Are We Correctly Measuring Mandibular Stability After Surgery-First Approach? A Comparative Study Based on Novel 3-Dimensional Measurements.

Using traditional measures to assess mandibular stability after the surgery-first approach (SFA) may produce inaccurate results because unlike the conventional orthodontic-first approach (OFA), the main dental movements occur after surgery in SFA, which produce unavoidable mandibular movements, especially in cases with postsurgical premature dental contact. As these movements are part of the surgical-orthodontic plan, they should not be considered an actual relapse. In this study, to avoid postsurgical dental movement effects, the authors used the relationship between proximal and distal mandibular segments to evaluate stability after SFA. Four easily located points on computerized tomography/cone-beam computerized tomography reconstructed 3-dimensional images were used to calculate 4 measurements between proximal and distal mandibular segments across the osteotomy line in two matched groups of patients (SFA and OFA) at 3 different time points (before, immediately after, and 1 year after the surgery). A high level of skeletal stability was found in the SFA group, with changes 1 year after surgery not exceeding 0.5 mm. The SFA was as skeletally stable as OFA, and the mandibular counterclockwise rotation after surgery was related to the planned dental movements and not the instability of the surgery itself. To avoid the illusion of this preplanned relapse, stability should be measured as a relation between proximal and distal mandibular segments, across the osteotomy and fixation line, and not as a relation between maxillary and mandibular landmarks or between the mandible and facial planes as classically described.

Prepubertal IGF-1 and Possible Relation with Physical Features of Growth and Type 1 Diabetes Mellitus.

BACKGROUND: T1DM is considered as the most common chronic metabolic autoimmune disorder in childhood and adolescence as well as in the early adulthood. It appears frequently during 12- 13 years of age with distinctive features like immune-mediated chronic damage of pancreatic ß-cells, leading eventually to partial, or mostly, absolute insulin deficiency. Insulin-like growth factor 1 (IGF-1) is a polypeptide consisting of 70 amino acids with insulin-like chemical structure. In most cases, IGF-1 is a reliable growth marker and an anabolic one in adults. It plays an important role in the regulation of various physiological functions, e.g., glucose metabolism, cell survival and proliferation. OBJECTIVES: To compare the levels of IGF-1 in children having type-1 diabetes with that of healthy controls and also to determine whether there is a relationship between IGF-1 and physical features in T1DM. PATIENTS AND METHODS: The current study was conducted on 85 children of both sexes. Seventy patients were less than 12 years old with T1DMselected according to ADA 2014 criteria for diagnosis of diabetes from pediatric diabetes clinic at Ain Shams University hospital. All patients were divided into 2 groups based on the duration of diabetes to T1DM>1year duration and T1DM<1year duration and they were compared with fifteen normal children, attending the pediatric general clinics as a control group. Measurements of height, weight, and arm span, upper body segment, lower body segment, and body mass index, parents' height beside Fasting blood glucose, HbA1C, IGF-1, FSH, and LH were noted. RESULTS: Height percentile significantly higher inT1DM less than 1 year median 50 (10 to 75) than T1DM more than one year (median10 (3 to 44) p-value 0.007). IGF-1 level in the group of T1DM less than 1year median 90 (70 to 110) (ng/ml) was significantly lower than other groups (p-value 0.0008). IGF1 has a significant positive relation with Aram span in group T1DM more than 1year (p-value 0.024), positive significant relationship between mother height and IGF-1 level in group T1DM less than 1 year (p-value 0.013). CONCLUSION: IGF-1 level is reduced by the recent onset of T1DM but still it has some effect on the somatic features even in the presence of longstanding diabetes.