Skeletal Class III Surgical-Orthodontic Treatment and Remote Digital Monitoring during COVID-19 Pandemic: A Case Report

Moderate to severe cases of skeletal Class III malocclusion, where residual growth is no longer present and an orthodontic camouflage would not achieve satisfactory outcomes, are good candidates for a combined surgical-orthodontic approach. We present the case of a 34-year-old healthy male with skeletal Class III malocclusion, where aesthetics and masticatory function were further worsened by maxillary and mandibular transverse discrepancy, hyperdivergent pattern, moderate dental crowding, occlusal contacts present only on molars, negative overjet and overbite. The management of the case included a pre-surgical phase of surgically assisted rapid palatal expansion (SARPE) and an orthodontic treatment with fixed multibracket appliance, a surgical phase consisting in Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO), and a myofunctional physical therapy targeting orofacial muscles following the orthognathic surgery. The pre-surgical phase was additionally integrated with a system of remote digital monitoring, such as Dental Monitoring®, to early detect any orthodontic emergency. As in-office visits were abruptly interrupted because of COVID-19 pandemic, the remote digital system also permitted to regularly monitor the patient at long-distance. In conclusion, a case of skeletal Class III malocclusion was successfully managed with a multidisciplinary approach which involved orthognathic surgery, orthodontic treatment, and myofunctional physical therapy. The additional integration of remote digital technologies, such as Dental Monitoring®, may provide a continuity of care to orthodontic patients in times of COVID-19 pandemic, when the regularity of non-urgent chairside appointments might be disrupted

New frontiers on adjuvants drug strategies and treatments in periodontitis

Causes of the progression of periodontitis such as an imbalance between the immune response by the host by the release of inflammatory mediators in the response of the oral pathogenic dysbiotic biofilm have been identified. New insights on specific cell signaling pathways that appear during periodontitis have attracted the attention of researchers in the study of new personalised approaches for the treatment of periodontitis. The gold standard of non‐surgical therapy of perio-dontitis involves the removal of supra and subgingival biofilm through professional scaling and root planing (SRP) and oral hygiene instructions. In order to improve periodontal clinical outcomes and overcome the limitations of traditional SRP, additional adjuvants have been developed in recent decades, including local or systemic antibiotics, antiseptics, probiotics, anti‐inflammatory and anti-resorptive drugs and host modulation therapies. This review is aimed to update the current and recent evolution of therapies of management of periodontitis based on the adjunctive and target therapies. Moreover, we discuss the advances in host modulation of periodontitis and the impact of targeting epigenetic mechanisms approaches for a personalised therapeutic success in the management of periodontitis. In conclusion, the future goal in periodontology will be to combine and personalise the periodontal treatments to the colonising microbial profile and to the specific response of the individual patient

Effects of remote digital monitoring on oral hygiene of orthodontic patients: a prospective study

Background: Remote digital monitoring during orthodontic treatment can help patients in improving their oral hygiene performance and reducing the number of appointments due to emergency reasons, especially in time of COVID-19 pandemic where non-urgent appointments might be discouraged. Methods: Thirty patients scheduled to start an orthodontic treatment were divided into two groups of fifteen. Compared to controls, study group patients were provided with scan box and cheek retractor (Dental Monitoring®) and were instructed to take monthly intra-oral scans. Plaque Index (PI), Gingival Index (GI), and White Spot Lesions (WSL) were recorded for both groups at baseline (t0), every month for the first 3 months (t1, t2, t3), and at 6 months (t4). Carious Lesions Onset (CLO) and Emergency Appointments (EA) were also recorded during the observation period. Inter-group differences were assessed with Student's t test and Chi-square test, intra-group differences were assessed with Cochran’s Q-test (significance α = 0.05). Results: Study group patients showed a significant improvement in plaque control at t3 (p = 0.010) and t4 (p = 0.039), compared to control group. No significant difference was observed in the number of WSL between the two groups. No cavities were detected in the study group, while five CLO were diagnosed in the control group (p = 0.049). A decreased number of EA was observed in the study group, but the difference was not significant. Conclusions: Integration of a remote monitoring system during orthodontic treatment was effective in improving plaque control and reducing carious lesions onset. The present findings encourage orthodontists to consider this technology to help maintaining optimal oral health of patients, especially in times of health emergency crisis

Remote digital monitoring during the retention phase of orthodontic treatment: A prospective feasibility study

Objective: To evaluate if a remote digital monitoring system added at the end of orthodontic treatment could positively influence the retention phase by reducing the occurrence of misfit of removable appliances, number of emergency appointments (EA), and orthodontic relapse. Methods: Twenty-seven patients who completed active orthodontic treatment were divided into the study and control groups. In addition to the standard chairside follow-up appointments at month 1 (T1), month 3 (T2), month 6 (T3), the study group patients were monitored using Dental Monitoring® with monthly intra-oral scans. Occurrence of misfit of removable retainers, number of EAs, and intercanine width change were recorded for both groups. Differences in EAs and retainer fit were assessed using the chi-square test. Intra-group and inter-group differences in the intercanine width were assessed with Friedman test and Mann–Whitney U test, respectively (α = 0.05). Results: The study group showed a significantly lower occurrence of misfit of removable retainers (p = 0.027) compared to the control group. No significant inter-and intra-group difference was found in the EAs and intercanine width change at each time-point. Conclusions: Integrating remote monitoring systems, such as Dental Monitoring®, to the retention phase of the orthodontic treatment may lower the occurrence of misfit of removable retainers. However, a small sample size and a short observation period limit the strength of this evidence. These preliminary results tentatively suggest that remote monitoring technologies may be beneficial, especially during the COVID-19 pandemic, when the regularity of in-office visits might be disrupted

Three-dimensional dental analysis for sex estimation in the italian population: A pilot study based on a geometric morphometric and artificial neural network approach

Dental dimorphism can be used for discriminating sex in forensic contexts. Geometric morphometric analysis (GMA) allows the evaluation of the shape and size, separately, of uneven 3D objects. This study presents experiments using a novel combination of GMA and an artificial neural network (ANN) for sex classification, applied to premolars of Caucasian Italian adults (50 females and 50 males). General Procrustes superimposition (GPS) and the partial least square (PLS) method were performed, respectively, to study the shape variance between sexes and to eliminate landmark variations. The “set-aside” approach was used to assess the accuracy of the proposed neural networks. As the main findings of the pilot study, the proposed method applied to the first upper premolar correctly classified 90% of females and 73% of males of the test sample. The accuracy was 0.84 and 0.80 for the training and test samples, respectively. The sexual dimorphism resulting from GMA was low, although statistically significant. GMA combined with the ANN demonstrated better sex classification ability than previous odontometric or dental morphometric methods. Future research could overcome some limitations by considering a larger sample of subjects and other kinds of teeth and experimenting with the use of computer vision for automatic landmark positioning

Integration of cranial base and face in growing subject

Background: many papers investigate the role of the cranial base in facial development, but the results are not in agreement. This can be due to a difference between the central and lateral parts of the cranial base. The aim of the present study is to evaluate the relationship between the central and the lateral cranial base and the facial skeleton in pre-pubertal peak subjects and at the end of growth. Material/Methods: a total sample of 52 latero-lateral cranial teleradiographs were analyzed. To test the correlation between structures, the "Partial Least Square" analysis was performed. Geometric morphometric analysis were applied and partial least square analysis was used to test correlation. Integration was studied removing the effect of allometry. Results: facial skeleton has no significant relation with central cranial base. Facial skeleton has significant relationships with the lateral portion of the cranial base. This relationship is higher in the post-peak phase of growth. Conclusion: the Integration between facial structures and cranial base is significant. The Spatial orientation and shape of the facial structures are both influenced by cranial base. This is mainly due to the lateral portion of cranial base

Facial Asymmetry Detected with 3D Methods in Orthodontics: A Systematic Review

Background: Historically, the development of two-dimensional (2D) imaging techniques forerun that of three-dimensional (3D) ones. Some 2D methods are still considered valid and effective to diagnose facial asymmetry but 3D techniques may provide more precise and accurate measurements. Objective: The aim of this work is to analyze the accuracy and reliability of the imaging techniques available for the diagnosis of facial asymmetry in orthodontics and find the most reliable. Methods: A search strategy was implemented using PubMed (National Library of Medicine, NCBI). Results: A total of 3201 papers were identified in electronic searches. 90 articles, available in full text, were included in the qualitative synthesis consisting of 8 reviews on the diagnosis of facial asymmetry, 22 in vivo and in vitro studies on 2D methods and 60 in vivo and in vitro studies on 3D methods to quantify the asymmetry. Conclusion: 2D techniques include X-ray techniques such as posterior-anterior cephalogram, which still represents the first level exam in the diagnosis of facial asymmetry. 3D techniques represent the second level exam in the diagnosis of facial asymmetry. The most current used techniques are CBCT, stereophotogrammetry, laser scanning, 3D optical sensors and contact digitization. The comparison between bilateral parameters (linear distances, angles, areas, volumes and contours) and the calculation of an asymmetry index represent the best choices for clinicians who use CBCT. The creation of a color-coded distance map seems to represent the most accurate, reliable and validated methods for clinicians who use stereophotogrammetry, laser scanning and 3D optical sensors

Clinical Accuracy of Splintless Maxillary Positioning with Aid of CAD/CAM Fabricated Surgical Cutting Guides and Titanium Plates

New digital technologies are improving the accuracy of orthognathic surgery. One of the new approaches transfers the surgical plan into real surgery without using an occlusal splint. This pilot study aims to validate the splintless approach to orthognathic surgery on a series of cases. Five patients were enrolled. Surgeries were planned using a digital surgical simulation method thanks to three-dimensional images. The splintless surgical approach was planned for maxillary reposition. This consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates. These two were created using the computer-aided design and computer-aided manufacturing (CAD-CAM) technique and were used intraoperatively to guide the osteotomy and repositioning of the bony segments without the use of the surgical splint. The difference between the planned surgery and the real final position was analyzed thanks to superimposition techniques and landmark analysis. Statistical tests were performed to detect significant differences. No difference was found in any of the landmarks. Midline landmarks differed from the planned position by 0.34 mm. Higher variability was found in the posterior landmark. These findings suggest that a splintless approach is useful in transferring the surgical plan without using an occlusal splint

Impact of Periodontitis on Glycemic Control and Metabolic Status in Diabetes Patients: Current Knowledge on Early Disease Markers and Therapeutic Perspectives

Diabetes mellitus and periodontitis are two of the most common chronic diseases affecting the world's population, and they are intimately linked. For several years, in fact, it has been known that there is an interdependent relationship between the two diseases: Diabetes promotes the destruction of periodontal tissues, and periodontal disease negatively affects glycemic control. In relation to the control of dental plaque and oral dysbiosis responsible for periodontal disease, both nonsurgical and surgical therapy associated with proper home hygiene procedures have emerged as essential for good glycemic control. Moreover, several evidences suggest the essential role played by the control of periodontal disease in preventing the onset of the most common complications of diabetes: cardiovascular diseases, retinopathies, and other systemic diseases. The aim of this study is to update the current knowledge on the bi-univocal relationship between diabetes and periodontitis and the impact of therapy in the optimal management of these two disorders. From the information found in the literature, it has emerged that the correct treatment of periodontal disease in diabetic patients represents one of the main mechanisms and means currently established and valid to control periodontal disease and glucose metabolism and prevent the onset or development of diabetic complications

A Semi-Automatic Method on a Small Italian Sample for Estimating Sex Based on the Shape of the Crown of the Maxillary Posterior Teeth

Teeth are known to be reliable substrates for human identification and are endowed with significant sexual dimorphism not only in the size but also in the shape of the crowns. In the preliminary phase of our study (already published in 2021), a novel sex estimation method based on dental morphometric geometric (GMA) analysis combined with the artificial neural network (ANN) was developed and validated on a single dental element (first upper premolar) with an accuracy rate of 80%. This study aims to experiment and validate the combination of GMA-ANN on the upper first and second left premolars and the upper left first molar to obtain a reliable classification model based on the sexual dimorphic traits of multiple maxillary teeth of Caucasian Italian adults (115 males and 115 females). A general procrustes superimposition (GPS) and principal component analysis (PCA) were performed to study the shape variance between the sexes and to reduce the data variations. The "set-aside" approach was used to validate the accuracy of the proposed ANN. As the main findings, the proposed method correctly classified 94% of females and 68% of males from the test sample and the overall accuracy gained was 82%, higher than the odontometric methods that similarly consider multiple teeth. The shape variation between male and female premolars represents the best dimorphic feature compared with the first upper molar. Future research could overcome some limitations by considering a larger sample of subjects and experimenting with the use of computer vision for automatic landmark positioning and should verify the present evidence in samples with different ancestry