Bullying and malocclusion in adolescence: a case report

ABSTRACT Introduction: Adolescents with bad malocclusion can more often be victims of bullying and the improvement of their facial appearance through oral rehabilitation is nowadays an important issue. The aim of this case report was to describe the orthodontic treatment in a teenager with a dentoskeletal malocclusion exposed to bullying to correct his occlusal problems and improve facial esthetics and quality of life. Case presentation: The patient, a boy aged 13.5 years, had a class II, division 1, malocclusion with hyperdivergent pattern, mandibular asymmetry, constricted maxillary arch and molar crossbite, increased overjet, lower mild crowding and lip sucking. A two-phase approach was necessary to achieve proper occlusion, better esthetics and promote the patient\u27s self-esteem with consequent greater serenity of his family. Conclusion: Treatment of adolescent patients with severe dento-skeletal malocclusions is among the most difficult challenges for orthodontists. Orthodontic therapy cannot simply aim a simple occlusal correction but also have to establish a valid methodology to remove the "cause" of bullying and to treat the patient, together with appropriate psychological support

Comparison between rapid and mixed maxillary expansion through an assessment of arch changes on dental casts

Background: Aim of this retrospective observational study was to compare upper and lower dental changes in patients treated with Rapid Maxillary Expansion (RME) and Mixed Maxillary Expansion (MME), assessed by dental cast analysis. Methods: Treatment groups consisted of 42 patients: the RME group (n = 21) consisted of 13 female and 8 male subjects with the mean age of 8.8 years ± 1.37 at T0 and 9.6 years ± 1.45 at T1; the MME group (n = 21) consisted of 12 female and 9 male patients with a mean age of 8.9 years ± 2.34 at T0 and 10.5 years ± 2.08 at T1. The upper and lower arch analysis was performed on four dental bilateral landmarks, on upper and lower casts; also upper and lower arch depths were measured. The groups were compared using independent sample t-test to estimate dental changes in upper and lower arches. Results: Before expansion treatment (T0), the groups were similar for all examined variables (p>0.05). In both RME and MME group, significant increments in all the variables for maxillary and mandibular arch widths were observed after treatment. No significant differences in maxillary and mandibular arch depths were observed at the end of treatment in both groups. An evaluation of the changes after RME and MME (T1) showed statistically significant differences in mandibular arch depth (p<0.001) and maxillary intercanine widths (p<0.05). Differences in maxillary arch depth and arch width measurements were not significant. Conclusions: RME and MME can be considered two effective treatment options to improve transverse arch dimensions and gain space in the dental arches. A greater lower arch expansion was observed in the MME group, which might be attributed to the “lip bumper effects” observed in the MME protocol

Clinical Behavior of the Gingival Margin following Conservative "Coronally Dynamic" Restorations in the Presence of Non-Carious Cervical Lesions Associated with Gingival Recession: A Pilot Study

Gingival recessions (GR) are often associated with the presence of non-carious cervical lesions (NCCL). The latter result in the disappearance of the cement-enamel junction (CEJ), with consequent difficulties both in measuring the recession itself and in performing root coverage techniques. The restoration of cervical lesions is consequently an important aspect in the treatment of GR, with the re-establishment of a "new" CEJ. This pilot study aimed to verify whether restorative therapy alone, with the execution of a restoration that mimics the convexity of the natural CEJ and thanks to a slight horizontal over-contour, can stabilize a clot in the intrasulcular site and consequently is able to change the position of the gingival margin in a coronal direction. In periodontally healthy patients, with a non-thin gingival phenotype, 10 GR-associated NCCL restorations were performed using a protocol inspired by concepts of prosthetic conditioning, with a progressively reduced convexity ("coronally dynamic restoration") and de-epithelialization of the gingival sulcus. We observed that 70% of the treated teeth showed a reduction in crown length after 15 days (-0.267 mm), without an increase in probing depth. While considering the limitations of the sample and the need to evaluate the different parameters that can affect the result, the coronally dynamic restoration of NCCL with GR was able to influence the position of the gingival margin in a coronal direction

Feasibility and Accuracy of Transduodenal Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Solid Lesions Using a 19-Gauge Flexible Needle: A Multicenter Study

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Factors Affecting Patient Compliance during Orthodontic Treatment with Aligners: Motivational Protocol and Psychological Well-Being

Objective:Compliance is critical for successful outcomes in orthodontics, and personality traits may play a role in determining patient adherence. This study aimed to monitor compliance during treatment with removable clear aligners (CA) [Align Technology Inc, San José, Calif ], and evaluate the influence of motivational techniques and the patient’s profiles assessed through the psychological wellbeing (PWB) questionnaire on clinical outcomes.Methods:Thirty-nine consecutive patients in permanent dentition seeking treatment with CA were recruited from two universities. Casts were obtained before treatment and after 3, 6, and 12 months and the corresponding digital Clincheck©.STL files were used to calculate the discrepancy index to check for differences between virtual and real treatment stages. Patients were divided into two groups: the Case group, which received motivational techniques at each appointment, and the control group which received instructions only at the beginning. Psychological profiles were evaluated before treatment (T0) and after 3 (T1), 6 (T2), and 12 (T3) months.Results:There were no differences between the Case and Control groups regarding the use of motivational reminders. The analysis of the PWB showed that almost all values increased, and there was a strong correlation between dental casts and correspondent. STL files at every time point. The PWB showed increased values from T0 to T3 in the sample.Conclusion:Motivational techniques did not affect patient compliance, and treatment outcomes were achieved as planned. The PWB of all patients improved throughout the treatment with CA

L’organismo indipendente di valutazione in sanità. Riflessioni sull’implementazione e l’efficienza organizzativa quale strumento di prevenzione della corruzione

Per superare la complessità di approfondimento delle più recenti innovazioni in tema di “prevenzione della corruzione, pubblicità e trasparenza”, recte D. Lgs 97/2016, nonché del D. Lgs n. 74/2017 in materia di “ottimizzazione della produttività del lavoro pubblico e di efficienza e trasparenza delle pubbliche amministrazioni”, a seguito di una analisi sistematica della disciplina attualmente in vigore della norma fondamentale, recte D. Lgs. 150/2009, si giunge alla voluta connessione legislativa con le norme dettate in materia di trasparenza ed anticorruzione, allorquando si analizza la normazione degli Organismi indipendenti di valutazione agli articoli 12 e successivi. All’esito del lavoro di analisi e correlazione del corpus normativo che regola la materia, si individuano alcune criticità, fornendo spunti di riflessione per l’eventuale superamento delle stesse

La valutazione in sanità: riflessioni ed esempi di progettazione

La valutazione della performance è di particolare importanza per le aziende sanitarie. Dopo un’attenta analisi normativa alla base della valu-tazione (D.Lgs n. 150/ 200, D.Lgs n. 74/2017, D.Lgs 97/2016) si analizza come il Sistema di valutazione dovrebbe essere implementato, ma soprat-tutto interpretato al fine di rendere lo stesso effettivamente fruibile e uti-lizzato come strumento manageriale in grado di orientare le strutture e il personale nella direzione delle priorità strategiche definite dall'Ammini-strazione. Le fasi di selezionare delle informazioni rilevanti, individuazio-ne degli indicatori, definizione della loro misurazione e utilizzo dei risul-tati ottenuti, sono analizzate in dettaglio. Viene, inoltre, riportato un caso reale di progettazione del Sistema di valutazione, dell’UOC Day Surgery dell'azienda ospedaliera Sant'Anna e San Sebastiano di Caserta, commen-tando in dettaglio i risultati dell’indagine di Patient Satisfacion realizzata al suo interno