Haluk İşeri

Continued eruption of maxillary incisors and first molars in girls from 9 to 25 years, studied by the implant method

The aim of this study was to describe the average and individual patterns of continued eruption of the maxillary incisors and first molars in a longitudinal sample of girls. The sample comprised 14 series of lateral cephalometric films of girls, obtained from the archives of the implant study of Björk (1968). All subjects had bilateral posterior maxillary implants and one or two anterior maxillary implants. Subjects with craniofacial anomalies were excluded. The sample represented various types of malocclusions, but records during periods of orthodontic treatment were excluded from the calculation of average data and average curves. The final sample comprised 147 radiographs in the age range 9-25 years. Data were debugged by comprehensive numerical and graphical procedures. The average cumulative continued eruption from 9-25 years of age was 6 mm downwards and 2.5 mm forwards for the upper incisors, and 8 mm downwards and 3 mm forwards for the upper first molars. This resulted in an average reduction of the occlusal plane inclination (OLs/IPLs) of 4.5 degrees from 9-16 years. Attention is drawn to the fact that due to the continued eruption of the natural teeth, the use of osseointegrated implants with artificial teeth should not be recommended in childhood, adolescence, and early adulthood, unless special provision is made for later revision or replacement of the artificial teeth to compensate for the lack of continued eruption of such implants.

Effects of a bonded rapid maxillary expansion appliance during orthodontic treatment.

The aim of this prospective study was to evaluate changes in the transverse plane following use of an acrylic bonded rapid maxillary expansion (RME) appliance in growing individuals during the active phase of treatment. The sample comprised 14 consecutively treated orthodontic patients (11 girls, 3 boys) who required the use of an RME device on the basis of their individual treatment plans. The mean patient age at the start of treatment was 12.8 years, and the mean overall treatment time was 3.08 years. Seven posteroanterior cephalometric and two dental cast measurements were assessed. Repeated measure analysis of variance and Duncans multiple range test were used to assess treatment changes. Lower nasal and maxillary base widths and angles, and upper intermolar width increased significantly during RME treatment. Upper intermolar and intercanine widths measured from the dental casts also increased significantly. Except for upper intercanine width, all measurements remained constant at the end of orthodontic treatment. The results of this study suggest that dentoskeletal changes in the transverse dimension following the use of an acrylic bonded RME are maintained satisfactorily at the end of fixed appliance therapy.

Ten-year follow-up of a patient with hemifacial microsomia treated with distraction osteogenesis and orthodontics: An implant analysis

INTRODUCTION Distraction osteogenesis (DO) has become an accepted treatment method for patients requiring mandibular lengthening because of congenital malformations. However, the skeletal growth pattern of a distracted mandible in the long term has still not been clearly shown in the literature. The purpose of this report was to analyze the dentofacial changes observed during a 10-year follow-up period in a patient treated with mandibular DO. METHODS The patient was a 12-year-old girl with hemifacial microsomia who had undergone DO with an external device. Morphologic changes during the observation period were evaluated on panoramic radiographs and posteroanterior and lateral cephalograms. Six Björk-type titanium implants were placed bilaterally in the mandible under local anesthesia to analyze the mandibular skeletal changes over time. RESULTS Marked lengthening was achieved during the active phase of mandibular distraction. The ratio between the ramus heights of the affected and normal sides improved significantly in the affected sides favor as the mandible was lengthened, but this ratio returned to its initial value after 10 years. CONCLUSIONS Although there was some growth on the affected side during the follow-up period, it was not enough to catch up with the growth on the normal side. The original asymmetry recurred as a consequence of the growth pattern in this patient with hemifacial microsomia.

Average surface remodeling of the maxillary base and the orbital floor in female subjects from 8 to 25 years. An implant study.

The present study aimed to analyze the surface remodeling of the maxilla by the method of metallic implants. The sample comprised 14 series of lateral cephalometric films of girls, and was derived from the files of the implant study of Björk. Implants had been inserted below the anterior nasal spine and on the lower anterior surfaces of the zygomatic arches. Various types of malocclusion were represented in the sample, but records during periods of orthodontic treatment and retention were excluded from the analysis. No subjects with craniofacial anomalies were included. The final sample comprised 155 radiographs in the age range 8 to 25 years. In addition to the anatomically defined reference points, six fiducial points and two implant points in the maxilla were digitized from each film. Data were debugged by comprehensive numerical and graphical procedures. The average relocation of the reference point subspinale (ss, Downs A point) was about 4.5 mm down and 0.5 mm forward from 8 to 25 years, whereas the reference point spinal (sp, ANS) was relocated about 4.5 mm down and 1 mm forward. The reference point pterygomaxillare (pm, PNS) was relocated 6 mm backward and 1.5 mm down by surface remodeling. The relocation of the sp and pm points resulted in an angular remodeling of the palatal plane of 2.5 degrees (backward). At the same time the maxillary complex rotated -1.5 degrees (forward) in relation to the anterior cranial base, resulting in a 1 degrees increase in the inclination of the palatal plane to the anterior cranial base. The orbital floor showed an average relocation of about 2.5 mm up and 2 mm backward by surface apposition, partly masking both the downward and forward sutural translation and the average forward growth rotation of the maxilla. Because of the angular remodeling of the palatal plane and the surface apposition on the hard palate, it is recommended that great caution be exerted in the interpretation of clinical treatment analyses based on superimposition on lines or structures defined by the anatomy of the bony palate during the period of growth.

Microscopic evaluation of mandibular symphyseal distraction osteogenesis.

The purpose of this study was to evaluate microscopically the newly formed hard tissue after a consolidation period of mandibular symphyseal distraction osteogenesis (MSDO). Sixteen patients underwent MSDO treatment. After a latency period of seven days, the distraction device was activated by the patient once in the morning and once in the evening, for a total of one mm per day for a mean 10.1 +/- 2.8 days, and the mean opening of the device was 8.1 +/- 1.7 mm. The device was usually maintained in position approximately 90 days after surgery. After the completion of the distraction period, the lower anterior teeth were bonded and tooth movement into the distraction site was initiated. After a consolidation period, second surgery was performed to remove the distraction devices. During the second surgery, hard tissue biopsies were taken on the apical region of the two central incisors and the left canine. The samples were fixed in 10% buffered formalin and decalcified in 3% HNO(3) solutions. New bone formation was present within the distraction gap immediately after the consolidation period. The cellular construction was more irregular in the distraction sections than in the normal bone sections. The newly distracted area was not complete immediately after the consolidation period. Furthermore, the newly formed bone had a membranous structure, which indicates continual maturation. Bone exposed to stretching forces undergoes new bone formation, and the newly formed bone is of a membranous type also named as a woven type.

Rapid tooth movement and orthodontic treatment using dentoalveolar distraction (DAD). Long-term (5 years) follow-up of a Class II case.

The purpose of this report is to describe the dentoalveolar distraction (DAD) technique and to present its effects on the surrounding structures by presenting a Class II case. A 15-year-old skeletal and dental Class II female patient with an overjet of 9 mm was treated by DAD osteogenesis. A custom-made, rigid, tooth-borne intraoral distraction device was used for rapid canine retraction. Osteotomies surrounding the canines were made to achieve rapid movement of the canines within the dentoalveolar segment, in compliance with distraction osteogenesis principles. The amount of canine retraction was 7.5 mm in 12 days at a rate of 0.625 mm per day, with no posterior anchorage loss. The canine teeth showed 1.6 mm extrusion and 11 degrees inclination change (distal tipping) during the same period. Orthodontic treatment continued for 6 months with no clinical and radiographic evidence of complications such as root fracture, root resorption, ankylosis, and soft tissue dehiscence. The DAD technique is an innovative method, because it reduces overall orthodontic treatment time by about 50%, with no unfavorable effects on periodontal tissues and surrounding structures and with no need to use any intraoral or extraoral anchorage appliances.