomes. Materials and Methods: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) throughout the whole review protocol. A systematic review of the literature up to April 2022 was performed using Medline, Embase, and Cochrane Library databases. Only studies dealing with implant-based breast reconstruction combined with fat grafting were included. Results: We screened 292 articles by title and abstract. Only 48 articles were assessed for full-text eligibility, and among those, 12 studies were eventually selected. We included a total of 753 breast reconstructions in 585 patients undergoing mastectomy or demolitive breast surgeries other than mastectomy (quadrantectomy, segmentectomy, or lumpectomy) due to breast cancer or genetic predisposition to breast cancer. Overall, the number of complications was 60 (7.9%). The mean volume of fat grafting per breast per session ranged from 59 to 313 mL. The mean number of lipofilling sessions per breast ranged from 1.3 to 3.2. Conclusions: Hybrid breast reconstruction shows similar short-term complications to standard implant-based reconstruction but with the potential to significantly decrease the risk of long-term complications. Moreover, patient satisfaction was achieved with a reasonably low number of lipofilling sessions (1.7 on average)

Obstructive sleep apneas naturally occur in mice during REM sleep and are highly prevalent in a mouse model of Down syndrome

Study objectives: The use of mouse models in sleep apnea study is limited by the belief that central (CSA) but not obstructive sleep apneas (OSA) occur in rodents. We aimed to develop a protocol to investigate the presence of OSAs in wild-type mice and, then, to apply it to a validated model of Down syndrome (Ts65Dn), a human pathology characterized by a high incidence of OSAs. Methods: In a pilot study, nine C57BL/6J wild-type mice were implanted with electrodes for electroencephalography (EEG), neck electromyography (nEMG), and diaphragmatic activity (DIA), and then placed in a whole-body-plethysmographic (WBP) chamber for 8 h during the rest (light) phase to simultaneously record sleep and breathing activity. CSA and OSA were discriminated on the basis of WBP and DIA signals recorded simultaneously. The same protocol was then applied to 12 Ts65Dn mice and 14 euploid controls. Results: OSAs represented about half of the apneic events recorded during rapid-eye-movement-sleep (REMS) in each experimental group, while the majority of CSAs were found during non-rapid eye movement sleep. Compared with euploid controls, Ts65Dn mice had a similar total occurrence rate of apneic events during sleep, but a significantly higher occurrence rate of OSAs during REMS, and a significantly lower occurrence rate of CSAs during NREMS. Conclusions: Mice physiologically exhibit both CSAs and OSAs. The latter appear almost exclusively during REMS, and are highly prevalent in Ts65Dn. Mice may, thus, represent a useful model to accelerate the understanding of the pathophysiology and genetics of sleep-disordered breathing and to help the development of new therapies

Problematic sample in the study of interception of palatally displaced canines. Author's response

We thank Professor Peck and the Editor for the op- portunity of discussion. Approaching this research, we considered it to be unethical not to treat patients at risk for ectopically erupting canines or potential resorp- tive situations, since resorption of the incisor roots caused by ectopic canines has been found in almost 50% of patients in studies based on 3-dimensional im- aging. It is, therefore, advisable to eliminate the contact between the incisor and the unerupted canine as early as possible to reduce the risk of such a serious complica- tion. Patients with palatally displaced canines and those centrally positioned in the alveolar crest were included in this study because the latter are associated with the highest incidence of root resorption. This might explain the high occurrence rate of bilateral displacement in the study sample. Irrespective of the anteroposterior position of the canine, the common characteristic was the risk for ectopic eruption or potentially resorptive situations, established by using widely accepted clinical and radiographic criteria based on 2-dimensional panoramic radiographs. Some overestimation might have occurred; however, taking into account the complications that might arise and the possibility to prevent them, we believed that it was preferable to overestimate rather than to underestimate. We agree that the ability to distinguish the physio- logic position of the unerupted canine from a position indicating a pathologic eruption pattern at the same age would be particularly relevant for clinicians. 4 But therein lies a problem: 3-dimensional imaging is elective in evaluating the position of the canine, and the costs (from an economic and, more importantly, a biologic point of view) are still prohibitive in many practices. This probably accounts for some diagnostic limit in pa- tient selection. In this situation, it is preferable to per- form deciduous extractions with at least 1 already accepted clinical and radiographic criterion, rather than underestimating the problem. Concerning Professor Peck\u2019s statement that \u201cthe extraction of the maxillary deciduous canine alone is still the most prudent conservative interceptive standard of care,\u201d we do not agree. The double extraction of decid- uous canines and first deciduous molars only anticipates a physiologic event; it is no more technically difficult, bi- ologically expensive, or traumatic compared with the single extraction of only the deciduous canine. More fa- vorable changes of the intrabony position of the canine resulted in our study from double vs single extractions, including greater uprighting of the canine\u2019 s long axis and greater distal movement of its crown. These findings were corroborated in a further study conducted on a larger sample, which also highlighted (1) greater uprighting of the first premolar long axis (thus improving local conditions for uneventful eruption of the canine) and (2) greater parallelism between the roots of the canines and the adjacent lateral incisors (thus reducing the risk for iatrogenic root resorption on adjacent teeth). It is our opinion that these data, despite being obtained by means of \u201crandomized sampling methods and multiple statistical manipulations of data,\u201d can provide reliable information that is helpful in making a sound clinical decision