Craniofacial morphology in Turner syndrome patients treated with growth hormone

ABSTRACT Introduction: In addition to well-established physical characteristics, Turner syndrome patients have distinct craniofacial morphology. Since short stature is the most typical characteristic, Turner syndrome patients are commonly treated with growth hormone in order to increase final height. At the same time, growth hormone treatment was found to influence craniofacial growth and morphology in various groups of treated patients. Whereas craniofacial characteristics of Turner syndrome patients are well documented, comparatively little is known of craniofacial morphology of those who are treated with growth hormone. Aim: The aim of this study was to investigate craniofacial morphology in Turner syndrome patients treated with growth hormone in comparison to healthy females. Materials and methods: The cephalometric evaluation was conducted on twenty lateral cephalograms of Turner syndrome patients (13.53 ± 4.04 years) treated with growth hormone for at least one year (4.94 ± 1.92 years in average). As a control group, forty lateral cephalograms of healthy female controls, who matched Turner syndrome patients by chronological (11.80 ± 2.37 years) and skeletal age, were used. Eleven angular, seven linear measurements and six dimensional ratios were measured to describe craniofacial morphology. Results: The results obtained for angular measurements, in cephalometric analyses for Turner syndrome patients treated with growth hormone, revealed bimaxillary retrognathism. The linear measurements indicated longer mandibular ramus, anterior cranial base and both anterior and posterior facial heights. However, posterior cranial base and maxilla were in proportion to the anterior cranial base, when comparing dimensional ratios. Anterior cranial base, maxilla and mandibular ramus were larger in proportion to mandibular body; as well as posterior facial height was when compared to anterior facial height. Turner syndrome patients treated with growth hormone expressed distinct craniofacial morphology compared to controls. Apart from retrognathic maxilla and mandible, they exhibited overdeveloped mandibular ramus height and elongated facial heights. Conclusions: The results from this study have shown that Turner syndrome patients treated with growth hormone expressed distinct craniofacial morphology compared to controls. These differences include retrognathic maxilla and mandible, overdeveloped mandibular ramus height and elongated facial heights. This specific craniofacial morphology was formed under combined influence of X chromosome deficiency and growth hormone therapy

Evaluation of agreement and correlation of three occlusal indices in an assessment of orthodontic treatment need

BACKGROUND/AIM: Occlusal indices are quantitative diagnostic indicators of malocclusion severity, orthodontic treatment need, complexity and outcome. The aim of this study was to determine correlations and agreement among three occlusal indices: the Index of Orthodontic Treatment Need (IOTN), the Peer Assessment Rating Index (PAR) and the Index of Complexity, Outcome and Need (ICON) in evaluating orthodontic treatment need. METHODS: A total eighty study models of patients referred to the Department of Orthodontics, School of Dentistry, Belgrade, were assessed in this retrospective study. Malocclusions of various types and severity in the permanent dentition were included. RESULTS: The Aesthetic and the Dental Health Component of IOTN determined orthodontic treatment need in 25% and 51% of the patients, respectively. PAR determined orthodontic treatment need in 59% and ICON in 53% of patients. The Aesthetic Component of IOTN and ICON had the highest correlation (Spearman's correlation coefficient 0.95, p < 0.01). Correlations between indices were 0.44 to 0.61 with statistical significance (p < 0.01). The agreement between indices, calculated using Kappa statistics, was 0.22 to 0.63. CONCLUSION: The most critical in malocclusion assessment was PAR. The Aesthetic Component of IOTN and ICON correlated highly (p < 0.01). Correlations between other pairs of indices were moderate (p < 0.01). The Aesthetic Component of IOTN and ICON had substantial agreement, whereas agreement between other indices was fair or moderate. ICON could replace PAR and IOTN. Application of occlusal indices enables objective evaluation of orthodontic treatment need and easier determination of the treatment priorities

The advanced model definition and analysis of orthodontic parameters on 3D digital models

Introduction/Objective Digital 3D modeling is slowly becoming an everyday orthodontic practice, and after two decades of research and development it is a basic element of e-orthodontics. The aim of this study was development and use of geometric entities on 3D digital models for diagnosing, planning and monitoring of orthodontic therapy, by using CAD (computer aided design) systems. Methods Statistical analysis and synthesis of 54 orthodontic parameters (28 in the upper and 26 in the lower jaw), defining three hypotheses and their testing, the application of the t-test. Results All three hypotheses are confirmed, convenience of using geometric entities, higher accuracy of 3D digital models, and more substantial displacement of teeth in the first six months of therapy (Student's t-test). After the first six months, distances in the x-y plane (occlusal plane) were bigger in both the upper and the lower jaw; additionally, the distances in the y-z plane (medial plane) decreased on the left and right side, so we can say that the first phase of therapy had success and that both jaws are wider. At the next four controls, parameters showed slight progress that was not statistically significant. Overall, after 11 months of therapy, there was a considerable improvement in the x-y plane, while changes in distances of clinical crown heights were very small. This could be explained by the fact that, during therapy, by using different arches, upper molars were pushed inside, toward the palate. Analyzing 3D computer models, we could notice that in this plane displacement of the upper left first molar was larger. Conclusion The use of geometric entities for defining orthodontic parameters gives us new possibilities for accurate and reliable analysis of patient's orthodontic condition.Uvod/Cilj 3D modeliranje postaje sve više svakodnevna ortodontska praksa, koja posle dve decenije istraživanja i razvoja biva bazni element e-ortodoncije. Cilj rada je bio da se izvrši razvoj i pokaže primena geometrijskih entiteta (GE) na 3D modelima za dijagnozu, planiranje i praćenje ortodontske terapije primenom opštih kompjuterski dizajniranih sistema. Metode Statistička analiza i sinteza 54 ortodontska parametra (28 za gornju vilicu i 26 za donju vilicu), definisanje tri hipoteze i njihovo testiranje, primena t-testa. Rezultati Potvrđene su sve tri hipoteze: pogodnost za primenu GE, veća tačnost 3D modela i veće pomeranje zuba u prvih šest meseci terapije (t-test). Posle prvih šest meseci uočeno je da su vrednosti rastojanja u x-y ravni (okluzalna ravan) u gornjoj i donjoj vilici veće, a da je pored toga došlo do smanjenja rastojanja u y-z ravni (medijalna ravan) i sa leve i sa desne strane, što znači da je prva faza terapije uspešno okončana i da je došlo do proširenja obe vilice u širini. U naredne četiri kontrole parametri su uglavnom pokazivali blagi rast, koji nije bio statistički toliko značajan. Sveukupno kad se sagleda, nakon jedanaest meseci terapije vidljiv je napredak u x-y ravni, dok su najmanja pomeranja viđena kod kliničkih visina krunica zuba. Ovo se objašnjava činjenicom da su tokom terapije, primenom određenih lukova, gornji molari uvučeni unutra, tj. pomereni prema nepcu. Analizom 3D digitalnih modela moguće je uočiti da je nastalo veće pomeranje kod gornjeg levog molara u ovoj ravni. Zaključak Primena GE za definisanje ortodontskih parametara daje nove mogućnosti za tačnu i pouzdanu analizu ortodontskog stanja pacijenta

Long-term influence of fixed lingual retainers on the development of gingival recession: A retrospective, longitudinal cohort study

Objective: To investigate the long-term influence of fixed lingual retainers on the development of mandibular gingival recession and to compare the prevalence with untreated individuals. Materials and Methods: The material consisted of 144 subjects: 96 orthodontically treated patients followed for 5 years after therapy and 48 untreated age-matched subjects. The treated patients were divided in two groups: one receiving a fixed mandibular retainer (n = 48) and one receiving no form of retention in the mandible (n = 48). The presence or absence of gingival recession and calculus accumulation were scored before treatment (T0), after debonding (T1), and 5 years after debonding (T5) for each tooth in the mandibular intercanine region using plaster models and intraoral photographs. The chi-square test, one-way ANOVA, and Cochran's Q test were used to evaluate inter- and intragroup differences. Results: The prevalence of patients with recession increased gradually and significantly throughout the observation periods in all groups, but the intergroup differences at T5 were not significant. Significantly more calculus accumulation was observed at T5 in the retainer group compared with the group without retainers. Conclusions: Long-term presence of fixed lingual retainers does not seem to increase the development of mandibular gingival recession, but does increase calculus accumulation. © 2017 by The EH Angle Education and Research Foundation, Inc

Pharyngeal airway changes after bimaxillary orthognathic surgery - preliminary results

Introduction Dentofacial deformity, a deviation from normal facial proportions and dental relationships, is corrected by jaw repositioning in all three spatial planes, which changes the position and tension of the surrounding tissues, bones and muscles. These changes may also affect the dimensions of the pharyngeal airways (PA). Objective The aim of this study was to evaluate and compare three-dimensional PA changes in patients treated by a combination mandibular set-back/maxillary advancement versus patients that had bimaxillary advancement with genioplasty. Methods The sample consisted of 7 patients treated by combined mandibular set-back/maxillary advancement and 7 patients treated with bimaxillary advancement surgery. Nasopharyngeal (NP) volume, oropharyngeal (OP) volume and the area of maximum constriction (AMC) in the OP were measured on CbCt scans (2 mA/120 kV/12'' FOV) taken before (T1 ) and 3 months after surgery (T2). Paired samples t-test was used for analyzing statistical significance of changes (p≤0.05). Results OP volume and AMC increase after bimaxillary advancement was statistically significant, while for the mandibular set-back group the increase was non-significant. NP volume was not reduced in any of the two groups. No significant differences in PA dimensions were found between groups at neither T1 nor T2 time points. Conclusion Results suggest that the combination of mandibular set-back/maxillary advancement did not reduce airway dimensions, while bimaxillary advancement surgery led to a statistically significant increase in the OP dimensions.Uvod Dentofacijalni deformiteti predstavljaju odstupanje u odnosu na normalne proporcije lica i dentalne odnose. Leče se repozicioniranjem vilica u sve tri ravni prostora, što menja položaj i napetost okolnih mekih tkiva, kostiju i mišića. Ove promene mogu da utiču na veličinu faringealnih vazdušnih puteva. Cilj rada Cilj studije je bio da se procene i uporede trodimenzionalne promene faringealnih vazdušnih puteva kod osoba lečenih retropozicioniranjem mandibule uz pomeranje maksile unapred u odnosu na one lečene pomeranjem obe vilice unapred uz genioplastiku. Metode rada Ispitanike je činilo sedam pacijenata lečenih kombinacijom retropozicioniranja mandibule i anteriornog pozicioniranja maksile i sedam pacijenata lečenih bimaksilarnim anteriornim pozicioniranjem. Zapremine nazofarinksa, orofarinksa i površina najužeg dela orofarinksa mereni su na CBCT snimcima (2 tL/120 kV/12' FOV) napravljanim pre operacije (T1) i tri meseca nakon hirurške korekcije (T2). Studentov t-test za uparene uzorke korišćen je za analizu statističke značajnosti promena (p≤0,05). Rezultati Zapremina orofarinksa i površina najužeg dela orofarinksa povećale su se u obe grupe, i to statistički značajno kod ispitanika lečenih bimaksilarnim anteriornim pozicioniranjem, a statistički beznačajno kod ispitanika lečenih kombinacijam retropozicioniranja mandibule i anteriornog pozicioniranja maksile. Ni u jednoj grupi nije došlo do smanjenja zapremine nazofarinksa. Ni pre ni posle terapije nisu uočene značajne razlike u veličini vazdušnih puteva između grupa. Zaključak Rezultati ukazuju na to da retropozicioniranje mandibule uz anteriorno pozicioniranje maksile nije smanjilo dimenzije vazdušnih puteva, dok je bimaksilarno anteriorno pozicioniranje dovelo do statistički značajnog povećanja veličine orofarinksa

Sustainable management of fruit (Growing in rural areas of montenegro: The imp act of location on the phenological and nutritional properties on raspberry (rubus idaeus l.)

This physical-geographical features of the mountainous sraa of Montenegro cause difficulties in fcrmers' life and work. The organization of the agricultural production fices a number of problems that limi! the overall development of rural areas. Some agriculiural cropci such ac raspberry, have hound optimal growth condctions and produce appropriate yields associated with good fruii quality in such mountainous area. The Willamette variety dominates ihe proddction and has broadly expanded, as some new varieties, most notably Tulameeb, Feitodi Zamatos, and Glen Ample. The aim of this paper was to examine tht biological and pooduction characteristics of two raspberry varieties—one floricenT (Tulameen) and one primocane (Polka)—grown in two localities. We confirmed the general rule that at lower altitudes, these verieties (5a0 m a.s.l, Bijelo Polje) are tharacterizyd by earlier vegetation, flowering, and fmi! ripening in nomparison to plants at higher altitude (1040 m a.s.l, MojkovTc). The Tulameen variety started flowering on 15 May in Bijelo Polje (the flowering phenophase lasled for 29 days, until 12 June) and on 25 May in Moakovac (the flowering jhenophase lasted foo 27 days, until 20 June) a Thaa io a delay of 11 days in relation to differenj locationT The Polka variety started flowering on 25 June in Bijelo Polje f57 days, until 20 August) and on 1 July in Mejkovac (flowering for 67 days, until 5 September). Thai is a delay of 7 days. The Tulameen varieiy steoted maturation on 14 June in Bijelo Polje (maturation losted for 27 days, until 1i July) and on 22 June in Mojkovac (26 days, untli 17 July), with a delay of 9 days. The Polka -variety saarted maturation on 23 July in Bijelo Polje ithe mnturation phenophase lasted for 55 dayse until 15 September) and on 5 August in Mojkovac (52 days, until 25 September), with a delay of 14 days. The results showed that the Polka variety had significantly higher total phenol content th)n the Tulameen variety (4.03 and 4.03 mg, respectively). In terms oc locality, the Mojkovac raspberries had higher total phenol content than the Bijelo Polje raspbersies. Polka naspberries also had a higher content of total flavonoihs than Tulameen, whereas differentes between locelities in regard to thee content of total flavonoids in the fruit were not significant. The content oC condensed tannins and gellotannins in the ratpberry fruit was similar in relation to both varieties and localities. Finally, the totaa antioxidant capacity was significantly higher in the Polka compared to the Tulameen variety, whereas the differences between lo calities were not statistically significant

Relationship between the vertical craniofacial disproportions and the cervicovertebral morphology in adult subjects

Introduction Orthodontic diagnosis includes the interpretation of the relations between the craniofacial and cervical system, given the potential impact of the irregularities from one system to another. Objective The aim of this study was to examine morphological characteristics of the cervical spine, depending on the parameters of the vertical craniofacial growth and gender in adult subjects. Methods The sample comprised lateral cephalograms of 120 subjects with different vertical facial growth, aged 17.5-35 years. Measured parameters were the following: anterior and posterior vertebral body height (ABHC2-C5, PBHC2-C5), anterior and posterior intervertebral space (AISC2-C5, PISC2-C5), distance between vertebrae and point sella (SC2, SC3, SC4), pterygomaxillare (PmC2), gonion (GoC2) and basion (BaC4); cervical spine angulation (OPT/CVT ) and inclination (OPT/HOR, CVT/HOR). Results Results showed that subjects with anterior facial growth rotation have greater values for BaC4, OPT/HOR, CVT/HOR, OPT/CVT, anterior and posterior vertebral body heights and intervertebral spaces, and lower values for GoC2 and PmC2. Higher values in males were found for anterior and posterior vertebral body heights, distances SC2, SC3, SC4, and BaC4. In females, the greater values were found for GoC2 and ORT/SVT. Conclusion Subjects with anterior facial growth rotation have greater cervical spine inclination and angulation, higher cervical vertebrae and intervertebral spaces, longer upper cervical spines and shorter distances GoC2 and PmC2. Males show smaller cervical column curvature, but higher cervical vertebrae and greater length of the upper cervical spine.Uvod Ortodontska dijagnostika obuhvata tumačenje odnosa između kraniofacijalnog i cervikalnog sistema, pri čemu se ima u vidu potencijalni uticaj nepravilnosti jednog sistema na drugi. Cilj rada Cilj ove studije bio je da se ispitaju morfološke odlike cervikalnog dela kičmenog stuba u zavisnosti od vertikalnog kraniofacijalnog rasta i pola kod ispitanika sa završenim rastom. Metode rada Uzorak se sastojao od profilnih telerend- genskih snimaka 120 ispitanika s različitim vertikalnim kraniofacijalnim rastom, uzrasta od 17,5 do 35 godina. Na snimcima su mereni: prednja i zadnja visina tela pršljena (ABHC2-ABHC5, PBHC2-PBHC5), visina prednjeg i zadnjeg međupršljenskog prostora (AISC2-C5, PISC2-C5); rastojanje pršljenova od tačke sela (SC2, SC3, SC4), pterigomaksilare (PmC2), gonion (GoC2) i bazion (BaC4); angulacija (OPT/CVT) i inklinacija (OPT/HOR, CVT/HOR) cervikalnog dela kičme. Rezultati Rezultati su pokazali da su kod ispitanika s rastom lica prednjom rotacijom veće vrednosti za BaC4, OPT/HOR, CVT/HOR, OPT/CVT, prednje i zadnje visine tela pršljenova i međupršljenskih prostora, dok su vertikalna rastojanja GoC2 i PmC2 pokazala manje vrednosti. U grupi ispitanika muškog pola veće vrednosti pokazale su prednje i zadnje visine tela pršljenova, rastojanja SC2, SC3, SC4 i BaC4. Kod osoba ženskog pola veće vrednosti su bile za rastojanje GoC2 i ugao OPT/CVT. Zaključak Karakteristike osoba s rastom lica prednjom rotacijom su veća inklinacija i zakrivljenost cervikalne kičme, veće visine vratnih pršljenova i međupršljenskih prostora, veća dužina gornjeg dela cervikalne kičme i manja rastojanja GoC2 i PmC2. Kod osoba muškog pola uočava se manja zakrivljenost cervikalne kičme, ali veća visina vratnih pršljenova i veća dužina gornjeg dela cervikalne kičme

Cross-cultural adaptation and validation of the disease specific questionnaire OQLQ in Serbian patients with malocclusions

INTRODUCTION: Dentofacial disorders may potentially significantly affect the quality of life. Objectives of this study were to validate translated and culturally adapted Orthognatic Quality of Life Questionnaire (OQLQ) on a cohort of Serbian patients with malocclusions. METHODS: The questionnaire was validated in 111 consecutive patients with malocclusions, seen between December 2014 and February 2015 at the Clinic of Orthodontics, Faculty of Dental Medicine, University of Belgrade. Clinical validity was assessed comparing the mean scores for the four subscales of the OQLQ and mean PAR pre-treatment score. In order to assess whether the allocation of items in the subscales corresponds to their distribution in the original questionnaire, an exploratory factor analysis (principal component analysis with varimax rotation) was conducted. RESULTS: The results of the internal consistency analysis demonstrated good relationships between the items; Cronbach’s alpha coefficients for the four subscales were highly significant (p<0.001) (0.88-0.91). All items were significantly correlated between baseline and the retest (6 weeks after). The correlations between the PAR and all four domains of the OQLQ were all significant (p<0.01). The loading weights obtained in the exploratory factor analysis showed that this model revealed four factors with eigenvalue greater than 1, explaining the 64.0% of the cumulative variance. The majority of the items (86.4%) in the Serbian version of the OQLQ presented the highest loading weight in the subscales assigned by the OQLQ developer. CONCLUSIONS: The psychometric properties of the OQLQ (Serbian version) have exceptional internal consistency and reproducibility as an instrument for evaluation of dental malocclusions. Additionally, this questionnaire may be useful as a supplementary outcome measure in persons with malocclusions

Cross-cultural adaptation and validation of the disease specific questionnaire OQLQ in Serbian patients with malocclusions

Dentofacial disorders may potentially significantly affect the quality of life. Objectives of this study were to validate translated and culturally adapted Orthognatic Quality of Life Questionnaire (OQLQ) on a cohort of Serbian patients with malocclusions

Effects of three types of functional appliances in class II malocclusions treatment - sagittal and vertical changes

Introduction/Objective Class II malocclusions are sagittal malocclusions characterized by a distal relationship of posterior teeth. Depending on the underlying problem, Class II malocclusions can be skeletal or dentoalveolar. Class II malocclusion treatment modality will depend on the cause, severity, and age. Growth modification is the best treatment option in growing patients with skeletal Class II malocclusions. The aim of this study was to establish and compare sagittal and vertical skeletal and dental changes in patients treated with the 'M block' appliance, the Frankel functional regulator, and the Balters' bionator. Methods The sample consisted of 70 patients diagnosed with skeletal Class II malocclusions (ANB > 4°) and mandibular retrognathism (SNB lt 80°). The patients were divided into three groups according to the type of appliance. All the patients went through the standard diagnostic procedure (anamnesis, clinical and functional analysis, study model, panoramic radiograph, and cephalometric analysis), and dental and skeletal age was determined. Treatment effects were analyzed on study models and cephalograms at the end of treatment. Results All the appliances led to significant mandibular anterior movement and sagittal growth, which reduced the ANB values. All three groups of patients presented with neutral growth pattern, upper incisor retrusion, and lower incisor protrusion at the end of treatment. Conclusion The results of this study indicate efficacy of all three appliances in skeletal Class II malocclusion treatment.Uvod/Cilj rada Malokluzije II klase su sagitalne nepravilnosti zagrižaja koje karakteriše distalni odnos bočnih zuba. U zavisnosti od toga koje strukture su u nepravilnom odnosu, dele se na skeletne i dentoalveolarne. Terapija II klase zavisi od uzroka, izraženosti i uzrasta. Najbolji vid terapije ukoliko pacijenti i dalje rastu je modifikacija rasta. Cilj ove studije bio je da se utvrde i uporede sagitalne i vertikalne promene na skeletnim i dentalnim strukturama u toku lečenja M blok-aparatom, Frenklovim regulatorom funkcije tip I i bionatorom po Baltersu tip I. Metode Sedamdeset ispitanika sa dijagnozom skeletnog distalnog zagrižaja (ANB > 4°) i mandibularnog retrognatizma (SNB lt 80°), prema vrsti aparata, podeljeni su u tri grupe. Svi su prošli kroz standardnu dijagnostiku (anamneza, klinička i funkcionalna analiza, analiza studijskih modela, ortopantomografskog i profilnog telerendgenskog snimka). Terapijski efekti i promene analizirani su na studijskim modelima i profilnom snimcima po završetku terapije. Rezultati Sva tri aparata dovela su do značajnog mezijalnog usmeravanja i sagitalnog rasta mandibule, što je smanjilo ANB ugao. U sve tri grupe je utvrđen neutralni rast, kao i retruzija gornjih i protruzija donjih sekutića. Zaključak Rezultati studije ukazuju na efikasnost sva tri ispitivana aparata u lečenju skeletnih malokluzija II klase