Jenny Zwei-Chieng Chang

Comparison of treatment outcomes between skeletal anchorage and extraoral anchorage in adults with maxillary dentoalveolar protrusion

INTRODUCTION The goal of this retrospective cephalometric study was to compare orthodontic outcomes in patients with maxillary dentoalveolar protrusion malocclusion treated with extraoral headgear or mini-implants for maximum anchorage. MATERIALS Forty-seven subjects with Angle Class II malocclusion or Class I bimaxillary dentoalveolar protrusion were treated by retracting the maxillary dentoalveolar process by using the extraction space of the bilateral maxillary first premolars. Two anchorage systems were used. Group 1 (n = 22) received traditional anchorage preparation with a transpalatal arch and headgear; group 2 (n = 25) received mini-implants (miniplates, miniscrews, or microscrews) for bony anchorage. Pretreatment and posttreatment lateral cephalograms were superimposed to compare the following parameters between groups: (1) amount of maxillary central incisor retraction, (2) reduction in maxillary central incisor angulation, (3) anchorage loss of the maxillary first molar, (4) movements of the maxillary central incisor and first molar in the vertical direction, and (5) changes in skeletal measurements representing the anteroposterior and vertical jaw relationships. RESULTS The skeletal anchorage group had greater anterior tooth retraction (8.17 vs 6.73 mm) and less maxillary molar mesialization (0.88 vs 2.07 mm) than did the headgear group, with a shorter treatment duration (29.81 vs 32.29 months). Translational movement of the incisors was more common than tipping movement, and intrusion of the maxillary dentition was greater, in patients receiving miniplates than in those receiving screw-type bony anchorage, resulting in counterclockwise rotation of the mandible and a statistically significant decrease in the mandibular plane angle. Cephalometric analysis of skeletal measurements in patients with low to average mandibular plane angles showed no significant difference between groups, although greater maxillary incisor retraction and less mesial movement of the first molar were noted in the mini-implant group. In patients with a high mandibular plane angle, those receiving skeletal anchorage had genuine intrusion of the maxillary first molar and reduction in the mandibular plane angle, whereas those receiving headgear anchorage had extrusion of the maxillary first molar and an increase of mandibular plane angle. In contrast to the posterior movement in the headgear group, anterior movement of Point A was noted in the mini-implant group. CONCLUSIONS In both the anteroposterior and vertical directions, skeletal anchorage achieved better control than did the traditional headgear appliance during the treatment of maxillary dentoalveolar protrusion. Greater retraction of the maxillary incisor, less anchorage loss of the maxillary first molar, and the possibility of counterclockwise mandibular rotation all facilitated the correction of the Class II malocclusion.

Three-dimensional dental model analysis of treatment outcomes for protrusive maxillary dentition: Comparison of headgear, miniscrew, and miniplate skeletal anchorage

INTRODUCTION The aim of this retrospective study on dental models was to compare the orthodontic outcomes of maxillary dentoalveolar protrusion treated with headgear, miniscrews, or miniplates for maximum anchorage. METHODS The 40 subjects were diagnosed as having either Angle Class II malocclusion or Class I bimaxillary dentoalveolar protrusion. All patients were treated to retract the maxillary dentoalveolar process by using the extraction space of the bilateral maxillary first premolars. They were divided into 3 groups according to the type of anchorage used. Group 1 (n = 16) received traditional anchorage preparation with a transpalatal arch and headgear, group 2 (n = 15) received miniscrews, and group 3 (n = 9) received miniplates for skeletal anchorage. To investigate the movement of the maxillary teeth during dentoalveolar retraction, we used a 3-dimensional (3D) digitizer to assess the positional changes of the maxillary teeth relative to the stable palatal rugose structures on the serial dental models. The 3D coordinates representing pretreatment and posttreatment maxillary dental casts were superimposed to determine the movement of individual teeth from the positional changes of 18 landmarks of the central incisor, canine, second premolar, and first molar. RESULTS Three-dimensional analysis of the maxillary dental models in the buccopalatal, anteroposterior, and vertical directions showed significant differences in tooth movements between the headgear and the mini-implant (miniscrew or miniplate) groups. Both skeletal anchorage groups had greater incisor retraction (6.9 mm for the miniscrew, 7.3 mm for the miniplate) than did the headgear group (5.5 mm). Mesialization of occlusal centroid of the maxillary molar in the skeletal anchorage groups was less than that in the headgear group (1.3 mm for the miniscrew, 1.4 mm for the miniplate, 2.5 mm for the headgear). Tooth movements in the anteroposterior and buccopalatal directions did not reach a statistically significant difference between the miniscrew and miniplate groups, but the maxillary posterior teeth of the subjects receiving miniplates showed greater intrusion than those receiving miniscrews anchorage. CONCLUSIONS This 3D analysis of serial dental models demonstrated that, compared with headgear, skeletal anchorage achieved better results in the treatment of maxillary dentoalveolar protrusion. Significant intrusion of the maxillary posterior teeth was noted in the miniplate group but not in the miniscrew and headgear groups. Greater retraction of the maxillary anterior teeth, less anchorage loss of the maxillary posterior teeth, and the possibility of maxillary molar intrusion all facilitated correction of the Class II malocclusion, especially for patients with a hyperdivergent face.

Effects of thread depth, taper shape, and taper length on the mechanical properties of mini-implants

INTRODUCTION The primary stability of a mini-implant is critical, since most orthodontic mini-implant failures occur at an early stage. As orthodontic mini-implants have restrictions in diameter and length, an optimal design of the shape is important for sufficient primary stability. The purpose of this study was to investigate the influence of various mini-implants design factors, including thread depth, degree of taper, and taper length on insertion torque, pullout strength, stiffness, and screw displacement before failure. METHODS Finite element analyses were conducted first for identification of optimal design parameters. Four types of mini-implants with different design parameters were then custom manufactured and tested mechanically. All mechanical tests were performed in artificial bone with homogenous density to remove the variability associated with bone. RESULTS Finite element results showed that, for mini-implants with a fixed external diameter of 2 mm, a thread length of 9.82 mm, and a pitch of 0.75 mm, those with greater thread depths, smaller taper degrees, and shorter taper lengths generated higher maximum stresses on the bone and thread elements. These mini-implants also had larger relative displacements. Maximum pullout resistance was attained with a core/external diameter ratio of 0.68. All mechanical results were compatible with the findings in the finite element analyses. CONCLUSIONS Modification of the mini-implant design can substantially affect the mechanical properties. The finite element method is an effective tool to identify optimal design parameters and allow for improved mini-implant designs.

Radiographic Assessment of Skeletal Maturation Stages for Orthodontic Patients: Hand-wrist Bones or Cervical Vertebrae?

BACKGROUND/PURPOSE The skeletal maturation status of a growing patient can influence the selection of orthodontic treatment procedures. Either lateral cephalometric or hand-wrist radiography can be used to assess skeletal development. In this study, we examined the correlation between the maturation stages of cervical vertebrae and hand-wrist bones in Taiwanese individuals. METHODS The study group consisted of 330 male and 379 female subjects ranging in age from 8 to 18 years. A total of 709 hand-wrist and 709 lateral cephalometric radiographs were analyzed. Hand-wrist maturation stages were assessed using National Taiwan University Hospital Skeletal Maturation Index (NTUH-SMI). Cervical vertebral maturation stages were determined by the latest Cervical Vertebral Maturation Stage (CVMS) Index. Spearmans rank correlation was used to correlate the respective maturation stages assessed from the hand-wrist bones and the cervical vertebrae. RESULTS The values of Spearmans rank correlation were 0.910 for males and 0.937 for females, respectively. These data confirmed a strong and significant correlation between CVMS and NTUH-SMI systems (p less than 0.001). After comparison of the mean ages of subjects in different stages of CVMS and NTU-SMI systems, we found that CVMS I corresponded to NTUH-SMI stages 1 and 2, CVMS II to NTUH-SMI stage 3, CVMS III to NTUHSMI stage 4, CVMS IV to NTUH-SMI stage 5, CVMS V to NTUH-SMI stages 6, 7 and 8, and CVMS VI to NTUH-SMI stage 9. CONCLUSION Our results indicate that cervical vertebral maturation stages can be used to replace hand-wrist bone maturation stages for evaluation of skeletal maturity in Taiwanese individuals.

EGCG blocks TGFβ1-induced CCN2 by suppressing JNK and p38 in buccal fibroblasts

ObjectivesTransforming growth factor β (TGFβ) has been suggested as the main trigger for the increased collagen production and decreased matrix degradation pathways in oral submucous fibrosis (OSF). Connective tissue growth factor (CTGF/CCN2) and cyclooxygenase-2 (COX-2) were found to overexpress in OSF. The aim of this study was to investigate the molecular mechanism underlying the TGFβ-induced CCN2 expressions in human buccal mucosal fibroblasts (BMFs) to identify the potential targets for drug intervention or chemoprevention of OSF.Materials and methodsTGFβ-induced CCN2 expression and its signaling pathways were assessed by Western blot analyses in BMFs.ResultsTGFβ1 stimulated CCN2 synthesis in BMFs. Pretreatment with c-Jun NH2-terminal kinase (JNK) inhibitor SP600125, p38 mitogen-activated protein kinase (MAPK) inhibitor SB203580, and activin receptor-like kinase 5 (ALK5) inhibitor SB431542 significantly reduced TGFβ1-induced CCN2 synthesis. Epigallocatechin-3-gallate (EGCG) completely blocked TGFβ1-induced CCN2 synthesis by inhibiting the phosphorylation of JNK and p38 MAPK. Prostaglandin E2 (PGE2) inhibited the TGFβ1-induced CCN2 synthesis in human fetal lung fibroblasts IMR90 but not in BMFs.ConclusionsThe TGFβ1-induced CCN2 synthesis in BMFs could be mediated by the ALK5, JNK, and p38 MAPK pathways. EGCG blocks TGFβ1-induced CCN2 by suppressing JNK and p38 in BMFs.Clinical relevanceThe exceptional signal transduction pathways of TGFβ1-induced CCN2 production in BMFs contribute to the resistance of PGE2 downregulation of CCN2 expression; therefore, the CTGF/CCN2 levels are maintained in the OSF tissues in the presence of COX-2. EGCG may serve as a useful agent in controlling OSF.

Thrombin‐stimulated connective tissue growth factor (CTGF/CCN2) production in human buccal mucosal fibroblasts: Inhibition by epigallocatechin‐3‐gallate

Connective tissue growth factor (CTGF/CCN2) is associated with many human fibrotic disorders and was found to overexpress in oral submucous fibrosis (OSF). OSF is the result of persistent chemical irritation and microtrauma to oral mucosa from areca nut. Microtrauma could lead to the release of thrombin.

Curcumin Inhibits TGFβ1-induced CCN2 via Src, JNK, and Smad3 in Gingiva

Transforming growth factor β (TGFβ) is a key regulator associated with the pathogenesis of gingival overgrowth (GO). Connective tissue growth factor (CTGF/CCN2) is overexpressed in GO tissues. CCN2 promotes and sustains fibrosis initiated by TGFβ. Previous studies have shown that JNK and Smad3 activation is required for TGFβ-induced CCN2 expressions in human gingival fibroblasts (HGFs). In this study, we have found that Src is a major signaling mediator for TGFβ-induced CCN2 expressions in HGFs. Pre-treatment with 2 Src kinase inhibitors (PP2, Src inhibitor-1) significantly reduced TGFβ1-induced CCN2 synthesis and JNK and Smad3 activation in HGFs. These results suggest that Src is an upstream signaling transducer of JNK and Smad3 with respect to TGFβ1-stimulated CCN2 expression in HGFs. We further found that curcumin significantly abrogated the TGFβ1-induced CCN2 in HGFs by inhibiting the phosphorylations of Src, JNK, and Smad3. Furthermore, curcumin inhibited TGFβ1-induced HGF migration and α-SMA expression. Curcumin potentially qualifies as a useful agent for the control of GO.

Arecoline stimulated Cyr61 production in human gingival epithelial cells: inhibition by lovastatin.

Cyr61 is associated with growth and progression of many types of tumors and is an independent poor prognostic indicator for oral cancer patients. Areca nut (AN) chewing is the most important etiological factor in the pathogenesis of oral cancer in India and many Southeast Asian countries. Yet, the molecular mechanisms involved in the AN-induced oral cancer remain largely unknown. In this study, we show that arecoline, a main alkaloid found in AN, stimulated Cyr61 synthesis in human gingival epithelial S-G cells. Constitutive overexpression of Cyr61 protein in oral epithelial cells during AN chewing may play a role in the pathogenesis of oral cancer. ERK inhibitor PD98059, N-acetyl-L-cysteine, Rho-associated protein kinase (ROCK) selective inhibitor Y-27632 and a geranylgeranyltransferase inhibitor reduced the arecoline-stimulated levels of Cyr61 protein by ∼31%, 47%, 65% and 100%, respectively. Lovastatin also completely inhibited arecoline-induced Cyr61 synthesis and the inhibition is dose-dependent. Decreased of geranylgeranylated proteins could be the mechanism that lovastatin regulates Cyr61 synthesis and lovastatin could serve as a useful agent in controlling AN-induced oral cancer.

Morphometric analysis of mandibular growth in skeletal Class III malocclusion.

BACKGROUND The craniofacial growth patterns of untreated individuals with skeletal Class III malocclusion have rarely been systemically investigated. This study used morphometric techniques to investigate the growth characteristics of the mandible in individuals with skeletal Class III malocclusion. METHODS Lateral cephalometric head films of 294 individuals with untreated skeletal Class III malocclusion (134 males, 160 females) were selected and divided into five triennial age groups (T1-T5) and by gender to identify the morphologic characteristics and sexual dimorphism in changes of mandibular growth. Procrustes, thin-plate spline, and finite element analyses were performed for localization of differences in shape and size changes. Maximum and minimum principal axes were drawn to express the directions of shape changes. RESULTS From T1 (age 6-8 years) to T4 (age 15-17 years), the distribution of localized size and shape changes of the mandible was very similar between the two genders. From T1 to T2 (age 9-11 years), significant lengthening of the condylar region was noted (23.4-39.7%). From T2 to T3 (age 12-14 years), the greatest size and shape change occurred at the condylar head (27.4-34.9%). From T3 to T4, the greatest size and shape changes occurred in the symphyseal region (23.6-42.1%). From T4 to T5 (age>or=18 years), significant sexual dimorphism was found in the distribution and amount of localized size and shape changes. Females displayed little growth increments during T4. Despite differences in the remodeling process, the whole mandibular configurations of both genders exhibited similarly significant upward and forward deformation from T4 to T5. CONCLUSION We conclude that thin-plate spline analysis and the finite element morphometric method are efficient for the localization and quantification of size and shape changes that occur during mandibular growth. Plots of maximum and minimum principal directions can provide useful information about the trends of growth changes.

Arecoline stimulated early growth response-1 production in human buccal fibroblasts: suppression by epigallocatechin-3-gallate.

Early growth response‐1 (Egr‐1) protein plays an important role in many human fibrotic diseases. Areca nut chewing is the most important risk factor of oral submucous fibrosis (OSF).