Combining wrist age and third molars in forensic age estimation: how to calculate the joint age estimate and its error rate in age diagnostics.

BACKGROUND: Forensic age estimation in living adolescents is based on several methods, e.g. the assessment of skeletal and dental maturation. Combination of several methods is mandatory, since age estimates from a single method are too imprecise due to biological variability. The correlation of the errors of the methods being combined must be known to calculate the precision of combined age estimates. AIM: To examine the correlation of the errors of the hand and the third molar method and to demonstrate how to calculate the combined age estimate. SUBJECTS AND METHODS: Clinical routine radiographs of the hand and dental panoramic images of 383 patients (aged 7.8-19.1 years, 56% female) were assessed. RESULTS: Lack of correlation (r = -0.024, 95% CI = -0.124 to + 0.076, p = 0.64) allows calculating the combined age estimate as the weighted average of the estimates from hand bones and third molars. Combination improved the standard deviations of errors (hand = 0.97, teeth = 1.35 years) to 0.79 years. CONCLUSION: Uncorrelated errors of the age estimates obtained from both methods allow straightforward determination of the common estimate and its variance. This is also possible when reference data for the hand and the third molar method are established independently from each other, using different samples.

Accuracy of full-guided vs. pilot-guided implant insertion - A prospective laboratory study in fifth-year dental students.

BACKGROUND: Education of undergraduates in implant dentistry has been extended. In order to assess the correct implant position, the accuracy of implant insertion using templates for pilot-drill guided and full-guided implant insertion was examined in a laboratory set-up in a cohort of undergraduates. METHODS: After three-dimensional planning of the implant position in partially edentulous mandibular models, individual templates for the pilot-drill guided or full-guided implant insertion in the region of the first premolar were produced. A total of 108 dental implants were inserted. The results of the radiographic evaluation of the three-dimensional accuracy were statistically analyzed. Furthermore, the participants completed a questionnaire. RESULTS: The deviation of the three-dimensional angle of the implants inserted fully guided was 2.74 ± 1.49 degrees compared to 4.59 ± 2.70 degrees for pilot-drill guided. The difference was statistically significant (p < 0.01). The returned questionnaires revealed a high interest in oral implantology and a positive evaluation of the hands-on course. CONCLUSIONS: In this study, the undergraduates benefited from applying full-guided implant insertion considering the accuracy in this laboratory examination. However, the clinical effects are not clear as the differences are within a small range. Based on the returned questionnaires, the implementation of practical courses in the undergraduate curriculum should be encouraged.

Bone density of the midpalatal suture 7 months after surgically assisted rapid palatal expansion in adults.

INTRODUCTION: The aims of this study were to analyze changes in bone density of the midpalatal suture after surgically assisted rapid palatal expansion (SARPE) with the bone-borne Dresden Distractor (DD; ITU, Dresden, Germany) via computed tomography (CT) and to compare of preoperative surgical findings with a control group. METHODS: Sixteen adult patients (mean age 24.5 years) underwent axial CT scans before and 7 months after SARPE. CT image fusion was performed for the midpalatal suture bone. Sixty-six controls (mean age 25.7 years) served for comparing age-related bone density. Bone structure and density were assessed in the coronal plane at the anterior, median, and posterior levels. RESULTS: Highest density was found in the posterior part (1046 Hounsfield units [HU]) before expansion. Seven months after SARPE, bone density was 48% (anterior), 53% (median), and 75% (posterior) compared with preoperative values. The control group showed fairly equal Hounsfield units (889 HU to 900 HU) in all parts. CONCLUSIONS: Seven months after SARPE, the midpalatal suture's density achieves just one half to three quarters of the pretreatment values. To maintain the resistance against forces from the unsplit posterior part, the retention time should be lengthened.

Shear bond strength after multiple bracket bonding with or without repeated etching.

The purpose of the study was to measure the in vitro shear bond strength (SBS) of metal brackets after multiple bonding and debonding with and without repeated etching. One hundred and twenty extracted premolars were divided into three equal groups. In group 1, the brackets were bonded and debonded three times with repeated enamel etching and in groups 2 and 3 without repeated etching. In group 2, all composite remnants were removed before bonding, while in group 3, the remnants were levelled. Analysis of variance was used to determine significant differences in SBS with Bonferroni adjustment for the multiple testing procedures. The results showed that in group 1, the mean SBS was 11.69 MPa (SD 2.65) at the first, 14.30 MPa (SD 2.69) at the second, and 12.19 MPa (SD 2.26) at the third debonding. In group 2, SBS decreased from 12.57 MPa (SD 2.54) to below 8.0 MPa. In group 3, SBS remained constant from the first (11.93 MPa; SD 2.14) to the second (12.06 MPa; SD 1.65) debonding and only decreased significantly to 9.74 MPa (SD 1.80) at the third debonding. Less composite remained on the teeth after each debonding sequence. This was characterized by a shift from adhesive remnant index (ARI) scores 2 and 3 after the first debonding to ARI scores 1 and 2 after the second debonding to predominantly scores 0 and 1 after the third debonding. After bracket loss and levelling of composite remnants, the SBS is sufficient for application of orthodontic forces. Repeated etching may involve a higher risk of enamel tear-outs during debonding.

Changes in nasal volume after surgically assisted bone-borne rapid maxillary expansion.

INTRODUCTION: The purposes of this study were to detect, locate, and examine the changes in transverse nasal width, area, and volume from bone-borne, surgically assisted rapid maxillary expansion (SARME) with the Dresden distractor by using computer tomography (CT). METHODS: Sixteen patients (average age, 28.7 years) underwent axial CT scanning before and 6 months after SARME. They also underwent CT fusion on specific bony structures. The nasal bone width was examined in the coronal plane. The cross-sectional images of the nasal cavity were taken of the area surrounding the apertura piriformis, the choanae, and in between. We calculated cross-sectional areas and nasal volume according to these data. RESULTS: All but 2 patients had an increase in nasal volume of at least 5.1% (SD, 4.6%). The largest value of 35.3% (SD, 45.8%) was measured anteriorly on the nasal floor, decreasing cranially and posteriorly. This correlated with the V-shaped opening of the sutura palatina. There was no significant correlation between increase in nasal volume and transversal expansion. CONCLUSIONS: Because most of the air we breathe passes over the lower nasal floor, SARME is likely to improve nasal breathing.

Minimally invasive rapid palatal expansion with an implant-supported hyrax screw.

Rapid palatal expansion is indicated in the orthopedic treatment of transverse maxillary deficiency for correction of severe crossbite. The fixation of the appliance at the tooth crowns leads to more tipping connected with resorptions at the buccal cortical bone, fenestrations and gingival retraction. The aim of the present study was focused on the improvement of bodily movement and optimization of the surgical osteotomy (Glassman's technique) in adult patients with application of the Dresden Distractor (DD). In 18 patients, the new method with a special mechanism of adaptation involving minimized surgical intervention and direct fixation of the hyrax screw by one implant and one bone screw was tested. The implants were loaded directly by activation of the hyrax screw two times per day. CT scans were taken before and 6 months after insertion of the DD. In the horizontal and vertical planes there was a V-shaped opening of the suture in anterior and cranial direction, corroborating previous studies. Dental arch also showed this V-shape, indicating tooth protection. DD is a suitable minimally invasive tooth-independent bone-borne expansion method, protecting teeth and causing skeletal as well as dental effect with tipping reduced by 10 degrees.

Autotransplantation of first premolar to replace a maxillary incisor - 3D-volume tomography for evaluation of the periodontal space.

UNLABELLED: The anterior maxilla is the most traumatized region during childhood and tooth loss is frequently involved. Space closure with implants is contraindicated in growing patients and maintenance of space is necessary over a long period. Transplantation of premolars from the mandible with two-third to three-quarter root formation wide open foramen provides the best prognosis for permanent survival. CASE REPORT: This report describes the management of a 10 year old girl with autotransplantation to replace an upper incisor by a lower premolar under consideration of special care for the periodontal ligament during surgical procedure. A 3-D imaging with digital volume tomography (DVT) was used 20 months after transplantation to evaluate the periodontal morphology. DISCUSSION: Autotransplantation of premolars with incomplete root formation to replace maxillary incisor is a treatment alternative after traumatic loss of teeth. There were no signs of pathosis like resorption or ankylosis and a normal periodontal space demonstrated with DVT. There is no need for endodontic treatment before transplantation. In this case of autotransplantation of a premolar, the DVT after 20 months gives evidence of a successful regeneration of the periodontal ligament.

Treatment of a patient with Class II malocclusion, impacted maxillary canine with a dilacerated root, and peg-shaped lateral incisors.

The maxillary canines are important teeth in terms of esthetics and function. This case report describes the orthodontic treatment of a 12-year-old girl whose Class II malocclusion was complicated by an impacted maxillary canine and peg-shaped lateral incisors. Despite dilaceration of the root, the impacted canine was brought into alignment. The peg-shaped lateral incisors were extracted, and the spaces were closed, resulting in favorable esthetics and good occlusion in the long term.

Incisor inclination--risk factor for palatally-impacted canines.

OBJECTIVE: The purpose of this study was to evaluate the torque of upper incisors and the maxillary size in sagittal direction in patients with impacted canines. MATERIAL AND METHODS: Panoramic radiographs, cephalograms and pretreatment study models were evaluated in 199 patients (12.7 +/- 3.6 years) with impacted canines. The prevalence of malocclusions, inclination of the canine to the occlusal plane, incisors' inclination and maxillary size were determined. RESULTS: 45% of the patients showed symptoms of Class II, Division 2 malocclusion: at 18.5 degrees, the inclination of upper incisors (angle U1/NA) was lower and at 81.3 degrees the SNA angle higher than in patients with neutral conditions. CONCLUSIONS: There is no guidance for the erupting canine through the labial root torque of the upper incisors like in patients with missing lateral incisors. Patients with symptoms of Class II, Division 2 malocclusion should be regarded as a risk group for canine impaction.

Three-dimensional evaluation of surgically assisted implant bone-borne rapid maxillary expansion: a pilot study.

INTRODUCTION: The purpose of this study was to evaluate 3-dimensional changes in dental, alveolar, and skeletal structures caused by a bone-borne implant-supported rapid maxillary expansion device (Dresden distractor). METHODS: Axial computed tomography scans of 10 patients (mean age, 25.3 years) treated with the Dresden distractor were examined. Scans were taken immediately before and 9 months after expansion. Distances in all 3 dimensions were calculated for 38 skeletal, alveolar, and dental landmarks with respect to the reference point ELSA (point equidistant to both foramina spinosa). RESULTS: In the transverse dimension, a V-shaped opening of the suture was shown; the greatest amount of opening was anteriorly directed, with convergence of the suture opening in the posterior aspect of the palate. The expansion of the maxillary dental arch showed a V pattern similar to the opening of the suture. In the frontal view, expansion caused a wedge-shaped opening with its base at the central incisors and the estimated center of rotation next to the frontonasal suture. The alveolar processes tipped buccally (9.9 degrees to 13.3 degrees) as did the molars (2.5 degrees to 3.5 degrees) and the premolars (3.0 degrees to 3.9 degrees). Less tipping of teeth compared with skeletal tipping (about 6 degrees to 9 degrees less) is related to the torque effect of the fixed appliance. CONCLUSIONS: The Dresden distractor is a minimally invasive bone-borne expansion appliance that protects teeth by inducing more skeletal than dental changes. This might be a precondition for stable postsurgical occlusion.

Orthodontic space opening in patients with congenitally missing lateral incisors.

OBJECTIVE: To determine the best time to begin orthodontic treatment for patients scheduled for implants to replace congenitally missing upper lateral incisors. The aim of timing is to maximize the amount of bone available for implant insertion and to improve incisors inclination. MATERIALS AND METHODS: Seventy-three plaster casts of 14 patients with 26 missing lateral incisors were cross sectioned in the center of the planned insertion of the implant, and the implant profile was projected into the area at three different times: T1--beginning of orthodontic treatment, T2-- end of orthodontic treatment, and T3--implant insertion. Deficiency of alveolar ridge volume needed for implantation was determined by Leica Quin analySIS software. RESULTS: An increase of ridge-volume deficiency from 0.26 mm(2) at T1 to 3.77 mm(2) at T3 was found. During orthodontic treatment the incisors protruded about 9.4 degrees (differing from the O1-NA standard of 7.5 degrees ). To ensure optimal esthetic and functional implantation results, time management concerning orthodontic treatment has to be done carefully. CONCLUSIONS: To avoid a high degree of alveolar bone atrophy and the risk of relapse and retreatment, orthodontic treatment involving tooth movement should not be initiated before the age of 13 years. Furthermore, it is important to maintain anchorage of the upper incisors because high incisor proclination causes extra-axial stress on the implant. An interdisciplinary approach is essential to provide the best treatment outcome.

Skeletally-anchored rapid maxillary expansion using the Dresden Distractor.

INTRODUCTION: It was the aim of this study to carry out a 3-D analysis of the teeth, alveolar and skeletal structures during bone-borne, surgically-assisted rapid maxillary expansion (RME) with the Dresden Distractor (DD). We aimed to determine whether a translatory and skeletal movement of the segments would be possible while reducing the dento-alveolar side effects associated with tooth-borne RME. MATERIALS AND METHODS: Standardized axial computed tomography (CT) was performed on twelve patients averaging 25.3 years of age prior to and after RME with the DD. Reference planes and the triple-0-ELSA were defined bilaterally referring to the following anatomic points: the foramina spinosa, external auditory meati and the anterior margin of the foramen magnum. We measured the amount of movement that occurred before and after RME with the DD against ELSA. RESULTS: A screw activation of 6.0 mm led to a transverse expansion of 5.55 mm in the alveolar process in the premolar region, and of 4.87 mm in the molar region, with 8 degrees to 9.8 degrees of buccal tipping and an increase in width of 6.07 mm and 5.71 mm, respectively, occurred in conjunction with only slight buccal tipping of the premolars (3.1 degrees -4.6 degrees ) and molars (1,1 degrees -2.6 degrees ). These data signify, beyond the considerable skeletal efficacy, an uprighting of the teeth due to the multibracket appliance's torque effect, and a direct transfer of the expansion forces onto the bone. Autorotation of the mandible in forward and upward directions was possible due to the considerably less dental tipping resulting from RME with the DD in comparison to tooth-borne RME. This fact demonstrated that the DD is also well-suited for patients with vertical growth pattern. CONCLUSION: The bone-borne DD is an effective therapeutic method that spares the patient the negative side effects associated with tooth-borne RME such as root resorption, bone dehiscence, bite opening and excessive buccal tipping of the teeth. The prerequisites for stable occlusion are brought about by the fact that the expansion is skeletal in nature, with minimal dental tipping.

Developmental myosin heavy chain mRNA in masseter after orthognathic surgery: a preliminary study.

INTRODUCTION: A microarray study showed an increase of developmental myosin heavy chain (MyHC) mRNA in the masseter muscle after surgery. The aim of the study was to determine the expression of the embryonic MYH3 and perinatal MYH8 for use as potential marker for muscle adaptation after orthognathic surgery. MATERIAL AND METHODS: 24 adult patients with a prognathic (11) or retrognathic (13) mandible were involved in the study. 192 biopsies were taken from two parts of the muscles presurgically and 6 months following. The expression of MYH3 and MYH8 were quantified using real-time polymerase chain reaction (RT-PCR). Absolute quantification was done by CT-values. RESULTS: MYH3 was up-regulated in prognathia (8.5, P<0.001) and in retrognathia (2.8, P<0.043). MYH8 was up-regulated in retrognathia only (4.0, P<0.063) and down-regulated in prognathia (-1.6). MYH3 values correlated in retrognathic patients (P<0.005) before and after surgery. CONCLUSION: MYH3 and MYH8 could play a role in functional adaptation after orthognathic surgery and orofacial orthopaedics.

CT analysis of nasal volume changes after surgically-assisted rapid maxillary expansion.

OBJECTIVE: Aim of this study was to detect the changes in nasal volume due to bone-borne, surgically-assisted rapid palatal expansion (RPE) with the Dresden Distractor using computed tomography (CT). MATERIALS AND METHODS: 17 patients (mean age 28.8) underwent axial CT scanning before and 6 months after RPE. The nasal bone width was examined in the coronal plane. Cross-sectional images of the nasal cavity were taken of the area surrounding the piriform aperture, choanae and in between. Bony nasal volume was computed by connecting the three cross-sectional areas. RESULTS: All but two patients showed a 4.8% increase in nasal volume (SD 4.6%). The highest value, 33.3% (SD 45.1%), was measured anteriorly at the level of the nasal floor. This correlated with the midpalatal suture's V-shaped opening. There was no significant correlation between an increase in nasal volume and transverse dental arch expansion. CONCLUSION: As most of the air we breathe passes the lower nasal floor, an improvement in nasal breathing is likely.

Spontaneous tooth eruption after alveolar cleft osteoplasty using tissue-engineered bone: a case report.

To bridge the cleft in the alveolar bone and to allow for physiologic eruption of the canine teeth, alveolar bone grafting is often necessary in patients with cleft lips and palates. Instead of autogenous bone, biomaterial seeded with autogenous osteogenic cells has found some clinical application. However, so far no real functional proof has been available to demonstrate that this technique also allows further physiologic features such as tooth eruption to occur. This report describes the results of grafting tissue-engineered bone into the alveolar cleft of a 10-year-old boy. Immediate postoperative healing was uneventful. Eight months after grafting, erupting teeth had moved into the newly formed bone. Eighteen months postoperatively at the site where the tissue-engineered graft had been inserted, the canine had erupted spontaneously in its proper place. The data suggest that tissue-engineered bone can lead to the ossification of the alveolar cleft and allow for physiologic spontaneous tooth eruption.

[Bone-supported rapid maxillary expansion with an implant-borne Hyrax screw: the Dresden Distractor]. / Expansion maxillaire rapide par appui osseux avec une vis Hyrax implanto-portée : le Dresden Distractor (DD) ou Disjoncteur de Dresde.

Rapid palatal expansion is indicated in the orthopedic treatment of transverse maxillary deficiency for correction of severe crossbite. The fixation of the appliance at the teeth crowns leads to more tipping at the two halves of the maxilla than bodily transverse movement. Additional resorptions at the buccal cortical bone with fenestrations and gingival retraction were observed. The aim of the present study was focused on the improvement of bodily movement and optimization of the surgical osteotomy (Glassman's technique) in adult patients with application of the Dresden Distractor (DD). In 15 patients, the new method involving minimized surgical intervention and direct fixation of the hyrax screw by one implant and one bone screw was tested. The implants were loaded directly by activation of the screw two times per day. CT scans were taken before and six month after insertion of the DD. In the horizontal and the vertical planes there was a V-shaped opening of the suture in anterior, respective cranial direction, corroborating previous studies. Dental arch showed this V-shape as well, indicating tooth protection. If forces are transferred via teeth the progressive increase of skeletal resistance in anterior to posterior direction lead to dental tipping. DD is a suitable minimal invasive tooth-independent bone-borne expansion method, protecting teeth and causing skeletal as well as dental effect with 10 degree less tipping and as a precondition for stable post surgical occlusion.

MGF- and myostatin-mRNA regulation in masseter muscle after orthognathic surgery.

Patients with prognathism and retrognathism show extensive morphologic changes after orthognathic surgery. The inability of muscles to adapt adequately might be one reason for observed relapses. The aim of this prospective study was to analyze the regulation of functional genes after surgery and changes in myosin heavy chain (MyHC) isoform expression, a potential molecular marker profile for inadequate muscle adaptation. 29 adult patients with prognathic and retrognathic mandibles were involved. A total of 232 muscle biopsies were taken from both masseter muscles presurgically and 6 months later. The mRNA expression of "mechano growth factor" (MGF), myostatin, and 3 MyHC isoforms were quantified by real-time polymerase chain reaction. The MGF mRNA was significantly up-regulated (P < .005), whereas myostatin mRNA showed no significant regulation. There was a shift in MyHC isoform expression. The MyHC-I mRNA was decreased (P < .005), whereas MyHC-IIa mRNA was increased (P < .005). The coherence of increased MGF expression and MyHC isoform shift 6 months after orthognatic surgery indicates an adequate muscle adaptation and higher mastication activity.

Prevalence of malocclusions in the early mixed dentition and orthodontic treatment need.

Early interceptive treatment for the elimination of factors inhibiting dental arch development and mandibular and maxillary growth is applied varyingly by orthodontists, possibly because there is little scientific evidence that such interventions are of actual benefit. The aim of this study was to determine specific factors for treatment need in the early mixed dentition period in order to obtain basic data to support early intervention. The study was part of a larger survey of 8768 children aged between 6 and 17 years. From this sample, 1975 children aged between 6 and 8 years were used to estimate the prevalence of malocclusions using the Index of Orthodontic Treatment Need (IOTN) during the early mixed dentition period. The results showed that deep overbite and overjet, both more than 3.5 mm, were the most frequent discrepancies, affecting 46.2 and 37.5 per cent of patients, respectively. An anterior open bite was registered in 17.7 per cent, crossbite in 8.2 per cent, and a reverse overjet in 3.2 per cent. A tooth width to arch length discrepancy was recorded in 12 per cent of teeth in the upper arch and in 14.3 per cent in the lower arch. The proportion of children estimated using the Dental Health Component of the IOTN to have a great or very great treatment need (grades 4 and 5) was 26.2 per cent. The higher values of treatment need during the mixed dentition period may account for temporary changes in the dentition and for the discrepancy in overjet and overbite. These discrepancies will be compensated in part during mandibular growth and development of the dental arch. Nevertheless, the findings indicate the early development of progressive malocclusion symptoms which are evidenced in the IOTN and concur with the acronym 'MOCDO' hierarchy (missing, overjet, crossbite, displacement, overbite). This early formation of progressive symptoms inhibiting or disturbing mandibular or maxillary growth or the development of the normal dental arch, i.e. crossbite, reverse overjet and increased overjet with myofunctional disorders, should be treated at an early stage.