Three-dimensional evaluation of alveolar changes induced by nasoalveolar molding in infants with unilateral cleft lip and palate: A case-control study.

OBJECTIVE: The objectives of this study were to evaluate linear and volumetric alveolar changes induced by nasoalveolar molding (NAM) in infants with complete unilateral cleft lip and palate (UCLP) and compare the maxillary dimensions after NAM with the normal dimensions in infants without clefts. METHODS: A total of 26 infants with UCLP treated by NAM (mean age before and after NAM: 14.20 ± 8.09 days and 118.16 ± 10.06 days, respectively) comprised the treatment group, while 26 infants without clefts (mean age: 115.81 ± 8.71 days) comprised the control group. Changes in the maxillary dimensions following NAM were measured on three-dimensional models using Mimics software, version 17.0. RESULTS: During NAM, there was a decrease in the cleft widths, maxillary arch depths, and rotation of the greater segment. While the anterior alveolar arch width exhibited a significant decrease, the posterior arch width was mostly maintained. There were no changes in the anterior vertical deviations of the alveolar segments. The alveolar crest lengths, arch circumference, and bilateral posterior volumetric measures exhibited an increase. After NAM, the anterior arch width was comparable between the treatment and control groups, whereas the posterior arch width and anterior vertical deviations were greater in the treatment group than in the control group. The maxillary arch depths, alveolar crest lengths, and maxillary volumes were smaller in the NAM group than in the control group. CONCLUSIONS: During NAM in infants with UCLP, the cleft width and anteroposterior and transverse alveolar dimensions exhibited a decrease while the vertical dimensions were maintained. Compared with infants without clefts, those with UCLP treated by NAM exhibited sagittal and vertical alveolar growth deficiencies and tissue insufficiency.

Reliability of Measurements on Plaster and Digital Models of Patients with a Cleft Lip and Palate.

OBJECTIVE: The purpose of this study was to determine (1) the more and less reliable measurements/methods and (2) the influence of knowledge and skill on the inter-examiner, intra-examiner, and inter-method reliability of nasolabial measurements on plaster casts and three dimensional (3D) stereophotogrammetric images of casts in infants with an unrepaired unilateral cleft lip and palate (UUCLP). METHODS: Preoperative extraoral plaster casts from 42 patients with UUCLP were measured with a digital caliper, and the image acquisition of casts was performed with the 3dMDface stereophotogrammetry system (3dMD, Atlanta, GA). Two examiners (one postgraduate student, one lecturer) evaluated 19 nasolabial measurements in two separate sessions. RESULTS: Intra-rater, inter-rater, and inter-method reliability was lower in measurements of nasal, philtral, and nasal floor width. Almost all of the interclass correlation coefficients (ICC) for measurements performed by the lecturer were above 0.75, whereas the intra-examiner reliability of some measurements performed by the postgraduate student showed low ICC (<0.75). CONCLUSION: Measurements of curving slopes, such as nasal width, of small dimensions, such as nostril floor width, and deformity-affected anatomic parts, such as philtrum width, presented a low reliability. Measurements on 3D images showed a higher reliability compared to plaster model measurements performed by the postgraduate student. Therefore, it may be recommended to use 3D digital images of infants with CLP for nasolabial measurements especially if performed in postgraduate settings.

Evaluation of buccolingual molar inclinations among different vertical facial types.

OBJECTIVE: The aim of this study was to compare the buccolingual inclination of maxillary and mandibular molars in adults with different vertical facial types. METHODS: Cone-beam computed tomography images of 135 adult patients (age, 20-45 years) with skeletal Class I maxillomandibular relationships were assigned to normodivergent (n = 46), hypodivergent (n = 49), and hyperdivergent groups (n = 40) according to linear and angular sella-nasion/gonion-menton measurements. The normodivergent group consisted of 24 females and 22 males, hypodivergent group of 26 females and 23 males, and hyperdivergent group of 24 females and 16 males. Buccolingual inclination of the maxillary and mandibular first and second molars was measured relative to the occlusal plane. One-way analysis of variance was used for intergroup comparison. Gender differences were evaluated using independent t-tests. RESULTS: Buccolingual molar inclinations did not differ significantly between females and males (p > 0.05). There were no statistically significant differences among the buccolingual inclinations of the first and second maxillary and mandibular molars of the groups (p > 0.05). CONCLUSIONS: Buccolingual inclinations of maxillary and mandibular molars are similar in normodivergent, hyperdivergent, and hypodivergent adults with Class I sagittal relationships.

Comparison of Oxygen Saturation During Impression Taking Before and After Presurgical Orthopedic Therapy in Babies With Cleft Lip and Palate.

AIM: The objective of this study was to (1) evaluate the oxygen saturation (SpO2) levels during intraoral and extraoral impression taking and (2) compare the SpO2 levels during impression taking before and after presurgical orthopedic therapy (POT) of infants with cleft lip and palate (CLP). PATIENTS AND METHODS: In our study, 31 babies with CLP before (mean age 7.6 ± 3.2 days) and after (mean age 108.3 ± 24.2 days) POT were monitored, and SpO2 levels were measured under operating conditions before any intervention (T1), after oxygenation (T2), during taking intraoral (T3), and extraoral (T4) impressions with oxygen support and immediately before the discharge from the operating room (T5). RESULTS: In both groups, statistically significant differences in SpO2 measurements at T1, T2, T3, T4, and T5 stages were found (P < .01). For the pre-POT measurements, increases in SpO2 levels from T1 to T2 and T4 to T5 (P < .05) and decreases from T2 to T3 and T3 to T4 (P < .01) were noted. Similarly, SpO2 levels decreased significantly from the intraoral (T3) to extraoral (T4) post-POT impression periods (P < .01). Comparisons of pre- and post-POT measurements revealed that the SpO2 level of each time period was higher at the post-POT impression taking except for stages T2 and T5 (P < .01). CONCLUSION: The SpO2 values were low at the onset of POT in infants with CLP before any intervention. Oxygen saturation levels may decrease particularly during extraoral impression taking in infants with CLP despite the supplemental oxygen. SpO2 measurements were higher during post-POT intraoral and extraoral impression taking when compared with pre-POT measurements.

Prevalence and management of natal/neonatal teeth in cleft lip and palate patients.

OBJECTIVE: The aim of this study was to determine the prevalence and distribution of natal/neonatal teeth in infants with cleft lip and palate (CLP) according to gender, involving jaw and side and to show the management of some cases. MATERIALS AND METHODS: A retrospective study was carried out on medical history and photographic records of 69 infants with CLP, who were treated at the CLP clinic of Yeditepe University between years 2014-2015. The presence of neonatal teeth was determined, and if present the gender, type of cleft, and position were recorded. Statistical analysis was performed. RESULTS: Neonatal teeth were observed in 7% of the study group. No significant differences were found between cleft types and gender (P > 0.05). The prevalence of neonatal teeth in bilateral, unilateral and isolated cleft type was 16.5%, 6.5%, and none, respectively. All neonatal teeth were located in the maxilla and on the cleft-side (100%). CONCLUSION: The presence of natal/neonatal teeth in infants with CLP was not rare. In all of these cases the teeth were located adjacent to the cleft region. In isolated palatal cleft, where the alveolar region including the teeth buds are away from the cleft, no neonatal teeth were observed. It may be concluded that neonatal teeth in infants with CLP are frequently present and located inside the borders of the presurgical orthopedic treatment (POT) plate. Therefore, if possible, immediate extraction of the neonatal teeth is advised or if not possible because of systemic health reasons, modifications of the plate are required.

Evaluation of Oxygen Saturation and Heart Rate During Intraoral Impression Taking in Infants With Cleft Lip and Palate.

OBJECTIVE: The aim of the study was to evaluate the changes in oxygen saturation and heart pulse during intraoral impression taking from infants with cleft lip and palate (CLP) at onset of presurgical orthopedic therapy. SUBJECTS AND METHODS: In our study, 21 uni- and bilateral infants with CLP (9 female, 12 males, mean age 5.90 ±â€Š2.46 days) were monitored and heart pulse and oxygen saturation were measured under operating conditions before any intervention (T1), after delivery of 50% supplemental oxygen (T2), during impression taking with oxygen support (T3), and immediately before the discharge from the operating room (T4). RESULTS: Statistically significant differences were found in the average oxygen saturation levels (P < 0.01), but not in heart rates (P > 0.05) between T1, T2, T3, and T4. Decreases in the oxygen levels from T2 to T3 were noted (P < 0.01). Overall, oxygen levels increased from T1 to T4 (P < 0.01). CONCLUSIONS: Oxygen saturation levels may decrease during intraoral impression taking in infants with CLP despite the supplemental oxygen under operating conditions. No changes in the heart rate during the procedure showed that the cardiac output was sufficient, whereas the decrease in oxygen saturation demonstrated hypoventilation because of the anatomic structure and impression-taking process. It may be advised that the impression should be taken under the supervision of the anesthetist, with monitoring of, and supplying oxygen to, the infant with CLP.

Evaluation of facial hard and soft tissue asymmetry using cone-beam computed tomography.

INTRODUCTION: The purposes of this study were to (1) evaluate facial asymmetry 3 dimensionally using cone-beam computed tomography (CBCT) and (2) compare the right and left facial hard and soft tissues volumetrically and their interferences on each other. METHODS: The CBCT data of 49 asymmetric (soft tissue menton deviation, ≥4 mm; distance from the facial midline) (mean age, 19.9 ± 5.6 years) and 39 symmetric patients (soft tissue menton deviation, <4 mm) (mean age, 17.8 ± 5.5 years) were exported to the MIMICS software program (version 13.0; Materialise, Leuven, Belgium). Linear, surface distance, angular, volumetric, and surface area measurements were performed 3 dimensionally to assess and compare intragroup and intergroup differences. RESULTS: In the asymmetry group, linear measurements such as ramus height, mandibular effective and corpus length, and absolute mandibular volumetric measurements were significantly decreased (P <0.001), whereas facial mandibular, and soft and hard tissue volumetric measurements made on 3-dimensional images, and linear measurements on 2-dimensional images were increased (P <0.001) on the deviation side. CONCLUSIONS: Facial hard and soft tissue asymmetries can be precisely quantified using CBCT. However, especially in the gonial region where the surface topography shows alterations caused by asymmetry, many anatomic landmarks should be chosen for the assessment of asymmetry. At the gonial level, the compensation of the soft tissues for the hard tissues was found on 2-dimensional images; nevertheless, 3-dimensional right and left volumetric soft tissue evaluations provide evidence for asymmetry.

Prevention of demineralization around orthodontic brackets using two different fluoride varnishes.

OBJECTIVE: This in-vitro study was done to evaluate the effects of two different seal materials, Duraflor™ and Enamel Pro(®) Varnish, on enamel demineralization adjacent to orthodontic fixed appliances. METHODS: Seventy-two extracted solid premolars were allocated to three groups as one control and two study groups after brackets were placed and bonded with Transbond™ XT. The control group received no topical fluoride application after bonding, whereas in the study groups two fluoride varnishes, Enamel Pro(®) Varnish and Duraflor™ were applied on the teeth adjacent to brackets. All specimens were then immersed separately in demineralization solution for 96 hours at constant temperature. Demineralization of the enamel surface was evaluated quantitatively by cross-sectional microhardness testing: indentations were made at the edge of the bracket base (0 µm) and at 100 and 200 µm distant from it. In all of these positions, 5 indentations were made at 10, 20, 40, 70 and 90 µm of depths from the external surface of the enamel. RESULTS: The results revealed that, Enamel Pro(®) Varnish and Duraflor™ group values are higher than the values of control group at every depth. The differences between the depths showed that the microhardness values decreased significantly when the depth increased. In the control group, more demineralization occurred in every indentation compared to the study group. CONCLUSION: Duraflor™ and Enamel Pro(®) Varnish can be considered for use in clinic as an effective method to prevent or reduce demineralization during orthodontic treatment, especially in patients with poor oral hygiene.

The genetic basis of dental anomalies and its relation to orthodontics.

The interruption of odontogenesis by any etiological factor may result in dental anomalies. Apart from the environmental factors, the impact of genetics in dental anomalies was found to be a factor in different levels. Many authors had questioned a common genetic defect resulting in different phenotypic conditions such as absent, malformed, malposed or ectopic teeth. Because the multidisciplinary treatment of these dental anomalies such as hypodontia, impaction etc., involves orthodontic intervention, orthodontists must be aware of the etiology and possible correlative conditions with dental anomalies.

The genetic basis of facial skeletal characteristics and its relation with orthodontics.

Successful treatment of any orthodontic problem depends on an appropriate diagnosis of its etiology. It is well known that the genetics, as well as environmental factors, play an important role on the etiology of skeletal anomalies. Recent studies and advances in genetic sciences allowed the orthodontists to better understand the effects of genetics on the etiology of dentofacial characteristics and pathologies which in turn supported the effects of the genes in the development of dentofacial complex. In orthodontic practice, the genetic basis of a skeletal anomaly should also be considered during the diagnosis. Therefore orthodontic treatment plan should be chosen accordingly. However, further genetic studies are required to clearly determine all the specific genes leading to a particular skeletal variability caused by the polygenic nature of craniofacial traits. This article includes the current information on the association between orthodontics and genetics, an outline of the evidence based impact of heredity on dentofacial development as a review of the etiological factors of skeletal anomalies from the genetic point of view.

Perception of pain and discomfort during tooth separation.

OBJECTIVES: To evaluate patients' perceptions of pain and discomfort during tooth separation and to compare the effectiveness of brass wire and elastomeric separators. METHODS: The participants were 87 adults with a mean age of 22.1 +/- 1.9 years. Elastomeric and brass wire separators were inserted mesial and distal to upper right (elastomeric separators) and upper left first molars (brass wire separators) in each subject. After seven days, the amount of tooth separation was measured with a leaf gauge, and pain perception and discomfort were evaluated with a visual analogue scale and questionnaire. RESULTS: The elastomeric separators produced significantly more separation than the wire separators. There was a statistically significant difference in the subjects' perceptions of pain and discomfort at rest and during chewing between the different separators (p < 0.001). In general, the brass wire separators caused the greatest pain and discomfort immediately after insertion. Pain from the wire separators subsided over seven days, whereas elastomeric separators caused the greatest pain on the first two days after insertion. Eating was negatively influenced by the separation in 61 per cent of the subjects on the first day. On the other hand, other daily activities were affected minimally. CONCLUSIONS: The different levels of pain and discomfort caused by these separators, together with their advantages and disadvantages, can help the clinician to choose an appropriate separator. Patients should be warned that pain due to separation may affect their chewing, social life, school work and sleeping. Analgesics and soft food are recommended following placement of separators.