Hatice Gökalp

Magnetic Resonance Imaging of the Condylar Growth Pattern and Disk Position after Chin Cup Therapy: A Preliminary Study

This study was conducted on lateral cephalograms and magnetic resonance images (MRIs) obtained from 20 subjects with Class III malocclusion. Only clinically temporomandibular joint (TMJ) symptom-free subjects were included in this study. In the treatment group, a chin cup with 600 g of force was applied in 13 patients (10 girls and three boys) with a mean age of nine years. The chin cup was applied in a direction from the chin toward the TMJ. The control group consisted of seven patients (six girls and one boy) with a mean age of eight year nine months. Orthodontic treatment was not applied in the control group. Records were taken at the beginning and end of chin cup therapy from all the subjects. Measurements were made on lateral cephalograms and unilateral-left sagittal-oblique TMJ MRIs. Variables obtained at the beginning and end of the study were compared by Students t-tests and paired t-tests. Relationships between craniofacial and TMJ variables were analyzed by correlation analysis. The mandibular corpus length was increased and condylar head angle was decreased by chin cup therapy. A positive correlation existed between activation of sagittal maxillary and mandibular growth and bending of the condylar head. This study showed that the condylar growth pattern was altered by chin cup. It may be implied that the source of improvement is adaptation of the craniofacial structures to the changes of the condylar growth pattern produced by the chin cup.

Effects of symphyseal distraction osteogenesis on the temporomandibular joint seen with magnetic resonance imaging and computerized tomography

The aim of this case report was to evaluate the effect of symphyseal distraction osteogenesis on the position of the mandibular condyle and the disc of an asymptomatic adolescent patient by using magnetic resonance imaging and computerized tomography. A 15-year-old girl with severe maxillary and mandibular dental crowding was treated with a Haas-type banded maxillary expansion appliance and symphyseal distraction osteogenesis with a Hyrax-type tooth-borne distractor, respectively. Lateral cephalometric and panoramic radiographs, dental casts, and extraoral and intraoral photographs were obtained before and after treatment in addition to temporomandibular joint magnetic resonance imaging and computerized tomography scans. This patient was treated successfully. The distraction osteogenesis produced inconspicuous rotation of the mandibular condyles with an unchanged position of the disc as determined by the imaging and scans of the temporomandibular joint.

99mTechnetium-labeled methylene diphosphonate uptake in maxillary bone during and after rapid maxillary expansion.

The purpose of this study was to evaluate bone activity at the midpalatal suture that had been biomechanically stimulated by rapid maxillary expansion (RME). A rigid acrylic-bonded expansion device with a maxiskeleton screw was used for RME in three patients who were in three different growth periods. The screw was activated twice a day by 1/4 turns. After sufficient expansion, the screw was fixed with acrylic resin, and the same appliance was used as a removable retention plate for three months. Single photone emission computed tomography (SPECT) bone scintigraphy records were obtained before (T1) and at the end of RME (T2) and three months after the retention period (T3). According to the scintigraphic records, the increase in bone activity was highest in the anterior and medial sections on both the left and right sides of the maxilla in all cases. After three months of retention, the bone activity returned to its original level. Therefore, it may be stated that the retention period of three months was sufficient for bone reorganization.

Late growth period orthopedic therapy versus bimaxillary surgery for correction of skeletal class III.

Objective: To compare the effects of late orthopedic therapy with orthognathic surgery in skeletal class III cases. Materials and Methods: The subjects of the study were divided into 2 groups. Group 1 comprised 15 patients (8 females and 7 males) with a mean age of 14 years 6 months (range, 12 y 10 mo to 15 y 6 mo) and treated with maxillary expansion and a modified maxillary protraction appliance (MMPA). Group 2 comprised 11 patients (6 females and 5 males) treated with bimaxillary surgery (BMS) with a mean age of 23 years (range, 18 y 2 mo to 28 y 4 mo). Lateral cephalometric films were taken before (T1) and after orthopedic therapy (T2) in the MMPA group and before surgery (T1) and after fixed orthodontic therapy (T2) in the BMS group. Study groups were compared by analysis of variance and Tukey tests at the beginning and at the end of the treatment. Results: Maxillary forward displacement (P < 0.01) and the increase in ANS-Me distance (P < 0.05) were higher in the BMS group than in the MMPA group. The mandible exhibited significant posterior rotation in MMPA group (P < 0.01). Mandibular effective length decreased in the BMS group and increased in the MMPA group. Soft tissue profile (G-Sn-Pg) improved in both groups (P < 0.05) and labiomental angle reduced in the BMS group, whereas an increase was observed in the MMPA group. Conclusions: Orthognatic surgery can be more effective in patients with increased mandibular length, more anteriorly positioned mandibles, and increased vertical dimensions.

Alternate rapid maxillary expansion–constriction and tooth-borne symphyseal distraction osteogenesis

Surgically assisted rapid mandibular expansion is a contemporary treatment alternative to enable genuine skeletal mandibular widening. Mandibular widening via a tooth-borne distractor is a practical and noninvasive clinical approach. Recently, to expand and protract the maxilla, the alternate rapid maxillary expansion-and-constriction procedure was suggested. In this case report, we describe a female patient (12 years 7 months old) having severe maxillary and mandibular crowding who underwent repeated alternate rapid maxillary expansion and constriction in combination with tooth-borne symphyseal distraction osteogenesis.ZusammenfassungDie chirurgisch assistierte Erweiterung der Mandibula ist eine zeitgemäße Behandlungsalternative, um eine definitive skelettale Erweiterung des Unterkiefers zu ermöglichen. Die Erweiterung des Unterkiefers mittels eines zahngetragenen Distraktors stellt dabei einen pragmatischen, nichtinvasiven klinischen Ansatz dar. Zur Expansion und Protraktion des Oberkieferes wurde das ALT-RAMEC (“alternate rapid maxillary expansion and constriction”)-Verfahren vorgeschlagen. Vorgestellt wird eine Patientin im Alter von 12 Jahren und 7 Monaten mit gravierendem Engstand in Ober- und Unterkiefer, bei der das ALT-RAMEC-Verfahren in Kombination mit einer zahngetragenen Distraktionsosteogenese der Symphyse durchgeführt wurde.

A study to evaluate the changes in 3rd molar angulation with extraction of four premolars in class II malocclusion therapy

Aim: The objectives of the study are to evaluate the changes in third molar angulation during orthodontic treatment with extraction of premolars in Class II malocclusions, and to evaluate the relationship between the angulation of third molars and positional changes of incisors and molars. Materials and Methods: This study was conducted on lateral cephalograms and dental panoramic tomograms of 30 patients (mean age 13.48 years) with skeletodental Class II malocclusion treated with four first premolar extractions. Twenty-four cases were treated with edgewise, and six were treated with Begg technique. The changes in the eruption pattern of the third molars were observed at the beginning of the treatment (T1) and at the end of the treatment (T2). The changes in the anteroposterior position of the incisors and molars, original molar space, and mesiodistal third molar angulation were tested by paired t-test. Results: The positional changes of the upper/lower incisors and first molars and original molar space were found similar in edgewise and Begg technique. Original molar space was increased in both jaws during orthodontic treatment. Long axis angle of the upper right third molar due to occlusal plane was increased nonsignificantly. Lower right third molars uprighted significantly. A positive correlation was found between the inclination of the lower right third molars and position of lower incisors and first molars. Conclusion: Treatment with extraction of premolars result in a greater space in the third molar region as a result of the mesial movement of the molars during space closure.

ÇENELİK TEDAVİSİNİN TEMPOROMANDİBULER EKLEM DİSFONKSİYONU OLUŞMASINDAKİ ETKİSİNİN KLİNİK OLARAK DEĞERLENDİRİLMESİ

OZET: Bu arastirma, iskeletsel Sinif III olgularin erken donem tedavisinde kullanilan ceneligin kraniyomandibuler duzensizlige neden olup olmadiginin klinik olarak incelenmesi amaclanmistir. Arastirma, 17si (13 kiz, 4 erkek) kontrol, 17si (9 kiz, 8 erkek) tedavi grubu olmak uzere toplam 34 birey uzerinde yurutulmustur. Tedavi grubu bireyleri iskeletsel sinif III duzensizligine sahip olup; el-bilek grafilerine gore pubertal gelisimin PP2, S doneminde bulunmaktadir. Tedavi grubu bireylerine 16 ay sureyle cenelik uygulanmis ve bu bireyler tedavi bitirildikten 24 ay sonrasina kadar takip edilmistir. Kontrol grubunu ise ortodontik tedavi uygulanmamis ve TME bulgulari bakimindan semptomsuz; kronolojik yasi ortalama 15 yil olan farkli malokluzyona sahip bireyler olusturmustur. Tum bireylere Rakosi Fonksiyonel Analiz Yontemi uygulanarak, kraniyomandibuler disfonksiyon durumu degerlendirilmistir. Elde edilen veriler dogrultusunda erken donemde uygulanan ceneligin kraniyomandibuler duzensizlige neden olmadigi sap...