Longitudinal craniofacial growth patterns in patients with orofacial clefts: geometric morphometrics.

OBJECTIVE: To demonstrate craniofacial developmental patterns in repaired cleft lip and cleft palate (CLP). DESIGN: Retrospective, longitudinal. SETTING: Center for Craniofacial Disorders, San Juan, Puerto Rico. SAMPLE: Males aged 9 to 17 years: 13 noncleft (NC) Class I occlusion (NCC1); 13 NC Class III malocclusion (NCC3); 12 CLP Class I occlusion (CLPC1); and 15 CLP Class III malocclusion (CLPC3). MAIN OUTCOME MEASURES: Form changes (ages 10, 13, and 16 years), using finite-element scaling analysis. RESULTS: NCC1, 10 to 13 interval: 30% size increase in upper midface (p <.05), mental region (p <.01), mandibular body (p <.05); 13 to 16 interval: 10% to 35% size increase in bimaxillary region and ramus (p <.01). NCC3, 10 to 13 interval: 10% to 40% size increase in posterior cranial base, upper midface, and mandible (p <.05); 13 to 16 interval: 10% to 30% size increase in bimaxillary region (p <.01), especially ramus. CLPC1, 10 to 13 interval: 10% to 15% size increase in posterior cranial base (p <.01), midface (p <.05), and mandibular ramus (p <.05); 13 to 16 interval: 8% to 20% size increase in upper midface (p <.01), lower midface (p <.05), and mandible (p <.05). CLPC3, 10 to 13 interval: no significant changes; 13 to 16 interval: upper midface and cranial base show nonsignificant size decreases, but ramus showed size increase. CONCLUSIONS: Noncleft and CLP Class 1 occlusion groups show similar craniofacial growth patterns. Noncleft Class III groups show excessive cranial and mandibular growth. Class III malocclusion in CLP patients is associated with clinically deficient craniomaxillary growth. Growth guidance may be indicated in children with CLP with unfavorable craniofacial growth patterns.     

Assessing periodontal disease risk: a comparison of clinicians' assessment versus a computerized tool

BACKGROUND: The authors conducted a study to compare risk scores assigned by subjective expert clinician opinion with quantitative scores generated for the same subjects using the Periodontal Risk Calculator, or PRC. METHODS: The authors assembled a group of 107 subjects and performed standard periodontal examinations. The authors entered the resulting information into the PRC and calculated risk scores for two and four years, assuming no treatment would be performed. Using the same subject records, three groups of expert clinicians assigned risk scores for years 2 and 4. The authors analyzed the data to reveal the extent of interevaluator variation and the level of agreement between expert clinician scores and PRC scores. RESULTS: The extent of variation among scores assigned by individual expert clinicians was greater than the authors had expected. Expert clinicians consistently assigned more subjects to PRC risk group 2 and fewer to risk group 5 than did the PRC. The authors observed very high heterogeneity in the risk scores expert clinicians assigned to patients in each of the PRC-assigned groups. Thus, expert clinicians varied greatly in evaluating risk and, relative to the PRC, they appeared to underestimate periodontitis risk, especially for high-risk patients. CONCLUSIONS AND PRACTICE IMPLICATIONS: The authors' observations suggest that use of risk scores generated for individual patients by subjective expert clinician opinion about risk in periodontal clinical decision making could result in the misapplication of treatment for some patients and support the use of an objective tool such as the PRC. Use of the PRC over time may be expected to result in more uniform and accurate periodontal clinical decision making, improved oral health, reduction in the need for complex therapy and reduction in health care costs.     

Adhesive resin induces apoptosis and cell-cycle arrest of pulp cells

The application of an adhesive resin near or directly over the pulp was shown to induce pulp inflammation and lack of dentin regeneration. We hypothesize that the absence of dentin bridging is due to adhesive-resin-induced apoptosis of cells responsible for pulp healing and dentin regeneration. Mouse odontoblast-like cells (MDPC-23), undifferentiated pulp cells (OD-21), or macrophages (RAW 264.7) were exposed to SingleBond polymerized for 0-40 seconds. Annexin V and propidium iodide assays demonstrated that SingleBond induced apoptosis of MDPC-23, OD-21, and macrophages. The proportion of apoptotic cells was dependent on the degree of adhesive resin polymerization. Adhesive-resin-induced death of pulp cells was associated with activation of the pro-apoptotic cysteine protease Caspase-3. Interestingly, most cells exposed to adhesive resin that did not undergo apoptosis showed cell-cycle arrest. We conclude that an adhesive resin induces apoptosis and cell-cycle arrest of cells involved in the regeneration of the dentin-pulp complex in vitro.     

Image layer characteristics of the PC 1000 (mark II)

The objective of this study was to investigate empirically the image layer characteristics of the PC 1000 Mark II. Radiographs were taken of a lead resolution grid positioned at 1 mm increments along angular intervals of the projected x-ray beam. The receptor was T-Mat G film combined with Lanex Regular Screens. The path of the effective rotation center was determined using a film positioned horizontally at right angles to the slit beam. The vertical magnification factor, horizontal magnification and Distortion Index, corrected for the position of the tomographic layer, were calculated using a reference object placed at various resolution limits of the image layer. The beam projection angle was compared to the average dental arch shape and proximal contact angle. The maximum resolution observed at the central plane of the image layer was 4 lp · mm⁻¹. The image layer width at the 1.5 lp · mm⁻¹ resolution contour varied from 12 mm anteriorly to 41 mm posteriorly. The vertical magnification factor within the image layer showed a linear increase along the beam path from 1.21 to 1.36. The horizontal magnification varied from 1.07 to 1.71, and the Distortion Index from 0.85 to 1.15. The beam projection angulations to the average arch shape ranged from 90° anteriorly to 115° in the premolar segments and 105° in the molar regions. The empirically derived image layer of the PC 1000 Mark II conforms to the shape of the average dental arch and that found using MTF analysis. The spatial resolution attained using a standard receptor is within the acceptable range.     

FRCSEd (Oral and Maxillofacial Surgery): a milestone in the history of Oral and Maxillofacial Surgery in the United Kingdom

The British Association of Oral and Maxillofacial Surgeons (BAOMS) and the Royal College of Surgeons of Edinburgh (RCSEd) have had leading roles in organisation, assessment and improvement of surgical training in the United Kingdom. This was particularly well illustrated by the establishment of the fellowship examination in Oral and Maxillofacial Surgery (FRCSEd, OMFS).     

Beyond cosmetics--the esthetic rehabilitative patient

The evolution of the esthetic movement has been sustained over time because it touches a base psychological need for most people to feel they are attractive, youthful, and a vital part of society. Through well-organized team diagnosis and treatment planning, patients can benefit from a solid diagnostic and prerestorative foundation that can more predictably produce consistent optimal treatment results. As the chief diagnostician and treatment supervisor, the restorative dentist must continue to advance his or her knowledge and training to provide the other team members with a concise treatment vision for the patient. With a newly developed synergy among the disciplines of dentistry for team treatment and tremendous advancement in dental markets and equipment, it is possible to create natural-looking, esthetic rehabilitative treatments.     

Closing anterior open bites by intruding molars with titanium miniplate anchorage

The intent of this study was threefold: (1) to validate true intrusion of molars in adults, (2) to test the stability of miniplates as anchorage for intruding posterior teeth in the maxilla, and (3) to record the skeletal and dental changes of open-bite closure. Four adult patients who had anterior open-bite malocclusions were selected to undergo posterior intrusion with miniplate anchorage to close the open bite; all had true intrusion of the maxillary molars. Mean molar intrusion was 1.99 mm (range, 1.45-3.32 mm). No movement of miniplates occurred at any time during their use or before intentional clinical removal. Open-bite closure was achieved for all 4 patients. Mean closure of incisors was 3.62 mm (range, 3.0-4.5 mm) as the mandibular plane closed 2.62 degrees (range, 1.5 degrees -4.5 degrees ), and the occlusal plane decreased 2.25 degrees (range, 1.0 degrees -3.5 degrees ). Anterior facial heights decreased as the mandible closed and B-point rotated anteriorly and upward.     

Evaluation of bone height and bone density by computed tomography and panoramic radiography for implant recipient sites

The objective was to compare the bone height and bone density measurements of implant recipient sites by panoramic radiography and computed tomography. Thirty-seven sites of 21 patients were evaluated using both panoramic radiography and computed tomography. The bone height was measured as the vertical distance from the alveolar crest to the closest anatomical landmark. Density was compared by means of densitometric measurements. Data was evaluated using paired t-test and Pearson's correlation coefficient analysis. Although bone heights measured with the two imaging modalities differed significantly (p < 0.05), there was a significant correlation between bone density measurements (r = 0.93, p = 0.0). Measurements of bone height as well as bone density was found to be comparable using either radiographic method.     

Contribution of individual drugs to gingival overgrowth in adult and juvenile renal transplant patients treated with multiple therapy

Abstract. Drug regimens for transplantation often consist of multiple therapeutic agents and may result in drug-induced gingival overgrowth (DIGO). The aim of this study was to investigate the contribution of individual drugs in renal transplant patients. 147 adults (19–84 years) and 60 juveniles (3–18 years) were scored for DIGO and other clinical variables. Duration of treatment, dosage of drugs per kg body weight and serum cyclosporin levels were recorded. 44% of adults and 27% of children had DIGO. All patients were receiving prednisolone. More adults than children were administered cyclosporin, the reverse was true of azathioprine ( P 0.01), Explanatory models were evaluated by stepwise ordinal polynomial logistic regression. Statistically significant explanation ( P 0.05) of DIGO was afforded by prednisolone, nifedipine and azathioprine concentrations in adults and by cyclosporin, nifedipine and azathioprine concentrations in juveniles. Prednisolone and azathioprine were inversely related to the degree of DIGO. Plaque and irregularity scores, lip coverage and mouthbreathing status showed significant additional explanation in adults, replacing nifedipine and azathioprine in the final model. Irregularity was additionally explanatory in children, but no other clinical variables. A larger proportion of the variance of DIGO was explained by the available variables in children than in adults (pseudo r ²=0.50 versus 0.25). The degree of DIGO in renal transplant patients is influenced by the dosage of a number of individual components of multiple drug therapy independently of the presence of local clinical factors.