Mario Caltabiano

Landmark identification error in posteroanterior cephalometric radiography. A systematic review.

OBJECTIVE To evaluate the reliability of landmark identification in posteroanterior cephalometrics. MATERIALS AND METHODS A literature search was conducted to identify all articles concerning landmark identification error in the frontal radiograph. Electronic databases (PubMed, Web of Science, Cochrane Database, PubMed Central, and HubMed) were searched. Abstracts that appeared to fulfill the initial selection criteria were selected, and the full-text original articles were then retrieved and analyzed. Only articles that fulfilled the initial selection criteria were finally considered. Their references were also hand searched for possible missing articles from the database searches. RESULTS Twelve abstracts met the initial inclusion criteria, and these articles were retrieved. From these, eight were immediately rejected because of methodological issues. Only the four articles remaining seemed to fulfill the selection criteria, but two articles were later rejected, one because no landmark identification error mean values were provided and the other because of the sample. Only one article fulfilled the inclusion and exclusion criteria of this study. Midline landmarks were more reproducible than bilateral skeletal landmarks. CONCLUSION Only one study fulfilled the additional inclusion and exclusion criteria. Few studies exist about the random error in localization of landmarks in posteroanterior cephalograms, and several methodological issues affected these few studies. Thus, future well-designed studies are needed to allow the orthodontist to choose the most appropriate cephalometric analysis.

Expression of vascular endothelial growth factor in human dysfunctional temporomandibular joint discs

A high density of blood vessels is found in specimens of temporomandibular joint (TMJ) disc at any stage of internal derangement of the joint, but the factors responsible for angiogenesis in the disc have not been described. The purpose here was to investigate, in human TMJ discs, the expression of vascular endothelial growth factor (VEGF), a multifunctional cytokine that contributes to angiogenesis. Specimens, free of significant morphological alterations and with varying degrees of disc tissue degeneration/regeneration, were studied by immunohistochemistry for VEGF in order to correlate immunohistochemical with histopathological findings. In normal discs and discs with minor pathological changes, fibroblast-like cells, fibrochondrocytes and chondrocyte-like cells were either not or only weakly immunostained by VEGF antibody. In disc specimens from internal derangement of the TMJ with significant tissue degeneration/regeneration, VEGF was consistently expressed. In these specimens, immunoreaction products for VEGF were observed both in the disc and in the endothelial cells of newly formed vessels. This VEGF immunolocalization is consistent with the stimulation of angiogenesis and the morphogenesis and differentiation of chondrocytes. Therefore VEGF expression by disc chondrocyte-like cells might reflect the action of the cytokine as an inducer of angiogenesis and as an autocrine signal for cells of the chondrogenic lineage.

Heat Shock Protein 27 Expression in the Epithelium of Periapical Lesions

Heat shock protein (HSP) 27 is a member of the small HSP family that plays a part in the regulation of epithelial cell growth and differentiation, wound healing, apoptosis and cell protection against inflammatory cytotoxicity mediators. Thus the expression of HSP27 was investigated immunohistochemically in periapical granulomas with epithelial rests of Malassez and in radicular cysts. Anti-HSP27 mouse monoclonal antibody and peroxidase-labeled streptavidin-biotin standard technique were used to study the expression of HSP27. Proliferating epithelial cell rests, and islands of epithelium and epithelial lining of microcysts strongly reacted throughout all layers, whereas radicular cysts epithelial lining presented mainly a moderate suprabasal staining pattern. However both the proliferating epithelial cell rests and the radicular cysts shared an over-expression of HSP27 immunostaining intensity in coincidence with the presence of local infiltration of immune cells. HSP27 may play several roles in periapical lesions that include contributing to the migration of epithelial cell rests and an increased resistance both to necrotic and apoptotic cell deaths.

Palatally Displaced Canine Anomaly in Monozygotic Twins

The palatally displaced canine (PDC) anomaly is a tooth malposition occurring in 1% to 3% of most populations. From the results of family studies, the PDC phenotype appears to be under strong genetic influence. In this study we report monozygotic (MZ) twin girls with bilateral PDC expression. The finding of PDC anomaly in MZ twins--to our knowledge, the first such published case--lends further support to evidence of genetic control of the PDC anomaly.

Skeletal anomalies and normal variants in patients with palatally displaced canines

OBJECTIVE To test the null hypothesis that there is no increased prevalence of skeletal anomalies and/or normal variants as evidenced by the cephalometric radiographs of patients with palatally displaced canines (PDC). MATERIALS AND METHODS The treatment records of 38 white subjects between 14 and 20 years old with PDC were collected and evaluated retrospectively. Inclusion criteria for the study required that the case records include good-quality panoramic radiographs and lateral cephalometric radiographs with the first four cervical vertebrae clearly visible. The anomalies recorded for each case included sella bridge, atlanto-occipital ligament calcification or ponticulus posticus, and posterior arch atlas deficiency. A control group consisted of 70 consecutively treated subjects who had no other dental anomalies and whose maxillary canines had erupted normally. Fishers exact test and Pearsons chi-square test were used to determine possible statistically significant differences in the incidence of skeletal anomalies and/or normal variants between the group of patients with PDC and the control group. RESULTS The prevalence of skull anomalies and normal variants seen in cephalometric radiographs was increased in patients with PDC. Because of the presence of ponticulus posticus (Pearsons chi-square, P < .050; Fishers exact test, P < .052), sella bridge (Pearsons chi-square, P < .042; Fishers exact test, P < .042), and posterior arch deficiency (Pearsons chi-square, P < .047; Fishers exact test, P < .039), statistically significant differences were observed between subjects with PDC and the control group. CONCLUSIONS The null hypothesis was rejected. There is an increased prevalence of skull skeletal anomalies and/or normal variants in patients with PDC.

Mandibular growth in subjects with infraoccluded deciduous molars: a superimposition study.

The aim of this longitudinal cephalometric study was to analyze the growth characteristics of the mandible in subjects with infraocclusion of the mandibular deciduous molars. A group of 28 subjects with bilateral infraocclusion of mandibular deciduous molars (IG) were enrolled in a prospective longitudinal study on the growth characteristics of the mandible and compared with a control group (CG) of 28 subjects. Lateral cephalograms were collected in both groups at T1 and at T2, after a mean 19-month interval in the IG and after a mean 16-month interval in the CG. All subjects were observed in the early mixed dentition before the pubertal peak and did not receive any orthodontic treatment during the observation interval. Cephalometric analysis at T1 and superimposition of tracings at T1 and T2 were performed, and statistical comparisons between the two groups were carried out by means of independent sample t-tests. Discriminant analysis on the superimposition data identified Co-Gn angle (angle formed by line Co-Gn at T1 and at T2) as the single discriminant variable between IG and CG. There were significant differences between the two groups as to morphological changes of the mandible and direction of condylar growth, thus demonstrating anterior growth rotation of the mandible in subjects with infraocclusion. Because of the high levels of alveolar bone turnover and remodeling in anterior rotating mandibles, this study suggested that skeletal growth characteristics of the mandible may influence the clinical expression of infraocclusion.

Nevoid Basal cell carcinoma syndrome: a cephalometric study of patients and controls.

Craniofacial morphology of patients with nevoid basal cell carcinoma syndrome (NBCCS) has sometimes been reported at clinical examination, but any investigation has described it on the basis of cephalometric measurements. The purpose of this study was to conduct a cephalometric analysis of patients with NBCCS and to compare measurements with non-NBCCS subjects of similar ages, to elucidate if there is any relationship between NBCCS and craniofacial morphology. The study population consisted of 14 adult patients (9 men and 5 women), ranging in age from 18.2 to 56.8 years, with the diagnosis of NBCCS, with good-quality lateral cephalometric radiographs, and 14 adult healthy patients matched for age and sex to the NBCCS group. Cephalometric measurements were carried out on radiographs, and measurements of angles and distances were performed. Statistical differences between NBCCS subjects and controls were observed. Data analysis displayed that the measurements of the anterior cranial base (P ≤ 0.0043), mandibular length (P ≤ 0.0168), and maxillary length (P ≤ 0.0284), posterior facial height (P ≤ 0.0406), and of mandibular angle (P ≤ 0.0026), facial axis angle (P ≤ 0.0402), lower facial height angles (P ≤ 0.0135), and of interincisal angulation (P ≤ 0.0148) were higher in NBCCS subjects in respect to controls. On the contrary, the facial convexity (P ≤ 0.0189) and the mandibular arc angle (P ≤ 0.0378) were reduced in NBCCS subjects. According to these findings, NBCCS patients presented a sagittal lengthening of the anterior cranial base and maxilla and a vertically and horizontally overdeveloped mandible, together with the features of a long-face syndrome with a large gonial angle.