Aspects of Hemifacial Microsomia

Hemifaciale microsomia (HFM) is een aangeboren asymmetrische afwijking van het gelaat met grote variatie. Het ontstaan is onduidelijk. Buiten de craniofaciale (aangezichts) afwijkingen, komen ook andere defecten voor. Het klinisch beeld toont een enkelzijdige afwijking van het oor en een onderontwikkeling van het skelet, de weke delen en de aangezichtsspieren aan de aangedane gezichtshelft. Behandeling moet leiden tot een verbeterde functie en optimale gelaatssymmetrie aan het einde van de groei. Het uiteindelijke behandelresultaat wordt beïnvloed door externe factoren, zoals de chirurgische techniek, maar ook door intrinsieke patiënt factoren zoals genetische achtergrond, groei en ontwikkeling. Het eindresultaat is afhankelijk van het psychosociale welzijn van de patiënt en de psychosociale invloed van ouders op de patiënt. Een van de bestudeerde factoren is de aangezichtsgroei in HFM. We vonden dat patiënten meer terug liggende kaken hadden in vergelijking met de normale bevolking. De aangedane zijde vertoonde dit sterker dan de niet aangedane zijde. Voor de onderkaak geldt dat HFM patiënten starten met een kleinere onderkaak en ook eindigen met een kleinere onderkaak. Tijdens de groei blijft de verhouding tussen aangedane en niet aangedane zijde gelijk. Er is geen toenemende gezichtsasymmetrie zichtbaar. Deze kleinere onderkaak suggereert dat er ook een afwijking aan de lokale tandontwikkeling bestaat. We vonden een vertraagde tandontwikkeling in ernstig aangedane jonge HFM patiënten. Dit en de verdeling van aangeboren afwezige gebitselementen gerelateerd aan de ernst van de aandoening doen vermoeden dat er een vroege interactie bestaat tussen tand- en onderkaaksontwikkeling. De psychosociale implicaties van HFM op patiënt en ouders zijn onvoldoende bestudeerd. Voor het aanpassen aan de stressvolle gebeurtenis van het krijgen van een kind met een aangezichtsafwijking, zoals HFM, kan een grote rol zijn weggelegd voor verwerkingsstrategieën door de ouders. We onderzochten ouderlijke stress in relatie tot zowel kenmerken van het kind als de ouderlijke cognitieve verwerkingsprocessen. De manier van verwerking door ouders blijkt een groot deel van de ouderlijke stress te verklaren naast bepaalde kenmerken van hun kind. Vervolg onderzoek zou zich ook op functionele veranderingen moeten richten, zoals beweging van de onderkaak, esthetiek bij het lachen en de effectiviteit van kauwen waarbij rekening wordt gehouden met de drie dimensionale aard van de afwijking. Er kan dieper in gegaan worden op de manier waarop ouders verwerken dat zij een kind hebben met HFM en de strategie die zij daarvoor gebruiken. Dit kan het eindresultaat van de behandeling van hun kind beïnvloeden en daarmee, de kwaliteit van leven van hun kind

Disturbances of dental development distinguish patients with oligodontia-ectodermal dysplasia from isolated oligodontia

Contains fulltext : 189817.pdf (publisher's version ) (Open Access

The association of maternal folic acid supplementation and prenatal folate and vitamin B12 concentrations with child dental development

OBJECTIVE: Low folic acid, folate and vitamin B12 might affect tooth formation and mineralization. The conversion of folic acid into folate is catalysed by the methylenetetrahydrofolate (MTHFR) enzyme which is encoded by the MTHFR gene. Among 3728 mothers and their 10‐year‐old children from the Generation R Study, we investigated associations of maternal folic acid supplementation and prenatal folate and vitamin B12 concentrations with child dental development. Secondly, we checked the modifying effect of MTHFR‐C677T polymorphism. METHODS: Information on folic acid supplementation was obtained by questionnaires. Concentrations of folate and vitamin B12 were measured from venous samples taken in early pregnancy. Developmental stages of teeth were defined by the Demirjian method at the age‐10 assessment. In addition, dental age of the children was calculated using the Dutch standard. GLM and multivariate linear regression models were built to study the associations. RESULTS: Folic acid supplementation started when pregnancy was known (β = −0.09; 95% CI: −0.17, −0.01) and folic acid supplementation started prior to known pregnancy (β = −0.12; 95% CI: −0.20, −0.04) were both associated with decelerated dental development by 1‐2 months lower dental age of 10‐year‐old children. Folate (β = −0.02, 95% CI: −0.05, 0.02) and vitamin B12 (β = 0.03, 95% CI: −0.00, 0.06) were not associated with dental age. MTHFR‐C677T did not modify the associations. CONCLUSIONS: Maternal folic acid supplementation delays dental development of children by 1‐2 months dental age, whereas maternal folate and vitamin B12 concentrations in early pregnancy do not affect the timing of child dental development

The Prediction Accuracy of Digital Orthodontic Setups for the Orthodontic Phase before Orthognathic Surgery.

The purpose of this study was to verify whether pre-treatment digital setups can accurately predict the tooth positions after presurgical orthodontic treatment has been performed in a 3-dimensional way. Twenty-six patients who underwent a combined orthodontic-orthognathic surgical treatment were included. Pre-treatment digital dental models were merged with cone beam computed tomography (CBCT) scans. One operator fabricated virtual setups to simulate the tooth movements of the presurgical orthodontic treatment. Prior to surgery, digital dental models were merged with the CBCT scans. Differences between de virtual setups and the presurgical dental models were calculated using linear mixed model analyses. Differences in tooth displacements exceeding the boundaries of clinical acceptance (>2 degrees for rotations and >0.6 mm for translations) were found in 75% of the rotational and 52% of translational mean differences in the maxilla and in 74% of the rotational mean differences and 44% of the translational mean differences in the mandible. Significant differences were found for all tooth types and in all tooth displacement directions with significant effects of extractions and surgically assisted rapid maxillary expansion (SARME) procedures. The accuracy of the digital setup is still too limited to correctly simulate the presurgical orthodontic treatment

A semi-automatic three-dimensional technique using a regionalized facial template enables facial growth assessment in healthy children from 1.5 to 5.0 years of age.

Objectives To develop a semi-automatic technique to evaluate normative facial growth in healthy children between the age of 1.5 and 5.0 years using three-dimensional stereophotogrammetric images. Materials and Methods Three-dimensional facial images of healthy children at 1.5, 2.0, 2.5, 3.0, 4.0 and 5.0 years of age were collected and positioned based on a reference frame. A general face template was used to extract the face and its separate regions from the full stereophotogrammetric image. Furthermore, this template was used to create a uniform distributed mesh, which could be directly compared to other meshes. Average faces were created for each age group and mean growth was determined between consecutive groups for the full face and its separate regions. Finally, the results were tested for intra- and inter-operator performance. Results The highest growth velocity was present in the first period between 1.5 and 2.0 years of age with an average of 1.50 mm (±0.54 mm) per six months. After 2.0 years, facial growth velocity declined to only a third at the age of 5.0 years. Intra- and inter-operator variability was small and not significant. Conclusions The results show that this technique can be used for objective clinical evaluation of facial growth. Example normative facial averages and the corresponding facial growth between the age 1.5 and 5.0 years are shown. Clinical Relevance This technique can be used to collect and process facial data for objective clinical evaluation of facial growth in the individual patient. Furthermore, these data can be used as normative data in future comparative studies

The effect of lip closure on palatal growth in patients with unilateral clefts

Objectives The objective of this study was to compare maxillary dimensions and growth in newborns with Complete Unilateral Cleft Lip and Palate (UCLP) to healthy newborns before and after cheiloplasty. Additionally, a palatal growth curve is constructed to give more information about the natural growth before surgical intervention. Methods Twenty-eight newborns with complete UCLP were enrolled in this study. Multiple plaster-casts of each child during their first year were collected and grouped in before and after cheiloplasty. A previous developed semi-automatic segmentation tool was used to assess the maxillary dimensions and were compared to a healthy control group. Z-scores were calculated to indicate differences between the two populations and if cheiloplasty had influence on maxillary growth. Furthermore, the prediction model created in a previous study was used to indicate differences between predictions and the outcome in UCLP measurements. The analysis was tested for inter- and intra-observer variability. Results Results show differences in alveolar and palatal shape in UCLP patients in comparison with healthy controls. Prior to cheiloplasty an increased width and alveolar length was observed while the palatal depth was decreased. After cheiloplasty the widths moved towards normal but were still significantly larger

助成研究報告

Objectives: In this cross-sectional study, we aimed to investigate the pattern of hypodontia in the Dutch population and determine the association between hypodontia and dental development in children with and without hypodontia, applying three different standards, Dutch, French Canadian, and Belgian, to estimate dental age. Methods: We used dental panoramic radiographs (DPRs) of 1488 children (773 boys and 715 girls), with a mean age of 9.76 years (SD = 0.24) participating in a population-based cohort study in Rotterdam, the Netherlands, born in 2002–2004, and 452 children (219 boys and 233 girls) with a mean age of 9.83 years (SD = 1.09) participating in a mixed-longitudinal, interdisciplinary population-based cohort study in Nijmegen, the Netherlands born in 1960–1968. Results: The prevalence of hypodontia in the Generation R Study was 5.6 % (N = 84) and 5.1 % (N = 23) in the Nijmegen Growth Study. Linear regression analysis showed that children with hypodontia had a 0.37 [95 % CI (−0.53,-0.21)] to 0.52 [95 % CI (−0.76,-0.38)] years lower dental age than children without hypodontia. The ordinal regression analysis showed a delay in development of mandibular second premolars [1.68 years; 95 %CI (−1.90,-1.46)], mandibular first premolars [0.57 years; 95 % CI (−0.94,-0.20)], and mandibular second molars [0.47 years; 95 % CI (−0.84,-0.11)]. Conclusion: These findings suggest that children with hypodontia have a delayed dental development. Clinical relevance: The delay of dental development in children with hypodontia should be taken into consideration and therefore orthodontists should recognize that a later start of treatment in these patients may be necessary

Influence of self-esteem on perceived orthodontic treatment need and oral health-related quality of life

Background: Self-esteem (SE) is suggested to influence the relationship between orthodontic treatment need and oral health related quality of life (OHRQoL), but evidence lacks. The aim of the present study was to investigate SE in the relationship between subjective orthodontic treatment need (SOT) and OHRQoL in children. Methods: This cross-sectional study was embedded in the Generation R Study, a multi-ethnic population-based cohort. In total, 3849 10-year old children participated in the present study. OHRQoL, measured with the Child Oral Health Impact Profile-ortho, and SOT were assessed within parental questionnaires. SE was measured with a modified version of the Harter’s self-perception profile rated by the children. The role of SE in the association between SOT and OHRQoL was evaluated with linear regression mode

Ancestry and dental development: A geographic and genetic perspective

Objective: In this study, we investigated the influence of ancestry on dental development in the Generation R Study. Methods: Information on geographic ancestry was available in 3,600 children (1,810 boys and 1,790 girls, mean age 9.81±0.35 years) and information about genetic ancestry was available in 2,786 children (1,387 boys and 1,399 girls, mean age 9.82±0.34 years). Dental development was assessed in all children using the Demirjian method. The associations of geographic ancestry (Cape Verdean, Moroccan, Turkish, Dutch Antillean, Surinamese Creole and Surinamese Hindustani vs Dutch as the reference group) and genetic content of ancestry (European, African or Asian) with dental development was analyzed using linear regression models. Results: In a geographic perspective of ancestry, Moroccan (β=0.18; 95% CI: 0.07, 0.28), Turkish (β=0.22; 95% CI: 0.12, 0.32), Dutch Antillean (β=0.27; 95% CI: 0.12, 0.41), and Surinamese Creole (β=0.16; 95% CI: 0.03, 0.30) preceded Dutch children in dental development. Moreover, in a genetic perspective of ancestry, a higher proportion of European ancestry was associated with decelerated dental development (β=-0.32; 95% CI: -.44, -.20). In contrast, a higher proportion of African ancestry (β=0.29; 95% CI: 0.16, 0.43) and a higher proportion of Asian ancestry (β=0.28; 95% CI: 0.09, 0.48) were associated with accelerated dental development. When investigating only European children, these effect estimates increased to twice as large in absolute value. Conclusion: Based on a geographic and genetic perspective, differences in dental development exist in a population of heterogeneous ancestry and should be considered when describing the physiological growth in children