Laterolateral teleradiography of the skull as a screening method for OSA/OSAS, in patients in orthodontic treatment

Aim: Obstructive sleep apnea syndrome (OSAS) is the most common type of sleep apnea and it is caused by complete or partial obstruction of the upper airway. Adenotonsillar hypertrophy, obesity, cranio-facial anomalies and neuromuscular diseases are the main risk factors for the development of OSAS in the pediatric age. Specially several studies identify the relationship between respiratory disorders in sleep and obesity, and, in particular, between OSAS and obesity, designing a prevalence of OSAS among obese subjects between 14 and 78%. The diagnosis of OSAS in the child is of great importance as it can lead to neurocognitive and behavioral complications, growth retardation, systemic arterial hypertension, pulmonary hypertension, cardiovascular disease and metabolism. The WHO (World Health Organization) has established the new criteria for the classification of Obesity on the basis of BMI and the risk of comorbidities, identifying a moderate risk for underweight subjects, a very low risk for normal weights and an increased risk from severe to severe for overweight and obese individuals respectively. According to that the aim of this study is to evaluate the correlation between obstructive sleep apnea syndrome and cephalometric variables in children considering age and BMI. Materials and methods: Children aged 7–10 years and 11-14 years with no genetic syndrome, previous otorhinolaryngologic or orthodontic therapy treatments are being selected from our Departments of Paediatric Dentistry, University of Palermo, and from the Department of Orthodontics, University of Messina (Italy). All patients so far recruited and visited for orthodontic problems were in mixed or early permanent dentition phase, with the first upper molars fully erupted and presented to the history of several symptoms of Osas, such as recurring episodes of shallow or paused breathing during sleep, waking up frequently to urinate, morning headaches, memory or learning problems and not be able to concentrate or feeling irritable. Dental records and lateral cephalometric radiographs were obtained for all of the patients and than they have been subjected to paediatric, otolaryngology and polysomnography visits. Subject with a positive diagnosis of Osas were studied and they were divided in group based on their BMI. In all groups the inter-molar distance in dental records was measured, and the cephalometric traces have been calculated. As reported by the study by Galeotti et al. the cephalometric measurements analysed are S-PNS, ad1-PNS, and ad2-PNS for the nasopharynx; p-pp and pa for oropharynx; H-H’ for the Hyoid bone; SNA for the maxilla; SNB;ANB and Go-Me for the mandible; S-Go, N-Me and P-A for facial Height; SN for cranial base; SN-MP and PP-MP for the typology, and angle ArGoMe for Growth prevision. At the time that children are still in the way of recruitment the results may not yet be defined; however it is necessary to emphasize the importance of the study, because in the child respiratory disturbances in the sleep, and in particular the OSAS, are often underestimated, despite representing the third place between the threats of health after the smoke and the excess of weight

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A proportional correlation index for space analysis in mixed dentition derived from an italian population sample

Aim. The aim of this study was to establish a specific proportional correlation method for space analysis in mixed dentition applicable to the Italian population. Material and Methods. A retrospective analysis was performed on 300 plaster models taken from Italian subjects, 156 females and 144 males, aged between 12 and 25 years. Results. The variance analysis (ANOVA) showed a high correlation between the dimension of the mesio-distal diameters of the four mandibular incisor and those of the upper canine and premolars. The correlation coefficient showed the existence of a directly proportional, positive intra-dependence between the two groups. Discussion. The correlation tables used in the present study appear to be much more accurate if applied to groups of patients with similar ethnic backgrounds, thus explaining the differences between the various prediction indexes found in previous publications. Conclusion. This study highlights the need to develop specific values to fit the features of the different ethnic group

Correlation between Mesio-Distal Angulation and Bucco.-Lingual Inclination of First and Second Maxillary Premolars Evaluated with Panoramic Radiography and Cone-Beam Computed Tomography

Background: Panoramic radiography creates distortion in teeth position and inclination especially in lateral areas of the arches due to acquisition and curved shape of dental arch. The aim of this study was to evaluate panoramic distortion compared to cone-beam computed tomography. Methods: Mesiodistal angulations were measured on panoramic radiography. Mesiodistal angulations and buccolingual inclinations of the teeth were determined on cone-beam computed tomography scans. The previous measurements were then compared through Pearson correlation coefficient. Results: The results showed higher correlation between mesiodistal 2D angulation and buccolingual 3D inclination, especially for first premolars, rather than between mesiodistal angulations measured in 2D and 3D. Conclusion: Especially for the lateral areas of the dental arches, root mesiodistal angulation measured on panoramic radiography is not reliable; in fact, it is greatly influenced by buccolingual inclination. Therefore, clinical evaluation is highly recommended with panoramic radiography to provide correct diagnosis and the most satisfactory results

Midpalatal suture density evaluation after rapid and slow maxillary expansion with a low-dose CT protocol : a retrospective study

Background and objectives: The aim of the present paper is to use low-dose computed tomography (CT) to evaluate the changes in the midpalatal suture density in patients treated with rapid maxillary expansion (RME) and slow maxillary expansion (SME). Materials and Methods: Thirty patients (mean age 10.2 \ub1 1.2 years) were retrospectively selected from the existing sample of a previous study. For each patient, a low-dose computed tomography examination was performed before appliance placement (T0) and at the end of retention (T1), seven months later. Using the collected images, the midpalatal suture density was evaluated in six regions of interest. Results: No significant differences were found between the timepoints in the rapid maxillary expansion group. Three out of six regions of interest showed significant decreases between the timepoints in the slow maxillary expansion group. No significant differences were found in comparisons between the two groups. Conclusions: The midpalatal suture density showed no significant differences when rapid maxillary expansion groups were compared to slow maxillary expansion groups, suggesting that a similar rate of suture reorganization occurs despite different expansion protocols

Skeletal and Dental Effectiveness of Treatment of Class II Malocclusion With Headgear : a Systematic Review and Meta-analysis

Objective: To evaluate the skeletal and dental effects of headgear treatment by systematically reviewing the best available scientific evidence. Materials and Methods: A survey of articles published up to February 2017 investigating the effects of headgear in the treatment of patients with class II malocclusion was performed using 19 electronic databases. Only randomized clinical trials and prospective controlled clinical trials investigating growing patients with class II malocclusion treated with headgear were included. Two authors performed independently study selection, data extraction, and risk of bias assessment. All pooled data analyses were performed using the random-effect model. Statistical heterogeneity was evaluated. Results: In total, 6 trials were included (4 randomized clinical trials and 2 prospective controlled clinical trials), grouping data from 337 patients (170 treated patients and 167 untreated controls). The ages of the patients varied across the studies, but the majority of the trials had a sample with an age range between 8 and 9 years. The times of daily wear of the appliance varied across studies from 8 to 14 h/d. The significant mean differences in treatment effects compared with the untreated controls were 121.41\ub0 per year for SNA angle cephalometric parameter (95% confidence interval [CI]: 122.25\ub0 to 120.56\ub0), 120.57 mm/y for anterior maxillary displacement (95% CI: 120.75 to 120.40 mm), 121.42\ub0 per year for ANB angle cephalometric parameter (95% CI: 122.12\ub0 to 120.72\ub0), and 121.31 mm/y for the overjet cephalometric parameter (95% CI: 122.34 to 120.29 mm). Conclusion: Headgear treatment is effective in restricting sagittal maxillary growth and reducing the overjet in the short term

Effects of rapid vs slow maxillary expansion on nasal cavity dimensions in growing subjects: A methodological and reproducibility study

Aim To evaluate the methodological feasibility of a RCT comparing skeletal changes of nasal cavity size obtained with RME and SME, assessed via CBCT. Methods Twenty Caucasian children with a mean age of 10.4 years were recruited and allocated to receive RME (10 subjects, mean age 10.4 years) or SME (10 subjects, mean age 10.5 years). Inclusion criteria: constricted maxillary arch, upper and lower first molars erupted, unilateral or bilateral posterior crossbite. Exclusion criteria: age above 15 years, history of previous orthodontic treatment, periodontal disease, systemic disease affecting craniofacial growth, or craniofacial congenital syndrome. CBCT examinations were performed before treatment (T0) and 7 months after expander removal (T1). Changes of nasal width (NW), palatal width (PW) and total nasal volume (TNV) were assessed; palatal and nasal expansion was also calculated as a percentage of the increase of intermolar width IMW (PW% and NW%). Results The correlation between the first and the second readings ranged from 0.991 to 0.995 for linear measurements and was of 0.915 for volumetric measurements. The method error, as described by the value of s, was in general less than 0.3 mm for linear measurements and 0.372 cm3 for volumetric measurements. All linear transverse skeletal and dental measurements and the nasal volume increased with both RME and SME protocols. Conclusions The reported methodology can be reasonably used to investigate the transverse dimension of nasal cavity. The PW% and NW% parameters more accurately described the efficacy of the two expansion protocols as compared to their corresponding absolute measurement (PW and NW)

A dental implant dislocated in the ethmoidal sinus: A case report

Anatomy; Dental surgery; Dental materials; Eye-ear-nose-throat; Medical imaging; Dentistry; Dental implant; Chronic sinusitis; Atypical sinusitis; Endoscopic sinus surgery