Evaluation of the Change in Halitosis with the Improvement in Oral Health in Cleft Lip and Palate Patients.

AIM: This study aimed to assess the effects of hygiene education on periodontal health and mouth/nasal halitosis in patients with cleft. MATERIALS AND METHODS: 39 patients with cleft who were accepted for orthodontic treatment divided into two groups as with (Group1; n = 24) and without braces (Group2; n = 15). Plaque Index (PI), Gingival Index (GI), and Tongue coating Index (TCI) values were recorded. The BANA test microbiological kit, was used to determine the amount of anaerobic bacteria. Values of volatile sulfur components (VSC) for the measurement of oral and nasal halitosis were measured with a Halimeter device. After the initial measurements, oral hygiene instructions were given to eliminate the plaque production on teeth, periodontal structure, tongue and palate. All measurements were repeated 4 weeks after the hygiene instructions. Wilcoxon and Mann-Whitney U test were used for statistical analysis. RESULTS: In both groups, the PI, GI, values were significantly decreased (P < .05). Tongue coating area, thickness and TCI were significantly reduced (P < .05). Oral halitosis values decreased significantly (P < .05). The PI values decreased significantly more in the Group 1 (P < .05). Non significant difference was detected in nasal halitosis in both groups. In unilateral cleft lip and palate cases cases (n = 23), no significant difference was found in nasal halitosis values between the cleft and the healthy sides (P > 0.05). CONCLUSION: In patients with clet cases, periodontal health was improved and oral halitosis was reduced by the given hygiene education; brushing the teeth, especially the tongue and palate. However, hygiene education did not have a significant effect on nasal halitosis. Key Words: Cleft lip and palate, Halitosis, BANA test, Periodontal index.

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

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

Histomorphometric evaluation of the effects of mandibular advancement appliance and low level laser therapy (LLLT) with different doses on condylar cartilage and subchondral bone in rats / Evaluación histomorfométrica de los efectos del aparato de avance mandibular y la terapia con láser de bajo nivel (TLBN) con diferentes dosis en cartílago condilar y hueso subcondral en ratas

The aim of this study was to evaluate the effects of mandibular advancement appliance and low level laser therapy (LLLT) with different doses on cellular hypertrophic changes in the mandibular condyle of rats. Forty-eight 8-week-old male Wistar albino rats weighing between 260 and 280 g were randomly divided into four experimental and control groups. Group I was the control group; group II was the mandibular advancement appliance group; group III was the 8 J/cm2 (0.25 W, 20 s) laser irradiation with mandibular advancement appliance group; and group IV was the 10 J/cm2 (0.25 W, 25 s) laser irradiation with mandibular advancement appliance group. Mandibular condyle cartilage and subchondral bone changes with different LLLT dose and mandibular advancement appliance were evaluated by histomorphometrical analysis. Subchondral bone fraction results showed that there were no significant differences between groups (p<0.05). The statistically significant differences found between control group and experimental groups in anterior and posterior cartilage layers thickness (p<0.05) and (p<0.01). Posterior and anterior condylar cartilage layers of rats react differentially to LLLT and mandibular advancement application. Maximum changes in condylar cartilage layers were found in 8 J/cm2 laser irradiation with mandibular appliance group.

El objetivo de este estudio fue evaluar los efectos del aparato de avance mandibular y la terapia con láser de bajo nivel (TLBN) con diferentes dosis sobre los cambios hipertróficos celulares, en el cóndilo mandibular de ratas. Cuarenta y ocho ratas albinas macho Wistar de 8 semanas de edad con un peso de 260 y 280 g se dividieron aleatoriamente en cuatro grupos experimentales y control. El grupo I control; grupo II, dispositivos de avance mandibular; grupo III de irradiación con láser de 8 J / cm2 (0.25 W, 20 s) con el grupo dispositivos de avance mandibular; y grupo IV con irradiación láser de 10 J / cm2 (0,25 W, 25 s) con el grupo de dispositivos de avance mandibular. El cartílago del cóndilo mandibular y los cambios en el hueso subcondral con diferentes dosis de TLBN y dispositivo de avance mandibular, se evaluaron mediante análisis histomorfométrico. Los resultados de la fracción ósea subcondral indicaron que no hubo diferencias significativas entre los grupos (p <0,05). Las diferencias estadísticamente significativas encontradas entre el grupo control y los grupos experimentales, en el grosor del cartílago anterior y posterior (p<0,05) y (p<0,01). Las capas de cartílago condilar posterior y anterior de las ratas reaccionan de manera diferencial a la aplicación de TLBN y avance mandibular. Se encontraron cambios significativos en las capas de cartílago condilar con irradiación láser de 8 J /cm2 con el grupo de dispositivos mandibulares.

NAM Therapy-Evidence-Based Results.

Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

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

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

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

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

The effects of low-level laser therapy on condylar growth with a mandibular advancement appliance in rats.

OBJECTIVE: The aim of this study was to evaluate the effects of low-level laser therapy (LLLT) on condylar growth with a mandibular advancement appliance in rats. BACKGROUND DATA: Researchers studied new methods such as laser, for mandibular condyle growth stimulation and acceleration with or without functional appliances in experimental animals, but the specific mechanism and laser energy density values for condylar biostimulation and bone cell activities are still unknown. METHODS: Forty-eight 8-week-old male Wistar albino rats weighing between 260 and 280 g were randomly divided into four groups. Group I was the control group; group II was the mandibular advancement appliance group; group III was the 8 J/cm(2) (0.25 W, 20 sec) laser irradiation with mandibular advancement appliance group; and group IV was the 10 J/cm(2) (0.25 W, 25 sec) laser irradiation with mandibular advancement appliance group. Experimental rats in groups III and IV were stimulated with a low-level laser in the temporomandibular joint region bilaterally 15 times over 30 days. Morphological changes in the mandible were evaluated with lateral radiographs before and after the study with selected linear and angular measurements. Pearson correlation test, Friedman, Kruskal-Wallis, and Mann-Whitney U tests were used for statistical analysis. RESULTS: According the lateral radiograph results, the growth of mandibles in the experimental groups was significantly more than that of the control group (p<0.05). Group III also showed greater mandibular growth than the other groups (p<0.05). CONCLUSIONS: We concluded that an intraoral appliance with LLLT, including chosen parameters, can stimulate condylar growth and increase mandibular advancement.

Effects of bite-jumping appliances on mandibular advancement in growing rats: A radiographic study.

OBJECTIVE: The aim was to evaluate the effects of the use of mandibular advancement appliances on mandibular growth in growing rats. MATERIALS AND METHODS: Twenty-four 8-week-old male Wistar albino rats were randomly divided into two experimental groups (12 rats each): Group I was a control group, and Group II was the mandibular advancement appliance group. A functional bite-jumping appliance was used in Group II to promote mandibular advancement. Anatomical changes in the condyle and mandible were evaluated by comparing radiographic results from before and after the study, with angular and linear measurements. Friedman and Mann-Whitney U-tests were used in statistical analysis. RESULTS: According to the radiographic results, the growth of mandibles and condyles in Group II was significantly greater than with the length of the condylar process (A-B) and distance from condyle to menton (A-D) variables (P < 0.05). In addition, Group I showed greater mandibular base growth than did Group II (P < 0.05). CONCLUSIONS: We conclude that the use of an intraoral bite-jumping appliance can stimulate condylar growth and increase sagittal mandibular advancement in growing rats.

Long-term follow-up of a patient with multiple congenitally missing teeth treated with autotransplantation and orthodontics.

This study describes the management of a case of multiple missing teeth involving premolar autotransplantation, orthodontic treatment, and a 6-year follow-up of autotransplantation. The prognosis of the transplant was good with a satisfactory crown-root ratio. Autotransplantation is a viable treatment option that eliminates the need for prosthetic therapy or implants for children with missing permanent teeth.

Comparison of double-plate appliance and facemask therapy in treating Class III malocclusions.

The aim of this study was to compare the effects of the double-plate appliance (DPA) and the facemask (FM) in treating skeletal Class III malocclusions. Data were based on the pretreatment and posttreatment lateral cephalograms of 28 subjects with skeletal and dental Class III malocclusions. In the first group (7 girls, 7 boys; mean age, 10 years 3 months), each subject wore a DPA with 2 Class III elastics, which exerted a force of 350-400 g day and night except for meals. In the second group (7 girls, 7 boys; mean age, 10 years 5 months), each subject wore a Delaire-type FM with a removable intraoral appliance with a total force of 600 g. The patients were instructed to wear the appliance approximately 16 hours a day. An untreated control group (6 girls, 8 boys; mean age, 9 years 8 months) was formed that matched the treatment groups according to sagittal skeletal and dental classifications. Thirteen angular and 14 linear measurements were evaluated. The increase in ANB angle and the decrease in maxillomandibular differential in the treated groups showed significant differences compared with the control group (P < .05). The increases in ANB and SNA angles in the FM group were significantly greater than in the DPA group (P < .05). The increases in lower facial height and Me-ANS in the FM group were significantly different compared with the other groups (P < .05). The overjet increased significantly in both treatment groups (P < .001), but, in the DPA group, overjet was significantly greater than in the FM group (P < .05). Protrusion of the maxillary incisors and retrusion of the mandibular incisors in the DPA group showed significant differences compared with the other groups (P < .05).

Combined apexification and orthodontic intrusion of a traumatically extruded immature permanent incisor.

A patient with a traumatic extrusion of the maxillary right central incisor was referred to the Pedodontic Clinic of Gazi University Faculty of Dentistry after 15 days. Orthodontic repositioning of the tooth was planned in 6 months. At the beginning of orthodontic therapy it was observed that the tooth was necrotic and needed an apexification procedure. The apexification procedure and orthodontic intrusion were successfully performed at the same time. In addition, a "walking bleach" was performed after the orthodontic and endodontic procedures were completed. At the 3-year recall, the tooth appeared normal in all respects.