Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gra-dients. Objectives: This multicenter study aimed to describe caries experience, malocclusions, and oral hygiene status in pediatric populations residing in three Italian regions and to develop and preliminarily evaluate the feasibility of an integrated care pathway for the prevention and management of caries and malocclusions. Materials and Methods: Within the Italian Centre for Diseases Control and Prevention (CCM) 2024 program (ID 10), 795 children aged 6–11 years were examined in school settings and via mobile dental units. Caries experience was assessed using the dmft/DMFT indices and International Caries Detection and Assessment System (ICDAS) criteria. Malocclusions were evaluated using the Index of Orthodontic Treatment Need (IOTN). Oral hygiene was assessed through standardized clinical indices. The proposed care pathway comprises three tiers: (1) universal, school based oral health education; (2) targeted clinical preventive and interceptive interventions; and (3) telemedici-ne/AI supported follow up for high risk children. Descriptive and multivariable statistical analyses were performed. Results: Overall caries burden was low. No statistically significant differences in dmft/DMFT were observed between males and females. A non significant trend toward higher caries indices was found among children with a positive breastfeeding history. By contrast, oral hygiene level was strongly associated with caries indices: children with insufficient hygiene had the highest dmft/DMFT, those with mediocre hygiene showed intermediate values, and those with optimal hygiene presented the lowest caries expe-rience. In multivariable models, oral hygiene emerged as the main independent pre-dictor of dmft/DMFT. Conclusions: In this low caries cohort, oral hygiene was confirmed as the principal mo-difiable determinant of caries risk. A tiered, school and community based care pathway focused on hygiene promotion, early screening, and minimally invasive clinical inter-ventions appears feasible and potentially scalable, with the aim of reducing the burden of caries and malocclusions and improving equity in pediatric oral health.

Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gradients. Objectives: This multicenter study aimed to describe baseline caries experience, malocclusions, and oral hygiene status in pediatric populations residing in three Italian regions and to develop and preliminarily evaluate the feasibility of an integrated care pathway for the prevention and management of caries and malocclusions. Materials and Methods: Within the CCM 2024 program (ID 10), a cross-sectional baseline assessment was conducted on 795 children aged 6-11 years, examined in school settings and via mobile dental units. Caries experience was assessed using the dmft/DMFT indices and International Caries Detection and Assessment System (ICDAS) criteria. Malocclusions were evaluated using the Index of Orthodontic Treatment Need (IOTN). Oral hygiene was assessed through standardized clinical indices. The proposed care pathway comprises three tiers: (1) universal, school-based oral health education; (2) targeted clinical preventive and interceptive interventions; and (3) telemedicine/AI-supported follow-up for high-risk children. Descriptive and multivariable statistical analyses were performed. Results: At baseline, overall caries burden was low. No statistically significant differences in dmft/DMFT were observed between males and females. A non-significant trend toward higher caries indices was found among children with a positive breastfeeding history. By contrast, oral hygiene level was strongly associated with caries indices: children with insufficient hygiene had the highest dmft/DMFT, those with moderate hygiene showed intermediate values, and those with optimal hygiene presented the lowest caries experience. In multivariable models, oral hygiene emerged as the main independent predictor of dmft/DMFT. Conclusions: In this low-caries cohort, oral hygiene was confirmed as the principal modifiable determinant of caries risk. A tiered, school- and community-based care pathway focused on hygiene promotion, early screening, and minimally invasive clinical interventions appears feasible at baseline and may be scalable, with the aim of reducing the burden of caries and malocclusions and improving equity in pediatric oral health.

Background: Treatment of peri-implantitis remains challenging because biofilm removal from microstructured implant surfaces is often incomplete. The present study is an uncontrolled, prospective feasibility case series involving six patients (six implants), not a controlled clinical trial, in which short-term clinical outcomes following use of a multimodal protocol to decontaminate the titanium implant surface were obtained; consequently, the independent contribution of the Ximplant® device to the observed outcomes cannot be determined. The protocol comprised surgical access, mechanical debridement, chemical conditioning, systemic administration of medication, and cleaning with an alternating-current device (Ximplant®; LED, S.p.A., Aprilia, Italy). Methods: Six adults with peri-implantitis, each contributing one implant, were consecutively treated using the multimodal protocol. Probing depth (PD), bleeding on probing (BOP), plaque index (PI), and suppuration (SU) were determined at baseline, 3 weeks, 6 months, and 12 months. Longitudinal changes were analyzed using repeated-measures analysis of variance and non-parametric tests for categorical variables. Results: Mean total PD decreased from 4.56 ± 0.45 mm at baseline to 3.03 ± 0.44 mm at the 3-week follow-up and remained stable at the 6-month follow-up (3.08 ± 0.35 mm) and at 12-month follow-up (3.19 ± 0.41 mm; p < 0.0001). BOP and SU were absent in all implants at each follow-up visit. PI improved markedly, although the buccal aspect of one implant was PI-positive at the 3-week and the 12-month follow-up. Conclusions: The multimodal protocol used in this study was associated with rapid and sustained clinical improvement over the 12-month follow-up period. A study limitation is that because the individual parts of the protocol were applied concurrently, the independent contribution of any of them to the outcomes determined could not be isolated.

Introduction: Malocclusion and dysfunctional or atypical swallowing are two conditions that significantly affect the health and well-being of the stomatognathic system, so much so that they often interact, influencing each other, and the presence of one can cause the onset or aggravation of the other. In this regard, over the years studies have been carried out that tried to discover the correlation between atypical swallowing and malocclusion. The aim is to evaluate the prevalence of dysfunctional swallowing in patients with malocclusion, to examine the pathophysiological mechanisms linking malocclusion and dysfunctional swallowing, and above all to investigate what potential risk factors may be. Materials and Methods: A sample of 60 patients aged between 6 and 16 years was analyzed at the Department of Dentistry of the University of L'Aquila. Some characteristics of the subjects' face and posture were analyzed both from a frontal and lateral point of view. An orthodontic, temporomandibular joint, and masticatory muscle diagnosis was made. In addition, an examination of oral structures and functions was performed that allowed breathing, swallowing, chewing, and phono-articulation to be assessed. Results: It was observed that all the children had atypical swallowing, with significant postural abnormalities of the tongue; in fact, only 5% had a correct posture of the tongue at rest. In the analysis of occlusal characteristics, it emerged that with regard to the transverse plane, 21.67% of subjects have a condition of No Cross, while 10% show a Unilateral Cross. Finally, 68.33% show a Bilateral Cross. As far as the anterior-posterior plane is concerned, most of the subjects, equal to 76.67%, are placed in Class I, while 23.33% are in Class II. Finally, in relation to the vertical plane, 63.33% of subjects have normal occlusion, while 25% suffer from deep bite and 11.67% from open bite. The sample, stratified by presence or absence of alerts, shows significant differences for atypical swallowing (p = 0.031), for the presence of Class II malocclusion (p = 0.002), for low lingual posture, (p < 0.001), and for labial incompetence (p = 0.001). The multivariate logistic regression model showed that the presence of atypical swallowing (OR 1.04, 95% CI 1.04-1.07, p = 0.029), open bite malocclusion (OR 1.09, 95% CI 1.01-1.18, p = 0.013), low lingual posture (OR 1.11, 95% CI 1.04-1.18, p = 0.002), and the presence of labial incompetence (OR 1.06, 95% CI 1.02-1.10, p = 0.029) were significant clinical risk factors independently associated with the presence of alerts. Conclusions: The data collected confirm that atypical swallowing is a key element in the development of malocclusions, with a strong impact on posterior crossbite, anterior overjet, and other occlusal discrepancies. Among the data collected in the diagnostic phase, patients who presented at least one significant alert were also considered and atypical swallowing, low lingual posture, open bite malocclusion, and the presence of labial incompetence were statistically significant.

This study examines the relationships between the lower first molar, the condyleramus height, and the coronoid process of the mandible. It is based on the idea that craniofacial structures maintain consistent anatomical proportions, which could assist in orthodontic and prosthetic rehabilitation. The first molar is considered crucial to occlusion development, with its position possibly reflecting underlying skeletal patterns. Materials and Methods: A pilot clinical trial was carried out at the University of L’Aquila using CBCT scans from 27 adult patients. Measurements were taken at four points: - A: Top of the mandibular condyle - B: Mandibular angle - C: Buccal surface of the first lower molar - D: Coronoid process on the opposite side. Distances AB (condyle to angle), BC (angle to first molar), and CD (coronoid to molar) were calculated. Scans with asymmetries or artifacts were excluded to ensure consistency. Results: Patients were categorized by Angle’s classification: - **Class I (n=14)**: AB/BC average around 55.9 mm; CD approximately 84.7 mm - **Class II (n=7)**: AB/BC average about 55.2 mm; CD around 86.5 mm - **Class III (n=6)**: AB/BC average roughly 61.6 mm; CD approximately 90.6 mm In 85% of cases, point C (molar location) was found in the mesial half of the first molar. While AB and BC measurements correlated strongly (indicating a predictable molar location), no significant correlation was found between CD and the other distances. Discussion. The study confirms a consistent anthropometric relationship between the condyle, mandibular angle, and the lower first molar. This suggests that the position of the lower first molar is structurally determined and should guide orthodontic and prosthetic treatments. Therefore, clinicians should focus on maintaining or restoring this natural alignment in treatments, including implants or dentures. Conclusion: The position of the mandibular first molar demonstrates a consistent geometric relationship with skeletal landmarks. This anatomical constant should be utilized in clinical practice to improve long-term treatment outcomes in orthodontics and prosthodontics.

Aim: The purpose of the present study is the three-dimensional (3D) analysis of molar and incisor movements that occur during the correction of the upper midline deviation by using the Mesial-Distalslider appliance. Materials and Methods: A total of 20 consecutive patients (12 women and 8 men; mean age 19.6 ± 11.1 years) were selected from the Orthodontic Department of Heinrich-Heine University of Düsseldorf. To correct the upper midline deviation (>2 mm), the patients were treated with asymmetric mechanics (mesialization on one side and distalization on the contralateral side) with the aid of Mesial-Distalslider. Dental casts were taken for each patient before (T0) and after the treatment (T1). The casts were 3D digitized and the models were superimposed on the palatal anterior region. Three-dimensional molar movements and sagittal incisor movements (proclination and retroclination) were assessed for T0 and T1. Results: At the end of the treatment, the total movements of the molars resulted in 4.5 ± 2.2 mm (antero-posterior direction), −0.4 ± 2.4 mm (transverse direction) and 0.3 ± 0.9 mm (vertical direction) on the mesialization side, and −2.4 ± 1.7 mm (antero-posterior direction), −0.5 ± 1.5 mm (transverse direction) and 0.2 ± 1.4 mm (vertical direction) on the distalization side. Incisor displacement was 0.9 mm ± 1.7 (mesialization side) and 0.6 mm ± 0.7 (distalization side). Conclusion: The Mesial-Distalslider appliance could be considered a valuable tool in orthodontic treatment for upper midline correction. Within the limits of a retrospective study, asymmetric molar movements appeared possible without clinically relevant anchorage loss.

Objective Since its introduction 25 years ago, the Invisalign® system has undergone multiple digital and biomechanical evolutions and its effectiveness is often compared to traditional systems without considering the many differences which characterize them. The main aim of this systematic review is to look at the literature dealing with studies on teeth movements using the Invisalign® system and the management of these movements through digital planning and artificial intelligence. Materials and methods The following electronic databases were searched: MEDLINE, Embase, the Cochrane Oral Health Group’s Trials Register, and CENTRAL. Unpublished studies were searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. Results Twenty-four studies (15 retrospective, 5 prospective, 2 pilot, and 2 case–control) were included. The results of the analysis carried out on the available literature show that the Invisalign® system is recognized to be a valid alternative to conventional orthodontic treatment in no-extraction cases. The results are influenced by the methods for assessing the effectiveness of this technique and by the comparison bias of the traditional system with the innovative digital system. Conclusions Since the introduction of SmartForce and SmartTrack material, the efficacy of the treatment has improved. There is still a shortage of high-quality evidence concerning the treatment modality. In order to make the treatment with the aligners more efficient, a correct management of the ClinCheck® software and a proper use of the biomechanics are necessary. The aligned force-driven system should be taken into account when developing the digital planning.

Dental decay is a prevalent bacterial disease affecting a significant percentage of children globally. In paediatric dentistry, various materials are available for restoring deciduous teeth, addressing both functional and aesthetic concerns. However, paediatric dentists encounter challenges related to patient compliance, limited working time, and material handling. This study aims to observe the survival rate of bulk-fill composite restorations in paediatric patients over a five-year follow-up. A total of 198 patients aged 0 to 12 years underwent 673 class II restorations on deciduous first molars (1M) and second molars (2M). All restorations were conducted performed by 1 Pediatric DDS resident students from the Paediatric Dentistry Department (Padova University), utilizing using different isolation techniques. Bulk-fill composite restorations were evaluated over a five-year follow-up, and data were collected by a single investigator. After five years, 177 patients and 611 restorations were assessed. The retention rate was higher in primary second molars than in first molars, with fewer marginal dyschromies and less formation of secondary caries. The overall failure rate was higher in primary first molars and primary lower second molars. Bulk-fill composites demonstrated significantly positive performance in terms of retention, maintenance, and marginal dyschromies. Bulk-fill composites are promising materials of choice in paediatric dentistry due to their easy handling and favorable properties. Further research is necessary to compare high and low viscosity bulk-fill composites and assess the impact of different variables on restoration success.

Background: The injection of local anesthetics is the procedure that still causes the most fear and anxiety in a dental session; to minimize this problem, we can use topical anesthesia. The aim of this study is to analyze the tolerability and the clinical efficacy in the control of pain, during the subsequent injection of the local anesthetic, of an experimental anesthetic patch with a new formulation, which was previously tested in gel formula. Methods: A total of 150 children, aged 4 to 9 years, were included in the study. Each patient was treated using three different pre-anesthesia methods (placebo gel, experimental gel, and experimental patch), according to a split-mouth procedure, within a week of each other. The injection pain was analyzed using the WBFPRS and FLACC scales. Patients’ caregivers’ satisfaction was recorded at the end of the procedures. The data were analyzed using one-way ANOVA-RM, Wilcoxon–Mann–Whitney, Mann–Whitney U, and χ2 tests. Results: In this study, significantly higher pain ratings were observed with the topical placebo gel and lower pain ratings were observed with the experimental patch. Conclusion: The use of the patch proved to be very effective in reducing pain both subjectively and objectively, in the absence of both local and systemic side effects, validating its use in the oral mucosa.

Background: Mucositis and peri-implantitis are pathologies that may be encountered during dental implant rehabilitation. Therapeutic strategies for their resolution range from non-surgical to surgical treatments and aimed at eliminating the biofilm from the implant’s surface, through mechanical, chemical or photodynamic agents. Aim: The aim was to evaluate the effect of the electric field generated by the Ximplant machine on the bacterial load and on the biofilm grown on dental implants. Materials and Methods: Ten dental implants were brought into contact with a donor’s saliva, then five implants were treated with the electric field and four were not treated. Bacterial biofilm was then measured by resazurin assay, both on treated and untreated implants. Results: The study showed the preliminary success of the electrofield in reducing the microbial population and destroying the clinical biofilm, compared with a sterile implant as control.

The term hypomineralisation of molars and incisors (MIH), introduced in 2001 by Weerheijm et al., describes a clinical state of hypomineralisation of permanent molars with frequent involvement of the incisors. MIH is considered a global dental problem with a prevalence ranging from 2.4% to 40.2% in the entire world paediatric population. The continuous increase in the prevalence of enamel anomalies, including MIH, indicates the need to define new intervention protocols based on the technological advances that are revolutionising paediatric dentistry. The use of ozone associated with the selective and minimally invasive excavation of the dental tissue combines the antibacterial properties of the gas with an ultra -conservative approach aimed at the maximum conservation of the dental tissue. The operative protocol described can be an important tool in the prevention and treatment of MIH. The aim of this work is to illustrate an operative clinical protocol based on the combined use of selective excavation and ozone for the treatment of carious lesions in paediatric patients with MIH.

The intraoral scanner represents an important innovation in the world of dentistry, capable of transforming and digitizing conventional workflows and significantly improving communication with the patient, especially in pediatric age. The aim of this study is to investigate how digital dentistry, using the intraoral scanner, can interact in the communicative trinomial dentist–pediatric patient–parents and how this tool can be useful in communicating and understanding the received message. The value of the introduction of digital dentistry on communication schemes is evaluated by administering a questionnaire of 17 questions. A sample of 100 children aged between 6 and 12 years was studied. Of the sample of children/parents included in the study, 50 were re-examined 4 weeks after the first visit to re-administer the questionnaire. Internal consistency, assessed through Cronbach’s alpha, was adequate, being alpha equal to 0.728. Test–retest reliability was assessed with Cohen’s kappa index for dichotomous variables (percentage of agreement was >85.71%), and for the discrete variables it was assessed with the Intraclass Correlation Coefficient (ICC). The reliability was moderate (0.5 < ICC < 0.75) for Q4, Q9, Q11 and Q1; for the other answers, the reliability was poor (ICC < 0.5) and not statistically significant. The digital approach is confirmed not only as a powerful innovation from an engineering or clinical point of view, but also as a useful tool for a more effective communication in the approach to pediatric patients.

Aim The aim of this article is to compare the performance of ZeroExpander (R) realised using PEEK or PA12 for the expansion of the maxilla in paediatric patients, exploring a new concept for approaching maxillary expansion with a metal-free fixed automatic appliance, based on pre-programmed set-up and anchored on deciduous teeth. Matherial and Methods It is a retrospective comparative study with a sample of 40 children in early or mixed deciduous dentition and transversal maxillary deficit, 20 treated with ZeroExpander (R) in PEEK and 20 treated with ZeroExpander (R) in PA12 with a mean age of 7.3 years old. The intraoral scans at T0 and at the end of the expansion were all performed by the same operator to obtain digital models on which were performed measurements by two other different operators. A descriptive analysis was conducted using frequencies and percentages for nominal variables and means and standard deviations for continuous variables. Results A comparison between the two treatments highlighted a different response for variable C, with higher expansion values for PEEK. However, variables D, E and 6 degrees did not show statistical significance. The performed anchoring does not show significant differences in achieving the total set up, whether there is anchoring on the C or not, itself as proof of an expansion similar to what is seen in an orthopaedic expansion. The statistical analysis showed that PEEK and PA12 leads to overlapping results in terms of palatal expansion. The cementation of PEEK devices was more complex, due to their minor flexibility and this led clinicians to prefer ZeroExpander (R) in PA12 afterwards, because of its greater ease of bonding due to the surface microroughness. Conclusion In cases of allergy or hypersensitivity to metals or to specific chronic or acute pathological conditions, which may require periodic magnetic resonance imaging (MRI), it may not be possible to use traditional and metal fixed expansion devices. Moreover the concept of autonomous driving in paediatric orthodontics is not only possible, but it is and will be more real and very useful in the future. The "ortho-paediatric dentistry concept" will increase the range of benefits for children and their families which, in addition to care and thanks to technology, demand well-being, safety, comfort and quality of life beyond clinics.

The aim of the present study was to test a new topical anesthetic gel with a different formulation (10% lidocaine, 10% prilocaine) to analyze its effectiveness in pain control, during the subsequent injection of local anesthetic, and the presence of any side effects. Methods: The study’s research design was a randomized controlled clinical trial on 300 children, aged 5–8 years, divided into two groups, each of 150 patients, according to pre-injection procedures (presence or absence of topical anesthesia). The injection pain was analyzed using the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability Scale (FLACC). At the end of the procedures, patients’ parents’ satisfaction was recorded. The data were analyzed using the Student’s T test, Mann–Whitney U test and Chi-square test. Results: There were statistically significant differences between the two groups both in the PRS and FLACC ratings. Both in subjective and objective pain evaluations, significantly higher pain ratings were observed in the group without topical anesthesia. There was also a statistically significant difference in terms of patients’ parents’ judgment, as in the group with the use of topical anesthetic the level of parental satisfaction is statistically higher. Conclusion: The experimental anesthetic has proved very effective in its use as a topical gel in both pain measurement scales, thus validating its use on the oral mucosa, for its pharmacological and psychological effect, in the total absence of local and systemic side effects.

Novel foods, including edible insects, are emerging because of their nutritional characteristics and low environmental impacts and could represent a valid alternative source of food in a more sustainable way. Edible insects have been shown to have beneficial effects on human health. Insect-derived bioactive peptides exert antihypertensive, antioxidant, anti-inflammatory, and antimicrobial properties and have protective effects against common metabolic conditions. In this review, the roles of edible insects in human health are reported, and the possible applications of these peptides in clinical practice are discussed. A special mention is given to the role of antimicrobial peptides and their potential applications in controlling infections in orthodontic procedures. In this context, insects’ antimicrobial peptides might represent a potential tool to face the onset of infective endocarditis, with a low chance to develop resistances, and could be manipulated and optimized to replace common antibiotics used in clinical practice so far. Although some safety concerns must be taken into consideration, and the isolation and production of insect-derived proteins are far from easy, edible insects represent an interesting source of peptides, with beneficial effects that may be, in the future, integrated into clinical and orthodontic practice.

This paper aims to represent the orthodontic treatment of two young patients with skeletal Class I relationship and unilateral impacted canines (case 1 with palatally displaced canine and case 2 with buccally displaced canine). Before starting full-mouth alignment, canines are moved away from the roots of the neighbouring teeth. The protocol involved a surgical phase carried out in order to expose the canine and traction it with TADs (temporary anchorage devices) and an orthodontic phase performed to finalize the alignment. The canines were moved through vertical and distal force vectors by using TADs as well as a cantilever spring. As soon as the crown of the canine was fully visible, digital impressions were taken to start the digital planning of the orthodontic phase. At the end of the treatment, results show a control of the facial aesthetics both from the frontal and lateral perspectives with a harmonious profile. The molar and canine Class I relationship was achieved with the recovery of the impacted canines and the overbite and overjet were normalized.

AIMThe use of sealants is an effective measure for the prevention of pit and fissure caries in children and it has been well documented by several studies In order to plan and establish a preventive national programme, it is important to know the epidemiological pattern in an Italian paediatric population, correlated to the risk of caries, DMFT and other sociodemographic factors.METHODSThis study was conducted on 2,442 children aged between 6 and 12 years attending the paediatric dentistry department of the University of L'Aquila, Italy. In addition to the oral examination, a questionnaire was administered on bad habits and the family perception of sealing. For descriptive analysis, the sample was stratified into two groups based on the presence/absence of at least one tooth with sealant. The differences between discrete and nominal variables, reported as absolute and percentage frequencies, were assessed by applying the χ2 test or the Fisher's exact test, as appropriate. Continuous variables were expressed in terms of mean values and their standard deviation(±DS) and the differences between the two groups under consideration were analysed through Student's t-test. The tests used are two-way and a significance level of 5% was applied. The statistical analysis was carried out using the statistical package STATA/IC 15.0 (StataCorp LLC, Texas, USA).CONCLUSIONThe application of sealants to healthy occlusal surfaces is the best aid in preventing the development of caries in these areas, and this is especially important in childhood and adolescence, when the incidence of this pathology is particularly high.

Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that is very common in pediatric patients. In the literature, there are very few studies concerning the association between OSAS and class III malocclusion in children. The use of a rapid maxillary expander (RME) in association with the Delaire mask is a common treatment protocol for class III malocclusion. The aim of this work was to evaluate the cephalometric variations of upper airway dimensions and OSA-related clinical conditions after orthodontic treatment with an RME and the Delaire mask, as recorded in pediatric patients with a class III malocclusion who were affected by OSAS. In this preliminary study, 14 pediatric patients with mixed dentition, aged between 6 and 10 years, were selected. All patients were treated with an RME and the Delaire mask. Pre- and post-treatment cephalometric radiographs were traced, analyzed, and compared. The results demonstrated a significant increase in the upper airway linear measurements and the nasopharyngeal and oropharyngeal dimensions (p ≤ 0.05). This increase creates an improvement in airway patency and in OSAS-related clinical conditions. The use of the RME in association with the Delaire mask can be effective in the treatment of pediatric patients with a class III malocclusion who are affected by OSAS.

Obstructive Sleep Apnea (OSA) in children needs a multidisciplinary approach. Even if the first-line treatment of pediatric OSA is adenotonsillectomy, nowadays rapid palatal expansion (RPE) is considered a valid additional treatment. The aim of this study is to evaluate cephalometric changes in upper airways dimensions after rapid palatal expansion (RPE) in children suffering from Obstructive Sleep Apnea (OSA). A total of 37 children (range age 4–10 years) with diagnosis of OSA referred to Dentistry Unit of Bambino Gesù Children’s Research Hospital IRCCS (Rome, Italy) were included in this pre-post study and underwent lateral radiographs at the start (T0) and at the end (T1) of a RPE treatment. Inclusion criteria were: diagnosis of OSA confirmed by cardiorespiratory polygraphy (AHI > 1) or pulse oximetry (McGill = >2), skeletal maxillary contraction evaluated by presence of posterior crossbite. A control group of 39 untreated patients (range age 4–11 years), in good general health, was set up. A paired T-test was used to investigate the statistical differences between T0 and T1 values in both groups. The results showed a statistically significant increase of nasopharyngeal width in the treated group after RPE treatment. Moreover, the angle that identifies mandibular divergence compared to palatal plane (PP-MP°) was significantly reduced. In the control group, no statistically significant differences were observed. The present study showed that RPE treatment determines a significant sagittal space increase in the upper airways space and a counterclockwise mandibular growth in children with OSA compared to a control group. These results suggest that a widening of the nasal cavities induced by RPE may support a return to physiological nasal breathing and promote a counterclockwise mandibular growth in children. This evidence confirms the crucial role of the orthodontist in the management of OSA in pediatric patients.