Polymorphism analysis of myosin 1H (G/A) and P561T (C/A) genes on class I, class II, and class III malocclusion.

CONTEXT: Besides environmental factors, genetic factors play an important role in the etiology of malocclusion. Polymorphisms of the Myosin 1H gene in orofacial muscle fibers are thought to influence the growth and development of the mandible. Growth hormone receptors are present on the growth of cartilage, especially the condyle of the mandible. The polymorphisms of the growth hormone receptor have an effect on the growth and development of the mandible. The potential of the Myosin 1H and P561T genes as bioindicators in aiding diagnosis of malocclusion is quite good based on the available literature. However, until now there has been no research that has observed genetic analysis on polymorphism-based malocclusion of the Myosin 1H and P561T genes in the Indonesian population. AIMS: To determine the relationship between polymorphisms of Myosin 1H and P561T genes, towards the growth and development of the mandible in malocclusion cases. SETTINGS AND DESIGN: Subjects were patients aged 17--45 years old with skeletal malocclusions who were undergoing or were about to undergo orthodontic treatment at RSGM-FKG UI (Universitas Indonesia's Dental Hospital), with 50 people in each group. METHODS AND MATERIAL: Malocclusions were determined based on radiographic analysis of the initial cephalometry using the Stainer method. DNA samples were extracted from buccal swabs and blood cells in Class I and II malocclusion while nail clippings and hair follicles extracts were used in Class III malocclusion. DNA sequence amplification was carried out using Polymerase Chain Reaction, while Genetic Polymorphism Analysis of Myosin 1H and P561T genes was performed with Restriction Fragment Length Polymorphism. STATISTICAL ANALYSIS USED: Pearson Chi-Square was used to analyze the Myosin 1H gene, while the Fisher Exact Test was used to analyze the P561T gene. RESULTS: A relationship between Myosin 1H gene polymorphism and Class I, II, and III skeletal malocclusion was found. There was no correlation between P561T gene polymorphism and Class I, II, and III skeletal malocclusion. CONCLUSIONS: Myosin 1H gene polymorphism is one of the risk factors for Class I, II, and III malocclusion. Extraction of DNA from hair follicles gave good results in terms of DNA quality and was a relatively easier sampling method compared to blood cell purification and buccal swabs.

Vertical Mandibular and Trunk Symmetry in Indonesian Orthodontic Patients

Abstract Objective: To analyze differences in vertical mandibular and trunk symmetry in orthodontic patients. Material and Methods: This was a cross-sectional study of 129 growing orthodontic patients who sought orthodontic treatment at the Dental Hospital Universitas Sumatera Utara, Indonesia. Mandibular symmetry index was observed with pre-treatment panoramic radiography based on Kjellberg's technique and trunk symmetry was evaluated based on questionnaires and visual observation. Vertical mandibular asymmetry was decided if the index of asymmetry was lower than 93.7%. The bivariate analysis used the chi-squared and Fisher's exact tests, with a significance level of 5%. Results: There was a significant association between vertical mandibular and trunk symmetry (p<0.05). The prevalence odds ratio for the association with vertical mandibular asymmetry was 3.007 (95% CI = 1.016-8.905) for trunk asymmetry. Conclusion: The necessity to consider trunk symmetry could be included in orthodontics treatment of any malocclusion with vertical mandibular asymmetry that might require a multidisciplinary approach in the future.

Difference in Orthodontic Patients' Perceptions of Essix and Hawley Retainers

Abstract Objective: To determine differences in how orthodontic patients perceive the aesthetics relating to the use of Essix and Hawley retainers. Material and Methods: Photographs of a female patient using an Essix retainer and a Hawley retainer, respectively, were assessed by 70 orthodontic patients aged between 21 and 55 years. All participants were provided with the same images of the two retainer types being worn and were asked to grade the aesthetics of each retainer using a visual analog scale. The significance of differences in orthodontic patient perceptions of aesthetics in the use of Essix and Hawley Retainers in the young adult and adult age groups were tested using the Mann-Whitney test with assumed significance p<0.01. Results: There were differences in participants' perceptions between the two retainers that were statistically significant, with responses varying between young adults aged 21 to 35 years and adults aged 36 to 55 years. According to the VAS, the two retainers' average scores in the total population are 82 for Essix Retainer and 60 for Hawley Retainer in both groups. Conclusion: The Essix retainer as a retention appliance is considered more aesthetically pleasing than the Hawley retainer among both young and middle-aged adults.

Correlation between Pain Perception and CGRP Expression during Initial Tooth Alignment Using either a Self-ligating or a Pre-adjusted Bracket System.

AIM AND OBJECTIVE: Orthodontic tooth movement (OTM) occurs when the force applied to the tooth stimulates inflammation and alveolar bone remodeling. Less friction is produced by passive self-ligating (PSL) brackets compared to pre-adjusted edgewise (PE) brackets; therefore, PSL bracket use is thought to result in less pain than the use of PE brackets. The neuropeptide calcitonin gene-related peptide (CGRP), isolated from gingival crevicular fluid (GCF), can be used as a pain biomarker for OTM. Pain perception can be subjectively evaluated using the visual analog scale (VAS). This study aimed to analyze pain perception, using the VAS and CGRP levels, and to examine the correlation between VAS scores and CGRP levels. MATERIALS AND METHODS: A total of 15 patients were included in this study (a PSL group, a PE group, and a control group). GCF was collected from the lower anterior teeth, at interproximal sites, before bracket insertion and 2 hours, 24 hours, and 168 hours after lower archwire engagement. Pain perception was recorded using the VAS. CGRP concentrations were analyzed using an enzyme-linked immunosorbent assay (ELISA). RESULTS: The VAS scores of the PE and PSL groups increased 2 hours after archwire engagement, peaked after 24 hours, and returned to baseline after 168 hours, and the PE group had high scores than the PSL group, with the highest score being recorded at the 24 hour time point. CGRP concentrations were also the highest at the 24 hour time point compared to the other time points. CONCLUSION: These results showed that both the VAS score and the CGRP concentration increased during initial orthodontic tooth alignment when using either the PSL or the PE bracket systems. Pain perception scores and CGRP concentrations were weakly positively correlated. CLINICAL SIGNIFICANCE: The type of bracket system used influenced the patients' pain perception scores and the release of CGRP.

Camouflage treatment of skeletal Class III malocclusion in an adult cleft-palate patient using passive self-ligating system.

This case report describes the successful camouflage treatment to correct a moderate skeletal Class III malocclusion in a 19-year-old male cleft-palate patient. Early closure of the palate produced palatal scar tissue that inhibited midfacial growth, causing maxillary arch deficiency, severe maxillary crowding, and anterior and posterior crossbites. Combined surgical-orthodontic therapy would have been the preferred treatment of choice; however, the patient declined this option because of surgical risks and costs. Therefore, nonextraction camouflage treatment using a passive self-ligating bracket system was used. Treatment aims including expansion of the maxillary arch and correction of the anterior and posterior crossbites were achieved without the use of an additional maxillary arch expander or other auxiliary appliances. This treatment resulted in satisfying facial esthetics and a normal dental occlusion.

The difference of stress distribution of maxillary expansion using rapid maxillary expander (RME) and maxillary skeletal expander (MSE)-a finite element analysis.

BACKGROUND: Maxillary skeletal expander (MSE) in combination with miniscrews was developed to overcome the drawbacks that may have resulted from the application of conventional rapid maxillary expander (RME). This research was conducted to analyze the difference of stress distribution of maxillary expansion using RME and MSE in the region of interests (ROIs): first molars (M1), palatal alveolar bones of M1, palatine sutures, zygomatic sutures, miniscrews, and their surrounding bones. METHODS: A dry skull was scanned using CBCT and rendered into a three-dimensional (3D) model of craniomaxillary structures. The data analysis was done both visually and numerically. RESULT: The stress distributions in RME group were located at the palatal side of M1, mesial side of palatal alveolar of M1, pulp chamber of M1, and inferior cortex of palatine sutures. The stress distributions in the MSE group were located at the distopalatal cusp of M1, palatal side of palatal alveolar of M1, and inferior and superior cortex of palatine sutures. The stress distributions in zygomatic sutures on both groups were located at the zygomaticotemporal sutures, whereas in the miniscrews, the stress were located at the anterior miniscrews and palatal side of surrounding bones. CONCLUSIONS: There were significant differences of stress distribution of maxillary expansion measured in the ROIs in the craniomaxillary 3D model using RME and MSE.

TMD symptoms and vertical mandibular symmetry in young adult orthodontic patients in North Sumatra, Indonesia: a cross-sectional study.

Background: Temporomandibular joint disorder (TMD) includes symptoms of pain and dysfunction in the muscles of mastication and the temporomandibular joint. Differences in vertical condylar height, observed in the assessment of mandibular asymmetry, is a structural alteration that represents a risk factor for TMD. The study aimed to evaluate the association between TMD symptoms and vertical mandibular symmetry in young adult orthodontic patients in North Sumatra, Indonesia.  Methods: The cross-sectional study included 18-25-year-old (mean ± SD, 21.9 ± 2.0 years) old orthodontic patients admitted to the Dental Hospital of Universitas Sumatera Utara, Medan, between June 2016 and March 2017. Vertical mandibular asymmetry was assessed from all 106 subjects using Kjellberg's technique from pre-treatment panoramic radiographs. The TMD symptoms were assessed by structural interviews using modified questionnaires based on Temporomandibular Disorder Diagnostic Index and Fonseca's Anamnestic Index. Results: Of the 106 subjects, 26 (24.5% of the total) with vertical mandibular symmetry and 39 (36.8%) with vertical mandibular asymmetry were positive for TMD symptoms. By contrast, 17 patients (16.0% of the total) with vertical condylar symmetry and 24 patients (22.6%) with vertical mandibular asymmetry were regarded negative for TMD symptoms. There was no significant difference (p=0.520) in TMD symptoms based on vertical mandibular symmetry. Conclusion: The results from this studied Sumatran population indicate that there are common TMD symptoms in young adult orthodontic patients, but there is no significant association between vertical mandibular asymmetry and TMD symptoms. Further study on the development of TMD, mandibular asymmetry and treatment planning for growing patients is suggested, using longitudinal and transitional approaches.

Skeletal maturation in Indonesian and white children assessed with hand-wrist and cervical vertebrae methods.

INTRODUCTION: The purpose of this study was to describe the stages of skeletal maturity of Deutero-Malay Indonesian children according to the hand-wrist and cervical vertebrae methods and to compare them with white children. METHODS: The study included 2167 patients with hand-wrist radiographs and lateral cephalometric radiographs. Of these, there were 648 Indonesian boys, 303 white boys (age range of boys, 10-17 years), 774 Indonesian girls, and 442 white girls (age range of girls, 8-15 years). The skeletal maturation index (SMI) was used to evaluate the stages of skeletal maturity from hand-wrist radiographs, and the cervical vertebrae maturation (CVM) index was used to evaluate the stages of skeletal maturity from lateral cephalometric radiographs. One observer made all observations, and a repeatability study was undertaken. RESULTS: Box-and-whisker plots were used to show the age distribution on attainment of each maturation stage based on the SMI and CVM. On average, both the SMI and the CVM showed that white children attained each maturation stage about 0.5 to 1 year earlier than their Indonesian peers, although the differences were less obvious in girls than in boys. Multiple regression analysis was used to predict the SMI from the chronologic age. Both the Indonesian and the white boys groups showed a good relationship between predicted SMI and chronologic age (R(2) = 0.728 and 0.739, respectively), as did the Indonesian and white girls groups (R(2) = 0.755 and 0.748, respectively). Further multiple regression analyses used to investigate the differences in the ages of attainment of skeletal development between Indonesian and white subjects indicated that, across the age ranges investigated, on average for a particular age, the white boys were 1 SMI stage ahead of the Indonesian boys, and the white girls were about 0.5 SMI stage ahead of their Indonesian peers. Because the CVM has only 5 categories, it was not considered appropriate to use this form of multiple regression analysis. CONCLUSIONS: The findings confirmed marked variations in the chronologic ages for each skeletal maturity stage and also showed differences between the timing of skeletal maturity with both the SMI and the CVM between the sexes and the ethnic groups. These differences should be considered during orthodontic diagnosis and treatment planning.

Discriminatory ability of the skeletal maturation index and the cervical vertebrae maturation index in detecting peak pubertal growth in Indonesian and white subjects with receiver operating characteristics analysis.

INTRODUCTION: In this study, we aimed to determine the effectiveness of the skeletal maturation index (SMI) and the cervical vertebrae maturation (CVM) index in discriminating between patients who have yet to attain their peak pubertal growth, compared with those who have reached or passed it. An additional aim was to determine whether there was any significant difference in the ability of the 2 methods to predict peak pubertal growth. METHODS: The study included 2167 patients with hand-wrist and lateral cephalometric radiographs. There were 648 Indonesian boys and 303 white boys (age range, 10-17 years), and 774 Indonesian girls and 442 white girls (age range, 8-15 years). The SMI was used to evaluate the stages of skeletal maturity from hand-wrist radiographs, and the CVM index was used to evaluate skeletal maturity from lateral cephalograms. Several commonly used cephalometric parameters representing maxillary and mandibular dimensions were also measured to construct growth curves and calculate peak velocity. RESULTS: Receiver operating characteristic (ROC) analysis was performed for the craniofacial morphology parameters for both sex and ethnic groups. The percentages of correctly classified subjects into the appropriate maturational stages for the mandibular parameters, as well as the stages with high sensitivity values for the maxillary parameters, showed that both the CVM index and the SMI have good discriminatory ability. On average, the results of the area under curve (AUC) for the SMI (AUC >0.9) were greater than for the CVM (AUC >0.8), and the differences between them were also statistically significant (P <0.05 for all parameters investigated). However, the curves for both CVM and SMI approached the top left corner of the ROC graph, suggesting that both tests have good discriminatory ability, and the differences between the methods were only between 1% and 7%. CONCLUSIONS: Both the CVM index and the SMI are valid methods to discriminate between patients who have not yet attained peak pubertal growth and those who have reached or passed it. The differences in discriminatory ability between the SMI and the CVM index in detecting peak pubertal growth were small. These results question the necessity of taking hand-wrist radiographs and exposing a child to additional radiation when the discriminatory ability is similar with the CVM index, which is readily derived from most lateral cephalograms.