Il ruolo dell'ortodontista nel Surgery First Approach

Il “Surgery First Approach” (SFA) è un approccio alternativo al paziente con malocclusione dento-scheletrica in cui l’intervento di chirurgia ortognatica viene effettuato all’inizio del trattamento e tutte le fasi ortodontiche effettuate nel trattamento convenzionale, sia quella di preparazione delle arcate all’intervento chirurgico che quella di stabilizzazione dell’occlusione, vengono effettuate dopo l’intervento di chirurgia ortognatica. Con l’incremento dell’utilizzo del Surgery First Approach, diversi sono gli aspetti già indagati in letteratura man mano che tale protocollo viene adottato dalle Scuole chirurgiche e ortodontiche. Attualmente il punto di vista più valutato è quello chirurgico maxillo-facciale, mentre il ruolo dell’ortodontista nel Surgery First Approach e gli obiettivi dell’ortodonzia postchirurgica sono stati invece fino a oggi poco indagati. Lo scopo della ricerca è: riportare l'esperienza della UOC di Ortognatodonzia dell’Università “Sapienza” di Roma nel trattamento dei pazienti disgnatici con Surgery First Approach; presentare il protocollo Surgery First utilizzato presso la nostra UOC di Ortognatodonzia in collaborazione con la UOC di Chirurgia MaxilloFacciale; studiare il ruolo dell’ortodonzia post-chirurgica in questa nuova metodica.The Surgery First Approach is an alternative protocol to a dento-skeletal malocclusion. The first phase of the treatment is the orthognatic surgery followed by all the orthodonthic phases, both the pre-surgical preparation of the upper and lower arches and the post-surgical occlusal stabilization. At the present, the surgical point of view is the more studied by papers in literature, while the role of the post-surgical orthodontics is less analysed. Aim of the thesis is: to report the experience of the Unit of Orthodontics of the Rome "Sapienza" University with Surgery First approach in patients with dento-skeletal malocclusion; to present our protocol, developed in partnership with the Unit of Maxillo-Facial Surgery; to study the role of post-surgical orthodontics dealing with this new approach

Neonatal functional treatment for Pierre Robin Sequence

Objective: Pierre Robin Sequence (PRS) is a heterogeneous pathological condition characterized by the coexistence of micrognathia, glossoptosis, and cleft palate, resulting in upper airway tract obstruction. Among the treatment modalities, the orthodontic approach is one part of the comprehensive care of those patients and will be present in the treatment modalities during all the growth period of the child.Methods: All patients with PRS observed in the period 2013-2017 were treated with a definite functional approach. The results were retrospectively analyzed with regard to functional outcome, total treatment time, and number of plates provided for a single patient.Results: In all the patients, the indicated treatment protocol has been applied as early impression and plate supply, stimulation of bottle feeding with the use of the plate, eventual substitution of the plate if no more adequate to the transverse and sagittal growth of the palate, and continuing the use until the surgical closure of the cleft. All the patients showed a positive outcome to the proposed treatment approach, evaluated with regard to the incidence of feeding improvement and weight gain, to the limit for the surgical phase, in the absence of adverse effects.Conclusion: The use of a functional obturator plate, removing functional alterations to mandibular growth, reduces and, in some cases, eliminates the need for surgical intervention. As also stated in the literature, if despite the presence of the plate nutritional problems persist, immediate different surgical approaches, mainly mandibular osteodistraction, become necessary

Impacted maxillary canines and root resorption of adjacent teeth : a retrospective observational study

The prevalence of impacted maxillary canine is reported to be between 1% and 3%. The lack of monitoring and the delay in the treatment of the impacted canine can cause different complications such as: displacement of adjacent teeth, loss of vitality of neighbouring teeth, shortening of the dental arch, follicular cysts, canine ankylosis, recurrent infections, recurrent pain, internal resorption of the canine and the adjacent teeth, external resorption of the canine and the adjacent teeth, combination of these factors. An appropriate diagnosis, accurate predictive analysis and early intervention are likely to prevent such undesirable effects. The objective is to evaluate, by means of a retrospective observational study, the possibility of carrying out a predictive analysis of root resorption adjacent to the impacted canines by means of orthopantomographs, so as to limit the prescription of additional 3D radiography. 120 subjects with unilateral or bilateral maxillary impacted canine were examined and 50 patients with 69 impacted maxillary canine (22 male, 28 female; mean age: 11.7 years) satisfied the inclusion criteria of the study. These patients were subjected to a basic clinical and radiographic investigation (orthopantomographs and computerized tomography). All panoramic films were viewed under standardized conditions for the evaluation of two main variables: maxillary canine angulations (a, b, g angles) and the overlapping between the impacted teeth and the lateral incisor (Analysis of Lindauer). Binary logistic regression was used to estimate the likelihood of resorbed lateral incisors depending on sector location and angle measurements. Results indicated that b angle has the greatest influence on the prediction of root resorption (predictive value of b angle = 76%). If ? angle <18° and Lindauer = I, the probability of resorption is 0.06. Evaluation of b angle and superimposition lateral incisor/impacted canine analysed on orthopantomographs could be one of the evaluation criteria for prescribing second level examination (CT and CTCB) and for detecting root resorption of impacted maxillary canine adjacent teeth

Nahoum Index in Brachyfacial Patients: A Pilot Study

Objective:Our aim is to test the Nahoum Index as a support in the cephalometric study of vertical dimension and therapeutic orientation in adult patients suffering from Class II malocclusion, deep bite, or short face syndrome.Methods:Twenty-three patients with molar Class II and an overbite >4 mm were stratified into two groups: orthodontic (G2) and surgical orthodontic (G1). The ANB angle and Nahoum Index were calculated for cephalometric tracing pre- and post-treatment. The difference between the ANB and Nahoum Index values were analyzed using the Statistical Package for the Social Sciences software.Results:In G1, the Nahoum Index decreased from 0.954 to 0.797, and the ANB angle decreased from 5.2° to 3.2°. In G2, the Nahoum Index decreased from 0.825 to 0.817, and the ANB angle decreased from 4.4° to 4°.Conclusion:In G1, the difference between before and after treatment was significant for the Nahoum Index only. The difference between before and after values was not significant in the G2 group. It is possible to indicate the Nahoum Index of 0.934 as the limit value in case of which a patient may be treated with orthodontics only. This limit is the opposite of the limit proposed by Nahoum for vertical excess cases and respect the same interval. Therefore, we can consider the range 0.81-0.934 to indicate borderline patients, and >0.934 to indicate surgical patients. If the ratio is close to the normal value as 0.81, the treatment will be orthodontic; if it is further increased, the treatment will be surgical

Caratteristiche biomeccaniche nella tecnica linguale

Objectives Esthetics is a major consideration in the decision to undergo an orthodontic treatment. This report focuses on lingual orthodontics as a valid alternative for patients who require a truly “invisible” treatment. Materials and methods In recent years, considerable progress has been made in the field of biomechanics. We carried out a review of the literature to analyze the main features of the lingual orthodontic technique and to compare this approach with the vestibular technique. Results The advantages of the lingual approach include reduced distance between the applied force and the Center of Resistance and a bite-opening effect. The disadvantages include a reduced interbracket distance and a bowing effect. Conclusions Compared with the vestibular approach, the biomechanics used in lingual orthodontics offer potential advantages in terms of esthetics and treatment time along with valid functional results