Risk of renal cell carcinoma after kidney transplantation

Dental trauma occurs very often in children and its consequences vary from tiny fractures to the complete avulsion of the tooth. According to Andreasen, 86.5% of incidents of dental trauma suffered by preschool children cause injury to maxillary primary incisors, whereas only 0.5% cause injury to primary molars. This case report is of a male patient aged 7 years who had fallen down a month before, struck his chin against a step, and fractured the maxillary and mandibular left primary second molars (65 and 75) and the mandibular right primary second molar (85). The 65 required only smoothing of sharp edges, 75 received endodontic treatment and a stainless steel crown, and 85 was extracted and a space maintainer fitted. The early diagnosis of fractures of posterior teeth is very important; a thorough examination of all posterior teeth should be made, especially when child suffers trauma to the chin region.     

Dental trauma in schoolchildren six to twelve years of age

The prevalence of dental injuries in Spanish children living in an urban area was studied in 4000 schoolchildren ages six to twelve years. A total of 227 children experienced dental injuries. Simple enamel fracture was the predominant injury (46.2 percent). Boys showed a higher prevalence than girls In the majority of cases (74.9 percent), the trauma affected one tooth only. The maxillary central incisor was the most frequently affected tooth (87.9 percent). The most common fracture site was the mesioincisal angle (40.6 percent) followed by distoincisal angle (27.3 percent). Twenty-four percent of the children with dental injuries had an overjet of more than 3 mm.     

Childhood obesity: a risk factor for traumatic injuries to anterior teeth

The relationship between obesity and traumatic dental injuries was evaluated in a study population of 938 6- to 11-year-old schoolchildren from Rome, Italy, and it was suggested by the lifestyle and the physical activity of obese children, which, according to many authors, is different from the lifestyle of other children. The subjects were examined at school: presence and type of dental injury, overjet, incisor protrusion, upper lip incompetence and presence of obesity were recorded. Trauma predisposition was evaluated with a questionnaire investigating the behaviour which may predispose to impacts. Six out of eight questions in this questionnaire concerned the children's lifestyle and the trauma predisposition score was therefore also considered an estimate of lifestyle and physical activity. The dental injury prevalence of the study population was 21.3% and obesity prevalence was 11.4%. Of the obese children 30.8% had dental injuries vs. only 20.0% of non-obese subjects (P = 0.007). Obese children had only enamel and enamel-dentine fractures and the main reported trauma cause was indoor play; conversely, lean children also had other types of injuries and the most frequently reported cause was outdoor play. The main predisposing factors significantly affecting the probability of dental injury, evaluated with multiple logistic regression, were upper lip uncoverage (OR: 1.23; P = 0.02), overjet larger than 3 mm (OR: 1.68; P = 0.001) and obesity (OR: 1.45; P = 0.01). Surprisingly, trauma predisposition was a protective factor (OR: 0.50; P = 0.00001). The results of this study were explained by the significant inverse correlation between obesity and trauma-predisposing behaviour, thus suggesting that subjects frequently playing sports and lively games were not only less obese but also more skillful and, for this reason, less prone to trauma when they fell or sustained impacts.     

Hypodontia of primary and permanent teeth in a sample of Saudi children

Hypodontia, congenitally missing teeth is more common in permanent than primary dentition. The present investigation reports the prevalence and pattern of hypodontia in the primary and permanent dentitions, excluding third molars in a sample of Saudi children. The sample consists of 1,300 children, aged 5 to 10 years of age. Clinical and radiographic examinations were performed. The prevalence of children with hypodontia was found to be 2.6 percent. The mandibular second premolar was the tooth most frequently absent and account for 45 percent of the total missing teeth. In primary dentition, the maxillary lateral incisor was the tooth most frequently absent (9%). A peg-shaped permanent maxillary lateral incisor was present in 0.7 percent of the sample. Congenitally missing teeth were almost equally distributed between maxillary (52%) and mandibular (48%) arches.     

Extraoral tooth eruption and transposition of teeth following trauma

A six-year-old boy presented with extraoral eruption of a mandibular permanent canine and a loosely attached lateral incisor in the labial vestibule, 3 months following trauma to the chin. The trauma not only caused displacement of the permanent tooth buds, but also resulted in transposition of the lateral incisor and canine with subsequent ectopic eruption. The case is presented to demonstrate one of the infrequent complications of trauma involving the unerupted tooth buds of permanent teeth and its unusual clinical presentation.     

Juvenile chronic arthritis: a cephalometric analysis of the facial skeleton

A retrospective cross-sectional cephalometric investigation was undertaken to examine the facial form of a group of Finnish children with juvenile chronic arthritis (JCA). Following digitization, the radiographs were divided into three age groups, and according to whether or not 'bird-face' deformity was present. From a total of 67 cases (39 females and 28 males) 19 per cent were judged to be 'affected'. Analyses were carried out and the groups compared using t-tests. The mandible was found to be smaller both in ramal height and body length in the affected sample, with reduction in posterior face height being only partly compensated by increase in bony apposition at the angle producing antegonial notching. There was posterior rotation of the mandible with a reduction in angles S-N-B and S-N-Pog, and an increase in the gonial angle, the angle between the mandibular plane and S-N, maxillary, and occlusal planes. The changes in the maxilla were less marked. Although S-N-A was reduced in all three age groups, it was not significantly so. Maxillary length (ANS-PNS) was significantly smaller in the two younger age groups. In the vertical plane maxillary dimensions were reduced in the two younger age groups. A highly significant increase in the occlusal to maxillary planes angle was observed in all groups. There was, however, no difference in S-N to maxillary planes angle, indicating a more steeply inclined occlusal plane due to subnormally erupted maxillary molars. Although the inter-incisal angle was reduced there was no significant difference in the incisor inclinations in relation to the jaws and despite the posterior rotation of the mandible there was no significant increase in size of overjet or in the frequency of anterior open bite.     

Gene expression of trehalase during post-dormant development of the brine shrimp, Artemia: comparison of the two species

The purpose of this article is to summarize the short-term and long-term results of the authors' clinical prospective study on the treatment of Class III malocclusion using the protraction facemask. An attempt is made to answer questions pertaining to this treatment modality. Twenty patients with skeletal Class III malocclusion were treated consecutively with maxillary expansion and a protraction facemask. A positive overjet was obtained in all cases after 6 to 9 months of treatment. These changes were contributed to by a forward movement of the maxilla, backward and downward rotation of the mandible, proclination of the maxillary incisors, and retroclination of the mandibular incisors. The molar relationship was overcorrected to Class I or Class II dental arch relationship. The overbite was reduced with a significant increase in lower facial height. The treatment was found to be stable 2 years after removal of the appliances. At the end of the 4-year observation period, 15 of the 20 patients maintained a positive overjet or an end-to-end incisal relationship. Patients who reverted back to a negative overjet were found to have excess horizontal mandibular growth that was not compensated by proclination of the maxillary incisors. A review of the literature showed that maxillary expansion in conjunction with protraction produced greater forward movement of the maxilla. Maxillary protraction with a 30 degrees forward and downward force applied at the canine region produced an acceptable clinical response. The reciprocal force from maxillary protraction transmitted to the temporomandibular joint did not increase masticatory muscle pain or activity. Significant soft tissue profile change can be expected with maxillary protraction including straightening of the facial profile and better lip competence and posture. However, one should anticipate individual variations in treatment response and subsequent growth changes. Treatment with the protraction facemask is most effective in Class III patients with a retrusive maxilla and a hypodivergent growth pattern. Treatment initiated at the time of initial eruption of the upper central incisors helps to maintain the anterior occlusion after treatment.     

Treatment response to maxillary expansion and protraction

A prospective clinical trial was conducted to determine the skeletal and dental contributions to the correction of overjet and overbite in Class III patients. Thirty patients (12 males and 18 females with a mean age of 8.4 +/- 1.7 years) were treated consecutively with protraction headgear and fixed maxillary expansion appliances. For each patient, a lateral cephalogram was taken 6 months before treatment (T0); immediately before treatment (T1); and 6 months after treatment (T2). The time period (T1-T0) represented changes due to 6 months of growth without treatment; (T2-T1) represented 6 months of growth and treatment. Each patient served as his/her own control. Cephalometric analysis described by Bj?rk (1947) and Pancherz (1982a,b) was used. Sagittal and vertical measurements were made along the occlusal plane (OLs) and the occlusal plane perpendicular (OLp), and superimposed on the mid-sagittal cranial structure. The results revealed the following: with 6 months of treatment, all subjects were treated to Class I or overcorrected to Class I or Class II dental arch relationships. Overjet and sagittal molar relationships improved by an average of 6.2 and 4.5 mm, respectively. This was a result of 1.8 mm of forward maxillary growth, a 2.5-mm of backward movement of the mandible, a 1.7-mm of labial movement of maxillary incisors, a 0.2-mm of lingual movement of mandibular incisors, and a 0.2-mm of greater mesial movement of maxillary than mandibular molars. The mean overbite reduction was 2.6 mm. Maxillary and mandibular molars were erupted occlusally by 0.9 and 1.4 mm, respectively. The mandibular plane angle was increased by 1.5 degrees and the lower facial height by 2.9 mm. Individual variations in response to maxillary protraction was large for most of the parameters tested. Significant differences in treatment changes between male and female subjects were found only in the vertical eruption of mandibular incisors and maxillary and mandibular molars. These results demonstrate that significant overjet and overbite corrections can be obtained with 6 months of maxillary protraction in combination with a fixed expansion appliance.     

Prediction of mandibular autorotation

PURPOSE: The purpose of this investigation was to test the hypothesis that the mandible rotates around the same point during maxillary impaction surgery as during initial jaw opening. This point, called the center of mandibular autorotation (CAR), could then be used to predict mandibular position and to decide whether only maxillary impaction would be needed to correct the occlusion and the facial profile. PATIENTS AND METHODS: Preoperatively, two lateral cephalograms were obtained from a consecutive series of 20 patients who underwent maxillary impaction without concomitant mandibular ramus osteotomy. One cephalogram was taken with the mandible in centric relation using a wax bite wafer and another with a jaw opening of 10 mm using a fabricated acrylic bite block with the mandible manipulated to its most retruded position. The CAR was calculated before and after jaw opening using the Rouleaux method on the lower incisor and gonion point. A third lateral cephalogram was taken within 2 days postoperatively. The postoperative lower incisal point was then transferred to the first cephalogram using cranial base superimposition. RESULTS: When the preoperative and postoperative distances between CAR and incisal point were compared, there was no significant difference between these distances, proving the hypothesis. CONCLUSIONS: The method used is a practical and precise way to determine the center of mandibular autorotation on an individual basis. The center of rotation during initial jaw opening is the same as during impaction surgery.     

Control of the vertical dimension in Class II correction using a cervical headgear and lower utility arch in growing patients. Part I

A retrospective cephalometric study was performed comparing three groups of 30 growing patients with Class II, Division 1 malocclusions. Group 1 was treated with a cervical headgear/lower utility arch combination (CHG/LUA), group 2 was treated with a cervical headgear alone (CHG), and the third group was untreated. The average treatment time was 1 year, 6 months. No other appliances were used during this period. Maxillary and mandibular dental and skeletal treatment responses were compared with an analysis of variance (ANOVA) and a Scheffe's test. In addition, a multiple stepwise regression was performed to determine whether pretreatment measures of facial pattern were accurate predictors of mandibular rotational response. Both treatment groups demonstrated significant reduction in maxillary protrusion. The CHG-only group showed significantly greater anterior descent of the palatal plane as compared with the untreated group. The maxillary molars showed significant distal movement in both treatment groups without any extrusion beyond that seen with normal growth. The maxillary incisor demonstrated significant retroclination in the CHG-only group. There was no statistical difference among the groups for variables commonly used for measuring mandibular rotation or protrusion. The change in vertical position of the lower molar was not significantly different among the groups. A CHG as used in this study produced maxillary orthopedic and orthodontic changes without upper molar extrusion beyond that seen with normal eruption and in the absence of an opening rotation of the mandible, even in subjects with dolicocephalic facial patterns. The LUA did not appear to influence lower molar eruption or mandibular rotational response. None of the commonly used predictors of facial pattern, such as the Y-axis, XY-axis, or MP angle, accurately predicted mandibular rotational response. Further study would be necessary to ascertain whether this was a result of their invalidation as predictors, or a result of the treatment strategy employed.     

Occlusal stability in Class II, Division 1, deep bite cases followed up for many years after orthodontic treatment

This case report analyzes long-term occlusal stability that can be achieved in Class II, Division 1, deep bite cases with active treatment finished during the period of maxillomandibular growth. The analysis was designed to identify occlusal features common to two cases at the end of active treatment and to study how the occlusion changed with growth and jaw movement to achieve stability. The following occlusal features were shared by the two cases at the end of active treatment: (1) AB plane and axes of the maxillary and mandibular posterior teeth were perpendicular to functional occlusal plane; (2) the axis of the lower incisor was almost perpendicular to DC-L1i line; (3) the anterior occlusion was overcorrected to or near an edge-to-edge relationship. Items 1 and 2 remained unchanged throughout the follow-up periods, regardless of growth status, and the overjet and overbite increased during maxillomandibular growth after treatment. During the period of mandibular growth alone, after the end of retention, the axes of maxillary incisors tipped labially; as a result, F line became parallel to CDM line by the end of growth. The labial tipping of maxillary incisors brought the lower incisal edge into contact with or extremely near the inflection point (Bp).1 By the end of growth, the tangent of Bp became parallel to or coincident with DC-L1i line and perpendicular to the axis of the lower incisor, and the DC-L1i lines at various times posttreatment were almost parallel to each other in the two cases. Overjet increased as the maxillary incisors tipped labially, providing proper protrusive and retrusive paths for mandibular guidance. The angle between the functional occlusal plane and CDM line stayed almost the same as at the end of active treatment in the two cases, suggesting a possible change in the angle of eminence in harmony with the functional occlusal plane. These factors apparently contributed to the long-term occlusal stability in the two cases.     

Sex determination with a discriminant function analysis of deciduous teeth size in plaster models

Plaster models of the teeth of 3-year-old Japanese children (96 males, 98 females) were used to record the crown length, crown width and crown thickness of 5 maxillary and 5 mandibular deciduous teeth (30 measurement values). These measurements were used to devise a number of sex determination formulae. A sex-determination formula using all 30 values was calculated. Furthermore, a number of practical formulae were derived from only the crown width and crown thickness values because the deciduous teeth wear in 4 years and older children rapidly progress, making the crown length measurement unreliable. These formulae were calculated for the maxillary teeth alone and mandibular teeth alone. The formulae based on only the crown width or thickness were also calculated for both maxillary and the mandibular teeth. A step-wise discriminant analysis was then used to ascertain the most reliable measurements and a practical formula subsequently devised. The results obtained were as follows: 1. The mean value for each measurement was greater in males than in females. 2. Significant differences in the values recorded were seen in 28 out of the 30 measurements taken. The measurement items not exhibiting these significant differences were the crown width of the maxillary lateral incisor and the crown thickness of the mandibular second molar. 3. The accuracy rates for the sex-determination analysis and the step-wise sex determination analysis calculated using all 30 values were 78.6% and 75.7%, respectively. 4. The accuracy ranges for the modified sex-determination formulae and the associated step-wise sex determination analyses were 70.6-78.4% and 67.0-76.8%, respectively.     

Antihistamine-containing cough/cold medications present a low hazard in pediatric accidental exposure incidents: analysis of Poison Control Center data

Although the mandibular condyle is one of the most common sites of injury of the facial skeleton, it is also the most overlooked and least diagnosed site of trauma in the head and neck region. The condyle forms the very cornerstone of mandibular form and function and therefore injuries to the mandibular condyle in growing children may adversely affect growth and development of the jaws and the occlusion. The aim of this article is to present an overview of condylar injuries in growing patients for the purpose of increasing the awareness of all dental practitioners involved in the treatment of children with acute oro-facial injuries.     

Successful treatment of brain metastases from ovarian cancer using gamma-knife radiosurgery

We report two cases of fully intruded tooth after facial fracture in adults. In the first case, the lateral incisor was intruded into the nasal cavity and slipped into the pyriform sinus during operation. The second case involved full intrusion of a molar into the maxillary sinus, resulting in infection. The importance of a thorough intraoral examination for patients with facial trauma is emphasized. All missing teeth should be accounted for to ensure that they have not dislodged inside the body. When full intrusion of a tooth is suspected, facial computed tomography scan may provide assistance with definite diagnosis. If an incisor is completely intruded into the nasal cavity, removal through the floor of the nostril should be considered.     

Rigid external distraction: its application in cleft maxillary deformities

Patients with severe maxillary hypoplasia secondary to congenital facial clefting present numerous challenging problems for the reconstructive surgeon. Traditional surgical/orthodontic approaches for these patients often fall short of expectations, especially for achieving normal facial aesthetics and proportions. The purpose of this paper is to present our clinical experience and cephalometric results with the use of rigid external distraction for the treatment of patients with severe maxillary deficiency. Eighteen consecutive orofacial cleft patients with severe maxillary hypoplasia were treated with maxillary distraction osteogenesis. Criteria for patient selection included severe maxillary hypoplasia with negative overjet of 8 mm or greater, patients with normal mandibular morphology, and patients with full primary dentition or older. There were 10 unilateral cleft lip and palate patients, 6 bilateral cleft lip and palate patients, and 2 patients with severe congenital facial clefting. A maxillary splint was prepared for each patient, and all patients underwent a high Le Fort I maxillary osteotomy. All surgery was performed on either an outpatient or a 23-hour admission basis. No patient required blood transfusions or intermaxillary fixation. Two types of mechanical distraction were utilized in this series. In group 1 (n = 14), the patients underwent rigid external distraction with an external distraction device. In group 2 (n = 4), patients underwent face mask distraction with elastics. There was no surgical morbidity in any of the patients. For the patients in the rigid external distraction group, the mean effective horizontal advancement of the maxilla was 11.7 mm. All of these patients had correction of their negative overjet. For patients in the face mask distraction group, the results were disappointing. The mean effective advancement of the maxilla in this group was only 5.2 mm. In all face mask distraction patients, the initial maxillary hypoplasia was undercorrected. Maxillary distraction osteogenesis with rigid external distraction permits full correction of the midfacial deficiency, including both the skeletal and soft-tissue deficiencies. Rigid external distraction in patients with severe maxillary hypoplasia allows full correction of the deformity through treatment of the affected region only. It offers the distinct advantage of correcting these severe deformities through a minimal procedure. Rigid external distraction has dramatically improved our treatment results for patients with severe cleft maxillary hypoplasia.     

Optimizing multiple individual anterior implant restorations with a new generation implant-abutment system; IMZTwinPlus: a case report and treatment rationale

A 53-year-old male with a history of initial oral facial trauma causing the loss of three maxillary incisors, multiple failures of tooth-borne fixed prosthetic reconstructions, and a resultant condition of structural failure of abutment cuspids and lateral incisor was to be retreated. The case contained numerous anatomic and dimensional constraints. The patient's desire to achieve a long-term, dependable prosthetic reconstruction prompted professional consideration of incorporating implants to lend structural support in the edentulous area. An extensive review of current implant-abutment options and their single-tooth implant replacement design and treatment rationales was conducted. The IMZ Generation III (IMZTwinPlus) implant system, a nonhex system, was chosen for treatment of the case of report to optimize mechanics, biomechanics, and esthetics for multiple individual-tooth implant replacement.     

Influence of the arterial blood pressure and nonhemodynamic factors on regional arterial wall properties in moderate essential hypertension

OBJECTIVES: The technique of resin-bonded bridgework is a well-accepted clinical technique to replace missing teeth. This study assesses the clinical performance of cantilevered resin-bonded bridgework provided in a university teaching hospital environment. METHODS: One-hundred and twelve patients who had a total of 142 cantilevered bridges were either examined or completed a questionnaire regarding their bridgework. The following data were recorded for each resin-bonded bridge: gender of patient, age at bridge cementation, date of initial cementation, tooth replaced, abutment(s) involved, and grade of clinician responsible for the provision of the bridge. Details of the incidence of debonding with date(s) and the subsequent treatment in relation to the debonded resin-bonded bridge were recorded. The subjects examined indicated their degree of satisfaction with their bridgework on a visual analogue scale. RESULTS: There were 112 patients with a total of 142 bridges, 116 (82%) maxillary and 26 (18%) mandibular. The mean length of clinical service was 36.2 months (s.d. 17.2 months). Only single pontics were included in the bridges, with almost half (49%) replacing a lateral incisor. Of the cantilever resin-bonded bridges studied, 88% remained bonded over the period of the study. A success rate of 94% is reported. CONCLUSION: This study confirms the clinical success of cantilever resin-bonded bridges particularly in the replacement of maxillary lateral incisors, maxillary premolar and permanent mandibular teeth.     

Profile changes following orthodontic correction of bimaxillary protrusion with a preadjusted edgewise appliance

This study aimed to determine the changes in soft tissue and skeletal profiles following orthodontic correction of bimaxillary protrusion in 50 Chinese adult patients. Treatment involved extractions of four premolars and use of the preadjusted edgewise appliance. The average treatment time was 2.2 years. Cephalometric analysis was carried out on pretreatment and posttreatment cephalograms. The result of treatment was a more harmonious soft tissue profile; with a less acute nasolabial angle (following a 10.55-degree change), 2.75- and 2.09-mm reductions in upper and lower lip protrusions, respectively, and a 3.41-mm decrease in interlabial gap. Effects on dental relationships included a 0.90-mm reduction in incisal show, a reduction of overbite, and an improvement in the inclination of maxillary and mandibular incisors. Therefore, orthodontic correction of bimaxillary protrusion achieved favorable soft tissue changes without causing undesirable effects on the underlying hard tissues.     

Effects of lead exposure on licking and yawning behaviour in rats

Most studies on facial trauma in the pediatric age group focus on special subgroups. This investigation encompasses all traumatic facial injuries, minor and major, of children and adolescents. Epidemiological data of the type and pattern of injury of trauma patients less than 19 years of age, treated during a 3-year-period in a large metropolitan trauma centre were reevaluated. Of the 1385 patients, 68% had soft tissue injuries, 24% had dental trauma, and 8% fractures of facial bones. More than 90% suffered from minimal or minor trauma. The leading cause of injury was a fall, predominantly at the toddler stage. In adolescents an adult mechanism of trauma prevailed: over 60% of injuries were sequelae of an assault or altercation. The male sex predominated through all age groups and for all types of injuries. The bulk of soft tissue injuries are located within a small falling zone, extending from the nose to the mental area. There was a rising incidence of fractures of facial bones towards older age groups, mandibular fractures being the most common. Condylar fractures, with their potential impact on further growth of the mandible, are seen frequently in children and adolescents, making up 80% of the fractures of the lower jaw.