Relationship between palatally impacted canines and dimensions and morphology of sella turcica: A cone-beam computed tomography study.

INTRODUCTION: This study aimed to analyze the association of unilateral and bilateral palatal canine impaction with the dimensions and morphology of sella turcica from 3-dimensional cone-beam computed tomography (CBCT) images. METHODS: CBCT images of patients with bilateral (BPI) (n = 12; 9 female 3 male; 20.75 ± 5.88 years) and unilateral (UPI) (n = 35; 22 female 13 male; 19.28 ± 5.57 years) palatally impacted canines were compared with a control group (n = 56; 34 female 22 male; 20.82 ± 4.88 years). Linear measurements regarding sella turcica were made, and its morphologic variations were categorized. Two group comparisons were made with the Student t test or Mann-Whitney U-test, whereas one-way analysis of variance or Kruskal-Wallis tests were used for multiple group comparisons. Categorical variables were compared using the chi-square or Fisher exact test as appropriate. The binary logistic regression analyses and correlations using Spearman or Pearson correlation analyses were used to determine associations between variables (P <0.05). RESULTS: Sella diameter was significantly smaller in the BPI group compared to UPI and control groups. There was a significant association between sella diameter and BPI when compared with the control group (χ2[1] = 9.150; P = 0.008). There were no significant differences between groups in the distribution of sella turcica morphology. CONCLUSIONS: Despite the similar genetic origin of the sella turcica region and teeth, the association of palatal canine impaction with dimensions and morphology of sella turcica was weak. Both local and genetic factors might contribute to the ectopic position of the canine.

Three-dimensional digital evaluation of tooth symmetry and volume in patients with missing and peg-shaped maxillary lateral incisors.

INTRODUCTION: This study aimed to evaluate the 3-dimensional tooth crown symmetry and the crown volumes of maxillary and mandibular teeth in patients with unilateral or bilateral missing or peg-shaped maxillary lateral incisors. METHODS: Six groups were established for the possible clinical variations in patients with unilateral missing or peg-shaped maxillary lateral incisors, bilateral presence of these tooth anomalies, and a control group (CG) with normal lateral incisors. The study was conducted on digital dental models of 132 patients. The morphologic symmetry of the antimere teeth was investigated using 3-dimensional deviation analysis. Volumes of contralateral teeth were compared within and among groups for the maxilla and mandible. Furthermore, volumes of teeth were compared in missing and peg-shaped quadrants and quadrants of CG. Intergroup differences were tested using one-way analysis of variance and Kruskal-Wallis tests, whereas paired t and Wilcoxon tests were used for parametric and nonparametric variables, respectively, for intragroup comparisons. RESULTS: Significant deviations in symmetry of antimere teeth were not detected (P >0.05). The volumes of mandibular central and lateral incisors in missing or peg-shaped lateral incisor groups were smaller than in the CG (P <0.05). Per quadrant analysis, volumes of the maxillary central incisor and mandibular central incisors, canines, and first molars in quadrants with missing or peg-shaped lateral incisors were smaller than in the control quadrants (P <0.05). CONCLUSIONS: Neither unilateral nor bilateral presence of missing or peg-shaped maxillary lateral incisors affected the morphologic symmetry of antimere teeth but did affect tooth volume, especially in the mandibular arch.

Assessment of salivary stress and pain biomarkers and their relation to self-reported pain intensity during orthodontic tooth movement: a longitudinal and prospective study.

PURPOSE: The aim of this prospective study was to evaluate the relationship between pain intensity and concentrations of salivary pain and stress biomarkers during orthodontic tooth movement. METHODS: Eighteen patients (8 males, 10 females; mean age 14.57 ± 2.39 years) who needed orthodontic treatment with maxillary premolar extraction and segmental canine distalization participated in this study. Baseline samples were collected (T1), and orthodontic attachments were placed to maxillary first molars, second premolars, and canines. Then extractions were performed. After 1­month follow-up, canine distalization started with a segmental wire (T2). Concentrations of salivary α­amylase (sAA), cortisol, secretory immunoglobulin A (sIgA) and chromogranin A (CgA) were examined at T1, T2, and on days 4 (T3), 7 (T4), 14 (T5), and 30 (T6) after starting retraction. Participants also scored their pain on a visual analogue scale (VAS). Pain catastrophizing behavior and dental anxiety levels of the participants were evaluated by the Pain Catastrophizing Scale (PCS) and Corah's Dental Anxiety Scale (C-DAS), respectively. Repeated measure ANOVA, Mann-Whitney U test and Spearman's rank correlation coefficient analysis were used for statistical evaluations (p < 0.05). RESULTS: The maximum values for sAA were seen at T1. Males had higher sAA levels than females with statistical differences at T1, T3, and T4. No significant differences for cortisol, sIgA, and CgA concentrations were observed. The highest mean VAS score was recorded at T3. No correlations were detected between any salivary biomarkers, VAS, C­DAS, and PCS scores. CONCLUSIONS: The stress of starting orthodontic treatment increased sAA levels more than the pain that was experienced during orthodontic tooth movement. Being male was a predictor of higher sAA concentrations. Orthodontic tooth movement did not cause significant alterations in salivary pain and stress biomarkers.

Information on the Internet about clear aligner treatment-an assessment of content, quality, and readability.

PURPOSE: The goal was to evaluate the content, quality, and readability of the information available about clear aligner treatment on the Internet. MATERIALS AND METHODS: The search terms "aligner," "clear aligner," and "Invisalign" (Align Technology, Tempe, AZ, USA) were analyzed in three search engines (Google [Google LLC, Mountain View, CA, USA], Bing [Microsoft, Redmond, WA, USA], and Yahoo [Yahoo, Sunnyvale, CA, USA]). The first 50 websites for each keyword in each search engine were screened. Duplicate websites, advertisements, links to scientific articles, videos, and other irrelevant websites were excluded. The quality of the remaining websites was analyzed using the DISCERN and Journal of American Medical Association (JAMA) benchmark instruments together with the Health on the Net code (HONcode, Health On the Net Foundation, Geneva, Switzerland). The readability of the websites was evaluated by the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL). Statistical analyses were performed by one-way analysis of variance, Kruskal-Wallis and Fischer's exact tests, with p < 0.05 accepted to be statistically significant. RESULTS: Among 111 evaluated websites, most belonged to multidisciplinary dental clinics (n = 49; 44.2%), followed by aligner companies (n = 26; 23.4%), orthodontists (n = 26; 23.4%), and professional organizations (n = 10; 9%). The mean DISCERN score (sections 1 and 2) for all websites was 29.95/75. The average FRES and FKGL were 55.77 and 9.74, respectively. Professional organization websites had significantly higher DISCERN scores than others (p < 0.001), and together with multidisciplinary dental clinic websites, they showed better compliance with JAMA benchmark criteria. Professional organization websites' FRES and FKGL were also higher than other websites (p > 0.05). CONCLUSIONS: Overall, the quality of web-based information about clear aligners was poor and the readability of the data was insufficient. Websites presenting high-quality data with better readability are needed for potential aligner patients.

Evaluation of heat shock protein 70 and toll-like receptor 4 expression in gingival crevicular fluid in response to orthodontic forces.

OBJECTIVES: The aim of this study was to assess the concentrations of heat shock protein 70 (HSP70) and toll-like receptor 4 (TLR4) during orthodontic tooth movement and to compare their levels with interleukin-1ß (IL-1ß), a well-known proinflammatory biomarker. MATERIALS AND METHODS: This study consisted of 20 patients (8 males, 12 females; mean age 14.75 ± 2.34 years) who needed maxillary premolar extraction and segmental canine distalization. Concentrations of HSP70, TLR4, and IL-1ß were examined before extraction (T1), at the 1st (T2), 4th (T3), 7th (T4), 14th (T5), and 30th (T6) days of canine retraction by enzyme-linked immunosorbent assay analysis of gingival crevicular fluid samples. Statistical analyses were performed with repeated measure ANOVA and Spearman's rank correlation coefficient analysis (p < 0.05). RESULTS: HSP70 increased gradually from T1 to T6 and showed significant differences between T1-T6 and T2-T6 (T1:3.28 ± 0.92 ng/ml; T2:3.72 ± 0.66 ng/ml; T6:9.35 ± 2.45 ng/ml). The lowest TLR4 concentration was at T1, peaked at T3 and remained constant afterwards with significant differences between T1-T3, T1-T4, and T1-T6 (T1:0.71 ± 0.02 pg/ml; T3:1.04 ± 0.11 pg/ml; T4:0.95 ± 0.06 pg/ml; T6:1.00 ± 0.07 pg/ml). IL-1ß increased from T1 to T6 with significant differences between T1-T4, T1-T5, and T1-T6 (T1:55.71 ± 5.48 pg/ml; T4:100.11 ± 16.92 pg/ml; T5:103.71 ± 23.19 pg/ml; T6:125.12 ± 22.04 pg/ml). The increase in HSP70 and TLR4 from T2-T3 showed a significant correlation (r = 0.598; p = 0.005). CONCLUSIONS: The increased levels of HSP70, TLR4, and IL-1ß show the contribution of these mediators to the inflammatory response from the early stages of orthodontic tooth movement. CLINICAL RELEVANCE: The regulation of HSP70, TLR4, and/or IL-1ß secretion during orthodontic force application could provide alterations for desired optimal tooth movement.

Morphometric evaluation of cranial base and sella turcica in patients with bilateral agenesis of maxillary lateral incisors.

The aim of this paper is to evaluate the dimensions and morphology of cranial base and sella turcica in patients with bilateral agenesis of maxillary lateral incisors (BMLI). This retrospective study was conducted on lateral cephalometric radiographs of 34 female patients with BMLI (17.69 ± 2.96 years) and 34 female patients with complete dentation and skeletal Class 1 relationship serving as a control group (17.22 ± 2.2 years). Basicranial and maxillomandibular variables together with linear dimensions and morphology of sella turcica were evaluated. Differences between groups were analyzed by Student's t test for parametric variables and Mann-Whitney U test for nonparametric variables. Chi-square test followed by post hoc test with Bonferroni correction was used for categoric variables (p < 0.05). When compared to control group, N-S-Se angle was less negative, dimensions between Ba-Se, N-Ba, and N-Ar were larger, and SNA angle was smaller in BMLI group. There were no significant differences between groups regarding the linear dimensions of sella turcica. However, variations in sella turcica morphology were more frequent in BMLI group (n = 17; 50%) when compared to control group (n = 2; 5.8%). The most common morphologic variations in BMLI group were oblique anterior wall (20.6%) and irregularity (notching) in the posterior part of sella turcica (14.7%). The present study showed a statistically significant relationship between the presence of BMLI with some craniofacial parameters and morphological variations of sella turcica. This information may be useful as an additional and early diagnostic tool for BMLI and to highlight the possible links to its development.

New perspective for evaluation of tooth widths in patients with missing or peg-shaped maxillary lateral incisors: Quadrant analysis.

INTRODUCTION: Missing or peg-shaped maxillary lateral incisors can affect the mesiodistal dimensions of the dentition. METHODS: The pretreatment casts of patients with bilateral (BMLI, n = 35) or unilateral (UMLI, n = 29) missing maxillary lateral incisors or bilateral peg-shaped maxillary lateral incisors (BPLI, n = 16) were evaluated. The mesiodistal widths of all permanent teeth except the second and third molars were measured, and the sums of total and quadrant tooth widths were calculated. The results were compared with a control group (n = 32) with normal maxillary lateral incisors. A quadrant analysis was performed by comparing the quadrants with lateral incisor agenesis, peg-shaped lateral incisors, and normal lateral incisors with each other. Statistical analysis was performed by 1-way analysis of variance followed by Tukey and Tamhane tests. RESULTS: In the BMLI and BPLI groups, significant reductions in individual tooth widths and total tooth widths were seen. The size discrepancies were the greatest in the maxillary central incisors and decreased gradually from the incisors to the molars. Compared with the control group, the tooth-size discrepancy was more pronounced in the BPLI group followed by the BMLI and UMLI groups. Due to the variability in clinical presentations of the UMLI group, the association with the reduction of the tooth sizes was not significant. But the quadrant analysis showed that in quadrants with a missing or peg-shaped lateral incisor, the teeth were significantly narrower than in quadrants with normal incisors; this indicates the importance of the contralateral side in unilaterally affected patients during analysis. CONCLUSIONS: Bilateral missing or peg-shaped maxillary lateral incisors were significantly associated with reduction of individual mesiodistal tooth widths as well as their total and quadrant sums. Patients with a unilaterally missing lateral incisor should be analyzed individually with quadrant analysis, since the variability in the contralateral side would affect the traditional analysis results.

Craniofacial and pharyngeal airway morphology in patients with acromegaly.

OBJECTIVE: The aim of this study was to assess differences in craniofacial characteristics, upper spine and pharyngeal airway morphology in patients with acromegaly compared with healthy individuals. MATERIALS AND METHODS: Twenty-one patients with acromegaly were compared with 22 controls by linear and angular measurements on cephalograms. The differences between the mean values of cephalometric parameters were analyzed with Mann-Whitney U-test. RESULTS: With respect to controls, anterior (p<0.05), middle (p<0.01) and posterior (p<0.05) cranial base lengths were increased, sella turcica was enlarged (p<0.001) and upper spine morphology demonstrated differences in the height of atlas (p<0.01) and axis (p<0.05) in patients with acromegaly. Craniofacial changes were predominantly found in the frontal bone (p<0.01) and the mandible (p<0.05). As for the airway, patients with acromegaly exhibited diminished dimensions at nasal (p<0.001), uvular (p<0.01), mandibular (p<0.01) pharyngeal levels and at the narrowest point of the pharyngeal airway space (p<0.001) compared to healthy controls. Soft palate width was significantly higher (p<0.001) and the hyoid bone was more vertically positioned (p<0.01) in patients with acromegaly. CONCLUSIONS: Current results point to the importance of the reduced airway dimensions and that dentists and/or orthodontists should be aware of the cranial or dental abnormalities in patients with acromegaly.

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.

Dimensions and morphologic variations of sella turcica in type 1 diabetic patients.

INTRODUCTION: Some chronic diseases are associated with changes in the morphology of sella turcica, and type 1 diabetes is the most common chronic disease in children and adolescents. Therefore, the aim of this study was to evaluate the size and morphology of sella turcica in patients with type 1 diabetes compared with a healthy control group. METHODS: The study included 76 type 1 diabetic patients (38 boys, 38 girls; ages, 14.16 ± 2.46 years) and 76 controls (38 boys, 38 girls; ages, 14 ± 2.08 years). The groups were categorized as pubertal and postpubertal according to bone age. The length, height, and diameter of sella turcica were measured. Then the morphology of sella turcica was analyzed and categorized as normal, oblique anterior wall, bridging, double contour of the floor, irregularity in the posterior part of dorsum sellae, or pyramidal shape of the dorsum sellae. All measurements were made on tracings of cephalometric radiographs. Differences between the groups were tested with the Mann-Whitney U test. Categorical data were evaluated with the Fisher exact test, and the Bonferroni correction was made. The significance level was assigned as P <0.05. RESULTS: There was no statistically significant difference in the dimensions of sella between the diabetic patients (diameter, 12.20 ± 1.49 mm; length, 10.49 ± 1.55 mm; height, 8.07 ± 1.25 mm) and the controls (diameter, 12.45 ± 1.43 mm; length, 10.90 ± 1.73 mm; height, 8.29 ± 1.66 mm). However, diameter and length increased with age in the overall assessment. Length was greater in the postpubertal controls (11.39 ± 1.69 mm) compared with the pubertal controls (10.41 ± 1.64 mm). Diameter was greater in the postpubertal diabetic patients (1.283 ± 1.55 mm) than in the pubertal diabetic patients (11.56 ± 1.12 mm) and was specifically higher in postpubertal boys. Normal sella morphology was less common in general in the diabetic patients, particularly in the diabetic boys and diabetic pubertal boys (P <0.05). CONCLUSIONS: The measurements concerning sella were similar in the type 1 diabetic and control subjects, but dysmorphologic types were more common in diabetic patients.

Influence of thermoplastic retainers on Streptococcus mutans and Lactobacillus adhesion.

INTRODUCTION: This study was designed to test the hypothesis that thermoplastic retainers influence oral microbial flora during the retention period because they prevent the flushing effect of saliva on dental and mucous tissues. METHODS: Twenty-four orthodontic patients finished the study. After debonding, the patients were given thermoplastic retainers (Essix ACE 0.040-in plastic, Dentsply International, York, Pa) for both jaws and instructed to wear them all day. Plaque samples from tooth surfaces and saliva samples were collected from each patient just after debonding (T0), and on day 15 (T1), day 30 (T2), and day 60 (T3) of retention. The jaws were divided into 6 regions, and the data for each region were evaluated separately. Total viable Lactobacillus and Streptococcus mutans colonies were counted, and the numbers of the viable microorganisms were calculated. RESULTS: The numbers of Lactobacillus colonies at T3 were higher than at T0, T1, and T2, and the difference between T0 and T3 was statistically significant (P <0.05). The numbers of S mutans colonies at T3 were higher than at T0, T1, and T2, and the differences between T0 and T1, and T1 and T2 were statistically significant (P <0.05). CONCLUSIONS: Retention with thermoplastic retainers might create oral conditions conducive to S mutans and Lactobacillus colonization on dental surfaces.