Effect of different palatal expanders with miniscrews in surgically assisted rapid palatal expansion: A non-linear finite element analysis.

INTRODUCTION: Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures. OBJECTIVE: The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis. MATERIAL AND METHODS: Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures. RESULTS: Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest). CONCLUSIONS: Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.

Effect of different palatal expanders with miniscrews in surgically assisted rapid palatal expansion: A non-linear finite element analysis

ABSTRACT Introduction: Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures. Objective: The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis. Material and Methods: Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures. Results: Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest). Conclusions: Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.

RESUMO Introdução: A expansão rápida da maxila assistida cirurgicamente (ERMAC) tem sido o tratamento de escolha em indivíduos que apresentam suturas esqueleticamente maduras. Objetivo: O objetivo deste estudo foi avaliar, utilizando uma análise não linear com elementos finitos, a distribuição de tensões e os deslocamentos das estruturas craniofaciais e dentoalveolares gerados por três tipos de expansores palatinos usados na ERMAC. Material e Métodos: Três tipos de expansores palatinos foram projetados: Modelo I (dento-osseossuportado com quatro mini-implantes), Modelo II (dento-osseossuportado com dois mini-implantes) e Modelo III (osseossuportado com quatro mini-implantes). Uma osteotomia Le Fort I foi realizada e foi simulada uma expansão palatina total de 5,0 mm. Um método de análise não linear (três teorias - teoria da não-linearidade geométrica, teoria do contato não linear e métodos para materiais não lineares) foi utilizado para avaliar a tensão e o deslocamento de diversas estruturas craniofaciais e dentoalveolares. Resultados: Independentemente do tipo de aparelho expansor palatino, a ERMAC produziu maior expansão anterior da maxila do que posterior (ENA variou de 2,675 mm a 3,444 mm e ENP variou de 0,522 mm a 1,721 mm); o Modelo I apresentou padrão de abertura mais paralela da sutura palatina mediana, com ENP/ENA igual a 54%. Com relação à ENA, o Modelo II (1,159 mm) e o Modelo III (1,000 mm) apresentaram maior deslocamento para baixo do que o Modelo I (0,343 mm). A ENP deslocou-se mais para anterior do que a ENA com todos os aparelhos; o Modelo III apresentou o maior deslocamento para anterior da ENP (1,147 mm) e da ENA (1,064 mm). Os três tipos de expansores apresentaram deslocamento dentário semelhante e separação mínima das suturas craniofaciais. Como esperado, diferentes designs de expansores palatinos produzem diferentes áreas primárias e níveis de tensões (o expansor osseossuportado apresentou tensão mínima nos dentes, e o expansor dento-osseossuportado com dois mini-implantes apresentou o maior). Conclusões: Com base nesse estudo de elementos finitos, os resultados mostraram que diferentes designs de expansores palatinos produzem diferentes áreas primárias e níveis de tensão, com deslocamento mínimo das suturas craniofaciais e diferentes expansões esqueléticas em forma de V.

Spondylo-meta-epiphyseal dysplasia (SMED), short limb-hand abnormal calcification type: Further expanding the mutational spectrum and dental findings of three new patients.

Genetic skeletal disorders are clinically and genetically heterogeneous group of disorders that affect the normal development, growth, and maintenance of the human skeleton. Spondylo-meta-epiphyseal dysplasia, short limb-abnormal calcification type (SMED-SL/AC; MIM# 271665) is a rare autosomal recessive genetic skeletal disorder characterized by distinctive facial features, disproportionate short stature, vertebral, metaphyseal, and epiphyseal abnormalities. This unique phenotype is caused by biallelic loss-of-function variants in Discoidin domain receptor 2 gene (DDR2, MIM# 191311). To date, only 10 pathogenic variants (six missense, two nonsense, one deletion, and one splice site) in DDR2 have been reported in patients with SMED-SL/AC. Dental anomalies related to skeletal dysplasia can include various abnormalities in the number, shape, and position of teeth in the jaw, as well as enamel hypoplasia and dentinogenesis imperfecta. Although abnormal dentition has previously been reported, orodental findings were described in only six patients with SMED-SL/AC. This study aimed to define the clinical, dental, radiological, and molecular findings of three new SMED-SL/AC patients from three unrelated families. Three DDR2 variants, two of which were novel, were detected with the aid of Sanger sequencing. Interestingly, one of the patients was diagnosed with Wilson's disease (WD) during the follow-up, a co-occurrence that has never been reported in patients with SMED-SL/AC so far.

The quality of root canal treatment and periapical status of permanent teeth in Turkish children and teens: a retrospective CBCT study.

OBJECTIVE: This study aimed to assess the quality of root canal fillings and the prevalence of periapical radiolucencies in the permanent teeth of 6-18 year-old Turkish children. METHODS: CBCT images of 150 patients' 235 teeth with a mean age of 16.0 ± 2.06 years were included. Root development stage, quality of root canal filling, the presence and severity of periapical radiolucencies, and their relationship with anatomical structures were recorded. Correlations between the quality of root canal filling, periapical lesion, and lesion size were assessed using regression analyses. RESULTS: A total of 235 teeth (528 root canals) were evaluated. 65.5% of root canals had periapical lesions. Immature roots and mandibular teeth had the highest prevalence and the largest size of periapical radiolucencies (p < 0.05). Overfilling (n = 52), underfilling (n = 93), unfilled (n = 46), inhomogeneously filled (n = 113) root canals and poor coronal restoration (n = 85 teeth) were observed in terms of technical failures of endodontic treatment. The quality of endodontic treatment was associated with the presence of periapical lesion and lesion size (p < 0.05). Teeth with under-filled, overfilled or inhomogeneously filled root canals and poor coronal restoration had a periapical lesion larger than 5 mm (p < 0.05). Immature teeth were most associated with the presence of lesion (OR = 4.07) and the lesion size > 5 mm (OR = 3.71). CONCLUSION: The prevalence of periapical radiolucencies in young permanent teeth showed an increase when the tooth was an incisor, had incomplete root development, or the root filling had technical errors.

Assessment of dental anxiety levels among dental emergency patients during the COVID­19 pandemic through the Modified Dental Anxiety Scale.

BACKGROUND: Coronavirus disease 2019 (COVID­19) continues to affect dental emergency services worldwide. Dental anxiety (DA) is described as a common and distressing problem in terms of oral health maintenance. OBJECTIVES: The present study aimed to evaluate DA levels as well as the COVID­19 fear and perception of control (COVID­19 FPC) in patients attending dental emergency clinics during the COVID­19 pandemic. MATERIAL AND METHODS: Sociodemographic, dental and medical data was obtained from the participants. A face-to-face questionnaire with questions referring to the reasons for the emergency dental visit, the visual pain scale, the Modified Dental Anxiety Scale (MDAS), and the COVID­19 Fear and Perception of Control Scale (COVID­19 FPCS) as well as additional questions concerning bruxism and a previous diagnosis of anxiety/panic attacks or depression was administered. The χ2 test was used to analyze the data. RESULTS: A total of 1,439 patients were included in the study. The most common reason for the dental visit was pain (47.5%). The prevalence of DA was 5.1% (74/1,439). A significant association was found between DA and gender (p = 0.020). The incidence of severe pain was higher in patients with DA than in those without DA (p = 0.002). No significant differences in the MDAS scores were found between patients with and without a chronic disease (p = 0.804), with regard to the educational status (p = 0.364), or between the age groups (p = 0.600). The prevalence of a 'strongly agree' response to all questions in COVID­19 FPCS was higher in patients with DA as compared to those without DA. CONCLUSIONS: Females and patients with severe pain were more likely to exhibit DA. In general, patients with DA strongly agreed with the statements of COVID­19 FPCS, which may indicate a correlation between the 2 scales.

Prevalence of Premature Eruption and Agenesis of Premolars in Turkish Children: A Retrospective Study.

OBJECTIVE: To determine the prevalence and distribution of premature eruption and agenesis of premolars in a sample of Turkish children. STUDY DESIGN: A sample of 1715 patients aged 5 to 11 years was selected. Panoramic radiographs were used to assess premature eruption and agenesis of premolars. Developmental stage of erupted premolars was assessed using Demirjian's method and selecting prematurely erupted premolars on the basis of clinical eruption with a root length less than half of their final expected root lengths. Statistical analysis was performed using chi-square test (p <.05). RESULTS: One hundred fifteen (6.7%) of 1715 patients presented at least one premolar agenesis with no significant sex difference (56 boys, 59 girls). Mandibular second premolars were the most absent teeth. Multiple agenesis of premolars (3.4%) was more common than single agenesis (3.3%). A total of 85 (5.0%) patients (51 boys, 34 girls; no significant sex difference) had at least one prematurely erupted premolar, and maxillary first premolars were most commonly affected. Early erupted premolars were in stage D or E based on Demirjian's dental formation scale. CONCLUSIONS: The prevalence of premature eruption and agenesis of premolars in Turkish children were 5.0% and 6.7%, respectively. Both conditions are not uncommon and may highlight the need for early diagnosis to prevent subsequent clinical problems.

Oral health status of children and young adults with maple syrup urine disease in Turkey.

BACKGROUND: Maple syrup urine disease (MSUD) is an inherited disorder clinically characterized by ketoacidosis, seizures, coma, psychomotor delay, and intellectual disability. The treatment requires a life-long protein-restricted diet, rich in carbohydrates and fats, supplemented with a medical amino acid formula. Diet, oral health and general health influence each other in a vicious cycle. The aim of this study was to investigate the oral health status of children and young adults with MSUD in Turkey. METHODS: A descriptive study was conducted on patients with MSUD who applied for routine follow-up to the pediatric metabolic diseases clinic at Hacettepe University, Children's Hospital in Ankara, Turkey in a 12-month period. Patients with any other concomitant genetic diseases and acute infection were excluded. A total of twenty-five patients were enrolled and underwent oral examination including DMFT/S, dmft/s (decayed/missing/filled teeth/surfaces for deciduous and primary teeth, respectively), plaque and gingival indices. Panoramic radiographs were obtained in 12 cooperative patients. RESULTS: Mean age was 9.88 ± 5.68 s.d years. More than half of the parents had only primary school level education, and low income. Fourteen patients consumed medical formula during or right before sleep. Fourteen patients reported caries-associated pain. Gingival inflammation was present in all 15 patients who cooperated for evaluation. Seven out of twelve patients had at least one dental anomaly or alterations in mandibular morphology. Five patients had previously been treated for caries under general anesthesia. To our knowledge, this is the first study to document oral clinical and radiologic findings in patients with MSUD. CONCLUSIONS: Impaired oral health was observed in this rare disease population. Regular dental referral by physicians, preventive measures and dental treatments should be included in multidisciplinary management of maple syrup urine disease to promote oral health.

Simple bone cyst of the hyoid: A radiological diagnosis and follow-up.

Simple bone cyst (SBC), also known as unicameral bone cyst, is a benign, fluid-filled cystic lesion that mainly appears in the long bones of young patients. Simple bone cysts are considered dysplastic or reactive lesions of bone. The most common locations for SBCs are the proximal humerus and femur. Lesions may occasionally be found in the jawbones. Simple bone cysts often have no clinical impact and are usually detected during routine radiographic examinations unless a gross pathologic fracture occurs. When symptoms develop, they may include mild pain, local tenderness and swelling. Computed tomography (CT) scans demonstrate a central, well-defined, mildly expansile or non-expansile, thin-walled lytic lesion, with little or no marginal sclerosis. Magnetic resonance imaging (MRI) usually confirms the cystic nature of the lesion by showing its fluid content. Cystic masses in the hyoid bone are very rare. Here we report an asymptomatic SBC in the hyoid bone, incidentally discovered in a cone-beam computed tomography (CBCT) examination, which appears to be the 2nd reported case.

Invasive squamous cell carcinoma arising in an inverted papilloma involving oral cavity.

Inverted papilloma (IP) is a benign tumour characterized by the growth of epithelial cells downward into the underlying supportive tissue. The tumour derives from the lining mucosa of the nasal cavity and paranasal sinuses. IP typically arises as a unilateral lesion from the lateral wall of the nasal cavity and extends secondarily to the paranasal sinuses. The aggressive behaviour of IP causing local invasion, its tendency for local recurrence, and its propensity to be associated with carcinoma constitute serious complications. This paper describes a very rare case of IP associated with squamous cell carcinoma, extending into paranasal sinuses, causing destruction of the bony wall of maxillary sinus and involvement of the oral cavity.

Evaluation of osteoarthritic changes in the temporomandibular joint and their correlations with age: A retrospective CBCT study.

BACKGROUND: Cone-beam computed tomography (CBCT) enables the radiographic examination and evaluation of osseous changes in the temporomandibular joint (TMJ). OBJECTIVES: The aim of this study was to determine the prevalence of various bony changes in TMJ in patients from a wide age range as well as to evaluate the CBCT findings of TMJ osteoarthritis (OA) and correlate them with age. MATERIAL AND METHODS: The study included the CBCT images of 150 patients (43 males and 107 females) who were refferred to the Department of Dentomaxillofacial Radiology for the evaluation of TMJs. Each TMJ was evaluated separately for the presence of any osseous changes in the condylar head or articular fossa/eminence, and for joint space narrowing. RESULTS: The mean age of the sample was 37.26 years (range: 10-90 years). A total of 101 (67.3%) patients presented 1 or more osseous changes. No significant differences were found between the right and left TMJs concerning the prevalence rates of osseous changes. Significant differences were found in the mean ages with regard to the absence and presence of the following findings: condylar erosion, osteophytes, loose bodies, erosion in the articular fossa, and joint space narrowing. CONCLUSIONS: Degenerative changes in TMJ may reflect an age-related bone remodeling process. Older patients may have more common findings of OA, such as condylar and articular erosion, osteophytes, loose joint bodies, and joint space narrowing.

Investigation of the determinants of the mandibular cortical morphology.

BACKGROUND: The mandibular cortical index (MCI) is a measurement based on the visual assessment of changes in the morphology of the mandibular cortex on panoramic radiographs. OBJECTIVES: The present study aimed to investigate age, gender, dental status (DS), occlusal function, and presence of torus mandibularis (TM) as variables that might have a possible effect on MCI. MATERIAL AND METHODS: A total of 381 patients (155 men and 226 women) aged 21-84 years (mean age: 43.8 ±14.5 years) were included in this study. Age, gender and DS were recorded for each patient. The occlusal function was evaluated using the Eichner index (EI). The presence of tori was assessed by visual inspection and digital palpation. The MCI assessments were done based on Klemetti's classification (C1-C3). Statistical comparisons were performed using the χ2 test, independent samples t-test and multiple logistic regression analysis (p < 0.05). RESULTS: Significant differences were observed between the MCI categories regarding age, gender, DS, EI, and TM. The likelihood of the MCI categories C2 and C3 was increased in males (odds ratio (OR) 9.33; p < 0.001), when TM was absent (OR 2.73; p < 0.001), in EI Class B (OR 2.68; p = 0.027), and in the age group 50-70 years (OR 2.5; p = 0.018). CONCLUSIONS: Morphological changes of the mandibular cortical bone are related to gender, presence of TM, occlusal function expressed as EI, and age.

CBCT assessment of gubernacular canals in relation to eruption disturbance and pathologic condition associated with impacted/unerupted teeth.

OBJECTIVES: The aim of this study was to demonstrate the imaging characteristics of gubernacular canals (GCs) in impacted/unerupted permanent teeth and to determine whether these characteristics differ as a result of the presence of eruption disturbances or pathologic conditions associated with impacted/unerupted teeth. STUDY DESIGN: GCs were retrospectively analyzed by using cone beam computed tomography in 250 patients with 753 impacted/unerupted permanent teeth (105 males, 145 females; mean age, 21.09 ± 14.45 years; range 6-70 years). RESULTS: The rate of detection of GCs was significantly lower in cases with eruption disturbances than in those without eruption disturbances. An inverse correlation was observed between age and detection of GCs. Similarly, root resorption of adjacent teeth and resorption of impacted/unerupted teeth were associated with lower rates of detection of GCs. However, no association was found for widening of the follicular space. Regression analysis determined disturbed eruption pattern as the most important factor for the absence of GCs. CONCLUSIONS: The absence of GC may indicate a disturbed eruption pattern of the tooth and may increase the risk of complications related to impaction resulting in a tooth that is more likely to remain unerupted.

Unilateral maxillary canine agenesis: a case report and literature review.

Congenital absence of maxillary permanent canines is an extremely rare condition, which may appear as part of a syndrome or as a nonsyndromic form. Nonsyndromic canine agenesis combined with other types of tooth agenesis has occasionally been described in the literature but isolated cases are rarely observed. This report presents an isolated case of maxillary permanent canine agenesis in a healthy 18-year-old female patient and a literature review on the prevalence, etiology, and differential diagnosis of the condition.