Publications by authors named "Maria Grazia Piancino"

40 Publications

Are occlusal splints effective in reducing myofascial pain in patients with muscle-related temporomandibular disorders? A randomized-controlled trial.

Turk J Phys Med Rehabil 2021 Mar 4;67(1):32-40. Epub 2021 Mar 4.

Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy.

Objectives: This study aims to evaluate the effectiveness of upper Michigan occlusal splint (OS) compared to mandibular OS in terms of pain, range of motion (ROM), and muscle activity as assessed by surface electromyography (sEMG) in patients affected by muscle-related temporomandibular disorders (TMD).

Patients And Methods: In this randomized-controlled trial, a total of 40 adult patients (13 males, 27 females; mean age: 47.2±12.8 years; range, 22 to 56 years) with a diagnosis of myofascial pain, lasting from at least three months on at least one masseter muscle. The patients were randomly allocated into two groups: Group 1 (n=20) using upper Michigan OS and Group 2 (n=20) using mandibular OS. At baseline (T0), at one (T1), three (T2), and six months (T3), the following outcomes were assessed: myofascial pain by Visual Analog Scale (VAS) and ROM of mandible movements, activity of the main masticatory muscles through sEMG.

Results: There were no significant intra-group differences in the outcome measures assessed in both groups. However, Group 2 had a significantly higher right lateral mandibular ROM at T2 (7.1±3.1 vs. 9.8±2.3, respectively; p<0.05) and a significantly higher left lateral mandibular ROM at T3 (7.6±3.5 vs. 10.5±2.1, respectively; p<0.05). We found no significant difference in none of the sEMG parameters.

Conclusion: Our study results suggest that OS, independently from being built on the upper or lower arch, seems to not have significant effects in reducing pain over a six-month period in TMD patients.
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http://dx.doi.org/10.5606/tftrd.2021.6615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088795PMC
March 2021

Juvenile/Adolescent Idiopatic Scoliosis and Rapid Palatal Expansion. A Pilot Study.

Children (Basel) 2021 Apr 30;8(5). Epub 2021 Apr 30.

Department of Public Health and Pediatrics, School of Medicine, University of Turin, 10126 Turin, Italy.

The question of whether orthodontic therapy by means of rapid palatal expansion (RPE) affects the spine during development is important in clinical practice. RPE is an expansive, fixed therapy conducted with heavy forces to separate the midpalatal suture at a rate of 0.2-0.5 mm/day. The aim of the study was to evaluate the influence of RPE on the curves of the spine of juvenile/adolescent idiopathic scoliosis patients. Eighteen patients under orthopedic supervision for juvenile/adolescent idiopathic scoliosis and independently treated with RPE for orthodontic reasons were included in the study: Group A, 10 subjects (10.4 ± 1.3 years), first spinal radiograph before the application of the RPE, second one during the orthodontic therapy with RPE; Group B, 8 patients (11.3 ± 1.6 years), first radiograph during the use of RPE second one after the removal. Group A showed a significant worsening of the Cobb angle ( ≤ 0.005) at the second radiograph after RPE. Group B showed a significant improvement of the Cobb angle ( = 0.01) at the second radiograph after removal of RPE. Based on the results, the use of RPE during adolescence might influence the spinal curves of patients with idiopathic scoliosis.
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http://dx.doi.org/10.3390/children8050362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146753PMC
April 2021

Evaluation of masticatory function in patients with cleft lip and/or palate.

Eur J Oral Sci 2021 06 30;129(3):e12781. Epub 2021 Mar 30.

Orthodontic Division, Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy.

The aim of this study was to evaluate the masticatory pattern in children with cleft lip and/or palate (CL/P) through investigation of the prevalence of reverse sequencing chewing cycles. The study group included 18 patients with CL/P (mean age: 7.4 yr, SD: 1.4 yr), 15 of whom had dental crossbite. The controls included a group of 18 non-CL/P children with the same types of crossbite as the study group (mean age: 7.2 yr, SD: 1.5 yr) and a group of 18 non-CL/P subjects with normal occlusion (mean age: 9.8 yr, SD: 1.9 yr). Mandibular movements during chewing of soft and hard bolus were recorded with a kinesiograph. Kinematic signals were analysed using a custom-made software. A statistical analysis was performed to compare the degree of reverse-sequencing chewing cycles between patients and controls (Kruskal-Wallis test with Dwass-Steel-Critchlow-Fligner pairwise comparisons post hoc test). A significant difference between patients with CL/P and non-CL/P subjects with normal occlusion was highlighted on the left side of mastication, which was the side with the higher prevalence of crossbite with both types of bolus. No statistical differences were found between CL/P patients and healthy controls with crossbite. Cleft-affected patients with posterior crossbite exhibited an anomalous masticatory pattern with increased reverse chewing cycles on the crossbite side.
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http://dx.doi.org/10.1111/eos.12781DOI Listing
June 2021

Immunofluorescence Evaluation of Myf5 and MyoD in Masseter Muscle of Unilateral Posterior Crossbite Patients.

J Funct Morphol Kinesiol 2020 Nov 7;5(4). Epub 2020 Nov 7.

Department of Surgical Science, University of Turin, 10124 Torino, Italy.

A unilateral posterior crossbite is a malocclusion where the low activity of the affected masseter muscle is compensated by the contralateral muscle hypertrophy. It is still unknown if, in the same condition, myogenesis with new fibre formation takes place.

Aim: the aim of the present study was to evaluate the expression of myogenesis markers, such as Myf5 and MyoD, in masseter muscles of unilateral posterior crossbite patients.

Materials And Methods: biopsies from fifteen surgical patients with unilateral posterior crossbites have been analysed by immunofluorescence reactions. The results show the expression of Myf5 and MyoD in the contralateral muscle but not in the ipsilateral one. Moreover, statistical analysis shows the higher number of satellite cells in the contralateral side if compared to the ipsilateral one.

Conclusions: these results suggest that in contralateral muscle, hyperplastic events take place, as well as hypertrophy.
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http://dx.doi.org/10.3390/jfmk5040080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739332PMC
November 2020

The influence of food hardness on the physiological parameters of mastication: A systematic review.

Arch Oral Biol 2020 Dec 9;120:104903. Epub 2020 Sep 9.

Orthodontic Department, Dental School, University of Brescia, Pza Spedali Civili, I-25123 Brescia, Italy. Electronic address:

Objective: This systematic review had the purpose to collect existing data concerning the influence of food hardness on mastication in adults.

Design: The review was listed with PROSPERO (CRD42017069760) and was directed following with PRISMA and CRD (Centre for Reviews and Dissemination, University of York) statement. A database search of articles issued from 1998 up to December 2018 was carried-out using four databases: Pubmed, Cochrane Library, Web of Science and Scopus. The lists of references of the articles selected for the review were read to identify any other relevant studies. The included publications were analysed for level of evidence, study design, sample characteristics, test of mastication, primary outcomes and key results. A quality assessment of the articles included in the review was performed.

Results: 1686 articles were found through database searching. The studies that complied with all the inclusion criteria and were considered for the conclusive analysis were 38 and their methodological quality was scored as moderate/low. The findings of the analysed articles were consistent, despite the presence of different methodologies and the lack of a complete control of the bias. They revealed that the majority of the chewing parameters, which were gathered in four groups: 1) number of cycles, 2) sequence duration, 3) muscle activity and 4) coordination and amplitudes and shape of mandibular displacements, increased in the transition from soft to hard food.

Conclusions: Hard-diet in adults has an impact on the masticatory function increasing almost all the physiological masticatory parameters, muscle coordination and changes of masticatory side.
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http://dx.doi.org/10.1016/j.archoralbio.2020.104903DOI Listing
December 2020

Altered mastication adversely impacts morpho-functional features of the hippocampus: A systematic review on animal studies in three different experimental conditions involving the masticatory function.

PLoS One 2020 20;15(8):e0237872. Epub 2020 Aug 20.

IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy.

Recent results have established that masticatory function plays a role not only in the balance of the stomatognathic system and in the central motor control, but also in the trophism of the hippocampus and in the cognitive activity. These implications have been shown in clinical studies and in animal researches as well, by means of histological, biochemical and behavioural techniques. This systematic review describes the effects of three forms of experimentally altered mastication, namely soft-diet feeding, molar extraction and bite-raising, on the trophism and function of the hippocampus in animal models. Through a systematic search of PubMed, Embase, Web of Science, Scopus, OpenGray and GrayMatters, 645 articles were identified, 33 full text articles were assessed for eligibility and 28 articles were included in the review process. The comprehensiveness of reporting was evaluated with the ARRIVE guidelines and the risk of bias with the SYRCLE RoB tool. The literature reviewed agrees that a disturbed mastication is significantly associated with a reduced number of hippocampal pyramidal neurons in Cornu Ammonis (CA)1 and CA3, downregulation of Brain Derived Neurotrophic Factor (BDNF), reduced synaptic activity, reduced neurogenesis in the Dentate Gyrus (DG), glial proliferation, and reduced performances in behavioural tests, indicating memory impairment and reduced spatial orientation. Moreover, while the bite-raised condition, characterized by occlusal instability, is known to be a source of stress, soft-diet feeding and molar extractions were not consistently associated with a stress response. More research is needed to clarify this topic. The emerging role of chewing in the preservation of hippocampal trophism, neurogenesis and synaptic activity is worthy of interest and may contribute to the study of neurodegenerative diseases in new and potentially relevant ways.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237872PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446800PMC
October 2020

Temporomandibular Disorders and Oral Features in Systemic Lupus Erythematosus Patients: An Observational Study of Symptoms and Signs.

Int J Med Sci 2020 1;17(2):153-160. Epub 2020 Jan 1.

Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Italy.

: Systemic Lupus Erythematosus (SLE) is a connective tissue disease characterized by a wide range of pleomorphic pictures, including mucocutaneous, renal, musculoskeletal and neurological symptoms. It involves oral tissues, with hyposalivation, tooth decay, gingivitis, angular cheilitis, ulcers and glossitis. Temporomandibular disorders represent a heterogeneous group of inflammatory or degenerative diseases of the stomatognatic system, with algic and/or dysfunctional clinical features involving temporomandibular joint (TMJ) and related masticatory muscles. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in SLE patients (Lp) compared with a control group. : Fifty-five patients (9 men and 46 women) with diagnosed Lupus were recruited in the study group. A randomly selected group of 55 patients, matched by sex and age, served as control group. The examination for TMD symptoms and signs was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a questionnaire and clinical examination. : Lupus patients complained more frequently (95.8%) of oral and TMJ symptoms (dysgeusia, stomatodynia, masticatory muscle pain during function, neck and shoulder muscles pain and presence of tinnitus) but only xerostomia (χ=4,1548 =0,0415), temple headache (χ=4,4542 =0,035) and the sensation of a stuck jaw (Mid-p-test =0,043) were significant. About signs, cheilitis (=0,0284) oral ulcers (χ=4,0104 =0,045) and fissured tongue are significantly more frequent in study group. The salivary flow was significantly decreased in the study group respect to the control one (p<0.0001). As regard to the oral kinematics, restricted movements (RM) in protrusion and left lateral movement were significantly different between study group and controls. In particular, 85,2% of Lp showed limited protrusion versus 56,4% of controls (χ= 10,91 <0,001); 59,3% of Lp had also a limitation during left lateral movement versus 47,3% of controls (T=2,225 =0,0282). About bruxism, only the indentations on the lateral edges of the tongue were found in Lp group (72,7%), with a significant difference respect to controls (χ=7,37 =0,007). While masticatory muscles have an overlapping behavior in both groups, the findings collected show a more severe TMJ kinematic impairment in Lp than in controls, with protrusion and left lateral movements significantly different. In addition, a remarkable reduction of salivary flow has been detected in Lp compared to controls. In conclusion, this autoimmune disease seems to play a role in oral manifestations and TMJ disorders, causing an increase in orofacial pain and an altered chewing function.
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http://dx.doi.org/10.7150/ijms.38914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990878PMC
September 2020

Chapter 14: Impact of Oral Health on Diet/Nutrition.

Monogr Oral Sci 2020 7;28:134-147. Epub 2019 Nov 7.

Division of Orthodontic, Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Torino, Italy.

An individual's oral health status has a profound impact on his/her acquisition and utilization of nutrients and interchangeably the nutrients an individual consumes determine the state of oral health by preventing tooth loss and oral diseases. Oral diseases have a considerable impact on the masticatory function which is a critical first step in oral processing of food materials for nutrient procurement. Specifically, a section of this chapter is dedicated to the physiology of masticatory function and to the recent acknowledgement of its influence on memory and cognition, both during development and aging. A description of the occlusal and skeletal pathologies that affect the balance of the chewing pattern and related muscular activation is provided. Intact neurocognitive functions and dentition are essential in mastication to achieve coordinated movements of the teeth and tongue to help propel the food material for ingestion and subsequent nutrient absorption. The tongue is equipped with chemoreceptive, gustatory cells, which modulate taste perception and contain metabolic hormones mediating satiety. Concomitantly, salivary processes, which are stimulated with the anticipation of food ingestion and those which occur during mastication of the food material, initiate digestive enzymes in the mouth and stomach and are important in affecting appetite and food bioavailability. Therefore, oral structures such as the dentition, tongue, and saliva in the context of mastication and nutrient acquisition will be reviewed as well as their impact on food choice and subsequent nutritional status.
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http://dx.doi.org/10.1159/000455383DOI Listing
January 2020

Adverse effects of the bite-raised condition in animal studies: A systematic review.

Arch Oral Biol 2019 Nov 5;107:104516. Epub 2019 Aug 5.

Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Italy.

Objective: To provide a systematic review of the effects of the bite-raised condition in animal models, a widespread technique in modern orthodontics.

Design: A systematic review of the literature was conducted. Original articles were searched through Pubmed, Cochrane Central database and Embase until December 2018.

Results: 242 articles were identified through database searching. After removing the duplicates, 198 articles were screened by reviewing the abstracts. 27 full text articles were assessed for eligibility and, after 7 exclusions, 20 articles were included in the review process. Studies selected by the review process concerned animal models. Histological, molecular, biochemical and electromyographical studies were evaluated. The results, with a high level of agreement in different animals, showed that the bite-raised condition is a source of stress, inducing increased plasma corticosterone, urinary cortisol and HPA axis alterations; it predisposes the organism to react to subsequent stressful stimulation with a significantly greater incretion of glucocorticoids, thus inducing hypersensitivity to novel forms of stress; it affects the structure of the hippocampus, reducing the number of neurons, increasing the number of glial cells and worsening memory and spatial orientation; it alters the electromyographical activity of masticatory muscles.

Conclusions: The results of research conducted on animal models do not necessarily apply directly to human beings. More clinical research, with special attention to adolescent patients, is necessary to clarify whether, in humans, the bite-raised condition is accompanied by adverse effects comparable to those observed in animals.
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http://dx.doi.org/10.1016/j.archoralbio.2019.104516DOI Listing
November 2019

Thoracic-lumbar-sacral spine sagittal alignment and cranio-mandibular morphology in adolescents.

J Electromyogr Kinesiol 2019 Oct 31;48:169-175. Epub 2019 Jul 31.

Department of Surgical Sciences, Dental School C.I.R., Division of Orthodontics, University of Turin, via Nizza 230, 10126 Turin, Italy.

Purpose: The relationship between thoracic-lumbar-sacral spine sagittal alignment and craniofacial morphology is still controversial. Evidence-based results are difficult to obtain and scientific studies are inhomogeneous. The aim of this study was to investigate the difference of thoracic-lumbar-sacral spine posture and cephalometric values comparing two groups of subjects with different cranial structure in the sagittal plane.

Methods: Eighty-one subjects were consecutively selected and divided into two groups, according to the orientation of the condyle-orbital plane (CoOr) with respect to the superior maxilla (SpP): Group1: 49 subjects 11.6 (2.1) years showing posterior-rotation of CoOr: SpP^CoOr ≤ -2°, -4.1°(2.1°); Group2: 32 subjects 12.9 (2.3)years showing anterior-rotation of CoOr: SpP^CoOr ≥ 2°, 3.7°(1.9°). Each patient underwent in blinding, Spinal Mouse recording and cephalometry of the skull.

Results: Group1 showed a significant forward tilting of the spine 4.4°(1.8°) with respect to Group2 2.4°(1.3°) (p < 0.0001) and higher values related to the vertical dimension of the skull: higher maxillary divergency (p < 0.0001), steep occlusal plane (p < 0.0007), higher gonial angle (p < 0.001).

Discussion: The results of this study showed a difference in the thoracic-lumbar-sacral spine inclination between groups with different craniofacial morphology. The achievement of this outcome is important to improve our multidisciplinary evaluation and treatment planning.
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http://dx.doi.org/10.1016/j.jelekin.2019.07.016DOI Listing
October 2019

Temporomandibular Disorders and Oral Features in Early Rheumatoid Arthritis Patients: An Observational Study.

Int J Med Sci 2019 1;16(2):253-263. Epub 2019 Jan 1.

Department of Basic Medical Sciences, Neurosciences and Sensory Organs, "Aldo Moro" University of Bari, Italy.

Temporomandibular disorders (TMD) represent a heterogeneous group of inflammatory or degenerative diseases of the stomatognatic system, with algic and/or dysfunctional clinical features involving temporomandibular joint (TMJ) and related masticatory muscles. Rheumatoid Arthritis (RA) is an autoimmune polyarthritis characterized by the chronic inflammation of synovial joints and oral implications such as hyposalivation, difficulty in swallowing and phoning, feeling of burning mouth, increased thirst, loss of taste or unpleasant taste and smell, dental sensitivity. The aim of this observational study was to investigate the prevalence of TMD symptoms and signs as well as oral implications in patients with Early Rheumatoid Arthritis (ERA), that is a RA diagnosed within 12 months, compared with a control group. : The study group included 52 ERA patients (11 men, 41 women) diagnosed according to the 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis. A randomly selected group of 52 patients not affected by this disease, matched by sex and age, served as the control group. The examination for TMD signs and symptoms was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) by means of a questionnaire and through clinical examination. Regarding the oral kinematics, the left lateral excursion of the mandible was restricted in statistically significant way in ERA patients (=0.017). The endfeel values were significantly increased in ERA group (=0.0017), thus showing the presence of a higher muscle contracture. On the other side, the study group complained less frequently (67.3%) of TDM symptoms (muscle pain on chewing, pain in the neck and shoulders muscles, difficulty in mouth opening, arthralgia of TMJ, tinnitus) than controls (90.4%) (χ= 8.301 =0.0039). The presence of TMJ noises was significantly lower in the study group (χ= 3.869 =0.0049), as well as presence of opening derangement (χ= 14.014 =0.0002). The salivary flow was significantly decreased in the study group respect to the control one (<0.0001). The data collected show a weak TMJ kinematic impairment, a paucisymptomatic muscle contracture (positive endfeel) and a remarkable reduction of salivary flow in ERA patients. Myofacial pain (MP) evoked by palpation was more frequent and severe in the control group than in the study one, this result being highly significant.
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http://dx.doi.org/10.7150/ijms.28361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367523PMC
June 2019

Condylar long axis and articular eminence in MRI in patients with temporomandibular disorders.

Cranio 2020 Sep 17;38(5):342-350. Epub 2018 Oct 17.

S.C. Diagnostic Radiology, A.O. Ordine Mauriziano Hospital "Umberto I" , Turin, Italy.

Objective: To compare morphologic findings in MRI and skeletal divergence of a group of patients with temporomandibular joint disorders (TMD) subdivided into condylar symmetric and asymmetric.

Methods: Fifty-nine adults (26.7 years old) with TMD were retrospectively recruited. Condylar height symmetry was evaluated by orthopantomography (Habets's method) and used to divide patients into Symmetric and Asymmetric groups; skeletal divergence was assessed on lateral cephalograms. MRI was used to evaluate the condylar long axis' angle, the glenoid fossa morphology, and the degree of disc displacement.

Results: Asymmetric subjects showed a hyperdivergent skeletal pattern (= 0.036), asymmetric condylar long axis (= 0.018), and deeper (= 0.025) and asymmetric (= 0.001) glenoid fossa compared to symmetric subjects.

Conclusion: Patients with TMD and condylar asymmetry diagnosed with orthopantomography are more likely to show hyperdivergent skull in cephalometry, condylar asymmetry of both height and major axis, and a steeper glenoid fossa in MRI.
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http://dx.doi.org/10.1080/08869634.2018.1532647DOI Listing
September 2020

Rapid palatal expansion (RPE): Meta-analysis of long-term effects.

Orthod Craniofac Res 2018 Nov 12;21(4):225-235. Epub 2018 Oct 12.

Department of Surgical Sciences-Orthodontic Division, PhD School, University of Turin, Turin, Italy.

Objects: Rapid palatal expansion (RPE) is a widespread orthopaedic procedure used in several clinical situations. The aim of the study was to provide a systematic review and meta-analysis of transverse intercanine and intermolar width changes after RPE and long-term effects.

Setting And Sample Population: A systematic literature search was conducted until January 2018 on original studies with RPE treatment.

Material And Methods: Intercanine and intermolar distance were measured at the start of RPE (T1, median age 9.2 years) and at the end of treatment (T2). The long-term evaluation was conducted on a subset of articles with 5-year follow-up (T3).

Results: Eighteen studies T1-T2 and 5 studies T3 were selected. Regarding the intercanine distance, the RPE resulted in a gain of space T1-T2 of 3.73 mm with a significant heterogeneity (P < 0.0001; I  = 94.21%) and a relapse T2-T3 of -0.81 mm with a significant heterogeneity (P < 0.0001; I  = 95.8%); the overall gain of space was 2.91 mm. Regarding the intermolar distance, the RPE resulted in a gain of space T1-T2 of 4.85 mm with a significant heterogeneity (P < 0.0001; I  = 92.41%) and a relapse T2-T3 of -0.47 mm with a significant heterogeneity (P < 0.0001; I  = 87.5%); the overall gain of space was 4.38 mm. Meta-regression analysis showed that at younger age, the amount of anterior expansion is similar to posterior. With increasing age, the anterior opening diminishes significantly more than the posterior, being half of the posterior at 15 years.

Conclusion: Because long-term results were obtained with simultaneously fixed appliances and long upper retention, RPE should be carefully considered before using.
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http://dx.doi.org/10.1111/ocr.12244DOI Listing
November 2018

Cranial structure and condylar asymmetry of patients with juvenile idiopathic arthritis: a risky growth pattern.

Clin Rheumatol 2018 Oct 21;37(10):2667-2673. Epub 2018 Jun 21.

Department of Woman and Child and General and Specialized Surgery, University of Campania , Luigi Vanvitelli, Italy.

The aim of the study was to evaluate the cephalometric differences and condylar asymmetry between patients with juvenile idiopathic arthritis (JIA) and normal control group. Sixty-two JIA patients with a latero-lateral cephalogram and orthopantomography, seeking for orthodontic therapy, and 62 normal matched subjects were comprised in the study. Cephalometric analysis was used for the evaluation of facial morphology while the method of Habets et al. (J Oral Rehabil 15(5): 465-471, 1988) was used to compare the condyles in orthopantomography. The significance of between-group differences was assessed using the Mann-Whitney test, as appropriate. The results showed a prevalence of the upper maxilla with hypomandibulia (class II), hyperdivergency with short vertical ramus posterior and posterior rotation of the mandible in JIA children (SNB, ANB, NSL/ML, Fh/ML, NL/ML, ArGo, ML P < 0.0001, ML/Oc P < 0.004, ArGo/GoGn P = 0.02, no difference for SNA). The condyles of the JIA group resulted highly asymmetric (P < 0.0001). The growth pattern of JIA patients resulted clearly different from normal subjects. This serious impairment of the cranial growth may be considered as an indicator of the need for early and continuous orthognatodonthic therapy during the entire period of development for all JIA patients, independently from temporomandibular joint signs or symptoms. To this end, it is important that rheumatologists and orthognathodontists set up a multidisciplinary treatment planned to control the side effects of a deranged growing pattern, to strictly avoid any orthodontic therapies that may worsen function and growth, and to promote treatments improving the physiology and biology of the cranial development.
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http://dx.doi.org/10.1007/s10067-018-4180-5DOI Listing
October 2018

Dentoalveolar Effects of Early Orthodontic Treatment in Patients With Cleft Lip and Palate.

J Craniofac Surg 2017 Nov;28(8):2021-2026

*Doctoral School in Life and Health Science, PhD Program in Experimental Medicine and Therapy, CIR Dental School, University of Turin, Turin †Section of Orthodontics, Dental School, Department of Medicine and Surgery, University of Parma, Parma ‡Orthodontics and Gnatology, Masticatory Function, Department of Surgical Sciences, University of Turin, Turin §PhD Program in Molecular Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy.

No agreement exists on the most appropriate timing of orthodontic treatment in patients with cleft lip and palate. The aim of this study is to investigate the effect of early orthodontic treatment on development of the dental arches and alveolar bone.A dental casts analysis was performed on 28 children with cleft lip and palate before orthodontic treatment (T0; mean age, 6.5 ± 1.7) and at the end of active treatment (T1; mean age, 9.2 ± 2.1 years). The considered variables were: intercanine and intermolar distances; dental arch relationships, evaluated according to the modified Huddart/Bodenham system.The study group was divided into 2 samples according to the age at T0: Group A (age < 6 years) and Group B (age ≥ 6 years). A statistical comparison of the treatment effects between the 2 samples was performed.Patients in Group A exhibited a greater increase of intercanine distance (8 mm versus 2.7 mm; P<0.001), intermolar distance (7.2 mm versus 5 mm; P = 0.06), and Huddart/Bodenham score (7.1 versus 3; P < 0.05) when compared with patients in Group B.Early orthodontic treatment strongly improved the dental arch relationship, since subjects starting the therapy before the age of 6 had a better response in terms of anterior maxillary expansion.
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http://dx.doi.org/10.1097/SCS.0000000000003854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673300PMC
November 2017

Improvement of masticatory kinematic parameters after correction of unilateral posterior crossbite: Reasons for functional retention.

Angle Orthod 2017 Nov 3;87(6):871-877. Epub 2017 Aug 3.

Objective: To evaluate reverse-sequencing chewing cycles (RSCC) and their kinematic parameters on both sides before and after correction with the Function Generating Bite (FGB) appliance.

Materials And Methods: Forty-seven patients, 8.3 ± 1.1 (mean ± SD) years of age, with unilateral posterior crossbite (35 on the right side, 12 on the left side) and 18 age-matched controls (9.1 ± 0.8 years) were selected for the study from the orthodontic division of the University of Turin, Italy. The crossbite was corrected in all patients using FGB, and mandibular motion was recorded with a kinesiograph K-7 (Myotronics, Tukwila, Wash), during chewing on both sides of a soft and a hard bolus before and after correction.

Results: After correction, the percentage of RSCC significantly decreased for soft and hard (P < .001) boluses and fell within the normal range for 75% of the patients. The indices of the chewing pattern (closure angle, axis, maximum lateral excursion) significantly improved (P < .001), becoming symmetric between sides.

Conclusions: The results of this study showed that the functional appliance, FGB, was able to lower the percentage of RSCC significantly, bringing them back to the normal range in 75% of cases, and to improve the kinematic parameters that become symmetric between sides.
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http://dx.doi.org/10.2319/020917-98.1DOI Listing
November 2017

From periodontal mechanoreceptors to chewing motor control: A systematic review.

Arch Oral Biol 2017 Jun 13;78:109-121. Epub 2017 Feb 13.

Department of Biomedical Sciences and Morphological and Functional Images, Messina University, Italy.

Purpose: This critical review summarizes the current knowledge of the structural and functional characteristics of periodontal mechanoreceptors, and understands their role in the signal pathways and functional motor control.

Method: A systematic review of the literature was conducted. Original articles were searched through Pubmed, Cochrane Central database and Embase until january 2016.

Result: 1466 articles were identified through database searching and screened by reviewing the abstracts. 160 full-text were assessed for eligibility, and after 109 exclusion, 51 articles were included in the review process. Studies selected by the review process were mainly divided in studies on animal and studies on humans. Morphological, histological, molecular and electrophysiological studies investigating the periodontal mechanoreceptors in animals and in humans were included, evaluated and described.

Conclusion: Our knowledge of the periodontal mechanoreceptors, let us conclude that they are very refined neural receptors, deeply involved in the activation and coordination of the masticatory muscles during function. Strictly linked to the rigid structure of the teeth, they determine all the functional physiological and pathological processes of the stomatognathic system. The knowledge of their complex features is fundamental for all dental professionists. Further investigations are of utmost importance for guiding the technological advances in the respect of the neural control in the dental field.
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http://dx.doi.org/10.1016/j.archoralbio.2017.02.010DOI Listing
June 2017

Asymmetric molars' mesial rotation and mesialization in unilateral functional posterior crossbite and implications for interceptive treatment in the mixed dentition.

Eur J Orthod 2017 Aug;39(4):433-439

Medical and Surgical Specialties, Radiological Sciences, and Public Health, Dental School, University of Brescia.

Introduction : Symmetric transverse expansion is the main outcome of the early treatment in subjects with unilateral functional posterior crossbite. The aim of this study was to analyse mesial rotation and mesialization of upper first molars as sagittal parameters to be corrected in the treatment of these patients during the mixed dentition.

Methods : Digital dental cast measurements (rotation and mesialization) were performed in a sample of 48 subjects with unilateral posterior crossbite (UPXB; 19 males and 29 females, mean age 10.2 ± 1.2 years) and in a control group of 35 subjects with normal Class I occlusion (17 males and 18 females, mean age 9.9 ± 1.3 years). An independent sample t-test, the Mann-Whitney test, Fisher's exact test, and Pearson correlation were used for statistical comparison.

Results : The amount of upper molar rotation was significantly greater in the experimental group when compared with the control group. A clinically significant 'upper molar rotation' (UMR) was present in 66.7 per cent of the subjects with UPXB versus 5.7 per cent of the control group. The UMR group presented also a significant mesialization of upper first molars when compared with the control group. In the experimental group, there was a significant difference between rotation and mesialization in the right and left side and a correlation has been found between these two variables and the amount of Class II molar relationship at the crossbite side.

Limitations : This is an epidemiological case-control study and the discussed effects of an early correction of the asymmetric upper molars' migration are only speculations based on an association relationship.

Conclusions : The findings of this study show an asymmetric upper first molars' migration (rotation and mesialization) in unilateral functional posterior crossbite versus a control group. An early evaluation and correction of the molars' migration during the mixed dentition should be considered in order to obtain a correct inter-occlusal sagittal molar relationship, space for an adequate eruption of permanent teeth, and perhaps reduce the need of a following fixed appliance treatment in the permanent dentition.
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http://dx.doi.org/10.1093/ejo/cjw067DOI Listing
August 2017

Methodological quality and outcome of systematic reviews reporting on orthopaedic treatment for class III malocclusion: Overview of systematic reviews.

J Orthod 2016 Jun 18;43(2):102-20. Epub 2016 Apr 18.

a Tehran Dental Branch, Center of craniomaxillofacial research , Islamic Azad University , Tehran , Iran.

Objectives: The aim of this overview of systematic reviews was to investigate methodological quality and outcome of current systematic reviews (SRs) reporting on orthopaedic treatment for class III malocclusion.

Materials And Methods: Computerized and manual searches were performed in Medline, Google Scholar, Cochrane Library, Embase, LILACS, SciELO, American Journal of Orthodontics and Dentofacial Orthopaedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Orthodontics, Conference abstracts and Grey literature. No restrictions were set on language or date of publication. The search covered the starting date of the relevant databases until 30 April 2015. MeSH terms and free-text terms included 'malocclusion', 'Angle class III', 'orthodontic appliances', 'functional', facemask, review and meta-analysis. Screening of eligible studies, assessment of the methodological quality of the SRs and data extraction were conducted in duplicate and independently by two reviewers. Methodological quality was assessed using AMSTAR (assessment of multiple systematic reviews).

Results: A total of 222 studies were retrieved and after removal of duplicates, irrelevant studies, literature reviews and surgical approach treatments, 14 SRs and/or meta-analyses were included for qualitative synthesis. Mean AMSTAR score was 7.7/11 with a range of 3-10. There was evidence to demonstrate that face mask therapy can move the maxilla forward whilst causing a backward rotation of the mandible and increased facial height. There was also some evidence of mandibular growth retardation with chin cup therapy.

Conclusions: Orthopaedic appliances can improve a class III malocclusion in growing patients over the short-term; however, each appliance has a characteristic effect on the underlying skeletal pattern.
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http://dx.doi.org/10.1080/14653125.2016.1155334DOI Listing
June 2016

Effects of therapy on masseter activity and chewing kinematics in patients with unilateral posterior crossbite.

Arch Oral Biol 2016 Jul 24;67:61-7. Epub 2016 Mar 24.

CIR Dental School, Department of Surgical Sciences, Division of Orthodontics, University of Turin, Italy. Electronic address:

Objective: To describe the effects of therapy on masseter activity and chewing kinematic in patients with unilateral posterior crossbite (UPC).

Design: Fifty children (age: mean ± SD: 9.1 ± 2.3 years) with UPC (34 on the right side, 16 on the left side) and twenty children (age: 9.5 ± 2.6 years) with normal occlusion were selected for the study. The mandibular motion and the muscular activity during chewing soft and hard boli were simultaneously recorded, before and after correction with function generating bite, after a mean treatment time of 7.3 ± 2.4 months plus the retention time of 5-6 months. The percentage of reverse cycles and the percent difference between ipsilateral and contralateral peaks of the masseter electromyography envelopes were computed.

Results: Before therapy, the percentage of reverse cycles during chewing on the crossbite side was greater in patients than in controls (P<0.001) and significantly reduced after therapy (P<0.001) towards the reference normal value (soft bolus; pre: 57 ± 30%, post:12 ± 17%; hard bolus; pre: 65 ± 34%, post: 12 ± 13%; reference value: soft bolus 4 ± 2%, hard bolus 5 ± 3%). Before therapy the percent difference between electromyography envelope peaks in patients was lower than in controls (P<0.01) and significantly increased after therapy (P<0.05) becoming similar to the reference normal value.

Conclusions: The correction induced a normal-like coordination of masseter muscles activity together with a significant reduction of the reverse chewing patterns. The previous altered muscular activation corresponded to the altered kinematics of reverse chewing cycles that might be considered a useful indicator of the severity of the masticatory function involvement.
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http://dx.doi.org/10.1016/j.archoralbio.2016.03.013DOI Listing
July 2016

Condylar asymmetry in patients with juvenile idiopathic arthritis: Could it be a sign of a possible temporomandibular joints involvement?

Semin Arthritis Rheum 2015 Oct 2;45(2):208-13. Epub 2015 May 2.

Pediatric Immunology and Reumatology Unit, University of Brescia, Italy.

Objectives: The aim of the study was to evaluate the condylar and ramal asymmetry of the mandible in patients with juvenile idiopathic arthritis (JIA) using orthopantomographies (OPTs).

Methods: A total of 30 JIA patients with confirmed diagnosis of JIA and a routine OPT, seeking for orthodontic therapy, free of specific symptoms of temporomandibular joint involvement, and 30 normal matched subjects with OPT were comprised in the study. The method of Habets et al. was used to compare the condyles and rami in OPT. The significance of between-group differences were assessed using Mann-Whitney test.

Results: The results showed a high significant difference in the range of asymmetry of the condyle, being the patient group highly asymmetrical (P < 0.0001). No differences were found in the range of asymmetry of the ramus between groups (P = 0.47). The intra-group comparison between males and females showed a difference in the patient group (P = 0.04), being the females more asymmetric.

Conclusions: Knowing that the temporomandibular joint (TMJ) is highly susceptible to inflammatory alterations during growth, even in absence of symptomatology, and being the OPT a cost-benefit favorable imaging tool widespread in the dental field, the latter could be used as a first screening examination in JIA patients to calculate the condylar asymmetry index. The use of this screening tool will help the physicians in addressing the patients that should undergo a more detailed TMJ imaging to early detect TMJ abnormalities and to early set up a targeted therapy of the related cranial growth alterations.
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http://dx.doi.org/10.1016/j.semarthrit.2015.04.012DOI Listing
October 2015

Changes in electric activity of masseter and anterior temporalis muscles before and after orthognathic surgery in skeletal class III patients.

Oral Surg Oral Med Oral Pathol Oral Radiol 2013 Oct;116(4):398-401

Department of Orthodontics and Gnathology-Masticatory Function, University of Turin, Italy. Electronic address:

Objective: The purpose of this study was to evaluate, through clinical and electromyographic (EMG) assessments, the electric activity of masseter muscle and anterior temporalis muscles during clenching, before and after orthodontic treatment and mandibular setback, with or without LeFort I osteotomy, for correction of mandibular excess.

Study Design: Seventeen adult patients (10 males, 7 females, mean age: 22.5 ± 2.4 years) were recruited for this study. All patients received orthodontic treatment and surgical corrections. EMG recordings were obtained from 4 channels of the 8-channel electromyograph FREELY (DeGoetzen spa, Olgiate Olona, VA, Italy).

Results: A significant difference was found in the value of activity index at T0-T1 (33% T0, 1% T1) (P < .05), of asymmetry index at T0-T1 (21% T0, 4% T1) (P < .05), and of torque index at T0-T1 (24% T0, 5% T1) (P < .05).

Conclusions: The evaluation of EMG activity after surgery may be considered a sign of good adaptation of the neuromuscular system to the new occlusal condition and a good method for detecting nonresponding patients who might require further treatment.
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http://dx.doi.org/10.1016/j.oooo.2013.06.008DOI Listing
October 2013

Three-dimensional cephalometry: a method for the identification and for the orientation of the skull after cone-bean computed tomographic scan.

J Craniofac Surg 2013 May;24(3):e308-11

Division of Orthodontics, Department of Surgery, Dental School, Turin University, Turin, Italy.

The aims of this work were (1) to describe a method to identify new skeletal landmarks useful to define the reference system to orient the skull in a new position after cone-bean computed tomographic scan and (2) to demonstrate the reliability of this new method.Ten orthognathic patients (5 male, 5 female; mean [SD] age, 18.9 [1.2] years) underwent the cone-bean computed tomographic scan before surgery. Seven 3-dimensional skeletal measurements derived from 4 skeletal point of construction (C) (right, left, and median orbital C, and sella C) have been used for this study. Reliability has been calculated using Pearson correlation coefficient tests.Intraobserver reliability was 0.9999 for operator A (T1-T2) and 0.9999 for operator B (T1-T2); interobserver reliability was 0.9999 between the first (T1-T1) measurement and 0.9999 between the second (T2-T2).The original method is able to reduce the variability of landmark identification due to the variability of the human anatomy and the influence of the human error in cephalometric analysis. The innovation of this new method is the real possibility to use the anatomical structures in a 3-dimensional way, enhancing the reliability of the reference points.
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http://dx.doi.org/10.1097/SCS.0b013e31828f2e8eDOI Listing
May 2013

Self-ligating fully customized lingual appliance and chair-time reduction: a typodont study followed by a randomized clinical trial.

Eur J Orthod 2013 Dec 24;35(6):758-65. Epub 2012 Nov 24.

* Department of Orthodontics, School of Dentistry, University of Brescia, Italy.

In this study, we tested the hypothesis that self-ligation can reduce the chair time necessary for inserting and removing the archwire in a fully customized, multi-bracket, orthodontic, lingual appliance. A permuted-block, randomized trial design was employed to treat seven patients, each with Incognito(®) lingual appliances and Harmony(®) self-ligating lingual appliances. Three operators (a third year resident in orthodontics, an orthodontic specialist, and an experienced lingual orthodontist) were instructed, and they were allowed to familiarize themselves with two typodonts. Next, the operators were asked to insert and remove a.014 NiTi customized archwire for each patient, and they were timed. The time required for removing and inserting archwires decreased proportionally with operator experience: it was shorter with self-ligating appliances (114.82±18.06 seconds versus 595.83±289.09 seconds, P < 0.001) and when testing the typodonts' performances (480.61±285.74 seconds versus 518.65±296.97 seconds, P < 0.001). However, differences between operators were smaller when using typodonts (31.77±21.19 seconds versus 43.87±27.06 seconds, P < 0.001) and with self-ligation (15.17±9.29 seconds versus 45.37±25.44 seconds, P < 0.001). In vivo performance improved after typodont training, allowing for difference reductions between operators. Lingual self-ligation appears to require less hands-on ability and training of the orthodontist, for reduction of chair time.
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http://dx.doi.org/10.1093/ejo/cjs093DOI Listing
December 2013

Assessment of the reliability and repeatability of landmarks using 3-D cephalometric software.

Cranio 2012 Oct;30(4):255-63

University of Turin - Dental School, Dept. of Orthodontics and Gnathology, Via Nizza 230 10126 Torino, Italy.

The aim of this study was to analyze the reliability and repeatability of identification landmarks using 3-D cephalometric software. Ten orthognathic patients were selected for this study and underwent the following protocol: 1. radiographic evaluation (CBCT technique); 2. stone casts; 3. photos; and 4. 3-D cephalometric evaluation. Twenty-one hard tissue landmarks and 14 cephalometric measurements were taken three times (T1, T2, and T3) on each patient, with an interval of one week by two experts in orthodontics (A, B). Standard deviation and Pearson's correlation coefficient were calculated to evaluate intra- and inter-observer repeatability. The results showed a strong correlation for both intra- and inter-observer Pearson's correlation coefficient (>0.7). The current preliminary study showed that the reliability and repeatability of the identification landmarks were very high if the 3-D cephalometric landmarks are defined correctly in the three planes of the space. Further evaluation is necessary to better define the 3-D cephalometric system.
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http://dx.doi.org/10.1179/crn.2012.039DOI Listing
October 2012

Reverse cycle chewing before and after orthodontic-surgical correction in class III patients.

Oral Surg Oral Med Oral Pathol Oral Radiol 2013 Mar 21;115(3):328-31. Epub 2012 Sep 21.

Department of Orthodontics and Gnathology-Masticatory Function, University of Turin, Turin, Italy.

Objective: The aim of this study was to investigate the prevalence of reverse-sequence chewing cycles in skeletal class III patients before and after orthodontic-surgical therapy to evaluate whether the occlusal and skeletal correction is followed by a functional improvement.

Study Design: Twenty skeletal class III patients (11 males and 9 females, 22.7 ± 3.0 years old) were recruited for this study. All patients received orthodontic and surgical treatment. Chewing cycles were recorded with a kinesiograph before (T0) and after (T1) therapy.

Results: A significant decrease in the number of reverse chewing cycles after surgical correction was exhibited in all recordings, when chewing either soft or hard boluses, on both the right and the left side.

Conclusions: Evaluation of the prevalence of reverse chewing cycles could be considered an indicator of functional adaptation after therapy and a method for the early detection of nonresponding patients who may require further consideration using a different approach.
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http://dx.doi.org/10.1016/j.oooo.2012.04.025DOI Listing
March 2013

Cone-beam computed tomography: accuracy of three-dimensional cephalometry analysis and influence of patient scanning position.

J Craniofac Surg 2012 Jul;23(4):1038-43

Department of Orthodontics and Gnathology-Masticatory Function, University of Turin, TurinYDental School, Torino, Italy.

The aim of this research was to analyze the influence of the position of the skull during cone-beam computed tomography (CBCT) scan and if the three-dimensional cephalometric measurements are influenced by skull orientation during CBCT scan.The study consisted of 5 CBCT scanning (KODAK 9500 Cone Beam 3D System unit) in 5 different positions of a dry skull. The data were imported in SIMPLANT OMS Software version 13.0. Fifteen three-dimensional cephalometric measurements were calculated; moreover, the mean, the SD, the maximum/minimum Δ, and the maximum/minimum Δ percentage were calculated. The statistical analysis was performed by an independent-samples t-test to evaluate differences between the 5 scans.No difference was found in all the three-dimensional analysis. Twelve of 15 measurements have a Δ greater than 1.5, and 7 of 15 measurements have a Δ greater than 2. Nine of 15 have a Δ percentage greater than 5%. The preliminary results suggest that the three-dimensional cephalometric analysis is influenced by patient scanning position.
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http://dx.doi.org/10.1097/SCS.0b013e318252d5e1DOI Listing
July 2012

Expression of muscle-specific integrins in masseter muscle fibers during malocclusion disease.

Int J Mol Med 2012 Aug 30;30(2):235-42. Epub 2012 Apr 30.

Department of Biomorphology and Biotechnologies, Messina University, I-98125 Messina, Italy.

Integrins are heterodimeric cell surface membrane proteins linking the extracellular matrix to actin. α7B integrin is detected in proliferating and adult myofibers, whereas α7A plays a role in regenerating muscle fibers with a minor function in mature muscle fibers. The expression levels of β1A appear to be very low, whereas β1D appears to be the predominant integrin form in mature muscle. Considering the important features of masseter muscle we have studied integrin expression in masseter muscle specimens of surgical patients with posterior right crossbite and comparing them to left side masseter muscle specimens. Our results showed that the expression of integrins was significantly lower in the crossbite side muscle. Furthermore, the most important finding is that β1A is clearly detectable in adult masseter muscle. This behavior could be due to the particular composition of masseter, since it contains hybrid fibers showing the capacity to modify the contractile properties to optimize the energy efficiency or the action of the muscle during contraction. Moreover, masseter is characterized by a high turnover of muscle fibers producing a regeneration process. This may indicate a longer time to heal, justifying the loss of β1D and the consequential increase of β1A. Thus, our data provide the first suggestion that integrins in masseter muscle play a key role regulating the functional activity of muscle and allowing the optimization of contractile forces.
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http://dx.doi.org/10.3892/ijmm.2012.986DOI Listing
August 2012

Sensitivity of magnetic resonance imaging and computed axiography in the diagnosis of temporomandibular joint disorders in a selected patient population.

Int J Prosthodont 2012 Mar-Apr;25(2):120-6

Department of Orthodontics and Gnathology-Masticatory Function, University of Turin, Turin, Italy.

Purpose: The aim of this study was to compare sensitivity differences and interpretative agreement for magnetic resonance imaging (MRI) and computed axiography (CA) tracings in a patient population group with temporomandibular disorder (TMD).

Materials And Methods: A convenience sample of 173 patients (53 men, 120 women; mean age: 33.2 ± 2.6 years) diagnosed with TMD was selected for this study. Each patient underwent an evaluation as per the European Academy of Craniomandibular Disorders clinical form as well as MRI and CA.

Results: Use of the MRI results as the gold standard for the planned comparison led to the following observations: a CA sensitivity of 68% for joints without morphologic changes (so-called normal temporomandibular joints [TMJs]), sensitivity of 27% for those with disc displacement, and sensitivity of 8% for those with osteoarthritis. The kappa index, or agreement between the two examination methods, was weak for normal TMJs (0.16), acceptable for anterior disc displacement with reduction (0.28), little for anterior disc displacement without reduction (0.10), and very little for morphologic alterations (0.01).

Conclusion: The sensitivity and agreement of the two examination methods was generally low. It was even worse when pathologic changes in the TMJ were more severe. MRI and CA are different examinations that could both be considered for severe TMD diagnosis.
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May 2012
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