Ten-year follow-up of a patient with hemifacial microsomia treated with distraction osteogenesis and orthodontics: an implant analysis.

INTRODUCTION: Distraction osteogenesis (DO) has become an accepted treatment method for patients requiring mandibular lengthening because of congenital malformations. However, the skeletal growth pattern of a distracted mandible in the long term has still not been clearly shown in the literature. The purpose of this report was to analyze the dentofacial changes observed during a 10-year follow-up period in a patient treated with mandibular DO. METHODS: The patient was a 12-year-old girl with hemifacial microsomia who had undergone DO with an external device. Morphologic changes during the observation period were evaluated on panoramic radiographs and posteroanterior and lateral cephalograms. Six Björk-type titanium implants were placed bilaterally in the mandible under local anesthesia to analyze the mandibular skeletal changes over time. RESULTS: Marked lengthening was achieved during the active phase of mandibular distraction. The ratio between the ramus heights of the affected and normal sides improved significantly in the affected side's favor as the mandible was lengthened, but this ratio returned to its initial value after 10 years. CONCLUSIONS: Although there was some growth on the affected side during the follow-up period, it was not enough to catch up with the growth on the normal side. The original asymmetry recurred as a consequence of the growth pattern in this patient with hemifacial microsomia.

Witkop tooth and nail syndrome and orthodontics.

This case report presents the orthodontic treatment of a patient with Witkop syndrome, an autosomal dominant genetic disorder characterized by the absence of several teeth and abnormalities of the nails. The patient, a 6-year 4-month-old boy, was referred to our clinic for treatment of severe overjet and openbite. Radiographic and clinical evaluations showed peg-shaped maxillary lateral incisors and the congenital absence of three mandibular incisors as well as spoon-shaped fingernails. Treatment of openbite and overjet was initiated with functional appliances, and fixed orthodontic appliances were inserted at age 10 years 3 months. The edentulous spaces are being maintained for implants that will be provided once the patient's growth is complete. Evaluations of long-term treatment results to date have indicated improvements in both facial and dental esthetics.

Surgically assisted rapid maxillary expansion compared with orthopedic rapid maxillary expansion.

The objective of this study is to evaluate and compare the dental and skeletal changes occurring during orthopedic rapid maxillary expansion (RME) and surgically assisted RME during the active phase of treatment. The study was divided into two groups. The first group of 10 patients (six males, four females; mean age, 15.51 years) received orthopedic RME. The second group of 10 patients (seven males, three females; average age: 19.01 years) received surgically assisted RME (SARME). All patients underwent maxillary expansion with occlusal-coverage Hyrax-type expanders activated two turns a day (0.25 mm per turn). Preexpansion and postexpansion lateral and posteroanterior cephalograms were obtained for each patient. Statistically significant differences between the SARME and RME groups were found in the N-ANS, SN/ PP (P < .01) and SNA, SNB, mandibular dentoalveolar, and maxillary bony base (P < .05) measurements. Clinically, there is no difference in patient response between the RME and SARME groups. The only difference between the groups was their indication for RME or SARME, which is based on the age and skeletal maturation of the patient.

Comparison of skeletal and soft-tissue changes following unilateral mandibular distraction osteogenesis.

BACKGROUND: The purpose of this study was to investigate the relationship between soft-tissue and underlying skeletal structures before and after unilateral mandibular distraction osteogenesis. METHODS: The sample consisted of 11 patients (three girls and eight boys) with an average age of 4.6 years at the time of treatment. All patients had unilateral craniofacial microsomia (four right-sided and seven left-sided unilateral craniofacial microsomia) and all underwent unilateral mandibular distraction osteogenesis. Measurements were performed on frontal medical photographs and posteroanterior cephalograms at predistraction (time 1) and postdistraction (time 2) periods. Left and right ramus heights, skeletal midline deviation, and transverse occlusal plane were measured on the posteroanterior cephalograms and compared with the linear distances between the lip commissures and the orbital plane, the circumference of both sides of the faces, and the angulation of the oral commissure plane as recorded on the medical photographs, respectively. To reduce magnification error, ratios of affected to less affected sides of the mandibles and soft-tissue facial structures were selected and studied. RESULTS: A similar relationship was observed between soft-tissue and skeletal components. However, there was no 1:1 relationship between the changes in ramus height and improvement in parallelism of lip commissures to the orbital plane. CONCLUSIONS: A significant improvement in soft- and hard-tissue anatomy has been observed following unilateral distraction osteogenesis of the mandible. The relationship between the soft-tissue and skeletal correction was different for all patients because of the large range in severity of the craniofacial malformation. Greater skeletal deficiency requires more correction to achieve symmetry of both hard and soft tissue.

Effects of three-dimensional bimetric maxillary distalizing arches and cervical headgear on dentofacial structures.

The aim of this study was to compare the dentofacial effects of an intraoral technique, the three-dimensional bimetric maxillary distalizing arch (3D-BMDA), with an extraoral technique, cervical headgear (CH), in subjects requiring maxillary molar distalization. Twenty-one patients (12 females, 9 males; mean age at the start of treatment: 14.7 years) were treated with 3D-BMDA and 18 subjects (11 females, 7 males; mean age at the start of treatment: 13.3 years) with CH. Since the treatment period was longer in the CH group, the results for this group were also compared with a separate 'untreated' control group of 17 subjects (12 females, 5 males; mean age at the start of observation: 13.1 years). The measurements were carried out on lateral cephalometric radiographs which were taken at two time points (T(1): start of treatment/control, T(2): end of molar distalization/control). Paired t-tests were performed within, and analysis of variance to determine the differences between the groups. The total amount of distalization for the 3D-BMDA and CH was similar (3.55 and 4.56 mm, respectively). However, there were statistically significant differences in the total treatment period (3.4 and 10.2 months, respectively) and the monthly amount of distalization (1.11 and 0.55 mm, respectively). The 3D-BMDA system did not have a significant effect on mandibular rotation (an increase of 0.01 degrees), while the CH group showed a mean posterior rotation of the mandible of 1.08 degrees. The most significant differences between the two maxillary first molar distalization techniques were observed in the mandibular dental arches. Moderate anchorage loss in the mandibular dental arch was observed in the 3D-BMDA group. While the 3D-BMDA and CH techniques are both effective in distalizing maxillary molar teeth, the distalization time and rate of molar movement were significantly shorter with the 3D-BMDA than the CH.

Evaluation of changes in the vertical facial dimension with different anchorage systems in extraction and non-extraction subjects treated by Begg fixed appliances: a retrospective study.

The aim of the study was to evaluate and compare the effects of mesial movement of the maxillary and mandibular molars on the facial vertical dimensions following orthodontic treatment. Patients with an Angle Class I malocclusion were treated by four first premolar extractions and Begg fixed appliances (moderate and maximum anchorage groups), while those with an Angle Class II malocclusion were treated by Begg intraoral distalization mechanics without extractions (distalization group). Following treatment, the patients were grouped according to the mesial movement of the mandibular first molars and compared with an Angle Class I control group. All groups comprised 15 patients, their mean pre-treatment ages were 14.95 years for the moderate (13 females, 2 males), 14.88 years for the maximum (13 females, 2 males), 14.41 years for the distalization (10 females, 5 males), and 14.38 years for the control (13 females, 2 males) groups. Lateral cephalometric measurements were performed at two time points (T(1): pre-treatment/control, T(2): post-treatment/control). A paired t-test was used for within-group comparisons and non-parametric Kruskal-Wallis and Dunn's multiple-comparison tests to determine any differences. The increases in anterior and posterior face heights were similar between groups. The mandibular plane angle (SN/GoGn) was increased in all treatment groups, while it decreased in the control group. Although SN/GoGn increased more in the distalization and less in the moderate anchorage groups, these differences were not statistically significant. The change in SN/GoGn was significantly different only between the distalization and control groups. Facial vertical dimensions were not significantly affected by the amount of mesial movement of the molar teeth.