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Biomedical subjects

M L Omnell

Publications and source records attributed to M L Omnell.

12 recordsLinked to original sources
PubMed2000

Radiographic determination of the position of the maxillary lateral incisor in the cleft alveolus and parameters for assessing its habilitation prospects.

OBJECTIVE: Develop patient selection criteria and guidelines for the diagnostic work-up for early secondary alveolar bone graft designed to accommodate a lateral incisor in the cleft. DESIGN: A literature review with clinical examples. INTERVENTIONS: For the majority of cleft lip and palate (CLP) patients, the timing of the secondary alveolar bone graft procedure is devised to accommodate the eruption of the maxillary canine. However, when the lateral incisor is present in the cleft area, a decision may be made to perform early grafting in order to salvage an additional tooth. Appropriate case selection for this intervention is the key for successful dental habilitation in the cleft area. RESULTS AND CONCLUSIONS: Attempts to maintain the lateral incisor are recommended only if the tooth contributes to the comprehensive orthodontic and restorative patient care and when the presence of a lateral incisor with adequate size, shape, and proper position may be demonstrated. For optimal decision making, the position, form, and periodontal ligament support of the lateral incisor should be assessed. Evaluation of these parameters is based chiefly on radiographic imaging. Occlusal projections and traditional tomography may augment the information available from periapical and panoramic radiographs. However, each of these has benefits and drawbacks that require consideration.

Alveolar Process↗
PubMed2000

Do psychosocial variables predict the physical growth of infants with orofacial clefts?

This study sought to determine whether psychosocial variables (parent-infant feeding interactions, infant temperament, maternal social support, family socioeconomic status) are important in predicting the physical growth of infants with orofacial clefts, after controlling for selected medical variables (infant health status, cleft diagnosis, and previous weight). Infant growth (weight-to-height zscores) was tracked for 2 years, and models were developed to predict growth at 3, 12, and 24 months. The authors also examined the growth trajectories of infants with different cleft types: cleft lip and palate (CLP) and cleft palate only (CPO). CPO infants showed some increase in their growth relative to the population mean over time, whereas the growth of CLP infants remained lower than the population mean at all time points. After controlling for medical variables, psychosocial variables collectively accounted for an additional 42% of the variance in infants' growth at 3 months of age, but they did not account for growth at 12 months and 24 months, largely due to the strong effect of previous growth. The authors tentatively conclude that psychosocial variables influence the early growth trajectory of infants with clefts, but subsequent growth becomes increasingly regulated by biological factors.

Child Development↗
PubMed1999

Ethics for orthodontists.

When treating children, important ethical issues may arise relating to the best interests of the child and decision making for minors. The case of a child with a cleft lip and palate whose parents failed to bring her in for medically indicated orthodontic care is presented. Ethical features of the case are discussed, including the need to benefit the patient, avoid harm, and respect the preferences of the parents. Ethical codes of the American Dental Association and American Medical Association are referenced. Ethical dilemmas include the conflict between the orthodontist's obligation to the child and the need to respect parental autonomy. Parental autonomy is respected up until the point at which significant harm to a child may result. The orthodontist's primary ethical responsibility is to the child, not the parents. The orthodontist providing medically indicated care should involve the craniofacial team or hospital social worker when parental decision making is in question.

Child↗
PubMed1999

Psychosocial adjustment in twin pairs with and without hemifacial microsomia.

OBJECTIVE: To compare the psychosocial adjustment of children with and without hemifacial microsomia (HFM). DESIGN: This cross-sectional pilot study investigated psychosocial adjustment of twin pairs in which one twin was affected with HFM and the other was unimpaired. Data were analyzed using paired t tests. SETTING: The dental medicine clinic of a large urban children's hospital, serving a multistate area. PARTICIPANTS: Participants were six twin pairs aged 9 to 15 years and their parents. Data were also collected from classroom teachers. MAIN OUTCOME MEASURES: Outcome measures included: the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), the Coopersmith Self-Esteem Inventory (SEI), and a structured self-concept interview (the Self-Interview). RESULTS: Children with HFM had significantly higher CBCL and TRF total behavior problem scores and lower SEI general self-esteem scores than their unimpaired twins. No differences were found in CBCL competence scores. Interview data revealed concerns among the HFM group related to appearance, negative social responses, and fear of hospital procedures. Children also reported positive aspects of coping with HFM. CONCLUSIONS: The results of this study suggest that, similar to other craniofacial conditions, HFM is associated with an elevated risk for childhood psychosocial difficulties. Replication of specific findings with a larger sample is needed. Multicenter, collaborative studies are a crucial next step for this field.

Adaptation, Psychological↗
PubMed1998

Ossification of the human stylohyoid ligament: a longitudinal study.

We report the results of a longitudinal radiographic study of ossification of the stylohyoid ligament in a sample of patients treated for minor malocclusions. The results suggest that the vast majority of ossified sites in the stylohyoid ligaments are established during childhood and adolescence. The mean length of the sites shows a fairly rapid, linear increase with age until the end of adolescence; any further increase is nonlinear and occurs at a much slower rate. In young individuals the ossified sites were predominant in the superior part of the ligament. With increasing age ossified sites became prevalent also in other parts of the ligament. Ossified sites in the inferior part close to the hyoid bone were more common than previously reported.

Adolescent↗
PubMed1994

Periodontal complications following orthognathic surgery and genioplasty in a 19-year-old: a case report.

Bimaxillary osteotomies and a sliding genioplasty were performed to correct mandibular micrognathia and maxillary vertical hyperplasia in a 19-year-old white male with a Class II, division 1 malocclusion and anterior open bite. At a follow-up appointment with the orthodontist 4 weeks after the surgical procedure, the mandibular anterior teeth showed severe gingival recession, exposing labial root surfaces on the mandibular central incisors. Grafting procedures were able to restore labial soft tissue on the affected teeth. It is suggested that wound healing contraction of gingival tissue in the area of the incision for the genioplasty caused this complication.

Adult↗
PubMed1992

Periodontal status of teeth adjacent to nongrafted unilateral alveolar clefts.

The purpose of this study was to compare the periodontal condition of teeth adjacent to the cleft with contralateral teeth in adult subjects with a nongrafted unilateral alveolar cleft. Periodontal parameters were evaluated in 18 subjects who had at least one tooth immediately adjacent to the cleft. For each tooth investigated, plaque index, gingival index, and probing depth were recorded and each tooth was assigned a mobility score. Width of attached gingiva and extent of recession was measured. Bone level was assessed using standardized magnified radiographs and a computerized digitizing system. The overall findings of this study support those of other studies and indicate that in individuals with a nongrafted alveolar cleft, teeth adjacent to the defect show signs of gingivitis but not of periodontal disease. The anatomic defect, eruption pattern, orthodontic tooth movements, and the presence of restorations appear to contribute to the reduced bone level on the central incisor adjacent to the cleft and to the presence of gingivitis.

Adult↗
PubMed1990

Expression of Veratrum alkaloid teratogenicity in the mouse.

Jervine, a steroidal alkaloid found as a minor constituent in the teratogenic range plant Veratrum californicum, has produced similar terata in sheep, rabbit, hamster, and chick, although the sensitivity to the alkaloid varies in the different species. Sprague Dawley rats and Swiss Webster mice are relatively insensitive. The aim of this study was to determine the teratogenic potential of jervine in three strains of mice and to ascertain if the response is strain dependent. One strain, Swiss N:GP(S), was retested since a Swiss Webster strain had been found previously to be jervine-resistant. In addition, we tested C57BL/6J and A/J, which are known to differ in their response to the teratogenic action of steroids and vitamin A. Mice were treated by gavage with single doses of jervine (70, 150, or 300 mg/kg body weight) on either day 8, 9, or 10 of gestation. Jervine was teratogenic to C57BL/6J and A/J mice but not to N:GP(S). The induced terata included cleft lip with or without cleft palate, isolated cleft palate, mandibular micrognathia or agnathia, and limb malformations. Fetal teratogenicity and maternal and fetal toxicity were highly correlated. The prevalence of each defect and fetal death was a function of strain, dose, and time of treatment. Maternal death was higher in C57BL/6J than in A/J mice. Although some of the terata were similar, the response pattern between strains was different from corticosteroids and vitamin A for both sensitive period and the strain dose response. An effect on differentiation of chondrocyte precursors may account for many of the defects, but an earlier lethal effect on differentiation of neural crest cells or precordal mesenchyme may also occur.

Animals↗
PubMedDate not supplied

Cognitive and psychomotor development of infants with orofacial clefts.

OBJECTIVE: To compare at ages 3, 12, and 24 months the cognitive and psychomotor development of 29 infants with cleft lip and palate (CLP), 28 infants with cleft palate only (CPO), and a demographically matched comparison (COMP) group of 69 infants; to examine predictors of cognitive status at age 24 months in the cleft group. METHODS: Infants were administered the Bayley Scales of Infant Development (BSID), mother-infant interactions were observed, and medical records were reviewed. RESULTS: CLP and CPO groups scored lower than the COMP group on the BSID, but did not differ from one another. Cleft group infants scored lower than COMP group infants on BSID items assessing nonverbal and expressive language skills. Quality of maternal interaction predicted the 2-year Mental Development Index (MDI) scores of infants with clefts. CONCLUSIONS: Infants with clefts show relative deficits in cognitive and psychomotor development. Cognitive deficits are apparent in nonverbal as well as verbal areas of performance.

Child Development↗
PubMedDate not supplied

Skeletal and dental disturbances after facial burns and pressure garments.

Pressure garments alter facial growth. We conducted a prospective study of facial growth in children wearing such garments to quantify these skeletal and dental disturbances. Three children with total face masks and three children with devices covering the lower face were studied. Panoramic and cephalometric radiographs were obtained at the start of treatment, approximately 6 months later, and at the end of the treatment. Clinical examinations were performed to document occlusal status and subsequent changes. Total face masks affected maxillary horizontal growth more than vertical growth. Mandibular growth changed from the normal anterior and inferior direction to a more inferior direction. With partial face masks, the most notable change was increased proclination of anterior teeth. Facial growth and the position of anterior teeth appear to be affected by the combination of the extent of the burn and skin graft and the type of pressure garments worn during the time of rehabilitation.

Burns↗
PubMedDate not supplied

Skeletal and dental disturbances in children after facial burns and pressure garment use: a 4-year follow-up.

Pressure garment use alters facial growth during rehabilitation after a facial burn injury. We previously studied 3 children with full facial burns and 3 children with partial facial burns who wore pressure garments for 1 year, and we found that maxillary horizontal growth and mandibular anterior-inferior growth are inhibited during the time of pressure garment use. The purpose of this follow-up study was to prospectively document skeletal and dental changes after pressure garment use was discontinued. We found that although the growth and development of the facial bones seem to return to normal, lasting changes remain. The use of pressure garments after skin grafting is still recommended. However, it is also recommended that an orthodontist be included in the team of burn care specialists for children with facial burns to monitor facial and dental development. Close attention to facial development during and after pressure garment use is necessary to maintain normal dental and facial relationships.

Burns↗