Publications by authors named "Parisa Salehi"

39 Publications

Sotos syndrome with a novel mutation in the gene associated with congenital hypothyroidism.

Int J Pediatr Adolesc Med 2021 Sep 26;8(3):191-194. Epub 2020 Jun 26.

Division of Endocrinology and Diabetes, Seattle Children's Hospital/University of Washington, Seattle, WA, 98105, USA.

Childhood overgrowth syndromes are relatively rare. A generalized overgrowth syndrome should be suspected when tall stature and macrocephaly are present, after ruling out nutritional excess and endocrinopathies. Sotos syndrome is a well-described overgrowth syndrome due to haploinsufficiency of the gene. We present a case of an infant with permanent congenital hypothyroidism, who had tall stature and macrocephaly by 7 months of age. He was noted to have typical facial features, mild gross motor and speech delay, and scoliosis by 13 months of age. Gene sequencing revealed a heterozygous novel c6076_6087del12: p.Asn2026_Thr2029del variant in exon 20 of the gene, pathogenic for Sotos syndrome. Congenital hypothyroidism with Sotos syndrome has been infrequently reported and may expand the spectrum of disease characteristics. Early diagnosis of overgrowth syndromes is important for developmental follow up and multidisciplinary care coordination.
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http://dx.doi.org/10.1016/j.ijpam.2020.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319649PMC
September 2021

Behavioral features in Prader-Willi syndrome (PWS): consensus paper from the International PWS Clinical Trial Consortium.

J Neurodev Disord 2021 06 21;13(1):25. Epub 2021 Jun 21.

Centre for Applied Psychology, School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK.

Prader-Willi syndrome (PWS) is a rare neurodevelopmental genetic disorder associated with a characteristic behavioral phenotype that includes severe hyperphagia and a variety of other behavioral challenges such as temper outbursts and anxiety. These behaviors have a significant and dramatic impact on the daily functioning and quality of life for the person with PWS and their families. To date, effective therapies addressing these behavioral challenges have proven elusive, but several potential treatments are on the horizon. However, a limiting factor for treatment studies in PWS is the lack of consensus in the field regarding how to best define and measure the complex and interrelated behavioral features of this syndrome. The International PWS Clinical Trials Consortium (PWS-CTC, www.pwsctc.org ) includes expert PWS scientists, clinicians, and patient advocacy organization representatives focused on facilitating clinical trials in this rare disease. To address the above gap in the field, members of the PWS-CTC "Behavior Outcomes Working Group" sought to develop a unified understanding of the key behavioral features in PWS and build a consensus regarding their definition and description. The primary focus of this paper is to present consensus definitions and descriptions of key phenotypic PWS behaviors including hyperphagia, temper outbursts, anxiety, obsessive-compulsive behaviors, rigidity, and social cognition deficits. Patient vignettes are provided to illustrate the interrelatedness and impact of these behaviors. We also review some available assessment tools as well as new instruments in development which may be useful in measuring these behavioral features in PWS.
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http://dx.doi.org/10.1186/s11689-021-09373-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215770PMC
June 2021

Behavioral features in Prader-Willi syndrome (PWS): consensus paper from the International PWS Clinical Trial Consortium.

J Neurodev Disord 2021 06 21;13(1):25. Epub 2021 Jun 21.

Centre for Applied Psychology, School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK.

Prader-Willi syndrome (PWS) is a rare neurodevelopmental genetic disorder associated with a characteristic behavioral phenotype that includes severe hyperphagia and a variety of other behavioral challenges such as temper outbursts and anxiety. These behaviors have a significant and dramatic impact on the daily functioning and quality of life for the person with PWS and their families. To date, effective therapies addressing these behavioral challenges have proven elusive, but several potential treatments are on the horizon. However, a limiting factor for treatment studies in PWS is the lack of consensus in the field regarding how to best define and measure the complex and interrelated behavioral features of this syndrome. The International PWS Clinical Trials Consortium (PWS-CTC, www.pwsctc.org ) includes expert PWS scientists, clinicians, and patient advocacy organization representatives focused on facilitating clinical trials in this rare disease. To address the above gap in the field, members of the PWS-CTC "Behavior Outcomes Working Group" sought to develop a unified understanding of the key behavioral features in PWS and build a consensus regarding their definition and description. The primary focus of this paper is to present consensus definitions and descriptions of key phenotypic PWS behaviors including hyperphagia, temper outbursts, anxiety, obsessive-compulsive behaviors, rigidity, and social cognition deficits. Patient vignettes are provided to illustrate the interrelatedness and impact of these behaviors. We also review some available assessment tools as well as new instruments in development which may be useful in measuring these behavioral features in PWS.
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http://dx.doi.org/10.1186/s11689-021-09373-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215770PMC
June 2021

Effect of Maxillary Posterior Space Discrepancy on the Molars and Overbite in Class II Malocclusions with Different Vertical Patterns.

J Contemp Dent Pract 2020 Apr 1;21(4):438-444. Epub 2020 Apr 1.

School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.

Aim: The purpose of this cross-sectional study was to investigate the influence of maxillary posterior space discrepancy (MPDD) on angulation and vertical position of molars in patients with skeletal class II malocclusions, presenting long, short, and normal vertical growth patterns.

Materials And Methods: In total, 120 lateral cephalograms of patients (mean age: 23 years) with skeletal class II malocclusion were evaluated. Patients were divided into six groups based on their vertical growth pattern (normal, long, and short faces) and the presence or absence of maxillary posterior discrepancy. Maxillary molars' sagittal angulation and vertical position were measured on cephalograms via Dolphin™ three-dimensional (3D) software (version 11.5). The comparison between groups with the same vertical dimension and different status of MPDD was done with independent test. The analysis of analysis (ANOVA) was used to make pairwise comparison between all six groups. Finally, a multiple regression analysis was performed to evaluate the influence of molar position and MPDD on the anterior overbite.

Results: The results showed that the angulation of the maxillary first molar was not statistically different between groups with the same vertical dimension but varied in terms of MPDD. The maxillary second molar was more distally inclined in patients with MPDD than those without MPDD with short and normal facial types ( value = 0.016 and value = 0.001, respectively). The second molar had significantly more distal angulation in long face patients than short and normal face participants, without considering the status of MPDD. The upper first and second molars were erupted more in patients with long than short or normal faces, without any influence of MPDD.

Conclusion: The presence of MPDD caused more distal inclination of the maxillary second molar, in skeletal class II patients with short and normal vertical growth patterns.

Clinical Significance: The status of MPDD and its effect on the maxillary second molar teeth should be considered in skeletal class II patients with short and normal vertical growth patterns.
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April 2020

Effect of mini-screw-facilitated micro-osteoperforation on the rate of orthodontic tooth movement: a single-center, split-mouth, randomized, controlled trial.

Prog Orthod 2020 Mar 9;21(1). Epub 2020 Mar 9.

Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Qom Abad, Ghasrodasht St, Shiraz, 713451836, Iran.

Objective: The present study aimed to evaluate the effect of MOP over a 3-month period and to determine the influence of the number of perforations on the rate of canine retraction. In addition, the amount of pain and discomfort caused by the MOP method was evaluated.

Trial Design: A single-center, split-mouth, triple-blind, randomized, controlled trial was conducted.

Methods: The clinical trial was conducted from December 2018 to July 2019 in the Orthodontic Clinic, Shiraz Dental School. Twenty-eight patients (range from16.3 to 35.2 years) who need fixed orthodontic treatment were recruited and randomly assigned to MOP1 and MOP2 groups. In each patient one side of the mouth worked as a control side which received no MOPs. Four months after first premolars extraction, patients in MOP1 group received 3 MOPs on the buccal surface of alveolar bone in the experimental side to accelerate canine retraction whereas patients in MOP2 group received 3 buccal MOPs and 3 palatal MOPs in the experimental side. The amount of canine retraction was measured every 28 days at three intervals on both sides of the mouth. Pain perception was also measured on the day of MOP procedure and subsequently at 24 h. Randomization was performed using online software RANDOM.ORG; the recruited patients were divided into two parallel groups with a 1:1 allocation ratio then the side of MOPs intervention in each subject was randomly determined with coin tossing. Triple blinding design was employed.

Results: The result of the intra-examiner reliability using ICC was 0.97 (P <  0.001), indicating excellent repeatability and reliability of the measurements. The baseline characteristics between the groups were similar (P > 0.05). There was a significant difference in the rate of canine retraction between the MOP groups and the contralateral control sides, as well as between the MOP1 and MOP2 groups (P <  0.05).

Conclusion: The MOP procedure was effective in accelerating orthodontic tooth movement, although the amount of acceleration was not clinically significant in the case of canine retraction. An increase in the number of MOPs resulted in a significant acceleration of the canine retraction.

Trial Registration: The trial was registered 30 November 2018 at the Iranian Registry of Clinical Trials (IRCT20181121041713N1).
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http://dx.doi.org/10.1186/s40510-020-00306-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061095PMC
March 2020

How Are Transgender and Gender Nonconforming Youth Affected by the News? A Qualitative Study.

J Adolesc Health 2020 04 18;66(4):478-483. Epub 2020 Jan 18.

University of Washington, Seattle, Washington; Division of Endocrinology, Seattle Children's Hospital, Seattle, Washington.

Purpose: News stories about transgender and gender nonconforming (TGNC) people have become more common in recent years and TGNC youth may be disparately affected by this information compared with their cisgender peers. The aim of this study was to understand how TGNC youth react to news stories about TGNC and other gender and sexual minority (GSM) identifying persons.

Methods: As part of a larger study, 23 TGNC youth were recruited from the Seattle Children's Gender Clinic to participate in a semistructured interview. Interviews were audio recorded, transcribed, and thematically analyzed.

Results: Participating youth ranged in age from 13 to 19 years (mean = 16.9 years). Of the 23 participants, 43% identified as having a transfeminine gender identity, 39% transmasculine, and 17% nonbinary/gender fluid. Four main themes were identified: (1) news coverage of current political climate affects gender transition; (2) negative news coverage of GSM people contributes to concerns about mental well-being and safety; (3) geographical location affects perception of news; and (4) positive news coverage of TGNC people increases visibility and hope.

Conclusions: Exposure to negative news about GSM people may contribute to increased levels of stress among TGNC youth. With increased visibility, participants described frustration associated with inaccurate portrayals of the TGNC community in the news; however, with increased visibility, there is also a growing sense of shared community and opportunity for acceptance of TGNC people. Given the scope of responses to negative and positive news on GSM people, TGNC youth may benefit from increased support to promote resilience when interpreting the news.
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http://dx.doi.org/10.1016/j.jadohealth.2019.11.304DOI Listing
April 2020

Evaluation of Smile Characteristics in Three Different Sagittal Malocclusions Before and After Nonextraction Orthodontic Treatment.

Contemp Clin Dent 2018 Oct-Dec;9(4):625-629

Department of Orthodontics, Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: To investigate the smile esthetics variables in three malocclusion classifications of angle to find out if the final smile esthetics was correlated with the initial types of malocclusion.

Materials And Methods: This cross-sectional study was performed on 90 adult patients (18-28 years old) with three classes of malocclusion ( = 30 for each class), who were just treated by an orthodontist based on standard edgewise (0.018 inch). A standardized smile mesh analysis was used to evaluate seven smile characteristics.

Results: Orthodontic treatment improved all the smile characteristics in the three groups. All groups showed an increase in smile width, smile index, and vertical indices; while, the transverse indices decreased. Significant increase was observed in four smile measurements in patients with Class II malocclusion. Comparing the smile characteristic changes among the three groups revealed that the changes induced by orthodontic treatment were significantly higher in patients with Class II malocclusion.

Conclusion: The smile esthetics in all the three types of malocclusion benefited from the orthodontic treatment; however, the changes were more significant in Class II malocclusions. None of the three malocclusion types showed significant difference between the pre- and post-treatment smile characteristics.
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http://dx.doi.org/10.4103/ccd.ccd_554_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868621PMC
November 2019

Gender Affirming Hormone Replacement for the Adolescent and Young Adult Cancer Survivor with Hypogonadism.

J Adolesc Young Adult Oncol 2020 02 3;9(1):128-131. Epub 2019 Oct 3.

Department of Endocrinology, Seattle Children's Hospital, Seattle, Washington.

Hypogonadism is a known late effect of cancer treatment. Hypogonadism requires replacement of sex steroids to ensure appropriate development of secondary sex characteristics, growth, and other beneficial health effects. We present a cancer survivor with hypogonadotropic hypogonadism and gender dysphoria. The patient received gender affirming care in our gender clinic with a multidisciplinary team that included an endocrinologist. This is not an isolated case at our institution. Survivorship oncologists must include a discussion about gender concurrently with conversations about survivors' development of puberty. Conversations should start early to ensure appropriate referrals and gender affirming hormone replacement.
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http://dx.doi.org/10.1089/jayao.2019.0070DOI Listing
February 2020

Efficacy and Safety of Real-Life Usage of MiniMed 670G Automode in Children with Type 1 Diabetes Less than 7 Years Old.

Diabetes Technol Ther 2019 08 5;21(8):448-451. Epub 2019 Jun 5.

Division of Endocrinology, Seattle Children's Hospital, Seattle, Washington.

The Medtronic MiniMed 670G system with SmartGuard™ (Medtronic, Northridge, CA) is a commercial hybrid closed-loop (HCL) system approved for use in 2018 for children >7 years. Studies of this HCL system in subjects >7 years old show improvement in glycemic control, but no study has described its use in younger children. This is a retrospective analysis of patients with type 1 diabetes (T1D) <7 years of age who used the 670G HCL system at Seattle Children's Hospital for 3 months. We compared 2-week data from Carelink™ while in manual mode (MM) with suspend before low active with those in auto mode (AM). We used two tailed -test to compare variables related to glycemic control. Sixteen children were reviewed [age of AM start: average 4.3 years (range 2-6); 10 male]. The average time in AM was 6.3 ± 2.9 months (range 3-12). There was a statistically significant change for A1c [MM 7.9% (62.8 mmol/mol), AM 7.4% (57.4 mmol/mol); -value <0.001], percentage time in range (MM 42.8%, AM 56.2%; -value <0.001), percentage hypoglycemia (MM 1.3%, AM 2.4%; -value 0.04), and average sensor glucose [MM 200 mg/dL (11.1 mmol/L), AM 176 mg/dL (9.8 mmol/L); -value <0.001]. No serious adverse reports noted. This case series showed improvement in glycemic control in very young children using the 670G HCL. We did note more hypoglycemia although no serious adverse events, such as hypoglycemic seizure, were reported. A HCL system can be used in young children with T1D safely and effectively and should be an option for children <7 years.
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http://dx.doi.org/10.1089/dia.2019.0123DOI Listing
August 2019

Youth and Parent Experiences in a Multidisciplinary Gender Clinic.

Transgend Health 2019 2;4(1):100-106. Epub 2019 Apr 2.

Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington.

To assess youth and parent/caregiver satisfaction with care at a pediatric multidisciplinary gender clinic. Transgender/gender nonconforming youth (=33) and their parent/caregiver (=29) completed self-report questionnaires and individual interviews (=20) about experiences and satisfaction with care. Quantitatively, participants reported being extremely satisfied with care experiences (parents 97%; youth 94%). Qualitatively, main themes included (1) affirmation due to use of preferred name/pronouns, (2) access barriers due to scheduling and readiness assessments, and (3) positive interactions with Care Navigator. Youth and parents/caregivers are highly satisfied with multidisciplinary, coordinated health care for transgender/gender nonconforming youth; however, some challenges remain.
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http://dx.doi.org/10.1089/trgh.2018.0046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447995PMC
April 2019

Influence of Age on Perception of Best Esthetical Profile.

J Dent (Shiraz) 2019 Mar;20(1):16-23

Dept. of Prosthodontic, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.

Statement Of The Problem: As an important determinant of social acceptability, facial attractiveness can be influenced by decisions of orthodontists through treatment. The perception of facial attractiveness is influenced by several factors.

Purpose: The purpose of this study was to determine the difference in perception of facial attractiveness among male and female raters in different age groups through comparison of silhouettes.

Materials And Method: 208 subjects (99 male, 109 female) aged between 18 to 70 years were assigned to three groups of young adults, middle-aged and senior and rated pre-designed silhouettes on a 7-level rating scale (1= the least esthetic, 7=the most esthetic). Two series of 7 silhouettes were prepared for men and women in which the mandible was protruded or retruded in 2-mm increments from the average. The evaluators were asked to grade the profiles separately for male and female. T-test and one-way ANOVA were used for the statistical analysis with α = 0.05.

Results: The first and third age groups, favored female profile 2 among class II profiles. However, the second age group preferred the average profile. Male class II profiles were rated exactly as female ones among the three age groups. The average female class III silhouette was preferred in all age groups. The first and second age group preferred the average male profile in male class III silhouettes. The oldest group however, preferred profile 2. For both sexes, the least acceptable profile in each set of silhouettes was the most protruded or retruded.

Conclusion: There were few differences in perception of facial attractiveness between different age groups. In all groups, even small mandibular protrusion was unacceptable and mild retrusion was considered attractive.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421325PMC
March 2019

A multidisciplinary approach to the clinical management of Prader-Willi syndrome.

Mol Genet Genomic Med 2019 03 29;7(3):e514. Epub 2019 Jan 29.

Pediatric Endocrinology, University of Florida, Gainesville, Florida.

Background: Prader-Willi syndrome (PWS) is a complex neuroendocrine disorder affecting approximately 1/15,000-1/30,000 people. Unmet medical needs of individuals with PWS make it a rare disease that models the importance of multidisciplinary approaches to care with collaboration between academic centers, medical homes, industry, and parent organizations. Multidisciplinary clinics support comprehensive, patient-centered care for individuals with complex genetic disorders and their families. Value comes from improved communication and focuses on quality family-centered care.

Methods: Interviews with medical professionals, scientists, managed care experts, parents, and individuals with PWS were conducted from July 1 to December 1, 2016. Review of the literature was used to provide support.

Results: Data are presented based on consensus from these interviews by specialty focusing on unique aspects of care, research, and management. We have also defined the Center of Excellence beyond the multidisciplinary clinic.

Conclusion: Establishment of clinics motivates collaboration to provide evidence-based new standards of care, increases the knowledge base including through randomized controlled trials, and offers an additional resource for the community. They have a role in global telemedicine, including to rural areas with few resources, and create opportunities for clinical work to inform basic and translational research. As a care team, we are currently charged with understanding the molecular basis of PWS beyond the known genetic cause; developing appropriate clinical outcome measures and biomarkers; bringing new therapies to change the natural history of disease; improving daily patient struggles, access to care, and caregiver burden; and decreasing healthcare load. Based on experience to date with a PWS multidisciplinary clinic, we propose a design for this approach and emphasize the development of "Centers of Excellence." We highlight the dearth of evidence for management approaches creating huge gaps in care practices as a means to illustrate the importance of the collaborative environment and translational approaches.
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http://dx.doi.org/10.1002/mgg3.514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6418440PMC
March 2019

Comparison of Aberrant Behavior Checklist profiles across Prader-Willi syndrome, Down syndrome, and autism spectrum disorder.

Am J Med Genet A 2018 12 21;176(12):2751-2759. Epub 2018 Dec 21.

Seattle Children's Hospital, Division of Psychiatry, University of Washington, Seattle, Washington.

Prader-Willi syndrome (PWS, OMIM # 176270) and Down syndrome (DS, OMIM #190685) are neurodevelopmental genetic disorders with higher rates of autism spectrum disorder (ASD). The Aberrant Behavior Checklist (ABC) is a caregiver rating scale that assesses maladaptive behaviors. Overlapping symptoms exist between PWS, DS, and ASD, including maladaptive behaviors. We aimed to evaluate ABC profiles between PWS, DS, and ASD alone (without known genetic syndrome). In addition, we hypothesized PWS and DS with a comorbid ASD positive screen or diagnosis would have similar ABC profiles to ASD alone. ABC data from the following cohorts were analyzed: PWS (Seattle Children's Hospital, n = 28, mean age = 12.8 ± 4.9 years; University of Florida, n = 35, mean age = 9.3 ± 7.1 years), DS (Johns Hopkins, n = 406, mean age = 8.1 ± 2.4 years), and ASD (University of Florida, n = 102, mean age = 10.8 ± 3.5 years). ASD alone had significantly higher ABC scores. Subgroups of PWS and DS with a comorbid ASD positive screen or diagnosis had similarities in scores with the ASD only group, with subscale patterns unique to each syndrome. The ABC indicated worse maladaptive behaviors in children with ASD, including those with genetic syndromes. Although more studies are needed to evaluate the utility and the accuracy of the ABC as a tool to screen for ASD in special populations, it may be a useful adjunct in screening those children with PWS or DS who need more in depth ASD evaluation.
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http://dx.doi.org/10.1002/ajmg.a.40665DOI Listing
December 2018

Long-term antimicrobial assessment of orthodontic brackets coated with nitrogen-doped titanium dioxide against Streptococcus mutans.

Prog Orthod 2018 Sep 17;19(1):35. Epub 2018 Sep 17.

, Shiraz, Iran.

Background: The antimicrobial properties of orthodontic wire and brackets with nitrogen-doped titanium dioxide (N-doped TiO2) coating have been studied in the past. However, the evaluation period had been short and limited to 30 days. The aim of the present study was to extend the evaluation period (up to 90 days) of assessing the long-term antimicrobial effects of stainless steel orthodontic brackets coated with nitrogen-doped titanium dioxide (N-doped TiO2).

Methods: A total of 40 stainless steel pre-adjusted premolar brackets were equally divided into two groups; namely the control group (n=20, uncoated brackets) and the experimental group (n=20, coated brackets). RF magnetron sputtering was used to apply a thin film of TiO2 on the bracket surface. The crystalline structure of the thin film was assessed using X-ray diffraction. The antimicrobial property of the brackets against Streptococcus mutans (S. mutans) was evaluated using the survival rate by colony-forming units (CFU) at four intervals: 24 hours (T0), 30 days (T1), 60 days (T2), and 90 days (T3). 2-way ANOVA Repeated Measures was used to compare the effects between the groups over the time.

Results: There was no significant interaction between group and time (p = 0.568). The orthodontic brackets coated with the N-doped TiO2 thin film showed a significant CFU reduction (37.71 ± 5.21, 37.81 ± 5.03, 37.98 ± 5.37, and 37.74 ± 5.21 at T0, T1, T2, and T3, respectively) compared to the uncoated brackets (400.91 ± 14.67, 401.58 ± 14.01, 400.31 ± 14.68, and 402.04 ± 13.98 at T0, T1, T2, and T3, respectively) through visible light (p < 0.001).

Conclusion: N-doped TiO2 coated orthodontic brackets showed strong antimicrobial property against S. mutans over a period of 90 days, which is effective in preventing enamel decalcification during orthodontic therapy.
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http://dx.doi.org/10.1186/s40510-018-0236-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139290PMC
September 2018

Comparison of the Bony Changes of TMJ in Patients With and Without TMD Complaints Using CBCT.

J Dent (Shiraz) 2018 Jun;19(2):142-149

Postgraduate Student of Orthodontics, Dept. of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Iran.

Statement Of The Problem: Temporomandibular joint disorders (TMD) may show a poor correlation between their clinical findings and radiological characteristics.

Purpose: The aim of this study was to assess the osseous alterations of temporomandibular joint (TMJ) in symptomatic and asymptomatic subjects by employing cone beam computed tomography (CBCT) images.

Materials And Method: In this study, CBCT images of 120 temporomandibular joints in 30 patients with TMJ disorder and 30 age- and sex-matched individuals without TMJ complaints were evaluated. Osteoarticular derangements of the joint were assessed by two experienced examiners. Data was statistically analyzed with SPSS software using chi-square test ( <0.05).

Results: Out of 120 CBCT images (60 in each group), at least one osseous change was observed in 90% and 86.7% joints in symptomatic and asymptomatic subjects, respectively. There were no significant differences between symptomatic and asymptomatic subjects regarding frequency of osteoarticular changes including flattening (73.3% vs. 75%), irregularity (36.7% vs. 48.3%), sclerosis (20% vs. 8.3%), cyst (3.3% vs. 3.3%), erosion (13.3% vs. 21.7%), hypoplasia (3.3% vs. 5%), ankylosis (1.7% vs. Zero), osteophyte (43.3% vs. 40%), decrease joint space (3.3% vs. 3.3%), and increase joint space (5% vs. 5%). (> 0.05).

Conclusion: By employing CBCT as a modern diagnostic imaging tool, findings of this study revealed that the frequency of various temporomandibular joint alterations on CBCT images is comparable in patients with and without TMD complaints, suggesting that some people with TMJ structural damage may not display clinical manifestations. Moreover, CBCT imaging might not be necessary for TMD patients and more attention should be given to clinical examination.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960734PMC
June 2018

Review of Current Care Models for Transgender Youth and Application to the Development of a Multidisciplinary Clinic - The Seattle Children's Hospital Experience.

Pediatr Endocrinol Rev 2018 Apr;15(4):280-290

Division of Adolescent Medicine, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.

Care of transgender and gender diverse youth is complex and requires a multidisciplinary approach. Many transgender patients and providers feel the limited availability of affirming, knowledgeable professionals is a barrier to obtaining care. Such care can be provided through a clinic with providers from different disciplines who are trained in the unique care of transgender youth. In this paper, we discuss the care guidelines for transgender youth and the unresolved challenges that need to be addressed during the development of a transgender clinic. We describe our experience at Seattle Children's Hospital in the development of a multidisciplinary Gender Clinic which incorporates the expertise of social work, mental health professionals, pediatric endocrinology, adolescent medicine, and bioethics. Other institutions may build from our experience, with the ultimate goal of further decreasing health disparities for young transgender patients.
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http://dx.doi.org/10.17458/per.vol15.2018.sdc.TransgenderYouthDOI Listing
April 2018

Rectal Picking Masquerading as Inflammatory Bowel Disease in Prader-Willi Syndrome.

J Pediatr Gastroenterol Nutr 2018 07;67(1):59-63

Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, MD.

Prader-Willi syndrome (PWS) is a genetic syndrome in which individuals have multisystem medical challenges. Gastroenterological difficulties in the syndrome include decreased vomiting, constipation, delayed gastric emptying, delayed colonic transit, dysphagia, increased choking, and increased risk of gastric dilation and rupture. In addition, self-injurious behavior such as rectal picking may be present and severe enough to lead to rectal ulceration and bleeding. Many patients have extensive gastroenterological workup and treatment before their ultimate diagnosis of severe rectal picking. We describe 4 new cases of rectal picking in individuals with PWS leading to rectal bleeding and ulceration as well as a review of the literature of prior cases of severe rectal picking in PWS and potential treatment options. It is important to recognize these cases early in order to prevent unnecessary treatments and implement appropriate behavioral interventions.
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http://dx.doi.org/10.1097/MPG.0000000000001937DOI Listing
July 2018

Silent aspiration in infants with Prader-Willi syndrome identified by videofluoroscopic swallow study.

Medicine (Baltimore) 2017 Dec;96(50):e9256

Division of Endocrine, Seattle Children's Hospital University of Washington School of Nursing, University of Washington Occupational Therapy Department, Seattle Children's Hospital Division of Rehabilitation Medicine, University of Washington Division of Developmental Medicine Division of Genetic Medicine Division of Pulmonary and Sleep Medicine Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.

Feeding intolerance in Prader-Willi syndrome (PWS) infants is well-recognized, but their swallow physiology is not well understood. Swallow dysfunction increases risks of respiratory compromise and choking, which have a high incidence in PWS. To investigate swallow pathology in PWS infants we undertook a retrospective review of videofluoroscopic swallow studies (VFSS) in infants with PWS seen at our institution. We hypothesize that VFSS will characterize swallow pathology suspected by clinical observation during a feeding evaluation and may help determine feeding safety in these infants.Retrospective review of 23 VFSS on 10 PWS infants (average age 9.7 ± 8.4 months; range 3 weeks-29 months). Logistic regression models evaluated associations between gender, genetic subtype, and growth hormone (GH) use on aspiration incidence. Polysomnographic (PSG) studies conducted on the same participant ±1 year from VFSS were examined to characterize respiratory abnormalities.There was a high rate of swallowing dysfunction (pharyngeal residue 71%, aspiration events 87%) and disordered sleep. All aspiration events were silent. There were no differences in rates of aspiration for gender, genetic subtype, or GH use.A high incidence of aspiration was identified indicating swallow dysfunction may frequently be present in infants with PWS. Comprehensive evaluation of feeding and swallowing is essential and requires a multidisciplinary approach. Providers should recognize risk factors for swallow dysfunction and consider a multidisciplinary approach to guide decision making and optimize feeding safety in PWS.
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http://dx.doi.org/10.1097/MD.0000000000009256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815776PMC
December 2017

Effects of MetAP2 inhibition on hyperphagia and body weight in Prader-Willi syndrome: A randomized, double-blind, placebo-controlled trial.

Diabetes Obes Metab 2017 12 13;19(12):1751-1761. Epub 2017 Jul 13.

Departments of Psychiatry, Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, Kansas.

Aims: There are no treatments for the extreme hyperphagia and obesity in Prader-Willi syndrome (PWS). The bestPWS clinical trial assessed the efficacy, safety and tolerability of the methionine aminopeptidase 2 (MetAP2) inhibitor, beloranib.

Materials And Methods: Participants with PWS (12-65 years old) were randomly assigned (1:1:1) to biweekly placebo, 1.8 mg beloranib or 2.4 mg beloranib injection for 26 weeks at 15 US sites. Co-primary endpoints were the changes in hyperphagia [measured by Hyperphagia Questionnaire for Clinical Trials (HQ-CT); possible score 0-36] and weight by intention-to-treat. ClinicalTrials.gov registration: NCT02179151.

Results: One-hundred and seven participants were included in the intention-to-treat analysis: placebo (n = 34); 1.8 mg beloranib (n = 36); or 2.4 mg beloranib (n = 37). Improvement (reduction) in HQ-CT total score was greater in the 1.8 mg (mean difference -6.3, 95% CI -9.6 to -3.0; P = .0003) and 2.4 mg beloranib groups (-7.0, 95% CI -10.5 to -3.6; P = .0001) vs placebo. Compared with placebo, weight change was greater with 1.8 mg (mean difference - 8.2%, 95% CI -10.8 to -5.6; P < .0001) and 2.4 mg beloranib (-9.5%, 95% CI -12.1 to -6.8; P < .0001). Injection site bruising was the most frequent adverse event with beloranib. Dosing was stopped early due to an imbalance in venous thrombotic events in beloranib-treated participants (2 fatal events of pulmonary embolism and 2 events of deep vein thrombosis) compared with placebo.

Conclusions: MetAP2 inhibition with beloranib produced statistically significant and clinically meaningful improvements in hyperphagia-related behaviours and weight loss in participants with PWS. Although investigation of beloranib has ceased, inhibition of MetAP2 is a novel mechanism for treating hyperphagia and obesity.
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http://dx.doi.org/10.1111/dom.13021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673540PMC
December 2017

False-Positive Total T3 Using the Ortho Vitros Immunoassay in Pediatric Populations.

J Appl Lab Med 2017 May;1(6):751-753

Department of Laboratories, Seattle Children's Hospital, Seattle, WA.

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http://dx.doi.org/10.1373/jalm.2016.022814DOI Listing
May 2017

Photogrammetric Comparison of Facial Soft Tissue Profile before and after Protraction Facemask Therapy in Class III Children (6-11 Years Old).

J Dent (Shiraz) 2017 Mar;18(1):7-16

Orthodontic Research Center, Dept. of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.

Statement Of The Problem: Achieving a normal soft tissue facial profile is considered to be the main concern of class III patients and the goal of most class III treatments.

Purpose: The purpose of this study was to investigate the effects of facemask treatment on profile with photogrammetric method.

Materials And Method: Before (T0) and after (T1) treatment photograms of 40 class III patients profiles (20 male and 20 female individuals) treated with protraction face mask that met the inclusion criteria were digitized and analyzed using Aesthetic Analyzer software. Selected linear and angular measurements were performed for each patient and the changes were noted.

Results: An increase in inferior facial height (< 0.001) and inferior facial angle (< 0.001) was observed. Nasal prominence and upper lip prominence also increased significantly (< 0.001). Advancement of sub nasal area was observed to be significant in females (< 0.05) in contrast to males.

Conclusion: Remarkable advancement in the middle face and consequent fullness in the soft-tissue profile can be achieved by using protraction face mask. The response to treatment is not different between males and females.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5338179PMC
March 2017

Effects of Orthokin, Sensikin and Persica mouth rinses on the force degradation of elastic chains and NiTi coil springs.

J Dent Res Dent Clin Dent Prospects 2016 15;10(2):99-105. Epub 2016 Jun 15.

Professor, Department of Orthodontics, Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Qom Abad Street, Shiraz, Iran.

Background. Elastomeric chains and NiTi coil springs are two major traction aids in orthodontic tooth movements. Force degradation occurs over time in both groups, with higher percentages in elastic chains. The effects of environmental factors and some mouth rinses on this force decay have been previously studied. No study has been performed to evaluate the effect of current popular mouth rinses such as Orthokin, Sensikin and Persica on this force degradation. Methods . Forty pieces of elastic chains consisting of 5 loops (Ortho Technology, USA) and 40 NiTi closed coil springs (3M Unitek, Germany) were divided into 4 groups: control (artificial saliva), Orthokin mouthwash, Sensikin mouthwash and Persica mouthwash. All the groups were kept in an incubator at 37°C for 3 weeks. In the test groups, the samples were immersed in mouthwash twice a day. Force degradation was measured at 5 time intervals: baseline, 1 hour, 24 hours, 1 week and 3 weeks, using a digital force gauge. Repeated-measures ANOVA and one-way ANOVA were used for statistical analysis. Results. Force decay occurred over time in both elastic chainand coil spring groups. In elastic chain group, after 3 weeks, Orthokin mouth rinse had significantly lower force degradation compared to other groups (P < 0.05) and in coil spring group there were no statistically significant differences in force degradation after 3 weeks between the subgroups (P > 0.05). Conclusion. Based the results of this study, these three mouthwashes did not increase the force degradation of orthodontic traction aids under study.
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http://dx.doi.org/10.15171/joddd.2016.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946005PMC
July 2016

Dynamic response of C-type natriuretic peptide and its aminoterminal propeptide (NTproCNP) to growth hormone treatment in children with short stature.

Clin Endocrinol (Oxf) 2016 Oct 16;85(4):561-8. Epub 2016 Jun 16.

Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA.

Objective: C-type natriuretic peptide (CNP) and its aminoterminal propeptide (NTproCNP) are potential biomarkers of recombinant human growth hormone (rhGH) efficacy. The objective of this study was to describe the pharmacodynamics of plasma CNP and NTproCNP levels in response to rhGH treatment and to identify the optimal time of sampling after starting rhGH.

Design: This was a prospective, observational study. Subjects were treated with rhGH for 1 year, with blood sampled at regular intervals.

Patients: Eighteen prepubertal children, eight with low levels of GH on biochemical testing and ten with idiopathic short stature, completed the study.

Measurements: Blood levels of CNP, NTproCNP, GH, insulin-like growth factor-I, leptin and bone-specific alkaline phosphatase were measured. Anthropometrics were obtained.

Results: Plasma levels of both CNP and NTproCNP reached peak levels 7-28 days after starting rhGH treatment and then declined to intermediate levels through the first year. Plasma NTproCNP levels after 14 days trended towards a correlation with height velocity after 6 and 12 months of treatment. Unexpectedly, serum GH levels measured 2 and 28 days after starting rhGH correlated strongly with height velocity after 6 and 12 months of treatment.

Conclusions: This study identified 14 days after starting rhGH treatment as the optimal time for assessing CNP and NTproCNP levels as biomarkers of rhGH efficacy. Additionally, we identified GH levels as a potential biomarker. Larger, prospective studies are now needed to test the clinical utility of these biomarkers.
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http://dx.doi.org/10.1111/cen.13103DOI Listing
October 2016

Evaluating Stress Distribution Pattern in Periodontal Ligament of Maxillary Incisors during Intrusion Assessed by the Finite Element Method.

J Dent (Shiraz) 2015 Dec;16(4):314-22

Orthodontist, Orthodontic Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Statement Of The Problem: The use of miniscrews has expedited the true maxillary incisor intrusion and has minimized untoward side effects such as labial tipping.

Purpose: The aim of this study was to assess the stress distribution in the periodontal ligament of maxillary incisors when addressed to different models of intrusion mechanics using miniscrews by employing finite element methods. The degree of relative and absolute intrusion of maxillary incisors in different conditions was also evaluated.

Materials And Method: Finite element model of maxillary central incisor to first premolar was generated by assembling images obtained from a three-dimensional model of maxillary dentition. Four different conditions of intrusion mechanics were simulated with different placement sites of miniscrews as well as different points of force application. In each model, 25-g force was applied to maxillary incisors via miniscrews.

Results: In all four models, increased stress values were identified in the apical region of lateral incisor. Proclination of maxillary incisors was also reported in all the four models. The minimum absolute intrusion was observed when the miniscrew was placed between the lateral incisor and canine and the force was applied at right angles to the archwire, which is very common in clinical practice.

Conclusion: From the results yield by this study, it seems that the apical region of lateral incisor is the most susceptible region to root resorption during anterior intrusion. When the minimum flaring of maxillary incisors is required in clinical situations, it is suggested to place the miniscrew halfway between the roots of lateral incisor and canine with the force applied to the archwire between central and lateral incisor. In order to achieve maximum absolute intrusion, it is advised to place miniscrew between the roots of central and lateral incisors with the force applied at a right angle to the archwire between these two teeth.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664028PMC
December 2015

Comparison of the effects of preemptive acetaminophen, ibuprofen, and meloxicam on pain after separator placement: a randomized clinical trial.

Prog Orthod 2015 14;16:34. Epub 2015 Oct 14.

Orthodontics Department, University of Washington, Seattle, WA, USA.

Background: This study aims to evaluate and compare the effect of pre-procedural administration of acetaminophen, ibuprofen, and meloxicam in reducing pain after separator placement.

Methods: Three hundred twenty-one patients who needed orthodontic treatment and aged above 15 were randomly assigned to one of the three study groups: group A: 650 mg acetaminophen, group B: 400 mg ibuprofen, and group C: 7.5 mg meloxicam. All subjects received a single dose of medication 1 h prior to separator placement. Using visual analog scale, patients recorded their pain perception during rest, fitting posterior teeth together, and chewing at time intervals of immediately, 2, 6, 24, and 48 h after separator placement.

Results: There was no significant difference between acetaminophen, ibuprofen, and meloxicam in post-separator placement pain control when administered 1 h before the procedure. In all the groups, at rest, pain level elevated after separator placement and reached its peak at 24 h and then subsided until 48 h. But during chewing and fitting of the posterior teeth, some of the groups reached a peak in pain at 48 h. No significant difference was found in pain experience between males and females.

Conclusions: Meloxicam can be used as an effective analgesic in orthodontic pain control considering it has less gastric side effects compared to the conventional nonsteroidal anti-inflammatory drugs.

Trial Registration: Iranian Registry of Clinical Trials, IRCT2015041821828N1.
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http://dx.doi.org/10.1186/s40510-015-0104-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605934PMC
December 2016

An Analytical Study on an Orthodontic Index: Index of Complexity, Outcome and Need (ICON).

J Dent (Shiraz) 2015 Sep;16(3):149-55

Shiraz Orthodontic Research Center, Dept. of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.

Statement Of The Problem: The validity of the Index of Complexity, Outcome and Need (ICON) which is an orthodontic index developed and introduced in 2000 should be studied in different ethnic groups.

Purpose: The aim of this study was to perform an analysis on the ICON and to verify whether this index is valid for assessing both the need and complexity of orthodontic treatment in Iran.

Materials And Method: Five orthodontists were asked to score pre-treatment diagnostic records of 100 patients with a uniform distribution of different types of malocclusions determined by Dental Health Component of the Index of Treatment Need. A calibrated examiner also assessed the need for orthodontic treatment and complexity of the cases based on the ICON index as well as the Index of Orthodontic Treatment Need (IOTN). 10 days later, 25% of the cases were re-scored by the panel of experts and the calibrated orthodontist.

Results: The weighted kappa revealed the inter-examiner reliability of the experts to be 0.63 and 0.51 for the need and complexity components, respectively. ROC curve was used to assess the validity of the index. A new cut-off point was adjusted at 35 in lieu of 43 as the suggested cut-off point. This cut-off point showed the highest level of sensitivity and specificity in our society for orthodontic treatment need (0.77 and 0.78, respectively), but it failed to define definite ranges for the complexity of treatment.

Conclusion: ICON is a valid index in assessing the need for treatment in Iran when the cut-off point is adjusted to 35. As for complexity of treatment, the index is not validated for our society. It seems that ICON is a well-suited substitute for the IOTN index.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554305PMC
September 2015

Obesity management in Prader-Willi syndrome.

Pediatr Endocrinol Rev 2015 Mar;12(3):297-307

Prader-Willi Syndrome (PWS) is one of the most common genetic causes of obesity. The phenotype of obesity in PWS is unique and characterized by hyperphagia, earlier meal initiation, delayed meal termination, reduced energy expenditure, abnormal gut hormone profiles, as well as irregular responses to food in areas of the brain associated with satiety and reward. Management of obesity is necessary to avoid major morbidity. The relentless food-seeking behavior associated with PWS such as stealing, hoarding food, eating inedibles, and lying about eating, can cause turmoil both inside and outside of the home. Management is challenging for both patients and caretakers, but at this time there are limited medical therapies available besides dietary restriction and behavior management. However, current research shows promise for discovery of additional treatment options for hyperphagia and obesity management in PWS.
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March 2015

Effect of low-level laser irradiation on the rate and short-term stability of rotational tooth movement in dogs.

Am J Orthod Dentofacial Orthop 2015 May;147(5):578-86

Orthodontist, Orthodontic Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Low-level laser therapy (LLLT) has many biostimulative effects such as acceleration of mesiodistal orthodontic tooth movement. However, its effects on the extent and short-term stability of rotational tooth movement have not been researched. The purpose of this study was to investigate the effect of low-level laser irradiation during rotational tooth movement on the rate of movement and the amount of relapse in dogs.

Methods: In this interventional study, fixed orthodontic appliances were used to rotate both mandibular lateral incisors in 8 dogs. Sixteen teeth were divided into 2 groups: the experimental group with LLLT during orthodontic force application, and a control group with orthodontic couple force application only. In the first group, the gallium-aluminum-arsenide diode laser (810 nm, 200 mw, 10 seconds, 2 J/session, 32 J/cm(2)/point) was emitted on 2 points at the buccal side of the roots on days 0, 1, 2, 3, 4, 7, 14, 21, and 28 during 4 weeks of movement, and the amount of relapse was then observed for 3 months. The extent of rotational movement was measured on dental casts, and the statistical analysis was carried out with t tests.

Results: There was no significant difference between the LLLT group and the control group on the amount of rotational tooth movement (P = 0.66). The mean percentages of relapse after 1 week, 1 month, and 3 months were 33.02%, 53.44%, and 60.64% in the LLLT group and 54.22%, 68.74%, and 73.92% in the control group, respectively. This demonstrates significant differences between these groups at all studied times (P ≤0.05). This difference was greatest in the first week and then decreased until the end of the third month. The greatest percentage of relapse in both groups was registered in the first week after tooth movement.

Conclusions: The total energy dose of the laser used in this study could not accelerate rotational tooth movement, but it did effectively reduce the relapse tendency in teeth rotated by orthodontic movements.
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http://dx.doi.org/10.1016/j.ajodo.2014.12.024DOI Listing
May 2015

Evaluating the Stability of Open Bite Treatments and Its Predictive Factors in the Retention Phase during Permanent Dentition.

J Dent (Shiraz) 2015 Mar;16(1):22-9

Post graduate Specialist in Orthodontics, Member of Orthodontic Research Center, Dept. of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.

Statement Of The Problem: Orthodontists often find challenges in treating the anterior open bite and maintaining the results.

Purpose: This retrospective study was aimed to evaluate the stability of corrected open bite in the retention phase during permanent dentition.

Materials And Method: A total number of 37 patients, including 20 males and 17 females, with the mean age of 18±2.1 years at the beginning of the treatment were studied after correction of the anterior open bite. Overbites of the patients were measured from their lateral cephalograms before (T1), at the end (T2) and at least 3 years after the end of the treatment in the presence of their fixed retainers (T3).The mean overbite changes and the number of patients with open bite, due to treatment relapse, at T3 were calculated. The relationship between the pre-treatment factors and the treatment relapse was assessed at T1 and T2. Also the effects of treatment methods, extraction and adjunctive use of removable appliances on the post-treatment relapse were evaluated.

Results: The mean overbite change during the post-treatment period was -0.46±0.7 mm and six patients (16.2%) had relapse in the follow-up recall. Cephalometric Jaraback index showed statistically significant, but weak correlation with overbite changes after the treatment (p= 0.035; r= -0.353). No significant difference was found between the extraction and non-extraction groups (p= 0.117) the use and the type of the removable appliances (p= 0.801).

Conclusion: Fixed retainers alone are insufficient for stabilizing the results of corrected open bite. The change of overbite in the retention phase could not be predicted from cephalometric measurements. Extraction and use of adjunctive removable appliance did not have any effect on the treatment relapse.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345110PMC
March 2015

Evaluation of the effects of enameloplasty and air abrasion on sealant micro-leakage.

J Dent (Tehran) 2014 Nov 30;11(6):639-43. Epub 2014 Nov 30.

Dentist.

Objective: Micro-leakage, one of the major reasons for recurrent decays, may lead to uncontrollable flow of liquids, pulp inflammation and peri-apical pathology. The purpose of this in vitro study was to evaluate micro-leakage of pit and fissure sealants after using three different pit and fissure preparation techniques: 1) acid etching, 2) fissure enameloplasty and acid etching, and 3) air abrasion and acid etching.

Materials And Methods: Sixty-nine extracted sound molars and premolars were randomly divided into three groups (23 samples in each group). Teeth were prepared using one of three occlusal surface treatments. Then the sealant was applied on the occlusal fissures of all teeth. The teeth were thermocycled and stored in normal saline. All teeth were sealed apically and coated with nail varnish and then were immersed in a 2% solution of methylen blue. Two buccolingual sections were made. The surfaces were scored 0 to 3 for the extent of micro-leakage using a stereomicroscope. Data were analyzed by Kruskal- wallis and Dunn procedure.

Results: Enameloplasty and acid etching were significantly different regarding micro-leakage (P= 0.016), but no significant difference in micro-leakage was observed between air abrasion and the other methods.

Conclusion: Enameloplasty followed by acid etching produced significantly less micro-leakage than the acid etching technique. Air abrasion acid etching was better than the acid etching technique in reducing micro-leakage too.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281185PMC
November 2014
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