Ectodermal dysplasia: important role of complex dental care in its interdisciplinary management.

AIM: Despite the fact that ectodermal dysplasia (ED) is a rare disease, it is often seen in a tertiary clinic. ED affects ectodermal tissues such as skin, hair, teeth, nails, and sweat glands. Patients usually have sparse light hair, deformed nails, and dry skin. They suffer from dental abnormalities such as oligodontia (absence of 6 or more teeth) or complete anodontia; salivation can also be affected. The absence of teeth can be the overriding problem for both patients and their parents, and lead to substantial social ostracisation. This study aims to summarise the facts about the disease, especially dental treatment options based on data drawn from a representative Czech cohort. MATERIALS: The present article summarises the facts about ectodermal dysplasia (ED) in a cohort of 13 patients, where the following were evaluated: clinical manifestations of ED, pathogenic variants detected in selected candidate genes and dental treatment options from child removable dentures to fixed crowns and implants insertion. Three cases are described in detail and demonstrate approaches for different age groups. CONCLUSION: Early diagnosis and active cooperation between the geneticist and dentist will facilitate cooperation with parents and patients and assure secondary prevention. It is preferable that the geneticist understands dental treatment options and can discuss these with patients/parents.

Proclination-induced changes in the labial cortical bone thickness of lower incisors.

OBJECTIVES: We sought to objectivize the overall alveolar bone thickness changes in lower incisors after orthodontic intervention. BACKGROUND: The effect of orthodontic treatment on the cortical bone, specifically the clinical implications of proclination-induced change, have long been a matter of dispute. METHODS: Cone-beam computed tomographs of 58 patients were obtained before and after treatment and labial cortical bone thickness and overall alveolus width were measured in sagittal sections in the distance of 3, 6, 9 and 12 mm apically from the cemento-enamel junction. RESULTS: A statistically significant decrease of the cortical bone thickness in all four incisors was found at the levels 3, 6 and 9 mm (p 0.05). Moreover, no correlation was found between bone thickness change and extent of the incisor movement. CONCLUSION: Our results point to a marked cortical bone loss after proclination of lower incisors, furnishing a sound basis for caution in treatment planning due to the considerable risk of alveolar defect development, especially in patients with low initial bone thickness (Tab. 6, Fig. 2, Ref. 25).

Contemporary skull development - palatal angle analysis.

OBJECTIVES: The palatal angle is an important angle of the craniofacial complex. It is significant for the diagnosis of craniofacial disorders mainly for nasopharyngeal soft-tissue patterns.Background The dentists and otorhinolaryngologists use this relationship to establish proper treatment mechanics and evaluate facial profile. The aims of this study were to provide comparative cephalometric analyses of historical and contemporary skulls. MATERIALS AND METHOD: A total of 190 cephalograms of 2 groups of subjects were evaluated. Dolphin Imaging 11.0 - Cephalometric Tracing Analysis was used for the analysis. Unpaired two-tailed t-test assuming equality of variances was used for all variables (at the significance level p = 0.0001). RESULTS: The -modern forensic skulls had larger palatal angle at average value of 8.60 degrees ± 4.35, than that of archeological ones, the average value of which was 6.50 degrees ± 3.92. The difference was found significant. Unpaired two-tailed t-test assuming equality of variances showed that historical and contemporary skulls had statistically significant results. The difference was -2.09 with standard error of 0.60 (95% confidence interval from -3.29 to -0.89). Two-tailed probability attained value of P was less than 0.0001. CONCLUSION: The difference between both groups was found significant. An increase in the palatal angle can be directly connected with anterior rotation of upper jaw(Tab. 2, Fig. 5, Ref. 19).

Anomalous findings of number, morphology and size of permanent teeth in 7-10 years children living in the Czech Republic.

6,043 children, who were ordinary patients and children of Caucasian population, were examined clinically and radiographically. 430 children were aged 7-10 years. Dental anomalies were diagnosed in 14.1% (61 children) of those observed between 7-10 years. We aimed at numerical anomalies (78.6% of children with anomalies), morphological anomalies (19.6% of children with anomalies), size anomalies (3.2% of children with anomalies) and combinations of diagnoses (1.4% reflects the combinations of teeth 2 times calculated in combinations of diagnoses). Congenital numerical variations, i.e. hypodontia and hyperodontia, are among the most common deviations of the permanent dentition. Both conditions can occur as isolated traits or in association with other syndromes. Many studies indicate that hereditary factors are involved in the aetiology of anomalies. Gen MSX1 involves a primary position in mediating interactions between epithelium and mesenchyme in the development of teeth. Occurrence of dental anomalies is not very frequent; problems can arise with diagnosis of those affected teeth. It can be done using Orthopantomogram or Computed Tomography and 3D reconstruction. Some of the children with anomalies may have difficulties in treatment of affected teeth but in most cases the prognosis is good.

Study of edge detection task in dental panoramic radiographs.

The purpose of this study is (1) to introduce a new approach for edge detection in orthopantograms (OPGs) and an improved automatic parameter selector for common edge detectors, (2) to present a comparison between our novel approach with common edge detectors and (3) to provide faster outputs without compromising quality. A new approach for edge detection based on statistical measures was introduced: (1) a set of N edge detection results is calculated from a given input image and a selected type of edge detector, (2) N correspondence maps are constructed from N edge detection results, (3) probabilities and average probabilities are computed, (4) an overall correspondence is evaluated for each correspondence map and (5) the correspondence map providing the best overall correspondence is taken as the result of edge detection procedure. A comparison with common edge detectors (the Roberts, Prewitt, Sobel, Laplacian of the Gaussian and Canny methods) with various parameter settings (304 combinations for each test image) was carried out. The methods were assessed objectively [edge mismatch error (EME), modified Hausdorff distance (MHD) and principal component analysis] and subjectively by experts in dentistry and based on time demands. The suitability of the new approach for edge detection in OPGs was confirmed by experts. The current conventional methods in edge detection in OPGs are inadequate (none of the tested methods reach an EME value or MHD value below 0.1). Our proposed approach for edge detection shows promising potential for its implementation in clinical dentistry. It enhances the accuracy of OPG interpretation and advances diagnosis and treatment planning.

Evaluation of the three-year experience with all-ceramic crowns with polycrystalline ceramic cores.

The objective of the study was to evaluate the clinical outcomes of all-ceramic crowns three years after placement of the restoration in the oral cavity. The aim of the present clinical study were surveyed the Procera®, Cercon® and LAVA™ systems. In total, 121 crowns were followed in 33 patients (7 men and 26 women) with an average age of 53.5 years. The eighty crowns were placed in anterior and forty one crowns in posterior teeth. The crowns were fabricated in two dental laboratories and delivered in two private dental practices. The clinical trial was conducted according to American Dental Association guidelines. The patients were requested to provide their consent to the regular clinical examination including radiographic and photographic records. A total of 102 crowns were made of zirconium oxide ceramic cores - 58 Cercon®; 43 LAVA™, while 19 crowns were made of aluminum oxide cores Procera®. The veneering ceramic LAVA™ Ceram was used. The success rate was analyzed using Kaplan-Meier statistics and, in our case, the overall three-year success rate reached 96.7%. All-ceramic crowns with polycrystalline ceramic cores have low susceptibility to fracture, in this study just 3.3%.

Cephalometric floating norms for Czech adults.

The purpose of this study was to establish floating cephalometric norms for the description of the individual skeletal pattern in Czech adults. Floating norms provide a method of analysis that uses the variability of the associations among suitable cephalometric measures, on the basis of the regression model combining both sagittal and vertical skeletal parameters. Harmony box is a simple and useful tool for diagnostics of orthodontic anomalies according to individual cephalometric norms. 118 subjects, 53 male and 65 female, from Czech population were selected. The method of multiple regression analysis was used to determine interdependence among five cephalometric variables of the sample. Linear regression equations with corresponding r2 and standard error of the estimate (SE) were then illustrated as the harmony box. The results construct a harmony box based on correlated cephalometric variables. The multiple regression analysis of the data is graphically illustrated as a harmony schema which divides harmony box in three zones according to the type of the face - prognathic, orthognathic and retrognathic. The cephalometric floating norms describing the individual craniofacial pattern among Czech adults were established based on five correlated variables in the form of a harmony box.

Adolescent patient with bilateral crossbite treated with surgically assisted rapid maxillary expansion: a case report evaluated by the 3d laser scanner, and using FESA method.

Our purpose in this case report is to present an orthodontic treatment obtained and the results achieved in 17-year-old white female patient with Angle Class II malocclusion and bilateral posterior crossbite. Patient was treated with bonded acrylic Hyrax appliance and surgically assisted rapid maxillary expansion (SARME). The multiloop system 0.16 TMA (ß titanium) arch wire was used in the alignment phase and on purpose to prohibit bite opening and optimize threedimensional movement control. After treatment bonded lingual retainers were placed in between maxillary central incisors and in mandible canine-to-canine. A functional removable Klammt appliance was used for retention. The 3D Laser Scanner Roland LPX-250 was used in order to obtain digital dental casts. Evaluation of the treatment results was measured on these models and using finite element scaling analysis (FESA). An Angle Class I relationship was obtained after 2½ years of treatment, function and facial aesthetics were improved. The shape of the palate changed significant in the width direction, not significantly in length and high direction. The greatest expansion of palate was found in the region between the palatal cusps of the first molars 26.6%, followed by first 21.9% and second premolars 16.5%. SARME in adult patients with bilateral cross bite and maxillary deficiency lead to satisfactory results. The 3D laser scanned models and their measurements, using advanced software's are successfully used for precise studies.

Patients with special needs within treatment under general anesthesia - meta-analysis.

The study evaluates results obtained from the documentation of patients with special needs, who have undergone treatment under general anesthesia at the pediatric dentistry department. DMFT (decayed, missing, filled teeth) was used for comparison. A sample of 1,836 children from our dental clinic was evaluated. The sample was divided into two groups - special patient and disabled patient populations. A group of 5 years old children was chosen on the bases of WHO guidelines for the setting of the oral health status. A descriptive statistical analysis of the mean standard deviation was conducted with a focus on three factors: sex, age and year. A questionnaire was prepared to compare the oral health habits in the families of the patients. A literary review was conducted to compare the results with other studies from various countries. The meta-analysis using the software MedCalc was done. The DMFT of the patient was counted (disabled DMFT 11.05 - SD 4.82, special patient population 8.8 - SD 3.7) and the descriptive statistics mean standard deviation was calculated. The significant difference between the DMFT of disabled patient and special patient population was exerted (p<0.00003). It was statistically evaluated that the data gained from the studies and from the WHO as population average for 5 years old children are situated under the minimum limit of the confidence interval for our study. The meta-analysis confirmed the hypothesis that oral health status of the special needs children is worse than in other countries.

Voice-supported electronic health record for temporomandibular joint disorders.

OBJECTIVES: To identify support of structured data entry for an electronic health record application in temporomandibular joint disorders. METHODS: The methods of structuring information in dentistry are described and the interactive DentCross component is introduced. A system of structured voice-supported data entry in electronic health record on several real cases in the field of dentistry is performed. The connection of this component to the MUDRLite electronic health record is described. RESULTS: The use of DentVoice, an application which consists of the electronic health record MUDRLite and the voice-controlled interactive component DentCross, to collect dental information required by temporomandibular joint disorders is shown. CONCLUSIONS: The DentVoice application with the DentCross component showed the practical ability of the temporomandibular joint disorder treatment support.

Nasal prosthesis supported with self-tapping implants with bioactive surface--a case report.

Nasal prosthesis using dental implants and magnetic abutments is a method of choice in replacement of missing hard and soft facial tissues. Nose form, coloration, and texture must be as indiscernible from the surrounding natural tissues as possible. Rehabilitation efforts can be successful only when patients can appear in public without fear of attracting unwanted attention. This case report evaluates on a step-by-step basis the materials and methods including implants insertion.

Overdenture - implants versus teeth - quality of life and objective therapy evaluation.

An overdenture is a complete or removable partial denture that has one or more tooth roots or implants to provide a support. The study compares two types of prosthodontic treatment - overdenture supported by remained own teeth with ball attachments and that held by implants. The cohort of 35 patients (recall from 1 to 5 years) was evaluated. When subjectively and objectively assessed no significant difference between both groups was observed.

Forensic dentistry--identification from the dentist's point of view.

The paper deals with an identification of missing persons based on a dental documentation. The procedure of the identification is presented in two case reports with a new possibility of electronic imaging called Dental Cross in comparison with classical dental documentation, which is officially used for identification of the missing persons by Interpol.

Giant cell reparative granuloma in the mandible--case report and review of the literature.

OBJECTIVE: Central giant cell granuloma (GCG) is defined as an intraosseous lesion consisting of cellular fibrous tissue containing multiple foci of hemorrhage, aggregations of multinucleated giant cells. Peripheral GCG is a reactive exophytic lesion occurring on the gingiva and alveolar ridge originating from the periosteum or periodontal membrane, usually as a result of local irritating factors. STUDY DESIGN: The case report evaluated long-term therapy of giant cell granuloma. A 9-year-old boy generally healthy was admitted to our clinic with a swelling in the frontal area of mandible. Giant cell granuloma was detected. Surgical curettage was applied. After 3 years of the operation, the recurrence was seen during the physical examination. The new GCG was removed. The prosthetic rehabilitation including implants insertion (18-year-old adult patient) finished treatment. RESULTS: Three-year recall confirmed the stability of treatment. CONCLUSION: Esthetical and functional therapy is of great importance in the patient's rehabilitation.

Electronic health record for forensic dentistry.

OBJECTIVES: To identify support of structured data entry for electronic health record application in forensic dentistry. METHODS: The methods of structuring information in dentistry are described and validation of structured data entry in electronic health records for forensic dentistry is performed on several real cases with the interactive DentCross component. The connection of this component to MUDR and MUDRLite electronic health records is described. RESULTS: The use of the electronic health record MUDRLite and the interactive DentCross component to collect dental information required by standardized Disaster Victim Identification Form by Interpol for possible victim identification is shown. CONCLUSIONS: The analysis of structured data entry for dentistry using the DentCross component connected to an electronic health record showed the practical ability of the DentCross component to deliver a real service to dental care and the ability to support the identification of a person in forensic dentistry.

Influence of hydroxyapatite crystallinity on the growth of keratinocytes.

Dental implantology is a field, which has made a great progression recently. The main task nowadays is to shorten the healing period and so improve the comfort for the patients. One possibility how to full fil this task is to coat the surface of the implant. Very promising material seems to be hydroxyapatite, which is a natural component of human body and suitable method is the pulsed laser deposition. In our study we tried to evaluate difference between crystalline and amorphous hydroxyapatite coated dental implants from the biological point of view. We found that the cells were able to adhere to all of our studied samples. The worst proliferation of fibroblasts was found on the amorphous coating, whereas the adhesion was fully comparable with other surfaces. The level of keratinocyte differentiation was the same on both of the studied surfaces.

Effectiveness of low-level laser therapy in temporomandibular joint disorders: a placebo-controlled study.

OBJECTIVE: Low-level laser therapy (LLLT) treatment for pain caused by temporomandibular joint disorders (TMD) was investigated in a controlled study comparing applied energy density, subgroups of TMD, and duration of disorders. BACKGROUND DATA: Although LLLT is a physical therapy used in the treatment of musculoskeletal disorders, there is little evidence for its effectiveness in the treatment of TMD. METHODS: The study group of 61 patients was treated with 10 J/cm(2) or 15 J/cm(2), and the control group of 19 patients was treated with 0.1 J/cm(2). LLLT was performed by a GaAlAs diode laser with output of 400 mW emitting radiation wavelength of 830 nm in 10 sessions. The probe with aperture 0.2 cm(2) was placed over the painful muscle spots in the patients with myofascial pain. In patients with TMD arthralgia the probe was placed behind, in front of, and above the mandibular condyle, and into the meatus acusticus externus. Changes in pain were evaluated by self-administered questionnaire. RESULTS: Application of 10 J/cm(2) or 15 J/cm(2) was significantly more effective in reducing pain compared to placebo, but there were no significant differences between the energy densities used in the study group and between patients with myofascial pain and temporomandibular joint arthralgia. Results were marked in those with chronic pain. CONCLUSION: The results suggest that LLLT (application of 10 J/cm(2) and 15 J/cm(2)) can be considered as a useful method for the treatment of TMD-related pain, especially long lasting pain.

Study of laser created ZRO2 and hydroxyapatite/ZrO2 films for implantology.

Thin films of ZrO2 and hydroxyapatite/ZrO2 were created by excimer laser ablation on Ti6Al4V substrates. ZrO2 layers were fabricated in vacuum by KrF laser at various substrate temperatures and hydroxyapatite (HA) layers were fabricated in water vapor ambient by ArF laser and in water vapor/argon ambient by KrF excimer laser. Film properties were evaluated by XRD, SEM and WDX methods. The test of mechanical adhesion was proceeded on ZrO2 films. XRD analysis proved the presence of amorphous or crystalline HA in the deposited films. SEM method demonstrated smooth surface covered by droplets for both HA and ZrO2 films. Ca/P ratio of the HA films is higher than that of the natural HA and is within the range of 2.8-3.0. The HA/ZrO2 and ZrO2 samples were tested in vitro for cytotoxicity. The best results were received by the HA/ZrO2 samples in the test of cytotoxicity. Fibroblasts cultivating with HA/ZrO2 samples exhibited subconfluent and confluent growth and showed fibronectin homogenously.

Denture reconstruction of the edentulous upper jaw in cleft palate using implants--clinical report.

OBJECTIVE: Early prosthodontic therapy (usually at around 18 years of age) often leads to early loss of teeth and in extreme cases to complete loss of dentition at between 40 and 50 years of age. PATIENTS: This report describes the clinical features of two middle-aged cleft patients. Edentulous maxilla with cleft defect was treated with 6 implants supported by fixed appliance. RESULTS: Treatment of the whole dental arch on the basis of implants is currently frequently used as it provides a possibility of thorough functional and aesthetic therapy to a patient. The biomechanics of the reconstruction enables individual adjustment of the shape of the dental arch. CONCLUSIONS: The problem in cleft patients involves other diameter relations in the dental arch caused by the defect alone or also by affecting the growth of the maxillary segment by surgery. A potentially removable framework is therefore the main method of choice because the position of the implants must be prosthetically modified.

Multidisciplinary orofacial therapy after suicidal treatment: casuistical report.

Cutting wounds and bruises in the area of neck are very specific. The overall rehabilitation of these conditions is difficult and often needs to be combined with special and customised orofacial prostheses. This case-study reports special multidisciplinary treatment. The surgical diagnosis was: a cutting wound on a neck caused by a chain saw and disruption of oropharynx. Due to contusion of the tongue root and contusion of both hypoglossal nerves, a complete paralysis of tongue occurred. The tongue was immobile and the patient has problems with swallowing fluids. A special palatal prosthesis was made to reduce the space between the tongue and the palate. The fluoroscopically monitored swallowing action helps to receive optimal patient's rehabilitation.