Minimally invasive orthodontics: elastodontic therapy in a growing patient affected by Dentinogenesis Imperfecta

AIM: The aim of the study was to report the use of an elastodontic therapy in a growing patient affected by Dentinogenesis Imperfecta, second class malocclusion, deep bite and lower arch crowding from the deciduous dentition to permanent one. CASE REPORT: At first, the 5-year-old patient was treated with an elastodontic device known as "Nite-Guide". When the patient was 7 years old, during her first permanent molars and incisors eruption and after optimal house-practices, an Occlus-o-Guide Series G was placed at night and on daylight (two hours a day) performing exercises aimed to activate facial muscles and facilitate the deep bite reopening. At 9 years of age, with totally deep bite resolution, she used the Occluso-Guide only at night to hold down previous results and follow patient's dental growth. At 11 years of age, after successful teeth switching, we prescribed an Occlus-o-Guide Series N, which is functional for permanent dentition and guaranteed an eruptive guide for last dental elements. CONCLUSIONS: This clinic case could be considered an example of approach for all those patients with systemic and/or dental diseases that do not allow adequate dental retention, which is necessary for most orthodontic appliances; elastodontic devices do not require adequate dental retention and define a minimum intervention on the surfaces of the teeth

Healing environment in pediatric dentistry: strategies adopted by “Sapienza” University of Rome

Children’s dental anxiety has been of great worry for many years and it is still a barrier for dental care. According to recent guidelines for oral health prevention in childhood, additional strategies for a preventive care should be applied for pediatric patients. So it’s important to encourage pediatric dentists to develop a “child-friendly” environment for treating children. Environmental elements that produce positive feelings can reduce anxiety. The analysis of environmental design and features applied in Pediatric Dentistry Unit, Department of Oral and Maxillo-facial sciences, Sapienza University of Rome, highlighted special attention to the aspects supporting sensory conditions (colors, light, spatial organization); reassurance strategies (decorations, dental team attire, drawings); anxiety control strategies (playing area, TV, comics, toys); behavioral management strategies (positive reinforcement, modeling); in-formation (brochures, posters)

Early orthodontic treatment of Class II malocclusions with no-compliance appliances: study project with Forsus device system

Aim: Class II malocclusion is considered as a sagittal discrepancy between the maxillary bases characterized by a protrusion of the maxilla and/ or a retrusion of the mandible. There are several therapeutic approaches where the most suitable choise depends, for example, on the different level of patient’s cooperation. During childhood, the most used appliances for Class II malocclusion are the removable functional devices that need a good patient’s cooperation to be successful. The aim of this study was to evaluate the dental-alveolar and skeletal effects of an interceptive orthodontic treatment with a mandibular propulsive orthodontic appliance named Forsus in Class II growing patients with lack of compliance for functional appliances. Methods: A group of growing patients was selected to be treated with Forsus device following inclusion and exclusion methods. Some inclusion methods were: Class II malocclusion, OVJ more than 4 mm, stage of vertebral development Cs2-Cs3, lack of compliance for functional appliances. Some exclusion methods were though: permanent dentition, stage of vertebral development Cs4, presence of temporary mandibular disorders. The device wasn’t associated with a multibrackets orthodontic therapy but it presented a new design studied to be applied in mixed dentition. The telescopic system of Forsus device, that consists of a pushrod inside a Ni-Ti spring, was combined with a palatal arch and a double mandibular ferule. The upper and lower first molars presented orthodontic bands. The telescopic system connected the maxilla to the mandible from distal to mesial having contact, respectively, with the vestibular tubes of the upper first molars and with the mesial stops located in the vestibular sides of the mandibular ferule, at the level of the interproximal zone between canine and first deciduous molar or first premolar. A first patient was chosen to be treated to evaluate the effectiveness of the therapy with this new design, to underline both strengths and weaknesses of the therapy. A complete photographic intraoral record was carried out before installation of Forsus device as well as during the different stages of the treatment. Cephalometric radiograph analysis was taken before therapy and at the completion of comprehensive therapy. A comparison between initial and final digital study models was as well realized. The treatment lasted 8 months. Results: The overall therapeutic effects were mainly dento-alveolar while the skeletal effects were less significant as a slight improvement of ANB angle from 7,7° to 5,4°. The overjet decreased significantly from 7,1 mm to 3,2 mm and the overbite from 4,5 to 0,1. A new molar relationship of Class 1 of Angle was achieved. Conclusion: Forsus device is a valid option of no- compliance interceptive orthodontic treatment in Class II growing patients. Although the therapy had mainly dento-alveolar effects, it will be possible to achieve more skeletal effects for example taking care to apply the device for the whole period of the peak of growth

Preventive dental and orthodontic approach to transposition. A case report

Aim: The goal of this work is to briefly present teeth transposition and describe a successfully solved case in “Sapienza” University of Rome, U.O.C. Pediatric Dentistry. Tooth transposition is a severe positional anomaly, affecting 0.4 % of the population, that may create many orthodontic problems from both esthetic and functional points of view. Dental transposition is defined as the positional interchange of two adjacent teeth or the development or eruption of a tooth in a position normally occupied by a non-adjacent tooth. The maxillary canine is the most commonly involved teeth in the transposition, changing its eruptive place with the lateral incisor or the first premolar in most cases. In such canine transposition the treatment options may include alignment of the teeth in their transposed positions, extractions of one of transposed teeth, orthodontic movement into the correct position in the arch. The treatment options was decided with careful consideration of the multiple clinical variables: stages of development and position of root apices, facial esthetics, dental morphology, occusal consideration, treatment time, age and compliance of the patient. Methods: Many publications reporting people with maxillary tooth transpositions were examined from word-wide sources. This paper presents a case report demonstrating the preventive orthodontic management of a mandibular transposition in a girl 9 aged years. The panoramic radiograph of the early mixed dentition, is a very useful source for detecting the presence and position of the unerupted permanent teeth. The best time to begin assessing a child for potential tooth transposition is the early mixed dentition period, around the age 6 to 8 years. In this case panoramic showed an incomplete mandibular lateral incisor-canine tooth transposition which caused lack resorption 8.3 and eruptive obstacle of 4.3 and 4.4. Results: Early interceptive procedure has provided the pleacement of a lingual arch to preserve arch length, followed by the extraction of the deciduous tooth, and pleacement of eruption guider for the permanent teeth, thus preventing complete development of the anomaly. This allowed teeth to became upright and erupt into its proper position in the arch. Conclusions: Transposition of teeth in an uncommon dental anomaly. The interceptive treatment of the transposition in the early mixed dentition of pedodontic patient simplified the corrective orthodontic treatment, making it faster and less complex, how to cited in others studies

Comparative evaluation of the surface effect of two toothpastes with different fluorine concentration on primary teeth surface

BACKGROUND: The purpose of this study is to analyze the effect of two toothpaste, with different fluorine concentrations, on the enamel surface of deciduous teeth. The study was performed in vitro by means of SEM microscopy. METHODS: A selection of 20 deciduous molars was prepared. The teeth were extracted as a result of orthodontic treatments or physiological replacements. The procedures were performed at the UOC of Pediatric dentistry Sapienza University of Rome department of Oral and Maxillo-Facial Science. Each element, with no sign of cracks on the enamel, was preserved in normal saline and then sectioned at a cementum-enamel junction level. Successively the external and occlusal surfaces have been etched with 37% orthophosphoric acid for 1 minute in order to reproduce the demineralization that occurs in the oral environment. Each fragment of the same tooth was treated with two different toothpastes (with 500ppm and 1400ppm fluorine concentration respectively) for 15 days and manually brushed three times a day using pediatric toothbrushes for 2 min. Each section was rinsed and preserved in normal saline, renewed every brushing session. Finally a roughness analysis was carried out. RESULTS: In the samples treated with 500 ppm both surfaces present a cribrosus layer, uneven, with a worn out appearance and visible crater-like spaces. In the samples treated with toothpaste at 1400 ppm of fluorine, an improvement of the surface morphology of the enamel has been highlighted, which however maintains a superficial roughness not completely attenuated, due to a non-homogeneous distribution of the same material. The roughness analysis values highlight these differences between the two materials. CONCLUSIONS: The use of toothpaste with a high concentration of fluorine, compared to those with low concentration, shows a greater remineralizing power on surfaces of artificially demineralized deciduous teeth, ensuring a character of caries prevention. Toothpastes with 500 ppm, despite reducing the potential risk of systemic accumulation of fluorine (due to accidental ingestion of the material during daily oral hygiene), do not demonstrate significant effectiveness in the repair and protection of the enamel surface by acidic substances attack. These findings therefore translates into an increased risk of the onset of caries

Elastodontic therapy in a growing patient affected by dentinogenesis imperfecta

Aim. Dentinogenesis imperfecta (DI) is an autosomal dominant disorder of tooth development. This clinic condition can be associated with osteogenesis imperfecta. At first clinical examination, these patients have short roots and crowns, hypoplastic dentin, sane enamel which tends to deteriorate due to supporting lack and a larger breadth of the pulp chamber with respect to average. Moreover, the Dentinogenesis imperfecta (DI) is also associated with different degrees of discoloration, on a color spectrum from gray to yellow-brown. From a radiographic point of view, teeth affected from DI are called “specter teeth” because of the emptiness appeareance, as it is possible to observe only the polished outlines. We used an elastodontic therapy along patient growth from the deciduous dentition to permanent one, with second class malocclusion, deep bite and lower arch crowding. Materials and methods. Elastodontic braces are devices which allow through light forces use to carry out an eruptive guide for dental elements, improve deep bite and second class malocclusion through a preformed bite construction based on a mandibular advancement. Eventually, performing the so-called “lip bumper effect”. Initially, the patient, who was five and a half years old, was treated with an elastodontic brace “Nite-Guide”, which was carried both at night and on daylight (two hours per day) performing exercises aimed to activate facial muscles and facilitate the deep bite reopening. At a later stage, when the patient was 7 years old, during her first permanent molars and incisors eruption, following best practices, it has been placed a cloggedo- Guide Series G, which is usually utilized as a brace in case of mixed dentition. At 9 years with deep bite resolution, it was reported to the patient to use the occluded-o-Guide only at night to hold down previous results and sustain patient’s dental growth. At 11 years old, after successful teeth switching, it was prescribed an occluded-o-Guide Series N, which is functional for permanent dentition and guaranteed an eruptive guide for last dental elements. Results. The patient has corrected optimally her second class malocclusion, deep bite, and dental misalignment. The elastodontic devices have allowed a proper eruptive guide for all teeth in various commuting stages. Conclusion. This clinic case could be considered an exemplificative approach for all those patients with systemic and/or dental diseases that disallow adequate dental retention, which is necessary for most orthodontic appliances, whereas elastodontic devices do not require adequate dental retention thus result as the proper solution

Surface analysis on primary teeth after using of two toothpastes with different fluoride concentration: an in vivo study

BACKGROUND: The aim of the study was to observe in vivo the surface effect of two different toothpastes, available on the market, with different fluorine concentration. The analysis was conducted in vivo on deciduous teeth. METHODS: A selection of 20 deciduous molars, from 20 patients, was prepared. The selected teeth showed no alteration of the enamel. The teeth were extracted as a result of orthodontic treatments or physiological replacements. The procedures were performed at the UOC of Pediatric dentistry Sapienza University of Rome department of Oral and Maxillo-Facial Science. The selected patients was successively divided in two groups of ten patients each one respectively. The daily oral hygiene procedures was carried out with 500 ppm of fluorine, for the first Group and 1400 ppm of fluorine for the second Group. After 15 days the aforementioned primary teeth were extracted and preserved in normal saline. Successively the primary teeth were sectioned at a cementum-enamel junction and were viewed with VP-SEM electronic microscope to analyze the characteristics of the enamel surface. RESULTS: Micrographic analysis of the samples treated with toothpaste at 500 ppm of fluorine shows non-uniform layers, with a high surface roughness and the presence of irregularly scattered amorphous precipitates. Patient samples that instead used toothpaste with a fluoride concentration of 1400 ppm, show a less irregular surface with a present, but more attenuated, roughness. A finer granulation than the previous ones is visible in an uneven manner, which confers a non-uniform but in any case more structured stratification.CONCLUSIONS: In the pediatric field the prevention of caries lesions is one of the main targets. Early remineralization of initial enamel alterations may result in a delay in the progression of the carious process and an arrest of the same. The use of toothpaste with a high content of fluorine showed a better remineralizing effect, resulting in a more uniform surface compared to teeth after toothpaste treatment with 500 ppm fluorine. These do not improve the superficial morphology of the teeth, maintaining a relevant roughness that exposes the enamel more to the bacterial insult and the onset of carious lesions

Prevention campaign: "A Smile School": prevalence of dental caries in the pediatric population of central Rome

Aim: Tooth decay is a disease closely related to eating habits and lifestyles, easily correctable in the child and adolescent population. Indeed, it is remarkably widespread among the Italian population. Hence the need for a monitoring to define the trend of the disease and to provide educational programs that promote good eating habits and oral hygiene. Method: In this view The U.O.C. of Pediatric Dentistry, Policlinico Umberto I in Rome (Dir. Prof. Antonella Polimeni) sponsored by the second municipality of Rome, have promoted, for the current school year, dental examinations to pupils in nursery classes, primary and secondary, between the ages of 3 and 13 years old, carried out at school, trained by dentists, with the use of sterile disposable material (dental probe and mirror) and clinical detection folders that include: questionnaire addressed to parents about hygiene and eating habits of their children and personal data; a detection folder for caries and periodontal disease with plaque index for home oral hygiene assessment. Parents were issued a letter of accompany with the medical observations. For each child was asked consent to the visit and processing of data. Result: The examined sample of 372 children, 202 males and 170 females. Of these, 74.19% did not carry out any kind of additional fluoride further home care by toothbrushing. By clinical observation on sample, 40.05% had absence of plaque, plaque detectable to the probe in 27.69%, the 18.1% seen with the naked eye plaque and 10.48% abundant accumulations of plaque. Bleeding on probing was present only in 9.41%. The DMF is 0.7 and def 0.6. Compared with the data relating to the parents education, 69.62 of mothers graduated and 62.91 of the fathers, the remainder is split between middle and high schools, no one do not appear any kind of education. Conclusion: Sample thus far examined has a satisfactory level of oral health with a DMF of 0.7 and a def of 0.6 or less than 1. However, the WHO goals for 2020, we recall, promote between 5 and 6 years old subjects free from tooth decay, so prevention and oral health promotion campaigns in these age groups are necessary to achieve that goal not yet reached

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

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