Evaluation of 5 Years Profile of an Infant Cleft Lip and Palate Clinic

The aim of this report was to present the distribution of patients and treatment modalities of all cleft lip and palate (CLP) patients accepted for treatment in the newborn cleft clinic at the Marmara University, Faculty of Dentistry, Department of Orthodontics, during the 5 years from October 2001 to October 2006, and to summarize the structure and organization of the clinic. The goal was to initiate a nationwide exchange of opinions among orthodontic clinics that deal with the treatment of newborn CLP patients, to communicate clinical experience and information, and to make a step forward in standardizing records as a basis for future multicentered research. Even though preoperative orthopedics for newborn cleft lip and palate patients is still a matter of controversy, it has been adopted in our clinic, and the use of feeding plates and nasoalveolar molding is chosen according to the cleft type. Along with the medical history, digital pictures, maxillary and nasal impressions, and written treatment documentation are the basic records. Of the 263 newborn patients who have been accepted for treatment within the last 5 years, only one had a median cleft, 23.2 % were bilateral, 41.8 % were unilateral, 34.6 % were isolated cleft palate patients; while 95 % of the unilateral cases and 85 % of the bilateral cases have been treated via nasoalveolar molding. Patients are being followed up in 6 month intervals after the primary repair, with consultation of a pediatric dentist, a speech therapist, and the surgeon, where necessary. It is obvious that comprehensive cleft care can only be provided by specialists, who dedicate the majority of their time to cleft care in a common separate location and in an interdisciplinary fashion. In order to establish a national health policy that provides optimum conditions and sufficient financial contribution, it is necessary to join specialists all over Turkey in a cleft network and to establish a national data pool as soon as possible

The Effect of Second Molar Extraction and Septumotomy on Intraoral Molar Distalization - A Pilot Study

This study aimed to evaluate the combined effects of second mo tar extraction and interradicular septum removal on molar distalization, an intraoral distalization mechanism was used, emitting interrupted forces. The study group consisted of 12 Class II adolescents (6 females and 6 males), with a mean age of 15.17. Dental effects were analyzed on lateral cephalograms by means of acrylic caps with indicator wires at 3 stages: Pre-treatment, post-distalization, and 2 months after the distalization. Maxillary first premolar and first molar rotations and intermolar distance changes were evaluated from study models, taken at the same periods. All subjects were extracted the upper second molars, and interradicular septa were removed. At the same time, the mesial socket wall was cut vertically and horizontally. Distalization began the next day with bilaterally positioned compact RPE screws, which were activated once in two days. The mean time for the distalization was 3.25 months. Results showed maxillary first molars distalized 3.21 mm with 7.7° tipping and 4.2° mesial rotation. The anchorage loss was 3.41 mm for premolars, and 4.41 mm for incisors, which was reduced to 0.34 mm in premolars, and 2.16 mm in incisors during the post-distalization period. The inter-molar distance increased 4.42mm during distalization

Short- and Long-Term Evaluation of a Condylar Hyperplasia: A Case Report

Objective:This case report presents the diagnosis and short- and long-term treatment results of an orthodontically and surgically treated patient with condylar hyperplasia.Materials and Methods:Condylar hyperplasia was diagnosed in an 18-year-old patient. In the clinical and radiologic examination, asymmetrical face, overdevelopment of the head and lengthening of the neck of the right condyle, deviation of the menton to the opposite side, temporomandibular joint pain, occlusal canting, slight open bite in the affected side, and an impacted upper right premolar were detected. Technetium-99 radioisotope scanning was made in 6-month intervals, and surgery was planned and performed. Changes were measured on the cephalograms taken at the beginning of orthodontic treatment, before and after surgery, at the end of fixed treatment, and in 4 years 6 months follow-up period.Results:Skeletal and dental Class I relationship was established and the profile improved. Slight increase of the vertical dimension was observed in the finishing and follow-up cephalograms.Conclusion:In order to decide the appropriate time for surgery for condylar hyperplasia patients in which osteoblastic activity continues, isotope-scanning examination is a must. Short-term results achieved with the orthodontic and surgical treatment were satisfactory and were maintained in the long term

Cephalometric Evaluation of Skeletal and Dental Effects of Modified Facemask

The aim of this study was to examine the effects of the newly modified maxillary protraction facemask. 15 patients, having an average age of 12.42 ± 1.87 years, presenting Class III malocclusion with maxillary retrognathism were treated for 7.5 ± 1.02 months. Rapid palatal expansion was performed for 7 days with a full coverage acrylic cap splint type appliance. At the 7th day, protraction therapy was started with the combination of a specially designed face bow and Petit type facemask. The face bow was bent upward to raise the point of force application to pass through the center of resistance of the maxilla. A total of 1000 g (500 g on each side) of protrusive force was applied and the patients were instructed to wear the facemask for 16 h/day. Wilcoxon signed rank test was carried out to evaluate 48 parameters measured on cephalometric radiographs. Results showed that the maxilla was displaced anteriorly without rotation. Maxillary occlusal plane showed a clockwise rotation. Maxillary incisors were extruded and retroclined. Mandible was displaced downward and backward. In conclusion, by introducing our new face bow design, we were able to protract the maxilla bodily and at the same time to have a more effective force-moment system where the whole protractive force was utilized in protracting the maxilla

Cephalometric Evaluation of Molar Distalization by a Compact RPE Screw Combined with a Modified Nance Appliance

The aim of this study is to evaluate the effects and results of a newly designed intra-oral molar distalization device. The study involves 8 (1 male and 7 females) patients with class II dental relationship. The mean age of the patients was 14.1. Molar distalization was achieved by intermittent forces, where the compact RPE screw is placed in mesiodistal direction between molars and premolars. After the completion of distalization, the appliance was kept in mouth passively for 3 months for retention purpose. Patients were instructed to turn the screw 1 time a week (meaning 1/4 turn each week) and activation continued until super class one dental relationship was achieved. The status will be retained with the same screw, kept in position, for approximately 3 months. Lateral cephalometric radiographs were taken at the day of insertion of the device (before opening the screw), and at the end of treatment. Tracing of these radiographs gave us a detailed view of the result of our study and the effectiveness of the new device. The significant changes achieved were as follows: The upper first molars were distalized in an average of 2.68 mm, tipped 2.62° distally. The upper central incisors were proclined by an average of 2.5 mm and tipped 4.9° labially. IMPA increased 1.09°, the lower molars extruded 1mm, and overjet increased 1,3mm. On the other hand, there were no significant skeletal changes

Two Different Modeling Techniques for Fabrication and Application of Bone-Borne Symphysis Distractor

The aim of this study is to convert a simple, expansion screw used for rapid palatal expansion into a bone-borne symphysis distractor and to introduce two different modeling techniques for adapting of the screw to the anatomy of symphysis before surgery. The techniques will be presented on two cases. The cases used in this study showed mandibular transverse deficiency and lower anterior crowding. In the first case the distractor was fabricated on a study model obtained by cephalometric modeling technique. In the second case the SLA (Stereo-Litographic Apparatus) biomodeling technique was used. The active unit is a simple rapid palatal expansion screw and the parts used to fix the miniscrews to bone during surgery are prefabricated from titanium footplates. Both of the distractors were applied by the same surgeon following the same surgical procedures. During the surgical procedure, although the adaptation of the distractor to the symphyseal region was acceptable in the cephalometric modeling technique, the arms of the distractor needed minor, secondary bendings for perfect fit. During the surgical procedure of the distractor prepared by SLA biomodeling technique there was no need for any additional adaptation. In both of the cases sufficient widening and parallel distraction pattern was obtained; new bone was radiologically observed after the consolidation period. The lower crowding was resolved using the space obtained by distraction; no complication was observed. In conclusion although both of the techniques were successful, the distractor adaptation in SLA biomodeling technique was superior in shortening the surgical procedure and minimizing the possible complications