[Radiographic assessment of upper airway size in skeletal sagittal and vertical jaw discrepancies]

An important factor in the process of diagnosis and orthodontic treatment planning is patient's respiratory function that has a direct correlation with the upper airway size. The aim of this study was to measure and compare nasopharyngeal, oropharyngeal and hypopharyngeal airway volumes in Iranian subjects with sagittal [Class I, II and III] and vertical [normodivergent, hyperdivergent and hypodivergent] jaw discrepancies using standard cephalometric radiographs. In this descriptive cross-sectional study, 100 pre-treatment lateral cephalograms of orthodontic patients were evaluated to assess the size of upper airway space including the nasopharynx, oropharynx and hypopharynx. In order to assess airway dimensions in patients with sagittal and vertical discrepancies, subjects were divided into two large groups of normal sagittal and normal vertical patterns. Airway size was measured in sagittal plane in 50 subjects with normal vertical patterns and in vertical plane in 50 subjects with normal sagittal patterns. Linear variables i.e. the size of nasopharyngeal space [PNS-UPW], oropharyngeal space [U-MPW] and hypopharyngeal space [V-LPW] were measured by cephalometric tracing. Data were analyzed using SPSS version 15 software and chi-square, ANOVA and Tukey's HSD tests. Understudy subjects had normal age and gender distribution pattern. In patients with normal sagittal pattern, by an increase in vertical dimension, size of nasopharynx [PNS-UPW], oropharynx [U-MPW] and hypopharynx [V-LPW] decreased and the mentioned volumes were significantly smaller in subjects with hyperdivergent facial patterns compared to hypodivergents. In subjects with normal vertical pattern, by an increase in ANB angle, size of oropharynx [U-MPW] and hypopharynx [V-LPW] decreased and the mentioned volumes in CL II patients were significantly smaller than in CL III subjects; whereas, the largest nasopharynx [PNS-UPW] was observed in CL I subjects. Sagittal and vertical discrepancies affect upper and lower airway dimensions and by an increase in facial height, the mentioned volumes decrease. Smaller ANB angle results in larger airway dimensions

[Efficacy of ketoprofen and benzocaine chewing gums for reducing orthodontic pain]

Pain relief is important during orthodontic treatment. The aim of this study was to compare the efficacy of ketoprofen and benzocaine chewing gums for pain reduction during fixed orthodontic treatment. Thirty patients aged 15-25 years experiencing orthodontic pain were randomly divided into 3 groups, each receiving one of the experimental chewing gums namely ketoprofen, benzocaine and the placebo. Instructions were given to the pa-tients and they received the gums taking into account the washout period. Patients recorded their degree of pain perception at 2, 6 and 24 hours, and 2, 3 and 7 days using the visual analog scale [0-100]. Friedman and Wilcoxon tests were used to compare the mean pain scores among the 3 groups. The mean pain score decreased over time in both genders and all groups [P =0.017]. The mean pain score recorded in benzocaine group was lower than that in the ketoprofen and placebo groups but a significant difference was only observed between benzocaine and the ketoprofen groups during the first two hours using Friedman and Wil-coxon tests [P=0.042]. Compared to the control group, both ketoprofen and benzocaine chewing gums significantly decreased pain at all time points except for day 7. Ketoprofen and benzocaine gums were both significantly effective for or-thodontic pain reduction

Impaction of laparoscopic ovarian electrocautery on doppler indices of stromal blood flow in women with polycystic ovary syndrome

Polycystic ovary syndrom [PCOS] is characterized by infertility, oligomenorrhea, and hyperandrogenism. Clomiphene citrate [CC], an antiestrogen, is first-line treatment for PCOS, if CC fails to induce ovulation, laparascopic electrocautery of the ovaries is offered. In this prospective controlled study, 52 women with clomiphen-resistant PCOS [group 1] and 46 women with regular menstrual cycles as a control group [group 2] were included. Hormonal profile and doppler blood flow changes within the ovarian stroma befor and after laparascopic ovarian electrocautery [LOE] in women with clomiphen- resistant polycystic ovary syndrome assessed and compared between groups. The doppler indices [pulsatility index and resistance index] of ovarian stromal blood flow were significantly lower in group 1 befor LOE than in group 2. The serum levels of testosteron [T] and LH were significantly reduced in group 1 after LOE compared with in group 1 befor LOE [P < 0.05]. Doppler indices [pulsatility index and resistance index] of ovarian stromal blood flow were significantly increased after LOE. Laparascopic electrocautery reduced serum T and LH and reduced ovarian blood flow velocities, which may explain the reduction of ovarian hyperstimulation syndrome in women with PCOS after LOE. Laparascopic electrocautery of the ovaries is now accepted as the preferred first-line treatment of women with PCOS who are resistant to clomiphen citrate. All affected women could be considered for this treatment

[Comparison of upper molars movements in use of cervical headgear and pendulum appliance by finite element method]

The movement of molars has been evaluated in many studies to correct C1 II malocclusion by non-compliance appliances but the results are controversial. The aim of this study was to compare the upper first and second molars' movement in cervical headgear [HG] and pendulum appliance [PEND] by finite element method. For modeling process, one of the best dry skulls was CT scanned [1mm slices]. Modeling was done according to the mechanical properties of cortical and trabecular bone of maxilla and PDM and teeth and transferred to computer by scanner. Elementing, meshing and loading was done. The magnitude of force for both appliances was 250 gr and line of force for HG was 20 degree above the occlusal plane ac ion and for PEND was along the midlingual surface of upper first molar crown. Tooth movement analysis was performed by the software named Ansys 5.71. The amount of dislocation of the 1st molar cusps tip [mesiobuccal, mesiopalatal, distibuccal, distopalatal] at presence of second molar in bucco-lingual dimension showed distal-in rotation in HG and mesial-in rotation for pendulum. In mesio-distal dimension, the four cusps of 1st molar moved distally in HG and palatal cusps moved more in PEND. In vertical dimension, 1st molar showed extrusion in HG and intrusion in PEND for distal cusps. The presence of second molar had impact on the quality of upper first molar in both appliances and it moved in a distal direction, extruded and buccal drifted in both of them. Therefore, with regard to the cooperation of the patients, pendulum appliance is recommended to correct C1 II malocclusion instead of cervical headgear

Management and outcome of prolonged pregnancies in Shariati University Hospital

There is dearth of reports from Iran regarding the prevalence of postterm pregnancy and its complications. The present study was conducted to evaluate the prevalence, management and outcome of prolonged pregnancies. This cross-sectional study included data from the hospital records of all women referred to Shariati Hospital, Tehran, from 2001 to 2002 with pregnancies of more than 40 weeks in duration. Pregnancies >/= 40-42 weeks were considered postdate and those more than 42 weeks postterm pregnancy. The data compiled from the hospital records were subjected to t, X[2] and Mann-Whitney U tests. Of the 1500 deliveries in this hospital, 98 patients were included in this study, 66.3% of whom were nullipara and 33.7% multipara. The prevalence of postterm pregnancy was estimated to be 3.3%. Cervix dilation of 2 cm or less on admission occurred in 65 women [73.3%]. The mean Bishop score was 4.31. Of the 62 fetuses that underwent assessment tests, 54 [87.1%] were normal. The median time between the last test and induction of labor was 2.1 days, and 2.6 days for cesarean deliveries, which was not a significant difference [P = 0.6]. Cervical ripening with misoprostrol was performed in 36 cases [36.7%] and was successful in 18 cases. In this group, the median time for cervical ripening in multiparas was significantly less than nulliparas [4 vs. 7 hrs, P = 0.004]. Women not subjected to cervical ripening had a higher cesarean rate than those who did undergo cervical ripening [74.7% vs. 66.1%], although this difference was not significant [P = 0.9]. Vaginal and cesarean delivery rates showed no significant difference between cases that underwent induction with oxytocin and those subjected to cervical ripening with misoprostol [P = 0.9]. The mean Apgar score was 9.5, with all scores above 6. There were no cases of neonatal hypoglycemia, hypocalcemia, NICU admission or prenatal death. The mean nursery stay was 1.84 days with a range of 1-8 days. The prevalence of postterm pregnancies was 3.3% in this study, due in part to erroneous estimation of gestational age. Sonography exam in the first half of pregnancy can provide a better estimation of gestational age and thereby reduce the rate of postterm pregnancy. Cervical ripening and induction of labor shorten the duration of pregnancy; however, whether it has any beneficial effect on neonatal outcome remains controversial

Evaluation of a breakfast as screening test for the detection of gestational diabetes

A standard breakfast was evaluated as a screening test [BT] for gestational diabetes in a case-control study. Blood sugar [BS] was measured 1 hour after a breakfast that had 50gr simple sugar and was designed based on women preferences. In the same women glucose challenge test [GCT, 50gr 1hour glucose screening test] was performed one week later in randomized sequential. Cutoff values for both tests was 130 mg/dl. For both or one positive test GTT [100gr-oral glucose tolerance test] was performed. Sensitivity and specificity; optimal cutoff and concordance of both tests with GTT were calculated by X2, receiver operating characteristic [ROC] curve and kappa test. 41 women [29.3%] had positive GCT and 28 women [20%] had positive BT. 12 women [8.57%] had positive GTT. For BT and GCT, a sensitivity of 83.3% and 91.7% and specificity of 85.9% and 76.6% with cutoff level >/= 130 mg/dl at 60 minute were found respectively. Optimal cutoff for BT and GCT were 130 mg/dl and 135 mg/dl respectively. Concordance of GTT with GCT and BT was 0.429 and 0.432, respectively. Standard breakfast can be used as an alternative method for assessing carbohydrate intolerance in pregnancy with same physiological response, better compliance and low cost

Modified index of orthodontic treatment needs [IOTN] assessment by senior dental students

Rater's reliability is an important issue in index calculation. The purpose of this study was to evaluate the intra-examiner agreement in identification of orthodontic treatment needs using modified IOTN. In this analytical cross-section study, six senior dental students identified IOTN on 42 dental casts by means of a standard DHC ruler with a two-week time lag. The kappa and association models were used to analyze the data. The kappa statistics showed intra-rater agreements between 0.54 and 0.77 [ +/- 0.65], which can be considered as [good]. About 33% of the students had problems in distinguishing the first and second levels of the index, while there were fewer problems in distinguishing between the second and third levels. The category identification with most problems was the distinction between the first and second levels [0.48], and the one with the least problem was that of the second and third levels [0.99]. The distinction of the first and second levels in modified IOTN is hard for the examiners. Therefore, this issue should be considered in calibration training programs when using this index in screening, survey or epidemiological evaluations

relationship between first premolar extraction and third angulation in orthodontic treatment

Extraction of first premolars and their influence on the third molars' eruption and impaction has been of concern to dental profession. The aim of this study, was to determine the relation between the changes of third molar angulation and the first premolar extraction in orthodontic treatment. This analytical study was carried out on a total 90 subjects selected from two orthodontic clinics. Forty five subjects [14 males and 31 females] 14.46 +/- 1.64 years old treated with extraction of four first premolars [extraction group] and the other 45 subjects [13 males, 32 females] 13.9 +/- 1.99 years old treated by non-extraction were studied. Lateral cephalometric and panoramic films were studied before and after treatment. Eight angles in panoramic, four angles and 4 linear variables on the lateral cephalometric films were measured. Age, gender, amount of crowding in both dental arches and treatment duration were matched in the two groups. Student t and chi square tests were used to analyze the data. The upper eruption space and the lower eruption spaces were more in extraction group and the difference was significant [P=0.02, P=0.004, P<0.001]. The changes of third molar angulation was not significant between the two groups. Eruption rate of the third molars in both arches were more in extraction group and the difference was significant [P<0.001]. Extraction of the first premolars did not influence the changes in the third molar angulation, while it affected the third molar eruption by space creation. It seems that extraction of the first premolars is not a way for secure eruption of the third molar

Knowledge, attitude and behavior regarding osteoporosis among women in three age groups: Shariati hospital, Tehran

Osteoporosis threatens the aged population especially the menopausal women and can lead to life long disability and death. Appropriate knowledge and behavior have an important role in prevention of osteoporosis. In this study the knowledge, attitude and behavior of women regarding osteoporosis is assessed and compared in different age groups. This cross sectional study includes 390 women in reproductive, premenopausal and menopausal age groups who had come to Shariati hospital clinics and each had answered the designed questionnaire. The questionnaires were scored and analyzed. Women's knowledge, attitude and behavior were assessed and compared by X2 test in the three age groups and P < 0.05 was considered significant. 15 - 30% of women didn't know what osteoporosis is and in 380 of them attitude or behavior was not good. Education had a significant effect on knowledge of women in reproductive and premenopausal ages [P = 0.002, 0.04 respectively], but had no effect on their attitude or behavior. Age had a significant effect on knowledge and attitude [P = 0.001] but had no effect on behavior. Age had significant effect on the knowledge that exercise can prevent osteoporosis [P = 0.014] but not on attitude or behavior. Age had no effect on knowledge, attitude or behavior of daily calcium intake to prevent osteoporosis. [P = 0.123, 0.12, 0.153 respectively] 93% to 95% of women thought the risks of osteoporosis are less than cardiovascular disease or breast cancer. 15-30% of women didn't know what osteoporosis is. The total knowledge about osteoporosis was low. Although 22-75% of women younger than 54 years old had knowledge about the predisposing factors but their attitude or behavior was not good

prospective randomized controlled trial of two regimens of vaginal misoprostol in second trimester termination of pregnancy

The search continues for a safe effective and cheap method for mid-trimester termination of pregnancy. Misoprostol is a strong contender in this respect. The dose schedule is still not fixed. The objective of this study was to compare the efficacy and adverse effects of two dose regimens of vaginal misoprostol for second trimester termination. Prospective randomized double blind controlled trial was undertaken in 162 women at 14-24 weeks gestation in a teaching hospital. Subjects were randomized to receive either regime A: 400 microg of intra vaginal misoprostol every 6h, or regime B: 200 microg of intravaginal misoprostol every 6h. The main outcome measure was the success rate at 24h, total dose required, induction-abortion interval and adverse effects. Data was analyzed by student's t-test, Mann-whitney U-test, the chi-squared test or Fisher's exact test. There was a significant difference in the success rate at 24 and 48hr [regime A: 74% and 97.5%; regime B: 61.7% and 88.9% P=0.016 and 0.029 respectively] and in the mean induction abortion interval [14 Vs 20h, P=0.01] Mean Misoprostol requirement was significantly higher for regime A [731 microg +/- 362 microg vs. 531microg +/- 357 microgm, P=0.001]. Use of 400 microg vaginal misoprostol is superior to 200 microg vaginal misoprostol for second trimester abortion

Effect of steam versus dry heat sterilization on the wear of orthodontic ligature cutting pliers

Orthodontic ligature cutting pliers are expensive. Methods of sterilization should be safe considering patients' health as well as lifetime of orthodontic pliers. The purpose of this study was to compare the wear of orthodontic ligature cutting pliers after sterilizing with dry heat or steam autoclave. In this experimental study, thirty ligature cutting pliers from 3 different factories [Dentarum-Germany, RMO and ETM-USA] were sterilized in either dry heat or steam autoclave. The amount of wear at the tip of each plier in both groups was measured with a stereomicroscope and digital photomicrography. Wear was defined as the difference of the initial length and the length after 10, 20, 30 cycles of sterilization measured by the distance from a reference line on the tip of the plier. Three way ANOVA was used to compare wear between the two sterilization groups. P<0.05 was considered as the limit of significance. The amount of wear of the ligature cutting pliers' tip after 10, 20 and 30 cycles in dry heat sterilization was 1.0 +/- 0.16, 0.98 +/- 0.22 and 0.94 +/- 0.31 mm respectively. These figures were 1.16+0.15, 1.16 +/- 0.13 and 1.15 +/- 0.14mm for steam heat sterilization. The higest wear was observed after 20 cycles of sterilization in autoclavce whereas the lowest was seen in dry heat sterilization after 30 cycles. The differences between the two studied groups were statistically significant [P<0.0001]. In addition, increasing sterilization cycles decreased the rate of wear in both groups. Based on the results of this study routine autoclaving caused more damage and wear at the tip of the pliers than dry heat sterilization

Prevalence of tooth size discrepancies [Bolton analysis] in sagittal malocclusions

To evaluate the prevalence of tooth-size discrepancies among orthodontic patients with sagittal malocclusions by performing Bolton analysis. Two hundred pairs of study models of skeletal Cl I, II, III and crowding were selected. All permanent teeth were present except second and third molars, without any attrition, caries or restorations on their interproximal surfaces. The greatest mesiodistal diameter was measured to the nearest 0.01 mm by means of digimatic calipers. The Bolton's anterior and overall ratios were perfomed on these models to find tooth-size discrepancies. The mean, SD, range, CV and SE were assessed. The four groups were compared by variance analysis. The amount of obtained ratios were compared with Bolton's ratios by T - test, and the difference over 2SD was considered significant. The tooth size discrepancy was more prevalent in crowding group [%14] regarding the overall ratio, and more in cl III group [%28] regarding anterior ratio. The means of Anterior and Overall ratios in the present study [78.21 +/- 2.69, 92.01 +/- 2.45] were larger than Bolton's measurements [77.2 +/- 1.65, 91.3 +/- 1.91] [P<0.0001]. Even though the means of the tooth size ratios of the current study were significanthy different from Bolton's results, the amount of differences were not more than 1.5 mm, hence we can apply the Bolton's ratios for Iranian people. When the Bolton's results were applied to our study, for the Anterior ratio 23% and for the Overall ratio 9% of patients fell outside of 2SD and tooth-size discrepancies. Regarding tooth- size discrepancies specially in crowding and crossbite cases, which are not detectable by inspection alone, it is suggested that Bolton's tooth size analysis be performed before starting the orthodontic treatment