Nil Cura

Orthodontic and orthopedic effects of Activator, Activator-HG combination, and Bass appliances: A comparative study

The orthodontic and orthopedic effects of the Activator, Activator-Headgear Combination (ACHG) and the Bass appliance systems were compared by analyzing the cephalometric records of 64 subjects, who were treated for skeletal Class II malocclusion, with both conventional and Pancherzs methods. Differences between observations on the different occasions (starting and ending values) were tested with Wilcoxons matched pairs rank test. Kruskal-Wallis nonparametric analysis of variance was carried out in different situations among all three groups. If a level of significance less than 0.05 was observed, Scheffès method of multiple comparisons was used to determine differences among groups. The results of this study showed that greater improvement in sagittal skeletal relationship (ANB angle) was obtained in both Bass and ACHG groups than in the Activator group. The differences between the groups were most pronounced for dental variables. The Bass appliance was found to be more effective in the control of the unwanted side effects (proclination of lower incisors, retroclination of upper incisors). Unfavorable labial tipping of the lower incisors was also prevented with the ACHG appliance.

Examination of Craniofacial Morphology In Children with Unilateral Cleft Lip and Palate

Craniofacial morphology of children with and without clefts has been reported to differ because of a combination of factors including, morphogenetic pattern, adaptive changes, and lip and palate management. The purpose of this study was to make a cephalometric evaluation of possible differences in craniofacial morphology of Turkish children with and without unilateral cleft lip and palate (UCLP). Twenty UCLP children (7 girls, 13 boys) with a mean age of 10.75 years (SD = 2.58 years) were compared with a control group of children without UCLP, who were matched for age (mean = 10.64 years, SD = 2.58 years) and sex. No patient had received orthodontic treatment. Linear and angular variables were measured from tracings of lateral cephalometric radiographs and the resulting data were evaluated statistically. Compared with children in the control group, the children in the cleft palate group demonstrated a greater flattening of the cranial base, a more retrognathic and posteriorly inclined maxilla with decreased length, a larger mandibular plane and gonial angle, larger anterior facial height, and decreased posterior and upper-posterior facial heights.

Oropharyngeal airway changes following bimaxillary surgery in Class III female adults.

AIM The aim of this study was to evaluate oropharyngeal airway changes following Le Fort I maxillary advancement and impaction with mandibular setback in Class III deformity. SUBJECTS AND METHODS 53 female Class III patients (mean age: 24.9+/-0.8 years) had Le Fort I maxillary advancement with impaction, and mandibular setback osteotomies. Lateral cephalograms were taken before (T0), one week postoperatively (T1) and 1.3+/-0.2 years after (T2) bimaxillary surgery. Paired t and Pearson tests were used to evaluate the changes. RESULTS The mandibular plane-hyoid, upper retropalatal airway space (URP) and hyoid to horizontal reference plane (HY-HOR) distances significantly increased and the third vertebra to menton, hyoid to vertical reference plane (HY-VER) distances decreased in the T0-T1 period. Relapses were found in mandibular plane to hyoid (MP-HY), URP, HY-HOR, third cervical vertebra to menton (C3-Me) and HY-VER distances in T1-T2 period. Correlations were found between the mandibular retraction and increases of the narrowest retropalatal (r: 0.29, p<0.05) and lowest retropalatal airway spaces (r: -0.30, p<0.05) and posterior movement of hyoid (r: 0.60, p<0.001). CONCLUSIONS Bimaxillary surgery caused an increase in the URP, together with posterior and inferior movement of hyoid bone one week postoperatively. Some relapse was found in these changes over one year later.

Changes in soft tissue profile after mandibular setback surgery in Class III subjects

The aim of this study was to investigate changes in hard and soft tissue profile after mandibular setback surgery. Lateral cephalograms of 25 Class III subjects were assessed before and 1.5+/-0.4 years after mandibular setback surgery. Paired t test, Pearson correlation test and linear regression analysis were used to evaluate the changes in soft tissue profile. Significant changes were found in skeletal (SNB -3.6+/-0.9 degrees, ANB 3.7+/-1.0 degrees, overjet 5.0+/-1.2 and overbite 2.5+/-1.1 mm, P<0.001), soft tissue (facial convexity 5.9+/-1.6 degrees, P<0.001; labiomental fold 0.6+/-0.6 mm, P<0.001; upper and lower lip protrusion 0.5+/-0.8 mm, P<0.01; -3.3+/-1.2 mm, P<0.001), and upper and lower lip lengths (0.9+/-1.2mm, P<0.01; -1.8+/-2.1 mm, P<0.001). Correlations were found between facial convexity and SNB and ANB angles and between upper lip length and SNB and ANB angles. The change in lower lip length was correlated with SNB, ANB, overjet and overbite. Lower lip retrusion was correlated with overjet and a significant correlation was found between the retrusion of lower incisor and lower lip. Mandibular setback surgery was effective in producing an orthognathic profile in adult Class III subjects with mandibular prognathism.

Changes in pharyngeal (airway) morphology in Class III Turkish female patients after mandibular setback surgery

INTRODUCTION The aim of this study was to evaluate changes in the pharyngeal and lower facial morphology in Turkish female Class III patients 1.5+/-0.4 years after mandibular setback surgery (bilateral sagittal split osteotomy), and orthodontic multi-bracket treatment. Only women with mandibular prognathism were selected because sex differences in pharyngeal airway changes were evident. MATERIAL AND METHODS Lateral cephalograms of 25 Turkish female Class III patients (mean age: 25.4+/-2.6 years) with mandibular prognathism, were assessed before and 1.5+/-0.4 years after operation. Paired t and Pearson tests were used. RESULTS The pharyngeal airway morphology showed significant changes in soft-palate length and posterior reference line (PRL) to point of posterior tongue. The decrease in PTV-Pg distance was correlated with the decreases in PRL-PSP, PRL-PTO and PRL-E distances. It was considered normal for the pharyngeal airway morphology to adapt after surgery to improve the hard tissue relationship. CONCLUSION The lower facial morphology significantly changed and the pharyngeal airway narrowed 1.5+/-0.4 years after mandibular setback surgery.

Changes in head posture and hyoid bone position in Turkish Class III patients after mandibular setback surgery

The aim of this study was to determine the changes in head posture and hyoid bone position after mandibular setback osteotomy in Turkish adult Class III patients. Serial lateral cephalograms of 42 Turkish Class III patients (24 female, 18 male patients, mean age: 25.4+/-1.2 years) who underwent mandibular setback surgery were evaluated preoperatively, 1.2+/-0.6 years, 2.3+/-0.8 and 4.2+/-0.9 years postoperatively. A mean mandibular setback of 5.6+/-0.8mm was associated with a posterior and inferior movement of the hyoid bone and a significant flexion in the neck posture. Surgical correction of mandibular prognathism altered the position of the hyoid bone by downward repositioning carrying the root of the tongue downwards immediately postoperatively, but followed with a tendency to return to its original position.

Body fat composition and weight changes after double-jaw osteotomy.

Nutritional problems might be observed after surgical procedures. In this study, body weight and fat composition changes have been investigated in dentofacial deformity patients after the double-jaw osteotomy procedure.Thirty Angle class 3 patients operated on with double-jaw osteotomies during the period of March 2006 to July 2008 were included in the study. Interocclusal splints were applied continuously in the first 2 weeks after surgery, whereas intermittent splint was used for the next 2 weeks. Patients were analyzed before surgery and on the first month after surgery with the help of Tanita Composition Analyzer 310 bioimpedance method for weight, fat mass, and fat-free mass values. Results were evaluated statistically with the paired-sample test using SPSS version 13.0.Although significant results were obtained in female patients before surgery (weight [P = 0.011], body mass index [BMI; P = 0.012], fat mass [P = 0.010], and fat-free mass [P = 0.051, not significant]), none of the values were significant for male patients (P = 0.747, P = 0.747, P = 0.645, and P = 0.803, respectively). Weight gain was observed in 9 patients (30%). In contrast, weight gain was not seen in underweight patients. No sex differences in terms of weight gain/loss and fat composition have been observed.Interocclusal splint in female patients operated on with double-jaw osteotomies might cause nutritional deficiency in the first month after surgery. This eventually causes fat and weight loss, which may lead to poor wound healing and recovery later.

Orthodontic treatment and follow-up of a patient with cerebral palsy and spastic quadriplegia

INTRODUCTION This report describes the clinical orthodontic management of a patient with spastic quadriplegia and cerebral palsy. Guidelines to overcome difficulties encountered during the treatment period are suggested. METHODS A 13-year-old boy with cerebral palsy and spastic quadriplegia complained of an undesirable oral appearance because of his malocclusion. He had a Class II molar relationship, with severe maxillary and moderate mandibular anterior crowding. Enamel hypoplasia was apparent on all teeth. He had losses of body function and upper extremity function of 70% and 39%, respectively. His physical limitations necessitated a treatment approach that did not rely on patient-dependent appliances. The treatment plan called for maxillary first premolar extractions, mandibular incisor protrusion, and air rotor stripping. RESULTS The patients oral function and esthetic appearance were significantly improved. Aligned dental arches with good occlusion were obtained. The patients self-confidence improved during the treatment period. CONCLUSIONS Physical appearance can influence personality and social acceptability. Corrective orthodontic treatment for patients with physical handicaps can improve not only oral function, but also self-confidence and self-esteem.

Nasal Profile Changes With Le Fort I Maxillary Advancement Surgery

Introduction The purpose of this study was to quantify anteroposterior facial soft tissue changes with respect to underlying skeletal movements after Le Fort I maxillary advancement surgery by using lateral cephalograms taken before and after the operation. Materials and Methods The study group consisted of 20 patients (10 women, 10 men; mean age 23.4 ±1.4 years) having a Class III skeletal deformity caused by a retrognathic maxilla. All patients were treated by Le Fort I maxillary advancement osteotomy. Lateral cephalograms were taken before and 1.6 ± 0.4 years after surgery. Results The anteroposterior position of A-point and anteroposterior position of maxillary incisor were significantly protracted (–2.69 ± 3.34 and 2.68 ± 3.21, respectively; P < .01). The nasal anteroposterior and superoinferior positions (NASALAP and NASALSI, respectively) were significantly changed (–2.70 ± 6.81, P < .01, and 2.55 ± 5.80, P < .05, respectively) and nasal elevation and protraction were observed after Le Fort I maxillary advancement surgery. Conclusions The changes in anteroposterior and superoinferior positions of A-point were correlated with the nasal superoinferior position (r = −0.71, P < .05; r = 0.72, P < .05) after Le Fort I maxillary advancement surgery.