Gaetano Ierardo

Allergic rhinitis as a possible risk factor for malocclusion: a case-control study in children

BACKGROUND Prolonged oral respiration is known to cause postural alterations, which can lead to dental malocclusions. Allergic rhinitis, a common cause of upper airway obstruction in children, must therefore be seen as a possible risk factor in the development of malocclusions. AIM Aim of this study was to investigate the association between allergic rhinitis and malocclusions in primary and early-mixed dentition. DESIGN A case-control study was carried out involving 275 Italian children aged 5-9. The case group and the control group were composed of 125 individuals affected by malocclusions and by 150 healthy patients, respectively. Through a questionnaire, we assessed the presence of professionally diagnosed allergic rhinitis. Data were analysed to identify associations between these variables and the presence of malocclusions. RESULTS Children with a history of allergic rhinitis had a threefold increased risk to develop one or more dento-skeletal alterations [OR = 3.16; 95% CI (1.79-5.58), P < 0.001]. Statistically significant associations were found between allergic rhinitis and the development of posterior crossbite and increased overjet. No significant association was found for anterior openbite. CONCLUSIONS Allergic rhinitis is a significant risk factor for the development of malocclusions in general and is associated with the development of posterior crossbite and increased overjet.

A network approach to orthodontic diagnosis

BACKGROUND Network analysis, a recent advancement in complexity science, enables understanding of the properties of complex biological processes characterized by the interaction, adaptive regulation, and coordination of a large number of participating components. OBJECTIVE We applied network analysis to orthodontics to detect and visualize the most interconnected clinical, radiographic, and functional data pertaining to the orofacial system. MATERIALS AND METHODS The sample consisted of 104 individuals from 7 to 13 years of age in the mixed dentition phase without previous orthodontic intervention. The subjects were divided according to skeletal class; their clinical, radiographic, and functional features were represented as vertices (nodes) and links (edges) connecting them. RESULTS Class II subjects exhibited few highly connected orthodontic features (hubs), while Class III patients showed a more compact network structure characterized by strong co-occurrence of normal and abnormal clinical, functional, and radiological features. Restricting our analysis to the highest correlations, we identified critical peculiarities of Class II and Class III malocclusions. CONCLUSIONS The topology of the dentofacial system obtained by network analysis could allow orthodontists to visually evaluate and anticipate the co-occurrence of auxological anomalies during individual craniofacial growth and possibly localize reactive sites for a therapeutic approach to malocclusion.

FEM and Von Mises Analysis on Prosthetic Crowns Structural Elements: Evaluation of Different Applied Materials

The aim of this paper is to underline the mechanical properties of dental single crown prosthodontics materials in order to differentiate the possibility of using each material for typical clinical condition and masticatory load. Objective of the investigation is to highlight the stress distribution over different common dental crowns by using computer-aided design software and a three-dimensional virtual model. By using engineering systems of analyses like FEM and Von Mises investigations it has been highlighted the strength over simulated lower first premolar crowns made by chrome cobalt alloy, golden alloy, dental resin, and zirconia. The prosthodontics crown models have been created and put on simulated chewing stresses. The three-dimensional models were subjected to axial and oblique forces and both guaranteed expected results over simulated masticatory cycle. Dental resin presented the low value of fracture while high values have been recorded for the metal alloy and zirconia. Clinicians should choose the better prosthetic solution for the teeth they want to restore and replace. Both prosthetic dental crowns offer long-term success if applied following the manufacture guide limitations and suggestions.

Does a social/behavioural gradient in dental health exist among adults? A cross-sectional study:

Objective To explore the potential presence of a social/behavioural gradient in dental health among Italian adults using a cross-sectional study. Methods Caries indices were recorded among 480 subjects (52.9% men, 47.1% women) who also completed a structured self-administered social and behavioural questionnaire. A social/behavioural gradient was generated as the sum of the worst circumstances recorded on the questionnaire (cariogenic diet, smoking, lowest occupational profile, brushing teeth < twice daily, lowest educational level, uneven dental examination attendance). Results Caries figures (DMFT) and the number of filled sound teeth (FS-T) were statistically significantly linked to the social/behavioural gradient (DMFT: χ2(9) = 20.17 p = 0.02, Z = 0.02 p = 0.99; FS-T: χ2(9) = 25.68 p < 0.01, Z = −4.31 p < 0.01). DMFT was statistically significantly associated with gender and with social and behavioural variables. FS-T was higher in women (p = 0.03) and was linked to smoking (p < 0.01). Conclusions The proposed social/behavioural gradient demonstrated how subjects reporting the worst circumstances on the questionnaire exhibited the worst dental health. The use of the gradient demonstrates that health promotion and prevention cannot be compartmentalized.

Osteogenesis imperfecta and rapid maxillary expansion: Report of 3 patients

INTRODUCTION The aim of this study was to analyze the effects of orthopedic therapy with rapid maxillary expansion (RME) in growing patients affected by osteogenesis imperfecta and treated with bisphosphonates. METHODS Three boys with osteogenesis imperfecta (mean age, 10.6 years) were treated with RME. They all had treatment with quarterly intravenous infusions of bisphosphonates. They were in either the early or the late mixed dentition and had indications for RME. The expansion screw was activated twice daily until correction of the transverse relationships was achieved. The retention period with the expander in place was 6 months. In 2 Class III patients, RME was associated with the use of a facemask. In all patients, occlusal radiographs were taken at the end of active RME therapy to assess the opening of the midpalatal suture and 1 year after the end of active expansion therapy to evaluate the reossification and reorganization of the midpalatal suture. RESULTS In all patients, the opening of the midpalatal suture and the healing with reorganization of the midpalatal suture were documented with the occlusal radiographs. No complications were found after a 1-year follow-up. CONCLUSIONS In growing patients affected by osteogenesis imperfecta and treated with bisphosphonates, it is possible to perform RME with a standard protocol with no complications after a 1-year follow-up.

Today Prospects for Tissue Engineering Therapeutic Approach in Dentistry

In dental practice there is an increasing need for predictable therapeutic protocols able to regenerate tissues that, due to inflammatory or traumatic events, may suffer from loss of their function. One of the topics arising major interest in the research applied to regenerative medicine is represented by tissue engineering and, in particular, by stem cells. The study of stem cells in dentistry over the years has shown an exponential increase in literature. Adult mesenchymal stem cells have recently been isolated and characterized from tooth-related tissues and they might represent, in the near future, a new gold standard in the regeneration of all oral tissues. The aim of our review is to provide an overview on the topic reporting the current knowledge for each class of dental stem cells and to identify their potential clinical applications as therapeutic tool in various branches of dentistry.

How to manage the biological risk in a dental clinic: state of the art and future perspectives

Dental personnel (DP) may be exposed to pathogens during dental treatment, either through contact contaminated equipment, or with blood and respiratory secretion. On the other hand, health care professionals are constantly exposed to pathogens and opportunists in their work environment. Consequently, the dental healthcare environment is connected with the risk of exposure to biological agents both for patients and dental workers, and involves a wide number of microorganisms that can be present in biological matrices (gingival fluids, saliva, blood), contaminated and/or non-sanitized surfaces, water used in the dental unit, or emitted by patients suffering or carrier of a transmissible disease. The main determinants of exposure to biological agents in dentistry are related, therefore, to several factors, such as the lack in the application of disinfection/sterilization procedures for surfaces, reusable tools, water, etc.; the lack in the use of protective equipment by workers; an insufficient or inefficient training of personnel; the use of non-targeted, too diluted, or expired biocides. Therefore, each single patient needs to be treated as a potential communicable infectious disease carrier and each case must receive high level of attention in compliance with preventive and hygiene standards, following disinfection and sterilization procedures, and always wearing personal protective equipment. The goal of this article was to discuss on the infection risks related to dental practice both for patients and workers, and to evaluate the state of the art and future perspectives, with particular attention to disinfection procedures, for occupational biological hazards and HAIs prevention in this setting.

Sindrome delle Apnee Ostruttive del Sonno (OSAS): valutazione e terapia dei problemi a livello odontostomatologico

The Obstructive Sleep Apnea Syndrome (OSAS) is a breathing disorder characterized by repeated episodes of apnea/hypopnea occurring during sleep and caused by the obstruction of the upper airway. As OSAS can have a significant impact on quality of life, an early diagnosis and a multi-specialized recognition become important. Therapeutic proposals include the Mandibular Advancement Devices (MADs), intraoral devices that induce a mandibular advancement during the night to eliminate snoring and apnea. Italian guidelines on dental aspects of OSAS in adults and children focus primarily on anamnestic and clinical methods by which the dentist, in a role of epidemiological sentinel, can first identify a patient with OSAS and then participate in the therapeutic process using specific orthodontic intraoral devices.

Evaluation of the orthodontic treatment need in a paediatric sample from Southern Italy and its importance among paediatricians for improving oral health in pediatric dentistry

Background Data from epidemiological studies investigating the prevalence and severity of malocclusions in children are of great relevance to public health programs aimed at orthodontic prevention. Previous epidemiological studies focused mainly on the adolescence age group and reported a prevalence of malocclusion with a high variability, going from 32% to 93%. Aim of our study was to assess the need for orthodontic treatment in a paediatric sample from Southern Italy in order to improve awareness among paediatricians about oral health preventive strategies in pediatric dentistry. Material and Methods The study used the IOTN-DHC index to evaluate the need for orthodontic treatment for several malocclusions (overjet, reverse overjet, overbite, openbite, crossbite) in a sample of 579 children in the 2-9 years age range. Results The most frequently altered occlusal parameter was the overbite (prevalence: 24.5%), while the occlusal anomaly that most frequently presented a need for orthodontic treatment was the crossbite (8.8%). The overall prevalence of need for orthodontic treatment was of 19.3%, while 49% of the sample showed one or more altered occlusal parameters. No statistically significant difference was found between males and females. Conclusions Results from this study support the idea that the establishment of a malocclusion is a gradual process starting at an early age. Effective orthodontic prevention programs should therefore include preschool children being aware paediatricians of the importance of early first dental visit. Key words:Orthodontic treatment, malocclusion, oral health, pediatric dentistry.

Er:YAG laser for brackets bonding: a SEM study after debonding.

Background. The introduction of Er:YAG laser in dentistry for ablation of hard tissues advocated an alternative method of enamel etching for orthodontics purpose. Materials and Methods. 55 extracted human third molars were inserted in acrylic resin blocks and divided into five groups of 11 teeth. Group 1 was treated with 37% orthophosphoric acid for 30 seconds. Group 2 was treated with laser irradiation (Er:YAG Fidelius III, Fotona, Slovenia) at 80 mJ and 4 Hz. Group 3 underwent laser treatment (80 mJ, 4 Hz), followed by 37% orthophosphoric acid for 30 seconds. The teeth in Group 4 were treated with laser at 40 mJ and 10 Hz. The teeth in Group 5 were treated with laser (40 mJ, 10 Hz), followed by 37% orthophosphoric acid for 30 seconds. The adhesive remnant index was determined after debonding. Results. Kruskas-Wallis test showed that location parameters (median and mean) are significantly different between Groups 2 and 4 when compared with control group; on the contrary no significant difference was detected between Groups 3 and 5 with the controls. Conclusion. The use of Er:YAG laser alone, as in Groups 2 and 4, showed no significant advantages over phosphoric acid in the bonding procedure for orthodontics brackets.