Anne Marie Bollen

Bone resorption rates in children monitored by the urinary assay of collagen type I cross-linked peptides

When bone is resorbed, cross-linking amino acids from collagen type I (pyridinolines) are excreted in the urine as small peptides. The purpose of this cross-sectional study was to measure the urinary excretion of type I collagen bone degradation products in children and to correlate the results with growth velocity on a population basis. Spot urines from 1076 children and 24 adults were analyzed. The concentrations of cross-linked N-telopeptides of collage type I were measured using a new monoclonal antibody-based microtiter-plate assay, and normalized to creatinine. Age-related changes in cross-link excretion mirrored published standard growth velocity rates for males and females. The correlation coefficient between growth rates and cross-link excretion was 0.91. These results encourage more definitive longitudinal studies where growth rates and collagen cross-link excretion are correlated on an individual-patient basis.

Activation time and material stiffness of sequential removable orthodontic appliances. Part 1: Ability to complete treatment

Recent advances in technology have led to the availability of sequential removable orthodontic appliances (aligners) to move teeth in a stepwise fashion (Invisalign, Align Technology, Santa Clara, Calif). This study was undertaken to compare 2 distinctly different materials (hard and soft) and 2 activation frequencies (1 week and 2 weeks) for this technique. Fifty-one subjects, stratified by peer assessment rating (PAR) and need for extractions, were randomly assigned to a hard or a soft plastic appliance, and a 1-week or 2-week activation time. The primary endpoint was the completion of the initially prescribed series of aligners. Changing aligners every other week was more likely to lead to completion of the initial series of aligners than changing aligners weekly (37% vs 21%). No substantial difference in the completion rate was observed for the soft versus the hard appliance (27% vs. 32%). The completion rate was highest (46%) among patients with PAR scores less than 15 and no planned extractions, and lowest (0%) among subjects who had 2 or more premolars extracted. All who completed their initial series of aligners required an additional series of aligners or fixed appliances to achieve the original treatment goals. This exploratory study suggests that subjects with a 2-week activation regimen, no extractions, and a low PAR score are more likely to complete their initial series of aligners.

Activation time and material stiffness of sequential removable orthodontic appliances. Part 2: Dental improvements ☆

Fifty-one patients were enrolled in this study to explore the treatment effects of material stiffness and frequency of appliance change when using clear, sequential, removable appliances (aligners). Patients were stratified based on pretreatment peer assessment rating (PAR) scores and need for extractions. They were randomized into 4 treatment protocols: 1-week activation with soft material, 1-week activation with hard material, 2-week activation with soft material, and 2-week activation with hard material. Patients continued with their protocols until either the series of aligners was completed, or until it was determined that the aligner was not fitting well (study end point). Weighted PAR score and average incisor irregularity (AII) indexes were used to measure pretreatment and end-point study models, and average improvement was compared among the 4 groups. In addition to the evaluation of the 4 treatment groups, comparisons were made of the individual components of the PAR score to determine which occlusal components experienced the most correction with the aligners. The percentages and absolute extraction space closures were evaluated, and papillary bleeding scores before and during treatment were compared. Although no statistical difference was observed between the 4 treatment groups, a trend was noted with the 2-week frequency having a larger percentage of reduction in weighted PAR and AII scores, and greater extraction space closure. Anterior alignment was the most improved component, and buccal occlusion was the least improved. When analyzed by type of extraction, incisor extraction sites had a significantly greater percentage of closure than either maxillary or mandibular premolar extraction sites. A statistically significant decrease in mean average papillary bleeding score was found during treatment when compared with pretreatment scores, although this difference was not clinically significant.

Effect of estrogen use on tooth retention, oral bone height, and oral bone porosity in Japanese postmenopausal women.

Objective:Recent studies in the United States support the protective effect of estrogen use on tooth retention; however, little is known as to how estrogen promotes tooth retention. The aims of this study were to investigate the effects of estrogen use on tooth retention, oral bone height, and oral bone porosity in Japanese postmenopausal women and to clarify how estrogen promotes tooth retention. Design:Relationships among the number of teeth remaining (total, anterior, and posterior teeth), oral bone height, oral bone porosity, bone mineral density of the lumbar spine and the femoral neck, estrogen use status, and the duration of estrogen use were evaluated in 330 Japanese postmenopausal women (mean age ± SD, 56.8 ± 7.6 y). Results:Analysis of covariance adjusted for confounding variables revealed that estrogen users (66 women) tended to have more posterior teeth than did nonusers (264 women) (P = 0.065), although there were no significant differences in number of total (P = 0.196) and anterior (P = 0.751) teeth remaining, oral bone height (P = 0.970), oral bone porosity (P = 0.745), and bone mineral density of the lumbar spine (P = 0.459) and the femoral neck (P = 0.749) between estrogen users and nonusers. Multiple regression analysis showed that the duration of estrogen use was significantly associated with number of total (P = 0.019) and posterior (P = 0.007) teeth remaining, independent of age and oral bone height. Conclusion:Our results suggest that estrogen may promote tooth retention by strengthening the periodontal attachment surrounding the teeth, but not increasing oral bone height and not decreasing oral bone porosity.

Number of teeth and residual alveolar ridge height in subjects with a history of self-reported osteoporotic fractures.

The purpose of this case-control study was to determine if elderly subjects with a history of osteoporotic fractures have fewer teeth and greater residual ridge resorption than subjects without such fractures. Patients older than 60 with a panoramic radiograph were invited to a phone interview. Information was obtained regarding fracture history, smoking, and hormone replacement therapy (HRT). The number of teeth was obtained from the panoramic radiograph. The residual ridge height of the edentulous mandible was measured at the site of the mental foramen. Multiple regression models were used to assess the association between fracture status and number of teeth or residual ridge height (controlling for age, gender, HRT, smoking, height and weight). Cases (n=93) were individuals reporting osteoporotic fractures (fractures occurring after minor impact). Controls (n=394) were individuals reporting traumatic fractures (n=105) or no fractures (n=289). Fracture status in this population affect neither the number of teeth nor the residual ridge height. In the regression model, the variables that had a statistically-significant effect on the number of teeth were age (p<0.0001) and smoking (p<0.0001). There was a dose-effect of smoking on the number of teeth. In the regression model, the variables that had a significantly-significant on residual ridge height (n=95 edentulous subjects) were age and gender. Our conclusion was that in elderly dental-school patients the number of teeth and residual ridge height were not influenced by fracture status. Age and smoking had the most influence ; there was no effect from HRT. The clinical implication is that a history of osteoporotic fractures is not an important cause for tooth loss and residual ridge resorption in an elderly dental-school population.

Activation time and material stiffness of sequential removable orthodontic appliances. Part 3: Premolar extraction patients

INTRODUCTION The purpose of this study was to describe the movement of teeth adjacent to premolar extraction spaces during space closure with aligner appliances and then fixed appliances. METHODS The sample included 24 subjects from a larger study investigating an aligner system. All subjects had at least 1 premolar extracted as part of treatment. Dental casts and panoramic radiographs were measured for tooth tipping adjacent to extraction spaces at 3 treatment points: T0, initial; T2, end of aligners; and T3, end of fixed appliances. Chart records were reviewed for information about time in treatment. RESULTS Treatment with aligners resulted in significant tipping of the teeth adjacent to premolar extraction sites. When followed by fixed appliances, these teeth were significantly uprighted. Aligner treatment followed by treatment with fixed appliances took an average of 40 months. CONCLUSIONS In premolar extraction patients treated with aligners, dental tipping occurs but can be corrected with fixed appliances. This dual modality treatment might require more time than treatment with fixed appliances alone.

First-Year Mortality among Infants with Facial Clefts

Children born with a facial cleft are not thought to be at a greater risk for infant mortality than are those without congenital anomalies. The purpose of this study was to investigate whether the presence of a facial cleft alone or its coexistence with other anomalies increases a childs risk for dying. Birth and death certificate data from Washington State for the years 1984 to 1988 were linked for infants who died before 1 year of age. Mortality rates for different types of facial clefts and for births without noted abnormalities were compared. Relative to infants with no diagnosed abnormalities noted in the birth certificate, infants with facial clefts without other abnormalities have a 3.7 fold increased odds for dying during their first year of life. This elevated risk for dying was fairly consistent during the first year of life. When facial clefts are associated with other abnormalities there is an 82.3 fold increase in odds for mortality during the first year of life. This elevated risk is highest during the neonatal period; 77% of all deaths occurred during the first 27 days. It is concluded that infants with facial clefts with or without associated anomalies have a significantly increased mortality risk when compared to infants without any diagnosed abnormalities at birth.

Effectiveness of the cervical vertebral maturation method to predict postpeak circumpubertal growth of craniofacial structures

INTRODUCTION Our aim was to assess effectiveness of the cervical vertebral maturation (CVM) method to predict circumpubertal craniofacial growth in the postpeak period. METHODS The CVM stage was determined in 176 subjects (51 adolescent boys and 125 adolescent girls) on cephalograms taken at the end of treatment (T2; mean ages, 15.75 years [boys] and 15.23 years [girls]) in subjects from the postretention database at the University of Washington in Seattle. Craniofacial growth was evaluated from the following measurements on cephalograms at T2 and end of follow-up (T3) (mean ages, 29.01 years [men] and 28.08 years [women]): condylion to gnathion, condylion to gonion, gonion to gnathion, sella to gnathion, nasion to menton, anterior nasal spine to menton, and sella to gonion. The change of each variable from T2 to T3 was assessed with paired t tests. Parametric (t tests or analysis of variance [ANOVA]) or nonparametric (Mann-Whitney or Kruskal-Wallis) tests were used to detect intergroup differences. RESULTS One hundred eight subjects (35 boys, 73 girls) demonstrated CVM stage 3, 56 (16 boys, 40 girls) were in CVM stage 4, and 12 (all girls) were in CVM stage 5 at T2. Intrasex comparisons showed that boys in CVM stages 3 and 4 could be differentiated regarding changes of all variables. In the girls, only those in CVM stages 3 and 4 could be differentiated based on the amount of changes of 2 measurements: condylion to gonion and sella to gonion. Intersex comparisons showed that boys in CVM stage 3 had significantly more changes than girls (P <0.01). Boys in CVM stage 4 showed significant differences compared with girls in CVM stage 4 for only 2 variables (sella to gonion and condylion to gonion; P <0.001 and P = 0.012, respectively). CONCLUSIONS The CVM method was modestly effective in determining the amount of postpeak circumpubertal craniofacial growth.

Relationship between self-reported periodontal status and skeletal bone mineral density in Japanese postmenopausal women.

Objective: Several investigators have linked periodontal disease progression and low skeletal bone mineral density in postmenopausal women. However, little is known about whether self-reported periodontal status is the reflection of skeletal bone mineral density. We investigated whether self-reported poor periodontal status is associated with low skeletal bone mineral density in postmenopausal women. Design: Relationships among self-reported periodontal status, number of teeth remaining, and bone mineral density of the lumbar spine and the femoral neck were evaluated in 253 Japanese postmenopausal women (mean ± SD, 56.6 ± 7.7) recruited from the patients who visited our clinic for bone mineral assessment between 1997 and 2003. Self-reported periodontal symptoms included gingival swelling, gingival bleeding, purulent discharge, and tooth mobility at the time of bone mineral assessment. Results: Analysis of covariance adjusted for age, height, weight, years since menopause, duration of estrogen use, and regular oral care revealed that subjects without periodontal symptoms had significantly higher BMD of the lumbar spine than did those with periodontal symptoms (mean ± SEM, 0.962 ± 0.014 vs 0.921 ± 0.013; P = 0.038); however, there were no significant differences in the number of remaining teeth and bone mineral density of the femoral neck between them. The odds of low spine bone mineral density in subjects with periodontal symptoms was 2.01 (95% CI = 1.15 to 3.50). Conclusion: Our results suggest that self-reported poor periodontal status may be associated with low bone mineral density of the lumbar spine in postmenopausal women.

Head-and-neck organ doses from an episode of orthodontic care.

INTRODUCTION The high prevalence of orthodontic treatment in young people makes the associated radiation to the head and neck of potential public-health significance. In this study, we estimated secular changes (1963-2003) in age-specific organ doses associated with orthodontic care and collective organ doses in the United States in 1999. METHODS A survey of radiographic records at 1 university clinic was combined with published estimates to provide organ-specific radiation doses. Collective organ doses were estimated from the 1999 US Nationwide Evaluation of X-ray Trends and published orthodontic utilization surveys. RESULTS Before 1992, orthodontic care in a university setting was associated with mean doses of 7.0 milligrays (mGy) to the thyroid, 0.8 mGy to the red bone marrow, 2.7 mGy to the brain, 13.2 mGy to the salivary glands, and 5.1 mGy to the bone. After 1992, the doses decreased to 2.8 mGy to the thyroid, 0.3 mGy to the red bone marrow, 0.7 mGy to the brain, 6.2 mGy to the saliva glands, and 2.4 mGy to the bone. Around 1999, the collective doses associated with orthodontic care in the United States in patients less than 19 years of age were 400 Gy to the red bone marrow and 3800 Gy to the thyroid. CONCLUSIONS Orthodontic care, in part due to its high prevalence, potentially contributes significantly to the diagnostic radiation burden in those less than 19 years old in the United States.