Nazan Küçükkeleş

A comparison of two different rapid palatalexpansion techniques from the point of root resorption

The aim of this investigation is to compare Haas and Cast Cap Splint devices from the point of rootresorption. The material comprised thirty-eight upper and twelve lower premolar teeth derived from nineteen patients who required RME and subsequent removal of the first premolars as part of their full banded orthodontic treatment. Root resorption and repair areas were observed on the buccal surfaces of premolars. Repair tissue was cellular cementum in both groups. There was no significant difference between these two techniques from the point of root resorption amount.

Morphologic changes of the nasal cavity induced by rapid maxillary expansion: A study on 3-dimensional computed tomography models

INTRODUCTION The aim of this study was to evaluate the effect of rapid maxillary expansion on the volume of the nasal cavity by using computed tomography. METHODS The sample consisted of 24 patients (10 boys, 14 girls) in the permanent dentition who had maxillary constriction and bilateral posterior crossbite. Ten patients had skeletal Class I and 14 had Class II relationships. Skeletal maturity was assessed with the modified cervical vertebral maturation method. Computed tomograms were taken before expansion and at the end of the 3-month retention period, after active expansion. The tomograms were analyzed by Mimics software (version 10.11, Materialise Medical Co, Leuven, Belgium) to reconstruct 3-dimensional images and calculate the volume of the nasal cavities before and after expansion. RESULTS AND CONCLUSIONS A significant (P = 0.000) average increase of 11.3% in nasal volume was found. Sex, growth, and skeletal relationship did not influence measurements or response to treatment. A significant difference was found in the volume increase between the Class I and Class II patients, but it was attributed to the longer expansion period of the latter. Therefore, rapid maxillary expansion induces a significant average increase of the nasal volume and consequently can increase nasal permeability and establish a predominant nasal respiration pattern.

A Novel Vector Control Device in Horizontal Bone Transport

Bone grafting is the most frequently used technique for cleft palate repair. The major shortcoming of this method is the difficulty of achieving complete soft tissue coverage in cases with large defects. Buccal or tongue flaps are used most commonly in such cases, but the outcome is not always ideal. Alveolar distraction may be a more promising method for overcoming such problems. 1-4 This article describes a new method developed to treat cases with large defects and presents a case to illustrate the use of this protocol. Materials and Methods Chromium-cobalt crowns with double tubes for the molars and semicircular tubes for other teeth were prepared separately for each segment. Care was taken to orient the tubes in the same horizontal plane. The cast segments were connected by two 1.5-mm stainless steel arch wires. The arches were extended distally from the tubes to accommodate the planned anterior movement of the distraction segments. To avoid mucosal irritation, double tubes were placed as mesially as possible on the molar crowns. The anchoring segments were connected by a transpalatal bar. A custom-designed tooth-borne distractor was positioned occlusally on the arch (Fig 1). Case Report A 16-year-old female patient presented with absence of the premaxilla and bilateral complete cleft lip and palate. The etiology was uncertain. The treatment plan was reconstruction of the premaxilla and correction of the sagittal jaw relationship, using the alveolar distraction protocol to improve the patient’s facial profile and appearance (Fig 2). Treatment started with leveling and alignment of the dental arches, leaving a space of 3 mm between the maxillary second premolar and first molar to avoid root exposure during osteotomy. SURGICAL METHOD First, a cast metal appliance was cemented. The next day, surgery was performed under general anesthesia. The segments were mobilized by making vertical incisions between the maxillary second premolars and first molars, followed by horizontal osteotomies above the roots. During this process, the palatal mucosa was left intact. Arches and distractors were inserted intraoperatively, and the distractors were activated with five full turns (5 mm) to observe the mobility of the discs. The distractors were then closed, the segments were ligated tightly, and the flaps were sutured. After a 5-day latency period, activation was started at a rate of one half turn (0.5 mm) twice a day. The patient was monitored weekly until the 2 segments contacted at the midline. Activation was continued bilaterally until the desired amount of premaxillary augmentation, including 30% overcorrection, was achieved (Fig 3).

Rapid maxillary expansion compared to surgery for assistance in maxillary face mask protraction

OBJECTIVE To compare the treatment outcomes of rapid maxillary expansion (RME) plus face mask (FM) and LeFort 1 osteotomy + FM during maxillary protraction. MATERIALS AND METHODS This study was carried on 34 patients all having maxillary retrognathic, anterior cross-bite, Class III skeletal and dental malocclusion characteristics and a concave profile. Eighteen patients with milder maxillary retrognathism were treated with RME + FM. Sixteen other patients with moderate to severe maxillary retrognathism were treated with an incomplete LeFort 1 osteotomy + FM therapy. Cephalometric data were evaluated statistically. RESULTS Significantly higher values of maxillary advancement and reduced treatment time were achieved with surgically assisted FM therapy. CONCLUSIONS The surgically assisted FM treatment was more rapid and effective in maxillary protraction compared to the RME + FM treatment.

Sagittal airway changes: rapid palatal expansion versus Le Fort I osteotomy during maxillary protraction

The purpose of the present study was to evaluate upper airway changes related to craniofacial changes induced by a facemask (FM) combined with Le Fort I osteotomy without down-fracture in Class III maxillary retrusion subjects (group 1) when compared with a similar group of subjects treated with traditional rapid palatal expansion and FM therapy. Pre- (T1) and post- (T2) protraction cephalometric radiographs of group 1 (10 females and 6 males; mean age 12.75 ± 1.91 years) and group 2 (7 females and 9 males; mean age 12 ± 1.7 years) were traced. The treatment duration was 149 ± 14 days (approximately 5 months) and 270 ± 46 days (approximately 9 months) for groups 1 and 2, respectively. A paired t-test for intergroup comparisons of values at T1, an independent samples t-test for intragroup comparisons of values at T1 and T2, and a non-parametric Mann-Whitney U-test for intergroup comparisons were used. To evaluate the relationship between changes in upper airway dimension and craniofacial morphology, a multiple-regression analysis was performed. Significant maxillary protraction along with clockwise rotation of the mandible was achieved in both groups. Counter-clockwise maxillary rotation was significant in group 1 (P < 0.05) but not in group 2. While nasopharyngeal measurements (PNS-ad1, PNS-ad2) showed significant increases (P < 0.05) as a result of treatment in both groups, oropharyngeal measurements did not change. Maxillary protraction, which was achieved in both groups but in a shorter period of time in group 2, improved nasopharyngeal but not oropharyngeal airway dimensions.

Corticotomy-assisted maxillary protraction with skeletal anchorage and Class III elastics

OBJECTIVE To analyze the treatment effects of corticotomy-assisted maxillary protraction with skeletal anchorage and Class III elastics in patients with Class III malocclusions. MATERIALS AND METHODS The study group consisted of 19 patients with a mean age of 13.12 ± 1.28 years. Initially, patients were monitored for 5 months before treatment to evaluate growth changes. Changes during control, protraction and fixed orthodontic treatment periods were compared with the cephalometric radiographs taken initially, before protraction, after protraction, and after fixed orthodontic treatment. Treatment outcomes also were compared with the growth effects. RESULTS Sagittal measurements of maxilla showed significant improvements (3.59 ± 1.32 mm) during the protraction period (3.85 ± 1.12 months) whereas no significant changes were seen during the control period. Upper and lower incisor inclinations were increased, and the upper occlusal plane angle showed significant counterclockwise rotation during protraction. Significant soft-tissue changes also reflected the underlying skeletal changes. Maxillary advancement was stable during fixed orthodontic treatment. CONCLUSION Compared with control period of the patients, this protocol produced significant improvements in skeletal and soft-tissue structures.

Long-term results of surgically assisted maxillary protraction vs regular facemask

OBJECTIVE To evaluate the short- and long-term treatment results of rapid maxillary expansion (RME) and surgical assistance during maxillary protraction with a facemask (FM). MATERIALS AND METHODS This study was carried out in 28 patients (12 male, 16 female) with maxillary retrognathism, anterior crossbite, and Class III skeletal and dental malocclusion characteristics. Seventeen patients (9 male, 8 female) with mild maxillary retrognathism were treated by RME and FM. The other 11 patients (8 female, 3 male), who had moderate to severe maxillary retrognathism, were treated with surgically assisted FM treatment. Patients treated with RME and FM were recalled after 5.64 years, and the surgically assisted FM group was recalled after 6.08 years. Cephalometric films taken before treatment (T0), right after maxillary protraction (T1), and at recall (T2) were used to evaluate and compare the results. RESULTS In the short term, good maxillary advancement and a shorter treatment period were achieved with surgically assisted FM therapy. However, in the long term, maxillary advancement and some soft tissue improvements were lost. On the other hand, in the RME and FM protraction group, maxillary advancement and soft tissue improvement were well maintained. CONCLUSION In the short term, statistically significant maxillary advancement was achieved with surgically assisted maxillary protraction. However, in the long term, these sagittal changes were not stable, whereas RME and FM provided stability.

Mini-implant Usage in Orthodontic Practice

ABSTRACT Objective: The present study was designed to investigate the general anchorage protocols and especially the tendencies during mini-implant usage among Turkish orthodontists. The main aim of the survey is to reveal if mini-implants are being used more than once and in different patients. Materials and Method: This is a cross-sectional study conducted with orthodontists who are members of the Turkish Orthodontic Society. The orthodontists were asked to click on a link to complete an automated questionnaire of 27 multiple-choice questions. Results: It was found that mini-implants are used by a great majority of the participants and in various cases. General tendencies during mini-implant usage show compatibility with the literature. Conclusion: This survey displays the preferences of Turkish orthodontists regarding mini-implant usage in their clinical practice. Moreover, it is especially important for documenting the fact that mini-implants are being used more than once and also in different patients.

Long-Term Results of Rapid Maxillary Expansion and Facemask: Long-Term of Regular Protraction

ABSTRACT Objective: Evaluation of the long-term skeletal, dental, and soft tissue treatment results of 17 patients who completed their protraction with the facemask. Materials and Method: Twenty-three Class III patients with a mean age of 12, characterized with maxillary retrognathism, who were treated by facemask protraction therapy, were recalled after 6.08 years following protraction. Only 17 patients presented and their records were renewed. Study was carried out on the initial (T0), after protraction (T1), and 6.08 years following protraction (T2) films. Long-term skeletal, dental, and soft tissue changes were measured. Results: After 6.08 years, the profile and dental relationships achieved by protraction were found to be well maintained clinically. The cephalometric examination revealed stable sagittal advancement with a mandibular forward positioning. After protraction (T1) and at 6.08 years of recall (T2), there were no statistically significant changes found in parameters showing sagittal positi...