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PubMed1983

Humoral and cellular immune reactions against tumor cells in patients with urinary bladder carcinoma. Correlation between direct and antibody-dependent cell-mediated cytotoxicity.

Serum IgG fractions from a large and homogeneous group of patients with transitional cell carcinoma of the urinary bladder (TCC) were tested for their capacity to induce antibody-dependent cellular cytotoxicity (ADCC) with lymphocytes from healthy donors against a TCC-derived target cell and one derived from adenocarcinoma of the colon. Both targets have previously been shown to be of comparable susceptibility to cell-mediated lysis in vitro. Some of the IgG preparations showed strong and dose-dependent ADCC against either one or both targets, while others gave weak reactions or none at all. Similar results were obtained with IgG from a matched group of patients with prostatic carcinoma who were used as clinical controls (CC). In parallel experiments, lymphocytes taken from the two donor groups at the same time as the serum samples were tested for their direct cytotoxicity (CMC) against the two targets. CMC gave similar results to ADCC. The differences in cytotoxicity displayed by either IgG or lymphocytes from individual donors were analysed statistically, using nonparametric statistics. To avoid introducing bias due to arbitrary data selection, the entire set of results, comprising both high and low reactors, was included in the statistical assessment. ADCC of the TCC donors' IgG against the TCC target was significantly stronger than against the colon carcinoma and also significantly stronger than that of the control donors. Similarly, the TCC patients' lymphocytes displayed a significantly higher CMC against the TCC target than against the control targets. This was not seen when the lymphocytes from the patients with prostatic carcinoma were tested. When CMC and ADCC of individual donors were compared, a statistically significant correlation between these activities was seen in three of the four donor/target combinations. These results support earlier findings and suggest that a significant fraction of both the disease-related and the 'non-selective' CMC (NK) displayed by cancer patients lymphocytes against allogeneic tumor cells in vitro reflects antibody-dependent reactions.

Aged↗
PubMed2001

The profile of bone mineral density in chinese women: its changes and significance in a longitudinal study.

Bone mineral density (BMD) has been shown to be different in different ethnic groups. When lifestyle and diet evolve, there is a possibility of a change in the normal reference BMD values within an ethnic group over a period of time. As the osteoporotic risk uses the T-score as the bench mark, it is pertinent to evaluate whether such changes do occur. Two measurements, 5 years apart, of the BMD of the spine and the hip were made in a cohort of Chinese women in Hong Kong. A kernel function smoothing method, a nonparametric statistical method, was employed to present the BMD data. The greatest rate of bone loss was found to occur between 50 and 59 years of age, but this rate of loss was reduced from age 60 onwards. The BMD values obtained in these two measurements were different from the previous studies in the same population and were found to be higher at the lumbar spine and neck of femur in women over 65 years of age. Even within the cohort, there seemed to be a reduction in the BMD values of the hip in a span of 5 years, although the differences were statistically insignificant. These studies suggest that BMD values could change in a population for a variety of possible reasons. Hence, the reference BMD values might need to be evaluated at regular intervals for the T-score to be meaningful.

Absorptiometry, Photon↗
PubMed2004

A cephalometric comparison of treatment with the Twin-block and stainless steel crown Herbst appliances followed by fixed appliance therapy.

This study compared the effects of 2 treatment protocols for correcting Class II disharmony. The first phase of treatment consisted of functional jaw orthopedics with either the Twin-block or the stainless-steel crown Herbst appliance; the second phase consisted of comprehensive fixed-appliance therapy in both protocols. Each of the 2 samples comprised 28 consecutively treated Class II patients. The mean age at the start of treatment was approximately 12 years, and the mean age at the end of the treatment was approximately 14.5 years in both groups. The duration of the treatment phase with the functional appliance was approximately 13 months, and the duration of fixed-appliance therapy was approximately 15 months in both groups. The sex distribution was identical in the 2 groups. Lateral cephalograms were analyzed at the start of treatment (T1) and at the end of the overall treatment protocol (T2). Nonparametric statistics were used for comparisons of starting forms and of the T1-T2 changes between the 2 treatment groups. The stainless-steel crown Herbst appliance and the Twin-block appliance produced very similar therapeutic modifications in Class II patients, although the Twin-block group exhibited almost 2 mm greater correction of the maxillomandibular differential than did the crown Herbst group. The treatment effects of both protocols led to a normalization of the dentoskeletal parameters at the end of the overall treatment period. Twin-block therapy also induced a greater increase in the height of the mandibular ramus (posterior facial height). Overall, only minor differences were detected in the treatment and posttreatment effects of a compliance-free (crown Herbst) and a noncompliance-free (Twin-block) appliance for correcting Class II disharmony.

Adolescent↗
PubMed2004

Increasing the visibility of coding decisions in team-based qualitative research in nursing.

OBJECTIVES: To examine the use of the multi-rater Kappa measure of agreement (Nonparametric Statistics for the Behavioural Sciences, McGraw Hill, New York, 1988) in team based, mixed method, qualitative nursing research. DESIGN: The article presents an illustrative description of the application of the qualitative coding procedure and associated multi-rater Kappa measurement at four time points in 9 months amongst a five person health services research team. MAIN OUTCOME MEASURES: The multi-rater Kappa statistic. This is a measure of the extent to which observers achieve possible agreement beyond any agreement expected to occur by chance alone. RESULTS: Closeness to primary qualitative research data, working relationships over time, and focused research team discussion can all lead to greater agreement and convergence at the level of descriptive coding. The method of measuring agreement between groups of coders was easily applied and appeared a feasible option for similar research projects wishing to demonstrate transparency in their coding procedures. CONCLUSION: Measuring agreement beyond chance by the multi-rater Kappa statistic has some utility for research teams whose qualitative coding tasks are primarily descriptive. The method offers a standard and transparent approach for demonstrating agreement between coders and should be a feature of qualitative research reporting where appropriate.

Abstracting and Indexing↗
PubMed2005

Single-bottle adhesives behave as permeable membranes after polymerisation. II. Differential permeability reduction with an oxalate desensitiser.

OBJECTIVES: This study examined the changes in hydraulic conductance and ultrastructure of dentine bonded with simplified etch-and-rinse adhesives to oxalate desensitiser pre-treated acid-etched dentine. METHODS: Human dentine disks were acid-etched, treated with an oxalate desensitiser (BisBlock, Bisco), and bonded with One-Step (OS), Single Bond (SB), OptiBond Solo Plus (OB) or Prime and Bond NT (PB). Similar disks from each group were acid-etched, and bonded without oxalate pre-treatment. Hydraulic conductance of the specimens was measured at 20 cm of water pressure and analysed with nonparametric statistical methods. Epoxy resin replicas of the smear layer-covered dentine and bonded dentine were examined with SEM for the extent of fluid transudation. Specimens bonded under perfusion were examined with TEM after tracer immersion. RESULTS: OB and PB exhibited a highly significant reversal of the reduced hydraulic conductance obtained with BisBlock on unbonded acid-etched dentine. Profuse water transudation across the bonded dentine was observed from the replicas. Adhesive interfaces were covered with spherical globules that interfered with dentine hybridization. Conversely, no significant difference in hydraulic conductance was observed in SB, between Bisblock pre-treated, unbonded and bonded acid-etched dentine. Significantly lower hydraulic conductance was shown on application of OS to Bisblock-treated acid-etched dentine. Water transudation was sparse, interfering surface globular structures were absent, and only angular subsurface crystals were seen in the dentinal tubules. CONCLUSIONS: Convective water fluxes through dentine may be reduced by applying Bisblock to acid-etched dentine before bonding with One-Step or Single Bond. However, reducing adhesive permeability with the use of oxalate desensitiser is not applicable to low acidity adhesives such as OptiBond Solo Plus and Prime and Bond NT.

Adhesives↗
PubMed2006

Evaluation of tissue response to MTA and Portland cement with iodoform.

OBJECTIVE: The aim of this study was to evaluate the biocompatibility of Portland cement with the addition of iodoform, compared to MTA (ProRoot). STUDY DESIGN: Eighteen Wistar albino rats were divided into 3 groups of 6 animals each. Polyethylene tubes were filled either with freshly mixed MTA or Portland cement mixed with iodoform (20% wt/wt) and implanted subcutaneously. An empty tube served as control. After 7, 30, or 60 days, the implants together with the surrounding tissues were removed in blocks. Sections were evaluated for the presence and thickness of a fibrous capsule, presence of granulation tissue, and the severity of inflammatory response. Data were submitted to nonparametric statistical analysis with individual comparisons between groups at a significance level of P < 0.05. RESULTS: There were no differences between inflammatory responses at 7 and 30 days. After 60 days from surgical removal, there was significantly more tissue reaction to the MTA and Portland cement compared to the control group. CONCLUSION: There were no significant differences regarding inflammatory responses between MTA and Portland cement with iodoform after 7, 30, or 60 days. After 60 days, the fibrous capsule around the Portland cement appeared more organized than tissue surrounding MTA implants. After 60 days, there was still a significantly increased tissue reaction to the 2 cements compared to the empty polyethylene tubes.

Aluminum Compounds↗
PubMed1999

Psychoeducational profile of the 22q11.2 microdeletion: A complex pattern.

OBJECTIVES: To examine the psychoeducational profile associated with the chromosome 22q11.2 microdeletion (DiGeorge/velocardiofacial syndrome). STUDY DESIGN: Thirty-three patients (aged 6 to 27 years) with a 22q11.2 microdeletion underwent psychoeducational testing as part of a comprehensive evaluation. Nonparametric statistics were used to compare verbal and performance IQ, academic achievement scores, and receptive versus expressive language scores. Post hoc comparisons were made of IQ subtest scores and of language versus verbal IQ. RESULTS: Full-scale IQ ranged from the normal to the moderately retarded range. Mean verbal IQ was significantly higher than mean performance IQ. In a similar manner, mean reading and spelling scores were superior to the mean mathematics score, although achievement scores typically were in the range of verbal IQ. In addition, many children showed clinically significant language impairments, with mean language scores lower than mean verbal IQ. CONCLUSIONS: The IQ and academic profiles are reminiscent of a "nonverbal learning disability," although achievement was not discrepant from IQ. The coincidence of language impairment with a relative strength in reading belies a unique neuropsychologic profile. Educational programming for these children must address both verbal and nonverbal deficits.

Adolescent↗
PubMed1995

Comparison of three methods of critical evaluation of microleakage along restorative interfaces.

This in vitro study compared microleakage along the dentin-restorative interface by use of a conventional single-surface and two stereoscopical protocols. The extent of microleakage in class V cylindric cavities that were restored with Scotchbond 2/P-50 was assessed after thermocycling and silver staining were performed. Specimens were randomized into three groups of 10 teeth for the three different protocols to be investigated. The categories were group 1, a single longitudinal section through the midline of the restoration, group 2, a multiple-surface protocol based on computer reconstruction of digitized images from multiple serial abrasions, and group 3, a clearing protocol based on immersion of demineralized specimens in methyl salicylate. The severity of microleakage for all groups was recorded on an ordinal scale and based on linear leakage length. The median leakage score for groups 1 through 3 was 2, 4, and 4, respectively. When comparisons were performed with nonparametric statistical analysis, both the clearing and the multiple-surface protocols recorded significantly more severe leakage than those detected from a conventional, single longitudinal, midline sectioning technique, (x2 = 8.595, p < 0.02). Furthermore microleakage patterns generated from the two stereoscopical protocols revealed extensive microleakage that advanced unilaterally or bilaterally through the dentin-restorative interface along the embrasure regions into the axial wall of the restorations. No significant difference was noted between the two stereoscopical protocols (Q = 0.260, p > 0.05), which suggested that the clearing protocol, which is less labor-intensive than the multiple-surface protocol, may be recommended for future comparative microleakage studies that involve the dentin-restorative interface.

Analog-Digital Conversion↗
PubMed2004

Remediation of soil contaminated with dioxins by subcritical water extraction.

The effectiveness of subcritical water extraction (SCWE) was examined for removing dioxins from contaminated soil. Most dioxins in the soil sample were reduced at 300 degrees C or more, but decreased dioxin concentrations were also observed at 150 degrees C. After 4 h of extraction, 99.4%, 94.5% and 60% of PCDDs were removed from samples at 350, 300 and 150 degrees C, respectively. It was also determined that degradation of dioxins had occurred, since the sum of dioxins in the soil plus water extracts after the experiments had considerably decreased. This study revealed that pressurizing is not essential for the removal of dioxins. Reduction was complete within 30 min at 350 degrees C; however, it took a much longer time at lower temperatures. The results of addition experiments in which OCDDs were added to different types of soil samples have shown that dechlorination is one of the major reaction pathways. After addition of OCDD to soil samples, experiments were carried out to examine in detail the degradation pathways of PCDDs. The removal rates and congener profiles varied among soil types. Although it was previously assumed that removal rates and congener profiles depended on the chemical components in soil, nonparametric statistical analysis revealed no significant relationship between the rate of reduction and elements present in the soil. It was confirmed from isomer patterns that dechlorination of the 2,3,7,8-positions in PCDDs takes place somewhat faster than for the 1,4,6,9-positions.

Dioxins↗
PubMed2002

Comparison of pulse activation vs conventional light-curing on marginal adaptation of a compomer conditioned using a total-etch or a self-etch technique.

OBJECTIVES: This study investigated the effect of two factors: conditioning methods and light-curing techniques on the marginal adaptation of Dyract AP (Dentsply DeTrey, Germany). The 'pulse activation' curing technique was compared with a conventional light-curing technique for their effectiveness in reducing marginal gaps in restorations that were conditioned with three different protocols. MATERIALS AND METHODS: Cylindrical cavities, 3mm in diameter, were prepared in extracted human molar teeth. They were restored with Dyract AP using Prime&Bond NT (PBNT; Dentsply DeTrey) as the adhesive. Cavities were etched with: Conditioner36/PBNT (group 1), Non-Rinse Conditioner (NRC)/PBNT (group 2), and PBNT only (group 3). Either conventional or the 'pulse activation' technique was used for light-curing of the material. Epoxy resin replicas were obtained from longitudinal sections of the specimens, and the restoration-tooth interfaces were examined using scanning electron microscopy. Marginal qualities along the resin-dentin interfaces were further measured using image analysis and analyzed using nonparametric statistical methods. RESULTS: With the conventional curing technique, enamel margin fractures were frequently observed. Marginal gaps were found along the compomer-dentin interfaces irrespective of the conditioning protocol. A significantly lower percentage of gap-containing margins were found in cavities that were conditioned with 36% phosphoric acid. With the 'pulse activation' technique, no marginal gap was found along compomer-dentin interfaces that were etched with either Conditioner36 or NRC. More than 90% of the total margin length were excellent. No cohesive failure of enamel could be observed along cavosurface margins. SIGNIFICANCE: The 'pulse activation' curing technique significantly improves the marginal integrity of Dyract AP when Conditioner36/Prime&Bond NT and NRC/Prime&Bond NT are used as conditioning/bonding systems. The use of Prime&Bond NT without etching is not recommended, as marginal gaps are present irrespective of the curing techniques employed.

Acid Etching, Dental↗
PubMed2003

Treatment considerations for comminuted mandibular fractures.

PURPOSE: We sought to assess the methods of treatment used and outcomes for a large sample of patients with comminuted fractures of the mandible. PATIENTS AND METHODS: The records of all patients who were identified as having comminuted fractures of the mandible over a 10-year period with sufficient follow-up were collected and analyzed for demographic information, treatment rendered, and outcomes. Standard descriptive statistics and nonparametric statistics were used to analyze the data. RESULTS: A total of 196 patients (167 males and 29 females) with 198 comminuted fractures met the inclusion criteria. The mandibular body was the most commonly affected region. Approximately half were sustained in altercations. Gunshot wounds created fractures that were more comminuted than other causes. The comminuted regions were treated by closed reduction and maxillomandibular fixation (MMF) in 35 fractures, open reduction with stable internal fixation in 146 fractures, and 17 were treated with external pin fixation. For those patients treated with open reduction, a single reconstruction bone plate was used in the majority of cases (114). For those patients treated open, 98 were treated using an intraoral approach and 52 were treated using an extraoral approach. The mean follow-up was 140.6 days. Complications occurred in 26 fractures (13%). The complications were malocclusion in 8 fractures and nonocclusal (ie, infection, nonunion, etc) in 18 fractures. There was a statistically significant relationship between the development of complications and the degree of fragmentation (P <.05). There was also a significant relationship between treatment and the development of complications (P <.05). Patients treated with external pin fixation had a 35.2% complication rate compared with a 17.1% complication rate for patients undergoing closed treatment with MMF, or patients treated with open reduction and stable internal fixation (10.3%). However, patients treated with external pin fixation had more severe injuries. CONCLUSIONS: The results of this study show that, when possible, the use of open reduction and stable internal fixation is associated with a low complication rate. However, not all comminuted fractures are amenable to this treatment, and in those, alternatives such as closed reduction with MMF or the application of external pin fixation may be necessary.

Adolescent↗
PubMed1998

Determining cephalometric norms for Caucasians and African Americans in Birmingham.

The purpose of this study was to establish age- and sex-specific normative data for Caucasians and African Americans in Birmingham, Ala. Subjects (136) between 6 and 18 years old were included in the study. Chang's method (AF-BF) and 12 other measurements were used as determinates of the skeletal sagittal jaw relationship. All subjects had acceptable facial profiles and Class I occlusion. Subjects were divided into eight subgroups based on race, gender, and age. Differences of mean cephalometric values were tested using parametric and nonparametric statistical tests. Compared with Caucasians, African Americans had greater mean values for all measurements except AFB and AF-BF. More negative values were found for the African Americans in the Wits appraisal. Most measurements were found to decrease with age. These findings support our hypothesis that cephalometric norms should be based on racial, sex, and age differences.

Adolescent↗
PubMed2003

Long-term effectiveness and treatment timing for Bionator therapy.

The aim of the present investigation was to provide information about the long-term effects and optimal timing for class-II treatment with the Bionator appliance. Lateral cephalograms of 23 class-II patients treated with the Bionator were analyzed at three time periods: T1, start of treatment; T2, end of Bionator therapy; and T3, long-term observation (after completion of growth). T3 includes a phase with fixed appliances. The treated sample was divided into two groups according to their skeletal maturity as evaluated by the cervical vertebral maturation (CVM) method. The early-treated group (13 subjects) initiated treatment before the peak in mandibular growth, which occurred after completion of Bionator therapy. The late-treated group (10 subjects) received Bionator treatment during the peak. The T1-T2, T2-T3, and T1-T3 changes in the treated groups were compared with changes in control groups of untreated class-II subjects by nonparametric statistics (P < .05). The findings of the present study on Bionator therapy followed by fixed appliances indicate that this treatment protocol is more effective and stable when it is performed during the pubertal growth spurt. Optimal timing to start treatment with the Bionator is when a concavity appears at the lower borders of the second and the third cervical vertebrae (CVMS II). In the long-term, the amount of significant supplementary elongation of the mandible in subjects treated during the pubertal peak is 5.1 mm more than in the controls, and it is associated with a backward direction of condylar growth. Significant increments in mandibular ramus height also were recorded.

Activator Appliances↗
PubMed2003

Evaluation of the validity of tooth size and arch width measurements using conventional and three-dimensional virtual orthodontic models.

Measurements and different analyses of dental casts are essential for precise diagnosis of an orthodontic case. At present, virtual computerized models, such as OrthoCAD, are available for clinicians, supplemented by dedicated software for performing needed measurements on them. The purpose of this study was to test the accuracy of measuring casts with the aid of calipers or OrthoCAD and compare these two techniques. Twenty setups using artificial teeth corresponding to various malocclusions were created. Impressions were taken of them, providing 20 plaster and 20 virtual orthodontic models. Measurements of mesiodistal tooth dimension as well as intercanine and intermolar width were made on both. Additionally, values of tooth size were calculated from the isolated artificial teeth removed from the setups and of arch width from the existing setups. The resulting values were compared by the use of nonparametric statistics, and methods' errors were also calculated. Results showed the methods being highly valid and reproducible for both tooth size and arch width. For the tested clinically applicable methods, measurement with digital calipers on plaster models showed the highest accuracy and reproducibility, closely followed by OrthoCAD. Digital calipers seem to be a more suitable instrument for scientific work. However, OrthoCAD's accuracy is clinically acceptable, and most likely, considering its present advantages and future possibilities, the examined or an equivalent 3D virtual models' procedure would become the standard for orthodontic clinical use.

Calibration↗
PubMed2003

Clinical use of the ABO-Scoring Index: reliability and subtraction frequency.

This study tested the reliability and subtraction frequency of the study model-scoring system of the American Board of Orthodontists (ABO). We used a sample of 36 posttreatment study models that were selected randomly from six different orthodontic offices. Intrajudge and interjudge reliability was calculated using nonparametric statistics (Spearman rank coefficient, Wilcoxon, Kruskal-Wallis, and Mann-Whitney tests). We found differences ranging from 3 to 6 subtraction points (total score) for intrajudge scoring between two sessions. For overall total ABO score, the average correlation was .77. Intrajudge correlation was greatest for occlusal relationships and least for interproximal contacts. Interjudge correlation for ABO score averaged r = .85. Correlation was greatest for buccolingual inclination and least for overjet. The data show that some judges, on average, were much more lenient than others and that this resulted in a range of total scores between 19.7 and 27.5. Most of the deductions were found in the buccal segments and most were related to the second molars. We present these findings in the context of clinicians preparing for the ABO phase III examination and for orthodontists in their ongoing evaluation of clinical results.

Adolescent↗
PubMedDate not supplied

Health care delivery system influences changes in nursing educational materials.

The changing health care delivery system has affected nursing care delivery models. To meet the needs of these shifting sands, health-related professions must examine curricula preparing new graduates. An exploratory, descriptive survey design was employed to discover motivators for and types of curricular changes occurring in nursing programs and determine what supportive educational materials are needed. One hundred sixty-seven (26%) of the 651 surveys mailed to a sample of the whole of U.S. baccalaureate nursing programs were returned. Relationships between and among categories of nominal data culled from the participants' experiences were compared using nonparametric statistics. Findings demonstrated why and what changes were made and what educational materials are needed to support new curricula. Results also indicated that blurring of boundaries between community and general acute care nursing is necessary, and changes throughout curricula, including educational materials, must reflect the real-life community aspects of the health care needs of all individuals.

Curriculum↗
PubMed2001

Phenotypic and metabolic characteristics of monocytes and granulocytes in preeclampsia.

OBJECTIVE: The maternal syndrome of preeclampsia has recently been attributed to a systemic intravascular inflammatory response and endothelial cell activation and dysfunction. This novel hypothesis has considerable clinical and biological implications. This study was designed to determine whether women with preeclampsia have evidence of intravascular inflammation by examination of the phenotypic and metabolic activity of granulocytes and monocytes. STUDY DESIGN: A cross-sectional study was performed that included patients with preeclampsia (n = 31) and normal pregnancies (n = 58) matched for gestational age at blood draw. Intravascular inflammation was studied with use of flow cytometry. Peripheral venous blood was assayed to determine granulocyte and monocyte phenotype with the use of monoclonal antibodies for selective cluster differentiation (CD) antigens. The panel of antibodies included CD11b, CD14, CD16, CD18, CD49d, CD62L, CD64, CD66b, and HLA-DR. The quantity of basal intracellular reactive oxygen species and oxidative burst was assessed. Results were reported as mean channel brightness or intensity of detected fluorescence. Analysis was conducted with nonparametric statistics. A P value <.01 was considered to be significant. RESULTS: Preeclampsia was associated with a significant increase in mean channel brightness for CD11b on granulocytes and monocytes but lower mean channel brightness for CD62L on granulocytes than those from women with normal pregnancy (P <.01 for each). Basal intracellular reactive oxygen species were increased in monocytes but not in granulocytes. The oxidative burst was higher in both cell types. CONCLUSION: Preeclampsia is associated with phenotypic and metabolic changes in granulocytes and monocytes.

Adolescent↗
PubMed2000

Treatment timing for Twin-block therapy.

This cephalometric study evaluated skeletal and dentoalveolar changes induced by the Twin-block appliance in 2 groups of subjects with Class II malocclusion treated at different skeletal maturation stages in order to define the optimal timing for this type of therapy. Skeletal maturity in individual patients was assessed on the basis of the stages of cervical vertebrae maturation. The early-treated group was composed of 21 subjects (11 females and 10 males). Mean age of these subjects at time 1 (immediately before treatment) was 9 years +/- 11 months, and at time 2 (immediately after discontinuation of the Twin-block appliance) was 10 years 2 months +/- 11 months. According to the cervical vertebrae maturation staging at times 1 and 2, the peak in growth velocity was not included in the treatment period for any of the subjects in the early group. The late-treated group consisted of 15 subjects (6 females and 9 males). Mean age of this group was 12 years 11 months +/- 1 year 2 months at time 1 and 14 years 4 months +/- 1 year 3 months at time 2. In the late group, treatment was performed during or slightly after the onset of the pubertal growth spurt. Both treated samples were compared with control samples consisting of subjects with untreated Class II malocclusions also selected on the basis of the stage in cervical vertebrae maturation. A modification of Pancherz's cephalometric analysis was applied to the lateral cephalograms of all examined groups at both time periods. Linear and angular measurements for mandibular dimensions, cranial base angulation, and vertical relationships were added to the original analysis. Annualized differences for all the variables from time 1 to time 2 were calculated for both treated groups and contrasted to the annualized differences in the corresponding untreated groups by means of nonparametric statistics. The findings of this short-term cephalometric study indicate that optimal timing for Twin-block therapy of Class II disharmony is during or slightly after the onset of the pubertal peak in growth velocity. When compared with treatment performed before the peak, late Twin-block treatment produces more favorable effects that include: (1) greater skeletal contribution to molar correction, (2) larger increments in total mandibular length and in ramus height, and (3) more posterior direction of condylar growth, leading to enhanced mandibular lengthening and to reduced forward displacement of the condyle in favor of effective skeletal changes. The importance of the biological evaluation of skeletal maturity in individual patients with Class II disharmony to be treated with functional appliances is emphasized.

Age Factors↗