Histological evaluation of periodontal ligament in human after orthodontic treatment with piezosurgery and monolateral tooth dislocation and ligament distraction technique: a first morphologic and histologic evaluation

Traditional orthodontic tooth movement is based on the concept that application of a protracted force causes alveolar bone remodelling and adaptive changes in periodontal and dental tissues. Thus, if orthodontic tooth movement is described as a biological bone reaction to orthodontic forces mediated by the periodontal ligament (PDL), this event involves a series of sophisticated signal transduction processes that allows the PDL compression with specific histologic and biomolecular modifications. However, the preservation of the integrity of the PDL is generally difficult to achieve when it is associated with a long duration of orthodontic treatment. A total of 20 Caucasian patients with different dental-skeletal were treated using the Monocortical Tooth Dislocation and Ligament Distraction (MTDLD) technique with Piezosurgery associated with morphologic and histological evaluation of the PDL. The histological results obtained, confirm a good clinical outcome with an improvement of the speed on orthodontic treatment without any signs of tissue injury of PDL fiber without areas of hyalinization. The data suggests that MTDLD with Piezosurgery seems to be a valid alternative to the traditional orthodontic movement in adult patients preserving the anatomy and the integrity of PDL.

Cone-beam volumetric imaging in craniofacial medicine

With the development of X-ray computed tomography (CT) in the 1960s and its first use for clinical studies in 1972 by Sir Godfrey Hounsfield, radiological tomography attained widespread use and today is one of the essential imaging techniques in medical radiology. It is a technically mature and clinically widely accepted method and complements classical X-ray panoramic radiography in many areas. The technology is frequently used in craniofacial radiology, because of its characteristic low radiation dose, high spatial resolution and lower cost compared with CT. The aim of this work was to describe the principles of cone beam computed tomography, to make a brief description of the existing devices, to present briefly the use of 3D diagnosis in craniofacial medicine.

Bilateral pneumothorax and pneumomediastinum after orthognathic surgery

The occurrence of postoperative complications after various orthognatic surgery procedures is rare but all of them might be life-threatening complications. We report a case of a 22-year old female patient who underwent a bimaxillary orthognathic surgery procedure and developed bilateral pneumothorax and pneumomediastinum.

In vivo study of titanium healing screws surface modifications after different debridment procedure

Introduction: Over the years, several different implant systems have been introduced, and the indications for implant rehabilitation have gradually been extended 2. Although an high success rates have consistently been reported for many implant systems, complications leading to loss of osseointegration still occurs 3. Thus, oral hygiene and maintenance are imperative, because implants, as well as teeth, are susceptible to accumulation of bacterial plaque and calculus formation. The aim of the present study was to evaluate and compare the in vivo cleaning efficacy of the three systems (air powder, curette, laser) comparing at the same time the alterations of the titanium abutment surface in terms of roughness. Methods: Forthy-two patients (25 males and 17 females) were included in the study. The 42 healing abutments were treated by the same clinician (UC). Results and conclusions: The rate of debris removal by the air powder was higher than that for the laser and than that for the curettes. The SEM analysis showed that the air powder system did not induce significant differences of the abutment if compared to the curettes as well as to the laser.

Inclusion of all permanent mandibular molars and all maxillary second and third molars: a case report and review of the literature

Simultaneous impactions of first, second, and third permanent molars on both mandibular sides together with the all maxillary second and third molars is a clinical situation never reported before in the literature and it might be a difficult challenge for maxillofacial surgeons and dentists. Early diagnosis and treatment of eruption disturbances contributes to optimal outcomes. This article reports the treatment of an adult with severe impaction of all mandibular first, second, and third molars together with all maxillary second and third molars, which limits the masticatory function and dental arch integrity. The impacted molars were surgically removed as the patients declined orthodontic treatment. The combined surgical-orthodontic approach represents a challenging treatment and the optimal one as it eliminates the need for prosthetic rehabilitation and implant replacement of the impacted molars, when accepted.

Blood levels of interleukins in patients with ameloblastoma

The aim of study was to determine and compare serum concentrations of interleukin 1 beta (IL-1β), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) in patients with oral ameloblastoma and healthy controls. Sixteen patients with ameloblastoma and 16 healthy controls were enrolled in this study. Cytokine concentrations were measured by chemiluminescent enzyme linked immunoassay. Serum concentrations of IL-1β were below level of detection in all but four participants. No significant differences between the groups were observed in serum concentrations of IL-6. Serum TNF-α was significantly higher in control subjects than in ameloblastoma patients. Patients diagnosed with ameloblastoma have relatively normal levels of inflammatory cytokines in their blood and thus cannot be used as indicators of disease severity or for monitoring the treatment outcomes.

Salivary levels of IgA in healthy subjects undergoing active orthodontic treatment

It has been reported that the immune system undergoes changes due to various factors, inflammation, surgery, medication, age and gender. The aim of this study was to investigate therapy-dependent changes of salivary IgA among healthy subjects undergoing active orthodontic treatment. The levels of IgA were determined at the beginning, and after 1,4, 8,16 weeks and 32 weaks of active orthodontic treatment. A total of 100 healthy individuals (aged 15-42 years) were enrolled in the study. Two milliliters of saliva were collected from all participants, and salivary IgA levels were measured by the ELISA technique. Mean salivary IgA levels were significantly higher in subjects after 1 week as compared to subjects at the beginning of orthodontic treatment (P < 0.01).. The mean levels of salivary IgA were significantly higher after 4 and 8 weeks of therapy than those observed in the control group (P < 0.00001 and P < 0.05, respectively) and reached the highest level at 16 weeks and then remained stable during treatment. Gender had no effect on the salivary levels of IgA as any significant differences were observed between men and women. The results highlight the importance of the salivary defense mechanism, translated through the increase in the levels of IgA, once orthodontic treatment is started.

The benefits of Quercitin for dentistry and maxillofacial surgery: a systematic review

Quercetin (3,3',4',5,7-pentahydroxyflavone) is the major bioflavonoid in the human diet and belongs to an extensive class of polyphenolic flavonoid compounds almost ubiquitous in plants and plant food sources. The estimated average daily dietary intake of quercetin by an individual in the United States is 25 mg. In recent years, research about quercetin has evolved from animal studies to in vitro and in vivo studies and to human clinical studies and trials in order to establish its real properties and effects. In oral medicine, quercetin has been extensively studied, as a real increase in major diseases like cancers, periodontal disease, oral lesions, tooth decay and infections have been reported worldwide by health providers.It has been thus established that quercetin exhibits beneficial effects on oral health with its broad pharmacological properties, as preventive and therapeutic agent in dental caries with anti-inflammatory effect against oral pathogens, as well as an antioxidant and anti-cancer agent .The aim of the review is to present evidence-based aspect of treatment with quercetin in order to validate its tremendous role in dentistry and maxillofacial surgery.

Salivary calcium levels during orthodontic treatment

Saliva contains many defense factors and plays a key role in oral metabolism. Salivary calcium, due to its affinity to be readily taken up by plaque, is an important factor not only with regard to the onset of periodontitis but also significantly with regard to dental health. The aim of this study was to estimate the salivary concentration of calcium, in a group of adults undergoing active orthodontic treatment. The levels of salivary calcium were determined at the beginning, and after 16 weeks of active orthodontic treatment. A total of 40 healthy individuals with a mean age of 23.9 years were enrolled in the study group, while 40 subjects served as controls. Two milliliters of saliva were collected from all participants, and salivary calcium levels were measured by biochemical assay. Mean salivary calcium levels were significantly higher in subjects after 16 weeks as compared to subjects at the beginning of orthodontic treatment and to the control group (p= 0.001). A significant association between higher salivary calcium levels and orthodontic treatment has been established, therefore, monitoring salivary calcium levels might be a useful tool to establish periodontal health status during active orthodontic treatment along with other inflammatory parameters.

Bimaxillary distraction osteogenesis used for treatment of crowding in non-growing individuals. Case report

Dental crowding is frequently associated with transverse jaw discrepancies, resulting in a less-than-ideal position of the teeth in the basal bone. The classic aproach for correcting bimaxillary crowding are extractions or arch expansion. Rapid maxilla-mandibular expansion was used to treat transverse discrepancies in growing patients, but with aging, the upper and lower jaw bones become increasingly resistant to expansion. The surgically assisted rapid maxillary expansion (SARME) and the mandibular midsymphyseal distraction osteogenesis procedure overcome this age limitation and are of great importance for the treatment of transverse discrepancies in adults. The aim of this paper is to report a case with a severe transverse deficiency treated with SARME, mandibular midsymphyseal distraction together with orthodontic treatment in an adult patient. The case highlights the esthetic advantages of increasing the transversal dimension of both jaws in patients with severe crowding associated with constricted dental arches and recommends the maxillo-mandibular transverse distraction osteogenesis as an and effective form of surgical treatment for patients with malocclusions or dentofacial deformities featuring severe transverse discrepancies, combined with a carefully monitored orthodontic treatment.

Conservative treatment of unicystic odontogenic keratocyst by piezosurgery approach. A case report

The present case report describes the case of a 15-year-old female who was referred with a radiolucent lesion between her mandibular right molars. The original radiographic image suggested the presence of an odontogenic cyst. The surgical enucleation and the following osteotomy of the residual cavity was performed by using the piezoelectric technology. The histological analysis confirmed that the lesion was an odontogenic keratocyst with no evidence of epithelial invasion in the connective tissue wall. The patient refused any further surgical treatment. In consideration of the pathological result - no presence of invasive epithelial cells in the connective tissue wall of the cyst- the patient was suggested a "follow-up and wait-and-see policy", with more extensive surgical treatment to be given only in case of a recurrence. The patient was followed up clinically and radiographically at 6 months intervals for 5 years.

Dental white spots associated with bulimia nervosa in orthodontic patients

Bulimia nervosa is an eating disorder characterized by consuming a large amount of food in a short amount of time followed by an attempt to rid oneself of the food consumed (purging), typically by vomiting, taking a laxative, diuretic, or stimulant, and/or excessive exercise, because of an extensive concern for body weight. The frequent contact between teeth and gastric acid, in particular, may cause: severe dental erosion, perimolysis, or the erosion of tooth enamel and swollen salivary glands. Constant vomiting can lead to gastroesophageal reflux. The aim of this article is to report two cases of patients with severe dental demineralization associated with bulimia nervosa during orthodontic treatment. Diagnosis and prevention aspects are highlighted and discussed.

Comparison between oscillating-twisting rotating of brush head vs a characteristic sweeping bristles motion on reducing oral inflammation

Background: The aim of present study was to clinically assess and compare a sonic toothbrush versus a rotating oscillating power toothbrush on plaque removal and gingival health in reducing plaque and bleeding on probing. Methods: Patients were selected according to specific inclusion and exclusion criteria and they were enrolled in test group or control group using Random Allocation Software. Visual score plaque index (PI) was recorded by the same blind operator using a plaque revelator and bleeding on probing (BoP) index was recorded using a periodontal probe at baseline, 15th day and 30th day. Results: The group of patients who used sonic toothbrush showed a greater reduction of PI and BoP comparing with patients who used rotating-oscillating power toothbrush. Conclusions: Although this pilot study has several limitations, it seems to indicate that sonic toothbrushes are capable of removing plaque and reducing bleeding on probing better than electric toothbrushes.

Non-traumatic unilateral bifid mandibular condyle and multiple inclusions: a case report

Simultaneous impactions of first, second, and third permanent molars on both mandibular sides together with the all maxillary second and third molars is a clinical situation never reported before in the literature and it might be a difficult challenge for maxillofacial surgeons and dentists. Early diagnosis and treatment of eruption disturbances contributes to optimal outcomes. This article reports the treatment of an adult with severe impaction of all mandibular first, second, and third molars together with all maxillary second and third molars, which limits the masticatory function and dental arch integrity. The impacted molars were surgically removed as the patients declined orthodontic treatment. The combined surgical-orthodontic approach represents a challenging treatment and the optimal one as it eliminates the need for prosthetic rehabilitation and implant replacement of the impacted molars, when accepted.

A rare case of canine anomaly - a possible algorithm for treating it

Canine transmigration is a very rare dental anomaly in which an unerupted mandibular canine migrates, crossing the mandibular midline. This unusual condition is most often diagnosed by chance during a routine X-ray examination. The most common clinical signs announcing the presence of this anomaly are over-retention of the deciduous canine and the absence of permanent canine from the dental arch after its physiological period of eruption. In this paper, we present a clinical case, 10-year-old boy, who was diagnosed with mandibular right canine transmigration at three years after the start of orthodontic treatment, during which we were expecting the eruption of mandibular canines. The orthopantomograph revealed the mandibular right canine to be in a horizontal position under the apices of the incisors - type 2 transmigration pattern classified by Mupparapu (2002). Based on cone-beam computer tomography examination, we recommended a surgical exposure of the canine and orthodontic alignment. Due to the risk of root resorption of the mandibular right lateral incisor during orthodontic movement phase of canine transmigrated to the dental arch, we decided to align the mandibular right canine in a transposition, between the two mandibular right incisors. Then we resorted to adapting the mandibular right lateral incisor coronary morphology to simulate a canine and also to reshaping the canine coronary morphology to resemble a lateral incisor. This therapeutic approach allowed us to restore morphologically and functionally the mandibular dento-alveolar arch, preserving the entire dental system.

Unusual anatomical detection of a third molar in the infratemporal fossa

Third molar presence in the infratemporal fossa is a rare event and it has been reported previously only two times in the literature, except for the cases which arise from complications occurring during the extraction of the impacted upper third molar. Due to the presence of important vessel bundles and nerves in this area, third molar removal requires a correct surgical management in order to avoid many possible serious side effects. We report an unusual case of upper third molar detected in the infratemporal fossa, which has been thoroughly investigated radiologically and removed through a safe surgical approach.

Modifications of the marginal paradentium to a case of Angle Class III/1 malocclusion

Angle Class III malocclusions are not so frequently met but they raise big problems of treatment. The analyzed case represents a 14-year-old patient that came to the dental consulting room with an Angle Class III malocclusion determined by the excess of the somatotropic pituitary hormone and a gingival hyperplasia more emphasized at the level of inferior frontal teeth. The patient followed a fixed appliance treatment, the straight-wire technique. All along the treatment and after it, the hyperplasia and the gingival inflammation not only maintained but they even got worse. Thus, an improper hygiene associated with a severe Angle Class III malocclusion maintains and aggravates the gingivitis. The histological and immunohistochemical study of the gingiva revealed important epithelial modifications that led to an epithelial hypertrophy with a tendency toward acanthosis and to severe epithelial erosions. An inflammatory chronic process (rich in lymphocytes, plasma cells and macrophages full of angiogenesis vessels) and an intense reaction of the fibroblastic cells appeared in the gingival corium.

Cranial sutures and diploae morphology

The aim of the study was to assess the normal cranial suture and bone diploae ultrastructural morphology. Two types of sutures from different specimens were collected. The micro-CT scanning provided a three-dimensional view of the sutures at a microscopic level thus allowing the evaluation of the development stage and a rapid analysis evaluation of bone and diploae morphology. In the meantime, the micro-CT is able to generate more slices than the normal histology preserving the analyzed specimens and became one of the most powerful tools in the craniofacial area. The micro-CT analysis generated structure-orientated slices that in conjunction with the histological sections provide a high quality quantitative analysis of all cranial sutures and of the cranial bones diploae.

Bimaxillary distraction osteogenesis--an effective approach for the transverse jaw discrepancies in adults

Severe dental crowding in adult patients is one of the features of disparity between the size of the teeth and the jaws. It is most frequently found in cases with a transverse hypoplasia of the maxilla and the mandible. The traditional orthodontic approach is extraction of teeth or arch expansion, both of them with major esthetic disadvantages for the patients. The surgically assisted maxillary expansion (SARME) and the mandibular midsymphyseal distraction osteogenesis procedures open new horizons for the orthodontists and maxillofacial surgeons in the effort to solve the esthetic demands of the patients with dental crowding and severe transversal discrepancy. The amount of surgical expansion is of higher magnitude and stability then the one achieved in orthodontic cases. The case presented here highlights the importance of the surgical procedure followed by the orthodontic therapy due to the enhancement in occlusion, dental alignment and facial morphology.

Three-dimensional cranial suture morphology analysis

The aim of the study was to assess the normal and synostosed coronal cranial sutures morphology at an ultrastructural level. Different operative specimens of human coronal sutures were collected. Three-dimensional reconstruction of the microcomputed tomography (micro-CT) slices were obtained and compared with the representative histologic sections. The micro-CT scanning provides a three-dimensional view of the sutures at a microscopical level thus allowing to establish the stage of development and the bone morphology. The micro-CT has the advantage of being able to image more slices than the normal histology without any damage to the analyzed specimens. Micro-CT is a powerful tool in the craniofacial area that allows us to obtain many structure-orientated slices and in conjunction with the histologic sections provides an overall thorough quantitative analysis of all cranial sutures.

Dental white spots associated with gastro-esophageal reflux in orthodontic and orthognathic surgery patients

Gastro-esophageal reflux is a gastrointestinal disorder that might cause irreversible damages to the hard tissues of the teeth. The aim of this article is to report two cases of patients with severe dental demineralization associated with gastro-esophageal reflux during orthodontic and combined orthodontic-orthognathic surgery treatment. Diagnosis and prevention aspects are highlighted and discussed.

Correlations between the changes in patients' dental-facial morphology at the end of the orthodontic treatment and the psychological variables

The purpose of this research was to assess the impact that the improvement of patients' dental-facial morphology has at the end of the orthodontic treatment upon the following psychological variables: self-esteem, current self-related thoughts as well as upon the variables of social self-esteem and performance. The number of patients included in the study was of 168 (82 children and 86 adolescents) who carried out the orthodontic treatment. At the end of the active treatment, we applied to all patients the assessment instruments for the level of self- esteem and self-related current thoughts: the Rosenberg's Self-Esteem Scale and the Heatherton & Polivy Current Thoughts Scale. As far as the patients in the study are concerned, the improvement of their facial aspect at the end of the treatment showed a significantly positive correlation with the variables of global self-esteem, self-related current thoughts, social self-esteem and performance, with the exception of the girls in children study group who showed no correlations between physical aspect and the performance variable.

[A combined surgical-orthodontic approach of a class II/1 malocclusion. A case report]

This case report highlights the possibility of a non extraction orthodontic treatment, surgically assisted, in a Class II Division 1 malocclusions in order to reduce maxillary protrusion prior to the surgical advancement of the mandible for the correction of the skeletal deficiency. The combined orthodontic-surgical approach optimizes the profile while allowing the settling of a Angle Class I occlusion at the end of the entire treatment sequence.

[New morpho-functional rehabilitation methods in cleft lip and palate]

The interdisciplinary, complex therapeutic protocol of the cleft lip and palate patients, applied in the Clinic of Cranio-Maxillo-Facial Surgery of "I. Haţieganu" University of Medicine and Pharmacy Cluj-Napoca, involves the morphologic reconstruction as well as the functional rehabilitation. Functional rehabilitation is the aspect, which gives the esthetics, social and familial integration of the patient, offering good quality of life.

METHOD

In the current study, a new method and concept of improving the phonetic function in the primary and secondary surgical steps, with the effect on muscle and bone, is presented. The new surgical techniques used comprise of the surgery of the levator veli palatini using the method designed by Sader, and bone distraction, during the same surgical procedure. The assessment of the phonetic results was performed using the NARSOM test.

RESULTS

Following up the results of the techniques mentioned above, we consider that they improve extremely well the morphological status, while giving a functional and physiological support to the patient.

CONCLUSION

Thus, they offer optimal conditions for the future progress of functional rehabilitation using specific speech therapy methods.