Roberta Cimino

Efficacy of the Sander bite-jumping appliance in growing patients with mandibular retrusion: a randomized controlled trial

OBJECTIVES The efficacy of functional appliances remains highly debated. This randomized controlled trial investigated the skeletal and dentoalveolar effects determined by the Sander bite-jumping appliance (BJA). The null hypothesis to be tested was that the appliance would not induce supplementary mandibular growth compared to untreated controls. SETTING AND SAMPLE POPULATION This study was carried out at the Section of Orthodontics, University of Naples Federico II, Italy. Forty-six patients receiving a clinical diagnosis of skeletal and dental class II due to mandibular retrusion were either allocated to a treatment (23 patients;15 boys, 8 girls; mean age ± SD: 10.9 ± 1.3 years) or to an untreated control group (23 patients;11 boys, 12 girls; mean age ± SD: 10.5 ± 1.2 years), by using a balanced block randomization. METHODS Lateral cephalograms were taken before and after treatment and used for comparisons. Measurements were analyzed by descriptive statistics, univariate and multivariate statistical tests. RESULTS Treated individuals had a significant increase in mandibular length (6.4 ± 2.3 vs. 3.5 ± 2.5 mm; p < 0.001), overjet reduction (-5.0 ± 2.9 vs. 0.3 ± 1.2 mm; p < 0.001) and molar relationship improvement (-5.3 ± 2.4 vs. 0.1 ± 1.1 mm; p < 0.001) compared to controls. The use of the appliance did not significantly affect jaw divergence. Proclination of lower incisors was slightly greater (3.0°, p = 0.023) in treated patients than in controls. The increase in mandibular length was not significantly influenced by cervical stage (p = 0.40). CONCLUSION The BJA can effectively correct class II malocclusions by a combination of dentoalveolar and skeletal effects. The long-term stability of the correction needs to be evaluated.

Association between posterior crossbite, masticatory muscle pain, and disc displacement: a systematic review

BACKGROUND Among different malocclusions, posterior crossbite is thought to have a strong impact on the correct functioning of the masticatory system. OBJECTIVE To assess, by systematically reviewing the literature, the association between posterior crossbite and different temporomandibular disorder (TMD) diagnosis: disc displacement and masticatory muscle pain. MATERIALS AND METHODS A literature survey covering the period from January 1965 to April 2012 was performed. Two reviewers extracted the data independently and assessed the quality of the studies. RESULTS The search strategy resulted in 2919 citations, of which 43 met the inclusion criteria. The scientific and methodological quality of these studies was found to be medium-low, independently by association reported. In several studies, posterior crossbite is reported to be associated to the development of disc displacement, muscular pain, and tenderness, possibly linked to a skeletal and muscular adaptation of the stomatognathic system. However, the lack of consistency of the results reported deeply reduces the external validity of the studies, with a consequent impossibility to draw definite conclusions. CONCLUSIONS It is not possible to establish an association between posterior crossbite, muscle pain, and disc displacement because the distribution of the studies supporting or not supporting the association is similar. The consequences of posterior crossbite on the development of TMDs deserve further investigations, with high sample size, well-defined diagnostic criteria, and rigorous scientific methodologies. Finally, long-term controlled studies are needed to identify posterior crossbite as a possible risk factor for TMDs.

Myofascial pain syndrome misdiagnosed as odontogenic pain: a case report.

ABSTRACT The aim of this report is to illustrate the case of a patient whose myofascial pain syndrome was misdiagnosed as odontogenic pain, and who was treated using irreversible dental procedures. Even if dental pain commonly has an odontogenic etiology, it is also possible that pain arising from different orofacial sites such as jaw muscles, maxillary sinus, or nervous structures can be referred to the teeth. When the etiology of a dental pain condition cannot be clearly identified, it is necessary to consider all possible causes of dental pain, which may also be nonodontogenic. The need for comprehensive examination and careful diagnosis before irreversible dental treatment is emphasized.

Social impairment of individuals suffering from different types of chronic orofacial pain

BackgroundThe daily life of patients suffering from orofacial pain is considerably impaired as compared to healthy subjects. The aim of this study was to investigate the influence of different categories of orofacial pain on the habitual life of adult individuals.MethodsSeven hundred eighty-one individuals with orofacial pain were recruited from an initial sample of 1,058 patients. All the individuals were allocated to groups according to their diagnosis: myofascial pain (group A, 676 subjects, 525 females and 151 males; mean age ± SD = 35.2 ± 12.6), migraine (group B, 39 subjects, 29 females and 10 males; mean age ± SD 36.0 ± 10.7), and both myofascial pain and migraine (group C, 66 subjects, 56 females and 10 males, mean age ± SD = 35.6 ± 10.8). Characteristic pain intensity (CPI), disability days (DD), disability score (DS), and graded chronic pain intensity (GCPS) were calculated according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II. Depression and somatization (nonspecific physical symptoms) scores were also calculated.ResultsA significant association between groups and GCPS categories was found (p < 0.0001). Post hoc tests showed a significant difference between groups A and B and between A and C, but not between B and C. In group A, the most frequent GCPS score was grade II. The most frequent GCPS score in groups B and C was grade III, indicating a moderate limiting impairment. This score was more frequent in group B (41%) than in the other groups (group A = 20.6%, group C = 34.8%). GCPS grade IV was more frequent in group C (19.7%) than in the other groups. Group C had significantly higher scores for nonspecific physical symptoms than group A (p < 0.05).ConclusionsMyofascial pain and migraine sensibly affect the common daily life of adult individuals. The comorbidity of both conditions determines a major impairment.

Effect of pH on in vitro biocompatibility of orthodontic miniscrew implants

BackgroundAlthough the clinical use of miniscrews has been investigated on a large scale, little is known about their biocompatibility. Since low pH can affect corrosion resistance, the aim of this study was to evaluate the cytotoxic effect of orthodontic miniscrews in different pH conditions.MethodsFour orthodontic miniscrews of stainless steel and grade IV and grade V titanium were immersed in a pH 7 and pH 4 saline solution for 1, 7, 14, 21, 28, and 84 days. Human osteogenic sarcoma cells (U2OS), permanent human keratinocytes (HaCat), and primary human gingival fibroblasts (HGF) were exposed to eluates, and the mitochondrial dehydrogenase activity was measured after 24 h to assess the cytoxicity. The results were analyzed using the Mann-Whitney U test (P < 0.05).ResultsWhen exposed to pH 7-conditioned eluates, the cell lines showed an even greater viability than untreated cells. On the contrary, the results revealed a statistically significant decrease in U2OS, HaCat, and HGF viability after exposure to eluates obtained at pH 4. Among the cell lines tested, HGF showed the most significant decrease of mitochondrial activity. Interestingly, grade V titanium miniscrews caused highest toxic effects when immersed at pH 4.ConclusionsThe results suggested that at pH 7, all the miniscrews are biocompatible while the eluates obtained at pH 4 showed significant cytotoxicity response. Moreover, different cell lines can produce different responses to miniscrew eluates.

Oromandibular dystonia and hormonal factors: twelve years follow‐up of a case report

Oromandibular dystonia (OMD) is a focal neurological movement disorder characterized by involuntary sustained and often painful muscle contraction, usually producing repetitive movements or abnormal positions of the mouth, jaw and/or tongue. We report on a 30-year-old woman affected with OMD with a 12-year follow-up. Focal dystonia involved an involuntary activity of the lateral pterygoid muscles causing forceful jaw displacement in the maximal protrusive position. These episodes initially occurred during jaw function and increased up to an open-lock with bilateral pre-auricular pain. Dystonic spasms were absent during sleep and were reduced temporarily by sensory tricks. Treatment with botulinum toxin type A (BTX) was performed during three different sessions over a 1-year period. Electromyographic-guided BTX injections into the lateral pterygoid muscles were given with cannula electrodes. Botox reduced the involuntary activity of the muscles. Recurrence and exacerbation of dystonic symptoms occurred during the two pregnancies and completely disappeared immediately after both deliveries with prolonged symptom-free periods. During the last 8 years, the patient had a slight relapse of symptoms during flu attacks, periods of stress and during menses. The temporal pattern of these symptoms indicates a possible relationship between OMD and hormonal factors.