Evaluation of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on Eustachian tube function with audiological tests: A randomized clinical trial.

OBJECTIVES: Maxillary expansion improves the hearing function. This trial aimed to examine the effects of Eustachian tube function (ETF) with audiological tests in orthodontic patients who underwent rapid maxillary expansion (RME) or alternate rapid maxillary expansion and constriction (Alt-RAMEC) treatment. METHODS: Forty individuals (mean age = 13.35 years) included in the trial had a healthy eardrum, no history of orthodontic treatment, maxillary constriction, mandibular constriction and were not affected by acute or chronic otitis. Patients were randomly assigned to one of two groups (n = 20 each): the RME protocol or the Alt-RAMEC protocol. ETF was evaluated using Williams' test at three time points: before expansion (T0), after expansion (T1), and in the 3rd month of retention (T2). RESULTS: In the RME group, Eustachian tube dysfunction (ETD) was observed in 18 of 40 ears before expansion (T0). The RME group showed significant improvement in tube function in the 3rd month of retention (T2) (p = 0.003). In the Alt-RAMEC group, ETD was observed in 22 of the 40 ears at baseline (T0). Significant improvements in tubal function were observed in the Alt-RAMEC group after expansion (T1) (p = 0.008) and in the 3rd month of retention (T2) (p < 0.001). In the RME group, 17 of 18 ears recovered, while in the Alt-RAMEC group, 21 of 22 ears recovered. CONCLUSION: Eustachian tube function improved in the RME and Alt-RAMEC groups compared to the pre-expansion period. REGISTRATION: This trial was not registered.

Effects of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on nasal mucociliary clearance : A randomized clinical trial.

PURPOSE: This parallel trial aimed to evaluate the changes in nasal mucociliary clearance (MCC) after a rapid maxillary expansion (RME) protocol or an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol in orthodontic patients. METHODS: This trial included 36 patients with a mean age of 14.38 years, with a narrow maxillary arch, bilateral posterior crossbite, no narrowing of the mandibular arch, no previous orthodontic treatment, and no nasal or systemic disease. Patients were randomly distributed into two groups (n = 18 each)-one group was treated with the RME protocol and the other group was treated with the Alt-RAMEC protocol. MCC was evaluated using the saccharine transit time (STT) test, which was measured for each individual before expansion (T0), after expansion (T1), and after a 4-month retention phase (T2). The study was single blinded, and blinding was applied only to the outcome assessor. The primary objective was to evaluate the effect of the Alt-RAMEC and RME protocols on MCC. The secondary objective was to determine the relationship between age, sex, and MCC. The χ 2 test and independent samples t­test were used to evaluate the data. RESULTS: The STT decreased after expansion and retention in the RME group. In the Alt-RAMEC group, the STT decreased after expansion and slightly increased after retention. When the RME and Alt-RAMEC groups were compared, the STT showed a significant difference after expansion and retention (p < 0.05). No significant relationship was observed between age and sex and STT (p > 0.05). CONCLUSION: This study demonstrated that the Alt-RAMEC protocol improved MCC and had a positive effect on nasal physiology by increasing the nasal volume more than that achieved by RME.

Dental Anxiety and Fear Levels, Patient Satisfaction, and Quality of Life in Patients Undergoing Orthodontic Treatment: Is There a Relationship?

OBJECTIVE: This study aimed to evaluate the relationship between dental anxiety and fear levels, patient satisfaction, and oral health-related quality of life (OHRQoL) in patients undergoing orthodontic treatment. METHODS: The study was conducted in the Department of Orthodontics, Sivas Cumhuriyet University Faculty of Dentistry. This cross-sectional study included 252 patients, aged 11-14 years undergoing orthodontic treatment. The data collection tools were the Index of Dental Anxiety and Fear (IDAF-4C+), the Child Perceptions Questionnaire (CPQ 11-14), the Patient Satisfaction Questionnaire, and the Clinical Examination Data Form. The CPQ 11-14 was used to measure OHRQoL. Descriptive statistics, the independent samples t-test, analysis of variance (ANOVA), Cronbach's alpha, and Pearson coefficient were used for statistical analysis at a significance level of 0.05. RESULTS: The CPQ 11-14 parameters were sufficiently reliable, and the patients mostly had problems with oral symptoms. A significant difference was observed between the type of treatment, the initiation of treatment, emotional well-being, and social well-being (P < .05). The relationship between treatment satisfaction and all parameters was significant (P < .05). There was a significant relationship between IDAF-4C+ and CPQ 11-14, while a moderate correlation was found between dental anxiety and emotional well-being. CONCLUSION: According to the results of this study, the type of treatment, the initiation of treatment, and dental anxiety impact the quality of life. It was found that treatment satisfaction and a positive patient-dentist relationship positively affect the quality of life and dental anxiety.

Effect of Strontium Ranelate on Condylar Growth during Mandibular Advancement in Rats.

OBJECTIVE: Strontium ranelate (SR), unlike other anti-osteoporotic agents, might not only prevent bone resorption but also might induce bone formation. The aim of this experimental study was to evaluate the effects of systemic SR on condylar growth during mandibular advancement (MA) in growing rats. METHODS: Fifty-six, 8-week-old Wistar male rats weighting 160-190 g were randomly divided into four groups; one control (n=14) and three experimental (n=14). Group 1: Control group, Group 2: SR (900mg/kg daily dose), Group 3: MA, Group 4: SR +MA. The amount and direction of mandibular growth were assessed by linear measurements on the computed tomography (CT) images taken on days 1, 15, and 30. For immunohistochemical evaluation, half of the subjects in the groups were sacrificed on the 15th day (early phase) and the rest of them on the 30th day (late phase). New cartilage and bone formation areas on the condyle were analyzed by using Sox9 and Osteopontin antibodies. RESULTS: Early and late CT images measurements showed no significant difference between the groups (p<0.05). However, there were significant differences between the control and experimental groups in the immunohistochemical assessment. Severe immunolocalization of SOX9 and Osteopontin was observed in Group 4, while the immunolocalization scores were moderate in Group 2 and Group 3. In addition, early histological findings were similar to late results in all groups. CONCLUSION: In mandibular advancement therapy, Strontium ranelate could be therapeutically effective in avoiding relapse and reducing the duration of retention.

Orthodontic Approach to Patients with Autism: A Review.

Autism is a complex neurobehavioral disorder that causes problems in thinking, feeling, language, and the ability to communicate with other people. Over the past two decades, there has been a great deal of interest in autism disorder. This problem is recognized worldwide, and various measures are taken both nationally and internationally to improve the lives of affected individuals and families. The oral health care of such patients can be complicated since they cannot express their problems and can show unpredictable behaviors during treatment. The aim of the literature review was to collect information about the general oral health status of patients with autism, the difficulties that may be encountered during treatment, and the precautions that can be taken and the treatment approaches. This article reviews the dental literature from 1943 to the present.

Dentofacial Effects of Fixed Functional Appliances with or without Mini Screw Anchorage in the Treatment of Class II Division I Malocclusion: A Finite Element Analysis.

OBJECTIVE: This study aimed to examine the biomechanical effects of the fixed functional appliances reinforced with miniscrews by finite elements analysis over the cranial and facial bones, temporomandibular joint, and maxillary-mandibular teeth, which are used for the treatment of Class II division 1 malocclusions characterized as mandibular retrognathia. METHODS: Three-dimensional (3-D) models of the cranial, mandibular, and maxillary bones were purchased from a company that produces 3-D models of the bones. Simulations of Forsus, screwed Forsus, Twin-Force and screwed Twin-Force appliances were conducted on the 3 D models. The miniscrew was placed in the inter-radicular area between the upper canine and first upper premolar teeth. RESULTS: It was observed in the models that the first upper molar tooth was the most affected. The compressive stress was observed in the anterior area of the mandibular condyle neck in the Forsus appliances; however, it was observed in the posterior area of the mandibular condyle neck in Twin-Force appliances. CONCLUSION: It was observed that molar distalization and expansion decreases in the functional appliances with the support of miniscrew. The highest tension rates were determined in the areas of condylar and articular discs.

Treatment of Midline Deviation with Miniscrews: A Case Report.

A 15-year-old female presented with the chief complaint of crowding. Extraoral examination revealed little facial asymmetry, which was related with mandibular deviation caused by constriction of the maxilla. Upon intraoral examination, Class III molar and Class II canine relationships were seen on the right side, and Class III molar and Class III canine relationships were seen on the left side. A morphological lower midline shift was detected (4 mm to the right). After the start of treatment with rapid maxillary expansion, miniscrews were inserted into the buccal shelf and canine-premolar areas in order to solve the morphological deviation without extractions. Because there was a need to shift the lower midline to the right side, miniscrews were inserted into the left buccal shelf at the right canine-premolar area. The miniscrews were placed vertically so that the angle between the long axes of the teeth and the long axes of the screws were approximately 20 degrees. Acceptable correction of the midline deviation lasted for four months. At the end of the treatment, a good occlusal relationship was obtained.

Camouflage Treatment of a Severe Deep-Bite and Orthognathic Surgery Required Case with En Masse Retraction.

In adult patients with severe class II division 2 malocclusion, the ideal treatment option is the orthognathic surgery. However, camouflage therapy is also an acceptable treatment option due to its less traumatic and acceptable esthetic and functional results. In this case report, the camouflage treatment with two maxillary premolar extractions in a 21-year-old female patient who did not accept orthognathic surgery is presented. Acceptable esthetic and functional results were obtained at the end of the treatment.

Effects of rapid maxillary expansion on nasal mucociliary clearance.

OBJECTIVE: To evaluate the changes in nasal mucociliary clearance in orthodontic patients after rapid maxillary expansion (RME) therapy. MATERIALS AND METHODS: Forty-two children (25 boys and 17 girls) participated in this study. The RME group consisted of 21 patients (mean age, 13.8 years), who had undergone RME at the initiation of orthodontic treatment. The control group consisted of 21 subjects (mean age, 13.6 years), who were attending the department of orthodontics for active orthodontic treatment. The nasal mucociliary clearance was assessed by the saccharin test. Saccharin transit times (STTs) were measured for each treated subject before expansion (T1), after RME (T2), and after a 3-month retention period (T3). Records were obtained at the same time intervals for each group. RESULTS: The STT decreased significantly in the RME group after expansion and retention (P < .05). A statistically significant difference was found when the STTs of the control and RME groups were compared after expansion and retention (P < .05). CONCLUSIONS: The STTs of young orthodontic patients with maxillary narrowness and without any history of nasal or systemic disease were within normal limits. However, RME increased the mucociliary clearance in patients who had maxillary narrowness, having positive effects on nasal physiology and increasing nasal cavity volume.

Late development of a mandibular second premolar.

In this report, we present the case of a girl with delayed odontogenesis of a lower second premolar for which she was followed up for 8.5 years. Congenital absence of permanent mandibular second premolars was observed at the initial radiographic examination at 8 years and 1 month. One year later, during the treatment period, an unexpected odontogenesis of a right second premolar was diagnosed on follow-up radiography. The original treatment plan was revised and a new plan was successfully implemented. Th is unusual case showed that the orthodontist's clinical philosophy must be flexible because unexpected situations can arise, especially when treating growing patients.

Orthodontic treatment of a patient with oral-facial-digital syndrome.

Oral-facial-digital syndrome is characterized by heterogeneous clinical features involving malformations of the face, oral cavity, and digits. The syndrome has been reported only in women, suggesting that it is lethal in males. Affected females have malformations of the oral cavity (cleft palate, lip and tongue, abnormal dentition, and hamartomas), face (hypertelorism and milia), and digits (syndactyly, brachydactyly, and polydactyly). In this article, we report the orthodontic treatment of a 21-year-old woman with oral-facial-digital syndrome.

Restoring Function and Aesthetics in a Class II Division 1 Patient with Amelogenesis Imperfecta: A Clinical Report.

Amelogenesis imperfecta (AI) encompasses a complicated group of hereditary conditions that cause developmental alterations in the structure of the enamel in the absence of a systemic disorder. AI primarily affects the quality and/or quantity of dental enamel, and it may affect all or only some of the teeth in the primary and/or permanent dentition. This clinical report describes the oral rehabilitation of a 21-year-old man diagnosed with hypomaturation-type AI. He presented with discolored and mutilated teeth. Cephalometrically, the patient has skeletal class II malocclusion due to mandibular deficiency considered as a result of maxillary constriction. The interdisciplinary approach was followed because of the complex needs of the patient. The aim of treatment was to restore aesthetics, improve malocclusion and masticatory function. Aesthetic and functional expectations were met with metal ceramic restorations. In this report, the interdisciplinary approach for a patient with AI and a malocclusion is described.

The treatment of an impacted mandibular canine: case report.

The treatment of a patient with an impacted lower canine. After surgical exposure of the tooth, extrusion was performed with a removable appliance and followed by fixed orthodontics. In radiographic assessment, no resorption was observed either on canine or on the neighboring premolar root.

Pulpal blood flow changes due to rapid maxillary expansion.

OBJECTIVE: To determine the pulpal blood flow (PBF) changes in anchorage teeth associated with the high forces of a rapid maxillary expansion (RME) appliance. MATERIALS AND METHODS: The study was performed with 14 girls and 7 boys for a total of 21 patients between 10 and 15 years of age (mean, 13.1 +/- 1.39 years). A modified acrylic bonded RME appliance was used as an expansion appliance. Laser Doppler flowmetry was used for the pulpal perfusion measurements. Records were taken from 42 upper central incisors, 28 canines, and 42 first molars at the following time intervals: just before expansion (T1); at the first week of expansion (T2); at the end of the expansion process (T3); and at the third (T4), seventh (T5), and 12th weeks of retention (T6). The data gained were statistically evaluated by parametric tests. RESULTS: PBF values of the anchorage teeth were doubled at the first week of expansion; however, these values began to decrease because of separation of the median palatal suture. PBF values tended to reach their initial values during the retention period. Pulpal perfusion changes of all examined anchorage teeth were similar to each other from the beginning to the end of the evaluation. CONCLUSION: PBF changes that occur with RME are reversible.

Comparison of the effects of RME and fan-type RME on nasal airway by using acoustic rhinometry.

OBJECTIVE: To evaluate and compare the nasal airway changes following rapid maxillary expansion (RME) and fan-type RME using acoustic rhinometry (AR). MATERIALS AND METHODS: The study sample consisted of three groups. The RME group comprised 15 subjects with maxillary transverse discrepancies and posterior crossbites. The fan-type RME group comprised 15 subjects, who had an anteriorly constricted maxilla with a normal intermolar width. The third group included 15 patients who had an ideal occlusion and received no orthodontic treatment and served as the control group. AR was used to measure nasal volume and the minimal cross-sectional area (MCA) before expansion (T1), after expansion (T2), and 6 months after expansion (T3). Each AR recording was performed with and without the use of a decongestant. Two-way analysis of variance was used to determine differences among the groups and three-way analysis of variance was used for the differences between groups. If evidence of statistically significant differences was found, a Bonferroni test was used. RESULTS: The results showed that nasal volume and MCA were significantly increased with RME and fan-type RME immediately after expansion (P < .05). At the end of retention, nasal volume and MCA values of RME showed significant differences with both expansion fan-type RME and control groups (P < .05). CONCLUSIONS: RME and fan-type RME had similar effects on the nasal airway immediately after expansion. The increase in nasal volume and MCA was more stable in the RME group than in the fan-type RME group at the end of the retention period.

Oral and nasal malodor in patients with and without cleft lip and palate who had undergone orthodontic therapy.

OBJECTIVE: To compare oral and nasal malodor in patients with and without cleft lip and palate (CLP) who had undergone orthodontic therapy. SETTING: University of Cumhuriyet, Sivas, Turkey. PATIENTS: The study included 33 patients. Group 1 was composed of 11 patients with CLP. Measurements were taken while they were undergoing treatment with orthodontic fixed appliances. Group 2 included 11 individuals without CLP; measurements were taken during fixed orthodontic therapy. Group 3 consisted of 11 individuals without CLP who did not receive orthodontic therapy. INTERVENTION: Oral malodor, nasal malodor, Gingival Index, Plaque Index, and probing depths were evaluated in each group. RESULTS: Plaque Index, Gingival Index, and probing depths showed no significant differences between groups 1 and 2. In contrast, oral malodor was significantly different between the two groups (p < .05). Groups 2 and 3 showed differences in gingival and plaque indices but not in probing depths and oral malodor. All healthy nostrils in Group 1, Group 2, and Group 3 were significantly different from affected nostrils in the CLP patients. There was significant malodor in affected nostrils when compared with nonaffected nostrils in group 1 (p < .05). CONCLUSION: Oral malodor was increased in patients with CLP. Nasal malodor level was also higher in affected nostrils of the CLP patients compared to nostrils of healthy subjects.

Comparison of nasal volume changes during rapid maxillary expansion using acoustic rhinometry and computed tomography.

The purpose of this study was to compare nasal volume changes using acoustic rhinometry (AR) and computed tomography (CT). The subjects were 10 children (6 girls and 4 boys, with an age range of 12-14 years) who required rapid maxillary expansion (RME) on the basis of their individual malocclusion. All patients were found to have normal nasal cavities following anterior rhinoscopic examination. AR and CT were undertaken at the start of treatment (t(1)) and 6 months after expansion (t(2)). Volume changes due to expansion were evaluated using Wilcoxon's test, and the correlation between the two methods was assessed with correlation analyses. Both methods demonstrated that nasal volume significantly increased following the use of RME (P<0.05). Correlation analyses showed no difference in volume (P>0.05) using either of the two methods.

Rapid maxillary expansion and surgically assisted rapid maxillary expansion effects on nasal volume.

The purpose of this study was to compare the effects of rapid maxillary expansion (RME) and surgically assisted rapid maxillary expansion (SARME) on nasal volume using acoustic rhinometric methods. Two groups of subjects were used in the study. Group 1 consisted of 10 subjects (mean age 12.30 +/- 0.82 years) who were treated with RME, and group 2 consisted of 10 subjects (mean age 18.70 +/- 2.54 years) who were treated by SARME. In both groups, all cases had a maxillary width deficiency with bilateral crossbites. Nasal volume records were taken by the same otorhinolaryngologist with an AR device. AR recordings were performed for each patient with and without the use of a decongestant. The first record was taken before expansion, and the second record was taken at the end of retention. The data for both groups were evaluated using Wilcoxon signed rank test and Mann-Whitney U-test. The nasal volume showed a significant increase in both the RME and the SARME groups (P < .05). The measurement with the use of decongestant was similar to that without use of decongestant on the both groups (P < .05), but the different increments in nasal volume between the RME and the SARME groups were not statistically significant. Although the mean ages between the RME and the SARME groups were different, the increase in nasal volume was similar in both groups.

Correction of a mandibular lateral incisor-canine transposition.

Early diagnosis of a transposition can simplify the orthodontic correction. In this report, we describe the orthodontic management of a patient with mandibular right lateral incisor and canine transposition. Nonextraction therapy was performed with removable multibracket appliances. Natural tooth order was attained, and a symmetric and functional Class I occlusion was achieved.

Extraoral nasal molding in a newborn with unilateral cleft lip and palate: a case report.

OBJECTIVE: The purpose of this case report is to introduce an extraoral nasal molding appliance (ENMA) and treatment approach for presurgical nasoalveolar molding in newborns with unilateral cleft lip and palate. METHODS: A 15-day-old girl presented with complete unilateral cleft lip and palate. A circumferential headband supported the actual nasoalveolar molding device, which consisted of a nasal stent made from a 0.8-mm stainless steel helical spring. The spring was activated at 2-week intervals. DISCUSSION: The shape of the cartilaginous septum, alar cartilage tip, medial and lateral crus and alveolar segments were molded to resemble the normal shape of these structures. ENMA can be helpful in any patient with unilateral cleft lip and palate because it is easy to fabricate, practical to activate, and comfortable to wear and use.