A systematic review of the clinical outcomes for various orthodontic and physiotherapy appliances used for the management of temporomandibular joint ankylosis.

Ankylosis of the temporomandibular joint (TMJ) is associated with restricted mandibular movements, with deviation to the affected side. The management of TMJ ankylosis involves surgery to mitigate the effects of ankylosis, and adjunctive appliance therapy to supplement the results achieved through surgery. Several appliances have been used to help maintain jaw mobility postsurgery, but have been rarely documented in the literature. Our systematic review aimed to examine the clinical outcomes of various appliances for TMJ ankylosis management. A comprehensive electronic search of the literature was performed in July 2022 to identify eligible articles that had tested the use of orthodontic or physiotherapy appliances for the management of TMJ ankylosis. In total, 13 publications were included in the narrative synthesis. Both generic and custom-made appliances were used, with overall findings suggesting that using these appliances improved mouth opening and reduced chances of re-ankylosis. In this review no universally accepted appliance was found to be utilized, and the criteria used for appliance selection were unclear. The field of research in developing appliances for the treatment of TMJ ankylosis is open to advancement, and this review will help guide future research in this area.

Root development differences between cleft-adjacent teeth on the cleft side in comparison to their analogs on the noncleft side in patients with nonsyndromic cleft lip and palate who received secondary alveolar bone grafting.

OBJECTIVE: To assess differences in root development between the cleft side (CS) and noncleft side (NCS) for permanent maxillary central incisor and canine longitudinally in patients with nonsyndromic complete unilateral cleft lip and palate (cUCLP) who received secondary alveolar bone grafting (SABG) and to evaluate the effects of SABG on the acceleration of root development of these teeth. MATERIALS AND METHODS: Permanent maxillary central incisors and canines of 44 subjects with nonsyndromic cUCLP who had all their cleft-related surgeries performed by the same surgeon were analyzed retrospectively from chart notes and radiographs. Panoramic and periapical radiographs at time point 1 (T1) (age, 7.55 years), at SABG (time point 2 [T2], 10.13 years), and a minimum of 2 years after SABG were studied. Root development rating scores on the NCS and CS were compared using paired t-tests and analyses of proportions. RESULTS: Mean root development score differences (NCS - CS) for canines and central incisors were greatest at T2 but diminished at time point 3 (T3). A larger proportion of teeth on the CS trailed the teeth on the NCS by at least 1 point at T2 than at T1 or T3, with the smallest proportion being observed at T3. The change in root development scores from T1 to T2 and from T2 to T3 showed relative CS acceleration from T2 to T3, indicating a catch-up of root development of cleft-adjacent teeth after SABG. CONCLUSIONS: Root development of cleft-adjacent central incisors and canines is slow in comparison with their noncleft analogs. Root development of these teeth accelerates following SABG.

Catalytic effect of graphene on the inversion of corannulene using a continuum approach with the Lennard-Jones potential.

The catalytic effect of graphene on the corannulene bowl-to-bowl inversion is confirmed in this paper using a pair-wise dispersion interaction model. In particular, a continuum approach together with the Lennard-Jones potential are adopted to determine the interaction energy between corannulene and graphene. These results are consistent with previous quantum chemical studies, which showed that a graphene sheet reduces the barrier height for the bowl-to-bowl inversion in corannulene. However, the results presented here demonstrate, for the first time, that the catalytic activity of graphene can be reproduced using pair-wise dispersion interactions alone. This demonstrates the major role that pair-wise dispersion interactions play in the catalytic activity of graphene.

Presurgical Cleft Management of Infants: A Survey of ACPA Approved and International Cleft Palate and Craniofacial Teams.

OBJECTIVE: To characterize the presurgical infant orthopedics (PSIO) and gingivoperiosteoplasty (GPP) protocols across the American Cleft Palate-Craniofacial Association (ACPA) approved and international cleft palate (CP) and craniofacial teams. DESIGN: Cross-sectional survey. SETTING: ACPA approved and international CP and craniofacial teams. RESULTS: Respondents from 115 out of 215 ACPA approved and international CP and craniofacial teams permitted to contact (out of a total of 259 total teams) completed the survey (response rate = 53.5%). There were 89 (77.4%) ACPA approved teams and the remaining international teams were mainly located in Europe (13.0%). Seventy-eight CP and craniofacial teams (67.8%) provided PSIO and 65 (83.3%) of these teams used alveolar molding (AM). Twenty-two CP and craniofacial teams (19.1%) provided GPP. A mean of 9.5 ± 2.6 different specialists were on the cleft team with the most common being orthodontists (97.4%), speech therapists (96.5%), and plastic/craniofacial surgeons (90.4%). CONCLUSIONS: Most ACPA approved and ACPA registered international CP and craniofacial teams provided PSIO techniques by orthodontists using lip taping (LT) and AM, while few provide GPP.

The Impact of Fan-Type Rapid Palatal Expanders on Speech in Patients With Unilateral Cleft Lip and Palate.

Rapid palatal expanders (RPEs) are commonly used in patients with cleft lip and palate (CLP) prior to secondary alveolar bone grafting (SABG). Their position and size can impede tongue movement and affect speech. This study assessed changes in perception and production of speech over the course of RPE treatment.Prospective longitudinal.Tertiary university-affiliated hospital.Twenty-five patients with unilateral CLP treated with Fan-type RPEs, and their parents.Patient and parent speech questionnaires and patient speech recordings were collected at baseline before RPE insertion (T1), directly after RPE insertion (T2), during RPE expansion (T3), during RPE retention (T4), directly after RPE removal but before SABG (T5), and at short-term follow-up after RPE removal and SABG (T6).Ratings for patient and parent questionnaires, first (F1) and second (F2) formants for vowels /a/, /i/, and /u/, and nasalance scores for non-nasal and nasal sentences, were obtained and analyzed using mixed model analyses of variance.Ratings worsened at T2. For the vowel /a/, F1 and F2 were unchanged at T2. For the vowel /i/, F1 increased and F2 decreased at T2. For the vowel /u/, F1 was unchanged and F2 decreased at T2. Nasalance was unchanged at T2. All outcome measures returned to T1 levels by T4.RPE insertion resulted in initial adverse effects on speech perception and production, which decreased to baseline prior to removal. Information regarding transient speech dysfunction and distress may help prepare patients for treatment.

Continuum Modeling with Functional Lennard-Jones Parameters for Methane Storage inside Various Carbon Nanostructures.

Methane capture and storage are of particular importance for the development of new technology to reduce the effects of climate change and global warming. Carbon-based nanomaterials are among several porous nanomaterials proposed as potential candidates for methane storage. In this paper, we adopt a new continuum approach with functional Lennard-Jones parameters to provide interaction energies for methane inside carbon nanostructures, namely fullerenes, nanotube bundles, and nanocones. This study provides a significant improvement to previous continuum modeling approaches using the Lennard-Jones potential.

Eruption path of permanent maxillary canines after secondary alveolar bone graft in patients with nonsyndromic complete unilateral cleft lip and palate.

INTRODUCTION: Successful eruption of the maxillary canine after secondary alveolar bone grafting (SABG) improves dentoalveolar outcomes in the final occlusal rehabilitation of patients with cleft lip and palate (CLP). We aimed to study eruptive positions of the maxillary canine in CLP post-SABG. METHODS: This retrospective longitudinal study included 27 patients with complete unilateral CLP who received standardized SABG from the same surgeon. Rigorous selection criteria enabled a relatively homogeneous sample. Using panoramic radiographs, angulation, horizontal and vertical positions of the maxillary canines were recorded 3 times. Linear proportions along with sectorial methods were used. Linear regression and t tests were performed to assess and compare the position of the canine on the cleft side (CS) and noncleft side from pre-SABG (T1) to a minimum 2 years post-SABG (T3); to evaluate its displacement and identify predictors for its impaction, and to analyze the characteristics of the impacted canines vs the nonimpacted canines at T3. RESULTS: The CS maxillary canine was more acutely angulated and more apically positioned than the noncleft side canine at all times. It was relatively more distally positioned at T1 and exhibited significantly greater mesial movement from T1 to T3 (P <0.0001). Canine impaction on the CS was associated with a more apical position at 1-year post-SABG (P = 0.022) and a more acute angulation of this tooth. CONCLUSION: More acute angulation and more apical position of the CS maxillary canine before SABG may be associated with an increased risk of its impaction after SABG.

Tooth Resorption Following an Alveolar Bone Graft in a Patient With Complete Unilateral Cleft Lip and Palate.

We report a case of secondary alveolar bone grafting (ABG) without removal of a supernumerary tooth in a patient with unilateral cleft lip and palate. A conical supernumerary tooth located distal to the upper left central incisor within the cleft site was left in situ at the time of ABG. The tooth within the ABG site commenced resorption from both the apical and incisal edges until only minor tooth remnants remained at 22 months. Although external root resorption of teeth neighboring a cleft site has been described previously, this is the first report of almost complete tooth resorption following ABG.

Comparison of dental outcomes in patients with nonsyndromic complete unilateral cleft lip and palate who receive secondary alveolar bone grafting before or after emergence of the permanent maxillary canine.

INTRODUCTION: For patients with complete unilateral cleft lip and palate (CUCLP), secondary alveolar bone grafting (SABG) can be performed before or after the emergence of the cleft side permanent canine (pre-CE and post-CE, respectively). The controversy regarding dental outcomes related to the timing of SABG remains unsettled. The objective of this study was to evaluate dental survival and specific dental outcomes of cleft-adjacent teeth in children with CUCLP who received either pre-CE or post-CE SABG. METHODS: The permanent maxillary canines and the central and lateral incisors of 21 pre-CE and 23 post-CE SABG subjects with nonsyndromic CUCLP and all cleft-related surgeries performed by the same surgeon were analyzed retrospectively. Intraoral radiographs and clinical chart notes were collected at age 7 years, at the time of the SABG, and approximately 4 years after the grafting. Dental survival, spontaneous canine eruption, planned prosthetic replacement, root development, and root resorption were analyzed. RESULTS: Dental outcomes on the noncleft side were better than those on the cleft side. On the cleft side, dental survival of the cleft-adjacent teeth was not significantly different between the pre-CE and post-CE SABG groups (P >0.05). Most teeth completed root development after grafting, and the cleft side canine root development in the pre-CE SABG group appeared to accelerate after SABG. Trends showed that the pre-CE SABG group suffered less root resorption (16.28%; post-CE: 22.73%; P >0.05) and received fewer planned prosthetic replacements (14.29%; post-CE: 26.01%; P >0.05) but required a greater number of canine exposures (33.33%; post-CE: 4.55%; P = 0.02). CONCLUSIONS: Pre-CE SABG showed better dental outcomes in patients with CUCLP, with fewer adverse dental outcomes than post-CE SABG.

Continuum Modelling for Interacting Coronene Molecules with a Carbon Nanotube.

The production of single dimensional carbon structures has recently been made easier using carbon nanotubes. We consider here encapsulated coronene molecules, which are flat and circular-shaped polycyclic aromatic hydrocarbons, inside carbon nanotubes. Depending on the radius of the nanotube, certain specific configurations of the coronene molecules can be achieved that give rise to the formation of stacked columns or aid in forming nanoribbons. Due to their symmetrical structure, a coronene molecule may be modelled by three inner circular rings of carbon atoms and one outer circular ring of hydrogen atoms, while the carbon nanotube is modelled as a circular tube. Using the continuous model and the Lennard-Jones potential, we are able to analytically formulate an expression for the potential energy for a coronene dimer and coronene inside a carbon nanotube. Subsequently, stacking of coronene molecules inside a nanotube is investigated. We find that the minimum energy tilt angle of coronenes in a stack differs from that of a single coronene within the same nanotube. More specifically, for both (18, 0) and (19, 0) zigzag carbon nanotube, we find that the minimum energy tilt angles of the single coronene case (≈42 ∘ and ≈20 ∘ respectively) do not occur in the stack model.

Orthognathic Surgery for Patients with Cleft Lip and Palate.

Cleft orthognathic surgery is an important component of a comprehensive cleft care plan. Applying combined orthodontic and orthognathic treatment principles to a cohort of patients with cleft lip and palate raises many challenges not encountered in conventional orthognathic care. Cleft patients share a commonality in their midfacial anatomy that is characterized by a 3-dimensionally deficient maxilla. The residual sequelae of multiple previous surgeries along with dental differences and unhealed fistulae are considerations when embarking on treatment. This article describes many of these challenges and highlights approaches that are used to address the specific needs of this special group of patients.

An integrated approach for identifying priority contaminant in the Great Lakes Basin - Investigations in the Lower Green Bay/Fox River and Milwaukee Estuary areas of concern.

Environmental assessment of complex mixtures typically requires integration of chemical and biological measurements. This study demonstrates the use of a combination of instrumental chemical analyses, effects-based monitoring, and bio-effects prediction approaches to help identify potential hazards and priority contaminants in two Great Lakes Areas of Concern (AOCs), the Lower Green Bay/Fox River located near Green Bay, WI, USA and the Milwaukee Estuary, located near Milwaukee, WI, USA. Fathead minnows were caged at four sites within each AOC (eight sites total). Following 4d of in situ exposure, tissues and biofluids were sampled and used for targeted biological effects analyses. Additionally, 4d composite water samples were collected concurrently at each caged fish site and analyzed for 132 analytes as well as evaluated for total estrogenic and androgenic activity using cell-based bioassays. Of the analytes examined, 75 were detected in composite samples from at least one site. Based on multiple analyses, one site in the East River and another site near a paper mill discharge in the Lower Green Bay/Fox River AOC, were prioritized due to their estrogenic and androgenic activity, respectively. The water samples from other sites generally did not exhibit significant estrogenic or androgenic activity, nor was there evidence for endocrine disruption in the fish exposed at these sites as indicated by the lack of alterations in ex vivo steroid production, circulating steroid concentrations, or vitellogenin mRNA expression in males. Induction of hepatic cyp1a mRNA expression was detected at several sites, suggesting the presence of chemicals that activate the aryl hydrocarbon receptor. To expand the scope beyond targeted investigation of endpoints selected a priori, several bio-effects prediction approaches were employed to identify other potentially disturbed biological pathways and related chemical constituents that may warrant future monitoring at these sites. For example, several chemicals such as diethylphthalate and naphthalene, and genes and related pathways, such as cholinergic receptor muscarinic 3 (CHRM3), estrogen receptor alpha1 (esr1), chemokine ligand 10 protein (CXCL10), tumor protein p53 (p53), and monoamine oxidase B (Maob), were identified as candidates for future assessments at these AOCs. Overall, this study demonstrates that a better prioritization of contaminants and associated hazards can be achieved through integrated evaluation of multiple lines of evidence. Such prioritization can guide more comprehensive follow-up risk assessment efforts.

Environmental gestagens activate fathead minnow (Pimephales promelas) nuclear progesterone and androgen receptors in vitro.

Gestagen is a collective term for endogenous and synthetic progesterone receptor (PR) ligands. In teleost fishes, 17α,20ß-dihydroxy-4-pregnen-3-one (DHP) and 17α,20ß,21-trihydroxy-4-pregnen-3-one (20ß-S) are the predominant progestogens, whereas in other vertebrates the major progestogen is progesterone (P4). Progestins are components of human contraceptives and hormone replacement pharmaceuticals and, with P4, can enter the environment and alter fish and amphibian reproductive health. In this study, our primary objectives were to clone the fathead minnow (FHM) nuclear PR (nPR), to develop an in vitro assay for FHM nPR transactivation, and to screen eight gestagens for their ability to transactivate FHM nPR. We also investigated the ability of these gestagens to transactivate FHM androgen receptor (AR). Fish progestogens activated FHM nPR, with DHP being more potent than 20ß-S. The progestin drospirenone and P4 transactivated the FHM nPR, whereas five progestins and P4 transactivated FHM AR, all at environmentally relevant concentrations. Progestins are designed to activate human PR, but older generation progestins have unwanted androgenic side effects in humans. In FHMs, several progestins proved to be strong agonists of AR. Here, we present the first mechanistic evidence that environmental gestagens can activate FHM nPR and AR, suggesting that gestagens may affect phenotype through nPR- and AR-mediated pathways.

An inexpensive, temporally integrated system for monitoring occurrence and biological effects of aquatic contaminants in the field.

Assessment of potential risks of complex contaminant mixtures in the environment requires integrated chemical and biological approaches. In support of the US Great Lakes Restoration Initiative, the US Environmental Protection Agency lab in Duluth, MN, is developing these types of methods for assessing possible risks of aquatic contaminants in near-shore Great Lakes (USA) sites. One component involves an exposure system for caged fathead minnow (Pimephales promelas) adults suitable for the wide range of habitat and deployment situations encountered in and around the Great Lakes. To complement the fish exposure system, the authors developed an automated device for collection of composite water samples that could be simultaneously deployed with the cages and reflect a temporally integrated exposure of the animals. The present study describes methodological details of the design, construction, and deployment of a flexible yet comparatively inexpensive (<600 USD) caged-fish/autosampler system. The utility and performance of the system were demonstrated with data collected from deployments at several Great Lakes sites. For example, over 3 field seasons, only 2 of 130 deployed cages were lost, and approximately 99% of successfully deployed adult fish were recovered after exposures of 4 d or longer. A number of molecular, biochemical, and apical endpoints were successfully measured in recovered animals, changes in which reflected known characteristics of the study sites (e.g., upregulation of hepatic genes involved in xenobiotic metabolism in fish held in the vicinity of wastewater treatment plants). The automated composite samplers proved robust with regard to successful water collection (>95% of deployed units in the latest field season), and low within- and among-unit variations were found relative to programmed collection volumes. Overall, the test system has excellent potential for integrated chemical-biological monitoring of contaminants in a variety of field settings.

Cross-species sensitivity to a novel androgen receptor agonist of potential environmental concern, spironolactone.

Spironolactone is a pharmaceutical that in humans is used to treat conditions like hirsutism, various dermatologic afflictions, and female-pattern hair loss through antagonism of the androgen receptor. Although not routinely monitored in the environment, spironolactone has been detected downstream of a pharmaceutical manufacturer, indicating a potential for exposure of aquatic species. Furthermore, spironolactone has been reported to cause masculinization of female western mosquitofish, a response indicative of androgen receptor activation. Predictive methods to identify homologous proteins to the human and western mosquitofish androgen receptor suggest that vertebrates would be more susceptible to adverse effects mediated by chemicals like spironolactone that target the androgen receptor compared with invertebrate species that lack a relevant homolog. In addition, an adverse outcome pathway previously developed for activation of the androgen receptor suggests that androgen mimics can lead to reproductive toxicity in fish. To assess this, 21-d reproduction studies were conducted with 2 fish species, fathead minnow and Japanese medaka, and the invertebrate Daphnia magna. Spironolactone significantly reduced the fecundity of medaka and fathead minnows at 50 µg/L, whereas daphnia reproduction was not affected by concentrations as large as 500 µg/L. Phenotypic masculinization of females of both fish species was observed at 5 µg/L as evidenced by formation of tubercles in fathead minnows and papillary processes in Japanese medaka. Effects in fish occurred at concentrations below those reported in the environment. These results demonstrate how a priori knowledge of an adverse outcome pathway and the conservation of a key molecular target across vertebrates can be utilized to identify potential chemicals of concern in terms of monitoring and highlight potentially sensitive species and endpoints for testing.

Impact of a rapid palatal expander on speech articulation.

INTRODUCTION: Rapid palatal expanders (RPEs) have attachments cemented to the teeth and a screw that covers the palate. Because of their position and relative size, RPEs can affect speech. Our objective was to assess speech perturbation and adaptation related to RPE appliances over time. METHODS: RPEs were planned for the treatment of 22 patients in the orthodontic clinic at the University of Toronto in Canada. Speech recordings were made at 6 time points: before RPE placement, after placement, during expansion, during retention, after removal, and 4 weeks after removal. The speech recordings consisted of 35 sentences, from which 3 sentences were chosen for analysis. Speech acceptability was assessed perceptually by 10 listeners who rated each sentence on an equal-appearing interval scale. The vowel formants for /i/ and the fricative spectra for /s/ and /∫/ were measured with speech analysis software. Repeated-measures analysis of variance with post-hoc paired t tests was used for statistical analysis. RESULTS: When the appliance was placed, speech acceptability deteriorated. Over time, the ratings improved and returned to baseline when the appliance was removed. For the vowel /i/, the first formant increased, and the second formant decreased in frequency, indicating centralization of the vowel. The formants returned to the pretreatment levels during treatment. For the fricatives (/s/ and /∫/), low-to-high frequency ratios indicated that the fricatives were distorted when the appliance was placed. The ratios returned to baseline levels once the appliance was removed. The results for the spectral moments indicated that spectral mean decreased and skewness became more positive. Repeated-measures analysis of variance showed significant effects for time for all acoustic measures. CONCLUSIONS: Speech was altered and distorted when the appliance was first placed. The patients' speech gradually improved over time and returned to baseline once the appliance was removed. The results from the study will be useful for pretreatment counseling of patients and their families.

Cost: benefit of point-of-care blood gas analysis vs. laboratory measurement during stabilization prior to transport.

INTRODUCTION: This study was conducted to determine whether point-of-care testing, using the iSTAT Portable Clinical Analyzer, would reduce time at the referring hospital required to stabilize ventilated pediatric patients prior to interfacility, air-medical transport. METHODS: The following data were collected prospectively: (1) When a blood gas analysis was ordered; (2) If it was necessary to call in a technician; (3) Waiting time for blood to be drawn; and (4) Waiting time for results. The cost-efficacy of point-of-care testing was calculated based on: (1) Three minutes for a transport team member to draw a sample and obtain a result using the iSTAT (unit cost 8,000 CDN dollars); (2) Lab technician call-back (minimum two hours at 90 dollars); (3) Paramedic overtime (by the minute at 49 dollars/hour); and (4) Cost of charter aircraft wait time (200 dollars per hour) for every hour beyond four hours. RESULTS: Data were collected on 46 ventilated patients over a three month period. A blood gas analysis was ordered on 35 patients. Laboratory technicians were called in for 17 (49%). For 12 (34%) patients, there was a wait for the sample to be drawn, and for 23 (66%), there was a wait for results to become available. Total time waiting to obtain laboratory gases was 526 minutes compared with a calculated 105 minutes using point-of-care testing. An iSTAT cartridge cost of 420 dollars would not have been different from laboratory costs. Cost-saving on technician callback (1,530 dollars), paramedic overtime (690 dollars) and aircraft time waiting charges (2,000 dollars) would have totaled (4,220 dollars). From this study, the cost of point-of-care equipment could be recouped in 101 patients if aircraft charges apply or 192 patients if no aircraft costs are involved. For 11 cases, ventilator adjustments were made subsequently during transport, and for six patients, point-of-care testing, if in place, would have been used to optimize transport care. CONCLUSION: The data from the present study indicate significant cost-efficacy from use of this technology to reduce stabilization times, and support the potential to improve quality of care during air medical interfacility transport.