Morphometric characteristics of anencephalic skulls - A comparative study.

Anencephaly is the most severe form of a neural tube defect resulting from the incomplete occlusion of the anterior neuropore in the fourth week of development and associated with a severely underdeveloped brain mass. As desmal ossification of the neurocranium is induced by the presence of soft tissues (brain), no bone develops as direct consequence of the missing brain. The cranial base, by contrast, is formed by chondral ossification, which is genetically determined, and thus present also in anencephaly. Morphometric characteristics of anencephalic skulls, however, have not yet been investigated in sufficient detail before. In this study we therefore comparatively assessed macroscopic morphological-anatomical and cephalometric CT data on structures and dimensions of 11 macerated anencephalic and 4 normal neonatal skulls highlighting skeletal morphological differences. The most striking results were the missing skullcap and the greatly changed morphology of the existing skull bones, which were reduced in size. The parameters of the skull base, the transverse orbital diameter and maxillary width were significantly smaller in anencephalic skulls. The morphology of the viscerocranium appeared similar to that of normal neonatal skulls. The results of this study can be used in diagnosis and skeletal classification for anencephaly. This can help identify bones that are incomplete, fragmented and taphonomically altered, which is often the case in historical and forensic studies.

The morphological variations of the lateral pterygoid muscle: A systematic review.

BACKGROUND: The lateral pterygoid muscle (LPM) has been described in many anatomical and functional studies. The morphology of the LPM is still under debate because of its deep location in the infratemporal fossa and the difficulties to approach this area with different anatomical methods. Although it has been generally accepted that this muscle is mainly composed of two separate parts, other forms have been described in the past. OBJECTIVES: To conduct a systematic literature review regarding the anatomy and variations of the LPM. METHODS: We included studies published in English, German or French employing anatomical and imaging methods or a combination of the two methods. The cadavers used in the dissections had to be human and without any pathological alterations. Studies were only included when focusing on the anatomy of the LPM or its morphological variations or when taking the frequency of variations into account. We searched 26 biomedical databases including MEDLINE, EMBASE, BIOSIS Previews and Science Citation Index Expanded (part of Web of Science) through October 2014. The review was followed by the dissection of a hemisected head in two different planes. RESULTS: We identified 4279 records (2200 after deduplication) in the databases searches plus 17 articles from manual searches. 81 studies out of these articles were included in this review. 69 articles used anatomical methods, 5 imaging methods and 7 studies a combination of the two methods. 11 studies took into account that the LPM may have variations and also considered the relative frequency of each variation. The frequency of one-headed LPMs ranged between 7.7% and 26.7%, of two-headed LPMs between 61.4% and 91.1% and of three-headed LPMs between 4.0% and 35.0%. Our own dissection showed a three-headed version of the LPM. DISCUSSION: In anatomical studies, different preparation techniques seem to be the main reason for diverging results.

Meloxicam medication reduces orthodontically induced dental root resorption and tooth movement velocity: a combined in vivo and in vitro study of dental-periodontal cells and tissue.

Non-steroidal anti-inflammatory drugs (NSAID) are used to alleviate pain sensations during orthodontic therapy but are also assumed to interfere with associated pseudo-inflammatory reactions. In particular, the effects of partially selective COX-2 inhibition over the constitutively expressed COX-1 (11:1) on periodontal cells and tissue, as induced by the NSAID meloxicam, remain unclear. We investigate possible adverse side-effects and potentially useful beneficial effects during orthodontic therapy and examine underlying cellular and tissue reactions. We randomly assigned 63 male Fischer344 rats to three consecutive experiments of 21 animals each (cone-beam computed tomography; histology/serology; reverse-transcription quantitative real-time polymerase chain reaction) in three experimental groups (n = 7; control; orthodontic tooth movement [OTM] of the first/second upper left molars [NiTi coil spring, 0.25 N]; OTM with a daily oral meloxicam dose of 3 mg/kg). In vitro, we stimulated human periodontal ligament fibroblasts (hPDL) with orthodontic pressure (2 g/cm2) with/without meloxicam (10 µM). In vivo, meloxicam significantly reduced serum C-reactive protein concentration, tooth movement velocity, orthodontically induced dentine root resorption (OIRR), osteoclast activity and the relative expression of inflammatory/osteoclast marker genes within the dental-periodontal tissue, while presenting good gastric tolerance. In vitro, we observed a corresponding significant decrease of prostaglandin E2/interleukin-6/RANKL(-OPG) expression and of hPDL-mediated osteoclastogenesis. By inhibiting prostaglandin synthesis, meloxicam seems to downregulate hPDL-mediated inflammation, RANKL-induced osteoclastogenesis and, consequently, tooth movement velocity by about 50%, thus limiting its suitability for analgesia during orthodontic therapy. However, its protective effects regarding OIRR and good tolerance profile suggest future prophylactic application, which merits its further investigation.

Interactive effects of periodontitis and orthodontic tooth movement on dental root resorption, tooth movement velocity and alveolar bone loss in a rat model.

BACKGROUND: Many adult orthodontic patients suffer from chronic periodontitis with recurrent episodes of active periodontal inflammation. As their number is steadily increasing, orthodontists are more and more frequently challenged by respective treatment considerations. However, little is currently known regarding interactive effects on undesired dental root resorption (DRR), tooth movement velocity, periodontal bone loss and the underlying cellular and tissue reactions. MATERIAL AND METHODS: A total of 63 male Fischer344 rats were used in three consecutive experiments employing 21 animals each (A/B/C), randomly assigned to 3 experimental groups (n=7, 1/2/3), respectively: (A) CBCT; (B) histology/serology; (C) RT-qPCR-(1) control; (2) orthodontic tooth movement (OTM) of the first/second upper left molars (NiTi coil spring, 0.25N); (3) OTM with experimentally induced periodontitis (cervical silk ligature). After 14days of OTM, we quantified blood leukocyte level, DRR, osteoclast activity and relative gene expression of inflammatory and osteoclast marker genes within the dental-periodontal tissue as well as tooth movement velocity and periodontal bone loss after 14 and 28 days. RESULTS: The experimentally induced periodontal bone loss was significantly increased by concurrent orthodontic force application. Periodontal inflammation during OTM on the other hand significantly augmented the extent of DRR, relative expression of inflammatory/osteoclast marker genes, blood leukocyte level and periodontal osteoclast activity. In addition, contrary to previous studies, we observed a significant increase in tooth movement velocity. CONCLUSIONS: Although accelerated tooth movement would be favourable for orthodontic treatment, our results suggest that orthodontic interventions should only be performed after successful systematic periodontal therapy and paused in case of recurrent active inflammation.

The upper ankle joint: Curvature morphology of the articulating surfaces and physiological function.

PURPOSE: The curvature morphology of the articulating surfaces determines the physiological movement pattern. We quantitatively examined the curvature morphology of the tibiotalar articulating surfaces and specified their geometric contact patterns. METHODS: Geometrically equivalent cartographic nets were marked on the talar and tibial articulating surfaces of true-to-scale moldings of 20 human ankle joints (intervals of 5 mm) to relate corresponding articulating units of the surfaces. The corresponding contours of the net lines were compared, and the incongruity of articulating surfaces could thus be quantified locally. RESULTS: All tibial sagittal net lines represented circular arcs. Along the sagittal talar net lines, the curvature radii increased medially from anterior to posterior but decreased laterally. Each net line could be approximated by three circular arcs. Examining these three parts of the talar net lines, the anterior sagittal curvature radii increased from medial to lateral, whereas the posterior radii decreased. The tibial and talar transversal net lines were congruent. The articulation surfaces showed a transversal contact line in every dorsal/plantar joint position. The degree of local congruity was solely ascertained by the incongruity of the corresponding sagittal net lines. The maximal degrees of congruity were found laterally for dorsal flexion, laterally/centrally for neutral joint position, and centrally/medially for plantar flexion. CONCLUSIONS: By the transversal line contact, the contact area is broadened over the articulating surfaces from lateral to medial. In dorsal flexion, compressive loads are mainly transferred by lateral/anterior zones and in plantar flexion by medial/posterior zones of the articulating surfaces. Reconstruction of the transversal contact line is essential.

The thumb carpometacarpal joint: curvature morphology of the articulating surfaces, mathematical description and mechanical functioning.

PURPOSE: The purpose is to present a mathematical model of the function of the thumb carpometacarpal joint (TCMCJ) based on measurements of human joints. In the TCMCJ both articulating surfaces are saddle-shaped. The aim was to geometrically survey the shapes of the articulating surfaces using precise replicas of 28 TCMCJs. METHODS: None of these 56 articulating surfaces did mathematically extend the differential geometrical neighbourhood around the main saddle point so that each surface could be characterised by three main parameters: the two extreme radii of curvature in the main saddle point and the angle between the saddles' asymptotics (straight lines). RESULTS: The articulating surfaces, when contacting at the respective main saddle points, are incongruent. Hence, the TCMCJ has functionally five kinematical degrees of freedom (DOF); two DOF belong to flexion/extension, two to ab-/adduction. These four DOF are controlled by the muscular apparatus. The fifth DOF, axial rotation, cannot be adjusted but stabilized by the muscular apparatus so that physiologically under compressive load axial rotation does not exceed an angle of approximately ±3°. CONCLUSIONS: The TCMCJ can be stimulated by the muscular apparatus to circumduct. The mechanisms are traced back to the curvature incongruity of the saddle surfaces. Hence we mathematically proved that none of the individual saddle surfaces can be described by a quadratic saddle surface as is often assumed in literature. We derived an algebraic formula with which the articulating surfaces in the TCMCJ can be quantitatively described. This formula can be used to shape the articulating surfaces in physiologically equivalent TCMCJ-prostheses.

Reference genes for valid gene expression studies on rat dental, periodontal and alveolar bone tissue by means of RT-qPCR with a focus on orthodontic tooth movement and periodontitis.

OBJECTIVES: To obtain valid results in relative gene/mRNA-expression analyses by RT-qPCR, a careful selection of stable reference genes is required for normalization. Currently there is little information on reference gene stability in dental, periodontal and alveolar bone tissues of the rat, especially regarding orthodontic tooth movement and periodontitis. We therefore aimed to identify the best selection and number of reference genes under these experimental as well as physiological conditions. MATERIALS AND METHODS: In 7 male Fischer344-rats the upper left first and second molars were moved orthodontically for 2 weeks and in 7 more animals additionally subjected to an experimental periodontitis, whereas 7 animals were left untreated. Tissue samples of defined size containing both molars (without crowns) as well as the adjacent periodontal and alveolar bone tissue were retrieved and RNA extracted for RT-qPCR analyses. Nine candidate reference genes were evaluated and ranked according to their expression stability by 4 different algorithms (geNorm, NormFinder, BestKeeper, comparative ΔCq). RESULTS: PPIB/YWHAZ were the most stabile reference genes for the combined dental, periodontal and alveolar bone tissue of the rat overall, in untreated animals and rats with additional periodontitis, whereas PPIB/B2M performed best in orthodontically treated rats with YWHAZ ranking third. Gene-stability ranking differed considerably between investigated groups. A combination of two reference genes was found to be sufficient for normalization in all cases. CONCLUSIONS: The substantial differences in expression stability emphasize the need for valid reference genes, when aiming for meaningful results in relative gene expression analyses. Our results should enable researchers to optimize gene expression analysis in future studies by choosing the most suitable reference genes for normalization.

Craniofacial and cervical morphology related to sagittal spinal posture in children and adolescents.

Studies on the relationship between body posture and craniofacial parameters often focus on the cervical spine. Thus, less attention has been paid to the morphology of the vertebra C2 that serves as both a structural and functional link between the craniofacial area and the other part of the spine. The objective of this study was to assess the relation of craniofacial features to certain morphological and positional characteristics of the cervical vertebrae and the spine during growth. We determined body posture indices for 69 children and adolescents by means of a radiation-free method (rasterstereography). The morphological and positional analysis of the craniofacial area and the cervical vertebrae was based on standardized lateral X-ray cephalograms. Medium to strong correlations were found between body posture, C2 morphology, and craniofacial parameters. We found significant correlations between the C2 dens axis height and maxillary indices as well as between the C2 dens axis inclination and cephalometrical values of the mandibular area. Similarly the correlation between the C2 dens axis inclination and the postural index flèche cervicale was highly significant (P < 0.05, r = 0.333). These results suggest that morphological features of the odontoid process may serve as valuable predictive markers in interdisciplinary orthopedic-orthodontic diagnostics.

Cellular response to orthodontically-induced short-term hypoxia in dental pulp cells.

Orthodontic force application is well known to induce sterile inflammation, which is initially caused by the compression of blood vessels in tooth-supporting apparatus. The reaction of periodontal ligament cells to mechanical loading has been thoroughly investigated, whereas knowledge on tissue reactions of the dental pulp is rather limited. The aim of the present trial is to analyze the effect of orthodontic treatment on the induction and cellular regulation of intra-pulpal hypoxia. To investigate the effect of orthodontic force on dental pulp cells, which results in circulatory disturbances within the dental pulp, we used a rat model for the immunohistochemical analysis of the accumulation of hypoxia-inducible factor-1α in the initial phase of orthodontic tooth movement. To further examine the regulatory role of circulatory disturbances and hypoxic conditions, we analyze isolated dental pulp cells from human teeth with regard to their specific reaction under hypoxic conditions by means of flow cytometry, immunoblot, ELISA and real-time PCR on markers (Hif-1α, VEGF, Cox-2, IL-6, IL-8, ROS, p65). In vivo experiments showed the induction of hypoxia in dental pulp after orthodontic tooth movement. The induction of oxidative stress in human dental pulp cells showed up-regulation of the pro-inflammatory and angiogenic genes Cox-2, VEGF, IL-6 and IL-8. The present data suggest that orthodontic tooth movement affects dental pulp circulation by hypoxia, which leads to an inflammatory response inside treated teeth. Therefore, pulp tissue may be expected to undergo a remodeling process after tooth movement.

Ultrasound analyses, anatomical considerations, and clinical experience with the peroneus brevis muscle flap.

This ultrasound study investigated the frequency, location, and diameter of segmental blood supply of 34 lower legs in relation to muscle size. Furthermore, we investigated the possibilities and constraints of distally pedicled peroneus brevis muscle flaps, which allow defect coverage down to the medial as well as the lateral ankle. In the proximal part of the peroneus brevis muscle, blood is supplied by branches from the anterior tibial artery that perforate the anterior intermuscular septum; in the distal part of the muscle, blood is supplied by branches from the peroneal artery that perforate the posterior intermuscular septum. All lower legs showed at least one perforating vessel penetrating the posterior intermuscular septum. In all, 32.4% of the legs showed two perforators and 17.6% three perforators. The average position of the most distal perforator was 4.8cm proximal to the tip of the malleolus lateralis. Based on this blood supply, muscle tissue measuring up to 15-20cm can be harvested and rotated by 180° to cover defects of the lower ankle. Our ultrasound study is supplemented by an anatomical dissection and two clinical cases of successful defect coverage with the distally pedicled peroneus muscle flap.

Total knee replacement with natural rollback.

A novel class of total knee replacement (AEQUOS G1) is introduced which features a unique design of the articular surfaces. Based on the anatomy of the human knee and differing from all other prostheses, the lateral tibial "plateau" is convexly curved and the lateral femoral condyle is posteriorly shifted in relation to the medial femoral condyle. Under compressive forces the configuration of the articular surfaces of human knees constrains the relative motion of femur and tibia in flexion/extension. This constrained motion is equivalent to that of a four-bar linkage, the virtual 4 pivots of which are given by the centres of curvature of the articulating surfaces. The dimensions of the four-bar linkage were optimized to the effect that constrained motion of the total knee replacement (TKR) follows the flexional motion of the human knee in close approximation, particularly during gait. In pilot studies lateral X-ray pictures have demonstrated that AEQUOS G1 can feature the natural rollback in vivo. Rollback relieves the load of the patello-femoral joint and minimizes retropatellar pressure. This mechanism should reduce the prevalence of anterior knee pain. The articulating surfaces roll predominantly in the stance phase. Consequently sliding friction is replaced by the lesser rolling friction under load. Producing rollback should minimize material wear due to friction and maximize the lifetime of the prosthesis. To definitely confirm these theses one has to wait for the long term results.

Morphofunctional aspects of dental implants.

Although oral implantology is among the most beneficial developments of modern dentistry, the widely spread opinion that the long-term outcome of implants is superior to that of natural teeth has been refuted. To evade uncritical extractions, the morphofunctional properties of natural teeth and implant-supported restorations are compared from a proprioceptive and occlusal trauma perspective. The periodontal ligament of natural teeth provides the central nerve system with feedback for sensory perception and motor control. Conversely, the lack of such proprioception causes lower tactile sensitivity and less coordinated masticatory muscle activity in implant-borne restorations and makes them more prone to occlusal overload and possible subsequent failure. Moreover, occlusal anomalies may be conducive to parafunctional activity, craniomandibular disorder, tinnitus, and headache. Oral implantology, therefore, has to take appropriate account of occlusal conditions and the biomechanical and neuromuscular aspects of masticatory function.

Construction-conditioned rollback in total knee replacement: fluoroscopic results.

Firstly, the way of implementing approximatively the initial rollback of the natural tibiofemoral joint (TFJ) in a total knee replacement (AEQUOS G1 TKR) is discussed. By configuration of the curvatures of the medial and lateral articulating surfaces a cam gear mechanism with positive drive can be installed, which works under force closure of the femoral and tibial surfaces. Briefly the geometric design features in flexion/extension are described and construction-conditioned kinematical and functional properties that arise are discussed. Due to a positive drive of the cam gear under the force closure during the stance phase of gait the articulating surfaces predominantly roll. As a result of rolling, a sliding friction is avoided, thus the resistance to motion is reduced during the stance phase. Secondly, in vivo fluoroscopic measurements of the patella tendon angle during flexion/extension are presented. The patella tendon angle/ knee flexion angle characteristic and the kinematic profile in trend were similar to those observed in the native knee during gait (0°-60°).

Physiologically shaped knee arthroplasty induces natural roll-back.

After total knee replacement the persistence of pain represents a significant problem. In this study, a novel knee arthroplasty (Aequos G1 knee arthroplasty) is investigated that was designed to replicate main features of human knee morphology to reduce the periodically occurring pain after knee replacement. Previous work showed theoretically that this arthroplasty design may reconstruct the four-bar linkage mechanism as it occurs in human knee by contriving a convex lateral tibial compartment and a sagittal offset of the centre of the medial and lateral femur condyles - inducing a roll-back mechanism as it exists in human. The aim of this study was to determine whether this potential roll-back mechanism can be confirmed by in-vivo measurements. This retrospective study showed that the patellar tendon angle decreases during flexion of 0.21° per degree of flexion on average in the 16 knees studied. This amount is similar to physiological knee kinematics and in contrast to existing results in the literature after implantation of conventional total knee replacements which lack physiological knee kinematics. The results suggest that physiological motion after implantation of the Aequos G1 knee arthroplasty occurs during loaded motion up to approximately 45° knee flexion.

Mathematical study on the guidance of the tibiofemoral joint as theoretical background for total knee replacements.

The mathematical approach presented allows main features of kinematics and force transfer in the loaded natural tibiofemoral joint (TFJ) or in loaded knee endoprostheses with asymmetric condyles to be deduced from the spatial curvature morphology of the articulating surfaces. The mathematical considerations provide the theoretical background for the development of total knee replacements (TKR) which closely reproduce biomechanical features of the natural TFJ. The model demonstrates that in flexion/extension such kinematic features as centrodes or slip ratios can be implemented in distinct curvature designs of the contact trajectories in such a way that they conform to the kinematics of the natural TFJ in close approximation. Especially the natural roll back in the stance phase during gait can be reproduced. Any external compressive force system, applied to the TFJ or the TKR, produces two joint reaction forces which--when applying screw theory--represent a force wrench. It consists of a force featuring a distinct spatial location of its line and a torque parallel to it. The dependence of the geometrical configuration of the force wrench on flexion angle, lateral/medial distribution of the joint forces, and design of the slopes of the tuberculum intercondylare is calculated. The mathematical considerations give strong hints about TKR design and show how main biomechanical features of the natural TFJ can be reproduced.

Quantified contours of curvature in female index, middle, ring, and small metacarpophalangeal joints.

PURPOSE: To study and quantify the morphology of the curvature of the surfaces of metacarpophalangeal metacarpophalangeal joints and to relate joint morphology to joint function. METHODS: Forty metacarpophalangeal joints of the index, middle, ring, and small fingers from 5 right and 5 left hands were taken from female cadavers. The articulating surfaces of the metacarpal head and the base of the proximal phalanx were copied in a true-to-scale fashion. The hard plaster models were sliced in 7 sagittal and 7 transverse planes. The curvatures of the section contours were determined with circular gauges. Statistical analyses were performed by analysis of variance and paired Student t-tests. RESULTS: In the sagittal plane, the cartilaginous surface of the metacarpal head is divided into 2 functional regions and a third dorsal region that does not articulate with the base of the proximal phalanx. The articulating surface of the base of the proximal phalanx approximates a circle in the midsagittal plane. The mean median sagittal radius of curvature of the dorsal articulating aspect of the metacarpal head (6.9 mm) is 33% smaller than that of the base of the proximal phalanx (10.3 mm). The palmar articulating aspect of the metacarpal head (5.8 mm) is 44% smaller than that of the base of the proximal phalanx (10.3 mm). In the median transverse section, the mean radius of curvature of the metacarpal head (7.3 mm) is 18% smaller than that of the base of the proximal phalanx (8.9 mm). CONCLUSIONS: The data demonstrate the highly significant incongruity in the curvature of the articulating pair. This incongruity provides a joint space with its greatest dimension in the sagittal plane. From a mechanical perspective, the metacarpophalangeal joint mechanically represents a joint with 5 kinematic degrees of freedom: 2 for flexion and extension, 2 for abduction and adduction, and 1 for axial rotation.

Non-linearity of flexion-extension characteristics in spinal segments.

Spinal biomechanics is still known just fragmentary since the only description by angle-torque characteristics without simultaneous recording of migration of the instantaneous helical axis (IHA) is not sufficient. Time-dependent flexion/extension following a cyclic laterally directed torque was measured at all six degrees of freedom by a highly precise custom-made 6D apparatus. In order to enhance the localizing resolution of IHA migration as the function of the flexional/extensional angle, small ranges of motion (ROM) were used at several degrees of pre-extension. 4 L3/L4, 3 L4/L5 and 2 T2/T3 human segments were investigated. In extensional motion, wide dorsal IHA-migrations were measured in lumbar segments and correlated with the distinct asymmetric shapes of the characteristics in extensional motion. The respective increase of differential stiffness could mainly be traced back to the enlarging geometrical moment of inertia of the segments by the dorsally migrating IHA. Both thoracic segments showed a predominant IHA-migration in cranial/caudal direction. A simple model makes it evident that the opposite curvature morphology of lumbar and thoracic joint facets conditions the different directions of IHA migration.