Maria Giacinta Paolone

Objectives: To conduct a systematic review assessing quantitative enamel loss occurring after orthodontic debonding and clean-up procedures. Materials and Methods: A systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed on different databases (Embase, Medline, Scopus, Web of Science) for papers investigating volumetric enamel loss due to bracket and clear aligner attachment debonding and/or clean-up procedures. Studies investigating in vivo and in vitro articles published in the English language until 16 July 2022 were included. The study selection was then performed by two authors who screened the abstracts independently. Results: Of 421 screened abstracts, 41 articles were selected for full-text analysis. Finally, nine studies were included in this review. No in vivo papers were retrieved. In vitro papers investigated volumetric loss caused by the removal of metal brackets (n = 7), ceramic brackets (n = 1), and both (n = 1). The clean-up procedure varied among all investigations. Impressions at baseline and after debonding/clean-up were superimposed, and the volumes were subtracted using different 3D digital analysis software. Among all included studies, the volumetric loss of enamel ranged from 0.02 ± 0.01 mm³ to 0.61 ± 0.51 mm³ per tooth. Conclusions: Debonding and clean-up procedures produce enamel loss. The debonding/clean-up procedure that is able to cause the least enamel volume loss has yet to be identified.

The aim of this study was to assess the skeletal and dentoalveolar effects induced by the Paolone-Kaitsas functional appliance (PK appliance) in the treatment of growing patients affected by Class II malocclusion. A group of 25 Class II patients, treated with the PK appliance followed by fixed appliances, was evaluated with lateral cephalograms at the start (9.6 ± 1.6 years) and at the end of treatment (13.0 ± 1.5 years), and was compared with a matched untreated Class II control group of 23 subjects selected from the web archive of the American Association of Orthodontists Foundation Craniofacial Growth Legacy. Statistical comparisons were performed with the Student’s t-tests. The treated group showed a significant decrease in SNA (−2.2°), ANB (−2.2°), and Wits appraisal (−3.4 mm), a significant increase in the SN-palatal plane angle (1.1°), and a significant improvement in overjet (−2.9 mm), overbite (−2.5 mm), and molar relationship (3.6 mm). The PK appliance produced favorable dentoalveolar and skeletal effects: it inhibited maxillary growth without effects on the mandible and it also induced a downward inclination of the palatal plane.

An hopeless upper central incisor was subjected to forced eruption in order to improve and develop the implant site by distraction of the periodontal ligament-alveolar bone complex. The orthodontic extrusion was carried out with two aesthetic approaches: lingual orthodontics and a composite resin 2-2 veneer pontic. The first part of the extrusion was realized with lingual orthodontics alone, then, when the crown had been remodelled in its greatest part and the aesthetics was no more acceptable to the patient a composite resin 2-2 veneer pontic was bonded to the vestibular side of the other three incisors to mimetise the extruded tooth and to be anchorage to the lingual mechanics. The orthodontic preparation of the implant site allowed the correction of the periodontal defect due to the fracture, the enhancement of the alveolar bone and the soft tissue remodelling.