The functional matrix hypothesis revisited. 2. The role of an osseous connected cellular network

Management of Pediatric Mandibular Condyle Fractures: A Literature Review

This narrative review evaluates the literature on the management of mandibular condyle fractures in growing patients. It aims to illustrate some fundamental biological principles and to offer a series of considerations applicable to clinical practice. The discussion is based on 116 papers published in PubMed and two relevant textbooks. Condylar fractures may be overlooked, especially in pre-scholar children, where compliance is usually reduced. However, these injuries can have disabling sequelae such as ankyloses, facial deformities, malocclusion, and chronic pain in some patients if not diagnosed and managed correctly. Due to their significance, mandibular condyle fractures in children are a subject of considerable clinical interest. As of today, there is consensus about their treatment. Four management options are available: expectative (analgesia, soft food and follow-up), functional protocols (guiding elastics, orthodontic appliances and exercises), maxillomandibular fixation (MMF), and open reduction and internal fixation (ORIF). Nondisplaced and minimally displaced fractures should be treated expectantly; severely displaced non-comminuted fractures can be safely operated on if the expertise is available, even in patients with deciduous dentition. Moderately displaced fractures can be managed with functional protocols or operatively, depending on the background and know-how of the specialist. Functional protocols can achieve good outcomes, especially in patients with deciduous dentition. MMF should be foregone in children due to its many drawbacks.

Sagittal suture strain in capuchin monkeys (Sapajus and Cebus) during feeding

OBJECTIVES

Morphological variation in cranial sutures is used to infer aspects of primate feeding behavior, including diet, but strain regimes across sutures are not well documented. Our aim is to test hypotheses about sagittal suture morphology, strain regime, feeding behavior, and muscle activity relationships in robust Sapajus and gracile Cebus capuchin primates.

MATERIALS AND METHODS

Morphometrics of sinuosity in three regions of the sagittal suture were compared among museum specimens of Sapajus and Cebus, as well as in robust and gracile lab specimens. In vivo strains and bilateral electromyographic (EMG) activity were recorded from these regions in the temporalis muscles of capuchin primates while they fed on mechanically-varying foods.

RESULTS

Sapajus and the anterior suture region exhibited greater sinuosity than Cebus and posterior regions. In vivo data reveal minor differences in strain regime between robust and gracile phenotypes but show higher strain magnitudes in the middle suture region and higher tensile strains anteriorly. After gage location, feeding behavior has the most consistent and strongest impact on strain regime in the sagittal suture. Strain in the anterior suture has a high tension to compression ratio compared to the posterior region, especially during forceful biting in the robust Sapajus-like individual.

DISCUSSION

Sagittal suture complexity in robust capuchins likely reflects feeding behaviors associated with mechanically challenging foods. Sutural strain regimes in other anthropoid primates may also be affected by activity in feeding muscles.

Endocranial anatomy of the Guercy 1 early Neanderthal from Baume Moula-Guercy (Soyons, Ardèche, France)

We provide the first comparative description of the endocranium of the Guercy 1 Early Neanderthal and examine its affinities to Preneanderthals, Neanderthals, and Homo sapiens. The Guercy 1 cranium derives from deposits chronostratigraphically and biostratigraphically dated to the Eemian Interglacial (MIS 5e). For comparative purposes, we compiled a sample of European and Southwest Asian subadult and adult Middle-to-Late Pleistocene hominins (≈MIS 12-MIS 1; N = 65). We sampled both a Preneanderthal-Neanderthal group and a Homo sapiens group. The Preneanderthal-Neanderthal group was further divided into three time-successive subgroups defined by associated MIS stages. Metric and morphological observations were made on original fossils and physical and virtual endocranial reconstructions. Guercy 1 and other Early Neanderthals, differ from Preneanderthals by increased development of the prefrontal cortex, precentral and postcentral gyri, inferior parietal lobule, and frontoparietal operculum. Early Neanderthal differ, in general, from Late Neanderthals by exhibiting less development in most of the latter brain structures. The late group additionally differentiates itself from the early group by a greater development of the rostral superior parietal lobule, angular gyrus, superior and middle temporal gyri, and caudal branches of the superior temporal gyrus. Endocranial morphology assessed along the Preneanderthal-Neanderthal sequence show that brain structures prominent in Preneanderthals are accentuated in Early-to-Late Neanderthals. However, both the Early and Late groups differentiate themselves by also showing regionally specific changes in brain development. This pattern of morphological change is consistent with a mosaic pattern of neural evolution in these Middle-to-Late Pleistocene hominins.

Dental and Skeletal Effects of Herbst Appliance, Forsus Fatigue Resistance Device, and Class II Elastics-A Systematic Review and Meta-Analysis

Background: Our study aimed to systematically summarize the dentoskeletal effects of Herbst appliance; Forsus fatigue resistance device; and Class II elastics in adolescent Class II malocclusion. Methods: Five databases; unpublished literature; and reference lists were last searched in August 2022. Randomized clinical trials and observational studies of at least 10 Class II growing patients that assessed dentoskeletal effects through cephalometric/CBCT superimpositions were eligible. The included studies quality was assessed with the RoB 2 and ROBINS-I tools. A random-effects model meta-analysis was performed. Heterogeneity was explored with subgroup and sensitivity analyses. Results: Among nine studies (298 patients); two-to-three studies were included in each meta-analysis. Less post-treatment upper incisor retroclination (<2) and no overbite; overjet; SNA; SNB; and lower incisor inclination differences were found between Herbst/Forsus and Class II elastics. No differences in maxilla; condyle; glenoid fossa; and most mandibular changes were found between Herbst and Class II elastics; except for a greater 1.5 mm increase in mandibular length and right mandibular ramus height (1.6 mm) with Herbst. Conclusions: Herbst and Class II elastics corrected the molar relationship; but Herbst moved the lower molars more mesially. Apart from an additional mandibular length increase; no other dental and anteroposterior skeletal difference was found. Forsus was more effective in molar correction; overjet reduction; and upper incisor control than Class II elastics. Trial registration number OSF: 10.17605/OSF.IO/8TK3R.

Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up

BACKGROUND

The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients.

METHODS

Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed.

RESULTS

Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location.

CONCLUSIONS

A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.

Facial asymmetry in children with either unilateral lambdoid craniosynostosis or positional posterior plagiocephaly

BACKGROUND

In unilateral lambdoid craniosynostosis (ULC), the posteriorly situated lambdoid suture of the cranial vault fuses prematurely. Positional posterior plagiocephaly (PPP) causes flattening of the posterior side of the head, either through external forces or through underlying differences in brain development. Both conditions cause occipital flattening of the head, but the aetiology is different.

MATERIALS AND METHODS

Eight ULC children were compared with 16 sex- and age-matched PPP children. 3D computer tomography scans of all 24 children were analysed with Dolphin imaging software. The location and symmetry of the temporomandibular joint (Co), and the symmetry of the maxillary anterior nasal spine (ANS) and the mandibular symphysis (Pgn) were analysed. Furthermore, the mandibular bone (Co-Pgn) length, corpus length, ramus height, positional changes in the external acoustic meatus (PoL) and the distance from the orbital margin to the articular fossa were measured.

RESULTS

In all eight ULC children, the Co was anteriorly displaced on the affected side compared with the unaffected side. In all ULC and PPP children, the ANS, which is considered the bony maxillary midpoint, was shifted towards the affected side. In all ULC children, the mandibular bone (Co-Pgn) was shorter on the affected side. The PoL was antero-inferiorly positioned in all ULC children on the affected side compared with the unaffected side.

CONCLUSIONS

Our results show that both types of posterior plagiocephaly are associated with an asymmetric position of the Co and asymmetry of the mandible and maxilla. Facial asymmetry was more frequently seen in ULC than PPP children.

Three-dimensional evaluation of hyoid bone position in nasal and mouth breathing subjects with skeletal Class I, and Class II

BACKGROUND

This retrospective study investigated the effect of breathing pattern, skeletal class (Class I, Class II), and age on the hyoid bone position (HBP) in normodivergent subjects.

METHODS

A total of 126 subjects (61 males, 65 females) aged 7-9 years and 10-12 years were scanned using cone-beam computed tomography (CBCT). All participants were classified according to the anteroposterior skeletal pattern into (Class I, Class II). Each skeletal group was further divided according to the breathing mode into mouth breathers (MB) and nasal breathers (NB). The HBP was measured accordingly. Independent sample t-test and Mann Whitney U test were used to detect significant differences between the groups, and binary logistic regression was used to identify MB predictive indicators.

RESULTS

The breathing mode and skeletal class affected the vertical HBP in subjects with 7-9 years, while they affected the anteroposterior HBP in subjects with 10-12 years. Regarding the age effect, hyoid bone was located more anteriorly in the older NB subjects, and hyoid bone was more inferiorly in the older age group. A regression equation of the significant variables was formulated, C3-Me (P: 001, OR: 2.27), and H-EB (P: 0.046, OR: 1.16) were positively correlated with occurrence of MB.

CONCLUSION

There were significantly different HBPs among subjects with different anteroposterior skeletal classes, breathing modes, and age cohorts. Moreover, C3-Me, and H-EB were significant predictors and correlated with increased likelihood of being MB subject.

Cranial-Vertebral-Maxillary Morphological Integration in Down Syndrome

Background: Morphological integration refers to the tendency of anatomical structures to show correlated variations because they develop in response to shared developmental processes or function in concert with other structures. The objective of this study was to determine the relationships between the dimensions of different cranial-cervical-facial structures in patients with Down syndrome (DS). Methodology: The study group consisted of 41 individuals with DS who had undergone cone-beam computed tomography (CBCT) at the Dental Radiology Unit of the University of Santiago de Compostela (Spain). In the historical archive of this same unit, 41 CBCTs belonging to individuals with no known systemic disorders or severe malformations of the maxillofacial region were selected, forming an age and sex-matched control group. Twenty-nine measurements were performed on each participant’s CBCT images, which were grouped into three blocks: atlantoaxial dimensions, craniovertebral dimensions and cephalometric dimensions. To determine whether there were significant differences between the dimensions obtained in the DS and control groups, we applied multiple analysis of variance and linear discriminant analysis tests. The analysis of the association between blocks (in pairs) was performed with the canonical correlation analysis test. Results: The dimensions evaluated in the three blocks of variables of individuals with DS differ significantly from those of nonsyndromic controls (p < 0.001). The highest discriminative capacity to identify controls and patients with DS was obtained with the cephalometric dimensions (87.5%). With regard to the association between blocks (two-by-two measurements), we found no significant relationship in the DS group. However, we confirmed a statistically significant correlation between all pairs of blocks of variables in the controls, especially between the atlantoaxial and cephalometric dimensions (p < 0.001) and between the craniovertebral and cephalometric dimensions (p < 0.001). Conclusions: Our results confirm a very poor morphological integration of the cranial-cervical-maxillary complex in individuals with DS. This finding reinforces the proposal that gene overload enhances the channeling process.

Anatomic development of the upper airway during the first five years of life: A three-dimensional imaging study

PURPOSE

Normative data on the growth and development of the upper airway across the sexes is needed for the diagnosis and treatment of congenital and acquired respiratory anomalies and to gain insight on developmental changes in speech acoustics and disorders with craniofacial anomalies.

METHODS

The growth of the upper airway in children ages birth to 5 years, as compared to adults, was quantified using an imaging database with computed tomography studies from typically developing individuals. Methodological criteria for scan inclusion and airway measurements included: head position, histogram-based airway segmentation, anatomic landmark placement, and development of a semi-automatic centerline for data extraction. A comprehensive set of 2D and 3D supra- and sub-glottal measurements from the choanae to tracheal opening were obtained including: naso-oro-laryngo-pharynx subregion volume and length, each subregion's superior and inferior cross-sectional-area, and antero-posterior and transverse/width distances.

RESULTS

Growth of the upper airway during the first 5 years of life was more pronounced in the vertical and transverse/lateral dimensions than in the antero-posterior dimension. By age 5 years, females have larger pharyngeal measurement than males. Prepubertal sex-differences were identified in the subglottal region.

CONCLUSIONS

Our findings demonstrate the importance of studying the growth of the upper airway in 3D. As the lumen length increases, its shape changes, becoming increasingly elliptical during the first 5 years of life. This study also emphasizes the importance of methodological considerations for both image acquisition and data extraction, as well as the use of consistent anatomic structures in defining pharyngeal regions.

Genes and Pathways Associated with Skeletal Sagittal Malocclusions: A Systematic Review

Skeletal class II and III malocclusions are craniofacial disorders that negatively impact people’s quality of life worldwide. Unfortunately, the growth patterns of skeletal malocclusions and their clinical correction prognoses are difficult to predict largely due to lack of knowledge of their precise etiology. Inspired by the strong inheritance pattern of a specific type of skeletal malocclusion, previous genome-wide association studies (GWAS) were reanalyzed, resulting in the identification of 19 skeletal class II malocclusion-associated and 53 skeletal class III malocclusion-associated genes. Functional enrichment of these genes created a signal pathway atlas in which most of the genes were associated with bone and cartilage growth and development, as expected, while some were characterized by functions related to skeletal muscle maturation and construction. Interestingly, several genes and enriched pathways are involved in both skeletal class II and III malocclusions, indicating the key regulatory effects of these genes and pathways in craniofacial development. There is no doubt that further investigation is necessary to validate these recognized genes’ and pathways’ specific function(s) related to maxillary and mandibular development. In summary, this systematic review provides initial insight on developing novel gene-based treatment strategies for skeletal malocclusions and paves the path for precision medicine where dental care providers can make an accurate prediction of the craniofacial growth of an individual patient based on his/her genetic profile.

Combating Constraints of the Functional Matrix: The Importance of Overcorrection in Pediatric Craniofacial Surgery

Background:

To effectively manipulate the bone, particularly in the growing patient, the craniofacial surgeon must understand the principles related to bone-based reconstruction. A theory of craniofacial growth that is both biologically accurate and clinically relevant is thus needed.

Methods:

A historical review of major findings across various disciplines (including orthopedic surgery, anatomy, embryology, orthodontics, and cell biology) will be covered, as it pertains to the concept of the functional matrix of the craniofacial skeleton.

Results:

The functional matrix dictates the interplay between the soft tissue envelope and bone grafts, thus guiding donor site choice and inset methods. The soft tissue may also warrant the use of bony hypercorrection especially in cranial vault remodeling. Control of both bone and boundaries of the soft tissue functional matrix can be achieved via distraction osteogenesis.

Conclusion:

The soft tissue functional matrix must be accounted for during craniofacial bone grafting, mobilizing osteotomies, and distraction osteogenesis if optimal aesthetic results are to be obtained using the least amount of procedures.

Study of Upper Pharyngeal Airway Dimension in Young Adults Visiting Orthodontic Department of a Dental College: A Descriptive Cross-sectional Study

Introduction:

Orthodontic treatment may affect the size and position of oropharyngeal structures altering the airway dimension. Airway dimension is considered as one of the parameter of orthodontic diagnosis and treatment planning. Narrow airway passage is associated with sleep disordered breathing. This aims to study about the measurement of upper pharyngeal airway dimension of young Nepalese adults visiting orthodontic department of a dental college.

Methods:

This descriptive cross-sectional study conducted at Department of Orthodontics, People's Dental College and Hospital, Kathmandu. Data was collected from 8^th December 2020 to 28^th February 2021. Ethical clearance (Reference number. 1, CH100 06, 2077/2076) was taken from Institutional Review Committee of Peoples Dental College and Hospital, Kathmandu, Nepal. Convenient Sampling technique was done. Data was collected and analysis was done using Statistical Package of Social Sciences 16.

Results:

Mean upper pharyngeal airway dimension was 11.40±1.84mm and 11.68±1.96mm for male and female respectively. Upper pharyngeal airway dimension was found to be almost similar for male and female.

Conclusions:

Gender diversity regarding upper pharyngeal airway dimesnion was not observed in this study while other studies also revealed similarities in upper pharyngeal airway dimension between male and female, inspite of larger craniofacial dimension in males than females.

Evaluation of pharyngeal airway dimensions and hyoid bone position according to craniofacial growth pattern

OBJECTIVE

To compare pharyngeal airway dimensions and hyoid bone position in different craniofacial growth patterns.

METHODS

In total, 611 patients divided into 9 subgroups were compared according to malocclusion classification and vertical growth pattern, and these subgroups were compared in terms of pharyngeal airway and hyoid measurements. A two-way ANOVA test was used to compare the findings of the subgroups.

RESULTS

No significant difference was found for the pharyngeal measurements between the groups (p>0.05). The vertical airway length (PNS-Ep) was significantly shorter in the Class III malocclusion group (p<0.05) and in the hypodivergent group (p<0.05). No statistically significant difference was found between any subgroups in any measurements of the position of the hyoid bone (p>0.05).

CONCLUSION

The pharyngeal airway dimensions and hyoid bone position are similar among individuals in the sagittal direction. The vertical airway length is significantly shorter in Class III and hypodivergent individuals.

Nose approximation among South African groups from cone-beam computed tomography (CBCT) using a new computer-assisted method based on automatic landmarking

Considering the high demand for the identification of unknown remains in South Africa, a need exists to establish reliable facial approximation techniques that will take into account sex and age and, most importantly, be useful within the South African context. This study aimed to provide accurate statistical models for predicting nasal soft-tissue shape from information about the underlying skull subtract among a South African sample. The database containing 200 cone-beam computer tomography (CBCT) scans (100 black South Africans and 100 white South Africans). The acquisition and extraction of the 3D relevant anatomical structures (hard- and soft-tissue) were performed by an automated three-dimensional (3D) method based on an automatic dense landmarking procedure using MeVisLab © v. 2.7.1 software. An evaluation of shape differences attributed to known factors (ancestry, sex, size, and age) was performed using geometric morphometric and statistical models of prediction were created using a Projection onto Latent Structures Regression (PLSR) algorithm. The accuracy of the estimated soft-tissue nose was evaluated in terms of metric deviations on training and un-trained datasets. Our findings demonstrated the influence of factors (sex, aging, and allometry) on the variability of the hard- and soft-tissue among two South African population groups. This research provides accurate statistical models optimized by including additional information such as ancestry, sex, and age. When using the landmark-to landmark distances, the prediction errors ranged between 1.769mm and 2.164mm for black South Africans at the tip of the nose and the alae, while they ranged from 2.068mm to 2.175mm for the white subsample. The prediction errors on un-trained data were slightly larger, ranging between 2.139mm and 2.833mm for the black South African sample at the tip of the nose and the alae and ranging from 2.575mm to 2.859mm for the white South African sample. This research demonstrates the utilization of an automated 3Dmethod based on an automatic landmarking method as a convenient prerequisite for providing a valid and reliable nose prediction model that meets population-specific standards for South Africans.

Correlations between dental wear and oral cavity characteristics: Mandibular torus, palatine torus, and oral exostoses

OBJECTIVE

This study evaluates the correlations amongst mandibular torus, palatine torus, oral exostoses to dental wear/loss and temporomandibular damage.

METHODS

The sample consists of 504 skulls from the Hamann-Todd Osteological Collection; 223 African American and 281 European Americans aged between 30 and 80 years. The sample was analyzed using Pearson's Chi-square for significance of sex, age, ancestry, and wear as well as the interactions between the demographic variables and the presence of mandibular torus, palatine torus and oral exostoses.

RESULTS

Wear was statistically significant by age and sex but not ancestry. The maxillary exostoses varied significantly by age, ancestry and wear but not sex. Mandibular torus frequencies varied significantly by wear, sex and ancestry. The palatine torus varied significantly across wear groups, sex and ancestry.

DISCUSSION

The etiology of nonmetric oral cavity characteristics, mandibular torus, palatine torus and oral exostosis, is complex. The degree to which traits' presence and expression is the result of genetic and environmental interactions is not fully understood. More than age, sex or ancestry, the degree of dental wear and tooth loss influences the presence and expression of the oral cavity traits. The sample can be characterized as the presence of exostoses in higher frequencies in young African American males with little tooth loss. Males of both ancestral groups with heavy wear have higher frequencies of mandibular tori than females. The palatine torus is more common in edentulous European American females.

Evaluation of stylohyoid complex in subjects with different types of malocclusions using cone-beam computed tomography: a retrospective study in a Turkish subpopulation

PURPOSE

According to the functional matrix theory, the development of maxillomandibular complex may be affected by the surrounding tissues. The aim of this study was to evaluate the length and angulation of the styloid process in different types of malocclusions using cone-beam computed tomography (CBCT).

METHODS

Angulations and length of the styloid process were evaluated in CBCT images of 97 individuals retrospectively. The patients were classified as class I, II, and III groups according to sagittal skeletal classes. The mean length, anterior angulation, and medial angulation of the styloid process were analyzed. Statistical significance was evaluated at p < 0.05.

RESULTS

The mean styloid process length in group class III was found to be significantly longer than class I (p: 0.035). Anterior angle was significantly higher in class III group than in other groups (p < 0.05). No statistically significant difference was found in medial angle between the groups (p: 0.506).

CONCLUSION

According to present findings, class III malocclusion is associated with the stylohyoid complex morphology due to longer styloid process lengths and higher anterior angle values.

Inter-premolar width changes related to the orthodontic traction of maxillary impacted canines in adolescents and young adults: A retrospective CBCT study

OBJECTIVE

Maxillary canine impaction is directly associated with a narrow maxillary arch, mainly in the inter-premolar widths. This study compared the transverse changes at the level of maxillary premolars after traction of maxillary impacted canines (MICs) in adolescents and young adults through three main goals: to compare unilateral versus bilateral cases, to compare buccally versus palatally MIC cases, and to compare the affected versus non-affected side exclusively in the unilateral group.

METHODS

This before and after CBCT study involved 45 MIC orthodontically tractioned until the occlusal plane with a standardized protocol. The sample was classified regarding the impaction type (unilateral versus bilateral), impaction location (palatal versus buccal) and the affected versus unaffected sides in the unilateral cases. MIC characteristics as impaction sector, height, and complexity of the traction, as well as α and β angles, canine root length and area were measured. Moreover, cephalometric characteristics were also evaluated. Mann-Whitney U or Wilcoxon signed-rank tests and multiple regressions were applied (α=0.05).

RESULTS

Maxillary inter-premolar widths (first or second) expanded approximately 3mm after traction of unilateral or bilateral MIC (P>0.05). Changes in hemi-arch widths between palatal (1.67mm) versus buccal (1.90mm) MIC were similar (P>0.05). In unilateral impaction, the transversal changes on the affected side were 2mm versus almost 1mm observed in the unaffected side (P<0.05). Finally, the multiple linear regressions were identified to the ANB angle, the impaction sectors and the distance from middle raphe to the cusp tip of MIC as influential variables.

CONCLUSION

The maxillary inter-premolar widths increase after traction of MIC without differences between type or location of impaction. In addition, the transverse change in the affected side in unilateral MIC is greater than the unaffected side resolving the earlier transverse asymmetry.

Relationship between pterygomaxillary fissure morphology and maxillary/mandibular position : A cone beam computed tomography assessment

PURPOSE

The aim of this study was to investigate the possible correlation between maxillary and mandibular positioning via cephalometric analysis with pterygomaxillary fissure (PMF) morphology using cone beam computed tomography (CBCT).

METHODS

In this study, CBCT images from 825 individuals (448 female, 377 male; age range was 18-91 years with this cohort) were analyzed; PMF length and width were measured. Three-dimensional cephalometric analysis was also performed using cephalometric analysis software. The landmarks and measurements in relation to maxillary and mandibular positions were identified and performed for the cephalometric analysis. Analysis of variance (ANOVA) was used for comparison of the parameters, while the Bonferroni test was used for multiple comparisons. Pearson's test was also used to assess the correlations between the parameters.

RESULTS

The results showed that males had significantly larger PMF length (p < 0.001) and width (p < 0.001) compared to females. The mean PMF length was 17.7 mm (standard deviation [SD] 3.2 mm) for right and 17.7 mm (SD 3.3 mm) for left but were not significantly different (p > 0.05). In terms of the cephalometric measurements, a significant correlation was found between upper central incisor (U1toAperp2D) and posterior facial height (PostFaceHtSGo2D) and PMF length, while correlations were found between PMF width and several cephalometric parameters such as lower lip (LwLiptoEPln2D and LwLiptoHLine2D) and occlusal plane (OPtoFHAng2D) (p < 0.05).

CONCLUSION

A significant relationship was observed between PMF morphology and the position of the maxilla or mandible. PMF lengths and widths were larger in males than females. Posteroanterior maxillary and mandibular lengths and posterior facial height are associated with PMF length and width.

Effect of extraction or nonextraction orthodontic treatment modality on favorability of eruption of impacted third molars

Objective

The objective of the study is to determine if extraction of permanent teeth, for orthodontic purpose, causes a change in third molar angulation and also to determine if extraction of permanent teeth causes an increase in eruption space available for third molars.

Methods

This systematic review includes retrospective cohort studies which evaluated the change in third molar angulation or eruption space available for third molars among orthodontic patients treated by a fixed appliance with either extraction or nonextraction protocol. Search engines used were MEDLINE, IndMED, Web of Science, Cochrane, EMBASE, and Google Scholar from the year 1975 to 2015. Separate data collection forms were used to extract data from the studies. The Cochrane Risk of Bias Assessment Tool was used to assess the studies included in the systematic review.

Results

Fifteen studies included in the systematic review proved that third molar angulation and eruption space improved in patients treated with extraction treatment modality. However, two studies concluded that change in third molar angulation and eruption space occurred irrespective of the type of treatment involved.

Conclusion

The angulation and eruption space of third molar improved following extraction of premolar or molar. Nonextraction treatment modality did not cause any adverse effects.

Do Exostoses Correlate with Contact Disfunctions? A Case Study of a Maxillary Exostosis

A maxillary exostosis is a benign overgrowth of bone that occurs on the outer or facial surface of the maxilla and is usually located near the premolar or molar teeth. This paper investigates the correlation between the presence and growth of jaw exostoses and the oral mechanics of contact. For this purpose, a case study of an upper jawbone exostosis of a female patient was considered. 3D models of the patient’s cranial bones were extracted from 2D computerized tomography (CT) data and were analyzed by proper software. A contact congruence evaluation based on the Winkler contact model was performed, and results were presented in terms of indentation maps and load distributions. Results were correlated with the theory of bone remodelling by Wolff.

Breastfeeding Versus Bottle Feeding on Malocclusion in Children: A Meta-Analysis Study

BACKGROUND

Breastfeeding plays an important role in child health. However, there are doubts about its influence on malocclusions. Systematic reviews have yielded contradictory results. Research aim: This study aimed to investigate whether the type and duration of breastfeeding are associated with malocclusions in primary teething.

METHODS

The review strategy included several electronic databases, lists of references, reviews, dissertation and thesis websites, experts, and other relevant documents. Published and unpublished observational studies ( N = 42) were reviewed using the Participants (children), Interventions (breastfeeding), Comparisons (bottle feeding), Outcomes (malocclusion), and Study design (observational) strategy, without restrictions on language or locale. Information about the authors, publication year, country of study, setting, study design, sample size, age, type and duration of exclusive and mixed breastfeeding, and malocclusions was recorded by two blinded evaluators. Quantitative meta-analysis ( N = 30) of the studies with available data was performed.

RESULTS

Breastfeeding was a protective factor against malocclusions. The odds of association increased with breastfeeding duration. Irrespective of duration, breastfeeding had a protective association with open bite. For those who were breastfed for up to 6 months, breastfeeding protected against overjet, open bite, posterior crossbite, and crowding. Breastfeeding for 12 months or longer was associated with lower odds of overjet, open bite, and posterior crossbite. Breastfeeding exclusively for 6 months was also a protective factor against malocclusions. However, studies on this subject presented low quality, statistical heterogeneity, and only unadjusted measures of association in most of the cases.

CONCLUSION

Breastfeeding beneficially affects primary occlusion when practiced for at least 6 months.

Dietary material properties shape cranial suture morphology in the mouse calvarium

Cranial sutures are fibrous connective tissue articulations found between intramembranous bones of the vertebrate cranium. Growth and remodeling of these tissues is partially regulated by biomechanical loading patterns that include stresses related to chewing. Advances in oral processing structure and function of the cranium that enabled mammalian-style chewing is commonly tied to the origins and evolution of this group. To what degree masticatory overuse or underuse shapes the complexity and ossification around these articulations can be predicted based on prior experimental and comparative work. Here, we report on a mouse model system that has been used to experimentally manipulate dietary material properties in order to investigate cranial suture morphology. Experimental groups were fed diets of contrasting material properties. A masticatory overuse group was fed pelleted rodent chow, nuts with shells, and given access to cotton bedding squares. An underuse group was deprived of cotton bedding as well as diverse textured food, and instead received gelatinized food continuously. Animals were raised from weaning to adulthood on these diets, and sagittal, coronal and lambdoid suture morphology was compared between groups. Predicted intergroup variation was observed in mandibular corpus size and calvarial suture morphology, suggesting that masticatory overuse is associated with jaw and suture growth. The anterior region of the sagittal suture where it intersects with the coronal suture (bregma) showed no effect from the experiment. The posterior sagittal suture where it intersects with the lambdoid sutures (lambda) was more complex in the overuse group. In other words, the posterior calvarium was responsive to dietary material property demands while the anterior calvarium was not. This probably resulted from the different strain magnitudes and/or strain frequencies that occurred during overuse diets with diverse material properties as compared with underuse diets deprived of such enrichment. This work highlights the contrasting pattern of the sutural response to loading differences within the calvarium as a result of diet.

Three-dimensional assessment of the middle cranial fossa and central skull base following Herbst appliance treatment

OBJECTIVES:

The purpose of this three-dimensional (3D) study was to assess retrospectively the middle cranial fossa and central skull base of patients treated with the Herbst appliance (HA).

MATERIALS AND METHODS:

3D surface virtual models of 40 Class II, division 1 malocclusion patients were generated from cone-beam computed tomography (CBCT) acquired before treatment (T0) and after 8 months of HA treatment (T1). T0 and T1 3D models were superimposed volumetrically at the anterior cranial fossa. Twenty subjects who had been treated with the Herbst appliance (HAG) were compared to 20 subjects who were not treated orthopedically. The latter group served as a comparison control group (CG). Quantitative assessments of the location and directional changes were made with linear and angular measurements between anatomical landmarks. Qualitative assessments of the spatial behavior of the middle cranial fossa and central skull base relative to the anterior cranial fossa were displayed graphically for visualization with color maps and semitransparent overlays. Non-parametric tests were performed to compare the between the HAG and CG.

RESULTS:

Point-to-point linear measurements and skeletal rotation (pitch, roll, and yaw) changes were very small along the observational period and were not significantly different between HAG and CG. Visual analysis of color maps and overlays confirmed that no changes in the cranial base were associated with HA.

CONCLUSIONS:

HA therapy did not produce clinically significant changes in the middle cranial fossa and central skull base.

Presurgical Preparation of Infants With Unilateral Cleft Lip and Palate: The SAC-PP-MR Innovative Technique

In this article, we demonstrate an effective, cheap, and fast way to shape the nasal alar cartilage in patients with unilateral cleft lip and palate. This technique straightens the vomer and brings the philtrum, columella, premaxilla, and the maxillary frenum to the midsagittal plane, while the alveolar ridges are shaped and positioned. This reduces the lip and palatal cleft to zero even in a 4-week period.

Skeletal dimensions as predictors for the shape of the nose in a South African sample: A cone-beam computed tomography (CBCT) study

The profile of the nose is an important feature for facial approximations. Although several manual and semi-automated prediction guidelines exist for estimating the shape of the nose, the reliability and applicability of these methods to South Africans groups are unknown. The aim of this study was to predict the displacements of capulometric landmarks from hard-tissue planes to facilitate nasal soft-tissue reconstruction in a South African sample. Cone beam computed tomography (CBCT) scans of 120 adult South Africans were selected from the Oral and Dental Hospital, University of Pretoria, South Africa. Measurements involving craniometric and capulometric landmarks of the nose were obtained as plane-to-plane distances. Correlation coefficients between hard- and soft-tissue measurements were determined, and regression equations computed to assist in the prediction of the most probable shape and size of the nose. All hard- and soft-tissue measurements appeared significantly different between groups, except for the distance between the pronasale and nasion in the transverse plane and for the distance between the alare and the nasion in the coronal plane. The nasal height, nasal bone length and the nasal bone projection were significant predictors of the pronasale, subnasale and alare positions. More precisely, the nasal height and the nasal bone length were significant predictors of the pronasale position in both groups. Nasal bone projection was only useful for predicting shape in white South Africans. The variation in the skeletal predictors of the external shape of the nose noted between black and white South Africans and the results of the cross-validation testing emphasize the need for population specific guidelines.

Evaluation of the Effects of the Dental and Skeletal Anchored Face Mask Therapies on the Craniofacial System by Using Nonlinear Finite Element Analysis

Aims

The aim of this study was to evaluate the biomechanical effects on the craniofacial complex of skeletal anchorage and dental anchorage during face mask therapy.

Subjects and Methods

Two nonlinear finite element (FE) simulations were performed using a three-dimensional FE model. Face mask therapy with dental anchorage in the upper canines and face mask therapy with skeletal anchorage in the piriform apertures of the maxilla were simulated. In both simulations, the magnitude of the applied force was 750 g per side, and the force direction was 30° forward and downward relative to the occlusal plane.

Results

The circummaxillary sutures showed greater and more uniform stresses in the skeletal anchorage model than the dental anchorage model. This is the result of the more parallel forward movement of the maxilla in the skeletal anchorage model.

Conclusions

In Class III malocclusions with maxillary deficiency, for improved effects on the maxilla, choosing skeletal anchorage may be more effective in face mask therapies

Ontogeny of the Postorbital Region in Tarsiers and Other Primates

Bony structure of the postorbital region is a key trait distinguishing major clades of primates. Strepsirrhines share a postorbital bar, and anthropoids share a complete postorbital septum. At issue is whether the partial postorbital septum of tarsiers unites living tarsiers more closely with anthropoids than with certain large-eyed Eocene fossils. Previously we reported incomplete postorbital closure in tarsiers at birth. In this article, we document comparative analyses of the postorbital region in a broad range of perinatal primates. Virtual reconstructions of microCT data were used to study three-dimensional structure of the perinatal cranium in these taxa. We also describe and illustrate formation of the tarsier partial postorbital septum through the perinatal period using a growth series of Tarsius syrichta. Our results support the hypothesis that partial postorbital septation in the tarsier is secondary to eye hypertrophy. Based on these observations, we propose a structural hypothesis for phylogenetic differences observed in the primate postorbital region. Specifically, we propose that key postorbital traits, including the frontal spur in strepsirrhines and the posterior lamina of the zygomatic in anthropoids, develop as a result of the spatial relationships of brain, eyes, and teeth. Haplorhines are united by expansion of the anterior cranial fossa and loss of the frontal spur. Anthropoids are further united to the exclusion of tarsiers by expansion of the temporal lobes and associated formation of the posterior lamina of the zygomatic. Mechanical forces related to these spatial relationships may be modulated by deep fascia of the orbit to induce formation of the postorbital septum. Anat Rec, 299:1631-1645, 2016. © 2016 Wiley Periodicals, Inc.

Assessment of Labionasal Structures in Patients With Unilateral Cleft Lip

INTRODUCTION

Unilateral cleft lip (UCL) patients have lip and nose deformities that must be addressed during lip repair. Currently, devices to achieve lip and nose improvements have been developed. The most researched presurgical molding device is the nasoalveolar molding (NAM), which has shown favorable results. However, clinical observation shows that unilateral cleft patients, even without molding devices, achieve spontaneous improvements. The aim of this study is to compare morphological and symmetry changes in nose and lip, between patients less than 30-day old and those submitted to cheiloplasty, at 6 months of age.

MATERIALS AND METHODS

A total of 27 UCL patients with 2 photographs were selected. The pictures were taken from frontal view and nasal base view at 2 distinct moments: before 30 days of life (t1) and at 6 months of age, during cheiloplasty surgery (T2). Images were analyzed with indirect measurement to assess lip and nose dimensions and nasal symmetry. ImageJ software was used to perform the analyses.

RESULTS

A total of 20 patients (P < 0.05) had an average cleft width reduction of 15% [standard deviation (SD) ± 11%]. A 55% average increase (SD ± 29%) was observed in nostril height of cleft side in 16 of patients (P < 0.05). There was an reduction in facial asymmetry of nostril width (P < 0.05), from 95% (SD ± 90%) (t1) to 59% (SD ± 50) (T2). Also, nasal base width asymmetry (P < 0.05) was decreased from 64% (SD ± 66%) (t1) to 40% (SD ± 29%) (T2).

CONCLUSION

Facial growth causes a natural improvement on cleft morphological changes and nasal symmetry.

Functional dental occlusion: an anthropological perspective and implications for practice

Physiologic changes occur in dental occlusion throughout life, resulting from the interplay between functional demands and reciprocating adaptive responses. These changes have been reported in the anthropological literature and they reflect evolutionary changes in the human stomatognathic system during the Paleolithic, hunter-gatherer period. Specific occlusal changes occur in response to different environments, leading to extensive variation within and between extinct and extant human populations. For example, functional demands can cause occlusal and interproximal tooth wear, resulting in shortening of the dental arch, continual tooth eruption and changes in masticatory patterns. Since the advent of farming through to our current industrialized culture, functional demands on the human masticatory system, and its adaptive responses to these demands, have been reduced considerably. Indeed, it is only occasionally that functional demands are severe enough to lead to obvious pathology in the modern human dentition. In contrast to normal masticatory activity, 'modern-day conditions' such as dental caries, periodontal disease and erosion, can lead to significant changes in dental occlusion that are pathological and need to be treated. The masticatory system is a dynamic, functional unit that displays considerable change over a lifetime. In this concept paper, it is proposed that modern human populations living in industrialized environments display dental occlusions that can be considered to be 'neotenous'; that is, our dentitions tend to reflect an unworn stage of our ancestors that was only seen in infants, juveniles and young adults. Clinicians can draw on both phylogenetic and ontogenetic perspectives of 'functional dental occlusion' to differentiate continual physiological changes occurring over time that require ongoing review, from pathological responses that require intervention.

Growth of the flat bones of the membranous neurocranium: a computational model

This article assumes two stages in the formation of the bones in the calvaria, the first one takes into account the formation of the primary centers of ossification. This step counts on the differentiation from mesenchymal cells into osteoblasts. A molecular mechanism is used based on a system of reaction-diffusion between two antagonistic molecules, which are BMP2 and Noggin. To this effect we used equations whose behavior allows finding Turing patterns that determine the location of the primary centers. In the second step of the model we used a molecule that is expressed by osteoblasts, called Dxl5 and that is expressed from the osteoblasts of each flat bone. This molecule allows bone growth through its borders through cell differentiation adjacent to each bone of the skull. The model has been implemented numerically using the finite element method. The results allow us to observe a good approximation of the formation of flat bones of the membranous skull as well as the formation of fontanelles and sutures.

Postnatal changes in the growth dynamics of the human face revealed from bone modelling patterns

Human skull morphology results from complex processes that involve the coordinated growth and interaction of its skeletal components to keep a functional and structural balance. Previous histological works have studied the growth of different craniofacial regions and their relationship to functional spaces in humans up to 14 years old. Nevertheless, how the growth dynamics of the facial skeleton and the mandible are related and how this relationship changes through the late ontogeny remain poorly understood. To approach these two questions, we have compared the bone modelling activities of the craniofacial skeleton from a sample of subadult and adult humans. In this study, we have established for the first time the bone modelling pattern of the face and the mandible from adult humans. Our analyses reveal a patchy distribution of the bone modelling fields (overemphasized by the presence of surface islands with no histological information) reflecting the complex growth dynamics associated to the individual morphology. Subadult and adult specimens show important differences in the bone modelling patterns of the anterior region of the facial skeleton and the posterior region of the mandible. These differences indicate developmental changes in the growth directions of the whole craniofacial complex, from a predominantly downward growth in subadults that turns to a forward growth observed in the adult craniofacial skeleton. We hypothesize that these ontogenetic changes would respond to the physiological and physical requirements to enlarge the oral and nasal cavities once maturation of the brain and the closure of the cranial sutures have taken place during craniofacial development.

Management of Traumatic Injury to Maxillary Central Incisors associated with Inverted Mesiodens: A Case Report

Maxillary incisors are the most frequently injured teeth in the primary and permanent dentition. Stage of adolescence show a significant number of dental injuries as they engage in contact sports. Children with accident prone profile, i.e. class II division I or class I type II malocclusion are more prone for injuries because of the proclined maxillary incisors. Supernumerary teeth are those that are additional to the normal complement. They occur in single or multiple, unilateral or bilateral in either of the jaws. This paper reports the presence of an inverted supernumerary tooth in the right maxillary central incisor region with trauma involving both maxillary central incisors and also the management of the supernumerary tooth and traumatized teeth in a 14-year-old boy.

How to cite this article: Pavuluri C, Nuvvula S. Management of Traumatic Injury to Maxillary Central Incisors associated with Inverted Mesiodens: A Case Report. Int J Clin Pediatr Dent 2013;6(1):30-32.

Crouzon's Syndrome: A Case Report

Crouzon's syndrome (CS) is a rare autosomal dominant condition with multiple mutations of the fibroblast growth factor receptor (FGFR2) gene, which accounts for 4.8% of all cases of craniosynostosis. It is characterized by premature closure of cranial sutures, cranial deformities, midface hypoplasia, relative mandibular prognathism, hypertelorism, proptosis, strabismus and short upper lip, crowding of teeth, pseudocleft or sometimes cleft palate and other associated abnormalities. The CS can vary in severity from mild presentation to severe forms involving multiple cranial sutures. We report a case of CS in 11-year-old boy. How to cite this article: Kumar GR, Jyothsna M, Ahmed SB, Lakshmi KS, Crouzon's Syndrome: A Case Report. Int J Clin Pediatr Dent 2013;6(1):33-37.

Effect of Propolis on Streptococcus mutans Counts: An in vivo Study

Propolis, a natural antibiotic, is a resinous substance that honey bees (Apis mellifera) produce. The main chemical classes present in propolis are flavonoids, phenolics and other various aromatic compounds.

Aim: To evaluate the antibacterial action of propolis on the concentration of Streptococcus mutans colonizing the oral cavity of children.

Materials and methods: Thirty children performed the rinses, with no other changes in their oral hygiene and dietary habits. Saliva was collected at two time points: Before using the product, 1 hour after the rinse.

Results: Paired t-test was used for analysis of the results. A reduction in the concentration of Streptococcus mutans was observed in samples collected after use of the extract. There was a reduction in Streptococcus mutans count when compared to samples obtained in baseline. Significant reductions were seen at the end of 1 hour. The result was statistically significant. There were no side effects in soft and hard tissues of mouth.

Conclusion and clinical implication: The propolis possesses in vivo antimicrobial activity against Streptococcus mutans present in the oral cavity and might be used as a measure to prevent dental caries.

How to cite this article: Hegde KS, Bhat SS, Rao A, Sain S. Effect of Propolis on Streptococcus mutans Counts: An in vivo Study. Int J Clin Pediatr Dent 2013;6(1):22-25.

A comparative study of color stability and fluoride release from glass ionomer cements combined with chlorhexidine

Background: Restoring carious teeth is one of the major treatment needs of young children. Glass ionomer cement (GIC) systems had become the most important dental restorative and luting materials for use in preschoolers, children and teenagers. Several attempts in developing GIC with antibacterial effects by addition of bactericides, such as chlorhexidine, have been reported.

Aim: Aim of the study was to evaluate and compare the color and fluoride ion release of conventional and resin-modified GICs in combination with 1.25 and 2.5% chlorhexidine diacetate.

Materials and methods: The control groups consisted of conventional GIC and resin-modified GIC. The experimental groups consisted of conventional and resin-modified GIC groups, consisting of 1.25 and 2.5% chlorhexidine. A total of six groups were included with each group being allotted 20 specimens for the evaluation of color stability and 10 specimens each were allotted for the evaluation of fluoride release.

Color and fluoride release were recorded using spectrophoto-meter and fluoride selective electrode respectively at 24 hours 7 days and 1 month.

Results: Resin-modified GIC groups showed less color stability and better fluoride release at the end of the study compared to conventional GIC groups.

Conclusion: There was no significant change in color and fluoride release between 1.25 and 2.5% conventional GIC and also between 1.25 and 2.5% resin-modified GIC combined with chlorhexidine diacetate at the end of the study. Conventional GIC showed better color stability and less fluoride release compared to resin-modified GIC.

How to cite this article: Prabhakar AR, Pattanshetti K, Sugandhan S. A Comparative Study of Color Stability and Fluoride Release from Glass Ionomer Cements Combined with Chlorhexidine. Int J Clin Pediatr Dent 2013;6(1):26-29.

Foreign body in root canals of two adjacent deciduous molars: a case report

Children often tend to have the habit of inserting foreign objects in the oral cavity unknowingly for relief of dental pain. Sometimes, children do not reveal to their parents due to fear. These foreign objects may act as a potent source of infection and painful condition. The discovery of foreign bodies in the teeth is a special situation, which is often diagnosed accidentally. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, location of the foreign body and the difficulty involved in its retrieval. Here is a case report, where foreign object was accidentally lodged in the carious deciduous molars by a child. How to cite this article: Dhull KS, Acharya S, Ray P, Dhull RS. Foreign Body in Root Canals of Two Adjacent Deciduous Molars: A Case Report. Int J Clin Pediatr Dent 2013;6(1):38-39.

Classification of Interdental Space for Different Quadrants on the Basis of Standardization through Threshold Data and Its Comparison with BMI and Socioeconomic Status

BACKGROUND

A better knowledge about the Interdental space is important since it provides insights on the prevalence of malocclusion. To date, there is conflicting evidence on the impact of body mass index (BMI) and Socioeconomic status (SES) on interdental space. A recent review concluded that a greater understanding is required of the interdental space. Therefore, there is a need for a more comprehensive and rigorous assessments of the interdental space and impacts of BMI and SES.

AIM

BMI and SES can be associated with the interdental spacing in deciduous dentition.

DESIGN

The present cross-sectional study was carried out on 448 children of age group of 3 to 5 years out of which 392 were meeting our criteria. Research assessment questionnaire on demographic data was completed by the parents. Study model cast of 392 children free from malocclusion were analyzed.

RESULTS

A statistically significant association between interdental spacing and BMI category was observed. Comparison of BMI with above threshold interdental space revealed that after an optimum weight there is no effect on interdental space. A significant association between SES and interdental spacing was observed for all the four locations (p < 0.01).

CONCLUSION

Evolved normative value can be taken as a standard and the occlusion and interdental spaces are not two completely separate entities and they are interdependent. How to cite this article: Singh T, Singh R, Singh JP. Classification of Interdental Space for Different Quadrants on the Basis of Standardization through Threshold Data and Its Comparison with BMI and Socioeconomic Status. Int J Clin Pediatr Dent 2013;6(1):16-21.

Facial skeletal trauma in the growing patient

The management of pediatric craniomaxillofacial trauma requires the additional dimension of understanding growth and development. The surgeon must appreciate the considerable influence of the soft tissue envelope and promote function when possible. Children heal well but with an exuberant tissue response that may contribute to greater scarring, therefore, careful and prudent attention given to meticulous soft tissue repair and support is critical. Support must also be given and sought from the family of the injured child. Follow-up management of children must continue to ensure that the growth of the craniomaxillofacial skeleton continues within the normal parameters of development.