Nonsurgical improvement of severe upper airway obstruction in infants with Robin sequence and cleft palate using Stanford Orthodontic Airway Plate treatment.

STUDY OBJECTIVES: Severe respiratory distress of neonates with Robin sequence (RS) is traditionally managed by surgery. Stanford Orthodontic Airway Plate treatment (SOAP) is a nonsurgical option. The study aimed to determine if SOAP can improve polysomnography (PSG) parameters of neonates with RS. METHODS: PSG of neonates with RS treated with SOAP at a single hospital were retrospectively analyzed. Patients without PSG at all 4 time points (pre-, start of-, mid-, and post-treatment) were excluded. Data were analyzed using a linear mixed effects model. RESULTS: Sixteen patients were included. All patients had cleft palate (CP). The median age (min, max) at the start of treatment was 1.1 months (0.5, 2.3) with the treatment duration of 4.5 months (3.5, 6.0). The mean obstructive apnea-hypopnea index (95% confidence interval) decreased from 39.3 events/hour (32.9, 45.7) to 12.2 events/hour (6.7, 17.7) (P < 0.001), obstructive apnea index decreased from 14.1 (11.2, 17.0) events/hour to 1.0 (-1.5, 3.5) events/hour (P < 0.001), and oxygen nadir increased from 79.9% (77.4, 82.5) to 88.2% (85.5, 90.8) (P < 0.001) between pre- and start of treatment. Respiratory improvements were sustained during and after the treatment. All patients avoided mandibular distraction osteogenesis or tracheostomy following SOAP. CONCLUSIONS: As being a rare diagnosis, the number of participants was, as expected, low. However, the current study demonstrates that SOAP can improve PSG parameters, demonstrating its potential utility before surgical interventions for neonates with RS and CP experiencing severe respiratory distress.

Presurgical Reduction of the Cleft Palate: Serendipitous Benefit of the Stanford Orthodontic Airway Plate Treatment (SOAP) for Infants with Robin Sequence.

OBJECTIVE: Narrowing of the palatal cleft is often observed in infants with Robin sequence (RS) treated with the Stanford Orthodontic Airway Plate treatment (SOAP) even though SOAP is utilized primarily to establish airway patency. The current study quantified dimensional changes of the cleft palate (CP) in infants with RS treated with SOAP. DESIGN: A retrospective chart review. PATIENTS: Infants with RS and CP who completed SOAP and had maxillary arch models at both pre- and post-treatment time points at a single tertiary referral hospital between September 2019 and July 2023. SETTING AND OUTCOME MEASURE: Maxillary arch models were measured and analyzed using Bivariate statistical analysis. RESULTS: Seventeen infants were included in the study. The median age (min, max) was 6.7 weeks (1.1, 21.9) at pre-treatment and 26.6 weeks (18.7, 37.0) at post-treatment. The median Obstructive Apnea Hypopnea Index was 36.2 events/hour (8.1, 103.1) at pre-treatment and 4.1 events/hour (1.9, 8.6) at post-treatment. The pre-treatment width of CP decreased by an average (± standard diviation) of 6.37 mm (± 3.55, p < 0.001) at post-treatment. The ratio of the posterior cleft width to the total maxillary arch width decreased from 40% (± 9.1) at pre-treatment to 22% (± 11) at post-treatment (p < 0.001). CONCLUSION: The dimensions of CP reduced significantly during SOAP in infants with RS and CP treated for their severe upper airway obstruction. The findings highlight a potential benefit of SOAP that may contribute favorably to the palate repair surgery.

Weight Gain of Infants with Robin Sequence Treated Nonsurgically Using the Stanford Orthodontic Airway Plate (SOAP): 1-Year Follow-Up.

OBJECTIVE: To identify weight gain trends of infants with Robin sequence (RS) treated by the Stanford Orthodontic Airway Plate treatment (SOAP). DESIGN: Retrospective longitudinal cohort study. SETTING: Single tertiary referral hospital. PATIENTS: Eleven infants with RS treated with SOAP. INTERVENTIONS: Nonsurgical SOAP. MAIN OUTCOME MEASURES: Body weight, Weight-for-age (WFA) Z-scores, and WFA percentiles at birth (T0), SOAP delivery (T1), SOAP graduation (T2), and 12-months old (T3). RESULTS: Between T0 and T1, the weight increased but the WFA percentile decreased from 36.5% to 15.1%, and the Z-score worsened from -0.43 to -1.44. From T1 to T2, the percentile improved to 22.55% and the Z-score to -0.94. From T2 to T3, the percentile and the Z-scores further improved to 36.59% and -0.48, respectively. CONCLUSIONS: SOAP provided infants experiencing severe respiratory distress and oral feeding difficulty with an opportunity to gain weight commensurate with the WHO healthy norms without surgical intervention.

Biocreative Alveolar Molding Plate Treatment (BioAMP) for neonatal unilateral cleft lip and palate with excessively wide alveolar cleft and maxillary arch width.

Since its inception in Europe in the 1950s, alveolar molding treatment for neonates with complete cleft lip and palate has undergone significant evolution in both design and application methodology, demonstrating effectiveness in normalizing the alveolar cleft and nasal shape. However, excessively wide alveolar clefts accompanied by disproportionately wide total maxillary arch pose significant challenges when utilizing conventional alveolar molding methods involving cyclical adding and grinding of acrylic on molding plates. The current report introduces a novel alveolar molding method named Biocreative Alveolar Molding Plate Treatment (BioAMP), which can normalize the maxillary alveolar cleft and arch shape without laborious conventional acrylic procedures. BioAMP sets the target arch form and provides unrestricted space for natural growth of the maxillary alveolar bones while systematically reducing the total maxillary arch width in precise increments. Two exemplary cases are presented as proof-of-concept, showcasing the clinical innovation of BioAMP.

Effects of daily versus weekly teriparatide for medication-related osteonecrosis of the jaw: A case-control study.

INTRODUCTION: Medication-related osteonecrosis of the jaw (MRONJ) is uncommon but can result in severe destruction of the jaw. This case-control study investigated the therapeutic effects of daily or weekly administration of teriparatide in the management of MRONJ using a cohort for osteonecrosis of the jaw. METHODS: Patients who were diagnosed with MRONJ and consented to teriparatide administration were assigned either to a group of daily injection or of weekly injection and completed a 4-week course of injection preoperatively and at least an 8-week course postoperatively. The control group received either the intraoperative rhBMP treatment (CG_BMP) or no additional perioperative treatment (CG_noBMP). The state of MRONJ was evaluated 2 months (T1) and 6 months (T2) postoperatively for all participants. RESULTS: Either group of daily injection (8.35 weeks ± 1.58; n = 17) or weekly injection (9.17 ± 3.79; n = 12) showed significantly faster healing than those of CG_BMP (14.40 ± 6.08; n = 25) or CG_noBMP (15.79 ± 9.79; n = 39). MRONJ was resolved completely in 24 out of 29 participants who completed the course of teriparatide injections, whereas 46.9% of CG showed delayed resolution. Multiple regression analysis indicated 7.50 times (95% CI, 1.77-31.82) more likelihood of complete resolution of MRONJ for participants with teriparatide injections. CONCLUSION: A course of daily or weekly administration of teriparatide injections may improve treatment outcomes for patients with MRONJ.

Miniscrews position for a tissue bone borne palatal C-expander affects the displacement pattern of nasomaxillary complex: a finite element study.

This study aimed to evaluate the difference in expansion patterns based on the position of miniscrews for a tissue-bone-borne palatal C-expander using a finite element method. Ten expansion models were examined, each representing a different position of miniscrews on the palate. Models A and B had miniscrews symmetrically placed 7 mm and 15 mm below the cementoenamel junction (CEJ), respectively. Models C to J had miniscrews positioned in a triangular manner at 7 mm and 15 mm below CEJ. Stress, displacement, angular changes of the bone and teeth, and changes in the nasomaxillary complex were measured using elastoplastic behavior models through static-nonlinear simulation employing an implicit method. The anterior and posterior parts of paramidpalatal suture area were identified as ANT, TPS-M, and TPS-L, and their ratio was assessed. Model A, which featured three miniscrews located 7 mm below the CEJ, exhibited the least molar inclination and the smallest amount of skeletal expansion. Model I, with two miniscrews placed between the first and second molars, demonstrated the greatest lateral displacement at point N on the nasal cavity wall, along with the smallest ratio of ANT to TPS-M or TPS-L. This finding suggests that the posterior expansion of the palate in relation to the anterior expansion was maximized. The results of this study indicate that strategic positioning of miniscrews is effective in achieving various expansion patterns based on the targeted correction areas within the nasomaxillary complex.

Disruptive Therapy Using a Nonsurgical Orthodontic Airway Plate for the Management of Neonatal Robin Sequence: 1-Year Follow-up.

We recently published the 3-month follow-up of 2 neonates with Robin sequence whose mandibular hypoplasia and restricted airway were successfully treated with an orthodontic airway plate (OAP) without surgical intervention. Both infants were successfully weaned off the OAP after several months of continuous use. We present the course of OAP treatment in these patients with a focus on breathing, feeding, and facial growth during their first year of life. Both infants demonstrated stable mandibular projection, resolution of obstructive sleep apnea, and normal development.

Development and systematic characterization of GelMA/alginate/PEGDMA/xanthan gum hydrogel bioink system for extrusion bioprinting.

Gelatin methacryloyl (GelMA)/alginate-based hydrogels have shown great promise in bioprinting, but their printability is limited at room temperature. In this paper, we present our development of a room temperature printable hydrogel bioink by introducing polyethylene glycol dimethacrylate (PEGDMA) and xanthan gum into the GelMA/alginate system. The inclusion of PEGDMA facilitates tuning of the hydrogel's mechanical property, while xanthan gum improves the viscosity of the hydrogel system and allows easy extrusion at room temperature. To fine-tune the mechanical and degradation properties, methacrylated xanthan gum was synthesized and chemically crosslinked to the system. We systematically characterized this hydrogel with attention to printability, strut size, mechanical property, degradation and cytocompatibility, and achieved a broad range of compression modulus (∼10-100 kPa) and degradation profile (100% degradation by 24 h-40% by 2 weeks). Moreover, xanthan gum demonstrated solubility in ionic solutions such as cell culture medium, which is essential for biocompatibility. Live/dead staining showed that cell viability in the printed hydrogels was over 90% for 7 days. Metabolic activity analysis demonstrated excellent cell proliferation and survival within 4 weeks of incubation. In summary, the newly developed hydrogel system has demonstrated distinct features including extrusion printability, widely tunable mechanical property and degradation, ionic solubility, and cytocompatibility. It offers great flexibility in bioprinting and tissue engineering.

Cross-species comparisons reveal resistance of human skeletal stem cells to inhibition by non-steroidal anti-inflammatory drugs.

Fracture healing is highly dependent on an early inflammatory response in which prostaglandin production by cyclo-oxygenases (COX) plays a crucial role. Current patient analgesia regimens favor opioids over Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) since the latter have been implicated in delayed fracture healing. While animal studies broadly support a deleterious role of NSAID treatment to bone-regenerative processes, data for human fracture healing remains contradictory. In this study, we prospectively isolated mouse and human skeletal stem cells (SSCs) from fractures and compared the effect of various NSAIDs on their function. We found that osteochondrogenic differentiation of COX2-expressing mouse SSCs was impaired by NSAID treatment. In contrast, human SSCs (hSSC) downregulated COX2 expression during differentiation and showed impaired osteogenic capacity if COX2 was lentivirally overexpressed. Accordingly, short- and long-term treatment of hSSCs with non-selective and selective COX2 inhibitors did not affect colony forming ability, chondrogenic, and osteogenic differentiation potential in vitro. When hSSCs were transplanted ectopically into NSG mice treated with Indomethacin, graft mineralization was unaltered compared to vehicle injected mice. Thus, our results might contribute to understanding species-specific differences in NSAID sensitivity during fracture healing and support emerging clinical data which conflicts with other earlier observations that NSAID administration for post-operative analgesia for treatment of bone fractures are unsafe for patients.

Bio-Exercise (BioEx) - A biocreative orofacial myofunctional therapy: preliminary cephalometric study and clinical application.

OBJECTIVE: To introduce newly structured and developed orofacial myofunctional therapy (OFMFT) protocols named Bio-Exercise (BioEx), and evaluate the treatment effect of this method, using lateral cephalometric analysis on malocclusion with low tongue posture in young patients. METHODS: A retrospective preliminary study was performed using orthodontic records from 28 patients (mean age of 8.41±1.45-year-old, 13 males, 15 females) treated with BioEx therapy using tongue elevators for 18.14±9.04 months (range: 6 to 37 months). Pretreatment (T0) and post-BioEx therapy (T1) lateral cephalograms were subsequently analyzed for tongue posture changes by linear, anteroposterior and vertical measurements. The data were analyzed by paired t-test, considering a 5% significance level. RESULTS: The tongue length (TGL) and tongue height (TGH) increased statistically significant between T0 and T1. The decrease of the dorsum of the tongue perpendicular to the palatal plane (Td-PP value) was statistically significant. The increase of the tip of the tongue perpendicular to the pterygomaxillary vertical line (TT-PMV) was not statistically significant. CONCLUSIONS: These preliminary cephalometric results indicate that BioEx can be an effective OFMFT modality in increasing the tonicity of the tongue muscles to establish more normalized tongue position at rest.

Split orthodontic airway plate: An innovation to the utilization method of conventional orthodontic airway plate for neonates with Robin sequence.

Since the emergence of neonatal infant orthodontics for treatments of cleft lip and palate with or without Robin sequence (RS) in Europe in the 1950s, advancements in design and scope of its application have been remarkable. As the first institution to adopt orthodontic airway plate (OAP) treatment in the United States in 2019, we saw a need for innovation of the original design to streamline the most labor-intensive and time-consuming aspects of OAP utilization. A solution is introduced using a systematic split expansion mechanism to re-size the OAP periodically to accommodate the neonate's maxillary growth. To date, seven RS patients have received this modified treatment protocol at our institution. Each patient completed full treatment using only one OAP. This innovative utilization method is aptly named the split orthodontic airway plate (S-OAP). Details of the S-OAP and its modifications from conventional OAP are reported.

New Frontier in Advanced Dentistry: CBCT, Intraoral Scanner, Sensors, and Artificial Intelligence in Dentistry.

The advancement of science and technology has brought innovation in the dental field [...].

Nonsurgical Orthodontic Airway Plate Treatment for Newborns With Robin Sequence.

Despite promising outcomes for >50 years, nonsurgical orthodontic airway plates (OAP) are only infrequently offered for babies with Robin sequence in a few parts of the world. This article demonstrates possibility of providing functional improvement using an OAP to help these babies overcome their functional and structural difficulties on their own. Two consecutively treated cases are presented exemplifying that OAP treatment that had originated from Europe is reproducible and effective in an institution in the United States.

A Systematic Review of Mandibular Distraction Osteogenesis Versus Orthodontic Airway Plate for Airway Obstruction Treatment in Pierre Robin Sequence.

OBJECTIVE: Mandibular distraction osteogenesis (MDO) is frequently performed to address airway obstruction in patients with Pierre Robin sequence (PRS), though more recently the technique of orthodontic airway plating (OAP) has gained traction. We aimed to evaluate OAP compared to MDO for airway obstruction in PRS. DESIGN: A systematic literature search across PubMed, Embase, and Google Scholar identified all studies published in English, which involved MDO or any form of OAP as treatments for PRS. All relevant articles were reviewed in detail and reported on, adhering to PRISMA guidelines. MAIN OUTCOME MEASURES: Airway (tracheostomy avoidance, decannulation rate), feeding (full oral feeding tolerance). RESULTS: Literature search identified 970 articles, of which 42 MDO studies and 9 OAP studies met criteria for review. A total of 1159 individuals were treated with MDO, and 322 individuals were treated with OAP. Primary outcomes appear similar for MDO and OAP at face value; however, this must be interpreted with different pretreatment contexts in mind. CONCLUSIONS: Orthodontic airway plating may be considered for airway obstruction in PRS, as some airway-related and feeding-related outcomes appear similar with MDO, per existing evidence in the literature. However, since PRS severity differed between studies, OAP cannot be uniformly considered a replacement for MDO. Further research is required to more comprehensively assess these treatment modalities inclusive of metrics that allow for direct comparison.

Bio-Exercise (BioEx) - A biocreative orofacial myofunctional therapy: preliminary cephalometric study and clinical application

ABSTRACT Objective: To introduce newly structured and developed orofacial myofunctional therapy (OFMFT) protocols named Bio-Exercise (BioEx), and evaluate the treatment effect of this method, using lateral cephalometric analysis on malocclusion with low tongue posture in young patients. Methods: A retrospective preliminary study was performed using orthodontic records from 28 patients (mean age of 8.41±1.45-year-old, 13 males, 15 females) treated with BioEx therapy using tongue elevators for 18.14±9.04 months (range: 6 to 37 months). Pretreatment (T0) and post-BioEx therapy (T1) lateral cephalograms were subsequently analyzed for tongue posture changes by linear, anteroposterior and vertical measurements. The data were analyzed by paired t-test, considering a 5% significance level. Results: The tongue length (TGL) and tongue height (TGH) increased statistically significant between T0 and T1. The decrease of the dorsum of the tongue perpendicular to the palatal plane (Td-PP value) was statistically significant. The increase of the tip of the tongue perpendicular to the pterygomaxillary vertical line (TT-PMV) was not statistically significant. Conclusions: These preliminary cephalometric results indicate that BioEx can be an effective OFMFT modality in increasing the tonicity of the tongue muscles to establish more normalized tongue position at rest.

RESUMO Objetivo: Introduzir protocolos de terapia miofuncional orofacial (TMO) recém-estruturados e desenvolvidos, denominados Bio-Exercise (BioEx), e avaliar o efeito do tratamento com esse método, usando análise cefalométrica em radiografias laterais de jovens com má oclusão e postura baixa da língua. Métodos: Foi realizado um estudo preliminar retrospectivo com registros ortodônticos de 28 pacientes (idade média de 8,41±1,45 anos, 13 homens, 15 mulheres) tratados com terapia BioEx usando elevadores de língua por 18,14±9,04 meses (intervalo: 6 a 37 meses). As radiografias cefalométricas laterais pré-tratamento (T0) e pós-tratamento com BioEx (T1) foram analisadas quanto às alterações na postura da língua, por meio de medidas lineares, anteroposteriores e verticais. Os dados foram analisados pelo teste t pareado, considerando-se um nível de significância de 5%. Resultados: O comprimento da língua (CL) e a altura da língua (AL) aumentaram entre T0 e T1, com significância estatística. A diminuição do dorso da língua perpendicular ao plano palatino (valor Td-PP) foi estatisticamente significativa. O aumento da ponta da língua perpendicular à linha vertical pterigomaxilar (PL-PMV) não foi estatisticamente significativo. Conclusões: Esses resultados cefalométricos preliminares indicam que o BioEx pode ser uma modalidade de TMO eficaz no aumento da tonicidade dos músculos da língua, para estabelecer uma postura de língua adequada em repouso.

Root proximity of the anchoring miniscrews of orthodontic miniplates in the mandibular incisal area: Cone-beam computed tomographic analysis.

OBJECTIVE: This outcome analysis study evaluated the actual positions of the orthodontic miniplate and miniplate anchoring screws (MPASs) and the risk factors affecting adjacent anatomic structures after miniplate placement in the mandibular incisal area. METHODS: Cone-beam computed tomographic images of 97 orthodontic miniplates and their 194 MPASs (diameter, 1.5 mm; length, 4 mm) in patients whose miniplates provided sufficient clinical stability for orthodontic treatment were retrospectively reviewed. For evaluating the actual positions of the miniplates and analyzing the risk factors, including the effects on adjacent roots, MPAS placement height (PH), placement depth (PD), plate angle (PA), mental fossa angle (MA), and root proximity were assessed using the paired t-test, analysis of variance, and generalized linear model and regression analyses. RESULTS: The mean PDs of MPASs at positions 1 (P1) and 2 (P2) were 2.01 mm and 2.23 mm, respectively. PA was significantly higher in the Class III malocclusion group than in the other groups. PH was positively correlated with MA and PD at P1. Of the 97 MPASs at P1, 49 were in the no-root area and 48 in the dentulous area; moreover, 19 showed a degree of root contact (19.6%) without root perforation. All MPASs at P2 were in the no-root area. CONCLUSIONS: Positioning the miniplate head approximately 1 mm lower than the mucogingival junction is highly likely to provide sufficient PH for the P1- MPASs to be placed in the no-root area.

Evaluation of strategic uprighting of the mandibular molars using an orthodontic miniplate and a nickel-titanium reverse curve arch wire: Preliminary cephalometric study.

OBJECTIVE: To evaluate the overall treatment effects in terms of the amount of uprighting with changes in the sagittal and vertical positions of mandibular molars after applying an orthodontic miniplate with a nickel-titanium (NiTi) reverse curve arch wire (biocreative reverse curve [BRC] system). METHODS: A total of 30 female patients (mean age, 25.99 ± 8.96 years) were treated with the BRC system (mean BRC time, 10.3 ± 4.07 months). An I-shaped C-tube miniplate (Jin Biomed) was placed at the labial aspect for the alveolar bone of the mandibular incisors. A 0.017 × 0.025-inch NiTi reverse curve arch wire was engaged at the C-tube mini-plate anteriorly and the first and second premolars and molars posteriorly in the mandibular arch. Pre- and post-BRC lateral cephalograms were analyzed. A paired t-test was used to analyze the treatment effects of BRC. RESULTS: The mandibular second molars were intrusively uprighted successfully by the BRC system. Distal uprighting with a controlled vertical dimension was noted on the first molars when they remained engaged in the BRC and the distal ends of the arch wire were laid on the second molars. The mandibular first and second premolars showed a slight extrusion. The changes in the mandibular incisors were unremarkable, while the mandibular molar angulation improved significantly. The lower occlusal plane rotated counterclockwise (MP-LOP: 1.13° ± 2.60°). CONCLUSIONS: The BRC system can provide very effective molar uprighting without compromising the position of the mandibular anterior teeth.

Finite element analysis of C-expanders with different vertical vectors of anchor screws.

INTRODUCTION: C-expanders are tissue- and bone-borne maxillary expanders that are anchored by 6 orthodontic miniscrews, 3 on each side of the palate. The purpose of the study was to investigate the effect of C-expanders on the circummaxillary sutures and bucco-palatal axis of teeth in 3-dimensional finite element analyses when anchor screw vectors are different. METHODS: Five expansion models were studied on the basis of the vertical positions of anchor screws on the palate. Anchor screws for models A, B, and C were placed symmetrically at 4 mm, 7 mm, and 15 mm below the cementoenamel junction (CEJ), respectively. Anchor screws for models D and E were placed asymmetrically at 4 mm and 15 mm below CEJ and 7 mm and 15 mm below CEJ, respectively. Stress, displacement, and angular changes of the bone and teeth were measured in elastoplastic behavior models using a static-nonlinear simulation in an implicit method. RESULTS: Symmetrical and asymmetrical anchor screw placement with different vertical vectors were compared using finite element analyses on 5 models. CONCLUSIONS: Using different vectors of anchor screws for C-expanders does change the pattern of palatal expansion (null hypothesis was rejected). The current investigation presents a promising future of controlled asymmetric skeletal maxillary expansion when asymmetric maxillary architecture needs to be corrected for successful orthodontic outcomes without involving orthognathic surgeries.