Effects of maxillomandibular advancement on respiratory function and facial aesthetics in obstructive sleep apnoea patients with versus without maxillomandibular deficiency

The aim of this study was to compare the effects of maxillomandibular advancement (MMA) on respiratory function between obstructive sleep apnoea (OSA) patients with and without maxillomandibular deficiency, and to compare the changes in facial aesthetics after MMA between the two groups. MMA-treated patients who had both baseline and follow-up polysomnography (PSG) data and lateral cephalograms were enrolled in this retrospective study. In addition to PSG and cephalometric data, patient satisfaction with postoperative breathing and facial aesthetics, and overall satisfaction with the treatment were assessed. Twenty-one patients were classified as not having maxillomandibular deficiency (without-deficiency group) and 40 patients as having maxillomandibular deficiency (with-deficiency group). The improvements in respiratory parameters (e.g., apnoea–hypopnoea index) and patient satisfaction with postoperative breathing were comparable in the two groups (P = 0.094–0.713). The changes in facial profile measurements (e.g., nasal prominence, nasolabial angel, and lip positions relative to the true vertical line) and patient satisfaction with postoperative facial aesthetics were also comparable in the two groups (P = 0.148–0.983). In conclusion, no significant difference in the effects of MMA on respiratory function and facial aesthetics between OSA patients with and without maxillomandibular deficiency was observed.     

Adenoid hypertrophy,craniofacial morphology in apneic children

PurposeEvaluation of the correlation between adenoid hypertrophy, airway space, craniofacial morphology, and apnea–hypopnea index (AHI).MethodsFor the study, 21 children with obstructive sleep apnea (OSA) between 6 and 10 years of age (48% female) and 22 nasal breathing (control group, CG) children between 6 and 9 years of age (45% female) were included. Using the cephalometric analyses, 14 craniofacial measurements, four pharyngeal widths, and two adenoidal measurements were assessed. The t-test was used to detect significant differences in the craniofacial and airway space measurements between the groups. Pearson's correlation was used to correlate the cephalometric data and AHI.ResultsThe two craniofacial measurements were different between the groups. AFAi (p = 0.0407) increased in the OSA group and the ramus length was shorter in the CG (p = 0.030). The adenoid increased in OSA (Ad2-So p = 0.0028; Ad1-Ba p = 0.0021), while the airway space decreased (PPW1 p = 0.0084; t-ppw p = 0.0056; PSA, p = 0.001). A correlation was observed in both Ad2-So-AHI (R² = 0.21; p = 0.037) and PPW1-AHI (R² = 0.21; p = 0.035).ConclusionsFew alterations in the craniofacial measurements were found; however, hypertrophy of the lymphoid tissues and airway space obstruction were observed. There was a correlation among the enlargement of lymphoid tissue, the airway space, and the AHI values. This study indicated that the narrowing of the airway space was more influenced by changes in soft tissue.     

Soft-tissue cephalometric norms for north Indian Mongoloids

IntroductionHarmonious facial esthetics and functional occlusion have long been recognized as the two most important goals of orthodontic treatment. The purpose of this study was: (1) To establish soft tissue cephalometric norms for Mongoloid tribes of north India using Holdaway analysis. (2) To study the sexual dimorphism in soft tissue cephalometric norms of this population. (3) To compare the norms obtained in this study with Holdaway norms.MethodsLateral cephalometric radiographs of 60 north Indian Mongoloid subjects (30 male, 30 female) in the age group of 18–25 years with normal occlusion and well balanced faces were used. The cephalograms were analyzed with Holdaway soft tissue cephalometric analysis. Unpaired t-test was used to compare results obtained for Mongoloid subjects with Holdaway norms and to determine sexual dimorphism.ResultsStatistically significant differences were found for nose prominence, superior sulcus depth, soft tissue subnasale to H-line, basic upper lip thickness, max incisor to upper lip, H-angle, lower lip to H-line and soft tissue chin thickness. In comparison of sexes, statistically significant differences were found for basic upper lip thickness, max incisor to upper lip and H-angle.ConclusionThese results show that the soft tissue facial profile of north Indian Mongoloid subjects and North-Europeans are different. These racial differences must be considered during diagnosis and treatment planning.     

Validity of the combined use of two esthetic rating systems,the infant index and 5-point aesthetic index,for pre- and postsurgical evaluation of cleft lip repair

ObjectiveThe present study was designed to investigate the usefulness of combining two different ordinal scaling indices, infant index (I–I) and 5-point aesthetic index (5-PAI), for the assessment and prediction of esthetic outcome of primary lip repair for patients with unilateral cleft lip.Materials and methodsThe nasolabial appearance of the patients was evaluated before primary lip repair and at 5 years of age using cropped facial photographs with frontal and oblique views. The I–I and 5-PAI employ expanded reference photographs and objective esthetic variables for judgment.ResultsThe inter- and intrarater Kappa values of both I–I and 5-PAI demonstrated good to very good agreement (range: 0.74–0.84 for I–I and 0.62–0.77 for 5-PAI). Furthermore, both the declination of the columella and the deformity of the alar cartilage in I–I showed a correlation with nasal rating score of 5-PAI and were identified as predictable independent parameters (declination of the columella: Rs = 0.37, P = 0.04; deformity of the alar cartilage: Rs = 0.35, P = 0.02).ConclusionThe combined use of I–I and 5-PAI with expanded reference photographs and objective variables could be useful for obtaining greater accuracy of the esthetic assessment and predicting postsurgical nasolabial esthetics at infancy.     

The use of SymNose for quantitative assessment of lip symmetry following repair of complete bilateral cleft lip and palate

IntroductionThe SymNose computer program has been proposed as an objective method for the quantitative assessment of lip symmetry following unilateral cleft lip repair. This study aims to demonstrate the use of SymNose in patients with complete bilateral cleft lip and palate (BCLP), a group previously excluded from computer-based analysis.MethodsA retrospective cohort study compared several parameters of lip symmetry between BCLP cases and non-cleft controls. 15 BCLP cases aged 10 (±1 year) who had undergone primary repair were recruited from the patient database at the South West Cleft Unit, Frenchay Hospital. Frontal facial photographs were selected for measurement. 15 age-matched controls were recruited from a local school. Lip symmetry was expressed as: percentage mismatch of left vermillion border and upper lip area over the right, horizontal lip tilt and lateral deviation of the lip.ResultsA significant increase in lip asymmetry was found in the BCLP group expressed as upper vermillion border mismatch across computer-defined and user-defined midlines (mean difference was 16.4% (p < 0.01) and 17.5% (p < 0.01) respectively).ConclusionsThe results suggest that a significant degree of lip asymmetry remains in BCLP patients even after primary repair. This challenges previous assumptions that those with bilateral defects would be relatively symmetrical.     

Unilateral cleft lip/nose repair using an equal bows /straight line advancement technique – A preliminary report and postoperative symmetry-based anthropometry

In the evolution of cleft lip repair there has been continuous attempt to minimize local trauma, improve lip and nasal appearance and, especially, prevent conspicuous scars. The surgical technique presented meets these criteria, resulting in an appropriate scar course in children with a specific philtral ridge shape.Postoperative digital anthropometry was performed in 18 patients who underwent unilateral cleft lip repair using the equal bows/straight line advancement technique and in matched healthy control individuals. Symmetry values were assessed for lip length, philtral ridge length, vermilion height, width of the alar base, nasocanthal length, circumference of the nostrils, nostril width and height in both cleft and control groups.Evaluation revealed no significant differences in the symmetry values between cleft patients and control group (lip length: p = 0.71, philtral ridge length: p = 0.52, vermilion height: p = 0.23, alar base width: p = 0.69, nasocanthal length: p = 0.25, nostril circumference: p = 0.17, nostril width: p = 0.34, nostril height: p = 0.33). Principles of cleft lip repair can be achieved using the described technique which provides adequate lip length and natural nasal appearance in patients with a parallel-shaped philtral ridge.     

Presurgical Orthopaedic Nasoalveolar Molding in Cleft Lip and Palate Infants: A Comparative Evaluation of Cases Done With and Without Nasal Stents

Addressing the craniofacial anomaly of cleft lip and palate presurgically has been done since more than 50 years now, with a constant improvisation of the treatment protocols from time to time. The present study deals with a modification of the technique devised 16 years ago. The effect of nasal stents attached to a pre-surgical naso-alveolar molding (PNAM) appliance on the nasal morphology achieved prior to primary surgical correction of the cleft lip was to be evaluated. Twenty subjects, infants with cleft lip and palate, less than 2 months of age were selected for presurgical nasoalveolar molding treatment. Impressions were recorded, casts made and PNAM appliance fabricated. Ten infants were given the appliance without nasal stents and to the other ten appliances nasal stents were added. The patients were recalled every 2–3 weeks and a series of 9 measurements were recorded every visit along with adjustments made to the appliance for desirable effects on the lip, alveolus and nose. This was carried out till the patient was taken up for lip repair. The final measurements obtained at the end of the presurgical treatment were recorded. Mann-Whitney test, between study and control group showed that the increase in the columella length was statistically significant (p = 0.0001 and p = 0.033) in the study group as compared to the control group. Also the increase of the nasal tip projection (mean = 1.30 mm) in the study group was found to be statistically significant (p = 0.006) as compared to the control group. We concluded that nasal stents attached to the alveolar molding appliance, yield significant improvement of the nasal morphology and better nasal aesthetics presurgically.     

The time-course change in the lip closing force in Class III malocclusion after orthognathic surgery

ObjectivesThe purpose of this study was to examine the changes with time in lip pressure after orthognathic surgery for skeletal Class III patients.Study designThe subjects consisted of 63 patients (32 female and 31 male) diagnosed with mandibular prognathism who underwent sagittal split ramus osteotomy with and without Le Fort I osteotomy. Maximum and minimum lip closing forces were measured with Lip De Cum^®. The changes with time were compared statistically.ResultsThe maximum and minimum lip closing force increased time-dependently in men and women after surgery and there were significant differences between men and women with changes with time in the maximum lip closing force (p = 0.0086) and the minimum lip closing force (p = 0.0302). After 1 year, the Class III group maximum lip closing force was significantly smaller than the control group in both men (p < 0.0001) and women (p < 0.0001).ConclusionsThis study suggests that there was significant difference in over time in the lip closing force between men and women in Class III patients. Although the maximum lip closing force increased with time, it did not reach the level of the control group after 1 year.     

Obwegeser II osteotomy (transoral angle osteotomy) for open bite with skeletal class III deformity

IntroductionThis study evaluated postoperative stability after Obwegeser II osteotomy (transoral angle osteotomy, first reported by Obwegeser 1973) for severe open bite with mandibular prognathism.Patients and methodsThis retrospective study reviewed 20 consecutive patients who underwent only mandibular Obwegeser II osteotomy to correct open bite and mandibular prognathism. Lateral cephalograms were evaluated preoperatively (T1), immediate postoperatively (T2) and at least 6 months after the surgery (T3). Surgical and postsurgical changes in cephalometric measurements were evaluated statistically.ResultsOpen bite with skeletal class III malocclusion was corrected by the Obwegeser II osteotomy alone. After an average of 9.9 ± 5.2 mm of mandibular setback with open bite closure (T2–T1, over-bite change, 5.7 ± 2.4 mm) by counter-clockwise rotation of the mandible, the patients showed 0.8 ± 1.7 mm of horizontal relapse (p > 0.05), 1.1 ± 1.7 mm of vertical relapse at the B point (p = 0.011) and −0.2 ± 1.6 mm of over-bite change postoperatively (T3–T2).DiscussionWith the adequate control of the condylar position with rigid internal fixation, Obwegeser II osteotomy showed acceptable stability after the correction of open bite with mandibular prognathism without a simultaneous maxillary osteotomy. An isolated Obwegeser II osteotomy can be considered a reliable option in cases with moderate to severe open bite with mandibular prognathism when the maxillary osteotomy is not needed if the patients have a well-positioned maxilla.     

Soft-tissue profile characteristics in children with beta thalassaemia major

Abstract

Objectives: To compare soft-tissue profile characteristics of patients with beta thalassaemia major (BTM) with a group of non-thalasseamic subjects with a similar skeletal pattern. Subjects and methods. The material for this cross-sectional retrospective study consisted of lateral cephalograms of 40 BTM patients (23 males, 17 females, aged 9.5 ± 0.97 years). These were compared with lateral cephalograms of a control group of 40 non-thalasseamic subjects (23 males, 17 females, aged 11.0 ± 0.87 years) who had similarities with the study group in the following cephalometric variables: SNA (°), SNB (°), ANB (°) and anterior face height (N-Me). Overall, 22 linear and angular soft-tissue cephalometric variables were measured. Results. Horizontal soft-tissue measurements, except for the thickness at B point (B-B'), were larger relative to non-thalasseamic subjects; particularly showing a statistically larger mean values for the following variables: soft-tissue thickness at Pronasale (ANS-Prn, p < 0.01), Subnasale (ANS-Sn, p < 0.01), point A (A-A′, p < 0.01) and at the Pogonion point (Pg-Pg′, p < 0.05). Compared to controls, BTM patients showed significantly larger (p < 0.05) mean values for the anterior nose length (Prn-Prn', p < 0.01) and lower nose height (Prn-Sn, p < 0.05). Variables that represented the lip profile, including the nasolabial angle, did not significantly differ from controls. The average values for the mid-face (N-ANS), posterior face height (S-Go) and the inclination of maxillary incisors to the SN plane were significantly larger (p < 0.01) in BTM patients. Conclusion: The soft-tissue profile differences in BTM patients may have implications for their future orthodontic or orthognathic management. Future studies can investigate the 3D soft-tissue changes and the possible contributing factors.     

3D photogrammetric analysis in hump nose correction based on nasal tip projection without dorsal augmentation in Asian rhinoplasty

IntroductionHump nose in Asians should be managed differently in consideration of the lateral profile and the balance between the dorsal height and nasal tip projection. We suggest an alternative approach comprising mild rasping and nasal tip projection using a septal extension graft.Material and methodsIn this retrospective study, patients who underwent hump nose correction with rhinoplasty between March 2012 and July 2015 were recruited. Instead of applying conventional dorsal augmentation after humpectomy, our approach involved only smooth dorsal contouring in limited cases. 15 patients were evaluated, with surgical outcomes demonstrated using three-dimensional photogrammetry.ResultsOver the postoperative period, hump height decreased (pre 2.77 ± 2.07, post 0.31 ± 0.55, p = 0.001). Regarding the efficacy of tip projection, both nasal tip protrusion (pre 17.64 ± 4.82, post 20.46 ± 4.05, p = 0.001) and tip projection (pre 19.75 ± 4.26, post 21.83 ± 4.17, p = 0.023) were increased. The hump nose reduction ratio was 84.94% after 6 months and 76.47% after 1 year, whereas increases in nasal tip projection and dorsal augmentation were minimal, with ratios of 14.75% and 12.76%, respectively, after 6 months).ConclusionTherefore, creating a balance between the nasal tip and nasal dorsum in hump nose correction is more important than dorsal augmentation after hump resection in Asians.     

3-D based minimally invasive one-stage lateral sinus elevation – A prospective randomized clinical pilot study with blinded assessment of postoperative visible facial soft tissue volume changes

ObjectiveThe purpose of this prospective and randomized clinical study was to assess differences in patient morbidity between minimally invasive lateral sinus elevation (study group, n = 14) and conventional one-stage lateral sinus elevation (control group, n = 12). It was hypothesized that trauma to soft tissue was reduced in the study group.Materials and methodsOptical 3-D imaging was assessed blinded on days 1 and 7 after surgery to determine the visible soft tissue swelling of the upper lip and cheeks. Postoperative pain and discomfort were evaluated by a visual analogue scale (VAS; scale 0–10).ResultsImmediately and on day 1 after surgery, the study group patients rated pain and discomfort as 2.4 [SD 1.7] and 3.1 [SD 2.1], respectively, on the VAS; while, the controls rated 4 [SD 1.6] and 5.6 [SD 1.7], respectively. The mean facial soft tissue volume change, assessed on day 1 after surgery, was 5.0 cm³ [range: 0.2–9.2] for the study group and 15.5 cm³ (9.3–21.55) for the controls (p = 0.00).ConclusionsDespite the small number of patients in this prospective study, 3-D based minimally invasive one-stage lateral sinus elevation resulted in favourable patient morbidity with less postoperative visible facial soft tissue volume changes.     

Stability of nasal symmetry following primary cleft lip and nasal repair: five years of follow-up

Despite advances in cleft lip treatment, various levels of residual deformity remain after primary repair of cleft lip and palate. The aim of the current study was to compare the stability of short- and long-term postoperative nasal symmetry. This retrospective study included 100 consecutive non-syndromic patients with unilateral complete cleft lip who underwent primary cleft lip repair with follow-up of 5 years. Measurements taken from basal and frontal standard photograph views, obtained preoperatively (T1) and immediately (T2), 1 year (T3), and 5 years postoperative (T4), were analysed. Paired and independent t-tests were applied to assess the significance of differences and relationships, while the inter-class correlation coefficient was used to assess reliability; P < 0.05 was considered significant. The male to female ratio was 1:1; mean age at the time of surgery was 0.43 ± 0.25 years. All patients showed significant improvements following unilateral complete cleft lip repair. All variables measured at T3 revealed a significant relapse when compared to T2, except alar base position, which showed a constant mean across all postoperative follow-ups. Late relapse (T3–T4) was not significant for alar collapse, alar base position, or columellar angle (all P > 0.05). On the other hand, columellar height (P = 0.003), and nostril height (P = 0.038) and width (P = 0.007) showed significant improvements during the late relapse period. In conclusion, the majority of the relapse and changes following the nasal cleft repair occurred within the first postoperative year. However, nasal asymmetries tended to remain stable or reduced during the first 5 postoperative years.     

Impact of pretherapeutic neutrophil-to-lymphocyte ratio,serum albumin,body-mass index,and advanced lung cancer inflammation index on clinical outcome in sinonasal squamous cell carcinoma

BackgroundSquamous cell carcinoma of the nasal cavity and paranasal sinuses is a rare and aggressive cancer entity with poor survival rates. Data on this group of head and neck tumors are scarce. Inflammation and cachexia-based markers and their impact on clinical outcome have been studied in several cancer groups. The aim of this study was to evaluate their prognostic potential in sinonasal squamous cell carcinoma.Patients and methodsThis retrospective analysis included all patients treated for sinonasal squamous cell carcinoma at a tertiary referral center between 2002 and 2015. Patients were divided into groups with low and high pretherapeutic values based on the values of serum albumin (ALB, median 41.6 g/l), neutrophil-to-lymphocyte ratio (NLR, median 3.5), body-mass index (BMI, median 24.7), or advanced lung cancer inflammation index (ALI, median 29.5). Main outcome measures were overall survival (OS) and disease-free survival (DFS). Statistical analysis included calculation of survival differences using log-rank tests, hazard ratios (HR), and respective 95% confidence intervals (CI).Results41 patients were included. Low ALB values did not influence OS (median OS not reached in both groups; p = 0.59, HR = 0.75, CI = 0.3–2.1) or DFS (median DFS 0.9 years vs 2.2 years; p = 0.6, HR = 0.8, CI = 0.4–1.8). High NLR was significantly associated with worse OS rates (median OS not reached vs 1.7 years, p = 0.02, HR = 3.4, CI = 1.0–108) but with no influence on DFS (median DFS 3.1 years vs 0.8 years; p = 0.15, HR = 1.8, CI = 0.8–4.2). Similar results were observed for patients with low ALI (median OS 1.7 years vs not reached; p = 0.03, HR = 0.3, CI = 0.1–0.9 and median DFS 0.8 years vs 2.2 years; p = 0.58, HR = 0.8, CI = 0.3–1.8). BMI was the strongest prognosticator in our study. Low pretherapeutic BMI was linked to significantly worse OS (median OS 1.4 years vs not reached; p = 0.003, HR = 0.2, CI = 0.0–0.6) and DFS (median DFS 0.8 years vs not reached; p = 0.02, HR = 0.4, CI = 0.2–0.8). In multivariate analysis BMI was revealed as an independent marker for OS (p = 0.015). No marker reached the level of significance in regard to DFS in multivariate analysis.ConclusionPretherapeutic BMI had a superior prognostic value in patients with sinonasal squamous cell carcinoma in comparison with other tested variables. BMI may be a simple tool for estimating clinical outcome in SNSCC. However, larger studies are necessary to validate our results.     

Effects of growth on maxillary distraction osteogenesis in cleft lip and palate

PurposeThe objective was to analyze the effects of growth on the long-term result of maxillary distraction osteogenesis (DO) in cleft lip and palate (CLP).Patients and methodsRetrospective study of 24 CLP cases with long-term follow-up operated for maxillary DO using the Polley and Figueroa technique: 10 patients were distracted during growth, while 14 patients were operated after their growth spurt. Preoperative (T0), 6–12 months postoperative (T1), and ≥4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess the treatment stability, and a Procrustes superimposition method was performed to assess local changes in the maxilla and the mandible.ResultsAt T0, the mean age was of 11.9 ± 1.4 years for growing patient, and 17.9 ± 3.5 years for patient treated after their growth spurt (P < 0.001). Between T0 and T1, a greater increase of the SNA was shown in growing patients (P = 0.036), but the relapse was more important between T1 and T2, with a significant decrease of the SNA (P = 0.002) and ANB (P = 0.032) compared to the patients treated after their growth spurt. Although not significant, growing patients showed greater rotations of their palatal plane and mandibular plane.ConclusionsMaxillary DO in CLP does not correct the growth deficit inherent to the pathology. Overcorrection of at least 20% is advised during growth.     

Primary cheilorhinoseptoplasty using the Talmant protocol in unilateral complete cleft lip: functional and aesthetic results on nasal correction and comparison with the Tennison–Malek protocol

Many surgical procedures used to treat patients with unilateral complete cleft lip do not include a complete primary rhinoseptoplasty, which is delayed until the end of growth as part of secondary surgery. Primary cheilorhinoseptoplasty using the Talmant technique has been performed at Lapeyronie University Hospital, Montpellier for 15 years. This retrospective study evaluated and compared the functional and aesthetic results obtained in such patients at 4–6 years after surgery with those obtained without primary rhinoseptoplasty in patients undergoing the Tennison–Malek technique. This study included a cohort of 60 children who presented a unilateral complete cleft lip: 29 were operated on with the Tennison–Malek technique and 31 with the Talmant technique. Three functional and 14 aesthetic criteria were evaluated. All functional criteria showed better results in the Talmant group: nocturnal nasal breathing (P < 0.001), incidence of closed rhinolalia (P = 0.0019), and presence of asymmetric nasal breathing (P < 0.001). Concerning the aesthetic results, all criteria evaluated on the frontal and basal photographs of each patient showed significantly better results in the Talmant technique group. The rate of satisfactory results was> 75% for 12 of the 14 criteria in the Talmant group, compared with none of the 14 criteria in the Tennison–Malek group.     

Anterior maxillary dentoalveolar and skeletal cephalometric factors involved in upper incisor crown exposure in subjects with Class II and III skeletal open bite

Objective:To compare the anterior dentoalveolar and skeletal maxillary cephalometric factors involved in excessive upper incisor crown exposure (UICE) in subjects with skeletal open bite Class II (SOBCIIG) and Class III (SOBCIIIG) against an untreated control group (CG).Materials and Methods:Seventy pretreatment lateral cephalograms of orthodontic young adult patients (34 men, 36 women) were examined. The sample was divided into three groups according to both sagittal and vertical growth pattern and occlusion. The CG group (n  =  25) included Class I, normodivergent cases with adequate overbite, and the SOBCIIG group (n  =  25) and SOBCIIIG group (n  =  20) included skeletal Class II or III malocclusions, respectively, with hyperdivergent pattern and negative overbite. Several cephalometric measurements were considered (skeletal and dental). Analysis of variance, multivariate analysis of covariance, and Tukey HSD post hoc tests were used. Principal component analysis (PCA) was used for reducing the number of cephalometric variables related to UICE. Finally, a multiple linear regression was calculated.Results:Significant differences in UICE were found between the groups (P < .05). UICE was 3.9 mm in SOBCIIG, 2.5 mm in SOBCIIIG, and 0.4 mm in CG. PCA showed that a nondental component—including vertical maxillary height (VMH) and upper lip height (ULH)—was the only component significantly associated with UICE. The regression model had a moderate prediction capability.Conclusions:Although the UICE was statistically different in SOBCIIG, the values were within the esthetic standards. The UICE was mainly influenced by VMH and ULH.     

Is high-viscosity glass-ionomer-cement a successor to amalgam for treating primary molars?

ObjectivesTo assess and compare the cumulative survival rate of amalgam and atraumatic restorative treatment (ART) restorations in primary molars over 3 years.Methods280 children aged 6–7 years old were enrolled in a cluster randomized controlled clinical trial using a parallel group design covering two treatment groups: conventional restorative treatment with amalgam (CRT) and atraumatic restorative treatment (ART) using a high-viscosity glass-ionomer (HVGIC) Ketac Molar Easymix. Three pedodontists placed 750 restorations (364 amalgam and 386 ART in 126 and 154 children, respectively) which were evaluated at 0.5, 1, 2 and 3 years. The proportional hazard rate regression model with frailty correction, ANOVA and Wald tests, and the Jackknife procedure were applied in analysing the data.ResultsThe cumulative survival rates over 3 years for all, single- and multiple-surface CRT/amalgam restorations (72.6%, 93.4%, 64.7%, respectively) were no different from those of comparable ART/HVGIC restorations (66.8%; 90.1% and 56.4%, respectively) (p = 0.10). Single-surface restorations had higher survival rates than multiple-surface restorations for the both treatment procedures (p < 0.0001). A higher proportion of restorations failed because of mechanical reasons (94.8%) than of secondary caries (5.2%). No difference in reasons for restoration failures between all types of amalgam and ART/HVGIC restorations were observed (p = 0.24).SignificanceThe high-viscosity glass-ionomer used in this study in conjunction with the ART is a viable option for restoring carious dentin lesions in single surfaces in vital primary molars.     

Changes in facial profile during orthodontic treatment with extraction of four first premolars

The present study was designed to evaluate soft tissue profile changes after the orthodontic treatment of class I bimaxillary dentoalveolar protrusion in adult cases. Pre- and post-treatment cephalograms of 20 Caucasian female class I bimaxillary dentoalveolar protrusion patients were selected from private practice. All of them were treated by extraction of four first premolars, and banded and bonded by 022 × 028 standard edgewise technique. t-Test was used to analyze pre- and post-treatment cephalograms. This study showed that upper and lower lip protrusions were decreased respectively 2.7 ± 2.9 mm (p < 0.001) and 2.8 ± 2.8 mm (p < 0.001). The mean changes of upper and lower lip thickness and length, as well as nasolabial and labiomental angles were not significant. Significant positive correlation was found between changes of maxillary and mandibular incisors with changes in upper lip (r_UI = 0.70, p < 0.001, r_LI = 0.59, p < 0.006) and the lower lip positions (r_UI = 0.64, p < 0.002, r_LI = 0.72, p < 0.001). By using stepwise regression it was found that a ratio of 0.63:1 was obtained between upper lip retraction and maxillary incisor retraction and a ratio of 0.62:1 was obtained between lower lip retraction and mandibular incisor changes. This study concluded that, a strong correlation exists between anterior tooth retraction and the position of both lips.     

Single-stage repair of secondary unilateral cleft lip-nose deformity in adults

Correction of cleft lip-nose deformity in adult patients is different from that in children. One-stage correction has proved to be a suitable technique for patients with cleft-lip nose deformity. This study aimed to explore a particular single-stage method and evaluate the effect of simultaneous reparation of secondary unilateral cleft lip-nose deformities.Cleft lip patients who had previously undergone nasolabial surgery with residual poor nasal/lip appearance were included. The alveolar bone defect was repaired with granular costal cortical bone. Lip revision and rhinoplasty were performed using diced costal cartilage. The lip, nose, and alveolar deformities were corrected in one stage.From 2011 to 2017, 53 cases were treated. The vermilion discrepancy was corrected in all cases. Fifty-one patients were successfully treated, with primary healing in the bony recipient area. Cancellous bone exposure occurred in two cases. The wounds were healed after debridement and drainage. Appearances were improved in all patients. The mean change in columella–labial angle ranged from 82.50 to 92.78° (p < 0.001).This one-stage correction appears to have led to a distinct improvement in the nasal tip projection and lip. The method is considered to be effective and reliable in patients with secondary unilateral cleft lip-nose deformities.