Psychological profile and self-administered relaxation in patients with craniofacial pain: a prospective in-office study

Introduction: The objective of this study was to evaluate the psychological profile of craniofacial pain sufferers and the impact of patient subtype classification on the short-time effectiveness of a self-administered relaxation training. Methods: One hundred unselected in-office patients (67% females) suffering from chronic facial pain and/or headache with the presumptive diagnose of temporo-mandibular disorder (TMD) completed a questionnaire battery comprising craniofacial pain perception, somatic complaints, irrational beliefs, and pain behavior and were classified into subtypes using cluster analysis. They underwent a self-administered progressive relaxation training and were re-evaluated for pain perception after 3 months. Results: Pain was mild to moderate in the majority of patients. Symptom domains comprised parafunctional activities, temporo-mandibular pain and dysfunction, fronto-temporal headache, head/neck and neck/back pain. Three patient subtypes were identified regarding symptom/dysfunction level: (i) low burden (mild/moderate), (ii) psychosocial dysfunction (moderate/high), (iii) adaptive coping (moderate/mild). Self-rated adherence to the recommended relaxation training was moderate throughout the sample, but self-rated relief was significantly different between clusters. At follow-up, pain intensity was significantly decreased in all patients, whereas pain-related interference was improved only in dysfunctional and adaptive patients. Improvement of symptom domains varied between clusters and was most comprehensive in adaptive patients. Conclusions: In conclusion, craniofacial pain sufferers can be divided in meaningful subtypes based on their pain perception, irrational beliefs, and pain behaviour. A self-administered relaxation training generally yielded positive effects on pain perception, however the benefit may be greater in patients with more marked symptom impact (both dysfunctional and adaptive).<br

Association of dentoskeletal morphology with incisor inclination in angle class II patients: a retrospective cephalometric study

Introduction: The purpose of this study was to identify possible dentoskeletal parameters associated with variation of anterior tooth inclination in Angle Class II subdivisions. Methods: Pre-treatment lateral radiographs of 144 Class II patients (68 males, 76 females) aged 9 to 17 years were classified for upper incisor inclination into three groups (proclined, normally inclined, retroclined) homogeneous for gender and skeletal jaw relationship. The effect of age on the 22 cephalometric variables was controlled by covariance analysis. Results: Multivariate analysis of the cephalometric parameters indicated significant inter-group differences. Systematic associations with incisor inclination were revealed using rank correlation: Lower incisor proclination, Wits appraisal and gonial angle significantly decreased (0.04 ≥ p ≥ 0.002), while intercisal angle, mandibular total and corpus length and nasolabial angle increased (0.04 ≥ p ≥ 0.001) with decreasing incisor proclination. Conclusions: Clear-cut classification criteria and control of confounding effects may clarify conflicting previous findings on dentoskeletal differences between Class II subdivisions in the mixed dentition. Only minor dentoskeletal differences appear to be associated with incisor inclination. The increased interincisal and nasolabial angle in Class II division 2 subjects are due to reclination of both upper and lower incisors. Jaw positions and chin prominence are not significantly different between the subdivisions. However, Wits appraisal is decreased in Class II division 2. The increased mandibular length observed in Class II division 2 requires further scrutinization.<br

The effect of e-learning on the quality of orthodontic appliances

Purpose: The effect of e-learning on practical skills in medicine has not yet been thoroughly investigated. Today’s multimedia learning environment and access to e-books provide students with more knowledge than ever before. The aim of this study is to evaluate the effect of online demonstrations concerning the quality of orthodontic appliances manufactured by undergraduate dental students. Materials and methods: The study design was a parallel-group randomized clinical trial. Fifty-four participants were randomly assigned to one of the three groups: 1) conventional lectures, 2) conventional lectures plus written online material, and 3) access to resources of groups one and two plus access to online video material. Three orthodontic appliances (Schwarz Plate, U-Bow Activator, and Fränkel Regulator) were manufactured during the course and scored by two independent raters blinded to the participants. A 15-point scale index was used to evaluate the outcome quality of the appliances. Results: In general, no significant differences were found between the groups. Concerning the appliances, the Schwarz Plate obtained the highest scores, whereas the Fränkel Regulator had the lowest scores; however, these results were independent of the groups. Females showed better outcome scores than males in groups two and three, but the difference was insignificant. Age of the participants also had no significant effect. Conclusion: The offer that students could use additional time and course-independent e-learning resources did not increase the outcome quality of the orthodontic appliances. The advantages of e-learning observed in the theoretical fields of medicine were not achieved in the educational procedures for manual skills. Factors other than e-learning may have a higher impact on manual skills, and this should be investigated in further studies

Spine deviations and orthodontic treatment of asymmetric malocclusions in children

Background: The aim of this randomized clinical trial was to assess the effect of early orthodontic treatment for unilateral posterior cross bite in the late deciduous and early mixed dentition using orthopedic parameters. Methods: Early orthodontic treatment was performed by initial maxillary expansion and subsequent activator therapy (Münster treatment concept). The patient sample was initially comprised of 80 patients with unilateral posterior cross bite (mean age 7.3 years, SD 2.1 years). After randomization, 77 children attended the initial examination appointment (therapy = 37, control = 40); 31 children in the therapy group and 35 children in the control group were monitored at the follow-up examination (T2). The mean interval between T1 and T2 was 1.1 years (SD 0.2 years). Rasterstereography was used for back shape analysis at T1 and T2. Using the profile, the kyphotic and lordotic angle, the surface rotation, the lateral deviation, pelvic tilt and pelvic torsion, statistical differences at T1 and T2 between the therapy and control groups were calculated (t-test). Our working hypothesis was, that early orthodontic treatment can induce negative therapeutic changes in body posture through thoracic and lumbar position changes in preadolescents with uniltaral cross bite. Results: No clinically relevant differences between the control and the therapy groups at T1 and T2 were found for the parameters of kyphotic and lordotic angle, the surface rotation, lateral deviation, pelvic tilt, and pelvic torsion. Conclusions: Our working hypothesis was tested to be not correct (within the limitations of this study). This randomized clinical trial demonstrates that in a juvenile population with unilateral posterior cross bite the selected early orthodontic treatment protocol does not affect negatively the postural parameters

Early treatment of posterior crossbite - a randomised clinical trial

Background: The aim of this randomised clinical trial was to assess the effect of early orthodontic treatment in contrast to normal growth effects for functional unilateral posterior crossbite in the late deciduous and early mixed dentition by means of three-dimensional digital model analysis. Methods: This randomised clinical trial was assessed to analyse the orthodontic treatment effects for patients with functional unilateral posterior crossbite in the late deciduous and early mixed dentition using a two-step procedure: initial maxillary expansion followed by a U-bow activator therapy. In the treatment group 31 patients and in the control group 35 patients with a mean age of 7.3 years (SD 2.1) were monitored. The time between the initial assessment (T1) and the follow-up (T2) was one year. The orthodontic analysis was done by a three-dimensional digital model analysis. Using the ‘Digimodel’ software, the orthodontic measurements in the maxilla and mandible and for the midline deviation, the overjet and overbite were recorded. Results: Significant differences between the control and the therapy group at T2 were detected for the anterior, median and posterior transversal dimensions of the maxilla, the palatal depth, the palatal base arch length, the maxillary arch length and inclination, the midline deviation, the overjet and the overbite. Conclusions: Orthodontic treatment of a functional unilateral posterior crossbite with a bonded maxillary expansion device followed by U-bow activator therapy in the late deciduous and early mixed dentition is an effective therapeutic method, as evidenced by the results of this RCT. It leads to three-dimensional therapeutically induced maxillary growth effects. Dental occlusion is significantly improved, and the prognosis for normal craniofacial growth is enhanced

Comparative treatment outcomes after bilateral extractions of maxillary second molars or first premolars in patients with class II malocclusion: a retrospective study

Background This retrospective cohort study aimed to compare treatment results between bilateral extraction of upper second molars (M2) and first premolars (P1) in terms of treatment timing, cephalometry, upper third molar alignment and relapse in the long-term. Methods Fifty-three consecutively treated Caucasian patients with a brachyfacial pattern, skeletal class I and dental class II requiring extraction in the maxilla due to crowding were retrospectively divided into group I (M2 extracted; N = 31) and II (P1 extracted; N = 22). Fixed appliances were inserted after extraction and after distalisation of the first molars in group I. Post-treatment lateral cephalograms were digitally analysed and compared between groups. Six to seven years later relapse and success of upper third molar alignment were clinically evaluated as well as orthodontic treatment duration, pre-treatment age and gender recorded. Results After debonding patients with second molar extraction showed significantly smaller values for the Wits-appraisal, but higher values for index and facial axis. Extracting first premolars caused significantly more retroinclination/−position of anterior teeth and an increased profile concavity, more relapse and less successful alignment of upper third molars. Orthodontic treatment duration, pre-treatment age and gender were not significantly different between groups. Conclusions Bilateral extraction of upper first premolars or second molars may solve dental crowding in skeletal class I dental class II patients with a brachyfacial growth pattern. Upper second molar extraction seems to affect maxillary third molar alignment, long-term stability and dental and soft-tissue cephalometric parameters positively, but no intervention proved to be clearly superior

Differences in labile soil organic matter explain potential denitrification and denitrifying communities in a long-term fertilization experiment

Content and quality of organic matter (OM) may strongly affect the denitrification potential of soils. In particular, the impact of soil OM fractions of differing bioavailability (soluble, particulate, and mineral-associated OM) on denitrification remains unresolved. We determined the potential N2O and N2 as well as CO2 production for samples of a Haplic Chernozem from six treatment plots (control, mineral N and NP, farmyard manure - FYM, and FYM + mineral N or NP) of the Static Fertilization Experiment Bad Lauchstädt (Germany) as related to OM properties and denitrifier gene abundances. Soil OM was analyzed for bulk chemical composition (13C-CPMAS NMR spectroscopy) as well as water-extractable, particulate, and mineral-associated fractions. Soils receiving FYM had more total OM and larger portions of labile fractions such as particulate and water-extractable OM. Incubations were run under anoxic conditions without nitrate limitation for seven days at 25 °C in the dark to determine the denitrification potential (N2O and N2) using the acetylene inhibition technique. Abundances of nirS, nirK, and nosZ (I + II) genes were analyzed before and after incubation. The denitrification potential, defined as the combined amount of N released as N2O + N2 over the experimental period, was larger for plots receiving FYM (25.9–27.2 mg N kg−1) than pure mineral fertilization (17.1–19.2 mg N kg−1) or no fertilization (12.6 mg N kg−1). The CO2 and N2O production were well related and up to three-fold larger for FYM-receiving soils than under pure mineral fertilization. The N2 production differed significantly only between all manured and non-manured soils. Nitrogenous gas emissions related most closely to water-extractable organic carbon (WEOC), which again related well to free particulate OM. The larger contribution of N2 production in soils without FYM application, and thus, with less readily decomposable OM, coincided with decreasing abundances of nirS genes (NO2− reductase) and increasing abundances of genes indicating complete denitrifying organisms (nosZ I) during anoxic conditions. Limited OM sources, thus, favored a microbial community more efficient in resource use. This study suggests that WEOC, representing readily bioavailable OM, is a straightforward indicator of the denitrification potential of soils

Sagittal jaw position in relation to body posture in adult humans – a rasterstereographic study

BACKGROUND: The correlations between the sagittal jaw position and the cranio – cervical inclination are described in literature. Only few studies focus on the sagittal jaw position and the body posture using valid and objective orthopaedic examination methods. The aim of this study was to test the hypothesis that patients with malocclusions reveal significant differences in body posture compared to those without (upper thoracic inclination, kyphotic angle, lordotic angle and lower lumbar inclination). METHODS: Eighty-four healthy adult patients (with a mean age = 25.6 years and ranging from 16.1 to 55.8 years) were examined with informed consent. The orthodontic examination horizontal overjet (distance between upper and lower incisors) was determined by using an orthodontic digital sliding calliper. The subjects were subdivided in respect of the overjet with the following results: 18 revealed a normal overjet (Class I), 38 had an increased overjet (Class II) and 28 had an reversed overjet (Class III). Rasterstereography was used to carry out a three – dimensional back shape analysis. This method is based on photogrammetry. A three-dimensional shape was produced by analysing the distortion of parallel horizontal white light lines projected on the patient's back, followed by mathematical modelling. On the basis of the sagittal profile the upper thoracic inclination, the thoracic angle, the lordotic angle and the pelvic inclination were determined with a reported accuracy of 2.8° and the correlations to the sagittal jaw position were calculated by means of ANOVA, Scheffé and Kruskal-Wallis procedures. RESULTS: Between the different overjet groups, no statistically significant differences or correlations regarding the analysed back shape parameters could be obtained. However, comparing males and females there were statistically significant differences in view of the parameters 'lordotic angle' and 'pelvic inclination'. CONCLUSION: No correlations between overjet and variables of the thoracic, lordotic or the pelvic inclination could be observed

Relationship between back posture and early orthodontic treatment in children

Background!#!The purpose of this study was to analyze the relationship between body posture and sagittal dental overjet in children before and after early orthodontic treatment with removable functional orthodontic appliances.!##!Methods!#!Angle Class II patients (mean age 8.2 ± 1.2 years; 29 males and 25 females) with a distinctly enlarged overjet (&amp;gt; 9 mm) were retrospectively examined regarding body posture parameters before and after early orthodontic treatment. In addition, changes in overjet were investigated with the aid of plaster models. Forms of transverse dysgnathism (crossbite, lateral malocclusions) and open bite cases were excluded. Body posture parameters kyphosis, lordosis, surface rotation, pelvic tilt, pelvic torsion and trunk imbalance were analyzed by means of rasterstereographical photogrammetry to determine, if the orthodontic overjet correction is associated with specific changes in posture patterns.!##!Results!#!In nearly all patients an overjet correction and an improvement regarding all body posture and back parameters could be noted after early orthodontic treatment. Overjet reduction (- 3.9 mm ± 2.1 mm) and pelvic torsion (- 1.28° ± 0,44°) were significantly (p &amp;lt; 0.05) and moderately correlated (R = 0.338) with no significant associations found for the other posture and back parameters (p &amp;gt; 0.05).!##!Conclusion!#!Overjet reduction during early orthodontic treatment may be associated with a detectable effect on pelvic torsion

Accuracy of virtual planning in orthognathic surgery

Background: The elaboration of a precise pre-surgical plan is essential during surgical treatment of dentofacial deformities. The aim of this study was to evaluate the accuracy of computer-aided simulation compared with the actual surgical outcome, following orthognathic surgery reported in clinical trials. Methods: Our search was performed in PubMed, EMBASE, Cochrane Library, and SciELO for articles published in the last decade. A total of 392 articles identified were assessed independently and in a blinded manner using eligibility criteria, out of which only twelve articles were selected for inclusion in our research. Data were presented using the intra-class correlation coefficient, and linear and angular differences in three planes. Results: The comparison of the accuracy analyses of the examined method has shown an average translation (< 2 mm) in the maxilla and also in the mandible (in three planes). The accuracy values for pitch, yaw, and roll (°) were (< 2.75, < 1.7 and < 1.1) for the maxilla, respectively, and (< 2.75, < 1.8, < 1.1) for the mandible. Cone-beam computed tomography (CBCT) with intra-oral scans of the dental casts is the most used imaging protocol for virtual orthognathic planning. Furthermore, calculation of the linear and angular differences between the virtual plan and postoperative outcomes was the most frequent method used for accuracy assessment (10 out of 12 studies), and a difference less than 2 mm/° was considered acceptable and accurate. When comparing this technique with classical planning, virtual planning appears to be more accurate, especially in terms of frontal symmetry. Conclusion: Virtual planning seems to be an accurate and reproducible method for orthognathic treatment planning. However, more clinical trials are needed to clearly determine the accuracy and validation of virtual planning in orthognathic surgery