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Examines the relationship between the orientation and moment arms of the human jaw muscles and normal craniofacial morphology. Characteristics of the jaw muscles of subjects with increased vertical craniofacial dimensions; Method used in defining the subjects' jaw muscle orientation; Use of magnetic resonance imaging in analyzing the craniofacial morphology of the subjects.

Objective: Surgical mandibular advancement procedures induce major adaptations of jaw-closing muscles. In this study, adaptation of antagonist muscles, the lateral pterygoid (LPM) and anterior digastric (DigA) muscles, was evaluated., Study Design: Eighteen adult patients with mandibular retrognathia and individually varying vertical craniofacial dimensions were treated with bilateral sagittal split osteotomies (BSSO), in some cases combined with a Le Fort I osteotomy (LF Bimax). The sample was divided into 1 short-face (SF, n = 7) and 2 long-face groups (LF BSSO, n = 3; and LF Bimax, n = 8). Pre- and postoperative maximum cross-sectional areas (CSA) and volumes were compared in these groups., Results: Postoperatively, CSA and volume of LPM increased in BSSO cases and decreased in bimaxillary cases. Inconsistent increases and decreases of CSA and volume of DigA were seen in all groups., Conclusions: The LPM became larger in SF and LF BSSO patients and smaller in LF Bimax patients. The DigA adapted unpredictably.

Objective: In humans, the vertical craniofacial dimensions vary significantly with the size of the jaw muscles, which are regarded as important controlling factors of craniofacial growth. The functional relevance of the maximum cross-sectional area (CSA), indicating maximum muscle strength, is questionable since peak forces are generated only a fraction of the day. Alternatively, muscle volume (indicating the generated loads) might be a more meaningful functional variable. Therefore, the aim of this study was to investigate if jaw muscle volume is stronger related with vertical craniofacial dimensions than with jaw muscle CSA., Design: Thirty-one adult healthy subjects with varying vertical craniofacial morphology participated in this study. Axial magnetic resonance imaging (MRI) scans were used for segmentation of the masseter (Mas) and medial pterygoid muscles (MPM). This enabled measurements of the muscle CSA and volume. Cephalometric analysis was performed using lateral radiographs. With factor analysis, the number of cephalometric variables was reduced into two factors that represented the anterior face height and the posterior face height (PFH), respectively. Subsequently, mutual relationships between these factors and muscular variables were assessed using a multiple regression analysis., Results: It was found that vertical craniofacial dimensions were significantly better (up to 12%) related with muscle volume rather than with CSA. Furthermore, it was shown that especially the PFH factor was significantly correlated with the Mas and MPM., Conclusion: Vertical craniofacial dimensions are stronger related with jaw muscle volume than with CSA. Tentatively, it can be assumed that the generated muscle loads, rather than maximum forces, influence vertical craniofacial growth.

The aim of the present study was to investigate to what extent general factors (e.g. genotype, hormones) and factors at the craniofacial level (e.g. craniofacial size, jaw muscle architecture) contribute to the size and strength of the jaw muscles. A strong relationship of jaw muscle size and strength with that of other muscles would argue for general influences, whereas a weak relationship would argue for craniofacial influences. In 121 adult individuals, moments of maximal bite force, arm flexion force and leg extension force were measured. In addition, thicknesses of jaw muscles, arm flexor muscles and leg extensor muscles were measured using ultrasound. Relationships were assessed by using a principal component analysis. In females, one component was found in which all force moments were represented. Bite force moment, however, loaded very low. In males, two components were found. One component loaded for arm flexion and leg extension moments, the other loaded for bite force moments. In both females and males, only one component was found for the muscle thicknesses in which all muscle groups loaded similarly. It was concluded that the size of the jaw muscles was significantly related to the size of the limb muscles, suggesting that they were both subject to the same general influences. Maximal voluntary bite force moments were not significantly related to the moments of the arm flexion and leg extension forces, suggesting that besides the general influence on the muscle size, variation in bite force moment was also influenced by local variables, such as craniofacial morphology.

One aim of this study was to assess right-left differences in the volume of masticatory muscles in controls so as to be able to distinguish between normal variations and pathological differences. The other aim was to compare the masticatory muscle volume of the nonaffected side of hemifacial microsomia patients with the smaller side of controls so as to test the compensation hypothesis. The study group consisted of 39 children with hemifacial microsomia and the control group of 52 children. Computed tomography scans were made using a Philips Tomoscan 350 and a Pro Speed S Fast Spiral General Electric scanner. The normal right-left differences in volume of the masticatory muscle of the controls, calculated as a percentage of the total, demonstrated small mean differences of 2.57% to 2.88% (SD:1.98-2.74). For hemifacial microsomia patients, the relative difference was about 10 times the difference for controls. For controls, the averages of the right-left differences (%) were all below the generally accepted SEM of 4%. Testing the compensation hypothesis of all effects, only the age effect was multivariately significant (P < 0.001). No overcompensation of the masticatory muscles of the nonaffected side of hemifacial microsomia patients could be demonstrated.

Objectives: To compare approximal caries detection on Digora storage phosphor images pre-enhanced with the automatic "caries-specific Oslo enhancement procedure" ("Oslo-enhanced" method) and storage phosphor images individually enhanced by observers particularly experienced in digital imaging using standard brightness and contrast functions of the Digora system ("Digora-enhanced" method)., Methods: Seven staff members from four oral radiology departments rated 240 approximal surfaces for caries with regard to lesion depth in the inner and outer half of the enamel and dentine, using a 5-point confidence scale. The observations were validated histologically. A receiver operating characteristic (ROC) analysis and an analysis of variance with three dependent variables (observer confidence, observer signed error and observer absolute error) were performed., Results: The most evident difference between the methods as elucidated by the ROC analysis was the highly significant smaller interobserver and intraobserver variance with the Oslo-enhanced method for all but one observer. The methods were not different with regard to average diagnostic accuracy (A(z) values) as tested with paired t-tests, and there was no correlation between A(z) across methods. The method and lesion main effects, as well as the lesion by method interaction effect, were multivariately significant (P<0.001) in favour of the Oslo-enhanced method. On a univariate level, the method main effect was not significant for the absolute observer error (P=0.330). All other univariate effects were significant (P<0.001)., Conclusions: The accuracy of approximal caries detection with Digora storage phosphor images pre-enhanced and images individually enhanced was similar, but interobserver and intraobserver variability improved with the Oslo-enhanced method. Since image manipulation is not performed with the Oslo-enhanced method, the increased speed of the diagnostic procedure combined with the improved observer variability would probably be even more pronounced for the general dental practitioner.

Objective: To determine a proper scanning resolution for digitizing bitewing radiographs in the detection of approximal caries., Methods: Fifty-two premolars and 48 molars were mounted in blocks and imaged on conventional film (Ektaspeed Plus, Eastman-Kodak, Rochester, NY USA) simulating a bitewing projection. The 15 bitewing radiographs were then scanned with a flatbed scanner at three resolutions 150, 300 and 600 d.p.i. The digitized images were displayed in random order on a high-resolution cathode ray tube monitor. Ten observers assessed the caries status of 200 approximal surfaces. They scored lesion presence on a 5-point confidence scale and depth on a 3-point scale. The observer's scores were compared with the results from a histological examination. Data were analysed using analysis of variance, by calculating signed observer error, absolute observer error and observer confidence., Results: Lesion depth had a significant effect on confidence of lesion recognition. The main effect of resolution and the interaction between resolution and lesion depth were significant. Pair-wise comparison showed a significant difference between resolutions in case of sound surfaces and surfaces with dentinal lesions for absolute error. The confidence increased as the resolution increased but no significant difference was found between 300 and 600 d.p.i. The best score for depth estimation was obtained at the 300 d.p.i. scanning resolution., Conclusions: When bitewing radiographs are scanned with a flatbed scanner, a resolution of 300 d.p.i. seems the best choice. At this resolution the digital file size is manageable without significant loss of the information necessary for caries diagnosis.

Objectives: To determine the interaction between image noise and file compression, with special emphasis on the accuracy of caries diagnosis., Methods: Fifty-nine bitewing radiographs of patients were taken simultaneously with Ektaspeed Plus (Eastman-Kodak, Rochester, NY, USA) film without lead foil and the Digora storage phosphor system (Soredex, Helsinki, Finland). Three different levels of Gaussian noise were added to the original digital images which were then compressed with JPEG 53. Seven observers evaluated the presence and depth of caries lesions on selected approximal surfaces on a 5-point scale. The results of JPEG 27 compression from a previous study were also included. ROC analysis was used together with multivariate analysis of variance (MANOVA)., Results: JPEG 27 and 53 reduced the file size down to 7% and 4.6% of the original respectively. ROC curve analysis showed no significant difference between image conditions (original, JPEG 27, and JPEG 53) at the same noise level. JPEG 27 and 53 had larger Az scores than their original counterparts at the same noise level. However, MANOVA showed that for depth estimation of enamel lesions JPEG 53 resulted in a higher observer error., Conclusions: Both JPEG 53 and 27 could reduce some of the adverse effect of noise from the image by removing high spatial frequencies. JPEG 53, resulting in a compression ratio of 1:21, does not compromise the diagnostic performance in general. JPEG 53 compression may however affect the ability to detect enamel lesions.

Objectives: To examine the effects of developer age on image quality., Methods: Endodontic files, size 10 and 15, were placed in upper and lower molars and premolars up to the root apex or 1.5 mm short. A series of radiographs were made with each of three film types: Dentus M2 (Agfa-Gevaert, Mortsel, Belgium), Ektaspeed Plus and Ultra-speed (Kodak Eastman Co, Rochester, USA). The films were processed bi-weekly using the same Agfa chemicals (Heraeus Kulzer, Dormagen, Germany) over a 6-week period. An additional set of Dentus M2 films was processed using Periomat chemicals (Dürr Dental, Bietigheim-Bissingen, Germany). The films were viewed by eight dentists who rated the position of the tip of the file using a 5-point confidence scale. ROC data were analysed by means of analysis of variance. Az value was the dependent variable, whereas observer age group was entered as between subject factor. The null hypothesis was rejected when P<0.05., Results: The diagnostic accuracies of the three films were comparable during the first 4 weeks. In the sixth week Ultra-speed was significantly better than the other two films (P=0.046). The Periomat chemicals showed significantly greater consistency than the Agfa chemicals (P=0.004). Developer exhaustion significantly affected the performance of the older observers (P=0.008), especially when Agfa chemicals and file size 10 were used., Conclusion: Agfa chemicals older than 4 weeks significantly affect the assessment of endodontic file length. In earlier stages there are no significant differences between the three films tested. Dentus M2 and Ektaspeed Plus films should be used as they require lower exposures.

Objectives: To compare the diagnostic accuracy for the detection of approximal caries of three dental X-ray films using fresh and aged processing chemicals., Methods: Fifty-six extracted unrestored premolars were radiographed under standardized conditions using the new Dentus M2 (Agfa-Gevaert, Mortsel, Belgium), Ektaspeed Plus and Ultra-speed (Kodak Eastman Co, Rochester, USA) dental films. The films were processed manually using Agfa chemicals (Heraeus Kulzer, Dormagen, Germany). The procedure was repeated once a week until the complete exhaustion of the chemicals (6 weeks). Three independent observers assessed 210 radiographs using the following rating scale: 0 = sound, 1 = enamel lesion; 2 = lesion reaching the ADJ; 3 = dentinal lesion. True caries depth was determined by histological examination (14 sound surfaces, 11 enamel lesions, eight lesions reaching the ADJ and 23 dentinal lesions). True caries depth was subtracted from the values given by the observers and an analysis of variance was performed. The null hypothesis was rejected when P < 0.05., Results: No significant differences were found in the diagnostic accuracy between the three films when using chemicals of up to 3 weeks old (P = 0.056). After the third week, Ultra-speed was significantly better than the other two films (P = 0.012). On average caries depth was underestimated., Conclusion: A similar level of diagnostic accuracy for approximal caries is achieved when using the three films. Dentus M2 and Ektaspeed Plus are at present the fastest available films and they should therefore be recommended for clinical practice. Agfa chemicals should be renewed every 3 weeks. Fifty per cent reduction in average gradient is indicative of renewing processing chemicals.

Objectives: To examine the effects of exhaustion of five different processing solutions on the sensitometric properties of four dental X-ray films: Ektaspeed Plus and Ultra-speed (Kodak Eastman Co. Rochester, USA) and new and previous Dentus M2 (Agfa-Gevaert, Mortsel, Belgium)., Methods: An aluminum stepwedge was used to construct characteristic curves for the four films. All films were processed manually using three sets of chemicals for manual processing: Agfa (Heraeus Kulzer, Dormagen, Germany), Kodak (Kodak-Pathé, Paris, France) and Demat (Viscopac, Athens, Greece) and two sets for automatic processing: Dürr XR and Periomat (Dürr Dental, Bietigheim-Bissingen, Germany). Film speed and gradient were evaluated until the chemicals were completely exhausted. An analysis of variance was performed separately for each set of chemicals for manual and automatic processing., Results: Ektaspeed Plus was the fastest film in the manual processing solutions. The new Dentus M2 and Ektaspeed Plus films had similar speed using the chemicals for automatic processing. Ultra-speed had the lowest speed in all solutions, but it had the greatest consistency. Exhaustion of the developer caused a comparable decrease in speed of Ektaspeed Plus and the two Dentus M2 films. In fresh chemistry Agfa was the strongest manual processing solution, but it had the highest exhaustion rate. The Dürr XR chemical was stronger than Periomat over the whole test period., Conclusions: The combination of film and processing solution is an important factor for achieving constant sensitometric properties. Ektaspeed Plus and the new Dentus M2 film should be used in dental practice, as they require lower exposure and have equivalent or superior properties compared with Ultra-speed.

Objectives: To compare the sensitometric properties of four dental films: Ektaspeed Plus and Ultra-speed (Kodak Eastman Co, Rochester, USA) and new and previous Dentus M2 (Agfa-Gevaert, Mortsel, Belgium) in five different processing solutions., Methods: Characteristic curves were constructed for four dental X-ray films using five different processing solutions. All films were processed manually in three sets of chemicals for manual processing: Agfa (Heraeus Kulzer, Dormagen, Germany), Kodak (Kodak-Pathé, Paris, France) and Demat (Viscopac, Athens, Greece) and two sets of chemicals for automatic processing: Dürr XR and Periomat (Dürr Dental, Bietigheim-Bissingen, Germany). Analysis of variance and regression analysis was performed to examine the factors significantly affecting film density., Results: The new Dentus M2 film had comparable gradient, higher speed and lower base-plus-fog than its predecessor. It had comparable speed with Ektaspeed Plus in chemicals for automatic processing. All films had a higher speed and lower gradient when processed in the chemicals for automatic processing. The highest film speed was achieved using Dürr XR chemicals., Conclusions: The new Agfa Dentus M2 film is an E-speed film and can be considered an alternative to Ektaspeed Plus: both can be recommended for use in dental practice as they contribute to dose reduction.

The existence of an interaction among bite force magnitude, jaw muscle size (e.g., cross-sectional area, thickness), and craniofacial morphology is widely accepted. Bite force magnitude depends on the size of the jaw muscles and the lever arm lengths of bite force and muscle forces, which in turn are dictated by craniofacial morphology. In this study, the relative contributions of craniofacial morphology and jaw muscle thickness to the bite force magnitude were studied. In 121 adult individuals, both magnitude and direction of the maximal voluntary bite force were registered. Craniofacial dimensions were measured by anthropometrics and from lateral radiographs. The thicknesses of the masseter, temporal, and digastric muscles were registered by ultrasonography. After a factor analysis was applied to the anthropometric and cephalometric dimensions, the correlation between bite force magnitude, on the one hand, and the "craniofacial factors" and jaw muscle thicknesses, on the other, was assessed by stepwise multiple regression. Fifty-eight percent of the bite force variance could be explained. From the jaw muscles, only the thickness of the masseter muscle correlated significantly with bite force magnitude. Bite force magnitude also correlated significantly positively with vertical and transverse facial dimensions and the inclination of the midface, and significantly negatively with mandibular inclination and occlusal plane inclination. The contribution of the masseter muscle to the variation in bite force magnitude was higher than that of the craniofacial factors.

Objectives: To determine the effect of noise on the compressibility and the diagnostic accuracy for caries detection of digital bitewing radiographs., Methods: Bitewing radiographs of patients were obtained with a storage phosphor (Digora, Soredex, Helsinki, Finland) and compressed at different JPEG compression levels (2, 27, 53 and 128). A just noticeable difference study was performed to select a compression level to study the added noise effect. Gaussian noise was added at low, medium, and high levels to both the original and compressed images. Seven observers examined the selected approximal surfaces to identify the caries depth. ROC analysis was performed together with ANOVA at P = 0.05., Results: The compressibility of the images decreased as the noise level increased. ROC analysis revealed no significant difference between the original and compressed images within the same noise level (P > 0.06). With added noise compressed/decompressed images had a higher Az than the corresponding original images., Conclusions: JPEG compression at level 27 can be used without a significant deterioration in diagnostic accuracy. Compression at this level seemed to reduce the effect of noise to some extent.

Objectives: To measure the entrance dose from periapical radiography in Greece and to determine the relative influence of factors affecting it., Methods: Special packs, containing a questionnaire, a film (X-Omat MA 18 x 22.4 cm, Ready Pack, Kodak-Pathe, Paris, France) with an attached aluminium stepwedge and a pre-exposed Ektaspeed Plus (Kodak) film, were mailed to 550 randomly selected dental practitioners. The results were tested statistically using an Analysis of Variance (level P < 0.05)., Results: Three hundred and sixty-four packs were returned: 311 were complete but in 53 the pre-exposed film had not been developed. The average HVL was 1.4 mm Al 51% of the units had pointed cones and 34% a beam diameter larger than 6 cm. 54% of the dentists used E-speed films. Eighty per cent of the films were inadequately processed. For the total group the average entrance dose was 6.9 mGy (range 0.6-36 mGy), and 6.3 mGy (range 0.6-35 mGy) for the completed packs (n = 311). The radiation dose for the completed packs was significantly influenced by HVL, film speed, length of cone and standard of processing., Conclusions: HVL, film speed, length of cone and standards of processing influence the entrance dose. Not all of the available measures for reducing radiation dose are commonly practised in Greece. Continuing education programs can help to improve radiation safety for dental patients.

Objectives: To analyse the interaction of calibration, automatic greyscale adjustment and X-ray exposure on the evaluation of simulated bone lesions with the Digora (Orion Corporation Soredex, Helsinki, Finland) storage phosphor system., Methods: Exposures were made under five conditions based on the exposure time for Ektaspeed Plus film: A-calibration exposure 100%, exposure 100%; B-calibration exposure 100%, exposure 50%; C-calibration exposure 100%, exposure 10%; D-calibration exposure 50%, exposure 50%; E-calibration exposure 10%, exposure 10%. Series of images of artificial bone lesions were created each representing one of the five conditions, with or without automatic greyscale adjustment and including one of two lesion sizes. The series were evaluated by seven expert radiologists. Results were analysed by means of MANOVA statistics., Results: The large lesions were evaluated significantly better than the small lesions (P < 0.011). The two 10% exposure conditions were evaluated significantly worse than the other three (P < 0.029) which had comparable results. Automatic greyscale adjustment had no significant effect (P > 0.253)., Conclusions: The Digora should be calibrated for the highest exposure to be used to optimize the wide latitude. Automatic greyscale adjustment is not useful for the detection of simulated bone lesions.

Objective: To determine whether a thyroid collar is a reasonable measure to reduce patient exposure from intraoral radiography (cost benefit analysis)., Design: In the thyroid gland of a Rando phantom dose measurements were carried out to determine the effect of a thyroid collar during intraoral radiography., Setting: Department of Oral Radiology at ACTA, Amsterdam., Methods: Dose measurements were carried out using LTDs. The average absorbed dose to the thyroid gland with and without thyroid collar from intraoral radiography was compared using an analysis of variance., Results: For periapical radiographs the equivalent dose to the thyroid gland was significantly lower (p < 0.05) when a thyroid collar was used. For bitewing radiography there were no significant effects of the thyroid collar (p > 0.05). The cost benefit analysis showed that it takes more than 40 years before the benefits of a thyroid collar exceed the costs., Conclusion: Collective use of thyroid collars therefore does not seem to be a reasonable measure to optimize radiological protection during intraoral radiography.

Objective: The purpose of this study was the validation of two-point discrimination, Semmes-Weinstein, and pinprick tests of possible sensory disturbance of the inferior alveolar nerve after the surgical removal of lower wisdom teeth., Study Design: Forty-two patients who had undergone elective unilateral lower wisdom tooth removal and 30 control subjects were given two-point discrimination, Semmes-Weinstein, and pinprick tests bilaterally in the dermatome of the mental nerve. Test results were compared to the patients subjective experiences of sensory disturbance. Statistical analysis was done with multivariate analysis of variance., Results: Untreated sides in patients and test sides in control subjects agreed well for all tests. Five of the 42 patients mentioned sensory disturbance, which was confirmed objectively in 3 (by pinprick and two-point discrimination tests). Testing revealed that 16 of the 42 patients had abnormal pinprick and two-point discrimination tests without subjective sensory disturbance. No abnormal values were found for Semmes-Weinstein tests in any of the patients. Multivariate analysis of variance identified a univariately significant effect of the two-point discrimination test (p = 0.027); all other interactions were multivariately insignificant., Conclusion: The value of neurosensory testing after third molar removal is limited because of inconsistency between objective test results and subjective findings.

Objectives: To compare the standards of periapical radiography with a CCD-image receptor with film., Methods: Three radiography technicians exposed a total of fifty teeth from all areas of the jaws using either size 1 or size 2 film and the Sidexis (Siemens, Bensheim, Germany) direct digital dental radiography system with the appropriate film holders. Image quality was assessed by two dental radiologists for nine individual criteria and overall, on a three-point scale., Results: There was a significant difference between film and sensor exposures (P < 0.014). Six per cent of dental films required retakes compared with 28% with the sensor., Conclusion: Periapical radiography with a CCD sensor leads to more errors and thus more retakes than conventional film.

Due to the increasing number of osteoporotic fractures of hip, spine, and wrist there is a growing need for methods to track down the subjects with inferior bone structure and to monitor the effects of therapeutic measures. This study aims at a noninvasive diagnostic tool, deriving architectural properties of trabecular bone from in vivo measurements on plane radiographic films. Pelvic radiographs of the nonfractured hips of 81 patients with hip fractures and of the right hips of 74 controls were studied. The regions of interest, 2 x 2 cm2, located in the femoral neck, were sampled and digitized with a video camera connected to an image analysis system. Several geometrical and directional measurements were made. The measurements were evaluated by statistical comparison with fracture risk, gender, and Singh index. By discriminant analysis, type of fracture, as well as gender and Singh index could be predicted correctly for 58% of the subjects, whereas guessing would be correct in only 8%. It was found that the geometrical parameters discriminate between hips of controls and patients. With respect to the directional measurements associations were found with gender and Singh index. Although the new parameters assess fracture risk less accurately than bone density measurements, some parameters suggest by their behavior that they are relevant with respect to femoral bone architecture and its mechanical behavior. Although interpretation of the measurements in histological concepts requires methods that have been reported in literature only recently, it is concluded that digital analysis of the radiographic trabecular pattern is an interesting option to increase the diagnostic yield of plane film radiographs and to study the structure of bone in vivo.

The aim of this in vivo study was to compare approximal caries depth on storage phosphor plate images to conventional film. A Soredex Digora imaging plate was placed in a film bite-wing positioner behind a Kodak Ektaspeed Plus film package without lead foil. The effect of scattered radiation on film without lead foil with a storage phosphor plate at the back was studied in a separate in vitro experiment. Compared with film protected by lead foil, the film showed higher density, but comparable contrast. For the in vivo study, clinical bite-wing exposures were made with the setup described above, with exposure settings for Ektaspeed Plus film. A four-point scale was chosen for approximal caries depth: 0 = no caries; 1 = caries in enamel; 2 = caries reaching dentino-enamel junction; 3 = caries into dentin. The bite-wing film images were shown to a panel of four experts. Sixty surfaces were selected for observer performance, based on identical scorings of the experts consensus classification. Next, six dentists evaluated both film and storage phosphor plate images with the same four point scale. Analysis of variance revealed a significant observer and image modality effect without an interaction effect. In conclusion, caries depth on storage phosphor plate images was underestimated compared with film-based images.

The trabecular pattern depicted on radiographs of the distal radius of women around the menopause is analysed by a new method to measure orientation. It is shown that the trabecular pattern on radiographs of the distal radius is aligned preferentially along the axial direction and to a lesser extent along the transverse direction. Two minima of orientation are found at 60 degrees off the axial direction. A significant correlation is found between the average value of the orientation in the radius and the average lumbar bone mineral density. It is known that the bone mineral content decreases around the menopause. Previous reports on the present images describe several features that were found to be related to bone mineral content and to time. The orientation of the trabecular pattern, however, is found to be independent of time, at least during the two years of the investigation. Therefore, it is concluded that the orientation of the radiographic trabecular pattern tends to remain stable even if some features of the pattern evolve. Previous studies on radiographs of the radius of children and elderly women and men provide evidence for the tendency of orientation to remain stable not only in women around the menopause, but also in men and women during the entire adult life.

Digital images produced by direct sensor systems are much larger than conventional radiographic film images because of monitor resolution and digital image file sizes. This difference in size may introduce difficulties when estimating distances (for example, during endodontic treatment). The aim of this study was to compare observers' estimates of distances on digital images with those of conventional radiographs.

Objectives: The purpose of this study was to determine the relationship between dental crowding and the clinical presence or absence of third permanent molar teeth., Methods: Ninety-nine patients were analysed before and after orthodontic treatment and at least three years after the end of retention. The sample consisted of four groups: subjects whose third permanent molar teeth had erupted into the mouth, were non-erupted, were extracted, and were congenitally absent. Arch Length Discrepancy, Irregularity Index and observer bias were examined. Multivariate analysis of variance with repeated measurements was used to analyse differences between the four groups., Results: Significant differences in Arch Length Discrepancy during time were shown between the premolar segment and the frontal area. The group with third permanent molar teeth congenitally missing showed a significant higher positive Arch Length Discrepancy in the premolar segment of the upper jaw. No significant differences in Irregularity Index were found between the third molar groups., Conclusions: It can be concluded that there is no relation between crowding and the presence or absence of third permanent molar teeth.

Objectives: The purpose of this study was to introduce stereophotogrammetry as a three-dimensional registration method for quantifying facial morphology and detecting changes in facial morphology during growth and development., Methods: Using stereophotogrammetry, three-dimensional (3-D) co-ordinates for the bilateral landmarks Exocanthion and Cheilion and the midsagittal landmark Pronasale were determined in 10 subjects to ascertain the reproducibility of the method, and in 59 children to detect changes in facial morphology due to growth and development. Linear and angular measurements were calculated by means of the 3-D co-ordinates in order to quantify facial morphology. Significant differences were determined by means of analyses of variance (MANOVA)., Results: During the observation period, significant (P < 0.01) changes in facial morphology were determined for the linear measurements. Advantages and disadvantages of current registration methods are discussed., Conclusion: It is concluded that stereophotogrammetry is a suitable 3-D registration method for quantifying and detecting developmental changes in facial morphology.

Long-face subjects have strongly reduced bite forces relative to normal subjects. This difference cannot be fully explained by the reduced cross-sectional area of the jaw muscles. In this study, we investigated whether the orientation and moment arms of the jaw muscles of normal and long-face subjects are different, and if so, to what extent these differences contribute to the observed differences in maximum molar bite-force levels. Three MRI scan series with different orientations were made of the jaw muscles of 30 normal and 13 long-face subjects. These served as the basis for computer reconstructions of the external shape of the muscles. The spatial orientation of the jaw muscles was defined by the regression line through the centroids of the muscular cross-sections. The moment arms of the jaw muscles and the bite point of the first mandibular molar were measured with respect to the center of the ipsilateral condyle. The muscular variables-including angles, moment arms, and mechanical advantage-were analyzed with a discriminant analysis and a multivariate analysis of variance (MANOVA). Differences in the spatial orientation of the temporalis muscle and the anterior digastric muscle contributed most to the distinction of the normal and long-face group. With MANOVA, it was shown that the normal and long-face group did not significantly differ with respect to the jaw muscle moment arms and mechanical advantage data. Only small differences were found between the sagittal muscle angles of the masseter and anterior digastric muscles in the two groups. In both the normal and long-face group, the orientation and moment arm data of the right and left muscles differed significantly. It was concluded that the variation of the spatial orientation of the jaw muscles is small and does not significantly contribute to the explanation of the different molar bite-force levels of long-face and normal subjects. Therefore, it is tempting to assume that the jaw muscles of normal and long-face subjects are different with respect to the maximum force they can exert per unit of cross-sectional area.

It is widely accepted that an interaction exists between masticatory muscle function and craniofacial growth. In adults, correlations have been found between facial dimensions and jaw-muscle cross-sectional area, and between facial dimensions and masseter muscle thickness. Little is known about growth of the human masticatory muscles and its relation with facial dimensions at different ages. In 329 Greek individuals, aged 7-22 yr, masseter muscle thickness was measured by ultrasonography. Muscle thickness was related to age, stature and weight, and to facial dimensions, measured by means of anthropological calipers. Muscle thickness was statistically assessed by univariate analysis of variance, after the males and females had been divided into three age groups. Facial dimensions were assessed by multivariate analysis of variance, age being considered as a covariate. The relation between muscle thickness and facial dimensions was subjected to stepwise multiple regression analysis. Masseter muscle thickness increased with age in both sexes. No differences were found between the left- and right-hand side. For each age group (and corrected for stature and weight), males had significantly thicker masseters than females (p < 0.01). Variation in muscle size and facial dimensions mainly coincided with variation in age, stature and weight. Apart from these, muscle thickness showed a significantly negative relation with anterior facial height and mandibular length, and a significantly positive relation with intergonial width and bizygomatic facial width.

To describe structural and textural changes in bone structure, the radiographic trabecular pattern of children, aged 4-14 years, was examined using a digital image processing system. This investigation is based on data from the Nijmegen Growth Study, a mixed-longitudinal growth study comprised of three birth cohorts, which were observed for five years. Of 3075 left hand-forearm radiographs of 426 children, a standard area of 10 x 10 mm of the radius was digitized and the trabecular pattern was described by ten image features. It is demonstrated that all image features show significant changes during the observation period (multivariate analysis of variance of p < 0.01). The age of the children correlates significantly with the image features (Spearman's Rho = 0.4; p < 0.05). Because of cohort effects, the three cohorts were studied separately. Highest correlations between age and trabecular pattern were shown in the cohort of the youngest children. The changes of the image features during the observation period seems to indicate that the fine trabecular pattern of young children changes into a coarser adult pattern. It is concluded that digital quantification of the radiographic trabecular pattern is appropriate to describe changes in trabecular bone.

The purpose of the present study was to describe three-dimensional developmental changes of facial asymmetry in children with an operated complete unilateral cleft lip and palate (UCLP) and in children without craniofacial anomalies (controls). Using stereophotogrammetry, three-dimensional coordinates for 16 bilateral and 10 midsagittal facial landmarks were determined for the UCLP group (n = 33) and the control group (n = 63) on two occasions. In this mixed-longitudinal study, the children were 4 to 12 years of age. Facial asymmetry and left-right dominance was measured and resolved for transverse, vertical, and sagittal components. Significant effects were analyzed with multivariate analyses of variance (MANOVA). We concluded that individuals with complete unilateral cleft lip and palate, as well as individuals without craniofacial anomalies, show an increase, during growth, in the amount of facial asymmetry in the basal region of the nose. In the region that is related to the cleft, children with complete unilateral cleft lip and palate do not show changes in the amount of facial asymmetry between the occasions. Regarding facial left-right dominance and variation in dominance, no demonstrable growth changes take place in individuals with complete cleft lip and palate, nor in individuals without craniofacial anomalies.

The effects of intermittent hydrostatic compressive force (ICF; 13 kPa applied at 0.3 Hz frequency), as a substitute for moderate loading in vivo, on ossifying bone organ cultures, were evaluated by means of (histo)-morphometry. In earlier studies, biochemical tests have shown an increased 45Ca intake and an increased alkaline phosphatase activity in bone organ cultures that received ICF, suggesting that ICF promoted matrix mineralization. The purpose of this study was to examine whether an effect of ICF on mineralization can be described by means of histomorphometrical analysis. Fetal mouse metatarsal bone rudiments were cultured for 5 days in serum-free medium, with (experimental) or without (control) ICF. Linear measurements taken during culture demonstrated that the dark zone in the center of the rudiment, representing mineralized hypertrophic cartilage, became significantly longer in the group that received ICF when compared with the control group. This finding was in conformation with the former studies. Histological sections of the rudiments, stained with Goldner's trichrome method were used to study changes at the cellular level and to describe the position and relative amount of mineralizing cartilage matrix (defined as Goldner-positive matrix [GPM]). Histomorphometry demonstrated that ICF treatment significantly increased the length of the hypertrophic cartilaginous zone and enhanced the amount of GPM between the mineralizing hypertrophic chondrocytes. However, the total length of the zone containing GPM was not increased, nor was the future bone collar, consisting of a thin osteoid seam, lengthened by ICF. These data indicate that the cellular processes involved in chrondrocyte hypertrophy were accelerated by ICF, as well as the extracellular processes leading to matrix mineralization. The study supports the earlier conclusion that embryonic bone rudiments are sensitive to mechanical stimulation and that moderate loading promotes their ossification in vitro.

A three-dimensional method to quantify facial asymmetry is introduced. Stereophotogrammetry was applied to determine three-dimensional (3-D) coordinates for eight pairs of surface landmarks of 106 individuals, including 16 with an operated complete unilateral cleft lip and palate. Facial asymmetry was quantified from four different reference planes that were defined perpendicular to and bisecting lines between pairs of bilateral landmarks related to the eyes, nose and mouth. Significant differences (P < 0.01) between these four planes were determined using multivariate analyses of variance (MANOVA). It is concluded that the best reference plane to select in studies of facial asymmetry is formed by the one which is perpendicular to and bisects the line that connects the landmarks Exocanthion. Reproducibility and validity of the method is demonstrated.

The aim of this study was to examine changes in orientation of trabecular bone during growth and development in relation to the location of trabeculae between the epiphysial growth plate and the marrow cavity. Five annual hand-wrist radiographs of 57 children between 4-9 years of age, originating from the Nijmegen Growth Study, were analysed by a digital image processing system. Analysis was carried out on four adjacent areas of 7 mm x 7 mm located in the distal head of the radius between the epiphyseal growthplate and the marrow cavity. The orientation of the trabecular pattern was measured in twelve directions. The orientation of trabeculae at a standardized distance from the epiphysial growth plate did not change significantly during growth and development. The orientation in directions perpendicular to the long axis of the radius was higher in newly formed trabecular bone, which is located just below the epiphysial growthplate, than in older trabecular bone at a larger distance from the epiphysial growth plate. Observation of one single area during five years of growth and development showed a comparable development.

A digital image processing system was used to study changes in orientation of the radiographic trabecular pattern of bone in children aged 4-14 years. The radiographs originated from a mixed-longitudinal growth study (The Nijmegen Growth Study), which comprised of three birth cohorts and which was carried out between 1971 and 1975. Of 3075 left hand-forearm radiographs of 426 children, the orientation of the trabecular pattern of the radius was analysed in twelve directions on a standard area of 10 x 10 millimetres. It was demonstrated that the trabecular pattern of the radius shows two predominant directions of orientation: along and perpendicular to the long axis of the radius. Spearman's Rank Correlations were calculated between direction of orientation and age of the children for the total population as well as for the cohorts separately, because the existence of cohorts-effects. The cohort of the youngest children showed more and higher significant correlations than the other cohorts, indicating that the trabecular pattern of young children is more subjected to changes. The results indicate that the prevalence of trabeculae orientated perpendicular to the long axis of the radius decreases. We speculate that this development reflects the effects of changes in mechanical loading in that direction during growth and development resulting in functional adaptation of the trabecular bone.

Non-invasive imaging techniques such as computerized tomography, magnetic resonance imaging (MRI), and ultrasonography enable measurements of the cross-section and thickness of human jaw muscles in vivo, providing an indication of the maximal force a muscle can exert. In 15 adult Caucasian men the thickness of the masseter muscle was registered bilaterally on three different levels by ultrasonography. Scans were made on the contracted and relaxed muscle. A comparison was then made with measurements from serial MRI scans, using univariate analysis of variance for repeated measurements and Pearson's correlation coefficients. Variances of the repeated measurements were calculated for the different scanning levels and the different muscle conditions and tested for homogeneity. For both the ultrasound and MRI measurements there was no difference in thickness between the left and right muscle. The registration level with highest reproducibility was halfway between the origin and insertion. Measurements from the contracted muscle were more reproducible than those from the relaxed muscle. The relaxed muscle thickness measured by ultrasonography was smaller than that measured by MRI. The correlation between ultrasound and MRI was significant for the upper and middle level of scanning (p < 0.001). The highest correlation was found between MRI (relaxed) and ultrasound (contracted) at the middle level (R = 0.83, p < 10(-6)). The conclusion is that ultrasonography is an accurate and reproducible method for measuring the thickness of the masseter in vivo. It allows for large-scale longitudinal study of changes in jaw-muscle thickness during growth in relation to change in biomechanical properties of masticatory muscles.

Studies on facial left-right dominance in individuals without craniofacial anomalies have demonstrated controversial results. This is probably due to the frequent use of two-dimensional methods, yet left-right dominance consists of transverse, vertical, and sagittal components. The aim of the present study was to describe three-dimensionally facial left-right dominance in individuals with an operated complete unilateral cleft lip and palate on the left side (LUCLP), on the right side (RUCLP), and in individuals without craniofacial anomalies (controls). Using stereophotogrammetry, three-dimensional coordinates for 16 bilateral and 10 midsagittal facial landmarks were determined for the LUCLP group (N = 32), the RUCLP group (N = 17), and the control group (N = 80). Left-right dominance was measured in three directions. Individuals without craniofacial anomalies showed a facial left sided dominance in the transverse direction, a facial right sided dominance in the sagittal direction, and no particular dominated side in the vertical direction. Individuals with a unilateral cleft lip and palate demonstrated a facial dominance of the nonaffected side in the vertical direction as well as in the sagittal direction, with no particular side dominant in the transverse direction. Generally, there was more variation in left-right dominance within the face in the vertical and sagittal directions.

We observed in a controlled 2 year longitudinal trial in 248 perimenopausal women that a daily calcium supplement of either 1000 or 2000 mg Ca2+ significantly reduced lumbar bone loss and bone turnover in the first year of calcium supplementation. In the second supplementation year the rate of lumbar bone loss in the treated subjects was not significantly different from that in the control group, although two of the three biochemical parameters of bone turnover remained decreased throughout the study. To quantify further the long-term effect of calcium supplementation, we extended the study for another year in 214 women. In the women of the control group who were menstruating until the last year of the trial, the mean change in lumbar bone mineral density after 3 years was -3.2% of the initial value versus 1.6% in the calcium-supplemented groups (p < 0.01). The decrease in lumbar bone loss in these supplemented premenopausal and early perimenopausal women remained statistically significant in the second and third years of supplementation. In the women who stopped menstruating before or during the study, the long-term reduction in lumbar bone loss was not significant (mean difference between control and treatment groups < 0.6% points after 3 years). The decrease in metacarpal cortical thickness (MCT) in the treated subjects during 3 years was on average -3.0% of the initial value in the control versus -2.0% in the supplemented subjects (P < 0.01). The effect of calcium supplementation on MCT was not significantly related to the menopausal status of the subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of the present study was to describe facial asymmetry in three dimensions in individuals with an operated complete unilateral cleft lip and palate (UCLP) and in individuals without craniofacial anomalies (controls). Three-dimensional coordinates for 16 bilateral and 10 midsagittal facial landmarks were determined for the UCLP group (N = 49) and the control group (N = 80) by means of stereophotogrammetry. The total asymmetry was measured and resolved for transverse, vertical, and sagittal components. It can be concluded that all three components are important in studies on facial asymmetry. Individuals with UCLP show more facial asymmetry in the vertical direction than controls. They demonstrate more facial asymmetry in the region related to the cleft than controls. And, males in general demonstrate more asymmetry of the nose than females.

The long term stability of orthodontic treatment was evaluated in 7 orthodontic patients who were three to 12 years out of retention. Dental relationships and irregularities in the dental arch were recorded and scored on study models taken prior to orthodontic treatment, at the end of active treatment, and at long term follow up. Lateral skull radiographs taken at the start of active treatment were also analysed. According to the (mal)occlusion observed on the post-retention study models it appeared that the sample could be subdivided into three groups. The group of patients with relatively good results after active treatment showed less relapse than the group with relatively moderate results after active treatment. The patients with relatively good treatment results were mostly treated with extractions followed by fixed appliances in both jaws. This observation indicates that treatment planning in this group generally was correct. Patients showing skeletal Class II features before orthodontic treatment showed most relapse in overjet and overbite.

Long-face subjects have smaller maximum molar bite forces than do normal individuals. This has been attributed both to differences in moment arms and size of the jaw muscles. In this study, a comparison was made between the mid-belly cross-sectional areas of the jaw muscles of 13 long-face and 35 normal adults by means of serial MRI scans. The subjects were selected on the basis of anterior lower face height as a percentage of anterior total face height. These and other cephalometric variables were measured from lateral radiographs. In the long-face group, the cross-sectional areas of the masseter, medial pterygoid, and anterior temporal muscles were, respectively, 30%, 22%, and 15% smaller than in the control group. By a discriminant analysis and a multivariate analysis of variance, these differences were found to be significant (p less than 0.001). The findings of this study hint that differences in the sizes of the jaw muscles of long-face and normal subjects might explain, in part, the observed differences in maximum molar bite force.

In 32 Caucasian adult males serial MRI scans of the jaw muscles were taken approximately perpendicular to the mean fibre direction of the jaw muscles to determine their cross-sectional areas. These areas are proportional to the maximal isometric strength of a muscle. To describe facial skeletal variation, nine angular and 21 linear cephalometric measurements were recorded, and statistically reduced by means of multiple regression and principal component analysis. Six components were extracted, rotated, and subsequently correlated with the maximal cross-sectional areas of the jaw elevators and anterior digastric muscle. Positive significant correlations were found between a linear combination of several transversal skull dimensions on the one hand, and the maximal temporalis and masseter cross-sections on the other. A negative significant correlation was found between the flexure of the cranial base and the temporalis cross-section. Surprisingly, no significant correlations were found between either anterior facial height or posterior facial height and any of the jaw muscles cross-sections. It was concluded that, in adult males with normal skull shape, relationships exist to a limited extent between craniofacial morphology and the cross-sectional areas of the jaw muscles.

To study the effect of calcium supplementation on perimenopausal bone loss, 295 women were randomized into a control group and 2 supplementation groups receiving, respectively, 1000 and 2000 mg elemental calcium/day for a period of 2 yr. We observed a significant decrease in lumbar bone loss in relation to the calcium supplementation (mean loss after 2 yr of 3.5% in the control group vs. 1.3% and 0.7% in the 1000 and 2000 mg groups, respectively), a significant increase in urinary calcium excretion, and a significant decrease in the urinary hydroxyproline/creatine ratio, serum alkaline phosphatase, osteocalcin, and 1,25-dihydroxyvitamin D. The effect of calcium supplementation on lumbar bone loss was significant in the first year of supplementation, but not in the second. However, the urinary hydroxyproline/creatinine ratio and the serum alkaline phosphatase level remained significantly decreased in the treatment groups at the end of the study; this was not the case for serum osteocalcin. Calcium supplementation did not have a significant effect on metacarpal cortical bone loss. The difference in biochemical parameters between the 2 supplementation groups was small. No significant interaction was observed between the menopausal status of the subjects and the effect of calcium supplementation. We conclude that calcium supplementation retards lumbar bone loss in the first year of calcium supplementation by reducing bone turnover. However, the effect on lumbar bone loss over a longer time span is still uncertain.

The effects of 8 weeks of daily oral treatment with 1 mg 17 beta-oestradiol (E2), 2.5 mg Org OD 14 [7 alpha, 17 alpha)-17-hydroxy-7-methyl-19-norpregn-5(10)-en-20-yn-3-one) , a steroid with weak androgenic, weak oestrogenic and weak progestational activity, or placebo on calcium and lipid metabolism were compared in 21 healthy, early post-menopausal women in a randomised double-blind study. The treatment period was followed by a treatment-free period of 8 weeks to study the reversibility of drug-induced effects. The results show that both E2 and Org OD 14 reduce bone resorption, as indicated by the decreases in the urinary hydroxyproline/creatinine and calcium/creatinine ratios in 2-h fasting urine. In contrast to E2, Org OD 14 did not reduce serum calcium levels. As regards lipid parameters, E2 reduced the concentration of serum cholesterol and Org OD 14 decreased serum levels of high-density-lipoprotein cholesterol and triglycerides. All these effects appeared to be reversible after cessation of treatment. It is concluded that both of these steroids reduce bone resorption in early post-menopausal women, but that their mechanisms of action are most likely different.

Recently, bisphosphonates have been used to prevent postmenopausal bone loss. As the effects of bisphosphonates on normal bone metabolism are unknown, 3-amino-1-hydroxypropylidene-1,1-diphosphonate (APD) was studied in healthy subjects. The effects of a single 20-mg APD infusion on biochemical parameters of calcium and bone metabolism were investigated during 2 months in 10 healthy male volunteers. This single moderate dose of APD reduced biochemical parameters of bone resorption during the time of follow-up. After 2 months, urinary hydroxyproline excretion was still below the basal level. The decreased serum calcium levels did not return to basal values. Biochemical parameters of bone formation, serum alkaline phosphatase and osteocalcin, showed a slight increase during the first month after stimulation of the parathyroids and a corresponding increase in serum 1,25-dihydroxyvitamin D. These formation parameters decreased thereafter, probably representing coupling between bone resorption and bone formation.

Immobilization may lead to severe bone loss. Physical activity decreases with age and lower mobility might influence bone loss. We have evaluated the degree of mobility and parameters of bone turnover in 70 residents of a nursing home (mean age +/- SD 81 +/- 9 years) and 68 residents of an old people's home (mean age +/- SD 84 +/- 6 years). The mobility was assessed with a standing and walking score from 1 (severely disabled) to 5 (standing/walking without help). When the subjects were arranged according to increasing walking score from 1 to 5, fasting urinary hydroxyproline/creatinine ratio gradually decreased from 31 +/- 19 to 14 +/- 5 mumol/mmol (P less than 0.001). There was also a significant linear decrease of fasting urinary calcium/creatinine ratio, and serum calcium concentration and a significant increase of serum albumin and 1,25-dihydroxyvitamin D concentrations with increasing walking score. These data indicate that lower mobility in the elderly leads to higher bone resorption, which may suppress the formation of 1,25-dihydroxyvitamin D.

In 124 patients with femoral neck fracture and 74 aged control subjects a seasonal variation was observed in the serum concentrations of 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, and PTH. The serum PTH concentrations were maximal in winter, when the vitamin D metabolites were lowest, suggesting a secondary phenomenon.

Serum vitamin D metabolites were measured in 160 normocalcemic urinary calcium stone formers and in 217 control subjects. No difference in concentrations of 25-hydroxy-vitamin D (25[OH]D), 24,25-dihydroxyvitamin D (24,25[OH]2D), and 1,25-dihydroxyvitamin D (1,25[OH]2D) was found between stone formers and control subjects. Values for 25(OH)D and 24,25(OH)2D were higher in hypercalciuric stone formers than in normocalciuric stone formers independent of seasonal fluctuation. No difference in concentration of serum 1,25(OH)2D was found between hypercalciuric and normocalciuric stone formers. No correlations were present between the serum concentrations of the measured vitamin D metabolites and of measures of calcium and phosphate metabolism. These findings suggest no major pathophysiologic role of the main vitamin D metabolites in urinary calcium stone formation.