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Revista Cientifica Odontologica... 2023The purpose of this systematic review was to identify, evaluate, and provide information about palatal bone thickness in different vertical growth patterns for the... (Review)
Review
INTRODUCTION
The purpose of this systematic review was to identify, evaluate, and provide information about palatal bone thickness in different vertical growth patterns for the placement of orthodontic anchorage devices.
METHODS
We performed a systematic review of the published data in Medline via PubMed, Web of Science, Cochrane Library, and Scopus from January 2000 to August 2022 using eligibility criteria. Data collection analysis and data extraction were performed independently by three reviewers. Sensitivity analyses were performed with the Cochrane risk of bias tool and the ROBINS-I tool was used for non-randomized studies.
RESULTS
A total of 343 articles were identified. The inclusion criteria included palatal bone thickness and vertical facial growth. However, both variables were found in 4 studies and only 2 had a control group. The different studies evaluated palatal bone thickness according to sex (male 14.1 mm; female 9.68 mm) and vertical malocclusion (normal 2.2 -12.6 mm; open bite 1.9 -13.2mm) with heterogeneous results. Likewise, the vertical growth pattern with a low angle (9.39 mm) was greater than the normal (8.55 mm) and high angle (7.53 mm).
CONCLUSIONS
Palatal bone thickness varies according tp different vertical growth patterns, with the greatest thickness being found near the incisive foramen in hypodivergent individuals.
PubMed: 38288456
DOI: 10.21142/2523-2754-1102-2023-152 -
Frontiers in Pediatrics 2024Malocclusion, a common oral health problem in children, is associated with several contributing factors. This study aimed to investigate the prevalence of mixed...
INTRODUCTION
Malocclusion, a common oral health problem in children, is associated with several contributing factors. This study aimed to investigate the prevalence of mixed dentition stage malocclusion and its contributing factors in Chinese Zhuang children aged 7-8 years.
METHODS
Overall, 2,281 Zhuang children, about 7-8 years old, were randomly selected using a stratified whole-cluster sampling method from schools in counties in Northwestern Guangxi, China. The children were examined on-site for malocclusion and caries by trained dentists, and basic data on the children were collected using questionnaires, including age, sex, parental education, parental accompaniment, and children's knowledge of malocclusion and treatment needs. Data were analyzed using the chi-square test and logistic regression analysis.
RESULTS
The total prevalence of malocclusion in Zhuang children aged 7-8 years was 58.5%, with the highest prevalence of anterior crossbite tendency, and the prevalence of anterior crossbite and anterior edge-to-edge occlusion was 15.1% and 7.7%, respectively. This was followed by an anterior increased overjet of 13.3% and an inter-incisor spacing of 10.3%. The lowest prevalence was 2.7% for anterior open bite. Sex, parental accompaniment, parental education, and decayed, missing, and filled teeth of the first primary molar were factors that contributed to malocclusion in Zhuang children.
CONCLUSION
Malocclusion is a common oral problem among Zhuang children. Therefore, more attention must be paid to the intervention and prevention of malocclusion. The impact factors should be controlled as early as possible.
PubMed: 38288319
DOI: 10.3389/fped.2024.1308039 -
Journal of Prosthodontic Research Jan 2024This case report describes a procedure for assessing changes in occlusal relationships in patients with acquired open bites due to temporomandibular joint disease using...
PATIENTS
This case report describes a procedure for assessing changes in occlusal relationships in patients with acquired open bites due to temporomandibular joint disease using an intraoral scanner (IOS). A digital impression was made using the IOS at the initial visit. Subsequent impressions were made every 6 months using the IOS and magnetic resonance imaging (MRI) or computed tomography (CT). Standard triangulated language (STL) image files of two digital impressions at different points in time were superimposed, including the occlusal relationship with reference to the maxillary dentition. Finally, three-dimensional (3D) changes in the occlusal relationship over time were evaluated.
DISCUSSION
In Case 1, the superimposed STL image indicated almost no evident deviation of the mandible. Therefore, an orthodontic treatment was initiated. In contrast, in cases 2 and 3, where changes in the occlusal relationship continued, secondary treatment was postponed and patients continued to be monitored periodically. In case 3, even though left condyle resorption was progressive, the degree of open bite on the right side improved after 6 months. However, the open bite continued to progress for another 6 months despite the stability of the condyle.
CONCLUSIONS
Changes in the condylar shape observed using imaging may not always reflect changes in the occlusal relationship. In addition to changes in the condyles and eminences of the temporomandibular joint (TMJ), changes in the occlusal relationships of patients with acquired open bite should be evaluated using an intraoral scanner.
PubMed: 38281760
DOI: 10.2186/jpr.JPR_D_23_00146 -
JBJS Essential Surgical Techniques 2023Talar arthroscopic reduction and internal fixation (TARIF) is an alternative approach for the operative fixation of talar fractures that may be utilized instead of more...
BACKGROUND
Talar arthroscopic reduction and internal fixation (TARIF) is an alternative approach for the operative fixation of talar fractures that may be utilized instead of more traditional open approaches such as medial, lateral, or even dual anterolateral. The TARIF approach allows for nearly anatomic fracture reduction and fixation of talar neck, body, and posterior dome fractures while minimizing the soft-tissue stripping and vascular injury associated with the standard anterolateral approach.
DESCRIPTION
Following initial closed fracture reduction and any associated procedures, we recommend obtaining computed tomography scans of the injured ankle in order to evaluate the fracture pattern and allow for preoperative planning. Most patients can be positioned prone for this procedure, except for those with fractures associated with anterior loose bodies and those with neck fractures requiring reduction, which are both amenable to lateral positioning. The feet are positioned off the end of the bed in a neutral position with room to plantar flex and dorsiflex the ankle freely for reduction maneuvers. Following induction of anesthesia and positioning of the patient, the fluoroscopic screen and arthroscopy equipment are positioned on the side opposite the surgeon. A mini C-arm is utilized for the fluoroscopy. The team may then proceed with preparing and draping the surgical field. The surgeon proceeds with creating posteromedial and posterolateral portals to view the fracture site. For talar neck fractures, we utilize standard posterolateral and posteromedial portals directly adjacent to the Achilles tendon at the level of the tip of the medial malleolus, which have previously been established as safe with respect to neurovascular structures. Of note, for talar body fractures these portals are placed slightly more distal at the level of the distal fibula, allowing the screws to be placed perpendicular to the fracture site. An accessory sinus tarsi portal can be established if further reduction to correct varus is needed. The flexor hallucis longus tendon serves as a landmark throughout the case to maintain orientation. We prefer to utilize a 1.9-mm malleable arthroscopic NanoScope (Arthrex), which maximizes our view in the small subtalar space and allows for visualization over the talar dome. A shaver is then utilized to clear out the deep joint capsule and remove fracture hematoma. In our experience, after the initial primary reduction attempt by the orthopaedic trauma provider, the fracture is relatively stable and often held by an external fixator. The remaining reduction is performed with use of manipulation of the ankle in combination with an accessory sinus tarsi portal, utilizing an elevator or a small reduction tool in 1 of the posterior portals. We have also utilized percutaneous Kirschner wires to "joystick" the fragments prior to the placement of the guidewires. We then place multiple 1.1-mm guidewires under direct arthroscopic and fluoroscopic visualization, utilizing the flexor hallucis longus tendon as our safe margin to ensure that we are lateral on the posterior talar dome. This approach in turn allows us to ensure the integrity of the neurovascular structures, such as the tibial artery and nerve medially as well as the sural nerve laterally. Finally, cannulated headless compression screws are passed over the guidewire to achieve fixation. The senior author (K.D.M.) prefers fully threaded, cannulated 3.5-mm titanium headless compression screws because the cannulation allows the guidewires to be placed through the posterolateral and posteromedial portals, while the headless design allows the screws to be placed under the articular cartilage. Additionally, the use of titanium allows for improved postoperative magnetic resonance imaging quality as well as favorable biomechanics as titanium has a modulus of elasticity similar to bone. After drilling is complete, we sequentially tighten the screws by hand to prevent varus or valgus angulation. Although we have not experienced failure or a poor bite when utilizing the 3.5-mm fully threaded compression screw, we have found that the partially threaded screw can at times have a poorer bite. Additionally, we select a 3.5-mm screw rather than a larger screw-say 5.5 mm-as we have found that the larger screws do not easily pass through our portals, which are minimal in size when utilizing this approach. Throughout this process, fluoroscopy, in tandem with arthroscopy, is obtained in multiple views to ensure that fixation and orientation are appropriate and the screws are in the optimal position, off of the articular surface. If large osseous defects or collapse are encountered, an accessory anteromedial portal is utilized to add grafting material. Following confirmation of adequate fracture fixation, final arthroscopic images of the talar dome continuity, subtalar continuity, and ankle joint during range of motion are obtained. The portal sites are closed with use of 3-0 nonabsorbable sutures, and a well-padded L and U splint is applied postoperatively.
ALTERNATIVES
Alternatives include the standard anterolateral approach to fixation or dual anterior approach, a medial or lateral approach, and external fixation with interval operative fixation.
RATIONALE
TARIF is indicated for reduction of a wide variety of talar fractures, including neck, body, and posterior facet fractures, and offers the added advantage of minimizing the soft-tissue stripping and vascular injury associated with the standard anterolateral approach. Additionally, TARIF is well suited for patients with a compromised soft-tissue envelope or associated vascular injury, such as those with open-fracture pathology, because the approach avoids further disruption of these tissues. The overall aim of the procedure is to obtain adequate fracture reduction while avoiding the neurovasculature and soft-tissue envelope that would commonly be encountered anteriorly. The procedure is completed through 2 incisions, a posteromedial portal and a posterolateral portal, through which the fracture is visualized, reduced, and fixated using cannulated screws. The fixated talus is tested through its range of motion while under arthroscopy and fluoroscopy to ensure adequate fixation while preserving range of motion.
EXPECTED OUTCOMES
The TARIF procedure has been shown to successfully treat many complex talar fractures. We theorize that this procedure produces equivalent outcomes when compared with the standard approaches to fracture fixation, with the added benefit of avoiding excessive soft-tissue disruption and neurovascular compromise. Our arthroscopic approach allows for direct visualization of articular injuries and reduction, with the ability to evacuate loose bodies and fracture hematoma, reducing matrix metalloproteinases (MMPs) known to cause posttraumatic ankle arthritis. Multiple case series have assessed the use of this technique, showing preserved range of motion and minimal residual pain or disability, as measured with use of multiple scoring systems such as the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scale.
IMPORTANT TIPS
Immediately after accessing the ankle via the operative portals, identify the flexor hallucis longus tendon to prevent iatrogenic injury to the neurovascular bundle.Plantar flexion of the ankle while applying anterior force to the talar body often aids in reduction.Place the medial guidewire directly adjacent to the flexor hallucis tendon in order to ensure that it is medial enough.Utilize anterior-to-posterior fluoroscopic images of the foot and ankle to ensure screw placement.Directly visualize the fracture site as the screws are sequentially tightened in order to prevent malalignment.Countersink all screw heads and directly verify with arthroscopic visualization.
ACRONYMS & ABBREVIATIONS
MVC = motor vehicle collisionXR = x-ray (radiograph)CT = computed tomographyEx-fix = external fixatorMRI = magnetic resonance imagingFT = fully threadedFHL = flexor hallucis longusAP = anteroposteriorROM = range of motionDVT = deep vein thrombosisBID = bis in die (twice daily dosing).
PubMed: 38274280
DOI: 10.2106/JBJS.ST.22.00007 -
National Journal of Maxillofacial... 2023Mandibular fracture is the second most common fracture of facial bone, next to nasal bone. Twenty-five to forty percent of mandibular fractures involve the condyle. In...
BACKGROUND
Mandibular fracture is the second most common fracture of facial bone, next to nasal bone. Twenty-five to forty percent of mandibular fractures involve the condyle. In the literature, there exists no consensus "gold standard" treatment for mandibular condylar fractures, and there is a continuing debate on whether condylar fractures should undergo closed or open reduction.
MATERIALS AND METHOD
Twenty patients who had undergone open reduction and closed reduction treatment were included in the study. Clinically maximal interincisal opening, laterotrusive and protrusive movements, pain on mouth opening, malocclusion, chin deviation on mouth opening, facial nerve palsy, hematoma, infected implant, and bite force were evaluated after a minimum of 3 months postoperatively. Also, a postoperative CT is done to evaluate the anatomical position of fragment.
RESULTS
On evaluation of clinical parameters, both groups had comparable results. However, none of the patients in open reduction group had deviation of mandible from midline on mouth opening. Also, better anatomical repositioning is obtained in open reduction group.
CONCLUSION
The results of this study suggest that the open reduction method is a better alternative to closed reduction in treatment of mandibular condylar fractures.
PubMed: 38273922
DOI: 10.4103/njms.njms_22_22 -
National Journal of Maxillofacial... 2023Mandibular angle fracture (MAF) is the second most common site of all fractures of the mandible with the highest complication rate. Management of MAF has evolved in the...
INTRODUCTION
Mandibular angle fracture (MAF) is the second most common site of all fractures of the mandible with the highest complication rate. Management of MAF has evolved in the past four decades. The purpose of the prospective study was to compare the efficacy of new design titanium miniplate (NDM) with conventional titanium miniplate (CTM) in the treatment of MAF.
OBJECTIVES
Mouth opening, occlusion, bite force measurement, and radiographs compared preoperatively and first week, first month and third month postoperatively.
MATERIALS AND METHOD
Fourteen patients diagnosed with MAF were randomly divided into two groups: Group A (seven patients) was treated with NDM and Group B (seven patients) with CTM. Patients were assessed preoperatively and postoperatively at an interval of one week, one month and three months.
RESULTS
Repeated measures ANOVA and Post hoc Tukey test showed a significant increase in bite force and mouth opening for both groups in first and third postoperative months. Unpaired -test showed slightly better mouth opening in Group B and slightly higher bite force in Group A.
DISCUSSION
Both miniplates fulfilled all the study objectives and equally satisfactory healing was seen at the end of third month. NDM offers better stability, rigidity, and anatomic reduction of the fracture with a drawback of difficulty in adaptation and increased operative timing compared to CTM. Hence, we would like to conclude that both miniplates are equally efficient in the treatment of non-comminuted angle fractures with the NDM having upper hand in stability.
PubMed: 38273910
DOI: 10.4103/njms.njms_451_21 -
Cureus Dec 2023Electromyography, commonly known as EMG, utilizes superficial or needle electrodes to record and analyze the fundamental electrical characteristics of skeletal muscles,... (Review)
Review
Electromyography, commonly known as EMG, utilizes superficial or needle electrodes to record and analyze the fundamental electrical characteristics of skeletal muscles, determining whether the muscles are contracting. The motor unit, which consists of a collection of group muscle fibers and the motor neurons that govern them, is the structural basis of EMG. Three types of electrode are used in EMG which are needle electrode, fine wire electrode, and surface electrode. A significant amount of literature indicates that the correction of muscle function affects the relationships between teeth within the same jaw and between the jaws on opposing sides. The mechanism of action in myofunctional appliance therapy is linked to neuromuscular and skeletal adaptations resulting from altered function in the orofacial region. Both myofunctional therapy and orthodontics aim to address abnormal muscular behavior, restore abnormal muscle activity, and maintain proper alignment in various areas, including the lips, lower jaw, and tongue. This knowledge is essential for functions such as swallowing, speaking, chewing, and respiration as well as for minimizing incorrect movements and positioning. This article aims to describe the application of surface EMG as a diagnosis tool for assessing muscle activities in various orthodontic disorders, such as class II malocclusion open bite, crossbite, maxillary constriction, cleft lip and palate (CLP), and temporomandibular dysfunction, in patients. The electrodes used in EMG can be utilized to detect bioelectric activity in the muscles of the jaws and abnormalities in jaw movement. Analyzing EMG data is vital for obtaining a comprehensive understanding of the masticatory muscle system.
PubMed: 38239516
DOI: 10.7759/cureus.50773 -
JPMA. the Journal of the Pakistan... Jan 2024This case report described th e surgical- orthodontic interdisciplinar y t reatment of a patie nt with skeletal anterior open bite, class III skelet al pa ttern, steep...
This case report described th e surgical- orthodontic interdisciplinar y t reatment of a patie nt with skeletal anterior open bite, class III skelet al pa ttern, steep mandibular plane, increa sed lower face heigh t, and thin mandibular sym physis. The or thodontic p reparation included an unusual extraction pattern (maxillary right first molar, maxillary left second premolar, and mandibular right central incisor), combined with two-jaw surger y comprised of maxillar y advancement and d ifferential impac tion, b ilateral malarplasty augme ntation and man dib ula r asymmetric bilateral sagittal split osteotomy setback. The follow-up of a rare complication of surgical hooks breakage during surgery is reported. Guided by 3- dimesional digital platforms, treatment planning and execution, resulted in a more ba lan ced a nd proportionate face with functional occlusion, and the case stability is shown i n a 32-m onth follow-up.
Topics: Male; Humans; Open Bite; Cephalometry; Mandible; Osteotomy; Maxilla; Follow-Up Studies
PubMed: 38219191
DOI: 10.47391/JPMA.9365 -
JAMA Network Open Jan 2024Tick-borne diseases (TBDs) other than Lyme disease, such as spotted fever group rickettsiosis, ehrlichiosis, and galactose-α-1,3-galactose (α-gal) syndrome, are an...
IMPORTANCE
Tick-borne diseases (TBDs) other than Lyme disease, such as spotted fever group rickettsiosis, ehrlichiosis, and galactose-α-1,3-galactose (α-gal) syndrome, are an emerging public health issue. Long-term sequelae secondary to Ehrlichia or Rickettsia infection are uncommon; however, musculoskeletal symptoms are often attributed to prior tick exposure.
OBJECTIVE
To evaluate the potential associations between prior exposure to TBDs and musculoskeletal symptoms, including radiographic osteoarthritis.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study analyzed serum samples from the fourth visit (2017-2018) of the Johnston County Osteoarthritis (JoCo OA) project, an ongoing longitudinal, population-based study in Johnston County, North Carolina. Biospecimen testing and analysis were performed between May 2022 and November 2023. Participants in the JoCo OA project are noninstitutionalized White and Black Johnston County residents 45 years or older.
MAIN OUTCOME AND MEASURES
The primary outcome was seropositivity with Ehrlichia IgG, Rickettsia IgG, and/or α-gal IgE and musculoskeletal symptoms. Secondary outcomes included risk factors associated with elevated α-gal IgE and weighted population point prevalence rates. Participants completed questionnaires, underwent physical assessments, and provided biospecimens for serological testing. Multivariable models were used to estimate associations of interest.
RESULTS
Of the 605 participants who completed the fourth visit of the JoCo OA project, 488 (80.7%) had serum samples available for testing. The 488 participants had a median (IQR) age of 72 (68-78) years and included 336 females (68.9%) and 161 Black (33.0%) and 327 White (67.0%) individuals. The overall weighted point prevalence was 8.6% (95% CI, 5.9%-11.3%) for Ehrlichia IgG, 17.1% (95% CI, 12.6%-21.5%) for Rickettsia IgG, and 19.6% (95% CI, 15.3%-23.8%) for α-gal IgE level greater than 0.1 IU/mL. Only α-gal IgE was associated with knee pain, aching or stiffness (mean ratio, 1.30; 95% CI, 1.09-1.56). Antibodies to Rickettsia, Ehrlichia, and α-gal were not associated with symptomatic radiographic knee osteoarthritis. Male sex (odds ratio [OR], 2.63; 95% CI, 1.55-4.47), current smoker status (OR, 3.55; 95% CI, 1.38-9.18), and an attached tick bite in the past 5 years (OR, 3.99; 95% CI, 2.22-7.15) were all risk factors that were associated with α-gal IgE level greater than 0.1 IU/mL. Despite only 84 individuals (17.2%) recalling a tick bite in the past 5 years, 178 (36.5%) had evidence of prior tick-borne exposure, suggesting frequent human-tick interactions.
CONCLUSIONS AND RELEVANCE
Results of this cross-sectional study indicate no association between Ehrlichia or Rickettsia seropositivity and chronic musculoskeletal symptoms or osteoarthritis. Further investigation is needed into the pathogenesis of α-gal syndrome and interventions to reduce human-tick interactions.
Topics: Female; Male; Humans; Aged; Musculoskeletal Pain; Tick Bites; Cross-Sectional Studies; Galactose; Tick-Borne Diseases; Immunoglobulin G; Osteoarthritis; Immunoglobulin E
PubMed: 38206624
DOI: 10.1001/jamanetworkopen.2023.51418