Alexandra Ioana Holst

Three-dimensional Analysis of Facial Symmetry in Cleft Lip and Palate Patients Using Optical Surface Data

Aim:Presentation of a new technique to determine the plane of symmetry of a face, and to assess the degree of facial symmetry in patients with unilateral cleft lip and palate based on three-dimensional (3D) optical surface data.Patients and Methods:After having determined a plane of symmetry according to optical 3D facial surface data, we identified differences in landmarks, the surface areas of the upper lip vermilion and nostrils and virtual volumes of the midface, nose and upper lip for cleft and unaffected sides in forty 10-year-old patients suffering from complete unilateral cleft lip, alveolus and palate. The children had undergone lip repair via the Tennison-Randall technique and had received subsequent orthodontic treatment (but not secondary osteoplasty).Results:Statistically significant differences were apparent between cleft and non-cleft sides in terms of the nasal landmarks, nostril angle and virtual volume of the nose. The upper lip was symmetrical when cleft and non-cleft sides were compared.Conclusions:This new technique of symmetry analysis reveals that the noses of 10-year-old patients with complete unilateral cleft lip and palate who had not undergone revisional surgery present a measurable and significant degree of asymmetry, while the upper lip is symmetrical as a consequence of interdisciplinary treatment by orthodontists and oral and maxillofacial surgeons. Further 3D analyses on larger numbers of patients will allow more comprehensive and consistent analysis of the potential and limitations of various surgical and conservative methods so as to identify those techniques with the best outcome in terms of facial symmetry.ZusammenfassungZiel:Ziel der Studie war es, eine neue Technik zur Beurteilung der Symmetrieebene des Gesichts auf Basis dreidimensionaler Datensätze vorzustellen und ihre Anwendung bei Patienten mit einseitiger Lippen-Kiefer-Gaumen-Spalte zu demonstrieren.Patienten und Methodik:Bei vierzig 10-jährigen Patienten mit einseitiger, vollständiger Lippen-Kiefer-Gaumen-Spalte, die bisher keine sekundäre Osteoplastik erhalten hatte, aber alle kieferorthopädisch behandelt wurden, erfolgte mit Hilfe von optischen 3-D-Daten der Gesichtsoberfläche und einer spezialisierten Software die Bestimmung der Symmetrieebene. Danach wurden die Unterschiede zwischen Landmarken, Flächen des Lippenrots und der Nasenlöcher sowie virtueller Volumina des Mittelgesichts, der Nase und der Oberlippe getrennt nach Gesichtshälften berechnet.Ergebnisse:Zwischen der Gesichtshälfte mit Spaltbildung und der Seite ohne Spalte bestanden statistisch signifikante Unterschiede in Bezug auf Landmarken, Winkel, Flächen und Volumina der Nasen. Im Bereich der Oberlippe wurden keine statistisch signifikanten Unterschiede zwischen der Spaltseite und der nicht betroffenen Seite bestimmt.Schlussfolgerungen:Die vorgestellte Technik der Symmetrieanalyse zeigt beim vorliegenden Patientengut, dass 10-jährige Patienten mit einseitiger Lippen-Kiefer-Gaumen-Spalte, die keine Korrekturoperationen im Verlauf erhielten, eine messbare, statistisch signifikante Asymmetrie der Nase aufweisen. Die Oberlippe dagegen ist bedingt durch das interdisziplinäre Behandlungskonzept aus kieferorthopädischen und mund-, kiefer- und gesichtschirurgischen Maßnahmen symmetrisch. Weitere dreidimensionale Analysen einer größeren Anzahl von Patienten werden die Möglichkeiten und Grenzen der verschiedenen operativen und konservativen Behandlungsmöglichkeiten herausstellen und die Auswahl des Behandlungskonzeptes erleichtern, das in Bezug auf die Gesichtssymmetrie mit den besten Ergebnissen aufwartet.

Vertical and Sagittal Growth in Patients with Unilateral and Bilateral Cleft Lip and Palate—A Retrospective Cephalometric Evaluation:

Objective: To investigate whether the craniofacial vertical and sagittal jaw relationship in patients with cleft lip and palate (CLP) differed from that of age-matched noncleft controls, before and after the pubertal growth spurt. Design: Retrospective observational study. Patients: The study group comprised 126 patients with CLP, subdivided according to gender and cleft type, and the control group comprised 53 age-matched skeletal class I patients. Methods: Angular and linear measurements were taken from prepubertal and postpubertal lateral cephalograms of all patients. Results: In patients with cleft lip and palate, the maxillary retrognathism became more remarkable with increasing age; whereas, the retrognathic position of the mandible became less pronounced as compared with controls. Reduced posterior midfacial height, a common prepubertal finding in patients with cleft lip and palate, was significant in postpubertal girls and young women with unilateral cleft lip and palate (p  =  .002). The total anterior facial height in male patients with bilateral cleft lip and palate was larger than in control patients (p  =  .002) after the pubertal growth spurt due to an increased anterior midfacial height. In male patients with unilateral cleft lip and palate, this finding was due to an increased anterior lower facial height (p < .001). Conclusions: Patients with cleft lip and palate treated according to a standardized treatment concept had adequate craniofacial jaw relationships after puberty. Despite a measured skeletal class I in both male and female patients with cleft lip and palate regardless of cleft type, there was a slight tendency toward a skeletal class III. Findings were similar for all groups of cleft lip and palate patients irrespective of the type of orthodontic treatment performed.

Noncontact intraoral measurement of force-related tooth mobility

The aim of this pilot study was to measure force-related tooth mobility. Vertical and horizontal anterior tooth mobility in 31 healthy periodontal subjects was measured by a noncontact optical measurement technique. The subjects continuously increased the force on each tooth by biting on a load cell. An automated software program recorded tooth displacement at 9-N intervals. Vertical and horizontal displacements were subsequently measured. The vector of tooth mobility in the buccal direction was calculated using the Pythagorean theorem. The average displacements over all subjects for each tooth were determined. Global differences were assessed with the Wilcoxon test. There were no significant differences between contralateral teeth overall load stages. There were no significant differences in tooth mobility between the central and lateral incisors except for in the horizontal direction. However, there were significant differences between central incisor and canine and lateral incisor and canine teeth.

Prosthetic Considerations for Orthodontic Implant Site Development in the Adult Patient

Proper site development is a key factor for long-term clinical success of dental implants. Whereas surgical and restorative techniques have been refined to ensure predictable functional and esthetic outcome, individual clinical prerequisites do not always allow proper placement of implants when prosthetic and material properties are considered. Orthodontic tooth movement may be a viable and nonsurgical site development treatment option. With the introduction and advancements of minimal invasive and less visible orthodontic appliances, a growing number of adult patients are willing to obtain orthodontic treatment. The spectrum of modern appliances is broad and ranges from clear aligners to lingual brackets. Skeletal anchorage devices such as orthodontic mini-implants often eliminate unpopular external anchorage devices (ie, headgear) in adult patients, This article discusses the selection of an appropriate pretreatment approach by taking patient-specific criteria into account.

Automatically evaluated degree of intelligibility of children with different cleft type from preschool and elementary school measured by automatic speech recognition

Maria Schuster *, Andreas Maier , Tobias Bocklet , Emeka Nkenke , Alexandra Holst , Ulrich Eysholdt , Florian Stelzle d Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Ludwig-Maximilians-University Munich, Marchioninstrasse 15, D-81377, Munich, Germany b Pattern Recognition Lab, Technical Faculty, Friedrich-Alexander-University Erlangen-Nuremberg, Martensstrasse 3, D-91058 Erlangen, Germany Department of Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Bohlenplatz 21, D-91054 Erlangen, Germany Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glucksstrasse 11, D-91054 Erlangen, Germany e Clinic for Orthodontics, University Hospital Erlangen, Gluckstrasse 11, D-91054 Erlangen, Germany

Blood transfusion in bimaxillary orthognathic operations: Need for testing of type and screen

We prospectively evaluated the incidence of blood transfusion in 105 consecutively treated patients (45 men and 60 women) having bimaxillary orthognathic operations, to find out whether type and screen testing are adequate in clinical practice. All patients had Le Fort I osteotomy combined with bilateral sagittal split osteotomy of the ramus. The preoperative routine was restricted to type and screen testing and verification of ABO/Rhesus (Rh) status. Autologous blood donation or routine cross-matching of allogeneic units of blood was not done. Intraoperative haemoglobin concentrations and the need for blood transfusion in patients having bimaxillary osteotomies were recorded in a prospective database. The mean duration of operation was 196 min (range 115-325). The median length of hospital stay was 8 days (range 4-16). The mean (SD) reduction in haemoglobin during operation was 34 (16)g/L in men and 32 (10)g/L in women (p=0.32). No patients had an allogeneic blood transfusion. We found that type and screen testing and verification of ABO/Rh status seems to be an adequate precaution to manage blood loss. As reflected by the low rate of transfusion in the present study, severe haemorrhage that requires transfusion of allogeneic blood has become the exception rather than the rule in bimaxillary orthognathic operations.

Restoration of a nonrestorable central incisor using forced orthodontic eruption, immediate implant placement, and an all-ceramic restoration: A clinical report

The long-term clinical and esthetic success of an implant-supported restoration is determined by stable periimplant soft-tissue morphology that is in harmony with the surrounding tissue architecture of the natural dentition. An interdisciplinary approach can significantly improve predictability when restoring missing teeth in the anterior maxilla. This clinical report describes the application of forced orthodontic eruption prior to initiation of surgical and restorative implant treatment to achieve a coronal shift of bone and gingiva and enhance the 3-dimensional topography of the recipient implant site.

Diagnostic potential of 3D-data-based reconstruction software: an analysis of the rare disease pattern of cherubism.

Cherubism is an autosomal-dominant syndrome characterized by bilateral maxillomandibular bony degeneration, fibrous connective tissue hyperplasia, and displacement of permanent tooth germs. Reossification of the cystic lumen occurs spontaneously, but dislocated teeth must be realigned orthodontically. Advancements in virtual 3D reconstruction of anatomic structures based on computed tomography (CT) or cone beam CT data have provided for more predictable individual treatment planning. We evaluated two software programs for making densitometry and volume measurements of cystic areas in the mandibles, and for 3D visualization of permanent tooth germs within the cystic lumen, in two siblings with cherubism.

Retrieval analysis of different orthodontic brackets: the applicability of electron microprobe techniques for determining material heterogeneities and corrosive potential

Objective The objective of this study was to investigate the applicability of micro-analytical methods with high spatial resolution to the characterization of the composition and corrosion behavior of two bracket systems. Material and methods The surfaces of six nickel-free brackets and six nickel-containing brackets were examined for signs of corrosion and qualitative surface analysis using an electron probe microanalyzer (EPMA), prior to bonding to patients tooth surfaces and four months after clinical use. The surfaces were characterized qualitatively by secondary electron (SE) images and back scattered electron (BSE) images in both compositional and topographical mode. Qualitative and quantitative wavelength-dispersive analyses were performed for different elements, and by utilizing qualitative analysis the relative concentration of selected elements was mapped two-dimensionally. The absolute concentration of the elements was determined in specially prepared brackets by quantitative analysis using pure element standards for calibration and calculating correction-factors (ZAF). Results Clear differences were observed between the different bracket types. The nickel-containing stainless steel brackets consist of two separate pieces joined by a brazing alloy. Compositional analysis revealed two different alloy compositions, and reaction zones on both sides of the brazing alloy. The nickel-free bracket was a single piece with only slight variation in element concentration, but had a significantly rougher surface. After clinical use, no corrosive phenomena were detectable with the methods applied. Traces of intraoral wear at the contact areas between the bracket slot and the arch wire were verified. Conclusion Electron probe microanalysis is a valuable tool for the characterization of element distribution and quantitative analysis for corrosion studies.