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Purpose: The aim of this respectively cohort study was to evaluate the lower second and third molars and canine angulations, retromolar space and occlusal relationships after functional orthodontic treatments with the monoblock or Herbst appliance using panoramic radiographs., Methods: Pre- and posttreatment cephalometric and panoramic radiographs of 133 patients (mean age 13.89 ± 1.14 years) treated non-extraction with monoblock (n: 44), Herbst (n: 45) and fixed orthodontic appliances (control group; n: 44) were included to the study. Dental and skeletal measurements were performed on cephalometric radiographs. The angle between the third and second molars, and canines with the lower border of the mandible and the occlusal plane, gonial angle, the angle between the third and second molars and the retromolar space width were assessed on pre- and posttreatment panoramic radiographs. Paired and independent t tests were used for the statistical analysis of the data for intragroup and intergroup comparisons., Results: Functional treatment with both the monoblock and the Herbst appliances resulted in improvement of skeletal class II relationships. Retromolar space significantly increased in the functional appliance groups compared to the control group (p ≤ 0.001), but improvement of the angulations of posterior teeth was significant only in the monoblock group (p ≤ 0.001)., Conclusion: While both the Herbst and monoblock appliances led to an increase in retromolar space, monoblock treatment resulted in more favorable angulation of the third molars compared to the Herbst treatment., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: This study compared dentoskeletal and soft tissue changes with face mask (FM) therapy. Rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocols were used with the two different types of expansion appliance, and their effects on the treatment outcome were investigated., Methods: The study consisted of 79 (37 and 42 patients in the RME and Alt-RAMEC groups with FM, respectively) patients who had received FM treatment. The effects of the RME/FM (20 female, 17 male) and Alt-RAMEC/FM (14 female, 28 male) protocols were evaluated using lateral cephalometric films. The chronological ages of the RME/FM and Alt-RAMEC/FM groups were 11.58 and 11.99 years, respectively. In addition, both groups were divided into two subgroups based on the design of the expansion appliance (Spolyar or full coverage type). Differences in all parameters were analyzed using Student's t-tests., Results: The maxilla significantly moved forward in both the RME/FM and Alt-RAMEC/FM groups (p<0.001). No significant skeletal differences were observed between the groups. Sagittal movement of the upper incisors significantly increased, and the lower incisors significantly retruded in both groups. While similar skeletal changes were found between the Spolyar and full-coverage appliance groups, the upper incisors protruded significantly more in the full-coverage type., Conclusion: RME/FM and Alt-RAMEC/FM therapies were found to be efficient for maxillary protraction and resulted in similar skeletal changes. A full-coverage expansion appliance produced a more upper incisor protrusion than a spherical-type appliance.

Objective: Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance., Design: Cross-sectional survey-based evaluation., Setting: International comprehensive cleft care workshop., Participants: Total of 489 participants., Interventions: Three-day simulation-based hybrid comprehensive cleft care workshop., Main Outcome Measures: Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance., Results: The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 ± 3.08 vs 27.63 ± 3.93; P  = .04) and perceived impact on their clinical practice (22.37 ± 3.42 vs 21.02 ± 3.45 P  = .01)., Conclusion: Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.

Purpose: To evaluate and compare patients' oxidative stress parameters and antioxidant status with fixed orthodontic appliances during the pubertal and postpubertal growth periods., Methods: Saliva samples of 20 pubertal (mean age: 12.94 ± 0.34 years) and 20 postpubertal (mean age: 16.34 ± 0.45 years) patients were collected just before the application of fixed orthodontic appliances (T0), 4-5 h (T1), and 7 days (T2) after the initial orthodontic activation. Myeloperoxidase (MPO), nitric oxide (NO), 8‑hydroxydeoxyguanosine (8-OHdG) levels, and superoxide dismutase (SOD) activity in the saliva were examined. Repeated measures analysis of variance (ANOVA), least significant difference (LSD) pairwise comparison, and independent sample t‑tests were used to analyze the differences between the time points and growth periods, respectively., Results: MPO levels in the saliva of patients in the pubertal period showed a significantly higher increase within the first days of treatment (T2-T1) than in patients in the postpubertal period (p < 0.05). The SOD antioxidant enzyme activity decreased in the samples from T0 to T1 in the patients in the pubertal and postpubertal groups and returned to baseline values (T0) at T2 (p < 0.01). No significant differences in the other biochemical parameters between groups were observed., Conclusions: Comparing the pubertal and postpubertal groups, orthodontic force application with fixed orthodontic appliances did not change the final levels (on day 7) of antioxidant status or oxidative stress markers, except for MPO in saliva., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Alveolar distraction osteogenesis (ADO) has been used for the reconstruction of atrophic alveolus for decades. The advantage of this technique is that it augments the bone and soft tissues together, creating a better alveolar platform for subsequent surgeries and dental rehabilitation. It is especially useful in patients with large and/or complex alveolar clefts for which approximating the alveolar segments reduces the size of the bony cleft and associated fistula. Displacement of the transported segment is the most frequently encountered complication of ADO but can be managed by constructing case-specific distractors., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact., Design: Cross-sectional survey-based evaluation., Setting: Simulation-based comprehensive cleft care workshop., Participants: Total of 180 participants., Interventions: Three-day simulation-based comprehensive cleft care workshop., Main Outcome Measures: Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice., Results: The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 ± 5.7 vs 25.7 ± 7.6; P < .001) and palate (32.4 ± 7.1 vs 23.7 ± 6.6; P < .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices., Conclusion: Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants' clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.

BACKGROUND The purpose of this prospective study was to compare adolescent and post-adolescent growth periods regarding the effectiveness of conventional activator appliance in patients with Class II mandibular retrognathia by using lateral cephalometric radiographs and three-dimensional photogrammetry (3dMDface). MATERIAL AND METHODS We enrolled 2 groups: 15 patients in the adolescent growth period and 17 patients in the post-adolescent growth period. All patients had Class II anomaly with mandibular retrognathia and were treated with conventional activator appliances. Lateral cephalometric radiographs and three-dimensional photogrammetric views were obtained at the beginning and end of the activator treatment of Class II patients. Maxillomandibular discrepancy, mandibular protrusion and lengths, convexity angles, facial heights, and dental measurements were evaluated cephalometrically. Projections of the lips and the chin and volumetric measurements of the lip and the mandibular area were assessed using three-dimensional photogrammetry. RESULTS Conventional activator therapy resulted in similar effects in both growth periods regarding improvements in the mandibular sagittal growth and maxillomandibular relationship (ANB° and the SNB° angles). Mandibular effective length was increased (Co-Gn length) and the maxillary horizontal growth was restricted (decreased SNA° angle) in both groups following the treatment. Treatment duration was significantly longer in the post-adolescent group. Increases in the projections of menton, pogonion, and sublabial points were observed in the three-dimensional photogrammetric views. Total lip volume was reduced while the mandibular volume was significantly increased in both groups. Lower gonial angle showed a greater increase in the post-adolescent group. CONCLUSIONS Correction of Class II anomaly with mandibular retrognathia was achieved with a combination of dental and skeletal changes in both growth periods. Conventional activator therapy may be an alternative treatment approach in the late growth period as it led to significant skeletal and dental changes.

Background. This experimental study aimed to assess the effects of Vitamins C and E on orthodontic tooth movement. Methods. Fifty-one male Wistar albino rats were divided into six groups: five appliance groups and one control group. The appliance groups had an orthodontic appliance consisting of a closed-coil spring ligated between the maxillary incisor and maxillary first molar (50 g). Vitamin E and C (150 mg/kg) were injected intraperitoneally per day in the first and second groups, respectively. Vitamins E and C (20 μL) were locally injected into the periodontal gap of the moving teeth in the third and fourth groups, respectively, once every three days. No vitamin was injected in the last (fifth) appliance group.The experimental period was 18 days. Histological and biochemical (alkaline phosphatase, osteocalcin, and NTx levels) evaluations of the samples were performed, and maxillary incisor‒molar distance was measured before and after the experiment. Results. The amount of tooth movement was similar in the appliance groups. All the vitamin groups showed significantly increased osteoblastic activity, while those treated with systemic vitamins exhibited significantly increased numbers of collagen fibers on the tension side compared to the appliance control group (P<0.05). Conclusion. Vitamin C and E supplements positively affected bone formation on the tension side of the teeth during experimental orthodontic tooth movement., (© 2020 The Authors.)

This clinical report presents the outcomes of segmental corticotomy-assisted orthodontic treatment in a class III patient. A 13.5-year-old female patient presented with class III anomaly and a thin alveolus in the mandibular anterior region. After the alignment of the mandibular incisors, segmental corticotomy with platelet-rich fibrin (PRF) was performed in the mandibular incisor area to facilitate incisor retraction to ensure periodontal support after the changes in the inclination of the teeth. Lateral cephalograms were taken at the beginning (T0), precorticotomy (T1), at the end of the treatment (T2), and 2 years after the treatment (T3). Cone-beam computed tomography (CBCT) records were collected at the T1, T2, and T3 periods to evaluate the bone structures. The measurements included the inclination and the position of the mandibular incisors, symphysis width, symphysis height, B-B' width, cervical alveolar width, the vertical alveolar bone level on the labial and the lingual sides, and the amount of labial and lingual bone at the apex in the mandibular central incisor and canine areas.The class I molar and canine relationship was achieved in this borderline case. The amount of labial bone at the root apex and the B-B' width increased. A vertical alveolar bone gain was observed. The facial profile was improved significantly. The treatment outcome was stable at the 2-year follow-up. The segmental anterior mandibular corticotomy provided an effective correcting inclination of the mandibular teeth with the use of class III elastics. This technique ensured the maintenance of a sufficient amount of labial bone with no periodontal side effects.

This retrospective cohort study aimed to determine the impact of a nasoalveolar molding (NAM) protocol on midface growth in school-aged children with non-syndromic unilateral cleft lip and palate (UCLP). Data from 56 consecutively treated, NAM-prepared, Caucasian patients with non-syndromic UCLP from a single US cleft palate center were compared to pooled center data based on 56 patients with non-syndromic UCLP treated at 2 Eurocleft centers that did not use presurgical infant orthopedics (non-PSIO). Lateral cephalograms were obtained and 28 landmarks were identified. Published cephalometric measurements from Eurocleft centers were used for comparison. Seven cephalometric measurements (SNA, SNB, ANB, A'N'B', G'-Sn'-Pg', Sn-CT-LS, ANS-Me/N-Me%), available or derivable for both centers, were analyzed. Means and standard deviations for the 7 measurements were calculated for the NAM center. Student's t-tests were used to compare group means for 6 of the measures and a test of proportion was used for ANS-Me/N-Me%. No significant differences were found between the NAM protocol-prepared group and the Eurocleft non-PSIO centers on any of the 7 analyzed cephalometric relationships after accounting for false discovery rate. The NAM treatment protocol does not appear to impact skeletal or soft tissue facial growth in school-aged children with non-syndromic UCLP.

BACKGROUND In cleft lip and palate (CLP) patients, the shape of the facial soft tissues shows variety in 3 dimensions (3D). Two-dimensional (2D) photographs and radiographs are insufficient in the examination of these anomalies. The aim of this retrospective study was to examine the soft tissue and craniofacial characteristics of individuals with nonsyndromic unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), skeletal Class III malocclusions, or skeletal Class I malocclusions using 3D facial imaging. MATERIAL AND METHODS The entire study group consisted of a total of 158 patients, aged 8-32 years: 29 of the patients had UCLP, 22 BCLP, 54 had skeletal Class III malocclusions, and 53 had skeletal Class I malocclusions. 3D stereophotogrammetric soft-tissue recordings of all patients were analyzed. ANOVA and the Kruskal-Wallis test were performed to compare the groups. RESULTS Statistically significant differences were observed among the groups in terms of linear, angular, proportional. and volumetric measurements. While nasal differences were not observed in the Class III group, nose and upper-lip deformities were common in the CLP groups. Upper-lip projection was reduced in all 3 groups. In the Class III patients, the lower lip and chin were more prominent than in the other groups. The facial convexity angle was increased in the CLP and Class III groups. The upper-lip volume was decreased in the BCLP, the UCLP, and the Class III groups. CONCLUSIONS Patients with skeletal Class III or CLP anomalies showed significantly different soft-tissue characteristics than the Class I control group. 3D stereophotogrammetric facial imaging is an easy and noninvasive method that can be used in examination and recording of these facial deformities. It is possible to make volumetric measurements using this method.

Aim: The aim of this retrospective study was to evaluate the change in inferior sclera exposition after maxillary protraction with or without skeletal anchorage in patients with maxillary retrognathia., Materials and Methods: Fifteen patients (Group 1) who applied maxillary protraction with teeth-supported appliance and fifteen patients who applied maxillary protraction with skeletal anchorage (Group 2) were compared in order to investigate the effect of different maxillary protraction methods on the visibility of sclera. The patients in both groups had dental and skeletal Class III malocclusion with maxillary retrusion (ANB <0; SNA <80), increased vertical growth pattern (SnGoGn> 32) (long face), increased sclera exposure, and no congenital anomalies and dentofacial deformities. Pre- and posttreatment records were used to assess the amount of visible sclera on facial photographs using Adobe Photoshop CS6 program and the change in the movement of maxilla on cephalometric film. The pretreatment and after maxillary protraction values were compared statistically by the Wilcoxon signed-rank test (level of significance, P < 0.05)., Results: The amount of inferior sclera exposure to eye height decreased in the right and left eyes of the 30 patients with maxillary protraction. The amount of inferior sclera exposure to eye height of the right and left eyes decreased from 3.59 to 3.5 and from 3.44 to 3.39, respectively, in Group I (P = 0.001 and P < 0.001, respectively). The amount of inferior sclera exposure to eye height of the right and left eyes decreased from 4.17 to 3.93 and from 3.86 to 3.68, respectively, in Group II (P = 0.001 and P < 0.001, respectively)., Conclusion: There were important results in both of the two methods. Although more improvement was obtained in the skeletal anchorage group, statistically no significant differences were found between the groups., Competing Interests: There are no conflicts of interest

Background: Gingivoperiosteoplasty can avoid secondary alveolar bone grafting in up to 60 percent of patients with a cleft. However, preoperative predictors of success have not been characterized. This study reports on the preoperative alveolar segment position most favorable for successful gingivoperiosteoplasty., Methods: The authors performed a single-institution, retrospective review of patients with a unilateral cleft who underwent nasoalveolar molding. Alveolar segment morphology was directly measured from maxillary dental models created before and after nasoalveolar molding. Statistical analysis was performed to identify parameters associated with the decision to perform gingivoperiosteoplasty and its success, defined as the absence of an eventual need for alveolar bone grafting., Results: Fifty patients with a unilateral cleft who received nasoalveolar molding therapy were included in this study (40 underwent gingivoperiosteoplasty and 10 did not). Eighteen alveolar morphology and position characteristics were tested, including cleft gap width, horizontal and vertical positions of the alveolar segments, alveolar stepoff, and degree of alveolar segment apposition. Post-nasoalveolar molding vertical rotation of the greater segment and the percentage of segment alignment in the correct anatomical zone were statistically significant predictors of the decision to perform gingivoperiosteoplasty (86 percent predictive power). Cleft gap, greater/lesser segment overlap, alveolar segment alignment, greater segment horizontal rotation, and alveolar segment width following nasoalveolar molding were significant predictors of gingivoperiosteoplasty success (86.5 percent predictive power)., Conclusions: Greater segment vertical rotation and proper alveolar segment anatomical alignment are positive predictors of the decision to perform gingivoperiosteoplasty. Post-nasoalveolar molding evidence of proper alignment and direct contact between the alveolar segments were significant predictors of successful gingivoperiosteoplasty., Clinical Question/level of Evidence: Risk, III.

Background: The aim of this study was to identify cephalometric measurements associated with clinical severity in patients with Treacher Collins syndrome., Methods: A retrospective single-institution review of patients with Treacher Collins syndrome was conducted. Preoperative cephalograms and computed tomographic scans (n = 30) were evaluated. Fifty cephalometric measurements were compared to age-specific normative data using analysis of variance. These cephalometric measurements and the patient's Pruzansky classification were correlated to clinical severity using Spearman analysis. Clinical severity was defined as severe (required tracheostomy), moderate (obstructive sleep apnea, oral cleft, or gastrostomy-tube), or mild (absence of listed comorbidities). Cephalometric measurements with a strong correlation (r > 0.60) were identified as predictors of clinical severity., Results: Cephalograms of the study population contained 30 measurements that were found to be significantly different from normative data (p < 0.01). These measurements were related largely to maxillary/mandibular projection, maxillary/mandibular plane angle, mandibular morphology, facial height, facial convexity, and mandible/throat position. Ten of these 30 statistically significant measurements in addition to Pruzansky classification were found to be strongly correlated (r > 0.60) to clinical severity. These measurements include the following: mandibular projection/position (sella-nasion-pogonion, r = -0.64; hyoid-menton, r = -0.62); posterior facial height (posterior facial height/anterior facial height, r = 0.60; condyle-gonion, r = -0.66); maxillary/mandibular plane angle (sella-nasion-mandibular plane, r = 0.62; Frankfort horizontal-mandibular plane, r = 0.61; sella-nasion-palatal plane, r = 0.69; sella-nasion-symphysis, r = -0.69); and Pruzansky classification (r = 0.82)., Conclusion: Specific cephalometric measurements of increased mandibular retrognathia, decreased posterior facial height, more obtuse maxillary/mandibular plane angle and more obtuse symphysis notch angle are strongly correlated to increased clinical severity in patients with Treacher Collins syndrome.

Purpose: The aim of this study was to evaluate the complications and success rates of the miniplates using both maxilla and mandible for orthodontic anchorage in growing patients., Materials and Methods: One hundred and fifty-five consecutive patients (range 8.7-13.8 years) with Class II and III malocclusion without congenital or acquired deformities were included in this study. A total of 382 titanium miniplates were placed by the same surgeon. All miniplates were inserted under local anesthesia. Loading of the miniplates with a force of 200 g with the help of elastics or functional devices were initiated 3 weeks after surgery., Results: The overall success rate of miniplate anchorage in terms of stability was 96.8%. Twenty-one patients reported irritation of the mucosa of the cheeks or lower lip after the surgery in the mandible group. Twelve miniplates needed to be removed and were successfully replaced., Conclusion: Skeletal anchorage miniplates is effective for correcting malocclusions. Success depends on proper presurgical patient counseling, minimally invasive surgery, good postsurgical instructions, and orthodontic follow-up.

Our aim was to investigate the differences in the dynamics of lip force between a group of participants with repaired cleft lips and a group of patients the same age but without clefts. We evaluated 101 children between the ages of 10 to 15 years (unilateral clefts n=35, bilateral clefts n=15, class I malocclusion n=25, and class III malocclusion n=26). Maximum and minimum forces required to close the lips were evaluated with the Lip De Cum ® device (Cosmos Instruments Co Ltd, Tokyo, Japan) for the all groups. We found no significant differences between the maximum and minimum values between boys and girls within the groups, whereas the mean maximum and minimum lip force of the boys was higher than those of the girls in all the groups. This study showed that maximum and minimum lip closing force values were statistically similar in all groups. We conclude, therefore, that patients with bilateral cleft lip have reduced maximum and minimum lip force., (Copyright © 2017 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Aim: The aim of this prospective study was to test the efficacy of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste applied in-office to prevent white spot lesions (WSL) in patients undergoing fixed orthodontic treatment., Materials and Methods: Study design: this study was designed as a randomised controlled clinical trial. Fifty-seven patients undergoing nonextraction fixed orthodontic treatment were enrolled and divided randomly into two groups (control n = 28, experimental n = 29). The pretreatment plaque, gingival and bleeding indices, and oral hygiene habits were recorded. One group received CPP-ACP paste (GC Tooth Mousse) at each monthly orthodontic follow-up examination; the control group received routine orthodontic treatment. The mean patient age was 16.9 years in the experimental group and 17.1 years in the control group. The periodontal indices, decayed, missing, and filled teeth (DMFT), decayed, missing, and filled surfaces (DMFS), and the WSL prevalence pre- and post-treatment were measured and compared between the groups., Statistics: differences between groups in normally distributed data between groups were assessed by the paired-t test, and the Wilcoxon Signed Rank test was used to compare variables that were not normally distributed., Results: There was a lower incidence of WSL in the experimental group compared to the control group. Most of the WSL occurred at the maxillary incisors, mandibular canines and premolars., Conclusion: The in-office application of CPP-ACP paste did not prevent WSL development completely; however, it did significantly decrease the number of WSL compared to the control patients.

Objective: A male patient with Tessier No. 4 cleft (unilateral left) presented at 20 days of age. The cleft defect beginning between the cupid bow and oral commissure extended to the ipsilateral orbital floor, skirting the nose and lacrimal duct while passing through the cheek medial to the infraorbital nerve. With the lesser segment disposed 16 mm transversely, the wide gap included an absence of orbital floor and lower eyelid. A deficient midfacial platform caused a severe inferior globe dystopia, superiorly displaced left ala base, and severe vertical shortening between ala-canthus and ala-globe., Intervention: A modified Latham device applied directional orthopedics to contract the cleft gap and with an eye part added to elevate the dystopic globe. Two different Latham devices used in succession were each applied for 4 weeks. Lastly, a removable plate further repositioned the eye. Each appliance was designed to differentially move the noncleft and cleft segments of the maxilla. Presurgical orthopedics began at 3 weeks lasted 14 weeks. Intraoperatively at 17 weeks, the inferior globe dystopia was effectively reduced, and the cleft gaps were nearly closed and aligned at the orbital floor, cheek, and the alveolus. Respecting the aesthetic units of face became possible with the soft-tissue repair yet were tight enough in the malar region to retract the lower lid., Conclusion: The presurgical directional orthopedic and eye-globe mechanics were sufficient to enable medial canthal repositioning, sustainable correction of orbital distopia, and optimized primary soft-tissue repair. Early result suggests that surgery with presurgical orthopedics is superior to surgery alone.

Introduction: The aim of this study was to compare the short-term dental and skeletal effects of a face mask (FM) with those of skeletal anchorage (SA) therapy with intermaxillary elastics in prepubertal patients with skeletal Class III malocclusion., Methods: Fifty patients with skeletal Class III malocclusion and maxillary deficiency were divided into two groups. In the FM group, an FM was applied by a bite plate with a force of 400g for each side. In the SA group, mini-plates were placed between mandibular lateral incisors and canines, and mini-implants were inserted between maxillary second premolars and first molars. A bite plate was inserted into the upper arch, and Class III elastics were applied with a force of 200g between each mini-plate and mini-implant., Results: Mean treatment durations were 0.52±0.09 years for FM and 0.76±0.09 years for SA. After the treatment, statistically significant increases in SNA°, ANB°, A-y, 1-NA, SnGoGn°, Co-A, Co-Gn, and A-Nperp, and reductions in SNB° and FH┴N-Pg were observed in both groups, and these changes were similar in both groups. In the FM group, 1-NB decreased significantly, and in the SA group, it increased significantly (P < 0.05)., Conclusions: The undesired dentoalveolar effects of the FM treatment were eliminated with SA treatment, except with regard to lower incisor inclination. Favourable skeletal outcomes can be achieved by SA therapies, which could be an alternative to the extraoral appliances frequently applied to treat skeletal Class III patients with maxillary deficiency., (© The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Rehabilitation of the large alveolar clefts with autogenous graft or distraction osteogenesis is one of the most common treatment choices. Depending on the clinical situation such as vertical deficiencies, linear transport of the segment does not always ensure a proper closure of the cleft space. In this report, the authors present a patient in whom large unilateral cleft and vertical alveolar deficiency were closed by unilateral Le Fort I osteotomy and distraction technique using the orthodontic elastics.

Introduction: The aim of this study was to evaluate the dentoskeletal effects of a modified slow maxillary expansion appliance (MSMEA) during the transition from the mixed to the permanent dentition., Methods: Forty subjects presenting with posterior crossbites were divided into two groups. Twenty-three subjects were assigned to a treatment group (mean age: 9.45 years) and 17 subjects assigned to a control group (mean age: 9.25 years). An MSMEA with acrylic occlusal coverage limited to the palatal cusps was used to provide maxillary expansion. The mean slow expansion treatment period was 7.8 months, while the mean observation period continued for 14.8 months of a 22.6-month total study period., Results: Substantial dental and skeletal effects were observed following treatment with the MSMEA. Most maxillary inter-molar and deciduous inter-second molar width increases were maintained in the permanent dentition (91% and 97%, respectively). Skeletal maxillary transverse dimensions, which increased by 2 mm after active expansion, were significantly greater (p < 0.001) when compared with the controls., Conclusion: The findings suggested that an MSMEA provided orthopaedic and dental effects as a result of posterior crossbite correction. The effects of the appliance seen during the mixed dentition were maintained in the permanent dentition.

The aim of this case report is to describe the treatment of a patient with skeletal Class III malocclusion with maxillary retrognathia using skeletal anchorage devices and intermaxillary elastics. Miniplates were inserted between the mandibular lateral incisor and canine teeth on both sides in a male patient aged 14 years 5 months. Self-drilling mini-implants (1.6 mm diameter, 10 mm length) were installed between the maxillary second premolar and molar teeth, and Class III elastics were used between the miniplates and miniscrews. On treatment completion, an increase in the projection of the maxilla relative to the cranial base (2.7 mm) and significant improvement of the facial profile were observed. Slight maxillary counterclockwise (1°) and mandibular clockwise (3.3°) rotations were also observed. Maxillary protraction with skeletal anchorage and intermaxillary elastics was effective in correcting a case of Skeletal Class III malocclusion without dentoalveolar side effects.

Introduction: We aimed to investigate the morphometric development of the cranial base and its related structures, and their growth rate changes from the ninth gestational week to full term in a large group of human fetuses., Methods: We selected 203 (109 male, 94 female) fetuses between 9 and 40 weeks of gestation and without any external anomalies. From each fetus, standard lateral and posteroanterior cephalometric images were taken using a dental digital panoramic and cephalometric x-ray machine. Fourteen linear and 9 angular parameters were measured., Results: The cranial base angle showed a statistically significant increase between the groups from only the second to the third trimester periods. The sagittal translation of the maxilla increased during the prenatal period, whereas the mandibular sagittal relation grew at a steady rate. The vertical plane angles of the maxilla and the mandible did not show any significant changes. The maxillary length to mandibular length ratio remained stable., Conclusions: The cranial base angle increased, especially in the second through the third trimesters. The maxilla and the mandible demonstrated different growth patterns in the sagittal direction. The findings of this study could be a guide for interpreting the relationships among the craniofacial structures., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Objective: The aims of this retrospective study were to determine compliance with dental and chronological ages and to analyze the relationships between dental age and orthodontic sagittal anomalies., Materials and Methods: A total of 221 subjects between the ages of 7 and 15.9 years (165 girls and 156 boys) were included in the study. The dental age of seven left mandibular teeth was assessed according to the Demirjian method. The maxillary protrusion, mandibular protrusion, maxillo-mandibular and vertical plane angles were measured from cephalometric films., Results: The mean difference between the chronological age and dental age in female patients was 0.94 years and 0.33 years in male patients (P < 0.01). No differences between the sagittal classification groups were found. There was no relationship between dental age and the SNA° or the GoGn-SN°. A statistically significant negative relationship was found between dental age and the SNB° and there was a significant linear relationship between dental age and the ANB°., Conclusion: Dental age in girls and boys has been estimated to be more advanced than chronological age in all classes and dental maturation advanced in cases with a tendency to develop Class II malocclusions.

Objective : The aim of the present study was to compare the morphometrics of the craniofacial and alveolar arch structures of anencephalic fetuses with those of normal human fetuses without anencephaly or any other anomaly. Design : Original article. Methods : Standard lateral and posteroanterior cephalometric radiographs of 23 anencephalic and 33 normal human fetuses aged between 21 and 40 weeks of gestation were compared. These fetuses were divided into three periods based on gestational age, and vertical, sagittal, transverse, and angular measurements were taken in the cranial base and facial regions. Moreover, intraoral measurements from the maxillary and mandibular arches were also made to determine the width and depth. Results : N-S and S-Ba lengths and the N-S-Ba angle, measured on lateral cephalometric radiographs, were statistically smaller in anencephalic fetuses (p < .05). The S-N-ANS, S-N-Pg, and ANS-N-Pg angles and the Go-Me length were significantly greater in anencephalic fetuses (p < .05). Maxillary length, ramus length, and anterior facial heights were similar in both groups. On posteroanterior radiographs, all parameters except bigonial distance were found to be smaller in the anencephalic fetuses (p < .05). Maxillary alveolar width was small among anencephalic fetuses in all three periods; whereas, the mandibular alveolar width was narrow only in the third period. Conclusion : Cranial and facial structures were affected morphometrically to various degrees in anencephalic cases. The most significant alterations in anencephalic cases were related to measurements in the transverse direction. This indicated that cephalic tissue influenced not only the cranial base but also all facial structures.

The aim of this study was to investigate the levels of the oxidant and antioxidant changes in orthodontic tooth movement and the effects of vitamin E on these parameters. For this purpose, 50 orthodontic patients (aged 13-18 years) required non-extracted treatment were divided randomly into the following groups: Control and Vitamin E. Same pre-adjusted appliances were applied to all patients, and vitamin E (300 mg day(-1)) was given during 1 month in vitamin E group. Gingival crevicular fluid was collected and periodontal indexes were recorded at the baseline and after 1 month. Lipid peroxidation (LP) levels as malonyldialdehyde, reduced glutathione (GSH) and glutathione peroxidase (GSH-Px), vitamin C and E levels were measured in the anterior and posterior regions of the dentition. After 1 month, orthodontic treatment LP levels increased in control group in both anterior and posterior regions in vitamin E group. LP levels also increased in vitamin E group in only posterior region. The level of GSH and vitamin C did not change statistically in control and vitamin E groups. Periodontal indexes did not show any differences in comparison with the groups. In conclusion, we observed protective role of vitamin E on LP levels in anterior region of patients with orthodontic tooth movement., (Copyright © 2011 John Wiley & Sons, Ltd.)

Objectives: The aim of this study was to investigate the alveolar and symphysis region properties in hyper-, hypo-, and normodivergent Class II division 1 anomalies., Methods: Pretreatment lateral cephalograms of 111 young adult female patients with skeletal Class II division 1 anomalies were compared to those of 54 Class I normal subjects (control group). Class II cases were divided into hyperdivergent (n = 58), hypodivergent (n = 19), and normodivergent groups (n = 34). The heights and widths of the symphysis and alveolus and the depth of maxillary palate were measured on the lateral cephalograms., Results: Mean symphysis width was wider in the hypodivergent Class II group than in the other groups, while mean symphysis height was similar among all groups. Maxillary palatal depth, upper incisor angle, upper and lower molar alveolar heights, and Id-Id' width were also similar among groups., Conclusion: Symphysis width is the main factor in the differential diagnosis of Class II division 1 anomaly rather than symphysis height and hypodivergent Class II Division 1 anomaly is more suitable for mandibular incisors movements.

Objective: The objective of this study was to determine the developments, morphometric features, and shapes of the maxillary and mandibular arches during the prenatal period in a large series of fetal material., Methods: The study was carried out on 225 human fetuses aged between 8 and 40 weeks of gestation. General, extraoral, and intraoral parameters were taken from each fetus. The width and depth measurements and the shapes of the maxillary and mandibular arches were achieved using the casts obtained. The arches were categorized according to the shapes of the anterior and posterior regions of the arches., Results: Palatal and mandibular indices did not change during the prenatal period. Maxillary arch measurements were greater than the mandibular measurements. Moreover, width measurements of both arches were greater than the depth measurements during fetal life. We found that the frequencies of triangular maxillary and mandibular arches were highest in the first and second trimesters; whereas, the square model became more frequent in the third trimester and at full term. Classification of the arches according to their posterior regions showed that the tips of the arches shifted medially toward the term. There were significant correlations between width and depth parameters of the arches and extraoral parameters., Conclusion: Data obtained in the study would be useful for clinicians by presenting an objective scale related to the prenatal period as well as being helpful in assessing the development of this region, identifying the anomalies and pathologies, and assisting treatment.

Objective: The aim of this study was to identify and quantify nasal profile changes following maxillary advancement (MA) and maxillary advancement with impaction (MAI) with Le Fort I osteotomies., Methods: The study consisted of preoperative and postoperative lateral cephalograms of 42 class III adult patients. The study sample was divided into 2 groups, with the first group composed of 22 patients who underwent MA surgery and the second group composed of 20 patients who underwent MAI surgery. In total, 7 skeletal parameters and 17 soft-tissue parameters related to nasal projection, hump, dorsal convexity, and the nasolabial region were evaluated on the cephalograms, and hard- and soft-tissue relationships were assessed., Results: Nasal length, hump, nasal depths, distance from the most convex point of the Alar curvature to the most inferior point of the nostril, alar curvature-subnasale, and subnasale-pronasale measurements decreased postoperatively. In the MAI group, MA correlated with significant decreases in nasal length and hump. In the MA group, MA correlated with pronasale position (P < 0.05); significant decreases in nasal depth, columella convexity, and subnasale-pronasale length; and significant changes in subnasale position., Conclusions: There is little difference in the effects of the 2 different maxillary surgeries on the postoperative nasal profile.

The purpose of this paper was to present a case of surgical exposure of a horizontally impacted permanent maxillary left central incisor followed by fixed orthodontic treatment to eruption in a 9-year-old boy with a 2-mm overjet and 2-mm overbite who had sustained a traumatic injury to his primary maxillary central incisors when he was 6-years-old. Panoramic, occlusal, and cepholometric radiographs showed the affected tooth's crown to be positioned horizontally, and a CT scan showed the impacted central incisor's crown to be located below the anterior nasal spine and its apex to be located parallel to the palatal plane. A treatment plan was devised that included surgically exposing the impacted teeth and applying extrusive forces in the direction of the occlusal plane to bring about eruption. After 22 months of treatment, the central incisor erupted into the oral cavity. The patient now possesses the confidence to smile and enhanced self-esteem.

Objectives: The aim of this retrospective study was to compare the consistency of orthodontic measurement performed on cephalometric films and 3D CT images of cleft lip and palate (CLP) patients., Methods: The study was conducted with 2D radiographs and 3D CT images of 9 boys and 6 girls aged 7-12 with CLP. 3D reconstructions were performed using MIMICS software., Results: Frontal analysis found statistical differences for all parameters except occlusal plane tilt (OcP-tilt) and McNamara analysis found statistical differences in 2D and 3D measurements for all parameters except ANS-Me and Co-Gn; Steiner analysis found statistical differences for all parameters except SND, SNB and Max1-SN. Intra-group variability in measurements was also very low for all parameters for both 2D and 3D images., Conclusions: Study results indicate significant differences between measurements taken from 2D and 3D images in patients with cleft lip and palate.

Introduction: Our aim in this study was to investigate the frequency, distribution, sex differences, and characteristics of supernumerary teeth in a referred Turkish population., Methods: A total of 2599 patients' panoramic radiographs (1360 girls, 1239 boys) were evaluated, including children in both the mixed and the permanent dentitions. Their mean age was 8.6 +/- 0.23 years. Number, location, classification, side, and impaction of supernumerary teeth were evaluated. Furthermore, the development of these teeth was evaluated., Results: Eighty-four supernumerary teeth were found on 69 radiographs; 9 were deciduous and 75 were permanent teeth. Most supernumerary teeth were in the premaxillary region (67%). Mesiodens (n = 43) was the most frequent supernumerary tooth (51.2%). This was followed by the maxillary lateral incisor (15.5%), the mandibular premolar (14.3%), the maxillary canine (9.5%), the maxillary premolar (6%), the mandibular lateral incisor (2.4%), and the mandibular canine (1.2%). Sixty-two (73.8%) supernumerary teeth were impacted. The male-female ratio was 1.13:1, which was not statistically significant., Conclusions: The prevalence of supernumerary teeth in Turkish children was 2.7% in this study.

The aim of this study was to identify the types and etiologies of dento-alveolar injuries among patients who were treated for injuries to maxillary and/or mandibular permanent teeth at the Gulhane Medical Academy, Department of Pediatric Dentistry, Center of Dental Sciences in Ankara, Turkey to provide a basis for determining optimal treatment approaches and educational needs. From a total of 4956 children aged 6-12 years (mean age: 8.91 +/- 1.95) applying to the Center, 472 children (9.5%) were found to have suffered dental injuries during a period of 2 years. Injuries were classified according to drawings and texts based on the WHO classification system, as modified by Andreasen and Andreasen. Injury rates were highest among children age 6 and ages 8-10. The most frequently injured permanent teeth were the maxillary central incisors (88.2%), and the maxillary right central permanent incisor made up 47.2% of all injured teeth. The most common cause of dental trauma was falling while walking or running (40.3%). Most injuries involved a single tooth (64.8%). The most common type of injury was enamel fracture (44.6%). There was a significant difference in gender, where boys more often suffered from a dental hard tissue and pulp injury than girls (P = 0.019), whereas there was no difference in gender (P = 0.248) in the distribution of periodontal injuries. Injuries were found to occur more frequently during the summer (P < 0.001). Children with increased overjet were 2.19 times more likely to have dental injuries than other children. Considering that the incidence of traumatic dental injury is highest among children ages 6 and ages 8-10 as well as the fact that patients with increased overjet are more prone to dental trauma, preventive orthodontic treatment in early mixed dentition may play an important role in reducing traumatic dental injuries.

Orofacial trauma is a serious orodental and general health problem that may have medical, esthetic and psychological consequences for children and their parents. When the root of the primary tooth is close to the unerupted permanent tooth, primary tooth trauma may result in developmental disturbances and pulpal reaction in that permanent tooth. We report an unusual case in which injury to the primary dentition resulted in developmental disturbances in the crown and the calcified structures in the pulp chamber of the permanent tooth. Localized malformation of the crown and enamel hypoplasia were treated with a light-cured composite resin restoration. We also discuss the formation of pulp calcification and the need for endodontic treatment.

Objective: To examine inconsistencies in the differential diagnosis of open bite., Materials and Methods: Using visual judgments, a total of 77 anterior open-bite cases in the postpubertal growth period were grouped as either morphogenetic, functional, or combination. The same sample was also grouped as either hyperdivergent, normodivergent, or hypodivergent using mandibular-plane angle and conventional cephalometry. Kappa analysis was used to test the agreement between the 2 methods of evaluation, and chi2 tests were used to analyze the distribution of cephalometrically grouped hyperdivergent, normodivergent, and hypodivergent cases among the visually assessed morphogenetic, functional and combination groups and vice versa. A kappa score of 0.343 indicated a weak agreement between visual judgment and cephalometric methods of evaluation (P < .001)., Results: Despite the expectation that cases evaluated as hyperdivergent using cephalometry would be visually evaluated as morphogenetic, more than half of the cases assessed as hyperdivergent were in fact classified as functional., Conclusions: These findings highlight the inadequacy of relying solely on cephalometric evaluation to classify open bite.

Pseudoxanthoma elasticum (PXE) is an inherited disorder that has both autosomal recessive and autosomal dominant pathways and is characterized by severe malformation of elastic and collagen fibers. Clinically, 3 main groups of systemic findings involving skin, eye, and vessels emerge in the symptoms. In this report, we present the case of a patient with PXE who has agenesis of most of the permanent teeth. No previous reports in the English literature have mentioned oligodontia in PXE. Our treatment plan consisted of extraction of the upper left deciduous canine followed by fixed orthodontic treatment. Further prosthodontic rehabilitation was planned to restore the edentulous area.