Levantine cranium from Manot Cave (Israel) foreshadows the first European modern humans.

A key event in human evolution is the expansion of modern humans of African origin across Eurasia between 60 and 40 thousand years (kyr) before present (bp), replacing all other forms of hominins. Owing to the scarcity of human fossils from this period, these ancestors of all present-day non-African modern populations remain largely enigmatic. Here we describe a partial calvaria, recently discovered at Manot Cave (Western Galilee, Israel) and dated to 54.7 ± 5.5 kyr bp (arithmetic mean ± 2 standard deviations) by uranium-thorium dating, that sheds light on this crucial event. The overall shape and discrete morphological features of the Manot 1 calvaria demonstrate that this partial skull is unequivocally modern. It is similar in shape to recent African skulls as well as to European skulls from the Upper Palaeolithic period, but different from most other early anatomically modern humans in the Levant. This suggests that the Manot people could be closely related to the first modern humans who later successfully colonized Europe. Thus, the anatomical features used to support the 'assimilation model' in Europe might not have been inherited from European Neanderthals, but rather from earlier Levantine populations. Moreover, at present, Manot 1 is the only modern human specimen to provide evidence that during the Middle to Upper Palaeolithic interface, both modern humans and Neanderthals contemporaneously inhabited the southern Levant, close in time to the likely interbreeding event with Neanderthals.

Sleep disordered breathing in children seeking orthodontic care.

INTRODUCTION: Our objective was to evaluate the prevalence of high-risk factors for sleep disordered breathing (SDB) in an orthodontic population of children. SDB is a spectrum of breathing disorders ranging from primary snoring to obstructive sleep apnea. METHODS: The sample included 303 healthy children between the ages of 9 and 17. High risk of SDB was assessed using the Pediatric Sleep Questionnaire, a validated instrument that consists of 22 questions, and high risk is defined as positive answers to 33% or more of the questions answered. Sixteen randomly selected patients repeated the questionnaire 1 month after the initial survey for reliability. RESULTS: In this sample, high-risk status on the Pediatric Sleep Questionnaire was not associated with sex, age, or race. The percentage of patients who were screened as high risk was 7.3% (95% confidence interval, 4.7%-10.6%). CONCLUSIONS: The results of this study suggest that approximately 7% of adolescent orthodontic patients may be at a significant risk for some form of SDB.

Gingival crevicular fluid bone turnover biomarkers: How postmenopausal women respond to orthodontic activation.

INTRODUCTION: Bone turnover associated with orthodontic tooth movement is evidenced by increased bone turnover markers in gingival crevicular fluid (GCF). Postmenopausal women have an increased concentration of serum bone turnover markers. The filtrate of this serum makes up GCF, but little is known of the bone turnover around teeth in this cohort. The objective of this investigation was to compare the GCF bone turnover markers in premenopausal vs postmenopausal women receiving orthodontic treatment at baseline and at orthodontic activation. METHODS: Twenty-eight women were enrolled in the study and separated into 2 groups: premenopausal (16) and postmenopausal (12). Bone turnover was evaluated by GCF at baseline and 24 hours after orthodontic appliance activation. GCF concentrations of RANKL and OPN were measured using ELISA. Baseline and change in concentrations were compared between groups. RESULTS: Baseline RANKL and OPN were significantly different between the premenopausal and postmenopausal groups (P <0.05). Both markers increased significantly from baseline to 24 hours after orthodontic appliance activation in both groups (P <0.05). However, the response to orthodontic activation was not significantly different between groups. CONCLUSIONS: Although postmenopausal women have a different bone turnover profile at baseline than do their premenopausal counterparts, there is no difference in their response to orthodontic activation. This confers a level of security associated with orthodontic activation. Future studies are warranted to construct biomarker curves throughout orthodontic therapy.

Effects of Case Western Reserve University's transverse analysis on the quality of orthodontic treatment.

INTRODUCTION: The purpose of this study was to evaluate the effect of using the transverse analysis developed at Case Western Reserve University (CWRU) in Cleveland, Ohio. The hypotheses were based on the following: (1) Does following CWRU's transverse analysis improve the orthodontic results? (2) Does following CWRU's transverse analysis minimize the active treatment duration? METHODS: A retrospective cohort research study was conducted on a randomly selected sample of 100 subjects. The sample had CWRU's analysis performed retrospectively, and the sample was divided according to whether the subjects followed what CWRU's transverse analysis would have suggested. The American Board of Orthodontics discrepancy index was used to assess the pretreatment records, and quality of the result was evaluated using the American Board of Orthodontics cast/radiograph evaluation. The Mann-Whitney test was used for the comparison. RESULTS: CWRU's transverse analysis significantly improved the total cast/radiograph evaluation scores (P = 0.041), especially the buccolingual inclination component (P = 0.001). However, it did not significantly affect treatment duration (P = 0.106). CONCLUSIONS: CWRU's transverse analysis significantly improves the orthodontic results but does not have significant effects on treatment duration.

When static meets dynamic: Comparing cone-beam computed tomography and acoustic reflection for upper airway analysis.

INTRODUCTION: Upper airway measurement can be important for the diagnosis of breathing disorders. Acoustic reflection (AR) is an accepted tool for studying the airway. Our objective was to investigate the differences between cone-beam computed tomography (CBCT) and AR in calculating airway volumes and areas. METHODS: Subjects with prescribed CBCT images as part of their records were also asked to have AR performed. A total of 59 subjects (mean age, 15 ± 3.8 years) had their upper airway (5 areas) measured from CBCT images, acoustic rhinometry, and acoustic pharyngometry. Volumes and minimal cross-sectional areas were extracted and compared with software. RESULTS: Intraclass correlation on 20 randomly selected subjects, remeasured 2 weeks apart, showed high reliability (r >0.77). Means of total nasal volume were significantly different between the 2 methods (P = 0.035), but anterior nasal volume and minimal cross-sectional area showed no differences (P = 0.532 and P = 0.066, respectively). Pharyngeal volume showed significant differences (P = 0.01) with high correlation (r = 0.755), whereas pharyngeal minimal cross-sectional area showed no differences (P = 0.109). The pharyngeal volume difference may not be considered clinically significant, since it is 758 mm3 for measurements showing means of 11,000 ± 4000 mm3. CONCLUSIONS: CBCT is an accurate method for measuring anterior nasal volume, nasal minimal cross-sectional area, pharyngeal volume, and pharyngeal minimal cross-sectional area.

History of imaging in orthodontics from Broadbent to cone-beam computed tomography.

The history of imaging and orthodontics is a story of technology informing biology. Advances in imaging changed our thinking as our understanding of craniofacial growth and the impact of orthodontic treatment deepened. This article traces the history of imaging in orthodontics from the invention of the cephalometer by B. Holly Broadbent in 1930 to the introduction of low-cost, low-radiation-dose cone-beam computed tomography imaging in 2015.

Cephalometric evaluation of deep overbite correction using anterior bite turbos.

OBJECTIVES: To evaluate the outcome of treating deep overbite (OB) using anterior bite elevators concurrently with a pre-adjusted edgewise appliance. MATERIALS AND METHODS: The Case Western Reserve University (CWRU) cephalometric analysis was used to isolate tipping movement of upper (TUI) and lower incisors (TLI), bodily tooth movement of upper (BUI), and lower incisors (BLI), as well as vertical skeletal changes in the anterior region of the maxilla (MXSK) and mandible (MNSK). Thirty treated subjects were examined at pretreatment (T1) and posttreatment (T2) and compared to an untreated control group matched on age, sex, and Angle malocclusion from the Bolton Brush Growth Study Collection (CWRU, Cleveland, Ohio). RESULTS: Overbite (OB) in the treated group was decreased significantly (P < .001) (-5.6 mm) compared to controls. Statistically significant (P < .001) changes were found for BUI (-0.7 mm), TUI (0.9 mm), TLI (-1.4 mm), BLI (-1.1 mm), and MNSK (-1.6 mm). Most of the overbite correction was in the lower arch and included tipping and intrusion of the lower incisors along with an increase in lower vertical facial height. CONCLUSIONS: Deep OB correction was achieved efficiently using anterior bite elevators with pre-adjusted edgewise appliance. Correction using bite turbos would be a treatment option for individuals presenting with decreased lower facial height and deep bite.

Use of intraoral miniplates to control postoperative occlusion after high condylectomy for the treatment of condylar hyperplasia.

Mandibular condylar hyperplasia is a rare disorder, characterized by unilateral mandibular overgrowth with overeruption of the dentition on the affected side. Although the etiology is unclear, multiple surgical techniques have been described to correct the associated mandibular bone, occlusal, and soft tissue deformities. Often a condylectomy, to arrest mandibular growth, is combined with various orthognathic procedures to restore occlusion and facial harmony. Here we report our technique of isolated high condylectomy with simultaneous intraoral placement of maxillary and mandibular miniplates. Each plate has an intraoral extension that allows our orthodontists to develop vertical force vectors to intrude the maxillary and mandibular molar segments. Using this combined surgical and orthodontic technique, we were able to postoperatively control the occlusal cant, restore the dental midline, improve facial aesthetics, and resolve the patient's contralateral temporomandibular joint dysfunction without concomitant orthognathic surgery. As a result of our findings, we are currently using, and would recommend, this technique for patients requiring surgical-orthodontic intervention for other conditions.

Accuracy and reliability of cone-beam computed tomography for measuring alveolar bone height and detecting bony dehiscences and fenestrations.

INTRODUCTION: The purpose of this study was to evaluate the accuracy and reliability of cone-beam computed tomography (CBCT) in the diagnosis of naturally occurring fenestrations and bony dehiscences. In addition, we evaluated the accuracy and reliability of CBCT for measuring alveolar bone margins. METHODS: Thirteen dry human skulls with 334 teeth were scanned with CBCT technology. Measurements were made on each tooth in the volume-rendering mode from the cusp or incisal tip to the cementoenamel junction and from the cusp or incisal tip to the bone margin along the long axis of the tooth. The accuracy of the CBCT measurements was determined by comparing the means, mean differences, absolute mean differences, and Pearson correlation coefficients with those of direct measurements. Accuracy for detection of defects was determined by using sensitivity and specificity. Positive and negative predictive values were also calculated. RESULTS: The CBCT measurements showed mean deviations of 0.1 +/- 0.5 mm for measurements to the cementoenamel junction and 0.2 +/- 1.0 mm to the bone margin. The absolute values of the mean differences were 0.4 +/- 0.3 mm for the cementoenamel junction and 0.6 +/- 0.8 mm for the bone margin. The sensitivity and specificity of CBCT for fenestrations were both about 0.80, whereas the specificity for dehiscences was higher (0.95) and the sensitivity lower (0.40). The negative predictive values were high (>or=0.95), and the positive predictive values were low (dehiscence, 0.50; fenestration, 0.25). The reliability of all measurements was high (r >or=0.94). CONCLUSIONS: By using a voxel size of 0.38 mm at 2 mA, CBCT alveolar bone height can be measured to an accuracy of about 0.6 mm, and root fenestrations can be identified with greater accuracy than dehiscences.

Pretreatment characteristics associated with orthodontic treatment duration.

INTRODUCTION: Pretreatment characteristics can assist orthodontists in accurately estimating treatment duration. METHODS: This case-control study identified 400 patients, 9 to 18 years of age. Short treatment duration was 20 months or less, and long treatment duration was 30 months or longer. Potential pretreatment explanatory variables included planned treatment, sociodemographic, behavior, dental, skeletal, and soft-tissue characteristics. Univariable and multivariable logistic regression modeling was used to quantify the association between patient characteristics and treatment duration by reporting the unadjusted odds ratios (ORcrude), the adjusted odds ratios (ORadj), and the 95% confidence intervals (CIs). RESULTS: Patients planned as nonextraction (ORadj = 2.3; 95% CI, 1.3-4.2), no deciduous teeth (ORadj = 3.0; 95% CI, 1.5-5.9), less than 80% overbite (ORadj = 2.4; 95% CI, 1.3-4.4), less than 6 mm of maxillary crowding (ORadj = 3.6; 95% CI, 1.7-7.7), and good oral hygiene (ORadj = 3.2; 95% CI, 1.3-1.8) were 2 to 3 times more likely to have short treatments. Patients with decreased lower facial height (ORadj = 3.4; 95% CI, 1.6-7.1), extractions (ORadj = 1.8; 95% CI, 1.0-3.2), deciduous teeth (ORadj = 1.9; 95% CI, 1.0-3.4), poor grades (ORadj = 2.0; 95% CI, 1.1-3.8), excessive overjet (ORadj = 2.3; 95% CI, 1.4-3.8), 80% or more overbite (ORadj = 2.0; 95% CI,1.2-3.6), and 6 mm or more of maxillary crowding (ORadj = 2.6; 95% CI,1.4-4.6) were 2 to 3 times more likely to have long treatments. CONCLUSIONS: Presence or absence of severe maxillary crowding, deciduous teeth, 80% overbite, and extractions were consistently, inversely, and independently associated with short and long treatment durations.

Retainer wear and compliance in the first 2 years after active orthodontic treatment.

INTRODUCTION: The purpose of this descriptive study was to estimate retainer wear and compliance among orthodontic patients in the first 2 years after active orthodontic treatment. METHODS: A random sample of 1200 orthodontic patients was selected from 4 offices. Data were collected by a self-administered questionnaire that consisted of 6 items: type of retainer prescribed, age, sex, length of time since debond, and hours per day and nights per week that patients wore their retainers. Responses were solicited by mail or the Internet. Data were gathered on a categorical scale and analyzed. RESULTS: The overall response rate was 36% during a 6-week period. In the first 3 months after debond, 60% of patients were wearing their retainers more than 10 hours during a 24-hour cycle, and 69% were wearing the retainers every night. At 19 to 24 months after debond, 19% of the patients were not wearing their retainers, and 81% wore their retainers at least 1 night per week. Compliance rates during the periods of 0 to 3, 4 to 6, 7 to 9, 10 to 12, 13 to 18, and 19 to 24 months were 69%, 76%, 55%, 62%, 45%, and 45%, respectively. Age, sex, and type of retainer did not influence the levels of compliance. CONCLUSIONS: Most continued to wear their retainers at least 1 night per week, with compliance rates, as defined, tending to decrease in our sample. It was encouraging that 81% of the patients in this sample largely maintained their orthodontic result.

Assessment of infrazygomatic bone depth for mini-screw insertion.

OBJECTIVE: To investigate the bone depth at the infrazygomatic crest with regard to orthodontic mini-screw insertion. MATERIAL AND METHODS: Twenty-nine adult human dry skulls were imaged using CBCT technology, slice data were generated and multiple measurements were undertaken at three sites associated with the infrazygomatic crest and five different measurement levels. The data were analyzed using intraclass correlation and repeated measures ANOVA. RESULTS: The greatest bone depth was available at, on average, 11.48+/-1.92 mm apical from the cemento-enamel junction of the maxillary first molar and decreased rapidly further apically. Maximum bone depth (7.05+/-3.7 mm) was present at the lowest measurement level. However, here, insufficient clearance to the molar roots was present. Both the measurement site and the level at which the measurements were conducted had a significant impact on bone depth. CONCLUSIONS: When inserting orthodontic mini-screws (6 mm or longer) into the infrazygomatic crest while staying clear of the molar roots perforation of the maxillary sinus or the nasal cavity can be expected, but bone depth varies considerably between individuals.

Buccal cortical bone thickness for mini-implant placement.

INTRODUCTION: The thickness of cortical bone is an important factor in mini-implant stability. In this study, we investigated the buccal cortical bone thickness of every interdental area as an aid in planning mini-implant placement. METHODS: From the cone-beam computed tomography scans of 30 dry skulls, 2-dimensional slices through every interdental area were generated. On these, cortical bone thickness was measured at 2, 4, and 6 mm from the alveolar crest. Intraclass correlation was used to determine intrarater reliability, and analysis of variance (ANOVA) was used to test for differences in cortical bone thickness. RESULTS: Buccal cortical bone thickness was greater in the mandible than in the maxilla. Whereas this thickness increased with increasing distance from the alveolar crest in the mandible and in the maxillary anterior sextant, it behaved differently in the maxillary buccal sextants; it was thinnest at the 4-mm level. CONCLUSIONS: Interdental buccal cortical bone thickness varies in the jaws. There appears to be a distinct pattern. Knowledge of this pattern and the mean values for thickness can aid in mini-implant site selection and preparation.

Reliability and accuracy of cone-beam computed tomography dental measurements.

INTRODUCTION: Dental measurements are an integral part of the orthodontic records necessary for proper diagnosis and treatment planning. In this study, we investigated the reliability and accuracy of dental measurements made on cone-beam computed tomography (CBCT) reconstructions. METHODS: Thirty human skulls were scanned with dental CBCT, and 3-dimensional reconstructions of the dentitions were generated. Ten measurements (overbite, overjet, maxillary and mandibular intermolar and intercanine widths, arch length available, and arch length required) were made directly on the dentitions of the skulls with a high-precision digital caliper and on the digital reconstructions with commercially available software. Reliability and accuracy were assessed by using intraclass correlation and paired Student t tests. A P value of < or = 0.05 was used to assign statistical significance. RESULTS: Both the CBCT and the caliper measurements were highly reliable (r >0.90). The CBCT measurements tended to slightly underestimate the anatomic truth. This was statistically significant only for compounded measurements. CONCLUSIONS: Dental measurements from CBCT volumes can be used for quantitative analysis. With the CBCT images, we found a small systematic error, which became statistically significant only when combining several measurements. An adjustment for this error allows for improved accuracy.

Mini-implant anchorage for the orthodontic practitioner.

Mini-implant-enhanced anchorage has become a popular concept in orthodontics over the past years. Although these systems are routinely used in university settings, there is some reservation because of lack of information in private practices. This article will introduce the concept of mini-implant anchorage to the orthodontic practitioner.

Image quality produced by different cone-beam computed tomography settings.

INTRODUCTION: The aim of this study was to evaluate image quality at different cone-beam computed tomography settings and 3 fields of view. METHODS: A Hitachi CB MercuRay (Hitachi Medical Systems, Tokyo, Japan) was modified to allow different setting combinations. The variables consisted of 4 milliampere settings (2, 5, 10, and 15 mA), 2 kilovolt (peak) settings (100 and 120 kV[p]), presence or absence of a copper filter, and 3 fields of view (6, 9, and 12 in). Thirty-two scans were taken on a cadaver head and 16 scans on a dry skull. The groups were divided by field of view, and the images were ranked by at least 30 judges. Diagnostic quality was addressed in a questionnaire. Descriptive statistics and rankings were calculated with Excel 2003 (Microsoft, Redmond, Wash) and the Friedman and Wilcoxon signed rank tests with SPSS software (version 14.0.1; SPSS, Chicago, Ill). RESULTS: The presence or absence of a filter showed significant differences (P <.006) in 2 pairs of the 9-in field of view. Variation in kilovolt (peak) settings showed significant differences (P <.006) in the 6-in 5-mA images with a filter. Altering the milliampere settings showed significant differences (P <.008) in the 6- and 12-in groups. The 9-in group showed significant differences between 2 mA and 10 and 15 mA. Overall, the 6-, 9-, and 12-in images had diagnostic quality 56%, 99%, and 99% of the time, respectively. CONCLUSIONS: Presence or absence of a filter and the kilovolt (peak) setting did not affect overall image quality. Images taken at lower milliampere settings showed good diagnostic quality.

Image distortion and spatial resolution of a commercially available cone-beam computed tomography machine.

INTRODUCTION: Our objective was to evaluate images produced by a commercially available cone-beam computed tomography (CBCT) machine (i-CAT model 9140-0035-000C, Imaging Sciences International, Hatfield, Pa) for measurement and spatial resolution (ie, the ability to separate 2 objects in close proximity in the image) for all settings and in all dimensions. METHODS: A custom phantom containing 0.3 mm diameter chromium metal markers approximately 5 mm apart in 3 planes of space was developed for analyzing distortion and measurement accuracy. This phantom was scanned in the CBCT machine by using all 12 commercially available settings. The distance between the markers was measured 3 times on the 3-dimensional images by using a Digital Imaging and Communications in Medicine (DICOM) viewer and was also measured 3 times directly on the phantom with a fine-tipped digital caliper. A line-pair phantom was used to evaluate spatial resolution. Thirty evaluators analyzed images and assigned a resolution from 0.2 to 1.6 mm according to the separation of the line pairs. RESULTS: There were no statistically significant differences among the 3-dimensional images for any setting, in any dimension, or in images divided by thirds in terms of measurement accuracy. Comparison of the CBCT measurements to the direct digital caliper measurements showed a statistically significant difference (P <0.01). However, the absolute difference was <0.1 mm and is probably not clinically significant for most applications. The worst spatial resolution found was 0.86 mm. Spatial resolution was lower at faster scan times and larger voxel sizes. CONCLUSIONS: This CBCT machine has clinically accurate measurements and acceptable resolution.

Correlations between cephalometric and facial photographic measurements of craniofacial form.

INTRODUCTION: The purpose of this study was to compare craniofacial measurements from cephalometric radiographs with analogous measurements from standardized facial photographs. METHODS: The sample consisted of 326 subjects (168 white, 158 black) enrolled in a genetic epidemiological family study of sleep behavior. Traditional lateral cephalograms and standardized facial photographs were taken of each subject. Three angular, 3 linear, total face height, and lower face height cephalometric measurements were compared with 4 angular and 4 linear measurements from standardized photographs. Descriptive statistics for all measurements in the entire sample and for the racial subgroups were computed. Pearson product moment correlation coefficients were computed between analogous measurements, and intraclass correlation coefficients were calculated from repeated measurements on the photographs. RESULTS: The reliability of the photographic technique was excellent, with all measurements having intraclass correlation coefficients above 0.90. However, the correlations between analogous photographic and cephalometric measurements were lower and varied between 0.356 and 0.643. The highest correlations were observed for lower facial height and mandibular length, 0.643 and 0.562, respectively. In the black group, the correlations between cephalometric and photographic measurements of mandibular length and lower facial height were 0.676 and 0.690, respectively. Both were higher than those for white subjects, 0.399 and 0.577, respectively. CONCLUSIONS: Both linear and angular measurements useful for characterizing facial morphology can be reliably measured from facial photographs. However, only moderate correlations with analogous cephalometric measures were found. Therefore, standardized photographs and cephalograms most likely measure different aspects of facial morphology and cannot be used interchangeably. Cephalometrics remains the method of choice for clinical patient care, whereas photographs might be better for large-scale epidemiological studies, especially if there is a need for a low-cost, noninvasive method that be used in diverse clinical and field settings.