Signalling molecules in jaw bones and gingival tissues of patients with Class II and Class III dentofacial deformities

OBJECTIVES: To detect signalling molecule specificities in jaw bone growth zones in skeletal class II and class III patients and compare them to those of a control group. MATERIAL AND METHODS: Twenty skeletal Class II and 20 skeletal Class III patients who underwent orthognathic surgery treatment were in the study group and five skeletal Class I patients who had impacted third molars extracted were in the control group. During the orthognathic surgery, tissue samples were taken from the tuber maxillae, ramus mandibulae anterior and posterior part together with mucosa from the gingival transitory fold in the second molar region of the lower jaw. The samples were stained to detect TGF-β, BMP2/4, FGFR1, VEGF, OC, OP and MMP2 expression. The distributions of these factors were assessed semiquantitatively. RESULTS: We observed significant expression of TGF-β, BMP2/4, OC and OP in the bone tissue of the study group. FGFR1 expression was more pronounced only in mucosa. VEGF and MMP2 were found only in some tissue samples. More apoptotic cells were observed in the bone tissue and soft tissue of the control patients than in those of the skeletal Class II and Class III patients, in which apoptotic cell frequencies were relatively equal. CONCLUSION: From bone tissue in tuber maxillae region the greater TGF-β and BMP2/4 expression is seen in Class III and control groups, comparing to Class II. In ramus mandibulae anterior part the expression of significant factors in bone tissue growth (TGF-β un BMP2/4) is higher in the control group and Class II patients, while in ramus mandibulae posterior part higher expression of TGF-β and BMP2/4 is in Class III patients, comparing to Class II, which indicates to a preserved growth potential in these jaw bone regions. More active bone extracellular matrix protein (osteocalcin and osteopontin) expression in tuber maxillae region both in class II and class III patient groups and different expression in ramus mandibulae anterior part, prove to the bone mineralization and metabolism activity changes, which, perhaps, characterize just these dentofacial deformations.publishersversionPeer reviewe

Osteopontin and osteocalcin in maxilla tissue of skeletal Class III patients

Bone extracellular matrix proteins osteopontin and osteonectin have important function during embryonic osteogenesis and are active in bone remodeling process. Knowledge about bone extracellular matrix proteins explores the mechanisms of craniofacial development and helps to understand better morphopathogenesis of severe dentofacial anomalies. Aim of the current study was to investigate an expression of osteopontin and osteocalcin in maxilla tissue in skeletal Class III patients. The study group included 10 skeletal Class III patients to whom combined orthodontic and surgical treatment was recommended. Samples of tuber maxillae tissue from ten skeletal Class III malocclusion patients were collected due the orthognatic surgery procedure. The routine histological method was followed and samples were stained by hematoxyline-eosine. Tissue samples were stained according the standard immunohistochemical methods and expression of osteocalcin and osteopontin in maxilla tissue was examined. Distribution of these factors was evaluated semiquantitetively by counting the positive structures in visual field. The trabecules of bone contained parallel located collagen fibers and irregular bone mineralization. Connective tissue proliferation in osteon channels was observed. Quantity of cells positive to osteopontin was higher than quantity of cells containing osteocalcin in all patterns extracted of maxilla tissue in patients with skeletal Class III. In few cases osteocalcin positive cells were located near the border with soft tissue - close to osteogenic cells zone, but no osteocalcin was observed deeper in bone. The intensity of osteocalcin expression was variable, and differs individually despite the relatively regular osteopontin distribution in all patterns. There were pronounced osteopontin, but not osteocalcin-containing cells with approximately similar intensity of protein expression in tuber maxillae in skeletal Class III patients.publishersversionPeer reviewe

Specific signaling molecule expressions in the interradicular septum in different age groups

Orthodontic teeth movement is accompanied by the remodeling of alveolar bone, including the interradicular septum. Bone contains three cell types, osteoblasts, osteocytes, and osteoclasts that are in direct contact with all of the cellular elements in the bone marrow. Marrow is the source of both bone-building osteoblasts and bone destroying osteoclasts, and the turnover of bone occurs throughout life. Bone signalling molecules have important functions during osteogenesis, and they are active in the bone remodelling process. Patients involved in orthodontic treatment belong to different age groups: therefore age must be considered as a contributing factor compromising the osteogenetic potential of bone. The aim of the current study was to investigate the specific expression of signalling molecules in the interradicular septum in different age groups. The study group included 17 patients to whom the extraction of teeth was recommended as part of further orthodontic treatment. Patients (9 males and 8 females) - were divided into 3 groups 1st group - 12-14 years old); 2nd group - 15-22 years old; 3rd group - 23 years old or older. Expression of BMP 2/4, TGF-α, IL-1, IL-8, OPG, MMP-1, MMP-2, MMP-8, MMP-9, MMP-13, NGFR, NKpB 105, osteocalcin, and osteopontin in interradicular septum tissues was examined. TUNEL staining was also completed. The distribution of these factors was evaluated semi quantitalively. In the interradicular septum bone structure, the expression levels of osteocalcin, osteoprotegerin, matrix metalloproteinases 8 and 9, and nuclear factor kappa B were determined in all samples. TUNEL staining was also done. Age related decreases in the mean values of signalling factors and the number of apoptotic cells were statistically significant. Specific to interradicular septum osteoblasts and osteoclasts factors include osteoprotegerin, osteocalcin, matrix metalloproteinase 8, matrix metallproteniase 9, and nuclear factors kappa B. The mean expression levels of these proteins and the mean TUNEL staining statistically significantly decreased with age. This is preliminary study and more patients are necessary for more precise statistical analysis in the future.publishersversionPeer reviewe

The relationship between the severity of malposition of the frontal teeth and periodontal health in age 15-21 and 35-44

INTRODUCTION: In the recent past there has been an increase in the number of adults seeking orthodontic treatment therefore special attention to periodontal status of these patients needs more careful evaluation. Periodontal considerations in adult orthodontic treatment are increasingly important as patients become older. The aim of the study was to assess the interrelationship between the severity of malposition of frontal teeth with periodontal health considering to age in Latvian population. METHODS: The data were analyzed from a detailed crossectional study in Latvian population. Selected samples consisted of two age groups: 15-21 (n=323) and 35-44 (n=286) years old. For the assessment of periodontal health CPI scores was analyzed for upper frontal sextant. For assessment of malocclusion 2 components of ICON index were used: upper arch crowding and incisor overbite. The differences in the distribution of ICON index and CPI index between age groups were tested using Pearson chi(2)test. Statistical significance of the differences in the mean values was tested using t-test. Possible interaction between above mentioned indexes was tested by means of analysis of variance. RESULTS: Upper arch crowding and incisor overbite severity increase with age was statistical significant. There was statistically significant interrelation between upper arch crowding degree and incisor overbite and CPI scores severity in the age 15-21 and was not in the age 35-44. However comparing higher degree of the crowding and overbite severity to percent of subjects with bleeding, calculus and periodontal pockets greater percents of measurements were in older group. CONCLUSIONS: 1. Severity of upper arch crowding and overbite statistically significant increased with age with remarkable increasing of periodontal problems. 2. Interrelation between severity of upper arch crowding, incisor overbite and CPI scores was statistically significant in age group 15-21.publishersversionPeer reviewe

Three-dimensional evaluation of TMJ parameters in Class II and Class III patients

The aim of our study was to assess condylar parameters and condyle position within glenoid fossa of TMJ in volumetric 3D imaging in patients with Class II and Class III malocclusions. MATERIALS AND METHODS. The study group included 15 patients with severe skeletal Class II (mean age 18.0 yrs) and 14 patients with severe skeletal Class III ( mean age 19,2 yrs) with an indication for combined orthodontic and orthognathic treatment. CT examination was performed, pictures were reconstructed in three - dimensional (3D) rendering and measured in two dimension projection (2D) pictures using IAC review and Transparent bone programs to quantify following condylar and glenoid fossa parameters - glenoid fossa width and height; tuberculum articulare angle; anterior, superior and posterior joint space; height and width of condyle, height of procesus condylaris. Mean values were calculated separately for left and right side. Differences of the mean values were tested using paired t-test. RESULTS. There were statistically significant differences (p<0,05) between two study groups for all spatial measurements on both sides with larger spatial measurements in patients with Class II malocclusions. Also the height of procesus condylaris varied between groups with statistical difference. Unilateral differences were detected for width of fossa glenoidale and height of condyle. CONCLUSION. Results show that there are a tendency for smaller condyle and wider spaces between condyle and walls of glenoid fossa comparing TMJ of Class II with Class III patients.publishersversionPeer reviewe

The severity of malocclusion and need for orthodontic treatment in correspondence with the age

Awareness of the age related situation as to the malocclusion prevalence in population and orthodontic treatment need is very important and useful for planning an orthodontic care, especially taking into account the interdisciplinary aspect of the problem. The aim of this study was to investigate the degree of severity of malocclusion and the need of orthodontic treatment in three different age groups of population in Latvia. The study group comprised samples of 12-13-yr-olds (n=46), 18-yr-olds (n=32) and 35-44-yr-olds (n=278). The Index of Complexity, Outcome and Need (ICON) was used for the assessment of the results. In order to provide the accuracy use of ICON, more than 4 missing teeth and prosthetic restorations were chosen as an exclusion factor for the age group 35-44 years. A statistically significant difference was determined between the mean ICON values in 12-13 and 18 year-old age groups. Professionally defined orthodontic treatment need according to ICON score >43 was determined to be higher in the age group 18 year-olds. Overall, the tendency for orthodontic treatment complexity grade was observed to increase with the age.publishersversionPeer reviewe

Validation of a Latvian and a Russian version of the Oral Health Impact Profile for use among adults

BACKGROUND. The need for appraisal of oral health-related quality of life has been increasingly recognized over the last decades. The aim of this study was to develope a Latvian and a Russian version and test the validity of the Oral Health Impact Profile (OHIP-49) for use among adults in Latvia. METHODS. The original English version of the OHIP-49 was translated using the forward-backward technique, pilot-tested, and then applied to 60 adults aged 18 years and above. The questionnaire was filled out during face-to-face interviews conducted by one specialist. The internal consistency of the questionnaire was evaluated using Cronbach's alpha (α) coefficient and inter-item and item-total correlations. Discriminant and convergent validities were assessed. RESULTS. Cronbach's α was estimated to be 0.96. Inter-item correlations coefficients ranged from 0.19 to 0.91, with averige value 0.35, while item-total correlations coefficients from 0.14 to 0.86. CONCLUSIONS. The OHIP-49 is a reliable and valid questionnaire for the assessment of OHRQoL among adults in Latvia.publishersversionPeer reviewe

Correlation of temporomandibular joint clinical signs with cone beam computed tomography radiologic features in juvenile idiopathic arthritis patients

OBJECTIVE: Patients with juvenile idiopathic arthritis (JIA) have a high risk of temporomandibular joint (TMJ) involvement. Early detection of osseous destruction of the TMJ that can be seen radiographically is vital to provide appropriate treatment before significant craniofacial deformities and problems with occlusion arise. The aim of study was to evaluate whether there is a correlation between the clinical signs and cone beam computed tomography (CBCT) radiologic features of TMJ in patients with JIA. MATERIAL AND METHODS: Study group consisted of 65 patients (46 females and 19 males) aged 10 to 17 years with a confirmed JIA diagnosis and mean disease duration 2 years 9 month, all patients underwent a clinical examination of the TMJ and masticatory muscles as well as a radiological assessment of the TMJ osseous structures by CBCT. RESULTS: Majority of the patients' study population experienced 2 or 3 clinical signs with mean number 2.1 (standard deviation (SD) =1.00) and 3-5 radiological features related to the TMJ destruction with mean number 4.9 (SD=1.96). Statistically significant weak correlation only between pain and condyle surface flattening (Spearman`s Rho test (rho) =0.396; p value (p) =0.001) was found. No correlation between number of clinical signs and radiological features was found. CONCLUSIONS: There was no conclusive evidence found regarding correlation between TMJ clinical signs and radiological features of osseous destruction in patients with JIA - only weak correlation between pain and condyle surface flattening was observed. The number of clinical TMJ signs does not correlate with number of radiological features. For the clinical decision both clinical examination and CBCT would be useful in the early detection of osseous destruction of the TMJ in JIA patients.publishersversionPeer reviewe

The relationship between mandibular rotation and osseous structure of the TMJ in pre-surgery orthognathic patients : A cone beam CT study

The aim of the study was to assess the relationship between vertical skeletal pattern in terms of mandibular rotation and osseous structural changes of the TMJ in pre- surgical orthognatic patients. TMJ skeletal morphology was evaluated in cone beam computer tomography images of 117 consecutive patients with Class II and Class III dentofacial deformities according to the research diagnostic criteria of the osseous components of the TMJ related to the maxillary-mandibular plane (MM) angle. The distribution of the number and percentage of joints with structural changes in Class II was markedly different in groups divided according to the MM angle. Statistically significant increase was found in the percentage of TMJ's with osseous changes separately for each side, i.e., right (p=0.001), left (p=0.04) and both together (p=0.0001), in the Class II patient group, an increased MM angle indicated backward rotation of the mandible. In Class III patients, there were no statistically significant differences in the number of joints with TMJ structural changes. The presence of mentioned changes was asymmetrical between the left and right joints in both the Class II and Class III patient groups. In conclusion, structural changes in the osseous parts of the TMJ are more common in patients with Class II skeletal dentofacial deformities with backward rotation of the mandible than in Class III pre-surgery orthognathic patients.publishersversionPeer reviewe

Growth factors, apoptotic cells and barx1 gene in bone and soft tissue of skeletal class III patients

Growth factors and growth stimulating genes are main signaling molecules for growth and development in ante- and postnatal period involved in cellular proliferation, differentiation and morphogenesis of tissues and organs during embryogenesis, postnatal growth and adulthood. The aim of this study was to evaluate TGF-beta (transforming growth factor-beta), BMP2/4 (bone morphogenetic protein 2/4), FGFR1 (fibroblast growth factor receptor one), barx1 gene and apoptosis from tissue samples of oro-maxillo-facial region in skeletal class III patients to reveal possible morphopathogenesis of severe skeletal anomalies. The study group included 9 patients with skeletal class III malocclusion. During orthognatic surgery tissue samples from tuber maxillae, ramus mandibulae anterior and posterior part, as well as gingiva from the lower jaw in region of second molar have been taken. Samples were stained with immunohistochemistry for TGF-beta, BMP2/4, FGFR1, apoptosis and barx1 gene. We used also the routine histological staining with haematoxyline and eosine. In tuber maxillae, ramus mandibulae anterior and posterior part staining for TGF-beta was the most relevant. Also BMP2/4, FGFR1 and barx1 showed the highest mean number of positive cells in tuber maxillae. Barx1 was equally expressed in ramus mandibulae, but BMP2/4 and FGFR1 mainly stained its posterior part cells. Apoptosis mostly affected ramus mandibulae anterior part. CONCLUSIONS: We suggest about more active stimulation of bone growth in tuber maxilla whereas ramus mandibulae. Apoptosis mainly affects ramus mandibulae anterior part that possibly connects to the lower expression of growth stimulating factors and may indicate lower bone remodelation ability.publishersversionPeer reviewe