Personalized Orthodontics: From the Sagittal Position of Lower Incisors to the Facial Profile Esthetics.

BACKGROUND: One of the goals of orthodontic treatment is to obtain maximum facial harmony. The sagittal position of the lower incisors plays a significant role in the planning of orthodontic treatment. The aim of the study was to evaluate the relationship between the sagittal position of lower incisors and facial profile esthetics with reference to the skeletal vertical dimension. METHODS: There were 200 patients included in the study. Patients were allocated into three groups, depending on the vertical growth pattern: normal-angle, low-angle, and high-angle cases. Tweed-Merrifield cephalometric analysis was used to assess the sagittal and vertical position of the mandible, as well as to assess the sagittal position of the lower incisors. RESULTS: Z-angle and Frankfort mandibular incisor plane angle (FMIA) decreased significantly (p < 0.001) with the increase of the skeletal vertical dimension. Incisor mandibular plane angle (IMPA) was significantly higher (p < 0.001) in low-angle patients compared to the high-angle ones. Z-angle appeared to be the most accurate parameter (area under curve, AUC = 0.957) describing patients with a convex profile. The cutoff value of Z-angle 68.0° was characterized by the sensitivity of 94.1% and the specificity of 84.3%. CONCLUSIONS: The sagittal position of the lower incisors significantly affects the facial profile convexity. The Z-angle is the parameter which most accurately describes the patients with a convex profile.

Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis-A Systematic Review.

Temporomandibular joint osteoarthritis (TMJ OA) is a low-inflammatory disorder with multifactorial etiology. The aim of this review was to present the current state of knowledge regarding the mechanisms of action and the efficacy of hyaluronic acid (HA), corticosteroids (CS) and platelet-rich plasma (PRP) in the treatment of TMJ OA.: The PubMed database was analyzed with the keywords: "(temporomandibular joint) AND ((osteoarthritis) OR (dysfunction) OR (disorders) OR (pain)) AND ((treatment) OR (arthrocentesis) OR (arthroscopy) OR (injection)) AND ((hyaluronic acid) OR (corticosteroid) OR (platelet rich plasma))". After screening of 363 results, 16 studies were included in this review. Arthrocentesis alone effectively reduces pain and improves jaw function in patients diagnosed with TMJ OA. Additional injections of HA, either low-molecular-weight (LMW) HA or high-molecular-weight (HMW) HA, or CS at the end of the arthrocentesis do not improve the final clinical outcomes. CS present several negative effects on the articular cartilage. Results related to additional PRP injections are not consistent and are rather questionable. Further studies should be multicenter, based on a larger group of patients and should answer the question of whether other methods of TMJ OA treatment are more beneficial for the patients than simple arthrocentesis.

Is the Temporomandibular Joints' Reciprocal Clicking Related to the Morphology and Position of the Mandible, as Well as to the Sagittal Position of Lower Incisors?-A Case-Control Study.

The number of patients diagnosed with temporomandibular joint (TMJ) internal derangements, who are seeking orthodontic treatment, is increasing. The aim of the study was to assess the relationship between the presence of TMJ reciprocal clicking and the morphology and position of the mandible, and position of lower incisors, examined on the lateral cephalograms. Fifty patients diagnosed with reciprocal clicking in at least one of the TMJs and 55 patients with no symptoms of TMJ dysfunction were included in the study. Cephalometric analysis was used for the assessment of: skeletal class, sagittal and vertical position of the mandible, angle of the mandible, inclination of the mandibular ramus and the mandibular corpus, as well as for the assessment of the position of the mandibular incisors. The statistical significance level was set at p = 0.05. There were no statistically significant differences between the examined groups regarding the sagittal and vertical position of the mandible, as well as regarding the sagittal position of the mandibular incisors. Presence of TMJ reciprocal clicking is not associated with the position and the morphology of the mandible, as well as with the sagittal position of the mandibular incisors. Patients with early stages of TMJ internal derangements do not present any significant changes in Cephalometrics. Patients diagnosed with TMJ internal derangements before orthodontic treatment require an interdisciplinary approach to the treatment, including physiotherapy.

Orally Administered NSAIDs-General Characteristics and Usage in the Treatment of Temporomandibular Joint Osteoarthritis-A Narrative Review.

Background: Temporomandibular joint osteoarthritis (TMJ OA) is a degenerative joint disease. The aim of this review was to present the general characteristics of orally administered nonsteroidal anti-inflammatory drugs (NSAIDs) and to present the efficacy of NSAIDs in the treatment of TMJ OA. Methods: PubMed database was analyzed with the keywords: "(temporomandibular joint) AND ((disorders) OR (osteoarthritis) AND (treatment)) AND (nonsteroidal anti-inflammatory drug)". After screening of 180 results, 6 studies have been included in this narrative review. Results and Conclusions: Nonsteroidal anti-inflammatory drugs are one of the most commonly used drugs for alleviation of pain localized in the orofacial area. The majority of articles predominantly examined and described diclofenac sodium in the treatment of pain in the course of TMJ OA. Because of the limited number of randomized studies evaluating the efficacy of NSAIDs in the treatment of TMJ OA, as well as high heterogeneity of published researches, it seems impossible to draw up unequivocal recommendations for the usage of NSAIDs in the treatment of TMJ OA. However, it is highly recommended to use the lowest effective dose of NSAIDs for the shortest possible time. Moreover, in patients with increased risk of gastrointestinal complications, supplementary gastroprotective agents should be prescribed.

Cancer survivors present significantly lower long-term stability of orthodontic treatment: a prospective case-control study.

BACKGROUND/OBJECTIVES: The aim of the study was to compare the stability of orthodontic treatment in cancer survivors who had been treated with cytotoxic drugs with a generally healthy control group. MATERIALS/METHODS: The study included 52 cancer survivors treated orthodontically and 52 healthy control subjects matched for age, gender, and malocclusion. The weighted Peer Assessment Rating (w-PAR) index, the Index of Complexity, Outcome and Need (ICON) were assessed before treatment, after the treatment, and at the 3-year follow-up. Patients Satisfaction Score was assessed after the treatment and at the 3-year follow-up. A repeated analysis of variance test was used to check the statistical significance between the scores. RESULTS: Ideal occlusion was achieved in all patients. The mean w-PAR and ICON values were significantly reduced in both groups after the end of the orthodontic treatment with no significant differences between the groups regarding the obtained results. However, after the 3-year follow-up, only the cancer survivors' group presented statistically significant (P < 0.001) increase of the w-PAR and ICON values comparing to the values obtained at the end of the treatment. There was no significant change in Patients' Satisfaction Score within 3 years after treatment. LIMITATIONS: The limited size of the study sample as well as different types of oncological diagnoses could have had an impact on the final results of the study. CONCLUSIONS/IMPLICATIONS: Previous cytotoxic drug treatment significantly decreases the stability of orthodontic treatment among the cancer survivors, particularly within first 12 months after the end of the treatment.

Comparison of Oral Health Impact Profile (OHIP-14) Values in Cancer Survivor Patients Treated Orthodontically with Either Rapid or Standard Duration Protocols of Treatment-A Prospective Case-Control Study.

BACKGROUND: The aim of the study was to compare the oral-health-related quality of life (OHRQoL) between cancer survivors: with rapid orthodontic treatment (TX) (up to 12 months) and standard TX (orthodontic treatment time longer than 16 months). METHODS: There were 76 cancer survivors (48 women and 28 men) allocated into groups with rapid (36 people) or standard (40 people) duration of TX. OHRQoL was assessed on the basis of Oral Health Impact Profile (OHIP-14) values, measured before TX, 2 weeks and 3 months after the onset of TX, and after the end of TX. A repeated ANOVA test was used to check the statistical significance between the scores. RESULTS: There were no significant differences regarding the OHIP-14 values between the examined groups at all stages of the examination. Both groups presented significant (p < 0.001) improvement of the values of OHRQoL at the end of TX comparing to the values achieved before the onset of TX. CONCLUSIONS: Duration of orthodontic treatment by itself had no impact on oral-health-related quality of life.

Quality of Life in Orthodontic Cancer Survivor Patients-A Prospective Case-Control Study.

Background: The aim of the study was to compare the quality of life (QoL) of cancer survivors with a control group of healthy subjects before, during, and after the orthodontic treatment. Methods: Consecutive cancer survivors (40 people) who were looking for orthodontic treatment between 2008 and 2015 were enrolled into the study. Healthy orthodontic patients matched for age (±4 years), sex, and malocclusion served as controls. The 14-item version of the Oral Health Impact Profile was used to assess the effect of orthodontic treatment on QoL before, during, and after the orthodontic treatment. Results: There were no significant differences between both groups regarding the cast model, cephalometric analysis, and photographic documentation analysis. There was a significant worsening of QoL after the onset of the orthodontic treatment with a significant improvement after the treatment. Male cancer survivor patients reported significantly lower QoL during the treatment time, which was not observed in the male control group. Conclusions: The outcome of orthodontic treatment in cancer survivors did not differ from the healthy orthodontic patients. The orthodontic treatment had an impact on the oral health quality of life both in the cancer and the control groups with a significantly higher impact in male cancer survivor patients.

Usefulness of eight screening tools for predicting frailty and postoperative short- and long-term outcomes among older patients with cancer who qualify for abdominal surgery.

INTRODUCTION: The aim of this study was to compare the ability of eight frailty screening scores to predict short- (30-day major morbidity and mortality), long-term outcomes (12-month mortality) and to compare their accuracy for predicting frailty among older patients with cancer undergoing elective abdominal surgery with curative intent. MATERIALS AND METHODS: Consecutive patients aged ≥70 years were enrolled prospectively. The diagnostic performance of eight screening tests were evaluated: The Vulnerable Elderly Survey (VES-13), Triage Risk Screening Tool (TRST), Geriatric 8 (G8), Groningen Frailty Index (GFI), abbreviated Comprehensive Geriatric Assessment (aCGA), Rockwood, Balducci and Fried score. Frailty was defined based on the Geriatric Assessment (GA) with two (2ID) or three impaired domains (3ID). RESULTS: The study included 269 consecutive patients; median age 78 (range 70-94) years. The prevalence of frailty based on the reference GA was: 40.9% (2ID), 34.2% (3ID) and using screening tools 40-75.5%. The area under the curve (AUC) for predicting the postoperative outcome was: 0.58-0.75 (30-day morbidity), 0.54-0.71 (30-day mortality) and 0.59-0.74 (12-month mortality), respectively, being the highest for the G8. The AUC for the frailty screening tests was: 0.67-0.85 (at the 2ID) and 0.63-0.83 (at the 3ID), being the highest for the aCGA. CONCLUSION: The G8 was the best predictor of 30-day major morbidity, 30-day and 12-month mortality. It also had the highest sensitivity and negative predictive value in frailty screening, in case of both frailty definitions. In turn, the aCGA had the highest discriminatory ability in terms of frailty screening.

Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis-Review of the Literature.

Background and objectives: There are an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. The aim of this study was to present an interdisciplinary approach to TMJOA, including current diagnostics and treatment modalities on the basis of the available literature. Materials and Methods: PubMed and Scopus databases were analyzed using the keywords: ((temporomandibular joint AND osteoarthritis) AND imaging) and ((temporomandibular joint AND osteoarthritis) AND treatment). The bibliography was supplemented with books related to the temporomandibular joint. After screening 2450 results, the work was based in total on 98 publications. Results and Conclusions: Osteoarthritis is an inflammatory, age-related, chronic and progressive degenerative joint disease. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT), together with clinical symptoms, play significant roles in TMJOA diagnosis. Current MRI techniques seem to be clinically useful for assessment of bony changes in temporomandibular joint (TMJ) disorders. Treatment of TMJOA requires a complex, interdisciplinary approach. TMJOA treatment includes the cooperation of physiotherapists, rheumatologists, gnathologists, orthodontists and quite often also maxillofacial surgeons and prosthodontists. Sometimes additional pharmacotherapy is indicated. Thorough examination of TMJ function and morphology is necessary at the beginning of any orthodontic or dental treatment. Undiagnosed TMJ dysfunction may cause further problems with the entire masticatory system, including joints, muscles and teeth.

Temporomandibular Joints' Morphology and Osteoarthritic Changes in Cone-Beam Computed Tomography Images in Patients with and without Reciprocal Clicking-A Case Control Study.

Background: Patients referred for orthodontic treatment often present symptoms of temporomandibular joints' disorders (TMD), predominantly clicking. The objective was to analyze the morphology of the temporomandibular joints in cone-beam computed tomography (CBCT) images based on the presence of reciprocal clicking before orthodontic treatment. Methods: 105 participants took part in the study. 210 temporomandibular joints (TMJs) were allocated into one of two groups regarding the presence of reciprocal clicking. Morphology of condyle's head, glenoid fossa, and articular eminence as well as condylar head position in the glenoid fossa and osteoarthritic changes in the area of the condylar head were examined for each TMJ in the CBCT images. Statistical analysis was performed with STATISTICA version 12.0. The following tests were performed: U-Mann Whitney, Kruskal-Wallis, t-Student, and chi-square. The statistical significance level was p = 0.05 for all the measurements included. Results: Significantly smaller condylar A-P dimension (p = 0.040) characterized temporomandibular joints with reciprocal clicking. Condyles were substantially more often positioned posteriorly (p = 0.043) and were significantly more often accompanied by subcortical cysts and pathologic osteoarthritic bone changes (p < 0.001). Conclusions: The early stages of internal derangements stay with alterations in morphology and position of TMJs as well as with the presence of osteoarthritic changes.

Morphology of the Temporomandibular Joints Regarding the Presence of Osteoarthritic Changes.

(1) Osteoarthritis, the most common disease of the temporomandibular joints (TMJs), is diagnosed by clinical and radiographic examination. Cone beam computed tomography (CBCT) is a method of choice for the imaging of osteoarthritic changes. The objective was to compare the morphology of the TMJs in CBCT images regarding the number of the osteoarthritic changes diagnosed in the area of the condyle. (2) A total of 105 patients participated in the study; their 210 TMJs were allocated into one of three groups regarding the number of diagnosed osteoarthritic changes: 1 (none or 1 type), 2 (2 types), 3 (3 or more types). The morphology of the TMJ was examined for each TMJ in the CBCT images. Statistical analysis was performed with STATISTICA version 12.0. The statistical significance level was p = 0.05 for all the measurements included. (3) The articular surface flattening was the most common type of the osteoarthritic changes (90%). The condylar A-P dimension differed significantly among the groups (p = 0.0001). The bigger the number of osteoarthritic changes diagnosed in one joint, the smaller the condylar A-P dimension that was observed. (4) The temporomandibular joints' osteoarthritic changes occur very often, even among asymptomatic patients. The increased number of osteoarthritic changes seems to have an impact on the condylar anteroposterior dimension.

The Surgical Apgar Score predicts outcomes of emergency abdominal surgeries both in fit and frail older patients.

The Surgical Apgar Score (SAS) is a simple and rapid scoring system predicting postoperative mortality and morbidity. However, it remains unknown whether it might be useful in fit and frail older patients undergoing abdominal emergency surgery. METHODS: Consecutive patients ≥65 years, needing emergency abdominal surgery were enrolled in this prospective study. Additionally to the SAS, the G8 screening score was used to determine the frailty status. The logistic regression analysis was conducted investigating the association between the scores and 30-day postoperative outcomes. RESULTS: The study sample comprised 315 older patients (165 female, 150 male) with a median age of 77 (range 65-100) years old. The prevalence of frailty was 60.3%. The most frequent surgical indications were acute cholecystitis, followed by ileus, complicated diverticulitis, ulcer perforation, complication of gastric cancer and other causes. The decreasing SAS was significantly associated with the increasing likelihood of both 30-day postoperative major complications (p < 0.01) and death (p < 0.01) both in fit and frail older patients. Multivariate analyses have identified the G8, frailty screening test, and the SAS score as independent factors that predict postoperative adverse events. The model combining both scores increased the discriminatory ability for 30-day postoperative major morbidity and mortality. CONCLUSION: The SAS confirmed to be a simple and powerful predictor of 30-day postoperative morbidity and mortality both in fit and frail older patients undergoing emergency abdominal surgery. The department allocation algorithm based of the combination of the G8 and the SAS may be considered as an option to improve the outcomes of older patients undergoing abdominal emergency surgery.

Analysis of Dental Maturation in Relation to Sagittal Jaw Relationships.

BACKGROUND: The degree of mineralization of permanent tooth germs in dental age assessment has been an area of interest among many authors for years. However, only recently have researchers attempted to determine the potential interdependencies between dental age and jaw relationships. The aim of this work was to compare dental maturation in patients with skeletal Class II to patients with skeletal Classes I and III. MATERIAL/METHODS: The study involved 150 patients who sought orthodontic treatment. Dental age was assessed from panoramic radiographs using the Demirjian's method. Skeletal class was evaluated according to the value of the ANPg angle from the Björk's analysis. We used the analysis of variance (ANOVA) and the Student's t-test. RESULTS: The mean dental age in patients with skeletal Class III was significantly higher than the mean dental age in patients with skeletal Class II (p<0.0005). A correlation between the dental age and chronological age was established. The weakest correlation was seen between the dental age and skeletal Class II. Among patients with skeletal Class II, the strongest correlation was found between chronological age and the formation of the germ of the second lower premolar (r=0.67; p<0.001). CONCLUSIONS: Dental age among patients with skeletal Class II was the lowest.

Radiological Indicators of Bone Age Assessment in Cephalometric Images. Review.

The ability to assess bone age accurately is important and allows to diagnose the patient correctly and to plan orthodontic treatment appropriately. The aim of the work is to present views of different authors on the subject of using cephalometric images to determine bone age and its significance for conducting appropriate orthodontic treatment. Publications from the PubMed medical database were analyzed. Search criteria: bone age assessment, CVM method. Ultimately, 36 papers out of 1354 publications were selected. The research of many authors confirms the usefulness of various methods using cephalometric images to assess skeletal age. Currently, the CVM method devised by Baccetti et al. is the most frequently mentioned one in literature. It seems that bone age assessment methods based on evaluating the morphological structure of the cervical vertebrae in cephalometric images can clearly differentiate skeletal maturity in children regardless of their race or sex. Bearing in mind the constant technological progress in medicine and stomatology, bone age assessment methods need to be perfected in order to alleviate their impact on the patient as much as possible.

The role of permanent first molar relationship in assessing class ii malocclusions based on the analysis of diagnostic models from the palatal side.

AIM: The aim of the work is to determine the significance of posterior relationship between the first upper and lower molars from the palatal side in diagnosing Class II malocclusions. MATERIAL AND METHODS: One hundred and fifty diagnostic models and lateral cephalograms of patients from the Zbigniew Zak District Memorial Outpatient Clinic in Cracow were assessed. RESULTS: Out of 150 patients, skeletal Class II was diagnosed in 108 patients based on measuring the ANB angle (>4°), and in 115 patients based on the Wits appraisal (≥2 mm). In 68 patients (45.3%) with a bilateral complete posterior relationship of permanent first molars from the palatal side, skeletal Class II was confirmed on the basis of the ANB angle (>4°). In 3 patients (2%) skeletal Class II did not occur, despite a bilateral complete posterior relationship of permanent first molars from the palatal side. In 69 patients (46%) with a bilateral complete posterior relationship of permanent first molars from the palatal side, skeletal Class II was confirmed by means of the Wits appraisal. Only in 2 patients (1.3%), skeletal Class II did not occur despite a bilateral complete posterior relationship of permanent first molars from the palatal side. CONCLUSIONS: The occurrence of a bilateral complete posterior relationship of permanent first molars from the palatal side constitutes a very reliable predictive parameter of skeletal Class II. Diagnosing a correct first molar relationship from the palatal side leads to a high probability that skeletal Class II does not occur.

[Coronary artery disease as cause of non-odontogenic toothache. A review of literature]. / Choroba wiencowa jako przyczyna niezebopochodnego bólu zebów. Przeglad pismiennictwa.

AIMS: The aim of the work is to present, based on the latest available literature, the clinical picture of non-odontogenic toothache as a symptom of coronary artery disease. MATERIAL AND METHODS: Analysis of full text scientific studies, including research and casuistic works, which present the characteristics of the most frequently reported pain symptoms of the viscerocranium area, including toothache, in patients in the course of coronary artery disease. RESULTS: The pain of the viscerocranium region turned out to be the most frequent symptom of ischaemic heart disease when chest pain is absent. The most frequently reported pain symptoms of the viscerocranium area in the course of ischaemic heart disease involve: pain of the upper part of the thorax, left side of the mandible, right side of the mandible, the region of the left temporomandibular joint and the left ear, toothache. The patients most frequently described the pain as pressing and burning. The pain also intensified during physical exercise. CONCLUSION: The aetiology of toothache may be very diverse. An accurate and quick differential diagnosis of odontogenic and non-odontogenic toothache is not an easy task even for an expert clinician. Nonetheless, it is crucial for patients' life and health. A dentist may play a significant role in an early diagnosis of ischaemic heart disease.

Cumulative deficit model of geriatric assessment to predict the postoperative outcomes of older patients with solid abdominal cancer.

OBJECTIVE: The geriatric assessment (GA) has proven to be of great value for clinicians treating older patients. However, a clear consensus on the optimal set of GA instruments is lacking, particularly for surgical patients. Therefore, the aim of this prospective study was to compare the prevalence of frailty, depending on the number of incorporated GA domains, and to evaluate its accuracy in predicting postoperative outcome. MATERIALS AND METHODS: Seventy-five patients aged 65 years and older, qualified for abdominal surgery due to solid cancer, were enrolled. The GA included a wide variety of validated tools that evaluate functional, mobility, nutritional, co-morbidity, polypharmacy, and psychosocial domains. RESULTS: Depending on the number of incorporated GA domains the frequency of frailty was 23-97%. The cumulative score rather than individual components of the GA, turned out to be an independent risk factor of 30-day postoperative morbidity. In predicting 30-day "any" and "major" morbidities, the area under the curve was 0.67-0.72 and 0.70-0.82 (model including the severity of the surgery) vs. 0.57-0.66 and 0.50-0.65 (model not including the severity of the surgery), respectively. CONCLUSION: The number of incorporated GA domains has a great influence on the prevalence of frailty and on adequate surgical risk assessment. The summary deficit score based on Pre-operative Assessment of Cancer in the Elderly (PACE) or the GA consisting of functional, mobility, cognitive, depression, nutritional, co-morbidity, polypharmacy, and social support assessment domains can predict 30-day postoperative morbidity. However, only models with addition of the severity of surgery show moderate to good predictive value.

Orthodontic treatment in oncological patients.

The progress in oncological treatment has led to the current increase of childhood cancer survival rate to 80%. That is why orthodontists more and more frequently consult patients who had completed a successful anti-cancer therapy in childhood. Oncological treatments such as chemotherapy, radiotherapy or supportive immunosuppressive therapy cause numerous side effects in growing patients, connected i.a. with growth, the development of teeth or the viscerocranium. This is a special group of patients that needs an optimised plan of orthodontic treatment and often has to accept a compromise result. The purpose of the current work is to discuss the results of orthodontic treatment in patients after an anti-cancer therapy. Time of treatment was 12,5 months. In 6 patients (from 40 undergoing orthodontic therapy) we haven't reached a normocclusion, in 9 patients we should have stopped the therapy because of the recurrence. In 11 patients we found mucosa inflammation and in 1 patient the therapy stopped before the end because of very low oral hygiene level. Bearing in mind the limited number of original works on the above topic in Polish medical literature, the study has been carried out in order to make Polish orthodontists more acquainted with the topic and the standards of dealing with an oncological patient.

Prosthetic rehabilitation of patients with unilateral complete cleft of the primary and secondary palate.

The goal of this paper was to present the orthodontic treatment of a patient with unilateral lip, alveolar and hard palate cleft (UCLP) and the agenesis of permanent teeth and prosthetic rehabilitation of two cases differing from each other in the extent of tissue deficiency. Both patients underwent a long, multi-specialist surgico-orthodontic treatment including derotation of the maxilla's smaller segment and restoration of space for the missing teeth. In the first case presented, cross-bite on the front teeth and the canine was eliminated during a late phase of orthodontic treatment in order to prepare for final prosthetic rehabilitation. Two prosthetic restorations in patients with similar dental anomalies (hypodontia of the right upper incisors) were presented and discussed in detail. Prosthetic rehabilitation with cemented restoration was carried out after the end of growth. Satisfactory function of the orthognathic system and face appearance were accomplished. In both cases cemented prosthetic restorations preserve the treatment outcome and bite stability. The results were excellent and satisfying for the patients. The patient who presented more extensive tissue distortion has retained correct bite and prosthetic restorations for 20 years. The patient whose correction of the malocclusion and the cemented prosthetic restoration was completed is also predicted to maintain long-standing oral health and good functioning of the masticatory system.

Bone age assessment using cephalometric photographs.

BACKGROUND: The assessment of bone age comprises the basic element of orthodontic diagnostics as it enables the recognition of deviations from normal growth, determines the choice of treatment, helps determine the appropriate moment to begin treatment, establish prognosis and plan a retention strategy. In order to make an assessment of skeletal maturity possible in a single examination, radiological methods were adopted. The following characteristics are evaluated on a radiograph: the appearance, size and shape of ossification centers, the width and the shape of growth cartilage and the degree of fusion between diaphyses and epiphyses. In order to assess the maturity of bones, hand-wrist radiographs were introduced in the second decade of the 20(th) century. Bone age assessment of bone age could also be made based on an analysis of a morphological maturity of cervical vertebrae utilizing cephalometric radiographs. OBJECTIVE: The objective of the study was to evaluate the correspondence between bone age assessments made from hand-wrist radiographs and those from cephalometric radiographs. MATERIAL/METHODS: In order to fulfill the objectives, hand-wrist radiographs as well as cephalometric radiographs of 30 patients (15 girls and 15 boys) between 10 and 17 years of age were collected. Bone age of hand, wrist and cervical spine was assessed. Bone age on hand-wrist radiographs was evaluated using the Björk method, whereas cephalometric radiographs were analyzed by the Baccetti et al. method. RESULTS: A strong and statistically highly significant (r=0.98; p<0.00001) Pearson's correlation was found between bone age assessed from hand-wrist radiographs using Björk's method and bone age assessed from cephalometric radiographs using the method by Baccetti et al. CONCLUSIONS: The analysis of cervical vertebrae in cephalometric radiographs appears to be the most desirable method of bone age assessment. Performing the analysis on routinely taken cephalograms eliminates the need for additional exposure to X-ray radiation and shortens the duration of examination.