Three-dimensional evaluation of treatment results of the Alt-RAMEC and facemask protocol in growing patients.

PURPOSE: The aim of this retrospective study was to evaluate the skeletal, dental, and soft tissue effects of the alternating rapid maxillary expansions and constrictions (Alt-RAMEC) protocol combined with a facemask in prepubertal patients. METHODS: The study group (mean age 9.74 ± 1.46 years) consisted of 20 patients with class III malocclusion characterized by maxillary retrognathism. They were treated with a facemask for 7 months following a 9­week Alt-RAMEC protocol. Cone-beam computed tomography (CBCT) records and three-dimensional (3D) photographs taken before (T0) and after the protraction and retention period (T1) were evaluated. The study group was compared with a well-matched control group of 16 untreated patients (mean age 9.44 ± 0.79 years) with the same malocclusion. The records for the control group included cephalometric radiographs and 3D photographs. RESULTS: In the study group, significant forward movements of A point (3.49 mm), nasal (2.91 mm) and zygomatic bones were achieved. Intermolar, internasal, and interzygomatic widths increased. Soft tissue points followed the hard tissue movements, apart from b and pog. In the control group, A (0.97 mm), B (1.69 mm), Pog, and b points presented forward movement. Significant differences were found regarding the forward movement of the maxilla between the groups. CONCLUSION: The Alt-RAMEC/facemask protocol was effective not only in the maxillary region but also in the midface.

Interdental distraction osteogenesis for the management of alveolar clefts: archwise distraction.

Bone grafting is a successful protocol for cleft repair but it is very challenging to close large gaps using local gingival tissue. In the last decade, interdental distraction osteogenesis has been introduced as a successful treatment protocol for repairing such large clefts. In this article a new method for closing the alveolar cleft is introduced and one case is presented. A tooth supported distractor which was specially designed to be inserted on to the main arch wire was used for the distraction. The aim was to distract the tooth segments through the curve of the dental arch and achieve complete closure of the gaps. The distractor introduced had several advantages: it is simple to apply, activate and remove; there is no need for a second operation; it is an outpatient procedure. In the case reported, a very large gap was successfully closed using this protocol whilst maintaining the ideal arch form and generating new bone behind the distracted segments.

Compatibility of mechanical and computerized axiographs: a pilot study.

STATEMENT OF PROBLEM: There is little known information comparing axiographic data obtained with a mechanical device and data obtained with a computerized device. However, long-term follow-up of patients may necessitate comparison of previously made mechanical axiographic data with records obtained through computer-aided axiography. PURPOSE: The purpose of this study was to compare measurements between mechanical and computerized axiographs in recording the rotational and translation movements of the mandible. MATERIAL AND METHODS: The study enrolled 31 subjects with no detectable clinical signs of temporomandibular disorders. A single operator obtained 3 separate axiographic tracings of right and left condylar paths for each subject, using repeated opening, closing, protrusive, and retrusive movements. Data were collected for both the mechanical (SAM Axiograph Axo 200), and the computerized axiographs (SAM Axiotron and Axo 500). Angular (degrees) and linear measurements (mm) for the mechanical axiograph were made from the tracings obtained on grid paper using a compass, ruler, and protractor. The computer performed the measurements for the computerized axiograph tracings. All parameters were compared statistically with a Wilcoxon signed rank test (alpha = .05). The same operator remeasured all mechanical axiographic tracings for 20 subjects 1 week later to evaluate measurement error. Chronbach's alpha was used as a measure of consistency between the 2 measurements. RESULTS: Mean opening and closing angles varied between 52.4 and 54.2 degrees, and mean protrusive, and retrusive angles varied between 50.1 and 54.9 degrees. Mean opening and closing distances varied between 11.4 and 12.3 mm, and mean protrusive and retrusive distances varied between 8.2 and 8.7 mm. Comparison with the Wilcoxon signed rank test showed no significant differences for any parameter tested. There were high and medium inter-item correlations between repeated measurements of the manual device when Chronbach's alpha was applied, but these results were not sufficient to prove consistency between 2 consecutive measurements. CONCLUSION: The results showed nonsignificant differences between the recordings of the mechanical and computerized axiographs tested. The authors hypothesize that minor differences may be attributed to hand-measuring errors for the tracings generated by the mechanical axiograph. This study is limited due to the impact of poor precision of the manual device on the study results when these recordings are compared to another instrument. Therefore, it is not possible to conclude that data from the manual and the computerized axiographs are compatible with each other.

Comparison of deep bite and open bite cases: normative data for condylar positions, paths and radiographic appearances.

To compare normal overbite, deep bite and open bite cases with clinically healthy temporomandibular joints (TMJ) regarding the difference between condylar positions in centric relation (CR) and habitual or centric occlusion (CO), condylar paths and radiographic findings of condylar appearance in order to establish normative data. Three study groups of normal overbite, deep bite and open bite cases consisted each of 30 subjects with no detectable clinical signs of temporomandibular disorder. The CR-CO differences and axiographic tracings were recorded using the School Artikulator of Mack (SAM) diagnostic system. Condylar shape was evaluated on panoramic radiographs. The CR-CO differences were greater in the vertical plane in open bite cases, and direction of movements from CR to CO showed great variability. Open bite cases had significantly shorter condylar paths. Radiographic findings exhibited that 23% of the total sample showed evidence of erosion and 83% evidence of flattening of condyles. The erosion rates were higher in the open bite group, but flattening was seen more often in the deep bite group. Results of this study showed that open bite cases show larger vertical CR-CO slides and, shorter protrusion paths than normal and deep overbite cases. The radiographic appearance of condyles in non-patients may also differ significantly according to vertical incisor guidance type. Deep bite cases demonstrated a higher incidence of condylar flattening. This study indicates that the clinician should be paying special attention to the TMJ status of open bite patients.

Condylar pathway changes following different treatment modalities.

The purpose of this investigation was to evaluate the effect of extraction and non-extraction approaches on the condylar pathways in subjects treated with fixed orthodontic appliances. The study was carried out on 70 patients (47 female, 23 male) who had undergone orthodontic treatment with fixed appliances. The mean age for the total group was 16.3 years (16.5 years for the females and 16 years for the males). Forty-seven patients were treated non-extraction and 23 with extractions. None of the patients had any temporomandibular joint (TMJ) problems before orthodontic treatment and all were treated with standard edgewise mechanics. The condylar pathway recordings were taken before and after treatment with an axiograph. The maximum opening capacity was measured and the right and left condylar pathways of each patient were recorded in protrusion and during opening movements. During treatment the left opening angle (LOA) only decreased significantly in the upper premolar extraction group. The left opening distance (LOD) decreased in all groups during treatment but was only statistically significant in the non-extraction and upper and lower extraction groups. In the small overjet group (OJ < or = 4 mm), the LOA, right opening distance (ROD) and LOD decreased significantly while there was no significant change in axiographic parameters in the large overjet group (OJ > 4 mm). In the latter group, overjet and overbite decreased while mouth opening (3 mm P < 0.05) significantly increased. These results indicate that there is no difference between the effect of different treatment protocols on the condylar pathways.

A histologic and histomorphometric evaluation of pulpal reactions following rapid palatal expansion.

The aim of this study was to investigate the effects of the heavy forces exerted by the rapid palatal expansion (RPE) appliance on the pulpal tissue of anchor premolar teeth and to evaluate these effects by histologic and histomorphometric methods. Materials consisted of 34 sound upper premolars, extractions of which were required as part of orthodontic treatment. Twenty-three teeth were extracted after RPE; the remaining 11 teeth, which had not undergone any orthodontic force, were taken as controls. After extraction, the teeth were prepared for histologic examination under light microscopy. Histomorphometric measurements were performed by using image analysis. The data gained were statistically evaluated by nonparametric tests. The null hypothesis was that there was no difference between pulpal tissues of control and test teeth with respect to different durations of RPE. Our results reveal that the null hypothesis was rejected. Of the parameters evaluated, vessel area and minimum and maximum vessel diameters showed significant differences among the groups. Especially the difference between the control and 3-month groups had marked statistical significance. In conclusion, forces applied by RPE appliances caused an adaptive vascular tissue response, as well as fibrotic changes, in the "affected" upper premolars.

Cephalometric evaluation of open bite treatment with NiTi arch wires and anterior elastics.

The aim of this study was to evaluate cephalometrically the effects of open bite treatment with NiTi arch wires and anterior elastics. The study group comprised of 17 patients who displayed a high angle skeletal pattern, along with an anterior open bite. After initial leveling, 0.016 x 0.022 inch upper accentuated-curve and lower reverse-curve arch wires were placed, with anterior elastics applied in the canine regions. Cephalometric assessment was carried out on lateral head films taken at the beginning of treatment and on average 2.8 months after open bite closure was obtained. The results of this study indicated that open bite closure had been achieved mainly by extrusion of the lower incisors and uprighting of the upper incisors. The functional occlusal plane was leveled by extrusion of lower premolars and uprighting of lower molars. Lateral cephalograms obtained from 10 patients who had been available after 1 year postretention were used to evaluate relapse changes. During the follow-up period, position of the upper and lower incisors and the inclination of the occlusal plane were maintained. However, extrusion of upper and lower molar teeth resulted in a reduction in overbite.

Fluoride release capacities of four different orthodontic adhesives.

The aim of this study was to evaluate the fluoride release capacities of four orthodontic light cured adhesives. Groups 1 and 2 were the composites, Transbond and Sequence; Groups 3 and 4 were the glass ionomer cements, Fuji Ortho LC and 3M. Ten disc shaped specimens were prepared from each adhesive, and placed into a 1 ml of distilled water at 37 degrees C. The measurements were taken every day for a week, then once a week till the end of the first month, and once in two weeks till the end of the third month. The total and daily released fluoride amount during the testing period was statistically analyzed. The difference between the composite and glass ionomer cements was obvious. All the groups were statistically different from each other (p < 0.001). When the daily fluoride release graphics were detected, a sudden decrease was seen for all the adhesives. The fluoride values of the composites decreased to almost zero after the second day. The glass ionomer cements showed a decrease, too, but, they remained at a high level.

Comparisons between cervical vertebrae and hand-wrist maturation for the assessment of skeletal maturity.

It was claimed that, skeletal maturity could be determined by using anatomical changes of the cervical vertebrae observed on the lateral cephalometric radiographs. In this method of assessment cervical vertebrae C2, C3, and C4 are observed and each patient is placed in a cervical vertebrae maturation index (CVMI). Fishman developed a system of hand-wrist skeletal maturation indicators (SMI), using four stages of bone maturation at six anatomic sites. The purpose of this study was to analyze associations between cervical vertebrae maturation index (CVMI) and skeletal maturation index (SMI). The second objective was to determine the reproducibility of the identifications on the lateral cephalograms and hand-wrist films. Lateral cephalometric and left hand-wrist radiographs of 180 untreated subjects (99 girls and 81 boys) aged from 8 to 18 years were obtained from the files of the Marmara University School of Dentistry, Department of Orthodontics. The results of this study indicated that cervical vertebrae maturation and hand-wrist skeletal maturation were significantly related.

Pulp reaction to a tri-cure resin-modified glass ionomer.

OBJECTIVE: This study evaluated the pulp response to a tri-cure resin-modified glass ionomer cement and compared this response to those elicited by a zinc oxide-eugenol cement and a silicate cement. Materials were placed in nonexposed class V cavity preparations on human teeth. STUDY DESIGN: Sixty premolars were selected in orthodontic patients in a voluntary group of teenagers. All cavities were prepared according to International Dental Federation specifications. Resin-modified glass ionomer and silicate applications were carried out according to the manufacturers' instructions. RESULT: All teeth were asymptomatic. Pulp responses to the resin-modified glass ionomer cement were slightly greater than to the zinc-oxide-eugenol cement. Bacterial staining attempts were inconclusive with regard to time intervals and pulp responses. No necrotic pulps were seen in any teeth. CONCLUSION: The tri-cure resin-modified glass ionomer cement elicited a slightly greater adverse pulp response than did the zinc-oxide-eugenol cement with respect to the healing process of the pulp.

Nickel-titanium coil springs and repelling magnets: a comparison of two different intra-oral molar distalization techniques.

The aim of this study was to compare two intra-oral molar distalization procedures, involving 15 cases with Class II molar relationships. Magnetic devices were applied to the upper right first molars in each case, while nickel-titanium coil springs were used against the upper left first molars, for a period of 3 months. Measurements were made from lateral cephalograms and from photocopies of models taken before and after the distalization procedure. Although upper molar distalization was achieved with ease in both techniques, nickel-titanium coil springs were found to be the more effective in terms of movement achieved.

Molar distalization with bimetric molar distalization arches.

The aim of this study was to observe the clinical and cephalometric effects of intra-oral distalization with the maxillary bimetric arches. 3 girls and 1 boy with a mean age of 13.5 years with Class II skeletal and dental relationship were selected. Care was taken to select patients having a normal vertical growth pattern. Lateral cephalograms were taken at the beginning and at the end of the distalization period, which was approximately 3 months. To observe the distal movement, a metal marker was attached to the distal end of the buccal tube of the first molar. On each lateral cephalometric radiograph a reference plane perpendicular to the occlusal plane and passing through the point Sella was drawn to assess the amount of distalization. Cephalometric measurements indicated that the upper molars moved approximately 3 mm distally and that the lower incisors were proclined.

Root resorption and pulpal changes due to intrusive force.

Intrusion has been regarded as a controversial topic in the literature. It is apparent from many studies that excessive forces applied in orthodontic treatment might lead to undesirable results such as circulatory disturbances, pulp degeneration, calcification and even necrosis. This study was performed to observe the reaction of pulp and roots following tooth intrusion. Material consisted of four first premolar teeth of two adult patients. One premolar of each patient was intruded orthodontically and the other premolars were taken as controls. The palatal roots of the experimental teeth were cut and examined in scanning electron microscope (SEM) and the pulps of the teeth were examined in transmission electron microscope (TEM). At SEM examination, root surfaces of intruded teeth showed resorption cavities of different diameters and depths. At TEM examination, vascular degeneration was the main change in the pulps of experimental teeth.

A comparison of two different rapid palatal expansion techniques from the point of root resorption.

The aim of this investigation is to compare Haas and Cast Cap Splint devices from the point of root resorption. The material comprised thirty-eight upper and twelve lower premolar teeth derived from nineteen patients who required RME and subsequent removal of the first premolars as part of their full banded orthodontic treatment. Root resorption and repair areas were observed on the buccal surfaces of premolars. Repair tissue was cellular cementum in both groups. There was no significant difference between these two techniques from the point of root resorption amount.

Bio-thermal Herbst application during the mixed dentition period.

As is well known Class II division 1 cases are the most common cases which may be treated by functional therapy. The best treatment time is the peak growth period for such cases which might coincide with mixed dentition usually. Removable functional appliances are used in cooperative patients successfully but they are not indicated in noncooperative and mouth-breathing patients. Biothermal Herbst appliance is such an appliance which may be used as a fixed appliance in the mixed dentition period. The aim of this study was to observe the clinical usage and the effectiveness of Biothermal Herbst appliance with four cases in mixed dentition. At the end of the treatment period, Class II skeletal and dental relationships were transformed to Class I, upper incisors uprighted in all cases and lower incisors proclined in whole except one case.

Cephalometric evaluation of Haas and Hyrax rapid maxillary appliances in the treatment of the skeletal maxillary transverse deficiency.

Two different rapid palatal expansion appliances were compared, using lateral cephalograms, anterio-posterior cephalograms and diagnostic models. The Haas appliance was used on ten patients and the Hyrax appliance on another ten. A difference in the effect of the two appliances was found only for the increase in intermolar distance. This difference could be the result of the different appliance design.

Cephalometric evaluation of the therapeutic effects of the Herbst appliance in the treatment of Class II. Div I. malocclusion.

The purpose of this investigation was to assess the therapeutic effects of the Herbst appliance cephalometrically. Twenty patients were chosen from our clinical intake. Care was taken to select patients who had Class II Div I malocclusion and horizontal growth pattern. Skeletal age was the main selection criterion. Patients in the peak growth period were chosen. A Herbst appliance was used on the first ten patients. The other ten patients served as controls. Standardized profile roentgenograms were taken initially and at the end of a six month observation period. The following results were obtained: 1. Normal occlusal conditions occurred. 2. The mandible was positioned anteriorly and lengthened due to the Herbst therapy. 3. The most significant effect on the maxilla was the decrease in the 1- SN angle and in overjet reduction.

Cephalometric evaluation of crib therapy for cases of mixed dentition (open bite).

The effect of crib therapy for the treatment of cases of open bite was investigated. Extrusion of the lower and upper incisors and intrusion of the lower first molars were the most significant effects of the appliance. Intrusion of the lower molars resulted in decreased lower facial height. These findings were considered to result from the posterior tongue posture. Thus, the clockwise pattern of the mandibular complex was changed to a counter-clockwise pattern.

[Herbst appliance and clinical treatment]. / Herbst apareyi ve klinik uygulamalari.

Functional appliances are very efficient devices in correcting the orthopedic malocclusions. In order to use such an appliance, active growth spurt is recommended. Herbst appliance is a device that doesn't need patient's cooperation. In this article we tried to explain the Herbst appliance and wanted to show 3 cases were treated by us.