Rosaria Bucci

Dental and skeletal effects of palatal expansion techniques: a systematic review of the current evidence from systematic reviews and meta-analyses

The aim was to assess the quality and to summarise the findings of the Systematic Reviews (SRs) and Meta-Analyses (MAs) on the dental and skeletal effects of maxillary expansion. Electronic and manual searches have been independently conducted by two investigators, up to February 2015. SRs and MAs on the dentoalveolar and skeletal effects of fixed expanders were included. The methodological quality was assessed using the AMSTAR (A Measurement Tool to Assess Systematic Reviews). The design of the primary studies included in each SR/MA was assessed with the LRD (Level of Research Design scoring). The evidence for each outcome was rated applying a pre-determined scale. Twelve SRs/MAs were included. The AMSTAR scores ranged from 4 to 10. Two SRs/MAs included only RCTs. The current findings from SRs/MAs support with high evidence a significant increase in the short-term of maxillary dentoalveolar transversal dimensions after Rapid Maxillary Expansion (RME). The same effect is reported with moderate evidence after Slow Maxillary Expansion (SME). However, there is moderate evidence of a non-significant difference between the two expansion modalities concerning the short-term dentoalveolar effects. With both RME and SME, significant increase of skeletal transversal dimension in the short-term is reported, and the skeletal expansion is always smaller than the dentoalveolar. Even though dental relapse to some extent is present, long-term results of the dentoalveolar effects show an increase of the transversal dimension, supported by moderate evidence for RME and low evidence for SME. Skeletal long-term effects are reported only with RME, supported by very low evidence.

Skeletal and dental effects of Class III orthopaedic treatment: a systematic review and meta-analysis

To summarise the skeletal, dental and soft tissue effects of orthopaedic treatment on growing skeletal class III patients compared with a concurrent untreated similar control group and to evaluate whether the design of the primary studies may affect the results. A literature search was performed up to the end of February 2016. No restrictions were applied concerning language and appliances. Once the quality score was assessed, a meta-analysis was performed for the appliances used in more than three studies. A moderator analysis for study design was performed. The level of evidence was evaluated by means of the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool. The search resulted in 21 papers. The quality of most of the studies was medium. Each study reported skeletal sagittal improvement and overjet correction. Fourteen studies reported a significant increase in lower facial height. Follow-up data showed slight relapses in about 15% of patients. Meta-analyses were performed for the facemask and chin cup. The two appliances were efficient for correcting the sagittal discrepancy, increasing the divergence. In the analysis for study design, the retrospective studies showed a more efficient appliance than RCTs for 6 of 13 variables. The level of evidence was between very low and moderate. There is very low to low evidence that orthopaedic treatment is effective in the correction of Class III skeletal discrepancies and moderate evidence for the correction of the overjet. A common side effect is mandibular clockwise rotation in older subjects.

Does clinical experience affect the reproducibility of cervical vertebrae maturation method

OBJECTIVE To assess interobserver and intraobserver reproducibility of the cervical vertebrae maturation method (CVMM) among three panels of judges with different levels of orthodontic experience (OE). MATERIALS AND METHODS Fifty individual lateral cephalograms of good quality with complete visualization of cervical vertebrae 1 to 4 were selected. Thirty clinicians, divided according to their OE into three groups (junior group, JU, OE ≤ 1 year; postgraduate group, PG, 2 ≤ OE ≤ 4 years; specialist group, SP, OE ≥ 7 years), evaluated the cephalograms in two sessions (T1 and T2) at 3 weeks apart. Kendalls W and weighted Cohens kappa (κ) coefficients were performed to assess interobserver and intraobserver agreement. The level of significance was set as P < .05. For both the interobserver and the intraobserver datasets, the percentage of perfect agreement (PPA) and the number of stages apart for each disagreement were calculated. RESULTS Kendalls W at T1 was SP  =  0.61, PG  =  0.70, and JU  =  0.87; at T2 it was SP  =  0.78, PG  =  0.85, and JU  =  0.86. The percentage of total interobserver perfect agreement (Inter-PPA) was 42.3% at T1 and 46.3% at T2. The JU group had the highest Cohens κ coefficient at 0.78, while the PG and SP had coefficients of 0.64 each. The percentage of total intraobserver perfect agreement (Intra-PPA) was 54.2%. CONCLUSIONS The reproducibility of the method was not improved by the level of orthodontic experience. The group with the lowest level of orthodontic experience had the best performance.

Erratum to: Evaluation of masticatory muscle activity in patients with unilateral posterior crossbite before and after rapid maxillary expansion

Objectives The relationship between unilateral posterior crossbite (UPCB) and the possible asymmetric activation of the jaw muscles in children is still under debate. This study aimed at evaluating the jaw muscle activity of children with UPCB before and after rapid maxillary expansion (RME) by means of surface electromyography and a standardized sampling protocol. Subjects and methods Twenty-nine children with UPCB (UPCB-group, mean age 9.6 ± 1.6 years) and 40 UPCB-free controls (Control-group, 10.5 ± 1.1) were recruited. The activity of the left and right anterior temporalis (AT) and superficial masseter muscles (MM) was recorded during maximum voluntary clenching and a chewing task (T0). In the UPCB-group, data were collected, also, after the correction of the UPCB with RME (T1) and 6 months later (T2), without any further treatment. Electromyographic indices comparing the activity of paired muscle were computed via software to estimate the extent of asymmetric AT and MM activity. Paired and unpaired t-test or Wilcoxon-signed rank and Mann-Whitney U test, ANOVA or Friedman test and chi-squared test were used in the statistical analysis. Results Both groups presented with asymmetric activity of the muscles, which did not differ between groups (T0, all P > 0.05). The treatment determined a decrease in muscular activity (T1, P = 0.040), and a more asymmetric pattern of muscle activation during chewing (T1, P = 0.040), which returned similar to baseline values at T2 (all P > 0.05). Conclusions UPCB does not contribute to an asymmetric activation of AT and MM during functional tasks. The treatment of UPCB by RME did not determine a more symmetric activity of the assessed muscles.

Orthodontic management of congenitally missing maxillary lateral incisors: a case report.

This case report describes the orthodontic treatment of a woman, aged 15 years, with permanent dentition, brachyfacial typology, with congenitally missing maxillary lateral incisors. Multibracket straightwire fixed appliance was used to open the space for dental implant placement, and treat the impaired occlusion. The missing lateral incisors were substituted with oral implants.