C. Maspero

Hyper-IgE syndrome: dental implications

Hyper-IgE syndrome (HIES) is a rare multisystem disorder with both immunologic and nonimmunological features. It is characterized by extremely elevated IgE serum levels, eczema, and recurrent skin and pulmonary infections. Dental anomalies are often included, such as retention of deciduous teeth together with ectopic eruption or noneruption of permanent teeth. Severe susceptibility to caries and mycotic infections, insufficient transversal diameter of the palate, mucosal plaques, and fissures typically located on the tongue and on the palate are often present. The aim of this study was to review the literature and to report a 6-year observation of 6 patients with HIES (aged 8-39 years) with focus on their oral problems and the treatment provided. The importance of the role of the dentist both in early diagnosis of this syndrome and in monitoring oral conditions was stressed. The dentist can prevent infective complications and intercept the development of malocclusion with a reduction of the need for complex treatment.

Orthodontic-surgical treatment: neuromuscular evaluation in skeletal Class II and Class III patients.

OBJECTIVESnThe aim of this study was the evaluation of the neuromuscular response to treatment according to diagnostic phases, as a follow-up of patients under surgical orthodontic treatment. The patient sample was subdivided into sub-samples, according to clinical characteristics.nnnMATERIALS AND METHODSnAll of the patients who underwent orthognathic surgery in the Department of Orthodontics (University of Milan) were subjected to periodic electromyographic evaluation of the masticatory muscles (masseter and anterior temporal muscles), and to electrokinesiographic evaluation of the mandibular movements. The patient sample comprised 80 patients (37 males; and 43 females) at the end of growth. The electromyographic instruments used in the study included a Freely and a K6-I electromyography. Statistical evaluation was carried out with the Students t-tests for independent samples.nnnRESULTSnThere are many differences between the skeletal Class II and skeletal Class III patients that are shown through the analysis of these data obtained. In the beginning phases of the treatment the muscular activities were higher in the Class II patients than in the Class III patients. Nevertheless this difference was reversed at the end of the treatment. A similar difference could be found in the mandibular kinesiology, in fact the maximum mandibular opening movement was greater in the skeletal Class II patients than in the skeletal Class III patients at the beginning of the treatment. At the end of the treatment this difference was lost. At the beginning of the treatment the Class II patients showed a greater protrusive movement of the mandibular than the Class III patients. At the end the treatment however this gap was reduced without being reversed.nnnCONCLUSIONSnFunctional evaluation in patients in surgical orthodontic therapy is an important element in the diagnostic-therapeutic recordings, so as to reduce as much as possible any incorrect neuromuscular activity that can result in relapse.

Orthodontic-surgical treatment: neuromuscular evaluation in open and deep skeletal bite patients

BackgroundThe aim of this study was to compare electromyographic data of two groups of patients (open and deep skeletal bite) before and after surgical orthodontic treatment.MethodsAll patients who underwent orthognathic surgery at the Department of Orthodontics (University of Milan) were subjected to periodic electromyographic evaluation of the masticatory muscles (masseter and anterior temporal muscles) and to electrokinesiographic evaluation of mandibular movements. The sample comprised 72 patients (35 open skeletal bite patients and 37 deep skeletal bite patients) at the end of craniofacial growth. The electromyographic instruments used in the study included a Freely and a K6-I electromyograph. Statistical evaluation was carried out with Student’s t tests for independent samples.ResultsLots of differences between open and deep skeletal bite patients have been underlined by the analysis of the electromyographic data obtained. These results have been obtained with both electromyographic systems. Muscular activity in microvolts is higher in deep skeletal bite patients at the beginning of the treatment than in open bite ones, but during the following phases of the treatment, the two values became similar.ConclusionsMorphologic differences between open and deep bite patients can also be demonstrated by instrumental examinations, and their correction after surgical treatment is observable on electromyographic and electrognatographic exams.

A 5-year longitudinal study of survival rate and periodontal parameter changes at sites of dilacerated maxillary central incisors

BackgroundAlthough dental dilaceration disinclusion is an accepted treatment modality, few studies have evaluated the prognosis for dilacerated maxillary incisors and changes in clinical periodontal parameters still need to be demonstrated. The objectives of this study were to evaluate the prognosis and changes in clinical attachment level (CAL), probing depth (PD), and soft tissue recession (REC) for disincluded dilacerated maxillary incisors.MethodsTen impacted dilacerated teeth were scheduled for disinclusion. Five of them were disincluded with the apically repositioned flap technique and the other five with the closed eruption technique and brought into alignment with light orthodontic forces.ResultsAll the dilacerated teeth were disincluded as planned. CAL, PD, and REC were the same as natural teeth. Among the two surgical techniques, no statistically significant differences have been found.ConclusionThe choice to disinclude dilacerated central maxillary incisors reached the goals planned. Periodontal parameters obtained in a short- and long-term follow-up allow to affirm that the disinclusion of dilacerated teeth has a good survival rate.

Sagittal and vertical effects of transverse sagittal maxillary expander (TSME) in three different malocclusion groups

BackgroundThe aim of this retrospective study was to cephalometrically evaluate the skeletal and dental effects of the transverse sagittal maxillary expander (TSME), for the correction of sagittal and transverse maxillary deficiency in class I, II, and III malocclusions.MethodsThe sample for this retrospective study included 45 patients (mean age, 8.4xa0years; 26 females, 19 males; 15 skeletal class I subjects, 15 skeletal class II subjects, and 15 skeletal class III subjects) with maxillary bilateral cross-bite.For each patient, a lateral cephalogram was obtained before treatment and at the end of the retention period. Changes in the groups during the observation period were calculated, compared, and statistically analyzed with a t-test.ResultsThe cephalometric values before T0 and T1 showed significant changes.ConclusionsThe TSME can produce skeletal changes due to the transverse force and sagittal effects on the maxillary alveolar process. These modifications have benefic effects in classes I, II, and III. The data obtained in this study permit us to underline the fact that TSME can be used in all of the skeletal classes, with good vertical and sagittal results.

Titanium TSME appliance for patients allergic to nickel

AIMnThe aim of this article is to describe the use of a titanium TSME appliance for patients with allergy to resin and nickel. We aim to highlight the optimal way to avoid problems such as stomatitis and peri-labial dermatitis, which generally appear in patients who use traditional orthodontic appliances made in acrylic resin and steel.nnnMATERIALS AND METHODSnThe construction of a titanium appliance is described and a case treated with it is reported.nnnRESULTSnThe titanium TSME presented in this paper has excellent biocompatibility due to its ability to form superficial oxides, which prevent oxidation and thus corrosion.nnnCONCLUSIONnThe non-allergic properties of titanium allow to propose it as an alternative in patients with a long-term history of allergic reactions to nichel.

Orthodontic-surgical treatment and respiratory function: Rhinomanometric assessment

BACKGROUNDnSeveral correlations between morphological and/or positional alterations of the jaws and respiratory functional impairments have been reported. Nasal airway obstruction represents a critical issue with no clearly defined gold standard as for its measurement. Rhinomanometry was adopted by multiple Authors to evaluate whether patients with malocclusion developed respiratory functional changes after an orthodontic-surgical treatment. However, there are contrasting findings in the literature regarding the possibility of improving the respiratory function by means of surgically-assisted rapid palatal expansion (SARPE) or bimaxillary repositioning of the bony bases.nnnMETHODSnTen patients aged from 18 to 30 years and scheduled for orthodontic-surgical treatment of maxillary constriction volunteered as participants for this study. Orthognathic surgery consisted in: 1) SARPE in 4 patients; 2) Le Fort I down fracture combined with a bilateral sagittal split osteotomy (BSSO) in 6 patients. All patients underwent a computerized rhinomanometric test before treatment (T0) and 40 days after surgery, at the time of the inter-maxillary splint removal (T1). Specifically, all 10 patients received AAR evaluations, while 6 patients received both active anterior (AAR) and active posterior rhinomanometry (APR).nnnRESULTSnBoth AAR and APR tests showed a decrease in mean nasal resistance following the intervention. As for the AAR, a difference of 0.19 Pa/s/cm3 was found. The difference found for APR at a reference pressure of 75 Pa was 0.24 Pascal/s/cm3, while for APR at 150 Pa it was 0.20 Pa/s/cm3.nnnCONCLUSIONSnThis study helps to confirm respiratory benefits obtainable after mono and bi-maxillary orthognathic surgery.

Periodontal conditions in juvenile idiopatic arthritis.

BACKGROUNDnThe possible relationship between periodontitis and juvenile idiopathic arthritis (JIA) is now mostly unknown but there are common characteristics in these two diseases. The purpose of this study is to evaluate etanercept (Enbrel®) effects on periodontal conditions of children affected by JIA.nnnMETHODSnFor this study three group of patients were selected. The first one is represented by JIA subjects in pharmacologic therapy with etanercept (Enbrel®). The second one was composed by subjects in pharmacologic therapy with other drugs and the third one by healthy subjects. Twenty subjects for each group were selected. For each subject two periodontal scores were taken: Plaque Index and bleeding on probing. In order to check the reliability of the method a second registration has been performed in all the 3 groups after one month. A statistic Kruskal-Wallis test was performed.nnnRESULTSnThe average Plaque Index was 48% in the first group, 37% in the second group and 20% in the control group. The average Bleeding Index was 5% in the first group, 5% in the second group and 9% in the control group.nnnCONCLUSIONSnEtanercept seems to reduce periodontal inflammation in children affected by JIA as the other therapy.

Terapia ortodontico-chirurgica: protocollo virtuale 3D tramite TC cone beam

Riassunto Obiettivi Verificare la precisione di un protocollo di programmazione ortodontica prechirurgica virtuale e confrontarlo con quella di un protocollo non virtuale. Materiali e metodi Lo studio ha compreso 7 pazienti: 3 sono stati sottoposti a un protocollo di programmazione virtuale, i restanti 4 al protocollo tradizionale. Effettuate le scansioni tridimensionali dei modelli delle arcate dei pazienti, mediante un software dedicato e stata valutata l’aderenza tra le immagini digitali delle situazioni prechirurgiche e quelle dei rispettivi set-up. Sono stati inoltre considerati i valori di massima deviazione positiva e negativa, deviazione media e deviazione standard forniti dal software per le varie sovrapposizioni. Risultati L’analisi dei valori considerati non ha evidenziato differenze statisticamente significative tra le due metodiche di programmazione. Conclusioni Dallo studio si evince che l’affidabilita dei due protocolli e equiparabile. Cio che cambia e la quantita delle informazioni ricavabili, la ripetibilita della procedura e la velocita con la quale questa viene eseguita.

Considerazioni sul trattamento ortodontico nei pazienti affetti da diabete mellito: revisione della letteratura

Riassunto Obiettivi Il diabete mellito e una malattia frequente e la sua prevalenza e in costante aumento. L’odontoiatra, pertanto, dovra occuparsi sempre piu spesso della salute orale di questi pazienti. Lo scopo del lavoro e stato quello di compiere una revisione della letteratura sugli effetti che il diabete puo avere nel corso di un trattamento ortodontico. Materiali e metodi Sono stati consultati testi universitari e la banca dati Medline considerando articoli pubblicati tra il 1980 e il 2013. Risultati e conclusioni Il trattamento ortodontico nel paziente diabetico e legato alla sua salute parodontale e al controllo della malattia metabolica. Se la malattia e poco controllata, la terapia ortodontica e controindicata. Se il diabete e ben compensato, il paziente puo ricevere le cure ortodontiche a condizione che mantenga ottimi livelli di igiene orale per prevenire il danno parodontale.