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BACKGROUND: It is well known that in bidimensional photography the orientation of the head is fundamental to obtain a correct reproduction of the subject. Even minimal errors in yaw, roll and pitch of the head can be cause of unreliability of the photography itself. This is not the case in three-dimensional photography in which head positioning may have no influence on the reliability of the results since on the computer the 3D reconstruction of the face can be oriented as desired, allowing any small errors to be corrected. The authors, in a previous in-vitro study, demonstrated this using a mannequin of the head. In the present study, the Authors repeat the study in vivo to verify any differences. METHODS: Seventeen anthropometric points were marked on the face of a young adult female (26 years old) with eyeliner. Images of the face were then acquired with a stereo-photogrammetric system (Face Shape 3D MaxiLine) in natural head position and with varying degrees of roll, pitch and yaw. The anthropometric points marked on the skin were then recognized and marked on a digital software (Viewbox, dHAL Software, 6 Menandrou Street, Kifissia 14561, Greece) on each individual image. 14 linear distances between these points were measured using the same software. RESULTS: The linear distances of these points in the stereophotos taken at centered positions were then compared with those taken with different degrees of roll, pitch and yaw. This study confirms previous results obtained in vitro regarding the presence of areas of non-equivalence (P<0.05) when comparing the frontal and lateral regions of the face at various angles. CONCLUSIONS: However, it introduces important suggestions on the collection of data from specific anthropometric points. If these points are to be assessed, the medical staff will have to take special precautions to obtain reliable images.

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Obstructive sleep apnoea syndrome is a respiratory sleep disorder that affects 1-5% of children. It occurs equally in males and females, with higher incidence in school age and adolescence. OSAS may be caused by several factors, but in children, adenotonsillar hypertrophy, obesity, and maxillo-mandibular deficits are the most common. In general, there is a reduction in the diameter of the airway with reduced airflow. This condition worsens during sleep due to the muscular hypotonia, resulting in apnoeas or hypoventilation. While snoring is the primary symptom, OSAS-related manifestations have a wide spectrum. Some of these symptoms relate to the nocturnal phase, including disturbed sleep, frequent changes of position, apnoeas and oral respiration. Other symptoms concern the daytime hours, such as drowsiness, irritability, inattention, difficulties with learning and memorisation, and poor school performance, especially in patient suffering from overlapping syndromes (e.g., Down syndrome). In some cases, the child's general growth may also be affected. Early diagnosis of this condition is crucial in limiting associated symptoms that can significantly impact a paediatric patient's quality of life, with the potential for the condition to persist into adulthood. Diagnosis involves evaluating several aspects, beginning with a comprehensive anamnesis that includes specific questionnaires, followed by an objective examination. This is followed by instrumental diagnosis, for which polysomnography is considered the gold standard, assessing several parameters, including the apnoea-hypopnoea index (AHI) and oxygen saturation. However, it is not the sole tool for assessing the characteristics of this condition. Other possibilities, such as night-time video recording, nocturnal oximetry, can be chosen when polysomnography is not available and even tested at home, even though with a lower diagnostic accuracy. The treatment of OSAS varies depending on the cause. In children, the most frequent therapies are adenotonsillectomy or orthodontic therapies, specifically maxillary expansion.

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Who does refer patients for an orthodontic consultation? Which are the main reasons for the referral? Does the visit of the orthodontic specialist confirm these reasons or reveal undiagnosed problems? Is there the risk that only evident dental problems are addressed, while craniofacial malformations remain underdiagnosed? This cross-sectional epidemiologic study aims to answer these questions, analysing the clinical data collected during the orthodontic visits of 500 Caucasian young patients referred to a public health structure of northern Italy. All patients were visited by the same expert specialist in orthodontics. Clinical data were collected, analysing both dental and skeletal features. The reasons for the referral of the visit were analysed and compared with the specialistic diagnoses. In our sample, dentists, relatives/friends and paediatricians were the major source of the referrals, followed by family doctors and other facial specialists. In most cases, the reasons for the referral were dental irregularities, but approximately 80% of dental irregularities were associated with undiagnosed facial dysmorphism. Skeletal facial anomalies need an early diagnosis to prevent the development of severe facial malformations that would require invasive and expensive treatments. These findings reveal poor diagnostic skills regarding skeletal anomalies in dentists and paediatricians and the need for better specific training.

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This study investigates the reliability and precision of anthropometric measurements collected from 3D images and acquired under different conditions of head rotation. Various sources of error were examined, and the equivalence between craniofacial data generated from alternative head positions was assessed. 3D captures of a mannequin head were obtained with a stereophotogrammetric system (Face Shape 3D MaxiLine). Image acquisition was performed with no rotations and with various pitch, roll, and yaw angulations. On 3D images, 14 linear distances were measured. Various indices were used to quantify error magnitude, among them the acquisition error, the mean and the maximum intra- and inter-operator measurement error, repeatability and reproducibility error, the standard deviation, and the standard error of errors. Two one-sided tests (TOST) were performed to assess the equivalence between measurements recorded in different head angulations. The maximum intra-operator error was very low (0.336 mm), closely followed by the acquisition error (0.496 mm). The maximum inter-operator error was 0.532 mm, and the highest degree of error was found in reproducibility (0.890 mm). Anthropometric measurements from alternative acquisition conditions resulted in significantly equivalent TOST, with the exception of Zygion (l)-Tragion (l) and Cheek (l)-Tragion (l) distances measured with pitch angulation compared to no rotation position. Face Shape 3D Maxiline has sufficient accuracy for orthodontic and surgical use. Precision was not altered by head orientation, making the acquisition simpler and not constrained to a critical precision as in 2D photographs.

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The aim of this study was to evaluate the masticatory pattern in children with cleft lip and/or palate (CL/P) through investigation of the prevalence of reverse sequencing chewing cycles. The study group included 18 patients with CL/P (mean age: 7.4 yr, SD: 1.4 yr), 15 of whom had dental crossbite. The controls included a group of 18 non-CL/P children with the same types of crossbite as the study group (mean age: 7.2 yr, SD: 1.5 yr) and a group of 18 non-CL/P subjects with normal occlusion (mean age: 9.8 yr, SD: 1.9 yr). Mandibular movements during chewing of soft and hard bolus were recorded with a kinesiograph. Kinematic signals were analysed using a custom-made software. A statistical analysis was performed to compare the degree of reverse-sequencing chewing cycles between patients and controls (Kruskal-Wallis test with Dwass-Steel-Critchlow-Fligner pairwise comparisons post hoc test). A significant difference between patients with CL/P and non-CL/P subjects with normal occlusion was highlighted on the left side of mastication, which was the side with the higher prevalence of crossbite with both types of bolus. No statistical differences were found between CL/P patients and healthy controls with crossbite. Cleft-affected patients with posterior crossbite exhibited an anomalous masticatory pattern with increased reverse chewing cycles on the crossbite side.

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The purpose of this commentary is to update the evidence reported in our previous review on the advantages and limitations of computer-aided design/computer-aided manufacturing technology in the promotion of dental business, as well as to guarantee patient and occupational safety. The COVID-19 pandemic led to an unprecedented focus on infection prevention; however, waves of COVID-19 follow one another, asymptomatic cases are nearly impossible to identify by triage in a dental setting, and the effectiveness of long-lasting immune protection through vaccination remains largely unknown. Different national laws and international guidelines (mainly USA-CDC, ECDC) have often brought about dissimilar awareness and operational choices, and in general, there has been very limited attention to this technology. Here, we discuss its advantages and limitations in light of: (a) presence of SARS-CoV-2 in the oral cavity, saliva, and dental biofilm and activation of dormant microbial infections; (b) the prevention of SARS-CoV-2 transmission by aerosol and fomite contamination; (c) the detection of various oral manifestations of COVID-19; (d) specific information for the reprocessing of the scanner tip and the ward from the manufacturers.

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Recent data indicates limited awareness and compliance on infection prevention procedures by dental offices and by dental laboratories. Guidelines for infection prevention in dentistry have been published by Centres for Disease Control and Prevention since 2003; the section "IX-Special consideration" includes a subsection concerning the prevention in dental laboratories, but it has not been modernised in later versions to fit the needs of traditional and computer-aided technology. Traditional techniques required disinfecting items (impression, chewing waxes, and appliances) with well-suited products, which are also chosen for limiting impression changes or appliance deterioration. Effective procedures are available with difficulties. Some of these contain irritant or non-eco-friendly disinfectants. The transport of impression, to dental laboratories, is often delayed with limited precautions for limiting cross-infection. Gypsum casts are frequently contaminated mainly by bacteria and their antibiotic-resistant strains and even stored for long periods during dental implant supported restoration and orthodontic therapy, becoming a hidden source of infection. Nowadays, computer-aided design/computer-aided manufacturing technology seems to be an interesting way to promote both business and safety, being more comfortable for patients and more accurate than traditional technology. A further advantage is easier infection prevention since, for the most part, mainly digital impression and casts are not a source of cross-infection and the transport of contaminated items is reduced and limited to try-in stages. Nevertheless, a peculiar feature is that a digital electronic file is of course unalterable, but may be ruined by a computer virus. Additionally, the reconditioning of scanner tips is determinant for the optical characteristics and long term use of the scanner, but information for its reconditioning from producers is often limited. This study focuses on some critical points including (a) insufficient guidelines, (b) choice of proper procedure for scanner reconditioning, and (c) data protection in relation to patient privacy.

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PURPOSE: To quantify the surface facial asymmetry in a group of young patients with hemifacial microsomia (HFM) and to investigate differences with a homogeneous sample of healthy subjects, using a novel stereophotogrammetric method. MATERIALS AND METHODS: Twelve patients (mean age 13.1 ± 3.1 years) with different degrees of HFM and 15 healthy controls (mean age 12.2 ± 3.5 years) were imaged with a stereophotogrammetric facial scanner. The root mean square error (RMSE) of the distances between the corresponding points of each original photograph and its mirror copy was calculated for the whole face and for each trigeminal third, as defined by the innervation of trigeminal branches. A statistical analysis was performed to compare the RMSE value of all facial areas within each group and between patients and controls. RESULTS: RMSE values progressively increased from the upper to the lower third of face, both in patients and controls. The level of asymmetry was significantly higher in HFM subjects for middle third (p < 0.01), lower third (p < 0.001) and whole face (p < 0.001); no statistically significant differences were found between the groups for the upper third. CONCLUSIONS: The reported technique provides an accurate topographic analysis of the facial asymmetry, and is recommended for conditions such as HFM affecting only part of the face.

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OBJECTIVE: The aim of the present study is to propose a 3-dimensional evaluation of lower intrusion obtained with lingual orthodontics considering not only the crowns but also dental roots. METHODS: 9 adult patients underwent fixed lingual orthodontic treatment with i-TTя lingual brackets system for the correction of crowding in the lower arch associated with a deep overbite. Initial records, consisting of photos, CBCTs and intraoral scans were collected. Threshold segmentation of the CBCT was performed to generate a three-dimensional virtual model of each the teeth of the lower arch, superimposed with the crown of the same teeth obtained by intraoral scan models to generate a complete set of digital composite lower arch The same procedure was performed to monitor one key step of the i-TTЯ technique consisting in lower incisors intrusion (T2). T1-T2 three-dimensional superimposition and color displacement maps were generated to measure and evaluate the movements obtained at the lower arch. RESULTS: The root displacement of the incisors during their intrusion in the early stage was totally "bone-safe" in the 88.9% (8 of 9) of the cases observed. No significant extrusion of the premolars used as anchorage unit was measured. CONCLUSION: This method has proved to be an accurate and reliable approach to dynamically visualize the 3-dimensional positions of the teeth, including their roots, with no additional radiation for in-progress treatment monitoring. The 3-dimensional evaluation showed that the employed lingual appliance allowed to obtain significant lower incisors intrusion with negligible undesired extrusion of premolars employed as anchorage teeth.

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BACKGROUND: Moebius syndrome is a rare condition characterized by bilateral facial and abducens nerve paralysis. The aim of this study is to evaluate the main orthodontic features and the frequency of associated clinical characteristics in patients with Moebius syndrome (MS). METHODS: According to Terzis classifications, 58 patients with MS aged 8 months to 46 years old underwent orthodontics and clinical examination. RESULTS: Strabismus, upper and lower limb malformations, lip and palatal cleft were frequently associated with MS. Reduced TM movements were noted (48%). Cephalometric analysis did not allow identifying a typical facies and a characteristic cephalometric pattern; we have noticed a higher prevalence of Class II (56%) with micrognathia and excessive maxillary development probably due to the lack of lip seal. Early treatment is recommended, with a multidisciplinary approach to reduce the impact of sequelae on the lives of MS patients or their families. CONCLUSIONS: Early treatment is recommended, with a multidisciplinary approach to diminish the impact of sequelae on the lives of MS patients or their families.

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OBJECTIVE: This study was performed to evaluate the feasibility of noninvasive measurement of the ANB angle using photographic and ultrasonographic methods. METHODS: Twenty consecutive orthodontic patients were evaluated. The ANB angle and soft tissue thickness covering the N, A, and B cephalometric points were measured by lateral teleradiography; these measurements were made by two expert operators. The soft tissue thickness covering the N, A, and B cephalometric points was measured by ultrasonography; these measurements were also made by two expert operators. On a 1:1 photographic profile print on which the ultrasonographic points were marked, the ANB ultrasonographic angle was measured. The following comparisons were considered: averaged and single measurements of N, A, and B points by first versus second ultrasonographer; averaged and single ultrasonographic versus radiographic soft tissue thickness covering the N, A, B points; and averaged and single ultrasonographic versus radiographic measurements of ANB angle. RESULTS: High correlation and concordance of the averaged and single measurements, but no significant difference, was found between the two ultrasonographers. No statistically significant difference was found between the two methods for measuring averaged soft tissue thickness, but a 20% difference was found for the single measurements. High correlation and concordance between the ultrasonographic and radiographic measurements, but no significant difference, was found between the single and averaged ANB angle measurements. CONCLUSION: Ultrasonography seems to be a noninvasive and reliable technique for measurement of the ANB angle and may replace radiographic measurement in some cases.

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No agreement exists on the most appropriate timing of orthodontic treatment in patients with cleft lip and palate. The aim of this study is to investigate the effect of early orthodontic treatment on development of the dental arches and alveolar bone.A dental casts analysis was performed on 28 children with cleft lip and palate before orthodontic treatment (T0; mean age, 6.5 ±â€Š1.7) and at the end of active treatment (T1; mean age, 9.2 ±â€Š2.1 years). The considered variables were: intercanine and intermolar distances; dental arch relationships, evaluated according to the modified Huddart/Bodenham system.The study group was divided into 2 samples according to the age at T0: Group A (age < 6 years) and Group B (age ≥ 6 years). A statistical comparison of the treatment effects between the 2 samples was performed.Patients in Group A exhibited a greater increase of intercanine distance (8 mm versus 2.7 mm; P<0.001), intermolar distance (7.2 mm versus 5 mm; P = 0.06), and Huddart/Bodenham score (7.1 versus 3; P < 0.05) when compared with patients in Group B.Early orthodontic treatment strongly improved the dental arch relationship, since subjects starting the therapy before the age of 6 had a better response in terms of anterior maxillary expansion.

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Unilateral posterior crossbite often involves only one tooth, especially upper first molar; in these cases it is never easy to obtain an asymmetrical movement of a molar and a proper planning of the orthodontic device with its anchorage is necessary to avoid arch overexpansion. Thanks to its simplicity and efficacy, the modified Quad Helix here described represents a valid therapeutic tool in cases of isolated posterior crossbite.

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Condylar fractures are among the most frequent fractures in the context of traumatic lesions of the face. The management of condylar fractures is still controversial, especially when fractures occur in children: if overlooked or inappropriately treated, these lesions may lead to severe sequelae, both cosmetic and functional. The therapy must be careful because severe long-term complications can occur. In this case report, the authors present a case of mandibular fracture in which the decision between surgical therapy and functional therapeutic regimen may be controversial due to the particular anatomy of the fracture line and the age of the patient.

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The authors report a combined orthodontic-surgical correction of an adult patient's malocclusion affected by Moebius Syndrome (MS). The treatment was conducted at the Dentistry Unit and the Maxillofacial Surgery Unit of the University Hospital of Parma. Treatment of malocclusion was performed after the correction of facial mimic mobility with smile surgery. The postoperative stability and orthodontic results were good and the correction of the morphological problems related to the syndrome was very satisfactory.

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INTRODUCTION: Orthodontic miniscrews are an increasingly popular choice to achieve absolute anchorage. The temporary use of miniscrews and their recent introduction have limited the debate over the biological aspect of the materials to that of the surface that permeates the field of dental implants. The aim of the present study was to investigate the integration of grade 5 titanium mini-implants with machined or sand blasted acid etched surface (SAE) under mechanical load in a rabbit tibia model of implant integration. METHODS: A total of 64 miniscrews (Ti6Al4V) of 1.5 mm diameter and 6.5 mm length were inserted in the proximal medial surface of each tibia in eight male rabbits aged 6 months. Each tibia received four miniscrews. A 100 g nickel-titanium coil spring (Neosentalloy) was applied between two miniscrews along the main axis while two miniscrews were left unloaded. The removal torque was measured for loaded and unloaded miniscrews after 12 weeks. Two miniscrews were harvested for histology. RESULTS: Removal torque was significantly higher for SAE mini-implants than for machined screws, under both loading conditions. Although no difference in bone to implant contact was observed among the groups, cortical area significantly decreased with both surfaces under loading. CONCLUSIONS: Our data indicate that SAE miniscrews have higher bone retention than MA miniscrews, although the effects of mechanical loading of these devices on cortical bone require further investigations.

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In maxillofacial surgery, every patient presents special problems requiring careful evaluation. Conventional methods to study the deformities are still reliable, but the advent of tridimensional (3D) imaging, especially computed tomography (CT) scan and laser scanning of casts, created the opportunity to better understanding the skeletal support and the soft tissue structures. Nowadays, virtual technologies are increasingly employed in maxillofacial surgery and demonstrated precision and reliability. However, in complex surgical procedures, these new technologies are still controversial. Especially in the less frequent cases of three-part maxillary surgery, the experience is limited, and scientific literature cannot give a clear support. This paper presents the case of a young patient affected by a complex long face dentofacial deformity treated by a bimaxillary surgery with three-part segmentation of the maxilla. The operator performed the surgical study completely with a virtual workflow. Pre- and postoperative CT scan and optical scanning of plaster models were collected and compared. Every postoperatory maxillary piece was superimposed with the presurgical one, and the differences were examined in a color-coded map. Only mild differences were found near the osteotomy lines, when the bony surface and the teeth demonstrated an excellent coincidence.

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The aim of this paper is to report treatment effects of functional therapy in a growing patient affected by hemifacial microsomia (HM). According to Kaban's classification, the patient was classified as grade IIa as she presented all mandibular and temporomandibular joint components and a normal shaped, hypoplastic mandible. The therapeutic approach included the use of an asymmetrical functional activator (AFA) to stimulate the growth of the affected side and consequently to improve symmetry of the mandible and maxillary deficiency. Further effects were the lengthening of the mandibular ramus, restoration of occlusion, and expansion of soft tissues.

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