Third molar angulation and retromolar space after functional orthodontic treatment : Evaluation of panoramic radiographs after monoblock or Herbst appliance.

PURPOSE: The aim of this respectively cohort study was to evaluate the lower second and third molars and canine angulations, retromolar space and occlusal relationships after functional orthodontic treatments with the monoblock or Herbst appliance using panoramic radiographs. METHODS: Pre- and posttreatment cephalometric and panoramic radiographs of 133 patients (mean age 13.89 ± 1.14 years) treated non-extraction with monoblock (n: 44), Herbst (n: 45) and fixed orthodontic appliances (control group; n: 44) were included to the study. Dental and skeletal measurements were performed on cephalometric radiographs. The angle between the third and second molars, and canines with the lower border of the mandible and the occlusal plane, gonial angle, the angle between the third and second molars and the retromolar space width were assessed on pre- and posttreatment panoramic radiographs. Paired and independent t tests were used for the statistical analysis of the data for intragroup and intergroup comparisons. RESULTS: Functional treatment with both the monoblock and the Herbst appliances resulted in improvement of skeletal class II relationships. Retromolar space significantly increased in the functional appliance groups compared to the control group (p ≤ 0.001), but improvement of the angulations of posterior teeth was significant only in the monoblock group (p ≤ 0.001). CONCLUSION: While both the Herbst and monoblock appliances led to an increase in retromolar space, monoblock treatment resulted in more favorable angulation of the third molars compared to the Herbst treatment.

Does puberty affect oxidative stress levels and antioxidant activity of saliva in patients with fixed orthodontic appliances?

PURPOSE: To evaluate and compare patients' oxidative stress parameters and antioxidant status with fixed orthodontic appliances during the pubertal and postpubertal growth periods. METHODS: Saliva samples of 20 pubertal (mean age: 12.94 ± 0.34 years) and 20 postpubertal (mean age: 16.34 ± 0.45 years) patients were collected just before the application of fixed orthodontic appliances (T0), 4-5 h (T1), and 7 days (T2) after the initial orthodontic activation. Myeloperoxidase (MPO), nitric oxide (NO), 8­hydroxydeoxyguanosine (8-OHdG) levels, and superoxide dismutase (SOD) activity in the saliva were examined. Repeated measures analysis of variance (ANOVA), least significant difference (LSD) pairwise comparison, and independent sample t­tests were used to analyze the differences between the time points and growth periods, respectively. RESULTS: MPO levels in the saliva of patients in the pubertal period showed a significantly higher increase within the first days of treatment (T2-T1) than in patients in the postpubertal period (p < 0.05). The SOD antioxidant enzyme activity decreased in the samples from T0 to T1 in the patients in the pubertal and postpubertal groups and returned to baseline values (T0) at T2 (p < 0.01). No significant differences in the other biochemical parameters between groups were observed. CONCLUSIONS: Comparing the pubertal and postpubertal groups, orthodontic force application with fixed orthodontic appliances did not change the final levels (on day 7) of antioxidant status or oxidative stress markers, except for MPO in saliva.

The First Hybrid International Educational Comprehensive Cleft Care Workshop.

OBJECTIVE: Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance. DESIGN: Cross-sectional survey-based evaluation. SETTING: International comprehensive cleft care workshop. PARTICIPANTS: Total of 489 participants. INTERVENTIONS: Three-day simulation-based hybrid comprehensive cleft care workshop. MAIN OUTCOME MEASURES: Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance. RESULTS: The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 ± 3.08 vs 27.63 ± 3.93; P = .04) and perceived impact on their clinical practice (22.37 ± 3.42 vs 21.02 ± 3.45 P = .01). CONCLUSION: Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.

Comparison of Rapid Maxillary Expansion and Alternate Rapid Maxillary Expansion and Constriction Protocols with Face Mask Therapy.

Objective: This study compared dentoskeletal and soft tissue changes with face mask (FM) therapy. Rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocols were used with the two different types of expansion appliance, and their effects on the treatment outcome were investigated. Methods: The study consisted of 79 (37 and 42 patients in the RME and Alt-RAMEC groups with FM, respectively) patients who had received FM treatment. The effects of the RME/FM (20 female, 17 male) and Alt-RAMEC/FM (14 female, 28 male) protocols were evaluated using lateral cephalometric films. The chronological ages of the RME/FM and Alt-RAMEC/FM groups were 11.58 and 11.99 years, respectively. In addition, both groups were divided into two subgroups based on the design of the expansion appliance (Spolyar or full coverage type). Differences in all parameters were analyzed using Student's t-tests. Results: The maxilla significantly moved forward in both the RME/FM and Alt-RAMEC/FM groups (p<0.001). No significant skeletal differences were observed between the groups. Sagittal movement of the upper incisors significantly increased, and the lower incisors significantly retruded in both groups. While similar skeletal changes were found between the Spolyar and full-coverage appliance groups, the upper incisors protruded significantly more in the full-coverage type. Conclusion: RME/FM and Alt-RAMEC/FM therapies were found to be efficient for maxillary protraction and resulted in similar skeletal changes. A full-coverage expansion appliance produced a more upper incisor protrusion than a spherical-type appliance.

Alveolar Distraction.

Alveolar distraction osteogenesis (ADO) has been used for the reconstruction of atrophic alveolus for decades. The advantage of this technique is that it augments the bone and soft tissues together, creating a better alveolar platform for subsequent surgeries and dental rehabilitation. It is especially useful in patients with large and/or complex alveolar clefts for which approximating the alveolar segments reduces the size of the bony cleft and associated fistula. Displacement of the transported segment is the most frequently encountered complication of ADO but can be managed by constructing case-specific distractors.

Relationship Between the Initial Position of Palatally Displaced Canines and Treatment Duration / Relación entre la posición incial de caninos desplazados palatalmente y la duración del tratamiento

Abstract This prospective study aimed to assess the positional features of palatally displaced maxillary canines (PDCs), their relationship with both cephalometric and dental cast measurements and treatment duration. Pretreatment panoramic and lateral cephalometric radiographs and dental casts of 46 patients (23 patients with uni/bilateral PDC and 23 patients with Class I malocclusion) were collected. The mesial inclination of the permanent canine to the midline (α angle), the distance from the cusp tip of the permanent canine to the occlusal line (d distance), and the mesial position of the crown of the displaced canine (sector) were measured on the panoramic radiographs. SNA°, SNB°, ANB°, SN-GoGn°, SN-PP°, and PP-MP° angles and sagittal inclinations of the PDCs' (C-PP°) were measured on cephalometric radiographs. Arch length discrepancies and transversal arch measurements were also performed. The Student's t-test, Mann-Whitney U test and Kruskal-Wallis test were used to compare variables that were not normally distributed while ANOVA was used for the normally distributed data. The arch widths were similar between the groups while crowding was significantly greater in the PDC group. A negative correlation was found between the α angle and vertical plane angle (SN-GoGn°). Treatment duration was positively correlated with α angle and d distance but there was no relationship with the sagittal angulation of the PDC to the palatal plane (C-PP°) and the treatment duration. Treatment duration can be expected to be longer with every increase in the angle of the PDC to the midline and distance from the occlusal plane.

Resumen El objetivo de este estudio prospectivo fue evaluar las características de los caninos mailares desplazados palatalmente (CDPs), su relación con las radiografías cefalométricas, las medidas en los modelos de yeso y el tiempo de duración del tratamiento. Se recolectaron radiografías panorámicas, laterales cefalométricas y modelos dentales de 46 pacientes (23 pacientes con CDPs uni/bi laterales y 23 pacientes con maloclusión de Clase I). Se midieron la inclinación mesial de los caninos permanentes con respecto a la línea media (ángulo α), la distancia de la punta de la cúspide del canino permanente a la línea oclusal (distancia d) y la posición mesial de la corona del canino desplazado (sector) en la radiografía panorámica. En las radiografías cefalométricas se midieron los ángulos SNA°, SNB°, ANB°, SN-GoGn°, SN-PP° y PP-MP° y las inclinaciones sagitales de los CDPs (C-PP°). También se realizaron las medidas de las discrepancias de la longitud de arco y las medidas de arco transversal. La prueba de t de student, prueba Mann-Whitney U y la prueba Kruskal-Wallis se usaron para comparar las variables que no se comportaron con una distribución normal, mientras que se utilizó la ANOVA para los datos de distribución normal. El ancho de los arcos fue similar entre grupos mientras el apiñamiento fue significativamente mayor en el grupo de CDPs. Se encontró una correlación negativa entre el ángulo α y el ángulo del plano vertical (SN-GoGn°). La duración del tratamiento fue positivamente correlacionado con el ángulo α y la distancia d peron o se encontró relación entre la angulación sagital del CDP con el plano palatal (C-PP°) y la duración del tratamiento. Se puede esperar que la duración del tratamiento sea mayor con el aumento del ángulo entre el CDP a la línea media y la distancia desde el plano oclusal.

Evaluation of the effects of vitamins C and E on experimental orthodontic tooth movement.

Background. This experimental study aimed to assess the effects of Vitamins C and E on orthodontic tooth movement. Methods. Fifty-one male Wistar albino rats were divided into six groups: five appliance groups and one control group. The appliance groups had an orthodontic appliance consisting of a closed-coil spring ligated between the maxillary incisor and maxillary first molar (50 g). Vitamin E and C (150 mg/kg) were injected intraperitoneally per day in the first and second groups, respectively. Vitamins E and C (20 µL) were locally injected into the periodontal gap of the moving teeth in the third and fourth groups, respectively, once every three days. No vitamin was injected in the last (fifth) appliance group.The experimental period was 18 days. Histological and biochemical (alkaline phosphatase, osteocalcin, and NTx levels) evaluations of the samples were performed, and maxillary incisor‒molar distance was measured before and after the experiment. Results. The amount of tooth movement was similar in the appliance groups. All the vitamin groups showed significantly increased osteoblastic activity, while those treated with systemic vitamins exhibited significantly increased numbers of collagen fibers on the tension side compared to the appliance control group (P<0.05). Conclusion. Vitamin C and E supplements positively affected bone formation on the tension side of the teeth during experimental orthodontic tooth movement.

Simulation-Based Comprehensive Cleft Care Workshops: A Reproducible Model for Sustainable Education.

OBJECTIVE: Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact. DESIGN: Cross-sectional survey-based evaluation. SETTING: Simulation-based comprehensive cleft care workshop. PARTICIPANTS: Total of 180 participants. INTERVENTIONS: Three-day simulation-based comprehensive cleft care workshop. MAIN OUTCOME MEASURES: Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice. RESULTS: The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 ± 5.7 vs 25.7 ± 7.6; P < .001) and palate (32.4 ± 7.1 vs 23.7 ± 6.6; P < .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices. CONCLUSION: Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants' clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.

A Prospective Study Comparing Adolescent and Post-Adolescent Periods Regarding Effects of Activator Appliance in Patients with Class II Mandibular Retrognathia by Using 3dMDface Analysis and Cephalometry.

BACKGROUND The purpose of this prospective study was to compare adolescent and post-adolescent growth periods regarding the effectiveness of conventional activator appliance in patients with Class II mandibular retrognathia by using lateral cephalometric radiographs and three-dimensional photogrammetry (3dMDface). MATERIAL AND METHODS We enrolled 2 groups: 15 patients in the adolescent growth period and 17 patients in the post-adolescent growth period. All patients had Class II anomaly with mandibular retrognathia and were treated with conventional activator appliances. Lateral cephalometric radiographs and three-dimensional photogrammetric views were obtained at the beginning and end of the activator treatment of Class II patients. Maxillomandibular discrepancy, mandibular protrusion and lengths, convexity angles, facial heights, and dental measurements were evaluated cephalometrically. Projections of the lips and the chin and volumetric measurements of the lip and the mandibular area were assessed using three-dimensional photogrammetry. RESULTS Conventional activator therapy resulted in similar effects in both growth periods regarding improvements in the mandibular sagittal growth and maxillomandibular relationship (ANB° and the SNB° angles). Mandibular effective length was increased (Co-Gn length) and the maxillary horizontal growth was restricted (decreased SNA° angle) in both groups following the treatment. Treatment duration was significantly longer in the post-adolescent group. Increases in the projections of menton, pogonion, and sublabial points were observed in the three-dimensional photogrammetric views. Total lip volume was reduced while the mandibular volume was significantly increased in both groups. Lower gonial angle showed a greater increase in the post-adolescent group. CONCLUSIONS Correction of Class II anomaly with mandibular retrognathia was achieved with a combination of dental and skeletal changes in both growth periods. Conventional activator therapy may be an alternative treatment approach in the late growth period as it led to significant skeletal and dental changes.

NAM Therapy-Evidence-Based Results.

Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

Segmental Corticotomy-Assisted Orthodontic Treatment With Platelet-Rich Fibrin Augmentation of Class III Anomaly.

This clinical report presents the outcomes of segmental corticotomy-assisted orthodontic treatment in a class III patient. A 13.5-year-old female patient presented with class III anomaly and a thin alveolus in the mandibular anterior region. After the alignment of the mandibular incisors, segmental corticotomy with platelet-rich fibrin (PRF) was performed in the mandibular incisor area to facilitate incisor retraction to ensure periodontal support after the changes in the inclination of the teeth. Lateral cephalograms were taken at the beginning (T0), precorticotomy (T1), at the end of the treatment (T2), and 2 years after the treatment (T3). Cone-beam computed tomography (CBCT) records were collected at the T1, T2, and T3 periods to evaluate the bone structures. The measurements included the inclination and the position of the mandibular incisors, symphysis width, symphysis height, B-B' width, cervical alveolar width, the vertical alveolar bone level on the labial and the lingual sides, and the amount of labial and lingual bone at the apex in the mandibular central incisor and canine areas.The class I molar and canine relationship was achieved in this borderline case. The amount of labial bone at the root apex and the B-B' width increased. A vertical alveolar bone gain was observed. The facial profile was improved significantly. The treatment outcome was stable at the 2-year follow-up. The segmental anterior mandibular corticotomy provided an effective correcting inclination of the mandibular teeth with the use of class III elastics. This technique ensured the maintenance of a sufficient amount of labial bone with no periodontal side effects.

Midface Growth in Patients With Unilateral Cleft Lip and Palate Treated With a Nasoalveolar Molding Protocol.

This retrospective cohort study aimed to determine the impact of a nasoalveolar molding (NAM) protocol on midface growth in school-aged children with non-syndromic unilateral cleft lip and palate (UCLP). Data from 56 consecutively treated, NAM-prepared, Caucasian patients with non-syndromic UCLP from a single US cleft palate center were compared to pooled center data based on 56 patients with non-syndromic UCLP treated at 2 Eurocleft centers that did not use presurgical infant orthopedics (non-PSIO). Lateral cephalograms were obtained and 28 landmarks were identified. Published cephalometric measurements from Eurocleft centers were used for comparison. Seven cephalometric measurements (SNA, SNB, ANB, A'N'B', G'-Sn'-Pg', Sn-CT-LS, ANS-Me/N-Me%), available or derivable for both centers, were analyzed. Means and standard deviations for the 7 measurements were calculated for the NAM center. Student's t-tests were used to compare group means for 6 of the measures and a test of proportion was used for ANS-Me/N-Me%. No significant differences were found between the NAM protocol-prepared group and the Eurocleft non-PSIO centers on any of the 7 analyzed cephalometric relationships after accounting for false discovery rate. The NAM treatment protocol does not appear to impact skeletal or soft tissue facial growth in school-aged children with non-syndromic UCLP.

Three-Dimensional Soft-Tissue Evaluation in Patients with Cleft Lip and Palate.

BACKGROUND In cleft lip and palate (CLP) patients, the shape of the facial soft tissues shows variety in 3 dimensions (3D). Two-dimensional (2D) photographs and radiographs are insufficient in the examination of these anomalies. The aim of this retrospective study was to examine the soft tissue and craniofacial characteristics of individuals with nonsyndromic unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), skeletal Class III malocclusions, or skeletal Class I malocclusions using 3D facial imaging. MATERIAL AND METHODS The entire study group consisted of a total of 158 patients, aged 8-32 years: 29 of the patients had UCLP, 22 BCLP, 54 had skeletal Class III malocclusions, and 53 had skeletal Class I malocclusions. 3D stereophotogrammetric soft-tissue recordings of all patients were analyzed. ANOVA and the Kruskal-Wallis test were performed to compare the groups. RESULTS Statistically significant differences were observed among the groups in terms of linear, angular, proportional. and volumetric measurements. While nasal differences were not observed in the Class III group, nose and upper-lip deformities were common in the CLP groups. Upper-lip projection was reduced in all 3 groups. In the Class III patients, the lower lip and chin were more prominent than in the other groups. The facial convexity angle was increased in the CLP and Class III groups. The upper-lip volume was decreased in the BCLP, the UCLP, and the Class III groups. CONCLUSIONS Patients with skeletal Class III or CLP anomalies showed significantly different soft-tissue characteristics than the Class I control group. 3D stereophotogrammetric facial imaging is an easy and noninvasive method that can be used in examination and recording of these facial deformities. It is possible to make volumetric measurements using this method.

Preoperative Alveolar Segment Position as a Predictor of Successful Gingivoperiosteoplasty in Patients with Unilateral Cleft Lip and Palate.

BACKGROUND: Gingivoperiosteoplasty can avoid secondary alveolar bone grafting in up to 60 percent of patients with a cleft. However, preoperative predictors of success have not been characterized. This study reports on the preoperative alveolar segment position most favorable for successful gingivoperiosteoplasty. METHODS: The authors performed a single-institution, retrospective review of patients with a unilateral cleft who underwent nasoalveolar molding. Alveolar segment morphology was directly measured from maxillary dental models created before and after nasoalveolar molding. Statistical analysis was performed to identify parameters associated with the decision to perform gingivoperiosteoplasty and its success, defined as the absence of an eventual need for alveolar bone grafting. RESULTS: Fifty patients with a unilateral cleft who received nasoalveolar molding therapy were included in this study (40 underwent gingivoperiosteoplasty and 10 did not). Eighteen alveolar morphology and position characteristics were tested, including cleft gap width, horizontal and vertical positions of the alveolar segments, alveolar stepoff, and degree of alveolar segment apposition. Post-nasoalveolar molding vertical rotation of the greater segment and the percentage of segment alignment in the correct anatomical zone were statistically significant predictors of the decision to perform gingivoperiosteoplasty (86 percent predictive power). Cleft gap, greater/lesser segment overlap, alveolar segment alignment, greater segment horizontal rotation, and alveolar segment width following nasoalveolar molding were significant predictors of gingivoperiosteoplasty success (86.5 percent predictive power). CONCLUSIONS: Greater segment vertical rotation and proper alveolar segment anatomical alignment are positive predictors of the decision to perform gingivoperiosteoplasty. Post-nasoalveolar molding evidence of proper alignment and direct contact between the alveolar segments were significant predictors of successful gingivoperiosteoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Cephalometric Predictors of Clinical Severity in Treacher Collins Syndrome.

BACKGROUND: The aim of this study was to identify cephalometric measurements associated with clinical severity in patients with Treacher Collins syndrome. METHODS: A retrospective single-institution review of patients with Treacher Collins syndrome was conducted. Preoperative cephalograms and computed tomographic scans (n = 30) were evaluated. Fifty cephalometric measurements were compared to age-specific normative data using analysis of variance. These cephalometric measurements and the patient's Pruzansky classification were correlated to clinical severity using Spearman analysis. Clinical severity was defined as severe (required tracheostomy), moderate (obstructive sleep apnea, oral cleft, or gastrostomy-tube), or mild (absence of listed comorbidities). Cephalometric measurements with a strong correlation (r > 0.60) were identified as predictors of clinical severity. RESULTS: Cephalograms of the study population contained 30 measurements that were found to be significantly different from normative data (p < 0.01). These measurements were related largely to maxillary/mandibular projection, maxillary/mandibular plane angle, mandibular morphology, facial height, facial convexity, and mandible/throat position. Ten of these 30 statistically significant measurements in addition to Pruzansky classification were found to be strongly correlated (r > 0.60) to clinical severity. These measurements include the following: mandibular projection/position (sella-nasion-pogonion, r = -0.64; hyoid-menton, r = -0.62); posterior facial height (posterior facial height/anterior facial height, r = 0.60; condyle-gonion, r = -0.66); maxillary/mandibular plane angle (sella-nasion-mandibular plane, r = 0.62; Frankfort horizontal-mandibular plane, r = 0.61; sella-nasion-palatal plane, r = 0.69; sella-nasion-symphysis, r = -0.69); and Pruzansky classification (r = 0.82). CONCLUSION: Specific cephalometric measurements of increased mandibular retrognathia, decreased posterior facial height, more obtuse maxillary/mandibular plane angle and more obtuse symphysis notch angle are strongly correlated to increased clinical severity in patients with Treacher Collins syndrome.

Unilateral Le Fort I Osteotomy for Rehabilitating the Large Alveolar Cleft and Vertical Malocclusion With the Distraction Technique.

Rehabilitation of the large alveolar clefts with autogenous graft or distraction osteogenesis is one of the most common treatment choices. Depending on the clinical situation such as vertical deficiencies, linear transport of the segment does not always ensure a proper closure of the cleft space. In this report, the authors present a patient in whom large unilateral cleft and vertical alveolar deficiency were closed by unilateral Le Fort I osteotomy and distraction technique using the orthodontic elastics.

Comparison of short-term effects between face mask and skeletal anchorage therapy with intermaxillary elastics in patients with maxillary retrognathia.

INTRODUCTION: The aim of this study was to compare the short-term dental and skeletal effects of a face mask (FM) with those of skeletal anchorage (SA) therapy with intermaxillary elastics in prepubertal patients with skeletal Class III malocclusion. METHODS: Fifty patients with skeletal Class III malocclusion and maxillary deficiency were divided into two groups. In the FM group, an FM was applied by a bite plate with a force of 400g for each side. In the SA group, mini-plates were placed between mandibular lateral incisors and canines, and mini-implants were inserted between maxillary second premolars and first molars. A bite plate was inserted into the upper arch, and Class III elastics were applied with a force of 200g between each mini-plate and mini-implant. RESULTS: Mean treatment durations were 0.52±0.09 years for FM and 0.76±0.09 years for SA. After the treatment, statistically significant increases in SNA°, ANB°, A-y, 1-NA, SnGoGn°, Co-A, Co-Gn, and A-Nperp, and reductions in SNB° and FH┴N-Pg were observed in both groups, and these changes were similar in both groups. In the FM group, 1-NB decreased significantly, and in the SA group, it increased significantly (P < 0.05). CONCLUSIONS: The undesired dentoalveolar effects of the FM treatment were eliminated with SA treatment, except with regard to lower incisor inclination. Favourable skeletal outcomes can be achieved by SA therapies, which could be an alternative to the extraoral appliances frequently applied to treat skeletal Class III patients with maxillary deficiency.

Serial Presurgical Orthopedics for Eye Repositioning and Optimization of Soft-Tissue Repair in an Infant With Tessier No. 4 Cleft.

OBJECTIVE: A male patient with Tessier No. 4 cleft (unilateral left) presented at 20 days of age. The cleft defect beginning between the cupid bow and oral commissure extended to the ipsilateral orbital floor, skirting the nose and lacrimal duct while passing through the cheek medial to the infraorbital nerve. With the lesser segment disposed 16 mm transversely, the wide gap included an absence of orbital floor and lower eyelid. A deficient midfacial platform caused a severe inferior globe dystopia, superiorly displaced left ala base, and severe vertical shortening between ala-canthus and ala-globe. INTERVENTION: A modified Latham device applied directional orthopedics to contract the cleft gap and with an eye part added to elevate the dystopic globe. Two different Latham devices used in succession were each applied for 4 weeks. Lastly, a removable plate further repositioned the eye. Each appliance was designed to differentially move the noncleft and cleft segments of the maxilla. Presurgical orthopedics began at 3 weeks lasted 14 weeks. Intraoperatively at 17 weeks, the inferior globe dystopia was effectively reduced, and the cleft gaps were nearly closed and aligned at the orbital floor, cheek, and the alveolus. Respecting the aesthetic units of face became possible with the soft-tissue repair yet were tight enough in the malar region to retract the lower lid. CONCLUSION: The presurgical directional orthopedic and eye-globe mechanics were sufficient to enable medial canthal repositioning, sustainable correction of orbital distopia, and optimized primary soft-tissue repair. Early result suggests that surgery with presurgical orthopedics is superior to surgery alone.

Nasoalveolar molding in a case of incomplete cleft lip: Is it worth doing?

The purpose of this study was to evaluate the effects of presurgical nasoalveolar molding in an infant with incomplete cleft lip and alveolar notch. The patient was a 15-day-old female infant with a two-thirds vertical separation of the left side of the upper lip, with an intact nasal sill. A modified molding appliance was made to improve nasal esthetics and correct the alveolar notch. Although the nasal and alveolar region abnormalities were not serious, the molding appliance improved the nasal and lip esthetics and was stable during the 4-year follow-up.

An evaluation of the dentoskeletal effects of slow maxillary expansion from the mixed to the permanent dentition.

INTRODUCTION: The aim of this study was to evaluate the dentoskeletal effects of a modified slow maxillary expansion appliance (MSMEA) during the transition from the mixed to the permanent dentition. METHODS: Forty subjects presenting with posterior crossbites were divided into two groups. Twenty-three subjects were assigned to a treatment group (mean age: 9.45 years) and 17 subjects assigned to a control group (mean age: 9.25 years). An MSMEA with acrylic occlusal coverage limited to the palatal cusps was used to provide maxillary expansion. The mean slow expansion treatment period was 7.8 months, while the mean observation period continued for 14.8 months of a 22.6-month total study period. RESULTS: Substantial dental and skeletal effects were observed following treatment with the MSMEA. Most maxillary inter-molar and deciduous inter-second molar width increases were maintained in the permanent dentition (91% and 97%, respectively). Skeletal maxillary transverse dimensions, which increased by 2 mm after active expansion, were significantly greater (p < 0.001) when compared with the controls. CONCLUSION: The findings suggested that an MSMEA provided orthopaedic and dental effects as a result of posterior crossbite correction. The effects of the appliance seen during the mixed dentition were maintained in the permanent dentition.