The Erasmus programme for postgraduate education in orthodontics in Europe: an update of the guidelines.

In 1989, the ERASMUS Bureau of the European Cultural Foundation of the Commission of the European Communities funded the development of a new 3-year curriculum for postgraduate education in orthodontics. The new curriculum was created by directors for orthodontic education representing 15 European countries. The curriculum entitled 'Three years Postgraduate Programme in Orthodontics: the Final Report of the Erasmus Project' was published 1992. In 2012, the 'Network of Erasmus Based European Orthodontic Programmes' developed and approved an updated version of the guidelines. The core programme consists of eight sections: general biological and medical subjects; basic orthodontic subjects; general orthodontic subjects; orthodontic techniques; interdisciplinary subjects; management of health and safety; practice management, administration, and ethics; extramural educational activities. The programme goals and objectives are described and the competencies to be reached are outlined. These guidelines may serve as a baseline for programme development and quality assessment for postgraduate programme directors, national associations, and governmental bodies and could assist future residents when selecting a postgraduate programme.

Disturbances in dental development and craniofacial growth in children treated with hematopoietic stem cell transplantation.

OBJECTIVES: To investigate the correlation between age, degree of disturbances in dental development, and vertical growth of the face in children treated with hematopoietic stem cell transplantation (HSCT). PATIENTS: 39 long-term survivors of HSCT performed in childhood and transplanted before the age of 12, at a mean age of 6.8±3.3 years. METHODS: Panoramic and cephalometric radiographs were taken at a mean age of 16.2 years. For each patient two age- and sex-matched healthy controls were included. The area of three mandibular teeth was measured and a cephalometric analysis was performed. RESULTS: The mean area of the mandibular central incisor, first and second molar was significantly smaller in the HSCT group, and the vertical growth of the face was significantly reduced, especially in the lower third, compared to healthy controls. A statistically significant correlation between age at HSCT, degree of disturbances in dental development, and vertical growth of the face was found. Children subjected to pre-HSCT chemotherapy protocols had significantly more growth reduction in vertical craniofacial variables compared to children without pre-HSCT chemotherapy. Conditioning regimens including busulfan or total body irradiation had similar deleterious effects on tooth area reduction and craniofacial parameters. CONCLUSIONS: The younger the child is at HSCT, the greater the impairment in dental and vertical facial development. This supports the suggestion that the reduction in lower facial height found in SCT children mainly is a result of impaired dental development and that young age is a risk factor for more severe disturbances.

Opinions of American and Swedish orthodontists about the role of erupting third molars as a cause of dental crowding.

OBJECTIVE: To compare the opinions of Swedish orthodontists and American orthodontists regarding the association between third molar eruption and dental crowding. MATERIALS AND METHODS: A survey was distributed to Swedish orthodontists (n = 230) asking their views on the force exerted by erupting third molars, its relationship to crowding, and their recommendations for prophylactic removal. Results were compared with those from a similar study conducted in the United States. Chi square analysis was used to determine differences in responses to questions between Swedish and American orthodontists. P < or = .05 was considered significant. RESULTS: Both Swedish and American orthodontists believed that lower third molars were more likely than upper third molars to cause force (65% and 58% for Swedish and American orthodontists, respectively) and crowding (42% and 40%, respectively). No statistically significant differences were seen between the answers of American and Swedish orthodontists regarding the role of upper and lower third molars in causing crowding. Although only 18% of Swedish orthodontists "generally" or "sometimes" recommended prophylactic removal of mandibular third molars, 36% of American orthodontists "generally" or "sometimes" recommended removal (P < .0001). CONCLUSIONS: Most orthodontists in the United States and Sweden do believe that erupting lower third molars exert an anterior force; however, they also believe that these teeth "rarely" or "never" cause crowding of the dentition. The reason that more American orthodontists recommend prophylactic removal of mandibular third molars remains unexplained.

Dental maturation in children with shunt-treated hydrocephalus.

OBJECTIVE: The aim of this study was to examine the relationship between dental maturation and somatic development and to discover their possible deviations in children with shunt-treated hydrocephalus. DESIGN: Radiographs (orthopantomogram and hand-wrist radiograph) from children with shunt-treated hydrocephalus were analyzed with respect to the dental maturation and compared with values of an age- and sex-matched control group and population standards. PATIENTS: Forty-one children with shunt-treated hydrocephalus (27 boys and 14 girls) aged from 5 to 16 years (median age 11.0 years). RESULTS: The mean deviation of dental age from chronological age was significantly greater in the hydrocephalic group than in the control group. The mean value of dental age deviation was advanced in early pubertal stages but reduced in later pubertal stages. CONCLUSIONS: These findings can be explained by changes in the endocrinological conditions, which are due to disturbed pituitary secretion. The present results could also partly reflect an adaptable developmental pathway in an otherwise strictly genetically determined process.

Morphology of Singapore chinese.

The aims of this study were to provide a description of the craniofacial morphology of Singaporean Chinese children and to compare gender differences. Lateral cephalometric radiographs were obtained of 81 Singaporean Chinese children (31 boys and 50 girls; mean age 12.7 and 12.5 years, respectively, standard deviation = 0.7) with Class I incisor relationships. The radiographs were traced and 27 hard and soft tissue cephalometric landmarks digitized. Fourteen linear and 13 angular cephalometric variables were obtained using the Neodigiplottrade mark computerized cephalometric analysis software. A comparison of the genders showed that girls had greater maxillary and mandibular protrusion, but the upper and lower incisor inclinations were reduced. In addition, girls showed reduced facial convexity and reduced upper lip prominence. Pogonion to nasion perpendicular was greater for boys. Although not statistically significant, the values of intermaxillary protrusion and Wits showed a tendency for the girls towards a Class III skeletal base. The boys also had statistically significantly longer cranial base lengths, and anterior and posterior face heights. Overall, the results reflect gender differences in both angular and linear cephalometric craniofacial measurements, which should be taken into account when establishing cephalometric reference data for Singaporean Chinese children.

Orthodontic treatment in long-term survivors after pediatric bone marrow transplantation.

Children treated for childhood cancers with both radiation and chemotherapy often exhibit disturbances in dental development. A retrospective analysis of treatment outcome in 10 orthodontically treated children was performed. A questionnaire was sent to each child's orthodontist, and 5 orthodontists reported that the patient's medical condition influenced their choice of treatment plan. Three orthodontists, all treating patients with severely disturbed root development, reported using lighter forces than they used with the average patient. With regard to complications related to orthodontic treatment, 1 of the 10 patients showed evidence of root resorption. In 4 of the 10 patients, the treatment result was judged to be unsatisfactory. This study showed that, although ideal treatment results were not always achieved, orthodontic treatment did not produce any harmful side effects in children who are long-term survivors of childhood cancer.

Long-term follow-up of early treatment of unilateral forced posterior cross-bite with regard to temporomandibular disorders and associated symptoms.

Forty-four subjects, who at the age of 4 years had been treated for unilateral forced cross-bite by grinding or by maxillary arch expansion, were 16-19 years later followed-up by means of a questionnaire about their present condition with regard to temporomandibular disorders (TMD). Twenty-two of them had received only early treatment (early questionnaire group) and 22 had received late treatment (late questionnaire group). Fourteen of the subjects who received late treatment also received early treatment. Twenty-nine of the subjects were also examined clinically. Eighteen of these had only received early treatment at 4 years of age (early clinical group), whereas 11 of them also received later treatment in the mixed or permanent dentition because of relapse (late clinical group). No significant differences were found between the early and late groups with regard to signs and symptoms of TMD. Most of the young adults who had undergone orthodontic treatment had well-functioning masticatory systems, and severe TMD signs and symptoms were rare. The results of this study suggest that relapse of early orthodontic treatment and further need of treatment does not influence the later status of subjective symptoms or clinical signs of TMD in young adults.

Eruption pattern of autotransplanted premolars visualized by radiographic color-coding.

Eruption patterns and root growth were visualized with the use of a new technique, radiographic color-coding, for comparison of the development of autotransplanted premolars with contralateral control teeth. Rates of eruption and root growth were studied. The eruption pattern and rate was assessed relative to the first molar. Maximum rates were found to occur between 30 and 60 days after transplantation. There were no significant differences between transplants and their contralaterals. Two distinct categories of eruption patterns were demonstrated. One group showed a tendency toward an initial rate of transplant eruption that was somewhat faster than that of the contralaterals. The other group showed initially retarded eruption. Possible explanations were discussed. Because no significant differences between the transplants and the contralaterals were observed, it was concluded that autotransplantation is a sound treatment option for substitution of missing teeth, at least from a tooth development point of view.

Mapping of the second locus for the Van der Woude syndrome to chromosome 1p34.

The Van der Woude syndrome (VWS) is a dominantly inherited developmental disorder characterized by pits and/or sinuses of the lower lip, cleft lip and/or cleft palate. It is the most common cleft syndrome. VWS has shown remarkable genetic homogeneity in all populations, and so far, all families reported have been linked to 1q32-q41. A large Finnish pedigree with VWS was recently found to be unlinked to 1q32-q41. In order to map the disease locus in this family, a genome wide linkage scan was performed. A maximum lod score of 3.18 was obtained with the marker D1S2797, thus assigning the disease locus to chromosomal region 1p34. By analyses of meiotic recombinants an approximately 30 cM region of shared haplotypes was identified. The results confirm the heterogeneity of the VWS syndrome, and they place the second disease locus in 1p34. This finding has a special interest because the phenotype in VWS closely resembles the phenotype in non-syndromic forms of cleft lip and palate.

Frontal head posture in shunt-treated hydrocephalic patients.

OBJECTS: The aim of this study was to evaluate frontal head posture in shunt-treated hydrocephalic patients and its relation to the sidedness of the shunt device. METHODS: Natural head position and frontal cephalograms of 55 shunt-treated Finnish hydrocephalic patients and 33 healthy Finnish subjects were analysed using a computerised digitising program (X-METRIX). The following reference angles were used: ORB/HOR, indicating the head position related to the true horizontal; CER/VER, indicating the cervical position related to the true vertical; and CER/CR, indicating the craniocervical position. CONCLUSIONS: The results showed an increased skewness of the head in the shunt-treated subjects, which was not related to the shunt side.

Linkage analysis of candidate regions in Swedish nonsyndromic cleft lip with or without cleft palate families.

OBJECTIVE: To analyze linkage of five candidate regions for nonsyndromic cleft lip with or without palate (CLP) on chromosome 2p13, 4q, 6p23, and 19q13; in addition chromosome 1q32, the locus for van der Woude syndrome, on Swedish CLP families. DESIGN: Three to five linked microsatellite markers were selected from each candidate region. Polymerase chain reaction (PCR) with fluorescent-labeled microsatellite markers was performed on DNA samples from the participating families. Electrophoresis of the PCR products was performed on a laser-fluorescent DNA sequencer. The genotype data were analyzed with multipoint linkage analysis. Modes of inheritance tested included two autosomal dominant, an autosomal recessive, and a nonparametric model. Multipoint logarithm of odds (LOD) scores were also calculated by assuming genetic heterogeneity. PARTICIPANTS: Nineteen Swedish multigenerational families with at least two first-degree relatives affected with CLP. Greater than 50% of the families studied show vertical transmission of the clefting phenotype and both inter- and intrafamilial variability were noted. RESULTS: Cumulative multipoint LOD scores for the whole group of families calculated under autosomal dominant modes of inheritance were negative in all regions and less than -2 except chromosome 6p23. LOD scores calculated under recessive inheritance and the nonparametric model were inconclusive. There was no significant evidence of genetic heterogeneity among the sample group. CONCLUSIONS: The group of Swedish CLP families did not demonstrate significant linkage to any of the five candidate regions examined. This might suggest a new but yet unknown CLP locus or loci in this family group. However, because linkage could not be excluded in some individual families, they should still be tested with candidate genes from these regions.

Associations between thoracic kyphosis, head posture, and craniofacial morphology in young adults.

The aim of the present study was to investigate associations between thoracic hyper- and hypokyphosis, head posture, and craniofacial morphology in young adults. Using forward bending test and spinal pantographic measurements, 31 subjects, 16 with thoracic hyper- and 15 with hypokyphosis, were selected from a population-based cohort of 430 young adults. Lateral roentgen-cephalograms were taken in natural head posture and craniofacial and postural angular measurements were calculated. Any statistically significant differences between the groups thoracic hyperkyphosis and thoracic hypokyphosis--were analysed using Student's t test. Subjects with thoracic hyperkyphosis had a larger atlantocervical angle (At/ CVT, P < 0.01) than subjects with thoracic hypokyphosis. However, head position (NSL/VER) was similar in both groups, probably owing to the visual perception control of craniovertical relation. There was no statistically significant difference in craniofacial morphologyy between the groups.

Clinical and genetic studies of Van der Woude syndrome in Sweden.

Van der Woude syndrome (VWS) is an autosomal dominant craniofacial disorder characterized by pits of the lower lip, hypodontia and cleft lip and/or cleft palate. It has been reported as the most common form of syndromic orofacial clefting with very high penetrance and varied expressivity. The disease locus for VWS has been mapped to chomosome 1q32, but the gene is yet to be cloned. Here we report a total of 11 Swedish VWS patients: 9 familial cases from two families and two isolated cases. Clinical examination of these patients showed phenotypic variability, even between patients from the same family. Genetic studies were performed using four microsatellite markers from chromosome 1q32. Constitutional deletion in this region was not demonstrated in any of the familial or isolated cases. However, in the two VWS families, linkage analysis using these markers showed positive LOD (logarithm of the odds) scores ranging from 2.56 to 2.88 to all individual markers. The highest LOD score of 3.75 was obtained with the combined haplotypes of D1S491 and D1S205, thus confirming linkage of VWS in these two families to 1q32. We conclude that there is varied expressivity but no evidence of genetic heterogeneity in VWS.

Long-term follow-up of early treatment of unilateral forced posterior cross-bite. Orofacial status.

Twenty-nine subjects, 20 years old on average and all treated at 4 years of age for unilateral forced posterior dento-alveolar cross-bite by grinding or by expansion of the upper dental arch, were clinically examined to evaluate the long-term effects of their treatment. The frequency of successful treatment-indicated as stable correction of the cross-bite-by means of only 1 treatment sequence was 59%; by grinding, 57%; and by expansion, 60%. The 18 subjects that had only been treated at the age of 4 years formed the 'early group' in our study. Eleven of our subjects had been retreated later in the mixed or permanent dentition because of a relapse of the unilateral forced posterior cross-bite and formed the 'late group'. A significantly higher frequency of mouth breathing, breathing obstacles, and snoring was found in this group. According to our clinical investigation, 2 of the subjects in our cohort still had a unilateral forced posterior cross-bite. Our findings regarding masticatory performance, bite force, and endurance showed no significant differences between the initial cross-bite and the healthy sides or between the early and the late group subjects, which showed that the masticatory function of the treated subjects was symmetrical. Grinding and expansion treatments seem to display similar success rates in the long-term regarding correction of unilateral posterior forced cross-bite.

The effect of growth hormone therapy on craniofacial growth and dental maturity in children with Down syndrome.

Craniofacial growth was evaluated 3 years after termination of growth hormone (GH) therapy in ten Down syndrome (DS) children. The control group consisted of 16 age-matched children with DS. The treatment started at 6-9 months of age, and the duration was 36 months. There were no statistically significant differences in craniofacial development between DS children treated with GH or DS children not treated. In conclusion, the results of this study indicate that GH therapy for 36 months in children with DS did not change the craniofacial morphology compared to a group of DS children not given GH.

Cervical headgear therapy as a factor in obstructive sleep apnea syndrome.

PURPOSE: Obstructive sleep apnea syndrome (OSAS) has been a subject of increasing interest from the orthodontic point of view, but less attention has been paid to the possible influence of orthodontic treatment on its occurrence. The aim here was to study possible associations between the use of cervical headgear and nocturnal cessations of airflow and the severity of the latter. METHODS: The subjects were 30 children (12 boys, 18 girls, mean age 8.2, sd 1.61 years), divided into three groups: a group of 10 children undergoing headgear therapy, selected for this examination because of symptoms of OSAS while using headgear, an age-matched control group of 10 healthy children and a group of 10 with OSAS. Standard cephalograms of the headgear group prior to the orthodontic therapy and the corresponding cephalograms of healthy controls were analysed. A polygraphic (PG) sleep evaluation was used to assess the tendency for OSAS. Apnea and hypopnea periods were summated as apnea index (AI) and number of desaturations as desaturation index (ODI). All the subjects spent one night sleeping under laboratory conditions, those with orthodontic treatment spending the first half of the night with the headgear and the latter half without. RESULTS: The position of the mandible was found to be slightly more posterior in the headgear group than in the control group. The children in the headgear group were found to have significantly more apnea/hypopnea periods during the hours when the appliance was used, and the ODI-index showed increased values in this group. CONCLUSIONS: We suggest that headgear therapy may contribute to the occurrence of sleep apnea, when a strong predisposition, such as mandibular retrognathia to the development of upper airway occlusion already exists.

Malocclusion and the need for orthodontic treatment in 9-year-old immigrant children in Stockholm, Sweden.

In this study the prevalence of malocclusion and the need for orthodontic treatment were studied from objective and subjective aspects in 174 immigrant children (89 boys and 85 girls). At the time of the study the children were 9 years of age. The objective need for orthodontic treatment was judged according to the 5-point scale of the Swedish National Board of Health and Welfare (Medicinalstyrelsen 1966). No need for treatment (grade 0) was observed in 11% of the children and only minor treatment need (grade 1) in 29%. A desirable need for treatment (grade 2) was found in 28% of the children at the time of the examination and an urgent need for treatment (grades 3 and 4) in 32%. Twenty per cent of those with a desirable need for treatment (grade 2; 6% of all the children) will probably develop an urgent need for treatment when the mixed dentition is replaced by the permanent dentition. 56% of the children were not interested in orthodontic treatment, and 63% found the arrangement of their teeth attractive. These results are discussed in relation to earlier Scandinavian epidemiological studies.

Treatment difficulty and treatment outcome in orthodontic care.

The influence of perceived treatment difficulty on the outcome of and investment in orthodontic treatment was studied in 19-year-old individuals treated by general practitioners or specialists within the totally subventioned Swedish system for orthodontic care. A total of 313 individuals were evaluated according to treatment outcome and treatment investment. About one-quarter of the treatments evaluated were classified as easy, one-quarter as moderately difficult, and one-half as difficult. The perceived treatment difficulty was on a group basis associated with the pretreatment need. The treatment outcome became less favourable and the treatment investment more expensive the greater the perceived difficulty. More than one-quarter of the treatments provided by general practitioners were classified as difficult compared with three-quarters of those provided by specialists. The outcomes were, in general, more favourable for specialist treatments than for those provided by general practitioners, although the individuals treated by specialists, on the average, were classified as more difficult than those provided by general practitioners. Easy treatments were found to be extremely cost-effective and should be carried out when possible. General practitioners should preferably treat uncomplicated cases, and an increased use of fixed appliances would be desirable in the treatment of moderately difficult treatments. Difficult cases should be treated exclusively by specialists. Cases with little need or benefit of treatment, or a poor prognosis should be given low treatment priority, and patients and parents should in these cases be informed about the small expected benefit and risks involved.

Reference structures for assessment of frontal head posture.

The aim of the study was to test (a) the validity of the supra-orbital line as a substitute for the interpupillary line, and (b) the reproducibility of two different approaches of assessing cranio- and cervico-vertical relationships on frontal cephalograms. The material consisted of natural head position frontal cephalograms of 21 healthy Finnish students and 11 Danish young adults prepared according to a method described previously, modified in the Danish sample by addition of spectacles with a wire to indicate the interpupillary line. The cephalograms were analysed manually twice by two investigators with an interval of one week. The following reference lines were selected: (1) orbital line (ORB): a tangent to the extreme cranial point on the supra-orbital margins; (2) cranial line (CR): the line drawn through crista galli and anterior nasal spine; (3) cervical line (CER): a line drawn through the midpoints of atlas (half the distance between the most median points on the tubercle of the transverse ligament), and C4 (half the distance between the most concave points of the lateral masses); (4) the main course of the upper cervical spine (SPINE): a subjective impression of the spinal inclination; (5) the interpupillary line (IP); and (6) the true vertical and horizontal lines (VER, HOR). The angles were measured to the nearest 0.5 degrees. Intra- and inter-examiner reproducibility was calculated. The supra-orbital line almost coincided with the interpupillary line as the mean inclination between the lines was only 0.5 degrees. Both intra- and inter-examiner errors were less for ORB and CER than for CR and the line indicating the main course of the upper cervical spine (SPINE). The intra-examiner reproducibility s(i) for ORB/HOR and CR/VER was 0.4 and 0.8 degrees respectively, and for CER/VER and SPINE/VER 0.8 degrees and 1.0 degrees. Based on these results, the supra-orbital line and the cervical line (defined as the mid-transversal line between the atlas and the fourth cervical vertebra) are recommended as reference lines for assessing frontal head posture.