Maxillary protraction in patients with unilateral cleft lip and palate : Evaluation of soft and hard tissues using the Alt-RAMEC protocol.

PURPOSE: The aim of this study was to evaluate the hard and soft tissue effects and differences of the Alt-RAMEC protocol to the facemask and conventional facemask protocols in patients with unilateral cleft lip and palate. METHODS: This prospective study was carried out with 30 patients with unilateral cleft lip and palate with skeletal and dental class III malocclusions who were referred to a university department of orthodontics. The patients were evaluated with the cervical vertebral maturation method and divided into two groups, each consisting of 15 patients. The patients in group I (mean age 10.00 ± 0.73 years) were treated according to conventional facemask protocol, and the patients in group II (mean age 10.07 ± 2.43 years) were treated according to the Alt-RAMEC protocol before facemask application. Lateral cephalometric radiographs were evaluated by using the Dolphin Imaging Software version 11.7. The skeletal, dentoalveolar and soft tissue differences and treatment times were evaluated. RESULTS: Group II demonstrated a 5.73° increase in SNA, which was statistically significant, while this increase was 3.13° in group I (p < 0.001). Results for Co­A and A­PTV showed a significant increase for group II only (group I: 1.02 mm, 1.06 mm, group II: 3.02 mm, 2.21 mm; p < 0.05 and p < 0.01, respectively). In addition, group II presented significant increase for the values of ANB, N­A-Pg, SN/MP, Wits, U1-SN, U1-L1, U1-PTV, U1-FHP, U6-PTV, U6-FHP, overjet, Ss-PTV, UL-PTV and UL­S line (p < 0.001). The treatment mean times were 7.3 months in group I and 4.7 months in group II (p < 0.01). CONCLUSION: Applying the facemask after having followed the Alt-RAMEC protocol induced more skeletal, dentoalveolar and soft tissue changes in comparison to the conventional facemask protocol in patients with unilateral cleft lip and palate.

Multidisciplinary management and long-term follow-up of mesiodens: a case report.

Supernumerary teeth are relatively common in the oral cavity and are characterized by an excessive number of teeth. The term "mesiodens" refers to a supernumerary tooth located in the midline of the maxilla between the central incisors. Mesiodens may cause a variety of pathological complications such as impaction of the maxillary central incisors, tooth retention or delayed eruption of the permanent incisors, crowding, eruption within the nasal cavity, formation of diastema, intraoral infection, root anomaly, root resorption of adjacent teeth and cyst formation accompanied by bone destruction. Therefore it is recommended to follow-up with regular radiographic examination. Early diagnosis minimizes treatment needs and prevents associated complications. The present case, followed for 7 years, presented bilateral mesiodens resulting in delayed eruption of the permanent incisors and emphasizes the importance of multidisciplinary management and long-term follow-up.

Osseointegrated implants with pendulum springs for maxillary molar distalization: a cephalometric study.

INTRODUCTION: Maxillary molar distalization is a common treatment approach for patients with Class II malocclusions who do not require extractions. Despite the many advantages of pendulum appliances, the maxillary incisors and premolars tend to shift mesially as the maxillary molars move distally. The purpose of this study was to investigate anchorage loss in patients treated with palatal osseointegrated implants combined with pendulum springs. METHODS: Pretreatment and posttreatment lateral cephalometric films of 30 consecutively treated patients were examined. One group (n = 15) had been treated with conventional pendulum appliances, and the other group (n = 15) was treated with palatal osseointegrated implants combined with pendulum springs. RESULTS: In the pendulum group, significant distal tipping of the maxillary first molars and mesial tipping of the maxillary premolars were noted. Distalization of the maxillary first molars, mesialization of the maxillary first premolars, and proclination of the maxillary left central incisor were significant in the linear measurements. In the implant group, the distal tipping of the maxillary first molars and first premolars and the increases in SNGoGn, FMA, Na Me, and Na ANS were significant. Intergroup comparisons showed that changes in the maxillary first premolars, maxillary central incisors, and vertical measurements were significant. CONCLUSIONS: The use of palatal osseointegrated implants is reliable and provides absolute anchorage.