Valutazione multidisciplinare e trattamento delle agenesie degli incisivi laterali mascellari. Revisione della letteratura

Objectives

The purpose of this work was to identify the most effective treatment plan for missing maxillary lateral incisors by means of a review of the relevant literature published on this topic during the last 10 years.

Material and methods

Using the PubMed and Cochrane Library search engines, we selected articles published between 1999 and 2009 with the following Keywords: “congenitally missing lateral incisors”; “treatment option”; “long term clinical results”; “soft tissue aspects”; and “bone level”. Fifty articles were selected: 20 were eliminated; and 30 articles were considered relevant. Ultimately; only 11 articles proved useful for identification of the best treatment option for patients with missing maxillary lateral incisors.

Results

Our review confirms that the most frequently used approach in patients with missing maxillary lateral incisors is the multidisciplinary plan (orthodontics, implantology, prosthetics), but the current trend is to use orthodontic space closure alone whenever possible.

Conclusions

Treatment options for patients with missing maxillary lateral incisors include space closure or space reopening, and insertion of implants. Both options can be considered effective from both the functional and esthetic points of view.     

Malocclusioni di Classe II prima divisione: considerazioni sulla scelta di eseguire una o due fasi di trattamento

Objectives

To determine the appropriate timing for treatment of Class II Division 1 malocclusion.

Materials and methods

We conducted a review of the literature to analyze the controversy surrounding the use single-phase versus two-phase orthodontic treatment for this type of malocclusion.

Results

The evidence shows that early orthodontic treatment is effective in specific clinical situations, but in many other cases, later single-phase treatment is more appropriate.

Conclusions

The practicing orthodontist should tailor treatment timing to the specific clinical situation.     

Valutazione estetica del sorriso in pazienti con agenesia degli incisivi laterali mascellari: revisione della letteratura

Objectives

Our aim was to identify the aesthetic parameters of the smile that should be assessed in patients with missing maxillary lateral incisors, by means of a review of the most recent literature on this topic.

Materials and methods

Using the most common search engines, such as Pub Med and the Cochrane library, we selected articles published between 1995 and 2010, which were indexed with the following Keywords “congenitally missing lateral incisors”, “aesthetic aspects”, “long-term clinical results”, “smile arc”, and “soft-tissue aspects”. Of the 28 articles selected, 10 were eliminated because they had follow ups <5 years or referred to sponsored studies. The remaining 18 articles only 12 articles were analyzed to identify the aesthetic parameters to evaluate in smile assessment of patients with missing maxillary lateral incisors.

Results

The review showed that when upper incisors are missing, good aesthetic results can be obtained with the traditional space-opening approach or with orthodontic space closure and mesialization of the lateroposterior sectors. However, clinicians currently prefer the orthodontic space closure option.

Conclusions

Treatment options for patients with missing maxillary lateral incisors include either space closure approaches and those based on space reopening and insertion of implants. Both offer good results in terms of smile aesthetics.     

Deficit trasversale del mascellare superiore e problematiche relative all’orecchio medio

Objectives

Restriction of the maxillary dental arch frequently results in decreased nasal canal patency with mouth breathing, and this situation may also be associated with conductive hearing loss. The aim of this paper is to review some of the literature on this condition and to advance several hypotheses regarding the changes observed in conductive hearing loss following orthodontic-orthopedic treatment.

Materials and methods

A literature review was carried out to critically analyze the relationship between “rapid maxillary expansion” and “improvement in conductive hearing loss”.

Results

The limited data in the literature on this specific topic suggest that hearing levels can be improved by correction of the palatal anatomy.

Conclusions

The positive effect on conductive hearing levels can be considered a possible additional benefit of rapid maxillary expansion, but this does not mean that rapid maxillary expansion should be proposed as a treatment for conductive hearing loss that is not associated with maxillary restriction.     

Risultati clinici e istologici delle preparazioni subgengivali a lama di coltello. Casi clinici

Objectives

This article evaluates the correlation between clinical and histological results in teeth prepared for fixed prosthodontics using the Biologically Oriented Preparation Technique (BOPT).

Materials and methods

Clinical cases are presented to illustrate the main steps in the BOPT procedure and the clinical results. Six anterior teeth regarded as “hopeless” were used for histological analysis. Three were prepared according to the BOPT (test), and the other three were prepared with a rounded juxtagingival shoulder (control). Temporary acrylic resin restorations were immediately placed. The teeth were extracted after five weeks.

Results

The junctional epithelium (JE) measured 2.5 ± 0.4 mm (test) and 1.7 ± 0.3 mm (control) (p < 0.001). The area of connective tissue infiltrated by inflammatory cells was 2.7 ± 0.7 mm² (test) and 1.5 ± 0.3 mm² (control) (p < 0.001).

Conclusions

The BOPT appears to favor the formation of a long JE and inflammatory-cell infiltration of the connective tissue, so it should not be used on periodontically sound teeth.     

Scelta ragionata dei dispositivi ortopedico-ortodontici nella malocclusione di Classe II

Objectives

Functional treatment of Class II malocclusion has been advocated to control and modify the direction of growth of the maxillary teeth and to reduce the need for treatment involving the permanent teeth.

Materials and methods

Many studies demonstrate the effectiveness of functional appliances in the treatment of Class II malocclusion caused by mandibular retrognathism in growing patients. A wide range of functional/orthopedic appliances are available for the correction of this problem. The aim of all these appliances is to stimulate mandibular growth by forward posturing of the mandible.

Results

A systematic review of the literature reveals substantial variability in the reported outcomes of functional jaw orthopedics in Class II malocclusion. These differences depend mainly on the type of appliance used and the timing of intervention. The growth peak that occurs during puberty is the most suitable period for undertaking this type of treatment.

Conclusions

Subjects with habits that interfere with proper maxillary and mandibular development benefit from early treatment of Class II malocclusion that guarantees proper mandibular growth.     

Dental occlusion and posture: an overview

Objectives

In recent decades, it has been suggested that disorders of the masticatory system such as malocclusions, can influence whole body posture. A growing number of patients are seeking concomitant treatment for dental malocclusions and postural disorders. The aim of this overview is to critically analyze the relationship between dental occlusion and posture.

Materials and methods

A literature overview was carried out to analyze the association between “malocclusion” versus “head posture”, “spine curvature”, and “body sway”.

Results

The studies showed that even if some associations have been found between occlusal factors and postural alterations, there is not enough scientific evidence to support a cause-effect relations. Most studies suffer from major flaws such as lack of control groups, failure to take into account for the possible confounders, inappropriate study design, and lack of sufficient reliability and validity of used diagnostic tests.

Conclusions

On the basis of this overview, it is not advisable to perform occlusal and/or orthodontic treatment, especially if irreversible and expensive, to treat or prevent postural imbalances or alteration of spine curvatures.     

Prevalenza della malattia parodontale in soggetti con patologie correlate all’aterosclerosi

Objectives

In this article, which includes a review of the current literature, author examines atheromatous disease as a risk factor for severe forms of cardiac and cerebral disease, and its possible correlation with periodontal disease.

Materials and methods

Periodontal examinations were performed on 180 patients hospitalized in the divisions of Cardiology or Neurology for disease related to atherosclerosis. The results were analyzed in light of epidemiologic data on the prevalence of periodontal disease in the general population.

Results

Compared with the general population, the patients examined exhibited a slightly higher prevalence of periodontal disease.

Conclusions

Considering the grave consequences of atherosclerosis, it seems reasonable to make every attempt to reduce the risk for these events by controlling all “modifiable” risk factors (smoking, obesity, stress etc.), including periodontal disease. This can be achieved with a simple oral hygiene interventions (by patients and dental hygienists) and minor periodontal surgery when needed.     

Reimpianto dentario post-traumatico: stabilizzazione con metodica ortodontica e presentazione di un caso clinico a 27 anni di distanza

Objectives

The aim of this paper is to demonstrate, by means of a review of the literature and presentation of an illustrative case, the successful management of traumatic dental avulsion with replantation and stabilizing orthodontic therapy.

Materials and methods

The authors report a case of traumatic loss of the first right upper incisor (11). Treatment consisted of replantation of the tooth and stabilization of the implant with a fixed orthodontic appliance.

Results

After 27 years, clinical and radiological findings show no root resorption, and the incisor is viable and stable.

Conclusions

Dental replantation after traumatic avulsion is now a valid option for treatment of traumatic avulsion. It allows functional and esthetics rehabilitation of the dental element.     

I denti sovrannumerari: revisione della letteratura

Objectives

The aim of this study was to evaluate the incidence and prevalence of supernumerary teeth in the population and to analyze possible treatment options.

Materials and methods

The literature review was based on a search conducted in the US National Library of Medicine's PubMed database for articles published since 1966.

Results and conclusions

Our review of the literature indicates that the incidence and prevalence of hyperdontia is higher when one considers permanent rather than deciduous teeth, and in general males are more frequently affected than females. Multiple supernumerary teeth can be associated with cleidocranial dysostosis, cleft lip or cleft palate, Ehlers-Danlos syndrome, Gardner's syndrome, and Fabry-Anderson syndrome. The mesiodens is the most common supernumerary tooth. Fourth molars are also fairly common. Hyperdontia is known to cause malocclusion. Different treatment options are available for this condition, and a specific treatment plan should be drawn up for each patient.     

Eziopatogenesi e manifestazioni cliniche della sindrome di Crouzon: revisione della letteratura

Objectives

The term Craniofacial dysostosis (CFD) is used to describe familiar forms of synostosis involving different sutures of the cranial base and midface. The aim of this work consists in a systematic review of literature on aetiology, etiopathogenesis, epidemiology, diagnosis, clinical, systemic, and oral manifestations and therapeutic options of Crouzon syndrome.

Materials and methods

A systematic review of literature through Medline data bank [www.ncbi.nim.nih.gov/pubmed] was done using “Craniofacial Dysostosis”, “Craniosynostosis”, and “Crouzon Syndrome” as keywords.

Results

Crouzon syndrome is the most common craniosynostosis. It develops after an early fusion of superior and posterior sutures of the maxilla with orbital ones, with consequent underdevelopment of the midface and ocular proptosis. Oral manifestations are maxillary hypoplasia, maxillary dental crowding, ogival palatus, and relative mandibular prognathism. Diagnosis can be done either through the evaluation of clinical phenotypes or DNA analysis with polymerase chain reaction (PCR). Treatment is mainly surgical. Orthodontic therapy is performed during the early skeletal maturation.

Conclusions

Thanks to the important innovations in surgical techniques and to a muldisciplinary approach, patients affected by this syndrome may aspire to normal cerebral development, physical status, and social relationships.     

Efficacia degli apparecchi funzionali nel trattamento delle malocclusioni di II classe. Parte I

Objectives

We aimed to evaluate the effectiveness and treatment timing of functional appliances in growing patients affected by class II malocclusion.

Materials and methods

This study is based on a literature review (meta-analysis, RCT, CCT) of the last 10 years; the articles selection is based on explicit inclusion and exclusion criteria.

Results

We selected 14 articles: the functional appliances led to statistically significant skeletal effects in 12 out of 20 samples for the mandibular growth and 1 out of 13 samples for the maxillary one.

Conclusions

At a short-term observation, functional appliances produce small beneficial changes in skeletal mandibular pattern, but they have no significant maxillary effects.     

Trattamento ortopedico in pazienti con III classe scheletrica: una revisione sistematica

Objectives

To evaluate the efficacy of orthopedic devices for maxillary protraction in patients with class III malocclusion, with reference to the indications for and timing of treatment and the short-term and long-term outcomes.

Materials and methods

This study is based on a review of the literature (CCTs, RCTs, reviews, metanalyses) published during the period from January 2000 to May 2011.

Results

Fifteen articles were selected for review on the basis of explicit criteria for inclusion and exclusion. The articles differed from one another in terms of the treatments assessed (devices, protocols, and timing).

Conclusions

Orthopedic maxillary protraction devices are indicated for correction of class III malocclusion in patients under 10 years old of age. They appear to be effective on the basis of short-term observations; no long-term outcomes have been reported thus far.     

Efficacia degli apparecchi funzionali associati alla trazione extraorale nel trattamento delle malocclusioni di II classe. Parte II

Objectives

The effectiveness of functional appliances (FJO) in association with extraoral traction (EOT) compared to functional appliances only in the skeletal correction of class II malocclusion in growing patients was evaluated.

Materials and methods

A literature review of the last 10 years was performed: the articles selection (RCT, CCT, meta-analysis) was based on explicit inclusion and exclusion criteria.

Results

We selected only three articles: the FJO + EOT treatment produced statistically significant skeletal effects in two of three samples for the mandibular growth, in one of three samples for the maxillary one.

Conclusions

The FJO + EOT treatment may produce slightly greater short-term skeletal effects than FJO treatment alone. More clinical trials are needed to prove this hypothesis.     

La valenza del consenso del minore nei trattamenti odontoiatrici

Objectives

To provide dentists (who are frequently unable to assess the potential medico-legal “risks”) with the means for involving minor patients in a legally unobjectionable way.

Materials and methods

The author analyze current international and national laws and regulations that represent the foundations of the evaluation of self-determination for patients without the so-called capacity to act.

Results and conclusions

Since there is no specific legislation governing the self-determination of minors or dental treatment in relation to these patients’ overall right to health, dentists are forced to assume several substantial medico-legal responsibilities, such as identifying the age at which a patient's consent is recognized as legally valid, case-by-case assessment of psychological maturity, and the importance of expressed dissent to treatment.     

Principi di base e applicazioni cliniche del sistema Invisalign

Objectives

To describe the Invisalign system that allows an esthetical orthodontic treatment in adult patients with malocclusions where pure tooth movement is required by orthodontic clear aligners. These appliances cover the whole teeth surface, unlike traditional orthodontic brackets and wires.

Materials and methods

The innovation of this system is the virtual displaying of orthodontic tooth movement with a CAD system and the manufacturing of clear aligners (CAM stage) using the newest technologies. Study analyses are always needed to allow the orthodontist to devise the first virtual treatment plan followed by a critical evaluation before the selection of the final result.

Results

Two cases with dentoalveolar problems in permanent dentition are reported with pre- and post-treatment records. A case of combined treatment with esthetical brackets and Invisalign is also reported. Finally, the author shows records of a case at the beginning, before finishing, and two years after treatment.

Conclusions

The type of malocclusion and patient selection are the most important factors for a successful treatment with the Invisalign system, because patients must comply in wearing aligners day and night.     

Metodiche self-ligating versus metodiche convenzionali

Objectives

This study is based on a literature review in order to compare self-ligating brackets with conventional brackets.

Materials and methods

The literature review was conducted on the US National Library of Medicine database, using PubMed. The keywords used in PubMed research were: “active self-ligating brackets”, “passive self-ligating brackets”, “conventional brackets”, “dental movement”, “orthodontics”.

Results

We found a total of 209 articles, 38 of which were selected, as related to our research, and the full text version was evaluated.

Conclusions

Self-ligating brackets seem to give a significant benefit in terms of chair-time reduction and show a slightly lower proclination of mandibular incisors.     

Inclusione dei canini mascellari permanenti e riassorbimento radicolare degli incisivi: prevenzione e aspetti medico-legali

Objectives

To discuss the risk of incisor root resorption in the presence of ectopic eruption of the permanent maxillary canines.

Discussion

Early detection of an anomalous intraosseous position of the maxillary canine is essential. To this end, patients should undergo a comprehensive clinical and radiographic assessment starting at the age 8 years.

Results and conclusions

Eruption of the ectopic permanent canines can be facilitated with early extraction of the primary maxillary canines (and possibly the primary first molars). This approach can prevent impaction (which requires more complicated, prolonged, and biologically expensive treatment) and limit the risk of root resorption involving the adjacent teeth (an event that causes irreversible damage and may give rise to medicolegal litigation).     

Significance of the platelet-derived growth factor in periodontal tissue regeneration

Aim

The aim was to review the significance of the platelet derived growth factor (PGDF) in periodontal tissue regeneration.

Methods and results

Databases were searched using the following terms in different combinations: “growth factors”, “guided bone regeneration”, “guided tissue regeneration”, “periodontal”, “platelet rich plasma” and “platelet derived growth factor”. Titles and abstracts of articles obtained using the above-described criteria were then screened by the authors and checked for agreement. The next step was to hand-search the reference lists of original and review studies that were found to be relevant in the previous step. PDGF has a stimulatory effect on the DNA replication and chemotaxis of osteoblasts, fibroblasts, leukocytes, monocytes, neutrophils periodontal and alveolar bone cells. Proliferation of mesenchymal stem cells is also promoted by supplement treatment with PDGF. PDGF in combination with other growth factors enhances periodontal tissue repair.

Conclusions

The PDGF plays a significant role in periodontal bone and tissue regeneration.     

Analisi della cefalometria di Bimler

Objectives

A clinical case of dentoskeletal II Class with overjet and overbite increased was tracted to obtain of the physiological occlusal conditions, respecting the individual biotypological growth of the patient.

Materials and methods

During diagnosis was used the Bimler chephalometric analysis that offers angular and linear measurements of the skull profile offering morphological information (nature and seriousness of the malocclusion), biotypological notions (predominant growth direction of the face), and data about the cranial developmental harmony (vector uniformity of growth of the separate facial areas).After definung the severity of malocclusion and have understood the nature and direction of facial growth, balanced forward and downward, by means of biotypological and harmony analyses, we performed a therapeutic positional change of the jaw, advancing and post-rotating it, using the functional Bimler apparatus. The biotypological and harmony Bimler analyses confirmed that our therapeutic action would be supported, without impediments, by the facial development.

Results

After two years from the beginning of the treatment, the malocclusion had resolved with all the dentoskeletal parameters in normal, physiological ranges (as evidenced by the morphological Bimler analysis of end treatment) without modifications in the biotypological growth of the face.

Conclusions

Bimler chephalometric analysis represents a fundamental diagnostic tool for some orthodontic schools that work for the correction of dental and skeletal malocclusion by means of neurocclusal rehabilitation methods. Its advantage consists in offering a double analysis simultaneously, that is “morphological” and of “growth prevision”. More than other analysis, this cephalometric approach drives the physician, from the first measurements, to understand the maxillary growth direction, representing an interesting prognostic aid to treatment.