Angle Class Research Articles

Sit-to-walk strategy classification in healthy adults using hip and knee joint angles at gait initiation

Forward continuation, balance, and sit-to-stand-and-walk (STSW) are three common movement strategies during sit-to-walk (STW) executions. Literature identifies these strategies through biomechanical parameters using gold standard laboratory equipment, which is expensive, bulky, and requires significant post-processing. STW strategy becomes apparent at gait-initiation (GI) and the hip/knee are primary contributors in STW, therefore, this study proposes to use the hip/knee joint angles at GI as an alternate method of strategy classification. To achieve this, K-means clustering was implemented using three clusters corresponding to the three STW strategies; and two feature sets corresponding to the hip/knee angles (derived from motion capture data); from an open access online database (age: 21–80 years; n = 10). The results identified forward continuation with the lowest hip/knee extension, followed by balance and then STSW, at GI. Using this classification, strategy biomechanics were investigated by deriving the established biomechanical quantities from literature. The biomechanical parameters that significantly varied between strategies (P < 0.05) were time, horizontal centre of mass (COM) momentum, braking impulse, centre of pressure (COP) range and velocities, COP–COM separation, hip/knee torque and movement fluency. This alternate method of strategy classification forms a generalized framework for describing STW executions and is consistent with literature, thus validating the joint angle classification method.

Prevalence of Progressive Collapsing Foot Deformity in Hallux Valgus Patients

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus (HV) and progressive collapsing foot deformity (PCFD) are very common foot and ankle conditions in the adult population. Both could potentially disrupt the tripod construct of the foot which leads to chronic pain and arthritis. Several procedures were described to address HV deformity depending on deformity characteristics. PCFD could alter the management plan for HV if they occur simultaneously. The aim of this study was to detect the prevalence of PCFD in HV patients and study the frequency of individual PCFD classes. Methods: In this retrospective IRB approved study, patients &gt; 18 years old who were evaluated for symptomatic hallux valgus and had a weight bearing computed tomography (WBCT) imaging were included. Patients were considered for further analysis if they have a hallux valgus angle (HVA) &gt; 15° or inter-metatarsal angle (IMA) &gt; 9°. All relevant demographic data were extracted. Two fellowship trained foot and ankle orthopaedic surgeon measured the following parameters: foot and ankle offset (FAO%) (Class A), talo-navicular coverage angle (TNCA) (Class B), Meary’s angle (Class C) and middle facet subluxation (MFS%) (Class D). Cases that showed FAO% &gt; 4.6% and MFS% &gt; 28.7% were diagnosed as PCFD. The prevalence of PCFD classes (A,B,C and D) was calculated using threshold values for its respective radiographic marker. Descriptive statistics were performed. Results: Thirty-four cases were included. 16 cases were females (46.06%) and 16 (46.06%) were right side. The average age was 52.51 years (SD ± 17.75), the average BMI was 30.14 (SD ± 7.15). The average HVA was 26.82 (SD ± 9.98) and the average IMA was 15.41 (SD ± 3.53). 13 patients (38.24%) had MFS% and FAO% above the threshold values. The average FAO was 4.75% (SD ± 4.92) and the average MFS was 29.17% (SD ± 15.89). Prevalence of Class A (FAO%) was 20 (58.82%), Class B (TNCA) was 12 (35.29%), Class C (Meary’s angle) was 15 (44.12%) and Class D (MFS%) was 16 (47.06%). Conclusion: Progressive collapsing foot deformity is prevalent in the hallux valgus population (38.24%). Class C which indicates medial column instability was prevalent in 44.12% of the cases. Given this high prevalence of PCFD, we believe that in addition to the classic hallux valgus parameters, PCFD classes evaluation could favor a surgical approach over another such as first tarsometatarsal joint procedures over isolated distal first metatarsal procedures to correct the HV deformity and simultaneously halt PCFD progression.

Relationship between stomatognathic alterations and idiopathic scoliosis: a systematic review with meta-analysis of observational studies.

The objective of this systematic review was to assess a possible relationship between stomatognathic alterations and idiopathic scoliosis (IS). This study is a systematic review with meta-analysis of observational studies. The protocol of this systematic review with meta-analysis was registered in PROSPERO (CRD42022370593). A bibliographic search was carried out in the Pubmed (MEDLINE), Scopus, Web of Science and CINAHL databases using the MeSH terms 'Scoliosis' and 'Stomatognathic Disease'. The odds ratio (OR) of prevalence and standardized mean difference (SMD) were used to synthesize the results. Of 1592 studies located, 14 studies were selected with 3018 subjects (age: 13.9 years). IS was related to Angle's class II (OR = 2.052, 95% CI = 1.236-3.406) and crossbite (OR = 2.234, 95% CI = 1.639-3.045). Patients with malocclusion showed a higher prevalence of IS than controls (OR = 4.633, 95% CI = 1.467-14.628), and subjects with IS showed high overjet (SMD = 0.405, 95% CI = 0.149-0.661) and greater dysfunction due to temporomandibular disorders (SMD = 1.153, 95% CI = 0.780-1.527). Compared with healthy controls, subjects with IS have twice the risk of suffering from occlusion disorders, present greater temporomandibular dysfunction and have a greater overjet in the incisors. Moreover, subjects with malocclusion have an IS prevalence up to four times higher. The systematic orofacial examination of patients with IS should be recommended.

The predictability of maxillary curve of Wilson leveling with the Invisalign appliance.

This retrospective study aims to evaluate the predictability of the Invisalign appliance (Align Technology, Santa Clara, CA) in leveling the maxillary curve of Wilson (COW). 53 adult subjects treated by orthodontists who are experienced Invisalign providers, between 2013 and 2019 were selected. All patients had either Angle Class I or II malocclusions and were treated by non-extraction in the maxillary arch with a minimum of 14 Invisalign aligners with no bite ramps or auxiliaries. Initial, predicted, and actual outcomes were analyzed with Geomagic Control X software (3D systems, Rock Hill, SC; Version 2017.0.3). Despite planning mean (SD) COW leveling of 0.25 mm (1.91), the curve became significantly more pronounced by 1.15 mm (0.85) (P<.001). There was a significant overexpression of buccal inclinations between mean prescribed versus actual values from 0.10 mm (0.39) (P=.007) to 0.29 mm (0.47) (P<.001) from the first premolars to the second molars, respectively. These differences were more pronounced posteriorly. The differences between the predicted and actual arch width values were underexpressed for all teeth except the second molars; a mean underexpression between 0.28 mm (0.92) and 0.60 mm (1.14). The second molars were the only teeth to overexpress with a mean of 0.42 mm (1.02). Overall mean maxillary COW was not predictably controlled with Invisalign. The appliance tends to overexpress the buccal crown tip regardless of prescribed direction, especially posteriorly. Arch expansion was underexpressed at all levels of the arch except for second molars which overexpressed by almost four times.

A clinical and X-ray analysis of temporomandibular joint bone elements ratio in children and adolescents with distal position of lower jaw

Aim to conduct a clinical and radiological analysis of the temporomandibular joint (TMJ) bone elements ratio in patients of 1217 years old with a distal position of lower jaw.&#x0D; Material and methods. We examined 122 patients of two age groups: 1215 years old and 1517 years old. Patients with malocclusion class II formed the main group, the control group consisted of patients with physiological occlusion. Depending on the diagnosis, the patients of the main group were divided into subgroups in accordance with Angle's classification of malocclusion: patients with class II, subclass 1; patients with class II, subclass 2. The TMJ tomograms were analyzed according to the method of N.A. Rabukhina and the method proposed by the authors. The results were compared in patients from different groups.&#x0D; Results. The size of the TMJ space in the anterior section in patients with class II subclass 1 malocclusion increases with age from 2.440.14 mm to 2.960.17 mm, P = 0.048, P = 0.008 in comparison with patients with physiological occlusion. In patients with class II subclass 2 the TMJ space increases from 2.920.21 mm to 3.120.19 mm (P = 0.001). In patients with class II subclass 1 in the age group of 1215 years, the value of the angle in habitual occlusion is increased to 20.011.01 on the right (P = 0.035), and to 20.781.11 on the left (P = 0.044). In the group of 1517 years the value of the angle ⟨ is reduced to 16.331.15 on the right (P = 0.04) and to 16.930.93on the left (P = 0.049). In patients with class II subclass 2 malocclusion in the age group of 1517 years, the value of the angle on the right is reduced to 16.471.02 (P = 0.016), on the left to 16.030.86 (P = 0.011). The revealed differences indicate violations of ratio of the TMJ bone elements with age in patients with malocclusion class II. The asymmetry and distal position of the mandibular heads in the TMJ are most prominent in the subgroup of patients with class II subclass 2 malocclusion.&#x0D; Conclusion. The method of analyzing angular indicators on the TMJ CBCT data complements the study of the TMJ CBCT data according to the method of N.A. Rabukhina.

Anterior Open Bite Treatment in the Mixed Dentition: a Brief Review and Case Report

Anterior open bite (AOB) is a vertical plane malocclusion characterized by a negative vertical overbite and can be classified according to its nature: dentoalveolar or skeletal. The dentoalveolar anterior open bite (DAOB) occurs in individuals who have a good relationship between the bone bases and its etiology is associated with environmental factors. DAOBS´s treatment tends to have a favorable prognosis and it's up to the dentist to choose the most adequate method in each case. Thus, the objective of this study is to present a case report of DAOB. Female patient of 6 years old attended the Preventive Orthodontics Clinic of the Faculty of Dentistry of Araçatuba - UNESP, having as main complaint “open bite”. In the anamnesis the patient revealed that used a pacifier and presented a digital sucking habit. The patient was in the first transitional period of mixed dentition with permanent incisors and first molars partially erupted. The diagnosis was of Angle Class I malocclusion with dentoalveolar anterior open bite and dentoalveolar anterior crossbite of the deciduous right maxillary canine. The bi-helix with crib appliance was installed and the patient was oriented to perform myofunctional exercises daily. This therapeutic protocol represents an efficient and effective approach for the correction of DAOBs providing improved aesthetics, social well-being and a more appropriate and correct occlusion that allows oral functions (deglutition, speech and chewing) to work properly. The results acquired through this treatment are essentially of dentoalveolar nature.

Advansync2 Current Trend for Correction of Skeletal Class II Malocclusion: A Case Study

The most frequent skeletal discrepancy seen across all age groups is class II malocclusions, which account for roughly 15-20% of orthodontic procedures. The most frequent type of malocclusion, Angle's class II division 1 malocclusion, is challenging to treat, especially when an underlying skeletal misalignment is present. For the treatment of skeletal class II malocclusion brought on by retrognathic mandible, different fixed functional appliances have been developed over the years by various authors. The molar-to-molar appliance, also known as Advansync2 (Ormco Co, Glendora, Calif.), has lately been employed successfully among the fixed functional appliances available for class II correction. This fixed tooth-born functional appliance has the benefit of enabling the use of fixed orthodontic therapy simultaneously. As a result, the length of the entire treatment can be shortened. We provide two case reports of patients who used the Advansync2 class II corrector and describe the skeletal and dentoalveolar abnormalities that were noticed as a result of the treatment. The observed outcomes were equivalent to those of the majority of fixed functional equipment, although in every instance, the treatment time was greatly shortened.

The Impact of Orthodontic Treatment on Facial Appearance in Angle Class III Patients: A Mini Review

Angle Class III malocclusion has a strong genetic influence that can occur in several generations of the same family group. This dentofacial deformity can be identified from an early age, even in childhood. The perception of beauty in the transition phase to adolescence has a greater weight, because in this phase there are immense physiological changes. The need for attention through aesthetic enhancement generates vanity, which can have both beneficial and harmful influences. Nowadays, the young generation craves prominence and subsequently values the exaggerated importance of beauty and the quest for aesthetic perfection. A young patient with a dentofacial deformity caused by Angle Class III malocclusion has a major facial impact. They are usually the victims of teasing, nicknames and psychological pressure and bullying. They become embarrassed, irritable and their self-esteem and social integration suffer. From this perspective, early treatment in children can be beneficial, reducing the psychological burden of facial and dental alterations in the future. The purpose of this article is to review the literature on the facial aspects resulting from orthodontic treatment in Angle Class III patients.

Two-dimensional facial measurements for anterior tooth selection in complete denture treatment

PurposeAnterior tooth selection is one of the most challenging parts in determining tooth dimensions and critical to the aesthetic aspect of the complete denture treatment. However, the methods for anterior tooth size selection using facial measurements are still controversial. This study aimed to investigate the relationship between dental measurements and facial measurements, and to establish the anterior tooth size prediction equation using facial dimensions in the Thai population for the complete denture treatment. Materials & methodsOne hundred and twenty-five Thai participants (53 men and 72 women) aged 18–35 years old with Angle class I occlusion, did not currently undergo orthodontic treatment, had normal alignment on the maxillary anterior teeth, no attrition, abrasion, proximal restoration or prosthesis were investigated. One frontal facial photograph and one dental photograph of each participant were made using an image analyzing program (ImageJ version 1.53b) to measure the six horizontal facial distances, five vertical facial distances and three dental distances as 2D facial and dental measurements. Pearson correlation and multiple linear regression analysis were performed. ResultsThe difference of facial and dental measurements between men and women were statistically significant (P < .001). Interpupillary width, interlateral canthal width, intercommissural width and bizygomatic width were correlated to dental measurements in both sexes. Intermedial canthal width and lip thickness were correlated to dental measurements in women. Face length and lateral canthus to lower border of face were correlated to dental measurements in men. Prediction equations of each dental measurement were established using only horizontal facial dimension and using both horizontal and vertical facial dimensions. ConclusionsFacial and dental dimensions are sex-dependent. Facial measurements can be applied in a regression equation to predict dental measurements. Adding vertical dimensions of facial measurements to the prediction equations of anterior tooth size selection results in a higher R squared to 0.444. This finding can be used as a tool for anterior tooth size selection in the complete denture treatment.

Dentoalveolar and Soft Tissue Changes Following en-Masse Anterior Retraction With Different Force Vectors in Subjects With Bidental Protrusion: A Retrospective Evaluation.

Introduction The aim of the study is to determine the effects of different vertical force vectors acting on dentoalveolar and soft tissues while applying a retraction force using various anchorage sources and their effects on these tissues. Material andmethods Based on the selection criteria, a total of 35 patient case records with Angle's Class I bidental malocclusion and incompetent lips treated with four premolar extractions were included. Retraction was achieved using a NiTi coil spring with two different force vectors. The anchorage in group 1 was enhanced by a transpalatal arch (TPA)and Lower Stabilizing Arch(LSA) in the upper and lower arch, respectively, with a force vector parallel to the occlusal plane,whereas in group 2, the force vector using Temporary Anchorage Devices (TADs) was 15 - 20 degrees to the occlusal plane. The skeletal, dental, and soft tissue were obtained using 40 parameters. Intra-group comparisons between pre- and post-treatment records were conducted using a paired t-test, while inter-group comparisons were conducted using an independent t-test. Result Significant anchor loss was observed in group 1, indicated by mesial movement of molar crowns by (-2.10±0.50) in the maxillary arch and (-1.75±0.38) in the mandibular arch. Distal movement of incisors following premolar extractions with both studied force vectors resulted in an improvement in lip procumbency and incisor inclinations, without any significant skeletal changes.Molar mesial movement was observed in subjects treated with conventional anchorage. Conclusion En masse anterior retraction did lead to anchorage loss when carried out without TADs.Altering the force vector did not produce significant changes in tooth movement along the vertical plane.

A Novel 3D Evaluation of the Correlation Between the Condylar Position and Angle Classification in a Lebanese Population: A Pilot Study

Introduction: The temporomandibular joint (TMJ) is one of the most complex joints. Its morphology varies between individuals, and even between the left and right sides. Several studies have found a significant relation between certain occlusal features and joint morphology. Cone-beam computed tomography (CBCT) imaging is currently the most widely adopted modality for the examination of the TMJ. Objective: This study aimed to compare the joint space in a Lebanese cohort with different Angle classification using CBCT. Methodology: We retrospectively analyzed CBCT images performed at the Saint Joseph University of Beirut in Lebanon, over a period of 1 year, between 2021 and 2022. Four clearance values were selected, representing the minimum distance between the temporal bone and the mandibular condyle that defines the joint space: 0.5 mm, 1 mm, 1.5 mm, and 2 mm. For each value chosen, we looked for the presence or not of a visible surface. This surface corresponds to the area of the condyle with a distance from the condyle to the temporal bone less than or equal to the chosen value. Results: Twenty-nine patients aged between 12 and 60 years old were included; 12 (41%) were males and 17 (59%) females. We classified 48 CBCT images (23 on the right side and 25 on the left side) into three groups according to Angle’s classification: class I (n=14), class II (n=29), and class III (n=5). For a distance of [0-1.5 mm] corresponded a surface of 0 mm2. For the interval between [1.5-2 mm] corresponded a surface of 18,8 mm2 for class I subjects, 16,6 mm2 for class II, and 30,5 mm2 for class III. The results showed no statistically significant differences between the articular spaces and the different types of occlusion. Conclusion: The three-dimensional evaluation of the condylar position by CBCT showed that there are no significant differences between the joint spaces and the different types of occlusion according to Angle’s classification.

Skeletal and dento-alveolar changes obtained with customised and preformed eruption guidance appliances after 1-year treatment in early mixed dentition.

The aim of this study was to assess the skeletal and dento-alveolar changes produced by a customised eruption guidance appliance (EGA) and a preformed EGA in subjects presenting a skeletal class II pattern during early mixed dentition and to evaluate the differences between the two devices. All subjects included in the study were randomly selected from the record's archive according to the following inclusion criteria: (1) patients presenting upper central incisor and first permanent molars fully erupted; (2) early mixed dentition with age between 7 to 9 years old; (3) Angle class I or class II malocclusion; (4) increased overjet > 4 mm;(5) deep bite with at least 2/3 overlapping of the incisors; (6) no previous orthodontic treatment apart from maxillary expansion treatment. All children belonging to the case group received treatment with a 3D printed EGA whereas the other patients belonging to the control group were treated with preformed EGA. Records consisted in digital dental models and lateral cephalogram at the beginning (T0) and after 1 year of treatment (T1). Data collected on the digital models included the dentoalveolar changes in overbite, overjet, sagittal molar relationship, and dental crowding. Cephalometric tracings were computed by a single blinded observer using Dolphin Imaging software. Statistical analysis was performed with SPSS (version 25.00; IBM Corp, Armonk, NY). Comparison regarding the cephalometric changes between T1-T2 was carried out with paired t-test. Difference in distribution regarding sagittal molar and canine relationship and anterior crowding between groups at T1 and T2 has been computed with chi-square test. The independent sample t-test was used to perform the between group comparison. In the short time, both the appliances showed to be effective in correcting class II malocclusion, anterior crowding, overjet and overbite. Custom-made appliance demonstrated to be significantly more effective in correcting anterior crowding, the dento-skeletal vertical relation and position of permanent incisor compared to the preformed appliance. Adopting a customised device, effects due to an average prescription appliance used to a specific patient can be reduced, resulting in more predictable results.

Full single arch distalization in Class II malocclusion using subzygomatic temporary anchorage devices: A case report

Abstract Distalization of the maxillary molars is among the most commonly employed nonextraction treatment strategies for angle Class II malocclusion. This approach is primarily recommended for subjects with dentoalveolar maxillary protrusion or minor skeletal abnormalities. A case of a 17-year-old Hispanic male patient with Class II skeletal base with Class II end on canines and molars, upper anterior crowding, severe overjet, and moderate overbite is hereby reported. He refused extraction; therefore, he was offered full single upper arch distalization using subzygomatic temporary anchorage devices (TADs). After 11 months of retraction, the TADs were removed and it was observed that the overjet and overbite were now within normal values and midline shift was also corrected. Satisfactory leveling and alignment, alleviation of crowding, and Class I molar and canine relationship were achieved. The aim of this case report was to describe full single arch distalization using subzygomatic TADs in a patient with Class II skeletal, molar, and canine relationships.

Developing a new tool for scoliosis screening in a tertiary specialistic setting using artificial intelligence: a retrospective study on 10,813 patients: 2023 SOSORT award winner.

The study aims to assess if the angle of trunk rotation (ATR) in combination with other readily measurable clinical parameters allows for effective non-invasive scoliosis screening. We analysed 10,813 patients (4-18years old) who underwent clinical and radiological evaluation for scoliosis in a tertiary clinic specialised in spinal deformities. We considered as predictors ATR, Prominence (mm), visible asymmetry of the waist, scapulae and shoulders, familiarity, sex, BMI, age, menarche, and localisation of the curve. We implemented a Logistic Regression model to classify the Cobb angle of the major curve according to thresholds of 15, 20, 25, 30, and 40 degrees, by randomly splitting the dataset into 80-20% for training and testing, respectively. The model showed accuracies of 74, 81, 79, 79, and 84% for 15-, 20-, 25-, 30- and 40-degrees thresholds, respectively. For all the thresholds ATR, Prominence, and visible asymmetry of the waist were the top five most important variables for the prediction. Samples that were wrongly classified as negatives had always statistically significant (p ≪ 0.01) lower values of ATR and Prominence. This confirmed that these two parameters were very important for the correct classification of the Cobb angle. The model showed better performances than using the 5 and 7 degrees ATR thresholds to prescribe a radiological examination. Machine-learning-based classification models have the potential to effectively improve the non-invasive screening for AIS. The results of the study constitute the basis for the development of easy-to-use tools enabling physicians to decide whether to prescribe radiographic imaging.

Short- and Long-Term Prediction of the Post-Pubertal Mandibular Length and Y-Axis in Females Utilizing Machine Learning.

The aim of this study was to create a novel machine learning (ML) algorithm for predicting the post-pubertal mandibular length and Y-axis in females. Cephalometric data from 176 females with Angle Class I occlusion were used to train and test seven ML algorithms. For all ML methods tested, the mean absolute errors (MAEs) for the 2-year prediction ranged from 2.78 to 5.40 mm and 0.88 to 1.48 degrees, respectively. For the 4-year prediction, MAEs of mandibular length and Y-axis ranged from 3.21 to 4.00 mm and 1.19 to 5.12 degrees, respectively. The most predictive factors for post-pubertal mandibular length were mandibular length at previous timepoints, age, sagittal positions of the maxillary and mandibular skeletal bases, mandibular plane angle, and anterior and posterior face heights. The most predictive factors for post-pubertal Y-axis were Y-axis at previous timepoints, mandibular plane angle, and sagittal positions of the maxillary and mandibular skeletal bases. ML methods were identified as capable of predicting mandibular length within 3 mm and Y-axis within 1 degree. Compared to each other, all of the ML algorithms were similarly accurate, with the exception of multilayer perceptron regressor.

Effects of headgear timing on dental arch changes from 7 to 18 years of age: a follow-up study.

Dental arch effects after cervical headgear (CHG) treatment have been researched from several different perspectives. However, the long-term effects of CHG timing are still unknown. To analyse the long-term effects of CHG timing on dental arches. A total of 67 children with Angle Class II malocclusion comprised the study group in this trial. The participants were randomized into two equal-sized groups. In the early group (EG, n = 33), treatment was started after the eruption of the first upper molars. In the later-timed group (LG, n = 34), treatment was started 18 months later compared with the early group. Long-term effects were measured from dental casts taken at five time points between 7 and 18 years of age. The total maxillary dental arch length was achieved earlier, the gained length persisted better in the long term, and significantly more space was achieved in EG compared with LG (P = .048). The intermolar width in the maxillary dental arch was more stable and was reached earlier in EG compared with LG (P = .002). The results showed that in terms of total mandibular arch length increases, EG males benefited the most and LG females the least from CHG treatment (P = .031). Both genders benefited from earlier CHG treatment. The maxillary dental arches remained longer, and the final width was gained earlier in EG compared with LG.

Influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors

ObjectivesTo evaluate the influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors.Materials and methodsPatients who completed MARPE treatment at the Radboud University Medical Center between 2018 and 2021 were included in this retrospective study. The papilla height between the maxillary central incisors was evaluated on frontal intraoral photographs taken before expansion (T0) and 1.5 years after MARPE treatment (T1) using the Jemt classification. The difference in Jemt score at T0 and T1 was the primary outcome variable. In addition, gender, age, Angle classification, MARPE duration, midpalatal suture maturation stage, maximal central diastema (MCD) immediately after expansion, crown width to length ratio (W/L), pretreatment overlap of maxillary central incisors, and the distance between the approximal contact point of the central incisors and the bone crest (CP-B) were also record.ResultsTwenty-two patients were included (2 men, 20 women, mean age 27.3 ± 8.8 years) and 4 patients (18%) showed a significant reduction in the Jemt score following MARPE (p = 0.04), indicating papilla recession. Interdental papilla recession was significantly associated with the increase of CP-B (p = 0.02), smaller W/L (p < 0.01), overlapping of maxillary central incisors (p < 0.01), and smaller MCD immediately after expansion (p = 0.02).ConclusionsOne and a half years after MARPE, 18% of patients exhibited mild recession of papilla height of the maxillary central incisors. Overlapping and smaller W/L of maxillary central incisors were prognostic factors for interdental papilla recession.Clinical relevanceClinicians have to be aware of and inform the patients about the occurrence of papilla recession following MARPE.

The validity of I-Scan in diagnosis of gastroesophageal reflux disease

Background: The evaluation of patients with suspected gastroesophageal reflux disease (GERD) frequently represents a diagnostic dilemma. Confirmation of the presence of the esophogeal mucosal injury is one of the roles of endoscopy in GERD diagnosis. In this context, there are limitations of white light endoscopy (WLE) because of the inadequate visualization of the minute mucosal changes and the uncertainty in describing the severity of mucosal injury. I-SCAN technology helps in revealing fine details of the GI mucosa. Aim: to evaluate the diagnostic efficacy of I-SCAN technology as compared to white light endoscopy (WLE) in Egyptian patients suffering from GERD symptoms. Patients and methods: This study included adult patients with GERD questionnaire (Q) score ≥ 8 points. The distal esophagus was examined by WLE followed by I-SCAN 2 to evaluate the presence of mucosal injuries and to classify GERD severity according to the Los Angles (LA) classification &amp; its Japanese modification, respectively. Biopsies were taken from the lower esophageal mucosa as well as from the visible mucosal breaks and subjected to histopathologic examination. Results: Sixty patients were enrolled; 32 (53.3%) were females &amp; 28 (46.7%) were males. WLE showed erosive reflux disease (ERD) in 41 patients (68.3%); while 19 patients (31.7%) showed no mucosal breaks. As regard LA classification; 18 of the cases were classified as grade A (30%); 15 as grade B (25%); 7 as grade C (11.7%) and 1 as grade D (1.7%). Reexamination of distal esophagus by I-SCAN 2 showed minimal change esophagitis (MCE) (grade M) &amp; ERD in 57 patients (95%); while only 3 patients (5%) showed no mucosal changes (grade N). As regard the modified LA classification; 16 cases were classified as grade M (26.6%); 12 as grade A (20%); 21 as grade B (35%); 7 as grade C (11.7%) and 1 as grade D (1.7%). There was perfect agreement of WLE with I-SCAN 2 in LA grades B, C &amp; D. There was poor agreement of WLE with I-SCAN 2 in cases who had no mucosal breaks &amp; LA grade A cases on WLE (weighted Kappa was 0.11); as 16 cases were reclassified as grade M on I-SCAN 2 (had no mucosal breaks on WLE) and 6 cases were reclassified as class B on I-SCAN 2(were classified as grade A on WLE). As regard the histological proven reflux esophagitis (HPRE), it was present in 41 (68.3%) of the studied cases with statistically significant higher proportion of male gender. It was present in 28 (68.3%) of the patients who had ERD on WLE; 13(68.4%) of the patients who had no mucosal breaks on WLE; 38 (66.6%) of the cases who had grade M or ERD on I-SCAN 2 &amp; the three patients who had grade N on I-SCAN 2.GERD Q score ranged from 10 to 12 points with median of 11 points. It was significantly higher in patients with HPRE (11.4 ± 1.8 points) than those without (10.3 ± 1.3 points) (p= 0.026). GERD Q score strongly correlated with both the modified LA grade by I-SCAN 2 (p=0.03) and the histological severity score (p=0,016). On univariate &amp; multivariate analysis, male gender and GERD Q score &gt; 11points were significant predictors of HPRE (p &lt; .001). ROC analysis curve showed that GERD Q score at a cut-off &gt; 11points was a significant predictor of HPRE with a sensitivity of 47%, specificity of 85%, AUC of 66.7% and p = 0.015. Conclusion: I-SCAN technology may improve the diagnosis of the esophogeal mucosal injury in GERD patients. There was poor agreement of WLE with I-SCAN 2 in patients who had no mucosal breaks &amp; those with LA grade A on WLE. However, there was perfect agreement of WLE with I-SCAN 2 in patients with LA grades B, C&amp; D. GERD Q score had positive correlation with both the modified LA grade on I-SCAN 2 and the histological severity score. Male gender and GERD Q score &gt; 11points were significant predictors of histological proven reflux esophagitis.

Retrospective Analysis of the Airway Space Changes in Dentofacial Deformity after Two-Jaw Orthognathic Surgery Using Cone Beam Computed Tomography.

Orthognathic surgery is used to modify anomalies in maxillomandibular position; this process can significantly affect the anatomy of the airway and cause functional changes. This study aims to define the impact of mandibular maxillary movement on the airway of subjects with dentofacial deformity. A retrospective study was conducted on subjects with Angle class II (CII group) and Angle class III (CIII group) dentofacial deformities. The subjects were treated via bimaxillary surgery; for all of them, planning was performed with software and 3D printing. Cone beam computed tomography (CBCT) was obtained 21 days before surgery and 6 months after surgery and was used for planning and follow-up with the same conditions and equipment. Was used the superimposition technique to obtain the maximum and minimum airway areas and total airway volume. The data were analyzed with the Shapiro-Wilk test and Student's t-test, while Spearman's test was used to correlate the variables, considering a value of p < 0.05. Thus, 76 subjects aged 18 to 55 years (32.38 ± 10.91) were included: 46 subjects were in CII group, treated with a maxillo-mandibular advancement, and 30 subjects were in the CIII group, treated with a maxillary advancement and a mandibular setback. In the CII group, a maxillary advancement of +2.45 mm (±0.88) and a mandibular advancement of +4.25 mm (±1.25) were observed, with a significant increase in all the airway records. In the CIII group, a maxillary advancement of +3.42 mm (±1.25) and a mandibular setback of -3.62 mm (±1.18) were noted, with no significant changes in the variables measured for the airway (p > 0.05). It may be concluded that maxillo-mandibular advancement is an effective procedure to augment the airway area and volume in the CII group. On the other hand, in subjects with mandibular prognathism and Angle class III operated with the maxillary advancement and mandibular setback lower than 4 mm, it is possible to not reduce the areas and volume in the airway.

Behaviour and sun exposure in holidaymakers alters skin microbiota composition and diversity.

Introduction: The skin microbiota plays a crucial role in maintaining epidermal homeostasis. Ultraviolet radiation (UVR) and other environmental challenges can impact the skin microbiota through direct and indirect mechanisms. This study aimed to investigate the effects of sun exposure on the skin microbiota and its relationship with individual skin phototypes. Methods: Healthy volunteers (n = 21 [4M, 17F], mean age 33.2years) holidayed in a sunny destination for a minimum of 7days with swabs taken pre-holiday and up to 84days post-holiday. Participant group was categorised by individual typology angle (ITA) classification and the composition of the skin microbiota was examined using 16S rRNA gene sequencing. Results: In the entire cohort and at all time points, the major bacterial phyla were Actinobacteria, Proteobacteria and Firmicutes. There was a significant change in microbial beta diversity at day 28 post-holiday, compared to baseline, for all participants. However, when participants were segregated into three cohorts dependent on the degree of skin tanning response between baseline (pre-holiday) and immediately one-day post-holiday, there was a reduction in Proteobacteria in the sun-seeking participants 1day after the holiday, which recovered over time. Discussion: These findings suggest that sun exposure can affect the diversity and composition of the skin microbiota, which may have downstream effects on skin health.