Use of three-dimensional medical modeling methods for precise planning of orthognathic surgery

Stereolithographic (medical rapid prototyping) biomodeling allows three-dimensional computed tomography to be used to generate solid plastic replicas of anatomic structures. Reports in the literature suggest that such biomodels may have a use in maxillofacial surgery, craniofacial surgery, orthopedics, neurosurgery, otology, vascular, and nasal research. A prospective trial to assess the usefulness of biomodeling in orthognathic surgery has been performed. In 12 patients with mandibular prognathism and/or maxillary retrusion, in addition to routine preoperative cephalometric analysis, preoperative high-resolution (cutting slice thickness of 1 mm) three-dimensional computed tomography scan of the patients was obtained. Raw data obtained from computed tomography scanning was processed with a Mimics 9.22 Software (Materialise's Interactive Medical Image Control System, Belgium). Fabrication of three-dimensional medical models was obtained through a process called powder depositional modeling by use of a Spectrum Z 510 3D Color Printer (Z Corporation, Burlington, MA). Alveolar arches of the maxilla and mandibula of the models were replaced with orthodontic dental cast models. Temporomandibular joints of the models were fixed with Kirschner wire. Maxillary and mandibular bony segments were mobilized according to preoperative orthodontic planning done by analysis of cephalometric plain radiographs. The relation between proximal and distal mandibular segments after bilateral sagittal split osteotomies were evaluated on models preoperatively. The same surgeon had a role in both model cutting preoperatively and as an instructor preoperatively. The same bony relation was observed both in preoperative modelsand in the perioperative surgical field in all patients. Condylar malpositioning was not observed in any of the patients. Studying preoperative planned movements of osteotomized bone segments and observing relations of osteotomized segments of mandibula and maxilla in orthognathic surgery increased the intraoperative accuracy. Limitations of this technology were manufacturing time and cost.

Comparison of the effects of 1,25 dihydroxycholecalciferol and prostaglandin E2 on orthodontic tooth movement

This study compared the effects of local administrations of prostaglandin E2 (PGE2) and 1,25-dihydroxycholecalciferol (1,25-DHCC) on orthodontic tooth movement in rats. Thirty-seven 6-week-old male Sprague-Dawley rats, weighing 160 +/- 10 g were used. Five rats served as the baseline control group. A fixed appliance system exerting 20 g of distally directed force was applied on the maxillary incisors of 32 animals for 9 days. Eight rats served as the appliance control group; 8 received a 20-microL injection of dimethyl sulfoxide (solvent for 1,25-DHCC) on days 0, 3, and 6; 8 received 20 microL of 10(-10) mol/L 1,25-DHCC on days 0, 3, and 6; 8 received a single injection of 0.1 mL of 0.1 microg PGE2 only on day 0. There was no significant difference in tooth movement between the PGE2 and the 1,25-DHCC groups. Both PGE2 and 1,25-DHCC enhanced the amount of tooth movement significantly when compared with the control group. The numbers of Howship's lacunae and capillaries on the pressure side were significantly greater in the PGE2 group than in the 1,25-DHCC group. On the other hand, the number of osteoblasts on the external surface of the alveolar bone on the pressure side was significantly greater in the 1,25-DHCC group than in the PGE2 group. Thus, 1,25-DHCC was found to be more effective in modulating bone turnover during orthodontic tooth movement, because its effects on bone formation and bone resorption were well balanced.

Effect of low-level laser therapy (LLLT) on orthodontic tooth movement

The aim of this study is to evaluate the effects of low-level laser therapy (LLLT) on (1) the velocity of orthodontic tooth movement and (2) the nitric oxide levels in gingival crevicular fluid (GCF) during orthodontic treatment. The sample consisted of 20 patients (14 girls, six boys) whose maxillary first premolars were extracted and canines distalized. A gallium-aluminum-arsenide (Ga-Al-As) diode laser was applied on the day 0, and the 3rd, 7th, 14th, 21st, and 28th days when the retraction of the maxillary lateral incisors was initiated. The right maxillary lateral incisors composed the study group (the laser group), whereas the left maxillary lateral incisors served as the control. The teeth in the laser group received a total of ten doses of laser application: five doses from the buccal and five doses from the palatal side (two cervical, one middle, two apical) with an output power of 20 mW and a dose of 0.71 J /cm(2). Gingival crevicular fluid samples were obtained on the above-mentioned days, and the nitric oxide levels were analyzed. Bonferroni and repeated measures variant analysis tests were used for statistical analysis with the significance level set at p ≤ 0.05. The application of low-level laser therapy accelerated orthodontic tooth movement significantly; there were no statistically significant changes in the nitric oxide levels of the gingival crevicular fluid during orthodontic treatment.

Evaluation of the treatment changes of functional posterior crossbite in the mixed dentition

INTRODUCTION

Functional posterior crossbite (FPXB) malocclusion is frequently seen in the deciduous or mixed dentition. It is often accompanied by lateral mandibular shift and mandibular midline deviation because of the reduction in the width of the maxillary dental arch. The aims of this prospective study were to examine in detail the morphologic, skeletal, dental, and functional effects of FPXB, and the effects of maxillary expansion treatment with quad-helix appliance.

METHODS

The experimental group consisted of 35 FPXB patients (20 girls, 15 boys) having a mean age of 10.6 +/- 1.4 years; the control group consisted of 31 normocclusive subjects (18 girls, 13 boys) with a mean age of 9.8 +/- 1.6 years. Lateral, posteroanterior, and submentovertex cephalograms, transcranial temporomandibular joint radiographs, joint vibration analysis, and electromyographic recordings were obtained from every patient before and after maxillary expansion. Magnetic resonance images were taken before treatment for diagnostic purposes. These data were collected at 1 time point in the controls.

RESULTS

The pretreatment posteroanterior, submentovertex, and transcranial temporomandibular joint radiographs showed mandibular asymmetry relative to the cranial base and condylar malpositioning in the glenoid fossa. Joint vibration analysis findings showed different vibrations between the crossbite and noncrossbite sides, and imbalanced electromyographic findings in the experimental group. After treatment, the asymmetric morphology and position of the mandible and condyles were eliminated, and the stomatognathic system functions were normalized.

CONCLUSIONS

Early orthodontic treatment of FPXB creates optimum conditions for normal growth of the craniofacial skeleton and normal function of the stomatognathic system.

Tensile bond strength of ceramic orthodontic brackets bonded to porcelain surfaces

The aim of this study was to compare various surface treatment methods to define the procedure that produces adequate bond strength between ceramic brackets and porcelain. The specimens used in this study, 60 porcelain tabs, were produced by duplication of the labial surface of a maxillary first premolar. The 6 different preparation procedures tested were: (1) sandblasting with 50 microm aluminum oxide in a sandblasting device, (2) application of silane to the porcelain and the bracket base, (3) sandblasting followed by application of silane, (4) acid etching with 9.6% hydrofluoric acid, (5) acid etching with 9.6% hydrofluoric acid followed by application of silane, and (6) sandblasting followed by application of 4-Meta adhesive. The ceramic brackets were bonded with no-mix orthodontic bonding material. A bonding force testing machine was used to determine tensile bond strengths at a crosshead speed of 0.5 mm per second. The results of the study showed that porcelain surface preparation with acid etching followed by silane application resulted in a statistically significant higher tensile bond strength (P < .05). Sandblasting the porcelain surface before silane treatment provided similar bond strengths, but sandblasting or acid etching alone were less effective. Silane application was recommended to bond a ceramic bracket to the porcelain surface to achieve bond strengths that are clinically acceptable.

The effect of enamel air abrasion on the retention of bonded metallic orthodontic brackets

The purpose of this study was to compare the conventional acid-etch technique with an air abrasion surface preparation technique. Eighty freshly extracted noncarious human premolar teeth were randomly divided into the following 4 groups: (1) acid etched with 37% phosphoric acid for 15 seconds (Express Dental Products, Toronto, Canada), (2) sandblasted with 50 mu aluminum oxide by a microetcher (Danville Engineering Inc, Danville, Calif), (3) polished with pumice followed by acid etched with 37% phosphoric acid for 15 seconds, (4) sandblasted with 50 mu aluminum oxide by a microetcher followed by acid etched with 37% phosphoric acid for 15 seconds. All the groups had stainless steel brackets (Dentaurum, Standard Edgewise) bonded to the buccal surface of each tooth with no-mix adhesive (Express Dental Products, Toronto, Canada). A Lloyd testing machine (Lloyd Instrument LR 30K; Segensworth West, Foreham, UK) was used to determine tensile bond strengths at a crosshead speed of 0.5 mm/sec. The mean bond strength values of these are as follows: the only sandblasted group was 38.05 +/- 9.93 N; the only acid-etched group was 62.72 +/- 11.44 N; the group that was polished with pumice followed by acid etched was 69.78 +/- 14.87 N; and the group that was sandblasted followed by acid etched was 89.31 +/- 13. 34 N. The statistical analysis was done by an analysis of variance and Scheff¿e test. The sandblasting followed by acid etching group had significantly higher bond strength values when compared to the other 3 groups. This study showed that sandblasting should be followed by acid etching to produce enamel surfaces with comparable bond strength. The current findings indicate that enamel surface preparation using sandblasting with a microetcher alone results in a significantly lower bond strength and should not be advocated for clinical use as an enamel conditioner.

Changes in soft tissue profile after orthodontic treatment with and without extractions

The effects of orthodontic treatment on the facial profile, with or without the extraction of teeth, have greatly concerned orthodontists. A study was made of 80 patients with Angle Class I malocclusion. Forty patients (24 girls, 16 boys) did not undergo extraction of teeth, and 40 patients (23 girls, 17 boys) underwent extraction of maxillary and mandibular first premolars. Data were obtained from the corresponding lateral radiographs of the head taken before and after orthodontic treatment. The purpose of this study was to compare the response of the soft tissue of the facial profile in Class I malocclusions treated with and without the extraction of the 4 first premolars. The main soft tissue differences between the groups at the end of treatment were more retruded upper and lower lips in the extraction patients.

Effect of self-etching primer and adhesive formulations on the shear bond strength of orthodontic brackets

PURPOSE

Despite many published articles on the bond strength of self-etching primers and adhesives in the restorative dentistry literature, there have been relatively few laboratory studies of the bond strength of new orthodontic materials, and, in most of these published studies, investigators used various methodologic approaches during different stages of the in vitro testing procedures. The aim of this study was to compare the shear bond strength of 4 self-etching primer and adhesive formulations, a nonrinse conditioner and acetone adhesive system, and a conventional system.

MATERIAL

The self-etching products tested were Prompt L-Pop (3M ESPE, Seefeld, Germany), Clearfil SE Bond (Kuraray Dental, Osaka, Japan), FL Bond (Shofu Dental, Kyoto, Japan), and One-Up Bond F (Tokuyama, Tokyo, Japan); the nonrinse conditioner and acetone-based adhesive system was NRC and Prime&Bond NT (Dentsply International, Konstanz, Germany); the conventional acid-etch and bond system was Transbond XT (3M Unitek, Monrovia, Calif). Brackets were bonded to intact bovine mandibular incisors (n = 7 per group) according to each manufacturer's recommendations. The specimens were first stored in deionized water at 37 degrees C for 24 hours and then subjected to thermal cycling in deionized water at 5 degrees C +/- 2 degrees C to 55 degrees C +/- 2 degrees C for 1000 cycles. To facilitate degradation of bonds, the specimens were further stored in distilled water for 6 weeks before debonding procedures.

RESULTS

The shear bond strengths of the 5 experimental groups were all significantly lower (P < .05) than that of the control group (Prompt L-Pop, 1.72 +/- 0.13 MPa; Clearfil SE Bond, 1.75 +/- 0.19 MPa; FL Bond, 1.71 +/- 0.22 MPa; One-Up Bond F, 1.77 +/- 0.14 MPa; control, 10.5 +/- 0.86 MPa) but not different from one another (P > .05).

CONCLUSIONS

The tested self-etching primer and adhesive systems produced bond strength values much lower than that of the control product. Clinically, these products might not be suitable for orthodontic bracket bonding in terms of the shear bond strength achieved after thermal cycling and water storage.

Effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions; a pilot study

OBJECTIVE

To describe the dentoskeletal and soft tissue effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions (Alt-RAMEC) in maxillary retrusion patients.

MATERIALS AND METHODS

The sample consisted of 15 patients with a mean skeletal age of 11.6 ± 1.59 years undergoing 8 weeks of Alt-RAMEC followed by maxillary protraction. Three hundred fifty to 400 g of force per side was applied to the facemask from the titanium miniplates inserted on the lateral nasal wall of the maxilla. Total treatment time was 9.9 ± 2.63 months. Treatment changes were evaluated cephalometrically and analyzed by means of the dependent t-test and the Wilcoxon signed rank test.

RESULTS

The miniplates withstood the orthopedic forces exerted during the treatment. Cephalometric findings showed that the maxilla moved forward by 2 mm, with an 0.8° counterclockwise rotation and without maxillary incisor movement. The mandible moved slightly in a downward and backward direction (1.2°). The inclinations of the mandibular incisors decreased significantly (2°). Statistically significant increases were observed in the vertical dimension (1°-1.3°). Soft tissue changes were more marked in the upper lip and soft tissue pogonion than in the lower lip.

CONCLUSIONS

This treatment approach can offer an advantage for correcting mild/moderate maxillary retrusion in Class III patients.

The effect of first premolar extraction on vertical dimension

The purpose of this study was to evaluate the vertical changes occurring in Class I patients treated orthodontically with first premolar extraction and to compare these changes with those occurring in Class I patients treated orthodontically without extractions. Records of 40 Class I nonextraction cases (24 girls, 16 boys) and 40 Class I maxillary and mandibular first premolar extraction cases (23 girls, 17 boys) were obtained. The pretreatment and posttreatment cephalograms were digitized, and 6 linear and 8 angular cephalometric measurements were selected to evaluate vertical changes. Evaluation of the treatment results of the extraction and nonextraction cases showed that the vertical changes occurring after the extraction of maxillary and mandibular first premolars were not different than those occurring in the nonextraction cases.

Combined endodontic-orthodontic and prosthodontic treatment of fractured teeth. Case report

A case history of a 10 year old patient who accidentally injured his maxillary left central incisor is presented. The fracture of the crown extended about 4 mm below the crest of the alveolar bone. After pulpectomy and root canal therapy, a screw was cemented into the canal of the incisor. By means of a removable orthodontic appliance, the fractured tooth was extruded and the fracture line was brought above the level of the alveolar bone. The tooth was then restored with a veneer crown over a post core. A tooth that would have been extracted routinely was thus saved and restored through the use of a collaborative approach.

Skeletal and dental stability after maxillary distraction with a rigid external device in adult cleft lip and palate patients

PURPOSE

To evaluate skeletal and dental stability in adult cleft lip and palate patients treated with a rigid external distraction system at the end of distraction and during the postdistraction period.

PATIENTS AND METHODS

Lateral cephalograms of 7 patients were obtained before distraction, at the end of distraction, and during the postdistraction period. The mean age before distraction was 21.56 +/- 4.73 years. The mean follow-up was 37.3 +/- 12.4 months.

RESULTS

The assessment of findings showed that skeletal maxillary sagittal movement was achieved in a superoanterior direction. The maxillary depth angle and effective maxillary length increased significantly (2 degrees and 9 mm, respectively) after distraction, whereas the palatal plane angle increased by 8 degrees , resulting in an anterior movement of the maxilla with a counterclockwise rotation. The lower facial height showed no significant changes after distraction. The sagittal movement of the upper incisors and the angulation of the upper first molars increased significantly (4.5 mm and 5.5 degrees , respectively). During the postdistraction period, the maxilla showed a slight relapse (22%). The effective maxillary length decreased by 2 mm. The palatal plane angle almost returned to its original position, showing 7 degrees of clockwise rotation. The lower facial height remained stable. The upper incisors moved anteriorly and the upper first molars showed a significant mesioangular change during follow-up.

CONCLUSIONS

After distraction, significant maxillary advancement was achieved with a counterclockwise rotation. The upper incisors moved labially, and the upper first molars angulated mesially. After 3 years, a 22% relapse rate was seen in the maxilla. The counterclockwise rotation of the maxilla was returned to its original position. The upper incisors moved more anteriorly.

Upper airway changes after Xbow appliance therapy evaluated with cone beam computed tomography

OBJECTIVE

To determine the treatment effects of the Xbow appliance on the upper airway dimensions and volume using cone-beam computed tomography (CBCT); to evaluate the cephalometric changes in the skeletal and dental structures of the skeletal Class II patients.

MATERIALS AND METHODS

The sample consisted of 25 Class II patients (11 male, 14 female) with a mean age of 11.1 ± 1.1 years. CBCT images were obtained at the beginning of the treatment (T0) and after the debonding of the Xbow (T1).

RESULTS

Changes in superior, middle, and inferior parts of the oropharynx in the retroglossal region and changes in the oropharyngeal airway volume were statistically significant (P < .05, P < .01). The differences favoring the Xbow for the changes in the direction of Class II correction included SNA, SNB, ANB, maxillary depth angles, and point A-NPg and Co-B distances. Data of the dental parameters showed palatal tipping and extrusion of the maxillary incisors, labial tipping of the mandibular incisors, and mesial movement and extrusion of the mandibular molars.

CONCLUSIONS

Treatment with the Xbow appliance in Class II patients resulted in favorable increase in the oropharyngeal airway dimensions and volume. Further studies with larger study samples and with control groups are needed.

Reliability of reference distances used in photogrammetry

OBJECTIVE

To determine the reliability of the reference distances used for photogrammetric assessment.

MATERIALS AND METHODS

The sample consisted of 100 subjects with mean ages of 22.97 +/- 2.98 years. Five lateral and four frontal parameters were measured directly on the subjects' faces. For photogrammetric assessment, two reference distances for the profile view and three reference distances for the frontal view were established. Standardized photographs were taken and all the parameters that had been measured directly on the face were measured on the photographs. The reliability of the reference distances was checked by comparing direct and indirect values of the parameters obtained from the subjects' faces and photographs. Repeated measure analysis of variance (ANOVA) and Bland-Altman analyses were used for statistical assessment.

RESULTS

For profile measurements, the indirect values measured were statistically different from the direct values except for Sn-Sto in male subjects and Prn-Sn and Sn-Sto in female subjects. The indirect values of Prn-Sn and Sn-Sto were reliable in both sexes. The poorest results were obtained in the indirect values of the N-Sn parameter for female subjects and the Sn-Me parameter for male subjects according to the Sa-Sba reference distance. For frontal measurements, the indirect values were statistically different from the direct values in both sexes except for one in male subjects. The indirect values measured were not statistically different from the direct values for Go-Go. The indirect values of Ch-Ch were reliable in male subjects. The poorest results were obtained according to the P-P reference distance.

CONCLUSIONS

For profile assessment, the T-Ex reference distance was reliable for Prn-Sn and Sn-Sto in both sexes. For frontal assessment, Ex-Ex and En-En reference distances were reliable for Ch-Ch in male subjects.

Surgical and orthodontic treatment of an impacted permanent incisor: case report

This case report presented a combined surgical/orthodontic treatment of an impacted permanent incisor of a 10-year-old boy. Trauma to the primary dentition caused the impaction of the maxillary left permanent central incisor. Application of push coil spring between the adjacent teeth created space for the impacted tooth. A button with an extension of ligature wire was bonded to the maxillary left permanent central incisor to bring it into the arch. The maxillary left permanent central incisor was brought to its proper position after 16 months of active orthodontic treatment.

Adhesive fragment reattachment after orthodontic extrusion: a case report

In the treatment of crown fractures, adhesive fragment reattachment provides a good alternative to other restorative techniques, offering several advantages. The present paper reports a case in which the treatment of a cervical crown fracture was accomplished by reattaching the tooth fragment with a flowable resin composite. Orthodontic root extrusion was performed with a modified Hawley appliance prior to fragment reattachment. The clinical and radiographic results after 2.5 years were successful.

Tridimensional Evaluation of Maxillary and Mandibular Movements in Orthognathic Surgery

For better evaluation of long-term results of orthognathic surgery, movements of osteotomized maxillary and mandibular segments should be documented both in x-, y-, and z-axes and in terms of kind of movement (either linear or rotational movements). Lateral cephalometric, anteroposterior cephalometric, and submentovertex radiographs of 14 patients, treated with combined orthodontic and surgical treatment for skeletal class III malocclusion, were reevaluated retrospectively to demonstrate the applicability and usefulness of defined parameters in four maxillary and five mandibular movements. There was no clinically significant relapse in the follow-up period of 6 months in any of the patients. Differences between preoperative and postoperative measurements to demonstrate the linear movement in the z-axis, rotational movements in the x-axis and y-axis of the maxilla, and the linear movement in the z-axis of the mandibula were found to be statistically significant. Differences between early postoperative and late postoperative measurements to demonstrate rotational movement in the y-axis of the maxilla and rotational movement in the y-axis of the mandibula were found to be statistically significant. In this article, the possible tridimensional movements and cephalometric measurements of osteotomized bony segments after LeFort I and sagittal split osteotomy surgery were defined for better evaluation and follow up of the postoperative results.

Lower incisor retraction with a modified corticotomy

This case report demonstrates the orthodontic treatment facilitated with a new conservative corticotomy technique to shorten the treatment time during lower incisor retraction. The patient was a 22-year-old woman with protrusive profile, severe anterior crowding, an anterior crossbite, and Class III dental relationship. Orthodontic treatment consisted of the extraction of four first premolars with maximum anchorage. A modified corticotomy technique, in which the lingual vertical and subapical horizontal cuts were eliminated, was combined with orthodontic therapy for the retraction of the lower anterior teeth. Corticotomy-facilitated orthodontics dramatically reduced the treatment time without any adverse effects on the periodontium and the vitality of the teeth. The main advantages of this modified corticotomy technique were the elimination of the lingual cuts and flap, the reduction of surgery time, and minimum discomfort to the patient. At the end of active orthodontic therapy, balanced occlusion and facial esthetics were achieved.

Arch width changes in extraction and nonextraction treatment in class I patients

The aim of this retrospective study was to examine the dental arch width changes of extraction and nonextraction treatment in Class I patients. The study was performed on pretreatment and posttreatment dental casts of 60 patients (30 extraction and 30 nonextraction). The mean ages were 14.3 +/- 2.02 years for the extraction group and 14.1 +/- 2.9 years for the nonextraction group. The maxillary and mandibular crowding was -6.7 +/- 3.1 and -6.3 +/- 2.8 mm for the extraction group and -4.5 +/- 3.6 and -2.1 +/- 3.5 mm for the nonextraction group, respectively. The intercanine and intermolar arch width measurements were measured using a digital caliper. Paired samples t-test was used to evaluate the treatment changes within each group. To compare the changes between groups, independent samples t-test was performed. At the start of treatment, the maxillary and the mandibular intercanine and intermolar widths of both groups did not differ statistically. At the end of treatment, maxillary and mandibular intercanine widths of both groups increased significantly. The mandibular intermolar width decreased significantly for the extraction group and the maxillary intermolar width increased significantly for the nonextraction group. The decrease in maxillary intermolar width for the extraction group and the increase in mandibular intermolar width for the nonextraction group were not significantly different. No differences were observed between the groups in maxillary and mandibular intercanine widths. Maxillary and mandibular intermolar width indicated a significantly larger value in the nonextraction group than that in the extraction group.

Evaluation of Ricketts' long-range growth prediction in Turkish children

This study was conducted to evaluate Ricketts' long-range growth prediction in Turkish children. Cephalometric analysis was conducted at baseline and 7 years for 40 children (20 girls, 20 boys) who received no orthodontic treatment. Ricketts' long-range prediction was performed from baseline cephalograms and compared with actual growth 7 years later. Twenty-one cephalometric (12 angular and 9 linear) parameters were measured on actual and predicted tracings. The Pearson correlation coefficient was used to evaluate relationships between the "predicted" and "actual" measurements. Analysis was conducted on pooled data (males and females) and data by sex. There was a higher level of correlation for growth prediction in girls. Data indicate predictability in boys was greater for maxillary mandibular growth parameters. It was concluded that Ricketts' long-range growth prediction may be helpful in improving treatment planning. Further work on accurate soft tissue and hard tissue growth prediction is indicated.

Dental arch relationships in Turkish patients with complete unilateral cleft lip and palate born between 1976 and 1990: a comparison with eurocleft

OBJECTIVE

To compare the dental arch relationships of Turkish patients with complete unilateral cleft lip and palate (UCLP) with the results reported for participants in the Eurocleft study.

PATIENTS

Study models of 109 patients with complete UCLP from five university clinics in Turkey were evaluated (clinic A = 25 patients, clinic B = 23 patients, clinic C = 20 patients, clinic D = 21 patients, and clinic E = 20 patients). The mean age of the patient cohort was nine years old (range = 8-11 years old), and the cohort was born between 1976 and 1990.

METHODS

The examiners rated the three-dimensional (3D) models using the GOSLON Yardstick. The scores were compared with those from the Eurocleft centers: E1(B), E2(E), E3(A), E4(F), E5(C), and E6(D). Intra- and interexaminer agreements were evaluated using weighted kappa statistics.

RESULTS

The mean GOSLON scores for the Turkish clinics were as follows: clinic A = 3.16, clinic B = 3.13, clinic C = 3.25, clinic D = 3.67, and clinic E = 3.70. Scores for three of the Turkish clinics (A, B, and C) were significantly worse than the scores for the three best Eurocleft centers, E1(B), E2(E), and E3(A) (P < .001, P < .001, and P < .05, respectively). Scores for two of the Turkish clinics (D and E) were similar to those for Eurocleft center E6(D) but worse than the scores for the other Eurocleft centers (P < .01, P < .001, respectively).

CONCLUSIONS

This was the first study in which three-dimensional models were used to derive scores to compare with those of the Eurocleft centers. According to the results of analysis of 109 3D models, 50.4 % of the patients in Turkey were classified as GOSLON score 4 and 5. This may have been attributable to poor surgical procedures, low-volume surgeons, and the decentralized treatment approach in Turkey between 1985 and 2000. Further research is needed to assess the situation in Turkey in more recent years.

The effects of first premolar extractions on third molar angulations

The purpose of this study was to determine the relationship between the inclinations of second and third molars during a two- to 2.5-year period in patients treated orthodontically both with and without premolar extractions. Records of 37 first premolar extraction patients and 33 nonextraction patients were examined. The pretreatment and posttreatment panoramic radiographs were analyzed. The angles were measured between the long axis of the third molar and the occlusal plane and between the long axis of the third molar and the long axis of the second molar. Changes in third molar angulations from pretreatment to posttreatment for two groups were compared by Mann-Whitney U-test. Statistical analysis revealed that mandibular third molars showed an improvement in angulation relative to the occlusal plane in the first premolar extraction group.

Apical Root Resorption: A Prospective Radiographic Study of Maxillary Incisors

Objectives: The aim of this study was to determine the prevalence of apical root resorption in maxillary incisors during the initial stages of active orthodontic treatment and to test the hypothesis that root resorption increases with the progress of the treatment. Methods: The study sample consisted of 80 teeth of 20 patients (14 female, 6 male) with a mean age of 14.9±2.8 years. Root resorption was determined with standardized digitized periapical radiographs. All the periapical radiographs were obtained at the beginning of orthodontic treatment (T0) and 3 months (T1), 6 months (T2) and 9 months (T3) after the beginning of the treatment by a paralleling device. They were digitalized as 600 dpi with a flatbed scanner and analyzed by software for image analysis at 400x magnification utilizing a personal computer. Results: All of the 4 maxillary incisors had an increasing amount of resorption during the 9-month period. The amount of root resorption between the time intervals was statistically significant (P<.05). Conclusions: Root resorption of maxillary incisors can be detected in the early stages of orthodontic treatment and appears to be related to treatment duration. According to 9-month evaluation period, apical root resorption is of limited clinical significance for the average orthodontic patient. (Eur J Dent 2011;5:318-323)

Influence of two different bracket base cleaning procedures on shear bond strength reliability

PURPOSE

To search if the shear bond strengths of brackets would change after two different base-cleaning procedures such as sandblasting or carbide bur cleaning, and to determine if a previously bonded tooth surface had any effect on bond strength.

MATERIALS AND METHODS

A total of 120 new brackets were first bonded to 120 extracted premolars and then debonded and bond strength was recorded. The debonded brackets were divided into two groups and recycled either by sandblasting or tungsten-carbide bur cleaning. Sixty recycled brackets were divided into two subgroups: In each group; 30 recycled brackets were bonded to unused 30 extracted premolars. The remaining brackets were bonded to 30 previously used premolars. The brackets were debonded again and their bond strengths were remeasured.

RESULTS

Bond strength of rebonded brackets after sandblasting was not significantly different from that of new brackets while the bond strength of rebonded brackets after carbide bur cleaning group significantly decreased. The previously bonded tooth surface did not affect the bond strength significantly.

CLINICAL SIGNIFICANCE

This study showed that rebonding the brackets after sandblasting supplies sufficient bond strength. Previously bonded tooth surface did not cause a decreasing effect on bond strength. However, when carbide bur cleaning procedure is chosen, the clinician should proceed cautiously.

Mandibular dental arch changes with active self-ligating brackets combined with different archwires

Objective

The aim was to compare mandibular arch and incisor inclinational changes by comparing active self-ligating brackets used with different forms of archwires with a control group in nonextraction cases.

Materials and Methods

The sample of 50 patients with Class I malocclusion was divided into three groups: Group I was treated with active self-ligating brackets (Nexus, Ormco/Orange, CA, USA) used with Damon arch form copper nickel-titanium (Cu-NiTi) and stainless steel (SS) wires; Group II was treated with interactive self-ligating bracket system (Empower, American Orthodontics, Sheboygan, Wis, USA) used with standard Cu-NiTi and SS wires; and Group III was treated with Roth prescribed conventional brackets (Forestadent, Pforzheim, Germany) with standard Cu-NiTi and SS wires which was designed as a control group. Changes in dimension of mandibular arch and inclination of incisors were assessed on dental models and lateral cephalometric radiographs at pretreatment (T1) and posttreatment (T2) periods. Paired-t test and one-way analysis of variance were used to perform intragroup and intergroup comparisons, respectively.

Results

In all groups, an average increase of transversal distances occurred from pretreatment to the posttreatment period (P < 0.05). However, mandibular arch length increase was significantly different among the Groups I-III (P = 0.008) and I-II (P = 0.006). No significant intergroup difference was found with regard to incisor inclinational changes.

Conclusions

Bracket type had no significant effect on the mandibular dimensional or incisor inclination changes. Besides this, archwire type had only little effect on the treatment results as active self-ligating bracket with Damon archwires increased mandibular arch length greater than other groups.