Growth of the maxillary sinus in children and adolescents: A longitudinal study.

Maxillary sinus volumetric and surface area data and growth models from longitudinal samples of children and adolescents are presented. Cone-beam radiographic CT scans from two small retrospective longitudinal samples, one from the Baylor College of Dentistry, Dallas, TX (N=17, 12 females, 5 males, 10.9-17.4 years) and one from a group private orthodontic practice in Nevada (N=15, 9 females, 6 males, 6.4-13.4 years) were used to collect maxillary sinus volumes and surface areas from each individual imaged at two times separated by variable intervals. Volume and surface area values were collected in Analyze® (Mayo Clinic) and growth models were produced in MLwiN®, a multi-level modeling program. There is a large degree of inter-individual variation. Surface area and surface-area-to-volume ratio (SA:V) changes are particularly variable. Growth models suggest linear growth in both volume and surface area, without growth spurts.

Mandibular asymmetry in patients with the crouzon or apert syndrome.

The aim of this study was to describe directional and fluctuating mandibular asymmetry over time in children with Crouzon or Apert syndrome. Mandibular asymmetry of children between 7.5 and 14 years of age with Crouzon syndrome (n = 35) and Apert syndrome (n = 24) were compared with controls (n = 327). From panoramic radiographs, mandibular directional and fluctuating asymmetry was determined for the three groups. Multilevel statistical techniques were used to describe mandibular asymmetry changes over time. Patients with Crouzon and Apert syndromes showed statistically significant more fluctuating asymmetry for mandibular measures than did controls. Between the Crouzon and Apert syndromes groups, no statistical differences were found in directional and fluctuating asymmetry. The control group showed statistically significantly more directional asymmetry than did patients with Crouzon or Apert syndrome. The controls showed no change over time for the directional asymmetry of condylar-ramal height; however, the directional asymmetry of the gonial angle increased. Patients with Crouzon syndrome showed side dominance for only condylar-ramal height; whereas, patients with Apert syndrome did not show dominance for any of the measurements. Apert and Crouzon syndromes showed developmental instability, in contrast to the controls. No statistically significant longitudinal differences were found for either the directional or the fluctuating asymmetry between Crouzon and Apert syndromes. Findings for fluctuating and directional asymmetry for both syndromes may indicate an inability to cope with genetic and environmental stress during development and treatment, compared with untreated nonsyndromic individuals.

Effects of increased surgical trauma on rates of tooth movement and apical root resorption in foxhound dogs.

PURPOSE: To experimentally determine the effects of increased surgical trauma on the rates of tooth movement and apical root resorption. Two surgical techniques for rapid protraction of multi-rooted teeth in foxhound dogs immediately following premolar extraction were compared. METHODS: Split-mouth design to randomly assign two surgical techniques [periodontal ligament distraction (RAP side) and a modified form of dentoalveolar distraction (RAP+ side)] to the maxillary quadrants. First premolars were extracted, and second premolars were protracted 0.5 mm per day for 15 days using a custom made jack-screw distractor. Serial caliper and radiographic measurements were performed to quantify tooth movements and apical root resorption. RESULTS: Both techniques demonstrated significant movement of the crown and apex. The second premolar crowns were protracted significantly more on the RAP+ side (2.9 mm) than on the RAP (1.8 mm) side. The premolars on both sides demonstrated significant tipping (4.3 and 3.9 degrees for the RAP+ and RAP sides, respectively). The distal root apex showed almost twice as much apical root resorption than the mesial root apex, but resorption was limited (<0.16 mm) and not statistically different between sides. CONCLUSIONS: Increased surgical trauma increased the rate and, ultimately, the amount of tooth movement. The heavy forces used to protract the teeth produced statistically, but not clinically, significant apical root resorption on the mesial and distal roots of the maxillary second premolars.

Reliability of maximum bite force measurements in age-varying populations.

In order for bite forces to be used clinically, they must be reliable. While bite force transducers are accurate and precise during bench tests, widely varying reliabilities of intra-oral bite forces have been reported when measured in human subjects. Because few studies have reported total reliability, the clinical use of intra-oral bite forces measurements remains questionable. The purposes of this study were to (i) estimate total reliability, including both within- and between-session reliabilities, of repeated maximum incisor and molar bite force measurements and (ii) demonstrate how extraneous variation affects reliability by comparing estimates for which the effects of age have and have not been controlled. A sample of 28 healthy subjects with Class I normal occlusion (seven subjects in each of four age groups: 5, 8, 11 and 14 years) performed two sessions approximately 90 min apart. Each session consisted of three maximum voluntary bites at three bite positions (incisor and right and left molars). For each bite position, between-subject variance (true variance), between-session variance and within-session variance were calculated using Multilevel modelling procedures. The variances were used to estimate between-session reliabilities, within-session reliabilities and total reliabilities. Within-session reliabilities were substantially higher than between-session reliabilities, which in turn was higher than total reliabilities at all bite positions. Reliabilities were highest at the incisor bite position. Not controlling for age effects substantially overestimated total reliability at all bite positions. After controlling for age effects, total reliabilities of repeated maximum bite forces were low to moderate.

Temporary orthodontic anchorage devices for improving occlusion.

The objective of the study was to provide insight into clinical and laboratory aspects of mini-screw implant (MI) research conducted in the Department of Orthodontics at Baylor College of Dentistry. Excerpts were selected from clinical and laboratory MI research utilizing one type of implant and one consistent placement protocol to illustrate the clinical usage of MI as skeletal anchorage during Class II bimaxillary correction. In addition, a translational animal model was utilized to illustrate possible side-effects of MI placement. Our studies have shown that successful and consistent clinical results are possible with MI use. Although iatrogenic trauma may occur during the placement of MI, a translational research model has provided data used to develop a placement protocol in order to avoid this dilemma. Absolute skeletal anchorage is a reality with MI use and can be used for successful orthodontic outcomes in the correction of Class II bimaxillary protrusion malocclusions to ideal Class I occlusions. Moreover, meticulous care has been shown to be essential with treatment planning and during placement of MI. Significant and extensive damage can occur with poor placement while healing is possible following minor trauma.

Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses: part III--pain and dysfunction outcomes.

47 end-stage TMJ patients with high occlusal plane angulation, treated with TMJ custom-fitted total joint prostheses and simultaneous maxillo-mandibular counter-clockwise rotation were evaluated for pain and dysfunction presurgery (T1) and at the longest follow-up (T2). Patients subjectively rated their facial pain/headache, TMJ pain, jaw function, diet and disability. Objective functional changes were determined by measuring maximum interincisal opening (MIO) and laterotrusive movements. Patients were divided according to the number of previous failed TMJ surgeries: Group 1 (0-1), Group 2 (2 or more). Significant subjective pain and dysfunction improvements (37-52%) were observed (

The effect of force, timing, and location on bone-to-implant contact of miniscrew implants.

This study was conducted to evaluate the effect of timing and force of loading, as well as implant location, on bone-to-implant contact (BIC) of loaded and control miniscrew implants (MSI). Using seven skeletally mature male beagle dogs, 1-2 years of age, followed over a 110 day period, a randomized split-mouth design compared immediate versus delayed loading, 50 versus 25 g loading, and 25 g loads in the maxilla versus the mandible. Mobility was evaluated using a 0-3 point scale before the MSIs were prepared for histological analysis. Histomorphometric analyses were performed under light microscopy using Metamorph software on undecalcified sections. The percentage BIC was measured at three levels (coronal, middle, and apical) of the MSI. BIC was compared statistically using pairwise Wilcoxon signed-rank tests. Mobility was detected in three of the 56 (5.4 per cent) MSIs. The mobile implants were all unloaded controls and showed no BIC. All remaining stable MSIs showed some BIC. However, variation in BIC was large, ranging from 2.2 to 100 per cent. There were no significant (P > 0.05) differences in BIC associated with timing of force application, amount of force applied, or implant location. There was a tendency for less BIC at the coronal level, but the differences between levels were not statistically significant. Within the limits of this study, it is concluded that the timing and amount of force at loading and location of implant placement do not affect BIC. Moreover, it appears that only limited amounts of osseointegration are necessary to ensure implant stability.

Reducing within-subject variation in chewing cycle kinematics--a statistical approach.

OBJECTIVES: High levels of within-subject variability have limited the use of chewing cycle kinematics in the experimental and clinical context. The purpose of this study was to validate a new strategy for reducing within-subject variability in chewing cycle kinematics, based on the 10 most representative cycles from a chewing sequence. METHODS: This prospective study included 25 young subjects, with normal class I occlusions. An optoelectronic recording system was used to track chin movements of subjects chewing gum (2.5 g). Computer programs provided estimates for duration and movement as well as the 3D coordinates of the chin point. The total output files were further processed for selection of 10 representative cycles based on standard scores for total duration, excursive ranges in the lateral, vertical and antero-posterior directions. Multilevel modelling procedures were used to test for significant differences. RESULTS: There were no significant differences in cycle duration or excursions between the estimates for all cycles versus the 10 most representative cycles. Cycle shapes were very similar. There were no statistically significant differences in between-subject variances. All within-subject variances were smaller when using data from the 10 most representative cycles. The reduction of variance was approximately 33% for total duration and 75% for total 3D excursion. CONCLUSIONS: The results validate the pre-processing strategy that selects the 10 most representative cycles from a sequence without altering cycle duration, excursions or shape or affecting between-subject variation but reducing within-subject variation substantially.

The efficacy of pain control following nonsurgical root canal treatment using ibuprofen or a combination of ibuprofen and acetaminophen in a randomized, double-blind, placebo-controlled study.

AIM: To compare ibuprofen, to an ibuprofen/acetaminophen combination in managing postoperative pain following root canal treatment. It is hypothesized that the drug combination will provide more postoperative pain relief than the placebo or ibuprofen alone. METHODOLOGY: Patients presenting at the Texas A&M Baylor College of Dentistry's graduate endodontic clinic, experiencing moderate to severe pain, were considered potential candidates. Fifty-seven patients were included based on established criteria. Following administration of local anaesthesia, a pulpectomy was performed. The patients were administered a single dose of either: (i) placebo; (ii) 600 mg ibuprofen; or (iii) 600 mg ibuprofen and 1000 mg of acetaminophen. Patients recorded pain intensity following treatment on a visual analogue scale and a baseline four-point category pain scale as well as pain relief every hour for the first 4 h then every 2 h thereafter for a total of 8 h. A general linear model (GLM) analysis was used to analyse the outcome. RESULTS: Based upon the GLM analysis, there was a significant difference between the ibuprofen and the combination drug group, and between placebo and combination drug groups. There was no significant difference between the placebo and the ibuprofen. CONCLUSION: The results demonstrate that the combination of ibuprofen with acetaminophen may be more effective than ibuprofen alone for the management of postoperative endodontic pain.

Bolus size and unilateral chewing cycle kinematics.

The purpose of this study was to determine how bolus size alters the human chewing cycle. This prospective within-subject design evaluated chewing cycles of 38 young adults between 20 and 38 years of age (21 males and 17 females). An optoelectric jaw tracking system was used to record movements of the chin during unilateral (right sided) chewing of four randomly ordered bolus sizes (1, 2, 4 and 8 g) of gum. Using each subject's 10 most representative cycles, multilevel statistical procedures were used to evaluate jaw kinematics. The results showed that bolus size has no consistent effect on opening, closing or total cycle duration. Cycle excursions increased significantly with increasing bolus size. With increasing bolus sizes, chewing cycle excursions along the three axes increased 52-115%. The greatest differences between bolus sizes occurred when the jaw was changing direction (i.e. passing from opening to closing and from working to balancing sides). However, the increases were proportionate and the shape of the chewing cycle was maintained. In order to maintain cycle duration while increasing excursive ranges, jaw velocities increased significantly, with the greatest differences occurring at approximately 70% of opening and 30% of closing. We conclude that humans adapt to larger bolus sizes by increasing chewing cycle perimeter and by increasing cycle speed, while maintaining cycle shape and duration.

Secular change in height, sitting height and leg length in rural Oaxaca, southern Mexico: 1968-2000.

OBJECTIVE: To evaluate secular changes in height, sitting height and estimated leg length between 1968 and 2000 in residents in a rural Zapotec-speaking community in Oaxaca, southern Mexico. MATERIALS AND METHODS: Height and sitting height were measured in school children 6-13 years (1968; 1978, 2000), in adolescents 13-17 years (1978, 2002) and adults 19-29 years (1978, 2000). Leg length was estimated as height minus sitting height. The sitting height/ height ratio was calculated. Subjects were grouped by sex into four age categories: 6-9, 10-13, 13-17 and 19-29 years for analysis. The Preece-Baines Model I growth curve was fitted to cross-sectional means for 1978 and 2000. RESULTS: There were no differences between children 6-9 and 10-13 years in 1968 and 1978 with the exception of the sitting height ratio in girls 6-9 years. Children of both sexes 6-13 years and adolescent boys 13-17 years were significantly larger in the three dimensions in 2000 compared to 1978; adolescent girls differed only in height and sitting height. Adult males in 2000 were significantly taller with longer legs than those in 1978, but the samples did not differ in sitting height and the ratio. Adult females in 1978 and 2000 did not differ significantly in the three dimensions. Rates of secular change in height and sitting height between 1978 and 2000 were reasonably similar in the three age groups of male children and adolescents, but the rate for estimated leg length was highest in 10-13-year-old boys. Secular gains were smaller in adult males, but were proportionally greater in estimated leg length. Girls 6-9 and 10-13 years experienced greater secular gains in height, sitting height and estimated leg length than adolescent and young adult females, while secular gains and rates decreased from adolescent girls to young adult women. Ages of peak velocity for height, sitting height and estimated leg length declined in boys, while only ages of peak velocity for height and estimated leg length declined in girls. CONCLUSIONS: There are major secular increases in height, sitting height and estimated leg length of children and adolescents of both sexes since 1978. Secular gains in height are of similar magnitude in boys and girls 6-13 years, but are greater in adolescent and young adult males than females. The secular increase in height of young adults of both sexes is smaller than that among adolescents. Estimated leg length accounts for about 60% of the secular increase in height in children of both sexes. Estimated leg length and sitting height contribute equally to the secular increase in height in adolescent boys, whereas estimated leg length accounts for about 70% of the secular increase in height in young adult males. Sitting height contributes about two-thirds of the secular increase in height in adolescent and young adult females.

Masticatory performance: a protocol for standardized production of an artificial test food.

A protocol for standardizing the production of an artificial test food was established and its reliability was determined. An artificial test food was selected based on its superior properties compared with natural foods. The primary emphasis during production was the incorporation of all 3 cm of paste-hardener and thoroughly kneading the material for 30 s. The curing process was studied to determine overall setting time. After at least 30 min, the physical properties of the test food were ready to be measured. The overall mean hardness of the test food was 489 +/- 60 load grams. Random error between operators was +/-16 load grams while batches differed by +/-13 load grams and individual tablets differed by +/-15 load grams. This protocol provides a reliable standardized method for future masticatory performance studies.

Anthropometric asymmetry in chronically undernourished children from Southern Mexico.

In previous studies, environmental stress has been associated with increased structural asymmetry, indicating differential rates of development on either side of the median plane. To analyse the effect of environmental stress upon anthropometric asymmetry, six bilateral measurements and one derived measurement were compared between chronically mild-to-moderately undernourished school children (7-13 years of age) and a well-nourished control sample (5-35 years of age). The undernourished sample was from a subsistence agricultural community in Southern Mexico. The well-nourished comparison (control) sample was middle class, White children and young adults in Texas. Anthropometric asymmetry of the skeleton was not consistently increased in the undernourished school children compared to the well-nourished controls. Arm and estimated mid-arm muscle circumferences had significantly increased asymmetry, but these differences are likely due more to laterality in function or physical work than to undernutrition. Genetic influences are hypothesized to underlie skeletal asymmetry (i.e. differences in development on either side of the median plane).

The effects of bolus hardness on masticatory kinematics.

This study investigated how jaw kinematics, including cycle duration, three-dimensional (3-D) excursive ranges and velocities, and cycle shape, changed with increasing hardness of chewing gum. Twenty-six subjects (13 males and 13 females; mean age 23.6 +/- 2.5 years) with Class I normal occlusion were asked to chew two brands of gum with differing hardness. Jaw motion during chewing was tracked with an Optotrak camera at 100 Hz, and all movements were recorded as pure 3-D mandibular movements relative to Frankfort horizontal. Cycle duration did not change significantly with harder gum, but 3-D excursive ranges and velocities increased, except during the occlusal phases of the chewing. Cycle shape was similar for hard and soft gum, but the overall size of the cycle was larger with hard gum. These results suggest that greater muscular effort when chewing harder gum produces a greater acceleration of the mandible in all phases except when the harder gum slows the mandible during the occlusal phases.

Does malocclusion affect masticatory performance?

This purpose of this study was to evaluate the largely untested assumption that malocclusion negatively affects masticatory performance. A sample of 185 untreated subjects (48% male and 52% female) from 7 to 37 years of age, representing subjects with normal occlusion (n = 38), Class I (n = 56), Class II (n = 45), and Class III (n = 46) malocclusion, were evaluated. Masticatory performance was evaluated objectively using artificial (CutterSil, median particle size and broadness of the distribution) and real foods (number of chews for jerky and almonds), and subjectively using a visual analog scale. The results showed no significant differences in age or the body mass index (Wt/Ht2) between the occlusion groups. Subjects with normal occlusion had significantly smaller particle sizes (P = .001) and broader particle distributions (P < .001) than subjects with malocclusion. Compared with the normal occlusion group, the median particle sizes for the Class I, II, and III malocclusion groups were approximately 9%, 15%, and 34% larger, respectively. There were also significant group differences in their subjective ability to chew fresh carrots or celery (P = .019) and firm meat (P = .003). Class III subjects reported the greatest difficulty, followed by Class II subjects, Class I subjects, and subjects with normal occlusion, respectively. We conclude that malocclusion negatively affects subjects' ability to process and break down foods.

The effects of isometric exercise on maximum voluntary bite forces and jaw muscle strength and endurance.

The effects of training and exercise on the strength and endurance of limb muscles has been investigated extensively, but the response of the jaw muscles to exercise remains poorly known. The purpose of this study was to determine whether short-term isometric training increases strength and endurance of the superficial masseter and anterior temporalis muscles. Maximum and submaximum voluntary bite forces and corresponding electromyographic (EMG) activity were measured in 28 young adults, randomly divided into exercise and non-exercise (control) groups. Subjects in the exercise group performed isometric clenches against a soft maxillary splint for five 1-min sessions per day over a 6-week period. After exercise, subjects increased their maximum bite forces by 37%, but control subjects' bite forces also increased by 25%. After exercise, EMG levels per unit of bite force generally decreased, but similar decreases were also seen in the non-exercised controls. Masseter muscle activity levels during standardized 10-kg bites decreased after 6 weeks of exercise. Fatigue resistance increased significantly with exercise but did not differ significantly from control values after 6 weeks of exercise. The results of this study indicate that increases in maximum bite force can be easily produced with training, but that actual strengthening of the jaw muscles is more difficult to achieve.

An evaluation of growth and stability in untreated and treated subjects.

This retrospective longitudinal study compared skeletal and dental changes in orthodontically treated patients with changes in a comparable untreated group to evaluate the relationship between skeletal changes and mandibular incisor crowding. Cephalograms and models of 44 untreated subjects from the Broadbent-Bolton Growth Study and 43 treated patients were evaluated at "posttreatment" (14.3 +/- 1.5 and 15.2 +/- 1.1 years, respectively) and at "postretention" (23.2 +/- 3.4 and 28.9 +/- 3.6 years, respectively). Cranial base and mandibular superimpositions were used to measure cephalometric changes. Tooth-size-arch-length discrepancy, contact irregularity, and space irregularity were measured. In both groups, growth in the vertical dimension was twice that in the horizontal dimension. The untreated subjects, who were younger, exhibited greater yearly vertical growth increments than did the treated subjects. The treated subjects exhibited greater overjet and overbite increases than did the untreated subjects. Yearly changes in tooth-size-arch-length discrepancy were greater in the untreated than in the treated subjects, but there were no differences in the changes in irregularity between the 2 groups. A multivariate regression model, relating posterior facial height (Ar-Go) increase and lower incisor eruption to change in space irregularity, explained 42% of the variation in the untreated group (r = 0.64; P <.001). A weaker relationship was found in the treated group. Overjet change was negatively correlated with tooth-size-arch-length discrepancy. Changes in lower incisor crowding were related to growth in the vertical dimension and lower incisor eruption in both untreated (r = 0.64) and treated (r = 0.51) subjects.

Mandibular rest position: a reliable position influenced by head support and body posture.

This prospective study was designed to establish how the positions of the molars and the condyles are related to incisor position in the mandibular rest position and how their positions are altered by changing head posture. Measurements of the mandibular rest position were taken on 24 men (age range, 23 to 35) with normal Class I occlusion, skeletal patterns, and temporomandibular joint function. The movements of 5 landmarks (lower incisor, and condyles and molars bilaterally) were tracked from maximum intercuspation into 4 independent rest positions (upright supported, upright unsupported, supine supported, and supine unsupported) using an optoelectric (Optotrak; Northern Digital, Waterloo, Ontario, Canada) computer system. The positions were based on minimal electromyographic and verbal instructions to swallow, lick the lips, and say "Mississippi." The results showed significant (P <.01) movements of the incisors, the molars, and the condyles into each of the 4 rest positions. Movements of the molars and the condyles into the supported upright posture and the unsupported upright posture differed slightly but significantly because of greater movement into the supported posture. Patterns of mandibular movement were entirely different between the upright and the supine rest positions; the mandible rotated anteriorly in the supine position and posteriorly in the upright position. We concluded that movement into the mandibular rest position from the intercuspal position is not a simple opening rotation of the mandible, and that the pattern of movement is influenced by head support and body postures.

Morphological and positional asymmetries of young children with functional unilateral posterior crossbite.

This prospective clinical study evaluated the morphological and positional mandibular asymmetry of young patients with functional unilateral posterior crossbite. The sample included 9 girls and 6 boys (8.8 +/- 1.0 years of age), evaluated at the initiation of treatment and approximately 6 months after the retention phase (1.1 +/- 0.2 years after initiation of treatment). Each patient had a complete unilateral posterior crossbite involving 3 or more posterior teeth, a functional shift from centric relation-intercuspal position, and no signs or symptoms of temporomandibular disorder. A bonded palatal expansion appliance was used to rapidly expand the maxilla (1 month) and retain the treatment changes (6 months). Zonograms were used to assess articular joint spaces, and submental vertex radiographs were used to assess morphological and positional asymmetry. The results showed that the mandible was significantly longer on the noncrossbite side than it was on the crossbite side. The asymmetry was most evident for the ramus and involved both the condylar and the coronoid processes. The posterior and superior joint spaces were larger on the noncrossbite side than they were on the crossbite side. After treatment and retention, the mandible showed no significant morphological asymmetries. Mandibular growth was greater on the crossbite side than it was on the noncrossbite side, and the mandible had been repositioned; the crossbite side had rotated forward and medially toward the noncrossbite side. We concluded that unilateral posterior crossbites produce morphological and positional asymmetries of the mandible in young children, and that these asymmetries can be largely eliminated with early expansion therapy.

Changes in the masticatory cycle following treatment of posterior unilateral crossbite in children.

In a previous study, we established that young children with unilateral posterior crossbite have a longer mandibular ramus and more superiorly and posteriorly positioned condyles on the crossbite side. In this study, we evaluated chewing cycle shape and duration in 14 of the patients before treatment, and we looked for changes in cycle shape and duration 6 months after treatment with rapid palatal expansion. Mandibular kinematics was recorded while chewing gum using an optoelectric recording system at 100 Hz. Subjects were asked to chew normally for 20 cycles, chew on the crossbite side only for 20 cycles, and chew on the noncrossbite side only for 20 cycles. A special computer program selected the 10 most representative cycles from each series and computed an average duration and an average maximum excursion along 3 orthogonal axes. Multilevel linear models were used to generate an 8th-order polynomial describing average cycle shape and to test for statistically significant differences in shape between the patients and the controls and between the patients before and after treatment. Before treatment, the patients chewed more slowly than did the controls. Treatment shortened their cycle duration to equal control values. Before treatment, the patients also had larger maximum excursions than did the controls and exhibited a reverse-sequence cycle shape when chewing on the crossbite side. Treatment did not alter the patients' abnormal cycle shape. These results suggest that some features of the masticatory kinematics respond to orthodontic treatment alone, but others do not.