Assessment of Changes in Behavior and Quality of Life after Monobloc Treatment in Children with Obstructive Sleep Apnea or Primary Snoring.

Objective: The aim of this study was to examine the quality of life and behavioral disorders in children with obstructive sleep apnea (OSA) or primary snoring, as well as how these problems changed after monobloc treatment. Methods: Fourteen children with primary snoring and 16 children with OSA who had skeletal class II malocclusion due to mandibular retrognathia were treated with monobloc appliances. To investigate the relationship between behavioral disorders and quality of life, parents were asked to complete four questionnaires: attention deficit and hyperactivity disorder (ADHD) scale, strength and difficulties questionnaire (SDQ), pediatric sleep questionnaire (PSQ), and Pittsburgh sleep quality scale (PSQS). Mann-Whitney U and Wilcoxon signed-rank tests were used to evaluate the data. Results: According to the results of the PSQ and PSQS, an increase in sleep quality was observed after monobloc treatment. The decrease in the total ADHD score at the end of the treatment was found to be statistically significant in both the OSA (p<0.01) and snoring (p<0.01) groups. According to the SDQ scores, the increase in the social behavior score and the decrease in the peer bullying score in the snoring group were statistically significant (p<0.05). Conclusion: The use of a monobloc appliance in pediatric patients exhibiting primary snoring and OSA resulted in a notable reduction in sleep-breathing disorder symptoms and a notable enhancement in their overall quality of life. Based on the analyses of the questionnaires, it was concluded that the increase in sleep quality improved the pediatric patients' quality of life after orthodontic treatment with orthodontic monobloc appliances.

The effects of two methods of Class III malocclusion treatment on temporomandibular disorders.

The aim of this research was to evaluate, within a controlled clinical study, the effects of a Delaire-type facemask or a modified Jasper Jumper (JJ) used in the treatment of children with Class III malocclusions due to maxillary retrognathia on temporomandibular disorders (TMDs). Forty-six patients with Class III malocclusions referred for orthodontic treatment were divided into two groups, a test and a control. The test group comprised 33 randomly chosen patients (15 females, 18 males) aged 8-11 years. The control group included 13 patients (eight females, five males) with similar features. TMD assessment was performed before and after treatment using a two-axis questionnaire, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMDs). Qualitative data were evaluated using chi-square and McNemar tests. No statistically significant differences related to the presence of TMD were observed pre- or post-treatment (P > 0.05). The most commonly encountered diagnosis was arthralgia in the JJ group both before and after treatment. Evaluation of joint and muscle regions showed decreased symptoms, apart from the diagnosed discomforts, in the JJ group (P < 0.05). Reduced symptoms were observed in the Delaire group; however, this reduction was not statistically significant. An increase, not considered to be statistically significant, was observed in the control group. The Delaire-type facemask and modified JJ used in the early phase of Class III malocclusion treatment did not result in TMD.

Comparison of objective wear time between monoblock and twin-block appliances measured by microsensor.

OBJECTIVES: To assess the objective compliance levels in skeletal Class II patients with mandibular retrognathia wearing monoblock and twin-block appliances. MATERIALS AND METHODS: A prospective clinical study was conducted with 30 patients between 10 and 15 years old who were equally divided into two study groups. Group 1 was treated with monoblock, and group 2 was treated with twin-block appliances. The patients were instructed to wear their appliance for 15 hours per day. Wear times were monitored by a microsensor. (TheraMon; MCTechnology, Hargelsberg, Austria) for an average of six appointments. Patients were also instructed to record their wear times on a chart, and this record was admitted as subjective wear time. Statistical analysis was performed with the data derived from both the patients' charts and the monitoring records. RESULTS: The mean wear time by the patients was 10.67 ± 3.93 hours, which was less than the 15 hours prescribed by the orthodontist, with no difference between the two appliances (P > .05). The regular use rate, which included the days with a wear time of 8 hours or more per day, was 75%. Compliance levels decreased by 35% throughout the six control appointments. Patients declared that their wear time was more than their objective wear time by an average of 3.76 hours. CONCLUSIONS: Despite their different designs, there was no significant difference between the monoblock and twin-block appliances in terms of compliance.

Attention-Deficit Hyperactivity Disorder Symptoms in A Group of Children Receiving Orthodontic Treatment in Turkey.

OBJECTIVE: Children with attention-deficit hyperactivity disorder (ADHD) are known to have several oral health problems, particularly traumatic dental injuries, decayed or filled teeth, and poor oral hygiene. The objective of the present study was to determine the ADHD symptoms in a group of patients with malocclusion and receiving orthodontic treatment. METHODS: A total of 88 subjects with a diagnosis of malocclusion between aged 8 and 17 years were included in the study. Socio-demographic characteristics, breastfeeding history, oral habits, and dental trauma history of the subjects were acquired by a detailed questionnaire. Subjects and their parents completed questionnaires addressing ADHD, other psychiatric problems, and dental health impact on the quality of life. During the orthodontic examination, the Index of Complexity, Outcome, and Need was applied to confirm the diagnosis of malocclusion. RESULTS: Parent-reported psychiatric complaint occurred in almost half of the patients (n=38, 43.2%); the most frequent psychiatric complaints were inattention (n=22, 25%), opposition (n=13, 14.8%), and hyperactivity (n=11, 12.5%). The estimated ADHD prevalence according to parent measure was 15.9% (n=14). Self-report measures revealed that 18.4% (n=16) had behavioral symptoms. The most affected quality of life domain was psychological discomfort. CONCLUSION: The findings indicate that ADHD prevalence in children with malocclusion is high. The orthodontists should have a keen eye on behavioral problems.

An atypical form of necrotizing periodontitis.

BACKGROUND: Necrotizing ulcerative gingivitis/periodontitis are considered necrotizing periodontal diseases. This case report presents an atypical form of necrotizing periodontitis, which does not fit into this classification. METHODS: A 12-year-old child was referred to our clinic for gingival inflammation, extensive alveolar bone loss, and tooth mobility. Clinical and microbiologic examinations were carried out, and radiographs were taken. Clinical examination revealed soft and hard tissue destruction up to the mucogingival junction at the right maxillary premolar and mandibular incisors. Unusual infections or abnormalities in systemic functions were not detected through clinical and laboratory evaluations made at the Pediatrics Department, Istanbul University. Although an intensive established treatment protocol for necrotizing periodontitis was completed, management of long-standing health conditions could not be achieved because of recurrence of the disease, which caused us to repeat this treatment protocol at short intervals. RESULTS: Investigation led to a diagnosis of an atypical form of necrotizing periodontitis because the disease had a recurrent acute phase even under a standard treatment protocol. CONCLUSIONS: Our patient exhibits an unusual, necrotizing form of periodontal disease. The reason for the rapid rate of periodontal disease progression remains unclear.

Evaluation of Orthodontic Patients at State and Foundation Universities According to the ICON Index.

OBJECTIVE: In Turkey, orthodontic treatments of individuals aged <18 years are covered by the Social Security Institution (SSI) according to the Index of Complexity, Outcome, and Need (ICON) index at contracted healthcare providers. The aim of this study was to determine treatment needs and difficulties of patients applying to orthodontic clinics in state and foundation universities in Istanbul according to the ICON and to evaluate the extent of treatment coverage by the SSI. METHODS: Pre-treatment study casts of 831 patients were evaluated in terms of treatment needs and difficulties according to the ICON. This sample was distributed as 677 patients who applied to a State University's Orthodontic Department and 154 who applied to a Foundation University's Orthodontic Department. RESULTS: At the state university, 27.9% of the 437 patients had a score of <43 and were thus, described as "no treatment needed." At the foundation university, 35% of the 154 patients had a score <43 and were thus, described as "no treatment needed." When the ICON scores of the two universities were compared, no statistically significant difference was found between treatment needs distributions. CONCLUSION: The number of patients who applied for treatment for the same period was three times higher in the state university than in the foundation university, whereas the rates of treatment needs were found to be similar between both state and foundation universities. At both universities, nearly one-third of patients were evaluated as "no treatment needed." The ICON index was found to be a reliable index in terms of reproducibility.

Evaluation of Skeletal and Dental Effects of Modified Jasper Jumper Appliance and Delaire Face Mask with Pancherz Analysis.

OBJECTIVE: The aim of this study was to evaluate the skeletal and dental changes in Class III patients treated with Modified Jasper Jumper appliance and Delaire face mask before the growth peak. METHODS: A study sample comprising 16 patients with functional Class III malocclusion treated with Modified Jasper Jumper appliance and 17 patients treated with Delaire face mask was compared with a control group comprising 13 patients. Pancherz analysis was used as the analysis method. RESULTS: In both treatment groups forward movement of maxillary base and incisors and an increase in the overjet while no positional change in the mandibular base was observed. In the Modified Jasper Jumper group, 4.63 mm overjet correction was due to 51.4% skeletal and 48.6% dental changes; 4.77 mm Class III molar correction was due to 49.9% skeletal and 50.1% dental changes. In the Delaire face mask group, 5.17 mm overjet correction was due to 70.6% skeletal and 29.4% dental changes and 4.87 mm Class III molar correction was due to 75% skeletal and 25% dental changes. CONCLUSION: It was shown that both appliances were skeletally and dentally effective. Therefore, Modified Jasper Jumper therapy may be an alternative treatment modality for patients with poor cooperation, who are not ideal recipients for Delaire face mask.

Clinical and cephalometric analysis of three cases with pycnodysostosis: case reports.

The aim of this article is to present intra- and extra-oral and cephalometric findings of three patients with a rare disease: the pycnodysostosis. Two cases had skeletal Class III malocclusion due to maxillary retrognathia and one had bimaxillary retrusion with Class I relationship. Total circular crossbite, increased gonial angle and vertical facial proportions, deep-narrow palates and retruded upper lip were found in all cases. Maxillary expansion, face mask treatment or/and orthognathic surgery are treatment alternatives, considering the growth and development. Bone fragility and the risk of osteomyelitis after extractions should be considered in such cases before orthodontic treatment and orthognatic surgery.