Incisor Tip Research Articles

Accuracy of Orthognathic Surgical Outcomes Using 2- and 3-Dimensional Landmarks—The Case for Apples and Oranges?

To verify predicted versus obtained surgical movements in 2-dimensional (2D) and 3-dimensional (3D) measurements and compare the equivalence between these methods. A retrospective observational study of bimaxillary orthognathic surgeries was performed. Postoperative cone-beam computed tomographic (CBCT) scans were superimposed on preoperative scans and a lateral cephalometric radiograph was generated from each CBCT scan. After identification of the sella, nasion, and upper central incisor tip landmarks on 2D and 3D images, actual and planned movements were compared by cephalometric measurements. One-sample t test was used to statistically evaluate results, with expected mean discrepancy values ranging from 0 to 2mm. Equivalence of 2D and 3D values was compared using paired t test. The final sample of 46 cases showed by 2D cephalometry that differences between actual and planned movements in the horizontal axis were statistically relevant for expected means of 0, 0.5, and 2mm without relevance for expected means of 1 and 1.5mm; vertical movements were statistically relevant for expected means of 0 and 0.5mm without relevance for expected means of 1, 1.5, and 2mm. For 3D cephalometry in the horizontal axis, there were statistically relevant differences for expected means of 0, 1.5, and 2mm without relevance for expected means of 0.5 and 1mm; vertical movements showed statistically relevant differences for expected means of 0, 0.5, 1.5 and 2mm without relevance for the expected mean of 1mm. Comparison of 2D and 3D values displayed statistical differences for the horizontal and vertical axes. Comparison of 2D and 3D surgical outcome assessments should be performed with caution because there seems to be a difference in acceptable levels of accuracy between these 2 methods of evaluation. Moreover, 3D accuracy studies should no longer rely on a 2-mm level of discrepancy but on a 1-mm level.

Effects of force magnitude on torque control in the correction of bimaxillary protrusion with mass retraction.

OBJECTIVES:This study was designed to explore whether force magnitude would influence incisor torque control and the overall outcome in patients with bimaxillary protrusion who need mass incisor retraction.MATERIALS AND METHODS:Forty-one female patients (aged > 15 years) with bimaxillary protrusion requiring mass incisor retraction were selected. Two sliding mechanics were utilized, with the elastic group receiving a light force of ~100 g by wearing elastics and the power chain group receiving a moderate force of ~250 g by power chain. Lateral cephalograms obtained before and after treatment were traced and measured.RESULTS:Patients in both groups displayed maxillary protrusion with a similar skeletal class II tendency. A longer treatment time was found in the elastic group. No difference in the distance of incisor tip movement was observed between the two groups; however, a larger inclination of upper incisors was found in the elastic group, indicating less loss of torque. In addition, larger reduction in Sella-Nasion-A and A-Nasion-B angle was observed in the elastic group, which was accompanied by a larger ratio of upper lip retraction to upper incisor retraction as well as more upper lip retraction.CONCLUSIONS:Sliding mechanics with elastics to generate light forces can achieve better torque control with more reduction in skeletal and soft tissue protrusion.

Intravesicular Phosphatase PHOSPHO1 Function in Enamel Mineralization and Prism Formation.

The transport of mineral ions from the enamel organ-associated blood vessels to the developing enamel crystals involves complex cargo packaging and carriage mechanisms across several cell layers, including the ameloblast layer and the stratum intermedium. Previous studies have established PHOSPHO1 as a matrix vesicle membrane-associated phosphatase that interacts with matrix vesicles molecules phosphoethanolamine and phosphocholine to initiate apatite crystal formation inside of matrix vesicles in bone. In the present study, we sought to determine the function of Phospho1 during amelogenesis. PHOSPHO1 protein localization during amelogenesis was verified using immunohistochemistry, with positive signals in the enamel layer, ameloblast Tomes' processes, and in the walls of ameloblast secretory vesicles. These ameloblast secretory vesicle walls were also labeled for amelogenin and the exosomal protein marker HSP70 using immunohistochemistry. Furthermore, PHOSPHO1 presence in the enamel organ was confirmed by Western blot. Phospho1−/− mice lacked sharp incisal tips, featured a significant 25% increase in total enamel volume, and demonstrated a significant 2-fold reduction in silver grain density of von Kossa stained ground sections indicative of reduced mineralization in the enamel layer when compared to wild-type mice (p < 0.001). Scanning electron micrographs of Phospho1−/− mouse enamel revealed a loss of the prominent enamel prism “picket fence” structure, a loss of parallel crystal organization within prisms, and a 1.56-fold increase in enamel prism width (p < 0.0001). Finally, EDS elemental analysis demonstrated a significant decrease in phosphate incorporation in the enamel layer when compared to controls (p < 0.05). Together, these data establish that the matrix vesicle membrane-associated phosphatase PHOSPHO1 is essential for physiological enamel mineralization. Our findings also suggest that intracellular ameloblast secretory vesicles have unexpected compositional similarities with the extracellular matrix vesicles of bone, dentin, and cementum in terms of vesicle membrane composition and intravesicular ion assembly.

An esthetic evaluation of unilateral canine substitution for a missing maxillary lateral incisor.

The aim of this study is to determine whether variation in size, morphology, and color of a unilateral substituted maxillary canine has influence on the dentogingival attractiveness perceived by dental professionals and laypeople. A frontal clinical photograph of a patient with unilateral canine substitution was used as standard picture. Five different series were created by modification of following parameters with a raster graphics editor (Photoshop CS 6): (1) width, (2) color, (3) gingival margin height, and (4) crown tip morphology of the substituted canine and (5) the gingival margin height of the neighboring first premolar. For each parameter, the photograph deviating the most from the standard photograph, was combined into a final series. Four groups of examiners (orthodontists, periodontists, dentists, and laypeople) were asked to rank the photographs from most to least attractive. One hundred seventy-four examiners ranked the photographs in order of attractiveness. Overall, a darker canine color (mean rank 4.36±1.03) and a more pronounced canine tip morphology (mean rank 3.47±1.11) were significantly ranked as most unattractive (P<.05). The gingival height of the neighboring premolar was ranked as least unattractive by all groups of examiners (mean rank 1.30±0.74). Darker canine color and a pronounced tip morphology of a substituted canine are rated as the most unattractive by dental professionals and laypeople. The present study showed that the canine color and crown tip morphology are important parameters when considering unilateral canine substitution, both for professionals and laypeople. There is a general preference in favor of canines with a light color and a reduced incisal tip.

Soft Tissue Changes in Patients Undergoing Intraoral Quadrangular Le Fort II Osteotomy Versus Conventional Le Fort I Osteotomy

The aim of this study was to evaluate soft tissue changes after intraoral quadrangular Le Fort II osteotomy (IOQLFII) and correlate those changes to underlying osseous changes. Twenty-six non-growing patients with midfacial deficiency and Class III malocclusion were analyzed. A study group of 13 patients who underwent IOQLFII was compared with 13 patients who underwent conventional Le Fort I osteotomy (LFI). After fusion of pre- and postoperative computed tomograms, each patient's hard and corresponding soft tissue changes were measured. Measurement points were defined at 3 levels in the IOQLFII group (infraorbital rim [IR], sinus floor [SF], and lateral incisor tip [LI]) and at 2 levels in the LFI group (SF and LI). Linear models were created to test for correlations between hard and soft tissues. The slope (a1 coefficient) between anteroposterior hard and soft tissue changes was found to be highly significant at each measurement point for all groups. In the IOQLFII group, soft tissue advancement was 69% (confidence interval [CI], 62 to 77%) of the hard tissue advancement at the IR, 90% (CI, 84 to 96%) at the SF, and 73% (CI, 64 to 82%) at the LI. In the LFI group, the corresponding percentages were 90% (83to 97%) at SF and 84% (77 to 90%) at LI. IOQLFII results in predictable correction of midfacial deficiency. At the IR, bony advancement always resulted in markedly less soft tissue advancement than at the SF level. These results indicate that the planned infraorbital advancement should not be too conservative because soft tissue changes are smaller in this region.

Stim1 Regulates Enamel Mineralization and Ameloblast Modulation

Loss-of-function mutations in the Ca2+ release-activated Ca2+ channel genes ORAI1 and STIM1 abolish store-operated Ca2+ entry (SOCE) and result in ectodermal dysplasia with amelogenesis imperfecta. However, because of the limited availability of patient tissue, analyses of enamel mineralization or possible changes in ameloblast function or morphology have not been possible. Here, we generated mice with ectodermal tissue-specific deletion of Stim1 (Stim1 cKO [conditional knockout]), Stim2 (Stim2 cKO), and Stim1 and Stim2 (Stim1/2 cKO) and analyzed their enamel phenotypes as compared with those of control (Stim1/2fl/fl) animals. Ablation of Stim1 and Stim1/2 but not Stim2 expression resulted in chalky enamel and severe attrition at the incisor tips and molar cusps. Stim1 and Stim1/2 cKO, but not Stim2 cKO, demonstrated inferior enamel mineralization with impaired structural integrity, whereas the shape of the teeth and enamel thickness appeared to be normal in all animals. The gene expression levels of the enamel matrix proteins Amelx and Ambn and the enamel matrix proteases Mmp20 and Klk4 were not altered by the abrogation of SOCE in Stim1/2 cKO mice. The morphology of ameloblasts during the secretory and maturation stages was not significantly altered in either the incisors or molars of the cKO animals. However, in Stim1 and Stim1/2 cKO incisors, the alternating modulation of maturation-stage ameloblasts between the smooth- and ruffle-ended cell types continued beyond the regular cycle and extended to the areas corresponding to the zone of postmodulation ameloblasts in the teeth of control animals. These results indicate that SOCE is essential for proper enamel mineralization, in which Stim1 plays a critical role during the maturation process.

Synchrotron X-ray diffraction to understand crystallographic texture of enamel affected by Hunter syndrome

ObjectiveTo determine whether Hunter syndrome (MPS II) affects the crystallographic texture (preferred orientation) of enamel. DesignSynchrotron X-ray diffraction, being a state of the art technique, has been used to determine the enamel crystallite orientation in enamel affected by Hunter syndrome (MPS II). The incisal, lingual and cervical regions of the MPS II affected tooth were observed and compared to healthy tooth. ResultsIt was observed that there is a loss of organization of crystallites in deciduous incisal enamel affected by Hunter syndrome (MPS II) as compared to healthy deciduous enamel tissue. Generally it was observed that, in contrast to the healthy enamel, the enamel affected by MPS II possessed a lower crystallographic preferred orientation, with a more uniform spatial distribution; however, the enamel at the incisal tip was relatively unaffected. ConclusionHunter syndrome affects the enamel texture in the lingual and cervical regions of the tooth.

Precision of Le Fort I osteotomy: planning versus outcome. A multi-centre retrospective study.

The purpose of this study was to evaluate the accuracy of Le Fort I surgery by comparing planned surgical movements with actual outcomes. A minimum number of seven consecutive cases that had undergone a Le Fort I osteotomy procedure alone or in combination with a mandibular osteotomy from six different hospital units in the East of England between 2009 and 2010 were identified. A total of 56 cases met the inclusion criteria where surgical splints were used and model surgery had been performed. Pre- and post-operative lateral cephalograms were digitised using Dolphin© imaging software (Version 10.0) and three cephalometric points were assessed to measure precision of surgical movements: A point (A-pt); Upper incisor tip (U1 tip); and Upper first molar occlusal point (U6 occ). The final position of the maxilla was compared to the planned position. In 71% of cases surgical movements were within 2 mm and 20% of this group were within 1 mm of the predicted position. The mean accuracy was 1.39 mm (SD 0.92 mm) for the former and 0.78 mm (SD 0.58 mm) for the latter. Accuracy correlated negatively with increased surgical complexity, particularly posterior differential impactions of the maxilla. There was no statistically significant difference between centres. Pre-operative surgical planning of Le Fort I osteotomies was generally accurate. This study demonstrates that different operators across six centres produced consistent surgical outcomes and this confirms previously reported data.

A Cephalometric Study of Relationship of Anterior Teeth to Incisive Papilla, Mucolabial Reflections and A-Pogonion Line in Dentulous Subjects and In Complete Denture Wearers

Facial appearance influences the social acceptance and psychological well-being of an individual. Prosthodontic treatment restores the lost support. Regardless of judgment and technical ability the dentist can place the artificial teeth more correctly if some natural stable landmarks are available to guide. In this study, lateral cephalograms were used to determine the relation of anterior teeth to incisive papilla, mucolabial reflections and A-Pogonion line in dentulous subjects and in complete denture wearers. The results of this study indicate that within dentulous subjects there is no significant difference in the horizontal or vertical relationship of anterior teeth with various landmarks such as incisive papilla, mucolabial reflections and A-Pog line, irrespective of age group. In complete denture wearer, the dentures which were constructed to esthetic and phonetic sense of dentist, there is not much variation in labiolingual position of anterior teeth, as compared to the natural teeth; however, there was slight increase in the vertical measurement from the denture borders to the tips of maxillary and mandibular incisors.

Determination of the appropriate sizes of oropharyngeal airways in adults: correlation with external facial measurements: A randomised crossover study.

Two external facial measurements have been recommended as reference criteria for estimating appropriate oropharyngeal airway sizes: the distances between the maxillary incisors to the angle of the mandible, and that from the corner of the mouth to the angle of the mandible. To compare the two guidelines and to determine the optimal external facial measurements for the selection of an appropriately sized airway in adults. Randomised crossover study. Operating theatres in a university hospital. A total of 113 patients requiring tracheal intubation for general anaesthesia. Two oropharyngeal airway sizes were selected on the basis of two external facial measurements (tip of the upper central maxillary incisors to the angle of the mandible and corner of the mouth to the angle of the mandible). After assessing manual and pressure-controlled ventilation without an airway, the adequacy of ventilation with each oropharyngeal airway was assessed in a similar manner. Before changing the oropharyngeal airway, the view at the distal end of each airway was evaluated using endoscopy via a fibreoptic bronchoscope. Ventilation parameters and the endoscopic views at the distal ends of the airways were assessed. In the maxillary incisors to the angle of the mandible group, there was clear manual ventilation through the oropharyngeal airway in all patients, whereas partially obstructed ventilation was observed in 6% of patients in the corner of the mouth to the angle of the mandible group. In the maxillary incisors to the angle of the mandible group, mechanical ventilation through the oropharyngeal airway was adequate in all patients but in the corner of the mouth to the angle of the mandible group, inadequate ventilation was observed in 7% patients. In the maxillary incisors to the angle of the mandible group, the endoscopy did not identify any patient with complete obstruction of the airway by the tongue but in the corner of the mouth to the angle of the mandible group, 40% of patients had complete obstruction by the tongue. In the maxillary incisors to the angle of the mandible group, the tip of the airway passed beyond the tip of the epiglottis in 22% of patients, in contrast, none of the airways in the corner of the mouth to the angle of the mandible group passed beyond the tip of the epiglottis. With regard to adequate ventilation in conjunction with an acceptable endoscopic view, an oropharyngeal airway whose size is based upon the distance from the maxillary incisors to the angle of the mandible is more advantageous than if based upon the distance from the corner of the mouth to the angle of the mandible. Clinicaltrials.gov identifier: NCT01945411. The clinical trial was registered before patient enrolment.

Cephalometric analysis for functional occlusion

BackgroundVarious elements contributing to good functional occlusion have not been clearly assessed with cephalometrics for the diagnosis of functional problems and their application in clinical practice. The aim of this study, therefore, was to analyze different components of functional occlusion to formulate concise functional cephalometric analysis.Materials and MethodsEighty-two cases (38 males and 44 females), with class I occlusion and balanced facial profile, were examined based on the selection criteria, and cephalograms were taken in natural head position. All the radiographs were then analyzed using various functional parameters.ResultsThe mean values of condylar path angle and incisal path angle were 55.83° and 65.67°, respectively, with large deviations. However, both showed positive correlation. The value of the angle of long axis of mandibular incisor with respect to the line joining center of condyle and lower incisor tip was 88.04°. Moreover, the angle between the occlusal plane and horizontal plane was 12.88°. In vertical plane, lower face height (LFH) was found to be slightly less than the upper face height. Maxilla contributed around 45% of the LFH while mandible formed about 60%. Furthermore, upper alveolar component (maxillary alveolar height) formed more than half of the maxilla (53.79%) whereas lower alveolar component (mandibular alveolar height) was 74.8% of the mandible.ConclusionThis study has analyzed various components of functional occlusion and formulated a concise functional cephalometric analysis for diagnosis, treatment planning, and assessment of treatment results.

Effect of retraction of anterior teeth on pharyngeal airway and hyoid bone position in Class I bimaxillary dentoalveolar protrusion

BackgroundTo test the hypothesis that the retraction of anterior teeth has no effect on the dimensions of pharyngeal airway and to evaluate the retraction of anterior teeth on each parameter of pharyngeal airway. MethodsTwenty-two adult patients of Class I bimaxillary protrusion requiring first premolar extractions with maximum anchorage requirements were selected. The pharyngeal airway and dentofacial parameters of the patients were compared using pre- and post-treatment lateral cephalograms with the help of Student's paired t-test (P<0.05). The relationship between airway size and dentofacial parameters was also evaluated using Pearson correlation coefficient. ResultsThe upper and lower lips were retracted by 2.25 and 5.4mm after retraction of the incisors. The tips of upper and lower incisors were retracted by 7.75 and 7.15mm, respectively. There was a statistically significant decrease in SPP-SPPW (P<0.05), U-MPW (P<0.001), TB-TPPW (P<0.001), and change in HRGN (P<0.01). A significant correlation was observed between the amount of retraction of lower incisor and decrease in the pharyngeal airway posterior to soft palate (r=0.102), tongue (r=0.322), and change in HRGN (r=0.265). ConclusionsThe size of the pharyngeal (velopharyngeal and glossopharyngeal) airway reduced and hyoid bone position changed after retraction of the incisors in extraction space in bimaxillary protrusive adult patients.

Changes of lip morphology following mandibular setback surgery using 3D cone-beam computed tomography images.

BackgroundThe aims of this study are to evaluate the lip morphology and change of lip commissure after mandibular setback surgery (MSS) for class III patients and analyze association between the amount of mandibular setback and change of lip morphology.MethodsThe samples consisted of 14 class III patients treated with MSS using bilateral sagittal split ramus osteotomy. Lateral cephalogram and cone-beam CT were taken before and about 6 months after MSS. Changes in landmarks and variables were measured with 3D software program Ondemand™. Paired and independent t tests were performed for statistical analysis.ResultsLandmarks in the mouth corner (cheilion, Ch) moved backward and downward (p < .005, p < .01). However, cheilion width was not statistically significantly changed. Landmark in labrale superius (Ls) was not altered significantly. Upper lip prominence angle (ChRt-Ls-ChLt °) became acute. Landmarks in stomion (Stm), labrale inferius (Li) moved backward (p < .005, p < .001). Lower lip prominence angle (ChRt-Li-ChLt °) became obtuse (p < .001). Height of the upper and lower lips was not altered significantly. Length of the upper lip vermilion was increased (p =< 0.01), and length of the lower lip vermilion was decreased (p < .05). Lip area on frontal view was not statistically significantly changed, but the upper lip area on lateral view was increased and change of the lower lip area decreased (p > .05, p < .005). On lateral view, upper lip prominent point (UP) moved downward and stomion moved backward and upward and the angle of Ls-UP-Stm (°) was decreased. Lower lip prominent point (LP) moved backward and downward, and the angle of Stm-LP-Li (°) was increased. Li moved backward. Finally, landmarks in the lower incisor tip (L1) moved backward and upward, but stomion moved downward. After surgery, lower incisor tip (L1) was positioned more superiorly than stomion (p < .05). There were significant associations between horizontal soft tissue and corresponding hard tissue. The posterior movement of L1 was related to statistically significantly about backward and downward movement of cheilion.ConclusionsThe lip morphology of patients with dento-skeletal class III malocclusion shows a significant improvement after orthognathic surgery. Three-dimensional lip morphology changes in class III patients after MSS exhibited that cheilion moved backward and downward, upper lip projection angle became acute, lower lip projection angle became obtuse, change of upper lip area on lateral view was increased, change of lower lip area decreased, and morphology of lower lip was protruding. L1 was concerned with the lip tissue change in statistically significant way.

Incisal tips through the window

Incisal tips through the window

Laminin γ2 knockout mice rescued with the human protein exhibit enamel maturation defects

The epithelial ameloblasts are separated from the maturing enamel by an atypical basement membrane (BM) that is enriched in laminin 332 (LM-332). This heterotrimeric protein (α3, ß3 and γ2 chains) provides structural integrity to BMs and influences various epithelial cell processes including cell adhesion and differentiation. Mouse models that lack expression of individual LM-332 chains die shortly after birth. The lethal phenotype of laminin γ2 knockout mice can be rescued by human laminin γ2 (LAMC2) expressed using a doxycycline-inducible (Tet-on) cytokeratin 14 promoter-rtTA. These otherwise normal-looking rescued mice exhibit white spot lesions on incisors. We therefore investigated the effect of rescue with human LAMC2 on enamel maturation and structuring of the atypical BM. The maturation stage enamel organ in transgenic mice was severely altered as compared to wild type controls, a structured BM was no longer discernible, dystrophic matrix appeared in the maturing enamel layer, and there was residual enamel matrix late into the maturation stage. Microtomographic scans revealed excessive wear of occlusal surfaces on molars, chipping of enamel on incisor tips, and hypomineralization of the enamel layer. No structural alterations were observed at other epithelial sites, such as skin, palate and tongue. These results indicate that while this humanized mouse model is capable of rescue in various epithelial tissues, it is unable to sustain structuring of a proper BM at the interface between ameloblasts and maturing enamel. This failure may be related to the atypical composition of the BM in the maturation stage and reaffirms that the atypical BM is essential for enamel maturation.

Biomechanical aspects of incisor action of beavers ( Castor fiber L.)

AbstractBeavers are known for their gnawing performance, e.g., felling trees. Even though this is well known, the biomechanics of it are not, and so this is the focus of this study. The lower incisors work as main cutting tools so that their technical parameters were studied. There are 3 angles (adding to 90°) of importance in cutting: 1) the wedge angle, the angle of the incisor tip; 2) the clearance angle between tooth and material (tree trunk); and 3) the chip angle between incisor tip and the perpendicular to the surface of the trunk. Cutting is usually oblique to the wood fibers. For technical wood cutting tools, an optimal wedge angle of 27° is known under certain conditions, and for the incisor of Castor fiber the wedge angle was determined using micro-Computed Tomography (µCT) scans to be 26.95°. Potential cutting forces of beavers were estimated for wood chips (2mm in thickness) of 3 sample tree species. For plum trees hardness forces ranged from 246 to 328N, and for maples from 190 to 254N. Finite element analyses were performed to determine stresses in the incisor under different loads on the incisor tip. Three hypotheses concerning gnawing were posed and are supported by the data: 1) The shape of the cutting blade of the incisor determines the geometry of wood chips and ultimately the maximum wood hardness that can be cut. 2) Clearance angle and maximum gape determine the maximum diameter of a tree that can be cut (if rough bark is neglected). 3) Functionally most importantly the lower incisors are optimized in shape and supporting tissue for compression stress with all forces being transmitted along the locations of the center of gravity in theoretical cross sections within the tooth, so that only compression occurs under load.

Finite element analysis of maxillary incisor displacement during en-masse retraction according to orthodontic mini-implant position.

ObjectiveOrthodontic mini-implants (OMI) generate various horizontal and vertical force vectors and moments according to their insertion positions. This study aimed to help select ideal biomechanics during maxillary incisor retraction by varying the length in the anterior retraction hook (ARH) and OMI position.MethodsTwo extraction models were constructed to analyze the three-dimentional finite element: a first premolar extraction model (Model 1, M1) and a residual 1-mm space post-extraction model (Model 2, M2). The OMI position was set at a height of 8 mm from the arch wire between the second maxillary premolar and the first molar (low OMI traction) or at a 12-mm height in the mesial second maxillary premolar (high OMI traction). Retraction force vectors of 200 g from the ARH (-1, +1, +3, and +6 mm) at low or high OMI traction were resolved into X-, Y-, and Z-axis components.ResultsIn M1 (low and high OMI traction) and M2 (low OMI traction), the maxillary incisor tip was extruded, but the apex was intruded, and the occlusal plane was rotated clockwise. Significant intrusion and counter-clockwise rotation in the occlusal plane were observed under high OMI traction and -1 mm ARH in M2.ConclusionsThis study observed orthodontic tooth movement according to the OMI position and ARH height, and M2 under high OMI traction with short ARH showed retraction with maxillary incisor intrusion.

Perivascular Stem Cells at the Tip of Mouse Incisors Regulate Tissue Regeneration

Cells with in vitro properties similar to those of bone marrow stromal stem cells are present in tooth pulp as quiescent cells that are mobilized by damage. These dental pulp stem cells (DPSCs) respond to damage by stimulating proliferation and differentiation into odontoblast-like cells that form dentine to repair the damage. In continuously growing mouse incisors, tissue at the incisor tips is continuously being damaged by the shearing action between the upper and lower teeth acting to self-sharpen the tips. We investigated mouse incisor tips as a model for the role of DPSCs in a continuous natural repair/regeneration process. We show that the pulp at the incisor tip is composed of a disorganized mass of mineralized tissue produced by odontoblast-like cells. These cells become embedded into the mineralized tissue that is rapidly formed and then lost during feeding. Tetracycline labeling not only revealed the expected incorporation into newly synthesized dentine formation of the incisor but also a zone covering the pulp cavity at the tips of the incisors that is mineralized very rapidly. This tissue was dentine-like but had a significantly lower mineral content than dentine as determined by Raman spectroscopy. The mineral was more crystalline than dentine, indicative of small, defect-free mineral particles. To identify the origin of cells responsible for deposition of this mineralized tissue, we genetically labeled perivascular cells by crossing NG2(ERT2) Cre and Nestin Cre mice with reporter mice. A large number of pericyte-derived cells were visible in the pulp of incisor tips with some having elongated, odontoblast-like shapes. These results show that in mouse incisors, rapid, continuous mineralization occurs at the tip to seal off the pulp tissue from the external environment. The mineral is formed by perivascular-derived cells that differentiate into cells expressing dentin sialo-phosphoprotein (DSPP) and produce a dentine-like material in a process that functions as continuous natural tissue regeneration.

Curve of Spee and its relationship to vertical eruption of teeth among different malocclusion groups

Our objectives were to assess the depth of the curve of Spee (COS) in different malocclusion groups, to relate this to the eruption of anterior or posterior teeth quantitatively, and to determine whether the depth of the COS is affected by the vertical eruption of anterior or posterior teeth. Two hundred conventional lateral cephalograms and 3-dimensional models of untreated patients (70 boys, mean age: 16.4 ± 1.4 years; 130 young women, mean age: 18.1 ± 1.8 years) were included and assigned to 4 malocclusion groups as Class I, Class II Division 1, Class II Division 2, and Class III. The depth of the COS, overjet, and overbite were measured on 3-dimensional models. The perpendicular distance between the incisal tip of the mandibular central incisor (L1-MP), the deepest point of the COS (S-MP), and the distobuccal cusp tip of the mandibular second molar (L7-MP) to the mandibular plane were calculated and proportioned with each other. The Pearson correlation coefficient was calculated, and multiple linear regression analysis was carried out. Also, multivariate analysis of variance was performed at the P <0.05 level. The mesiobuccal cusp of the first molar was the deepest part of the COS in all groups, with a maximum depth of 2.44 ± 0.73 mm in the Class II Division 1 subjects and a minimum depth of 1.76 ± 0.94 in the Class III subjects. The depth of the COS changed as follows: Class II Division 1 > Class II Division 2 > Class I > Class III malocclusion groups. Statistically significant positive correlations were found between the depth of the COS and L1-MP/S-MP (r = 0.541) and L7-MP/S-MP (r = 0.269) in the Class I and Class III subjects, and between the depth of the COS and overjet (r = 0.483) and L7-MP/S-MP (r = 0.289) in the Class II Division 1 subjects. All variables except overjet had positive correlations with the depth of the COS in Class II Division 2 subjects. The multivariate analysis of variance showed statistically significant differences in overjet, overbite, L1-MP/S-MP, L7-MP/S-MP, and the depth of the COS (P <0.001) among the groups. Although the overjet differed, vertical eruption of the anterior teeth did not differ among the different malocclusion groups and had a significant contribution to the depth of the COS in subjects with Class I and Class III malocclusions.

Indications and experience with counterclockwise rotation of the maxilla- mandibular complex

In orthognathic treatment planning for the correction of dentofacial deformities imaging and planning are important steps prior to surgery. Based on the natural head orientation, the anterio-posterior and vertical position of the upper incisor tip is one of the key elements in aesthetic planning. Gum exposure and facial and smile harmony are factors that influence this position. After definition of the upper incisor tip position, the maxillomandibular complex (MMC) can be altered according to the treatment needs (severe class II deficiency, reduced airway space etc.). Depending on the pivot point and the amount of rotation of the MMC, the hard and soft tissue changes can vary. Placement of the pivot point anteriorly (anterior nasal spine or upper incisor tip) results in an increase of the posterior face height and in extensive advancement of the lower face (up to 25 mm). In contrast, placement of the pivot point posteriorly reduces the anterior face height and has limited effect to the lower face profile. The advancement of the lower face is influenced by the location of the pivot point, the amount of rotation of the MMC (up to 5 degree), the amount of overjet corrected with sagittal split osteotomy and the amount of advancement of genioplasty. Careful analysis of the cephalograms and the face and implementation of these data into the planning are important to optimize occlusal function and facial aesthetics after orthognathic surgery. The concept of rotation of the MMC in either way widens the spectrum in treatment planning.