| 1. |
- Chetpakdeechit, Woranuch, et al.
(författare)
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Dental appearance, with focus on the anterior maxillary dentition, in young adults with bilateral cleft lip and palate (CLP). A follow up study
- 2010
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Ingår i: Swedish Dental Journal. - 0347-9994. ; 34:1, s. 27-34
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Tidskriftsartikel (refereegranskat)abstract
- Bilateral CLP interferes with both facial and dental development. Surgical and orthodontic treatments help in optimizing facial and dental appearance. In order to improve the quality of treatment one of the keys is to evaluate the physical outcome. The aim of the present study was to evaluate the longitudinal treatment results in young adults born with a bilateral CLP during 1975-1991 in the south-west region of Sweden. Records and casts (13, 16 and 19 years) were evaluated for 35 persons with total bilateral CLP:s. They all belonged to the CLP team of Gothenburg. Occlusion, congenitally missing laterals, peg shaped laterals, impacted canines, midline, implants, prosthetic treatment and maxillofacial surgery were among the recorded variables. Unilateral or bilateral missing laterals were common (40%) as were peg shaped laterals (40%). Six children had impacted canines. A good symmetry and a straight midline between jaws were found after treatment for 60% of the young adults. It was more common to have canines positioned in the region for a missing or extracted lateral compared to having the lateral replaced with an implant or other prosthetic treatment. Asymmetrical maxillary frontal appearance and an acceptable occlusion are not always achieved. Awareness of and effort to solve this problem are important in reducing factors that are likely to negatively affect the harmony of the face.
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| 2. |
- Hallberg, Ulrika, et al.
(författare)
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Living with Crouzon syndrome: transition from childhood to adulthood
- 2011
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Ingår i: Scandinavian Journal of Disability Research. - : Stockholm University Press. - 1745-3011 .- 1501-7419. ; , s. 199-211
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The aim of this qualitative investigation is to study the subjective experiences of transition from childhood to adulthood in individuals with Crouzon syndrome. Material and methods. Telephone interviews were carried out with eight informants and data were analysed according to grounded theory. Results. A core category emerged labelled facing barriers when developing self-image, which illuminates the different barriers the child had to face when trying to develop a self-image during the transition from childhood to adulthood. Facing barriers should not be confused with the actual barriered development. These barriers are further illuminated in five descriptive categories. Conclusions. These children face a variety of stressful barriers when developing their self-image during the transition from childhood to adulthood. The produced psychological outcome seems to be related to a complex interaction among multiple variables, including variables related to the individual with Crouzon syndrome, treatment variables, parent and family variables and social variables.
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| 3. |
- He, Tailun, 1969, et al.
(författare)
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Effects of masticatory muscle training on maximum bite force and muscular endurance
- 2013
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Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 71:3-4, s. 863-869
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Tidskriftsartikel (refereegranskat)abstract
- Objective. This study evaluates the effects of chewing training on strength and endurance of the masticatory muscles. Materials and methods. Of the 49 healthy young adults included in the study, nine served as controls for a baseline measurement of bite force. The 40 participants who actively trained their masticatory muscles were randomly divided into a ‘continuous training group' (CTG) and an ‘intermittent training group' (ITG). The participants performed oral motor training by clenching silicon tubes (Chewy Tubes™) according to a designed protocol. The muscular strength was studied in terms of maximum bite force. Muscular endurance was evaluated by measuring the duration for which the participants held 50% of their maximum bite force value. Results. Both the maximum bite force and the muscular endurance capacity increased after intensive training for both groups. After 2 months, the ITG stopped training for 1 month. At this point, a significant difference was identified both in the mean bite force values and the mean muscular endurance duration: the ITG exhibited lower values. For both groups, the highest values were attained after 3 months of training. The maximum bite force values and the muscular endurance duration were observed to follow similar patterns. The effects attained decreased rapidly in both groups when the training stopped. Conclusions. For both the continuous and intermittent training groups, 4 months of chewing exercises strengthened masticatory muscles, but such effects diminished gradually for both groups when the exercises stopped.
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| 4. |
- Kloukos, Dimitrios, et al.
(författare)
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Bone turnover markers in gingival crevicular fluid and blood serum of patients with fixed orthodontic appliances
- 2022
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 44:4
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Bone remodelling can be followed through the bone turnover markers (BTMs). Aim of the present study was to record the fluctuation of an osteoclastic and an osteoblastic BTM [C-terminal telopeptide of type I collagen (CTX) and N-terminal pro-peptide of type I pro-collagen (PINP), respectively] in both the gingival crevicular fluid (GCF) and the serum of orthodontic patients before and after the initial application of orthodontic forces.MATERIALS AND METHODS: Twenty-one Caucasian patients were prospectively evaluated. GCF and blood samples were collected in order to measure the selected biomarkers by ELISA at three time-points: exactly before, 5 days, and 14 days after bonding of the appliances. Standardized sample handling and patient preparation procedures were adopted in order to reduce pre-analytical variability.RESULTS: GCF and serum CTX levels were found to be independent of age, although higher in the serum of female subjects. PINP levels were found higher in the serum of patients ≥25 years old, as well as in the GCF of males. A positive correlation between serum and GCF baseline PINP levels was observed.LIMITATIONS: The effect of orthodontic treatment on bone remodelling might not be absolutely representative of the local bone microenvironment as the levels of the specific BTMs where measured within the GCF of the lower front teeth.CONCLUSIONS: This is the first time PINP and CTX have been evaluated in the GCF and serum of orthodontic patients with fixed appliances. No statistically significant alterations of CTX and PINP levels in the GCF and the serum of patients were recorded over time during the initial stages of orthodontic treatment.
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| 5. |
- Kloukos, Dimitrios
(författare)
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Gingival recession development in orthodontic patients : studies on gingival phenotype diagnostics, local and systemic biomarkers, and the impact of orthodontic treatment on gingival recession development
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Gingival recession refers to the apical displacement of the gingival margin from the cemento-enamel junction, resulting in exposure of the root of the tooth. Recessions can be localized, involving a single surface and tooth or may involve more tooth surfaces and/or teeth. Exposure of the root surface often causes a esthetic concerns, dentin hypersensitivity and increased susceptibility to root caries. Gingival recessions have been found to be more frequent in mandibular than maxillary teeth, and on buccal than lingual surfaces, especially within creasing age and have been found in persons with both good and poor oral hygiene.Several factors are associated with the etiology of gingival recessions; these are often categorized in predisposing and causative factors. A possible etiological factor for gingival recession is orthodontic tooth movement. The precise mechanism, nevertheless, by which orthodontic treatment influences the occurrence of recessions remains unclear, since bone dehiscence development during orthodontic treatment, per se, does not always lead to recession. It has been, therefore, assumed that the presence of a bone dehiscence before the beginning of orthodontic therapy is a prerequisite for the development of gingival recession. The retrospective and uncontrolled design of the available studies up to date, have not yet allowed the elucidation of the treatment- or patient- related risk factors for the development of gingival recession.The overall aims of this thesis were:• to determine whether or not orthodontic treatment is associated with the development of gingival recession and to quantify its magnitude and significance.• to document possible periodontal and systemic factors that are linked with gingival recession before, during or after orthodontic therapy.This thesis is based on 6 studies:• Paper I was designed as a cross-sectional study to determine accuracy and reproducibility of four different methods for assessing gingival thickness.• Paper II comprised an ex-vivo study assessing how well transgingival probing represents the true value of soft tissue thickness. The aim of this study was to assess differences and variation in gingival thickness when measured with transgingival probing or scanned with an intraoral device in porcine cadavers.• Paper III evaluated in a prospective manner if bone remodeling can be followed through the bone turnover markers (BTMs) in orthodontic patients. Aim was to record the fluctuation of an osteoclastic and an osteoblastic BTM [C-terminal telopeptide of type I collagen (CTX) and N-terminal pro-peptide of type I pro-collagen (PINP), respectively] in both the gingival crevicular fluid (GCF) and the serum of orthodontic patients before and after the initial application of orthodontic forces.• Paper IV assessed in a prospective process the impact of fixed orthodontic appliances on blood Count and High-Sensitivity C-Reactive Protein Levels. Aim was to elucidate the magnitude of alterations in systemic blood counts in healthy individuals and identify possible inflammation status during the first period after fixed orthodontic appliance placement.• Paper V was a prospective controlled study aimed to assess whether incisor inclination change during orthodontic treatment with fixed appliances affects gingival thickness and the width of keratinized gingiva at mandibular incisors, compared with an untreated group of participants.• Paper VI was a prospective controlled study to assess whether orthodontic treatment with fixed appliances, compared to no treatment, has an effect on the development of gingival recession up to one year after treatment.The following conclusions were drawn:Paper I• The results demonstrated the differences between the tested methods (a.transgingival probing with a standard periodontal probe, b. transgingival probing with a stainless-steel acupuncture needle, c. ultrasound and d. color-coded periodontal probe), as far as accuracy and reproducibility were concerned.• Based on the reproducibility, the transgingival probing with the periodontal probe as well as the ultrasound determination seem to present an adequate choice for everyday practice.Paper II• Transgingival probing with a standard metal periodontal probe for assessing gingival thickness is a reliable method, with values very close to the true gingival thickness, and it can thus be considered as the clinical gold standard.Paper III• This was the first time PINP and CTX have been evaluated in the GCF and serum of orthodontic patients with fixed appliances.• No statistically significant alterations of CTX and PINP levels in the GCF and the serum of patients were recorded over time during the initial stages of orthodontic treatment.Paper IV• Orthodontic fixed appliances led to a limited and transient change in WBC and Hb levels during the first days after bracket placement.• The fluctuation of hs-CRP levels was not significant, demonstrating a lack of association between systemic inflammation and orthodontic treatment.Paper V• Mandibular incisor proclination during orthodontic treatment does not appear to significantly alter gingival thickness and width of keratinized gingiva, but orthodontic treatment, overall, leads to reduction of the width of keratinized gingiva.• Whether this limited reduction of width of keratinized gingiva during orthodontic therapy has an impact on the development of gingival recessions, especially on the long-term, still remains to be elucidatedPaper VI• Evolution of recessions varied during orthodontic treatment: in some patients recession developed over time, but in several cases orthodontic treatment resulted in a reduction in the number of gingival recessions. The most affected teeth were the canines and the first premolars.• Orthodontic therapy exerted a negative impact on the development of gingival recession at 1-year posttreatment. The adjusted incidence rate was 67% higher for the intervention group versus the control; however, the severity was limited since most recessions were up to 1mm.• A long-term follow-up (5 years or more) after orthodontic treatment is necessary to provide data on whether orthodontic treatment is a major risk factor for the development of gingival recession.Key Conclusions and Clinical Implications• Transgingival probing with the periodontal probe as well as the ultrasound determination present an adequate choice for gingival thickness evaluation.• No statistically significant alterations of CTX and PINP levels in the gingival crevicular fluid and the blood serum of patients were recorded over time during the initial stages of orthodontic treatment. Moreover, a lack of association between systemic inflammation and orthodontic treatment during the first days after bracket placement was demonstrated.• Mandibular incisor proclination during orthodontic treatment does not appear to significantly alter gingival thickness and width of keratinized gingiva, but orthodontic treatment, overall, may lead to reduction of the width of keratinized gingiva.• Evolution of recessions varied during orthodontic treatment: in some patients recessions developed over time, but in several cases orthodontic treatment resulted in a reduction in the number of gingival recessions. The most affected teeth were the canines and the first premolars.• Orthodontic therapy exerted a negative impact on the development of gingival recession at 1-year post treatment. The adjusted incidence rate was 67% higher for the intervention group versus the control; however, the severity was limited, since most recessions were up to 1mm.• A detailed 3D analysis of the movement of the involved teeth presenting recession after orthodontic movement could provide further insights on the effect of orthodontic tooth movement on the development of gingival recession.• A long-term evaluation will show whether orthodontic treatment is a major factor for the development of gingival recession.
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| 6. |
- Kloukos, Dimitrios, et al.
(författare)
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Gingival Thickness Assessment at Mandibular Incisors of Orthodontic Patients with Ultrasound and Cone-beam CT : A Cross-sectional Study
- 2021
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Ingår i: Oral Health & Preventive Dentistry. - : Quintessence. - 1602-1622 .- 1757-9996. ; 19:1, s. 263-270
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To use and evaluate two methods for measuring gingival thickness (GT) at mandibular incisors of orthodontic patients and compare their performance in assessing periodontal anatomy through soft tissue thickness. Materials and Methods: The sample consisted of 40 consecutive adult orthodontic patients. GT was measured just before bracket placement at both central mandibular incisors, mid-facially on the buccal aspect, 2 mm apically to the free gingival margin with two methods: clinically with an ultrasound device (USD) and radiographically with cone beam computed tomography (CBCT). Results: CBCT measurements were consistently higher than USD measurements, with the difference ranging from 0.13 mm to 0.21 mm. No statistically significant difference was noted between the repeated CBCT measurements at the right central incisor (bias = 0.05 mm; 95% CI =-0.01, 0.11; p = 0.104). Although the respective results for the left incisor statistically indicated that the measurements were not exactly replicated, the magnitude of the point estimate was small and not clinically significant (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014). Small differences between CBCT measurements made by the 2 examiners at the left central incisor (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014) were detected. However, this difference was minor and also not clinically significant. The respective analysis on the right incisor showed no statistically significant difference (bias = 0.05 mm; 95% CI =-0.01, 0.11; p = 0.246). Conclusions: Based on reproducibility, CBCT imaging for gingival thickness assessment proved to be as reliable as ultrasound determination. However, CBCT consistently yielded higher values, albeit at a marginal level, than did the ultrasound device.
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| 7. |
- Kloukos, Dimitrios, et al.
(författare)
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Impact of fixed orthodontic appliances on blood count and high-sensitivity C-reactive protein levels : A prospective cohort study
- 2023
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Ingår i: American Journal of Orthodontics and Dentofacial Orthopedics. - : Elsevier. - 0889-5406 .- 1097-6752. ; 164:3, s. 351-356
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The aim was to elucidate the magnitude of alterations in systemic blood counts in healthy patients during the first 14 days after fixed orthodontic appliance placement.METHODS: This prospective cohort study consecutively included 35 White Caucasian patients starting orthodontic treatment with fixed appliances. The mean age was 24.48 ± 6.68 years. All patients were physically and periodontally healthy. Blood samples were collected at 3 time points: (1) baseline (exactly before the placement of appliances), (2) 5 days after bonding, and (3) 14 days after baseline. Whole blood and erythrocyte sedimentation rates were analyzed in automated hematology and erythrocyte sedimentation rate analyzer. Serum high-sensitivity C-reactive protein levels were measured by the nephelometric method. Standardized sample handling and patient preparation procedures were adopted to reduce preanalytical variability.RESULTS: A total of 105 samples were analyzed. All clinical and orthodontic procedures were performed without complications or side effects during the study period. All laboratory procedures were performed per protocol. Significantly lower white blood cell counts were detected 5 days after bracket bonding, compared with baseline (P <0.05). Hemoglobin levels were lower at 14 days than baseline (P <0.05). No other significant shifts or alteration patterns were observed over time.CONCLUSIONS: Orthodontic fixed appliances led to a limited and transient change in white blood cell counts and hemoglobin levels during the first days after bracket placement. The fluctuation of high-sensitivity C-reactive protein levels was not significant, demonstrating a lack of association between systemic inflammation and orthodontic treatment.
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| 8. |
- Kloukos, Dimitrios, et al.
(författare)
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Transgingival probing : a clinical gold standard for assessing gingival thickness
- 2021
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Ingår i: Quintessence International. - : Quintessence. - 0033-6572. ; 52:5, s. 394-401
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Transgingival probing is often used in the clinic to assess gingival thickness. However, what is not completely known is how well this method represents the true value of soft tissue thickness. The aim of this study was to assess differences and variation in gingival thickness when measured with trans-gingival probing or scanned with an intraoral device. Method and materials: This ex vivo study evaluated gingival thickness on 20 porcine cadavers. Gingival thickness was assessed at both central and lateral mandibular incisors through transgingival probing with a standard metal periodontal probe and also using intraoral scanning, which was considered as the method providing the 'true value' of soft tissue thickness. Intra-examiner repeatability and method error were evaluated. Results: No evidence of systematic difference for any of the mandibular central or lateral incisors (mandibular right incisors: mean difference -0.17 to -0.01 mm, and mandibular left incisors: mean difference -0.11 to 0.04 mm) was observed between the periodontal probe and intraoral scanning methods. The absolute differences between the repeated measurements with intraoral scanning for each tooth type (n = 30) were calculated: the overall median was 0.089 mm and the interquartile range was 0.080 mm. Conclusions: Transgingival probing with a standard metal periodontal probe for assessing gingival thickness is a reliable method, with values very close to the true gingival thickness, and it can thus be considered as the clinical gold standard.
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| 9. |
- Stavropoulos, Dimitrios, et al.
(författare)
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Comparing patients with Apert and Crouzon syndromes--clinical features and cranio-maxillofacial surgical reconstruction.
- 2012
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Ingår i: Swedish dental journal. - 0347-9994. ; 36:1, s. 25-34
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Tidskriftsartikel (refereegranskat)abstract
- Cranio-maxillofacial malformations, as seen in Crouzon and Apert syndromes, may impose an immense distress on both function and aesthetics of the person affected. The aims of this study were to describe and compare the main facial and intraoral features of patients with Apert and Crouzon syndromes, the clinical manifestations that may be present, additionally to the main syndromic traits, as well as the cranio-maxillofacial surgical treatment protocols followed.Twenty-three patients with Apert syndrome (6 males, 17 females), and 28 patients with Crouzon syndrome (20 males, 8 females) were evaluated for general medical aspects, craniofacial characteristics, dentoalveolar traits before and after the final orthognathic surgery, and types and timing of cranio-maxillofacial operations. Mental retardation, associated additional malformations, cleft palate, and extensive lateral palatal soft tissue swellings were more common in children with Apert syndrome. In both syndromes, clinical findings included concave profile, negative overjet, posterior crossbites, anterior openbite, and dental midline deviation, which were corrected in almost all cases with the final orthognathic surgery, with the exception of the lateral crossbites, including more than one tooth pair, which were persisting in about half of the cases. Cranial vault decompression and/or reshaping, midfacial and orbital advancement procedures, often in conjunction with a mandibular setback, were the most frequent cranio-maxillofacial operations performed. In conclusion, Apert syndrome is more asymmetric in nature and a more severe clinical entity than Crouzon syndrome. The syndromic dentofacial features of both conditions could be significantly improved after a series of surgical procedures in almost all cases with the exception of the posterior crossbites, with haIf of them persisting post-surgically.
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| 10. |
- Stavropoulos, Dimitrios, et al.
(författare)
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Dental agenesis patterns in Crouzon syndrome
- 2011
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Ingår i: Swedish Dental Journal. - 0347-9994. ; 35:4, s. 195-201
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Tidskriftsartikel (refereegranskat)abstract
- Dental agenesis may be present in an isolated familiar manner, or occur as a part of a syndrome.To date, this clinical trait seems to have been overlooked in patients with Crouzon syndrome.The aim of the present study was to investigate dental agenesis and dental agenesis patterns in a population of persons with Crouzon syndrome in Sweden. Serial panoramic radiographs of 26 individuals with Crouzon syndrome (20 males, 6 females) were examined.Third molars were excluded from the assessment. The prevalence of agenesis for at least one tooth was 42.3%. Each affected patient was found to have up to 5 missing teeth. Upper and lower second premolars were the most frequently congenitally missing teeth. Eleven dental agenesis patterns of the entire dentition were identified, as described by the tooth agenesis code (TAC). All patterns were unique and asymmetric,with only one exception, a symmetric pattern of the maxillary and mandibular second premolars. In conclusion, persons with Crouzon syndrome were found to have a high prevalence of dental agenesis and a remarkable variability of dental agenesis patterns. It is important to be aware of this clinical situation, especially when orthodontic treatment planning for these patients is performed as early as in the mixed dentition.
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