Nasal septum changes in adolescent patients treated with rapid maxillary expansion.

OBJECTIVE: To analyze cone-beam computed tomography (CBCT) scans to measure changes in nasal septal deviation (NSD) after rapid maxillary expansion (RME) treatment in adolescent patients. METHODS: This retrospective study involved 33 patients presenting with moderate to severe nasal septum deviation as an incidental finding. Out of these 33 patients, 26 were treated for transverse maxillary constriction with RME and seven, who did not undergo RME treatment, were included in the study as control group. CBCT scans were taken before appliance insertion and after appliance removal. These images were analyzed to measure changes in nasal septum deviation (NSD). Analysis of variance for repeated measures (ANOVA) was used. RESULTS: No significant changes were identified in NSD regardless of the application or not of RME treatment and irrespective of the baseline deviation degree. CONCLUSION: This study did not provide strong evidence to suggest that RME treatment has any effect on NSD in adolescent patients; however, the results should be interpreted with caution, due to the small sample size and large variation amongst individual patient characteristics.

Nasal septum changes in adolescent patients treated with rapid maxillary expansion

Objective: To analyze cone-beam computed tomography (CBCT) scans to measure changes in nasal septal deviation (NSD) after rapid maxillary expansion (RME) treatment in adolescent patients. Methods: This retrospective study involved 33 patients presenting with moderate to severe nasal septum deviation as an incidental finding. Out of these 33 patients, 26 were treated for transverse maxillary constriction with RME and seven, who did not undergo RME treatment, were included in the study as control group. CBCT scans were taken before appliance insertion and after appliance removal. These images were analyzed to measure changes in nasal septum deviation (NSD). Analysis of variance for repeated measures (ANOVA) was used. Results: No significant changes were identified in NSD regardless of the application or not of RME treatment and irrespective of the baseline deviation degree. Conclusion: This study did not provide strong evidence to suggest that RME treatment has any effect on NSD in adolescent patients; however, the results should be interpreted with caution, due to the small sample size and large variation amongst individual patient characteristics.

Objetivo: analisar imagens de tomografia computadorizada de feixe cônico (TCFC) para mensurar as alterações no desvio de septo nasal (DSN) após o tratamento com expansão rápida da maxila (ERM) em pacientes adolescentes. Métodos: o presente estudo retrospectivo incluiu 33 pacientes com desvio de septo nasal de moderado a severo, diagnosticado como um achado incidental. Dos 33 pacientes analisados, 26 tiveram a constrição maxilar transversal tratada por meio de ERM; 7 pacientes não foram submetidos à ERM, sendo incluídos no estudo como grupo controle. As imagens de TCFC foram obtidas antes da instalação do aparelho e após sua remoção, sendo analisadas para mensurar as alterações no DSN. A análise de variância para medidas repetidas (ANOVA) foi empregada. Resultados: não foram identificadas alterações significativas no DSN, independentemente da realização ou não do tratamento com ERM e do grau inicial de desvio. Conclusão: esse estudo não fornece evidências suficientes para sugerir que o tratamento com ERM produza qualquer efeito sobre o DSN em pacientes adolescentes. Porém, esses resultados devem ser interpretados com cautela, em virtude do tamanho reduzido da amostra e da grande variação das características individuais dos pacientes.

Effect of non-surgical maxillary expansion on the nasal septum deviation: a systematic review.

Nasal breathing is a requirement for proper growth and development of the craniofacial complex. Inadequacy of the nasal airway from obstruction such as from nasal septal deviation (NSD) can affect craniofacial development. Further investigation of the possibility of rapid maxillary expansion (RME) correcting NSD would be valuable, considering the undesirable sequelae of NSD on nasal breathing, which can consequently affect craniofacial development. A systematic review of the effect of RME treatment on NSD was conducted. Electronic database searches were conducted until April 2015 using MEDLINE, EMBASE, Web of Science, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CCTR), Cochrane Methodology Register (CMR), Database of Abstracts of Reviews of Effects (DARE), American College of Physicians Journal Club (ACP Journal Club), Health Technology Assessments (HTA), and NHS Economic Evaluation Database (NHSEED). MeSH terms used in database searches were 'nasal septum,' 'palatal expansion,' and 'maxillary expansion,' 'orthodontic device,' and 'palatal expansion technique.' The methodological quality of studies was reviewed using methodological index for non-randomized studies (MINORS). Only two studies were finally selected and reviewed. Both studies had significant methodological limitations. One study reported a significant straightening of the nasal septum in the middle and the inferior third of nasal cavity from RME in children aged 5 to 9 years. The other study reported no positional change in the nasal septum from RME in adolescent orthodontic patients. Thus far, the limited available (moderate risk of bias) evidence suggests a potentially positive effect on the nasal septum asymmetry during childhood, but no significant change in adolescence from RME in patients with NSD. The clinical significance of reported changes could be considered questionable.

Measurement tools for the diagnosis of nasal septal deviation: a systematic review.

OBJECTIVE: To perform a systematic review of measurement tools utilized for the diagnosis of nasal septal deviation (NSD). METHODS: Electronic database searches were performed using MEDLINE (from 1966 to second week of August 2013), EMBASE (from 1966 to second week of August 2013), Web of Science (from 1945 to second week of August 2013) and all Evidence Based Medicine Reviews Files (EBMR); Cochrane Database of Systematic Review (CDSR), Cochrane Central Register of Controlled Trials (CCTR), Cochrane Methodology Register (CMR), Database of Abstracts of Reviews of Effects (DARE), American College of Physicians Journal Club (ACP Journal Club), Health Technology Assessments (HTA), NHS Economic Evaluation Database (NHSEED) till the second quarter of 2013. The search terms used in database searches were 'nasal septum', 'deviation', 'diagnosis', 'nose deformities' and 'nose malformation'. The studies were reviewed using the updated Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS: Online searches resulted in 23 abstracts after removal of duplicates that resulted from overlap of studies between the electronic databases. An additional 15 abstracts were excluded due to lack of relevance. A total of 8 studies were systematically reviewed. CONCLUSIONS: Diagnostic modalities such as acoustic rhinometry, rhinomanometry and nasal spectral sound analysis may be useful in identifying NSD in anterior region of the nasal cavity, but these tests in isolation are of limited utility. Compared to anterior rhinoscopy, nasal endoscopy, and imaging the above mentioned index tests lack sensitivity and specificity in identifying the presence, location, and severity of NSD.

Prediction of lower incisor proclination during Xbow treatment based on initial cephalometric variables.

OBJECTIVE: To predict lower incisor proclination from initial cephalometric values in Class II division 1 patients treated in phase I with the Xbow appliance. MATERIALS AND METHODS: Two hundred forty-nine mild to moderate Class II division 1 patients treated with the Xbow appliance as a phase I treatment were considered. Patients were in late mixed dentition or early permanent dentition. Commonly used cephalometric variables at T1 (before treatment) were used to predict lower incisor proclination after Xbow treatment (T2). A principal component analysis (PCA) was performed. The four extracted PCA components were skeletal component, incisal distance, anterior facial projection, and maxillo-mandibular relation. Thereafter, a multiple linear regression analysis (MLRA) was performed using the four extracted PCA components at T1 as predictor variables, and lower incisor inclination relative to the mandibular plane (L1-MP) at T2 as the dependent variable. RESULTS: The mean L1-MP at T1 was 95.46 degrees and the mean L1-MP at T2 was 98.51 degrees, resulting in a mean difference of 3.04 degrees. Only incisal distance and maxillo-mandibular relation PCA components had significance (P < .05) according to the MLRA. The overall model gave an adjusted R2 value (coefficient of determination) of 0.091. CONCLUSION: The best prediction model could account for only 9% of the total variability. Using common cephalometric variables at T1, average lower incisor proclination from Xbow treatment cannot be predicted in a clinically meaningful way.

Dimensional stability of irreversible hydrocolloid impression materials as a function of pouring time: a systematic review.

STATEMENT OF PROBLEM: Pouring time of irreversible hydrocolloid impressions differs depending on the brand and intended use, either of which may result in variable dimensional stability. PURPOSE: The purpose of this study was to investigate the available literature on dimensional stability of irreversible hydrocolloid impression materials as a function of pouring time and disinfectant solutions used. MATERIAL AND METHODS: Three electronic database searches (Medline, PubMed, and EMBASE) were conducted to identify in vitro peer-reviewed studies published in English between the early 1970s and October 2010. Selection criteria included in vitro studies, irreversible hydrocolloid as impression material, and storage time. Heterogeneity in the methodology of the selected studies precluded a meta-analysis. RESULTS: Of 62 initially selected studies only 18 were included. Traditional irreversible hydrocolloids were generally stable when poured immediately. However, stability decreased as time elapsed. New irreversible hydrocolloid substitutes appear to allow delay in pouring time and repouring of impressions without significant side effects. CONCLUSIONS: Shorter storage time of irreversible hydrocolloid impressions before pouring is desirable, although this may not be necessary for the extended-pour types. The lack of a standardized technique for studying the effect of storage condition, with or without the use of disinfectants, makes it difficult to make clear recommendations.

A comparison of anterior vs posterior isolated mandible fractures treated with intermaxillary fixation screws.

OBJECTIVE: To compare complication rates after use of intermaxillary fixation (IMF) bone screws for anterior (ie, symphyseal/parasymphyseal) and posterior (ie, body and angle) mandible fractures. METHODS: A retrospective analysis of isolated mandible fractures treated with intraoperative IMF bone screws at 2 major level 1 trauma centers within the Department of Otolaryngology-Head and Neck Surgery at the University of Minnesota. From January 1, 2003, through January 31, 2006, we accrued 53 patients with 67 isolated mandible fractures treated with intraoperative IMF bone screws. These patients had at least 6 weeks of follow-up. RESULTS: Twenty-one patients had anterior mandible fractures and 32 had posterior mandible fractures. In the anterior group, there was 1 incident of wound dehiscence, resulting in a total complication rate of 5%. In the posterior fracture group, there was 1 infection (3%), 4 malunions/malocclusions (12%), and 1 nonunion (3%), for an overall complication rate of 19%. The difference between groups for malocclusion rates (12% vs 0%) was significant (P < .001). CONCLUSIONS: The IMF bone screw system has a superior speed and safety profile. It produces better occlusion results in anterior mandible fractures and might have a lower overall complication rate compared with arch bars. Given this, IMF bone screws are the preferred modality of intermaxillary fixation in properly selected mandible fractures.

A systematic review of the association between appliance-induced labial movement of mandibular incisors and gingival recession.

OBJECTIVE: To determine if an association exists between appliance-induced labial movement of mandibular incisors and gingival recession. METHODS: Electronic databases were searched for studies with the terms: 'incisor', 'incisor proclination', 'tooth movement', 'orthodontic tooth movement', 'gingival recession' and 'orthodontic appliance'. The original articles and abstracts that met the initial inclusion criteria were retrieved, and their references hand searched for possible articles missed by the database searches. Inclusion criteria included human studies that suggested a link between labial movement of lower incisors produced by orthodontic treatment and gingival recession. Exclusion criteria included significant intrusion or extrusion of the mandibular incisors, periodontal disease, subjects taking medication that affects gingival health and subjects with systematic diseases. RESULTS: Seven articles fulfilled the selection criteria. Gingival recession after labial movement of lower incisors was assessed on dental casts, intra-oral slides, lateral cephalograms and gingival examination. The articles were analysed to determine the impact of their treatment methodology on the outcomes. CONCLUSIONS: No association between appliance-induced labial movement of mandibular incisors and gingival recession was found. Factors that may lead to gingival recession after orthodontic tipping and/or translation movement were identified as a reduced thickness of the free gingival margin, a narrow mandibular symphysis, inadequate plaque control and aggressive tooth brushing.