Orthodontic archwire in the nasal cavity. A case report.

We present the unusual case of a patient who lost an orthodontic archwire after having, via manipulation, detached it from the brackets. It was only on a routine radiograph at the end of treatment that the archwire was found in the patient's nasal cavity, where it had failed to cause any symptoms! We discuss the treatment following the inhalation and ingestion of foreign bodies in orthodontics, as well as their prevention.

Occlusal status and prevalence of occlusal malocclusion traits among 9-year-old schoolchildren.

The aim of this study was to provide detailed information concerning clinically relevant occlusal traits and the prevalence of occlusal anomalies in an orthodontically relevant period of dental development. Four hundred and ninety-four German schoolchildren (237 males and 257 females), median age 9 years, were orthodontically examined. Overjet and overbite were measured to the nearest 0.5 mm, and sagittal molar relationships were registered clinically to the nearest quarter unit. In addition, crossbites, scissor bites, and midline displacements were evaluated. Descriptive statistics was complemented by testing gender differences and differences between groups with Class I and Class II anomalies (Mann-Whitney U-test) as well as a statistical evaluation of differences between the three dental stages (Kruskal-Wallis test). Overjet exhibited an extreme range between -2 and 12 mm (median values 3-3.5 mm). An increased overjet was more prevalent than a reduced or reverse overjet, and a severely increased overjet greater than 6 mm was a common finding affecting around 5-10 per cent of the children. Similarly, overbite showed considerable variations of between -1 and 9 mm (medians 3-3.5 mm) and males exhibited a significantly larger overbite than females. In Class II malocclusion subjects, overbite was significantly enlarged (on average between 0.5 and 1 mm) when compared with those with a Class I malocclusion. Traumatic contact of the gingiva affected every 14th child. A Class II molar relationship of three-quarter units or more was a frequent finding affecting more than one child in five. In addition, at 9 years of age, 3 per cent of the children exhibited a Class III molar relationship of at least a half unit. The wide range of orthodontically relevant occlusal traits found in the present study underlines the need for orthodontic screening at 9 years of age (or earlier).

Space conditions and prevalence of anterior spacing and crowding among nine-year-old schoolchildren.

OBJECTIVE: To give detailed insight into the space conditions and prevalence of spacing and crowding in schoolchildren at nine years of age. The reliability and validity of screening methods was also assessed. DESIGN: Epidemiological survey. SETTING: South-western part of Germany (Rhein-Neckar-Kreis); elementary schools in a region with a low orthodontic care rate. SAMPLE AND METHODS: 494 nine-year-old German schoolchildren (237 males, 257 females, median age 9 years) were examined orthodontically in cooperation with the local community dentistry service. A special measurement ruler was developed to enhance validity and reliability of space measurements on location in the schools. RESULTS AND CONCLUSIONS: Concerning space conditions in the incisor segments: in the maxilla the variety encountered comprised both space excess and moderate to severe crowding. This was considerably larger in the maxilla than in the mandible. Severe crowding (> 5 mm) was found more often in the maxilla than in the mandible and affected around 2-3% of the maxillary dentitions. Also severe contact point displacements (IOTN Grade 4) were mainly restricted to the maxilla (prevalence approximately 3%). In the canine-premolar segments, the arch segments in males were in general around 0.5 mm larger than among the females, also within each dental stage. In general, the maxilla was more often affected by posterior crowding than the mandible. Anterior crowding seemed to be more prevalent than posterior crowding. With respect to the screening methods used in the present study, reliable and valid measurements were also found to be possible in schools. This may open up further opportunities for orthodontic screening by community dentistry services or similar organizations.

Discrimination of epithelium-like and fibroblast-like phenotypes derived from ethanol-treated immortalised human gingival keratinocytes in epithelial equivalents.

Ethanol treatment of immortalised human gingival keratinocytes (IHGK) yields in an epithelium-like (EPI) and fibroblast-like (FIB) phenotype. With respect to the stratified gingival epithelium, putative structural and molecular differences assigning cells to these phenotypes have not, to date, been analysed in a three-dimensional tissue/epithelial context. Therefore, we generated epithelial equivalents (EEs) in organotypic co-cultures of IHGK, EPI and FIB cells for 1 and 2 weeks and conducted protein and gene expression studies on the EEs for epithelial biomarkers including keratin K14, integrin subunits alpha6 and beta1, E-cadherin, and mesenchymal vimentin. As in the EEs of IHGK and EPI, indirect immunofluorescence revealed continuous expression of beta1 integrin in EEs of FIB cells. However, FIB cells exhibited a significant down-regulation in K14 and integrin alpha6 protein and a loss of E-cadherin at week 2, whereas vimentin was increased. FIB EEs were devoid of transcripts for E-cadherin at both time points, although transcription of the other genes remained constant in all phenotypes. Thus, the FIB phenotype exhibited a poor epithelial structure coinciding with disturbances in the expression of epithelial biomarkers and the persistence of mesenchymal vimentin. Transcription analysis revealed post-transcriptional regulation of vimentin in IHGK and EPI and of K14 and alpha6 in FIB cells. Our findings indicate that differences in the epithelial integrity and expression of molecules in EEs allow for the discrimination of EPI and FIB cells. This suggests that FIB cells share features of epithelial-mesenchymal transition and reflect a more progressive stage in epithelial cell transformation.

Long-term Stability of Extraction Therapy in Anterior Open Bite. A Case Report.

The following cases describe three sisters with anterior open bite (overbite between 0 and -4.5 mm) coinciding with vertical growth pattern. All patients showed tongue thrusting and tongue-tip protrusion. They underwent functional appliance and fixed straight-wire appliance therapy primarily. Bite closure was effected by premolar extraction. Orthodontic treatment was supported by speech therapy. All cases resulted in a stable Class I molar relationship with an overbite of 2 mm. The results remained stable 6-8 years after the end of treatment. Speech and tongue function were physiological.

Elevated expression of genes assigned to NF-kappaB and apoptotic pathways in human periodontal ligament fibroblasts following mechanical stretch.

There is growing evidence that apoptosis involves the nuclear transcription factor NF-kappaB in conjunction with related genes. However, in the context of mechanical orthodontic forces, force-sensing target genes assigned to pathways of NF-kappaB and apoptosis have not been fully characterised. To contribute to the identification of putative target genes, we used cDNA arrays specific for NF-kappaB and apoptotic pathways and analysed elevated gene expression in primary human periodontal ligament fibroblasts (PDL-F) after a 6 h application of mechanical force. Among several identified genes (including several caspases), interleukin-1 beta (IL-1 beta) and NF-kappaB displayed significantly higher expression on the NF-kappaB array, whereas higher expression was obtained for BCL2-antagonist of cell death (BAD), member 6 of the TNF-receptor superfamily (FAS) and CASP2 and RIPK1 domain-containing adaptor with death domain (CRADD) on the apoptosis array. Based on a defined cut-off level of a more than 1.5-fold higher expression, this significance in elevated gene expression was corroborated by reverse transcription/polymerase chain reaction (RT-PCR). Here, semi-quantitative (sq) PCR revealed a more pronounced elevation of mRNA gene expression in PDL-F after 6 h of stretch, when compared with 12 h. Moreover, the elevation after 6 h as observed by sq-PCR was convergent with quantitative PCR (q-PCR). q-PCR yielded levels of 5.8-fold higher relative gene expression for IL-1 beta and 1.7-fold for NF-kappaB, whereas that computed for BAD indicated a 5.2-fold, for CRADD a 2.1-fold and for FAS a 2.0-fold higher expression. The data obtained from the expression analysis thus indicate a stretch-induced transcriptional elevation of genes assigned to the NF-kappaB and apoptotic pathways. This elevation may render them target candidates for being addressed by mechanical orthodontic forces.

Early keratinocyte differentiation on micropillar interfaces.

We employed topographical patterning to analyze early keratinocyte differentiation on top of microfabricated pillar arrays. Fibronectin immobilized on pillar "heads" yielded a nucleus-associated granular keratin 1 (K1) pattern in immortalized human gingival keratinocytes (IHGK) at pillar interspaces of 14 mum. Decreasing distances of 11and 8 mum revealed cytoplasmic extension of the early differentiation marker K1 on poly(dimethylsiloxane) (PDMS) pillars. The most extensive cytoplasmic K1 protein distribution noted at the smallest pillar scale coincided with higher ratios of K1 mRNA gene transcription. These experiments suggest that early keratinocyte differentiation was governed by the topographical characteristics of the pillar pattern. Moreover, they form the basis to study cell functions such as differentiation in a defined topologically structured environment.

Organotypic co-cultures allow for immortalized human gingival keratinocytes to reconstitute a gingival epithelial phenotype in vitro.

We report here that the organotypic co-culture (OCC) system allows for significant preservation of the tissue-specific phenotype of human gingival keratinocytes (IHGK) immortalized with the E6/E7 gene of the human papillomavirus type 16 (HPV16). The approach adopted is based on the OCC system facilitating spatially separated cell growth and cell-to-cell interactions via diffusible growth factors. Generally, IHGK reveal transcription of the HPV16 E6/E7 gene at rising passages. Fluorescence in situ hybridization performed for chromosomes 1, 8, 10, and 18 demonstrates that disomic fractions differ between the tested chromosomes but otherwise remain fairly constant. Monosomies of chromosome 18 are more prominent in late passages 81 and 83, while polysomies of chromosome 10 and 18 are detected in early passages 25 and 27. In comparison with corresponding monolayer cultures (MCs), IHGK in OCCs form stratified epithelia, proliferate, and express gingival-specific gene products in vitro. Moreover, mRNA gene transcription for growth factors interleukin 1beta, granulocyte-macrophage colony stimulating factor, fibroblast growth factor 7, and EGF in OCCs is different from that in MCs. When grafted onto nude mice, IHGK develop hyperplastic, differentiated surface epithelia devoid of malignant growth. We are not aware of any other OCC system comprising of IHGK, which allows for site-specific expression of gingival epithelial markers. This substantiates reconstitution of a gingival epithelial phenotype in vitro.

Molecular changes in the gingival epithelium associated with necrotizing ulcerative periodontitis: a case report.

A case of necrotizing ulcerative periodontitis (NUP), the most severe inflammatory periodontal disorder caused by plaque bacteria, is shown. Clinically, the gingiva showed distinct signs of ulceration, and radiography revealed horizontal bone loss. Indirect immunofluorescence, carried out on frozen sections of tissue specimens obtained from the NUP lesion, exhibited clear expression of atypical keratin K19, particularly in basal cells, when compared to noninflamed gingiva. Moreover, NUP tissue showed extensive intraepithelial abundance for the basement membrane component laminin-1/10 and the extracellular matrix molecule tenascin. Strong expression of integrin subunit alphav and matrix metalloproteinase-13 in conjunction with interleukin 1-beta further discriminated NUP gingival epithelium from normal tissue. The results suggest that NUP is associated with changes in the expression and topography of the analyzed molecules in the gingival epithelium, which in turn may reflect the fast progression of the disease.

The effect of nasopharyngoscopic biofeedback in patients with cleft palate and velopharyngeal dysfunction.

OBJECTIVE: To evaluate the immediate, long-term, and carry-over effects of nasopharyngoscopic biofeedback therapy in patients with cleft palate who exhibit velopharyngeal dysfunction (VPD). DESIGN: Pre- versus posttreatment and follow-up comparisons. SETTING: Cleft palate center of the Heidelberg University Hospital, Heidelberg, Germany. SUBJECTS: Eleven patients with VPD who had received conventional speech therapy without showing significant improvement. INTERVENTIONS: A four-stage feedback procedure. The patients watched and evaluated their velopharyngeal (VP) valving during speech by an endoscopic image displayed on a video monitor. Two feedback sessions took place for every target sound. MAIN OUTCOME MEASURES: Mean occurrence of VP closure during speech sound production on different linguistic levels. Patients' self-perception was assessed by a questionnaire and speech diary. RESULTS: Significant improvement and stability of VP closure was noted. Mean occurrence of VP closure was 5% before therapy, 91% after two biofeedback sessions, and 86% in the follow-up after 6 months. Velopharyngeal dysfunction associated with compensatory articulation proved to be equally well trained as VPD on sounds with good articulatory placement. No significant difference was observed in the degree of improvement between phoneme-specific VPD and generalized VPD. The transfer to the level of words and sentences was successful and showed significant stability. The stability of VP closure for vowels was less than the stability for fricatives and stop sounds. Patients gained improved auditory and kinesthetic self-perception of their articulation. CONCLUSIONS: Nasopharyngoscopic biofeedback therapy proves to be a quick and effective method to change VPD. It shows stable results and carry-over effects.

Age-related changes in sagittal relationship between the maxilla and mandible.

The aim of the study was to assess age-related changes in sagittal jaw relationship during pre-pubertal and pubertal development on the basis of angular [ANB, anteroposterior dysplasia indicator (APDI) and A-B plane angle] and linear (Wits, AF-BF, App-Bpp, and App-Pgpp) measurements. Lateral cephalograms of orthodontically untreated subjects were evaluated at 7, 9, 11, 13 and 15 years of age. Cephalometric standards and age-related changes were determined on the basis of Class I subjects with a good occlusion (n = 18, 10 males and 8 females). With respect to changes related to growth, the main findings were, in both genders, a statistically significant age-related decrease in ANB angle, App-Bpp and App-Pgpp, a significant increase in APDI, but no age-related change in Wits. A reduction of sagittal jaw distance during pre-pubertal and pubertal development was observed arising from a relative dominance of sagittal mandibular growth. For an evaluation of differences concerning jaw relationship in Class II subjects, a group with Class II division 1 malocclusions (n = 17) and a group with Class II division 2 malocclusions (n = 12 were compared with two control groups, i.e. the good occlusion group and a Class I group (n = 37). Conclusions about the sagittal discrepancy in Class II division 1 and Class II division 2 subjects depended on the geometric reference used in the various parameters, and further research is called for with respect to the diagnostic performance of the various measurements. Differences between Class II subjects and controls present at 15 years of age were already established at 7 years of age, but were less pronounced.

Orthodontic treatment in a patient with Papillon-Lefèvre syndrome.

BACKGROUND: Report of a combined periodontal and orthodontic treatment in a patient with Papillon-Lefevre Syndrome (PLS). METHODS: A patient with PLS was treated orthodontically 26 months after the start of a combined mechanical and antibiotic therapy. Clinical periodontal parameters were obtained 26 (t1), 60 (t2), and 79 (t3) months after anti-infective therapy. The deepest site of each tooth was sampled for microbiological analysis at 26 and 60 months. Periodontal maintenance therapy was provided every 6 weeks. After a stable periodontal situation was achieved, orthodontic treatment, consisting of space opening for the upper canines with a multibracket appliance and coil springs, was carried out. In the lower jaw, crowding was resolved by an orthodontic mesialization of the canines. RESULTS: Twenty-six months (t1) after the beginning of the combined mechanical and antibiotic therapy, 6% of the sites exhibited 4 mm probing depth (PD) with bleeding on probing (BOP) or PD > or =5 mm. Sixty months (t2) after therapy the number of sites with 4 mm PD with BOP or PD > or =5 mm had increased to 17%, and 79 months after therapy (t3) 13% of all sites were similarly affected. From 26 to 60 months, a slight mean clinical attachment level (CAL) gain was observed, whereas the mean PD increased. From 60 to 79 months, there was a mean PD reduction. However, a significant mean attachment loss was also noted. After 26 months (t1), RNA probes failed to detect A. actinomycetemcomitans, P. gingivalis, or T. forsythensis from any site. Thirty-four months later (t2), subgingival recolonization was observed. A. actinomycetemcomitans was detected by RNA probes at three sites. At 26 and 60 months (t1, t2), trypticase-soy with serum, bacitracin, and vancomycin (TSBV) culture failed to detect A. actinomycetemcomitans at any of the sampled sites. Eighty-two months after the beginning of therapy (t4), none of the applied methods could detect A. actinomycetemcomitans from the pooled samples from the deepest pockets of each quadrant or the oral mucosa. In the present case, concomitant orthodontic treatment with a fixed appliance could be performed without further pronounced periodontal deterioration. Space for eruption of the canines and premolars was created, in addition to an alignment of the teeth. CONCLUSION: After a successful combined mechanical and antibiotic periodontal therapy of the PLS periodontitis, moderate orthodontic tooth movements may be possible within a complex interdisciplinary treatment regimen.

[Psychosocial problems and coping strategies of young patients with cleft lip and palate]. / Probleme und Bewältigungsverhalten von Jugendlichen mit Lippen-Kiefer-Gaumenspalte -- Ein Vergleich der Sichtweisen von Müttern und deren Kindern.

OBJECTIVE: The purpose of this study was to improve the psychological care of young patients with cleft lip and palate by gaining insight into those problematic areas in which social conflicts arise and coping-strategies become necessary for the patients. METHODS: The procedure included semi-standardized interviews with 20 patients aged between 12 - 17 and their mothers. Every interview was recorded on tape, transcribed, analyzed contextually and categorized. RESULTS: Four areas of main problems showed up: the time of surgery, the experience of being rejected or teased by peers, remaining visible defects and how to integrate them into self-percept, the problems of the siblings. The mothers showed more pessimistic perceptions regarding the coping strategies of their children and the helpful role of parental support. Consequences for individual support and family therapy are derived.

Sagittal and vertical growth of the jaws in Class II, Division 1 and Class II, Division 2 malocclusions during prepubertal and pubertal development.

AIM: The aim of the present study was to evaluate the sagittal and vertical development of the jaws in Class II, Division 1 (II/1) and Class II, Division 2 (II/2) malocclusions. In addition, facial morphology was to be investigated in probands with these malocclusions. PROBANDS AND METHODS: Maxillary and mandibular development was investigated with reference to lateral cephalograms of orthodontically untreated probands from the Belfast Growth Study at 7, 9, 11, 13 and 15 years of age. Moreover, development of facial width was assessed from the associated posteroanterior cephalograms, with radiographic magnifications being corrected in both the lateral and the posteroanterior cephalograms. A Class II/1 group (n = 17) and a Class II/2 group (n = 12) were compared with two control groups: a group with good occlusion (n = 18) and a Class I group (n = 37). RESULTS AND CONCLUSIONS: With respect to the sagittal position of the maxilla, no significant differences between the Class II groups and the controls were found. In the Class II/1 group, mandibular retrognathism was observed. The posterior position of the mandible present at 15 years of age had been present even at 7 years of age, and growth increments in the Class I and Class II/1 subjects were similar. In the Class II/2 groups no uniform pattern with respect to mandibular position was found. With respect to vertical development, a deficit in lower anterior facial height was found in the Class II/2 groups. In addition, between 7 and 15 years of age, growth increments in lower anterior facial height were significantly smaller in the Class II/2 subjects than in the controls. Furthermore, the Class II/2 groups displayed a more euryprosopic facial form on average. The cause of this characteristic facial morphology was the vertical deficit in lower anterior facial height. Overall, however, the broad variability and the small sample sizes, in particular of the Class II/2 groups, in the present study have to be seen as limitations.

Applications for direct composite restorations in orthodontics.

BACKGROUND AND AIM: Besides prosthetic and indirect, laboratory-produced restorations, the focus of dental therapy is increasingly on restorative measures and direct restorations as minimally invasive treatment concepts. Thus, the use of direct composite restorations with modern restorative materials for the shaping and recontouring of teeth in combination with orthodontic treatment offers a diversified, extensive sphere of application. The aim of the study was to demonstrate applications for direct composite restorations with reference to selected cases. MATERIAL AND METHODS: The composites used were hybrid composites, which offer increased abrasion resistance and color stability and are applied incrementally. Special attention was paid to the shape, color and structure of the tooth. CASE REPORTS: The case reports present patients in whom relatively narrow or peg-shaped teeth were built up with composite to correct various tooth size discrepancies or cuspids were recontoured by means of direct composite restorations following orthodontic space closure in cases with missing lateral incisors. Similarly, space closure was achieved using orthodontically repositioned lateral incisors recontoured to resemble central incisors after traumatic loss of upper central incisors. Finally, direct composite restorations were used for retention following completion of orthodontic treatment. CONCLUSIONS: Observations over recent years confirm the stability of composites in both form and color, as well as their ability to maintain gingival health. Our case reports demonstrate that, subject to a corresponding indication, recontouring single teeth using direct composite restorations can optimize orthodontic treatment results.

Three-dimensional analysis of maxillary and mandibular growth increments.

OBJECTIVE: To analyze changes in the facial, maxillary, and mandibular skeleton in the vertical, sagittal, and transverse dimensions during an orthodontically relevant period of dentofacial development (i.e., between 7 and 15 years of age). SUBJECTS AND METHOD: This longitudinal study comprised posteroanterior (PA) and lateral cephalograms at 7, 9, 11, 13, and 15 years of 18 untreated Class I subjects with good occlusion. Transverse growth (width) was analyzed on the basis of PA cephalograms and sagittal (depth) and vertical (height) growth by means of lateral cephalograms. For each linear measurement, mean percentage increases were calculated relative to the size at 7 years of age. RESULTS AND CONCLUSIONS: Between 7 and 15 years of age, in the whole facial skeleton and the maxilla, percentage increases were most pronounced in the vertical dimension when compared with the sagittal and transverse dimensions. In the mandible, the largest percentage increases were found in both sexes for vertical growth of the ramus, followed by sagittal growth (body length) and then mandibular width. In the sagittal dimension, development was more pronounced in the mandible (at pogonion more than at B point) than in the maxilla (A point). With respect to vertical growth, percentage increases in posterior face height exceeded the increases in anterior face height. When facial shape changes were analyzed between 7 and 15 years of age in both sexes, the ratio facial height/facial width increased and the ratio facial depth/ facial height decreased, which points toward an age-related increasing influence of vertical development.

The HPV-16 E5 protein inhibits TRAIL- and FasL-mediated apoptosis in human keratinocyte raft cultures.

By using raft cultures of the polyclonal HaCaT cell lines stably transfected either with E5 (HaCaT/E5) or the empty vector (HaCaT/pMSG) as reference, we investigated the effect of the human papillomavirus type 16 (HPV-16) E5 protein on apoptosis. In comparison to conventional monolayer cultures this model system allows analysis of apoptosis under more tissue-like conditions by mimicking the stratified organization of a normal surface epithelium. Apoptosis was triggered either by FasL or TRAIL. Execution of the death program was checked at early and late stages by monitoring procaspase-3 cleavage and DNA fragmentation, respectively. Rafts of E5-expressing keratinocytes were completely protected from apoptosis and showed a background of apoptotic cells as low as the untreated cultures. In contrast, the HaCaT/pMSG cultures revealed a dramatic increase in apoptotic cells upon ligand treatment throughout the epithelial compartment. We conclude that the presence of the HPV-16 E5 protein in our tissue-like model prevents FasL- or TRAIL-mediated apoptosis.

Transverse development of the craniofacial skeleton and dentition between 7 and 15 years of age--a longitudinal postero-anterior cephalometric study.

The aim of this study was to identify the transverse growth pattern of the craniofacial skeleton and dentition from 7 to 15 years of age. The database for this longitudinal study comprised the postero-anterior (PA) cephalograms and dental casts at 7, 9, 11, 13 and 15 years of age of 18 untreated Class I subjects with good occlusion from the Belfast Growth Study. Differential magnification of the PA cephalograms was corrected using the method of similar triangles. Most of the craniofacial widths were larger in males than in females. At 15 years of age, the gender differences in craniofacial widths were more pronounced than at 7 years of age. The majority of the skeletal dimensions showed a progressive increase in width. In contrast, there was a deceleration in the increase in maxillary and mandibular intermolar widths after 11 years of age in males and even a slight decrease in the intermolar width beyond 11 years of age in females. Growth curves were calculated where the values of the respective variables were expressed in terms of percentage of attainment at 7, 9, 11 and 13 years of age when compared with 15 years of age. For mid-facial, bizygomatic and skeletal maxillo-mandibular widths, percentile attainments in the range of 84-91 per cent indicated a greater remaining growth potential at 7 years of age than for the cranial width where growth was almost complete. By the age of 7 years, over 95 per cent of the growth in the intermolar width had occurred.

Dental arch widths and mandibular-maxillary base widths in Class II malocclusions between early mixed and permanent dentitions.

The aim of the study was to analyze the transverse morphology and development of the dental arches and skeletal mandibular-maxillary bases in untreated Class II malocclusions. Using the records of the Belfast Growth Study, a Class II division 1 group (II/1) and a Class II division 2 group (II/2) were compared with a Class I group and a control group with good occlusion. On posteroanterior cephalograms, maxillary skeletal base width and bigonial and biantegonial widths were determined at two-year intervals between seven and 15 years. Maxillary and mandibular intermolar widths were measured on the associated study casts. As a result, maxillary skeletal base widths were smallest in the Class II/1 subjects. No statistically significant differences were found among the groups for the skeletal mandibular widths. With respect to the development of the dental arches, maxillary intermolar widths were smaller in the Class II/1 group than in the Class I and the good-occlusion groups. These group differences were present for the total period of observation, ie, seven to 15 years, and statistically significant at most ages. When the relative difference between the maxillary and the mandibular intermolar widths was examined, the Class II/1 cases were found to have the largest average difference (about -2.5 mm for boys and -1.5 mm for girls), indicating a relatively narrow maxillary arch. Less pronounced molar differences were found in the Class II/2 group. In the Class II/1 subjects the deviations in molar differences observed at 15 years of age were established already at 7 years of age and maintained during 7 and 15 years of age.

Spectral analysis of prespeech sounds (spontaneous cries) in infants with unilateral cleft lip and palate (UCLP): a pilot study.

OBJECTIVE: The objectives of the present study were: (1) to analyze the cry features of infants with cleft lip and palate (UCLP) by means of spectral analysis, (2) to describe changes of the acoustic parameters from birth until 9 months of age, and (3) to compare these data with existing cry data of infants without cleft (control group). DESIGN: The study was designed on a interdisciplinary, prospective, and longitudinal basis. SETTING: Interdisciplinary study: (1) Institute of Anthropology at the Humboldt-University, Berlin; (2) Heidelberg University Hospital: Interdisciplinary Cleft Palate and Craniofacial Center. PATIENTS AND METHOD: The cry parameters of five patients with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were analyzed from birth to 9 months of age. The patients were treated with the same protocol. At the age of 24 months, sensomotor development was assessed using the KIPHARD test. Perceptual judgment of speech, performed after 36 months of life, included nasal resonance, nasal emission of air, articulation disorders, and speech intelligibility. MAIN OUTCOME MEASURE: The cry parameters of fundamental frequency (F(0)), pitch period perturbation quotient (PPQ), and cry duration (Tsam) were analyzed. RESULTS: Contrary to the expectation that laryngeal parameters are not affected by vocal tract malformations, differences of cry parameters were found between the patients with UCLP and the non-cleft group. Particularly, the F(0) and its short-time variability (PPQ) were affected. CONCLUSIONS: The preliminary results of this study showed that F(0) and PPQ of spontaneous cries are influenced in patients with UCLP, and a cry analysis might become a noninvasive tool for early detection of an at-risk status for neuromuscular development and prediction of an at-risk status for later speech and language acquisition in infants with cleft lip and palate. Future research strategies are outlined.