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Zaza H, Mostafa Y, Dakrory AE, Dawlatly ME. Bilateral distalization of maxillary first molars in a group of adult patients after extraction of maxillary second molars using infra-zygomatic mini-implants: A prospective clinical trial. J World Fed Orthod 2024:S2212-4438(24)00018-3. [PMID: 38609801 DOI: 10.1016/j.ejwf.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND It is now possible to predictably distalize maxillary first molars in nongrowing patients with the infra-zygomatic gear distalizer and to improve malocclusions without having to extract the premolars and regardless of the patient's compliance. The purpose of this study was to investigate the amount and rate of distal movement of the maxillary first molars using our proposed appliance after extraction of maxillary second molars. METHODS Ten nongrowing female patients successfully treated with our proposed appliance were the subjects of this study. The amount, rate, and type of distalization, were analyzed through upper jaw cone beam computed tomography (pre- and post-treatment) and scanned casts taken on a monthly interval. RESULTS The average amount of distalization of the maxillary first molars was 4.03 mm at the crown level and 2.88 mm at the root level. The rate of distalization had an average of 0.61 mm per month with a maximum of 0.79 mm in the first month because of the regional acceleratory phenomena after extracting the maxillary second molar. CONCLUSIONS The maxillary first molars were distalized in a significant manner and all patients reached a Class I relation within an average duration of 6.4 months. The proposed appliance proved to be a viable noncompliance modality to distalize maxillary first molars correcting maxillary Class II malocclusions characterized by maxillary protrusion or maxillary incisor crowding.
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Affiliation(s)
- Hosam Zaza
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Future University, Cairo, Egypt.
| | - Yehia Mostafa
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Future University, Cairo, Egypt
| | - Amr El Dakrory
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mostafa El Dawlatly
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Cozzarelli NF, DeSimone CA, D'Amore T, Sherman MB, Lonner JH. Joint line position change in primary total knee arthroplasty: a radiographic analysis comparing conventional and robotic techniques. Int Orthop 2024; 48:1023-1030. [PMID: 37946052 PMCID: PMC10933191 DOI: 10.1007/s00264-023-06031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Joint line (JL) position change in total knee arthroplasty (TKA) may alter knee biomechanics and impact function. The purpose of this study was to compare the change in JL position between robotic-assisted TKA (RA-TKA) and conventional TKA (C-TKA). METHODS A retrospective, radiographic analysis was conducted of patients who underwent RA-TKA and C-TKA to compare JL position change. JL position was measured in consecutive RA-TKAs and C-TKAs performed by four fellowship-trained arthroplasty surgeons. Statistical analysis was done utilizing t-tests and Mann Whitney U tests, with statistical significance being defined as a p value < 0.05. RESULTS Six hundred total RA-TKAs and 400 total C-TKAs were included in the analysis. There were no significant differences in patient baseline characteristics such as body mass index, range of motion, and tibiofemoral coronal alignment. RA-TKAs were associated with an average of 0.04 (2.2) mm JL position change, and C-TKAs were associated with an average 0.5 (3.2) mm JL position change (p = 0.030). There were inter-surgeon differences when comparing the change in JL position for RA-TKAs and C-TKAs between the four participating surgeons. CONCLUSION RA-TKA leads to better preservation of the JL position than C-TKA, and this seems to be dependent on the arthroplasty surgeon's preferences and techniques during TKA. Whether this statistically significant difference is clinically relevant needs to be further investigated.
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Affiliation(s)
- Nicholas F Cozzarelli
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, 125 South 9th Street Suite 1000, Philadelphia, PA, 19107, USA.
| | - Cristian A DeSimone
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, 125 South 9th Street Suite 1000, Philadelphia, PA, 19107, USA
| | - Taylor D'Amore
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, 125 South 9th Street Suite 1000, Philadelphia, PA, 19107, USA
| | - Matthew B Sherman
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, 125 South 9th Street Suite 1000, Philadelphia, PA, 19107, USA
| | - Jess H Lonner
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, 125 South 9th Street Suite 1000, Philadelphia, PA, 19107, USA
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Yurdakul Z, Karsli N. Evaluating anchorage loss in upper incisors during distalization of maxillary posterior teeth using clear aligners in adult patients: A prospective randomized study. Korean J Orthod 2024; 54:117-127. [PMID: 38533599 DOI: 10.4041/kjod23.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/15/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Objective : To evaluate the effect of clear aligner treatment and differential sequence distalization of maxillary posterior teeth on anchorage loss in the upper incisors (U1s). Methods : This study used lateral cephalometries and digital models of 12 patients treated with 33% sequential distalization (group 1, mean age: 22.9 ± 0.7 years, five males, seven females) and 12 treated with 50% sequential distalization (group 2, mean age: 25.83 ± 0.5 years, three males, nine females) acquired before and after distalization of upper second premolars (U5) and upper first molars (U6) and upper second molars (U7). The amount of distalization was determined as 2.5 mm in both the groups. Independent Samples t test was used to compare normally distributed parameters. Mann-Whitney U and Wilcoxon tests were used to compare parameters that were not normally distributed. Results : In both groups, the posterior teeth significantly moved by tipping distally and the U1s were displaced anteriorly. Increase in maxillary posterior transverse width (P < 0.001) and distopalatal rotation were observed in U5, U6, and U7 after distalization. It was also observed that U1 was significantly more proclined (1.82°; P < 0.001) and protruded (0.62 mm; P < 0.001), and the overjet (0.45 mm; P < 0.001) increased more in group 1 than in group 2. Conclusions : After sequential distalization of maxillary posterior teeth, more anchorage loss was observed in the anterior region in group 1 than in group 2.
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Affiliation(s)
- Zehra Yurdakul
- Faculty of Dentistry, Karadeniz Technical University, Trabzon, Türkiye
| | - Nurver Karsli
- Faculty of Dentistry, Karadeniz Technical University, Trabzon, Türkiye
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Al-Worafi NA, Al-Aroomi MA, Al-Nasri A, Al-Balaa M, Al-Warafi LA, Al-Rokhami RK, Liu Y. Evaluation of maxillary sinus changes following molar distalization using clear aligners: A three-dimensional study. J Stomatol Oral Maxillofac Surg 2024:101815. [PMID: 38458547 DOI: 10.1016/j.jormas.2024.101815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To evaluate the impact of molar distalization with clear aligners (CAs) on maxillary sinus parameters and its proximity to the root apices of maxillary molars using Cone Beam Computed Tomography (CBCT). METHODS The study involved pre- and post-treatment CBCT images of 27 adult patients. MIMICS 21.0 software was used to measure maxillary sinus volume and surface area, while Invivo Dental 6.0 program was used to measure the sinus diameters and proximity of the maxillary molar root apices to the sinus floor. RESULTS Post-treatment, there was a marked increase in the average volume and surface area of the maxillary sinus on both sides; however, changes in dimensions were not statistically significant. Sinus proximity to the root apices of the maxillary molars showed statistically significant differences, particularly on the left side for all roots. Gender and age impacted the outcomes, with males and younger individuals showing more pronounced changes. No significant differences were observed between the left and right sinuses in all parameters. CONCLUSION Molar distalization with CAs increases maxillary sinus parameters, more notably in younger and male patients. All molar teeth roots moved toward the sinus, particularly the mesiobuccal root of the maxillary second molar protruded to the sinus.
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Affiliation(s)
- Naseem Ali Al-Worafi
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Shenyang Clinical Medical Research Center of Orthodontic Disease, Shenyang 110002, PR China
| | - Maged Ali Al-Aroomi
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | - Maher Al-Balaa
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Leena Ali Al-Warafi
- Department of Orthodontics, Faculty of Dentistry, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Remsh Khaled Al-Rokhami
- Department of Orthodontics, Affiliated Stomatological Hospital of Nanchang University, Nanchang, China
| | - Yi Liu
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Shenyang Clinical Medical Research Center of Orthodontic Disease, Shenyang 110002, PR China.
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Aboalnaga AA, Fouda AS. Evaluation of the effect of extraction in comparison to distalization on the maxillary third molars in class II malocclusion: a retrospective study. Clin Oral Investig 2024; 28:191. [PMID: 38433151 PMCID: PMC10909771 DOI: 10.1007/s00784-024-05576-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To compare the effects of first premolar extraction versus distalization on the vertical position and mesiodistal angulation of maxillary third molars (MxM3) in adolescent class II patients. METHODS The panoramic x-rays (OPGs) of 200 adolescent class II patients with developing MxM3s were screened. The chosen sample consisted of 2 groups: Group 1 (Distalization) comprising 48 MxM3s, and Group 2 (Extraction) comprising 50 MxM3s. The pre- and post-treatment OPGs were traced to detect the mesiodistal angulation changes of the second molars (MxM2) and MxM3s. RESULTS The angulation and vertical position of the MxM3s at T0 & T1 were also evaluated using Archer's classification. The distalization group presented a non-significant decrease in the mean angulation of MxM2 and MxM3 (-2.4o & -4.5o uprighting respectively). In the extraction group, both MxM2 and MxM3 presented a highly significant decrease in the mean angulation (-10.5o & -11o uprighting respectively). The angulation and vertical position change of MxM3 significantly improved in the extraction group when compared to the distalization group (P < .001). CONCLUSION Significant uprighting and occlusal positioning of the maxillary third molars occurred in the premolar extraction treatment group when compared to the distalization treatment group. The results of the current study highlight the importance of recognizing maxillary third molars during orthodontic treatment planning of Class II malocclusion cases.
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Affiliation(s)
- Amira A Aboalnaga
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, 11 EL-Saraya St. Manial, Cairo, Egypt
| | - Ahmed S Fouda
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, 11 EL-Saraya St. Manial, Cairo, Egypt.
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Bauer S, Blakeney WG, Meylan A, Mahlouly J, Wang AW, Walch A, Tolosano L. Humeral head size predicts baseplate lateralization in reverse shoulder arthroplasty: a comparative computer model study. JSES Int 2024; 8:335-342. [PMID: 38464453 PMCID: PMC10920133 DOI: 10.1016/j.jseint.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background In reverse shoulder arthroplasty (RSA), the ideal combination of baseplate lateralization (BL), glenosphere size (GS), and glenosphere overhang (GOH) with a commonly used 145° neck shaft angle (NSA) is unclear. This is the first study evaluating correlations of body height (BH), humeral head size (HS), glenoid height (GH), and association of gender with best glenoid configurations for range of motion (ROM) maintaining anatomic lateralization (aLAT) for optimized muscle length in 145° and less distalized 135° RSA. Methods In this computer model study, 22 computed tomographies without joint narrowing were analyzed (11 male/female). A standardized semi-inlay 145° platform stem was combined with 20 glenoid configurations (baseplate [B] 25, 25 + 3/+6 lateralized [l], 29, 29 + 3/6l combined with glenosphere 36, 36 + 2 eccentric [e], 36 + 3l, 39, 39 + 3e, 39 + 3l , 42, 42 + 4e). Abduction-adduction, flexion-extension, external rotation-internal rotation, total ROM (TROM), and total notching relevant (TNR) ROM were computed, best TROM models respecting aLAT (-1 mm to +1 mm) and HS/GH recorded. Second, the 145° models (Ascend Flex stem; Stryker, Kalamazoo, MI, USA) were converted and compared to a 135° inlay RSA (New Perform stem; Stryker, Kalamazoo, MI, USA) maintaining GOH (6.5-7 mm) and aLAT. Results Best 145° models had eccentric glenospheres (mean BL: 3.5 mm, GOH 8.8 mm, GS 38.1 mm, distalization 23 mm). The 135° models had concentric glenospheres, mean BL 3.8 mm, GOH 6.9 mm, GS 39.7 mm, and distalization 14.1 mm. HS showed the strongest positive correlation with BL in 145° and 135° models (0.65/0.79). Despite reduced GOH in smaller females with a 135° NSA, adduction, external rotation, extension, TNR ROM, and TROM were significantly increased (P = .02, P = .005, P = .005, P = .004, P = .003), abduction however reduced (P = .02). The same trends were seen for males. Conclusion HS is a practical measure in surgery or preoperatively, and the strong positive correlation with BL is a useful planning aid. Despite reduction of GOH, conversion to a less distalized 135° NSAinlay design is powerful to maintain and even significantly increase all components of TNR ROM (extension/external rotation/adduction) in small females with the drawback of reduced abduction which may however be compensated by scapula motion. Lateralization with a less distalized 135° RSA optimizes muscle length, may facilitate subscapularis repair, and maintains highest rigid body motion.
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Affiliation(s)
- Stefan Bauer
- Chirurgie de l’épaule et du coude, Service d'Orthopédie et de Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
- School of Surgery, University of Western Australia, Perth, WA, Australia
| | - William G. Blakeney
- School of Surgery, University of Western Australia, Perth, WA, Australia
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA, Australia
| | - Arnaud Meylan
- Chirurgie de l’épaule et du coude, Service d'Orthopédie et de Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jaad Mahlouly
- Chirurgie de l’épaule et du coude, Service d'Orthopédie et de Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - Allan W Wang
- School of Surgery, University of Western Australia, Perth, WA, Australia
| | - Arnaud Walch
- CHU de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Luca Tolosano
- Chirurgie de l’épaule et du coude, Service d'Orthopédie et de Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Tai K, Park S, Weissheimer A, Sato Y, Akyalcin S. Nonextraction anterior open bite treatment with distalization and intrusion. J World Fed Orthod 2024; 13:48-54. [PMID: 38151392 DOI: 10.1016/j.ejwf.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023]
Abstract
This case report describes successful orthodontic retreatment for vertical control with nonextraction orthodontic therapy. A 31-year-old woman complained of anterior open bite and crowding. She had slightly protrusive lips but wanted to correct her malocclusion without extraction. Two palatal temporary skeletal anchorage devices were used for the distalization of the maxillary arch along with posterior intrusion. Mandibular distalization was performed with Class III elastics. The duration of active treatment was 22 months. The plain and efficient mechanics used contributed to the effective distalization of both arches, the intrusion of the maxillary posterior teeth, and favorable profile changes. The results were still stable at the five-year follow-up period.
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Affiliation(s)
- Kyoshi Tai
- Visiting Adjunct Professor, Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Arizona; Private Practice of Orthodontics, Okayama, Japan
| | - Steven Park
- Dental Student, College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah
| | - Andre Weissheimer
- Clinic Director, Division of Orthodontics, Harvard School of Dental Medicine, Boston, Massachusetts
| | | | - Sercan Akyalcin
- Head of Orthodontics and Graduate Program Director, Harvard School of Dental Medicine, Boston, Massachusetts.
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Ghozy EA, Albelasy NF, Shamaa MS, El-Bialy AA. Cephalometric and digital model analysis of dentoskeletal effects of infrazygomatic miniscrew vs. Essix- anchored Carriere Motion appliance for distalization of maxillary buccal segment: a randomized clinical trial. BMC Oral Health 2024; 24:152. [PMID: 38297285 PMCID: PMC10832169 DOI: 10.1186/s12903-024-03925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Abstract
TRIAL DESIGN Parallel. OBJECTIVE To compare skeletally anchored Carriere Motion appliance (CMA) for distalization of the maxillary buccal segment vs. Essix anchored CMA. METHODS Thirty-two class II malocclusion patients were randomly allocated into two equal groups. One group was treated with infrazygomatic (IZC) miniscrew- anchored CMA (IZCG) and the other group treated with Essix retainer- anchored CMA (EXG). Two lateral cephalograms and two digital models for upper and lower arches were taken for each patient: immediately before intervention and after distalization had been completed. RESULTS Distalization period was not significantly different between the two groups. In contrast to EXG, IZCG showed insignificant difference in ANB, lower incisor proclination, and mesial movement of the lower first molar. There was significant rotation with distal movement of maxillary canine and first molar in both groups. CONCLUSION IZC anchored CMA could eliminate the side effects of class II elastics regarding lower incisor proclination, mesial movement lower molars with a more significant amount of distalization of the maxillary buccal segment but with significant molar rotation. TRIAL REGISTRATION The ClinicalTrials.gov Protocol Registration and Results System (PRS) has this RCT registered as (NCT05499221) on 12/08/2022.
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Affiliation(s)
- Eglal Ahmed Ghozy
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura, 35116, Egypt.
| | - Nehal Fouad Albelasy
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura, 35116, Egypt
| | - Marwa Sameh Shamaa
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura, 35116, Egypt
| | - Ahmed A El-Bialy
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura, 35116, Egypt
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Dang JT, Hider AM, Barajas-Gamboa JS, Mocanu V, Shin T, Romero-Velez G, Lee Y, Navarrete S, Rodriguez J, Kroh M. Safety of limb lengthening after Roux-en-Y gastric bypass: an analysis of the MBSAQIP database. Surg Obes Relat Dis 2024:S1550-7289(24)00023-6. [PMID: 38316579 DOI: 10.1016/j.soard.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/29/2023] [Accepted: 12/25/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) effectively treats severe obesity, but some patients may require revisional surgery like limb lengthening (LL) for postoperative weight gain. OBJECTIVES This study aims to compare 30-day serious complications and mortality rates between LL and primary RYGB, given limited safety data on LL. METHODS Patients who underwent LL and RYGB were identified from the 2020 and 2021 MBSAQIP databases, the only years in which LL data were available. Baseline characteristics and 30-day rates of serious complications and mortality were analyzed. RESULTS A total of 86,990 patients underwent RYGB and 455 underwent LL. Patients undergoing RYGB were younger (44.4 versus 49.8 yr, P < .001), had a higher body mass index (BMI) (45.5 versus 41.8 kg/m2, P < .001) and higher rates of comorbidities including diabetes (30.0 versus 13.6%, P < .001). RYGB and LL had similar operative duration (125.3 versus 123.2 min, P = .5). There were no statistical differences between cohorts for length of stay (LOS) (1.6 RYGB versus 1.6 LL d, P = .6). After LL, there were higher 30-day rates of reoperation (3.3 versus 1.9%, P = .03) and deep surgical site infections (1.3 versus .5%, P = .03) compared to RYGB. There were no differences in overall serious complications (5.1 LL versus 5.0% RYGB, P = 1.0) and mortality (.2 LL versus .1% RYGB, P = .5). Multivariable logistic regression adjustment found that previous venous thromboembolism was associated with serious complications after LL. CONCLUSIONS When compared to primary RYGB, LL has a favorable safety profile with similar 30-day rates of serious complications and mortality.
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Affiliation(s)
- Jerry T Dang
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Ahmad M Hider
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Juan S Barajas-Gamboa
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Shin
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Yung Lee
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - John Rodriguez
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Matthew Kroh
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
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Verkade C, van Tilborg GFAJB, Stijns J, Wasowicz DK, Zimmerman DDE. Distalization of perianal fistulas after loose silicone seton drainage is a myth. Tech Coloproctol 2023; 28:16. [PMID: 38097914 PMCID: PMC10721694 DOI: 10.1007/s10151-023-02882-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND It is often stated that loose seton drainage results in distal migration of a fistula tract in perianal fistula. The aim of the present study was to assess this distalization of trans- and suprasphincteric perianal fistulas after a silicone seton has been inserted. METHODS Consecutive patients who underwent loose seton placement for the management of a transsphincteric or suprasphincteric fistula between January 2016 and December 2021 with a pre- and postoperative magnetic resonance imaging (MRI) were included in the present retrospective study. The height of the external anal sphincter (EAS) and the level of penetration of perianal fistula through the EAS or puborectal muscle (PRM) were determined on MRI. Primary outcome was migration of the fistula tract through the EAS and PRM. RESULTS Thirty-eight patients with perianal fistulas were included. Median height of the EAS was 28 (IQR 25-34) mm before seton placement and 27 (IQR 24-33) mm afterward. Median level of perforation was 32 (IQR 17-40) mm before seton placement and 28 (IQR 17-40) mm afterward (p = 0.37). One fistula (3%) was downgraded from mid to low transsphincteric and was laid open after 14.9 months of loose seton drainage. CONCLUSIONS No statistically significant distalization of complex fistula tracts after loose silicone seton drainage was found. Some complex fistulas may downgrade to a less complex fistula after long-term seton drainage. However, loose silicone seton drainage should not be offered to patients as a treatment option to downgrade a complex fistula to a simple one or even have the hope to heal it.
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Affiliation(s)
- Carolien Verkade
- Colorectal Research Group, Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - G Fiek A J B van Tilborg
- Colorectal Research Group, Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Department of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Jasper Stijns
- Colorectal Research Group, Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Department of Surgery, University Hospital Brussels, Brussels, Belgium
| | - Daria K Wasowicz
- Colorectal Research Group, Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - David D E Zimmerman
- Colorectal Research Group, Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
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Inan A, Gonca M. Effects of aligner activation and power arm length and material on canine displacement and periodontal ligament stress: a finite element analysis. Prog Orthod 2023; 24:40. [PMID: 38008884 PMCID: PMC10678869 DOI: 10.1186/s40510-023-00492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/16/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND This study aimed to assess the impact of aligner activation and power arm length and material on canine and aligner displacement, von Mises stress in the power arm, and principal stress in the periodontal ligament (PDL) during canine tooth distalization using finite element analysis (FEA). The effects of aligner activation and power arm length were primary outcomes, while the effect of the power arm material was a secondary outcome. METHODS Aligner activation (0.1 mm or 0.2 mm) was applied without using a power arm in two models. The effects of aligner activation, power arm length (12, 13, or 14 mm) and power arm material (stainless steel [SS] or fiber-reinforced composite [FRC]) on canine distalization were investigated in 12 models by evaluating displacement and stress via ALTAIR OptiStruct analysis. RESULTS Greater canine displacement was observed in all models with 0.2 mm than 0.1 mm of aligner activation. When models with the same aligner activation were compared, reduced mesiodistal tipping, increased palatal tipping, and increased extrusion of the canine cusp were observed with increasing power arm length. Moreover, the von Mises stress increased as the power arm length increased. Increasing the aligner activation and power arm length increased the maximum principal stress in the PDL. Power arms of the same length in both materials showed the same results in terms of canine displacement, clear aligner displacement, and maximum principal stress in the PDL. However, under conditions of equal length and aligner activation, the von Mises stress of the SS power arm was higher than that of the FRC power arm. CONCLUSION Using a power arm in canine distalization reduced mesiodistal tipping but increased palatal tipping and extrusion of the canine cusp. Aligner activation and additional force increased tooth movement and principal stress in the canine PDL. FRC power arms exhibited less von Mises stress than SS power arms.
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Affiliation(s)
| | - Merve Gonca
- Department of Orthodontics, Faculty of Dentistry, Recep Tayyip Erdoğan University, Rize, Turkey.
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Oh S, Choi YK, Kim SH, Ko CC, Kim KB, Kim YI. Biomechanical analysis for different mandibular total distalization methods with clear aligners: A finite element study. Korean J Orthod 2023; 53:420-430. [PMID: 37989578 PMCID: PMC10663580 DOI: 10.4041/kjod23.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 11/23/2023] Open
Abstract
Objective : The purpose of this finite element method (FEM) study was to analyze the biomechanical differences and tooth displacement patterns according to the traction direction, methods, and sites for total distalization of the mandibular dentition using clear aligner treatment (CAT). Methods : A finite element analysis was performed on four FEM models using different traction methods (via a precision cut hook or button) and traction sites (mandibular canine or first premolar). A distalization force of 1.5 N was applied to the traction site by changing the direction from -30 to +30° to the occlusal plane. The initial tooth displacement and von Mises stress on the clear aligners were analyzed. Results : All CAT-based total distalization groups showed an overall trend of clockwise or counterclockwise rotation of the occlusal plane as the force direction varied. Mesiodistal tipping of individual teeth was more prominent than that of bodily movements. The initial displacement pattern of the mandibular teeth was more predominant based on the traction site than on the traction method. The elastic deformation of clear aligners is attributed to unintentional lingual tipping or extrusion of the mandibular anterior teeth. Conclusions : The initial tooth displacement can vary according to different distalization strategies for CAT-based total distalization. Discreet application and biomechanical understanding of traction sites and directions are necessary for appropriate mandibular total distalization.
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Affiliation(s)
- Sewoong Oh
- Department of Orthodontics, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Youn-Kyung Choi
- Department of Orthodontics, Pusan National University Hospital, Busan, Korea
| | - Sung-Hun Kim
- Department of Orthodontics, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Ching-Chang Ko
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Ki Beom Kim
- Department of Orthodontics, Saint Louis University, Saint Louis, Mo, USA
| | - Yong-Il Kim
- Department of Orthodontics, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
- Dental and Life Science Institute, School of Dentistry, Pusan National University, Yangsan, Korea
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Elfouly D, El-Harouni NM, Ismail HA, El-Bialy T, Ghoneima A. Does maxillary sinus proximity affect molar root resorption during distalization using Invisalign? a CBCT study. BMC Oral Health 2023; 23:905. [PMID: 37990186 PMCID: PMC10664583 DOI: 10.1186/s12903-023-03672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND This study aimed to assess the correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption during molar distalization using clear aligner therapy (CAT). MATERIALS AND METHODS Thirty-eight cone beam computed tomography scans (CBCTs) obtained pre- (T0) and post-treatment (T1) from 19 adult patients (36.68 ± 13.50 years), who underwent maxillary molar distalization using Invisalign® aligners (Align Technology, Inc., San José, CA, USA) with a minimum of 2 mm distalization, were evaluated in this study At least 22 h of aligner wear per day was a main inclusion criterion. Sinus proximity and changes in root lengths were measured for 61 molars (183 roots). Spearman coefficient analysis was used for assessing correlation between sinus proximity and root resorption. The level of significance was set at p ≤ 0.05. The reproducibility of measurements was assessed by intraclass correlation coefficient (ICC). RESULTS Spearman coefficient revealed no significant correlation between sinus proximity and molar root resorption for mesiobuccal, distobuccal or palatal roots (p = 0.558, p = 0.334, p = 0.931, respectively). CONCLUSION There was no correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption.
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Affiliation(s)
- Dina Elfouly
- Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champollion St., P.O. Box 21521, Azarita, Alexandria, Egypt.
| | - Nadia M El-Harouni
- Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champollion St., P.O. Box 21521, Azarita, Alexandria, Egypt
| | - Hanan A Ismail
- Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champollion St., P.O. Box 21521, Azarita, Alexandria, Egypt
| | - Tarek El-Bialy
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ahmed Ghoneima
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
- Adjunct Faculty, Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indianapolis, IN, USA
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Uppstrom TJ, Cash BM, Jahandar A, Fletcher C, Nguyen JT, Maher SA, Strickland SM, Gomoll AH. Proximal bone block with distal screw trajectory improves mechanical stability during distalization tibial tubercle osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4239-4245. [PMID: 37300701 DOI: 10.1007/s00167-023-07467-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to quantify differences in mechanical stability of a wedge-shaped distalization tibial tubercle osteotomy (TTO) with a standard technique, versus a modified technique with use of a proximal bone block and distally angled screw trajectory. METHODS Ten fresh-frozen cadaver lower extremity specimens (five matched pairs) were utilized. Within each specimen pair, one specimen was randomly assigned to undergo a standard distalization osteotomy fixed with two bicortical 4.5-mm screws oriented perpendicular to the long axis of the tibia, and the other to undergo a distalization osteotomy with modified fixation utilizing a proximal bone block and distally angled screw trajectory. Each specimen's patella and tibia were mounted on a servo-hydraulic load frame using custom fixtures (MTS Instron). The patellar tendon was dynamically loaded to 400 N at a rate of 200 N/second for 500 cycles. Following the cyclic loading, loading to failure was done at 25 mm/min. RESULTS The modified distalization TTO technique demonstrated significantly higher average load to failure compared to the standard distalization TTO technique (1339 N vs. 844.1 N, p < 0.001). Average maximum tibial tubercle displacement during cyclic loading was significantly smaller in the modified TTO technique group compared to the standard TTO technique (1.1 mm vs. 4.7 mm, p < 0.001). CONCLUSION This study demonstrates that distalization TTO utilizing a modified technique with a proximal bone block and distally aimed screws is biomechanically superior to standard distalization TTO without proximal bone block and screw trajectory perpendicular to the long axis of the tibia. This increased stability may aid in reducing the reported higher complication rates (including loss of fixation, delayed union and nonunion) following distalization TTO, although future clinical outcome studies are warranted.
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Affiliation(s)
- Tyler J Uppstrom
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.
| | - Brian M Cash
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | | | - Connor Fletcher
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joseph T Nguyen
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Suzanne A Maher
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | | | - Andreas H Gomoll
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
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Eagleston J, Nimeri A. Optimal Small Bowel Limb Lengths of Roux-en-Y Gastric Bypass. Curr Obes Rep 2023; 12:345-354. [PMID: 37466789 DOI: 10.1007/s13679-023-00513-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW Gastric bypass and biliopancreatic diversion (BPD) have come full circle, from a loop configuration to a Roux-en-Y and finally back to a loop configuration as one anastomosis gastric bypass and single-anastomosis duodenal switch. Most surgeons performing Roux-en-Y gastric bypass (RYGB) do not measure the common channel (CC) length and most surgeons performing BPD do not measure the biliopancreatic limb length (BPL). RECENT FINDINGS The small bowel length in humans is variable from as short as < 400 cm to as long as > 1000 cm. The combination of these two facts means that even if surgeons keep the limb lengths constant, surgeons will get variable limb length due to the variability of small bowel length in patients. Hence, outcomes of weight loss, resolution of medical problems, or developing nutritional deficiencies which are related to limb length are variable. In this article, we evaluate the published literature related to the effect of varying the Roux limb, BPL, CC, and total alimentary limb lengths on the outcomes of RYGB. We have focused on historical and current randomized controlled trials as well as systematic reviews and meta-analysis to outline the current literature and our interpretation of this literature.
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Affiliation(s)
- Justin Eagleston
- Bariatric Surgery, Department of Surgery, Atrium Health, Charlotte, USA
| | - Abdelrahman Nimeri
- Wake Forest School of Medicine, Bariatric Surgery, Atrium Health, Charlotte, NC, USA.
- Director, of Bariatric Surgery, Brigham and Womens Hospital, Harvard Medical School, 75 Francis, MA, 02115, Boston, USA.
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Hany M, Ibrahim M, Abouelnasr AA, Torensma B. Conversion of Open Unclassical Bariatric Metabolic Surgery into Laparoscopic Roux-en-Y Gastric Bypass: a Multimedia Article. Obes Surg 2023; 33:2954-2956. [PMID: 37422550 PMCID: PMC10435391 DOI: 10.1007/s11695-023-06724-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
- Madina Women's Hospital, Alexandria, Egypt.
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Anwar Ashraf Abouelnasr
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Bart Torensma
- Leiden University Medical Center (LUMC), Leiden, Netherlands
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Shah ND, Goje SK. Skeletal Anchorage Augmentation in Extraction/Nonextraction Orthodontic Treatment: A Randomized Clinical Study. J Contemp Dent Pract 2023; 24:424-436. [PMID: 37622618 DOI: 10.5005/jp-journals-10024-3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
AIM To evaluate and compare skeletal, dental, and soft tissue parameters by therapeutic extraction of first premolar and nonextraction distalization of maxillary and mandibular arches in bimaxillary proclination using the skeletal anchorage system. MATERIALS AND METHODS About 40 orthodontic patients undergoing extraction or nonextraction treatment are enrolled in a randomized clinical trial. Participants are randomly assigned to either the extraction or nonextraction group and receive treatment augmented with skeletal anchorage. Mini implants were placed in the extraction group for retraction and infra-zygomatic crest (IZC) and buccal shelf screws were placed in the nonextraction group for distalization. OBSERVATIONS AND RESULTS Comparison between the ages of the patients among both Groups showed no significant difference. A significant difference is observed in dental and soft tissue parameters before and after the treatment in group A, whereas skeletal parameters also showed significant changes along with dental and soft tissue parameters in group B. CONCLUSION There is a significant change in the position of incisors by retraction and facial profile improves gradually in group A while for group B, a marked change in lower facial height was even seen. On comparing both the groups, a highly significant difference can be seen with respect to the amount of incisor retraction and change in molar inclination. The time taken for retraction of incisors is less in comparison to distalization. CLINICAL SIGNIFICANCE With this, we can easily avoid premolar extraction, and in cases of impacted third molars distalization as when indicated can be helpful as a part of the nonextraction treatment plan.
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Affiliation(s)
- Niti Dharmendra Shah
- KM Shah Dental College & Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India, Phone: +91 9978601796, e-mail:
| | - Santosh Kumar Goje
- Department of Orthodontics and Dentofacial Orthopaedics, KM Shah Dental College & Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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Aleassa EM, Papasavas P, Augustin T, Khorgami Z, Benson-Davies S, Ghiassi S, Carter J, Nimeri A. American Society for Metabolic and Bariatric Surgery literature review on the effect of Roux-en-Y gastric bypass limb lengths on outcomes. Surg Obes Relat Dis 2023; 19:755-762. [PMID: 37268517 DOI: 10.1016/j.soard.2023.04.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/02/2023] [Indexed: 06/04/2023]
Abstract
This literature review is issued by the American Society for Metabolic and Bariatric Surgery regarding limb lengths in Roux-en-Y gastric bypass (RYGB) and their effect on metabolic and bariatric outcomes. Limbs in RYGB consist of the alimentary and biliopancreatic limbs and the common channel. Variation of limb lengths in primary RYGB and as a revisional option for weight recurrence after RYGB are described in this review.
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Affiliation(s)
- Essa M Aleassa
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | | | - Toms Augustin
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma
| | - Sue Benson-Davies
- Department of Surgery, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Saber Ghiassi
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, North Carolina
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Somaskandhan A, Kumar NMV, Vijayalakshmi RD. Stress distribution and displacement in the maxillofacial complex during intrusion and distalization of the maxillary arch using miniplates versus mini-implants: a 3-dimensional finite element study. Prog Orthod 2023; 24:8. [PMID: 36854939 PMCID: PMC9975133 DOI: 10.1186/s40510-023-00455-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/03/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES To three-dimensionally analyse the stress distribution and displacement pattern in the maxillofacial complex following intrusion and distalization of the maxillary arch using finite element analysis in skeletal class II malocclusion with prognathic maxilla and vertical maxillary excess using miniplates and mini-implants. MATERIALS AND METHODS Finite Element models of a skull, Y-shaped stainless steel miniplate, mini-implant and a posted arch were generated. Three force levels (1) 200 g (2) 300 g and (3) 500 g per side were applied to the assembly. The models were pre-processed and the analysis was performed using ANSYS version 18.1 software. Alterations in von mises stress, principal maximum stress, principal minimum stress and compressive stress were analysed around the sutures and surface landmarks. RESULTS With miniplates, there was a maximum stress concentration at the zygomatic buttress with even stress distribution at the fronto-maxillary, zygomatico-temporal, zygomatico-frontal and pterygomaxillary sutures along with anatomical landmarks such as frontal process of maxilla, ANS, Point A, prosthion and maxillary process of zygoma. First molars experienced greater distalization effects with buccal flaring when miniplates were used. With mini-implants, canine and premolars also exhibited greater distalization effects. In the root apices, lateral incisors showed increased lingual root movement with mini-implants. CONCLUSION Miniplates provide a greater distalizing effect while mini-implants produce increased intrusive effect. The distalizing effect is greater when 500 g of force is applied using miniplates with significantly even stress distribution and displacement pattern.
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Affiliation(s)
- Abinaya Somaskandhan
- Department of Orthodontic and Dentofacial Orthopaedics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu, India.
| | - N M. Vijay Kumar
- grid.415239.80000 0004 1767 5012Department of Orthodontic and Dentofacial Orthopaedics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu India
| | - R. Devaki Vijayalakshmi
- grid.415239.80000 0004 1767 5012Department of Orthodontic and Dentofacial Orthopaedics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu India
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Shah K, Nergård BJ, Fagerland MW, Gislason H. Failed Roux-en-Y Gastric Bypass-Long-Term Results of Distalization with Total Alimentary Limb Length of 250 or 300 cm. Obes Surg 2023; 33:293-302. [PMID: 36459358 DOI: 10.1007/s11695-022-06388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/02/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Weight loss failure or weight regain may occur after Roux-en-Y gastric bypass (RYGB). Revisional surgery includes distalization. However, few studies have looked at the associations between the total alimentary limb length (TALL) and weight loss outcomes, none with long-term results. OBJECTIVES Peri- and postoperative outcomes were assessed after employing TALL of either 250 cm or 300 cm in the failed RYGB. METHODS This study is a retrospective cohort analysis of 90 patients that underwent laparoscopic distalization between January 2006 and January 2016 due to failed RYBG. The index RYGB was modified to TALL of 250 cm (n = 48) or of 300 cm (n = 42) which entailed elongating the bilio-pancreatic limb (BPL) and transposing the Roux limb (RL) to a common limb (CL) of 100 cm and 150 cm, respectively. Long-term weight loss outcomes along with nutritional and vitamin status were analyzed. RESULTS Preoperative BMI at distalization was 38.6 kg/m2. After 8 years, excess weight loss (EWL) was 61.8%. No differences between the two groups were seen in weight loss outcomes or early surgical complication rates (6.7%). However, more vitamin and nutritional deficiencies were present in the TALL 250-cm group (50.0% and 35.4%, respectively) versus the TALL 300-cm group (33.3% and 14.3% respectively), which led to laparoscopic revision in 27 patients by lengthening the TALL with 100 cm. Patients with weight regain after index RYGB had in average 59.9% higher EWL than patients with EWL failure. CONCLUSION Distalization of the failed RYGBP is safe and effective, but TALL should not be shorter than 300 cm (and CL 150 cm) due to high rates of malnutrition. Adequate supplementation and long-term follow-up are mandatory to prevent serious malnutrition.
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Hao KA, Dean EW, Hones KM, King JJ, Schoch BS, Dean NE, Farmer KW, Struk AM, Wright TW. Influence of humeral lengthening on clinical outcomes in reverse shoulder arthroplasty. Orthop Traumatol Surg Res 2022; 109:103502. [PMID: 36470370 DOI: 10.1016/j.otsr.2022.103502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Deltoid tensioning secondary to humeral lengthening after reverse shoulder arthroplasty (RSA) is commonly theorized to be crucial to improving range of motion (ROM) but may predispose patients to acromial/scapular spine fractures and neurologic injury. Clinical evidence linking patient outcomes to humeral lengthening is limited. This study assesses the relationship between humeral lengthening and clinical outcomes after RSA. METHODS A single institution review of 284 RSAs performed in 265 patients was performed. Humeral lengthening was defined as the difference in the subacromial height preoperatively to postoperatively as measured on Grashey radiographs. The subacromial height was measured as the vertical difference between the most inferolateral aspect of the acromion and the most superior aspect of the greater tuberosity. The relationship between humeral lengthening and clinical outcomes was assessed on a continuous basis. Secondarily, clinical outcomes were assessed using a dichotomous definition of humeral lengthening (≤25 vs. >25mm) based on prior clinical and biomechanical work purporting a correlation with clinical outcomes. Improvement exceeding the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for ROM and outcome scores after RSA were also compared. RESULTS Humeral lengthening demonstrated a nonlinear relationship with postoperative ROM, clinical outcome scores, and shoulder strength and their improvement preoperatively to postoperatively. Furthermore, there were minimal differences in ROM measures, outcome scores, and shoulder strength when stratified using the dichotomous definition of humeral lengthening. No difference in the proportion of patients exceeding the MCID or SCB when stratified by humeral lengthening ≤25 vs. >25mm was found. There was no difference in humeral lengthening in patients with versus without complications. CONCLUSION No clear relationship between humeral lengthening and clinical outcomes was identified. The previously purported 25mm threshold for humeral lengthening did not predict improved patient outcomes. Outcomes after RSA are multifactorial; the relationship between humeral lengthening and outcomes is likely confounded by other patient and surgical factors. LEVEL OF EVIDENCE IV; Case Series.
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Affiliation(s)
- Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ethan W Dean
- Piedmont Orthopedics
- OrthoAtlanta, Atlanta, GA, USA
| | - Keegan M Hones
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Natalie E Dean
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Aimee M Struk
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA.
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Hutin A, Gebeile-Chauty S. [Third molars in the orthodontic therapeutic decision]. Orthod Fr 2022; 93:377-99. [PMID: 36718757 DOI: 10.1684/orthodfr.2022.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Introduction Despite a high prevalence of agenesis, third molars should frequently be considered in our orthodontic treatment plans. Material and Method The aim of this study was to describe, according to the literature, the therapeutic possibilities of third molar management. Results The avulsion isn't systematic. The French National Authority for Health has updated its guidance about it. Indeed, surgical procedures can present with potentially irreversible risks (nerve damage, bone necrosis). It is necessary to assess the benefit/risk balance and to inform the patient accordingly. Whether symptomatic or not, pathological third molars are among the most obvious indication for avulsion as well as third molars that may lead to resorption or carious lesion of the adjacent molar. On the other hand, it is not recommended to avulse third molars to prevent the appearance of anterior crowding or in case of a favorable evolution. Some of our orthodontic therapies can lead to the avulsion of the third molars: the orthognathic surgery (especially mandibular surgery) or the distalization. They can be placed by transplantation, by mesialization, sometimes with the help of bone anchors, or by straightening the axis for a prosthetic or implant-prosthetic restoration. Discussion In the adolescent, the germs of the third molars would not limit the amount of distalization; these molars would continue to grow despite the distalization of the more anterior molars. Conclusion Wisdom teeth should be considered as third molars in their own right and can thus be used in edentulous situations.
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Lione R, Balboni A, Di Fazio V, Pavoni C, Cozza P. Effects of pendulum appliance versus clear aligners in the vertical dimension during Class II malocclusion treatment: a randomized prospective clinical trial. BMC Oral Health 2022; 22:441. [PMID: 36217134 PMCID: PMC9552402 DOI: 10.1186/s12903-022-02483-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022] Open
Abstract
Background The aim of the present study was to compare the effects on vertical dentoskeletal dimension produced by Pendulum appliance and Clear Aligners in patients with Class II malocclusion.
Trial design This is a prospective two-arm parallel group randomized clinical trial with 1:1 allocation ratio. Methods The Pendulum Group (PG) consisted of 20 patients (15F, 5 M) with a mean age of 17.2 ± 4.3 years. The Clear Aligners Group (CAG) comprised 20 patients (13F, 7 M) with a mean age of 17.2 ± 3.2 years. Distalization’s protocol in PG involved the activation of TMA wires till the achievement of Class I molar relationship. A protocol of sequential distalization was applied in the CAG. For each subject lateral cephalograms have been analyzed before treatment (T1) and at the end of the therapy (T2). Descriptive statistics and statistical between-group comparisons (PG vs CAG) were calculated for the craniofacial starting forms at T1 and for the T2–T1 changes. Statistical between-group comparisons for the T2–T1 changes were performed with independent samples t-tests (P < 0.05).
Results The PG showed significantly greater increases in SN^GoGn° when compared with CAG (+ 2.1 and − 0.3 degrees, respectively). Clockwise rotation of the occlusal plane with significantly greater increase of SN^POccl angle was observed in PG (+ 2.8 degrees) when compared with CAG (− 4.2 degrees). The PG revealed a significant increase in the N-Me variable with a mean change of + 4.4 mm compared to the CAG with mean values of − 1.2 mm. The PG showed an increase in the ArGo^GoMe angle (+ 0.7° degrees) compared to the CAG (− 3.4° degrees). The PG showed significantly greater increases in both maxillary and mandibular first molar to palatal plane (+ 1.3 and + 2.1 mm, respectively) when compared with CAG (− 0.9 and − 0.2 mm, respectively).
Conclusions Upper molar distalization with clear aligners represents a valid alternative to non-extraction treatment of Class II malocclusion, reducing the extrusion of maxillary first molars and improving the management of the occlusal plane and vertical dimension. Trial registration: ClinicalTrials.gov, NCT05298280. Registered 28 March 2022—Retrospectively registered, https://clinicaltrials.gov.
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Affiliation(s)
- Roberta Lione
- Department of Systems Medicine, University of Rome 'Tor Vergata', Viale Oxford, 81, 00133, Rome, Italy. .,Department of Dentistry, UNSBC, Tirana, Albania. .,Department of Faculty of Medicine and Surgery, UniCamillus International Medical University, Rome, Italy.
| | - Alessia Balboni
- Department of Systems Medicine, University of Rome 'Tor Vergata', Viale Oxford, 81, 00133, Rome, Italy
| | - Valentina Di Fazio
- Department of Systems Medicine, University of Rome 'Tor Vergata', Viale Oxford, 81, 00133, Rome, Italy
| | - Chiara Pavoni
- Department of Systems Medicine, University of Rome 'Tor Vergata', Viale Oxford, 81, 00133, Rome, Italy.,Department of Dentistry, UNSBC, Tirana, Albania
| | - Paola Cozza
- Department of Dentistry, UNSBC, Tirana, Albania.,Department of Faculty of Medicine and Surgery, UniCamillus International Medical University, Rome, Italy
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Raghis TR, Alsulaiman TMA, Mahmoud G, Youssef M. Efficiency of maxillary total arch distalization using temporary anchorage devices (TADs) for treatment of Class II-malocclusions: A systematic review and meta-analysis. Int Orthod 2022; 20:100666. [PMID: 35871982 DOI: 10.1016/j.ortho.2022.100666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate the treatment effects and post-treatment stability of the maxillary total arch distalization using TADs during the non-extraction treatment of class II malocclusions. MATERIALS AND METHODS Study involved an electronic search followed by hand searching for randomized and non-randomized clinical studies about maxillary total arch distalization using TADs. After data extraction and risk of bias assessment, meta-analysis was performed for dental, skeletal and soft tissue changes using the Generic-inverse variance approach by use of the mean difference and random-effect model. RESULTS In total, 1788 articles were identified, 88 full texts were screened and 22 studies were found eligible; 17 of them were included in the quantitative analysis. The means of distalization/distal tipping of the maxillary first molar were 4mm/3.17° in adults, 3.95mm/1.61° in adolescents after treatment with the Modified C-Palatal plate (MCPP), while they were 2.44mm/2.91° with the inter-radicular mini-screws. Both MCPP's treatment in adults and inter-radicular mini-screws resulted in significant intrusion of U6 (1.64 and 0.75mm, respectively), while insignificant extrusion of U6 was resulted in adolescents treated by MCPP. MCPP appliances resulted in palatal inclination/extrusion of maxillary incisors U1 (6.77°/2mm in adults, 7.46°/3.14mm in adolescents). In contrast, inter-radicular mini-screws resulted in less palatal less amount of palatal inclination/insignificant intrusion of U1 (2.42°/0.14mm). MCPP treatment also resulted in significant changes in the skeletal measurements (SNA, ANB, occlusal and mandibular planes). Insignificant differences were found between subgroups in the retraction amount of maxillary incisors, as well as the upper and lower lips. In the follow-up of adolescents treated with MCPP, a significant amount of mesial movement, mesial tipping, and extrusion (2.94mm, 2.84°, and 3.94mm, respectively) was found. However, skeletal and occlusal corrections of the Class II relationship were maintained. CONCLUSIONS Maxillary total arch distalization using TADs can be an effective and stable treatment procedure. However, RCTs or prospective cohort studies are highly recommended to establish a clinical evidence regarding their efficiency.
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Affiliation(s)
- Tuqa Rashad Raghis
- Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, Syria.
| | | | - Ghiath Mahmoud
- Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Mohamed Youssef
- Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, Syria
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Abstract
Coronal malalignment of the patellofemoral joint may contribute to both instability as well as pain and joint overload. The use of distal realignment procedures has evolved to include uniplanar and multiplanar osteotomies, which allows patient-specific treatment. With a careful understanding of the complex pathoanatomy, including osseous, soft tissue, and dynamic muscular factors, an appropriately designed tibial tubercle osteotomy (TTO) is an invaluable tool for the orthopedic surgeon to improve joint biomechanics and off-load articular injuries. Current techniques have improved TTO surgery to limit complications and produce reliably good results.
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Affiliation(s)
- Elizabeth C Gardner
- Department of Orthopaedic Surgery and Rehabilitation, Yale University, Yale University School of Medicine, 47 College Street, New Haven, CT 06510, USA.
| | - David A Molho
- Department of Orthopaedic Surgery and Rehabilitation, Yale University, Yale University School of Medicine, 47 College Street, New Haven, CT 06510, USA. https://twitter.com/TotalHipKnee
| | - John P Fulkerson
- Department of Orthopaedic Surgery and Rehabilitation, Yale University, Yale University School of Medicine, 47 College Street, New Haven, CT 06510, USA. https://twitter.com/patelladoc
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Abstract
Patella alta is described as abnormally high-riding patella in relation to the femur, the trochlear groove, or the tibia with decreased bony stability. Patella alta represents an important predisposing factor for patellofemoral instability. Different measurement methods are used to define patella alta. Despite the clinical importance of patella alta, there is only limited consensus on cutoff values, indications for treatment, and ideal correction. In addition, the impact of patella alta on other risk factors for lateral patellar instability is significant. This must be considered when assessing clinical complaints and choosing the best individual treatment. Combined surgical interventions may be necessary.
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Affiliation(s)
- Roland M Biedert
- SportsClinic#1, Wankdorf Center, Papiermühlestrasse 73, CH-3014 Bern, Switzerland.
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27
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Fouda AS, Attia KH, Abouelezz AM, El-Ghafour MA, Aboulfotouh MH. Anchorage control using miniscrews in comparison to Essix appliance in treatment of postpubertal patients with Class II malocclusion using Carrière Motion Appliance. Angle Orthod 2021; 92:45-54. [PMID: 34338733 DOI: 10.2319/021421-126.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate anchorage control using miniscrews vs an Essix appliance in treatment of Class II malocclusion by distalization using the Carrière Motion Appliance (CMA). MATERIALS AND METHODS Twenty-four postpubertal female patients with Class II, division 1 malocclusion were randomly distributed into two equal groups. CMA was bonded in both groups, and one group was treated with miniscrews as anchorage (12 patients, mean age = 18.0 years) while the other group was treated with an Essix appliance as anchorage (12 patients, mean age = 17.8 years). For each patient, two cone-beam computed tomographic scans were obtained: one preoperatively and another after completion of distalization. RESULTS In the Essix appliance group, there was a statistically significant anterior movement (2.2 ± 1.43 mm) as well as proclination of the lower incisor (5.3° ± 4.0°), compared to a nonsignificant anterior movement (0.06 ± 1.45 mm) and proclination (0.86° ± 2.22°) in the miniscrew group. The amount of maxillary molar distalization was higher in the miniscrew group (2.57 ± 1.52 mm) than in the Essix appliance group (1.53 ± 1.11 mm); however, the difference was not statistically significant. CONCLUSIONS Miniscrews led to a decrease in the amount of anchorage loss in the mandibular incisors, both in terms of anterior movement and proclination.
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Kim SH, Cha KS, Lee JW, Lee SM. Mandibular skeletal posterior anatomic limit for molar distalization in patients with Class III malocclusion with different vertical facial patterns. Korean J Orthod 2021; 51:250-259. [PMID: 34275881 PMCID: PMC8290085 DOI: 10.4041/kjod.2021.51.4.250] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The aim of this study was to compare the differences in mandibular posterior anatomic limit (MPAL) distances stratified by vertical patterns in patients with skeletal Class III malocclusion by using cone-beam computed tomography (CBCT). Methods CBCT images of 48 patients with skeletal Class III malocclusion (mean age, 22.8 ± 3.1 years) categorized according to the vertical patterns (hypodivergent, normodivergent, and hyperdivergent; n = 16 per group) were analyzed. While parallel to the posterior occlusal line, the shortest linear distances from the distal root of the mandibular second molar to the inner cortex of the mandibular body were measured at depths of 4, 6, and 8 mm from the cementoenamel junction. MPAL distances were compared between the three groups, and their correlations were analyzed. Results The mean ages, sex distribution, asymmetry, and crowding in the three groups showed no significant differences. MPAL distance was significantly longer in male (3.8 ± 2.6 mm) than in female (1.8 ± 1.2 mm) at the 8-mm root level. At all root levels, MPAL distances were significantly different in the hypodivergent and hyperdivergent groups (p < 0.001) and between the normodivergent and hyperdivergent groups (p < 0.01). MPAL distances were the shortest in the hyperdivergent group. The mandibular plane angle highly correlated with MPAL distances at all root levels (p < 0.01). Conclusions MPAL distances were the shortest in patients with hyperdivergent patterns and showed a decreasing tendency as the mandibular plane angle increased. MPAL distances were significantly shorter (~3.16 mm) at the 8-mm root level.
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Affiliation(s)
- Sung-Ho Kim
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
| | - Kyung-Suk Cha
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
| | - Jin-Woo Lee
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
| | - Sang-Min Lee
- Department of Orthodontics, Dankook University College of Dentistry, Cheonan, Korea
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29
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Beyling F, Klang E, Niehoff E, Schwestka-Polly R, Helms HJ, Wiechmann D. Class II correction by maxillary en masse distalization using a completely customized lingual appliance and a novel mini-screw anchorage concept - preliminary results. Head Face Med 2021; 17:23. [PMID: 34187487 PMCID: PMC8240392 DOI: 10.1186/s13005-021-00273-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023] Open
Abstract
Background The aim of the study was to evaluate the efficacy of a novel en masse distalization method in the maxillary arch in combination with a completely customized lingual appliance (CCLA; WIN, DW Lingual Systems, Germany). Therefore, we tested the null-hypothesis of a significant deviation from an Angle-Class I canine relationship and a normal overjet defined by an individual target set-up after dentoalveolar compensation in Angle Class II subjects. Methods This retrospective study included 23 patients, (m/f 3/20, mean age 29.6 years (min/max, 13.6/50.9 years)), with inclusion criteria of an Angle Class II occlusion of more than half a cusp prior to en masse distalization and treatment completed consecutively with a CCLA in combination with a mini-screw (MS) anchorage for uni- or bilateral maxillary distalization (12 bilateral situations, totalling 35). Plaster casts taken prior to (T0) and following CCLA treatment (T3) were compared with the treatment plan / set-up (TxP, with a Class I canine relationship and a normal overjet as the treatment objective). MSs were placed following levelling and aligning (T1) and removed at the end of en masse distalization at T2. Statistical analysis was carried out using Schuirmann’s TOST [two one-sided tests] equivalence test, based on a one-sample t-test with α = 0.025 on each side (total α = 0.05). Results Ninety-seven percent of planned correction of the canine relationship was achieved (mean 3.6 of 3.7 mm) and also 97 % of the planned overjet correction (mean 3.1 of 3.2 mm), with a statistically significant equivalence (p < 0.0001) for canine relationship and overjet between the individual treatment plan (set-up) and the final outcome. Adverse effects were limited to the loss of n = 2 of 35 mini-screws. However, in each instance, the treatment was completed, as scheduled, without replacing them. Accordingly, the null-hypothesis was rejected. Conclusions The technique presented allows for a predictable correction of an Angle-Class II malocclusion via dentoalveolar compensation with maxillary en masse distalization.
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Affiliation(s)
- Frauke Beyling
- Private Practice, Kieferorthopädische Fachpraxis, Lindenstraße 44, 49152, Bad Essen, Germany.
| | - Elisabeth Klang
- Private Practice, Kieferorthopädische Fachpraxis, Lindenstraße 44, 49152, Bad Essen, Germany
| | - Eva Niehoff
- Private Practice, Kieferorthopädische Fachpraxis, Lindenstraße 44, 49152, Bad Essen, Germany.,Department of Orthodontics, Hannover Medical School (MHH), Hannover, Germany
| | | | - Hans-Joachim Helms
- Department of Medical Statistics, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Dirk Wiechmann
- Private Practice, Kieferorthopädische Fachpraxis, Lindenstraße 44, 49152, Bad Essen, Germany.,Department of Orthodontics, Hannover Medical School (MHH), Hannover, Germany
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30
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Barakat D, Bakdach WMM, Youssef M. Treatment effects of Carriere Motion Appliance on patients with class II malocclusion: A systematic review and meta-analysis. Int Orthod 2021; 19:353-64. [PMID: 34127400 DOI: 10.1016/j.ortho.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the treatment effects of Carriere Motion Appliance (CMA) on class II patients. METHODS A comprehensive electronic search was performed in PubMed, Scopus, Web of science, ScienceDirect, ProQuest (dissertation and thesis), Google Scholar and ClinicalTrials.gov. All types of clinical trials that contained at least pre- and post-treatment measures of patients treated by CMA were included in this systematic review and meta-analysis. The risk of bias was assessed for all included studies. The considered outcomes were the skeletal, dento-alveolar, soft tissues, temporomandibular joint and airway changes, electromyographic activity and stability. RESULTS Sixteen studies were included in this systematic review and meta-analysis. The absence of randomized controlled trials which could induce confounding and selection of participant bias is considered the main risk of bias affecting the available studies. Regarding the skeletal changes, no significant effects were appreciated (changes in SNB angle; SMD=-0.13; 95% CI (-0.57, 0.31); P=0.58. Changes in SN-MP; SMD=-0.11; 95% CI (-0.54, 0.33); P=0.64). With respect to the dento-alveolar changes, an increased lower incisor's proclination (L1-MP) was observed; SMD=-0.69; 95% CI (-1.14, -0.24); P=0.003. CMA caused an increase in the airway volume, an increase in the masseter and temporalis muscles activities and a minor relapse of malocclusion after 4-years of follow-up. The results should be taken with caution because only secondary level of evidence was found. CONCLUSIONS The CMA used for the treatment of class II malocclusion did not cause skeletal changes; however, largely dento-alveolar effects were noticed. Prospective randomized clinical trials are highly recommended.
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31
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Pillukat T, Heitzmann W, Kalb K, Windolf J, van Schoonhoven J. [Revision surgery after resection arthroplasty of the CMC-1 joint using the extensor carpi radialis longus muscle tendon]. Oper Orthop Traumatol 2021; 33:200-15. [PMID: 34100960 DOI: 10.1007/s00064-021-00712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Resuspension of the first metacarpal bone using the extensor carpi radialis longus muscle tendon. Prevention of contact between the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Preservation of motion. INDICATIONS Pain after preceeding resectional arthroplasty due to proximalisation of the first ray. Radiologically demonstrated contact between the base of the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Instability of the first ray at the site of the suspension. CONTRAINDICATIONS Proven specific reasons: neuropathical complaints and dysaesthesia in the region supplied by the superficial branch of the radial nerve, tendinitis of the flexor carpi radialis tendon etc. SURGICAL TECHNIQUE: Distalisation of the first ray after mobilisation and debridement at the base of the first metacarpal bone with resection of scar tissue, Resection of the pre-existing tendon plasty and contouring the base of the first metacarpal bone with removal of osteophytes. Interposition of tendon material between the base of the first and second metacarpal bones. POSTOPERATIVE MANAGEMENT Immobilisation in a forearm cast including the thumb metacarpophalangeal joint for 6 weeks. RESULTS Of 21 patients treated using this procedure, 15 (13 women, 2 men, average age 59 (51-70) years) were evaluated retrospectively on average 4 (2-10) years postoperatively. Opposition of the thumb was nearly normal. Grip strength and strength of pinch grip did not differ significantly from the contralateral side. Pain at rest and exercise (evaluated by a visual analogue scale from 0-10) was postoperatively significantly reduced. On plain X‑rays the distance between the base of the first metacarpal bone and the distal scaphoid pole was significantly increased as a sign of a successful distalisation. Ultimately, 12 patients postoperatively returned to work, 10 to their original occupation. No patient required additional procedures.
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Abstract
Background Functional internal rotation (fIR) of the shoulder is frequently limited after reverse shoulder arthroplasty (RTSA). The objective of this study was to study a cohort of satisfied patients after RTSA who had comparable active mobility except for fIR and to identify factors associated with selective loss of fIR. Methods A retrospective cohort study was conducted to compare 2 patient groups with either poor (≤ 2 points in the Constant-Murley score [CS]) or excellent (≥8 points in CS) fIR after RTSA at a minimum follow-up of 2 years. Influencing factors (demographic, surgical or implant related, radiographic parameters) and clinical outcome were analyzed. Results Fifty-two patients with a mean age of 72.8 (±9.3) and a mean follow-up of 41 months were included in the IR≤2 group and 63 patients with a mean age of 72.1 (±8.0) and a mean follow-up of 59 months in the IR≥8 group. All patients had undergone RTSA with the same implant type and only 2 different glenosphere sizes (36 and 40) for comparable indications. A multivariate analysis identified the following significant risk factors for poor postoperative fIR: poor preoperative fIR (pts in CS: 3 [range: 2-6] vs. 6 [range: 4-8], P<.0001), smoking (17.3% vs. 6.5%, P = .004), male gender (59.6% vs. 31.7%, P = .002), less preoperative to postoperative distalization of the greater tuberosity (Δ 19.4 mm vs. 22.2 mm, P = .026), a thin humeral insert (≤3 mm: 23.1% vs. 54.8%, P = .039), and a high American Society of Anesthesiologists score (≤ III: 30.8% vs. 14.3%, P = .043). Subscapularis repair status and glenosphere size had no influence on fIR. Clinical outcome scores improved in both groups from preoperatively to last follow-up. The IR≥8 group had overall significantly better outcome scores compared to the IR≤2 group (Δ 9.3% SSV and Δ 9.5% relative CS, P < .0001). There was no difference in CS between the cohorts when the score for fIR was discarded. Conclusion Independent risk factors for poor postoperative fIR after RTSA are poor preoperative fIR, smoking, male gender, less preoperative to postoperative distalization of the greater tuberosity, a thin humeral insert height, and a high American Society of Anesthesiologists score. Except for male gender, these factors are modifiable. These findings may be a valuable addition to patient counselling as well as preoperative planning and preoperative and intraoperative decision-making. The relevance of fIR for overall satisfaction is substantiated by this study.
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Affiliation(s)
- Bettina Hochreiter
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Anita Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Julian Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Philipp Kriechling
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Paul Borbas
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Khan J, Goyal M, Kumar M, Kushwah A, Kaur A, Sharma M. Comparative evaluation of displacement and stress distribution pattern during maxillary arch distalization with Infra Zygomatic Screw- A three dimensional finite element study. Int Orthod 2021; 19:291-300. [PMID: 33875363 DOI: 10.1016/j.ortho.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to evaluate and compare the distribution of stress and displacement of teeth during maxillary arch distalization with IZC (Infra zygomatic crest) screw with two maxillary positions and different lever arm heights. SETTINGS AND DESIGN Six three-dimensional finite element models of the maxillary arch were constructed with third molars extracted. Models 1, 2 and 3: IZC 6 (mesial to mesiobuccal root of first molar, 6) with 0mm, 4mm and 8mm lever arm height; Models 4, 5 and 6: IZC 7 (mesial to mesiobuccal root of second molar, 7) with 0mm, 4mm and 8mm, respectively. MATERIAL AND METHODS MBT preadjusted Brackets (slot size 0.022×0.028") were placed over the clinical crown's centre with 0.019×0.025" stainless steel archwire on all six models. Retraction force of 4N was applied with different combinations of IZC screws and lever arm bilaterally using Nickel-Titanium (NiTi) closed coil spring. Then, evaluation of stress distribution, von Mises stress and maxillary teeth displacement were performed using ANSYS 12.1 software. RESULTS In this study, maximum von Mises stress in alveolar bone (cortical bone) was observed in Model 4 (107.79MPa) at the screw fixation site that was within the optimum limit (135MPa). Different extents of displacements like labiolingual tipping of crown, labiolingual tipping of root, extrusion and intrusion were noticed. The models with 0mm and 4mm lever arm height (models1, 2, 4 and 5) showed more controlled crown and root movements in comparison to 8mm long lever arm models (models 3 and 6). In model 5, a maximum distal movement compared to all other five models was observed. CONCLUSIONS IZC 7 position showed the most favourable results (maximum distalization) with the lever arm height of 4mm. Therefore, the nearer the force to the centre of resistance of the tooth, the greater is distalization. Stresses on the IZC screw decreases when lever arm height increases, in all the models.
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Affiliation(s)
- Junaid Khan
- Department of Orthodontics and Dentofacial Orthopaedics, Teerthanker Mahaveer Dental College, Moradabad, Uttar Pradesh, India.
| | - Manish Goyal
- Department of Orthodontics and Dentofacial Orthopaedics, Teerthanker Mahaveer Dental College, Moradabad, Uttar Pradesh, India
| | - Mukesh Kumar
- Department of Orthodontics and Dentofacial Orthopaedics, Teerthanker Mahaveer Dental College, Moradabad, Uttar Pradesh, India
| | - Ashish Kushwah
- Department of Orthodontics and Dentofacial Orthopaedics, Institute of Dental Education & Advanced Studies, Gwalior, Madhya Pradesh, India
| | - Amandeep Kaur
- Department of Orthodontics and Dentofacial Orthopaedics, Teerthanker Mahaveer Dental College, Moradabad, Uttar Pradesh, India
| | - Madhur Sharma
- Department of Orthodontics and Dentofacial Orthopaedics, Teerthanker Mahaveer Dental College, Moradabad, Uttar Pradesh, India
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34
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Li C, Sfogliano L, Jiang W, Lee H, Zheng Z, Chung CH, Jones J. Total maxillary arch distalization by using headgear in an adult patient. Angle Orthod 2021; 91:267-278. [PMID: 33289800 DOI: 10.2319/010320-857.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 08/01/2020] [Indexed: 01/02/2023] Open
Abstract
Although headgear is rarely used in adult patients, its use in adults is mainly for anchorage control. In the current case report, a 24-year-old patient had a skeletal Class I relationship with a Class II tendency, brachyfacial pattern, significant facial asymmetry, and dental 3/4 cusp Class II molar and canine relationships on both sides. The patient declined surgery, and facial asymmetry was not his concern. The final treatment goal was to achieve a stable Class I dental relationship and normal occlusion without significantly compromising the patient's profile. The patient was compliant with the use of cervical-pull headgear after he refused the options of orthodontic-orthognathic combined treatment, maxillary premolar extraction, or temporary skeletal anchorage mini-implants. A 5-mm maxillary arch distal movement was accomplished without significant distal tipping of the molar crowns. The active treatment duration was 31 months. Proper overbite and overjet, balanced occlusion, and an acceptable facial profile were achieved. The treatment results inspire reconsideration of the possibility of using headgear in dental Class II correction in adult patients.
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Abstract
Laparoscopic Roux-en-Y gastric bypass is an effective surgical procedure to manage obesity and associated comorbidities. Despite this, some patients experience suboptimal weight loss or weight regain. Several revisional options are available following gastric bypass. Distalization, by increasing the biliopancreatic limb and decreasing the common channel, has been previously shown to improve weight loss with low perioperative morbidity. The impact on weight and nutritional deficiencies is associated with lengths of the different intestinal limbs. Although gastric bypass distalization is an established procedure, in this video we present some technical tips and peals.
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Affiliation(s)
- Andrew M Brown
- Department of Surgery, Health Sciences Center, Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Health Sciences Center T18-040, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA
| | - Konstantinos Spaniolas
- Department of Surgery, Health Sciences Center, Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Health Sciences Center T18-040, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA.
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Park JH, Saito T, Yoo SK, Alfaifi M, Kook YA. Distalization with a modified C-palatal plate for severe upper crowding and a missing lower incisor. Korean J Orthod 2020; 50:52-62. [PMID: 32042720 PMCID: PMC6995829 DOI: 10.4041/kjod.2020.50.1.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 11/15/2022] Open
Abstract
This case report presents the orthodontic treatment of a 25-year-old patient with skeletal Class II and severe maxillary arch crowding, moderate mandibular arch crowding, anterior crossbite, and a missing lower incisor. He was treated with molar distalization using a modified C-palatal plate and temporary anchorage devices to create sufficient space for retraction. The total treatment duration was 21 months. After treatment, his occlusion and smile esthetics showed significant improvement. The modified C-palatal plate represents a treatment modality that enhances the prospects of non-extraction treatment and reduces the need for extraction.
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Affiliation(s)
- Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA.,Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Traci Saito
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA.,Private Practice, Portland, OR, USA
| | - Sun Kyong Yoo
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA
| | - Mohammed Alfaifi
- Department of Orthodontics, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
| | - Yoon-Ah Kook
- Department of Orthodontics, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
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Abstract
Objective: To compare two molar distalization devices, the Pendulum appliance (PA) and the Jones Jig (JJ) in dental Class II patients. Materials and Methods: Pretreatment and postdistalization lateral cephalograms and study models of 20 subjects (6 males, 14 females) Class II malocclusion subjects were examined. PA and JJ group both consisted of 10 patients each with a mean pretreatment age of 12 years 1 month for females and 12 years 5 months for males. The PA and the JJ appliance were activated once in a month until Class II molar relationship was corrected to a super Class I molar relationship in both groups. Initial and final measurements and treatment changes were compared by means of Paired t-test. Results: Maxillary first molar distalized an average of 3.85 mm in the PA and 2.75 mm in the JJ between T1 and T2; rate of molar distalization was 1.59 mm/month for PA, and the JJ appliance averaged 0.88 mm/month, distal molar tipping was greater in PA (6.2°) than in the JJ (3.9°). Average mesial movement of the premolars was 2.2 mm with PA and JJ both. JJ showed a greater rotation of first molars after distalization as compared to PA. The increase in vertical facial height was also greater for JJ as compared to PA. Conclusions: Both the appliances were effective in molar distalization with PA requiring less distalization time (16 days less than JJ). Some adverse effects were noted with both which one should strive to control.
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Affiliation(s)
- Sushruth Shetty
- Department of Orthodontics, Maaruti Dental College, Bengaluru, Karnataka, India
| | | | - H V Pruthvi Raj
- Department of Orthodontics, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Anand Patil
- Department of Orthodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
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Felsenreich DM, Langer FB, Bichler C, Kristo I, Jedamzik J, Eilenberg M, Arnoldner MA, Prager G. Surgical therapy of weight regain after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2019; 15:1719-28. [PMID: 31474525 DOI: 10.1016/j.soard.2019.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/28/2019] [Accepted: 07/03/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is a well-established surgical method for morbid obesity; however, weight regain (WR) after initially good results may be considered an issue, the treatment of which has found no consensus yet. OBJECTIVES The aim of this study was to compare the different surgical methods treating WR after RYGB that are used at the Vienna Medical University in a larger number of patients, concerning further weight loss, complications, and reoperations. SETTING University hospital, Austria. METHODS This study includes all patients with RYGB who were reoperated due to WR at the Vienna Medical University by December 2016 (n = 84). The follow-up rate was 93%. The following 4 approaches to treating WR after RYGB were taken: (1) pouch resizing, (2) pouch banding, (3) pouch resizing plus pouch banding, and (4) common limb shortening (i.e., distalization). RESULTS The mean maximum excess weight loss referring to the WR procedure in the 4 groups was as follows: group 1: 69.0% ± 35.2%, group 2: 62.8% ± 39.5%, group 3: 83.1% ± 30.9%, and group 4: 81.5% ± 41.6%. Reoperations occurred in the following different groups: group 1 had 2 balloon dilations (20%), groups 2 (n = 13) and 3 (n = 29) had 5 (38% and 17%) band removals each, and group 4 had 9 reversal procedures due to malnutrition (30%). CONCLUSIONS There are nonsignificant differences in terms of additional weight loss between the different methods. However, differences lay in the areas of adverse symptoms and further reoperations. While there was no risk of malnutrition with pouch resizing, there was with distalization. Pouch banding (with or without resizing) poses a higher risk of dysphagia.
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Jung MH. Total arch distalization with interproximal stripping in a patient with severe crowding. Korean J Orthod 2019; 49:194-201. [PMID: 31149610 PMCID: PMC6533184 DOI: 10.4041/kjod.2019.49.3.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
When a patient shows severe crowding, premolar extraction should be considered to provide required available space for alignment. If the third molars have already erupted and demonstrate a poor prognosis, third molar extraction and distalization of the posterior dentition can be used instead of premolar extraction to obtain space. Interproximal stripping (IPS) may also be used to gain space in cases of crowding. This case report describes the treatment of a 25-year-old man with severe crowding and mild lip protrusion. Although the crowding in the lower arch was severe enough to require first premolar extraction, distalization of the entire lower dentition with orthodontic mini-implants, extraction of the lower third molars, and IPS could successfully resolve the crowding and lip protrusion.
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Affiliation(s)
- Min-Ho Jung
- Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, Korea.,Private Practice, Seoul, Korea
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Park JH, Kim S, Lee YJ, Bayome M, Kook YA, Hong M, Kim Y. Three-dimensional evaluation of maxillary dentoalveolar changes and airway space after distalization in adults. Angle Orthod 2018; 88:187-194. [PMID: 29337633 DOI: 10.2319/121116-889.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To evaluate the changes in position of the maxillary dentition and the airway space after distalization using a modified C-palatal plate (MCPP) in adult patients through CBCT images and to analyze the relationship between the amount of distalization and the changes in the airway space. MATERIALS AND METHODS CBCT images of 33 adult Class II patients (22.2 ± 4.0 years old; 27 women and 6 men) treated by total maxillary arch distalization using the MCPP were evaluated before and after distalization. The patients were divided into nonextraction and extraction groups. The changes in the airway space as well as the changes in the positions of the maxillary dentition were evaluated. The distalization effects were calculated and assessed using paired t-tests. RESULTS After distalization, the first molar showed significant distalization and intrusion ( P < .001) with no significant rotation of the crown and no significant buccal displacement of its root in the transverse dimension. There were no significant changes in the airway volume or the minimum cross-sectional area of the oropharynx. CONCLUSIONS The application of the MCPP resulted in significant total arch distalization without a significant effect on the transverse dimensions or changes in the oropharynx airway space. The MCPP can be considered a viable treatment option for patients with Class II malocclusion.
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Paranna S, Shetty P, Anandakrishna L, Rawat A. Distalization of Maxillary First Permanent Molar by Pendulum Appliance in Mixed Dentition Period. Int J Clin Pediatr Dent 2017; 10:299-301. [PMID: 29104393 PMCID: PMC5661047 DOI: 10.5005/jp-journals-10005-1454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 02/23/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Mesial drifting of molar teeth in maxillary arch is corrected by movement of the molars distally. In addition to traditional distal movement techniques, such as extraoral force application and removable appliances, various intra-arch devices have been introduced since 1980s. These intra-arch appliances have nearly eliminated the need for patient cooperation. Case report The purpose of this paper is to report a case of 10-year-old male patient with loss of space in maxillary molar teeth treated by intra-arch appliance-pendulum appliance by distalization of maxillary first permanent molar teeth. Distaliza-tion of the permanent molar teeth helped in proper eruption of second premolar teeth without any extensive treatment procedures. Conclusion In the present case report, the treatment of developing malocclusion was corrected by utilizing the concept of interceptive orthodontics. Hence, correction of space loss in mixed dentition period using pendulum appliance can eliminate the fixed orthodontic therapy. How to cite this article Paranna S, Shetty P, Anandakrishna L, Rawat A. Distalization of Maxillary First Permanent Molar by Pendulum Appliance in Mixed Dentition Period. Int J Clin Pediatr Dent 2017;10(3):299-301.
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Affiliation(s)
- Sujatha Paranna
- Senior Lecturer, Department of Pediatric Dentistry, P.M. Nadagouda Memorial Dental College and Hospital, Bagalkot, Karnataka, India
| | - Prakashchandra Shetty
- Professor, Department of Pedodontics and Preventive Dentistry, Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Latha Anandakrishna
- Professor and Head, Department of Pedodontics and Preventive Dentistry, Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Anuradha Rawat
- Senior Lecturer, Department of Orthodontics, J.K.K. Nattaraja Dental College & Hospital, Namakkal, Tamil Nadu, India
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Kim KA, Hwang HS, Chung KR, Kim SH, Nelson G. Recovery of multiple impacted maxillary teeth in a hyperdivergent Class I patient using Temporary Skeletal Anchorage Devices and augmented corticotomy. Angle Orthod 2017; 88:107-121. [PMID: 29087728 DOI: 10.2319/071117-464.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Treatment of multiple impacted teeth is challenging. Three-dimensional treatment planning can help in delivering a better outcome. This case report presents a patient with an incomplete dental transposition between the canine and lateral incisor of the maxillary right side associated with the impaction of a dilacerated right central incisor. Using a two-stage surgical exposure and augmented corticotomy, the patient's occlusion and smile esthetics were significantly improved, and Class I occlusal relationships with optimal overjet and overbite were achieved after 50 months of orthodontic treatment. Thirty-month posttreatment records revealed a stable result.
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Park M, Na Y, Park M, Ahn J. Biomechanical analysis of distalization of mandibular molars by placing a mini-plate: A finite element study. Korean J Orthod 2017; 47:289-297. [PMID: 28861390 PMCID: PMC5548709 DOI: 10.4041/kjod.2017.47.5.289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/17/2017] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
Objective The objective of this study was to analyze the patterns of tooth movements when distalization of mandibular molars using a mini-plate took place. A finite element analysis was applied to analyze patterns of tooth movements. Methods The model of the mandible and teeth were used to build a finite element analysis model, and a mini-plate was inserted in the mandibular ramus. Two different orthodontic forces were established for displacement of mandibular molars. Orthodontic forces were applied at the level of the bracket and at the level of the cemento-enamel junction in the mandibular canine respectively. Results orthodontic forces at the level of the cemento-enamel junction resulted in a greater biomechanical bodily movement in distalization of the mandibular molars compared to when the orthodontic forces were applied at the level of the bracket. Applying orthodontic forces to the cemento-enamel junction also resulted in unwanted greater extrusive movements in distalization of the mandibular molars compared to the bracket level. Conclusions With considering the mode of orthodontic teeth movement, applying different vertical orthodontic forces for distalization of mandibular molars can lead to more effective distalization of teeth.
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Affiliation(s)
- Myungsoon Park
- Department of Orthodontics, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | | | | | - Janghoon Ahn
- Department of Orthodontics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
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Abstract
Early and timely pedo-orthodontic treatment is aimed at eliminating the disturbances of skeletal or dentoalveolar development, to harmonize the stomatognathic system before the full eruption of all permanent teeth. The advantages of pendulum appliance are its minimal dependence on patient’s compliance (child cooperation), ease of fabrication, onetime activation and adjustment of the springs if necessary to correct minor transverse and vertical molar positions. This article reports a successful treatment method of class II malocclusion with pendulum appliance in mixed dentition phase. Distalization of maxillary molar was done, followed by guidance of canine impaction orthodontically and other dental correction using 0.022 MBT appliances. Posttreatment results were stable and remarkable. How to cite this article: Patil RU, Prakash A, Agarwal A. Pendulum Therapy of Molar Distalization in Mixed Dentition. Int J Clin Pediatr Dent 2016;9(1):67-73.
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Affiliation(s)
- Raju Umaji Patil
- Professor and Head, Department of Pedodontics and Preventive Dentistry Department of Pedodontics and Preventive Dentistry, STES Sinhgad Dental College and Hospital, Pune, Maharashtra, India
| | - Amit Prakash
- Readers, Department of Orthodontics and Dentofacial Orthopedics Rishiraj College of Dental Sciences and Research Centre Bhopal, Madhya Pradesh, India
| | - Anshu Agarwal
- Readers, Department of Orthodontics and Dentofacial Orthopedics Rishiraj College of Dental Sciences and Research Centre Bhopal, Madhya Pradesh, India
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Chang NY, Park JH, Lee MY, Cho JW, Cho JH, An KY, Chae JM. Orthodontic Treatment of Maxillary Incisors with Severe Root Resorption Caused by Bilateral Canine Impaction in a Class II Division 1 Patient. J Clin Pediatr Dent 2016; 40:161-8. [PMID: 26950820 DOI: 10.17796/1053-4628-40.2.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This case report shows the successful alignment of bilateral impacted maxillary canines. A 12-year-old male with the chief complaint of the protrusion of his maxillary anterior teeth happened to have bilateral maxillary canine impaction on the labial side of his maxillary incisors. Four maxillary incisors showed severe root resorption because of the impacted canines. The patient was diagnosed as skeletal Class II malocclusion with proclined maxillary incisors. The impacted canine was carefully retracted using sectional buccal arch wires to avoid further root resorption of the maxillary incisors. To distalize the maxillary dentition, two palatal miniscrews were used. After 25 months of treatment, the maxillary canines were well aligned without any additional root resorption of the maxillary incisors.
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Janakiraman N, Gill P, Upadhyay M, Nanda R, Uribe F. Response of the maxillary dentition to a statically determinate one-couple system with tip-back mechanics: A prospective clinical trial. Angle Orthod 2015; 86:32-8. [PMID: 25978684 DOI: 10.2319/012815-68.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To quantify the effects of tip-back mechanics on the maxillary first molars and incisors. MATERIALS AND METHODS Sixteen subjects with Class II end-on malocclusion were treated with an intrusion arch to achieve distalization of the maxillary molar through tip-back mechanics. Lateral cephalograms were taken prior to molar tip-back (T1), after molar tip-back (T2), and after molar root uprighting (T3). Data were analyzed using the Friedman's and Wilcoxon signed rank tests to evaluate differences in time points (P ≤ .016). RESULTS The maxillary first molar distalized 1.53 mm (P = .001) with 6.65° (P = .001) of distal tipping and 0.86 mm (P = .001) of extrusion at T2. Minor relapse of the first molar (mesial direction) was seen at T3. The maxillary incisors flared labially 0.4 mm, and the incisor root apex moved palatally 1.19 mm (P = .005) at T2. At T3, the incisor root apex moved palatally 1.5 mm (P = .003) from T1. An angular change from T1 of 3.31° (P = .008) and 3.53° (P = .014) was seen at T2 and T3, respectively, as a result of palatal root movement of the maxillary incisors. CONCLUSIONS A significant amount of distalization of maxillary molars was attained at the crown level with tip-back mechanics. Palatal root angulation change was significant in the incisors with minimal anteroposterior movement of the incisal edge.
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Affiliation(s)
- Nandakumar Janakiraman
- a Clinical Assistant Professor, Division of Orthodontics, University of Connecticut, School of Dental Medicine, Farmington, Conn
| | | | - Madhur Upadhyay
- c Assistant Professor, Director Orthodontic Fellowship Program, Division of Orthodontics, University of Connecticut, School of Dental Medicine, Farmington, Conn
| | - Ravindra Nanda
- d Professor and Head, Department of Craniofacial Sciences, Alumni Endowed Chair, School of Dental Medicine, University of Connecticut, Farmington, Conn
| | - Flavio Uribe
- e Associate Professor, Graduate Program Director, Charles Burstone Professor, Division of Orthodontics, University of Connecticut, School of Dental Medicine, Farmington, Conn
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Nalcaci R, Kocoglu-Altan AB, Bicakci AA, Ozturk F, Babacan H. A reliable method for evaluating upper molar distalization: Superimposition of three-dimensional digital models. Korean J Orthod 2015; 45:82-8. [PMID: 25798414 PMCID: PMC4367135 DOI: 10.4041/kjod.2015.45.2.82] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 11/13/2014] [Accepted: 11/13/2014] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to evaluate the reliability of measurements obtained after the superimposition of three-dimensional (3D) digital models by comparing them with those obtained from lateral cephalometric radiographs and photocopies of plaster models for the evaluation of upper molar distalization. Methods Data were collected from plaster models and lateral cephalometric radiographs of 20 Class II patients whose maxillary first molars were distalized with an intraoral distalizer. The posterior movements of the maxillary first molars were evaluated using lateral cephalometric radiographs (group CP), photocopies of plaster models (group PH), and digitized 3D models (group TD). Additionally, distalization and expansion of the other teeth and the degrees of molar rotation were measured in group PH and group TD and compared between the two groups. Results No significant difference was observed regarding the amount of molar distalization among the three groups. A comparison of the aforementioned parameters between group PH and group TD did not reveal any significant difference. Conclusions 3D digital models are reliable to assess the results of upper molar distalization and can be considered a valid alternative to conventional measurement methods.
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Affiliation(s)
- Ruhi Nalcaci
- Department of Orthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
| | | | - Ali Altug Bicakci
- Department of Orthodontics, Faculty of Dentistry, Gaziosmanpasa University, Tokat, Turkey
| | - Firat Ozturk
- Department of Orthodontics, Faculty of Dentistry, Pamukkale University, Denizli, Turkey
| | - Hasan Babacan
- Department of Orthodontics, Faculty of Dentistry, Pamukkale University, Denizli, Turkey
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Sung EH, Kim SJ, Chun YS, Park YC, Yu HS, Lee KJ. Distalization pattern of whole maxillary dentition according to force application points. Korean J Orthod 2015; 45:20-8. [PMID: 25667914 PMCID: PMC4320314 DOI: 10.4041/kjod.2015.45.1.20] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/05/2014] [Accepted: 07/21/2014] [Indexed: 12/26/2022] Open
Abstract
Objective The purpose of this study was to observe stress distribution and displacement patterns of the entire maxillary arch with regard to distalizing force vectors applied from interdental miniscrews. Methods A standard three-dimensional finite element model was constructed to simulate the maxillary teeth, periodontal ligament, and alveolar process. The displacement of each tooth was calculated on x, y, and z axes, and the von Mises stress distribution was visualized using color-coded scales. Results A single distalizing force at the archwire level induced lingual inclination of the anterior segment, and slight intrusive distal tipping of the posterior segment. In contrast, force at the high level of the retraction hook resulted in lingual root movement of the anterior segment, and extrusive distal translation of the posterior segment. As the force application point was located posteriorly along the archwire, the likelihood of extrusive lingual inclination of the anterior segment increased, and the vertical component of the force led to intrusion and buccal tipping of the posterior segment. Rotation of the occlusal plane was dependent on the relationship between the line of force and the possible center of resistance of the entire arch. Conclusions Displacement of the entire arch may be dictated by a direct relationship between the center of resistance of the whole arch and the line of action generated between the miniscrews and force application points at the archwire, which makes the total arch movement highly predictable.
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Affiliation(s)
- Eui-Hyang Sung
- Department of Orthodontics, School of Dentistry, Yonsei University, Seoul, Korea
| | - Sung-Jin Kim
- Department of Orthodontics, School of Dentistry, Yonsei University, Seoul, Korea
| | - Youn-Sic Chun
- Division of Orthodontics, Department of Dentistry, Ewha Womans University Medical Center, Seoul, Korea
| | - Young-Chel Park
- Department of Orthodontics, School of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Seog Yu
- Department of Orthodontics, School of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics, School of Dentistry, Yonsei University, Seoul, Korea
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