Obstructive sleep apnea (OSA) syndrome is a relatively
|
|
- Cecil Gilbert
- 6 years ago
- Views:
Transcription
1 Surgicl mngement of ostructive sleep pne PUSHKAR MEHRA, BDS, DMD, AND LARRY M. WOLFORD, DMD Ostructive sleep pne (OSA) syndrome is common disorder tht hs recently received much ttention y the medicl community due to its potentilly serious physiologicl consequences. The clinicl significnce of OSA results from hypoxemi nd sleep frgmenttion cused y collpse of the irwy, which leds to pne or hypopne during sleep. This pper reviews common surgicl techniques used for clinicl mngement of OSA ptients, with emphsis on jw dvncement surgicl procedures. Ostructive sleep pne (OSA) syndrome is reltively common disorder tht involves periodic prtil or totl collpse of the phryngel irwy during sleep. This results in progressive sphyxi, which incresingly stimultes rething efforts ginst the collpsed irwy, typiclly until the ptient is wkened from sleep (1). Clinicl sequele of OSA result from the hypoxemi nd sleep frgmenttion (2). The respirtory disturnce index is the numer of pneic or hypopneic events per hour during sleep, determined y polysomnogrphy, nd is used to quntify the severity of OSA. Additionl symptoms include snoring, dytime sleepiness, nd ftigue. As OSA progresses, cognitive dysfunction, inility to concentrte, memory nd judgment impirment, irritility, nd depression cn develop, leding to work nd socil prolems. Systemic consequences of OSA include hypertension, crdic rrhythmis, pulmonry hypertension, cor pulmonle, left ventriculr dysfunction, stroke, nd deth (2). Nonsurgicl options for treting OSA include weight loss, ltertion of sleep posture, orl pplince therpy, externl nsl support devices, phrmcologicl therpy, nd continuous positive irwy pressure (CPAP) therpy (1). Surgicl tretment options include trcheostomy, mndiulr osteotomy with genioglossus or inferior order dvncement, uvulopltophryngoplsty (UPPP), lser-ssisted uvuloplsty (LAUP), reduction glossectomy, internl nd externl nsl reconstruction, tonsillectomy nd denoidectomy, nd dvncement of the upper nd lower jws. We review the vrious surgicl techniques nd present some of our clinicl nd reserch experience in the mngement of ptients with OSA syndrome. TRACHEOSTOMY Permnent trcheostomy ws the first efficcious procedure nd the most common procedure used for tretment of OSA in the 1970s nd 1980s (3, 4). Trcheostomy hs very high success rte in reversing OSA symptoms, except possily for ptients Figure 1. () The nterior mndiulr osteotomy with genioglossus dvncement procedure. A surgicl ccess window is creted in the nterior mndile y cutting through the outer nd inner cortices nd medullry one. () The outer cortex nd medullry one hve een removed. The inner cortex incorporting the genil tuercles (with ttched musculture) hs een nteriorly repositioned replcing the removed outer cortex. This simultneously dvnces the hyoid one nd se of the tongue (T) (rrows). with oesity-hypoventiltion syndrome, s it ypsses ll potentil upper irwy ostructive sites. Despite its effectiveness, trcheostomy is rrely used s first-line tretment of OSA ecuse of serious disdvntges, which include trchel stenosis, lood vessel erosion, recurrent purulent ronchitis, speech difficulties, nd esthetic disfigurement. ANTERIOR MANDIBULAR OSTEOTOMY WITH GENIOGLOSSUS ADVANCEMENT This procedure involves n osteotomy in the nterior mndile, creting lock segment tht incorportes the genil tuercles nd ssocited muscle ttchments (Figure 1). The ony lock is then repositioned nteriorly to dvnce nd suspend the hyoid one to the mndile (Figure 1). Riley et l reported 67% success rte, with filures relted to oesity nd norml mndiulr skeletl development (5). This procedure hs the dvntges of eing offered on n outptient sis nd eing reltively minimlly invsive. Its disdvntges re tht it does From the Deprtment of Orl nd Mxillofcil Surgery, Bylor University Medicl Center, Dlls, Texs. Dr. Mehr is now with the Deprtment of Orl nd Mxillofcil Surgery t Boston University School of Dentl Medicine, Boston, Msschusetts. Corresponding uthor: Lrry M. Wolford, DMD, 3409 Worth Street, Suite 400, Dlls, Texs BUMC PROCEEDINGS 2000;13:
2 gittion, velophryngel incompetence, hypernsl speech, pltl stenosis, nd residul OSA. Wolford developed modifiction of the trditionl UPPP procedure tht minimizes incisions long the posterior order of the soft plte, decreses postsurgicl scrring, nd predictly shortens the soft plte length, effectively improving the orophryngel irwy spce fter surgery (Figure 3). Figure 2. () The nterior mndiulr horizontl osteotomy with genioglossus muscle nd inferior order dvncement (genioplsty). The osteotomy is mde through oth outer nd inner cortices of the mndile. () The genioplsty segment hs een dvnced, cusing simultneous dvncement of the hyoid one, se of the tongue (T), nd inferior order of the mndile (rrows). not enlrge the orl cvity; genioglossus muscles cn ecome detched, negting its effectiveness; nd it is not effective in more severe OSA cses. ANTERIOR MANDIBULAR OSTEOTOMY WITH INFERIOR BORDER ADVANCEMENT (GENIOPLASTY) This procedure consists of n nterior mndiulr horizontl osteotomy with genioglossus muscle nd inferior order dvncement (Figure 2). Advntges nd disdvntges of this technique re similr to those of the Riley technique descried ove (5). However, this procedure results in chnge in fcil profile nd my e eneficil for ptients with esthetic deficiency in the chin re. LASER-ASSISTED UVULOPLASTY LAUP hs gined populrity for tretment of snoring with reports of 80% to 85% success rtes (4). Its dvntges over UPPP re tht it is n outptient procedure under locl nesthesi, it cn e repeted, nd it hs decresed postopertive complictions. However, recent report on the efficcy of LAUP for treting OSA showed tht 27% of the ptients hd good response, 34% hd poor response, nd 30% got worse fter surgery (12). REDUCTION GLOSSECTOMY True or reltive mcroglossi my e oserved in some OSA ptients (4, 13). An enlrged tongue cn decrese the posterior irwy spce (PAS) t the orophrynx. Computerized xil tomogrphy hs confirmed tht tongue volume increses with incresing oesity. However, the tongue my e of norml size ut pper lrger thn norml if the volume of the orl cvity is decresed ecuse of retropositioned jws. If true mcroglossi exists, reduction glossectomy cn e done, removing the nterior nd portion of the middle third of the tongue (Figure 4). Tste nd senstion re minimlly ffected fter surgery (4, 13). Wolford et l hve previously presented the dignosis, indictions, techniques, nd results of reduction glossectomy for tretment of mcroglossi (13). UVULOPALATOPHARYNGOPLASTY UPPP ws first descried y Ikemtsu in 1964 for tretment of hitul snoring (6). Fujit et l modified the technique to increse the orophryngel irwy spce y excising the uvul nd 8 to 15 mm of the posterior spect of the soft plte, s well s the redundnt lterl phryngel wll mucos (7). Although UPPP hs resulted in symptomtic improvement from hitul snoring in up to 90% of cses, only 41% to 66% of ptients see improvement or elimintion of OSA nd results my worsen over time (8 11). The reson UPPP cn fil is tht the procedure ddresses the ostruction t the soft plte re only, without improving the irwy t the se of the tongue (hypophryngel re) or nsl cvity. In ddition, scr contrcture t the posterior order of the soft plte cn crete curtin effect, pulling the soft plte downwrd ginst the tongue nd cusing significnt trnsverse nrrowing etween the posterior fucil pillrs, further contriuting to OSA. Complictions from UPPP include nsl regur- c Figure 3. () Wolford s modified uvulopltophryngoplsty procedure. Note the hypertrophic uvul nd the nrrow trnsverse dimension etween the right nd left fucil pillrs. The incisions re outlined t the se of the posterior fucil pillr ilterlly nd t the se of the uvul. () Following completion of incisions, the uvul flps re closed. Dissection into the lterl spect of the soft pltl tissues is performed in sumucosl plne etween the orl nd nsl sides with right-ngled scissors. A mttress suture is pssed sumucoslly from the se of the mxillry tuerosity to the dissected lterl flp of the posterior fucil pillr. The suture is pssed through the end of the flp nd tunneled ck to the mxillry tuerosity re. The sutures re then tightened to shorten the soft plte to the desired dimension. (c) Postsurgicl view of the velophryngel structures fter modified uvulopltophryngoplsty procedure. Note the incresed trnsverse dimension of the orophryngel irwy fter lterliztion nd forwrd positioning of the posterior fucil pillrs. OCTOBER 2000 SURGICAL MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA 339
3 c Figure 4. () The keyhole technique is used for surgicl reduction of tongue size. Mrkings show the plnned incisions. () The nterior middle prt of the tongue hs een resected nd removed. (c) Suturing of the tongue reestlishes ntomic continuity nd physiologic function, with the tongue eing reduced in length nd width. NASAL RECONSTRUCTION Procedures such s nsoseptoplsty, nsl turinectomies, columell nrrowing, enlrgement of the luminl vlves, nsl polypectomies, nd reconstruction of externl crtilge nd one my e indicted for correction of nsl irwy ostruction. These re usully used s djuncts in comintion with other surgicl procedures ecuse their role in treting multilevel OSA is very limited. TONSILLECTOMY AND ADENOIDECTOMY Hypertrophied tonsillr nd denoid tissues cn contriute to irwy ostruction t the nsophryngel nd orophryngel levels, especilly in children nd dolescents. Clinicl nd rdiogrphic (lterl cephlometric x-ry) exmintion, s well s nsophryngoscopy, cn usully identify involvement of these structures. Tonsillectomy nd denoidectomy cn e performed to eliminte the ostructions. MAXILLOMANDIBULAR ADVANCEMENT SURGERY (ORTHOGNATHIC SURGERY) Over the pst few yers, comined dvncement of the mxill nd mndile hs ecome the surgicl procedure of choice for tretment of OSA in ptients with decresed orophryngel irwys, nd numerous studies hve reported the eneficil effects on the PAS (13 17). Studies hve shown tht ptients with diminished crosssectionl re of the phrynx my e predisposed to phryngel collpse nd OSA (18, 19). It hs een clerly documented tht mxillomndiulr dvncement surgery is very efficcious in eliminting OSA y enlrging the PAS nd tightening the upper irwy muscles nd tendons (velophryngel nd suprhyoid muscles) y dvncement of their ony origin (15 20). Prevlence of OSA hs lso een linked to specific fcil morphology types. Prchrktm et l found tht vriles relted to soft tissues, hyoid one to mndiulr plne, ody mss index, nd soft plte length hd the highest predictive vlue (18). Riley et l reported tht PAS of <11 mm nd mndiulr plne hyoid one ngle >15.4 were indictive of OSA (21). Mxillomndiulr dvncement surgery hs the enefits of correcting the ptient s fcil nd occlusl deformities while lso ddressing OSA symptoms very effectively y enlrging the size of the orl cvity nd pulling the se of the tongue nd soft plte forwrd, thus incresing the PAS. PRESURGICAL CONSIDERATIONS Plnning the skeletl, soft tissue, nd dentl correction of crniofcil deformities requires comprehensive collection nd nlysis of dt from vrious sources, including the ptient s description of the prolem nd medicl nd dentl history, clinicl evlution, rdiogrphic exmintion, nd dentl model nlysis. Orthodontic nd dentl tretment my e required efore nd/or fter surgery to mximize the functionl nd esthetic results of the orthognthic surgicl procedures performed. Creful ttention is pid to the evlution of the fcil form in ll 3 dimensions. Besides the clinicl exmintion, the lterl cephlometric rdiogrph is of prticulr vlue, s it gives informtion out the fcil skeletl nd soft tissue structures s well s the PAS (norml dimension is 11 ± 2 mm) (16). The PAS in OSA ptients is often nrrower thn in norml controls (22 24). Although PAS evlution on lterl cephlometric rdiogrph represents only 2-dimensionl overview of 3-dimensionl prolem nd is not tken in supine sleeping position, when properly tken it provides very useful informtion in evluting the ntomic interreltionships of the irwy structures nd in estimting tongue nd nsophryngel volume. Bony nd soft tissue lndmrks on the lterl cephlometric rdiogrph re nlyzed with specific ngulr nd liner mesurements to id in dignosis nd tretment plnning. Surgicl tretment ojective trcings re constructed to predict the surgicl movements required to correct the OSA nd ny coexisting ssocited fcil deformity. The surgery is then simulted on dentl plster models of the ptient s teeth nd jw structures mounted on jw rticultor. Acrylic surgicl stilizing splints re fricted in the lortory on these plster models, which reflect the jws in their new position. These surgicl splints help in the ccurte repositioning of the jws during surgery. SURGICAL PROCEDURES The most common orthognthic surgicl procedures used in OSA correction re the mxillry Le Fort I osteotomy nd the ilterl mndiulr rmus sgittl split osteotomy. Using oth mxillry nd mndiulr osteotomies usully llows for greter dvncement of the jw structures in OSA tretment, providing etter outcome. Wolford et l were the first to show tht orthognthic surgery with counterclockwise dvncement of the mxill nd mndile mximizes the increse of the PAS while lso optimizing fcil esthetics (25, 26). Adjunctive procedures to correct irwy ostruction in other res (e.g., septoplsty, turinectomies, externl nsl reconstruction, modified UPPP, reduction glossectomy, tonsillectomy, denoidectomy) cn e performed concurrently with the jw surgery. Bone pltes nd screws re used to rigidly stilize the jw structures during surgery. This elimintes the need for wiring the jws together fter 340 BAYLOR UNIVERSITY MEDICAL CENTER PROCEEDINGS VOLUME 13, NUMBER 4
4 surgery, therey incresing ptient comfort, permitting immedite ctive jw function, improving dietry intke nd orl hygiene, llowing norml speech, nd minimizing chnces of irwy compromise immeditely fter surgery. CLINICAL AND RESEARCH EXPERIENCE The senior uthor of this pper (Dr. Wolford) hs >20 yers of experience in using orthognthic surgery for tretment of OSA. We hve oserved tht mny ptients with OSA symptoms hve common clinicl nd rdiogrphic chrcteristics, including retruded mndile, retruded mxill, posterior verticl mxillry deficiency, retropositioned tongue, high occlusl plne nd high mndiulr plne ngultions, short chin-neck line, nd decresed PAS on lterl cephlogrm (25). Other chrcteristics tht my e present include nsl irwy ostruction (e.g., nrrow nostrils, wide columell, enlrged turintes, devited septum, polyps, nsophryngel denoid tissue, decresed posterior chonl height, constricted luminl vlves, externl nsl deformity) nd orophryngel normlities (e.g., elongted soft plte nd uvul, medilly nd posteriorly positioned posterior fucil pillrs, enlrged denoids, hyperplstic tonsils, mcroglossi). Cliniclly, the tongue my pper lrge nd retropositioned due to the decresed orl cvity volume resulting from the retruded position of the jws. c d Ptients nd methods We performed retrospective study to evlute the effects of orthognthic surgery on the PAS ntomy. The tretment records of 72 ptients (14 men, 58 women) operted on y Dr. Wolford for correction of dentofcil deformities (not ll with OSA) t Bylor University Medicl Center were retrospectively nlyzed. All ptients underwent Le Fort I mxillry osteotomies nd mndiulr rmus sgittl split osteotomies with rigid fixtion for counterclockwise dvncement of the mxillomndiulr complex. Although mny of these ptients hd turinectomies nd nsoseptoplsties t surgery, none hd ony genioplsties, UPPP, denoidectomies, tonsillectomies, or reduction glossectomies. Stndrdized lterl cephlometric rdiogrphs were tken efore surgery (T1) nd t longest follow-up (T2) intervls. T1 nd T2 rdiogrphs were trced on cette sheets nd superimposed y n exminer to ssess chnges in phryngel ntomy. The PAS dimensions were clculted y mesuring the nrrowest dimension from the posterior phryngel wll to the tongue se nd to the soft plte. A Student t test ws used to ssess the sttisticl significnce of results. A P vlue < ws considered sttisticlly significnt. Results The verge ge of the ptient smple ws 36.3 yers (rnge, 12 to 56 yers), nd the verge follow-up time ws 3 yers (rnge, 1 to 8.1 yers). The men mndiulr dvncement ws 12 mm (SD, 5.4) mesured t the genil tuercles. The men mxillry dvncement t point A ws 5.1 mm (SD, 2.1). At the soft plte, the men PAS presurgery ws 7.9 mm (SD, 2.8) nd postsurgery ws 14.1 mm (SD, 3.7), for men increse of 6.2 mm (P < ; SD, 3.1). At the tongue se, the men PAS presurgery ws 7.7 mm (SD, 2.6) nd postsurgery ws 15.8 mm (SD, 3.6), for men increse of 8.1 mm (P < ; SD, 3.6). Figure 5. () Frontl view of 49-yer-old womn who ws referred y her physicin for correction of OSA symptoms. () Profile view shows the presence of dentofcil deformity with retruded upper nd lower jws. (c) The ptient 5 yers fter mxill nd mndile dvncement nd intrnsl surgery. The sleep pne symptoms hve een eliminted. (d) Profile view shows good esthetic result with hrmonious fcil lnce. Thus, the men PAS increse rnged from 52% to 63% of the mount of mndiulr dvncement performed. No ptients hd ny significnt OSA symptoms t longest follow-up. CASE PRESENTATION A 49-yer-old womn (Figure 5, 5) ws referred for tretment of OSA symptoms y her physicin. She gve history of loud snoring while sleeping, dytime somnolence, generlized ftigue, nd nsl irwy ostruction. She hd een using CPAP mchine while sleeping for 1 yer prior to presenttion, without significnt relief of symptoms. Other previously filed nonsurgicl OSA therpy included weight loss, use of medictions, nd orthodontic/dentl pplince therpy. A presurgicl polysomnogrphic study showed severe sleep pne with respirtory disturnce index of 51 nd men oxygen sturtion of 84%. Presurgicl clinicl nd rdiogrphic evlution (Figure 6) reveled dignosis of 1) mndiulr retrusion; 2) mxillry retrusion; 3) posterior verticl mxillry deficiency; 4) severely decresed PAS (2 mm); 5) high occlusl nd mndiulr plne ngles; 6) devited nsl septum; 7) hypertrophied nsl turintes; 8) wide nsl columell, creting nrrow nostrils; nd 9) nsl irwy ostruction cused y the 3 previous dignoses. After the necessry orthodontic tretment ws completed, the following surgicl procedures were performed t 1 opertion OCTOBER 2000 SURGICAL MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA 341
5 Figure 6. () Presurgicl trcing of the dentofcil structures on the lterl cephlometric x-ry. Note the nrrowed PAS of 2 mm (norml is 11 ± 2 mm). () Postsurgicl trcing of the dentofcil structures on the lterl cephlometric x-ry showing the effects of surgery performed on the upper nd lower jws. Note the incresed dimension of the PAS to 13 mm t the tongue se nd 9 mm t the soft plte. (Figure 6): 1) multiple-segment Le Fort I osteotomies to dvnce the upper jw 8 mm, 2) ilterl mndiulr rmus sgittl split osteotomies to dvnce the lower jw 16 mm, 3) 5-mm chin implnt, 4) nsl septoplsty; 5) ilterl prtil inferior turinectomies, nd 6) nsl columellr nrrowing to enlrge the nostrils. The chin point dvnced 21 mm forwrd from its presurgicl position (s result of the mndiulr dvncement nd chin implnt). The PAS t the tongue se incresed to 13 mm (650% improvement from the presurgery PAS of 2 mm) nd t the soft plte level incresed to 9 mm (450% improvement from the presurgery PAS of 2 mm) (Figure 6). Postopertive polysomnogrphy reveled significnt improvement, with respirtory disturnce index of 5 (presurgery ws 51) nd men oxygen sturtion of 95% (presurgery ws 84%). Five yers fter surgery, the ptient hd stle clinicl result (Figure 5c, 5d). She does not suffer from snoring, dytime somnolence, or ftigue nd hs not required the use of CPAP since surgery. 1. Thornton WK, Roerts DH. Nonsurgicl mngement of the ostructive sleep pne ptient. J Orl Mxillofc Surg 1996;54: Weiglnd L, Zwillich CW. Ostructive sleep pne. Dis Mon 1994;40: Kuhlo W, Doll E, Frnk MD. Erfolgrieche Behndlung eines Pickwick- Syndroms durch eine Duertrchelknuele. Dtsc Med Wochenschr 1969; 94: Tiner BD. Surgicl mngement of ostructive sleep pne. J Orl Mxillofc Surg 1996;54: Riley RW, Guilleminult C, Powell NB, Dermn S. Mndiulr osteotomy nd hyoid one dvncement for ostructive sleep pne: cse report. Sleep 1984;7: Ikemtsu T. Study of snoring, 4th report: therpy. Journl of Jpnese Otorhinolryngology 1964;64: Fujit S, Conwy W, Zorick F, Roth T. Surgicl correction of ntomic normlities in ostructive sleep pne syndrome: uvulopltophryngo- plsty. Otolryngol Hed Neck Surg 1981; 89: Simmons FB, Guilleminult C, Silvestri R. Snoring, nd some ostructive sleep pne, cn e cured y orophryngel surgery. Arch Otolryngol 1983;109: Simmons FB, Guilleminult C, Miles LE. The pltophryngoplsty opertion for snoring nd sleep pne: n interim report. Otolryngol Hed Neck Surg 1984;92: Ktsntonis GP, Schweitzer PK, Brnhm GH, Chmers G, Wlsh JK. Mngement of ostructive sleep pne: comprison of vrious tretment modlities. Lryngoscope 1988;98: Guilleminult C, Hyes B, Smith L, Simmons FB. Pltophryngoplsty nd ostructive sleep pne syndrome. Bull Eur Physiopthol Res 1983;19: Ryn CF, Love LL. Unpredictle results fter lser ssisted uvuloplsty in the tretment of ostructive sleep pne. Thorx 2000;55: Wolford LM, Cottrell DA. Dignosis of mcroglossi nd indictions for reduction glossectomy. Am J Orthod Dentofcil Orthop 1996;110: Guilleminult C, Hill MW, Simmons FB, Dement WC. Ostructive sleep pne: electromyogrphic nd fieroptic studies. Exp Neurol 1978;62: Li KK, Riley RW, Powell NB, Troell R, Guilleminult C. Overview of phse II surgery for ostructive sleep pne syndrome. Er Nose Throt J 1999; 78: Riley RW, Powell NB, Guilleminult C. Ostructive sleep pne syndrome: surgicl protocol for dynmic irwy reconstruction. J Orl Mxillofc Surg 1993;51: Reiche-Fischel O, Wolford LM. Posterior irwy spce chnges fter doule jw surgery with counter-clockwise rottion. J Orl Mxillofc Surg 1996; 54: Prchrktm N, Nelson S, Hns MG, Brodent BH, Redline S, Rosenerg C, Strohl KP. Cephlometric ssessment in ostructive sleep pne. Am J Orthod Dentofcil Orthop 1996;109: Riley RW, Guilleminult C, Herrn J, Powell N. Cephlometric nlyses nd flow-volume loops in ostructive sleep pne ptients. Sleep 1983; 6: Riley RW, Powell NB, Guilleminult C. Current surgicl concepts for treting ostructive sleep pne syndrome. J Orl Mxillofc Surg 1987;45: Guilleminult C, Riley RW, Powell N. Ostructive sleep pne nd norml cephlometric mesurements. Implictions for tretment. Chest 1984; 86: Lowe AA, Gionhku N, Tkeuchi K. Three-dimensionl CT reconstructions of tongue nd irwy in dult sujects with ostructive sleep pne. Am J Orthop Dentofcil Orthop 1986;90: Hponik EF, Smith PL, Bohlmn ME, Allen RP, Goldmn SM, Bleecker ER. Computerized tomogrphy in ostructive sleep pne. Correction of irwy size with physiology during sleep nd wkefulness. Am Rev Respir Dis 1983;127: Surtt PM, Dee P, Atkinson RL, Armstrong P, Wilhort SC. Fluoroscopic nd computed tomogrphic fetures of phryngel irwy in ostructive sleep pne. Am Rev Respir Dis 1983;127: Wolford LM, Chemello PD, Hillird FW. Occlusl plne ltertion in orthognthic surgery Prt I: Effects on function nd esthetics. Am J Orthod Dentofcil Orthop 1994;106: Chemello PD, Wolford LM, Buschng MS. Occlusl plne ltertion in orthognthic surgery Prt II: Long-term stility of results. Am J Orthod Dentofcil Orthop 1994;106: BAYLOR UNIVERSITY MEDICAL CENTER PROCEEDINGS VOLUME 13, NUMBER 4
Severe Gummy Smile with Class II Malocclusion Treated with LeFort I Osteotomy Combined with Horseshoe Osteotomy and Intraoral Vertical Ramus
2013 67 1 5560 Severe Gummy Smile with Clss II Mlocclusion Treted with LeFort I Osteotomy Comined with Horseshoe Osteotomy nd Introrl Verticl Rmus Osteotomy * 56 Shimo et l. Act Med. Okym Vol. 67, No.
More informationA Comparison Study of Upper Airway among Different Skeletal Craniofacial Patterns in Nonsnoring Chinese Children
Originl Article A Comprison Study of Upper Airwy mong Different Skeletl Crniofcil Ptterns in Nonsnoring Chinese Children Zhe Zhong ; Zhihui Tng b ; Xuemei Go c ; Xing-Long Zeng c ABSTRACT Objective: Ptients
More informationSoft tissue response after Class III bimaxillary surgery Impact of surgical change in face height and long-term skeletal relapse
Originl Article Soft tissue response fter Clss III bimxillry surgery Impct of surgicl chnge in fce height nd long-term skeletl relpse Gundeg Jkobsone ; Arild Stenvik b ; Lisen Espelnd b ABSTRACT Objective:
More informationEvaluation of canting correction of the maxillary transverse occlusal plane and change of the lip canting in Class III two-jaw orthognathic surgery
Originl Article Evlution of cnting correction of the mxillry trnsverse occlusl plne nd chnge of the lip cnting in Clss III two-jw orthognthic surgery Seung-Je Kim ; Jin-Young Choi b ; Seung-Hk Bek c ABSTRACT
More informationChanges in Occlusal Relationships in Mixed Dentition Patients Treated with Rapid Maxillary Expansion
Originl Article Chnges in Occlusl Reltionships in Mixed Dentition Ptients Treted with Rpid Mxillry Expnsion A Prospective Clinicl Study Jmes A. McNmr,Jr ; Luren M. Sigler b ; Lorenzo Frnchi c ; Susn S.
More informationUse of Lateral Cephalometric Analysis in Diagnosing Craniofacial Features in Papillon-Lefevre Syndrome
Cse Report Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2017/508 Use of Lterl Cephlometric Anlysis in Dignosing Crniofcil Fetures in Ppillon-Lefevre Syndrome Ahishek Soni Senior Lecturer,
More informationDentoskeletal changes following mini-implant molar intrusion in anterior open bite patients
Originl Article Dentoskeletl chnges following mini-implnt molr intrusion in nterior open bite ptients Tyler R. Hrt ; Richrd R. J. Cousley b ; Leonrd S. Fishmn c ; Ross H. Tllents d ABSTRACT Objective:
More informationOriginal Article. Heon-Mook Park a ; Yang-Ku Lee b ; Jin-Young Choi c ; Seung-Hak Baek d
Originl Article Mxillry incisor inclintion of skeletl Clss III ptients treted with extrction of the upper first premolrs nd two-jw surgery Conventionl orthognthic surgery vs surgery-first pproch Heon-Mook
More informationLong-Term Profile Changes Associated with Successfully Treated Extraction and Nonextraction Class II Division 1 Malocclusions
Originl Article Long-Term Profile Chnges Associted with Successfully Treted Extrction nd Nonextrction Clss II Division 1 Mlocclusions Eileen C. Zierhut, DDS, M ; Donld R. Joondeph, DDS, MS b ; Jon Artun,
More informationA Comparative Study of Two Methods of Quantifying the Soft Tissue Profile
Originl Article A Comprtive Study of Two Methods of Quntifying the Soft Tissue Profile Hyeon-Shik Hwng, DDS, M, PhD ; Wng-Sik Kim, DDS, M b ; Jmes A. McNmr, Jr, DDS, PhD c Abstrct: One of the most importnt
More informationBiomechanics Orthodontics
Biomechnics IN Orthodontics PRINCIPLES AND PRACTICE Rm S. Nnd, BDS, DDS, MS, PhD Professor Emeritus Deprtment of Orthodontics College of Dentistry University of Oklhom Oklhom City, Oklhom Yhy S. Tosun,
More informationInfluence of lateral cephalometric radiography in orthodontic diagnosis and treatment planning
Originl Article Influence of lterl cephlometric rdiogrphy in orthodontic dignosis nd tretment plnning An Reis Durão ; Ali Alqerbn b ; Afonso Pinhão Ferreir c ; Reinhilde Jcobs d ABSTRACT Objective: To
More informationOptimal sites for orthodontic mini-implant placement assessed by cone beam computed tomography
Originl Article Optiml sites for orthodontic mini-implnt plcement ssessed by cone bem computed tomogrphy Mon Mohmed Slh Fyed ; Pwel Pzer b ; Christos Ktsros c ABSTRACT Objectives: To determine (1) the
More informationSkeletal and Soft Tissue Point A and B Changes Following Orthodontic Treatment of Nepalese Class I Bimaxillary Protrusive Patients
Originl Article Skeletl nd Soft Tissue Point A nd B Chnges Following Orthodontic Tretment of Neplese Clss I Bimxillry Protrusive Ptients Jgn Nth Shrm ABSTRACT Objectives: To test the hypothesis tht there
More informationMandibular vertical asymmetry in adult orthodontic patients with different vertical growth patterns: A cone beam computed tomography study
Originl Article Mndibulr verticl symmetry in dult orthodontic ptients with different verticl growth ptterns: A cone bem computed tomogrphy study Slih Celik ; Mevlut Celikoglu b ; Suleymn K. Buyuk c ; A.
More informationEffects of physical exercise on working memory and prefrontal cortex function in post-stroke patients
Effects of physicl exercise on working memory nd prefrontl cortex function in post-stroke ptients M Moriy, C Aoki, K Sktni Grdute School of Helth Sciences Reserch, Mjor of Physicl Therpy, TeikyoHeisei
More informationMorphologic evaluation of the incisive canal and its proximity to the maxillary central incisors using computed tomography images
Originl Article Morphologic evlution of the incisive cnl nd its proximity to the mxillry centrl incisors using computed tomogrphy imges Eun-Ae Cho ; Sung-Jin Kim ; Yoon Jeong Choi b ; Kyung-Ho Kim c ;
More informationSkeletal, Dental and Soft-Tissue Changes Induced by the Jasper Jumper Appliance in Late Adolescence
Originl Article Skeletl, Dentl nd Soft-Tissue Chnges Induced by the Jsper Jumper Applince in Lte Adolescence Didem Nlbntgil ;Tülin Arun b ; Korkmz Syinsu c ; Fuly Işık c Abstrct: The purpose of this study
More informationCorrelation between periodontal soft tissue and hard tissue surrounding incisors in skeletal Class III patients
Originl Article Correltion between periodontl soft tissue nd hrd tissue surrounding incisors in skeletl Clss III ptients Jeong-Ho Prk ; Ji-Yeon Hong b ; Hyo-Won Ahn c ; Su-Jung Kim d ABSTRACT Objectives:
More informationEFFECTS OF AN ACUTE ENTERIC DISEASE CHALLENGE ON IGF-1 AND IGFBP-3 GENE EXPRESSION IN PORCINE SKELETAL MUSCLE
Swine Dy 22 Contents EFFECTS OF AN ACUTE ENTERIC DISEASE CHALLENGE ON IGF-1 AND IGFBP-3 GENE EXPRESSION IN PORCINE SKELETAL MUSCLE B. J. Johnson, J. P. Kyser, J. D. Dunn, A. T. Wyln, S. S. Dritz 1, J.
More informationModified tandem traction bow appliance compared with facemask therapy in treating Class III malocclusions
Originl Article Modified tndem trction bow pplince compred with fcemsk therpy in treting Clss III mlocclusions Tub Tortop ; Emine Kygısız b ; Deniz Gencer c ; Sem Yuksel ; Zeynep Atly d ABSTRACT Objective:
More informationOriginal Article INTRODUCTION
Originl Article Evlution of mxillry centrl incisors on the noncleft nd cleft sides in ptients with unilterl cleft lip nd plte Prt 1: Reltionship etween root length nd orthodontic tooth movement Ay Med-Iino
More informationA Cineradiographic Study of Deglutitive Tongue Movement and Nasopharyngeal Closure in Patients with Anterior Open Bite
Originl Article A Cinerdiogrphic Study of Deglutitive Tongue Movement nd Nsophryngel Closure in Ptients with Anterior Open Bite Ttsuy Fujiki, DDS, PhD ; Teruko Tkno-Ymmoto, DDS, PhD b ; Hruhiro Noguchi,
More informationASK AN EXPERT THINGS YOU WANT TO KNOW
ASK AN EXPERT THINGS YOU WANT TO KNOW Q BJÖRN U. ZACHRISSON OSLO, NORWAY A Mndiulr third molrs nd lte lower rch crowding the evidence se The issue of the influence of unerupted third molrs on the dentition
More informationValue of beat-to-beat blood pressure changes, detected by pulse transit time, in the management of the obstructive sleep apnoea/ hypopnoea syndrome
Eur Respir J 1998; 12: 685 692 DOI: 1.1183/931936.98.123685 Printed in UK - ll rights reserved Copyright ERS Journls Ltd 1998 Europen Respirtory Journl ISSN 93-1936 Vlue of et-to-et lood pressure chnges,
More informationPNEUMOVAX 23 is recommended by the CDC for all your appropriate adult patients at increased risk for pneumococcal disease 1,2 :
PNEUMOVAX 23 is recommended y the CDC for ll your pproprite dult ptients t incresed risk for pneumococcl disese 1,2 : Adults ged
More informationHealth-Related Quality of Life and Symptoms of Depression in Extremely Obese Persons Seeking Bariatric Surgery
Oesity Surgery, 15, 3-39 Helth-Relted Qulity of Life nd Symptoms of Depression in Extremely Oese Persons Seeking Britric Surgery Anthony N. Frictore, PhD; Thoms A. Wdden, PhD; Dvid B. Srwer, PhD; Myles
More informationAssessment of Depression in Multiple Sclerosis. Validity of Including Somatic Items on the Beck Depression Inventory II
Assessment of Depression in Multiple Sclerosis Vlidity of Including Somtic Items on the Beck Depression Inventory II Peggy Crwford, PhD; Noh J. Webster, MA Signs nd symptoms of multiple sclerosis (MS)
More informationUniversity of Cape Town
.. I i I II I I The copyright of this thesis vests in the uthor. No quottion from it or informtion derived from it is to be published without full cknowledgement of the source. The thesis is to be used
More informationSymptomatic Remote Cyst after BCNU Wafer Implantation for Malignant Glioma
Cse Report doi: 10.2176/nmc.cr.2017-0218 Neurol Med Chir (Tokyo) 58, 270 276, 2018 Symptomtic Remote Cyst fter BCNU Wfer Implnttion for Mlignnt Gliom Online My 21, 2018 Hideki MATSUMURA, 1 Eiichi ISHIKAWA,
More informationOcclusal Status in Asian Male Adults:
Originl Article Occlusl Sttus in Asin Mle Adults: Prevlence nd Ethnic Vrition Jen Soh ; Andrew Sndhm ; Yiong Huk Chn c Astrct: The purpose of this study ws to determine the occlusl sttus in young Asin
More informationWhich Hard and Soft Tissue Factors Relate with the Amount of Buccal Corridor Space during Smiling?
Originl Article Which Hrd nd Soft Tissue Fctors Relte with the Amount of Buccl Corridor Spce during Smiling? Il-Hyung Yng ; Dong-Seok Nhm b ; Seung-Hk Bek c ABSTRACT Objective: To investigte which hrd
More informationCase Presentation CASE REPORT. Pedro Couto Viana, DMD. André Correia, DMD, PhD. Manuel Neves, DMD. Zsolt Kovacs, CDT. Rudiger Neugbauer, CDT
CASE REPORT Cse Presenttion Pedro Couto Vin, DMD Prosthodontist, Dr Mnuel Neves Dentl Clinic, Porto, Portugl André Correi, DMD, PhD Dentist, Dr Mnuel Neves Dentl Clinic, Porto, Portugl Invited Assistnt
More informationMeat and Food Safety. B.A. Crow, M.E. Dikeman, L.C. Hollis, R.A. Phebus, A.N. Ray, T.A. Houser, and J.P. Grobbel
Met nd Food Sfety Needle-Free Injection Enhncement of Beef Strip Loins with Phosphte nd Slt Hs Potentil to Improve Yield, Tenderness, nd Juiciness ut Hrm Texture nd Flvor B.A. Crow, M.E. Dikemn, L.C. Hollis,
More informationA comparison of treatment effects of total arch distalization using modified C-palatal plate vs buccal miniscrews
Originl Article A comprison of tretment effects of totl rch distliztion using modified C-pltl plte vs uccl miniscrews Sng Kyu Lee ; Noh H. As ; Mohmed Byome c,d ; Un-Bong Bik ; Yoon-Ah Kook e ; Mihee Hong
More informationAn Occlusal and Cephalometric Analysis of Maxillary First and Second Premolar Extraction Effects
Originl Article An Occlusl nd Cephlometric Anlysis of Mxillry First nd Second Premolr Extrction Effects Hoe Boon Ong, BDS (Sing), MDSc (Melb) ; Michel G. Woods, DDSc, FRACDS, FRACDS (Orth), DOrthRCS (Eng)
More informationSYNOPSIS Final Abbreviated Clinical Study Report for Study CA ABBREVIATED REPORT
Finl Arevited Clinicl Study Report Nme of Sponsor/Compny: Bristol-Myers Squi Ipilimum Individul Study Tle Referring to the Dossier (For Ntionl Authority Use Only) Nme of Finished Product: Yervoy Nme of
More informationArthroscopic Anatomy of Shoulder
Arthroscopic Antomy of Shoulder Murt Bozkurt, Mehmet Emin Simsek, nd Hlil İrhim Açr 2 2.1 Introduction In the lst 30 yers, shoulder rthroscopy hs ecome of greter importnce in the dignosis nd tretment of
More informationThree-dimensional Facial Morphometry of Attractive Children and Normal Children in the Deciduous and Early Mixed Dentition
Originl Article Three-dimensionl Fcil Morphometry of Attrctive Children nd Norml Children in the Deciduous nd Erly Mixed Dentition Chirell Sforz ; Alberto Lino b ; Roul D Alessio c ; Cludi Dellvi d ; Gi
More informationInput from external experts and manufacturer on the 2 nd draft project plan Stool DNA testing for early detection of colorectal cancer
Input externl experts nd mnufcturer on the 2 nd drft project pln Stool DNA testing for erly detection of colorectl cncer (Project ID:OTJA10) All s nd uthor s replies on the 2nd drft project pln Stool DNA
More informationThe Aetiology, Diagnosis and Management of Mandibular Asymmetry
44 Orthodontic Updte My 2008 Mtthew SY Chi Frhd B Nini nd Dljit S Gill The Aetiology, Dignosis nd Mngement of Mndiulr Asymmetry Astrct: An understnding of the etiology of mndiulr symmetry nd thorough methodicl
More informationGender Differences in Class III Malocclusion
Originl Article Gender Differences in Clss III Mlocclusion Tizino Bccetti ; Brin C. Reyes b ; Jmes A. McNmr Jr c Abstrct: This study evluted gender differences in the cephlometric records of lrge-scle
More informationDental Arch Dimensions in Class II division 1 Malocclusions with Mandibular Deficiency
Originl Article Dentl Arch Dimensions in Clss II division 1 Mlocclusions with Mndibulr Deficiency Omr Gbriel d Silv Filho ; Flávio Muro Ferrri Júnior b ; Terumi Okd Ozw c ABSTRACT Objective: To test the
More informationAgenesis of Third Molar Germs Depends on Sagittal Maxillary Jaw Dimensions in Orthodontic Patients in Japan
Originl Article Agenesis of Third Molr Germs Depends on Sgittl illry Jw Dimensions in Orthodontic Ptients in Jpn Tkshi S. Kjii, DDS, PhD ; Yoshiki Sto, DDS, PhD b ; Sori Kjii, DDS c ; Yuki Sugwr, DDS,
More informationThree-dimensional positional assessment of glenoid fossae and mandibular condyles in patients with Class II subdivision malocclusion
Originl Article Three-dimensionl positionl ssessment of glenoid fosse nd mndibulr condyles in ptients with Clss II subdivision mlocclusion Julin Mcêdo de Mttos ; Jun Mrtin Plomo b ; Antonio Crlos de Oliveir
More informationStudy of Stress Distribution in the Tibia During Stance Phase Running Using the Finite Element Method
Ksetsrt J. (Nt. Sci.) 48 : 729-739 (2014) Study of Stress Distriution in the Tii During Stnce Phse Running Using the Finite Element Method Thepwchr Ruchirh 1, Tumrong Puttpitukporn 1, * nd Siriporn Ssimontonkul
More informationClinical Study Report Synopsis Drug Substance Naloxegol Study Code D3820C00018 Edition Number 1 Date 01 February 2013 EudraCT Number
EudrCT Number 2012-001531-31 A Phse I, Rndomised, Open-lbel, 3-wy Cross-over Study in Helthy Volunteers to Demonstrte the Bioequivlence of the Nloxegol 25 mg Commercil nd Phse III Formultions nd to Assess
More informationEVALUATION OF DIFFERENT COPPER SOURCES AS A GROWTH PROMOTER IN SWINE FINISHING DIETS 1
Swine Dy 2001 Contents EVALUATION OF DIFFERENT COPPER SOURCES AS A GROWTH PROMOTER IN SWINE FINISHING DIETS 1 C. W. Hstd, S. S. Dritz 2, J. L. Nelssen, M. D. Tokch, nd R. D. Goodbnd Summry Two trils were
More informationDental archforms in dentoalveolar Class I, II and III
Originl Article Dentl rchforms in dentolveolr Clss I, II nd III Mrtin Slj ; Stjepn Splj ; Durvko Pvlin c ; Dvor Illes d ; Mlden Slj e ABSTRACT Ojective: To test the hypothesis tht no differences exist
More informationLATE RESULTS OF TRANSFER OF THE TIBIAL TUBERCLE FOR RECURRENT DISLOCATION OF THE PATELLA1
LATE RESULTS OF TRANSFER OF THE TIBIAL TUBERCLE FOR RECURRENT DISLOCATION OF THE PATELLA1 W. G. J. HAMPSON nd P. HILL, BRISTOL, ENGLAND The uthors wished to determine the lte results of the Huser opertion,
More informationOcclusal Morphology 1 Year after Orthodontic and Surgical-Orthodontic Therapy
Originl Article Occlusl Morphology 1 Yer fter Orthodontic nd Surgicl-Orthodontic Therpy A Quntittive Anlysis of Cliniclly Successful Ptients Cludi Dellvi ; Luis Toms Hunc Ghislnzoni b ; Redento Perett
More informationEffect of orthodontic treatment on oral health related quality of life
Originl Article Effect of orthodontic tretment on orl helth relted qulity of life Dniel Feu ; Jose Augusto M. Miguel ; Roger K. Celeste c ; Brnc Helois Oliveir d ABSTRACT Ojective: To ssess chnges in orl
More informationTechnetium-Labeled Methylene Diphosphonate Uptake in Maxillary Bone During and After Rapid Maxillary Expansion
Originl Article 99m Technetium-Lbeled Methylene Diphosphonte Uptke in Mxillry Bone During nd Rpid Mxillry Expnsion Z. Mirzen Art, DDS, PhD ; Htice Göklp, DDS, PhD b ; Tmer Atsever, DDS, PhD c ; Hkn Türkkhrmn,
More informationLong-term Effectiveness and Treatment Timing for Bionator Therapy
Originl Article Long-term Effectiveness nd Tretment Timing for Biontor Therpy Kurt Fltin Jr, DD, PhD; Rolf M. Fltin, DD, Mc, PhD; b Tizino Bccetti, DD, PhD; c Lorenzo Frnchi, DD, PhD; c Bruno Ghiozzi,
More informationDental arch response to Haas-type rapid maxillary expansion anchored to deciduous vs permanent molars: A multicentric randomized controlled trial
Originl Article Dentl rch response to Hs-type rpid mxillry expnsion nchored to deciduous vs permnent molrs: A multicentric rndomized controlled tril Alessndro Ugolini ; Crmen Cerruto b ; Luc Di Vece c
More informationDirect v/s Indirect sinus lift in maxillary dental implants
Originl Clinicl Studies - Comprtive Study: Implnts Direct v/s Indirect sinus lift in mxillry dentl implnts Access this rticle online Wesite: www.msjournl.com DOI: 10.4103/2231-0746.119228 Quick Response
More informationsleep apnoea Model for investigating snorers with suspected subwts were obtained during polysomnography
Thorx 1993;48:275-279 Model for investigting snorers with suspected sleep pnoe 275 Pulmonry Deprtment, Krnkenhus Linz, A-1130 Vienn, Austri H Ruscher W Popp H Zwick Reprint requests to: Dr H Ruscher Received
More informationBioactive milk components to secure growth and gut development in preterm pigs ESTER ARÉVALO SUREDA PIGUTNET FA1401 STSM
Bioctive milk components to secure growth nd gut development in preterm pigs ESTER ARÉVALO SUREDA PIGUTNET FA1401 STSM STSM Pigutnet FA1401 STSM 03/Septemer 30/Novemer/2017 (3 months) Host: Home: Thoms
More informationKøbenhavns Universitet
university of copenhgen Københvns Universitet Risk fctors for smll phryngel irwy dimensions in preorthodontic children Anndrjh, Seerone; Dudhi, Rhib; Sndhm, Andrew; Sonnesen, Liselotte Published in: Angle
More informationRestorative planning for hemisection surgery: a technique report
CLINICAL REPORT 215 Sr Tit-Pour, Anthony Roerts, Ro Hrrison, Iin Chpple Restortive plnning for hemisection surgery: technique report KEY WORDS hemisection, lortory stges, restortion Hemisection surgery
More informationTreatment of Generalised Aggressive Periodontitis: A 4-year Follow-up Case Report
Tretment of Generlised Aggressive Periodontitis: A 4-yer Follow-up Cse Report Rui Fng LU 1, Li XU 1, Hun Xin MENG 1, Xing Hui FENG 1, Ki Ning LIU 1 Aggressive periodontitis comprises group of rre, often
More informationTreatment time, outcome, and anchorage loss comparisons of self-ligating and conventional brackets
Originl Article Tretment time, outcome, nd nchorge loss comprisons of self-ligting nd conventionl brckets Ferdinnd M. Mchiby ; Xingfu Bo b ; Lihu Zho c ; Min Hu d ABSTRACT Objective: To compre the tretment
More informationThe potential future of targeted radionuclide therapy: implications for occupational exposure? P. Covens
The potentil future of trgeted rdionuclide therpy: implictions for occuptionl exposure? Introduction: Trgeted Rdionuclide Therpy (TRT) Systemic tretment Molecule lbelled with rdionuclide delivers toxic
More informationEruption of the permanent maxillary canines in relation to mandibular second molar maturity
Originl Article Eruption of the permnent mxillry cnines in reltion to mndibulr second molr mturity Giuseppe Perinetti ; Mrilen Cllovi b ; Stefno Slgrello c ; Mtteo Bisotto d ; Luc Contrdo d ABSTRACT Objective:
More informationChildren with Class III Malocclusion: Development of Multivariate Statistical Models to Predict Future Need for Orthognathic Surgery
Originl Article Children with Clss III Mlocclusion: Development of Multivrite Sttisticl Models to Predict Future Need for Orthognthic Surgery Gbriele Schuster, DDS ; Christopher J. Lux, DDS b ; Angelik
More informationOriginal Article. Shushu He a ; Jinhui Gao b ; Peter Wamalwa c ; Yunji Wang d ; Shujuan Zou e ; Song Chen f
Originl Article Cmouflge tretment of skeletl Clss III mlocclusion with multiloop edgewise rch wire nd modified Clss III elstics by mxillry mini-implnt nchorge Shushu He ; Jinhui Go b ; Peter Wmlw c ; Yunji
More informationThe International Journal of Periodontics & Restorative Dentistry
The Interntionl Journl of Periodontics & Restortive Dentistry 235 Evlution of Bone Stility nd Esthetic Results After Immedite Implnt Plcement Using Novel Synthetic Bone Sustitute in the Anterior Zone:
More informationOriginal Article. Hyo-Won Ahn a ; Sung Chul Moon b ; Seung-Hak Baek c
Originl Article Morphometric evlution of chnges in the lveolr bone nd roots of the mxillry nterior teeth before nd fter en msse retrction using cone-bem computed tomogrphy Hyo-Won Ahn ; Sung Chul Moon
More informationA Long-term Study on the Expansion Effects of the Cervical-pull Facebow With and Without Rapid Maxillary Expansion
Originl Article A Long-term Study on the Expnsion Effects of the Cervicl-pull Fcebow With nd Without Rpid Mxillry Expnsion Frederick A. Fenderson, DDS, MS ; Jmes A. McNmr Jr, DDS, PhD b ; Tizino Bccetti,
More informationOriginal Article. Department of Orthodontics, Göteborg University, Göteborg, Sweden. b
Originl Article A -Yer Follow-up of Signs nd Symptoms of Temporomndiulr Disorders nd Mlocclusions in Sujects With nd Without Orthodontic Tretment in Childhood Inger Egermrk, LDS, Odont Dr/PhD ; Toms Mgnusson,
More informationDynamic smile evaluation in different skeletal patterns
Originl Article Dynmic smile evlution in different skeletl ptterns Noshi Siddiqui ; Prdeep Tndon b ; Alk Singh c ; Jitesh Hryni ABSTRACT Objective: To evlute dynmic smile in different skeletl ptterns nd
More informationPROVEN ANTICOCCIDIAL IN NEW FORMULATION
PROVEN ANTICOCCIDIAL IN NEW FORMULATION Coxidin 100 microgrnulte A coccidiosttic dditive for roilers, chickens rered for lying nd turkeys Contins 100 g of monensin sodium per kg Aville s homogenous grnules
More informationBENIGN ulceration along the greater curvature of the pars media of the
BENIGN ULCERS OF THE GREATER CURVATURE OF THE STOMACH Report of Two Cses CHARLES H. BROWN, M.D. Deprtment of Gstroenterology nd ANTHONY D. INTRIERE, M.D.* BENIGN ulcertion long the greter curvture of the
More informationStability of anterior crossbite correction: A randomized controlled trial with a 2-year follow-up
Originl Article Stbility of nterior crossbite correction: A rndomized controlled tril with 2-yer follow-up Ann-Pulin Wiedel ; Lrs Bondemrk b ABSTRACT Objective: To compre nd evlute the stbility of correction
More informationLong-term Skeletal Changes with Rapid Maxillary Expansion:
Review Article Long-term Skeletl Chnges with Rpid Mxillry Expnsion: A Systemtic Review Mnuel O. Lgrvere ; Pul W. Mjor b ; Crlos Flores-Mir c Abstrct: The objective ws to evlute long-term trnsverse, nteroposterior
More informationProsthetic Valve Dysfunction 35 Years after Mitral Valve Replacement with a Starr-Edwards Caged-disc Valve
CASE REPORT Prosthetic Vlve Dysfunction 35 Yers fter Mitrl Vlve Replcement with Strr-Edwrds Cged-disc Vlve Tetsuro Yokokw 1, Tkhiro Ohr 1, Seiji Tkshio 1, Mri Skmoto 1,YukoWd 1, Kenji Nkmur 1, Hiroyuki
More informationPostinfective physeal bars MRI features and choice of management
Postinfective physel rs MRI fetures nd choice of mngement Murry Hyes, MB ChB Svvs Andronikou, MB BCh, FC Rd, FRCR, PhD Crey Mckenzie, MB ChB, FCRd Jco du Plessis, MB ChB Reen George, MB BS, MMed Rd Slomine
More informationApplication of a Modified Roll Technique to Ridge Augmentation Before Implant Surgery: A Case Report
Copyright CASE REPORTS Appliction of Modified Roll Technique to Ridge Augmenttion Before Implnt Surgery: A Cse Report Luiz Gustvo Nscimento de Melo, José Sérgio Mi Neto, Wendel Teixeir, Frederico Ciporkin,
More informationEvaluation of the Masticatory Part and the Habitual Chewing Side by Wax Cube and Bite Force Measuring System (Dental Prescale )
J Jpn Prosthodont Soc 5:513-50, 008 ORIGINAL ARTICLE Evlution of the Mstictory Prt nd the Hitul Chewing Side y Wx Cue nd Bite Force Mesuring System (Dentl Prescle ) Mutsumi Tkhshi, DDS, Fumi Tkhshi, DDS,
More informationQuantitative and perceived visual changes of the nasolabial fold following orthodontic retraction of lip protrusion
Originl Article Quntittive nd perceived visul chnges of the nsolil fold following orthodontic retrction of lip protrusion Eui Seon Bek ; Soonshin Hwng ; Yoon Jeong Choi c ; Mi Ryung Roh d ; Tung Nguyen
More informationSoft Tissue Changes with Fixed Functional Appliances in Class II division 1
Review Article Soft Tissue Chnges with Fixed Functionl Applinces in Clss II division 1 A Systemtic Review Crlos Flores-Mir ; Michel P. Mjor b ; Pul W. Mjor c ABSTRACT Objective: To evlute fcil soft tissue
More informationTreatment planning of adhesive additive rehabilitations: the progressive wax-up of the three-step technique
CLINICAL RESEARCH Tretment plnning of dhesive dditive rehilittions: the progressive wx-up of the three-step technique Frncesc Vilti, MD, DMD, MSc Privte prctice, Genev Dentl Tem, Genev, Switzerlnd Senior
More informationCorticotomy facilitated correction of skeletal class II malocclusion
Open Access Journl of Orl Helth nd Crniofcil Science Cse Report ISSN 2573-6191 Corticotomy fcilitted correction of skeletl clss II mlocclusion Arif Yezdni A* Deprtment of Orthodontics nd Dentofcil Orthopedics,
More informationSupplementary Online Content
Supplementry Online Content Zulmn DM, Pl Chee C, Ezeji-Okoye SC, et l. Effect of n intensive outptient progrm to ugment primry cre for high-need Veterns Affirs ptients: rndomized clinicl tril. JAMA Intern
More informationDentofacial Effects of Asymmetric Headgear and Cervical Headgear with Removable Plate on Unilateral Molar Distalization
Originl Article Dentofcil Effects of Asymmetric Hedger nd Cervicl Hedger with Removble Plte on Unilterl Molr Distliztion Hndn Altug ; A. Osmn Bengi b ; Erol Akın; c Seniz Krcy d Abstrct: Cervicl hedger
More informationNonpharmacologic Interventions for Treatment-Resistant Depression in Adults Executive Summary
Comprtive Effectiveness Review Numer 33 Effective Helth Cre Progrm Nonphrmcologic Interventions for Tretment-Resistnt Depression in Adults Executive Summry Bckground Mjor depressive disorder (MDD) is common
More informationThe RUTHERFORD-2 trial in heterozygous FH: Results and implications
The RUTHERFORD-2 tril in heterozygous FH: Results nd implictions Slide deck kindly supplied s n eductionl resource by Professor Derick Rl MD PhD Crbohydrte & Lipid Metbolism Reserch Unit University of
More informationMidfoot and forefoot. Specific fractures. Fractures of the navicular. Fracture patterns and treatment. Fractures of the cuboid
.10 Specific frctures Foot.10.2 1 Midfoot nd forefoot Frctures of the nviculr 919 1.1 Surgicl ntomy 919 1.2 Frcture ptterns nd tretment 919 2 Frctures of the cuoid 922 2.1 Surgicl ntomy 922 2.2 Frcture
More informationAre Changes in Specific Landmark Anatomy on a Panoramic Image Suggestive of Maxillary Sinus Disease?
Enhnced CPD DO C Thmesh Keri Kndsmy Gnesn Are Chnges in Specific Lndmrk Antomy on Pnormic Imge Suggestive of Mxillry Sinus Disese? Astrct: Dentl pnormic rdiogrphy is commonly employed investigtion in dentistry,
More informationA FACTORIAL STUDY ON THE EFFECTS OF β CYCLODEXTRIN AND POLOXAMER 407 ON THE SOLUBILITY AND DISSOLUTION RATE OF PIROXICAM
IJRPC 20, (3) Chowdry et l. ISSN: 223 278 INTERNATIONAL JOURNAL OF RESEARCH IN PHARMACY AND CHEMISTRY Aville online t www.ijrpc.com Reserch Article A FACTORIAL STUDY ON THE EFFECTS OF β CYCLODEXTRIN AND
More informationEvaluation of treatment of late-onset tibia vara using gradual angulation translation high tibial osteotomy
Act Orthop. Belg., 2010, 76, 360-366 ORIGINAL STUDY Evlution of tretment of lte-onset tii vr using grdul ngultion trnsltion high tiil osteotomy Adel Rhmn Adel Ltif AMER, Ashrf A. KHANFOUR From the Dmnhour
More informationSafety and Tolerability of Subcutaneous Sarilumab and Intravenous Tocilizumab in Patients With RA
Sfety nd Tolerbility of Subcutneous Srilumb nd Intrvenous Tocilizumb in Ptients With RA Pul Emery, 1 Jun Rondon, 2 Anju Grg, 3 Hubert vn Hoogstrten, 3 Neil M.H. Grhm, 4 Ming Liu, 4 Nncy Liu, 3 Jnie Prrino,
More informationAnchorage Control in Bioprogressive vs Straight-wire Treatment
Originl Article Anchorge Control in Bioprogressive vs Stright-wire Tretment Dyse Uris ; Ftim Ibrhim Abdel Mustf b Abstrct: Orthodontic techniques with different concepts nd philosophies hve emerged to
More informationbuild Firm, sexy arms
w uild Firm, sexy rms Wnt toned, strong rms tht crown you pushup queen t oot cmp? Wnt to rock tnk top? These four moves re wht you need. Achieve Totl Arm Envy Mny women zero in on the show-off muscles,
More informationConsiderations in Detecting Soft Tissue Calcifications on Panoramic Radiography Ibrahim Nasseh 1, Sayde Sokhn 2, Marcel Noujeim 3, Georges Aoun 4
Received: 20 th Jnury 2016 Accepted: 03 rd April 2016 Conflict of Interest: None Source of Support: Nil Cse Report Doi: 10.2047/jioh-08-06-20 Considertions in Detecting Soft Tissue Clcifictions on Pnormic
More informationConcepts of occlusion in prosthodontics: A literature review,
Review Article Concepts of occlusion in prosthodontics: A literture review, prt II V. Rngrjn, P. B. Yogesh, B. Gjpthi, M. Mohmed Irhim, R. Gnesh Kumr, Murli Krthik Deprtment of Prosthodontics, Sri Venkteswr
More informationStart ORKAMBI today. INDICATIONS AND USAGE IMPORTANT SAFETY INFORMATION. Sydney Age 4
F O R H E A L T H C A R E P R O F E S S I O N A L S For ptients ge 2 yers nd older who re homozygous for the F508del muttion 1,2 Modify the course. Strt tody. Sydney Age 4 F508del/F508del INDICATIONS AND
More informationOriginal Article. T Akter 1, N Islam 2, MA Hoque 3, S Khanam 4, HA khan 5, BK Saha 6. Abstract:
Fridpur Med. Coll. J. 214;9(2):61-67 Originl Article Nebuliztion by Isotonic Mgnesium Sulphte Solution with Provide Erly nd Better Response s Compred to Conventionl Approch ( Plus Norml Sline) in Acute
More informationSkeletal and dental effects of molar distalization using a modified palatal anchorage plate in adolescents
Originl Article Skeletl nd dentl effects of molr distliztion using modified pltl nchorge plte in dolescents Noor Lith S ed ; Chong Ook Prk b ; Mohmed Byome c ; Je Hyun Prk d ; YoonJi Kim e ; Yoon-Ah Kook
More information