Effects of cleft lip and palate on the development of permanent upper central incisors: a cone-beam computed tomography study.

OBJECTIVE: The aim of this study was to evaluate 1. the differences among the cleft sides of unilateral cleft lip and palate (UCLP) patients, non-cleft sides of the same UCLP patients and well matched control patients in the root development and position of permanent upper central incisors and 2. possible gender differences. MATERIALS AND METHODS: The study sample consisted of 40 patient (20 males and 20 females; mean age: 14.84±3.2 years) with non-syndromic UCLP patients, and 40 control patients (20 males and 20 females; mean age: 13.38±1.6 years). Cone-beam computed tomography (CBCT) images were taken off from all patients. All tomographs were obtained in supine position by using CBCT (NewTom 5G, QR, Verona, Italy). RESULTS: Significant smaller root volume of central incisor was observed on the cleft side than on the non-cleft side of UCLP patients (P < 0.05). No significant difference in the root development and position of the central incisors was found between the non-cleft side of the UCLP and the control group (P > 0.05). There were no statistically significant gender differences in any linear, angular, or volumetric measurements (P > 0.05). Only the root volume of the cleft side was smaller in females than in males (P < 0.05). CONCLUSIONS: In general, root volumes of central incisors on the cleft side were 12.15 per cent smaller than non-cleft side. Root development of the central incisor was much more influenced by the cleft in females than in males.

Facial soft-tissue thickness in patients affected by bilateral cleft lip and palate: a retrospective cone-beam computed tomography study.

INTRODUCTION: The purposes of this study were to evaluate the facial soft-tissue thicknesses and craniofacial morphologies of patients affected by bilateral cleft lip and palate (BCLP) and to compare the findings with a well-matched control group without any clefts using cone-beam computed tomography. METHODS: The study sample consisted of 40 retrospectively and randomly selected patients divided into 2 groups: a BCLP group (20 patients; mean age, 13.78 ± 3.20 years) and an age- and sex-matched control group without clefts (20 patients; mean age, 13.94 ± 2.52 years). Craniofacial and facial soft-tissue thickness measurements were made with cone-beam computed tomography. The Student t test and multiple linear regression analyses were performed for the statistical evaluations. RESULTS: The BCLP group had an increased SN-MP angle (P = 0.003), a decreased Co-A (P = 0.000), and retruded maxillary (P = 0.000) and mandibular (P = 0.026) incisors. In addition, patients affected by BCLP had statistically significantly decreased thickness measurements for the variables subnasale (P = 0.005) and labrale superior (P = 0.026) compared with the controls. The most predictive variables were found at U1-SN (r = 0.417, P = 0.004), IMPA (r = 0.368, P = 0.010), and ANB (r = -0.297, P = 0.031) for subnasale and U1-SN (r = 0.284, P = 0.038) for labrale superior. CONCLUSIONS: The BCLP group showed greater vertical growth, greater retrusion of the maxilla and the maxillary and mandibular incisors, and decreased subnasale and labrale superior thicknesses compared with the well-matched controls without clefts. These differences should be taken into account when planning orthodontic and orthognathic surgery treatment for those patients.

Condylar and ramal vertical asymmetry in adolescent patients with cleft lip and palate evaluated with cone-beam computed tomography.

INTRODUCTION: The aims of this study were to evaluate condylar and ramal mandibular vertical asymmetry in a patient group affected by unilateral (UCLP) and bilateral (BCLP) cleft lip and palate, and to compare the findings with a well-matched control group with normal occlusion. METHODS: The study groups included 20 UCLP patients (12 male, 8 female), 21 BCLP patients (12 male, 9 female), and a control group of 21 subjects with normal occlusion (10 male, 11 female). Measurements of condylar, ramal, and condylar plus ramal heights and asymmetry indexes were examined on cone-beam computed tomography images. One-way analysis of variance was used to determine potential statistical differences among the groups for condylar, ramal, and condylar plus ramal asymmetry index measurements. The post-hoc Tukey HSD test was used to determine individual differences. RESULTS: No investigated group showed a statistically significant sex difference for any asymmetry index (P >0.05). There was a statistically significant difference between the normal and cleft sides in the ramal height and ramal plus condylar height measurements in the UCLP group (P = 0.004 and P = 0.006, respectively). The Tukey HSD test showed a statistically significant difference between the UCLP and BCLP groups in terms of ramal asymmetry index values (P = 0.018). CONCLUSIONS: The ramal height and ramal plus condylar height measurements were significantly lower in the cleft side in the UCLP patients, and there was a statistically significant difference in ramal asymmetry index values between the patients affected by UCLP and BCLP.

Are there any differences in mandibular morphology of patients with bisphosphonate-related osteonecrosis of jaws?: a case-control study.

OBJECTIVES:: The aim of this study was to compare the morphological differences in the mandible between patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) and healthy individuals and to detect the correlation between these parameters on panoramic radiography and CBCT. METHODS:: The CBCT and panoramic images of patients with BRONJ (n = 32) and control groups (n = 32) were included in the study. All the comparisons were analyzed between the osteonecrosed and healthy sides of patients with BRONJ and control group. The panoramic radiographs were used to measure the values of the condyle angle, gonial angle, antegonial angle, antegonial depth, condylar height and ramal height. The mandibular cortical index (MCI) and bone quality index (BQI) were also examined on cross-sectional scans of CBCT images. RESULTS:: There were significant differences in the MCI (p = 0.014) and BQI (p = 0.021) between the left and right side of the BRONJ group and also between the osteonecrosed side of the BRONJ and control group (p < 0.0001). No significant difference was found in other comparisons. CONCLUSIONS:: The outcomes of the present study indicate that bisphosphonates influenced some internal morphological changes in the mandible. These changes may be a reason of BRONJ. But, these changes are not reflective of the measured values obtained using panoramic radiographs on the external morphology of the mandible.

Evaluation of mandibular transverse widths in patients affected by unilateral and bilateral cleft lip and palate using cone beam computed tomography.

OBJECTIVE: To evaluate the mandibular dental, alveolar, and skeletal transversal widths in patients affected by unilateral (UCLP) and bilateral (BCLP) cleft lip and palate and to compare the findings with a well-matched normal occlusion sample using cone beam computed tomography images. MATERIALS AND METHODS: The study sample consisted of 75 patients divided into three groups: the UCLP (29 patients; mean age: 15.40 ± 3.22 years), BCLP (18 patients; mean age: 15.54 ± 3.72 years), and normal occlusion (28 patients; mean age: 15.82 ± 2.11 years) groups. Mandibular dental (intercanine and -molar), alveolar (intercanine and -molar), and skeletal (bigonial width) transversal measurements were performed three-dimensionally and analyzed using the one-way variance analysis and post hoc Tukey tests. RESULTS: Patients affected by UCLP and BCLP had statistically significantly lower intercanine alveolar widths (P < .05 and P < .001, respectively) and larger intermolar (P < .001 and P < .05, respectively) and intermolar alveolar widths (P < .001) compared with the normal occlusion group. Furthermore, the patients affected by UCLP and BCLP had similar mandibular dental, alveolar, and skeletal transversal widths (P > .05). CONCLUSION: The UCLP and BCLP groups showed statistically significantly smaller values for intercanine alveolar widths and larger values for intermolar dental and alveolar widths compared with the normal occlusion group. This shows the importance of using individualized archwires according to the pretreatment arch widths of the patients affected by UCLP and/or BCLP.

Assessment of the soft tissue thickness at the lower anterior face in adult patients with different skeletal vertical patterns using cone-beam computed tomography.

OBJECTIVE: To evaluate and compare the soft tissue thickness values at the lower anterior face among adult patients with different vertical growth patterns using cone-beam computed tomography. MATERIAL AND METHODS: The study sample consisted of 105 adult patients (54 women and 51 men) with a normal sagittal skeletal pattern divided into three groups according to the vertical growth pattern: high-angle (women/men, 22/13; mean age, 24.54 ± 4.45 years), low-angle (women/men, 14/21; mean age, 24.62 ± 5.08 years), and normal-angle (women/men, 18/17; mean age, 24.22 ± 5.40 years) groups. The soft tissue thickness measurements at the lower anterior face in each group were done and analyzed using the one-way analysis of variance and Tukey tests. RESULTS: Soft tissue thickness values were the lowest in the high-angle group for both women and men. For women, the thickness values at the labrale superius, labrale inferius, and pogonion were found to be statistically significantly smaller in the high-angle group (11.49 ± 1.05 mm, 12.70 ± 1.92 mm, and 11.64 ± 2.65 mm, respectively) compared with the values in the normal-angle group (13.31 ± 2.01 mm, 15.08 ± 1.94 mm, and 14.69 ± 3.08 mm, respectively) (P < .05, P < .05, and P < .01, respectively). For men, however, no statistically significant differences were found among the vertical growth patterns (P > .05). CONCLUSION: Women had statistically significantly thinner thickness at the labrale superius, labrale inferius, and pogonion in the high-angle group compared with the normal-angle group.

Comparison of pharyngeal airway volume among different vertical skeletal patterns: a cone-beam computed tomography study.

OBJECTIVE: To test the null hypothesis that there are no significant differences in pharyngeal airway volumes among adult patients with different vertical skeletal patterns and a clinically normal sagittal skeletal pattern using cone-beam computed tomography (CBCT). MATERIAL AND METHODS: The study sample consisted of 100 adult patients (45 men and 55 women; mean age  =  24.0 ± 5.3 years) with a normal sagittal skeletal pattern divided into three groups according to the vertical skeletal patterns: high angle (32 patients: 15 women and 17 men), low angle (34 patients: 14 women and 20 men), and normal angle (34 patients: 16 women and 18 men) groups. Nasopharyngeal, oropharyngeal, and total airway volumes of patients in all vertical groups were calculated. Group differences were analyzed using one-way analysis of variance and post hoc Tukey tests. RESULTS: Nasopharyngeal airway volume in the high-angle group (mean  =  6067.9 ± 1693.9 mm(3)) was significantly lower than that of the low- and normal-angle groups (P < .01). Oropharyngeal airway volume was highest in the low-angle group (mean  =  15,957.6 ± 6817.2 mm(3)) and significantly decreased in the control (mean  =  11,826.1 ± 4831.9 mm(3); P  =  .008) and high angle (mean  =  10,869.1 ± 4084.1 mm(3); P  =  .001) groups. Total airway volume was highest in the low-angle group (mean  =  24,261.6 ± 8470.1 mm(3)) and lowest in the high-angle group (mean  =  16,937.0 ± 5027.4 mm(3); P < .001). CONCLUSION: The null hypothesis was rejected. Significant differences were found in pharyngeal airway volumes among different skeletal vertical patterns.

Effects of early unilateral mandibular first molar extraction on condylar and ramal vertical asymmetry.

OBJECTIVE: The objective of the following study is to investigate the mandibular vertical asymmetry in a group of patients with early unilateral mandibular first molar extractions. MATERIALS AND METHODS: Mandibular asymmetry index measurements (condylar, ramal and condylar-plus-ramal) were performed on the panoramic radiographs of a study group including 51 patients (mean age: 18.60 ± 1.11 years) and a control group of 51 patients (mean age: 18.53 ± 1.29 years). Group I included patients with a unilateral mandibular first molar extracted before the age of 12 years. Group II included patients with no extractions and had excellent Class I relationships, no missing teeth and slight or moderate anterior crowding. A paired t-test was used to determine possible statistically significant differences between the sides for the measurements. Student's t-test was used for the comparison of asymmetry index values between the groups and genders. RESULTS: No group showed statistically significant sex-or side-specific differences for posterior vertical height measurements. Condylar asymmetry index and ramal asymmetry index measurements were not statistically different between the groups, while condylar-plus-ramal asymmetry index (CRAI) measurements were statistically different between the groups (P = 0.019). CONCLUSIONS: A slight difference for CRAI value was found in patients with early unilateral mandibular first molar extractions.

Assessment of pharyngeal airway volume in adolescent patients affected by bilateral cleft lip and palate using cone beam computed tomography.

OBJECTIVE: To test the null hypothesis that there were no significant differences for pharyngeal airway volumes between the adolescent patients affected by bilateral cleft lip and palate (BCLP) and well-matched controls using cone beam computed tomography. MATERIALS AND METHODS: The study sample consisted of 16 patients (11 female and 5 male; mean [SD] age 14.1 [2.1] years) affected by BCLP and 16 patients (10 female and 6 male; mean [SD] age 13.4 [2.0] years) as age- and sex-matched control group. Craniofacial measurements and pharyngeal airway dimension, area, and volume measurements of patients in both groups were calculated and statistically examined using Student's t-test and multiple linear regression analyses. RESULTS: Statistically significant differences were found between the BCLP and control groups for SNB (P < .05), SN-GoGn (P < .05), Co-A (P < .05), PAS (P < .01), minAx (P < .01), and oropharyngeal airway volume (P < .05). The most predictive variables for oropharyngeal airway volume were found as PAS (r  =  .655 and P  =  .000) and minAx (r  =  .787 and P  =  .000). CONCLUSIONS: The null hypothesis was rejected. Oropharyngeal (P < .05) and total (P > .05) airway volumes were found to be less in the BCLP group, and thus the treatment choice in these patients should have positive effects on the pharyngeal airway.

Prevalence of bifid mandibular condyle in a Turkish population.

The aim of this study was to determine the frequency of bifid mandibular condyle (BMC) using panoramic radiographs supported by different radiographic techniques. A retrospective study was carried out by evaluating panoramic radiographs of 18,798 patients referred to the Department of Dentomaxillofacial Radiology. T-tests were used to compare the frequency of BMC between left and right sides and between female and male patients. In this study, 98 patients (0.52%) were found to have BMC. Of these patients, 51 (52%) were females and 47 (48%) were males. Of the 98 patients, 71 (72.4%) had unilateral and 27 (27.6%) had bilateral BMC. A total of 125 BMCs were found in 98 patients. No statistically significant differences were found between the right and left BMCs or between female and male patients (P > 0.05). Because symptoms associated with BMC are either absent or minimal, it is usually discovered as an incidental finding during routine radiographic examination. Different appearances of BMC can be seen on panoramic radiographs. The exact orientation of the condyles can only be determined using 3D imaging techniques. BMC may be a more frequent condition in the Turkish population.