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The effect of improvement in prenatal identification of cleft lip or palate (CL/P) on termination of pregnancy (TOP) worldwide is scarcely reported. Our aim was to assess changes in the prevalence of cleft palate attributed to the high access and availability of prenatal advanced screening and pregnancy termination in Israel.A retrospective study was conducted on CL/P patients which were treated in our institute and born between January 2000 and December 2018. Clinical and demographic data were extracted from medical records. Data on TOP were collected based on accessible information from the Ministry of Health. Cleft palate severity was evaluated using the Veau Classification.The study was conducted on 258 patients. Higher incidence of Veau II and III was evident throughout the examined period (2000-2018). However, when evaluating the incidence per year, we found that the incidence of severe cases (Veau III and IV) decreased every year showing a major decline of 60% in the last decade, whereas mild cases (Veau type I and II) demonstrated a marked increase of 90%. Regarding the incidence of abortions in Israel, a decrease of 30% was observed in the last two decades, meanwhile a substantial increase was detected in the rate of abortions related to physical malformations of the fetus. Additionally, the number of late terminations due to physical malformations significantly increased in the last decade.Significant decrease was observed in the incidence of severe cleft palate cases in the last decade. Concurrently, we found a substantial increase in percentage of abortions performed due to physical malformations. We suggest that these changes might be attributed to the accessibility of advanced prenatal screening and pregnancy termination in Israel under the social healthcare system.

Introduction Basic research in orthodontics is commonly conducted in rodents. However, experimental studies on orthodontic tooth movement (OTM) lack a standard method to examine OTM and periodontal changes. This study describes a unifying protocol for the analysis of OTM and associated bone microarchitectural changes in mice using microcomputed tomography (µCT). Methods Mice (10 animals/group) were divided into control and OTM groups. OTM was generated by anchoring a nickel–titanium closed-coil spring to the upper incisors to pull the upper left first molar. A third group of TNFα −/− mice was added since these are known to have slower OTM. Using µCT, we implemented and tested a number of methods to measure OTM distance and examine 3D bone morphometric parameters associated with OTM in mice. Results In total, we tested five methods to measure the OTM distance in mice. The results indicated that measuring the intermolar diastema, and assessing tooth movement relative to the anterior root of the zygomatic arch, displayed the lowest standard deviation and enabled optimal detection of intergroup differences. We also developed two protocols for µCT analysis of the periradicular bone that yielded no false-positive results. Our results revealed that including the width of the periodontal ligament rather than excluding it from the region of interest in mice detected more statistically significant differences in the morphometric parameters between the OTM and control sides and between WT and TNFα −/− mice despite more subtle differences. Conclusions We, therefore, propose new guidelines for a standardized μCT-based method to analyse OTM and the extent of the periradicular bone structural changes in mice.

Background Distraction osteogenesis has widespread clinical use in the treatment of congenital and acquired craniofacial deformities. Nonetheless, during the prolonged consolidation period, the newly regenerated bone carries the risk of complications. A known method for enhancing bone healing is extracorporeal shock wave therapy, which has been shown to induce neovascularization and promote tissue regeneration. The authors investigated whether extracorporeal shock wave therapy can accelerate bony consolidation and regeneration in distraction osteogenesis of the rat mandible and at which stage of distraction osteogenesis it should be applied. Methods Twenty-four male Sprague-Dawley rats were subjected to distraction osteogenesis of the right mandible (latency period, 3 days; distraction period, 10 days; 0.5 mm/day). Experimental groups consisted of the following: group I (control), no extracorporeal shock wave therapy; group II, extracorporeal shock wave therapy (0.18 mJ/mm(2)) at the latency period; and group III, extracorporeal shock wave therapy (0.18 mJ/mm(2)) at the consolidation period. Explants were removed for evaluation after 4 weeks of consolidation. Results Histologic evaluation showed well-developed cortical cortex and a higher degree of bone formation and mature bone in group III; micro-computed tomography showed significantly increased bone mineral density, bone volume fraction, and trabecular thickness; immunohistochemistry demonstrated significantly increased expression of bone morphogenetic protein-2, vascular endothelial growth factor, and proliferating cell nuclear antigen. Conclusion Extracorporeal shock wave therapy application at the consolidation period during distraction osteogenesis in the rat mandible enhances bone formation and osteogenic and angiogenic growth factors, improves bone mechanical properties, and accelerates bone mineralization.

Objectives Successful aesthetic repair of the bilateral cleft lip and palate (BCLP) is one of the most challenging cases encountered by a surgeon. This challenge is heightened when the premaxilla is anteriorly protruded in relation lateral maxillary segments. Our aim is to demonstrate a useful technique for reducing the cleft size before secondary lip repair. We use a premaxillary osteotomy to posteriorly reposition the premaxilla between the lateral segments. Methods Six patients with BCLP underwent repositioning of the protruded premaxilla. Five patients had previous primary lip closure procedures with unsatisfactory results. The cleft size was reduced by premaxillary osteotomy from nasal septum and partial removal of the vertical vomer. The osteotomized premaxilla was then repositioned, fixed with a custom-made orthodontic appliance. Following this procedure, the lip was closed in a traditional fashion. Results All patients demonstrated satisfying lip closure without tension. In each case, the premaxilla was vital and exhibited partial stabilization during follow-up. Conclusions In this study the authors demonstrate the usefulness of a premaxillary segment setback as an adjunct to improved function and aesthetics in bilateral lip repair. This method serves as useful technique for previously unsuccessful closure of BCLP.

Sustained mechanical forces applied to tissue are known to shape local immunity. In the oral mucosa, mechanical stress, either naturally induced by masticatory forces or externally via mechanical loading during orthodontic tooth movement (OTM), is translated, in part, by T cells to alveolar bone resorption. Nevertheless, despite being considered critical for OTM, depletion of CD4+ and CD8+ T cells is reported to have no impact on tooth movement, thus questioning the function of αβT cells in OTM-associated bone resorption. To further address the role of T cells in OTM, we first characterized the leukocytes residing in the periodontal ligament (PDL), the tissue of interest during OTM, and compared it to the neighboring gingiva. Unlike the gingiva, monocytes and neutrophils represent the major leukocytes of the PDL. These myeloid cells were also the main leukocytes in the PDL of germ-free mice, although at lower levels than SPF mice. T lymphocytes were more enriched in the gingiva than the PDL, yet in both tissues, the relative fraction of the γδT cells was higher than the αβ T cells. We thus sought to examine the role of γδT cells in OTM. γδT cells residing in the PDL were mainly Vγ6+ and produced interleukin (IL)–17A but not interferon-γ. Using Tcrd-GDL mice allowing conditional ablation of γδT cells in vivo, we demonstrate that OTM was greatly diminished in the absence of γδT cells. Further analysis revealed that ablation of γδT cells decreased early IL-17A expression, monocyte and neutrophil recruitment, and the expression of the osteoclastogenic molecule receptor activator of nuclear factor–κβ ligand. This, eventually, resulted in reduced numbers of osteoclasts in the pressure site during OTM. Collectively, our data suggest that γδT cells are essential in OTM for translating orthodontic mechanical forces to bone resorption, required for relocating the tooth in the alveolar bone.

The objective was to investigate the effect of extracorporeal shock wave therapy (ESWT) on the magnitude of orthodontic tooth movement, in a rat model, based on a previously established treatment protocol.In conjunction with orthodontic force commencement, rats underwent ESWT. The amount of tooth movement along with different microarchitectural parameters were measured after three weeks by means of microcomputed tomography. In addition, the percentage of cells expressing vascular endothelial growth factor, the number of tartrate-resistant acid phosphatase (TRAP) positive cells/area and blood vessel density were evaluated both for the pressure and tension sides.The addition of ESWT to the orthodontic force after three weeks more than doubled the average tooth movement. The addition of ESWT on the pressure side induced a significant decrease in volumetric bone mineral density. Blood vessel density and the number of TRAP positive cells were higher after the application of ESWT.The induction of ESWT during orthodontic tooth movement in a rat model increases the rate of tooth movement by accelerating bone resorption on the pressure side and possibly enhances bone formation on the tension side.

pObjective: An esthetic facial soft tissue profile is an important objective of contemporary orthodontics. The extent to which clinicians and the public agree on profiles that are esthetically acceptable versus profiles recommended for treatment is unclear. Thus, this work examined the profile considered esthetic by laypeople and general dental practitioners compared to orthodontists.br /Method and materials: An Israeli balanced male-female group comprising 284 participants (orthodontists [nnbsp;=nbsp;86], general dental practitioners [nnbsp;=nbsp;64], laypeople [nnbsp;=nbsp;134]) rated the attractiveness of five standardized masculine and feminine profiles presented in standardized silhouettes ranging from concave to convex.br /Results: Laypeople see no esthetic difference between masculine and feminine profiles, and prefer moderately concave over moderately convex and severely concave over severely convex profiles. While all raters preferred the straight silhouettes, orthodontists rated them significantly higher than general dental practitioners (Pnbsp;lt;nbsp;.0001) or laypeople (Pnbsp;lt;nbsp;.020). Similar to the general population, orthodontists gave higher ratings to concave profiles for masculine profiles, but significantly lower ratings for feminine profiles. The severely convex male profile was the least attractive to clinicians and laypeople. There was a significant difference in the attractiveness of the female profile between practitioners (Pnbsp;lt;nbsp;.001 and Pnbsp;lt;nbsp;.02 for general dental practitioners and orthodontists, respectively) and laypeople.br /Conclusions: The findings suggest that orthodontic training and clinical adherence to strict beauty norms results in more critical judgment of female attractiveness, which may affect orthodontic treatment. They indicate trends that reflect changes in recent decades in the public perception of facial beauty, which may affect patient expectations of treatment outcomes./p.

Tooth root resorption is an unwanted result of orthodontic tooth movement, and it can be expressed by a reduction in cementum thickness. The aim of this experimental study was to evaluate the effect of intraligamentary injection of osteogenic-induced gingival fibroblasts (OIGF) on cellular and acellular tooth root cementum thickness in modeled orthodontic tooth movement. Six beagle dogs were used in the study. All the upper and lower third and fourth premolars were subjected to mechanical loading for 4 weeks, which induced orthodontic tooth movement. Fifteen premolars were assigned to the OIGF group, which received a single OIGF injection through the periodontal ligament near the root apex (n = 7 teeth), and to the control group, which received a single injection of Dulbecco's modified eagle's medium in the periapical area (n = 8 teeth). The evaluation of histomorphometry was performed to assess the thicknesses of cellular and acellular cementum at the root apex and four bilateral sites distal to the apex. We found no statistically significant enhancing effects of gingival fibroblasts on either cellular or acellular cementum thicknesses when compared with the control group. We conclude that a single intraligamentary injection of OIGF does not stimulate the formation of tooth root cementum in the dog model of orthodontic tooth movement. Thus, OIGF is unlikely to prevent orthodontic-induced tooth root resorption.

Tooth root resorption is an unwanted result of orthodontic tooth movement, and it can be expressed by a reduction in cementum thickness. The aim of this experimental study was to evaluate the effect of intraligamentary injection of osteogenic-induced gingival fibroblasts (OIGF) on cellular and acellular tooth root cementum thickness in modeled orthodontic tooth movement. Six beagle dogs were used in the study. All the upper and lower third and fourth premolars were subjected to mechanical loading for 4 weeks, which induced orthodontic tooth movement. Fifteen premolars were assigned to the OIGF group, which received a single OIGF injection through the periodontal ligament near the root apex (n = 7 teeth), and to the control group, which received a single injection of Dulbecco's modified eagle's medium in the periapical area (n = 8 teeth). The evaluation of histomorphometry was performed to assess the thicknesses of cellular and acellular cementum at the root apex and four bilateral sites distal to the apex. We found no statistically significant enhancing effects of gingival fibroblasts on either cellular or acellular cementum thicknesses when compared with the control group. We conclude that a single intraligamentary injection of OIGF does not stimulate the formation of tooth root cementum in the dog model of orthodontic tooth movement. Thus, OIGF is unlikely to prevent orthodontic-induced tooth root resorption.

Objectives The aim of the present research was to evaluate the current caries experience of schoolchildren in the Republic of Moldova. Methods A pathfinder study was planned and executed according to the World Health Organization (WHO) recommendations. Caries experience was recorded in three large cities (the capital city and two other large cities) and four villages throughout the country. Within each site and age group, school clusters were randomly chosen. Three different age groups (6, 12 and 15 years) of schoolchildren were assessed. Results Overall, 1,100 children were examined: 724 from cities and 376 from the villages. Among the study population, 408 (37.1%) were female and 692 (62.9%) were male, 380 were 6 years of age, 365 were 12 years and 355 were 15 years. The prevalence of caries experience [decayed, missing and filled scores of > 1 for primary (dmft) and secondary (DMFT) teeth] was 87.4% (dmft score = 3.9 ± 3.0) for 6-year-old participants, 77.53% (DMFT score = 2.7 ± 2.3) for 12-year-old participants and 86.2% (DMFT score = 3.7 ± 2.9) for 15-year-old participants. For the 12-year group, a higher proportion of caries-free children were detected in urban areas than in rural areas (25.5% vs. 15.5%, P = 0.003). We found more caries-free participants among 12-year-olds than among 15-year-olds (22.5% vs. 13.8%, P = 0.004). Conclusions These WHO key index age groups may be inserted into the global oral health databank and provide a 'pathfinder' baseline for formulating and conducting future public oral health programmes in the Republic of Moldova, with an emphasis on children in rural locations.

Rapid blood cell turnover and bone marrow expansion caused by beta-thalassemia (βT) result in craniofacial and dentoalveolar anomalies. This report presents a systematic review of the literature over the past 50 years on orthodontic and surgical considerations in the management of βT-affected patients. Seventeen publications encompassed 24 patients, 11 male individuals and 13 female individuals, 7 to 43 years of age. Eleven patients underwent only surgical treatment, eleven combined orthodontic-surgical treatment, and 2 orthodontic treatment. Surgical treatment primarily addressed typical maxillary overgrowth by maxillary reshaping, premaxillary segmental repositioning, or complete Le Fort I impaction and set back osteotomy. In severe maxilla-mandibular discrepancy and/or increased lower facial height, a bilateral sagittal split mandibular osteotomy is the treatment of choice. Although surgery involves risks of excessive bleeding, morbidity, and impaired nasal esthetics, little attention is given to the orthodontic modality. In conclusion, the current literature recommends early interceptive orthodontics aimed to decrease dentoskeletal deformities, severe malocclusion, and soft tissue imbalance. Treatment includes maxillo-mandibular orthopedic and functional manipulation with dentoalveolar treatment, which might either prevent orthosurgical procedures later or reduce its extent. This suggested a multidisciplinary approach comprising a hematologist, a pediatrician, a pediatric dentist, and an orthodontist, which might also significantly improve the patient's quality of life.

Purpose Cephalometric evaluation of craniofacial and craniopharyngeal morphology is important for understanding the factors affecting velopharyngeal dysfunction (VPD) in patients with palatal anomalies. Materials and methods In this study, 366 patients with VPD were retrospectively stratified into cleft lip and palate (CLP), cleft palate (CP), submucous cleft palate (SMCP), occult submucous cleft palate (OSMCP), and non-CP groups. Lateral cephalometrics were used to assess craniofacial, craniopharyngeal, and velopharyngeal anatomy. Results The average craniofacial morphology in patients with VPD differed significantly according to the type of palatal anomaly. The non-CP and OSMCP groups differed from the CLP, CP, and SMCP groups in nasopharyngeal size and shape as depicted by a larger ANS–Ptm–Ve angle, a smaller S–N–Ba and NBa–PP angles, and a shorter linear value of S–Ar in the non-CP group. The CLP and CP groups had shorter ANS–Ptm, shorter Ptm–P, and smaller SNA and SNB angles. Conclusion VPD patients with overt clefts have different skeletal and nasopharyngeal shapes compared to non-CP and OSMCP. Velopharyngeal function assessment should include the size and shape of the nasopharyngeal space in addition to the size and the activity of the velum and posterior and lateral walls of the nasopharynx. This should enable a more precise understanding of VPD pathology, and lead to improvements in the posterior pharyngeal flap technique in order to obtain better postoperative speech outcomes after surgical management of velopharyngeal dysfunction.

Maxillary hypoplasia is a common outcome in patients with cleft lip and palate after surgical and orthodontic interventions, and maxillary distraction osteogenesis has become a useful procedure for patients with extensive maxillary deformities. The aim of this study was to evaluate long term (two years) stability after maxillary advancement of more than 10mm by distraction osteogenesis in cleft patients using internal devices. We organised a retrospective study on 42 patients with cleft lip and palate using cephalometric analysis before and after maxillary distraction osteogenesis and evaluated them for 24 months. Postoperative measurements showed a marked advancement with an increase of 13.3mm and 10.8° in the length of the maxilla (Co-A) and SNA, respectively, including a shift from Angle class III to class I in dental relations. Follow-up observations showed preservation of maxillary length with a relapse of only 6.0 % (mean (SD) 0.8 (0.7) mm) and 10% relapse in SNA angle (mean (SD)1.1 (1.4) °) one year postoperatively and a negligible regression at the two years' follow up. This large-scale study shows stable results of skeletal advancement using distraction osteogenesis, indicating safe and reliable outcomes among patients with cleft lip and palate.

Preorthodontic socket preservation after tooth extraction is intended to enhance favorable dentoalveolar ridge morphology and architecture, and facilitate orthodontic tooth movement (OTM) and extraction space closure. This 13-year-old skeletal Class II case presents a unique opportunity to evaluate and compare the OTM extraction space closure by means of a split-mouth analysis in a single patient. The comprehensive orthodontic-periodontal treatment included nonsimultaneous extraction of the bilateral periodontally compromised mandibular first molars and the eruption of bilateral impacted mandibular canines. While the right post-extraction space underwent a natural healing process, the left one was grafted using 4BONE BCH (hydroxyapatite β-tricalcium phosphate [HA-β-TCP], HA 60%, and β-TCP 40%). The 3-year multidisciplinary treatment approach resulted in Class I relationships on the right side and Class II on the left side, improved facial appearance, and dento-skeletal jaw relationships. However, a 3-mm residual alveolar space remained unclosed on the grafted left-site, along with an unerupted left third molar. This split-mouth comparative analysis of the orthodontic space closure demonstrated a significant clinical difference in the outcome. Preorthodontic placement of HA-β-TCP grafting material on the left segment, proved to be an obstacle for OTM extraction space closure, hindering the establishment of good occlusion.

Purpose To evaluate the image quality generated by eight commercially available intraoral sensors. Methods Eighteen clinicians ranked the quality of a bitewing acquired from one subject using eight different intraoral sensors. Analytical methods used to evaluate clinical image quality included the Visual Grading Characteristics method, which helps to quantify subjective opinions to make them suitable for analysis. Results The Dexis sensor was ranked significantly better than Sirona and Carestream-Kodak sensors; and the image captured using the Carestream-Kodak sensor was ranked significantly worse than those captured using Dexis, Schick and Cyber Medical Imaging sensors. The Image Works sensor image was rated the lowest by all clinicians. Other comparisons resulted in non-significant results. Conclusions None of the sensors was considered to generate images of significantly better quality than the other sensors tested. Further research should be directed towards determining the clinical significance of the differences in image quality reported in this study.

Background: Transverse maxillomandibular discrepancies are widespread. Treatment is comprised of orthodontic expansion in patients younger than 15 years or by surgically assisted rapid palatal expansion (SARPE) in skeletally mature patients where the possibility of successful orthodontic maxillary expansion decreases as sutures close and resistance to mechanical forces increases. Aim: To present our experience of treating transverse maxillary deficiency using a unique L-shaped osteotomy and to demonstrate stable results. Patients and Methods: 32 patients aged between 19 and 54 years exhibiting transverse maxillary deficiency. L-shaped osteotomy was performed laterally from the pterygoid plate posteriorly to above the roots of the second incisive anteriorly continuing with a vertical osteotomy between the lateral incisive and canine teeth toward the horizontal osteotomy. In 18 patients with dysgnathia, bimaxillary surgery was performed one year following the SARPE procedure. Results: Mean transverse maxillary expansion of 6.2mm at the canine incisal and 6.4mm at the first molar occlusal regions were obtained. One year postoperatively results were relatively stable, 5.8mm and 6.2mm respectively. The SARPE procedure resulted in overcoming the maxillary buttress resistance, expansion of the anterior dental arch and bilateral distraction creating bone on both sides of the premaxilla contributing to better alignment of the anterior teeth and superior stability. Conclusions: We conclude that SARPE is an effective and stable method for addressing severe maxillary transverse discrepancy in adults while the unique osteotomy performed allowed for maintaining proper position of the premaxilla and maxillary midline and allowing for division of the newly created bone bilaterally thus resulting in a more stable outcome.

Background:. Ectrodactyly ectodermal dysplasia-cleft syndrome is a rare genetic syndrome with an incidence of 1/90,000 live births, characterized by cleft lip and palate, severely hypoplastic maxilla, and hypodontia. Patients diagnosed with ectrodactyly ectodermal dysplasia-cleft syndrome suffer from a severely hypoplastic maxilla that is highly difficult to treat using traditional orthognathic methods. In this study, we propose using distraction osteogenesis to achieve a major advancement while maintaining good stability and minimal relapse. To our knowledge, this is the first description of patients with this syndrome treated using distraction osteogenesis. Methods:. Five patients diagnosed with ectrodactyly ectodermal dysplasia-cleft syndrome were included in the study. All patients had been operated on according to the well-established protocol of cleft lip and palate reconstruction before maxillary distraction osteogenesis. Hard and soft-tissue changes were evaluated by cone beam computed tomography and lateral cephalograms before distraction osteogenesis (T1), at the postdistraction point (T2) and after 1 year of follow-up (T3). Results:. Examination revealed marked maxillary advancement in all our patients with a significant mean difference in hard tissue parameters (condylion to A point = 18 mm; nasion-sella line to A point = 15.2 degrees) and a notable improvement in facial convexity (20.9 degrees). One year follow-up measurements demonstrated mild relapse rates of 6% in the horizontal plane. Conclusions:. We conclude that despite the challenging anatomic and physiological features of ectrodactyly ectodermal dysplasia-cleft patients, by enhancing current surgical techniques, there is promising potential for improved patient outcomes, achieving normognathic facial appearance with implant supported rehabilitation.

Rehabilitation of missing decoronated permanent incisors in growing children and adolescents is a major challenge. The psychologic impact of the loss of an incisor is significant due to its immediate influence on facial appearance. Final restoration is planned only after skeletal growth cessation. Consequently, the fabrication and installation of an immediate temporary restoration, which is expected to remain in place for a long period, must meet the patient's esthetic demands and be durable in the oral environment. Several proposed removable and fixed restorations have presented significant shortcomings. The purpose of this report is to suggest a comfortable dental device for restoring the missing permanent tooth with improved esthetic, functional, and psychologic benefits. An alternative fixed orthodontic laboratory fabricated appliance for permanent tooth restoration is described among children with posttraumatic tooth decoronation. Unlike removable restorative appliances, this fixed device is not dependent on the child's compliance. Esthetically, no metal part is exposed in the anterior region and the architecture is more sturdy and stable, with minimum interruption to the alveolar ridge's vertical development.An alternative fixed orthodontic laboratory appliance is described for intermediate restoration of a missing permanent tooth.A posttrauma intermediate fixed orthodontic appliance is a beneficial solution from esthetic, psychologic, functional, and economic perspectives for replacing missing anterior maxillary teeth. This device may be worn by patients for a long period until final restoration is indicated.

Extracorporeal shockwaves are noninvasive mechanical forms of sound wave treatment. They were introduced in medical therapy approximately 30 years ago in order to disintegrate kidney stones. Over the last 15 years, extracorporeal generated shockwaves have been used in many fields of medicine due to their versatility and ability to stimulate healing processes by inducing neovascularization and differentiate stem cells into cells of the injured tissue to allow proper healing and regeneration.

Introduction: The main points to consider in secondary alveolar bone grafting (ABG) of cleft patients are age at the time of surgery, the type of bone graft, and pre/postorthodontic expansion of the upper jaw. Purpose: The aim of this study is to evaluate the reverse quad-helix (RQH) expander device. Does RQH improve the surgical procedure before ABG? We will evaluate the outcome of the procedure, duration of the operation, hospitalization time, satisfaction of the surgeon with this procedure and the success of the bone graft in the long-term. Patients and Methods: We reviewed the medical records of 103 cleft patients who underwent secondary bone grafting at our institution between 2001 and 2012. All patients were treated presurgically with a RQH appliance to expand the cleft area. The following data were recorded for each of the patients: Unilateral/bilateral cleft, surgery time, hospital stay, success/failure, and follow-up. Conclusion: Presurgical orthodontic application of the RQH expander in the cleft area enabled improved anterior expansion rather than posterior expansion. This technique improves access for surgery and bone grafting, the use of RQH facilitates the improved manipulation of the nasal mucosa via direct view due to the wide separation of the alveolar segments in the cleft area. Furthermore, this gap enables improved access for the bone grafting procedure, shortens the surgery time and provides stable maxillary transverse correction.

Aims To examine the effects of smoking cessation on body composition and muscle strength in comparison with continued smoking. Design and Setting Twelve-month longitudinal study of adult smokers conducted in Haifa, Israel. Participants Eighty-one smokers recruited from a smoking cessation programme combining group counselling and varenicline treatment. Measurements Measurements were taken at the beginning of the programme and after 12 months. Body composition was assessed by dual-energy X-ray absorptiometry. Muscle strength was measured by handgrip dynamometry and predicted one-repetition maximum tests. Dietary intake and physical activity levels were estimated using questionnaires. Smoking status was determined by urine cotinine. The effect of smoking cessation was assessed using univariate and multivariable linear regression analyses. Findings Forty-one participants (age 44 ± 12 years) completed all baseline and follow-up measurements (76% continued smokers; 24% quitters). All measures of body composition and muscle strength were increased among quitters when compared with continued smokers. Adjusted differences [95% confidence interval (CI)] between quitters and smokers were: body weight 4.43 kg (1.56–7.31 kg); lean mass 1.26 kg (0.24–2.28 kg); fat mass 3.15 kg (0.91–5.39 kg); bone mineral content 48.76 g (12.06–85.54 g); bone mineral density 0.024 g/cm2 (0.004–0.043 g/cm2); handgrip strength 3.6 kg (1.12–6.08 kg); predicted one-repetition maximum of chest press 7.85 kg (1.93–13.76 kg); and predicted one-repetition maximum of leg press 17.02 kg (7.29–26.75 kg). Conclusions Smoking cessation is associated with weight gain mainly through accumulating extra fat, but is also associated with increased muscle mass, muscle strength and bone density.

Background: In craniofacial microsomia (CFM) Type III patients, autogenous costochondral grafts (CCG) are conventionally used for the reconstruction of the ramus and condyle. The aim of this study was to describe the use of CCG in children with CFM in terms of outcomes, growth patterns, and complications. Materials and Methods: This is a retrospective study of nine, aged 4–12 years, patients with CFM Type III, who underwent reconstruction of the mandibular ramus condyle unit by CCG. Seven patients had right-sided CFM and two had left-sided CFM. The rationale for this choice was to utilize the potential growth of the CCG, providing length to the ramus, and the joint by acting as a growth center; to control the repositioning of the chin center; and to improve child compliance by undergoing only one operation. The surgical treatment plan was determined preoperatively, based on measurements of mandibular vertical and horizontal deficiency and analysis of the mandibular posterior and anterior angulation. The mandibular planes and axis were defined by a three-dimensional simulation software program to perform a “mock surgery”, by creating a prototype model. Clinical follow-up included measurements of the maximal opening, observation of the facial symmetry, and recording of complications, such as reankylosis. Results: There were no serious postoperative complications, infections, or graft rejections. Successful postoperative occlusal cants were noted and measured in five patients and acceptable results were obtained in three patients. In one case, the CCG underwent distraction osteogenesis to improve the facial symmetry. In one patient, the graft continued to grow and the chin started to deviate into the opposite side. Measuring and calculating the ratio of the ramus height on the panoramic X-ray revealed a good relation between the healthy contralateral and the reconstructed ipsilateral ramus. Postoperative mean mouth opening was 34.3 mm, with minimal midline deviation of 2.6 mm in occlusion. Mean follow-up was 51.7 months. The mean postoperative occlusal cant analysis for eight patients was 3.66°. Conclusion: CCG is useful in treating CFM Type III. The growth potential of the CCG makes it the ideal choice for children. The advantages of this graft are its biological compatibility, workability, functional adaptability, and minimal additional detriment to the patient. The use of a stereolithographic model preoperatively improved intraoperative precision by clearly displaying detailed anatomy of the patient undergoing craniofacial surgery. The surgeon can plan the length of the CCG before surgery and use the printed template while harvesting without waiting for the exact measurements to be provided by the facial surgical team.

Obstructive sleep apnea (OSA) is a highly prevalent sleep breathing disorder characterized by intermittent hypoxia (IH), leading to blood hypoxemia, hypercapnia, and sleep fragmentation. Studies on the effects of OSA on oral epithelial tissue healing are limited. Smoking is considered a risk factor for OSA through the exposure to chemically active toxins, present in the smoke. Acrolein is the most chemically active unsaturated aldehyde, impairing a variety of biological processes. The aim of this study was to determine the effect of IH on oral epithelial tissue healing, with and without acrolein. HaCaT cells were wounded by a cross-scratch made in the cell cultures, considered as time zero. Then, cells were exposed to 28 IH cycles (5-20% oxygen) during 12 h using the BioSpherix OxyCycler-C42 system. Control cells were maintained in normoxic conditions or in sustained hypoxia (SH) (5% oxygen) for the same durations, after which all cells were maintained for additional 12 h in normoxia. The migrating abilities of cells were measured after 24 h by calculating the percent of the residual cross-scratch area. In parallel experiments, 25 μM acrolein were added to each treatment. We found that the scratch closure was the slowest under IH. After 24 h, the residual scratch area in the IH treated cells was 29.5 ± 13.4% of the initial area, while in normoxia and SH it was 9.2 ± 5.8% and 10.3 ± 11.3%, respectively (p0.01 for both vs. IH). Adding acrolein further attenuated the migratory ability in IH as compared to normoxia and SH. We conclude that IH delays the healing process of oral epithelial tissue by slowing the cells' migratory abilities. The healing might be further attenuated by chemically active unsaturated aldehydes such as acrolein.

Distraction osteogenesis for the augmentation of severe alveolar bone deficiency has gained popularity during the past two decades. In cases where the vertical bone height is not sufficient to create a stable transport segment, performing alveolar distraction osteogenesis (ADO) is not possible. In these severe cases, a two-stage treatment protocol is suggested: onlay bone grafting followed by ADO. An iliac crest onlay bone graft followed by ADO was performed in 13 patients: seven in the mandible and six in the maxilla. Following ADO, endosseous implants and prosthetic restorations were placed. In all cases, the onlay bone graft resulted in inadequate height for implant placement, but allowed ADO to be performed. ADO was performed to a mean total vertical augmentation of 13.7mm. Fifty-two endosseous implants were placed. During a mean follow-up of 4.85 years, two implants failed, both during the first 6 months; the survival rate was 96.15%. In severe cases lacking the required bone for ADO, using an onlay bone graft as a first stage treatment increases the bone height thus allowing ADO to be performed. This article describes a safe and stable two-stage treatment modality for severely atrophic cases, resulting in sufficient bone for implant placement and correction of the inter-maxillary vertical relationship.

Purpose Maxillary retrognathism appears in 14.3% of patients exhibiting malocclusion after trauma treatment. This report describes the application of alveolar distraction osteogenesis (ADO) for treating the severely deficient anterior maxilla after trauma injuries in the vertical and anteroposterior planes. Materials and Methods This is a retrospective study of patients exhibiting severe vertical and anteroposterior maxillary bone deficiency after trauma injuries and treated by ADO as a first stage with additional Le Fort I advancement when required. Predictor variables included ADO for alveolar augmentation and Le Fort I advancement for anteroposterior discrepancy after ADO. Outcome variables included dental implant failure and anteroposterior maxillary relations. Results Twelve patients with severe atrophic anterior maxilla secondary to trauma injuries were included and treated using ADO. In accordance to the size of the horizontal deficiency, 1 or 2 distractors were used. Vertical alveolar distraction was performed and the transported segments were elongated at a rate of 0.5 mm/day to a mean total of 13.9 mm (12 to 15 mm). In 4 of 12 cases, there was a severe anteroposterior discrepancy larger than 8 mm that could not be fully corrected using an anterior inclination during the vertical elongation. Therefore, a second stage of conventional Le Fort I advancement was performed. Thirty-eight dental implants were inserted, with a survival rate of 97.37% (median follow-up, 6.2 yr). Conclusions This report describes treatment of the deficient anterior maxilla after trauma injuries in the vertical and anteroposterior planes, including implant-based dental rehabilitation. The main advantages include simultaneous bone and mucosa augmentation, no donor site morbidity, considerably higher vertical augmentation compared with other methods, and minimal relapse. Using an additional Le Fort I advancement in severe cases permits a useful method for proper repositioning of the maxilla, thus resulting in superior intermaxillary relations.

Objective. To examine the comparative effectiveness of two topical anesthetics in controlling the pain associated with tongue-tie release (frenotomy) in young infants. Design. Randomized trial. Setting. A Pediatric Craniofacial Clinic. Subjects. Forty-two infants who were referred for frenotomy were randomly allocated to receive the topical anesthetic gel 2% tetracaine or 20% benzocaine applied prior to frenotomy. Frenotomies were videotaped. The primary outcome measure was the Neonatal Facial Coding System (NFCS) score. Secondary outcome measures included cry duration and a visual analog scale (VAS) assessed by the parents. Results. The two groups were comparable with regard to weight, age, gender, previous painful experience, and last feeding time. Median NFCS scores prior to frenotomy in the tetracaine and the benzocaine groups were 4.5 (IQR: 0.75–10.2) and 3.5 (IQR: 0–9.5), respectively ( P = 0.89, 95% CI −3 to 4). During frenotomy, median NFCS score increased to 28 (IQR: 24.5–30.25) in the tetracaine group ( P

Obstructive sleep apnea (OSA) is a highly prevalent sleep breathing disorder characterized by intermittent hypoxia (IH), leading to blood hypoxemia, hypercapnia, and sleep fragmentation. Studies on the effects of OSA on oral epithelial tissue healing are limited. Smoking is considered a risk factor for OSA through the exposure to chemically active toxins, present in the smoke. Acrolein is the most chemically active unsaturated aldehyde, impairing a variety of biological processes. The aim of this study was to determine the effect of IH on oral epithelial tissue healing, with and without acrolein. HaCaT cells were wounded by a cross-scratch made in the cell cultures, considered as time zero. Then, cells were exposed to 28 IH cycles (5–20% oxygen) during 12 h using the BioSpherix OxyCycler-C42 system. Control cells were maintained in normoxic conditions or in sustained hypoxia (SH) (5% oxygen) for the same durations, after which all cells were maintained for additional 12 h in normoxia. The migrating abilities of cells were measured after 24 h by calculating the percent of the residual cross-scratch area. In parallel experiments, 25 μM acrolein were added to each treatment. We found that the scratch closure was the slowest under IH. After 24 h, the residual scratch area in the IH treated cells was 29.5 ± 13.4% of the initial area, while in normoxia and SH it was 9.2 ± 5.8% and 10.3 ± 11.3%, respectively (p < 0.01 for both vs. IH). Adding acrolein further attenuated the migratory ability in IH as compared to normoxia and SH. We conclude that IH delays the healing process of oral epithelial tissue by slowing the cells’ migratory abilities. The healing might be further attenuated by chemically active unsaturated aldehydes such as acrolein.

Congenital craniofacial malformations such as Pierre Robin sequence or Treacher Collins syndrome are associated with mandibular micrognathia, resulting in obstructive sleep apnea (OSA) due to a decreased pharyngeal airway; in severe cases this leads to tracheostomy dependence. We present a series of 18 patients in whom we performed mandibular lengthening using internal distraction devices to relieve airway obstruction. Seven were tracheostomy-dependent and 11 were respiratory distressed without tracheostomy. The mandible was distracted at a rate of 1 mm per day. Following 3 months of consolidation for bony maturation, the distraction devices were removed. Results demonstrated forward mandibular elongation of a mean 22 mm (range 20–25 mm) and an increase in SNB angle and in pharyngeal airway. All patients with tracheostomies were decannulated, and there was an improved airway with resolution of signs and symptoms of OSA and elimination of oxygen requirement in all patients. We conclude that mandibular distraction using internal devices is a useful and comfortable method for younger children to expand the mandible forward and increase the pharyngeal airway.

Background and Objective Extracorporeal shock wave therapy has been used in various clinical conditions as a result of its ability to stimulate healing processes in acute and chronic inflammatory states. Orthodontic force application triggers an inflammatory reaction in the periodontal tissue surrounding the involved teeth, resulting in tooth movement. Preliminary work revealed that extracorporeal shock wave therapy increased the expression of the inflammatory cytokines involved. Our aim was to investigate the expression of inflammatory cytokines in the periodontal tissues following orthodontic force induction, with and without shock wave therapy, in experimental rats. Material and Methods An orthodontic appliance was fabricated and applied between the molars and the incisors of adult Wistar rats. In conjunction with orthodontic force commencement, the rats were treated with a single episode of 1000 shock waves. Every day, during the 3 d of the study, rats were killed and the immunolocalization of RANKL, interleukin (IL)-1β, IL-6 and tumor necrosis factor-alpha was evaluated. Results The percentage of the area staining positively for all inflammatory cytokines during the first 2 d decreased statistically significantly more in the shock wave-treated group compared with the nontreated control group. On the first day, the percentage of the area staining positively for IL-1β and RANKL on the compression side peaked in both groups, with a sequential rise in the number of TRAP-positive cells. Conclusion The induction of shock wave therapy during orthodontic tooth movement influences the expression of different inflammatory cytokines in the tissue and might alter the expected periodontal remodeling rate.

The purpose of this study was to evaluate the developmental stage of teeth adjacent to the agenesis site in comparison to their antimeres.Panoramic views of 39 patients with unilateral dental agenesis and 42 normal controls were evaluated. The dental developmental stage (normal or delayed) of the teeth adjacent to the agenesis site was determined for each patient using the Haavikko's method, while the overall dental age was determined by Becker's method.No statistically significant difference was found in the developmental stage of teeth adjacent to the agenesis, compared to their antimere and to the same teeth in the normal control group. However, the prevalence of cases with no difference in development was almost double for the tooth distal to the agenesis site compared to the tooth mesial to the agenesis site in the hypodontia group (84.6% distal and 43.6% mesial; p0.001) and in the control group (83.3% distal and 52.4% mesial; p0.002). In most of the cases the tooth distal to the agenesis site was the 1st permanent molar.(1) No difference was found between the developmental stage of teeth adjacent to the agenesis site and their antimeres. (2) Teeth mesial to the agenesis site showed some delay in development compared to teeth distal to the agenesis site, in this study. (3) The 1st molars, which were in most of the cases the distal adjacent tooth to the site of agenesis, showed developmental stability. (4) Additional longitudinal studies are needed to examine the dental developmental pattern in patients with agenesis.

Introduction Macrodontia of anterior teeth may occur as an isolated condition or as a result of fusion or gemination and may cause clinical problems such as tooth crowding and esthetic problems. Preliminary planning and careful management are often required by a dental team comprising an orthodontist, an endodontist, a prosthodontist, and an oral surgeon. A multidisciplinary treatment approach in a case with fused teeth is presented. Methods A 9-year-old girl presented with macrodontia of a left maxillary central incisor. The patient was referred to the orthodontic department because of a large central incisor as a result of fusion with an unspecific supernumerary tooth. The surgical procedure included sectioning off the mesial segment as far as possible, both apically and subgingivally, and extracting 1 of the fused supernumerary teeth. During the sectioning procedure, the pulp of the remaining tooth was exposed at the middle third of the root. Direct pulp capping was performed by an endodontist using mineral trioxide aggregate. Twelve weeks later, orthodontic treatment was commenced, and finally after a 26-month orthodontic treatment period, the central incisors' crown was restored using composite material. Results A 10-year clinical and radiographic follow-up revealed that the remaining resected central incisor kept its vitality, and the patient was pleased with the esthetic result. Conclusions Proper interdisciplinary treatment planning of complicated cases such as anomalous teeth, which involve fusion to a supernumerary tooth, may lead to minimal invasive conservative procedures that maintain tooth vitality and result in a pleasing esthetic result.