Outcomes of Presurgical Nasoalveolar Molding using Modified Nostril Retainers in Patients with Unilateral Cleft Lip and Palate at an Average Follow-up of 2 Years.

Objective: Presurgical nasoalveolar molding (PNAM) using a modified nostril retainer is a new treatment approach. This study aimed to evaluate the outcomes of early nasal molding using this approach with an average follow-up of 2 years in patients with severe unilateral cleft lip and palate. Methods: This retrospective study included 18 patients with unilateral cleft lip and palate without genetic syndromes who underwent PNAM with modified nostril retainers. The Grayson technique was employed with an intraoral plate to approximate cleft segments. Nasal molding was initiated before reducing the cleft width to 5 mm. Measurements, including alar base height ratio (ABHR), nasal floor width ratio (NFWR), columellar length ratio (CLR), columellar angle (CA), and nostril axis inclination on the cleft and non-cleft sides (NAI-C and NAI-NC, respectively), were calculated from standard photographs taken before PNAM (T1), after PNAM (T2), after an average of 1.81 months post-surgery (T3), and after an average of 2.2 years after T3 (T4). Pairwise comparisons of values at the four time points were conducted. Results: NFWR, CLR, CA, NAI-C and NAI-NC significantly increased after PNAM (p<0.05). However, no significant change was observed in ABHR (p>0.05) from T1 to T2. These outcomes were maintained at T4, and no patient developed a mega nostril. Conclusion: The use of a modified nostril retainer for nasal molding appears to provide stability during the high probability of relapse reported in the literature.

Prevalence of Temporomandibular Dysfunction and its Association with Malocclusion in Children: An Epidemiologic Study.

INTRODUCTION: Malocclusion is one etiological factor of temporomandibular joint disorder (TMD). This study investigates the prevalence of TMD and the relationship between TMD and the type of occlusion. STUDY DESIGN: A sample of 923 children (463 girls and 460 boys, ages 7-12 years old) was grouped not only by chronological age but also by gender. The information was collected on functional occlusion (anterior and lateral sliding, interferences), dental wear, mandibular mobility (maximal opening, deflection, deviation), and temporomandibular joint and muscular pain recorded by palpation. RESULTS: Headache was the only symptom of temporomandibular dysfunction (TMD) reported by the children. The results showed that one or more clinical signs were recorded in 25% of the subjects, most of which were mild in character. The prevalence increased during the developmental stages. Girls were in general more affected than boys. CONCLUSIONS: In this study, many subjects with TMD had malocclusions. Early treatment may be important in the prevention of severe TMD. Significant associations were found between different signs, and TMD was associated with posterior crossbite, anterior open bite, Angle Class II and III malocclusions, and extreme maxillary overjet.

Malocclusion prevalence and orthodontic treatment need in central Anatolian adolescents compared to European and other nations' adolescents.

OBJECTIVE: To determine the prevalence of malocclusion and orthodontic treatment need in a large sample of Central Anatolian adolescents and compare them with European-other nations' adolescents. METHODS: The sample included 1125 boys and 1204 girls aged between 12 and 16 years with no previous orthodontic treatment history. Occlusal variables examined were molar relationship, overjet, overbite, crowding, midline diastema, posterior crossbite, and scissors bite. The dental health (DHC) and aesthetic components (AC) of the Index of Orthodontic Treatment Need (IOTN) were used as an assessment measure of the need for orthodontic treatment for the total sample. RESULTS: The results indicated a high prevalence of Class I (34.9%) and Class II, Division 1 malocclusions (40.0%). Moreover, increased (18%) and reduced bites (14.%), and increased (25.1%) and reversed overjet (10.%) were present in the sample. CONCLUSION: Using the DHC of the IOTN, the proportion of subjects estimated to have great and very great treatment need (grades 4 and 5) was 28.%. However, only 16.7% of individuals were in need (grades 8-10) of orthodontic treatment according to the AC.

Malocclusion prevalence and orthodontic treatment need in central Anatolian adolescents compared to European and other nations' adolescents

Abstract Objective: To determine the prevalence of malocclusion and orthodontic treatment need in a large sample of Central Anatolian adolescents and compare them with European-other nations' adolescents. Methods: The sample included 1125 boys and 1204 girls aged between 12 and 16 years with no previous orthodontic treatment history. Occlusal variables examined were molar relationship, overjet, overbite, crowding, midline diastema, posterior crossbite, and scissors bite. The dental health (DHC) and aesthetic components (AC) of the Index of Orthodontic Treatment Need (IOTN) were used as an assessment measure of the need for orthodontic treatment for the total sample. Results: The results indicated a high prevalence of Class I (34.9%) and Class II, Division 1 malocclusions (40.0%). Moreover, increased (18%) and reduced bites (14.%), and increased (25.1%) and reversed overjet (10.%) were present in the sample. Conclusion: Using the DHC of the IOTN, the proportion of subjects estimated to have great and very great treatment need (grades 4 and 5) was 28.%. However, only 16.7% of individuals were in need (grades 8-10) of orthodontic treatment according to the AC.

Resumo Objetivo: determinar a prevalência de má oclusão e a necessidade de tratamento ortodôntico em uma amostra extensa de adolescentes da Anatólia Central, e compará-los a adolescentes europeus de outras nacionalidades. Métodos: a amostra consistiu de 1125 meninos e 1204 meninas, com idades entre 12 e 16 anos, sem histórico de tratamento ortodôntico prévio. As variáveis oclusais avaliadas foram a relação entre molares, overjet,overbite, apinhamento, diastema na linha média, mordida cruzada posterior e mordida em tesoura. O Componente de Saúde Dental (DHC) e o Componente Estético (AC) do Índice de Necessidade de Tratamento Ortodôntico (IOTN) foram utilizados para avaliar a necessidade de tratamento ortodôntico de toda a amostra. Resultados: os resultados sugerem uma alta prevalência de má oclusão de Classe I (34,9%) e Classe II, subdivisão 1 (40,0%). Além disso, overbiteaumentado (18,3%) e reduzido (14,4%), e overjet aumentado (25,1%) e reduzido (10,4%) também foram observados na amostra. Conclusão: com base no uso do DHC do IOTN, observou-se que a proporção dos indivíduos avaliados com necessidade grande e muito grande de tratamento (notas 4 e 5) foi de 28,7%. Porém, de acordo com o AC, apenas 16,7% dos indivíduos apresentaram necessidade (notas 8-10) de tratamento ortodôntico.

Comparison of soft tissue cephalometric norms between Turkish and European-American adults.

One of the most important components of orthodontic diagnosis and treatment planning is the evaluation of the patient's soft tissue profile. The main purpose of this study was to develop soft-tissue cephalometric standards for Turkish men and women and compare them with the cephalometric standards of normal European-American white people. The sample included 96 Turkish adults (48 women, 48 men), aged 20 to 27 years. Turkish subjects have increased facial convexity associated with retruded mandible, more obtuse lower face-throat angle, increased nasolabial angle and upper lip protrusion, deeper mentolabial sulcus, and smaller interlabial gap compared with European-American white people. It is appropriate to consider these differences during routine diagnosis and treatment planning of a Turkish patient or an American patient of European ancestry. Turkish males reveal more obtuse mandibular prognathism and upper lip protrusion, and smaller nasolabial angle than females.

Determination and application of Pont's Index in Turkish population.

Disharmony between tooth size and dental arch size induces orthodontic problems. So, dental indices were identified by various authors. One of these is Pont who determined a method of prediction of the ideal dental arch width which has become known as Pont's Index. The purpose of this study was to assess the applicability of Pont's Index to a Turkish population and to compare the results with those obtained from studies of different ethnic subjects. The sample comprised 64 male subjects and 78 female subjects with age range from 14 to 15 years. Measurements were obtained directly from plaster casts; they included mesiodistal crown diameters of the four maxillary incisors, as well as interpremolar and intermolar maxillary arch widths as specified by Pont. Correlation coefficients determined between the measured arch width values and those calculated according to Pont's Index were low in all cases, with r values ranging from 0.02 to 0.36. It was concluded that Pont's Index should not be used to predetermine ideal arch width values in Turkish individuals.

Effects of silica coating and silane surface conditioning on the bond strength of rebonded metal and ceramic brackets.

OBJECTIVE: The aim of this study was to evaluate the effects of tribochemical silica coating and silane surface conditioning on the bond strength of rebonded metal and ceramic brackets. MATERIAL AND METHODS: Twenty debonded metal and 20 debonded ceramic brackets were randomly assigned to receive one of the following surface treatments (n=10 for each group): (1) sandblasting (control); (2) tribochemical silica coating combined with silane. Brackets were rebonded to the enamel surface on the labial and lingual sides of premolars with a light-polymerized resin composite. All specimens were stored in distilled water for 1 week and then thermocycled (5,000 cycles) between 5-55ºC. Shear bond strength values were measured using a universal testing machine. Student's t-test was used to compare the data (α=0.05). Failure mode was assessed using a stereomicroscope, and the treated and non-treated bracket surfaces were observed by scanning electron microscopy. RESULTS: Rebonded ceramic brackets treated with silica coating followed by silanization had significantly greater bond strength values (17.7±4.4 MPa) than the sandblasting group (2.4±0.8 MPa, P<0.001). No significant difference was observed between the rebonded metal brackets treated with silica coating with silanization (15±3.9 MPa) and the sandblasted brackets (13.6±3.9 MPa). Treated rebonded ceramic specimens primarily exhibited cohesive failure in resin and adhesive failure at the enamel-adhesive interface. CONCLUSIONS: In comparison to sandblasting, silica coating with aluminum trioxide particles followed by silanization resulted in higher bond strengths of rebonded ceramic brackets.

Effects of silica coating and silane surface conditioning on the bond strength of rebonded metal and ceramic brackets

OBJECTIVE: The aim of this study was to evaluate the effects of tribochemical silica coating and silane surface conditioning on the bond strength of rebonded metal and ceramic brackets. MATERIAL AND METHODS: Twenty debonded metal and 20 debonded ceramic brackets were randomly assigned to receive one of the following surface treatments (n=10 for each group): (1) sandblasting (control); (2) tribochemical silica coating combined with silane. Brackets were rebonded to the enamel surface on the labial and lingual sides of premolars with a light-polymerized resin composite. All specimens were stored in distilled water for 1 week and then thermocycled (5,000 cycles) between 5-55ºC. Shear bond strength values were measured using a universal testing machine. Student's t-test was used to compare the data (α=0.05). Failure mode was assessed using a stereomicroscope, and the treated and non-treated bracket surfaces were observed by scanning electron microscopy. RESULTS: Rebonded ceramic brackets treated with silica coating followed by silanization had significantly greater bond strength values (17.7±4.4 MPa) than the sandblasting group (2.4±0.8 MPa, P<0.001). No significant difference was observed between the rebonded metal brackets treated with silica coating with silanization (15±3.9 MPa) and the sandblasted brackets (13.6±3.9 MPa). Treated rebonded ceramic specimens primarily exhibited cohesive failure in resin and adhesive failure at the enamel-adhesive interface. CONCLUSIONS: In comparison to sandblasting, silica coating with aluminum trioxide particles followed by silanization resulted in higher bond strengths of rebonded ceramic brackets.

Effects of different chlorhexidine formulations on shear bond strengths of orthodontic brackets.

OBJECTIVE: To test the hypothesis that the application of different chlorhexidine formulations to the etched enamel will not affect shear bond strength (SBS). MATERIALS AND METHODS: Forty-four freshly extracted human premolars were collected and stored in distilled water. The teeth were etched with 37% phosphoric and were rinsed and dried. The teeth then were divided into four equal groups. While Group 1 served as a control, Groups 2 to 4 were treated before bonding with a chlorhexidine formulation that included solution (2%), gel (1%), and mouthwash (0.2%). Orthodontic brackets were bonded with Transbond XT (3M Unitek, Monrovia, Calif). Bond strength results were evaluated with the use of one-way analysis of variance (ANOVA) (P < .05) and post hoc tests. Modes of failures were verified by means of scanning electron microscopy. RESULTS: Although no statistically significant difference was observed between Groups 1 and 4 (P > .05), both were statistically superior to Groups 2 and 3 (P < .05). In this in vitro study, the observed measures for Groups 2 and 3 (14.5-10.6 MPa) were lower than those for Groups 1 and 4 (27.3-24.9 MPa), but these values were much higher than those required for clinical use (6-8 MPa). CONCLUSION: The hypothesis is rejected. The application of chlorhexidine mouth rinse before bonding had no significant effect on the SBS value, and the application of chlorhexidine solution and gel significantly decreased SBS.

Prosthetic and orthodontic rehabilitation of a patient with missing maxillary lateral incisors: a case report.

IPS Empress 2 materials can be used for fabrication of short-span fixed partial dentures in the anterior region as well as single crowns. This clinical report describes the prosthodontic treatment of a 16-year-old male patient with missing permanent maxillary left and right incisors with IPS Empress 2 fixed partial dentures following orthodontic treatment.

Comparison of 2 distalization systems supported by intraosseous screws.

INTRODUCTION: The aim of this study was to compare the effects of 2 distalization systems supported by intraosseous screws for maxillary molar distalization. METHODS: Forty subjects with skeletal Class I dental Class II malocclusion were divided into group 1 (8 girls, 12 boys) and group 2 (11 girls, 9 boys). An anchorage unit was prepared by placing an intraosseous screw in the premaxillary area of each subject. To increase the anchorage in group 2, we used an acrylic plate resembling the Nance button around the screw. The screws were placed and immediately loaded to distalize the maxillary first molars or second molars when they were present. Skeletal and dental changes were measured on cephalograms, and dental casts were obtained before and after distalization. RESULTS: The average distalization times were 4.6 months for group 1 and 5.4 months for group 2. On the cephalograms, the maxillary first molars were tipped 9.05 degrees in group 1 and 0.75 degrees in group 2. The mean distal movements were 3.95 mm in group 1 and 3.88 mm in group 2. On the dental casts, the mean distalization amounts were 4.85 mm for group 1 and 3.70 mm for group 2. In group 1, the maxillary molars were rotated distopalatally to a moderate degree, but this was not significant in group 2. Mild protrusion of the maxillary central incisors was also recorded for group 1 but not for group 2. However, there were no changes in overjet, overbite, and mandibular plane angle measurements for either group. CONCLUSIONS: Immediately loaded intraosseous screw-supported anchorage units were successful for molar distalization in both groups. In group 2, side effects such as molar tipping and rotation were smaller, but distalization times were longer and hygiene was poorer.

Prevalence of malocclusion among adolescents in central anatolia.

OBJECTIVES: The objective of this study was to describe the prevalence of malocclusion in a population of Central Anatolian adolescents in relation to gender. METHODS: The sample comprised 2329 teenagers (1125 boys and 1204 girls), aged between 12 and 17 years (mean age: 14.6 yrs). Occlusal anteroposterior relationships were assessed using the Angle classification. Other variables examined were overjet, overbite, crowding, midline diastema, posterior crossbite, and scissors bite. RESULTS: The results showed that about 10.1% of the subjects had normal occlusions, 34.9% of the subjects had Class I malocclusions, 40.0% had Class II Division 1 malocclusions, 4.7% had Class II Division 2 malocclusions and 10.3% had Class III malocclusions. Over 53.5% had normal overbites, and 18.3%, 14.4%, 5.6%, and 8.2% had increased, reduced, edge-to-edge or anterior open bite values, respectively. Overjet relationship was normal in 58.9%, increased in 25.1%, reversed in 10.4%, and edge-to-edge in 5.6%. A posterior crossbite registered in 9.5% and scissors bite in 0.3%. Anterior crowding was present in 65.2% of the sample and midline diastema in 7.0%. No clear gender differences were noted, except for normal overbite (most frequent in girls, P<.001) and increased overbite (most frequent in boys, P<.05). CONCLUSIONS: Class II Division 1 malocclusion is the most prevalent occlusal pattern among the Central Anatolian adolescents and the high values (25.1% and 18.3%) of increased overjet and overbite were a reflection of the high prevalence of Class II malocclusion.

Hypodontia. Does the prevalence and distribution pattern differ in orthodontic patients?

OBJECTIVE: The aim of this study was to document the prevalence of hypodontia in the permanent dentition among a group of Turkish sample who sought orthodontic treatment and to compare present results with the specific findings of other populations. The occurrence was evaluated in relation to gender, specific missing teeth, the location and pattern of distribution in the maxillary and mandibular arches and right and left sides. MATERIALS AND METHODS: Orthodontic files of 2413 patients (1557 females-mean age: 17.78+/-5.41 years old and 856 males-mean age:17.02+/-5.47 years old) which included orthopantomograms, study models, and anamnestic data were examined for evidence of hypodontia. RESULTS: The prevalence of hypodontia was 7.54% (8.09% for female and 6.54% for male). Hypodontia was found considerably more frequently in the maxilla than in the mandible. Similarity in the distribution of missing teeth between the right and left sides was detected. The most frequently missing teeth were the maxillary lateral incisors, followed by the mandibular and maxillary second premolars. The majority of patients had one or two teeth missing, but seldom three or more. CONCLUSIONS: Present data for hypodontia were within the wide range reported in the literature. The findings of patients with hypodontia involving the anterior teeth and others missing more than two teeth in the same quadrant were an indication of a great need for orthodontic treatment. By early detection of missing teeth, alternative treatment modalities can be planned and performed with a multidisciplinary team approach.

Use of the intraosseous screw for unilateral upper molar distalization and found well balanced occlusion.

BACKGROUND: The aim of this study was to present a temporary anchorage device with intraosseous screw for unilateral molar distalization to make a space for the impacted premolar and to found well balanced occlusion in a case. CASE PRESENTATION: A 13-year-old male who have an impacted premolar is presented with skeletal Class I and dental Class 2 relationship. The screw was placed and immediately loaded to distalize the left upper first and second molar. The average distalization time to achieve an overcorrected Class I molar relationship was 3.6 months. There was no change in overjet, overbite, or mandibular plane angle measurements. Mild protrusion (0.5 mm) of the upper left central incisor was also recorded. CONCLUSION: Immediately loaded intraosseous screw-supported anchorage unit was successful in achieving sufficient unilateral molar distalization without anchorage loss. This treatment procedure was an alternative treatment to the extraction therapy.

Effects of silica coating and silane surface conditioning on the bond strength of metal and ceramic brackets to enamel.

OBJECTIVE: To evaluate the effect of tribochemical silica coating and silane surface conditioning on the bond strength of metal and ceramic brackets bonded to enamel surfaces with light-cured composite resin. MATERIALS AND METHODS: Twenty metal and 20 ceramic brackets were divided into four groups (n = 10 for each group). The specimens were randomly assigned to one of the following treatment conditions of the metal and ceramic brackets' surface: (1) tribochemical silica coating combined with silane and (2) no treatment. Brackets were bonded to the enamel surface on the labial and lingual sides of human maxillary premolars (20 total) with a light-polymerized resin composite. All specimens were stored in water for 1 week at 37 degrees C and then thermocycled (5000 cycles, 5 degrees C to 55 degrees C, 30 seconds). The shear bond strength values were measured on a universal testing machine. Student's t-test was used to compare the data (alpha = 0.05). The types of failures were observed using a stereomicroscope. RESULTS: Metal and ceramic brackets treated with silica coating with silanization had significantly greater bond strength values (metal brackets: 14.2 +/- 1.7 MPa, P < .01; ceramic brackets: 25.9 +/- 4.4 MPa, P < .0001) than the control groups (metal brackets: 11.9 +/- 1.3 MPa; ceramic brackets: 15.6 +/- 4.2 MPa). Treated specimens of metal and ceramic exhibited cohesive failures in resin and adhesive failures at the enamel-adhesive interface, whereas control specimens showed mixed types of failures. CONCLUSIONS: Silica coating with aluminum trioxide particles coated with silica followed by silanization gave higher bond strengths in both metal and ceramic brackets than in the control group.

The use of parental data to evaluate soft tissues in an Anatolian Turkish population according to Holdaway soft tissue norms.

INTRODUCTION: The relative influence of genetic and environmental factors in the etiology of malocclusion has long been a matter for discussion. The aim of this study was to compare the soft tissue structures of parents and their prepubertal, pubertal, and postpubertal offspring according to the Holdaway soft tissue norms to determine the similarity among them. Differences related to age and sex between the parents and offspring were also evaluated. METHODS: Lateral cephalometric radiographs were used to determine the similarities in soft tissue structures in 120 families, which were divided into prepubertal (n = 40), pubertal (n = 40), and postpubertal (n = 40) groups according to the children's skeletal ages. A total of 12 variables (2 angular and 10 linear) were measured according to Holdaway's soft tissue analysis. Pairs were formed between family members (mother to son, mother to daughter, father to son, father to daughter, midparent (mean of the father's and mother's values) to son, and midparent to daughter) in each group. Descriptive statistics and multiple linear regression analysis were performed. RESULTS: Statistically significant correlations between parents and their offspring were found. The parental data showed that a mother's genetic influence on her child's soft tissues was greater than the father's. Moreover, it was found that daughters had greater genetic influences from their parents than did sons. As age increased, the similarity was greater. Soft tissue facial angle (beta: 0.671), soft tissue chin thickness (beta: 0.549), and basic upper lip thickness (beta: 0.537) were the most similar variables between parents and their offspring. CONCLUSIONS: A few selected cephalometric measurements of the parents might furnish important data to the clinician in predicting a child's facial growth characteristics and aging process.

Non-surgical treatment of Class III malocclusion in adults: two case reports.

Class III malocclusions are usually growth-related discrepancies, which often become more severe until growth is complete. The surgery can be part of the treatment plan. The purpose of this report is to review the orthodontic treatment of two patients with a Class III malocclusion who were treated non-surgically. The basis for this treatment approach is presented and the final treatment result reviewed. Important factors to consider when establishing a Class III molar relationship are discussed.

Intraosseous screw-supported upper molar distalization.

The aims of the present study were to investigate (1) the efficiency of intraosseous screws for anchorage in maxillary molar distalization and (2) the sagittal and vertical skeletal, dental, and soft tissue changes after maxillary molar distalization using intraosseous screw-supported anchorage. Twenty-five subjects (18 girls and seven boys; 11.3 to 16.5 years of age) with skeletal Class I, dental Class II malocclusion participated in the study. An anchorage unit was prepared for molar distalization by placing an intraosseous screw behind the incisive canal at a safe distance from the midpalatal suture following the palatal anatomy. The screws were placed and immediately loaded to distalize upper first molars or the second molars when they were present. The average distalization time to achieve an overcorrected Class I molar relationship was 4.6 months. The skeletal and dental changes were measured on cephalograms and dental casts obtained before and after the distalization. In the cephalograms, the upper first molars were tipped 8.8 degrees and moved 3.9 mm distally on average. On the dental casts, the mean distalization was five mm. The upper molars were rotated distopalatally. Mild protrusion (mean 0.5 mm) of the upper central incisors was also recorded. However, there was no change in overjet, overbite, or mandibular plane angle measurements. In conclusion, immediately loaded intraosseous screw-supported anchorage unit was successful in achieving sufficient molar distalization without major anchorage loss.