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

Can computer-guided surgery help orthodontics in miniscrew insertion and corticotomies? A narrative review

Orthodontics has considerably increased the use of technology combined with surgery as a tool to improve dental movements in terms of predictability, acceleration of movement, and fewer side effects. To achieve these goals miniscrews and corticotomy were introduced. The digital workflow permits an increase in the accuracy of surgical and orthodontic setups. The tool that transfers the information is the CAD/CAM (Computer-Aided Design/ Computer-Aided Manufacturing) template. The aim of this review is to illustrate the use of computer-guided surgery in orthodontics regarding miniscrews and piezocision. The search strategy was a combination of Medical Subject Headings (Mesh) and free text words for PubMed. A total of 27 articles were included in this review: 16 concerned miniscrews and 11 concerned corticotomy. The current need for faster treatments, the improved systems of anchorage, and the evolution of imaging technologies require operators to be knowledgeable of the digital workflow. CAD/CAM templates allow greater precision and predictability of miniscrew insertion even if in the hands of less experienced clinicians and permit a better orientation and depth of the cortical incision. In conclusion, digital planning makes surgery faster and easier and allows for the identification and correction of any potential problem before the procedure

Whole exome sequencing in an Italian family with isolated maxillary canine agenesis and canine eruption anomalies

Objective: The aim of this study was the clinical and molecular characterization of a family segregating a trait consisting of a phenotype specifically involving the maxillary canines, including agenesis, impaction and ectopic eruption, characterized by incomplete penetrance and variable expressivity. Design: Clinical standardized assessment of 14 family members and a whole-exome sequencing (WES) of three affected subjects were performed. WES data analyses (sequence alignment, variant calling, annotation and prioritization) were carried out using an in-house implemented pipeline. Variant filtering retained coding and splice-site high quality private and rare variants. Variant prioritization was performed taking into account both the disruptive impact and the biological relevance of individual variants and genes. Sanger sequencing was performed to validate the variants of interest and to carry out segregation analysis. Results: Prioritization of variants “by function” allowed the identification of multiple variants contributing to the trait, including two concomitant heterozygous variants in EDARADD (c.308C&gt;T, p.Ser103Phe) and COL5A1 (c.1588G&gt;A, p.Gly530Ser), specifically associated with a more severe phenotype (i.e. canine agenesis). Differently, heterozygous variants in genes encoding proteins with a role in the WNT pathway were shared by subjects showing a phenotype of impacted/ectopic erupted canines. Conclusions: This study characterized the genetic contribution underlying a complex trait consisting of isolated canine anomalies in a medium-sized family, highlighting the role of WNT and EDA cell signaling pathways in tooth development

Comparision of profile macro-estethic perception among orthodontists, dentistry students, orthodontic patients and surgical orthodontic patients

The patient?s needs should guide the orthodontist in choosing the most appropriate therapy. The purpose of the present survey was to compare the esthetic perception of the facial profile by orthodontists (O), dentistry students (DS), orthodontic patient

Predictive analysis of maxillary canine impaction through sella turcica bridging, ponticulus posticus calcification, and lateral incisor anomalies: a retrospective observational study

Maxillary canine impaction is an increasing dental anomaly and is often related to other dento-skeletal anomalies. The aim of this work is to support the clinician in evaluating the relationship between a displaced maxillary canine and clinical (the features of lateral incisors)/skeletal (ponticulus posticus and sella turcica bridging) anomalies through orthopanoramic radiographs, lateral cephalograms, and plaster casts to identify the parameters that best predict maxillary canine impaction. A retrospective observational study was carried out on the analysis of the medical records, radiographic findings (panoramic radiographs and lateral cephalograms), and plaster casts of 203 orthodontic patients divided into a case group, with at least one impacted maxillary canine, and a control group, without an impaction. A chi-square test and logistic regression analysis were used to analyze the data. A statistically significant association was found between the impaction of the maxillary canine and the female sex, the bridging of the sella turcica, the ponticulus posticus calcification, and the anomaly of the lateral incisor; a logistic regression revealed that these significant variables were found to be positive predictors of impacted maxillary canines, particularly in reference to the impaction in the palatal area. Finding one of these clinical and radiographic elements can represent a predictive sign of the possible impaction of the maxillary canine

Efficacy and accuracy of maxillary arch expansion with clear aligner treatment

The aim of this work was to evaluate the efficacy and accuracy of maxillary arch transverse expansion using the Invisalign® clear aligner system without auxiliaries other than Invisalign attachments. Knowing the accuracy of a movement through a clear aligner system allows the clinician to plan the treatment with greater precision and to achieve the expected result faster. The study group included 28 patients with a mean age of 17 ± 3.2 years. The treatment protocol for all the selected patients included the application of the Invisalign® clear aligner system without auxiliaries, except for the Invisalign® attachments; in no case were tooth extraction or interproximal enamel reduction (IPR) performed. Linear measurements of the expansion were assessed before treatment (T0), at the end of treatment (T1), and on final virtual models by ClinCheck® (TC). A paired t-test was used to compare T0-T1 and T1-TC differences. A paired t-test was applied, and one normality was validated with the Shapiro-Wilks test. If normality was not met, the nonparametric test (Mann-Whitney U test) was applied. The level of significance was set at 5%. Statistically significant differences were found for all measurements at T0-T1. The results showed an average accuracy of efficacy of 70.88%. The differences in predictability between the various vestibular measurements (intercanine, inter-premolar, and intermolar) were not statistically significant, while they were for gingival measurements. The overall accuracy of the expansion treatment was 70%, regardless of tooth type

Drop-out rate among patients treated with omalizumab for severe asthma: Literature review and real-life experience

In patients with asthma, particularly severe asthma, poor adherence to inhaled drugs negatively affects the achievement of disease control. A better adherence rate is expected in the case of injected drugs, such as omalizumab, as they are administered only in a hospital setting. However, adherence to omalizumab has never been systematically investigated. The aim of this study was to review the omalizumab drop-out rate in randomized controlled trials (RCTs) and real-life studies. A comparative analysis was performed between published data and the Italian North East Omalizumab Network (NEONet) database

Clinical Outcomes in Patients Aged 80 Years or Older Receiving Non-Invasive Respiratory Support for Hypoxemic Acute Respiratory Failure Consequent to COVID-19

: As the clinical outcome of octogenarian patients hospitalised for COVID-19 is very poor, here we assessed the clinical characteristics and outcomes of patients aged 80 year or older hospitalised for COVID-19 receiving non-invasive respiratory support (NIRS). A multicentre, retrospective, observational study was conducted in seven hospitals in Northern Italy. All patients aged ≥80 years with COVID-19 associated hypoxemic acute respiratory failure (hARF) undergoing NIRS between 24 February 2020, and 31 March 2021, were included. Out of 252 study participants, 156 (61.9%) and 163 (64.6%) died during hospital stay and within 90 days from hospital admission, respectively. In this case, 228 (90.5%) patients only received NIRS (NIRS group), while 24 (9.5%) were treated with invasive mechanical ventilation (IMV) after NIRS failure (NIRS+IMV group). In-hospital mortality did not significantly differ between NIRS and NIRS+IMV group (61.0% vs. 70.8%, respectively; p = 0.507), while survival probability at 90 days was significantly higher for NIRS compared to NIRS+IMV patients (0.379 vs. 0.147; p = 0.0025). The outcome of octogenarian patients with COVID-19 receiving NIRS is quite poor. Caution should be used when considering transition from NIRS to IMV after NIRS failure

The combined use of clear aligners and computer-guided piezocision: a case report with a 2-year follow-up

AIM: An orthodontic treatment is described that combines the use of clear aligners and computer-guided piezocision to overcome the drawbacks of traditional corticotomy in accelerating orthodontic tooth movement. The relapse at the 2-year follow-up was also evaluated. MATERIALS AND METHODS: A 13-year-old male patient was selected and treated due to a molar Class II malocclusion with moderate dental crowding. Treatment time, oral health-related quality of life (OHRQoL), and periodontal indexes were assessed. To reduce the treatment time, computer-guided piezocision was utilized to perform flapless interproximal corticotomy cuts through the depth of the cortical bone. The orthodontic therapy using clear aligners began on the same day as the surgery. RESULTS: The overall duration of the therapy was 6 months. There was an improvement in the periodontal indexes at the end of the therapy. An aggravation of OHRQoL only occurred for 3 days after surgery. The 2-year follow-up evaluation showed a relapse of 0.2 mm on the maxillary left lateral incisor and 0.25 mm on the mandibular right lateral incisor. CONCLUSION: The present case report describes the advantages of a combination of computer-guided piezocision and clear aligners to treat a Class II malocclusion with moderate crowding

The efficacy of miniscrew-supported distal-jet in clinical practice

OBIETTIVI Lo scopo del presente studio pilota caso-controllo è stato valutare l’efficacia del dispositivo ortodontico distal-jet a supporto scheletrico rispetto al distal-jet ad ancoraggio dentale in termini di quantità di distalizzazione ottenuta nell’arco di 6 mesi e di perdita di ancoraggio dentale riscontrata. MATERIALI E METODI Venti pazienti sono stati assegnati in modo casuale a ricevere un trattamento con distal-jet su miniviti (Gruppo A) o con distal-jet tradizionale (Gruppo B). Nel Gruppo A due miniviti sono state inserite in sede para-mediana della volta palatina; l’inserimento delle miniviti ortodontiche è stato computer-guidato grazie all’utilizzo di una guida chirurgica realizzata con una stampante 3D. Sono stati raccolti e analizzati i modelli di studio digitali e i cefalogrammi latero-laterali pre-trattamento e a 6 mesi di follow-up. Sia sui modelli dentali che sul telecranio in proiezione latero-laterale sono stati valutati la quantità di distalizzazione molare superiore e gli effetti collaterali dento-alveolari. È stata condotta un’analisi statistica descrittiva per valutare la quantità di distalizzazione del molare superiore e gli effetti collaterali dento-alveolari ottenuti a 6 mesi di follow-up. Il T-test è stato utilizzato per calcolare le differenze tra i due gruppi con una significatività settata a P ≤0,05. È stata calcolata l’affidabilità intra-operatore, utilizzando un T-test a 2 campioni, la significatività è stata settata a P ≤0,05. RISULTATI Nel Gruppo A è stata registrata una maggiore quantità di distalizzazione del primo molare superiore nei 6 mesi di follow-up con una differenza statisticamente significativa tra i gruppi (P = 0,002). Considerando gli effetti dento-alveolari, nel Gruppo A è stata riscontrata una spontanea distalizzazione dei primi premolari e una retro-inclinazione degli incisivi centrali. Nel Gruppo B, invece, i primi premolari si sono spostati mesialmente (mesial drift) e gli incisivi centrali mascellari hanno subito una vestibolo-inclinazione (flaring incisale) con conseguente perdita di ancoraggio anteriore. In entrambi i gruppi si è osservato un aumento del diametro trasversale in zona molare e una maggiore tendenza alla rotazione del primo molare mascellare nel Gruppo con distal-jet tradizionale. CONCLUSIONI Il presente studio ha confrontato due sistemi di distalizzazione dei molari mascellari: il distal-jet ad ancoraggio scheletrico e quello ad ancoraggio dentale. Il distal-jet su miniviti ha permesso una maggiore quantità di distalizzazione nel breve follow-up (6 mesi) non causando gli effetti collaterali dentoalveolari (deriva mesiale dei premolari e flaring incisale) presenti quando si utilizza il distal-jet tradizionale. Sono necessari studi randomizzati controllati per confermare tali risultati. SIGNIFICATO CLINICO La distalizzazione molare mascellare è il trattamento non estrattivo più utilizzato nella correzione della malocclusione di II Classe. L’utilizzo di dispositivi intra-orali tradizionali non è privo di effetti indesiderati. Oggi l’impiego di apparecchiature supportate da miniviti permette un maggiore controllo dell’ancoraggio. Il presente studio pilota ha fornito risultati che, nel breve follow-up, dimostrano una maggiore quantità di distalizzazione del molare mascellare senza la perdita di ancoraggio tipica del distal-jet tradizionale. Tali risultati dovrebbero incoraggiare il clinico a utilizzare apparecchiature ad ancoraggio scheletrico.OBJECTIVES The aim of the present pilot study was to evaluate the efficacy of the miniscrew-supported distal-jet appliance versus traditional distal-jet appliance in terms of amount of upper first molar distalization and the dentoalveolar side effects, obtained in six months. MATERIALS AND METHODS Twenty patients were randomly assigned to receive a treatment with miniscrew-supported distal-jet appliance (Group A) or withtraditional distal-jet appliance (Group B). To ensure a minimally invasive miniscrew insertion a computer-guided surgical guide was designed and subsequently manufactured using a 3D printer. Digital models and lateral cephalograms were obtained and analyzed before orthodontic treatment and at 6-month follow-up. The amount of upper first molar distalization and the dentoalveolar side effects were assessed both on digital models and on lateral cephalograms. In order to reduce the bias in the selection of subjects, considering that the sample size was too small to represent the entire spectrum of subjects in the target population, the results were analyzed at 6 months from the start of therapy. A descriptive statistical analysis was carried out. Intergroup differences were determined using T-test. The significance was set at P ≤0.05. The intra-operator reliability was calculated and a 2 sample T-test was used with significance estabilished at P ≤0.05. RESULTS In Group A a greater maxillary first molar distalization was recorded in 6 months of follow-up with a statistically significant difference between the groups (P = 0.002). Considering the dento-alveolar side effects, in Group A a spontaneous distalization of the first premolars and a retroclination of central incisors were observed. In Group B, on the other hand, the first premolars tipped mesially (mesial drift) and a proclination of the maxillary central incisors (incisal flaring) was observed, causing a loss of anterior anchorage. The transverse widths of the dental arch increased in both groups, and a greater tendency of maxillary first molar rotation was observed in the group with traditional distal-jet appliance. CONCLUSIONS The present pilot study compared two maxillary molar distalization systems: the traditional distal-jet appliance versus the miniscrew-supported distal-jet appliance. The skeletal anchorage device achieved a greater first molar distalization at 6-month follow-up and did not cause dento-alveolar side effects, such as the mesial drift of the premolars and the incisors. Randomized controlled trials are needed to confirm these preliminary results. CLINICAL SIGNIFICANCE Maxillary molar distalization is the most frequently used non-extraction treatment in the correction of Class II malocclusion. The use of traditional intra-oral devices shows unreliable results. Nowadays the use of miniscrew-supported appliances helps prevent anchorage loss. The present pilot study has provided results that, in the short follow-up, demonstrate a greater amount of maxillary molar distalization without the anchorage loss observed in traditional distal-jet appliances. These results should encourage the clinical use of supported-miniscrew orthodontic appliances but randomized controlled trials are needed to confirm these preliminary results