Craniofacial characteristics in Van der Woude syndrome.

AIM: To describe the particular craniofacial characteristics of Van der Woude syndrome(VWS) patients compared to patients with a non-syndromic cleft (CG1) and to a malocclusive healthy population (CG2). MATERIAL AND METHODS: Retrospective case-control study. A sample of 110 matched-patients was recruited (VWS (n = 7), CG1 (n = 49), CG2 (n = 49)). Subsequently, 37 radiometric variables were analysed and the dental-skeletal ages were determined. The intra/inter-observer method errors were quantified. Descriptive statistics were computed, and different inferential analysis tests were used depending on the normality of the data (Chi-square test, Fisher's exact test, paired Student's T-test, Mann-Whitney U test) (p-value < 0.05). Pairwise comparisons were corrected by Bonferroni's criteria. RESULTS: VW-patients presented specific craniofacial characteristics and morphology. A marked tendency to the vertical growth pattern was found in VW-patients compared to CG1-CG2 (p < 0.001); at the sagittal level, skeletal class II caused by mandibular retrognathism, with a greatly increased ANB angle compared to CG1 (p = 0.042). Dental analysis showed that the lower incisor was more retruded and retroclined (p < 0.05 in all cases) and the interincisal angulation was increased (p < 0.001 (CG2)). At the profile level, an open nasolabial angle (p = 0.040; CG1) and a more protruding lower lip with respect to the Sn-Pg plane (p = 0.040 (CG1); p = 0.044 (CG2)) were observed. CONCLUSIONS: VW-patients present particular characteristics in the facial skeletal structures. There is a critical necessity to increase the evidence regarding specific clinical features and orofacial pathology of rare diseases such as VWS, which will help to these minorities to gain access in the future to a better quality of care with precise treatment and diagnostic necessities.

Skeletal, Dentoalveolar and Dental Changes after "Mini-Screw Assisted Rapid Palatal Expansion" Evaluated with Cone Beam Computed Tomography.

The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping.

Efficacy and predictability of maxillary and mandibular expansion with the Invisalign® system.

BACKGROUND: The purpose of this study is to evaluate the efficacy and predictability of upper and lower orthodontic expansion with the Invisalign® system. MATERIAL AND METHODS: From a sample of 167 patients; 64 upper and 51 lower arches were randomly selected from patients who had been treated with plastic orthodontics (Invisalign® aligners, SmartTrack® material). Digital models were extracted at the beginning (ModT1) and at the end of treatment (ModT2) as well as the final ClinCheck® (CkT2). The canine, premolar and molar width was measured at the gingival and cuspid level of both arches, as well as the inclination of the upper first molar. Likewise, both arches were divided regarding the planned expansion at the level of the first molar into mild, moderate and severe. RESULTS: The efficacy of expansion in the upper and lower arches showed a statistically significant difference (p<0.00005). During the measurements of predictability, around 98-100% was achieved at the coronal level and between 85-90% at the gingival level. Analyzing predictability regarding to the magnitude of expansion, superior and inferior moderate expansion, both gingival and cuspid, presented higher values. CONCLUSIONS: The Invisalign® system aligners (SmartTrack® material), proved to be a positive alternative for expansion movement offering high degree of predictability, both in the upper and lower arches. As a result, the most predictable level of expansion was moderate, having being the lower arch more foreseeable at the gingival level than the upper arch. Key words:Predictability, Efficacy, Expansion, Aligner, Invisalign®.

Indicación de las distintas técnicas de expansión rápida del paladar quirúrgicamente asistida y comparativa de la estabilidad / Indication of the different surgically assisted rapid palatal expansion techniques and stability comparison

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Unusual Case of Extraction of Maxillary Lateral Incisors and Mandibular Central Incisors.

INTRODUCTION: This article's purpose is to report a case where maxillary lateral incisors and mandibular central incisors are extracted and a canine substitution was performed as the best therapeutic option in order to obtain symmetry in a malocclusion with an upper lateral incisor with poor prognostic, solve moderate crowding, get enough space for the permanent dentition, and provide stability to the results. CASE REPORT: An 11-year-old boy with straight profile with acute-to-normal nasolabial angle and protruded lips, mixed dentition, lower and upper severe crowding, and a bilateral molar angle Class I. The left maxillary lateral incisor failed endodontic treatment secondary to an intrusive traumatic lesion in the primary and permanent dentition. The treatment of choice was the extraction of both upper lateral incisors and both central lower incisors. The patient finished with molar and canine angle Class I and coincident midlines and was functionally stable; both lateral and protrusive jaw movements were effectively made by the first premolars and central incisors and canines without improper contacts of the rest of the teeth. Overbite of one-third and correct overjet were also achieved, and the esthetic outcome was satisfactory due to the composed material restorations of both the central and lateral incisors, as well as recontouring of the first maxillary premolars.

Five radiographic methods for assessing skeletal maturity in a Spanish population: is there a correlation?

OBJECTIVES: The need for accurate techniques of estimating age has sharply increased in line with the rise in illegal migration and the political, economic and socio-demographic problems that this poses in developed countries today. The methods routinely employed for determining chronological age are mainly based on determining skeletal maturation using radiological techniques. The objective of this study was to correlate five different methods for assessing skeletal maturation. MATERIALS AND METHODS: 606 radiographs of growing patients were analyzed, and each patient was classified according to two cervical vertebral-based methods, two hand-wrist-based methods and one tooth-based method. Spearman's rank-order correlation coefficient was applied to assess the relationship between chronological age and the five methods of assessing maturation, as well as correlations between the five methods (p < 0.05). RESULTS: Spearman's rank correlation coefficients for chronological age and cervical vertebral maturation stage using both methods were 0.656/0.693 (p < 0.001), respectively, for males. For females, the correlation was stronger for both methods. The correlation coefficients for chronological age against the two hand-wrist assessment methods were statistically significant only for Fishman's method, 0.722 (p < 0.001) and 0.839 (p < 0.001), respectively for males and females. CONCLUSIONS: The cervical vertebral, hand-wrist and dental maturation methods of assessment were all found to correlate strongly with each other, irrespective of gender, except for Grave and Brown's method. The results found the strongest correlation between the second molars and females, and the second premolar and males. CLINICAL RELEVANCE: This study sheds light on and correlates with the five radiographic methods most commonly used for assessing skeletal maturation in a Spanish population in southern Europe.

Effectiveness of biologic methods of inhibiting orthodontic tooth movement in animal studies.

INTRODUCTION: A number of biologic methods leading to decreased rates of orthodontic tooth movement (OTM) can be found in the recent literature. The aim of this systematic review was to provide an overview of biologic methods and their effects on OTM inhibition. METHODS: An electronic search was performed up to January 2016. Two researchers independently selected the studies (kappa index, 0.8) using the selection criteria established in the PRISMA statement. The methodologic quality of the articles was assessed objectively according to the Methodological Index for Non-Randomized Studies scale. RESULTS: We retrieved 861 articles in the initial electronic search, and 57 were finally analyzed. Three biologic techniques were identified as reducing the rate of OTM: chemical methods, low-level laser therapy, and gene therapy. When the experimental objective was to slow down OTM, pharmacologic modulation was the most frequently described method (53 articles). Rats were the most frequent model (38 of 57 articles), followed by mice (9 of 57), rabbits (4 of 57), guinea pigs (2 of 57), dogs (2 of 57), cats (1 of 57), and monkeys (1 of 57). The sample sizes seldom exceeded 25 subjects per group (6 of 57 articles). The application protocols, quality, and effectiveness of the different biologic methods in reducing OTM varied widely. CONCLUSIONS: OTM inhibition was experimentally tested with various biologic methods that were notably effective at bench scale, although their clinical applicability to humans was rarely tested further. Rigorous randomized clinical trials are therefore needed to allow the orthodontist to improve the effect of translating them from bench to clinic.

Short-term effect of removal of fixed orthodontic appliances on gingival health and subgingival microbiota: a prospective cohort study.

OBJECTIVE: The aim of this prospective longitudinal study was to assess and compare the microbiological and clinical parameters of patients wearing a fixed orthodontic appliance, as opposed to 10 days after the bracket had been removed following treatment. MATERIALS AND METHODS: In total, 122 patients participated in this study; 61 of the subjects were assessed at baseline (wearing a fixed orthodontic appliance: T1) and 10 days after bracket removal (T2). The other 61 individuals had never worn an orthodontic appliance before and these subjects served as controls (CT). Subgingival plaque samples were assessed for bleeding on probing (GBI) and plaque index (VPI). PCR of 16s rDNA, followed by reverse species-specific hybridization for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola were performed. A descriptive analysis was conducted; chi-squared, Student's matched and unmatched t-tests, the point biserial correlation coefficient and the McNemar test were used to test for differences between groups (p < 0.05). RESULTS: The GBI and VPI clinical parameters showed statistical differences (p < 0.05) between T1-T2, T1-CT and T2-CT. The prevalence of T. denticola had significantly decreased (p = 0.039) 10 days after appliance removal. At T2, a significant positive correlation was found between GBI and A. actinomycetemcomitans (p < 0.01) and between clinical parameters and P. intermedia. In patients without a fixed orthodontic appliance (T2 and CT), there was a significant positive correlation between T. forsythia and VPI. CONCLUSION: Local factors associated with the wearing of a fixed orthodontic appliance influence changes in subgingival plaque that leads to more inflammation and bleeding.

Management of occlusal canting with miniscrews.

A 14-year-old boy with a skeletal Class II malocclusion and open bite whose chief complaint was a posterior crossbite showed a canted occlusal plane with asymmetric gummy smile and mandibular deviation at clinical examination. The treatment with miniscrews focused on the bilateral intrusion of the maxillary posterior teeth and, after resolving the open bite, a new biomechanical technique involving joined miniscrews was applied for an en masse intrusion of the left side. This treatment strategy achieved optimal occlusion with improvements to the sagittal, vertical, and transverse relationships and achieved a harmonious smile.

Determination of periodontopathogens in patients with Cri du chat syndrome

OBJECTIVES: Cri du chat syndrome is a genetic alteration associated with some oral pathologies. However, it has not been described previously any clinical relationship between the periodontal disease and the syndrome. The pur-pose of this comparative study was to compare periodontopathogenic flora in a group with Cri du chat syndrome and another without the síndrome, to assess a potential microbiological predisposition to suffer a periodontitis.Study DESIGN: The study compared nineteen subjects with Cri du chat Syndrome with a control group of nineteen patients without it. All patients were clinically evaluated by periodontal probing, valuing the pocket depth, the clinical attachmente level and bleeding on probing. There were no significant differences between both groups. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola were detected by multiplex-PCR using 16S rDNA (microIDENT).RESULTS: When A. actinomycetemcomitans, P. gingivalis, P. intermedia and T. denticola were compared, no statis-tically significant differences were found between the two groups (p > 0.05). The value of T. forsythia was signifi-cantly higher for Cri du chat syndrome (31.6%) than for the control group (5.3%). The odds ratio for T. forsythia was 8.3.CONCLUSIONS: In the present study T. forsythia is associated with Cri du chat syndrome subjects and not with healthy subjects

Determination of periodontopathogens in patients with Cri du chat syndrome.

OBJECTIVES: Cri du chat syndrome is a genetic alteration associated with some oral pathologies. However, it has not been described previously any clinical relationship between the periodontal disease and the syndrome. The purpose of this comparative study was to compare periodontopathogenic flora in a group with Cri du chat syndrome and another without the síndrome, to assess a potential microbiological predisposition to suffer a periodontitis. STUDY DESIGN: The study compared nineteen subjects with Cri du chat Syndrome with a control group of nineteen patients without it. All patients were clinically evaluated by periodontal probing, valuing the pocket depth, the clinical attachmente level and bleeding on probing. There were no significant differences between both groups. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola were detected by multiplex-PCR using 16S rDNA (microIDENT). RESULTS: When A. actinomycetemcomitans, P. gingivalis, P. intermedia and T. denticola were compared, no statistically significant differences were found between the two groups (p>0.05). The value of T. forsythia was significantly higher for Cri du chat syndrome (31.6%) than for the control group (5.3%). The odds ratio for T. forsythia was 8.3. CONCLUSION: In the present study T. forsythia is associated with Cri du chat syndrome subjects and not with healthy subjects.

Integrated periodontal, orthodontic, and prosthodontic treatment in a case of severe generalized aggressive periodontitis.

OBJECTIVE: This article reports a case of severe generalized aggressive periodontitis and subsequent collapse of the occlusion in a psychiatric patient, treated by an extremely conservative orthodontic-periodontal-prosthodontic treatment. SUMMARY: A woman presented with severe anterior proclination caused by severe periodontal disease and Angle's class II molar malocclusion. The patient wanted to preserve her teeth and rejected the idea of implant treatment. This case report demonstrates that combining periodontal therapy, orthodontic treatment, and prosthodontics (through a decision-making system with a proper interdisciplinary coordination) can greatly improve function and the esthetic result. Comprehensive periodontal treatment took place before other intervention, and periodontal maintenance and follow-up throughout the treatment and after played a crucial role.

Bone- and dentoalveolar-anchored dentofacial orthopedics for Class III malocclusion: new approaches, similar objectives? : a systematic review.

OBJECTIVES: To analyze the scientific literature and compare in the results of conventional orthopedic appliances with those obtained from recent bone-anchored orthopedics for Class III malocclusion. MATERIALS AND METHODS: The literature was systematically reviewed using PubMed/Medline, Scopus, and Scirus databases up to January 2012. Articles were selected by two different researchers (kappa index  =  0.83), based on established inclusion/exclusion criteria. Methodologic quality was classified as high, medium, or low quality. RESULTS: The search strategy identified 1020 titles. Thirty studies were selected after applying the criteria (high quality  =  9, medium quality  =  21). Protraction rates differed within a range of one- to twofold between bone-anchored and dentoalveolar therapies (P < .001). All studies noted the effect of clockwise rotation on the mandible and an increase in inferior-anterior and total facial height; this was more obvious in dentoalveolar therapy than in bone-anchored orthopedics (P < .001). CONCLUSIONS: Dental parameters like overjet increased significantly with both sets of groups, ranging from 1.7 to 7.9 mm with dentoalveolar therapy and from 2.7 to 7.6 mm with bone-anchored orthopedics.

Uso de una checklist para reducir los errores cognitivos en la enseñanza práctica odontológica / Use of checklist to reduce cognitive errors in dental practice teaching

Introducción: Las estrategias de razonamiento heurístico predominan en el ámbito clínico. En odontología, y en particular en la práctica clínica diaria ortodóncica, se hace esencial diagnosticar bajo condiciones de presión, lo que fomenta los errores cognitivos por parte de los alumnos. El objetivo de este estudio fue proponer y validar una checklist como herramienta para disminuir los errores cognitivos diagnósticos por parte de los alumnos. Sujetos y métodos: Treinta y seis estudiantes posgraduados realizaron dos evaluaciones clínicas de pacientes, una de la manera tradicional y otra aplicando la checklist propuesta. Resultados: Se produjo una disminución estadísticamente significativa (p < 0,05) en los errores mediante la prueba de los rangos de Wilcoxon tras el uso de la checklist. Conclusiones: La checklist propuesta ha demostrado su eficacia y ha sido evaluada positivamente por los alumnos; sin embargo, se debe prestar especial atención a los errores cognitivos de comisión porque aumenta de manera considerable su proporción (AU)

Introduction: Heuristic reasoning often dominate clinical judgments. Decision-making process in dentistry, and especially in orthodontics, is carry out under conditions of complexity and uncertainty. Therefore, the student decision processes are flawed by cognitive biases. The aim of our study was suggest and validate a checklist to reduce student diagnostic cognitive biases. Subjects and methods: Thirty-six postgraduate students evaluated clinically patients without checklist and using the proposed checklist. Results: Statistically significant difference (p < 0.05) was found using the Wilcoxon matched signed-rank test between two evaluations. Conclusions: Effectiveness is prove by using the proposed checklist in reduce student cognitive errors and students have been positively evaluated it. Nevertheless, special attention is required to new increment of proportion of commission cognitive errors (AU)

Lower incisor position in different malocclusions and facial patterns

Introduction: The position of lower incisor has been of considerable concern when planning an orthodontic treatment, having been recognized as one of diagnostic keys, Very important in the development of malocclusion and facial pattern. Objectives: In this study we claim to determine the importance of the position and inclination of lower incisor in the different malocclusions and facial patterns, and to base which of the cephalometric measurement parametersare the mostreliable. Material and Methods: Ninety lateral radiographies were taken, and they were classified by skeletal malocclusion and facial pattern. These teleradiographies have been performed cephalometric analysis, which include lower incisorposition belong the following analysis: Ricketts, Riolo, Tweed, McHorris, Jarabak-MSE and Holdaway. Study Design: Cross-sectional study where we perform statistical analysis Anova test, Pearson correlations and Bonferroni analysis. Results: The analyzed measurements present a statistically significant differentiation in lower incisor inclination respect to the anterior cranial base, McHorris angle, angulation of lower incisor respect to occlusal plane and mandibular plane. Conclusions: There are statistically significant differentiation in lower incisor position and inclination respect the malocclusion and individual facial pattern (AU)

Lower incisor position in different malocclusions and facial patterns.

INTRODUCTION: The position of lower incisor has been of considerable concern when planning an orthodontic treatment, having been recognized as one of diagnostic keys, Very important in the development of malocclusion and facial pattern. OBJECTIVES: In this study we claim to determine the importance of the position and inclination of lower incisor in the different malocclusions and facial patterns, and to base which of the cephalometric measurement parameters are the mostreliable. Material and methods. Ninety lateral radiographies were taken, and they were classified by skeletal malocclusion and facial pattern.These teleradiographies have been performed cephalometric analysis, which includelower incisor position belong the following analysis: Ricketts, Riolo, Tweed, McHorris, Jarabak-MSE and Holdaway. STUDY DESIGN: Cross-sectional study where we perform statistical analysis Anova test, Pearson correlations and Bonferroni analysis. Results. The analyzed measurements present a statistically significant differentiation in lower incisor inclination respect to the anterior cranial base, McHorris angle, angulation of lower incisor respect to occlusal plane and mandibular plane. CONCLUSIONS: There are statistically significant differentiation in lower incisor position and inclination respect the malocclusion and individual facial pattern.

Stem cells in current paediatric dentistry practice.

New protocols for regenerative endodontic treatment along with the parallel development of tissue engineering technologies are changing traditional knowledge and treatment possibilities for young patients with pulp-affected permanent immature teeth. The regeneration and completion of apical root development in pathological situations such as these is a clinical challenge that traditional treatments have not so far been able to resolve with complete success. In clinical terms, the decision of whether to perform apexogenesis or apexification on an immature tooth is determined by whether the pulp tissue is vital or non-vital. Recent evidence and reports in the literature have questioned the old dogmas. In this respect, the ever growing scientific literature in this field makes it essential to compile a critical reflection and summary of everything that has been written to date, in order to understand the biological basis of current clinical advances and ensuing lines of future therapy. In this paper, we wish to give scientific coverage and background to more recent clinical and molecular advances described in the field of apical regeneration using stem cell therapy and their potentially key role in the future clinical success of new pulp regenerative protocols.

Interleukin 1 receptor antagonist (IL1RN) genetic variations condition post-orthodontic external root resorption in endodontically-treated teeth.

External apical root resorption (EARR) is a frequent iatrogenic problem following orthodontic treatment in endodontically-treated teeth, about which the literature reports substantial variability in post-orthodontic treatment EARR responses. The main focus of the present study is to clarify whether variants in the interleukin-1 receptor antagonist gene coding for the IL-1ra protein have a positive/negative influence on EARR of endodontically-treated teeth. Ninety-three orthodontic patients were genetically screened for a single nucleotide polymorphism (SNP:rs419598) in the IL1 cluster. The sample was classified into 2 groups: group 1 (affected-group) showed radiographic EARR of more than 2mm; group 2 (control-group), had no EARR or EARR ≤ to 2mm following orthodontic treatment on root-filled teeth. Logistic regression analysis was performed to obtain an adjusted estimate between the SNPs studied and EARR. Genotype distributions, allelic frequencies, adjusted odds ratios (OR) and 95% confidence intervals were also calculated. We found that subjects homozygous [1/1(TT)] for the IL1RN gene [OR:10.85; p=0.001;CI:95%] were at risk of EARR in root-filled teeth. Genetic variants in the antagonist axis balance of the IL1RN (rs419598) have a direct repercussion on the predisposition to post-orthodontic EARR in root-filled teeth. Variants in allele 1 of the interleukin-1 receptor antagonist gene(rs419598) are associated(p=0.001**) with an increased risk of suffering post-orthodontic EARR in root-filled teeth.

Obstructive Sleep Apnea Syndrome (OSAS). Review of the literature

Obstructive sleep apnea and hypopnea syndrome is characterized by repeated airway collapse during sleep. The literature describes multiple causes of the disease. The main cause is a reduction of the expansion forces of the pharyngeal dilator muscles, as in situations of genioglossal muscle dysfunction, and discoordination between the inspiratory activity of the muscle and respiratory effort, which play an important role in progression of the disease. Other described causes are soft tissue disorders, such as macroglossia or tonsillar hypertrophy, and skeletal structural alterations such as micrognathia and retrognathia. The syndrome is also more frequent in obese people, where the accumulation of fat in the neck region produces narrowing of the pharyngeal airway, thereby diminishing the passage of air. This review focuses on the pathogenesis, epidemiology, main features and diagnosis of the disease, and on its main forms of treatment (AU)

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