Evaluation of Anxiety in Turkish Parents of Newborns with Cleft Palate with or Without Cleft Lip.

OBJECTIVE: (1) To compare anxiety between parents of newborns with cleft lip and palate (CLP), isolated cleft palate (CP), and healthy newborns and (2) to evaluate anxiety between parental dyads within these groups. DESIGN: A cross-sectional study. SETTING: University Hospital. PARTICIPANTS: Surveys were completed by 20 mothers and 20 fathers of newborns with CLP, 21 mothers and 21 fathers of newborns with CP, and 23 mothers and 23 fathers of healthy newborns (controls). MAIN OUTCOME MEASURE: The State-Trait Anxiety Inventory (STAI) assessed parental anxiety. Mothers of newborns with a cleft reported on concerns regarding cleft-related issues and facial appearance. RESULTS: State and trait anxiety were generally in the moderate range for parents of newborns with a cleft, while control parents had low state anxiety and moderate trait anxiety. Mothers of newborns with CP and CLP had significantly higher state and trait anxiety levels than control mothers (p < .05). Fathers of newborns with CLP had a higher state anxiety level than control fathers. When maternal and paternal anxiety was compared within the groups, only trait anxiety scores were significantly higher in mothers of newborns with CLP than that of fathers (p < .05). More than half of mothers of newborns with a cleft were concerned about their newborn's feeding, speech, and palate. CONCLUSIONS: Parents of children with a cleft may need psychological support in the early postnatal period. It is important for neonatal cleft team providers to help reduce parental anxiety and educate families about cleft care, with a focus on feeding.

Comparison of the effects of different rapid maxillary expansion techniques on craniofacial structures: a finite element analysis study.

AIM: To compare the effects of three different maxillary expansion appliances with five different types of expansion modalities on stress distribution and displacement on the maxilla and its adjacent craniofacial structures using the finite element method (FEM). MATERIALS AND METHODS: Cone-beam computed tomography data of a patient with maxillary transverse deficiency were rendered into a three-dimensional model of craniomaxillary structures. The expansion appliances included tooth-borne, hybrid, and bone-borne expanders. Five different expansion modalities were applied to each expander [conventional Rapid Maxillary Expansion (RME) (type 1), midpalatal suture cortico-puncture-assisted RME (type 2), LeFort l cortico-puncture-assisted RME (type 3), surgically assisted RME (SARME) without pterygomaxillary junction (PMJ) separation (type 4), and SARME with bilateral PMJ separation (type 5)]. The numerical and visual data were analyzed. RESULTS: The highest amount of stress accumulation on teeth was found in the tooth-borne and hybrid groups. On the other hand, more stress concentration on the maxilla was observed in the bone-borne group. SARME cuts with PMJ separation increased total movement by reducing the stress on the midpalatal suture in all groups. While types 1, 2, and 3 were similar in terms of the amounts of displacement, types 4 and 5 increased the total amount of displacement in all groups. The total amounts of displacements from the highest value to the lowest value for the anterior and posterior maxilla were in the bone-borne, tooth-borne, and hybrid groups. CONCLUSIONS: SARME cuts were effective in reducing stress on the teeth, but the cortico-puncture application affected neither the stress values on the teeth nor the transverse displacement in the tooth-borne expanders. Surgical procedures such as SARME and corticotomy should be used with bone-borne devices to improve the outcomes of maxillary expansion procedures.

Apical Root Resorption of Endodontically Treated Teeth after Orthodontic Treatment: A Split-mouth Study.

Objective: The influence of pulp status on orthodontically induced root resorption has attracted attention. The purpose of this study was to compare orthodontically induced root resorption in endodontically treated teeth and their contralateral vital teeth in a split-mouth design. Methods: The sample included 173 patients who had at least one endodontically treated tooth, and their vital contralateral teeth served as the control group before the completion of orthodontic treatment. Apical root resorption measurements were performed by the comparison of digital panoramic X-ray images obtained at the beginning and at the end of the orthodontic treatment. Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests were used for statistical analysis. Results: There was no statistically significant difference in apical root resorption between the endodontically treated teeth and the contralateral teeth (p>0.05). Sex and tooth type had no effect on apical root resorption both in the endodontically treated teeth and the contralateral vital teeth (p>0.05). Orthodontic treatment with extraction caused more apical root resorption in the vital teeth than in the endodontically treated teeth (p<0.05). The quality of the endodontic treatment had no significant influence on apical root resorption (p>0.05). Conclusion: Endodontic treatment does not produce greater apical root resorption compared with the vital teeth.

Occlusal plane rotation and orthodontic decompensation: influence on the outcome of surgical correction of class III malocclusion.

PURPOSE: The aim of this retrospective multicenter study is to evaluate the influence of surgical manipulation of the upper occlusal plane (UOP) and orthodontic decompensation on the outcome of class III orthognathic surgery. METHODS: Incisor inclinations, occlusal plane inclination as well as skeletal and soft tissue changes were assessed in lateral cephalograms of 85 class III patients who had previously undergone orthognathic surgery. Fourteen linear and eight angular measurements were performed on each radiograph at the beginning of treatment (T0), before surgery (T1) and at the end of treatment (T2) using imaging software. After measurement of variables, Mann-Whitney U­test, repeated-measures analysis of variance (ANOVA) with Bonferroni multiple comparison test, and Spearman's correlation analysis were performed. RESULTS: A statistically significant improvement was observed in both sagittal skeletal and soft tissue measurements (p < 0.05). Surgical change in UOP was significantly correlated with changes in overbite, upper lip strain and soft tissue B­point change in the sagittal direction (p < 0.05). Overjet change was significantly correlated with changes in the soft tissue and all sagittal skeletal parameters except for SNA. Changes in the incisor inclinations was significantly correlated with changes in the sagittal skeletal parameters and lower facial height. Significant differences were also observed between the groups with induced clockwise or counterclockwise rotation of the mandible in terms of IMPA (long axis of LI to mandibular plane), overbite, upper lip strain and position of soft tissue B­point (p < 0.05). CONCLUSION: Sufficient dental decompensation is crucial for controlling the sagittal as well as the vertical relationship during surgery. Counterclockwise rotation provides an increase in sagittal projection of the mandibular body at the soft tissue B­point.

Differences in third molar development and angulation in class II subdivision malocclusions.

PURPOSE: To assess and compare the developmental stages and angulations of third molars between the class II and class I sides in class II subdivision malocclusions. METHODS: This retrospective study was performed using panoramic x­rays of 38 individuals (mean age: 15.5 years; 24 females, 14 males) with class II subdivision malocclusions, which were further divided into type 1 and 2 subgroups according to midline deviation, and a control group of 42 individuals (mean age: 17.0 years; 30 females, 12 males) with normal occlusion. Third molars were categorized using the developmental stages defined by the Demirjian method. Angles between the third molars and horizontal reference lines and also to the second molars were measured. RESULTS: No difference was found in developmental stages or angulations between the left and right third molars in the control group. In the class II subdivision malocclusion cases, no difference in third molar developmental stages was observed, but the angle between the long axes of the mandibular third and second molars was significantly greater on the class II side. In the type 2 subgroup, developmental stage of the maxillary third molar was more advanced on the class II side. In both subgroups, the angles of the maxillary third molars' long axis to the interorbital plane differed significantly between the two sides. CONCLUSION: Class II subdivision malocclusion may cause differences in third molar development and angulations between the two sides. Orthodontic treatment should be planned considering the third molars in this malocclusion.

Evaluating the changes in nasal airway volume and nasal airflow after surgically assisted rapid maxillary expansion.

OBJECTIVE: This study aims to compare the changes in the nasal airway volume and nasal airflow using acoustic rhinometry (AR), rhinomanometry (RMN), and dental volumetric tomography (DVT) after surgically assisted rapid maxillary expansion (SARME). STUDY DESIGN: Our study consists of 13 adults, 3 male and 10 female patients, aged between 15 and 26, with completed skeletal development. In our study, DVT imaging was obtained twice, preoperation and 3 months after expansion. AR and RMN measurements were recorded, and Visual Analog Score (VAS) and Nasal Obstruction Symptom Evaluation (NOSE) Scale surveys were scored at preoperation and 3 months after expansion. Nasopharyngeal-oropharyngeal airway volume and areas were calculated using the Romexis 3.8.3.R (Planmeca, Helsinki, Finland) and Nemotec V2019 (Madrid, Spain) software programs. IBM SPSS Statistics 22 (SPSS IBM, Armonk, New York) was used for statistical analysis. RESULTS: Comparing the preoperation and postexpansion measurements by both software programs revealed a statistically significant increase in the nasopharyngeal airway volume. No statistically significant change was observed in the oropharyngeal airway volume. Furthermore, we found a statistically significant increase in VAS but a significant decrease in NOSE. CONCLUSION: According to our findings, nasal airway volume increased after SARME, and although there was no significant change in nasal resistance, patients' quality of life increased significantly.

The Effects of Occlusal Plane Inclination and Dental Decompensation on the Overall Result of Surgical Correction of Class II Malocclusion.

PURPOSE: To evaluate the effects of upper occlusal plane (UOP) inclination and incisor decompensations on the outcome of surgical Class II patients. MATERIALS AND METHODS: Pretreatment (T0), preoperative (T1), and posttreatment (T2) cephalograms of 30 surgical Class II patients were included. Cephalometric measurements were performed using the Dolphin Imaging Software in this retrospective study. The differences between time points were analyzed with repeated measures ANOVA. Spearman correlation test was used to determine any correlations between either the UOP alterations or incisor decompensations and the cephalometric variables. RESULTS: A significant improvement was obtained in the sagittal skeletal, dental variables, and soft tissue B point. Significant correlations were found between the decompensation achievement ratio and the change of the convexity angle. The relative percentage ratio (RPR) of the lower incisor was correlated with Wits appraisal, ANB, and Convexity Angle at the T2 stage. The RPR of the upper incisor was found to be correlated with lip strain. The relative surgical correction ratio of the UOP angle was found to be correlated with the surgical change of Wits appraisal and convexity angle. The RPR of the UOP angle was correlated with the SNB, ANB, and SN-GOGN angles at the T2 stage. CONCLUSIONS: Significant improvement in the incisor inclinations was achieved, but the incisors were inadequately decompensated at the preoperative phase. Surgical correction was limited by the inadequate presurgical decompensation. The surgical alteration of the UOP should be taken into consideration for the surgical planning to obtain better outcomes for Class II patients.

Comparison of the Stability of Sandblasted, Large-Grit, and Acid-Etched Treated Mini-Screws With Two Different Surface Roughness Values: A Histomorphometric Study.

PURPOSE: To evaluate the effects of 2 different surface roughness values produced by sandblasted, large-grit, and acid-etched treatments at different loading conditions on the stability of mini-screws. MATERIAL AND METHODS: A total of 56 mini-screws (Group 1; 28 with Ra value of 1 µm, Group 2; 28 with Ra value of 1.5 µm) were inserted into the tibia of fourteen New Zealand rabbits. Surface analysis was performed before the placement of the miniscrews using multi-technique characterization. The mini-screws were loaded with 500 grf after different healing times: unloaded, immediate, 4 and 8 weeks. Resonance frequency analyses were performed immediately after mini-screw placement and at the end of loading. Biomechanical and histomorphometric analyses were also performed at the end of the loading period. RESULTS: All mini-screws preserved their stability at the end of the loading period. However, the resonance frequency analyses showed higher implant stability quotient scores for 8-week group, unlike the immediate loading and unloaded groups (P < 0.05). According to the infinite focus microscopy results, prolongation of healing time resulted in a greater bone area on the loaded mini-screws in Group 2 (P < 0.05). Similarly, the histomorphometric analysis revealed higher bone-to-implant contact values in the 8-week group. There was no significant difference in the stability between the miniscrews with the Ra values of 1 and 1.5 µm. CONCLUSIONS: Sandblasted, large-grit, and acid-etched treated mini-screws showed significantly higher stability with healing time under heavy forces. Sandblasted, large-grit, and acid-etched treated mini-screws can be removed without fracture of the screw or the bone surfaces.

Do we pay for maxillary protraction? Evaluation of the effects of Alt-RAMEC protocol and face mask treatment on root development.

OBJECTIVES: To evaluate root development of pediatric patients treated with Alt-RAMEC + Face mask therapy. MATERIAL AND METHODS: The 19 subjects (9 girls, 10 boys; mean age: 8.6 ± 1.1 years) treated with Alt-RAMEC and a Petit-type face mask were included to the study. The cone-beam tomography (CBCT) records of these patients were used to quantify the root length. The root length measurements of 456 permanent teeth (maxillary-mandibular incisors, canines, premolars, and first molars) were performed at the beginning of the treatment (T0), after the Alt-RAMEC protocol (T1), and at the end of the face mask treatment (T2) using Planmeca Romexis software. RESULTS: Tooth length values increased significantly in the maxillary teeth except the central incisors, left lateral incisor, the palatal root of the right first molar, and distal and palatinal roots of the left first molar (p < 0.05). Mandibular teeth also showed significant increase in the root length except mandibular central incisors and the distal root of left first molar (p < 0.05). The change in tooth lengths from T0 to T1 showed positive delta values. The comparison of the change in tooth lengths after the Alt-RAMEC protocol and after the face mask therapy showed that ∆T2-T1 was statistically significantly higher compared with ∆T1-T0 (p < 0.05). CONCLUSIONS: Alt-RAMEC + Face mask therapy seem not to inhibit root development of maxillary and mandibular teeth in the mixed dentition. CLINICAL RELEVANCE: These findings suggest that early Alt-RAMEC + Face mask interventions have not played a negative role in root development. However, further studies involving a control group need to be performed.

The evaluation of the effect of hypercalcemia in oral pathologies.

OBJECTIVE: Hypercalcemia is determined as an increase in the serum calcium level (above 10.5 mg/dL or ionized calcium is above 1.5 mmol/L). It was aimed to evaluate the effect of the increased serum calcium levels in dental panoramic radiographs with oral pathologies. MATERIALS & METHODS: The final sample number of the present study was determined as 143. 61 patients with hypercalcemic calcium levels were grouped in Hypercalcemia Group (HPEG) whereas 82 patients were grouped in Normal Group. (NG) Measurements were performed only on the panoramic radiographs. The evaluated parameters were cyst-tumor or granuloma existence, sinus pneumatization, stylohyoid ligament calcifications, lamina dura loss, bone loss existence, etc. Statistical tests were carried out at p < 0.05 significance level. RESULTS: The cyst-tumor formation (p = 0.03) and stylohyoid ligament calcification (p = 0.009) and increased radiopacity (p = 0.03) were significantly more common in NG than the HPEG group. Alveolar bone loss (p = 0.001) and periodontal defects (p = 0.01) were significantly more common in HPEG than the NG group. There was no significant relationship between other examined parameters. (p > 0.05) CONCLUSION: The serum calcium level revealed statistically significant outcomes and a close relationship with the pathologies occurring in the alveolar bone in the oral and maxillofacial region. However, it is highly recommended to include more patients in the newly planned studies and another bone-related biomarker should be evaluated simultaneously.

Histologic and Biomechanical Evaluation of Osseointegrated Miniscrew Implants Treated with Ozone Therapy and Photobiomodulation at Different Loading Times.

PURPOSE: The aim of this study was to evaluate how continuous heavy orthopedic forces affect the stability of sandblasted, large-grit, acid-etched (SLA)-surfaced miniscrew implants and surrounding bone tissue healing at three different loading periods with treatment of photobiomodulation and ozone therapy. MATERIALS AND METHODS: Miniscrew implants were applied on the tibias of 9-month-old rabbits (n = 18). The animals were randomly divided into three groups: control, photobiomodulation, and ozone therapy. In all groups, miniscrew implants were loaded with 500 gf at 0, 4, and 8 weeks, respectively (G1, G2, and G3). Several biomechanical and histologic analyses were performed in different centers to measure the implant stability quotient level, bone volume, and bone-to-implant contact. RESULTS: According to the results of the Infinite Focus Microscopy, the ozone therapy group revealed significantly higher scores than the control group and photobiomodulation group at the 4-week loading time, whereas the photobiomodulation and ozone therapy groups revealed significantly higher scores than the control group at the 8-week loading time in terms of bone volume measurements in mm3 (P < .05). According to the histologic analysis, the ozone therapy and photobiomodulation groups revealed significantly higher scores than the control group at the 4-week loading time, whereas the photobiomodulation group showed the highest scores among the 8-week loading groups (P < .05). CONCLUSION: This is the first study in the literature that reveals a better osseointegration process in miniscrew implants when treated with photobiomodulation and ozone therapy compared with control groups. Although the photobiomodulation and ozone therapy groups did not reveal significantly higher scores in immediately loaded miniscrew implants (G1), these treatments were significantly more effective when loaded after 4 or 8 weeks of osseointegration (G2 and G3). SLA-surfaced miniscrew implants are successful in the orthopedic forces (500 gf) and can be removed without complications.

Dental root development associated with treatments by rapid maxillary expansion/reverse headgear and slow maxillary expansion.

OBJECTIVES: To assess dental root development in two groups of paediatric patients who received treatments with reverse headgear and rapid maxillary expansion and slow maxillary dental arch expansion. MATERIALS AND METHODS: The 20 subjects (13 girls, 7 boys; mean age: 8.9 ± 1.3 years) in the first group were treated with a Petit-type reverse headgear attached to a full-coverage bonded rapid maxillary expander via elastics (RME&RHg group). The 20 subjects included in the second group (9 girls, 11 boys; mean age: 9.1 ± 2.2 years) were selected among patients who were treated with Hawley appliances for slow maxillary expansion (SME group). Digitized panoramic radiographs were used. A total of 960 permanent teeth (maxillary-mandibular incisors, canines, premolars, and first molars) were measured quantitatively for pre-treatment and post-treatment. RESULTS: No significant increase was found except for the right and left maxillary and mandibular second premolars and left mandibular and first premolar in the RME&RHg group (P < 0.05). Teeth length values increased significantly in all maxillary and mandibular teeth except maxillary first molars and mandibular incisors in the SME group (P < 0.05). Inter-group comparisons showed that statistically significant differences were observed in maxillary and mandibular incisors, left maxillary first premolar, and molar teeth (P > 0.05). LIMITATION: A limitation of this study is the use of two-dimensional radiographic images for root length measurement. However, ethical obligations limit the dental cone beam computed tomography imaging application for protection of paediatric patients from harm. CONCLUSIONS: RME&RHg therapy inhibits root development of maxillary and mandibular teeth in the early period. However, further studies should be performed to determine whether this effect on root development is reversible or irreversible.

Do total or partial etching procedures effect the rate of white spot lesion formation? A single-center, randomized, controlled clinical trial.

OBJECTIVE: To determine whether total or partial etching procedures influence the appearance of white spot lesions (WSLs). MATERIALS AND METHODS: This split-mouth, double-blind, controlled, randomized study included 20 patients (mean age 16.75 years), who had class I malocclusion, mild crowding, and satisfactory oral hygiene. A total of 40 maxillary quadrants were randomly allocated to be treated using a total etching (TE) or partial etching (PE) protocol. Quantitative light fluorescence images were captured at the beginning and at 3 (T1) and 6 (T2) months after beginning orthodontic treatmen, as well as when the debonding phase of orthodontic treatment was complete (T3). The presence of pre- and posttreatment WSLs was assessed with quantitative light fluorescence software and analyzed with Student's t-test. RESULTS: The analyses showed that, at T2, the total etching group had significantly higher ΔQ and A scores than the partial etching group ( P < .05). The ΔF scores increased significantly at all timepoints in the TE group, but only at T1 and T3 in the PE group. However, no differences were noted at T3 between the TE and PE groups ( P > .05). The inclusion of only right-handed people may have limited the generalizability of the findings. The absence of analyses of the plaque and gingivitis scores of patients was another limitation of this study. CONCLUSIONS: WSL formation was observed mostly in maxillary lateral incisor teeth irrespective of the etching technique. Although PE seems to be more successful in the first 6 months, no difference was observed between PE and TE in the long term for WSL formation.