Ultrasound-assisted dilute acid hydrolysis for production of essential oils, pectin and bacterial cellulose via a citrus processing waste biorefinery.

An orange peel waste biorefinery was developed employing a design of experiments approach to optimize the ultrasound-assisted dilute acid hydrolysis process applied for production of useful commodities. Central composite design-based response surface methodology was used to approximate the combined effects of process parameters in simultaneous production of essential oils, pectin and a sugar-rich hydrolyzate. Application of a desirability function determined the optimal conditions required for maximal production efficiency of essential oils, pectin and sugars as 5.75% solid loading, 1.21% acid concentration and 34.2 min duration. Maximum production yields of 0.12% w/w essential oils, 45% w/w pectin and 40% w/w sugars were achieved under optimized conditions in lab- and pilot-scale facilities. The hydrolyzate formed was applied in bacterial cellulose fermentations producing 5.82 g biopolymer per 100 g waste. Design of experiments was efficient for process analysis and optimization providing a systems platform for the study of biomass-based biorefineries.

Experiences Of Individuals Concerning Combined Orthodontic and Orthognathic Surgical Treatment: A Qualitative Twitter Analysis.

OBJECTIVE: The aim of this qualitative study was to analyze the content of posts on Twitter in order to gain an in-depth understanding of patients' thoughts and experiences surrounding orthognathic surgical treatment. MATERIALS AND METHODS: Using the Twitter search function, with the keywords "jaw surgery," the 1,000 most recent posts on Twitter with relevance to a combined orthodontic and orthognathic surgical treatment were extracted. After applying relevant inclusion and exclusion criteria, the selected posts were analyzed using thematic analysis by 2 independent investigators. Distinct themes and subthemes were developed. RESULTS: A total of 689 posts were analyzed; the 3 main themes identified in relation to orthognathic surgery were preoperative engagement, postoperative difficulties, and posttreatment satisfaction. Twelve subthemes were also identified, expressing issues such as anticipation or apprehension of the surgical procedure, postoperative pain and edema, dietary restrictions and weight loss, paresthesia, depression, and satisfaction with improvements in appearance and self-confidence. The 6 terms most frequently used in tweets were "recovery," "braces," "swollen," "eat," "liquid diet," and "pain." CONCLUSIONS: The findings from the present study can increase the awareness of clinicians involved in the combined orthodontic and orthognathic surgical treatment of patients with dentofacial deformities, allowing them to better educate and counsel their patients throughout the entire treatment process.

Highly cited orthodontic articles from 2000 to 2015.

INTRODUCTION: Identification of highly cited articles based on the h-index and its properties is important for the evaluation of the past, present, and future of any research discipline. In this study, we aimed to identify the h-classic articles in orthodontics. METHODS: One search on the Web of Science identified all articles from 2000 to 2015 in the 89 journals indexed by the 2015 InCites Journal Citation Reports in the scientific area "dentistry, oral surgery, and medicine." A second search was performed in the Web of Science using all mesh terms related to orthodontics. Then, we applied the h-classic method to select the recent articles with the greatest scientific impact in orthodontics. RESULTS: Eighty articles were considered as h-classic articles. They were published in 20 of the 89 dental journals of the 2015 InCites Journal Citation Reports list. Only 36 articles appeared in orthodontic journals: 23 in the American Journal of Orthodontics & Dentofacial Orthopedics (28.8%), 7 in The Angle Orthodontist (8.8%), and 6 in European Journal of Orthodontics (7.5%). Thirty-eight articles originated from Europe, 28 from the Americas, and 14 from the Middle East and Asia. CONCLUSIONS: More than half of fundamental orthodontic research is published in nonorthodontic journals showing that our field is currently limited, and interactions with other research fields should be sought to increase orthodontic research importance and appeal.

A novel colourimetric technique to assess chewing function using two-coloured specimens: Validation and application.

OBJECTIVES: Chewing efficiency may be evaluated using cohesive specimen, especially in elderly or dysphagic patients. The aim of this study was to evaluate three two-coloured chewing gums for a colour-mixing ability test and to validate a new purpose built software (ViewGum©). METHODS: Dentate participants (dentate-group) and edentulous patients with mandibular two-implant overdentures (IOD-group) were recruited. First, the dentate-group chewed three different types of two-coloured gum (gum1-gum3) for 5, 10, 20, 30 and 50 chewing cycles. Subsequently the number of chewing cycles with the highest intra- and inter-rater agreement was determined visually by applying a scale (SA) and opto-electronically (ViewGum©, Bland-Altman analysis). The ViewGum© software determines semi-automatically the variance of hue (VOH); inadequate mixing presents with larger VOH than complete mixing. Secondly, the dentate-group and the IOD-group were compared. RESULTS: The dentate-group comprised 20 participants (10 female, 30.3±6.7 years); the IOD-group 15 participants (10 female, 74.6±8.3 years). Intra-rater and inter-rater agreement (SA) was very high at 20 chewing cycles (95.00-98.75%). Gums 1-3 showed different colour-mixing characteristics as a function of chewing cycles, gum1 showed a logarithmic association; gum2 and gum3 demonstrated more linear behaviours. However, the number of chewing cycles could be predicted in all specimens from VOH (all p<0.0001, mixed linear regression models). Both analyses proved discriminative to the dental state. CONCLUSION: ViewGum© proved to be a reliable and discriminative tool to opto-electronically assess chewing efficiency, given an elastic specimen is chewed for 20 cycles and could be recommended for the evaluation of chewing efficiency in a clinical and research setting. CLINICAL SIGNIFICANCE: Chewing is a complex function of the oro-facial structures and the central nervous system. The application of the proposed assessments of the chewing function in geriatrics or special care dentistry could help visualising oro-functional or dental comorbidities in dysphagic patients or those suffering from protein-energy malnutrition.

The 100 Most-Cited Human Cleft Lip and Palate-Related Articles Published in Dentistry, Oral Surgery, and Medicine Journals.

OBJECTIVE: To identify the 100 most-cited articles pertaining to human cleft lip and palate research published in dentistry, oral surgery, and medicine journals and to identify their principal bibliometric characteristics. DESIGN: Web-based bibliometric analysis. MAIN OUTCOME MEASURE: The Web of Science was searched to identify the 100 most-cited clinical articles related to cleft lip and/or palate. Information was extracted with regard to total number of citations, number of authors, affiliations, year, and journal of publication, Medical Subject Headings, type of study, specific area of study. Trends in citations were assessed. RESULTS: The 100 most-cited articles identified received between 437 and 58 citations. The oldest was published in 1954 and the most recent in 2008. The number of authors ranged from 1 to 12, with an average of three authors per article. Most of the first authors were affiliated with institutions in the United States, with the most prolific institution being the University of Iowa. More than 70% of the studies appeared in The Cleft Palate-Craniofacial Journal. There was a significant negative correlation between average citations per year and time since publication (P < .001); whereas, a significant positive correlation was observed between average citations per year and number of total citations (P < .001). CONCLUSIONS: The 100 most-cited articles in human cleft lip and palate research published in dentistry, oral surgery, and medicine journals are listed and characterized. This can be used as a potential knowledge base for specialists in training or to produce relevant knowledge defining the direction of future research.

Agenesis of maxillary lateral incisor and tooth replacement: cost-effectiveness of different treatment alternatives.

PURPOSE: To evaluate the long-term cost-effectiveness of five treatment alternatives for maxillary lateral incisor agenesis where space maintenance and tooth replacement are indicated. MATERIALS AND METHODS: The following treatment modalities were considered: single-tooth implant-supported crown, resin-bonded fixed partial denture (FPD), cantilever FPD, full-coverage FPD, and autotransplantation. The cost-effectiveness for each treatment modality was determined as the ratio of the outcome of each modality divided by the cost. Direct costs, clinical and laboratory, were calculated based on national fee schedules and converted to international dollars using purchasing power parity exchange rates. Outcomes were based on the most recently published long-term (10-year) survival rates. Sensitivity analyses were carried out, testing the robustness of the cost-effectiveness analysis. RESULTS: The five treatment modalities ranked in the following order from most to least cost-effective: autotransplantation, cantilever FPDs, resin-bonded FPDs, single-tooth implants and implant-supported crowns, and full-coverage FPDs. Sensitivity analysis illustrated that the cost-effectiveness analysis was reliable in identifying autotransplantation as the most and full-coverage FPDs as the least cost-effective treatment modalities. CONCLUSIONS: When replacing a missing maxillary lateral incisor, the most costeffective, long-term treatment modality is autotransplantation, whereas the least cost-effective is full-coverage FPDs. However, factors such as patient age, the state of the dentition, occlusion, and tooth conservation should also influence the choice of restoration.

Geometric morphometric 3D shape analysis and covariation of human mandibular and maxillary first molars.

Dental casts of 160 Greek subjects (80 males, 80 females) were scanned by a structured-light scanner. The upper and lower right first molar occlusal surface 3D meshes were processed using geometric morphometric methods. A total of 265 and 274 curve and surface sliding semilandmarks were placed on the upper and lower molar surfaces, respectively. Principal component analysis and partial least square analysis were performed to assess shape parameters. Molars tended to vary between an elongated and a more square form. The first two principal components (PCs), comprising almost 1/3 of molar shape variation, were related to mesiodistal-buccolingual ratios and relative cusp position. Distal cusps displayed the greatest shape variability. Molars of males were larger than those of females (2.8 and 3.2% for upper and lower molars respectively), but no shape dimorphism was observed. Upper and lower molar sizes were significantly correlated (r(2) = 0.689). Allometry was observed for both teeth. Larger lower molars were associated with shorter cusps, expansion of the distal cusp, and constriction of the mesial cusps (predicted variance 3.25%). Upper molars displayed weaker allometry (predicted variance 1.59%). Upper and lower molar shape covariation proved significant (RV = 17.26%, P < 0.0001). The main parameter of molar covariation in partial least square axis 1, contributing to 30% of total covariation, was cusp height, in contrast to the primary variability traits exhibited by PC1 and PC2. The aim of this study was to evaluate shape variation and covariation, including allometry and sexual dimorphism, of maxillary and mandibular first permanent molar occlusal surfaces.

Aesthetic outcome of cleft lip and palate treatment. Perceptions of patients, families, and health professionals compared to the general public.

The aesthetic outcome of cleft treatment is of great importance due to its complex management and the psychosocial consequences of this defect. The aim of the study was to assess the aesthetic evaluations of patients following cleft surgery by various groups and investigate potential associations of the assessments with life quality parameters. Head photos of 12 adult patients with treated unilateral cleft lip and palate were evaluated by laypeople and professionals. A questionnaire was distributed and answered by the patients and their parents. Intra-panel agreement was high (α > 0.8) for laypeople and professionals. Between-groups agreement was high for both laypeople and professionals, but not when patients and/or parents were tested. Professionals, parents, and patients were more satisfied with patients' appearance than laypeople, although in general all groups were not highly satisfied. Low satisfaction with aesthetics correlated with increased self-reported influence of the cleft in the patients' social activity and professional life (0.56 < rho < 0.74, p < 0.05). These findings highlight the observed negative influence of the cleft on the patient's social activity and professional life and underline the need for the highest quality of surgical outcome for this group of patients.

Mesiodistal tooth size in non-syndromic unilateral cleft lip and palate patients: a meta-analysis.

OBJECTIVES: To evaluate, using meta-analysis methodology, mesiodistal tooth dimensions in non-syndromic unilateral cleft lip and palate (CLP) patients. MATERIALS AND METHODS: A literature search was conducted using PubMed, Medline, Google Scholar Beta, EMBASE Excerpta Medica, CINAHL, Web of Science, and the Cochrane Collaboration, identifying English and non-English articles reporting on mesiodistal tooth dimensions on the cleft and non-cleft side of non-syndromic unilateral CLP patients. Additional studies were identified by searching reference lists of articles consulted. Only studies with a suitable control group were included. Two examiners independently performed the literature search and data extraction. Using meta-analysis software, data extracted from each selected study were statistically combined using the fixed-effects model. Weighted mean differences, 95 % confidence intervals, and heterogeneity were calculated for each measurement. RESULTS: Four articles fulfilling the inclusion criteria were located and included in the meta-analysis. Maxillary incisors and first molars were found to be significantly larger on the non-cleft side while mandibular incisors and premolars were larger on the cleft side, in non-syndromic unilateral CLP patients. On the cleft side, maxillary premolars and second molars were larger in cleft than control patients while incisors were smaller, whereas all mandibular teeth were larger in cleft patients. On the non-cleft side, all maxillary teeth except for the central incisors were larger in the cleft than control patients, while all mandibular teeth were larger in the cleft patients except for lateral incisors. CONCLUSIONS: Non-syndromic unilateral CLP patients tend to have larger posterior but smaller anterior teeth compared with the general population. Comparing sides, unilateral CLP patients tend to have smaller maxillary but larger mandibular teeth on the cleft than on the non-cleft side. CLINICAL RELEVANCE: Given that obtaining a stable, functional, and esthetic occlusion requires a thorough evaluation of tooth size, knowledge about trends in tooth size variations in CLP patients can help with dental and orthodontic treatment planning.

Quantitative evaluation of neurosensory disturbance after bilateral sagittal split osteotomy using Semmes-Weinstein monofilaments: a systematic review.

PURPOSE: To evaluate neurosensory disturbance of the inferior alveolar nerve, after bilateral sagittal split osteotomy, from before surgery to 1 year postoperatively, by quantitatively evaluating published data using Semmes-Weinstein monofilaments. MATERIALS AND METHODS: A literature search was conducted by use of PubMed, EMBASE, Scopus, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library in June 2012. The related citations function in PubMed, reference lists, and authors' names were used to expand the search. From each included study, study and sample characteristics were extracted, as were results. The main outcome was the lightest pressure the patient could discern at 1 month and at 1 year after the osteotomy procedure, in comparison with before surgery. RESULTS: Of the 3,107 articles initially identified, 7 were chosen according to the preset inclusion and exclusion criteria. The results from the studies could not be combined for the purpose of a meta-analysis because of the lack of standardization. Only 2 studies provided data that allowed an estimation of average detectable applied force to be carried out. Before surgery, the lowest detectable threshold corresponded to a mean of 0.07 to 0.16 g. At 1 month after surgery, the lowest detectable threshold averaged 6 g, and at 1 year after surgery, the mean value was 0.16 to 0.4 g. CONCLUSIONS: After bilateral sagittal split osteotomy, at 1 month after surgery, the sensory threshold increases approximately 35- to 85-fold compared with the presurgery threshold. Within 1 year, the threshold normally decreases almost to presurgery levels, representing 96% to 98% sensory recovery. Studies should aim to quantitatively use the Semmes-Weinstein monofilament method and standardize the presentation of results.

Assessment of potential orthodontic mini-implant insertion sites based on anatomical hard tissue parameters: a systematic review.

PURPOSE: To estimate the applicability of potential sites for insertion of orthodontic mini-implants (OMIs) by a systematic review of studies that used computed tomography (CT) or cone beam CT to evaluate anatomical bone quality and quantity parameters, such as bone thickness, available space, and bone density. MATERIALS AND METHODS: Medline and the Cochrane Database of Systematic Reviews were searched to identify all relevant papers. Several key words were used, such as computerized/computed tomography, mini-implants, and OMIs. The anatomical variables that were assigned in each article to a specific site suggesting it as the ideal or best alternative were assessed separately and evaluated with a scoring system. RESULTS: Twenty-two articles were included in the study. The most favorable areas for OMI insertion in the maxilla are proposed between the first and second molars buccally and palatally. The best area in the mandible is also between the first and second molars, both buccally and lingually. In the palate, the paramedian area 3 to 6 mm posterior to and 2 to 9 mm lateral to the incisive foramen was identified as the best site for OMI placement. CONCLUSIONS: Despite the heterogeneity of the studies, there was considerable agreement regarding the optimal site for OMI insertion among most studies that investigated anatomical hard tissue parameters based on CT or CBCT data. In this respect, the posterior area from the second premolar to the second molar is the best option for OMI placement in alveolar bone.

Appreciation of cleft lip and palate treatment outcome by professionals and laypeople.

The aim of the study was to analyse the aesthetic evaluation of head photographs of treated individuals with clefts by laypeople and professionals and to investigate how certain cephalometric variables could be related to their rating. A set of five standardized head photos (frontal, both laterals, three-quater right and left) of 12 Caucasian patients with treated unilateral cleft lip and palate were presented to 12 adult laypeople, 12 orthodontists, and 12 maxillofacial surgeons. For each set of photos the judges had to answer four questions on a visual analogue scale (VAS). The answers were analysed for intra- and inter-panel level of agreement and correlations of assessments with certain cephalometric parameters were determined. There was a high level of agreement for all assessments of each panel of raters. However, laypeople were less satisfied with lip and nose aesthetics compared to professionals. The three groups were similarly satisfied with the aesthetics of the jaws and the face. The anterior position of the maxilla (SNA) influenced positively professionals' ratings of facial aesthetics. Orthodontists were negatively influenced when the vertical dimension of the face or the distance of the lower lip to E-plane were relatively increased. The latter was the only cephalometric parameter correlated with lower aesthetic scores obtained from laypeople. Professionals report greater satisfaction from the treatment outcome and evaluate cleft consequences with less severity than laypeople. According to cephalometric findings, the relative positions of the lips seem to dominate facial aesthetics' appreciation by laypeople, while specialists appear to focus on different features of the face.

Gingival changes and secondary tooth eruption in adolescents and adults: a longitudinal retrospective study.

INTRODUCTION: Our aim was to investigate 8 years of vertical changes of the gingival margin and tooth displacement of maxillary molars and incisors in adolescents and adults. METHODS: Twenty-five adolescents and 10 adults were included in this study, with dental casts taken 2 and 10 years after orthodontic treatment. The gingival contour of the teeth was traced digitally using calibrated photographs of the 2 dental casts, and gingival changes were measured on crown superimposition. Eruption of the central incisors and first molar were measured on dental casts after scanning and superimposition on the palatal vault. RESULTS: Adults and adolescents presented a mean molar eruption of 0.27 and 0.34 mm and a mean incisor eruption of 0.39 and 0.73 mm, respectively. Adults and adolescents presented a mean molar gingival displacement of respectively 0.34 and 0.77 mm, and the adolescents a mean incisor gingival displacement of 0.44 mm. Correlation between secondary tooth eruption and gingival displacement was obtained only for the incisors in the adolescent group. CONCLUSIONS: Adolescents and adults presented apical displacement of the gingival contour of the maxillary first molars, as was the case for maxillary incisors in adolescents. Secondary eruption of maxillary first molars and central incisors continues in adolescents and adults.

Oral health-related quality of life in hospitalised stroke patients.

OBJECTIVE: The aim of this study was to test the hypothesis that impairment of orofacial function following stroke affects the patients' oral health-related quality of life (OHRQoL). MATERIAL AND METHODS: From the University Hospitals of Geneva, 31 stroke patients (18 men, 13 women, mean age 69.0 ± 12.7 years) with unilateral facial and limb palsy were recruited (patient group, PG). In the study, the Oral Health Impact Profile (OHIP)-EDENT was utilised to assess OHRQoL. Further examinations comprised a test of masticatory efficiency and lip force, stroke severity National Institute of Health Stroke Scale and dental state. The control group (CG) consisted of 24 subjects with similar age, gender and dental state. RESULTS: The PG mean OHIP-EDENT sum score was 18.8 ± 15.5 and proved higher than one of the CG, indicating a lower OHRQoL in the PG (p < 0.01). The score of the sub-domains 'functional limitation' and 'physical pain' were significantly higher in PG (p < 0.03 and p < 0.02, respectively). The masticatory efficiency was significantly lower in the PG (p < 0.0001) and was associated with the OHIP-EDENT sum score and its sub-domains, except for 'physical disability'. This effect was not present in the CG. CONCLUSION: The OHRQoL is significantly reduced in hospitalised stroke patients whereby functional impairment seems predominant when compared with psychological and psycho-social aspects.

Distances between facial landmarks can be measured accurately with a new digital 3-dimensional video system.

INTRODUCTION: The aim of this study was to investigate a new digital 3-dimensional infrared video system to determine its accuracy, precision, and validity in measuring facial distances. METHODS: Bench experiments were performed by measuring the vertical and diagonal distances of chessboard squares of known length to determine the system's accuracy and precision. To test the system's validity, 16 healthy volunteers participated in this study. Vertical and horizontal distances of the face were measured electronically at rest, and on posed and aggressive smiles. All measurements were repeated after 8 weeks. Direct measurements of the intercanthal distance were obtained twice with calipers. RESULTS: A minor systematic error was found in the bench experiments, with the highest absolute error of 0.227 +/- 0.39 mm. The analysis with this video system showed good reproducibility of all measured distances when the mean of 2 frames was used to compare distances. Digital measurements of the intercanthal distances showed high agreement with the clinically obtained values. CONCLUSIONS: This digital video system can measure geometric distances in a 3-dimensional environment with high precision. Facial distances can be measured with good accuracy and precision, allowing applications in research and clinical practice.

Vertical growth-related changes in the positions of palatal rugae and maxillary incisors.

INTRODUCTION: With 3-dimensional scanning, the image of 1 digital dental cast can be superimposed on another to observe growth or treatment changes; however, this requires stable references. The palatal rugae were considered reliable points for detecting dental changes on the cast's occlusal plane, but is this the case in the vertical plane? Our aims were to assess the long-term stability of the palatal rugae in the vertical dimension, relate them to possible maxillary incisor posteruptive movements, and validate them as references for the evaluation of longitudinal dental changes. METHODS: Four-year longitudinal lateral cephalograms and dental casts of 10 adults and 13 adolescents were used. The median palatal contour of each cast and marks corresponding to each ruga were superimposed on the palate of the cephalograms. Changes in rugae positions during the observation period were measured with respect to the palatal plane. RESULTS: Vertical changes were greater for the first rugae (closest to the incisors), less for the second, and even less for the third (farthest from the incisors). The adolescents showed greater vertical changes in rugae position than the adults. There were no statistically significant differences in the anteroposterior changes between the groups. The maxillary central incisor and the first ruga had vertical displacements proportional to the increase of the subject's lower anterior facial height. CONCLUSIONS: We found vertical displacement of the maxillary incisor and the rugae during the 4 years of observation in adolescents and adults. The third ruga, the farthest from the incisors, can be used as a reliable reference to assess longitudinal dental changes mainly when growth changes are less prominent.