Improved stability of open bite deformities: taking control of the transverse width using digital technology and robotic archwire bending.

Many factors need to be considered when selecting treatment protocol for surgical correction of skeletal open bite deformities. In order to achieve stable long-term results, it is essential to explore the origin of the open bite, including dysfunction of the temporomandibular joint, tongue and compromised nasal breathing, in addition to the skeletal deformity. Recurrence of skeletal open bite is associated with relapse of the expanded transverse width. Three-dimensional virtual planning allows different treatment options to be explored and final decisions to be made together with the orthodontist. This study presents a treatment protocol for predictable and stable widening of the maxillary transverse width over the long term, involving premolar extraction and rounding and shortening of the upper dental arch by advancing the molar segments. The stability of inter-canine, inter-premolar, and inter-molar distances, as well as overjet and overbite, were measured in 16 patients treated with this technique; measurements were obtained pre- and post-surgery, and the mean follow-up was 43 months. Orthodontic treatment was designed digitally and finished with robotically bent wires (SureSmile), which allowed exact planning of the overall treatment, thus making orthognathic surgery more predictable for the patient. The changes in transverse width were significant and stable over time.

Alliance formation and treatment outcome among maltreated adolescents.

This study examined relationships among maltreatment experience, therapeutic alliance formation, and treatment outcome in a sample of 38 psychiatrically hospitalized adolescents. It was hypothesized that the experience of maltreatment would interfere with alliance formation, thereby compromising the effectiveness of therapy. Results indicated that maltreatment, multiplicity of maltreatment, and type of perpetrator of maltreatment were all associated with initial alliance difficulties. None of these variables predicted change in the alliance over time; instead, severity of interpersonal problems was the best predictor of alliance development. Maltreatment status was not directly related to treatment outcome; however, maltreated adolescents who failed to develop positive alliances with their therapists tended to show the poorest outcomes. Given the strong relationship between alliance formation and outcome, clinical recommendations for therapists who treat maltreated adolescents are presented.

Presynaptic muscarinic receptors mediating inhibition of neurogenic contractions in rabbit vas deferens are of the ganglionic M1-type.

The present study was designed to further characterize the presynaptic muscarinic M1-receptor responsible for the inhibition of neurogenic contractions in the isolated rabbit vas deferens. Electrically induced twitch contractions of this preparation were inhibited by the M1-agonist, McN-A-343, and by some of its analogs: 4-chloro-phenyl derivative greater than McN-A-343 greater than trans-olefinic analog greater than cis-olefinic analog. The same rank order of potency was observed for these agonists to raise the blood pressure of pithed rats by stimulation of M1-receptors in sympathetic ganglia. A highly significant correlation was found between the antimuscarinic potencies of atropine, pirenzepine and a series of 9 antagonists structurally related to the ganglionic M1 beta-receptor selective compounds, hexocyclium and hexahydro-difenidol, to antagonize the McN-A-343-induced inhibition of twitch contractions in rabbit vas deferens or the muscarine-induced depolarization in rat isolated superior cervical ganglia. It is suggested that the presynaptic muscarinic receptor that mediates inhibition of neurogenic contractions in rabbit vas deferens is of the ganglionic M1 beta-type.