The impact of dental midline angulation towards the facial flow curve on the esthetics of an asymmetric face: Perspective of laypeople and orthodontists.

PURPOSE: The objective of the present article was to evaluate the impact of dental midline angulation in asymmetrical faces. MATERIALS AND METHODS: A full-portrait image was used to create a set of digitally modified images with a different degree of facial asymmetry, towards the right and the left side of the face respectively. Half of the images were designed with an equivalent angulation of the dental midline in respect to the curve of the lower third of the face and half of them without. Through a web survey, 250 laypeople and 250 orthodontists were asked to assess the attractiveness of each image separately. RESULTS: As the asymmetry of the face was increased, facial attractiveness was further decreased both for laypersons and orthodontists. For each one of the modified images, when the dental midline was following the curve that was formed from the inclination of the simulated asymmetry of the face, the smile attractiveness scores were significantly higher compared to a straight dental midline. CONCLUSION: Facial asymmetries derived from the inclination of the nose, the chin and the commissural line of the lips can significantly affect the smile attractiveness. An orientation of the dental midline towards the facial asymmetry in order to follow the facial curve, can be beneficial for the smile attractiveness compared to a perpendicular to the face dental midline. During the design of a smile, clinicians have to take into consideration deviations in facial midline, in order their restorations to be in harmony with the rest of the face. CLINICAL SIGNIFICANCE: During the design of a smile, clinicians have to take into consideration deviations in the facial midline, in order their restorations to be in harmony with the rest of the face.

Sella turcica morphometrics in subjects with down syndrome.

OBJECTIVE: Since the number of patients diagnosed with Down syndrome seeking orthodontic treatment is increasing, clinicians could contribute by applying diagnostic modalities used frequently in the orthodontic field for research purposes. Thus, The aim of the present study is to implement morphometric methods to investigate the size and shape of sella turcica in subjects with Down syndrome. MATERIALS AND METHODS: In this retrospective study, archive records of 24 individuals with Down syndrome were compared to 48 healthy controls matched for age and gender. Parameters such as sella anterior, midpoint, and posterior height were measured, as well as sella width, area, and length were calculated. Independent sample t-tests were applied for the comparison of differences in sella turcica dimensions. Geometric morphometric analysis of the sella was performed with, implementing methods such as Procrustes superimposition and principal component analysis. Statistical significance was set at p<0.05. RESULTS: Statistically significant differences were found for sella anterior height, sella midpoint height, sella posterior height, sella maximum height, sella length, and sella area. All the aforementioned values were significantly increased in the Down syndrome subjects (p<0.05). Principal component analysis (PCA) depicted a statistically significant difference in sella shape between patients with Down syndrome and healthy controls (p<0.05). CONCLUSIONS: Subjects with Down syndrome presented significantly increased sella turcica dimensions as well statistically significant differences in shape compared to healthy controls.

Perception of smile attractiveness among laypeople and orthodontists regarding the buccal corridor space, as it is defined by the eyes. An innovated technique.

OBJECTIVE: To investigate whether there is a relationship between the distance between the iris and pupil with the ideal size of buccal corridors. MATERIALS AND METHODS: A full-portrait image of a male Caucasian was used to create a set of 11 digitally modified images with different buccal corridor space. A web-based cross-sectional study was designed and distributed via an online survey to 200 laypeople and 200 orthodontists to assess image attractiveness, using a Visual analogue scale. For the statistical analysis, Wilcoxon signed-rank and Mann-Whitney U tests were used. The significance level was set at p < 0.05. RESULTS: The response rate for laypeople was 70% (n = 139), while the rate for orthodontists was 73% (n = 146). For the layperson group, the maximum smile attractiveness score was 10% of buccal width reduction, compared to the iris-pupillary distance, while for the orthodontists, it was 20%. The attractiveness of the smile was significantly reduced in both groups when the buccal corridor width was increased in comparison to the iris-pupillary distance. CONCLUSION: The length between the mesial part of the iris and the distal of the pupil, may constitutes a landmark for the estimation of the desired width of the buccal corridor. CLINICAL RELEVANCE: Inter iris-pupillary distance can be the starting point in the smile designing process, in order to perform a facial driven selection of buccal corridor size.

Does surgically assisted maxillary protraction with skeletal anchorage and Class III elastics affect the pharyngeal airway? A retrospective, long-term study.

Objective: Surgically assisted maxillary protraction is an alternative protocol in severe Class III cases or after the adolescent growth spurt involving increased maxillary advancement. Correction of the maxillary deficiency has been suggested to improve pharyngeal airway dimensions. Therefore, this retrospective study aimed to analyze the airway changes cephalometrically following surgically assisted maxillary protraction with skeletal anchorage and Class III elastics. Methods: The study population consisted of 15 Class III patients treated with surgically assisted maxillary protraction combined with skeletal anchorage and Class III elastics (mean age: 12.9 ± 1.2 years). Growth changes were initially assessed for a mean of 5.5 ± 1.6 months prior to treatment. Airway and skeletal changes in the control (T0), pre-protraction (T1), post-protraction (T2), and follow-up (T3) periods were monitored and compared using lateral cephalometric radiographs. Statistical significance was set at p < 0.05. Results: The skeletal or airway parameters showed no statistically significant changes during the control period. Sella to nasion angle, N perpendicular to A, Point A to Point B angle, and Frankfort plane to mandibular plane angle increased significantly during the maxillary protraction period (p < 0.05), but no significant changes were observed in airway parameters (p > 0.05). No statistically significant changes were observed in the airway parameters in the follow-up period either. However, Sella to Gonion distance increased significantly (p < 0.05) during the follow-up period. Conclusions: No significant changes in pharyngeal airway parameters were found during the control, maxillary protraction, and follow-up periods. Moreover, the significant increases in the skeletal parameters during maxillary protraction were maintained in the long-term.

Soft tissue evaluation after maxillary protraction with RPE or with the ALT-RAMEC protocol : A controlled 3D study.

PURPOSE: To evaluate soft tissue changes following maxillary protraction with different expansion protocols using three-dimensional (3D) stereophotogrammetry. METHODS: Pretreatment (T0) and postprotraction (T1) stereophotogrammetry and lateral cephalometric images of skeletal class III patients were included in this retrospective study. In all, 32 patients were treated either with a combination of rapid palatal expansion and facemask (RPE/FM; n = 16; mean age: 9.94 ± 0.68 years) or with alternate rapid maxillary expansion and constriction together with a facemask (Alt-RAMEC/FM; n = 16; mean age: 9.74 ± 1.35 years). As a control group 16 untreated patients were recruited (mean age: 9.46 ± 0.8 years). For superimpositioning of the 3D images taken at T0 and T1, the face was divided into defined regions and 3D and differences between the groups were evaluated using 3­matic software (Materialise Europe, Leuven, Belgium). Cephalometric analyses were also performed. RESULTS: While the increases in the cephalometric parameters SNA and ANB were significantly greater in the treatment groups, the value for SNB also increased in the control group (p < 0.05). The results of the stereophotogrammetry analyses demonstrated that the mean changes in the RPE/FM and in the Alt-RAMEC/FM groups were significantly different for the midface compared to the control group (0.33 ± 0.26 mm, 0.3 ± 0.31 mm, 0.1 ± 0.18 mm). The maximum positive, negative, and mean changes were also significantly different between the treatment and control groups for the upper lip (p < 0.05). For the lower lip and the chin significant backward movements in the RPE/FM as well as in the Alt-RAMEC/FM group (-1.06 ± 1.26 mm, -0.68 ± 0.45 mm) were observed, while the control group (0.09 ± 0.53 mm) presented changes in the opposite direction. Regarding soft tissue changes, no significant differences were found between the RPE/FM and Alt-RAMEC/FM groups. CONCLUSION: Both treatment protocols improved the soft tissue profile due to a forward movement of the midface and the upper lip, and a backward movement of the lower lip and chin, compared to the control group.

Changes in the condylar head after orthognathic surgery in Class III patients: a retrospective three-dimensional study.

OBJECTIVES: To evaluate the axial and dimensional changes of the condylar head after orthognathic surgery, including Le Fort I and bilateral sagittal split ramus osteotomies, and to assess condylar remodeling through three-dimensional (3D) surface superimposition. MATERIALS AND METHODS: Twenty-four patients (15 females, 9 males; mean age: 32.22 ± 6.92 years) with skeletal Class III deformity were included in the study. Cone-beam computed tomography data obtained in the preoperative (T0) and postoperative (T1) periods were examined using Mimics and 3-Matic software. The height, depth, and width of the condylar head and its angular changes were measured. The volumes of the 3D reconstructed models were calculated, and remodeling amounts were evaluated through regional surface superimposition. Statistical significance was set at P < .05. RESULTS: Following the surgery, there was a significant decrease in the size of condyles (P < .05). An inward rotation of the condyles was found in the axial plane (T0: 79.60 ± 6.01°, T1: 76.6 ± 6.48°, P < .05). The maximum resorption, maximum apposition, mean remodeling, and mean absolute remodeling were -2.63 ± 1.23 mm, 1.15 ± 0.4 mm, -0.30 ± 0.34 mm, and 0.73 ± 0.43 mm, respectively. No correlation was found between the angular changes and remodeling parameters or linear and volumetric changes of the condylar head (P > .05). CONCLUSIONS: Condyles undergo a remodeling process with a resorptive character following orthognathic surgery, without clinically significant effects in the present study.

Does Maxillary Protraction with Alt-RAMEC Protocol Affect Inferior Sclera Exposure? A Controlled 3dMD Study.

OBJECTIVE: The purpose of this controlled retrospective study was to measure and evaluate the inferior sclera exposure changes using 3dMD stereophotogrammetric images in a prepubertal Class III patient sample that underwent maxillary protraction with alternate rapid maxillary expansions and constrictions protocol followed by facemask. METHODS: The study group included 15 prepubertal patients (mean age: 9.85 ± 1.44 years) with Class III malocclusion due to maxillary retrognathism. Nine weeks of alternate rapid maxillary expansions and constrictions protocol was followed prior to 7 months of face mask treatment and 3 months of retention with Bionator. Pretreatment (T0) and post-retention (T1) lateral cephalometric radiographs and 3dMD images were retrieved from clinical archive. The same records were used for a control group of 15 well-matched, untreated patients (mean age: 9.4 ± 0.79 years). The distance between the upper eyelid margin and the lower eyelid margin was recorded as the overall eye height (E), and the distance between inferior limbus and the lower eyelid margin was recorded as inferior sclera exposure (S). The S : E ratio in percentage was calculated. Sella-nasion-A point angle (SNA) was used as the skeletal variable. RESULTS: SNA angle, right S : E, and left S : E changed significantly in both groups at T1-T0. The intergroup comparison was highly significant for SNA angle but was not significant for right and left S : E variables. CONCLUSION: The S : E ratio decreased significantly in both alternate rapid maxillary expansions and constrictions/facemask and the control groups. However, the change in S : E ratio between groups was not significant.

The Assessment of Neurosensory Disturbance Following Bilateral Sagittal Split Osteotomy With Subjective and Three-Dimensional Evaluation.

PURPOSE: Inferior alveolar neurosensory disturbance (IAND) is the most common complication of bilateral sagittal split osteotomy (BSSO). The aim of the present study was to evaluate IAND with subjective tests postoperatively and assess the relationship between three-dimensional measurements of the mandibular canal (MC) and IAND. METHODS: Eighteen patients (Mean age: 24.05 ±â€Š5.85 years) treated with BSSO were retrieved from the archive. Subjective tests (light touch, tactile sensitivity, 2-point discrimination, brush-stroke directional discrimination, sharp/blunt discrimination, dental vitality, questionnaire) and three-dimensional measurements related to MC and fixation screws were done postoperatively (on average 20.43 ±â€Š8.76 months after surgery). Statistical significance was set at P  < 0.05. RESULTS: Subjective test results were found compatible with each other except brush-stroke directional discrimination test. According to the questionnaire, IAND was apparent in all patients immediately after surgery, and recovery after 1 to 2 years was statistically significant ( P  < 0.05). Preoperative ramus width, medial and lateral cancellous bone lengths, the decrease in MC length, and the presence of screw in MC were not related to IAND ( P  < 0.05). CONCLUSIONS: There is a high incidence of IAND following BSSO, and the subjective tests are efficient to evaluate the disturbance. Spontaneous recovery of the nerve occurs during the follow-up periods. Instead of preoperative measurements of bone thickness, MC length, and the position of fixation screws, the surgical procedure seems to be more important in IAND occurrence.

Does Alt-RAMEC protocol and facemask treatment affect dentoalveolar structures?

OBJECTIVES: To evaluate dentoalveolar changes immediately after the alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol and facemask (FM) treatment using cone-beam computed tomography images. MATERIALS AND METHODS: Cone-beam computed tomography images of 20 patients (mean age = 9.64 ± 1.3 years) who received the Alt-RAMEC protocol before FM treatment were retrieved in this retrospective study. Dental and alveolar inclinations, buccal and palatal alveolar bone thickness, and buccal and palatal alveolar bone height changes were measured before treatment (T0), after the Alt-RAMEC protocol (T1), and after FM treatment (T2). Measurements for right and left molars were performed separately. The Shapiro-Wilks test was used to assess the conformity of the parameters to the normal distribution. The paired t-test and repeated measures analysis of variance were used for normally distributed data. The Wilcoxon signed-rank test and Friedman test were used for non-normally distributed data. The Bonferroni correction was used to reduce the chances of obtaining false-positive results. Statistical significance was set at P < .05. RESULTS: Buccal alveolar bone thickness and alveolar bone inclinations decreased significantly from T1 to T0 and showed no significant change from T2 to T1. The total reduction T2-T0 was statistically significant. The change in palatal alveolar bone thickness was not significant T1-T0 but increased significantly for T2-T1 and T2-T0. Buccal alveolar bone height, palatal alveolar bone height, and molar inclinations increased significantly T1-T0, but there was no significant change T2-T1. The total reduction at T2-T0 was statistically significant. CONCLUSIONS: The results of this study revealed that the effects of the Alt-RAMEC protocol on dentoalveolar tissues were similar to the changes reported in the literature after rapid palatal expansion.

The Assessment of Knowledge, Behaviors, and Anxiety Levels of the Orthodontists about COVID-19 Pandemic.

OBJECTIVE: A new viral disease called Coronavirus disease-19 (COVID-19) affected the whole world because of its characteristics of spreading rapidly via respiratory droplets and aerosol. As one of the most aerosol-generating occupations, dentists are at high risk and are recommended to treat emergency cases only. We aimed to assess the general knowledge, emergencies, personal precautions, and avoided behaviors among the orthodontists and also their anxiety levels, during COVID-19. METHODS: A survey research, including demographic information, general knowledge about COVID-19, treatment strategies, protective measures, and Generalized Anxiety Disorder (GAD) 7 test, was conducted via a web-based questionnaire (1 open-ended and 26 closed-ended questions). A total of 215 orthodontists older than 20 years of age and practicing in different regions of Turkey were included in this study. The answers received within the first 10 days were included. RESULTS: Most of the orthodontists were aware of COVID-19 symptoms and transmission routes (n=159 and n=183, respectively). Almost all of them treated only emergency cases (n=209). Orthodontic emergencies were reported mostly as injury due to band/bracket failure, soft/hard tissue trauma, and problems in retention appliances (n=197, n=186, and n=81, respectively). The participants also avoided aerosol-generating procedures and used transmission-based protective equipment. The prevalence of GAD was 16.7% during COVID-19, and there was no statistically significant difference when it was stratified by gender, age, city, and COVID-19 related questions (p>0.05). CONCLUSION: The orthodontists followed the guidelines and took protective measures during COVID-19, and the majority had subthreshold anxiety levels.

The Prevalence of Cleft Lip and Palate Patients: A Single-Center Experience for 17 Years.

OBJECTIVE: The aim of the present study was to report the prevalence of cleft lip and palate (CLP), isolated cleft palate (CP), isolated cleft lip (CL), and median cleft (MC) applied in Marmara University School of Dentistry, Department of Orthodontics. METHODS: There were 1058 patients who applied to the center between 2000 and 2017. A total of 1026 patients were included in the study. Files, models, and photographs were evaluated. The patients were divided into six groups: unilateral right or left CLP, bilateral CLP, isolated CP, isolated CL, and MC. The prevalence was identified according to cleft type, side, gender, age, and application year. RESULTS: The most common type was unilateral CLP (44.3%), which was observed more on the left side (28.9%), followed by CP (28.7%). MC had a minimum ratio (0.3%) between cleft types. Males were more prone to have unilateral CLP (right side, 64.6%) and bilateral CLP (64.1%), whereas females were more prone to have CP (59.9%). The greatest number of applications was recorded in 2004, and the patients mostly applied in the neonatal period (64.9%). The ratios of complete cleft cases in all types of clefts were statistically significantly higher. CONCLUSION: Unilateral CLP was the most common cleft type and seen more on the left side. While males were affected more by CLP, isolated CP was seen more in females than in males.

Orthodontic Extrusion with Circumferential Supracrestal Fiberotomy: A Report of Two Cases.

Surgical extrusion, surgical crown lengthening, and orthodontic extrusion (OE) with circumferential supracrestal fiberotomy (CSF) are reported as effective methods in cases when clinical crowns are destroyed. The aim of these case reports was to evaluate the results of OE+CSF in a canine and a mandibular second molar tooth. Case 1: A 24-year-old male patient was referred with a fracture of the maxillary canine at the subgingival level. After the examinations, OE+CSF was planned. Following leveling-aligning, a mini-screw was placed into the root canal of the canine, and 50 g of extrusive force was applied from the mini-screw to a stainless steel (SS) wire. Case 2: A 67-year-old female patient was referred with a mandibular second molar destroyed at the gingival level. OE+CSF was planned. An extrusive force (50 g) was applied from the segmental SS wire to the hook inserted into the root canal. CSF and root planning (RP) were performed weekly in both patients. Overall, 5 mm of extrusion was achieved for the upper canine after 6 weeks of active extrusion in Case 1. In Case 2, 5 mm of extrusion was achieved after 3 weeks of active extrusion. OE+CSF is an effective and rapid method for the extrusion of teeth with insufficient clinical crown.