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Biomedical subjects

C Carels

Publications and source records attributed to C Carels.

At least 19 recordsLinked to original sources

[Genetics and the dento-facial complex].

Recently mutations in single genes have been found to cause dentofacial deviations like hypodontia, cleft lip and palate, as well as some craniofacial malformation syndromes like Aperts/Crouzon syndromes, cleidocranial dysostosis... These findings may lead to an overestimation and oversimplification of the role of genes in our daily life. The "one gene, one disease" principle has been applied too often, while most complex human characteristics are determined by a large number of genes, each leading to an increased liability for a certain condition. Whether this condition is expressed or not depends upon the environment the individual is exposed to as well as upon the position of a certain gene in the genetic network. The question is not whether a condition is genetically or environmentally determined, but to what extent environment and genes play a role and how they interact with each other. As early as 1870 Galton with his classical twin studies initiated the Nature-Nurture debate, whose immediate result was a great belief in the primacy of "Nature". Later, after Darwin proposed his theory of evolution (1871), the pendulum swung too far in the direction of "Nurture". At present, the dominance of the Nature camp has returned because of exceptional genetic scientific progress. Again new insights are expected that will clarify the mutual interaction of genes and between genes and the environment. After deciphering DNA, scientists need to carry out more research to explain how it is translated into the human phenotype, in health and in disease. Therefore, analysing the phenotypic variance with detailed clinical data--especially in twins--will contribute equally as much as DNA analysis to elucidating the functioning of our genes. More than their concordance, the discordance of monozygotic twins will be extremely instructive for the task of determining the genotype-phenotype relationship as well as for explaining the role of epigenetic phenomena.

Adaptation, Physiological↗

Exclusion of coding region mutations in MSX1, PAX9 and AXIN2 in eight patients with severe oligodontia phenotype.

PURPOSE: This paper describes the screening of eight patients with severe oligodontia for PAX9 and AXIN2 mutations. SUBJECTS AND METHODS: Anamnestic data and a panoramic radiograph were collected to study the phenotype of eight patients with oligodontia and their first-degree relatives. A blood sample was taken for a mutational screening for PAX9 and AXIN2 mutations. RESULTS: No mutations were discovered, but a unique nucleotide change in a conserved 5' flanking region of PAX9 was revealed. Earlier screening of the same patients for MSX1 mutations also had a negative outcome. CONCLUSIONS: Considering the discrepancy between the high incidence rate of agenesis and the relatively small number of reported causative mutations in PAX9, MSX1 and AXIN2 genes, the genetic contribution to oligodontia probably is much more heterogeneous than expected so far. Therefore negative results, like the present exclusion data, should be published more often in order to get a better appreciation of the relative contribution of these specific mutations causing oligodontia. In this context the exact number of tested probands also should be mentioned at all cases. Recent evidence of PAX9-MSX1 protein interactions in odontogenesis as well as other genes and developmental factors should receive more attention.

5' Flanking Region↗

[Dentomaxillary and -facial problems in cleidocranial dysplasia].

A 14-year old boy with cleidocranial dysplasia was referred because of an almost complete presence of the deciduous dentition. Diagnostics by means of a panoramic radiograph, lateral headfilm, CT scan and 3D computer images of the dentomaxillary complex showed 7 supernumerary permanent teeth: 13', 11', 21', 23', 28', 35' and 45'. A combined orthodontic-surgical treatment was started. The supernumary teeth were removed surgically and the impacted teeth are exposed. The closed eruption technique was used to extrude these teeth orthodontically.

Adolescent↗

[The combination of a fused tooth and a supernumerary central incisor: a possible treatment plan].

An 8-year old boy was referred to the orthodontic department because of a fused tooth. The clinical and radiological examination showed that - besides the double tooth at the region of the 21 - there was a normal tooth 22 in eruption as well. Moreover a still impacted supernumerary tooth was present in the right upper front region. The treatment included the extraction of the fused tooth and an autotransplantation of the supernumerary tooth to the extraction site of the fused tooth. During the follow-up period the pulp showed a progressive obliteration starting at the crown level with a conservation of the vitality. Apexification of the root of the transplanted tooth proceeded successfully. Furthermore a review of the literature is given in this article on the aetiology and treatment of fused teeth and on the application of autotransplantation.

Child↗

A novel MSX1 mutation in hypodontia.

MSX1 mutations have been reported in four unrelated families with autosomal dominant tooth agenesis. In one family, some individuals also had cleft lip and/or palate. We have identified a novel MSX1 mutation (559 C --> T, resulting in Gln187Stop) in three individuals of one family.

Anodontia↗

Dynamic frictional behaviour of orthodontic archwires and brackets.

The aim of this study was to evaluate the frictional behaviour of 15 different archwires and 16 different brackets using small oscillating displacements when opposed to a standard stainless steel bracket or a standard stainless steel wire. Tests were run according to a pilot study at a frequency of 1 Hz and with a reciprocating tangential displacement of 200 microm, while the wire remained centred in the bracket slot under a load of 2 N. The results indicated a significant difference between the evaluated wires and brackets. The mean coefficient of friction (COF) of the wires varied from 0.16 for Imagination NiTi tooth-coloured wire to 0.69 for the True Chrome Resilient Purple wire, while for the brackets it ranged from 0.39 for Ultratrimm to 0.72 for the Master Series. The fact that in this study, a large number of different commercially available archwires and brackets were evaluated with the same apparatus according to the same protocol, allows a direct comparison of the different archwire and bracket combinations, and can assist in the choice of the optimal bracket-wire combination with regard to friction.

Analysis of Variance↗

Treatment of hemifacial microsomia in a growing child: the importance of co-operation between the orthodontist and the maxillofacial surgeon.

The treatment of patients with hemifacial microsomia (HM) always requires an interdisciplinary approach including at least maxillofacial surgery and orthodontics. Co-operation not only within the team, but also with the patients and their family is essential in order to achieve the best results. In the case history of the 10-(1/2) year old female patient reported here, three surgical interventions (two with costo-chondral bone grafts) and a 3-year orthodontic treatment have taken place. A harmonious facial and occlusal result was finally reached.

Ankylosis↗

A split-mouth study on periodontal and microbial parameters in children with complete unilateral cleft lip and palate.

BACKGROUND: Complete unilateral cleft lip and palate (UCLP) is a hereditary or multifactorial malformation that can be corrected successfully with a combined orthodontic, surgical and restorative treatment. Such multidisciplinary treatment takes many years and demands a lot of attention to both patients' teeth and periodontium. OBJECTIVES: This split-mouth study aimed to compare the periodontal health as well as the microbial parameters between cleft and non-cleft region. MATERIAL AND METHODS: 75 patients (52 males, 23 females) between 8 and 20 years with a complete unilateral cleft lip and palate (before (n = 30), during (n = 34) and after (n = 11) the active orthodontic treatment) volunteered for this study. Four regions were defined for the split-mouth comparison: teeth neighbouring cleft (site 1), tooth in cleft (site 2), and the corresponding contra-lateral teeth, respectively, in the unaffected quadrants (sites 3 and 4). At all sites the following periodontal parameters were recorded: plaque and gingivitis indices, pocket depth, attachment loss, bleeding on probing, tooth mobility (visual and Periotest), radiographic bone loss and gingival width. In addition, three pooled subgingival plaque samples were taken (around tooth in cleft, teeth facing the cleft, and contra-lateral teeth of the latter). RESULTS: The differences between the teeth neighbouring the cleft and the corresponding contra-lateral opponents were of borderline significance (P <or= 0.05) for the plaque index, the approximal probing depths and the attachment loss (teeth facing the cleft always had slightly higher parameters). When the tooth in the cleft was compared to the contra-lateral tooth, differences were only found for both the approximal probing depths, attachment loss and bone loss, which were significantly higher for the tooth in the cleft. The microbial analysis did not reveal differences between the different sites, neither in the proportion of aerobic and anaerobic bacteria (differences < 0.5 log), nor in the detection frequency of periopathogens. CONCLUSIONS: These data indicate that the periodontium in UCLP patients can cope well with a long-term orthodontic treatment, even in unfavourable conditions (like absence of attached gingiva and poor oral hygiene).

Adolescent↗

Instructional multimedia programs for self-directed learning in undergraduate and postgraduate training in orthodontics.

OBJECTIVES: The objectives of this study were to develop and evaluate an interactive multimedia courseware package in orthodontics and to provide dental undergraduate and postgraduate students with an interactive means of self-study and self-evaluation. METHODS: A commercially available software authoring system was used to develop the courseware package. The courseware was presented for evaluation through a questionnaire to four different groups of undergraduate and postgraduate students. Each group consisted of 25 students. The first three groups were third, fourth, and fifth year of dental curriculum at the Katholieke Universiteit Leuven, Belgium. The fourth group comprised postgraduate students. A one-way ANOVA was carried out in order to check for statistical differences, whereas a Scheffe's test was used in order to locate the statistical differences between groups. The p value was set at 0.05. RESULTS: The majority of undergraduate and postgraduate students in this study were very enthusiastic about this form of educational approach (74/100) because it was experienced as very helpful in understanding the orthodontic curriculum more efficiently (98/100). CONCLUSIONS: The program provides both undergraduate and postgraduate dental students with a useful interactive means of self-study and self-evaluation.

Analysis of Variance↗

Cephalometric evaluation of maxillary advancement with an internal distractor in an adult boxer dog.

OBJECTIVE: The aim of the study was to evaluate cephalometrically the effects of distraction of the maxilla over a 1-year period by means of an internal distractor applied in a boxer dog. DESIGN: Internal distractors were placed bilaterally in the internal cavity of the maxillary sinus of a 2-year-old boxer dog after a Le Fort I osteotomy. Distraction was started 5 days after surgery and activations were continued for 14 days at a rate of 1 mm/day. Standardized lateral cephalograms were taken with an extemal source of 90 kV, 60 mS immediately pre-surgery, at day 1 after the start of the distraction (dp) and at day 5 dp, day 7 dp, day 10 dp, day 14 dp (end of distraction), at 14 days of consolidation period (cp), at 28 days cp and at 56 days cp (removal of the distractors). One year after the removal of the distractor, a final lateral cephalogram was taken. Cephalometric analysis was performed and superimpositions were used for the evaluation of the sagittal position of the maxilla. RESULTS: The linear measurements, as well as the superimposition showed evidence for a significantly advanced position of the maxilla, which was stable 1 year after removal of the distractor. CONCLUSION: The application of the internal maxillary distractor in a boxer dog resulted in a sagittal advancement of the midface that was still present after 1 year.

Animals↗

Gonial angle changes after bilateral unidirectional mandibular distraction in sheep.

It was the aim of this study to investigate radiologically the distraction site in the gonial angle area after three different protocols of unidirectional mandibular distraction in sheep. Bilateral mandibular distraction was performed in nine sheep, and one other sheep served as a sham-operated control. In the nine experimental sheep, three different distraction protocols were used. In three sheep, an oblique corticotomy line was applied and the distractors were positioned perpendicular to the corticotomy line. In three other sheep, a horizontal corticotomy line was applied and the distractors were also positioned perpendicular to this corticotomy line. In the remaining three sheep, again, a horizontal corticotomy was performed, but with an angular positioning of the distractors relative to this corticotomy line. Distraction of 20 mm was performed over 20 days at a rate of 1 mm per day. After 3 weeks of retention the sheep were sacrificed, the mandibles were dissected and hemisectioned, and standardized hemimandibular contact radiographs were made of the specimens. The distracted gaps were traced from the radiograph and the gonial angle was measured. The displacements of the distracted parts were measured, the gonial angles were determined, and the values were compared with four additional control non-distracted sheep mandibles. The results show that there was a very large variability in the distracted gaps as well as in the gonial angle changes after distraction, and it was not possible to recognize any of the three different distraction protocols radiographically after distraction. Although performed under standardized conditions it is difficult to reproduce intended mandibular corticotomy lines in sheep.

Animals↗

Idiopathic gingival hyperplasia and orthodontic treatment: a case report.

There are many reasons for gingival hyperplasia. Mostly, proper oral hygiene is sufficient to achieve normal healthy gingiva. In some situations, however, gingival hyperplasia is drug-induced or can be a manifestation of a genetic disorder. In the latter, it may exist as an isolated abnormality or as part of a syndrome. If orthodontic treatment is needed in patients with gingival hyperplasia, both orthodontic and periodontal aspects need to be considered. Extreme hereditary gingival fibromatosis was periodontally treated, by removal of all gingival excess using flaps and gingivectomies. After a follow-up period, the orthodontic treatment started with fixed appliances. Monthly periodontal check-ups (scaling and polishing) were scheduled to control the gingival inflammation. After the orthodontic treatment, permanent retention was applied, once more followed by a complete gingivectomy in both maxilla and mandible. One of the most important keys to successful treatment of hyperplasia patients is the cooperation between the periodontist and the orthodontist.

Adolescent↗

Dental abnormalities, bone graft quality, and periodontal conditions in patients with unilateral cleft lip and palate at different phases of orthodontic treatment.

OBJECTIVES: To evaluate the dental and periodontal condition of patients with unilateral cleft lip and palate (UCLP) before orthodontic treatment and evaluate whether the dental and periodontal condition of these patients during and after orthodontic treatment was jeopardized by the duration of the orthodontic and surgical treatment. DESIGN: Seventy-five individuals with UCLP (52 males, 23 females), between ages 8 and 20 years, participated in a retrospective study during their final follow-up visit with regard to dental abnormalities, such as hypodontia, external root resorption, crown and root malformation, and supernumerary teeth. Alveolar bone height and periodontal attachment loss on the cleft side were also screened before or after bone grafting and at different stages of orthodontic treatment. RESULTS: Hypodontia of the lateral incisor was found in more than 50% of the patients on the cleft side. Second premolars and/or lateral incisors outside the cleft area were missing in 27.2% of the patients. In 32%, malformations of the teeth near the cleft were noticed. In general, the teeth around and in the cleft of the patients showed normal septal bone heights and a healthy periodontium. Sixty of the 75 patients received a bone graft to restore the interrupted alveolar process. In 93.3% of these patients, the cleft was grafted before the eruption of the canine. CONCLUSION: The periodontium of the teeth in and around the cleft in patients with UCLP observed during and after orthodontic treatment can cope relatively well with the long orthodontic treatment and combined surgical interventions. The children, who had not yet started treatment, also showed enough bone support and no periodontal problems of the teeth besides the cleft. Early secondary bone grafting seems to give optimal periodontal results.

Adolescent↗

Comparison of modified Teuscher and van Beek functional appliance therapies in high-angle cases.

The aim of this study was to investigate the effects of modified Teuscher and van Beek functional appliances on the skeletal and dento-alveolar pattern in high-angle Class II, Division 1 patients. The collective consisted of 32 patients with a high-angle Class II, Division 1 malocclusion. The modified Teuscher activator was applied to a group of twelve patients, and the van Beek activator to a group of ten patients. A control group of ten subjects was used for comparison purposes. The mean chronological ages of the groups were 12, 11.8 and 11.5 years, respectively. 64 cephalograms taken before and after the treatment were evaluated. Intra-group measurement relations were determined by the Wilcoxon test, and inter-group relations by analysis of variance and Duncan tests, using SPSS statistical software. The following results were observed for both treated groups without any change in growth direction: inhibition of maxillary growth, stimulation of mandibular growth, retrusion of upper incisors, distal tipping of upper molars, and reduction of overjet and overbite compared with the control group. The decrease in overbite in the van Beek group was due mainly to intrusion of the incisors, and in the modified Teuscher group to molar extrusion. Both activators were considered preferable in terms of vertical control of the facial height in high-angle cases with deep overbite. However, stimulation of mandibular growth in the modified Teuscher activator group was found to be more significant than in the van Beek activator group.

Cephalometry↗

Treatment and standard evaluation using the Peer Assessment Rating Index.

The aim of this retrospective study was to determine the outcome of orthodontic treatment carried out on patients by postgraduate students at the Katholieke Universiteit Leuven, Belgium. The treatment outcome of 292 'final examination' patients and of 287 'control' patients was compared by means of the Peer Assessment Rating (PAR) index. The sample consisted of dental casts representing a wide range of malocclusions at the start of treatment and post-treatment. All patients received non-surgical treatment between 1987 and 1996 by one of 18 different postgraduate students. The data were analysed with a variant of the analysis of covariance. A significantly higher (P < 0.001) treatment standard was found for final examination patients compared to the control, indicated by the mean percentage PAR score reduction of 79.1% and 70.7%, respectively. When the results are expressed in terms of treatment outcome, 44.5% of the examination patients and 44.0% of the controls were allocated to the 'Greatly improved' group, while 3.1% of the patients examined and 7.3% of the control patients were classified as 'Worse or no different'.

Adolescent↗

Prevalence of dentofacial characteristics in a belgian orthodontic population.

The aim of this retrospective study was to provide quantitative information on the prevalence of dentofacial characteristics to find correlations between them and to determine the orthodontic treatment need in a Belgian orthodontic population. Data were acquired from 1,477 patients who had initial records made at the Department of Orthodontics, Katholieke Universiteit Leuven, Belgium between February 1983 and June 1997. The prevalence of Angle Class I, Class II div. 1, Class II div. 2 and Class III malocclusions was, respectively, 31%, 52%, 11% and 6%. The male-to-female ratio was 4:6. Spacing and trauma to teeth occurred more in males than in females. The prevalence of the following dentofacial characteristics was significantly different between the Angle classes: segmental crossbite; crossbite of one tooth; facial asymmetry; protral and lateral mandibular shift; horizontal and vertical growth patterns, impacted teeth; traumatised teeth; ectopically erupting canines; age at first records. No significant difference in the prevalence of the Angle classes between the sexes was found. Several clinically relevant correlations were found between the examined dentofacial characteristics. This Belgian orthodontic population from the Leuven region seems to be comparable to other orthodontic populations in Europe.

Adolescent↗

A quantitative genetic study of cephalometric variables in twins.

This study aimed at determining the relative genetic and environmental impact on a number of well-known cephalometric variables in twins. In order to find a clue in the heritability pattern of some dentofacial characteristics and on the expected limits of the therapeutic impact on the dentofacial subparts they are representing. Cephalograms were collected from 33 monozygotic and 46 dizygotic twins, who did not undergo any orthodontic treatment. Nineteen linear and four angular variables were selected all representing a different definite subpart of the dentofacial complex. The reproducibility of the measurement of most of the linear variables was very high. A genetic analysis using model fitting and path analysis was carried out. First, data were checked on the fulfilment of the conditions for genetic analysis in twins reared together. The results show that the genetic determination is significantly higher for vertical (72%) than for horizontal (61%) variables. As far as the genetic component is concerned, all variables selected seem to be inherited by additive genes, except for mandibular body length, which was determined by dominant alleles. Sex differences in genetic determination were found for the anterior face height, showing a significantly higher genetic component for boys (91%) than for girls (68%). For the angular measurements, no genetic influence was found: only environmental influences common to both members of each pair could be demonstrated.

Journal Article↗

Frictional behavior of stainless steel bracket-wire combinations subjected to small oscillating displacements.

In orthodontic treatment, sliding is frequently used to cause tooth movement. Inherent to this technique is the generation of a counteracting frictional force. In this pilot study, a fretting test consisting of reciprocating tangential displacements was used to investigate test parameters influencing frictional forces during sliding processes. Tests were run at a normal load of 2 N and a frequency of 1 Hz for tangential displacement strokes of 200 microm. Stainless steel orthodontic wires with cross-sections of .017 x .025 in (W17) and .018 x .025 in (W18), and brackets with slot sizes of .018 in (B18) and .022 in (B22) were used. A specific centered positioning method was developed to achieve a parallel alignment of the wire and the bracket slot. The experimental results indicated the significant role of the centered positioning method on the friction value. Implementation of the centered positioning method resulted in a friction force ranging from 0.89 N to 0.97 N at a 200 microm displacement amplitude and 1 Hz frequency, corresponding to a coefficient of friction ranging from 0.45 to 0.49 for the B18-W17 and the B22-W17 bracket-wire combinations, respectively. When the centered positioning method was not used, significantly higher values for the coefficient of friction were found for both bracket-wire combinations. The slot-filling, bracket-wire combinations (B18-W18 and B22-W22) resulted in an increased coefficient of friction and therefore are not recommended as sliding systems.

Analysis of Variance↗