Effect of Alveolar Bone Grafting on Health Quality in Patients With Cleft Lip and Palate.

INTRODUCTION: This study aimed to explore the effect of alveolar bone grafting on the clinical outcomes, health quality, and satisfaction in patients with cleft lip and palate. MATERIALS AND METHODS: Questionnaire review study was done to patients who underwent secondary alveolar bone grafting retrospectively. This study included 28 patients who underwent secondary alveolar bone grafting by harvesting graft from the anterior iliac crest, excluding one, in Oral and Maxillofacial Department, Faculty of Dentistry, Ankara University, Turkey, during the period from January 2012 to March 2016. All patients were operated using the same technique and by the same surgical team. Patients were interviewed to fill Short-Form Health Survey (SF-12) and Postsurgical Patient Satisfaction Questionnaire (PSPSQ) 6 months postoperatively. The questionnaires were used to assess the relationship between health quality and patient satisfaction. Also, grafted sites were evaluated with respect to fistula, presence of cleft palate. RESULTS: The sample consisted of 28 patients (19 females and 9 males), including 13 with bilateral clefts and 15 with unilateral clefts. The mean Physical Component Summary (PCS) and Mental Component Summary (MCS) of SF-12 scores were 54.5718 and 44.6436, respectively. The mean PSPSQ score was 36.7368. PCS scores were found to be significantly correlated with the PSPSQ scores (P ≤0.05). No correlation was found between MCS and PSPSQ scores (P >0.05). A precise and good planned surgery resulted in good satisfaction among patients with cleft lip and palate who underwent alveolar bone grafting. The patient satisfaction was correlated with the success of the operation.

Effects of Surgical and Nonsurgical Rapid Maxillary Expansion on Palatal Structures.

AIM: The aim of the present study was to compare the effects of surgical and nonsurgical rapid maxillary expansion (RME) in skeletally mature patients. MATERIALS AND METHODS: Surgically assisted rapid maxillary expansion (SARME) was used in 18 patients (2 males, 16 females) with a mean age of 19.90 years. Two nonsurgical RME groups were constructed to compare the expansion changes of SARME. Eighteen patients in maximum pubertal peak (12 males, 6 females) with a mean age of 13.04 years comprised the growing RME group, while the nongrowing RME (NG-RME) group consisted of 18 skeletally mature patients (1 male, 17 females) with a mean age of 16.41 years. Thirteen linear and 2 angular measurements were made on the study models taken before expansion (T0) and after 3 months of retention period (T1). Intragroup differences were evaluated with paired t test and the intergroup differences were analyzed with 1-way analysis of variance. RESULTS: All groups showed significant transversal skeletal and dental expansion. The palatal width changes at gingival and midpalate levels were the highest in the NG-RME group (6.85 and 5.84 mm, respectively). The most molar tipping was in the NG-RME group (15.00°) and the palatal vault angle showed the most increase in the SARME group (9.77°). The greatest expansion at the base of palatal vault was in the SARME group (4.42 mm). CONCLUSIONS: The pattern of expansion was rotation of the maxillary halves for SARME and lateral displacement of the dentoalveolar structures for NG-RME. Patients with severe skeletal discrepancy or increased age are good candidates for SARME.

Treatment effects of a twin-force bite corrector versus an activator in comparison with an untreated Class II sample: a preliminary report.

OBJECTIVES: The present study aimed to compare the treatment outcomes of a fixed-functional appliance (Twin-Force Bite Corrector - TFBC) and a conventional removable functional appliance (Activator) in the treatment of skeletal Class II malocclusions. METHODS: The TFBC and Activator Groups each included 10 young adults possessing a skeletal Class II malocclusion, and the treatment outcomes of both groups were quantified and compared, using lateral cephalometric radiographs, with an untreated skeletal Class II Control Group. RESULTS: A skeletal Class I relationship and a marked reduction in overjet were achieved in both treatment groups; however, the duration of treatment was significantly shorter in the TFBC Group (0.45 years) when compared with the Activator Group (1.37 years) (p < 0.001). Effective length and sagittal positioning of the mandible underwent significant changes in the TFBC and Activator Groups. Vertical facial dimensions increased in each group; however, these increases were significantly greater in the Activator Group when compared to the TFBC and Control Groups (p < 0.05). Dentoalveolar changes also contributed to the reduction in overjet. CONCLUSIONS: Although both appliances succeeded in eliminating the Class II relationship and improving the overjet and overbite, the short treatment time in the TFBC Group raises questions regarding the long-term stability of the results.

Validation of a Finite Element Model for Clinical and Virtual Evaluation of the Changes in Airway Dimensions Following Class III Bimaxillary Orthognathic Surgery.

Introduction: The aim of this study was to evaluate pharyngeal airway changes in adult skeletal Class III cases whose bimaxillary surgical treatments were planned with different amounts of maxillary and mandibular movement using lateral cephalometric radiographs and finite element analysis (FEA). Our null hypothesis was that bimaxillary orthognathic surgery in which maxillary forward movement (MF) is greater than mandibular backward movement (MB) will result in more expansion of the pharyngeal airway. Materials and Methods: A total of 31 individuals (11 females, 20 males) with class III skeletal deformity were included in the study. Patients who underwent bimaxillary orthognathic surgery with greater maxillary advancement (MF > MB) were categorized in Group 1 (n = 15), and those with greater mandibular set-back (MB > MF) as Group 2 (n = 16). Changes in airway dimensions were evaluated from lateral cephalometric radiographs. In addition, FEA modeling was used to determine pharyngeal airway changes with 5 different MF/MB combinations performed in skeletal class III bimaxillary surgeries. Results: Nasopharyngeal and oropharyngeal airway dimensions increased in direct proportion to the amount of MF. Hypopharyngeal volume decreased compared to preoperative value in direct proportion to the decrease in MB. According to the FEA models, total pharyngeal airway volume decreased when MF was less than or equal to MB, was nearly unchanged when MF was 2 mm greater than MB, and increased when MF was 4 mm greater than MB. The results of FEA and lateral cephalometric analysis were compatible. Conclusion: Our results supported the null hypothesis. We concluded that when possible, planning slightly more maxillary advancement than mandibular set-back will not have an adverse impact on the airway. Although the skeletal deformity only causes forward displacement of the mandible, dividing the skeletal correction between the maxilla and mandible may be considered to avoid the risk to patients' quality of life in terms of respiratory function.

Relationship between vertical facial morphology and dental arch measurements in class II malocclusion: a retrospective study.

Background: To evaluate the relationship between dental arch measurements and the vertical facial pattern determined in skeletal Class II untreated patients. Methods: Lateral cephalograms and plaster models were obtained from 124 untreated female adults (average age: 17.6 ± 3.8 years). Class I (CI), Class II Division 1 (CII/1) and Class II Division 2 (CII/2) malocclusions were divided into three subgroups according to their vertical morphology as hypodivergent, normodivergent and hyperdivergent. The multivariate variance analysis (MANOVA) method was used in the comparison of measurement values according to vertical and sagittal morphology. The relationship between both A point-Nasion-B point (ANB) and Frankfurt-mandibular plane (FMA) angles and dental arch measurements was examined by Pearson correlation analysis. The significance level was received as p < 0.05. Results: While vertical morphology has a statistically significant effect on mandibular arch length, sagittal morphology affects maxillary arch depth. The parameters influenced by both morphologies are maxillary and mandibular arch length, as well as maxillary intermolar width. The mandibular arch length was significantly shorter in hyperdivergent-CII-2 malocclusion (50.5 ± 7.4 mm). Larger values were obtained in both mandibular arch length and maxillary arch depth measurements in CII-1 malocclusion compared to CII-2 malocclusion. The maxillary intermolar width was significantly shorter in hypodivergent-CII-1 malocclusion (46.8 ± 3.4 mm), while it was higher in hypodivergent-CI malocclusion (51.1 ± 3.4 mm). The maxillary arch length was the lowest in hyperdivergent-CI malocclusion (63.1 ± 13.3 mm) and the highest in hypodivergent-CI malocclusion (72.8 ± 7.6 mm). Additionally, a positive but weak correlation was found between ANB and FMA angles. Conclusion: Dental arch measurements have been found to be affected by both vertical facial morphology and skeletal sagittal relationship. A positive correlation was found between ANB and FMA angles.

A retrospective comparison of two protocols for correction of skeletal Class III malocclusion in prepubertal children: hybrid hyrax expander with mandibular miniplates and rapid maxillary expansion with face mask.

BACKGROUND: This study compared the skeletal and dental effects of a hybrid maxillary expander with mandibular miniplates (HE-MP) and Class III elastics to conventional tooth-borne rapid maxillary expander and face mask (RME-FM) in skeletal Class III treatment. METHODS: This retrospective study included 36 skeletal Class III patients. Eighteen patients (mean age 10.24 ± 1.31 years) were treated with a hybrid expander, two mandibular L-shaped miniplates and full-time Class III elastics (HE-MP group). Their results were compared to a group of patients treated with conventional RME-FM (n = 18; mean age 10.56 ± 1.41 year). Radiographs were taken before (T1) and after treatment (T2). All patients were in cervical maturation stages CS1-CS3 at T1. The measured outcomes were the changes in sagittal and vertical skeletal and dental cephalometric measurements. RESULTS: Treatment time was approximately 15.5 ± 2.8 months with the HE-MP and 11.85 ± 3.41 months for the RME-FM. The Class III malocclusion was corrected in both groups with significant changes. The maxilla advanced more in the HE-MP group, with an increase in SNA of 4.26° ± 2.15° compared to 1.14 ± 0.93 in the RME-FM group (p < 0.001). The effect on the mandible was similar in both groups, while the overall skeletal change was significantly greater with HE-MP, with an increase in the ANB of 5.25° ± 2.03° and a Wits appraisal increase of 6.03 ± 3.13 mm, as opposed to 2.04° ± 1.07° and 2.94 ± 1.75 mm with the RME-FM (p < 0.001). Dental changes were significantly higher with RME-FM, with an increase in incisor inclination (U1-SN) of 5.02° ± 3.93° (p < 0.001), with no significant changes in the HE-MP group. The mandibular incisors retroclined by 5.29° ± 3.57° at L1-MP with the RME-FM, while they advanced slightly with the HE-MP by 2.87° ± 5.37° (p < 0.001). CONCLUSION: The use of skeletal anchorage for maxillary expansion and protraction significantly increases skeletal effects and reduces dental side effects compared to tooth-borne maxillary expansion and protraction. These results need to be investigated in the long term.

Evaluation of Dental Age in Individuals of Different Ages with Unilateral Cleft Lip and Palate.

OBJECTIVE: This study aimed to evaluate the dental age of unilateral cleft lip and palate (UCLP) patients aged 7-12 and 12-16 years using Demirjian's method and to compare these results with a control group. METHODS: We evaluated the panoramic radiographs of 54 individuals with UCLP and 54 age- and gender-matched individuals without UCLP (control). The UCLP and control groups were divided into two groups: 7-12 and 12-16 years of age. Their dental ages were determined using Demirjian's method. Dental ages of the cleft side and noncleft side were assessed separately and were also compared with those of the control group to assess potential asymmetric dental developments in the UCLP group. RESULTS: The chronological age was lower than the dental ages on both right and left sides in the control group (p<0.01). When age groups were evaluated separately, it was found that the chronological age was lower than the dental age in 7-12 year old individuals in the UCLP group (p<0.05), whereas it was less than the left and right dental ages in 7-12 (p<0.01) and 12-16 year old individuals (p<0.05) in the control group. CONCLUSION: We detected no differences in dental age between UCLP patients and healthy controls, and lack of asymmetrical dental development in the mandibular teeth of either group. However, based on assessments performed using Demirjian's method, subjects' dental and chronological ages were incompatible.

Is It Possible to Protract the Maxilla by Surgically Assisted Rapid Maxillary Expansion and Intermaxillary Class III Elastics?

OBJECTIVE: The purpose of the present study was to evaluate skeletal and soft tissue changes with surgically assisted rapid maxillary expansion (SARME) and intermaxillary Class III elastics. METHODS: A total of 15 patients (mean age: 19.58 years) were included in the study. Each patient underwent SARME with the use of Class III elastics (500 g) applied through miniscrews to stimulate maxillary advancement. Lateral cephalograms and posteroanterior radiographs obtained before treatment (T1), after SARME and elastic use (T2), and after treatment (T3) were analyzed to determine the changes in each phase of treatment. Planimeter was used to evaluate facial soft tissue changes. Wilcoxon signed-rank test was used to evaluate the changes that occur during treatment. RESULTS: SARME provided permanent and efficient maxillary expansion at both skeletal and dental levels (p<0.01). Maxillary skeletal (ANS-Ver and U1i-Ver; p<0.01) and soft tissue (Pr-Ver, Sn-Ver, and ULA-Ver; p<0.01) variables and superior upper labial area (Area 1; p<0.05) increased due to maxillary dental and skeletal changes. Superior lower labial area (Area 3; p<0.05) decreased as a result of slight increase in facial height and changes in maxillary-mandibular incisor relationship at the end of the treatment. CONCLUSION: The results suggest that the improvement in the facial profiles of the patients is related to the significant increase in the bony and dental support of the upper lip region together with the contribution of the superior lower lip area.

Comparison of the Accuracy of Manual and Digital Cephalometric Prediction Methods in Orthognathic Surgical Planning: A Pilot Study.

OBJECTIVE: To compare and evaluate the reliability of manual and digital cephalometric prediction methods in orthognathic surgical planning. METHODS: Ten adults (5 females and 5 males) with skeletal class III malocclusion were included. The mean patient age was 21.97 years. Pre- to postoperative changes were evaluated using paired t-test. Manual surgical predictions made by tracing on acetate paper and digital predictions made using computer software were compared with actual postoperative values using intraclass correlation coefficient and root mean square. RESULTS: Statistically significant changes were observed in SNA, SNB, ANB, U1i-FH, and Nperp-A following bimaxillary orthognathic surgery (p<0.001). Postoperative changes in Co-A and Nperp-Pg were statistically significant (p<0.05). Comparison of manual and digital surgical predictions with actual postoperative values revealed that overbite and overjet showed the lowest agreements. Manual predictions were less accurate for points that were difficult to distinguish (Co and U6). Skeletal predictions were more accurate than dental predictions. CONCLUSION: Parameters with low reproducibility (Co and U6) decrease the reliability of predictions. Dental predictions were inaccurate in both methods due to the effects of intermaxillary elastics, but both methods yielded similar predictions for skeletal parameters. The impact of applying strong elastics for postoperative intermaxillary fixation should be considered when making surgical predictions.

Presurgical Nasoalveolar Molding of Bilateral Cleft Lip and Palate Infants: An Orthodontist's Point of View.

Nonsyndromic complete cleft lip and palate deformity is primarily functional, then esthetic, and finally but not least importantly, a dental challenge. Feeding and facial appearance are important during the first years of a newborn. Nutrition is universally provided by passive feeding plates. If the Cleft Team prefers to use active plates, alveolar molding combined with nasal approaches in infants is the best method to improve esthetics to date. Orthodontists are predominantly responsible for achieving both the goals. After those difficulties have been met in early days of the life, dentists are mainly responsible for the treatment thereafter. If the infants have a dentoalveolar unity without any fistulas and correctly aligned maxillary deciduous teeth, this is a real success. Therefore, this article is an overview of presurgical infant orthopedics and its contribution to subsequent dental practice.

Class II Young Adult Treatment with Twin Force Bite Corrector: 10-Year Follow-up.

One of the most preferred compliance free fixed functional appliances in nongrowing patients is Twin Force Bite corrector (TFBC). The aim of this case report is to evaluate the effectiveness of TFBC in the treatment of an adult Class II case. A 16-year 1-month-old boy having skeletal and dental Class II relationship was selected. Roth 0.018 × 0.025 inch slots brackets were attached; a fixed lingual arch in the mandibular dental arch and a Nance appliance in the maxillary dental arch were used to increase anchorage. The TFBC therapy used for sagittal activation and stimulation of forward mandibular growth lasted for 3 months. The post-TFBC treatment lasted 6 months and the total treatment time was 9 months. Treatment of a young adult Class II malocclusion with TFBC resulted in a Class I molar occlusion, an ideal overjet, overbite, and incisor angulation in a short time and maintained in the 10-year follow-up.