Multiple dental inclusion in monozygotic twins with congenital visual impairment

The study presents two monozygotic twins (MZ) with multiple impacted teeth, affecting the upper canines and lower second molars, as well as congenital aniridia. The clinical aspect of the upper canines is peculiar because of the different positions - palatal in one and buccal in the other twin. Studies reporting different scenarios of impaction in monozygotic twins can contribute more data to the debate on tooth eruption aetiology and more so in this case because of the association with a genetic panocular disease. Patients' Concerns. The patients were referred by a general dentist, who diagnosed the presence of multiple inclusions. Diagnostic Study. Both patients showed severe malocclusion, classified as grade 5 of the Index of Orthodontic Treatment Need (IOTN). The MZ showed class I malocclusion, upper and lower crowding, and impacted lower right and left second molars. A Dentascan was prescribed for the canine impaction. The impaction of the upper canine was palatal of 2.3 in one of the MZ and buccal of 1.3 in the other one. The same altered pattern of eruption of the lower second molars was identified in both twins. The proposed treatment plan contemplated orthodontic surgical recovery of the impacted elements, followed by orthodontic treatment with multibracket appliance after the extraction of the first four premolars, given the crowding entity. The use of a retraction spring action was chosen for the recovery of the lower second molars. Many aspects of the possible genetic aetiology of tooth impaction are still under discussion. The study of diseases in twins offers decisive information. Finally, the possibility that alterations in the eruptive pattern of the dental elements may be associated with other congenital problems broadens the range of investigations related to the possible aetiological causes of the inclusions in humans

Unilateral condylar hyperplasia: a thee-dimensional CBCT morphometric and volumetric evaluation of mandibular condyle by open-source softwares : Hiperplasia condilar unilateral: Evaluación morfométrica y volumétrica en TCHC tridimensional del cóndilo mandibular mediante softwares de código abierto

SUMMARY: Unilateral condylar hyperplasia (UCH) is an alteration of the mandibular condyle growth. The aim of this study was to evaluate condyle volume, surface area, and Morphological Index (MI) differences between the affected condyle and an unaffected one in patients with UCH, evaluated through 3D reconstructions cone beam computed tomography (CBCT) images by two open-source softwares. A retrospective cross-sectional study of 16 patients with a certain UCH, 9 females and 7 males with mean age 25.13 ± 6.8 years was made. The image obtained from the CBCT of each condyle were reconstructed using the open-source software 3D SLICER 4.6 ®. The volumetric and area measurements of the 3D reconstruction of the mandibular condyle were made using the open-source software NETFABB basic 5.0 ®. The mean condylar volume of the hyperplastic condyles was 2.07 ± 1.51 cm3 and the non-hyperplastic condyles was 1.16 ± 0.82 cm3 (p<0.05). The mean area surface of the hyperplastic condyle was 11.77 ± 3.71 cm2 and the non-hyperplasic condyle mean was 8.05 ± 2.17 cm2 (p < 0.05). The mean area surface difference was 3.72 ± 3.57 cm2 (28.0 %). The MI of the hyperplastic condyle was 1.8 ± 0.3 mm and the non-affected condyle was 1.3 ± 0.6 mm (p < 0.05). The use of open-source software for 3D reconstruction with manual segmentation for evaluation of the volume and the condylar surface is a valid tool available to the clinic in the diagnosis and monitoring of patients with condylar hyperplasia. © 2021, Universidad de la Frontera. All rights reserved

CBCT and intra-oral scanner: the advantages of 3D technologies in orthodontic treatment

Background: The aim is to demonstrate the validity of the monitoring through intraoral scanner of the dental movements and the real impact, advantages, and convenience, in terms of treatment time and efficiency gain, to frequently monitor a patient with the scanner application. Methods: A movement control of palatally impacted canines was performed, surgically treated with laser opercolectomy. Three-dimensional models of the patient’s dental arch were obtained with intraoral scanner during a monitoring time of 4 months. The STL (Standard Triangle Language) files were superimposed with the 3D models extrapolated from the pre-operative CT (Computerized Tomography). The measurements of eruption, exposed palatal and vestibular areas, and distances between the canines and the incisors were performed, using digital technologies and with a digital caliber. Results: Descriptive and inferential statistical analysis of the data obtained from both conventional and digital monitoring has been realized and performing the T Student Test for paired data. Conclusion: The advantages of digital monitoring are numerous, like the possibility to reduce the error of method caused by manual measurement on plaster casts and the possibility to compare the pattern and amount of eruption of the canine in the same patient overtime

Association between the temporomandibular joint disc position on magnetic resonance imaging and the mandibular deviation on posteroanterior cephalogram: a cross-sectional study in adolescents

Objective. The aim of this cross-sectional research was to analyze the association between the disc position of the temporomandibular joint (TMJ) evaluated by magnetic resonance imaging (MRI) and the mandibular deviation evaluated by posteroanterior cephalometric (PA) in adolescents. Materials and Methods. The sample was 53 adolescents aged 11-18 years. This cross-sectional study was based on the analysis of PA and bilateral TMJ MRI images retrospectively selected. The mandibular deviation was evaluated by PA and defined by the amount of menton (Me) deviation from the midsagittal reference line. The temporomandibular disc position was evaluated by MRI: normal (N), disc displacement with reduction (DDR) and disc displacement without reduction (DDNR). The DDNR was considered more severe than the DDR. The patients were classified into three groups based on the bilateral disc position: group I, the same bilateral disc position; group II, disc displacement more severe on the ipsilateral side of the menton deviation; group III, disc displacement more severe on the contralateral side of the menton deviation. ANOVA followed by post hoc Tukey’s test was used to evaluate the interaction between the menton deviation and the bilateral disc position. Results. There was an association statistically significant between the bilateral disc position and the Me deviation (p<0.05). There were significant differences in the mean of the menton deviation between group II (4,40 ±2,26), and group I (2,17±1,93) and III (2,10±1,70). Conclusions. the menton deviation was significantly correlated with the disc position in the TMJ exhibit more deflection to the side more affected

Asimetría Mandibular asociada a cóndilo bífido e hipoplasia condilar: reporte de un caso clínico.

Introducción: La asimetría mandibular (AM) se define como el desequilibrio en forma, tamaño o posición de un lado de la mandíbula con respecto al contralateral. Durante el desarrollo de este tipo de displasia, las estructuras de la Articulación Temporomandibular (ATM) juegan un papel etiológico preponderante. Entre las alteraciones del crecimiento condilar que favorecen el desarrollo de una AM se encuentra el cóndilo bífido, anomalía poco común de la cabeza mandibular, de etiología y patogénesis desconocida. Así mismo, la hipoplasia condilar, caracterizada por crecimiento deficiente de la cabeza condilar también puede ser considerada un factor etiológico o predisponente de AM. El objetivo de este reporte de caso es describir a un paciente con AM asociada a cóndilo bífido e hipoplasia condilar, quien acudió al Postgrado de Ortodoncia de la Facultad de Odontología de la UCV. Reporte del caso: Paciente femenina, asintomática, de 21 años de edad que presentaba severa AM hacia el lado derecho de su cara así como un plano oclusal superior canteado. Paciente clase III esquelética y a nivel dentario clase I derecha y clase III izquierda. A la evaluación de sus ATMs, presentó ruidos articulares. En TC se evidenció un cóndilo bífido del lado izquierdo e hipoplasia condilar del lado derecho. En RM se observó desplazamiento discal bilateral. El plan de tratamiento programado fue ortodóncico-quirúrgico. Conclusión: La comprensión de los factores morfológicos de la ATM asociados con la etiopatogenia de la asimetría mandibular, permitirá establecer un adecuado diagnóstico que conlleve a un correcto plan de tratamiento

Premio Miglior poster per la tematica: "Orthodontics and TMD: evidence and challenge". 50th SIDO International Congress. Roma, 2019

OBIETTIVO: valutare la relazione tra il dislocamento discale dell’Articolazione Temporomandibolare (ATM) e la Classe Scheletrica in pazienti adolescenti con disordini temporomandibolari (DTM). MATERIALI E METODI: Studio retrospettivo di un campione di pazienti adolescenti afferenti alla UOC di Ortognatodonzia del Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali dell’Università degli Studi di Roma La Sapienza, con diagnosi di disordini temporomandibolari all’esame obbiettivo. Sono state valutate la radiografia cefalica laterale e la risonanza magnetica (RM) di ATM previo l’inizio del trattamento ortodontico. I pazienti furono divisi secondo la malocclusione scheletrica sagittale in: Classe I e Classe II, basato nell’angolo ANB misurato sulla radiografia cefalica laterale. Mediante la RM dell’ATM è stata valutata la posizione del disco a bocca aperta e bocca chiusa in ogni articolazione, destra e sinistra, classificando il dislocamento discale in: Normale (N) se la posizione era fisiologica in entrambi le ATM, Dislocamento Discale con Riduzione (DDwR) se almeno una delle articolazioni presentò un dislocamento riducibile e la contro laterale era uguale o normale, e Dislocamento Discale senza Riduzione (DDwoR) se almeno una delle due articolazioni presentò un dislocamento non riducibile. È stato eseguito il test statistico Chi2 per la valutazione della relazione tra il dislocamento discale e la Classe Scheletrica. RISULTATI: sono stati valutati 49 pazienti di età compressa tra 11 e 18 anni (media 13.45±2.42) di entrambi i sessi (33 femmine e 16 maschi). Secondo la Classe scheletrica 22 pazienti furono Classe I e 27 pazienti Classe II. Il DDwR si presentò in 12 pazienti Classe I (66,7%) e in 6 pazienti Classe II (33.3%). In comparazione il DDwoR si è presentato in 2 pazienti Classe I (12.5%) e in 14 pazienti Classe II (87.5%) (P 0.005). CONCLUSIONI: questo studio suggerisce che i pazienti Classe II scheletrica hanno un maggiore rischio di avere un DDwoR, per questo una valutazione della condizione dell’ATM è necessaria durante la diagnosi e la pianificazione del trattamento ortodontico nei pazienti in crescita

Poster: Importancia de la Resonancia Magnetica en la evaluacion de los trastornos temporomandibulares en los pacientes adolescentes. Premio al miglior poster di ricerca bibliografica. Congresso di Radiologia della Società di Radiologia del Venezuela. Novembre 2019

Presentazione del Poster

Relationship between temporomandibular disc displacement and skeletal class in adolescent patients: A retrospective study

OBIETTIVO: valutare la relazione tra il dislocamento discale dell’Articolazione Temporomandibolare (ATM) e la Classe Scheletrica in pazienti adolescenti con disordini temporomandibolari (DTM). MATERIALI E METODI: Studio retrospettivo di un campione di pazienti adolescenti afferenti alla UOC di Ortognatodonzia del Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali dell’Università degli Studi di Roma La Sapienza, con diagnosi di disordini temporomandibolari all’esame obbiettivo. Sono state valutate la radiografia cefalica laterale e la risonanza magnetica (RM) di ATM previo l’inizio del trattamento ortodontico. I pazienti furono divisi secondo la malocclusione scheletrica sagittale in: Classe I e Classe II, basato nell’angolo ANB misurato sulla radiografia cefalica laterale. Mediante la RM dell’ATM è stata valutata la posizione del disco a bocca aperta e bocca chiusa in ogni articolazione, destra e sinistra, classificando il dislocamento discale in: Normale (N) se la posizione era fisiologica in entrambi le ATM, Dislocamento Discale con Riduzione (DDwR) se almeno una delle articolazioni presentò un dislocamento riducibile e la contro laterale era uguale o normale, e Dislocamento Discale senza Riduzione (DDwoR) se almeno una delle due articolazioni presentò un dislocamento non riducibile. È stato eseguito il test statistico Chi2 per la valutazione della relazione tra il dislocamento discale e la Classe Scheletrica. RISULTATI: sono stati valutati 49 pazienti di età compressa tra 11 e 18 anni (media 13.45±2.42) di entrambi i sessi (33 femmine e 16 maschi). Secondo la Classe scheletrica 22 pazienti furono Classe I e 27 pazienti Classe II. Il DDwR si presentò in 12 pazienti Classe I (66,7%) e in 6 pazienti Classe II (33.3%). In comparazione il DDwoR si è presentato in 2 pazienti Classe I (12.5%) e in 14 pazienti Classe II (87.5%) (P 0.005). CONCLUSIONI: questo studio suggerisce che i pazienti Classe II scheletrica hanno un maggiore rischio di avere un DDwoR, per questo una valutazione della condizione dell’ATM è necessaria durante la diagnosi e la pianificazione del trattamento ortodontico nei pazienti in crescita.AIM: to evaluate the relationship between the temporomandibular disc displacement and the skeletal Class in adolescent patients with temporomandibular disorders (DTM). MATERIALS AND METHODS: A retrospective study of a sample of adolescent patients from the UOC of Orthodontics of the Department of Odontostomatological and Maxillofacial Sciences of the University of Rome La Sapienza, with a diagnosis of temporomandibular disorders on objective examination. Lateral cephalogram and magnetic resonance (MRI) of temporomandibular joint (TMJ) were recorded before orthodontic treatment. Patients were divided according to the sagittal skeletal malocclusion in: Class I and Class II, based on the ANB angle measured on lateral cephalogram. The position of the disk with open mouth and closed mouth in each joint, right and left, was evaluated by MRI of the TMJs, classifying the disc displacement in: Normal (N) if the position was physiological in both TMJs, Disc Displacement with reduction (DDwR) if at least one of the joints presented a reducible displacement and the contralateral was equal or normal and Disc Displacement without Reduction (DDwoR) if at least one of the two joints presented a non-reducible displacement. The Chi2 statistical test was performed for the evaluation of the relationship between the disc displacement and the skeletal class. RESULTS: 49 patients of age compressed between 11 and 18 years (mean 13.45 ± 2.42) of both genders (33 females and 16 males) were evaluated. According to the skeletal class, 22 patients were Class I and 27 Class II patients. DDwR occurred in 12 Class I patients (66.7%) and in 6 Class II patients (33.3%). In comparison, DDwoR occurred in 2 Class I patients (12.5%) and in 14 Class II patients (87.5%) (P 0.005). CONCLUSIONS: this study suggests that patients with skeletal Class II have a greater risk of having a DDwoR, so an assessment of the condition of the TMJ is necessary during the diagnosis and planning of orthodontic treatment in growing patients

Correlation between menton deviation and mandibular asymmetry

Obiettivo: lo scopo del presente studio consiste in analizzare la relazione tra la deviazione del mento e l'asimmetria scheletrica mandibolare. Metodo: le immagini CT di 85 soggetti sono state analizzate retrospettivamente. Gli individui sono stati divisi in due gruppi, simmetrico (N = 30) e asimmetrico (N = 55). Sono stati calcolati gli indici di asimmetria tramite misurazioni di linee bilaterali; la classificazione dell'asimmetria è stata determinata sulla base della valutazione regionale della mandibola e sono stati divisi in quattro gruppi: I, senza asimmetria, II asimmetria esclusivamente nel corpo mandibolare, III asimmetria esclusivamente nel ramo mandibolare e IV asimmetria nel corpo e ramo mandibolare. Il grado di deviazione del mento dalla linea anatomica di riferimento verticale è stato valutato e correlato con i diversi gruppi di asimmetria. Risultati: l'età media dei soggetti e di 20,3 anni (74% femmine, 26% maschi). Si evidenza associazione statisticamente significative tra la deviazione del mento e l'asimmetria mandibolare (p <0,001). L'asimmetria del corpo mandibolare ha mostrato deviazione del mento verso il lato omolaterale, mentra che l'asimmetria del ramo mandibolare ha mostrato la massima deviazione del mento verso il lato controlaterale. La deviazione del mento potrebbe essere più grave nel gruppo III e IV. Conclusione: la deviazione del mento è stata osservata nei diversi gruppi di asimmetria, ma il lato e il grado di questa deviazione varia in ciascun gruppo. L'asimmetria del ramo mandibolare sembra contribuire maggiormente alla deviazione del mentoObjective: The aim of this study was to analyze the relationship between the deviation of the menton and the mandibular skeletal asymmetry. Methods: The CT images of 85 subjects were retrospectively analyzed. The individuals were divided into the symmetry group (N=30) and the asymmetry group (N=55). The asymmetry indices of the bilateral lines were calculated and the classification of asymmetry was determined based on the regional assessment and they were divided into four groups: I, without asymmetry, II asymmetry solely in the mandibular body, III asymmetry solely in the mandibular ramus and IV asymmetry in the mandibular body and ramus. The degree of menton deviation from the vertical reference line was evaluated and correlated with the different groups of asymmetry. Results: The mean age of the subjects was 20.3 years (74% females, 26% males). There were statistically significant associations between the menton deviation and the mandibular asymmetry (p<0.001). The asymmetry of mandibular body showed the highest menton deviation to the homolateral side, and the asymmetry of mandibular ramus showed the highest menton deviation to the contralateral side. The menton deviation might be more severe in group III and IV. Conclusion: the deviation of menton was observed into the different group of asymmetry, but the side and degree of this deviation variated in each group. The mandibular ramus asymmetry appeared to contribute more in the menton deviation

Multiple Dental Inclusion in Monozygotic Twins with Congenital Visual Impairment

The study presents two monozygotic twins (MZ) with multiple impacted teeth, affecting the upper canines and lower second molars, as well as congenital aniridia. The clinical aspect of the upper canines is peculiar because of the different positions—palatal in one and buccal in the other twin. Studies reporting different scenarios of impaction in monozygotic twins can contribute more data to the debate on tooth eruption aetiology and more so in this case because of the association with a genetic panocular disease. Patients’ Concerns. The patients were referred by a general dentist, who diagnosed the presence of multiple inclusions. Diagnostic Study. Both patients showed severe malocclusion, classified as grade 5 of the Index of Orthodontic Treatment Need (IOTN). The MZ showed class I malocclusion, upper and lower crowding, and impacted lower right and left second molars. A Dentascan was prescribed for the canine impaction. The impaction of the upper canine was palatal of 2.3 in one of the MZ and buccal of 1.3 in the other one. The same altered pattern of eruption of the lower second molars was identified in both twins. The proposed treatment plan contemplated orthodontic surgical recovery of the impacted elements, followed by orthodontic treatment with multibracket appliance after the extraction of the first four premolars, given the crowding entity. The use of a retraction spring action was chosen for the recovery of the lower second molars. Many aspects of the possible genetic aetiology of tooth impaction are still under discussion. The study of diseases in twins offers decisive information. Finally, the possibility that alterations in the eruptive pattern of the dental elements may be associated with other congenital problems broadens the range of investigations related to the possible aetiological causes of the inclusions in humans