Two-stage palatal repair in non-syndromic CLP patients using anterior to posterior closure is associated with minimal need for secondary palatal surgery.

OBJECTIVE: The aim of the present study was to assess the need for secondary palatal corrective surgery in a concept of palate repair that uses a protocol of anterior to posterior closure of primary palate, hard palate and soft palate. METHODS: A data base of patients primarily operated between 2001 and 2021 at the Craniofacial and Cleft Care Center of the University Goettingen was evaluated. Cleft lips had been repaired using Tennison Randall and Veau-Cronin procedures in conjunction with alveolar cleft repair. Cleft palate repair in CLP patients was accomplished in two steps with repair of primary palate and hard palate first using vomer flaps at the age of 10-12 months and subsequent soft palate closure using Veau/two-flap procedures 3 months later. Isolated cleft palate repair was performed in a one-stage operation using Veau/two-flap procedures. Data on age, sex, type of cleft, date and type of surgery, occurrence and location of oronasal fistulae, date and type of secondary surgery performed for correction of oronasal fistula (ONF)and / or Velophyaryngeal Insufficiency (VPI) were extracted. The rate of skeletal corrective surgery was registered as a proxy for surgery induced facial growth disturbance. RESULTS: In the 195 patients with non-syndromic complete CLP evaluated, a total number of 446 operations had been performed for repair of alveolar cleft and cleft palate repair (Veau I through IV). In 1 patient (0,5%), an ONF occurred requiring secondary repair. Moreover, secondary surgery for correction of VPI was required in 1 patient (0,5%) resulting in an overall rate of 1% of secondary palatal surgery. Skeletal corrective surgery was indicated in 6 patients (19,3%) with complete CLP in the age group of 15 - 22 years (n = 31). CONCLUSIONS: The presented data have shown that two-step sequential cleft palate closure of primary palate and hard palate first followed by soft palate closure has been associated with minimal rate of secondary corrective surgery for ONF and VPI at a relatively low need for surgical skeletal correction.

Reliability of landmark identification for analysis of the temporomandibular joint in real-time MRI.

BACKGROUND: Real-time magnetic resonance imaging (rtMRI) is essential for diagnosing and comprehending temporomandibular joint (TMJ) movements. Current methods for tracking and analysis require manual landmark placement on each acquisition frame. Therefore, our study aimed to assess the inter- and intra-rater reliability of placing cephalometric landmarks in frames from a dynamic real-time TMJ MRI. MATERIAL AND METHODS: Four real-time MRIs of the right TMJ were taken during mandibular movement at ten frames per second. Seven dentists identified ten landmarks on two frames (intercuspal position-ICP-and maximum mouth opening-MMO) twice at a two-week interval, yielding 112 tracings. Six typical cephalometric measurements (angles and distances) were derived from these landmarks. The reliabilities of landmarks and measurements were evaluated using distance-based (dbICC), linear mixed effect model intraclass correlation (lmeICC), and standard ICC. RESULTS: The average inter-rater reliability for the landmarks stood at 0.92 (dbICC) and 0.93 (lmeICC). The intra-rater reliability scores were 0.97 and 0.98. Over 80% of the landmarks showed an ICC greater than 0.98 (inter-rater) and over 0.99 (intra-rater). The lowest landmark ICC was observed for the orbitale and the oblique ridge of the mandibular ramus. However, the cephalometric angle and distance measurements derived from these landmarks showed only moderate to good reliability, whereas the reliability in the frames with ICP was better than those with MMO. Measurements performed in the ICP frame were more reliable than measurements in the MMO frame. CONCLUSION: While dentists reliably localize isolated landmarks in real-time MRIs, the cephalometric measurements derived from them remain inconsistent. The better results in ICP than MMO are probably due to a more familiar jaw position. The higher error rate of the TMJ measurements in MMO could be associated with a lack of training in real-time MRI analysis in dentistry.

The impact of orthodontic-surgical treatment on facial expressions-a four-dimensional clinical trial.

OBJECTIVE: The objective of this clinical trial was to compare facial expressions (magnitude, shape change, time, and symmetry) before (T0) and after (T1) orthognathic surgery by implementing a novel method of four-dimensional (4D) motion capture analysis, known as videostereophotogrammetry, in orthodontics. METHODS: This prospective, single-centre, single-arm trial included a total of 26 adult patients (mean age 28.4 years; skeletal class II: n = 13, skeletal class III: n = 13) with indication for orthodontic-surgical treatment. Two reproducible facial expressions (maximum smile, lip purse) were captured at T0 and T1 by videostereophotogrammetry as 4D face scan. The magnitude, shape change, symmetry, and time of the facial movements were analysed. The motion changes were analysed in dependence of skeletal class and surgical movements. RESULTS: 4D motion capture analysis was feasible in all cases. The magnitude of the expression maximum smile increased from 15.24 to 17.27 mm (p = 0.002), while that of the expression lip purse decreased from 9.34 to 8.31 mm (p = 0.01). Shape change, symmetry, and time of the facial movements did not differ significantly pre- and postsurgical. The changes in facial movements following orthodontic-surgical treatment were observed independently of skeletal class and surgical movements. CONCLUSIONS: Orthodontic-surgical treatment not only affects static soft tissue but also soft tissue dynamics while smiling or lip pursing. CLINICAL RELEVANCE: To achieve comprehensive orthodontic treatment plans, the integration of facial dynamics via videostereophotogrammetry provides a promising approach in diagnostics. TRIAL REGISTRATION NUMBER: DRKS00017206.

Radiodiagnostics of standard orthodontic radiographs-dental and extradental incidental findings : Do we see everything we should see?

OBJECTIVES: The extent of undetected incidental findings in routine orthodontic radiographs is still unknown. However, incidental findings that are not in the primary focus of orthodontic diagnostics may be of high medical relevance. Therefore, this study aimed to analyse whether incidental findings are reliably detected and which parameters influence the orthodontist's assessment. METHODS: In a clinical cross-sectional study 134 orthodontists evaluated two orthopantomogram (OPT) and two lateral cephalogram (LC) radiographs each via a standardised online survey. The radiographs were previously examined by three dentists and one radiologist-in a pilot phase-regarding the number of incidental findings and subsequently defining as gold standard in a consensus procedure. The radiographs were presented consecutively, the number of incidental findings detected were noted and the individual findings could be described in free text form. RESULTS: Overall, 39.1% of the incidental findings were detected. The orthodontists' focus was primarily on the dental region. Here, 57.9% of incidental findings were detected, while 20.3% were detected in extradental regions (p < 0.001). A highly relevant finding of suspected arteriosclerotic plaque was detected in 7.5% of cases (OPT). Significantly more incidental findings were detected on OPTs than on LCs (OPT 42.1%, LC 36.0%, p < 0.001). As participants' length of professional experience increased, significantly more time was spent on the assessment (p < 0.001), correlating positively with the detection of incidental findings. CONCLUSIONS: Even in daily routine practice, attention must be paid to a thorough assessment of all radiographed regions. The factors time and professional experience can prevent practitioners from overlooking findings outside the orthodontic focus.

Evaluation of occlusal function during orthognathic therapy : A prospective clinical trial using a digital registration method.

OBJECTIVES: Reduced occlusal function is a main characteristic of orthognathic patients. The present study aimed to investigate the extent of therapy-induced functional improvements in occlusal function using a digital diagnostic method. METHODS: This prospective clinical study included 41 orthognathic patients (24 women and 17 men, median age 27.26 ± 8.2 years) and 10 control patients (5 women and 5 men, median age 29.8 ± 13.5 years) with neutral skeletal and dental configurations. The patients were divided into classes I, II and III based on their cephalometry. Digital occlusal registrations in habitual occlusion in an upright sitting position were taken before (T1) and after (T2) therapy using the T­Scan Novus (Tekscan, South Boston, MA, USA) application. RESULTS: Class II and III patients showed a significantly less efficient occlusal pattern than the untreated controls regarding total antagonism (p < 0.001), time of occlusion (p = 0.004), occlusal asymmetry (p = 0.001), anterior antagonism (p < 0.001) and posterior antagonism (p < 0.001). After therapy, the occlusal pattern increased in both therapy groups, where class III patients became indistinguishable from the controls, and class II patients differed only in posterior antagonism (p = 0.035). CONCLUSIONS: The digital occlusal registration method proved to be a useful diagnostic tool and provided new insights into therapeutic effects in orthognathic patients. By precisely adjusting the occlusal function, masticatory performance improved significantly. CLINICAL RELEVANCE: Severe malocclusion leads to a significantly lower masticatory performance for patients, which can be improved by orthognathic therapy and captured by digital occlusal registration.

Prevalence of incidental findings in adult vs. adolescent patients in the course of orthodontic X-ray diagnostics.

OBJECTIVE: Due to increasing numbers of adult patients presenting to orthodontic practices, an increase in incidental findings on diagnostic X­rays, which are the cornerstone of orthodontic diagnostics, is expected. This raises the clinically relevant question of whether an age effect exists regarding prevalence, localisation and severity of incidental findings on orthodontic diagnostic X­rays. MATERIALS AND METHODS: The clinical, primarily retrospective study examined pathological incidental findings from 600 orthopantomograms (OPT) and lateral cephalogram (LC) images in two groups of orthodontic patients (group I: 150 children/adolescents, age 11.89 ± 2.47 years; group II: 150 adults, age 27.03 ± 10.42 years). Prevalence, localisation and severity of the findings were recorded based on a classification sheet. The assessment was done by three experienced examiners following a systematic approach along the nine locations: mandible, maxilla, dentition, paranasal sinuses, temporomandibular joint, cranial base, orbit, cervical spine, soft tissues. RESULTS: In all, 1458 incidental findings were detected, with 66% of the findings having occurred away from the dentition. There was a significant age effect (p < 0.001) with respect to the prevalence of incidental findings (group II-adults 1026 findings-OPT: 566/LC 460 vs. group I-children/adolescents 432 findings-OPT: 221/LC 211). Regarding localisation, incidental findings in adults commonly occurred in the dentition, paranasal sinuses and mandibular regions. Furthermore, analysis of the LC images revealed significantly more incidental findings in the area of the cranial base and cervical spine in adults (p < 0.001, p = 0.003). Categorisation according to the severity of the incidental findings showed that 33% of the incidental findings needed further diagnostic investigation and possibly treatment by other specialities. CONCLUSION: Diagnostic assessment using orthodontic diagnostic X­rays results in a high prevalence of incidental findings away from the dentition. Particularly in adults, a large number of incidental findings outside the dental/alveolar region may be expected on orthodontic diagnostic X­rays. Thus, a structured approach during diagnostic assessment is required to minimise the extent to which incidental findings of clinical relevance are overlooked.

Three-dimensional mandibular characteristics in skeletal malocclusion : A cross-sectional study.

PURPOSE: We aimed to comprehensively analyse a possible correlation between skeletal malocclusions, gender and mandibular characteristics in all three dimensions in adults and to identify mandibular characteristics that are typical for extreme skeletal patterns. METHODS: A 3D model of the skull was calculated in 111 adult patients (mean age = 27.0 ± 10.2 years; 49 women, 62 men) from available computed tomography or cone beam computed tomography scans of their heads. Based on the 3D models, the skeletal patterns were examined in (a) the transversal dimension regarding asymmetry according to menton deviation, (b) the sagittal dimension according to the Wits appraisal and (c) the vertical dimension according to the maxillomandibular plane angle. The mandibular characteristics assessed were linear (ramus height and width, body length), angular (ramus, gonial and body angle) and volumetric (ramus/mandibular volume, body/mandibular volume) parameters. RESULTS: No correlation between transversal skeletal asymmetry and mandibular characteristics were found, while sagittal (F(16, 174) = 3.32, p < 0.001, η2 = 0.23) and vertical (F(16, 174) = 3.18, p < 0.001, η2 = 0.23) skeletal patterns were shown to have a significant effect on the mandible. Gender correlated with mandibular characteristics independently from the skeletal pattern. Discriminant analysis revealed that class II and III patients differed in ramus and body angle with class II patients showing higher angles (ramus angle: class II = 89.8 ± 3.9° vs. class III = 84.4 ± 4.8°; body angle: class II = 87.7 ± 4.8° vs. class III = 82.1 ± 5.2°). Hypo- and hyperdivergent patients were discriminated by gonial angle, body angle and body/mandibular volume with hyperdivergent patients having a greater gonial and body angle and body/mandibular volume (gonial angle: hypodivergent = 114 ± 9.3° vs. hyperdivergent = 126.4 ± 8.6°; body angle: hypodivergent = 82.9 ± 4.4° vs. hyperdivergent = 87.7 ± 6.5°; body/mandibular volume: hypodivergent = 72.4 ± 2.7% vs. hyperdivergent = 76.2 ± 2.6%). CONCLUSION: When analysing 3D data for treatment planning of adult patients, the orthodontist should pay attention to angular and volumetric characteristics of the mandible to identify extreme skeletal sagittal or vertical malocclusions.

Stereophotogrammetry can feasibly assess 'physiological' longitudinal three-dimensional head development of very preterm infants from birth to term.

Head development is a surrogate for brain development in infants and is related to neurocognitive outcome. There is only limited knowledge on early extra-uterine head shape and size assessment in very preterm infants. Here, 26 very preterm infants with a mean gestational age of 29.1 ± 2.2 weeks and a mean birth weight of 1273.8 ± 427.7 g underwent serial stereophotogrammetric 3D head imaging in weekly intervals from birth to term-equivalent age. The main outcome was the longitudinal assessment of the 'physiological' preterm head development with cephalometric size (head circumference, cranial volume) and shape parameters (cranial index, cranial vault asymmetry index) according to chronological and postmenstrual age (PMA). Potential clinical risk factors for the development of an abnormal low cranial index (dolichocephaly) were analysed. In serial measurements of 26 infants, the estimated head volume (95% confidence interval) increased from 244 (226-263) cm3 at 28 weeks PMA to 705 (688-721) cm3 at 40 weeks PMA. Moderate or severe dolichocephaly occurred in 21/26 infants (80.8%). Cranial index decreased over time (72.4%; 70.7-74 95% confidence interval). Brachycephaly and plagiocephaly were uncommon. No risk factors for severe dolichocephaly were identified. Our study shows that early detection of head shape and size anomalies utilizing 3D stereophotogrammetry is feasible and safe even in very preterm infants < 1500 g and/or < 32 weeks. 3D stereophotogrammetry could be used for timely identification of infants at risk for head shape anomalies. No specific risk factors for head shape anomalies were identified, especially not mode and duration of respiratory support.

Effect of Cleft Lip on Adolescent Evaluation of Faces: An Eye-Tracking Study.

PURPOSE: Adolescence is a delicate phase during life in which self-stigmatization increases and acceptance by peers becomes more important. However, little is known about how adolescents with cleft lip and/or palate experience this stage of life. Therefore, the purpose of this study was to investigate how cleft lip and/or palate (CLP) adolescents are looked at by their peers and how they look at others with/without CLP. METHODS: In this prospective, cross-sectional study 54 observers (CLP versus control) performed an eye-tracking task and gave attractiveness/ valence ratings. For this purpose, they were shown pictures of patients with and without CLP with neutral or smiling facial expressions. RESULTS: Adolescents with CLP were looked at differently compared to their unaffected peers, with shorter fixations of the eyes and longer fixations of the nose and mouth. Smiling altered the scan path toward the mouth for all faces. Contrary to the control group, adolescents with CLP tended to spend less time fixating the eyes. In the attractiveness/valence ratings, CLP adolescents were rated more negatively. CONCLUSIONS: Adolescents with cleft lip and/or palate look differently at peers and are also viewed with an alternate scan path.

Stereophotogrammetric head shape assessment in neonates is feasible and can identify distinct differences between term-born and very preterm infants at term equivalent age.

The development of head shape and volume may reflect neurodevelopmental outcome and therefore is of paramount importance in neonatal care. Here, we compare head morphology in 25 very preterm infants with a birth weight of below 1500 g and / or a gestational age (GA) before 32 completed weeks to 25 term infants with a GA of 37-42 weeks at term equivalent age (TEA) and identify possible risk factors for non-synostotic head shape deformities. For three-dimensional head assessments, a portable stereophotogrammetric device was used. The most common and distinct head shape deformity in preterm infants was dolichocephaly. Severity of dolichocephaly correlated with GA and body weight at TEA but not with other factors such as neonatal morbidity, sex or total duration of respiratory support. Head circumference (HC) and cranial volume (CV) were not significantly different between the preterm and term infant group. Digitally measured HC and the CV significantly correlated even in infants with head shape deformities. Our study shows that stereophotogrammetric head assessment is feasible in all preterm and term infants and provides valuable information on volumetry and comprehensive head shape characteristics. In a small sample of preterm infants, body weight at TEA was identified as a specific risk factor for the development of dolichocephaly.

Predictability of maxillary positioning: a 3D comparison of virtual and conventional orthognathic surgery planning.

BACKGROUND: Virtual surgery planning (VSP) is believed to reduce inaccuracies in maxillary positioning compared to conventional surgery planning (CSP) due to the elimination of face-bow transfer and laboratory steps. However, there is still a lack of comparative studies for the accuracy of splint-based maxillary positioning in CSP versus VSP. Therefore, the objective of this retrospective, observational study was to compare if splints produced by VSP and CSP reach postoperative outcomes within clinically acceptable limits. METHODS: The planned and actual postoperative results of 52 patients (VSP: n = 26; CSP: n = 26) with a mean age of 24.4 ± 6.2 years were investigated by three-dimensional (3D) alignment with planning software. The conventional treatment plan was digitized, so that the evaluation of both methods was performed in the same manner using the same coordinate system. Inaccuracies were measured by sagittal, vertical and transversal deviations of the upper central incisors and the inclination of the maxillary occlusal plane between the planned and achieved maxillary positions. RESULTS: Both methods demonstrated significant differences between the planned and actual outcome. The highest inaccuracies were observed in vertical impaction and midline correction. No significant differences between CSP and VSP were observed in any dimension. Errors in vertical and sagittal dimension intensified each other. CONCLUSIONS: In conclusion, splint-based surgeries reached similar results regardless of the applied planning method and splint production.

The adult orthodontic patient over 40 years of age: association between periodontal bone loss, incisor irregularity, and increased orthodontic treatment need.

OBJECTIVES: Adult orthodontic treatment, especially in patients over 40 years, is steadily increasing. One causal factor for the treatment need in this age group is periodontal breakdown. The aim of this study was to detect correlations between periodontal problems and orthodontic parameters in interdisciplinary patients. METHODS: This observational, cross-sectional study included 118 patients over 40 years (51 men/67 women; mean age, 58.03 years) classified into three groups according to periodontal breakdown (group I, controls; group II, moderate periodontitis; group III, severe periodontitis). Clinical periodontal and orthodontic parameters as well as the index of orthodontic treatment need (IOTN) were assessed and compared between the groups. RESULTS: A gradual deterioration of all periodontal and orthodontic parameters according to periodontal bone loss (lowest values in group I; highest values in group III) was observed. Especially groups I and III differed significantly regarding the overjet (p < 0.001) and the little indices of the maxilla (p < 0.001) and mandible (p < 0.010). The IOTN was highest in group III: 90% of the patients with severe periodontitis were classified to have moderate to very great treatment need. CONCLUSIONS: The higher the degree of periodontal breakdown was, the more severe were overjet, overbite, irregularity of the anterior teeth, and the orthodontic treatment need. CLINICAL RELEVANCE: Adult patients over 40 years represent a challenge for an orthodontic/periodontal treatment approach with high incidence of pathologic tooth migration, orthodontic treatment need, and periodontal breakdown. Therefore, this special patient collective requires a focus in clinical orthodontics and research.

Orthodontic incisor decompensation in orthognathic therapy-success and efficiency in three dimensions.

OBJECTIVES: Sufficient dental decompensation is crucial for treatment success in combined orthodontic-surgical treatment. The study's objective was to determine the treatment success and efficiency in sagittal, vertical, and transversal decompensation. METHODS: This longitudinal, observational study enrolled 52 adult patients, who underwent orthodontic-surgical treatment. Incisor inclinations and positions as well as skeletal changes were assessed pre-treatment (T1), pre-surgical (T2), and post-surgical (T3) by lateral cephalograms and CBCT scans. RESULTS: Incisor decompensation was insufficient in all three dimensions. Sagittal: treatment efficiency did not differ between class II and III patients. Vertical: patients with open bite demonstrated pre-surgical bite deepening and insufficient surgical reduction of the maxillomandibular plane angle. Transversal: Dental midline deviations were not adapted to the skeletal asymmetry so that menton deviations were not properly corrected. CONCLUSIONS: Incisor decompensation was not as successful as requested in all three dimensions and the treatment ideal was seldom achieved. CLINICAL RELEVANCE: To improve the skeletal outcome, the orthodontist has to treat the patient with the desired surgical movements in mind and should critically evaluate the pre-surgical incisor decompensation before referral to the surgical team.

Donor variation and sex hormone receptors in periodontal ligament cells.

OBJECTIVE: This study evaluated the gene expression and protein synthesis of sex hormone receptors in human periodontal ligament cells (PDLCs) in relation to donor- and tooth-specific factors with the aim to clarify the debate about sex hormone receptors in PDLCs. DESIGN: The expression patterns of estrogen receptors (genes: ESR1 and ESR2; proteins: ERα and ERß), androgen receptor (AR) and progesterone receptor (PR) were investigated in the context of immortalization status, previous orthodontic tooth movement (OTM), donor age, sex and hormonal stimulation in PDLCs from 14 healthy donors (male: n = 8, female: n = 6; adolescents: n = 8, adults: n = 6) using quantitative real-time polymerase chain reaction, Western blot and immunocytochemistry. RESULTS: For ERß, the full-length isoform ERß1 and truncated variants were detected. For ERα, the expected isoform ERα66 was not observed, but a novel isoform ERα36 was detected. Immortalization status, previous OTM and donor age had no impact on ESR1 and ESR2 expression. Estradiol stimulation for 24 h doubled the ratio of ESR2/ESR1 in PDLCs from female but not male donors, indicating sex-specific patterns of receptor expression. AR and PR demonstrated insufficient protein synthesis in PDLCs. CONCLUSIONS: The data revealed a pivotal role for and complex interplay between ERα and ERß in human PDLCs regardless of variable donor characteristics. Therefore, PDLC biology might be altered in patients of each age group and both sexes due to hormonal changes. This should be kept in mind during periodontic and orthodontic treatment of patients with special hormonal status.

Comprehensive 3D analysis of condylar morphology in adults with different skeletal patterns - a cross-sectional study.

BACKGROUND: The correlation between individuals' condylar morphology and their skeletal pattern is of great interest for treatment strategies ranging from orthodontic orthopaedics to orthognathic surgery. The objective of the present study was to investigate this relationship three-dimensionally. METHODS: A total of 111 adult patients (mean age = 27.0 ± 10.2 years) who underwent head computed tomography or cone beam computed tomography scans were included. Based on these data, 3D models of the skull and the condyles were calculated. The craniofacial skeleton was evaluated (1) transversally regarding skeletal symmetry (menton deviation), (2) sagittally regarding skeletal classes (Wits appraisal) and vertically regarding the inclination of the jaws (maxillomandibular plane angle). The condylar morphology was assessed (a) linearly by the condylar width, height and depth; (b) angularly by the antero-posterior and medio-lateral condylar inclination; and (c) volumetrically by the ratio of the condylar volume/mandibular volume (C/Mand). RESULTS: (1) Transversal: Asymmetric patients showed significantly higher discrepancies in the volumetric ratio C/Mand on the deviation and non-deviation side compared to symmetric patients. (2) Sagittal: Class III subjects demonstrated longer, more voluminous condyles with higher antero-posterior and medio-lateral inclination angles compared to Class II participants. (3) Vertical: Hyperdivergent subjects had smaller condyles with higher antero-posterior inclination angles than those of hypodivergent subjects. No interactions of skeletal class and vertical relationships regarding condylar morphology were observed. CONCLUSIONS: This study demonstrates a clear correlation between pronounced skeletal patterns and condylar morphology in an adult population. The description of radiographic condyle characteristics in relation to the craniofacial morphology improves orthodontic treatment planning and could be helpful in the diagnosis of temporomandibular joint pathologies.

From 3D imaging to 3D printing in dentistry - a practical guide.

3D imaging in dentistry plays an essential part in diagnostics and treatment planning. To transform digital images into a real object that can be experienced haptically may provide new opportunities to practitioners regarding patient communication, skills training, and treatment planning. Therefore, the aim of this article is to provide a practical guide from 3D imaging to 3D printing using low-cost printers and open source software; the authors used 3D Slicer software and a Meshmixer printer, including the printer's own software. The article presents step-by-step instructions on how to perform rapid prototyping via fused deposition modeling (FDM) and stereolithography (SLA). As an example, we printed the skull of a patient with Saethre-Chotzen syndrome who was undergoing maxillofacial surgery. The protocol explained here should enable the technically interested clinician to produce patient-specific 3D models in-house, prefabricate osteosynthesis plates, and take advantage of the benefits of 3D printing for dentist-patient communication.

TMJ pathomorphology in patients with JIA-radiographic parameters for early diagnosis.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is often accompanied by pathomorphological changes to the temporomandibular joint (TMJ). By analyzing orthodontical orthopantomograms of JIA patients the aims of the study were a) classification of condyle changes, b) quantification of bony asymmetries of condylar destruction and c) detection of relationships between disease duration and TMJ-involvement. PATIENTS/METHODS: 46 caucasian JIA-patients (28 female; 18 male; < 16.0 years) were enrolled, each joint (n = 92) was morphologically assessed by means of orthopantomogram, quantitatively analysed and compared with duration of general disease. Condyle morphology was assessed using the Billiau scale for severity of destruction [1]. The quantitative analysis was based on ratios of condyle, ramus and mandible height. RESULTS: Patients were divided into groups (Group I - slightly affected, n = 36; Billiau severity 0-2; condyle findings: X-ray normal, condyle erosions, condylar flattening; Group II - severely affected, N = 10; Billiau severity 3-4; condyle findings: condylar flattenings and erosions, unilateral/bilateral complete loss of condyles), based on morphological analysis of condylar destruction. Duration of disease was significantly longer in Group II (8.9 ± 5.2 years) than in Group I (4.6 ± 4.7 years). Asymmetries of condyle, ramus and mandible height, quantitatively analysed by contralateral comparison, were significantly more marked in patients of Group II than of Group I. CONCLUSIONS: Orthopantomogram imaging can be used in orthodontics clinical routine to detect TMJ-pathologies and is an important reference for monitoring progression of JIA. Classification into severe and slightly affected TMJ is possible by analysis of condylar pathomorphology. An association between degree of destruction, extent of lower jaw asymmetry and disease duration is suggested by the results.

From melody to words: The role of sex hormones in early language development.

Contribution to Special Issue on Fast effects of steroids. Human infants are the most proficient of the few vocal learner species. Sharing similar principles in terms of the generation and modification of complex sounds, cross-vocal learner comparisons are a suitable strategy when it comes to better understanding the evolution and mechanisms of auditory-vocal learning in human infants. This approach will also help us to understand sex differences in relation to vocal development towards language, the underlying brain mechanisms thereof and sex-specific hormonal effects. Although we are still far from being capable of discovering the "fast effects of steroids" in human infants, we have identified that peripheral hormones (blood serum) are important regulators of vocal behaviour towards language during a transitory hormone surge ("mini-puberty") that is comparable in its extent to puberty. This new area of research in human infants provides a promising opportunity to not only better understand early language acquisition from an ontogenetic and phylogenetic perspective, but to also identify reliable clinical risk-markers in infants for the development of later language disorders.

Baby babbling at five months linked to sex hormone levels in early infancy.

Gender-dependent differentiation of the brain at morphological, neurochemical and functional levels of organization have been shown to be primarily controlled by sex differences in gonadal hormone concentrations during pre- and early postnatal development. Indeed, previous studies have reported that pre- and perinatal hormonal environments influence brain development and, consequently, affect sex specific long-term language outcomes. Herein, we investigated whether postnatal surges of estrogen (estradiol) and androgen (testosterone) may predict properties of pre-speech babbling at five months. This study is the first attempt to investigate a possible correlation between sex hormones and infants' articulatory skills during the typical postnatal period of extended hormonal activity known as 'mini-puberty.' A hierarchical, multiple regression approach revealed a significant, robust positive relationship between 4-week concentrations of estradiol and individual articulatory skills. In contrast, testosterone concentrations at five months negatively correlated with articulatory skills at the same age in both boys and girls. Our findings reinforce the assumption of the importance of sex hormones for auditory-vocal development towards language in human infants.