Evaluation of the Change in Halitosis with the Improvement in Oral Health in Cleft Lip and Palate Patients.

AIM: This study aimed to assess the effects of hygiene education on periodontal health and mouth/nasal halitosis in patients with cleft. MATERIALS AND METHODS: 39 patients with cleft who were accepted for orthodontic treatment divided into two groups as with (Group1; n = 24) and without braces (Group2; n = 15). Plaque Index (PI), Gingival Index (GI), and Tongue coating Index (TCI) values were recorded. The BANA test microbiological kit, was used to determine the amount of anaerobic bacteria. Values of volatile sulfur components (VSC) for the measurement of oral and nasal halitosis were measured with a Halimeter device. After the initial measurements, oral hygiene instructions were given to eliminate the plaque production on teeth, periodontal structure, tongue and palate. All measurements were repeated 4 weeks after the hygiene instructions. Wilcoxon and Mann-Whitney U test were used for statistical analysis. RESULTS: In both groups, the PI, GI, values were significantly decreased (P < .05). Tongue coating area, thickness and TCI were significantly reduced (P < .05). Oral halitosis values decreased significantly (P < .05). The PI values decreased significantly more in the Group 1 (P < .05). Non significant difference was detected in nasal halitosis in both groups. In unilateral cleft lip and palate cases cases (n = 23), no significant difference was found in nasal halitosis values between the cleft and the healthy sides (P > 0.05). CONCLUSION: In patients with clet cases, periodontal health was improved and oral halitosis was reduced by the given hygiene education; brushing the teeth, especially the tongue and palate. However, hygiene education did not have a significant effect on nasal halitosis. Key Words: Cleft lip and palate, Halitosis, BANA test, Periodontal index.

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.

Dentoskeletal morphology in adults with Class I, Class II Division 1, or Class II Division 2 malocclusion with increased overbite.

INTRODUCTION: The treatment options for adults with increased overbite are limited to dentoalveolar changes that camouflage the condition. Because of high relapse tendency, defining the problem area is important when creating a treatment plan. This study aimed to evaluate dentoskeletal morphology in skeletal Class I and II anomalies associated with Angle Class I, Class II Division 1 (Class II/1), and Class II Division 2 (Class II/2) malocclusions with increased overbite compared with normal occlusion. METHODS: Pretreatment cephalograms of 306 patients (131 men, 175 women; overall ages 18-45 years) were evaluated. Four groups were constructed. Three groups had increased overbite (>4.5 mm): group 1 (n = 96) skeletal Class I (ANB = 0.5°-4°), group 2 (n = 85) skeletal Class II (ANB >4.5°) with Class II/1; and group 3 (n = 79) skeletal Class II with Class II/2 malocclusion. Group 4 as a control (n = 46) skeletal Class I normal overbite. Dental and skeletal characteristics of the groups were compared by sex. For statistical evaluations, analysis of variance followed by Tukey post hoc, Mann-Whitney U, and Kruskall-Wallis tests were used. Additionally correlation coefficients between overbite and skeletal/dental parameters were calculated. RESULTS: Between sexes, with regard to skeletal parameters, the men had greater values in millimetric measurements, and the women had higher SN/GoGn values. Maxillary/mandibular molar heights and the mandibular incisor heights were higher in men. In group 1, decreased lower anterior facial height (LAFH), retrusive mandibular incisors, and increased interincisal degree were determined. The maxillary molars were intrusive, whereas the vertical position of the mandibular molars and incisors in both jaws were normal. In group 2, retrognathic mandible, increased LAFH and mandibular plane angle, extrusive maxillary/mandibular incisors, protrusive mandibular incisors, and decreased interincisal degree were found. In group 3, decreased LAFH, increased interincisal degree, and retrusive incisors in both jaws were determined. There were significant negative correlations between SN/GoGN, palatal plane, and overbite in group 2 and between ANS-SN and overbite in group 3, and positive correlation between interinsical angle and overbite in all increased overbite groups. CONCLUSIONS: Dental morphology seems to be the main factor of increased overbite. Differences between groups were related primarily to inclinations and vertical positions of the incisors, rather than molar positions.

Nonextraction Treatment of a Class III Malocclusion Case Using Mini-Screw-Assisted Lower Molar Distalization.

Mini-screw assisted lower molar distalization was planned for a present mild Class III malocclusion case. Two mini-screws were inserted into the available inter-root area: one on the left, and the other on the right side in the posterior region in the mandible. Distalization of lower molars, premolars and canines were achieved. Orthodontic treatment lasted approximately 2.5 years with 1 year of molar distalization. Minimal relapse was seen in the postretention period. Dentoalveolar changes with mini-screw assisted lower molar distalization are reported in the present case.

Teeth number anomalies in permanent dentition among non-syndromic dental patients.

The aim of this study was to establish teeth number anomalies in relation to gender, tooth type, location, distribution pattern and the association between frequently missing teeth among a group of dental patients in Turkey. A total of 378 non-syndromic patients (240 females and 138 males) with an age range of 7-45 (x +/- SD = 22.07 +/- 3.6) having evidence of absent or excess teeth were evaluated in the study. Pearson Chi-square, Fisher's exact, McNemar and Kappa coefficients were used for statistical analysis. 237 patients had a total of 546 congenitally missing teeth and 141 had 185 excess teeth. Congenitally missing teeth were more commonly seen rather than the presence of supernumerary teeth. Difference was determined in the frequent locations of congenital missing and supernumerary teeth. The most frequent missing tooth type was found to be the mandibular second premolar (26.6%), while the majority of supernumerary teeth were located in the anterior region of the maxillary arch (37.9%). Both teeth number anomalies were more commonly seen among females. In hypodontia cases the occurrence of symmetrical agenesis of laterals and second premolars in maxilla; centrals and second premolars in mandible was notable. Agenesis of mandibular centrals was found to be associated with maxillary lateral agenesis in males. Also higher prevalence of molar teeth agenesis was determined in the occurrence of at least 4 teeth agenesis. These findings will serve as information about the contemporary demographic pattern of teeth number anomalies among non-syndromic Turkish dental patients and can provide evidence that agenesis of some teeth symmetrically or together are the products of the same genetic mechanisms.

Comparison of the effects of modified and full-coverage thermoplastic retainers on occlusal contacts.

AIM: The purpose of this prospective study was to determine the number of contacts in centric occlusion during retention with modified and full-coverage thermoplastic Essix retainers. METHODS: This research was based on 36 patients who were randomly assigned to wear either modified (18 patients) or full-coverage (18 patients) Essix retainers. Silicone-based bite registrations were used to record occlusal contacts at the beginning (T1), end of full-time (6 months; T2), and end of night-time (3 months; T3) wear of retainers. The occlusal contacts determined in treated patients were compared with the values of 18 untreated "normal" Class I subjects. Bonferroni-adjusted Wilcoxon and Kruskal-Wallis tests were used to evaluate intra- and intergroup differences. RESULTS: Total posterior contacts increased significantly at T3 compared to T1 and T2 only in the modified Essix group. Non-ideal and total contacts on premolars, non- ideal and actual contacts on first molars, and actual contacts on second molars increased significantly at T3 in the modified Essix group. No significant increase was determined in the final total posterior contacts in the full-coverage Essix group. Actual contacts on premolars and first molars and total posterior actual contacts were significantly greater at T3 in the modified Essix group compared to the full-coverage Essix Group. Also the number of final posterior ideal contacts in the modified Essix group was greater than in the normal sample. Total anterior contacts decreased significantly in the modified Essix group, whereas they increased significantly in the full-coverage Essix group. CONCLUSIONS: Increase in posterior contacts was achieved only during night-time wear of modified Essix retainers.

Long-term follow-up of a patient with multiple congenitally missing teeth treated with autotransplantation and orthodontics.

This study describes the management of a case of multiple missing teeth involving premolar autotransplantation, orthodontic treatment, and a 6-year follow-up of autotransplantation. The prognosis of the transplant was good with a satisfactory crown-root ratio. Autotransplantation is a viable treatment option that eliminates the need for prosthetic therapy or implants for children with missing permanent teeth.

Effects of the reciprocal mini-chin cup appliance.

The aim of this prospective study was to evaluate the dentofacial effects of the reciprocal mini-chin cup (RMCC) appliance in subjects with pubertal growth and development potential (group 1) and in subjects that had completed this period (group 2). Eighteen patients (13 females, five males) with an Angle Class II division 1 and nine patients (six females, three males) with a Class II division 2 malocclusion, with mandibular dentoalveolar retrusion and optimal vertical facial dimension were included. A control group consisting of 14 subjects (nine females, five males) with pubertal growth and development potential was constructed for comparison with group 1. In both treatment groups a RMCC was used. A Class I molar relationship was achieved in an average period of 5.11 months in group 1 and 10.57 months in group 2. From lateral cephalometric tracings, beside the angular and linear parameters, eight parameters that determined the ratio of the skeletal and dental effects of RMCC were measured and statistically evaluated. A paired comparison t-test was used to assess the differences in each group and a Student's t text to evaluate the differences between the groups. In both groups, no effect of RMCC was found on either the maxilla and/or the sagittal position of the mandible. In group 1, lower anterior face height was increased more compared with group 2; the mandibular plane angle increased and the mandible developed mostly in the vertical dimension. While a Class I molar relationship and correction of the overbite and overjet were achieved in both groups, a greater correction of overjet was found in group 1. Retrusion of the upper incisors without extrusion, protrusion, or proclination of the lower incisors, distalization of the upper molars, mesialization and extrusion of the lower molars and mesialization of the mandibular dentoalveolar structures were observed in both groups. Contributions to the correction of overjet and molar relationship were mostly dentoalveolar in both groups.

Maxillary advancement with internal distraction device in cleft palate patients.

This study aimed to evaluate the results of maxillary advancement by using internal Le Fort 1 distractors on six patients with unilateral cleft lip and palate who had maxillary hypoplasia. The retrognathic maxilla of five patients were protracted with distractor bilaterally, and asymmetric advancement was performed in one patients. A removable intraoral acrylic appliance was used as an anchorage appliance in two patients, and Ragno fan-type expander appliance was used in the others to prevent maxillary collapse during the distraction period. The maxilla of one patient was not distracted successfully due to the maxillary collapse in result of breaking the removable anchorage appliance away. Lateral cephalograms were evaluated before 3 and 12 months after distraction.A desired level of advancement was attained in five patients. In one patient distraction was not performed due to the maxillary collapse. In one of the five patients with a wide oronasal fistula, the size of the fistula was decreased with asymmetric advancement of right and left maxillary segments. Following the retention period of 12 months, the results were stable. It was concluded that effective and easy distraction is possible with internal Le Fort 1 distractors in cleft lip and palate patients who requires maxillary advancement.

The relationship between craniofacial structures and the nose in Anatolian Turkish adults: a cephalometric evaluation.

INTRODUCTION: The aim of this study was to evaluate the relationship between the facial skeletal and the nasal profile in Anatolian Turkish adults. This prospective study was conducted at Gazi University, Faculties of Dentistry and Medicine, in Ankara, Turkey. METHODS: The sample included 262 Turkish adults (167 women, 95 men), aged 18 to 30 years. Fifteen facial skeletal parameters and 12 nasal parameters (10 soft tissue and 2 nasal skeletal) were measured on lateral cephalograms. Analysis of variance, Duncan test, and Pearson correlation analysis were used for statistical analysis. RESULTS: The anteroposterior and vertical classifications were found to be significant with analysis of variance in certain parameters such as nasolabial angle (P < .05), nasomental angle (P < .001), and soft-tissue facial convexity (P < .001). Sex was also found to be significant for nasal length (P < .001), nasal depths (P < .05, P < .001), and hump (P < .01), in addition to soft-tissue facial convexity (P < .01). The results also showed correlations between the skeletal and nasal parameters. Facial heights, lengths, and the anteroposterior/vertical position of the maxilla and mandible were found to be correlated to nasal length and form. CONCLUSIONS: Nasal length, prominence, and form are associated with height and length of the maxilla and the mandible. Posterior-inferior development of the face results in a convex nasal profile, whereas anterior development produces a straight or concave nasal profile.