Fabiana Ballanti

Treatment and posttreatment skeletal effects of rapid maxillary expansion studied with low-dose computed tomography in growing subjects

INTRODUCTION The aim of this study was to apply low-dose computed tomography (CT) to evaluate treatment and posttreatment effects produced by rapid maxillary expansion (RME) at the levels of the midpalatal suture and the pterygoid processes. METHODS A sample of 17 subjects (7 boys, 10 girls; mean age, 11.2 years) was analyzed. Multi-slice CT scans were taken before RME, at the end of the active expansion phase, and after a retention period of 6 months. Statistical analysis was performed with ANOVA for repeated measures with post-hoc tests. RESULTS The amounts of opening of the midpalatal suture during the active phase of expansion were 3.01, 2.17, and 1.15 mm for the anterior, middle, and posterior suture widths, respectively. Pterygoid width also showed a statistically significant increase (1.49 mm). In the postretention period, all transverse measurements had significant decreases except for pterygoid width. CONCLUSIONS At the end of the retention phase after RME therapy, the transverse width of the midpalatal suture was similar to the pretreatment width, whereas the width between the pterygoid processes was significantly increased.

Immediate and post-retention effects of rapid maxillary expansion investigated by computed tomography in growing patients

OBJECTIVE To determine by low-dose computed tomography (CT) protocol the dental and periodontal effects of rapid maxillary expansion (RME). MATERIALS AND METHODS The sample comprised 17 subjects (7 males and 10 females), with a mean age at first observation of 11.2 years. Each patient underwent expansion of 7 mm. Multislice CT scans were taken before rapid palatal expansion (T0), at the end of the active expansion phase (T1), and after a retention period of 6 months (T2). On scanned images, measurements were performed at the dental and periodontal levels. Mean differences between measurements at T0, T1, and T2 were examined through analysis of variance (ANOVA) for repeated measures with post-hoc tests. RESULTS All interdental transverse measurements were significantly increased at both T1 and T2 with respect to T0. In the evaluation of T0-T1 changes, periodontal measurements were significant on the buccal aspect of banded teeth with a reduction in alveolar bone thickness corresponding to the mesial (-0.5 mm; P < .05) and distal (-0.4 mm; P < .05) roots of the right first molar and to the mesial root of the left first molar (-0.3 mm; P < .05). In the evaluation of overall T0-T2 changes, the lingual bone plate thickness of both first molars was found to be significantly increased (+0.6 mm; P < .05). CONCLUSIONS RME therapy induces a significant increase in the transverse dimension of the maxillary arch in growing subjects without causing permanent injury to the periodontal bony support of anchoring teeth discernible on CT imaging.

Intersession reliability of a posturo-stabilometric test, using a force platform

AIM OF THE STUDY To evaluate the intersession reliability of a posturo-stabilometric examination. METHODS Single blind clinical trial conducted in two sessions over two weeks. 44 healthy volunteers free from postural and temporomandibular disorders. All the subjects complied with the criteria for completing the study. All the subjects underwent two sessions of posturo-stabilometric examinations in different visual and mandibular conditions. Sway area, sway length and the coordinates of the center of pressure were evaluated and statistically analyzed using the Intraclass correlation coefficient (ICC). RESULTS All the posturo-stabilometric parameters seemed to have an excellent reproducibility with overall ICCs higher than 70% and good confidence intervals except for the sway area (ICC 0.422 with CI 0.283-0.560 with open eyes and ICC 0.554 with CI 0.424-0.683 with closed eyes). CONCLUSIONS The posturo-stabilometric examination carried out using a force platform has a good intrasession and intersession reliability, especially considering sway velocity, COP X and COP Y parameters. The force platform usefulness in analyzing static posture is confirmed in any medical field.

Craniofacial features of subjects with adenoid, tonsillar, or adenotonsillar hypertrophy

OBJECTIVE To analyze the craniofacial features in children with adenoid hypertrophy, tonsillar hypertrophy, and adenotonsillar hypertrophy. MATERIALS AND METHODS 20 patients with adenoid hypertrophy (AG), 20 subjects with tonsillar hypertrophy (TG) and 20 patients with adenotonsillar hypertrophy (ATG) were selected. A control group (CG) of 20 children with non-obstructive adenoids or tonsils was also obtained. Kruskal-Wallis test and Tukeys post hoc tests were used to compare the angular and linear measurements obtained from the lateral cephalograms. RESULTS No significant differences were observed between AG and CG. Conversely TG exhibited smaller ANB and OVJ values and a larger SNB value when compared to both CG and AG, larger Go-Me, Ar-Gn and Ar-Go measures and a smaller NSGn angle with respect to AG. ATG showed a smaller ANB angle in comparison with CG and AG, larger Ar-Gn and Go-Me values when compared to AG, a smaller SNB angle and a larger NSGn angle with respect to TG. CONCLUSIONS Subjects with tonsillar hypertrophy showed an increased length of the mandibular ramus, a more horizontal growth direction, an increased length of the mandibular body, a more anterior mandibular position and a smaller sagittal discrepancy between the maxilla and the mandible than subjects with adenoid hypertrophy.

Influence of activation protocol on perceived pain during rapid maxillary expansion

OBJECTIVE To investigate the influence of two different activation protocols on the timing and intensity of pain during rapid maxillary expansion (RME). MATERIALS AND METHODS A total of 112 prepubertal patients (54 males and 58 females, mean age 11.00 ± 1.80 years) with constricted maxillary arches underwent RME with two different activation protocols (group 1: one activation/day; group 2: two activations/day). Patients were provided with a numeric rating scale (NRS) and the Faces Pain Scale (FPS) to correctly assess their daily pain. RESULTS Subjects treated with RME at two activations/day reported statistically significantly greater amounts of pain than subjects treated with RME at one activation/day. Differences related to gender and skeletal maturity were found. CONCLUSION The choice of activation protocol influences the perceived pain during RME, and less daily expansion is correlated to less pain. Pain reported during RME could be influenced by skeletal maturity and gender of the subjects under treatment.

Transverse dentoskeletal features of anterior open bite in the mixed dentition a morphometric study on posteroanterior films

OBJECTIVE To apply both conventional cephalometric analysis and morphometric analysis (thin-plate spline analysis) to posteroanterior (PA) cephalograms to test the hypothesis that the dentoskeletal features of subjects with anterior open bite in the mixed dentition are no different from those of normal controls. MATERIALS AND METHODS A group of 22 white subjects (6 males, 16 females; mean age, 8.7 +/- 0.7 years) with anterior open bite (AOBG) was compared with a control group (CG) of 22 white subjects (11 males, 11 females; mean age, 9.2 +/- 0.8 years) with Class I occlusal relationships, and without anterior open bite and sucking habits. Subjects of both groups were in the mixed dentition and had no history of orthodontic treatment. Between-group statistical comparisons were performed with independent sample t-tests and permutation tests. RESULTS AOBG exhibited statistically significant shape differences with respect to CG that consisted of a transverse contraction of the zygomatic region, of the maxilla (at both skeletal and dentoalveolar levels), and of the mandible (in both condylar and gonial regions), with a downward dislocation of point menton. With conventional cephalometrics, AOBG showed a statistically significant transverse deficiency in the zygomatic region (-4.8 mm), in the maxilla at both skeletal and dentoalveolar levels (-2.0 mm and -3.0 mm, respectively), and in the mandible in both condylar and gonial regions (-3.6 mm and -4.0 mm, respectively). CONCLUSION Subjects with anterior open bite showed transverse deficiencies in the zygomatic region, in the maxilla, and in the mandible when compared with normal subjects.

Influence of the mandibular position on the active cervical range of motion of healthy subjects analyzed using an accelerometer

Abstract Objective: The aim of this study is to analyze the influence of the mandibular positions (habitual rest position, habitual maximum intercuspation, habitual maximum intercuspation with clenching, and mandibular position with cotton rolls) on the active cervical range of motion (ROM) (flexion-extension, lateroflexions, rotations) using an accelerometer in a sample of healthy subjects. Methods: A total of 21 (14 M, 7 F) healthy volunteers aged from 18 to 27 years (mean age 23.88 ± 2.34 years; mean weight 67.86 ± 11.38 kg; mean height 172.52 ± 9.00 cm) underwent a cervical range of movement examination using a 9-axis accelerometer. A one-way ANOVA analysis was performed in order to statistically evaluate the effective influence of the mandibular position on the recorded parameters. Results: The analysis showed no statistically significant differences (all p-values > 0.1) with variations smaller than three degrees among the different mandibular positions. Discussion: The mandibular position seems to have no influence on the active cervical ROM in healthy subjects. Further studies are needed to assess the usefulness of the accelerometer in the cervical analysis of temporomandibular disorder subjects.

Mandibular position influence on pilots’ postural balance analyzed under dynamic conditions

Abstract Objective: The aim of this study is to evaluate the influence of the mandibular position on the postural stability in a sample of civilian and military pilots. Methods: Twenty military pilots (males, mean age 35.15 ± 3.14 years) and 17 civilian pilots (males, mean 34.91 ± 2.15 years) were enrolled in this study and underwent a Sensory Organization Test (SOT) using the EquiTest® (NeuroCom International Inc., Clackamas, OR, USA) computerized dynamic posturography. The composite parameter was recorded and analyzed. Results: The equilibrium score (ES) recorded in centric occlusion is slightly higher than the ES recorded in mandibular rest position; civilian pilots showed ESs slightly higher than military pilots. The two-way ANOVA analysis shows these differences are not statistically significant. Discussion: The findings of this study seem to suggest that the composite parameter of the SOT is not sensitive in analyzing the influence of the stomatognathic system on the postural balance of civilian and military pilots.

Is there a correlation between nasal septum deviation and maxillary transversal deficiency? A retrospective study on prepubertal subjects

INTRODUCTION Deviated nasal septum may cause a reduction of the nasal airflow, thus, during the craniofacial development, a reduced nasal airflow could originate a chronic mouth-breathing pattern, related with moderate to severe maxillary constriction. The aim of this retrospective study is to analyze the correlation between maxillary transverse deficiency and nasal septum deviation. METHODS Frontal cephalograms were performed on 66 posterior-anterior radiographs of subjects (34M, 32F; mean age 9.95±2.50 years) with maxillary transverse deficiency and on a control group of 31 posterior-anterior radiographs of subjects (13M, 18F; 9.29±2.08 years). Angular parameters of the nasal cavities were recorded and compared between the two groups using a Students t-test. RESULTS Generally all the parameters are very similar between the two groups except for the ASY angle that differs for about the 27%; anyway the Students t-test showed no statistically significant differences between the two groups (mostly p>0.20). CONCLUSIONS This study failed to show an association between transverse maxillary deficiencies and nasal septum deviations. Moreover, no significant differences were found between the mean nasal cavities dimensions in subjects with transverse maxillary deficiency and the control group.

Long Term Therapeutic Efficacy of a Soft Monobloc Mandibular Advancement Device in Adults with Obstructive Sleep Apnea

Aim. To evaluate the long term (48 months) therapeutic efficacy of a soft monobloc mandibular advancement device in adult patients with mild or moderate obstructive sleep apnea. Methods. The study population comprised 28 patients (6 female and 22 male, mean age 52.2 ± 6.8 years) affected by obstructive sleep apnea. After a baseline medical and somnographic examination, a functional examination of the stomatognathic system, and a questionnaire focused on sleep-related qualities and a daytime somnolence, each patient received an individual device. Two follow-ups were made 6 months (T1) and 48 months (T2) after soft monobloc mandibular advancement device treatment had been initiated, and all initial examinations were repeated. Results. The statistical analysis showed a significant decrease in body mass index value between T1 and T2 (ρ = 0,012), an increase of Epworth sleepiness scale value between T1 and T2 (ρ = 0,012), and a significant improvement and decrease of apnea/hypopnea index between T0 and T1 (ρ = 0,010) and between T0 and T2 (ρ = 0,013). Conclusion. Treatment with the soft monobloc mandibular advancement device is a therapeutic solution with long term and stable effects (48 months) for patients suffering from mild or moderate obstructive sleep apnea.