Presurgical Orthopedic Treatment of a 3-Year-Old Child with Unoperated Complete Bilateral Cleft Lip and Palate and Protruding Premaxilla.

Unoperated patients with bilateral complete cleft lip and palate (BCCLP), who do not receive orthopedic treatment in infancy and present with significant sagittal excess of the premaxilla, are among the most difficult patients to treat. Delay in primary reconstruction reduces the elastic characteristics of the tissues. The resulting rigidity of bony structures accompanied by the wide alveolar and palatal clefts associated with sagittal excess of the premaxilla pose a great challenge for both surgeon and orthodontist. There is no unique protocol for treatment of these conditions. This paper describes the use of orthopedic treatment in an unoperated 3-year-old male child with BCCLP and a protrusive premaxilla whose appearance and function were both severely affected. A modified Meazzini technique, as described in operated BCCLP patients with a downward-displaced premaxilla, was used. The device itself consists of the 2 independent components mutually connected by a 17 × 25 steel arch. The first is an active fan-type expander. The second consists of an acrylic cap covering the premaxilla and 3 brackets used for the steel arch application. They are connected by a rectangular steel 17 × 25 archwire. Reduction of the premaxillary sagittal excess of is carried out with an elastic chain. The use of this orthopedic appliance is a reliable and valuable presurgical treatment in the therapy of children with BCCLP and protrusive premaxilla whose orthopedic and surgical treatment have been delayed.

Comparison of cefixime and amoxicillin plus metronidazole in the treatment of chronic periodontitis.

BACKGROUND/AIM: Despite significant advances in current medicine and improvement of overall health education, chronic periodontitis is still a widespread disease. Losing teeth is the most serious complication of this particular illness. The aim of this study was to examine patients with chronic periodontitis in order to evaluate the efficacy of non-surgical therapy and combination of amoxicillin and metronidazole compared with cefixime, which has not been so far used for the treatment of this disease. METHODS: Adult patients with chronic periodontitis (n = 90) underwent non-surgical periodontal treatment (zero-day) and then randomly divided into three groups. The group I served as a control, the group II was additionally treated with the combination of amoxicillin and metronidazole (for 7 days), while the group III was treated with cefixime (also for 7 days). To assess the condition of periodontium before and seven days after the therapy, four clinical parameters were used: gingival index (GI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL). RESULTS: On the day 7 after the beginning of the therapy, we found that all the three groups of patients had statistically significant clinical improvement of three parameters: GI, BOP and PD, but not of the CAL. However, the improvement of PD was only statistically, but not clinically significant. The improvement in the control group of patients on the day 7 was 19% in BOP and 28% in GI; this improvement was statistically highly significant after the addition of amoxicillin plus metronodazole (71% in BOP and 77% in GI) or cefixime (62% in BOP and 82% in GI). Compared to the combination of amoxicillin and metronidazole, cefixim was statistically significantly more effective for GI (p < 0.05), while for the other three clinical parameters their effects were equal. CONCLUSION: The conjunction of amoxicillin plus metronidazole or cefixime to the causal treatment of patients with chronic periodontitis led to statistically significant improvement in efficacy in relation to GI and BOP parameters, while cefixime was statistically significantly more efficient than the combination of amoxicillin and metronidazole for GI.

Rare Disease: Lobar Holoprosencephaly With a Median Cleft Lip-Case Report.

Holoprosencephaly is a complex malformation of the brain associated with the median facial defects. Variability of the clinical picture is the characteristic of this anomaly. In most cases, the degree of severity of the facial anomaly correlates with the degree of damage to the brain. This article aims to present a rare case of child with a milder form of brain anomaly combined with a severe form of facial anomaly. The article also presents the application of a feeding stimulator to improve the child's quality of life. The anomaly was diagnosed by postnatal sonography of the brain, magnetic resonance imaging of the endocranium, and three-dimensional computed tomography of the craniofacial skeleton.

Index of orthodontic treatment need in children from the Nis region.

BACKGROUND/AIM: The Index of Orthodontic Treatment Need (IOTN) is a scoring system for malocclusion that con- sists of the two independent components: Denal Health Component (DHC) and Aesthetic-Component (AC). IOTNs are usually used in the countries with dental healthcare financed by the government through the national healthcare system or healthcare insurance. The aim of the study was to determine IOTN in primary school children from the town of Nis and to asses percent of children with any kind of orthodontic treatment. METHODS: The study involved 301 school children, 11-14 (12.4 ± 1.1) years old. The IOTN was used by the two examiners in order to evaluate the treatment need. RESULTS: The results of the study showed that 111 (37%) out of 301 examined children had orthodonic treat- ment (33.33% boys and 66.67% girls) and they were excluded from the study. Out of final sample of 190 school children, considering DHC of the IOTN, 27.4% of the children showed great (grades 4-5), 41.0% moderate (grade 3) and 31.6% slight or no treatment need (grade 1-2). Considering IOTN AC, 15.3% of the children showed great (grade 8-10), 24.3 % moderate (grade 5-7) and 60.4% slight or no treatment need (grade 1-4). CONCLUSION: The need for ortho- dontic treatment in school children in the town of Nis, Serbia, is similar to the need in most European countries, despite the fact that the number of children orthodontically treated is much higher compared to most of European countries.

Treatment of a large radicular cyst-enucleation or decompression?

INTRODUCTION: Radicular cysts treatment involves surgical approach, more or less aggressive. However, treatment of large cystic lesions, including radicular cysts, causes some of dilemmas concerning the choice of the surgical method, especially the degree of radicalism. CASE REPORT: We presented a 65-year-old male patient with large radicular cyst in the mandible. A large elliptical multilocular radiolucency, located in the left side of the mandible, being in close vicinity to the mandibular canal, was registered at the orthopantomographic radiography. There was a risk of pathological fracture of the mandible. However, the cyst was completely removed by enucleation without intraoperative and postoperative complications. CONCLUSION: The presented case support the opinion that careful enucleation of large mandibular cysts may be done without complications, such as damages of surrounding anatomical structures or mandibular fracture. The authors indicate reasons for strong support of the undertaken surgical approach of treating large radicular cysts in the mandible.

Presurgical orthodontic treatment of patients with complete bilateral cleft lip and palate.

INTRODUCTION: Cleft lips and palates are the most common congenital orofacial anomaly. This type of clefts is the most severe from the orthodontic-surgical therapy aspect. CASE REPORT: A female newborn with a complete cleft of the primary and the secondary palate was admitted to the clinic, where a multiple-role orthodontic device was specially designed and applied to primarily manage the closure of the existing cleft and help to improve the suckling ability of the baby. Besides the fact that it allows breastfeeding, it has a significant orthodontic effect, too. CONCLUSION: Specificity of this device is the lack of extraoral fixation. What can easily be observed is a progressive reduction of the cleft between the separated segments and the premaxilla retrusion. It, thus, allows the creation of much better conditions for further surgical management of the said defect.

A cephalometric analysis of the cranial base and frontal part of the face in patients with mandibular prognathism.

BACKGROUND/AIM: The literature suggests different views on the correlation between the cranial base morphology and size and saggital intermaxillary relationships. The aim of this study was to investigate the cranial base morphology, including the frontal facial part in patients with mandibular prognathism, to clarify a certain ambiguities, in opposing viewspoints in the literature. METHODS: Cephalometric radiographies of 60 patients were analyzed at the Dental Clinic of the Military Medical Academy, Belgrade, Serbia. All the patients were male, aged 18-35 years, with no previous orthodontic treatment. On the basis of dental and sceletal relations of jaws and teeth, the patients were divided into two groups: the group P (patients with mandibular prognathism) and the group E (the control group or eugnathic patients). A total of 15 cephalometric parametres related to the cranial base, frontal part of the face and sagittal intermaxillary relationships were measured and analyzed. RESULTS: The results show that cranial base dimensions and the angle do not play a significant role in the development of mandibular prognathism. Interrelationship analysis indicated a statistically significant negative correlation between the cranial base angle (NSAr) and the angles of maxillary (SNA) and mandibular (SNB) prognathism, as well as a positive correlation between the angle of inclination of the ramus to the cranial base (GoArNS) and the angle of sagittal intermaxillary relationships (ANB). Sella turcica dimensions, its width and depth, as well as the nasal bone length were significantly increased in the patients with mandibular prognathism, while the other analyzed frontal part dimensions of the face were not changed by the malocclusion in comparison with the eugnathic patients. CONCLUSION: This study shows that the impact of the cranial base and the frontal part of the face on the development of profile in patients with mandibular prognathism is much smaller, but certainly more complex, so that morphogenetic tests of the maxillomandibular complex should be included in further assessment of this impact.

TMD in class III patients referred for orthognathic surgery: psychological and dentition-related aspects.

OBJECTIVE: To investigate temporomandibular disorders (TMD), psychosocial, and occlusal variables in class III orthognathic surgery patients with respect to the control subjects, and to compare psychosocial and occlusal features in class III patients with different Research Diagnostic Criteria for TMD (RDC/TMD) diagnoses. MATERIALS AND METHODS: The study enrolled 44 class III patients referred for orthognathic surgery and 44 individuals without a malocclusion. TMD, depression and somatization were assessed by RDC/TMD. Occlusal analysis included Helkimo's Occlusal Index items, overjet and overbite. RESULTS: In the controls, patients with class III deformities had higher prevalence of myogenic TMD, increased grade of chronic pain, and more occlusal deviations. Within the study group, TMD patients reported higher depression score (P < 0.01), myofascial pain was related to higher depression and somatization grades (P < 0.01, P < 0.05 respectively), and disc displacement showed relation with RCP-ICP slide interferences (P < 0.05). CONCLUSION: With respect to subjects without a malocclusion, TMD in class III dentofacial deformities is similar in prevalence, but differs in clinical appearance. Occlusal, but not psychosocial features deviate from those in the controls. While psychosocial variables accompanied TMD and myofascial pain, increased RCP-ICP slide was related to disc displacement in class III patients.

Orthodontic-surgical treatment of the skeletal class III malocclusion: a case report.

BACKGROUND: Class III malocclusions are considered to be ones of the most difficult problems to treat. Their causes are multifactorial and include genetic and/or environmental factors. Class III malocclusions are generally classified into 2 categories: skeletal and dental. The diagnosis is important due to the different treatment approaches. Generally a dental class III can be treated with orthodontics alone, while a true skeletal class III requires a combination of orthodontics and surgery. CASE REPORT: We presented a female patient with skeletal Class III malocclusion. The treatment was complete with positive overbite and acceptable occlusion using a combination of fixed orthodontic appliance treatment as well as the surgical operation. The patient was happy with her new appearance and function. CONCLUSION: Class III discrepancy should be diagnosed and classified according to its etiology and treated with appropriate surgery, including, if necessary, not only mandibular, but also maxillary surgery, in order to achieve a normal facial appearance. In any case, as the field of orthodontics continues to develop technologically and philosophically, we can expect that advances in diagnosis and treatment planning are im minent and inevitable.

Temporomandibular disorders after orthognathic surgery in patients with mandibular prognathism with depression as a risk factor.

OBJECTIVE: To examine the prevalence of temporomandibular disorders (TMD) after orthodontic-surgical treatment in patients with mandibular prognathism and analyze psychosocial variables related to TMD. MATERIALS AND METHODS: The case-control study comprised 40 patients with mandibular prognathism who underwent combined orthodontic-surgical treatment (orthognathic surgery group). Forty-two patients with untreated mandibular prognathism served as a control group. Research diagnostic criteria for temporomandibular disorders was used in order to assess the clinical diagnosis of TMD (Axis I) and to estimate depression, somatization and patient's disability related to chronic pain (Axis II). RESULTS: The overall prevalence of TMD was not significantly different between the groups. Myofascial pain was significantly higher, while arthralgia, arthritis and arthrosis was significantly lower in the orthognathic group compared with the controls (90.5% vs 50.0%, 0.0% vs 27.8%, respectively) (p < 0.05). Females in orthognathic surgery group showed higher prevalence of TMD (p < 0.05) and myofascial pain (p < 0.01) and increased level of chronic pain (p < 0.05) in comparison with post-operative males. No significant difference in chronic pain, somatization and depression scores was found between investigated groups. With respect to presence of TMD within the groups depression was higher in untreated subjects with dysfunction (p < 0.05). CONCLUSION: Prevalence of TMD immediately after completion of orthodontic-surgical treatment for mandibular prognathism is similar to frequency of dysfunction in untreated subjects, is significantly higher in females and is most commonly myogenic. Furthermore, females show an increased level of chronic pain post-operatively. Somatization and depression levels do not differ between patients with corrected prognathism and untreated prognathic patients.

[Radiographic cephalometry analysis of dimensions of condylar processus in persons with mandibular prognathism].

INTRODUCTION/AIM: There are numerous factors that influence the formation of condylar processus: the growth and development of cranial base, growth and development of the jaws and alveolar extensions, teething, the way of intercuspidation, the overlap of incisors, functions of masticatory muscles, etc. Considering the fact that the above-mentioned factors significantly differ in persons with different morphological set of the face, we set a hypothesis that dimensions of condylar processus and the mandibular ramus considerably differ in persons with mandibular prognathism compared to eugnatic persons. The aim of this study was to establish the differences in dimensions of condylar processus between the above-mentioned groups. METHODS: Six parameters representing the dimensions of the condylar processus were measured on profile teleradiographs of 30 eugnatic persons and 30 paersons with mandibular prognathism: the height of condylar processus, the height of head of the mandible, width of the head, width of the neck, height of the ramus without the condylar processus and the overall height of the ramus. RESULTS: A considerable difference in the values of the parameters was found, as well as the distribution toward the values of reference. It was found that the height of the condylar processus was significantly greater in persons with mandibular prognathism, whereas the width of the head of the mandible, the width of the neck and the height of the ramus without the condylar processus was considerably decreased within the same group. The height of the head of the mandible and the overall height of the ramus was not significantly changed. CONCLUSION: In persons with mandibular prognathism, morphological features of the condylar processus are changed. The condylar processus lengthens on account of shortening of the lower part of the ramus, and the mentioned lengthening is the most prominent in its condylar neck area which is also the centre of its most intense growth.

[Analysis of dimensions of sella turcica in patients with mandibular prognathism].

INTRODUCTION/AIM: Patients with mandibular prognathism as dominant symptom have disordered sagittal interjaw relations that make prominent appearance to this dental craniofacial anomaly beside hyperplastic mandibles and inverted front teeth overlap. The aim of this study was to examine the differences in dimensions of sella turcica in patients with mandibular prognathism and in eugnathic. METHODS: On profile teleradiographs of 30 eugnathic control and 30 patients with mandibular prognathism, three parametres, which represent dimensions of sella turcica, were measured (surface, width and depth). RESULTS: Statistically significant difference in values between the groups was found. All the three measured parametres were significantly higher in the patients with mandibular prognathism (p < 0.01). CONCLUSION: In the patients with mandibular prognathism all the measured dimensions of sella turcica were bigger, and so was sella turcica, but that enlargement was not in correlation with the degree of anomaly itself.