Evaluation of mid-buccal gingival recessions and occlusal interferences.

BACKGROUND: Dental malocclusions may cause disruption in occlusal harmony, and destructive interferences during mandibular functional movements can be seen. Ideal occlusal contacts during dynamic mandibular movements may be crucial for preventing the occurrence of mid-buccal gingival recession (mbGR). While determining mbGR risk factors in young adults, the effect of occlusal interferences on mbGR has not yet been focused on. Based on this gap, this field needs to be clarified with new studies. OBJECTIVE: The aim of this case-control study was to evaluate the relationships between the presence, extent and severity of mbGRs to dental malocclusions, occlusal interferences in anterior (AG) and lateral guidance (LG) and to determine the potential risk indicators in a young population. METHODS: A total of 149 dental students were comprised and 70 of them presented mbGR(s) and 79 did not (18-25 years, 4553 teeth). Periodontal status was assessed with full mouth bleeding (FMBS) and plaque score (FMPS), probing depth, clinical attachment level, recession depth and keratinised tissue width (KTW) by a periodontist. Malocclusions and occlusal interferences were evaluated by an orthodontist. Logistic regression analyses provided data on the effect of occlusal interferences and the other indicators towards mbGR. RESULTS: The mean of the number of teeth with mbGR(s) per subject was 4.3. The mean of the overall extent of teeth with mbGR(s) was 14.2%. FMBS, decreased KTW, self-reported bruxism, group function occlusion, increased contact number of all teeth and only premolars/molars in AG or LG and Class III malocclusions were significantly associated with the presence of mbGR. Decreased KTW presenting mbGR in the mandible and non-carious cervical lesion adjunct to mbGR significantly increased the odds of the severity of mbGR. Group function occlusion revealed higher mbGRs in premolar/molars than canine guided occlusion. CONCLUSION: Increase in the occlusal interferences in premolars/molars during lateral and anterior guidance may have an effect on the presence and severity of mbGR. Further studies should be designed to confirm these findings.

Levels of Cytokines in Gingival Crevicular Fluid during Rapid Maxillary Expansion and the Subsequent Retention Period.

OBJECTIVE: To monitor the effects of rapid maxillary expansion (RME) on bone metabolic activities during and after 3 months of retention. STUDY DESIGN: Fifteen patients with a mean age of 12.9 ± 0.6 years were treated with a bonded expansion device, activated 2 turns per day. The retention period was 3 months. Clinical periodontal parameters were recorded at baseline and after retention. Gingival crevicular fluid (GCF) samples were collected from maxillary first molars from the compression sides at baseline, then at 1 and 10 days and after retention. Tension side samples were obtained at baseline and after retention. Interleukin-1beta (IL-1ß), transforming growth factor beta1 (TGF-ß1), prostaglandin E2 (PGE2) and nitric oxide (NO) levels were specifically measured. RESULTS: Periodontal parameters increased significantly after retention relative to baseline values. Levels of IL-1ß, TGF-ß1 and PGE2 increased on day 10, and decreased after retention on the compression side. NO levels were elevated on day 10, and remained higher after retention on the compression side. Tension side cytokine levels remained higher relative to baseline values after retention. CONCLUSIONS: The results of this study indicate the importance of ongoing adaptive bone activities after 3 months of retention with RME, which should be considered questionable as an effective retention period.

Changes in airway dimensions and hyoid bone position following class II correction with forsus fatigue resistant device.

OBJECTIVE: The objective of this study was to investigate the effects of fixed functional therapy on oropharyngeal airway dimensions and hyoid bone positions in Class II patients and make comparison with an untreated Class II group. MATERIALS AND METHODS: Eighteen patients (8 girls, 10 boys; mean age 13.62 ± 1.92 years) who were treated with Forsus Fatique Resistant Device (FFRD) and 19 patients (11 girls, 8 boys; mean age 12.74 ± 0.91 years) who served as control were enrolled. Cephalograms were used to assess linear, angular, and area measurements. Intragroup comparisons were made by paired t and Wilcoxon tests and intergroup comparisons were performed by independent t test. RESULTS: With respect to controls, FFRD group showed increased airway dimensions at soft palate (P < 0.05) and more forward positioning of the hyoid bone (P < 0.05). Dentoalveolar changes exhibited mesial movement of lower incisors and molars and reduction in overjet (P < 0.001) in FFRD group. CONCLUSIONS: Positive effects in oropharyngeal airway dimensions and increased values of hyoid bone displacement to a more forward position were found after fixed functional therapy. CLINICAL RELEVANCE: Treatment with fixed functional appliances is mostly based on mesial movement of mandibular dentition, which might influence changes in tongue posture. The present results might indicate that oropharyngeal airway dimensions may be affected by postural changes of the hyoid bone in consequence of dentoalveolar changes. Clinically, these may be considered especially in Class II cases with reduced airway dimensions.

Cephalometric assessment of soft tissue morphology of patients with acromegaly.

AIM: To assess the sagittal soft tissue morphology of patients with acromegaly in comparison with a healthy control group. METHODS: Twenty-seven patients with acromegaly (11 male, 16 female; mean age 47.3 ± 11.5 years) and 30 healthy subjects (15 male, 15 female; mean age 42.2 ± 17.4 years) were included in the study. Linear and angular measurements were made on lateral cephalograms to evaluate soft tissue and skeletal characteristics. The intergroup comparisons were analysed with the Student's t-test. RESULTS: Facial convexity (p < 0.01) and the nasolabial angle (p < 0.001) were reduced in patients with acromegaly, whereas nose prominence (p < 0.01), upper lip sulcus depth (p < 0.01), upper lip thickness (p < 0.01), basic upper lip thickness (p < 0.01), lower lip protrusion (p < 0.05), mentolabial sulcus depth (p < 0.05) and soft tissue chin thickness (p < 0.001) were increased. Anterior cranial base length (p < 0.05), the supraorbital ridge (p < 0.01), the length of the maxilla and mandible (p < 0.001, p < 0.01, respectively) were significantly increased, and mandibular prognathism was an acromegalic feature (p < 0.05). CONCLUSION: Acromegalic coarsening and thickening of the craniofacial soft tissues was identified from lateral cephalograms, which may therefore contribute to early diagnosis when evaluated together with other changes caused by the disease.

Evaluation of airway dimensions and changes in hyoid bone position following class II functional therapy with activator.

AIM: The aim of this study was to evaluate the long-term effects of Class 2 functional treatment on airway dimensions and positional changes in hyoid bone and compare it with that of an untreated Class 2 control group. METHODS: Lateral cephalograms of 16 patients (eight girls, eight boys, mean chronological age = 11.36 ± 0.77 years) who were treated with activator and 19 patients (11 girls, eight boys, mean chronological age = 12.14 ± 0.65 years) who served as control were used for linear, angular and area measurements regarding airway track and hyoid bone. Statistics. Intra-group comparisons were performed by paired t-test and Wilcoxon test, whereas independent t-test and Mann Whitney-U were used for inter-group comparisons. RESULTS: During treatment (T2-T1), nasopharyngeal height and nasopharyngeal area increased (p < 0.05) and hyoid bone moved downward (H-SN; p < 0.001) and forward (H-C3; p < 0.01). During retention period (T3-T2); nasopharyngeal (p < 0.01) and oropharyngeal area increased (p < 0.05). H-SN (p < 0.01) and C3-H distances (p < 0.05) increased. Hyoid bone position exhibited significant changes (H-SN, p < 0.001; C3-H, p < 0.01). The increases in C3-H in long-term was more in the activator group than control (p < 0.05). CONCLUSIONS: In growing Class 2 patients with mandibular deficiency and airway track without obstructions, functional appliance treatment provided favorable effects on nasopharyngeal and oropharyngeal area throughout the retention period.

Aetiological Evaluation of Oligodontia in a Three-Generation Family.

PURPOSE: The aim of this study was to assess the genetic evaluation of a three-generation consanguineous family with isolated oligodontia. MATERIALS AND METHODS: A 16-year-old male patient who had been referred for orthodontic treatment due to the presence of oligodontia, and his family members who presented several missing teeth had been enrolled in the study. Clinical and radiological assessments and genetic analysis including whole-exome sequencing were performed. RESULTS: Genetic evaluations revealed both homozygous and heterozygous mutations (c.T682A:p.F228I) in the WNT10A gene of six affected members of the family. Higher frequency of agenesis of mandibular second molar was found in homozygous relative to heterozygous WNT10A mutations. CONCLUSION: The present findings have provided evidence for a known variant in the WNT10A gene in a three-generation consanguineous family with isolated oligodontia, while the results confirmed that cases with homozygous mutation revealed clinical heterogeneity.

Effect of fluoride-releasing light-cured resin on shear bond strength of orthodontic brackets.

INTRODUCTION: The aim of this study was to analyze the effect of an enamel-protective resin on the shear bond strength (SBS) of orthodontic brackets bonded with self-etching primer. METHODS: Eighty extracted premolars were randomly divided into 4 groups of 20, and metal brackets were bonded. Group 1 specimens were bonded with Transbond Plus self-etching primer (3M Unitek, Monrovia, Calif) and no fluoride resin; in group 2, a fluoride-releasing resin (Ortho-Coat, Pulpdent, Watertown, Mass) was used with the Transbond Plus self-etching primer; group 3 teeth were bonded with a new antimicrobial self-etching primer (Clearfil Protect Bond, Kuraray Medical, Osaka, Japan) with no fluoride resin; and the same protocol was used in group 4 with an application of Ortho-Coat. A universal testing machine was used to determine the SBS, and the adhesive remaining after debonding was assessed. RESULTS: There was no difference in SBS whether fluoride-releasing resin was used. Groups 3 and 4 had higher SBS values than the other groups (P <0.001). The Kruskal-Wallis test showed no significant differences in the adhesive remnant index (chi-square = 0.019, P = 0.990). CONCLUSIONS: The application of enamel-protective resin did not affect the bond strength of orthodontic brackets to enamel with self-etching primer systems.

Effects of maxillary protraction and fixed appliance therapy on the pharyngeal airway.

OBJECTIVE: To evaluate the long-term outcome of treatment with reverse headgear in patients with skeletal Class III malocclusion diagnosed as maxillary deficient. MATERIALS AND METHODS: Twenty-five patients (11 girls, 14 boys; mean age, 11.32 years) treated with a reverse headgear appliance were included in this study. Pretreatment, posttreatment, and 4-year follow-up cephalometric radiographs were obtained; linear, angular, and area measurements were performed. Comparison of treatment and observation changes was performed using a paired t-test. RESULTS: A significant increase was found in the forward movement of the maxilla, which was maintained 4 years after reverse headgear treatment. Treatment changes revealed significant increases in the sagittal dimensions and area of nasopharyngeal airway and remained significant at the end of the 4-year follow-up period. The oropharyngeal airway area increased nonsignificantly after the treatment, but significant increases occurred during the follow-up period. CONCLUSIONS: In young individuals diagnosed with maxillary deficiency treated with reverse headgear, the nasopharyngeal airway dimensions were improved after the treatment, and favorable effects of the treatment remained over the posttreatment period of 4 years.

Endodontic and orthodontic treatment of fused maxillary central incisors: a case report.

The purpose of this case report was to describe combined endodontic and orthodontic treatment of a patient who had permanent maxillary central incisors fused with supernumerary teeth. A severe esthetic problem and crowding in the maxillary arch were present clinically. Radiographic examination demonstrated two separate crowns, roots and pulpal canals on each side. The therapy was initiated with endodontic treatment. Six months after the completion of endodontic therapy, mesio-distal trimming was performed and the defects were restored with anterior resin composites in order to re-establish the esthetics. Orthodontic treatment was performed for the alignment of the upper arch. Follow-up at 4 years demonstrated that the teeth were asymptomatic and neither root nor alveolar bone resorption was found. In conclusion, instead of extracting the supernumerary teeth, the anomaly was treated successfully in a conservative way.

Osteotomy assisted maxillary posterior impaction with miniplate anchorage.

This case report presents orthodontic treatment with miniplate anchorage accelerated by osteotomy-assisted maxillary posterior impaction in a severe open bite case. A 14-year-old girl with a severe anterior open bite was treated by intrusion of the maxillary posterior teeth. A segmental osteotomy was applied, and the miniplates were fixed to the zygomatic buttress area. The intrusive force was applied with nickel-titanium closed coil springs using a force of 250 g between the miniplates and the upper first and second molar buccal tubes. The intrusion was completed 2.5 months after osteotomy. The treatment was continued with the fixed orthodontic appliances and completed after 12 months. At the end of treatment, optimal occlusion and the correction of the anterior open bite were achieved. The maxillary molars were impacted 4.0 mm, and the mandibular plane showed a counterclockwise autorotation of 3.0 degrees . The results showed that osteotomy-facilitated orthodontic treatment clearly reduced the treatment time and had no adverse effects. In conclusion, this one-stage osteotomy technique can be an effective option to help molar intrusion in severe open bite cases.

Information on the Internet Regarding Orthognathic Surgery in Turkey: Is It an Adequate Guide for Potential Patients?

OBJECTIVE: To evaluate the quality of information on websites regarding orthognathic surgery in Turkey using the DISCERN toolkit. METHODS: An Internet search was performed using the Google search engine with the terms "orthognathic surgery", "jaw surgery", "jaw operation", "correcting jaw surgery", and "surgery orthodontics." The first 25 websites obtained after searching for each term were evaluated. Duplicate websites, advertisements, discussion groups, links to research articles, videos, and images were not considered. The remaining websites were analyzed using the DISCERN toolkit. This toolkit is composed of 15 questions that were scored from 1 to 5. Results were calculated as mean scores, percentages, and ranges. RESULTS: Among the 36 evaluated websites, 12 (33.3%) belonged to plastic surgeons, 11 (30.6%) belonged to orthodontists, 8 (22.2%) belonged to private dental clinics, 3 (8.3%) belonged to maxillofacial surgeons, 1 (2.8%) was a professional organization website, and 1 (2.8%) belonged to a private hospital. The Turkish Orthodontic Society had the only listed professional organization website. The mean total DISCERN score was 28/75 (range: 15-48). The overall quality of information in 44.4% of the websites was low. The main problems of websites were as follows: no mention of the aims, sources, and production time of information; no links for additional sources of information; and no information for patient carers. CONCLUSION: The quality of web-based information on orthognathic surgery was generally low. Higher quality information provided by public organizations that do not have profit concerns is required.

Efficacy of different methods to reduce pain during debonding of orthodontic brackets.

OBJECTIVE: To determine pain during debonding and the effects of different pain control methods, gender, and personal traits on the pain experience. MATERIALS AND METHODS: Patients who had fixed orthodontic treatment with metal brackets, but no surgical treatment or craniofacial deformity, were included. Sixty-three patients (32 female, aged 17.2 ± 2.9 years; 31 male aged, 17.2 ± 2.5 years) were allocated to three groups (n = 21) according to the pain control method: finger pressure, elastomeric wafer, or stress relief. Pain experience for each tooth was scored on a visual analogue scale (VAS), and general responses of participants to pain were evaluated by Pain Catastrophizing Scale (PCS). Multiple linear regression analysis, the Mann Whitney U-test, and Spearman's rank correlation coefficient analysis were used to analyze the data. RESULTS: When the VAS scores were adjusted, finger pressure caused a 47% reduction overall, 56% in lower elastomer wafer total, 59% in lower right arch, 62% in lower left, and 62% in lower anterior compared with the elastomeric wafer. In the elastomer wafer group, upper and lower anterior scores were higher than posterior scores, respectively. Females had higher VAS (lower left and anterior) and total PCS scores than males. Regardless of the pain control method, total PCS scores were correlated with total (r = .254), upper total (r = .290), right (r = .258), left (r = .244), and posterior (r = .278) VAS scores. CONCLUSIONS: The stress relief method showed no difference when compared with the other groups. Finger pressure was more effective than the elastomeric wafer in the lower jaw. Higher pain levels were recorded for the anterior regions with the elastomeric wafer. Females and pain catastrophizers gave higher VAS scores.

Levels of interleukin-8 during tooth movement.

A host-derived neutrophil-activating cytokine interleukin-8 (IL-8) is secreted mainly by monocytes and is considered to be important in regulating alveolar bone resorption during tooth movement. The aim of this study was to evaluate the levels of IL-8 during mechanical forces on periodontal tissues at different stages of orthodontic therapy. Ten canine teeth of patients having different Angle classifications were selected for the study. After the premolars were extracted, the maxillary/mandibular canines were tipped distally. Gingival crevicular fluid was sampled from mesial and distal gingival crevices of each canine separately at baseline and one hour, 24 hours, six days, 10 days, and 30 days after the application of the force. An enzyme-linked immunosorbent assay for quantitative detection of IL-8 was used. Although there was an increase in the concentration of IL-8 at tension (mesial) sites after one hour, 24 hours, six days, and 10 days, a decrease was observed at 30 days. Pressure (distal) sites did not demonstrate such an increase at any period except at 10 days. However, the concentration of IL-8 at both sites showed a similar decrease and approached each other at day 30. We concluded that local host response toward the orthodontic forces might lead an increase in IL-8 and neutrophil accumulation, and this may be one of the triggers for bone remodeling processes.

A case report comparing 3-D evaluation in the diagnosis and treatment planning of hemimandibular hyperplasia with conventional radiography.

INTRODUCTION: Cephalometric radiography is the main investigation used in the diagnosis of maxillofacial deformities. Three-dimensional (3-D) computed tomography (3-D CT) imaging has recently been used in the diagnosis and treatment planning of craniofacial morphology. The purpose of this report was to present the diagnosis and treatment planning of a hemimandibular hyperplasia case by using conventional radiographs and 3-D cephalometric analysis. METHODS: A 24-year-old girl presented with hemimandibular hyperplasia and the main complaint was her facial appearance. Conventional cephalometric analysis including lateral and frontal cephalograms were traced by hand and evaluated by the same clinician. Twenty-one measurements on the lateral cephalograms and 13 measurements on the frontal cephalograms were performed. In addition, axial images were reconstructed into a 3-D model by using medical image processing software. Linear and angular measurements were presented in coronal and sagittal planes. RESULTS: The 3-D CT analysis has a superior image quality when compared with conventional cephalograms. CONCLUSIONS: The 3-D CT analysis provides more advanced diagnostic image information in evaluating craniofacial morphology. We conclude that 3-D CT images can facilitate the diagnosis, treatment planning, and outcome evaluation of severe asymmetry cases.