Evaluation of Condylar Positional, Structural, and Volumetric Status in Class III Orthognathic Surgery Patients.

BACKGROUND AND OBJECTIVES: The need to evaluate the condylar remodeling after orthognathic surgery, using three-dimensional (3D) images and volume rendering techniques in skeletal Class III patients has been emphasized. The study examined condylar positional, structural, and volumetric changes after bimaxillary or single-jaw maxillary orthognathic surgeries in skeletal Class III patients using the cone-beam computed tomography. MATERIALS AND METHODS: Presurgical, postsurgical, and one-year post-surgical full field of view (FOV) cone-beam computed tomography (CBCT) images of 44 patients with skeletal Class III deformities were obtained. Group 1 underwent a bimaxillary surgery (28 patients: 24 females and 4 males), with mean age at the time of surgery being 23.8 ± 6.0 years, and Group 2 underwent maxillary single-jaw surgery (16 patients: 8 females and 8 males), with mean age at the time of surgery being 23.7 ± 5.1 years. After the orthognathic surgery, the CBCT images of 88 condyles were evaluated to assess their displacement and radiological signs of bone degeneration. Three-dimensional (3D) condylar models were constructed and superimposed pre- and postoperatively to compare changes in condylar volume. RESULTS: Condylar position was found to be immediately altered after surgery in the maxillary single-jaw surgery group, but at the one-year follow-up, the condyles returned to their pre-surgical position. There was no significant difference in condylar position when comparing between pre-surgery and one-year follow-up in any of the study groups. Condylar rotations in the axial and coronal planes were significant in the bimaxillary surgery group. No radiological signs of condylar bone degeneration were detected one year after the surgery. Changes in condylar volume after surgery were found to be insignificant in both study groups. CONCLUSIONS: At one year after orthognathic surgery, there were no significant changes in positional, structural, or volumetric statuses of condyles.

Musculomandibular morphology in individuals with different vertical skeletal growth patterns: an MRI and cone beam computed tomography study.

OBJECTIVE: The aim of this study was to analyse the volumetric and crossectional parameters of masseter and medial pterygoid muscles in the relation with mandibular skeletal morphology in individuals with different underlying growth patterns in the vertical dimension. MATERIAL AND METHODS: The study originally involved 76 individuals with definite clinical and radiological criteria: 31 skeletal Class III and 26 skeletal Class II patients before the orthognathic surgery and 20 skeletal class I (normal) individuals with complaints of wisdom teeth and associated medical problems. On the basis of cephalometric measurement of the mandibular plane and sella-nasion (MP-SN), the study sample was categorised according to the vertical facial dimension in 3 different growth pattern subgroups: 19 subjects with horizontal growth pattern, 25 subjects with vertical growth pattern and 33 subjects with neutral growth pattern. MRI was performed for the masseter and medial pterygoid muscles, and volume and cross-sectional area measurements were performed. Cone beam computed tomography (CBCT) investigation was performed for the assessment of craniofacial structures and the following measurements of the mandibular parameters were obtained: height of ramus, length of mandibular corpus, overall mandibular length, inter-angular width and intercondylar width. RESULTS: There were statistically significant differences among all study groups regarding masseter volume (p<0.006) and CSA (p<0.006), with the highest values in the horizontal growth pattern group and the lowest values in vertical growth pattern group. After Bonferroni correction, statistically significant difference (p<0.004 and p<0.008) was noted between the horizontal and vertical growth pattern groups, respectively. A similar tendency was observed for the medial pterygoid, but with no statistical significance. A statistically significant negative correlation was observed between MP-SN and the volume of masseter and medial pterygoid in the overall sample. Of the seven muscular and mandibular variables included in the regression analysis, the final model included only four variables that were significantly associated with MP-SN and explained 37% of its variance (masseter volume (p=0.017), mandibular overall length (p<0.001), height of mandibular ramus (p=0.003), and length of mandibular corpus (p<0.001)). CONCLUSIONS: The masseter muscle seems to be more sensitive to the variation in mandibular morphology than the medial pterygoid muscle, and volume as the biomechanical characteristic seems to be a more significant parameter of the size of the interaction with vertical skeletal growth patterns.

Exploring the midline soft tissue surface changes from 12 to 15 years of age in three distinct country population cohorts.

INTRODUCTION: Several studies have highlighted differences in the facial features in a White European population. Genetics appear to have a major influence on normal facial variation, and environmental factors are likely to have minor influences on face shape directly or through epigenetic mechanisms. AIM: The aim of this longitudinal cohort study is to determine the rate of change in midline facial landmarks in three distinct homogenous population groups (Finnish, Latvian, and Welsh) from 12.8 to 15.3 years of age. This age range covers the pubertal growth period for the majority of boys and girls. METHODS: A cohort of children aged 12 were monitored for facial growth in three countries [Finland (n = 60), Latvia (n = 107), and Wales (n = 96)]. Three-dimensional facial surface images were acquired (using either laser or photogrammetric methods) at regular intervals (6-12 months) for 4 years. Ethical approval was granted in each country. Nine midline landmarks were identified and the relative spatial positions of these surface landmarks were measured relative to the mid-endocanthion (men) over a 4-year period. RESULTS: This study reports the children who attended 95 per cent of all scanning sessions (Finland 48 out of 60; Latvia 104 out of 107; Wales 50 out of 96). Considerable facial variation is seen for all countries and sexes. There are clear patterns of growth that show different magnitudes at different age groups for the different country groups, sexes, and facial parameters. The greatest single yearly growth rate (5.4 mm) was seen for Welsh males for men-pogonion distance at 13.6 years of age. Males exhibit greater rates of growth compared to females. These variations in magnitude and timings are likely to be influenced by genetic ancestry as a result of population migration. CONCLUSION: The midline points are a simple and valid method to assess the relative spatial positions of facial surface landmarks. This study confirms previous reports on the subtle differences in facial shapes and sizes of male and female children in different populations and also highlights the magnitudes and timings of growth for various midline landmark distances to the men point.

Correlation of temporomandibular joint clinical signs with cone beam computed tomography radiologic features in juvenile idiopathic arthritis patients.

OBJECTIVE: Patients with juvenile idiopathic arthritis (JIA) have a high risk of temporomandibular joint (TMJ) involvement. Early detection of osseous destruction of the TMJ that can be seen radiographically is vital to provide appropriate treatment before significant craniofacial deformities and problems with occlusion arise. The aim of study was to evaluate whether there is a correlation between the clinical signs and cone beam computed tomography (CBCT) radiologic features of TMJ in patients with JIA. MATERIAL AND METHODS: Study group consisted of 65 patients (46 females and 19 males) aged 10 to 17 years with a confirmed JIA diagnosis and mean disease duration 2 years 9 month, all patients underwent a clinical examination of the TMJ and masticatory muscles as well as a radiological assessment of the TMJ osseous structures by CBCT. RESULTS: Majority of the patients' study population experienced 2 or 3 clinical signs with mean number 2.1 (standard deviation (SD) =1.00) and 3-5 radiological features related to the TMJ destruction with mean number 4.9 (SD=1.96). Statistically significant weak correlation only between pain and condyle surface flattening (Spearman`s Rho test (rho) =0.396; p value (p) =0.001) was found. No correlation between number of clinical signs and radiological features was found. CONCLUSIONS: There was no conclusive evidence found regarding correlation between TMJ clinical signs and radiological features of osseous destruction in patients with JIA - only weak correlation between pain and condyle surface flattening was observed. The number of clinical TMJ signs does not correlate with number of radiological features. For the clinical decision both clinical examination and CBCT would be useful in the early detection of osseous destruction of the TMJ in JIA patients.

Signalling molecules in jaw bones and gingival tissues of patients with Class II and Class III dentofacial deformities.

OBJECTIVES: To detect signalling molecule specificities in jaw bone growth zones in skeletal class II and class III patients and compare them to those of a control group. MATERIAL AND METHODS: Twenty skeletal Class II and 20 skeletal Class III patients who underwent orthognathic surgery treatment were in the study group and five skeletal Class I patients who had impacted third molars extracted were in the control group. During the orthognathic surgery, tissue samples were taken from the tuber maxillae, ramus mandibulae anterior and posterior part together with mucosa from the gingival transitory fold in the second molar region of the lower jaw. The samples were stained to detect TGF-ß, BMP2/4, FGFR1, VEGF, OC, OP and MMP2 expression. The distributions of these factors were assessed semiquantitatively. RESULTS: We observed significant expression of TGF-ß, BMP2/4, OC and OP in the bone tissue of the study group. FGFR1 expression was more pronounced only in mucosa. VEGF and MMP2 were found only in some tissue samples. More apoptotic cells were observed in the bone tissue and soft tissue of the control patients than in those of the skeletal Class II and Class III patients, in which apoptotic cell frequencies were relatively equal. CONCLUSION: From bone tissue in tuber maxillae region the greater TGF-ß and BMP2/4 expression is seen in Class III and control groups, comparing to Class II. In ramus mandibulae anterior part the expression of significant factors in bone tissue growth (TGF-ß un BMP2/4) is higher in the control group and Class II patients, while in ramus mandibulae posterior part higher expression of TGF-ß and BMP2/4 is in Class III patients, comparing to Class II, which indicates to a preserved growth potential in these jaw bone regions. More active bone extracellular matrix protein (osteocalcin and osteopontin) expression in tuber maxillae region both in class II and class III patient groups and different expression in ramus mandibulae anterior part, prove to the bone mineralization and metabolism activity changes, which, perhaps, characterize just these dentofacial deformations.

Radiologic features of temporomandibular joint osseous structures in children with juvenile idiopathic arthritis. Cone beam computed tomography study.

INTRODUCTION: Patients with juvenile idiopathic arthritis (JIA) have a high risk of temporomandibular joint (TMJ) involvement. Lesions in the TMJ appear early in the course of this disease. Evaluating the structure of the TMJ in JIA patients using cone beam computed tomography (CBCT) provides an understanding of the typical radiologic features of morphological change in TMJs of JIA patients. This study aims to report these features as seen in CBCT and thus comparing them with the features observed in a control group within the same age group and in females and males. MATERIALS AND METHODS: Cross-sectional observational study whereby CBCTs of 65 (130 joints) patients with a confirmed JIA diagnosis and 30 (60 joints) control group - patients without JIA upto the age of 17. Structural radiologic features of the joint's hard tissues were assessed according to the research diagnostic criteria for temporomandibular disorders as developed by Ahmad et al. RESULTS: The radiologic features of the osseous structures of the TMJ occurred asymmetrically between the right and left sides when compared in the JIA and control groups. The most prevalent feature in the JIA group is condyle surface flattening for both sides. Condyle surface erosion and osteophyte were also frequent and occurred with high statistical significance in both males and females. CONCLUSIONS: TMJ destruction features observed in CBCT images were prevalent in the JIA group and occurred infrequently in the control group.

The relationship between mandibular rotation and osseous structure of the TMJ in pre-surgery orthognathic patients: A cone beam CT study.

The aim of the study was to assess the relationship between vertical skeletal pattern in terms of mandibular rotation and osseous structural changes of the TMJ in pre- surgical orthognatic patients. TMJ skeletal morphology was evaluated in cone beam computer tomography images of 117 consecutive patients with Class II and Class III dentofacial deformities according to the research diagnostic criteria of the osseous components of the TMJ related to the maxillary-mandibular plane (MM) angle. The distribution of the number and percentage of joints with structural changes in Class II was markedly different in groups divided according to the MM angle. Statistically significant increase was found in the percentage of TMJ's with osseous changes separately for each side, i.e., right (p=0.001), left (p=0.04) and both together (p=0.0001), in the Class II patient group, an increased MM angle indicated backward rotation of the mandible. In Class III patients, there were no statistically significant differences in the number of joints with TMJ structural changes. The presence of mentioned changes was asymmetrical between the left and right joints in both the Class II and Class III patient groups. In conclusion, structural changes in the osseous parts of the TMJ are more common in patients with Class II skeletal dentofacial deformities with backward rotation of the mandible than in Class III pre-surgery orthognathic patients.

Validation of a Latvian and a Russian version of the Oral Health Impact Profile for use among adults.

BACKGROUND. The need for appraisal of oral health-related quality of life has been increasingly recognized over the last decades. The aim of this study was to develope a Latvian and a Russian version and test the validity of the Oral Health Impact Profile (OHIP-49) for use among adults in Latvia. METHODS. The original English version of the OHIP-49 was translated using the forward-backward technique, pilot-tested, and then applied to 60 adults aged 18 years and above. The questionnaire was filled out during face-to-face interviews conducted by one specialist. The internal consistency of the questionnaire was evaluated using Cronbach's alpha (α) coefficient and inter-item and item-total correlations. Discriminant and convergent validities were assessed. RESULTS. Cronbach's α was estimated to be 0.96. Inter-item correlations coefficients ranged from 0.19 to 0.91, with averige value 0.35, while item-total correlations coefficients from 0.14 to 0.86. CONCLUSIONS. The OHIP-49 is a reliable and valid questionnaire for the assessment of OHRQoL among adults in Latvia.

Specific signaling molecule expressions in the interradicular septum in different age groups.

INTRODUCTION: Orthodontic teeth movement is accompanied by the remodeling of alveolar bone, including the interradicular septum. Bone contains three cell types, osteoblasts, osteocytes, and osteoclasts that are in direct contact with all of the cellular elements in the bone marrow. Marrow is the source of both bone-building osteoblasts and bone destroying osteoclasts, and the turnover of bone occurs throughout life. Bone signalling molecules have important functions during osteogenesis, and they are active in the bone remodelling process. Patients involved in orthodontic treatment belong to different age groups: therefore age must be considered as a contributing factor compromising the osteogenetic potential of bone. The aim of the current study was to investigate the specific expression of signalling molecules in the interradicular septum in different age groups. MATERIALS AND METHODS: The study group included 17 patients to whom the extraction of teeth was recommended as part of further orthodontic treatment. Patients (9 males and 8 females) - were divided into 3 groups 1st group - 12-14 years old); 2nd group - 15-22 years old; 3rd group - 23 years old or older. Expression of BMP 2/4, TGF-α, IL-1, IL-8, OPG, MMP-1, MMP-2, MMP-8, MMP-9, MMP-13, NGFR, NKpB 105, osteocalcin, and osteopontin in interradicular septum tissues was examined. TUNEL staining was also completed. The distribution of these factors was evaluated semi quantitalively. RESULTS: In the interradicular septum bone structure, the expression levels of osteocalcin, osteoprotegerin, matrix metalloproteinases 8 and 9, and nuclear factor kappa B were determined in all samples. TUNEL staining was also done. Age related decreases in the mean values of signalling factors and the number of apoptotic cells were statistically significant. CONCLUSION: Specific to interradicular septum osteoblasts and osteoclasts factors include osteoprotegerin, osteocalcin, matrix metalloproteinase 8, matrix metallproteniase 9, and nuclear factors kappa B. The mean expression levels of these proteins and the mean TUNEL staining statistically significantly decreased with age. This is preliminary study and more patients are necessary for more precise statistical analysis in the future.

The stability of bilateral sagittal ramus osteotomy and vertical ramus osteotomy after bimaxillary correction of class III malocclusion.

INTRODUCTION: The purpose of this retrospective cephalometric study was to compare the stability of bilateral sagittal split osteotomy (BSSO) with extra-oral vertical ramus osteotomy (VRO) after correction of class III malocclusion by means of bimaxillary orthognathic surgery. METHODS: The sample comprised 51 consecutively treated patients, 38 females and 13 males, with a mean age of 19.1 years. All had a one-piece Le Fort I osteotomy with maxillary advancement and mandibular setback. VRO was performed in 30 cases, and BSSO was performed in 21 cases. Lateral cephalograms were obtained before surgery, within 1 week of surgery and 1 year after surgery. RESULTS: The mean forward movement of the maxilla was 5.6 mm in both groups (p<0.001). The mean horizontal surgical change in the VRO group was 4.4 mm (p<0.001), and in the BSSO group it was 5.4 mm (p<0.001). In the VRO group, the horizontal relapse was 1.2 mm (p<0.001), and in the BSSO group, it was 1.4 mm (p<0.001). CONCLUSION: There was no difference in the stability between the BSSO and VRO groups. The average relapse in the whole sample was 26% of the surgical movement.

Specific signaling molecule expression in periodontal ligaments in different age groups: pilot study.

INTRODUCTION. Orthodontic teeth movement is accompanied by remodeling of alveolar bone, including the interradicular septum and periodontal ligaments (PDL). Periodontal signaling molecules have important functions during tooth movement and they are active in the bone remodeling process. Patients involved in orthodontic treatment belong to different age groups: therefore age must be considered as a contributing factor compromising the remodeling potential of periodontal tissues. The aim of the current study was to investigate the specific expression of signaling molecules in the PDL of interradicular septum in patients from different groups of age. MATERIALS AND METHODS. The study group included 25 patients to whom extractions of teeth was recommended as a part of further orthodontic treatment. 25 patients (10 males and 15 females) were divided into three groups as follows: 1) 12-14 years old; 2) 15-22 years old; and 3) 23 years old or older. The routine histological method was followed and samples were stained with hematoxyline-eosine. According to literature data in current immunohistochemical study were included and examined expression of NGFR (nerve growth factor receptor), TGF-ß (transforming growth factor ß), bFGF (basic fibroblast growth factor), FGFR1 (fibroblast growth factor receptor), IL-1 (interleukin 1), IL-6 (interleukin 6), IL-8 (interleukin 8), MMP-1 (matrix metalloproteinase 1), MMP-2 (matrix metalloproteinase 2), MMP-8 (matrix metalloproteinase 8), MMP-9 (matrix metalloproteinase 9), MMP-13 (matrix metalloproteinase 13) in PDL of interradicular septum. The distribution of these factors was evaluated semi quantitatively. RESULTS. Expression levels of FGFR1, bFGF, MMP 8 and 9, and IL-6 in PDL of interradicular septum structure were determined in all samples. Decreases in the mean values of signaling factors relevant to age were statistically significant in bFGF. CONCLUSIONS. Analyzed data suggest that bFGF, FGFR, IL-6, MMP 8 and 9 were determined as signaling factors in PDL of interradicular septum. Mean expression level decrease with age of FGFR1, IL-6, MMP-8, MMP-9 was non- statistically significant. The mean expression level of bFGF decreased with age, and this decrease was statistically significant. In younger patients, signal molecule expression is higher because of increased PDL metabolic activity. Increased PDL metabolic activity is a reason for higher expression of signal molecule in younger patients. Activity of remodeling process of periodontal tissue decreases with the aging and expression of signaling molecule decreases in adults.

Today's understanding about bone aging.

Patient's age is an important factor in orthodontic treatment. There are many studies about bone aging from the aspects of osteoporosis and other bone diseases. Both, aging and osteoporosis are associated problems and have a great importance in relation to their incidence. But not only osteoporosis or other bone related diseases are issue for many studies, because the knowledge of bone pathophysiology and diagnostics with signaling molecules makes it possible to predict treatment outcome and specific cell targeted pharmacology. In recent years immunohistological studies had become very popular in all fields of medicine including orthodontics, too. The question we tried to answer in this literature mini-review was--what kind of immunohistological studies were done from the aspect of bone aging in relation to patient`s age and orthodontic treatment? Search on Cochrane Library, PubMed, Science Direct, and DynaMed data bases by keywords: Alveolar bone aging, RANK, RANKL, OPG, MMP-1, MMP-8, IL-1, IL-6, TNF-α, TNF-ß, and BM, resulted with 147 full-text articles; from them 90 met the criteria, 30 were reviews, and only in 22 articles from 60 bone aging from the aspect of signaling molecules were discussed. Interestingly, only 2 articles (Cei 2006 and Zhang 2003) were related to alveolar bone, and none studied it from the orthodontic point of view. Patient`s age plays an important role in orthodontic treatment, because of the bone response to mechanical loading. It is in accordance to clinical studies, or alike, that tooth movement in younger patient occurs much faster than in adults, but the question which factors are responsible for the process still remains.

Three-dimensional evaluation of musculoskeletal in Class II and Class III patients.

OBJECTIVE: To evaluate and compare dimensional morphology of masseter and medial pterygoid muscles and mandibular skeletal parameters between subjects with skeletal Class II and Class III. MATERIALS AND METHODS: The sample consisted of 13 patients with skeletal Class II and 10 patients with skeletal Class III prior to the start of combined orthodontic treatment and orthognathic surgery with correspondence to definite inclusion and exclusion criteria. Magnetic resonance imaging was performed for mandibular muscles and following 2D and 3D measurements were done: cross-sectional area (CSA), thickness, width, longitudinal dimension and volume. 3D multi-slice computed tomography investigation was performed for the assessment of skeletal mandibular parametres and following measurements were done: height of mandibular ramus, length af mandibular corpus, overall mandibular length, intergonial width. All the measurements were done bilaterally. Data were analyzed using descriptive statistics, t-test, and correlation coefficients. RESULTS: It was found that values of all mandibular and medial pterygoid measurements were higher in Class III subjects with statistical significance (p<0.05). There was a tendency of all masseter variables to be higher in Class III patients. Positive correlations were found between muscles' volume and CSA in both groups, muscles' volume and all mandibular parameters in Class II group, CSAs and all mandibular variables except intergonial width in Class II group. Overall symmetry was observed between left and right sides in all muscular and mandibular measurements in both groups. CONCLUSIONS: The data were acquired using two different imaging techniques - MRI and MSCT that can be mentioned as a novelty in this field of research. Remarkable differences were observed between study groups for both skeletal and muscular measurements.

Three-dimensional evaluation of TMJ parameters in Class II and Class III patients.

The aim of our study was to assess condylar parameters and condyle position within glenoid fossa of TMJ in volumetric 3D imaging in patients with Class II and Class III malocclusions. MATERIALS AND METHODS. The study group included 15 patients with severe skeletal Class II (mean age 18.0 yrs) and 14 patients with severe skeletal Class III ( mean age 19,2 yrs) with an indication for combined orthodontic and orthognathic treatment. CT examination was performed, pictures were reconstructed in three - dimensional (3D) rendering and measured in two dimension projection (2D) pictures using IAC review and Transparent bone programs to quantify following condylar and glenoid fossa parameters - glenoid fossa width and height; tuberculum articulare angle; anterior, superior and posterior joint space; height and width of condyle, height of procesus condylaris. Mean values were calculated separately for left and right side. Differences of the mean values were tested using paired t-test. RESULTS. There were statistically significant differences (p<0,05) between two study groups for all spatial measurements on both sides with larger spatial measurements in patients with Class II malocclusions. Also the height of procesus condylaris varied between groups with statistical difference. Unilateral differences were detected for width of fossa glenoidale and height of condyle. CONCLUSION. Results show that there are a tendency for smaller condyle and wider spaces between condyle and walls of glenoid fossa comparing TMJ of Class II with Class III patients.

Osteopontin and osteocalcin in maxilla tissue of skeletal Class III patients.

Bone extracellular matrix proteins osteopontin and osteonectin have important function during embryonic osteogenesis and are active in bone remodeling process. Knowledge about bone extracellular matrix proteins explores the mechanisms of craniofacial development and helps to understand better morphopathogenesis of severe dentofacial anomalies. Aim of the current study was to investigate an expression of osteopontin and osteocalcin in maxilla tissue in skeletal Class III patients. The study group included 10 skeletal Class III patients to whom combined orthodontic and surgical treatment was recommended. Samples of tuber maxillae tissue from ten skeletal Class III malocclusion patients were collected due the orthognatic surgery procedure. The routine histological method was followed and samples were stained by hematoxyline-eosine. Tissue samples were stained according the standard immunohistochemical methods and expression of osteocalcin and osteopontin in maxilla tissue was examined. Distribution of these factors was evaluated semiquantitetively by counting the positive structures in visual field. The trabecules of bone contained parallel located collagen fibers and irregular bone mineralization. Connective tissue proliferation in osteon channels was observed. Quantity of cells positive to osteopontin was higher than quantity of cells containing osteocalcin in all patterns extracted of maxilla tissue in patients with skeletal Class III. In few cases osteocalcin positive cells were located near the border with soft tissue - close to osteogenic cells zone, but no osteocalcin was observed deeper in bone. The intensity of osteocalcin expression was variable, and differs individually despite the relatively regular osteopontin distribution in all patterns. There were pronounced osteopontin, but not osteocalcin-containing cells with approximately similar intensity of protein expression in tuber maxillae in skeletal Class III patients.

Condylar and mandibular morphological criteria in the 2D and 3D MSCT imaging for patients with Class II division 1 subdivision malocclusion.

UNLABELLED: The condyle has a special multidirectional capacity for the growth and adaptive remodeling of temporomandibular joint (TMJ). Being part of TMJ structure, it plays an important role in the stability of long-term treatment results for orthodontic and orthognatic patients with Class II division 1 subdivision malocclusions. Several computed tomography (CT) investigation modes have been used to evaluate the craniofacial morphology and particularly, for TMJ. Dimensional images, acquired using new generation multislice CT (MSCT) and cone beam CT scanning data, are becoming increasingly popular in the clinical work and research. The aim of the study was to develop a new CT investigation protocol for the quantification of morphological structures and skeletal landmarks of condyle, procesus condylaris and mandible. For this purpose we created two dimensional (2D) and three dimensional (3D) reconstruction images from primary axial MSCT scans using IAC review and Transparent bone programms and acquired accordant measurements of condylar and mandibular structures. This technic allowed to get truly volumetric reflexion of the joint components in its real anatomical size and avoided the bony superimpositions. Our material included 12 patients with skeletal Class II division 1 subdivision malocclusion who had indications for combined orthodontic and orthognatic treatment. CT examination was performed before the start of treatment. For statistical analysis paired Student t-tests were applied to test the diferences of mean values and correlation coefficients were calculated to assess possible interrelations between measurements. The preliminary results showed weak corrrelation between condylar and mandibular measurements. More significant correlation was observed between procesus condylaris and mandible. It was a significant difference between right and left side in the height of procesus condylaris in patients without clinicaly relevant facial asymetry which could be considered in the individual planning of orthognatic treatment. CONCLUSION: The developed combined 2D and 3D MSCT investigation protocol for condylar and mandibular measurements provides precise and demonstrative quantitative images of condylar and mandibular structures and its dimensional relationships., which could be qualified as informative criteria for the individual treatment planning for patients with Class II division 1 subdivision malocclusion.

The relationship between the severity of malposition of the frontal teeth and periodontal health in age 15-21 and 35-44.

INTRODUCTION: In the recent past there has been an increase in the number of adults seeking orthodontic treatment therefore special attention to periodontal status of these patients needs more careful evaluation. Periodontal considerations in adult orthodontic treatment are increasingly important as patients become older. The aim of the study was to assess the interrelationship between the severity of malposition of frontal teeth with periodontal health considering to age in Latvian population. METHODS: The data were analyzed from a detailed crossectional study in Latvian population. Selected samples consisted of two age groups: 15-21 (n=323) and 35-44 (n=286) years old. For the assessment of periodontal health CPI scores was analyzed for upper frontal sextant. For assessment of malocclusion 2 components of ICON index were used: upper arch crowding and incisor overbite. The differences in the distribution of ICON index and CPI index between age groups were tested using Pearson chi(2)test. Statistical significance of the differences in the mean values was tested using t-test. Possible interaction between above mentioned indexes was tested by means of analysis of variance. RESULTS: Upper arch crowding and incisor overbite severity increase with age was statistical significant. There was statistically significant interrelation between upper arch crowding degree and incisor overbite and CPI scores severity in the age 15-21 and was not in the age 35-44. However comparing higher degree of the crowding and overbite severity to percent of subjects with bleeding, calculus and periodontal pockets greater percents of measurements were in older group. CONCLUSIONS: 1. Severity of upper arch crowding and overbite statistically significant increased with age with remarkable increasing of periodontal problems. 2. Interrelation between severity of upper arch crowding, incisor overbite and CPI scores was statistically significant in age group 15-21.

Growth factors, apoptotic cells and barx1 gene in bone and soft tissue of skeletal class III patients.

UNLABELLED: Growth factors and growth stimulating genes are main signaling molecules for growth and development in ante- and postnatal period involved in cellular proliferation, differentiation and morphogenesis of tissues and organs during embryogenesis, postnatal growth and adulthood. The aim of this study was to evaluate TGF-beta (transforming growth factor-beta), BMP2/4 (bone morphogenetic protein 2/4), FGFR1 (fibroblast growth factor receptor one), barx1 gene and apoptosis from tissue samples of oro-maxillo-facial region in skeletal class III patients to reveal possible morphopathogenesis of severe skeletal anomalies. The study group included 9 patients with skeletal class III malocclusion. During orthognatic surgery tissue samples from tuber maxillae, ramus mandibulae anterior and posterior part, as well as gingiva from the lower jaw in region of second molar have been taken. Samples were stained with immunohistochemistry for TGF-beta, BMP2/4, FGFR1, apoptosis and barx1 gene. We used also the routine histological staining with haematoxyline and eosine. In tuber maxillae, ramus mandibulae anterior and posterior part staining for TGF-beta was the most relevant. Also BMP2/4, FGFR1 and barx1 showed the highest mean number of positive cells in tuber maxillae. Barx1 was equally expressed in ramus mandibulae, but BMP2/4 and FGFR1 mainly stained its posterior part cells. Apoptosis mostly affected ramus mandibulae anterior part. CONCLUSIONS: We suggest about more active stimulation of bone growth in tuber maxilla whereas ramus mandibulae. Apoptosis mainly affects ramus mandibulae anterior part that possibly connects to the lower expression of growth stimulating factors and may indicate lower bone remodelation ability.

The severity of malocclusion and need for orthodontic treatment in correspondence with the age.

Awareness of the age related situation as to the malocclusion prevalence in population and orthodontic treatment need is very important and useful for planning an orthodontic care, especially taking into account the interdisciplinary aspect of the problem. The aim of this study was to investigate the degree of severity of malocclusion and the need of orthodontic treatment in three different age groups of population in Latvia. The study group comprised samples of 12-13-yr-olds (n=46), 18-yr-olds (n=32) and 35-44-yr-olds (n=278). The Index of Complexity, Outcome and Need (ICON) was used for the assessment of the results. In order to provide the accuracy use of ICON, more than 4 missing teeth and prosthetic restorations were chosen as an exclusion factor for the age group 35-44 years. A statistically significant difference was determined between the mean ICON values in 12-13 and 18 year-old age groups. Professionally defined orthodontic treatment need according to ICON score >43 was determined to be higher in the age group 18 year-olds. Overall, the tendency for orthodontic treatment complexity grade was observed to increase with the age.

Soft tissue profile of children with impaired nasal breathing.

UNLABELLED: The aim of the study was to evaluate soft tissue profile of the children with impaired nasal breathing. MATERIALS AND METHODS: Soft tissue points relative to the true vertical line (TVL) were measured on the lateral cephalograms in natural head position of 54 subjects with diagnosed nasal obstruction (34 males, 20 females, mean age 13.3+/-2.7). As controls served 33 patients receiving orthodontic treatment for different types of malocclusion (19 males, 14 females, mean age 13.4+/-2.7). Nasal airflow measurements were performed for all children. RESULTS: Both groups had retrognathic soft tissue profile, and there were no statistically significant difference between the groups in the linear and angular measurements of the soft tissue measurements, except for the interlabial gap measurement. Soft tissue profile projections to TVL were dependent on craniocervical and cervical inclination angles. In addition head extension was associated with flattened mentolabial sulcus and increased lower face height. Some of the soft profile measurements correlated with age. CONCLUSION: Soft tissue profile of the children with impaired nasal breathing in general is not different from the soft tissue profile of other orthodontic patients and mostly is dependent on the craniocervical posture and age.