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J Clin Orthod. 2024 Apr;58(4):221-235.

NO ABSTRACT

PMID:38754439

J World Fed Orthod. 2024 May 7:S2212-4438(24)00021-3. doi: 10.1016/j.ejwf.2024.03.008. Online ahead of print.

ABSTRACT

BACKGROUND: Although they have proven effective in the resolution of mild to moderate malocclusions, aligners demonstrate substantial limitations. More complex malocclusions therefore require a combination of auxiliaries, or a hybrid approach involving both aligners and fixed appliances, such as miniscrew-supported appliances or sectionals. This case report presents a 25-year-old female patient with a severe transversal discrepancy associated with an anterior open-bite tendency effectively treated with a tooth bone-borne palatal expander characterized by two expansion screws (tandem expander) and a hybrid treatment with aligners.

METHODS: After accurate matching between the pretreatment cone-beam computed tomography scan and digital models, four self-drilling miniscrews were inserted palatally using a computer- aided design and computer-aided manufacturing surgical template to guide their correct and safe placement, and a tooth bone-borne appliance was fitted. After this first phase, the hybrid clear aligner approach was used to obtain alignment, leveling, and arch coordination, with the use of a partial lingual fixed appliance.

RESULTS: Transverse maxillary deficiency was corrected, crowding has been resolved, Class I molar and canine relationship were obtained, and marginal ridges has been aligned.

CONCLUSIONS: Double jackscrew of the tandem expander enabled effective expansion of both the posterior segments as required to correct the skeletal discrepancy and the anterior region, thus relieving the dental crowding. Lingual sectional appliances have been shown to increase the effectiveness of clear aligners which, on the other hand, have been shown to be effective in closing the anterior bite by retroclination of the maxillary and mandibular incisors and, only minimally, by extrusion movements.

PMID:38719759 | DOI:10.1016/j.ejwf.2024.03.008

Sleep Sci. 2024 Feb 20;17(1):e55-e63. doi: 10.1055/s-0043-1776752. eCollection 2024 Mar.

ABSTRACT

Objectives To evaluate the efficacy of mandibular advancement devices (MADs) in improving apnea-hypopnea index (AHI) in positional obstructive sleep apnea (POSA), compared with a control group of nonpositional OSA (NPOSA) patients, from mild to very severe degree, in order to to find the main variables characterizing the examined group as potential predictors of treatment success. Materials and Methods In the present observational study, we retrospectively collected polysomnographic records of 39 positional adult patients, divided into 30 supine isolated OSA (siOSA) and 9 supine predominant OSA (spOSA) undergoing MADs from 2003 to 2019, and compared with those of a control group of 47 NPOSA patients. Demographics and anthropometrical data, home sleep apnea test (HSAT) records, drug-induced sleep endoscopy (DISE) results, and dental casts evaluation were analyzed pre- and post-treatment with MADs. Results A prevalence of the male sex (86%), mean age of 49,4 ± 14.98 years, and mean body mass index (BMI) of 26.74 ± 4.29 kg/m 2 were found among the OSA patients with significant differences between the three groups for sex and BMI. After MADs, the HSAT revealed significant reduction of AHI in all of the groups, with greater reduction of the supine AHI in POSA and significant reduction of the snore index for NPOSA. The hypopharynx section (H) of the NOHL Index, a fourth degree of hypopharyngeal collapse and an anteroposterior pattern was the most frequent to occur (19.9%) from DISE exam. No significant correlation between the initial total AHI and the dental variables was found, except for a reduced maxillary intermolar distance. Conclusion MADs are effective in reducing AHI in POSA and NPOSA patients from mild to very severe degree. Supine AHI decreased after treatment with MADs mainly in siOSA and spOSA patients compared with the NPOSA group. The snore index decreased significantly after treatment with MADs in all groups, showing the greater reduction in the NPOSA group. The tongue base (H) represented the most frequent anatomic area of collapse and there was a high prevalence of upper maxillary constriction.

PMID:38545244 | PMC:PMC10965295 | DOI:10.1055/s-0043-1776752

Int J Cardiol. 2024 Feb 19:131893. doi: 10.1016/j.ijcard.2024.131893. Online ahead of print.

ABSTRACT

BACKGROUND: Whether P2Y12 inhibitor monotherapy (P2Y12-I) is superior to aspirin following DAPT discontinuation post-PCI remains to be established.

METHODS: We updated our prior network meta-analysis where P2Y12-I and aspirin had been compared with DAPT or directly with each other. The focus is specifically on the available direct evidence, now consisting of the three head-to-head comparisons of P2Y12-I and aspirin in event-free PCI patients after DAPT. We include a Trial Sequential Analysis of the direct evidence based on meta-analytical literature.

RESULTS: The main finding reveals a 39% significantly lower risk of myocardial infarction with P2Y12-I (RR 0.61, 95% CI 0.47-0.78, p = 0.0001, I2 = 0%) with no difference in bleeding. Trial Sequential Analysis demonstrates clinically meaningful evidence for a reduction in the incidence of myocardial infarction with P2Y12-I that is also supported by statistical significance.

CONCLUSIONS: Accruing data highlight that P2Y12-I following DAPT discontinuation after PCI is associated with lower risk for MI and a similar risk for bleeding as compared with ASA. In light of potential limitations to the widespread adoption of life-long P2Y12-I treatment, clinicians should consider identifying selected patients who are expected to derive the highest benefit.

PMID:38382856 | DOI:10.1016/j.ijcard.2024.131893

Int Orthod. 2024 Feb 19;22(2):100848. doi: 10.1016/j.ortho.2024.100848. Online ahead of print.

ABSTRACT

This case report describes a complex full-step class II case in a young adult patient treated with lingual straight-wire appliance and upper first molar extraction. As the patient refused a surgical treatment, she was offered the best possible camouflage with the double aim of obtaining an ideal occlusal relationship and maintaining the profile; appropriate biomechanical strategies, including extraction choice and anchorage control during space closure, were needed to achieve the planned results. This case report demonstrates the possibility of successfully resolving severe sagittal discrepancies in an adult patient without surgical treatment by means of a completely invisible non-compliance technique, with the extraction of the most compromised teeth. This report also underlines the need for careful planning during both diagnostic and treatment phases, in order to obtain the best results.

PMID:38377831 | DOI:10.1016/j.ortho.2024.100848

J Clin Orthod. 2023 Dec;57(12):735-746.

NO ABSTRACT

PMID:38346253

Prog Orthod. 2023 Dec 25;24(1):44. doi: 10.1186/s40510-023-00496-x.

ABSTRACT

BACKGROUND: The aim of the study was to compare the accuracy and reproducibility of three different 3D facial scanning systems, relying, respectively, on stereophotogrammetry, structured light and a smartphone app and camera.

METHODS: Thirty subjects have been scanned with three different facial scanning systems, stereophotogrammetry, structured light and a smartphone app and camera. Linear measurements were compared with direct anthropometries measured on the patient’s face, while the study of areas (forehead, tip of the nose, chin, right and left cheek) was evaluated by overlapping scans using the Geomagic Control X program. Statistical analyses were conducted using IBM SPSS v28 software.

RESULTS: The ANOVA test was used to compare linear distances and direct anthropometry measurements, revealing statically significant values for all distances investigated, especially for the Face Hunter scanner, except for the Prn-Pog’ distance (p = 0.092). The three facial scans were superimposed pairwise almost the 100 per cent of the overlapping areas fell within the tolerance limits for all three comparisons analysed. The chin was the most accurately reproduced, with no differences among scanners, while the forehead proved to be the least accurately reproduced by all scanners.

CONCLUSIONS: All three acquisition systems proved to be effective in capturing 3D images of the face, with the exception of the Face Hunter scanner, that produced statistically significant differences in linear measurements for the distances Tr-Na’ and Zyg-Zyg with respect to direct anthropometric measurements.

PMID:38143253 | DOI:10.1186/s40510-023-00496-x

Int Orthod. 2023 Nov 29;22(1):100825. doi: 10.1016/j.ortho.2023.100825. Online ahead of print.

ABSTRACT

This article describes a class II subdivision malocclusion successfully treated by an invisible lingual appliance. The combination of en-masse distalization by interradicular palatal mini-screws and inner unilateral class II auxiliaries, first by intermaxillary elastic, later by a class II coil spring, resulted in a dento-alveolar correction, allowing one to maintain the appliance completely invisible. At the same time, the inclination of buccal sectors was normalized by a correct torque expression with set-up overcorrections, resulting in a significant improvement of the buccal corridors. This case report demonstrates the possibility of successfully solving class II division 2 subdivision malocclusion in adult patients without surgery by means of a completely invisible appliance. It also demonstrates that correct levelling and torque expression, for the correction of asymmetrical Spee and Wilson curves, are achievable with an accurate set-up planning. On the other hand, it underlines the necessity of mini-screws, auxiliaries and set-up overcorrections in order to obtain the best results.

PMID:38035872 | DOI:10.1016/j.ortho.2023.100825

Eur J Orthod. 2023 Nov 18:cjad069. doi: 10.1093/ejo/cjad069. Online ahead of print.

ABSTRACT

BACKGROUND: The widespread use of CAD/CAM transfer trays warrants evaluation of their accuracy as compared to PVS transfer trays.

OBJECTIVES: To quantify the accuracy of CAD/CAM and PVS transfer trays, investigating any differences between soft and hard trays CAD/CAM transfer trays.

SEARCH METHODS: Eight different databases (Scopus, Web of Science, PubMed, Google Scholar, ProQuest, Embase, Cochrane Library, ClinicalTrials.gov) were searched, without restrictions, up to an end date of February 2023.

SELECTION CRITERIA: Clinical trials (randomized and non-randomized) and in vitro studies reporting average imprecision values for bracket positioning obtained by digital superimpositions of digitally planned and real positions.

DATA COLLECTION AND ANALYSIS: Data eligibility, data extraction, and risk of bias (RoB-2 and ROBINS-I) were conducted independently. The data, where possible, were synthesized and quantitatively analysed (meta-analysis of mean differences with 95% confidence intervals). The Grade of Recommendation, Assessment, Development and Evaluation (GRADE) analysis of the quality of evidence was performed. The t-test for independent samples was used to compare the transfer accuracy of hard and soft CAD/CAM transfer trays.

RESULTS: Thirteen studies were synthesized in this systematic review, and then eight studies were included in the quantitative meta-analysis. As regards linear measurements, there was a mean transfer error of 0.0752 mm (95%CI: 0.0428, 0.1076) for mesiodistal measures, 0.0943 mm (95%CI: 0.0402, 0.1484) for vertical, and 0.0815 mm (95%CI: 0.0469, 0.1160) for buccolingual. As for angular measurements, there was an average transfer error of 1.2279° (95% CI: 0.6011, 1.8548) for inclination, 0.9397° (95%CI: 0.4672, 1.4123) for angulation, and 0.8721° (95%CI: 0.4257, 1.3185) for rotation. CAD/CAM transfer trays were less accurate than polyvinylsiloxane (PVS) transfer trays, with those made of soft material being more accurate than the hard ones, except for vertical dimension. The GRADE quality of evidence ranged from very low to moderate.

CONCLUSIONS AND IMPLICATIONS: CAD/CAM transfer trays provide high bracket positioning accuracy, with soft transfer trays offering greater precision than rigid ones. Future randomized prospective trials are required to enhance the strength of the available evidence.

REGISTRATION: Prospero (CRD42023401278 number).

PMID:37977877 | DOI:10.1093/ejo/cjad069

J Clin Orthod. 2023 Sep;57(9):522-531.

NO ABSTRACT

PMID:37898117