World Federation of Orthodontists guidelines for postgraduate orthodontic education.

Advanced dental education programs in orthodontics and dentofacial orthopedics require an extensive and comprehensive evidence-based experience, which must be representative of the current didactic and technical advancements. Over the past 25 years, the World Federation of Orthodontists (WFO) has placed emphasis in the support for the recognized orthodontic specialty training programs in every region of the world. In its early years, the WFO developed general principles for specialty education that culminated in the first comprehensive curriculum recommendations, i.e., the WFO Guidelines for Postgraduate Orthodontic Education, which was published in February 2009. In view of the significant changes in the specialty of orthodontics, the WFO has revised and updated its previous document to reflect the expanded scope and demands of current orthodontic education and practice. The members of the task force participated in a thorough revision of the guidelines and created a new document that takes into consideration the didactic, clinical, and the appropriate physical facilities to provide clinical care, study, and research areas. Although it is recognized that there will be variations in teaching and faculty assets, as well as facilities, access to materials, and equipment, the aim of the WFO Educational Guidelines is to provide the minimum program requirements necessary to provide orthodontic specialty residents the educational experience that prepares them to deliver the best level of orthodontic treatment for their patients. It is recommended that these guidelines be used universally by orthodontic specialty program educators and related educational, scientific, and administrative institutions to evaluate and compare their curriculum to a world standard.

Effect of anodization on friction behavior of ß­titanium orthodontic archwires.

PURPOSE: To evaluate the effects of anodization on the friction behavior of beta-titanium (ß-Ti) orthodontic archwires in conventional or self-ligating brackets in vitro. METHODS: ß­Ti archwires (0.018â€¯× 0.025 inch) pre- and postanodization were tested in combination with 0.022-inch stainless steel conventional and self-ligating brackets. The surface composition and oxide thickness of the ß­Ti archwires pre- and postanodization were measured using Auger electron spectroscopy (AES) and transmission electron microscopy (TEM). Detailed surface topography and roughness were assessed using atomic force microscopy (AFM). Surface topographies of the ß­Ti archwires pre- and postanodization were examined using scanning electron microscopy (SEM). Friction was measured using a universal testing machine; the data were statistically analyzed. RESULTS: Postanodization, the identified titanium oxide layer on the surface of the ß­Ti archwires increased in thickness from 10 to 100 nm; at the same time, the values for surface roughness were significantly reduced by half (p < 0.001). The archwire surfaces post anodization were harder and had fewer scratches after the friction test. Anodization significantly reduced 23.77% of the static (p < 0.01) and 25.61% of the kinetic (p < 0.001) friction of the ß­Ti archwires in conventional brackets, while it significantly reduced 85.71% of the static and 84.38% of the kinetic friction (p < 0.01) in self-ligating brackets. CONCLUSION: Anodization reduced the ß­Ti archwire friction, which was particularly more effective in combination with self-ligating brackets. The friction reduction via anodization could be attributed to the increased thickness, surface hardness, and decreased surface roughness of the titanium oxide layer.

Redirecting mandibular growth through orthodontic dentoalveolar height development in growing patients with Class III malocclusion undergoing maxillary orthopedic protraction.

INTRODUCTION: To control mandibular growth could be the determining factor for any growing patients with Class III malocclusion undergoing maxillary orthopedics. It has been reported that orthodontic dentoalveolar height development (ODHD) through orthodontic total arch extrusion might redirect mandibular growth backward and downward in growing patients with Class III malocclusion. We hypothesized bimaxillary-ODHD (bimax-ODHD) should be equal to or exceed the mandibular condylar growth to redirect the mandible to grow downward and backward in growing patients with Class III malocclusion. METHODS: Twenty-seven consecutive growing patients with Class III malocclusion who underwent maxillary orthopedics (MO) were recruited in this study, including 13 control patients (aged 12.70 ± 2.09 years) who underwent treatment of MO with no ODHD and another 14 patients who underwent MO and ODHD (ODHD group; aged 12.75 ± 1.40 years). The pretreatment (T1) and posttreatment (T2) CBCT images were superimposed and measured for the amount of ODHD and maxillary downward growth (ODHD-Mx), ODHD in the mandible (ODHD-Mn), T2 - T1 changes on facial convexity, y-axis, maxillary and condylar growth, and mandibular posture. The data were analyzed statistically. RESULTS: The T2 - T1 treatment duration was 7.5 months, significantly (P = 0.028) shorter in the ODHD group. The maxillary and condylar growth were similar among the groups. The mandible grew forward and downward in the control group, the ODHD-Mx and ODHD-Mn were significantly (P = 0.011) more in the ODHD group, and the mandible significantly (P = 0.001) grew backward and downward. The mandible grew backward and downward when the bimax-ODHD (ODHD-Mx + ODHD-Mn) exceeded the condylar growth (r = 0.715; P <0.001). CONCLUSIONS: The bimax-ODHD, including the downward growth of the maxilla, should be equal to or exceed the mandibular condylar growth to redirect the mandible to grow downward and backward and improve the skeletal facial convexity in growing patients with Class III malocclusion.

Comparison between microporous and nanoporous orthodontic miniscrews : An experimental study in rabbits.

PURPOSE: Surface characteristics of orthodontic miniscrews might affect survival rates and removal torque values (RTVs). This experimental study aimed to clarify whether and why a microporous or nanoporous surface promotes higher survival rates and RTVs for orthodontic miniscrews. METHODS: Using a split-leg design, one set each of nonporous (sham control, n = 24) and microporous (control, n = 6), and three sets of nanoporous (experimental, n = 6 per set) miniscrews were implanted in the tibias of 12 New Zealand rabbits and immediately loaded with 1.5 N nickel-titanium coil springs for 12 weeks. The surface morphology, micropores, and nanotube diameters of the miniscrews were examined using scanning electron microscopy and field-emission scanning electron microscopy. The surface composition and thickness were determined using Auger electron spectroscopy. The survival rates and RTVs of each set were assessed. RESULTS: The nanoporous miniscrews had higher survival rates, RTVs (p < 0.001), and thicker nanotube oxide thicknesses (p < 0.001) than the nonporous and microporous miniscrews. The nonporous and microporous miniscrews had no nanotube structures. The surface oxide composition was titanium dioxide (TiO2). The threshold RTV, TiO2 thickness, and nanotube diameter of nanoporous miniscrews needed to promote the experimental survival rate to 100% was determined to be 6.6 ± 0.8 N-cm (p < 0.05), 22.5 ± 4.8 nm (p < 0.05), and 17.6 ± 2.3 nm or above, respectively. CONCLUSION: Nanoporous surfaces promoted higher survival rates and RTVs than microporous miniscrews. This could be due to TiO2 nanotube structures with thicker oxide layers in nanoporous miniscrews.

Orthodontic board certifications: Global perspectives, challenges, and evolving trends.

The Society of Orthodontic Specialty Certifying Boards aims to encourage the formation of new certifying orthodontic boards worldwide and stimulate existing orthodontic certifying boards to review and revise their certification process. The main goal of Society of Orthodontic Specialty Certifying Boards is to motivate more orthodontists to become board certified by demonstrating their skills through time to protect the public and the specialty from unqualified practitioners. This article identifies the existing barriers in board certification and suggests a scenario-based clinical examination.

Preliminary study: evaluating the reliability of CBCT images for tongue space measurements in the field of orthodontics.

INTRODUCTION: Accurately measuring tongue space is challenging, but this information can be useful to many dental specialties. This study was intended to estimate the reliability of using cone-beam computed tomography (CBCT) to measure tongue space, which includes tongue volume and the oral cavity air capacity. METHODS: For this preliminary study, CBCT images from ten participants (five females and five males, mean age of 29.8 ± 3.3 years) were available for evaluation. Each participant was radiographed two times (T0 and T1). The average time between T0 and T1 was 15.8 ± 3.7 days. CBCT scans were standardized to reduce variability. Three-dimensional landmarks were established to identify tongue space and 3D image analysis software (SimPlant® 17 Pro; Materialise Dental, Leuven, Belgium) was used to measure the volume circumscribed by the landmarks. Two investigators independently calculated airway, tongue dimensions, and total tongue space for CBCT image T0 twice (day 1 and day 14), and T1 once. Intraclass correlation coefficients (ICCs) were used to estimate intra-rater and inter-rater reliability. Bland-Altman charts were constructed to demonstrate agreement within and between raters. RESULTS: The intra-rater and inter-rater ICCs of the CBCT measurements at T0 were excellent (> 0.90). Measurements for T0 vs. T1 show good (0.75-0.90) intra-rater and excellent (> 0.90) inter-rater reliability. Bland-Altman charts show that 90-95% of the total measurements fall within the 95% limits of agreement for both intra- and inter-rater pairs CONCLUSIONS: The results of this preliminary study suggest that the landmarks chosen to measure the overall tongue space are reproducible and can be measured clearly using CBCT.

History and Evolution of Orthognathic Surgery at Chang Gung Craniofacial Center: Lessons Learned From 35-Year Experience.

BACKGROUND: Modern orthognathic surgery (OGS) was established on the basis of contributions from multidisciplinary centers worldwide. This study reports the history and evolution of OGS at the Chang Gung Craniofacial Center (CGCC) and identifies the lessons learned from 35 years of experience. METHODS: The total number of OGS procedures managed by the CGCC multidisciplinary team between 1981 and 2016 was determined. The database of the senior author (Y.-R.C.) was reviewed for consecutive OGS procedures performed between 2003 and 2016. A literature review was also performed to retrieve the contributions from the total CGCC team. RESULTS: The 35 years of experience at a single center and 13-year experience of a single surgeon corresponded to 8073 and 2883 OGS procedures, respectively. Moreover, 53 peer-reviewed articles were reviewed. Teamwork (plastic surgeons, orthodontists, and anesthetists) ensured an optimal balance between occlusion functional and facial aesthetic outcomes, with patient safety ensured and a minimum of OGS-related complications. Progression from the conventional orthodontics-first approach to the surgery-first OGS approach decreased the overall treatment time. Transition from 1-jaw to 2-jaw surgery enabled more consistent aesthetic outcomes to be achieved. Conversion from the 2-splint to the single-splint technique enabled development of a more precise tridimensional simulation plan and surgical execution, including in challenging scenarios such as malocclusion associated with facial asymmetry. Clockwise pitch rotation of the maxillomandibular complex has been designed for facial aesthetic purposes in class III malocclusion, whereas counterclockwise pitch rotation of the maxillomandibular complex improves airway function in those with sleep apnea. CONCLUSIONS: The lessons learned from experience and outcome-based articles reveal that OGS has successfully evolved at the CGCC, with a balance being achieved between functional and aesthetic outcomes and effective decreases in the burden of care (ie, morbidity, complications, and treatment time).

Esthetic Interdisciplinary Treatment: An Effective Approach to Address Complex Short-Face Adult Cases.

Traditional interdisciplinary treatment (IDT) for simultaneous correction of complex facial, smile, and dental problems in a so-called "shortface" adult patient can be extremely challenging. Such treatment typically has been based mainly on dental diagnosis with little or no consideration given to the proper correspondence of teeth position to the patient's jaws so as to enhance overall esthetics. Modern esthetic interdisciplinary treatment (E-IDT), however, is an overall esthetics-driven treatment planning approach based on a global diagnosis rather than primarily a dental diagnosis, while still considering the patient's health and function. This article, which features a clinical report, describes treatment of a woman with a short, square face who originally was contemplating cosmetic surgery for correction of her facial features. Instead, a nonsurgical E-IDT approach was taken to successfully and wholly resolve her multifaceted disorders. The article reviews conventional treatment options for short-face adult patients and explains modern E-IDT, which may involve a combination of orthodontic therapy, implant treatment, periodontal treatment, and prosthodontic correction.

Retrospective and Clinical Evaluation of Aftermarket CAD/CAM Titanium Abutments Supporting Posterior Splinted Prostheses and Single Crowns.

PURPOSE: To evaluate the clinical outcomes of aftermarket computer-aided design/computer-assisted manufacturing (CAD/CAM) titanium abutments supporting splinted prostheses and single crowns in the posterior region. MATERIALS AND METHODS: This study retrospectively evaluated the records of patients who received posterior implant-supported splinted restorations and single crowns supported by aftermarket CAD/CAM titanium abutments. Recall and clinical examination of the patients were performed between January 2017 and February 2018. A logistic regression was conducted to evaluate the influence of variables on the occurrence of complications and success rates. Correlations between the bone-level change and variables were calculated using the Spearman correlation. RESULTS: One hundred thirty-five patients with 287 implants (86 crowns and 97 splinted prostheses) were recalled and examined clinically and radiographically after a mean observation period of 6.3 ± 1.2 years (range 4.1 to 9 years). Failure of 3 implants led to a survival rate of 99.0%. Complications included 18 (9.8%) ceramic chippings, 15 (8.2%) screw loosenings, 8 (4.4%) decementations, 52 (38.5%) patients with peri-implant mucositis, and 9 (6.7%) patients with peri-implantitis. A significantly higher incidence of ceramic chipping occurred with bruxers (odds ratio [OR] = 3.939, 95% confidence interval [CI] = 1.28-12.09, P < .05). All screw loosenings occurred in single crowns. All decementations were observed in restorations cemented with temporary cement. Marginal bone loss around implants was significantly correlated with smoking (r = -0.155, P < .05). Hypertension was significantly associated with peri-implant mucositis (OR = 4.7, 95% CI = 1.65-13.39, P < .05). The technical success rate was 80.1%. The biologic success rate was 57%. There was no association between the restoration type and the success rates of the restorations. CONCLUSIONS: Using aftermarket CAD/CAM titanium abutments to support posterior restorations yielded comparable survival and success rates after a mean observation period of 6 years. However, in light of the relatively high incidence of screw loosenings, especially in patients receiving single-implant crowns, informing patients of the additional chairside aftercare with this type of treatment option is recommended.

The immediate effect of alternate rapid maxillary expansions and constrictions on the alveolus: a retrospective cone beam computed tomography study.

BACKGROUND: Rapid maxillary expansion reduced the expander's anchor teeth buccal alveolar bone thickness. However, the effects of alternate rapid maxillary expansions and constrictions (Alt-RAMEC) on the expander's anchor teeth alveolar thickness has not been assessed. The purpose of this retrospective study was to evaluate the effects of Alt-RAMEC on the alveolus surrounding the anchor teeth of a double-hinged expander. METHODS: Twenty-six individuals, including 12 males (11.5 ± 1.00 years) and 14 females (11.5 ± 0.90 years), who had double-hinged expander for 7 weeks of Alt-RAMEC and then 3 months of maxillary protraction, were included. Their cone beam computed tomography (CBCT) images taken 3-6 months before treatment (T0) and after 7 week of Alt-RAMEC (T1), were studied for the buccal alveolar bone thickness (BABT) and palatal alveolar bone thickness (PABT) of the expander's anchor teeth (first molars and first and second premolars) in four axial sections. The intra-class correlation coefficient, Dahlberg's formula, and paired t tests were used to analyze the method errors, and the intra-group changes of the BABT and PABT at T0-T1 were analyzed by paired t test (p < 0.05). RESULTS: The 7 weeks of Alt-RAMEC significantly reduced the BABT of the expander's anterior anchor teeth (0.54~ 70 mm, p < 0.05) and at the cervical region (0.14~ 0.25 mm, p < 0.05), but not at the apical region of the expander's posterior anchor teeth. The reduction of BABT by 7 weeks of Alt-RAMEC was within the scope of the initial BABT. On the opposite, the Alt-RAMEC significantly (p < 0.05) increased the PABT in the anterior anchor teeth and the cervical region of posterior anchor teeth. CONCLUSIONS: A 7-week protocol of Alt-RAMEC with double-hinged expander for maxillary protraction might reduce the buccal alveolar bone thickness of the expander's anchor teeth, although the reduction is within the scope of initial alveolar thickness of the expander's anchor teeth.

Airway Changes after Cleft Orthognathic Surgery Evaluated by Three-Dimensional Computed Tomography and Overnight Polysomnographic Study.

Cleft lip and palate is the most common congenital craniofacial anomaly. Up to 60% of these patients will benefit from cleft orthognathic surgery, which consists primarily of maxillary advancement and mandibular setback to address midface retrusion and relative mandibular protrusion, respectively. It is believed that maxillary advancement can enlarge the airway whilst mandibular setback can reduce the airway, but this has not previously been quantified for cleft patients undergoing orthognathic surgery. This unique longitudinal prospective study of 18 patients was conducted between April 2013 and July 2016. No significant changes occurred by six months postoperatively in body mass index, apnoea-hypopnoea index or lowest oxygen saturation (LSAT). There was a mean increase of 0.73 cm3 in velopharyngeal volume, a mean decrease of 0.79 cm3 in oropharyngeal volume, an improvement in snoring index, and no statistically significant change in hypopharyngeal volume. In conclusion, cleft orthognathic surgery that produced anterior advancement of the maxilla, setback of the mandible and clockwise rotation of the maxillo-mandibular complex resulted in increased velopharyngeal, decreased oropharyngeal and unchanged hypopharyngeal airways, and improved snoring, but did not significantly alter objective sleep-related breathing function.

Three-dimensional surgical simulation improves the planning for correction of facial prognathism and asymmetry: A qualitative and quantitative study.

Traditional planning method for orthognathic surgery has limitations of cephalometric analysis, especially for patients with asymmetry. The aim of this study was to assess surgical plan modification after 3-demensional (3D) simulation. The procedures were to perform traditional surgical planning, construction of 3D model for the initial surgical plan (P1), 3D model of altered surgical plan after simulation (P2), comparison between P1 and P2 models, surgical execution, and postoperative validation using superimposition and root-mean-square difference (RMSD) between postoperative 3D image and P2 simulation model. Surgical plan was modified after 3D simulation in 93% of the cases. Absolute linear changes of landmarks in mediolateral direction (x-axis) were significant and between 1.11 to 1.62 mm. The pitch, yaw, and roll rotation as well as ramus inclination correction also showed significant changes after the 3D planning. Yaw rotation of the maxillomandibular complex (1.88 ± 0.32°) and change of ramus inclination (3.37 ± 3.21°) were most frequently performed for correction of the facial asymmetry. Errors between the postsurgical image and 3D simulation were acceptable, with RMSD 0.63 ± 0.25 mm for the maxilla and 0.85 ± 0.41 mm for the mandible. The information from this study could be used to augment the clinical planning and surgical execution when a conventional approach is applied.

Lysophosphatidylcholine induces cytotoxicity/apoptosis and IL-8 production of human endothelial cells: Related mechanisms.

Increased levels of oxidized low-density lipoprotein oxLDL) are shown to elevate the risk of cardiovascular diseases such as atherosclerosis, thrombosis, stroke, and myocardial infarction. This is possibly due to the toxic effects of oxLDLs on vascular cells. Various oxLDLs including lysophosphatidylcholine (LPC) and 7-ketocholesterol injure vascular endothelial cells and stimulate inflammatory reaction. However the toxicity of LPC on endothelial cells is not clear. In this study, human endothelial cells were exposed to LPC. Cytotoxicity was measured by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay. Propidium iodide (PI) staining or PI/Annexin V dual staining flow cytometry were used to determine cell cycle progression and apoptosis. Reactive oxygen species (ROS) level was analyzed by DCFH-DA labeling flow cytometry. RNA and protein expression of endothelial cells was studied by reverse transcriptase-polymerase chain reaction and western blotting. IL-8 secretion was measured by enzyme-linked immunosorbant assay. LPC showed cytotoxicity to endothelial cells (>50 µg/ml). LPC induced cell cycle arrest and apoptosis with concomitant inhibition of cdc2 and cyclin B1 expression. LPC stimulated intracellular ROS production and ATM/Chk2, ATR/Chk1 and Akt activation. IL-8 expression and secretion in endothelial cells were induced by LPC. LPC-induced apoptosis, and IL-8 expression/secretion was attenuated by LY294002, a PI3K/Akt inhibitor. These results reveal that LPC is involved in the pathogenesis of atherosclerosis and vascular diseases by stimulation of inflammation and injury to endothelial cells. These events are related to ROS, ATM/Chk2, ATR/Chk2 and PI3K/Akt signaling. Understanding the toxic mechanisms of LPC is useful for future prevention and treatment atherosclerosis.

Effect of Butyrate on Collagen Expression, Cell Viability, Cell Cycle Progression and Related Proteins Expression of MG-63 Osteoblastic Cells.

AIMS: Butyric acid is one major metabolic product generated by anaerobic Gram-negative bacteria of periodontal and root canal infection. Butyric acid affects the activity of periodontal cells such as osteoblasts. The purposes of this study were to investigate the effects of butyrate on MG-63 osteoblasts. METHODS: MG-63 cells were exposed to butyrate and cell viability was estimated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The mRNA and protein expression of type I collagen and cell cycle-related proteins were measured by reverse-transcriptase polymerase chain reaction (RT-PCR), western blotting or immunofluorescent staining. Cellular production of reactive oxygen species (ROS) was analyzed by 2',7'-dichlorofluorescein (DCF) fluorescence flow cytometry. RESULTS: Exposure to butyrate suppressed cell proliferation, and induced G2/M (8 and 16 mM) cell cycle arrest of MG-63 cells. Some cell apoptosis was noted. The mRNA expression of cdc2 and cyclin-B1 decreased after exposure to butyrate. The protein expression of type I collagen, cdc2 and cyclin B1 were decreased, whereas the expression of p21, p27 and p57 was stimulated. Under the treatment of butyrate, ROS production in MG-63 cells markedly increased. CONCLUSIONS: The secretion of butyric acid by periodontal and root canal microorganisms may inhibit bone cell growth and matrix turnover. This is possibly due to induction of cell cycle arrest and ROS generation and inhibition of collagen expression. These results suggest the involvement of butyric acid in the pathogenesis of periodontal and periapical tissue destruction by impairing bone healing responses.

7-Ketocholesterol induces ATM/ATR, Chk1/Chk2, PI3K/Akt signalings, cytotoxicity and IL-8 production in endothelial cells.

Cardiovascular diseases (atherosclerosis, stroke, myocardiac infarction etc.) are the major systemic diseases of elder peoples in the world. This is possibly due to increased levels of oxidized low-density lipoproteins (oxLDLs) such as 7-ketocholesterol (7-KC) and lysophosphatidylcholine (LPC) that damage vascular endothelial cells, induce inflammatory responses, to elevate the risk of cardiovascular diseases, Alzheimer's disease, and age-related macular degeneration. However the toxic effects of 7-KC on endothelial cells are not known. In this study, 7-KC showed cytotoxicity to endothelial cells at concentrations higher than 10 µg/ml. 7-KC stimulated ATM/Chk2, ATR-Chk1 and p53 signaling pathways in endothelial cells. 7-KC also induced G0/G1 cell cycle arrest and apoptosis with an inhibition of Cyclin dependent kinase 1 (Cdk1) and cyclin B1 expression. Secretion and expression of IL-8 in endothelial cells were stimulated by 7-KC. 7-KC further induced intracellular ROS production as shown by increase in DCF fluorescence and Akt phosphorylation. LY294002 attenuated the 7-KC-induced apoptosis and IL-8 mRNA expression of endothelial cells. These results indicate that oxLDLs such as 7-KC may contribute to the pathogenesis of atherosclerosis, thrombosis and cardiovascular diseases by induction of endothelial damage, apoptosis and inflammatory responses. These events are associated with ROS production, activation of ATM/Chk2, ATR/Chk1, p53 and PI3K/Akt signaling pathways.

Simultaneous maxillo-mandibular distraction in early adolescence as a single treatment modality for durable correction of type II unilateral hemifacial microsomia: Follow-up till completion of growth.

BACKGROUND: Timing of surgical intervention in hemifacial microsomia (HFM) is controversial. Although mandibular osteodistraction in childhood for HFM is popular, recent data for single-stage distraction in growing HFM patients demonstrated long-term relapse. Literature suggests that adolescents in the late mixed dentition age or permanent dentition age (11-16-year-old) had more stable outcomes post-distraction than younger children. We present favorable experience using single-treatment simultaneous maxillo-mandibular distraction in early adolescent Pruzansky-Kaban type II HFM patients. METHODS: This was a retrospective longitudinal study of seven consecutive type IIa/b HFM growing patients (12-16-year-old) treated with simultaneous maxillo-mandibular distraction. Oral commissure cant was photographically measured preoperatively and at 6 months and annually ranging 3-7 years post-distraction. Ramus height and chin deviation were measured from radiographs done preoperatively and at distractor-removal, 1 year, 2 years, and 4 years post-distraction. RESULTS: Average age at osteodistraction and at latest follow-up was 13.7 and 18.6 years, respectively. Improvement was significant (p < 0.05) and sustained for mean oral commissure cant (5.1°-0.41°), mean ramus height ratio (0.59-0.86), and average chin deviation (15.9 mm-1.2 mm). Two subjects had mandibular branch palsy and one had mild pin-tract infection - all resolved. All were satisfied with their facial appearance. CONCLUSION: We have demonstrated good lasting outcomes at completion of growth with single-stage simultaneous maxillo-mandibular distraction for type II HFM adolescents in the late mixed-dentition or older age, and advocate this as an alternative to osteodistraction or orthognathic surgery upon skeletal maturity.

A modified presurgical orthopedic (nasoalveolar molding) device in the treatment of unilateral cleft lip and palate.

Nasoalveolar molding (NAM) can be done effectively to reshape the nasal cartilage and mold the maxillary dentoalveolar arch before surgical cleft lip repair and primary rhinoplasty. Presurgical NAM helps as an adjunct procedure to enhance the esthetic and functional outcome of the surgical procedures. We have developed a modified NAM device to suit to the needs of the patients coming from distant places for the treatment. This device helps in reducing the number of frequent visits the patient needs to take to the craniofacial center. The purpose of this presentation is to report this treatment technique and discuss its application.