Comment on Reply to Comment of Finger et al. (2013) on: 'Evidence for an Early-Middle Miocene age of the Navidad Formation (central Chile): Paleontological, paleoclimatic and tectonic implications' of Gutiérrez et al. (2013, Andean Geology 40 (1): 66-78)

Indexación: Web of Science; ScieloIn their answer to our Comment (Finger et al., 2013), Le Roux et al. (2013) misunderstand several of our remarks and present what we view as f lawed arguments, principally their case for a shallow-marine environment for part of the Navidad Formation. We do not wish to see this exchange evolve into an endless discussion, but we feel obligated to clarify some points. We think this is necessary because of history and importance of the Navidad Formation as the reference for the marine Miocene of Chile. Here we also expound upon some concepts relevant to the distinction between shallow-and deep-marine environments

Gingival crevicular fluid alkaline phosphatase activity in relation to pubertal growth spurt and dental maturation: A multiple regression study

Introduction: The identification of the onset of the pubertal growth spurt has major clinical implications when dealing with orthodontic treatment in growing subjects. Aim: Through multivariate methods, this study evaluated possible relationships between the gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity and pubertal growth spurt and dentition phase. Materials and methods: One hundred healthy growing subjects (62 females, 38 males; mean age, 11.5±2.4 years) were enrolled into this doubleblind, prospective, cross-sectional-design study. Phases of skeletal maturation (pre - pubertal, pubertal, post - pubertal) was assessed using the cervical vertebral maturation method. Samples of GCF for the ALP activity determination were collected at the mesial and distal sites of the mandibular central incisors. The phases of the dentition were recorded as intermediate mixed, late mixed, or permanent. A multinomial multiple logistic regression model was used to assess relationships of the enzymatic activity to growth phases and dentition phases. Results: The GCF ALP activity was greater in the pubertal growth phase as compared to the pre - pubertal and post - pubertal growth phases. Significant adjusted odds ratios for the GCF ALP activity for the pre - pubertal and post - pubertal subjects, in relation to the pubertal group, were 0.76 and 0.84, respectively. No significant correlations were seen for the dentition phase. Conclusions: The GCF ALP activity is a valid candidate as a non - invasive biomarker for the identification of the pubertal growth spurt irrespective of the dentition phase

Radiographic growth indicators: The issue of diagnostic reliability and clinical feasibility

The use of radiographic growth indicators, such as the hand-and-wrist maturation (HWM) and cervical vertebral maturation (CVM)methods, has been recommended in previous clinical trials on the skeletal effects obtained by functional treatment in growing ClassII patients. The concept behind the use of indicators resides in the identification of the pubertal growth spurt in individual patients allowing the delivery of the treatment at this specific stage of skeletal maturation when the mandible response is expected to be maximum growth. Interestingly, while many of the former types of investigations reported a poor correlation between the stages of growth indicators (mainly the CVM) and mandibular growth spurt, most of the latter type of investigations reported clinically relevant favorable effects when the growth indicators are used. It is perhaps that investigations are still missing the relevant piece of evidence.The first critical issue relates to the correlation between two variables (i.e., stages of maturation and mandibular growth) that does not imply diagnostic accuracy, as it has been extensively reported for the case of dental maturation. The other relevant issue relates to the clinical feasibility of the repetition of the recording when dealing with invasive methods based on X-rays, irrespective of whether the methods are accurate. Meanwhile, more opportunity will be given by the use of non-invasive (serum or GCF) biomarkers. According to all these considerations, more reports will be necessary to elucidate the role of the growth indicators in orthodontics fully

Duration of stages of the Middle Phalanx Maturation method in a contemporary population: A 6-year longitudinal analysis

Objective: To determine the duration and age at the beginning of each stage corresponding to the circumpubertal period in the Middle Phalanx Maturation method (MPM) and to assess the differences between males and females. Materials and Methods: Sets of X-rays of the middle phalanx of the third finger taken at 6-month intervals were analysed for 246 skeletal Class I subjects (102 females and 144 males) between 9 and 15 years of age. After staging, the duration of each stage was derived from chronological ages, and the difference between males and females for both duration and age at the beginning of each stage was investigated. Results: The median duration for MPS2 and MPS3 was 1 year for both sexes, while MPS4 showed a median duration of 1 year in females and 9 months in males, with no significant differences between the sexes. Mean age at the beginning of MPS2 was 10y11m for females and 11y11m for males; for MPS3, it was 11y8m for females and 13y1m for males; for MPS4, it was 12y9m for females and 13y11m for males; for MPS5, it was 13y4m for females and 14y3m for males. The differences between the sexes were statistically significant for all the stages (P <.001). Conclusions: This study confirms, with relevant sample size, the median duration of 1 year for each MPM stage from MPS2 to MPS4. Despite the distinctive interindividual variability, the interquartile range is 6 months or less for all but one interval, confirming the soundness of the results

Disc Displacement with Intermittent Lock: A Case Series of a Rarely-addressed Disorder

Aim: We describe a series of five cases presented with disc displacement with reduction and intermittent lock (DDwRIL), from presentation to follow-up. Background: Disc displacement with reduction with intermittent lock is a temporomandibular disorder in which the disc is displaced and reduced, along with temporary locking leading to limited opening. Due to the fact that it has only been recognized as a separate disease in 2013, there is no clear guideline on the management of these cases. Cases descriptions: We present five cases of clinically established DDwRIL in different age groups. We walk through clinical presentation and diagnostic workup. Several modalities were used in the management of described cases from noninterventional management with counselling only to physical and splint therapies. Conclusion: Disc displacement with reduction, with intermittent locking is a challenging temporomandibular disorder with risk to progress into disc displacement without reduction and hence necessitates a tailored approach and long-term follow-up. Clinical significance: To our knowledge, this is the first case series reported on DDwRIL which provides detailed clinical presentation, examination, management, and discussion for orofacial pain practitioners as well as for future studies on this disease

Gingival crevicular fluid protein content and alkaline phosphatase activity in relation to pubertal growth phase

OBJECTIVE: To evaluate gingival crevicular fluid (GCF) protein content and alkaline phosphatase (ALP) activity in growing subjects in relation to stages of skeletal maturation, ie, the growth phase, as prepubertal, pubertal, and postpubertal. SUBJECTS AND METHODS: Fifty healthy growing subjects (31 girls and 19 boys; age range, 7.8–17.7 years) were enrolled in this study that followed a double-blind, prospective, cross-sectional design. Collection of GCF was performed at the mesial and distal sites of both central incisors, for the maxilla and mandible. Growth phase was assessed through the cervical vertebral maturation method. GCF parameters were expressed as total protein content, total ALP activity, and normalized ALP activity. RESULTS: The total GCF protein content was similar between the different growth phases. On the contrary, the total ALP activity showed a peak for the pubertal growth phase. The normalized GCF ALP activity was only poorly associated with growth phase. No differences were seen between the maxillary and mandibular sites, or between the sexes, for any GCF parameter. CONCLUSIONS: The total GCF protein content is not sensitive to the growth phase. However, GCF ALP activity has potential as a diagnostic aid for identification of the pubertal growth phase in individual subjects when expressed as total, but not normalized, values

Extracciones dentarias en pacientes en tratamiento con anticoagulantes: revisión de la literatura

Objetivo del trabajo. En pacientes en terapia con anticoagulantes orales, una simple extracción puede provocar hemorragias importantes. En la literatura se describen dos enfoques terapéuticos en casos de intervenciones quirúrgicas en esta categoría de pacientes. Uno propone la reducción de la dosis terapéutica del fármaco, mientras que el segundo sugiere la sustitución con heparina. El objetivo de este trabajo es revisar la literatura que trata este tema con el fin de obtener un protocolo ideal. Conclusiones. En caso de extracciones simples es suficiente usar anestesia con vasoconstrictor (en el caso de que no haya otras contraindicaciones), realizar suturas bien tensadas, aplicar coadyuvantes hemostáticos locales y ácido tranexámico tópico. Solo en casos de intervenciones más complejas, o con valores de INR mayores a 3,5, será necesario reducir la dosis del fármaco y consecuente sustitución con heparina de acuerdo a las instrucciones del hematólogo y del cardiólogo. Aim of the work. In patients treated with oral anticoagulants, even simple tooth extractions can produce large hemorrhages. There are two main therapeutic outlines suggested in literature in case of little oral surgery. The first one is based on the reduction of the therapeutic dose of the drug, and the second one on the substitution with heparin. The aim of this paper was to review the.literature on the management of patients treated with anticoagulants in order to obtain univocal guidelines. Conclusion. In case of simple tooth extractions generally a vasoconstrictive anaesthetic (if there are no other contraindications), tight sutures, the application of hemostats and tronexamic acid are enough. Only in case of more complex surgery or of INR values higher than 3,5 it is necessory to reduce the anticoagulant dose or to change the therapy with heparin, if agreed by the hoemotologist and/ or the cardiologist

Bone quality in relation to skeletal maturation in palatal miniscrews insertion sites

Introduction: This study aimed to investigate the relationship between bone density and quantity at the insertion sites of palatal miniscrews and skeletal maturation—evaluated with the middle phalanx maturation method—in growing patients. Methods: Sixty patients were analyzed as having a staged third finger middle phalanx radiograph and a cone-beam computed tomography of the maxilla. On the cone-beam computed tomography, a grid was designed to parallel the midpalatal suture (MPS) and posterior to the nasopalatine foramen, both on the palatal and lower nasal cortical bones. Bone density and thickness were measured at the intersections, and medullary bone density was also calculated. Results: Of patients in MPS stages 1-3, 67.6% showed a mean palatal cortical thickness of 1 mm. The nasal cortical thickness showed a similar trend (MPS stages 1-3: 62.16% 1 mm). There was a significant difference in the density of the palatal cortical bone between MPS stages 1-3 (1272.05 ± 191.13) and stages 4 and 5 (1572.33 ± 274.89) and in nasal cortical density between MPS stages 1-3 (1428.09 ± 198.97) and stages 4 and 5 (1597.97 ± 267.75) (P <0.001). Conclusions: This study revealed a correlation between skeletal maturity and maxillary bone quality. MPS stages 1-3 have lower palatal cortical bone density and thickness but high nasal cortical bone density values. MPS stage 4 and, even more, stage 5 show increasing palatal cortical bone thickness and palatal and nasal cortical bone density values

Outcome stability of orthopaedic treatment of skeletal Class III malocclusion: A study of prognostic agreement between three models

Introduction: Long-term stability of the treatment outcome of skeletal Class III malocclusion is always not achievable, thereforeseveral prediction models of stability of orthopaedic treatment of the Class III malocclusion have been proposed. Aim: This cross-sectional study was aimed at the evaluation of the prognostic agreement and association between three differentprediction models based on skeletal parameters recorded on lateral cephalograms. Materials and methods: A total of 75 subjects (34 females and 41 males, age range 7-11, mean age 9.1±1.2years) having skeletal ClassIII malocclusion were included in the study. Prediction models reported by Baccetti et al. 2004 (prediction model 1), Moon et al.2005 (prediction model 2) and Yoshida et al. 2006 (prediction model 3), were considered. Percentage agreement and unweighted kappa coefficient evaluated the agreement between the prediction models in terms of stable or unstable cases. Multiple regressions were run to evaluate the association between the absolute scores obtained from each of the prediction model (prediction scores). Results: Percentage agreement ranged from 77.3% (models 2 and 3) to 89.3%, (models 1 and 2) and corresponding unweighted kappa coefficients ranged from 0.099 (models 1 and 3) to 0.205 (models 2 and 3). The prediction score from model 3 was significantly associated with those from both the other models; on the contrary, prediction scores from models 1 and 2 were not significantly associated. Conclusions: Agreement in terms of stability or instability outcome derived from these models is only partial and not satisfactory,even though significant association between the prediction scores denotes a common biological meaning of the models

Treatment effects of fixed functional appliances alone or in combination with multibracket appliances: A systematic review and meta-analysis

"Abstract Objective: To assess skeletal and dentoalveolar effects of fixed functional appliances, alone or in combination with multibracket appliances (comprehensive treatment), on Class II malocclusion in pubertal and postpubertal patients. Materials and Methods: Literature survey was conducted using the Medline, SCOPUS, LILACS, and SciELO databases and The Cochrane Library, and through a manual search. The studies retrieved had to have a matched untreated control group. No restrictions were set regarding the type of fixed appliance, treatment length, or to the cephalometric analysis used. Data extraction was mostly predefined at the protocol stage by two authors. Supplementary mandibular elongation was used for the meta-analysis. Results: Twelve articles qualified for the final analysis of which eight articles were on pubertal patients and four were on postpubertal patients. Overall supplementary total mandibular longationsas mean (95 confidence interval) were 1.95 mm (1.47 to 2.44) and 2.22 mm (1.63to 2.82) among pubertal patients and -1.73 mm (-2.60 to -0.86) and 0.44 mm (-0.78 to 1.66) among postpubertal patients, for the functional and comprehensive treatments, respectively. For pubertal subjects, maxillary growth restraint was also reported. Nevertheless, skeletal effects alone would not account for the whole Class II correction even in pubertal subjects with dentoalveolar effects always present. Conclusions: Fixed functional treatment is effective in treating Class II malocclusion with skeletal effects when performed during the pubertal growth phase, very few data are available on postpubertal patients.