The effects of the pendulum distalising appliance and cervical headgear on the dentofacial structures.

BACKGROUND: Headgears are effective in distalising maxillary molars, but success depends on patient compliance and tolerance. Intra-oral distalising appliances are simple to construct and use and may be a better alternative for patients who are non-compliant or cannot tolerate headgear. AIMS: To compare the Pendulum (PEN) appliance and cervical headgear (CHG) on distal movement of maxillary first molars in patients requiring maxillary molar distalisation. METHODS: Thirty patients were randomly divided into two groups. Both groups had comparable occlusal and cephalometric characteristics before treatment. Fifteen patients (9 girls, 6 boys) with a mean age of 1 1.45 +/- 1.54 years (Range: 8.58-13.50 years) were treated with Pendulum appliances and 15 patients (10 girls, 5 boys) with a mean age of 11.72 + 1.24 years (Range: 9.58-13.33 years) were treated with a Ricketts-type CHG. A pilot study of four patients estimated that the time required to distalise the maxillary molars with the Pendulum appliance was five months. Therefore, the end of treatment records for the CHG group were taken after 4.96 +/- 0.35 months. Lateral and postero-anterior cephalometric radiographs were taken of both groups at the start (T1) and end of distalisation/treatment (T2). Changes in cephalometric measurements in the two groups were compared with Wilcoxon and Mann-Whitney U tests. RESULTS: Measurements indicated that U6-ANS distance, overjet and U1-APo distance increased, U6-PP angle and U6-PTV distance reduced, and the molar relationship improved more in the PEN group compared with the CHG group. Statistically, significant right molar - left molar differences were found between the two groups. Distalisation produced significant side effects, resulting in distal tipping of the first molars and an increase in overjet, whereas the CHG reduced the overjet. CONCLUSION: The Pendulum appliance was more effective than the CHG in distalising the maxillary first molars.

Effects of nasoalveolar molding therapy on nasal and alveolar morphology in unilateral cleft lip and palate.

OBJECTIVE: The objective of this study was to evaluate the effects of presurgical nasoalveolar molding (PNAM) therapy on nasal and alveolar tissues in patients with unilateral cleft lip and palate. PATIENTS AND METHODS: Twenty-two patients with a mean age of 23 days, having complete unilateral cleft lip and palate, were included in this prospective study. After the impressions were taken of the palatal and nasolabial regions separately, the maxillary and nasal plaster models were scanned for linear, angular, and area measurements before and after PNAM therapy. The distances between the identified landmarks were measured in the maxillary casts, and the distance and area measurements were performed for the nasal casts with the specified software called Image J developed by the National Institutes of Health. All subjects have undergone PNAM therapy for 6 months. The nasal and maxillary casts are scanned, and the images were evaluated using the software Image J. The alveolar segments should be approximated, and the cleft width and alar base of the affected side after PNAM should be reduced, and the nostril area of the cleft side should be increased. The columella deviation should be decreased. RESULTS: The decrease of the cleft width, arch length, and alar base width on the cleft side and the deviation of the columella were significant, in addition to the significant increase of the arch circumference and nostril area on the affected side (P < 0.001). CONCLUSIONS: Presurgical nasoalveolar molding therapy is a significantly helpful treatment for patients with unilateral cleft lip and palate. The reduction in the alveolar cleft region and the nasal reshaping are favorable.

Repositioning of premaxilla in bilateral cleft lip and palate using a "J-hook headgear".

The purpose of this clinical approach is to present the successful treatment of the severely protruded and extruded premaxilla with high-pull J-hook headgear. Two patients with bilateral cleft lip and palate deformity and a protruding and extruding premaxilla causing a deep bite were treated with high-pull J-hook headgear and fixed orthodontic appliances. The lateral cephalometric measurements before and after orthodontic treatment were evaluated with Ricketts analysis. The premaxillae of the two patients were repositioned, correcting the deep overbite and overjet and a well-functioning occlusion was attained. The repositioning of an inferiorly positioned and protruded premaxilla with J-hook headgear is an alternative treatment approach compared to other treatment modalities.

Lower incisor retraction with a modified corticotomy.

This case report demonstrates the orthodontic treatment facilitated with a new conservative corticotomy technique to shorten the treatment time during lower incisor retraction. The patient was a 22-year-old woman with protrusive profile, severe anterior crowding, an anterior crossbite, and Class III dental relationship. Orthodontic treatment consisted of the extraction of four first premolars with maximum anchorage. A modified corticotomy technique, in which the lingual vertical and subapical horizontal cuts were eliminated, was combined with orthodontic therapy for the retraction of the lower anterior teeth. Corticotomy-facilitated orthodontics dramatically reduced the treatment time without any adverse effects on the periodontium and the vitality of the teeth. The main advantages of this modified corticotomy technique were the elimination of the lingual cuts and flap, the reduction of surgery time, and minimum discomfort to the patient. At the end of active orthodontic therapy, balanced occlusion and facial esthetics were achieved.

Familial syndrome of unusual triangular facies associated with cleft palate, malocclusion, midfacial hypoplasia and sensorineural hearing loss in two siblings. Is it a new autosomal recessive syndrome?

We present a previously undescribed syndrome characterized by triangular facial appearance, mid-facial hypoplasia, cleft palate and mild sensorineural hearing loss in two siblings. The parents were unrelated. The patients' stature and intelligence were normal. We suggest that the inheritance is autosomal recessive.

Facial asymmetry case with multiple missing teeth treated by molar autotransplantation and orthognathic surgery.

Autotransplantation is an alternative treatment in cases of missing teeth. Autotransplantation of teeth can lead to significantly shorter treatment time and an improved treatment result in certain cases of tooth loss, wherever a suitable tooth is available and the anatomic circumstances permit it. The presented case report, treated successfully with molar autotransplantation and orthognathic surgery, had a number of missing teeth and facial asymmetry.

Augmentation mentoplasty using a custom-design wire cage.

Mentoplasty is often a complimentary procedure to rhinoplasty. At least 25% of all rhinoplasty patients may need a chin implant to balance facial features better. Augmentation mentoplasty using alloplastic implants such as silicone, rubber, or other materials provides a simple approach to the treatment of the hypoplastic chin. Although these types of implants are readily available in developed countries, there are parts of the world where they are unavailable or quite expensive. The authors have developed a chin implant made of wire that is available throughout the world and is custom designed to the mentum of the patient after a cephalometric evaluation. This technique has been used in 125 patients along with rhinoplasty over the last 20 years at our institution. In an initial series of 8 patients, the prosthesis became displaced and was removed in 2 patients. Since then, a new radiographic technique has been developed to demonstrate the shape of the mentum before surgery and new bone formation after surgery. By using this special radiographic technique, it was possible to detect four types of mentum before surgery and to construct a custom-design wire cage according to this shape. The prosthesis is constructed by an orthodontist according to the cephalometric measurements and shape of the mentum. By using the buccal approach, a pocket is prepared subperiosteally and a wire cage is inserted. In the last 20 cases, the wire cage was filled with diced cartilage wrapped with Surgicel. The results were esthetically satisfactory in most patients. After the shape of the wire prosthesis was modified to conform to the shape of the underlying bone better, no displacement of the prosthesis has been experienced. In 3 patients, it was necessary to remove the prosthesis when new tissue formation began to fill the prosthesis. These specimens were examined histologically, and the regenerating tissue was found to be connective tissue with a thin layer of bone formation. Most patients could be followed up for only 3 to 12 years. In all patients, the results have been consistent and the procedure has been safe.

Facemask therapy with rigid anchorage in a patient with maxillary hypoplasia and severe oligodontia.

In this report, we describe the treatment of a 10-year-old girl with a Class III skeletal relationship with maxillary hypoplasia and severe oligodontia. The maxillary arch was in a complete crossbite relationship with the mandibular arch. The treatment plan called for displacing the maxillary complex anteriorly with a facemask. Because of the lack of available teeth, a rigid anchorage implant was used in combination with the remaining teeth to provide anchorage. A titanium lag screw was placed in the maxillary alveolus. Three weeks later, 800 g of orthodontic force was applied. A significant anterior displacement of the nasomaxillary complex was achieved with the facemask. At the end of treatment, a temporary removable partial denture was placed.