Short-term effects of a modified Alt-RAMEC protocol for early treatment of Class III malocclusion: a controlled study.

OBJECTIVES: To assess the effects of a modified alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol in combination with facemask (FM) in Class III growing patients. SETTING AND SAMPLE POPULATION: Thirty one Class III patients (17 males, 14 females) were treated with a modified Alt-RAMEC/FM protocol at the Department of Orthodontics of the University of Florence. MATERIAL AND METHODS: All patients were evaluated at the beginning (T1, mean age 6.4 ± 0.8 years) and at the end of orthopedic therapy (T2, mean age 8.1 ± 0.9 years), and they were compared to a matched sample of 31 Class III patients (16 males and 15 females) treated with rapid maxillary expansion and facemask (RME/FM) and to a matched control group of 21 subjects (9 males and 12 females) with untreated Class III malocclusion. The three groups were compared with anova with Benjamini-Hochberg correction for multiple tests. RESULTS: Both the Alt-RAMEC/FM and the RME/FM protocols showed significantly favorable effects leading to correction of the Class III malocclusion. The Alt-RAMEC/FM protocol produced a more effective advancement of the maxilla (SNA +1.2°) and greater intermaxillary changes (ANB +1.7°) vs. the RME/FM protocol. No significant differences were recorded as for mandibular skeletal changes and vertical skeletal relationships. CONCLUSION: The Alt-RAMEC/FM protocol induced more favorable skeletal short-term effects compared with RME/FM therapy in Class III growing patients.

Treatment protocol for the impaction of deciduous maxillary anterior teeth due to compound odontoma.

AIM: The purpose of this paper was to describe the dental and surgical management of the impaction of deciduous maxillary anterior teeth due to compound odontoma. In all analysed patients impaction of the maxillary deciduous canine was associated with the presence of an odontoma. Therefore, impaction of the maxillary deciduous canine can be considered as pathognomonic of the presence of an intraosseous odontoma. The analysis of the described cases showed that early diagnosis and early removal of the odontoma are essential in improving the prognosis of the involved teeth. Early treatment allows the impacted tooth to re-start the physiological eruption. A conservative surgical approach is advisable in order to minimise damage to the impacted teeth and preserve their normal timing and path of eruption.

Dental arch dimensions and tooth wear in two samples of children in the 1950s and 1990s.

AIM: The objective of this study was to compare the degree of tooth wear in posterior deciduous teeth and the dental arch dimensions in the mixed dentition in two modern samples living in the same geographic area and separated by almost 35 years. METHODS: Dental casts of a group of subjects born between 1953 and 1959 were compared with subjects born between 1990 and 1998. The evaluation of tooth wear scores and measurements for posterior and anterior arch segments, intermolar and intercanine width, and mesiodistal size of incisors were taken. The available anterior space in both arches and the posterior and anterior transverse dimensions were calculated. Groups were compared using a nonparametric test (Mann-Whitney U-test) for independent samples (P<0.05). RESULTS: The results show that both boys and girls of the 1990s showed significantly smaller maxillary intermolar width when compared with the 1950s. Posterior transverse interarch discrepancy was significantly minor in girls of the 1990s. The comparison of abrasion showed significant differences between the two groups for all examined teeth which appeared to be more abraded in the 1950s group. CONCLUSIONS: This association can partially explain the greater risk of developing malocclusions in contemporary children compared with children living 35 years before.

Case report: orofacial characteristics of Hallermann-Streiff Syndrome.

BACKGROUND: Hallermann in 1948 and Streiff in 1950 described patients characterised by "bird face", congenital cataract, mandibular hypoplasia, and dental abnormalities. The new syndrome was later defined as Hallermann-Streiff Syndrome (HSS), underlining the differences with regard to Franceschetti's mandibulofacial dysostosis. CASE REPORT: Examination of a white male affected by Hallermann-Streiff Syndrome revealed facial characteristics typical of the "bird face" in HSS. The nose appeared thin, sharp and hooked; the prominence of the chin was absent in the lateral view; a marked microstomia was evident as well. Radiographic records showed aplasia of teeth 14, 13, 12, 22, 24, 35, 34, 33, 32, 31, 41, 42, and 43. As for orthodontic diagnosis, the following dentoskeletal features were assessed: skeletal Class II malocclusion, narrow upper arch, bilateral posterior crossbite, and anterior open bite. Lateral cephalogram showed hypoplasia of the mandible, a typical sign of HSS. The mandible revealed a clockwise rotation growth pattern with an opening of the gonial angle, skeletal anterior open bite, and an excessive vertical dimension of the lower third of the face. Radiographs at the age of 13 years showed an anomaly in shape of the lower right first bicuspid, which appeared with a double crown. TREATMENT: Orthodontic treatment started at 10 years of age with rapid maxillary expansion in the early stages of the mixed dentition, in order to correct the posterior crossbite due to the narrow maxillary arch. A subsequent phase of the orthodontic therapy consisted of a functional appliance with the goal of maintaining the transverse dimension of the dental arches and of controlling the tongue thrust in the anterior open bite. Surgical and prosthetic interventions were scheduled at completion of growth to solve the skeletal discrepancy and for occlusal rehabilitation. FOLLOW-UP: The therapeutic protocol used in the patient presented here was able to reach the orthodontic goals during the developmental ages. Further treatment is planned as there are multiple missing permanent teeth and prosthetic/restorative care is needed until the patient reaches full adulthood.

Oral manifestations of congenital neutropenia or Kostmann syndrome.

Infantile congenital agranulocytosis or Kostmann syndrome is a rare hereditary kind of severe neutropenia. The typical symptoms, which appear since the first days of life, are abscesses located on various parts of the body: ear, cutis, lung and oral cavity. These abscesses are due to an almost total disimmunity typical of the neutropenia. The aim of this article is to describe the most typical signs of this pathology in the oral cavity, reporting a case observed in our department in Florence, Italy. On the basis of the personally observed case and of the review of the literature, it is possible to consider, as a characteristic finding in Kostmann syndrome, a typical very serious periodontal pathology, which is similar to the prepubertal periodontitis in deciduous dentition. At the age of 19 years the patient showed a dramatic compromise of the masticatory function. It is obvious that the lack of response of the host can obstruct the interaction between the host and the microbic flora, because the lack of neutrophils increases the susceptibility of the patient to every kind of infection, even to periodontitis. A periodontal prophylaxis, since the very first observations, followed by a rigorous maintenance with frequent and regular professional hygienic treatments could be effective in controlling the effects of periodontal disease and could reduce the tragic evolution. We need to recognise that it could be hard to monitor the oral situation correctly in these patients, as they have a continuously poor systemic condition. Finally in these cases the rehabilitative therapy is very problematical.

Craniofacial abnormalities associated with congenital fiber type disproportion myopathy.

Congenital Fiber-Type Disproportion myopathy (CFTD) is a relatively rare muscular disorder due to predominance and reduction in size of type 1 fibers, with large type 2 fibers. After a review of the clinical and histopathological aspects of the disease, the present work described craniofacial skeletal and EMG features of a 9-year-old child affected by CFTD. Narrow maxillary arch, incompetent lips, severe skeletal open bite, and EMG evidence of weakness of masticatory muscles, were found in the examined patient. All these findings are fully consistent with previously-reported craniofacial features of patients affected by myotonic disorders (muscular dystrophy), and they may represent important diagnostic signs of a congenital muscular disease.

[Cephalometric study of the results of orthodontic treatment of Class III malocclusion]. / Contributo cefalometrico sui risultati del trattamento ortognatodontico delle malocclusioni di III Classe.

It's carried out a research on 60 children, 32 boys and 28 girls, taken from 5-12 of age, affected by Class III malocclusion. All of cases was subdivided in four groups on the ground of the age of orthodontic treatment beginning. Two teleradiographs of each patient were examined, one at the beginning and one at the conclusion of the treatment. About the results reported on the boards, were expressed some considerations on the effects of Class III malocclusions treatment as they result at the cephalometric analysis, in comparison with the starting situation of lack of balance. In every case is pointed out the significance of interception and a more favourable behaviour of cephalometric data in the groups with a earlier beginning of treatment.

Effect of i.v. indoprofen on cancer pain and serum prolactin and growth hormone levels--a controlled pharmacologic study vs i. m. morphine and placebo.

Single doses of indoprofen (400 mg, i.v.), morphine hydrochloride (10 mg, i.m.), and placebo were given to 12 women with moderate to severe tumor pain, mainly due to bone involvement, according to a Latin square design. Analgesic response, along with serum prolactin (PRL) and growth hormone (GH) levels, were measured after each treatment under double-blind conditions. Indoprofen and morphine were not significantly different as regards pain relief, but both were significantly more effective than placebo. Unlike morphine, however, indoprofen did not raise PRL. GH levels did not change following any treatment. In a second study indoprofen (400 mg, i.v., three times daily for 7 days) did not modify the PRL response to thyrotropin-releasing hormone nor serum GH levels. On the basis of the above findings it is suggested that indoprofen may be a safe alternative to opiates for relief of moderate to severe pain in women with breast tumors suspected of being prolactin-dependent.