The Relationship between Maxillary Sinus Volume and Different Cephalometric Characteristics in Orthodontics.

Introduction: This study aimed to evaluate the maxillary sinus volume (MSV) in both genders in a Saudi sample and among different skeletal patterns. Materials and Methods: This retrospective cross-sectional study included 52 cone-beam computed tomography (CBCT) scans of 18 years or older individuals with complete dentition and healthy medical history. MSV was measured as the mean value of both sides in cubic millimeters (mm3) using OnDemand three-dimensional™ Dental. Cephalometric tracings were conducted on cephalograms obtained from CBCT scans. The beta, A × B, and Frankfort-mandibular plane angles were selected to determine the sagittal and vertical skeletal patterns of the study subjects. Descriptive statistics and other tests were conducted. The significance level was set at P < 0.05. Results: Fifty-two CBCT scans were included in this study (23 males and 29 females), with a mean age of 36 (±14) years. The mean MSV was 14887 (±5030.79) mm3. Males had statistically significantly larger MSV (16517 ± 5335 mm3) compared with females (13595 ± 4,452 mm3) (P = 0.036). There was no statistically significant difference in MSV among all other cephalometric measurements (P > 0.05). Conclusions: The MSV in the studied Saudi sample was larger among males. However, different skeletal patterns have no statistically significant differences in MSV.

A study to estimate tooth size discrepancy values specific to Saudi orthodontic patients: A systematic review and meta-analysis.

Objective: This study aimed to establish intermaxillary tooth size ratios (overall index (OI) and anterior index (AI)) for normal occlusion and different Angle's malocclusions specific to the Saudi population and compare them to Bolton's values, which were specific to Americans. Methods: The Saudi Digital Library, PubMed, Web of Science, Cochrane Library, Scopus, and Embase were searched systematically to acquire articles which reported OI and AI for Saudi patients; inclusion and exclusion criteria were applied. Data, including author's name, publication year, city, measurement technique, number of subjects, type of occlusion, means, and standard deviations, were extracted and sorted. To assess the methodological quality of the included studies, The National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was utilized. Results: Of the 1473 articles, eight met the inclusion criteria and were included in the meta-analysis. Values for normal occlusion and Bolton's values were not significantly different. All malocclusion classes showed significant differences in the overall OI and AI values compared with Bolton's original values and values for normal occlusion, but they did not differ from each other. Gender showed an effect only on the OI ratio for Class III malocclusion. Conclusions: Bolton's original values can be used in Saudi patients only with normal occlusion. For cases with any Angle's malocclusion, we recommend using an AI value of 79.08 (±3.4) for both genders. Classes I and II, regardless of gender, have the same OI value of 92.51 (±2.82). For Class III, values of 91.97 (±2.4) for females and 93.13 (±2.6) for males can be used.

Transient downregulation of NR4A1 leads to impaired osteoblast differentiation through the TGF-ß pathway, and Elesclomol (STA-4783) rescues this phenotype.

Bone formation is regulated by numerous factors, such as transcription factors, cytokines, and extracellular matrix molecules. Human hormone nuclear receptors (hHNR) are a family of ligand-regulated transcription factors that are activated by steroid hormones, such as estrogen and progesterone, and various lipid-soluble signals, including retinoic acid, oxysterols, and thyroid hormone. We found that an hHNR called NR4A1 was the most highly expressed after human MSC differentiation into osteoblasts by whole-genome microarray. NR4A1 knockout decreased the osteoblastic differentiation of hMSCs in terms of ALPL expression and key marker gene expression. Whole-genome microarray analysis further confirmed the decrease in key pathways when we knocked down NR4A1. Further studies with small molecule activators identified a novel molecule called Elesclomol (STA-4783), which could activate and enhance osteoblast differentiation. Elesclomol activation of hMSCs also induced the gene expression of NR4A1 and rescued the phenotype of NR4A1 KD. In addition, Elesclomol activated the TGF-ß pathway by regulating key marker genes. In conclusion, we first identified the role of NR4A1 in osteoblast differentiation and that Elesclomol is a positive regulator of NR4A1 through activation of the TGF-ß signalling pathway.

A Rare Case of Pancreatic Adenocarcinoma With Incidental Synchronous Hepatic and Sigmoid Colonic Metastasis: A Case Report and Literature Review.

Metastasis of pancreatic adenocarcinoma to the colon is a very rare condition that might be underdiagnosed and underreported in the literature. We report a very rare case of incidental findings of sigmoid metastasis secondary to pancreatic adenocarcinoma in a 60-year-old Saudi male, who is a non-smoker with a normal medical and surgical history. The patient presented to a primary care clinic with abdominal bloating and vague on/off abdominal pain for almost 1 year as well as unintentional weight loss without lower gastrointestinal (GI) symptoms. After the case was discussed in the multidisciplinary tumor board, the patient was started on systematic palliative chemotherapy. However, after receiving the first cycle, he started to deteriorate rapidly and succumbed to secondary cardiopulmonary arrest. Cases of synchronous metastasis of pancreatic adenocarcinoma to the colon might not be well known or common. However, a high index of suspicion and individualizing the workup tools may need to be used.

Management of maxillary impacted canines: A prospective study of orthodontists' preferences.

BACKGROUND: Maxillary canines are considered the most commonly impacted teeth, after the third molars. Orthodontists have different preferences on how to approach maxillary impacted canines (MIC). The objective of this article was to investigate orthodontists' approach to managing MIC. MATERIAL AND METHODS: A cross-sectional study comprising a comprehensive survey with 22 questions was sent to practicing orthodontists. This study explored the preferred diagnostic measures, surgical techniques, materials, and mechanics utilized to manage MIC;104 responses were returned. RESULTS: Palatal impaction was reported to be encountered more often than labial impaction by 60% of the respondents. In 62% of the respondents, an oral and maxillofacial surgeon was the specialist preferred to perform the surgical exposure. In 66%, the choice of required surgical techniques was reported as a joint decision between orthodontists and other specialists who perform the surgery. Cone-beam computed tomography (CBCT) was reported to be the diagnostic x-ray of choice. The gold button with a chain was the preferred bonded attachment in 86% of cases. Less than half of the respondents bonded the attachments themselves during surgical exposure. A clear plastic retainer was the preferred retainer in 61% of the respondents, and 43% of the respondents tended to use a closed exposure technique. Coe-pakTM was the preferred surgical pack for orthodontists who prefer an open exposure technique. Piggyback (double wire) was the preferable mechanic to move a palatally impacted canine. CONCLUSION: Our findings indicate that there are variations among orthodontists on how to manage MICs in terms of diagnostic methods, surgical management, materials, and mechanics.

Association between sella turcica bridging and congenitally missing maxillary lateral incisors.

BACKGROUND/PURPOSE: Sella turcica bridging (STB) and its association with dental anomalies has been investigated and reported in literature. This is the first study that exclusively compared STB among the orthodontic patients with congenital missing maxillary lateral incisors (CMMLI) and individuals with complete dentition. MATERIALS AND METHODS: The retrospective study has recruited 49 patients with CMMLI (13 males and 36 females aged between 12 and 43 years) and 49 patients with complete dentition. Sella dimensions and association of STB with CMMLI were evaluated and the results were analysed using descriptive and inferential statistics. RESULTS: The comparison of mean diameter, length, and depth of sella between groups showed reduction in length among the CMMLI (p = 0.04). CMMLI group has shown a significant higher (p < 0.05) number of subjects (69.4%) with calcification when compared to control group (46.9%). The odds of having sella's bridging in patients with CMMLI were 2.5 times greater than patients with full set of teeth. Age showed a significant (p < 0.001) positive correlation with sella's width only in CMMLI. CONCLUSION: Patients with CMMLI tend to have an increased frequency of STB, and decreased sella turcica length.

Medically compromised patients in orthodontic practice: Review of evidence and recommendations.

INTRODUCTION: Due to advances in the field of medicine, early diagnosis and high-quality medical management has become available for medically compromised patients. This increases their life expectancy and improves their quality of life. Therefore, orthodontic treatment can be provided to these patients whose medical conditions are well controlled. OBJECTIVE: This article will discuss some medical conditions that might be seen by orthodontists. Also, recommendations and modifications of the orthodontic treatment plan will be discussed thoroughly. MATERIALS AND METHODS: A computerized electronic search of the literature was conducted in Google Scholar and PubMed and was limited to publications in English. RESULTS: Orthodontic management was studied in cases of Infective endocarditis (IE), Thrombocytopenia, Hemophilia, Sickle cell anemia, Thalassemia, Diabetes mellitus (DM), Thyroid Disorders, Asthma, DiGeorge Syndrome, HIV/AIDS, Organ transplantation, Orthodontic management, Juvenile idiopathic arthritis (JIA), Seizure disorders, Autism Spectrum Disorder (ASD), Mood disorders, Schizophrenia and Eating disorders.

An experience of laparoscopic sleeve gastrectomy in obese, morbidly obese, and super morbid obese patients.

OBJECTIVE: To report experience with laparoscopic sleeve gastrectomy (LSG) in obese, morbidly obese, and super morbid obese patients, and to evaluate comparative efficacy of LSG among these patient groups. METHODS: A total of 147 patients underwent LSG between March 2008 and December 2011 at the Department of Surgery, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia. Patients were grouped according to the preoperative body mass index (BMI) into obese (35-39.9 kg/m2), morbidly obese (40-49.9 kg/m2), and super morbid obese (>50 kg/m2). Patients who did not have a regular follow-up (n=38) were excluded, and 108 patients were included in this prospective study. RESULTS: The mean total weight loss (TWL) among the super morbid obese group (41.31 +/- 21.23 kg) was statistically significantly greater compared to the obese group (24.31 +/- 13.00 kg, p=0.009) and morbidly obese group (26.81 +/- 15.56 kg, p=0.001). The mean percentage excess weight loss (EWL) was clinically significant among obese (57.8%), morbidly obese (42.5%), and super morbid obese patients (45.7%), however, it was not statistically significant between the groups (F[2,105]=2.132, p=0.124). There was no mortality; however, 6 major complications occurred including intra-abdominal collection with suspected leak, staple line bleeding, bowel ischemia, and inferior vena cava injury. CONCLUSION: Laparoscopic sleeve gastrectomy resulted in satisfactory and effective EWL in all 3 groups of obesity patients at 30-months follow-up.