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.

Relationship between the nasal profile and craniofacial structures: does part of the nasal profile reflect some craniofacial structures?

This study aims to evaluate the relationship between the nasal profile and other craniofacial structures. Lateral cephalometric images of 124 adults were collected for this purpose. Statistical analyses such as regression analysis and canonical correlation analysis (CCA) were conducted on nasal and craniofacial anatomical parameters and their relationships. The regression analysis revealed that nasal length was related to maxillary height; nasal depth was related to the position of the maxilla and anterior cranial base length; and nasal base angle was related to upper dentoalveolar height. CCA revealed that nasal parameters (nasal length, depth, and hump) correlated more strongly with craniofacial parameters (maxillary height, anterior-posterior position of the maxilla, and maxillary length). Individuals with maxillary development curved anteriorly upwards had a straighter and smaller nasal profile, while those with maxillary development curved posteriorly downwards had a more arched and large nasal profile. The shape of the nasal dorsum was affected by the maxillomandibular rotation, while the increase in nasal base inclination was accompanied by an upward rotation of the maxillary plane, an increase in the upper dentoalveolar height, and an increase in the lower facial height. While it was observed that each nasal parameter was correlated with the underlying craniofacial structures to some extent, it was also observed that it would be more useful to evaluate the cumulative effects posed by craniofacial parameters. Various combinations of skeletal and dental structures are related to the nasal profile in varying forms and knowing these relationships will help reshape the face and provide aesthetic harmony.

Evaluation of Orbitomalar Region Projection in Patients With Operated Cleft Lip and Palate (Cephalometric Study).

OBJECTIVE: The aim of this study was to compare the orbitomalar region projection in patients with cleft lip and palate (CLP) with skeletal class 1 cases. DESIGN: Retrospective. SETTING: Single center. PATIENTS: Cephalometric data of 52 cases with unilateral CLP, 25 cases with bilateral CLP, and 60 healthy participants in skeletal class 1 without CLP were included. MAIN OUTCOME MEASURE(S): A total of 5 parameters, 3 in the orbital and 2 in the suborbital region, that determine the projection of the orbitomalar region on lateral cephalograms, and 13 parameters of the craniofacial region were evaluated. RESULTS: Lateral, inferior, and anterior orbital parameters were similar between groups, while suborbital parameters were in a retrusive position in the CLP groups compared to the control group (P < .05). No significant difference was found between the CLP groups in terms of suborbital parameters. A moderate positive correlation was found between orbitomalar parameters and the anteroposterior positions of the maxilla and mandible. The lateral orbital region had a moderate negative correlation with anterior maxillary height, and the suborbital region had a negative moderate correlation with maxillary inclination. CONCLUSION: Suborbital projection was more retrusive in CLP compared to the control group, but no difference was found between the CLP groups. On the other hand, the correlation between orbitomalar projection and maxillary and mandibular development was significant. The results show that there is a need for alternative treatment modalities for the suborbital region in patients with CLP.

The Effect of Knowledge Levels of Breastfeeding Mothers About the Disease on Their Levels of Anxiety During the COVID-19 Pandemic Process.

Background: The health impact of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) spans across all age groups including mothers and their newly born infants; and breastfeeding women during this pandemic deserves special attention due to its short and long-term health implications. When planning the current study, our hypothesis was that the anxiety of transmitting the COVID-19 disease to the baby through breastfeeding would increase among breastfeeding women and it would predominantly be state anxiety. The current study aims to investigate the relationship between the knowledge levels of breastfeeding mothers about COVID-19 and their anxiety levels. Materials and Methods: This is a cross-sectional study and we aimed to reach all mothers with babies between 0 and 24 months of age who applied to the Healthy Child Care Policlinic of Ankara University Faculty of Medicine Hospital between July 1 and August 31, 2020 Questionnaires measuring the level of knowledge about COVID-19 disease and breast milk and questionnaires measuring anxiety levels were administered to mothers. The state-trait anxiety levels and knowledge levels of breastfeeding mothers about COVID-19 disease, as well as their knowledge levels about breast milk and sociodemographic characteristics were compared. Results: A total of 145 breastfeeding mothers were included in the study. The trait anxiety was found to be either absent or mild in 89 (61.4%), moderate in 28 (19.3%), and advanced in 28 (19.3%) mothers. The state anxiety level, however, was found to be either absent or mild in 51 (35.2%), moderate in 42 (29%), and advanced in 52 (35.9%) mothers. When mothers' trait and state anxiety levels and their knowledge levels about breast milk, their knowledge levels about COVID-19 disease and their sociodemographic characteristics were compared, it was determined that mothers with 0-6 months old infants had lower state anxiety levels compared to mothers with older infants. However, the anxiety levels of mothers whose children were >12 months old were mostly moderate (p < 0.05). There was no statistically significant difference in terms of other variables (p < 0.05). A positive correlation was found between the child age and state anxiety level (p = 0.027). Conclusion: Moderate and advanced level of state anxiety was found to be higher than level of trait anxiety parallel to our hypothesis. Among breastfeeding mothers, those with the lowest state anxiety scores were those who had babies between 0 and 6 months. It is important to support breastfeeding mothers in promoting breastfeeding, especially after 6 months of birth. Policymakers, obstetricians and especially the family physicians should be aware that adverse life events may put a higher burden on the emotional wellbeing of breastfeeding women especially after 6 months of birth of the babies. So, breastfeeding promotion, protection and support strategies should be reconsidered specially after 6 months.

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.

The Relationship Between Ocular Protrusion and Craniofacial Structures.

OBJECTIVE: This study aimed to evaluate the relationships between ocular protrusion and other craniofacial structures. METHODS: The lateral cephalograms of 124 nonsyndromic white adults were assessed. Two orbital and 13 craniofacial parameters were measured. Subgroups were constructed according to sex, anteroposterior position of maxilla, and mandibular plane angle values.Anatomical parameters and their relationships were statistically analyzed by analysis of variance and multivariate stepwise regression analysis. RESULTS: There were no significant differences in ocular protrusion distances between sexes, and between individuals with different maxillary anteroposterior position and mandibular plane angle values. Ocular protrusion distances, the distance between the eyeball apex and the lateral orbital margin (Eyeball apex-LOr: OP1) and inferior orbital margin (Eyeball apex-IOr: OP2), were found to be 20.6 ±â€Š2.8 and 16.5 ±â€Š3.1, respectively. However, regression analysis showed that the ocular protrusion distances had weak correlation with a few craniofacial structures. The OP1 had a low negative relationship with the maxillary anteroposterior position (N-Aperp) (r: -0.289) (P < 0.05). The OP2 had a low negative relationship with the palatal plane angle (FH/PP) (r: -0.291) (P < 0.01) but had a positive relationship with the cranial base angle (BSN) (r: 0.304) (P < 0.01) and posterior facial height (SGo) (r: 0.299) (P < 0.01). CONCLUSIONS: Ocular protrusion distances did not differ by sex, maxillary anteroposterior position, and amount of mandibular plane angle and showed weak correlation with a few craniofacial structures. Ocular protrusion amounts can be used for diagnosis and treatment plan in craniofacial syndromic or nonsyndromic anomalies.

Family Functions and Life Quality of Parents of Children With Cleft Lip and Palate.

OBJECTIVE: This study was designed to identify variables affecting family functions and life quality of parents with cleft lip and/or palate children. MATERIALS AND METHODS: Family Assesment Scale (FAS) and short form of World Health Organization quality of life (WHOQOL-BREF-TR) were used to measure family functions and life quality of parents. Questionnaire Forms were given to 146 parents: 74 having cleft lip and/or palate children (cleft-group), and the other 72 with healthy children (control-group). Parents were divided into 3 subgroups according to children's age as 0 to 6, 7 to 12, and 13 to 18 years. Kruskal-Wallis and Mann-Whitney U tests were used to evaluate differences between the groups. RESULTS: Behavior of cleft patients' parents was found to be problematic in behavioral control, required attention and role areas at 0 to 6 years, required attention area at ages 7 to 12 and 13 to 18 years. When compared to control group, significant differences were detected in required attention at ages 0 to 6 years, problem-solving, and communication areas at 7 to 12 years. Findings of life quality were found to be over medium level in physical, social, psychological and environmental areas in cleft group at all age groups; however, life quality was found better in control group in physical, psychological, and social subtests at age 13 to 18 years. CONCLUSION: Cleft children influence family functions in behavioral control, required attention and role areas at early childhood, and continue to affect required attention through adolescence. Also social, physical, and psychological fields of life quality were found lower in cleft parents compared to control group at adolescence.

Effects of Nasoalveolar Molding Therapy on Alveolar and Palatal Cleft Deformities in Unilateral and Bilateral Cleft Lip and Palate.

OBJECTIVE: The purpose of this study was to evaluate and compare the efficacy of nasoalveolar molding (NAM) therapy in the improvement of alveolar and palatal cleft deformity on unilateral (UCLP) versus bilateral (BCLP) cleft lip and palate. MATERIALS AND METHODS: A total of 19 UCLP (14 boys and 5 girls) and 8 BCLP (7 boys and 1 girl) infants completed NAM therapy were included in this study. Standardized parameters of cleft width of alveol and palate were measured on photocopies taken from the pre- and post-treatment plaster casts. To assess the intragroup differences, paired-samples test in UCLP and Wilcoxon test in BCLP groups were used. Mann-Whitney U test was used to evaluate the differences between the groups. RESULTS: Significant decreases in alveolar and palatal cleft gaps were achieved in an average period of 3.3 ±â€Š1.9 and 3.7 ±â€Š1.6 months in UCLP and BCLP patients, respectively. The alveolar cleft decreased 7.85 ±â€Š4.59 mm in UCLP and 4.25 ±â€Š3.13 and 3.81 ±â€Š3.50 mm in right and left alveolar cleft sides in BCLP, respectively. The palatal clefts were decreased 4.63 ±â€Š2.44 mm in medial and 3.72 ±â€Š2.62 mm in posterior parts in UCLP. The decrements in BCLP were 3.00 ±â€Š2.75 mm in medial and 2.88 ±â€Š2.75 mm in posterior palatal cleft distances. No significant differences were determined in the amount of alveolar or palatal cleft closure between UCLP and BCLP groups. The only decrease in arch width was 1.39 mm in medial part of palate in UCLP. CONCLUSION: The NAM device provides significant decreases in both alveolar and palatal cleft deformities in UCLP and BCLP infants, as compared with their birth status.

Treatment Approach to Severe Microgenia Cases: Combined Use of Osseous and Implant Genioplasty.

INTRODUCTION: As well as the chin is an important esthetic unit of the facial structure, it is also the region having a key role in the appearance of the face. Correction of cosmetic and functional deformities that may occur in this region because of serious hypoplasia (microgenia) is performed by chin augmentation. Chin augmentation is most frequently performed via implant or osseous genioplasty in the literature. Both 2 techniques have their own advantages and disadvantages. In the literature, various studies comparing these 2 techniques and their long-term results are present, but in some severe microgenia cases, these techniques can be insufficient only for augmentation. In such cases, combined use of implant and osseous genioplasty techniques can come up and data and experiences regarding such combined uses are limited in the literature. In our study, we aim to report our experiences and long-term results regarding 3 cases to whom chin augmentation combined with implant and osseous method is applied because of serious chin hypoplasia (microgenia). METHOD: Three patients to whom chin augmentation combined with osseous and implant genioplasty was applied because of severe microgenia between 2011 and 2016 are included in our study. Before the chin restoration, orthognathic surgery or maxillomandibular distraction applications owing to existing obstructive sleep apnea, malocclusion, or facial asymmetry, are performed in the patients. In preoperative period, chin augmentation amount required is planned for all the patients via cephalometric analysis and the operations of all the patients are performed under general anesthesia via intraoral access. RESULTS: Among 3 patients, 2 were male and 1 was female and their mean age was 27.3 years (22-33). In all the patients, primarily horizontal subapical sliding osteotomy was performed and advancement was performed. After osteotomy, mean 8-mm osseous advancement was obtained and Medpor implant was placed in the chin at the same session for additional augmentation. Mean advancement amount obtained by the Medpor implants was 9 mm. A total average of 17-mm augmentation was obtained in the patients via osseous and implant genioplasty. The reflection of this advancement amount on the soft tissue was measured as 13 mm. Mean follow-up period is 24 months and the patients did not encounter with a major complication in the postoperative period. In the postoperative period, early-period band application was performed at the chin of the patients to reduce edema and to support immobilization. CONCLUSIONS: Chin contour is an important part of facial aesthetics and osseous genioplasty is the ideal treatment option for the correction of most chin deformities. However, in some serious microgenia cases, osseous genioplasty may be insufficient to correct the existing deformity. In such cases, it is seen that the combined correction procedures to be applied together with the implant use can be applicable in terms of the safety and its long-term results.

Orthognathic treatment of facial asymmetry due to temporomandibular joint ankylosis.

The aim of this study was to present a case series of the orthognathic treatment of facial asymmetry due to temporomandibular joint (TMJ) ankylosis and to characterize the current treatment modalities through a literature review. Four patients who presented with facial asymmetry due to TMJ ankylosis between 2010 and 2014 were included in this study. TMJ ankylosis was surgically treated before bimaxillary surgery with advancement genioplasty in some of the cases. In 2 cases, 3-dimensional (3D) models were used for diagnosis and treatment planning, as 3D models are very important tools for planning surgical maneuvers. Aesthetically pleasant facial symmetry and a good facial profile were obtained in all the cases.

The Importance of the Condition of the Donor Teeth and Jaws During Allogeneic Face Transplantation.

The authors aimed to present dental treatment of the cadaveric tooth in a transplanted maxilla in a patient with facial transplantation with bony framework and soft tissue envelope. The treatment procedure was scheduled after physical examination, and the final plan was designed according to the patient's special medical condition. The authors reported the first successful endodontic treatment of an allogeneic cadaveric donor tooth in a patient with facial transplantation. Dental disease represents a potential risk for infection in patients with allogeneic transplantation, which could affect the success of tissue transplantation and might lead to life-threatening conditions. The (re)treatment of the diseased teeth is possible even after the transplantation. The health of the teeth and jaws of the donor should be evaluated before transplantation, especially when maxilla or mandible transplantation is planned.

Evaluation of the nose profile after maxillary advancement with impaction surgeries.

OBJECTIVE: The aim of this study was to identify and quantify nasal profile changes following maxillary advancement (MA) and maxillary advancement with impaction (MAI) with Le Fort I osteotomies. METHODS: The study consisted of preoperative and postoperative lateral cephalograms of 42 class III adult patients. The study sample was divided into 2 groups, with the first group composed of 22 patients who underwent MA surgery and the second group composed of 20 patients who underwent MAI surgery. In total, 7 skeletal parameters and 17 soft-tissue parameters related to nasal projection, hump, dorsal convexity, and the nasolabial region were evaluated on the cephalograms, and hard- and soft-tissue relationships were assessed. RESULTS: Nasal length, hump, nasal depths, distance from the most convex point of the Alar curvature to the most inferior point of the nostril, alar curvature-subnasale, and subnasale-pronasale measurements decreased postoperatively. In the MAI group, MA correlated with significant decreases in nasal length and hump. In the MA group, MA correlated with pronasale position (P < 0.05); significant decreases in nasal depth, columella convexity, and subnasale-pronasale length; and significant changes in subnasale position. CONCLUSIONS: There is little difference in the effects of the 2 different maxillary surgeries on the postoperative nasal profile.

A comparison of three-dimensional and two-dimensional cephalometric evaluations of children with cleft lip and palate.

OBJECTIVES: The aim of this retrospective study was to compare the consistency of orthodontic measurement performed on cephalometric films and 3D CT images of cleft lip and palate (CLP) patients. METHODS: The study was conducted with 2D radiographs and 3D CT images of 9 boys and 6 girls aged 7-12 with CLP. 3D reconstructions were performed using MIMICS software. RESULTS: Frontal analysis found statistical differences for all parameters except occlusal plane tilt (OcP-tilt) and McNamara analysis found statistical differences in 2D and 3D measurements for all parameters except ANS-Me and Co-Gn; Steiner analysis found statistical differences for all parameters except SND, SNB and Max1-SN. Intra-group variability in measurements was also very low for all parameters for both 2D and 3D images. CONCLUSIONS: Study results indicate significant differences between measurements taken from 2D and 3D images in patients with cleft lip and palate.

Head posture in cleft lip and palate patients with oronasal fistula and its relationship with craniofacial morphology.

OBJECTIVE: This study aimed to evaluate the relationship between head posture and craniofacial morphology in nonsyndromic cleft lip and palate children with oronasal fistula. PATIENTS: A total of 31 cleft lip and palate patients with a mean skeletal age of 7.59 (+/-2.11) years were involved. Fifteen had complete unilateral cleft lip and palate, 13 had complete bilateral cleft lip and palate, and three had complete cleft palate. Each of the cleft patients was matched with a noncleft Class I subject, on the basis of sex and skeletal age. DESIGN: Lateral cephalograms were taken of all subjects in the standardized upright posture and in orthoposition. Sixteen postural parameters and 44 morphological parameters were evaluated. RESULTS: The correlations with the cranio-cervical and mandibulo-cervical parameters indicated a trend of retrusion in the incisors with extention of the head. The positive nontopographical relationship between the nasolabial angle and some of the postural parameters supplemented the retrusion tendency in the upper incisors with head extension. Vertical skeletal morphological parameters correlated with the postural parameters. Cranio-cervical parameters seemed to be mostly related to mandibular position. CONCLUSION: Most of the cranio-cervical parameters measured confirmed an increased cranio-cervical angulation in the cleft sample when compared to controls. This head posture change was associated with alterations in tooth position and craniofacial morphology when comparisons were made to the control group.

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.

A comparison of the effects of 2 mandibular anchorage systems used with a 3-dimensional bimetric maxillary distalizing arch.

The purpose of this study was to compare the effects of 2 mandibular anchorage systems used with a 3-dimensional bimetric maxillary distalizing arch. The Wilson rapid molar distalization appliance for Class II molar correction was used with 26 patients; two groups of 13 patients each were formed. In the first group (9 girls, 4 boys with a mean age 11 years 5 months), mandibular anchorage was gained by a modified lip bumper with a standard lingual arch of 0.9-mm stainless steel. The second group (7 girls, 6 boys, with a mean age of 13 years) had a 0.016 x 0.016-inch utility arch, with a 3-dimensional lingual arch for anchorage. Cephalometric radiographs were taken before and after maxillary first molar distalization. The treatment results showed that the extrusion of the mandibular first molar was statistically significant in both the modified lip bumper and utility arch groups (P < .01 and P <.05, respectively). The incisal edge of the mandibular incisor moved forward significantly in the modified lip bumper and utility arch groups (P < .05 and P < .01, respectively); however, the protrusion in the utility arch group was significantly greater than in the lip bumper group (P <.05). In both groups, significant proclination of the mandibular incisor was observed (P < .01). Comparison of the anchor units showed that there was significantly greater proclination in the utility arch group than in the modified lip bumper group (P < .05). Both anchor units similarly enhanced the mandibular first molar anchorage. However, particularly in the utility group, mandibular incisor anchorage control seemed to be inadequate.