Indian Board of Orthodontics Case Report: Management of Class II Skeletal Malocclusion Using 2-Phase Treatment

KL, a 12-year-old boy, presented with a class II Div I malocclusion on a class II skeletal base (retrognathic mandible) with a 7-mm overjet and a horizontal growth pattern. He had a convex profile, incompetent lips, lip trap, deep mentolabial sulcus, everted lower lip, and positive visual treatment objective (VTO). KL had a CS2 cervical maturation stage, which indicates 65% to 85% adolescent growth remaining. Treatment involved growth modification using a removable Twin Block with midpalatal expansion screw. This was followed by upper and lower fixed appliance using 0.022” × 0.028” slot Mclaughlin Bennet and Trevisi (MBT) prescription. The retention protocol involved upper wrap around and lower lingual bonded retainer.

Cervical Vertebral Maturation Method: Reproducibility and Efficiency of Chronological Age Estimation

The aim of this study was to investigate the reproducibility of the Cervical Vertebral Maturation (CVM) method and the potential for chronological age estimation using this method. The sample consisted of 474 lateral cephalometric radiographs, from orthodontic patients aged 6.4–22.4 years. Six raters were trained to the CVM method (Baccetti). All images were assessed twice. Intra- and inter-rater agreements were assessed by Cohen’s weighted kappa and intraclass correlation coefficient, respectively. Analysis of variance was performed to investigate the correlation between cervical maturation stages and chronological age. The age prediction potential of the method was tested by general linear model regression analysis. Intra-rater reliability ranged from 0.857 to 0.931. Intra-rater absolute agreement ranged from 77% to 87% however inter-rater absolute agreement was lower than 50%. Inter-rater reliability was higher than 0.9. The 3rd Cervical Maturation Stage (CS3) showed the lowest reproducibility. The mean age differences among the 6 CS stages were statistically significant and increased as the CS increased. CS and gender could roughly explain the 60% (adjusted R2 = 0.61) of the age variance of the sample. This CVM method proved able to show high reliability; however, it cannot predict accurately the pubertal growth spurt. A direct correlation was found between cervical stages and chronological age. This method provides a broad estimation of chronological age.

Study of Influence of Vaginal Ph on the efficacy of Dinoprostone gel for Induction of Labor

Background: Inducing labor is a procedure intended to trigger artificial contractions of the uterus that generally involve progressive erasure and dilation of the cervix. This will hopefully lead to the birth of a baby through the vaginal route. To assess the efficacy of dinoprostone gel in cervical maturation and its effect on vaginal pH. Subjects and Methods: The participants were grouped by their vaginal pH into two groups. Group, I included patients with vaginal pH 4.5 and Group II included vaginal pH >4.5 and the differences between the groups with respect to maternal age, parity, gestational age. Those women with minimal change in Bishop Score, received up to 3 doses of dinoprostone gel intracervically, 6 hours apart. Women, who had no change in Bishop Score at the end of induction with 3 doses of dinoprostone, were further reassessed. Results: There was no statistically pertinent relationship between the two groups in regard to maternal age, gestational age, parity, and initial Bishop Score. The mean maternal age in Group I was 25.9 years and Group II was 26.9 years. The mean gestational age was 39.5 weeks in group I and 38.9 weeks in group II. The majority of subjects were primigravidas (70 percent in group I and 63 percent in group II). The mean Bishop score before labor induction was 3.6 0.9 in Group I and 4 1.0 in Group II. Out of 200 cases, 33 (23.3 percent) needed an improvement in Oxytocin, 33 (33.3 percent) in Group I and 4 (13.3 percent) in Group II. The vaginal delivery rate was 90% in Group I and 87% in Group II. The Caesarean section was marginally higher in Group II (10 percent) compared with Group I (13 percent). Conclusion: Parity has a major impact on the pre-induction of the Bishop Score and the pH itself has a vaginal influence. Knowing the pre-induction vaginal pH may also be a helpful method for determining the outcome of PGE2 induction.

Concerning some morphofunctional aspects of the uterine cervical ripenening

The onset of pregnancy is marked by profound morphological and functional changes occurring in the uterine cervix, the whole combination of which is described by the term cervical ripenening. The study of morphological and functional aspects of cervical maturation is both of theoretical and practical importance since many disorders of cervical maturation often lead to premature delivery or the birth of premature infants. The improvement of research methods enabled to study the process of cervical maturation at the molecular and cellular levels of organization. Our paper summarizes current data on the main morphological and functional changes that occur in the uterine cervix during maturation. In the course of the analysis of literature data, it became possible to identify three structural components that play a leading role in the maturation of the uterine cervix: epithelial, immuneinflammatory, connective tissue extracellular matrix component. Understanding the morphofunctional changes that occur in the uterine cervix during its maturation at different levels of organization of living organisms (molecular, cellular, tissue) is crucial for the development and improvement of treatment and prevention strategies.

Lipopolysaccharide-induced premature cervical ripening and inflammation in pregnant mice can be alleviated by nicotine

Background Clinical treatment of preterm birth (PTB) is usually dependent on inhibiting uterine contractions. Such therapy is only effective in the short-term and cannot fundamentally low the incidence of PTB. Premature cervical maturation is another important cause of PTB; it is associated with invasion of macrophages, which produce proinflammatory cytokines. We previously found that activation of the alpha-7 nicotinic acetylcholine receptor (α7nAChR) by nicotine alleviates the systemic inflammatory response in murine models of lipopolysaccharide (LPS)-induced PTB, but the underlying mechanisms remain unclear. Methods Cervical tissues were collected from women in preterm and term labor. An animal model of PTB was established by administering 25 µg/kg lipopolysaccharide (LPS) to normal pregnant C57BL/6 mice on gestational day 16 (GD16). PTB animals received 1 mg/kg of α7nAChR agonist nicotine or nicotine combined with 1 µg/kg α7nAChR antagonist α-bungarotoxin (α-BGT) from GD14 to GD17. The gestational age, the rates of preterm birth and the survival rate of pups were recorded. Immunofluorescence staining were utilized for the quantification of α7nAChR expression on cervical macrophages and changes in macrophage polarization, RT-PCR was used to determine the mRNA levels of M1 and M2 macrophage biomarkers. Elisa assay was used to detect changes in fetal inflammation. Immunofluorescence staining and western blotting were used to investigate the signaling pathways underlying nicotine’s promoting LPS-induced conversion of M1 macrophage to M2 in the cervix of PTB animals. Results α7nAChR expression on cervical macrophages and cervical collagen content was decreased in PTB patients and murine models of LPS-induced PTB. The number of M1 cervical macrophages, other pro-inflammatory mediators in the cervix and fetal inflammation was unregulated in pregnant mice following LPS administration. Nicotine treatment reduced the rate of PTB, decreased fetal inflammation, improved maternal and neonatal outcome; nicotine also increased polarization of cervical macrophages toward the anti-inflammatory M2 phenotype possibly by suppressing activation of the MAP kinases JNK and ERK1/2 and nuclear translocation of NF-κB and rescuing the inhibited JAK2/STAT3 and PI3K/AKT pathways. The effects of nicotine were reversed by the selective α7nAChR antagonist α-bungarotoxin (α-BGT). Conclusions Our findings indicate that nicotine prevents LPS-induced cervical ripening and inflammatory response by inducing M2 macrophage polarization, and nicotine may serve as potential anti-premature cervical maturation agents for treatment of PTB.