Podcasts about Maxilla

Join me for a look at CBCT and its use in the diagnosis of the transverse problem, and if it offers the solution to the debated topic. The podcast is based on a lecture by Chun Hsi Chung at this year's AAO and appraises established methods of assessment, the Curve of Wilson and the WALA ridge line through the lens of a CBCT, as well as how to use a CBCT to assess the maxilla and mandible, which although revealed an ideal measurement, may not be telling the full story. What is ideal? inclination  Curve of Wilson – CBCT study  Vertical distance buccal and lingual cusp, 1mm vertical difference  Buccal inclination upper 5 degrees Alkhatib 2017 Lingual inclination lower 12 degrees Alkhatib 2017 Andrews WALA ridge 2000 Bucco-lingual distance from crown ( FA point) to the most prominent portion of mandibular buccal alveolar bone (coincident with mucogingival junction) Hypothesised teeth over the basal bone , Glass 2019 1st molar = 2mm Ideal mandibular intermolar width FA – FA = WALA-WALA distance minus 4mm Normal width  CBCT CBCT age 13 N = 79 Miner 2012 Maxilla slightly smaller mid point molar root on lingual bone -1.22 +/- 2.91mm CBCT Age 22.7 years Koo 2017 Measure CoR furcation 1st molar Mx – Mn = -0.39+/- 1.87mm CBCT 56 adults normal occlusion  Lee 2022 PENN STUDY Buccal – buccal on crestal bone, furcation, 6s Lingual – lingual crestal furcation 6s Reliable reading on lingual aspect – buccal shelf bone prevents reliable readings Maxilla narrower than mandible -1 +/- 3mm Previous literature  Tamburrino 2010 describes  5mm cortical plate level of furcation buccal aspect, however Lee 2022 showed for males 1.1mm +/- 4.5mm and 1.6mm +/- 2.9mm Without cbct can transverse diagnosis occur? Models = lingual surface at furcation level (4mm vertical below gingival margin) maxillary width slightly narrower than mandible -2+/- 3mm Issue with CBCT for diagnosis Standard Deviation is large = +/- 3mm, range from -4mm-+2mm falls into SD Issue with study model transverse analysis from 4mm at the gingiva Not validated

Teinisydämet pamppailevat kiihtyvään tahtiin kun Jutta ja Mikko blaastaavat Some Kind of Wonderfulista (1987), John Hughesin kirjoittamasta kasariklassikosta joka tunnetaan myös nimellä Jännät suhteet. Duunariperheen kiltti poika Keith ihastuu suosittuun Amandaan ja bestis, myös Keithiin salaa ihastunut ”poikatyttö” Watts seuraa tilannetta kauhulla vierestä. Pyörryttävän upealla leukalinjalla varusteltu Eric Stoltz ja julmetun tyylikäs Mary Stuart Masterson saavat jumikemuilijoiden täyden ihailun osakseen. Kuumissa kyssäreissä arvaillaan, miksi Jokeri 2 ei kiinnostanut ketään ja katsotaan jo marraskuussa Maxilla alkavan Dyyni-sarjan traileri. Loppuun tietysti sweet chili dipit eli kulttuurisuosituksemme teille. Tuu mukaan, nää on kivat kemut!

Suositun Game of Thronesin yhtä suosittu spin-off sarja House of The Dragon jatkui vihdoin Maxilla toisen kauden merkeissä.  Tottahan toki tämä tuli katsottua ja vieläpä pari kertaa. Joten täytyyhän siitä myös vähän mietteitä kertoa. Mukaan juttelemaan pyysin Mikä Homma podcastistä ja YouTube kanavasta, sekä Top Tusinasta tutun Allun.  Allun kanssa käytiin läpi molempien mietteitä tästä kaudesta ja verrattiin edelliseen, sekä hieman Game of Thronesiin. Ja puhuimme oikein kunnolla spoilaten asioita.  Joko sinä olet katsonut tämän? Mitä mieltä? Odotatko innolla jatkoa? Vai alkako meno puuduttamaan? Tai etkö ole tätä halunnut edes alkaa katsomaan? Ketä on sinun suosikki hahmo? 

On this episode, co-hosts Dr. Tania Cubitt and Katy Starr chat with Dr. Stephanie Bonin, a principal and senior biomechanical engineer, about her research on the movement of how horses chew and why it matters, including:How horses chew long-stem hay or grass versus smaller pelleted feeds and forageHow the height at which horses eat can affect their jaw movement and teeth alignmentPotential dental management needs depending on the horse's dietFor our more advanced horse owners and those asking for a deeper dive into the science – THIS episode is for you! See the notes below for a brief glossary on some terms discussed in this episode. Have a topic idea or feedback to share? We want to connect with you! Email podcast@standlee.com_______________________________Episode References:~8:54 – Dr. Bonin's image description in episode of the McPhail Equine Performance Center set-up with Dr. Hilary Clayton - https://hoofcare.blogspot.com/2011/07/research-clayton-and-bowkers-effects-of.html~12:02 - Kinematics of the equine temporomandibular joint -https://www.researchgate.net/publication/7270686_Kinematics_of_the_equine_temporomandibular_joint~27:49 - Comparison of mandibular motion in horses chewing hay and pellets - https://www.researchgate.net/publication/6311792_Comparison_of_mandibular_motion_in_horses_chewing_hay_and_pellets Glossary of Terms:~9:55 – Retroreflective makers – reflect light back in the direction it came, in this scenario, to the cameras~11:39 – TMJ - Temporomandibular joint~12:24 – Mandible – lower jaw, Maxilla – upper jaw~13:01 – Caudally – in the direction of or situated in or near the tail or posterior part of the body~13:05 – Kinematics – the study of motion without referencing any force that may actually cause the motion – how they're moving, not why they're moving, e.g. distance or displacement, speed or velocity, and acceleration.~17:26 – Adbraded down – worn down~17:32 – Atlanto-Occipital Joint – the poll of the horse which connects the first vertebrae with the skull~19:47 – Ramus – the large bone of the mandible or lower jaw~36:32 – Malocclusions – the misalignment between a horse's upper and lower jaws~42:00 – Lateral excursion– the side-to-side movement of the lower jaw away from the midline Helpful Standlee Products:Standlee Certified Timothy Pellets - https://www.standleeforage.com/products/certified-timothy-grass-pellets/Standlee Alfalfa Cubes - https://www.standleeforage.com/products/alfalfa-cubes/Standlee Alfalfa/Orchard Grass Compressed Bale - https://www.standleeforage.com/products/alfalfa-orchard-compressed-bale/_______________________________Stay connected with Dr. Stephanie Bonin:LinkedIn - https://www.linkedin.com/in/stephanieboninResearchGate - https://www.researchgate.net/profile/Stephanie-Bonin_______________________________*Views and opinions expressed by guests are their own and do not necessarily reflect the view of Standlee Premium Products, LLC.*_______________________________ Love the podcast? Leave a rating and review on Apple – https://podcasts.apple.com/.../beyond-the-barn/id1541221306Leave a rating on Spotify – https://open.spotify.com/show/3dmftQmwLKDQNueUcCJBZaHave a topic idea or feedback to share? We want to connect with you! Email podcast@standlee.comShare our podcast and learn more about our co-hosts at our Beyond the Barn podcast pageSUBSCRIBE to the Beyond the Barn podcast email to be an exclusive insider!Find us on Apple, Spotify or Google Podcasts and SUBSCRIBE, so you never miss an episode._______________________________Check out the Standlee Barn Bulletin BlogFind more nutritional resources from Dr. Stephen Duren and Dr. Tania Cubitt at https://www.standleeforage.com/nutrition/ Connect with Standlee on Facebook, Instagram, YouTube and TikTok

In this episode, craniofacial surgeon and children's book author, Edward Buchanan, discusses his pediatric facial microsurgery experience with Carolyn Rogers-Vizena and FACE resident ambassador Chioma Obinero. Read the article here.

Join me for a podcast summary looking at the grey topic of lower third molar management. The podcast explores the different guidelines of removal, factors for consideration for removal as well as the effect orthodontics can have on third molar pathology. The lecture was given by Flavia Artese at this year's British Orthodontic Conference in my city London.       Flavia Artese began with asking the clincal question we face, what would you do with an impacted 3rd molar?   Difference in international practice ·      UK NICE guidelines 2000: Surgical removal of impacted third molars should be limited to patients with evidence of pathology ·      AAOMS White paper USA 2016: currently or likely to be non-functional associated with disease or at a high risk of developing disease     What factors in decision making   1.     Eruption path ·      Mandible = mesial, whereas Maxilla = distal o   Rate of impaction Mandible 25%, maxilla 14% Worthington 2016   2.     Mechanism of tooth eruption – explained by Frazier-Bowers ·      A pathway created by the dental follicle o   Triggers eruption of intraosseous eruption o   Genetic control of cell differentiation in dental follicle §  Requires root elongation, vascular pressure and DL ise 2008   Orthodontic influence  = SPACE ·      Decrease with distal movement of posterior teeth o   Distalisation, elastics §  Kim 2014 = limit of lower molar distalisation §  35% of cases already have contact with lingual cortical plate ·      Increase through mesial movement o   80% of 3rd molars erupted in premolar extraction cases Kim 2003 o   Increase in retromolar area o   2nd molars – removal of guidance = unpredictable alignment of 3rd molars, tipped, therefore will likely require orthodontic alignment Gooris 1990 §  Flavia suggested if 7s impacted, removal of 8s and 2nd molar uprighting, as no delay until full root development   Prediction method ·      Mandibular morphology o   Longer the mandible = greater chance of 3rd molar eruption: Begtrub 2012 ·      Retromolar space o   OPG -  size of crown and space available: If space greater then size of the tooth = 75% eruption, if less space available than the tooth size = 75% of impaction Olive Prediction of orthodontists and surgeons Bastos 2016 ·      Orthodontists 38% extract ·      Surgeons 50% extract ·      Surgeons extract more o   Surgical morbidly 10% Yamada 2022 o   Greater pathology: 82% when erupted, 74% in soft tissue, bone 33%   Surveillance protocol ·      No complaints from patients   Fully erupted ·      No consensus of protocol pathology   Review of guidelines Gadiwalla 2021             Only 2 guidelines were recommended , RCS and SIGN ·      Recommended guidelines   Conclusion ·      Limited evidence ·      Orthodontists can influence the space ·      If second molars require extraction, will require time to erupt as well as ·      CBCT should be used for diagnosis ·      Refer to oral surgeon for assessment of difficulty in removal     Please join Flavia Artese at the 2025 International Orthodontic Conference in Rio De Janeiro   Contributions Contents: AbdAllah Sharafeldin Contents edited and produced: Farooq Ahmed  

Our guest, Dr. Jeffrey S. Rouse, D.D.S., is a distinguished figure in the world of dentistry. He's a private practitioner in San Antonio, Texas, but his career has spanned across various roles and locations, including a teaching stint at Spear Education in Scottsdale, AZ, and an adjunct professorship at the University of Texas Health Science Center at San Antonio.Dr. Rouse's journey began with general dentistry, followed by a specialization in Prosthodontics. He's an esteemed member of dental organizations and a published author, making significant contributions to the field.In this episode, we explore Dr. Rouse's dental journey, the often-overlooked biology in dentistry, shifts in dental education, and the various TMJ treatment perspectives. We also touch upon the distinctions between maxilla and mandible, common mistakes made by general dentists, and his personal experiences. Dr. Rouse emphasizes the importance of diversity in his mentorship program and discusses dental leadership.Join the conversation, where we uncover the transformative aspects of dentistry and gain valuable insights from his wealth of experience.We talk about:[0:00] Intro[04:02] Dr. Jeffrey Rouse's dental journey[09:28] The overlooked biology of dentistry[13:21] The changing landscape of dental education[16:14] Different TMJ camps[25:30] Maxilla vs. Mandible[28:30] What general dentists get wrong[32:56] Dr. Jeffrey's Rouse personal experience[36:55] Diversity in Dr. Rouse's mentorship program[45:17] Dental leadership[49:18] What's on the horizon for Dr. Jeffrey RouseResources mentioned:https://www.speareducation.com/study-club/module-details/id/169https://www.speareducation.com/study-club/module-details/id/179Connect with Dr. Jeffrey Rouse here:https://www.rousedds.com/Connect with Tiffany here:Courses: https://www.tmdcollective.online/https://www.tmdcollective.comhttps://www.instagram.com/tmd.collective/Patreon: https://www.patreon.com/tmdcollectiveSupport the show

Words covered in today's episode: Lac, lactis; milk (lactase, delectation, ablactation) Lacerare, laceratum; to tear to pieces, mangle (laceration, dilacerate) Latus; wide, broad (i.e. Vastus Lateralis, latissimus (superlative) dorsi) Latus, lateris; side (Lateral, mediolaterial [plane], latissimus dorsi) Libet; it pleases (libido, ad libitum) Lien; spleen (gastrolienal, perilienal) Limen, liminis; threshold (liminal, supraliminal) Linea; line (linear) Lingua; tongue (breviligulata, sublingual, cervicolingual) Locus; place (dislocation, translocation, intralocular) Longus; long (adductor longus, opposed to adductor brevis) Lumbus; loin (dorsolumbar, lumbar) Luxare, luxatum; to dislocate (subluxation, dislocation, relaxation) Magnus; large, great Malleus; hammer, club (one of the small bones of the ear; malleolus) Malus; bad, faulty (malformation, malignant, malposition) Mandibula; jaw, bone of lower jaw (mandible, submandibular gland) Maxilla; jaw, upper jawbone (bimaxillary, submaxillary, maxilla) Medius; middle (mediolateral axis, admedial, Medial; refers to the midline of the body) Mens, mentis; mind (mental, dementia) Mola; millstone or Molaris; adapted for grinding (molar) Musculus; little mouse, muscle [From Mus, muris; mouse] (muscle, musculature) --- Support this podcast: https://anchor.fm/liam-connerly/support

The party fights their way through the Cave of Wonders in search of the cornucopia that will save Maxilla's village from certain starvation

Welcome to #HometownHeroes, an all new series here on the Healthy Sleep Revolution Podcast where we're featuring professionals from all over who are saving lives one airway at a time. Join us on this pilot episode and meet Dr. Michelle Jorgensen, an airway extraordinaire impacting lives in American Fork, Utah.   Episode Highlights:   - Is midline deficiency genetic?   - What caused midline birth defects?   - How does the airway connect to different health issues?   - What treatments are available for autoimmune disorders?   - What treatment options are there for airway issues?     Quotes:   “infection will influence airway and it will cause a very obstructed airway.”   ”Maxilla is the first bone affected by malnutrition."   ”Health belongs to you.”   “The tongue should be smooth.”   “Providers look at patients like a blind man and an elephant.”   “Untreated airway issues can contribute to chronic diseases.”     Learn more about Meghna Dassani www.meghnadassani.com www.dassanidentistry.com Get a copy of Airway is Life: https://amzn.to/3Bi3Hr4     Learn more about Michelle Jorgensen www.livingwellwithdrmichelle.com Get a copy of Be Prepared, Not Scared: https://amzn.to/3gB58Zr Get a copy of Self-Sufficient Living: https://amzn.to/3kyoWy6

Question and answer review of lesions of the mandible and maxilla for radiology and nuclear medicine board review.  Download the free study guide on this and other topics available at www.theradiologyreview.com. 

The last day of the Harvest Festival comes to a close and our party finds themselves spending some much needed downtime. Lione and Malleus find themselves perusing the many stalls of the festival, Ariadne finally gets a few drinks from Travis, Bee and Galen make some big decisions, and Gris spends some time with Maxilla and Stapes.

Today’s guest is Dr. Joseph Funderburk, Oral and Maxillofacial Surgery Specialist at Grand Junction Oral Surgery, Colorado. He joins us on the show to talk about running a practice and share some of his techniques for surgery procedures too. Dr. Funderburk received his Doctor of Dental Surgery degree from the University of Colorado Health Sciences Center (UCHSC) in Denver, and he kicks the show off talking about his education and plans to set up a practice in his hometown thereafter. Grand Junction is a small town and Dr. Funderburk talks about the challenges of inserting himself into the small community of oral surgeons there. He shares the story of how he eventually struck a deal with an older surgeon to buy his practice, thereafter partnering with him for many years, and why he is having to take on a new associate now. We speak to Dr. Funderburk about the challenges of running a practice, hearing him weigh in on some of the techniques he is using to market his business. From there, we take a deep dive with Dr. Funderburk into the world of instruments, anesthesia, and techniques around implants and bone grafting. Dr. Funderburk talks about his use of a precordial stethoscope, nasal hood, Versah drills for implant placement, and his protocol around drug administration for putting his patients to sleep. For all this and more, be sure to tune in today.Key Points From This Episode:An overview of Dr. Funderburk’s education and experiences joining a practice after.The story of how Dr. Funderburk bought a practice from an older surgeon in Grand Junction.Reasons why typical partnerships don’t work and how Dr. Funderburk navigated this.How the first phases of the partnership worked out regarding logistics and staff.Why Dr. Funderburk ended up taking on a new associate who will become a partner at his practice.Some of the biggest challenges Dr. Funderburk faces as a practice owner.Systems Dr. Funderburk has put in place to market his practice; integrating his staff with that of other practices.The mission statement at Dr. Funderburk’s practice; ways his services go beyond what is required.Recent changes to Dr. Funderburk’s techniques and the benefits of these shifts.The protocol at Dr. Funderburk’s practice regarding administration of anesthesia drugs.Devices and setups Dr. Funderburk uses to administer anesthesia drugs.Why Dr. Funderburk had to work harder recently; how things are going with his new associate.Dr. Funderburk’s techniques for taking out upper maxilla molars; why he doesn’t use forceps.Approaches to grafting and implants at Dr. Funderburk’s practice.Techniques for implant placement in the posterior maxilla using Versah drills.Advice from Dr. Funderburk for future guests on this podcast.Links Mentioned in Today’s Episode:Dr. Joseph FunderburkColorado State UniversityVersahGrand Junction Oral SurgeryDr. Grant Stucki Contact — 720-775-5843

Part 1 explores key themes around the effectiveness of class 2 correction, how they work, different times, the role of headgear and fixed functional appliances. Q1 & 2 Do we have the evidence, and is it effective? Phase 1 o Phase 1 there is no advantage, no difference in clinical outcomes: Cochrane review Harrison 2007. o 9-10% of patients benefit from phase 1 through a reduction in trauma, Gianelly 1995. o “Just because we can doesn't mean we should” Jay Bowman Trauma · Increased OJ greater than 3mm = 2 x risk of trauma Nguyen 1999 Questions 3 Growth can we predict it? · No restraining effect on Maxilla, slight growth of the mandible and increase vertical growth Mills 1991 o 3mm growth Pg-Go o SNB improvement of 4o o NO we cannot - Unpredictable Question 4 When to treat and which on? · When: CVM 3-4 is where peak growth occure, (PHV): however only 25% of patients have 1 single peak, most have ‘multiple peaks' · Which one: Efficiency- Herbst 0.28mm, TB 0.23mm, Herbst more efficient - fixed more efficient Question 5 What changes take place? Functional appliances don't all work the same: · Removable: o Upper molar distalisation / upright o Upper incisor uprighting · Fixed o Upper molar distalisation / upright o Increase mandibular length (Po-Go) Question 6 Do they grow mandibles? · AAO Council statement 2005 – “No scientific evidence of increase in mandible” o Lengthening of condyle and ramus does occur. o Glenoid fossa remodelling does occur. o No evidence shows: § Insignificant overall increase in length . § Condyle growth cannot be permanently increased. Question 7 Does HG still have a role? · Vertical and AP changes do occur with HG after 6/12 Burke 1992, Nanda 2006, · Compliance however is 56% Brandao Question 8 Effectiveness of fixed functional appliances? · Compliance nearly 100% · Phase 1 shorter 4.5 months · Forsus Vs Powerscope: o More AP change with Forsus Arora 2018 · New ideas of fixed functional and TAD / miniplates References Harrison, J.E., D O'Brien, K. and Worthington, H.V., 2007. Orthodontic treatment for prominent upper front teeth in children. Cochrane Database of Systematic Reviews, (3) Nguyen, Q.V., Bezemer, P.D., Habets, L.L.M.H. and Prahl-Andersen, B., 1999. A systematic review of the relationship between overjet size and traumatic dental injuries. European Journal of Orthodontics, 21(5), pp.503-515. Mills, J.R.E., 1991. The effect of functional appliances on the skeletal pattern. British Journal of Orthodontics, 18(4), pp.267-275. Vaid, N.R., Doshi, V.M. and Vandekar, M.J., 2014, December. Class II treatment with functional appliances: A meta-analysis of short-term treatment effects. In Seminars in Orthodontics (Vol. 20, No. 4, pp. 324-338). WB Saunders.

How considerations and the management plan differ in children, teenagers and adults. A podcast between orthodontist Dr Andrew Chang and pediatric dentist Dr Diane Tay that covers the issues in detail.   Dr.Andrew Chang: Diane, welcome, it's nice to have you back on our podcast. Dr. Diane Tay: Hi Andrew. Very good to chat to you again. As always. Dr.Andrew Chang: Well, what we'd like to talk to our audience of dentists today and if there is any interested parents out there as well, but mainly for dentists. The topic of supernumeraries or what we call,extra teeth types. And we were going to focus on the area of the upper front maxilla, the upper front teeth region. So maybe Diane, if you could provide our audience an outline of the different classifications or types of uninterrupted supernumeraries that we're going to talk about. Dr. Diane Tay: Yeah, absolutely Andrew, thank you. And yes, you are right for the benefit of the audiences. We know there's many different types of supernumeraries they can be in different positions, different numbers. And so just to clarify to be, particularly, you know, a really interesting topic and there's so much to say about that, but we're just going to limit it to unerupted teeth and anterior maxilla, which is something really common and has an impact. And I think can be reasonably,picked out and you know, and noticed and managed early by dentists. So as we were saying, souvenir is basically it's just a type of dental normally in the numeric form in terms of the number. So there are different types of supernumeraries and generally overall we divide them into what we call supplemental tooth or supervisor supplemental tooth is where it actually has the exact same form, the exact same function as adjacency. Dr. Diane Tay: So they pretty much don't really have any difference in anatomical differences versus supernumerary. More so where is the tooth? It's characterized by an atypical anatomic form and sometimes they can be smaller or different in the anatomy, very very briefly and a very old classification. You can classify them into the more conical shape form, you can classify them as tuberculate or supplemental form. So it's just a different sort of classification depending on the roots. Obviously there's other kinds of which I won't go into, such as composite odontomes etc. But really important to look at them and also determine the position. So it's not just what type of supernumerary it is, but the position of the supernumerary. So sometimes they can be just in a normal position they could be inverted. Dr. Diane Tay: So those ones tend to, and we'll talk about them more but inverted do generally and very rarely they don't erupt by itself. So hence sometimes the management does become different. And being aware that generally these ones will not erupt. We need to decide whether we need to remove them pending other things, which Andrew and I will discuss, just to clarify for a lot of our dentists, because we hear commonly misused terms, but strictly speaking, mesiodens is a tooth that's located between the central upper incisors. So a supernumerary say, you know, how little or to the 11. So that would not necessarily classify as a mesiodens. So it means it's actually one that's located between the upper incisors. Dr. Diane Tay: But I guess most irrelevant in classifications. While important, I guess like you and I, Andrew are very interested in the clinical management. So what are some of the signs that are important to know? And I know from my point of view, I always think the picking up, sort of knowing our, again going all where I was going back to first principles, knowing our dental development, knowing when teeth erupt, when should they exfoliate, always will help us lead to picking up these things early. And again, the earlier these things are picked up, then management always becomes, easier, less complicated. So the first thing I always think about when I'm looking at a patient is this dentition appropriate for their age? And so if you notice that there's somewhat of a delay or a failure of eruption in the permanent incisors. Dr. Diane Tay: So let's say a patient is eight years old and they've lost the lower incisors, the upper incisors, there's absolutely no mobility in the central incisors. Or even if you may see asymmetrical eruption. So, for instance, you may see the 51 has exfoliated and the 61 is still absolutely no signs of mobility, clinical mobility. I would be starting to look into reasons as to why. There is a failure of exfoliation and failure of eruption, of the permanent incisors. Also of course I know is different, but maybe there's an extra tooth in the sequence so you may notice that there may be a supplemental 52. So again, counting the teeth and charting them properly. But another thing that really, is important also if you start noticing a large gap or a diastema between the two front central incisors, often times people tend to think, Oh look there, that must be caused by a labial frenum. And that may be the case. But for me, I always will check if there is, if I'm concerned, it's just taking a very, very simple radiograph and you might find something else that may be present there. I mean, Andrew id be really happy to hear from your perspective or clinical experience of what you think or is there any other clinical signs that you might Dr.Andrew Chang: I've definitely seen your two, the two most common ones that in my experience has been the large gap, between the front central incisors where one incisor has erupted and the other incisor has not formed. So I suppose this leads to the next question is what other, you did mention a periapical, but what other diagnostic age should a dentistfirst of all use to diagnose this? Dr. Diane Tay: Yeah, that's a really good question, Andrew. From my side of things, I guess coming from a surgical standpoint where I'm starting to think, okay, how am I going to manage this. This for me, first of all, it requires management, what do we need to do? We have to remove it. Can we wait? Can we watch and see? So I guess a simple thing which all of us in clinical practice can do to start with is a periapical you could, and I know a lot of us practitioners do have our own OPG machine, which you can do to get an overall view. However, the only thing I would probably suggest is to get a cone beam scan and again a lot of practitioners I know have their own cone beam machine. The benefit or the value of a cone beam x-ray, sorry, a cone beam scan is that it also acts as a surgical means to localize the tooth and guide surgery planning. Dr. Diane Tay: So from a surgical standpoint if I'm going in, it's good to know exactly where the tooth is and also relative, obviously how much with bone is overlying it where to position it, how easy to retrieve it, what the proximity to adjacent structures adjacent developing permanency. So these are all really important to decide on a really separate known because I do have a really keen interest in that other, you know, other in children, managing kids with medical comorbidities and certain syndromes. I think it's also relevant and important to just consider if you do take an X-Ray and you see multiple supernumerary that you have to stop thinking of other systemic causes such as Gardner's syndrome, or cleidocranial dysplasia. I know those things tend to exhibit other signs as well. However, it's just valuable to start thinking about things. And that was just a really side comment I thought I'd make off the top of my head. Dr.Andrew Chang: Yes, yes. All clinical clinician. And I think I do recall with an opg, if it's outside the focal trough and there's multiple supernumeraries, that may not necessarily pick that up. Is that correct? Dr. Diane Tay: Yeah thats right. So, which is why I think a periapical is used if you're concerned that there may be another, you can always do that simple SLOB rule, have a look in and do a few angles to get, but I guess a cone beam CT, which is very easily obtainable these days,and the radiation is very low and comparable now. It's a worthwhile x-ray or diagnostic film to get so you can also use it for your surgical planning as well. Dr.Andrew Chang: So to recap for dentists, if you suspect there's a supernumerary, i.e as in you see a large gap between their front teeth or delayed eruption, you would take a screening, a x-ray like a periapical. And if one is considering in terms of the surgical management or in terms of how do we go about approaching this orthodontically then it would definitely need a CT. From my perspective and what I look at, I definitely require a CT to locate the tooth, so we can see in terms of is it close proximity to the developing adult teeth. Let's say if it's the upper central incisors, which may not be able to erupt because there's an impediment with the supernumerary and the permanent central incisors from erupting. I would want to make an assessment, well what is it's proximity because that would be an indication of what are the risks associated with the exposures in terms of with the surgeon accessing that area. And also in terms of moving that central incisor down. Having a CT provides three dimensional information that it goes far beyond what an OPG can provide. Dr. Diane Tay: I think cone beams are definitely coming up in terms of not being diagnostic and clinical management. Dr.Andrew Chang: So I suppose it now leads into the you did raise an important point. One of the things that you had talked about with the classification, these uninterrupted supernumeraries is that they often atypical as in, does that mean that the crown is usually not like a normal size is usually perhaps smaller or a a funny shape perhaps? Dr. Diane Tay: Yeah. In my experience, usually the unerupted supernumerary tend to be very, they have a very clinical form, the smaller and oftentimes when they're inverted, as I said, they don't actually, they won't erupt until, I guess it is. I tend to advise parents that these are probably the ones that will need to be removed. But again, that goes into looking at what other factors to consider. Dr.Andrew Chang: I suppose this is now a segue into this topic. So we've located the Supernumerary. What are the implications of having a supernumerary and what happens if we don't do anything? What may happen? Dr. Diane Tay: Because parents do want to know, they want to understand, do we often question is really do I need to remove this as is not causing a problem or my child has not complained. What do I need to know? When should I look at managing it? I think the important thing with supernumeraries is because generally of where they are located, they can or tend to cause failure of eruption in incisors, eruption of the permanent and you know, usually the central incisors and sometimes they can also cause ectopic positioning and movement of the permanent teeth or displacement in some way of, of adjacent teeth. And sometimes I've also seen supernumeraries that do not impede the eruption of the permanent teeth. Dr. Diane Tay: And parents say the permanent teeth are coming out. Do I really need to remove the supernumeraries cause it's clearly not blocking the way. However, you also have to consider from an orthodontic, and obviously we value your opinion but from an orthodontic perspective, can supernumeraries interfere with orthodontic teeth movements? And that's where, for me, I always tend to work with orthodontists to treatment plan these things. And I think you and I, Andrew had worked in a few cases very successfully together. Dr.Andrew Chang: I have. So I should talk about in terms of three patients I can recall on this one was that we collaborated on where the supernumerary or that extra tooth was what we call incisal to the adult developing adult front tooth. So it was clearly in the path of the erupting tooth. And,fortunately one of the things is we got to that early. Generally, If the root of the adult front tooth has fully formed, there's a lesser chance of it wanting to erupt by itself. So it becomes a balance of well, do we go in soon knowing that the root of the front tooth has not fully developed, possibly it may be risking its root development by doing this surgical exposure, or do we wait and let the root form a bit longer and then do we expose it,remove the supernumerary and expose the tooth at the same time. Dr.Andrew Chang: So generally, we normally would like to have at least half to two thirds root formation on that central incisor before I go in, as I don't want to make a surgical intervention too early, in terms of removing that supernumerary,if I felt that there was a high risk of interfering with development of the upper central incisor root. Dr.Andrew Chang: In another case where we collaborated. In this case, the girl was a bit older. She was about, 9 if i recall. So,the root was literally almost fully formed. So in this case we made a decision to remove the supernumerary and expose the central incisor at the same time. There was another instance where I saw another patient who was a slightly younger and we clearly had enough space for the adult, cetral incisor that to come down. And I can't exactly recall, it may have been a mesiodens right in between or may have been a supernumerary. But in that instance she had the mesiodens removed and the central incisor erupted without orthodontic intervention. Dr.Andrew Chang: And the last patient that I can recall quite clearly is an adult where the supernumerary in this case it's probably a mesiodens where it was right in between the two front teeth. It was actually located incisal to the upper permanent incisor. So the tooth was inverted and was conical in shape exactly what you described. And it was actually right below the nasal floor. So being an adult, she's very wary of having that removed, so the consideration for orthodontics is would its presence interfere with the zones of movement or the boundaries of movement of the teeth. Dr.Andrew Chang: And in this case we took a cone beam CT & we've verified that supernumerary was actually quite high superiorly and along the palatal aspect and we determined that at that point in time we would be monitoring with another CT in 12 months time, and as you may understand she was very hesitant about having the supernumerary removed. So we went through a discussion of the risks and benefits, the pros and cons,but because it was quite high up, d after running through that with her, e made a decision together to review that in 12 months time with another cone beam CT. Dr. Diane Tay: Yeah i think that explains things really well. You have a really good point about all of them. Dr.Andrew Chang: I mean there's one other thing in terms of implications of having an extra supernumerary is sometimes leaving it too long can lead to displacement, not just of the central, but it can also lead to displacement of the lateral incisor, which may be impeded in its eruption. So depending on where that location of that supernumerary is keeping it in there, f it's located incisal to the adult upper incisors is probably not something I would do, indefinitely, ue to the effects on eruption of the adjacent teeth there. Definitely, if you're going to monitor that, it will need closely monitoring and at some point you need to make a decision to have that supernumerary removed. And working in conjunction with in this case a surgeon or a pediatric dentist and an orthodontist is definitely very helpful as a team effort. Dr. Diane Tay: Absolutely. No, Andrew, I think your cases really classify and very well illustrate what we were looking at and talking about before. So what are important things to consider when we're managing supernumeraries because identifying it is easy, but what are you looking at when you're thinking about how to manage it? So, I mean from my perspective as you correctly saying you illustrated it again, you know, across your cases, the age of the patients shouldn't just be a guide, because we're looking at the root development stage of the permanent incisors. So you're weighing up the risk benefits of surgery of damaging developing permanent teeth & waiting too long and impeding or preventing the spontaneous eruption of the permanent incisors. Dr. Diane Tay: You also have to think and consider as we discussed, the number of supernumeraries, the position, where is it, is it inverted, what type of supernumeraries and which is why we say use the cone beam to determine exactly, the locality and the position and, and proximity to adjacent teeth, we have to consider which tooth is it around, is it an erupted supernumerary or unerupted supernumerary? And also what are the parents' expectations? What's the occlusion like? Is this, you know, is this child likely to require orthodontic movement of teeth so is it something, can you leave it or monitor it. So is the supernumerary actually causing ectopic or displacement of the permanent teeth? In which case then you may need to consider,acting and being more proactive in your approach. Those are some of the things I'll be be thinking about. Was there any other points, Andrew, that you'd like to get from your clinical experience? Dr.Andrew Chang: I think if we had to list out the factors which we covered on, all we touched on. One was the, the age of the patient. We talked about in a child, we also talked about it as an adult. As we talked about it, I can recall a teenage patient who also had a supernumerary where he was in his permanent dentition and he was about 13 or 14, and most of the supernumeraries that I've had in the anterior maxilla tend to be slightly along the Palatal. And I can recall because this patient, while he had crowded teeth but his upper front teeth were also,proclined as well. And when the mum went to see the surgeon because of where the supernumerary was, it was located apical but close to the apices of the permanent central incisors. Dr.Andrew Chang: But because the surgeon mentioned there is a risk of the upper front teeth losing their vitality or nerve, and in case what it means by that if there's any parents listening to this, is that nerve could suffer and a tooth may die or darken, in which case he may require a root canal, as a complication of surgery to remove the supernumerary tooth. But because of that risk, the possibility of that risk, they held off removing this supernumerary. And because the supernumerary was lying more a bit more palatal, we could not bring his upper front teeth back. So we kept them at a forward inclination. In other words, the upper front was sloping forward. So while his teeth were crowded, we straightened them. We didn't really bring them back but of course, then we came to a point where I said, well, we can't move it back. She wasn't happy with the current smile either. Dr.Andrew Chang: So at the end she made a decision, yes, the risks, but based on what the surgeon said, the risk was actually very small. So she went back to the surgeon and found out the risk was actually very small. So then she said, well I made a decision, I mean it's a balance of benefits versus risks. Okay, we'll have that supernumerary out,and turn out in the end the upper central incisors were fine, the vitality was fine and we managed to move the upper adult front teeth back and correct the protrusion and he is very close now to getting his braces off. So it's a balance of where, when we talk about for teenage patients, it's more getting the orthodontist involved and in terms of where the movements of their adult teeth are going to go and would the presence of the supernumerary interfere with them getting an ideal treatment outcome in terms of their smile & orthodontic correction for teenage patients. Dr.Andrew Chang: That's a main consideration for the adults of course there's often may be other medical histories that may affect in terms of surgical risk, and would involve maybe a closer conversation with the oral surgeon. Often adults,need to be more aware of the situation and they tend to be less inclined doing invasive surgery,particularly if its quite high. If a decision is made to keep a supernumerary, close monitoring is important and if the patient goes and for some reason doesn't come back, they need to be aware of that, that a supernumerary needs to be monitored because in a very, very small number of cases there can be cases of cysts. I mean the possibility is very small. It's just something that the patient needs to be aware about. Dr.Andrew Chang: So is there any other important factors I suppose to consider if we had to list it out, we've already covered root development, child, teen and adult management, is this a permanent incisor or primary incisor? Is the supernumerary erupted or non erupted? I suppose the good thing is nowadays with a CT you can easily see the shape and the size and the widths of the supernumerary. Some supernumeraries are generally smaller in size as we touched on. Very briefly and I know this is not really the topic on this podcast it becomes a bit harder when it's a supplemental, when a tooth is already erupted and is quite close in shape to the other incisors. Dr.Andrew Chang: One of the things that I'm inclined to look at is the width, but also the root formation and because sometimes some supernumeraries may have dilacerations in terms of root or dens in dente associated with them. So there's something that I'll be looking at quite closely, in terms of their pulpal status, but the main decision is which tooth could look nicer, both on the clinical point of view or aesthetic point of view and has got a good pulpal health as well. The other consideration for important factors is root development stage. And I know we touched on the risk of surgery and the position of the adult incisors, is a supernumerary causing displacement of the other incisors , patient factors: cooperation and the parent factors as well. Is there anything you want to elaborate on Diane? Dr. Diane Tay: No. Covered points very, very thoroughly and exactly what you're saying with looking out for these things. I think that's a key to success and management of the case. Dr.Andrew Chang: We've touched on these management options earlier by talking about these case studies, but could you briefly outline the management options if you haven't covered any of it? Dr. Diane Tay: We pretty much covered it through our discussion on the cases. But I guess to just really summarize it, mainly first if the option is to monitor, say maybe because the child's only three or four younger, we're waiting to decide what we're going to do or versus if the patient's older to say, then monitoring closely, ensuring you get appropriate radiographs just to manage monitoring for any specific changes such as cone beams would be very good and very clear x-rays or scans. So sometimes it may just involve simple surgical extractions. Dr. Diane Tay: And then let's say the child is six, six and a half, seven, and we know this, a supernumerary that's impeding the eruption of the permanent incisor and you have an over retained say 51 or 61. So you'd want to remove the primary incisor as well as the supernumerary and then monitor the eruption of the permanent incisors. So this would obviously be, and I often at times in the cases I've done before, work together with the orthodontist to determine and finalize the treatment plan: So if I'm going in surgically knowing whether we're just going to monitor the incisor based on the root development as you correctly say Andrew, we're looking at the root development if its about half to a third of roots. Dr. Diane Tay: However, conversely, if the roots, let's say this has been picked up and now the child is 10 or 11 years old and the root of the permanent incisors have already formed, then sometimes what we'll need to do is in addition to removing the supernumerary and the retained primary incisor, then we would really would be looking at doing a surgical exposure and potential bonding of the tooth orthodontically, to bring the tooth down into the arch. Oftentimes I get them to see the orthodontist first to lay down those braces archwires. And prior to surgery, was there anything else Andrew you'd like to add to that? Dr.Andrew Chang: I think we covered that really well. And it's really nice to have you on Diane and I hope the audience took something away today. Dr. Diane Tay: And thank you so much for listening again, and we will have more interesting topics to discuss next time. Thank you.  

“It’s no accident I do what I do. I come from a long line of people making culture, considering how we live and responding either sonically or aesthetically to that.” - my inspiring guest, Lotte Anderson, who was described as ‘emblematic of the city of London’Lotte, an artist living and working in London, creates work that explores the politics of taking up space, community, pleasure seeking and human behavior. Lotte tells me how growing up in West London amongst families of ‘creative dynasties’ inspired who she is today and how through the creation of her party series, MAXILLA, she realized she was making art the whole time. From there, she’s found herself in museums like the Tate Modern and we discuss how she’s able to recognize her own accomplishments.We discuss how she navigates the art world as a woman of color and how her racial ambiguity weighs on her at times and how she explores it in her work. We talk about Scary Spice, how Mel B’s blackness was treated, and re-evaluating GIRL POWER. After attending fashion school and working for Alexander McQueen, Lotte tells me why fashion ultimately wasn’t for her. We discuss Supreme, the CFDA, casting in fashion and Fenty.Although she’s often cited as one of the coolest girls in london, I’m shocked to learn that she felt awkward growing up. We talk about building community, the healing properties of water, CHANEL beauty, being a Gucci ambassador & lots more!Products/Things Mentioned@nakedbeautyplanet where you can find a lot of my natural beauty recipesMore info on Lotte’s latest show: How Do You Feel About Lying?Shy Girl, the artist she collaborated withhttps://www.coeval-magazine.com/coeval/shygirlKelis - Caught Out There (Iconic)https://www.youtube.com/watch?v=N3JFwd1bk4Q111 Cryo where Lotte tried Cryotherapyhttps://www.111cryo.com/REN Rose Body Oilhttps://www.sephora.com/product/morroccan-rose-otto-ultra-moisture-body-oil-P378013Women’s Balance Essential Oil Blend from Neal Yardhttps://www.nealsyardremedies.com/aromatherapy/aromatherapy-oils-and-blends/essential-oil-blends/2715.htmlAesop Facial Tonerhttps://www.aesop.com/nz/p/skin/tone/parsley-seed-anti-oxidant-facial-toner/Chanel beauty compact cream essential palette (comes in a range of 6 shades)https://www.chanel.com/us/makeup/p/149150/palette-essentielle-conceal-highlight-color/Dazed Beauty on IG - Constructed beauty at workThe Cleremont twins - for anyone unfamiliar------Follow Lotte: https://www.instagram.com/_lotte_andersen_/-----Thank you for listening! Be sure to subscribe, rate, review & tell a friend about the #nakedbeautypodcast :) See acast.com/privacy for privacy and opt-out information.

In this episode I discuss a recent trauma case were a young man riding his motorcycle took a beating to his premaxilla fracturing tooth numbers eight causing a maxillary dental alveolar fracture a partial lefort fracture and an avulsed tooth numbers 11 up into the maxillary vestibule lateral to the nose.

This week I begin our discussion with a review of a case report of a 64 year old lady who acquired hemophilia A.  This lady went in with no known bleeding disorders and had a mandibular third molar removed and found herself intubated for 5 days and near death but survived and was released from the hospital 10 days after admission. I also discuss two bone grafting techniques that you will want to consider to solve the failed implant in the esthetic zone as well as for the atrophic maxilla or mandible 3 tunneling approach.

Did you know the position of 8 and 9 can tell you what implant restoration your need in the mandible? Is adding more implants always the right move? WE want to save your implant case before it even starts this week on the Dental Guys.

Hello and welcome to this week's episode of My Big Idea, an ASOS Podcast. This week our guest is Lotte Andersen. Lotte is the zine maker, party thrower and all-round good time gal you want to know. Before leaving her BA in fashion, Lotte interned heavily, even working on McQueen’s last collection (you know, the one that crashed SHOWstudio). You'll now mostly find her co-presenting her Know Wave radio show, Living For The Weekend, or throwing her famous Maxilla parties at her local Portuguese restaurant in Ladbroke Grove. This is Lotte's big idea. See acast.com/privacy for privacy and opt-out information.

Moni suomalainen käy toisella paikkakunnalla töissä ja asuttaa kakkoskotia. Max Holmin kakkoskoti on muutaman neliön kokoinen ja kelistä riippuen enemmän tai vähemmän keinahteleva. Max on Viking Gabriellan risteilyisäntä ja asustaa vuoroin maissa omassa kodissa, vuoroin laivan hytissä. Laivavuoro kestää kymmenen vuorokautta, vapaa saman verran. Laivahenkilökunnan hytit eivät ole luksusluokkaa, risteilyisännän hyttiin mahtuu juuri sänky eikä paljon muuta. Hytti on samanlainen, johon jokainen ruotsinlaivalla kävijä on tutustunut, kylpyhuonekin on sitä mallia, että jos käy suihkussa, kastuvat varpaat myös pytyllä. Max ei ole hyttiään sisustanut, omaa on vain untuvapeitto ja lakanat, sekä aina mukana kulkeva golfmaila. Max sanoo, että koska hytissä käydään lähinnä nukkumassa, hän ei halua sinne mitään mikä kerää turhaa pölyä. Tosin hänen vapaidensa aikana hytti on toisen työntekijän käytössä ja erityisesti naispuoliset asukkaat tuppaavat keräämään hyttiin pehmoleluja, joita Max vuorollaan korjailee pois. Henkilökunnan kanttiini on kodikas ja laivalla on omalle väelle myös kuntosali ja lukuisia saunoja. Kotona kaksi kertaa päivässä saunova Max kertoo, ettei jostain syystä ole käynyt viiteen vuoteen laivan saunassa, vaikka lähin niistä sijaitsee aivan hytin tuntumassa. Omaa oikeaa kotiaan Max Holm kuvailee minimalistiseksi ja funkkistyyliseksi, sinnekään hän ei ole halunnut turhaa tavaraa, vaan haluaa antaa tilaa arkkitehtuurille. Kotiin päästyään laivavieraiden viihtyvyydestä vastaava risteilyisäntä sulkeutuu muutamaksi päiväksi hiljaisuuteen, mutta vapaan lähetessä loppuaan on Maxilla ikävä jo laivalle.

In dieser Studie wurde eine individuelle faziale Weichteilprognose mit der Finiten-Elemente-Methode getestet und deren Validität und Prognosegenauigkeit geprüft. Zum Vergleich wurden die Messwerte mit einem zweidimensionalen Verfahren, dem Dentofacial Planner Plus Version 2.01, verglichen. Für die Erstellung der Weichteilprognose stellten sich 12 erwachsene Probanden zur Verfügung, bei denen eine kombiniert kieferorthopädisch-kieferchirurgische Behandlung durchgeführt wurde. Zur präoperativen Prognose der Weichteilveränderungen wurde ein Profilfoto mit einer digitalen Kamera der Firma Canon, EOS 10D, und ein Fernröntgenseitenbild für die Weichteilprognose des zweidimensionalen Verfahrens hergestellt. Nach Eingabe der kephalometrischen Messpunkte in das interaktive Softwaretool des Dentofacial Planners konnte die Operation simuliert werden. Dazu wurden die Werte der Modelloperation hinzugezogen. Nach Verschiebung der Maxilla und Mandibula in sagittaler und vertikaler Richtung errechnete die Software die Weichteilprognose, die als Profillinie zweidimensional visualisiert wurde. Für die digitale Gesichtserfassung der Probanden wurden mittels 3-D Laserscanner die fazialen Weichteile für das dreidimensionale Verfahren erfasst. Die akquirierten Punktwolken konnten vereinigt und über spezielle Algorithmen in ein CAD-Modell verarbeitet werden. Über diese CAD-Schnittstelle war es möglich ein Finite-Elemente-Modell zu generieren. Die Simulation zur fazialen Weichteilprognose erfolgte mit der Software Design Space (Ansys Inc.). Im Unterschied zum zweidimensionalen Verfahren besteht beim Finite-Elemente-Verfahren die Möglichkeit einer falschfarbenkodierten Visualisierung der regionalen Weichteilveränderungen im dreidimensionalen Raum. Es kann neben der Prognose der Profillinie auch eine ästhetisch wichtige Beurteilung der Wangen, der Nasenflügel und Nasiolabialfalten getroffen werden. Bei vergleichenden Messungen zwischen den beiden Prognoseverfahren zeigen sich bezüglich der Validität und der Prognosegenauigkeit eindeutige Unterschiede. Der durchschnittliche Gesamtfehler des Dentofacial Planners ist fast doppelt so hoch, im Vergleich zum Fehler des Finite-Elemente-Verfahrens. Es konnten regionale Unterschiede festgestellt werden. Im Mittelgesicht ist die Prognose der beiden Verfahren als gut einzustufen, währenddessen die Prognose des unteren Gesichtsdrittels mit dem Dentofacial Planner hohe Abweichungen zum postoperativen Gesichtsprofil aufweist. Diese Ergebnisse wurden von Fischer (2002) in einer Dissertation bestätigt. Die Prognosegenauigkeit des Finite-Elemente-Verfahrens ist im unteren Gesichtsdrittel höher. Jedoch wurde am Messpunkt Weichteilmenton Abweichungen in vertikaler Richtung mit Messwerten von über 1,5 mm aufgezeigt. Eine mögliche Erklärung dafür ist die geringe Simulation der Autorotation des Unterkiefers bei der Bearbeitung des Finite-Elemente-Modells. Es muss jedoch berücksichtigt werden, dass trotz der besseren Beurteilung der individuellen, fazialen Weichteilverhältnisse in allen drei Dimensionen des Raumes im Vergleich zum zweidimensionalen Verfahren keine absolut perfekte Weichteilprognose getroffen werden kann. Um dieses Verfahren der Finiten-Elemente-Methode zu verfeinern sollten bei der Herstellung des Finite-Elemente-Modells die Weichgewebsschichten und die Autorotation des Unterkiefers berücksichtigt werden.

Ziel der vorliegenden Studie war es, die Wirkung einer Behandlung mit der in der Poliklinik Kieferorthopädie in München entwickelten MSR-Platte bei Patienten mit einer Angle Klasse II Malokklusion im Vergleich mit einer nicht behandelten Kontrollgruppe, ebenfalls eine Klasse II Malokklusion aufweisend, zu untersuchen und dabei entstehende skelettale und dento-alveoläre Veränderungen festzustellen. Die retrospektiv angelegte Studie umfasste 26 Patienten. Die Behandlung mit der MSR-Platte wurde bei allen Patienten in Verbindung mit einem high-pull Headgear durchgeführt und entweder mit einer Multibandtherapie oder einem Positioner fortgesetzt. Es wurden jeweils zwei Fernröntgenseitenbilder analysiert. Eines unmittelbar vor Therapiebeginn mit der MSR-Platte und eines ca. 12 Monate später, zum Ende des Behandlungszeitraumes. Die größten Veränderungen wurden bei den dentalen Werten verzeichnet. Die oberen, sowie die unteren Inzisiven wurden aufgrund der Behandlung retrudiert. Die Entwicklung der Kontrollgruppe ist gegenläufig. Folgende Tendenzen der skelettalen Beeinflussung lassen sich erkennen: (1) Der SNA-Winkel verkleinert sich durch den Einsatz der MSR-Platte in Kombination mit einem Headgear (2) Der SNB-Winkel tendiert in der MSR-Gruppe eher nach anterior, während er in der Kontrollgruppe eher nach posterior und damit in eine verstärkte retrognathe Stellung weicht. (3) Die anteriore Untergesichtshöhe vergrößert sich tendenziell mehr bei den behandelten Patienten, als in der Kontrollgruppe. Die Ergebnisse führen zu folgender Schlußfolgerung: 1. Die MSR-Platte bewirkt signifikante dento-alveoläre Veränderungen im Vergleich zur Kontrollgruppe. 2. Die MSR-Platte bewirkt zwar keine wesentlichen skelettalen Veränderungen. Einfluss auf die Maxilla durch den Einsatz eines high-pull Headgear zu verzeichnen. Die vorliegende kephalometrische Studie ergibt einen Hinweis darauf, dass die MSR-Platte ihren Indikationsbereich bei dento-alveolär bedingten Klasse II Malokklusionen findet. Leichte skelettale Disharmonien lassen sich bei günstiger Wachstumsprognose ebenfalls beeinflussen. Es sollte dennoch zum Abschluss der Behandlung der Einsatz festsitzender Apparate in Erwägung gezogen werden, um eine Feineinstellung der dentalen Harmonie vorzunehmen.

In der vorliegenden Arbeit wurden vergleichende Untersuchungen zur Wachstumsanalyse nach BJÖRK (1969) [16] von sechs unterschiedlich erfahrenen Betrachtern im Fach Kieferorthopädie vorgenommen. Der Fokus dieser Betrachtung bezieht sich auf den Vergleich dieser Prognose mit dem wirklich eingetretenen Wachstum und den Empfehlungen von STEINER (1953) [72] für die Prognose der sagittalen Relation von Maxilla zu Mandibula dargestellt im ANB-Winkel. Der erste Teil der Untersuchungen prüft die Merkmale 1 bis 3 (Form der Kondylen, Canalis mandibularis, Unterrand der Mandibula mit Symphyse) der Wachstumsanalyse nach BJÖRK auf die Abhängigkeit vom Erfahrungswert der Betrachter und ihren Einfluss auf die Gesamtanalyse. Der zweite Teil der Arbeit befasst sich mit dem Vergleich der Analysenergebnisse mit den wirklich eingetretenen Veränderungen. 50 Kinder im Alter zwischen 8 und 12 Jahren mit einer ANGLE-Klasse II-Anomalie wurden für diese Studie ausgewählt. Von jedem Patienten liegen Fernröntgenseitenbilder zu zwei Zeitpunkten (Behandlungsbeginn und Behandlungsende) vor. Die kephalometrische Auswertung erfolgte nach Empfehlungen von HASUND und WINGBERG durch eine einzige Person. Die von sechs Betrachtern ermittelte Wachstumsprognose, erstellt nach dem Anfangsbefund, konnte so mit dem tatsächlich erhaltenen Ergebnis nach Abschluss der Behandlung beziehungsweise nach Wachstumsende gegenübergestellt werden. Die computergestützte Auswertung erfolgt nach der Empfehlung von BECKMANN, WINGBERG und HASUND (1983) [6]. Die ermittelten Werte werden als konstant angesehen. Nach der strukturellen Analyse nach BJÖRK (1969) [16] und OEDEGAARD (1970) [51],[52] wurde von allen sechs Betrachtern an den Fernröntgenseitenbildern zu Behandlungsbeginn die ersten drei Bewertungsmerkmale der Wachstumsanalyse beurteilt. Die Kriterien 4 bis 6 der Analyse werden nach den gemessenen Werten als konstant angesehen und als objektive Merkmale bezeichnet. Somit können die subjektiv bewerteten Kriterien 1 bis 3 von den sechs Betrachtern einzeln bewertet und deren Einfluss auf die Gesamtanalyse untersucht werden. Ein Vergleich dieser Bewertungen zeigt einerseits, dass die Tendenz zur Übereinstimmung von Merkmal 1 zu Merkmal 3 wächst, und dass die bestehenden Diskrepanzen der Einzelmerkmale in der Zusammenfassung bei der Gesamtanalyse zunehmend an Einfluss verlieren. Obwohl das subjektive Merkmal 1 mit der geringsten Übereinstimmung gemeinsam mit dem objektiven Merkmal 6 die Translation vorhersagt, ist die Tendenz auch hier sehr konvergent. Die Rotationsaussagen, bewertet aus allen Einzelmerkmalen, zeigen dieselbe hohe Übereinstimmung. Eine Abhängigkeit vom Erfahrungswert der Betrachter konnte weder bei den Einzelmerkmalen noch bei dem Ergebnis der Gesamtanalyse festgestellt werden. Die Diskrepanzen zwischen den Studenten, den Assistenten und dem Professor waren gleichmäßig verteilt und unauffällig. In Merkmal 1 und 2 stimmten die signifikanten Ergebnisse überein, hingegen konnten bei Merkmal 3 keine auffälligen Übereinstimmungen festgestellt werden. Der erste Teil der Studie zeigt, dass Betrachter mit unterschiedlichen orthopädischen Kenntnissen zu vergleichbaren Ergebnissen bei der Wachstumsanalyse nach BJÖRK und OEDGAARD kommen. Bei den Einzelmerkmalen allerdings gelangen sie nur in einem gewissen Prozentsatz zu gleichen Bewertungen. Da der Einfluss der einzelnen „subjektiven" Merkmale auf das Gesamtergebnis durch die als konstant angesehenen „objektiven" Merkmale in der Endaussage sinkt, sind diese Diskrepanzen als wesentlich anzusehen. Die ANB-Prognose 1 nach STEINER (ANB/2+1), ohne eine Individualisierung des Sicherheitsfaktors 1, gemäß den Ergebnissen der Wachstumsanalyse von BJÖRK und OEDEGAARD, liegt der Realität zum Zeitpunkt T3, also am Ende der kieferorthopädischen Behandlung, am nächsten. Die nach der Wachstumsprognose von BJÖRK und OEDEGAARD individualisierte Vorhersage durch Varianten des Sicherheitsfaktors 1 liegt durchschnittlich unter der ANB-Prognose 1 nach STEINER, weisen also kleinere Werte auf. Dadurch war der ANB-Winkel zum Zeitpunkt T3 größer als nach BJÖRK und OEDGAARD vorhergesagt. Da man davon ausgehen kann, dass vom Zeitpunkt des Endbefundes T3 eine weitere Verkleinerung des ANB-Winkels stattfindet, könnte diese ANBPrognose 2 den ANB-Winkel zu einem späteren Zeitpunkt, nach Abschluss des Restwachstums, vorhersagen.