Arch Size Research Articles

Kajian Literatur tentang Dimensi Lengkung Gigi Fase Gigi Bercampur pada Anak Laki-Laki dan Perempuan

The tooth growth phase starts from the age of 6 years with the first molar growth, this is a reference to assess the need for space and the possibility of malocclusion in adulthood. The dimension of the tooth arch is important in orthodontic treatment in children, especially in the mixed teeth phase because it will affect the treatment plan. The dimensions of the tooth arch are affected by various factors such as tooth eruption, genetics, growth patterns, environment and ethnicity. This study is a Literature Review using secondary databases from Google Scholar, Science Direct and Pubmed with the keywords "Dental Arch Dimension AND mixed dentition", "Gender AND Mixed Dentition" and "Children AND Dental Arch Dimension" which have been carried out previously domestically and abroad. Based on the results of the screening, 15 articles were obtained that met the criteria. In the study, 10 non-specific articles were found to discuss the dimensions of tooth arch in boys and girls in the mixed tooth phase. The five selected articles showed significant differences between sex, age, and race that affected the length and dimensions of the tooth arch in this phase. However, some studies have also shown that the differences are not significant in certain age ranges and races. In conclusion, The mixed tooth phase is an important period in the growth of a child's dental arch, where differences in the size of the tooth arch can be seen between different racial or ethnic groups. Gender also plays a role in determining the dimensions of the tooth arch, which affects the orthodontic treatment plan.

Changes in the size of dental arches in different variants of the course of the retention period of treatment in patients with anomalies in the maxillary canines position

Objective. To assess the changes in the size of dental arches in different variants of the course of the retention period in patients with anomalies in the position of the maxillary canines in a long-term follow-up. Materials and methods. An open prospective clinical and instrumental study with elements of retrospective analysis was conducted. The study included 69 patients aged 18 to 45 (median age 24,1 ± 0,9 years) in the retention period of orthodontic treatment for anomalies in the position of the maxillary canines. The duration of patients` observation was from 2 to 8 years (median duration 3,57 ± 0,24 years). The patients were divided into groups depending on the course of the retention period. Group 1 contained patients with an unfavorable course (having a relapse of the dentoalveolar anomaly): 22 people (9 males and 13 females), average age 23,8 ± 3,4 years; group 2 included patients with a favorable course (having a clinically stable result of treatment): 47 people (19 males and 28 females), average age 22,6 ± 1,9 years. Results. At a long-term follow-up in the retention period a common pattern of geometric changes in the dentition with various degrees of severity, was revealed in patients of both groups. The most pronounced reduction of the transverse dimensions of the dental arches was in the area of ​​the maxillary canines (–1,38 ± 0,27 mm in group 1, – 0,30 ± 0,20 mm in group 2) and upper premolars (–3,25 ± 0,52 mm in group 1, –1,27 ± 0,12 mm in group 2). The increase in the length of the anterior sections of the dental arches in individuals with the phenomena of "true relapse" was 0,95 ± 0,32 mm on the upper jaw, 0,50 ± 0,19 mm on the lower jaw, in individuals with "relapse-like movement" of teeth – 2,44 ± 0,16 mm on the upper jaw and 1,53 ± 0,24 mm on the lower jaw, in patients with a stable treatment result – 0,66 ± 0,25 on the upper jaw, 0,51 ± 0,19 mm on the lower jaw, which indicates a mutually balanced change in the transverse and sagittal parameters. Conclusions. In the long-term observation period (2 or more years from the beginning of the retention period of orthodontic treatment), a change in the metric parameters of the dental arches is revealed in patients with anomalies in the position of the maxillary canines, which causes a recurrent change in their shape in the lateral parts. At the same time, the final values ​​of absolute increase of transverse parameters both in case of a stable result of orthodontic treatment and with a relapse of the anomaly practically have no differences.

A step-by-step technical report on the novel 'PREMADE Protocol' for fabricating acrylic provisional prostheses for all-on-4 treatment concept

Background: This technical report describes how to use a prosthetic protocol with a standardized immediate and fixed prosthesis that is the same for all patients. The prosthesis called “PREMADE” is adapted to various arch sizes (narrow, regular, and wide, with uniform teeth in all cases). This aim is to obviate the need for all laboratory procedures following the positioning of the implant. Case Presentation: This report details the application of the PREMADE protocol in a clinical setting. It illustrates its use in a patient requiring immediate dental implant loading, highlighting the protocol’s step-by-step technical nuances. The case underscores the protocol’s efficiency in reducing laboratory phases and chair time, facilitated by its innovative approach of utilizing a standardized prefabricated arch adaptable to various jaw sizes. The procedure’s success is evident in the minimized patient discomfort and improved osseointegration, attributed to the protocol’s stability and micromotion control. Conclusions: The PREMADE protocol signifies a transformative advancement in immediate dental implant loading, enhancing procedural efficiency and patient outcomes. Its application demonstrates the potential to reduce procedural complexity and time, thereby improving the patient experience. However, further research is required to establish its universal applicability and to compare it with other immediate loading protocols. The future integration of this protocol in all-on-4 rehabilitation could revolutionize the prosthetic phase, making advanced dental treatments more accessible.

Deciphering risk elements: exploring precursors to recoarctation in individuals with aortic coarctation.

Coarctation of the aorta (CoA) patients often experience recoarctation, the reoccurrence of aortic narrowing, presenting a considerable clinical challenge. This study aims to investigate the triggers or contributing factors associated with the development of recoarctation (reCoA) following the initial repair of CoA. The retrospective cohort study includes information about 120 patients, who underwent 4 different types of surgical repairs of coarctation of the aorta through left thoracotomy in the period 2012-2022. Recoarctation was evaluated using the pressure gradient on the coarctation site measured by echocardiography (echoCG). A threshold of more than 20 mm Hg was employed to define recoarctation. All statistical analysis was performed using SPSS and Jamovi applications. The study revealed that 30 (25%) patients experienced early recoarctation, while 52 (43.7%) patients encountered late recoarctation. Among the 28 (23.3%) patients who had arch hypoplasia, 12 experienced early recoarctation, and 22 exhibited late recoarctation. Correlation tests demonstrated a strong negative correlation of the z-score of the arch size with both early recoarctation (r = -0.229, p = 0.013) and late recoarctation (r = -0.421, p < 0.001). Resection and end-to-end anastomosis (EEA) displayed the highest proportions of early (59%) and late (77%) recoarctation. Aortic arch hypoplasia emerges as a significant risk factor for both early and late recoarctation. Additionally, while all coarctation repair methods carry some risk of recoarctation, resection and end-to-end anastomosis and prosthetic patch aortoplasty may pose a higher risk compared to extended end-to-end anastomosis.

Sternotomy or thoracotomy for neonatal repair of coarctation of the aorta with aortic arch hypoplasia

ObjectiveFor neonatal repair of coarctation of the aorta, patients may either undergo thoracotomy with extended end-to-end anastomosis or sternotomy for aortic arch reconstruction with cardiopulmonary bypass. The objective of this study was to evaluate the comparative effectiveness of the 2 approaches in patients with arch hypoplasia. MethodsThis is a single-center retrospective cohort study from July 2005 through May 2022 of patients who underwent neonatal repair for isolated coarctation of the aorta with additional arch hypoplasia. Inverse probability of treatment weighting is a statistical method for creating comparable pseudopopulations and was used to account for baseline differences in population. The primary outcome was aortic reintervention, and secondary outcomes were vocal cord dysfunction, length of stay, chylothorax, and phrenic nerve palsy. ResultsThere were 130 patients who met inclusion criteria. After weighting, the interaction between distal transverse arch size and operative approach (sternotomy vs thoracotomy) was statistically significant, P < .05 for interaction. Among patients with a distal arch z-score <−3.5, patients undergoing thoracotomy with extended end-to-end anastomosis had an increased hazard for reintervention. Sternotomy was associated with an increased length of stay in the intensive care unit by 4.7 days, P < .001, and odds of vocal cord dysfunction were also greater, odds ratio 7.1 (95% confidence interval, 1.66 to 41.26; P = .01). ConclusionsAmong patients with a distal arch z-score smaller than −3.5, the hazard of reintervention was increased for patients undergoing thoracotomy with extended end-to-end anastomosis. However, length of stay and risk of vocal cord paresis was reduced in patients undergoing thoracotomy.

Обоснование технологии освоения техногенных месторождений

Introduction. The article contains information on the development of technology for the development of man - made deposits represented by the tailings of mining and processing of coal mines in the coal - mining regions of the country. The development of the resources of man - made deposits will stimulate the integrated development of the mining region and increase its economic attractiveness. Research methods include the analysis of best practices, literature sources, analysis of the results of field and remote observations, laboratory experiments and mathematical modeling. The results of the research. The experience of borehole excavation is generalized and is widely used in the underground and open - pit mining of coal deposits and tailings dumps, as well as sand deposits. Information is provided on a new technology for mining man - made deposits using a drilling rig for destruction and delivery of raw materials by rotating and feeding a drilling screw shaft. Calculation models are given to determine the parameters of mining a man - made deposit by a drilling rig using conveyor transport. The organizational factors of using the machine during the shift and technological factors are detailed, taking into account the conditions of its operation differentially in a specific situation. The issues of geomechanics of the drilling process with the calculation of the size of the natural collapse arch above the borehole and the natural collapse arch are considered. The advantages of auger mining of technogenic deposits are substantiated in comparison with existing technologies and an assessment of the prospects for using this technology in the development of technogenic deposits of coal - mining regions is given. Resume. The proposed technology for the development of man - made deposits has a promising use and is provided by the use of continuous operation technology, cost minimization and the possibility of selective extraction of raw materials and is recommended for the development of solid minerals at mining enterprises

Correlations of teleroentgenometric indicators according to the Steiner method with the dimensions of teeth and dental arches in young men and young women with a physiological bite without taking into account the type of face

Annotation. The importance of teleradiographic indicators in the diagnosis and planning of orthodontic treatment is difficult to overestimate, but their relationship with the size of teeth and dental arches in different age and sex groups remains insufficiently studied. This is especially relevant for the Ukrainian population, where individual anatomical features can affect the effectiveness of orthodontic interventions, which makes the study of such relationships important for improving approaches to diagnosis and treatment. The purpose of the study is to establish the specifics of correlations between teleroentgenometric parameters according to the Steiner method with the dimensions of teeth and dental arches in Ukrainian young men and young women with a physiological bite. A morphometric study of the teeth and dental arches was carried out, and teleroentgenometric indicators were determined using the Steiner method from the primary computer tomograms of 41 Ukrainian young men (aged 17 to 21) and 68 Ukrainian young women (aged 16 to 20), which were obtained from data bank of the Department of Pediatric Dentistry and Research Center of the National Pirogov Memorial Medical University, Vinnytsya. The evaluation of correlations between teleroentgenometric indicators according to the Steiner method and computed tomographic dimensions of teeth and dental arches was carried out in the license package “Statistica 6.0” using Spearman's non-parametric statistics. As a result of the analysis of the reliable and average strength of unreliable correlations between teleroentgenometric parameters according to the Steiner method with the sizes of teeth and dental arches, it was established: in young men – 5.71 % of similar relationships with the sizes of the teeth of the upper jaw (mostly reliable straight lines of average strength with the sizes of incisors and canines), only 1.79 % with the dimensions of the teeth of the lower jaw and 6.60 % with the dimensions of the dental arches (mainly reliable straight and reverse of medium strength with distances characterizing the position of canines and first premolars relative to the hard palate, as well as the distance between the crowns of the central incisors and the line that connects the molars of the upper jaw); in young women – 4.82 % of similar relationships with the dimensions of the teeth of the upper jaw (mostly reliable straight lines of weak force with the dimensions of canines), 5.00 % with the dimensions of the teeth of the lower jaw (mostly reliable straight lines of weak force with the dimensions of incisors), 14.58 % with the dimensions of dental arches (mainly reliable direct and reverse medium strength with the distances between the crowns of the central incisors and the line connecting the canines, the first premolars and molars of the upper jaw, as well as the distances between the distal and medial roots of the lower first molars). Thus, in Ukrainian young men and young women with a physiological bite, the peculiarities and gender differences of the correlations between teleroentgenometric indicators according to the Steiner method and computed tomographic dimensions of teeth and dental arches were established.

Efficacy of a new customized navigation template for placement of transpedicular screws for unilateral access in children with congenital spinal deformity and thoracic malformation

BACKGROUND: Surgical treatment of congenital spinal deformities combined with thoracic development anomalies in children is an urgent and a complex problem in surgical practice. The surgical method of correcting congenital deformities caused by segmentation disorder of the lateral surfaces of vertebral bodies and unilateral rib synostosis is aimed at correcting the existing deformity using a transpedicular system. This technique is effective for treating this group of patients. However, it requires precise and accurate installation of the supporting elements of the metal structure owing to the high risk of damage to the neurovascular structures in the area of surgical intervention. A solution to this problem is the use of an individualized guide template with rib support for unilateral access in children with congenital deformities of the thorax and spine. AIM: To perform a comparative analysis of the results of using an individual rib-supported guide template for transpedicular screw placement and the “free hand” method in children during surgical correction of congenital spinal deformities accompanied by thoracic development anomalies. MATERIALS AND METHODS: The study included 14 patients who underwent surgical treatment for congenital deformity of the thoracic spine against the background of segmentation disorder of the lateral surfaces of the vertebral bodies in combination with thoracic anomalies. The patients were divided into two groups. Group 1 included six patients operated on using a new navigation template guide, and group 2 consisted of eight patients who underwent installation of support elements using the “free hand” method. The following parameters were compared: time spent at the stage of formation of bone canals for the support elements of the metal structure and accuracy and correctness of support element installation. Clinical data included demographic information and the size of the scoliotic arch, number of support elements, and presence of complications. Statistical analysis using Student’s t-test for unpaired samples or Mann–Whitney test was used to compare results. RESULTS: Data obtained in the course of the study confirmed the high efficiency and accuracy and showed that the use of the template reduces the time of bone canal formation, increases the accuracy, and provides greater correctness of the position of the supporting elements compared to the “free hand” method, which increases the efficiency and safety of surgical treatment. CONCLUSIONS: The developed template guide with support on the rib for the installation of the supporting elements of the metal structure in the surgical treatment of children with congenital deformity of the thoracic spine in combination with thoracic development anomaly showed better results compared to the use of the “free hand” method.

Postoperative aortic isthmus size after arch reconstruction with patch augmentation predicts arch reintervention

BackgroundRates of reintervention (RI) after patch-augmented reconstruction for hypoplastic aortic arch (HAA) remain moderately high. We analyzed mid-term outcomes of aortic arch reconstruction to define modifiable reintervention risk factors. MethodsExcluding Damus-Kaye-Stansel anastomoses and previous arch repair, 338 patients underwent arch reconstruction between 2000 and 2021 at median age of 6 days (interquartile range [IQR], 4-13 days) and a median weight of 3.2 kg (IQR, 2.8-3.7 kg). Surgical technique was patch augmentation with coarctectomy with or without interdigitation in 269 patients (80%), isolated patch aortoplasty in 41 (12%), and other reconstruction in 28 (8%). Risk factors for reintervention were assessed using competing risk models. ResultsAt median follow-up of 3.9 years (IQR, 1.1-8.0 years), 35 patients (10.4%) required reintervention (endovascular, n = 30; surgical, n = 12; both, n = 7). The 10-year cumulative incidence of death/transplant was 10% (95% confidence interval [CI], 4%-20%), and that of and reintervention was 13% (95% CI, 8%-20%). On univariate analysis, isolated patch aortoplasty (P = .002), aortic homograft patch material (P = .006), and postoperative aortic size z-score ≤-2 for each segment were associated with greater risk of reintervention: ascending aorta (P = .006), proximal (P = .001) and distal (P = .005) transverse arches, and aortic isthmus (P < .001). On multivariable analysis, aortic homograft (hazard ratio [HR], 6.29; 95% CI, 1.94-20.5; P = .002) and postoperative isthmus z-score ≤-2 (HR, 10.5; 95% CI, 5.15-21.5; P < .001) remained significant. Patients with a repaired isthmus z-score ≤-2 had a 72.8% (95% CI, 44.6-94.4%) cumulative incidence of reintervention at 10 years, versus 6.8% (95% CI, 4.1%-11.4%) in those with a z-score >-2. ConclusionsAortic undersizing during patch-augmented reconstruction of HAA results in a >10% rate of reintervention at mid-term follow-up. Achieving adequate postoperative arch size is critical for preventing reintervention, with aortic isthmus size of utmost importance.

Impact of surgical strategy and postrepair transverse aortic arch size on late hypertension after coarctation repair during infancy

BackgroundLate hypertension (HTN) after coarctation of the aorta (CoA) repair contributes to higher morbidity and mortality. An association between transverse aortic arch (TAA) hypoplasia and HTN has been found, but its relationship with surgical strategy is unclear. We studied the association between late HTN and initial surgical strategy pertaining to the TAA. MethodsWe retrospectively reviewed patients who underwent surgical repair of CoA during infancy with at least 10 years of follow-up, excluding those with atypical coarctation, major associated heart defects, and residual isthmic narrowing. TAA diameter z-score immediately postrepair was measured as a marker of surgical strategy. Systemic HTN at latest follow-up was assessed using standard criteria. ResultsA total of 130 patients underwent surgical repair of CoA (76% via thoracotomy, 24% via sternotomy) with resection and end-to-end anastomosis (62%), extended end-to-end anastomosis (30%), subclavian flap (5%), or arch repair with patch (4%), at a median age of 14 days (interquartile range [IQR], 7-62 days). The median postrepair TAA diameter z-score was −2.04 (IQR, −2.69 to 1.24). At a mean follow-up of 17.3 years, 43 of the 130 patients (33%) developed HTN. After controlling for age at repair, sex, and presence of a genetic syndrome, HTN was not associated with immediate postrepair TAA diameter z-score (P = .41), type of surgical incision (P = .99), or type of surgical repair (P = .66). ConclusionsIn patients undergoing surgical repair of CoA during infancy, late HTN was not associated with immediate postrepair TAA size or surgical strategy pertaining to the TAA. These results suggest that factors other than surgical strategy, such as differential growth of the TAA during childhood, may be important.

CT Anatomical Analysis of C4 Pedicle and Lateral Mass in Children Aged 0-14 in Southern China.

The C4 is the transition point between the upper and lower cervical vertebrae and plays a pivotal role in the middle of the cervical spine. Currently, there are limited reports on large-scale sample studies regarding C4 anatomy in children, and a scarcity of experience exists in pediatric cervical spine surgery. The current study addresses the dearth of anatomical measurements of the C4 vertebral arch and lateral mass in a substantial sample of children. This study aims to measure the imaging anatomy of the C4 vertebral arch and lateral mass in children under 14 years of age across various age groups, investigate the growth and development of these structures. We measured 12 indicators, including the size (D1, D2, D3, D4, D5, D6, D7, and D8) and angle (A, C, D, and E) of the C4 vertebral arch and lateral mass, in 513 children who underwent cervical CT examinations at our hospital. We employed the aggregate function for statistical analysis, conducted t-tests for difference statistics, and utilized the least squares method for regression analysis. Overall, as age increased, there was a gradual increase in the size of the vertebral arch and lateral mass. Additionally, the medial inclination angle of the vertebral arch decreased, and the lateral mass flattened gradually. The rate of change decreased gradually with age. The mean value of D1 increased from 2.31 mm to 3.88 mm, of D2 from 16.75 mm to 29.2 mm, of D3 from 2.21 mm to 4.92 mm, and of D4 from 7.34 mm to 11.84 mm. Meanwhile, the mean value of D5 increased from 5.2 mm to 9.71 mm, of D6 from 10.19 mm to 16.16 mm, of D7 from 2.53 mm to 5.67 mm, and of D8 from 6.11 mm to 11.45 mm. Angle A ranged from 49.12° to 54.97°, angle C from 15.28° to 19.83°, angle D from 39.91° to 53.7°, and angle E from 18.63° to 28.08°. Prior to cervical spine surgery in children, meticulous CT imaging anatomical measurements is essential. The imaging data serves as a reference for posterior C4 internal fixation, aids in designing posterior cervical screws for pediatric patients, and offer morphological anatomical references for posterior cervical spine surgery and screw design in pediatric patients.

Role of the Flexion Relaxation Phenomenon in the Analysis of Low Back Pain Risk in the Powerlifter: A Proof-of-Principle Study.

Unlike the most common training approaches for bodybuilding, powerlifting programs are generally based on maximum and submaximal loads, putting enormous stresses on the lumbar spine. The flexion relaxation phenomenon evaluation is a clinical tool used for low back pain (LBP) assessment. This study aimed to evaluate the role of the flexion relaxation phenomenon in the analysis of LBP in the powerlifters. Healthy professional powerlifters participated in the study. In fact, we divided the participants into a LBP-low-risk group and a LBP-high-risk group, based on a prior history of LBP. Outcome measures included flexion relaxation ratio (FRR) and trough surface electromyography collected during trunk maximum voluntary flexion; furthermore, during a bench press lifting, we measured the height of the arched back(ARCH), using a camera and the Kinovea video editing software, to consider a potential correlation with the risk of LBP. We included a group of 18 male (aged 24-39y) powerlifters of 93kg category. We measured a nonsignificant mean difference of ARCH between low-risk LBP group and high-risk LBP subjects. Curiously, maximum voluntary flexions were both above the threshold of 3.2μV; therefore, with an absence of appropriate myoelectric silence, on the contrary, the FRR ratios were higher than 9.5, considering the presence of the phenomenon, exclusively for the low-risk group. The lumbar arched back measurement data did not report any association with the LBP risk, regarding the maximum voluntary flexion value, and even more than the FRR there is a relationship with the presence or the absence of LBP risk. FRR could be considered as a useful parameter for studying the risk of LBP in powerlifting. The FRR index not only refers to the possible myoelectric silence of the lumbar muscles in trunk maximum forward flexion but also takes into account the energy value delivered by the lumbar muscles during the flexion. Furthermore, we can indicate that the size of the powerlifter ARCH may not be a determining factor in the occurrence of LBP.

Identifying Predictors for Hypoplastic Aortic Arch (HAA) in Pediatric Patients with Complex Coarctation of the Aorta (CoA)

HAA is a significant risk factor in complex CoA patients. We conducted a retrospective study to explore the relationship between HAA and other cardiovascular factors. We analyzed 103 patients diagnosed with complex CoA using CT angiography and echocardiography. Aortic diameter was measured at six levels, and severe coarctation was defined as coarctation site to diaphragmatic level ratio (CDR) < 50%. Correlations between non-HAA and HAA groups were assessed. Univariate and multivariate logistic regression identified HAA risk factors. Among 103 children with complex CoA, 55 were in the non-HAA group and 48 in the HAA group. The incidence of PDA (56.3% vs. 32.7%, p < 0.05), severe coarctation (CDR < 50%, 81.3% vs. 34.5%, p < 0.01), and collateral arteries (39.6% vs. 0, p < 0.01) were higher in the HAA group than one in the non-HAA group. The aortic arch size was positively correlated with age and negatively correlated with severe coarctation, VSD, collateral arteries, and left heart dysfunction. Logistic regression results showed that collateral arteries were risk factors for the whole aortic arch (proximal arch OR = 11.458; p < 0.01, distal arch OR = 4.211; p < 0.05, and isthmus OR = 11.744; p < 0.01), severe coarctation (OR = 6.653; p < 0.01), and left heart dysfunction (OR = 5.149; p < 0.01) associated with isthmus hypoplasia. This study highlights the prevalence of HAA in complex CoA patients and its associations with various cardiovascular factors. These insights improve diagnosis and treatment approaches.

Comparison of jaw arch size in stunting patients at Asemrowo Public Health Center

Background: The etiology of malocclusion is multifactorial, it can occur due to intrinsic, extrinsic factors or a combination of both. Malnutrition, which is one of the extrinsic factors of malocclusion, is a frequent case in Indonesia. An example of a malnutrition case that commonly occurs in Indonesia is stunting in children's growth and development, which can trigger malocclusions such as crowded teeth and bone crowding. Purpose: To identify the size of the dental arches in stunting sufferers at the Asemrowo public health center. Methods: In the study model of stunting patients, the length and width of the jaw arch were measured. The results of the measurements are then analyzed and compared with the data from the measurements of healthy children to see whether there are significant differences. Results: In terms of maxillary arch length, the 7 year age group yields p = 0.179. In terms of maxillary arch width, the 7 year age group yields p = 0.282. In terms of mandibular arch length, the 7 year age group yields p = 0.398. In terms of maxillary arch width, the 7 year age group yields p = 0.398. In terms of maxillary arch length, the 8 year age group yields p = 0.438. In terms of maxillary arch width, the 8 year age group yields p = 0.082. In terms of mandibular arch length, the 8 year age group yields p = 0.302. In terms of mandibular arch width, the 8 year age group yields p = 0.190. Conclusion: There is no significant difference between the length and width of the jaw arch in all age groups (p &gt; 0.05).

Aortic growth after arch reconstruction with patch augmentation: a 2-decade experience.

Optimal aortic sizing during aortic arch reconstruction remains unknown. Negative effects of arch under- or oversizing are well-published. We aimed to characterize longitudinal aortic growth after patch-augmented arch reconstruction to identify the initial reconstructed arch size that results in normal mid-term arch dimensions. Single-centre, retrospective review of infants undergoing Damus-Kaye-Stansel (DKS) or non-DKS patch-augmented aortic arch reconstruction between 2000 and 2021. Ascending aorta, proximal and distal transverse arch, aortic isthmus (AIsth) and descending aorta dimensions were measured in postoperative echocardiograms (<3 months from index operation) and cross-sectional imaging (>12 months). Longitudinal changes to aortic dimensions and z-scores were analysed. Secondary outcomes included reintervention, valve and ventricular function, mortality and transplantation. Fifty-four patients (16 DKS, 38 non-DKS) were included. At 6.3 [2.2, 12.0]-year follow-up, all aortic segments grew significantly in both groups, while z-scores remained unchanged except for non-DKS proximal and distal transverse arch z-scores, which significantly increased (P < 0.05 each). When stratified by initial postoperative z-score (z < -1, -1 ≤ z ≤ 1, z > 1), non-DKS patients with initial AIsth z-score <-1 had a final z-score significantly smaller than both the targeted z-score zero (P = 0.014) and final z-score in a group with initial postoperative z-score ±1 (P = 0.009). Valve and ventricular function remained stable. Eighteen patients required reintervention, 1 died and 1 underwent transplant. Over mid-term follow-up, aortic growth after arch reconstruction with patch augmentation was proportional when repaired to normal z-score dimensions, aside from proximal transverse arch, which disproportionately dilated. AIsth undersizing prevailed mid-term and trended towards a higher reintervention rate. Initial reconstruction between z-score 0 and +1 resulted in maintenance of that z-score size at mid-term follow-up. Overall, it is crucial to achieve targeted aortic sizing at index operation to maintain appropriate aortic dimensions over time and reduce reintervention risk with specific focus on the AIsth.

Assessment of anatomy of the aorta in patients with a coarctation of aorta

BackgroundCoarctation of the aorta (CoA) is a congenital heart disease characterized by the narrowing of the aorta, resulting in reduced blood flow to the body and increased pressure in the left ventricle. The pathophysiology of CoA is complex and involves several changes in the structure and function of the aorta. Recent studies have suggested that patients with CoA may have changes in the aortic wall beyond the site of the narrowing. Understanding these changes in the aorta is essential for optimizing the management of patients with CoA.MethodsEighty-five patients who were diagnosed with an isolated coarctation of aorta (CoA) and underwent elective surgical repair—during the last 10 years were included in the study.ResultsEighty-five patients (62 males, 72.9%) with a median age of 7 years old (range from 1 month to 48 years old) underwent surgical repair of CoA during the last 10 years using 4 different methods of operation.The study showed that more than a half (51.7%) of our patients with coarctation of the aorta had an enlargement of an ascending aorta, and z-score of ascending aortic size positively correlated with age, height, and weight, which means in patients with non-corrected CoA, ascending aorta tends to enlarge by time. In the present study, 31.8% of patients had an aortic arch hypoplasia, and aortic arch sizes z-score negatively correlated with ICU and hospital stay, which indicates that, patients with smaller aortic arch have poorer outcomes. Therefore, evaluating AAH before planning surgical repair is important for achieving better results. CT examination showed advantages in assessing aortic anatomy.ConclusionsIt is suggested that an MSCT examination should be performed to take into consideration of current aortic anatomy, before planning the surgical correction of the aortic coarctation to achieve better results.

Sex-Specific Morphometric Analysis of Ascending Aorta and Aortic Arch for Planning Thoracic Endovascular Aortic Repair: A Retrospective Cohort Study.

In many studies on aortic disease, women are underrepresented. The present study aims to assess sex-specific morphometric differences and gain more insight into endovascular treatment of the ascending aorta (AA) and arch. Electrocardiogram-gated cardiac computed tomography scans of 116 consecutive patients who were evaluated for transcatheter aortic valve replacement were retrospectively reviewed. Measurements of the AA and aortic arch were made in multiplanar views, perpendicular to the semi-automatic centerline. Multiple linear regression analysis was performed to identify predictors affecting AA and aortic arch diameter in men and women. Propensity score matching was used to investigate whether sex influences aortic morphology. In both sexes, body surface area (BSA) was identified as a positive predictor and diabetes as a negative predictor for aortic diameters. In men, age was identified as a positive predictor and smoking as a negative predictor for aortic diameters. Propensity score matching identified 40 pairs. Systolic and diastolic mean diameters and AA length were significantly wider in men. On average, male aortas were 7.4% wider than female aortas, both in systole and diastole. The present analysis demonstrates that, in women, increased BSA is associated with increased aortic arch diameters, while diabetes is associated with decreased AA and arch diameters. In men, increased BSA and age are associated with increased AA and arch diameters, while smoking and diabetes are associated with decreased AA and arch diameters. Men were confirmed to have 7.4% greater AA and arch diameters than women. Men had 7.4% greater ascending aorta and arch diameters than women in a retrospective cohort, gated computed tomography-based study of 116 patients. Sex-specific differences in ascending aortic and arch size should be considered by aortic endovascular device manufacturers and physicians when developing ascending and arch endografts and planning aortic interventions.

Abstract 18989: Neonatal Arch Reconstruction via Sternotomy or Thoracotomy: A Propensity Score Matched Analysis

Introduction: For neonatal repair of coarctation of the aorta, patients may either undergo thoracotomy or sternotomy with cardiopulmonary bypass. While some guidance exists, the optimal approach remains poorly defined. Methods: This is a single center retrospective cohort study from 7/05 through 5/22 including patients who underwent neonatal aortic arch reconstruction for isolated coarctation of the aorta and excluding genetic syndromes, heterotaxy, and right aortic arch. Propensity score was estimated using demographic and anatomic variables and 1:1 optimal matching was performed. Primary outcomes were reintervention, either open or catheter-based, and survival. A hazard spline was constructed in order to assess the effect of varying distal arch size on hazard of reoperation (Figure 1). ICU and Hospital length of stay were secondary outcomes. Results: There were 263 patients who underwent isolated coarctation repair during the given time period. Matching yielded 50 patient pairs (n = 100). In the propensity matched population, one patient died and 11 patients underwent reintervention, with 2 of these patients undergoing 2 reinterventions. The interaction between distal transverse arch size and operative approach (sternotomy vs. thoracotomy) was statistically significant, p &lt; 0.05 for interaction. Among patients with a distal arch z-score &lt; -3.5, there appeared to be an advantage to sternotomy. With a distal arch z-score &gt; -3.5, patients undergoing sternotomy appeared to have a disadvantage with respect to risk for reintervention. ICU length of stay was greater for patients undergoing sternotomy, 5.9 days [IQR: 4 to 12.6] vs 2.8 days [IQR: 1.7 to 4.2], p &lt; 0.001, as was hospital length of stay, 14.3 days [IQR: 11 to 23.7] vs 6.5 days [IQR: 5.2 to 9.8], p &lt; 0.001. Conclusions: Patients with a distal arch z-score larger than -3.5 may benefit from thoracotomy, and those with a distal arch z-score smaller than -3.5 may benefit from sternotomy.

Investigation of the effects of arch size and implant angulation on the accuracy of digital impression using two intraoral scanners: An in vitro study.

The aim of this in vitro study was to evaluate the effect of arch size and implant angulation on the accuracy of digital impression in two intraoral scanners of Trios (3shape) and CEREC (Omnicam). Four acrylic models each including six implants at sites 11, 12, 15, 17, 23, and 27 were used, including large with parallel implants, large with angled implants, small with parallel implants, and small with angled implants. After tightening the scan bodies, distance measurements were done using a coordinate measuring machine. Then, each model was scanned 10 times using each scanner. Trueness and precision measurements were finally computed. The trueness values ranged from 20 to 260 μm in CEREC Omnicam, and from 40 to 1030 μm in Trios. The precision values ranged from 30 to 190 μm in CEREC Omnicam, while from 50 to 770 μm in Trios. The multivariate test analysis indicated that the measured distances via two scanners and different models show different behaviors. Pairwise interactions between these three variables were significant (p < .05). Pairwise interactions between these variables were also significant. (p < .0001). Arch width could affect the accuracy of digital impression; by rotating toward the second quadrant and end points of the scan, errors have increased. However, the angulation of the implants had no effect on the accuracy of digital impression. The CEREC Omnicam scanner showed higher accuracy (trueness and precision) compared to the Trios (3shape) one.

2 x 6 appliance a versatile option for treatment of malocclusion in early permanent dentition

Children in growing age develop dental malocclusion due to transition and exchange of dentition, oral habits or discrepancy in tooth size and arch size. If timely treatment is not performed it may progress to full fledged malocclusion that may require much time-consuming treatment and also correlation of trauma prone profile like class II div I or class II div II can even be beneficial in prevention of trauma. Early correction also reduces the psychological trauma associated with malocclusion. This Versatile 2x6 fixed appliance appliance offers many advantages over alternative techniques as it provides complete control of anterior tooth position, is extremely well tolerated, ease the space closure by precise tooth movement with shorter duration of correction, reduces the patient compliance, and less laboratory work makes it a acceptable treatment option in growing child. In the case report mentioned here a successful management of correction of class I malocclusion with maxillary anterior proclination was done during early permanent dentition using 2 x 6 appliance.