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PubMedDate not supplied

Is the volume of distribution of digoxin reduced in patients with renal dysfunction? Determining digoxin pharmacokinetics by fluorescence polarization immunoassay.

STUDY OBJECTIVE: To determine digoxin pharmacokinetics in subjects with different degrees of renal function using fluorescence polarization immunoassay (FPIA), which is associated with less interference from digoxin-like immunoreactive substances (DLIS) than radioimmunoassay. SETTING: University hospital clinical research center. PARTICIPANTS: Eighteen subjects (mean age 44 yrs) with different degrees of renal function: group 1, creatinine clearance (Clcr) below 10 ml/minute; group 2, Clcr 10-50 ml/minute; and group 3, Clcr greater than 50 ml/minute (6 patients in each group). INTERVENTION: Over 5-7 days, 15 serum samples were collected after a single intravenous dose of digoxin 7 or 10 micrograms/kg actual body weight (WT) for serum concentration measurements by FPIA. Two-compartment pharmacokinetic parameters (zero-time intercept of the concentration-time curve of the initial distribution phase [A], zero-time intercept of the concentration-time curve of the terminal elimination phase [B], initial distribution phase constant [alpha], terminal elimination rate constant [beta], volume of distribution in the central compartment [Vc] and at steady state [Vss], total body clearance [Cl], mean residence time [MRT], area under the concentration-time curve [AUC]) were determined using a nonlinear least squares regression program. MEASUREMENTS AND MAIN RESULTS: No significant differences were found among groups for A, B, alpha, beta, beta-half-life Vc/WT, MRT, AUC, and Cl/WT. Significant differences were observed in Vss/WT (4.8 +/- 1.0, 6.6 +/- 0.5, 6.4 +/- 0.7 L/kg) between group 1 versus group 2 and group 1 versus group 3 (p < 0.01). Measured Clcr was correlated with Cl (r2 = 0.40, p < 0.01), Cl/WT (r2 = 0.29, p < 0.05), Vss (r2 = 0.35, p = 0.01), and Vss/WT (r2 = 0.24, p < 0.05). CONCLUSION: This study confirmed that Vss is smaller in patients with chronic renal failure (Clcr < 10 ml/min) than those without chronic renal failure. Therefore, previous recommendations that lower digoxin loading doses should be administered in patients with renal failure are applicable to digoxin serum concentration monitoring using FPIA.

Adolescent↗
PubMed1997

Effect of high-performance liquid chromatography on plasma angiotensin II measurements in treated and untreated normotensive and hypertensive patients.

BACKGROUND: Angiotensin II (Ang II) levels are normally very low in human plasma, approximately 5 pg/ml. They are usually measured by radioimmunoassay after extraction and concentration. An additional high-performance liquid chromatography (HPLC) step is reportedly necessary for accurate measurement but it is laborious and time-consuming, severely limiting the number of samples that can be assayed. OBJECTIVE: To investigate whether the HPLC step was necessary for measuring Ang II in human plasma samples in our laboratory using our own Ang II antiserum. DESIGN: Human plasma Ang II levels, measured with and without the HPLC step, were compared in two different studies. Since the action of renin is the rate-limiting step in the production of Ang II in plasma, the relationships of plasma renin activity (PRA) to Ang II levels measured with and without HPLC were also evaluated. In the first study, 108 blood samples were collected from 29 hypertensive patients during placebo or treatment with the Ang II antagonist BMS-186295. In the second study blood samples were collected from 12 normal subjects before and during beta-adrenergic blockade. RESULTS: In samples collected during angiotensin II antagonism, which predictably increased plasma Ang II levels, a highly significant relationship between the Ang II measurements with and without HPLC was found (y = 0.99x + 1.7; r = 0.97, P < 0.001). The y intercept of 1.7 pg/ml suggested that the nonspecific immunoreactivity was close to 2 pg/ml in samples assayed without the HPLC step. During beta-adrenergic blockade, which predictably suppressed plasma renin levels, highly significantly linear relationships between HPLC and non-HPLC Ang II measurements (y = 1.3x + 1.6; r = 0.93. P < 0.001, n = 16) and between non HPLC Ang II and PRA (y = 1.9x + 1.7; r = 0.73, P < 0.001, n = 108) were again found. The relationship between PRA and HPLC Ang II was also highly significant (y = 1.4x + 0.04; r = 0.92, P < 0.001, n = 16), but the y intercept was significantly lower (P < 0.001), approaching zero, indicating the removal of nonspecific immunoreactivity during the HPLC step. CONCLUSIONS: These results demonstrate once more that, when using polyclonal antibody 182, the accuracy of the Ang II measurement in human plasma is improved by the inclusion of a HPLC step, especially for samples with Ang II levels in the normal-to-low range. They also show that plasma Ang II and PRA increase or decrease proportionally during treatment with Ang II antagonists or beta-adrenergic blockade, respectively.

Adrenergic beta-Antagonists↗
PubMed1997

Comparison of five measures derived from in vivo pulmonary vascular pressure-flow curves.

In order to facilitate evaluation of acute changes in lung vascular characteristics in vivo, pressure-flow (delta P-Q) curves of the pulmonary circulation were obtained by step-wise flow reduction. A balloon-tipped Swan-Ganz catheter was inserted via the jugular vein into the inferior vena cava of anesthetized, open chest, ventilated rabbits. Pulmonary arterial (Ppa) and left atrial (Pla) pressures were measured via catheters, and cardiac output Q by an electromagnetic flow probe on the aorta. Inflation of the balloon for 10 s reduced Q by 30-70%. delta P-Q curves were constructed by plotting a series of values of Q against corresponding delta P (= Ppa-Pla). To evaluate the feasibility and sensitivity of the method, these curves were compared under three conditions each paired with control (normoxia): hypoxia (8% O2), isoproterenol infusion, and serotonin infusion. Within our measured flow ranges, most delta P-Q plots were fairly linear, and extrapolated to a positive delta P intercept. Comparing slope, intercept, resistance, delta P at fixed Q, and Q at fixed delta P, we found that the latter two provided the more sensitive index to differentiate vasomotor changes. Since delta P-Q curves generally miss the origin, calculated pulmonary vascular resistance must depend on Q. Therefore, using the shifts in entire delta P-Q curves to select common range of Q and/or delta P is in general more quantitatively reliable for defining altered vascular characteristics.

Animals↗
PubMed1997

Flow versus uptake comparisons of thallium-201 with technetium-99m perfusion tracers in a canine model of myocardial ischemia.

UNLABELLED: We investigated the myocardial flow kinetics of six putative radioperfusion agents (99mTc-Q3, 99mTc-Q4, 99mTc-Q12, 99mTc-sestamibi, 99mTc-tetrofosmin and 99mTcN-NOET) and 201Tl in a canine model of myocardial ischemia with pharmacologic coronary artery vasodilation. METHODS: In 31 open-chest dogs with acute coronary occlusion, dipyridamole (approximately 0.56 mg/kg) was infused intravenously, followed by a perfusion tracer injection and radioactive microspheres for myocardial blood flow (MBF) measurement. The paired data were normalized using three techniques; average, normal or maximum myocardial tracer activity and MBF. RESULTS: The upper limit of MBF obtained for the group of tracers ranged from 4.2 ml/min/g to 8.2 ml/min/g. There was a statistically significant (p < 0.0001) linear correlation (r = 0.87-0.98) between the normalized myocardial activity and the normalized MBF values of each of the tracers. The slope of the curve normalized by average for 201Tl (0.83) was greater than those for the 99mTc tracers, and the intercept (0.07) was lower than those for the 99mTc tracers. Slopes and intercepts for the 99mTc agents were as follows: 99mTc-Q3, 0.81 and 0.18; 99mTc-Q4, 0.61 and 0.41; 99mTc-Q12, 0.63 and 0.39; 99mTc-sestamibi, 0.62 and 0.34; 99mTc-tetrofosmin, 0.68 and 0.32; and 99mTcN-NOET, 0.71 and 0.29, respectively. CONCLUSION: In an anesthetized open-chest canine model of regional myocardial ischemia with dipyridamole induced hyperemia, 201Tl shows a more ideal relationship between tracer uptake and MBF than do the 99mTc-based agents. Of the various 99mTc-based imaging agents studied, the myocardial flow kinetics of 99mTc-Q3 appear to be closest to ideal. This relationship is maintained regardless of the normalization technique used. This may, in theory, imply a higher sensitivity in discerning ischemic from normal myocardium and a role in diagnostic nuclear imaging for 99mTc-Q3.

Animals↗
PubMed1997

[Postcoital contraception. Dates based on a 5-year use in a private consultation service].

BACKGROUND: The aim of this 5-year retrospective study is to define the efficacy of oestro-progestinic interception. METHODS: An oestro-progestinic mixture (0.05 mg ethinyl estradiol and 0.250 mg dlnorgestrel) was prescribed to 6003 women attending the gynaecological outpatients clinic of AIED (Associazione Italiana per l'Educazione Demografica) in Genoa, Italy, without evidence of any previous contra-indications. The prescription was of two pills at once and two pills 12 hours after. Before examination, the doctor asked for personal and medical history (age, date of onset of menses, unprotected intercourse date and anticonceptional failure); patients were also asked to report the data of the following menses to the clinic. The largest age range was between 20 and 24 years, probably because of their inadequate knowledge of contraceptives. The reasons for post-coital contraception were: sexual intercourse without contraceptive, failure of coitus interruptus and of the condom. RESULTS: Post-coital interception efficacy (monthly oestro-progestinic contraception was 99.5%) according to retrospective statistical analysis, was according to Pearl index 92.9% vs 50% without any contraceptive. CONCLUSIONS: Finally, the efficacy of this method, together with its easy management and low frequency of severe contra-indications, allows us to indicate the "morning after pill" as one of the most useful outpatient strategies to avoid unwanted pregnancies.

Adult↗
PubMed1997

Mechanoenergetics of rat left ventricles in in situ and excised blood-perfused hearts and in unloaded rat left ventricular slices.

We investigated rat left ventricular (LV) mechanoenergetics in three different preparations. We obtained an upward convex curvilinear end-systolic pressure-volume relation (ESPVR) regardless of left ventricular (LV) contractility in in situ and excised cross-circulated rat hearts. We also obtained a linear myocardial O2 consumption per beat (VO2)-end-systolic pressure-volume area (PVA; a measure of ventricular total mechanical energy) relation regardless of the curvilinear LV ESPVR in the excised cross-circulated heart. The slope and the VO2 intercept of the VO2-PVA relation was similar to those in other species. The basal metabolism obtained by KCl arrest was higher than those in other species. In the whole heart preparation, the VO2 intercept may include O2 consumption for residual crossbridge cycling as well as O2 consumption for excitation-contraction (E-C) coupling and basal metabolism. Therefore, we established a new system for measuring myocardial O2 consumption of mechanically unloaded (zero PVA) rat LV slices. The increment in O2 consumption by stimulation of the slices represents O2 consumption for E-C coupling (but not for crossbridge cycling). Most O2 consumption for E-C coupling seems consist of O2 consumption for the sarcoplasmic reticulum Ca2+ pump.

Animals↗
PubMed1998

Fit of Ehrenberg's equation to height & weight of young healthy Indian males.

Height-weight relationship in young healthy Indian males (16-21 yr) has been established for different states of India as well as for the combined data of all the states. It was observed that these relationships have large deviations of the intercepts and slopes from the intercept (a = 0.4) and slope (b = 0.8) of the Ehrenberg's equation. The results of the present study show that Ehrenberg's equation may not be applicable for young healthy Indian males aged 16-21 yr.

Adolescent↗
PubMed1976

Incorporation rate in vitro of choline and methyl-methionine into human hepatic lecithins.

In order to evaluate the quantitative role of cytidinediphosphate-choline and phosphatidyl-ethanolamine-methylation pathways in the synthesis of phosphatidylcholine in human liver tissue, the incorporation rate of [14C]choline and [14C]methyl-methionine into liver lecithins was determined. Liver biopsy was taken in 27 patients operated upon for uncomplicated gallstone disease. Linear incorporation into lecithin was achieved for N-methyl-methionine during 4 hours' incubation and for choline from 7.5 min to 60 min of incubation but with a significant positive Y-intercept. This Y-intercept was directly proportional to the concentration of choline in the medium and might be explained by a rapid base exchange between free choline in the medium and bases in phosphoglycerides. Fertile women showed significantly higher incorporation rate of methyl-methionine than postmenopausal women. Bile acids in the incubation medium did not influence the incorporation rate of thesebation medium did not influence the incorporation rate of these precursors into hepatic lecithin: The results indicate that the contribution of the methylation pathway in the synthesis of human liver lecithin accounts for about 10-15 per cent of that of the CDP-choline pathway.

Adult↗
PubMedDate not supplied

[Normal ventilatory response to hypoxia and hypercapnia at an altitude of 2240 meters].

OBJECTIVE: To evaluate the ventilatory response to hypoxia and hypercapnia in healthy residents of Mexico City at 2240 m above sea level. METHODS: 15 healthy subjects, 10 women and 5 men, were studied (mean age 38; range 26-76). All completed one or two tests of ventilatory response to hypoxia and hypercapnia as described by Rebuck-Campbell and Read, respectively. The results were analyzed by linear regression using the minute ventilation as the dependent variable and SaO2 (hypoxia) or PCO2 (hypercapnia) as the independent variables. RESULTS: Seven subjects had very low or no response to hypoxia. The mean hypoxia slope was 0.7 +/- 0.6 L/min/% (+/- SD) and the hypercapnia slope was 3.0 +/- 1.4 L/min/mmHg. The intercepts were 176 +/- 278 for SaO2 and 3.0 +/- 7 for PCO2. CONCLUSIONS: A low respiratory response to hypoxia was found in Mexico City Healthy residents. The response to hypercapnia was similar in slope to other studies but had an intercept shifted to lower values. The Mexico City residents showed a behavior typical of patients with chronic hypoxemia or of dwellers at high altitudes.

Adult↗
PubMed1998

[Comparison of Quick/INR values of whole capillary blood (CoaguChek Plus) and venous citrate plasma in patients with and without oral anticoagulation].

BACKGROUND: The prothrombin time, also called thromboplastin time ("Quick"), is usually measured by using citrated plasma from venous blood. Recently, portable coagulation monitors have been developed which measure prothrombin time using non-anticoagulated capillary whole blood from a finger-stick. In the present study we evaluated the CoaguChek Plus coagulation monitor in comparison with a standard laboratory method in various patient groups: patients on oral anticoagulation with or without heparinisation, patients receiving heparin without oral anticoagulation, patients with a deficiency of one of the coagulation factors of the extrinsic or common pathway, and patients with liver disease. Furthermore, we studied the influence of the haemoglobin concentration on the test results. METHOD: Capillary prothrombin time was measured by using the portable coagulation monitor CoaguChek Plus and venous prothrombin time was assessed by using Thromborel S. RESULTS: We found a correlation coefficient of 0.94 between capillary and venous INR values in 216 determinations from 167 patients. The slope of the regression line was 1.03, and the y-intercept 0.05, 93.5% of the results were within 0.9, 90.7% within 0.7, and 83.8% within 0.5 INR units. Similar results were obtained in patients on oral anticoagulation, patients with a deficiency of a factor of the extrinsic system and in patients with liver disease. Correlation and agreement were somewhat lower among patients on oral anticoagulation and simultaneous heparinisation (40 patients): correlation coefficient was 0.83, slope of the regression line was 0.87 and y-intercept was 0.27 INR units. No influence of the haemoglobin concentration on INR results could be demonstrated. CONCLUSION: Our results show the CoaguChek Plus coagulation monitor to be a valuable tool for measuring prothrombin time in patients on oral anticoagulation, in patients with liver disease to estimate the capacity of protein synthesis, and to screen for possible deficiencies of one of the coagulation factors of the extrinsic or common pathway. However, based on our preliminary data we cannot recommend the use of the CoaguChek Plus coagulation monitor in heparinised patients.

Acenocoumarol↗
PubMed1991

[The anatomical and physiological aspects in the treatment of temporomandibular joint disorders].

The specialty of orthodontics and its relationship to TMJ problems is in the thick of controversy. Several anatomic and physiologic aspects are discussed so as to improve the understanding of the multi-faceted problems. The use of this biologically-based information is likely to make therapy more successful. From a therapeutic point of view, it is incumbent on the dentist to institute early preventive or interceptive procedures.

Dental Occlusion↗
PubMed2003

Orthodontic findings in the deciduous and early mixed dentition--inferences for a preventive strategy.

AIM AND METHOD: The aim of the present epidemiologic study was to obtain representative basic data on the frequency, extent and age-dependence of malocclusions in the deciduous and early mixed dentition. The developmental tendencies of specific malocclusions were investigated from the aspect of orthodontic prevention. The collective comprised 8,864 preschool and school-aged children, of whom 1,225 were in the deciduous dentition (mean age 4.5 years) and 7,639 in the mixed dentition (mean age 8.9 years). The orthodontic data were clinically assessed as sagittal, transversal, or vertical single-arch and occlusal findings. In addition, the malocclusions were classified according to their primary symptoms. Early infantile habits, tongue dysfunctions, speech defects and incompetent lip closure were registered separately. RESULTS: 57% of the children were found to have malocclusions, with the frequency rising statistically significantly in dependence on age from the deciduous to the mixed dentition (p < or = 0.001). The mean extent of excessive overjet increased significantly from the deciduous to the mixed dentition. Crossbite with mandibular midline discrepancies were observed significantly more frequently in the deciduous dentition. Although the frequency of anterior open bite underwent a significant decline from the deciduous to the mixed dentition, open bite was the malocclusion most frequently associated with dysfunction in both groups. The significant increase in traumatic deep bite in the mixed dentition indicates an unfavorable developmental tendency in this anomaly until after the eruption of the permanent incisors. CONCLUSION: The need for preventive orthodontic therapy and for the intensified application of interceptive and early treatment measures is stressed in view of the high number of malalignments and malocclusions in the deciduous and mixed dentition and the tendency for some forms of malocclusion to deteriorate as the dentition develops.

Adolescent↗
PubMed2004

Cephalometric variables predicting the long-term success or failure of combined rapid maxillary expansion and facial mask therapy.

The aim of this study was to select a model of cephalometric variables to predict the results of early treatment of Class III malocclusion with rapid maxillary expansion and facemask therapy followed by comprehensive treatment with fixed appliances. Lateral cephalograms of 42 patients (20 boys, 22 girls) with Class III malocclusion were analyzed at the start of treatment (mean age 8 years 6 months +/- 2 years, at stage I in cervical vertebral maturation). All patients were reevaluated after a mean period of 6 years 6 months (at stage IV or V in cervical vertebral maturation) that included active treatment plus retention. At this time, the sample was divided into 2 groups according to occlusal criteria: a successful group (30 patients) and an unsuccessful group (12 patients). Discriminant analysis was applied to select pretreatment predictive variables of long-term treatment outcome. Stepwise variable selection of the cephalometric measurements at the first observation identified 3 predictive variables. Orthopedic treatment of Class III malocclusion might be unfavorable over the long term when a patient's pretreatment cephalometric records exhibit a long mandibular ramus (ie, increased posterior facial height), an acute cranial base angle, and a steep mandibular plane angle. On the basis of the equation generated by the multivariate statistical method, the outcome of interceptive orthopedic treatment for each new patient with Class III malocclusion can be predicted with a probability error of 16.7%.

Adolescent↗
PubMed2005

Eligibility for publicly funded orthodontic treatment determined by the handicapping labiolingual deviation index.

INTRODUCTION: Access to orthodontic care for Medicaid patients has been limited, in part because of orthodontists' reluctance to treat severe malocclusions for low reimbursements. Limited orthodontic treatment in the mixed dentition (phase 1 treatment) has been proposed to address this issue, because the intent of phase 1 treatment is to improve or prevent severe malocclusions. Orthodontists might be more willing to provide shorter, simpler treatment. The purpose of this study was to determine whether phase 1 treatment would reduce malocclusion severity to the extent that eligibility for subsequent Medicaid-funded treatment was significantly reduced. METHODS: Eligibility was determined by the handicapping labiolingual deviation (HLD) index, which is used by several states for this purpose. Eligibility was also determined with the index of complexity, outcome, and need (ICON). This allowed us to compare these 2 indexes. Pre-phase 1 and post-phase 1 index scores were calculated by using study casts from 193 patients treated at the University of Washington orthodontic clinic and the Odessa Brown Children's Dental Clinic, both in Seattle. RESULTS: Using the HLD index, we found that eligibility for orthodontic treatment decreased by 62% after phase 1 treatment. This change was statistically significant at P < .0001. The ICON found significantly more treatment need before phase 1 (90%) than did the HLD index (35%) (P < .0001). CONCLUSIONS: Early interceptive treatment significantly reduces eligibility for comprehensive Medicaid-funded orthodontic treatment. The HLD index is a useful tool for determining Medicaid eligibility.

Adolescent↗
PubMed1995

Extrusion of the ectopic maxillary canine using a lower removable appliance.

The ectopic eruption and impaction of maxillary canines is a frequently encountered problem. The prevalence is estimated to be between 0.92% to 2.2%. It is found to be palatal to the dental arch in about 85% of cases and buccal only in about 15% of cases. Ericson and Kurol suggested that removal of the deciduous canine before the age of 11 years will normalize the position of the ectopically erupting permanent canine in 91% of cases if the canine crown is distal to the midline of the lateral incisor. We strongly endorsed this interceptive approach. Early recognition that a canine is erupting ectopically is extremely important. Ericson and Kurol estimate that in 0.71% of children in the 10 to 13 year age group, permanent incisors have resorbed because of the ectopic eruption of maxillary canines. Resorption may be found as early as 10 years but occurs most frequently in the age groups 11 to 12 years. In this article a simple, well-clasped lower removable appliance is shown to be an excellent base for using light elastics to move the impacted canine, first posteriorly away from the incisor roots and then vertically and buccally. A gold chain is bonded to the unerupted canine to provide a simple and flexible means of traction that ensures the canine erupts into a zone of attached mucosa with normal crown length.

Adolescent↗
PubMed2004

[Orthodontic treatment of children with cleft lip and cleft palate].

Orthodontic treatment of children with cleft palates continues through the periods of the three dentitions: temporary, mixed, and adult. Using examples, this paper deals with the different difficulties that can be encountered during treatment of this malformation. Orthodontic interception at the time of the temporary dentition corrects the heart of the problem, the transverse insufficiency, but also addresses moderate maxillary retrusion. Cooperation with a speech therapist at this stage is essential. In the mixed dentition, orthodontists correct incisal malalignment and, depending upon the severity of the deformity, consider surgical intervention. In the adult dentition, a variety of decisions must be made: whether to open or close the spaces left by absent lateral incisors; whether to accept an orthodontic compromise or to elect surgical advancement of the maxilla; and, if surgery is deemed appropriate, whether to embark on an early distraction procedure or to rely on a classical osteotomy.

Adolescent↗
PubMed2005

[Tweed-Merrifield technique and vertical dimension in hyperdivergent Class II].

The cases presented in this paper share a common skeletal characteristic, hyperdivergence, a common therapeutic strategy, similar diagnostic elements, and a common choice of non-symmetrical extractions. Interceptive treatment is especially useful for this type of malocclusion to prevent deep over-bites, atypical habits, and severe malocclusion. In the Tweed-Merrifeld technique, orthodontists use careful dental, occlusal, cephalometric, and esthetic evaluations to establish an appropriate treatment plan and therapeutic strategy whose goal will be: to eliminate unhealthy compensations, re-position, if necessary, alveolar structures on basal bone, reduce anterior-posterior and vertical discrepancies, favor anterior mandibular rotation, improve facial esthetics, restore functional occlusion, and assure stability of results. Because of its consistent capability of achieving predictable resolution of the most varied and complex orthodontic disorders, the author has chosen this technique for routine use in his daily orthodontic practice.

Cephalometry↗
PubMed2000

Sagittal and vertical changes after treatment of Class II Division 1 malocclusion according to the Cetlin method.

This cephalometric study was designed to evaluate the dentoskeletal anteroposterior and vertical changes produced by Cetlin therapy (lower lip bumper, ACCO, cervical headgear) to correct Class II Division 1 malocclusion in the late mixed dentition. All measurements were made on 2 lateral headfilms, at pretreatment and at 1 year after beginning treatment. The selected sample (n = 110; 67 boys and 43 girls; mean age, 10 to 11 years) and the control group (n = 100; 48 boys, 52 girls; mean age, 10 to 11 years) matched for number, age, and malocclusion. The average observation interval was 13 months. The final measurements between intervals were averaged and tested for significance by analysis of variance. A one-factor (group) repeated measure model and a two-factor (group and facial type) repeated measure model were fitted to each variable separately and significance values were set at P </=.05. The Class I molar relationship was achieved in all treated subjects primarily through distalization of upper first molars. A significant distal tipping was found in 70% of the treated cases. The results showed a significant forward growth limitation of the maxilla with the use of cervical headgear. No significant change of mandibular position was found in the treated group compared with the control group. Both bite opening and proclination of upper and lower front teeth occurred. Cetlin therapy is reliable and effective for space recovery and interceptive Class II Division 1 treatment. Additional therapy may be needed later.

Analysis of Variance↗