Evaluation of Swallowing Function in Relation to Oropharyngeal Dysphagia in Patients with Operated Unilateral Cleft Lip and Palate.

OBJECTIVE: To determine the occurrence of oropharyngeal dysphagia (OD) signs and symptoms in patients with operated unilateral cleft lip and palate (CLP). MATERIALS AND METHODS: This prospective study was conducted on 15 adolescents with operated unilateral CLP (CLP group) and 15 non-cleft volunteers (control group). Initially, the Eating Assessment Tool-10 (EAT-10) questionnaire was administered to subjects. OD signs and symptoms such as coughing, the sensation of choking, globus sensation, the need to clear the throat, nasal regurgitation, difficulties of bolus control multiple swallowing were evaluated by patient complaints and physical examination of swallowing function. Also, the Functional Outcome Swallowing Scale was used to determine the severity of the OD. Fiberoptic endoscopic evaluation of swallowing (FEES) with water, yogurt, and crackers was performed. RESULTS: The prevalence of OD signs and symptoms based on patient complaints and physical examination of swallowing was low (range, 6.7 to 26.7%), and nonsignificant differences were observed between the groups for these parameters as well as for EAT-10 scores. According to the Functional Outcome Swallowing Scale findings, 11 of 15 patients with CLP were asymptomatic. Fiberoptic endoscopic evaluation of swallowing indicated that post-swallow pharyngeal wall residues with yogurt were significant in the CLP group with a prevalence of 53% ( P < 0.05), whereas differences between the groups in terms of cracker and water residues were nonsignificant ( P > 0.05). CONCLUSION: OD in patients with repaired CLP was manifested mainly in the form of pharyngeal residue. However, it did not appear to cause significant increases in patient complaints compared with healthy individuals.

Evaluation of swallowing in transverse maxillary deficiency patients before and after rapid maxillary expansion.

OBJECTIVES: To evaluate swallowing function in relation to oropharyngeal dysphagia (OD) in adolescents who had transverse maxillary deficiency with posterior crossbite and high-arched palate, before, and after rapid maxillary expansion (RME). MATERIALS AND METHODS: Twenty patients (mean age: 13.0 ± 3.1) with bilateral posterior crossbite and high-arched palate (RME group: RMEG) and 20 volunteers (mean age: 13.4 ± 2.6) with Class I crowding without posterior crossbite or high-arched palate (control group: CG) were recruited. OD signs and symptoms were evaluated using the Eating Assessment Tool-10 (EAT-10) questionnaire, patient complaints, and physical examination of swallowing function before (T1) and 7 months after (T2) RME. Additionally, fiberoptic endoscopic evaluation of swallowing (FEES) with water, yogurt, and cracker was performed. In CG, evaluation of swallowing was performed only once, corresponding to T1 of RMEG. RESULTS: Prevalence of OD signs and symptoms based on patient complaints and physical examination of swallowing was low (5%-15%), and nonsignificant differences were observed between CG and RMEG at T1 for these parameters as well as for EAT-10 scores. Total post-swallow pharyngeal residue with yogurt was significantly different between CG and RMEG at T1, with a prevalence of 60% in RMEG (P < .05). There was no significant difference regarding residue with yogurt between T1 and T2 in RMEG (P > .05). CONCLUSION: Patients with a maxillary transverse deficiency were affected by pharyngeal residue as indicated by FEES, but it did not appear to improve in short-term follow-up in patients treated with RME.

Nickel Release and the Viability of Streptococcus mutans Corresponding to Low Risk of Dental Caries in Artificial Saliva Containing Orthodontic Appliances: In Vitro Study.

OBJECTIVE: The aims of this study were to determine the effect of different levels of Streptococcus mutans that correspond to a low risk of dental caries on nickel release and to determine the viability of S. mutans. METHODS: Simulated fixed orthodontic appliances composed of copper nickel titanium, nickel titanium, or stainless steel were immersed in Klimek artificial saliva for 10 days with or without S. mutans inoculation on day 7. Same levels of S. mutans cultures (4 × 104 cfu/mL) were inoculated into the artificial saliva without orthodontic appliances. Nickel release was detected by inductively coupled plasma mass spectrometry. The archwire surface was analyzed by atomic force microscopy and scanning electron microscopy. RESULTS: The density of S. mutans significantly increased in the artificial saliva without orthodontic appliances (P < .05). Appliances with nickel titanium alloys showed higher nickel release in the artificial saliva with or without S. mutans than those with copper nickel titanium or stainless steel archwires (P < .05). However, S. mutans increased nickel release only in orthodontic appliances with stainless steel archwires (P < .05). Although atomic force microscopy showed that the surface of as-received stainless steel archwires was smoother than that of nickel titanium or nickel titanium archwires, S. mutans increased the surface roughness of only the SS archwires. S. mutans adhered to all archwire types. CONCLUSION: While corrosion or corrosion-related processes may have decreased the growth capacity of S. mutans, reciprocally, S. mutans influenced corrosion. Rough surfaces can also promote corrosion; therefore, the surface roughness of metal alloy orthodontic appliances should be evaluated to determine their corrosion behavior.

Three-dimensional digital evaluation of tooth symmetry and volume in patients with missing and peg-shaped maxillary lateral incisors.

INTRODUCTION: This study aimed to evaluate the 3-dimensional tooth crown symmetry and the crown volumes of maxillary and mandibular teeth in patients with unilateral or bilateral missing or peg-shaped maxillary lateral incisors. METHODS: Six groups were established for the possible clinical variations in patients with unilateral missing or peg-shaped maxillary lateral incisors, bilateral presence of these tooth anomalies, and a control group (CG) with normal lateral incisors. The study was conducted on digital dental models of 132 patients. The morphologic symmetry of the antimere teeth was investigated using 3-dimensional deviation analysis. Volumes of contralateral teeth were compared within and among groups for the maxilla and mandible. Furthermore, volumes of teeth were compared in missing and peg-shaped quadrants and quadrants of CG. Intergroup differences were tested using one-way analysis of variance and Kruskal-Wallis tests, whereas paired t and Wilcoxon tests were used for parametric and nonparametric variables, respectively, for intragroup comparisons. RESULTS: Significant deviations in symmetry of antimere teeth were not detected (P >0.05). The volumes of mandibular central and lateral incisors in missing or peg-shaped lateral incisor groups were smaller than in the CG (P <0.05). Per quadrant analysis, volumes of the maxillary central incisor and mandibular central incisors, canines, and first molars in quadrants with missing or peg-shaped lateral incisors were smaller than in the control quadrants (P <0.05). CONCLUSIONS: Neither unilateral nor bilateral presence of missing or peg-shaped maxillary lateral incisors affected the morphologic symmetry of antimere teeth but did affect tooth volume, especially in the mandibular arch.

Effect of Cleft Width on the Outcome of Presurgical Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate.

ABSTRACT: The purpose of this study was to investigate the short-term effects of presurgical nasoalveolar molding (PNAM) according to cleft width (CW) in patients with unilateral cleft lip and palate (UCLP). In this retrospective study, 32 newborns with nonsyndromic UCLP treated with PNAM were allocated to 2 groups based on CW (group A, CW ≤5 mm; and group B, CW >5 mm). The following measurements were carried out using standardized photographs taken before and after PNAM therapy (before primary lip surgery): nostril axis inclination of healthy (NAI-NC) and cleft sides (NAI-C), columellar angle (CA), nasal base inclination (NBI), nasal floor width ratio (NFWR), alar base height ratio (ABHR), and columellar length ratio. Before PNAM therapy, there were significant differences between the 2 groups with respect to NAI-C, NBI, NFWR, and ABHR, indicating greater deformation of the nose in group B. After PNAM therapy, CA, NAI-C, NAI-NC, NFWR, and columellar length ratio were significantly improved in both the groups, whereas NBI and ABHR significantly worsened in group B. The improvement in CA, NAI-C, and NFWR was significantly greater in group B. Although a larger CW had some negative effects on the outcome of PNAM, it was found to be advantageous for nasal symmetry, if initiated as early as possible. Nevertheless, it is important to consider those aspects of the nasolabial area that are involved in the perception of symmetry when evaluating the effect of CW on PNAM outcomes in UCLP.

Comparison of 2 treatment protocols using fixed functional appliances in Class II malocclusion: Treatment results and stability.

INTRODUCTION: The objective of this research was to compare the 2 treatment protocols including a functional mandibular advancer (FMA; Forestadent, Pforzheim, Germany) followed by multibracket appliances (MBAs) vs a Forsus device (3M Unitek, Monrovia, Calif) in combination with MBA concerning treatment outcomes and posttreatment stability. METHODS: This study was conducted using lateral cephalograms of patients who were treated with MBA, which was used either after an FMA or concurrently with a Forsus device, and of patients who had untreated Class II malocclusion (control group). Each group consisted of 19 subjects in cervical stage 2 or cervical stage 3 stages according to the cervical vertebral maturation index. Cephalograms were taken for the treated groups at T1 (pretreatment), T2 (completion of the MBA treatment), and T3 (at least 2 years after T2). RESULTS: Significant intergroup differences at the T1-T2 period were observed in favor of the FMA concerning mandibular advancement, intermaxillary relationship, and mandibular elongation. With Forsus treatment, restrained maxillary growth and a slightly improved intermaxillary relationship rebounded after treatment (P <0.05). At the end of treatment, mandibular incisor protrusion and occlusal plane rotation were greater in the Forsus group than in the FMA group (P <0.05), and maxillary incisor retroclination was significant in the Forsus group. During the posttreatment period, although no significant changes were present in the incisors' inclination, relapses of the T1-T2 improvements in overjet and overbite and the recidive of the occlusal plane rotation were significantly higher in the Forsus group. CONCLUSIONS: Treatment protocol including an FMA was found to be more effective with mandibular skeletal effects and was more stable with a lesser degree of relapse in overjet and overbite than the Forsus protocol.

Root resorption due to orthodontic treatment using self-ligating and conventional brackets : A cone-beam computed tomography study.

OBJECTIVES: Purpose of the present study was to compare external root resorption (ERR) volumetrically in maxillary incisors induced by orthodontic treatment using self-ligating brackets (Damon Q, DQ) or conventional brackets (Titanium Orthos, TO) with the help of cone-beam computed tomography (CBCT). PATIENTS AND METHODS: A sample of 32 subjects, with Angle Class I malocclusion and anterior crowding of 4-10 mm, was divided randomly into two groups: a DQ group, in which self-ligating DQ brackets with Damon archwires were used; and a TO group, in which conventional TO brackets with large Orthos archwires were applied. The study was conducted using CBCT scans taken before (T1), and near the end (9 months after the initiation of treatment; T2) of the orthodontic treatment. The extent of ERR was determined volumetrically using Mimics software. Changes in root volume were evaluated by repeated-measures analysis of variance as well as by paired and independent t-tests. RESULTS: While significant differences were found between T1 and T2 for root volume in both groups (p < 0.05), there was no difference between the groups regarding the amount (mm3 or relative change) of ERR (p > 0.05). Maxillary central and lateral incisors showed similar volume loss (p > 0.05). Furthermore, the TO group showed a higher prevalence of palatinal and proximal slanted RR compared with the DQ group (p < 0.05). CONCLUSIONS: It is not possible to suggest superiority of one bracket system over the other only considering root resorption pattern or amount. Higher incidence of slanted RR found in patients treated with the TO system warrants further research to identify possible specific causes.

The effects of maxillary expansion on the soft tissue facial profile.

PURPOSE: The aims of this retrospective study were to evaluate the possible changes in soft tissue facial profile induced by orthopedic rapid maxillary expansion (RME) and surgically assisted rapid maxillary expansion (SARME), and to correlate them with the underlying hard tissue alterations. MATERIALS AND METHODS: 16 patients who received bone borne SARME and 25 patients who were subjected to RME using metal cast splint hyrax appliance were analyzed retrospectively. This research was conducted on lateral cephalometric radiographs taken on 2 occasions: before expansion (T1) and at the beginning of any further orthodontic treatment (T2). Investigated lateral cephalometric parameters consisted of Holdaway soft tissue measurements with some supplementary soft tissue, skeletal and dental assessments. RESULTS: The acquisition of T2 cephalograms which conforms to the initiation of further orthodontic treatment corresponded to 83.25±3.51 days for SARME and 85.68±4.37 days for RME after the expansion was completed. The only significant change in soft tissue profile of the SARME group was a decrease in upper lip thickness (p<0.05), whereas in the RME group, decrease in soft tissue facial profile angle and increase in H angle were found to be statistically significant (p<0.05 for each). For the RME group, the changes in soft tissue facial profile angle and H angle correlated only with the changes in SNB angle (p<0.05). CONCLUSION: While bone-borne SARME did not seem to possess the potential to alter soft tissue profile, tooth-borne RME caused a more convex soft tissue profile related to a reduction in SNB.

Presurgical Orthopedic Treatment Using Modified Nostril Retainers in Patients With Unilateral Cleft Lip With or Without Cleft Palate.

This study aimed to present a new technique for presurgical orthopedic treatment of patients with unilateral cleft lip with or without cleft palate (UCL±P) by means of modified nostril retainers manufactured using a special mold with soft acrylic or orthodontic acrylics material. Nasal molding with the modified nostril retainer is considerably effective and comfortable for the patient.

Comparison of stepwise vs single-step advancement with the Functional Mandibular Advancer in Class II division 1 treatment.

OBJECTIVE: To compare two groups of subjects at the peak of the pubertal growth period treated with the Functional Mandibular Advancer (FMA; Forestadent, Pforzheim, Germany) appliance using either single-step or stepwise mandibular advancement. MATERIALS AND METHODS: This study was conducted on 34 Class II division 1 malocclusion subjects at or just before the peak phase of pubertal growth as assessed by hand-wrist radiographs. Subjects were assigned to two groups of mandibular advancement, using matched randomization. Both groups were treated with the FMA. While the mandible was advanced to a super Class I molar relation in the single-step advancement group (SSG), patients in the stepwise mandibular advancement group (SWG) had a 4-mm initial bite advancement and subsequent 2-mm advancements at bimonthly intervals. The material consisted of lateral cephalograms taken before treatment and after 10 months of FMA treatment. Data were analyzed by means paired t-tests and an independent t-test. RESULTS: There were statistically significant changes in SNB, Pg horizontal, ANB, Co-Gn, and Co-Go measurements in both groups (P < .001); these changes were greater in the SWG with the exception of Co-Go (P < .05). While significant differences were found in U1-SN, IMPA, L6 horizontal, overjet, and overbite appraisals in each group (P < .001), these changes were comparable (P > .05). CONCLUSION: Because of the higher rates of sagittal mandibular skeletal changes, FMA using stepwise advancement of the mandible might be the appliance of choice for treating Class II division 1 malocclusions.

Upper airway changes following single-step or stepwise advancement using the Functional Mandibular Advancer.

OBJECTIVES: Purpose of the present study was to determine and compare possible changes in the dimensions of the pharyngeal airway, morphology of the soft palate, and position of the tongue and hyoid bone after single-step or stepwise mandibular advancement using the Functional Mandibular Advancer (FMA). PATIENTS AND METHODS: The sample included 51 peak-pubertal Class II subjects. In all, 34 patients were allocated to two groups using matched randomization: a single-step mandibular advancement group (SSG) and a stepwise mandibular advancement group (SWG). Both groups were treated with FMA followed by fixed appliance therapy; the remaining 17 subjects who underwent only fixed appliance therapy constituted the control group (CG). The study was conducted using pre- and posttreatment lateral cephalometric radiographs. Data were analyzed by paired t test, one-way analysis of variance, and Pearson's correlation coefficient. RESULT: In the SWG and SSG, although increases in nasopharyngeal airway dimensions were not significant compared with those in the CG, enlargements in the oropharyngeal airway dimensions at the level of the soft palate tip and behind the tongue, and decreases in soft palate angulation, were significant. Tongue height increased significantly only in the SWG. Compared with the CG, while forward movement of the hyoid was more prominent in SSG and SWG, the change in the vertical movement of the hyoid was not significant. No significant difference between SWG and SSG was observed in pharyngeal airway, soft palate, tongue or hyoid measurements. CONCLUSIONS: The mode of mandibular advancement in FMA treatment did not significantly affect changes in the pharyngeal airway, soft palate, tongue, and hyoid bone.

Survey on Retention Protocols Among Turkish Orthodontists.

OBJECTIVE: The purpose of this study was to identify general retention protocols practiced by Turkish orthodontist and to compare the results obtained with those of similar studies in Western countries. METHODS: The Web-based survey consisted of 29 questions: 3 to identify the demographic characteristics of the participants and 26 to examine how orthodontists manage the retention phase. Data was interpreted by descriptive statistical methods such as the median test, the Mann-Whitney U-test and logistic regression analysis. RESULTS: The survey return rate was 73.8%. Pretreatment malocclusion status (87%), oral hygiene status (78%), and presence of third molars (63%) were reported to be the most important factors in determining the type of retainer. Bonded retainers, either alone (29% in maxilla and 34% in mandible) or supplemented with vacuum-formed retainers (27% in maxilla and 32% in mandible) were the most commonly used type of retainer. The preference for lifelong retention varied from 7% to 19%. Female orthodontists scheduled the first appointment after debonding sooner than male orthodontists (p<0.05). Orthodontists working in universities scheduled first appointments later than orthodontists working in private practices (p<0.05). CONCLUSION: Turkish orthodontists still give importance to the third molars in their retention protocols, contrary to what is suggested in the current literature, and lifetime retention is rarely preferred as compared to other countries.

Treatment of lateral open bite with vertical dentoalveolar distraction osteogenesis.

The aim of this article is to describe the surgical, orthodontic, and periodontal treatment of an adult patient with a lateral open bite, anterior crowding, and gingival recession on the mandibular right lateral incisor. The lateral open bite, which resisted conventional mechanics, was successfully corrected by the combination of dento-osseous osteotomies and vertical alveolar distraction using orthodontic multibracket appliances in conjunction with nickel-titanium archwires and intermaxillary elastics. After the orthodontic treatment, the denuded root surface of the mandibular right lateral incisor was closed using a coronally advanced flap technique with platelet-rich fibrin. The results at the 2-year posttreatment follow-up were satisfactory from both the occlusal and the periodontal standpoints.

Does transpalatal distraction affect pharyngeal airway dimensions and related soft tissues?

PURPOSE: Previous studies of transpalatal distraction (TPD) have been based on dentoskeletal alterations of the jaws and nasal airway changes. The main aim of this study was to determine the effects of TPD on soft palate and pharyngeal airway dimensions and tongue posture. MATERIAL AND METHODS: This was a retrospective cohort study. The sample was comprised of 16 patients with skeletal maxillary deficiency who had bilateral crossbite combined with a high palatal vault and partial or near total nasal obstruction treated with TPD using bone-borne distractors (Transpalatal Distractor, SurgiTec NV, Bruges, Belgium). This research was carried out on lateral cephalometric radiographs taken before distraction and after a distraction period of 6.75 ± 1.61 months. The primary predictor variable was pharyngeal airway dimensions and tongue posture. Other variables were demographic and lateral cephalometric parameters. Changes in the length, angle, and thickness of the soft palate; nasopharyngeal, retropalatal, retroglossal, and lower pharyngeal airway dimensions; and tongue length and height were evaluated. Data were analyzed by paired t test. RESULTS: The sample included 16 adult patients (mean age, 25.13 ± 6.13 yr; 7 women, 9 men). The desired amount of distraction was achieved in all patients within 7 to 10 days. The total activation average was 8.38 ± 0.96. TPD caused statistically significant changes in sagittal nasopharyngeal airway dimensions (1.19 mm), the minimal oropharyngeal distance behind the tongue base (1.81 mm), and tongue height (2.12 mm). CONCLUSIONS: The results of this study suggest that, in adult patients with nasal obstruction, TPD has the potential to increase sagittal nasopharyngeal airway dimensions and the minimal oropharyngeal distance behind the tongue, with an elevation in tongue posture. Further studies using cone-beam computed tomography that focus on how the bone-borne expander alters pharyngeal airway volume will make valuable contributions to the literature.

Comparison of treatments with the Forsus fatigue resistant device in relation to skeletal maturity: a cephalometric and magnetic resonance imaging study.

INTRODUCTION: The aim of this study was to compare the dentoskeletal changes and alterations of mandibular condyle-disc-fossa relationships in subjects at the peak and the end of the pubertal growth period treated with the Forsus fatigue resistant device (3M Unitek, Monrovia, Calif). METHODS: The sample consisted of 29 subjects with Class II Division 1 malocclusions who were classified according to their hand-wrist radiographs. Fifteen patients were at or just before the peak phase of pubertal growth (peak pubertal group). Fourteen patients were near the end of the pubertal growth period (late pubertal group). The study was conducted by using lateral cephalometric radiographs and magnetic resonance images obtained at the beginning and at the end of the application of the Forsus fatigue resistant device. The treatment period was 9 months. RESULTS: The Wilcoxon signed rank test was used to evaluate differences within groups. The changes observed in both groups were compared by using the Mann-Whitney U test. There were statistically significant group differences in mandibular length and ramus length, with significant increases of these parameters in the peak pubertal group (P <0.05). No significant differences were observed between the groups concerning dental parameters (P >0.05), with the exception of mandibular molar vertical movements, which were significantly greater in the peak pubertal group (P <0.05). Analysis of the magnetic resonance images showed no positional changes of the mandibular condyle in relation to the glenoid fossa in either group (P >0.05). Although the articular disc was positioned more anteriorly in the peak pubertal group compared with its pretreatment position (P <0.05), the position of the disc was still within the physiologic range. No significant intergroup difference was observed for disc-condyle relationship (P >0.05). CONCLUSIONS: The Forsus fatigue resistant device did not appear to cause significant increases in mandibular dimensions in subjects in late puberty. According to the magnetic resonance image findings, Forsus treatment is not a risk factor for the development of temporomandibular dysfunction in subjects with no signs and clinical symptoms of dysfunction.

Dimensional changes of the nasal cavity after transpalatal distraction using bone-borne distractor: an acoustic rhinometry and computed tomography evaluation.

PURPOSE: The aims of this study were as follows: 1) evaluation of the effects of transpalatal distraction (TPD) on nasal minimum cross-sectional area (MCA) and nasal volume, and assessment of long-term stability of TPD outcomes on the nasal cavity, using acoustic rhinometry (AR); 2) quantifying the alveolar, basal, and nasal components of the maxillary expansion at both canine and molar levels by computed tomography (CT); 3) investigation of the relationship between CT transverse measurements and AR measurements. PATIENTS AND METHODS: The sample was comprised of 11 adult patients with maxillary transverse deficiency and partial/near total nasal obstruction. Standard corticotomies were carried out and bone-borne transpalatal distractors were used in all cases. AR recordings were used to determine nasal minimum cross-sectional area of the anterior (MCA1) and posterior (MCA2) and the volume of the nasal cavity in these regions (Volume1, Volume2) before surgery (T1), when the distractor was removed (T2), and at least 1 year after the expander was removed (T3). CT images were taken at T1 and T2. CT measurements included maxillary base, alveolar, and nasal cavity widths at both canine and first molar slices. RESULTS: There were significant increases in MCAs and volumes of nasal cavity between T1 and T2 and between T1 and T3 with the exception of the right MCA2 and right Volume2 at the latter time (P < .05). All maxillary transverse dimensions in canine and molar CT slices displayed significant increases (P < .05). The change in binasal width at the canine level showed significant correlations with the changes in total MCA1 and total Volume1 (P < .05). CONCLUSION: TPD provided great increases in MCA and volume of the nasal cavity, and these changes generally remained stable long term. The use of TPD in adult patients granted the opportunity of efficient maxillary expansion concurrent with increases in the nasal dimensions.

Effects of transmandibular symphyseal distraction on teeth, bone, and temporomandibular joint.

PURPOSE: The aim of this clinical study was to investigate the clinical effects and long-term results of the transmandibular symphyseal distraction technique for the correction of mandibular transverse deficiencies. This was achieved by assessing the dental, skeletal, and temporomandibular joint changes in the sagittal, vertical, and axial planes using cephalograms, dental casts, and computed tomography (CT). PATIENTS AND METHODS: Seven patients with mandibular transverse deficiencies (3 females and 4 males), aged 14.3 to 22.5 years (mean 16.2), were treated with a bone-borne transmandibular distractor. Lateral and posteroanterior cephalometric films, CT scans of both temporomandibular joints, and dental casts were obtained preoperatively, at the end of the distraction period, and at the end of 3 years (clinical follow-up period). The clinical findings were assessed according to the morphologic and functional success criteria established by the Steering Group of European Collaboration on Cranial Facial Anomalies for patients with developmental dentofacial anomalies undergoing craniofacial distraction osteogenesis. The statistical analysis of cephalometric films and dental cast measurements was done using the paired t test. The mean postoperative examination period was 40 months (range 36 to 48). RESULTS: The desired amount of distraction was achieved in all patients (mean 6.48 mm). The intraoperative and postoperative complications encountered included damage to the central incisors during vertical osteotomy (1 patient), wound dehiscence after a latent period (3 patients), mild temporomandibular joint pain during the distraction period (3 patients), and chronic gingivitis around the activation rods (7 patients). The success criteria for craniofacial distraction osteogenesis were fulfilled at the end of the 3-year follow-up period. Model analysis showed that the maximal amount of expansion was achieved at the premolar region (first premolar 5.79 mm, second premolar 5.07 mm). Frontal (posteroanterior) cephalograms taken at the end of the distraction period revealed significant increases in the bicondylar (0.35 mm), bigonion (3.43 mm), biantegonion (2.29 mm), and intermolar (4.0 mm) widths, and the ramal angle had decreased significantly (-1.64 degrees). The increase in the transverse measurements was greater at the dentoalveolar level than at the base of the mandible. Lateral cephalograms showed that transmandibular symphyseal distraction produced significant increases in the incisor mandibular plane angle (2.79 degrees) and mandibular body length (1.72 mm). The effect of the procedure on the condyle was 2.5 degrees to 3 degrees of distolateral rotation as calculated using the CT scans. Dental crowding was resolved rapidly by the movement of the teeth into the distraction regenerate. CONCLUSIONS: The clinical and radiologic results of the present study have shown that a transmandibular distractor is a clinically effective bone-borne distractor for the correction of mandibular transverse deficiencies and anterior crowding. The follow-up cephalograms and CT scans showed the transverse skeletal stability of the distraction procedure and no permanent temporomandibular dysfunction. However, additional multicenter studies with more patients are necessary to precisely evaluate the long-term postdistraction changes on the skeleton, teeth, and temporomandibular joint.

Enhanced effect of combined treatment with corticotomy and skeletal anchorage in open bite correction.

PURPOSE: To determine the effects of combined treatment with corticotomy and skeletal anchorage in open bite correction. PATIENTS AND METHODS: Ten patients (6 females, 4 males) with ages ranging from 15 to 25 years were involved. All of the individuals received combined subapical corticotomy and skeletal anchorage procedure and intrusion forces of 200 to 300 g were applied on the attachments of each molar and both premolars during 12 to 15 weeks. Mean changes for the measurements for the sample group were evaluated with Wilcoxon signed ranks test. RESULTS: Significant intrusion of maxillary posterior teeth provided counterclockwise rotation of the mandible and open bite was successfully corrected. SNB angle increased and the ANB angle decreased (P< .05). Significant decreases were noted for vertical skeletal characteristics and overbite increased accordingly (P< .05). CONCLUSIONS: Our results indicated that the use of combined treatment with corticotomy and skeletal anchorage provided safe and noncompliance intrusion of posterior teeth in a short period and may be regarded as an alternative method for skeletal open bite correction in adults who reject orthognathic surgery.

Transpalatal distraction using bone-borne distractor: clinical observations and dental and skeletal changes.

PURPOSE: The aim of this clinical study was to analyze the outcome, complications, and long-term results of transpalatal distraction for the correction of maxillary transverse deficiency (MTD) and assess skeletal and dental changes in the sagittal, vertical, and transverse planes through cephalograms and dental casts. PATIENTS AND METHODS: Ten adult patients with MTD were treated with a Transpalatal Distractor (Surgi-Tec, Bruges, Belgium). Lateral and posteroanterior cephalometric films and dental casts were taken before surgery and at the end of the consolidation period. The statistical analysis of cephalometric film and dental cast measurements was undertaken with paired t tests. RESULTS: The intraoperative and postoperative problems encountered were damage to the central incisive teeth as a result of vertical osteotomy, wound dehiscence after the latent period, pain during the distraction period, and loosening of the distractor and buccal displacement of the left alveolar segment during the consolidation period. Model analysis showed that the greatest amount of transverse increase was in the premolar region (7.07 mm for first premolar and 7.10 mm for second premolar). Frontal cephalometric analysis indicated that transverse distances increased more at the alveolar level (7.75 mm) than in the maxillary base (5.25 mm) and nasal region (4.3 mm). The asymmetries between the left and right sides in both dental and skeletal expansions were statistically nonsignificant. The changes in the Sella-nasion-point A, Sella-nasion-point B, Sella-nasion and gonion-gnasion angles were statistically significant. CONCLUSIONS: According to the results of this study, transpalatal distraction was found to be a clinically effective technique for palatal expansion in adult patients with MTD. However, treatment planning and regular clinical follow-up visits are necessary for long-term clinical success.

Vertical changes following orthodontic extraction treatment in skeletal open bite subjects.

The purpose of this investigation was to assess the vertical changes occurring in skeletal open bite patients treated orthodontically with different extraction patterns. The study was conducted using lateral cephalometric radiographs taken before and after treatment. Fifteen patients who had an anterior open bite (AOB) only were treated with first premolar extractions (Group E4). Seventeen patients with an AOB extending to the posterior teeth were grouped according to the extractions: extraction of second premolars (Group E5) and first molars (Group E6). Cephalometric data were analysed according to the 'two-factor experiment with a repeated measure on one factor' model. The treatment group factor had three levels, E4, E5, and E6, and the time factor two levels, pre- and post-treatment. The differences between the pre- and post-treatment periods were statistically significant for all the cephalometric variables (P < 0.001, P < 0.0001), except for ANS-Me/Na-Me. The time and group interaction were found to be statistically significant for the variables where the time factor is important, such as SN-GoGn angle, SGn-NBa angle, ANS-Me dimension, Na-Me dimension, forward movement of the maxillary and mandibular molars, and the distance to the mandibular plane of the lower molars. The severity of vertical dysplasia did not change in group E4. Generally, however, within the appropriate indications, extraction of the second premolars or the first molars led to a closing rotation of the mandible in subjects with a skeletal AOB extending to the posterior teeth.