Many disorders present with characteristic abnormalities of the craniofacial complex. Precise descriptions of how and when these abnormalities emerge and change during childhood and adolescence can inform our understanding of their underlying pathology and facilitate diagnosis from craniofacial shape. In this paper we develop a framework for analysing how anatomical differences between populations emerge and change over time, and for binary group classification that adapts to the age of each participant. As a proxy for a disease-control comparison we use a database of 3D photographs of normally developing boys and girls to examine emerging sex-differences. Essentially we define 3D craniofacial ‘growth curves’ for each sex. Differences in the forehead, upper lip, chin and nose emerge primarily from different growth rates between the groups, whereas differences in the buccal region involve different growth directions. Differences in the forehead, buccal region and chin are evident before puberty, challenging the view that sex differences result from pubertal hormone levels. Classification accuracy was best for older children. This paper represents a significant methodological advance for the study of facial differences between growing populations and comprehensively describes developing craniofacial sex differences.

PURPOSE Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent but morbid and potentially serious condition associated with antiresorptive and antiangiogenic therapies. Although MRONJ can be prevented by optimizing oral health, management of established cases is supportive and remains challenging. Teriparatide, an osteoanabolic agent that improves bone healing in preclinical studies and in chronic periodontitis, represents a potential treatment option. PATIENTS AND METHODS In a double-blind, randomized, controlled trial, 34 participants with established MRONJ, with a total of 47 distinct MRONJ lesions, were allocated to either 8 weeks of subcutaneous teriparatide (20 µg/day) or placebo injections, in addition to calcium and vitamin D supplementation and standard clinical care. Participants were observed for 12 months, with primary outcomes that included the clinical and radiologic resolution of MRONJ lesions. Secondary outcomes included osteoblastic responses as measured biochemically and radiologically and changes in quality of life. RESULTS Teriparatide was associated with a greater rate of resolution of MRONJ lesions (odds ratio [OR], 0.15 v 0.40; P = .013), and 45.4% of lesions resolved by 52 weeks compared with 33.3% in the placebo group. Teriparatide was also associated with reduced bony defects at week 52 (OR, 8.1; P = .017). The incidence of adverse events was balanced between groups, including nausea, anorexia, and musculoskeletal pain, most of mild severity. CONCLUSION Teriparatide improves the rate of resolution of MRONJ lesions and represents an efficacious and safe treatment for it.

The present study investigates how sexual dimorphism in the human mandible develops in three-dimensionally during adolescence. A cross-sectional sample of mandibular meshes of 268 males and 386 females, aged between 8.5 and 19.5 years of age, were derived from cone beam computed tomography and were analysed using geometric morphometric methods. Growth trajectories of the mandible in males and females were modelled separately using a recently developed non-linear kernel regression framework. Growth rate and direction at a dense array of points all over the mandibular surface were visualized within each group and compared between groups. We found that mandibular sexual dimorphism already exists at 9 years of age, but this is mostly in size not in shape. The differential growth rate and duration between the sexes during pubertal growth largely explained by adult sexual dimorphism: the growth direction in both males and females is similar but the male mandible changed more quickly and over a longer period than the female mandible, where the growth rate peaked and declined earlier. This results in increasing dimorphism in form, which is evident in both size and shape. The development of dimorphic features, concentrated in the chin and ramus, were further visualized. The dense morphometric approach provides detailed three-dimensional quantitative assessment of the development of sexual dimorphism of the mandible.

No abstract