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Orthodontics

Smiling to rheumatoid arthritis: how an a TC Cone Beam (baseline and after 2 years), analysis
appropriate diagnostic iter can allow to treat of clinical signs and symptoms with diagnostic tests
orthodontic and gnathologic problems ultrasound-specific radiographic. 5) preventive-
therapeutic approach, local and systemic therapy,
Albertini Paolo, Bassani Luca, Martintoni Alessandro, correction of parafunctions, targeted physiotherapy,
Ciuffreda Claudio, Korolija Sofija, Gastaldi Giorgio, Manuelli gnathological therapy, orthodontic treatment, arthro-
Maurizio, Lucchese Alessandra centesis, maxillo-facial surgery.
Results: The protocol adopted by us represents a valid
Department of Orthodontics, Unit of Dentistry, Vita-Salute San aid for the prevention of functional problems tem-
Raffaele University, IRCSS, San Raffaele Hospital, Milan, Italy poromandibular joint (atm) in patients with juvenile
rheumatoid arthritis. No statistically significant cor-
Aim: Rheumatoid arthritis is a chronic, systemic and relation was found between symptoms reported by
debilitating inflammatory disease, with no clear etio- patients and detected clinical signs. No statistically
logy, but probably of autoimmune origin. It predomi- significant correlation was foundbetween clinical si-
nantly affects symmetrical joints, but also tendons, gns detected by the visit and structural alterations
synovium joints, muscles, bags and other tissues. The highlighted radiographically.
onset is observed mainly at the end of adolescence or Conclusion: This protocol is easy to use for orthodon-
between 4th and 5th decade of life; a second peak is tists, gnathologists, rheumatologists, radiologists,
observed between 60 and 70 years. An early variant pediatricians and primary care physicians who can
of RA is made by rheumatoid arthritis childhood. The perform an early diagnosis of functional problems
objective is to develop a protocol by a ‘multi-speciali- temporomandibular joint and is also be extended to
zed medical team in order to allow an early diagnosis asymptomatic patients juvenile rheumatoid arthritis.
of the temporo-mandibular functional problems in
patients affected by ARG.
Method: There have been 497 visits to specialists gna- Smiling to severe Class II malocclusion: the
thological, orthodontic and rheumatologic, during influence of Twin Block therapy on mandibular
which the clinical signs and symptoms present with growth
diagnostic ultrasound findings were analyzed and
Specific radiographers. Necessary step in the scree- Albertini Paolo, Marcolina Marta, Lucchese Carlotta,
ning phase for all patients: 1) visit pediatric rheuma- Gastaldi Giorgio, Lucchese Alessandra, Gherlone Enrico
tology , physical examination, identification of the risk
factors involved in TMJ. 2) power Doppler ultrasound Department of Orthodontics, Unit of Dentistry, Vita-Salute San
study of atm (contextual to the visit rheumatologic) is Raffaele University, IRCSS, San Raffaele Hospital, Milan, Italy
able to: identify synovitis , study the translation of the
condyles. 3) visit orthognathic, extraoral inspection Aim: The aim of this clinical study was to evaluate the
(profile, symmetry) and intraoral (type of occlusion), treatment skeletal effects induced by Twin Block in the
palpation (masticatory and neck muscles and joint therapy of Class II malocclusion during or slightly after
capsule), loading (to detect indirect signs of no ap- the onset of the pubertal peak in the growth velocity.
preciable muscles EO). 4) X-ray examinations targeted Method: The study sample was obtained from the re-
at atm only if suspect a pathological picture making cords of the author’s private practice and consisted

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Poster presentations - Orthodontics

of a parent sample of 70 Class II division 1 subjects **Dental School, Vita- Salute San Raffaele University, Milan, Italy
treated consecutively with the Twin-block appliance,
from whom good quality lateral cephalograms were Aim: One of the most frequent problems in Orthodon-
available. From this sample, 30 subjects (Study Sam- tics is Class II malocclusion for this reason the For-
ple) 15 males and 15 females, were selected accor- susTM Fatigue Resistant Device has become increasin-
ding to the following inclusion criteria: ANB greater gly popular between orthodontists. A recent survey
than or equal to 4°, full Class II or end-to-end molar reported that 26% of american orthodontists use
relationships, no history of previous orthodontic tre- Forsus routinely to treat Class II malocclusion. Clinical
atment or surgery treatment, absence of congenital effectiveness of the Forsus has been proved by the
anomalies, same caucasian race. All patients recei- literature, and the no-compliance nature of this ap-
ved active treatment with Twin-block before or du- pliance can explain its rising use among orthodontist.
ring their pubertal growth spurt, as assessed by the As for all fixed appliance, breakages and minor pro-
cervical vertebral maturation (CVM) method. Lateral blems may occur. The aim of this essay is to provide a
cephalograms for each subject was digitized by a sin- clinical report of a comprehensive series of problems
gle author (AL) respectively at time 1 (T1), immedia- that can occur when using the Forsus appliance. Solu-
tely before treatment, (mean age 10.0± 1.1years) and tions are reported for each complication. The second
at time 2 (T2) immediately after treatment (mean age aim is to analyze the relevant aspect of the patients’
12.0 ± 1.1 years). The error of the method was calcula- experiences and the detection of the acceptance.
ted with the formula described by Dahlberg (1940). In Method: The clinical management of the Forsus ap-
addition systematic error and the coefficient of relia- pliance to correct Class II dental relationships, was
bility were determined as suggested by Houston. 
The analyzed for 120 consecutively treated patients at
Control Group consisted of untreated Class II subjects. University Vita Salute, San Raffaele Hospital, Milan,
A modification of the Twin-block appliance, original- Italy. The Forsus was used five months on average and
ly developed by Clark, was used in this study. In the pictures and clinical record were registered each time
present study the mean duration of the Twin -block a patient had a problem. All minor and major pro-
treatment was 1.2 ± 0.5 years. blems related to the Forsus were recorded and each
Results: The statistical comparisons between Study patient filled a Wong Backer formulary and also a
Sample (treated subjects) and Control Group (untrea- five-point Likert scale was used to investigate the pa-
ted subject) during the T1–T2 observation showed si- tients’ feedback and level of acceptance.
gnificantly favourable changes: the total mandibular Results: The most common problem (22%) was bre-
length (Co-Me) and ramus height (Co-Go) and cor- akage of the appliance. Breakage could occur as de-
pus length (Go-Me) increased more in cases than in bonding of the lower first premolars or as unsoldering
controls. Our results show a significantly higher ave- of the tube of the upper first molar band. Upper bands
rage answer in the Study Sample, both in the paired need to be changed. Lower premolar debonding could
t- test, comparing pre and post treatment, and in the be prevented with an extra layer of flow composite
unpaired t- test, comparing the Study Sample and the surrounding the bracket base. The same solution was
Control Group. Paired T-test data for the variables possible to repair the appliance in the mouth. 18 %
Co-Me, Co- Go, Go- Me, with a P = 0.05 significance of the patients experienced the lesion of the cheek
level, lead us to reject the null hypothesis (differences mucosa. In four cases it was necessary to tempora-
average = 0) in favour of the alternative of a positive rily remove the appliance from the mouth to allow
differences average, meaning that the average of the for healing. A soft cotton pad used as “wax” was an
values is higher after the treatment. effective solution to allow mucosa recovery. A minor
Conclusion: The Twin Block appliance showed a higher problem (4%) was deformation of the spring modu-
increase of mandibular growth in the Study Sample le due to fatigue. Deformation can lead to enhanced
than in the Control Group, but the most important friction between the spring module and the push rod
parameter to use this appliance is the pubertal peak module, that make it hard for the patient to open and
and its influence on the growth. close the mouth. The solution is to change the spring
module. There was also a significative correspondence
with complications and the increase of pain reveled
The Forsus appliance: most frequent on the Wong Baker faces scale by the patients and
complications and clinical tips also the results of the Likert scale were coherent.
Conclusion: The ForsusTM Fatigue Resistant Device can
Bassani Luca*,**, Albertini Paolo*,**, Visone Ada*, Nardi be effectively managed to allow a full effective cor-
Nicola*,**, Caldara Giulia*,**, Lucchese Alessandra*, rection of Class II malocclusions. A comprehensive list
Gherlone Enrico* of precautions to prevent problems and acts to re-
pair breakage was presented to decrease the pain and
*Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy discomfort for the patients, showing the importance

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XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

of a stable and long lasting appliance in the patients’ perimplant soft tissues; limited distance between the
experience. centre of resistance of the mini implants; application
point of the force and the correct placement procedure.

Orthodontic anchorage with mini implants:


clinical tips Bone depth and cortical bone thickness of
mandibular buccal shelf for miniscrew insertion: a
Bassani Luca*,**, Albertini Paolo*,**, Nardi Nicola*,**, Liguori CBCT study
Alessandra*,**, Manuelli Maurizio*, Lucchese Alessandra*,
Gherlone Enrico* Nucera Riccardo, Bellocchio Angela Mirea, Lo Giudice
Antonino, Spinuzza Paola, Longo Vanessa, Fastuca
*Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy Rosamaria, Cassarà Federico, Portelli Marco, Militi Angela,
*Dental School, Vita- Salute San Raffaele University, Milan, Italy Cordasco Giancarlo

Aim: Mini-implants are becoming a frequent choice in Department of Biomedical and Dental Sciences and Morphofunctional
orthodontics. They can represent a helpful anchorage Imaging - Section of Orthodontics, School of Dentistry, University of
device as a substitute for more traditional techniques Messina
requiring patient collaboration. Titanium mini implants
are frequently used for their qualities like versatility, Aim: The aim of this study was to evaluate buccal bone
small size, low cost and the ease in positioning and re- thickness, bone depth and cortical thickness of mandi-
moval; with this system osteointegration is not necessa- bular buccal shelf (MBS) to evaluate the most suitable
ry and it can be used for a large range of orthodontical sites for mini-screw insertion in this area.
procedures. The use of mini implants is indicated for Methods: The sample included CBCT records of 30 adult
sagittal movements (retrusion/protraction) and for ver- Caucasian subjects (mean age 30.9±7.0) retrospectively
tical movements (intrusion/extrusion). The aim of this evaluated. All CBCT examinations were performed with
poster is to demonstrate the clinical usage and show i-CAT CBCT scanner (Imaging Sciences International,
the benefits of mini implants in a 46-year-old female Hatfield, Pa) setting the acquisition parameters as fol-
patient with a severely compromised dentature. lows: 120 kV, 5mA, 4s to 6s exposure time. Each exam
Method: Titanium mini-implants were placed between was converted into DICOM format and processed with
the maxillary second premolar and first molar (2R=2mm OsiriX Medical Imaging software. Proper view sections
and lenght= 7mm). The loss of lower premolars and mo- of MBS were obtained for quantitative and qualitative
lars often bring to supereruption of the maxillar antago- bone characteristics assessment. The methodology in-
nist teeth causing insufficient space for the prosthetic cluded the identification of the vestibular cement-ena-
rehabilitation. In this situation the possible treatments mel junction (CEJ) on each considered scan view root
are odonoplasty of the extruded teeth with the neces- section. Evaluation of the buccal total bone thickness
sary endodontic treatment, maxillary impaction surge- was performed on two horizontal reference lines apical-
ry or orthodontic treatment. In this case report (T1 at ly dislocated at 6mm (TotThick-at-6) and 11mm (TotTick-
6 months distance from T0, and T0 at the moment of at-11) from the CEJ. The evaluation of Apico -coronal
mini- screws placement) is shown the situation of an total bone depth (cortical + medullary bone) and cor-
adult patient requiring the intrusion of the first maxillar tical coronal bone depth was measured on two vertical
molar to obtain enough space for a removable prosthe- reference lines buccally dislocated at 4mm (TotDepth-
sis in the fourth sector. Furthermore, in this case the at-4 and CortDepth-at-4) and 6mm (TotDepth-at-6 and
utility of the mini implants to obtain a reduction of the CortDepth-at-6) from the CEJ. A set of 8 measurements
upper incisor protrusion is demonstrated. was taken for each scan root plane assessing the total
Results: The mini implant allows the intrusion and the and cortical bone depth (at 4 and 6mm from CEJ) and
backward movement of the maxillary anterior teeth. This buccal (at 6 and 11mm from CEJ) bone thickness.
treatment allows a high preservation of dental structu- Results: At the MBS area, mesial and distal second mo-
res and a restoration of the mandibular dentition. lars roots scan sections showed enough buccal bone for
The patient obtained with this technique a safety and mini-screw insertion. The mesial root of second man-
proper solution to her denture serious problems. dibular molar showed at 4 and 6mm an average bone
Conclusion: Mini implants used as temporary devices du- depth of 18.51mm and 14.14mm respectively. The distal
ring orthodontic therapy are a solution in many diffe- root of second mandibular molar showed, for the same
rent clinical situations. - Immediate loading of these parameters, values of 19.91mm and 16.5 mm. All sites
devices with slight force is not a cause of their failure. showed cortical bone depth thickness greater that 2mm.
- Stability of the mini implants can be obtained throu- Conclusion: Specific sites of MBS offer enough bone
gh: good bone quality (adequate cortical bone thickness quantity and adequate bone quality for mini-screw in-
and high trabecolar bone density); absence of inflamed sertion. The best insertion site with the optimal anato-

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mic characteristics is the buccal bone corresponding Inspiratory Flow or PNIF) and olfactory tests (Nez du
to the distal root of second molar; with screw inser- Vin Test, Threshold Test with Sniffin’ Sticks®) before
tion 4mm buccally dislocated to the cementoenamel (T0), after rapid maxillary expansion or after 30 days
junction. Considering the amount of cortical bone for the control group (T1) and after 6 months from
thickness in MBS area, pre-drilling is always recom- the second evaluation (T2). They were also submitted
mended in order to avoid high insertion torque. the SNOT-22 Questionnaire, to exclude symptoms that
could distort the tests. The average expansion of the
study group treated with RME was of 6,04 ± 1,07 mm
Rhinologic effects of rapid maxillary expansion (range 5-8 mm) with an average of 30,18 ± 5,33 total
in pediatric age activations of the screw (range 25-40).
Results: The Wilcoxon-Mann-Whitney test, with a
Borghetto G.*, Cicognini C.*, Volpato A.*, Balian A.*, 95% confidence interval, was used to identify if the
Maculan P.**, Favero R.*, Ottaviano G.**, Favero L.* changes of PNIF, AAR and Threshold values between
T0, T1 and T2 and between the two groups showed a
*Department of Neurosciences, Section of Dentistry, University of statistically significant change. Results show a stati-
Padova, Italy stically significant increase in PNIF values in treated
**Department of Neurosciences, Section of Otolaryngology, patients compared to the control group (p=0.003)
University of Padova, Italy at T0, which is even more evident six months after
RME (p=0.0005). This improvement is not shown by
Aim: Maxillary hypoplasia has been often correlated to AAR values at both times (p=0.170 and p=0.205 re-
a structural deficit of nasal cavities that means ob- spectively). Even Threshold Test results don’t show
struction of upper airways and diminution of respi- an improvement of olfactory function immediately
ratory capacity. Many studies in the Literature have after RME (p=0.154), but significantly increase at T2
shown an improvement of respiratory function after (p=0.0005).
Rapid Maxillary Expansion (RME) that is considered Conclusion: RME significantly improves the respiratory
a well-founded technique for posterior crossbite cor- capacity of treated patients measured by PNIF. At six
rection, typical expression of maxillary hypoplasia. A months from RME treatment is also evident an impro-
recent pilot study has also described an improvement vement in olfactory function, measured by Threshold
of olfactory function six months after the treatment. subtest. AAR however does not show a significant im-
The aim of this study is to evaluate the effects indu- provement of nasal patency. Further studies based on
ced by RME therapy, used as an early treatment of larger series should be performed in order to evaluate
skeletal crossbite, on nasal respiratory and olfactory if also AAR could show any improvement after the
function, comparing treated patients with a control treatment.
group similar for age, growth stage (prepubertal) and
transversal skeletal deficiency.
Methods: We selected 22 consecutive patients aged Rhinofibroscopic evaluation of patients with
6-11 years old (mean age 8,27 ± 1,41) that presented maxillary contraction treated with rapid
unilateral or bilateral posterior crossbite, transversal maxillary expansion. A prospective pilot study
discrepancy ≥ 4 mm between upper jaw and mandible
and needed rapid maxillary expansion as initial phase Cammarata Silvia*, Giugno Francesca M.D.*, Di Vece Luca**,
of interceptive treatment. The subjects were selected Doldo Tiziana***
regardless of sex, social class or race, with the following
exclusion criteria: genetic disease or congenital syn- *DDS, University of Siena, Siena, Italy
dromes; systemic diseases; periodontal disease; ENT **DDS, PhD student Department of Medical Biotechnologies,
diseases; bad habits and mouth breathing; previous University of Siena , Siena, Italy
orthodontic treatment. All patients were in mixed or ***MD, DDS, Researcher, Department of Medical Biotechnologies,
early permanent dentition phase, with the first upper University of SienaSiena, Italy
molars fully erupted and in prepubertal phase (sta-
ge CS1-CS2) according to CVM method. The subjects Aim: The aim of this study was to evaluate through
were randomized into two groups: the study group (11 nasal fiberoptic endoscopy the patency of upper nasal
subjects; 8 males and 3 females; mean age 8,27 ± 1,62 airways in patients treated with rapid palatal expan-
years), has undertaken the RME; the control group (11 sion.
subjects; 3 males and 8 females; mean age 8,27 ± Methods: A sample of 34 Caucasian Children aged 7-11
1,25 years), remained under observation for the pe- years old and needing a RME treatment was selected.
riod of the study, and was subsequently treated. All They all presented mixed dentition uni- or bilateral po-
the patients have been subjected to respiratory tests sterior crossbite involving at least deciduous canines
(Active Anterior Rhinomanometry or AAR, Peak Nasal and permanent first molars. Only 30 patients (12 males

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XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

and 18 females) were fitting the study purpose: 3 fai- Correlation between the incisors axis inclination
led to return after initial records and 1 had the RME and the exposure of the vermilion
removed prematurely. The selected subjects underwent
orthodontic as well as ear, nose and throat (ENT) exa- Candida E.* Summa S.** D’Apolito I.** Strappa C.* Deli R.***
minations (T0). An experienced ENT specialist perfor-
med nasopharingoscopy before (T0) and after the rapid *CLMOPD Students in Catholic University of Sacred Heart, Rome
palatal expansion (T1). The examination was accompli- **PhD Programme in Cellular and Molecular Clinical Research in
shed by using a flexible fiberoptic nasopharyngoscopy, Dental Deseases
which was pushed along the floor of the decongested ***CLMOPD full professor in Catholic University of Sacred Heart,
nasal passage and reached the nasopharinx under to- Rome
pical anesthesia. The amount of nasopharynx obstruc-
tion was quantified with reference to the full choanal Aim: the enhancement of the lips through cosmetic
surface and the following 4 grades were defined: techniques is a popular procedure. In literature the-
Grade 0 = 0-25% of choanal surface obstructed re are not many studies which demonstrate all the
Grade 1 = 25-50% of choanal surface obstructed aspects that influence this area which is so impor-
Grade 2 = 50-75 % of choanal surface obstructed tant for patients. Orthodontic biomechanics related
Grade 3 = 75-100 % of choanal surface obstructed to the incisors axis correction can change the patient
Rapid maxillary expansion was realized using a Hyrax- aesthetic perception in this area of the face. The aim
type rapid expander cemented on first permanent of this study is to investigate the possible correlation
molars. The activation protocol involved one quarter between the incisors’ axis and the exposure of the
of turn (0.25) in the morning and one quarter in the vermilion area.
evening for the first 2 weeks, then 1 activation a day Methods: For this study, 26 patients aged 8-11 years old
until the upper molar palatal cusps were in contact have been selected from the Orthodontic Department
with the lower molar buccal cusps. The amount of na- of the Policlinico Gemelli in Rome. The selection cri-
sopharynx obstructionwas quantified with reference terion of the study was the presence of an overjet
to the full choanal surface using the Wilcoxon Sig- between 0 and 12 mm. Three-dimensional images
ned Rank test. The statistical significance of the cor- were acquired with a stereophotogrammetric techni-
relation between T0-T1 differences in the amount of que (3dMD. Atlanta, Ga). From selected images, it was
nasopharynx obstruction was assessed with the Spe- possible to calculate the areas of the upper lip and
arman’s correlation coefficient. In all the analyses the lower lip of each patient through a Geomagic Con-
level of significance was set at α=0.05 and calculations trol software. The incisors inclination was measured
were handled by SPSS 11.0 software (SPSS, Chicago, on latero-lateral teleradiography through the Illinois
IL, USA). In conclusion the differences in nasopharynx analysis: the upper incisor axis inclination compared
obstruction between T0 and T1 were statistically eva- to the SN line (Sella – Nasion) and the lower incisor
luated. axis inclination compared to the ML line (Mandibular
Results: Nasoendoscopy performed at T0 showed that Line) have thus been measured. Two multiple linear
adenoid hypertrophy was the most common cause of regressions were performed by a SPSS software. The
airway obstruction (22 out of 30 patients). Inferior first regression examined as a dependent variable the
turbinates hypertrophy was the second most frequent upper lip areas and as an independent or predictor
cause (13 out of 30), followed by obstructive septal variable the inclination of the incisors’ axis and the
deviation (7 out of 30).No sleep apnea were reported dental overjet. The second regression examined as a
by parents probably due to lack of knowledge of this dependent variable the lower lip areas and as an in-
kind of pathologies. Medical history showed no gene- dependent the same variable of the first regression.
ral health problems were related to severe obesity. The Results: Our statistical analysis through software sho-
amount of nasopharynx obstruction decreased signi- wed that there isn’t any correlation between the den-
ficantly after palatal expansion (p<0.001). A statisti- tal overjet and the appearance of the vermilion area;
cally significant positive correlation existed between this is because even 0 is included inside the confiden-
the T1-T0 differences in amount of nasopharynx ob- ce interval (95%) of B coefficients not standardized
struction (p = 0.03). from the incisors axis.
Conclusions: The results of this study, confirm that RME Conclusion: From the results obtained it was possible to
has an influence on nasal resistance and the amount highlight a possible orthodontics’ limit in improving
of nasopharynx obstruction. The obstruction can be the exposure of vermilion. There is not a statistically
improved in patients with minor or moderate bre- significant correlation between teeth and lips posi-
athing problems caused by the lack of patency of up- tion. This result suggests a possible limit of orthodon-
per airways. Although palatal expansion cannot repla- tic treatment to improve the exposure of vermilion,
ce medical treatment (intranasal corticosteroids) or which may have been influenced by the low number
surgical procedures (adenoidectomy) when indicated. of samples examined. Prospective studies should then

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increase the number of patients in order to investi- growth factor alpha (TGFA) on 2p13.3, tumor protein
gate better the relationship between the orthodontic p63 (TP63) on 3q28, bone morphogenetic protein 4
treatment and the exposure of the vermillion area. (BMP4) on 14q22.2. Notably, mutations in IRF6 were
first discovered to be etiologic in an autosomal-domi-
nant clefting syndrome (Van der Woude syndrome);
Genetics of non-syndromic cleft lip and palate: a subsequently, the causative role of this gene has been
critical review identified also for NSCL/P and independently replica-
ted across the studies.
Cassi Diana*.**.****, Gandolfini Mauro**, Di Blasio Conclusion: Among the new genomic tools, GWASs
Alberto**, Magnifico Marisabel***, Piancino Maria are considered ideal for dissecting common, complex
Grazia*,**** (non-single-gene) traits and NSCL/P is one of the few
birth-onset disorders to have been investigated with
*Doctoral School in Life and Health Science – PhD Program in this powerful method. Collectively, these studies have
Experimental Medicine and Therapy, 29th cycle – CIR Dental demonstrated that orofacial clefts exhibit significant
School - University of Turin genetic heterogeneity, having successfully identified
**Section of Orthodontics - Centro Universitario di Odontoiatria - multiple genome-wide significant associations with
Department of Medicine and Surgery - University of Parma CL/P as well as potential gene-environment interac-
***PhD Program in Molecular Medicine - Department of Medicine tions for CP. However, with the important exception
and Surgery - University of Parma of IRF6, the significant risk loci from GWAS of NSCL/P
****Orthodontics and Gnatology - Masticatory Function - are diverse than the significant risk loci from genome-
Department of Surgical Sciences - University of Turin wide linkage analyses, this highlighting the different
strengths of the two approaches.
Aim: Non-syndromic cleft lip and/or palate (NSCL/P)
is considered a genetically complex trait supporting
a multifactorial model of inheritance, in which gene- Second molar management: a survey directed to
tic risk factor of small individual impact may interact italian orthodontists
with environmental contributions. The aim of the pre-
sent work is to review the current literature regarding Cicognini C. *, Borghetto G.*, Volpato A.*, Balian A.*, Favero
genetics of NSCL/P, focusing on the multiple methods L.*, Perinetti G.**, Contardo L.**
of genetic investigation. Furthermore, genes and ge-
netic loci best-supported as involved in NSCL/P are *Department of Neurosciences, Section of Dentistry, University of
discussed. Padova, Padova, Italy
Methods: A Medline and Scopus search was conducted **Department of Medical, Surgical and Health Sciences, Othodontic
in order to identify publications related to the topic, Post-graduate Program, School of Dentistry, University of Trieste,
with no limitations of language or time period. Ent- Trieste, Italy
ry words included: “orofacial cleft”, “cleft lip”, “cleft
palate”, “genetics”, “nonsyndromic”. Relevant infor- Aim: The studies of L. Andrews and RH. Roth represent
mation was also derived from reference lists of the the state of the art regarding the principles of occlu-
publications retrieved. sion. They define for the second molar certain values
Results: Genetic approaches to non-syndromic CLP of tip, torque and in-out. In the literature there is no
have included: linkage analysis, association studies, piece of work explaining the various implications of
identification of chromosomal anomalies or micro- the proper management of the second molar in or-
deletions in cases and direct sequencing of affected thodontic treatments. Careful analysis of the occlu-
individuals. These methods can be applied to candi- sion shows that in many cases the inadequate closure,
date genes or genome-wide strategies can be used. the incongruous overbite and the presence of joint
To date, there have been eight independent genomic problems or relapses are caused by the presence of
wide association studies (GWASs) for CL/P, a geno- rear pre-contacts especially at the second molars le-
me-wide meta-analysis of two CL/P GWASs, and two vel. A survey was drafted to investigate how othodon-
GWASs for isolated left palate (CP). For CL/P at least tists clinically manage the second mandibular molar
20 different loci have been confirmed with statistical during therapy.
and biological supporting data. The genes and genetic Methods: In inter-university cooperation with the Uni-
loci best supported as involved in NSCL/P are: interfe- versity of Trieste 15 questions were drawn up about
ron regulatory factor 6 (IRF6) on chromosome 1q32.2, the second mandibular molar in the orthodontic tre-
MAFB on 20q12, ARHGAP29 on 1p22, gene desert re- atment in the base year 2014. The whole survey was
gion on 8q24, ventral anterior homeobox 1 (VAX1) on submitted to 911 orthodontists either through e-mail
10q25.3, paired box protein Pax-7 (PAX7) on 1p36.13, messages, through the site survio.com, with both or a
forkhead box E1 (FOXE1) on 9q22.33, transforming direct compilation during orthodontic events meeting.

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XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

Results: The results have shown that 73% of those Methods: A resine model was scanned by an indepen-
with an EBO-IBO certification and 63% of the specia- dent laboratory specialized in measuring, designing
lists always apply a bracket or a band on the second and fabricating CAD/CAM structures to obtain a 3D
molar in contrast with those who have less orthodon- digital reference; a fully automatic Zfx Evolution
tic experience. In 90% of interceptive treatments the (Zimmer Dental) stripe light scanner which utilizes a
use of lip-bumper does not exceed half of the cases; green light and an open interface was used. The in-
68,1% of those with a specialist certification and traoral Zfx IntraScan (Zimmer Dental) scanner was
84,5% of those with a diploma of excellence is more utilized to obtain thirty full-arch scans of the same
inclined to wait the coming out of the second molar model by three different techniques; this type of
of the mandible before removing the band. When the scanner uses a confocal measuring system to measure
second molar has not come out yet, the control x- the distance between the scanner and the structure
ray tests are done by almost 60% of those who have scanned. Ten scans were acquired using Technique A,
been in the field for more than 5 years and those who scanning from 2.7 up to (and including) element 1.7;
have been working for more than 15 years, by almost Ten scans using Technique B, from element 1.1 up to
80% of those who have a diploma of excellence and (and including) element 1.7 and then from element 2.1
by 65% of specialists in orthodontics in contrast with up to (and including) element 2.7; and finally 10 scans
those who are not specialist. No matter the category by Technique C, which includes the first scan from ele-
(specialist, non-specialist..), about 80% of orthodon- ment 2.2 up to (and including) element 1.7, and the
tists carry out tooth extractions from the lower set in second scan from element 1.2 up to (and including)
no more than a quarter of cases. In more detail, the element 2.7. The STL files obtained were superimposed
extractions carried out between a quarter and a half on and aligned to the reference scan.
of the cases are performed by 13% of those who do Results: The results showed that Technique A’s devia-
not have a EBO-IBO certification and by 23% of those tion with respect to the reference scan in terms of
who have it. The extractions between half and three- volumetric error was 302.47 ± 37.42 μm; Technique B
quarters of the cases are not performed by anyone had a mean deviation of 180.41 ± 29.84 μm; Techni-
who does not have diplomas of excellence whereas que C had a deviation with respect to the reference
they are carried out by 5% of those who graduated scan of 147.33 ± 28.23 μm.
EBO-IBO or belongs to the Angle Society. Conclusion: The results show that the three methodo-
Conclusion: Greater attention to various aspects of the logies do indeed have different accuracies: Technique
second molar control is paid by professionals with C was the most accurate, followed by Technique B and
a title of specialization in orthodontics, diplomas of Technique A. The longer the portion of arch that was
excellence and many years of experience. This sug- scanned, the greater were the scanning errors that
gests us to always include this tooth in the therapy, were uncovered (Technique A); this was due to a cu-
according to the clinical guidelines and to study a mulative error linked to the data matching process
more accurate control of its three-dimensional posi- by the software during acquisition. The error can be
tion during orthodontic treatment to obtain an occlu- reduced by utilizing techniques that scan the two he-
sal and functional stability over time. miarches at different times and subsequently pair the
scans by means of a dedicated software (Technique C).

Intraoral scanner in orthodontics: comparing 3D


digital models obtained by three different Smiling to OSAS: how an appropriate diagnostic
procedures approach can allow to treat OSAS only with oral
devices
Volpato Andrea, Cicognini Caterina, Borghetto Gloria,
Favero Riccardo, De Francesco Maurizio, Di Fiore Adolfo, Sigorini P.*,**, Pellegrino M.*, Ciuffreda C.*, Ghilardi G.*,
Balian Araxi, Favero Lorenzo Gastaldi G.***, Gherlone E.F.****, Lucchese A.*****

Department of Neurosciences, Odontostomatology Institute, *Resident, Department of Orthodontics, Vita Salute San Raffaele
University of Padova, Padova, Italy Univerisity, Milan, Italy
**Resident, Department of Orthodontics, Istituto Clinico San Rocco,
Aim: Successful orthodontic treatments rely on care- Brescia, Italy
ful treatment planning based on accurate impressions ***Associate Professor Oral Science Dept. Vita Salute IRCCS, San
which are crucially important to this process. Raffaele University Milan, Italy
Accuracy of 3D digital models obtained by direct intra- ****Full Professor, Dental School, Dept. of Dentistry, Chairman
oral scanning of dental arches is not satisfactory. This Prof. EF Gherlone, University Vita-Salute San Raffaele, Milano, Italy
study compares the accuracy of digital models fabri- *****Aggregate professor, Dept. of Orthodontics, Vita Salute
cated using three different scanning methodologies. San Raffaele Univerisity, Milan, Italy; Unit of Dentistry, Division

118 © ariesdue January-April 2017; 9(1)


Poster presentations - Orthodontics

of Orthodontics, Research area in Dentofacial Orthopedics and Stefani Alberto, Gracco Antonio, Stellini Edoardo
Orthodontics, IRCCS San Raffaele Scientific Institute, Milan, Italy
University of Padua, Department of Neuroscience, Dental School
Aim: Previous studies suggested that a possible solu-
tion to cure the Obstructive Sleep Apnea Syndrome Aim: Tooth agenesis or hypodontia consists of the de-
(OSAS) and its systemic complications was the use of velopmental absence of one or more teeth. Many stu-
oral devices for the anterior-motion of the jaw. This dies confirm that this condition is almost frequent in
clinical trial aims to demonstrate the efficacy of the general population; the prevalence reported is betwe-
use of removable bite for the anterior-translation of en 2,7% and 11,3%. According to Bozga’s study publi-
the jaw to treat OSAS in specific categories of patients, shed on JMedLife in 2014, mandibular second premo-
compared to Continuous Positive Airway Pressure de- lar is the tooth most affected, followed by maxillary
vices (CPAP). In particular, the mandibular advance- lateral incisor, maxillary second premolar, mandibular
ment device is the least invasive and the most com- central incisor, mandibular second molar and mandi-
pliant solution in patients with low to moderate OSAS, bular lateral incisor. This condition shows a multifac-
whose apnea is due to retro-lingual obstruction. torial etiology: genetic factors (genes most commonly
Methods: In order to establish the eligibility of the involved are: MSX1, PAX9, AXIN2 and WTNT10A), he-
patient to treat OSAS with mandibular advancement reditary factors, environmental factors, local or gene-
devices, specific exams are needed. The first one is ral infective processes, radiations, drugs and traumas.
the polysomnography, which distinguishes between Genes involved are: MSX1, PAX9 and VTN4A. A Japa-
central and peripheral obstruction. If the problem is nese study published by Kanako Ota in 2015 on AJO-
peripheral, a fibroscopy will be performed in order DO, reports a prevalence of tooth agenesis doubled in
to understand which level of the pharynx is respon- subjects with Angle Class II Division II malocclusion,
sible of the airways obstruction (rino-, oro-, hypo- compared to other Angle’s Classes. The aim of this re-
pharynx). In this process, the patient undergoes to trospective study was to evaluate the prevalence of
the STOP-BANG questionnaire, aimed to classify the tooth agenesis in a general orthodontic population,
severity of OSAS (low-medium-high). Subsequently, considering each Angle’s Class.
an orthodontic visit allows to assess the relationship Methods: In this retrospective study, 150 patients of
between the maxilla and the jaw and the kind of den- the Padua dental clinic were analyzed through intra-
tal-occlusion. If the patient is eligible, radiographical oral photographs, panoramic radiographs and lateral
examinations are required (Teleradiography L-L and cephalograms. The diagnostic records of each patient
Ortopantomograpy) for further investigation. Only were studied by two operators. The inclusion criteria
suitable individuals can take the dental impression to were: no previous orthodontic treatment and absen-
create a removable transitory device, whose effecti- ce of any syndrome. Any doubtful case, like previous
veness is showed during the sleep endoscopy: an exa- surgical treatments or missing teeth with uncertain
mination during which the sleeping phase is simulated. dental history were kept out.
Uniquely in those cases in which the transitory den- Results: Angle Class II Division II malocclusion is the
tal-device has demonstrated a true effectiveness in most common class with tooth agenesis (as found in
the decrease of apneas, a definitive dental-appliance the Japanese study published by Kanako Ota) followed
is manufactured. by Angle class II Division I malocclusion, Angle Class
Results: This bite for the anterior-translation of the I malocclusion and Angle Class III. The most common
jaw has to be used only during the night as a OSAS missing teeth in the general population analyzed in
therapy, after careful patients selection. As a matter this study are: lower second premolar, upper second
of fact, it avoids that the retro-lingual section glides premolar and upper lateral incisor.
backward to occlude the upper airways. Conclusion: The study confirms a specific relationship
Conclusion: In those cases, accurately selected with the between tooth agenesis and Angle Classes malocclu-
clinical and radiographic examinations previously de- sion. Angle Class II Divison II is the most common class
scribed, the appliance for the anterior-translation of with tooth agenesis. The most frequent missing teeth
the jaw is the most valid solution to cure OSAS and its are: lower second premolar, upper second premolar
systemic complications. A correct diagnostic proce- and upper lateral incisor.
dure is necessary to select patients with OSAS and to
choose the most suitable therapy for each single case.
Stress distribution on TMJ during mandibular
advancement device (MAD) use for OSAS
Prevalence of tooth agenesis evaluation in Angle treatment. A FEM (Finite Element Method) pilot
Class I, II, III study
Conte Edoardo, Frezza Alessandro, Bruno Giovanni, De Crivellin G.*, Perri A.*, Mazzoli A.**, Mandolini M.**, Gracco

January-April 2017; 9(1) © ariesdue 119


XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

Antonio*, Stellini Edoardo* low-up model of TMJ.

*University of Padua, Department of Neuroscience, Dental School


**Marche Polytechnic University, Department of Science and Comparative experimental study of the jaws
Material Engineering between the ancient and modern skulls through
linear and angular measurements of 3D software
Aim: Obstructive sleep apnea (OSAS) is one of the
most common sleep disorders: in fact its prevalence in De Angelis S., Macrì M., Festa F.
adult population varies from 3 to 28% depending on
the study. Apneas in OSAS are caused by obstruction Università G. D’Annunzio di Chieti- Pescara
of upper airway (snoring is the first sign) developed for
both anatomic and neurological patient’s problems. Aim: The objective of this study is to determine, throu-
OSAS patients show excessive daytime sleepiness and gh the study of fossils of ancient skulls, the quantita-
impaired cognitive ability. This syndrome is currently tive changes that suffered the jaw bone in the course
recognized as a public health problem and a risk of of two millennia. This will clarify the evolutionary
cardiovascular, cerebrovascular and metabolic disea- trend of the jaw and the problems that orthodontists
ses. Polysomnography (PSG) is the standard test to will face more and more often. The hypothesis of this
diagnose OSAS and the severity of the disease is rated study is that the size of the jaw have changed over
with apnea-hypoapnea index (AHI). In several studies time in response to different functional demands.
it was attested that MADs (Mandibular Advancement Methods: This study is based on a comparison with me-
Device) are a treatment option to reduce snoring and asurements of 9 skulls of Opi, small town in Abruzzo,
AHI. MADs function is to push forward the mandible dating back to 200 A. C. with nine patients of the De-
to solve the upper airway obstruction. This study was partment of Orthodontics of the Dental Clinic of the
designed to evaluate patterns of stress generation in University of Chieti. All measurements were perfor-
the temporo-mandibular joint (TMJ) during mandibu- med using Dolphin software.
lar protraction. Finite Element Method (FEM) allows Results: We observed a reduction in both the maxilla
to examine the forces generated by positioning the and the mandible. The maxilla has shrunk more than
mandible forward: FEM is a numeric analysis done the mandible.
with high-fidelity computers software and it allows a Conclusion: The comparative analysis of quantitati-
reliable approximation of biologic tissue. ve changes showed a reduction in both the maxilla
Methods: The CBCT, RMI, arch models and a construc- and the mandible in modern patients. The maxilla has
tion bite of a skeletal Class I normodivergent female shrunk more than the mandible whose reduction is
patient were used. All this data were collected to per- minimal and not significant with the exception of the
form the following FEM analysis on an ideal patient. anterior segment. This size reduction is justified by
The target position was recorded at 4 mm of sagittal the loss of function that has had all the masticatory
advancement. The mandibular advancement device system. With the evolution in fact, the power has be-
(MAD) was obtained with a head to head position of come more nutritious and easy to eat more and more,
upper and lower incisor with a saggital advancement thanks to more and more processed foods.
of 4 mm. A computer aided design (CAD) model of
the stomatognathic system was built from the CBCT.
The posterior connective tissue, the capsule and the Changes in masseter activity and coordination
oblique and horizontal band of the TMJ were designed after correction of unilateral posterior
from RMI, anatomy text-books and medical literature. crossbites: functional reasons
The 3-dimensional computer aided design model was
created using MIMICS software and then analyzed de Biase Corrado, Vallelonga Teresa, di Benedetto Laura,
with ANSYS software for FEM analysis. The MAD was Matacena Giada, Deregibus Andrea, PiancinoMaria Grazia
scanned and STL 3-dimensional model was created
and included in ANYS analysis. *Orthodontic Division, Department of Surgical Sciences, CIR Dental
Results: FEM analysis shows the areas of tension and School, University of Turin, Italy
compression on mandibular condylar region and gle-
noid fossa. A pattern of stress in created on TMJ when Aim: Unilateral posterior crossbite is a serious asym-
MAD protracts the mandible forward. metric malocclusion that may become clinically evi-
Conclusions: This FEM study is useful to create a mo- dent in early childhood, involving structures that are
del and to show biological response to stress and actively developing, including motor control of ma-
loading, but it is limited because it can analize only sticatory function. In fact, the significant presence
instantaneous stress patterns. More studies are nee- of reverse chewing cycles has been well established
ded to estimate variations between initial and fol- in patients with unilateral posterior crossbite, during

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Poster presentations - Orthodontics

chewing on the crossbite side only. As a result, there masseter muscles. Interestingly, results showed that
is a serious asymmetry of the masticatory function. the normal-like coordination of masseters between
Mirroring the kinematic pattern, the activation of the sides was reached thanks to the lowering of the hype-
masseter muscles is altered as well. During chewing ractivity of the normal side. In comparison, the hypo-
on the crossbite side, patients show decreased activity activity of the masseter of the crossbite side showed
of the masseter on the crossbite side and increased a limited improvement, meaning that a longer time is
masseter activation on the contralateral side during required to restore the hypotrophy of a muscle.
reverse cycles, resulting in a reduced side to side dif-
ference in masseter muscle activity, whereas normal-
ly, unilateral chewing is characterized by a significant Epidemiological evaluation of impacted
difference in activation between the ipsilateral and permanent mandibular canines
contralateral masseter muscles. The aim of this work
was to describe the effects of functional therapy on De Palma A., Agastra E., Saettone M., Deregibus A.
masseter activity and chewing kinematic in patients
with unilateral posterior crossbite. University of Turin , Department of Surgical Sciences, C.I.R. Dental
Methods: Fifty children (9.1 ± 2.3 years) with unilateral School
posterior crossbite (34 on the right side, 16 on the left
side) and twenty children (9.5 ± 2.6 years) with normal Aim: Mandibular canine impaction is a very rare phe-
occlusion were selected for the study. The mandibu- nomenon and there are very few studies concerning
lar motion and the muscular activity during chewing this event. Because of the paucity of data and the di-
soft and hard boli were simultaneously recorded with screpancies in the literature, the aim of the present
a K7 kinesiograph (Myotronics, USA) before and after study was to evaluate the actual epidemiological fe-
correction of unilateral posterior crossbite with the atures and patterns of impacted mandibular canine
appliance Function Generating Bite (mean treatment teeth in an orthodontic patient population treated
time of 7.3 ± 2.4 months plus the retention time of inside the Dental School of Turin, Italy.
5–6 months). Chewing cycles were divided into non- Methods:This is a retrospective study. Panoramic ra-
reverse and reverse, based on the vectorial direction diographs, intraoral photographs and dental casts of
of closure. Since the amplitude of the EMG signal is 1479 patients (682 male (46,11 % )and 797 females
influenced by individual anatomical characteristics, (53,89 % )) who attended the clinical department of
the percent difference between ipsilateral and con- Orthodontics of Dental School , University of Turin,
tralateral peaks of the masseter amplitude was com- Italy, from 1995 to 2016, were retrospectively reviewed
puted together with the percentage of reverse cycles. in order to detect impacted mandibular canine teeth.
Significance level was set at P < 0.05. Observations were made on missing permanent man-
Results: Before therapy, the percentage of reverse dibular canines, retained deciduous canines, sex and
cycles on the crossbite side was greater in patients age of patients , side and number of mandibular cani-
than in controls (P < 0.001) and significantly reduced nes and any other associated pathology or symptoms.
after therapy (P < 0.001) towards the reference nor- A customized data entry was prepared to record and
mal value (soft bolus; pre: 57 ± 30%, post:12 ± 17%; evaluate the status of impacted canine teeth.
hard bolus; pre: 65 ± 34%, post: 12 ± 13%; reference Results: The prevalence of mandibular canine impac-
value: soft bolus 4 ± 2%, hard bolus 5 ± 3%). Before tion was found to be 1.6% in the 1479 patients of
therapy the percent difference between electromyo- this orthodontic population. A total of 24 patients had
graphy envelope peaks in patients was lower than in impacted mandibular canines with 13 being males and
controls (P < 0.01) and significantly increased after 11 being females. No statistical difference was found
therapy (P < 0.05) becoming similar to the referen- among gender. 13 ( 54,2 % ) of the patients had uni-
ce normal value. The normalization of coordination laterally impacted canines ( 9 on the left side and 4
between the bilateral masseters after therapy was on the right side ), while 11 ( 45,8 % ) of the patients
due to a significant reduction of the activity of the had bilateral impaction. In 16 of the patients there
contralateral masseter muscle for both bolus types. were retained mandibular deciduous canines. In 3 of
Conclusion: The altered muscular activation and the the patients there was an early loss of the mandibular
altered kinematics in presence of unilateral posterior deciduous canines, while in three cases the impacted
crossbite might be considered a useful indicator of canines were transposed in the region of lateral inci-
the severity of the masticatory function involvement. sors. In 1 of the patients there was a supernumerary
The correction of the malocclusion with a functional tooth in the lateral incisor region and the deciduous
appliance induced a favorable change in the neuro- canine was still in the arch.
muscular control of chewing of patients, who reco- Conclusion: Maxillary canine impaction is more fre-
vered a significant reduction of the reverse chewing quent than mandibular canine impaction. Mandibular
patterns and a normal-like coordination between the canine impaction prevalence in this study was found

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XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

to be higher than in the published literature to date. oth agenesis are reported both in the upper and in
The reason for this higher prevalence may be related the lower arches, but the upper arch show an higher
to the patient selection from the Orthodontic de- prevalence of hypodontia
partment. This result may not represent the general Conclusion: Bilateral cleft and lip palate patients show
population, but definitely this study provides a base- an higher prevalence of tooth agenesis than the other
line regarding the frequency and types of impacted groups. The most commonly missing tooth is the ma-
mandibular canines in this particular population. Also xillary lateral incisor on the cleft side.
this higher prevalence value can be the evidence of an
actual increase of the number of impacted mandibu-
lar canine teeth among patients. The early detection Taurodontism and orthodontics treatment
of mandibular impacted canines is crucial for suc-
cessful treatment. Faccioni P.*, Pancera P.**, Sinigaglia S.**, Ferrari F.*, Faccioni
F.***

Prevalence of tooth agenesis in cleft patients University of Verona, Department of Odontostomatologic Surgical
Sciences, Director Prof. P.F. Nocini
De Stefani Alberto, Bruno Giovanni, Balasso Paolo*, Gracco *DDS
Antonio, Stellini Edoardo **Student
***DMD
University of Padua, Department of Neuroscience, Dental School
*University of Padua, Department of Management and Engineering Aim: The purpose of this work is to discuss the pro-
blems that may occur during the orthodontic tre-
Aim: Clefts are one of the most prevalent deformi- atment in patients with taurodontism and to suggest
ties of the oral and facial region related to the birth. approaches to reduce the risk of complications during
Clefts are usually associated with dental anomalies in the phases of the orthodontic movement.
the structure, size, shape. Tooth number anomalies or Methods: An initial research of the abstracts has been
hypodontia are also associated with clefts. Hypodon- carried out using the scientific archive “PubMed” by
tia is the congenital absence of at least one perma- using the keywords “taurodontism”, “taurodontic to-
nent teeth. Hypodontia shows an high incidence in oth”, “taurodontism in orthodontics” “taurodontism
the human population, that was evaluated between & syndromes”. The research was limited to the inter-
2,7 and 11,3%. A study made in 1991 by Polastri et al. national literature in the English language including
in the Italian population evaluates 700 patients and systematic reviews and case reports published from
found a prevalence of 5,14%. Hypodontia shows a 1980 up to the present. Only the articles with scienti-
multifactorial etiology like as genetic factors (MSX1 fic accuracy in explaining the problem were selected
and PAX9 genes mutations), hereditary factors, am- for a total of 21 articles.
biental factors, radiations, drugs. There are several Results: Taurodontism is an anomaly in the root form
studies that evaluates an higher prevalence of tooth of multi-rooted teeth which results from an ectoder-
agenesis in cleft patients.The aim of this study was to mal defect in the invagination of the Hertwig foil. It
evaluate the prevalence of tooth agenesis in patients occurs in the 18% of the general population, and in
with unilateral and bilateral cleft lip and palate in the the 37.5% of subjects with a condition of hypo- and
italian population using orthopanoramic radiographs. oligodontia. It’s characterized by an elongated sha-
Methods: This is a retrospective study. Orthopanoramic pe of the pulp chamber, by a more apical position of
radiographs were evaluated at the Padua dental clinic. the portion of the fork than in normal conditions and
120 patients were evaluated in the study: 40 patients by the lack of the natural shrinkage at the level of
with bilateral cleft lip and palate, 40 patients with the cementoenamel line tooth. This alteration can be
mono lateral cleft lip and palate in the right side and diagnosed only radiographically as at physical exami-
40 patients with unilateral cleft lip and palate in the nation these teeth present a normal clinical crown.
left side. In this study were evaluated patients betwe- Taurodontism can be found isolated, associated with
en six and fifteen years old. All radiographs were eva- other dental abnormalities such as agenesis or amelo-
luated by the same operator. genesis imperfecta, or forming part of different syn-
Results: In this study hypodontia is found in the per- dromes such as Mohr’s syndrome, Down’s syndrome,
manent dentition and the data reported are highest Van der Woude syndrome, cleft lip and palate. There
in the cleft region. The maxillary lateral incisor on the are different classifications and diagnostic criteria for
cleft side is the tooth most commonly missing. An the diagnosis of taurodontism. The first study that in-
higher prevalence of tooth agenesis was also found troduced mathematical criteria for classifying it was
outside the cleft site, the most prevalent tooth that conducted by Shiffman and Chanannel (1978): a to-
shows agenesis is the second maxillary premolar. To- oth is considered ‘taurodontic’ if the distance from

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Poster presentations - Orthodontics

the most apical point of the pulp chamber roof (A) to performed using a digital cephalometric analysis.The
the most coronal point of the chamber floor (B) divi- same variables were compared within the sub-group
ded by the distance from A to the root apex (C) is gre- of patients with a full or moderate class II malocclu-
ater than or equal to 0.2. Tulensalo et al. described a sion at T0. All the patients showed a cervical vertebral
radiographic method for diagnosing taurodontism in maturation stage CS1 or CS2 (according to Franchi
permanent teeth with incomplete root development, and Baccetti). The statistical comparison of the varia-
measuring on the orthopantomography the distance bles was performed with the paired sample t test, with
between the most coronal point of the pulp chamber significance equal to 0,05.
floor and the line passing between the distal and me- Results: The collected data show a significant decrea-
sial CEJ: this distance must be greater than 3.5mm. se of ANB angle (-0,96±1,75°). The sagittal position
It is important to consider the clinical implications of of the mandible, given by the Pg-OLP distance (OLP:
this anomaly in the various dental disciplines inclu- perpendicular line to occlusal plane passing by S point)
ding orthodontics in order to achieve the most appro- and the total lenght of the mandible, given by the
priate treatment plan. summa of the distances Co-OLP and Pg-OLP, show
Conclusion: The orthodontic treatment must be pro- an average significant increase of 4,25±6,07mm and
perly planned in patients with taurodontic elements. 4,89±6,65mm. The FMA angle has significantly decre-
It must be taken into consideration that the peculiar ased (-1,26±2,47mm). Moreover, a significant increase
morphology of these teeth determines less anchora- of the SNB angle (1,37±2,14°) has been registered in the
ge during orthodontic movements and, at the same sub-group of patients with the II class malocclusion.
time, it creates a greater risk of root resorption if the Conclusion: The outcomes of this study show an impro-
teeth are subjected to too heavy tractions. Moreo- vement of the skeletal relationship between the upper
ver, a taurodontic tooth has less surface area than a and the lower jaw, a facial height reduction, a likely
normal tooth, this is why very short and thin roots do anterior repositioning of the mandible and an incre-
not oppose to orthodontic movements with the same ased mandible length itself, especially in the class II
force as well represented roots. It’s frequent an as- patients. These results suggest that the presence of
sociation between taurodontism and hypodontia. The the occlusal resin-splints frees the mandible from
best treatment option in presence of edentulous gaps the inter-maxillary occlusal relationships, allowing it
in the posterior zone is the correct repositioning of to develop freely with an anterior repositioning. The
taurodontic teeth through very light and intermittent treatment with this type of rapid palatal expander has
orthodontic forces. Alternatively we recommend the proved to be an effective therapy of transversal ma-
clinician to rehabilitate the edentulous gap using the- xillary deficiency in the early mixed dentition. Besides
se elements as prosthetic pillars. it could be an advantageous therapeutic option in
those patients that, in addition to the transversal di-
screpancy, show a class II malocclusion characterized
Upper and lower jaw short-term sagittal by an insufficient growth of the mandible or a hyper-
modifications in 6 to 10 years old patients divergence or tendency toward a mandibular growth
treated with McNamara rapid palatal expander in a vertical way rather than a horizontal one.

Ferrari F.*, Faccioni P.*, Pancera P.**, Sinigaglia S.**,


Faccioni F.*** Treatment of open bite in patient with TMJ
disorder using invisalign: case report
University of Verona, Department of Odontostomatologic Surgical
Sciences, Director Prof. P.F. Nocini Fiore V., Macrì M., Festa F.
*DDS
**Student Università G. d’Annunzio di Chieti- Pescara
***DMD
Aim: Resolution of a skeletal Class III malocclusion with
Aim: The aim of this study is to evaluate the sagit- open bite using invisible aligners. The patient with tmj
tal skeletal and dento-alveolar short-term effects on disorder presented back repositioned jaw, contract
the upper jaw and the consequences on the mandi- maxilla, dental crowding in both arches and open bite.
ble of the rapid palatal expansion in 18 subjects aged The patient also reported frequent episodes of heada-
between 6 and 10 years with posterior unilateral or che and neck pain.
bilateral cross-bite, using McNamara acrylic-splint ra- Methods: Treatment, conducted with Invisalign ali-
pid palatal expander. gners, was aimed at expanding the upper arch, to sol-
Methods: A comparison between the skeletal and den- ve the overcrowding by stripping and for the proper
to-alveolar variables, measured before(T0) and after management of the torque incisal.
(T1) therapy on latero-lateral teleradiographs, was Conclusion: Bite closure achieved in 15 months. The

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XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

mandible was repositioned forward with remission of (clench 1 condition) or with teeth clenching on cot-
neck pain. The stability of the treatment is performed ton rolls (clench 2 condition).
by passive aligners and the proper application of anti- Results: Retrieved clinical records concerned 20 pa-
squeezing protocol. tients, 5 men and 15 women, between 20 and 44 years
(average: 30.1 ± 8.2). All subjects had been treated by
the same surgeon. Details about patients and their sur-
Effectiveness of orthodontics-orthognathic geries are respectively. All patients had been subjected
surgery combined treatment: to post-surgical intermaxillary fixation, as surgery did
electromyographic and clinical study not involve any rigid internal fixation of the mandibular
sections. No patients in the present study showed any
Garagiola U., Colangelo B., del Rosso E., Ghiglione V., Grossi pre-surgical peculiarity or post-surgical compliances
G.B. as it had been observed in previous studies. A signifi-
cant increase of the average EMG activity after ortho-
Department of Biomedical, Surgical and Dental Sciences gnathic corrective surgery was observed (p=.01). The
Maxillo-Facial and Odontostomatology Unit post-surgical increase of EMG values showed a nega-
Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico tive correlation trend with those collected before sur-
University of Milan, Italy gery (r=-.38, clenching on teeth; r=-.33, clenching on
cotton rolls). None of the independent variables had
Aim: Orthognathic treatment aims to normalize the any effect on the post-surgical outcome.
skeletal relations of the masticatory apparatus by Conclusions: Results of the present study confirm that
achieving a class I molar configuration. To achieve corrective orthognathic surgery improves the mastica-
this, resorting to a combination of orthodontic and tory muscular activity force of patients who present
orthognathic surgery is often necessary. Evaluating class III malocclusions, and that such improvement
the outcome of the intervention involves assessing can be objectively assessed by performing EMG me-
both the occlusal, periodontal, aesthetic results and asurements. Additionally, they suggest that patients
the functional recovery of the rehabilitated district. whose masticatory muscle force benefits more from
Clinical parameters that may be recorded for this pur- orthognathic surgery are those displaying the lowest
pose comprise the masticatory efficiency; the maxi- pre-surgical EMG activity. Such hypothesis should be
mum bite force, the number and distribution of the further investigate with proper, controlled prospective
occlusal contacts, the functionality of the temporo- clinical studies. If it were proved true, pre-surgical EMG
mandibular joint, the maximum range of mandibular might be used to screen patients before surgery in or-
movements. Additionally, the neuromuscular post- der to predict if the surgical outcome would imply only
surgical recovery may be assessed with electromyo- an aesthetic improvement or also a muscular benefit.
graphy (EMG). This study evaluates retrospectively if
the initial electromyography (EMG) status of patients
who underwent orthognathic surgery correlates with Polarized light as valid alternative treatment of
the extent of post-surgical EMG functional recovery. temporomandibular disorders
Methods: Clinical records were selected among tho-
se of patients who underwent orthognathic surgery Garagiola U., Cressoni P., Soldo R., Farronato F.
through Le Fort I and/or sagittal osteotomy of the
mandibular ramus to correct 20 patients with skeletal Department of Biomedical, Surgical and Dental Sciences,
dental class III malocclusions. Other inclusion crite- Maxillo-Facial and Odontostomatology Unit,
ria were: absence of any clinical signs indicating a Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico
TMJ disorder, pre-surgical EMG recording performed University of Milan, Italy
the day before surgery; post-surgical EMG recording Aim: The objective was to assess the effectiveness of a
performed not earlier than one year after surgery, therapy using low energy polarized light (PL) devices,
and after completion of the post-surgical orthodon- in reducing pain, promoting healing of soft tissue in-
tic treatment. Ten clinical records concerning skeletal juries and reducing inflammation, improving function
dental class I healthy subjects, not showing clinical and quality of life of the temporomandibular disor-
signs of TMJ disorder were selected to collect EMG ders (TMD) patients.
data for further comparison with those of the treated Methods: 35 patients (20 female), with TMD diagno-
patients. EMG data had been collected according to sed using standard criteria, were assessed using elec-
standard measuring procedures with single-use, bi- tromyography (EMG) and computerized mandibular
polar electrodes applied on the patient’s skin. EMG scan (K6). 8 minute PL therapy has been applied, 3
measurements concerned the activity of the anterior times per week for 4 weeks. No other treatment was
temporal muscles and of the two masseter muscles given and patients were asked to refrain from taking
in three conditions: at rest, with teeth in occlusion analgesics during the course of the study. Polarized

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Poster presentations - Orthodontics

light therapy used a non-invasive optical device to information of low dose Cone Beam CT with a cepha-
project a beam of light on to the skin and mucosa. This lometric simplified protocol thanks to the latest in-
light has four characteristics: polarization – the light formatics aids. Cephalometry is an essential clinical
waves move in parallel planes, producing a narrow, and research tool in orthodontics. It has been used
concentrated beam, unlike ordinary light, where waves for decades to obtain absolute and relative measu-
oscillate in all directions; polychromy – it contains a res of the craniofacial skeleton. Lateral cephalograms
broad spectrum of wavelengths or colours, including are two-dimensional (2D) radiographs that are used
visible light & part of the infrared range, enabling it to depict three-dimensional (3D) structures. Conse-
to stimulate a range of light receptors on the skin (cf. quently, cephalograms have inherent limitations as a
lasers, which are monochromatic, i.e. they contain only result of distortion and differential magnification of
one wavelength); incoherency – the light waves are out the craniofacial complex. This may lead to errors of
of phase or unsynchronized, unlike laser light, which is identification and reduced measurement accuracy.
coherent; it has low energy density, unlike laser light, The introduction of maxillofacial Cone Beam (CBCT)
which may have high or low energy density. Patient- has made 3D imaging more readily available for dental
reported questionnaires (PORs) and performance me- applications.
asures are used to assess TMD pain and function in Methods: A low-dose CBCT machine was used to ac-
clinical practice. PROs assess the patient’s perspective, quire the radiographic images in this study of the ten-
while performance measures assess functions such as point 3D cephalometry method. The image quality of
mandibular kinesiology (mouth opening and closing or CBCT compares favorably to that of multi-slice CT, as
other standardized maneuvers) in a controlled setting. it has minimum image noise and a maximum signal-
Standardized assessment of patient outcomes allows to-noise ratio. 130 patients were selected randomly
physicians to measure the success or failure of diagno- for the study. They ranged in age from 8 to 42 years;
stics and treatments that TMD patients receive. there were 80 females and 50 males. Each patient had
Results: Electromyographical, kinesiographical and cli- already had lateral and posteroanterior cephalograms
nical data showed statistically significant reductions taken less than 6 months earlier. The cephalometric
in pain and muscular spams, improvements in fun- analysis was performed by three operators repeating
ction and increases in muscular strength were repor- the measurements twice (15 days apart) with a ca-
ted (compared to baseline measures). (P<0.01). libration meeting. The positions of the maxilla and
Conclusion: Joint pain typically involving the TMJ is the mandible in 3D space were determined using low-
predominant complaint of people living with tempo- dose CBCT by assigning three reference planes to
romandibular disorders. Pain is what drives patients to obtain the (x, y, z) position of each point of the skull
seek medical care. People with TMD are most distres- relative to point S with coordinates (0, 0, 0), which
sed by the intensity, quality, and predictability of their was automatically determined by the computer as the
joint pain, as well as its impact on physical function, intersection of the reference planes. The position of
sleep, fatigue, and mood. Valid and reliable PROs and the jaws in 3D space was determined by assigning 18
performance measures are available to assess these easily identified, repeatable cephalometric point. By
aspects of the pain experience. The polarized light analyzing the relationships among the surfaces crea-
characteristics enable to penetrate the skin and un- ted and the angular and linear evaluations based on
derlying tissues in order to stimulate various biologi- reported criteria, the program automatically detects
cal processes. PL improves microcirculation, stimula- the expansion of the jaws with very high precision, fa-
tes regeneration and repair, promotes wound healing cial asymmetry in the three spatial planes, the skeletal
and relieves pain, with no adverse effects. Low energy class, and the anterior vertical dimension.
polarized light could be a valid alternative or conco- Results: Statistically significant differences were found
mitant treatment of temporomandibular disorders. between angular and linear measurements taken with
conventional radiographs and those taken with CBCT
(p<0.01).
3D versus 2D: a more reliable and accurate Conclusions: Three-dimensional imaging provides in-
cephalometric analysis formation and images of craniofacial structures free
from perspective distortion, with none of the ma-
Garagiola U., del Rosso E., Cressoni P., Soldo R. gnification or superimposition associated with 2D
images. The 3D cephalometric analysis is easier to
Department of Biomedical, Surgical and Dental Sciences, interpret than 2D cephalometric analysis (interpola-
Maxillo-Facial and Odontostomatology Unit, tion of cephalometric values on different projections)
Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico because it allows movement from a purely mathema-
University of Milan, Italy tical interpretation (evaluation of angles and linear
measurements) to a graphical interpretation, with
Aim: This study was to combine the huge amount of verification of the results using mathematical values

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XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

(volumetric). Another aid to the clinician is the repe- to stereophotogrammetry with the following degrees
atability and reproducibility of this method, which of rotation of the head to the left (rotation along z
reduces human error in cephalometric analysis. This axis): - ten shots with the manikin’s head not rota-
method saves time and increases precision, offering a te (0 degrees); - one shot for each of the following
valuable aid to orthodontic diagnosis. This preliminary rotation degrees: 1, 2, 3, 4, 5, 8, 12, 16. All the 3D
study expands the landscape of diagnostic methods, images were processed and analyzed by Viewbox®, a
allowing for more extensive studies to confirm the cli- 3D management software able to develop a custom
nical effectiveness and validation of the 18-point 3D template by typing the anthropometric points corre-
cephalometric analysis. The value of a 3D image model sponding to those chosen for the analysis of our inte-
directly corresponds to the quality of the information, rest. On each image the anthropometric points descri-
the accurate anatomic data derived, and its collection bed before were typed by the same operator in order
in a 3D anatomic database. Used appropriately, 3D to eliminate inter-operator error. The software allows
cephalometrics allows clinicians to analyze, diagno- to calculate three-dimensional coordinates (x, y, z)
se, plan, and communicate. Treatment changes can and so obtain 14 measurements of distance on each
then be recommended based on a patient’s individual three-dimensional reconstruction: Chel-Chel, N-Prn,
preference within his or her biologic, physiologic, and Sn-Pg, Glab-Chr, Glab-Chl, Glab-Ftr, Glab-Ftl, Zyr-Trr,
anatomic limits. Zyl-Trl, Chr-Trr, Chl-Trl, Chr-Gnr, Chl-Gnl). The measu-
res were compared with the real measurements taken
with a electronic calipers. For each distance the dif-
Technical validation of a new 3D ferences were analyzed in terms of average, standard
stereophotogrammetry system deviation, standard error and coefficient of variation,
in order to assess the possible influence of rotation
Giampellegrini G.*, Magnifico M.*, di Blasio C.**, Toffoli A.*, on linear measurements of distances between points.
Macaluso G.M.*, Cassi D.*, di Blasio A.*, Gandolfini M.* Results: The first data reveals a high correlation betwe-
en real measurements and those detected by the ma-
*University Dental Center, University of Parma, Italy chine with differences always inferior to system error
**Section of Maxillo-Facial Surgery, University Hospital of Parma, (0,425 mm) and the presence of greater precision in
Italy frontal and nose areas. Even the variations observed
between shots made at different angular values are
Aim: The measurements obtained with stereophoto- mostly below the system error.
grammetry 3D systems are sufficiently accurate for Conclusions: This study allows to validate the reliability
clinical use and research in the field of dysmorphoses of this stereophotogrammetric system. Horizontal ro-
and for orthodontic and/or surgical diagnosis and plan- tation of the face does not seem to affect most of the
ning. One of the problems you may encounter using measurements. Additional data and statistical analysis
this technique is to find a correct position of the head are required, also to analyze head movements in the
allowing proper detection of data and that it is easily other two planes of the space.
repeatable. The aim of the study is to evaluate the re-
producibility and accuracy of Face Shape 3D Maxi Line
photogrammetric scanner developed by Polishape Srl Rhinomanometric evaluation of patients with
and investigate the influence of head position in a th- maxillary contraction treated with rapid
ree-dimensional sterephotogrammetry system. maxillary expansion. A prospective pilot study
Methods: The scanner includes 6 high definition reflex
cameras (Canon EOS) mounted on a rigid support pla- Giugno Francesca M.D.*, Cammarata Silvia*, Di Vece Luca**,
ced at a distance of one metre from the subject to Doldo Tiziana***
be photographed, and connected to a computer for
remote control of the system and storing scanned *DDS, University of Siena, Siena, Italy
images. A mannequin was selected as “model” for va- **DDS, PhD student Department of Medical Biotechnologies,
lidation in vitro. The mannequin was positioned on a University of Siena , Siena, Italy
stand with a graduated scale, in order to record the ***MD, DDS, Researcher, Department of Medical Biotechnologies,
angular value of rotation of the head. Subsequently University of Siena Siena, Italy
different anthropometric points were plotted on the
mannequin with an eyeliner: Glabella (Gb), Nasion (N), Aim: The aim of this prospective study was to eva-
Pronasle (Prn), Subnasale (Sn), Labiale superius (Ls), luate, through rhinomanometry, the changes of the
Labiale inferius (Li), Sublabiale (Sl), Pogonion (Pg), upper nasal airway before and after rapid palatal ex-
Frontotemporalis (Ft r/l), Zygion (Zy r/l), Tragion (Tr pansion.
r/l), Gonion (Gn r/l), Cheek (Ch r/l), Cheilion (Chel r/l), Methods: Were collected 34 Caucasian children aged
Orbitale inferius (Or inf r/l). The dummy was subjected 7-11 years, in need of RME trearment, mixed dentition,

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Poster presentations - Orthodontics

with uni- or bi-lateral posterior crossbite involving at of space analysis, that is traditionally focused on the
least deciduous canines and permanent first molars. measurement of the mesio-distal diameter of teeth.
Of the selected subjects, 30 were enrolled in the study However, in most cases, mesio-distal dental diame-
because 3 dind’t show up after initial records and 1 ter is normal (see reference tables) and the etiology
had the RME removed prematurely. Of these 30 pa- of space-related problems has to be ascribed to the
tients, 12 were males and 18 females (mean age 8.7 amount of available space in the jaws, that can be
years with a standard deviation of 0.9). They were in excess, clinically appearing with the presence of
enrolled in the prospective study and submitted to diastemata, or in deficiency, clinically appearing with
orthodontic, ear, nose and throat examinations. A crowding.
specialist did the rhinomanometric examination befo- Methods: Presentation of clinical cases of crowding or
re (T0) and after rapid palatal expansion (T1). For this presence of diastemata for space excess solved by the
analysis Atmos Rhinomanometer 300® and a face- modification of the lenght of osseous basis (palatal
mask were used. The rate of airflow and the pressure expansion, osseous distraction, median ostectomy)
gradient between nasopharynx and nostrils were me- and rewiew of literature to point out the more signi-
asured. Nasal resistance was recorded in Pa/cm 3 /s on ficative indexes that must be included in the space
the right and the left nostril. Measurements of both analysis to evaluate the amount of available space.
sided were then combined. Rapid maxillary expansion Results: In cases of severe crowding, orthodontic and
was realized by a Hyrax-type rapid expander with a surgical combined methods represent a valid alterna-
palatinal split screw, cemented on first permanent tive to extractions in order to correct the problem at
molars. The activation protocol provided 2 activation the origin of the dento-basal disorder, that is a tran-
a day for the first 2 weeks, then 1 activation a day sversal deficit of basal bone. this therapy can lead
until the upper molar palatal cusps were in contact to excellent esthetic outcomes, emproving the facial
with the lower molar buccal cusps. The differences in profile. extraction therapy, in contrary, results in a
nasal resistance between T0 and T1 were statistically flattening of the profile and biretrusion. Osseous di-
evaluated with the Paired Samples ‘t’ Test to assess straction provides new bone generation by an oste-
the significance of T0-T1 and with Kolmogorov-Smir- otomy and a gradual separation of the two bone
nov test and Levene test to check homogeneity and surfaces, stimulating the natural biological tissue
normal distribution. reparation processes. This technique can be applied
Results: Total nasal inspiration and expiration resi- both to the maxilla and mandible. In the upper jaw
stance significantly decreased at T1 (p<0.001). The distraction force is applied to the palatal suture (ra-
reduction ranged between 0. 23 and 0. 66 Pa/cm3/s pid palatal expansion or scheletal anchorage devices)
for inspiration and between 0. 20 and 0,.58 Pa/cm3/s and in the mandible to the simphysis. Vice versa, in
for expiration. A statistically significant positive cor- cases of severe space eccess and presence of diaste-
relation existed between the T1-T0 differences in ex- mata, mandibular or maxillary median ostectomy, re-
piration nasal airway resistance (Spearman’s correla- verse palatal distraction for the maxilla in growing
tion coefficient rho = 0.38; p = 0.03). patients for the treatment of scissor bite in patients
Conclusions: Nasal resistance can be improved by rapid affected by Brodie’s syndrome represent a valid tre-
maxillary exspansion in patients with minor or mo- atment option.
derate breathing problems caused by the presence of Conclusions: In conclusion it is recommended to eva-
nasal obstruction. Despite this the maxillary exspan- luate the severity and etiology of crowding or pre-
sion cannot replace medical or surgical treatment sence of diastemata during the procedure of space
when needed. analysis and take in consideration orthodontic and
surgical combined methods in cases of severe lack or
eccess of available space to obtain satisfying esthetic
The importance of the evaluation of available and functional results.
space in the jaws as a variable that can be
modified by treatment for the solution of cases
of space deficiency or eccess Relationship between periodontal biotype and
dental malocclusion: a longitudinal cohort study
Gumirato E.*, Bazzanella S.*, Brun V.*, Faccioni P.**
Isola Gaetano*,**, Perillo Letizia***, Lucchese
University of Verona, Department of Maternal-Infant and Surgical Alessandra****, Matarese Marco*, Picciolo Giacomo*,
Odontostomatologic Sciences, Director Prof. P.F. Nocini Ramaglia Luca**, Matarese Giovanni*
*Student
**DDS *Department of Biomedical, Odontostomatological Sciences and
of Morphological and Functional Images, University of Messina,
Aim: The aim of this work is to provide a critical view Messina, Italy

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XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

**Department of Neurosciences, Reproductive and ars) was statistically, but not clinically, significantly
Odontostomatological Sciences School of Medicine University higher respect to the patients with thick gingival type
“Federico II”, Naples, Italy (14.1±0.7 years), p=0.026. There was not a significant
***Associate Professor, Head of Orthodontic Unit and Chair of the association between type of malocclusion and gingi-
Orthodontic Postgraduate Program, Multidisciplinary Department val biotype (p=0.143) and there was a prevalence of
of Medical-Surgical and Dental Specialties, Second University of thick gingival biotype in patient with class II maloc-
Naples, Naples, Italy clusion and a slight prevalence of thin gingival biot-
****Division of Orthodontics, Research Area in Dentofacial ype in patient with class I malocclusion.
Orthopedics and Orthodontics, IRCCS San Raffaele Scientific Conclusion: Patient age, health status of periodontal
Institute, Milan, Italy tissues, duration of treatment, the amount and type
of tooth movement, the width of keratinized gingiva
Aim: In clinical practice, a proper diagnosis of the pe- and gingival thickness are considered risk factors of
riodontal biotype is considered important with re- gingival recession that can be seen especially in man-
spect to the decision-making. Periodontal biotype and dibular incisors area depending on orthodontic tre-
the gingival thickness is considered as an important atment. The present longitudinal cohort study showed
factor, which affects the success of periodontal and that that female subjects presented a higher preva-
orthodontic treatment results. Long-term studies that lence of thin gingival biotype respect to male subjects
evaluated the association between the gingival reces- and that no relationship was found between gingival
sion and orthodontic treatment were concluded that biotypes and malocclusion, based on Angle’s classifi-
gingival recession was more frequent in individuals cation. Further studies are needed, in a large scale, to
who have been treated orthodontically and mandi- confirm this important relationship between gingival
bular incisors were more prone to gingival recession biotype, skeletal profile and facial type.
than the other teeth. The aim of this study was to as-
sess the prevalence of the gingival biotypes in a group
of patients and to evaluate if the gingival biotypes Asymmetric molars’ mesial rotation and
were related with the different types of Angle’s clas- mesialization in unilateral functional posterior
sification of malocclusion. crossbite and implications for interceptive
Methods: This a longitudinal cohort study was con- treatment in the mixed dentition
ducted on 74 patients (35 males, 38 females, mean
age 14.7 years old). Gingival thickness was assessed Laffranchi Laura*, Tonni Ingrid*, Iannazzi Alessandra*,
clinically, on each patient by a single calibrated exa- Piancino MariaGrazia**, Costantinides Fulvia***, Sangalli
miner. Intra- examiner agreement was verified by cal- Linda*, Bindi Marino*, Dalessandri Domenico*
culating Cohen’s k coefficient. The kappa coefficients
were calculated for the measurements obtained at *Medical and Surgical Specialties, Radiological Sciences, and Public
each different examination. Gingival biotypes were Health, Dental School, University of Brescia, Italy
assessed with the evaluation on the translucence of **Orthodontic Division, Department of Surgical Sciences, Dental
a periodontal probe through the gingival margin of School, University of Turin, Italy
the tooth during the probing, at the mid facial aspect ***Department of Medical Sciences, Surgery and Health, Dental
of both maxillary central, lateral incisors and canine School, University of Trieste Italy
on each patient, Angle’s classification of malocclusion
was also recorded. Dental occlusion was clinically as- Aim: Symmetric transverse expansion is the main out-
sessed using Angle’s classification of malocclusion. In come of the early treatment in subjects with unila-
order to assess the association between gender, gingi- teral functional posterior crossbite. The aim of this
val biotype and Angle’s classification of malocclusion study was to analyse mesial rotation and mesializa-
(categorical variables) χ2 (Chi square) test was used. tion of upper first molars as sagittal parameters to be
For continuous variables, Student’s t-test was perfor- corrected in the treatment of these patients during
med in order to compare male and female subjects the mixed dentition.
and, therefore, thin and thick gingival biotype. Methods: Digital dental cast measurements (rotation
Results: The prevalence in the whole sample of thin and mesialization) were performed in a sample of 48
gingival biotype was 42.3% and thick gingival biot- subjects with unilateral posterior crossbite (UPXB; 19
ype was 52.4%. The frequency of female gender with males and 29 females, mean age 10.2 ± 1.2 years) and
thin gingival biotype was significantly less respect to in a control group of 35 subjects with normal Class I
male patients (41.2% and 52.4%, respectively) whi- occlusion (17 males and 18 females, mean age 9.9 ±
le the frequency of thick gingival biotype was higher 1.3 years). An independent sample t-test, the Mann–
in the female respect to male patients (54.5% and Whitney test, Fisher’s exact test, and Pearson correla-
46.3%, respectively) (χ2=1.337, p=0.245). The mean tion were used for statistical comparison.
age of patients with thin gingival type (14.6±0.5 ye- Results: The amount of upper molar rotation was signi-

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Poster presentations - Orthodontics

ficantly greater in the experimental group when com- males, 15 females) with a 12,3 years mean age, all trea-
pared with the control group. A clinically significant ted with non-extraction orthodontic treatment. Using
‘upper molar rotation’ (UMR) was present in 66.7 per intraoral scanner (Trios 3 ® shape) and cephalometric
cent of the subjects with UPXB versus 5.7 per cent of analysis it was possible to evaluate the following pa-
the control group. The UMR group presented also a rameters: i) evaluation of incisal edge displacement
significant mesialization of upper first molars when in the sagittal and vertical plane; ii) variation of ve-
compared with the control group. In the experimen- stibular gingiva after treatment; iii) distance between
tal group, there was a significant difference between incisal edge of upper central incisor and perpedicular
rotation and mesialization in the right and left side line to the Frankfurt plane trough SNA point; iv) angle
and a correlation has been found between these two between incisive axis and Palatal plane (IncSup^PP);
variables and the amount of Class II molar relationship v) distance between Prostion and Palatal plane. These
at the crossbite side. Limitations: This is an epidemio- data were analyzed in inizial orthodontic treatment
logical case–control study and the discussed effects (T0) and after orthodontic treatment (T1). The ini-
of an early correction of the asymmetric upper mo- tial and final models are superimposed by “n point”
lars’ migration are only speculations based on an as- method. The landmarks used are nasopalatin papilla
sociation relationship. and palatine premaxillari wrinkles, consequently the
Conclusions: The findings of this study show an asym- dentals intercuspidation guaranteed the correct loca-
metric upper first molars’ migration (rotation and lizzation of mandible bone.
mesialization) in unilateral functional posterior Results: The data showed on the lower central left
crossbite versus a control group. An early evaluation incisor: a) vestibular displacement of incisal edge
and correction of the molars’ migration during the of 2,7 mm and apical displacement of incisal edge
mixed dentition should be considered in order to of 0,99 mm; b) variation of gingiva in vertical plane
obtain a correct inter-occlusal sagittal molar rela- of 2,7 mm; c) displacement of free gingival edge of
tionship, space for an adequate eruption of perma- 0,04 mm; d) coronal displacement of incisal edge of
nent teeth, and perhaps reduce the need of a fol- 1 mm; e) mean esoinclination of 1,3°. On the upper
lowing fixed appliance treatment in the permanent central left incisor: a) apical displacement of 0,51
dentition. mm; b) mean esoinclination of 4,38°. Using Spear-
man correlation we showed an increased statistical
significance between sagittal displacement of incisal
Evaluation of non-extraction orthodontic edge and esoinclination of lower central left incisor,
treatment effects on the periodontal structure and between vertical displacement of incisal edge
by digital and cephalometric analysis and vertical displacement of maxilla bone.
Conclusions: Using digital analysis we identified the re-
Laurenziello M.*, Giuliani M.*, Illuzzi G.*, Di Fede O.**, Lo lationship of periodontal fibers changes after dental
Russo L.*, Ciavarella D.* displacement on the vertical, sagittal and trasversal
planes. We confirmed the no-relation between vesti-
*Department of Clinical and Experimental Medicine, University of bular displacemnt and incisal edge position. Instead
Foggia, Foggia, Italy the vestibular gingiva is modified after orthodontic
**Department of Surgical, Oncological and Oral Sciences, University treatment more than estrusion movement. The mo-
of Palermo, Palermo, Italy difications on the lower central left incisor are: ve-
stibularization and increased on the vertical plane
Aim: In accordance with Muhlemann and Zander du- of dental crown, thickening of vestibular gingiva and
ring the initial phase of the tooth movement there is no-variation of free gingival edge. The modification
a new positioning of periodontal fibers to support on the upper central left incisor are: esoinclination
the tensile forces. The periodontal system, during end relative intrusion of dental crown, vertical incre-
normal masticatory cicles, is subjected to hard and ase of the whole tooth.
intermitted forces in the range of 2 - 50 kg. Accor-
ding to the priciples of hydrodynamics forces, the
fluids inside the periodontal ligament do not leak, Smiling to OSAS: the role of interdisciplinarity
allowing the cushioning action, that they convert
compression forces in trophic stimulation for bone Lucchese A., Sigorini P., Toma S., Palonta F., Trevisani F.,
architecture. The orthodontic forces must be able to Bettiga A., Liguori A., Bussi M., Bassani L., Gastaldi G.
induce a direct reabsorption in the bone. The aim of
this research is to evaluate the periodontal changes Dental School, Department of Dentistry (Head: Prof. E. Gherlone),
after non-extraction orthodontic treatment by digi- IRCCS San Raffaele Hospital, Milan, Italy
tal and cephalometric analysis.
Methods: In this study we are analyzed 22 patients (7 Aim: Too often the obstructive sleep apnea syndro-

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XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

me (OSAS) is not taken sufficiently into account, This is essential, not only for systemic health corre-
although it’s a disease which affects about 6% of lations, but also to prevent the patient from feeling
the population. The aim of this study is to highlight abandoned by making him able to rely on the most
the importance of having a team of specialists, experienced specialists in the field which can help
which includes a dentist, an otorhinolaryngologist, him solve this problem.
a nephrologist, a neurologist, a pulmonologist and Conclusion: After explaining what risks and complica-
a nutritionist, working synergistically to treat this tions a patient suffering from sleep apnea can un-
disease. Furthermore this study aims to demonstra- dergo to, the aim is that of taking care of the patient
te how this condition should not be underestimated in Day Hospital so to perform in a single day: Holter
and indeed requires early intervention, since its ef- monitoring, sleep endoscopy, dental exam, neuro-
fects are reflected on everyday life: going from the logical exam, pneumological exam and visit by the
risk of accidents caused by somnolence to clinical nutritionist.
consequences which can bring to cardiovascular, ce-
rebrovascular and nephrological problems.
Methods: Why involve nephrologist? Apneas in obe- Effectiveness of orthodontic treatment with
se, or even just overweight patients, don’t allow an headgear in the Class II malocclusion: a
adequate oxygenation of their entire organism. The systematic review and meta-analysis
first organs to be affected are the ones which are
usually the most perfused such as kidneys, and in Nucera Riccardo, Lo Giudice Antonino, Longo Vanessa,
the long term episodes of renal ischemia may occur. Fastuca Rosamaria, Bellocchio Angela Mirea, Spinuzza
It has been shown that after such ischemic injuri- Paola, Cassarà Federico, Portelli Marco, Militi Angela,
es these patients may become affected by hyper- Cordasco Giancarlo
tension, resulting in a concrete risk of stroke. Why
involve nutritionist? The role of the nutritionist is Department of Biomedical and Dental Sciences and
to keep under control hypertension and proteinuria Morphofunctional Imaging, Section of Orthodontics, School of
(resulting from kidney damage) by educating them Dentistry, University of Messina, Messina, Italy
about correct dietary habits. Why involve pulmono-
logist? The pulmonologist is often the first specialist Aim: The aim of this systematic review and meta-
to be interviewed by the patient suffering from sleep analysis was to evaluate the skeletal and dental
apnea. He prescribes to the patient the polysomno- effects of headgear treatment on growing Class II
graphy, a diagnostic test that records the progress patients using published RCTs and CCTs in order to
and changes of some physiological parameters du- achieve the highest quality of evidence on this topic.
ring REM and NON-REM sleep in individuals with su- Methods: This systematic review and meta-analysis
spected sleep disorders. CPAP (Continuous Positive was conducted according to the guidelines of the
Airway Pressure) are given to people who have major Cochrane Handbook for Systematic Reviews of Inter-
problems that don’t allowed them to breath spon- ventions (version 5.1.0) and is reported according to
taneously. Why involve otorhinolaryngologist? This the PRISMA statement. A survey of articles published
figure can improve the quality of these patients’ sle- up to June 2016 about the effects of headgear for
ep through interventions of functional nasal surgery the treatment of Class II malocclusion was performed
such as septoplasty and the reduction of the inferior using nineteen electronic databases. Only randomi-
turbinate. In addition, after performing a polysom- zed clinical trials and prospective controlled clinical
nography and having received the data, he can re- trials investigating Class II malocclusion growing
quest a Sleep Endoscopy that can be used to identify patients treated with headgear were included. Two
the type of intervention which could be more effec- authors accomplished independently study selection,
tive against the specific cause each patient’s sleep data extraction, and risk of bias assessment. All po-
apnea. Why involve dentist? During the session of oled analyses of data were based on random-effects
Sleep Endoscopy MADs (Mandibular Advancement models. Statistical heterogeneity was evaluated.
Devices), made by the dentist after a careful exami- Results: In total, 5 studies were included (3 rando-
nation, are applied to see if they can work for that mized clinical trials, 2 prospective controlled clini-
specific patient. In case of a positive effect these de- cal trials) that collected data from 318 patients (161
vices could be a valid alternative to CPAP (which is treated, 157 untreated controls). The ages of the pa-
more bulky and presents more side effects such as tients varied across the studies but the majority of
claustrophobia, aerophagy and earache). Furthermo- the trials had a sample with an age range between 8
re, the compliance of patients using MADs turns out and 9 years. The times of daily wear of the applian-
to be higher than that of patients using CPAP (65%). ce varied across studies from 8 to 14 hours per day.
Results: The main result that this study aims to achie- The mean differences in treatment effect of head-
ve is an interdisciplinary approach to this disease. gear, relative to the untreated controls, were -1.35°

130 © ariesdue January-April 2017; 9(1)


Poster presentations - Orthodontics

per year (95% CI, -2.14° to -0.57°) for SNA angle, - records were obtained. Statistical analyses using the
0.59 mm per year (95% CI, -0.86 mm to -0.32 mm) sign test were performed. For all these patients were
for anterior maxillary displacement, - 1.41° per year conducted the following exams: laboratory tests,
(95% CI, -2.09° to -0.73°) for ANB angle, and - 1.38 microbiological evaluation, hematological and im-
mm per year (95% CI, -2.67 mm to -0.10 mm) for munological evaluation, brain MRI, brain TC, ortho-
overjet. However, the treated group showed no sta- pantomografy and hand – wrist radiografy in order
tistically significant changes for the following para- to evaluate the effect of Wiskott-Aldrich syndrome
meters: SNB angle - 0.19° per year (95% CI, -0.46° on growth and an oral examination.
to 0.08°); overbite - 0.14 mm per year (95% CI, -0.54 Results: Medical signs and symptoms such as recur-
mm to 0.25 mm); palatal plane rotation 0.92° per rent infections, eczema, bleeding, thrombocytope-
year (95% CI, -1.37° to -3.21°). nia, anemia, petechiae, ecchymosis, hemorrhagic
Conclusion: Headgear therapy in growing subjects diathesis, major bleeding were usually observed. Oral
with Class II malocclusion with a marked maxillary examination revealed gingivitis, periodontitis, aph-
prognathism is effective in the short term. Moreover, thous lesions, gingival bleeding, oral petechiae and
early treatment with traction allows a significant re- severe oral infections (caries, pulpitis, abscesses). As
duction of overjet and consequently reduces the risk regards the othodontic aspect, an higher incidence
of dental trauma in the growing patients. of alterations in the physiological eruptive sequen-
ce, with more inclusions and transpositions, was
observed, probably due to untreated inflammatory
Smile to Wiskott-Aldrich syndrome: oral and and infectious processes. Infective processes affec-
orthodontic manifestations ting the permanent tooth may also result in maloc-
clusion, that could possibly represent the cause of
Lucchese A.*, Manuelli M.**, Cicalese M.P.***, Ciuffreda future skeletal problems. Moreover Wiskott-Aldrich
C.****, Aiuti A.*** syndrome could compromise and interfere with the
orthodontic treatment which has the purpose of ali-
*Aggregate professor, Dept. of Orthodontics, Vita Salute San gning teeth and solving skeletal issues.
Raffaele Univerisity, Milan, Italy; Unit of Dentistry, Division of Conclusions: Since Wiskott-Aldrich syndrome presents a
Orthodontics, Research area in Dentofacial Orthopedics and wide spectrum of symptoms and complications, it is
Orthodontics, IRCCS San Raffaele Scientific Institute, Milan, Italy mandatory to increase awareness of this entity and to
**Assistant Professor, Department of Orthodontics , Vita Salute San apply a multidisciplinary approach that should inclu-
Raffaele Univerisity, Milan, Italy de the dentist, in order to intercept pathologies of the
***San Raffaele Telethon Institute for Gene Therapy (TIGET), San oral cavity and to improve patients’ quality of life.
Raffaele Scientific Institute , Milan, Italy
****Resident, Department of Orthodontics , Vita Salute San
Raffaele Univerisity, Milan, Italy Dental-skeletal effects of the treatment with
aligners in adult
Aim: The oral cavity is an anatomical structure cha-
racterized by the juxtaposition of soft and hard tis- Montaruli G.* Guida L.*, Battista G.*, Panzarella V.**,
sues and which is continuously subject to challenge Laurenziello M.*, Ciavarella D.*
by the external environment and foreign material. Di-
seases and disorders caused by oral microorganisms *Department of Clinical and Experimental Medicine, University of
are very common, in particular dental caries, perio- Foggia, Foggia, Italy
dontitis and halitosis. Oral diseases can be seconda- **Department of Surgical, Oncological and Oral Sciences, University
ry to systemic pathologies, such as Wiskott-Aldrich of Palermo, Palermo, Italy
syndrome, a rare X-linked primary immunodeficiency.
Despite progress in its diagnosis and treatment, its Aim: The aim of the present study is to evaluate the
prognosis remains poor. The aim of this study is to craniofacial modifications on vertical plane with in-
find possible common oral and, more specifically visible aligners. The use of this device in adults is a
orthodontic manifestations among individuals with topic both for general dentist or specialist. The invisi-
Wiskott-Aldrich syndrome, in order to establish pre- ble aligners treatment was about 8 months. Authors
cautions that help to improve patient’s quality of life, of the present paper evaluated the dental-skeletal
particularly related to dental aspects. effects pairing the results with adult patients trea-
Methods: Eighteen patients (18 males, mean age 11 ±1 ted with fixed appliance.
years) with Wiskott-Aldrich syndrome were recruited Methods: In this study 18 patients at the end of growth
between 2010 and 2015 from referrals to the Immu- (cervical vertebral maturation stage VI), orthodonti-
noematology Department at San Raffaele Hospital, cally treated at the Dental Clinic of the University of
Scientific Institute, Milan, Italy. Routine diagnostic Foggia, were considered. 9 patients were treated with

January-April 2017; 9(1) © ariesdue 131


XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

CAT method (Clear Aligner Treatment) and 9 with stan- lar and podalic systems, the stomatognathic system
dard biomechanics. Patients treated with aligners wore provides input to the tonic postural system, which
the device for 18 months while those treated with controls and manages the three-dimensional posi-
standard biomechanics for 24 months. Cephalograms tioning of the body in its surrounding space. Taking
at the start of the treatment (T0) and at the end of the the above into consideration, it is useful for a clini-
treatment (T1) were performed; SN-PM (cranial angle cian who is attempting to understand a dysfunctio-
between the anterior cranial basis and the mandibular nal patient to adopt a global perspective that syn-
plan), Plan I (angle between the perpendicular to the thesises interdisciplinary medical elements by taking
anterior cranial base and the bi-spinal plan), PP-AM into account the way in which the stomatognathic
(angle between the bi-spinal plan and the mandibular system interacts with the tonic postural system. To
plan), PF-1 (upper central incisor incisal edge to the this end, the 2011 ministerial guidelines report that
perpendicular at the Frankfurt plan) were evaluated. a dysfunctional patient who also presents postural
All the values obtained were processed by GraphPad problems should be administered the following for
InStat® statistical software; for each index considered diagnostic purposes: a postural examination, the
these values were considered: arithmetic mean, stan- detection of anthropometric data, an analysis of
dard deviation, average statistical difference, P-value the overall joint mobility, the examination on the
and pairing mean test. stabilometric platform, an electromyography and
Results: The data obtained by the statistical analysis a mandibular kinesiography. These assessment me-
have been considered among the two groups of asures provide stabilometric data by assessing the
subjects. Considering the difference of the average quality and quantity of the oscillations of the center
statistics the test group showed an increase of man- of pressure (CoP) and posturometric informations by
dibular divergence (SN-PM) of 3°, while the control identifying the soil projection of postural load. The
group of -0.2°. In the evaluation of the Plan I the following work performs a product analysis of the
difference of the average statistics in the test group main stabilometric and baropodometric platforms
was -4.8°, -1.1° in the control group. PP-PM: the dif- currently available on the market in order to help
ference of the average statistics in the test group the clinician to choose the best instrument.
was 0.2°, -0.1 ° in the control group. PF-1: the value Methods: The product research we conducted for this
obtained in the test group was 1.4 mm versus - 2.4 study examined the technical details provided on the
mm in the control group. website of the manufacturer for each stabilometric
Conclusion: The research evidenced that invisible ali- and baropodometric platform commonly used in
gners treatment generated a post-rotation on den- dentistry. These instruments are considered to be
tal-skeletal complex respect to the patients treated a valid diagnostic aid, drawing on a global, interdi-
with the fixed appliance. In patients treated with sciplinary perspective that allows the integration of
CAT method it has been possible to observe an in- orthognatodontic clinical data with instrumental in-
crease in the vertical dimension of the lower third formation about posture and balance.
of the face but also an increased gummy exposure. Results and Conclusions: Data obtained from the re-
Within the limits of this work we can observe that sults of this research are used to create a table con-
the aligners determine major skeletal changes com- taining technical and functional characteristics of
pared to the classical biomechanics. each platform. Technical characteristics such as size,
thickness, weight, power and connection technologies
adumbrate for a potential buyer the design and the
Product analysis of the main stabilometric and workability of the instrument so that he can decide
baropodometric platforms used in dental whether the instrument is compatible or not with the
practice currently on market space and the technologies present in his office. The
functional information concerns the number of load
Pacella E., Lombardelli E., Dari M., Galluccio G., Barbato E. cells, the kind of sensors and the static and dynamic
types of analysis performed by the software of each
Department of Oral an Maxillofacial Sciences, “Sapienza” University platform in order to provide a potential buyer with
of Rome data that is more useful for clinical practice.

Aim: Nowadays there are more and more studies


highlighting the relationship between the stoma- The role of dental hygienist and oral hygene
tognathic system and the tonic postural system. In motivation on the gingival health of patients
fact, in addition to the well-known functions of ma- undergoing orthodontic treatment with
stication, deglutition, phonation and respiration, the multibracket fixed appliance and clear aligners
stomatognathic system seems to play a role in main-
taining body balance. Alongside the visual, vestibu- Pango Ada, Bucci Rosaria, Donnarumma Valeria, Manisera

132 © ariesdue January-April 2017; 9(1)


Poster presentations - Orthodontics

Elisabetta, Bellia Loredana, Valletta Rosa, D’Antò Vincenzo Missing lateral maxillary incisors: approach and
treatment with a mini-screw anchored apparatus
Department of Neuroscience, Reproductive and Oral Sciences,
Section of Orthodontics and Temporomandibular disorders. Portelli M., Gatto E., Militi A., Cicciù M., Cervino G., Lauritano
University of Naples Federico II, Naples, Italy F., Bertino R., Triolo G., Lo Giudice A., Nucera R.

Aim: The maintenance of adequate gingival health has Dept of Biomedical, Dental Science and Morphological and Functional
always been a crucial issue for orthodontic patients. Images, Dental School, University of Messina, Italy
The aim of the current study was to compare the ef-
fectiveness of oral hygiene motivation and professional Aim: Missing lateral maxillary incisors is a common to-
oral hygiene on the gingival health of adult patients oth anomaly associated to therapeutic set of problems;
undergoing orthodontic treatment with multibracket the management of these clinical cases often requires
fixed appliances and clear aligners. an integrated orthodontic and restorative approach.
Methods: The sample comprised 36 ongoing orthodon- Methods: Authors reported a therapy note referred to a
tic patients (24 females; 12 males, mean age 24.4±7.6 patient of 14 years old, man, affected by missing ma-
years) recruited at the Section of Orthodontics and xillary lateral incisors, bilateral dental second class e
Temporomandibular Disorders of the University of Na- deep bite, treated at the Department of Orthodontics
ples Federico II (Italy), with full permanent dentition of the University of Messina. An orthodontic treatment
and without periodontal disease. Seventeen subjects has been planned with the aim of distalize maxillary
(mean age 21.9±5.3 years) were undergoing multi- first molars and the space recovery necessary for the
bracket fixed orthodontic therapy (Fixed Group – F), prosthetic restoration of missing lateral incisor. For the
while 19 subjects (mean age 26.7±8.7 years) were in distalization of maxillary molars has been used a Distal
treatment with clear aligners (Clear Aligners Group – Jet supported by mini screw. After seven months of
CA). At the baseline (T0) the patients were submitted treatment with distal screw maxillary molar distaliza-
to an evaluation of Full-Mouth Bleeding Score and tion has been completed, obtaining a bilateral molar
Full-Mouth Plaque Score. Subsequently, the patients first class. A multi-bracket orthodontic appliance was
underwent a professional oral hygiene, along with pe- bonded in the upper and lower arch using Enpower
riodontal scaling for removing of supra- and subgin- Brackets, to finalize the occlusion.
gival bacterial plaque/biofilm and calculus. Finally, all Results: Class II molar relationship has been over-corrected
the patients were instructed for individualized tooth- to Class I in about seven months. The orientation of the
brushing technique. Every two weeks, the subjects force vector resulted in a distal tipping and rotation of
were re-called for reinforcement of the instructions the first molars, without significant vertical changes.
of the daily oral hygiene. After 2 months (T1), Full- Conclusions: Mini screw anchored Distal Jet seems to be
Mouth Bleeding Score and Full-Mouth Plaque Score effective in molar distalization without any type of side
were re-evaluated. The intra-group comparisons (T1 effects. The advantages of this device are the absence
vs. T0) were calculated with a paired sample t-test. of patient compliance, relatively predictable outcomes,
The comparisons between groups (F vs. CA) were per- favorable aesthetics, possibility of different activations
formed with an independent sample t-test. The signi- in each side.
ficant level was set at p<0.05.
Results: The intra-group comparisons showed statisti-
cally significant differences for all the variables exa- Treatment of ectopic eruption of permanent
mined, except for the bleeding score of the group we- maxillary first molar: case reports
aring multibracket fixed appliance (p=0.085). On the
other hand, the between-groups comparisons revealed Ricciardi Camilla, Cagetti Maria Grazia, Campus Guglielmo,
statistically significant differences for the plaque score Strohmenger Laura
(F: -65.02 ± 15.4 vs. CA: -46.37 ± 19.0; p<0.005) and
for the bleeding score (F: -7.68 ± 16.0 vs. CA: -23.87 ± Department of Biomedical, Surgical and Dental Science, School of
13.7; p<0.005). Dentistry, University of Milan
Conclusions: The plaque and the bleeding scores decre- Department of Surgery, Microsurgery and Medicine Sciences,
ased during the study period in both groups (F vs. CA). School of Dentistry,University of Sassari
The current findings support the implementation of
motivational technique, individualized tooth-brushing Aim: To present a new approach for patients with ec-
technique and the intervention of a professional oral topically erupting first permanent molars (EEM), with
hygienist during the orthodontic treatment for the undermining reabsorption of second primary molars.
improvement of gingival health in patients with both Methods: EEM has a prevalence of 2.5% among pa-
fixed orthodontics and clear aligners, in a two months tients eligible for orthodontic therapy. It occurs 20
of follow-up. times more frequently in maxillary first molars than

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XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

for mandibular first molars. Frequently, in 2/3rds of matched for sex and age, were selected to under-
cases, after the reabsorption of the distal root sur- go treatment with Invisalign aligners. For each of
face of the second primary molar, the permanent them 2 teeth were selected: an upper second mo-
molar is able to erupt into a normal position, with lar on which distalization was applied from the first
self-correction of the problem. In the remaining ca- aligner and a frontal tooth on which no force was
ses, the first molar is blocked by the second prima- applied for at least 4 aligners. Plaque Index, Gingival
ry molar and remains in an ectopic position, until Index and Bleeding on Probing scores were recorded
orthodontic treatment or premature exfoliation of on test and control teeth at baseline and after any
the primary tooth occurs. This eruption’s abnormali- sampling stage, in order to identify any possible al-
ty is associated with severe crowding and posterior teration of crevicular fluid due to increase in bacte-
interarch transverse discrepancies. It is commonly ria concentration. Gingival crevicular fluid sampling
treated with removable plates with distal screws was executed in the mesial and distal sides of the
or separating ligatures. In this clinical report two considered teeth. Gingival crevicular fluid was taken
EEM cases are presented, treated with a special de- through the application of PerioPaper Strips (Ora-
sign Quadhelix, fixed on a resin splint cemented on flow NY) for 30 seconds at 1mm depth. Sampling was
the primary molars. The first patient is 7.7 years old carried out before force application (T0), after one
male. He shows a severe crowding with mild class hour (T1), one week (T2) and 3 weeks (T3) from the
III tendency. EEM is detectable on the left side. The beginning of the treatment. Quantitative analysis
appliance was worn for 15 weeks, until the correc- was obtained through an electronic analyzer (Peri-
tion of the eruption of 2.6 was obtained. The second otron 8000, Oraflow NY). Strips were then placed in
patient is 8.6 years old female, she presents a severe a buffered solution of NaCl, stored at -80 C° and
crowding with posterior transverse deficiency and a analyzed by ELISA test to measure IL-1β, RANKL, TGF
open bite tendency. EEM is detectable on the right β, osteogenin and osteoprotegerin concentration.
side. The appliance was worn for 8 months to allow Results: No significant changes for Plaque Index, Gin-
arch expansion and a correct eruption path of 1.6. gival Index and Bleeding on Probing were recorded
Results: Both patients treated with this special design for test and control teeth in any stage of the study.
Quadhelix showed a good correction of the EEM. Orthodontics forces produced tissue-degrading
Further orthodontic treatment is needed enzymes and inflammatory mediators, as well as an
Conclusions: The special design Quadhelix presented is increase of flow rate occurred before the bioche-
an effective alternative to correct ectopic eruption mical changes. The expression of the enzymes and
of permanent maxillary first molar, and it obtained mediators did change, with an increase in the molar
good results, being independent by the compliance group, indicating the efficiency of the force applied
of the patient. in order to obtain the distalization.
Conclusions: Results from this pilot study suggest the
hypothesis that a different biochemical response do-
Split mouth analysis of gingival crevicular fluid esn’t occur in the gingival tissues of the two groups.
during orthodontic treatment with Invisalign®
aligners
Down syndrome: proposal of a new orthodontic
Rossini G.*,**, Deregibus A.***, Piancino M.G.****, treatment need index according to patient’s
Castroflorio T.***** psychological evaluation
*PhD Student, Department of Mechanical and Aerospace Strappa C.*, Ricci B.**, Candida E.*, Dagheti B.***, Grippaudo
Engineering, Politecnico di Torino, Turin, Italy C.****
**Resident, Department of Orthodontics, University of Turin –
Dental School, Turin, Italy *CLOMPD students. Catholic University of Sacred Heart, Rome
***Aggregate Professor, Chief Specialization School of **PhD Programme in Cellular and Molecular Clinical Research in
Orthodontics, University of Turin – Dental School, Turin, Italy Dental Diseases
****Aggregate Professor, Specialization School of Orthodontics, ***Postgraduate School in Orthodontics student, Catholic
University of Turin – Dental School, Turin, Italy University of Sacred Heart, Rome
*****Adjunct Professor, Specialization School of Orthodontics, ****Chairman of Postgraduate School in Orthodontics: Prof.
University of Turin – Dental School, Turin, Italy Cristina Grippaudo. Catholic University of Sacred Heart, Rome

Aim: The aim of this study is to analyze gingival cre- Aim: Down Syndrome (DS) is a craniofacial syndro-
vicular fluid changes in human subjects undergoing me caused by trisomy 21, the most common chro-
orthodontic treatment with Invisalign aligners. mosomal abnormality associated with intellectual
Methods: 10 consecutive healthy adult patients, impairment. Craniofacial abnormalities include a

134 © ariesdue January-April 2017; 9(1)


Poster presentations - Orthodontics

characteristic pattern of dysmorphic features. As re- A. Rahim et al. reported, perceive dental treatment
ported by Andersson et al., dental malocclusion is with exaggerated levels of apprehension.
very common among persons with DS and phenot- For this reason, a proper understanding of the pa-
ypic characteristics are openbite, crossbite and Class tient’s psychology is essential in order to establish
III malocclusion. There is a reduction in the masti- a good patient-physician relationship and to make
cation and phonation which leads to increase diffi- dental sessions the least disruptive possible.
culty in reaching autonomy and social integration.
The main aim of orthodontic care for these patients
is restore mastication, improving breathing and A blinded multi-centered study to analyse the
speech. The use of orthodontic treatment need in- correlations between cervical vertebrae
dex is important in order to provide specific care and maturation and tooth mineralization for
treatment. In patients with DS a careful assessment pubertal skeletal growth spurt assessment
of the psychological profile is important to program-
me the most appropriate treatment plan according Toma F.*, Mariani G.*, Albertini P.*, Bassani L.P.*, Manuelli
to the patient’s compliance and to evaluate any im- M.**, Lucchese A.***, Gastaldi G.****, Gherlone E.F.*****
provements over time. The aim of this study is to
propose a new orthodontic treatment need index in *Resident, Department of Orthodontics , Vita Salute San Raffaele
patients with DS according to patient’s compliance. Univerisity, Milan, Italy; Unit of Dentistry, Division of Orthodontics,
Methods: A questionnaire was created to evaluate co- Research area in Dentofacial Orthopedics and Orthodontics, IRCCS
operation of the individual, it was compiled by the San Raffaele Scientific Institute, Milan, Italy
clinician at the end of the first dental visit and then **Assistant Professor , Department of Orthodontics , Vita Salute
updated during the following sessions. It consists of San Raffaele Univerisity, Milan, Italy; Unit of Dentistry, Division
three levels, each of which is assigned a score to as- of Orthodontics, Research area in Dentofacial Orthopedics and
sess the degree of collaboration. Each question of Orthodontics, IRCCS San Raffaele Scientific Institute, Milan, Italy
each level is assigned a score of 0 in case of a nega- ***Aggregate professor, Department of Orthodontics, Vita Salute
tive answer; in case of a positive answer the score is San Raffaele Univerisity, Milan, Italy; Unit of Dentistry, Division
assigned according to the time required to carry out of Orthodontics, Research area in Dentofacial Orthopedics and
the procedure (minimum score of 1, maximum score Orthodontics, IRCCS San Raffaele Scientific Institute, Milan, Italy
of 3). Level I includes the steps of the first approach ****Associate Professor, Oral Science Department, Vita Salute
to the patient. Once you have completed Level I, a San Raffaele University, Milan, Italy; Unit of Dentistry, IRCCS San
score is assigned by summing the various points as- Raffaele Scientific Institute, Milan, Italy
sociated to each question. *****Professor and Chairman, Department of Dentistry and
Level II includes procedures performed during the II Implantology, Vita Salute San Raffaele University, Milan, Italy; Unit
orthodontic visit and less invasive dental procedures. of Dentistry, IRCCS San Raffaele Scientific Institute, Milan, Italy
Level III is intended to evaluate the cooperation of
the patient in the short- and long-term recall. Aim: The aim of the study was determining the pos-
Results: All the levels are then summed to evaluate the sible correlations between the cervical vertebrae
overall score. Score between 0 and 10: the patient maturation method (CVM) and the mineralization of
with DS is uncooperative and incurable. This influen- mandibular teeth (TMS) in a sample of the Mediter-
ces the specialist to choose the type of treatment. ranean area. In the last decades several authors per-
Score between 10 and 20: the patient is as a par- formed studies in order to obtain the most reliable
tial cooperator, treatable with simple therapies. The method to determine the pubertal skeletal growth
specialist can carry out professional hygiene proce- spurt (PGS) in adolescent. As widely descibred in li-
dures, fluoride applications, conservative treatments terature, infact, the accuracy of PGS identification
and insert simple orthodontic appliances. Score over is fundamental to perform an efficient and effective
20: the best score desirable, the patient is cooperati- orthopedic treatment.
ve and curable even with complex therapies. Methods: A cross-sectional study was conducted in
Conclusion: The tests revealed that an adequate ap- three orthodontic centers, two in Italy (Milan and
proach to patients with DS is necessary to rehabi- Turin) and one in Greece (Thessaloniki). Two blinded
litate them in a proper way; therefore, during the operators analyzed pre-treatment panoramic (OPG)
first visit, it would be better to have an empathetic and lateral x-rays of 667 orthodontic patients (379
attitude towards the patient, by using the method females, 288 males). TMS of mandibular left canine,
“tell-show-do” with particular attention to the psy- first and second premolars and second molar were
chological aspect and dialogue. The clinic should be evaluated through the method described by De-
as much as possible quiet, with few operators around mirjian et al. The growth phase was assessed using
and short visit time and the physician’s voice tone the CVM method proposed by Baccetti et al. Sta-
should be calm and low. These individuals, indeed, as tistical correlations and multiple regression analysis

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XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

for different predictors adjusted for covariates (sex was an important factor of the occlusion and Bol-
and group) were performed by a blinded statistician. ton’s ratio has been suggested as the seventh “key”
Post-hoc power analysis conducted after the study for an ideal occlusion. Anterior Bolton discrepancy
has been completed, and uses the obtained sample involved the six anterior teeth from left side canine
size and effect size to determine what the power was to the right side. Anterior TSDs, showed a prevalence
in the study; the post-hoc power was about 1. between 17% and 31% among orthodontic patients
Results: Significant correlations between CVM and and were more common in Class II division 1 maloc-
TMS stages were identified for each tooth. Signifi- clusions and in Class III malocclusions. In this case
cant age differences resulted for CVM, second molar Bolton discrepancy was solved through direct resto-
and second premolar (p<0.05). Among the female rative treatment of the upper frontal teeth.
sample, significant correlations for second molar Methods: The patient started Orthodontic treatment
(p<0.01 – rho=0.853) were observed between TMS at the age of 13 at the Dental Clinic of the Hospital
D and CVM I-II, TMS G and CVM III-IV, TMS H and of Padua. Timing to start the treatment with fun-
CVM V-VI. Regarding males, significant correla- ctional appliance has been established with hand
tions resulted for second molar (p<0.01, rho=0.813) wrist radiographic control. At the pubertal spurt the
between TMS D and CVM I-II, TMS G and CVM III, patient was treated with a removable Herbst ap-
TMS H and CVM IV-V-VI. pliance on acrylic splint for one year, to get a class II
Conclusions: The present study confirmed a rela- overcorrection. At the end of the first phase of tre-
tionship between CVM and Demirjian methods to as- atment, a preadjusted MBT fixed appliances was used
sess pubertal growth spurt (PGS). Thus OPG could be to finalize the occlusion. Leveling and aligning pha-
suggested as a reliable method to identify PGS. The se was performed with 0.16 NiTi and 0.19x0.25 NiTi.
results obtained by this study confirmed that mandi- Intermaxillary short class II elastics were used since
bular second molar is the best predictor for skeletal 0.16 NiTi arch for the control of molar class. Spaces
maturity and that stage G for both sexes indicates closure was performed with 0.19x0.25 SS, maintai-
the ongoing of growth peak. Stage G for boys and ning spaces for reconstructions with passive coils
stage H for girls correlate significantly with the late between lateral incisors and canines. 0.19x0.25 mul-
part of PGS. First premolar stage G for boys and sta- tibraided was used for the finishing phase. At the end
ge F for girls are associated with PGS. However, first of the orthodontic treatment the patient underwent
premolar is not recommended as a first choice indi- a restorative treatment. The restorative treatments
cator, due to the variability of data about it. have been performed according to a diagnostic wax,
realized on the plaster models taken immediately af-
ter the orthodontic treatment. The size and shape of
Multidisciplinary approach to a Class II dental restorations have been based on the golden
hypodivergent growing patient proportion, so the relation between central and la-
teral incisors was calculated in order to achieve the
Zanatta S., Crivellin G., Siviero L., Drago P., Gracco A., most desirable aesthetic result. The restorative tre-
Stellini E. atment was performed using the adhesive technique.
Thanks to restorations, the smile design had become
University of Padua, Department of Neuroscience, Dental School much harmonious.
Results: At the end of the treatment the patient pre-
Aim: The use of removable functional appliances in sented an ideal Class I occlusion, with a good ca-
growing individuals with skeletal Class II growing nine guidance function and molar intercuspidation.
pattern, has demonstrated to be effective for tre- Class II resolution was confirmed by cephalometric
atment of Class II malocclusion. These functional analysis and photographic reports, despite the pa-
devices are commonly used to improve mandibular tient maintained a retrusive pattern. The restorative
length in skeletal class II patients. This case report treatment improved aesthetics and gave a harmonic
assesses skeletal and dento-alveolar effects of remo- shape to the teeth.
vable functional appliances in Class II malocclusion Conclusion: An accurate treatment planning and a
treatment in a pubertal patient. Indeed, regarding multidisciplinary approach allow to get excellent ae-
evidence on the efficiency of functional treatment, sthetic and functional results.
when a class II patient is treated during the puber-
tal growth spurt, more favorable skeletal response is
seen, even though large individual remains responsi- Correlated variation between the lateral and the
veness. This clinical case also shows how significant middle basicranium and the face: a geometric
tooth size discrepancy (TSD) prevents to get an ideal morphometric longitudinal study
occlusion at the end of orthodontic treatment. W.A.
Bolton in 1958 suggested that mesio-distal width Oliva Giorgio, Zotti Rinaldo, Zotti Francesca, Oliva Bruno,

136 © ariesdue January-April 2017; 9(1)


Poster presentations - Orthodontics

Paganelli Corrado JIA and ultrasound: evaluation of sample


Department of Orthodontics, Dental School, University of Brescia, Cressoni Paolo, Garagiola Umberto, Chiara Occhipinti,
Italy Borzani Irene, Colangelo Bruno, Schiavone Laura, Bricchi
Elisabetta
Aim: Thanks to new geometric morphometric analysis,
the role of the cranial base in the growth and deve- Università degli Studi di Milano, Degree in Dentistry- President
lopment of facial bones is still a subject of study and Prof. G. Farronato
investigation. There is literature that contains incon- IRCCS Ca’ Granda Foundation- Ospedale Maggiore Policlinico - UOC
gruous results in the degrees of correlation between Odontostomatological and Maxillofacial Surgery- Director Prof.
the shape of the skull base and the development of A.B. Giannì
the face. Some authors have speculated that the re-
ason for this disagreement is a different relationship Aim: The purpose of this work is the evaluation of
between the lateral skull base and the central one the effectiveness of the ultrasound examination for
with the face. The aim of this longitudinal study is to early diagnosis of pathological changes of tempo-
analyze and compare the patterns of morphological romandibular joint. We analyzed the information
variation between the face and the lateral cranial obtained by ultrasound examinations in a sample of
base with those between the face and the central pediatric patients with juvenile rheumatoid arthritis.
skull base in subjects before and after the pubertal In this study we included 65 patients with juvenile
peak. idiopathic arthritis: 10 males and 55 females aged
Methods: 47 male subjects were selected from the ar- between 1 and 23 years with a mean age of 12.8
chives made available by the “American Association years and median of 13.1. The course of the disease
of Orthodontists Foundation” in particular those from the diagnosis of JIA is between 0 and 20 years
from the archive of the “Bolton-Brush study”. The with a mean of 7.9 and median of 6.5. All patients
subjects’ cephalometric x-rays were analyzed before were clinically examined: clinical examination inclu-
the pubertal peak and at the end of growth. After ded analysis of the face, intraoral examination and
being superimposed by means of the “Procrustes su- functional exam of temporomandibular joint.
perimposition”, the “Principal component analysis” Methods: All patients were subjected to ultrasound
was used to describe the changes in the two groups examination, with standardized technique, by 1 sin-
and the “partial least square analysis” has been used gle operator. The operator who performed the ultra-
to study the correlation among the shapes of facial sound examinations is a doctor with a specialization
bones, the lateral and central skull base. in Radiology of the Radiology Unit - Pediatric Divi-
Results: In the subjects analyzed pre-pubertal peak sion Fondazione IRCCS Ca’ Granda General Hospital.
the first two “singular axes” show statistically signifi- Ultrasound examination was carried out with stan-
cant correlations between the central skull base and dardized technique with the patient lying down. At
the face, while only the SAs-1 between the lateral least 2-3 oblique and axial scans were performed for
portion and the face is significant. The variations of each ATM right and left, having the articular bone
the base of the skull are strongly connected with the heads as reference, in particular the mandibular
variations in the vertical growth of the face. No SAs condyle. The patients were examined with all the
between central portion of skull base and the face same equipment of ultrasound platform (branded
is statistically significant in the analysis at the end GE model Logic E9) and high-frequency linear array
of growth. The SAs-1, however, remains statistically transducer (12 to 18 MHz depending on the age of
significant between lateral skull base and the face. the patient).
This axis describes more than 60% of the coarcta- Results: By Ultrasound examinations carried out, the
tion between the two forms. interpretation of ultrasound images and the reading
Conclusion: The study confirms the central role of the of the reports, we can summarize the following data.
cranial base during the development of the face. The Analyzed the case histories of 70 ultrasound eva-
relationship between the morphology of the skull luations: 11 instrumental testing proves negative to
base and the face in children before pubertal peak any pathological changes (0 reports altered) (16%
is statistically and clinically significant. The study of the total); with an average age of 8.5 years (ran-
also confirms the need to distinguish between the ge 3-19.5) and with a mean of 4.7 years after the
growth patterns of the central portion of skull base onset of AIG (range 0-10.5) - 21 instrumental tests
and those of the lateral portion. The facial bones, show bilateral alterations (30%); - 31 instrumental
despite also growing on the basis of “environmental” tests unilateral alterations; - 7 instrumental tests
and “functional” stimuli, maintain a larger growth show abnormalities not to the condylar structure. A
ratio with the lateral skull base than the one with balance between changes of condylar profile on the
the central portion. right and left sides can be observed: 36 and 37 cases

January-April 2017; 9(1) © ariesdue 137


XXIV Congresso Nazionale Collegio dei Docenti Universitari di Discipline Odontostomatologiche

respectively. (51%, 53%). Methods: The study was performed at Department of


Conclusion: Thanks to the analysis of the data, we can Dentistry in San Raffaele Hospital (Milan) (Dean:
say that US examination can be considered a tool for Prof. Enrico F. Gherlone).
All selected patients had
diagnosing condylar structure’s alterations ,especial- to submit a questionnaire aimed to assess their
ly in patients with AIG, despite it does not allow th- knowledge about “correlation between orthodontic
ree-dimensional visualization of the whole structure. therapy and white spots”. Data were obtained from
It is emphasized at the same time that ultrasoun- 70 selected patients, all undergoing orthodontic tre-
ds represent easily repeatable tests without biolo- atment. The only inclusion criteria was the presen-
gical costs. It is also important to underline that ce of orthodontic brackets on vestibular tooth face.
the ultrasound examination is well-accepted by the All the questions who patients had to answer were
patient and its parents as a diagnostic test. We con- enough easy to be understood by patients.
clude supporting the importance of as early as pos- Then 60 patients were selected, divided randomly in
sible diagnosis in Orthodontics for all the patients 2 groups: group A patients were treated with GC To-
,particularly in patients with arthritis. Therefore we oth Mousse and group B patients were treated with
consider interesting in the future to keep an indica- a placebo (T0). After one month (T1) was verified the
tion of ultrasounds as toll for study initial TMJ in- result from the use of GC Tooth Mousse protocol.
volvement: above all, we suggest US exams in small Results: The aim of the survey was to compare the
patients who increasingly are presenting at our Den- knowledge of patients about spots with deminerali-
tal Clinic directed by the Hospital or other centers. zation. The questionnaire showed that the 56% of
patients were aware of what white spots are, and
that 21% develop at least on of this kind of lesions
Etiology and treatment of white spot in patients on the vestibular enamel surface of tooth. The majo-
undergoing orthodontic treatmeant by fixed rity of patients surveyed reported that they were sa-
bonding: state-of-the-art and demographic tisfied with their smile and do not believe that white
survey spots can affect the beauty of their smile. Then the
efficacy of GC Tooth Mousse protocol was evalua-
Polizzi E.*, Manuelli M.**, Ciuffreda C.***, Ferreri A.R.*, ted. In T0, there were no statistically significant dif-
Lucchese A.**** ferences in number (p = 0.6359) and average size (p
= 0.5475) of White Spots between the group A and
*Dept. of Dental Hygiene, Vita Salute San Raffaele Univerisity, the group B. After one month (T1), statistically signi-
Milan, Italy; Unit of Dentistry, Division of Dental Hygiene, IRCCS San ficant differences both in number (p <0.0001) and
Raffaele Scientific Institute, Milan, Italy size (p <0.001) of white spots were observed betwe-
**Assistant Professor, Department of Orthodontics , Vita Salute San en A and B groups.
Raffaele Univerisity, Milan, Italy Conclusion: White spots do not affect, according to
***Resident, Department of Orthodontics , Vita Salute San Raffaele the patient’s point of view, the beauty of their smile.
Univerisity, Milan, Italy Data shows a serious lack of communication related
****Aggregate professor, Dept. of Orthodontics, Vita Salute to the problem of white spots from dentists to pa-
San Raffaele Univerisity, Milan, Italy; Unit of Dentistry, Division tients; from this situation results a general misinfor-
of Orthodontics, Research area in Dentofacial Orthopedics and mation of the patients. Moreover, from our study we
Orthodontics, IRCCS San Raffaele Scientific Institute, Milan, Italy can have a first evidence of the effectiveness of GC
Tooth Mousse in blocking the progression of tooth
Aim: The purpose of the study is to perform an analysis demineralization. There is also evidence of reduction
collecting demographic data related to white spots of number and size of white spot on enamel surface.
formation and check the effectiveness of treatment Finally recommend GC Tooth Mousse as prophyla-
with GC Tooth Mousse in a group of patients under xis or as a treatment in presence of demineralization
fixed multi-bracket orthodontic treatment. and white spot lesions.

138 © ariesdue January-April 2017; 9(1)