RESIDENTS' JOURNAL REVIEW

ARTICLES FROM THE CURRENTORTHODONTIC LITERATURE, SELECTED ANDREVIEWED BY:SENIOR ORTHODONTIC RESIDENTS,MAIMONIDES MEDICAL CENTER, BROOKLYN,NY

David Chung, Department Chair and ProgramDirector

Presurgical nasoalveolar molding in cleftpatientsSuri S, Disthaporn S, Atenafu EG, Fisher DM.Presurgical presentation of columellar features,nostril anatomy, and alveolar alignment in bilateralcleft lip and palate after infant orthopedics with andwithout nasoalveolar molding. Cleft PalateCraniofac J 2012;49:314-24.

Achieving an esthetic outcome from surgical proce-dures in cleft patients is a common concern for all

treating clinicians, parents, and patients. Many cleftteams include presurgical infant orthopedics in theirtreatment protocols before initial lip repair. Infantorthopedics is described in this article as an oral platewith lip taping with or without nasoalveolar molding.Nasoalveolar molding is becoming more popular withthese teams that include infant orthopedics, althoughit remains controversial. The aim of this retrospectivestudy was to quantitatively analyze, in infants withbilateral cleft lip or palate, the presurgical nasal anat-omy and the alveolar alignment after orthopedic treat-ment. The authors also wanted to explore the possiblerelationships among presurgical anatomy, length oftreatment time before lip surgery, age at lip repair,and age at which treatment started. Data were col-lected on 29 patients (51 nostrils) treated with nasoal-veolar molding and 17 patients (29 nostrils) treatedwith infant orthopedics only. Each nostril was analyzedand calculated individually. Nostrils with Simonart'sbands were excluded. One surgeon made all measure-ments immediately before lip repair while the patientwas under general anesthesia. Orthopedic treatmenthad been conducted by several orthodontists. The anal-ysis showed that the group treated with nasoalveolarmolding had decreased alveolar irregularity, a longerand narrower columella, an increased columellarlength-to-width ratio, and a decreased columellar an-gle. The age at which the patients were started with

presurgical infant orthopedics, lip repair, and treatmenttime differences was not statistically significant. Theauthors concluded that more favorable presurgical al-veolar and columellar presentations were seen with na-soalveolar molding than with infant orthopedics alone;however, they also suggested that further research iswarranted.

Reviewed by Kevin Toms

Head alignment and distortion ofpanoramic radiographsSadat-Khonsari R, Fenske C, Behfar L, Bauss O.Panoramic radiography: effects of head alignmenton the vertical dimension of the mandibular ramusand condyle region. Eur J Orthod 2012;34:164-9.

Panoramic radiographs are a common diagnostictool used by orthodontists. These radiographs

are helpful in visualizing pathology, periodontalhealth, root positions, impactions, bone morphology,and other abnormalities. These authors examined thereliability of using the panoramic radiograph fordiagnosing ramal and condylar asymmetries. A dryhuman skull was mounted on a cephalostat in a pan-oramic machine and purposefully displaced along thesagittal, transverse, and vertical planes or axes. Theauthors obtained 252 radiographs with defined posi-tioning simulated errors and compared them witha set of 42 ideally positioned panoramic radiographs.Translating the skull along the sagittal and transverse(y-axis) planes did not result in significant distortionof the condyle or ramus region. However, simulta-neous rotation of the skull around the cranio-caudal z-axis and the transverse y-axis to the sameside resulted in significant magnification errors. Thegreatest distortion was due to shifting the head alongthe transverse and cranio-caudal axes concomitantly.Despite these simulated errors in positioning, dimen-sional differences were statistically significant butclinically small. The authors concluded that asymme-tries of more than 6% between the vertical dimen-sions of the right and left condyles and rami mightbe due to true asymmetries and not to operator error.Proper positioning of the patient in the panoramicmachine is vital for proper diagnosis and treatmentplanning.

Reviewed by Jay S. Garrel

287

288 Residents' journal review

Identification of specific salivarypeptides prevalent during orthodontictreatmentZhang J, Zhou S, Zheng H, Zhou Y, Chen F, Lin J.Magnetic bead-based salivary peptidome profilinganalysis during orthodontic treatment durations.Biochem Biophys Res Commun 2012;421:844-9.

Numerous changes and biologic responses occurduring orthodontic treatment. Identifying factors

that are consistent with orthodontic treatment could be-come beneficial to diagnosis, treatment planning, andtreatment mechanics. Saliva is rife with potential bio-markers or factors (such as proteins) thatmight be relatedto specific conditions. The objective of this study was tocompare differences in protein mass peaks in saliva fromorthodontic patients with differing treatment durations.The authors also aimed to identify specific biomarkerswith differential expressions during these treatment du-rations. The saliva samples came from40 healthy subjectswho underwent comprehensive orthodontic treatmentwith 4 premolar extractions. Split into 4 groups, the salivawas tested at either 0, 2, 7, or 12 months. By usingmatrix-assisted laser desorption/ionization time-of-flight mass spectrometry, the peaks among mass spectrawere quantified and compared with extract relevantbiomarkers. Eight peptides were identified as having sig-nificantly differing peak intensities. Half of these demon-strated a consistent time-dependent increase in intensitythrough treatment; patients without treatment hadlower peak intensities of these peptides than did thosewho had 2 months of treatment. Likewise, intensities in-creased for subjects who had undergone orthodontictreatment for 7 months and then again for 12 months.These authors used a novel methodology to furtherdefine the inner physiologic mechanisms surroundingorthodontic tooth movement, which is complex andnot completely understood. Identification of specific bio-markers might aid in future physiologic assessment orpathophysiologic diagnosis. Furthermore, biomarkerscould perhaps be used in determining optimal treatmentforces, leading to increased orthodontic treatmentefficiency with minimal clinical side effects. Their identi-fication appears worthy of continued investigation, es-pecially with a noninvasive approach.

Reviewed by Matthew Etter

September 2012 � Vol 142 � Issue 3 American

Protection of the temporomandibularjoint during neonatal mandibulardistractionFan K, Andrews BT, Liao E, AllamK, Raposo AmaralCA, Bradley JP. Protection of thetemporomandibular joint during syndromicneonatal mandibular distraction using condylarunloading. Plast Reconstr Surg 2012;129:1151-61.

Mandibular distraction osteogenesis is used in grow-ing patients to alleviate upper airway obstructions.

Mandibular advancement of a neonate with severe mi-crognathia or a hypoplastic mandible might reduce theneed for a tracheostomy. It was hypothesized that, by al-leviating condylar overloading during mandibular dis-traction osteogenesis, the risk of temporomandibularjoint abnormalities would also decrease. The purposeof this study was to evaluate the differences betweensyndromic and nonsyndromic neonates with respect tocondylar anatomy and temporomandibular joint pathol-ogy based on the outcomes of mandibular distraction.During the 10-year study period, 155 newborns with mi-crognathia and upper airway obstruction were studied.Computed tomography scans of the temporomandibularjoint were evaluated in syndromic, nonsyndromic, andnormal patients. The results showed no significant dif-ferences in the pathology of the temporomandibularjoint between the groups except for the syndromicgroup, which had more abnormal coronoid processesthan did the nonsyndromic or normal patients. Postop-eratively, a significant number of the syndromic patientsdeveloped temporomandibular joint abnormalities. Nononsyndromic patient had more than a 25% decreasein incisor opening or abnormalities shown on a com-puted tomography scan. In a subgroup of patients, thecondylar load was decreased during distraction withthe use of Class II elastics on temporary anchorage de-vices extending from the anterior maxilla to the posterioraspect of the distraction device. The postoperative tem-poromandibular joint outcomes were significantly betterfor the condylar-unloaded patients. The authors con-cluded that syndromic patients undergoing distractionhave a higher incidence of temporomandibular joint pa-thology, and that better outcomes were achieved whencondylar-unloading Class II elastics were used.

Reviewed by Richard J. Moses III

Journal of Orthodontics and Dentofacial Orthopedics