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Background and Purpose: chronic urticaria is a tormenter and does not have a known etiology. Association between chronic urticaria and thyroid auto-immunity has shown different results. The aim of this study is to evaluate the effect of Levo-thyroxine on the chronic urticaria and association between chronic urticaria with thyroid auto-immunity. Materials and Methods: In a prospective case-control study, we compared the frequency of thyroid auto antibodies in 60 patients (all females, with exception of six males, ages 15 to 60 years) with chronic urticaria and compared with 60 mached age healthy volunteers. All cases with chronic urticaria and control group were normal CBC, antinuclear antibodies, rheumatoid factors, complement, stool exam, liver function test (LFT), kidney function and skin prick test, prior to being referred to us. We performed thyroid auto antibodies, thyroid hormones and IgE antibodies before treating all subjects. Half of them with positive anti-thyroid antibody' (n=11), received Levo-thyroxine (100 μg) daily for 1 month and the remaining half (n=11) were control group. Results: The frequency of thyroid auto antibodies was significantly higher in patients with chronic urticaria than in healthy control (36.6% vs. 9%; p<0.01).() All patients were euthyroid, however, one was found to have increased anti-thyroid antibody levels with sub clinical hypothyroidism (TSH increased, low T4). Total serum IgE increased in ten cases of patients group (16.6%) compared with six control groups (10%). Nine patients (40%) had complete response, five patients (30%) had partial response and five patients (30%) did not show any response to treatment compared with control group, in which complete and partial resolution was 30% and others with no resolution. Conclusion: chronic urticaria may be associated with thyroid disorders (positive anti- thyroid antibodies) despite normal thyroid function test. For chronic urticaria despite increase serum IgE level with unknown origin, must be evaluated by a thyroid function test, along with anti-thyroid antibodies and treatment if necessary. [ABSTRACT FROM AUTHOR]

The rapid growth of nanotechnology has increased the occupational exposure to nanomaterials. On the other hand, a growing body of evidence considers exposure to these materials to be hazardous. Therefore, it is necessary to examine the effects of occupational exposure to these materials by different methods. Biological monitoring, especially the investigation of oxidative stress induced by exposure to nanomaterials, can provide useful information for researchers. This study systematically reviews studies that have investigated oxidative stress caused by occupational exposure to nanomaterials. The search was conducted on the PubMed, Scopus and Web of Science databases. Of the 266 studies we obtained in our initial search, eventually 11 were included in our study. There is currently no specific biomarker for investigating oxidative stress induced by exposure to nanomaterials. Therefore, the reviewed studies have used different biomarkers in different biological fluids for this purpose. Also, the methods of assessing occupational exposure to nanomaterials in the investigated studies were very diverse. Given the approach of the investigated studies to biomarkers and exposure assessment methods, finding a specific biomarker for investigating exposure to nanomaterials seems unattainable. But reaching a group of biomarkers, to assess exposure to nanomaterials seems more applicable and achievable.

Background: Oral health is important to general health but use of dental services varies considerably, particularly for children., Aims: We aimed to determine factors associated with parents' use of dental services for their children in Lebanon, and their perception of dental care relative to medical care., Methods: A convenience sample of public and private schools in Beirut was selected between January and May 2013. Parents of children in grades 2-6 (aged 7-12 years) were invited to complete a questionnaire covering socioeconomic characteristics and use of dental services. Logistic regression analysis was used to assess the relationship between use of dental services, and parents' socioeconomic characteristics and awareness and perceptions of dental services., Results: The parents of 316 children returned the questionnaire. Most children (72.8%) had been taken to the dentist in the past year, mainly for emergency care. Most parents (78.2%) considered dental care as important as or more important than medical care, and 89.9% were willing to contribute to dental insurance. Use of dental services was significantly associated with: older age of the parent (odds ratio, OR = 1.04; 95% confidence interval, CI: 1.02-1.06); awareness of dental care centres offering affordable treatment (OR = 3.18; 95% CI: 1.52-6.68); and children being in private schools (OR = 2.00, 95% CI: 1.08-3.95). It was negatively associated with > 4 children in the family compared with 1 child (OR = 0.18; 95% CI: 0.04-0.81)., Conclusion: Barriers to dental care for children were mostly related to economic factors., (Copyright © World Health Organization (WHO) 2020. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Monitoring the trace amount of chemicals in various samples remains a challenge. This study was conducted to develop a new solid-phase microextraction (SPME) system (inside-tube SPME) for trace analysis of n-hexane in air and urine matrix. The inside-tube SPME system was prepared based on the phase separation technique. A mixture of carbon aerogel and polystyrene was loaded inside the needle using methanol as the anti-solvent. The air matrix of n-hexane was prepared in a Tedlar bag, and n-hexane vapor was sampled at a flow rate of 0.1 L/min. Urine samples spiked with n-hexane were used to simulate the sampling method. The limit of detection using the inside-tube SPME was 0.0003 μg/sample with 2.5 mg of adsorbent, whereas that using the packed needle was 0.004 μg/sample with 5 mg of carbon aerogel. For n-hexane analysis, the day-to-day and within-day coefficient variation were lower than 1.37%, with recoveries over 98.41% achieved. The inside-tube SPME is an inter-link device between two sample preparation methods, namely, a needle trap device and an SPME system. The result of this study suggested the use of the inside-tube SPME containing carbon aerogel (adsorbent) as a simple and fast method with low cost for n-hexane evaluation., (© 2020 John Wiley & Sons, Ltd.)

Background: Existing evidence on changes of the palatal rugae following rapid maxillary expansion (RME) is scarce and inconclusive, particularly immediate post-expansion changes in three-dimensional assessments., Objectives: Our aims were to assess the dimensional stability of the palatal rugae in the antero-posterior and transverse dimensions following RME treatment, as well as the three-dimensional changes in palatal volume and area., Material and Methods: The sample consisted of the dental casts of 30 adolescents (16 males; 14 females, age 11.46 ± 1.42 years) who underwent RME. The models, available at T1 (pretreatment) and T2 (immediately after expansion) were scanned using a laser scanning system. Various parameters were recorded including individual ruga transverse and antero-posterior linear and angular measurements; palatal dimensions (width, length, volume, surface area, vault depth/height); and dental characteristics (interincisor, intercanine, interpremolar, and intermolar distances). Statistical analyses included paired t-tests for group comparisons, and Pearson moment product for associations among variables., Results: Palatal rugae were altered by RME in all dimensions in both linear and angular measurements, almost equally on right and left sides, albeit the average linear changes were about 1 mm. Correlation coefficients among rugal and dental measures suggested an association between rugae changes and the underlying bony movements. Except for the first rugae that had higher correlations to the intercanine width, the correspondence of changes seems to be asymmetric, thus not precisely predictable., Conclusions: The results suggest a variable trend in the rugae response to expansion, likely reflecting the constitutional asymmetric pattern or nature of pairs of rugae., (© The Author 2017. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com)

Background: The use of the palatal rugae in forensic odontology is based on their unique and individual characteristics. Few studies have assessed the palatal rugae in Mediterranean populations and none in the Lebanese population., Objective: Assess the shape and other morphological features of the palatal rugae in a Lebanese adult population, and compare them with reported similar features in other populations., Materials and Methods: Rugae characteristics were assessed on the maxillary dental casts of 217 non-growing subjects (95 males, 122 females, age 25.5 ± 7.6 years) according to guidelines established by Thomas and Kotze (1983) and Lysell (1955). The overall number of rugae and numbers of primary rugae (> 5mm in length), secondary rugae (3-5mm) and fragmentary rugae (2-3mm) on either side were recorded. Rugae were classified according to shape, direction and presence of unification. Z-tests were used to compare the proportions between right and left sides and between genders. The mean numbers of rugae in each category were compared with independent samples t-tests between males and females; paired samples t-tests were employed to compare mean numbers of rugae in each category between right and left sides. The data were compared with published reports on other Mediterranean cohorts., Results: The average number of rugae was 7.7 per individual, 3.81 on the right and 3.89 on the left. Curved, wavy and straight rugae patterns were equally common (one third each). The spatial direction of most rugae (49.3%) was backward. Circular, non-specific and convergent rugae were rare (< 2% each). Rugae numbers (total, primary, secondary, fragmentary) were symmetrical but shape, direction and the occurrence of convergence were asymmetrical (p < 0.05). None of the examined characteristics showed gender dimorphism. Tabulated comparisons disclosed the equality of rugae patterns as major differences with findings from other Mediterranean studies., Conclusions: The palatal rugae in the Lebanese population display shape distinct from other reported Mediterranean and non-Caucasian populations. Studies in large samples and primary comparisons with other Mediterranean populations are warranted.

Background: The associations between the length and morphological shape-related characteristics of palatal rugae have not been fully explored., Objective: We aimed to assess the possible association among various geometric configurations of the palatal rugae in an adult population., Materials and Methods: The maxillary dental casts of 217 non-growing subjects (95 males, 122 females, mean age 25.5±7.6 years) were scanned (laser scanning system Perceptron ScanWorks® V5) and digitized for linear measurements. The casts were also surveyed for visual categorization into curved, wavy, straight and other topographical forms, along with spatial direction of the rugae and the presence of unification. The rugae were categorized as primary, secondary, and fragmentary based on their lengths (> 5mm, 2-3mm, < 2mm, respectively). Chi square and one-way ANOVA and post-hoc tests were used to compare the palatal rugae groupings., Results: Primary and backward-directed rugae prevailed in the total sample (84.7% and 49.3%, respectively). Wavy form was dominant among primary lengths, while straight form was associated with the shorter secondary and fragmentary groups (p=0.0042). Absence of unification was the norm (88.8%)., Conclusions: Associations of length and shape characteristics among palatal rugae combine wavy patterns with increased length, and straight forms with shorter folds. These features contribute to the definition of ruga individuality in combination rather than separately.

While abundant research has been conducted on palatal rugae (PR), the literature pertaining to the sex dimorphism of the palatal rugae and their use for sex prediction is inconclusive. Moreover, palatal rugae have been classified into categories based on length, shape, direction and unification but accurate rugal morphometric linear and angular measurements have not yet been reported., Objective: The aims of this study were to -1- assess the dimensions and bilateral symmetry of the first three palatal rugae in an adult population and -2- explore sex dimorphism and the ability to predict sex from palatal rugae measurements., Materials and Methods: The maxillary dental casts of 252 non-growing subjects (119 males, 130 females, mean age 25.6 ± 7.7 years) were scanned using a laser system (Perceptron ScanWorks® V5). Angular and linear transverse and anteroposteior measures of the first three palatal rugae were recorded. Independent samples t-tests and paired samples t-tests were used to test for side related differences and sex dimorphism. Multiple logistic regression was employed to model sex using associated palatal rugae measures., Results: Palatal rugae exhibited lateral asymmetry in the majority of bilateral measures. Males presented with larger values for 9 out of 28 parameters. Four linear rugae measurements and one angular measurement together correctly classified 71.4% of the subjects in their true gender., Conclusions: Morphometric palatal rugae measurements demonstrated promising usefulness in sex prediction. Recording morphometric linear and angular measures is recommended as an adjunct to the commonly used classification based on the shapes of rugae.

Introduction: Asthma and allergies in addition to demanding social costs-the economic community, one of the major causes of morbidity and mortality in the world is considered. In the last decade in Iran despite the positive developments in many areas of health records into categories based asthma and allergy international standards, less attention has been paid. Improving the quality of care system, identifying groups at risk of asthma and allergies, control plan, prevention and assessment of asthma and allergies due to possible that when allergy and asthma information registration system and create the complete and timely data to be collected. Considering now an efficient national system of registration allergy and asthma that can meet the health needs can no need for this study was felt., Materials and Methods: This study, study-the comparison was done in the years 2010-2011. In this research, using library resources, information networks and consultations with experts inside the country gathered on the main axis and branches of national registration system, asthma and allergies in American countries-Australia and England were examined and given economic conditions, cultural and geographical themes for our records system, the axes were proposed objectives, structure, data elements, standard registration process? Data and classification systems are given., Results: The proposed model for national registration system, asthma and allergies in the country is shown in a table. In this table the proposed system based on six main "targets", "structure", "data elements", "data collection process," "registration criteria" and "classification system" is designed., Conclusion: The results and recommendations to the International Institute for asthma and allergies, reduction in low registers, and can increase the quality of the proposed model, including advantages in comparison with the existing system of the country noted.

Vertical maxillary asymmetry (VMA) is a condition characterized by distinct morphologic features: dentoalveolar asymmetry, canted nasal floor and occlusal plane, and asymmetric lip elevation. An extensive literature search failed to produce depictions of differential vertical asymmetry in conditions other than specific congenital or pathologic symptoms, the most prominent of which are presented in this report for comparison with VMA. The records of nine patients illustrate the localized nasal/maxillary/occlusal vertical asymmetry, which does not affect the orbits or the mandible. Although a prevalent rotational roll in spatial orientation is observed with VMA, many patients exhibit deviations in the other rotational planes of space (pitch and yaw). Potential etiology includes dentoalveolar compensation to localized skeletal or dental disturbances and possibly neuromuscular origins. Treatment approaches, prevention, and research avenues are discussed. Regardless of future confirmation of VMA as an independent entity encompassing hard and soft tissue components, its establishment as a phenotype associated with malocclusion warrants its inclusion in orthodontic diagnosis, with a possible impact on treatment planning and conduct. Moreover, its introduction as a diagnostic feature of malocclusion justifies the incorporation of the posteroanterior cephalograph as a key pretreatment record in orthodontics.

Asthma, affecting as many as 400 million individuals worldwide, is one of the most prevalent chronic health condition in the United States. With an increasing number of patients with asthma and the frequent inability of conventional lifestyle modification and therapy to effectively control the problem, nutritional and dietary therapies are being sought. This study was undertaken to investigate the efficacy of the purple passion fruit peel (PFP) extract, a novel mixture of bioflavonoids, on asthma symptoms. Patients with asthma were studied in a 4-week randomized, placebo-controlled, double-blind trial with oral administration of PFP extract (150 mg/d) or placebo pills. The effects of PFP extract were evaluated by assessing the clinical symptoms of asthma and spirometry tests. Most clinical symptoms of asthma of the PFP extract-treated group were moderated significantly compared to the baseline. The prevalence of wheeze, cough, as well as shortness of breath was reduced significantly in group treated with PFP extract (P < .05), whereas the placebo caused no significant improvement. Purple passion fruit peel extract supplementation resulted in a marked increase in forced vital capacity (P < .05) as placebo showed no effect. However, no significant improvement was observed in the forced expiratory volume at 1 second of those supplemented with PFP extract. No adverse effect was reported by any of study participants. The PFP extract may be safely offered to asthmatic subjects as an alternative treatment option to reduce clinical symptoms.

Introduction: The aims of this study were (1) to evaluate cephalometric changes in subjects with Class II Division 1 malocclusion who were treated with headgear (HG) or Fränkel function regulator (FR) and (2) to compare findings from regional superpositions of cephalometric structures with those from conventional cephalometric measurements., Methods: Cephalographs were taken at baseline, after 1 year, and after 2 years of 65 children enrolled in a prospective randomized clinical trial. The spatial location of the landmarks derived from regional superpositions was evaluated in a coordinate system oriented on natural head position. The superpositions included the best anatomic fit of the anterior cranial base, maxillary base, and mandibular structures., Results: Both the HG and the FR were effective in correcting the distoclusion, and they generated enhanced differential growth between the jaws. Differences between cranial and maxillary superpositions regarding mandibular displacement (Point B, pogonion, gnathion, menton) were noted: the HG had a more horizontal vector on maxillary superposition that was also greater (.0001 < P < .05) than the horizontal displacement observed with the FR. This discrepancy appeared to be related to (1) the clockwise (backward) rotation of the palatal and mandibular planes observed with the HG; the palatal plane's rotation, which was transferred through the occlusion to the mandibular plane, was factored out on maxillary superposition; and (2) the interaction between the inclination of the maxillary incisors and the forward movement of the mandible during growth., Conclusions: Findings from superpositions agreed with conventional angular and linear measurements regarding the basic conclusions for the primary effects of HG and FR. However, the results suggest that inferences of mandibular displacement are more reliable from maxillary than cranial superposition when evaluating occlusal changes during treatment.

The aim of the present study was to examine the effects of a course of aerobic exercise on pulmonary function and tolerance of activity in asthmatic patients. Among the asthmatic patients, 36 patients (M= 16, F= 20) were chosen after clinical examinations, pulmonary function test, skin prick test (SPT) for aeroallergen and a six minute walk test (6MWT) on their own free will. A patient was said to have Exercise Induced Asthma (EIA) when he/she fulfilled the following criteria; (1) FEV1 less than 80%, (2) 12% increase or more in FEV1 or PEF after short-acting ss2 agonist prescription and (3) 15% decrease in FEV1 or PEF after 6MWT with 70% or 80% of maximum heart rate. The patients were randomly put into two groups of case (M=8, F=10, Mean age=27) and control (M=8, F=10, Mean age=29). Case group participated in eight-week aerobic exercise plan, while control group had no plan of exercise. Pulmonary function tests were done before and after the course of exercise. There were significant changes in FEV1, FVC, PEF, FEF25-75%, MVV, RF and 6MWT between asthmatic patients of the two groups (P less than or equal to 0.05), but FEV1/FVC showed no significant change. Mean of changes in FEV1, FVC, PEF, FEF25-75%, MVV, RF and 6MWT were -25.56, -17.19, 32.09, -27.93, -22.18, 5.63 and -307.5 in case group respectively while they were 6.2, 4.67, 1.96, 6.65, 15.56,-2.87 and 18.78 in the control group. This study shows that aerobic exercises in asthmatic patients lead to an improvement in pulmonary functions. Aerobic exercise rehabilitation can be a complement to medical treatment of asthma.

Superimposition of serial cephalograms provides a limited description of tooth movement that could be complemented by data obtained from serial dental casts. The aim of this study was to develop a mathematical method for superimposing 3-dimensional data obtained from selected landmarks on longitudinally collected dental casts to describe maxillary first molar movement during headgear treatment. The material consisted of dental casts taken bimonthly from 36 children whose Class II Division 1 malocclusion was treated with straight-pull headgear during a 24-month period. Control data were collected from initial and final models of 38 subjects with a similar malocclusion who were not treated during a 24-month observation period. Spatial data from each subject's initial model were oriented similarly in an anatomically derived coordinate system, and a best-fit superimposition of palatal rugae landmarks from subsequent models allowed the measurement of molar movement. On average, headgear treatment resulted in distal movement of the molars, and the fitted net difference between treated and control subjects was 3.00 mm (SE, 0.37 mm; P < .001). Also, the headgear caused significantly more molar extrusion (0.56 mm; SE, 0.20 mm; P < .006) and buccal expansion (0.58 mm; SE, 0.17 mm; P < .001) on average than in the control group. Poor reliability of the method for measuring molar rotations indicated that they could not be determined accurately. Longitudinal description of molar movement for each subject revealed great individual variability in the amount and pattern of tooth movement. Several reasons could account for the wide range of individual variation and warrant exploration.

The aims of this study were (1) to develop a reliable noninvasive method to evaluate the masseter muscle metabolism, by using (31)P-magnetic resonance spectroscopy, and (2) to evaluate the metabolic profile of the masseter muscle in subjects with various facial patterns. The maxillary-mandibular relationship, which varied from hypodivergent to hyperdivergent, was measured on lateral cephalograms of 20 adults, 22 to 35 years of age. (31)P-spectra were acquired from the masseter muscle at rest with a custom-made, single-turn, double-tuned, 3 x 5-cm oblong surface coil. The inorganic phosphate to phosphocreatine (Pi/PCr) ratios were measured and compared in relation to vertical and sagittal cephalometric measurements. A statistically significant (R(2) = 0.65, r = 0.81, P = .001) relationship was found between Pi/PCr ratio and the palatal-to-mandibular plane angle. As the maxillary-to-mandibular divergence increased, the Pi/PCr ratio decreased. This correlation suggests that muscles with a higher Pi/PCr ratio have a higher resting metabolic activity than those with a lower Pi/PCr ratio. Consequently, these muscles may keep bone under more tension and influence its growth in a more horizontal direction. Another possible explanation of the results is that the fiber type composition of the masseter muscle varies with facial morphology.

We report a rare case of an ectopic third molar at the level of the osteomeatal complex. A 21-year-old man came to us with a left-sided nasal obstruction of 2 years' duration. Computed tomography of the paranasal sinuses revealed that an aberrant tooth was obstructing the osteomeatal complex and bulging into the ethmoid infundibulum. Opacity of the entire left maxillary sinus indicated the presence of an associated cystic formation. A transnasal endoscopic sinus technique was employed to create a large middle meatal antrostomy and to remove the tooth as well as the cystic contents and cyst wall. Pathologic analysis revealed that the cyst was dentigerous. After recovery from surgery, the patient resumed nasal breathing. The endoscopic surgical approach used in this case caused less morbidity than do the more common methods (e.g., the Caldwell-Luc procedure) of removing ectopic teeth from the sinus.

The aim of the study was to evaluate posteroanterior (PA) cephalometric characteristics in a normal longitudinal database and compare these measurements with corresponding measures in a group of patients treated with rapid maxillary expansion. Posteroanterior cephalographs of 16 girls and 14 boys from the Bolton-Brush growth study, taken at ages 10 and 18 years, were used to track growth in children with normal occlusion. Pretreatment PA cephalograms of 24 patients who had palatal distraction around age 10 were compared with the 10-year-old normal patients. Digitized landmarks included right and left jugale (J, at intersection of maxillary tuberosity and zygomatic buttress) and antegonion (AG, at notch of antegonial protuberance). Mandibular width (AG-AG) was similar in boys and girls at age 10 but not 18, when the difference between gender groups was statistically significant (P < .05). Maxillary width (J-J) was greater in boys than girls at both ages. The increase in AG-AG (5.5 mm, boys; 3.9 mm, girls) was more than twice that of J-J (2.4 mm, boys; 1.2 mm, girls). Arch width (at first molar) was nearly stable with age, indicating compensatory occlusal adaptation to differential changes between maxillary and mandibular widths. At age 18, the distance between the centers of the orbits, a surrogate measure of cranial width, was almost equal to J-J in girls and significantly correlated with AG-AG in boys (r = .71, P < .002) and girls (r = .77, P < .0001). The majority of treated children had both skeletal and dentoalveolar widths narrower than control values. Linear regressions between J-J and AG-AG revealed almost parallel slopes for control and treated groups in both genders, but the treated group was at a lower level, which is consistent with smaller maxillary widths.

Identification of craniofacial landmarks, particularly condylar anatomy, on the lateral cephalometric radiograph is erratic. The accuracy of recognition is critical for proper diagnosis of malocclusion and for assessing growth and orthodontic treatment. The aim of this study was to evaluate the identification of condylion and other cephalometric landmarks commonly used, or thought to be easily identifiable. A lateral cephalograph was taken on each of 34 adult subjects. Five examiners, three orthodontists, a dental radiologist and a second-year orthodontic resident rated the condyle, along with sella (S), nasion (Na), point A (A), infradentale (I), pogonion (Pog) and menton (Me) as identifiable, non-identifiable and interpreted. In addition, distances between several of these landmarks were measured. The left condyle, subject to less magnification than the right condyle because it is closer to the film, was more identifiable than the right condyle, which had the highest rating as non-identifiable. Among other landmarks, nasion and point A were the least identifiable, Pog and Me the most. Correlation coefficients for measurements between identifiable landmarks (I-Me) were greater than coefficients for distances involving less identifiable landmarks (S-A). Interestingly, linear measurements were less variable than the identification of corresponding landmarks. These findings corroborate the previous conclusions that clearly identifiable (and the least amount of interpreted) landmarks should be used for proper evaluation of dentofacial relationships. They also suggest, on average, precision in landmark identification is more critical for research purposes than in routine clinical cephalomteric measurements, which serve only as a guide to diagnosis.

Cephalometric superimposition on cranial base is the accepted method for evaluating mandibular displacement during orthodontic treatment and/or growth. However, assessing mandibular position relative to the maxillary base may yield different information. The aim of this study was to evaluate the effects of regional superpositions (cranial versus maxillary) on interpreting mandibular displacement. Both methods were applied to pre- and posttreatment cephalograms of 22 growing children (12 female, 10 male) treated for Class II Division 1 malocclusion. Differences in linear and angular measurements of three mandibular landmarks (pogonion, gnathion, menton) between cranial and maxillary superpositions were statistically significant (p = 0.0001). Vertical displacement of these landmarks contributed significantly to the differences (p = 0.0001). The contribution of horizontal displacement was not statistically significant. The results support the proposition that, in growing children, posttreatment displacement of mandibular skeletal and dental components should be assessed by both maxillary and cranial base superimpositions. The maxilla is subject to rotational and translational changes during growth that may affect the position of the mandible relative to the maxilla in a way inconsistent with the mandibular displacement perceived upon cranial superposition. Since occlusion is directly associated with the positions of the maxillary and mandibular basal bones, the positions of these bones relative to each other is critical in assessing occlusal changes in individual patients.

The aim of this study was to evaluate the correlation between timing of emergence of the permanent teeth and sagittal occlusal changes in children enrolled in a prospective clinical trial of Class II, division 1 treatment. The children, ages 7.2-13.3 years, met strict inclusion criteria and were assigned at random to treatment with either a headgear or a Fränkel functional appliance. Relationships between maxillary and mandibular first molars and canines, as well as overjet, were measured with digital calipers on casts made every 2 months and mounted on a SAM II articulator. The emergence of a permanent tooth was scored on a scale from 1 to 3, depending on the eruptive level of the tooth from cutting through the gingiva (1) to reaching the occlusal table (3). Specifically, emergence of the second premolars (PM2) and permanent second molars (M2), the most adjacent teeth to the first molars, was evaluated as it interacted with the development of the sagittal occlusion. Treatment of the distocclusion was as effective in late childhood as in mid-childhood. Within each appliance group, the emergence of PM2 and M2 did not affect the amount of progress toward Class I significantly (p > 0.05), indicating that improvement from distocclusion to neutrocclusion with each appliance is not influenced by the timing of emergence of these teeth. Although these findings support a one-phase treatment starting in the late mixed dentition, earlier intervention in mid-childhood may be required in the presence of several developmental conditions, or when the dental and skeletal development deviate significantly in the individual patient.

This communication addresses the issue of interpretation of serial cephalometric records. Angular measurements provide information that combines the vertical and sagittal components of a landmark's displacement. For example, a decrease in the SNA angle following orthodontic treatment with a headgear demonstrates maxillary retraction relative to nasion, an important assessment to depict a change closely related to the facial profile. Upon superimposition on the anterior cranial base, however, the vertical movement of point A may be the prevalent displacement, which would still account for the decrease in the SNA angle. The superposition allows the evaluation of the displacement in its vertical and sagittal components separately, relative to a structure that is relatively more stable than nasion. The superimposition enhanced the precision of the information regarding the actual displacement of the jaw. A patient's cephalometric records are presented, further demonstrating that the interpretation of changes during growth and treatment should be based not only on angular measurements, but also on regional superpositions. The frames of reference of both procedures are needed to fully understand the facial changes.

The purpose of this paper was to compare the findings from three randomized clinical trials that investigated alternative treatments of Class II, division 1 malocclusion in young children. The trials were conducted at the University of North Carolina, the University of Florida, and the University of Pennsylvania. The appliances investigated in each center were a functional appliance versus a headgear. Variations in the specific aims and the working hypotheses were noted. The types of appliances, length of treatment, and methods of evaluation were also different. A general comparison of selected clinically relevant findings reveals similarities and differences in conclusions, but underlines the importance of assessing each study on the basis of its original hypothesis. The separate and combined contribution of these studies to the state of knowledge and research is discussed.

In an attempt to increase retention of orthodontic bands, orthodontic companies market bands with surfaces prepared to increase roughness. A comparison of six groups of bands, including two with untreated surfaces, revealed a wide range of variation in shear forces. Three classes of retention may be differentiated on the basis of non-statistically significantly different mean shear forces in each category: high (Unitek, treated), moderate (Unitek, untreated; A Co., treated; GAC, treated), and low (A Co., untreated; Dentaurum, treated). Surface roughness, as evaluated through atomic force microscopy, correlated moderately with shear force (r = 0.61; p < 0.05). This method is examined and compared with the qualitative profiles of the orthodontic band surfaces provided by optical micrography.

A prospective randomized clinical trial was conducted to evaluate the early treatment of Class II, Division 1 malocclusion in prepubertal children. Facial and occlusal changes after treatment with either a headgear or a Fränkel function regulator are reported. Molar and canine relationships, overjet, intermolar and intercanine distances were measured from casts taken every 2 months, and mounted on a SAM II articulator. Cephalometric radiographs were taken annually. The results indicate that both the headgear and function regulator were effective in correcting the malocclusion. A common mode of action of these appliances is the possibility to generate differential growth between the jaws. The extent and nature of this effect, as well as other skeletal and occlusal responses differ. Treatment in late childhood was as effective as that in midchildhood. This finding suggests that timing of treatment in developing malocclusions may be optimal in the late mixed dentition, thus avoiding a retention phase before a later stage of orthodontic treatment with fixed appliances. However, a number of conditions may dictate an earlier intervention in the individual patient.

Norms available for the posteroanterior (PA) cephalometric analysis yield different information. The material used to generate these standards is not clearly defined. The purpose of this study was to use data from the Bolton-Brush Growth Study to generate new norms for the PA analysis. The Bolton material is recognized as a controlled longitudinal record of growing children. The assumption that growth in the transverse dimension is the first to be completed is challenged by finding that increments in maxillary and mandibular width vary, like sagittal and vertical growth, according to gender and chronologic age.

The relationship between somatic growth and orthodontic treatment has been limited to the evaluation of body height and skeletal age relative to craniofacial development. The aim of this study was to evaluate the correlation of anthropometric and biochemical measures of general growth with facial and occlusal changes during the early treatment of Class II Division 1 malocclusion. Findings are reported from 46 children, ages 7.20 to 12.85 years (skeletal ages, 5.75 to 12.75 years), who are enrolled in a prospective clinical trial. Body and knee heights were measured monthly, with a Holtain stadiometer and a Knee Height Measuring Device, respectively. Every three months, serum levels were measured of the hormone dehydroepiandrosterone sulfate (DHEAS), an androgen associated with growth in midchildhood, and osteocalcin, an indicator of bone turnover. Significant correlations existed between knee height and various occlusal measurements, but mandibular length was not significantly correlated with knee height and DHEAS levels. Knee height correlated significantly (P < .05) with DHEAS and osteocalcin only in 46% and 37% of the children, respectively. The results indicate that the evaluated biochemical measures, at the time intervals considered, may not increase the accuracy of growth depiction by physical measures alone (height and skeletal maturation).

Ceramic brackets became popular as esthetic appliances which could withstand orthodontic forces and resist staining better than plastic brackets. Several clinical complications may arise from the use of ceramic brackets. They include the effects debonding can have on underlying enamel, attrition of teeth occluding with ceramic brackets and increased friction in the orthodontic appliance. Solutions to these problems are discussed which indicate the need for careful selection of teeth to be bonded with ceramic brackets.

This study uses comparisons of silhouette profiles to determine the effects of orthodontic treatment on facial esthetics. Forty-eight white patients with Class II, Division 1 malocclusions and mandibular retrognathism were treated, without tooth extraction, with the Fränkel appliance and by the Begg light-wire, the straight-wire edgewise, and the Tweed edgewise methods. One hundred first-year dental students selected the profile which they estimated had the best facial esthetics and then evaluated this preferred profile as "satisfactory" or "unsatisfactory." As more posttreatment than pretreatment profiles were preferred for each of the four treatment groups, there was no clear trend in preference among the treatment modalities assessed. Percentages of the preferred posttreatment silhouettes selected as "satisfactory" ranged from 46 to 55. The results support the use of the silhouette in the evaluation of profiles. Also, they show the advantage of determining, in surveys of facial esthetics, whether or not preferred profiles or faces are "satisfactory" to the viewers. However, since it is a simplified representation of a profile, the silhouette is a complement to other methods of profile evaluation, not a substitute.

Mandibular displacement during orthodontic treatment and/or growth is usually analyzed through cephalometric superposition on the cranial base. Evaluation of mandibular movement in relation to the maxillary base has considerable value because the occlusion of the teeth is associated directly with the position of the maxillary and mandibular basal bones. The method of superimposition is outlined and applied to a number of treated malocclusions. Incorporation of this method in the study of treatment results is suggested.

Continuous anterior and vertical displacement of the rat mandible produces an increase in area of the resting zone and accelerated ossification of the hypertrophic zone. These responses differ greatly from those reported with intermittent displacement. They may be transient, or they may be an expression of accelerated maturation.