Evaluation of Protraction Face-Mask Therapy on the Craniofacial and Upper Airway Morphology in Unilateral Cleft Lip and Palate.

INTRODUCTION: The aim of the authors' study was to evaluate the effects of protraction face-mask therapy on the craniofacial and upper airway morphology in patients with unilateral cleft lip and palate (UCLP). METHODS: Twenty-three growing UCLP patients (mean age: 8.3 + 2.4) were enrolled in the study group. Protraction face-mask in combination with Hyrax appliance was applied for the correction of anterior crossbite and maxillary insufficiency. Twenty-six patients with maxillary retrusion (mean age: 8.1 + 2.5) were evaluated as the control group. The pharyngeal airway morphology was assessed via the area measurements of upper airway structures on the lateral cephalometric radiographs. RESULTS: The upper airway morphology was similar compared with the control group subjects at the beginning of the treatment. The pharyngeal airway area was increased significantly following the maxillary expansion and protraction. Nasopharyngeal area increased and the oropharyngeal area decreased significantly. There was an increase in the sagittal and vertical dimensions after the protraction therapy. CONCLUSION: The pharyngeal morphology in both UCLP patients and control group patients was similarly improved with the protraction face-mask therapy.

Three-dimensional analyses of palatal morphology and its relation to upper airway area in obstructive sleep apnea.

OBJECTIVE: To evaluate the relationship between palatal morphology and pharyngeal airway morphology in patients who have obstructive sleep apnea (OSA) and compare with a nonsnoring and nonapneic control group. MATERIALS AND METHODS: Three-dimensional maxillary dental cast measurements from 25 OSA patients (6 women, 19 men) with a mean age of 41.5 (4.8) years, and 25 control group participants (14 women, 11 men) without any symptom of OSA with a mean age of 38.3 (3.7) were correlated with an analysis of pharyngeal area evaluated with lateral cephalograms. Intermolar and intercanine widths and palatal volumes were calculated on the dental casts, and the upper airway area measurements were performed on lateral cephalograms. RESULTS: OSA patients had smaller oropharyngeal volume and upper airway when compared with controls (P < .001). Palatal area measurements were significantly smaller in OSA (P < .001). OSA patients had significantly narrower maxilla with smaller intermolar and intercanine widths (P < .001). A positive correlation was found between the palatal morphology and pharyngeal dimensions. CONCLUSIONS: A significant correlation exists between palatal morphology and pharyngeal airway.

Comparison of temporary anchorage devices and transpalatal arch-mediated anchorage reinforcement during canine retraction.

OBJECTIVE: The purpose of this study was to compare the dental and skeletal effects of canine retraction using conventional anchorage reinforcement systems and comparing them with the usage of TADs. MATERIALS AND METHODS: The sample consisted of 50 patients having Class I malocclusions with bimaxillary protrusion indicated for first premolar extraction, and allocated into two groups. The first group consisted of 25 patients with a mean age of 18,7 years (min:14, max:22 years, 16 girls and 9 boys) that TADs were applied as an anchorage mechanic between attached gingiva of upper second premolar and first molar teeth. The second group consisted of 25 patients with a mean age of 19,4 years (min:15, max:23 years, 14 girls and 11 boys) that conventional molar anchorage with Transpalatal arch (TPA) was applied for the anchorage mechanics against canine retraction. RESULTS: The results showed that mean mesial movement and the tipping of the first molars in TAD group between T0 - T1 were insignificant (P > 0,05), however in the TPA group were significant (P<0,01). Vertical movement of the molars were not significant when two groups were compared (P>0,05). CONCLUSION: Although TPA is a useful appliance, it doesn't provide an effective anchorage control on anteroposterior movement maxillary first molar teeth concerning first premolar extraction treatment. TADs are more convenient to provide absolute anchorage during maxillary canine retraction in contrast to transpalatal arch.

Shear bond strength of brackets to demineralize enamel after different pretreatment methods.

OBJECTIVE: To compare the influence of demineralized and variously pretreated demineralized enamel on the shear bond strength of orthodontic brackets. MATERIALS AND METHODS: Sixty bovine enamel specimens were allocated to five groups (n  =  12). Specimens of group 1 were not demineralized and were not pretreated, but served as controls. The other specimens were demineralized to form artificial carious lesions. Samples from group 2 were only demineralized and were kept untreated in artificial saliva. The other samples were pretreated with highly concentrated fluoride preparations (group 3: Elmex Gelee, 1.23% F; group 4: Clinpro White Varnish, 2.23% F) or with an infiltrating resin (group 5: Icon). After respective pretreatments, brackets were adhesively fixed on all specimens with an adhesive system after etching with 35% phosphoric acid and application of a primer and bracket resin cement (Transbond XT). Bracket shear bond strength was evaluated with a universal testing machine. Statistical analysis was performed by one-way analysis of variance followed by a post-hoc Scheffé test. RESULTS: Shear bond strength in control group 1 was statistically significantly greater compared with that in all other groups. Application of the infiltrating resin Icon (group 5) as pretreatment resulted in statistically significantly greater bond strength as compared with pretreatments with fluoride compounds (groups 3 and 4) and treatment provided without pretreatment (group 2). Groups 2, 3, and 4 did not significantly differ from each other. CONCLUSION: Pretreatment with the infiltrating resin is a beneficial approach to increasing the shear bond strength of brackets to demineralized enamel.

Utilization of a modified bite guard for preventing traumatic macroglossia.

This clinical report describes the treatment of a patient having traumatic macroglossia due to schwannoma in the craniocervical region. Enlarged tongue or macroglossia may compromise vital functions of the patient. To avoid a chronic tongue bite trauma, a bite guard that was inspired from a habit breaker was fabricated. Tongue injury has significantly healed with the use of this appliance, and the patient was able to masticate without biting on his tongue.

Mandibular hypoplasia with curvilinear distraction.

Mandibular distraction with intraoral curvilinear distractor is an effective procedure for lengthening the mandibular corpus and ramus dimensions. Mandibular distractor is valuable for the treatment of hypoplastic mandible. The aim of this article was to describe the treatment of a patient with hypoplastic and severely retrognathic mandible resulting from isolated Pierre Robin sequence, by means of curvilinear distraction osteogenesis followed by fixed orthodontic treatment. As a result, the curvilinear path of distraction can form a new mandibular angle and bring the mandible significantly forward. Attention should be given for the stability of the treatment results.

Effects of nasoalveolar molding therapy on nasal and alveolar morphology in unilateral cleft lip and palate.

OBJECTIVE: The objective of this study was to evaluate the effects of presurgical nasoalveolar molding (PNAM) therapy on nasal and alveolar tissues in patients with unilateral cleft lip and palate. PATIENTS AND METHODS: Twenty-two patients with a mean age of 23 days, having complete unilateral cleft lip and palate, were included in this prospective study. After the impressions were taken of the palatal and nasolabial regions separately, the maxillary and nasal plaster models were scanned for linear, angular, and area measurements before and after PNAM therapy. The distances between the identified landmarks were measured in the maxillary casts, and the distance and area measurements were performed for the nasal casts with the specified software called Image J developed by the National Institutes of Health. All subjects have undergone PNAM therapy for 6 months. The nasal and maxillary casts are scanned, and the images were evaluated using the software Image J. The alveolar segments should be approximated, and the cleft width and alar base of the affected side after PNAM should be reduced, and the nostril area of the cleft side should be increased. The columella deviation should be decreased. RESULTS: The decrease of the cleft width, arch length, and alar base width on the cleft side and the deviation of the columella were significant, in addition to the significant increase of the arch circumference and nostril area on the affected side (P < 0.001). CONCLUSIONS: Presurgical nasoalveolar molding therapy is a significantly helpful treatment for patients with unilateral cleft lip and palate. The reduction in the alveolar cleft region and the nasal reshaping are favorable.

Effects of titanium plate fixation on mandibular growth in a rabbit model.

PURPOSE: The purpose of this study was to evaluate the effect of metallic rigid fixation of mandibular corpus fracture on mandibular growth in growing rabbits. MATERIALS AND METHODS: Thirteen 90-day-old white New Zealand rabbits weighing 2 to 2.6 kg were included in this study. Unilateral mandibular fractures were created in all of the animals and fixed with microplates and screws. Microplates that had been adapted for fixation of the left (experimental) side were also used as a template for the drilling procedure on the right (control) side of the mandible. The plate was then removed, and screws were inserted. Digital submentovertex radiographs of each animal were taken before the operation and 6 months after surgery. Cephalometric values were analyzed. The distance between the centers of the 2 screws on the right side of the mandible was measured with a caliper in all samples, and values were compared with measurements taken from the left (experimental) side of the mandible upon which the plates had been placed. RESULTS: The mean amount of mandibular growth was 4.38+/-2.43 mm on the right (control) side and 4.64+/-2.27 mm on the left (experimental) side. This difference was not statistically significant (P> .05). The distance between the 2 screws was 13.89+/-0.23 mm on the experimental side and 13.44+/-0.46 mm on the control side. This difference was statistically significant (P< .05). CONCLUSIONS: Metallic fixation of a mandibular body fracture did not cause mandibular asymmetry or restricted mandibular growth in growing rabbits in this relatively small sample.

Effect of acidulated phosphate fluoride and casein phosphopeptide-amorphous calcium phosphate application on shear bond strength of orthodontic brackets.

OBJECTIVE: To evaluate the effect of a recently introduced prophylactic agent, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), on shear bond strength of brackets and compare it with the effect of acidulated phosphate fluoride (APF). MATERIALS AND METHODS: Forty-eight freshly extracted mandibular bovine incisors were used. Teeth were randomly divided into four groups (n = 12) as follows: group 1 served as control, and no pretreatment was performed on the enamel; group 2, enamel was treated with 1.23% APF and CPP-ACP, respectively; group 3, enamel was treated with CPP-ACP; and group 4, enamel was treated with 1.23% APF for 4 minutes. In all groups, brackets were bonded using a conventional acid-etch and bond system (Transbond XT, 3M Unitek, Monrovia, Calif). Bonded specimens were first stored in deionized water at 37 degrees C for 24 hours, subjected to thermal cycling for 1000 cycles, and further stored in distilled water for 6 weeks before debonding procedures. After debonding, teeth and brackets were examined under a stereomicroscope at 10x magnification for any adhesive remaining, in accordance with the modified adhesive remnant index. RESULTS: The shear bond strengths of all experimental groups were significantly higher than that of the control group (P < .01). There was no significant difference between the shear bond strengths of the experimental groups (P > .05). CONCLUSION: The use of CPP-ACP either alone or combined with APF could be considered as an alternative prophylactic application in orthodontic practice since it did not compromise bracket bond strength.

Evaluation of the treatment changes of functional posterior crossbite in the mixed dentition.

INTRODUCTION: Functional posterior crossbite (FPXB) malocclusion is frequently seen in the deciduous or mixed dentition. It is often accompanied by lateral mandibular shift and mandibular midline deviation because of the reduction in the width of the maxillary dental arch. The aims of this prospective study were to examine in detail the morphologic, skeletal, dental, and functional effects of FPXB, and the effects of maxillary expansion treatment with quad-helix appliance. METHODS: The experimental group consisted of 35 FPXB patients (20 girls, 15 boys) having a mean age of 10.6 +/- 1.4 years; the control group consisted of 31 normocclusive subjects (18 girls, 13 boys) with a mean age of 9.8 +/- 1.6 years. Lateral, posteroanterior, and submentovertex cephalograms, transcranial temporomandibular joint radiographs, joint vibration analysis, and electromyographic recordings were obtained from every patient before and after maxillary expansion. Magnetic resonance images were taken before treatment for diagnostic purposes. These data were collected at 1 time point in the controls. RESULTS: The pretreatment posteroanterior, submentovertex, and transcranial temporomandibular joint radiographs showed mandibular asymmetry relative to the cranial base and condylar malpositioning in the glenoid fossa. Joint vibration analysis findings showed different vibrations between the crossbite and noncrossbite sides, and imbalanced electromyographic findings in the experimental group. After treatment, the asymmetric morphology and position of the mandible and condyles were eliminated, and the stomatognathic system functions were normalized. CONCLUSIONS: Early orthodontic treatment of FPXB creates optimum conditions for normal growth of the craniofacial skeleton and normal function of the stomatognathic system.

Kenny-Caffey Syndrome: oral findings and 4-year follow-up of overlay denture therapy.

Kenny-Caffey Syndrome (KCS) is an extremely rare osteosclerotic bone dysplasia associated with hypocalcemia and ocular abnormalities. Although the condition is well reported in the medical literature, dental manifestations have not been discussed in great detail. The purpose of this report is to present specific oral features and prosthetic management in a KCS patient. Overlay dentures were utilized in the management of low vertical dimension of occlusion, congenital absence of several permanent teeth, and problems associated with function and esthetics. Results of the 4-year follow-up overlay denture therapy are presented.

Repositioning of premaxilla in bilateral cleft lip and palate using a "J-hook headgear".

The purpose of this clinical approach is to present the successful treatment of the severely protruded and extruded premaxilla with high-pull J-hook headgear. Two patients with bilateral cleft lip and palate deformity and a protruding and extruding premaxilla causing a deep bite were treated with high-pull J-hook headgear and fixed orthodontic appliances. The lateral cephalometric measurements before and after orthodontic treatment were evaluated with Ricketts analysis. The premaxillae of the two patients were repositioned, correcting the deep overbite and overjet and a well-functioning occlusion was attained. The repositioning of an inferiorly positioned and protruded premaxilla with J-hook headgear is an alternative treatment approach compared to other treatment modalities.

Effect of self-etching primer and adhesive formulations on the shear bond strength of orthodontic brackets.

PURPOSE: Despite many published articles on the bond strength of self-etching primers and adhesives in the restorative dentistry literature, there have been relatively few laboratory studies of the bond strength of new orthodontic materials, and, in most of these published studies, investigators used various methodologic approaches during different stages of the in vitro testing procedures. The aim of this study was to compare the shear bond strength of 4 self-etching primer and adhesive formulations, a nonrinse conditioner and acetone adhesive system, and a conventional system. MATERIAL: The self-etching products tested were Prompt L-Pop (3M ESPE, Seefeld, Germany), Clearfil SE Bond (Kuraray Dental, Osaka, Japan), FL Bond (Shofu Dental, Kyoto, Japan), and One-Up Bond F (Tokuyama, Tokyo, Japan); the nonrinse conditioner and acetone-based adhesive system was NRC and Prime&Bond NT (Dentsply International, Konstanz, Germany); the conventional acid-etch and bond system was Transbond XT (3M Unitek, Monrovia, Calif). Brackets were bonded to intact bovine mandibular incisors (n = 7 per group) according to each manufacturer's recommendations. The specimens were first stored in deionized water at 37 degrees C for 24 hours and then subjected to thermal cycling in deionized water at 5 degrees C +/- 2 degrees C to 55 degrees C +/- 2 degrees C for 1000 cycles. To facilitate degradation of bonds, the specimens were further stored in distilled water for 6 weeks before debonding procedures. RESULTS: The shear bond strengths of the 5 experimental groups were all significantly lower (P < .05) than that of the control group (Prompt L-Pop, 1.72 +/- 0.13 MPa; Clearfil SE Bond, 1.75 +/- 0.19 MPa; FL Bond, 1.71 +/- 0.22 MPa; One-Up Bond F, 1.77 +/- 0.14 MPa; control, 10.5 +/- 0.86 MPa) but not different from one another (P > .05). CONCLUSIONS: The tested self-etching primer and adhesive systems produced bond strength values much lower than that of the control product. Clinically, these products might not be suitable for orthodontic bracket bonding in terms of the shear bond strength achieved after thermal cycling and water storage.

Condylar disc relationships and vibration energy in asymptomatic class I 9- to 12-year olds.

A proper diagnosis is the key to successful treatment. The purpose of this study was to evaluate the temporomandibular joints (TMJ) by means of lateral and anteroposterior cephalograms, transcranial temporomandibular radiographs, magnetic resonance imaging (MRI), and TMJ electrovibratography (EVG) in asymptomatic and orthodontically untreated Angle Class I subjects. The study sample comprised 31 (13 boys, 18 girls) asymptomatic Class I children with a mean age of 9.7 years. The lateral cephalometric findings revealed that the subjects were mesofacial with an Angle Class I skeletal relationship, and the anteroposterior cephalograms showed a symmetrical craniofacial skeleton. Transcranial TMJ radiographs showed that the TMJs on both sides were symmetrically positioned. The time-frequency distributions of sounds from both right and left TMJs showed a wide range, and the vibrations measured by EVG were considerable. The MRI revealed unilateral disc displacement with reduction in four of the 31 subjects (13%), bilateral disc displacement with reduction in three subjects (10%), and bilateral disc displacement without reduction in one subject (3%). The data confirm that a standardized clinical examination to determine the status of the joint is not an efficient tool. This study suggests that the clinical diagnosis should be supported by extensive TMJ evaluation techniques.