Objectives: This pilot study was conducted to test the protocol of a randomized controlled trial evaluating whether rapid maxillary expansion (RME) can relieve nocturnal enuresis (NE) and improve breathing in children, after ruling out a placebo effect, and investigating whether the effects of RME and NE are related to the morphology of the upper airway. Methods: Seventy 6–15-year-old patients with NE were assessed for eligibility (e.g., constricted maxilla). Enrolled subjects were randomized to immediate treatment with RME (Group 1) or to have the same treatment (RME) delayed for at least six weeks (Group 2). Outcomes comprised the number of wet nights per week, the nocturnal urine production, and the scores of a pediatric sleep questionnaire at baseline, after active treatment (Group 1) or delayed treatment (Group 2), and after 3 months’ retention. Cone beam computed tomographies were taken at baseline and after retention. Results: Six patients were randomized: three in each group. In four of six patients, the number of wet nights per week decreased. Moreover, in responders, nocturnal urine production was reduced following RME. Conclusions: This pilot study suggested that RME might reduce the severity of NE and showed that the protocol of this randomized controlled clinical trial was appropriate.

Early detection of COVID-19 is important for reduction in the spread of the disease and gustatory disturbances (GD) are known to have a strong predictive value. In the present study, we aimed to map the geographical differences in the prevalence of GD in individuals infected with SARS-CoV-2 during the first wave of COVID-19 in order to improve case identification and to facilitate prioritization. We undertook a rapid scoping review of articles published in the repository of the National Library of Medicine (MEDLINE/PubMed) and medRxiv from their inception until 3rd September, 2020. The minimum requirements for completing a restricted systematic review were fulfilled. Of the 431 articles retrieved, 61 studies (28,374 cases confirmed with COVID-19) from 20 countries were included in the analysis. GD were most prevalent in the Americas [66.78%, 95% CI 54.77-78.79%] compared to Europe [57.18%, 95% CI 52.35-62.01%], the Middle East [38.83%, 95% CI 27.47-50.19%] and East Asia [13.1%, 95% CI 0.14-26.06%]. No differences of GD prevalence were evident between February and August 2020. The data demonstrate that there is a marked geographical distribution of GD in COVID-19 patients which, possibly, might be explained by differences in diagnostic criteria for COVID-19 case definition during the early phase of the pandemic.

BACKGROUND: Accurate implant impression is an essential requirement for the fabrication of implant prosthesis. This in vitro study evaluated the accuracy of digital impressions by intraoral scanner (IOS) systems in comparison to conventional impressions for recording the position of 2 parallel implants and 2 divergent implants. MATERIALS AND METHODS: In vitro 3-unit prosthesis master models with 2 tissue level implants were fabricated; one model had parallel implants, and the other model had one 15° tilted implant. The conventional open-tray impressions were obtained with non-splinted (NSP) and splinted (SP) impression copings. Trios 4 (TS), Medit i500 (MT), and True Definition (TD) were used to make digital impressions with scan bodies. A total of 10 impressions were obtained with every technique. The virtual test images of the conventional and digital impressions were converted to 2 virtual implant images. For each group, trueness, precision, inter-implant distance deviation, and angle deviation were measured. RESULTS: There was a general tendency for digital impressions to provide a more accurate outcome for trueness, precision, and angle deviation. The 2 conventional impressions showed similar accuracy, except for the angle deviation, where the NSP was significantly inferior than SP (p < 0.01) for the divergent implants model. The TD was generally the least accurate among all the IOS systems, especially for the inter-implant distance deviation (p < 0.05). CONCLUSIONS: Within the limitations of the laboratory set-up of the present study and the limited clinical resemblance, the digital impressions appeared to have sufficient accuracy for 2 implants and were least affected by the presence of angle between implants. The most inferior outcome was observed for the NSP technique.

BACKGROUND: As part of a larger study on the identification of undiagnosed Type 2 diabetes (T2D), and prediabetes patients in dental settings, this study explored oral healthcare professionals' (OHP) attitudes with respect to the relevance and appropriateness of screening for prediabetes/T2D in general oral healthcare settings. It also aims to gain a deeper understanding of OHPs' concerns and perceived barriers to screening for T2D. METHODS: Semi-structured interviews were conducted with 11 OHPs: eight dentists, two dental hygienists and one oral health therapist. Interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: Themes that emerged from the interviews were organised under three major categories: 1) Implementation: OHPs willingness to screen for prediabetes/T2D; 2) Barriers to implementation of screenings; subdivided into: a) lack of knowledge and formal training about T2D screening methodology; b) concerns about patients' awareness and acceptance of T2D screening in oral healthcare settings; c) costs and reimbursement for the time and resources required to screen patients; and d) legal and scope of practice; and 3) Collaboration and communication between OHPs and General practitioners (GP). CONCLUSIONS: The oral healthcare setting was considered as appropriate for medical screening, and OHPs were willing to participate in screening for prediabetes/T2D. Nonetheless, for the successful implementation of a screening programme, several barriers need to be addressed, and effective medical screening would require collaboration between oral health and medical and other health professionals, as well as clarification of legal and reimbursement issues.

BACKGROUND: Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this "Caries OUT" study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. METHODS: In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children's oral-health behaviour change, parents' and dentists' process acceptability, and costs exploration. A sample size of 258 3-5 and 6-8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments' time. A trained examiner per centre will conduct examinations at baseline, at 5-5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child's CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents' and dentists' process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. DISCUSSION: The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time. TRIAL REGISTRATION: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h . Protocol-version 2: 27/01/2021.

OBJECTIVE: To define a map of interradicular spaces where miniscrew can be likely placed at a level covered by attached gingiva, and to assess if a correlation between crowding and availability of space exists. METHODS: Panoramic radiographs and digital models of 40 patients were selected according to the inclusion criteria. Interradicular spaces were measured on panoramic radiographs, while tooth size-arch length discrepancy was assessed on digital models. Statistical analysis was performed to evaluate if interradicular spaces are influenced by the presence of crowding. RESULTS: In the mandible, the most convenient sites for miniscrew insertion were in the spaces comprised between second molars and first premolars; in the maxilla, between first molars and second premolars as well as between canines and lateral incisors and between the two central incisors. The interradicular spaces between the maxillary canines and lateral incisors, and between mandibular first and second premolars revealed to be influenced by the presence of dental crowding. CONCLUSIONS: The average interradicular sites map hereby proposed can be used as a general guide for miniscrew insertion at the very beginning of orthodontic treatment planning. Then, the clinician should consider the amount of crowding: if this is large, the actual interradicular space in some areas might be significantly different from what reported on average. Individualized radiographs for every patient are still recommended.

Background: Sleep-related breathing disorders (SRDB) are a group of pathological conditions characterized by a dysfunction of the upper airways. The value of SRDB's prevalence, in the pediatric population, ranges from 2 to 11% depending on the different methodologies used in measure and the difficulties in the diagnosis. The aim of this study was to assess the prevalence of SRDB using the Pediatric Sleep Questionnaire (PSQ). Methods: 668 patients were enrolled from the Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy and from the Unit of Integrated Pediatric Dentistry, University of Murcia, Spain. The questionnaires were administered to patients with no previous orthodontic and surgical treatment who attended on the first visit at the two units of pediatric dentistry. Data regarding general health status were extracted from the standard anamnestic module for first visit. Prevalence and logistic regression models were computed. Results: The ages ranged from 2 to 16 years old (average 7 years old). The prevalence of SRDB was 9.7% for the entire sample. The models showed a positive correlation between three variables (snoring, bad habits, and anxiety) and SRDB. Conclusions: The prevalence obtained demonstrates the relevance of sleep disorders in the pediatric population and highlights the central role of pediatric dentists in the earlier diagnosis of these disorders.

OBJECTIVES: Natural head position is recommended to be optimal at cone-beam computed tomography acquisition. For standardization purposes in control of treatment outcome, it is clinically relevant to discuss, if a change of posture from natural head position may have an effect on the pharyngeal airway dimensions and morphology, during computed tomography, cone-beam computed tomography or magnetic resonance imaging acquisition. This was the aim of the present literature review study for purposes of valid evidence, which was hypothesized, to be present. MATERIAL AND METHODS: This systematic literature review has been registered in PROSPERO database with following number: CRD42015024567. A systematic literature search performed in PubMed, Embase and Cochrane was carried out in order to evaluate if the effect of human head or tongue posture has an effect on upper airway dimensions and morphology in CT, CBCT or MRI. Study quality assessment was performed. Predictor variable was head and tongue posture. Endpoints were numerical values of upper airway dimensions and morphology. RESULTS: Overall 1344 articles (Embase 1063, PubMed 269, and Cochrane 12) resulted in four included publications. Quality assessments revealed poor quality and low-level evidence by 46 - 67% of the maximum achievable score. Heterogeneous methodology made a meta-analysis impossible, consequently a narrative synthesis was performed. CONCLUSIONS: Limited, poor quality and low evidence level literature is available on the effect of head posture on upper airway dimensions and morphology in three-dimensional imaging. Valid evidence requires a standardized method of head and tongue posture during image acquisition in future studies.

INTRODUCTION: Patients with juvenile idiopathic arthritis (JIA) and involvement of the temporomandibular joint (TMJ) often experience abnormal facial growth. Three-dimensional (3D) assessment of dentofacial growth deviation has become more common with advancement and commercialization of imaging technologies. However, no standardized guidelines exist for interpretation of 3D imaging in patients with JIA. The aim of this study was to propose and validate morphometric measures for the 3D radiographic assessment of dentofacial growth deviation in patients with JIA to enhance: 1) Description of dentofacial growth deviation; 2) Treatment planning; 3) Longitudinal follow-up. METHODS: The study was conducted in a standardized sequential-phased approach involving: 1) Preliminary decision-making; 2) Item generation; 3) Test of content-validity; 4) Test of reliability; 5) Test of construct validity; 6) Establishment of final recommendations. RESULTS: Twenty-one morphometric measures were evaluated. Based on results of reliability and validity-testing including subjects with JIA (n = 70) and non-JIA controls (n = 19), seven measures received a "high recommendation" score. Those measures were associated with posterior mandibular height, occlusal cant, mandibular asymmetry, mandibular inclination, and anterior/posterior lower face height. Nine other measures were "moderately recommended" and five received a "somewhat recommendation" score. CONCLUSION: Seven morphometric measures were considered very useful in the 3D assessment of growth deviation in patients with TMJ disease associated with JIA. These variables can be used to standardize the description of dentofacial deformities and to plan corrective interventions.