Success of zygomatic plate-screw anchorage system.

PURPOSE: To evaluate the success of zygomatic plate-screw anchorage and to define the key points that help to improve the success of this system. MATERIALS AND METHODS: A total of 74 zygomatic plate-screw anchors were applied to 37 patients from 2 groups receiving orthodontic treatment. The first group consisted of 19 patients, and the zygoma anchors were applied bilaterally to distalize the maxillary buccal segment. The second group consisted of 18 patients, and the zygoma anchors were applied bilaterally to stabilize the maxillary molars during maxillary canine retraction. The orthodontic force was applied 1 week after the insertion of the plates. In the first group, 450 g of direct force and in the second group 150 g of indirect force were applied to the zygomatic plates. The success rate of the zygomatic plate-screw anchorage system was evaluated. RESULTS: One plate was lost and the others remained stable all through the orthodontic treatment. Mild gingival inflammation was observed in 1 patient (2 plates), and pus formation was detected in 1 patient (2 plates). One plate was covered because of mucosal hypertrophy. CONCLUSION: Zygomatic plate-screw anchorage system is a reliable technique to obtain orthodontic anchorage and may eliminate the need for extraoral force. However, the surgical insertion technique, position of the plates, and oral hygiene status of the patients certainly influence the success of the system.

Urofacial (ochoa) syndrome: can a facial gestalt represent severe voiding dysfunction?

Urofacial (Ochoa) syndrome is a rare autosomal-recessive disorder that features an unusual "inverted" facial expression, such that patients appear to be crying when they smile. This syndrome also involves serious urinary tract disorders, though the diagnosis may be missed because of variability of these problems and failure to recognize the characteristic facial grimacing. The urinary issues usually result in enuresis, urinary tract infection, and hydronephrosis, and some severely affected patients become hypertensive and progress to end-stage renal disease. Early diagnosis is very important for management of urinary problems and best prognosis in these patients. We report the first published case of urofacial syndrome in Turkey. The patient was diagnosed at 16 years of age, after having been followed with the diagnosis of recurrent urinary tract infection and vesico-ureteral reflux. Physicians should keep this syndrome in mind for any patient who presents with dysfunctional voiding, particularly in countries with high rates of consanguineous marriage.

Comparison of the zygoma anchorage system with cervical headgear in buccal segment distalization.

This prospective study aimed to evaluate the effects of the zygoma anchorage system (ZAS) in buccal segment distalization in comparison with cervical headgear (CH). Thirty patients with Class II dental malocclusions were included in the study and were divided into two equal groups: the first group (10 females and 5 males, mean age 14.74 years at T1) received buccal segment distalization with ZAS and the second group (8 females and 7 males, mean age 15.26 years at T1) with CH. The skeletal, dental, and soft tissue changes were measured on cephalograms obtained before (T1) and after (T2) distalization, and these changes were statistically evaluated using a repeated measures analysis of variance, Mann-Whitney U-test, and Wilcoxon test. The Class II buccal segment relationship was corrected to a Class I in an average period of 9.03 +/- 0.62 months in the ZAS group and 9.00 +/- 0.76 months in the CH group. Significant distalization was observed for the posterior teeth in both groups (P < 0.001). Distal tipping of all posterior teeth occurred in the CH group (P < 0.001), but only for the molars in the ZAS group (P < 0.001). The upper incisors retroclined, overjet decreased, and the upper and lower lips retruded in both groups. The ZAS provided absolute anchorage for distalization of the maxillary posterior teeth and can be used as an aesthetic and non-compliant alternative to extraoral traction in the treatment of Class II malocclusions.

Stability of zygomatic plate-screw orthodontic anchorage system: a finite element analysis.

OBJECTIVE: To evaluate the biomechanical properties of a standard and a newly designed plate-screw orthodontic anchorage system. MATERIALS AND METHODS: A three-dimensional model of the posterior maxilla, including the zygomatic buttress region, was prepared. Insertion of standard and newly designed plates was simulated on the three-dimensional model. The effect of 200 g of orthodontic force on the plate, screws, and zygomatic bone was evaluated in three-dimensional models by finite element analysis. To determine the force distribution, Von Mises stress, principal maximum and minimum stress, and principal maximum and minimum elastic strain values were evaluated. RESULTS: In all plate models the highest stresses occurred on the threaded bone site where the force application unit was attached. CONCLUSION: Changing the plate configuration did not affect the stress distribution in the newly designed plates. To equalize the force distribution, new plate designs that change the location of the force application unit are required.

A comparison of white spot lesion formation between a self-ligating bracket and a conventional preadjusted straight wire bracket.

AIM: Demineralization following removal of orthodontic appliances is a common problem. Presence of archwires, especially those with loops and different types of ligatures, complicate cleaning around bands and brackets during orthodontic treatment. These factors led clinicians to develop self-ligating brackets. The purpose of this study was to compare the incidence of white spot lesion formation with the use of a self-ligating bracket with conventional preadjusted straight wire brackets. METHODS: Twenty patients were randomly divided into 2 groups. In the first group (aged 13.4 ± 2.5 years), the teeth were bonded with In-ovation brackets; the second group's (aged 14 ± 3.34 years) teeth were bonded with conventional preadjusted straight wire brackets. The patients were followed throughout treatment, and the number of white spot lesions was noted at debonding. RESULTS: The results revealed no statistically significant differences in white spot lesion development between conventional straight wire and self-ligating brackets. CONCLUSION: No differences in terms of white spot lesion formation were found between conventional straight wire and self-ligating brackets, and white spot lesion formation does depend largely on patients' oral hygiene status, not the type of bracket or ligation used.

Fiber-reinforced technology in multidisciplinary chairside approaches.

There is an increasing demand to improve dentofacial esthetics in the adult population. This demand usually requires a close collaboration within the various disciplines of dentistry and the patient at every stage of the therapy. The materials and techniques used by these interdisciplinary clinicians must be conservative and minimally invasive. Fiber-reinforced composite technology offers such solutions for chairside applications. This case report presents two cases where fiber-reinforced ribbon and composite complex was used in a multidisciplinary approach to improve esthetics.

Orthodontic and surgical treatment of hemimandibular hyperplasia.

Correction of facial asymmetries is still a major problem in need of an adequate solution. In this case report, the differential diagnosis and treatment strategies of hemimandibular hyperplasia are described with the present patient.

Shear bond strength of orthodontic brackets with 3 self-etch adhesives.

INTRODUCTION: The purpose of this study was to compare shear bond strength and mode of failure of brackets bonded with 3 self-etching products. METHODS: The products tested were (1) a recently developed, modified self-etching, 1-step adhesive system (Adper Prompt L-Pop Self Etch Adhesive, 3M, St Paul, Minn); (2) a new fluoride-releasing, antibacterial, self-etching adhesive system (Clearfil Protect Bond, Kuraray, Osaka, Japan); and (3) a fluoride-releasing, self-etching adhesive system (Transbond Plus Self Etching Primer, 3M). Thirty-six defect-free premolars were randomly divided into 3 groups (n = 12 each), and metal brackets were bonded according to the manufacturer's instructions. Brackets were debonded in shear on a universal testing machine with a crosshead speed of 1 mm per minute. RESULTS: One-way ANOVA showed a statistically significant (P < .001) difference between groups. Group 2 had the highest shear bond strength. The difference between groups 1 and 3 was not statistically significant. The Kruskal-Wallis test showed no significant differences in the ARI scores (P = .595; P < .05). CONCLUSIONS: The fluoride-releasing, antibacterial, self-etching adhesive system, Clearfil Protect Bond, produced greater shear bond strength than the other 2 products tested and could be considered for clinical use.

Qualitative and quantitative evaluation of enamel after various stripping methods.

INTRODUCTION: In this study, we investigated ultramorphology, surface roughness, and microhardness of permanent and deciduous tooth enamel after various stripping methods. METHODS: One hundred twenty deciduous and permanent teeth (n = 60 each) were used. Qualitative (scanning electron microscopy) and quantitative (surface roughness and microhardness tests) experiments were carried out in the following experimental groups: group 1, stripping disk; group 2, diamond-coated metal strip; group 3, stripping disk and Sof-Lex discs (3M-ESPE, Seefeld, Germany); group 4, diamond-coated metal strip and Sof-Lex discs; group 5 (chemical stripping), 37% orthophosphoric acid in conjunction with diamond-coated metal strip; group 6 (control), no stripping. Surface roughness values (Ra) for permanent and deciduous enamel were evaluated with Welch analysis of variance (ANOVA) and Tamhane tests, and Kruskal-Wallis and Mann-Whitney tests, respectively. Microhardness values were evaluated statistically with Kruskal-Wallis, 1-way ANOVA, and Duncan tests. RESULTS: Deciduous and permanent teeth showed similar results in terms of surface roughness and surface morphology. Groups 3 and 4 had the smoothest deciduous and permanent enamel surfaces, whereas chemical stripping (group 5) produced the roughest surfaces in both enamel types. Stripping did not lead to a significant change in the microhardness of permanent enamel. CONCLUSIONS: All stripping methods significantly roughened the enamel surfaces. Polishing the stripped surface with Sof-Lex discs decreased the roughness.

Microleakage beneath ceramic and metal brackets photopolymerized with LED or conventional light curing units.

OBJECTIVE: To test the null hypotheses that (1) the type of light curing unit used (quartz-tungsten-halogen [QTH] or light-emitting diode [LED]) would not affect the amount of microleakage observed beneath brackets, and (2) the bracket type used (ceramic or metal) would not influence the amount of microleakage observed beneath brackets. MATERIALS AND METHODS: 40 freshly-extracted human premolars were randomly assigned into 4 bonding groups (n = 10/group): group 1, metal bracket + LED-cured Transbond XT; group 2, ceramic bracket + LED-cured Transbond XT; group 3, metal bracket + QTH-cured Transbond XT; and group 4, ceramic bracket + QTH-cured Transbond XT. The teeth were kept in distilled water for 1 month, and thereafter subjected to 500 thermal cycles. Then, specimens were sealed with nail varnish, stained with 0.5% basic fuchsin for 24 hours, sectioned, and photographed under a stereomicroscope. Microleakage was scored with regard to the adhesive-tooth interface and the bracket-adhesive interface at both incisal and gingival margins. Statistical analysis was accomplished by Kruskal-Wallis and Mann-Whitney U-tests with Bonferroni correction. RESULTS: Microleakage was observed in all groups. When an LED curing unit was used for adhesive polymerization, ceramic brackets displayed significantly less microleakage than metal brackets in both tooth-adhesive and bracket-adhesive interfaces. When a QTH curing unit was used, ceramic brackets displayed significantly less microleakage than metal brackets in the bracket-adhesive interface in both gingival and incisal margins. CONCLUSIONS: Ceramic brackets cured with LED units were the best combination, demonstrating the lowest microleakage scores.

Effect of resin-removal methods on enamel and shear bond strength of rebonded brackets.

The objective of this study is to determine (1) the effect of different resin-removal methods on shear bond strength (SBS) of rebonded brackets, (2) condition of the enamel surface, (3) time spent to remove resin remnants, and (4) the location of the bond failure. A total of 80 premolars were included in the study. Fifty of them were divided into five groups and bonded using Light Bondtrade mark sealant and Quick Curetrade mark adhesive. Ten of the samples were debonded, and the SBS of the first debonding was calculated. Forty brackets were debonded using pliers and examined by an optical microscope (16x) to determine the location of the bond failure interface, using a modified Adhesive Remnant Index (ARI). The remnant adhesives were cleaned with four methods: (1) low-speed tungsten-carbide bur (TCB), (2) high-speed TCB, (3) Sof-Lex finishing disks, and (4) microetcher. The brackets were rebonded, and a second set of SBS and ARI values were calculated and statistically evaluated. Thirty of the premolars were divided into five groups receiving the same resin-removal methods and examined by scanning electron microscope. Rebonded teeth had a greater SBS than the initial bonding, except in group 4. The rebonded SBS values were similar in groups 1-3, and only group 4 showed a statistical difference. Sof-lex discs were the most time-consuming procedures and left much adhesive remnant. The high-speed TCB was found to be the most hazardous to the enamel. The scarring of enamel after the debonding is inevitable but can be reduced.

Microleakage beneath ceramic and metal brackets bonded with a conventional and an antibacterial adhesive system.

OBJECTIVE: To assess microleakage of a tooth-adhesive-bracket complex when metal or ceramic brackets were bonded with a conventional and an antibacterial self-etching adhesive. MATERIALS AND METHODS: Forty freshly extracted human premolars were randomly assigned to four equal groups and received the following treatments: group 1 = Transbond XT + metal bracket, group 2 = Transbond XT + ceramic bracket, group 3 = Clearfil Protect Bond + ceramic bracket, and group 4 = Clearfil Protect Bond + metal bracket. After photopolymerization, the teeth were kept in distilled water for 1 month and thereafter subjected to thermal cycling (500 cycles). Specimens were further sealed with nail varnish, stained with 0.5% basic fuchsin for 24 hours, sectioned and examined under a stereomicroscope, and scored for marginal microleakage for the adhesive-tooth and bracket-adhesive interfaces from incisal and gingival margins. Statistical analysis was accomplished by Kruskal-Wallis test and Mann-Whitney U-test with Bonferroni correction. RESULTS: All groups demonstrated microleakage between the adhesive-enamel and bracket-adhesive interfaces. A significant difference was observed among all groups (P < .05) for the microleakage between the bracket-adhesive interface. Metal brackets exhibited significantly more microleakage than did ceramic brackets between the bracket-adhesive interface with either of the adhesives. Clearfil Protect Bond exhibited results similar to Transbond XT. Clearfil Protect Bond may be a choice of adhesive in bracket bonding because of its antibacterial activity and similar microleakage results with the orthodontic adhesive. CONCLUSIONS: Metal brackets cause more leakage between an adhesive-bracket interface, which may lead to lower clinical shear bond strength and white-spot lesions.

Differential diagnosis of skeletal open bite based on sagittal components of the face.

AIMS: This study examined the morphology of skeletal open bite with respect to the sagittal components of the face. METHODS: The material consisted of cephalometric and hand-wrist films of 49 girls and 22 boys with skeletal open bite. The samples were grouped into Class I, II, and III facial types on the basis of ANB angle. In addition to conventional dentofacial variables, nasopharyngeal airway area was also measured on lateral headfilms. All measurements were examined by analysis of variance and Duncan test. Subsequently the factors leading to open bite were evaluated using multiple-regression analysis. RESULTS: Dentofacial morphology differed in the sagittal components of skeletal open bite, and the differences were most obvious between the Class II and Class III open bite groups. Posterior maxillary dentoalveolar height and mandibular incisor inclination were important factors in the development of open bite in the skeletal Class I and Class II open bite groups, while in the skeletal Class III open bite group, the nasopharyngeal airway and the gonial angle were involved. CONCLUSION: Sagittal components of skeletal open bite should be considered in the differential diagnosis and treatment planning of such cases.

Profile changes associated with different orthopedic treatment approaches in Class III malocclusions.

The aim of this study was to evaluate and compare the soft tissue effects of chincup (CC), chincup plus bite plate (CC+P), and reverse headgear (RHg) therapies with each other and with an untreated control group (C). The material consisted of lateral cephalometric and hand-wrist films of 59 Class III cases and 20 nontreated control subjects. Thirty-one cases were treated with CC, 14 with CC+P, and 14 with RHg, and Class I relation was achieved. The mean pretreatment ages were approximately 11 years and the observation period was one year. The cephalometric films were analyzed according to the structural superimposition method of Björk. All tracings were double digitized, and the measurements were calculated by a computer program (PORDIOS). Treatment and control changes within the groups and the differences between the groups were analyzed statistically. Forward positioning of the maxilla was significant in the RHg group, whereas the mandible was positioned backward significantly in all the treatment groups. Posterior rotation of the mandible was significant in the CC+P and RHg groups. The overjet increased and the overbite decreased significantly in all the treatment groups. Forward movement of soft tissue A and upper lip was significant in all groups, whereas more pronounced in the CC+P group. The soft tissue changes in the mandibular region were significant in the CC and CC+P groups, whereas in the maxillary region more significant and similar improvements were obtained by CC+P and RHg treatments. Longterm studies are required to confirm the stability of these changes.

Effect of LED curing on marginal integrity of an ormocer-based sealant.

PURPOSE: The purpose of this study was to investigate the microleakage of a light cured, ormocer-based fissure sealant when photopolymerized with 2 different light emitting diode (LED) curing units and a conventional quartz-tungsten halogen (QTH) light-curing unit. METHODS: Thirty freshly extracted, unerupted human third molars from 9 adolescent were randomly assigned into 3 groups (N=10/group). Pits and fissures were acid etched for 30 seconds, rinsed for 15 seconds with an air-water spray, and air-dried. An ormocer-based fissure sealant material (Admira Seal) was applied to all fissures. In group 1, the sealant was photopolymerized with a Smart Light LED curing unit (Dentsply) for 10 seconds. Another LED curing unit (Elipar II) and a conventional QTH curing unit (Hilux) were used in groups 2 and 3 for 10 and 30 seconds, respectively. Specimens were immersed in 0.5% basic fuchsin for 24 hours, sectioned and examined under a stereomicroscope, and scored for marginal microleakage. RESULTS: Statistical analysis of microleakage scores revealed no significant difference among the groups tested (P>.05, Kruskal-Wallis test). CONCLUSION: The tested LED curing units may provide reduction in total application time without comprising marginal integrity of the ormocer-based sealant.

Forced eruption and implant treatment in posterior maxilla: a clinical report.

Periodontal disease can result in bone defects that surround periodontally compromised teeth. After the loss of those teeth, remaining defects may compromise successful treatment with dental implants. Forced eruption, induced by applying light orthodontic forces in the coronal direction, provides enhancement of the implant recipient site by enabling the extraction of the periodontally hopeless teeth. This report describes the use of forced eruption to promote the formation of new bone and soft tissue in the resorbed maxillary posterior region, followed by placement of an implant-supported fixed partial denture.

Unexpected breakage of mandibular midline distraction device: case report.

Management of the transverse mandibular deficiency and anterior crowding by mandibular midline distraction osteogenesis (MMDO) is an efficient and stable alternative to orthodontic mechanics with minor complications. Although the only major complication reported previously during MMDO is the nonunion of the segments, in the present case report an unexpected breakage of the distractor in MMDO during the consolidation period as a new major complication was presented.

Evaluation of maxillary protraction and fixed appliance therapy in Class III patients.

The aim of this study was to examine the dentofacial changes in Class III patients treated with fixed appliances subsequent to rapid maxillary expansion (RME) and facemask therapy. The material consisted of the cephalograms and hand-wrist films of 14 (9 girls, 5 boys) skeletal Class III and 15 (10 girls, 5 boys) untreated subjects obtained at the beginning of treatment/observation T1, immediately after orthopaedic therapy T2, and at the end of the observation period T3. The mean pre-treatment/control ages were approximately 11.5 years and the observation period was 3 years T2-T1: 1 year, T3-T2: 2 years). The cephalometric films were analysed according to the structural superimposition method of Björk. All tracings were double-digitized and the measurements were calculated by a computer program. Intragroup changes and intergroup differences were statistically analysed. Forward movement of the maxilla (P < 0.01), backward movement and rotation of the mandible, an increase in the ANB angle (P < 0.001), lower face height and overjet (P < 0.001), a decrease of overbite, and an improvement in the sagittal lip relationship (P < 0.01) presented significant intergroup differences between T2 and T1. During the second phase of treatment T3-T2, although not statistically significant, forward movement of the maxilla was less than in the control subjects. Overall changes during the observation period T3-T1 revealed that correction was mainly due to favourable changes in the mandibular and dentoalveolar components of the discrepancy, while these in maxillary position were not different from the control group. The soft tissue profile improved significantly (P < 0.001) in the treatment group. Comparison with the Class I controls at the end of the observation period confirmed that some Class III characteristics still remained in the treated patients.

Mandibular midline distraction using a simple device.

OBJECTIVE: Mandibular midline distraction osteogenesis represents a new option for creation of intra-arch space in the mandibular arch. The aim of this paper is to introduce a simple device (hyrax expander) and method for mandibular midline distraction. STUDY DESIGN: The sample consisted of 24 patients (mean age: 18.07 years) treated with mandibular midline distraction. Hyrax expanders were used as symphyseal distractors, and distraction procedure was carried out with a rate of 1 mm and rhythm of twice daily. RESULTS: Mandibular midline distraction was completed successfully in all patients and the distraction amount was 7.01 mm. No major complication other than mild mucosal irritation and gingival recession was observed. CONCLUSION: The presented method is a viable option for mandibular midline distraction osteogenesis.

Vector alignment in maxillary distraction osteogenesis.

Maxillary distraction osteogenesis is an alternative treatment of cleft patients with severe maxillary hypoplasia. The aim of this paper is to present the combined surgical/orthodontic treatment of a cleft lip and palate patient and to evaluate the maxillary distraction procedure and the distraction vector in high Le Fort I osteotomy.