Palatal Extension Research Articles

Patient-reported outcome measures after periodontal surgery

ObjectivesThe present study aimed to explore the impact of different periodontal surgical treatments on the quality of life and postoperative morbidity.Materials and methodsThe present study is a single-center, prospective, observational cohort trial. One hundred fifty-five patients, referred to the Periodontal Department of Bologna University who needed periodontal surgical treatment, were recruited. The self-reported perception of the postoperative course was assessed using the following anonymous questionnaires: Italian oral health impact profile (I-OHIP-14), visual analog scale (VAS) to evaluate the intensity of the pain, and 5-point Likert scale.ResultsPatients reported a mean OHIP-14 total score of 9.87±8.5 (range 0–42), significantly influenced by the female sex, flap extension, and periodontal dressing. A mean VAS score of 2.96±2.39 (range 0–9) was calculated, and was found to be influenced by the presence of vertical releasing incisions and palatal flap extension. Of the 155 subjects, 40 (25.8%) patients reported bleeding as a post-surgical complication, 96 (61.9%) swelling, 105 (67.7%) eating discomfort, and 44 (28.4%) reported speech discomfort.ConclusionsWithin the limitations of the nature of the present study, periodontal surgical procedures have a low impact on patients’ quality of life evaluated through the OHIP-14 and VAS pain questionnaires.Clinical relevancePeriodontal surgical procedures are safe procedures, with a limited duration of postoperative discomfort as well as the incidence of complications.

Effects of different custom-made mouthguard palatal extensions on the stress-state of dentoalveolar structures: a 3D-FEA.

The present study aimed to simulate the influence of palatal extensions for custom-made mouthguards (MGs) on protecting dentoalveolar structures and to provide a theoretical basis for designing a comfortable MG. Based on finite element analysis (3D-FEA), five groups of maxillary dentoalveolar models of wearing MGs were established: no MG on palatal side (NP), on palatal gingival margin (G0), 2 mm from the palatal gingival margin (G2), 4 mm from the palatal gingival margin (G4), 6 mm from the palatal gingival margin (G6), and 8 mm from the palatal gingival margin (G8). A cuboid was created to simulate the solid ground impacted in falls, a gradually increasing force was applied from 0 to 500 N on the vertical ground, and the distribution and peak values of the Critical modified von-Mises stress, maximum principal stress, and displacement of dentoalveolar models were calculated. Stress distribution range, stress, and deformation peak value of dentoalveolar models increased as the impact strength increased, at 500 N. Maximum critical modified von-Mises stress, peak maximum principal stress and maximum displacement of dentoalveolar models G4, G3, G2, G1, G0, and NP were 154.5 MPa, 154.5 MPa, 154.4 MPa, 154.7 MPa, 154.4 MPa, and 154.7 MPa; 191.65 MPa, 192.11 MPa, 191.62 MPa, 191.81 MPa, 191.56 MPa, and 191.62 MPa; and 88.78 μm, 88.57 μm, 88.19 μm, 88.67 μm, 88.43 μm, and 89.04 μ, respectively. However, the position of the MG palatal edge had little effect on stress distribution, stress, and deformation peak values of the dentoalveolar models. Different extension ranges of the MG palatal edge have little effect on the protective effects of MGs on maxillary teeth and maxilla. An MG with palatal extension on the gingival margin is more appropriate than other models and may help dentists to design a suitable MG and increase its usage. MGs with palatal extensions on the gingival margin may provide a more comfortable wearing experience for individuals involved in sports and encourage increased MG usage.

Midpalatal suture bone repair after miniscrew-assisted rapid palatal expansion in adults

BackgroundMidpalatal suture (MPS) repair in growing patients after RPE has been previously reported. However, differences between young and adult patients for timing and pattern of MPS repair after rapid maxillary expansion are expected. The aim of this study was to evaluate the midpalatal suture repair pattern after miniscrew-assisted rapid palatal expansion (MARPE) in adult patients.Materials and methodsThe study included 21 patients (six males, 15 females) successfully treated with MARPE with a mean initial age of 29.1 years of age (SD = 8.0; range = 20.1–45.1). MPS repair was evaluated using maxillary axial and coronal sections derived from CBCT exams taken 16 months after the expansion (SD = 5.9). Objective and subjective assessments of MPS repair were performed. Objective assessments were performed measuring MPS bone density at anterior, median and posterior region of hard palate. Pre-expansion and post-retention bone density changes were evaluated using paired t tests (p < 0.05). Midpalatal suture bone repair was scored 0 to 3 considering, respectively, the complete absence of bone repair in the MPS, the repair of less than 50% of the MPS, the repair of more than 50% of the MPS and the complete repair of the MPS. Intra- and interexaminer reliability evaluation were assessed using Kappa coefficient.ResultsThe objective evaluation showed a significant higher bone density at the pre-expansion stage in all palatal regions. The reliability of the subjective method was adequate with intra- and interexaminer agreements varying from 0.807 to 0.904. Scores 1, 2 and 3 were found in 19.05%, 38.09% and 42.86% of the sample, respectively. The most common region demonstrating absence of bone repair was the middle third. The anterior third of the midpalatal suture was repaired in all patients.ConclusionsA decreased bone density was observed after the retention period when compared to pre-expansion stage. Most adult patients demonstrated incomplete repair of the midpalatal suture 16 months after MARPE. However, adequate bone repair covering more than half of the hard palate extension was observed in 80.95% of the patients.

Evaluation of potential mini-implant insertion sites for maxillary skeletal expander: A computerized tomography study

ABSTRACT Objective To estimate palatal bone thickness (PBT), inferior surface palatal bone density (ISPBD), superior surface palatal bone density (SSPBD), palatal soft tissue thickness (PST) and hard palate extension (HPE) in relation to maxillary dentition for maxillary skeletal expander (MSE) mini-implant insertion sites. Materials and Methods Computerized Tomography images of 40 subjects were selected (19 male, 21 female) with mean age 23.12 years. The measurements of PBT, ISPBD, SSPBD, and PST were made at 14 different levels from incisive foramen at 2 mm intervals using BlueSky software. HPE was measured in relation to the distal surface of the maxillary second molar tooth. Statistical analysis was used to compare and correlate variables. Result PBT, ISPBD, and SSPBD decrease from anterior to posterior region with a significant difference in PBT between anterior and posterior areas in the total sample and in males. PST showed no significant differences between anterior and posterior areas and between males and females. HPE located 4 mm anterior to the line tangent to the distal surface of the second molar. There was a positive relationship between PBT and PST in anterior regions of the palate and negative one in the posterior region. Conclusion PBT decreased in the posterior direction. Anatomical variables measured at sites 13–19 mm from incisive foramen support MSE insertion locations. A significant positive correlation between PBT and PST was found in the anterior region of the palate while a negative correlation between these parameters was documented posteriorly. However, no correlation was reported between PBT and ISPBD except at 5 mm, and no correlation was detected between PBT and PST.

The Diagnosis Methods and Management Modalities of Maxillary Transverse Discrepancy

Transverse deficiency of the maxilla (TDM) is the most common skeletal change that involves the maxilla. The craniofacial skeletal assessment as early as possible is critical, as the early diagnosis of TDM influences the effectiveness of treatment. Methods for treating TDM have been reported since the mid-19th century and continue to evolve. This article puts forward a literature review on the topic, investigating the diagnosis and management of TDM, as well as stability after surgical and nonsurgical interventions. We conducted a literature search using a logical combination of the terms “palatal extension,” “maxillary transverse deficiency,” “diagnosis,” and “management.” More recent approaches include three-dimensional imaging, which has allowed for accurate depictions of the craniofacial region to be examined, allowing for evaluation of the spatial relationships between the jaw elements. The success of nonsurgical management compared to surgical management depends on the growth stage of the patient. Unfortunately, data comparing the stability of surgical and nonsurgical management is still lacking. However, for surgical intervention, surgically assisted palatal expansion (SARPE) appears to be the appropriate choice, especially when a large expansion is needed.

A RARE CASE OF MAXILLARY BROWN TUMOUR AS PRIMARY PRESENTATION OF THE PARATHYROID CARCINOMA.

Background: Brown tumours are expansile osteolytic lesions of bone, occurring in Hyperparathyroidism. Brown tumours occur most commonly in ribs, clavicle, long bones and pelvis and are uncommon in other facial bones except mandible. Other facial bones are rarely affected. Brown tumors are due to the direct effect of the parathyroid hormone. Brown tumors occur more with primary hyperparathyroidism than secondary. However, they are reported more in secondary hyperparathyroidism. In primary hyperparathyroidism, a parathyroid adenoma is a cause in 81% while other causes include hyperplasia in 15% and parathyroid carcinoma only in 4%. We present a case report of maxillary Brown tumor due to parathyroid carcinoma in an elderly male patient. Case Report: A 67-year-old male presented with right maxillary swelling increasing in size for the last few months associated with ipsilateral nasal block and right eye epiphora. The contrast CT scan of paranasal sinuses and neck revealed a large expansile right maxillary tumor aggressively eroding maxillary wall with extension into the orbital oor, ethmoid, sphenoid sinuses, nasal cavity, and oral cavity with the erosion of hard palate and soft tissue extension to subcutaneous Plane. A three cm sized soft tissue density lesion was also noted posterior to the right thyroid lobe in CT sections of the neck. Blood prole was normal except extremely high serum parathormone and calcium as well as mildly elevated serum creatinine (S. PTH 3437 pg./ml. S. Ca. 19 mg%. S. Creatinine 1.77mg%.) Ultrasonography of the abdomen also revealed calcication in the renal medulla. Right lower parathyroidectomy was done with the frozen section as well as the Intraoperative Rapid PTH assay. The PTH level was reduced by 90 percent of the original value. The nal histopathology was suggestive of parathyroid carcinoma. Summary: The patient was under regular surveillance, as the maxillary tumor was under remittance after the resection of parathyroid carcinoma. Parathyroid carcinoma is a very rare tumor and involvement of maxillary bone due to primary hyperparathyroidism due to parathyroid carcinoma is also uncommon.

Conocimiento de los tutores sobre el síndrome aéreo de los perros braquicefálicos

The present research aimed to certify the level of knowledge about the airway syndrome of brachycephalic dogs, which is more predisposed in the breeds obtained by the interviewed tutors. The brachycephalic airways syndrome is characterized by the set of upper respiratory tract abnormalities in brachycephalic animals, where we can evidence stenosis of the nostrils, soft palate extension and tracheal hypoplasia. Secondary changes may also occur such as edema and thickening of the soft palate, laryngeal dysfunction evolving into laryngeal collapse, pharyngeal and laryngeal edema, and laryngeal sagging. To carried-out this study, data were collected through anonymous online questionnaires, realized on google form, of eighty-three (83) tutors of brachycephalic dogs, conducted from January to June 2020, to attest their knowledge about the existence of this syndrome, its severity, whether there is a cure, whether the animal has the syndrome, and whether it manifests the characteristic clinical signs in a recurrent manner. According to the survey only 36.1% informed themselves about the disease by their veterinarian of choice, 34.9% said they did not know what it was, 18.1% informed themselves by internet, 7.2% informed themselves by a friend or family member and 3.6% by magazines or newspapers. Therefore, we can conclude that only 39.7% of the interviewed tutors informed themselves about the disease through reliable sources. Most tutors had already heard about Brachycephalic Dog Airways Syndrome, but they did not know if their animal had it or not, despite having one or more characteristic recurrent clinical signs. The present study has shown that the level of schooling is directly related to misinformation about the syndrome, due to the difficulty that the lack of schooling provides, making it difficult to look for safe sources of access to information about the syndrome.Keywords:

HISTOPLASMOSIS IN YOUNG MAN WITH HIV/AIDS: CASE REPORT

Histoplasmosis is a fungal systemic infectious disease, which affects humans, caused by Histoplasma capsulatum. We report a case of a male with HIV/AIDS, 28 years old, feoderma, referred to the stomatology center with complaining of several lumps in his mouth. The patient was under severe immunosuppression and not adherent to HIV-treatment. Intraoral examination showed a tumor with papillary surface reaching all extension of palate presenting a painful ulcerated lesion in the middle, which has perforated the palate. The clinical diagnosis hypotheses were Paracoccidioidomycosis and Lethal midline granuloma. An incisional biopsy and histopathological specimens, stained with HE, and special colorations with Giemsa (Negative) and PAS (Positive) had led to the diagnosis of histoplasmosis. The patient was referred to treatment with an infectious disease specialist with good follow-up. This case reinforces the importance of stomatology professional in diagnosis and direction of treatment cases of systemic diseases with exclusive presentation in the mouth. Histoplasmosis is a fungal systemic infectious disease, which affects humans, caused by Histoplasma capsulatum. We report a case of a male with HIV/AIDS, 28 years old, feoderma, referred to the stomatology center with complaining of several lumps in his mouth. The patient was under severe immunosuppression and not adherent to HIV-treatment. Intraoral examination showed a tumor with papillary surface reaching all extension of palate presenting a painful ulcerated lesion in the middle, which has perforated the palate. The clinical diagnosis hypotheses were Paracoccidioidomycosis and Lethal midline granuloma. An incisional biopsy and histopathological specimens, stained with HE, and special colorations with Giemsa (Negative) and PAS (Positive) had led to the diagnosis of histoplasmosis. The patient was referred to treatment with an infectious disease specialist with good follow-up. This case reinforces the importance of stomatology professional in diagnosis and direction of treatment cases of systemic diseases with exclusive presentation in the mouth.

Sox2 Controls Periderm and Rugae Development to Inhibit Oral Adhesions

In humans, ankyloglossia and cleft palate are common congenital craniofacial anomalies, and these are regulated by a complex gene regulatory network. Understanding the genetic underpinnings of ankyloglossia and cleft palate will be an important step toward rational treatment of these complex anomalies. We inactivated the Sry (sex-determining region Y)–box 2 (Sox2) gene in the developing oral epithelium, including the periderm, a transient structure that prevents abnormal oral adhesions during development. This resulted in ankyloglossia and cleft palate with 100% penetrance in embryos examined after embryonic day 14.5. In Sox2 conditional knockout embryos, the oral epithelium failed to differentiate, as demonstrated by the lack of keratin 6, a marker of the periderm. Further examination revealed that the adhesion of the tongue and mandible expressed the epithelial markers E-Cad and P63. The expanded epithelia are Sox9-, Pitx2-, and Tbx1-positive cells, which are markers of the dental epithelium; thus, the dental epithelium contributes to the development of oral adhesions. Furthermore, we found that Sox2 is required for palatal shelf extension, as well as for the formation of palatal rugae, which are signaling centers that regulate palatogenesis. In conclusion, the deletion of Sox2 in oral epithelium disrupts palatal shelf extension, palatal rugae formation, tooth development, and periderm formation. The periderm is required to inhibit oral adhesions and ankyloglossia, which is regulated by Sox2. In addition, oral adhesions occur through an expanded dental epithelial layer that inhibits epithelial invagination and incisor development. This process may contribute to dental anomalies due to ankyloglossia.

Morphometric Analysis of Efnb1 Dependent Palate Growth

Congenital craniofacial anomalies represent one of the most prevalent types of structural birth defects and include common dysmorphology such as cleft palate. While morphometric analysis of surfaces generated from micro computed tomography (micro‐CT) and magnetic resonance imaging (MRI) is a well‐established method, it has not yet been applied to understanding the three‐dimensional changes in palatal shelf morphology that result in a cleft palate phenotype. EFNB1 mutations result in craniofrontonasal syndrome, an X linked condition, consisting of a variety of craniofacial anomalies, including cleft palate. Mouse models for loss of Efnb1, have demonstrated its importance during normal development of the anterior secondary palate, with loss of Efnb1 resulting in changes in secondary palatal shelf shape including apparently reduced anterior palatal shelf extension, leading to a cleft secondary palate. Palatal shelf shape appears more disrupted in Efnb1+/− embryos, which are mosaic for EPHRIN‐B1 expression, but how this mosaicism contributes to palate dysmorphology has been difficult to understand in two dimensions. This study aims to establish a method of quantifying secondary palatal shelf outgrowth and shape that is coupled with an ability to quantify gene expression changes through the use of morphometrics. We performed whole‐mount immunofluorescent staining of E‐CADHERIN, EPHRIN‐B1, and DAPI followed by confocal microscopy to generate 3D renderings that we quantify using landmark based morphometrics. This method allows a deeper understanding of changes in tissue shape as they relate to gene expression.Support or Funding InformationThis study was supported by NIH grant R01DE023337 from NIDCR

ANAPLASTIC TUMOR OF THE ANTERIOR MAXILLA: DIFFERENTIAL DIAGNOSIS AND IMMUNOHISTOCHEMICAL STUDY

The present study reports a rare case of anaplastic malignant melanoma in a 23-year-old female patient, in the anterior maxilla. On clinical examination, the lesion presented as a 5-cm sessile nodule, with brownish irregular macules on the mucosal surface, painless, with a firm consistency ranging from teeth 14 to 24 with palatal and nasal extension causing facial asymmetry and dental mobility. The computed tomography showed irregular lytic bone reabsorption, without dental involvement. The incisional biopsy followed by microscopic examination suggested primitive neuroectodermal tumor, due to the presence of round blue cells, periodic acid-Schiff (PAS)-positive clear cells, with considerable pleomorphism, atypical mitosis, hemorrhagic areas, and coagulative necrosis. Immunohistochemistry revealed high-grade epithelioid neoplasm and a diagnosis of invasive melanoma was concluded; the melanoma was positive for S-100 protein, gp100, and SOX 10 antigens. The patient underwent partial maxillectomy with no postsurgical complications after 3-month follow-up. The aggressive nature of the lesion and its prognosis are discussed. The present study reports a rare case of anaplastic malignant melanoma in a 23-year-old female patient, in the anterior maxilla. On clinical examination, the lesion presented as a 5-cm sessile nodule, with brownish irregular macules on the mucosal surface, painless, with a firm consistency ranging from teeth 14 to 24 with palatal and nasal extension causing facial asymmetry and dental mobility. The computed tomography showed irregular lytic bone reabsorption, without dental involvement. The incisional biopsy followed by microscopic examination suggested primitive neuroectodermal tumor, due to the presence of round blue cells, periodic acid-Schiff (PAS)-positive clear cells, with considerable pleomorphism, atypical mitosis, hemorrhagic areas, and coagulative necrosis. Immunohistochemistry revealed high-grade epithelioid neoplasm and a diagnosis of invasive melanoma was concluded; the melanoma was positive for S-100 protein, gp100, and SOX 10 antigens. The patient underwent partial maxillectomy with no postsurgical complications after 3-month follow-up. The aggressive nature of the lesion and its prognosis are discussed.

Varied orbital manifestations of paranasal sinus disease

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Even though sinusitis is a common clinical entity, its complications are seen rarely after the advent of antibiotics. Hence we aimed to analyse varied clinical presentations and manifestations of orbital involvement in paranasal sinus diseases and their outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Hospital based prospective study done from January 2007 to December 2017. We selected 65 patients in our study based on our inclusion and exclusion criteria. Type of orbital involvement was analysed by computed tomography scan. Immediate aggressive medical management was started and surgery was undertaken if there is no clinical improvement in 48 hours. Endoscopic sinus surgery done along with orbital decompression and drained pus was sent for culture sensitivity. Patients were followed up regularly and suction clearance was done. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 65 patients, 50 were male and 15 were female. 24 patients had bacterial pathology, 40 had fungal pathology and 1 patient had non specific inflammatory disease consistent with mucocoele. Out of 24 bacterial sinusitis, 2 had bilateral disease and 1 patient had scalp and neck extension. Out of 40 fungal sinusitis, 2 patients had 6th cranial nerve palsy with sphenoid disease, 5 patients had palatal extension and 8 patients had intracranial involvement.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; All cases of orbital oedema and proptosis should be thoroughly evaluated for sinus disease. Computed tomography aids to know the extent of disease, deciding about the type and mode of intervention. Early diagnosis and immediate intervention reduces significant mortality and morbidity. However regular follow up, counselling the patients and relatives helps in achieving appropriate outcome.&lt;/p&gt;

Satisfaction with shortening the palatal extension of a mouthguard for water polo players: A randomized crossover study.

Approximately 50% of water polo players have suffered orofacial injuries. However, fewer than 8% of players wear a mouthguard. A more comfortable mouthguard design is therefore needed to increase compliance. The aim of this study was to assess the effect of reducing the palatal extension of a custom-made mouthguard on the degree of satisfaction with a mouthguard among water polo players. Eighteen elite water polo players participated in this randomized crossover trial. Two custom-made mouthguards were fabricated for each participant using 4-mm-thick ethyl vinyl acetate foils, defined by the extension of the palatal margin from the cervical line: conventional (6mm) and shortened (2mm). The mouthguards were worn during all training sessions and matches, in a randomized sequence (one mouthguard type for the first and fourth weeks and the other for the second and third weeks). Mouthguards were evaluated on 10-point scales for discomfort, interference with oral functions, protection, and general satisfaction after each training session or match. Players evaluated the shortened mouthguard as having less interference with speech (Effect 1.30; P<0.001), breathing (Effect 0.98; P=0.004), swallowing (Effect 1.30; P<0.001), and athletic performance (Effect 0.61; P=0.03) compared with the conventional mouthguard. The perceived degree of protection was similar among participants when wearing each type of mouthguard. Overall, players were more satisfied with the shortened mouthguard (Effect 0.64; P=0.03). Reducing the palatal extension of a custom-made mouthguard from 6 to 2mm improves the overall satisfaction of elite water polo players without affecting the perceived degree of protection.

Prosthetic Rehabilitation with Palatal Lift/Augmentation in a Patient with Neurologic/Motor Deficit Due To Cancer Therapy for Chondrosarcoma.

This clinical report describes the prosthetic rehabilitation of a 25-year-old man with a history of grade II chondrosarcoma at the skull base who had undergone surgical resection and thereafter developed velopharyngeal incompetency (VPI), dysarthria, and dysphagia. Upon baseline fiberoptic endoscopic evaluation of swallowing (FEES), the patient had an atypical pattern of VPI with minimal to no velar lift during speech, blow, or suck tasks, but near complete velar lift and seal during swallowing. A palatal augmentation prosthesis combined with a resilient palatal lift extension was fabricated to enhance speech by displacing the soft palate and to decrease hypernasality, while avoiding interference with bolus transport. A resilient wrought wire extension was necessary to accommodate the velar movement upon swallowing while keeping the integrity of the velar lift during speech. In conclusion, this unique combination prosthesis was able to help the patient's atypical pattern of VPI by improving speech and preserving swallowing function, which was confirmed during a post-endoscopic evaluation.

Stress Analysis of Ceramic Laminate Veneer for Diastema Closure with Different Extensions and Different Directions of Applied Load

Purpose: To analyze stress distribution on the IPS e. max (lithium di silicate) laminate veneer used for diastema closure with different free median extensions and different extensions of proximal preparation using two directions of applied force. Statement of the problem: Closure of large median diastema by laminate veneer will increase stress intensity on the unsupported mesial extension. Materials and Methods: Finite element model of unprepared maxillary central incisor was made, by deletion method, the labial surface was reduced by 0.5 mm. and is taken up to the height of the incisal edge (feather design), then, the basic geometric configurations of different laminate veneer designs and its dimensions in millimeters were introduced into the ANSYS software program to obtain the different nine models from three proximal extensions (1, 1.5 and 2 mm) and three unsupported median extensions ( 0.5, 1 and 1.5 mm), then the stress distributions were evaluated by applying load of 100 N at two angulations( 60° and 125°). Results: In case of 60° applied load the highest stress value was recorded in Model 3 (veneer with 1 mm labio – palatal extension with 1.5 free median extension, 30.95 Mpa) where The lowest stress value was recorded in Model 7 (veneer with 2 mm labio – palatal extension with 0.5 free median extension, 20.15 Mpa). Statistically, there was a significant difference between tested models (P at the level 0.05) except in cases of model 1, 4 and 7 which exhibited no statistical significant difference (P > 0.05). In case of 125° applied load the highest stress value was recorded in Model 3 (veneer with 1 mm labio – palatal extension with 1.5 free median extension, 53.61 Mpa) where The lowest stress value was recorded in Model 7 (veneer with 2 mm labio – palatal extension with 0.5 free median extension, 39.27 Mpa). Statistically, there was a significant difference between tested models (P at the level 0.05) except in cases of model 4, 5 and 8 which exhibited no statistical significant difference (P > 0.05). Conclusion: Stress is concentrated on the free median extension, incisal edge, and the mesio - labio - incisal point angle. The stress intensity increase in the following cases: - (1) increase in free median extension of the veneer, (2) increase in angulation of applied force, (3) decrease in proximal extension of laminate veneer.

Analysis of Arch Widths in Patients With Isolated Pierre Robin Sequence.

To compare arch widths of patients with isolated Robin sequence (IRS) operated using modified von Langenbeck technique and modified Furlow double-opposing z-plasty. Retrospective, transversal study. Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil. Three groups of patients were analyzed. Group VL comprised 30 patients with IRS operated by von Langenbeck technique (mean age of 8.1 years); group FL included 30 patients with IRS operated by Furlow technique (7.6 years); and the control group included 30 noncleft patients with class I occlusion (7.4 years). The palate repair was performed between 1.0 and 1.7 years of age in both study groups. Transversal measurements of maxillary and mandibular arches were performed digitally on 3D digital models. The intergroup comparison was performed using analysis of variance and Tukey test. An independent t test was used to compare the complete and incomplete types of cleft in both study groups. The level of significance was 5%. No statistically significant difference was found between the VL and FL groups for maxillary and mandibular arches. However, both groups showed decreased transversal dimensions compared with the control group (P < .01) for both dental arches. No differences for arch widths were observed for complete or incomplete palatal clefts. No influence of palate repair techniques was observed in the transversal arch widths in patients with IRS. Children with IRS operated for palate repair showed constriction of the maxillary and mandibular dental arches compared with noncleft children regardless the palatal cleft extension.

Osteossarcoma crâniofacial: um enfoque imagenológico

Objetivo: relatar um caso de osteossarcoma craniofacial e revisar a literatura sobre os achados de imagem. Relato de Caso: as informações foram obtidas por revisão de prontuário. A paciente do sexo feminino, 25 anos, com parestesia e dor em hemiface direita. Os exames de imagem evidenciaram extenso tumor comprometendo seio maxilar, palato, arcada dentária e cavidade nasal e extensão à fossa infratemporal. Discussão: a maioria dos osteossarcomas craniofaciais são lesões líticas com sinais de agressividade em radiografias. A tomografia é excelente para detectar lesões ósseas e calcificações. A ressonância magnética (RM) mostrou baixo sinal nas ponderações em T1 e alto sinal em T2, com realce heterogêneo pelo meio de contraste. A tomografia computadorizada (TC) é excelente para detectar calcificações e lesões ósseas. A ressonância magnética (RM) é excelente para caracterizar a extensão da lesão. Conclusão: os achados imaginológicos trazem importantes informações para avaliação pré-operatória e monitoramento de recidivas.

Inhibition of the miR-17-92 Cluster Separates Stages of Palatogenesis

The role that noncoding regions of the genome play in the etiology of cleft palate is not well studied. A novel method of microRNA (miR) inhibition that allows for specific miR knockdown in vivo has been developed by our laboratory. To further understand the role of miRs in palatogenesis, we used a new mouse model to inhibit specific miRs within the miR-17-92 cluster. Transgenic mice expressing inhibitory complexes for miR-17 and miR-18 manifested a clefting phenotype that was distinct from that observed in mice carrying inhibitory complexes for miR-17, miR-18, miR-19, and miR-92. An in silico candidate gene analysis and bioinformatics review led us to identify TGFBR2 as a likely target of miR-17 and miR-19 family members. Reverse transcription polymerase chain reaction (RT-PCR) experiments showed that TGFBR1 and TGFBR2 expression levels were elevated in the palates of these miR transgenic embryos at embryonic day 15.5. RT-PCR data also showed that the expression of mature miRs from the miR-17-92 cluster was significantly decreased in the transgenic embryos. Decreased expression of TGFB pathway signaling ligands was also observed. Experiments in cells showed that inhibition of miR-17 and miR-18 was sufficient to induce increases in expression of TGFB receptors, while a concomitant decrease in TGFB signaling ligands was not observed. RT-PCR of mature miR-17-92 in cells demonstrated the selectivity and specificity of inhibitory complexes. While this study builds on previous studies that have implicated miR-17-92 in the regulation of important molecular components of the TGFB signaling pathway, it is likely that interactions remain to be elucidated between miR-17-92 and as-of-yet unidentified molecules important for the control of palatogenesis. The differential regulation of palatogenesis by members of the miR-17-92 cluster indicates that several gene combinations regulate palate elevation and extension during development.

In Vivo Inhibition of microRNA (miR) Using a Novel miR Inhibitor System Reveals a Role for miR‐17‐92 in Palate Elevation and/or Extension

MicroRNAs (miRs) are short non‐coding RNA molecules approximately 22 nucleotides long. miRs bind to complementary targets on the 3′ untranslated region (UTR) of messenger RNAs (mRNAs), attenuating mRNA translation via either mRNA strand degradation or sequestration. Given their redundancy throughout the genome, conventional knockout strategies are difficult to employ when studying miRs. To circumvent this difficulty, we have developed a novel method of miR inhibition, the Plasmid‐Based miRNA Inhibition System (PMIS), to allow for the simultaneous knockdown of homologous miRs. Short hairpin structures that flank the anti‐sense miR target site on the PMIS inhibitor complex (PMIS‐IC) dramatically increase miR inhibition by associating with RISC complex factors. The PMIS‐IC is composed of native, unmodified nucleic acids and can be stably integrated into the genome. In this study, we employ this strategy to analyze the effects of inhibition of mature miRs in the miR‐17‐92 cluster. Here we show how the PMIS system can be used to inhibit miRs from the miR‐17‐92 cluster and associated family members in stable cell lines and transgenic mice. We also show how inhibition of the miR‐17‐92 cluster can lead to differences in the point of palate formation arrest in mice carrying PMIS‐ICs for miR‐17‐92. These results demonstrate the effectiveness of this novel miR inhibition strategy and indicate new roles for miR‐17‐92 in palatogenesis.Support or Funding InformationUniversity of Iowa Carver College of MedicineUniversity of Iowa College of DentistryUniversity of Iowa Research FoundationNational Institutes of Health (National Institute for Dental and Craniofacial Research)

Ossifying pleomorphic adenoma presenting as a nasopalatine mass

&lt;p class="abstract"&gt;&lt;span lang="EN-IN"&gt;Pleomorphic adenomas are benign tumors that are uncommon in the nasal cavity. However, they can rarely arise from septum, erode hard palate and thus masquerade a bone tumor. We report one such rare case of septal pleomorphic adenoma with hard palatal extension and ossification. A combined endoscopic intranasal and transpalatal surgical approach was performed and tumor was excised completely. A high index of clinical suspicion and biopsy can diagnose such swellings.&lt;/span&gt;&lt;/p&gt;