Antonella Mattei

Background: Artificial intelligence (AI)-assisted remote monitoring is increasingly used in dentistry, but evidence in children who are not undergoing active orthodontic treatment remains limited. This prospective pilot study evaluated the agreement between an AI-based Observational Monitoring system and conventional clinical examination for selected oral health findings in children with mixed dentition. Methods: Twenty children (10 males and 10 females; mean age 10.5 years, range 9–12 years) were evaluated at baseline (T0), 6 months (T1), and 12 months (T2). Six clinical conditions—dental plaque, persistent dental calculus, minor food debris, mild gingivitis, satisfactory oral hygiene, and dental staining—were assessed by a clinical observer and by the DentalMonitoring Observational Monitoring system. None of the patients included in the study were undergoing orthodontic treatment. Observer and AI classifications were analyzed as paired data. For each condition and time point, observed agreement and Cohen’s kappa were calculated from the paired 2 × 2 table, and systematic differences between methods were assessed with the exact McNemar test; changes in prevalence over time were assessed with Cochran’s Q test. Results: Observed agreement ranged from 65% to 95% at T0, from 65% to 100% at T1, and from 85% to 100% at T2, with wide 95% confidence intervals (e.g., 65.0%, 95% CI 40.8–84.6%). Cohen’s kappa ranged from −0.14 to 0.64 and was not computable when a condition was absent according to both methods. For low-prevalence findings, high observed agreement coincided with kappa values close to zero. For conditions with more balanced prevalence, chance-corrected agreement was only fair. During follow-up, the prevalence of dental plaque and food debris decreased, whereas that of satisfactory oral hygiene and dental staining increased. Conclusions: AI-assisted Observational Monitoring showed moderate-to-high observed agreement but variable chance-corrected agreement with direct clinical assessment in this small pediatric cohort. The system may represent a complementary tool for longitudinal dental follow-up, but professional supervision remains necessary and larger validation studies are required.

Background: Treatment of peri-implantitis remains challenging because biofilm removal from microstructured implant surfaces is often incomplete. The present study is an uncontrolled, prospective feasibility case series involving six patients (six implants), not a controlled clinical trial, in which short-term clinical outcomes following use of a multimodal protocol to decontaminate the titanium implant surface were obtained; consequently, the independent contribution of the Ximplant^® device to the observed outcomes cannot be determined. The protocol comprised surgical access, mechanical debridement, chemical conditioning, systemic administration of medication, and cleaning with an alternating-current device (Ximplant^®; LED, S.p.A., Aprilia, Italy). Methods: Six adults with peri-implantitis, each contributing one implant, were consecutively treated using the multimodal protocol. Probing depth (PD), bleeding on probing (BOP), plaque index (PI), and suppuration (SU) were determined at baseline, 3 weeks, 6 months, and 12 months. Longitudinal changes were analyzed using repeated-measures analysis of variance and non-parametric tests for categorical variables. Results: Mean total PD decreased from 4.56 ± 0.45 mm at baseline to 3.03 ± 0.44 mm at the 3-week follow-up and remained stable at the 6-month follow-up (3.08 ± 0.35 mm) and at 12-month follow-up (3.19 ± 0.41 mm; p < 0.0001). BOP and SU were absent in all implants at each follow-up visit. PI improved markedly, although the buccal aspect of one implant was PI-positive at the 3-week and the 12-month follow-up. Conclusions: The multimodal protocol used in this study was associated with rapid and sustained clinical improvement over the 12-month follow-up period. A study limitation is that because the individual parts of the protocol were applied concurrently, the independent contribution of any of them to the outcomes determined could not be isolated.

Background: The management of complete mandibular edentulism in frail patients with severe bone atrophy is a clinical challenge. Ultrashort implants (≤4 mm) have been proposed as a minimally invasive alternative to bone augmentation procedures; however, long-term evidence in full-arch rehabilitations remains limited. Methods: This retrospective single-center cohort study presents the 10-year follow-up of patients treated with full-arch mandibular rehabilitation under immediate loading supported by 4 mm ultrashort implants. Patients were originally treated between 2015 and 2017. The primary outcome was prosthetic success at 10 years, defined as a stable and functional prosthesis supported by four implants. Secondary outcomes included implant survival, timing of implant loss, and biological and prosthetic complications. Results: Fourteen patients were available for evaluation at the 10-year follow-up. The success of the prosthetic structure was 100%, with all patients maintaining stable and functional rehabilitation. As regards the implants, a total of 82 implants had been placed, with 14 implant losses, resulting in a cumulative implant survival rate of 82.9%. Implant losses occurred mainly in early (1 week, 4 months) and late phases (between 3 and 10 years), while no losses were observed between 1 and 3 years. Overall, 71.43% of patients experienced at least one implant loss; however, this did not compromise prosthetic function. Conclusions: In this retrospective cohort, all full-arch prostheses remained functional at 10 years, although cumulative implant survival was 82.9%. These findings suggest that rehabilitation supported by 4 mm ultrashort implants may represent a treatment option for carefully selected frail patients with severe mandibular atrophy. Prospective controlled studies are needed to confirm these findings and compare this approach with standard-length implants and bone augmentation procedures.

Background: Herpes Zoster (HZ) is caused by the reactivation of the varicella zoster virus (VZV). Although aging is the most well-known risk factor for herpes zoster, little is known about the strength of the association between patient-related characteristics, including comorbidities, and their contribution to an increased risk of mortality, among patients hospitalized for HZ. The aim of this study was to assess hospitalization trends and the strength of this association. Methods: This retrospective population-based study, conducted among all patients hospitalized with HZ in Italy, between January 1st 2011 and December 31st 2023, analysed Hospital Discharge Records (HDR) reporting the ICD-9-CM codes related to HZ infection. Comorbidities that induce a reduced response of VZV-specific cell-mediated immunity - such as malignant neoplasms, chronic obstructive pulmonary disease, kidney diseases, diabetes mellitus, autoimmune diseases - were considered. Poisson regressions models, adjusted for age classes and sex, were used to identify factors associated with an increased risk of death. Results: Between 2011 and 2023, 47,933 hospitalizations with HZ were recorded. HZ comorbidities were diagnosed in 27.71% of cases (13,280 hospitalizations). The analysis revealed that the presence of neoplasms (IRR: 3.15; 95% C.I. 2.61–3.78) and kidney disease (IRR: 2.05; 95% C.I. 1.66–2.53) increased the risk of death among patients hospitalized with HZ. In the presence of comorbidities, males had a higher risk of death than females, and age was the strongest predictor. The risk increased significantly after the age of 40, reaching an IRR of 37.16 in patients over 80 years old with neoplasms. Conclusions: The findings of this Real-World study may raise awareness of the risks associated with HZ and support vaccination efforts to prevent infection, particularly among older adults and individuals with comorbidities.

Introduction: Malocclusion and dysfunctional or atypical swallowing are two conditions that significantly affect the health and well-being of the stomatognathic system, so much so that they often interact, influencing each other, and the presence of one can cause the onset or aggravation of the other. In this regard, over the years studies have been carried out that tried to discover the correlation between atypical swallowing and malocclusion. The aim is to evaluate the prevalence of dysfunctional swallowing in patients with malocclusion, to examine the pathophysiological mechanisms linking malocclusion and dysfunctional swallowing, and above all to investigate what potential risk factors may be. Materials and Methods: A sample of 60 patients aged between 6 and 16 years was analyzed at the Department of Dentistry of the University of L’Aquila. Some characteristics of the subjects’ face and posture were analyzed both from a frontal and lateral point of view. An orthodontic, temporomandibular joint, and masticatory muscle diagnosis was made. In addition, an examination of oral structures and functions was performed that allowed breathing, swallowing, chewing, and phono-articulation to be assessed. Results: It was observed that all the children had atypical swallowing, with significant postural abnormalities of the tongue; in fact, only 5% had a correct posture of the tongue at rest. In the analysis of occlusal characteristics, it emerged that with regard to the transverse plane, 21.67% of subjects have a condition of No Cross, while 10% show a Unilateral Cross. Finally, 68.33% show a Bilateral Cross. As far as the anterior–posterior plane is concerned, most of the subjects, equal to 76.67%, are placed in Class I, while 23.33% are in Class II. Finally, in relation to the vertical plane, 63.33% of subjects have normal occlusion, while 25% suffer from deep bite and 11.67% from open bite. The sample, stratified by presence or absence of alerts, shows significant differences for atypical swallowing (p = 0.031), for the presence of Class II malocclusion (p = 0.002), for low lingual posture, (p < 0.001), and for labial incompetence (p = 0.001). The multivariate logistic regression model showed that the presence of atypical swallowing (OR 1.04, 95% CI 1.04–1.07, p = 0.029), open bite malocclusion (OR 1.09, 95% CI 1.01–1.18, p = 0.013), low lingual posture (OR 1.11, 95% CI 1.04–1.18, p = 0.002), and the presence of labial incompetence (OR 1.06, 95% CI 1.02–1.10, p = 0.029) were significant clinical risk factors independently associated with the presence of alerts. Conclusions: The data collected confirm that atypical swallowing is a key element in the development of malocclusions, with a strong impact on posterior crossbite, anterior overjet, and other occlusal discrepancies. Among the data collected in the diagnostic phase, patients who presented at least one significant alert were also considered and atypical swallowing, low lingual posture, open bite malocclusion, and the presence of labial incompetence were statistically significant.

Background/Objectives: Previous studies on clear aligner therapy (CAT) in mixed dentition primarily focused on the predictability of maxillary arch expansion. However, limited evidence is available regarding mandibular arch changes, particularly in relation to inter-arch coordination. This study aims to evaluate the effectiveness and predictability of dental expansion in both the upper and lower arches using Invisalign First^® aligners. Methods: A retrospective analysis was conducted with 15 participants. Dental expansions were assessed before and after treatment using iTero intraoral scans processed with 3D analysis software. Measurements were compared to the predicted movements planned in ClinCheck^®. Data normality was verified (Shapiro–Wilk test), descriptive statistics were calculated, and paired t-tests were performed to compare clinical and predicted expansions, with significance set at 0.05. Results: Clear aligners achieved effective dento-alveolar expansion in both arches. Predictability was higher at the cusp level than at the gingival level, indicating a tendency toward tipping movements rather than bodily expansion. The study also highlighted mandibular expansion outcomes and gingival-level discrepancies, providing new insights compared to the previous literature. Minor differences between predicted and achieved movements were observed, partly attributable to natural growth and deciduous tooth exfoliation. Conclusions: Clear aligners are effective in achieving maxillary and mandibular arch expansion in mixed dentition, with good predictability at the coronal level. Overengineering buccal root torque may help promote bodily expansion and reduce cuspal–gingival discrepancies. Further studies with larger sample sizes are needed to optimize treatment planning and predictability.

More than two years of the Russian-Ukrainian war have resulted in widespread human and economic tragedy. This crisis also affects health status, including oral health. To carry out an exploratory analysis on the extent of caries in Ukrainian war refugee children and adolescents, and in addition to determine whether there was a statistically significant association between caries and age, gender, periodontal health status (using the Periodontal Screening and Recording (PSR) index), self-reported socioeconomic status and Italian language speaking skills. This study used a cross-sectional design, was conducted in Perugia, Italy at the University Dental Clinic (COU) between November 2023 and April 2024 and included 50 children and adolescents between 3 and 18 years old (mean age 9.2 SD 4.6) with Ukrainian citizenship who had left their home country due to the war. The visits were conducted in the presence of a cultural mediator. The visits consisted of two parts: the administration of questionnaires on socio-economic status and communication skills, followed by a dental examination. A logistic regression model was used to identify the factors independently associated (age, sex, PSR, socio-economic status and level of communication) with high DMFT/dmft values. The refugees’ mean DMFT/dmft was 3.5 SD 2.5. The multivariate logistic regression model showed that increased PSR (OR 7.71, 95% CI 1.38–22.94, p = 0.020) and low communication (OR 6.09, 95% CI 1.34–27.69, p = 0.019) were independently associated with the risk of having a DMFT/dmft > 4. The study findings were worrying in terms of the prevalence and severity of caries, especially in refugee children with a poor level of integration in the host country. This study with its preliminary data provides a starting point to reflect on the need for specific health policies adapted to a complex type of social vulnerability such as refugee children status.

The intraoral scanner represents an important innovation in the world of dentistry, capable of transforming and digitizing conventional workflows and significantly improving communication with the patient, especially in pediatric age. The aim of this study is to investigate how digital dentistry, using the intraoral scanner, can interact in the communicative trinomial dentist–pediatric patient–parents and how this tool can be useful in communicating and understanding the received message. The value of the introduction of digital dentistry on communication schemes is evaluated by administering a questionnaire of 17 questions. A sample of 100 children aged between 6 and 12 years was studied. Of the sample of children/parents included in the study, 50 were re-examined 4 weeks after the first visit to re-administer the questionnaire. Internal consistency, assessed through Cronbach’s alpha, was adequate, being alpha equal to 0.728. Test–retest reliability was assessed with Cohen’s kappa index for dichotomous variables (percentage of agreement was >85.71%), and for the discrete variables it was assessed with the Intraclass Correlation Coefficient (ICC). The reliability was moderate (0.5 < ICC < 0.75) for Q4, Q9, Q11 and Q1; for the other answers, the reliability was poor (ICC < 0.5) and not statistically significant. The digital approach is confirmed not only as a powerful innovation from an engineering or clinical point of view, but also as a useful tool for a more effective communication in the approach to pediatric patients.

Executive functions (EFs) are related abilities, associated with the frontal lobes functions, that allow individuals to modify behavioral patterns when they become unsatisfactory. The aim of this study was to assess EFs in children with sensorineural hearing loss (SNHL) and in children with “specific language impairment” (SLI), compared with a control group of children with normal development, to identify specific skill deficits. Three groups of preschool children aged between 2 and 6 years were assessed: 19 children with normal hearing, cognitive, and language development, 10 children with SNHL, and 20 children with SLI. The FE-PS 2-6 Battery was used for the assessment of preschool EFs, supplemented with the Modified Bell Test for the analysis of selective attention. Statistically significant differences were found between the two experimental groups and the control one, regarding the investigated skills. Children with SNHL showed a clear deficit in flexibility, whereas children with SLI had greater problems in self-regulation and management of waiting for gratification. Selective attention was found to be deficient in all three groups, with no statistically significant differences. This study shows that the skills investigated were found to be deficient in both SNHL and SLI patients. It is essential to start targeted exercises based on specific deficient skills as part of the rehabilitation program. It is of great importance to understand the consequences of EF deficit in preschool children to achieve an accurate diagnosis and carry out customized rehabilitation programs.