Hazem T. Al-Ahmad

Mixed Dentition Analysis in a Jordanian Population

OBJECTIVE To examine the applicability of the Tanaka and Johnston method of prediction in a Jordanian population and to develop a new prediction method for this specific population if necessary. MATERIALS AND METHODS Three-hundred and sixty-seven Jordanians (193 female, 174 male, mean age 15.5 years) were randomly selected to represent 0.1% of 10th grade schoolchildren from Amman, Jordan. The mesiodistal crown diameters of the permanent teeth were measured and compared with the predicted values derived from the Tanaka and Johnston equations. RESULTS Significant sexual dimorphism was found in tooth sizes. The correlation coefficients between the total mesiodistal width of the mandibular permanent incisors and that of the maxillary and mandibular canines and premolars were found to be 0.60 and 0.66, respectively. There were significant differences between the actual measurements and measurements derived from the Tanaka and Johnston equations. New linear regression equations were derived for both genders to allow tooth size prediction in Jordanians. CONCLUSIONS There is a limitation in the application of the Tanaka and Johnstons prediction method to a Jordanian population. It is important to use separate equations for male and female patients.

A comparison of health-related quality of life between Jordanian and British orthognathic patients

The aim of this study was to assess health-related quality of life (HRQoL) in adult Jordanian patients referred for orthognathic treatment, and to compare this with previously published data from a British cohort. Thirty-eight Jordanians (21 females and 17 males; aged 16-31 years) who were about to commence a course of orthognathic treatment completed a generic HRQoL questionnaire [Short-Form 36 (SF-36)] and a condition-specific orthognathic quality-of-life questionnaire (OQoLQ). The questionnaires were completed prior to commencing any pre-surgical orthodontic treatment. The data were compared using the Mann-Whitney U-test for independent groups with non-normally distributed data. There were no statistically significant differences between the Jordanian males and females for any of the OQoLQ or SF-36 items; hence, the groups were combined for analysis. When comparing the OQoL data with that of the British sample, there was no statistically significant differences for three of the four domains: dentofacial aesthetics (P = 0.726), social aspects (P = 0.096), or the awareness of dentofacial aesthetics (P = 0.066). There was, however, a significant difference for oral function (P = 0.016), with the Jordanian group reporting a poorer quality of life (QoL) (mean value 10.9) than the British cohort (mean value 8.4). However, it is questionable whether this difference would be of clinical relevance. While it was not possible to directly compare the results of the SF-36 questionnaires with the same British cohort, Jordanian patients had generally lower scores, and therefore a poorer QoL, than reported in other studies. These differences may be cultural or may be due to differences in the health care systems criteria for funding, and this needs further investigation.

Prevalence and distribution of dental anomalies: A comparison between maxillary and mandibular tooth agenesis

INTRODUCTION The aim of this study was to compare the pattern and prevalence of associated dental anomalies between maxillary and mandibular tooth agenesis (hypodontia). METHODS A sample of 3315 dental patients, aged 8.6 to 25.4 years, was surveyed for tooth agenesis (excluding third molars): 106 subjects were diagnosed with maxillary hypodontia (group 1) and 70 with mandibular hypodontia (group 2). Both groups were examined for the following dental anomalies: retained deciduous molars, infraocclusion of deciduous molars, impaction, microdontia of maxillary lateral incisors, supernumerary teeth, transposition, transmigration, and ectopic eruption of the permanent molars. For statistical testing, the chi-square test (P <0.05) was used to compare the occurrences of these anomalies among the groups. RESULTS We found that 77.5% of the patients in the mandibular hypodontia group had at least 1 dental anomaly compared with 49.5% in the maxillary hypodontia group (P <0.0001). The only dental anomaly with a significantly increased prevalence in the maxillary hypodontia group compared with the mandibular hypodontia group was microdontia of the maxillary lateral incisors (groups 1, 46.7%; group 2, 12.9%; P <0.0001). On the other hand, the prevalences of retained deciduous molars (group 1, 9.4%; group 2, 60.0%), infraoccluded deciduous molars (group 1, 0.9%; group 2, 7.1%), and impacted teeth (group 1, 22.6%; group 2, 38.6%) were significantly higher in the mandibular hypodontia group. The prevalences of supernumerary teeth, transposition, transmigration, and ectopic eruption of permanent molars were low and not significantly different between the groups. CONCLUSIONS Tooth agenesis isolated to the maxilla is frequently associated with microdontia of the maxillary lateral incisors, whereas tooth agenesis isolated to the mandible is frequently associated with retained deciduous molars, infraoccluded deciduous molars, and impacted teeth. The results of this study may provide additional evidence supporting the field-specific genetic control theory for dental development in both jaws.

The effect of temporomandibular disorders on condition-specific quality of life in patients with dentofacial deformities

OBJECTIVE This study investigated the effect of temporomandibular disorders on quality of life (QOL) of patients with dentofacial deformities. STUDY DESIGN A case-control study was performed involving 3 age- and gender-matched groups: 38 preoperative participants, 38 postoperative participants, and 39 control participants. Temporomandibular joints were assessed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD axis I), and QOL was assessed using the Orthognathic Quality of Life Questionnaire (OQLQ) and the Short-Form Health Survey (SF-36). RESULTS Significantly lower OQLQ scores were found in postoperative patients with one or more RDC/TMD findings; the domains in which these occurred were mental health, dentofacial esthetics, and awareness of dentofacial esthetics for patients with myofascial pain; social aspects and awareness of dentofacial esthetics for patients with disk displacement with reduction; and all domains for patients with arthritis (all P < .05). CONCLUSIONS Despite the variable effect of orthognathic treatment on TMDs, the presence of TMDs in patients after treatment can have a negative effect on their QOL.

Standardization of quantitative single photon emission computed tomography in control individuals and in patients with condylar hyperplasia.

ObjectivesThe aim of the study was to evaluate the diagnostic accuracy of various single photon emission computed tomography (SPECT) quantitative methods in patients with condylar hyperplasia (CH) and to investigate whether normal condylar activity changes with age. Patients and methodsWe analyzed the SPECT images of 33 patients with CH and those of 16 control individuals. Regions of interest (ROIs) were drawn on whole condyle, or fixed-size ROIs were drawn on both condyles and the clivus on the slice with higher activity [a two-dimensional (2D) approach] and on the summation of five adjacent transaxial slices [a three-dimensional (3D) approach]. A percentage difference between both condyles of above 10% or a cutoff value of 1.44 or 1.88 for abnormal condyle/clivus ratio was considered abnormal. ResultsSeventeen patients with active CH, 16 with inactive CH, and 16 control individuals were evaluated. The highest sensitivity and highest specificity were observed for the whole-condyle approach (88 and 87%, respectively), followed by the percentage 2D maximum condyle/total (82.4 and 81.3%, respectively). The condyle/clivus ratio yielded low sensitivity for both 2D and 3D approaches. No effect of age on condylar activity was demonstrated. No statistically significant difference in condyle/clivus ratio was evident between patients with active and those with inactive CH. ConclusionUse of 2D maximum fixed-size ROI and percentual difference in condylar activity offers optimal diagnostic accuracy in patients with CH and should be encouraged in future studies. The condyle/clivus ratio offers suboptimal results and cannot, therefore, be recommended. No effect of age on normal condylar activity was demonstrated.

Evaluation of an innovative computer-assisted sagittal split ramus osteotomy to reduce neurosensory alterations following orthognathic surgery: a pilot study.

Sagittal split ramus osteotomy (SSRO) can be associated with postoperative neurosensory disturbances. This study aimed to evaluate the effectiveness of computer‐assisted SSRO in reducing the incidence and severity of neurosensory alterations, using a surgical guide fabricated by computer‐aided design and rapid prototyping (to guide bone cutting lateral to the inferior alveolar nerve).

Anxiety and post-traumatic stress symptoms in orthognathic surgery patients.

Objective: To assess the impact of orthognathic surgery in terms of anxiety and stress levels in pre-treatment and post-treatment groups compared with controls and the role of previous trauma exposure on anxiety and stress levels following treatment. Materials and methods: A case–control study was performed involving three age-gender matched groups: 38 ‘pre-surgery’, 39 ‘post-surgery’ and 39 ‘control’ subjects. All subjects had assessment of dental anxiety, post-traumatic stress responses and frequency of previous distressing events. Seventeen subjects were followed up prospectively for 1 year after surgery. Results: ‘Post-surgery’ group reported lower dental trait anxiety (S-DAI) scores than other groups (P = 0.001). S-DAI was significantly associated with frequency of previous traumatic events in ‘pre-surgery’ and ‘post-surgery’ groups (P < 0.01), and was significantly associated with post-traumatic stress disorder (PTSD) symptoms in ‘pre-surgery’ subjects (P < 0.01) who had the highest PTSD symptoms among the three groups (P = 0.005). Symptom severity (IES-R) levels were significantly associated with frequency of previous distressing dental events in ‘pre-surgery’ (P < 0.05) and ‘post-surgery’ groups (P < 0.01). Post-operative S-DAI and IES were significantly associated with pre-operative PTSD symptoms (P < 0.01). Conclusions: The two orthognathic groups were associated with low levels of anxiety and PTSD symptoms in comparison with the control group of the study. Trauma exposure prior to orthognathic treatment can be considered as a risk factor for the development of dental anxiety and PTSD symptoms. The need to improve communication between patients and team is emphasized, especially during the assessment of patients’ emotional state pre-operatively, in addition to discussing psychological issues and psychosocial treatment implications.

Erratum to: Duration of Hospital Stay Following Orthognathic Surgery at the Jordan University Hospital

[This corrects the article DOI: 10.1007/s12663-011-0327-5.].

Oral Health-Related Quality of Life Changes Following Third Molar Surgery in a Jordanian Population : Effect of Demographic and Clinical Factors on the Immediate Postoperative Period

Objective: This study aimed to evaluate oral health-related quality of life (OHRQOL) changes following third molar surgery, and investigate demographic and clinical variables’ effect on (OHRQOL) in the first postoperative week. Methods: 45 subjects had surgical removal of lower third molar/s by one surgeonat Jordan University hospital from March 2011 to November 2011, following a standardized protocol. Patients’ demographics and clinical data were recorded. (OHRQOL) was evaluated before surgery using the Oral Health Impact Profile (OHIP)-14. On postoperative days (PD) 1, 3, 5 and 7, patients completed the (OHIP)-14 & the condition-specific (HRQOL) instrument. Results: A significant deterioration in OHRQOL was seen on (PD)1(P=0.000), and (PD)3 (P=0.000), except for psychological discomfort and disability domains. On (PD)5, no difference was found, however, females had significantly lower OHRQOL levels than males on (OHIP)-14 (P=0.008) and the domains: physical (P=0.048), psychological (P=0.016) and social disability(P=0.018). Conclusions: Third molar surgery was associated with deterioration in patients’ OHRQOL on the first three postoperative days. Females had a slower recovery, with no effect of other factors on patients’ recovery pattern.