Publications by authors named "Tommaso Castroflorio"

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

Variations in athletic performance with occlusal splint in track and field athletes: a randomized clinical trial.

J Sports Med Phys Fitness 2021 Apr 19. Epub 2021 Apr 19.

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

Background: Several studies have been proposed with the aim to demonstrate correlations between the dento-mandibular apparatus and the skeletal muscle system of the human body even in regions distant from the oral cavity. However, a definite conclusion cannot be drawn. The aim of this paper is to demonstrate a possible correlation between dental occlusion and sport performances in track and field athletes.

Methods: 16 track and field athletes were enrolled for the study and were randomly divided in three groups: Untreated control group, Placebo group (with a lower plaque without occlusal coverage) and Treated group (with occlusal splint). Changes in sprint and jump performance were assessed on a weekly basis for 5 consecutive weeks, during which athletes had to wear oral devices, except for the first week of baseline, for at least 3 trainings lasting 2 hours per week. All participants performed the countermovement jump (CMJ), the drop jump (DJ), the 10m and 30m sprint tests, always on the same day on the week.

Results: No statistically significant difference resulted between Control group and Placebo group and between Control group and Treated group. However it was possible to observe a clinical improvement of measurements obtained, especially for CMJ, 10m and 30m sprint tests. No variation neither statistical neither clinical was observed in DJ test analysis.

Conclusions: Even if statistically it was not possible to demonstrate an improvement in sport performance, most of the athlete analyzed showed better results during training session with occlusal splint compared to athlete without occlusal splint, in countermovement jump, in 10m and 30m sprint tests.
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http://dx.doi.org/10.23736/S0022-4707.21.12081-XDOI Listing
April 2021

The 50 most-cited articles on clear aligner treatment: A bibliometric and visualized analysis.

Am J Orthod Dentofacial Orthop 2021 Apr 27;159(4):e343-e362. Epub 2021 Feb 27.

Department of Surgical Sciences, CIR Dental School, Università degli Studi di Torino, Turin, Italy.

Introduction: Research on clear aligner treatment (CAT) has increased in recent years. In this study, we aimed to perform a bibliometric and visualized analysis to identify and critically assess the 50 most highly cited articles on CAT.

Methods: Web of Science was selected as a data source and consulted until March 2020 to identify all articles potentially relevant to the analysis. All the eligible articles were collected until 50 manuscripts were listed. Article-based parameters, journal-based parameters, and author-based parameters were registered to perform the bibliometric analysis. Keywords were automatically harvested from the selected articles to implement the visualized analysis.

Results: The search identified a total of 378 articles; the total number of citations of the selected articles varied from 15 to 112. The average number of citations per year varied from 1.15 to 13.83. The predominant study design was clinical (31.7%). Over the 15 journals in which the most cited articles were published, the American Journal of Orthodontics and Dentofacial Orthopedics published the majority of those included in the list (14) and also received the greatest number of citations (671). A total of 195 authors contributed to the 50 most cited articles; a significant portion of them (26) were unaffiliated with academic institutions. A total of 184 keywords were gathered from the article list.

Conclusions: The number of citations on CAT is expected to grow steadily in parallel with the rising number of research projects. The present work identifies the most influential articles on CAT and their characteristics, placing emphasis on the journals, the authors, and the topics addressed.
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http://dx.doi.org/10.1016/j.ajodo.2020.11.029DOI Listing
April 2021

Micro computed tomography evaluation of Invisalign aligner thickness homogeneity.

Angle Orthod 2021 05;91(3):343-348

Objectives: To measure the thickness homogeneity of Invisalign (Align Technology Inc, San José, Calif) aligners with micro-computed tomography (micro-CT) scans.

Materials And Methods: Starting from micro-CT scanning of 20 different aligners, multiplanar reconstructions were obtained. An orthodontist blinded about the study measured aligner thickness in different regions (molar, canine, incisor) and in different sites (gingival-buccal, buccal, occlusal, lingual, and gingival-lingual). To assess various thicknesses in different aligner sites and regions, the sample was stratified into subgroups and linear regression analysis was performed.

Results: Descriptive analysis showed that mean thickness of aligners in the incisor region ranged from 0.582 mm to 0.639 mm, in the canine region from 0.569 mm to 0.644 mm, and in the molar region from 0.566 mm to 0.634 mm. Student's t-tests showed no significant differences in the aligner thickness of different regions when data were stratified by different sites. Student's t-tests showed significant differences in thickness homogeneity for the molar region when the data were stratified by tooth (mean difference = 0.068 mm; 95% confidence interval, 0.009-0.126 mm; P = .024).

Conclusions: Invisalign aligner thickness is characterized by small differences. The only significant difference was revealed in the molar region where thickness of the gingival-lingual edge is significantly thinner than that measured at the occlusal aspect. From a clinical perspective, the results of the present study could be considered to explain the reduced predictability of several orthodontic tooth movements in the molar region.
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http://dx.doi.org/10.2319/040820-265.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084474PMC
May 2021

Evaluation of masticatory muscle response to clear aligner therapy using ambulatory electromyographic recording.

Am J Orthod Dentofacial Orthop 2021 Jan 21;159(1):e25-e33. Epub 2020 Nov 21.

Faculty of Dentistry, Discipline of Orthodontics, Centre for Multimodal Sensorimotor and Pain Research, Centre for The Study of Pain, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada. Electronic address:

Introduction: Patients undergoing clear aligner therapy (CAT) report muscle tenderness and produce wear facets on their aligner trays. However, little is known about the masticatory muscle response to clear aligners. Here, we measured the activity of the masseter during CAT using ambulatory electromyography. We also explored whether psychological traits modulate the masticatory muscle response to CAT.

Methods: Using portable data loggers, we recorded the electromyographic (EMG) activity in the right masseter muscle of 17 healthy adults without temporomandibular disorder (16 females, 1 male; mean age ± standard deviation, 35.3 ± 17.6 years) commencing treatment with CAT over 4 weeks, under the following conditions: week 1 without aligners (baseline), week 2 with a passive aligner (dummy), week 3 with their first active aligner (active1), and week 4 with their second active aligner (active2). We used a mixed-effect model to test differences in EMG activity over the 4-weeks and a general linear model to test the effect of psychological traits on EMG activity.

Results: The EMG activity of the masseter increased significantly with aligners compared with baseline. The largest relative increase in EMG activity was seen during the dummy (152%; P <0.001) and active1 (155%; P <0.001) stages. During active2, the activity of the masseter decreased significantly toward baseline levels. Participants' trait anxiety was positively associated with increases in EMG activity (P = 0.027).

Conclusions: CAT is associated with a transient increase in masticatory muscle activity, possibly because of an increase in wake-time parafunctional tooth clenching. Temporomandibular disorder-free patients adapt well to CAT as the masticatory muscle activity decreases toward baseline levels after 2 weeks.
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http://dx.doi.org/10.1016/j.ajodo.2020.08.012DOI Listing
January 2021

Correction to: Morphometric analysis of dental arch form changes in class II patients treated with clear aligners.

J Orofac Orthop 2020 Nov;81(6):447

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

The authors would like to correct the conflicts of interest statement for this article. Unfortunately, the original statement did not include the authors' nonfinancial conflicts of interest, including grants and personal fees. The corrected conflict of interest statement is shown below:T. ….
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http://dx.doi.org/10.1007/s00056-020-00258-yDOI Listing
November 2020

Impact of clear aligner therapy on tooth pain and masticatory muscle soreness.

J Oral Rehabil 2020 Dec 5;47(12):1521-1529. Epub 2020 Oct 5.

Faculty of Dentistry, Discipline of Orthodontics and Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada.

Background: Clinical findings suggest that orthodontic treatment with clear aligners (clear aligner therapy/CAT) may cause masticatory muscle soreness in some patients.

Objective: This multi-site prospective study investigated tooth pain and masticatory muscle soreness and tenderness in patients undergoing CAT and explored whether psychological traits affected these outcomes.

Methods: Twenty-seven adults (22F, 5M; mean age ± SD=35.3 ± 17.6 years) about to start CAT were recruited at three clinics. During CAT, they reported on 100-mm visual analogue scales their tooth pain, masticatory muscle soreness and stress three times per day over 4 weeks (week 1 = baseline; week 2 = dummy aligner; week 3 = first active aligner; week 4 = second active aligner). Pressure pain thresholds (PPTs) were measured at the masseter and temporalis at baseline and after week 4. Mixed models were used to evaluate the outcome measures over time.

Results: Clear aligner therapy caused mild tooth pain, which was greater with the passive than the first and second active aligners (both P < .001). Mild and clinically not relevant masticatory muscle soreness was produced by all aligners (all P < .05), with the first active aligner producing less soreness than the dummy aligner (P < .001). PPTs did not change significantly after 4 weeks. Both tooth pain and masticatory muscle soreness were affected by stress and trait anxiety, whilst muscle soreness was affected also by oral behaviours.

Conclusions: In the short term, CAT produces tooth pain and masticatory muscle soreness of limited significance. Frequent oral behaviours are related to increased masticatory muscle soreness during CAT. The medium- and long-term effects of CAT should be further explored.
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http://dx.doi.org/10.1111/joor.13088DOI Listing
December 2020

Morphometric analysis of dental arch form changes in class II patients treated with clear aligners.

J Orofac Orthop 2020 Jul 14;81(4):229-238. Epub 2020 Apr 14.

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

Purpose: The purpose of this study was to evaluate the arch form changes in class II Caucasian patients treated with Invisalign® (Align Technology, San José, CA, USA).

Methods: A total of 27 class II patients, for whom a maximum of 4 mm arch expansion was planned, were selected. Both maxillary and mandibular digital casts were compared at three different times: pretreatment (T0), accepted set-up (T1), and retention phase (T2). Each digital model was imported into GOM Inspect© software (GOM GmbH, Braunschweig, Germany) to identify teeth crown facial axis (FA) and cusp points to create a coordinate system. In each model the origin of the coordinates was located at the contact point of central incisors and a system of Cartesian axes was constructed. Using the FA points, an average arch form was obtained for each clinical step and then the following comparisons were performed for each class group: T0-T1, T0-T2, and T1-T2.

Results: T1 showed wider maxillary and mandibular dental arches compared to T0 with maximum movements observed in the premolar regions (maximum movement 1.94 mm for tooth 15; P < 0.0001). In the T1-T2 comparison, a more buccal position of tooth 22, tooth 23, and tooth 24 (maximum movement 0.56 mm; P < 0.05) and a more lingual position of tooth 37 (maximum movement 0.81 mm; P < 0.01), tooth 36, and tooth 47 were observed at T1 with respect to T2.

Conclusions: Although Invisalign® treatment resulted in a significant increase in arch width according to the prescription, some of the outcomes were different than those planned especially in relation to the final position of the lower molars.
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http://dx.doi.org/10.1007/s00056-020-00224-8DOI Listing
July 2020

Clear aligner orthodontic therapy of rotated mandibular round-shaped teeth: .

Angle Orthod 2020 03 30;90(2):247-254. Epub 2019 Aug 30.

Objective: To evaluate, using the finite element method, the orthodontic rotational movement of a lower second premolar obtained with clear aligners, analyzing different staging and attachment configurations.

Materials And Methods: A CAD model including a complete lower dental arch (with element 4.5 mesially rotated 30°) and the corresponding periodontal ligaments, attachments, and aligner was designed and imported to finite element software. Starting from the CAD model, six projects were created to simulate the following therapeutic combinations for correcting element 4.5 position: (1) without attachments, (2) single attachment placed on the buccal surface of element 4.5, (3) three attachments placed on the buccal surfaces of teeth 4.4 to 4.6. For each project, both 1.2° and 3° of aligner activation were considered.

Results: All the analyzed configurations revealed a clockwise rotation movement of element 4.5 on the horizontal plane. Models with attachments showed a greater tooth displacement pattern than models without attachments. Simulations with attachments and 3° of aligner activation exhibited the best performance concerning tooth movement but registered high stresses in the periodontal ligaments, far from the ideal stress levels able to produce tooth rotational movement.

Conclusions: The model with a single attachment and 1.2° of aligner activation was the most efficient, followed by the three attachment model with the same degree of activation. Aligner activation should not exceed 1.2° to achieve better control of movement and reasonable stress in periodontal structures.
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http://dx.doi.org/10.2319/020719-86.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051248PMC
March 2020

Shape-Memory Polymers in Dentistry: Systematic Review and Patent Landscape Report.

Materials (Basel) 2019 Jul 10;12(14). Epub 2019 Jul 10.

Department of Surgical Sciences, CIR Dental School, Università degli Studi di Torino, Via Nizza, 230, 10126 Turin, Italy.

Objective: To perform a systematic review (SR) of existing literature and a patent landscape report (PLR) regarding the potential applications of shape-memory polymers (SMPs) in dentistry.

Search Strategy: Clinical and Biomedical online databases (Pubmed, Medline via Embase, Scopus, LILACS, Web of Science, Cochrane Library), Materials Science and Engineering databases (IEEE Explore, Compendex, Proquest), Material Science and Chemical database (Reaxys) so as Patents databases (Questel-Orbit, Espacenet, Patentscope) were consulted as recently as January 2019 to identify all papers and patents potentially relevant to the review. The reference lists of all eligible studies were hand searched for additional published work.

Results: After duplicate selection and extraction procedures, 6 relevant full-text articles from the initial 302 and 45 relevant patents from 497 were selected. A modified Consolidated Standards of Reporting Trials (CONSORT) checklist of 14 items for reporting pre-clinical in-vitro studies was used to rate the methodological quality of the selected papers. The overall quality was judged low.

Conclusions: Despite the great potential and versatility of SMPs, it was not possible to draw evidence-based conclusions supporting their immediate employment in clinical dentistry. This was due to the weak design and a limited number of studies included within this review and reflects the fact that additional research is mandatory to determine whether or not the use of SMPs in dentistry could be effective. Nevertheless, the qualitative analysis of selected papers and patents indicate that SMPs are promising materials in dentistry because of their programmable physical properties. These findings suggest the importance of furtherly pursuing this line of research.
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http://dx.doi.org/10.3390/ma12142216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678347PMC
July 2019

Clear aligner treatment: different perspectives between orthodontists and general dentists.

Prog Orthod 2019 Mar 11;20(1):10. Epub 2019 Mar 11.

Department of Orthodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA.

Purpose: To evaluate differences between orthodontists and general dentists in experience with clear aligners (CA), patients' demand and perception, types of patients, and malocclusion treated with CA and to compare the two groups of clinicians not using CA in their practice.

Methods: A Web-based survey was developed and sent to the 129 members of the European Aligner Society and randomly to 200 doctors of dental surgery by e-mail. They responded on demographics and to one of two different parts for clinicians using CA or not using CA. Statistical analysis was performed with SAS EGv.6.1.

Results: The response rate was 74%. Among the total of respondents, the majority reported utilizing CA in their practice with a greater percentage of orthodontists (P = 0.0040). Overall, orthodontists learned more about CA during academic seminars comparing to general dentists, and they treated more class I with crowding (P = 0.0002) and with open bite (P = 0.0462). The majority of patients treated with CA were female and adults with a full-time employment, and the patients' knowledge about CA treatment was mainly provided by information from external media advertising. For respondents not using CA, orthodontists were more likely to report that CA limit treatment outcomes, whereas general practitioners were reported not having enough experience to use them.

Conclusions: There were some significant differences between orthodontists and general dentists mainly in experience and case selection for clinicians using CA as well as in the reasons provided for not using CA in their practice.
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http://dx.doi.org/10.1186/s40510-019-0263-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6409290PMC
March 2019

Scanning electron microscopy analysis of aligner fitting on anchorage attachments.

J Orofac Orthop 2019 Mar 23;80(2):79-87. Epub 2019 Jan 23.

Department of Orthodontics, Dental School, University of Turin, Via Nizza 230, 10126, Turin, Italy.

Purpose: The aims of the study were (1) to evaluate the fitting of three different aligners (Invisalign [Align Technology, Santa Clara, CA, USA], CA Clear Aligner [Scheu-Dental, Iserlohn, Germany] and F22 [Sweden&Martina, Due Carrare, Italy]) on anchorage attachments using scanning electron microscopy (SEM), and (2) to analyze the influence of 2 different types of resin used to build attachments on aligner fitting.

Methods: Using STL files of a patient, six resin casts were obtained and rectangular attachments were bonded on them. Conventional bulk-fill resin was used to build upper attachments while a flowable resin was used to build the lower ones. Passive aligners were adapted on each cast and then sectioned buccolingually. Microphotographs of the obtained sections were performed using a SEM and then micrometric measurements of aligner fitting on anchorage attachments were recorded.

Results: Analyzing the overall fitting of upper arch aligners, Invisalign provided a significantly better fitting with respect to F22 (P = 0.009); differences were not significant when comparing Invisalign with CA Clear Aligner, and CA Clear Aligner with F22. Analyzing the overall fitting of lower arch aligners, F22 provided a significantly better fitting with respect to CA Clear Aligner (P = 0.008) and Invisalign (P = 0.011). The analysis showed a significantly better fitting on upper attachments, built using conventional bulk-fill resin (P = 0.034).

Conclusions: Invisalign, CA Clear Aligner and F22 have comparable performance in terms of fitting on anchorage attachments. Conventional bulk-fill resin provides the best fitting on anchorage attachments.
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http://dx.doi.org/10.1007/s00056-018-00167-1DOI Listing
March 2019

Buccolingual Inclination Control of Upper Central Incisors of Aligners: A Comparison with Conventional and Self-Ligating Brackets.

Biomed Res Int 2018 29;2018:9341821. Epub 2018 Nov 29.

Unit of Orthodontics and Paediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Italy.

Objective: The upper incisors torque expression is essential for the orthodontic treatment accuracy. Various orthodontic devices are claimed to have different inclination control capacity. The purpose of this retrospective study was to compare the radiographic buccolingual inclination of upper incisors in patients treated with three different orthodontic techniques.

Material And Methods: Conventional brackets (Victory, 3M), self-ligating appliances (Damon Q, Ormco), and aligners (Invisalign, Align Technology) were tested. Cephalometric data of 25 patients with similar skeletal and dental pretreatment parameters were collected for each technique. Position changes of upper central incisors were assessed with radiographic evaluation before and after therapy. Three different parameters were considered: 11SnaSnp, 11Ocl and I+ TVL. All variables were measured before (T0) and after (T1) treatment and their variation over treatment was assessed.

Results: When evaluating angular measurements, 11SnaSnp and 11Ocl angles showed the highest numeric variation with conventional brackets. Lowest values were reported with aligners. However, the differences among various techniques were not significant for both angles (P>0.05). Also I+ TVL linear value variation did not show significant differences among the different groups tested (P>0.05).

Conclusion: Conventional multibrackets appliance showed the highest incisal position variations over treatment, but the differences among various groups were not significantly different.
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http://dx.doi.org/10.1155/2018/9341821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304479PMC
April 2019

Does occlusal splint affect posture? A randomized controlled trial.

Cranio 2020 Jul 14;38(4):264-272. Epub 2018 Sep 14.

Department of Surgical Sciences, Gnathology Unit, Dental School, University of Torino , Torino, Italy.

Objective: The aim of this study was to evaluate the effect of an occlusal splint on body posture of intra-articular temporomandibular joint (TMJ) disorders patients.

Methods: The study was performed on 45 women affected by TMJ disorders divided into an occlusal splint group and a control group. Rasterstereographic recordings were performed at baseline and after 1, 3, and 6 months, in order to analyze the following postural parameters: trunk inclination, cervical and lumbar arrows, kyphotic and lordotic angles, trunk imbalance, pelvic tilt and torsion.

Results: Regarding the postural parameters in the intragroup analysis, no significant differences were detected. The analysis between the two groups revealed significant differences concerning the cervical arrow, the kyphotic and lordotic angles.

Discussion: Even if some differences were found between the control and the occlusal splint group, the low range of statistical significance made these results not significant from a clinical point of view.
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http://dx.doi.org/10.1080/08869634.2018.1511265DOI Listing
July 2020

Scanning electron microscopy evaluation of aligner fit on teeth.

Angle Orthod 2018 Sep 18;88(5):596-601. Epub 2018 Jun 18.

Objectives: The fitting of aligners on anchorage teeth is a crucial factor in clear aligner orthodontics. The purpose of this experimental study was to evaluate the fitting of two aligner systems, Invisalign and CA-Clear Aligner, using scanning electron microscopy (SEM).

Materials And Methods: Passive aligners (Invisalign and CA-Clear Aligner) were adapted on resin casts obtained by stereolithography (STL) files of a patient, and then sectioned buccolingually. Upper and lower central incisors, upper and lower first premolars, and upper and lower first molars were the regions analyzed. Representative microphotographs of sections were taken with a scanning electron microscope (SEM); a total of 160 micrometric measurements were obtained and analyzed with ANOVA tests.

Results: Invisalign provided an overall better fit on lower incisors ( F = 11.48, P = .0095) and on lower molars ( F = 19.93, P = .0012). Considering the different regions, Invisalign provided better fit at the gingival edge of the buccal aspect on lower incisors ( F = 11.33, P = 0.0056) and at the gingival edge of the lingual aspect on upper premolars ( F =5.34, P = 0.0047). On the upper molars, Invisalign provided better fit at the gingival edge of the buccal aspect, while CA-Clear Aligner provided better fit at the buccal maximum convexity, on the buccal cusp, on the occlusal groove and at the palatal cusp. On lower molars, Invisalign showed a more accurate fit at the buccal aspect points.

Conclusions: Invisalign and CA-Clear Aligner exhibited comparable fit on anchorage teeth. Invisalign provided better fit at the gingival edges of aligners, while the CA-Clear Aligner provided better fit on complex occlusal surfaces.
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http://dx.doi.org/10.2319/120417-827.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183126PMC
September 2018

Postural changes in orthodontic patients treated with clear aligners: A rasterstereographic study.

J Electromyogr Kinesiol 2018 Feb 14;38:44-48. Epub 2017 Nov 14.

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

Background: Correlation between malocclusions and body posture has been discussed in the last decades, but there is still a lack of consensus in existing literature. Rasterstereography allows tridimensional reconstruction of the spine, starting from the back surface analysis. So far studies which tested modifications of rasterstereographic parameters during orthodontic treatment, comparing with those obtained from untreated control group, are not available. Clear aligner treatment produces alteration of vertical height due to the occlusal coverage and, subsequently, a stimulation of periodontal receptors which causes an inhibition of the jaw closing muscles and, hypothetically, changes in mandibular posture.

Objectives: Evaluate possible correlations between orthodontic treatment and posture.

Materials And Methods: Rasterstereographic values of 15 untreated patients and of 15 patients treated with clear aligners were compared at baseline, after 1, 3 and 6 months. Rasterstereographic parameters considered were the following: the kyphotic angle, the lordotic angle, the upper thoracic inclination, and the pelvic inclination.

Results: Correlations between Kyphosis Angle, Upper Toracic Inclination and Pelvic Inclination and body posture were found after 6 months of treatment with clear aligners.

Conclusions: Occlusal coverage caused by aligners could influence body posture not only for upper spine sections but also lower spine sections.
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http://dx.doi.org/10.1016/j.jelekin.2017.11.002DOI Listing
February 2018

Sleep bruxism and related risk factors in adults: A systematic literature review.

Arch Oral Biol 2017 Nov 5;83:25-32. Epub 2017 Jul 5.

Department of Surgical Sciences, Specialization School of Orthodontics, Dental School, University of Torino, Via Nizza 230, 10126 Torino, Italy; Department of Surgical Sciences, Gnathology Unit, Dental School, University of Torino, Via Nizza 230, 10126 Torino, Italy.

Objective: The aim of this article was to systematically review the literature to assess the relationship between risk factors and sleep bruxism (SB) in adults (age ≥18 years).

Design: A systematic search of the following databases was carried out: PubMed, Embase, Scopus, Cochrane Oral Health Group's Trial Register and Cochrane Register of Controlled Trials, Web of Science, LILACs and SciELO. Nine out of the 4583 initially identified articles were selected. This review was conducted according to the guidelines from the Cochrane Handbook for Systematic Reviews of Interventions, with reporting in agreement to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Results: Among the nine analyzed articles, associations between SB and gastro-esophageal reflux disease (GERD) (OR=6.6, CI=1.4-30.9) was found in one randomized clinical trial (RCT). Four cross-sectional studies suggested history of SB during childhood (OR=8.1 CI=5.4-12-2), age (OR=3.1, CI=2.3-4.1) and chronic migraine (OR=3.8, C.I=1.8-7.8) as determinant factors for the development of SB. In one case-control study, patients with genetic polymorphisms were more likely to present SB (OR=4.3, CI=1.6-11.3). Smoking (OR=2.8, CI=2.2-3.5) and alcohol intake (OR=1.9, CI=1.2-2.8) showed moderate association in two case-control studies.

Conclusions: History of SB during childhood, gastro-esophageal reflux disease and genetic polymorphisms seem to be important risk factors associated to SB in adults. Dry mouth on awakening seems to be a protective factor. Association does not infer with causality. Even if the evidence emerged from the considered studies was clinically relevant, further studies are requested to better understand the biological mechanisms behind the described associations.
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http://dx.doi.org/10.1016/j.archoralbio.2017.07.002DOI Listing
November 2017

Root resorption during orthodontic treatment with Invisalign®: a radiometric study.

Prog Orthod 2017 Dec 15;18(1):12. Epub 2017 May 15.

Department of Surgical Sciences, University of Torino, Turin, Italy.

Background: Root resorption (RR) is described as a permanent loss of tooth structure from the root apex. Many reports in the literature indicate that orthodontically treated patients are more likely to have severe apical root shortening, interesting mostly maxillary, followed by mandibular incisors. The aim of the study was to investigate the incidence and severity of RR in adult patients treated with aligners. The study group consisted of 71 class I adult healthy patients (mean age 32.8 ± 12.7) treated with aligners (Invisalign®, Align Technologies, Santa Clara, CA, USA). All incisors, canines, upper first premolars, and first molars were assessed. Root and crown lengths of 1083 teeth were measured in panoramic radiographs at the beginning (T0) and at the end (T1) of clear aligner therapy. Individual root-crown ratio (RCR) of each tooth and therefore the relative changes of RCR (rRCR) were determined. A decrease of rRCR was assessed as a reduction of the root length during treatment.

Results: All patients had a minimum of one teeth affected with a reduction of root length, on average 6.38 ± 2.28 teeth per patient. Forty one, 81% of the 1083, measured teeth presented a reduction of the pre-treatment root length. A reduction in percentage of >0% up to 10% was found in 25.94% (n = 281), a distinct reduction of >10% up to 20% in 12.18% (n = 132) of the sample. 3.69% (n = 40) of the teeth were affected with a considerable reduction (>20%).

Conclusions: Orthodontic treatment with Invisalign® aligners could lead to RR. However, its incidence resulted to be very similar to that described for orthodontic light forces, with an average percentage of RR < 10% of the original root length.
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http://dx.doi.org/10.1186/s40510-017-0166-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430001PMC
December 2017

A Three-Dimensional Finite Element Analysis of Upper-Canine Distalization with Clear Aligners, Composite Attachments, and Class II Elastics.

J Clin Orthod 2017 Jan;51(1):24-28

Department of Orthodontics, Lingotto Dental School, University of Turin, Via Nizza 230, 10126 Turin, Italy.

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January 2017

Laypeople's perceptions of frontal smile esthetics: A systematic review.

Am J Orthod Dentofacial Orthop 2016 Nov;150(5):740-750

Professor, Department of Orthodontics, Dental School, University of Turin, Turin, Italy.

Introduction: The emphasis on dental esthetics has increased in recent years. There are, however, differences in esthetic perceptions among professional and lay groups. The aim of this comprehensive review was to update previous reviews and answer the following research question: Can lay thresholds for acceptance of smile esthetic anomalies be defined?

Methods: A systematic search in the medical literature (PubMed, PMC, NLM, Embase, Cochrane Central Register of Controlled Clinical trials, Web of Knowledge, Scopus, Google Scholar, and LILACs) was performed to identify all peer-reviewed articles reporting data regarding evaluations of laypeople's perceptions of dental esthetic factors.

Results: Of the 6032 analyzed articles, 66 studies were selected for the final review process. Among the selected articles investigated perceptions of diastema, 15 analyzed modifications in tooth size and shape, 8 considered incisor positions, 15 evaluated midline discrepancies, 16 investigated buccal corridors, 26 analyzed gingival display and design, 3 considered lip height, and 20 investigated miscellaneous factors. Threshold values were identified for the following features: diastema (0-2 mm), tooth size and shape of incisor position, midline discrepancy (0-3 mm), buccal corridors (5-16 mm), gingival exposure (1.5-4 mm), occlusal canting (0°-4°), and overbite (2-5 mm). Furthermore, few other smile characteristics were found to be significantly associated with perception of smile aesthetics, even though any threshold could be detected.

Conclusions: On the basis of the obtained results, threshold values for the main features of smile and dental esthetics could be identified. Limitations of the present study were the heterogeneity of data which made it impossible to perform a meta-analysis, and the lack of information about sample selection and selective outcome reporting.
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http://dx.doi.org/10.1016/j.ajodo.2016.06.022DOI Listing
November 2016

Biochemical markers of bone metabolism during early orthodontic tooth movement with aligners.

Angle Orthod 2017 Jan 13;87(1):74-81. Epub 2016 Jul 13.

Objective: To evaluate the expression of receptor activator of nuclear factor-kappa ligand (RANKL), osteoprotegerin (OPG), osteopontin (OPN), interleukin 1β (IL-1β), and transforming growth factor ß1 (TGF-ß1) in the gingival crevicular fluid (GCF) of teeth subjected to orthodontic forces released by aligners.

Materials And Methods: A total of 10 healthy, adult patients were selected to participate in this split-mouth study. The treatment plan was designed to obtain only one movement with the first aligner: distalization of a second molar. GCF samples were obtained from pressure and tension sites of the test tooth and from the mesiobuccal and distobuccal sites of the control tooth. The GCF sample volumes were measured using a Periotron 8000. Levels of TGF-β, IL-1β, RANKL, OPG, and OPN were measured by enzyme-linked immunosorbent assay.

Results: IL-1β showed a significant increase at the pressure sites after 1 week and 3 weeks with respect to baseline (P < .05) compared with control sites. The kinetics of TGF-1β and OPN were characterized by a significant increase at the tension sites of the test teeth (P < .05) after 3 weeks from the application of orthodontic force. The RANKL level was significantly increased at pressure and tension sites after 1 hour and after 1 week from the application of the orthodontic forces (P = .023 and P = .043, respectively).

Conclusions: An increased concentration of bone modeling and remodeling mediators at the pressure sites (IL-1β, RANKL) and tension sites (TGF-1β, OPN) was observed. These scenarios are compatible with previous in vivo and in vitro studies investigating the biological effects of orthodontic tooth movement.
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http://dx.doi.org/10.2319/022416-159.1DOI Listing
January 2017

Children's perceptions of smile esthetics and their influence on social judgment.

Angle Orthod 2016 Nov 19;86(6):1050-1055. Epub 2016 May 19.

Objective: To define a threshold of acceptance of smile esthetics for children and adolescents.

Materials And Methods: A systematic search in the medical literature (PubMed, PubMed Central, National Library of Medicine's Medline, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Knowledge, Scopus, Google Scholar, and LILACs) was performed to identify all peer-reviewed papers reporting data regarding the evaluation of children's and adolescents' perceptions of dental esthetic factors. The search was conducted using a research strategy based on keywords such as "children," "adolescents," "smile aesthetics perception," "smile aesthetics evaluation." Studies analyzing smile esthetics involving at least 10 observers younger than 18 years of age were selected.

Results: Among the 1667 analyzed articles, five studies were selected for the final review process. No study included in the review analyzed perception of smile anomalies in a quantitative or qualitative way, thus no threshold was identified for smile features. Among the analyzed samples, unaltered smiles were always significantly associated with better evaluation scores when compared with altered smiles.

Conclusions: Smile esthetics influence social perception during childhood and adolescence. However, thresholds of smile esthetic acceptance in children and adolescents are still not available.
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http://dx.doi.org/10.2319/102715-722DOI Listing
November 2016

Effectiveness of Composite Attachments in Controlling Upper-Molar Movement with Aligners.

J Clin Orthod 2016 Jun;50(6):341-7

Postgraduate School of Orthodontics, Department of Surgical Sciences, Lingotto Dental School, University of Turin, Via Nizza 230, 10100 Turin, Italy.

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June 2016

Assessment of Anxiety and Coping Features in Bruxers: A Portable Electromyographic and Electrocardiographic Study.

J Oral Facial Pain Headache Summer 2016;30(3):249-54

Aims: To determine whether there is a correlation between any psychological features and sleep bruxism (SB).

Methods: A total of 36 healthy volunteers underwent an in-home evaluation with a portable device combining electromyographic (EMG) and electrocardiographic (ECG) recordings for the diagnosis of SB. They were administered questionnaires that assessed state and trait anxiety levels and coping strategies. The study hypothesis was that the SB index was significantly correlated with an individual's anxiety and coping. Correlation between SB index and psychological features was assessed and a comparison between SB prevalences in subjects with different psychological scores was carried out.

Results: Correlation analysis showed that the SB index was not correlated with any of the psychological scales; however, there were some significant correlations (r values range from 0.393 to 0.458) between the SB index and specific items from the trait anxiety and coping scales. Crosstabulations of subjects with SB and with high (overmedian) or low (undermedian) scores for the various psychological measures revealed significant correlations between the prevalence of SB in higher-scoring subjects for state anxiety scores (Phi coefficient = .456; P = .006), trait anxiety scores (Phi = 0.369; P = .027), and social support coping strategy (Phi = 0.387; P = .020).

Conclusion: These findings support the study hypothesis only in part and confirm the absence of a clear-cut relationship between SB and psychological features.
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http://dx.doi.org/10.11607/ofph.1616DOI Listing
January 2017

Frequency of daytime tooth clenching episodes in individuals affected by masticatory muscle pain and pain-free controls during standardized ability tasks.

Clin Oral Investig 2017 May 9;21(4):1139-1148. Epub 2016 Jun 9.

Department of Neurosciences, Reproductive and Oral Sciences, Section of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy.

Objectives: Tooth clenching has been suggested to be related to temporomandibular pain. However, the electromyographic characteristics of daytime clenching episodes have been minimally investigated. This study aimed to analyze the frequency, amplitude, and duration of daytime clenching episodes in patients with masticatory muscle pain and pain-free individuals.

Methods: Fifteen women with masticatory muscles myalgia (MP group, mean ± SD age = 26.4 ± 7.6 years) matched for age to 18 pain-free women (CTR group, mean ± SD age = 25.3 ± 2.8 years) were submitted to three different ability tasks (filling out questionnaires for 40 min, reading for 20 min, and playing a videogame for 20 min). The electromyographic activity periods (AP) of the right masseter greater than 10 % (AP10), 20 % (AP20), and 30 % (AP30) of the maximum voluntary contraction were analyzed.

Results: The mean frequencies of AP10, AP20, and AP30 were greater in MP than in CTR individuals (all p < 0.05). The mean duration of AP10 was higher in MP group than CTR group only while filling out the questionnaires (p = 0.0033). CTR group had an increased frequency and duration of AP10 while playing the videogame than while reading a magazine. The ability tasks did not affect the muscle activity in the MP group.

Conclusions: Individuals with masticatory muscle pain have an increased frequency of both high and low-intense daytime clenching episodes. The type of ability task affects the frequency and the duration of clenching episodes only in pain-free individuals.

Clinical Relevance: Clinicians should recognize that the frequency and intensity of daytime clenching are noticeably increased in individuals with masticatory muscle pain in order to better tailor treatment.
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http://dx.doi.org/10.1007/s00784-016-1870-8DOI Listing
May 2017

Maxillary molar distalization with aligners in adult patients: a multicenter retrospective study.

Prog Orthod 2016 18;17:12. Epub 2016 Apr 18.

Post-Graduate School of Orthodontics, Lingotto - Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy.

Background: The aim of the present study was to test the hypothesis that bodily maxillary molar distalization was not achievable in aligner orthodontics.

Methods: Forty lateral cephalograms obtained from 20 non-growing subjects (9 male, 11 female; average age 29.73 years) (group S), who underwent bilateral distalization of their maxillary dentition with Invisalign aligners (Align Technology, Inc., San José, CA, USA), were considered for the study. Skeletal class I or class II malocclusion and a bilateral end-to-end class II molar relationship were the main inclusion criteria. Cephalograms were taken at two time points: (T0) pretreatment and (T2) post-treatment. Treatment changes were evaluated between the time points using 39 variables by means of paired t test. The level of significance was set at P < 0.05. Reproducibility of measurements was assessed by the intraclass correlation coefficient (ICC).

Results: The mean treatment time was 24.3 ± 4.2 months. At the post-treatment point, the first molar moved distally 2.25 mm without significant tipping (P = 0.27) and vertical movements (P = 0.43). The second molar distalization was 2.52 mm without significant tipping (P = 0.056) and vertical movements (P = 0.25). No significant movements were detected on the lower arch. SN^GoGn and SPP^GoGn angles showed no significant differences between pre- and post-treatment cephalograms (P = 0.22 and P = 0.85, respectively).

Conclusions: Aligner therapy in association with composite attachments and class II elastics can distalize maxillary first molars by 2.25 mm without significant tipping and vertical movements of the crown. No changes to the facial height were revealed.
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http://dx.doi.org/10.1186/s40510-016-0126-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834290PMC
October 2017

The use of conventional transcutaneous electrical nerve stimulation in chronic facial myalgia patients.

Clin Oral Investig 2017 Jan 22;21(1):275-280. Epub 2016 Mar 22.

Gnathology Unit, Department of Surgical Sciences, Dental School, University of Torino, Lingotto, Via Nizza 230, Torino, Italy.

Objectives: The aim of this study was to evaluate the efficacy of conventional TENS in women affected by chronic facial myalgia.

Materials And Methods: The study was performed on 49 women affected by chronic facial myalgia randomly allocated in the TENS group (34 women) and the control group (15 women). The subjective level of pain was assessed by the Visual Analogue Scale indicating the mean (VAS MEAN), the maximum (VAS MAX) and the current intensity of pain (VAS NOW). The level of pain at the muscular palpation sites was assessed by the Pericranial Muscle Tenderness Score (PTS) and the Cervical Muscle Tenderness Score (CTS). The TENS therapy lasted for 10 weeks, and data were collected at baseline, after 5, 10, 15 and 25 weeks. The differences between groups before and after treatment were compared with the Mann-Whitney and the Kolmogorov-Smirnov tests. The intra-group differences were compared with the one-way ANOVA test.

Results: The results showed that the VAS MEAN, VAS MAX, PTS and CTS were significantly reduced in the TENS group compared to the control group after 10 weeks of TENS (p < 0.05). The intra-group analysis revealed a decreasing tendency of VAS MEAN, VAS MAX, VAS NOW, PTS and CTS in the TENS group in a 25-week period (p < 0.05).

Conclusions: The study demonstrated the efficacy of conventional TENS in patients with chronic facial myalgia and the decrease in both subjective and objective pain.

Clinical Relevance: Conventional TENS is a safe, non-invasive, easy-to-administer therapy for chronic facial myalgia.
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http://dx.doi.org/10.1007/s00784-016-1787-2DOI Listing
January 2017

Sleep bruxism in adolescents: a systematic literature review of related risk factors.

Eur J Orthod 2017 Feb 15;39(1):61-68. Epub 2016 Feb 15.

Department of Surgical Sciences, Specialization School of Orthodontics, Dental School, University of Torino, Italy.

Background: Multiple risk factors have been associated to sleep bruxism (SB). Nevertheless, there are still many unsolved issues concerning the etiology of SB that have consequences on the clinical management strategies.

Objective: Systematically review the literature to assess the relationship between risk factors and SB symptoms in adolescents (age 11-19 years).

Search Methods And Selection Criteria: PubMed, Embase, Scopus, Cochrane Oral Health Group's Trial Register and Cochrane Register of Controlled Trials, Web of Science, LILACs, and SciELO were searched to identify all peer-reviewed articles potentially relevant to the review.

Data Collection And Analysis: The risk of bias was assessed according to the guidelines from the Cochrane handbook for systematic reviews of interventions, with reporting in agreement to the preferred reporting items for systematic reviews and meta-analyses guidelines.

Results: Four out of the 4546 initially identified articles were selected. According to the grading of recommendations assessment, development and evaluation assessment (GRADE), the magnitude of agreement was almost perfect for all checklist items. Sleep disturbances, and snoring in particular, headache, jaw muscle fatigue, and tooth wear seem to be associated to SB in adolescents from 11 to 19 years old.

Limitations: Despite the large interest of the scientific community in the field of oral parafunctions, only four articles met the eligibility criteria. Furthermore only associations and not definite cause-effect relationships were highlighted in the selected articles.

Conclusions: Sleep disturbances presented the strongest association with SB while very few occlusal features had a moderate association. As a common sense the investigation of sleep respiratory disorders could be of great help in the management of SB in adolescents.
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http://dx.doi.org/10.1093/ejo/cjw012DOI Listing
February 2017

Diagnostic accuracy and measurement sensitivity of digital models for orthodontic purposes: A systematic review.

Am J Orthod Dentofacial Orthop 2016 Feb;149(2):161-70

Professor and department chairman, Department of Orthodontics, Dental School, University of Turin, Turin, Italy.

Introduction: Our objective was to assess the accuracy, validity, and reliability of measurements obtained from virtual dental study models compared with those obtained from plaster models.

Methods: PubMed, PubMed Central, National Library of Medicine Medline, Embase, Cochrane Central Register of Controlled Clinical trials, Web of Knowledge, Scopus, Google Scholar, and LILACs were searched from January 2000 to November 2014. A grading system described by the Swedish Council on Technology Assessment in Health Care and the Cochrane tool for risk of bias assessment were used to rate the methodologic quality of the articles.

Results: Thirty-five relevant articles were selected. The methodologic quality was high. No significant differences were observed for most of the studies in all the measured parameters, with the exception of the American Board of Orthodontics Objective Grading System.

Conclusions: Digital models are as reliable as traditional plaster models, with high accuracy, reliability, and reproducibility. Landmark identification, rather than the measuring device or the software, appears to be the greatest limitation. Furthermore, with their advantages in terms of cost, time, and space required, digital models could be considered the new gold standard in current practice.
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http://dx.doi.org/10.1016/j.ajodo.2015.06.029DOI Listing
February 2016

Risk factors related to sleep bruxism in children: A systematic literature review.

Arch Oral Biol 2015 Nov 1;60(11):1618-24. Epub 2015 Sep 1.

Department of Surgical Sciences, Specialization School of Orthodontics, Dental School, University of Torino, Via Nizza 230, 10126 Torino, Italy; Department of Surgical Sciences, Gnathology Unit, Dental School, University of Torino, Via Nizza 230, 10126 Torino, Italy.

Objective: The aim of this article was to systematically review the literature to identify papers dealing with risk factors associated with sleep bruxism (SB) in children.

Design: A systematic search was carried out based on the following databases: PubMed, Embase, Scopus, Cochrane Oral Health Group's Trial Register and Cochrane Register of Controlled Trials, Web of Science, LILACs, SciELO. Studies investigating risk factors related to SB after multiple regression analysis and bruxism symptoms assessed with clinical diagnosis or specific questionnaires were searched. Six out of the 4546 initially identified studies were selected. This review was conducted according to the guidelines from the Cochrane Handbook for Systematic Reviews of Interventions, with reporting in agreement to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Results: Among the six analyzed articles, one randomized clinical trial (RCT) suggested the increase of SB in heavily exposed patients to second hand smoke (SHS) (OR=4.5, CI=2.2-9.4), two cross-sectional studies suggested neuroticism as determinant factor for the development of sleep bruxism (OR=1.9, CI=1.3-2.6), among children and three case-control studies suggested that children with sleep disturbances were more likely to have SB (OR=3.3, CI=1.6-6.6). Parafunctional behaviours (OR=2.3, CI=1.2-4.3) had a moderate association.

Conclusions: SHS and sleep disturbances presented the strongest association with SB. The most recurrent source of bias was the lack of blinding procedures. Furthermore, the use of reliable SB diagnostic procedures should be recommended to increase the quality of future studies. The evidence emerged from the considered studies was clinically relevant.
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http://dx.doi.org/10.1016/j.archoralbio.2015.08.014DOI Listing
November 2015