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Orthopedic Protraction with Skeletal Anchorage in a Patient with Maxillary Hypoplasia and Hypodontia

Multipurpose titanium miniplates were placed on the lateral nasal wall of the maxilla as anchorage for face mask protraction in an 11-year-old girl presenting with severe maxillary hypoplasia and hypodontia. Applying orthopedic forces directly to the maxilla resulted in an eight mm maxillary advancement. Intraosseous titanium screws were also placed on the palatal bone, near the alveolar crests, to provide anchorage for the expansion appliance. The maxilla was expanded from the median palatal suture, and seven mm of expansion was achieved across the buccal segments. No other tooth support was used for the expansion or the protraction of the maxilla.

Comparative evaluation of maxillary protraction with or without skeletal anchorage

INTRODUCTION The aim of this prospective clinical study was to evaluate the skeletal, dentoalveolar, and soft-tissue effects of maxillary protraction with miniplates compared with conventional facemask therapy and an untreated Class III control group. METHODS Forty-five subjects who were in prepubertal or pubertal skeletal growth periods were included in the study and divided into 3 groups of 15 patients each. All subjects had skeletal and dental Class III malocclusions with maxillary deficiency, vertically normal growth pattern, anterior crossbite, Angle Class III molar relationship, normal or increased overbite, and retrusive nasomaxillary complex. Before maxillary protraction, rapid maxillary expansion with a bonded appliance was performed in both treatment groups. In the first group (MP+FM), consisting of 5 girls and 10 boys (mean age, 10.91 years), facemasks were applied from 2 titanium miniplates surgically placed laterally to the apertura piriformis regions of the maxilla. The second group (FM) of 7 girls and 8 boys (mean age, 10.31 years) received maxillary protraction therapy with conventional facemasks applied from hooks of the rapid maxillary expansion appliance. The third group of 8 girls and 7 boys (mean age, 10.05 years) was the untreated control group. Lateral cephalometric films were obtained at the beginning and end of treatment or observation in all groups and analyzed according to a structural superimposition method. Measurements were evaulated statistically with Wilcoxon and Kruskal-Wallis tests. RESULTS Treatment periods were 6.78 and 9.45 months in the MP+FM and FM groups, respectively, and the observation period in the control group was 7.59 months. The differences were significant between the 3 groups (P <0.05) and the MP+FM and FM groups (P <0.001). The maxilla moved forward for 2.3 mm in the MP+FM group and 1.83 mm in the FM group with maxillary protraction. The difference was significant between 2 groups (P <0.001). The protraction rates were 0.45 mm per month in the MP+FM group and 0.24 mm per month in the FM group (P <0.001). The maxilla showed anterior rotation after facemask therapy in the FM group (P <0.01); there was no significant rotation in the MP+FM group. Posterior rotation of the mandible and increased facial height were more evident in the FM group compared with the MP+FM group (P <0.01). Both the maxilla and the mandible moved forward significantly in the control group. Protrusion and mesialization of the maxillary teeth in the FM group were eliminated in the MP+FM group. The maxillomandibular relationships and the soft-tissue profile were improved remarkably in both treatment groups. CONCLUSIONS The undesired effects of conventional facemask therapy were reduced or eliminated with miniplate anchorage, and efficient maxillary protraction was achieved in a shorter treatment period.

Comparison of the zygoma anchorage system with cervical headgear in buccal segment distalization

This prospective study aimed to evaluate the effects of the zygoma anchorage system (ZAS) in buccal segment distalization in comparison with cervical headgear (CH). Thirty patients with Class II dental malocclusions were included in the study and were divided into two equal groups: the first group (10 females and 5 males, mean age 14.74 years at T1) received buccal segment distalization with ZAS and the second group (8 females and 7 males, mean age 15.26 years at T1) with CH. The skeletal, dental, and soft tissue changes were measured on cephalograms obtained before (T1) and after (T2) distalization, and these changes were statistically evaluated using a repeated measures analysis of variance, Mann-Whitney U-test, and Wilcoxon test. The Class II buccal segment relationship was corrected to a Class I in an average period of 9.03 +/- 0.62 months in the ZAS group and 9.00 +/- 0.76 months in the CH group. Significant distalization was observed for the posterior teeth in both groups (P < 0.001). Distal tipping of all posterior teeth occurred in the CH group (P < 0.001), but only for the molars in the ZAS group (P < 0.001). The upper incisors retroclined, overjet decreased, and the upper and lower lips retruded in both groups. The ZAS provided absolute anchorage for distalization of the maxillary posterior teeth and can be used as an aesthetic and non-compliant alternative to extraoral traction in the treatment of Class II malocclusions.

Mandibular Symphyseal Distraction and Its Geometrical Evaluation: Report of a Case

In this report, the case of a patient who has been treated with a different use of a tooth-borne custom-made mandibular symphyseal distraction device is presented. The difference in the application is that the distal arm of the device was sectioned during the retention phase to allow the possible relapse of displaced condyles to their original positions while the labial segment expansion is being maintained. The effect of this procedure was also evaluated on a geometrical model using measurements from the patients cast. We conclude that symphyseal distraction is an effective and fast method of correcting orthodontic anomalies. The effect of the procedure on the condyle was only 3 degrees of distolateral rotation as calculated using the geometrical model.

Stability of zygomatic plate-screw orthodontic anchorage system: a finite element analysis.

OBJECTIVE To evaluate the biomechanical properties of a standard and a newly designed plate-screw orthodontic anchorage system. MATERIALS AND METHODS A three-dimensional model of the posterior maxilla, including the zygomatic buttress region, was prepared. Insertion of standard and newly designed plates was simulated on the three-dimensional model. The effect of 200 g of orthodontic force on the plate, screws, and zygomatic bone was evaluated in three-dimensional models by finite element analysis. To determine the force distribution, Von Mises stress, principal maximum and minimum stress, and principal maximum and minimum elastic strain values were evaluated. RESULTS In all plate models the highest stresses occurred on the threaded bone site where the force application unit was attached. CONCLUSION Changing the plate configuration did not affect the stress distribution in the newly designed plates. To equalize the force distribution, new plate designs that change the location of the force application unit are required.

Orthodontic and surgical treatment of hemimandibular hyperplasia.

Correction of facial asymmetries is still a major problem in need of an adequate solution. In this case report, the differential diagnosis and treatment strategies of hemimandibular hyperplasia are described with the present patient.

The extent of chin ptosis and lower incisor exposure changes following the osseous genioplasties.

Abstract The incision and dissection of the mentalis muscles are inevitable to access the osteotomy line during genial surgery. As the mentalis muscles elevate the central lower lip and support the lip vertically, inadvertent scarring or lengthening of these muscles may lead to lip incompetence and may increase the lower incisor exposure (LIE) that will cause an unaesthetic result. The aim of this study was to evaluate the extent of lip ptosis, LIE, and other soft-tissue changes following different types of osseous genioplasty procedures. Twenty-nine patients (18 females, 11 males) were included in this study. Patients were classified into 3 groups with respect to their genial movement type as genial setback (n = 10), genial advancement (n = 10), and vertical reduction (n = 9). Preoperative and postoperative lateral cephalograms were analyzed to evaluate the horizontal and vertical soft-tissue changes of the lower lip and chin in the 3 genioplasty groups. The statistical evaluations were performed with regression analysis. The mean increase in the LIE was 1.88 mm. Lower incisor exposure and soft-tissue thickness at pogonion were increased significantly in all patients (P < 0.05). Statistically significant differences for lower lip length and vertical position of soft-tissue supramentale values were detected in patients who underwent vertical reduction genioplasty (P < 0.05). Genioplasty procedures requiring the mentalis muscle release cause a 1.88-mm increase in LIE. Vertical positional alterations of the lower lip were especially observed following the vertical reduction genioplasty. Clinician should be aware of this consequence in the course of treatment planning.

Alveolar Ridge Splitting Versus Autogenous Onlay Bone Grafting: Complications and Implant Survival Rates

Purpose: To compare the complications and implant survival rates of localized alveolar ridge deficiencies in the horizontal dimension reconstructed by alveolar ridge splitting (ARS) or autogenous onlay bone grafting (OBG). Materials and Methods: Twenty-eight ARS and 28 OBG were performed. The survival rate of the all included implants was evaluated using the clinical and radiographical evaluation criteria of Misch et al. Temporary exposure of graft, mild infection, temporary paresthesia, and bad split were defined as minor complications; permanent exposure of graft, loss of graft, and permanent paresthesia were defined as major complications. Major and minor complications of ARS and OBG groups were statistically compared. Results: When the minor and major complication rates are considered, there was not any statistically significant difference between OBG (P = 0.099) and ARS (P = 0.241) groups. The satisfactory survival rate of OBG group was 92% and was 100% in the ARS group, and the difference was not statistically significant (P = 0.116). Conclusion: When reconstructing vertically sufficient but horizontally insufficient alveolar ridges, ridge splitting technique could shorten the treatment period, decrease postoperative swelling and pain, eliminate the need for a second surgical site, reduce the treatment cost, and ease the patient cooperation to the surgery.

Unilateral complex syngnathia of the maxilla, mandible, and zygomatic complex in a newborn baby

Syngnathia is a rare congenital fusion of the hard and soft issues of the jaw. Early intervention after birth is essential ecause without it the baby cannot feed, and facial growth nd function will be severely affected.1 A 3-day-old baby boy was referred to the oral and maxilloacial surgery clinic from a peripheral hospital. He presented ith his upper and lower gums completely attached and so ad to be fed through a nasogastric tube. His history showed hat his parents were related by blood, but there was no vidence of syngnathia, systemic disease, trauma, or drug reatment other than routine drugs and analgesics (for examle, paracetamol) during pregnancy. He was referred to the paediatric newborn intensive care linic for further evaluation, but there were no genetic, conenital, or systemic problems. His chin was deviated to the eft, and he had retrusion of the mandible. Intraorally the eft side of his maxilla and mandible were fused at gum level Fig. 1), but there was no cleft palate and no syndrome apparnt. We classified the deformity as a Type 2a according to the aster classification,2 and noted that he was malnourished nd had a low body weight. His left ascending ramus and he alveolar process of his mandible were fused to the upper

Comparative evaluation of simultaneous maxillary sinus floor elevation and implant placement with residual bone heights greater or less than 5 mm.

PURPOSE Implants can be inserted simultaneously during sinus floor elevation (SFE), or 6 months later, for posterior maxillary rehabilitation. The residual bone height (RBH) is a major factor that affects the type of surgical procedure that will be performed. The aim of this study was to compare the survival rates of implants inserted during one-stage SFE with two different RBHs (< 5 mm and ≥ 5 mm). MATERIALS AND METHODS This study consisted of implants inserted into an RBH of either < 5 mm or ≥ 5 mm, and the survival of the implants was assessed according to the clinical symptoms of the patients: pain or tenderness during function (or spontaneously), mobility, depth of probing, exudation history, and radiographic bone loss at the final follow-up appointment. The survival rates of the two groups were statistically compared using the Fisher exact test. RESULTS Fifty-nine consecutive patients (29 women and 30 men) undergoing a one-stage sinus elevation procedure simultaneously with implant insertion were included in this study. Fifty-one implants were placed in the study group (RBH: 1 to 4.9 mm), and 31 implants were placed in the control group (RBH: 5 to 8 mm). The survival rate of the implants in the study group was 94.2% at the 5.4-year follow-up and 95.8% in the control group at the 7.9-year follow-up. There was no statistically significant difference between the groups in terms of the implant survival rate (P = .785). CONCLUSION The results of this study suggest that SFE with simultaneous implant placement in patients with an RBH < 5 mm can be accomplished, and that the survival rate is similar to that of the one-stage SFE protocol with an RBH of > 5 mm.