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A 32-year-old female with a repaired right unilateral cleft lip and palate underwent several surgical and orthodontic procedures during the rehabilitation process of her condition. Nine years after this extensive treatment she underwent transverse relapse of her maxilla and requested a consultation for its correction as she felt her speech and chewing were negatively affected. She presented with a transverse maxillary arch collapse on the cleft side with significant palatal scarring secondary to multiple palate procedures. A course of maxillary expansion and dental alignment with fixed orthodontic appliances was carried out. In addition, she had 2 triamcinolone injections 7 months apart while undergoing orthodontic treatment and one 10 months after completion to soften the scarred palatal tissues. The maxillary arch was successfully expanded and aligned. She was retained with a removable chrome cobalt palatal frame to be used full-time and assure stability of the correction. She has been followed for 4 years with no clinical evidence of relapse. Triamcinolone injection into significant palatal scarring in cleft palate patients with a decreased transverse maxillary dimension can be considered an adjunct procedure in conjunction with orthodontic treatment.

Rapid maxillary expansion is one of the most common orthodontic procedures performed in the pediatric population, easy to accomplish and compliance free, therefore really effective. Nevertheless, a careful diagnosis and frequent clinical follow-up appointments are necessary during the first weeks of active treatment. The purpose of this article was to report two cases of unexpected complications during orthopaedic maxillary expansion, involving two 7-year-old female patients, one presenting a saddle nose with suborbital hematoma and the other one an asymmetric palatal expansion. In both cases, the clinical situation progressively relapsed during the months following expansion appliance removal.

Background To investigate the skeletal development of HIV infected children through a morphological analysis of the cervical vertebrae (CV) in lateral cephalometric radiographs. Material and Methods The sample consisted of 86 lateral cephalometric radiographs of male and female children aged between 6 and 14 years old. The radiographs were equally distributed in groups 1 (HIV infected children) and 2 (non-infected children, paired by sex and age). Two examiners analyzed the CV according to the method of Hassel and Farman (1995). Spearman correlation coefficient was used to associate age and skeletal development within groups, while Mann-Whitney test compared the skeletal development between groups. Results The correlation of age and skeletal development in group 1 reached 0.17, 0.27 and 0.27 (p >0.05) for C2, C3 and C4, respectively, while in group 2 it reached 0.65, 0.54 and 0.60, respectively (p 0.05). Conclusions HIV infected and non-infected children showed a similar development of the CV. However, the weak correlation between age and CV development in HIV infected children highlights the need for careful decisions prior to therapeutic approaches – especially those founded on the prediction of skeletal development, such as maxillofacial surgeries, and orthopedic and orthodontic procedures. Key words:Cervical vertebrae, growth and development, HIV, radiology.

Unilateral palsy of the hypoglossal nerve is a rare complication of orthodontic procedures. The main reported causes of HNP are: orthopedic and otorhinolaryngology surgical interventions, and in particular maneuvers involving compression or overstretching of the hypoglossal nerve, dental procedures and traumas, and also infections, motoneuron disorders, tumors, vascular diseases. Diagnosis is usually performed by electrophysiology studies (EMG-VCN), and brain magnetic resonance imaging (MRI) is useful to exclude other causes. The prognosis depends on the location and extension of the damage. Currently there is not a standardized treatment approach except the speech therapy, although, in some cases, the high-dose steroid treatment could be useful. We describe the case of a ten-year-old female, who was admitted in our Unit after a deviation of the tongue associated with dysarthria and dysphagia, occurred after the application of a mobile orthodontic device.

OBJECTIVE: The purpose of this study was to analyze the psychological aspects of adult patients who sought and underwent orthodontic treatment, evaluating their expectations and discomfort during treatment, as well as their satisfaction after completion of dental movement. RESULTS AND CONCLUSIONS: Data obtained from previous published papers, and also from questionnaires answered by 54 patients, showed that adult patients stood out for their attention to details and high interest in the esthetic improvements provided by treatment, and also for a greater perception of their initial malocclusion. On the other hand, the same data showed that adult patients, once informed about the limitations of their treatment and having confidence on the orthodontist, presented a high level of satisfaction with treatment results, revealing themselves as good patients for indication and execution of orthodontic procedures. OBJETIVO: o propósito desse trabalho foi analisar as características psicológicas dos pacientes adultos que procuraram e se submeteram a tratamentos ortodônticos, avaliando suas expectativas, desconforto durante o tratamento e satisfação final após a conclusão das movimentações dentárias propostas. RESULTADOS E CONCLUSÕES: os dados obtidos por meio de uma revisão bibliográfica e de questionários realizados com 54 pacientes demonstraram que os pacientes adultos se destacaram por serem mais detalhistas e exigentes em relação às melhoras estéticas proporcionadas pelo tratamento, e por apresentarem uma maior percepção de sua má oclusão antes do início do tratamento. Por outro lado, esses mesmos dados demonstraram que os pacientes adultos, uma vez bem esclarecidos sobre as limitações peculiares ao seu tratamento e sentindo-se bem amparados e orientados pelos profissionais responsáveis, apresentaram um alto índice de satisfação frente aos resultados finais do tratamento, sendo ótimos pacientes para a indicação e execução de procedimentos ortodônticos.

金沢大学医薬保健研究域医学系

As in the traditional combined surgical and orthodontic procedures, an Orthodontist can plays vital role in treatment planning and the orthodontic treatment of patient undergoing distraction osteogenesis. This role includes predistraction assessment of the craniofacial skeleton and occlusal function, pre-distraction, and post-distraction orthodontic care. Based on clinical evaluation, dental study models, photographic analysis, cephalometric evaluation, and three-dimensional computed tomographic analysis, the Orthodontist, in collaboration with the Surgeon, plans distraction device placement and the predicted vectors of distraction. Finally, as in other forms of orthognathic surgery, the practice of distraction osteogenesis depends on the cooperation and planning between orthodontist and surgeon as a team. Purpose of this paper is to review biomechanics and orthodontic treatment protocol of distraction osteogenesis in the maxillofacial region.

Introduction Mini-implants are placed in restricted sites, requiring an accurate surgical technique. However, no systematic study has quantified technique accuracy to reliably predict the surgical risks. Therefore, a graduated 3-dimensional radiographic-surgical guide (G-RSG) was proposed, and its inaccuracy and risk index (RI) were estimated. Methods The sample consisted of 6 subjects (4 male, 2 female), who used mini-implant anchorage. Ten drill-free screws (DFS) were placed by using the G-RSG. The central point of the mesiodistal septum width (SW) was the selected implant site on the presurgical radiograph. The distances between DFS and the adjacent teeth (5-DFS and 6-DFS) were measured to evaluate screw centralization and inaccuracy degree (ID). These distances were statistically compared by independent t tests, and inaccuracy was determined by the expression ID = (5-DFS – 6-DFS)/2, which represents deviation of the mini-implant's final position regarding the central point initially selected. Then SW, ID, and screw diameter (SO) were combined to estimate the surgical risk with RI expressed by RI = SO/SW – ID. Results The 5-DFS and 6-DFS distances were not significantly different. The ID of the G-RSG was 0.17 mm. The low ID ensured a safe RI ( Conclusions The G-RSG accuracy allowed fine prediction of the final DFS position in the interradicular septum, with a low RI, which is a helpful tool to estimate surgical risks.

Neste estudo, apresenta-se relato de caso clínico de um paciente do gênero masculino, com 11 anos e 2 meses, portador de maloclusão de classe II de Angle, sobremordida e curva de Spee acentuadas e tendência de crescimento equilibrado. Após análise do perfil do paciente, dos modelos de estudo e da avaliação cefalométrica, optou-se pelo tratamento com disjunção, exodontia de quatro pré-molares, intrusão dos dentes anteriores inferiores, segundo a técnica do arco segmentado. Essa técnica consiste em uma seqüência de procedimentos ortodônticos baseados em princípios mecânicos, guiados por sistemas de forças, que regem a movimentação dos dentes, o que possibilita controlá-la da melhor maneira, levando em consideração a magnitude e o ponto de aplicação da força, a localização do centro de resistência e a rotação para aplicação da técnica. Neste trabalho, tem-se como objetivo analisar essa opção de tratamento da mordida profunda e também sua filosofia e princípios mecânicos.

To investigate the expression of osteocalcin during rapid orthodontic tooth movement aided by alveolar surgery in beagle dogs.Eight male beagles were used, and bilateral mandibular second premolars were extracted for distalization of the first premolars against the third premolars by orthodontic NiTi coil spring with a force of 100 gm. Right and left mandibular sides were randomly assigned to experimental and sham sides, and alveolar surgery was performed only on the experimental side to reduce the osteal resistance on the mesial side of the extraction socket. Distance of tooth movement was measured once a week during the first 4 weeks. Two beagles were sacrificed after 1, 2, 4, and 8 weeks of orthodontic force application, and expression of osteocalcin was demonstrated by immunohistochemistry and quantified with computer-aided image analysis.The average total movement of the first premolars in 4 weeks on the experimental side (1.868 +/- 0.022 mm) was approximately double that on the sham side (1.008 +/- 0.057 mm). As regards the average total anchorage loss, no significant difference (P.05) was revealed. Dynamic osteocalcin concentrations presented at 4 time periods (P.05). The staining intensity of osteocalcin on the experimental sides was higher than the corresponding sham sides, and that on the compression sites higher than the corresponding tension sites (P.05).The results suggested that alveolar surgery might serve as an effective and safe way to accelerate orthodontic tooth movement, and promote the rate of bone remodeling as revealed by the expression of osteocalcin.

The common protocol of a week-long duration of elastomeric separators to facilitate band placement usually causes discomfort. In this study, we examined the minimum separation time required to create an interproximal space0.16 mm (band thickness), the interproximal changes over 24 hours after separator removal, and the mechanical characteristics of various separators.Thirty subjects, ages 28.1 +/- 2.8 years, had an elastomeric separator placed between the mandibular second premolar and first molar (CP5-6) for 1, 4, 12, and 24 hours. After separator removal, CP5-6 was measured for space and tightness of dental contact point (TDCP) changes up to 24 hours after separator removal. The mechanical behaviors of 6 manufacturers' separators were compared.After 12 and 24 hours of separation, all patients demonstrated space0.16 mm (P.001). A significant negative correlation (R = -0.59 to -0.63; P = .001) was found between baseline TDCP and the space measured at separator removal. A biphasic viscoelastic recovery (82%-95%) to baseline tightness level occurred within 24 hours. Variation between manufacturers was low (9%).Separators should be placed a day before banding. The patient should arrive 3 to 4 hours before the appointment for separator replacement if the separator is lost. Rapid recovery after separation removal implies the biological soundness of elastomeric separation regardless of the manufacturer used.

Cognitive, affective, and behavioral responses to pain associated with mechanical tooth movement differ from responses to other procedures involved in changing physical appearance. Although orthodontic treatment can be an unpleasant experience that may be painful at times, it is more of a discomfort that can be attenuated by the expectation of improvement in quality of life resulting from an improvement in occlusion and facial morphology. In contrast to the almost immediate changes in appearance following plastic surgery, patients undergoing orthodontic treatment have a longer time to adjust their perceptions, emotions, and behavior to the relatively smaller changes in morphology. Techniques for managing the discomfort and behavioral changes associated with orthodontic procedures are described.

Summary Routine othodontic management is unavoidable in all patients with cleft lip and palate after primary surgery. This management combines dental arch alignment with maxillary expansion of the lesser fragment before alveolar bone grafting. To treat dental arch asymmetry, the space of the missing lateral incisor is preserved until the age of dental implant. Otherwise, dento-orthopedic treatment attempts to normalize transversal dental dimension once alveolar bone grafting is done in order to prepare the surgical advancement of the maxilla.

SUMMARY Patients with clefts of lip, alveolus and palate or some facial syndromes need complex and long-lasting orthodontic therapy. The possibility of orthodontic anchorage is often limited by congenital absence of teeth, disturbed skeletal growth or failing compliance with extraoral sources of force. Correct positioning and insertion provided, miniscrews can serve as anchorages and shorten the period of active treatment in patients with clefts. With the help of a case presentation, an outline of using orthodontic miniscrews (like: Titan, Forestadent®) for anchorage in patients with clefts of lip, alveolus and palate is given along with a discussion of advantages and disadvantages. Thus miniscrews are suited for use in cleft patients. However, they require careful orthodontic and surgical planning.

The aim of this study was to explore the use of mini-implants for skeletal anchorage, and to assess their stability and the causes of failure. Forty-five mini-implants were used in orthodontic treatment. The diameter of the implants was 2mm, and their lengths were 8, 10, 12 and 14mm. The drill procedure was directly through the cortical bone without any incision or flap operation. Two weeks later, a force of 100-200g was applied by an elastometric chain or NiTi coil spring. Risk factors for the failure of mini-implants were examined statistically using the Chi-square or Fisher exact test as applicable. The average placement time of a mini-implant was about 10-15min. Four mini-implants loosened after orthodontic force loading. The overall success rate was 91.1%. The location of the implant was the significant factor related to failure. In conclusion, the mini-implants are easy to insert for skeletal anchorage and could be successful in the control of tooth movement.

Objective : To determine patients′ expectation, acceptance and experience of pain with mini-implants. Materials and methods: Thirty patients were treated with 60 oral mini-implants (OMIs) measuring 1.6 mm in diameter and 6 mm in length. Each patient was given a questionnaire that included a visual analog scale to indicate discomfort after implantation. One month after insertion of miniimplant patients were asked to rate their acceptance of procedure using structured questionnaire. Results: The postoperative pain experienced decreased continuously from days 1 to 7 for all orthodontic procedures. Most patients were satisfied with mini-implant surgery and would recommend it to a friend or family member. Conclusion: Patients tended to overestimate pain anticipated with mini-implant surgery. Patients were accepting of the surgery and would recommend it to others.

Distraction and segment transport are accepted treatments for fracture management. This study shows distraction as the more efficient method for osteoinduction.

論文(Article)

Resume Introduction. – Le but de cette etude est de revoir les modalites techniques et les indications de la greffe osseuse secondaire dans les fentes labio-maxillo-palatines (FLMP). Materiel et methode. – Soixante-deux greffes osseuses secondaires ont ete revus retrospectivement de 1993 a 2000. Il y avait 50 FLP unilaterales et 12 FLP bilaterales. L'âge au moment de la greffe osseuse va de 9 ans a 25,5 ans, avec une moyenne de 14,34 ± 2,9 ans. Le meme operateur a pratique une GingivoPeriOsteoplastie (GPO) dans tous les cas et le greffon utilise etait de l'os spongieux de crete iliaque dans tous les cas. Resultats. – Il existe trois types d'indications de la greffe osseuses. Premierement la greffe osseuse interceptive (50 %) : elle a ete realisee avant le traitement orthodontique a 12,8 ± 2,3 ans. Elle apporte un support osseux pour les dents de bord de fentes. Deuxiemement la greffe de stabilisation (33,8 %) : elle stabilise le traitement orthodontique et/ou pour preparer une chirurgie orthognathique (15,2 ± 1,6 ans). Troisiemement la greffe de comblement (16,2 %) : c'est une greffe secondaire tardive en fin de croissance (17,3 ± 3,6 ans) de correction des sequelles. Elle restaure la continuite du maxillaire, stabilise les dents de bord de fente et prepare une rehabilitation prothetique. Conclusion. – Les avantages de la greffe osseuse secondaire avec GPO sont nombreux et elle fait partie du protocole de traitement des patients porteurs d'une FLMP. Un suivi multidisciplinaire est necessaire pour poser l'indication.

Objective. The objective of this study was to determine the cytocompatibility of 5 different extracts of resin-based restorative materials (2 resin-modified glass ionomer cements, 1 compomer, and 2 composite resins) on human pulp cells. Study Design. Set specimens from 2 resin-modified glass-ionomer cements (Fuju II LC and Fuji IX), 1 compomer (Dyract), and 2 composite resins (Tetric and Superfil) were eluted with culture medium for 2 and 5 days. The effects of resin-based restorative materials on human pulp cells were evaluated with cytotoxicity and mitochondrial activity assays. Results. The results showed that the eluates from resin-modified glass-ionomer, compomer, and composite resins were cytotoxic to primary human pulp cells. In addition, Superfil, Fuji IX, and Tetric demonstrated an inhibitory effect on mitochondrial activity of human pulp cells. It was found that composite resin Superfil was the most toxic restorative material among the chemicals tested. Conclusion. The influence of the cytotoxicity depended on the materials tested. Compomer or light-curing resin-modified glass ionomer may initially react more favorably to pulp cells. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:361-5)

Objective This paper reports the experience with a two-stage approach to surgical correction of the complete cleft palate, wherein timing of the second stage is dependent on the judgment of the speech pathologist and the orthodontist together with the surgeon. Patients Of a total of 35 patients having complete unilateral clefts a sample of 22 were available for postsurgical assessment. The first-stage repair of the palate was carried out at an average age of 10.7 months (range 6 to 17 months), and the second-stage repair of the residual cleft was completed at an average age of 32.7 months (range 26 to 34 months). Interventions The first-stage repair of the soft palate defect involved mobilizing two short posteriorly based flaps, which extend onto the posterior quarter of the hard palate thus including up to 1 cm of mucoperiosteum. Careful freeing of the muscle is followed by an intravelar veloplasty. The later closure of the residual cleft involved turnover hinge flaps and small mucoperiosteal flaps. Results Eighty-seven percent of the sample had good to excellent speech as assessed by the Great Ormond Street screening method. Only two patients showed evidence of recessive maxillae with Class III malocclusions. Conclusions A two-stage surgical closure of the palate using this procedure would appear to confer several valuable advantages to the patient. These include favorable outcomes for speech in the large majority of cases and minimal adverse effects on the growth of the midface region.

An original alveolar osseous distraction method using a Hyrax orthodontic device connected to two miniplates modified as a skeletal orthodontic anchorage (Bollard™ type) is reported and illustrated by three cases. In all three cases with alveolar bone insufficiency, the alveolar osseous distraction allowed for dental implant positioning and fixed dental prosthetic rehabilitation.

The case records of 72 patients in Northern Ireland who had secondary bone grafting of 94 alveolar clefts between 1987 and 1997 were examined. Details were recorded of age, sex, laterality of cleft, preoperative orthodontic treatment, whether grafting was combined with soft tissue revision, method of harvesting the graft, complications, eruption of canines, and the success of grafting as established by bone levels around the erupted canine. Bone levels were assessed on a four-point scale. Of 64 canines fully erupted in 94 clefts, 91% achieved bone levels of Type I or II and only two grafts failed. The outcome was more favourable when the canine was unerupted preoperatively.

The purpose of this study was to investigate the possibilities of distraction osteogenesis to correct mandibular hypoplasia. Fourteen young patients (mean age 14.1 years) with a proven resistance to initial, functional orthodontic therapy, were treated by means of bilateral intraoral distractors. The corticotomy was performed in the region of the third molar. The latency time was six days and the stabilization period six weeks. In all cases the planned lengthening of the mandible and class 1 occlusion were achieved. Seven patients required additional elastic band traction to close a mild open-bite directly after active distraction. In the first seven patients, insufficient mobilization at the site of the corticotomy had resulted in a broken distraction rod in two patients and incomplete distraction of the lingual cortex in one patient. Adequate mobilization at the site of the corticotomy prevented these problems in later cases. No permanent sensory disturbances were seen. Twelve patients finished their orthodontic treatment within six months after distraction.

Resume Introduction La reparation des automutilations faciales est souvent vouee a l’echec si la reconstruction n’est pas protegee. Les auteurs rapportent la prise en charge d’une autophagie labiale par un procede orthodontique : le lip bumper. Observation Une patiente, de quatre ans, s’automutilait la levre inferieure, dans un contexte de syndrome polymalformatif. La perte de substance concernait les deux tiers de la levre inferieure. Le traitement a associe une antibiotherapie, des soins locaux, une prise en charge psychiatrique, puis un lip bumper. L’evolution locale a ete favorable sans reconstruction secondaire. Discussion Le lip bumper ou pare-choc labial est un procede orthodontique simple qui eloigne la levre inferieure des arcades dentaires en la projetant en avant. Il a permis de rompre le cercle vicieux « agitation–mutilation–d’infection ».

Five cases of dentin dysplasia type I within one family are described. Clinically and radiologically, such patients are characterized by a delayed eruption pattern, opacity of the incisional margins, hypermobility of the teeth, short and defective roots, and obliterated pulp chambers. A conservative attitude toward the treatment of common conditions in dentin dysplasia type I favors the preservation of a vulnerable dentition.

Hintergrund: Die rezidivierende Parotitis stellt nach der Parotitis epidemica die haufigste entzundliche Speicheldrusenerkrankung im Kindesalter dar, deren Pathogenese ungeklart ist. Fallbericht: Wir stellen einen 10 Jahre alten, seit 1 Jahr orthodontisch versorgten Jungen mit einer rezidivierenden einseitigen Schwellung der Glandula parotis vor, dessen Hauptbeschwerden durch Kauschmerzen sowie ein uncharakteristisches Spannungsgefuhl der betroffenen Gesichtsseite gekennzeichnet waren. Serologisch fanden sich keine Hinweise auf eine Virusinfektion oder Autoimmunerkrankung. In der Sonographie zeigte sich eine vergroserte Parotis mit multiplen echoarmen Arealen. Die durchgefuhrte Sialographie erbrachte das typische Bild von multiplen zystischen Gangektasien und -stenosen. Therapeutisch verordneten wir speicheltreibende Masnahmen. Nachdem es 4 Monate spater zu einem Rezidiv gekommen war, wurde die orthodontische Versorgung entfernt. Seitdem ist der Patient rezidivfrei. Diskussion: Aufgrund ihrer guten Prognose sollte die rezidivierende Parotitis mit moglichst konservativen Masnahmen behandelt werden. Ursachlich konnte die Parotitis durch Mikrotraumen am Ausfuhrungsgangsystem infolge Manipulation durch die orthodontische Versorgung ausgelost worden sein.

Purpose: This study evaluated whether orthodontists' treatment of patients was influenced by their perception of the justification for the cost of Orthognathic surgery. Materials and Methods: A survey of 334 Canadian orthodontists was used to determine what factors influenced views of cost justification. Results: Approximately 80%, 49%, and 9% of orthodontists perceived cost of surgery to be justified for severely, moderately, and mildly compromised patients, respectively. Whether the compromise was functional or aesthetic did not particularly affect their views. Least experienced orthodontists were more likely than more experienced orthodontists to perceive cost of surgery as justified for patients with moderate functional compromise (P < .01). Most experienced orthodontists were more likely than less experienced orthodontists to perceive cost of surgery as unjustified for patients with moderate aesthetic compromise (P < .01). Orthodontists who did not believe cost of surgery to be justified for patients with mild or moderate compromise tended to recommend Orthognathic surgery less frequently than camouflage orthodontics for borderline surgery patients (P < .05). Conclusions: The findings suggest that costs may be contained by orthodontists rationing surgery on the basis of severity of facial skeletal malrelationship and perception of justification of cost. Less experienced orthodontists are less likely to contain costs for patients with moderate functional and aesthetic compromise. Most experienced orthodontists are less likely to contain costs for patients with severe functional compromise. Patient satisfaction may be affected by rationing, which affects the treatment approach and thus the outcome.

Purpose: This study evaluated the results of periradicular surgery performed using ultrasonic root-end preparation. Patients and Methods: The course of healing during observation periods ranging from 6 months to 3 years was examined in 157 teeth. Results: One hundred forty-five teeth were successfully treated, for a success rate of 92.4%. Conclusion: It was concluded that the ultrasonic root-end preparation technique for periradicular surgery is a simple procedure that provides excellent results.

The principle of distraction osteogenesis can be applied to the dentoalveolar region. Reported applications include vertical height augmentation of the alveolus and creation of new edentulous alveolar ridge. The newly created ridge can be used for rapid orthodontic movement, to facilitate closure of wide alveolar cleft and reconstruction. The application of interdental distraction osteogenesis to the management of a case of maxillary hypoplasia with severe dental crowding in repaired cleft palate is presented to illustrate the feasibility of utilizing the principle of interdental distraction osteogenesis to create new bone for tooth alignment and simultaneous correction of maxillary hypoplasia.

Computed tomography (CT) was used to determine the fate of the bone graft in cleft lip and palate patients. Eight right-sided unilateral cleft lip and palate patients from the Free University Hospital in Amsterdam, treated with early, secondary bone grafting, were evaluated immediately after the operation and 1 year postoperatively. Approximately 70% of the volume of transplanted iliac crest bone was still present in the cleft area after 1 year.

Orthognathic surgery for the cleft lip and palate patient should be designed to achieve good facial aesthetics and a stable, functional occlusion. Maxillary and mandibular osteotomies, which benefit cleft lip and palate patients with associated dentofacial deformities, should be modified to meet the needs of the individual patient. Soft-tissue correction of the upper lip and nose adds to the overall aesthetic result, but should be performed as a separate procedure.

We report a simple, effective method of managing displaced unilateral condylar fractures with occlusal disruption using vacuum-formed thermoplastic foil splints with bonded wire cleats. The cleats enable intermaxillary fixation in the form of orthodontic elastics to be used, which guide then maintain the occlusion in centric relation. A case is presented in which this technique was used successfully.

This study assessed the adequacy of anchorage strength of infrazygomatic mini-implants in vertical and horizontal directions. Each brand of infrazygomatic mini-implant tested provided acceptable skeletal anchorage.

The aim of this study was to measure the heat generated when using a self-drilling miniscrew at speeds of 50, 100, 150, and 250 rpm. Specimens were classified into two groups: in the thin group the cortical bone thickness was 1.2 ± 0.02 mm on average and in the thick group it was 2.0 ± 0.03 mm on average. The thin group was used to model maxillary bone and the thick group to model mandibular bone in humans. The temperature in the 1.2-mm and 2.0-mm cortical bone specimens was measured according to revolution speed. As the revolution speed increased, the temperature significantly increased in both bone thicknesses. The temperature increased significantly more in the thicker cortical bone. The temperature increase in the 2.0-mm thick bone at 250 rpm exceeded 10 °C, regarded as the threshold for bone damage in this study; other temperature increases were below this threshold. Installing self-drilling screws at high speeds with an implanter is not recommended; low speeds of less than 150 rpm should be used.

Item does not contain fulltext INTRODUCTION: Our aim was to assess effectiveness of the cervical vertebral maturation (CVM) method to predict circumpubertal craniofacial growth in the postpeak period. METHODS: The CVM stage was determined in 176 subjects (51 adolescent boys and 125 adolescent girls) on cephalograms taken at the end of treatment (T2; mean ages, 15.75 years [boys] and 15.23 years [girls]) in subjects from the postretention database at the University of Washington in Seattle. Craniofacial growth was evaluated from the following measurements on cephalograms at T2 and end of follow-up (T3) (mean ages, 29.01 years [men] and 28.08 years [women]): condylion to gnathion, condylion to gonion, gonion to gnathion, sella to gnathion, nasion to menton, anterior nasal spine to menton, and sella to gonion. The change of each variable from T2 to T3 was assessed with paired t tests. Parametric (t tests or analysis of variance [ANOVA]) or nonparametric (Mann-Whitney or Kruskal-Wallis) tests were used to detect intergroup differences. RESULTS: One hundred eight subjects (35 boys, 73 girls) demonstrated CVM stage 3, 56 (16 boys, 40 girls) were in CVM stage 4, and 12 (all girls) were in CVM stage 5 at T2. Intrasex comparisons showed that boys in CVM stages 3 and 4 could be differentiated regarding changes of all variables. In the girls, only those in CVM stages 3 and 4 could be differentiated based on the amount of changes of 2 measurements: condylion to gonion and sella to gonion. Intersex comparisons showed that boys in CVM stage 3 had significantly more changes than girls (P

Proper site development is a key factor for long-term clinical success of dental implants. Whereas surgical and restorative techniques have been refined to ensure predictable functional and esthetic outcome, individual clinical prerequisites do not always allow proper placement of implants when prosthetic and material properties are considered. Orthodontic tooth movement may be a viable and nonsurgical site development treatment option. With the introduction and advancements of minimal invasive and less visible orthodontic appliances, a growing number of adult patients are willing to obtain orthodontic treatment. The spectrum of modern appliances is broad and ranges from clear aligners to lingual brackets. Skeletal anchorage devices such as orthodontic mini-implants often eliminate unpopular external anchorage devices (ie, headgear) in adult patients, This article discusses the selection of an appropriate pretreatment approach by taking patient-specific criteria into account.

Introduction The purpose of this study was to report on the clinical outcomes of a 24-month orthodontic residency. Methods One examiner scored 1019 consecutive pretreatment records and 714 consecutive posttreatment records annually over 5 years, using the American Board of Orthodontics discrepancy index and objective grading system. Results The mean discrepancy index scores were 19.63, 14.84, 12.30, 15.72, and 15.39 for years 1 through 5, respectively. The mean objective grading system scores were 31.16, 34.79, 28.55, 26.28, and 22.11 for years 1 through 5, respectively. The residents' completion rates for all cases were 58.9%, 60.5%, 82.7%, 74.4%, 78.2%, and 72.2% for years 1 through 5, respectively. Conclusions The establishment of an annual objective outcomes assessment benefited patients by improving objective grading system scores and reduced the number of transfers between residents (increased case completion rate), thus reducing faculty time for managing many transfer patients.

Although the cause of the midfacial anomalies in Apert syndrome is still elusive, a great experience has accrued in the management of these physically and psychologically handicapping deformities. An interdisciplinary approach that includes input from an orthodontist, pediatric dentist, and oral and maxillofacial surgeon should be an integral part of the management of affected patients. This theme of surgical-orthodontic-dental communication and interaction is stressed and illustrated throughout the article.

Using the same arguments as for early bone grafting of the alveolar process in unilateral clefts, the cleft team of the University of Nijmegen started about 10 years ago to apply early osteotomy-stabilization of the premaxilla to bilateral clefts. A series of 13 cases with a minimum follow-up of 15 months is presented. The patients were operated on at the age of 8 2/12 to 12 5/12 years. The results are considerably better than when doing the same operation in the adult. More than 90% are successful. In comparison with adults we additionally register more favourable eruption of the canine, the possibility of closing the dental arch without prosthetic appliances and in some cases also the elimination of a psychological handicap. The inhibition of growth by this operation seems not to be important. If need be, Le Fort I osteotomies are possible after completion of growth. They will be in one piece which is technically easier than the usual three-segment Le Fort I. In conclusion we prefer early secondary osteotomy and stabilization of the premaxilla to the tertiary operation.

Attention is drawn to premature aging of the face after orthognathic surgery. Three examples are given of patients of around 30 years or over in whom maxillary excess was reduced. Suggestions for prevention of this (rare?) complication are made.