Olga-Elpis Kolokitha

Cephalometric Methods of Prediction in Orthognathic Surgery

Over the past decade the growing number of adult patients seeking for orthodontic treatment made orthognathic surgery popular. Surgical and orthodontic techniques have developed to the point where combined orthodontic and surgical treatment is now feasible to manage dentofacial deformity problems very satisfactorily. The prediction of orthognathic treatment outcome is an important part of orthognathic planning and the process of patient’ inform consent. The predicted results must be presented to the patients prior to treatment in order to assess the treatment’s feasibility, optimize case management and increase patient understanding and acceptance of the recommended treatment. Cephalometrics is a routine part of the diagnosis and treatment planning process and also allows the clinician to evaluate changes following orthognathic surgery. Traditionally cephalometry has been employed manually; nowadays computerized cephalometric systems are very popular. Cephalometric prediction in orthognathic surgery can be done manually or by computers, using several currently available software programs, alone or in combination with video images. Both manual and computerized cephalometric prediction methods are two-dimensional and cannot fully describe three-dimensional phenomena. Today, three-dimensional prediction methods are available, such as three-dimensional computerized tomography (3DCT), 3D magnetic resonance imaging (3DMRI) and surface scan/cone-beam CT. The aim of this article is to present and discuss the different methods of cephalometric prediction of the orthognathic surgery outcome.

Impaction and apical root angulation of the maxillary central incisors due to supernumerary teeth: Combined surgical and orthodontic treatment

This case report describes the treatment of a boy with both central maxillary incisors impacted because of 2 supernumerary teeth. Therapeutic management of the impacted teeth was combined with orthodontic treatment of a Class II Division 1 malocclusion. A sequential approach of surgical removal of the supernumerary teeth with 2 stages of surgical exposure and orthodontic traction of the impacted teeth resulted in proper incisor positioning. Close monitoring and multidisciplinary cooperation during the various treatment phases led to a successful esthetic result, with good periodontal health and functional occlusion.

A 13-year-old caucasian boy with cleidocranial dysplasia: a case report

BackgroundCleidocranial dysplasia (CCD) is a rare congenital autosomal dominant skeletal disorder. The disorder is caused by heterozygosity of mutations in human RUNX2, which is present on the short arm of chromosome 6p21. The incidence of CCD is one per million births. CCD appears spontaneously with no apparent genetic cause in approximately 40% of affected patients, and one in three patients has unaffected parents. The most prevalent features associated with CCD are aplastic or hypoplastic clavicles, supernumerary teeth, failed eruption of permanent teeth, and a hypoplastic maxilla.Case presentationA 13-year-old Caucasian boy presented with a chief complaint of delayed eruption of the permanent anterior teeth. The patient was subsequently diagnosed with CCD based on the clinical examination, panoramic X-ray, anterior-posterior and lateral cephalogram, and chest radiograph findings. The details of this case are herein reported because of the extremely low incidence of this disorder.ConclusionsCCD is of clinical importance in dentistry and medicine because it affects the bones and teeth and is characterized by many changes in skeletal patterning and growth. Particularly in dentistry, CCD is of great clinical significance because is associated with delayed ossification of the skull sutures, delayed exfoliation of the primary teeth, lack of permanent teeth eruption, multiple supernumerary teeth, and morphological abnormalities of the maxilla and mandible. Patients with CCD seek treatment mainly for dental problems. Knowledge of the pathogenesis, clinical characteristics, and diagnostic tools of CCD will enable clinicians to render the appropriate treatment to improve function and aesthetics. Early diagnosis of CCD is crucial for timely initiation of an appropriate treatment approach.

Factors Influencing the Accuracy of Cephalometric Prediction of Soft Tissue Profile Changes Following Orthognathic Surgery

The cephalometric prediction of orthognathic treatment outcome is an important part of the surgical planning and the process of informed consent. The orthodontic and surgical changes must be described accurately prior to treatment in order to assess the treatment’s feasibility, to optimize case management and to increase patient’s understanding and acceptance of the recommended treatment. The aim of the present article was to investigate on the factors that could influence the accuracy of cephalometric prediction in planning orthognathic surgery. Review of the literature revealed that, besides factors directly related to the prediction method and its use, there exist a considerable number of factors which could affect significantly the accuracy of soft tissue response. These factors could be biological ones such as relapse, centre of mandibular rotation and individual variation in response to treatment and others such as gender, race, pre-operative soft tissue thickness and data bases for mean ratios of soft to hard tissue movement changes. Some of the factors affecting the accuracy of prediction of soft tissue response following orthognathic surgery are inevitable and there are others, difficult to control and predict. However, patients should be informed that predictions are only a guide, may not represent the actual result of the surgical outcome, and as such they should be implemented.

Relation between soft tissue and skeletal changes after mandibular setback surgery: A systematic review and meta-analysis

Accurate prediction of hard and soft tissue changes is essential in orthognathic surgery. The aim of the present study was to systematically investigate the relation between soft and hard tissue relocation after mandibular setback surgery. A systematic search was performed, correlation coefficients and ratios were retrieved from the eligible studies, and the risk of bias was assessed. The random effects method was used to combine data. The five eligible studies showed that sagittal changes in pogonion, point B, and incision inferius incisalis are highly correlated with respective soft tissue movements and exhibit ratios ranging from 0.915 to 1.051. Only two studies were classified as having a moderate risk of bias. Although the characteristics of the included data limit the formation of definite conclusions, the soft to hard tissue movement ratios produced constitute initial clinically relevant guidance. Further long-term standardized and well-conducted trials are needed.

Response to “Concerning the Article Entitled ‘Judgment of Nasolabial Esthetics in Cleft Lip and Palate Is Not Influenced by Overall Facial Attractiveness’”

A ‘‘Letter to the Editor’’ is usually valuable to authors because, first, it demonstrates that the publication attracts attention of the readers and, second, remarks included in such a letter might help improve future studies. We read the letter byMosmuller et al. (in press) regarding our recent publication in Cleft Palate–Craniofacial Journal (Kocher et al., 2016)with both interest anddisappointment. Our disappointment results from the fact that the claims of Mosmuller et al. (in press) are mostly beliefs and prejudices not supported by facts. Authors expressed criticism regarding three aspects of the study: (1) design, (2) statistics, and (3) discussion of findings. First, the study design of our investigation was based on the old principle of experimental work that causation cannot be proved without manipulation. Themanipulation in our study was fusion of nasolabial areas of 11-year-olds with UCLP with facial features of peers without the cleft, followed by esthetic evaluation of the nasolabial areas in fused images. In our opinion, the core of the design was relatively simple. A suggestion by Mosmuller et al. (in press) that, this way, ‘‘the effect of a cleft on the facial attractiveness was determined instead of the other way around’’ can be easily declined because raters were asked to focus on evaluation of the nasolabial area. This was clearly explained in the ‘‘Subject and Methods’’ section. Furthermore, the authors imply that selection of photographs used for fused images might have been biased. They ignored, however, all measures undertaken to minimize selection bias, such as participation of different raters for subjects with and without the cleft or the long time between rating sessions. Finally, Mosmuller et al. (in press) proposed an alternative study design that actually was the one used 25 years prior by Asher-McDade et al. (1991) during development of the esthetic index. We explained in the ‘‘Introduction’’ of our paper why this design is not optimal. Second, comments regarding our statistical methods are rather surprising because we followed the recommendation of Mosmuller et al. (2013) who advocated ‘‘calculating the interobserver and intraobserver reliability [with ICC] in combination with the Cronbach.’’ Moreover, we find the remark that ‘‘the very high ICC (0.90) in this study needs to be questioned’’ as completely inappropriate in the light of arguments ofMosmuller et al. (in press). The authors claim that—based on their own experience and earlier publications—‘‘it is very unlikely the interobserver reliability is this high when eight different observers judge 72 photographs with a visual analog scale.’’ However, three systematic reviews (Al-Omari et al., 2005; Sharma et al., 2012; Mosmuller et al., 2013) showed that no study focusing on assessment of the nasolabial area in subjects with UCLP used visual analogue scale (VAS) and ICC for evaluation of rater reliability. In addition, Mosmuller et al. (2014, 2015) did not use VAS in their studies; instead, they applied a 5point Likert-type scale and 200-point numerical scale in their works. Therefore, claims of an excessively high ICC score in our study are entirely unsubstantiated. Third, regarding our ‘‘Discussion,’’ we offered a possible explanation for why the perception of nasolabial esthetics in UCLP is not influenced by overall facial attractiveness. We understand that one can disagree with our arguments, but the point made by Mosmuller et al. (in press) would be much stronger if supported by any alternative explanation. In conclusion, we would not like to dissuade Mosmuller et al. (in press) from cropping photographs if they ‘‘believe’’ that this is still necessary. However, based on our results, the use of uncropped photographs of girls and boys with UCLP for esthetic assessment of nasolabial area seems to be justified.

A Rare Case Of Hypodontia In Kawasaki Disease: Review Of The Literature And Case Report

Kawasaki disease (KD) is a rare idiopathic infantile multi-organ vasculitis of medium-sized arteries that predominantly affects children younger than the age of 5 years. Besides the persistent fever of 5 or more days and among the typical criteria for the diagnosis of KD, a dentist may encounter oral manifestations such as “strawberry tongue”, red or dry fissured lip and oropharyngeal erythema. If left untreated, the disease may have fatal prognosis due to the involvement of vital organs. Hypodontia belongs to the most common congenital anomalies in humans. Genetic studies suggest both genetic and environmental etiology toward this anomaly. It is frequently associated with other oral anomalies and altered craniofacial growth. Different health problems have been observed in patients with hypodontia. In the literature, the finding of hypodontia in KD is very rare. This article aims to report a case of a Caucasian 8 year-old boy with hypodontia, who was treated in the age of 7 months for KD. A short review of the literature regarding the two conditions is presented.