Temporal evaluation of juvenile and adolescent skeletofacial growth rates.
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Biomedical subjects
Publications and source records attributed to H T Perry.
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This survey of five dental groups revealed that the dental profession still is far from reaching a consensus about temporomandibular disorders. Despite a great deal of research that has clarified many issues in this field, clinicians often cling to outdated concepts and practices. However, many respondents did give answers that demonstrated their awareness of modern TMD diagnostic and treatment guidelines.
Long-term (1 to 7.5 years) follow-up evaluations of 110 adult patients who were seen for diagnosis and treatment of symptoms related to myofascial problems (MP), internal derangement (ID), or both were conducted by means of telephone interview. One half of the patients were seen at the Northwestern University Dental School TMJ Clinic, while the other half were seen in the private office of one author (H. T. P.). The purpose of this study was to evaluate patient response to conservative therapy combined with advice about self-management, as compared with the response to advice only. Further, we desired to compare treatment outcomes among (1) diagnostic categories ID, MP, and ID plus MP, (2) clinic patients and private patients, and (3) patients with acute disease and those with chronic disease. Chronic disease was identified as that in which pretreatment symptoms had persisted for more than 4 months. The ridit analysis was used to assess differences in outcomes for patients in the three diagnostic categories and for clinic patients compared with private patients. The results revealed no significant differences. There was a trend for patients with acute conditions to improve more than those with chronic problems; however, further research is needed to determine whether a correlation exists between symptom duration and treatment outcome. At the time of the follow-up evaluation, 88% of all patients reported substantial or total improvement in their symptoms of pain and dysfunction. Therefore, conservative therapy, including advice about self-management, was found to be both adequate and appropriate for most of these patients.
This study used magnetic resonance imaging to assess disk-condyle relationships before and after arthroscopic surgery. Disk positions relative to condyles were found to be generally unchanged, despite the greater range of opening. Clinical findings were positive symptomatic changes with improved interincisal openings in 11 of 12 patients (92%). The results suggest that the clinical success of arthroscopic surgery as a treatment modality does not occur as a result of disk repositioning or recapturing.
The biological responses to the repair of palatal clefts has been evaluated principally by monitoring craniofacial growth. Little is known about the regenerative ability of the repaired palate. In the present study, 18 Beagle pups (51 to 58 days old) were assigned to one of three groups: (1) control group, having no surgery; (2) cleft group, having a surgically created cleft of the posterior hard palate (mean bony measurement: 3.1 x 11.7 mm) at 8 weeks of age; and (3) repaired group, same as group 2, and followed by soft-tissue closure at 12 weeks of age. Craniofacial growth was monitored by cephalometric and dental cast measurements. Records were taken at 6-week intervals. Animals were sacrificed either 16 or 28 weeks after time of cleft creation. Routine histologic examination and histochemical detection of alkaline phosphatase activity were performed to examine the quality and extent of soft-tissue repair and bone formation. Analysis of the cleft palate group revealed that the size of the bony cleft increased with time. The histologic examination demonstrated at 24 weeks of age (12 weeks after the repair) active reduction of medial margin of the bony palate as evidenced by osteoclastic activity. At 36 weeks of age, neither osteoblastic nor osteoclastic activity was detected. The mean dimensions of the bony cleft, in the cleft group at 36 weeks, were 7.9 x 18.8 mm. In the repaired group, partial bone repair occurred. However, no consistency was seen in predicting extent or location of repair. Histochemical detection of alkaline phosphatase activity indicated that the repaired group had greater amounts of new bone formation. In some sites, suture regeneration was seen. As with the amount of bone formation, the amount of suture regeneration was variable. This study revealed that the presence of a cleft inhibits osteoblastic activity along the margin of the cleft, and there is limited potential for regeneration of the palate subsequent to the repair.
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Thirty-six premolars which were scheduled for routine extraction were bracketed with either N or G system adhesives. After one week the brackets were removed and the residual adhesive removed by low-speed green stone, a hand scaler, or an ultrasonic scaler. Half the teeth were given a final pumice, and then all were extracted. The SEM was used to evaluate the enamel surface, and quantitative assessments were made for the area covered with retained adhesive and for damage to the surface. All three removal techniques left appreciable amounts of retained adhesive 20 to 60 per cent coverage for G and 55 to 75 per cent for N adhesive. All detectable adhesive was removed by final pumicing. The detectably roughened area was over 50 per cent for the green stone treatment for both materials and appeared to introduce unnecessary roughness. The hand scaler and the particular ultrasonic scaler used in this study did not severely roughen the enamel for either material and appeared to be effective for initial adhesive removal. All three techniques introduced occasional gouges 10 to 20 micrometer in depth which could not be removed. All other roughness was generally smoothed by final pumicing. Thus, pumicing is a necessary final step with all removal procedures studied.
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