Effects of teriparatide on bone formation in rats with experimentally induced premaxillary expansion.

OBJECTIVE: This study aimed to evaluate the effects of systemic teriparatide on sutural bone formation after premaxillary suture expansion in rats. MATERIAL AND METHODS: Twenty Wistar male rats (8-10 weeks old) were randomly divided into two groups, namely, control (C, n=10) and teriparatide (T, n=10). An expansion force was applied to the maxillary incisors using helical spring for a seven-day expansion period, for both groups. On the eighth day, the rats were kept for a seven-day consolidation period, and then 60 µg/kg teriparatide (once a day) was administered to group T subcutaneously for seven days. Then, all the rats were sacrificed, and histological sections were stained with hemotoxylin-eosin for examination. Anti-osteonectin, anti-osteocalcin, anti-Vascular endothelial growth factor (VEGF) and anti-transforming growth factor beta (TGF-ß) were evaluated by immunohistochemical analysis in the midpalatal suture area. RESULTS: Histologically, the newly formed bone tissue was observed to be larger in group T than in group C. The number of immunoreactive osteoblasts for osteonectin, osteocalcin and VEGF antibodies was significantly higher in group T than in group C (p = 0.0001). The TGF-ß antibody showed a mild reaction in group T, but did not reach significance in comparison with group C (p ˃ 0.05). CONCLUSION: Systemic teriparatide application following the premaxillary expansion of the suture area may stimulate bone formation and add to the consolidation of the expansion in rats by regulating osteonectin, osteocalcin and VEGF.

Three-dimensional soft tissue evaluation after rapid maxillary expansion and mandibular midline distraction osteogenesis.

OBJECTIVES: To evaluate the effects of rapid maxillary expansion (RME) and mandibular midline distraction osteogenesis (MMDO) on facial soft tissues using three-dimensional (3D) images. MATERIALS AND METHODS: A total of 20 patients (average age 15.86 ± 2.17 years) were treated with RME and MMDO using tooth-borne distractors. Three-dimensional photographs of each patient were taken with a stereophotogrammetry system at baseline (T0), at the end of the distraction period (T1), and at the end of the consolidation period (T2). All data were analyzed using a dependent-samples t-test at a significance level of 5%. RESULTS: Total and lower face height increased after MMDO (P < .05). Nasal and mouth width increased after RME as compared with baseline (P < .05). The labiomental angle increased at T1 and decreased at T2 (P < .05). After MMDO, the convexity angle increased while the mandibular angle decreased (P < .05). Upper and lower lip angles increased after RME (P < .05). The distance from the lower lip to the E plane increased after MMDO and decreased after RME (P < .05). CONCLUSIONS: The MMDO and RME procedures provide an efficient nonextraction treatment alternative for transverse maxillomandibular deficiency. MMDO may improve the facial soft tissue profile in the transverse and vertical axis of the mandibular region.

Eruption of an impacted canine in an adenomatid odontogenic tumor treated with combined orthodontic and surgical therapy.

An adenomatoid odontogenic tumor is an uncommon asymptomatic lesion that is often misdiagnosed as a dentigerous cyst. It originates from the odontogenic epithelium. Enucleation and curettage is the usual treatment of choice. Marsupialization may be attempted instead of extraction of the impacted tooth, since it provides an opportunity for tooth eruption. This case report is the first to report on the eruption of an impacted canine in an adenomatoid odontogenic tumor treated with combined orthodontics and marsupialization. The impacted canine erupted uneventfully, with no evidence of recurrence 3 years after the treatment.

Effect of menstrual cycle on orthodontic pain perception : A controlled clinical trial.

BACKGROUND AND OBJECTIVE: The aim of this prospective, single-center, controlled clinical trial was to evaluate the effects of menstrual cycle phases on orthodontic pain perception. MATERIALS AND METHODS: A total of 48 women between 16 and 20 years old with regular menstrual periods who were scheduled to undergo extraction of two upper first premolars for orthodontic treatment were enrolled in this study. Laceback ligatures were used to move canines distally. After activating the laceback ligatures, each patient completed a questionnaire in order to assess pain and quality of life. Pain perception was recorded by patients on a visual analogue scale (VAS) and a verbal rating scale-4 (VRS) immediately after activation (T1) and 24 h after activation (T2). During the appointment, each patient's menstrual-cycle phase (follicular or luteal) was determined by asking some questions about her cycle. For statistical analysis of data, the Mann-Whitney U, independent t test, and Wilcoxon tests were applied. RESULTS: Mean orthodontic pain score was 1.96 ± 0.80 and 47.08 ± 21.68 in the follicular phase, 1.92 ± 0.82 and 46.25 ± 18.92 in the luteal phase at T1 using the VRS and VAS, respectively. Orthodontic pain scores were worse in those patients in the luteal phase than those in the follicular phase (p < 0.05) in terms of both VRS (p = 0.025) and VAS (p = 0.046). No significant difference between pain scores at T1 and those at T2 in both luteal and follicular phases (p > 0.05) were observed. CONCLUSION: The menstrual phase has an influence on the perception of orthodontic pain which is higher in the luteal phase following the activation of laceback ligatures. In clinical practice, the phases of the menstrual cycle may have a significant role in how women perceive orthodontic pain.

Evaluation of Enamel Surface Roughness after Various Finishing Techniques for Debonding of Orthodontic Brackets.

OBJECTIVE: The aim of this study was to evaluate the surface roughness of enamel after debonding with various types of burs. METHODS: The buccal surfaces of 20 mandibular incisors for each group of bur were subjected to profilometer analysis, and three parameters of surface irregularity were recorded. After bracket debonding, adhesive remnants were removed by tungsten carbide burs in low-speed, high-speed, and stainbuster settings. The samples were evaluated at pre-treatment (on sound enamel) (T1) and post-treatment (T2) by a profilometer. The specimens were measured twice, and the mean values were recorded. RESULTS: The results were analyzed in intra-group comparisons with paired t-tests and in inter-group comparisons with one-way ANOVA and Tukey's HSD test. All resin removal techniques significantly increased enamel surface roughness (p<0.05). According to one-way ANOVA, there were significant differences in the effect of enamel surface roughness between all methods (p<0.05). The high-speed bur caused the maximum roughness values and the stainbuster bur caused the minimum roughness values in all the parameters (Ra, Rz, and Rq). CONCLUSION: The three types of burs used for finishing methods revealed significant differences in the enamel surface after debonding. However, the stainbuster bur created smoother surfaces than the other applied methods.

Effects of remineralization procedures on shear bond strengths of brackets bonded to demineralized enamel surfaces with self-etch systems.

OBJECTIVE: To compare the effects of different remineralization procedures on the surface roughness of teeth, shear bond strengths (SBSs), and Adhesive Remnant Index scores of self-etching primer (SEP) used to bond orthodontic brackets to previously treated demineralized enamel surfaces. MATERIALS AND METHODS: A total of 140 extracted human premolar teeth were randomly divided into seven equal groups. Group I was the control group. A demineralization procedure was performed in the other six groups. A remineralization procedure was performed before bonding by using casein phosphopeptide-amorphous calcium phosphate, fluoride, a microabrasion mixture (18% hydrochloric acid-fine pumice), a microabrasion agent, and resin infiltration in groups III to VII. Brackets were bonded using a self-etching primer/adhesive system. The specimens were tested for SBS. The roughness and morphology of the enamel surfaces were analyzed using profilometer and scanning electron microscopy. Data were analyzed with analysis of variance, Tukey, and G-tests at the α  =  .05 level. RESULTS: Significant differences were found in the SBS values among the seven groups (F  =  32.69, P  =  .003). The lowest SBS value was found in group II (2.62 ± 1.46 MPa). No significant differences were found between groups I, III, and VII, between groups III and IV, or between groups V and VI. The differences in the roughness values were statistically significant among the groups (P  =  .002). CONCLUSIONS: Remineralization procedures restore the decreased SBS of orthodontic brackets and decrease surface roughness caused by enamel demineralization. SEPs provide clinically acceptable SBS values for bonding orthodontic brackets to previously treated demineralized enamel surfaces.

Three-dimensional evaluation of hybrid expander appliances: A pilot study.

OBJECTIVE: To evaluate transverse dimensional changes in dentoalveolar and skeletal structures caused by hybrid expander, using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The CBCT records of nine patients (five boys and four girls) (mean age 13.61 ± 0.72 years) treated with hybrid expander were examined. CBCT images were taken at pretreatment and after the expansion. ELSA (point equidistant to both foramina spinosa) was determined as a reference point to compare the distances in all three dimensions. Nineteen transversal dimensions and four angles were measured for both right and left sides. Wilcoxon signed rank test was used for statistical comparison at P < .05 levels. RESULTS: A V-shaped expansion of suture was successfully achieved in all patients without teeth support. The amount of opening was greater in anterior than posterior and in inferior than superior. An 8.75-mm screw expansion was achieved for all patients. Expansion effects reverberated to maxillary central incisor, canine, first premolar, and first molar at 70%, 75%, 92%, and 89%, respectively. The molar teeth tipped buccally (right 3.06° and left 3.24°) as did premolars (right 2.88° and left 3.02°). CONCLUSION: The hybrid expander, minimally invasive expansion appliance that protects teeth by including bone support, can be used easily for rapid maxillary expansion treatment.

Shear-bond-strength of orthodontic brackets to aged nano-hybrid composite-resin surfaces using different surface preparation.

The aim of this study was to evaluate the effects of different surface preparation methods on the shear bond strength (SBS) of orthodontic metal brackets to aged nano-hybrid resin composite surfaces in vitro. A total of 100 restorative composite resin discs, 6 mm in diameter and 3 mm thick, were obtained and treated with an ageing procedure. After ageing, the samples were randomly divided as follows according to surface preparation methods: (1)Control, (2)37% phosphoric acid gel, (3)Sandblasting, (4)Diamond bur, (5)Air-flow and 20 central incisor teeth were used for the control etched group. SBS test were applied on bonded metal brackets to all samples. SBS values and residual adhesives were evaluated. Analysis of variance showed a significant difference (p<0.001) between the groups. Sandblasted group had the highest SBS value (12.85 MPa) in experimental groups. The sandblasting surface treatment is recommended as an effective method of bonding orthodontic metal brackets to nano-hybrid composite resin surfaces.

Porcelain laminate veneer conditioning for orthodontic bonding: SEM-EDX analysis.

The purpose of this in vitro study was to evaluate and compare the effects of different surface treatments and laser irradiation on the bond strength of brackets bonded to porcelain laminate veneer. Porcelain laminate veneer specimens were embedded in the centers of acrylic resin blocks. Thirty-nine teeth were used for shear bond strength testing and the remaining three (one tooth for each group) were used for evaluation of the debonded bracket interface. Specimens were randomly divided into three groups, each containing 13 specimens. The details of the groups are as follows: Group SB, sandblasting with alumina particles (50 µm); Group HFA, 9.6 % hydrofluoric acid etching; Group ER, erbium-doped yttrium-aluminum-garnet (Er: YAG) irradiation (from 1 mm distance, 2 W, 10 Hz for 10 s). After conditioning, the upper central brackets were bonded to the porcelain surfaces. Porcelain laminate veneers were examined under stereomicroscope for adhesive remnant index and surface damage after debonding. The highest shear bond strength values were obtained with Group HFA (10.8 ± 3.8 MPa) and Group ER (9.3 ± 1.5 MPa), whereas Group SB revealed the lowest values. Scanning electron microscopy energy-dispersive X-ray (SEM-EDX) analysis revealed that the silicon level in the porcelain decreased after debonding in all groups. The sandblasting method did not demonstrate any ideal bond strength values; however, the 9.6 % hydrofluoric acid etching and Er: YAG laser did. There were no significant differences among all groups in terms of laminate surface damages. The Er: YAG laser therefore can be selected for ideal bond strength and minimal damage to porcelain laminates.

Alveolar bone changes after asymmetric rapid maxillary expansion.

OBJECTIVE: To quantitatively evaluate the effects of asymmetric rapid maxillary expansion (ARME) on cortical bone thickness and buccal alveolar bone height (BABH), and to determine the formation of dehiscence and fenestration in the alveolar bone surrounding the posterior teeth, using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The CBCT records of 23 patients with true unilateral posterior skeletal crossbite (10 boys, 14.06 ± 1.08 years old, and 13 girls, 13.64 ± 1.32 years old) who had undergone ARME were selected from our clinic archives. The bonded acrylic ARME appliance, including an occlusal stopper, was used on all patients. CBCT records had been taken before ARME (T1) and after the 3-month retention period (T2). Axial slices of the CBCT images at 3 vertical levels were used to evaluate the buccal and palatal aspects of the canines, first and second premolars, and first molars. Paired samples and independent sample t-tests were used for statistical comparison. RESULTS: The results suggest that buccal cortical bone thickness of the affected side was significantly more affected by the expansion than was the unaffected side (P < .05). ARME significantly reduced the BABH of the canines (P < .01) and the first and second premolars (P < .05) on the affected side. ARME also increased the incidence of dehiscence and fenestration on the affected side. CONCLUSIONS: ARME may quantitatively decrease buccal cortical bone thickness and height on the affected side.

Asymmetric rapid maxillary expansion in true unilateral crossbite malocclusion: a prospective controlled clinical study.

OBJECTIVE: To investigate the short-term effects of the asymmetric rapid maxillary (ARME) appliance on the vertical, sagittal, and transverse planes in patients with true unilateral posterior crossbite. MATERIALS AND METHODS: Subjects were divided into two groups. The treatment group was comprised of 21 patients with unilateral posterior crossbite (mean age  =  13.3 ± 2.1 years). Members of this group were treated with the ARME appliance. The control group was comprised of 17 patients with Angle Class I who were kept under observation (mean age  =  12.3 ± 0.8 years). Lateral and frontal cephalograms were taken before the expansion (T1), immediately after expansion (T2), and at postexpansion retention (T3) in the treatment group and at preobservation (T1) and postobservation (T2) in the control group. A total of 34 measurements were assessed on cephalograms. For statistical analysis, the Wilcoxon test and analysis of covariance were used. RESULTS: The ARME appliance produced significant increases in nasal, maxillary base, upper arch, and lower arch dimensions (P < .01) and a clockwise rotation of the occlusal plane (P  =  .001). CONCLUSION: The ARME appliance created asymmetric increments in the transversal dimensions of the nose, maxilla, and upper arch in the short term. Asymmetric expansion therapy for subjects with unilateral maxillary deficiency may provide satisfactory outcomes in adolescents, with the exception of mandibular arch expansion. The triangular pattern of expansion caused clockwise rotation of the mandible and the occlusal plane and produced significant alterations in the vertical facial dimensions, whereas it created no displacement in maxilla in the sagittal plane.

Cone-beam computed tomography evaluation of dentoskeletal changes after asymmetric rapid maxillary expansion.

INTRODUCTION: The aims of this study were to quantitatively evaluate the changes in arch widths and buccolingual inclinations of the posterior teeth after asymmetric rapid maxillary expansion (ARME) and to compare the measurements between the crossbite and the noncrossbite sides with cone-beam computed tomography (CBCT). METHODS: From our clinic archives, we selected the CBCT records of 30 patients with unilateral skeletal crossbite (13 boys, 14.2 ± 1.3 years old; 17 girls, 13.8 ± 1.3 years old) who underwent ARME treatment. A modified acrylic bonded rapid maxillary expansion appliance including an occlusal locking mechanism was used in all patients. CBCT records had been taken before ARME treatment and after a 3-month retention period. Fourteen angular and 80 linear measurements were taken for the maxilla and the mandible. Frontally clipped CBCT images were used for the evaluation. Paired sample and independent sample t tests were used for statistical comparisons. RESULTS: Comparisons of the before-treatment and after-retention measurements showed that the arch widths and buccolingual inclinations of the posterior teeth increased significantly on the crossbite side of the maxilla and on the noncrossbite side of the mandible (P <0.05). Comparison of the 2 sides showed statistically significant differences in both the maxilla and the mandible (P <0.05). CONCLUSIONS: After ARME treatment, the crossbite side of the maxilla and the noncrossbite side of the mandible were more affected than were the opposite sides.

Incidence of white spot lesions among patients treated with self- and conventional ligation systems.

OBJECTIVES: The aim of this study was to investigate the incidence of white spot lesions (WSLs) and its relationship with various patient and treatment variables, in patients treated with self-ligation and conventional ligation orthodontic bracket systems. METHODS: Two-hundred randomly selected patient records (136 female, 64 male) for self-ligation and (108 female, 92 male) for conventional ligation groups were examined to determine WSL development. In the self-ligation group, Damon 3MX (Ormco, Glendora, Calif) brackets had been used, and in the conventional ligation group, Equilibrium 2 (Dentaurum, Phorzeim, Germany) had been used. Labial surfaces of 24 teeth in the pre- and post-treatment photographic records were scored using the WSL index. RESULTS: The prevalence of patients who developed at least 1 WSL before treatment was 19%, whereas after treatment, it was 49% in the self-ligation and 54% in the conventional ligation groups. Before treatment, the patients had only mild WSL, but after treatment, severe WSL and cavitation were observed in both groups. Bracket type, age, and hygiene care were significantly associated with new WSL development (P = 0.008, P = 0.004, P = 0.013, respectively). CONCLUSION: Bracket type and more importantly, the hygiene care therapy provided appeared to influence the development of new WSLs. Ligation can promote plaque accumulation and thereby new WSL development in conventional bracket systems. CLINICAL RELEVANCE: This article investigates the incidence of WSLs in patients treated with self-ligation and conventional ligation. The present study showed that incidence of WSL less in the self-ligation than in the conventional ligation but hygiene care was mostly important factor in developed WSL.

Bacteremia after piezocision.

INTRODUCTION: The aim of this study was to investigate the presence of transient bacteremia after a piezocision procedure. METHODS: The sample consisted of 30 subjects (24 women, 6 men; mean age, 19.6 ± 0.7 years; range, 18.1-22.4 years) with the American Society of Anesthesiologists' physical status I. All patients had Class I skeletal and dental relationships and had fixed orthodontic treatment with the Damon system. The piezocision surgery was performed 1 week after the placement of the orthodontic appliances in all patients. Two 20-mL venous blood samples were collected before and 30 to 60 seconds after the first microincision using an aseptic technique. The samples were inoculated into BACTEC Plus aerobic and anaerobic blood culture bottles and were assessed in the BACTEC blood culture analyzer (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md). The results were analyzed statistically using the McNemar test, with P <0.05 indicating statistical significance. RESULTS: No significant difference between the preoperative and postoperative samples was determined with respect to transient bacteremia (P = 0.250). No bacteremia was detected in the pretreatment samples, although Gemella sanguinis, Streptococcus pluranimalium, and Streptococcus mitis/oralis were detected in 3 postoperative blood samples. CONCLUSIONS: The piezocision procedure might be related to transitory bacteremia. Hence, orthodontists should consider the possibility of bacterial endocarditis in at-risk patients when piezocision is part of the treatment plan.

Long-term stability of dentoalveolar, skeletal, and soft tissue changes after non-extraction treatment with a self-ligating system.

OBJECTIVE: To evaluate the long-term effects of self-ligating brackets (SLBs) on transverse dimensions of arches and skeletal and soft tissues and to quantitatively evaluate the treatment outcome after non-extraction treatment with SLBs. METHODS: The sample consisted of 24 (18 female and six male) subjects, with a mean age of 14.23 ± 2.19 years, who received treatment with the Damon®3 appliances. Complete records including cephalometric radiographs and plaster models were obtained before treatment (T1), immediately after treatment (T2), six months after treatment (T3), and two years (T4) after treatment. Digital study models were generated. Twenty lateral cephalometric, six frontal cephalometric, and eight dental cast measurements were examined. The Peer Assessment Rating index was used to measure the treatment outcome. The Wilcoxon test was applied for statistical analysis of the changes. RESULTS: There were significant increases in all transverse dental cast measurements with active treatment. There was some significant relapse in the long term, particularly in maxillary width (p < 0.05). Statistically significant increases were found in nasal (p < 0.001), maxillary base, upper molar, lower intercanine, and antigonial (p < 0.05) widths in T1-T2. Lower incisors were proclined and protruded in T1-T2. CONCLUSIONS: SLBs correct crowding by mechanisms involving incisor proclination and protrusion and expansion of the dental arches, without induction of clinically significant changes in hard and soft tissues of the face.

Can demineralized enamel surfaces be bonded safely?

OBJECTIVE: To evaluate and compare the effects of enamel demineralization, microabrasion therapy and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application on the shear bond strength (SBS) of orthodontic brackets bonded to enamel surfaces and enamel color. MATERIALS AND METHODS: Eighty freshly extracted human maxillary premolar teeth were allocated to one of the four groups. Brackets were bonded directly to non-demineralized enamel surfaces in Group I (control group), directly to the demineralized enamel surfaces in Group II, to demineralized enamel surfaces after CPP-ACP application in Group III and to demineralized enamel surfaces after microabrasion therapy in Group IV. The samples were stored in water for 24 h at 37°C and then underwent thermocycling. The SBS in megapascals (MPa) was determined by a shear test with 0.5 mm/min crosshead speed and failure types were classified with modified adhesive remnant index scores. The data were analyzed with one-way analyses of variance (ANOVA), Tukey and chi-square tests at the α = 0.05 level. RESULTS: Significant differences were found among the four groups (F = 21.57, p < 0.01). No significant difference was found between Group I and III (17.12 ± 2.84 and 15.08 ± 3.42 MPa, respectively) or between Group III and IV (12.82 ± 2.64 MPa). The lowest SBS value was determined in Group II (5.88 ± 2.12 MPa). Enamel demineralization, microabrasion therapy and CPP-ACP application affected enamel color significantly. CONCLUSION: CPP-ACP application and microabrasion therapy are able to increase the decreased SBS of orthodontic brackets because of enamel demineralization.

Effect of pine bark extract on bond strength of brackets bonded to bleached human tooth enamel.

AIM: The purpose was to investigate the effect of pine bark (proanthocyanidin, natural antioxidant) solution on the shear bond strength (SBS) of metal brackets bonded with composite resin to human enamel after bleaching with hydrogen peroxide (HP). MATERIALS AND METHODS: Sixty recently extracted premolars were divided into an experimental group (n = 45), which was bleached with 40% HP, and a control group (n = 15), which was not bleached. The experimental group was further divided into three sub-groups. Specimens in group IB (n = 15) were bonded immediately after bleaching; specimens in group SA (n = 15) were bleached, then treated with 10% sodium ascorbate and then bonded; group PB specimens (n = 15) were bleached, then treated with 5% pine bark solution and bonded. The specimens were debonded with Universal testing machine. The adhesive remnant index was calculated. RESULTS: No significant differences in shear bond strength were noted when the pine bark treated group was compared with the control group and sodium ascorbate group (p > 0.05). Treating the bleached enamel surface with 10% sodium ascorbate or 5% pine bark solution reverses the SBS reduction. CONCLUSION: So, as a natural antioxidant and less hazardous, clinicians can choose pine bark solution instead of sodium ascorbate.

Intranasal midazolam may prevent gagging reflex: a case report.

BACKGROUND: Gagging can become a conditioned response that makes dental treatment difficult or impossible for both the individual and the dentist. The aim of this study is to report a 50 year old female and two children (15 and 11 years old) with exaggerated gag reflex referred to Faculty of Dentistry of Selçuk University. METHODS: During obtaining records, taking impression procedure was elicited the patients' hypersensitive gagging reflex. Therefore, it was decided to administer intranasal midazolam to facilitate the taking of accurate dental impressions. After given verbal information about the procedure, 2.5 mg intranasal midazolam (Demizolam, Dem Medikal, Istanbul) were applied incrementally in both nostrils. RESULTS: Five minutes later; patients had no gagging reflex and allowed the clinician to take satisfying impressions. No serious adverse effects were observed and the patients remained cooperative during the entire procedure which was completed to the full satisfaction of all involved. The short absorption time and the fast relief process of anaesthetics transferred to the systemic circulatory system are important advantages of nasal application. CONCLUSIONS: Intranasal midazolam may be very useful for the treatment of gag reflex probably effecting on the depression of upper airway reflex sensitivity.