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Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A case of mandibular asymmetry is presented. It appears that in this patient the mandible was adapted to changes in the maxillary sinus area. Abnormal bone growth of unknown aetiology inside the sinus most likely caused complete remodelling in the maxillary sinuses and asymmetry of the mandible. Special tests used for detailed assessment of the patient supported the definitive diagnosis. [ABSTRACT FROM AUTHOR]

We present the unusual case of a patient who lost an orthodontic archwire after having, via manipulation, detached it from the brackets. It was only on a routine radiograph at the end of treatment that the archwire was found in the patient's nasal cavity, where it had failed to cause any symptoms! We discuss the treatment following the inhalation and ingestion of foreign bodies in orthodontics, as well as their prevention.

Ethanol treatment of immortalised human gingival keratinocytes (IHGK) yields in an epithelium-like (EPI) and fibroblast-like (FIB) phenotype. With respect to the stratified gingival epithelium, putative structural and molecular differences assigning cells to these phenotypes have not, to date, been analysed in a three-dimensional tissue/epithelial context. Therefore, we generated epithelial equivalents (EEs) in organotypic co-cultures of IHGK, EPI and FIB cells for 1 and 2 weeks and conducted protein and gene expression studies on the EEs for epithelial biomarkers including keratin K14, integrin subunits alpha6 and beta1, E-cadherin, and mesenchymal vimentin. As in the EEs of IHGK and EPI, indirect immunofluorescence revealed continuous expression of beta1 integrin in EEs of FIB cells. However, FIB cells exhibited a significant down-regulation in K14 and integrin alpha6 protein and a loss of E-cadherin at week 2, whereas vimentin was increased. FIB EEs were devoid of transcripts for E-cadherin at both time points, although transcription of the other genes remained constant in all phenotypes. Thus, the FIB phenotype exhibited a poor epithelial structure coinciding with disturbances in the expression of epithelial biomarkers and the persistence of mesenchymal vimentin. Transcription analysis revealed post-transcriptional regulation of vimentin in IHGK and EPI and of K14 and alpha6 in FIB cells. Our findings indicate that differences in the epithelial integrity and expression of molecules in EEs allow for the discrimination of EPI and FIB cells. This suggests that FIB cells share features of epithelial-mesenchymal transition and reflect a more progressive stage in epithelial cell transformation.

Objective: To give detailed insight into the space conditions and prevalence of spacing and crowding in schoolchildren at nine years of age. The reliability and validity of screening methods was also assessed., Design: Epidemiological survey., Setting: South-western part of Germany (Rhein-Neckar-Kreis); elementary schools in a region with a low orthodontic care rate., Sample and Methods: 494 nine-year-old German schoolchildren (237 males, 257 females, median age 9 years) were examined orthodontically in cooperation with the local community dentistry service. A special measurement ruler was developed to enhance validity and reliability of space measurements on location in the schools., Results and Conclusions: Concerning space conditions in the incisor segments: in the maxilla the variety encountered comprised both space excess and moderate to severe crowding. This was considerably larger in the maxilla than in the mandible. Severe crowding (> 5 mm) was found more often in the maxilla than in the mandible and affected around 2-3% of the maxillary dentitions. Also severe contact point displacements (IOTN Grade 4) were mainly restricted to the maxilla (prevalence approximately 3%). In the canine-premolar segments, the arch segments in males were in general around 0.5 mm larger than among the females, also within each dental stage. In general, the maxilla was more often affected by posterior crowding than the mandible. Anterior crowding seemed to be more prevalent than posterior crowding. With respect to the screening methods used in the present study, reliable and valid measurements were also found to be possible in schools. This may open up further opportunities for orthodontic screening by community dentistry services or similar organizations.

Objective: Having established the importance of compliance as a significant factor of a successful orthodontic treatment, the aim of the present study was to evaluate intrapersonal and interpersonal factors which could help predict patient compliance., Methods: The attributional style of 58 patients was assessed by a standardised questionnaire. An individual questionnaire was designed to determine attitudes concerning orthodontic treatment, the doctor-patient relationship, the wearing behaviour and control behaviour. The questionnaire was answered by the patient and by the orthodontist. The compliance was evaluated by the orthodontist on the basis of commonly used indicators for compliance: wearing time, oral hygiene and reliability of keeping the appointments., Results: The results showed a significant correlation between the compliance and the attributional style of the patients in positive situations, but not between the compliance and the wearing behaviour estimated by the patient. The interpersonal comparison revealed a lack of knowledge on the part of the orthodontist about the patients' daily activities and their ability to correctly wear their appliances., Conclusion: The questionnaire answers show compliance to be a subjective construct of the orthodontist demonstrating mostly social-emotional matters. There is no consistency with compliance and the patients' statement concerning their wearing behaviour but with a positive attitude on the part of the patients demonstrating independent responsibility.

Background: Velopharyngeal dysfunction (VPD) is generally known to be difficult to influence. Dysfunctional velopharyngeal motor patterns during speech were analyzed with the aim of optimizing the therapeutic strategies., Methods: Velopharyngeal dysfunctions were videotaped and contextually analyzed during 89 speech sequences in 25 patients. Distinctive features of the motor patterns formed the basis of categorization by three therapists experienced in nasopharyngoscopy. There was a high inter-rater reliability of 94%., Results: A total of four different function profiles were found: 1. VPD with retracted articulatory placement (compensatory articulation) (38%), 2. VPD with motor coordination problems characterized by mistiming of VP movements and voice onset/offset (15%), 3. VPD with verbal dyspraxia characterized by a silent positioning of VP closure before phonation started and a malregulation of muscle tonus (10%) and 4. phoneme-specific VPD (37%)., Conclusion: Specific knowledge regarding the characteristics of dysfunctional speech motor patterns enables specifically tailored therapy.

The following cases describe three sisters with anterior open bite (overbite between 0 and -4.5 mm) coinciding with vertical growth pattern. All patients showed tongue thrusting and tongue-tip protrusion. They underwent functional appliance and fixed straight-wire appliance therapy primarily. Bite closure was effected by premolar extraction. Orthodontic treatment was supported by speech therapy. All cases resulted in a stable Class I molar relationship with an overbite of 2 mm. The results remained stable 6-8 years after the end of treatment. Speech and tongue function were physiological.

There is growing evidence that apoptosis involves the nuclear transcription factor NF-kappaB in conjunction with related genes. However, in the context of mechanical orthodontic forces, force-sensing target genes assigned to pathways of NF-kappaB and apoptosis have not been fully characterised. To contribute to the identification of putative target genes, we used cDNA arrays specific for NF-kappaB and apoptotic pathways and analysed elevated gene expression in primary human periodontal ligament fibroblasts (PDL-F) after a 6 h application of mechanical force. Among several identified genes (including several caspases), interleukin-1 beta (IL-1 beta) and NF-kappaB displayed significantly higher expression on the NF-kappaB array, whereas higher expression was obtained for BCL2-antagonist of cell death (BAD), member 6 of the TNF-receptor superfamily (FAS) and CASP2 and RIPK1 domain-containing adaptor with death domain (CRADD) on the apoptosis array. Based on a defined cut-off level of a more than 1.5-fold higher expression, this significance in elevated gene expression was corroborated by reverse transcription/polymerase chain reaction (RT-PCR). Here, semi-quantitative (sq) PCR revealed a more pronounced elevation of mRNA gene expression in PDL-F after 6 h of stretch, when compared with 12 h. Moreover, the elevation after 6 h as observed by sq-PCR was convergent with quantitative PCR (q-PCR). q-PCR yielded levels of 5.8-fold higher relative gene expression for IL-1 beta and 1.7-fold for NF-kappaB, whereas that computed for BAD indicated a 5.2-fold, for CRADD a 2.1-fold and for FAS a 2.0-fold higher expression. The data obtained from the expression analysis thus indicate a stretch-induced transcriptional elevation of genes assigned to the NF-kappaB and apoptotic pathways. This elevation may render them target candidates for being addressed by mechanical orthodontic forces.

We employed topographical patterning to analyze early keratinocyte differentiation on top of microfabricated pillar arrays. Fibronectin immobilized on pillar "heads" yielded a nucleus-associated granular keratin 1 (K1) pattern in immortalized human gingival keratinocytes (IHGK) at pillar interspaces of 14 mum. Decreasing distances of 11and 8 mum revealed cytoplasmic extension of the early differentiation marker K1 on poly(dimethylsiloxane) (PDMS) pillars. The most extensive cytoplasmic K1 protein distribution noted at the smallest pillar scale coincided with higher ratios of K1 mRNA gene transcription. These experiments suggest that early keratinocyte differentiation was governed by the topographical characteristics of the pillar pattern. Moreover, they form the basis to study cell functions such as differentiation in a defined topologically structured environment.

We report here that the organotypic co-culture (OCC) system allows for significant preservation of the tissue-specific phenotype of human gingival keratinocytes (IHGK) immortalized with the E6/E7 gene of the human papillomavirus type 16 (HPV16). The approach adopted is based on the OCC system facilitating spatially separated cell growth and cell-to-cell interactions via diffusible growth factors. Generally, IHGK reveal transcription of the HPV16 E6/E7 gene at rising passages. Fluorescence in situ hybridization performed for chromosomes 1, 8, 10, and 18 demonstrates that disomic fractions differ between the tested chromosomes but otherwise remain fairly constant. Monosomies of chromosome 18 are more prominent in late passages 81 and 83, while polysomies of chromosome 10 and 18 are detected in early passages 25 and 27. In comparison with corresponding monolayer cultures (MCs), IHGK in OCCs form stratified epithelia, proliferate, and express gingival-specific gene products in vitro. Moreover, mRNA gene transcription for growth factors interleukin 1beta, granulocyte-macrophage colony stimulating factor, fibroblast growth factor 7, and EGF in OCCs is different from that in MCs. When grafted onto nude mice, IHGK develop hyperplastic, differentiated surface epithelia devoid of malignant growth. We are not aware of any other OCC system comprising of IHGK, which allows for site-specific expression of gingival epithelial markers. This substantiates reconstitution of a gingival epithelial phenotype in vitro.

The aim of the study was to assess age-related changes in sagittal jaw relationship during pre-pubertal and pubertal development on the basis of angular [ANB, anteroposterior dysplasia indicator (APDI) and A-B plane angle] and linear (Wits, AF-BF, App-Bpp, and App-Pgpp) measurements. Lateral cephalograms of orthodontically untreated subjects were evaluated at 7, 9, 11, 13 and 15 years of age. Cephalometric standards and age-related changes were determined on the basis of Class I subjects with a good occlusion (n = 18, 10 males and 8 females). With respect to changes related to growth, the main findings were, in both genders, a statistically significant age-related decrease in ANB angle, App-Bpp and App-Pgpp, a significant increase in APDI, but no age-related change in Wits. A reduction of sagittal jaw distance during pre-pubertal and pubertal development was observed arising from a relative dominance of sagittal mandibular growth. For an evaluation of differences concerning jaw relationship in Class II subjects, a group with Class II division 1 malocclusions (n = 17) and a group with Class II division 2 malocclusions (n = 12 were compared with two control groups, i.e. the good occlusion group and a Class I group (n = 37). Conclusions about the sagittal discrepancy in Class II division 1 and Class II division 2 subjects depended on the geometric reference used in the various parameters, and further research is called for with respect to the diagnostic performance of the various measurements. Differences between Class II subjects and controls present at 15 years of age were already established at 7 years of age, but were less pronounced.

Objective: To evaluate the immediate, long-term, and carry-over effects of nasopharyngoscopic biofeedback therapy in patients with cleft palate who exhibit velopharyngeal dysfunction (VPD)., Design: Pre- versus posttreatment and follow-up comparisons., Setting: Cleft palate center of the Heidelberg University Hospital, Heidelberg, Germany., Subjects: Eleven patients with VPD who had received conventional speech therapy without showing significant improvement., Interventions: A four-stage feedback procedure. The patients watched and evaluated their velopharyngeal (VP) valving during speech by an endoscopic image displayed on a video monitor. Two feedback sessions took place for every target sound., Main Outcome Measures: Mean occurrence of VP closure during speech sound production on different linguistic levels. Patients' self-perception was assessed by a questionnaire and speech diary., Results: Significant improvement and stability of VP closure was noted. Mean occurrence of VP closure was 5% before therapy, 91% after two biofeedback sessions, and 86% in the follow-up after 6 months. Velopharyngeal dysfunction associated with compensatory articulation proved to be equally well trained as VPD on sounds with good articulatory placement. No significant difference was observed in the degree of improvement between phoneme-specific VPD and generalized VPD. The transfer to the level of words and sentences was successful and showed significant stability. The stability of VP closure for vowels was less than the stability for fricatives and stop sounds. Patients gained improved auditory and kinesthetic self-perception of their articulation., Conclusions: Nasopharyngoscopic biofeedback therapy proves to be a quick and effective method to change VPD. It shows stable results and carry-over effects.

Background: Report of a combined periodontal and orthodontic treatment in a patient with Papillon-Lefevre Syndrome (PLS)., Methods: A patient with PLS was treated orthodontically 26 months after the start of a combined mechanical and antibiotic therapy. Clinical periodontal parameters were obtained 26 (t1), 60 (t2), and 79 (t3) months after anti-infective therapy. The deepest site of each tooth was sampled for microbiological analysis at 26 and 60 months. Periodontal maintenance therapy was provided every 6 weeks. After a stable periodontal situation was achieved, orthodontic treatment, consisting of space opening for the upper canines with a multibracket appliance and coil springs, was carried out. In the lower jaw, crowding was resolved by an orthodontic mesialization of the canines., Results: Twenty-six months (t1) after the beginning of the combined mechanical and antibiotic therapy, 6% of the sites exhibited 4 mm probing depth (PD) with bleeding on probing (BOP) or PD > or =5 mm. Sixty months (t2) after therapy the number of sites with 4 mm PD with BOP or PD > or =5 mm had increased to 17%, and 79 months after therapy (t3) 13% of all sites were similarly affected. From 26 to 60 months, a slight mean clinical attachment level (CAL) gain was observed, whereas the mean PD increased. From 60 to 79 months, there was a mean PD reduction. However, a significant mean attachment loss was also noted. After 26 months (t1), RNA probes failed to detect A. actinomycetemcomitans, P. gingivalis, or T. forsythensis from any site. Thirty-four months later (t2), subgingival recolonization was observed. A. actinomycetemcomitans was detected by RNA probes at three sites. At 26 and 60 months (t1, t2), trypticase-soy with serum, bacitracin, and vancomycin (TSBV) culture failed to detect A. actinomycetemcomitans at any of the sampled sites. Eighty-two months after the beginning of therapy (t4), none of the applied methods could detect A. actinomycetemcomitans from the pooled samples from the deepest pockets of each quadrant or the oral mucosa. In the present case, concomitant orthodontic treatment with a fixed appliance could be performed without further pronounced periodontal deterioration. Space for eruption of the canines and premolars was created, in addition to an alignment of the teeth., Conclusion: After a successful combined mechanical and antibiotic periodontal therapy of the PLS periodontitis, moderate orthodontic tooth movements may be possible within a complex interdisciplinary treatment regimen.

Objective: The purpose of this study was to improve the psychological care of young patients with cleft lip and palate by gaining insight into those problematic areas in which social conflicts arise and coping-strategies become necessary for the patients., Methods: The procedure included semi-standardized interviews with 20 patients aged between 12 - 17 and their mothers. Every interview was recorded on tape, transcribed, analyzed contextually and categorized., Results: Four areas of main problems showed up: the time of surgery, the experience of being rejected or teased by peers, remaining visible defects and how to integrate them into self-percept, the problems of the siblings. The mothers showed more pessimistic perceptions regarding the coping strategies of their children and the helpful role of parental support. Consequences for individual support and family therapy are derived.

Aim: The aim of the present study was to evaluate the sagittal and vertical development of the jaws in Class II, Division 1 (II/1) and Class II, Division 2 (II/2) malocclusions. In addition, facial morphology was to be investigated in probands with these malocclusions., Probands and Methods: Maxillary and mandibular development was investigated with reference to lateral cephalograms of orthodontically untreated probands from the Belfast Growth Study at 7, 9, 11, 13 and 15 years of age. Moreover, development of facial width was assessed from the associated posteroanterior cephalograms, with radiographic magnifications being corrected in both the lateral and the posteroanterior cephalograms. A Class II/1 group (n = 17) and a Class II/2 group (n = 12) were compared with two control groups: a group with good occlusion (n = 18) and a Class I group (n = 37)., Results and Conclusions: With respect to the sagittal position of the maxilla, no significant differences between the Class II groups and the controls were found. In the Class II/1 group, mandibular retrognathism was observed. The posterior position of the mandible present at 15 years of age had been present even at 7 years of age, and growth increments in the Class I and Class II/1 subjects were similar. In the Class II/2 groups no uniform pattern with respect to mandibular position was found. With respect to vertical development, a deficit in lower anterior facial height was found in the Class II/2 groups. In addition, between 7 and 15 years of age, growth increments in lower anterior facial height were significantly smaller in the Class II/2 subjects than in the controls. Furthermore, the Class II/2 groups displayed a more euryprosopic facial form on average. The cause of this characteristic facial morphology was the vertical deficit in lower anterior facial height. Overall, however, the broad variability and the small sample sizes, in particular of the Class II/2 groups, in the present study have to be seen as limitations.

Objective: To analyze changes in the facial, maxillary, and mandibular skeleton in the vertical, sagittal, and transverse dimensions during an orthodontically relevant period of dentofacial development (i.e., between 7 and 15 years of age)., Subjects and Method: This longitudinal study comprised posteroanterior (PA) and lateral cephalograms at 7, 9, 11, 13, and 15 years of 18 untreated Class I subjects with good occlusion. Transverse growth (width) was analyzed on the basis of PA cephalograms and sagittal (depth) and vertical (height) growth by means of lateral cephalograms. For each linear measurement, mean percentage increases were calculated relative to the size at 7 years of age., Results and Conclusions: Between 7 and 15 years of age, in the whole facial skeleton and the maxilla, percentage increases were most pronounced in the vertical dimension when compared with the sagittal and transverse dimensions. In the mandible, the largest percentage increases were found in both sexes for vertical growth of the ramus, followed by sagittal growth (body length) and then mandibular width. In the sagittal dimension, development was more pronounced in the mandible (at pogonion more than at B point) than in the maxilla (A point). With respect to vertical growth, percentage increases in posterior face height exceeded the increases in anterior face height. When facial shape changes were analyzed between 7 and 15 years of age in both sexes, the ratio facial height/facial width increased and the ratio facial depth/ facial height decreased, which points toward an age-related increasing influence of vertical development.

Background and Aim: Besides prosthetic and indirect, laboratory-produced restorations, the focus of dental therapy is increasingly on restorative measures and direct restorations as minimally invasive treatment concepts. Thus, the use of direct composite restorations with modern restorative materials for the shaping and recontouring of teeth in combination with orthodontic treatment offers a diversified, extensive sphere of application. The aim of the study was to demonstrate applications for direct composite restorations with reference to selected cases., Material and Methods: The composites used were hybrid composites, which offer increased abrasion resistance and color stability and are applied incrementally. Special attention was paid to the shape, color and structure of the tooth., Case Reports: The case reports present patients in whom relatively narrow or peg-shaped teeth were built up with composite to correct various tooth size discrepancies or cuspids were recontoured by means of direct composite restorations following orthodontic space closure in cases with missing lateral incisors. Similarly, space closure was achieved using orthodontically repositioned lateral incisors recontoured to resemble central incisors after traumatic loss of upper central incisors. Finally, direct composite restorations were used for retention following completion of orthodontic treatment., Conclusions: Observations over recent years confirm the stability of composites in both form and color, as well as their ability to maintain gingival health. Our case reports demonstrate that, subject to a corresponding indication, recontouring single teeth using direct composite restorations can optimize orthodontic treatment results.

The aim of this study was to identify the transverse growth pattern of the craniofacial skeleton and dentition from 7 to 15 years of age. The database for this longitudinal study comprised the postero-anterior (PA) cephalograms and dental casts at 7, 9, 11, 13 and 15 years of age of 18 untreated Class I subjects with good occlusion from the Belfast Growth Study. Differential magnification of the PA cephalograms was corrected using the method of similar triangles. Most of the craniofacial widths were larger in males than in females. At 15 years of age, the gender differences in craniofacial widths were more pronounced than at 7 years of age. The majority of the skeletal dimensions showed a progressive increase in width. In contrast, there was a deceleration in the increase in maxillary and mandibular intermolar widths after 11 years of age in males and even a slight decrease in the intermolar width beyond 11 years of age in females. Growth curves were calculated where the values of the respective variables were expressed in terms of percentage of attainment at 7, 9, 11 and 13 years of age when compared with 15 years of age. For mid-facial, bizygomatic and skeletal maxillo-mandibular widths, percentile attainments in the range of 84-91 per cent indicated a greater remaining growth potential at 7 years of age than for the cranial width where growth was almost complete. By the age of 7 years, over 95 per cent of the growth in the intermolar width had occurred.

By using raft cultures of the polyclonal HaCaT cell lines stably transfected either with E5 (HaCaT/E5) or the empty vector (HaCaT/pMSG) as reference, we investigated the effect of the human papillomavirus type 16 (HPV-16) E5 protein on apoptosis. In comparison to conventional monolayer cultures this model system allows analysis of apoptosis under more tissue-like conditions by mimicking the stratified organization of a normal surface epithelium. Apoptosis was triggered either by FasL or TRAIL. Execution of the death program was checked at early and late stages by monitoring procaspase-3 cleavage and DNA fragmentation, respectively. Rafts of E5-expressing keratinocytes were completely protected from apoptosis and showed a background of apoptotic cells as low as the untreated cultures. In contrast, the HaCaT/pMSG cultures revealed a dramatic increase in apoptotic cells upon ligand treatment throughout the epithelial compartment. We conclude that the presence of the HPV-16 E5 protein in our tissue-like model prevents FasL- or TRAIL-mediated apoptosis., (Copyright 2004 S. Karger AG, Basel)

The aim of the study was to analyze the transverse morphology and development of the dental arches and skeletal mandibular-maxillary bases in untreated Class II malocclusions. Using the records of the Belfast Growth Study, a Class II division 1 group (II/1) and a Class II division 2 group (II/2) were compared with a Class I group and a control group with good occlusion. On posteroanterior cephalograms, maxillary skeletal base width and bigonial and biantegonial widths were determined at two-year intervals between seven and 15 years. Maxillary and mandibular intermolar widths were measured on the associated study casts. As a result, maxillary skeletal base widths were smallest in the Class II/1 subjects. No statistically significant differences were found among the groups for the skeletal mandibular widths. With respect to the development of the dental arches, maxillary intermolar widths were smaller in the Class II/1 group than in the Class I and the good-occlusion groups. These group differences were present for the total period of observation, ie, seven to 15 years, and statistically significant at most ages. When the relative difference between the maxillary and the mandibular intermolar widths was examined, the Class II/1 cases were found to have the largest average difference (about -2.5 mm for boys and -1.5 mm for girls), indicating a relatively narrow maxillary arch. Less pronounced molar differences were found in the Class II/2 group. In the Class II/1 subjects the deviations in molar differences observed at 15 years of age were established already at 7 years of age and maintained during 7 and 15 years of age.

Objective: The objectives of the present study were: (1) to analyze the cry features of infants with cleft lip and palate (UCLP) by means of spectral analysis, (2) to describe changes of the acoustic parameters from birth until 9 months of age, and (3) to compare these data with existing cry data of infants without cleft (control group)., Design: The study was designed on a interdisciplinary, prospective, and longitudinal basis., Setting: Interdisciplinary study: (1) Institute of Anthropology at the Humboldt-University, Berlin; (2) Heidelberg University Hospital: Interdisciplinary Cleft Palate and Craniofacial Center., Patients and Method: The cry parameters of five patients with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were analyzed from birth to 9 months of age. The patients were treated with the same protocol. At the age of 24 months, sensomotor development was assessed using the KIPHARD test. Perceptual judgment of speech, performed after 36 months of life, included nasal resonance, nasal emission of air, articulation disorders, and speech intelligibility., Main Outcome Measure: The cry parameters of fundamental frequency (F(0)), pitch period perturbation quotient (PPQ), and cry duration (Tsam) were analyzed., Results: Contrary to the expectation that laryngeal parameters are not affected by vocal tract malformations, differences of cry parameters were found between the patients with UCLP and the non-cleft group. Particularly, the F(0) and its short-time variability (PPQ) were affected., Conclusions: The preliminary results of this study showed that F(0) and PPQ of spontaneous cries are influenced in patients with UCLP, and a cry analysis might become a noninvasive tool for early detection of an at-risk status for neuromuscular development and prediction of an at-risk status for later speech and language acquisition in infants with cleft lip and palate. Future research strategies are outlined.

Objective: An approach based on Euclidean distances between cephalometric landmarks is presented (1) to visualize and localize the individual shape changes of the complex craniofacial skeleton during growth and (2) to depict the individual dynamic behavior of developmental size and shape changes., Patients and Method: Growth-related craniofacial changes were investigated exemplarily for two male orthodontically untreated subjects from the Belfast Growth Study on the basis of lateral cephalograms at 7, 9, 11, 13, and 15 years. The interlandmark distances among seven skeletal cephalometric landmarks served as a database for the study. A modified Karhunen-Loève decomposition based on orthogonal modes and time-dependent scalar amplitudes was used to describe the growth process. The individual shape changes of the various craniofacial regions were visualized by allocation of colors to the respective distances, and overdrawn representations were reconstructed by means of multidimensional scaling., Results and Conclusions: This visualization technique allows anatomical regions to be characterized with respect to reduced or strengthened growth, compared with pure size changes. The clinically relevant mechanisms of craniofacial changes are visualized (e.g., shifts in the anteroposterior or vertical dimensions of the jaws in relation to cranial base and structural imbalances during development). In addition, overdrawing the effects of shape change on the skeletal structures gives a more readily comprehensible impression of the growth process. Taking account of the methodical limitations of this approach (e.g., the restrictions concerning the number of landmarks), the clinician may take advantage of this technique in orthodontic or surgical diagnostics to gain additional insight into the individual complex size and shape changes during development along with their dynamic behavior.

The aim of the present study was to investigate putative relationships between different malocclusions such as Class III and Class II division 1, and congenital tooth anomalies. Two-hundred Class III and 215 Class II division 1 patients were examined for the presence of any of the following congenital tooth anomalies: maxillary incisor hypodontia, maxillary canine impaction, transpositions, supernumerary teeth, and tooth agenesis. Their occurrence rates were then calculated as a percentage of the total sample and were compared for statistical differences. The results revealed no statistical difference (P > 0.05) in the occurrence rates of upper lateral incisor agenesis, peg-shaped laterals, impacted canines, or supernumerary teeth between the Class III and the Class II division 1 malocclusions. When the occurrence rate of all congenital tooth anomalies was compared between the two malocclusions, Class III subjects showed significantly higher rates (P < 0.05). Comparison with published surveys on general populations showed similar occurrence rates. It can be concluded that subjects with Class III and Class II division 1 malocclusions show patterns of congenital tooth anomalies similar to those observed in the general population. Congenital tooth anomalies may represent another criterion for the study of malocclusion, with respect to their origin and development.

The generic term median facial dysplasia (MFD) describes a subgroup of patients with cleft lip and palate exhibiting characteristic craniofacial defects: (1) short prolabium, (2) absence of frenulum labii, (3) hypoplasia of premaxilla, (4) absent upper central and lateral incisors of the cleft side, and (5) deficient septal cartilage and nasal spine. Gross brain malformations are usually absent in MFD. The same craniofacial malformations are also described in patients with holoprosencephaly sequence (HPE-S). We report on two male patients with bilateral cleft lip and palate showing the facial findings of MFD or HPE-S. Additional congenital malformations were anal atresia in one patient and severe cardiac defect in the other. In both, HPE was excluded by brain imaging, although uncommon brain anomalies were detected consisting of multiple white-matter lesions in the one patient and unusual enlargement and tortuosity of intracerebral blood vessels in both patients. In addition to facial anomalies, the patients also had psychiatric problems typically seen in velo-cardio-facial syndrome (VCFS). Fluorescence in situ hybridization (FISH) analysis confirmed a 22q11.2 microdeletion in both., (Copyright 2001 Wiley-Liss, Inc.)

It has been shown that the E5 protein of the human papillomavirus type 16 modulates epidermal growth factor receptor downregulation in monolayer cultures of human keratinocytes and mouse fibroblasts. We have now analysed the effect of this protein on the expression, the distribution and the activation of EGF receptors in raft cultures derived from an E5-transfected human keratinocyte cell line. The epithelia generated in these cultures were stratified and exhibited suprabasal expression of cytokeratins 1 and 10, which are known markers of early epidermal differentiation. In situ hybridization with an antisense riboprobe to the human papilloma virus type 16 E5 protein revealed a homogeneous gene expression within the entire epithelium of E5-transfected but not empty vector-transfected control cultures. Treatment of serum-starved rafts with EGF for 48 hours led to a strong decrease of suprabasal EGF receptors in control cultures, but not in rafts of E5-expressing cells. Under these conditions, no activated receptors were observed in control cultures, but activated receptors were still present in E5-raft cultures. Our results indicate that human papilloma virus type 16 E5-mediated modulation of EGF receptor expression occurs in a time- and structure-dependent manner in epithelial equivalents of human keratinocytes.

Whilst a patient is undergoing orthodontic treatment, dental appliances based on non-precious metals or titanium remain in the oral cavity for up to several years. Throughout this period the appliance is in either direct or indirect contact with the oral mucosa. To investigate the possibility of cell damage occurring as a result of appliance corrosion, monolayer cultures of immortalized human gingival keratinocytes were assessed for acute cyto- and genotoxicity using the hexosaminidase assay and the Comet assay respectively. The materials tested included 1. a nickel-free wire, 2. a UK-1 bond, 3. nickel-free as well as nickel-containing brackets with and without color signature and 4. a titanium expansion screw. Each of the test materials was corroded in a solution consisting of equal amounts of lactic acid and sodium chloride (0.1 M) for 1, 3, 7 and 14 days. The cell cultures were then exposed to eluates exhibiting the highest ion concentrations. None of the eluates was found to exhibit acute cytotoxicity, regardless of the type of test system used. Qualitative assessment using neutral red dye for live cells and either trypan blue or propidium iodide to disclose dead cells failed to reveal any significant increase in cell damage when exposed cells were compared to control cultures. Unrestricted cell vitality was confirmed by quantifying viable cells through measurement of hexosaminidase enzyme activity. Furthermore, assessment of genotoxicity revealed no apparent DNA damage to immortalized gingival keratinocytes following exposure to the test eluates. Because the materials tested in this study were corroded using the exacting methods normally applied to precious metals or gold-containing alloys, the lack of either acute cyto- or genotoxic effects following exposure to the test eluates indicates that the materials tested exert no adverse effects on cells similar to those of the target tissue exposed to the materials in situ.

Objective: The objectives of the present study were (1) to investigate whether growth increments until 6 months of age are influenced by particular factors, (2) to analyze whether anterior cleft reduction is dependent on the extent of the cleft width at birth, and (3) to examine the correlation between maxillary measurements at birth and the anterior cleft width at 6 months of age., Design: The study design was prospective and longitudinal., Setting: Heidelberg University Hospital Interdisciplinary Cleft/Craniofacial Center., Patients and Method: The longitudinal records of 34 patients (24 male and 10 female) with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were included in this study. All patients were treated with the same protocol. All participants were assessed at 0 and 6 months of age. Maxillary plaster casts of the patients were analyzed using a computer-controlled three-dimensional digitizing system., Main Outcome Measure: Maxillary models were measured and compared to putative factors influencing growth., Results: No statistically significant differences were found between maxillary growth changes and increases in weight and length. Similarly, there was no significant interaction between the extent of the alveolar cleft width at birth and its reduction prior to lip closure. In contrast, significant differences of maxillary growth increments could be found between male and female patients. Stepwise regression analysis demonstrated a correlation between maxillary measurements at birth and growth increments., Conclusion: The results of the study indicate that gender plays a certain role in growth changes within the first 6 months of age.

In the context of orthodontic treatment planning, the decisions to be made are often affected by the assumption of future growth patterns, especially the direction of mandibular rotation. Using longitudinally available lateral cephalograms from the Belfast Growth Study, it was examined whether, on the basis of the cephalometric variables at the ages of 7, 9 and 11, the direction of mandibular rotation can be predicted in the respective subsequent 4-year intervals. For statistical analysis of this problem, logistic regression models were applied to describe and quantify the influence of potential explanatory variables on the direction of mandibular rotation (dependent variable). In addition, graphical methods taken from the field of medical diagnostics were applied for prediction and for determination of predictive accuracy. The use of logistic regression models revealed no relations between the explanatory variables SN-MeGo and S-Go/N-Me and the subsequent mandibular growth pattern. Only the upper and lower parts of the gonial angle showed a minor predictive impact. A graphical evaluation of their prognostic impact by means of "receiver operating characteristics" (ROC) curves, complemented by determination of the areas under the curves, confirmed the relations discovered. Nevertheless the prognostic limits of the lateral cephalogram emerged clearly for all variables investigated.

Fibroblasts isolated from human periodontal ligament (PDL) were cultured under a medium supplemented with ascorbic acid, beta-glycerophosphate and dexamethasone. The cultures were assessed for their ability to elaborate a mineralized matrix. Cell cultures stained positive when analyzed for alkaline phosphatase activity throughout the culture period. After about 3 weeks in culture, the cells produced a calcified matrix. Light microscopy showed formation of clusters of different shapes and sizes. Von Kossa staining revealed mineral deposits as amorphous brown-black precipitates. Transmission electron microscopy showed cells in multilayers and mineralized formations in close association with a dense network of collagen fibers. Scanning electron microscopy revealed smooth formations rising over the cultures with an abundant fiber matrix. We conclude that human PDL fibroblasts can be induced to form a mineralized matrix which shares features with bone mineralized matrix but most likely represents a more immature type of in vitro mineralization. Moreover, the present study further supports the osteoblastic potential of these cells.

The aim of this study was to analyze the dynamic development of Class II, Division 2 malocclusion with reference to the untreated patients from the Belfast Growth Study. As a second step, the influences of premolar extraction in all 4 quadrants and of maxillary second molar extraction in the upper jaw in Class II/2 patients were examined, focusing on the cephalometric variables in comparison to those of the untreated patients from the Belfast study. The longitudinal cephalometric values of 20 patients in each group were compared. In addition, the possibility of third molar eruption was evaluated in the extraction patients from the panoramic radiographs. The overbite based on study models at the beginning and end of treatment was calculated. Furthermore, renewed spacing after premolar extraction was assessed. The results derived from cephalometric analysis demonstrated that profile flattening was also observed in untreated Class II/2 patients during the growth period. Comparison of these data with those obtained from the extraction groups revealed a significantly marked recession of the upper lip after premolar extraction. In contrast, only slightly increased flattening after maxillary second molar extraction was observed compared with the untreated patients of the control group. Whereas the interincisal angle was reduced to a value approximating that of untreated Class I patients after maxillary second molar extraction, only a small decrease was recorded after premolar extraction. From our point of view, the claim that premolar extraction facilitates third molar eruption should be seen in an extremely critical light and should not contribute to the decision in favor of extraction. In addition, there is a problem of renewed spacing in the extraction area after premolar extraction.

Planning of treatment in the field of orthodontics and maxillo-facial surgery is largely dependent on the individual growth of a patient. In the present work, the growth of 43 orthodontically untreated children was analysed by means of lateral cephalograms taken at the ages of 7 and 15. For the description of craniofacial skeletal changes, the concept of tensor analysis and related methods have been applied. Thus the geometric and analytical shortcomings of conventional cephalometric methods have been avoided. Through the use of an artificial neural network, namely self-organizing neural maps, the resultant growth data were classified and the relationships of the various growth patterns were monitored. As a result of self-organization, the 43 children were topologically ordered on the emerging map according to their craniofacial size and shape changes during growth. As a new patient can be allocated on the map, this type of network provides a frame of reference for classifying and analysing previously unknown cases with respect to their growth pattern. If landmarks are used for the determination of growth, the morphometric methods applied as well as the subsequent visualization of the growth data by means of neural networks can be employed for the analysis and classification of growth-related skeletal changes in general.

Objective: Oblique facial clefts are extremely rare. In view of their variability, surgical treatment cannot be standardized. To date, early maxillary orthopedics in the treatment of oblique facial clefts have not been reported. The case described here presents a newborn child with a Tessier 3 cleft. Because of the enormous width of the alveolar cleft, a narrowing of the segments was regarded as prerequisite for definitive lip closure. To bring the segments together, an actively working plate with a forward pull was designed., Conclusion: After a period of 4 weeks, proper alignment and proximity of the segments were achieved, so that definitive lip closure and plastic reconstruction of the remaining soft tissue defect could be easier performed.

The purpose of this study was to examine, on pre-treatment and post-treatment lateral cephalograms, the effects of combined activator/chin-cup therapy on Class III patients, and to compare mean cephalometric differences noted during treatment with untreated Class I subjects. Fourteen females and fifteen males who exhibited a Class III malocclusion were the subjects of the study. Direct comparison of the mean value changes of the cephalometric variables during treatment of Class III patients with untreated Class I subjects revealed that SNA increased more and SNB increased less in the Class III patients than in the control group, thus improving the ANB angle. At the end of treatment, all patients had a positive overjet but a more concave profile. In this study, combined activator/chin-cup therapy seemed to induce improvement in those Class III patients selected for their moderate condition and treated over a five-year period. The changes seemed to indicate growth patterns which imitate those of the untreated Class I subjects. Moreover, dentoalveolar compensations helped to improve the overjet and conceal skeletal deviations.

In orthodontics, removable acrylic appliances are preferably produced from methylmetacrylates. However, in the adjacent oral mucosal tissue, cell damage may be caused by the evaporation of residual monomer. The aim of this study was to modify the classic agar overlay assay in order to apply histochemical methods by comparing conventionally used transformed mouse fibroblasts (L-929) with primary human gingival fibroblasts to further elucidate the term toxicity. While proliferation was assessed via the incorporation of the base analogon bromdesoxyuridine, differentiation was investigated by detection of the fibroblast-specific intermediate filament vimentin. After the monomers had taken effect, reduced proliferation extending over the inhibition area was observed by indirect immunofluorescence, independent of cell type. In contrast to this observation, a few cells within the inhibition area which could not be clearly detected by neutral red staining still exhibited mitotic activity. Detection of the differentiation-specific intermediate filament vimentin was comparable with the degree of neutral red fading visible in the classic agar overlay assay. The study showed that the inhibition areas with primary gingival fibroblasts were smaller (approximately 1/3) after monomer action compared with conventionally applied transformed fibroblasts. The results indicate that the modified assay is comparable with the classic method. Evaluation of neutral red staining with respect to toxic material influence can moreover be supplemented by histochemical studies of typical cell properties.

A class II/2 malocclusion with considerable amount of crowding was treated non-extraction by distalization. The upper molars were moved posteriorly with the use of superelastic wires. The orthodontic therapy-mode is presented and the results are discussed. This treatment approach shows another use of superelastic wires.

The results of treatment following the extraction of maxillary second molars for Class II correction were evaluated. Records (cephalograms, orthopantomograms, and models) of 32 patients treated with maxillary second molar extraction were analyzed. Cephalograms taken before and after treatment were traced and 18 variables were compared. Changes in the axial inclination of the erupted third molars relative to the occlusal plane were measured on the orthopantomograms. The form and the position (eruption in occlusion, rotations) of the maxillary third molars were evaluated on the models. The average treatment time was 26 months. The results of this study show significant changes of the angles SNA, SNB, ANB, 1/4:SN, and the distances 1-NPog, and 1-APog, as well as significant effects on the soft tissue profile. In 19 cases examined 4 years postretention, all maxillary third molars had erupted into occlusion with a mesial contact point and acceptable mesiodistal axial inclination.