Suppression of enhanced physiological tremor via stochastic noise: initial observations.

Enhanced physiological tremor is a disabling condition that arises because of unstable interactions between central tremor generators and the biomechanics of the spinal stretch reflex. Previous work has shown that peripheral input may push the tremor-related spinal and cortical systems closer to anti-phase firing, potentially leading to a reduction in tremor through phase cancellation. The aim of the present study was to investigate whether peripherally applied mechanical stochastic noise can attenuate enhanced physiological tremor and improve motor performance. Eight subjects with enhanced physiological tremor performed a visuomotor task requiring the right index finger to compensate a static force generated by a manipulandum to which Gaussian noise (3-35 Hz) was applied. The finger position was displayed on-line on a monitor as a small white dot which the subjects had to maintain in the center of a larger green circle. Electromyogram (EMG) from the active hand muscles and finger position were recorded. Performance was measured by the mean absolute deviation of the white dot from the zero position. Tremor was identified by the acceleration in the frequency range 7-12 Hz. Two different conditions were compared: with and without superimposed noise at optimal amplitude (determined at the beginning of the experiment). The application of optimum noise reduced tremor (accelerometric amplitude and EMG activity) and improved the motor performance (reduced mean absolute deviation from zero). These data provide the first evidence of a significant reduction of enhanced physiological tremor in the human sensorimotor system due to application of external stochastic noise.

Enhanced corticomuscular coherence by external stochastic noise.

Noise can have beneficial effects as shown by the stochastic resonance (SR) phenomenon which is characterized by performance improvement when an optimal noise is added. Modern attempts to improve human performance utilize this phenomenon. The purpose of the present study was to investigate whether performance improvement by addition of optimum noise (ON) is related to increased cortical motor spectral power (SP) and increased corticomuscular coherence. Eight subjects performed a visuomotor task requiring to compensate with the right index finger a static force (SF) generated by a manipulandum on which Gaussian noise was applied. The finger position was displayed on-line on a monitor as a small white dot which the subjects had to maintain in the center of a green bigger circle. Electroencephalogram from the contralateral motor area, electromyogram from active muscles and finger position were recorded. The performance was measured by the mean absolute deviation (MAD) of the white dot from the zero position. ON compared to the zero noise condition induced an improvement in motor accuracy together with an enhancement of cortical motor SP and corticomuscular coherence in beta-range. These data suggest that the improved sensorimotor performance via SR is consistent with an increase in the cortical motor SP and in the corticomuscular coherence.

Broad-band Gaussian noise is most effective in improving motor performance and is most pleasant.

Modern attempts to improve human performance focus on stochastic resonance (SR). SR is a phenomenon in non-linear systems characterized by a response increase of the system induced by a particular level of input noise. Recently, we reported that an optimum level of 0-15 Hz Gaussian noise applied to the human index finger improved static isometric force compensation. A possible explanation was a better sensorimotor integration caused by increase in sensitivity of peripheral receptors and/or of internal SR. The present study in 10 subjects compares SR effects in the performance of the same motor task and on pleasantness, by applying three Gaussian noises chosen on the sensitivity of the fingertip receptors (0-15 Hz mostly for Merkel receptors, 250-300 Hz for Pacini corpuscles and 0-300 Hz for all). We document that only the 0-300 Hz noise induced SR effect during the transitory phase of the task. In contrast, the motor performance was improved during the stationary phase for all three noise frequency bandwidths. This improvement was stronger for 0-300 Hz and 250-300 Hz than for 0-15 Hz noise. Further, we found higher degree of pleasantness for 0-300 Hz and 250-300 Hz noise bandwidths than for 0-15 Hz. Thus, we show that the most appropriate Gaussian noise that could be used in haptic gloves is the 0-300 Hz, as it improved motor performance during both stationary and transitory phases. In addition, this noise had the highest degree of pleasantness and thus reveals that the glabrous skin can also forward pleasant sensations.

The strength of the corticospinal coherence depends on the predictability of modulated isometric forces.

Isometric compensation of predictably frequency-modulated low forces is associated with corticomuscular coherence (CMC) in beta and low gamma range. It remains unclear how the CMC is influenced by unpredictably modulated forces, which create a mismatch between expected and actual sensory feedback. We recorded electroencephalography from the contralateral hand motor area, electromyography (EMG), and the motor performance of 16 subjects during a visuomotor task in which they had to isometrically compensate target forces at 8% of the maximum voluntary contraction with their right index finger. The modulated forces were presented with predictable or unpredictable frequencies. We calculated the CMC, the cortical motor alpha-, beta-, and gamma-range spectral powers (SP), and the task-related desynchronization (TRD), as well as the EMG SP and the performance. We found that in the unpredictable condition the CMC was significantly lower and associated with lower cortical motor SP, stronger TRD, higher EMG SP, and worse performance. The findings suggest that due to the mismatch between predicted and actual sensory feedback leading to higher computational load and less stationary motor state, the unpredictable modulation of the force leads to a decrease in corticospinal synchrony, an increase in cortical and muscle activation, and a worse performance.

Improved sensorimotor performance via stochastic resonance.

Several studies about noise-enhanced balance control in humans support the hypothesis that stochastic resonance can enhance the detection and transmission in sensorimotor system during a motor task. The purpose of the present study was to extend these findings in a simpler and controlled task. We explored whether a particular level of a mechanical Gaussian noise (0-15 Hz) applied on the index finger can improve the performance during compensation for a static force generated by a manipulandum. The finger position was displayed on a monitor as a small white point in the center of a gray circle. We considered a good performance when the subjects exhibited a low deviation from the center of this circle and when the performance had less variation over time. Several levels of mechanical noise were applied on the manipulandum. We compared the performance between zero noise (ZN), optimal noise (ON), and high noise (HN). In all subjects (8 of 8) the data disclosed an inverted U-like graph between the inverse of the mean variation in position and the input noise level. In other words, the mean variation was significantly smaller during ON than during ZN or HN. The findings suggest that the application of a tactile-proprioceptive noise can improve the stability in sensorimotor performance via stochastic resonance. Possible explanations for this improvement in motor precision are an increase of the peripheral receptors sensitivity and of the internal stochastic resonance, causing a better sensorimotor integration and an increase in corticomuscular synchronization.

Corticomuscular coherence reflects interindividual differences in the state of the corticomuscular network during low-level static and dynamic forces.

In the investigation of corticomuscular coherence (CMC), it remained unclear why some subjects do not present significant CMC. We predicted that such subjects will develop CMC as a result of learning as indexed by improved performance during a visuomotor task. We investigated CMC, cortical motor spectral power (SP), and performance in 14 subjects during isometric compensation of a static force or dynamic force (DF) with their right index finger. We compared data from the beginning of the experiment (Time-Period 1) and after learning (Time-Period 2). Eight subjects (Group CMC++) presented CMC during Period 1 which increased during Period 2. Six subjects (Group CMC-+) presented CMC only during Period 2. Group CMC-+ was "more desynchronized" (lower SP, and stronger task-related desynchronization) than Group CMC++. The performance was better in Group CMC++ than in Group CMC-+. Learning was associated with higher SP, higher CMC, and better performance in both groups. However, in the more complicated DF condition, Group CMC++ learned better than Group CMC-+. The present study demonstrates the presence of CMC in all subjects tested and evidence that this is due to the fact that individuals may fall into 2 different groups in terms of oscillatory motor control: Group CMC-+ presents CMC only after learning.

Impact of a weekly dance class on the functional mobility and on the quality of life of individuals with Parkinson's disease.

Individuals with Parkinson's disease (PD) mainly suffer from motor impairments which increase the risk of falls and lead to a decline of quality of life. Several studies investigated the long-term effect of dance for people with PD. The aims of the present study were to investigate (i) the short-term effects of dance (i.e., the effect immediately after the dance class) on motor control in individuals with PD and (ii) the long-term effects of 8 months of participation in the weekly dance class on the quality of life of the PD patients and their caregivers. The dance lessons took place in a ballet studio and were led by a professional dancer. Eleven people with moderate to severe PD (58-85 years old) were subjected to a motor and quality of life assessments. With respect to the motor assessments the unified Parkinson disease rating scale III (UPDRS III), the timed up and go test (TUG), and the Semitandem test (SeTa) before and after the dance class were used. With respect to the quality of life and well-being we applied quality of life scale (QOLS) as well as the Westheimer questionnaire. Additionally, we asked the caregivers to fill out the Questionnaire for caregivers. We found a significant beneficial short-term effect for the total score of the UPDRS motor score. The strongest improvements were in rigidity scores followed by significant improvements in hand movements, finger taps, and facial expression. No significant changes were found for TUG and for SeTa. The results of the questionnaires showed positive effects of the dance class on social life, health, body-feeling and mobility, and on everyday life competences of the PD patients. Beneficial effect was also found for the caregivers. The findings demonstrate that dance has beneficial effect on the functional mobility of individuals with PD. Further, dance improves the quality of life of the patients and their caregivers. Dance may lead to better therapeutic strategies as it is engaging and enjoyable.

Corticospinal beta-range coherence is highly dependent on the pre-stationary motor state.

During steady muscle contractions, the human sensorimotor cortex generates oscillations in the beta-frequency range (15-30 Hz) that are coherent with the activity of contralateral spinal motoneurons. This corticospinal coherence is thought to favor stationary motor states, but its mode of operation remains elusive. We hypothesized that corticospinal beta-range coherence depends on the sensorimotor processing state before a steady force task and may thus increase after sensorimotor tuning to dynamic force generation. To test this hypothesis we instructed 16 human subjects to compensate static force after rest as well as after compensating predictable or unpredictable dynamic force with their right index finger. We calculated EEG-EMG coherence, cortical motor spectral power, and the motor performance during the force conditions. Corticospinal beta-coherence during stationary force was excessively elevated if the steady-state contraction was preceded by predictable dynamic force instead of rest, and was highest after unpredictable dynamic force. The beta-power decreased from rest to predictable dynamic force, and was lowest during unpredictable dynamic force. The increase in corticospinal beta-coherence showed a significant negative correlation with the preceding change in beta-power. The tuning to dynamic force did not entail an inferior motor performance during static force. The results imply a correlation between corticospinal beta-range coherence and the computational load of the preceding isometric motor engagement. We suggest beta-range coherence provides a functional corticospinal gateway for steady force-related processing that can override cortical states tuned to dynamic force. The modulation of corticospinal beta-range coherence might thus ensure comparable precision of static force in various motor contexts.

Chylothorax after surgery on congenital heart disease in newborns and infants -risk factors and efficacy of MCT-diet.

OBJECTIVES: To analyze risk factors for chylothorax in infants after congenital heart surgery and the efficacy of median chain triglyceride diet (MCT). To develop our therapeutic pathway for the management of chylothorax. PATIENTS AND METHODS: Retrospective review of the institutional surgical database and patient charts including detailed perioperative informations between 1/2000 and 10/2006. Data analyzing with an elimination regression analysis. RESULTS: Twenty six out of 282 patients had chylothorax (=9.2%). Secondary chest closure, low body weight, small size, longer cardiopulmonary bypass (242 ± 30 versus 129 ± 5 min) and x-clamp times (111 ± 15 versus 62 ± 3 min) were significantly associated with chylothorax (p < 0.05). One patient was cured with total parenteral nutrition (TPN) and one without any treatment. 24 patients received MCT-diet alone, which was successful in 17 patients within 10 days. After conversion to regular alimentation within one week only one chylothorax relapsed. Out of 7 patients primarily not responsive to MCT-diet, 2 were successfully treated by lysis of a caval vein thrombosis, 2 by TPN + pleurodesis + supradiaphragmatic thoracic duct ligation, one by octreotide treatment, and two patients finally died. CONCLUSIONS: Chylothorax may appear due to injury of the thoracic duct, due to venous or lymphatic congestion, central vein thrombosis, or diffuse injury of mediastinal lymphatic tissue in association with secondary chest closure. Application of MCT alone was effective in 71%, and more invasive treatments like TPN should not be used in primary routine. After resolution of chylothorax, MCT-diet can be converted to regular milk formula within one week and with very low risk of relapse.

General surgery among long-term residents with and without active epilepsy at the Kork Epilepsy Centre - a prospective comparative one-year survey.

BACKGROUND/AIMS: We prospectively assessed the frequency, type, severity and cause of treatment among the long-term residents of the Kork Epilepsy Centre in the year 2005. METHODS: All long-term residents were exclusively referred to the general surgeon practicing on the campus. Patients were divided into 2 groups comprising 285 patients with active epilepsy and 53 controls who either never had epileptic seizures or have remained seizure free for at least 4 years. RESULTS: The 1-year incidence of injuries was 54.2% among the active epilepsy group and 36.8% among controls (p = 0.0275). Several admissions due to differing reasons occurred in 16.8% of people with active epilepsy and in 7.5% of the controls (not significant). More than 2 admissions due to various reasons only occurred in patients with active epilepsy (range 3-9). Of all injuries, 41.3% were directly related to seizures. Among patients with active epilepsy, the 3 most frequent injuries were lacerations, bruises and fractures (29.6, 17.0 and 11.7%, respectively). CONCLUSION: According to this prospective study, active epilepsy turned out to be a significant risk factor for injuries under homogenous patient and observer conditions.

Ten years stable internal fixation of metacarpal and phalangeal hand fractures-risk factor and outcome analysis show no increase of complications in the treatment of open compared with closed fractures.

BACKGROUND: : Stable internal screw/plating systems for hand fractures have evolved during the last 20 years. The improved versatility leads to the increased use of these materials in open fractures, with the benefit of early mobilization. The aim of this retrospective study is to discern whether the broadening of the indications for these implants is accompanied by increased complication rates. METHODS: : Data from 365 patients treated during the last 10 years at our department for metacarpal or phalangeal fractures with stable internal fixation by screw or plate were gathered and analyzed. RESULTS: : Uneventful bony consolidation was observed in 91.2% (n = 333). The functional results were excellent to acceptable in 85.2%, whereas in 14.8% (n = 54), the result was unsatisfactory, the latter group presenting with concominant soft tissue injury. There was no statistically significant difference in infection and nonunion rates when comparing open and closed fractures. CONCLUSION: : These results confirm that most patients with open metacarpal and phalangeal fractures can be treated by stable internal fixation.

Corticospinal interaction during isometric compensation for modulated forces with different frequencies.

BACKGROUND: During isometric compensation of modulated low-level forces corticomuscular coherence (CMC) has been shown to occur in high-beta or gamma-range. The influence of the frequency of force modulation on CMC has up to now remained unexplored. We addressed this question by investigating CMC, motor performance, and cortical spectral power during a visuomotor task in which subjects had to compensate a modulated force of 8% of the maximum voluntary contraction exerted on their right index finger. The effect of three frequencies of force modulation (0.6, 1.0 and 1.6 Hz) was tested. EEG, EMG from first dorsal interosseus, hand flexor and extensor muscles, and finger position were recorded in eight right-handed women. RESULTS: Five subjects showed CMC in gamma- (28-45 Hz) and three in beta-range (15-30 Hz). Beta- and gamma-range CMC and cortical motor spectral power were not modulated by the various frequencies. However, a sharp bilateral CMC peak at 1.6 Hz was observed, but only in the five gamma-range CMC subjects. The performance error increased linearly with the frequency. CONCLUSIONS: Our findings suggest that the frequency of force modulation has no effect on the beta- and gamma-range CMC during isometric compensation for modulated forces at 8% MVC. The beta- and gamma-range CMC may be related to interindividual differences and possibly to strategy differences.

Aurora A is differentially expressed and regulated in chromosomal and microsatellite instable sporadic colorectal cancers.

The centrosome-associated kinase aurora A has been shown to be involved in genetic instability and to be (over)expressed in several human carcinomas. This study investigated aurora A gene copy numbers, mRNA and protein expression as well as tumour cell proliferation and aneuploidy in chromosomal and microsatellite instable sporadic colorectal cancers. Case-matched tissues of normal (n=71) and dysplastic (n=49) colorectal epithelium and invasive carcinomas (n=71) were included in this study. PCR-based microsatellite analysis classified 14/71 (20%) of carcinomas as microsatellite instable. A stepwise increase of aurora A mRNA expression (P<0.0001; quantitative RT-PCR) and aurora A protein expressing tumour cells (P=0.0141; immunohistochemistry) occurred in the adenoma-carcinoma sequence. Within invasive carcinomas, aurora A mRNA levels (P=0.0259) and aurora A positive tumour cells (P<0.0001) were closely associated with tumour cell proliferation (Ki-67 specific immunohistochemistry). Compared with chromosomal instable carcinomas, microsatellite instable carcinomas had significantly more aurora A positive tumour cells (P=0.0043) and a higher tumour cell proliferation (P=0.0335). In contrast, only chromosomal instable carcinomas exhibited marked tumour cell aneuploidy (P=0.0004, fluorescence in situ hybridization) and significantly higher aurora A gene copy numbers (P=0.0206) as compared with microsatellite instable carcinomas. This study further supports a role of aurora A in the carcinogenesis of sporadic colorectal cancers. Moreover, it demonstrates that in a minority of predominantly microsatellite instable carcinomas the presence of aurora A positive tumour cells is merely reflecting tumour cell proliferation. In contrast, the large majority of chromosomal instable carcinomas shows additional (de)regulation of aurora A by gene amplification and concomitant tumour cell aneuploidy. Thus, sporadic colorectal cancers exhibit different mechanisms of aurora A regulation and this may impact the efficacy of aurora-targeted therapies.

Role of proprioception and vision in handwriting.

The objective of this study is to better understand the role of proprioception in handwriting and test earlier conclusions stating that the automated shaping of letters was not impaired by the removal of visual control in deafferentation. To this aim we compared the performance of the deafferented patient GL, who suffers from a complete loss of cutaneous and proprioceptive sensation, with that of eight healthy age- and sex-matched subjects. The word "Parallele", written within a short sentence with and without visual control, was quantified using a digital writing tablet. Three of the 13 analyzed parameters were strikingly different in patient GL compared to healthy subjects, both with and without vision: increase of number of pen touches, increase in number of inversions in velocity, and decrease of mean stroke frequency. The changes in these three parameters indicate a strong impairment in automated behaviour in the absence of proprioception and touch. This impairment is also supported by the significantly longer movement duration, which is also significantly increased by the removal of visual control. The present study provides for the first time a quantification of handwriting in a completely deafferented patient and reveals the central role of proprioception for the storage, updating, and maintenance of skilled motor programs. The fact that the deficits are already present with visual feedback suggests that the role of vision in handwriting is only secondary.

Retrobulbar optic nerve diameter measured by high-speed magnetic resonance imaging as a biomarker for axonal loss in glaucomatous optic atrophy.

PURPOSE: To assess a novel magnetic resonance imaging (MRI) protocol for quantifying the optic nerve diameter (OND) as a measure of axonal loss in the optic nerve. METHODS: Included in the study was one eye each from 47 subjects, of whom 9 had no eye disease, 16 had preperimetric glaucoma, 11 had a glaucomatous mean visual field defect of <10 dB and 11 of >10 dB. Each subject underwent automated perimetry, scanning laser polarimetry, optic coherence tomography, scanning laser tomography, and ultrafast high-resolution MRI at 3 T. OND was determined 5, 10, and 15 mm behind the eye with a half Fourier-acquired single-shot turbo spin-echo (HASTE)-sequence requiring 1.5 seconds of data acquisition time per slice and providing a spatial resolution of 0.11 mm. A multiple linear regression model was applied to determine correlations (r) among the different techniques. RESULTS: The correlation (r) was <0.37 for OND measurements taken 5 mm behind the eye. At 10 mm behind the eye, r increased to 0.57 and was statistically significant in four out six instances. In the orbital apex 15 mm behind the eye, r reached a maximum of 0.80 and was statistically significant in all instances. OND correlated best with the retinal nerve fiber layer thickness measured by optic coherence tomography. CONCLUSIONS: Retina- or optic nerve head-related surrogate markers for axonal content correlated closely with the OND, although only when it was measured in the orbital apex. High-resolution MRI using an ultrafast HASTE-sequence at 3 T proved useful for OND quantification and may be a valuable asset in future neuroprotection trials.

Beta-range EEG-EMG coherence with isometric compensation for increasing modulated low-level forces.

Corticomuscular synchronization has been shown to occur in beta (15-30 Hz) and gamma range (30-45 Hz) during isometric compensation of static and dynamic (periodically modulated) low-level forces, respectively. However, it is still unknown to what extent these synchronization processes in beta and gamma range are modified with increasing modulated force. We addressed this question by investigating the corticomuscular coherence (CMC) between the electroencephalogram (EEG) and electromyogram (EMG) from the first dorsal interosseus muscle (FDI) as well as the cortical and muscular spectral power during a visuomotor task where different levels of a dynamic (modulated) force were used. Seven healthy right-handed female subjects compensated dynamic forces at 8, 16, and 24% of the maximal voluntary contraction (MVC) isometrically with their right index finger. Under the three conditions investigated, we found a broad-band CMC comprising both beta and gamma range and peaking at approximately 22 Hz within the beta band. This broad-band coherence increased linearly with higher force level. A separate analysis of the gamma range CMC did not show significant modulation of the CMC by the force levels. EEG and EMG spectral power did not show any significant difference among the three force conditions. Our results favor the view that the function of beta range CMC is not specific for low-level static forces only. The sensorimotor system may resort to stronger and also broader beta-range CMC to generate stable corticospinal interaction during increased force level, as well as when compensating for dynamic modulated forces. This finding re-enforces the importance of the beta-range EEG-EMG coherence in sensorimotor integration.

Magnetic resonance imaging compared with biopsy in the diagnosis of brainstem diseases of childhood: a multicenter review.

OBJECT: Data analysis was performed in a multicenter study to evaluate magnetic resonance (MR) imaging for classification of brain tumors, prognosis, and prediction of tumor histological diagnosis. METHODS: The clinical, MR imaging, and histological findings obtained in 142 pediatric cases of brainstem disease were assessed in a multicenter study performed as a blinded review. Clinical data were available in 142 cases, histopathological findings in 126, and MR images in 131. The subgroup of cases involving brainstem gliomas (78 cases) was analyzed separately. Images that met criteria for evaluation were reviewed in random order by three experienced observers who were initially blinded to clinical data as well as histopathological diagnoses. Subsequently, the images were randomized again and provided to the observers for review together with the clinical symptoms of the specific patients. The three observers were able to correctly identify lesions as tumors or nontumorous disease on MR images in 99, 96, and 95% of cases, resulting in an overall sensitivity of 0.94, a specificity of 0.43, a positive predictive value of 0.96, and a negative predictive value of 0.45. Awareness of clinical symptoms did not change the results. CONCLUSIONS: Based on 14 imaging criteria together with the patient's clinical history and symptoms, laboratory data (results of cerebrospinal fluid analysis as well as infectious and immunological parameters), and imaging follow up, a diagnosis of brainstem tumor, as opposed to demyelination, encephalitis, or granuloma, could generally be made. Given these findings, there is only rarely a need for biopsy, and in those patients in whom it is considered, the potential costs and benefits must be carefully assessed on a case-by-case basis.

Non-destructive visualisation of protective proteins in the in situ pellicle.

Several salivary anti-microbial and buffering components are part of the acquired in vivo pellicle. The purpose of the present in situ study was to visualise these proteins within the in situ formed pellicle and to investigate their distribution with respect to pellicle formation time and intra-oral localisation. Bovine enamel slabs were fixed on individual splints. They were carried by 6 subjects buccally and palatally in the region of the upper first molar teeth over 30 and 120 min, respectively, for in situ pellicle formation. After intra-oral exposure, enamel specimens were processed for transmission electron microscopy. Secretory immunoglobulin A (sIgA), lactoferrin, lysozyme, carbonic anhydrase (CA) I and II were visualised successfully in the in situ pellicle layer by gold immuno-labelling. All components were found to be distributed randomly within all layers of the pellicle. Significantly higher amounts of the proteins were detected after 120 min of formation time. Furthermore, significantly more labelled lactoferrin and lysozyme were found on buccal surfaces compared with palatal sites. For CA I, CA II and sIgA, no significant influence of the localisation was detected. All investigated anti-bacterial and buffering proteins are distributed randomly in the in situ formed pellicle layer and thus could contribute to its protective properties as an early defence barrier.

Dentofacial parameters explaining variability in retroclination of the maxillary central incisors.

BACKGROUND AND AIM: The interrelation between retroclination of the maxillary central incisors and dentofacial parameters is a controversial subject in the literature. In contrast to comparisons between malocclusion and control groups, the objective of the present study was to identify skeletal, dentoalveolar or perioral (soft-tissue) factors which primarily determine how severely retroclination is individually manifested. MATERIALS AND METHODS: For this purpose we evaluated the pretherapeutic lateral cephalograms of 83 patients with an inclination of the maxillary central incisors ranging from physiological values to very severe retroclination (inclination to anterior cranial base between 104 degrees and 64 degrees ). A detailed analysis of the skeletal, dentoalveolar, and soft-tissue morphology was performed using lateral cephalograms taken prior to therapy. The statistical analysis included the calculation of multiple regression models for maxillary central incisor inclination and different parameters describing the lip-to-incisor relationship as dependent variables. RESULTS: A regression model including 1) the lip-line level measured at the dorsal upper-lower lip contact point, 2) the sagittal intermaxillary relationship, and 3) the inclination of the mandibular central incisors explained 81% of the variability in maxillary central incisor inclination (p < 0.0001 for all three parameters). Statistical analysis of the morphologic base of a high dorsal lip-line level (i.e., the predominant characteristic in the retroclination cases) revealed the significance of soft-tissue, dentoalveolar, and skeletal variables (p < 0.001). CONCLUSIONS: Complementary to results of previous resting lippressure measurements, this cephalometric study suggests that a high lip-line level is the predominant causative factor for a cover- bite or Class II, Division 2 malocclusion. Therefore, we conclude that (1) lip-line measurements should be included in routine cephalometric diagnostics, and (2) that a high lip-line must be eliminated by therapeutic measures in these malocclusions to prevent a post-orthodontic relapse.

Lip-to-incisor relationship and postorthodontic long-term stability of cover-bite treatment.

OBJECTIVE: To investigate the impact of a persisting high lip line and other potential relapse-inducing factors on long-term stability of orthodontic correction of retroinclined maxillary central incisors. MATERIALS AND METHODS: Thirty-one cover-bite ("Deckbiss") patients with retroinclined maxillary central incisors and a deep frontal overbite were evaluated. The maxillary central incisor inclination was determined odontometrically with study models made pretreatment, posttreatment, and at a follow-up examination (mean posttherapeutic interval: 9.0 years). The lip-to-incisor relationship, the interincisal angle, and the anteroposterior maxillary central incisor position were measured on lateral cephalograms taken after active treatment. RESULTS: The relapse tendency of the orthodontic correction of the retroinclined maxillary central incisors displayed great interindividual variability with a range of posttherapeutic inclination change of -6.75 degrees to +8.00 degrees. Multiple regression analysis revealed an increased tendency for relapse in patients with (1) a high posttherapeutic (dorsal) lip line level combined with the maxillary central incisor and lower lip contact only in the incisal crown area (P < .01) and (2) a marked therapeutically induced inclination change of the maxillary central incisors (P < .05). Interrelations between the relapse of the corrected maxillary central incisors and other evaluated parameters were not statistically significant. CONCLUSIONS: For maximum treatment stability, the elimination of an excessive overlap of the upper incisors by the lower lip should be regarded as one of the most important therapeutic objectives when treating this malocclusion.