[Differences between laypersons and orthodontists in recognizing the light reflection zone on the maxillary central incisors crowns].

The light reflection zone (LRZ) is a new parameter that may serve as a tool for the diagnosis of smile esthetics. It is a bright white dot or area that appears on the surface of the maxillary central incisors and/or the gingiva of the front teeth, visible in intra-oral and smile extra-oral photographs. Recently it was found that the general population defines a nicer smile when the LRZ is located in the gingival area of the upper central incisors' surface rather than the incisal third. The aim of this study was to find out in two populations that are not aware of this new parameter, laypersons and orthodontists, whether there is a difference in the identification of the LRZ and the importance of the LRZ in determining the quality of the smile. Twelve pairs of facial photographs, including 10 of ordinary smiling persons and 2 of smiling models, were presented to 108 laypersons and 30 orthodontists. The only difference between each pair was the location of the LRZ that was moved, compared to the original photograph, gingivally or incisally respectively, using Photoshop (Adobe). Each participant was asked to mark whether he/she noticed a difference between the 2 pictures, and if so, to score the nicer smile. Data analysis was carried out using Chi square test and Fisher's exact test (SPSS v17). The results showed that both populations had difficulty in recognizing the differences between the pictures that were based solely on the LRZ parameter. However, when differences were recognized, most of the participants in both populations pointed on the smile where the LRZ was located gingivally as the nicer one. The orthodontic population recognized the difference between the two pictures, in which only the LRZ was changed, to a lesser extent compared to the laypersons populations. This result was with statistical significance (p = 0.007).

[Lip angle and the position of the maxillary lateral incisor--post orthodontics retention considerations].

The relations between the soft tissues draping, the dentoskeletal structure and teeth position have been thoroughly investigated. Nevertheless, it is still unclear to point on the primary underlying cause for pathology if exists, is it the frame or the content, the chicken or the egg. Those relations are of an utmost importance in the process of determining the retention procedure and length in post orthodontic treatment patients. This paper discusses the issue which, as far as we know, has never been examined - the upper lip angle, (the angle created by 3 points - the two intersections between the lip cupid arch and the lip philtrum columns and the lip commissural point in either side), as it related to the maxillary lateral incisors position. Long term clinical observations were behind our hypothesis that lips with acute angles go along with palatally positioned maxillary lateral incisors, one or two. The lips angel of both the study group (37 orthodontic patients ages 15.7+/-6.8, with at least one maxillary lateral incisor in palatal position), and the control group (37 orthodontic patients ages 16.5+/-8.7 with no mal-aligned maxillary teeth) were measured and compared. It was found that the lip angle of the control group was 152.256+/-5.52 degrees while for the study group it was 149.23+6.68. This result is with statistical difference (p=0.001). It was further found that the more acute the lip angle; the more the lateral maxillary tooth or teeth are palatally positioned. The results of this study and the clinical observations suggest long term fixed retention of the maxillary incisors, following orthodontic treatment especially in patients with acute lip angle.

[Light reflection zone on the incisors' surface--a new parameter for smile esthetics evaluation].

The light reflection zone (LRZ) is a bright white dot or area that appears on the surface of the maxillary central incisors and/or the gingiva of the front teeth, visible in intra-oral and smile extra-oral photographs. Previously, a positive correlation between the location of the LRZ as observed in intra-oral frontal photographs and the inclination of the upper central incisors as measured on lateral headfims was found. The purpose of this study was to find whether this LRZ location can serve as a new parameter influencing the level of smile esthetics. Twelve pairs of facial photographs, including 10 of ordinary smiling persons and 2 of smiling models, were presented to 138 participants. The only difference between each pair was the location of the LRZ that was moved, compared to the original photograph, gingivally or incisally respectively, using Photoshop (Adobe). Each participant was asked to mark whether he/she noticed a difference between the 2 pictures, and if so, to score the nicer smile. Data analysis was carried out using Chi square test and Fisher's exact test (SPSS v17). The results showed that most of the participants did not recognize the differences between the pairs however, when differences were recognized, most of the participants pointed on the smile where the LRZ was located gingivally as the nicer one. This result was with statistical significance for the 2 models (p < 0.05), In conclusion, the LRZ is a new, yet unrecognized, parameter that can serve as a tool for the diagnosis of esthetic smile. The general population defines a nicer smile when the LRZ is located in the gingival area of the upper central incisors' surface rather than the incisal third. The LRZ should probably be studied not only in Orthodontics but also in other branches of dentistry.

[The inaccuracy of the panoramic radiograph as a tool to determine tooth inclination].

The panoramic radiograph is one of the most common radiographs in orthodontics. It is sometimes used as an aid for the decision which teeth should be extracted as part of the individual treatment plan. When treating patients with clear plates (for example, Invisalign), it is very important to know the inclination direction of the involved teeth. Tipping is more predictable and it takes less time than bodily movement. The objective of this paper is to demonstrate the limitations of the panoramic radiograph in the decision making process related extraction in orthodontics. An eleven years old girl with lower anterior crowding of about 5 mm was examined prior to her orthodontic treatment. One possible treatment plan, in order to relieve the crowding, was to extract two lower bicuspids. The other treatment plan was to extract one lower incisor. Clinically, both cuspids were acutely tipped mesially, but were imaged uprighted and parallel to their adjacent teeth in the panoramic radiograph. In order to better understand the cuspids position, a model of the lower arch was prepared, with a similar malocclusion demonstrated by the patient. In the model, the cuspids' metal teeth, invested in wax, were mesially angulated. A panoramic radiograph of the model was then taken. The radiograph of the model shows a parallel position of the incisors, the cuspids and the bicuspids, exactly as was shown in the patient's radiograph. It has been demonstrated that there is a discrepancy between the actual position of the teeth and roots and their position in the panoramic radiograph, especially in the mesiodistal angulation. It was concluded that we should be very cautious when trying to interpret the panoramic radiograph as a tool for root parallelism, and remember the inherent image distortions. This is especially true before deciding which teeth will be extracted, on the basis of "incorrect" tooth angulation.

[Partial orthodontic treatment--a case report and its implications].

Several theories lie behind the development of lower incisors crowding. Nowadays, many adults are seeking for treatment to resolve this problem. The present case report describes development of mild lower incisor crowding during one year of partial orthodontic treatment in the maxillary arch of a young adult patient. In trying to explain what was behind the speedy process, which forced the orthodontist to add the lower arch to the treatment, we found that narrowing the upper arch in the canine's area was the best explanation to this pathological process. The effect of the upper arch width on the lower one is quoted in many publications but it is not related to the lower incisors crowding phenomenon.

[Prevalence of congenitally missing teeth in Israeli recruits].

AIM: To evaluate the prevalence of congenitally missing teeth in a population of 18-year old Israeli army recruits. PATIENTS AND METHODS: The study population consisted of 226 out of 280 random 18-year-old Israeli army male recruits. The panoramic radiographs of those who fitted the criteria were examined by two dentists. The absence of permanent teeth in those radiographs was recorded. RESULTS: The prevalence of tooth agenesis (including the third molars) was 43.8%. The prevalence of tooth agenesis excluding the third molars was 5.3%. There were 11 subjects (4.2%) with a missing lower 2nd pre-molar, 3 subjects (1.1%) presented congenitally missing maxillary lateral incisors. As for the third molars, 101 subjects (5.83%) presented hypodontia of at least one third molar. Hypodontia of lower third molar was more common than hypodontia of upper third (22.1% and 16.4% respectively). 20 subjects (7.6%) presented bilateral mandibular missing third molars, 13 (4.9%) presented bilateral maxillary missing third molars and nine (3.4%) presented combined bilateral maxillary and mandibular missing third molars. CONCLUSION: The prevalence of tooth agenesis in Israeli army recruits was found within the wide range of reported similar data in the literature with some unique characteristics to this population.

Severe disease in patients with rheumatoid arthritis carrying a mutation in the Mediterranean fever gene.

BACKGROUND: Pyrin is a newly recognised intracellular regulator of inflammation, and mutations in MEFV, the gene encoding pyrin, are the cause of familial Mediterranean fever. OBJECTIVE: To determine if known mutations of MEFV are associated with rheumatoid arthritis (RA) morbidity or can modify RA severity. METHODS: The frequency of the three most common MEFV mutations: M694V, V726A, and E148Q, was determined in 98 Israeli patients with RA (74 women, 24 men) and compared with that in 100 healthy subjects matched for origin. RA severity was determined using a new clinical score of 126 grades. The median severity score of mutation carrier and non-carrier groups was compared after confounding measures were eliminated by logistic regression. RESULTS: 17/98 (17%) patients with RA (all women) were heterozygous for common MEFV mutations, predominantly E148Q (12 patients), and one patient was homozygous for the V726A mutation. The overall mutation rate was comparable between patients with RA and healthy subjects. Patients carrying a mutation had a higher median severity score than the non-carrier group (42 v 29, p = 0.0005). The logistic regression model assigned a 15-fold odds ratio for severe RA in carriers, after adjusting for sex, presence of rheumatoid factor, age at onset, and disease duration (n = 97, p = 0.01, 95% CI 1.74 to 128). CONCLUSION: MEFV, and particularly the E148Q mutation, is an independent modifier of the clinical manifestations of RA. This is the second Th1-type autoimmune disease in which MEFV mutations have been shown to aggravate the clinical status.

Orthodontic facebows: safety issues and current management.

Some patients treated with extra-oral traction provided by simple elasticated materials and a standard facebow have experienced problems with the standard facebow coming out of the buccal tubes at night and the catapult effect of the extra-oral traction. The disengagement of the facebow at night has affected the success of treatment and occasionally injured the patient. This paper draws on material from a variety of papers and lists the known causes and considers the associated safety issues. It also provides some clinical tips and makes several suggestions for the continued use of this very useful form of additional orthodontic anchorage.

Can maxillary incisor trauma be predicted from cephalometric measurements?

Dental injury is a traumatic event related to many factors, including dentofacial morphology. In a previous study in which we used a logistic regression model, 5 cephalometric variables were defined as being the best predictors of traumatic injury. The purposes of this study were to test the predictive value of the logistic regression analysis results for the occurrence of dental injury in a new patient sample and to compare these results with the outcome based on a visual evaluation of cephalograms. The study population consisted of 2 groups of orthodontic patients: patients with injured incisors (n = 64) and patients with non-injured incisors (n = 90). Cephalometric skeletal, dental, and soft tissue measurements were made. In addition, 6 professional judges visually evaluated all cephalograms. Classification tables were constructed for the results of the logistic regression model and for the assignment of patients according to the visual evaluation of the cephalograms. The percentage of correctly classified patients at the.7 probability level was 62%. Surprisingly, the professional panel rendered an equal predictive value. The relatively inferior performance of both the mathematical model and the "eyeballing" may demonstrate that dentofacial morphology is only partially responsible for susceptibility to trauma.

Profile of an orthodontic patient at risk of dental trauma.

Increased overjet and inadequate lip coverage of the maxillary incisors are considered significant risk factors in many clinical studies. The purpose of the present study was to examine this issue of dental injury by actual cephalometric measurements in orthodontic patients. Pretreatment cephalograms (taken with lips in repose) of consecutive patients were used. The patients were allotted to two groups Group T (trauma): 56 patients who had injured their maxillary incisors prior to their orthodontic treatment, mean age at the start of treatment 11.9 years (SD = 1.5); and Group C (control): 98 patients with intact maxillary incisors, mean age at the start of treatment 11.6 years (SD = 1.3). Twelve cephalometric landmarks on the soft and hard tissue profile were identified and digitized and the relevant dental, skeletal and soft tissue measurements recorded. The variables in Groups T and C were compared and their predictive values for possible occurrence of trauma were tested by logistic regression analysis. No statistically significant differences between boys and girls were found. Overjet or maxillary incisor exposure or interlabial gap, each as a single variable, could differentiate between the two groups. Logistic regression analysis indicated that only a small percentage (28.7%) of the dependent variable variation (trauma vs control) can be explained by interlabial gap, gender, upper incisor long axis to facial plane (degree), upper incisor long axis to interlabial gap and overjet.

Severe high Angle Class II Division 1 malocclusion with vertical maxillary excess and gummy smile: a case report.

Severe Class II Division 1 malocclusion with vertical maxillary excess and gummy smiles can be treated in several ways. Early orthodontic treatment with vertical control may decrease the malocclusion as well as improve the appearance. In severe cases, orthognathic surgery might be the optimal solution. The following case report describes a patient with a severe gummy smile, where the final esthetic improvement was achieved by using a periodontal procedure after orthodontic treatment.

Pregnancy and amyloidogenesis: I. Offspring of amyloidotic mice are not predisposed to develop amyloidosis.

Amyloid enhancing factor (AEF) is a substance formed during amyloidogenesis that accelerates amyloid deposition in tissues. The administration of AEF followed by AgNO3 (inflammatory stimulus) to mice results in amyloidosis within 6 days. The purpose of the study was to determine whether the offspring of amyloidotic mice are exposed to maternal AEF during pregnancy and therefore become predisposed to the development of amyloidosis on inflammatory stimulus. To that end female mice were made amyloidotic by the administration of AEF and AgNO3, made pre-amyloidotic (a condition associated with self-generation of AEF) with a short course of casein, or treated with exogenous AEF without AgNO3; then mating and conception took place. The possible priming of offspring with maternal AEF was studied by the administration of AgNO3 alone (without AEF) to the offspring and the determination of the presence of amyloid deposits in their spleens. Despite the long-term effect of AEF and its high activity, amyloidosis did not develop in any of the studied offspring, implying that the newborn mice were not primed by maternal AEF. These findings suggest that amyloidotic mothers do not predispose their offspring to the risk of developing amyloidosis, probably because maternal AEF does not cross the placenta.

Periodic fever, aphthous stomatitis, pharyngitis, and adenopathy syndrome: clinical characteristics and outcome.

We report 28 patients (20 male) with a syndrome characterized by abrupt onset of fever, malaise, aphthous stomatitis, tonsillitis, pharyngitis, and cervical adenopathy (PFAPA syndrome). Episodes of fever occurred at intervals of 5.1 +/- 1.3 weeks beginning at the age of 4.2 +/- 2.7 years. Fever, malaise, tonsillitis with negative throat cultures, and cervical adenopathy were reported in all 28 patients, aphthae in 19, headache in 5, abdominal pain in 5, and arthralgia in 3. Mild hepatosplenomegaly was observed in 6 patients. Mild leukocytosis, elevation of the erythrocyte sedimentation rate, and fibrinogen were found during attacks. These episodes of illness resolved spontaneously in 4.3 +/- 1.7 days. Serum IgD was found elevated (>100 U/mL) in 12 of the 18 patients tested (140.2 +/- 62.4 U/mL). Affected children grow normally, have no associated diseases, and have no long-term sequelae. Attacks were aborted by a single dose of oral prednisone (2 mg/kg) at the beginning of the attack in all 15 patients in whom this medication was prescribed. In 9 patients the syndrome has completely resolved (beginning at the age of 2.9 +/- 1.3 and lasting 8 +/- 2.5 years). In 3 other patients complete resolution of the attacks occurred after tonsillectomy was performed. PFAPA is sporadic, and no ethnic predilection was found. Increased awareness of the clinical syndrome has resulted in more frequent diagnosis and adequate treatment.

Activation of the cytokine network in familial Mediterranean fever.

OBJECTIVE: To elucidate the role of cytokines in the pathogenesis of familial Mediterranean fever (FMF), an inherited disease characterized by attacks of serosal membrane inflammation. METHODS: Blood samples were obtained from patients with FMF during attacks and remission. The cytokine concentrations in plasma and in supernatants from whole blood stimulated by bacterial lipopolysaccharide (LPS) were determined. RESULTS: There were 27 patients with FMF, of whom 8 were studied during attacks, 9 during remission and 10 during both attack and remission. FMF attacks did not affect levels of plasma tumor necrosis factor-alpha (TNF-alpha) or interleukin 1beta (IL-1beta). In contrast, compared to remission, FMF attacks were associated with significantly higher mean levels of plasma IL-6 [8.4 pg/ml, 95% confidence interval (CI) 7.8-8.9 in remission vs 59 pg/ml, CI 21.4-96.7 during attacks; p=0.0005], sTNFr p55 (1.3 ng/ml, CI 1.2-1.4, vs 1.98 ng/ml, CI 1.6-2.3; p=0.005), and sTNFr p75 (2.9 ng/ml, CI 2.5-3.3, vs 4.09 ng/ml, CI 3.2-4.9; p=0.0249). The TNF-alpha, IL-1beta, and IL-6 content in supernatants derived from LPS stimulated blood cells was not modified by the attacks of FMF. Significant lower TNF-alpha release in LPS stimulated whole blood was detected in patients who were sampled in a later stage of the attacks (r=-0.54, p=0.047). CONCLUSION: Our results suggest that the cytokine network is activated during attacks of FMF. IL-6 appears to play an important role in the evolution of FMF attacks. Whether TNF-alpha or IL-1beta has a function in initiating the attacks remains to be established.