Gianluca Mampieri

Aim: To evaluate the leveling of the curve of Spee (COS) of the lower arch in deep-bite patients by using three different clear aligners: Invisalign^® Align Technology^® Inc. (Santa Clara, CA, USA), Spark™ Clear Aligner System Ormco™ (Brea, CA, USA) and Angel Aligner™ Technology Inc. (Shanghai, China). Material and Methods: Sixty-nine patients were selected based on specific criteria and subdivided in three different groups based on clear aligner systems used for their treatment: Invisalign^® Aligner (I group), Spark™ Clear Aligner (S group), and Angel Aligner™ (A group). All patients were treated from 2021 to 2025 by the same orthodontist with extensive experience in the aligner technique, following a standardized protocol for deep-bite resolution. The STL files of the lower arch were analyzed using MeshLab software at three specific time points: pre-treatment (ID), post-treatment (AC), defined as the result achieved after the first set of aligners, and digital planning (EC). In all three groups, the differences between AC-ID and EC-AC were examined by means of the T-test; intergroup variations were also compared using the ANOVA test. Results: The study revealed that aligners were only minimally effective at leveling the COS. The planned dental movements were not fully achieved, leading to a low accuracy of the treatment. The highest mean accuracy was detected in the Angel Aligner™ group (39%). Conclusions: The clear aligner treatment for leveling the COS presents limits in terms of biomechanics of the device. The study shows that no clinically and statistically significant differences emerged across the three systems used.

Surface hardness is a fundamental parameter influencing wear resistance, durability, and the interaction of occlusal ramps with opposing enamel during orthodontic treatment. Five commercially available materials (Harmonize, Leone F3172-01, Transbond™ XT, Band and Build LC, and Ultra Band-Lok) and one experimental material (Composite RK-F10) were evaluated for bite ramps. Twelve standardized specimens (n = 2 per material) were prepared using EVA molds and polymerized according to manufacturers’ instructions or internal protocols. Vickers microhardness (HV) was measured following ASTM E384-16 using a 500 g load, 20 s dwell time, and ten indentations per specimen. Load dependence was assessed (25–2000 g). Surface morphology was analyzed by SEM, and cytotoxicity of eluates was evaluated on dental pulp stem cells (DPSCs) and monocyte/macrophage cell lines using CCK-8 assays (ISO 7405, ISO 10993). Significant differences in hardness were observed among materials (p < 0.05). Harmonize (64.5 ± 1.6 HV), Band and Build LC (64.4 ± 1.9 HV), and Ultra Band-Lok (64.1 ± 2.0 HV) showed the highest values, whereas Transbond™ XT exhibited the lowest value (53.7 ± 6.0 HV). Composite RK-F10 demonstrated intermediate hardness and good cytocompatibility. SEM analysis revealed differences in surface homogeneity and filler distribution. Overall, the materials exhibited distinct mechanical and biological profiles. The combined Vickers microhardness, short-term (24 h) cytotoxicity, and SEM data provide an integrated preliminary in vitro characterization of materials for bite ramps. The observed differences contribute to a comparative description of their physico-biological behavior.

Objective: The aim of this study was to assess the effect of RME on upper airway structure and its relationship to improvements in sleep disordered breathing.Methods: The study was carried out in 23 children with malocclusion and OSA. Clinical assessment visits, daytime sleepiness questionnaire, polysomnography and orthognatodontic examination were performed before (T0) and 4 (T1) and 12 (T2) months after RME. CB CT scans with 2D and 3D reconstructions were performed before (T0) and 12 after months (T2) RME. The relationship between airway changes and improvements in sleep disordered breathing were evaluated.Results: In all cases, opening of the mid‐palatal suture was successfully achieved. Volume of the total upper airways, nasal cavity, nasopharynx and oropharynx increased significantly as well as the nasal osseous width. The increase in posterior suture, pterygoid process, maxillary, nasal cross‐sectional width were significantly correlated with total upper airway volume, nasal cavity volume, nasopharyngeal airway volume, and oropharyngeal airway volume.The improvement in AHI was correlated with the increase in total upper airway volume at 12 months.Conclusion: The study provides important details about the effect of RME on upper airway structure, including an enlarged posterior suture, pterygoid process, maxillary width and nasal cross‐sectional width and enlarged airway volume.

Background Proper development of deciduous and mixed dentition is essential to the oral health of growing patients, and early interceptive orthopedic or orthodontic treatments are indicated in specific clinical situations.Nowadays, orthodontists are subjected to a lot of pressure from growing patients and their parents about the orthodontic appliances that should be used.The aim of this article is to indicate how, when and why it is possible to effectively use aligners in growing patients.Case reports Two case reports are illustrated, one with a Cl.II subdivision, mono lateral cross-bite and vertical growth, and the other with a skeletal and dental Cl.II, vertical skeletal pattern, proclined and fractured upper incisors.The efficacy/efficiency ratio of aligners is analyzed in order to evaluate the suitability of this appliance for the treatment. Limits and advantages of aligners are widely discussed.Conclusions Aligner treatment in growing patients shall be carefully studied to reach an optimal result. At present, a hybrid treatment strategy represents the best solution in growing patients with a complex clinical situation.

Background: Relationships between reflectivity, hardness and chemical composition of the dispersed phase, included in orthodontic composites Transbond XT^TM (Trans), Light-Cure Orthodontic Paste (Leone) and Bisco Ortho Bracket Paste LC (Bisco), were investigated in vitro to evaluate whether reflectivity results can be useful in internal material composition interpretation, thus obtaining information on mechanical behaviours. Methods: Light transmission through 36 resin discs was measured with a UV/Vis spectrophotometer, evaluating the spectral range from 190–1100 nm. To have a benchmark of material hardness and internal composition, Vickers measurements and Cross-Sectional Focus Ion Beam Scanning Electron Microscopy (FIB/SEM) analysis were provided. Results: Bisco has the highest reflectivity, Leone shows an absorption pattern in the UV region similar to Bisco and Transbond has the lowest reflectivity compared to the others. This trend is confirmed by FIB/SEM imaging, showing a more similar induced roughness and internal composition for Bisco and Leone, with respect to Transbond. Higher filler presence in the composition of Bisco and Leone justifies a higher hardness of these two materials, with respect to Transbond, as confirmed by Vickers measurements. Conclusions: Bisco and Leone show similar optical responses and similarities in mechanical performance. This statement is explained by the lower and similar filler content as confirmed also by FIB/SEM analysis. The inner composition of Bisco and Leone provides a higher value of microhardness, as demonstrated by Vickers measurements. Therefore, this study confirms that the UV-Vis analysis can also offer a significant overview on the internal material composition, thus indirectly providing information on the mechanical properties of orthodontic composites.

OBJECTIVES In the multidisciplinary treatments, especially in case of missing teeth in aesthetic area, the compliance of patient during retention time post orthodontic therapy is evidently very high, even among teen patients, in particular when we adopt clear retainers comprising absent teeth. The purpose of this paper is to show an original use of the ovoid pontic technique associated with retainers to model soft tissues and achieve an ideal emergence profile around pontic to give the illusion of a natural gingival margin around prosthodontic restoration. MATERIALS AND METHODS The ovoid pontic technique is a procedure developed to adapt the gingiva to the prosthodontic bridge element as naturally as possible. The authors presented two clinical cases in which two different methods were utilized to perform ovoid pontic technique during retention time: 1. by means of the analogic technique, using a thermoformed 1.5 mm thick PETG essix; 2. by means of digital workflow, using a Vivera((R)) retainer (Align Technology, San Jose, CA, USA). The objective of the ovoid pontic technique is not only to achieve the ideal emergence profile around prosthodontic restorations but overall to avoid a traumatic second surgery to implement soft tissues. For this purpose is strategic to select patients with thick gingival tissues for obtaining best final results. A minimum thickness of 3 to 5 mm of soft tissue is required from the gingival crest to the alveolar ridge. In both procedures, the pontic was gradually increased by using a light-cured biocompatible fluid composite to determine increasing pressure over the gingival tissue, modeling the edentulous area and finally leading to a natural look of the prosthodontic restoration. Then, a gradual and controlled hyperpressure can transform an unfavorable tissue configuration. There is also a possibility of closing undesirable interdental "black holes" through papilla "formation", by pressuring the gingival tissues. CONCLUSIONS The proposed method allows to manage gingival tissues during retention time, which is usually a passive phase of the orthodontic therapy, accelerating the treatment for the final restorative phase and improving the esthetic outcome. In conclusion, according to the thermoformed retainer based ovoid pontic technique, orthodontists can manage gingival tissues on their own before referring the patient to a restorative dentistry specialist. CLINICAL SIGNIFICANCE This paper presents an original way of managing the ovoid pontic technique during the orthodontic retention time to accelerate the following restorative phase, allowing to take advantage from a passive treatment stage while conditioning soft tissues and thus limiting the aesthetic discomfort for the patient.

Background: Lower molar distalization is considered to be one of the most difficult movements to obtain with clear aligners. The aim of this study was to evaluate the possibility to distalize the lower molars using clear aligners in adults without miniscrews. Material and methods: rx cephalograms of 16 patients (8 males, 8 females; mean age of 25.6 years), who underwent lower molar distalization, were analyzed. Cephalograms were taken before the beginning of treatment (T0) and after the end of treatment (T1). Dental and skeletal changes between T0 and T1 were evaluated. The level of significance was set at p < 0.05. Results: At T1, the lower second molar moved distally 2.47 mm, but there was a significant tipping (p = 0.027); the same result was found at the first molar, with a mean distal movement of 1.16 mm and a significant tipping (p = 0.003). No significant changes were detected on the sagittal and vertical skeletal variables. Conclusion: Clear aligner therapy can provide more distal tipping than bodily movement in the lower molars when a distalization is programmed. This movement could be sufficient to correct the initial malocclusion and gain a class I molar relationship.

Fluoride-based mouthwashes and gels are preventive measures in countering demineralization and caries but, modifying environmental acidity, can reduce the wet corrosion resistance of orthodontic alloys. To evaluate chemical stability, in vitro experiments were conducted on stainless steel and nickel–titanium wires, weighed before and after immersion in household fluorinated mouthwashes and gels, measuring weight variations and elution of metal ions from acid corrosion phenomena. Elution samples were analyzed by inductively coupled plasma mass spectrometry, detecting residual ion concentration, while surface changes were analyzed under scanning electron microscopy. Results showed stainless steel wires do not undergo significant erosion when exposed to most fluorinated mouthwashes but, at prolonged exposure, alloys elute gradually greater amounts of metals and Ni–Ti wires become more sensitive to some mouthwashes. Ions’ elution varies considerably, especially for Ni–Ti wires, if exposed to household fluorinated gels, for which significant negative values were obtained. Changes, affecting wires’ outer layer, negatively act on shiny appearance and luster, reducing corrosion resistance. Although examined orthodontic wires showed good chemical stability and low toxicity, surface corrosion from exposure to fluorinated agents was observed. Home use must be accompanied by clinician prescription and, for household dental gels, must follow manufacturers’ recommendations, ensuring prophylactic action without damaging alloys surfaces.

Introduction . Orthodontic treatment is a recognized approach to support specific periodontal issues thanks to its capability to manipulate periodontal tissues. This concept is certainly not new, but the use of aligners in certain clinical conditions can be considered as being innovative when a multidisciplinary treatment is necessary. Moreover, aligners enable to plan 3D tooth movements, root placement, staging, and range of dental movements, alongside the improvement of oral hygiene. Thus, aligners can be suitable for the treatment of periodontal issues. In this article, the authors present two clinical cases with different periodontal issues: one with superficial periodontal problems and the other with a deep one. Both cases were successfully treated with aligners, highlighting how this invisible and comfortable tool can simplify the management of complex adult treatments. Conclusion . Digital workflow is the key for success in the aligner technique. The possibility to design a virtual plan of treatment and to transfer it in the real clinical world represents a way to limit errors and to reduce the time of orthodontic therapy.