The presurgical status of the alveolar cleft and success of secondary bone grafting.

OBJECTIVE: The primary purpose of this study was to evaluate presurgical status of the alveolar cleft site and success of secondary alveolar bone grafting. DESIGN: Thirty patient records were retrospectively reviewed. Patients selected for inclusion had isolated cleft of at least the primary palate. Patients with additional anomalies were not selected. The study population consisted of 15 female sites and 16 male cleft sites. There were two bilateral cleft lip and palate (CLP) patients and 28 unilateral CLP patients. The age at the time of the secondary alveolar bone grafting ranged from 7 years to 14 years, 4 months. SETTING: The study was conducted at the Cleft Palate Clinic at the University of Minnesota, School of Dentistry. METHOD: Presurgical radiographs taken at least 1 month prior to the secondary bone grafting and postsurgical radiographs taken at least 6 months after bone surgery were measured. Measurements included size of the cleft defect and bone support for distal and mesial teeth adjacent to the cleft. Evaluation of success was determined on the basis of postsurgical measurements of satisfactory, intermediate, and unsatisfactory outcomes. RESULTS AND CONCLUSION: The size of the cleft defect was not correlated with the success rate of the secondary alveolar bone grafting. If the amount of distal bone support for the mesial tooth was the same as those in a periodontally healthy individual, a satisfactory outcome was 5.8 times more likely. If the amount of mesial bone support for the distal tooth was the same as those in a periodontally healthy individual, the satisfactory outcome was 3.8 times more likely. Although not a primary purpose of the study, it was found that in this study population, if the patient was female, a satisfactory outcome was 3.8 times more likely.

Evaluation of the ceramic/ceramic interface.

The purpose of this study was to investigate bond strength for ceramic orthodontic brackets bonded to dental porcelain. The following factors were tested. Two types of ceramic brackets were placed on two different types of porcelain surfaces with two different bonding systems. Three different debonding techniques, and various composite removal techniques and surface restoration techniques were used. Two hundred porcelain samples were used that duplicated the labial surface of a maxillary right central incisor. Bond strengths were measured with an Instron Universal testing machine (Instron Corp., Canton, Mass.). Mean bond strength and standard deviations were calculated and significance was determined with analyses of variance (ANOVA) and a chi-square test. Composite removal and polishing methods were investigated by scanning electron microscopy. The results showed that tensile type debonding methods are the least likely to damage the porcelain surface. Some brackets (Unitek Corp., Minn.) having a higher bond strength (p < or = 0.01) fractured the porcelain surface when tested in the shear debonding mode. The bonding materials tested were comparable to adhesion studies of similar brackets to enamel. The Ormco primer-Concise porcelain bonding system was significantly stronger (p < or = 0.01) than the Scotchprime-Transbond. Composite removal by careful use of a carbide bur, followed by the use of the Shofu porcelain adjustment kit and porcelain glaze polish, restored the finish to a normal porcelain surface after debonding. The study showed that shear and tensile debonding forces for glazed porcelain with the use of silane primer, were comparable with those reported in the literature for enamel, thus clinically sufficient. At the same time, preservation of the glaze allowed an almost ideal polishing of the porcelain surface after debonding.

A validity test of cephalometric variables as a measure of clinical applicability in anteroposterior profile assessment.

Twenty-six profile silhouettes are divided by five judges into three categories: retrognathic, orthognathic, and prognathic. On the corresponding lateral cephalograms, 51 cephalometric variables are tested for profile recognition. Discriminant analysis indicates that measurements based on natural head position perform better than comparable variables based on an intracranial reference line. The soft tissue variables (SnPo'-SnTV, Po'-SnTV, ILS-SnTV) are most successful, but no single variable is totally accurate. Skeletal variables relating the maxilla to the mandible (APo, AB, NA-PoA) are more successful than those variables relating one arch to the remainder of the skull (A-FHP, B-NTV, SNA, SNB). A combination of soft tissue and dental variables (SnPo'-SnTV, SnPo'-TMe', 1u-Npo, 1l-NPo) is found to be completely successful. A methodological approach, as applied in this study, can pinpoint the cephalometric variables that are clinically more effective in describing certain facial features.

Bond strength of ceramic brackets under shear stress: an in vitro report.

The shear bond strength and the potential enamel damage on debonding of various currently available ceramic and stainless steel brackets were examined in vitro using extracted premolar teeth. The brackets were divided into two groups, one bonded with a new light-cured orthodontic adhesive and the other with a conventional chemically cured system. An Instron Universal testing machine was used to apply the shear stress. Mean, standard deviation, and extreme values were calculated for each group. Statistical analysis showed that the mean shear bond strength of the silane chemical bond provided by some ceramic brackets is significantly higher (p less than 0.05) than the mean of the mechanical bond of other ceramic and stainless steel brackets. There was no statistically significant difference between the mean shear bond strength of the two adhesives used. Mechanical bonds failed primarily within the adhesive itself, whereas chemical bonds failed predominantly at the adhesive-bracket interface. Single-crystal ceramic brackets tend to be more brittle than the polycrystalline ones. Strong chemical bonds can potentially lead to enamel failure on debonding.

Enamel abrasion from ceramic orthodontic brackets under an artificial oral environment.

The purpose of this investigation was to examine the potential enamel abrasion on contact with stainless steel and various ceramic orthodontic brackets under a simulated oral environment. Three groups of eight lower premolar ceramic brackets and one group of eight stainless steel brackets were used from four different manufacturers. An upper premolar was brought in contact with the bracket bonded to a lower premolar tooth and subjected to a lateral excursion type of movement by the artificial oral environment. A constant load of approximately 2 lb was used for the masticatory force. The rate of chewing was 1 cycle/sec. The teeth were subjected to 15, 60, and 100 masticatory cycles. The before-and-after occlusal surfaces of the upper premolars were compared by means of a computerized profiling system and the enamel volume loss was calculated. Qualitative changes, such as rate of enamel wear, were examined visually by means of computer graphics and the scanning electron microscope. Abrasion scores (mean +/- SD) in mm3 were 0.015 +/- 0.01 from the metal brackets and 0.135 +/- 0.103, 0.255 +/- 0.242, and 0.581 +/- 0.524 from the three ceramic bracket groups. The abrasion scores were significantly different at p less than 0.05. Ceramic brackets caused significantly greater enamel abrasion than stainless steel brackets. Artificial mouth in vitro testing gave a good indication of clinical performance of orthodontic brackets.

Enamel surface abrasion from ceramic orthodontic brackets: a special case report.

The purpose of this report is to present a dramatic case of enamel abrasion from ceramic orthodontic appliances that was discovered only after appreciation of the initial findings of a study underway at the Department of Orthodontics, University of Minnesota. An artificial oral environment used in this study to simulate mastication also is described. The potential detrimental effects of ceramic appliances on tooth contact are discussed. All aspects of any new material should be investigated before its clinical application to prevent undesired side effects.

Complications of orthognathic surgery.

The following are the most important factors in decreasing postoperative complications related to orthognathic surgery: 1. A good medical history, 2. Thorough clinical evaluation, analysis of surgical model, and cephalometric analysis, 3. Proper diagnosis and treatment planning, 4. Thorough knowledge of anatomy and tissue physiology, 5. Proper surgical technique, 6. Delicate handling of soft tissues, 7. Careful cutting of bone, 8. Good communication among surgeon, orthodontist, and patient. In spite of all the precautions the surgeon may take, complications may still occur. The surgeon should be familiar with possible complications and how to manage them.

Canines erupted through grafted alveolar cleft defects in patients with alveolar clefts: a pulp testing evaluation study.

An electric pulp tester (EPT) was used to evaluate the pulpal response of erupted canines in 75 patients: 16 patients with unilateral cleft palate who received autogenous bone grafts to correct their alveolar cleft defects before canine eruption; 35 patients without cleft palate whose canines erupted spontaneously, but who required orthodontic treatment for alignment; and 24 patients without clefts whose canines required surgical uncovering and orthodontic assistance for eruption. Thirty-one percent of the erupted canines in the patients with grafted unilateral clefts did not respond to EPT, whereas all canines in the contralateral noncleft side responded to EPT. There was no clinical or radiographic evidence of pulpal pathosis of the canines that had erupted through the grafted alveolar clefts. However, these teeth had a high incidence of nonresponsiveness to pulp stimulation, therefore necessitating close follow-up in case they show eventual signs of pulpal degeneration that may require endodontic intervention.

Repair of alveolar cleft defects with autogenous bone grafting: periodontal evaluation.

Twenty-six patients with cleft lip and palate (18 with unilateral and eight with bilateral clefts) with 34 canines that had erupted through grafted alveolar cleft defects were studied to evaluate their periodontal status. The results were compared with 58 canines erupted through a normal alveolus in 29 noncleft control patients. The overall periodontal status revealed a higher plaque index in the patients with cleft compared to the orthodontic control patients, but parameters of gingival index, probing depth, and attachment loss had no significant differences between these groups. The cleft-associated canines had more than 90 percent of their possible clinical attachment levels intact at the examination. This indicated that grafting of these alveolar cleft defects resulted in a clinically satisfactory periodontium to support these canines as they erupted through the osseous grafts for periods of at least 2 to 8 years following surgery.

The sagittal split osteotomy of the mandible.

Modifications of the sagittal split osteotomy of the mandible have essentially reduced the major drawbacks of the procedure, such as condyle displacement, short-term skeletal relapse, and protracted maxillomandibular fixation and mental nerve dysesthesia. These techniques have proved effective over a period of 4 years in fifty-seven patients treated.

Periodontal evaluation of canines erupted through grafted alveolar cleft defects.

Two to eight years after receiving autogenous iliac crest grafts for treatment of alveolar cleft defects, eighteen patients who had unilateral cleft palate were evaluated for their periodontal status. When cleft-associated canines were compared with contralateral control canines, no statistically significant differences were found between specific surface values for plaque index, gingival index, or probing depths. Attachment loss was found to be greater (less than 0.72 mm) on the mesio-facial, facial, and mesio-palatal surfaces of the cleft-associated canines than on the control canines. Fifty-six per cent of the cleft-associated canines required surgical exposure and 44% also required orthodontic assistance to erupt to a functional occlusion. Osseous grafting of alveolar cleft defects resulted in satisfactory clinical periodontal support for cleft-associated canines.

Apertognathia (open bite) and its surgical management.

The etiology, diagnosis, and management of apertognathia are reviewed. 2 apertognathia cases treated with LeFort I osteotomy and adjunctive procedures are presented.

Posttreatment stability and esthetics of orthognathic surgery.

Several procedures were identified as important adjuncts to successful orthognathic results. Among these were the use of laminagraphic X-rays to monitor condyle displacement, condyle resorption and fibrous union problems. Other aspects involve gnathological errors in splint and positioner design, misdiagnosis because of a lack of soft-tissue analysis, differential treatment planning in deciding if surgery is needed, and understanding surgical effects on proportionality of the nose and lip esthetics.

Surgical correction of maxillary hypoplasia.

In this report the pathophysiology of maxillary hypoplasia is reviewed, and two patients who underwent surgical treatment described. Included in the analyses are illustrations and photographs of the face, cephalometric measurements, predictive tracings, and model surgery. Corrective surgical techniques, consisting primarily of LeForte III osteotomies, are presented in detail. Segmental osteotomy of the lower jaw, sliding genioplasty, and augmentation rhinoplasty are discussed and shown as various adjunctive procedures in the correction of associated deformities. Postoperative tracings and photographs are used to illustrate the predictive changes and improved cosmetic and functional results.

Movement of the proximal and distal segments after mandibular ramus osteotomies.

Data was collected from 27 patients who were treated with various ramal surgical procedures. Movements of the proximal segment during and after surgery were frequently noted. If the proximal segment was moved from its preoperative position and fixed to the distal segment, occlusal relapse was visible shortly after release of maxillomandibular fixation. Proximal segments displaced during surgery and not fixed to the distal segment frequently returned to their preoperative positions during fixation or assumed positions of biologic equilibrium. In such cases, occlusal relapse was minimal or nonexistent.