Effect of intracanal cryotherapy on the inflammatory cytokine, proteolytic enzyme levels and post-operative pain in teeth with asymptomatic apical periodontitis: A randomized clinical trial.

AIM: To investigate the changes in the biomarker levels related to inflammation and tissue destruction in the periapical exudate of mandibular pre-molar teeth with asymptomatic apical periodontitis after receiving intracanal cryotherapy, to compare cryotherapy and control groups in terms of analgesic intake, interappointment, and post-operative pain and evaluate the correlation between biomarker levels and interappointment pain. METHODOLOGY: Mandibular pre-molar teeth of 44 patients aged 18-35 years, diagnosed with asymptomatic apical periodontitis, were root canal treated in two visits (registered as NCT04798144). Baseline periapical exudate samples were obtained, and the patients were assigned to either control or intracanal cryotherapy group according to the final irrigation with distilled water either at room temperature or 2.5°C. The canals were dressed with calcium hydroxide. In the second visit, the calcium hydroxide was removed with passive ultrasonic irrigation, and the periapical exudate was sampled again. IL-1ß, IL-2, IL-6, IL-8, TNF-α, PGE2 and MMP-8 levels were determined with ELISA. Post-operative pain levels were recorded for 6 days following both visits using a visual analogue scale. Data were analysed using t-test, the Mann-Whitney U test and correlation tests. RESULTS: There was a significant correlation between the pain scores reported after first visit and IL-1ß and PGE2 levels (p < .05). IL-1ß, IL-2 and IL-6 levels showed no significant difference in the cryotherapy group (p > .05), while they significantly increased in the control group (p < .05). There was a decrease in IL-8, TNF-α, PGE2 and MMP-8 levels, however, the difference was not significant (p > .05). Pain scores were significantly lower in the cryotherapy group for the first 3 days (p < .05), except for 24th hours (p > .05). CONCLUSIONS: The positive correlation between interappointment pain and IL-1ß and PGE2 levels might indicate that these biomarker levels can be used to predict the severity of post-operative pain. Intracanal cryotherapy was effective in reducing post-operative pain in the short term in teeth with asymptomatic apical periodontitis. Cryotherapy prevented an increase in IL-1ß, IL-2 and IL-6 levels compared with the control group.

Neutrophil-to-lymphocyte ratios in pregnant women with familial mediterranean fever.

OBJECTIVE: To investigate the association between maternal serum neutrophil-to-lymphocyte ratios (NLRs) and pregnancy outcomes in women with familial mediterranean fever (FMF). BACKGROUND: FMF exists worldwide, it primarily affects Mediterranean countries METHODS: We retrospectively analysed data from 269 pregnant women, who underwent a routine prenatal follow-up and delivery in our hospital from 2016 to 2020. Clinical and demographic data, including age, gravida, parity, abortus, proteinuria in the first trimester, NLR, obstetrical complications, gestational age at delivery, birthweight were retrieved from the patients' medical records. Data from 67 pregnant women with FMF and 202 healthy pregnant women were compared. RESULTS: Patients with FMF showed higher rates of preeclampsia and primary caesarean delivery; however, there were no differences between the groups in terms of other obstetric complications or adverse neonatal outcomes. In both the FMF and control groups, NLRs in the third trimester were significantly higher than those in the first trimester. Additionally, patients in the FMF group demonstrated higher NLRs than patients in the control group in the third trimester. CONCLUSIONS: The NLRs are a haematological parameter that can be used to predict subclinical inflammation and the effects of ongoing subclinical inflammation on the pregnancy outcomes in women with FMF (Tab. 4, Ref. 39).

Evaluation of dentine thickness of middle mesial canals of mandibular molars prepared with rotary instruments: a micro-CT study.

AIM: To evaluate, using micro-CT, the remaining dentine thickness after preparation of the mesiobuccal (MB), mesiolingual (ML) and middle mesial (MM) canals of mandibular first molars with the ProTaper Next rotary system. METHODOLOGY: Eleven mesial roots of mandibular first molars having three independent canals from the furcation level up to at least 5 mm towards the apical direction were selected. Preparation of MM canals was performed in two steps using ProTaper Next X2 (step 1) and X3 (step 2) instruments, whilst MB and ML canals were prepared in a single step up to X3 instruments. The roots were scanned (pixel size of 10 µm) before and after each step, and the dentine volume was calculated. Postoperative models of the roots were coregistered with their preoperative dataset and colour-coded cross-sections of the roots were used to measure the smallest dentine thickness surrounding each canal at 1.0-mm intervals from the furcation level up to 5 mm in the apical direction, in both mesial and distal aspects of the roots. Changes in the remaining wall thickness between mesial canals were analysed with repeated-measures anova and post hoc Tukey test. Significance level was set at 5%. RESULTS: Mean percentage reduction of dentine volume after steps 1 and 2 was 4.66% and 5.16%, respectively. Overall, pre- and postoperative dentine thickness of the MM canal walls, in both mesial and distal aspects of the root, were significantly thinner than those of MB and ML canals (P < 0.05). No significant difference was observed when comparing dentine thickness in the mesial and distal directions of MM canal after preparation step 1 (0.88 ± 0.18 mm and 0.73 ± 0.26 mm, respectively) or 2 (0.83 ± 0.17 mm and 0.67 ± 0.26 mm, respectively) (P > 0.05). Dentine thickness values less than 0.5 mm were observed mostly towards the distal aspect of the MM canal. Mesial roots were not associated with strip perforations after canal preparation procedures. CONCLUSIONS: A significant decrease in the thickness of canal walls at all levels evaluated in the mesial roots of mandibular molars suggests that files with small tapers should be used in preference to instruments with large tapers to prepare mesial canals in mandibular molars.

Primary Immunodeficiency Disorders in children with Non-Cystic Fibrosis Bronchiectasis.

Summary: Introduction. Primary immunodeficiency diseases (PID) are common in patients with non-cystic fibrosis bronchiectasis (NCFB). Our objective was to determine ratio/types of PID in NCFB. Methods. Seventy NCFB patients followed up in a two-year period were enrolled. Results. Median age was 14 years (min-max: 6-30). Male/female ratio was 39/31; parental consanguinity, 38.6%. Most patients with NCFB (84.28%) had their first pulmonary infection within the first year of their lives. Patients had their first pulmonary infection at a median age of 6 months (min-max: 0.5-84), were diagnosed with bronchiectasis at about 9 years (114 months, min-max: 2-276). PID, primary ciliary dyskinesia (PCD), bronchiolitis obliterans, rheumatic/autoimmune diseases, severe congenital heart disease and tuberculosis were evaluated as the most common causes of NCFB. About 40% of patients (n=16) had bronchial hyperreactivity (BH) and asthma. Twenty-nine patients (41.4%) had a PID, and nearly all (n=28) had primary antibody deficiency, including patients with combined T and B cell deficiency. PID and non-PID groups did not differ according to gender, parental consanguinity, age at first pneumonia, age of onset of chronic pulmonary symptoms, bronchiectasis, presence of gastroesophageal reflux disease (GERD), BH and asthma (p greater-than 0.05). Admission to immunology clinic was about 3 years later in PID compared with non-PID group (p less-than 0.001). Five patients got molecular diagnosis, X-linked agammaglobulinemia (n=2), LRBA deficiency (n=1), RASGRP1 deficiency (n=1), MHC Class II deficiency (n=1). They were given monthly IVIG and HSCT was performed for three patients. Conclusions. PID accounted for about 40% of NCFB. Early diagnosis/appropriate treatment have impact on clinical course of a PID patient. Thus, follow-up in also immunology clinics should be a routine for patients who experience pneumonia in the first year of their lives and those with NCFB.

Effect of various solutions on the removal of orange-brown precipitate formed by interaction of sodium hypochlorite and chlorhexidine with or without ultrasonic activationZ.

OBJECTIVES: This study aimed to compare the effect of different solutions on the removal of orange-brown precipitate with or without ultrasonic activation. MATERIALS AND METHODS: One hundred and twenty extracted maxillary anterior teeth were instrumented. In experimental groups (n = 10), canals were flushed with 17% EDTA, 10% citric acid, 1% phytic acid, 96% alcohol and distilled water either using syringe irrigation or ultrasonic activation, after creating orange-brown precipitate. Teeth were sectioned longitudinally and subjected to stereomicroscopic analysis. The amount of precipitate was scored and the data were analyzed (P = 0.05). RESULTS: There were no differences detected among the tested solutions (P > 0.05). There was a significant difference between ultrasonically activated irrigation and syringe irrigation for EDTA and distilled water in coronal, middle portions (P < 0.05). CONCLUSIONS: Ultrasonic activation significantly improved the precipitate removal capacity of EDTA and DW. Tested solutions were similarly effective regarding the removal of the precipitate.

Influence of static and dynamic cyclic fatigue tests on the lifespan of four reciprocating systems at different temperatures.

AIM: To compare the cyclic fatigue resistance of four reciprocating single-file systems within artificial stainless-steel canals at two temperatures using different kinematics. METHODOLOGY: A total of 240 instruments, Reciproc Blue, Reciproc, WaveOne Gold and WaveOne, (60 of each), were tested at room and intracanal temperature using both a static and a dynamic model (n = 15) in a stainless-steel artificial canal with an inner diameter of 1.5 mm, 60° angle of curvature and 5 mm radius of curvature until fracture occurred. The time to fracture was measured in seconds using a digital chronometer, and data were analysed using one-way analysis of variance and Bonferroni tests. RESULTS: WaveOne instruments had significantly less fatigue resistance compared to that of other systems in all conditions (P < 0.05). Comparison of the results from the static and dynamic models at both temperatures revealed that fatigue resistance was significantly increased in the dynamic model for all the instrument systems (P < 0.05). Temperature did not influence the cyclic fatigue resistance results (P > 0.05). There were no significant differences in the mean length of the fractured fragments of the various instruments tested (P > 0.05). CONCLUSION: WaveOne files had a shorter cyclic fatigue life. The dynamic axial movement extended the cyclic fatigue life, but it did not have any influence on the comparison among the instruments tested in respect of the static test. Temperature did not significantly affect the cyclic fatigue of these nickel-titanium files.

A micro-computed tomographic study of band-shaped root canal isthmuses, having their floor in the apical third of mesial roots of mandibular first molars.

AIM: To conduct a quantitative and qualitative analysis of the band-shaped isthmus area, the floor of which was in the apical third in the mesial roots of mandibular first molars using micro-computed tomography (micro-CT). METHODOLOGY: Micro-CT images of 269 mesial roots of mandibular first molars were evaluated, and 40 specimens with a band-shaped isthmus, with a floor in the apical third, were selected. The major diameter, minor diameter, roundness, area and perimeter values for the most coronal and apical slices where the isthmus was visible were measured. The distances between these slices were measured as the isthmus length, and the total volume, structure model index and surface area of the isthmus were measured. The distances between the isthmus floor and two apical foramina and the number of root canal orifices were calculated. The dimensions of the isthmus roof and the floor were compared, and the data were analysed using descriptive statistics and Student's t-tests with a significance threshold set at 5%. RESULTS: A total of 15% of the specimens had band-shaped isthmuses with a floor in the apical third. The isthmus roof exhibited significantly greater major and minor diameter values compared to the isthmus floor (P < 0.05). No significant difference was detected between the isthmus roof and the floor with regard to roundness (P > 0.05). CONCLUSION: Three- and two-dimensional analyses of the mesial roots of mandibular molars revealed that band-shaped isthmuses had complex shapes.

Micro-CT evaluation of the quality of root fillings when using three root filling systems.

AIM: To evaluate the percentage volumes of filling materials and voids in single-rooted teeth filled with three different filling systems using micro-computed tomography (micro-CT). METHODOLOGY: Thirty single-rooted human teeth were used. After preparation of the root canals, the teeth were randomly divided into three groups (n = 10). The canals were filled with EndoREZ, ActiV GP or AH Plus/gutta-percha. Each specimen was scanned using a micro-CT device at a resolution of 13.68 µm. Percentage volumes of root filling materials and voids were calculated and data were analysed statistically using the Kruskal-Wallis test and the Mann-Whitney U-test with Bonferroni adjustment. Within each group, the Friedman test was performed with the Wilcoxon signed-rank test to detect discrepancies. RESULTS: The percentage volume of filling material was significantly lower in the ActiV GP group than in the other groups (P < 0.05), whilst the percentage volume of voids was significantly higher in the ActiV GP group than in the other groups (P < 0.05). CONCLUSION: None of the systems were associated with void-free root fillings. The ActiV GP system had a significantly higher percentage volume of voids than the other systems.

Influence of oval and circular post placement using different resin cements on push-out bond strength and void volume analysed by micro-CT.

AIM: To evaluate the percentage volume of voids within cement layers, to determine the push-out bond strength of circular and oval fibre posts luted with different commercial resin cements in oval cross-sectional root canals, and to correlate push-out bond strength values and volume of voids of circular and oval fibre posts. METHODOLOGY: Seventy-two mandibular premolars with oval-shaped root canals were selected. The specimens were divided into two main groups according to the post type (oval and circular). Groups were further divided into three subgroups (n = 24) according to resin cement type: Maxcem Elite, Rely-X Unicem and Duo-Link. The volumes of voids within the cements were analysed by micro-computed tomography (micro-CT). The bond strength was then measured using a push-out test with an Instron universal testing machine. The failure modes were evaluated. Statistical analyses were performed using a three-way anova, Tukey's post hoc, Pearson's correlation and chi-square test (P = 0.05). RESULTS: The push-out bond strength values were significantly affected by root canal region, post type and cement type (P < 0.001). Root canal region, post type and cement type also significantly affected void volume (P < 0.001). There was a significant interaction between post type and cement type (P < 0.001). The most frequent failure type was adhesive failure in all the groups. There was no significant correlation between the push-out bond strength and void volume (P > 0.05). CONCLUSIONS: Void volume did not affect push-out bond strength of oval and circular posts luted in oval canals.

Comparison of SKIP expression in malignant pleural mesotheliomas with Ki-67 proliferation index and prognostic parameters.

We aimed to determine the presence of SKI-interacting protein (SKIP) expression in malignant pleural mesothelioma (MPM) and its effect on prognosis by investigating SKIP correlation with the Ki-67 proliferation index and prognostic parameters. Pathological preparations of the patients diagnosed with MPM between 2006 and 2012 were evaluated. Immunohistochemical analyses were performed to evaluate the expression of SKIP and the Ki-67 proliferation index. Correlations between SKIP expression, clinicopathological factors and survival were investigated. Survival data were calculated using the Kaplan-Meier method, and Cox regression analysis was used to evaluate the prognostic value of the variables. In total, 52 patients were evaluated in the study; 36 of them were male and 16 were female. The mean age of the patients was 62.3 ±12.2 years. The median overall survival period was 8.5 months. Factors negatively affecting general survival in the univariate analysis included high SKIP expression, Ki-67 proliferative index over 30%, presence of non-epithelioid type MPM and stage III-IV disease (p < 0.05). Cox regression analysis revealed that high SKIP expression, high Ki-67 proliferative index and presence of non-epithelioid type MPM are independent factors that affect the survival rate. Higher SKIP expression is associated with poor prognosis in MPM.

Assessment of the biocompatibility of mineral trioxide aggregate, bioaggregate, and biodentine in the subcutaneous tissue of rats.

OBJECTIVE: The objective of this study was to evaluate the tissue inflammation caused by three endodontic repair materials. MATERIALS AND METHODS: The materials included micro mega-mineral trioxide aggregate (MM-MTA), bioaggregate (BA), and biodentine (BD), which were implanted into the subcutaneous tissue of rats. The tissue samples for histological examination were prepared. The infiltration of lymphocytes and macrophages into the tissue was examined to assess the inflammatory response. RESULTS: Lymphocyte infiltration: A significant increase was detected in the MM-MTA and BA groups on the 7th and 14th days as compared with the control (7th day P=0.0001, 14th day P=0.0176). There was no difference between the groups on the 45th day (P=0.1730). Lymphocyte infiltration had decreased over time in all groups. Macrophage infiltration: There was a significant increase by the 7th day in the test groups as compared to the control group (P=0.007). However, there was no difference between the experimental groups on the 14th (P=0.2708) and 45th (P=0.1291) days. CONCLUSION: While MM-MTA and BA showed a similar biocompatibility, BD was more biocompatible than MM-MTA and BA in the 1 st week of the experiment. However, there was no difference between the materials at the end of the 45th day. MM-MTA, BA, and BD can be considered suitable endodontic repair materials.

Micro-CT evaluation of root filling quality in oval-shaped canals.

AIM: To assess the percentage volumes of filling materials and voids in oval-shaped canals filled with either cold lateral compaction or warm compaction techniques, using micro-computed tomography (micro-CT). METHODOLOGY: Twenty-four single-rooted maxillary premolar teeth with oval-shaped canals were selected and the root canals prepared and assigned to two groups (n = 12), according to the filling technique: cold lateral compaction (CLC) or warm vertical compaction (WVC). Each specimen was scanned using a micro-CT device at an isotropic resolution of 12.5 µm. Percentage volumes of root filling materials and voids were calculated, and data were statistically analysed using Student's t-test and Friedman's test, with a significance level of 5%. RESULTS: Overall, mean percentage volumes of gutta-percha, sealer and voids were 82.33 ± 3.14, 13.42 ± 2.91 and 4.26 ± 0.74 in the CLC group and 91.73 ± 4.48, 7.70 ± 4.44 and 0.57 ± 0.44 in the WVC group, respectively, with a statistically significant difference between groups (P < 0.05). At the apical level, differences in the percentage volumes of filling materials and voids between groups were not significant (P > 0.05). CONCLUSIONS: No root fillings were void free. Warm vertical compaction produced a significantly greater volume of gutta-percha and a significantly lower percentage of voids than those achieved with cold lateral compaction. Distribution of sealer and voids within the root canal space after root filling was unpredictable, irrespective of the technique used.

Comparison of the efficacy and safety of onabotulinum toxin A and mirabegron for overactive bladder in elderly patients.

OBJECTIVE: This study aimed to investigate the efficacy and tolerability of mirabegron and onabotulinum toxin A (BoNT/A) injections for overactive bladders. The treatment we provided was to patients over the age of 65 years who were not satisfied with the results of anticholinergic monotherapy. PATIENTS AND METHODS: This multicenter retrospective observational study was conducted between March 2017 and December 2021. Thirty patients who were unable to take anticholinergics or mirabegron due to side effects received a total of 100-unit intravesical injections of BoNT/A. Furthermore, 30 patients receiving 50 mg of mirabegron daily were compared. Micturition frequency, urgency of urinary incontinence, pad usage, and nocturia were all evaluated for efficacy. Patients' health-related quality of life and subjective satisfaction ratings were assessed before and six months after treatment using an incontinence-quality-of-life questionnaire. We documented all adverse events for all subjects. RESULTS: There was a statistically significant decrease in the frequency, daily pad usage, and incontinence episodes of both groups. The median (interquartile range) voiding frequency after onabotulinum toxin A treatment was lower than that after mirabegron treatment [9.4 (6.83-10.0) vs. 10.5 (8.37-11.67); p = 0.01]. Incontinence episodes showed similar differences [1.3 (1.17-3.67) vs. 2.53 (2.0-5.67); p = 0.05]. There was no significant difference in nocturia or maximum urine flow rate between the groups before and after treatment. CONCLUSIONS: We determined that mirabegron led to lower urinary retention, hematuria, infection and post-void residual urine volume rates than BoNT/A in the older patient population. In addition, mirabegron treatment had comparable incontinence-quality-of-life scores at six months post-treatment.

Association between lower extremity venous insufficiency and increased choroidal thickness.

PURPOSE: The goal of this study is to investigate the association between the choroid and lower extremity venous insufficiency (LEVI). METHODS: This prospective cross-sectional study includes 56 patients with LEVI and 50 age/sex-similar control subjects. Choroidal thickness (CT) measurements from 5 different points were captured from all participants by optical coherence tomography. In the group with LEVI on physical examination, reflux at the saphenofemoral junction, and the diameter of the great and small saphenous veins were evaluated via color Doppler ultrasonography. RESULTS: The mean subfoveal CT was higher in the varicose group than in the control group (363.04±99.75µm vs. 320.30±73.46µm, P=0.013). In addition, the CTs at the temporal 3mm, temporal 1mm, nasal 1mm, and nasal 3mm distance from the fovea were higher in the LEVI group compared to the controls (for all, P<0.05). There was no correlation between CT and diameter of the great and small saphenous vein in patients with LEVI (for all, P>0.05). However, the great and small saphenous veins of patients with CT above 400µm were observed to be wider in patients with LEVI (P=0.027 and P=0.007, respectively). CONCLUSION: Varicose veins can be a feature of systemic venous pathology. Another component of systemic venous disease may be increased CT. Patients with high CT should be investigated for susceptibility to LEVI.

Unusual case of extraovarian granulosa cell tumor.

We present a case of adult type extraovarian granulosa cell tumor in 22 years old woman. The pelvic and radiographic examination revealed right adnexial solid mass in patient who complaining from menstrual disregulation and pelvic pain. The patient underwent exploratory laparotomy which showed pelvic mass adjacent urinary bladder and fixed to the behind of pubic bone at pre-peritoneal area.

Endodontic treatment of a maxillary lateral incisor with vital pulp, periradicular lesion and type III dens invaginatus: a case report.

AIM: To report the healing of a periradicular lesion and maintaining vitality of the pulp following endodontic treatment of the invaginated canal of a dental invagination. SUMMARY: Dens invaginatus is a developmental malformation resulting from invagination of the tooth crown or root before calcification has occurred. A case of type III dens invaginatus, an invagination that extends from the crown to the apex, in the maxillary right lateral incisor with a healthy pulp and large peri-invagination periodontitis is reported. Non-surgical root canal treatment of the invagination was performed. There appeared to be no communication between the main root canal and the invaginated canal. The invaginated canal was filled by lateral condensation of gutta-percha and a calcium hydroxide sealer. The final restoration of the tooth was completed using composite, and the tooth was reviewed after 1 and 2 years. Non-surgical root canal treatment of the invagination retained the pulp in a health condition and resulted in resolution of a substantial peri-invagination lesion. KEY LEARNING POINTS: Even though there are no symptoms, radiography should be performed in teeth that exhibit anatomical differences from the contralateral tooth. Even if there is extensive apical pathology in a tooth with type III dens invaginatus, pulp sensibility tests should be performed. Correct diagnosis and treatment planning are fundamental when treating dens invaginatus.

Development of a neural network based control algorithm for powered ankle prosthesis.

Lower limb amputation is partial or complete removal of the limb due to disease, accident or trauma. Surface electromyograms (sEMG) of a large number of muscles and force sensors have been used to develop control algorithms for lower limb powered prostheses, but there are no commercial sEMG controlled prostheses available to date. Unlike ankle disarticulation, transtibial amputation yields less intact lower leg muscle mass. Therefore, minimizing the use of sEMG muscle sources utilized will make powered prosthesis controller economic, and limiting the use of specifically the lower leg muscles will make it flexible. Presently, we have used healthy population data to (1) test the feasibility of the neural network (NN) approach for developing a powered ankle prosthesis control algorithm that successfully predicts sagittal ankle angle and moment during walking using exclusively sEMG, and (2) rank all muscle combination variations according to their success to determine the economic and flexible NN's. sEMG amplitudes of five lower extremity muscles were used as inputs: the tibialis anterior (TA), medial gastrocnemius (MG), rectus femoris (RF), biceps femoris (BF) and gluteus maximus (GM). A time-delay feed-forward-multilayer-architecture NN algorithm was developed. Muscle combination variations were ranked using Pearson's correlation coefficient (r > 0.95 indicates successful correlations) and root-mean-square error between actual vs. estimated ankle position and moment. The trained NN TA + MG was successful (rposition = 0.952, rmoment = 0.997) whereas, TA + MG + BF (rposition = 0.981, rmoment = 0.996) and MG + BF + GM (rposition = 0.955, rmoment = 0.995) were distinguished as the economic and flexible variations, respectively. The algorithms developed should be trained and tested for data acquired from amputees in new studies.

Maxillary unilateral molar distalization with sliding mechanics: a preliminary investigation.

Fifteen patients, eight males and seven females with a mean age of 13.32 years, were selected for unilateral molar distalization. Dentally, all presented with a unilateral Class II molar relationship. The subjects were all in the permanent dentition with second molars erupted and with a well aligned lower dental arch. For maxillary molar distalization a new intra-oral appliance was developed, the Keles Slider, which comprised two premolar and two molar bands. The anchorage unit was a Nance button with an anterior bite plane. From the palatal side, the point of distal force application was carried towards the level of centre of resistance of the maxillary first molar. A Ni-Ti coil spring was used and 200 g distal force was applied to the Class II first molar. Lateral cephalograms were taken and analysed before and 2 months after molar distalization. The Class II molars were distalized bodily, on average, 4.9 mm (P < 0.001). Mesial migration of the Class II first premolars was 1.3 mm (P < 0.05), incisor protrusion was 1.8 mm (P < 0.05) and incisor proclination 3.2 degrees (P < 0.05). The overbite was reduced by 3.1 mm (P < 0.001) and the overjet increased 2.1 mm (P < 0.01). For stabilization, the corrected Class II unilateral molar relationship was maintained with a Nance button for 2 months. The results show that this newly developed device achieved bodily distal molar movement with minimum anchorage loss.

A new approach in maxillary molar distalization: intraoral bodily molar distalizer.

The objectives of our study were to achieve bodily molar distalization, avoid distal tipping of molars, eliminate the need for patient cooperation (no headgear, no elastics, and no esthetic and social concern), and finally to minimize the treatment period and maximize the treatment efficiency. The study was carried out on 5 males and 10 females, a total of 15 patients. Mean age for the study group was 13.53 years. Dentally, all the patients had Class II molar relationship on both sides. The patients were in permanent dentition, second molars were erupted, and the lower dental arch was well aligned. Patients showed normal or sagittally directed growth pattern. Lateral cephalograms and study models were taken and analyzed before and after molar distalization. In the present study, in order to achieve maxillary molar distalization, a new intraoral appliance was developed. The intraoral bodily molar distalizer (IBMB) was composed of 2 parts: the anchorage unit and the distalizing unit. The anchorage unit was a wide Nance button, and the active unit consisted of distalizing springs. The springs had 2 components: the distalizer section of the spring applied a crown tipping force, while the uprighting section of the spring applied a root uprighting force on the first molars. A total of 230 g of distalizing force was used on both sides. After the distal movement of the first molars, the cephalometric results of 15 patients showed the following. Maxillary first molars were moved distally by an average of 5.23 mm (P <.001) without tipping or extrusion. Maxillary first premolars were moved 4.33 mm mesially (P <.001), tipped 2.73 degrees distally (P <.05), and extruded by 3.33 mm (P <.001). Maxillary central incisors were proclined by an average of 4.7 mm (P <.001) and tipped 6.73 degrees labially (P <.01). Model analysis showed that maxillary first molars were not rotated, and intermolar distance did not change after distal movement of molars. In conclusion, unlike most of the other molar distalization mechanics, this newly developed device achieved (1) bodily distal movement of maxillary molars and (2) eliminated dependence on patient cooperation and did not require headgear wear for molar root uprighting.

The effects of a modified protraction headgear on maxilla.

Protraction headgears are commonly used in the treatment of Class III malocclusion characterized by maxillary retrognathism. The upward and forward rotation of the maxilla during protraction is a major unwanted side effect. The aim of this study was to eliminate the upward and forward rotation of maxilla while protracting. Seventeen patients with Class III malocclusion as a result of maxillary retrognathism were treated for 3 months; their average age was 12.81 years. A full coverage acrylic cap splint-type rapid maxillary expansion appliance was cemented and activated twice a day for 5 days. After sutural separation, a maxillary modified protraction headgear was worn and 750 g of force was applied. Wilcoxon signed rank test was carried out to evaluate 42 parameters measured on cephalometric radiographs. The maxilla was displaced anteriorly by downward and backward rotation. The mandible was displaced downward and backward due to anterior elongation of the maxilla. Extrusion and lingual tipping of the upper incisors and intrusion of upper molars and downward and backward rotation of functional occlusal plane were observed. The aim of our study was achieved, which was to avoid upward and forward rotation while protracting the maxilla. In conclusion, maxillary modified protraction headgear (MMPH) can be used effectively in Class III patients with retrognathic maxilla and anterior open bite tendency.