Correlation Analysis between Three-Dimensional Changes in Pharyngeal Airway Space and Skeletal Changes in Patients with Skeletal Class II Malocclusion following Orthognathic Surgery

Introduction. Studies on the pharyngeal airway space (PAS) changes using three-dimensional computed tomography (CT) have shed more light on patients with Class III than Class II malocclusion. This paper focuses on analyzing the long-term changes in the PAS and evaluating the postoperative association between these PAS and skeletal changes in patients with skeletal Class II malocclusion who have undergone orthognathic surgery. Methods. The records of 21 patients with skeletal Class II malocclusion who had undergone orthognathic surgery were included. The anatomical modifications in both jaws, changes in volume, sectional area (SA), minimum sectional area (MSA), and anterior-posterior (AP) and transverse (TV) width in the airway at one month before surgery ( T 0 ), and one month ( T 1 ) and one year ( T 2 ) after surgery were analyzed using CT images. The association between the skeletal and airway changes was evaluated between T 0 , T 1 , and T 2 . Results. After surgery, the ANS, A point, and PNS demonstrated significant posterior and superior movement. The B point and the pogonion exhibited substantial anterior and superior movement. The total and inferior oropharyngeal volumes (vol 3, vol 4) notably increased, while the nasopharyngeal volume (vol 1) decreased. The anterior-posterior movement at the ANS and PNS after surgery was significantly associated with the total volume, vol 2, vol 3, SA 1, MSA, and TV width 1, while substantial association with the total volume was found at the pogonion. Conclusion. Thus, an ideal treatment plan can be formulated for patients with skeletal Class II malocclusion by considering the postoperative PAS changes.

Oral appliance–generated malocclusion traits during the long-term management of obstructive sleep apnea in adults:

ABSTRACT Objectives To identify malocclusion characteristics generated after using oral appliances (OAs) for at least 5 years for the management of snoring and obstructive sleep apnea (OSA) in adults. Materials and Methods PubMed, MEDLINE (Ovid), Scopus, CINAHL, and Informit were searched without language restrictions through January 20, 2021. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and the Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Risk of bias was assessed through the revised Cochrane Risk of Bias tool for randomized controlled trials (RoB2) and Non-Randomized Studies of Interventions for non-RCTs and uncontrolled before–after studies (ROBINS-I). A random-effects meta-analysis was conducted only on studies that used the same OAs to exclude biomechanical differences. Risk of bias across studies was assessed with the Grading of Recommendations, Assessment, Development and Evaluation tool. Results A total of 12 studies were included in the final qualitative synthesis. Eight included studies had high, one had moderate, and three had low risks of bias. Significant progressive decreases of overjet (OJ; −1.43 mm; 95% confidence interval [CI], −1.66 to −1.20) and overbite (OB; −1.94 mm; 95% CI, −2.14 to −1.74) associated with maxillary incisor retroclination and mandibular incisor proclination were reported long term. Although most studies showed no sagittal skeletal changes, some degree of vertical skeletal changes were noted. Conclusions Based on a very low evidence level, inevitable anterior teeth positional changes seem to be a common long-term adverse effect of OAs. The magnitude of those changes could be considered clinically irrelevant for most pretreatment occlusions, but in occlusions with limited OJ and OB, it may be worth clinical consideration.

A possible case of Gigantism and/or Acromegaly in a 15th-17th century woman from Đurine Ćelije, Serbia

Endocrine disorders during growth and development that occur due to the secretion of excessive growth hormones are very rare in archaeological and modern populations. The human skeletal remains analyzed in this paper belong to an unusually tall woman, approximately 35-40 years of age, buried at the Đurine ćelije site (15th-17th century) in Serbia, who may have suffered from overgrowth syndrome. Individuals with this condition have an unusually tall stature and accompanying pathological changes related to organ systems and joint diseases. The aim of this paper is to show how the aforementioneddisorder affected the health status of an individual (grave No. 7a) and the performance of daily activities, but also the attitude of the community towards deformities during life and after death. Differential diagnosis was performed since otherdiseases tend to lead to similar skeletal changes. During the analysis, changes in growth were noticed, and her stature was determined to be 186.42 cm. Compared to the documented stature of post-medieval population from this period, theskeletal remains show a significant deviation from the average, especially when it comes to female individuals. Other pathological changes observed in this woman are osteoarthritis, spondyloarthropathy, and periosteal new bone formation.

The Deleterious Effects of Impaired Fibrinolysis on Skeletal Development Are Dependent on Fibrin(ogen), but Independent of Interlukin-6

Chronic diseases in growing children, such as autoimmune disorders, obesity, and cancer, are hallmarked by musculoskeletal growth disturbances and osteoporosis. Many of the skeletal changes in these children are thought to be secondary to chronic inflammation. Recent studies have likewise suggested that changes in coagulation and fibrinolysis may contribute to musculoskeletal growth disturbances. In prior work, we demonstrated that mice deficient in plasminogen, the principal protease of degrading and clearing fibrin matrices, suffer from inflammation-driven systemic osteoporosis and that elimination of fibrinogen resulted in normalization of IL-6 levels and complete rescue of the skeletal phenotype. Given the intimate link between coagulation, fibrinolysis, and inflammation, here we determined if persistent fibrin deposition, elevated IL-6, or both contribute to early skeletal aging and physeal disruption in chronic inflammatory conditions. Skeletal growth as well as bone quality, physeal development, and vascularity were analyzed in C57BL6/J mice with plasminogen deficiency with and without deficiencies of either fibrinogen or IL-6. Elimination of fibrinogen, but not IL-6, rescued the skeletal phenotype and growth disturbances in this model of chronic disease. Furthermore, the skeletal phenotypes directly correlated with both systemic and local vascular changes in the skeletal environment. In conclusion, these results suggest that fibrinolysis through plasmin is essential for skeletal growth and maintenance, and is multifactorial by limiting inflammation and preserving vasculature.

A primer on skeletal dysplasias

Skeletal dysplasia encompasses a heterogeneous group of over 400 genetic disorders. They are individually rare, but collectively rather common with an approximate incidence of 1/5000. Thus, radiologists occasionally encounter skeletal dysplasias in their daily practices, and the topic is commonly brought up in radiology board examinations across the world. However, many radiologists and trainees struggle with this issue because of the lack of proper resources. The radiological diagnosis of skeletal dysplasias primarily rests on pattern recognition—a method that is often called the “Aunt Minnie” approach. Most skeletal dysplasias have an identifiable pattern of skeletal changes composed of unique findings and even pathognomonic findings. Thus, skeletal dysplasias are the best example to which the Aunt Minnie approach is readily applicable.

Social differentiation and well-being in the Italian Iron Age: exploring the relationship between sex, age, biological stress, and burial complexity among the Picenes of Novilara (8th–7th c. BC)

The possible association between “biological” and “social” status in the past is a central topic in bioarchaeological studies. For the Italian Iron Age, previous research comparing skeletal and funerary variables depicts a multifaceted scenario consistent with nuanced biocultural patterns. This calls for additional studies on a broader series of archaeological contexts and skeletal assemblages. Here, we contribute new data about the biological correlates of social differentiation during the Italian Iron Age by comparing paleopathological and funerary variables in the Picene necropolis of Novilara (Marche region, 8th–7th c. BC). Novilara is one of the largest Picene necropolises in the Italian Peninsula and one of the most important funerary sites of the Italian Iron Age. The skeletal sample includes 147 individuals (females: 70; males: 35; 10 unsexed adults; 32 non-adults). We use linear enamel hypoplasia, cribra orbitalia, porotic hyperostosis, non-specific periosteal lesions, and stature to approximate non-specific stressors and compare them with archaeological variables summarizing funerary variability by means of logistic models, Mann–Whitney and Spearman tests. Results are heterogeneous and vary according to the considered variables. On average, they however show that (a) adults featuring a more complex funerary treatment have a lower probability of showing stress-related skeletal changes, and (b) even though funerary features suggests a strong gender differentiation, frequencies of paleopathological variables do not differ between sexes. Our analyses point to a complex link between biological and social status in this population and call for a critical reflection about the theoretical and methodological issues affecting similar studies.

Skeletal effects of mini-implant assisted rapid palatal expansion (MARPE) on the sagittal dimensions of the maxilla an in-vivo cone-beam computed tomography (CBCT) study

Introduction -Transverse discrepancies of the maxilla are one of the most prevalent skeletal problems. Due to drawbacks of conventional RPE and invasive surgical expansion methods alternative methods were developed such as Mini Implant-supported rapid maxillary expansion (MARPE).Haas17 , Davis and Kronman18, Akkaya et al19 and many other studies have reported the maxillary response after MARPE on the sagittal dimensions, but their results were inconclusive. Aim - This study analyzed the effects on the maxilla in the sagittal dimension after Mini Implant assisted rapid palatal expansion (MARPE) in adolescents using CBCT. Material and method -A pretreatment CBCT image (T1) was taken as a standard initial record for all patients and post treatment CBCT (T2) was taken after three months in retention. The parameters SNA angle, Frankfort horizontal plane to NA angle, A-N perpendicular, ANS –PNS were measured and calculated for evaluation of the sagittal maxillary changes. Comparisons were then made between the two treatment groups (T1, T2). Result -There was a positive increase in both angular and linear measurements from pretreatment to post treatment measurements showing significant skeletal changes in sagittal dimension. Conclusion -The study concludes that there was statistically significant forward displacement of maxilla after transverse skeletal expansion in patients with transverse problems achieved through MARPE in adolescent patients.

Assessment of Immediate Skeletal Changes after Alternate Rapid Maxillary Expansion and Constriction – A Case Report

The Alt-RAMEC protocol was introduced by Liou in the year 2005. It allows for sutural mobilisation by opening and closing the RME screw for 7-9 weeks. Maxillary protraction after the use of Alt-Ramec (alternate rapid maxillary expansion and contraction) protocol is an efficient method for early treatment of skeletal Class III malocclusion. This case report shows the results of using a hyrax bonded maxillary expander with the Alt-RAMEC protocol to treat a maxillary hypoplasia Class III malocclusion. A 12-year-old patient with skeletal class III malocclusion with anterior as well as the unilateral posterior crossbite was treated using this protocol. CBCT scans were taken before and after expansion. These CBCT scans were used for assessing and analysing the skeletal changes that have occurred after using the AltRamec protocol. The objective of this case report is to assess skeletal changes after using the Alt-RAMEC protocol.