Does childhood maltreatment play a role in temporomandibular disorders?

The aim of this study was to find out if experiences of maltreatment in childhood have an effect on the occurrence of temporomandibular joint disorders (TMD). The study was conducted on 380 volunteer adults (252 females and 128 males), with a mean (SD) age of 27.63 (9.06) years. The level of TMD was assessed using the Fonseca Anamnestic Index (FAI). Childhood Trauma Questionnaires (CTQ) were completed by the participants and their marital status and educational level were recorded. FAI scores were significantly higher in females than in males. There was no statistically significant difference between gender and total CTQ score. Moreover, there was no statistically significant difference between educational status, marital status, and total CTQ score. FAI scores correlated positively with total CTQ scores in all individuals. Similarly FAI scores correlated positively with total CTQ scores in males and females. Childhood maltreatment is associated with TMDs. Dentists should be aware that possible collaboration with psychiatrists and/or psychologists when treating patients with TMD could increase the success of their treatment.

Evaluation of mandibular osseous structure in patients with mandibular asymmetry: a fractal analysis study.

OBJECTIVE: We evaluated the effect of mandibular asymmetry on the trabecular structure of the mandible as measured through fractal analysis (FA). STUDY DESIGN: We divided a sample of 105 patients with skeletal class I occlusion, cervical vertebral maturation CS6, and skeletal vertical dimension ratios within normal limits into right asymmetric, left asymmetric, and symmetric groups. We performed FA on 6 bilateral regions of interest on panoramic radiographs of the patients and calculated the mean fractal dimension (FD) for each region. We performed the Wilcoxon signed-rank and paired t tests to compare the significance of differences in FD between sides within each group and between groups for all regions. Statistical significance was established at P < .05. RESULTS: We found statistically significant differences in mean FD values between the right and left condyles of the 2 asymmetric patient groups. The FD was greater in the left condyle of patients with right asymmetry and in the right condyle of patients with left asymmetry. The right condyle had a significantly greater FD in left asymmetric patients than in right asymmetric patients. CONCLUSIONS: The results of FA indicate that asymmetry is characterized by an increase in the mean FD of the condyle that is responsible for the asymmetry. Fractal analysis can be a valuable diagnostic technique in distinguishing trabecular differences in the condylar areas of asymmetric individuals.

Comparison of the effects of removable functional appliance therapy applied in pubertal and postpubertal periods: A retrospective cephalometric and fractal analyses study.

INTRODUCTION: In this study, we compared the effects of functional treatment with Twin-block appliance on the bony architectures of the maxilla and mandible by fractal dimension (FD) analysis, and the skeletal and dentoalveolar effects by cephalometric analysis, in pubertal and postpubertal patients with Class II malocclusion. METHODS: This study comprised 60 patients who underwent Twin-block treatment. Group 1 consisted of 30 patients in the pubertal period (6 boys and 24 girls; mean age 12.27 ± 1.35 years), whereas group 2 consisted of 30 patients in the postpubertal period (6 boys and 24 girls; mean age 13.73 ± 1.51 years). FD analysis was performed on the patients before and after Twin-block panoramic and lateral cephalometric radiographs. Cephalometric analysis was also conducted. Paired and Student t tests were used to compare the parametric data, and Wilcoxon signed rank and Mann-Whitney U tests were conducted to compare the nonparametric data. RESULTS: SNB, Pg-N, N-Me, ANS-Me, IMPA, L1/NB, Co-Gn, Go-Gn, S-Go, Co-Go, and Go-Me significantly increased in both groups after treatment. FD values of tuber, condyle, and molar regions significantly decreased in group 1, whereas no significant differences were observed in group 2 after treatment. CONCLUSIONS: In the pubertal period, the Twin-block appliance resulted in skeletal correction by causing bone remodeling and reshaping in both jaws along with the dentoalveolar correction. In the postpubertal period, Twin-block had no significant effect on the bone trabecular arrangement in the investigated areas but produced cephalometric improvement to a certain extent with lower skeletal and higher dental impact.

Effects of reverse headgear therapy on mandibular trabecular structure: A fractal analysis study.

OBJECTIVES: The aim of this study was to assess the effects of reverse headgear (RHG) treatment combined with rapid maxillary expansion (RME) on the trabecular structure of the mandibula using fractal dimension (FD) analysis. METHODS: Forty-four individuals with skeletal Class III malocclusion were selected from the archives and divided into two groups as patients who underwent treatment with RME + RHG (RHG-G, 22 patients) and untreated control group (C-G, 22 patients). The before (T0) and after (T1) treatment lateral cephalometric and panoramic radiographs were collected in the RHG-G and in the control group, radiographs obtained with similar time intervals were grouped as T0 and T1. Cephalometric and FD analysis was conducted on T0 and T1 lateral cephalometric and panoramic radiographs. The intragroup comparison of cephalometric and FD data was performed using paired t test and Wilcoxon Signed Ranks test, while independent t test and Mann-Whitney U test were used for intergroup comparison. RESULTS: C-G had higher FD values in the right mandibular corpus and left mandibular ramus values at T0 (P < .05). The only significant difference in the intragroup comparisons was detected in the FD values of the right mandibular corpus in the C-G (P < .05). No significant differences were found in the FD between the groups in any of the areas measured (P > .05). CONCLUSIONS: RME + RHG therapy did not cause any significant trabecular changes in the mandibula when compared to the control group.

Bullying in individuals with cleft lip and palate: A Twitter analysis.

OBJECTIVES: This study aimed to evaluate bullying in individuals with cleft lip and/or palate (CLP) using Twitter analysis. MATERIALS AND METHODS: By using Twitter's advanced search feature, the four selected keywords; "bully", "bullying", "bullied" and "teased" were searched along with the terms "cleft lip and palate", "cleft lip" and "cleft palate", respectively. A total of 1010 tweets meeting the criteria were selected. The data were evaluated qualitatively using thematic analysis and the determination of the themes were based on this analysis. RESULTS: Most of the tweets were posted by a layperson (80.8%), while most of the tweets were categorised in the theme "criticism of bullying" (36%). The tweets were distributed according to their uploader status as irrelevant individuals (60.6%), CLP subjects (26.9%), family of CLP subjects' (12.5%). Of the 1010 tweets evaluated, 707 were identified as negative, while 90 were identified as neutral and 213 were identified as positive. No significant differences were detected in retweet and like numbers between negative, neutral and positive comments (P > .05). CONCLUSIONS: Twitter is an important platform, in which the bullying victims with CLP and their families feel free to share their personal experiences of being bullied and how they feel about it, while the others are standing against bullying and promoting social support for these individuals.

Transfer accuracy of four different lingual retainer transfer methods using digital orthodontic models.

OBJECTIVES: To compare the transfer accuracy of four different lingual retainer (LR) transfer methods using three-dimensional digital models. MATERIALS AND METHODS: Four groups of 17 patients each were created: finger transfer (FT), silicone key transfer (SKT), acrylic resin transfer (ART), and indirect bonding (IDB). At the end of orthodontic treatment, the mandibular dental casts of patients were scanned with the LR wire. Then, intraoral scanning of the mandibular arches was performed after bonding the retainer wires. Linear and angular measurements were made using software on superimposed digital models. RESULTS: Horizontal and vertical errors among the teeth were not significantly different among the FT, SKT, and ART groups. However, in the IDB group, linear transfer errors showed significant differences among the different teeth. The tip and rotation errors in the FT group were not significantly different among the teeth. The angular errors were lower in canines than in the incisors. In all measured parameters, the SKT group showed the lowest errors, whereas the FT group had the highest transfer errors in all parameters except vertical. CONCLUSIONS: Among the transfer methods tested, SKT was determined to have the highest clinical accuracy.

Prediction of rapid palatal expansion success via fractal analysis in hand-wrist radiographs.

INTRODUCTION: This study aimed to evaluate the efficacy of fractal analysis of hand-wrist radiography in the decision of conventional or surgery-assisted rapid palatal expansion (RPE). METHODS: The study included 48 patients who underwent the RPE procedure. Study groups were as follows: group 1 (successful conventional RPE [n = 24, 5 male and 19 female patients; mean age ± standard deviation, 15.85 ± 0.97 years]) and group 2 (failed conventional RPE [n = 24, 5 male and 19 female patients; mean age ± standard deviation, 15.96 ± 1.08 years]). Fractal dimension (FD) analysis was conducted on hand-wrist radiographs of the patients for 4 different regions: the epiphysis-diaphysis line of the radius bone and the proximal, medial (MP3), and distal (DP3) phalanxes of the middle finger. A Student t test was performed to compare fractal values between the groups. A receiver operating characteristic analysis was applied to determine the optimal cutoff value of FDs. In addition, a Pearson correlation coefficient was calculated to evaluate the relationship between the fractal values and either age or hand-wrist stage in a second sample group (n = 90; age range, 8.7-18.7 years). RESULTS: Fractal values of the radius, MP3, and DP3 were significantly increased in the failed conventional RPE group (P <0.05). The optimal cutoff value of the FD for predicting the success of conventional RPE was 1.16 in the radius, 1.18 in proximal phalanxes, 1.29 in MP3, and 1.08 in DP3. There was a positive correlation between fractal values of the radius and age or hand-wrist stages (P <0.05). CONCLUSIONS: Within the limits of this study, results revealed that fractal analysis of hand-wrist radiographs might be considered a significant tool in the prediction of RPE success.

Effect of mouthwashes on the discoloration of bracket-bonded tooth surfaces: an in vitro study.

OBJECTIVES: This in vitro study aimed to investigate the color changes of the bracket-bonded tooth surfaces after the use of 4 different mouthwashes. MATERIALS AND METHODS: A total of 100 human premolar teeth were randomly divided into 10 equal groups. Color values (L*a*b*) of the buccal surfaces of each tooth were assessed using a digital spectrophotometer. Then the brackets were bonded. The groups were put either in sterile saline (4 test+1 control) or artificial saliva (4 test+1 control) solutions, and test groups were immersed in their mouthwashes (Colgate Plax, Listerine Cool Mint, Klorhex, and Tantum Verde) for 1 min each in the morning/evening to simulate the mouth washing for 21 days after the bonding. After the debonding and finishing procedures, final color measurements were performed. Color changes (∆E) were calculated. RESULTS: All of the parameters showed statistically significant differences among the groups. The least noticeable color changes were detected in the control groups. The most noticeable color change (ΔE) was observed in the Tantum Verde + artificial saliva group, followed by Tantum Verde + sterile saline and Klorhex + artificial saliva groups, all of which were significantly higher than the control groups. CONCLUSION: The use of mouthwashes during orthodontic treatment may cause noticeable changes in tooth color. Listerine Cool Mint may be the choice of mouthwash with its less discoloring effects. Artificial saliva should be preferred in similar in vitro studies to reflect the oral environment better. CLINICAL RELEVANCE: Mouthwash use during orthodontic treatment may result in different levels of enamel discoloration.

Effects of isotretinoin on new bone formation after maxillary sutural expansion.

PURPOSE: The aim of this study was to examine the effects of isotretinoin on new bone formation after maxillary sutural expansion in rats. MATERIALS AND METHODS: A total of 32 male Wistar rats were selected and randomly divided into four groups. The isotretinoin group was treated with 7.5 mg/kg isotretinoin, and the soybean group was treated with 2 ml/kg soybean oil for 57 days. The substances were applied via oral gavage. The expansion-only and the control groups were not treated with any substance. In the experiment groups, expansion springs were applied on day 41 of the experiment, and after day 5 of expansion, a 12-day retention period was established. At the end of the experiment, all the animals were sacrificed, and their maxillae were dissected for histological evaluation. The numbers of osteoclasts, osteoblasts and formation of new bone and capillaries were evaluated on slides centered around the suture. RESULTS: The statistical analysis showed significant differences between the groups for the number of osteoblasts and osteoclasts (p < 0.001). In the experiment groups, higher numbers of osteoblasts and osteoclasts were detected in comparison to the control group (p < 0.001), while there was no significant difference between the experiment groups. Capillary formation and new bone formation in the isotretinoin group were found to be on a higher level than in the other groups (p < 0.001). CONCLUSION: Isotretinoin had no negative effects on bone formation following the expansion of the maxillary suture in rats.

Comparison of hyoid bone positions and pharyngeal airway dimensions in different body mass index percentile adolescent subjects.

OBJECTIVE: Increased body mass index (BMI) is a growing problem worldwide and can affect medical conditions through morphological structures. The purpose of this study was to examine the hyoid bone position and pharyngeal airway dimensions on the sagittal section in different BMI percentile adolescent subjects. METHODS: Fifty-five adolescent patients were subdivided into three groups, considering their BMI percentiles: Normal-weight (16 subjects), overweight (20 subjects), and obese (19 subjects). A total of 13 linear and angular parameters of head posture angle, pharyngeal airway dimensions, and hyoid bone positions were investigated on 55 lateral cephalometric radiographs. RESULTS: Except for one hyoid bone measurement (RGN-H), there was no significant difference among groups. The RGN-H distances of obese and overweight adolescent subjects were higher than normal-weight adolescent subjects. CONCLUSION: Obese, overweight, and normal-weight adolescent subjects were likely to have similar hyoid bone position and pharyngeal airway dimensions.

YouTube as a Patient-Information Source for Cleft Lip and Palate.

OBJECTIVE: The aim of the present study was to evaluate the content and quality of the popular videos on YouTubeTM about the treatment of cleft lip and palate. DESIGN: Retrospective, YouTubeTM video analysis. METHODS: The 3 keywords "cleft lip and palate surgery," "cleft lip and palate treatment," and "cleft lip and palate repair" were searched on YouTubeTM. After sorted by view-count, final 50 videos were analyzed for general characteristics, primary purpose, information content, relevance, audiovisual quality, and also viewers' interaction index, and viewing rate formulas were calculated for each video. Kruskal Wallis and one-way analysis of variance tests were used to compare the video parameters between good, moderate, and poor information content videos. RESULTS: The viewing rate was significantly higher in good content videos (P = .003). Most of the videos were uploaded by a clinic (32%), a surgeon (20%), or individuals (22%) who shared their own experience. Most of the videos (54.00%) were classified as moderate general information content and 26.00% were rated as poor, and 20.00% were rated as good. Videos generally involved patient information (60.00%), followed by patient parent's experience (14.00%), and cleft lip and palate surgery (12.00%). The average viewers' interaction index of all evaluated YouTubeTM videos was 0.36. CONCLUSIONS: Although most of the videos were rated as moderate regarding the sufficiency of the information, the results of this study showed that YouTubeTM could still not be considered as a fully reliable source of information for patients on treatment of cleft lip and palate.

Quantitative light-induced fluorescence assessment of white spots following semi-rapid maxillary expansion.

BACKGROUND: This study aimed to investigate if the semi-rapid maxillary expansion (SRME) can cause white spot lesion (WSL) formation using quantitative light-induced fluorescence digital (QLF-D). METHODS: The SRME group comprised 15 patients (9 girls, 6 boys; 13.5 ± 1 years) who had transverse maxillary deficiency and underwent expansion with full-coverage expanders. The screw of the expanders in the SRME group was activated twice a day for the first week. After decementation at the end of the first week, the screw activation protocol was changed to 3 turns/ week. In the SRME group, the QLF-D images were captured before starting treatment and 3.18 ± 0.32 months later when the expansion treatment was completed. The control group consisted of 15 subjects (8 girls, 7 boys; mean age 14.2 ± 1.9 years) who never had orthodontic treatment. The images of the control group were obtained with 3 months interval. The images were analyzed in terms of demineralization using analysis software. RESULTS: The left central incisor was the only tooth that was affected by WSL formation in the SRME group after expansion. The left central incisor tooth's fluorescence levels were decreased and the lesion area increased significantly (p < 0.05). No significant mineralization changes occurred in the control group (p > 0.05). CONCLUSIONS: SRME resulted in WSL formation in the left central incisor, while other teeth were not affected by demineralization. Although providing adequate oral hygiene is easier during SRME due to the removable appliance, the orthodontist should still be aware that it may cause demineralization.

Comparing the effects of three different fluoride-releasing agents on white spot lesion prevention in patients treated with full coverage rapid maxillary expanders.

OBJECTIVE: The aim of this study was to assess the effects of three different fluoride-releasing agents on preventing white spot lesions that occur during treatment with full coverage rapid maxillary expanders. MATERIALS AND METHODS: A total of 48 patients with transverse maxillary deficiency were randomly assigned to four equal groups. A fluoride-containing agent was applied to teeth before cementation of the full coverage acrylic-bonded rapid maxillary expanders in the three experimental groups (gel, varnish, and sealent in groups 1, 2, and 3, respectively), while the control group received no agent application. Quantitative light-induced fluorescence (QLF) images of the patients were obtained before cementation and after decementation of the appliances. Four parameters (ΔF, ΔFmax, A, and ΔR) were evaluated on maxillary ten anterior teeth. RESULTS: In the fluoride gel group, upper central and lateral incisors, right first and left second premolars showed significant decreases in fluorescence levels indicating demineralization. Right central and left lateral incisors showed significant white spot lesion formation in the fluoride varnish group. Right and left central incisors and left first premolar were the teeth that mineral loss was observed in the sealent group, while all of the teeth except canines and first premolars showed significant demineralization in the control group. CONCLUSIONS: Multifluorid varnish and Proseal sealant were effective on preventing demineralization and should be applied to teeth clinically before appliance cementation. CLINICAL RELEVANCE: Demineralization is a major problem during orthodontic treatment. The application of effective fluoride-releasing agents could prevent this major iatrogenic complication.

Multidisciplinary Treatment of Severe Upper Incisor Root Resorption Secondary to Transposed Canine.

OBJECTIVE: Tooth transposition is a rare dental anomaly that could lead to undesirable side effects on other teeth. This case report aims to describe the multidisciplinary treatment of a patient with a severely resorbed permanent maxillary central incisor due to transposition with the permanent canine. CLINICAL CONSIDERATIONS: A girl aged 13 years and 7 months with a chief complaint of a pink spot on her maxillary left incisor with a slightly erupted tooth above it was referred to our clinic. Her left maxillary canine was transposed to her left central incisor site. The left canine was impacted and had caused severe resorption of the left central incisor root. Her maxillary left canine was substituted for the central incisor after the compulsory extraction of her left central incisor. The canine was prosthetically restored after orthodontic treatment. The results were stable 1 year after treatment had been completed. CONCLUSIONS: Orthodontic treatment in coordination with other dental specialties like prosthodontics, periodontology and oral and maxillofacial surgery can provide functional and esthetic outcome in cases of severely transposed canines. CLINICAL SIGNIFICANCE: This is a rare case of transposition that shows the significant root resorption on the maxillary central incisor due to the ectopic eruption of the canine. Canine substitution for the central incisor was chosen as a treatment plan instead of placing an implant. An esthetic smile and a functional occlusion were established at the end of the treatment. (J Esthet Restor Dent 29:5-12, 2017).

Effect of 3 cements on white spot lesion formation after full-coverage rapid maxillary expander: A comparative in-vivo study.

INTRODUCTION: The aim of this study was to assess the effects of 3 luting agents (glass ionomer cement, compomer, and polycarboxylate cement) on white spot lesion formation in patients with full-coverage bonded acrylic splint expanders. White spot lesion formation was assessed with quantitative light-induced fluorescence. METHODS: Full-coverage rapid maxillary expanders were cemented with glass ionomer cement, compomer, and polycarboxylate cement in groups 1, 2, and 3, respectively. A control group comprised patients who never had orthodontic treatment. Quantitative light-induced fluorescence images taken before and after rapid maxillary expansion treatment were analyzed for these parameters: the percentages of fluorescence loss with respect to the fluorescence of sound tooth tissue (ΔF) and maximum loss of fluorescence intensity in the whole lesion; lesion area with ΔF equal to less than a -5% threshold; and the percentage of fluorescence loss with respect to the fluorescence of sound tissue times the area that indicated lesion volume. RESULTS: All 3 groups showed statistically significantly greater demineralization than the control group. The 3 experimental groups differed from each other in half of the parameters calculated. Teeth in the polycarboxylate group developed the most white spot lesions. CONCLUSIONS: With the highest rate of white spot lesion formation, polycarboxylate cements should not be used for full-coverage bonded acrylic splint expanders. Compomers may be preferred over glass ionomer cements, based on the findings of this study.

White spot lesion formation after treatment with full-coverage rapid maxillary expanders.

INTRODUCTION: The aim of this study was to evaluate whether treatment with full-coverage bonded acrylic splint expanders causes formation of white spot lesions using quantitative light-induced fluorescence. METHODS: The experimental group underwent rapid maxillary expansion (RME) (n = 16; 6 boys, 10 girls; mean age, 14.1 ± 2.2 years), and the control group received no orthodontic treatment (n = 17; 9 men, 8 women; mean age, 20.7 ± 1.1 years). Quantitative light-induced fluorescence images of the RME patients were taken before cementation and after decementation of the appliances. The images of the control group comprised quantitative light-induced fluorescence images taken 3 months apart. Four parameters were calculated for 10 anterior teeth. RESULTS: Between cementation and decementation, statistically significant differences were found in all 4 parameters in the RME group, whereas no significant changes were found in any parameters in the control group. A comparison of the measured parameters between the RME and control groups showed statistically significant differences. CONCLUSIONS: Patients treated with a full-coverage bonded appliance tended to develop more white spot lesions than did the control subjects.