Age-related osteogenesis on lateral force application to rat incisor – Part III: Periodontal and periosteal bone remodeling

Objectives:

This study was aimed to compare the histological pattern of bone modeling on either periodontal or periosteal side induced by lateral orthodontic tooth movement in different age groups.

Material and Methods:

A total of 50 male Sprague-Dawley rats (25 rats in the adult group – 52 weeks and 25 rats in the young group – 10 weeks) were utilized in this study. Each age group was classified into the control, 3 days, 7 days, 14 days, and 21 days groups (five rats in each) by the duration of experimental device application. A double-helical spring was produced using 0.014” stainless steel wire to provide 40 g lateral force to the left and right incisors. Hematoxylin-eosin staining, proliferating cell nuclear antigen (PCNA) immunohistochemical staining, fibroblast growth factor receptor 2 (FGFR2) immunohistochemical staining, and Masson trichrome staining were performed; and the slides were subject to histological examination.

Results:

In 7 days, active bone modeling represented by the scalloped surface was observed on the periosteal side of the crestal and middle alveolus at the pressure side in the young group, while similar changes were observed only on the crestal area in the adult group. In the young group, the number of PCNA-positive cells increased significantly on the crestal area and middle alveolus on the 3, 7, and 14 day groups, with subsequent decrease at 21 days. In the adult group, PCNA-positive cells were localized on the crestal area throughout the period. In the young group, FGFR2-positive cells were observed mainly on the crestal and middle alveolus at 3, 7, and 14 days than the control group. In the adult group, these cells appeared on the crestal and middle alveolus in the 3 days group, but mainly on the crestal area at 14 days. In the young group, FGFR2-positive cells were observed on the crestal and middle alveolus on the 3, 7, and 14 days groups more than on the control group. In the adult group, these cells appeared on the crestal and middle alveolus in the 3 days group, but mainly on the crestal area in the 14 days group. In Masson trichrome stain, an increased number of type I collagen fibers were observed after helical spring activation in both age groups. Large resorption lacunae indicating undermining bone resorption were progressively present in both young and adult groups.

Conclusion:

According to these results, orthodontic tooth movement may stimulate cell proliferation and differentiation primarily on the periosteal side according to progressive undermining bone resorption on the periodontal side. This response may lead to prominent bone modeling during tooth movement in the young group, compared to the relatively delayed response in the adult group.

Age-related osteogenesis on lateral force application to rat incisor – Part II: Bony recession and cortical remodeling

Objective:

The aim of this study is to analyze the age-related changes in the bony recession and cortical bone remodeling induced by lateral orthodontic tooth movement, using a three-dimensional micro-computed tomography (CT) analysis.

Material and Methods:

A total of 40 male Sprague-Dawley rats were divided into two distinct age groups (young, 10 weeks and adult, 52 weeks). Double-helical springs exerting 40 g of force were applied to central incisors to analysis of changes in lateral cortical bone and tooth movement with age and time. The young and adult rats were divided into four subgroups, T0 (0 week), T1 (1 week), T2 (2 weeks), and T3 (3 weeks), depending on the period of wearing the appliance. Micro-CT image was taken on each dissected pre-maxilla specimen. In each subgroup, distance between the center of teeth, suture width, tooth displacement, bony recession, and bone volume was evaluated.

Results:

The changes in the distance between the center of teeth and the suture width were significantly greater in the young group. However, the change in the tooth displacement showed no significant difference between groups. In the young group, bony recession of outer cortical layer was observed at T1 (P < 0.05), but the amount of recession gradually decreased at T2 and T3. In contrast, in the adult group, bony recession increased gradually over observation period (P < 0.05). The bone volume decreased at T1 (P < 0.05), but recovered at T2 and T3 in both groups.

Conclusion:

The compensatory bone formation occurs in the pressure side of cortical bone more significantly in the young group than in the adult according to the lateral displacement of incisor in rats. The reduced bone reaction in the adult is considered a limiting factor of the excessive tooth movement in the compromised treatment of skeletal malocclusion.

Differences in mandibular condyle and glenoid fossa morphology in relation to vertical and sagittal skeletal patterns: A cone-beam computed tomography study

Objective

This study aimed to evaluate the following null hypothesis: there are no differences in the morphology of the temporomandibular joint (TMJ) structures in relation to vertical and sagittal cephalometric patterns.

Methods

This retrospective study was performed with 131 participants showing no TMJ symptoms. The participants were divided into Class I, II, and III groups on the basis of their sagittal cephalometric relationships and into hyperdivergent, normodivergent, and hypodivergent groups on the basis of their vertical cephalometric relationships. The following measurements were performed using cone-beam computed tomography images and compared among the groups: condylar volume, condylar size (width, length, and height), fossa size (length and height), and condyle-to-fossa joint spaces at the anterior, superior, and posterior condylar poles.

Results

The null hypothesis was rejected. The Class III group showed larger values for condylar width, condylar height, and fossa height than the Class II group (p < 0.05). Condylar volume and superior joint space in the hyperdivergent group were significantly smaller than those in the other two vertical groups (p < 0.001), whereas fossa length and height were significantly larger in the hyperdivergent group than in the other groups (p < 0.01). The hypodivergent group showed a greater condylar width than the hyperdivergent group (p < 0.01). The sagittal and vertical cephalometric patterns showed statistically significant interactions for fossa length and height.

Conclusions

TMJ morphology differed across diverse skeletal cephalometric patterns. The fossa length and height were affected by the interactions of the vertical and sagittal skeletal patterns.

Miniscrew-assisted rapid palatal expansion: A review of recent reports

The miniscrew-assisted rapid palatal expander (MARPE) has extended not only skeletal effects with fewer dental changes and but also the age limit of nonsurgical maxillary expansion treatment. Amid its gaining popularity in clinical orthodontics, our current understanding of treatment effectiveness, efficiency, and stability needs to be reassessed. In this review article, the authors have attempted to evaluate MARPE from various aspects with a focus on recent studies.

Positional changes in the mandibular proximal segment after intraoral vertical ramus osteotomy: Surgery-first approach versus conventional approach

Objective

To compare postoperative positional changes in the mandibular proximal segment between the conventional orthognathic surgery (CS) and the surgery-first approach (SF) using intraoral vertical ramus osteotomy (IVRO) in patients with Class III malocclusion.

Methods

Thirty-eight patients with skeletal Class III malocclusion who underwent bimaxillary surgery were divided into two groups according to the use of preoperative orthodontic treatment CS group (n = 18) and SF group (n = 20). Skeletal changes in both groups were measured using computed tomography before (T0), 2 days after (T1), and 1 year after (T2) the surgery. Three-dimensional (3D) angular changes in the mandibular proximal segment, condylar position, and maxillomandibular landmarks were assessed.

Results

The mean amounts of mandibular setback and maxillary posterior impaction were similar in both groups. At T2, the posterior portion of the mandible moved upward in both groups. In the SF group, the anterior portion of the mandible moved upward by a mean distance of 0.9 ± 1.0 mm, which was statistically significant (p < 0.001). There were significant between-group differences in occlusal changes (p < 0.001) as well as in overjet and overbite. However, there were no significant between-group differences in proximal segment variables.

Conclusions

Despite postoperative occlusal changes, positional changes in the mandibular proximal segment and the position of the condyles were similar between CS and SF, which suggested that SF using IVRO achieved satisfactory postoperative stability. If active physiotherapy is conducted, the proximal segment can be adapted in the physiological position regardless of the occlusal changes.

Stability of bimaxillary surgery involving intraoral vertical ramus osteotomy with or without presurgical miniscrew-assisted rapid palatal expansion in adult patients with skeletal Class III malocclusion

Objective

The aim of this study was to evaluate the stability of bimaxillary surgery involving bilateral intraoral vertical ramus osteotomy performed with or without presurgical miniscrew-assisted rapid palatal expansion (MARPE) in adult patients with skeletal Class III malocclusion.

Methods

A total of 40 adult patients with skeletal Class III malocclusion were retrospectively divided into two groups (n = 20 each) according to the use of MARPE for the correction of transverse maxillomandibular discrepancy during presurgical orthodontic treatment. Serial lateral cephalograms and dental casts were analyzed until 6 months after surgery.

Results

Before presurgical orthodontic treatment, there was no significant differences in terms of sex and age between groups. However, the difference of approximately 3.1 mm in the maxillomandibular intermolar width was statistically significant (p < 0.001). Two days after surgery, the mandible had moved backward and upward without any significant intergroup difference. Six months after surgery, the maxillary intercanine (2.7 ± 2.1 mm), interpremolar (3.6 ± 2.4 mm), and intermolar (2.0 ± 1.3 mm) arch widths were significantly increased (p < 0.001) relative to the values before presurgical orthodontic treatment in the MARPE group; these widths were maintained or decreased in the control group. However, there was no significant difference in surgical changes and the postsurgical stability between the two groups. No significant correlations existed between the amount of maxillary expansion and postsurgical mandibular movement.

Conclusions

MARPE is useful for stable and nonsurgical expansion of the maxilla in adult patients with skeletal Class III malocclusion who are scheduled for bimaxillary surgery.

Comprehensive orthodontic treatment of a young girl with an odontogenic keratocyst and impacted teeth in the mandible

Odontogenic keratocysts (OKCs) are one of the most aggressive cysts in the oral and maxillofacial area because of their high recurrence rate and infiltrative behavior. In growing patients with OKCs, a radical treatment approach might cause numerous complications, including the disturbance of jaw growth and loss of the involved tooth. This case report describes successful comprehensive orthodontic treatment combined with marsupialization of the cyst in a young girl who exhibited an OKC with impacted teeth. The 10-year-old girl presented with an OKC extending from the mandibular symphysis through the left mandibular body, with ectopic impaction of the mandibular left canine and first premolar, as well as congenitally missing bilateral mandibular second premolars. Interestingly, spontaneous improvement of the positions of the ectopic impacted teeth, along with a reduction in the size of the cyst, occurred during marsupialization. The sequential use of removable and fixed appliances enabled orthodontic traction of the impacted teeth. The treatment outcome was stable at 2.5 years after the end of the treatment. We speculate that comprehensive orthodontic treatment combined with marsupialization can be an effective treatment strategy for patients with OKCs, especially when they are encountered in young, growing patients with impacted teeth.

Diagnosis and Surgical Outcomes of Facial Asymmetry According to the Occlusal Cant and Menton Deviation

PURPOSE

Morphologic differences and surgical outcomes were compared between the ipsilateral type of facial asymmetry, in which the menton deviates to the side of the upward frontal occlusal plane (FOP) cant (FOP_UP), and the contralateral type, in which the menton deviates to the side of the downward FOP cant (FOP_DOWN), by using cone beam computed tomography (CBCT) images.

MATERIALS AND METHODS

This retrospective study included consecutive patients with skeletal Class III malocclusion and facial asymmetry who had undergone bimaxillary orthognathic surgery and serial CBCT before, 1 month after, and 1 year after surgery. CBCT images were reconstructed and analyzed for predictor (group and timing) and outcome (CBCT measurements over time) variables. The data were analyzed using independent t tests and paired t tests.

RESULTS

The contralateral group (n = 12) was selected first; the ipsilateral group (n = 12) was selected by matching age, gender, and degree of FOP cant with those of the contralateral group. Before surgery, in the ipsilateral group, the ramal length was longer on the nondeviated (N-Dev) side than on the deviated (Dev) side (P < .05) whereas the mandibular body length showed no significant difference (P > .05). In the contralateral group, the ramal length was longer on the Dev side (P < .05) whereas the mandibular body length was longer on the N-Dev side (P < .01). One year after surgery, most measurements were corrected symmetrically in both groups (P > .05); however, the hemi-lower facial area remained asymmetrical in the contralateral group (P < .05).

CONCLUSIONS

Differences in ramal lengths in the ipsilateral group and mandibular body lengths in the contralateral group between the Dev and N-Dev sides seemed to be the main cause of facial asymmetry. Although facial asymmetry improved after surgery in both groups, asymmetry in the soft tissue remained in the contralateral group 1 year after surgery.

Three-dimensional computed tomography analysis of mandibular morphology in patients with facial asymmetry and mandibular retrognathism

INTRODUCTION

The purpose of this study was to analyze the morphologic features of skeletal units in the mandibles of patients with facial asymmetry and mandibular retrognathism using cone-beam computed tomography.

METHODS

The subjects consisted of 50 adults with facial asymmetry and mandibular retrognathism, divided into the symmetry group (n = 25) and the asymmetry group (n = 25) according to the degree of menton deviation. Three-dimensional computed tomography scans were obtained with cone beam computed tomography. Landmarks were designated on the reconstructed 3-dimensional images. Linear and volumetric measurements were made on the mandibles.

RESULTS

In the asymmetry group, the lengths of condylar, body, and coronoid units were shorter, and condylar width was narrower on the deviated side than on the nondeviated side (P <0.01). The lengths of angular and chin units were not significantly different between the deviated and nondeviated sides (P >0.05). Hemimandibular, ramal, and body volumes were less on the deviated side than on the nondeviated side (P <0.01).

CONCLUSIONS

Condylar, body, and coronoid units contribute to mandibular asymmetry in patients with facial asymmetry and mandibular retrognathism.

Effects of bodily retraction of mandibular incisors versus mandibular setback surgery on pharyngeal airway space: A comparative study

Objective

The purpose of this study was to compare the changes induced in the pharyngeal airway space by orthodontic treatment with bodily retraction of the mandibular incisors and mandibular setback surgery without extraction.

Methods

This retrospective study included 63 adult patients (32 men and 31 women). Thirty-three patients who had been treated via four-bicuspid extraction and bodily retraction of the mandibular incisors (incisor retraction, IR group) were compared with 30 patients who had been treated via mandibular setback surgery (MS group) without extraction. Lateral cephalograms were acquired and analyzed before (T1) and after treatment (T2).

Results

The superior pharyngeal airway space did not change significantly in either group during treatment. The middle pharyngeal airway space decreased by 1.15 ± 1.17 mm and 1.25 ± 1.35 mm after treatment in the IR and MS groups, respectively, and the decrease was comparable between the two groups. In the MS group, the inferior pharyngeal airway space (E-IPW) decreased by 0.88 ± 1.67 mm after treatment (p < 0.01). The E-IPW was larger in the MS group than in IR group at T1, but it did not differ significantly between the two groups at T2. No significant correlation was observed between changes in the pharyngeal airway space and the skeletal and dental variables in each group.

Conclusions

The middle pharyngeal airway space decreased because of the posterior displacement of the mandibular incisors and/or the mandibular body. The E-IPW decreased only in the MS group because of the posterior displacement of only the mandibular body.

Repeated injections of botulinum toxin into the masseter muscle induce bony changes in human adults: A longitudinal study

OBJECTIVE

To evaluate soft- and hard-tissue changes in the mandibular angle area after the administration of botulinum toxin type A (BoNT-A) injection to patients with masseteric hypertrophy by using three-dimensional cone-beam computed tomography (3D-CBCT).

METHODS

Twenty volunteers were randomly divided into two groups of 10 patients. Patients in group I received a single BoNT-A injection in both masseter muscles, while those in group II received two BoNT-A injections in each masseter muscle, with the second injection being administered 4 months after the first one. In both groups, 3D-CBCT was performed before the first injection and 6 months after the first injection.

RESULTS

Masseter muscle thicknesses and cross-sectional areas were significantly reduced in both groups, but the reductions were significantly more substantial in group II than in group I. The intergonial width of the mandibular angle area did not change significantly in either group. However, the bone volume of the mandibular gonial angle area was more significantly reduced in group II than in group I.

CONCLUSIONS

The repeated administration of BoNT-A injections may induce bone volume changes in the mandibular angle area.

Is There a Difference in Stability After Intraoral Vertical Ramus Osteotomy Between Vertically High-Angle and Normal-Angle Patients?

PURPOSE

Few studies have evaluated the relapse pattern of intraoral vertical ramus osteotomy (IVRO) for the correction of mandibular prognathism with a high angle. The aim of this study was to measure the association between vertical facial types (high and normal mandibular plane angle) and relapse after IVRO for the management of mandibular prognathism.

MATERIALS AND METHODS

The retrospective cohort study sample (skeletal Class III patients) was divided into 2 groups according to the angle of the sella-nasion plane relative to the mandibular plane (SN-MP) at the initial examination. Lateral cephalograms were analyzed for the predictor (facial type) and outcome (cephalometric changes over time) variables before surgery, 7 days after surgery, and 12 months after surgery. The 2 groups were matched for sample size (n = 20 in each). Data were analyzed using repeated-measures analysis of variance with Bonferroni correction.

RESULTS

The normal-angle group (group N, SN-MP from 27° to 37°) and high-angle group (group H, SN-MP >37°) were not significantly different in terms of gender and age at the initial examination. Seven days after surgery, the mandibles in group H moved 2.5 mm more superiorly than those in group N (P = .013); consequently, the amount of overbite correction in group H was approximately 2 mm greater than that in group N (P = .002). Nevertheless, 12 months after surgery, there was no statistically significant difference in relapse of the maxilla and mandible between the 2 groups. In the 2 groups, the mandible moved approximately 0.7 mm superiorly during retention.

CONCLUSIONS

These findings suggest that IVRO is a clinically acceptable and stable treatment modality for mandibular prognathism with a high angle.

Evaluation of stability after pre-orthodontic orthognathic surgery using cone-beam computed tomography: A comparison with conventional treatment

OBJECTIVE

The aim of this study was to evaluate the skeletal and dental changes after intraoral vertical ramus osteotomy (IVRO) with and without presurgical orthodontics by using cone-beam computed tomography (CBCT).

METHODS

This retrospective cohort study included 24 patients (mean age, 22.1 years) with skeletal Class III malocclusion who underwent bimaxillary surgery with IVRO. The patients were divided into the preorthodontic orthognathic surgery (POGS) group (n = 12) and conventional surgery (CS) group (n = 12). CBCT images acquired preoperatively, 1 month after surgery, and 1 year after surgery were analyzed to compare the intergroup differences in postoperative three-dimensional movements of the maxillary and mandibular landmarks and the changes in lateral cephalometric variables.

RESULTS

Baseline demographics (sex and age) were similar between the two groups (6 men and 6 women in each group). During the postsurgical period, the POGS group showed more significant upward movement of the mandible (p < 0.05) than did the CS group. Neither group showed significant transverse movement of any of the skeletal landmarks. Moreover, none of the dental and skeletal variables showed significant intergroup differences 1 year after surgery.

CONCLUSIONS

Compared with CS, POGS with IVRO resulted in significantly different postsurgical skeletal movement in the mandible. Although both groups showed similar skeletal and dental outcomes at 1 year after surgery, upward movement of the mandible during the postsurgical period should be considered to ensure a more reliable outcome after POGS.

Changes in the craniofacial complex and alveolar bone height of young adults: Applications to dental medicine

The few studies on craniofacial complex changes in adults have reported contradictory findings. The aim of this study was to radiographically evaluate changes in the craniofacial complex and alveolar bone height of young adults over a 4-year period. This prospective study included 82 young adults (62 men; mean age, 19.0 ± 0.8 years; 20 women; mean age, 18.8 ± 0.9 years). Three radiographic examinations were performed longitudinally: the first (T0) was conducted at the start of the study, the second (T1) was conducted 2 years later, and the third (T2) was conducted at the end of the study period. As part of these examinations, lateral cephalograms, maxillary and mandibular anterior periapical radiographs, and bilateral posterior bitewing radiographs were obtained. During the 4-year follow-up period, all linear cephalometric measurements were significantly greater in men than in women. The amount of increase in the anterior facial height between T1 and T2 was lower in women than in men (P = 0.029). The rate of uprighting of the upper incisors was lower in men than in women over time (P = 0.020). The apex of the nose moved inferiorly between T0 and T2 (P = 0.006). The average overall change in the alveolar bone height was 0.27 mm and the yearly change was 0.07 mm over the 4-year period (P< 0.001). Significant changes in the skeletal, dental, and soft tissue, as well as, natural changes in alveolar bone, occur in young adults over time. Clin. Anat. 29:1011-1017, 2016. © 2016 Wiley Periodicals, Inc.

Five-year investigation of a large orthodontic patient population at a dental hospital in South Korea

Objective

The purpose of this study was to investigate the characteristics of orthodontic patients at Yonsei Dental Hospital from 2008 to 2012.

Methods

We evaluated Angle's classification from molar relationships, classification of skeletal malocclusion from the A point-nasion-B point angle, facial asymmetry, and temporomandibular joint disorders (TMDs) from the records of 7,476 patients who received an orthodontic diagnosis. The orthognathic surgery rate, extraction rate, and extraction sites were determined from the records of 4,861 treated patients.

Results

The patient number increased until 2010 and gradually decreased thereafter. Most patients were aged 19−39 years, with a gradual increase in patients aged ≥ 40 years. Angle's Class I, Class II divisions 1 and 2, and Class III malocclusions were observed in 27.7%, 25.6%, 10.6%, and 36.1% patients, respectively, with a gradual decrease in the frequency of Class I malocclusion. The proportion of patients with skeletal Class I, Class II, and Class III malocclusions was 34.3%, 34.3%, and 31.4%, respectively, while the prevalence of facial asymmetry and TMDs was 11.0% and 24.9%, respectively. The orthognathic surgery rate was 18.5%, with 70% surgical patients exhibiting skeletal Class III malocclusion. The overall extraction rate among nonsurgical patients was 35.4%, and the maxillary and mandibular first premolars were the most commonly extracted teeth.

Conclusions

The most noticeable changes over time included a decrease in the patient number after 2010, an increase in the average patient age, and a decrease in the frequency of Angle's Class I malocclusion. Our results suggest that periodic characterization is necessary to meet the changing demands of orthodontic patients.

Mandibular posterior anatomic limit for molar distalization

INTRODUCTION

The purpose of this study was to investigate the mandibular posterior anatomic limit for molar distalization.

METHODS

Three-dimensional computed tomography scans were obtained on 34 adults with a skeletal Class I normodivergent facial profile and a normal occlusion. Posterior available space was measured at the crown and root levels along the posterior occlusal line connecting the buccal cusps of the first and second molars on the axial slices. It was also measured at the occlusal level on the lateral cephalograms derived from the computed tomography scans. The measurements on the cephalograms were used to predict the actual posterior available space determined by computed tomography and to determine the presence of root contact with the inner lingual cortex by linear regression and discriminant analyses, respectively.

RESULTS

The posterior available space was significantly smaller at the root level than at the crown level. Root contact was observed in 35.3% of the 68 roots. The posterior available space measured on the lateral cephalograms resulted in a regression equation with a coefficient of determination of 0.261 to predict actual available space and correctly identified root contact in 66.2% of cases with a threshold value of 3.9 mm.

CONCLUSIONS

The posterior anatomic limit appeared to be the lingual cortex of the mandibular body. Computed tomography scans are recommended for patients who require significant mandibular molar distalization.

Dentoalveolar compensation according to skeletal discrepancy and overjet in skeletal Class III patients

INTRODUCTION

This study was designed to investigate dentoalveolar compensation in untreated skeletal Class III patients with either positive or negative overjet.

METHODS

The positive overjet groups consisted of 104 adults, divided into group 1 (angle between sella-nasion to mandibular plane (SN-MP) > 38°, n = 30), group 2 (30° < SN-MP < 38°, n = 43), and group 3 (SN-MP <30°, n = 31). The negative overjet groups (groups 4-6) consisted of 90 adults who were closely matched to the positive overjet groups with regard to the ANB and SN-MP angles. Twenty-two cephalometric measurements were compared between the matched groups. In the positive overjet groups, correlation analysis was performed between the skeletal and dental measurements, and regression analysis was performed to determine the incisor-mandibular plane angle.

RESULTS

The maxillary incisors were more proclined and the occlusal plane was more flattened in the positive overjet groups than in the negative overjet groups; however, there was no statistically significant difference between them with regard to mandibular incisor inclination. The inclinations of the maxillary and mandibular incisors were correlated with both the sagittal and vertical skeletal measurements. Eight regression equations for the incisor-mandibular plane angle were calculated with the highest coefficient of determination of 0.547.

CONCLUSIONS

Proclination of the maxillary incisors and flattening of the occlusal plane contributed to a positive overjet. Mandibular incisor inclination was more closely associated with sagittal and vertical skeletal discrepancies and was not affected by the incisal relationship.

Morphologic relationship between the cranial base and the mandible in patients with facial asymmetry and mandibular prognathism

INTRODUCTION

This study was conducted to measure the dimensional changes in the cranial base and the mandible in patients with facial asymmetry and mandibular prognathism, and to examine the morphologic relationship between asymmetries of the cranial base and the mandible.

METHODS

The patients were 60 adults with mandibular prognathism, divided into a symmetry group (menton deviation, <2 mm; n = 30) and an asymmetry group (menton deviation, >4 mm; n = 30) according to the degree of menton deviation. Three-dimensional computed tomography scans were obtained with a spiral scanner. Landmarks were designated on the reconstructed 3-dimensional surface models. Linear, angular, and volumetric measurements of the cranial base and mandibular variables were made.

RESULTS

In the asymmetry group, the hemi-base, anterior cranial base, and middle cranial base volumes were significantly larger (P <0.01), and crista galli to sphenoid, sphenoid to petrous ridge, anterior clinoid process to petrous ridge, and vomer to petrous ridge lengths were significantly longer (P <0.05) on the nondeviated side than on the deviated side. Menton deviation was significantly correlated with the difference in hemi-base volume, and ramal volume was significantly correlated with the difference in hemi-base and middle cranial base volumes between the nondeviated and deviated sides (P <0.05).

CONCLUSIONS

In patients with facial asymmetry and mandibular prognathism, cranial base volume increased on the nondeviated side and was also correlated with mandibular asymmetry.

Local application of periodontal ligament stromal cells promotes soft tissue regeneration

OBJECTIVES

To test the potential stimulatory effect of local application of periodontal ligament (PDL) stromal cells on soft tissue regeneration.

MATERIALS AND METHODS

Fluorescently labeled PDL cells outgrown from extracted human premolars or phosphate-buffered saline were locally injected to the cutaneous wounds created on mice. Soft tissue regeneration was evaluated for 14 days using photographs and histomorphometry. PDL cell engraftment was tracked with confocal microscopy. To detect the paracrine effect of the PDL cells on soft tissue regeneration, PDL cell-conditioned medium (CM) was evaluated for the concentration of secretory factors, transforming growth factor-beta 1 (TGFβ1). The effect of PDL CM on the proliferation and migration of dermal fibroblast and keratinocyte was tested using MTT assay and migration assay.

RESULTS

The application of PDL cells significantly promoted soft tissue regeneration compared with the application of PBS. Self-replicating PDL cells were engrafted into the hair follicles of the host tissue. Dermal fibroblast proliferation and keratinocyte migration were significantly enhanced by the treatment with PDL CM. Physiologically significant amount of TGFβ1 was secreted from PDL cells into the CM.

CONCLUSION

Local injection of PDL cells promoted soft tissue regeneration in part by the enhancement of fibroblast proliferation and keratinocyte migration through a paracrine mechanism.

Treatment of ankylosed maxillary central incisors by segmental osteotomy with autogenous bone graft

This case report describes the treatment of a 16-year-old girl with ankylosed maxillary central incisors that were noticeably infraoccluded and labially displaced. We performed a segmental osteotomy with an autogenous bone graft in a single-stage surgery to align and level the ankylosed teeth. The dento-osseous segment was successfully repositioned with satisfactory periodontal results.

Three-dimensional computed tomography analysis of mandibular morphology in patients with facial asymmetry and mandibular prognathism

INTRODUCTION

The purpose of this study was to investigate the dimensional changes in each skeletal unit in the mandibles of patients with facial asymmetry and mandibular prognathism.

METHODS

The patients consisted of 50 adults with mandibular prognathism, divided into the symmetry group (n = 20) and the asymmetry group (n = 30) according to the degree of menton deviation. Three-dimensional computed tomography scans were obtained with a spiral computed tomography scanner. Landmarks were designated on the reconstructed 3-dimensional surface models. The lines to represent condylar, coronoid, angular, body, and chin units were used. Ramal and body volumes were measured in the hemi-mandibles.

RESULTS

In the asymmetry group, condylar and body unit lengths were significantly longer, and coronoid unit length was significantly shorter on the nondeviated side than on the deviated side (P <0.01). Angular and chin unit lengths were not significantly different between the 2 sides (P >0.05). Ramal volume was significantly greater on the nondeviated side (P <0.01), but body volume was not significantly different between the 2 sides (P >0.05).

CONCLUSIONS

Both condylar and body units appeared to contribute to mandibular asymmetry, with a more central role of the condylar unit.

Expression of IL-1β, MMP-9 and TIMP-1 on the Pressure Side of Gingiva under Orthodontic Loading

Objectives: To test the hypothesis that orthodontic pressure does not induce gene transcription of IL-1β, MMP-9, and TIMP-1 in pressure gingival soft tissue.

Materials and Methods: A total of 14 male Wistar rats were used with three rats as no appliance controls and another three as the sham appliance group. On the 7th and the 14th day after orthodontic loading on the maxillary left molar, four rats were sacrificed, respectively. Maxillary right first molars served as the contralateral control side. A real-time RT-PCR for the excised gingiva was performed to measure the mRNA of IL-1β, MMP-9, and TIMP-1.

Results: Compared with the contralateral side, IL-1β mRNA from the pressure side significantly increased on the 7th day, then decreased on the 14th day (P &lt; .05). MMP-9 and TIMP-1 mRNA showed a significant constant increase on both the 7th and the 14th day (P &lt; .05).

Conclusions: The hypothesis is rejected. Orthodontic loading led to increases in IL-1β, MMP-9, and TIMP-1 mRNA in pressure side gingiva in rats.

Surface Anatomy of the Lip Elevator Muscles for the Treatment of Gummy Smile Using Botulinum Toxin

Objective: To propose a safe and reproducible injection point for botulinum toxin-A (BTX-A) as a supplementary method for the treatment of gummy smile, as determined by assessment of the morphologic characteristics of three lip elevator muscles.

Materials and Methods: A total of 50 hemi-faces from 25 adult cadavers (male 13, female 12; ages, 47 to 88 years) were used in this study. Topographic relations and the directions of the lip elevator muscles (ie, levator labii superioris [LLS], levator labii superioris alaeque nasi [LLSAN], and zygomaticus minor [ZMi]), were investigated. Possible injection points were examined through the study of predetermined surface landmarks.

Results: The insertion of the LLS was covered partially or entirely by the LLSAN and the ZMi, and the three muscles converged on the area lateral to the ala. The mean angle between the facial midline and each muscle vector was 25.8 ± 4.8 degrees for the LLS, 55.7 ± 6.4 degrees for the ZMi, and −20.2 ± 3.2 degrees for the LLSAN; no significant differences were noted between male and female subjects or between left and right sides. The three vectors passed near a triangular region formed by three surface landmarks. The center of this triangle, named the “Yonsei point”, was suggested as an appropriate injection point for BTX-A. The clinical effectiveness of the injection point was demonstrated in selected cases with or without orthodontic treatment.

Conclusions: Under careful case selection, BTX-A may be an effective treatment alternative for patients with excessive gingival display caused by hyperactive lip elevator muscles.

Morphological Characteristics of the Symphyseal Region in Adult Skeletal Class III Crossbite and Openbite Malocclusions

Objective: To evaluate the relationship of the morphological characteristics of the symphyseal region of adult Class III malocclusion to the differences in overjet and overbite.

Materials and Methods: The basal and symphyseal widths along with the alveolar and symphyseal heights were evaluated using data from the lateral cephalograms of Korean adult male skeletal Class III, divided into crossbite (n = 28) and openbite (n = 41) groups. Korean male normal occlusion samples (n = 32) were used as controls.

Results: The width of the symphyseal region including the basal width, point B width, Id width, symphyseal thickness, and pogonion width were similar in adult Class III crossbite and normal occlusion groups, but significantly less in the adult Class III openbite group (P &lt; .001). The alveolar height was similar in the adult Class III crossbite and control groups, but significantly less in the adult Class III openbite group (P &lt; .05). However, the symphyseal height was similar in all three groups.

Conclusions: An openbite, rather than a negative overjet, is the major factor influencing the symphyseal morphology in an adult Class III malocclusion.

Morphological characteristics of the symphyseal region in adult skeletal Class III crossbite and openbite malocclusions

OBJECTIVE

To evaluate the relationship of the morphological characteristics of the symphyseal region of adult Class III malocclusion to the differences in overjet and overbite.

MATERIALS AND METHODS

The basal and symphyseal widths along with the alveolar and symphyseal heights were evaluated using data from the lateral cephalograms of Korean adult male skeletal Class III, divided into crossbite (n = 28) and openbite (n = 41) groups. Korean male normal occlusion samples (n = 32) were used as controls.

RESULTS

The width of the symphyseal region including the basal width, point B width, Id width, symphyseal thickness, and pogonion width were similar in adult Class III crossbite and normal occlusion groups, but significantly less in the adult Class III openbite group (P < .001). The alveolar height was similar in the adult Class III crossbite and control groups, but significantly less in the adult Class III openbite group (P < .05). However, the symphyseal height was similar in all three groups.

CONCLUSIONS

An openbite, rather than a negative overjet, is the major factor influencing the symphyseal morphology in an adult Class III malocclusion.

Facial soft-tissue analysis of Korean adults with normal occlusion using a 3-dimensional laser scanner

INTRODUCTION

Developments in computer technology have made the 3-dimensional (3D) diagnosis of facial soft tissues possible, opening the window for 3D soft-tissue evaluation in orthodontic treatment planning and posttreatment results.

METHODS

Korean adults (30 men, 30 women) with normal occlusion were scanned with a 3D laser scanner, and 3D facial images were made with the Rapidform 2004 program (Inus Technology, Seoul, Korea). Reference planes in the facial soft tissues of the 3D image were established, and a 3D coordinate system (X-axis, left/right; Y-axis, superior/inferior; Z-axis, anterior/posterior) was established; 29 measurement points were assigned on the 3D image, and 39 linear measurements, 8 angular measurements, and 29 linear distance ratios were obtained.

RESULTS

Significant differences between the sexes were found in nasofrontal angle (men, 142 degrees; women, 147 degrees) and transverse nasal prominence (men, 112 degrees; women, 116 degrees) (P <.05). Transverse upper lip prominence was 107 degrees in the men and 106 degrees in the women, and transverse mandibular prominence was 76 degrees in both sexes. The distance between lower lip vermilion border (Li) and Me' was 0.4 times mandibular body length (Me' - Go'), and mouth height was also 0.4 times the mouth width. The linear distance ratios from the coronal reference plane to fronto-temporal point, zygomatic point, pronasale, upper lip point, labrale inferior, and soft-tissue menton were -1, -1, 1, 0.5, 0.5, and -0.6, respectively.

CONCLUSIONS

These data could be guidelines for the 3D evaluation of the facial image, because the 3D facial model constructed by the averaged coordinate values could be a template for orthodontic diagnosis and treatment planning.

Comparison of the shear bond strength of brackets using the led curing light and plasma arc curing light: polymerization time

The xenon plasma arc curing light and the LED curing light have substantially decreased the time required for polymerizing a bracket bonding composite. However, the expense and size of the plasma arc curing light has limited its use. The LED curing light is less expensive, smaller in size, and easier to handle. This study compared the bond strength afforded by the plasma arc curing light with that produced by the LED curing light, according to the polymerization time. In addition, the polymerization time required for adequate adhesion of the bracket was examined. After positioning the orthodontic brackets with the composite resin onto 120 human premolars, the plasma arc curing light and the LED curing light were used to polymerize the composite resin at 4-, 6-, and 8-second timepoints. The results showed that the LED curing light produces a bond strength sufficient for maintaining the orthodontic bracket even with a short burst of polymerization. Therefore, it is expected that the LED curing light will be readily accepted by orthodontists.

A proposal for a new analysis of craniofacial morphology by 3-dimensional computed tomography

INTRODUCTION

Three-dimensional (3D) analysis is essential for making a precise diagnosis of craniofacial morphology. Two-dimensional (2D) x-ray films are used to understand 3D structures. However, 2D images have several limitations. This article proposes a new type of cephalometric analysis by using 3D computed tomography.

METHODS

Axial images of 30 subjects (16 men; mean age, 19.2 years; 14 women, mean age, 20.5 years) were reconstructed into 3D models by using Vworks 4.0 (Cybermed, Seoul, Korea). The 3D models were measured with Vsurgery (Cybermed). The zygoma, maxilla, mandible, and facial convexity were analyzed.

RESULTS

The measurements were compared with Korean normal averages, and no statistically significant differences were found. Landmark identification was reproducible.

CONCLUSIONS

Three-dimensional computed tomography can provide information for use in diagnosis and treatment planning.

A proposal for soft tissue landmarks for craniofacial analysis using 3-dimensional laser scan imaging

AIM

To evaluate the accuracy of the 3-dimensional laser scanner and to propose reproducible soft tissue landmarks in the 3-dimensional facial images.

METHODS

A mannequin head was preliminarily scanned 6 times to calculate scanning errors. Mean errors in the linear measurements from the scanned images and the actual mannequin head were assessed and the magnification rate of the scanned images was calculated. The soft tissue landmarks were defined in the mannequin head and the patients with normal, Class II, and Class III malocclusions. The reliability and the reproducibility were investigated by comparing the x-, y-, and z-coordinate of each landmark gained from repeated landmarking procedure.

RESULTS

Scanning errors were 0.16 mm in the x axis, 0.15 mm in the y axis, and 0.15 mm in the z axis. The mean error of scanned image was 0.37 mm and the magnification rate was 0.66%. In the four 3-dimensional images, the standard deviations in the localization of all landmarks were less than 1.0 mm in the x, y, and z axes.

CONCLUSION

The laser scanner is a useful tool for understanding the 3-dimensional facial structure, and the soft tissue landmarks proposed in this study were considered highly reproducible and reliable.

Expression of an artificial polypeptide with a repeated tripeptide glutamyl-tryptophanyl-lysine in Saccharomyces cerevisiae

AIMS

Artificial genes, which encode 48 or 64 repeats of a tripeptide, glutamyl-tryptophanyl-lysine have been cloned to the yeast expression vector pAM82 containing the PHO5 promoter and expressed in Saccharomyces cerevisiae AH22.

METHODS AND RESULTS

When the yeast cells harbouring recombinant plasmids pALTG6-2 and pALTG4-4 were derepressed in Burkholder minimal medium (Toh-e, A., Ueda, Y., Kakimoto, S.I. and Oshima, Y. (1973) Journal of Bacteriology113, 727-738) containing low phosphate (0.03 g l-1 KH2PO4 and 1.5 g l-1 KCl), the expression was the highest after 24 h induction and the artificial polypeptides were synthesized to about 10% (pALTG6-2) and 14% (pALTG4-4) of the total cell protein.

CONCLUSIONS

The artificial polypeptides produced in yeast were made to react with the rabbit antiserum against the polypeptide purified from Escherichia coli and found only in the pellet fraction of cell lysates, indicating the formation of inclusion body. Artificial polypeptide consisting of Glu-Trp-Lys may be useful as partial supplement in food and feeds.

SIGNIFICANCE AND IMPACT OF THE STUDY

The production of single cell enriched with homopolymers of an essential amino acid in yeast might be an important tool of supplementing cereal diets and feed grain rations and could be used as means for improvement of the amino acid profile of single cell protein and production of pharmaceutical peptides.

Cephalometric characteristics of Korean Class III surgical patients and their relationship to plans for surgical treatment

In comparison to gender-matched normal Koreans, Korean patients selected for surgical correction of skeletal Class III problems have, on average, a shorter anterior and posterior cranial base, a shorter maxilla, a longer mandible, increased lower facial height, and a retrusive upper lip. In both males and females, about 40% of a group of Class III patients scheduled for surgery had a maxilla within one standard deviation of the normal position and a prognathic mandible, as compared with a group of normal Korean adults. Almost as many males (37%) in the surgical group had both a retrognathic maxilla and a prognathic mandible, while 18% had a retrognathic maxilla and normal mandible. In females, 25% had only a retrognathic maxilla and 25% had both jaws outside the normal range. The percentage of the Korean patients whose Class III relationship was primarily a result of mandibular prognathism (48%) is more than twice as high as the corresponding number for American Class III surgical patients (19%), somewhat higher than in Chinese patients (39%), and similar to the percentage of Japanese (50%). Maxillary surgery, alone or in conjunction with mandibular setback, is currently used in the treatment of most Class III patients. Both the esthetic consideration of widening the already broad Asian nose and the relative proportions of maxillary versus mandibular abnormalities suggest that mandibular setback alone can be considered for a higher number of Asian than Caucasian Class III patients.

Assessment of skeletal and dental changes by maxillary protraction

To further evaluate the effect of maxillary protraction on facial growth, cephalometric changes in 129 subjects with conditions diagnosed as skeletal Class III malocclusion and who had been treated with maxillary protraction were compared to 9 male and 12 female subjects with annual cephalometric records from the Yonsei growth study sample. The control subjects had Angle Class I malocclusions with normal overjet and overbite. More maxillary forward displacement and mandibular growth inhibition were observed in the protraction group during treatment, and the difference from the untreated controls was statistically significant. When changes due to treatment according to ages were compared, there was no statistical difference. The direction of maxillary growth was similar in the untreated and protraction groups. Maxillary protraction had a growth-stimulating effect on the maxilla during the treatment period.

The acid tolerance response of Salmonella typhimurium provides protection against organic acids

Salmonella typhimurium encounters a variety of acid stress situations during pathogenesis and in the natural environment. These include the extreme low pH encountered in the stomach and a less acidic intestinal environment containing large amounts of organic weak acids (volatile fatty acids). The acid tolerance response (ATR) is a complex defence system that can minimize the lethal effects of extreme low pH (pH3). The data presented illustrate that the ATR can also defend against weak acids such as butyric, acetic or propionic acids. Although an acid shock of pH 4.4 induced the ATR, growth in subinhibitory concentrations of weak acids did not. Various mutations shown to affect tolerance to extreme acid conditions (pH 3) were tested for their effects on tolerance to weak acids. An rpoS mutant lacking the alternative sigma factor sigma s failed to protect cells against weak acids as well as extreme acid pH. The fur (ferric uptake regulator) and atp (Mg(2+)-dependent ATPase) mutants defective in extreme acid tolerance showed no defects in their tolerance to weak acids. Curiously, the atbR mutant that exhibits increased tolerance to extreme acid pH proved sensitive to weak acids. Several insertions that rendered cells sensitive to organic acids were isolated, all of which proved to be linked to the rpoS locus.

Mechanisms of acid resistance in enterohemorrhagic Escherichia coli

Enterohemorrhagic strains of Escherichia coli must pass through the acidic gastric barrier to cause gastrointestinal disease. Taking into account the apparent low infectious dose of enterohemorrhagic E. coli, 11 O157:H7 strains and 4 commensal strains of E. coli were tested for their abilities to survive extreme acid exposures (pH 3). Three previously characterized acid resistance systems were tested. These included an acid-induced oxidative system, an acid-induced arginine-dependent system, and a glutamate-dependent system. When challenged at pH 2.0, the arginine-dependent system provided more protection in the EHEC strains than in commensal strains. However, the glutamate-dependent system provided better protection than the arginine system and appeared equally effective in all strains. Because E. coli must also endure acid stress imposed by the presence of weak acids in intestinal contents at a pH less acidic than that of the stomach, the ability of specific acid resistance systems to protect against weak acids was examined. The arginine- and glutamate-dependent systems were both effective in protecting E. coli against the bactericidal effects of a variety of weak acids. The acids tested include benzoic acid (20 mM; pH 4.0) and a volatile fatty acid cocktail composed of acetic, propionic, and butyric acids at levels approximating those present in the intestine. The oxidative system was much less effective. Several genetic aspects of E. coli acid resistance were also characterized. The alternate sigma factor RpoS was shown to be required for oxidative acid resistance but was only partially involved with the arginine- and glutamate-dependent acid resistance systems. The arginine decarboxylase system (including adi and its regulators cysB and adiY) was responsible for arginine-dependent acid resistance. The results suggest that several acid resistance systems potentially contribute to the survival of pathogenic E. coli in the different acid stress environments of the stomach (pH 1 to 3) and the intestine (pH 4.5 to 7 with high concentrations of volatile fatty acids). Of particular importance to the food industry was the finding that once induced, the acid resistance systems will remain active for prolonged periods of cold storage at 4 degrees C.

Clinical results of the maxillary protraction in Korean children

Sixty subjects with ages ranging from 8 to 13 years were divided into two groups according to the intraoral appliances used. Group I consisted of 47 subjects with rapid palatal expansion (RPE) appliances and group II consisted of 13 subjects with labiolingual appliances (La/Li). Group I was subdivided into three subgroups by age and two subgroups by the timing of the protraction. The cephalometric radiographs of all subjects were analyzed before and after correction of anterior crossbite. The following results were obtained: (1) After maxillary protraction, the maxilla and maxillary dentitions moved forward and downward, and the mandible and mandibular dentitions moved backward and downward. (2) The maxilla moved more forward in the RPE group, compared with La/Li group. (3) The palatal plane angle decreased more in the protraction-during-palatal-expansion group than protraction-after-palatal-expansion group. (4) Age did not show any statistically significant difference.

Video microscope observations of human premolar eruption

It is now possible to observe with an accuracy of 1-2 microns the pattern of eruptive movements of a human premolar as it moves from gingival emergence to the occlusal plane. This was accomplished by use of a video microscope to track the position of an optical ruling on the erupting tooth relative to a reference ruling mounted on adjacent teeth that were in occlusion. Net eruptive movements averaging 25-75 microns occurred from one day to the next until the tooth was almost in occlusion; then the eruptive rate slowed. Eruption occurred almost entirely at night. During the day, there was a marked slowing or cessation of eruption and often intrusion, which appeared to be related to masticatory activity.

[Case reports and discussion on anterior open bite]

Anterior openbites cause impaired masticatory, malfunction of tongue, speech defects, disuse atrophy of teeth and periodontal tissue, esthetic problem. It is corrected by some available orthodontic methods according to its etiologic factors and growth stage. Removable appliances with tongue crib, spring loaded occlusal bite block, M.E.A.W. with rubber elastics, vertical chin cap and high pull head gear are selected for its correction. Extraction is considered for preventing wedging effect and Adenoidectomy is performed as adenoid cause mouth breathing. In the case of treatment of anterior openbites, combined therapy acquire better results than single treatment method. Removal of etiologic factors and accurate diagnosis is the best way of prevention of its recurrence.