CBCT assessment of radicular volume loss after rapid maxillary expansion : a systematic review

The present systematic review analyzed the current literature to investigate whether rapid maxillary expansion (RME) causes radicular resorption, assessed by cone-beam computed tomography (CBCT). Eighteen electronic databases and reference lists of studies were searched up to November 2017. Grey literature was also screened. To be included, articles must be human studies on growing subjects with transversal maxillary deficiency treated with maxillary expansion protocol and with 3-D radiographic assessment of radicular volume by CBCT images. Two authors independently performed study selection, data extraction, and risk of bias assessment. Study characteristics (study design, sample size, age, sex, skeletal maturity, type of appliance, daily activation, teeth evaluated, CBCT settings), and study outcomes (radicular volume loss) were reported according to the PRISMA statement. Only 3 articles were considered eligible and an individual analysis of the selected articles was undertaken. The risk of bias assessment revealed low methodological quality for all the studies included. In all the considered studies, significant radicular volume loss was observed in posterior teeth, following RME. When reported in percentage, the radicular volumetric loss was similar between anchored (first molars and first premolars) and unanchored teeth (second premolars). A preliminary evaluation of the patient-related risk factors for RR is warmly advisable when administering RME

Erratum to "Ecotoxicological impact of pharmaceuticals found in treated wastewaters: study of carbamazepine, clofibric acid, and diclofenac": [Ecotoxicol. Environ. Saf. 55 (2003) 359–370]

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Class III Orthodontic Camouflage: Is the “Ideal” Treatment Always the Best Option? A Documented Case Report

Angle’s Class III is one of the most complex malocclusions to treat. In nongrowing skeletal class III malocclusions, the choice between orthognathic surgery and camouflage treatment remains a challenge to the orthodontist. In class III borderline cases, clinicians are called to find the best compromise between functional and aesthetics outcomes, with the latter which often turns in avoiding worsening of profile characteristics, which makes the treatment of these patients quite challenging. This case report describes a borderline nongrowing patient with skeletal class III malocclusion, upper incisor proclination and spacing, lower crowding, and arch width discrepancy, which has already undergone previous orthodontic treatment. The orthodontic treatment involved the mandibular first premolar extraction, resulting in class I canine relation with good overjet and overbite as well as good arch coordination. The orthodontic camouflage improved the dental relationship with normalization of upper incisor inclination without a relevant retroclination of lower incisors; the skeletal facial pattern of the patient experienced a slight improvement. The tendency to skeletal class III has remained nearly unaffected. Treatment outcomes were stable after 1-year posttreatment follow-up

Influence of Myeloperoxidase Levels on Periodontal Disease: An Applied Clinical Study

In this trial, we evaluated the influence on plasma and salivary myeloperoxidase (MPO) levels of periodontal health, coronary heart disease (CHD), periodontitis, or both periodontitis and CHD. Clinical and periodontal parameters were collected from periodontitis patients (n = 31), CHD patients (n = 31), patients with both periodontitis and CHD (n = 31), and from healthy patients (n = 31) together with saliva and plasma samples. The median concentrations of salivary and plasma MPO were statistically higher in the CHD patients [plasma: 26.2 (18.2–34.4) ng/mg; saliva 83.2 (77.4–101.5) ng/mL, p < 0.01] and in the periodontitis plus CHD patients [plasma: 27.8 (22.5–35.7) ng/mg; saliva 85.6 (76.5–106.7) ng/mL, p < 0.001] with respect to periodontitis and control patients. Through a univariate regression analysis, c-reactive protein (CRP) and CHD (both p < 0.001) and periodontitis (p = 0.024) were statistically correlated with MPO in plasma. The multivariate regression analysis demonstrated that only CRP was statistically the predictor of MPO in plasma (p < 0.001). The multivariate regression analysis in saliva demonstrated that, regarding MPO levels the only predictors were CRP (p < 0.001) and total cholesterol (p = 0.035). The present study evidenced that subjects with CHD and periodontitis plus CHD had higher plasma and salivary levels of MPO compared to subjects with periodontitis and healthy controls

Maxillary orthodontic expansion assisted by unilateral alveolar corticotomy and low-level laser therapy: a novel approach for correction of posterior unilateral cross-bite in adults

Introduction: The treatment of a true unilateral posterior crossbite often requires asymmetric maxillary expansion; however, this is challenging to achieve with conventional expansion methods because of several biomechanical limitations. In this paper, we introduce a new protocol for the treatment of a unilateral posterior crossbite in adults based on maxillary orthodontic expansion assisted by corticotomy and low-level laser therapy (LLLT) performed on the crossbite side. Methods: The study sample included 15 adults (8 females, 7 males) affected by a true unilateral posterior crossbite, with a mean age of 21.6 ± 3.1 years at the at the beginning of treatment. After the application of orthodontic appliances (palatal expander and self-ligating brackets), corticomy was performed at the buccal aspect of the crossbite side while LLLT was monthly administered up to the correction of the crossbite. The efficacy of the technique was evaluated through measurements performed on maxillary digital models. Results: All subjects reported successful correction of the posterior unilateral crossbite, and functional occlusion was achieved as well. The average expansion was greater at the crossbite side compared to the unaffected side and such difference was significant at the levels of first premolars (P &lt; 0.05), second premolars (P &lt; 0.05) and first molars (P &lt; 0.05). Conclusion: Orthodontic maxillary expansion assisted by unilateral corticotomy and LLLT was effective in the treatment of the true unilateral crossbite

A Full Computerized Workflow for Planning Surgically Assisted Rapid Palatal Expansion and Orthognathic Surgery in a Skeletal Class III Patient

: In the present case report, we present and discuss the digital workflow involved in the orthodontic/orthognathic combined treatment of a skeletal malocclusion correction in a 17-year-old male patient affected by a skeletal class III, facial asymmetry, sagittal and transversal deficiency of the medium third of the skull, dental crowding, and bilateral cross-bite. The first stage of the treatment involved surgically assisted rapid palatal expansion and occlusal decompensation, using fixed self-ligating appliance. An orthodontic software package (i.e., Dolphin 3D Surgery module) was used to perform virtual treatment objective evaluation by integrating data from cone beam computer tomography acquisition, intraoral scan, and extraoral photographs. The software allowed a comprehensive evaluation of skeletal, dento-alveolar, and soft-tissue disharmonies, qualitative and quantitative simulation of surgical procedure according to skeletal and aesthetic objectives, and, consequently, the treatment of the malocclusion. Using a specific function of the software, the surgical splint was designed according to the pre-programmed skeletal movements, and subsequently, the physical splint was generated with a three-dimensional (3D) printing technology. Once a proper occlusal decompensation was reached, a Le Fort I osteotomy of the maxilla and a bilateral sagittal surgical osteotomy of the mandible were executed to restore proper skeletal relations. The whole treatment time was 8 months. The orthodontic/orthognathic combined treatment allowed to correct the skeletal and the dental imbalance, as well as the improvement of facial aesthetics. Accordingly, the treatment objectives planned in the virtual environment were achieved. Virtual planning offers new possibilities for visualizing the relationship between dental arches and surrounding bone and soft structures in a single virtual 3D model, allowing the specialists to simulate different surgical and orthodontic procedures to achieve the best possible result for the patient and providing an accurate and predictable outcome in the treatment of challenging malocclusions

MMP-7 and MMP-9 Are Overexpressed in The Synovial Tissue from Severe Temporomandibular Joint Dysfunction

Matrix metalloproteinases (MMPs) are tissue-enzymes that play a key role during the remodeling process, such as in inflammatory diseases. MMP-7 and MMP-9 have been shown to be implicated in extracellular matrix homeostasis and in joint disc remodeling. The objective of this study was to determine the relation of MMP-7 and MMP-9 expression with severe temporomandibular joint dysfunction, in particular with anterior disk displacement without reduction (ADDwoR), using an immunohistochemical approach. Therefore, twenty human temporomandibular synovia in the test group and ten in the control group were collected. The results showed there was a statistically significant difference (P\u3c0.001) for morphometric and densitometric analysis of both detected MMPs in control and test groups. In conclusion, MMP-7 and MMP-9 were overexpressed in the synovial tissue of patients with ADDwoR

Evaluation of the changes of orbital cavity volume and shape after tooth-borne and bone-borne rapid maxillary expansion (RME)

Objective: To assess and compare volumetric and shape changes of the orbital cavity in patients treated with tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME). Study design: Forty adolescents with bilateral maxillary cross-bite received tooth-borne (TB group = 20; mean age 14.27 \ub1 1.36 years) or bone-borne (BB group = 20; mean age of 14.62 \ub1 1.45 years) maxillary expander. Cone-beam computed tomography (CBCT) were taken before treatment (T1) and 6-month after the expander activation (T2). Volumetric and shape changes of orbital cavities were detected by referring to a specific 3D digital technology involving deviation analysis of T1/T2 CBCT-derived models of pulp chamber. Student\u2019s t tests were used to 1) compare T1 and T2 volumes of orbital cavities in TB and BB groups, 2) compare volumetric changes and the percentage of matching of 3D orbital models (T1-T2) between the two groups. Results: Both TB and BB groups showed a slight increase of the orbital volume (0.64 cm3 and 0.77 cm3 ) (p &lt; 0.0001). This increment were significant between the two groups (p &lt; 0.05) while no differences were found in the percentage of matching of T1/T2 orbital 3D models (p &gt; 0.05). The areas of greater changes were detected in the proximity of the frontozygomatic and frontomaxillary sutures. Conclusion: TB-RME and BB-RME would not seem to considerably affect the anatomy or the volume of the orbital cavity in adolescents

A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion

Introduction: Miniscrew-assisted rapid palatal expansion (MARPE) appliances utilize the skeletal anchorage to expand the maxilla. One type of MARPE device is the Maxillary Skeletal Expander (MSE), which presents four micro-implants with bicortical engagement of the palatal vault and nasal floor. MSE positioning is traditionally planned using dental stone models and 2D headfilms. This approach presents some critical issues, such as the inability to identify the MSE position relative to skeletal structures, and the potential risk of damaging anatomical structures. Methods: A novel methodology has been developed to plan MSE position using the digital model of dental arches and cone-beam computed tomography (CBCT). A virtual model of MSE appliance with the four micro-implants was created. After virtual planning, a positioning guide is virtually designed, 3D printed, and utilized to model and weld the MSE supporting arms to the molar bands. The expansion device is then cemented in the patient oral cavity and micro-implants inserted. A clinical case of a 12.9-year-old female patient presenting a Class III malocclusion with transverse and sagittal maxillary deficiency is reported. Results: The midpalatal suture was opened with a split of 3.06 mm and 2.8 mm at the anterior and posterior nasal spine, respectively. After facemask therapy, the sagittal skeletal relationship was improved, as shown by the increase in ANB, A-Na perpendicular and Wits cephalometric parameters, and the mandibular plane rotated 1.6\ub0 clockwise. Conclusion: The proposed digital methodology represents an advancement in the planning of MSE positioning, compared to the traditional approach. By evaluating the bone morphol-ogy of the palate and midface on patient CBCT, the placement of MSE is improved regarding the biomechanics of maxillary expansion and the bone thickness at micro-implants insertion sites. In the present case report, the digital planning was associated with a positive outcome of maxillary expansion and protraction in safety conditions

One Step before 3D Printing\u2014Evaluation of Imaging Software Accuracy for 3-Dimensional Analysis of the Mandible: A Comparative Study Using a Surface-to-Surface Matching Technique

Abstract: The accuracy of 3D reconstructions of the craniomaxillofacial region using cone beam computed tomography (CBCT) is important for the morphological evaluation of specific anatomical structures. Moreover, an accurate segmentation process is fundamental for the physical reconstruction of the anatomy (3D printing) when a preliminary simulation of the therapy is required. In this regard, the objective of this study is to evaluate the accuracy of four dierent types of software for the semiautomatic segmentation of the mandibular jaw compared to manual segmentation, used as a gold standard. Twenty cone beam computed tomography (CBCT) with a manual approach (Mimics) and a semi-automatic approach (Invesalius, ITK-Snap, Dolphin 3D, Slicer 3D) were selected for the segmentation of the mandible in the present study. The accuracy of semi-automatic segmentation was evaluated: (1) by comparing the mandibular volumes obtained with semi-automatic 3D rendering and manual segmentation and (2) by deviation analysis between the two mandibular models. An analysis of variance (ANOVA) was used to evaluate dierences in mandibular volumetric recordings and for a deviation analysis among the dierent software types used. Linear regression was also performed between manual and semi-automatic methods. No significant dierences were found in the total volumes among the obtained 3D mandibular models (Mimics = 40.85 cm3, ITK-Snap = 40.81 cm3, Invesalius = 40.04 cm3, Dolphin 3D = 42.03 cm3, Slicer 3D = 40.58 cm3). High correlations were found between the semi-automatic segmentation and manual segmentation approach, with R coecients ranging from 0,960 to 0,992. According to the deviation analysis, the mandibular models obtained with ITK-Snap showed the highest matching percentage (Tolerance A = 88.44%, Tolerance B = 97.30%), while those obtained with Dolphin 3D showed the lowest matching percentage (Tolerance A = 60.01%, Tolerance B = 87.76%) (p &lt; 0.05). Colour-coded maps showed that the area of greatest mismatch between semi-automatic and manual segmentation was the condylar region and the region proximate to the dental roots. Despite the fact that the semi-automatic segmentation of the mandible showed, in general, high reliability and high correlation with the manual segmentation, caution should be taken when evaluating the morphological and dimensional characteristics of the condyles either on CBCT-derived digital models or physical models (3D printing)