Nejat Erverdi

The Use of Skeletal Anchorage in Open Bite Treatment: A Cephalometric Evaluation

The aims of the present study were to assess the effectiveness of skeletal anchorage for intrusion of maxillary posterior teeth, to correct open bite malocclusion, and to evaluate the usage of titanium miniplates for orthodontic anchorage. Anterior open bite is one of the most difficult malocclusions to treat orthodontically. Currently, surgical impaction of the maxillary posterior segment is considered to be the most effective treatment option in adult patients. Various studies have reported the use of implants as anchorage units at different sites of midfacial bones for orthodontic tooth movement. The zygomatic buttress area could be a valuable anchorage site to achieve intrusion of maxillary posterior teeth. Ten patients, 17 to 23 years old and characterized with an anterior open bite and excessive maxillary posterior growth, were included in this preliminary study. Titanium miniplates were fixed bilaterally to the zygomatic buttress area, and a force was applied bilaterally with nine mm Ni-Ti coil springs between the vertical extension of the miniplate and the first molar buccal tube. The results showed that, with the help of skeletal anchorage, maxillary posterior teeth were intruded effectively. As compared with an osteotomy, this minimally invasive surgical procedure eased treatment and reduced treatment time and did not require headgear wear or anterior box elastics for anterior open bite correction. In conclusion, the zygomatic area was found to be a useful anchorage site for intrusion of the molars in a short period of time.

Bodily Distalization of Molars with Absolute Anchorage

Palatal implants have been used over the last two decades to eliminate headgear wear and to establish stationary anchorage. In this case report, the stability of a palatal implant for distalization of molars bodily and for anchorage maintenance was assessed. The implant was a stepped screw titanium (4.5 mm diameter x 8 mm length), and it was placed in the palatal region for orthodontic purposes. A surgical template containing a metal drill housing was prepared. Angulation of the drill housing was controlled according to the radiologic tracing of the maxilla transferred to a plaster cast section in the paramedian plane. The implant was placed using a noninvasive technique (incision, flap, and suture elimination) and left transmucosally to facilitate the surgical procedure and to reduce the number of operations. The paramedian region was selected (1) to avoid the connective tissues of the palatine suture and (2) because it is considered to be a suitable host site for implant placement. After three months of healing, the implant was osseointegrated and orthodontic treatment was initiated. For molar distalization, the Keles Slider appliance was modified and, instead of a Nance button, a palatal implant was used for anchorage. The results showed that the molars were distalized bodily at five months, and no anchorage loss was observed. At the end of the treatment, the smile was improved, and an ideal Class I molar and canine relationship, an ideal overbite, and an ideal overjet were all achieved. In conclusion, palatal implants can be used effectively for anchorage maintenance and in space-gaining procedures. Use of a three-dimensional surgical template eliminated implant placement errors, reduced chair time, minimized trauma to the tissues, and enhanced osseointegration. This method can be used effectively to achieve distalization of molars bodily without anchorage loss.

Continuous vs. discontinuous force application and root resorption

The aim of this study was to compare the effects on root resorption of continuous and discontinuous force application. The experimental material consisted of 22 first premolars that were to be extracted as part of orthodontic treatment. Prior to extraction, a 100 g tipping force was applied to the experimental teeth by means of elastics. One side was randomly selected to be the continuous force side, and the contralateral side became the discontinuous force side. Elastics were worn 24 hours per day on the continuous force side and 12 hours per day on the discontinuous side. The experimental procedure lasted 9 weeks. Composite electron micrographs of the buccal surface of each specimen were digitized and areas affected by resorption were determined. The degree of root blunting was assessed by visual scoring. Mean percentage of resorption-affected areas was smaller and apical blunting was less severe on the discontinuous force side. The results of this study show that the application of discontinuous force results in less root resorption than does the application of continuous force.

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.

The effects of a modified protraction headgear on maxilla

Protraction headgears are commonly used in the treatment of Class III malocclusion characterized by maxillary retrognathism. The upward and forward rotation of the maxilla during protraction is a major unwanted side effect. The aim of this study was to eliminate the upward and forward rotation of maxilla while protracting. Seventeen patients with Class III malocclusion as a result of maxillary retrognathism were treated for 3 months; their average age was 12.81 years. A full coverage acrylic cap splint-type rapid maxillary expansion appliance was cemented and activated twice a day for 5 days. After sutural separation, a maxillary modified protraction headgear was worn and 750 g of force was applied. Wilcoxon signed rank test was carried out to evaluate 42 parameters measured on cephalometric radiographs. The maxilla was displaced anteriorly by downward and backward rotation. The mandible was displaced downward and backward due to anterior elongation of the maxilla. Extrusion and lingual tipping of the upper incisors and intrusion of upper molars and downward and backward rotation of functional occlusal plane were observed. The aim of our study was achieved, which was to avoid upward and forward rotation while protracting the maxilla. In conclusion, maxillary modified protraction headgear (MMPH) can be used effectively in Class III patients with retrognathic maxilla and anterior open bite tendency.

New Generation Open-bite Treatment with Zygomatic Anchorage

This technical note aims to present the fabrication and application of a new generation of posterior intrusion appliances using zygomatic anchorage. The use of zygomatic anchorage enables en masse impaction of the posterior segment without any side effects such as labial flaring. A 14-year-old, female Class II patient with an anterior open bite was treated with a new generation posterior intrusion appliance. At the end of treatment, a Class I canine and molar relationship and a correction of the anterior open bite were achieved. The molars were impacted 3.6 mm, and this impaction was maintained throughout the treatment. The mandibular plane showed a counterclockwise autorotation of 4 degrees. This case report demonstrates that zygomatic anchorage can be used effectively for molar intrusion and anchorage maintenance. However, further clinical studies with larger samples are required to confirm its effectiveness.

Effect of Varying the Force Direction on Maxillary Orthopedic Protraction

The aim of this study was to examine the effect of varying the force direction on maxillary protraction. A total of 20 patients with class III maxillary retrognathism were randomly divided into two groups. Group 1 was comprised of nine patients with a mean age of 8.58 years, and group 2 was composed of 11 patients with a mean age of 8.51 years. Both groups received a cap splint-type rapid palatal expander and the screw was activated twice a day for 10 days. After the expansion procedure the face mask protraction procedure was initiated. In group 1, we applied the force intraorally from the canine region with a forward and downward direction at a 30 degrees angle to the occlusal plane. In group 2, the force was applied extraorally 20 mm above the maxillary occlusal plane. In both groups a unilateral 500 g force was applied and the patients were instructed to wear the face mask for 16 h/d for the first three months and 12 h/d for the next three months. The Wilcoxon sign rank test was used to evaluate the effect of the two different face masks, and a Mann-Whitney U-test was carried out to evaluate the differences between the two groups. The results showed that both force systems were equally effective to protract the maxilla; however, in group I we observed that the maxilla advanced forward with a counter-clockwise rotation. In group 2 we observed an anterior translation of maxilla without rotation. The dental effects of both methods were also different. The maxillary occlusal plane did not rotate in group 1, in contrast to the clockwise rotation in group 2. The maxillary incisors were proclined slightly in group 1, but in contrast they were retroclined and extruded in group 2. In conclusion, the force application from near the center of resistance of the maxilla was an effective method to prevent the unwanted side effects, such as counter-clockwise rotation of the maxilla, in group 1. The group 2 results suggest that this method can be used effectively on patients who present as class III combined with an anterior open bite.

Investigation of bacteremia after orthodontic banding.

The aim of this study was to assess the incidence of bacteremia after orthodontic banding. The study was conducted on 40 healthy orthodontic patients with good oral hygiene. Venous blood samples were obtained with a strict aseptic technique before and after fitting of a molar band in each patient. Microbiologic evaluation of the samples revealed a postoperative bacteremia incidence of 7.5%.

Investigation of bacteremia after orthodontic banding and debanding following chlorhexidine mouth wash application.

This study investigates the prevalence of bacteremia after orthodontic banding and debanding, following the application of a 0.2% chlorhexidine gluconate mouthwash. The banding and debanding groups were each composed of 40 young adult patients. In the banding group, patients were asked to rinse their mouth with chlorhexidine gluconate for 60 seconds just prior to fitting of the bands. In the debanding group, they were asked to use the mouthwash immediately before removal of bands and brackets. In both groups pre- and post-treatment blood samples were obtained with a strict aseptic technique. In the banding group, no bacteremia was detected in the pretreatment sample and 2.5% post-treatment bacteremia was detected in the post-treatment sample. In the debanding group, 2.5% bacteremia was found in both the pre- and post-treatment samples. The prevalence of post-treatment bacteremia found in the present study were compared with the findings of 2 preliminary studies in which the prevalence of bacteremia had been investigated after banding and debanding without a prior application of chlorhexidine mouthwash. The application of chlorhexidine mouthwash resulted in a decrease in the prevalence of bacteremia after banding and debanding, but the decrease was not statistically significant.

Apical root resorption of maxillary first molars after intrusion with zygomatic skeletal anchorage.

The aim of this study was to evaluate radiographically the apical root resorption of maxillary first molars after their intrusion was done using zygomatic miniplates as skeletal anchorage in open-bite cases. The study group comprised 16 consecutively treated open-bite cases who had received special titanium miniplates in their zygomatic bones for use as anchorage to apply orthodontic intrusive forces to the maxillary posterior region. The control group consisted of 16 patients, who were matched regarding age, sex, and treatment duration but who had undergone fixed orthodontic treatment without intrusion mechanics for molars. Tooth lengths were measured on pretreatment, and posttreatment panoramic radiographs of all patients and mesiobuccal and distobuccal roots of left and right maxillary first molars were measured on-screen using a software program. The difference between the pre- and posttreatment tooth lengths was defined as apical root resorption. Comparison of the differences in root resorption of the two groups using the t-test for independent samples showed a statistically significant difference (P = .004) only for mesial roots on the right side. But because the mean difference in apical root resorption was only 0.5 mm, it was concluded that the apical root resorption of maxillary first molars after intrusion was done using zygomatic skeletal anchorage was not clinically significant.