The National Dental Practice-Based Research Network Adult Anterior Open Bite Study: Treatment success.

INTRODUCTION: Anterior open bite (AOB) continues to be a challenging malocclusion for orthodontists to treat and retain long-term. There is no consensus on which treatment modality is most successful. This study reports on the overall success rate of AOB orthodontic treatment in the adult population across the United States, as well as 4 major treatment modalities and other factors that may influence treatment success. METHODS: Practitioners and their adult patients with AOB were recruited through the National Dental Practice-Based Research Network. Patient dentofacial and demographic characteristics, practitioner demographic and practice characteristics, and factors relating to orthodontic treatment were reported. Treatment success was determined from posttreatment (T2) lateral cephalometric films and intraoral frontal photographs. Treatment was categorized into 4 main groups: aligners, fixed appliances, temporary anchorage devices (TADs), and orthognathic surgery. Extractions were also evaluated. Bivariate and multivariable models were used to investigate the association between treatment success and treatment modality, pretreatment (T1) dentofacial characteristics, patient and practitioner demographics, and practice characteristics, adjusting for clustering of patients within practice. RESULTS: A total of 254 patients, enrolled by 84 practitioners, contributed to T2 data for this study. There were 29 patients in the aligner group, 152 in fixed appliances, 20 in TADs, and 53 in surgery. A total of 49 patients underwent extractions of teeth other than third molars. Ninety-three percent finished treatment with a positive overbite on the T2 lateral cephalogram, and 84% finished with a positive vertical overlap of all incisors. The small number of aligners and TAD patients limited the ability to compare success rates in these groups. Patients treated with orthognathic surgery had a higher rate of success compared with those treated with fixed appliances only. Treatment success was also associated with academic practice setting, T1 mandibular plane angle ≤30°, no to mild T1 crowding, and treatment duration <30 months. CONCLUSIONS: The overall success of orthodontic treatment in adult patients with AOB who participated in this study was very high. Orthognathic surgery was the only treatment modality that exhibited a statistically higher odds of successful outcomes. Some T1 dentofacial characteristics and treatment factors were associated with the successful closure of AOB.

The National Dental Practice-Based Research Network adult anterior open bite study: A description of the practitioners and patients.

OBJECTIVES:: To describe the demographic and practice characteristics of the clinicians enrolled in a large, prospective cohort study examining recommendations and treatment for adult anterior open bite (AOB) and the relationship between these characteristics and practitioners' self-reported treatment preferences. The characteristics of the AOB patients recruited were also described. MATERIALS AND METHODS:: Practitioners were recruited from the National Dental Practice-Based Research Network. Participants in the study consisted of practitioners and their adult AOB patients in active treatment. Upon enrollment, practitioners completed questionnaires enquiring about demographics, treatment preferences for adult AOB patients, and treatment recommendations for each patient. Patients completed questionnaires on demographics and factors related to treatment. RESULTS:: Ninety-one practitioners and 347 patients were recruited. Demographic characteristics of recruited orthodontists were similar to those of American Association of Orthodontists members. The great majority of practitioners reported using fixed appliances and elastics frequently for adult AOB patients. Only a third of practitioners reported using aligners frequently for adult AOB patients, and 10% to 13% frequently recommended temporary anchorage devices (TADs) or orthognathic surgery. Seventy-four percent of the patients were female, and the mean age was 31.4 years. The mean pretreatment overbite was -2.4 mm, and the mean mandibular plane angle was 38.8°. Almost 40% of patients had undergone orthodontic treatment previously. CONCLUSIONS:: This article presents the demographic data for 91 doctors and 347 adult AOB patients, as well as the practitioners' self-reported treatment preferences.

A novel function for lysyl oxidase in pluripotent mesenchymal cell proliferation and relevance to inflammation-associated osteopenia.

Lysyl oxidase is a multifunctional enzyme required for collagen biosynthesis. Various growth factors regulate lysyl oxidase during osteoblast differentiation, subject to modulation by cytokines such as TNF-α in inflammatory osteopenic disorders including diabetic bone disease. Canonical Wnt signaling promotes osteoblast development. Here we investigated the effect of Wnt3a and TNF-α on lysyl oxidase expression in pluripotent C3H10T1/2 cells, bone marrow stromal cells, and committed osteoblasts. Lysyl oxidase was up-regulated by a transcriptional mechanism 3-fold in C3H10T1/2 cells, and 2.5-fold in bone marrow stromal cells. A putative functional TCF/LEF element was identified in the lysyl oxidase promoter. Interestingly, lysyl oxidase was not up-regulated in committed primary rat calvarial- or MC3T3-E1 osteoblasts. TNF-α down-regulated lysyl oxidase both in Wnt3a-treated and in non-treated C3H10T1/2 cells by a post-transcriptional mechanism mediated by miR203. Non-differentiated cells do not produce a collagen matrix; thus, a novel biological role for lysyl oxidase in pluripotent cells was investigated. Lysyl oxidase shRNAs effectively silenced lysyl oxidase expression, and suppressed the growth of C3H10T1/2 cells by 50%, and blocked osteoblast differentiation. We propose that interference with lysyl oxidase expression under excess inflammatory conditions such as those that occur in diabetes, osteoporosis, or rheumatoid arthritis can result in a diminished pool of pluripotent cells which ultimately contributes to osteopenia.

Tumor necrosis factor- α and interleukin-6: potential interorgan inflammatory mediators contributing to destructive periodontal disease in obesity or metabolic syndrome.

Obesity has become a worldwide health burden in the last two decades. Obesity has been associated with increased comorbidities, such as coronary artery disease, diabetes, and destructive periodontal disease. Obesity is also part of a group of risk factors occurring together in an individual, which is referred to as metabolic syndrome. Clinical studies have shown higher risk for destructive periodontal disease in obesity and metabolic syndrome. However, the role of obesity and metabolic syndrome in the onset and development of destructive periodontal disease has not yet been fully understood. In this review, we discuss a working model, which focuses on interorgan inflammation as a common etiological factor for destructive periodontal disease associated with obesity and metabolic syndrome. Specifically, we suggest that elevated levels of tumor necrosis factor- α (TNF- α ) or interleukin 6 (IL-6)--both adipokines and known risk factors for destructive periodontal disease--in obesity and metabolic syndrome contribute to the onset and development of destructive periodontal disease. The connections between destructive periodontal disease and systemic conditions, such as obesity or metabolic syndrome, are complex and potentially multidirectional. This review largely focuses on TNF- α and IL-6, inflammatory mediators, as potential common risk factors and does not exclude other biological mechanisms.

Adiposity and gingival crevicular fluid tumour necrosis factor-alpha levels in children.

AIM: To investigate whether adiposity is associated with gingival crevicular fluid (GCF) tumour necrosis factor-alpha (TNF-alpha) levels in children. We also examined whether this relationship is mediated through plasma fasting insulin. MATERIALS AND METHODS: This preliminary study used cross-sectional data from the baseline-visit of the Quebec Adipose and Lifestyle InvesTigation in Youth cohort, which is an ongoing longitudinal study investigating the natural history of obesity in Quebec children. Study participants (76 girls and 102 boys) include children aged 8-10 years and their families, living in the Montreal and Quebec City areas. TNF-alpha level was measured in pooled samples (N=4) for each child by enzyme-linked immunosorbant assay. Height and weight were measured. Body mass index (BMI) was calculated as weight/height(2) (kg/m(2)). Sex/age-specific BMI was categorized into normal (<85th percentile), overweight (85th-95th percentile) and obese (>or=95th percentile) defined by the 2000 US-CDC growth charts. Insulin resistance was measured using fasting plasma insulin in children. Data analysis involved descriptive and multiple linear regression analyses. RESULTS: Our results suggest that obesity in boys was associated with a 37% increase of GCF-TNF-alpha level. However, when accounting for insulin resistance this association was reduced and disappeared while the model's goodness of fit improved. CONCLUSIONS: These findings provide support for the link between adiposity in children and GCF-TNF-alpha level, which appears to be mediated by insulin resistance.