Evaluation of skeletal maturity using mandibular second premolar calcification stages. A digital x-ray study

Introduction: Evaluation of skeletal maturity and dental age with the aid of lateral cephalogram and panoramic radiograph plays a crucial role in orthodontic treatment planning, diagnosis and treatment timing in correction of malocclusions. Successful treatment of skeletal disharmonies may be achieved by growth modification in patients who have a certain amount of growth remaining as during the pubertal spurt. Aim: The purpose of this study was to evaluate the correlation and efficacy of using the calcification stages of maxillary permanent left second premolar (tooth 35) to predict the skeletal maturity in Bulgarian subjects.Materials and Methods: А total of 388 digital x-rays were evaluated. They were of 194 children in maturational stages CVM II, CVM III, and CVM IV. Developmental stages of left mandibular tooth 35 were assessed by the Demirjian et al. method (1973) and cervical vertebral maturation (CVM) stage by the Baccetti et al. method.Results: For both genders strong correlation was found between the mineralisation stages of tooth 35 and skeletal age – for girls (r = 0.659; Р < 0.05) and for boys (r = 0.544; Р < 0.05). For boys in the CVM II stage, 100% of the studied mandibular second premolars were with open apical foramen and developmental stage G being dominant in 60.5% (Р < 0.0001). In stage CVM III the number of teeth with incomplete root development was still significant – 83.3% with prevalence of stage G (Р = 0.028). In stage CVM IV 76.9% of the left mandibular second premolars were evaluated to be in stage H by the Demirjian method (P = 0.052). For girls in the CVM II stage, 100% of the studied mandibular tooth 35 were immature with developmental stage F being dominant (Р = 0.001). In stage CVM III the share of teeth 35 with incomplete root development was 89.3% of the studied subjects with prevalence of stage G (Р < 0.0001). In stage CVM IV 51.2% of the left mandibular second premolars were evaluated to be in stage H (P = 0.879). Conclusion: A strong correlation was found between mandibular left second premolar calcification stages and skeletal age, which eases the skeletal maturity evaluation with the aid of a single panoramic radiograph. In stage CVM II, observed at least a year before the pubertal growth spurt, with great growth potential ahead, maturational stage G of the mandibular tooth 35 could be used as a predictor of pubertal peak for boys and stage F – for girls. During the pubertal spurt – CVM III, the dominant stage of mineralisation of tooth 35 was G in both genders

Non-contrast Magnetic Resonance Angiography for Evaluation of Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a major cause of morbidity and mortality in the USA with an estimated prevalence of up to 20% in those over 75 years. Vascular disease and kidney impairment frequently coexist; prevalence of moderate to severe renal dysfunction in PAD patients is estimated at 27-36%. Knowledge of location, severity, and extent of PAD is imperative for accurate diagnosis and treatment planning. However, all established imaging modalities that are routinely used for treatment planning are contra-indicated in kidney disease patients. Contrast-enhanced x-ray and CT angiography are unsafe due to exposure to nephrotoxic contrast material and ionizing radiation. Recently, the FDA has also warned against the use of gadolinium-enhanced MRA (Gd-MRA) due to evidence that gadolinium could trigger a life-threatening condition known as nephrogenic systemic fibrosis (NSF) in patients with moderate to severe kidney dysfunction. There is a clinical need to develop vascular imaging techniques that are safe in patients with coexisting PAD and renal insufficiency. The focus of this thesis was the development of a non-contrast alternative to Gd-MRA for imaging of peripheral vessels from renal to pedal arteries with MRI. A new imaging sequence for non-contrast visualization of the abdominal and pelvic arteries was designed, implemented, and validated in a small cohort of PAD patients against Gd-MRA. In addition, an existing fast spin-echo based technique for unenhanced imaging of the lower extremities was optimized for improved performance in a clinical setting

Evaluation of skeletal maturity using mandibular canine calcification stages. A digital x-ray study

Introduction: Evaluation of skeletal maturity and dental age with the aid of lateral cephalogram and panoramic radiograph plays a crucial role in orthodontic treatment planning, timing, and diagnosis in correction of malocclusions. Successful treatment of skeletal disharmonies may be achieved by growth modification in patients who have a certain amount of growth remaining as during the pubertal spurt. Aim: The purpose of this study was to evaluate the correlation and efficacy of using the calcification stages of mandibular permanent left canine (tooth 33) to predict the skeletal maturity in Bulgarian subjects.Materials and Methods: A total of 388 digital x-rays were evaluated. They belonged to 194 children in maturational stages CVM II, CVM III, and CVM IV. Developmental stages of tooth 33 were assessed by the Demirjian et al. (1973) method (3) and cervical vertebral maturation (CVM) stages by the Baccetti et al. method.Results: For both genders a strong correlation was found between the mineralisation stages of the mandibular left canine and skeletal age defined by the Baccetti method et al. for girls (r = 0.637; Р < 0.05) and for boys (r = 0.605; Р < 0.05). For males in the CVM II stage, 76.3% of the studied mandibular canines were immature with developmental stage G being dominant (Р = 0.05). In stage CVM III the number of teeth with complete root development significantly increased to 72.2% (Р = 0.002). In stage CVM IV 100% of the left mandibular canines were evaluated to be in stage H. For girls in the CVM II stage, 80.8% of the studied mandibular canines were with open apical foramen with developmental stage G being dominant (Р = 0.304). In stage CVM III the number of teeth with complete root development rose significantly, reaching a share of 85.7% among the studied subjects (Р < 0.0001). In stage CVM IV 100% of the left mandibular canines were evaluated to be in stage H. Conclusion: A highly significant correlation found between mandibular left canine calcification stages and cervical vertebral maturation stages eases the skeletal maturity evaluation with the aid of a single panoramic radiograph. In stage CVM II, observed at least a year before the pubertal growth spurt, with great growth potential ahead and orthodontic treatment approaches, maturational stage G of the mandibular left canine could be used as predictor of pubertal peak for boys and stages F and G for girls

Dental age estimation using the Willems method in children with mixed and permanent dentition: a digital orthopantomographic study

Introduction:In recent years, different age estimation methods have become increasingly important to determine the age of individuals with unknown one and have played a crucial role in orthodontic treatment planning, diagnosis, and treatment timing in the correction of skeletal malocclusions. Identification of age is very important for a variety of reasons, including some social events, legal responsibility, marriage, employment.Aim:The aim of this study was to assess the method of Willems for dental age estimation (DA) in different age groups and to evaluate the possible correlation between DA and chronological age (CA) in Bulgarian population. Materials and Methods: Digital orthopantomograms of 295 subjects (180 females,115 males) who fit the study and criteria were obtained. Assessment of mandibular teeth (from central incisor to the second molar on left quadrant) development was undertaken and DA was assessed using the Willems method. Results and Discussion: The present study showed a significant correlation between DA and CA (Spearman’s rank test) in both males (r = 0.89 P < 0.0001) and females (r = 0.90 P < 0.0001). The Willems method overestimated the mean CA of the selected population of 295 Bulgarian subjects by -0.34 years and was statistically significant (P < 0.05). This result was valid for the age groups of 7.00–8.99 years; 9.00–10.99 years, and 11.00–12.99 years. In the age group of 13.00–14.99 years, DA coincided with HA (P ≥ 0.05). In the age group of 15.00–16.99-year-olds, the Willems method underestimated the mean CA by 0.54 (P ≤ 0.05).Conclusion: This study showed significant correlation between DA and CA. Thus, digital radiographic assessment of mandibular teeth development can be used to evaluate mean DA using the Willems method and also the estimated age for the purposes of orthodontic treatment planning and diagnosis in Bulgarians aged 7–16 with mixed or permanent dentition

The correlation between the rotation of upper first permanent molars and malocclusions in the individual dental arch and in the occlusion

IntroductionMalocclusions disturb the integrity of the dental arch and the interdental/occlusal relationship. All this leads to a change in the position of the upper molars in the sagittal, transversal and vertical plane. The rotation of the upper first molar leads to a shift of position of molar cups in a mesio-distal direction demonstrated by the great impact on the distribution of occlusal forces.AimThe rotation of upper first molars should not be underestimated in the biometrical analysis of diagnostic dental casts as this can lead to incomplete and improper treatment plan.Ðœaterials and MethodsOur study investigated 681 children aged 7-10 years who attended the Department of Orthodontics at the Faculty of Dental Medicine in Varna. All children were clinically evaluated and biometrical assessment of diagnostic dental casts was performed. Diagnostic records included also photo-analysis and measurements of diagnostic dental casts. The relationship between the rotation of upper first permanent molars and the transversal and sagittal dimension, and also the overjet were assessed. The degrees of rotation were classified using the Friel and Vigano methods.ResultsA regressional statistical analysis was conducted to determine the frequency of malocclusion and to establish the relationship between the rotation of upper first permanent molar and the length of the arch, the intercanine distance, and the overjet. The comparative analysis demonstrated inverse relationship not only between the rotational position of the molars and the length of the arch, but also between the canine distance and the rotation of the upper molars (p<0.01). It is reported that when an overjet up to 4 mm is present,  the mediopalatal rotation of the molars is negatively affected.ConclusionLosing the length of the arch leads to compression of the dental arch, medialization of permanent molars and crowding of the frontal teeth. The problem of mesiopalatal rotation of upper first permanent molars is manifested through increased overjet and increased overbite

Epidemiological research on the incidence of malocclusions among mouth-breathing children with primary and mixed dentition

Introduction: A literature review established that the number of mouth-breathing children varies between 5-75%. Girls are more often diagnosed with this condition compared to the boys. In the 19th century Linder-Aronson established the relationship between mouth-breathing and malocclusions. The recognition of the mouth-breathing pattern and the habitual mouth breathing as factors in developing malocclusions requires prophylaxis and timely treatment.Aim: The purpose of this study is to establish the incidence and type of malocclusions among mouth-breathing children with primary and mixed dentition.Materials and Methods: A total of 412 children diagnosed with mouth breathing and 317 children diagnosed with habitual mouth breathing aged 3-12 years were examined. The dental occlusion of every child was assessed in the three planes of space - sagittal, transverse and horizontal in both segments - frontal and buccal.Results: In both groups a statistically significant difference in dental malocclusions was demonstrated (p<0.001) depending on type of dentition. In both groups the vast majority of children were diagnosed with class II Angle malocclusion in both primary and mixed dentition. The children with primary dentition were more often diagnosed with class I Angle malocclusion.Conclusion:In both groups the most frequent malocclusions present were class II Angle, overjet, bilateral posterior crossbite, open bite within 3 mm in the frontal segment. In primary dentition the most frequent type of malocclusion was class I Angle.Introduction: A literature review established that the number of mouth-breathing children varies between 5-75%. Girls are more often diagnosed with this condition compared to the boys. In the 19th century Linder-Aronson established the relationship between mouth-breathing and malocclusions. The recognition of the mouth-breathing pattern and the habitual mouth breathing as factors in developing malocclusions requires prophylaxis and timely treatment.Aim: The purpose of this study is to establish the incidence and type of malocclusions among mouth-breathing children with primary and mixed dentition.Materials and Methods: A total of 412 children diagnosed with mouth breathing and 317 children diagnosed with habitual mouth breathing aged 3-12 years were examined. The dental occlusion of every child was assessed in the three planes of space - sagittal, transverse and horizontal in both segments - frontal and buccal.Results: In both groups a statistically significant difference in dental malocclusions was demonstrated (p<0.001) depending on type of dentition. In both groups the vast majority of children were diagnosed with class II Angle malocclusion in both primary and mixed dentition. The children with primary dentition were more often diagnosed with class I Angle malocclusion.Conclusion:In both groups the most frequent malocclusions present were class II Angle, overjet, bilateral posterior crossbite, open bite within 3 mm in the frontal segment. In primary dentition the most frequent type of malocclusion was class I Angle

Influence of adenotomy/adenoidectomy on the respiration and occlusion in mouth-breathing children

Introduction: Difficult nasal breathing is a common problem, which may be a result of multiple factors, leading to physiological disturbance and/or anatomical disorders of the nose and paranasal sinuses. One of the most frequent reasons in childhood age is adenoid hypertrophy.Aim: The aim of the current article is to determine the influence of adenotomy and adenoidectomy on the respiration and occlusion of children with difficult nasal breathingMaterials and Methods: A total of 412 children, diagnosed with difficult nasal breathing, took part in the study. Of them, 139 underwent a second clinical examination in the period of 1 to 3 months to determine the way of breathing after adenotomy/adenoidectomy.Results: In primary dentition, after removing the etiological factor for difficult nasal breathing, 68.00% of the children began to breathe spontaneously through the nose. In mixed dentition, there was a higher percentage of children, who maintained mouth breathing as a bad habit. In comparison to the dental class after adenotomy/adenectomy, there was a higher percentage of Angle class II. In the saggital plane there was an increase of the frequency of the overjet from 1 to 3mm, which led to preservation of mouth breathing.Conclusion: After adenotomy/adenectomy we have determined that in primary dentition a higher percent of children begin to breathe spontaneously through the nose, whereas in mixed dentition mouth breathing is preserved as a bad habit. In children with preserved mouth breathing, there is an increase in the degree of severity of orthodontic deformations and complications of the deformation

Determining the main reasons for difficult nasal breathing among children with primary and mixed dentition

Introduction: Difficult nasal breathing is the condition where there is a partial or full, temporary or permanent obstruction of the airways and the processes of inhalation and exhalation are carried out through the mouth.Aim: The aim of this paper is to define and analyse the reasons for mouth breathing among children with primary and mixed dentition.  Materials and Methods: A total of 1 667 children between the ages 3 and 12 years were examined. We used the methods of anterior and posterior rhinoscopy, acoustic rhinometry, and rhinomanometryResults: Among all the studied mouth-breathing children with deciduous dentition, the main reason for the difficult nasal breathing was allergic rhinitis. The children with first degree of obstruction predominated (54.50%), The second cause in this studied age group was adenoid hypertrophy. In early mixed dentition, the percentage distribution of second and third degree of obstruction was the same (45.70%). In the early mixed dentition, the most common cause of difficult nasal breathing was adenoid hypertrophy. The percentage of children in late mixed dentition who were with adenoid hypertrophy was lower.Conclusion: The main reason for difficult nasal breathing in primary dentition is allergic rhinitis, but in early mixed dentition it is adenoid hypertrophy. Our results showed that of all the children with difficult nasal breathing 24% had first degree of nasal obstruction, 39.30% had second degree, followed by 36.70% children with third degree

Correlation between maxillary canine calcification stages and skeletal maturation (skeletal age)

Introduction: Evaluation of skeletal maturity plays a crucial role in orthodontic treatment planning, diagnosis, and treatment timing in the correction of skeletal malocclusions. Growth modification is more effective when the pubertal spurt is used. Aim: The purpose of the article is to evaluate the efficacy of using the calcification stages of the permanent maxillary canine to predict the timing of skeletal maturity. Materials and Methods: A literature review of dental age (DA) evaluation of maxillary canine according to the method of Demirjian et al. and cervical vertebral maturation (CVM) stage assessment according to the method of Baccetti et al. was conducted.Discussion: Demirjian calcification stage E of the left maxillary canine coincided with the pre-peak of pubertal growth spurt (CS2), calcification stage F corresponded with the peak of pubertal growth spurt (CS3) and the calcification stage H coincided with the end of peak of pubertal growth spurt (CS4 and CS5).Conclusion: Successful treatment of skeletal disharmonies may be achieved by growth modification in patients who have a certain amount of growth remaining, as during the pubertal spurt. A highly significant correlation was found between the maxillary left canine calcification stages and the cervical vertebral maturation stages, which would facilitate the skeletal maturity evaluation with the aid of a single panoramic radiograph

Evaluation of individual indicators for orthodontic treatment of children with mixed and permanent dentition // Оценка на индивидуални показатели за ортодонтско лечение на деца в смесено и постоянно съзъбие

A study of individual indicators of the puberty period of growth was carried out to create a prognostic model on orthopantomogram for the initiation of orthodontic treatment. Four tasks were formulated, and 320 children aged 7–17 were examined. Evaluation of dental and skeletal age by methods applicable to routine diagnostic means in orthodontics has been performed. Digital radiographs total of 640 were analysed. The mean chronological age of the occurrence of the three stages of bone age, outlining the period of growth one year before the peak, peak and one year after the peak of puberty in Bulgarian boys and girls, has been determined. The most common stage of mineralisation of tooth germs of teeth 23, 33, 35, 37, and 38 relative to the stages of bone age during puberty was evaluated as well as their correlation. Prognostic models on orthopantomogram to determine puberty growth in girls and boys have been derived, and guidelines for the initiation of orthodontic treatment of children in mixed and permanent dentition have been indicated. The dissertation work has one contribution of an original character, six contributions of a scientific and theoretical nature and five contributions of a scientifically applied nature. The dissertation is illustrated with 39 tables, 55 figures, 5 schemes and 16 applications.Дисертационният труд представя изследване на индивидуални показатели на пубертетния период на растеж с цел да се създаде прогностичен модел за неговото настъпване върху ортопантомография за започване на ортодонтско лечение. Формулирани са четири задачи и са изследвани 320 деца на възраст 7-17 години, на които е определена зъбната и скелетната възраст по методи приложими върху рутинни диагностични средства в ортодонтията. Анализирани са 640 дигитални рентгенографии. Определена е средна хронологична възраст на настъпване на трите етапа на костна възраст, очертаващи периода на растеж една година преди пика, пика и една година след пика на пубертета при български момчета и момичета. Оценена е най-често срещаната степен на минерализация на зъбните зародиши на зъби 23, 33, 35, 37, 38 спрямо етапите на костна възраст през пубертета както и тяхната взаимовръзка. Изведени са прогностични модели върху ортопантомография за определяне на пубертетния растеж при момичета и момчета и са посочени насоки за започване на ортодонтско лечение на деца във смесено и постоянно съзъбие. Дисертационният труд има един принос с оригинален характер, шест приноса с научно-теоретичен характер и пет приноса с научно-приложен характер. Дисертацията е онагледена с 39 таблици, 55 фигури, 5 схеми и 16 приложения