Evaluation of the Change in Halitosis with the Improvement in Oral Health in Cleft Lip and Palate Patients.

AIM: This study aimed to assess the effects of hygiene education on periodontal health and mouth/nasal halitosis in patients with cleft. MATERIALS AND METHODS: 39 patients with cleft who were accepted for orthodontic treatment divided into two groups as with (Group1; n = 24) and without braces (Group2; n = 15). Plaque Index (PI), Gingival Index (GI), and Tongue coating Index (TCI) values were recorded. The BANA test microbiological kit, was used to determine the amount of anaerobic bacteria. Values of volatile sulfur components (VSC) for the measurement of oral and nasal halitosis were measured with a Halimeter device. After the initial measurements, oral hygiene instructions were given to eliminate the plaque production on teeth, periodontal structure, tongue and palate. All measurements were repeated 4 weeks after the hygiene instructions. Wilcoxon and Mann-Whitney U test were used for statistical analysis. RESULTS: In both groups, the PI, GI, values were significantly decreased (P < .05). Tongue coating area, thickness and TCI were significantly reduced (P < .05). Oral halitosis values decreased significantly (P < .05). The PI values decreased significantly more in the Group 1 (P < .05). Non significant difference was detected in nasal halitosis in both groups. In unilateral cleft lip and palate cases cases (n = 23), no significant difference was found in nasal halitosis values between the cleft and the healthy sides (P > 0.05). CONCLUSION: In patients with clet cases, periodontal health was improved and oral halitosis was reduced by the given hygiene education; brushing the teeth, especially the tongue and palate. However, hygiene education did not have a significant effect on nasal halitosis. Key Words: Cleft lip and palate, Halitosis, BANA test, Periodontal index.

Effects of Combined Rapid Maxillary Expansion and Facemask Therapy on the Mandibular Dental Arch in Mixed Dentition.

OBJECTIVE: The aim of this study was to evaluate changes in the mandibular dental arch and incisor alignment induced by combined bonded Rapid Maxillary Expansion (RME) and Face Mask (FM) therapy in the mixed dentition stage in which leeway space was used throughout the treatment. STUDY DESIGN: This retrospective study evaluates pretreatment (T0) and posttreatment (T1) cephalometric radiographs and orthodontic models of 25 patients (mean age: 10.75±2.64), in mixed dentition, having skeletal Class 3 anomaly (ANB<0) with maxillary retrognatism (SNA=77.2±0.68) and bilateral posterior crossbite treated with bonded Hyrax RME-FM. Mean treatment duration was 10.4 months. Dental model measurements were performed using the 3Shape OrthoAnalyzerTM 2013-1 program. Changes in the mandibular incisor and first molar positions were determined on cephalometric radiographs. Statistical evaluation was done with a paired t-test. RESULTS: A significant increase of 1.2 mm was found in intermolar width (p<0.001) in the mandibular dental arch. There was a significant decrease (1.4 mm) (p<0.001) in arch depth and an increase in arch length discrepancy (1.7mm)(p<0.01). There was a significant increase (0.8mm) (p<0.05) in the incisors' irregularity score (LII). IMPA showed a significant decrease (p<0.05). CONCLUSION: Clinicians should be aware that mandibular crowding tends to increase during this type of combined therapy.

NAM Therapy-Evidence-Based Results.

Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

Dentoskeletal morphology in adults with Class I, Class II Division 1, or Class II Division 2 malocclusion with increased overbite.

INTRODUCTION: The treatment options for adults with increased overbite are limited to dentoalveolar changes that camouflage the condition. Because of high relapse tendency, defining the problem area is important when creating a treatment plan. This study aimed to evaluate dentoskeletal morphology in skeletal Class I and II anomalies associated with Angle Class I, Class II Division 1 (Class II/1), and Class II Division 2 (Class II/2) malocclusions with increased overbite compared with normal occlusion. METHODS: Pretreatment cephalograms of 306 patients (131 men, 175 women; overall ages 18-45 years) were evaluated. Four groups were constructed. Three groups had increased overbite (>4.5 mm): group 1 (n = 96) skeletal Class I (ANB = 0.5°-4°), group 2 (n = 85) skeletal Class II (ANB >4.5°) with Class II/1; and group 3 (n = 79) skeletal Class II with Class II/2 malocclusion. Group 4 as a control (n = 46) skeletal Class I normal overbite. Dental and skeletal characteristics of the groups were compared by sex. For statistical evaluations, analysis of variance followed by Tukey post hoc, Mann-Whitney U, and Kruskall-Wallis tests were used. Additionally correlation coefficients between overbite and skeletal/dental parameters were calculated. RESULTS: Between sexes, with regard to skeletal parameters, the men had greater values in millimetric measurements, and the women had higher SN/GoGn values. Maxillary/mandibular molar heights and the mandibular incisor heights were higher in men. In group 1, decreased lower anterior facial height (LAFH), retrusive mandibular incisors, and increased interincisal degree were determined. The maxillary molars were intrusive, whereas the vertical position of the mandibular molars and incisors in both jaws were normal. In group 2, retrognathic mandible, increased LAFH and mandibular plane angle, extrusive maxillary/mandibular incisors, protrusive mandibular incisors, and decreased interincisal degree were found. In group 3, decreased LAFH, increased interincisal degree, and retrusive incisors in both jaws were determined. There were significant negative correlations between SN/GoGN, palatal plane, and overbite in group 2 and between ANS-SN and overbite in group 3, and positive correlation between interinsical angle and overbite in all increased overbite groups. CONCLUSIONS: Dental morphology seems to be the main factor of increased overbite. Differences between groups were related primarily to inclinations and vertical positions of the incisors, rather than molar positions.

Does Gender Have an Effect on Craniofacial Measurements?

OBJECTIVE: The aim of this cross-sectional study was to evaluate craniofacial structures in terms of different sagittal relations and gender in adolescent individuals. METHODS: Pre-treatment dental models, lateral cephalometric, and hand-wrist radiographs of 223 adolescent subjects (102 male, 121 female) were evaluated. Subjects were divided into the Angle Class I, II, and III (skeletally) subgroups according to the ANB angle. Four angular and 33 linear measurements were used to evaluate the lateral cephalometric radiographs relative to the R1 and R2 coordinate system. The Kolmogorov-Smirnov test was performed to assess the normal distribution of the data. The independent samples t-test and Mann-Whitney U test were used for the comparison of male and female subjects in each group. The values were considered statistically significant at p<0.05. RESULTS: The vertical facial dimension was found to be significantly greater in Class I male subjects than in female subjects (SGo, p=0.023; ANS-M, p=0.036), and there was a protrusive maxilla (R2ANS, p=0.038; R2A, p=0.016), while the mandibular sagittal position and the mandibular dimension were similar. The maxilla was placed protrusively (R2ANS, p=0.001; R2A, p=0.002), while the mandible was found to be larger both in the position and dimension (CoGn, p=0.003; R2M, p=0.014) in Class II male subjects. Class III male and female subjects were found to have similar maxillary and mandibular vertical and sagittal location and dimensions. CONCLUSION: Class I and II subjects showed more gender variation than Class III subjects. The gender-related results of this study declare that treatment planning of malocclusions should be based on gender differences rather than general treatment procedures, which will be useful in achieving successful orthodontic treatment results.

Peer Assessment Rating (PAR) Index as an Alternative for Orthodontic Treatment Need Decision in Relation to Angle Classification.

OBJECTIVE: This study aimed to determine cut-off points for the Peer Assessment Rating (PAR) index in relation with Angle classification to use as an alternative index for the treatment need assessment. METHODS: This study included 607 orthodontic patients aged between 9 and 18 years. Angle classification, PAR, and dental aesthetic index (DAI) scores were determined. The DAI was used as the gold standard to evaluate the subjects for treatment need. The receiver operating characteristics (ROC) analysis was used to evaluate the PAR index in relation to treatment need assessed by DAI. RESULTS: The mean PAR scores for Class I, II, and III malocclusions and total sample were 17.54, 14.27, 18.7, and 20.04, respectively. The areas under the ROC of PAR scores in relation to the DAI assessment were found as 68.3% for the total sample, 66.6% Class I, 59.2% Class II, and 71.3% Class III malocclusions. For the total sample, the optimum cut-off PAR score was 14 in relation to DAI assessment. The cut-off scores for Class I, II, and III malocclusions were 13, 11, and 16, respectively, but considering psychosocial aspects, the recommended score is 14 for Class III. CONCLUSION: The PAR index can be considered to have an acceptable level of validity for the assessment of orthodontic treatment need regarding Angle classification.

The Relationship Between Ocular Protrusion and Craniofacial Structures.

OBJECTIVE: This study aimed to evaluate the relationships between ocular protrusion and other craniofacial structures. METHODS: The lateral cephalograms of 124 nonsyndromic white adults were assessed. Two orbital and 13 craniofacial parameters were measured. Subgroups were constructed according to sex, anteroposterior position of maxilla, and mandibular plane angle values.Anatomical parameters and their relationships were statistically analyzed by analysis of variance and multivariate stepwise regression analysis. RESULTS: There were no significant differences in ocular protrusion distances between sexes, and between individuals with different maxillary anteroposterior position and mandibular plane angle values. Ocular protrusion distances, the distance between the eyeball apex and the lateral orbital margin (Eyeball apex-LOr: OP1) and inferior orbital margin (Eyeball apex-IOr: OP2), were found to be 20.6 ±â€Š2.8 and 16.5 ±â€Š3.1, respectively. However, regression analysis showed that the ocular protrusion distances had weak correlation with a few craniofacial structures. The OP1 had a low negative relationship with the maxillary anteroposterior position (N-Aperp) (r: -0.289) (P < 0.05). The OP2 had a low negative relationship with the palatal plane angle (FH/PP) (r: -0.291) (P < 0.01) but had a positive relationship with the cranial base angle (BSN) (r: 0.304) (P < 0.01) and posterior facial height (SGo) (r: 0.299) (P < 0.01). CONCLUSIONS: Ocular protrusion distances did not differ by sex, maxillary anteroposterior position, and amount of mandibular plane angle and showed weak correlation with a few craniofacial structures. Ocular protrusion amounts can be used for diagnosis and treatment plan in craniofacial syndromic or nonsyndromic anomalies.

Effects of Combined Bonded Maxillary Expansion and Face Mask on Dental Arch Length in Patients with Skeletal Class III Malocclusions.

OBJECTIVE: To evaluate the effects of combined rapid maxillary expansion (RME) and face mask (FM) therapy during the mixed dentition period on the dental arch length in patients with skeletal Class III malocclusion. STUDY DESIGN: We evaluated pre- and post-treatment orthodontic models of 52 patients (25 girls, 27 boys) aged 8-12 years with skeletal Class III malocclusion(ANB<0) accompanied by maxillary transverse deficiency and retrognatism treated by bonded RME-FM therapy for a mean duration of 8 months. Palatal rugae, the cusp tips of permanent first molars, deciduous molars/permanent premolars, deciduous canines and the incisal edges of permanent central incisors were marked on orthodontic models, which were then photocopied. Inter-molar, inter-premolar and inter-canine widths; the arch length; the arch depth and molar and incisor sagittal movements were measured on these photocopies. Statistical comparisons were made using paired t-tests. RESULTS: Inter-molar, inter-premolar and inter-canine widths and the arch length showed significant increases after treatment, while the arch depth showed a significant decrease (p<0.001 for all). CONCLUSIONS: With the study limitations, our results suggest that combined RME-FM therapy increases the arch length in the mixed dentition of patients with skeletal Class III malocclusion.

Comparison of transverse dental changes induced by the palatally applied Frog appliance and buccally applied Karad's integrated distalizing system.

OBJECTIVE: To compare the transverse dental changes induced by the palatally applied Frog appliance and buccally applied Karad's integrated distalizing system (KIDS). METHODS: We evaluated the pre- and post distalization orthodontic models of 39 patients, including 19 treated using the Frog appliance, which is palatally positioned (Frog group), and 20 treated using KIDS, which is buccally positioned (KIDS group). Changes in intermolar and interpremolar distances and the amount of maxillary premolar and molar rotation were evaluated on model photocopies. Wilcoxon and Mann-Whitney U tests were used for statistical evaluations. A p-value of < 0.05 was considered statistically significant. RESULTS: Significant distopalatal rotation of premolars and distobuccal rotation of molars were observed in Frog group (p < 0.05), while significant distopalatal rotation of molars (p < 0.05), with no significant changes in premolars, was observed in KIDS group. The amount of second premolar and first molar rotation was significantly different between the two groups (p < 0.05 and p < 0.001, respectively). Furthermore, expansion in the region of the first molars and second premolars was significantly greater in KIDS group than in Frog group (p < 0.001 for both). CONCLUSIONS: Our results suggest that the type and amount of first molar rotation and expansion vary with the design of the distalization appliance used.

Evaluation of the effects of modified bonded rapid maxillary expansion on occlusal force distribution: A pilot study.

OBJECTIVE: To evaluate the effects of modified bonded rapid maxillary expansion (RME) on occlusal force distribution. MATERIALS AND METHODS: The sample included 12 patients (7 girls and 5 boys; mean age: 13.1 years) at the permanent dentition stage with bilateral posterior cross-bite. The patients were treated with a modified bonded RME appliance, activated twice a day. The study was terminated when the palatal cusps of the maxillary posterior teeth were occluding with the buccal cusps of the mandibular posterior teeth. The postretention period was 3 months. The T-Scan III device was used to analyze the percentages of occlusal force distribution, and records were taken at the pretreatment (T1), the postreatment (T2), and the postretention (T3) periods. Wilcoxon signed rank test was used for statistical analyses. RESULTS: Incisors were most frequently without contact, followed by canines. The highest forces were seen in the second and first molar regions. A significant decrease was seen in total occlusal force during treatment (T1-T2); however, during retention, the force returned to its initial value, and no significant differences were found (T1-T3). No differences were found between right and left sides and in occlusal forces of the teeth in all time periods. CONCLUSION: The use of modified bonded RME decreases the total occlusal forces during the treatment period, but it does returns to its initial value after the postretention period.

A Comparison of Three Orthodontic Treatment Indices with Regard to Angle Classification.

OBJECTIVES: To calculate the agreement between the Dental Aesthetic Index (DAI) and the Index of Complexity, Outcome and Need (ICON) in assessing orthodontic treatment need and to determine correlations between the Peer Assessment Rating (PAR) and DAI and ICON scores according to Angle classification among patients referred for orthodontic evaluation. STUDY DESIGN: This study included 457 randomly selected patients between 9 to 17 years of age. Patients were divided into four groups according to Angle classification [Class I (n=154), Class II division 1(Class II/1) (n=155), Class II division 2(Class II/2) (n=52) and Class III (n=96)]. Relationships between PAR scores and ICON and DAI scores were evaluated with the Spearman correlation test. Unweighted kappa statistics were used to analyse agreement between the ICON and DAI on the need for treatment, according to Angle classification. RESULTS: Class I malocclusions scored significantly lower than other Angle classifications in all indices. Both the ICON and DAI showed significant positive correlations with the PAR in the general study population. For Class II/2 patients, no correlation was found between PAR and DAI scores. There was significant agreement between the ICON and DAI on treatment need among Class I, Class II/1 and Class II/2 patients however, no agreement was found for Class III malocclusions. CONCLUSIONS: The ICON, DAI and PAR produce similar results and can be used interchangeably for the general orthodontic patient population. However, based on Angle classification, prominent differences exist in scoring certain occlusal features.

Secular trend in the maturation of permanent teeth in a sample of Turkish children over the past 30 years.

This study was performed to evaluate the influence of secular trends on dental maturation among Turkish children over the past 30 years. Orthopantomograms of 757 (385 boys, 372 girls) Turkish children born in the 1980s, 1990s, and 2000s were evaluated. Three groups were formed based on decade with five subgroups by age from 9 to 13 years old for each gender. The number of samples in each age group and gender were matched. The mandibular left seven permanent teeth were evaluated based on formation stage to determine the overall dental maturity score. The groups were compared based on decade and gender. The Bonferroni-corrected Mann-Whitney U test and Kruskal-Wallis tests were used for statistical evaluation. Among 11-, 12-, and 13-year-olds born in the 2000s, girls exhibited significantly more mature dentition than did boys (p<0.01, p<0.05, and p<0.05, respectively). Twelve-year-old girls born in the 1990s and 2000s exhibited significantly more mature dentition than did girls born in the 1980s (p<0.01). Girls generally exhibited more mature dentition than boys. No significant positive secular trends in dental maturity were observed from the 1980s through the 2000s. Dental maturation among Turkish children was not affected by a secular trend.

Effects of self-ligating and conventional brackets on halitosis and periodontal conditions.

OBJECTIVE: To evaluate the effects of fixed orthodontic treatment with steel-ligated conventional brackets and self-ligating brackets on halitosis and periodontal health. MATERIALS AND METHODS: Sixty patients, at the permanent dentition stage aged 12 to 18 years, who had Angle Class I malocclusion with mild-to-moderate crowding were randomly selected. Inclusion criteria were nonsmokers, without systematic disease, and no use of antibiotics and oral mouth rinses during the 2-month period before the study. The patients were subdivided into three groups randomly: the group treated with conventional brackets (group 1, n  =  20) ligated with steel ligature wires, the group treated with self-ligating brackets (group 2, n  =  20), and the control group (group 3, n  =  20). The periodontal records were obtained 1 week before bonding (T1), immediately before bonding (T2), 1 week after bonding (T3), 4 weeks after bonding (T4), and 8 weeks after bonding (T5). Measurements of the control group were repeated within the same periods. The volatile sulfur components determining halitosis were measured with the Halimeter at T2, T3, T4, and T5. A two-way repeated measures of analysis of variance (ANOVA) was used to compare the groups statistically. RESULTS: No statistically significant group × time interactions were found for plaque index, gingival index, pocket depth, bleeding on probing, and halitosis, which means three independent groups change like each other by time. The risk of tongue coating index (TCI) being 2 was 10.2 times higher at T1 than at T5 (P < .001). Therefore, the probability of higher TCI was decreased by time in all groups. CONCLUSIONS: The self-ligating brackets do not have an advantage over conventional brackets with respect to periodontal status and halitosis.

Effect of the bracket types on microbial colonization and periodontal status.

OBJECTIVE: To evaluate the effect of different bracket types on the levels of Streptococcus mutans (SM) and Lactobacillus (LB) in saliva, in plaque, and on the periodontal condition. MATERIALS AND METHODS: Forty patients aged 14 to 16 years, who had Angle Class I malocclusion with minimal crowding, were nonsmokers, were without systematic disease, and did not use antibiotics or oral mouth rinses during the 3-month period before the study were randomly selected. The patients were subdivided into two groups with random allocation of bracket type: conventional brackets (CB; Avex Mx, OPAL orth.) with steel wire ligature or self-ligating brackets (SLB; F1000, Leone S.p.A.). Microbial and periodontal records were obtained before bonding (T1) and 1 month after bonding (T2). Microbial samples were collected from the stimulated saliva and the plaque from the labial surfaces of the upper and lower lateral incisors. To estimate the number of colony-forming units of SM and LB, Dentocult SM and LB kits were used. The plaque index (PI), gingival index (GI), and pocket depth (PD) values were recorded to evaluate the periodontal condition. Paired t-test and Mann-Whitney U-test were used to compare the groups statistically. RESULTS: No significant differences occurred in SM or LB colonization between the groups. In the SLB group, PI, GI, and PD values increased significantly (P < .05). A greater increase was found in PD value in the SLB group (0.98 mm) compared with the CB group (0.04 mm; P < .05). CONCLUSIONS: The F1000 SLB do not have an advantage over Avex Mx CB with respect to periodontal status and colonization of SM and LB.