Luca Levrini

Introduction: Children with Down syndrome (DS) are at increased risk of sleep-disordered breathing (SDB), but clinical correlates of polysomnography-derived severity remain incompletely defined. Objectives: This retrospective clinical–polysomnographic cohort study examined associations between selected demographic, anthropometric, cardiac, and otolaryngological variables and SDB severity metrics in children and adolescents with DS. Materials and Methods: Forty-eight participants aged ≤ 18 years underwent overnight polysomnography for suspected SDB. Respiratory events were scored according to paediatric AASM criteria; hypopnoeas required a ≥30% airflow reduction associated with ≥3% oxygen desaturation and/or arousal, and ODI was calculated using ≥3% desaturation events per hour of total sleep time. Outcomes included Apnoea–Hypopnoea Index (AHI), ODI, minimum SpO₂, and time with SpO₂ < 90%. Results: OSA was highly prevalent: AHI ≥ 1 event/h was observed in 93.8% of participants, AHI ≥ 5 events/h in 58.3%, and AHI ≥ 10 events/h in 35.4%. Mean AHI was 10.51 ± 11.82 events/h, and mean ODI was 7.07 ± 9.31 events/h. Age at PSG was not significantly associated with AHI. AHI correlated with ODI, and clinically documented adenoidal hypertrophy correlated with both AHI and ODI. Males showed significantly higher ODI values than females, whereas sex differences in AHI, minimum SpO₂, and time with SpO₂ < 90% were not significant. In exploratory multivariable models, adenoidal hypertrophy was associated with higher ODI, while adenotonsillectomy was associated with lower minimum SpO₂. Conclusions: The association between atrioventricular canal defect and hypoxaemic burden was not robust in bootstrap analyses. These exploratory findings do not warrant changes to current screening management strategies, but support further prospective studies incorporating standardised ENT and cardiac characterisation.

Background: This article describes a novel approach for the reconstruction of vertical and horizontal bone defects in the anterior maxilla that involves the use of an autogenous block graft harvested and rotated from the same surgical site. A case with a 3-year follow-up, featuring a vertical-horizontal bone deficiency, is presented as an example. Case presentation: A bone deficiency is presented at the 2.2 position. Through the use of a piezoelectric instrument, a bone block apical to the defect is harvested. The osteotomy produces a preoperatively planned volume and shape of the bone block, which is then perfected, flipped upside down and fixed using osteosynthesis screws, with the thickest portion in the crestal area. The reconstruction provided sufficient volume for the implant rehabilitation. After 3.5 years, bone remodelling appears contained; the horizontal volume is maintained. Conclusions: When residual anatomy appears eligible for this approach, this technique may represent an alternative to ectopic bone harvesting, thus reducing the patient’s discomfort and surgical invasiveness.

Introduction: Non-invasive methods to modulate orthodontic tooth movement have gained interest, particularly those targeting inflammatory mediators such as IL-1β and TNF-α, which regulate osteoclast and osteoblast activity. High-frequency vibrations (HFV), including those delivered by sonic toothbrushes, have been proposed to influence these biological responses. The aim of the study is to assess whether sonic vibrations affect IL-1β and TNF levels in patients undergoing clear aligner therapy. Materials and Methods: Twenty Invisalign^® patients were evaluated. For each patient, one tooth received HFV via a 285 Hz sonic toothbrush (experimental), while the contralateral served as a control. Gingival crevicular fluid was sampled at baseline (T0), after one week without HFV (T1), and after one week with HFV (T2). Cytokines were measured by ELISA. Because data were non-normally distributed, non-parametric tests were applied. Results: No significant differences across T0–T2 were found within the HFV group. At T2, IL-1β levels were significantly lower in the HFV group (mean: 23.04; SD: ± 20.18) than in controls (mean: 44.44; SD: ± 47.14), which showed an IL-1β increase with orthodontic force alone. TNF-α levels remained near the ELISA detection limit. Conclusions: Sonic vibrations combined with clear aligners appear to reduce IL-1β secretion and local inflammation without adverse effects. Sonic toothbrushes provide a simple HFV delivery method, though larger studies are needed to confirm these findings.

This cross-sectional experimental study compared a digital intraoral-scanner-based method with a traditional wax-registration method for the quantitative assessment of static occlusal contacts. Twenty adults with natural dentition were evaluated using an intraoral scan analyzed through a Java-based software (PixCount.java, version 1.0, version 1.0, University of Insubria, Varese, Italy) and wax registration analyzed with Z_TMJ software (Z_TMJ, version 1.0, University of Insubria, Varese, Italy). The primary outcome was the percentage distribution of static occlusal contacts between hemi-arches. A paired t-test and the intraclass correlation coefficient (ICC) were used to evaluate differences and agreement. Mean contact distribution was 49.75 ± 3.44% for the digital method and 48.02 ± 5.31% for the wax method. No statistically significant difference was observed (p > 0.05), and agreement analysis showed moderate concordance (ICC ≈ 0.43). Digital analysis provided superior visualization and workflow efficiency, whereas wax registration remained a practical, low-cost option. These findings indicate that both methods provide clinically meaningful information, with the digital approach offering additional practical advantages. The observed consistency between the two techniques supports the expanding role of digital tools in routine occlusal assessment.

Introduction: Preformed myofunctional appliances are increasingly being studied in orthodontics and are typically used to address oral function anomalies as well as malocclusions and development defects of the jaws. The aim of this study is to evaluate the efficacy of a protocol based on the use of preformed devices and myofunctional therapy for the correction of malocclusions. Materials and Methods: A retrospective study was conducted to evaluate the effectiveness of a preformed myofunctional devices in correcting certain orthodontic problems related to overbite, overjet, and cross-bite. Thirty-six patients in the mixed dentition phase were analyzed along with their clinical records, photos, and scans. Overjet, Overbite, and Crossbite were measured by analyzing the files exported in the Standard Tesselation Language format (Stl) of patients’ arches using Zeiss Inspect^® software (version 2025.1.0.1985). Results: The data analysis reveals a statistically significant improvement in the correction of deep bite, overjet, and crossbite. Specifically, regarding the overbite (OVB), the initial measurement at T0 showed an average of 2.52 mm. The average OVB decreased to 1.73 mm at T1. The overjet had an initial average of 3.59 mm at T0, which decreased to 1.77 mm at T1. In this case as well, the difference between the measurements at T0 and T1 was statistically significant. Finally, the crossbite was evaluated by comparing the difference between mandibular and maxillary intermolar widths at T0 and T1. The average difference decreased from 5.84 mm at T0, to 1.68 mm at T1. Conclusions: Preformed myofunctional appliances represent a valid alternative in interceptive orthodontics for correcting and preventing orthodontic issues, especially of mild severity.

Background: This study aimed to evaluate the effectiveness of xylitol- and fluoride-containing chewing gum in reducing dental plaque using a novel 3D colorimetric analysis, and to compare results with the Plaque Control Record (PCR). Methods: An acute intervention study was conducted on 34 healthy adults (18–45 years). A plaque-disclosing solution was applied, and intraoral scans were taken before and after 15 min of gum mastication. Plaque was quantified with PCR and the Placca Read software, which analyzes colorimetric patterns of scanned images. Statistical analyses (Shapiro–Wilk test, paired t-test) were performed with Jamovi Software version 1.6.14. Results: A significant reduction in plaque scores was observed after chewing gum (p < 0.05). Mean reduction reached −14.8% in the experimental group versus −3.9% in controls, where natural saliva flow and pigment washout may explain the modest decline. The 3D analysis provided precise measurements across all dental surfaces and showed strong correlation with PCR, supporting its validity. Conclusions: These findings indicate that functional chewing gum can significantly reduce plaque accumulation even after a single use, and that 3D colorimetric analysis offers a reliable, comprehensive alternative to conventional indices.

Aim: Pacifiers play a critical role in the early stages of craniofacial and palate development during infancy. While they provide comfort and aid in soothing, their use can also have significant impacts on the growth and function of the oral cavity. This study aimed to simulate and predict the behavior of six different types of pacifiers and their functional interaction with the tongue and palate, with the goal of understanding their potential effects on orofacial growth and development. Materials and Methods: Biomechanical analysis using Finite Element Analysis (FEA) mathematical models was employed to evaluate the behavior of six different commercial pacifiers in contact with the palate and tongue. Three-dimensional solid models of the palate and tongue were based on the mathematical framework from a 2007 publication. This allowed for a detailed investigation into how various pacifier designs interact with soft and hard oral tissues, particularly the implications on dental and skeletal development. Results: The findings of this study demonstrate that pacifiers exhibit different interactions with the oral cavity depending on their geometry. Anatomical–functional pacifiers, for instance, tend to exert lateral compressions near the palatine vault, which can influence the hard palate and contribute to changes in craniofacial growth. In contrast, other pacifiers apply compressive forces primarily in the anterior region of the palate, particularly in the premaxilla area. Furthermore, the deformation of the tongue varied significantly across different pacifier types: while some pacifiers caused the tongue to flatten, others allowed it to adapt more favorably by assuming a concave shape. These variations highlight the importance of selecting a pacifier that aligns with the natural development of both soft and hard oral tissues. Conclusions: The results of this study underscore the crucial role of pacifier geometry in shaping both the palate and the tongue. These findings suggest that pacifiers have a significant influence not only on facial bone growth but also on the stimulation of oral functions such as suction and feeding. The geometry of the pacifier affects the soft tissues (tongue and muscles) and hard tissues (palate and jaw) differently, which emphasizes the need for careful selection of pacifiers during infancy. Choosing the right pacifier is essential to avoid potential negative effects on craniofacial development and to ensure that the benefits of proper oral function are maintained. Therefore, healthcare professionals and parents should consider these biomechanical factors when introducing pacifiers to newborns.

The purpose of this systematic review is to analyze the dentoalveolar changes resulting from the use of clear aligners in the treatment of transverse maxillary deficiency among growing children in the mixed dentition stage. An electronic literature search was carried out using the following databases: PubMed, Scopus, Cochrane Library, Embase, and Web of Science. The review protocol was prospectively registered in the PROSPERO database. Eligible studies included children aged 6 to 12 years in the mixed dentition period, presenting with erupted maxillary first molars and a transverse deficiency of the maxilla, and undergoing treatment with Invisalign^® First aligners. The review encompassed various study types including retrospective and prospective designs, randomized controlled trials, preliminary studies, and case series. Two independent reviewers conducted the data extraction process. The quality of evidence was assessed using the GRADE approach. Except for studies by Bruni et al., the risk of bias in selected articles was visually summarized in a traffic light plot using the robvis tool, following the ROBINS-I methodology. For the studies by Bruni et al., a separate visual representation was created using robvis with the RoB2 evaluation framework, prepared by the authors S.E.I. and C.A. In total, 14 studies were included in the final synthesis, selected from 265 records retrieved through electronic searches and an additional 36 identified via manual screening. Several parameters were considered in order to assess dentoalveolar expansion: intercanine width, intercanine transpalatal width, intercanine dentoalveolar width, first and second interdeciduous molar width, first and second interpremolar width, first and second interdeciduous molar transpalatal width, first intermolar width, first intermolar mesial, distal, and transpalatal width, molar inclination, arch depth, and arch perimeter, and intermolar dentoalveolar width. An improvement was recorded in all parameters. The studies comparing treatment with Invisalign^® First clear aligners and rapid maxillary expander highlighted that these both determined statistically significant differences compared to the natural growth group. Treatment with Invisalign^® First in mixed dentition proved to be very effective for dentoalveolar expansion of the maxillary arch, with good control of the crown angulation of the upper first molar and an increase in the palatal area similar to RME, compared to pre-treatment or to the natural growth group. It could represent an effective and comfortable alternative to the traditional rapid maxillary expander treatment. However, further high-quality studies are required to support our current observations and verifying the stability of treatment outcomes on a long-term basis.

The increasing emphasis on appearance and well-being has underscored the significance of self-care. From an aesthetic perspective, this entails addressing the early onset of wrinkles and the initial signs of aging. In response, new techniques have been developed, supplementing existing methods, to mitigate the signs of aging. Aesthetic speech therapy has emerged in recent years as a non-invasive procedure to combat facial aging. The objective of this study is to evaluate its effects on the signs of facial aging in participants subjected to an experimental exercise protocol over a three-month period, focusing on orbicularis and zygomatic muscles, using both a digital evaluation analysis and a self-assessment questionnaire. A cohort of 21 female subjects, aged between 50 and 65, was instructed to perform a series of 4 targeted exercises for 15 min daily over a span of three months. The participants underwent monthly evaluations, each involving the collection of standardized photographic documentation and a three-dimensional facial scan. These scans were subsequently overlaid and analyzed by a colorimetric assay at the conclusion of the study period. Statistical tests were carried out by two-way ANOVA. Additionally, during the final evaluation (T3), the participants completed a questionnaire assessing their satisfaction with their self-image and the non-invasive aesthetic treatment they received. The statistical analysis of the overlays of the collected three-dimensional scans revealed a significant volumetric change around the orbicularis oris muscle. The difference between green and blue pixels was statistically significant (p < 0.05), as was the difference between blue and yellow pixels (p < 0.05). This change did not achieve statistical significance around the zygomatic muscles. The analysis of the participants’ questionnaire responses indicated an increasing level of satisfaction with their self-image at the end of the study compared to T0. Personal confidence increased by 20%, and participants reported a 53% improvement in satisfaction with their appearance in photographs. The observed volumetric changes may be attributed to modifications in the facial muscles targeted by the exercise protocol undertaken by the participants. However, further studies are warranted to delve deeper into this issue, considering the intricate process of facial aging and the complex three-dimensional structure of the face with its various components.