Evaluation of Auditory Changes in Patients Undergoing Temporomandibular Joint Discectomy.

PURPOSE: Discectomy is one of the preferred temporomandibular joint (TMJ) surgical procedures for the treatment of internal derangements when conservative and minimally invasive treatments have failed. The purpose of the current study is to investigate whether a TMJ discectomy operation influences auditory function and clinical variables. METHODS: This prospective study was composed of patients who underwent a TMJ discectomy operation between 2016 and 2020. Auditory function was evaluated with pure tone audiometry, tympanometry, and acoustic reflex tests at preoperatively (T0), postoperative first week (T1), first month (T2), and third month (T3). Clinical parameters including maximum mouth opening (MMO) and TMJ pain were also evaluated at T0, T1, T2, T3, and sixth month (T4). RESULTS: The study consisted of 17 patients (5 males, 12 females) with a mean age of 42.65. A significant reduction in visual analogue scale (VAS) pain scores and MMO values compared to baseline values was achieved in all follow up periods (PT0-T1= .001; PT0-T2/T3/T4 < .001). In pure tone audiometry, a significant increase in T1-T0 comparisons at 1000 Hz, 2000 Hz, 6000 Hz, 8000 Hz frequencies, and pure tone average (P = .008; P = .005; P = .012; P = .002; P = .001) was observed. In T3-T0 comparisons, a statistically significant decrease was observed in pure tone thresholds at 125 Hz and 8000 Hz frequencies (P = .008; P = .01). There was no statistically significant difference in middle ear pressure and compliance values at T1, T2, and T3 compared to T0 (P > .05). Type C tympanogram was seen in 3 patients at T1 and in 1 patient at T2. Acoustic reflex tests were positive in all patients. CONCLUSIONS: Although mild changes occurred in auditory tests in the early postoperative period, TMJ discectomy procedure has no permanent effect on auditory function.

Preoperative and postoperative assessment of temporal and masseter muscle size with magnetic resonance imaging in patients undergoing unilateral temporomandibular joint surgery.

The aim of this study was to assess any change between the preoperative and postoperative sizes of temporal and masseter muscles with magnetic resonance imaging (MRI) in patients undergoing unilateral temporomandibular joint surgery. This study was designed and implemented retrospectively. For clinical evaluation, a visual analog scale (VAS) and maximum mouth opening (MMO) were used. In order to make a preoperative diagnosis and perform a 6-month control, muscle size was measured in millimeters (mm) on T1 axial sections in MRI. Statistical analyses were performed using the SPSS 23.0 software package. Numeric variables were compared between two dependent groups using the Wilcoxon signed rank test. Statistical significance was set at p < 0.05. Twelve patients who underwent unilateral discectomy plus dermis-fat grafting, with classical preauricular inverse L incision, were included in the study, and data for eleven female patients were evaluated. The difference in size between the operated and non-operated sides was found to be statistically insignificant at the preoperative stage for both masseter muscle (operated side mM: 13.264 ± 1.822 mm; non-operated side mM: 13.264 ± 2.315 mm; pM = 0.929) and temporal muscle (operated side mT: 20.345 ± 2.609 mm; non-operated side mT: 20.582 ± 2.366 mm; pT = 0.594). There was a significant size reduction in the masseter muscle on the operated side in the postoperative period (preop mM: 13.264 ± 1.822 mm; postop mM: 12.036 ± 1.728 mm; pM = 0.018). Although there was also a size reduction in the operated side of the temporal muscle in the postoperative period, that difference did not reach statistical significance (preop mT: 20.345 ± 2.609 mm; postop mT: 19.445 ± 1.603 mm; pT = 0.182). On the non-operated side, there were no significant postoperative changes in the sizes of either the masseter muscle (preop mM: 13.264 ± 2.315 mm; postop mM: 12.682 ± 2.059 mm; pM = 0.248) or the temporal muscle (preop mT: 20.582 ± 2.366; postop mT: 19.891 ± 3.487 mm; pT = 0.625). Considering the study findings as a whole, a size reduction was observed in the operated side of the masseter muscle after TMJ surgery. The etiology of this change may be surgical trauma to the temporal and masseter muscles, skeletal alteration resulting from condylar change secondary to discectomy, and patients restraining themselves from application of maximum bite force as a result of a self-protection mechanism due to postoperative pain.

Management of Recurrence of Ameloblastoma and Odontogenic Keratocyst: A Cross-Sectional Study / Manejo de la recurrencia del ameloblastoma y keratoquiste odontogénico: Estudio de corte transversal

Abstract Objectives: Odontogenic keratocyst (OKC) and ameloblastoma are slowly growing and locally invasive tumors with high recurrence rate. The aim of this study was to investigate the clinicopathologic features of recurrent ameloblastoma and OKC cases, and evaluate outcomes of our treatments in terms of recurrence. Material and Methods: A total of 23 patients with confirmed recurrent ameloblastoma or OKC and treated in our clinic within eleven years period were reviewed retrospectively. Results: Eleven recurrent OKC cases and twelve recurrent ameloblastoma cases were included. Most recurrences occurred within five years after the initial treatment (69.6%). Enucleation had the highest recurrence rate among the first treatments (18/23). All recurrences were located in the mandible, with one exception (22/23). All recurrent OKCs were multilocular. Different histopathologic subtypes of ameloblastoma were seen in our study, follicular ameloblastoma was the most common (8/12). The mean diameter of the lesions was 4.3 cm (ranging from 2 cm to 7 cm). Statically significant relation was found between location and diameter of lesion and year of recurrence onset (p=0.004; p=0.026). We performed radical treatments in these cases (ten patients underwent marginal resections, and thirteen patients underwent segmental resection), and no recurrence was observed during the follow-up period. Conclusion: Previous inadequate surgical procedures were the most important cause of recurrence. Marginal or segmental resection with safety margins is the best method to treat recurrences of OKC or ameloblastoma cases.

Resumen Objetivo: Los keratoquistes odontogénicos (KQO) y ameloblastomas son tumores invasivos de lento crecimiento local con una alta tasa de recurrencia. El propósito de este estudio fue investigar las características clínico patológicas de los casos de ameloblastoma y KQO recurrentes y evaluar los resultados de tratamientos en término de recurrencia. Materiales y Métodos: Un total de 23 pacientes con casos confirmados de ameloblastomas o KQO recurrentes tratados en nuestra clínica en un período de once años fueron incluidos. Resultados: Once casos de KQO recurrentes y doce ameloblastomas recurrentes fueron incluidos. La mayoría de las recurrencias ocurrieron en los primeros 5 años posteriores al tratamiento inicial (69.6%). La enucleación mostró la tasa de recurrencia más alta entre los tratamientos iniciales (18/23). Todas las recurrencias se presentaron en la mandíbula excepto por un caso (22/23). Todos los KQO fueron multiloculares. Distintos subtipos histológicos del ameloblastoma fueron detectados en el estudio y el ameloblastoma folicular fue el más común (8/12). El diámetro promedio de las lesiones fue de 4.3cm en un rango de 2cm a 7cm. Una relación estadísticamente significativa se encontró entre la ubicación y el diámetro de la lesión y el tiempo de aparición de la recurrencia (p=0.004; p=0.026). Se realizaron tratamientos radicales en los siguientes casos, diez pacientes tuvieron resecciones marginales y trece pacientes resección segmental; no se observaron recurrencias en el período de seguimiento. Conclusión: Procedimientos previos inadecuados fueron la causa más relevante de recurrencia. Resección marginal o segmental con márgenes de seguridad son el mejor método para tratar casos de ameloblastoma y KQO recurrentes.

Corrigendum: Evaluation of success criteria for temporomandibular joint arthrocentesis.

[This corrects the article on p. 15 in vol. 45, PMID: 30847292.].

Evaluation of success criteria for temporomandibular joint arthrocentesis.

OBJECTIVES: The aim of this study was to use four sets of success criteria to evaluate the outcomes of arthrocentesis treatment with hyaluronic acid injection in patients with internal derangement (ID) of the temporomandibular joint (TMJ). MATERIALS AND METHODS: The study included 40 patients diagnosed with unilateral Wilkes stage III TMJ dysfunction. Clinical parameters, including maximum mouth opening (MMO) and pain during function, were evaluated preoperatively, 6 months, and 1 year after TMJ arthrocentesis. Outcomes were assessed and compared using four sets of success criteria from the following: the American Association of Oral and Maxillofacial Surgeons (AAOMS; MMO ≥35 mm and visual analogue scale [VAS] score ≤3), Murakami et al.'s criteria (MMO >38 mm and VAS score <2), Emshoff and Rudisch criteria (MMO ≥35 mm and >50% pain reduction), and patient self-reports (self-evaluation of treatment as successful or unsuccessful). RESULTS: Significant improvements in MMO and pain reduction during function were observed between the preoperative period and 6 months and 1 year postoperatively (P<0.01). The success rates of treatment determined using AAOMS (52.5%), Emshoff and Rudisch criteria (57.5%), and self-reported patient criteria (40.0%) were similar. Application of the Murakami et al. criteria reported the lowest success rate (12.5%). CONCLUSION: The AAOMS and Emshoff and Rudisch criteria are consistent with patient expectations and can be used to assess treatment efficacy.

Effect of platelet-rich plasma on temporomandibular joint cartilage wound healing: Experimental study in rabbits.

PURPOSE: The aim of the study is to evaluate the effect of platelet-rich plasma (PRP) injection on temporomandibular joint (TMJ) cartilage and subchondral bone healing. MATERIALS AND METHODS: Sixteen New Zealand rabbits were divided into two groups, including single PRP and multiple PRP injection groups. Sodium mono-iodoacetate (MIA) was injected bilaterally into the TMJ of all rabbits to create osteoarthritis (OA). PRP was injected once into the right TMJ in the single PRP group and was injected three times (once a week) into the right TMJ in the multiple injection group 4 weeks after injection of MIA. At the time of each PRP injection, isotonic NaCl solution was injected into the left TMJ in the control groups. All animals were sacrificed 30 days after the first PRP injection. RESULTS: As a result of the histological evaluation, there was no statistically significant difference in cartilage and subchondral bone regeneration between the groups (p > 0.05). CONCLUSIONS: Although there was no statistically significant difference between PRP and control groups, it was seen that improvement were better in PRP groups. According to the Results of our study, it seems that different methods should be tried to investigate the efficacy of PRP on the TMJ healing.

Trabecular structural changes in the mandibular condyle caused by degenerative osteoarthritis: a comparative study by cone-beam computed tomography imaging.

OBJECTIVES: Temporomandibular osteoarthritis causes pain and loss of function. In advanced cases, it may also result in destruction of joint cartilage surfaces and bone structure. METHODS: This study was performed to examine the potential changes in the condylar trabecular bone structure in patients with temporomandibular osteoarthritis. Condylar trabecular structures were compared between 35 healthy patients and 35 patients with temporomandibular osteoarthritis by a box-counting method using fractal dimensional analysis on cone-beam computed tomography images. RESULTS: The average fractal dimensions of patients with temporomandibular osteoarthritis and healthy patients were 1.18 and 1.23, respectively. This difference was statistically significant (p ≤ 0.05). CONCLUSIONS: Our results add to the existing preliminary knowledge regarding the osteoporotic changes that occur in the trabecular structure under the subchondral bone, which is normally not seen on radiographic images, as well as the destruction and remodeling that occur on the condyle surface, which is visible on radiographic images.

Short term histopathological effects of GaAlAs laser on experimentally induced TMJ osteoarthritis in rabbits.

The aim of this study was to evaluate the biostimulation (BS) effect of the gallium-aluminum-arsenide (GaAlAs) diode laser by histopathology with an experimental osteoarthritis (OA) model in the temporomandibular joints (TMJ) of rabbits, in the early period. GaAlAs diode laser is used for pain reduction in TMJ disorders. Twenty-four adult male New Zealand white rabbits were randomly divided into three equal groups: Control Group (CG), Study Group 1 (SG-1), and Study Group 2 (SG-2). Mono-iodoacetate (MIA) was administered to the right TMJs of all rabbits. The rabbits did not undergo any treatment for four weeks to allow the development of osteoarthritis. In SG-1, laser BS was applied to the rabbits at 940 nm, 5 W, and 15 J/cm2 in continuous wave mode at 48-hour intervals for 14 sessions; and in SG-2, laser BS was applied with the same parameters at 24-hour intervals for 28 sessions. Laser BS was not applied to the rabbits in CG. All rabbits were sacrificed simultaneously. The TMJ cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification were evaluated histopathologically. There was no statistically significant difference between the groups in terms of cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification values (p > 0.05). The laser BS protocol used in the study had no positive histopathological effects on TMJ OA in the early period.

Interpositional Flap Reconstruction of Temporomandibular Joint Using a Novel Anterior-Based Mastoid Flap Technique.

In this report, it was aimed to use the anterior-based mastoid fascia flap as an interpositional graft in TMJ surgery. This technical report, along with this characteristic, is the first in the literature.

Short term histopathological effects of GaAlAs laser on experimentally induced TMJ osteoarthritis in rabbits

Abstract The aim of this study was to evaluate the biostimulation (BS) effect of the gallium-aluminum-arsenide (GaAlAs) diode laser by histopathology with an experimental osteoarthritis (OA) model in the temporomandibular joints (TMJ) of rabbits, in the early period. GaAlAs diode laser is used for pain reduction in TMJ disorders. Twenty-four adult male New Zealand white rabbits were randomly divided into three equal groups: Control Group (CG), Study Group 1 (SG-1), and Study Group 2 (SG-2). Mono-iodoacetate (MIA) was administered to the right TMJs of all rabbits. The rabbits did not undergo any treatment for four weeks to allow the development of osteoarthritis. In SG-1, laser BS was applied to the rabbits at 940 nm, 5 W, and 15 J/cm2 in continuous wave mode at 48-hour intervals for 14 sessions; and in SG-2, laser BS was applied with the same parameters at 24-hour intervals for 28 sessions. Laser BS was not applied to the rabbits in CG. All rabbits were sacrificed simultaneously. The TMJ cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification were evaluated histopathologically. There was no statistically significant difference between the groups in terms of cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification values (p > 0.05). The laser BS protocol used in the study had no positive histopathological effects on TMJ OA in the early period.

Evaluation of effectiveness of concentrated growth factor on osseointegration.

BACKGROUND: Growth factor-containing products have been reported to increase implant stability and accelerate osseointegration. Concentrated growth factor (CGF) can be used for this purpose with the growth factors it contains. The aim of this study is to assess the effect of CGF on implant stability and osseointegration. METHODS: Twelve patients with maxillary anterior toothless were included in the study. Implant cavities prepared in the study group were covered with CGF membrane before implant placement, but conventional implant placement was performed in the control group. Resonance frequency measurements were performed with the Osstell device intra-operatively, post-operatively, at the 1st week, and at the 4th week. RESULTS: The mean ISQ values were found to be 79.40 ± 2.604 for the study group and 73.50 ± 5.226 for the control group at 1st week, 78.60 ± 3.136 for the study group and 73.45 ± 5.680 for the control group at 4th week. The differences between the groups were statistically significant (p < 0.05). CONCLUSIONS: It was observed that the concentrated growth factor had positive effects on implant stabilization. The ISQ measurements at week 1 and week 4 were notably higher in the study group. Application of this material seems to accelerate osseointegration.

Retrospective evaluation of three different joint surgeries for internal derangements of the temporomandibular joint.

PURPOSE: To compare the outcomes achieved with eminectomy, discectomy alone, and discectomy with an abdominal dermis fat graft (D + ADFG) in the treatment of internal derangements (IDs) of the temporomandibular joint (TMJ), and to briefly discuss the failed cases in which a second operation was needed. PATIENTS AND METHODS: This was a retrospective study of 31 patients (27 females, 4 males) who were unresponsive to conservative therapy and therefore underwent eminectomy (group A, n = 6), discectomy alone (group B, n = 8), or D + ADFG (group C, n = 17). All of the IDs of the TMJ were unilateral. Functional mandibular pain intensity on a visual analog scale (VAS) and maximum interincisal opening (MIO) were recorded preoperatively and at the latest postoperative examination (average, 30 months). The preoperative and postoperative results were compared between and within each group. RESULTS: Overall, patients in groups B and C had better outcomes than those in group A in terms of TMJ symptom relief. Postoperative increases in MIO were statistically significant in groups A, B, and C (P < 0.027, P < 0.017, and P < 0.000, respectively). Patients with discectomized joints (groups B and C) had significantly improved pain scores (P < 0.05) at the latest follow-up. In 6 of the 31 (19.3%) patients (3 eminectomy, 1 discectomy, and 2 D + ADFG), the procedure was deemed unsuccessful because of persistent symptoms and a second operation was performed. CONCLUSIONS: Discectomy with or without ADFG was clearly superior to eminectomy in reducing pain and improving joint function. But there were no significant differences in the two-discectomy groups with respect to symptom improvement.

Effects of zygoma-gear appliance for unilateral maxillary molar distalization: A prospective clinical study.

INTRODUCTION: The aim of the study was to evaluate the dentoskeletal effects of the zygoma-gear appliance used for unilateral maxillary molar distalization in patients with Class II subdivision malocclusion. METHODS: This prospective clinical study consisted of 21 patients (9 boys, 12 girls; mean age, 15.68 ± 2.18 years) with unilateral Class II malocclusion treated using the unilateral zygoma-gear appliance supported by a zygomatic miniplate inserted on the Class II malocclusion side. The dentoskeletal effects of the system were evaluated using cephalometric lateral and panoramic films with a paired t test. RESULTS: The mean amount of distalization for the maxillary first molar was found to be 5.31 ± 2.46 mm (P <0.001) in 0.45 ± 0.12 years, showing an amount of 0.98 mm of distalization per month. It was also accompanied by a slight intrusion (0.76 ± 2.85 mm; P >0.05) and distal tipping (6.39° ± 5.39°; P <0.001) of the maxillary molars. The maxillary premolar also spontaneously moved distally 1.63 ± 1.90 mm (P <0.01) with distal tipping (4.05° ± 3.47°; P <0.001). Moreover, the inclination of the maxillary incisors and overjet were decreased (-1.59° ± 1.45°, P <0.001; and -0.29 ± 0.63 mm, P <0.05; respectively) showing no anchorage loss. No statistically significant changes were found for the skeletal and soft tissue measurements (P >0.05). CONCLUSIONS: The zygoma-gear appliance system is an effective method for unilateral maxillary molar distalization.

Is Hyaluronic Acid Injection Effective for the Treatment of Temporomandibular Joint Disc Displacement With Reduction?

PURPOSE: Hyaluronic acid (HA) injections and occlusal splints have been suggested in the treatment of temporomandibular joint (TMJ) derangements, but no sufficient data are available from controlled clinical trials comparing HA injection with another treatment modality. This study compared the effectiveness of a single HA injection, a double HA injection, and splint therapy for the treatment of TMJ disc displacement with reduction (DDR). MATERIALS AND METHODS: A prospective clinical trial was designed. The study sample included patients with TMJ DDR. The primary predictor variable was treatment method. Patients were divided into 4 groups: control, single HA injection, double HA injection, and stabilization splint therapy. Patients were randomly assigned to 1 of 3 treatment groups. The control group was self-selected. The primary outcome variable was pain at rest and during mastication. The secondary outcome variables were TMJ noise, quality of life, and level of jaw movements. Clinical symptoms and jaw movements were evaluated at baseline and at 6-month follow-up. Descriptive, comparative, correlation, and multivariate analyses were conducted. RESULTS: The sample included 51 patients (66 TMJs) 18 to 48 years old. All treatment groups showed significant improvement compared with baseline values for pain, TMJ noise, quality of life, and maximum mouth opening (MMO) at 6-month follow-up (P < .05). However, the 2 HA injection groups indicated superior improvement for pain, MMO, and quality of life compared with the stabilization splint group (P < .05). CONCLUSIONS: The results of this study showed that HA injection and stabilization splinting are acceptably successful treatment modalities to alleviate the clinical signs and symptoms of TMJ DDR.

The effect of Er,Cr:YSGG laser irradiation on titanium discs with microtextured surface morphology.

Both mechanical and chemical methods can be used to clean and decontaminate implant surfaces. Incomplete debridement of infected tissue and failure to clear endotoxins can result in graft failure and a return of the defect. Recently, lasers have gained popularity for sterilizing and cleaning implant surfaces. We determined the effects of laser treatment on the surface characteristics of titanium discs with a Laser-Lok surface. The discs were irradiated with an erbium, chromium: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) laser under various conditions (R1-9). Scanning electron microscopy was used to evaluate the surface. Considerable surface alterations such as melting and flattening were seen at R6 (2 W, 20 Hz, 4 mm, 45 s) and R8 (3 W, 25 Hz, 2 mm, 45 s). In addition, cracking was seen at R8. The laser parameters should be optimized to conserve surface characteristics during the irradiation of implant surfaces.

Evaluation of the effects of skeletal anchoraged Forsus FRD using miniplates inserted on mandibular symphysis: A new approach for the treatment of Class II malocclusion.

OBJECTIVE: To evaluate the skeletal, dentoalveolar, and soft tissue effects of the Forsus Fatigue Resistant Device (FRD) appliance with miniplate anchorage for the treatment of skeletal Class II malocclusion. MATERIAL AND METHODS: The prospective clinical study group included 17 patients (11 girls and 6 boys; mean age 12.96 ± 1.23 years) with Class II malocclusion due to mandibular retrusion and treated with skeletal anchoraged Forsus FRD. After 0.019 × 0.025-inch stainless steel archwire was inserted and cinched back in the maxillary arch, two miniplates were placed bilaterally on the mandibular symphysis. Then, the Forsus FRD EZ2 appliance was adjusted to the miniplates without leveling the mandibular arch. The changes in the leveling and skeletal anchoraged Forsus FRD phases were evaluated by means of the Paired and Student's t-tests using the cephalometric lateral films. RESULTS: The success rate of the miniplates was found to be 91.5% (38 of 42 miniplates). The mandible significantly moved forward (P < .001) and caused a significant restraint in the sagittal position of the maxilla (P < .001). The overjet correction (-5.11 mm) was found to be mainly by skeletal changes (A-VRL, -1.16 mm and Pog-VRL, 2.62 mm; approximately 74%); the remaining changes were due to the dentoalveolar contributions. The maxillary and mandibular incisors were significantly retruded (P < .001). CONCLUSION: This new approach was an effective method for treating skeletal Class II malocclusion due to the mandibular retrusion via a combination of skeletal and dentoalveolar changes.

New hemostatic agent: the effect of Ankaferd Blood Stopper on healing wounds in experimental skin incision model.

AIM: To conduct a histopathological evaluation of the effects of Ankaferd Blood Stopper (ABS) on healing wounds in a rabbit skin incision model. MATERIALS AND METHODS: Incisions were performed on the backs of rabbits. The first incision was allowed to undergo normal secondary healing. ABS (1 mL) was applied to the second incision, which was subsequently allowed to undergo secondary healing. The third incision was sutured. ABS (1 mL) was applied to the fourth incision, which was subsequently sutured. During the wound healing period, the histopathologic signs of ulceration, inflammation, the proliferative phase, and the extent of early remodeling were comparatively evaluated by performing biopsies on days 5, 10, and 30. RESULTS: For all of the ABS-treated wounds, the appearance of the cavities during the early stage and the disappearance of the cavities during the late stage were observed. In addition, on days 5-10, the inflammatory granulation tissue in the ABS-treated wounds was less than in the normal wounds. By day 30, all of the wounds had achieved the same symptomatic state. CONCLUSION: As ABS does not exert any negative effects on wound healing, this agent is a secure and effective method for achieving hemostasis.

Effects of early unilateral mandibular first molar extraction on condylar and ramal vertical asymmetry.

OBJECTIVE: The objective of the following study is to investigate the mandibular vertical asymmetry in a group of patients with early unilateral mandibular first molar extractions. MATERIALS AND METHODS: Mandibular asymmetry index measurements (condylar, ramal and condylar-plus-ramal) were performed on the panoramic radiographs of a study group including 51 patients (mean age: 18.60 ± 1.11 years) and a control group of 51 patients (mean age: 18.53 ± 1.29 years). Group I included patients with a unilateral mandibular first molar extracted before the age of 12 years. Group II included patients with no extractions and had excellent Class I relationships, no missing teeth and slight or moderate anterior crowding. A paired t-test was used to determine possible statistically significant differences between the sides for the measurements. Student's t-test was used for the comparison of asymmetry index values between the groups and genders. RESULTS: No group showed statistically significant sex-or side-specific differences for posterior vertical height measurements. Condylar asymmetry index and ramal asymmetry index measurements were not statistically different between the groups, while condylar-plus-ramal asymmetry index (CRAI) measurements were statistically different between the groups (P = 0.019). CONCLUSIONS: A slight difference for CRAI value was found in patients with early unilateral mandibular first molar extractions.

Treatment of a skeletal Class II malocclusion using fixed functional appliance with miniplate anchorage.

Based on our literature search, we found that the use of miniplate anchorage with Forsus fatigue-resistance device (FRD) has not yet been reported. Therefore, the aim of the present case report was to present the treatment of a patient with skeletal Class II malocclusion with mandibular retrusion using Forsus FRD with miniplate anchorage. Fixed appliances with 0.022-inch slots were attached to the maxillary teeth and after 8 months of the leveling and alignment of the upper arch, 0.019 × 0.025-inch stainless steel archwire was inserted and cinched back. Two weeks after the placement of the miniplates bilaterally at the symphysis of the mandible, Forsus FRD was adjusted to the miniplates with a 35-mm length of rod chosen. Nine months after the skeletal anchored Forsus worn, Class I canine and molar relations were achieved and overjet was eliminated.