Diastema Research Articles

Acromegaly in humans and cats: Pathophysiological, clinical and management resemblances and differences

ObjectiveAcromegaly is a disorder associated with excessive levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). In general, GH/IGF-1 excess leads to morphologic craniofacial and acral changes as well as cardiometabolic complications, but the phenotypic changes and clinical presentation of acromegaly differ across species. Here, we review the pathophysiology, clinical presentation and management of acromegaly in humans and cats, and we provide a systematic comparison between this disease across these different species. DesignA comprehensive literature review of pathophysiology, clinical features, diagnosis and management of acromegaly in humans and in cats was performed. ResultsAcromegaly is associated with prominent craniofacial changes in both species: frontal bossing, enlarged nose, ears and lips, and protuberant cheekbones are typically encountered in humans, whereas increased width of the head and skull enlargement are commonly found in cats. Malocclusion, prognathism, dental diastema and upper airway obstruction by soft tissue enlargement are reported in both species, as well as continuous growth and widening of extremities resulting in osteoarticular compromise. Increase of articular joint cartilage thickness, vertebral fractures and spine malalignment is more evident in humans, while arthropathy and spondylosis deformans may also occur in cats. Generalized organomegaly is equally observed in both species. Other similarities between humans and cats with acromegaly include heart failure, ventricular hypertrophy, diabetes mellitus, and an overall increased cardiometabolic risk. In GH-secreting pituitary tumours, local compressive effects and behavioral changes are mostly observed in humans, but also present in cats. Cutis verticis gyrata and skin tags are exclusively found in humans, while palmigrade/plantigrade stance may occur in some acromegalic cats.Serum IGF-1 is used for acromegaly diagnosis in both species, but an oral glucose tolerance test with GH measurement is only useful in humans, as glucose load does not inhibit GH secretion in cats. Imaging studies are regularly performed in both species after biochemical diagnosis of acromegaly. Hypophysectomy is the first line treatment for humans and cats, although not always available in veterinary medicine. ConclusionAcromegaly in humans and cats has substantial similarities, as a result of common pathophysiological mechanisms, however species-specific features may be found.

Oral Manifestations and Maxillo-Facial Features in the Acromegalic Patient: A Literature Review.

Background: Acromegaly is a chronic disease caused by an abnormal secretion of growth hormone (GH) by a pituitary adenoma, resulting in an increased circulating concentration of insulin-like growth factor 1 (IGF-1). The main characteristics are a slow progression of signs and symptoms, with multisystemic involvement, leading to acral overgrowth, progressive somatic changes, and a complex range of comorbidities. Most of these comorbidities can be controlled with treatment. The literature reveals that the most evident and early signs are those related to soft tissue thickening and skeletal growth, especially in the head and neck region. Methods: The authors reviewed the available literature on the clinical oro-dental features of acromegaly, selecting articles from PubMed and Google Scholar. The aim of this review was to summarize all the reported clinical oro-dental features of acromegalic patients. Results: The most common facial dimorphisms involved the maxillo-facial district, with hypertrophy of the paranasal sinuses, thickening of the frontal bones, and protruding glabella, which may be associated with joint pain and clicks. Regarding the oro-dental signs, the most frequent are dental diastema (40–43%), mandibular overgrowth (22–24%), mandibular prognathism (20–22%), and macroglossia (54–58%). These signs of acromegaly can be significantly reduced with adequate treatment, which is more effective when initiated early. Conclusions: Increased awareness of acromegaly among dentists and maxillo-facial surgeons, along with the early identification of oro-facial changes, could lead to an earlier diagnosis and treatment, thereby improving patients’ quality of life and prognosis.

Reanatomization of anterior teeth with composite resin: case report

Dental diastema is a space or absence of contact between two consecutive teeth, which may represent an aesthetic embarrassment for the patient when smiling. For the aesthetic resolution of diastema some factors should be evaluated as, age of the patient, dental structure conservation, reversibility of treatment, cost and longevity. For closing diastema, for a long time, the clinical alternatives were the use of orthodontics and fixed prostheses. Currently, with composite resins, it is possible to reproduce natural characteristics of the teeth with a direct, reversible restorative technique, without the wear of healthy dental structure, with affordable cost, able to provide satisfactory aesthetic results. The aim of this study is to report a case of a patient diagnosed with inter incisor diastema and to present a literature review. Patient, male, 70 years old, was attended at oral clinic of Ingá University Center - Uningá, complaining about the aesthetics of his smile. Clinically, was observed the presence of a diastema between upper incisor, fracture of incisal edge of central incisors and poor dental positioning. A reverse planning of the case was carried out through diagnostic waxing. With aid of a silicone guide, the diastema was closed through reanatomizations in composite resin. After the proposed treatment, was possible to obtain a satisfactory aesthetic in the patient's smile. The closure of diastema, with the use of composite resins was able to provide a better contour to the teeth, closing the spaces present, resulting in an aesthetic and pleasant smile.

Diastema Olgularında Kompozit Rezin Restorasyonlar ile Ön Diş Estetiğinin Sağlanması

Diastema Olgularında Kompozit Rezin Restorasyonlar ile Ön Diş Estetiğinin Sağlanması

Sudipta Kar's cribbed thumb guard: An innovative inexpensive way to treat thumb sucking

Active thumb sucking often causes malocclusion and/or facial deformity. Thumb sucking is such a detrimental habit when found in children above 6 years of age causing open bite formation, speech distortion, maxillary prognathism, posterior crossbite, mandibular retrognathism, and midline diastema. On the other hand, abnormal tongue thrusting may also cause growth disturbances of the orofacial structures and malocclusion. The present article has discussed on the management of such detrimental habits with an innovative yet a simple approach never been used before.

Occurrence of Maxillary Central Diastema between Tooth-supported and Implant-supported Prostheses: a 5-year Clinical Follow-up.

A 27-year-old patient with a history of maxillary anterior tooth trauma presented with a maxillary central diastema between tooth- and implant-supported prostheses that had been in use for 5 years. The all-ceramic crowns were placed in 2012 after rigorous occlusal adjustment. Evaluations were carried out at 0, 2, 3, 4 and 5 years post restoration. The central diastema between the natural teeth and the implant-supported prosthesis on teeth 11 and 12 was first observed 2 years after implantation. After 5 years, the distance was found to have increased, with anterior occlusion and esthetic changes having taken place. The following possible causes were discussed: occlusal problems, anterior traumatic effects, the possible impact of guided bone regeneration (GBR) on the adjacent natural teeth and natural movement. More predictive information should be given to patients with implant-supported prostheses and natural teeth so that they are fully informed of the impact of any necessary clinical compromise and are aware of the modifications that may occur to their natural dentition.

Noninvasive interdisciplinary treatment of a dischromic partially worn dentition.

According to the classic concepts of prosthodontics the treatment of a patient presenting severely worn and dischromic dentition would involve a complex and demolitive treatment including periodontal surgery, endodontic therapy, posts and cores, and crowns; nowadays these problems can be solved with noninvasive procedures that allow preservation of dental and periodontal tissues. This article describes the interdisciplinary team approach (orthodontist, dental technician, prosthodontist) for the treatment of a patient showing attrition of the mandibular incisors in a deep bite relationship, contraction of the posterior sextants of both arches, diastemas in the anterior region of the maxilla, and highly dischromic teeth. The gingival tissue levels and the tooth malposition were corrected by orthodontic therapy, the abraded and the healthy dischromic teeth were restored with 20 additional veneers (the molars were the only teeth not involved in the restorative phase); tooth structure, tooth vitality, and bone level were maintained. No provisional restorations were delivered and no anesthesia was necessary either for tooth preparation or final impression. A protocol is shown to treat in a conservative and comfortable manner the structural and esthetic problems in a patient presenting highly dischromic teeth, worn mandibular incisors, and diastemas on the maxillary sextant.

Endoscopically-assisted surgical expansion (EASE) for the treatment of obstructive sleep apnea

ObjectiveThe aim of this retrospective study was to evaluate the results of an outpatient surgical procedure known as endoscopically-assisted surgical expansion (EASE) in expanding the maxilla to treat obstructive sleep apnea (OSA) in adolescent and adults. MethodsThirty-three patients (18 males), aged 15–61 years, underwent EASE of the maxilla. All patients completed pre- and post-operative clinical evaluations, polysomnography, questionnaires (Epworth Sleepiness Scale [ESS] and Nasal Obstruction Septoplasty Questionnaire [NOSE]) as well as cone beam computed tomography (CBCT). ResultsWith EASE, the overall apnea hypopnea index (AHI) improved from 31.6 ± 11.3 to 10.1 ± 6.3. The oxygen desaturation index (ODI) improved from 11.8 ± 9.6 to 1.8 ± 3.7, with reduction of ESS scores from 13.4 ± 4.0 to 6.7 ± 3.1. Nasal breathing improved as demonstrated by reduction of the NOSE scores from 57.8 ± 12.9 to 15.6 ± 5.7. Expansion of the airway from widening of the nasal floor was consistently evident on all postoperative CBCT; the anterior nasal floor expanded 4.9 ± 1.2 mm, posterior nasal floor expanded 5.6 ± 1.2 mm, and the dental diastema created was 2.3 ± 0.8 mm. Mean operative time was 54.0 ± 6.0 min. All patients with mild to moderate OSA were discharged the same day; patients with severe OSA were observed overnight. All patients returned to school or work and regular activities within three days. ConclusionsEASE is an outpatient procedure that improves nasal breathing and OSA by widening the nasal floor in adolescents and adults. Compared to current surgical approaches for maxillary expansion, EASE is considerably less invasive and consistently achieves enlargement of the airway with minimal complications.

MANEJO ESTOMATOLÓGICO DE UN PACIENTE PEDIÁTRICO CON DISTROFIA MUSCULAR DE DUCHENNE. REPORTE DE UN CASO

La Distrofia muscular de Duchenne (DMD) es una enfermedad ligada al cromosoma X, que afecta aproximadamente 1 de cada 3,300 varones nacidos vivos. Es causada por la ausencia o la mutación del gen que codifica la proteína distrofina. El propósito de este caso fue revisar la literatura actual sobre los aspectos importantes de atención infantil en la DMD. PRESENTACIÓN DE CASO: Acude a la clínica de Odontopediatría, un paciente masculino de 8 años de edad con discapacidad para la marcha y constitución ectomorfica, diagnosticado médicamente de DMD. A la exploración intraoral se encontró: clase I de Angle, mordida borde a borde anterior, diastemas, apiñamiento anteroinferior, gingivitis localizada, caries activas y macroglosia relativa. El manejo estomatológico fue realizado en cuatro fases: Preventiva, Restauradora, Quirúrgica y Mantenimiento. Se logró gran éxito clínico, requiriendo de un trabajo multidisciplinario, para proporcionarresultados satisfactorios a largo plazo que incrementen la calidad de vida del paciente.

Keratitis, ichthyosis, and deafness syndrome: a case report

A 10 year-old female child developed erythema on the scalp, perioral area, neck, trunk, buttocks, palms and soles within 1 month after birth. Her skin was dry and rough, and the hairs were fine, soft, sparse and easily broken. As age advanced, typical hyperkeratosis and thickening of the skin occurred on an erythematous base. At the age of 5 years, the child developed photophobia and vision impairment. When the child was 8 years old, progressive hearing loss was observed. Physical examination revealed that the height and weight were 109 centimeters and 19 kilograms respectively. Skin examination showed fine, soft, sparse and easily-broken hair, large areas of brown plaques with crusts on the scalp, perioral area, neck, trunk and buttocks, and fissured, purulent and foul-smelling verrucous hyperplasia over these plaques. Brown to black hyperkeratotic plaques were scattered over the extremities, and diffuse hyperkeratosis occurred on the palms and soles. Both fingernails and toenails became thickened, cloudy and white with distal separation and deformation of the nail plate. As ophthalmic examination showed, the patient had photophobia, bilateral bulbar conjunctival hyperemia, corneal opacity and corneal vascular proliferation, and the visual acuity was 0.5 in the left eye and 0.2 in the right eye. Otolaryngological examination revealed moderate binaural sensorineural deafness. Stomatological examination showed enamel hypoplasia and diastema widening. Genetic testing showed a heterozygous mutation (c.C50T) in exon 2 of the gap junction protein beta 2 (GJB2) gene. Based on these clinical manifestations and examinations, the patient was diagnosed with keratitis, ichthyosis, and deafness (KID) syndrome. Skin lesions of the patient were significantly improved after the treatment with oral acitretin. Key words: Keratosis; Mutation; Acitretin; Genes, GJB2; Keratitis, ichthyosis, and deafness syndrome

Porcelain laminate veneers – A novel dimension to minimalism in prosthodontics: A case series

The success of anterior esthetic rehabilitation depends on the resolution of initial esthetic issues, patient satisfaction, and good integration of the restoration with the surrounding tooth and soft tissues. Porcelain laminate veneers are thin facings of ceramic that have evolved since 1983 to become the esthetic alternative to full coverage restorations. By the advent of new materials and techniques based on the principles of adhesive dentistry, extremely minimal preparation with enamel preservation has improved and offered best results. This article focuses on the esthetic improvement of patients with diastema, fluorosis, and discolored teeth using porcelain laminate veneers.

Perception of smile attractiveness toward various forms of anterior diastemas among undergraduate dental and nondental students: A questionnaire-based study

Background: Smiling is the evident component of facial attractiveness. Midline diastema is considered in some cultures as unattractive and as a malocclusion, especially in Western countries while it is considered as a sign of beauty in Africa and Middle-East. Aim: The aim of this study is to compare the smile attractiveness perception of dental and nondental students toward anterior diastemas and to determine whether all spaces in the esthetic zone are considered unattractive as midline diastema. Materials and Methods: This is a descriptive cross-sectional study conducted among 156 dental and pharmacy students from the University of Medical Sciences and Technology, Sudan, from December 2015 to January 2016. A self-administered questionnaire was distributed to the participants and it consisted of two parts: part one – related to gender, faculty, educational level, and questions about dental diastema, and part two – containing four modified pictures of a young female's smile modified by photoediting software to create different spaces between anterior teeth (midline, Simian, Frush and Fisher, and Lombardi diastema). Participants were asked to rank the pictures according to attractiveness from the most to the least attractive using visual analog scale. Comparison between variables was made by Chi-square test with P Results: Smile attractiveness from the most to the least attractive was Simian > Frush and Fisher > midline > Lombardi among both dental and pharmacy students. Gender and presence of diastema had no relation with the student's perception (P > 0.05). There was a significant statistical difference between dental and pharmacy students regarding Frush and Fisher diastema (P = 0.034). Most of the students with diastema felt shy when smiling. Conclusions: The location and width of diastema had an important role on the attractiveness perception of dental diastemas. Midline diastema was not a gap with the most negative perception.

Z-plasty: An esthetic eraser for labial frenum

Maxillary labial frenum is capable of creating diastema and recession, affecting esthetics by compromising the orthodontic result in the midline diastema cases, thus causing a recurrence after the treatment. This case report demonstrates the removal of the abnormal labial frenum attachment with midline diastema in a 28-year-old male through the technique of basic Z-plasty. Z-plasty is a common procedure in plastic surgery, but not so common in the field of dentistry. It appears complex, but is really rather simple, safe, and reliable. The main aim is to promote the use of this surgical technique; which helps to release scar contracture, relieve soft-tissue tension, and facilitates healing by primary intention. Frenectomies commonly fail due to a high risk of re-occurrence and hypertrophic scarring with other techniques that can be reduced by the use of Z-plasty. Moreover, it is cost-effective and results in better functional and esthetic appearance.

Is flushing and packing adequate for diastema treatment?

Is flushing and packing adequate for diastema treatment?

An interdisciplinary noninvasive all-ceramic treatment concept for nonsyndromic oligodontia in adolescence.

Oligodontia has a substantial oral functional and psychosocial impact on the quality of life of children. The treatment of oligodontia in adolescence is an interdisciplinary approach which can include extraction of the primary teeth with orthodontic space closure, or prosthodontic rehabilitation. This case report describes a conservative approach for the rehabilitation of a 12-year-old patient with 19 ageneses (excluding third molars) of permanent teeth, infraocclusion of the persisting primary teeth, deep overbite, and reduced mesiodistal dimension of the maxillary incisors with a central diastema. The treatment plan to restore esthetics and function included an initial noninvasive prosthetic rehabilitation for deep bite correction with additive leucite-reinforced glass-ceramic onlays/veneers until definitive orthodontic and implant therapy are reevaluated and determined in adulthood. Esthetics, functional occlusion, and crown-to-root ratio remained stable over a follow-up period of 3 years. No signs of fractures within the all-ceramic restorations or symptoms of a temporomandibular disorder were evident.

The role of topical application of bone morphogenetic protein 7 (BMP7) on bone healing on rabbits (Immunohistochemical study on TGF-β 3 & IGF-1R)

Background: Bone is essentially a highly vascular, living, constantly changing mineralized connective tissue. It is remarkable for its hardness, resilience and regenerative capacity, as well as its characteristic growth mechanisms. This study aimed to: 1. To evaluate the effect of bone morphogenetic protein7 (BMP7) on bone healing in artificially created intrabony defect in rabbits upper diastema, histologically. 2. To study the immunohistochemical expression of TGF-β3 and IGF-1R as bone formation markers in experimental and control groups during bone healing. Material and method: Forty male rabbits, was used in this study, 8 rabbits for each healing interval (3 days, 1,2 ,4 and 6 weeks). In each rabbit two bone holes were created on the right and left sides of the maxilla.BMP7 was applied to the bone hole in the left side while bone hole in the right left for normal healing. Routine processing and sectioning technique performed for histological evaluation. Immunohistochemical analysis utilized to localize the expression of TGF-β3 and IGF-1R in experimental and control groups for all animals. Results: Histological findings indicated that bone defect coated with BMP7 illustrated an early bone formation, mineralization and maturation in comparison to control group. Immunohistochemical findings revealed high positive expression for TGF-B3 and IGF-1R in experimental in comparison to control group. Conclusion: The study concluded that BMP7 protein enhance bone healing and maturation, also it regulate the expression of TGF-B3 and IGF1R in bone.

Cyrtodactylus kunyai (Squamata: Gekkonidae), a new cave-dwelling Bent-toed Gecko from Loei Province, northeastern Thailand.

We describe a new cave-dwelling Cyrtodactylus from Suan Hin Pha Ngam, Nong Hin District, Loei Province, northeastern Thailand, characterized by a maximal known snout-vent length of 87.9 mm, a banded dorsal pattern with a medially interrupted nuchal loop and four or five brown bands between nuchal loop and hind limb insertions and three bicolored band interspaces between limbs insertions, a dark orangeish iris, a continuous series of enlarged femoro-precloacal scales with 5-6 femoral pores on each side separated by a diastema from 3 precloacal pores in males (no pores in females), 19 irregularly arranged dorsal longitudinal tubercle rows at midbody, 34 ventral scale rows between ventrolateral skin folds, transversely enlarged subcaudal plates, and no precloacal groove.

Esthetic rehabilitation with laminated ceramic veneers reinforced by lithium disilicate.

Because of their predictable results and conservation of tooth structure, ceramic veneers are indicated for the esthetic treatment of anterior teeth with anomalous positions or appearance. The objective of this case report is to highlight the steps in dental rehabilitation using ceramic veneers reinforced by lithium disilicate. In this case the patient had diastemas between the mandibular incisors. After preliminary procedures, diagnostic models, waxing, and mock-up were completed, an impression was made with addition silicone, and the veneers were fabricated and cemented with light-cure cement. As a result, the esthetics and function expected by the patient were achieved. The use of ceramic veneers enabled a conservative and esthetically successful rehabilitation treatment.

Studies Regarding Comparative Aspects of the Splahnocranium in Thebrown Bear (Ursusarctros) and Lion (Pantheraleo)

This paper aims to highlight the comparative aspects of the splanchnocranium, in two species that were not detailed in Romanian literature: the brown bear (Ursusarctos) - a protected species, and the lion(Pantheraleo). The lion is a mammal from theFelidaefamily, the 2nd largest feline after the tiger, while the bear is a particularly strong predator representative for the Romanian wildlife, belonging to theUrside family. For this study we have used two bear skulls and two lion skulls, all belonging to the Museum of the Comparative Anatomy Discipline of the University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca. The skulls were obtained through the usual techniques of osseous pieces processing. Following the examination, we have noted that adult bears have massive skulls. The line of the common profile of the nasal, frontal and occipital bones is relatively smooth, rising and falling progressively in the cranio-caudal direction. The cranial cavity is small, flattened and elongated. The incisors are well developed, and the canines are large and curved. The molars of the superior maxillary present a progressive development in the cranio-caudal sense, while the inferior dental arch has weakly developed first and last molars. The two diastemata are of considerable length. The lion’s skull has an elongated profile, the frontal region slightly fattened, a short post-orbital region, and the cranial cavity has thicker bones, protecting the brain. The nasal openings are large. The maxillary is strong, accommodating a number of 30 teeth. The four canines are long, to help suffocate the pray. The incisors are small, but the carnassials are like a scissor’s blade, in order to cut the meat. The bear skull is more massif than the lion’s, which in turn is more elongated.

An aesthetic and rapid approach to treat midline diastema

Maxillary midline diastema is a common esthetic problem of patients which adversely affects body image and self-esteem, especially in adults. Often, patients are more conscious about the spaces between front teeth and seek treatment for cosmetic reasons. Different treatment modalities include restoration, orthodontics, prosthodontics, surgery, and various combinations of the above. Orthodontic procedures are routinely used to close diastema; however, there may be concerns with the appearance of braces especially in adults limiting its use. Here, we describe a case where a clear thermoplastic retainer was modified to close the midline diastema in relatively shorter time period.