Muge Aksu

A prospective clinical evaluation of mandibular lingual retainer survival

Bonded retainers are considered reliable, independent of patient co-operation, and highly efficient. However, most studies regarding the survival of retainers are retrospective. The aims of this investigation were to prospectively evaluate the failure rate of bonded lingual retainers, the influence of direct or indirect bonding procedures on survival, and to determine the distribution of failures over a 6 month period. Mandibular lingual retainers were bonded in 66 patients. Thirty-two retainers were bonded using a direct method and 34 by an indirect method. There were 23 females and 9 males (mean age 15.96 ± 3.21 years) in the direct group and 29 females and 5 males (mean age 19.44 ± 6.79 years) in the indirect group. A 0.016 × 0.022 inch Bond-a-Braid retainer wire (eight-braided, flattened, stainless steel dead soft wire) was used with Transbond LR. Following bonding, the patients were observed monthly. A chi-square test was used to analyse the influence of the direct and indirect procedures on survival rate.Twenty-five retainers failed. The failure rate was 46.9 per cent with the direct method and 29.4 per cent with the indirect method. The difference between the methods was not statistically significant. The total failure rate was 37.9 per cent. The highest failure rate was seen in the first month. Seven patients had repeated failures. The failure rate was higher in the right quadrant. The total survival rate was 62.1 per cent.

Arch width changes in extraction and nonextraction treatment in class I patients.

The aim of this retrospective study was to examine the dental arch width changes of extraction and nonextraction treatment in Class I patients. The study was performed on pretreatment and posttreatment dental casts of 60 patients (30 extraction and 30 nonextraction). The mean ages were 14.3 +/- 2.02 years for the extraction group and 14.1 +/- 2.9 years for the nonextraction group. The maxillary and mandibular crowding was -6.7 +/- 3.1 and -6.3 +/- 2.8 mm for the extraction group and -4.5 +/- 3.6 and -2.1 +/- 3.5 mm for the nonextraction group, respectively. The intercanine and intermolar arch width measurements were measured using a digital caliper. Paired samples t-test was used to evaluate the treatment changes within each group. To compare the changes between groups, independent samples t-test was performed. At the start of treatment, the maxillary and the mandibular intercanine and intermolar widths of both groups did not differ statistically. At the end of treatment, maxillary and mandibular intercanine widths of both groups increased significantly. The mandibular intermolar width decreased significantly for the extraction group and the maxillary intermolar width increased significantly for the nonextraction group. The decrease in maxillary intermolar width for the extraction group and the increase in mandibular intermolar width for the nonextraction group were not significantly different. No differences were observed between the groups in maxillary and mandibular intercanine widths. Maxillary and mandibular intermolar width indicated a significantly larger value in the nonextraction group than that in the extraction group.

Skeletal and Dental Stability After Maxillary Distraction With a Rigid External Device in Adult Cleft Lip and Palate Patients

PURPOSE To evaluate skeletal and dental stability in adult cleft lip and palate patients treated with a rigid external distraction system at the end of distraction and during the postdistraction period. PATIENTS AND METHODS Lateral cephalograms of 7 patients were obtained before distraction, at the end of distraction, and during the postdistraction period. The mean age before distraction was 21.56 +/- 4.73 years. The mean follow-up was 37.3 +/- 12.4 months. RESULTS The assessment of findings showed that skeletal maxillary sagittal movement was achieved in a superoanterior direction. The maxillary depth angle and effective maxillary length increased significantly (2 degrees and 9 mm, respectively) after distraction, whereas the palatal plane angle increased by 8 degrees , resulting in an anterior movement of the maxilla with a counterclockwise rotation. The lower facial height showed no significant changes after distraction. The sagittal movement of the upper incisors and the angulation of the upper first molars increased significantly (4.5 mm and 5.5 degrees , respectively). During the postdistraction period, the maxilla showed a slight relapse (22%). The effective maxillary length decreased by 2 mm. The palatal plane angle almost returned to its original position, showing 7 degrees of clockwise rotation. The lower facial height remained stable. The upper incisors moved anteriorly and the upper first molars showed a significant mesioangular change during follow-up. CONCLUSIONS After distraction, significant maxillary advancement was achieved with a counterclockwise rotation. The upper incisors moved labially, and the upper first molars angulated mesially. After 3 years, a 22% relapse rate was seen in the maxilla. The counterclockwise rotation of the maxilla was returned to its original position. The upper incisors moved more anteriorly.

Botulinum toxin in closed treatment of mandibular condylar fracture.

Background:The topic of condylar injury in adults has generated more discussion and controversy than any other in the field of maxillofacial trauma. The treatment of condylar fractures in adults is still a highly debated theme. Methods:Patients with unilateral subcondylar or condylar neck fractures of the mandibula without any significant angulation of the condylar head were managed with closed-treatment protocol. Closed treatment was applied through the injection of 100 units of botulinum toxin A, diluted to a concentration of 20 IU/mL, into the muscles of mastication of the fractured side. Masseter and anterior fibers of temporalis muscles were reached through percutaneous extraoral route and 30 IU of the toxin was injected to each muscle. Additional 40 IU of the toxin was injected around the fractured bone fragments through transmucosal intraoral route to paralyze medial and lateral pterygoid muscles as much as possible. An asymmetric occlusal splint was applied for maxillomandibular fixation to restore the vertical height for 10 days. Functional therapy with intermaxillary guiding elastics was advocated for 2 months. Results:There were no complications related to either toxin injections or splint application procedures. The toxin was effective on all occasions. Fractured condylar process and ramus of the mandibula were in good approximation and remained in reduced positions. None of the patients had any occlusal disturbance, mandibular asymmetry, or joint dysfunction in the follow-up period. Conclusions:We believe that modification of treatment options concerning the clinical situation of the patients is the best method for condylar injury. The purpose of this study is to present and discuss the results achieved in closed treatment of a selected group of patients with mandibular condylar fractures to whom botulinum toxin A was injected to relieve the spasm of muscles of mastication, along with special splint application.

Pharyngeal Airway Changes Associated With Maxillary Distraction Osteogenesis in Adult Cleft Lip and Palate Patients

PURPOSE To investigate 1) the changes in pharyngeal airway sizes associated with maxillary distraction osteogenesis and 2) the correlations between maxillary skeletal variables and the pharyngeal airway in adult patients with cleft lip and palate. PATIENTS AND METHODS The study was carried out in 14 adult subjects with cleft lip and palate. Predistraction records were taken at a mean age of 22.7 ± 4.6 years. All patients had placement of a rigid external distraction device (RED I; KLS Martin, Tuttlingen, Germany) after Le Fort I osteotomy. Lateral cephalograms were assessed before surgery and at short-term follow-up (8.0 ± 6.4 months). The cephalometric skeletal and pharyngeal airway variables were statistically evaluated by use of the Wilcoxon signed-rank test. Spearman ρ correlation was performed to check the correlations between maxillary skeletal and pharyngeal variables. RESULTS The maxillary movement was 8.7 mm (P < .01). The maxillary depth angle (+7.9°) and effective maxillary length (9.4 mm) increased significantly (P < .01) after distraction, whereas the palatal plane angle remained unchanged. Anterior nasal spine (8.2 mm) and Posterior nasal spine (6.9 mm) moved anteriorly. The overjet increased (9.5 mm) significantly (P < .01). Posterior, superoposterior, and middle airway spaces increased significantly, with mean differences of 7.5 mm, 5.1 mm, and 3.3 mm, respectively. The soft palate moved anteriorly, with the greatest movement at its superior point. Significant positive correlations were observed for the posterior and superoposterior airway spaces and maxillary movement. PNS changes showed the highest correlation with posterior airway changes. CONCLUSIONS The significant anterior movement of the maxilla resulted in significant increases in posterior, superoposterior, and middle airway spaces. The posterior airway space showed the highest significant positive correlation with the movement of PNS. The posterior and superoposterior airway spaces also showed significant positive correlations with the maxillary skeletal variables.

Growth-related changes of skeletal and upper-airway features in bilateral cleft lip and palate patients

INTRODUCTION The craniofacial morphology of subjects with cleft lip and palate differs from that of subjects without clefts. Subjects with bilateral cleft lip and palate tend to have maxillary retrognathism, a smaller mandible with an obtuse gonial angle, greater anterior upper and lower facial heights, and retroclined maxillary incisors. The purposes of this research were to compare the skeletal and upper-airway features of subjects with bilateral cleft lip and palate with the same features in control subjects without clefts and to determine the growth-related changes at different growth stages. METHODS The sample comprised 212 subjects divided into 2 groups: 68 with bilateral cleft lip and palate, and 144 controls without clefts; each group was further divided into 4 subgroups according to growth stage using the cervical vertebral maturation stage method. The subgroups were defined as early childhood (stage 1), prepubertal (stage 2), pubertal (stage 3), and postpubertal (stage 4). The cephalometric variables were evaluated with 2-way analysis of variance and the Bonferroni test. RESULTS Maxillary position showed no significant differences between the male groups. The maxilla was more prognathic at stage 2 and became more retrognathic at stages 3 and 4 in the females. The mandible was more retrusive in the bilateral cleft lip and palate subjects at stage 1 in males and at stages 3 and 4 in females. ANB was larger at stages 1 and 2, and it became similar to the controls at stages 3 and 4 in male and female bilateral cleft lip and palate subjects. Vertical growth was seen in the bilateral cleft lip and palate subjects regardless of sex, and no change was observed with age. Posterior airway space was narrower in all stages (except for stage 1 in females). Middle airway space was wider after stage 1 in the male and female bilateral cleft lip and palate subjects. Inferior airway space was narrower in the male bilateral cleft lip and palate patients at the early childhood and pubertal stages. CONCLUSIONS Age- and sex-dependent differences in skeletal morphology and upper-airway widths of the bilateral cleft lip and palate subjects were identified when compared with the control subjects without clefts.

Influence of nasoalveolar molding on skeletal development in patients with unilateral cleft lip and palate at 5 years of age

Introduction: The aim of this retrospective study was to assess the influence of presurgical nasoalveolar molding (NAM) on skeletal development in patients with operated unilateral cleft lip and palate at 5 years of age. Materials: Lateral cephalometric radiographs of 26 unilateral cleft lip and palate patients who had undergone presurgical NAM (NAM group) and 20 unilateral cleft lip and palate patients who did not have any presurgical NAM (non‐NAM group) were analyzed. The radiographs were digitally traced using Quick Ceph Studio software (version 3.5.1.r (1151); Quick Ceph Systems, San Diego, Calif). Independent samples t tests were performed for statistical analysis. Results: No significant differences were observed in sagittal and vertical skeletal measurements between the NAM and non‐NAM groups. Conclusions: NAM resulted in no significant difference in skeletal development in unilateral cleft lip and palate patients compared with those without NAM in early childhood.

Assessment of upper airway size after orthopedic treatment for maxillary protrusion or mandibular retrusion

Introduction The aim of this retrospective study was to find out whether different Class II treatments would affect the airway sizes of patients having maxillary protrusion or mandibular retrusion. Methods The study sample comprised 57 Class II patients whose upper airway sizes were not significantly different at the start of treatment and whose sagittal skeletal jaw relationships showed that they had maxillary protrusion or mandibular retrusion. Twenty‐two of them were treated with cervical headgear, 16 with activator, and 19 were selected as a control. Lateral cephalograms at the start of treatment and the end of orthopedic treatment were assessed. The intragroup comparisons were performed by using the paired‐samples t test, and intergroup comparisons of the skeletal features and upper airways were performed with 1‐way analysis of variance, with the Tukey test as a second step, at P < 0.05. Results The ANB angle decreased significantly in the treatment groups. The middle airway space and the SNB angle were significantly increased after the activator therapy (P < 0.05). The SNB angle increased and SN‐1 decreased in the mandibular retrusion group when compared with both maxillary protrusion and control groups. No statistically significant difference between the maxillary protrusion and the mandibular retrusion groups was found regarding the upper airway sizes after cervical headgear or activator treatments, respectively (P > 0.05). The only significant differences observed in airway variables were at the middle airway space of the activator and control groups with an increase of 1.6 ± 2.5 mm and a decrease of 1.5 ± 2.3 mm, respectively. Conclusions Orthopedic treatment with either cervical headgear or activator did not result in different upper airway changes, but activator treatment resulted in increased middle airway space with regard to the Class II control group.

Derin Örtülü Kapanışın Diş Çekimi ve Bite-Fixer İle Kombine Tedavisi

OZET Bu vaka raporunda, premolar cekimi ve bite-fixer apareyi ile derin ortulu kapanisin tedavisi sunulmaktadir. 13 yasinda kiz hasta ust dislerinin carpik gorunumunden sikayetciydi ve retru-zif bir profile sahipti. Maksiller ve mandi-buler arklardaki caprasiklik sirasiyla 15 mm ve 9.5 mm idi. intraoral inceleme, bukkal segmentlerin . sinif 2 iliskide oldugunu gosteriyordu. Ust kaninler vestibul-deydi ve derin ortulu kapanis vardi. Sefa-lometrik analiz normal yuz yuksekligiyle birlikte sinif 2 mandibular retruzyonu gosteriyordu. Ust ve alt keserler de ret-roklineydi ve hem alt hem de ust dudak retruzif pozisyondaydi. Caprasikligi duzeltmek icin ust 1. ve alt 2. premolarlar cekildi, sonra ust ve alt keser egimleri duzeltildi ve mandibular dentoalveolar bolge Bite-fixer apareyi ile one dogru ilerletildi. Tedavi sonunda sinif 1 molar ve kanin iliskisi elde edildi, caprasiklik elimine edildi, ortulu kapanis duzeltildi ve alt keserler prokline edildi. Hastanin profili cekimli tedaviden olumsuz etkilenmedi. Bu ...

Fotogrametrik Değerlendirmede Kullanılan Farklı Referans Düzlemlerinin Güvenirliğinin Belirlenmesi

OZET Bu arastirmanin amaci, standart kosullarda kadinlardan elde edilen ekstraoral fotograflar uzerinde belirlenen ve fotogrametrik olcumler icin kullanilan 5 farkli referans duzleminden en guvenilir olanini belirlemektir. Yas ortalamalari 23,25±2,64 yil olan 35 saglikli kadin birey calismaya dahil edildi. Her bireyin yuzunde frontal ve lateralden direkt yumusak doku olcumleri yapildi. Direkt olcumleri takiben; bireylerin sabit bir mesafeden ve ayni isik kosullari altinda standardize edilmis yontemle dijital makine ile fotograflari cekildi. Fotograflar bilgisayar ortamina aktarildiktan sonra direkt yontemle olculen parametreler frontalden 3 farkli referans duzlemi (Ex-Ex, En-En, P-P) ve lateralden 2 farkli referans duzlemi (Sa-Sba, T-Ex) kullanilarak fotograflar uzerinde olculdu. Magnifikasyon hatasi, referans duzlem degerleri kullanilarak duzeltildi. Her parametre icin referans duzlemlerine gore frontalden 3, lateralden 2 farkli deger elde edildi. Bu degerler repeated measure ANOVA ile test edilip, hasta...