Three-dimensional evaluation of soft tissue change gradients after mandibular setback surgery in skeletal Class III malocclusion

Objective:To evaluate whether mandibular setback surgery (MSS) for Class III patients would produce gradients of three-dimensional (3D) soft tissue changes in the vertical and transverse aspects.Materials and Methods:The samples consisted of 26 Class III patients treated with MSS using bilateral sagittal split ramus osteotomy. Lateral cephalograms and 3D facial scan images were taken before and 6 months after MSS, and changes in landmarks and variables were measured using a Rapidform 2006. Paired and independent t-tests were performed for statistical analysis.Results:Landmarks in the upper lip and mouth corner (cheilion, Ch) moved backward and downward (respectively, cupid bow point, 1.0 mm and 0.3 mm, P < .001 and P < .01; alar curvature-Ch midpoint, 0.6 mm and 0.3 mm, both P < .001; Ch, 3.4 mm and 0.8 mm, both P < .001). However, landmarks in stomion (Stm), lower lip, and chin moved backward (Stm, 1.6 mm; labrale inferius [Li], 6.9 mm; LLBP, 6.9 mm; B′, 6.7 mm; Pog′, 6.7 mm; Me′, 6.6 mm; P < .001, respectively). Width and height of upper and lower lip were not altered significantly except for a decrease of lower vermilion height (Stm-Li, 1.7 mm, P < .001). Chin height (B′-Me′) was decreased because of backward and upward movement of Me′ (3.1 mm, P < .001). Although upper lip projection angle and Stm-transverse projection angle became acute (Ch_Rt-Ls-Ch_Lt, 5.7°; Ch_Rt-Stm-Ch_Lt, 6.4°, both P < .001) because of the greater backward movement of Ch than Stm, lower lip projection angle and Stm-vertical projection angle became obtuse (Ch_Rt-Li-Ch_Lt, 10.8°; Ls-Stm-Li, 23.5°, both P < .001) because of the larger backward movement of Li than labrale superius (Ls).Conclusions:Three-dimensional soft tissue changes in Class III patients after MSS exhibited increased gradients from upper lip and lower lip to chin as well as from Stm to Ch.     

双颌前突正畸治疗前后软组织的三维变化

目的:探讨双颌前突患者矫治前后软组织的三维变化。方法:选取双颌前突成人患者24例,分别在治疗前后拍摄头颅侧位片和三维扫描,测量27个软组织项目。所有结果采用配对t检验。结果:上切牙内收6.12 mm,下切牙内收4.58 mm,上唇显著后移,而下唇显著向上向后移动。唇和切牙内收比率在上颌约为52%,下颌约为82%。结论:三维扫描可以有效的反应软组织变化。双颌前突患者的上下唇显著向后移动。     

Evaluation of the effects of skeletal anchoraged Forsus FRD using miniplates inserted on mandibular symphysis: A new approach for the treatment of Class II malocclusion

Objective:To evaluate the skeletal, dentoalveolar, and soft tissue effects of the Forsus Fatigue Resistant Device (FRD) appliance with miniplate anchorage for the treatment of skeletal Class II malocclusion.Material and Methods:The prospective clinical study group included 17 patients (11 girls and 6 boys; mean age 12.96 ± 1.23 years) with Class II malocclusion due to mandibular retrusion and treated with skeletal anchoraged Forsus FRD. After 0.019 × 0.025-inch stainless steel archwire was inserted and cinched back in the maxillary arch, two miniplates were placed bilaterally on the mandibular symphysis. Then, the Forsus FRD EZ2 appliance was adjusted to the miniplates without leveling the mandibular arch. The changes in the leveling and skeletal anchoraged Forsus FRD phases were evaluated by means of the Paired and Student''s t-tests using the cephalometric lateral films.Results:The success rate of the miniplates was found to be 91.5% (38 of 42 miniplates). The mandible significantly moved forward (P < .001) and caused a significant restraint in the sagittal position of the maxilla (P < .001). The overjet correction (−5.11 mm) was found to be mainly by skeletal changes (A-VRL, −1.16 mm and Pog-VRL, 2.62 mm; approximately 74%); the remaining changes were due to the dentoalveolar contributions. The maxillary and mandibular incisors were significantly retruded (P < .001).Conclusion:This new approach was an effective method for treating skeletal Class II malocclusion due to the mandibular retrusion via a combination of skeletal and dentoalveolar changes.     

Treatment of Class III malocclusion using miniscrew-anchored inverted Forsus FRD: Controlled clinical trial

Objectives:To evaluate the skeletal, dental, and soft tissue changes after the use of miniscrew-anchored inverted Forsus fatigue-resistant device (FRD) in treatment of Class III malocclusion.Materials and Methods:In this controlled clinical trial, 16 patients (9 girls and 7 boys; age 12.45 ± 0.87 years) were consecutively treated with miniscrew-anchored inverted Forsus FRD. This group was compared with a matched control group of 16 untreated patients (8 girls and 8 boys; age 11.95 ± 1.04 years). Miniscrews were inserted bilaterally between the maxillary canine and first premolar. Forsus FRD was selected and inserted in an inverted manner mesial to the mandibular headgear tube and distal to the maxillary canine bracket.Results:Class I molar and canine relationships with positive overjet were achieved in an average period of 6.4 ± 1.46 months. Maxillary forward growth showed a statistically significant increase (SNA°: 1.73 ± 0.53, P < .5), maxillary incisor proclination was statistically significant (U1 to NA°: −0.39 ± 0.33, P > .5), and the lower incisors exhibited significant retroclination (L1 to NB°: 1.65 ± 0.83, P < .5). Significant lower lip retrusion and upper lip protrusion were obvious treatment outcomes (P < .5).Conclusions:The use of miniscrew-anchored inverted FRD could effectively increase maxillary forward growth, but it did not prevent mesial movement of the maxillary dentition. Significant lower incisor retroclination was observed. Significant esthetic improvement of the facial profile was achieved primarily because of lower lip retrusion and upper lip protrusion.     

Three-dimensional Analysis of Lip Changes in Response To Simulated Maxillary Incisor Advancement

ObjectiveTo assess the immediate response of lips in three dimensions (3D) resulting from simulated maxillary incisor advancement.Materials and MethodsIncremental maxillary incisor advancement was simulated by placing wax of increasing thickness (+2 mm, +4 mm, +6 mm) on the incisors of 20 participants, and the induced lip changes were recorded using 3D stereophotogrammetry. The induced displacement of lip landmarks was quantified using 3D image analysis software. Data were analyzed using a repeated-measures analysis of variance (ANOVA) after adjusting for age and sex of the study participants.ResultsA large interindividual variation in lip response to simulated incisor advancement was observed. A significant overall effect on 3D lip changes was found for increasing values of simulated incisor advancement (F = 13.2; P < .001) as well as significant differences between anatomical landmarks of the lip (F = 7.4; P < .01). Most points moved outward and anterosuperiorly, except the midpoint and corners of the lip. Greatest movement was observed in the sagittal plane, followed by the vertical and transverse planes.ConclusionsMaxillary incisor advancement significantly affects upper lip change in three planes of space: particularly the anteroposterior plane, in which the response to simulated advancement appears to be nonlinear.     

Effects of miniplate anchored and conventional Forsus Fatigue Resistant Devices in the treatment of Class II malocclusion

Objective:To compare the skeletal, dentoalveolar, and soft tissue effects of the miniplate anchored Forsus Fatigue Resistant Device (FRD) and the conventional Forsus FRD in the treatment of Class II malocclusion.Materials and Methods:The study was carried out with 30 patients (10 girls, 20 boys). In the MA-Forsus group, 15 patients (2 girls, 13 boys) were treated with a miniplate anchored Forsus FRD for 9.40 ± 2.25 months. In the C-Forsus group, 15 patients (8 girls, 7 boys) were treated with a conventional Forsus FRD for 9.46 ± 0.81 months. A total of 16 measurements were calculated and statistically analyzed to find intragroup and intergroup differences.Results:Statistically significant differences were found between the groups in IMPA, SN/Occ, SN/GoGn, overjet, overbite, and Li-S measurements (P < .05). In the C-Forsus group, a substantial amount of lower incisor protrusion was observed, whereas retrusion was found in the MA-Forsus group (P < .001). The mandible rotated backward in the MA-Forsus group, whereas it remained unchanged in the C-Forsus group (P < .05). Reductions in overjet (P < .001) and overbite were greater in the C-Forsus group (P < .05).Conclusion:Stimulation of mandibular growth and inhibition of maxillary growth were achieved in both treatment groups. In the C-Forsus group, a substantial amount of lower incisor protrusion was observed, whereas retrusion of lower incisors was found in the MA-Forsus group. The MA-Forsus group was found to be more advantageous as it had no dentoalveolar side effects on mandibular dentition.     

Effects of Invisalign (G5) with virtual bite ramps for skeletal deep overbite malocclusion correction in adults

ObjectivesTo investigate the skeletal and dentoalveolar effects of Invisalign''s G5 protocol with virtual bite ramps in the treatment of adults with skeletal deep bites.Materials and MethodsThis retrospective study was conducted on consecutively treated adults presenting with skeletal deep bites as defined by the Overbite Depth Indicator (ODI). Subjects were divided into 2 groups: Invisalign group (n = 24) treated with the Invisalign G5 protocol and a full fixed appliance (FFA) group (n = 24) treated with edgewise FFAs and matched to the Invisalign group by ODI, sex, type of malocclusion, and non-extraction treatment. Pretreatment (T₁) and post–comprehensive treatment (T₂) lateral cephalograms were obtained and analyzed.ResultsBoth the Invisalign and FFA groups showed significant changes from T₁ to T₂ in ODI and other skeletal and dentoalveolar measurements. The mean change in ODI was −1.5° (P < .001) for the Invisalign group and −2.0° (P < .001) for the FFA group. The mean decrease in overbite was 1.3 mm (P < .001) and 2.0 mm (P < .001) for the Invisalign and FFA groups, respectively. The mean increase in mandibular plane angle (Sn-GoGn) was 0.65° (P = .003) for the Invisalign group and 1.15° (P < .001) for the FFA group. When the groups were compared with each other, both ODI (P = .03) and overbite (P = .003) were significantly different in addition to other measurements.ConclusionsAlthough FFA treatment had more apparent skeletal changes for deep bite adult patients when compared with Invisalign, both systems were effective in opening deep bites at dentoalveolar and skeletal levels.     

Three-dimensional nasal septum and maxillary changes following rapid maxillary expansion in patients with cleft lip and palate:: A case-series analysis

ObjectivesTo determine the three-dimensional changes of the nasal septum (NS), alveolar width, alveolar cleft volume, and maxillary basal bone following rapid maxillary expansion (RME) in consecutive patients with unilateral cleft lip and palate (UCLP).Materials and MethodsA retrospective investigation was conducted based on the analysis of cone-beam computed tomography (CBCT) data of 40 consecutive patients with UCLP (mean age 11.1 ± 2.2 years). Scans were acquired prior to RME (T0) and after removal of the expander (T1) before graft surgery. A three-dimensional analysis of the effects of RME on the nasal septum, alveolar width, alveolar cleft volume, and maxillary basal bone was performed.ResultsNo changes in the NS deviation were observed following RME (P > .05). Significant increases of the alveolar transverse dimension were found in the anterior (14.2%; P < .001) and posterior (7.7%; P < .001) regions as well as in the volume of the alveolar cleft (19.6%; P < .001). No changes in the basal bone dimensions and morphology were observed (P > .05).ConclusionsFollowing RME, no changes were observed in the NS and maxillary basal bones of patients with UCLP despite the significant gain in the anterior and posterior alveolar width and the increase of the alveolar cleft defect. Clinicians should be aware that maxillary changes following RME in patients with UCLP are restricted to the dentoalveolar region.     

Bone- and dentoalveolar-anchored dentofacial orthopedics for Class III malocclusion: New approaches,similar objectives?: A systematic review

Objectives:To analyze the scientific literature and compare in the results of conventional orthopedic appliances with those obtained from recent bone-anchored orthopedics for Class III malocclusion.Materials and Methods:The literature was systematically reviewed using PubMed/Medline, Scopus, and Scirus databases up to January 2012. Articles were selected by two different researchers (kappa index  =  0.83), based on established inclusion/exclusion criteria. Methodologic quality was classified as high, medium, or low quality.Results:The search strategy identified 1020 titles. Thirty studies were selected after applying the criteria (high quality  =  9, medium quality  =  21). Protraction rates differed within a range of one- to twofold between bone-anchored and dentoalveolar therapies (P < .001). All studies noted the effect of clockwise rotation on the mandible and an increase in inferior-anterior and total facial height; this was more obvious in dentoalveolar therapy than in bone-anchored orthopedics (P < .001).Conclusions:Dental parameters like overjet increased significantly with both sets of groups, ranging from 1.7 to 7.9 mm with dentoalveolar therapy and from 2.7 to 7.6 mm with bone-anchored orthopedics.     

Three-dimensional changes of the hyoid bone and airway volumes related to its relationship with horizontal anatomic planes after bimaxillary surgery in skeletal Class III patients

Objective:To evaluate longitudinal changes of the hyoid bone position and pharyngeal airway space after bimaxillary surgery in mandibular prognathism patients.Materials and Methods:Cone-beam computed tomography scans were taken for 25 mandibular prognathism patients before surgery (T0), 2 months after surgery (T1), and 6 months after surgery (T2). The positional displacement of the hyoid bone was assessed using the coordinates at T0, T1, and T2. Additionally, the volume of each subject''s pharyngeal airway was measured.Results:The mean amount of posterior maxilla impaction was 3.76 ± 1.33 mm as the palatal plane rotated 2.04° ± 2.28° in a clockwise direction as a result of bimaxillary surgery. The hyoid bone moved backward (P < .05, P < .001) and downward (P > .05, P < .05) at 2 months and 6 months after surgery, while the total volume of the pharyngeal airway significantly decreased at the same time points (P < .001, P < .001). There was significant relationship between the changes of the hyoid bone position and airway volume at 2 months after surgery (P < .05). The change of the palatal plane angle was positively correlated to the decrease in the total airway volume (P < .001).Conclusions:The null hypothesis was rejected. The hyoid bone moved inferoposteriorly, and the pharyngeal airway volume decreased for up to 6 months after bimaxillary surgery. The decrease in the pharyngeal airway volume was correlated to the changes in the palatal plane inclination and the positional change of the hyoid bone.     

Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence

Objective:To evaluate the immediate effects of rapid maxillary expansion (RME) on the transverse skeletal and dentoalveolar changes with bone-borne (C-expander) and tooth-borne type expanders using cone-beam computed tomography (CBCT) in late adolescents.Materials and Methods:A sample of 28 female late-adolescent patients was divided into two groups according to the type of expander: bone-borne (C-expander, n  =  15, age  =  18.1 ± 4.4 years) and tooth-borne (hyrax, bands on premolars and molars, n  =  13, age  =  17.4 ± 3.4 years). CBCT scans were taken at 0.2-mm voxel size before treatment (T1) and 3 months after RME (T2). Transverse skeletal and dental expansion, alveolar inclination, tooth axis, vertical height of tooth, and buccal dehiscence were evaluated on maxillary premolars and molars. Paired t-test, independent t-test, one-way analysis of variance, and Scheffé post hoc analysis were performed.Results:The C-expander group produced greater skeletal expansion, except in the region of the first premolar (P < .05 or < .01), which showed slight buccal tipping of the alveolar bone. The Hyrax group had more buccal tipping of the alveolar bone and the tooth axes, except in the region of the second molar (P < .05 or < .01 or < .001). Dental expansion at the apex level was similar in the banded teeth (the first premolar and the first molar). Vertical height changes were apparent on the second premolar in the hyrax group (P < .05 or < .01). Significant buccal dehiscence occurred at the first premolar in the hyrax group (P < .01 or < .001). There were no significant differences between tooth types for any variables in the C-expander group.Conclusions:For patients in late adolescence, bone-borne expanders produced greater orthopedic effects and fewer dentoalveolar side effects compared to the hyrax expanders.     

Morphometric evaluation of changes in the alveolar bone and roots of the maxillary anterior teeth before and after en masse retraction using cone-beam computed tomography

Objective:To evaluate the morphometric changes in the alveolar bone and roots of the maxillary anterior teeth (MXAT) after en masse retraction with maximum anchorage (EMR-MA).Materials and Methods:The samples consisted of 37 female adult patients who had Class I dentoalveolar protrusion (CI-DAP) and were treated by extraction of the first premolars and EMR-MA. Using three-dimensional cone-beam computed tomography taken before treatment and after space closure, the maxillary central incisors (MXCI, N  =  66), lateral incisors (MXLI, N  =  69), and canines (MXC, N  =  69) were superimposed using individual reference planes. After alveolar bone area (ABA), vertical bone level (VBL), root length (RL), root area (RA), and prevalence of dehiscence (PD) were measured at the cervical, middle, and apical levels, statistical analyses were performed.Results:On the palatal side, ABA significantly decreased in all levels of MXAT (P < .001; middle of MXC, P < .01). MXCI and MXLI exhibited a greater decrease in the ratio of change in palatal ABA than did MXC (cervical, P < .01; middle and apical, P < .05; total, P < .001). Palatal/labial ABA ratios decreased in MXCI (cervical, middle, total, P < .001; apical, P < .05) and MXLI (cervical, P < .001; apical, P < .05). They showed greater amounts and ratios of change in VBL on the palatal side compared to the labial side (all P < .001). The palatal side showed more PD in the cervical area than did the labial side (MXCI and MXLI, P < .001; MXC, P < .01). Significant root resorption occurred in MXAT (RL and RA, all P < .001).Conclusions:During EMR-MA in cases with CI-DAP, ABA and VBL on the palatal side and RL and RA of MXCI and MXLI were significantly decreased.     

Evaluation of soft tissue changes around the lips after bracket debonding using three-dimensional stereophotogrammetry

Objective:To evaluate the changes in soft tissue around the lips after orthodontic bracket debonding using three-dimensional (3-D) stereophotogrammetry.Materials and Methods:3-D facial images of 20 subjects (10 men and 10 women; mean age, 26.81 ± 7.23 years) were taken with a white light scanner before and after debonding the labial brackets. Two images acquired from each subject were superimposed, and 15 soft tissue landmarks around the lips were plotted and analyzed. Statistical analysis was performed using both paired and independent t-tests (P < .05).Results:There were no significant changes in position of any landmark on the x (left-right)- or y (vertical)-axes after removal of the brackets. However, the landmarks in the oral commissures and lower lip (LLP, −0.55 mm; Li, −0.44 mm; Ch-L, −0.56 mm, all P < .05) on the z (anteroposterior)-axis showed statistically significant differences. There were no significant positional changes of most landmarks on the x-, y-, or z- axes after bracket removal among the various genders and lip thicknesses.Conclusions:There was a slight retrusion in the oral commissure and lower lip areas after debonding, but no changes were found in the upper lip area. This study showed that 3-D stereophotogrammetry can be useful in evaluating facial soft tissue changes in orthodontic patients.     

The longevity of casein phosphopeptide–amorphous calcium phosphate fluoride varnish's preventative effects: Assessment of white spot lesion formation

Objectives:To test how long casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) fluoride varnish prevents enamel demineralization in vitro.Materials and Methods:Human molars and premolars were sectioned buccolingually and randomly assigned to two groups. Standardized pretreatment images of enamel surfaces were obtained using FluoreCam. The control group received no treatment, and the experimental group received an application of CPP-ACP fluoride varnish. Over simulated periods of 2, 4, 8, and 12 weeks, specimens were placed in a toothbrushing simulator, thermocycled, subjected to 9 days of pH cycling, and imaged with FluoreCam. Samples were sectioned and polished for polarized light microscope (PLM) evaluation.Results:There were statistically significant time (P < .001) and varnish (P < .001) effects on area, intensity, and impact of enamel demineralization. The control group showed significant and progressive demineralization over the 12 weeks (P < .001). The experimental group revealed no significant demineralization during the first 4 weeks (P > .05) and significant (P < .001) increases thereafter. Experimental demineralization after 12 weeks was comparable to 2-week demineralization in the controls, with significant between-group differences (P < .001) in enamel demineralization at all time points. PLM of the control and experimental groups revealed lesion depths of 90 ± 34 μm and 37 ± 9 μm, respectively.Conclusions:Within the limitations of this in vitro study, CPP-ACP fluoride varnish prevents enamel demineralization for at least 4 weeks and limits demineralization up to 12 weeks.     

Dynamic smile evaluation in different skeletal patterns

Objective:To evaluate dynamic smile in different skeletal patterns and to correlate vertical smile parameters with the underlying causative factors.Materials and Methods:A total of 150 participants ranging in age from 16–25 years were selected and divided into one of three groups—horizontal, average, and vertical skeletal pattern—using the following three cephalometric parameters: SN-MP, FMA, and Jarabak ratio. Videographic records of smile were obtained, and measurements were recorded and analyzed at rest, including upper lip length, and during smile, including maxillary incisal display, interlabial gap, intercommisural width, change in upper lip length, and smile arc. Differences among the three groups were subjected to two-way analysis of variance and post hoc and chi-square tests for smile arc. Correlations between vertical smile variables and vertical skeletal (N-ANS, N-Me) and dental cephalometric measurements (U1 to palatal plane) were also investigated.Results:Vertical parameters were significantly increased in the vertical pattern when compared with the horizontal pattern, ie, upper lip length (P < .01), maxillary incisal display (P < .001), interlabial gap (P < .001), and change in upper lip length (P < .001), whereas intercommisural width was significantly decreased in vertical pattern when compared with the horizontal pattern (P < .001). Flat smile arc was seen more frequently in the horizontal pattern. Positive correlations were found between the N-Me, U1-PP, and change in upper lip length with vertical smile parameters.Conclusions:Different skeletal patterns exhibit their characteristic smile features. Upper lip length is not responsible for increased incisal display during smile. Increased incisal display during smile is more closely associated with upper lip elevation than vertical skeletal and dental factors.     

Initial growth pattern of children with cleft before alveolar bone graft stage according to cleft type: Unilateral cleft lip and alveolus,unilateral cleft lip and palate,and cleft palate

Objective:To test the null hypothesis that there is no significant difference in the initial growth pattern among three cleft types before alveolar bone graft (ABG) according to cleft type (unilateral cleft lip and alveolus [UCLA], unilateral cleft lip and palate [UCLP], and cleft palate [CP]).Materials and Methods:Samples consisted of the UCLA group, the UCLP group, and the CP group. Individuals were treated with the identical surgical technique by the same surgeon and had no history of orthodontic/orthopedic treatment. Lateral cephalograms taken 1 month before ABG were analyzed using 29 variables. One-way analysis of variance (ANOVA) testing and bivariate and logistic regression analyses were performed.Results:An increasing tendency for Class III relationships in the order of UCLA, UCLP, and CP was noted (ANB, AB-to-facial plane angle, AB-to-mandibular plane angle; P < .001, respectively). UCLP and CP groups demonstrated more posterior positioning of the maxilla (SNA, A-to-N-perp; P < .001, respectively) and a hyperdivergent pattern (gonial angle, SN-GoMe angle, FMA; P < .001, respectively) compared with the UCLA group. Because no differences in palatal plane angle and SN-to-occlusal plane angle were noted among the three groups, the hyperdivergent pattern in the UCLP and CP groups might be due to an innate growth pattern and eventual adaptation of the mandible to maxillary growth. UCLP and CP groups showed more Class III relationships (ANB: P < .05, P < .001, respectively) and a more hyperdivergent pattern (FMA: P < .05, P < .01, respectively) than the UCLA group.Conclusion:When the degree of cleft involvement increases from the primary palate to the secondary palate, the predominance of the Class III relationship and the hyperdivergent pattern increases also.     

Molar Inclination and Surrounding Alveolar Bone Change Relative To the Design of Bone-borne Maxillary Expanders: A Cbct study

ObjectiveTo evaluate the molar inclination and skeletal and alveolar bone changes when comparing tooth bone-borne (MSE) and tissue bone-borne type maxillary expanders (C-expander) using cone-beam computed tomography (CBCT) in late adolescence.Materials and MethodsA sample of 48 late-adolescent patients were divided into two groups according to the type of expander: MSE group (n = 24, age = 19.2 ± 5.9 years) and C-expander group (n = 24, age = 18.1 ± 4.5 years). CBCT scans were taken before treatment and 3 months after expansion. Transverse skeletal and dental expansion, alveolar inclination, tooth axis, buccal alveolar bone height, thickness, dehiscence, and fenestration were evaluated on the maxillary first molar. Paired t-test, independent t-test, Pearson''s chi-square test, and Spearman correlation analysis were performed.ResultsThe MSE group produced greater dental expansion (P < .05), whereas skeletal expansion was similar in both groups (P = .859). The C expander group had more alveolar bone inclination change (P < .01), and the MSE group had more buccal tipping of the anchorage teeth (P < .01 or .001). Buccal alveolar bone height loss and thickness changes were greater in the MSE group (P < .01 or <.001). Formation of dehiscences was more frequent in the MSE group (P < .001), whereas for fenestrations, there were no significant differences between the two groups. Buccal bone height loss in the MSE group had a negative correlation with initial buccal bone thickness.ConclusionsThe incorporation of teeth into bone-borne expanders resulted in an increase in the severity of side effects. For patients in late adolescence, tissue bone-borne expanders offer comparable skeletal effects to tooth bone-borne expanders, with fewer dentoalveolar side effects.     

Evaluation of mandibular transverse widths in patients affected by unilateral and bilateral cleft lip and palate using cone beam computed tomography

Objective:To evaluate the mandibular dental, alveolar, and skeletal transversal widths in patients affected by unilateral (UCLP) and bilateral (BCLP) cleft lip and palate and to compare the findings with a well-matched normal occlusion sample using cone beam computed tomography images.Materials and Methods:The study sample consisted of 75 patients divided into three groups: the UCLP (29 patients; mean age: 15.40 ± 3.22 years), BCLP (18 patients; mean age: 15.54 ± 3.72 years), and normal occlusion (28 patients; mean age: 15.82 ± 2.11 years) groups. Mandibular dental (intercanine and -molar), alveolar (intercanine and -molar), and skeletal (bigonial width) transversal measurements were performed three-dimensionally and analyzed using the one-way variance analysis and post hoc Tukey tests.Results:Patients affected by UCLP and BCLP had statistically significantly lower intercanine alveolar widths (P < .05 and P < .001, respectively) and larger intermolar (P < .001 and P < .05, respectively) and intermolar alveolar widths (P < .001) compared with the normal occlusion group. Furthermore, the patients affected by UCLP and BCLP had similar mandibular dental, alveolar, and skeletal transversal widths (P > .05).Conclusion:The UCLP and BCLP groups showed statistically significantly smaller values for intercanine alveolar widths and larger values for intermolar dental and alveolar widths compared with the normal occlusion group. This shows the importance of using individualized archwires according to the pretreatment arch widths of the patients affected by UCLP and/or BCLP.     

Comparative Use of Invisalign® by Orthodontists and General Practitioners

Objective:To test the hypothesis that there is no difference in the use of Invisalign® between orthodontists and general practitioners.Materials and Methods:A questionnaire was mailed to all Invisalign® providers within a 35-mile radius of Stony Brook University. The answers were statistically analyzed. The level of significance was set at P < .05.Results:Orthodontists started more Invisalign® cases (P < .0001). General practitioners started more Invisalign® cases in the last 12 months (P  =  .0012). For both groups, the percentage of cases started in the last 12 months was inversely related to the number of years certified in Invisalign® (P < .0001). Significant differences in opinion (P < .001) were noted between orthodontists and general practitioners regarding the level of experience necessary to treat a Class I malocclusion with a large diastema, and whether a Class II subdivision case should be treated with Invisalign®.Conclusion:The hypothesis is rejected. The use of Invisalign® by orthodontists and general practitioners was compared, and significant differences were found.     

Treatment effects of skeletally anchored Forsus FRD EZ and Herbst appliances: A retrospective clinical study

Objective:To evaluate the skeletal, dentoalveolar, and soft tissue effects of the Forsus FRD appliance with miniplate anchorage inserted in the mandibular symphyses and to compare the findings with a well-matched control group treated with a Herbst appliance for the correction of a skeletal Class II malocclusion due to mandibular retrusion.Materials and Methods:The sample consisted of 32 Class II subjects divided into two groups. Group I consisted of 16 patients (10 females and 6 males; mean age, 13.20 ± 1.33 years) treated using the Forsus FRD EZ appliance with miniplate anchorage inserted in the mandibular symphyses. Group II consisted of 16 patients (9 females and 7 males; mean age, 13.56 ± 1.27 years) treated using the Herbst appliance. Seventeen linear and 10 angular measurements were performed to evaluate and compare the skeletal, dentoalveolar, and soft tissue effects of the appliances using paired and Student''s t-tests.Results:Both appliances were effective in correcting skeletal class II malocclusion and showed similar skeletal and soft tissue changes. The maxillary incisor was statistically significantly more retruded in the skeletally anchored Forsus FRD group (P < .01). The mandibular incisor was retruded in the skeletally anchored Forsus FRD group (−4.09° ± 5.12°), while it was protruded in the Herbst group (7.50° ± 3.98°) (P < .001).Conclusion:Although both appliances were successful in correcting the skeletal Class II malocclusion, the skeletally anchored Forsus FRD EZ appliance did so without protruding the mandibular incisors.