Lateral Excursion Research Articles

The use of miniscrew as orthodontic anchorage in correction of maxillary protrusion with occlusal cant, spaced arch, and midline deviation without surgery

This report describes the use of the miniscrew as orthodontic anchorage in maxillary protrusion with a spaced arch and midline deviation in a 16-year-old female patient. In cases with midline deviation, a cant in the maxillary occlusal plane is often observed. Thus, the authors used the miniscrew to control the vertical dimension, thereby flattening the maxillary occlusal plane, and to close and retract the incisors to improve her convex profile. Effective incisor intrusion to correct the deep overbite was also observed. In addition, functional evaluation by a 6-degrees-of-freedom jaw movement recording system was performed. Significant improvement in the jaw movement was observed during maximum opening and lateral excursion during the retention phase. The authors suggest that miniscrews are effective in correcting midline deviation due to maxillary occlusal cant and intrusion and retraction of incisors, and may result in favorable functional movement of the jaw.

Longitudinal evaluation of jaw muscle activity and mandibular kinematics in young patients with Class II malocclusion treated with the Teuscher activator

Objectives: A longitudinal study was performed to evaluate the jaw muscle activity and mandibular kinematics after Teuscher activator treatment and at 2 years after orthodontic treatment completion. Material and Methods: Twenty-seven children with Class II division 1 malocclusion were evaluated before treatment (T0; mean: 11.6 years), after functional treatment (T1; mean: 12.8 years), and 2 years after orthodontic treatment (T2; mean: 18 years). Bilateral surface electromyographic activities of the anterior temporalis, posterior temporalis, masseter, and suprahyoid muscle areas were analyzed at rest and during clenching, swallowing, and mastication. Kinematic recordings of the mandibular maximum opening, lateral shift, right and left lateral excursions, and protrusion were evaluated. Results: Compared to T0, the left masseter activity during clenching was decreased at T1 but increased at T2, similar to the other evaluated muscles. The suprahyoid activity during swallowing was increased at T1 but decreased at T2. The masseter activity during mastication was increased at T1 and further increased at T2. The left and right lateral excursions and protrusion did not show significant changes throughout the experiment. Conclusions: Teuscher activator and subsequent fixed orthodontic treatment improved jaw muscle function; however, a long period was needed to attain complete neuromuscular adaptation. Key words:Class II malocclusion, jaw muscles, mandibular kinematics, sEMG, Teuscher activator.

Immediate Effects of Acute Postural Correction on Plantar Pressures and Gait Characteristics in an Individual with Diabetic Peripheral Neuropathy: A Case Report

Purpose: The purpose of this case report is to assess the immediate effects of acute postural changes on plantar pressure distribution and gait characteristics during comfortable walking speed in an individual with diabetic peripheral neuropathy. Case description/intervention: Subject is a 71 year old Caucasian male with a BMI of 31.3 and a medical diagnosis of Type II Diabetes given 8 years ago. The patient exhibits mild peripheral neuropathy as scored by the Michigan Neuropathy Screening Instrument (MNSI; 7/23) as well as callous formation over the 2nd and 3rd metatarsal heads. The patient performed 3 separate walking conditions at a comfortable walking speed. The 3 conditions were: (1) Normal walking (NW), (2) Forward bending walking (FBW), and (3) Upright walking (UW). Measurements were recorded and averaged from these 3 conditions. NW condition was used as a control for comparing gait characteristics and plantar pressure parameters with the other gait conditions. Results: UW may be the most mechanically efficient condition for distributing plantar pressure with increased gait speed (1.441 m/s), largest contact surface area of the foot, and increased hip range of motion; however, for this individual the increased plantar pressure in the forefoot (FF) area may contribute to the risk of ulceration. The FBW condition showed the limited medial to lateral excursion of the center of forceand lowest pressure in the FF area; therefore, FBW may be the most beneficial for this patient in decreasing the risk of ulceration in the area of greatest concern. Conclusion: Variations in gait characteristics during UW and FBW indicate that alterations in posture may serve as another method to reduce the risk of plantar ulcer formation; however, further research is needed to examine the long term effects of such an intervention.

Echocardiogram Versus Cardiac Magnetic Resonance Imaging for Assessing Systolic Function of Subaortic Right Ventricle in Adults With Complete Transposition of Great Arteries and Previous Atrial Switch Operation

In adults with congenital heart disease and a systemic right ventricle, subaortic ventricular systolic dysfunction is common. Echocardiographic assessment of systolic right ventricular (RV) function in these patients is important but challenging. The aim of the present study was to assess the reliability of conventional echocardiographic RV functional parameters to quantify the systolic performance of a subaortic right ventricle. We compared 56 contemporary echocardiograms and cardiac magnetic resonance studies in 37 adults, aged 26.9 ± 7.4 years, with complete transposition and a subaortic right ventricle. The fractional area change (FAC), lateral tricuspid annular plane systolic excursion, lateral RV systolic motion velocities by tissue Doppler, RV myocardial performance index, and the rate of systolic RV pressure increase (dp/dt) measured across the tricuspid regurgitant jet were assessed by echocardiography and correlated with the cardiac magnetic resonance-derived RV ejection fraction (EF). The mean RVEF was 48.0 ± 7.8%. FAC (r(2)= 0.206, p= 0.001) and dp/dt (r(2)= 0.173, p= 0.009) significantly correlated with RVEF, and the other nongeometric echocardiographic parameters failed to show a significant correlation with RVEF by linear regression analysis. FAC <33% and dp/dt <1,000 mm Hg/s identified a RVEF of <50% with a sensitivity of 77% and 69% and a specificity of 58% and 87%, respectively. In conclusion, in patients with a systemic right ventricle, routine nongeometric echocardiographic parameters of RV function correlated weakly with cardiac magnetic resonance-derived EF. RV FAC and the measurement of the rate of systolic RV pressure increase (dp/dt) should be preferentially used to assess systemic systolic function in adult patients with a subaortic right ventricle.

Neurosensory alterations and function of the temporomandibular joint after high oblique sagittal split osteotomy: an alternative technique in orthognathic surgery

The current most common technique for repositioning of the mandible, bilateral sagittal split osteotomy (BSSO), was first described by Obwegeser and Dal Pont in the early1960s, and has since been modified several times. However, there is always a risk of damaging the inferior alveolar nerve. We have studied 50 consecutive patients who had high oblique sagittal split osteotomy (HSSO) as an alternative to avoid damage to the nerve. The patients were evaluated for sensory alterations and function of the temporomandibular joint (TMJ). Healing of both wound and bone were complete and uneventful in all 50 patients. Mean (SD) sagittal movement of the mandible was 6.6 (2.9)mm and length of the osteotomy line was 11.0 (3.1)mm. No patient had either temporary or permanent alteration in sensitivity. Pinprick tests showed no significant changes between the preoperative and postoperative readings (p>0.16) or in the chronological results (p>0.23). No disorders of the TMJ developed. Mean (SD) mouth opening 6months postoperatively was 41.6 (8.6)mm. The lateral excursion increased postoperatively by 1.86mm to the left and by 0.76mm to the right. Protrusion increased by 0.66mm. HSSO is therefore a suitable alternative to BSSO as it avoids injury to the inferior alveolar nerve without compromising the TMJ. Ossification was uneventful though bony attachment was less than with the classic BSSO.

Seismic Behavior of Severe Damaged GFRP Tubed RC Bridge Piers Repaired with CFRP

In order to investigate the seismic behavior of earthquake-damaged glass fiber reinforced polymer (GFRP) tubed reinforced concrete(RC) bridge piers repaired with wrapped carbon fiber reinforced polymer (CFRP) sheets. An experimental study, in which four GFRP tubed RC bridge piers repaired with wrapped CFRP sheets were tested under constant axial load and cyclic lateral displacement excursions that simulated seismic force,are presented in this study. Researches show that repaired with CFRP not only increase bridge piers’ultimate strength but also improve the performance such as ductility.

Radiation pressure makes ellipsoidal particles tumble

We report on optical levitation of dielectric particles, of prolate ellipsoidal shape, a few tens of micrometers in length, in a low-aperture laser beam. Ellipsoids of moderate aspect ratio (k < 3) are observed to be trapped on the axis of the laser beam, similarly to simple spheres. Conversely, elongated particles (k > 3) cannot be kept immobile, and rather undergo sustained oscillating motions, comprising both lateral and angular excursions around the beam axis; hence the name “tumble”. The observed tumbling motion, a straightforward manifestation of the non-conservative character of radiation pressure forces, is explained through a 2-dimensional ray optics model of the interaction of light with an ellipsoid.

Regional odontodysplasia: Orthodontic treatment and transplantation of premolars

Regional odontodysplasia is a rare and unique dental anomaly involving both dentitions, but mostly the teeth of 1 quadrant. This report describes the combined surgical and orthodontic treatment of a boy with regional odontodysplasia. The mandibular right central and lateral incisors and the canine (as well as the deciduous predecessors) were affected. In a 2-step procedure, the maxillary right and left second premolars were autotransplanted to the affected area. The extraction sites in the maxilla were closed, and a good functional occlusion was established.

Correlation of the right ventricular systolic function indexes evaluated by two-and three-dimensional echocardiography with physical development in normal children

Objective To evaluate the right ventricular global systolic function by real-time three dimensional echocardiography (RT-3DE) and two dimensional echocardiography (2DE) in normal children,and investigate their correlation with age,height,weight,body surface area (BSA) and cardiac cycle time.Methods In 192 normal children,2DE right ventricular systolic function indexes were obtained at the apical four chamber view,including:tricuspid annular lateral wall peak systolic excursion (TAPSE),tricuspid annular peak systolic velocity (TRV) and right ventricular systolic area shortening (RVa).Full volume imaging of right ventricle was obtained at the parasternal four-chamber view near the apex by RT-3DE.The right ventricular ejection fraction (RVEF) was analyzed by TomTec RV-Function.The correlation analysis was performed between RT-3DE and 2DE indexes.The correlation and regression analysis on RT-3DE and 2DE indexes with above physical development indexes were also studied.At the same time 192 normal children were divided into five groups by age.2DE and RT-3DE indexes were compared with each other among five age groups.Results RVEF had no statistical correlation with all 2DE indexes (P ＞0.05).The correlation analysis on RT-3DE and 2DE indexes with physical development indexes demonstrated that TAPSE,TRV had strong positive correlation with the above indexes (P =0.000),while RVa had no statistical correlation with the above indexes (P ＞0.05).RVEF had weak positive correlation with cardiac cycle time r =0.180,P =0.014),but it had no statistical correlation with the other indexes (P ＞0.05).Stepwise regression analysis showed that the significant factor for TAPSE and TRV was height (R2 =0.508,P =0.000)and BSA (R2 =0.130,P =0.000)separately.In five age groups RVEF and RVa remained constant (P ＞0.05).However for TAPSE and TRV significant difference were found in part of comparisons between groups(P ＜0.05).Conclusions Although RVEF assessed by RT-3DE was slightly influenced by heart rate,it was independent of age,height,weight,BSA.It was a stable index for evaluating right ventricular systolic function among different age and physical development population. Key words: Echocardiography; Ventricular functin,right; Child

Frequency, Time Course, and Possible Causes of Right Ventricular Systolic Dysfunction after Cardiac Transplantation: A Single Center Experience

The frequency and causes of right ventricular (RV) systolic dysfunction early after cardiac transplantation are not well defined. We investigated the prevalence and causes of RV dysfunction in 27 heart transplant recipients, as measured by lateral tricuspid annular plane excursion (TAPSE) and fractional area change (FAC) at a mean of 15 ± 11 days after transplant. Tissue Doppler imaging was used to assess systolic time velocity integral (TVI) of the RV basal free wall. A subset of 22 patients had follow-up TAPSE measurement at 406 ± 121 days. RV systolic dysfunction, defined as TAPSE > 2 standard deviation (SD) below values in a control group, was present in 100% (27/27) of patients (P < 0.05). FAC was also significantly lower in patients compared with controls (P < 0.0001). TVI confirmed the presence of RV dysfunction in all 16 patients with both TAPSE and TVI (P < 0.05). Ischemic time (P = 0.017) and posttransplant tricuspid regurgitation (P = 0.024) were independent predictors of early RV dysfunction (r = 0.753). On follow-up, RV function improved in 15 of 22 patients but all patients remained with TAPSE > 2 SD below controls. This study showed that 100% of patients had reduced RV function early after transplant. Two thirds of patients had partial recovery of RV function during the first year. In all patients, however, RV function remained significantly lower than in controls.

Extraction of the lateral incisors to treat maxillary protrusion: Quantitative evaluation of the stomatognathic functions

To treat morphological abnormalities, impaction, and severe malposition of the teeth, the lateral incisors are sometimes extracted, followed by orthodontic space closure. This procedure often requires special consideration, not only with regard to esthetics but also for functional issues. However, thus far, few reports that have performed a functional evaluation in such cases. The purpose of this article is to report the successful treatment of an adult patient with a Class II division 1 malocclusion who was treated with extraction of the upper lateral incisors. The female patient, aged 23 years and 6 months, had a chief complaint of maxillary incisal protrusion and crooked teeth. In this patient, the upper lateral incisors were extracted to fulfill the patient's strong request, followed by orthodontic treatment using edgewise appliances. A high-pull J-hook headgear on the lower dental arch was used to prevent further labial inclination of the lower incisors. The total active treatment period was 37 months. The resulting occlusion and a satisfactory facial profile were maintained during a 4-year retention period. Additionally, this treatment did not affect the stomatognathic functions as assessed by the following criteria: range of the incisal path or condylar motion during maximal open-close movement, protrusive excursion, lateral excursion, and the chewing test. In conclusion, extraction of the upper lateral incisors can be an effective treatment choice when the upper lateral incisors are dwarfed, are nonvital, or demonstrate severe malposition.

Mandibular Kinematics in Patients With Alloplastic Total Temporomandibular Joint Replacement—A Prospective Study

The purpose was to analyze the mandibular patterns (condylar range of motion during opening; incisal range of motion during opening, lateral excursion, and protrusion; velocity during opening and closing; mandibular rotation angle during opening and closing) in patients with alloplastic total joint replacement (TJR). Seventeen patients with different diagnoses resulting in condylar hypomobility (8 patients, 15 joints) and condylar instability (9 patients, 12 joints) had undergone alloplastic TJR. Data were recorded preoperatively and 2, 6, and at least 12 months postoperatively. For ordinal data comparison at different time points, the Wilcoxon signed-ranks test was used. Analysis of the kinematic data at least 12 months postoperatively showed in patients with condylar hypomobility a statistically significant increase in all measured data except the incisal range of motion lateral excursion. In patients with condylar instability, the results showed a statistically significant decrease for incisal range of motion protrusion and laterotrusion. A slight increase in condylar range of motion, incisal range of motion linear distance, and velocity during opening and closing was found. Even after successful alloplastic TJR, a complete restoration of normal joint function is not achievable. Nevertheless, the kinematic data indicate that alloplastic TJR results in an improved function in patients with joint hypomobility and in a decrease of abnormal hypermobility in patients with condylar instability.

Balance control and muscle activity in various unstable shoes compared to barefoot during one-leg standing

The purpose of this study was to compare muscle activity and balance control of young healthy subjects during one-leg standing using various unstable shoes, a stable reference running shoe and barefoot condition. Twenty athletic female subjects participated in this study. The protocol consisted of quiet one-leg standing measured in six randomized conditions: four different unstable shoes, reference shoe and barefoot. The data were measured using the Pedar-X® insole system and a surface electromyography (EMG) system. Activity of eight muscles of the right leg was measured and integrated EMG (IEMG) and root mean square (RMS) values were calculated. For the balance control analysis, centre of pressure (CoP) total, medial–lateral and anterior–posterior excursions were calculated. A descriptive analysis and also one-way repeated-measures ANOVA (α = 0.05) and post-hoc tests were performed. The results indicate larger CoP total excursion as well as CoP medial–lateral excursion in barefoot compared to all shoe conditions (p < 0.05), whereas no differences were observed within the shoe conditions. Higher muscle activity (IEMG) was identified for the lateral gastrocnemius, vastus medialis and rectus femoris during barefoot standing with no difference between shoe conditions. No differences in RMS values could be observed for all analysed conditions. In conclusion, this study could not find any relevant differences between the shoe conditions for any of the analysed variables. Surprisingly, the barefoot condition showed the greatest instability (CoP excursions) and the highest muscle activity compared to all shoes analysed in the study. Further studies with unstable shoes are needed to investigate their instability effects.

Evaluation of acute radiation effects on mandibular movements of patients with head and neck cancer

To evaluate radiotherapy effects (RT) on mandibular movements of patients with head and neck cancer (H&NC) and associate them to the variables: functional capacity, radiation field, disease staging, type of feeding, concomitant chemotherapy and total dose of RT. Twenty-six patients with H&NC were followed up at the RT service. Physical examination was performed in 3 follow up time points: before the beginning of RT (T0), between 14th and 17th session of RT (T1) and after the last session of RT (T2). The physical examination consisted of the assessment of the following variables: mouth opening without pain (MO), maximum mouth opening (MMO), right lateral excursion (RLE), left lateral excursion (LLE) and protrusion (PR) of the jaw. The feeding type and the Karnofsky Performance Status Scale (KPS) were evaluated in each follow up time point. Data with regards to the tumor lesion and the RT were collected from the patient's clinical notes. There was a statistical significant reduction in the values of MO (p=0.006), MMO (p=0.001), LLE (p=0.006) and KPS (p=0.001). There was significant a statistical association among the reduction in KPS and decreased measure of MO (r=0.390, p=0.048) and MMO (r=0.435, p=0.026). The mouth and oropharynx radiation fields when combined showed a significant reduction for both the measure of MO (p=0.005) and for MMO (p=0.004). Patients who used nasoenteric tube feeding (NTF) had greater reduction in the measurement of MMO (p=0.031). The remaining variables showed no statistically significant difference. Patients with H&NC present reduction of the measures of MO and MMO during the RT, especially if they present reduced functional capacity, have radiation in the mouth and oropharynx fields and used NTF.

Prospective outcome assessment of the therapeutic benefits of arthroscopy and arthrocentesis of the temporomandibular joint

Patients who fail to respond to routine conservative measures to treat pain, restriction, and locking in the temporomandibular joint (TMJ) may have therapeutic arthroscopy or arthrocentesis, both of which are associated with symptomatic improvement in 86% of patients. To our knowledge there are no current data on improvements in mouth opening and lateral deviations after these procedures. This prospective audit includes 244 patients treated between 2005 and 2010 from one surgeon's practice, who were followed up at least once at 6 weeks after arthroscopy or arthrocentesis. They had various conditions but all had tender joints. Measurements of interincisal opening, left and right lateral excursions, and protrusion were taken before and during operation with callipers (mm). Opening and pain scores were also recorded on 10cm analogue scales before operation and at 6 weeks. Pain scores improved with intervention from a mean score of 37.1–16.1 (range 0–100). The improvement in mouth opening ranged from 0 to 78% (as some patients had locking or pain with normal opening before operation), and 86% had improved enough to be discharged at 6 weeks. Temporary forehead weakness in two patients resolved within the timescale of the study. The study shows improvements in mouth opening, and confirms that pain scores can be improved after arthroscopy or arthrocentesis when conservative approaches have failed. In the hands of a skilled practitioner, arthroscopy can be a useful diagnostic and therapeutic adjunct, which can be used repeatedly with low morbidity.

The developmental history of Complete denture and its occlusal principle

In an edentulous situation, the dentist must make several determinations when constructing artificial teeth. These include vertical and horizontal relationships of mandible with respect to the maxilla, occlusal form and position, vertical dimension, occlusal relationships during both centric closure and eccentric excursive movements. Artificial teeth are attached to a movable base resting on movable and displaceable living tissue subject to damage. They act as a unit; therefore, they must be arranged to function as a unit. Bilateral balanced occlusion is that stability of the denture is attained when bilateral contacts ex ist throughout all dynamic and static states of the denture during function. Lateral excursion in a balanced scheme implies simultaneous working side and nonworking side contact, while occlusal contacts are maintained on both anterior and posterior teeth as the mandible moves anteriorly into protrusion.

Hydroxyapatite/collagen block with platelet rich plasma in temporomandibular joint ankylosis: a pilot study in children and adolescents

The aim of this study was to evaluate the feasibility of using preshaped hydroxyapatite/collagen condyles as carriers for platelet-rich plasma after gap arthroplasty in patients with temporomandibular ankylosis, to assess the aesthetic and functional outcomes, and to find out if neocondylar regeneration was possible. We studied 19 patients with temporomandibular joint ankylosis (25 joints), in whom preshaped hydroxyapatite/collagen condyles with platelet-rich plasma were fixed to the ramus with a titanium miniplate, and temporal fascia was placed in between. We evaluated the type of ankylosis, mouth opening before and after operation, deviation on mouth opening, lateral excursion, protrusion, postoperative anterior open bite, radiographic assessment, and complications. All patients showed appreciable improvements in mouth opening and excursion of the jaw. There were a few complications such as mild fever, and temporary involvement of the facial nerve, which improved with time. No open bite or recurrence was reported during the 18 months’ follow up. Radiographic evaluation at 3 months showed a less opaque condyle, but the opacity at 18 months was more defined, suggesting a newly formed condyle. A preshaped hydroxyapatite/collagen condyle with platelet-rich plasma improves both aesthetics and function. However, a long term study is required to follow the growth patterns to see if the patients develop any facial deformity as they grow.

Meandering due to large eddies and the statistically self-similar dynamics of quasi-two-dimensional jets

AbstractWe investigate experimentally the structure of quasi-two-dimensional plane turbulent jets discharged vertically from a slot of width $d$ into a fluid confined between two relatively close rigid boundaries with gap $W\ensuremath{\sim} O(d)$. At large vertical distances $z\gg W$ the jet structure consists of a meandering core with large counter-rotating eddies, which develop on alternate sides of the core. Using particle image velocimetry, we observe an inverse cascade typical of quasi-two-dimensional turbulence where both the core and the eddies grow linearly with $z$ and travel at an average speed proportional to ${z}^{\ensuremath{-} 1/ 2} $. However, although the present study concerns quasi-two-dimensional confined jets, the jets are self-similar and the mean properties are consistent with both experimental results and theoretical models of the time-averaged properties of fully unconfined planar two-dimensional jets. We believe that the dynamics of the interacting core and large eddies accounts for the Gaussian profile of the mean vertical velocity as shown by the spatial statistical distribution of the core and eddy structure. The lateral excursions (caused by the propagating eddies) of this high-speed central core produce a Gaussian distribution for the time-averaged vertical velocity. In addition, we find that approximately 75 % of the total momentum flux of the jet is contained within the core. The eddies travel substantially slower (at approximately 25 % of the maximum speed of the core) at each height and their growth is primarily attributed to entrainment of ambient fluid. The frequency of occurrence of the eddies decreases in a stepwise manner due to merging, with a well-defined minimum value of the corresponding Strouhal number $\mathit{St}\geq 0. 07$.

Conservative management of unilateral condylar hyperplasia

The purpose of this study was to eliminate orthodontic treatment in mild to moderate cases of condylar hyperplasia in its early stages by condylectomy. A total of five patients (two females and three males) aged between 17 and 40 years were treated with unilateral condylectomy of the involved side without orthodontic treatment. All patients underwent standardized clinical and radiological examination at initial consultation, before surgery, immediately after surgery, and follow-up. Objective and subjective evaluation of temporomandibular joint (TMJ) included maximal incisal opening, lateral excursions, correction of facial asymmetry, occlusal harmony, TMJ pain, and jaw function. Results were recorded at 5-year follow-up. In all our cases, we achieved good mouth opening and near to normal occlusion. Good facial aesthetics was obtained after 3 months postoperative follow-up without secondary orthodontic treatment. Thus, we conclude that treatment of mild to moderate cases of unilateral condylar hyperplasia during the inactive phase can be treated with condylectomy without orthodontic treatment, and it significantly improves long-term surgical outcomes.

Behavior of corrosion damaged circular reinforced concrete columns under cyclic loading

This paper presents the results of an investigation on degradation of seismic performance of reinforced concrete (RC) columns damaged by reinforcement corrosion. A total of 13 reinforced concrete circular columns were tested under combined cyclic lateral displacement excursions and constant axial load after being subjected to accelerated corrosion tests. The controlled variables in the test were corrosion level and axial load ratio. The steel corrosion loss ratios ranged from 0% to 15.1%, and the axial load ratios varied from 0.15 to 0.9. Based on the test results, degradation models for loading capacity, stiffness, ductility and energy dissipation capacity of columns were proposed. Test results show that higher corrosion levels and higher axial loads result in less stable hysteretic loops with more severe strength and stiffness degradations and worse ductility, and that the energy dissipation of corroded specimens at the same displacement excursions is approximately the same as that of control specimens, regardless of the corrosion level, when the rebar corrosion loss ratio is less than 14%.