David M. Sarver

Combined rapid maxillary expansion and protraction facemask in the treatment of class III malocclusions in growing children: A prospective long-term study

A prospective study of 28 growing children (mean age of 8 years 3 months) with Class III malocclusions was consecutively treated using rapid maxillary expansion and maxillary protraction. All patients were treated from a negative overjet to a positive overjet and from a Class III dental malocclusion to a Class I dental relationship. For each patient, a lateral cephalogram was taken before treatment (T1), immediately posttreatment (T2), and after an observation period (T3) averaging 2 years 5 months. Using analysis of variance, the cephalograms were analyzed to determine skeletal and dental changes resulting from treatment. Long-term changes (2 years 5 month observation period) were also evaluated. Results showed that immediately posttreatment, the maxilla moved anteriorly a mean of 1.54 mm and Sella-Nasion-A point increased 0.87 degree. The maxillary teeth moved anteriorly 2.73 mm and proclined 5.23 degrees, while the mandible rotated in a downward and backward direction. Long-term, the anterior position of the maxilla was maintained, but some of the Class III correction was lost because of mandibular growth. Comparison of this studys results to Riolos longitudinal Class I data showed that, overall, rapid palatal expansion and maxillary protraction produced a small orthopedic effect with a moderate dentoalveolar effect which together contributed to the correction of the Class III malocclusion.

Orthognathic surgery and aesthetics: planning treatment to achieve functional and aesthetic goals.

Computerized video imaging is a valuable adjunct for communication with patients and planning orthognathic surgical treatment. The incorporation of adjunctive soft tissue procedures to enhance the final aesthetic result of orthognathic surgery is a valuable addition to the orthodontic and orthognathic treatment plan. This paper presents the use of video imaging techniques in the planning and execution of comprehensive functional and aesthetically orientated orthodontic and surgical treatment.

Simultaneous rhinoplasty procedures in orthognathic surgery

22 septorhinoplasties were performed in conjunction with orthognathic surgery, and followed for at least 12 months. No significant difference could be established between 15 cases done with a LeFort I and 7 cases done with isolated sagittal split osteotomies. Rigid bicortical fixation of the mandible was required to change the endotracheal tube from nose to mouth. Plating of the maxilla is recommended to achieve a stable bony support for the nose. Patient satisfaction and perception were surveyed. Clinical results are presented with pre- and post-operative photographs, along with mean data for the total group.

Interactions of hard tissues, soft tissues, and growth over time, and their impact on orthodontic diagnosis and treatment planning.

The approach to orthodontic diagnosis has changed gradually but steadily over the past 2 decades. The shift away from diagnosis based entirely on hard tissue evaluations has been a result of a broadened recognition of the importance of facial and smile appearance to our patients, and how they change over time. The purpose of this article is to describe and illustrate the integration of the new soft tissue paradigm into long-term treatment planning, with a focus on the esthetic goals of treatment.

Video Imaging—a Computer Facilitated Approach to Communication and Planning in Orthognathic Surgery

A case report is presented in order to illustrate the benefits of computerized video imaging in orthognathic surgery. It is suggested that superimposition of the cephalogram on the video image is helpful in treatment planning and in communication with the patient. Computerized video imaging techniques help clinicians and patients discuss the aesthetic impact of orthognathic surgery. The superimposition of the cephalogram and profile image, coupled with algorithmic predictions, allow the clinician to plan the surgery to closely match the desired result. This paper presents the planning and counselling of a patient using contemporary computerized video imaging techniques.

Effects of FGFR Signaling on Cell Proliferation and Differentiation of Apert Dental Cells

The Apert syndrome is a rare congenital disorder most often arising from S252W or P253R mutations in fibroblast growth factor receptor (FGFR2). Numerous studies have focused on the regulatory role of Apert FGFR2 signaling in bone formation, whereas its functional role in tooth development is largely unknown. To investigate the role of FGFR signaling in cell proliferation and odontogenic differentiation of human dental cells in vitro, we isolated dental pulp and enamel organ epithelia (EOE) tissues from an Apert patient carrying the S252W FGFR2 mutation. Apert primary pulp and EOE cells were established and shown to exhibit normal morphology and express alkaline phosphatase under differentiation conditions. Similar to control cells, Apert dental pulp and EOE cells expressed all FGFRs, with highest levels of FGFR1 followed by FGFR2 and low levels of FGFR3 and FGFR4. However, Apert cells had increased cell growth compared with control cells. Distinct from previous findings in osteoblast cells, gain-of-function S252W FGFR2 mutation did not upregulate the expression of epidermal growth factor receptor (EGFR) and platelet-derived growth factor receptor (PDGFRα), but elevated extracellular signal-regulated kinase (ERK) signaling in cells after EGF stimulation. Unexpectedly, there was little effect of the S252W mutation on odontogenic gene expression in dental pulp and EOE cells. However, after inhibition of total FGFR signaling or ERK signaling, the expression of odontogenic genes was upregulated in both dental cell types, indicating the negative effect of whole FGFR signaling on odontogenic differentiation. This study provides novel insights on FGFR signaling and a common Apert FGFR2 mutation in the regulation of odontogenic differentiation of dental mesenchymal and epithelial cells.