Cephalometric evaluation of deep overbite correction using anterior bite turbos.

OBJECTIVES: To evaluate the outcome of treating deep overbite (OB) using anterior bite elevators concurrently with a pre-adjusted edgewise appliance. MATERIALS AND METHODS: The Case Western Reserve University (CWRU) cephalometric analysis was used to isolate tipping movement of upper (TUI) and lower incisors (TLI), bodily tooth movement of upper (BUI), and lower incisors (BLI), as well as vertical skeletal changes in the anterior region of the maxilla (MXSK) and mandible (MNSK). Thirty treated subjects were examined at pretreatment (T1) and posttreatment (T2) and compared to an untreated control group matched on age, sex, and Angle malocclusion from the Bolton Brush Growth Study Collection (CWRU, Cleveland, Ohio). RESULTS: Overbite (OB) in the treated group was decreased significantly (P < .001) (-5.6 mm) compared to controls. Statistically significant (P < .001) changes were found for BUI (-0.7 mm), TUI (0.9 mm), TLI (-1.4 mm), BLI (-1.1 mm), and MNSK (-1.6 mm). Most of the overbite correction was in the lower arch and included tipping and intrusion of the lower incisors along with an increase in lower vertical facial height. CONCLUSIONS: Deep OB correction was achieved efficiently using anterior bite elevators with pre-adjusted edgewise appliance. Correction using bite turbos would be a treatment option for individuals presenting with decreased lower facial height and deep bite.

Correlation of spheno-occipital synchondrosis fusion stages with a hand-wrist skeletal maturity index: A cone beam computed tomography study.

OBJECTIVES: To examine the correlation between spheno-occipital synchondrosis fusion stages and the hand-wrist skeletal maturity index. MATERIALS AND METHODS: Digital records of 164 individuals (77 males, 87 females) aged 10 to 18 years old were examined. Three-dimensional CBCT scans and hand-wrist two-dimensional radiographs were scored for the spheno-occipital synchondrosis fusion stages and hand-wrist skeletal maturity index, respectively. Statistical analyses were performed for associations using R software with a significance threshold of P< .01. RESULTS: A significant positive relationship was demonstrated between spheno-occipital synchondrosis fusion stages and hand-wrist skeletal maturity in both sexes. The Kendall's rank correlation τ between hand-wrist skeletal maturity index and spheno-occipital synchondrosis fusion percentage were high and positive in males and females (r = .74 and r = .71, respectively). CONCLUSIONS: The significant, positive relationship between the hand-wrist skeletal maturity index and spheno-occipital synchondrosis fusion stages support the idea of using spheno-occipital synchondrosis fusion as a biological indicator for craniofacial and mandibular growth spurt prediction.

The dental remains from the Early Upper Paleolithic of Manot Cave, Israel.

This study presents the dental remains discovered at Manot Cave (MC), Western Galilee, Israel. The cave contains evidence for human occupation during the Early Upper Paleolithic period (46-33 ka) mainly of Early Ahmarian (∼46-42 ka) and Levantine Aurignacian (∼38-34 ka) cultural levels. Six teeth (three deciduous and three permanent) were found at the site, of which four could be thoroughly analyzed. The morphology of the teeth was qualitatively described and analyzed using traditional and geometric morphometric methods. A large comparative sample was used in order to assess the morphological affiliation of the Manot specimens with other Homo groups. The results provided equivocal signals: the upper first premolar (MC-9 P3) is probably modern human; the upper deciduous second molar (MC-10 dm2) and the upper second permanent molar (MC-8 M2) might be modern humans; the lower second deciduous molar (MC-7 dm2) might be Neanderthal. Owing to the small sample size and the almost total lack of distinctive characteristics, our outcome could not supply conclusive evidence to address the question of whether Manot Aurignacian population came from Europe or descended from the local Ahmarian population.

Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper.

The Board of Trustees of the American Association of Orthodontists asked a panel of medical and dental experts in sleep medicine and dental sleep medicine to create a document designed to offer guidance to practicing orthodontists on the suggested role of the specialty of orthodontics in the management of obstructive sleep apnea. This White Paper presents a summary of the Task Force's findings and recommendations.

Tongue Function: An Underrecognized Component in the Treatment of Obstructive Sleep Apnea with Mandibular Repositioning Appliance.

Obstructive sleep apnea (OSA) is a common but still underrecognized disorder. A mandibular repositioning appliance (MRA) is used to treat OSA by advancing the mandible and thereby reducing the collapsibility of the upper airway. It has been found that an MRA increases the volume of the upper airway, especially the velopharyngeal area, in OSA patients. We hypothesize that this increase in the velopharyngeal volume is associated with an anterior displacement of the tongue, but likely not with a stretching of the soft tissue connecting the soft palate, lateral pharynx, palatopharyngeal arch, and mandible. Since the function and structure of the genioglossus and hypoglossal nerve are always abnormal in patients with OSA, the tongue does not always move simultaneously with the mandible when an MRA is being used. Oropharyngeal exercises, especially tongue exercises, can improve the quality of life of OSA patients, including reduction of daytime sleepiness and snoring, better quality of sleep, and partial decrease in the AHI. Further, in animal models, tongue exercise is also found to be effective in tongue function recovery and in the remodeling of the hypoglossal nucleus. We suggest that a combination of tongue exercises along with MRA is a promising approach for patients who do not respond to an MRA alone.

Sleep disordered breathing in children seeking orthodontic care.

INTRODUCTION: Our objective was to evaluate the prevalence of high-risk factors for sleep disordered breathing (SDB) in an orthodontic population of children. SDB is a spectrum of breathing disorders ranging from primary snoring to obstructive sleep apnea. METHODS: The sample included 303 healthy children between the ages of 9 and 17. High risk of SDB was assessed using the Pediatric Sleep Questionnaire, a validated instrument that consists of 22 questions, and high risk is defined as positive answers to 33% or more of the questions answered. Sixteen randomly selected patients repeated the questionnaire 1 month after the initial survey for reliability. RESULTS: In this sample, high-risk status on the Pediatric Sleep Questionnaire was not associated with sex, age, or race. The percentage of patients who were screened as high risk was 7.3% (95% confidence interval, 4.7%-10.6%). CONCLUSIONS: The results of this study suggest that approximately 7% of adolescent orthodontic patients may be at a significant risk for some form of SDB.

Correction: Timing and rate of spheno-occipital synchondrosis closure and its relationship to puberty.

[This corrects the article DOI: 10.1371/journal.pone.0183305.].

Radiocarbon chronology of Manot Cave, Israel and Upper Paleolithic dispersals.

The timing of archeological industries in the Levant is central for understanding the spread of modern humans with Upper Paleolithic traditions. We report a high-resolution radiocarbon chronology for Early Upper Paleolithic industries (Early Ahmarian and Levantine Aurignacian) from the newly excavated site of Manot Cave, Israel. The dates confirm that the Early Ahmarian industry was present by 46,000 calibrated years before the present (cal BP), and the Levantine Aurignacian occurred at least between 38,000 and 34,000 cal BP. This timing is consistent with proposed migrations or technological diffusions between the Near East and Europe. Specifically, the Ahmarian could have led to the development of the Protoaurignacian in Europe, and the Aurignacian in Europe could have spread back to the Near East as the Levantine Aurignacian.

Timing and rate of spheno-occipital synchondrosis closure and its relationship to puberty.

OBJECTIVES: This study examines the relationship between spheno-occipital synchondrosis (SOS) closure and puberty onset in a modern American population. It also investigates the timing and the rate of SOS closure in males and females. MATERIALS AND METHODS: The sample includes cross-sectional and longitudinal 3D Cone Beam Computed Tomography (CBCT) scans of 741 individuals (361 males and 380 females) aged 6-20 years. Each CBCT scan is visualized in the mid-sagittal plane, and the spheno-occipital synchondrosis (SOS) is scored as completely open, partially fused, mostly fused, and completely fused. The Menarche commencement is used as an indicator of puberty onset in females. RESULTS: Mean ages of open, partially-fused, mostly-fused, and completely fused SOS were 11.07, 12.95, 14.44, and 16.41 years in males, and 9.75, 11.67, 13.25, and 15.25 in females, respectively. The results show there is a significant association between the SOS closure stage and the commencement of menarche (Fisher's Exact Test p < 0.001). It was found that females had a higher SOS closure rate (38.60%) per year than males at the age of 10 years. The closure rate in males appears slower than females at age 10, but it lasts a longer time, ranging between 22 and 26% per year from age 11 to 14 years. CONCLUSION: There is a significant relationship between puberty onset and SOS closure, suggesting its closure is at least partially affected by systemic, hormonal changes in the growing adolescent. Also, SOS closure occurs at a faster rate and at an earlier age in females compared to males.

Effects of Case Western Reserve University's transverse analysis on the quality of orthodontic treatment.

INTRODUCTION: The purpose of this study was to evaluate the effect of using the transverse analysis developed at Case Western Reserve University (CWRU) in Cleveland, Ohio. The hypotheses were based on the following: (1) Does following CWRU's transverse analysis improve the orthodontic results? (2) Does following CWRU's transverse analysis minimize the active treatment duration? METHODS: A retrospective cohort research study was conducted on a randomly selected sample of 100 subjects. The sample had CWRU's analysis performed retrospectively, and the sample was divided according to whether the subjects followed what CWRU's transverse analysis would have suggested. The American Board of Orthodontics discrepancy index was used to assess the pretreatment records, and quality of the result was evaluated using the American Board of Orthodontics cast/radiograph evaluation. The Mann-Whitney test was used for the comparison. RESULTS: CWRU's transverse analysis significantly improved the total cast/radiograph evaluation scores (P = 0.041), especially the buccolingual inclination component (P = 0.001). However, it did not significantly affect treatment duration (P = 0.106). CONCLUSIONS: CWRU's transverse analysis significantly improves the orthodontic results but does not have significant effects on treatment duration.

Gingival crevicular fluid bone turnover biomarkers: How postmenopausal women respond to orthodontic activation.

INTRODUCTION: Bone turnover associated with orthodontic tooth movement is evidenced by increased bone turnover markers in gingival crevicular fluid (GCF). Postmenopausal women have an increased concentration of serum bone turnover markers. The filtrate of this serum makes up GCF, but little is known of the bone turnover around teeth in this cohort. The objective of this investigation was to compare the GCF bone turnover markers in premenopausal vs postmenopausal women receiving orthodontic treatment at baseline and at orthodontic activation. METHODS: Twenty-eight women were enrolled in the study and separated into 2 groups: premenopausal (16) and postmenopausal (12). Bone turnover was evaluated by GCF at baseline and 24 hours after orthodontic appliance activation. GCF concentrations of RANKL and OPN were measured using ELISA. Baseline and change in concentrations were compared between groups. RESULTS: Baseline RANKL and OPN were significantly different between the premenopausal and postmenopausal groups (P <0.05). Both markers increased significantly from baseline to 24 hours after orthodontic appliance activation in both groups (P <0.05). However, the response to orthodontic activation was not significantly different between groups. CONCLUSIONS: Although postmenopausal women have a different bone turnover profile at baseline than do their premenopausal counterparts, there is no difference in their response to orthodontic activation. This confers a level of security associated with orthodontic activation. Future studies are warranted to construct biomarker curves throughout orthodontic therapy.

When static meets dynamic: Comparing cone-beam computed tomography and acoustic reflection for upper airway analysis.

INTRODUCTION: Upper airway measurement can be important for the diagnosis of breathing disorders. Acoustic reflection (AR) is an accepted tool for studying the airway. Our objective was to investigate the differences between cone-beam computed tomography (CBCT) and AR in calculating airway volumes and areas. METHODS: Subjects with prescribed CBCT images as part of their records were also asked to have AR performed. A total of 59 subjects (mean age, 15 ± 3.8 years) had their upper airway (5 areas) measured from CBCT images, acoustic rhinometry, and acoustic pharyngometry. Volumes and minimal cross-sectional areas were extracted and compared with software. RESULTS: Intraclass correlation on 20 randomly selected subjects, remeasured 2 weeks apart, showed high reliability (r >0.77). Means of total nasal volume were significantly different between the 2 methods (P = 0.035), but anterior nasal volume and minimal cross-sectional area showed no differences (P = 0.532 and P = 0.066, respectively). Pharyngeal volume showed significant differences (P = 0.01) with high correlation (r = 0.755), whereas pharyngeal minimal cross-sectional area showed no differences (P = 0.109). The pharyngeal volume difference may not be considered clinically significant, since it is 758 mm3 for measurements showing means of 11,000 ± 4000 mm3. CONCLUSIONS: CBCT is an accurate method for measuring anterior nasal volume, nasal minimal cross-sectional area, pharyngeal volume, and pharyngeal minimal cross-sectional area.

History of imaging in orthodontics from Broadbent to cone-beam computed tomography.

The history of imaging and orthodontics is a story of technology informing biology. Advances in imaging changed our thinking as our understanding of craniofacial growth and the impact of orthodontic treatment deepened. This article traces the history of imaging in orthodontics from the invention of the cephalometer by B. Holly Broadbent in 1930 to the introduction of low-cost, low-radiation-dose cone-beam computed tomography imaging in 2015.

Levantine cranium from Manot Cave (Israel) foreshadows the first European modern humans.

A key event in human evolution is the expansion of modern humans of African origin across Eurasia between 60 and 40 thousand years (kyr) before present (bp), replacing all other forms of hominins. Owing to the scarcity of human fossils from this period, these ancestors of all present-day non-African modern populations remain largely enigmatic. Here we describe a partial calvaria, recently discovered at Manot Cave (Western Galilee, Israel) and dated to 54.7 ± 5.5 kyr bp (arithmetic mean ± 2 standard deviations) by uranium-thorium dating, that sheds light on this crucial event. The overall shape and discrete morphological features of the Manot 1 calvaria demonstrate that this partial skull is unequivocally modern. It is similar in shape to recent African skulls as well as to European skulls from the Upper Palaeolithic period, but different from most other early anatomically modern humans in the Levant. This suggests that the Manot people could be closely related to the first modern humans who later successfully colonized Europe. Thus, the anatomical features used to support the 'assimilation model' in Europe might not have been inherited from European Neanderthals, but rather from earlier Levantine populations. Moreover, at present, Manot 1 is the only modern human specimen to provide evidence that during the Middle to Upper Palaeolithic interface, both modern humans and Neanderthals contemporaneously inhabited the southern Levant, close in time to the likely interbreeding event with Neanderthals.

An interview with Mark G. Hans.

It is a great honor to conduct an interview with Professor Mark G. Hans, after following his outstanding work ahead of the Bolton-Brush Growth Study Center and the Department of Orthodontics at the prestigious Case Western Reserve School of Dental Medicine (CWRU) in Cleveland, Ohio. Born in Berea, Ohio, Professor Mark Hans attended Yale University in New Haven, CT, and earned his Bachelor of Science Degree in Chemistry. Upon graduation, Dr. Hans received his DDS and Masters Degree of Science in Dentistry with specialty certification in Orthodontics at Case Western Reserve University. During his education, Dr. Hans' Master's Thesis won the Harry Sicher Award for Best Research by an Orthodontic Student and being granted a Presidential Teaching Fellowship. As one of the youngest doctors ever certified by the American Board of Orthodontics, Dr. Hans continues to maintain his board certification. He has worked through academics on a variety of research interests, that includes the demographics of orthodontic practice, digital radiographic data, dental and craniofacial genetics, as obstructive sleep apnea syndrome, with selected publications in these fields. One of his noteworthy contributions to the orthodontic literature came along with Dr. Donald Enlow on the pages of "Essentials of Facial Growth", being reference on the study of craniofacial growth and development. Dr. Mark Hans's academic career is linked to CWRU, recognized as the renowned birthplace of research on craniofacial growth and development, where the classic Bolton-Brush Growth Study was historically set. Today, Dr. Hans is the Director of The Bolton-Brush Growth Study Center, performing, with great skill and dedication, the handling of the larger longitudinal sample of bone growth study. He is Associate Dean for Graduate Studies, Professor and Chairman of the Department of Orthodontics, working in clinical and theoretical activities with students of the Undergraduate Course from the School of Dental Medicine and residents in the Department of Orthodontics at CWRU. Part of his clinical practice at the university is devoted to the treatment of craniofacial anomalies and to special needs patients. Prof. Mark Hans has been wisely conducting the Joint Cephalometric Experts Group (JCEG) since 2008, held at the School of Dental Medicine (CWRU). He coordinates a team composed of American, Asian, Brazilian and European researchers and clinicians, working on the transition from 2D cephalometrics to 3D cone beam imaging as well as 3D models for diagnosis, treatment planning and assessment of orthodontic outcomes. Dr. Hans travels to different countries to give lectures on his fields of interest. Besides, he still maintains a clinical orthodontic practice at his private office. In every respect, Dr. Hans coordinates all activities with particular skill and performance. Married to Susan, they have two sons Thomas and Jack, and one daughter Sarah, and he enjoys playing jazz guitar for family and friends.

Comparison of Chinese and white Bolton standards at age 13.

OBJECTIVES: To create a combined male-female Chinese Bolton standard for age 13 and to compare it to the combined Bolton standard for white 13 year olds. MATERIALS AND METHODS: Thirty-two Chinese and 32 white subjects (16 adolescent boys and 16 adolescent girls aged 13 years in each ethnic group) who fulfilled the selection criteria used to create the original Bolton standards were enrolled. Their cephalograms were traced and then averaged two at a time following the Bolton method. In addition to creating the template from the 32 subjects in each group, 43 linear and angular variables were measured and compared between the two ethnic groups and between the two sexes in each ethnic group using independent t-tests. A P value of .05 was used to assign statistical significance. The male-female combined templates for 13 year olds were also compared superimposing either in the Bolton relation or by soft tissue. RESULTS: No sexual dimorphism was found in the white subjects, whereas the Chinese girls had decreased upper face height (Na-ANS), more protrusive incisors (SNA-U1), and shorter cranial base (Ba-Na) and posterior cranial base (S-Ba) compared with the Chinese boys. In terms of ethnic comparison, the Chinese subjects presented shorter sagittal facial dimensions, a clockwise rotated mandible with a more acute gonial angle, and a convex facial profile with a less prominent nose and chin. However, overall vertical dimensions were similar. CONCLUSIONS: A 13-year-old combined male-female Chinese Bolton standard was created that demonstrated visually and with metric comparisons that Chinese and white clinically normal subjects have different craniofacial characteristics. These differences should be taken into consideration when an individualized orthodontic treatment plan is developed.