Tayfun Günbay

Enhanced Effect of Combined Treatment With Corticotomy and Skeletal Anchorage in Open Bite Correction

PURPOSE To determine the effects of combined treatment with corticotomy and skeletal anchorage in open bite correction. PATIENTS AND METHODS Ten patients (6 females, 4 males) with ages ranging from 15 to 25 years were involved. All of the individuals received combined subapical corticotomy and skeletal anchorage procedure and intrusion forces of 200 to 300 g were applied on the attachments of each molar and both premolars during 12 to 15 weeks. Mean changes for the measurements for the sample group were evaluated with Wilcoxon signed ranks test. RESULTS Significant intrusion of maxillary posterior teeth provided counterclockwise rotation of the mandible and open bite was successfully corrected. SNB angle increased and the ANB angle decreased (P< .05). Significant decreases were noted for vertical skeletal characteristics and overbite increased accordingly (P< .05). CONCLUSIONS Our results indicated that the use of combined treatment with corticotomy and skeletal anchorage provided safe and noncompliance intrusion of posterior teeth in a short period and may be regarded as an alternative method for skeletal open bite correction in adults who reject orthognathic surgery.

Effects of Transmandibular Symphyseal Distraction on Teeth, Bone, and Temporomandibular Joint

PURPOSE The aim of this clinical study was to investigate the clinical effects and long-term results of the transmandibular symphyseal distraction technique for the correction of mandibular transverse deficiencies. This was achieved by assessing the dental, skeletal, and temporomandibular joint changes in the sagittal, vertical, and axial planes using cephalograms, dental casts, and computed tomography (CT). PATIENTS AND METHODS Seven patients with mandibular transverse deficiencies (3 females and 4 males), aged 14.3 to 22.5 years (mean 16.2), were treated with a bone-borne transmandibular distractor. Lateral and posteroanterior cephalometric films, CT scans of both temporomandibular joints, and dental casts were obtained preoperatively, at the end of the distraction period, and at the end of 3 years (clinical follow-up period). The clinical findings were assessed according to the morphologic and functional success criteria established by the Steering Group of European Collaboration on Cranial Facial Anomalies for patients with developmental dentofacial anomalies undergoing craniofacial distraction osteogenesis. The statistical analysis of cephalometric films and dental cast measurements was done using the paired t test. The mean postoperative examination period was 40 months (range 36 to 48). RESULTS The desired amount of distraction was achieved in all patients (mean 6.48 mm). The intraoperative and postoperative complications encountered included damage to the central incisors during vertical osteotomy (1 patient), wound dehiscence after a latent period (3 patients), mild temporomandibular joint pain during the distraction period (3 patients), and chronic gingivitis around the activation rods (7 patients). The success criteria for craniofacial distraction osteogenesis were fulfilled at the end of the 3-year follow-up period. Model analysis showed that the maximal amount of expansion was achieved at the premolar region (first premolar 5.79 mm, second premolar 5.07 mm). Frontal (posteroanterior) cephalograms taken at the end of the distraction period revealed significant increases in the bicondylar (0.35 mm), bigonion (3.43 mm), biantegonion (2.29 mm), and intermolar (4.0 mm) widths, and the ramal angle had decreased significantly (-1.64 degrees). The increase in the transverse measurements was greater at the dentoalveolar level than at the base of the mandible. Lateral cephalograms showed that transmandibular symphyseal distraction produced significant increases in the incisor mandibular plane angle (2.79 degrees) and mandibular body length (1.72 mm). The effect of the procedure on the condyle was 2.5 degrees to 3 degrees of distolateral rotation as calculated using the CT scans. Dental crowding was resolved rapidly by the movement of the teeth into the distraction regenerate. CONCLUSIONS The clinical and radiologic results of the present study have shown that a transmandibular distractor is a clinically effective bone-borne distractor for the correction of mandibular transverse deficiencies and anterior crowding. The follow-up cephalograms and CT scans showed the transverse skeletal stability of the distraction procedure and no permanent temporomandibular dysfunction. However, additional multicenter studies with more patients are necessary to precisely evaluate the long-term postdistraction changes on the skeleton, teeth, and temporomandibular joint.

Transpalatal Distraction Using Bone-Borne Distractor: Clinical Observations and Dental and Skeletal Changes

PURPOSE The aim of this clinical study was to analyze the outcome, complications, and long-term results of transpalatal distraction for the correction of maxillary transverse deficiency (MTD) and assess skeletal and dental changes in the sagittal, vertical, and transverse planes through cephalograms and dental casts. PATIENTS AND METHODS Ten adult patients with MTD were treated with a Transpalatal Distractor (Surgi-Tec, Bruges, Belgium). Lateral and posteroanterior cephalometric films and dental casts were taken before surgery and at the end of the consolidation period. The statistical analysis of cephalometric film and dental cast measurements was undertaken with paired t tests. RESULTS The intraoperative and postoperative problems encountered were damage to the central incisive teeth as a result of vertical osteotomy, wound dehiscence after the latent period, pain during the distraction period, and loosening of the distractor and buccal displacement of the left alveolar segment during the consolidation period. Model analysis showed that the greatest amount of transverse increase was in the premolar region (7.07 mm for first premolar and 7.10 mm for second premolar). Frontal cephalometric analysis indicated that transverse distances increased more at the alveolar level (7.75 mm) than in the maxillary base (5.25 mm) and nasal region (4.3 mm). The asymmetries between the left and right sides in both dental and skeletal expansions were statistically nonsignificant. The changes in the Sella-nasion-point A, Sella-nasion-point B, Sella-nasion and gonion-gnasion angles were statistically significant. CONCLUSIONS According to the results of this study, transpalatal distraction was found to be a clinically effective technique for palatal expansion in adult patients with MTD. However, treatment planning and regular clinical follow-up visits are necessary for long-term clinical success.

Results and complications of alveolar distraction osteogenesis to enhance vertical bone height

OBJECTIVE The aim of this retrospective study was to analyze the outcome and complications of alveolar distraction osteogenesis for the correction of vertically deficient ridges by using intraosseous and extraosseous distractors. STUDY DESIGN Seven patients with severely atrophic alveolar crests were treated by distraction osteogenesis in 5 alveolar ridge deficiencies by intraosseous distractors and in 2 alveolar ridge deficiencies by extraosseous distractors. The bone deficiencies were secondary to atrophy after periodontal disease, tooth extraction, or trauma. Three months after consolidation of the distracted segments, implants were placed in the distracted areas. The average follow-up period after prosthetic loading was 50 months. RESULTS The mean alveolar height achieved was 7.8 mm (range, 4-9 mm). The intraoperative and postoperative problems encountered were lack of device activation (n = 1), lingual displacement of the distracted segment (n = 1), paresthesia of the lower lip (n = 4), and dehiscence and plate exposure (n = 2). Most of these complications were considered to be minor complications and were solved without any problems. CONCLUSION It was concluded that alveolar distraction osteogenesis seems to be an effective technique to treat vertical alveolar ridge deficiencies, but adequate treatment planning is necessary for success. The complications related to this technique can be solved with simple treatments.

Dimensional Changes of the Nasal Cavity After Transpalatal Distraction Using Bone-Borne Distractor: An Acoustic Rhinometry and Computed Tomography Evaluation

PURPOSE The aims of this study were as follows: 1) evaluation of the effects of transpalatal distraction (TPD) on nasal minimum cross-sectional area (MCA) and nasal volume, and assessment of long-term stability of TPD outcomes on the nasal cavity, using acoustic rhinometry (AR); 2) quantifying the alveolar, basal, and nasal components of the maxillary expansion at both canine and molar levels by computed tomography (CT); 3) investigation of the relationship between CT transverse measurements and AR measurements. PATIENTS AND METHODS The sample was comprised of 11 adult patients with maxillary transverse deficiency and partial/near total nasal obstruction. Standard corticotomies were carried out and bone-borne transpalatal distractors were used in all cases. AR recordings were used to determine nasal minimum cross-sectional area of the anterior (MCA1) and posterior (MCA2) and the volume of the nasal cavity in these regions (Volume1, Volume2) before surgery (T1), when the distractor was removed (T2), and at least 1 year after the expander was removed (T3). CT images were taken at T1 and T2. CT measurements included maxillary base, alveolar, and nasal cavity widths at both canine and first molar slices. RESULTS There were significant increases in MCAs and volumes of nasal cavity between T1 and T2 and between T1 and T3 with the exception of the right MCA2 and right Volume2 at the latter time (P < .05). All maxillary transverse dimensions in canine and molar CT slices displayed significant increases (P < .05). The change in binasal width at the canine level showed significant correlations with the changes in total MCA1 and total Volume1 (P < .05). CONCLUSION TPD provided great increases in MCA and volume of the nasal cavity, and these changes generally remained stable long term. The use of TPD in adult patients granted the opportunity of efficient maxillary expansion concurrent with increases in the nasal dimensions.

Alveolar distraction osteogenesis in the human mandible: a clinical and histomorphometric study.

Purpose:To identify the quality of newly formed bone in the distraction region and to determine the percentage of mineralized bone formed in the distraction area. Methods:Ten patients with vertically deficient mandibular alveolar ridges were treated by means of distraction osteogenesis. Four months after consolidation of distracted segments, a total of 40 dental implants were inserted in native bone and distracted bone. Bone biopsies were taken at the implant sites with trephine burrs for histological and histometric analyses. Four months after implant placement, abutments were connected, and prosthetic loading of the implants was started. Results:The mean bone gain at the end of distraction was 7.2 ± 0.8 mm. The cumulative success rate of implants 3 years after the onset of prosthetic loading was 100%. The newly formed bone consisted of woven bone reinforced by parallel-fibered bone with bone marrow spaces and the percentage of mineralized bone ranged from 50.56% to 76.88%. Conclusions:Alveolar distraction osteogenesis is able to produce adequate mature bone for the correction of mandibular bone deficits before dental implant insertion.

Does Transpalatal Distraction Affect Pharyngeal Airway Dimensions and Related Soft Tissues

PURPOSE Previous studies of transpalatal distraction (TPD) have been based on dentoskeletal alterations of the jaws and nasal airway changes. The main aim of this study was to determine the effects of TPD on soft palate and pharyngeal airway dimensions and tongue posture. MATERIAL AND METHODS This was a retrospective cohort study. The sample was comprised of 16 patients with skeletal maxillary deficiency who had bilateral crossbite combined with a high palatal vault and partial or near total nasal obstruction treated with TPD using bone-borne distractors (Transpalatal Distractor, SurgiTec NV, Bruges, Belgium). This research was carried out on lateral cephalometric radiographs taken before distraction and after a distraction period of 6.75 ± 1.61 months. The primary predictor variable was pharyngeal airway dimensions and tongue posture. Other variables were demographic and lateral cephalometric parameters. Changes in the length, angle, and thickness of the soft palate; nasopharyngeal, retropalatal, retroglossal, and lower pharyngeal airway dimensions; and tongue length and height were evaluated. Data were analyzed by paired t test. RESULTS The sample included 16 adult patients (mean age, 25.13 ± 6.13 yr; 7 women, 9 men). The desired amount of distraction was achieved in all patients within 7 to 10 days. The total activation average was 8.38 ± 0.96. TPD caused statistically significant changes in sagittal nasopharyngeal airway dimensions (1.19 mm), the minimal oropharyngeal distance behind the tongue base (1.81 mm), and tongue height (2.12 mm). CONCLUSIONS The results of this study suggest that, in adult patients with nasal obstruction, TPD has the potential to increase sagittal nasopharyngeal airway dimensions and the minimal oropharyngeal distance behind the tongue, with an elevation in tongue posture. Further studies using cone-beam computed tomography that focus on how the bone-borne expander alters pharyngeal airway volume will make valuable contributions to the literature.

Cone beam computed tomography findings of ectopic tooth in the maxillary sinus associated with dentigerous cyst: A report of two cases and review of the literature

Dentigerous cysts are the most common type of benign odontogenic lesions that associated with the crown of an unerupted or impacted tooth. They constitute the second most common cystic lesion of the jaws, after radicular cysts. Dentigerous cyst surrounding impacted teeth often displace these teeth into ectopic positions. Ectopic eruption of teeth into regions other than the oral cavity is common but dentigerous cysts associated with ectopic teeth within the maxillary sinus are fairly rare. The diagnosis is usually made by panoramic radiography. Cone beam computed tomography (CBCT) is indicated when an ectopic tooth is associated with an antral mass and prior to surgery. The standard treatment for a dentigerous cyst is enucleation and extraction of the cyst-associated impacted or unerupted tooth. We report CBCT findings of two cases of dentigerous cyst associated with an ectopic tooth in the maxillary sinus and review the literature reports of this condition over the past 34 years.

FARKLI DENTAL İMPLANTLARIN BAŞARI ORANLARININ GERİYE DÖNÜK OLARAK DEĞERLENDİRİLMESİ

Amac: Gunumuzde dental implant uygulamalari, yuk- sek basari orani nedeniyle dis hekimligi kliniginde rutin bir tedavi secenegi haline gelmistir. Bu calismanin amaci; 2010-2015 yillari arasinda agiz dis ve cene cerrahisi kliniginde uygulanan farkli ticari markalara ait dental implantlarin basari oranlarinin geriye donuk degerlendirilmesinin yapilarak basarisizlik nedenlerini aciklayabilmektir. Gerec ve Yontem: Bu calismada; 2010-2015 yillari arasinda Ege Universitesi Dis Hekimligi Fakultesi Agiz Dis ve Cene Cerrahisi Anabilim Dali’na basvuran 271 hastaya uygulanan kemik ici dental implantlarin sonuc- lari degerlendirildi. Kontrol seanslarinda hastalarin klinik ve radyolojik bulgulari kaydedildi. Ayrica; bireyle- rin yas ve cinsiyet dagilimlari, sistemik hastaliklarin ve sigara kullaniminin dagilimi, implant uygulamasi oncesi gerceklestirilen ek cerrahi islemler, implantlarin bolge- lere ve dis cekimi sonrasi uygulama zamanlarina gore dagilimi ve sayisi, implant kayiplarinin dagilimi ve nedenleri degerlendirildi. Calismada, agiz icinde fonsiyonel ve estetik olarak devamliligini koruyan implantlar basarili olarak kabul edildi. Bulgular: Bu calismada, toplam 271 hastaya 862 adet kemik ici dental implant uygulandi. Calismaya katilan hastalarin %59,04’ u herhangi bir sistemik hastaliga sahip degildi. Hastalarin %15,12’ si aktif olarak sigara kullanmaktaydi. Implant uygulamalarinin %39,21’ inde uygulama oncesi ek bir cerrahi isleme ihtiyac duyuldu. Bu calismada, uygulanan implantlarin 23 tanesi kaybedildi. Sonuc: Calismada, uygulanan toplam 862 implantin 1-6 yil arasindaki kayip orani %2,668 ve basari orani %97,332 olarak olculdu Anahtar kelimeler: Dental implant, risk faktorleri, basari RETROSPECTIVE EVALUATION OF THE SUCCESS RATES OF DIFFERENT DENTAL IMPLANTS ABSTRACT Aim: Recently, dental implant applications have become a routine treatment option in dentistry clinics due to their high success rate. The purpose of this study is to evaluate the success rates of different trademark dental implants applied in oral and maxillofacial surgery clinic between 2010-2015 and explain the reasons of failure. Materials and Methods: In this study; the results of dental implants applied to 271 patients who were treated in the Department of Oral and Maxillofacial Surgery of Ege University Faculty of Dentistry were evaluated. Clinical and radiological findings of the patients were recorded during the control sessions. Also; age and gender distribution of patients, distribution of systemic diseases and cigarette use, additional surgical procedures performed before implantation, distribution and number of implants according to the time of application and post-tooth extraction time, distribution of implant losses and reasons were evaluated. In this study, implants that retained their functional and aesthetic continuity in the mouth were considered successful. Results: In this study, a total of 272 patients were treated with 862 intrabony dental implants. 59,04% of the patients participating in the study did not have any systemic disease. 15,12% of the patients were actively smoking. An additional surgical treatment was required before implantation of 39.21% of implants. In this study, 23 implants were failed. Conclusion : In the study, the loss rate of 862 implants 1-6 years was evaluated as 2,668% and the success rate was evaluated as 97,332%. Keywords: Dental implant; risk factors; success

THE EFFECTS OF MAXILLARY EXPANSION ON THE SOFT TISSUE FACIAL PROFILE

Purpose: The aims of this retrospective study were to evaluate the possible changes in soft tissue facial profile induced by orthopedic rapid maxillary expansion (RME) and surgically assisted rapid maxillary expansion (SARME), and to correlate them with the underlying hard tissue alterations. Materials and Methods: 16 patients who received bone borne SARME and 25 patients who were subjected to RME using metal cast splint hyrax appliance were analyzed retrospectively. This research was conducted on lateral cephalometric radiographs taken on 2 occasions: before expansion (T1) and at the beginning of any further orthodontic treatment (T2). Investigated lateral cephalometric parameters consisted of Holdaway soft tissue measurements with some supplementary soft tissue, skeletal and dental assessments. Results: The acquisition of T2 cephalograms which conforms to the initiation of further orthodontic treatment corresponded to 83.25±3.51 days for SARME and 85.68±4.37 days for RME after the expansion was completed. The only significant change in soft tissue profile of the SARME group was a decrease in upper lip thickness (p<0.05), whereas in the RME group, decrease in soft tissue facial profile angle and increase in H angle were found to be statistically significant (p<0.05 for each). For the RME group, the changes in soft tissue facial profile angle and H angle correlated only with the changes in SNB angle (p<0.05). Conclusion: While bone-borne SARME did not seem to possess the potential to alter soft tissue profile, tooth-borne RME caused a more convex soft tissue profile related to a reduction in SNB.