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com

MASTER CLINICIAN
Mauro Cozzani, DMD, MScD
(Editor’s Note: Associate Editor Peter Sinclair conceived this department devoted
to recognizing the Master Clinicians who have made the orthodontic specialty
what it is today. He will delve into the career story and treatment principles of one
of these seminal figures. We welcome your nominees for future Master Clinicians.)

It gives me substantial pleasure to introduce tion the food and wine!). I met many highly capable
my friend and colleague, Dr. Mauro Cozzani, as our orthodontists, but one who stands out as singularly
current Master Clinician. A number of years ago, impressive is Dr. Cozzani. In the years since I first
shortly after I was named Editor of JCO, I was in- met him, he has been a frequent contributor to the
vited to lecture in the Department of Orthodontics pages of JCO and other international orthodontic
at the University of Ferrara, Italy. I eventually made publications, having published more than 80 papers.
several trips to Italy and, during the course of my Dr. Cozzani earned his degree in dentistry at
visits, gained a deep appreciation for the country, the University of Milan and gained his specializa-
its customs, and, especially, the people (not to men- tion in orthodontics at Boston University. He re-
ceived the Diplôme Université d’Orthodontie from
the University of Burgundy in Dijon, France; at-
tended the Corso di Perfezionamento in Ortodonzia
Intercettiva at the University of Parma; and earned
his European specialization in orthodontics at the
University of Ferrara. A member of several inter-
national orthodontic associations, he is a past Pres-
ident of the Italian Association of Orthodontic Spe-
cialists and of the Italian Board of Orthodontics, a
former Chairman of the Examiners and President
of the European Board of Orthodontists, and a
Diplomate of the American Board of Orthodontics.
Dr. Cozzani was Founder and President of
the Italian Academy of Orthodontics, and he
served for three years as co-editor of Progress in
Dr. Cozzani Dr. Sinclair Orthodontics. He has given numerous lectures all
over the world, including at AAO annual sessions.
Dr. Cozzani is a Full Professor of Orthodontics and Director,
Master’s Program in Clinical Dentistry Orthodontics, LUdeS
He has written one book, along with five chapters
Foundation Higher Education Institution, Kalkara, Malta, and in the in other orthodontic texts. For more than nine
private practice of orthodontics in La Spezia, Italy. Dr. Sinclair is an
Associate Editor of the Journal of Clinical Orthodontics and a
years, he has conducted research activity at the
Clinical Professor, Advanced Orthodontic Program, Division of Centro Studi e Ricerche di Ortodonzia in La Spe-
Endodontics, Oral and Maxillofacial Surgery, and Orthodontics,
School of Dentistry, University of Southern California, Los Angeles;
zia, Italy, focusing on molecular biology and bone
e-mail: sinclair@usc.edu. regeneration. His clinical interests include early

VOLUME LI NUMBER 1 © 2017 JCO, Inc. 11


MASTER CLINICIAN

treatment, non-compliance devices, skeletal an- gested that I study orthodontics in Dr. Gianelly’s
chorage, self-ligating brackets, and clear aligners. department.
Dr. Cozzani is particularly proud, and right- Dr. Gianelly was Chairman of the Ortho-
fully so, that he is the Founding Director of a new dontic Department at Boston University, where I
three-year master’s degree program in orthodon- got my postgraduate education. It is my personal
tics, taught in English, at the LUdeS Foundation opinion that to be a good educator and an excellent
Higher Education Institution in Malta. I am hon- chairman, one should be an outstanding clinician
ored to know Dr. Cozzani and to count him among (Dr. Gianelly was a DMD, an MD, and an Angle
my friends. RGK East Society active member), a good researcher (he
had a PhD in biochemistry), and a fantastic com-
municator. Moreover, one should love orthodontics.
DR. SINCLAIR Who were your mentors? Unfortunately, all these qualities are not enough.
In fact, young residents are demanding and hyper-
DR. COZZANI My father Giuseppe was an or- critical, so one should also have a strong leadership
thodontist, one of the first Italians who used fixed personality and be an exceptional human being.
appliances; he took the Tweed course in 1970. He Dr. Gianelly had all these prerequisites.3
founded a private school that taught fixed ortho- I feel I had the best teacher I could have had,
dontics to a large number of colleagues in the and I, of course, always considered him an ex-
1970s, ’80s, and ’90s (the first orthodontic pro- ample, and not just in the professional field. In fact,
gram in Italy was established in 1974). It is very Dr. Gianelly had the rare ability to transmit values
probable that he was the first Italian to be pub- through his example, his personality, and his cha-
lished in AJO.1 He founded the Angle Society of risma. He was able to positively affect the lives of
Europe with some colleagues and was the Presi- everyone who knew him. He was a giant in ortho-
dent and a representative of the Italian Society of dontics, a teacher for many, and a second father for
Orthodontics, and, consequently, the cofounder of me. Until his death, we were in constant contact.
the World Federation of Orthodontists in San Fran- I have to admit that any time I had to make an
cisco in 1995. important decision in my life, I talked to Dr. G.
In the late ’60s, he met Anthony A. Gianelly,
who became one of his best friends (Fig. 1). They
wrote a book that was a best seller in Italy.2 When
I graduated from dental school, my father sug-

Fig. 2 A. Non-occluding surfaces between cen-


tral incisors. B. Occluding surfaces between
Fig. 1 Drs. Anthony A. Gianelly and Giuseppe molars, with cusps and fossae in contact more
Cozzani. than 1,000 times per day.

12 JCO/JANUARY 2017
Mauro Cozzani, DMD, MScD

DR. SINCLAIR What is your orthodontic phi- Our final wire is .018" × .022" stainless steel. Ef-
losophy, and how does it guide you? ficient 3D control of a tooth is easier when com-
pletely filling the slot, while an undersize wire for
DR. COZZANI Teeth are different due to mor- premolars and molars allows those teeth to settle,
phology, and their function is different, so why following function.
should we use the same brackets for all teeth? We
need to control different teeth in different ways.
The three-dimensional control of incisors should DR. SINCLAIR What diagnostic principles do
be absolute. Incisors don’t have an occluding sur- you follow, and why?
face, making it crucial to control rotation, torque, DR. COZZANI When we visit a patient for the
tip, and in-out to obtain a correct overjet and first time, we look at facial esthetics. Our first
overbite and, as a consequence, functional incisor question is about facial harmony, especially a bal-
guidance. anced profile. We know we can change the lower
Premolars and molars do have occluding third of the face only and, very often, not in a very
surfaces, with cusps and fossae that come into relevant way without surgery. Incisor position can
contact more than 1,000 times per day when swal- make the difference. Ideally, the upper lip should
lowing (Fig. 2). Moreover, because dental arches stay in front of the esthetic line, as defined by
become shorter and wider, and posterior torque Gianelly: 2-3mm in females and 4-5mm in males.5
changes with age,4 premolar and molar torque is If the patient shows a protrusive upper lip, we
determined by function and growth. In this area, can hypothesize that the option of extraction can’t
it is critical to ensure that contact points are at the be excluded. On the contrary, in a case of a retru-
same level, that roots are within the cortical bone, sive upper lip, strict control of the upper-incisor
and that cusps and fossae are aligned to avoid pre- position is important to avoid worsening the profile.
maturities. After this evaluation, we analyze the lower
Finally, it is crucial to maintain the archform. arch and, in particular, crowding, lower-incisor
For that reason, we prefer to use .018" slots on in- position, midline, and curve of Spee (Table 1).
cisors and .022" slots on premolars and molars. It is well known that lower-arch expansion is
at risk of relapse. Archform and intercanine width
must not be changed.6,7 In a case of moderate or
TABLE 1 severe crowding, we consider extraction the only
TREATMENT PLAN ACCORDING reliable option, even if the profile analysis resulted
TO GIANELLY BIDIMENSIONAL in a nonextraction treatment plan. Changes in the
TECHNIQUE lower arch influence upper-lip position. To obtain
a correct overjet, the more the lower incisors are
Right Left retracted, the more the upper front teeth and lip
need to be retracted. We have to estimate the real
1. Crowding risk of worsening the profile and the consequent
2. Curve of Spee available treatment options to keep this risk lower,
3. Midline which include extractions in the buccal and poste-
rior areas or strict torque control of the front teeth.
4. Profile
When we assess if surgery could be an option,
5. Space required we discuss it with the patient and parents, who make
6. Extraction/expansion an educated decision whether or not to accept a
7. Lower-molar movement compromised result by weighing the pros and cons.
In conclusion, anteroposteriorly, we use the
8. Molar relationship
nasolabial angle as a reference as described by Dr.
9. Upper-molar movement Gianelly, while transversely, our limit is the man-

VOLUME LI NUMBER 1 13
MASTER CLINICIAN

A B C

Fig. 3 Margolis’s mandibular plane-occiput (M-OCC) angle. A. In normodivergent patient, M-OCC meets
occipital bone. B. In hyperdivergent patient, M-OCC lies within cranium. C. In hypodivergent patient, M-
OCC lies outside cranial structures.

dibular intercanine distance, which we don’t like control when the working wire (.018" × .022" high-
to expand. Our vertical reference is the mandibular ly tempered stainless steel) is inserted. In fact, the
plane-occiput angle as described by Margolis (Fig. play between the wire and slot is approximately
3). When we consider crowding, the mandibular 5°.9 At the same time, the larger slots of brackets
arch is our guide and only reference. bonded to the premolars and molars (.022" × .028")
create a predominance of occlusal forces during
DR. SINCLAIR What are the most important the interaction between slot and wire. Therefore,
mechanical principles to employ in leveling, align- the posterior teeth can settle in a stable position
ing, closing, finishing, and retention? during the period in which the final wire works.
If torque control is required in the premolar or
DR. COZZANI The milestone of a good treat- molar area—for example, during preparation of an
ment result is a correct diagnosis. After having asymmetrical patient for surgery to decompensate
defined clinical problems, we establish if and how premolar and molar torque—we make a 90° bend
we can correct the malocclusion. The identification in an .018" × .022" wire. We again fill the slot
of critical clinical factors permits us to forecast the completely, using an .022" × .018" wire in an .022"
probability to reach the treatment plan objectives. × .028" slot (Fig. 5). The combination of the verti-
A good technique is a fundamental tool to reach cal slot (V-slot) with the horizontal slot allows the
our goals, but only when the objectives and risks use of uprighting springs for each tooth when ad-
are well known. ditional anchorage control is required.
The Bidimensional technique is based pri- Dr. G’s technique is versatile. Slot dimension,
marily on a specific slot prescription in frontal and combined with uprighting springs inserted in the
posterior areas, and then on archwire sequence. V-slots, allows us to “play” with anchorage. We
Both are justified by biomechanical principles.8 As can choose which tooth to move and which one to
in many techniques, the first step of alignment keep stable. We can decide to close a space on the
requires undersize wires to maintain wire elastic- left side in the upper or lower arch and to anchor
ity and to allow the wire to be engaged inside the the other side. Asymmetrical treatment is not a
slot. An increase in wire size and, specifically, the concern.10 We are aware that we hold in our hands
use of rectangular wires (heat-activated .016" × a powerful means that can be added to such com-
.025" or .018" × .025" nickel titanium) allow monly used auxiliaries as elastics, lip bumpers,
torque, tip, and rotation to be corrected. temporary anchorage devices (TADs), or headgear.
The most relevant aspect of our technique is Lastly, for good finishing, we believe we
the differentiation of slot sizes in the anterior and have to bond brackets properly. We use an indirect
posterior areas (Fig. 4). On the front teeth, a slot bonding technique.11,12 A correct position and a
size of .018" × .025" provides adequate torque reduced composite layer are a good start for align-

14 JCO/JANUARY 2017
Mauro Cozzani, DMD, MScD

Fig. 4 Gianelly’s Bidimensional technique utilizes .018" × .025" slots on incisor brackets and .022" × .028"
slots on canine, premolar, and molar brackets. When .018" × .022" wire is inserted, incisor slots are filled
while all other slots maintain some degree of freedom.

Fig. 5 .018" × .022" wire bent at 90° for complete torque control of canines, premolars, and molars (selec-
tively or as a group). When wire is changed to .022" × .018", slots are completely filled.

ing teeth. Sometimes, even with indirect methods, correction needed, and the result can be controlled
brackets can be positioned incorrectly, so they have at the next appointment. Eventually, the bend is
to be debonded and rebonded properly after level- modified. We are orthodontists, and we have been
ing, alignment, rotation, and torque control. Near trained to bend and torque wires. I don’t under-
the end of treatment, finishing with rebonding is, stand why we prefer not to do so when, overall, it
in our opinion, less efficient than correcting tooth seems to be the most efficient procedure.
position with a small wire bend. When a bracket The last step in our treatment sequence is
is debonded, all reference points are lost. It should retention to maintain results over time. We prefer
also be considered that once rebonded, the wire removable over fixed retainers for two main rea-
utilized is often undersize and, therefore, the pre- sons. First, cleaning procedures are easy. Second,
scriptions are not completely read. A small com- we prefer not to be responsible for something we
pensating bend can be made by visualizing the don’t have under our constant control.

VOLUME LI NUMBER 1 15
MASTER CLINICIAN

DR. SINCLAIR What is your best clinical tip? or blocked-out tooth cannot be tied in convention-
ally, or when a tooth is misaligned after a bracket
DR. COZZANI I am convinced that having a V- has been lost between appointments. A stainless
slot in the bracket can improve the efficiency of steel ligature wire can be passed through the V-slot
any technique; in fact, it can be used to insert dif- and around the archwire. As the ligature wire is
ferent auxiliaries. Uprighting springs tip the crown reactivated at each appointment, the tooth will be
of a tooth until the opposite internal angles of the gradually drawn back into the arch.13 V-slots can
bracket slot contact the archwire, creating a bind- also be used to tie a lighter overlay wire with a
ing effect that increases resistance to sliding, thus stainless steel ligature—for example, when upper
increasing the tooth anchorage in a reversible man- second molars erupt buccally and a large-dimen-
ner (Fig. 6). sion rectangular wire is already in place, or to add
Longer power arms can be inserted into V- to a base small-diameter wire or a second expand-
slots to allow the application of orthodontic forces ed or reverse-curve wire.14
closer to the center of resistance of the teeth, main- In the last decade, we have switched to self-
ly when TADs are utilized as direct anchorage to ligating brackets to reduce chairtime. We utilize
close extraction spaces (Fig. 7). active .018" × .025" brackets on the incisors and
By changing the position of power pins, T- passive .022" × .028" brackets on the premolars and
pins, and elastic hooks, the clinician can prescribe molars. Of course, all the brackets have V-slots.
intermaxillary elastics to be worn from the upper We noticed some advantages, including that incisor
lateral incisors (long Class II) or from the lower
second premolars (short Class II). Inserting these
auxiliaries only where and when needed can re-
duce the possibility that the patient would misun-
derstand instructions for elastic insertion. Power
pins, T-pins, and elastic hooks can easily substitute
for labor-intensive soldered or crimpable hooks in
patients undergoing orthognathic surgery.
The V-slot can be utilized when an ectopic

Fig. 7 Power arm inserted in upper right canine


bracket to bring point of force application closer
to tooth’s center of resistance.

Fig. 6 Arm of uprighting spring before (dotted


yellow line) and after (yellow arrow) activation.
Force couple (orange arrows) increases resis-
tance to sliding of canine bracket, anchoring ca-
nine to wire. Fig. 8 Ligature ties impinging on mucosa.

16 JCO/JANUARY 2017
Mauro Cozzani, DMD, MScD

torque and rotation control are more accurate,9 and centuated curve of Spee is placed in the wire, and
emergencies due to ligature ties impinging on the a toe-in is placed in the molar area to counteract
mucosa are reduced (Fig. 8). To finalize leveling the bowing and rotational effect of the coil used to
and alignment, we use an .016" × .025" nickel tita- retract the incisor (Fig. 10A). A torque of 10-15°
nium wire that completely fills the slot horizon- is added in the incisor area (Fig. 10B). At every
tally. Two mechanisms work together to correct appointment, overjet and incisor torque are
rotations: the wire, which tends to return to its checked. If incisor palatal inclination (torque loss)
original form, and the active clip, which pushes the is detected, retraction forces are discontinued and
wire against the slot’s vertical wall (Fig. 9).15 more torque is added to the archwire until correct
inclination of the incisor is achieved. Then retrac-
DR. SINCLAIR How do you handle specific tion mechanics are re-established (Figs. 11,12).
clinical problems? In the mandibular arch, we utilize .018" ×
.025" standard (no prescription) incisor brackets
DR. COZZANI One of the major problems in with V-slots. Working wires are always .018" ×
orthodontics is controlling upper-incisor torque. .022" heavily tempered stainless steel to fill the
For this reason, central- and lateral-incisor torque incisor bracket slots. When Class II elastics are
prescriptions keep increasing—for example, 7° worn, we add lingual crown torque to partially
with Andrews for central incisors vs. 17° with counteract incisor proclination (Fig. 13A). On the
MBT.* Some clinicians use different prescriptions other hand, when mechanics to protract premolars
for different cases, increasing storage, expense, and molars are utilized, we add buccal crown torque
time, and effort to maintain control. It is well dem- to avoid lingual incisor inclination (Fig. 13B).10
onstrated that is not easy to efficiently control In conclusion, we have two ways of control-
torque when the final wire is .019" × .025" and the ling teeth in orthodontics: bracket prescriptions
bracket slot is .022" × .028".16 Additionally, ortho- and wirebending. Prescriptions are helpful, but in
dontists are used to evaluating “engagement an- my opinion, renouncing wirebending reduces
gles”, when they should consider “clinically effec- treatment efficiency. In fact, prescriptions are un-
tive torque”, which is even more difficult to changeable, while wirebending is versatile and
produce with undersize wires.9 allows the orthodontist to evaluate treatment prog-
Incisor retraction in the Bidimensional tech- ress and react accordingly.
nique is performed with an .018" × .022" heavily
tempered stainless steel wire inserted in an .018" DR. SINCLAIR What is your greatest clinical
× .025" slot, theoretically filling the slot vertically. challenge?
Incisor brackets have Roth prescriptions. An ac-
DR. COZZANI I believe treating Class II non-
*Trademark of 3M Unitek, Monrovia, CA; www.3Munitek.com. compliance is the greatest clinical challenge. After

Fig. 9 With self-ligating brackets, two mechanisms work together to correct rotations: archwire, which
tends to return to its original form, and active clip, which pushes wire against slot wall.

VOLUME LI NUMBER 1 17
MASTER CLINICIAN

A B
Fig. 10 Incisor retraction in Bidimensional technique (white arrow = force applied; orange arrows = couple
of force; gray arrow = moment of force; yellow line = power arm; red dot = tooth’s center of resistance).
A. Couple of force created by accentuated curve of Spee on distal third of wire, counteracting moment.
B. Couple of force created by adding buccal crown torque to wire.

Fig. 11 Case 1. 19-year-old female Class II, division 1 patient with miss-
ing lower second premolars before treatment.

18 JCO/JANUARY 2017
Mauro Cozzani, DMD, MScD

a study of palatal thickness at different points in miniscrews in vivo and through finite-element
cone-beam computed tomography,17 we developed analysis.22-24 Then we used miniscrews in combi-
a distalizer anchored to the palate with mini- nation with the Herbst** appliance. With this com-
screws.18,19 It is really easy to insert and doesn’t bination, we were able to control lower-incisor
require extra radiography or lab work compared proclination and enhance pogonion advancement.25
to a traditional appliance. We demonstrated that it We are now connecting the lower dentition—in
was able to distalize molars, premolars, and ca- particular, the canines—to the miniscrews with
nines without any compliance.20,21 To retract the elastic ligatures, which has allowed us to further
incisors, however, we had to insert two miniscrews reduce and even avoid lower-incisor protrusion.26
or use Class II elastics. Our group is convinced that the control of
Our aim is to reduce patient compliance al- the maxillary anteroposterior dental position and
most to only brushing teeth and showing up for **Registered trademark of Dentaurum, Inc., Newtown, PA; www.
appointments. We studied the clinical behavior of dentaurum.com.

Fig. 12 Case 1. After 24 months of treatment.

VOLUME LI NUMBER 1 19
MASTER CLINICIAN

A B
Fig. 13 A. Lingual crown torque utilized with Class II elastics. B. Buccal crown torque utilized with molar
protraction mechanics.

A B
Fig. 14 Case 2. A. Rapid palatal expander (RPE) anchored to deciduous teeth in 7-year-old male mixed-
dentition patient with unilateral crossbite on right. B. After one month of activation.

overjet is crucial, and we are currently running limited to the minimum. This could be why we
clinical experiments to test these ideas. noticed an increasing number of patients requiring
maxillary expansion.
DR. SINCLAIR Is there any other topic you We think timing and anchorage are crucial
would like to discuss? to obtain stable results. In the early ’90s, we pub-
lished a paper that suggested using deciduous teeth
DR. COZZANI The topic we have studied most in the mixed dentition as anchorage.27 The tradi-
is rapid maxillary expansion (RME). We noticed tional rapid maxillary expander (Hyrax** or Haas)
that our youngsters, quite often, are not used to anchors to the first permanent molars and premo-
breathing properly. They spend a lot of time on the lars. Using the deciduous dentition as anchorage
couch playing video games or watching smart- **Registered trademark of Dentaurum, Inc., Newtown, PA; www.
phones, and their physical activity seems to be dentaurum.com.

20 JCO/JANUARY 2017
Mauro Cozzani, DMD, MScD

Fig. 15 Case 3. 7-year-old female Class I patient in mixed dentition with unilateral crossbite on left before
treatment.

A B

B
Fig. 16 Case 3. A. Customized RPE anchored to deciduous teeth. B. After two months of activation.

instead of the permanent dentition aims to reduce upper lateral incisors have fully erupted, allows for
the risk of negative side effects on permanent teeth a rapid increase in arch length in the anterior region
from the expansion force and plaque accumulation and, consequently, in the space available, with a
around bands. The appliance we studied is a mod- concomitant reduction in crowding. Finally, anchor-
ified Haas rapid maxillary expander, but it should age to deciduous teeth produces a more pronounced
be noted that we did not extend arms or acrylic to and stable expansion in the anterior area.28-32
the permanent molars (Fig. 14). From a clinical point of view, placing bands
In different studies, we were able to confirm on deciduous molars could be challenging; their
that RME to correct a lateral crossbite should be retention is limited because their vertical slopes
performed during skeletal growth, and that it is are not curved. We have developed a customized
more efficient after eruption of the first permanent appliance that addresses these challenges and re-
molars and before the end of adolescence. We also duces chairtime to only taking an impression
found that it is effective in increasing transverse (Figs. 15-17).33,34
width in the intermolar and intercanine areas—
changes that are maintained until the full permanent DR. SINCLAIR Thank you for sharing your
dentition. Early expansion, performed before the clinical experience with our readers.

VOLUME LI NUMBER 1 21
MASTER CLINICIAN

Fig. 17 Case 3. Patient three years after treatment, in permanent dentition.

REFERENCES

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direct bonding technique: A clinical trial, Prog. Orthod. ic splint Herbst and an acrylic splint miniscrew-Herbst for
15:70, 2014. mandibular incisors proclination control, Int. J. Dent., pub-
13. Cozzani, M.; Mazzotta, L.; Bowman, S.J.; and Rinchuse, D.: lished online, May 19, 2014.
Use of vertical slot in orthodontic brackets, J. Clin. Orthod. 26. Manni, A.; Mutinelli, S.; Pasini, M.; Mazzotta, L.; and
49:574-581, 2015. Cozzani, M.: Herbst appliance anchored to miniscrews with 2
14. Menini, A.; Cozzani, P.; and Cozzani, M.: Eruption control of types of ligation: Effectiveness in skeletal Class II treatment,
maxillary second molars with segmental overlay wire, J. Clin. Am. J. Orthod. 149:871-880, 2016.
Orthod. 46:45-47, 2012. 27. Montera, V.; Zappulla, F.; Lanteri, C.; and Cozzani, M.:
15. Cozzani, M. and Mazzotta, L.: Bidi-self: La técnica bidimen- Bandaggio degli “E”, Mondo Ortod. 3:343-346, 1991.
sional con bracket de autoligado, Rev. Esp. Orthod. 42:240- 28. Cozzani, M.; Rosa, M.; Cozzani, P.; and Siciliani, G.:
246, 2012. Deciduous dentition-anchored rapid maxillary expansion in
16. Sifakakis, I.; Pandis, N.; Makou, M.; Eliades, T.; Katsaros, crossbite and non-crossbite mixed dentition patients: Reaction
C.; and Bourauel, C.: Torque expression of 0.018 and 0.022 of the permanent first molar, Prog. Orthod. 4:15-22, 2003.

22 JCO/JANUARY 2017
Mauro Cozzani, DMD, MScD

29. Cozzani, M.; Guiducci, A.; Mirenghi, S.; Mutinelli, S.; and 16:22, 2015.
Siciliani, G.: Arch width changes with a rapid maxillary ex- 32. Mutinelli, S. and Cozzani, M.: Rapid maxillary expansion in
pansion appliance anchored to the primary teeth, Angle early-mixed dentition: Effectiveness of increasing arch di-
Orthod. 77:296-302, 2007. mension with anchorage on deciduous teeth, Eur. J. Paediat.
30. Mutinelli, S.; Cozzani, M.; Manfredi, M.; Bee, M.; and Dent. 16:115-122, 2015.
Siciliani, G.: Dental arch changes following rapid maxillary 33. Cozzani, M.; Fontana, M.; and Cozzani, P.: A cast-metal
expansion, Eur. J. Orthod. 30:469-476, 2008. Haas-type expander for the deciduous dentition, J. Clin.
31. Mutinelli, S.; Manfredi, M.; Guiducci, A.; Denotti, G.; and Orthod. 44:738-740, 2010.
Cozzani, M.: Anchorage onto deciduous teeth: Effectiveness 34. Cozzani, M.; Fontana, M.; Cozzani, P.; and Bertelli, A.: Cast
of early rapid maxillary expansion in increasing dental arch Haas-type RME appliance: A case report, Orthod. (Chic.)
dimension and improving anterior crowding, Prog. Orthod. 12:252-259, 2011.

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