Missing upper incisors: a retrospective study of orthodontic space closure versus implant

Background: The aim of this retrospective study was to compare the esthetic, periodontal, and functional outcomes of orthodontic space closure versus implant substitution in patients with missing maxillary incisors 5 years after completion of treatment. Methods: The study group consisted of ten patients treated with orthodontic space closure (six males, four females, mean age 19 ± 2.1 years at the completion of treatment) and ten patients treated with implant insertion (five males, five females, mean age 20 ± 1.4 years at the time of implant insertion). Tooth mobility, plaque index, probing depth, infraocclusion, open gingival embrasure (black triangle), and temporomandibular joint function were recorded at the 5.6 years follow-up. Self-perceived dental esthetic appearance was also evaluated through a visual analog scale (VAS) questionnaire. T-test was used to evaluate the data. Results: All patients were equally satisfied with the appearance of their teeth 5.6 ± 0.4 years after the completion of treatment. No statistically significant differences were found in relation to the VAS scores of the subjects (P < 0.857). No significant differences were found in tooth mobility, plaque index (P < 0.632), and the prevalence of signs and symptoms of temporomandibular disorders. However, significant infraocclusion was noticed in all implant patients (P < 0.001). Probing depth was also significantly higher in implant patients (P < 0.001). Conclusions: Orthodontic space closure and implant of missing maxillary incisors produced similar, well-accepted esthetic results. None of the treatments impaired temporomandibular joint function. Nevertheless, infraocclusion was evident in implant patients. Space closure patients also showed better periodontal health in comparison with implant patients

Effects of Tongue Plate on the Nasomaxillary Complex of Patients with Unilateral Cleft Lip and Cleft Palate

Background and aim: Cleft lip and cleft palate are among the most common orofacial abnormalities. Patients with these deformities commonly present with midface deficiency and need challenging treatment modalities that focus on improving the position of the maxilla. Tongue plate appliance is an intraoral device that has shown promising results in the treatment of growing patients with maxillary deficiency. Nonetheless, the effects of tongue plate on patients with cleft lip and cleft palate have not been evaluated yet. This study aimed to assess the effects of tongue plate on growing patients with cleft lip and palate. Materials and methods: Twenty-four growing patients (12 girls and 12 boys) with non-syndromic unilateral cleft lip and cleft palate between the ages of 6-12 years volunteered to participate in this quasi-experiment. All the patients had undergone the preliminary stages of lip and palate closure during infancy, but none of them had received bone grafts. They were treated with tongue plate appliance for 18±3 months. Lateral cephalograms were obtained and were analyzed at the beginning and at the end of the treatment. Paired t-test was used for statistical analysis of normally-distributed data; otherwise, Wilcoxon test was used. Results: Paired t-test showed that the Sella-Nasion-Point A (SNA) angle was increased from 76.3±0.2 to 77.3±0.14 degrees, and the Point A-Nasion-Point B (ANB) angle was enhanced from -2.26±0.17 to 0.93±0.82 degrees (P<0.001). Conclusion: Tongue plate appliance has shown favorable results in the treatment of class 3 malocclusion and maxillary deficiency in growing patients with cleft lip and cleft palate

Treatment effects of R-Appliance and Fränkel-2 in Class II division 1 malocclusions

Aim The purpose of this study was to compare the effects of a differently designed functional appliance (the R-appliance) with Fränkel-2. Study Design Twenty-seven patients (16 girls and 11 boys) with a mean age of 9.8 (SD 1.6) years were treated with the R-appliance for 15.4 (SD 0.4) months and twentyseven (15 girls and 12 boys) patients with a mean age of 9.1 (SD 1.1) years were treated with a Fränkel-2 appliance for 19 (SD 5.6) months. All patients had Class II division 1 malocclusions due to mandibular deficiency and all of them had prepubertal stages of skeletal development. Lateral cephalograms obtained at the beginning (T1) and at the end (T2) of the study were analysed. Results Paired t-tests showed that SNB significantly increased in both groups. The incisor mandibular plane angle (IMPA) was reduced in the R-appliance group by 2.2 (SD 4.9) degrees (P &lt; 0.03) but increased by 2.2 (SD 2.6) degrees (P &lt; 0.001) in the Fränkel-2 group. The SNA in the R-appliance group showed an increase of 0.2 (SD 2) degrees (P &lt; 0.6), while it was decreased by 0.4 (SD 0.5) degrees (P &lt; 0.6) in the Fränkel-2 group. Conclusions Both treatment modalities were successful in moving the mandible forward. However, with the R-appliance, this was achieved without proclination of the lower incisors