Monica Macrì

This article presents a case study of a 64-year-old female patient who underwent orthodontic treatment to enhance the aesthetic appearance of her smile and replace a missing tooth (46). During the preliminary visit, significant gnathological concerns were identified, including headaches, orofacial pain, and muscle fatigue. These issues had to be addressed prior to the start of the orthodontic phase of treatment. Methods: a multidisci-plinary treatment plan was implemented using a sequential approach. The initial phase involved the implementation of techniques to reduce muscle tension and manage orofacial pain, with the objective of achieving clinical stability. Following the attainment of clinical stability, the orthodontic phase commences with the aim of improving occlusion and pos-ture. Results: a significant reduction in muscle tension-related symptoms was observed, along with effective gnathological stabilization. Subsequent orthodontic treatment resulted in aesthetic and functional improvements to the smile, optimizing occlusion and overall posture. The final phase will involve implant-prosthetic rehabilitation to replace tooth 46. Conclusions: a comprehensive and accurate initial gnathological diagnosis is essential for planning effective rehabilitative therapy in patients with partial edentulism and associated conditions. A multidisciplinary approach has proven fundamental in achieving stable and predictable long-term outcomes, even after the implant-prosthetic phase.

Background/Objectives: Currently, clear aligners are preferred to conventional appliances, especially among adult patients. However, the use of aligners for treating maxillary constriction is still debated in the literature. Therefore, the purpose of this study was to assess maxillary dentoalveolar expansion following clear aligner therapy in adults using CBCT scans. Methods: The study sample encompassed 50 non-growing patients (27 females and 23 males) aged 20 to 42 undergoing clear aligner orthodontics without dental extractions or auxiliaries. Transverse linear distances were measured on initial and final CBCTs and, subsequently, analysed through paired t-test and ANOVA. We considered alveolar bone measurements and interdental widths measured at the buccal apices and cusps from canines to second molars. Results: The buccal alveolar ridge width showed the greatest expansion (1.01 ± 0.38 mm), followed by the palatal alveolar ridge and maxillary alveolar bone. Statistically significant improvements were observed for all interdental measurements. The most considerable changes occurred in the interpremolar cusp distances, while the least changes were seen in the intermolar apex distances. At the cusp level, the average interpremolar widths increased by 3.44 ± 0.22 mm for the first premolars and 3.14 ± 0.27 mm for the second ones. Conclusions: Clear aligner treatment can effectively manage a constricted maxillary arch. We found significant changes in the maxillary alveolar bone. Both inter-apex and inter-cusp widths increased in all teeth, with the highest values in the premolars. Moreover, the increases in interdental distances at both apex and cusp levels were related to tooth position.

Background: Many studies analyse the effectiveness of the Herbst device in the treatment of dentoskeletal Class II malocclusion due to mandibular retrusion. This fixed device was devised by Emil Herbst for Class II treatment using a bite jumping, i.e., a device that holds the jaw in a forced anterior position. Comparison of the results obtained in numerous studies is difficult because they are often not comparable and not congruent due to a number of variables that prevent standardization. Methods: The purpose of the present study is to report some clinical-level considerations that may be important in order to obtain more predictable therapeutic outcomes. The simplified design of the Herbst device offers better patient comfort and easier cleanability but may show some disadvantages, such as less anchorage. Results: The device was evaluated in conjunction with the multi-bracket phase that preceded Herbst therapy and concluded after the device was removed. The therapy was performed in the absence of skeletal anchorage. Conclusions: In our opinion, standardization of therapy according to precise protocols may positively affect the therapeutic outcomes by achieving faster occlusal stabilization, more proper neuro-muscular balance, less stress on anchor units, and shorter treatment time.

Atlas Posterior Arch Deficiency (APAD) is a rare anatomical variation of the atlas vertebra detected using cone-beam computed tomography (CBCT). This study assessed the prevalence, classification, and clinical implications of APAD in an Italian cohort. Methods: We analyzed CBCT images from 500 Italian patients (17–60 years) from the University “G. D’Annunzio” in Chieti. The sample was evenly split between genders. The sample was evenly split between genders. APAD classification was performed, identifying five morphological types. Imaging used a low-dose protocol with a Pax-Zenith 3D CBCT machine and Dolphin imaging software (12.0.9.58). Results: APAD was identified in thirteen patients—twelve with partial APAD and one with complete APAD. Two cases also had Ponticulus Posticus. Type A anomalies were most common; no cases of types B, C, D, or E were observed. None of the cases were symptomatic. Conclusions: APAD is rare in this cohort, with partial forms being the most frequent. CBCT is effective for diagnosing APAD, highlighting the importance of routine imaging in orthodontic assessments. Despite the absence of symptoms, awareness and monitoring for potential symptoms are important. Further research is needed to understand APAD’s clinical significance across different populations.

Many studies analyze the effectiveness of Herbst's device in the treatment of dento-skeletal class II due to mandibular retrusion. This fixed device was devised by Emil Herbst for class II treatment bite jumping, a device that holds the jaw in a forced anterior position. Comparison of the results obtained in numerous studies is difficult because they are often not diriment and not congruent due to a number of variables that prevent standardization. The purpose of the present study is to report some clinical-level considerations that may be important in obtaining the therapeutic outcome. The simplified design of the device offers the advantage of better patient comfort, better cleanability but offers as disadvantages, less anchorage and other risks that will be described below. The device is evaluated in conjunction with the multi-brackets phase that precedes Herbst therapy and concludes it, after the device has been removed. The therapy was performed in the absence of skeletal anchorage. In our opinion, standardization of therapy according to precise protocols can positively affect the therapeutic outcome through achieving rapid occlusal stabilization, neuro-muscular balance, less stress on anchor units and shorter treatment time.

Background: Temporomandibular disorders (TMDs) represent a range of clinical issues affecting the temporomandibular joint (TMJ), the chewing muscles, and surrounding structures. This study aimed to identify the morphological profiles and skeletal malocclusions that most significantly influence the development of TMDs. Materials and Methods: The analysis was performed using cephalometric data from patients undergoing low-dose cone-beam computed tomography (CBCT) at the Orthodontics Department of Gabriele D’Annunzio University. The Results and Conclusions showed significant differences in cephalometric parameters and condylar positions between male and female patients with TMDs, emphasizing the need for individualized diagnostic and therapeutic approaches. Further research is needed to assess the implications of these variations for TMD management.

The increasing concern over environmental sustainability has prompted various industries to reassess their practices and explore greener alternatives. Dentistry, as a significant contributor to waste generation, is actively seeking methods to minimize its environmental footprint. This paper examines the environmental implications of clear aligner therapy (CAT) in orthodontics and explores strategies to prioritize sustainability in aligner manufacturing and usage. CAT has gained popularity as a viable alternative to traditional fixed appliances due to advancements in biomaterials and computer-aided design (CAD) and manufacturing (CAM) technologies. The global market for clear aligners is expanding rapidly, with significant growth projected in the coming years. To address these challenges, this paper proposes adopting the principles of reduce, reuse, recycle, and rethink (4Rs) in orthodontic practices. Strategies such as minimizing resource consumption, incorporating recycled materials, and promoting proper aligner disposal and recycling can significantly reduce environmental harm. This paper explores emerging technologies and materials to mitigate the environmental impacts of CAT. Additionally, initiatives promoting aligner recycling and repurposing offer promising avenues for reducing plastic waste and fostering a circular economy. In conclusion, while CAT offers numerous benefits in orthodontic treatment, its environmental impact cannot be overlooked. By implementing sustainable practices and embracing innovative solutions, the orthodontic community can contribute to a more environmentally conscious future while continuing to provide quality care to patients.

Background. The evaluation of midpalatal suture maturation is essential to undertake the most predictable maxillary expansion approach. Several factors, such as age, gender, and facial growth patterns, seem to be involved in midpalatal suture staging and, consequently, in its opening; however, the link between these variables and the stages of midpalatal suture development remains poorly understood. Our study aimed to analyse the midpalatal suture maturation in relation to age, sex, and skeletal growth patterns by CBCT. Methods. We enrolled 263 patients (119 males and 144 females) aged from 8 to 20 years. The midpalatal suture maturation was defined according to Angelieri et al.’s classification using a low-dose CBCT. The chi-square test and linear regression were applied to investigate the suture stages by age, sex, and vertical and sagittal growth patterns. Results. Stage A was present in 8- and 9-year-olds with a larger prevalence in boys, while the prevalence of stage E increased progressively with age. Stage D was the most prevalent in our sample. The statistical analysis described that stage A was more likely in the youngest subjects, and stage E in the oldest participants. The males tended to have lower maturation stages. Moreover, the hypodivergent and normodivergent subjects tended to have higher maturation stages, while Class III was more likely in subjects in stages D or E. Conclusions. A total of 127 patients were in stages A, B, and C, showing an unfused suture. In young individuals, the opening of the midpalatal suture leads to a proper facial growth development by correcting the transverse superior hypoplasia. The midpalatal sutural maturation classification was related to age, sex, and divergence.

The External Occipital Protuberance (EOP) is a notable anatomical landmark connected to neck musculature. With the rise of tech neck syndrome due to prolonged smartphone use, concerns have emerged regarding its influence on EOP morphology. This study compares EEOP characteristics in contemporary individuals (aged 18-30 years) from Abruzzo with ancient skulls from the Opi necropolis (VII-Vth century BC) Methods: Four null hypotheses were tested concerning EEOP prevalence and severity: (1) no gender differences, (2) no differences between modern and ancient populations, (3) no gender-based variations in severity, and (4) no temporal differences in severity. Statistical analyses were conducted to assess the significance of these hypotheses. Results: The study found a higher prevalence of EEOP in modern individuals compared to ancient populations, with no significant gender differences in prevalence. However, severity of EEOP showed significant variation by gender and historical period, with modern individuals exhibiting greater severity. Conclusions: The observed increase in EEOP prevalence and severity in modern populations suggests a potential influence of tech neck posture associated with increased screen time. These findings underscore the need for further research into the effects of contemporary lifestyle factors on cranial morphology.

Atlas Posterior Arch Deficiency (APAD) is a rare anatomical variation of the atlas vertebra that can be detected using cone-beam computed tomography (CBCT). This study aims to evaluate the prevalence, classification, and clinical implications of APAD in an Italian cohort.