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Background Arthrogryposis multiplex congenita is a rare condition that mainly involves the lower limbs, characterized by severe joint deformity and contracture, muscular atrophy, and functional impairment. Its clinical manifestations are heterogenous and may involve the maxillofacial district as well. Case presentation This case report describes a 20-year-old patient with arthrogryposis multiplex congenita with skeletal crossbite, facial asymmetry, reduced mouth opening and absence of lateral mandibular movement on the left side. After clinical evaluation, the following exams were required: postero-anterior cephalometric tracing, head and neck electromyography, computerized axiography, computed tomography scan, and maxillofacial magnetic resonance imaging. Orthognathodontic evaluation indicated skeletal asymmetry, reduced condylar movements on the left side and abnormally low electromyography activity of the masticatory muscles on the left side. Computed tomography and magnetic resonance imaging revealed unilateral left mandibular hypoplasia, hypotrophy, and fatty infiltration of masticatory muscles on the left side, as well as immobility of the left condyle during mouth opening, and hypoplasia of the left articular disk, which was however not displaced. Surgery was not indicated and conservative orthognathodontic treatment with function generating bite was suggested to balance the occlusal plane, as well as stretching exercises. Conclusions A rare case of arthrogryposis multiplex congenita with maxillofacial involvement illustrates that a patient-centred, multidisciplinary approach with accurate diagnosis is required to formulate the best treatment plan. Because of the considerable damage to the masticatory muscles, conservative orthognathodontic therapy may be the best treatment option.

Gorham’s disease, or vanishing bone disease, is a rare condition of unknown etiology characterized by bone absorption.The disease can affect any part of the skeleton, however the pelvis, humerus, axial skeleton and the mandible are morefrequently involved. The mechanism of bone resorption is unclear, but localized endothelial proliferation of lymphatic vesselsis shown in osteolytic lesions The diagnosis is based on clinical, radiological and histological features after excludingother infectious, inflammatory, endocrine and neoplastic etiological factors. Medical treatment for Gorham’s diseaseincludes anti-osteoclastic medications (bisphosphonates), and alpha-2b interferon, radiation therapy induced sclerosis ofthe proliferating vascular tissue within the bone. Also surgical treatment options are available including resection of thelesion and reconstruction with bone grafts and/or prostheses. We present a case of Gorham’s disease of the right maxillain a 67 years old female affecting the alveolar process, zygoma and the floor of the orbit. The initial clinical manifestationat the onset of the disease was the mobility of the upper right molars, mimicking periodontal disease followed by theworsening of a preexisting diplopia with undefined origin. The patient received a medical treatment with zoledronic acid,vitamin D and calcium carbonate for 12 months which proved to be effective in controlling the progression of the disease.

Background Gorlin syndrome, also known as Gorlin-Goltz syndrome (GGS) or basal cell nevus syndrome (BCNS) or nevoid basal cell carcinoma syndrome (NBCCS), is an autosomal dominant familial cancer syndrome. It is characterized by the presence of numerous basal cell carcinomas (BCCs), along with skeletal, ophthalmic, and neurological abnormalities. It is essential to anticipate the diagnosis by identifying the pathology through the available diagnostic tests, clinical signs, and radiological manifestations, setting up an adequate treatment plan. Main body In the first part, we searched recent databases including MEDLINE (PubMed), Embase, and the Cochrane Library by analyzing the etiopathogenesis of the disease, identifying the genetic alterations underlying them. Subsequently, we defined what are, to date, the major and minor clinical diagnostic criteria, the possible genetic tests to be performed, and the pathologies with which to perform differential diagnosis. The radiological investigations were reviewed based on the most recent literature, and in the second part, we performed a review regarding the existing jawbone protocols, treating simple enucleation, enucleation with bone curettage in association or not with topical use of cytotoxic chemicals, and “en bloc” resection followed by possible bone reconstruction, marsupialization, decompression, and cryotherapy. Conclusion To promote the most efficient and accurate management of GGS, this article summarizes the clinical features of the disease, pathogenesis, diagnostic criteria, differential diagnosis, and surgical protocols. To arrive at an early diagnosis of the syndrome, it would be advisable to perform radiographic and clinical examinations from the young age of the patient. The management of the patient with GGS requires a multidisciplinary approach ensuring an adequate quality of life and effective treatment of symptoms.

Bone morphogenic protein-2/4 (BMP-2/4) is an osteoinductive protein that accelerates osteogenesis when administered to bony defects. Sericin is produced by silkworms, and has a biological activity that differs depending on the degumming method used. Our results indicated that the high molecular weight fraction of silk sericin (MW > 30 kDa) obtained via sonication had a more abundant β-sheet structure than the low molecular weight fraction. Administration of the β-sheet structure silk sericin increased BMP-2/4 expression in a dose-dependent manner in RAW264.7 cells and human monocytes. This sericin increased the expression levels of toll-like receptor (TLR)-2, TLR-3, and TLR-4 in RAW264.7 cells. Application of a TLR-2 antibody or TLR pathway blocker decreased BMP-2/4 expression following sericin administration. In the animal model, the bone volume and BMP-2/4 expression were higher in rats treated with a sericin-incorporated gelatin sponge than in rats treated with a gelatin sponge alone or a sponge-incorporated with denatured sericin. In conclusion, sericin with a more abundant β-sheet structure increased BMP-2/4 expression and bone formation better than sericin with a less abundant β-sheet structure.

The main flaw of silkworm cocoon originated membranes for guided bone regeneration (GBR) techniques is that the maximum size of the membrane is determined by the size of the cocoon. Flatwise-spun silk does not have any limitation to its production size. The objective of this study was to compare flatwise-spun silk mats with cocoon-derived silk mats for a GBR technique. Tensile strength, scanning electron microscopy, Fourier transform infrared (FT-IR) spectroscopy and sericin contents analysis were done for in vitro test. Bone regeneration ability was tested in the critical sized defect of the animal model. In this study, flatwise-spun silk mats showed lower tensile strength and similar tensile strain to a cocoon-derived commercialized silk mat (TDI). Compared to TDIs, the flatwise-spun silk mats showed a similar second derivative spectrum, but they showed an increased abundance of the random coil and helix structures in the FT-IR spectra because of a higher content of sericin. In animal model experiments, the bone volume (BV) after the application of a flatwise-spun silk mat was similar to the volume observed after the application of a TDI. Both groups showed a significantly higher BV compared to an unfilled control group (P

The purpose of this investigation is to describe a potentially useful analysis in assessing the required extent of sagittal chin augmentation or set-back, by relating chin prominence to lower lip position using the ‘lower lip-chin prominence angle’. The secondary aim was to quantitatively evaluate the influence of this angle on perceived attractiveness and desire for surgery. Having described this angular analysis, a quantitative evaluation was undertaken by incrementally altering the angle on an idealised profile image to create a range of images that were rated on a 7-point Likert scale by a pre-selected group of pre-treatment orthognathic patients, clinicians and laypeople. In treatment planning alterations in chin prominence, an ‘ideal’ sagittal position with soft tissue pogonion on or just behind a true vertical line through the most prominent point of the lower lip may be used. Chin retrusion or prominence up to an angle of 15° retrusion to −5° prominence is deemed acceptable. Surgery is desired from chin prominence of greater than −15° and retrusions greater than 25°. The greater the retrusion or prominence of the chin from an angle of 0°, the less the perceived attractiveness and the greater the desire for surgical correction.

4-Hexyl resorcinol (4HR) is an organic compound and has been used in skin care application. 4HR is an M2-type macrophage activator and elevates vascular endothelial growth factor (VEGF) expression via the hypoxia-inducible factor (HIF)-independent pathway. As endothelial cells are important in wound healing, the human umbilical vein endothelial cells (HUVECs) were treated with 4HR, and changes in VEGF-A, -C, and transforming growth factor-&beta, 1 (TGF-&beta, 1) expression were investigated. The administration of 4HR increased the expression level of VEGF-A, -C, and TGF-&beta, 1. The application of TGF-&beta, 1 protein also increased the expression level of VEGF-A and -C. Knockdown with small interfering RNA (siRNA) targeting to TGF-&beta, 1 and the selective chemical inhibition (A83-01) to ALK5 confirmed the involvement of the TGF-&beta, signaling pathway in the 4-HR-mediated VEGFs expression. 4HR application in a burn model of diabetic rats demonstrated an increased level of angiogenic proteins with wound healing. Compared to sericin application, the 4HR application group showed more prominent capillary regeneration. Collectively, 4HR activated TGF-&beta, 1/ALK5/VEGFs signaling in endothelial cells and induced vascular regeneration and remodeling for wound healing.

Background In 1992, Pribaz described the facial artery musculomucosal flap (FAMM), an axial musculomucosal flap based on the facial artery. The FAMM flap, a modification of the nasolabial and buccal mucosal flaps, is widely used in the reconstruction of defects in the oral cavity. Many modifications of this flap have been described in the literature. Here we aimed to explore the use of an arterialized tunnelized FAMM island flap (a-FAMMIF) for the reconstruction tongue defects after tumor resection. Method From January 2015 to December 2016, five cases of tongue cancer were selected for the use of arterialized FAMMIF flap to reconstruct defects after tumor resection. Results Reconstruction was successful in all cases, except one case of total flap necrosis; partial necrosis of the flap occurred in two patients, which were solved with medications. Conclusion The authors consider the a-FAMMIF an unreliable flap in the reconstruction of tongue defects.The authors recommend avoiding tunneling and island modification when the vein is not included in the pedicle.

The aim of the study was to evaluate the cephalometric differences and condylar asymmetry between patients with juvenile idiopathic arthritis (JIA) and normal control group. Sixty-two JIA patients with a latero-lateral cephalogram and orthopantomography, seeking for orthodontic therapy, and 62 normal matched subjects were comprised in the study. Cephalometric analysis was used for the evaluation of facial morphology while the method of Habets et al. (J Oral Rehabil 15(5): 465–471, 1988) was used to compare the condyles in orthopantomography. The significance of between-group differences was assessed using the Mann–Whitney test, as appropriate. The results showed a prevalence of the upper maxilla with hypomandibulia (class II), hyperdivergency with short vertical ramus posterior and posterior rotation of the mandible in JIA children (SNB, ANB, NSL/ML, Fh/ML, NL/ML, ArGo, ML P < 0.0001, ML/Oc P < 0.004, ArGo/GoGn P = 0.02, no difference for SNA). The condyles of the JIA group resulted highly asymmetric (P < 0.0001). The growth pattern of JIA patients resulted clearly different from normal subjects. This serious impairment of the cranial growth may be considered as an indicator of the need for early and continuous orthognatodonthic therapy during the entire period of development for all JIA patients, independently from temporomandibular joint signs or symptoms. To this end, it is important that rheumatologists and orthognathodontists set up a multidisciplinary treatment planned to control the side effects of a deranged growing pattern, to strictly avoid any orthodontic therapies that may worsen function and growth, and to promote treatments improving the physiology and biology of the cranial development.

During the last decades there has been a progressive increase in proportion of incidence of oral cancer not related to a known etiologic factor, such as the so-called "oral cancer in young", a relevant tumor in non-smoker non-drinker (NSND) patients. The topic is matter of long standing debate, and adequate study models to analyze this entity are lacking. Spontaneous oral cancer in companion animals such as dogs and cats, presents more clinical and biological similarities with the human oral cancer than any other animal model. In our review we analyze how the study of spontaneous oral cancer in common pets can prospectively prove to be of double usefulness in unraveling the question about the origin of oral cancer in NSND patients, allowing both the analysis of environmental and behavioral risk factors, and the study of how carcinogenic viruses, chronic inflammation, and changes in immunity can influence pre-tumoral and tumoral microenvironment.

Introduction The purposes of the study were to investigate and evaluate the differences detected by the patients between the traditional orthognathic approach and the surgery-first one in terms of level of satisfaction and quality of life. Methods A total of 30 patients who underwent orthognathic surgery for correction of malocclusions were selected and included in this study. Fifteen patients were treated with the conventional orthognathic surgery approach, and 15 patients with the surgery-first approach. Variables were assessed through the Orthognathic Quality of Life Questionnaire and the Oral Health Impact Profile questionnaire and analyzed with 2-way repeated-measures analysis of variance. Results The results showed significant differences in terms of the Orthognathic Quality of Life Questionnaire (P Conclusions This study showed that the worsening of the facial profile during the traditional orthognathic surgery approach decompensation phase has a negative impact on the perception of patients’ quality of life. Surgeons should consider the possibility of a surgery-first approach to prevent this occurrence.

Aim This study aimed to report a well-succeeded use of equine enzyme-deantigenic cortical membrane and bone granules for guided bone regeneration (GBR) in the esthetic zone concomitant with implant placement. Background In the anterior maxilla, where patients typically have the highest expectations for implant-supported restorations, bone resorption in the wake of tooth loss often leads to a lack of soft tissue support and ultimately to unsatisfactory esthetic results. Buccal bone augmentation at the time of implant placement has thus become common. This is usually accomplished following GBR principles and employing membranes made from various materials to serve as a barrier between the soft tissue and graft material. One of the more recently introduced membrane materials is made from thin, flexible equine cortical bone, i.e., rendered nonantigenic in an enzymatic process that preserves native bone collagen. Case report This report describes the treatment of a patient who received an equine enzyme-deantigenic graft and membrane in conjunction with placement of an implant in the right maxillary lateral incisor site. Conclusion After 5 years of follow-up, the patient was very satisfied with her appearance. A cone-beam computed tomography scan showed that the peri-implant bone levels and ridge thickness had been maintained, and the cortical layer in the pristine ridge had also undergone remodeling. Clinical significance Guided bone regeneration with the concomitant use of enzyme-deantigenic membrane and graft is a valuable and suitable option for effective implant-supported prosthetic rehabilitation in the esthetic zone. How to cite this article Di Stefano DA, Garagiola U, Bassi MA. Preserving the Bone Profile in Anterior Maxilla using an Equine Cortical Bone Membrane and an Equine Enzyme-treated Bone Graft: A Case Report with 5-year Follow-up. J Contemp Dent Pract 2017;18(7):614-621.

The treatment of patients with atrophic ridge who need prosthetic rehabilitation is a common problem in oral and maxillofacial surgery. Among the various techniques introduced for the expansion of alveolar ridges with a horizontal bone deficit is the alveolar ridge split technique. The aim of this article is to give a description of some new tips that have been specifically designed for the treatment of atrophic ridges with transversal bone deficit. A two-step piezosurgical split technique is also described, based on specific osteotomies of the vestibular cortex and the use of a mandibular ramus graft as interpositional graft. A total of 15 patients were treated with the proposed new tips by our department. All the expanded areas were successful in providing an adequate width and height to insert implants according to the prosthetic plan and the proposed tips allowed obtaining the most from the alveolar ridge split technique and piezosurgery. These tips have made alveolar ridge split technique simple, safe, and effective for the treatment of horizontal and vertical bone defects. Furthermore the proposed piezosurgical split technique allows obtaining horizontal and vertical bone augmentation.

Purpose This study evaluated the opinion of different observer groups about the influence of the submental length on perceived attractiveness and when surgical correction was deemed necessary. Materials and Methods The submental length of an idealized silhouette of a white male profile was altered incrementally between 5 and 95 mm. Images were rated for attractiveness on a Likert scale by pretreatment orthognathic surgery patients (n = 75), laypersons (n = 75), and clinicians (maxillofacial surgeons and orthodontists) (n = 35). Results For perceived attractiveness, the ideal submental length was approximately 50 mm (range, 40 to 75 mm). A submental length shorter than or equal to 30 mm was deemed unattractive by all 3 groups. Overall, a submental length less than 40 mm generally was judged less attractive than a comparable increase in length. Clinicians were generally least likely to suggest surgery for varying submental lengths. For this group, the cutoff at which the majority suggested surgery was a submental length of 25 mm or less. For the patient and layperson groups, the corresponding cutoff values were a length shorter than or equal to 30 mm or equal to 95 mm. Conclusions A submental length of approximately 50 mm (range, 40 to 75 mm) was viewed by most observers as attractive. At 30 mm or less, it was generally deemed progressively less attractive. Clinicians were less likely to suggest corrective surgery than were the patient and layperson groups. For comparative proportional relationships, the submental length should be between the lower lip–chin height and lower facial height, assuming an otherwise proportional facial profile.

What is considered attractive may not fall into the "norm," and it can vary from culture to culture and depending on the historical time, for this reason the standard cephalometric and antropometric references may not be sufficient in these cases.Lately some techniques have arose to popularity that are aimed to changing the frontal and lateral aspect of the facial lower third, such as V-line or the Chin-Wing Osteotomy technique, but no reference system exists at the moment to define to which extent a modification of the lower third falls within what is considered beautiful, and everything is left to the patient's will or to the surgeon's sensitivity.The aim of this article is to study which antropometric value is considered attractive by the most for what concerns the frontal shape of the lower third of the face.Twenty-four female models were enrolled in this study and the angle taken into consideration was the one at the intersection between the 2 lines connecting the cutaneous gonial angle of each side of the face and the most external part of the chin on the same side. Measures were made on pictures in frontal view.Two hundred two random examiners were asked to see the pictures and rate them as attractive or nonattractive.Results were then paired with the angles values.Among the models the higher angle measured was 107.5° (found in 1 individual) while the lower angle was 76° (found in 1 individual), the average measure calculated was 88.3° while the median angle was 89.5°.According to the result the subjects considered more attractive were those with an angle between 84.5 and 91.5 (92 for male examiners).This could be an important starting point for studies who can evaluate attractiveness from a numerical point of view.

Background In the absence of clear guidelines for facial aesthetic surgery, most surgeons rely on expert intuitive judgement when planning aesthetic and reconstructive surgery. One of the most famous theories regarding “ideal” facial proportions is that of the golden proportion. However, there are conflicting opinions as to whether it can be used to assess facial attractiveness. The aim of this investigation was to assess facial ratios of professional black models and to compare the ratios with the golden proportion. Methods Forty photographs of male and female professional black models were collected. Observers were asked to assign a score from 1 to 10 (1 = not very attractive, 10 = very attractive). A total of 287 responses were analysed for grading behaviour according to various demographic factors by two groups of observers. The best graded photographs were compared with the least well-graded photographs to identify any differences in their facial ratios. The models’ facial ratios were calculated and compared with the golden proportion. Results Differences in grading behaviour were observed amongst the two assessment groups. Only one out of the 12 facial ratios was not significantly different from the golden proportion. Conclusions Only one facial ratio was observed to be similar to the golden proportion in professional model facial photographs. No correlation was found between facial ratios in professional black models with the golden proportion. It is proposed that an individualistic treatment for each ratio is a rather better method to guide future practice.

Pseudoaneurysms are an uncommon complication of mandibular condylar-subcondylar fractures; however, if present, their recognition and management is mandatory to avoid life-threatening situations. The authors report a case of internal maxillary artery pseudoaneurysm rupture that occurred after an open reduction and internal fixation of a mandibular subcondylar fracture, along with a review of the literature.

Riassunto Obiettivi Scopo di questo lavoro e studiare gli effetti di una struttura ergono-mica a vibrazione multifocale (MFV) sul sistema neuromuscolare e posturale in soggetti sani. Materiali e metodi 30 volontari (16 maschi e 14 femmine, di eta compresa tra 19 e 25 anni) sono stati sottoposti all'esame elettromiografico (EMG) e stabilometrico prima della seduta di risonanza propriocettiva globale mediante vibrazioni multifocali, ripetendo gli stessi esami subito dopo la MFV. Risultati Gli effetti della MFV sull'elettromiografia di superficie dei muscoli masseteri e temporali anteriori hanno evidenziato cambiamenti statisticamente significativi nei muscoli masseteri (p Conclusioni La vibrazione multifocale ha indotto modificazioni sia nei test neuromuscolari sia nei test posturali.

Background This study investigates retrospectively if the initial electromyography (EMG) status of patients who underwent orthognathic surgery correlates with the extent of postsurgical EMG functional recovery. Methods Clinical records concerning 20 patients who underwent Le Fort I and/or sagittal osteotomy of the mandibular ramus to correct skeletal dental class III malocclusions were retrieved and presurgical and postsurgical EMG data were analyzed and compared. Additionally, postsurgical EMG recovery was compared with that of a set of healthy, not surgically treated class I patients, with no sign of disorders affecting the temporomandibular joint (TMJ). Finally, the effect of six independent variables (age, sex, time from surgery, extent of segment re-positioning, malocclusion class, upper jaw repositioning) on muscular recovery was investigated by means of correlation analysis. Results A significant increase of the average EMG activity after orthognathic corrective surgery was observed (P=0.01). The postsurgical increase of EMG values showed a negative correlation trend with those collected before surgery (r=-0.38, clenching on teeth; r=-0.33, clenching on cotton rolls). None of the independent variables had any effect on the postsurgical outcome. Conclusions Orthognathic surgery improves the muscular activity of patients who present skeletal dental class III malocclusions. This improvement can be objectively assessed with EMG measurements. Patients who benefit more from orthognathic surgery seem to be those displaying the lowest presurgical EMG activity.

Objectives/Hypothesis Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and is caused by a multitude of well-studied disorders. However, the association between JIA and/or its treatment and sinonasal inflammatory disease (SNID) has never been studied. We therefore investigated this relationship to gain more insight into burdening pathologies connected to JIA. Study Design Retrospective evaluation. Methods A retrospective evaluation according to the Lund-Mackay score of cone-beam computed tomography scans (CBCT) performed in 70 children affected by JIA and compared to CBCT scans of 124 healthy controls was conducted. The prevalence of sinonasal opacification and adenoid hypertrophy in patients affected with JIA was compared with findings obtained in unaffected children. Results JIA was significantly associated with SNID (P = .030). Of patients with JIA, 18.6% had SNID, whereas in children without JIA, only 8.1% had SNID. The odds ratio values were 5.38 (95% confidence interval [CI]: 1.90-15.26) for treated and 0.92 (95% CI: 0.18-4.83) for untreated JIA. No clear difference was found depending on the duration of JIA. No association was found between adenoid hypertrophy and SNID (P = .816). Conclusions Our data suggest that JIA patients, especially when undergoing immunosuppressive therapy, should be subjected to an ear, nose, and throat evaluation. A prospective study including clinical evaluation would be of the utmost importance to provide evidence on which to base comprehensive healthcare for these patients. Level of Evidence 3b. Laryngoscope, 125:291–295, 2015

This study is a quantitative evaluation of the influence of the lower component of the nasofrontal angle on perceived attractiveness and threshold values of desire for rhinoplasty. The nasofrontal angle of an idealized silhouette male Caucasian profile image was altered incrementally between 106 and 148 degrees. Images were rated on a Likert scale by pretreatment patients (n = 75), laypeople (n = 75), and clinicians (n = 35). The results demonstrated that a nasofrontal angle of approximately 130 degrees is ideal, corresponding to a lower component of 60 degrees, with a range of 127 to 142 degrees deemed acceptable. Angles above or below this range are perceived as unattractive, and anything outside the range of 118 to 145 degrees is deemed very unattractive. Reduced nasofrontal angles, simulating a nasal hump deformity, of less than 115 degrees were deemed the least attractive. In terms of threshold values of desire for surgery, for all groups a threshold value of 148 degrees indicated a preference for surgery: for patients, the threshold value was 121 degrees or less; for lay people, the threshold value was 124 degrees or less; and similarly for clinicians, the threshold value was 118 degrees or less. Clinicians were the least critical, and patients appeared to be less critical than lay people. This stresses the importance of using patients as observers, as well as laypeople and clinicians, in facial attractiveness research. From the results of this study, it is recommended that in rhinoplasty planning, the range of normal variability of the nasofrontal angle, in terms of observer acceptance, is taken into account as well as the threshold values of desire for surgery.

The aims and purposes of this systematic review of the international literature are to discuss and clarify some considerations on Burning Mouth Syndrome (BMS). Over the last 40 years, many researchers have addressed this disease clinically or experimentally. Thus, the etiology and pathogenesis of BMS remain unclear. We analyzed the etiopathogenesis of Burning Mouth Syndrome and of the burning oral sensation and currently, we could not find a consensus on the diagnosis and classification of BMS. Further studies are required to better understand the pathogenesis of BMS, and a "Gold Standard" classification is required because not every burning sensation in the mouth is BMS.

A dolgozat célja az „égő száj szindrómával” (Burning Mouth Syndrome – BMS) kapcsolatos nemzetközi irodalom legfontosabbmegállapításainak összegzése és áttekintése. Az eltelt évtizedek alatt számos kutató gyakorlatban és elméletbenis foglalkozott ezzel a különös betegséggel. Ennek ellenére sem világos teljesen a szindróma etiológiája éspathogenezise. A szerzők az etiopathogenezissel kapcsolatos eddigi irodalmi adatokat analizálva nem találtak egyetértéstsem a BMS klasszifikációja, sem a diagnózis tekintetében. Ezért egy úgynevezett „Gold Standard” osztályozást tartanakszükségesnek a betegség jobb megértése érdekében, melynek első lépéseit megtették.

Objective The aim of this study was to combine the huge amount of information of low dose Cone Beam CT with a cephalometric simplified protocol thanks to the latest informatics aids. Lateral cephalograms are two-dimensional (2-D) radiographs that are used to represent three-dimensional (3-D) structures. Cephalograms have inherent limitations as a result of distortion, super imposition and differential magnification of the craniofacial complex. This may lead to errors of identification and reduced measurement accuracy. The advantages of CBCT over conventional CT include low radiation exposure, imaging quality improvement, potentially better access, high spatial resolution and lower cost. Materials and methods This study assessed cephalometric 2D and 3D measurements and the analysis of CBCT cephalograms of the volume and centroid of the maxilla and mandible, in 10 clinical cases. Results With a few exceptions the linear and angular cephalometric measurements obtained from CBCT and from conventional cephalograms did not differ statistically (p > 0.01). There was a correlation between the variation in the skeletal malocclusion and growth direction of the jaws, and the variation in the spatial position (x, y, z) of the centroids and their volumes (p Conclusions The 3D cephalometric analysis is easier to interpret than 2D cephalometric analysis. In contrast to those made on projective radiographies, the angular and linear measurements detected on 3D become real, moreover the fewest points to select and the automatic measurements made by the computer drastically reduced human error, for a much more reliable reproducible and repeatable diagnosis.

Lip paresthesia during mandibular molar orthodontic distalization is rare. When it occurs, it is often related to excessive dimensions of the mandibular second molar roots. In this clinical report, we describe a patient who developed lip paresthesia during orthodontic treatment. The paresthesia was relieved by immediate interruption of the forces applied to the mandibular second molars and pharmacologic therapy. Before fixed orthodontic treatment proceeds in patients with large tooth roots, it is important to diagnose the relationship between the roots and the mandibular canal to prevent nerve numbness and damage.

Background The aim of this case report was to describe the surgical–orthodontic treatment of an unerupted mandibular canine tooth in a 9-year-old girl. Case presentation A 9-year-old white girl presented with an unerupted right mandibular canine tooth. Combined surgical–orthodontic treatment was performed to correct dental impaction and to achieve good aesthetic and functional results. Conclusion Orthodontic treatment achieved all of the required objectives.

Glycogen storage disease type Ib is a rare inherited metabolic disorder that is caused by a deficiency of glucose-6-phosphate translocase with consequent accumulation of glycogen. The purpose of this study is to report a case affected by glycogen storage disease type Ib in which unusual oral findings were evident and to review the pertinent literature. The disease presents with failure to thrive, hepatomegaly, hypoglycemia, hyperlacticacidemia, neutropenia, and neutrophilic dysfunction causing increased susceptibility to recurrent infections. Common intraoral manifestations are dental caries, gingivitis, periodontal disease, delayed dental maturation and eruption, oral bleeding diathesis, and oral ulcers. Conversely, unusual oral lesions were observed in this case as hyperplastic-hypertrophic gingiva and giant cell granulomatous epulis. The treatment with granulocyte colony-stimulating factor markedly increased the neutrophil counts and reduced the frequency of infections and inflammations. Proper evaluation of the patient's oral condition, a program of preventive measures, and suitable medical consultation are important to minimize and avoid long-term complications.

Psoriatic arthritis (PA) is a chronic systemic disease that is difficult to detect. The diagnosis is made on mainly clinical grounds based on the findings of psoriasis and inflammatory arthritis of the joints. Many reports have described the damaging effects of PA on the temporomandibular joints (TMJs), but no study has clearly reported the TMJ as the first articulation to be involved in PA. This article reports a case of PA that was diagnosed several years after TMD onset because no signs besides psoriasis were present. The missed early diagnosis resulted in severe TMJ damage. The TMJ can be the first joint involved in PA. For a correct, early diagnosis of PA, collaboration between dental clinicians and rheumatologists is very important.

Temporomandibular joint (TMJ) involvement is common but usually delayed in patients with juvenile idiopathic arthritis (JIA). We describe the case of a JIA patient with bilateral TMJ involvement, mandibular retrognathia, bone erosion, and severely restricted mouth opening. The use of cone beam computed tomography and a 3D diagnostic protocol in young patients with JIA provides reliable, accurate and precise quantitative data and images of the condylar structures and their dimensional relationships. Analgesics and conventional disease modifying antirheumatic drugs were ineffective, but interdisciplinary treatment with etanercept and a Herbst functional appliance improved functional TMJ movement and bone resorption.

The aim of this study is to show the importance of Cone Beam Computerized Tomography to volumetrically quantify TMJ damage in patients with JIA, measuring condylar and mandibular real volumes. 34 children with temporomandibular involvement by Juvenile Idiopathic Arthritis were observed by Cone Beam Computerized Tomography. 4 were excluded because of several imaging noises. The mandible was isolated from others craniofacial structures; the whole mandibular volume and its components' volumes (condyle, ramus, hemibody, hemisymphysis on right side and on left side) has been calculated by a 3D volume rendering technique. The results show a highly significant statistical difference between affected side volumetric values versus normal side volumetric values above all on condyle region (P0.01), while they don't show any statistical differences between right side versus left side. The Cone Beam Computerized Tomography represents a huge improvement in understanding of the condyle and mandibular morphological changes, even in the early stages of the Juvenile Idiopathic Arthritis. The JIA can lead in children to temporomandibular joint damage with facial development and growth alterations.

Background Traditionally, maxillofacial deformities are corrected surgically after an initial orthodontic treatment phase. However in, this article, the authors emphasize the postsurgical therapeutic protocol which is extremely important for determining the final and permanent retention of the corrected occlusion. Methods A 55 year old female with severe skeletal Class II malocclusion is presented. Combined surgical and orthodontic correction of the malocclusion was used. Results : The step-by-step procedure the authors followed for the postsurgical therapy is described. The goals of the postoperative therapy were to restore and rehabilitate neuromuscular function, obtain occlusal stabilization, grind teeth selectively, and final occlusion retention. The importance of a surgical occlusal splint for rehabilitating stomatognathic neuromuscular function postoperatively was demonstrated. Furthermore, the orthodontic-prosthodontic treatment ensured occlusion stability after the surgical correction. The long-term results confirmed the efficacy of the treatment protocol presented here from both functional and aesthetical perspectives. Conclusions Postsurgical orthodontic treatment is an important step in the surgical and orthodontic therapy of maxillofacial deformities.

Psoriatic arthritis (PA) is a chronic systemic disease that is difficult to detect. The diagnosis is made on mainly clinical grounds based on the findings of psoriasis and inflammatory arthritis of the joints. Many reports have described the damaging effects of PA on the temporomandibular joints (TMJs), but no study has clearly reported the TMJ as the first articulation to be involved in PA. This article reports a case of PA that was diagnosed several years after TMD onset because no signs besides psoriasis were present. The missed early diagnosis resulted in severe TMJ damage. The TMJ can be the first joint involved in PA. For a correct, early diagnosis of PA, collaboration between dental clinicians and rheumatologists is very important.

Dental and surgical implant treatment for patients affected by ectodermal dysplasia syndrome can be very complicated. The guided bone regeneration (GBR) membrane technique together with bone grafting is used to facilitate the placement of osseointegrated implants in a prosthetically guided position. Two groups with the same bony anatomical features were assessed. The first consisted of 13 ectodermal dysplasia patients in whom 66 implants with bone grafts and membranes were inserted. In the second control group, 120 implants with GBR were placed in 20 patients. The implants were assessed at the second stage of surgery, and at a follow-up after 1, 2, and 3 years of functional loading. There was no statistically significant difference in the osseointegration rate between the two groups. Despite the anatomical defects associated with the decreased occlusal vertical dimension and the reduced edentulous alveolar ridges, both in height and width, osseointegrated implants together with GBR and bone grafts can be used successfully in patients with ectodermal dysplasia syndrome.

The question of whether or not to remove the titanium osteosynthesis plates used in maxillofacial surgery is not yet answered. These plates can be left a long time in the organism if there is no harmful interaction between the plates and the organism. The authors examined the properties of the surface oxide layers formed on osteosynthesis titanium plates by subsequent thermal and anodic oxidation, together with the properties of plates removed from patients after three years. Surface analytical method Secondary Ion Mass Spectroscopy (SIMS) was chosen. It was found that inside of the about 200-mum thick oxide on the original plates the concentration of impurities is much lower than near the oxide/titanium interface. On the surface of plates removed from the human body, a C (carbon), Ca (calcium) and P (phosphorus) enrichment was detected, suggesting a biological interaction between the organism and the plate. The passivating layer formed with thermal and anodic oxidation has not changed significantly in three years; it resisted to the corrosive effect of the human organism.

A case of mandibular fracture surgically consolidated in a wrong position resulting in craniomandibular disorders is reported. The inadequate surgical alignment of the healed bony segments caused a malocclusion. This changed the original neuromuscular system such that compensatory mechanisms began to change the whole balance of the organism. The patient presented a mandibular crossbite, an asymmetry of the face, and extensive alteration of muscular, articular, and postural function. The bony malunion and malocclusion were treated using an interdisciplinary surgical-orthodontic treatment for correcting functional disorders and aesthetic deformity. Electromyography and computerized mandibular scanning were used to evaluate improvement of the muscular activity, during rest and function, and of the mandibular kinesiology. Timing of surgical treatment and adequate fixation and immobilization of fracture segments are very important to avoid complications such as infection, delayed union, nonunion, malunion, skeletal discrepancies, nerve injury, and (rarely) ankylosis. The surgical approach should be based on the general criteria of traumatologic therapy, restoring the original bone shape and the right occlusal relations as soon as possible.