Differences in the Ratios of General and Dental Specialists in Europe.

BACKGROUND: The European Economic Area (EEA) is composed of member states with a multitude of different regions. This study aimed to analyse the ratios of general dentists and dental specialists to the total population and the proportion of dental specialists to general dentists in 24 European countries and to explore specific intranational differences within 2 countries: France and Germany. METHODS: Available official documents and webpages from the United Kingdom and 23 of the 30 countries comprising the EEA were analysed. Data were expressed as absolute values, ratios of general dentists and dental specialists in the total of population, and percentages of dental specialists/dentists. The Mann-Whitney U test was used to clarify the main ratios that distinguish France from Germany, and cluster analysis was employed to determine similar areas. RESULTS: Significant differences were found between countries, with Ireland and Austria having the lowest ratio of dentists and Romania and Greece having the highest. The Czech Republic, the Netherlands, France, and Denmark had the lowest ratios of dental specialists to the total population. Lithuania, Sweden, and Germany had the highest number of dental specialists. Orthodontists were the most numerous specialists (5.0% of dentists), followed by oral surgeons (2.7%). In France, differences between departments were pronounced and associated with the presence of dental schools and per capita income. In Germany, only the correlation between per capita income and the density of oral surgeons was significant. CONCLUSIONS: Diverse ratios of general dentists and dental specialists to the total population and the proportion of dental specialists to general dentists were discovered within the examined countries, and their maximum values were 2.5, 5.7, and 4.1 times the minimum values, respectively. Differences were even found within the same country, as was the case in France and, to a lesser extent, in Germany.

Is there a common pattern of dental specialties in the world? Orthodontics, the constant element.

BACKGROUND: There is a lack of studies comparing the status of dental specialties worldwide. Therefore, this study aimed to analyze the differences and similarities between the number and types of dental specialties in 31 countries, including every continent, in the world. MATERIALS AND METHODS: Available official documents and webpages from regulatory bodies, official colleges and councils, and dental institutions were collected from 31 countries and analyzed to obtain reliable data on dental specialties. Differences were analyzed using the Lorentz curve and Gini test. Additionally, a cluster analysis was performed to obtain groups of countries with similar patterns in the number and types of dental specialties. RESULTS: A total of 32 different specialties were officially recognized among all the analyzed countries. Orthodontics and oral surgery (100% and 93.1%, respectively) were the two most frequently officially recognized dental specialties worldwide. The total global degree of inequality in the 31 analyzed countries was 42.4%. The Anglo-Saxon countries showed the greatest similarity, approximately 15-fold higher than the European countries. Cluster analysis differentiated six main groups of countries according to the number and types of dental specialties. European countries formed one of the two largest clusters, and the other cluster was of Anglo-Saxon, Asian, African, and several Eastern European countries with a high number of specialties. CONCLUSIONS: Officially recognized dental specialties in the different continents and countries show an asymmetric organization. The number, names, and skills of officially recognized dental specialties exhibited significant differences, showing inequalities in their organization. The Anglo-Saxon pattern of dental specialties showed greater equality than the European pattern. Orthodontics was the only constant element among the different patterns.

Stability of class II correction with the Austro Repositioner associated with multi-brackets fixed appliances in dolichofacial patients.

BACKGROUND: The purposes of the present study were to evaluate the changes produced by the Austro Repositioner, and to assess the stability of Class II malocclusion treatment with the Austro Repositioner associated with fixed appliances and its capacity to control the vertical dimension in dolichofacial patients. METHODS: A group of patients with Class II malocclusion due to mandibular retrognathism and a dolichofacial growth pattern treated with the Austro Repositioner combined with fixed appliances were compared to a matched untreated control group of subjects with Class II malocclusion. Evaluations were made on the basis of lateral cephalograms taken at T1 (initial records), T2 (end of treatment), and T3 (1 year after treatment). Statistical comparisons were performed with paired- and two-sample t tests. RESULTS: The experimental (treated) group comprised 30 patients, 14 boys and 16 girls, and the control group comprised 30 subjects (15 boys and 15 girls) with similar ages at T1, T2 and T3. In the treated group, a significant decrease in the ANB angle was found (- 3.79 ± 1.46; p < 0.001). No significant differences were found in the maxillary skeletal measurements. In contrast, the SNB angle showed a significant increase of 3.77 ± 1.49 in the treated group compared with a nonsignificant increase of 0.77 ± 1.55 in the control group (p = 0.002). Vertical changes showed a significant decrease in the FMA angle (- 3.36 ± 1.62), while the lower anterior facial height distance and the overbite increased significantly in the treated group, reflecting a change in vertical dimensions after treatment. No significant changes were observed in either the treated or control group during the one-year posttreatment period; thus, the treatment results remained stable. CONCLUSIONS: The Austro Repositioner combined with fixed appliances could be considered an optimal treatment modality in Class II dolichofacial patients.

European inequalities and similarities in officially recognized dental specialties.

BACKGROUND: Although the European Economic Space usually acts in a united and organized way, several main differences are found regarding the type and number of dental specialties all around this group of member states. The aim of the study is to analyse the inequalities and similarities existing between 21 European countries, highlighting the number and types of recognized dental specialties. METHODS: Available official documents and webpages from 20 out of the 30 countries of which the European Economic Space is comprised plus the United Kingdom (UK), were analysed to obtain reliable data referred to dental specialties. Differences were tested with the Lorentz curve and Gini test. Additionally, a Cluster analysis was performed to obtain groups of countries with a similar pattern in the number and type of dental specialties. RESULTS: Up to a total of 15 different specialties are officially recognized in all the analysed countries. Orthodontics (90%) and Oral Surgery (81%) are the two most frequently recognized specialties. The total global degree of inequality of the analysed countries was 40.2%. Cluster analysis differentiated three different main groups of countries according to the number and type of dental specialties. CONCLUSIONS: The situation of dental specialties in the area of the EES plus the UK exhibits an unequal organization. Cluster analysis showed 3 main clusters of countries with a similar pattern of dental specialties.

Association between Eruption Sequence of Posterior Teeth, Dental Crowding, Arch Dimensions, Incisor Inclination, and Skeletal Growth Pattern.

BACKGROUND: We conducted research to investigate the effects of the eruption sequence of posterior teeth, arch dimensions, and incisor inclination on dental crowding. MATERIAL AND METHODS: A cross-sectional analytic study was performed on 100 patients (54 boys and 46 girls; mean ages: 11.69 and 11.16 years, respectively). Seq1 (canine-3-/second premolar-5-) or Seq2 (5/3) eruption sequences were recorded in maxilla, and Seq3 (canine-3-/first premolar-4-) or Seq4 (4/3) eruption sequences in mandible; tooth size, available space, tooth size-arch length discrepancy (TS-ALD), arch lengths, incisor inclination and distance, and skeletal relationship were noted. RESULTS: The most common eruption sequences in the maxilla and mandible were Seq1 (50.6%), and Seq3 (52.1%), respectively. In the maxilla, posterior tooth sizes were larger in crowded cases. In the mandible, anterior and posterior tooth sizes were larger in crowded patients. No relationship between incisor variables and the maxillo-mandibular relationship and dental crowding was found. A negative correlation between inferior TS-ALD and the mandibular plane was found. CONCLUSIONS: Seq1 and Seq 2 in the maxilla and Seq 3 and Seq 4 in the mandible were equally prevalent. An eruption sequence of 3-5 in the maxilla and 3-4 in the mandible is more likely to cause crowding.

Cardiovascular prevention in elderly patients.

In recent decades, life expectancy has been increasing significantly. In this scenario, health interventions are necessary to improve prognosis and quality of life of elderly with cardiovascular risk factors and cardiovascular disease. However, the number of elderly patients included in clinical trials is low, thus current clinical practice guidelines do not include specific recommendations. This document aims to review prevention recommendations focused in patients ≥ 75 years with high or very high cardiovascular risk, regarding objectives, medical treatment options and also including physical exercise and their inclusion in cardiac rehabilitation programs. Also, we will show why geriatric syndromes such as frailty, dependence, cognitive impairment, and nutritional status, as well as comorbidities, ought to be considered in this population regarding their important prognostic impact.

Sexual dimorphism in the long-term stability (10 years) of skeletal Class III treatment.

BACKGROUND: Class III malocclusion is associated with high sexual dimorphism, especially in individuals older than 13 years of age, with significant differences in growth between males and females during the pubertal and postpubertal stages, and in adulthood. The aim of this research was to examine differences between males and females in long-term stability (10 years) of treatment for skeletal Class III malocclusion. METHODS: Thirty patients (15 males and 15 females) with skeletal Class III malocclusion, who had been treated with rapid maxillary expansion (RME) combined with face mask protraction followed by fixed appliances, were selected sequentially. Thirty patients (15 males and 15 females) with skeletal Class I and mesofacial patterns treated only with fixed appliances for dental problems served as the control group. Differences between groups and sexes were evaluated using lateral cephalograms taken at the start of treatment (T0), immediately after the end of treatment (T1), and after 10 years (T2). The long-term treatment success rate was calculated. RESULTS: Ten years after Class III treatment, overjet and overbite relapse occurred similarly in females (- 0.68 ± 0.7 mm; - 0.38 ± 0.75 mm, respectively) and males (- 1.09 ± 1.47 mm; - 0.64 ± 0.9 mm, respectively); the ANB angle and Wits appraisal became significantly more negative in males (- 1.37 ± 1.06°; - 2.7 ± 2.53 mm) than in females (- 0.18 ± 1.26°; - 0.46 ± 1.94 mm). The success rate was 73.3% in males and 80% in females. CONCLUSIONS: Significant differences in the long-term stability of Class III treatment outcomes have been found between males and females, with a larger skeletal Class III relapse and lower long-term success rates in males.

Novel Sub-Clustering of Class III Skeletal Malocclusion Phenotypes in a Southern European Population Based on Proportional Measurements.

Current phenotypic characterizations of Class III malocclusion are influenced more by gender or ethnic origin than by raw linear skeletal measurements. The aim of the present research is to develop a Class III skeletal malocclusion sub-phenotype characterization based on proportional cranial measurements using principal component analysis and cluster analysis. Radiometric data from 212 adult subjects (115 women and 96 men) of southern European origin affected by Class III skeletal malocclusion were analyzed. A total of 120 measurements were made, 26 were proportional skeletal measurements, which were used to perform principal component analysis and subsequent cluster analysis. The remaining 94 supplementary measurements were used for a greater description of the identified clusters. Principal component analysis established eight principal components that explained 85.1% of the total variance. The first three principal components explained 51.4% of the variance and described mandibular proportions, anterior facial height proportions, and posterior-anterior cranial proportions. Cluster analysis established four phenotypic subgroups, representing 18.4% (C1), 20.75% (C2), 38.68% (C3), and 22.17% (C4) of the sample. A new sub-clustering of skeletal Class III malocclusions that avoids gender influence is provided. Our results improve clinicians' resources for Class III malocclusion and could improve the diagnostic and treatment approaches for this malocclusion.

Consenso de expertos en la asistencia multidisciplinaria y el abordaje integral de la insuficiencia cardiaca. Desde el alta hospitalaria hasta la continuidad asistencial con primaria / Expert consensus on multidisciplinary management and integrated approaches in heart failure. Continuity of care from hospital discharge to primary care

La insuficiencia cardiaca es una enfermedad que precisa un tratamiento multidisciplinario, dadas la diversidad de causas y entornos clínicos implicados que las tratan y las diferentes estrategias terapéuticas que precisan la participación indispensable de diversas disciplinas. La presencia en los servicios de cardiología de unidades de insuficiencia cardiaca centradas en el tratamiento de los pacientes con esta afección y unidades de rehabilitación cardiaca que, entre sus indicaciones para la reducción de la morbimortalidad, también están implicadas en la atención de esos mismos pacientes puede causar dificultades de coordinación y pérdida de una atención integral centrada en el paciente. Por estos motivos, en el presente documento se plantea una estrategia de coordinación entre las diferentes unidades implicadas en el tratamiento de los pacientes dentro de los servicios de cardiología y la continuidad asistencial con atención primaria, tanto tras haber conseguido la estabilidad como la interrelación para una coordinación posterior más efectiva

Heart failure is a condition that requires a multidisciplinary approach to treatment because of the wide range of causes and clinical contexts that may be involved and because the diverse treatment strategies used necessitate the participation of multiple disciplines. In cardiology departments, the presence of both heart failure units that focus on the treatment of affected patients and cardiac rehabilitation units that, as well as targeting reductions in morbidity and mortality, are also involved in caring for the same patients can create difficulties for coordination and can result in the loss of comprehensive patient-centered care. For these reasons, this paper presents a strategy for coordinating the different units involved in patient management in cardiology departments and for ensuring continuity of care in primary care, both immediately after achieving stabilization and subsequently, when these interactions are important for effective coordination

Consenso de expertos en la coordinación de la rehabilitación cardiaca entre cardiología y atención primaria. Proyecto RehaCtivAP / Expert consensus on the coordination of cardiac rehabilitation between cardiology departments and primary care. The RehaCtivAP project

En la continuidad asistencial del paciente que ha sufrido un síndrome coronario agudo es fundamental la rehabilitación cardiaca. Es más, centrar los cuidados en el paciente obliga a coordinar la atención cardiológica con atención primaria para mejorar la adherencia a los programas y una atención continua adecuada. Los programas de rehabilitación cardiaca comunitaria son indispensables para cumplir con los objetivos preventivos, pero somos conscientes de las dificultades de implementación y la necesidad de apoyo de gestores y especialistas. Debemos ayudar a concienciar sobre esta necesidad y apoyar a los especialistas que tengan iniciativas en la creación de este tipo de programas. Este documento trata de sintetizar los puntos básicos de la atención y la coordinación entre cardiología y atención primaria para la creación y el desarrollo de estos programas comunitarios

Cardiac rehabilitation is an essential part of continuing care for patients who have experienced an acute coronary syndrome. Moreover, a patient-centered approach requires the coordination of cardiology care and primary care in order to improve adherence to rehabilitation programs and to ensure appropriate continuing care. Community cardiac rehabilitation programs are essential for achieving the objectives of disease prevention. However, implementation may be difficult and program managers and specialists may need support. It is important to raise awareness of the need to support specialists who have taken the initiative in creating these programs. The aim of this paper was to summarize the basic elements of care and of the coordination between cardiology departments and primary care needed to create and develop community cardiac rehabilitation programs

Relationship between vertical facial pattern and brain structure and shape.

OBJECTIVES: Dolichofacial (long-faced) and brachyfacial (short-faced) individuals show specific and well-differentiated craniofacial morphology. Here, we hypothesise that differences in the basicranial orientation and topology between dolicho- and brachyfacial subjects could be associated with differences in the supporting brain tissues. MATERIAL AND METHODS: Brain volumes (total intracranial, grey matter, and white matter volume), cortical thickness, and the volumes and shapes of fifteen subcortical nuclei were assessed on the basis of magnetic resonance imaging in 185 subjects. Global, voxel-wise and shape analyses, as well as multiple regression models, were generated to evaluate the association between vertical facial variations (dolicho- and brachyfacial spectrum) and brain morphology. RESULTS: Several differences in brain anatomy between dolicho- and brachyfacial subjects, along with relevant associations between vertical facial indices and brain structure and shape, were found. The most relevant finding of this study is related to the strong association of vertical facial indices with the volumes and shapes of subcortical nuclei, as the dolichofacial pattern increased, the bilateral hippocampus and brain stem expanded, while the left caudate, right pallidus, right amygdala, and right accumbens decreased in volume. CONCLUSIONS: Long- and short-faced human subjects present differences in brain structure and shape. CLINICAL SIGNIFICANT: The results of our study increase the clinician's knowledge about brain structure in dolicho- and brachyfacial patients. The findings could be of interest since the affected brain areas are involved in higher cognitive functions in humans, including language, memory, and attention.

Subclustering in Skeletal Class III Phenotypes of Different Ethnic Origins: A Systematic Review.

OBJECTIVE: We aimed to systematically review articles investigating the efficiency of the clustering of skeletal class III malocclusion phenotypic subtypes of different ethnic origins as a diagnostic tool. METHODS: The review protocol was structured in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered in Prospero (CRD42016053865). A survey of articles published up to March 2018 investigating the identification of different subgroups of skeletal class III malocclusion via cluster analysis was performed using 11 electronic databases. Any type of study design that addressed the classification of subclusters of class III malocclusion was considered. The Newcastle-Ottawa scale for cohort and cross-sectional (modified) studies was used for quality assessment. RESULTS: The final selection included 7 studies that met all the criteria for eligibility (% overall agreement 0.889, free marginal kappa 0.778). All studies identified at least 3 different types of class III clusters (ranging from 3 to 14 clusters; the total variation of the prevalence of each cluster ranged from 0.2% to 36.0%). The main shared variables used to describe the more prevalent clusters in the studies included were vertical measurements (Ar-Go-Me: 117.51°-135.8°); sagittal measurements: maxilla (SNA: 75.3°-82.95°), mandible (SNB: 77.03°-85.0°). With regard to ethnicity, a mean number of 8.5 and 3.5 clusters of class III were retrieved for Asian and Caucasian population, respectively. CONCLUSIONS: The total number of clusters identified varied from 3 to 14 to explain all the variability in the phenotype class III malocclusions. Although each extreme may be too simple or complex to facilitate an exhaustive but useful classification for clinical use, a classification system including 4 to 7 clusters may prove to be efficient for clinical use in conjunction with complete and meticulous subgrouping. CLINICAL SIGNIFICANCE: The identification and description of a subclustering classification system may constitute an additional step toward more precise orthodontic/orthopedic diagnosis and treatment of skeletal class III malocclusion.

Short-term dentoskeletal changes following Class II treatment using a fixed functional appliance: the Austro Repositioner : A pilot study.

OBJECTIVE: Purpose of this prospective study was to evaluate the skeletal and dentoalveolar effects of a fixed functional appliance, the Austro Repositioner, in dolicho- and brachyfacial skeletal Class II patients. MATERIAL AND METHODS: In all, 20 dolicho- and 25 brachyfacial consecutive patients treated with the Austro Repositioner were compared with untreated controls (20 dolicho- and 20 brachyfacial patients) with the same initial dentoskeletal features. Lateral cephalograms were acquired before and 1.0±0.2 year after therapy. RESULTS: Significant improvements in skeletal Class II relationships were observed in both groups. The ANB angle decreased (3.56° in dolicho- and 3.13° in brachyfacial patients, P < 0.001) due to changes localized exclusively in the mandible, the SNB angle increased to 3.20° in dolicho- and 3.02° in brachyfacial patients, and the total mandibular length (Co-Pg) increased to 6.47 mm in dolicho- and 5.78 mm in brachyfacial patients (P < 0.001). A favorable guidance of vertical pattern was also achieved in both groups, and no significant changes were observed in the upper and lower incisors in both groups. CONCLUSIONS: The Austro Repositioner was effective for short-term treatment of skeletal Class II malocclusion resulting from the retrusion of the mandible in both dolicho- and brachyfacial patients.

Electromyographic activity of the jaw muscles and mandibular kinematics in young adults with theoretically ideal dental occlusion: Reference values

BACKGROUND: A necessary step to use neuromuscular analysis as diagnostic tool is to establish normal reference values for the physiological range in a healthy population. Surface electromyographic (sEMG) activity of the jaw muscles and mandibular kinematics were measured in young adults with theoretically ideal dental occlusion to determine normal reference values during different tasks. Differences between the sexes were evaluated. MATERIAL AND METHODS: Forty young adults (20 men, 20 women; mean age 22.8 ± 3.9 years) with theoretically ideal dental occlusion were selected using very restrictive criteria. sEMG activity of the anterior temporalis (AT), posterior temporalis, masseter (MA), and suprahyoid muscles were evaluated in the rest position and during swallowing, mastication, and clenching. Mandibular kinematics in the rest position and during maximum excursions were assessed. Asymmetry, activity, and torque indices and MA/AT ratios were calculated. RESULTS: For all muscles, sEMG values were 1.01-3.57 miV at rest, 3.50-10.85 miV during swallowing, and 41.04- 86.59 miV during mastication. During clenching, values were 230.08-243.55 miV for the AT and MA muscles. Mean total asymmetry, activity, and torque indices at rest were 20.34 %, -15.04 %, and 19.02 %, respectively; during clenching, these values were 6.14 %, -2.62 %, and 4.46 %. MA/AT ratios were near 1. Kinematic measurements during lateral excursion, protrusive and maximum opening were 7.54, 8.44, and 37.38 mm respectively; lateral mandibular shift was 1.41 mm; freeway and lateral displacement at rest were 1.40 and 0.26 mm. Right MA activity during mastication and clenching was higher in men than women. CONCLUSIONS: Reference values for sEMG activity and mandibular kinematics were determined. Some muscular asymmetry and torque were observed

Evidence of toothpick groove formation in Neandertal anterior and posterior teeth.

OBJECTIVES: During the microscopic examination of the Neandertal dentitions from El Sidrón (Spain) and Hortus (France), we found unusual fine parallel microstriations on the mesial and distal sides of all tooth types, near the cervix. As its appearance was similar to toothpick grooves described in other Homo species, it could correspond to early stages on its formation. To test this hypothesis we developed an experimental replication of a groove using grass stalks. MATERIALS AND METHODS: Comparisons between 204 isolated Neandertal teeth and the two experimental dental specimens corroborate that the marks correspond to initial stages of toothpick groove formation, and we propose a five-grade recording scale that summarized the groove formation process. RESULTS: Using this new recording procedure, we found that Hortus individuals have higher incidence of this trait (eight individuals out of nine) than the El Sidrón individuals (nine out of 11). Toothpick grooves from El Sidrón show the earliest stages of development, whereas the grooves found on Hortus Neandertals were well-developed. Toothpick grooves were also found in 21 incisors and canines. CONCLUSIONS: These differences could be due to the more advanced occlusal dental wear in Hortus individuals, maybe age-related and with a more meat-based diet maybe favoring the inclusion of food debris and thus probing as the cleaning methodology. Our results allow the identification and characterization of incipient toothpick grooves on the human fossil record and contribute to increase our knowledge on Neandertals behavioral and oral care habits.

Spheno-Occipital Synchondrosis Fusion Correlates with Cervical Vertebrae Maturation.

The aim of this study was to determine the relationship between the closure stage of the spheno-occipital synchondrosis and the maturational stage of the cervical vertebrae (CVM) in growing and young adult subjects using cone beam computed tomography (CBCT). CBCT images with an extended field of view obtained from 315 participants (148 females and 167 males; mean age 15.6 ±7.3 years; range 6 to 23 years) were analyzed. The fusion status of the synchondrosis was determined using a five-stage scoring system; the vertebral maturational status was evaluated using a six-stage stratification (CVM method). Ordinal regression was used to study the ability of the synchondrosis stage to predict the vertebral maturation stage. Vertebrae and synchondrosis had a strong significant correlation (r = 0.89) that essential was similar for females (r = 0.88) and males (r = 0.89). CVM stage could be accurately predicted from synchondrosis stage by ordinal regression models. Prediction equations of the vertebral stage using synchondrosis stage, sex and biological age as predictors were developed. Thus this investigation demonstrated that the stage of spheno-occipital synchondrosis, as determined in CBCT images, is a reasonable indicator of growth maturation.

Association between changes in soft and hard tissue after early chin cup treatment.

OBJECTIVE: To assess the soft tissue and to determine the potential association between changes in soft and hard tissue after early chin cup treatment in prognathic children. MATERIALS AND METHODS: A total of 42 children (21 boys, 21 girls) with skeletal Class III malocclusion due to mandibular prognathism were examined before (mean age, 8.5 ± 0.5 years) and after (mean age, 11.4 ± 0.6 years) chin cup treatment. Data were compared with 25 untreated matched controls (12 boys, 13 girls) with mean ages of 8.5 ± 0.5 years at the first and 11.7 ± 0.5 years at the second observation. Lateral cephalograms were taken before and after 36 months of treatment/observation. We evaluated the changes in hard and soft tissue and the correlations between these changes in both groups. RESULTS: The skeletal and soft-tissue facial profiles improved significantly in the treated patients, mainly due to changes in the mandible. The chin cup group revealed significant reductions in the facial-convexity angle and lower-lip inclination, leading to a remarkable improvement in the soft-tissue facial profile. We noted similar correlations between changes in the hard and soft tissue in both groups, except for a significant correlation between a pogonion retrusion and reduction in the facial-convexity angle detected only in the chin cup group. Various correlations were observed between corresponding soft and dentoalveolar changes between groups. CONCLUSION: Soft-tissue changes accompanied the underlying skeletal and dentoalveolar tissue changes after chin cup treatment.

Optimization of buffer solutions to analyze inflammatory cytokines in gingival crevicular fluid by multiplex flow cytometry

OBJECTIVE: the aim of this study was to test two buffer solutions in order to attain a reliable and reproducible analysis of inflammatory cytokines (IL-Beta, IL-6, TNF-alpha, OPG, OPN and OC), in gingival crevicular fluid (GCF)by flow cytometry. MATERIAL AND METHODS: GCF samples from healthy volunteers were collected with perio-paper strips and diluted either in phosphate buffered saline (PBS) or Tris-HCl buffer, with and without protease inhibitors (PI). Cytokine immunoassays were carried out by flow cytometry (Luminex Xmap 200) generating standard curves. RESULTS: standards curves generated with the use of phosphate-buffered saline (PBS) demonstrated best adjustment for cytokines IL-1beta, IL-6 and TNF- α levels, when using Tris-HCl (p < 0.05). CONCLUSIONS: The use of PBS buffer with the addition of PI provided reliable measurements of inflammatory bi-omarkers in GCF samples of healthy volunteers

Long-term stability of rapid maxillary expansion combined with chincup protraction followed by fixed appliances.

OBJECTIVE: To analyze the long-term stability of rapid maxillary expansion (RME) and protraction from chincup therapy in girls with Class III malocclusion. MATERIALS AND METHODS: Twenty-two girls (mean age  =  9.1 ± 0.6 years) with Class III malocclusion were treated with combined RME and protraction from a chincup, followed by fixed appliances. Lateral cephalograms were evaluated before treatment, at the end of a two-phase treatment protocol (mean age  =  15.1 ± 1.1 years), and 10.9 ± 0.5 years after the end of treatment (mean age  =  27.5 ± 0.5 years). The control group consisted of 22 matched girls with skeletal Class I malocclusion. RESULTS: After treatment, the Class III group showed significant improvement of the Class III malocclusion, mainly due to changes in the mandible (ie, SNB angle decreased 1.8 ± 1.6°) and significant improvement of the sagittal maxillomandibular relationship (Wits appraisal increased 2.6 ± 2.1 mm; ANB angle increased 1.0 ± 0.3 mm). These changes remained stable for an average of 10 years after the end of therapy. No tendency toward relapse was detected, and the mandibular position showed favorable outcomes. CONCLUSIONS: RME and protraction from chincup therapy led to successful long-term outcomes in 18 of 22 patients (81.8%). This treatment approach can be considered an efficient therapy in growing girls with mild skeletal Class III malocclusion caused by maxillary retrusion and mandibular protrusion.