Michele Tepedino

A comparative study of two different clear aligner systems

BackgroundThis study aims to compare the ‘Nuvola®’ system with ‘Fantasmino®’ system, examine their material properties, and define the indications for use of the aligners.MethodsTwo groups of patients were selected and were respectively treated with Nuvola® aligner and Fantasmino® system.ResultsThe goal of treatment has been achieved with the two systems.ConclusionsThe two types of aligners have shown differences during the treatment. Fantasmino® system has elastic properties of high performance, but its size does not encourage compliance throughout the day. Nuvola® system determines good tooth movement and its size facilitates the patient’s collaboration. In both aligner systems, difficulties were found in the correction of torque information and rotations.

Maxillary canine–first premolar bilateral transposition in a Class III patient: A case report

Tooth transposition is a rare dental anomaly that often represents a challenge for the clinician. The case of a girl with skeletal Class III malocclusion and concomitant maxillary canine-first premolar bilateral transposition, followed from 7 to 17 years of age, is presented. After a first phase of treatment aimed at resolving the Class III malocclusion, the transposition was maintained and the case finalized with a multibracket appliance.

Orthodontic management of bilateral maxillary canine-first premolar transposition and bilateral agenesis of maxillary lateral incisors: a case report

INTRODUCTION: Maxillary canine-first premolar transposition (Mx.C.P1) is an uncommon dental positional anomaly that may create many orthodontic problems from both esthetic and functional points of view. OBJECTIVE: In this report we show the orthodontic management of a case of Mx.C.P1 associated with bilateral maxillary lateral incisor agenesis and unilateral mandibular second premolar agenesis METHODS: The patient was treated with a multibracket appliance and the extraction of the lower premolar. RESULTS: treatment was completed without the need for any prosthetic replacement.

An adolescent treated with rapid maxillary expansion presenting with strabismus: a case report

IntroductionFew in vivo studies have investigated the effect of maxillary expansion on strabismus; however, some in vitro studies hypothesized that changes in the palatal width obtained with rapid maxillary expansion appliances could involve other bone structures that contain blood vessels and nerves conveying to the orbital cavity. The present case report seems to support that hypothesis, even if no analysis of pathogenetic mechanisms could be drawn.Case presentationWe present the case of a 14-year-old Caucasian girl affected by strabismus and referred for the treatment of a class III malocclusion with transverse maxillary deficiency, which was corrected by the application of a rapid maxillary expansion appliance (Haas type). At 2 months follow-up, the patient, who had not undergone any ophthalmologic treatment, was submitted to an ophthalmologic examination that revealed a marked change in the vision defect, which slightly relapsed at 6 months.ConclusionsThe results of our clinical evaluation showed a remarkable modification of the oculomotor system of our patient as an outcome of the rapid maxillary expansion.Further studies are needed to clarify these findings and to investigate the clinical implications of these observations.

Comparative evaluation of insertion torque and mechanical stability for self-tapping and self-drilling orthodontic miniscrews – an in vitro study

BackgroundThe aim of the present study was to evaluate the relationship between insertion torque and stability of miniscrews in terms of resistance against dislocation, then comparing a self-tapping screw with a self-drilling one.MethodsInsertion torque was measured during placement of 30 self-drilling and 31 self-tapping stainless steel miniscrews (Leone SpA, Sesto Fiorentino, Italy) in synthetic bone blocks. Then, an increasing pulling force was applied at an angle of 90° and 45°, and the displacement of the miniscrews was recorded.ResultsThe statistical analysis showed a statistically significant difference between the mean Maximum Insertion Torque (MIT) observed in the two groups and showed that force angulation and MIT have a statistically significant effect on miniscrews stability. For both the miniscrews, an angle of 90° between miniscrew and loading force is preferable in terms of stability.ConclusionsThe tested self-drilling orthodontic miniscrews showed higher MIT and greater resistance against dislocation than the self-tapping ones.

Predictable method to deliver physiologic force for extrusion of palatally impacted maxillary canines

Introduction Orthodontic treatment of palatally impacted maxillary canines raises many difficulties; to minimize complications, careful planning of orthodontic extrusion and the use of physiologic force are crucial. The aim of this study was to quantitatively evaluate a simple and reproducible system for orthodontic extrusion of impacted canines that can provide the correct amount of force. Methods Ten specimens were constructed, consisting of a cantilever made with a 0.6‐mm or 0.7‐mm stainless steel wire modeled around a transpalatal bar with 3, 5, or 7 loops in the shape of a helical torsion spring. A mechanical testing machine was used to measure the force produced by the cantilever at 3, 6, 9, 12, and 15 mm of activation. Results The force values ranged from 1.24 ± 0.13 N for the 0.7‐mm wire with 3 loops to 0.48 ± 0.04 N for the 0.6‐mm wire with 7 loops. The forces measured for the 0.6‐mm wire with 3 loops and the 0.7‐mm wire with 7 loops were similar at 15 mm of deflection. Conclusions The proposed system has a simple and robust design, is easy to construct and manage, and can provide the desired amount of force by changing the wire diameter and number of loops. Graphical abstract Figure. No caption available. HighlightsFew studies have evaluated the force used by devices for maxillary canine extrusion.The appliance uses a stainless steel cantilever arm with a helical torsion spring.Changing the wire diameter and the number of loops produces different forces.Physiologic force values below the recommended 0.6 N can be predictably reached.This device is simple, economical, easy to manage, stiff, and resistant to breakage.

Longitudinal effects of rapid maxillary expansion on masticatory muscles activity

Background To investigate the modifications induced by rapid maxillary expansion (RME) on the electromyographic (EMG) activities of the anterior temporal and superficial masseter muscles, in patients without pre-treatment EMG alterations. Material and Methods Twenty-one patients with unilateral posterior cross-bite selected from the orthodontic department of the University of L’Aquila (Italy), were enrolled. There was no control group in this study since each subject acted as a control of her/himself. Two surface EMG recordings were taken: T0 (before RME) and at T1 (3 month after the end of expansion). To verify the neuromuscular equilibrium, the EMG activities of both right and left masseter and anterior temporal muscles were recorded during a test of maximum clench. EMG indexes were compared by paired Student’s t-test. Results In both occasions, all indices showed a good symmetry between the right and left side masticatory muscles. No statistically significant differences were found between the two recordings. Conclusions In children without pre-treatment EMG alterations, no variations in standardized muscular activity after RME were found. The treatment did not alter the equilibrium of the masseter and temporal muscles. Key words:Rapid maxillary expansion, electromyography, masticatory muscles.

Post-orthodontic position of lower incisors and gingival recession: A retrospective study

Background To evaluate if changes in lower incisor position following orthodontic treatment are correlated with development of gingival recessions. Material and Methods Pre- and post-treatment digital models and lateral cephalograms of 22 subjects were collected retrospectively. The clinical crown length, gingival scallop, and papilla height of the central lower incisor were measured along with the cephalometric incisor’s inclination, the distance from the mandibular plane, and the distance between the Infradentale and Menton points. Statistical correlations between gingival and cephalometric variables were studied. In addition, two groups were defined based on the post-treatment incisor inclination value (‘normal’ or ‘proclined’) and compared. Results The incisor inclination was correlated with the change in gingival scallop and papilla height. Moreover, there was a statistically significant difference in clinical crown height and gingival scallop between the ‘normal’ group and the ‘proclined’ group. Conclusions Changes in lower incisor position, especially an excessive proclination, after orthodontic treatment may play a role in the development of gingival recession. Key words:Orthodontic treatment, Incisor inclination, IMPA, Gingival recession, Alveolar bone.

Post-orthodontic lower incisor inclination and gingival recession—a systematic review

BackgroundThe present systematic review was carried out to determine the correlation between gingival recession/bone height and incisor inclination in non-growing post-orthodontic patients compared to adult untreated subjects or patients treated with different methodologies.Materials and methodsPubMed, EMBASE, Web of Science, Scopus, Cochrane, and OpenGrey databases were searched without time and language restriction. Search terms included orthodontic, incisor, inclination, angulation, proclination, and gingival. Articles involving human participants and adult subjects receiving orthodontic treatment with fixed appliance, having incisors position, bone height and/or gingival recessions evaluated pre- and post-treatment were included. Two authors independently extracted data using predefined forms. Risk of bias in individual studies was assessed with the Newcastle-Ottawa Scale.ResultsTwo observational studies were included in the qualitative analysis. The heterogeneity in outcome assessment among the studies did not allow performing a meta-analysis. The two studies, while observing some effects of orthodontic treatment on the development of gingival recession, reported that these effects were not statistically or clinically significant.ConclusionsThere is no strong scientific evidence concluding that proclination of incisors by means of fixed orthodontic appliances can affect periodontal health. Further prospective studies are required to elucidate this statement.ProtocolPROSPERO database registration number CRD42016042369.

Movement of anterior teeth using clear aligners: a three-dimensional, retrospective evaluation

BackgroundClear aligner treatment offers several advantages, but the available literature shows that some kind of tooth movements are unpredictable. In addition, the majority of the studies are focused on one clear aligner system, while different characteristics of various systems can provide different treatment outcomes. The aim of the present retrospective cohort study was to evaluate the predictability of Nuvola® aligner system in achieving torque movements of anterior teeth.MethodsThirty-nine adult patients, who were consecutively treated with clear aligners, were retrospectively selected, and digital models pre-treatment (T0), post-treatment (T1) and the digital setup models (TS) were collected. Only the first phase of treatment made of 12 aligners was considered for the present study. Torque of anterior teeth was measured as labiolingual inclination on digital models at T0, T1, and TS using VAM software. Any difference between the predicted and achieved torque movements was evaluated using Wilcoxon signed-rank test or paired sample t test. First-type error was set as p < 0.008.ResultsNo statistically significant difference was found for all the anterior teeth between predicted and achieved torque movements.ConclusionsThe studied clear aligner system was able to produce clinical outcomes comparable to the planning of the digital setup relative to torque movements of the anterior teeth.