Endoscopic submucosal dissection (ESD) of fibrotic colorectal lesions is difficult and has a high complication rate. There are only a few reports on the utility of orthodontic rubber band (ORB) traction in reducing the difficulty of this procedure. This study aimed to investigate the risk factors for perforation when applying ORB traction during ESD of fibrotic colorectal lesions. We continuously collected the clinical data of 119 patients with fibrotic colorectal lesions who underwent ESD with ORB and clip traction between January 2019 and January 2024. Possible risk factors for perforation were analyzed. The median ORB-ESD operative time was 40 (IQR 28-62) min, and the en bloc and R0 resection rates were 94.1% and 84.0%, respectively. Perforation occurred in 16 of 119 patients (13.4%). The lesion size, lesion at the right half of the colon or across an intestinal plica, the degree of fibrosis, operation time, and the surgeon\'s experience were associated with perforation during ORB-ESD (P < 0.05). Multivariate logistic regression analysis showed that lesions in the right colon (OR 9.027; 95% CI 1.807-45.098; P = 0.007) and those across an intestinal plica (OR 7.771; 95% CI 1.298-46.536; P = 0.025) were independent risk factors for perforation during ORB-ESD. ORB-ESD is an effective and feasible approach to treat fibrotic colorectal lesions. Adequate preoperative evaluation is required for lesions in the right colon and across intestinal plicas to mitigate the risk of perforation.

This study aimed to synthesize a novel elastomeric ligature with dimethylaminohexadecyl methacrylate (DMAHDM) grafted, providing a new strategy for improving the issue of enamel demineralization during fixed orthodontics. DMAHDM was incorporated into elastomeric ligatures at different mass fractions using ultraviolet photochemical grafting. The antibacterial properties were evaluated and the optimal DMAHDM amount was determined based on cytotoxicity assays. Moreover, tests were conducted to evaluate the in vivo changes in the mechanical properties of the elastomeric ligatures. To assess the actual in vivo effectiveness in preventing enamel demineralization, a rat demineralization model was established, with analyses focusing on changes in surface microstructure, elemental composition, and nanomechanical properties. Elastomeric ligatures with 2% DMAHDM showed excellent biocompatibility and the best antibacterial properties, reducing lactic acid production by 65.3% and biofilm bacteria by 50.0% within 24 h, without significant mechanical property differences from the control group (p > 0.05). Most importantly, they effectively prevented enamel demineralization in vivo, enhancing elastic modulus by 73.2% and hardness by 204.8%. Elastomeric ligatures incorporating DMAHDM have shown great potential for application in preventing enamel demineralization, providing a new strategy to solve this issue during fixed orthodontics.

BACKGROUND: Children with autism spectrum disorder (ASD) face unique challenges in oral care. Aligner therapy offers a promising alternative to conventional approaches for this patient group.
OBJECTIVE: To evaluate orthodontic aligner therapy outcomes in children with ASD using the Peer Assessment Rating (PAR) Index and the Index of Complexity, Outcome, and Need (ICON), and to investigate whether concomitant disorders affect ICON, PAR scores, and treatment duration.
METHODS: Two calibrated observers assessed digital dental casts and intraoral pictures of 37 children with ASD before (T0) and after (T1) their treatment. At T0, the participants\' average age was 12.9 years (SD = 1.68); at T1, post-therapy, the average age was 14.9 years (SD = 1.51). All participants underwent orthodontic aligner therapy. Statistical methods employed in this study included descriptive analysis, Wilcoxon tests, and univariate linear regression.
RESULTS: Posttreatment, median ICON scores decreased significantly from 74 to 14, and median PAR scores from 36 to 8 (p < .0001), demonstrating \"excellent to substantial\" improvement in 89.2% (n = 33) of the children. Comorbidities, present in 62% of patients, did not significantly affect treatment duration (22.6 ± 11.02 months).
CONCLUSIONS: Children with ASD significantly benefit from orthodontic aligner therapy, emphasizing the need for tailored orthodontic care.

Background In the contemporary era, where science and technology know no boundaries, this in vivo study explores the impact of growth modulation therapy using Twin Block, Forsus Fatigue Resistant, and Clear Block appliances on alkaline phosphatase (ALP) levels in gingival crevicular fluid (GCF). Bone physiology involves modeling and remodeling, with orthodontics applying forces to teeth, influencing tissue reactivity and bone modeling. ALP, a marker of osteoblast function, plays a crucial role in bone growth. GCF reflects immunological and inflammatory responses during orthodontic force application, making it a valuable medium for studying ongoing metabolic processes related to bone turnover. Aim The study aims to comparatively analyze ALP levels in GCF during growth modulation therapy, assessing the efficacy of Twin Block, Forsus Fatigue Resistant, and Clear Block appliances. The research involves 30 experimental samples divided into three study groups and a control group. The samples are collected at various time intervals, and ALP levels are analyzed using a spectrophotometer. Statistical analysis includes paired and unpaired t-tests, one-way analysis of variance (ANOVA), and multiple comparisons. Results Results demonstrate a significant increase in ALP levels during the growth modulation therapy, indicating a positive correlation with bone remodeling. Twin Block appears to be the most effective appliance, exhibiting higher ALP activity compared to Clear Block and Forsus groups. Conclusion In conclusion, this study provides valuable insights into the biochemical responses during growth modulation therapy, emphasizing the potential of GCF analysis in understanding orthodontic treatment effects.

Nowadays, aligners represent a possible therapeutical approach that combines both esthetic and function in order to address dental malocclusion. However, they require a significant level of compliance from the patient. According to the manufacturer, at least 22 h of wearing a day is demanded to reach the optimal therapeutical level; hence, aligners can only be removed during meals. Patients\' compliance might increase and the duration of the treatment might decrease if they were allowed to eat with aligners on. The idea of patients keeping the aligners on during meals has been contemplated, not only to favor patients\' compliance but also treatment effectiveness. This study aims to assess the degree of chewing difficulty that aligners cause when eating certain kinds of food and the quantity of residue left.
METHODS: A questionnaire titled \"Questionnaire for the Assessment of Masticatory Function with Aligners\" was administered using Google Forms to 240 patients in treatment with clear aligners. The survey was validated through the reliability test using the test-retest method. This method had a higher correlation coefficient of 0.9 across all items (with a cutoff of 0.8) with statistical significance, and an excellent internal correlation coefficient (α > 0.9). The statistical analysis performed consisted of descriptive analysis, frequencies, percentages, Pearson\'s correlation test and Friedman\'s test.
RESULTS: Pearson\'s test showed a statistically significant correlation between all items except between meat or clams and yogurt or ice cream and with mozzarella or soft cheese regarding food chewing difficulties. Pearson\'s test showed a statistically significant correlation between all items regarding food residues. A total of 69.2% of the cohort reported some movements of aligners during mastication. In total, 88.3% of them affirmed not to have perceived deformations or breakage of aligners during chewing. Furthermore, 79.2% of them declared that they would continue to eat if eating with aligners was proven to speed up treatment.
CONCLUSIONS: Wearing clear aligners while chewing foods such as yogurt, ice cream, soft cheese, bread, rice, etc., can be possible and can help shorten the duration of orthodontic treatment, benefiting both the patient and the orthodontist. However, further research using qualitative methods is needed to understand the barriers and facilitators to chewing food with aligners.

OBJECTIVE: The aim of the study was to determine how the electrical activity of the temporalis, masseter and sternocleidomastoid muscles differs in children with reduced transverse jaw dimension compared to children with normal occlusion.
METHODS: It was a experimental study. Thirty-seven patients were included in the study. 18 in the study group received orthodontic treatment with removable appliances and 19 subjects were classified as normal occlusion subjects in the control group. A panoramic X-ray and digital intraoral scan were taken, followed by an surface electromyography of three muscle pairs (temporalis muscles, masseter muscles, sternocleidomastoid muscles) in resting position, while clenching and clenching on cotton rollers.
RESULTS: There was significantly greater activity in the experimental group than in the control group comparing muscles: temporalis muscles and masseter muscles in the resting position. Additionally, significantly greater activity of muscles in the control group was found during clenching. However, the asymmetry index of muscles indicates that there is significantly greater asymmetry of muscles activity in the experimental group. Compared to children with normal occlusion, children with a narrowed transverse dimension of the jaw have statistically significant differences in the bioelectrical activity of the temporalis, masseter and sternocleidomastoid muscles, as well as greater asymmetry in the bioelectrical voltage of the masseter muscles.
CONCLUSIONS: Patients with reduced transverse dimension of the jaw are characterized by increased resting activity of the masticatory muscles and reduced functional activity of the masticatory muscles. These patients have increased asymmetry in the bioelectrical tension of the masticatory muscles.

UNASSIGNED: To assess thickness variations of thermoformed and 3D-printed clear aligners.
UNASSIGNED: Six different thermoplastic materials with different initial thicknesses were used for aligner thermoforming using Biostar® device (Biostar®, SCHEU-DENTAL GmbH, Iserlohn, Germany). Also, two different dental resins were used to create the printed aligners in three digitally designed thicknesses using IZZI Direct printer (3Dtech, Zagreb, Croatia). The aligners were measured using an electronic micrometer (ELECTRONIC UNIVERSAL MICROMETER, Schut Geometrical Metrology, Groningen, The Netherlands, accuracy: 0.001 mm) on a total of 20 points per aligner. Statistical analysis was performed using the JASP program (JASP, University of Amsterdam, Amsterdam, The Netherlands).
UNASSIGNED: The difference between the thermoformed and printed groups was statistically significant. Significant differences between different thermoformed materials and between 3D-printed materials were found. The thickness of thermoformed aligners deviated more in the upper jaw, whereas the thickness of printed aligners deviated more in the lower jaw. Both differences were statistically significant. The greatest average deviation from the initial thickness was found in Duran 0.75; Erkodur 0.6; Erkoloc-Pro 1.0; IZZI 0.5; NextDent 0.6 and NextDent A 0.6. NextDent group had the lowest deviations for all teeth of both jaws, except for upper and lower first molar where NextDent A group was more accurate.
UNASSIGNED: Thermoformed aligners showed decreased values, while printed ones showed mostly increased values compared to the original material thickness. The highest mean deviation belonged to IZZI group, and the NextDent group had the lowest mean deviation. The thickness of both aligners was thinner at the edges compared to the thickness at cusps and fissures.

UNASSIGNED: We aimed to assess the impact of the COVID-19 pandemic on the concern of adolescents in orthodontic treatment, and to determine whether personality traits and parental perception were predictors of adolescent patients\' concerns.
UNASSIGNED: The sample consisted of 229 adolescent patients (57.2% female) and 223 parents (65.1% female). Questionnaires included items about the importance of infection control and concern about treatment duration and results. Their latent structure was determined using exploratory factor analysis. The Big Five Inventory was used for assessing personality traits. Predictors of patients\' and parental orthodontic concern and awareness of the importance of infection control measures were tested by the hierarchical multiple regression analysis.
UNASSIGNED: Two factors were revealed for the patient questionnaire, Treatment concern (TC) and Awareness of the importance of measures (AM), and four factors for the parent questionnaire, Parents\' treatment concern (PTC), Parents\' awareness of the importance of measures (PAM), Parents\' concern about the pandemic (PCP) and Parents\' concern about their child with regards to the pandemic (PCC). Adolescents\' personality traits were not predictors of either TC or AM. PTC was a predictor of TC (p<0.001), accounting for 28% of the variance. PAM and the patient\'s following of the news were predictors of AM (p≤0.022), accounting for 24% and 2% of the variance, respectively.
UNASSIGNED: Parental concern and awareness of measures had an important role in attitudes of adolescent orthodontic patients during the COVID-19 pandemic, while personality traits did not. The clinician should put additional emphasis on communication with the parent.

BACKGROUND: This article analyzes differences in microbiological parameters and periodontal health conditions among three patient groups: those undergoing conventional orthodontic treatment with fixed appliances, patients undergoing orthodontic treatment with clear aligners, and a control group receiving no treatment.
METHODS: In this study, 60 patients were enrolled. The microbiological analysis employed a qualitative and semi-quantitative methodology of bacterial morphotype analysis.
RESULTS: The analyses revealed a significant difference in favor of clear oral and periodontal health aligners. This could be attributed to better bacterial biofilm removal and reduced mechanical stress on the periodontal ligament, factors facilitated by the ease of clear aligner removal. Significant differences (p-value < 0.05) were observed for the Full-Mouth Plaque Score, Full-Mouth Bleeding Score, Plaque Index, and periodontal health assessment measurements.
CONCLUSIONS: Although overall hygiene appears to be improved in patients in the aligners group compared to those treated with conventional orthodontic appliances, there are no statistically significant results regarding plaque composition. Microbiological aspects will be further addressed using more specific techniques in the follow-up of this research.

Obstructive sleep apnea (OSA) can affect children and adults, and, if left untreated, could have a major impact on the general and overall well-being of the patient. Dental health care providers and orthodontists have an interdisciplinary role in screening patients at risk for OSA and make a referral to establish a definitive diagnosis by a sleep physician. The gold standard of diagnostic testing is polysomnography. The adeno-tonsillar hypertrophy is the primary cause of sleep apnea in children; therefore, adeno-tonsillectomy must be the first line of treatment. Post adeno-tonsillectomy, if there is residual OSA due to underlying skeletal discrepancy, the patient may be referred to an orthodontist for appropriate management. Currently the evidence in the literature for prophylactic growth modification in children to prevent OSA is weak. In adults, the gold standard for managing OSA is Positive Airway Pressure (PAP) therapy; however, adherence to this treatment is rather low. The oral appliance (OA) therapy is an alternate for PAP intolerant patients and for mild to moderate OSA patients. The OA therapy has to be administered by a qualified dentist or orthodontist after careful examination of dental and periodontal health as well as any pre-existing joint conditions. The OA therapy could cause OA-associated malocclusion and patients have to be made aware of prior to initiating treatment. In patients with severe OSA, surgical maxilla-mandibular advancement (MMA) is highly effective.