Abstract The recommendation for infants to sleep supine has decreased the incidence of sudden infant death syndrome by more than a half, but as another consequence, a dramatic rise has been observed in the incidence of acquired cranial asymmetry (deformational plagiocephaly, DP). According to recent data, almost half of otherwise healthy infants are affected by some degree of DP at 7 to 12 weeks of age, and especially in the USA and some Central European countries, major effort is put into treatment of severe DP. However, little is known of the prognosis of DP in the absence of intervention, and although primary preventive strategies are often recommended, a lack of evidence on the effectiveness of such measures persists. Furthermore, although 3D imaging is nowadays frequently used on infants with DP, no data is available on the accuracy of the measurements used to quantify cranial asymmetry. In the present study, the efficacy of a primary preventive program in reducing the incidence of DP was tested in a randomized, controlled trial. The course of DP in the absence of active treatment was studied throughout the first year of life, and factors impacting the prognosis of DP were investigated. The diagnostic accuracy of four 3D stereophotogrammetry-based measurements was also analyzed and compared, with a goal of determining their optimal cut-off values for DP. DP was less prevalent and less severe in the intervention group infants at the end of the RCT (3 months). The point prevalence of DP peaked at 3 months, whereafter spontaneous improvement in DP was seen throughout the follow-up period until 12 months of age. A preferential infant head position at 3 months was the strongest predictor of a subsequently unfavorable course of DP. Cranial asymmetry seen at birth was transient, and none of the older infants with torticollis had presented neck imbalance at birth, but rather appeared to develop the condition postnatally concomitantly with DP. Although all studied asymmetry-related measurements performed well regarding diagnostic accuracy, OCLR produced the most accurate classification of DP. In conclusion, primary preventive guidelines would likely aid in reducing the burden from both DP itself and associated healthcare costs, although substantial spontaneous improvement from DP can usually be expected. The cut-off values defined for the asymmetry-related measurements have clinical implication in both making the diagnosis of DP and determining the target outcomes for treatment. / Tiivistelmä Imeväisten nukuttaminen selällään on vähentänyt kätkytkuolemien määrää alle puoleen aiemmasta, mutta käytäntö on myös huomattavasti lisännyt asentoperäisen, ei-synostoottisen vinokalloisuuden esiintyvyyttä; tuoreen tutkimustiedon mukaan jopa lähes joka toisella imeväisellä on nähtävissä jonkinasteista asentovinokalloisuutta 7–12 viikon iässä. Etenkin USA:ssa ja muutamissa Keski-Euroopan maissa vaikea-asteista asentovinokalloisuutta hoidetaan aktiivisesti kypäräortoosein, mutta samanaikaisesti tietämys tilan luonnollisesta kulusta on vähäistä. Vaikka riskitekijöitä tunnetaan ja ehkäiseviä toimenpiteitä usein suositellaan, ei niiden tehosta ole juuri näyttöä. Nykyään 3D-pintakuvantamista käytetään usein vinokalloisten imeväisten seurannassa, mutta epäsymmetrian mittaamiseen käytettyjen muuttujien osuvuudesta ei ole tietoa. Tämän tutkimuksen tarkoituksena oli selvittää vastasyntyneiden vanhemmille annettavan vauvan käsittelyohjeistuksen vaikutusta asentovinokalloisuuden ilmaantuvuuteen satunnaistetussa, kontrolloidussa asetelmassa. Lisäksi pitkäaikaisseurannassa kartoitettiin asentovinokalloisuuden luonnollista kulkua ja ennusteeseen vaikuttavia tekijöitä suomalaisilla imeväisillä. Tutkimuksessa myös analysoitiin ja vertailtiin 3D-kuvista laskettavien epäsymmetriaa mittaavien muuttujien diagnostista osuvuutta. Käsittelyohjeita saaneiden lapsilla oli 3 kuukauden iässä merkittävästi vähemmän asentovinokalloisuutta ja kalloasymmetria oli lievempää kuin verrokkiryhmässä. Asentovinokalloisuuden esiintyvyys oli korkeimmillaan juuri 3 kuukauden iässä, jonka jälkeen merkittävää spontaania palautumista oli havaittavissa koko 12 kuukauden ikään jatkuneen seurannan ajan. Vastasyntyneillä nähty kalloasymmetria oli puolestaan ohimenevää, eikä myöskään vastasyntyneenä dokumentoitu kaulan liikerajoitus lisännyt myöhemmän vinokalloisuuden riskiä, vaan vinokalloisilla usein tavattava torticollis (kierokaula) näytti kehittyvän ensimmäisten elinviikkojen aikana yhdessä vinokalloisuuden kanssa. 3 kuukauden iässä havaittu imeväisen halu pitää päätään aina samaan suuntaan käännettynä oli yhteydessä kalloasymmetrian huonompaan spontaaniin palautumiseen. Tutkituista epäsymmetriaa mittaavista muuttujista OCLR erotteli vinokalloiset parhaiten. Yhteenvetona voidaan todeta, että ennaltaehkäisevä ohjeistus voisi vähentää vinokalloisuutta ja siitä aiheutuvia hoitokuluja kustannustehokkaasti, mutta vinokalloisuudelta on lupa odottaa myös merkittävää spontaania palautumista. Tutkimuksessa määritellyillä epäsymmetriaa mittaavien muuttujien raja-arvoilla on käyttöä sekä diagnostiikan että hoidon tavoitteiden määrittelemisen saroilla.

Indiana University-Purdue University Indianapolis (IUPUI) / Quantification of treatment outcomes (tooth displacement and bony changes) is the key to advance orthodontic research and improve clinical practices. Traditionally, treatment outcome were quantified by using two-dimensional (2D) cephalometric analysis. However, there are problems inherent in 2D analysis, such as tracing errors and inability to detect side-effects. Thus, a reliable three-dimensional (3D) image analysis method for treatment outcome quantification is of high interest. Systematic 3D image analysis methods were developed for digital dental cast models and Cone-Beam Computed Tomography (CBCT) models. A typical analysis procedure includes image reconstruction, landmarks identification, coordinate system setup, superimposition, and displacement or change calculation. The specified procedures for maxillary teeth displacements and anatomical landmarks movements were presented and validated. The validation results showed that these procedures were accurate and reliable enough for clinical applications. The 3D methods were first applied to a human canine retraction clinical study. The purposes of this study were to quantify canines and anchorage tooth movements, and to compare two commonly used canine retraction strategies, controlled tipping and translation. The canine results showed that (1) canine movements were linear with time; (2) the initial load system was not the only factor that controlled the canine movement pattern; and (3) control tipping was significantly faster than translation. The anchorage tooth results showed that (1) anchorage losses occurred even with transpalatal arch (TPA); (2) there was no significant difference in anchorage loss between the two treatment strategies; and (3) compared with removable TPA, fixed TPA appliance can significantly reduce the amount of anchorage loss in the mesial-distal direction. The second clinical application for the 3D methods was a mandibular growth clinical trial. The purposes of this study were to quantify skeletal landmark movements, and compare two widely used appliances, Herbst and MARA. The results showed that (1) the Herbst appliance caused mandibular forward movement with backward rotation; and (2) the treatment effects had no significant differences by using either Herbst or MARA appliances. The two clinical applications validated the methods developed in this study to quantify orthodontic treatment outcomes. They also demonstrated the benefits of using the 3D methods to quantify orthodontic treatment outcomes and to test fundamental hypotheses. These 3D methods can easily be extended to other clinical cases. This study will benefit orthodontic patients, clinicians and researchers.

O objetivo deste estudo foi avaliar a morfologia/crescimento craniofacial e a oclusão dentária em pacientes (ambos sexos), entre 4 e 10 anos e aumento adenoamigdaliano com e sem otite média secretora (OMS). Utilizou-se análise cefalométrica e modelos de estudo dentários. Não foram observadas diferenças significativas entre os grupos estudados, em relação às medidas lineares e angulares adotadas, exceto, a medida correspondente ao comprimento do palato ósseo (ENA-ENP), que mostrou relação com a idade e a OMS. Não houve um tipo facial predominante. Observou-se discreta predominância de mordida profunda, mordida cruzada posterior e desvio da linha média em relação à OMS, porém sem significância estatística. A atresia maxilar pode estar associada à OMS, assim como sua redução pode estar relacionada ao crescimento e desenvolvimento craniofacial / The aim of this study was to evaluate the craniofacial growth/morphology and dental occlusion in 100 patients (male and female) from 4 to 10 years old and tonsils and adenoid enlargement. There were two groups: with and without otitis media with effusion (OME). We used the cephalometric analyses and dental casts. It was not observed significant differences between the two groups, in relationship to the linear and angular measurements adopted, except for the measurement corresponding to the palate bone length, which had shown correlation with age and OME. It was not found a facial pattern predominance. It was observed a discreet predominance of deep bite, posterior cross bite and midline deviation to OME, however without statistical significance. The maxillary narrowing might be associated to OME as well as its reduction may be related to the craniofacial growth and development

O objetivo deste estudo foi avaliar a morfologia/crescimento craniofacial e a oclusão dentária em pacientes (ambos sexos), entre 4 e 10 anos e aumento adenoamigdaliano com e sem otite média secretora (OMS). Utilizou-se análise cefalométrica e modelos de estudo dentários. Não foram observadas diferenças significativas entre os grupos estudados, em relação às medidas lineares e angulares adotadas, exceto, a medida correspondente ao comprimento do palato ósseo (ENA-ENP), que mostrou relação com a idade e a OMS. Não houve um tipo facial predominante. Observou-se discreta predominância de mordida profunda, mordida cruzada posterior e desvio da linha média em relação à OMS, porém sem significância estatística. A atresia maxilar pode estar associada à OMS, assim como sua redução pode estar relacionada ao crescimento e desenvolvimento craniofacial / The aim of this study was to evaluate the craniofacial growth/morphology and dental occlusion in 100 patients (male and female) from 4 to 10 years old and tonsils and adenoid enlargement. There were two groups: with and without otitis media with effusion (OME). We used the cephalometric analyses and dental casts. It was not observed significant differences between the two groups, in relationship to the linear and angular measurements adopted, except for the measurement corresponding to the palate bone length, which had shown correlation with age and OME. It was not found a facial pattern predominance. It was observed a discreet predominance of deep bite, posterior cross bite and midline deviation to OME, however without statistical significance. The maxillary narrowing might be associated to OME as well as its reduction may be related to the craniofacial growth and development