[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to estimate the prevalence of malocclusion and the need for orthodontic treatment in a sample of 3,017 Italian schoolchildren.
Study design: 1,375 males and 1,642 females, aged between 8 and 13 years, were visited in primary and secondary schools. Signs of malocclusion were registered according to an occlusal index by trained and calibrated operators. First the prevalence of malocclusion was calculated in accordance to a scale of need for orthodontic treatment (R.O.M.A. index), which considers both malocclusion signs and risk factors for worsening of malocclusion without any treatment and during craniofacial development. Then the distribution of the most frequent characteristics, signs and symptoms was evaluated both within each risk grade and in the basic sample.
The overall percentage of children classified as 3, 4 and 5 grade accounted for 75.8% of the sample. The percentage of children classified as 4 and 5 grade are similar to those found in other European countries. The most frequent features found are poor oral hygiene, caries and early loss of deciduous teeth, deviation from full intercuspation, increased overbite and overjet.
This epidemiological research describes the current orthodontic treatment need in Italy in children with a late mixed dentition.
European Journal of Paediatric Dentistry. Official Journal of the Italian Society of Paediatric Dentistry. 12/2013; 14(4):314-8. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the study is to estimate the orthodontic treatment timing for the main occlusal problems in growing patients.
Study design: a cross-sectional study was carried out in Italian primary and secondary schools from 2008 to 2011; 1375 males and 1642 females, aged between 8 and 13 years, were visited. The sample is divided into two main groups: primary school and secondary school. Selected malocclusion signs were registered according to an occlusal index (ROMA index) by trained and calibrated operators. Prevalence of increased overjet, Class III malocclusion, crossbite, deep bite and open bite observed in each group are compared. A significant decrease of prevalence with age is considered a sign of spontaneous improvement of the malocclusion.
Descriptive analyses were performed using frequencies, percentages and chi-square tests to evaluate differences for categorical variables. The level of significance was set at p ≤0.05. Data were analysed with the software SPSS 19.0 for Windows. Class III malocclusion, moderate or severe crossbite and severe increased overjet and overbite seem not to improve spontaneously.
Early treatment of orthodontic problems that do not improve with age may be helpful to avoid worsening of the condition in permanent dentition. Moderate Class II malocclusion and crossbite treatment can be postponed.
European Journal of Paediatric Dentistry. Official Journal of the Italian Society of Paediatric Dentistry. 09/2013; 14(3):231-6. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study is to evaluate the relationship between dental arch form and the vertical facial pattern determined by the angle between the mandibular plane and the anterior cranial base (Sella-nasion/mandibular plane angle (SN-MP)) in skeletal class II untreated patients.
A sample of 73 Caucasians patients with untreated skeletal class II in permanent dentition was divided into three groups according to the values of the angle SN-MP. An evaluation of the arch form was performed by angular and linear relation values on each patient. Regression analysis was used to determine the statistical significance of the relationships between SN-MP angle and dental arch form. The differences among the three groups were analyzed for significance using a variance analysis.
A decrease of the upper arch transversal diameters in high SN-MP angle patients and an increase in low angle SN-MP ones (P < 0.05) were shown. Result analysis showed a change in upper arch shape, with a smaller intercanine width in patients with high SN-MP angle and a greater one in low angle patients. As SN-MP angle increased, the upper arch form tended to be narrower. No statistically significant difference in mandibular arch form among the three groups was found, except the angle value related to incisors position.
The results showed the association between the upper dental arch form and the vertical facial pattern. On the contrary, the lower arch form was not related to the mandibular divergence.
[Show abstract][Hide abstract] ABSTRACT: The advent of computed tomography (CT) provided a useful instrument for diagnosis and surgical treatment of patients with craniofacial malformations. The development of software for three-dimensional graphic simulation applied to CT scan has made possible the three-dimensional computerized analysis, surgical planning, and simulation. This kind of analysis is particularly useful in case of complex facial malformations, making reliable a surgical treatment in 1 step. The purpose of this report was to present the diagnosis and treatment planning on a patient with hemimandibular hyperplasia by three-dimensional cephalometric analysis.
A 20-year-old young woman who presented with hemimandibular hyperplasia was investigated with CT scan and plaster cast mounted on an articulator; a two-dimensional manual and computerized cephalometric analysis was also developed on frontal and lateral cephalograms. Images in DICOM format were processed on a PC by means of commercial software, thus obtaining the three-dimensional reconstruction of the skeletal structures.
Three-dimensional CT permits to program skeletal corrections and to foresee surgical outcomes with adequate realism. Surgical planning based on three-dimensional CT makes it easy and reliable to achieve the correction of the malformation in a single surgical intervention.
The virtual three-dimensional CT model, a versatile diagnostic aid, has proven to be effective in the exact reproduction of bone and soft tissue anatomy, thus helping in the diagnosis, surgical planning, and simulations. Three-dimensional analysis is particularly indicated in case of complex asymmetric malformations, in which the more accurate reproduction of the individual anatomy can be very useful in implementing surgical results.
The Journal of craniofacial surgery 11/2011; 22(6):2227-34. · 0.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the morphological effects and the surface irregularities produced by different methods of mechanical stripping (abrasive strips and burs) and chemical stripping (37% orthophosphoric acid) and the surface changes following the finishing procedures (polishing strips) or the subsequent application of sealants, in order to establish the right stripping method that can guarantee the smoothest surface. We have also analysed the level of wear on the different abrasive strips employed, according to their structure.
160 proximal surfaces of 80 sound molar teeth extracted for orthodontic and periodontal reasons, were divided into: 1 control group with non-treated enamel proximal surfaces and 5 different groups according to the stripping method used, were observed with scanning electron microscopy (SEM). Each one of the 5 treated groups was also divided into 3 different subgroups according to the finishing procedures or the subsequent application of sealants.
The finishing stage following the manual reduction proves to be fundamental in reducing the number and depth of grooves created by the stripping. After the air rotor stripping method, the use of sealants is advised in order to obtain a smoother surface. The analysis of the combinations of mechanical and chemical stripping showed unsatisfactory results. Concerning the wear of the strips, we have highlighted a different abrasion degree for the different types of strips analysed with SEM.
The enamel damages are limited only if the finishing procedure is applied, independently of the type of abrasive strip employed. It would be advisable, though clinically seldom possible, the use of sealants after the air rotor stripping technique.
[Show abstract][Hide abstract] ABSTRACT: Patients submitted to surgical advancement of the upper and middle facial third might have a relapse of the skeletal retraction after the removal of the distractor devices. Clinical signs related to this process are usually represented by exophthalmos, Obstructive sleep apnea syndrome (OSAS) or prognathism; however, the analytic definition of the relapse is very difficult , conventional cephalometric methods being influenced by the spatial movement of "N" (nasion) or "Or" (orbital) points. The authors present a new cephalometric technique that could be used as a more objective mean of follow-up evaluation of patients undergoing craniofacial advancement.
The cephalometric analysis proposed is based on angles, lines, areas and distances between BaS (Basion-Sella) axis and other craniofacial landmark points. We have defined this cephalometric technique as "BaS Analysis".
The "BaS analysis" is not influenced by splanchnocranium movements in the space; for this reason, it can be considered a useful method for cephalometric analysis in the follow-up of patients with craniofacial malformations.
Child s Nervous System 03/2009; 25(8):997-1006. · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess orthodontic treatment need in the Italian child population using the R.O.M.A. (Risk Of Malocclusion Assessment) Index.
Observational study (cross-sectional).
The ROMA Index was used in examining a sample of 420 children (214 males and 206 females; mean age: 9.3 years), none of whom had previously undergone orthodontic treatment. This basic sample was large enough to become the object of an epidemiological study and to be analysed through inferential statistics. After calculating the prevalence of malocclusion on the basis of the degrees of orthodontic risk determined by the Index, we evaluated the distribution of the most frequent characteristics, signs and symptoms within each risk grade. The percentage of children in each risk category was then worked out, together with its 95% confidence interval, in order to verify whether our results could be generalised to the reference population. Significantly, 50% of the examined children were classified as 'at moderate risk', as defined by grade 3 of the Index (non-severe alterations in dental and/or skeletal relationships, but tending to persist and often worsen with growth). Equally remarkably, a further 36% fell within grade 4 of the Index ('great risk'), presenting major craniofacial skeletal malformations and alterations of the occlusion, often in association with systemic or growth disorders likely to worsen the prognosis. Thus, since patients at moderate or great risk amounted to 86% of the basic sample, it appears that our estimate can be generalised to the reference population of Italian pre-adolescent children.
The study showed a high percentage of children at moderate or great risk (86%), and that this estimate can be generalised to the reference population of Italian pre-adolescent children. These findings should be taken into great account in devising strategies to improve patient service quality, whether in public or private settings, and also in planning preventive measures and interventions.
European Journal of Paediatric Dentistry. Official Journal of the Italian Society of Paediatric Dentistry. 07/2008; 9(2):71-5. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was designed to adapt the original English-language COAS (Children's Orthodontic Attitude Survey) for third- grade schoolchildren to the Italian cultural environment and to investigate its properties in typical populations, as well as to evaluate children self-perception of their dental appearance.
The COAS questionnaire for third-grade schoolchildren was translated and culturally adapted for Italian-speaking children. The Italian version of the questionnaire was tested on 169 (73 females, 96 males) children. Test-retest reliability was assessed on 34 children one week after the first administration. We also analysed correlations between social status and questionnaire findings.
All children filled in the questionnaire and then they were clinically examined by three residents. The clinical parameters were correlated with the questionnaire findings to evaluate children's satisfaction with their dental appearance.
Ninety-five per cent of children thought it was important to have straight teeth and 87 per cent considered that crooked teeth were ugly. Comparison with clinical parameters showed a statistically significant correlation between crowding and overjet and some answers. Urban children have a better opinion on braces: they would like to have braces and they think they need braces statistically more than rural subjects.
The Italian version of the modified-COAS questionnaire had a very good reliability. Social status and geographical context play a very important role in children's satisfaction with dental appearance. Children with different social context demonstrate they have very different approaches towards their dental aspect and braces.
European Journal of Paediatric Dentistry. Official Journal of the Italian Society of Paediatric Dentistry. 04/2008; 9(1):7-12. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to validate the ROMA (Risk Of Malocclusion Assessment) Index, verifying both its reproducibility and its ability to determine treatment priority.
The levels of treatment priority assessed for 75 children examined at the Gemelli General Hospital Orthodontic Service (Rome) ranged from grade 3 to grade 5 of the index. Multivariate analysis was conducted to verify the influence of covariates on the dependent variable. Moreover, the DHC of the IOTN was assessed for all patients, and a bivariate analysis was carried out to investigate its relationship with the ROMA Index. Intra- and inter- examiner reliability was calculated on a sample of 20 children, and the reproducibility of the index was evaluated using the Kappa statistic as a measure of concordance.
It arose that there is an inverse relation between risk grades and the time interval from the first examination and start of treatment. According to the index, patients at extreme risk require immediate treatment, whereas priority is lower in case of great or moderate risk. In statistical terms, the study revealed a significant correlation between the ROMA Index and the DHC of the IOTN. With regard to intra- and inter-examiner reliability, the data collected by the two examiners showed a high level of agreement.
The ROMA index appears quick to apply, reproducible, reliable and sensitive as a mean for carefully identifying different dento-skeletal problems. Furthermore, it is able to determine the priority of every risk grade and the corresponding timing of treatment.
European Journal of Paediatric Dentistry. Official Journal of the Italian Society of Paediatric Dentistry. 10/2007; 8(3):136-42. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to find a correlation between the evaluation of skeletal maturation performed by the study of cervical vertebrae maturation indicators and the evaluation obtained by the hand and wrist maturation indicators.
Left hand wrist radiographs and the corresponding lateral cephalograms of 90 patients (48 males and 42 females; aged 6 to 14 years) were paired and a study group of 128 pair of radiographs was obtained, having some patients 2 or more radiographs at different times. Hand and wrist radiographs were evaluated according to the protocol proposed by Grave (scores 0 to 9); corresponding lateral cephalograms were evaluated according to the method reported by Baccetti (scores 1 to 5). Values obtained with the 2 methods were analyzed by Spearman's correlation test.
When the values were compared globally in the 2 genders a good correlation was obtained (r=0.795; P<0.001); when the correlation was compared separately in the 2 genders a better correlation was observed in females (r=0.84; P<0.001) than in males (r=0.70; P<0.001).
The results obtained clearly underline the accuracy of the skeletal maturation evaluation by the analysis of cervical vertebrae in laterolateral cephalograms which can substitute the hand and wrist radiograph for the skeletal maturation evaluation in orthodontic diagnosis.
[Show abstract][Hide abstract] ABSTRACT: The interception of a Class III malocclusion requires a long-term growth prediction in order to estimate the subject's evolution from the prepubertal phase to adulthood. The aim of this retrospective longitudinal study was to highlight the differences in facial morphology in relation to the direction of mandibular growth in a sample of subjects with Class III skeletal anomalies divided on the basis of their Petrovic's auxological categories and rotational types.
The study involved 20 patients (11 females and 9 males) who started therapy before reaching their pubertal peak and were followed up for a mean of 4.3 years (range: 3.9-5.5 years).
Despite the small sample size, the definition of the rotational type of growth was the main diagnostic element for setting the correct individualised therapy.
We therefore believe that the observation of a larger sample would reinforce the diagnostic-therapeutic validity of Petrovic's auxological categories, allow an evaluation off all rotational types, and improve the statistical significance of the results obtained.
European Journal of Paediatric Dentistry. Official Journal of the Italian Society of Paediatric Dentistry. 04/2006; 7(1):23-8. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The auxologic evaluation, by periodic measurements of the height of children and the comparison of the values obtained with standard curves of growth, is a common practice for the pediatrician providing a precise indication on the general course of the growth and on the presence of possible growth pathologies. In fact, decelerations or pathological accelerations of growth can be a suspicious sign of endocrine, metabolic, genetic, gastric or tumoral diseases. The use of some growth variables and particularly the evaluation of the kinetics of statural height growth, should enter the daily practice of the orthodontist. In fact, the correspondence among peaks of statural and mandibular growth allows the orthodontist to choose the suitable time to intervene with the therapy aimed to stimulate the growth of the jaws. In this paper the authors report 2 orthodontic cases characterized by a malocclusion due to mandibular deficiency, in which the integration of the orthodontic and pediatric competences, through the use of the curves of the speed of growth and other growth variables, has allowed to reach optimal results, having achieved normal skeletal and occlusal relationships in the shorter time. The periodic measurement of height growth velocity represents a simple and safe method that allows to evaluate the kinetics of growth in children, with the remarkable advantage, unlike radiological examinations, to be repeated without any risk for the patient.
[Show abstract][Hide abstract] ABSTRACT: The aim of this article is to describe the orthodontic therapy for Parry-Romberg syndrome. The therapeutic goal is to minimize the wasting effects of progressive atrophy on facial development of a part of the face.
To correct problems affecting craniofacial development of these patients, occurring during puberty, an orthodontic appliance was employed, which helps maintain parallelism of the facial planes, in particular the mandibular plane.
Orthodontic care was carried out in the Dental Clinic of the Catholic University of the Sacred Heart of Rome.
Two patients underwent orthodontic therapy for 6 years. Appliances were checked every month and modified periodically so as to adapt to facial bone growth.
At the end of craniofacial growth, the mandible was almost symmetric and the problem relating to atrophy remained confined to the initial area. Cephalometric analyses demonstrated that the occlusal plane and the mandibular plane maintained a straight orientation in relation to the bizygomatic plane. The ratio between the left and right side of the ramus and condyle, in the mandible, improved.
The use of orthodontic therapy allows patients affected by hemifacial progressive atrophy to present a more harmonic face at the end of puberty when final reconstruction can be planned. These results provide for a limitation of surgical intervention to the sclerodermic area alone.
The Cleft Palate-Craniofacial Journal 02/2004; 41(1):95-104. · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many authors have observed that reduction of the posterior vertical dimension after the loss of teeth during cranio-facial growth can lead to alterations not only of occlusion but also of cranio-facial skull structure. The alteration differs according to whether the absence of teeth is mono- or bilateral. In this paper, the authors present the skeletal alterations after monolateral tooth loss.
An experiment was performed on 25 rabbits, all having undergone monolateral tooth extraction. The experiment followed two rules of procedure: in a group of rabbits we extrasted the upper teeth only (experiment A), in another group of rabbits the extractions were performed both in the upper and in the lower jaw (experiment B), the third group of rabbits was used as a control group. At regular intervals, the authors examined skeletal alterations by means of Engstrom's cephalometric analysis (the asymmetries, the vertical posterior dimension).
It was thus possible to observe some alterations of the cranio-facial bones and to compare the data with those of the control group.