Evaluation of an objective staging system for assessment of cervical vertebral maturation.

BACKGROUND: The aim of this study was to evaluate an objective method for Cervical Vertebral Maturation (CVM) staging. METHODS: An initial sample of 647 Lateral Cephalometric Radiographs (LCR) were staged according to the CVM (Baccetti et al.) by 4 examiners. The final sample (n = 394) included LCR on which the staging of the 4 investigators matched. The objective staging was performed by a single operator. The sample was divided according to the maturational stages into pre-pubertal, pubertal and post-pubertal groups. Measurements were performed on the cervical vertebrae (C2, C3 and C4). The angle between posterior and superior borders for C3 and C4 was the Superior Wall Inclination Angle (SWIA). Concavity Depth (CD) for C2, C3 and C4, and Body Shape (BS) (ratio of width to height of C3 and C4). Measurements of the 3 groups were compared. RESULTS: Reliability of subjective staging was high (intra-observer reliability, 0.948; inter-observer reliability, 0.967). Good agreement was observed for the outcomes measured. Intra-observer reliability was good (0.918, 0.885 and 0.722 for CD, BS and SWIA, respectively). The same was for the inter-observer reliability results (0.902, 0.889 and 0.728 for CD, BS and SWIA, respectively). Significant differences were observed for mean values of SWIA and BS and median values of CD within maturational stage. Similar findings were observed when the outcomes were compared at different phases (P < 0.001). CONCLUSIONS: A standardized, objective staging system using linear, angular measurements and ratios was applied for the determination of cervical vertebral maturation.

Salivary pH changes under the effect of stainless steel versus elastomeric ligatures in fixed orthodontic patients: a single-center, randomized controlled clinical trial.

BACKGROUND: Fluctuations in pH of saliva during a prolonged treatment course influences the enamel demineralization progress, which is one of the complications of fixed orthodontic treatment. This randomized clinical trial aimed to evaluate and compare the short-term effects of stainless steel (SS) versus elastomeric (EM) ligatures on salivary pH in patients scheduled for fixed orthodontic treatment. METHODS: Seventy participants were enrolled in the study (54 female, 16 male) aged 19-36 years who met specific inclusion criteria. They were randomly selected and allocated into two equal groups through computer-generated randomization. All patients received fixed orthodontic treatment using conventional orthodontic brackets. Two commonly used archwire ligature methods were used: SS and EMs. An unstimulated (resting) salivary sample was collected before tying of the ligatures at T0 (baseline), 2 weeks, 6 (weeks), and 12 (weeks). Salivary pH was measured using a digital pH meter. The level of significance was set at p value < 0.05. RESULTS: The salivary pH level was stable between T0 and T1 (6.72 ± 0.14), then significantly and progressively increased from T1 to T2 (6.78 ± 0.13) and from T2 to T3 (6.81 ± 0.14) with (p < 0.05) in the SS group. In the EM group, the salivary pH level was significantly decreased in all follow-up periods; T0 (6.77 ± 0.16), T1 (6.72 ± 0.14), T2 (6.67 ± 0.13) and T3 (6.64 ± 0.13). CONCLUSION: The EM ligatures showed a significant decrease in salivary pH to an unfavorable level, which increased the risk of enamel demineralization. Therefore, EMs as ligature material is preferably should not be recommended in patients with high caries index or inadequate oral hygiene. Trial registration ANZCTR.org. (ACTRN12618001647224) http://www.anzctr.org.au/ACTRN12618001647224.aspx . Registration Date: 5/10/2018, "Retrospectively registered".

Relationship between cervical vertebral maturation and dental development in a sample of yemeni children and adolescents / Relación entre la maduración vertebral cervical y el desarrollo dental en una muestra de niños y adolescentes yemeníes

Objective: This study was conducted to investigate the relationship between dental development and cervical vertebral maturation stages in a group of Yemeni children and adolescents. Materials an Methods: The study included digital panoramic radiographs and lateral skull cephalograms obtained from 207 Yemeni subjects­122 females and 85 males aged between 8 to 18 years. Dental maturity was evaluated according to the method of Demirijian et al., calcification stages of the left mandibular canines, first and second premolars and second molars were assessed. Skeletal maturity was assessed by the cervical vertebral maturation (CVM) stages according to the method of Baccetti et al. Correlation between CVM and dental maturation was evaluated by Spearman rank-order correlation coefficient (SROCC). Results: CVM and dental calcification stages were highly correlated (p<0.001) in both genders, ranging from 0.686 to 0.873 for females and 0.787 to 0.871 for males. Calcification stages of the second molars showed the strongest correlation with CVM. Conclusion: Calcification stages of the second molar may be used as a reliable maturation indicator. Dental maturation may be applied to determine the skeletal maturity status of Yemeni children and adolescents.

Objetivo: Este estudio se realizó para investigar la relación entre el desarrollo dental y las etapas de maduración vertebral cervical en un grupo de niños y adolescentes yemeníes. Material y Métodos: El estudio incluyó radiografías panorámicas digitales y cefalogramas laterales del cráneo obtenidos de 207 sujetos yemeníes: 122 mujeres y 85 hombres de entre 8 y 18 años. La madurez dental se evaluó de acuerdo con el método de Demirijian et al. Se evaluaron las etapas de calcificación de los caninos mandibulares izquierdos, primer y segundo premolares y segundos molares. La madurez esquelética se evaluó mediante las etapas de maduración vertebral cervical (CVM) de acuerdo con el método de Baccetti et al. La correlación entre la CVM y la maduración dental se evaluó mediante el coeficiente de correlación de orden de rango de Spearman (SROCC). Resultado: Las etapas de CVM y calcificación dental estuvieron altamente correlacionadas (p<0.001) en ambos sexos, con un rango de 0.686 a 0.873 para las mujeres y 0.787 a 0.871 para los hombres. Las etapas de calcificación de los segundos molares mostraron la correlación más fuerte con CVM. Conclusión: las etapas de calcificación del segundo molar pueden usarse como un indicador de maduración confiable. La maduración dental puede aplicarse para determinar el estado de madurez esquelética de los niños y adolescentes yemeníes.

Three-dimensional skeletal and pharyngeal airway changes following therapy with functional appliances in growing skeletal Class II malocclusion patients : A controlled clinical trial.

INTRODUCTION: To three-dimensionally analyze the skeletal and pharyngeal airway changes induced by Twin Block (TWB) and Forsus Fatigue Resistance Device (FFRD) in skeletal Class II female patients compared with untreated controls. MATERIALS AND METHODS: The study comprised 62 growing female patients with skeletal Class II malocclusion due to mandibular retrusion treated with either TWB (n = 23) or FFRD (n = 21), or neither (n = 18; controls). Pre- and posttreatment/observational cone beam computed tomography images were used to evaluate the treatment changes. RESULTS: TWB induced more obvious mandibular skeletal changes and caused significant retrusive effects on the maxilla. Similarly, the sagittal and vertical jaw relationships were affected more obviously with TWB (P <0.001) compared to FFRD. Changes in oropharyngeal volume and minimal axial area were more obvious with TWB. DISCUSSION: The TWB functional appliance induced significant skeletal and pharyngeal airway changes. These changes were more obvious relative to the slight changes induced by FFRD or by natural growth.

A novel approach for treatment of skeletal Class II malocclusion: Miniplates-based skeletal anchorage.

INTRODUCTION: The objective of this study was to evaluate the effect of a new approach-bimaxillary miniplates-based skeletal anchorage-in the treatment of skeletal Class II malocclusion compared with untreated subjects. METHODS: The study (miniplates) group comprised 28 patients (14 boys, 14 girls) with skeletal Class II malocclusion due to mandibular retrusion, with a mean age of 11.83 years. After 0.017 × 0.025-in stainless steel archwires were placed in both arches, 4 miniplates were fixed bilaterally, 2 in the maxillary anterior areas and 2 in the mandibular posterior areas, and used for skeletal treatment with elastics. Twenty-four Class II untreated subjects (11 boys, 13 girls), with a mean age of 11.75 years, were included as controls. Skeletal and dental changes were evaluated using pretreatment and posttreatment or observational lateral cephalometric radiographs. The treatment changes were compared with the growth changes observed in the control group using independent t tests. RESULTS: Compared with the minimal changes induced by growth in the control group, the skeletal changes induced by miniplates were more obvious. The mandibular length increased significantly (3 mm), and the mandible moved forward, with a significant restraint in the sagittal position of the maxilla (P <0.001). The overjet correction (-4.26 mm) was found to be a net result of skeletal changes (A-Y-axis = -1.18 mm and B-Y-axis = 3.83 mm). The mandibular plane was significantly decreased by 2.75° (P <0.001). CONCLUSIONS: This new technique, bimaxillary miniplates-based skeletal anchorage, is an effective method for treating patients with skeletal Class II malocclusions through obvious skeletal, but minimal dentoalveolar, changes.

Fixed functional appliances with multibracket appliances have no skeletal effect on the mandible: A systematic review and meta-analysis.

INTRODUCTION: Our aim was to assess the skeletal mandibular changes (anteroposterior and vertical) in circumpubertal patients with fixed functional appliances installed on multibracket appliances compared with untreated patients. METHODS: An open-ended electronic search of 4 databases (PubMed, Embase, Cochrane Library, and Web of Science) up to April 2014 was performed. Additional searches of relevant journals, reference lists of the retrieved articles, systematic reviews, and gray literature were performed. Specific inclusion and exclusion criteria were applied to identify relevant articles. Quality was evaluated using the Cochrane Collaboration risk of bias tool and the Newcastle-Ottawa scale for prospective controlled clinical trials. Meta-analyses were conducted with fixed and random effects models as appropriate. Statistical heterogeneity was also examined. RESULTS: Seven articles were included in the qualitative synthesis and 5 in the meta-analysis. The included randomized controlled trials were at high risk of bias, and the methodologic quality of the prospective controlled clinical trials was high. Based on assessment of the fixed functional appliance phase in isolation, no difference in mandibular anteroposterior positional changes (SNB angle) (standard mean difference, 0.11°; 95% CI, -0.28, 0.50) was found between the treated and control groups. The vertical dimension was not influenced by the fixed functional appliance treatment. CONCLUSIONS: There is little high-quality evidence concerning the relative influence of fixed functional appliances on skeletal and dentoalveolar changes. However, based on the limited evidence, it appears that they have little effect on the skeletal mandibular parameters.

Three-dimensional effects of the mini-implant-anchored Forsus Fatigue Resistant Device: A randomized controlled trial.

OBJECTIVE: To detect three-dimensionally the effects of using mini-implant anchorage with the Forsus Fatigue Resistant Device (FFRD). MATERIALS AND METHODS: The sample comprised 43 skeletal Class II females with deficient mandibles. They were randomly allocated into three groups: 16 patients (13.25 ± 1.12 years) received FFRD alone (Forsus group), 15 subjects (13.07 ± 1.41 years) received FFRD and mini-implants (FMI group), and 12 subjects (12.71 ± 1.44 years) were in the untreated control group. Three-dimensional analyses of cone beam computed tomographic images were completed, and the data were statistically analyzed. RESULTS: Class I relationship and overjet correction were achieved in 88% of the cases. None of the two treatment groups showed significant mandibular skeletal effects. In the FMI group, significant headgear effect, decrease in maxillary width, and increase in the lower facial height were noted. In the FMI group, retroclination of maxillary incisors and distalization of maxillary molars were significantly higher. Proclination and intrusion of mandibular incisors were significantly greater in the Forsus group. CONCLUSIONS: FFRD resulted in Class II correction mainly through dentoalveolar effects and with minimal skeletal effects. Utilization of mini-implant anchorage effectively reduced the unfavorable proclination and intrusion of mandibular incisors but did not produce additional skeletal effects.

Insulin-like growth factor I: a biologic maturation indicator.

INTRODUCTION: Determination of the maturation level and the subsequent evaluation of growth potential during preadolescence and adolescence are important for optimal orthodontic treatment planning and timing. This study was undertaken to evaluate the applicability of insulin-like growth factor I (IGF-I) blood level as a maturation indicator by correlating it to the cervical vertebral maturation index. METHODS: The study was conducted with 120 subjects, equally divided into 60 males (ages, 10-18 years) and 60 females (ages, 8-16 years). A lateral cephalometric radiograph and a blood sample were taken from each subject. For each subject, cervical vertebral maturation and IGF-I serum level were assessed. Mean values of IGF-I in each stage of cervical vertebral maturation were calculated, and the means in each stage were statistically compared with those of the other stages. RESULTS: The IGF-I mean value at each cervical vertebral maturation stage was statistically different from the mean values at the other stages. The highest mean values were observed in stage 4, followed by stage 5 in males and stage 3 in females. CONCLUSIONS: IGF-I serum level is a reliable maturation indicator that could be applied in orthodontic diagnosis.