[Evaluation of neuromuscular response to chronic whole body vibration training in elderly women]

Whole body vibration training can improve muscular force by affecting neuromuscular system and mechanical mechanisms. The aim of this study was to investigate the effect of an 8 week whole body vibration training [WBVT] on neuromuscular performance in healthy elderly women. Based on an experimental and BOSCO training protocol, thirty elderly female women [50 +/-5.5 yrs old] were selected and divided randomly into two experimental and control groups. Before and after vibration training, timed Up and Go and 5-chair stand tests were performed to evaluate neuromuscular performance in elderly women. Data were processed with SPSS software version 18 and one way ANOVA test was used for data analysis. P<0.05 was considered significant. Data analysis showed that there was a significant improvement in neuromuscular performance in WBVT group compared to control group [P

Evidence-based dentistry: Reality and dilemmas

The concept of evidence-based practice [EBP] relies on rendering treatment, the effectiveness is solidly demonstrated by rigorous research, not just empirical experience. The aim of this paper is to review the foudation of EBP and the reality of its application. Evidence is commonly ordered up in a "hierarchy" from expert opinion to case report, case series, case-control study, cohort study, randomized controlled trial, and systematic review/meta-analysis. We stratify this hierarchy into 3 categories ascending from perspective, to investigation then synthesis. Depending on the type and feasibility of research, the higher levels of evidence do not negate the value of lower strata. The application of evidence is illustrated in two representative areas of dentistry: timing of early orthodontic treatment and immediate loading of osseointegrated implants. The clinician faces dilemmas in the need to ground treatment into unquestionable basis and the difficulty of relating this basis to the individual treatment. Reasons for this dichotomy include the scale of variation around mean results delivered by the most sophisticated research and the potential for new more encompassing research to deviate from prior findings. While research sets central tendencies, individual variation favors interpretation of the evidence. In the face of viewpoints on EBP ranging from support to rejection, the clinician should not indict a needed process, but rather use judgment to apply the average response shown in investigations to the individual circumstances of patients

Individual appraisal of facial soft and hard tissues with the mesh diagram

The lateral cephalometric mesh diagram analysis presents advantages not readily available in conventional cephalometric methods. The face is oriented on the patient's natural head position, which provides comparability between cephalometric findings and the clinical facial examination. The patient's profile is not directly compared with the population norm but with an "individualized norm" derived from the application of the population norm to a grid scaled on the patient's facial shape namely, the upper face height [N-ANS] and facial depth [N-S]. Each landmark is assessed by its proportionate location in the mesh diagram grids. Thus, facial form is evaluated in one single display easily interpretable without computation of linear and angular measurements. These principles are illustrated for diagnosis of malocclusions and treatment with a combination of orthodontics and orthognathic surgery. The discrepancies between hard and soft tissues are readily ascertained and measured through the mesh display, and allow the formulation of conclusions on treatment and outcome. The mesh diagram is a flexible cephalometric analysis that should be incorporated in the routine dentofacial diagnosis and treatment planning

Sequencing cleft lip and palate treatment

Comprehensive treatment of cleft lip/palate involves a team approach [surgeon, orthodontist, prosthodontist, speech therapist, etc.] for long-term multidisciplinary planning, to achieve proper function and esthetics of facial structures, as well as optimal hearing and intelligible speech. Our aim is to review evidence-based treatment timing in relation to key growth events. Sequence: Within the first year of life, lip adhesion and/or closure are performed; soft palate closure is indicated with or without hard palate surgery, which is not delayed beyond the age of 2 years. Feeding appliances may be given to non-thriving infants. Before school begins [age 3-5 years], the lip and columella are lengthened and the alar base is repaired if indicated. In early to mid-childhood [6-12 years], orthodontics is initiated before secondary alveolar bone grafting [ABG]: expansion appliances are used to correct posterior/anterior crossbites; maxillary segments and teeth adjacent to the cleft are aligned. The optimal time for ABG is before the dental emergence age of 10 years, as research indicates the prevalence of ectopic tooth eruption if bone is provided later. A pharyngeal flap may be needed at the same time. In the adolescent years, final revisions of the lip and soft palate, and rhinoplasty, are performed. Orthodontic treatment is completed alone or with adjunctive orthognathic surgery. Permanent cosmetic and functional dental restorations are done last. Maxillofacial orthopedic treatment of cleft lip/palate is enhanced by proper sequencing, coordinated and implemented by a team of specialists from birth to adulthood

Effect of compromised nasal breathing on craniofacial development

The impact of nasal respiration impairment on craniofacial growth and development has been evaluated intensively in human and animal studies. The aims of this paper are to critically review: 1- the causes and diagnostic methods of nasal obstruction, specifically septal deviation, turbinate dysfunction, lymphoid tissue hypertrophy, and soft tissue alteration. 2- the growth pattern of the adenoids in relation to age and their size change in response to environmental factors. 3- the role of mouth breathing in the development of characteristic malocclusions and associated patterns of facial growth ["adenoid fades"], with a focus on available and needed research. 4- the ongoing debate about removal of lymphoid tissues to avoid facial dysmorphology, and the corollary issue of optimal timing of adenoidectomy and/or tonsillectomy that would prevent the development of such dysmorphology. The importance of a multidisciplinary approach in diagnosing, referring and treating patients with airway impairment will be emphasized

Root resorption during orthodontic tooth movement: a literature review

External root resorption [ERR] of permanent teeth is an unpredictable consequence of orthodontic treatment, usually diagnosed on periapical radiographs. The etiological and biochemical mechanisms are still unclear. Theories include excessive force that leads to the development of an avascular area referred to as hyalinized, resulting, through a cascade of cellular events, in increased cementoclast-osteoclast activity. Yet, risk .factors are incriminated that may be classified in two major categories: constitutional factors [gender, chronologic and dental ages, genetics, individual susceptibility, systemic factors, tooth structure, alveoloar hone density, specific tooth vulnerability to root resorption]; physiologic and environmental factors [nutrition, habits, occlusal trauma, endodontic treatment, trauma prior to orthodontic treatment, mechanical pressure such as types of orthodontic movement, appliances, and forces, duration of orthodontic treatment, repeated orthodontic treatment]. When resorption is detected, treatment objectives should be modified to maintain appropriate crown-to-root ratio and periodontal health, while light forces are used and root length monitored

Variability in the sequence and timing of emergence of primary and permanent teeth: discrepancies in norms and clinical significance

Norms of timing and sequence of emergence of primal], and permanent teeth are mostly based on old data. Discrepancies between studies put into question the applicability of these norms. The aim of this study was to evaluate specific discrepancies in emergence of human teeth, and determine potential clinical implications. We conducted a comprehensive literature search that extended from the seminal work of Kronfeld and associates [1929-1939] to 2002. All studies reported the same eruption sequence in the primal], dentition: central [A], lateral [B] incisors; first molar [12]; canine[C]; second molar [E]. Mandibular teeth emerge before their maxilla?], counterparts, except fin- B. Gender differences do not appear significant in all studies. Although the initiation of emergence [usually mandibular A] ranged between 6 and 8 months, tabulated means from studies with primary data suggest that the last tooth in every sequence of like-teeth emerges within 3 months from the preceding set of teeth, the maxillary canine[C] emerging around 18months. The last tooth [mandibular E] follows 9 months later.In the permanent dentition, the prevalent emergence sequence was: in the maxilla: Ml, 11, 12, Pm1, Pm2, C, M2, M3; in the mandible: M1, II, 12, C, Pm1 Pm2, M2, M3. The most common variation in the mandibular sequence seems to be the eruption of Pm1 ahead of the canine. Recent data indicate the tendency for the mandibular 11 to emerge before or at the same time as MI, and the maxillary canine to erupt before Pm2, a finding that may affect timing of treatment. The changes in pattern may indicate an evolutionary trend, or simply reflect variations inherent to the populations studied