A Novel Approach for the Reconstruction of Premaxilla by Archwise Distraction in Bilateral Cleft Lip and Palate.

Interdental distraction osteogenesis has been introduced as a successful treatment protocol for repairing large clefts. In this article, a new method for reconstruction of the premaxilla in 2 bilateral cleft lip and palate patients is introduced. The aim was to distract the lateral segments through the curve of the dental arch, achieve complete closure of the gaps, and use the premaxilla as a bone graft. Patient 1 (20-year-old female) had double jaw surgery before but presented residual alveolar cleft and small premaxilla. Patient 2 (21-year-old male) had anterior and posterior crossbite and caries of teeth on premaxilla. Following the preliminary fixed orthodontic treatment in both patients, archwise distraction protocol was performed. The distraction duration and the achieved amount of new bone per side were 4 weeks/22 mm and 5 weeks/25 mm in Patients 1 and 2, respectively. At the end of a 2-month retention period, docking side surgery was performed and premaxilla was used as the bone graft. The protocol was very effective for not only closure of the large cleft defects but also the reconstruction of the premaxilla. Anteroposterior relationship and the patients' profiles were considerably and positively affected.

Reconstruction of Premaxilla With Alveolar Distraction Osteogenesis in a Patient With Complete Cleft Lip and Palate: A Case Report.

This case report presents an early clinical evaluation of a patient with bilateral cleft lip and palate (CLP) treated with ArchWise Distraction Osteogenesis Technique and Appliance. A 16-year-old patient with a bilateral CLP had a chief complaint of missing upper anterior teeth and poor aesthetics. The patient had class III skeletal and dental relationships, maxillary hypoplasia, maxillary posterior arch constriction, premaxillary deficiency, multiple missing teeth due to an alveolar cleft, and a concave profile. Treatment plan consisted of maxillary expansion with quad helix appliance, leveling and aligning of the arches with fixed orthodontic appliances, and archwise distraction osteogenesis. Osteotomies were performed to mobilize the posterior segments. Activation of the distractors was continued until the lateral segments had contacted each other, and then sagittal distraction was performed in order to correct the sagittal discrepancy. Patient was referred to the oral surgeon and prosthodontist for the final restorations. A very large gap was successfully repaired using this protocol while maintaining the ideal arch form and generating new bone behind the distracted segments.

Anterior open-bite treatment by means of zygomatic miniplates: a case report.

This case report presents the treatment of a patient with skeletal Cl II malocclusion and anterior open-bite who was treated with zygomatic miniplates through the intrusion of maxillary posterior teeth. A 16-year-old female patient with a chief complaint of anterior open-bite had a symmetric face, incompetent lips, convex profile, retrusive lower lip and chin. Intraoral examination showed that the buccal segments were in Class II relationship, and there was anterior open-bite (overbite -6.5 mm). The cephalometric analysis showed Class II skeletal relationship with increased lower facial height. The treatment plan included intrusion of the maxillary posterior teeth using zygomatic miniplates followed by fixed orthodontic treatment. At the end of treatment Class I canine and molar relationships were achieved, anterior open-bite was corrected and normal smile line was obtained. Skeletal anchorage using zygomatic miniplates is an effective method for open-bite treatment through the intrusion of maxillary posterior teeth.

Dimensional changes of maxillary sinuses and pharyngeal airway in Class III patients undergoing bimaxillary orthognathic surgery.

OBJECTIVE: To evaluate the pharyngeal airway and maxillary sinus volume changes after mandibular setback surgery combined with maxillary advancement and/or impaction surgery. MATERIALS AND METHODS: Seventeen Class III skeletal patients (11 females, 6 males) who required bimaxillary orthognathic surgery were selected. Volumetric measurements were performed using cone beam computed tomography (CBCT) scans preoperatively and 3.9 ± 0.87 months postoperatively. All the CBCT scans were assessed and analyzed using MIMICS 14.0 software. Preoperative and postoperative volumes of pharyngeal airway and maxillary sinuses and the relationship between the amounts of surgical movement of the jaws and the above volumes were statistically evaluated. RESULTS: The pharyngeal airway area presented no significant change except for the lower and total pharyngeal airway volumes in males, in whom a significant decrease was observed (4196.27 ± 2061.11 mm(3) and 3375.53 ± 3624.67 mm(3), respectively). No significant change was observed in the minimal cross-sectional area of the pharyngeal airway. There was a significant decrease in the volume of the maxillary sinuses after the surgery by 3448.09 ± 3315.56 mm(3). No correlation was found between the amount of skeletal movement and the change in the volume of pharyngeal airway or maxillary sinuses. CONCLUSION: There was a significant decrease only for lower and total pharyngeal airway volumes in males and a significant decrease in the volume of the maxillary sinuses.

Noncompliance open-bite treatment with zygomatic anchorage.

OBJECTIVE: To evaluate the dentoalveolar and skeletal effects of the new-generation open-bite appliance. SUBJECTS AND METHODS: The study group was composed of 11 subjects with a mean age of 19.5 years who underwent intrusion of the posterior dentoalveolar segment using an open-bite appliance supported by bilateral zygomatic implants. The study was carried out on lateral cephalograms of the subjects taken before treatment and after intrusion. The mean intrusion time was 9.6 months. RESULTS: The mean intrusion measured as the distance of the U6 to the palatal plane was 3.6 +/- 1.4 mm (P < .001). This resulted in an average of 3.0 degrees +/- 1.5 degrees of closure of the Go-Gn-SN angle (P < .001). The gain in the overbite was 5.1 +/- 2.0 mm (P < .001), and the overjet was reduced by 1.4 +/- 1.5 mm (P < .01). The change in the occlusal plane angle was an average of 2.4 degrees +/- 1.4 degrees counterclockwise rotation (P < .001). The lower facial height was also decreased significantly by 2.9 +/- 1.3 mm (P < .001). No significant changes were observed in the SNA angle and incisor positions (P > .05), except for the interincisal angle, which was increased by 3.5 degrees (P < .05). CONCLUSION: Zygomatic anchorage can be used effectively for open-bite correction through posterior dentoalveolar intrusion.

New generation open-bite treatment with zygomatic anchorage.

This technical note aims to present the fabrication and application of a new generation of posterior intrusion appliances using zygomatic anchorage. The use of zygomatic anchorage enables en masse impaction of the posterior segment without any side effects such as labial flaring. A 14-year-old, female Class II patient with an anterior open bite was treated with a new generation posterior intrusion appliance. At the end of treatment, a Class I canine and molar relationship and a correction of the anterior open bite were achieved. The molars were impacted 3.6 mm, and this impaction was maintained throughout the treatment. The mandibular plane showed a counterclockwise autorotation of 4 degrees. This case report demonstrates that zygomatic anchorage can be used effectively for molar intrusion and anchorage maintenance. However, further clinical studies with larger samples are required to confirm its effectiveness.

Apical root resorption of maxillary first molars after intrusion with zygomatic skeletal anchorage.

The aim of this study was to evaluate radiographically the apical root resorption of maxillary first molars after their intrusion was done using zygomatic miniplates as skeletal anchorage in open-bite cases. The study group comprised 16 consecutively treated open-bite cases who had received special titanium miniplates in their zygomatic bones for use as anchorage to apply orthodontic intrusive forces to the maxillary posterior region. The control group consisted of 16 patients, who were matched regarding age, sex, and treatment duration but who had undergone fixed orthodontic treatment without intrusion mechanics for molars. Tooth lengths were measured on pretreatment, and posttreatment panoramic radiographs of all patients and mesiobuccal and distobuccal roots of left and right maxillary first molars were measured on-screen using a software program. The difference between the pre- and posttreatment tooth lengths was defined as apical root resorption. Comparison of the differences in root resorption of the two groups using the t-test for independent samples showed a statistically significant difference (P = .004) only for mesial roots on the right side. But because the mean difference in apical root resorption was only 0.5 mm, it was concluded that the apical root resorption of maxillary first molars after intrusion was done using zygomatic skeletal anchorage was not clinically significant.

Zygomatic anchorage for en masse retraction in the treatment of severe Class II division 1.

An adult female patient who presented with a severe Class II division 1 malocclusion was treated by en masse retraction of upper anterior teeth against zygomatic anchorage. This case report describes the surgical and orthodontic procedures followed during the treatment. En masse retraction of the six anterior teeth by using zygomatic bone anchorage proved to be an efficient method for the correction of a severe overjet problem.

The use of skeletal anchorage in open bite treatment: a cephalometric evaluation.

The aims of the present study were to assess the effectiveness of skeletal anchorage for intrusion of maxillary posterior teeth, to correct open bite malocclusion, and to evaluate the usage of titanium miniplates for orthodontic anchorage. Anterior open bite is one of the most difficult malocclusions to treat orthodontically. Currently, surgical impaction of the maxillary posterior segment is considered to be the most effective treatment option in adult patients. Various studies have reported the use of implants as anchorage units at different sites of midfacial bones for orthodontic tooth movement. The zygomatic buttress area could be a valuable anchorage site to achieve intrusion of maxillary posterior teeth. Ten patients, 17 to 23 years old and characterized with an anterior open bite and excessive maxillary posterior growth, were included in this preliminary study. Titanium miniplates were fixed bilaterally to the zygomatic buttress area, and a force was applied bilaterally with nine mm Ni-Ti coil springs between the vertical extension of the miniplate and the first molar buccal tube. The results showed that, with the help of skeletal anchorage, maxillary posterior teeth were intruded effectively. As compared with an osteotomy, this minimally invasive surgical procedure eased treatment and reduced treatment time and did not require headgear wear or anterior box elastics for anterior open bite correction. In conclusion, the zygomatic area was found to be a useful anchorage site for intrusion of the molars in a short period of time.

Bodily distalization of molars with absolute anchorage.

Palatal implants have been used over the last two decades to eliminate headgear wear and to establish stationary anchorage. In this case report, the stability of a palatal implant for distalization of molars bodily and for anchorage maintenance was assessed. The implant was a stepped screw titanium (4.5 mm diameter x 8 mm length), and it was placed in the palatal region for orthodontic purposes. A surgical template containing a metal drill housing was prepared. Angulation of the drill housing was controlled according to the radiologic tracing of the maxilla transferred to a plaster cast section in the paramedian plane. The implant was placed using a noninvasive technique (incision, flap, and suture elimination) and left transmucosally to facilitate the surgical procedure and to reduce the number of operations. The paramedian region was selected (1) to avoid the connective tissues of the palatine suture and (2) because it is considered to be a suitable host site for implant placement. After three months of healing, the implant was osseointegrated and orthodontic treatment was initiated. For molar distalization, the Keles Slider appliance was modified and, instead of a Nance button, a palatal implant was used for anchorage. The results showed that the molars were distalized bodily at five months, and no anchorage loss was observed. At the end of the treatment, the smile was improved, and an ideal Class I molar and canine relationship, an ideal overbite, and an ideal overjet were all achieved. In conclusion, palatal implants can be used effectively for anchorage maintenance and in space-gaining procedures. Use of a three-dimensional surgical template eliminated implant placement errors, reduced chair time, minimized trauma to the tissues, and enhanced osseointegration. This method can be used effectively to achieve distalization of molars bodily without anchorage loss.

Evaluation of the relationship between the anterior component of occlusal force and postretention crowding.

The aim of this study was to investigate whether a relationship exists between the anterior component of occlusal force (ACF) and postretention crowding in the mandibular incisor area. The study group comprised 32 adults who had undergone fixed orthodontic treatment in the department clinic at Marmara University in Istanbul, Turkey. In 13 subjects, the mandibular arch was treated without extractions; in 19, it was treated with bilateral first premolar extractions. The average postretention period was 3.5 years. The ACF created in the left side of the mandibular dentition was determined by measuring interdental frictional forces at each contact point mesial to the first molar and distal to the canine. Anatomic contact point displacements between the left mandibular anterior teeth (lateral incisor-canine, central incisor-lateral incisor, and central incisor-central incisor) were measured on plaster casts and summed to provide the irregularity index for these teeth. Correlation analysis was used to assess the relationship between the ACF values at each contact and the irregularity index. In the nonextraction group, statistically significant positive correlations were observed between the ACF and the irregularity index at the 3 contact points that were measured. The strongest correlation was found at the canine-first premolar contact (r = 0.65). In the extraction group, a positive correlation was found between the ACF and the irregularity index (r = 0.49, P <.05) at the second premolar-first molar contact, but no correlation was found at the canine-second premolar contact.

Effect of varying the force direction on maxillary orthopedic protraction.

The aim of this study was to examine the effect of varying the force direction on maxillary protraction. A total of 20 patients with class III maxillary retrognathism were randomly divided into two groups. Group 1 was comprised of nine patients with a mean age of 8.58 years, and group 2 was composed of 11 patients with a mean age of 8.51 years. Both groups received a cap splint-type rapid palatal expander and the screw was activated twice a day for 10 days. After the expansion procedure the face mask protraction procedure was initiated. In group 1, we applied the force intraorally from the canine region with a forward and downward direction at a 30 degrees angle to the occlusal plane. In group 2, the force was applied extraorally 20 mm above the maxillary occlusal plane. In both groups a unilateral 500 g force was applied and the patients were instructed to wear the face mask for 16 h/d for the first three months and 12 h/d for the next three months. The Wilcoxon sign rank test was used to evaluate the effect of the two different face masks, and a Mann-Whitney U-test was carried out to evaluate the differences between the two groups. The results showed that both force systems were equally effective to protract the maxilla; however, in group I we observed that the maxilla advanced forward with a counter-clockwise rotation. In group 2 we observed an anterior translation of maxilla without rotation. The dental effects of both methods were also different. The maxillary occlusal plane did not rotate in group 1, in contrast to the clockwise rotation in group 2. The maxillary incisors were proclined slightly in group 1, but in contrast they were retroclined and extruded in group 2. In conclusion, the force application from near the center of resistance of the maxilla was an effective method to prevent the unwanted side effects, such as counter-clockwise rotation of the maxilla, in group 1. The group 2 results suggest that this method can be used effectively on patients who present as class III combined with an anterior open bite.

Method for the placement of palatal implants.

PURPOSE: Palatal implants have been used in the last 2 decades to eliminate headgear wear and to establish stationary anchorage. The aim of this investigation was to establish a method and easy protocol for palatal implant placement. MATERIALS AND METHODS: The study comprised 8 male and 15 female patients each having a 4.5 x 8-mm stepped screw titanium implant placed in the palatal region for orthodontic purposes. A surgical template containing metal drill housing was prepared. Angulation of the drill housing was controlled according to the radiologic tracing of the maxilla transferred to a plaster cast section in the paramedian plane. Implants were placed using a noninvasive technique (incision, flap, and suture elimination) and left transmucosally to facilitate the surgical procedure and reduce operations. The paramedian region was selected so as to avoid connective tissues of the palatine suture and because it was considered to be a suitable host site for implant placement. RESULTS: After 3 months of healing, all implants were osseointegrated and no implant was lost throughout the orthodontic treatment. DISCUSSION: Palatal implants can be used effectively for anchorage maintenance and space-gaining procedures. CONCLUSION: Usage of a 3-dimensional surgical template eliminated faulty implant placement, reduced chair time, and minimized trauma to the tissues while enhancing osseointegration.