Dinamika rasta kraniofacijalnog kompleksa osoba sa Tarner sindromom

The morphology of craniofacial complex in Turner syndrome patients has been studied thoroughly, while data on growth pattern and rate are still scarce. Since growth hormone therapy is implemented in treatment of these patients, there was a need for exploring the craniofacial morphology and growth of Turner syndrome patients treated with growth hormone. The main aim of this doctoral dissertation was to examine the morphology and craniofacial complex growth of Turner syndrome patients treated with growth hormone and to compare them with healthy controls. Twenty one lateral cephalometric radiographs of Turner syndrome girls were compared to 46 radiographs of healthy controls, in order to establish the differences in craniofacial morphology. In order to examine the growth, the groups were divided according to cervical vertebral maturation stage into subgroups (“pre-growth” and “growth”). The craniofacial growth was assessed according to changes between subgroups and by superimposing 10 pairs of cephalograms of examined group. The craniofacial morphology in Turner syndrome patients treated with growth hormone was characterised by bimaxillar retrognathism, underdeveloped mandible, overdeveloped mandibular ramus and longer facial heights, when compared to healthy controls. The craniofacial growth did not differ between examined groups during pregrowth period. On the contrary, during growth period altered growth rate and pattern of craniofacial complex in Turner syndrome group caused the differences in craniofacial morphology. It has been established that both upper and lower jaws grow in such direction that causes bimaxillar retrognathism and that there is a difference in growth rate of jaws and facial heights in girls with Turner syndrome. Other structures did not exhibit differences in growth rate and pattern. The craniofacial growth of Turner syndrome patients treated with growth hormone differs in growth rate and pattern, when compared with healthy controls, which causes distinctive craniofacial morphology.Morfologija kraniofacijalnog kompleksa osoba sa Tarner sindromom je podrobno ispitana, dok su podaci o dinamici rasta oskudni u literaturi. Kako je hormon rasta sve više zastupljen u lečenju ovih pacijentkinja, javila se potreba za ispitivanjem morfologije i rasta kraniofacijalnog kompleksa osoba sa Tarner sindromom koje primaju hormon rasta. Ciljevi ove disertacije bili su da se ispita da li se i u kojoj meri morfologija i rast kraniofacijalnog kompleksa devojčica sa Tarner sindromom koje primaju hormon rasta razlikuje od zdravih devojčica. Razlike u morfologiji kraniofacijalnog kompleksa ustanovljene su na osnovu rendgen-kefalometrijske analize 21-og profilnog snimka glave devojčica sa Tarner sindromom koje primaju hormon rasta i 46 snimaka zdravih devojčica. Kako bi se ispitao rast kraniofacijalnog kompleksa svi snimci su, na osnovu stadijuma skeletne zrelosti vratnih pršljenova, podeljeni u dve podgrupe („pre intenzivnog rasta“ i „intenzivnog rasta“). Dinamika rasta ispitana je na osnovu promena između podgrupa kao i rezultata superponiranja 10 parova snimaka glave devojčica ispitivane grupe. Morfologija kraniofacijalnog kompleksa devojčica sa Tarner sindromom koje primaju hormon rasta se razlikovala od morfologije zdravih po bimaksilarnom retrognatizmu, nedovoljno razvijenom telu i prerazvijenoj grani donje vilice i većim visinama lica. Do perioda intenzivnog rasta nisu uočene razlike u rastu kraniofacijalnog kompleksa između devojčica sa Tarner sindromom koje primaju hormon rasta i zdravih devojčica. Tokom perioda intenzivnog rasta, razlike u dinamici i intenzitetu rasta dovele su do promena u morfologiji kraniofacijalnog kompleksa. Ustanovljeno je da je kod devojčica sa Tarner sindromom pravac rasta vilica takav da dovodi do bimaksilarnog retrognatizma i da postoji razlika u intenzitetu rasta vilica i visina lica. Nije ustanovljena razlika u dinamici i intenzitetu rasta ostalih struktura. Rast kraniofacijalnog kompleksa devojčica sa Tarner sindromom koje primaju hormon rasta se, po dinamici i intenzitetu, u određenoj meri razlikuje od rasta zdravih osoba što uzrokuje karakterističnu morfologiju kraniofacijalnog kompleksa

Craniofacial growth in Turner syndrome patients

Morfologija kraniofacijalnog kompleksa osoba sa Tarner sindromom je podrobno ispitana, dok su podaci o dinamici rasta oskudni u literaturi. Kako je hormon rasta sve više zastupljen u lečenju ovih pacijentkinja, javila se potreba za ispitivanjem morfologije i rasta kraniofacijalnog kompleksa osoba sa Tarner sindromom koje primaju hormon rasta. Ciljevi ove disertacije bili su da se ispita da li se i u kojoj meri morfologija i rast kraniofacijalnog kompleksa devojčica sa Tarner sindromom koje primaju hormon rasta razlikuje od zdravih devojčica. Razlike u morfologiji kraniofacijalnog kompleksa ustanovljene su na osnovu rendgen-kefalometrijske analize 21-og profilnog snimka glave devojčica sa Tarner sindromom koje primaju hormon rasta i 46 snimaka zdravih devojčica. Kako bi se ispitao rast kraniofacijalnog kompleksa svi snimci su, na osnovu stadijuma skeletne zrelosti vratnih pršljenova, podeljeni u dve podgrupe („pre intenzivnog rasta“ i „intenzivnog rasta“). Dinamika rasta ispitana je na osnovu promena između podgrupa kao i rezultata superponiranja 10 parova snimaka glave devojčica ispitivane grupe. Morfologija kraniofacijalnog kompleksa devojčica sa Tarner sindromom koje primaju hormon rasta se razlikovala od morfologije zdravih po bimaksilarnom retrognatizmu, nedovoljno razvijenom telu i prerazvijenoj grani donje vilice i većim visinama lica. Do perioda intenzivnog rasta nisu uočene razlike u rastu kraniofacijalnog kompleksa između devojčica sa Tarner sindromom koje primaju hormon rasta i zdravih devojčica. Tokom perioda intenzivnog rasta, razlike u dinamici i intenzitetu rasta dovele su do promena u morfologiji kraniofacijalnog kompleksa. Ustanovljeno je da je kod devojčica sa Tarner sindromom pravac rasta vilica takav da dovodi do bimaksilarnog retrognatizma i da postoji razlika u intenzitetu rasta vilica i visina lica. Nije ustanovljena razlika u dinamici i intenzitetu rasta ostalih struktura. Rast kraniofacijalnog kompleksa devojčica sa Tarner sindromom koje primaju hormon rasta se, po dinamici i intenzitetu, u određenoj meri razlikuje od rasta zdravih osoba što uzrokuje karakterističnu morfologiju kraniofacijalnog kompleksa.The morphology of craniofacial complex in Turner syndrome patients has been studied thoroughly, while data on growth pattern and rate are still scarce. Since growth hormone therapy is implemented in treatment of these patients, there was a need for exploring the craniofacial morphology and growth of Turner syndrome patients treated with growth hormone. The main aim of this doctoral dissertation was to examine the morphology and craniofacial complex growth of Turner syndrome patients treated with growth hormone and to compare them with healthy controls. Twenty one lateral cephalometric radiographs of Turner syndrome girls were compared to 46 radiographs of healthy controls, in order to establish the differences in craniofacial morphology. In order to examine the growth, the groups were divided according to cervical vertebral maturation stage into subgroups (“pre-growth” and “growth”). The craniofacial growth was assessed according to changes between subgroups and by superimposing 10 pairs of cephalograms of examined group. The craniofacial morphology in Turner syndrome patients treated with growth hormone was characterised by bimaxillar retrognathism, underdeveloped mandible, overdeveloped mandibular ramus and longer facial heights, when compared to healthy controls. The craniofacial growth did not differ between examined groups during pregrowth period. On the contrary, during growth period altered growth rate and pattern of craniofacial complex in Turner syndrome group caused the differences in craniofacial morphology. It has been established that both upper and lower jaws grow in such direction that causes bimaxillar retrognathism and that there is a difference in growth rate of jaws and facial heights in girls with Turner syndrome. Other structures did not exhibit differences in growth rate and pattern. The craniofacial growth of Turner syndrome patients treated with growth hormone differs in growth rate and pattern, when compared with healthy controls, which causes distinctive craniofacial morphology

Zavisnost između percepcije bola kod pacijenata sa šest različitih ortodontskih žica i teskobe zubnih nizova

Introduction Forces generated in orthodontic treatment with fixed appliances create tension and compression zones in the periodontal ligament resulting in a painful experience for patients. In the first phase of orthodontic treatment, when leveling of teeth is needed, nickel-titanium (NiTi) archwires can be completely engaged in brackets, even in the cases of extreme crowding, exerting small forces. There is a great individual variation in the pain perception related to the application of orthodontic forces. Objective The aim of this study was to investigate the pain perception among patients with dental crowding after insertion of six different NiTi orthodontic archwires as a part of fixed appliances in the first stage of orthodontic treatment. Methods The study was conducted on a sample of 189 orthodontic patients receiving one of six different either superelastic or heat activated NiTi archwires, in the first phase of orthodontic treatment. Pain perception was evaluated in groups of patients with different degree of crowding. The modified McGill Pain Questionnaire with Visual Analogue Scale was used to evaluate the quality and intensity of pain. Statistical analysis was performed using simple descriptive statistics, and Pearson's chi-square test with statistical significance of p lt 0.05. Results Majority of patients reported pain as discomfort or pressure of moderate intensity caused by chewing or biting, started within 12 hours, carried on for 3-4 days, and decreased over time without self-medication. Conclusion No correlation was found between pain perception among patients with different types of NiTi archwires and the degree of crowding.Uvod Ortodontske sile kojima se tokom terapije fiksnim aparatima pomeraju zubi dovode do istezanja i kompresije parodontalnih vlakana, te pojave bola kod pacijenata. U prvoj fazi ortodontskog lečenja, kada se zubi nivelišu, žice od legure nikl-titanijuma proizvode relativno malu silu i mogu se potpuno ligirati u slotove bravica, čak i u slučajevima velike teskobe. Postoje veoma velike individualne varijacije u percepciji bola prilikom primene ortodontskih sila. Cilj rada Cilj istraživanja je bio da se ispita percepcija bola kod osoba s teskobom u zubnim nizovima nakon ligiranja šest različitih ortodontskih žica u sklopu prve faze terapije fiksnim aparatima. Metode rada Studija je urađena na uzorku od 189 pacijenata kojima je u okviru ortodontskog lečenja fiksnim aparatima bila ligirana jedna od šest različitih superelastičnih ili termo žica od legure nikl-titanijuma. Percepcija bola je procenjivana kod osoba s različitom izraženošću teskobe. Korišćen je modifikovani Makgilov (McGill) upitnik za bol s Vizuelnom analognom skalom radi opisivanja kvaliteta i intenziteta bola. Statistička obrada podataka je obuhvatila deskriptivnu statističku analizu i primenu h2-testa sa statističkom značajnošću od p lt 0,05. Rezultati Najveći broj ispitanika je opisao bol kao neprijatnost ili pritisak srednjeg intenziteta izazvan žvakanjem ili dodirom, koji je počinjao do 12 sati od ligiranja žice, trajao je tri-četiri dana i smanjivao se bez primene lekova. Zaključak Nije utvrđena statistički značajna razlika u percepciji bola kod osoba s različitom izraženošću teskobe zubnih nizova kojima su bile ligirane superelastične i termo žice od legure nikl-titanijuma

The treatment of class III malocclusion in early mixed dentition: Two case reports

Class III malocclusion is orthodontic anomaly where mandibular arch is in mesial position to maxillary arch. Reasons for Class III malocclusion can be found in mandibular prognathism, maxillar retrognathism or combination of these two. In most cases of mandibular prognathism, it is necessary to postpone the treatment until the growth ceases. However, if certain conditions are accomplished it is possible to start early treatment of class III malocclusion to improve occlusal relations and provide more favorable environment for future growth. The aim of this study was to present treatment of two patients with Class III maloclussion in early mixed dentition, using two different appliances: Delaire mask and Frankel functional regulator type 3. The treatment with Delaire mask resulted in rotation of maxilla downward and forward due to the angle of extraoral part of the mask to the occlusal plane that was modified to be almost 45°. At the end of the treatment facial esthetics was significantly improved. Moving maxilla forward resulted in straight profile, whereas moving maxilla downward lead to coordination of upper, middle and lower facial third. The result of the treatment in patient who used Frankel functional regulator was correction of anterior crossbite by premaxilla development and incisors protrusion. Significant differences in SNA, SNB and ANB angle values at the beginning and at the end of the treatment were not found suggesting that most changes were dental but not skeletal

Terapija malokluzija III klase u ranoj mešovitoj denticiji - prikaz dva slučaja

Class III malocclusion is orthodontic anomaly where mandibular arch is in mesial position to maxillary arch. Reasons for Class III malocclusion can be found in mandibular prognathism, maxillar retrognathism or combination of these two. In most cases of mandibular prognathism, it is necessary to postpone the treatment until the growth ceases. However, if certain conditions are accomplished it is possible to start early treatment of class III malocclusion to improve occlusal relations and provide more favorable environment for future growth. The aim of this study was to present treatment of two patients with Class III maloclussion in early mixed dentition, using two different appliances: Delaire mask and Frankel functional regulator type 3. The treatment with Delaire mask resulted in rotation of maxilla downward and forward due to the angle of extraoral part of the mask to the occlusal plane that was modified to be almost 45°. At the end of the treatment facial esthetics was significantly improved. Moving maxilla forward resulted in straight profile, whereas moving maxilla downward lead to coordination of upper, middle and lower facial third. The result of the treatment in patient who used Frankel functional regulator was correction of anterior crossbite by premaxilla development and incisors protrusion. Significant differences in SNA, SNB and ANB angle values at the beginning and at the end of the treatment were not found suggesting that most changes were dental but not skeletal.Skeletna malokluzija III klase je nesklad u međusobnom odnosu gornje i donje vilice, jer je donja vilica postavljena mezijalnije u odnosu na gornju. Uzrok nastanka skeletne malokluzije III klase može biti mandibularni prognatizam, maksilarni retrognatizam ili kombinacija ova dva uzroka. U slučaju isuviše razvijene donje vilice najčešće je potrebno sačekati završetak rasta, kako bi se primenilo konačno lečenje. Međutim, ako su ispunjeni određeni uslovi, moguće je primeniti ranu terapiju III klase, da bi se poboljšali okluzalni odnosi i obezbedila dobra osnova za dalji rast. Cilj ovog rada bio je da se prikaže terapijski efekat dva slučaja malokluzije III klase u ranom uzrastu pomoću različitih ortodontskih aparata: Delerove maske i Frenklovog regulatora funkcije tip 3. Kod pacijentkinje koja je tokom lečenja nosila Delerovu masku gornja vilica je zarotirana unapred i nadole, jer je ugao delovanja sile modifikovan da bude skoro 45 stepeni. Na kraju lečenja postignut je znatno bolji izgled lica. Pomeranjem gornje vilice unapred postignut je prav profil, dok je pomeranje nadole dovelo do usklađivanja visine srednje trećine lica sa gornjom i donjom. Kod pacijenta kod kojeg je tokom lečenja primenjena terapija Frenklovim regulatorom funkcije tip 3 do korekcije obrnutog preklopa sekutića došlo je kombinacijom razvijanja premaksile i protruzije sekutića. Značajne promene u vrednostima uglova SNA, SNB i ANB nisu zabeležene na kraju terapije u odnosu na početak, što bi ukazivalo na to da su postignute promene uglavnom dentalne, a ne skeletne

Malocclusion from the prehistoric to the medieval times in Serbian population: Dentoalveolar and skeletal relationship comparisons in samples

The aims of this study were to reconstruct and analyze dental occlusion and skeletal jaw relationship in samples from Mesolithic-Neolithic, Bronze Age, Roman and Medieval times in Serbia, to compare results and to determine possible direction of the occlusal changes. Anatomically preserved skulls with mandibles and most of the posterior teeth were included in the investigation. Dental occlusion was reconstructed using the position of centric occlusion and centric relation and analyzed according to Angle's classification. Lateral cephalometric radiographs were traced manually Site differences were tested by one-way ANOVA, while sex, age and site impacts were analyzed by UNIANOVA. Most of the individuals in all groups had Class I occlusion. Half-cusp distal occlusion was also present in all groups, but there were no significant differences between the groups. Cephalometric analysis showed no differences in the sagittal measurements, almost all individuals had skeletal Class I jaw relationship. Vertical traits analysis revealed markedly decreased basal plane angle and also decreased posterior facial height and sum of the posterior angles in the oldest group in comparison to the later groups. These results indicate that in the Serbian skeletal sample from the Mesolithic-Neolithic to the Medieval times, malocclusions were present in the form of dentoalveolar Class II occlusion. Skeletal deep bite was found in the oldest group, while horizontal growth pattern decreased from prehistoric to the Medieval times. Samples were too small to confirm environmental impact on the vertical skeletal discrepancies

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

Teeth size reduction in the prehistoric populations in Serbia

Introduction. Anthropological studies show craniofacial changes with a reduction in teeth size during evolution of the human population. Objective. The objective was to measure and compare the sizes of teeth in the population of the Mesolithic-Neolithic sites in the Iron Gate Gorge and the population from the Early Bronze Age site of Mokrin. Methods. The study included teeth without advanced wear near the pulp. The material was divided according to the site of the skeletal population in two groups. Group 1 comprised 107 teeth from the Mesolithic-Neolithic sites Lepenski Vir and Vlasac. Group 2 included 158 teeth from the Mokrin graveyard dated in the Early Bronze Age. The mesio-distal diameter was measured in all teeth, while the vestibulo-oral diameter was measured in the molars only. Using the two-factor analysis of variance, the influence of sex, site and their interaction on the size of the teeth were investigated. Results. The vestibulo-oral diameter of the upper third molar was significantly higher in males compared to females. The comparison between the groups showed that the vestibulooral diameter of the lower first molar was significantly higher in group 1. Conclusion. The present difference in teeth size indicates the existence of reduction during the prehistoric times. However, the time period between the populations studied is probably too short to be manifested on a large number of teeth

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