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Introduction: The hypothesis behind this study is that the ectopic mandibular canines move vertically in the mandibular bone during childhood and puberty. The aim was to evaluate interosseous vertical movements of the ectopic mandibular canines for improvement of diagnostic treatment and planning. Material and Methods: The study had two parts: a cross-sectional study and a longitudinal study. The cross-sectional study included orthopantomograms from 54 patients (ages 9 years and 6 months to 16 years) with ectopic mandibular canines. The longitudinal study included series of orthopantomograms from 14 out of the 54 patients. Two methods were involved in both studies. 1) The canine angle expressing the vertical position (angle between canine axis and the vertical line perpendicular to the occlusal plane) was registered. 2) The crown morphology indicating rotation of the canine, as well as the maturity of the canine (Nolla Score System), were registered. Results: The cross-sectional study demonstrated that the largest canine angles were observed in the most mature canines, often with the canine crown appearing in the lateral view. The longitudinal study demonstrated in 4 out of the 14 cases that the canines moved in the vertical plane towards a more upright position, resulting in a smaller angle, while the other ten cases moved during the observation period to a lower and more horizontal position, creating a larger angle. The crown morphology was unchanged in the uprighting cases, while rotation occurred in the ten cases undergoing increasing inclination. Maturity increased during all observation periods. Conclusions: This study is the first study which demonstrates and accordingly proves the hypothesis that the vertical movements and rotation of mandibular canines can occur in children and young adults diagnosed with ectopic mandibular canine eruption. These spatio-temporal movements are believed to be of importance for diagnostics and treatment planning of ectopic mandibular canines.

This article examines how managers in a municipal social service department use and interpret accounting information and make sense of changes in social work when new methods of cost control, and consequently a need for a more cost-conscious behavior, are introduced. Previous studies have shown that the extent to which accounting information has been embraced by professionals is mixed. Based on a case study where top management, middle management, and staff specialists at a medium-sized Danish municipality are interviewed, it is shown that accounting information can link cost-consciousness with social work practices. The study shows how managers can influence how professionals interpret and use accounting information. Further, the study shows how cost-consciousness can be integrated with social work practices in order to reduce costs and improve the quality of the services. In addition, the study shows how management interpret accounting information as a contribution to the professionalization of social work, and that managers’ sensemaking and sensegiving processes are important in reducing resistance when professionals are introduced to new forms of accounting information.

Objectives: The aim of the study was to analyse differences in pharyngeal airway dimensions and head posture between obstructive sleep apnea patients with and without morphological deviations in the upper cervical spine and to analyse associations between pharyngeal airway dimensions and head posture in the total sample. Material and Methods: The sample comprised 53 obstructive sleep apnea (OSA) patients of which 32.1% had upper spine morphological deviations. Accordingly two groups were defined: 17 OSA patients with morphological deviations in the upper spine and 36 without upper spine deviations. Pharyngeal airway dimensions in terms of distances, cross-sectional areas and volume and upper spine morphological deviations were evaluated on cone-beam computed tomography. Head posture was evaluated on two-dimensional generated lateral cephalograms. Differences were analysed and adjusted for age and gender by multiple linear regression analysis. Results: OSA patients with upper spine morphological deviations had a significantly more backward and curved neck posture (OPT/HOR, P < 0.01; OPT/CVT, P < 0.05) compared to OSA patients without spine deviations. No significant differences were found in airway dimensions between patients with and without upper spine deviations. In the total group significant associations were found between head posture and pharyngeal airway distances and cross-sectional area at the nasal floor, epiglottis and hyoid bone level (P < 0.05, P < 0.01, P < 0.001). No significant association was found between head posture and airway volume. Conclusions: The results may contribute to differentiate obstructive sleep apnea patients and thereby may prove valuable in diagnosis and treatment planning of obstructive sleep apnea patients.

Objectives: To compare 1) temporomandibular joint (TMJ) mobility between patients with and without reduced upper cervical spine (UCS) mobility and with and without TMJ osseous osteoarthritic-like changes, and 2) UCS osseous changes between patients with and without TMJ osseous osteoarthritic-like changes and with and without reduced UCS mobility.Study Design: The study comprised 39 patients without pain from TMJ or UCS and with obstructive sleep apnea, 15 women (age range 26-72 years, mean 56.0) and 24 men (age range 27-71 years, mean 49.8). The range of motion (ROM) of the mandible and UCS was assessed clinically. Osseous changes of the TMJ and UCS were assessed by cone beam computed tomography. Differences were tested and adjusted for age and gender by multiple linear and logistic regression analyses.Results: The mandibular ROM was within normal range (45-64 mm) but the UCS ROM was reduced in 15 patients. Osseous TMJ and UCS changes were both found in 38.5% of the patients. Osseous UCS changes were found more frequently in patients with than without TMJ changes (P = .0003; odds ratio 21.9). No other significant results were found.Conclusions: The present findings of comorbid osseous changes in patients with obstructive sleep apnea support a possible biomechanical relationship between the TMJ and the UCS. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to analyze craniofacial profiles and head posture in patients with obstructive sleep apnea (OSA) subgrouped according to cervical column morphology. Methods: Seventy-four white men aged 27 to 65 years (mean, 49.0 years) diagnosed with OSA in sleep studies by using overnight polysomnography were included. Only patients with apnea-hypopnea index scores between 5.1 and 92.7 (mean, 36.4) were included. Lateral profile radiographs in standardized head posture were taken, and cephalometric analyses of sagittal and vertical jaw relationships were made. The patients were divided into 4 groups according to fusion in the cervical vertebrae: group I, no fusions (42 subjects); group II, fusion of cervical vertebrae 2 and 3 (15 subjects); group III, occipitalization (10 subjects); and group IV, block fusion (11 subjects). Mean differences of craniofacial dimensions between the groups were assessed by unpaired t tests. Results: No significant differences were seen between groups I and III. Between groups I and II, significant differences were seen in jaw relationship (P < 0.05). Between groups I and IV, anterior face height and mandibular length deviated significantly. No significant differences were seen in head posture. Conclusions: OSA patients with block fusions in the cervical vertebrae and fusion of 2 vertebrae differed significantly in craniofacial profile from other OSA patients. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to analyze craniofacial profiles and head posture in patients with obstructive sleep apnea (OSA) subgrouped according to cervical column morphology. Methods: Seventy-four white men aged 27 to 65 years (mean, 49.0 years) diagnosed with OSA in sleep studies by using overnight polysomnography were included. Only patients with apnea-hypopnea index scores between 5.1 and 92.7 (mean, 36.4) were included. Lateral profile radiographs in standardized head posture were taken, and cephalometric analyses of sagittal and vertical jaw relationships were made. The patients were divided into 4 groups according to fusion in the cervical vertebrae: group I, no fusions (42 subjects); group II, fusion of cervical vertebrae 2 and 3 (15 subjects); group III, occipitalization (10 subjects); and group IV, block fusion (11 subjects). Mean differences of craniofacial dimensions between the groups were assessed by unpaired t tests. Results: No significant differences were seen between groups I and III. Between groups I and II, significant differences were seen in jaw relationship (P < 0.05). Between groups I and IV, anterior face height and mandibular length deviated significantly. No significant differences were seen in head posture. Conclusions: OSA patients with block fusions in the cervical vertebrae and fusion of 2 vertebrae differed significantly in craniofacial profile from other OSA patients. [Copyright &y& Elsevier]

Objective: To survey potential predictors of success of mandibular advancement device (MAD) therapy in patients with obstructive sleep apnea (OSA), and in particular, to examine anatomical narrowings and sleep-related collapse levels in the upper airway., Methods: This was a prospective study of 62 OSA patients (median apnea-hypopnea index [AHI] of 34), who were treated with a custom-made, monobloc MAD. The upper airway was examined by inspection, nasopharyngoscopy, overnight acoustic reflectometry recording collapses, and cephalometry of soft tissue dimensions (in addition to skeletal parameters). MAD treatment was controlled by polysomnograpy before and after at least five weeks from the beginning of treatment. Independent predictors of actual reduction in AHI and treatment success (reduction in AHI ≥ 50% with residual AHI < 10) were determined, using multivariable linear and logistic regression., Results: Positional OSA (POSA) and nonsupine AHI (adjusted for upper airway narrowness and collapses, together with gender, age, body mass index, neck circumference, and baseline AHI) were the only independent predictors: POSA indicative for success, and nonsupine AHI inversely related to success. Cephalometry was not predictive. Two predictive models were proposed, one based on POSA having a specificity of 70% and sensitivity of 69%, and the other based on nonsupine AHI, generating a receiver operating characteristic (ROC) curve (area under ROC = 0.78). Using the ROC model, specificity could be increased to 80% without lowering sensitivity., Conclusions: Only variables related to sleep position proved to be independent predictors of success with MAD therapy. The results could be explained by the MAD counteracting the mandible from moving backwards when sleeping supine., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: The aim of the study was to analyse differences in pharyngeal airway dimensions and head posture between obstructive sleep apnea patients with and without morphological deviations in the upper cervical spine and to analyse associations between pharyngeal airway dimensions and head posture in the total sample., Material and Methods: The sample comprised 53 obstructive sleep apnea (OSA) patients of which 32.1% had upper spine morphological deviations. Accordingly two groups were defined: 17 OSA patients with morphological deviations in the upper spine and 36 without upper spine deviations. Pharyngeal airway dimensions in terms of distances, cross-sectional areas and volume and upper spine morphological deviations were evaluated on cone-beam computed tomography. Head posture was evaluated on two-dimensional generated lateral cephalograms. Differences were analysed and adjusted for age and gender by multiple linear regression analysis., Results: OSA patients with upper spine morphological deviations had a significantly more backward and curved neck posture (OPT/HOR, P < 0.01; OPT/CVT, P < 0.05) compared to OSA patients without spine deviations. No significant differences were found in airway dimensions between patients with and without upper spine deviations. In the total group significant associations were found between head posture and pharyngeal airway distances and cross-sectional area at the nasal floor, epiglottis and hyoid bone level (P < 0.05, P < 0.01, P < 0.001). No significant association was found between head posture and airway volume., Conclusions: The results may contribute to differentiate obstructive sleep apnea patients and thereby may prove valuable in diagnosis and treatment planning of obstructive sleep apnea patients.

Background/objectives: The aim of the study was to assess cephalometric predictive markers in terms of craniofacial morphology including posterior cranial fossa and upper spine morphology for mandibular advancement device (MAD) treatment outcome in patients with obstructive sleep apnoea (OSA)., Material/methods: Twenty-seven OSA patients were treated with MAD for 4 weeks. Apnoea-hypopnoea index (AHI) was recorded before and after MAD treatment. The criteria of treatment success were 75 per cent reduction of AHI. Accordingly, two groups occurred: the success treatment group of 8 patients and the no success treatment group of 19 patients. Before MAD treatment lateral cephalograms were taken and analyses of the craniofacial morphology including the posterior cranial fossa and upper spine morphology were performed. Differences between the groups were analysed by Fisher's exact test, t-test, and multiple regression analysis., Results: Upper spine morphological deviations occurred non-significantly in 25 per cent in the success treatment group and in 42.1 per cent in the no success treatment group. Body mass index (BMI; P < 0.05), maxillary prognathism (S-N-Ss; P < 0.01), mandibular prognathism (S-N-Pg; P < 0.05 and S-N-Sm; P < 0.01), and the distance between sella turcica and the deepest point in posterior cranial fossa (S-D; P < 0.05) was significantly smaller in the success treatment group. The maxillary prognathism (P < 0.05) was the most important factor for the MAD treatment outcome (R (2) = 0.47)., Limitations: Relatively small sample size., Conclusions: The results indicate that BMI, posterior cranial fossa morphology, and retrognathia of the jaws are factors related to MAD treatment outcome. Furthermore, OSA patients with upper spine morphological deviations may respond poorer to MAD treatment., (© The Author 2014. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aims: To assess the prevalence of temporomandibular joint (TMJ) bony changes in cone beam computed tomography (CBCT) images of adult subjects without ongoing orofacial pain or complaints from the TMJ., Methods: The study included 84 TMJs from 28 men and 14 women (mean age [± SD]: 51 ± 11 years) without orofacial pain or TMJ complaints who were participants in a study of patients with obstructive sleep apnea. They were examined before any treatment with the Research Diagnostic Criteria for Temporomandibular Disorders and with CBCT (NewTom VGi; 15 × 15 cm, exposure time 18 seconds, axial thickness 0.3 mm). Osseous TMJ deviations were assessed blindly and classified., Results: Degenerative changes were noted in the CBCT images of 33 (39.3%) of the TMJs, of which 21 were classified as osteoarthritic alterations and 12 as indeterminate changes of osteoarthritis. Two TMJs were clinically classified as osteoarthrosis and 6 as disc displacement with reduction. The CBCT images of the 2 TMJs with a clinical diagnosis of osteoarthrosis showed also bony changes, but the CBCT images also revealed osteoarthritic bony changes in the 18 TMJs without any clinical diagnosis., Conclusion: CBCT images of asymptomatic adult TMJs commonly show degenerative bony alterations. Accordingly, such radiographic findings should be used with care and only as a supplement to clinical assessment.

Objectives: Few studies have described morphological deviations in obstructive sleep apnoea (OSA) patients on two-dimensional (2D) lateral cephalograms, and the reliability of 2D radiographs has been discussed. The objective is to describe the morphology of the cervical vertebral column on cone beam CT (CBCT) in adult patients with OSA and to compare 2D lateral cephalograms with three-dimensional (3D) CBCT images., Methods: For all 57 OSA patients, the cervical vertebral column morphology was evaluated on lateral cephalograms and CBCT images and compared according to fusion anomalies and posterior arch deficiency., Results: The CBCT assessment showed that 21.1% had fusion anomalies of the cervical column, i.e. fusion between two cervical vertebrae (10.5%), block fusions (8.8%) or occipitalization (1.8%). Posterior arch deficiency occurred in 14% as partial cleft of C1 and in 3.5% in combination with block fusions. The agreement between the occurrence of morphological deviations in the cervical vertebral column between lateral cephalograms and CBCT images showed good agreement (κ = 0.64)., Conclusions: Prevalence and pattern in the cervical column morphology have now been confirmed on CBCT. The occurrence of morphological deviations in the cervical vertebral column showed good agreement between lateral cephalograms and CBCT images. This indicates that 2D lateral cephalograms (already available after indication in connection with, e.g. treatment planning) are sufficient for identifying morphological deviations in the cervical vertebral column. For a more accurate diagnosis and location of the deviations, CBCT is required. New 3D methods will suggest a need for new detailed characterization and division of deviations in cervical vertebral column morphology.