Smile projection-a new concept in smile design.

Vertical positioning of the maxillary incisors is critical in smile design, and orthodontists also have the capability of working in the anterior-posterior plane of space. As a result, the anterior posterior positioning of the maxillary incisors becomes equally important for smile aesthetics. This manuscript presents the concept of smile projection for incorporation into the current concepts of smile design.

Smile dimensions in adult African American and Caucasian females and males.

OBJECTIVES: To test smile dimension variations in adult African American and Caucasian females and males. SETTING AND SAMPLE POPULATION: The University of Alabama at Birmingham School of Dentistry and Hospital. Three hundred and ninety-four participants were recruited; African American females and males distributed over five age groups: 20-30, 30-40, 40-50, 50-60 and older than 60. MATERIAL & METHODS: Three-dimensional surface imaging was used to acquire two images of each participant, one at rest and one upon smile. Landmarks were plotted on the lips and linear distances measured to assess the length of the upper and lower lips, mouth width at rest and upon smile, gingival and dental display upon smile. RESULTS: Linear dimensions are larger in males than in females, and in African Americans than in Caucasians, except for the length of the upper lip that does not differ between male African American and Caucasian males, in any given age group. Gingival display and dental display decrease with age in all groups. CONCLUSION: Norms should reflect race, age and sex in order to optimize treatment goals.

Effects of FGFR Signaling on Cell Proliferation and Differentiation of Apert Dental Cells.

The Apert syndrome is a rare congenital disorder most often arising from S252W or P253R mutations in fibroblast growth factor receptor (FGFR2). Numerous studies have focused on the regulatory role of Apert FGFR2 signaling in bone formation, whereas its functional role in tooth development is largely unknown. To investigate the role of FGFR signaling in cell proliferation and odontogenic differentiation of human dental cells in vitro, we isolated dental pulp and enamel organ epithelia (EOE) tissues from an Apert patient carrying the S252W FGFR2 mutation. Apert primary pulp and EOE cells were established and shown to exhibit normal morphology and express alkaline phosphatase under differentiation conditions. Similar to control cells, Apert dental pulp and EOE cells expressed all FGFRs, with highest levels of FGFR1 followed by FGFR2 and low levels of FGFR3 and FGFR4. However, Apert cells had increased cell growth compared with control cells. Distinct from previous findings in osteoblast cells, gain-of-function S252W FGFR2 mutation did not upregulate the expression of epidermal growth factor receptor (EGFR) and platelet-derived growth factor receptor (PDGFRα), but elevated extracellular signal-regulated kinase (ERK) signaling in cells after EGF stimulation. Unexpectedly, there was little effect of the S252W mutation on odontogenic gene expression in dental pulp and EOE cells. However, after inhibition of total FGFR signaling or ERK signaling, the expression of odontogenic genes was upregulated in both dental cell types, indicating the negative effect of whole FGFR signaling on odontogenic differentiation. This study provides novel insights on FGFR signaling and a common Apert FGFR2 mutation in the regulation of odontogenic differentiation of dental mesenchymal and epithelial cells.

Magnetic Resonance Enterography (MRE): The role of imaging in the management of adult patients with Crohn's disease.

Crohn's disease, an inflammatory bowel disease with devastating complications, often requires frequent imaging to detect active disease and its complications. Endoscopy, which is the gold standard for diagnosis, is contraindicated in come patients and has limited role in detecting deep submucosal/mesenteric disease, mid small bowel disease and intra-abdominal complications. Magnetic Resonance Enterography (MRE) has evolved as a complimentary non-invasive, radiation free, high resolution imaging modality in evaluating these patients, with clinical studies haveing shown MRE to help in the diagnosis and follow up of these patients. Its major advantage over CT Enterography is the absence of radiation.

Interactions of hard tissues, soft tissues, and growth over time, and their impact on orthodontic diagnosis and treatment planning.

The approach to orthodontic diagnosis has changed gradually but steadily over the past 2 decades. The shift away from diagnosis based entirely on hard tissue evaluations has been a result of a broadened recognition of the importance of facial and smile appearance to our patients, and how they change over time. The purpose of this article is to describe and illustrate the integration of the new soft tissue paradigm into long-term treatment planning, with a focus on the esthetic goals of treatment.

Early therapy assessment of combined anti-DR5 antibody and carboplatin in triple-negative breast cancer xenografts in mice using diffusion-weighted imaging and (1)H MR spectroscopy.

PURPOSE: To assess the early response of triple-negative breast-cancer (TNBC) following TRA-8 and carboplatin therapy using DWI and MRS in 2LMP and SUM159 mouse models. MATERIALS AND METHODS: Four groups (n = 5/group) of each model were untreated or treated with carboplatin, TRA-8, and combination, respectively. DWI and MRS were applied on 0, 3, and 7 days after therapy initiation, and all tumors were collected thereafter for terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) staining. The changes in intratumoral apparent diffusion coefficient (ADC) and fat-water ratios (FWRs) were compared with tumor volume changes and apoptotic cell densities. RESULTS: Mean ADC values of 2LMP and SUM159 tumors significantly increased 4 ± 4% and 37 ± 11% during 7 days of combination therapy, respectively, as compared to control groups (P < 0.05). Similarly, mean FWRs of 2LMP and SUM159 tumors significantly increased 102 ± 30% and 126 ± 52%, respectively, for 7 days of combined treatment (P < 0.05). The changes of the mean ADC values for 3 days (or FWRs for 7 days) were linearly proportional to either the mean volume changes or apoptotic cell densities in both models. CONCLUSION: DWI and MRS assessed the early tumor response to TRA-8 and carboplatin in TNBC mouse models.

Re-evaluation of pectoralis major height as an anatomic reference for humeral height in fracture hemiarthroplasty.

BACKGROUND: Shoulder replacement may be indicated for complex proximal humeral fractures. The primary reason for disappointing results is the nonanatomic position of the prosthesis because the normal anatomic landmarks are disrupted when fractured. An anatomic reference outside of the zone of injury may facilitate proper positioning of fracture arthroplasty reconstructions. It is unknown whether the measurement from the top of the pectoralis major tendon (PMT) to the top of the humeral head is related to patient height. MATERIALS AND METHODS: PMT measurements were performed on 21 pairs of cadaveric shoulders. A second group of PMT measurements was performed on 107 patients receiving a shoulder magnetic resonance imaging scan. A third PMT comparison group was included using historical measurements from 20 pairs of cadaveric shoulders. All heights, sexes, and ages were known. Statistical analysis used mixed-effects linear regression models. RESULTS: A consistent association between patient height and PMT was found, with a mean distance from the top of the PMT to the top of the humeral head of 58.9 mm in men and 55.2 mm in women. For every 10-mm increase in patient height over 1.7 m, there is a 1.7-mm increase in PMT (P = .01). Age was not associated with PMT distance (P > .5). CONCLUSIONS: A predictable measurement from the upper portion of the PMT to the top of the humeral head exists to guide implant height in fracture hemiarthroplasty and may be approximated by use of patient height and sex.

Enameloplasty and esthetic finishing in orthodontics-identification and treatment of microesthetic features in orthodontics part 1.

Interdisciplinary treatment also has expanded to include not only soft tissue assessment of the periodontal components of the dentition and smile, but of the face as well. The next level of esthetic enhancement certainly will include facial proportionality as a key component in our patient evaluation. This paper expands the diagnostic vision of the dentist to include facial proportions and relationships of hard and soft tissues to improve diagnosis and treatment of dental and facial esthetics.

Enameloplasty and esthetic finishing in orthodontics-differential diagnosis of incisor proclination-the importance of appropriate visualization and records part 2.

The purpose of this paper is to briefly review some of the principals of ideal tooth shape and morphology and demonstrate how to use tooth reshaping through enameloplasty to treat and finish orthodontic cases to much more esthetic conclusions. This paper demonstrates the significant improvement to a smile orthodontists can achieve if they understand the principles of dental esthetics. In assessing smile design, the patient must be evaluated in three dimensions, and both dental and skeletal components must be considered. Expanded documentation in the form of frontal, profile, and oblique images taken both at rest and on dynamic smile permits the dentist to evaluate these elements without cephalometric radiography.

Soft tissue images from cephalograms compared with those from a 3D surface acquisition system.

OBJECTIVE: To assess whether 2D cephalometrics is comparable with 3D imaging devices and whether 3D technology could replace traditional 2D image capture in posttreatment evaluation. MATERIALS AND METHODS: The study is a prospective evaluation of superimposition techniques obtained from a cohort of 40 patients who underwent orthognathic surgery in a private practice environment. Surgical records were obtained from lateral cephalometric radiographs taken by a Kodak 8000C machine, and the 3D images were obtained from the 3dMD stereo photogrammetric camera capture system. Pre- and postlateral cephalometric records were superimposed on the cranial base (SN line) while pre- and post-3D surgical records were superimposed on the regional best-fit method. A mathematical algorithm, or best-fit calculation, was carried out on the selected surfaces. Each set of superimposed records was analyzed, and five soft tissue landmarks were plotted. The differences between the five surface points were analyzed for each set of records. RESULTS: The final sample consisted of 34 subjects with full records. A total of 680 surface landmarks were plotted and analyzed. The mean differences of the soft tissue landmarks were analyzed for each pair of data sets and were found to range between 1.06 and 8.07 mm and 1.26 and 7.34 mm for lateral cephalometric and 3D readings, respectively. Paired t-tests were carried out using the SPSS 15.0 software, and they showed that the results were not statistically significant between the superimposition techniques on the image capture systems (P > .05). CONCLUSIONS: The types of superimposition techniques used in the imaging modalities studied were comparable with one another.

Growth maturation aging: how the dental team enhances facial and dental esthetics for a lifetime.

As the body of research regarding facial esthetics increases, dentists are gaining a deeper understanding of their broadening roles in defining facial characteristics. Dentists are required to advance their repertoire of diagnostic skills in order to meet patients' esthetic needs and demands. The focus has been shifting from treatment plans being based entirely on the occlusal relationships to the balance of the teeth and smile presentation as well as soft-tissue support and facial appearance. This article presents two cases illustrating these principles.

Interview with an Insignia doctor: David M. Sarver.

Insignia (Ormco, Orange, Calif) offers custom-designed orthodontic appliances via fully interactive software. It is a precise, start-to-finish process that works with Damon, Inspire ICE, and conventional appliances. Insignia software incorporates the clinician's treatment plan into a virtual 3-dimensional model of each patient's ideal occlusion and delivers a complete custom solution: patient-specific brackets, precision (computer-assisted) bracket placement, and custom wires to eliminate time-consuming adjustments in all phases of treatment. Dr David Sarver, an orthodontist in Birmingham, Alabama, has treated patients with the Insignia technique since 1997.

Pitch, roll, and yaw: describing the spatial orientation of dentofacial traits.

The value of systematically enhancing the Angle classification by including transverse and vertical characteristics in addition to anteroposterior relationships for the face and the dentition is universally accepted. Three aeronautical rotational descriptors (pitch, roll, and yaw) are used here to supplement the planar terms (anteroposterior, transverse, and vertical) in describing the orientation of the line of occlusion and the esthetic line of the dentition. Each of the latter traits affects the modern clinical practice of orthodontics because of its greater focus on dentofacial traits beyond the correction of malocclusion. Consistent with the principle that every orthodontic intervention should begin with a thorough consideration of variation in a patient's dentofacial traits, this article offers further refinement of diagnostic description and classification.

Long-term efficacy of reverse pull headgear therapy.

OBJECTIVE: To add to the data for long-term reverse pull headgear (RPHG) outcomes and further explore possible variables that could be predictors of long-term failure. MATERIALS AND METHODS: Cephalometric radiographs of 41 Class III malocclusion children treated with RPHG (face mask) were evaluated before and immediately after treatment; at 5 years posttreatment; and, for 18 patients, at 10 years posttreatment. Patients were assigned to success or failure groups according to positive or negative overjet at the longest available recall. RESULTS: Seventy-five percent of the patients maintained positive overjet, whereas 25% outgrew the correction. In a stepwise discriminant analysis, a large mandible and vertical positioning of the maxilla and mandible so that mandibular growth would be projected more horizontally were the major indicators of unfavorable later mandibular growth. Patients who experienced downward-backward rotation of the mandible during RPHG treatment were more likely to be categorized in the failure group. The age at which treatment began had no effect on long-term success and failure for patients younger than 10 years, but the percentage of successful treatment decreased after that age. CONCLUSIONS: When RPHG treatment is used for all but the most obviously prognathic children to correct anterior cross-bite in the early mixed dentition, positive overjet is maintained long-term in 70%-75% of cases, whereas 25%-30% of cases relapse into reverse overjet mainly because of increased horizontally directed and often late mandibular growth. Up to age 10, the time at which RPHG treatment began does not appear to be a major factor in long-term success in maintaining positive overjet.

Use of the 810 nm diode laser: soft tissue management and orthodontic applications of innovative technology.

Innovative technologies such as the diode laser have provided considerable benefit to dental patients and professionals. Facilitating efficient cutting of tissue and subsequent coagulation, the soft tissue laser enhances tissue healing and can reduce postsurgical complications. Due to the conservative nature of treatment accomplished with the laser this technology is very useful in orthodontic procedures. The diode laser is utilized in both esthetic enhancement of the smile, and treatment management of soft tissue issues that impede efficient orthodontic treatment. Its clinical application will be illustrated in a series of orthodontic cases.

Magnetic resonance enterography: A stepwise interpretation approach and role of imaging in management of adult Crohn's disease.

Crohn's disease (CD) is a chronic inflammatory bowel disease that often requires frequent imaging of patients in order to detect active disease and other complications related to disease activity. While endoscopy is the gold standard for diagnosis, it may be contraindicated in some patients and has a limited role in detecting deep submucosal/mesenteric diseases and intra abdominal complications. In recent years, magnetic resonance enterography (MRE) has evolved as a noninvasive, radiation free imaging modality in the evaluation of patients with CD. This review article will focus on role of MRE in imaging patients with CD with emphasis on technical considerations, systematic image interpretation, differential diagnoses, and the role of imaging in deciding treatment options for patients.

Quantitative perfusion- and diffusion-weighted magnetic resonance imaging of gastrointestinal cancers treated with multikinase inhibitors: a pilot study.

BACKGROUND: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) are often used to detect the early response of solid tumors to an effective therapy. The early changes in intratumoral physiological parameters measured by DCE-MRI/DWI have been evaluated as surrogate biomarkers allowing a tailored treatment for the individual patient. METHODS: Patients with newly diagnosed, biopsy-proven, treatment-naïve gastrointestinal stromal tumor (GIST) or hepatocellular carcinoma (HCC) were enrolled prospectively after institutional review board (IRB)-approved informed consent (5 patients per tumor type). Patients with GIST were treated with sunitinib over 6 weeks. DCE-MRI/DWI was applied before therapy (baseline imaging) and at 2 and 6 weeks after therapy initiation. Patients with HCC were treated with radiation during the first 2 weeks and then with sorafenib for the next 6 weeks. DCE-MRI/DWI was applied in all patients with HCC before and after radiation therapy and at the end of sorafenib therapy. Tumor volume, perfusion parameters (K (trans), the forward volume-transfer constant, and k ep, the reverse reflux-rate constant) and the apparent diffusion coefficient (ADC) were measured. RESULTS: During 2 weeks of sunitinib therapy, GIST volume, K (trans), and k ep decreased 32 ± 13, 45 ± 24, and 42 ± 15%, respectively, whereas ADC increased 76 ± 24%. After 6 weeks of sunitinib therapy, GIST volume, K (trans), and k ep decreased 56 ± 7, 70 ± 7, and 50 ± 12%, respectively, whereas ADC increased 85 ± 33%. After completion of radiation therapy, HCC volume, K (trans), and k ep decreased 34 ± 14, 35 ± 12, and 4 ± 21%, respectively, but ADC increased 21 ± 9%. During the entire 10-week therapeutic period, HCC volume, K (trans), and k ep decreased 65 ± 15, 40 ± 9, and 26 ± 2%, respectively, whereas ADC increased 28 ± 10%. CONCLUSION: DCE-MRI/DWI can measure the perfusion and diffusion changes in GISTs or HCCs treated with multikinase inhibitors.