Prostaglandin E2 levels in gingival crevicular fluid during tooth- and bone-borne expansion.

The purpose of this study was to compare Prostaglandin E(2) (PGE(2)) levels in gingival crevicular fluid (GCF) of young adults with maxillary constriction during tooth- and bone-borne expansion. Thirty patients, 15 females and 15 males, with a mean age of 17.3 +/- 2.8 years were divided into three groups. Group I consisted of 10 patients, five females and five males, treated by transpalatal distraction (TPD) as a bone-borne device, group II 10 patients, five females and five males, with a Hyrax appliance as a tooth-borne device, and a control group of 10 patients, five females and five males, without any expansion appliances. GCF samples were collected with filter paper strips at six observation periods in order to evaluate the effect of heavy orthopaedic forces in both groups. In group II, the samples were additionally collected at two pre-treatment time points in order to evaluate the effect of the forces generated by the separators. An automated enzyme immunoassay was used to measure PGE(2) in the GCF. The differences within the groups were evaluated with a pairwise t-test and the differences between the groups were determined by the Mann-Whitney U-test. The mean PGE(2) level was significantly elevated on day 4 after placement of the separators in group II (P < 0.05). The PGE(2) values in group II were significantly different to those in group I and the controls at all observation periods. Lower PGE(2) levels were observed in group I compared with group II and the controls. Expansion using the TPD method could potentially enhance the prognosis of the teeth by inducing more skeletal dental changes when compared with the Hyrax appliance.

Extraction of a deeply impacted lower third molar by sagittal split osteotomy.

Extraction of deeply impacted wisdom molars from the lower jaw with the bone osteotomy may necessitate removal of extra bone and complicate the procedure with damage to the inferior alveolar nerve and iatrogenic fractures of the mandible. In such cases, the sagittal split osteotomy offers excellent exposure to the operative field and minimizes bone loss at the mandibular ramus. The presented case includes removal of a deeply impacted lower third molar presenting mild infection from the mid-ramus using the sagittal split of the mandible. The sagittal split osteotomy, which appears to be a reliable technique, should be the method of preference when lower molars are deeply positioned between buccal and lingual cortices.

Treatment of a patient with cleft lip and palate using an internal distraction device.

A 24-year-old man with a bilateral cleft lip and palate was treated by a multidisciplinary team composed of an orthodontist, plastic surgeon, and prosthodontist with assistance from an engineer. Before treatment, clinical photographs, dental casts, lateral and posteroanterior cephalograms, periapical and panoramic radiographs, and three-dimensional computed tomography (3D CT) images were obtained. He presented with a narrow and retrognathic maxilla with a 23-mm anterior open bite. Following maxillary expansion with rapid palatal expansion, a Le Fort I maxillary osteotomy was performed, and an internal distractor was placed. After a 5-day latency period, internal maxillary distraction was performed at a rate of 1 mm/day achieved by two activations per day. Cephalometric analysis showed a 7-mm maxillary advancement. Mandibular bilateral sagittal split osteotomy was also performed to close the open bite following maxillary distraction and a 3-month stabilization period. Finally, the treatment was completed with prosthetic rehabilitation. The changes in speech production were evaluated using an automatic speech recognition system.

Mandibular distraction with MD-DOS device.

Distraction osteogenesis is an alternative treatment method for the correction of mandibular hypoplasia. In this case report, mandibular distraction with a dynamic osteosynthesis system (MD-DOS) was performed to gradually lengthen the mandible of a patient who had a severe hypoplastic mandible. The patient underwent intraoral bilateral mandibular distraction osteogenesis. The latency period after the operation was seven days. The distraction was performed three times daily for 14 days at the rate of 0.33 mm each time. Subsequent retention was nine weeks. The patient's mandible was elongated successfully and a satisfactory profile and occlusion was achieved.