Biomarkers of Periodontal Tissue Remodeling during Orthodontic Tooth Movement in Mice and Men: Overview and Clinical Relevance

Tooth movement by orthodontic force application is dependent on remodeling in periodontal ligament and alveolar bone, involving the activation of complex cellular and molecular mechanisms correlated with several macro- and microscopic biological changes. The orthodontic process involves the activation of many complex cellular and molecular mechanisms mediated by the release of chemical substance cascades by many cells of the periodontium. Mainly during the early stage of application of orthodontic forces, an inflammatory process can occur in the periodontium as a physiological response to the tissue stress. Several potential biomarkers of the biological alterations after an orthodontic force application expressing bone resorption and formation, periodontal ligament changes, and vascular and neural responses, may be detected. The appropriate choice of the mechanical force to achieve the highest rate of tooth movement in the shortest time of treatment avoiding adverse consequences is a primary objective of a specialist. Thus, an insight into the biological phenomena occurring during the orthodontic therapies by evaluating these biomarkers may be quite relevant for the clinicians. In this chapter, two models of study, i.e., mice and men, were used to describe the clinical usefulness of some biomarkers in orthodontics

Treatment Considerations for Missing Teeth

Specific terms are used to describe the nature of tooth agenesis. Hypodontia is most frequently used when describing the phenomenon of congenitally missing teeth. Many other terms to describe a reduction in the number of teeth appear in the literature: oligodontia, anodontia, aplasia of teeth, congenitally missing teeth, absence of teeth, agenesis of teeth and lack of teeth. The term hypodontia is used when one to six teeth, excluding third molars, are missing, and oligodontia when more than six teeth are absent (excluding the third molars). The long‐term management of hypodontia in the aesthetic zone is a particularly challenging situation. Although there are essentially two distinct approaches to manage this problem, that is space closure or opening for prosthetic replacements, implant or autotransplantation. These patients often manifest with many underlying skeletal and dental problems and a multidisciplinary approach for management of this condition is recommended. Two treatment approaches including space closure and space reopening are described in details in this chapter

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

Orthodontic Management of a Mandibular Double-tooth Incisor: A Case Report

The presence of a double-tooth requires specific complex management due to the need for differential diagnosis and following treatment choices. The aim of this report was to present a rare case of a geminated mandibular lateral incisor, treated with an orthodontic approach. A Caucasian 10.9-year-old girl presented a lower right double-tooth incisor, with a class 1 molar and a class 2 cuspid tendency on both sides. The upper arch was constricted as shown by bilaterally tendencies to cross-bite, a slightly lower midline deviation was reported and a lack of space for all four permanent cuspids was confirmed also by the panoramic X-ray. In the lower arch, there was a severe crowding of about 14 mm and a buccally ectopic left canine. Overbite was normal and Overjet minimally increased. The double-tooth was identified like a geminated tooth, for the presence of one root and one pulp canal of increased size, as shown by the radiographic examinations. The anomalous tooth was managed with an orthodontic approach associated with a progressive stripping to reshape the crown. A two-phase treatment plan was performed, based on first maxillary expansion and lip bumper and then fixed appliances, in order to achieve a proper occlusion and a better aesthetic

Condylar Asymmetry in Children with Unilateral Posterior Crossbite Malocclusion: A Comparative Cross-Sectional Study

Unilateral posterior crossbite (UXB) is a common, severely asymmetric malocclusion, characterized by maxillary hypoplasia and masticatory dysfunction. The aim of this research is to evaluate the asymmetry of mandibular condyles and rami in children with UXB. This comparative cross-sectional study included 33 children with UXB (girls = 15, boys = 18; mean age ± SD = 8.0 ± 1.3 years.months]) and 33 age- and gender-matched controls (girls = 15, boys = 18; mean age ± SD = 8.4 ± 1.3 years.months]). Pre-treatment OPGs were analyzed by comparing the height of condyles and rami between the sides using the method by Habets et al. (1988); the result was considered significant if the degree of asymmetry was >6%. Children with UXB showed a significantly increased asymmetry of mandibular condyles (mean ± SD = 10.7% ± 9, p < 0.001), but not of rami (mean ± SD = 1.9% ± 2.3), compared to controls. The rami did not show significant asymmetry in either group. The presence of an increased condylar asymmetry index in a developing patient with unilateral posterior crossbite is a sign of altered skeletal growth and should be considered in the diagnostic process and treatment plan

Effect of Orthophosphoric Acid and Er:YAG Laser Etching on Micro-shear Bond Strength to Enamel: An In Vitro Pilot Study

Background: Dental conditioning is one of the most important phases during enamel bonding procedures to obtain clean surfaces, smear layer removal with collagen active sites and hydroxyapatite exposure. Objective: The aim of this study was to compare the micro-shear bond strength (μSBS) of different adhesive systems after two different etching techniques: 37% orthophosphoric acid (H3PO4) and Er:YAG laser. Methods: Ninety permanent extracted molars were embedded into epoxy resin blocks and sectioned longitudinally. Specimens were randomly assigned to one of the following groups (n=30), depending on the etching protocol: 37% H3PO4 for 30 s (Group 1), Er:YAG laser 100mJ-10Hz (Group 2), and Er:YAG laser 100mJ-10Hz followed by 37% H3PO4 for 30 s (Group 3). Each group was further divided into two subgroups depending on the bonding agent used on enamel (n=15): A) EE-Bond (Tokuyama) and B) Peak universal (Ultradent). A two-way analysis of variance (two-way ANOVA) was conducted and the level of significance was set to p=0.05. Results: The etching procedure was a significant factor influencing the results (p=0.006), while no differences were observed for the two adhesive systems tested (p&gt;0.05). Group 3 recorded the highest bond strength values, according to the following sequel: Group 3 &lt; Group 2 &lt; Group 1 &lt; 0.05. Conclusion: The combination of phosphoric acid etching with Er:YAG laser provided the most favourable bond strength to enamel. Further morphological studies are currently ongoing

Application of Vibrational Spectroscopies in the Qualitative Analysis of Gingival Crevicular Fluid and Periodontal Ligament during Orthodontic Tooth Movement

Optical vibrational techniques show a high potentiality in many biomedical fields for their characteristics of high sensitivity in revealing detailed information on composition, structure, and molecular interaction with reduced analysis time. In the last years, we have used these techniques for investigating gingival crevicular fluid (GCF) and periodontal ligament (PDL) during orthodontic tooth treatment. The analysis with Raman and infrared signals of GCF and PDL samples highlighted that different days of orthodontic force application causes modifications in the molecular secondary structure at specific wavenumbers related to the Amide I, Amide III, CH deformation, and CH3/CH2. In the present review, we report the most relevant results and a brief description of the experimental techniques and data analysis procedure in order to evidence that the vibrational spectroscopies could be a potential useful tool for an immediate monitoring of the individual patient's response to the orthodontic tooth movement, aiming to more personalized treatment reducing any side effects

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

A New Combined Protocol to Treat the Dentin Hypersensitivity Associated with Non-Carious Cervical Lesions: A Randomized Controlled Trial

The goal of this research is to assess the desensitizing effect of a diode laser on non-carious cervical lesions (NCCLs) responsible for dentin hypersensitivity (DH) in two separate output forces implemented both independently and in sequential combination modalities. A randomized controlled trial for this study was applied. Sixty-nine NCCLs responsible for DH pain with severity between 6 and 9 on the VAS scale were considered. Three study groups were developed using just one lesion from three different quadrants of the oral cavity of each patient. All treatment procedures were conducted using a laser diode (810 nm, 5 W) with varying power outputs used separately or in combination. The pain by DH was evaluated at baseline, at treatment completion, and at 15 days and 3 months after each laser procedure. Data analysis was performed using a Wilcoxon test for paired samples, a one-way ANOVA test, and an unpaired t-test. The significant reduction of the mean VAS score was estimated in each study group immediately and at 15 days and 3 months after the end of treatment and compared with the baseline mean VAS score (p-value < 0.0001). The best result concerning the improvement of DH symptomatology was assessed when a combined protocol of two different output powers of the diode laser was used. The authors conclude that the diode laser (810 nm) therapy procedure combining two separate output forces (low and high power) can improve the painful symptoms of DH from NCCLs

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