Effect of 2 elastomeric ligatures on microbial flora and periodontal status in orthodontic patients.

INTRODUCTION: The aim of this study was to compare the effects of a nonconventional elastomeric ligature (Slide; Leone, Florence, Italy) with those of a conventional elastomeric ligature (Ormco, Orange, Calif) on microbial flora and periodontal status in orthodontic patients. METHODS: A total of 13 orthodontic patients scheduled for fixed orthodontic treatment were selected for this study. The use of Slide and conventional elastomeric ligatures in fixed orthodontic appliances was tested. Microbial and periodontal records were obtained before bonding and 1 and 5 weeks after bonding. For the statistical analysis and calculations, SPSS software (version 15.0; SPSS, Chicago, Ill) was used. In the statistical decisions, P <0.05 values were accepted as significantly different. RESULTS: No significant differences between Slide and conventional elastomeric ligatures were evident at 1 week or 5 weeks after bonding, with regard to gingival index, plaque index, gingival bleeding index, or pocket depth scores (P >0.05). Similarly, aerobic and anaerobic bacteria counts did not differ significantly on the surface or on the elastics (P >0.05). CONCLUSIONS: Although the Slide ligatures cover the total surface of the bracket, they do not cause significantly more plaque accumulation or periodontal problems than do the conventional elastomeric ligatures.

A modified feeding plate for a newborn with cleft palate.

Objectives : Cleft palate is a common congenital maxillofacial defect. We wish to present the fabrication of a modified feeding plate that will adapt to the changing palatal and velopharyngeal morphology during function. Case Report : A neonate with unilateral cleft lip and palate was referred to our clinic for the fabrication of a feeding plate. Intraoral examination revealed a cleft involving the uvula and the soft palate, with an alveolar defect on the left side. An impression was taken and a dental cast was obtained. A 1-mm Bioplast clear soft plate was pressed on the model. After trimming the edges of the plate, several retentive holes were made for its attachment to the hard plate. With the Bioplast soft plate replaced on the cast, plaster was used to cover parts of the soft plate that were not to come in contact with the hard plate. Biocryl resin was put on the retentive holes and 2-mm Biocryl C Rosa-transparent plate was pressed. The edges of the plate were cut, trimmed, and polished. Conclusion : This modified feeding plate effectively obstructed the soft palate defect. The adaptation of the flexible bulb of the appliance with the soft palate was excellent. Evaluation with nasoendoscopy revealed the synchronized movement of the bulb of the appliance with the soft palate during swallowing. Soft extension of the feeding plate eliminated the risk of irritation, and the baby accepted the appliance easily.

Orthognathic surgery of a patient with oligodontia: alternative technique for intermaxillary fixation.

Oligodontia may cause various problems during orthognathic surgery because it may be difficult to fix the surgical guide splints. The aim of this clinical report was to present an alternative technique for intermaxillary fixation of a patient with oligodontia and facial deformity. A 20-year-old male patient, whose 8 maxillary and 11 mandibular teeth were congenitally missing, was treated using bimaxillary orthognathic surgery. Before the surgical approach, fixed mandibular prosthesis containing pins on the vestibule sides of the crowns was constructed to provide anchorage for intermaxillary splint and to achieve occlusal stability and vertical dimension during the surgery. This prosthesis was also used to hang intraoral elastics during the postoperative orthodontic treatment. At the end of treatment, these pins were cut, composite restoration material was applied to camouflage the places of the pins, and the patient continued to use this prosthesis. The patient gained an appropriate facial aesthetics and oral function using multidisciplinary approach.

Orthognathic surgical planning on three-dimensional stereolithographic biomodel.

The aim of this report was to present the orthognathic surgical planning of a patient with maxillary retrusion, mandibular prognathism, and midline shift on a three-dimensional stereolithographic biomodel. A patient who complained about facial deformity and difficulty in chewing was referred to our department. After a short-term presurgical orthodontic treatment, Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were performed. Triangular axial gaps occurred anteriorly and posteriorly between the proximal and distal segments of the osteotomized mandible. These gaps were filled with bone grafts in accordance with templates that were constructed on a three-dimensional stereolithographic biomodel. Rotational movement of the distal mandibular segment around the y axis caused axial triangular gapping between the proximal and distal mandibular segments. In the presented case, orthognathic surgical planning was performed on the three-dimensional solid models, and templates were reconstructed according to these gaps. These templates were used to determine the size of the bone grafts during the surgical approach. The patient was diagnosed with lateral cephalometric and posteroanterior cephalometric analysis in postretention for 2 years, and it was determined that long-term results were perfect and skeletal relapse did not occur after 2.5 years of surgery. Movement at the site of the osteotomy is usually the main cause of relapse after orthognathic surgery. In the presented case, a three-dimensional stereolithographic biomodel was used to plan the orthognathic surgery and to reconstruct the templates to determine the size and shape of the bone grafts. Using bone grafts established close contact between proximal and distal osteotomized bone segments, enhanced bone healing, and diminished relapse risk.

Tongue movements in patients with skeletal Class III malocclusions evaluated with real-time balanced turbo field echo cine magnetic resonance imaging.

INTRODUCTION: The aim of this study was to evaluate the position and movements of the tongue in patients with skeletal Class III malocclusion. METHODS: Sixty-six patients (31 male, 35 female) with Class III malocclusion were divided into 3 groups according to cephalometric analysis. The first group comprised 23 patients (13 male, 10 female) with mandibular prognathism, the second group comprised 21 patients (9 male, 12 female) with maxillary retrognathism, and the third group comprised 22 patients (9 male, 13 female) with both maxillary retrognathism and mandibular prognathism. Twenty-two skeletal Class I patients (10 male, 12 female) were also included as the control group. RESULTS: Dentofacial morphology affects the position and the movements of the tongue during deglutition. Contact of the anterior portion of the tongue with the rugae area of the hard palate decreased in the Class III malocclusion groups. The posterior portion of the dorsal tongue was positioned more inferiorly, and the root of the tongue was positioned more inferiorly and anteriorly in patients with Class III malocclusion than in the control group. The tip of the tongue was also in a more anterior position in the Class III groups. When the deglutition stages were evaluated, we observed that the manner of bolus transfer was different in patients with skeletal Class III malocclusion than in those with skeletal Class I malocclusion. CONCLUSIONS: Tongue posture is affected by dentofacial structures, and adaptive changes occur in the tip, dorsum, and root of the tongue. Deglutitive tongue movements in patients with skeletal Class III malocclusion are also different from those with skeletal Class I malocclusion.

Tongue movements in patients with skeletal Class II malocclusion evaluated with real-time balanced turbo field echo cine magnetic resonance imaging.

INTRODUCTION: The aim of this study was to evaluate the deglutitive tongue movements in patients with skeletal Class II malocclusion. METHODS: Fifty-nine patients (26 male, 33 female) with skeletal Class II relationship were divided into 3 groups according to cephalometric analysis. Group 1 (n = 19) had mandibular retrognathism, group 2 (n = 20) had maxillary prognathism, and group 3 (n = 20) had both mandibular retrognathism and maxillary prognathism. Twenty-two skeletal Class I patients (10 male, 12 female) were also included as the controls. RESULTS: In the mandibular retrusion group, the posterior portion of the dorsal tongue moved downward at stage 2 and upward at stage 3; the root of the dorsal tongue was in an inferior and anterior position at stage 2. In patients with both mandibular retrognathism and maxillary prognathism, the middle portion of the dorsal tongue was positioned superiorly at stage 3 relative to stage 1; the tongue tip was retruded at stage 3 relative to stages 1 and 2. In the control group, the middle portion of dorsal tongue was positioned superiorly at stage 3 relative to stages 1 and 2; the posterior portion of the tongue moved upward at stage 2 and downward at stage 3, and tongue-tip retrusion was observed at stage 2 relative to stage 1. Contact of the anterior portion of the tongue with the rugae area of the hard palate decreased in the Class II malocclusion groups relative to the control group. The middle portion of the dorsal tongue was positioned more superiorly in patients with Class II malocclusion during all stages of deglutition. The root of the tongue was more inferior and anterior, and the tongue tip was retruded in patients with Class II malocclusion compared with the control group. The posterior portion of the dorsal tongue was more inferiorly positioned in patients with mandibular retrusion than in the other Class II groups or the controls. In the third stage of deglutition, this portion of the tongue had a superior position in groups 2 and 3 relative to the control group. CONCLUSIONS: Dentofacial morphology affects the position and movements of the tongue during deglutition, and adaptive changes occur in the tip, dorsum, and root of the tongue. Deglutitive tongue movements in patients with a skeletal Class II relationship are different from those with a skeletal Class I relationship.

Volumetric Evaluation of Pharyngeal Airway after Functional Therapy.

The aim of this study was to evaluate three-dimensional (3D) effects of Twin-block functional appliance (TB) on the pharyngeal airway by using cone beam computed tomography (CBCT). A total of 30 patients (14 females, 16 males; mean age 12.50 ± 1.23 and 12.83 ± 1.17 years, respectively) with skeletal Class II malocclusion were included in this study and were treated with TB. On the pretreatment (T1) and posttreatment (T2) CBCT scans, volumetric changes in the pharyngeal airway; SNA, SNB, and ANB angles; and bilateral effective mandibular (Co-Gn) and midfacial length (Co-A) were also evaluated. The statistical differences were accessed by Wilcoxon signed-rank tests, and Mann-Whitney U tests were used to analyze the scores of male and female subjects. In this study, an increase was observed in SNB and Co-Gn (p < 0.01) while a decrease in ANB and SNA (p < 0.01 and p < 0.05, respectively) was found. However, increase in midfacial length was not statistically significant (p > 0.05). In the evaluation of volumetric pharyngeal airway changes, statistically significant increases (p < 0.01) in the upper and lower division and total airway volume were determined. Gender differences were insignificant for all measurements (p > 0.05). Volumetric changes in the pharyngeal airway after functional therapy can be successfully evaluated by CBCT images. The anterior repositioning of the mandible by TB increases the mandibular length and pharyngeal airway volume in patients with retrognathic mandible.

Three-Dimensional Evaluation of Soft Tissue Changes after Functional Therapy.

This study was aimed at proposing a three-dimensional (3D) evaluation method for the soft tissue effects of Twin Block (TB) functional appliance therapy by using cone beam computed tomography (CBCT) images. In this retrospective study, a total of 60 pre- and posttreatment (T0 and T1) CBCT images of Class II patients with mandibular retrognathia treated with a TB appliance were used. Volumetric and linear soft tissue changes were evaluated quantitatively with 3D measurements and qualitatively with color mapping visual. Linear (NV-A and NV-Pog) and angular (SNA, SNB, and ANB) skeletal changes were also measured on 3D images. The Wilcoxon signed-rank test was used to compare statistical differences, and the scores of male and female participant differences were observed with the Mann-Whitney U test. In this study, a decrease was observed in SNA (p < 0.05), ANB (p < 0.01), and NV-Pog (p < 0.05) while an increase in SNB (p < 0.01) was found. However, decrease in NV-A distance was not statistically significant (p > 0.05). As a result of the evaluation of soft tissue changes, while the anterior reposition of the lower lip, soft tissue pogonion, and soft tissue gnathion was found to be significant (p < 0.01, p < 0.01, and p < 0.05, respectively), the upper lip and subnasale repositions were not statistically significant (p > 0.05). 3D soft tissue changes after TB therapy can be evaluated quantitatively and qualitatively by using CBCT images. Anterior repositioning of the mandible with functional therapy also provides improvement in soft tissue profile, especially in the lower facial region.

Effects of hyperbaric oxygen during experimental tooth movement.

OBJECTIVE: To determine the effects of hyperbaric oxygen (HBO) on bone remodeling during orthodontic tooth movement. MATERIALS AND METHODS: Twenty-four male, adult Sprague Dawley rats were randomly divided into two groups. HBO was administered in the first group, and the second group served as a control. The mandibular first molars were moved mesially by means of Ni-Ti closed coil springs in all groups. RESULTS: Results were evaluated histomorphometrically and the parameters of trabecular bone volume (BV/TV), trabecular bone number (Tr.N), and trabecular separation (Tr.Sep) were evaluated at the interradicular bone area of the mandibular first molars. Increases in BV/TV and Tr.N and decreases in Tr.Sep revealed the osteoblastic activity of HBO. HBO application caused an increase in bone apposition and osteoblastic activity or a decrease in osteoclastic activity. CONCLUSIONS: HBO enhanced the bone formation during experimental tooth movement. Therefore, the findings of this study support our hypothesis that osteoblastic activity might be modulated by changes in the environmental oxygen tension.

Combined Use of Retraction and Torque Arch with Mini-Screws: A Cephalometric Study.

OBJECTIVE: Our objective was to investigate and quantify the treatment of micro-implant-aided retraction and torque (R&T) arch on dentofacial structures. METHODS: Twelve patients (mean age 21.2 years) who required orthodontic camouflage treatment were included in the study. Following the canine distalization, mini-screws were placed between maxillary first molars and second premolars, and R&T arch was applied for the retraction of incisors. The vertical retraction arms of the arch were adjusted between the apex of the lateral incisor and the alveolar bone so that the retraction force passed through the center of resistance of four incisors and forced the incisors to bodily retraction. Closed coil-springs applying 150 gr of force were used to retract the incisors. The retraction period lasted for 217±34 days. RESULTS: SNA and NV-A decreased (p<0.05), indicating alveolar bone remodeling around Point A. The reduction in the SNA caused a statistically significant decrease in the ANB (p<0.01). SN/1, NA/1, NA-1, and overjet decreased significantly (p<0.01), depending on the retrusion of the incisors. The distances from the apex and incisal point of the central incisor to the SV reference plane also decreased significantly (p<0.01), revealing a nearly parallel movement of the incisors. Anchorage loss of the molars and decrease in nasolabial angle were not significant (p>0.05). CONCLUSION: A combined use of R&T arch with mini-screws is an effective method to retract the incisors without anchorage loss. The type of movement is nearly parallel.

Cephalometric evaluation of patients treated by maxillary anterior segmental distraction: a preliminary report.

OBJECTIVE: The aim of this study was to evaluate the cephalometric results of distraction osteogenesis in patients with premaxillary deficiency. MATERIAL AND METHODS: In this study, an individual tooth-borne distraction device was used for advancement of the maxillary anterior segment. Unilateral or bilateral distraction was performed for 7 patients, according to the specific requirements of the individuals. Cephalometric radiographs were taken before treatment (T0), after distraction (T1), and after consolidation for 8 weeks (T2). RESULTS: Cephalometric analysis revealed that the premaxilla was moved forward and upward and the length of palatal plane increased. CONCLUSION: These alterations improved the soft tissue profile and solved the space deficiency of the maxilla by increasing the arch perimeter.

A unique treatment of finger-sucking habit in children with mental retardation: report of 2 cases.

Finger-sucking habit, or nonnutritive sucking, usually ceases spontaneously in childhood. If the habit is not broken, however, not only will dental occlusion be affected, but the shape of the finger may be altered as well. When the habit is broken, the threatening disturbances of digital growth and dental occlusion will resolve spontaneously. This article describes a unique type of habit-breaking appliance applied on the sucked fingers of 2 children with mental retardation. The advantages of this type of extraoral appliance are discussed.

Tumor necrosis factor-alpha levels during two different canine distalization techniques.

OBJECTIVES: To compare levels of tumor necrosis factor (TNF)-alpha while applying continuous and heavy interrupted forces. MATERIALS AND METHODS: A hybrid retractor was used in the first group. In the second group, rapid canine distalization through periodontal distraction was performed. Gingival crevicular fluid samples were collected from the distal sides of the canine teeth before attaching the appliances and at 1 hour, 24 hours, and 1 week after the force was applied. RESULTS: In the hybrid reactor group, concentration of TNF-alpha decreased at 1 week according to 24-hour measurements. In the rapid canine distalization group, it severely increased at 1 hour. In the evaluation of between-group differences, significantly higher values were determined in the rapid canine distalization group at 1 hour and 1 week. CONCLUSIONS: Heavy interrupted force induces a rapid release of TNF-alpha, and the tissue response continues for a longer time period. To avoid the harmful effects of heavy interrupted force, there might be feedback mechanisms that prevent the mediators from increasing excessively.

Effects of interferon-gamma on bone remodeling during experimental tooth movement.

OBJECTIVE: To determine the effects of interferon-gamma (IFN-gamma) on bone remodeling during orthodontic tooth movement. MATERIALS AND METHODS: Thirty adult male Sprague Dawley rats were randomly categorized into five groups. IFN-gamma was administered in three different doses (0.01, 0.02, and 0.05 microg/20 microL) and the remaining two groups served as control. Mandibular first molars were moved mesially by means of Ni-Ti closed coil springs in all groups. The results were evaluated histomorphometrically, and parameters of trabecular bone volume (BV/TV), trabecular bone number (Tr.N), and trabecular separation (Tr.Sep) were observed at the interradicular bone area of the mandibular first molars. RESULTS: Increases in BV/TV and Tr.N and decreases in Tr.Sep revealed the antiosteoclastic activity of IFN-gamma. CONCLUSION: IFN-gamma administration may be useful clinically for anchorage control.

Management of a fused central incisor in association with a macrodont lateral incisor: a case report.

Fusion is developmental anomaly of the dental hard tissue and is defined as the joining of 2 developing tooth germs resulting in a single large tooth structure. Different treatment methods can be used according to the requirements of the situation. The purpose of this case report was to present the multidisciplinary treatment of a patient who had a permanent maxillary left central tooth fused with a supernumerary incisor and a macrodont permanent maxillary right lateral incisor. In the radiographic evaluation, it was determined that the fused tooth had 2 separate roots. The supernumerary tooth was extracted after hemisection, and endodontic treatment was performed on the remaining portion. The distal side of the macrodont lateral incisor was recontoured, and the right central incisor was reshaped with a strip crown to provide aesthetic appearance and to gain space for the alignment of teeth. Following the restoration of the incisors, orthodontic treatment was provided.

Initial effects of the tongue crib on tongue movements during deglutition: a Cine-Magnetic resonance imaging study.

The objective of this study was to investigate the initial effects of a tongue crib on tongue movements during deglutition by using real time balanced turbo field echo (B-TFE) Cine-MR imaging. A total of 21 patients were evaluated in this study. The open-bite group (OBG) consisted of 11 patients (seven girls, four boys) who had a mean age of 11.09 +/- 2.02 years and a mean overbite of -5.14 +/- 1.83 mm. These patients were evaluated initially (T1) and while wearing a tongue crib (T2). A total of 10 patients (five girls, five boys) with a mean age of 14.5 +/- 2.6 years and with a mean overbite of 1.6 +/- 0.5 mm served as controls (CG), and only initial records were obtained from these patients. T2 was compared with T1 and CG. T1 was also compared with CG. We evaluated deglutition during three stages matching oral (1), pharyngeal (2), and esophageal (3) stages. Our results indicated that the tongue's tip positioned more posteriorly when the crib was in place (T2) compared with both T1 and CG; the anterior portion of the tongue's dorsum was at a lower position in T2 compared with both T1 and CG at stage 3; the midportion of the tongue's dorsum was at a lower position in T2 than in T1 and CG at stages 1 and 2. To compensate for the posterior position of the tongue's tip (caused by the tongue crib), adaptive changes occurred in the anterior and midportions of the dorsum of the tongue.

Dynamic MRI evaluation of tongue posture and deglutitive movements in a surgically corrected open bite.

Tongue thrust usually develops in the presence of anterior open bite in order to achieve anterior valve function. In the literature, tongue thrust is described both as the result and the cause of open bite. If it is an adaptation to malocclusion, then tongue posture and deglutitive tongue movements should change after treatment. In this case report, an adult who had skeletal open bite and Class II malocclusion caused by mandibular retrusion was treated surgically. The mandible was advanced in a forward and upward direction with a sagittal split osteotomy. The open bite and Class II malocclusion were corrected and an increase in the posterior airway space (PAS) was observed. Pretreatment and posttreatment dynamic magnetic resonance imaging (MRI) revealed that tongue tip was retruded behind the incisors and contact of the tongue with the palate increased. It was also determined that the anterior and middle portions descended, whereas the posterior portion was elevated at all stages. Advancement of the mandible, correction of open bite, and an increase in PAS affected not only the tongue posture and deglutitive movements, but also the breathing pattern of the patient.

Forsus Nitinol Flat Spring and Jasper Jumper corrections of Class II division 1 malocclusions.

OBJECTIVE: To compare the effects of Forsus Nitinol Flat Spring (FNFS) and Jasper Jumper (JJ) in the correction of Class II division I malocclusions. MATERIALS AND METHODS: Our research was conducted on 48 adolescents, who had a normal or horizontal growth pattern and retrognathic mandible. The patients were divided into three equal groups randomly. First group was treated with FNFS, and the second group was treated with JJ appliances, whereas the third group was the control group. Lateral cephalograms and study models were obtained after the leveling phase and at time of the removal of the appliances. RESULTS: Cephalometric analysis revealed that both the appliances stimulated mandibular growth, increased the anterior face height because of the lower face, and elongated the posterior face height because of the growth of temporomandibular joint. Maxillary central incisors were extruded, retruded, and distally tipped. Contrarily, intrusion, protrusion, and labial tipping were observed in the mandibular central incisors. Distal movement and intrusion of the maxillary first molars and mesial movement and extrusion of the mandibular first molars were the other dental alterations. Overjet and overbite were decreased, and a Class I molar relationship and improvement in the profile were attained in both treatment groups. Cast model analysis showed expansion in the maxillary and mandibular dental arches. CONCLUSIONS: Both the appliances were effective in the treatment of Class II malocclusion and revealed nearly same alterations in the skeletal, dental, and soft tissue parameters.

Use of zygomatic anchors during rapid canine distalization: a preliminary case report.

Rapid canine distalization is a technique involving periodontal ligament distraction. The primary aim of this technique is to distalize the canines without anchorage loss and to shorten the duration of orthodontic treatment. After the rapid canine distalization, the healing process of the periodontal ligament is similar to rapid palatal expansion and requires a consolidation period. The long consolidation period of the technique conflicts with the second aim. Skeletal anchorage systems seem to compensate for this conflict because they can be also used for retraction of incisors during consolidation period. This case report presents the orthodontic treatment of a 16-year-old female, who had a bimaxillary retrusion and a dental Class II division I malocclusion. Upper first premolars were extracted and, while the canines were being distalized rapidly by periodontal ligament distraction, the incisors were retracted using a zygomatic anchorage system. The treatment of the patient was completed in five months without any anchorage loss.

Dentofacial effects of asymmetric headgear and cervical headgear with removable plate on unilateral molar distalization.

Cervical headgear (CHG) is used widely in the treatment of Class II anomalies. Asymmetric headgear (AHG) is an alternative treatment for the correction of unilateral Class II dental relationships. The purpose of this investigation was to compare the effects of AHG with those of a CHG combined with a removable plate in unilateral first molar distalization. The study consisted of 20 patients with unilateral Class II molar relationship (12 girls and eight boys). One group of 10 patients was treated with an AHG, and a second group of 10 patients was treated with a CHG and a removable plate. Lateral cephalograms and basilar radiographs were taken before and after molar distalization. It was found that distalization and distal tipping of molar on the passive side was less in the CHG and removable plate (CHG-RP) group. Distalization and distal tipping of the second premolar on the distalization side was also reduced in this group. Incisors were retruded in both groups but were retruded more in the CHG-RP group.