The Effects of Er,Cr:YSGG laser on shear bond strength of orthodontic lingual brackets to CAD/CAM ceramic systems.

Purpose: The aim of this study is to compare the bond strength of lingual brackets bonded to resin-matrix and lithium disilicate based-ceramic crowns following various surface treatments. Materials and methods: Sixty ceramic crowns (IPS Emax and Cerasmart) were fabricated by CAD/CAM. Er,Cr:YSGG laser, sandblasting with aluminium oxide and hydrofluoric acid treatment effects on ceramics was tested (n=10/group). A light-cure orthodontic adhesive was used to bond lingual brackets to the ceramic surfaces. Bond strengths of the brackets to ceramics were assessed by shear bond test. The remnant adhesive on bracket and ceramic surfaces was inspected with a light microscope and adhesive remnant index scores were recorded. The data were analyzed statistically using the Kruskal-Wallis test followed by the Mann-Whitney U-test. Results: Cerasmart ceramic specimens showed lower shear bond strength values than IPS Emax ceramic specimens (p<0.05). The statistical analysis of the surface treatment groups regarding bond strength were ranked as follows: Laser ≤ Hydrofluoric acid ≤ Sandblasting (p=0.058). While laser-treated Cerasmart ceramic group displayed the lowest SBS (9.39 MPa), hydrofluoric acid-treated IPS Emax group had the highest (16.8 MPa) bond strength value. Conclusion: The use of Er,Cr:YSGG lasers for etching of CAD-CAM ceramics could be a promising alternative to "conventional techniques", to improve bond strength of lingual brackets to IPS Emax and Cerasmart ceramics.

Skeletal, dental, and sexual maturation as an indicator of pubertal growth spurt.

OBJECTIVES: The aims of this study were to determine the skeletal, dental, and sexual maturation stages of individuals at the peak of the pubertal growth spurt and to analyze the correlations between these parameters. METHODS: The study included 98 patients, 49 females (mean chronological age 12.05 ± 0.96 years) and 49 males (mean chronological age: 13.18 ± 0.86 years), in the MP3cap stage. Skeletal maturation stages were determined using the cervical vertebral maturation (CVM) method on lateral cephalometric radiographs. The Demirjian index was used to determine dental maturation stages and dental ages on panoramic radiographs. The sexual maturation of the patients was evaluated in the pediatric endocrinology clinic by a pediatrician according to the Tanner stages. The frequencies of the variables were determined, and the Spearman rank correlation coefficients were used to analyze the correlations between the variables. RESULTS: It was determined that the cervical vertebral maturation stage was CS3 in 81.6% (n = 40) of both female and male patients, and 81.6% of the female and 89.8% of the male patients were in stage G in terms of mandibular second molar tooth development. According to the Tanner pubic hair staging, 73.5% of the male and 51.0% of the female patients were in Stage 3. A significant correlation was found between the cervical vertebra stages and mandibular second molar tooth development stages in both sexes and between the cervical vertebra and Tanner pubic hair stages only among the male patients (r = 0.357; p < .05). There was also a significant and strong correlation between the Tanner pubic hair stages and breast development stages (r = 0.715; p < .05). CONCLUSION: Cervical vertebral development in the CS3 stage and mandibular molar tooth development in the G stage can be considered the peak of the pubertal growth spurt. Tanner Stage 3 marks the peak of the pubertal growth spurt in males.

Geometric morphometric analysis of the pharyngeal airway during treatment of Class III malocclusion.

INTRODUCTION: The pharyngeal airway is important during diagnosis and treatment planning in orthodontics. This study aimed to compare the changes in the shape of the pharyngeal airway in patients with Class III malocclusion treated with a facemask (FM) with a removable maxillary appliance and modified tandem traction bow appliance (MTTBA). METHODS: This study consisted of pretreatment and posttreatment lateral cephalograms of 35 subjects with skeletal and dental Class III malocclusion. In the first group, 20 patients (12 males, 8 females; mean age, 10.2 years) were treated with MTTBA. The mean treatment time was 12 months. In the second group, 15 patients (10 males, 5 females; mean age, 10.3 years) were treated with FM. The mean treatment time was 11.7 months. Nineteen pharyngeal landmarks were considered from the image corresponding to the midsagittal plane and marked using tpsDig software (version 2.04; Stony Brook, NY). Pharyngeal airway shape difference between the groups was assessed by performing a Generalized Procrustes analysis. The shape deformation of the pharyngeal airway from the pre- to posttreatment periods was evaluated using the thin-plate spline method. RESULTS: There were no differences between MTTBA and FM groups according to airway shape for pretreatment and posttreatment periods. However, there were some deformities using the enlargement of the nasopharyngeal area in the FM group and oropharyngeal area in the MTTBA group according to pretreatment periods. CONCLUSIONS: There were no differences between the groups according to the mean pharyngeal airway shapes when the posttreatment periods of the FM and MTTBA groups were examined.

Assessment of salivary stress and pain biomarkers and their relation to self-reported pain intensity during orthodontic tooth movement: a longitudinal and prospective study.

PURPOSE: The aim of this prospective study was to evaluate the relationship between pain intensity and concentrations of salivary pain and stress biomarkers during orthodontic tooth movement. METHODS: Eighteen patients (8 males, 10 females; mean age 14.57 ± 2.39 years) who needed orthodontic treatment with maxillary premolar extraction and segmental canine distalization participated in this study. Baseline samples were collected (T1), and orthodontic attachments were placed to maxillary first molars, second premolars, and canines. Then extractions were performed. After 1­month follow-up, canine distalization started with a segmental wire (T2). Concentrations of salivary α­amylase (sAA), cortisol, secretory immunoglobulin A (sIgA) and chromogranin A (CgA) were examined at T1, T2, and on days 4 (T3), 7 (T4), 14 (T5), and 30 (T6) after starting retraction. Participants also scored their pain on a visual analogue scale (VAS). Pain catastrophizing behavior and dental anxiety levels of the participants were evaluated by the Pain Catastrophizing Scale (PCS) and Corah's Dental Anxiety Scale (C-DAS), respectively. Repeated measure ANOVA, Mann-Whitney U test and Spearman's rank correlation coefficient analysis were used for statistical evaluations (p < 0.05). RESULTS: The maximum values for sAA were seen at T1. Males had higher sAA levels than females with statistical differences at T1, T3, and T4. No significant differences for cortisol, sIgA, and CgA concentrations were observed. The highest mean VAS score was recorded at T3. No correlations were detected between any salivary biomarkers, VAS, C­DAS, and PCS scores. CONCLUSIONS: The stress of starting orthodontic treatment increased sAA levels more than the pain that was experienced during orthodontic tooth movement. Being male was a predictor of higher sAA concentrations. Orthodontic tooth movement did not cause significant alterations in salivary pain and stress biomarkers.

Evaluation of heat shock protein 70 and toll-like receptor 4 expression in gingival crevicular fluid in response to orthodontic forces.

OBJECTIVES: The aim of this study was to assess the concentrations of heat shock protein 70 (HSP70) and toll-like receptor 4 (TLR4) during orthodontic tooth movement and to compare their levels with interleukin-1ß (IL-1ß), a well-known proinflammatory biomarker. MATERIALS AND METHODS: This study consisted of 20 patients (8 males, 12 females; mean age 14.75 ± 2.34 years) who needed maxillary premolar extraction and segmental canine distalization. Concentrations of HSP70, TLR4, and IL-1ß were examined before extraction (T1), at the 1st (T2), 4th (T3), 7th (T4), 14th (T5), and 30th (T6) days of canine retraction by enzyme-linked immunosorbent assay analysis of gingival crevicular fluid samples. Statistical analyses were performed with repeated measure ANOVA and Spearman's rank correlation coefficient analysis (p < 0.05). RESULTS: HSP70 increased gradually from T1 to T6 and showed significant differences between T1-T6 and T2-T6 (T1:3.28 ± 0.92 ng/ml; T2:3.72 ± 0.66 ng/ml; T6:9.35 ± 2.45 ng/ml). The lowest TLR4 concentration was at T1, peaked at T3 and remained constant afterwards with significant differences between T1-T3, T1-T4, and T1-T6 (T1:0.71 ± 0.02 pg/ml; T3:1.04 ± 0.11 pg/ml; T4:0.95 ± 0.06 pg/ml; T6:1.00 ± 0.07 pg/ml). IL-1ß increased from T1 to T6 with significant differences between T1-T4, T1-T5, and T1-T6 (T1:55.71 ± 5.48 pg/ml; T4:100.11 ± 16.92 pg/ml; T5:103.71 ± 23.19 pg/ml; T6:125.12 ± 22.04 pg/ml). The increase in HSP70 and TLR4 from T2-T3 showed a significant correlation (r = 0.598; p = 0.005). CONCLUSIONS: The increased levels of HSP70, TLR4, and IL-1ß show the contribution of these mediators to the inflammatory response from the early stages of orthodontic tooth movement. CLINICAL RELEVANCE: The regulation of HSP70, TLR4, and/or IL-1ß secretion during orthodontic force application could provide alterations for desired optimal tooth movement.

The Influence of Abnormalities in the Profile and Overjet on Psychological Well-Being.

OBJECTIVE: This study aimed to comparatively evaluate the psychological well-being and health-related quality of life of subjects having either a convex or concave profile and abnormal overjet, with subjects having a straight profile and normal overjet. METHODS: In this study, 163 children and their parents who applied to the Faculty of Dentistry were classified into 3 groups: Group 1: convex profile, Class II molar relationship, and increased overjet (n=62; 28 boys and 34 girls; mean age: 11.6 years); Group 2: concave profile, Class III molar relationship, and negative overjet (n=55; 32 boys and 23 girls; mean age: 11.2 years); and Group 3: straight profile, Class I molar relationship without crowding, and normal overjet (n=46; 24 boys and 22 girls; mean age: 11.0 years). The severity of malocclusion was evaluated using the Index of Orthodontic Treatment Need (IOTN). Self-concept, depression, and state-trait anxiety were evaluated to determine the psychological well-being of the children. RESULTS: No differences were found among the groups with respect to self-concept, depression levels, state-trait anxiety levels, and quality of life scores. No correlation was found between the IOTN scores and psychological well-being. CONCLUSION: Abnormalities in the facial profile and negative or increased overjet have no influence on children's psychological well-being.

Mandibular posterior space in class II division 1 and 2 malocclusion in various age groups.

PURPOSE: The aim of this study was to compare the mandibular posterior space in subjects with skeletal class II division 1 and division 2 malocclusions in two different age groups. METHODS: Pretreatment cephalometric radiographs of 160 patients from 9 to 13 years of age (n = 80) and 15 to 18 years of age (n = 80) with class II division 1 or division 2 malocclusion were used for the study. Equal numbers of male and female patients (n = 20) were included in the two age groups in each of the malocclusion groups. Eight linear and six angular measurements were taken for mandibular posterior space evaluation. The data obtained from the study were compared using the independent t-test. RESULTS: In the present study, the mandibular posterior space was greater in both malocclusion groups in subjects aged 15-18 years than in those aged 9-13 years (p < 0.05). The available posterior spaces behind the mandibular first molars were 4.4 mm and 6.3 mm in females (class II divisions 1 and 2, respectively) and 5.3 mm and 7 mm in males (class II divisions 1 and 2, respectively) in the 9­ to 13-year-old age group. This space increased significantly by 6.9 mm (p < 0.001) and 3.2 mm (p < 0.01) in females (class II division 1 and 2, respectively) and 3.8 mm (p < 0.01) and 3 mm (p < 0.01) in males (class II division 1 and 2, respectively) in the 15- to 18-year-old age group. CONCLUSION: Class II division 1 and division 2 malocclusions had similar and inadequate posterior space dimensions for the eruption of the third and an unknown portion of the second molars.

Evaluation of the effects of the hybrid Pendulum in comparison with the conventional Pendulum appliance.

OBJECTIVE: To evaluate the anchorage control and distalization of maxillary molars with the hybrid Pendulum appliance and to compare the results with a conventional Pendulum appliance. MATERIALS AND METHODS: This study was carried out on the pre-(T0) and post-(T1) treatment lateral cephalograms and dental casts of 43 patients with Angle Class II molar relationships who were treated with conventional or hybrid Pendulum appliances. The hybrid Pendulum (HP) group consisted of 22 patients (14 females; eight males; mean age 14.3 ± 2.43 years) and treatment results were compared with a conventional Pendulum appliance (CP) group, which consisted of 21 patients (15 females; six males; mean age 14.6 ± 3.39 years). Intragroup comparisons were made with Wilcoxon test and intergroup comparisons were made with Mann-Whitney U-test (P < .05). RESULTS: The mean distalization duration was 0.70 ± 0.25 years in the HP group and 0.83 ± 0.4 years in the CP group. Maxillary first molars showed significant distal movement and tipping of 4.25 mm and 9.09° in the HP group, and 3.21 mm and 9.86° in the CP group. Loss of anchorage at the first premolars was significantly smaller in the HP appliance group compared to CP group. The second premolars distalized spontaneously in the HP group while they mesialized significantly in the CP group. Proclination and protrusion of maxillary incisors were greater with the CP appliance compared to the HP appliance. CONCLUSIONS: Maxillary molar distalization was achieved with both appliances. Mesialization of the anchorage unit was controlled successfully with the hybrid Pendulum; however, the conventional Pendulum appliance caused anchorage loss.

Effects of facemask therapy on the mandibular retromolar space. A follow-up study.

OBJECTIVES: To evaluate the mandibular retromolar space after facemask therapy and a follow-up period.  Methods: This retrospective study was conducted between May and September in 2014. The sample consisted of pre-treatment (T1), post-treatment (T2), and follow-up(T3) panoramic radiographs of 19 skeletal and dental Class III patients (7 female, 12 male; mean age: 10.5 years) treated with facemask and a removable intraoral upper appliance in the Faculty of Dentistry Gazi University, Ankara, Turkey. Each patient's lower arches were evaluated as right and left segments. As third molars were congenitally absent in 3 segments, a total of 35 segments were evaluated. The average treatment time was one year. The average follow-up period was 2.4 years. The positions, angulations, dental maturations of lower third molars, and mandibular retromolar spaces (DJ) were assessed. Friedman's 2-way Analysis of Variance, multiple-comparison, Pearson's correlation, and Chi-square tests were used for statistical evaluation. A p less than 0.05 was considered as significant. RESULTS: The angulation of the first molar (ϒ) increased significantly only in the follow-up period (T3). Mandibular retromolar spaces were increased significantly during all periods. The most commonly determined position of the third molar, by Winter's classification, was vertical angulation in all periods. Moderate and significant correlations were found between third molar angulation(ß) and DJ at T2 and T3. Significant correlations were also found between DJ and Demirjian classification stages during all periods. CONCLUSION: Facemask therapy did not have an adverse effect on the mandibular retromolar space during treatment and follow up periods.

Treatment with facemask and removable upper appliance versus modified tandem traction bow appliance: the effects on mandibular space.

Objective: The aim of this study was to evaluate and compare the mandibular arch posterior space changes in Class III patients treated with facemask (FM) with removable upper appliance or modified tandem traction bow appliance (MTTBA). Methods: Pre- and post-treatment and pre- and post-observation lateral cephalograms of 76 subjects with skeletal and dental Class III malocclusion from the period 2000-10 years formed the materials of this study. In the first group, 25 patients (10 girls, 15 boys; mean age: 10 years, 1 month) were treated with MTTBA. The average treatment time was 12 months. In the second group, 26 patients were treated (13 girls, 13 boys; mean age: 10 years, 4 months) with a Delaire-type FM. The average treatment time was 13 months. The remaining 25 children (9 girls, 16 boys; mean age: 9 years, 8 months) were observed without treatment for 10 months. ANOVA, Duncan, and paired t-tests were used for statistical evaluation. Results: Although ramus width and mandibular posterior space increased significantly in all groups, no significant differences were found among the groups. Significant increase in tipping of lower molar (L6/GoMe) in the MTTBA group showed a significant difference compared with the FM and control groups. Significant retroclination of the lower incisors (L1/NB) in the MTTBA and FM treatment groups was significantly different compared with the control group. Retroclination of lower incisors in the MTTBA group was significantly greater than that in the FM group. Conclusions: FM and MTTBA treatment approaches did not affect the dimensions of posterior space. Limitations: To generalize the results of this study, long term evaluation by considering the third molar position should be done.

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.

Comparison of double-plate appliance/facemask combination and facemask therapy in treating class III malocclusions.

OBJECTIVE: To compare the treatment effects of double-plate appliance/facemask (DPA-FM) combined therapy and facemask (FM) therapy in treating Class III malocclusions. MATERIALS AND METHODS: The material consisted of lateral cephalometric radiographs of 45 children with skeletal and dental Class III malocclusion. The first treatment group comprised 15 patients (mean age  =  11 years) treated with FM. The second treatment group comprised 15 patients (mean age  = 10 years 9 months) treated with DPA-FM. The third group comprised 15 patients (mean age  =  10 years 5 months) used as controls. The paired t-test was used to evaluate the treatment effects and changes during the treatment and observation period in each group. Differences between the groups were determined by variance analysis and the Duncan test. RESULTS: With the DPA-FM and FM appliances, the SNA and ANB angles increased significantly. These changes were statistically different compared with the control group. Lower facial height showed a greater increase in both treatment groups than in the control group. Molar relation showed a greater increase in the DPA-FM group than in the FM group. The increase in U6/ANS-PNS angle in the FM group was significantly different from the DPA-FM and control groups. The L1/NB angle and Pg-T increased significantly only in the FM group, but no significant difference was found between the treatment groups. CONCLUSIONS: In the treatment of Class III malocclusion, both appliances were effective. The significant sagittal changes in the lower incisors and pogonion in the FM group compared with the nonsignificant changes in the DPA-FM group might be due to the restriction effect of acrylic blocks in the DPA-FM group.

Modified tandem traction bow appliance compared with facemask therapy in treating Class III malocclusions.

OBJECTIVE: To compare the effects of the modified tandem traction bow appliance (MTTBA) and the facemask in treating patients with Class III malocclusion. MATERIALS AND METHODS: The material consisted of the pre-post treatment\pre-post observation lateral cephalograms of 65 subjects with skeletal and dental Class III malocclusion. In the first group 21 patients (mean age: 10 years, 6 months) were treated with a Delaire-type facemask (FM). In the second group 22 patients treated (mean age: 10 years) with MTTBA. The remaining 22 children (mean age: 9 years, 7 months) were observed without treatment for 11 months. RESULTS: Increase in SNA, N-FH ⊥ A, and ANB angles were significantly greater in the treatment groups compared to the control group. However, ANB angle showed a significantly greater increase in the FM group (2.8 ± 0.30°) than in the MTTBA group (2.0 ± 0.18°). The overjet and molar relation increased significantly in both treatment groups, but in the FM group (5.2 ± 0.40 mm) increase in overjet was significantly greater than in the MTTBA group (4.0 ± 0.27 mm). Mesial movement of upper molar and incisor were found to be greater in the FM group compared to the modified TTBA group. CONCLUSIONS: Both appliances were found to be effective in the treatment of Class III malocclusion. Their skeletal and dental effects showed differences due to their design.

Post-treatment evaluation of a magnetic activator device in Class II high-angle malocclusions.

SUMMARY: The purpose of this study was to evaluate changes in dentofacial growth before, during, and after use of a magnetic activator device (MAD) II in high-angle Class II division 1 patients. Lateral cephalometric and hand-wrist radiographs of 10 patients (six girls and four boys) with an average chronological age of 10 years 5 months were obtained at the beginning of the observation period (T1, 9.5 months), beginning of MAD II application (T2), at the end of the treatment (T3), and approximately 4 years after the end of treatment (T4). Thirteen linear, 1 ratio, and 10 angular measurements were evaluated. Paired t-tests were used for statistical evaluation of differences that occurred between the time points. The increase in gonial angle, GnGoAr angle, S-N, Co-Gn, Go-Ar, ANS-Me, S-Go, and N-Me distances and the decrease of overjet, U1-NA distance, and ANB angle were statistically significant during the treatment. At T4, there was a decrease in gonial angle and U1-NA distance, which was significant. The changes as a result of treatment were stable at T4.

Effects of maxillary protraction and fixed appliance therapy on the pharyngeal airway.

OBJECTIVE: To evaluate the long-term outcome of treatment with reverse headgear in patients with skeletal Class III malocclusion diagnosed as maxillary deficient. MATERIALS AND METHODS: Twenty-five patients (11 girls, 14 boys; mean age, 11.32 years) treated with a reverse headgear appliance were included in this study. Pretreatment, posttreatment, and 4-year follow-up cephalometric radiographs were obtained; linear, angular, and area measurements were performed. Comparison of treatment and observation changes was performed using a paired t-test. RESULTS: A significant increase was found in the forward movement of the maxilla, which was maintained 4 years after reverse headgear treatment. Treatment changes revealed significant increases in the sagittal dimensions and area of nasopharyngeal airway and remained significant at the end of the 4-year follow-up period. The oropharyngeal airway area increased nonsignificantly after the treatment, but significant increases occurred during the follow-up period. CONCLUSIONS: In young individuals diagnosed with maxillary deficiency treated with reverse headgear, the nasopharyngeal airway dimensions were improved after the treatment, and favorable effects of the treatment remained over the posttreatment period of 4 years.

A case report comparing 3-D evaluation in the diagnosis and treatment planning of hemimandibular hyperplasia with conventional radiography.

INTRODUCTION: Cephalometric radiography is the main investigation used in the diagnosis of maxillofacial deformities. Three-dimensional (3-D) computed tomography (3-D CT) imaging has recently been used in the diagnosis and treatment planning of craniofacial morphology. The purpose of this report was to present the diagnosis and treatment planning of a hemimandibular hyperplasia case by using conventional radiographs and 3-D cephalometric analysis. METHODS: A 24-year-old girl presented with hemimandibular hyperplasia and the main complaint was her facial appearance. Conventional cephalometric analysis including lateral and frontal cephalograms were traced by hand and evaluated by the same clinician. Twenty-one measurements on the lateral cephalograms and 13 measurements on the frontal cephalograms were performed. In addition, axial images were reconstructed into a 3-D model by using medical image processing software. Linear and angular measurements were presented in coronal and sagittal planes. RESULTS: The 3-D CT analysis has a superior image quality when compared with conventional cephalograms. CONCLUSIONS: The 3-D CT analysis provides more advanced diagnostic image information in evaluating craniofacial morphology. We conclude that 3-D CT images can facilitate the diagnosis, treatment planning, and outcome evaluation of severe asymmetry cases.

Facemask therapy with and without expansion.

INTRODUCTION: The aim of this study was to compare the effects of facemask treatment with and without expansion in patients with skeletal Class lll malocclusion. METHODS: The material for this study consisted of the pretreatment and posttreatment lateral cephalograms of 28 subjects with skeletal and dental Class lll malocclusions, divided into 2 groups of 14. In the facemask with expansion group (FMEXP; 8 girls, 6 boys; mean age, 11 years 1 month), each subject wore a Delaire-type facemask and a bonded rapid maxillary expansion appliance. In the facemask only group (FM; 8 girls, 6 boys; mean age, 11 years 6 months), each subject wore a Delaire-type facemask with a removable appliance. A third group of untreated children with Class lll malocclusion (7 girls, 7 boys; mean age, 10 years 2 months) was used as the control sample. RESULTS: The forward displacement of the maxilla in both treated groups was significantly greater than in the control group. The forward displacement of pogonion and increase in facial depth in the control group showed significant differences compared with the treatment groups. Extrusion of the maxillary molars was significantly greater in the FM group than in the control group. The increase in the mandibular plane angle and the decrease in the facial axis were significantly different between the FMEXP group and the control group. Molar relationship increased more in the FM group than in the FMEXP group; this was the only significant difference between the treatment groups. In both treatment groups, dental and skeletal treatment of subjects with Class lll malocclusion were achieved. CONCLUSIONS: If the treatment indications are appropriate, facemask therapy can be an effective method for Class III treatment.

Treatment and posttreatment changes with combined headgear therapy.

OBJECTIVE: To determine the effects of combined headgear treatment in high-angle patients and to evaluate the differences 2 years after treatment. MATERIALS AND METHODS: The study material consisted of lateral cephalograms of 21 patients (13 girls and eight boys; mean age 10 years 3 months) with Class II dental relationship. Only extraoral combined traction that was applied to maxillary first molars was used in the treatment of all patients. The patients were instructed to wear the appliance 20 hours per day until the molar relationship was corrected. The treatment time was approximately 5 months. At the beginning (T0), at the end (T1), and approximately 2 years after (T2) combined headgear treatment, lateral cephalometric radiographs were obtained. RESULTS: SNA and ANB angles and convexity decreased significantly during treatment (T0-T1; P<.05 and P<.01, respectively), and the net changes (T0-T2) in ANB angle and convexity were also found to be statistically significant (P<.01). During treatment, significant distal movement was found in the upper first molar, and the second premolar and molar were also distalized significantly (P<.001). At the end of 2 years, there was a significant mesial migration of the upper molars and the second premolar during the posttreatment period, but all of them were positioned more distally compared to the beginning of treatment (P<.001). The decrease in molar relation was statistically significant during the T0-T1 and T0-T2 periods (P<.001).

A comparison of the effects of 2 mandibular anchorage systems used with a 3-dimensional bimetric maxillary distalizing arch.

The purpose of this study was to compare the effects of 2 mandibular anchorage systems used with a 3-dimensional bimetric maxillary distalizing arch. The Wilson rapid molar distalization appliance for Class II molar correction was used with 26 patients; two groups of 13 patients each were formed. In the first group (9 girls, 4 boys with a mean age 11 years 5 months), mandibular anchorage was gained by a modified lip bumper with a standard lingual arch of 0.9-mm stainless steel. The second group (7 girls, 6 boys, with a mean age of 13 years) had a 0.016 x 0.016-inch utility arch, with a 3-dimensional lingual arch for anchorage. Cephalometric radiographs were taken before and after maxillary first molar distalization. The treatment results showed that the extrusion of the mandibular first molar was statistically significant in both the modified lip bumper and utility arch groups (P < .01 and P <.05, respectively). The incisal edge of the mandibular incisor moved forward significantly in the modified lip bumper and utility arch groups (P < .05 and P < .01, respectively); however, the protrusion in the utility arch group was significantly greater than in the lip bumper group (P <.05). In both groups, significant proclination of the mandibular incisor was observed (P < .01). Comparison of the anchor units showed that there was significantly greater proclination in the utility arch group than in the modified lip bumper group (P < .05). Both anchor units similarly enhanced the mandibular first molar anchorage. However, particularly in the utility group, mandibular incisor anchorage control seemed to be inadequate.

Comparison of double-plate appliance and facemask therapy in treating Class III malocclusions.

The aim of this study was to compare the effects of the double-plate appliance (DPA) and the facemask (FM) in treating skeletal Class III malocclusions. Data were based on the pretreatment and posttreatment lateral cephalograms of 28 subjects with skeletal and dental Class III malocclusions. In the first group (7 girls, 7 boys; mean age, 10 years 3 months), each subject wore a DPA with 2 Class III elastics, which exerted a force of 350-400 g day and night except for meals. In the second group (7 girls, 7 boys; mean age, 10 years 5 months), each subject wore a Delaire-type FM with a removable intraoral appliance with a total force of 600 g. The patients were instructed to wear the appliance approximately 16 hours a day. An untreated control group (6 girls, 8 boys; mean age, 9 years 8 months) was formed that matched the treatment groups according to sagittal skeletal and dental classifications. Thirteen angular and 14 linear measurements were evaluated. The increase in ANB angle and the decrease in maxillomandibular differential in the treated groups showed significant differences compared with the control group (P < .05). The increases in ANB and SNA angles in the FM group were significantly greater than in the DPA group (P < .05). The increases in lower facial height and Me-ANS in the FM group were significantly different compared with the other groups (P < .05). The overjet increased significantly in both treatment groups (P < .001), but, in the DPA group, overjet was significantly greater than in the FM group (P < .05). Protrusion of the maxillary incisors and retrusion of the mandibular incisors in the DPA group showed significant differences compared with the other groups (P < .05).