Turkish Journal of Orthodontics最新文献

The aim of this systematic review was to evaluate the clinical outcomes of skeletal anchorage, compared to conventional anchorage, in the treatment of skeletal Class III malocclusion in growing patients. A systematic review was conducted following PRISMA guidelines. A specific search strategy was developed for PubMed, Web of Science, Embase, and Cochrane searching for randomized controlled trials and non-randomized clinical trials. Eleven interventions were assessed, three employing conventional anchorage (group A) and eight skeletal anchorage (group B). Nine pre-treatment (T0) and post-treatment (T1) mean cephalometric outcomes were statistically polled (SNA, SNB, ANB, Wits, Overjet, Overbite, SNMP, IMPA, U1PP). In total, 196 studies were identified, 17 studies were included in the qualitative and quantitative analysis. In the skeletal anchorage group, a greater increase in both ANB (+2.511°) and Wits (+4.691 mm) were observed and the increase in SNMP resulted well-controlled (+0.758°). The conventional anchorage group showed higher dentoalveolar side effects: increase in U1PP (+5.624°), decrease in IMPA (-0.866°) and increase in overjet (+5.255 mm). Treatments exploiting skeletal anchorage determined a better correction of skeletal Class III, thanks to a combination of greater advancement of the maxilla and more enhanced retrusion of the mandible. In all treatment protocols exploiting dental anchorage, the increase in the inclination of the central incisor resulted significantly greater. Further longitudinal studies are required to evaluate the long-term effects of skeletal anchorage in growing patients.

Objective: The aim of this study is to evaluate the effects of maxillary advancement (MxA) and bimaxillary osteotomy (MdS-MxA) on upper pharyngeal airway volume (PAV), apnea-hypopnea index (AHI), hyoid bone (HB) position, and head posture (HP) in young and healthy individuals with skeletal Class III malocclusion.

Methods: This prospective clinical study included three groups: MxA, MdS-MxA, and Class I control group, with 12 subjects each. In the surgical groups, lateral cephalometric radiographs, cone-beam computed tomography images, and AHI measurements were obtained preoperatively and approximately six months postoperatively. Only pre-treatment records were collected for the control group. Depending on data distribution, parametric (Paired Samples t-test and ANOVA) or non-parametric (Wilcoxon Signed-Rank and Kruskal-Wallis) tests were used for intra- and inter-group statistical comparisons, with a significance level set at p<0.05.

Results: The maxillary forward movement for the MxA group was 5.34 mm. It was 5.32 mm in the MdS-MxA group, and the mandibular setback was 4.71 mm. Nearly six months after surgery, significant differences were observed among the groups in the sagittal positions of the jaws, the vertical position of the mandible, the vertical position of the hyoid bone, and PAV sections. No significant differences were found in HP, minimum cross-sectional area or AHI.

Conclusion: PAV increase was observed in both surgical groups. MdS-MxA did not have an effect on obstructive sleep apnea. Postoperative HB displacement was minimal, with a slight inferior shift observed in the MdS-MxA group.

Objective: This study aims to evaluate the effect of low-level laser therapy (LLLT) on leveling mandibular anterior crowding and associated pain levels.

Methods: This double-blinded, parallel, randomized clinical trial included 30 participants who were randomly assigned to the laser group or the control group, with Little's irregularity index of 4-8 mm in the mandibular canine-canine region. Nickel-titanium archwires measuring 0.012 inches were tied with elastomeric ligatures and changed every 14 days throughout the leveling process. The leveling duration was recorded in days, from the bonding application to the end of leveling. Irradiation was performed at an 810-nm wavelength using a gallium-aluminum-arsenide diode laser device with a power output of 100 mW and an energy density of 8 J/cm². Laser applications were performed after archwire ligation (day 0), on days 3, 7, and 14 and every 14 days until leveling was completed. The leveling duration was calculated, and pain levels were evaluated using a visual analogue scale (VAS) after archwire ligation (hour 0), at hours 2 and 6 and on days 1, 3, 7, 14, and 21.

Results: The leveling duration showed no significant differences between the laser and control groups (p=0.170). Group comparison results of the VAS scores at hour 6 (p=0.001) and day 1 (p=0.006) exhibited significantly reduced pain levels in the laser group compared with the control group.

Conclusion: Although LLLT is not effective in reducing the leveling duration, it significantly reduces pain levels at hour 6 and on the 1^st day.

Objective: To compare skeletal ages determined using three different regression methods from measurements made on cervical vertebrae from lateral cephalometric radiographs (LCRs) with the skeletal age determined from hand-wrist radiographs (HWRs).

Methods: LCRs and HWRs of 794 individuals (329 boys, 465 girls) aged 7-18 years were examined. The hand-wrist skeletal age of the participants was determined using the Greulich-Pyle (GP) atlas. Forty-four linear and nine angular morphometric measurements in the C2-C5 vertebrae were made in LCRs. Vertebral skeletal age (VSA) was determined in both sexes using Ridge, the least absolute shrinkage and selection operator (LASSO), and ElasticNet regression methods. The study results were evaluated using R2 (explainability power). Bland-Altman analysis was performed to determine the consistency of chronologic age (CA), GP age, and VSAs.

Results: LASSO regression showed the highest explainability power for VSA, with boys at 0.783 and girls at 0.741. In both sexes, the vertebral depth of concavities had high beta coefficients, and the posterior height of C3 vertebrae (TVup-TVlp) had the highest beta coefficient in boys in LASSO regression. The width of the limits of agreement in both CA and VSA graphs of GP age was wider in boys than in girls. The width of the limits of agreement of CA-VSAs was wider in girls than in boys.

Conclusion: Although high R2 values were obtained, VSA showed no superiority over CA in the assessment of skeletal age, and no significant clinical advantage was observed. For the Turkish population, using GP age may be more accurate for determining skeletal age in orthodontic treatment planning.

Objective: This study aimed to evaluate proximal caries formation and Decay, Missing, Filled Teeth (DMFT) scores during clear aligner (CA) therapy compared with fixed orthodontic treatment.

Methods: A total of 50 patients with a mean age of 19.9 years were divided into two equal groups (n=25) according to treatment method. Both CA and fixed appliance (FA) patients had low-to-medium levels of crowding. Caries formation and DMFT scores were assessed via radiographic and clinical examination before treatment (T0) and at the end of a six-month observation period (T1). The numbers of caries lesions and fillings was analyzed using a Two-Way Analysis of Variance with a significance level of 0.05.

Results: Significant statistical differences were found for both groups (p<0.001). The amount of proximal caries significantly increased in both groups, whereas the increase in non-proximal caries was only statistically significant in the FA group. DMFT scores also increased significantly in both groups, with the FA group showing a higher increase at the end of the observation period.

Conclusion: Although CAs had an advantage in decreasing the overall risk of caries, no distinct advantage was found in reducing the risk of proximal caries lesions. The DMFT index was significantly higher in fixed orthodontic treatment patients than in CA treatment patients.

Tooth eruption is a highly complex mechanism that is controlled by many factors. Various mechanical, systemic, or genetic factors can cause eruption disorders. Primary failure of eruption (PFE) is known as an eruption disorder occurring due to non-syndromic genetic factors. It is frequently seen in the first and second molars and causes posterior open bite. It can be observed unilaterally or bilaterally. Studies show that mutations in many different genes that control the tooth eruption mechanism, mainly the PTH1R and KMT2C genes, constitute the genetic basis of PFE. Primary eruption disorders are very difficult to treat. It is known that the application of active orthodontic forces causes local ankylosis in the tooth and the failure of the tooth to return to its normal position. For this reason, determining the correct diagnosis and treatment method is very important. Although there are different treatment methods, the results of research about the success of these treatment methods are quite limited. This review aims to explain the etiology, diagnosis, and treatment of PFE in light of current genetic studies.

Objective: To assess the effects of rapid maxillary expansion (RME) and orthodontic treatment with fixed appliances on the developing roots of anchor teeth compared with completely formed roots.

Methods: Pre- and post-treatment cone-beam computed tomography (CBCT) scans of 19 patients (mean pre-treatment age 10.9±1.3, mean post-treatment age 13.66±1.29) with incompletely formed roots who had undergone RME and orthodontic treatment with fixed appliances were selected. In addition, 15 CBCT scans of age- and sex-matched untreated controls (mean age 13.69±1.08) with completely formed roots of the same teeth were obtained. Pre- and post-treatment CBCT records of the experimental group were segmented and reconstructed to obtain linear and volumetric measurements of the roots for comparison with the control group. Changes in the root dimensions were analyzed using the paired t-test; Independent Student's t-test was used for comparisons between the groups.

Results: All premolars in the experimental group showed a statistically significant increase in root length and volume post-treatment (p<0.05), with the greatest increase seen in the second premolar. The distobuccal and palatal root lengths of the molars decreased significantly after treatment in the experimental group. The comparison of post-treatment root dimensions between the experimental and untreated control groups showed no significant difference.

Conclusion: The teeth with developing roots attain normal root length after RME and orthodontic treatment with fixed appliances, with no significant differences in root length and volume compared with teeth with completely formed roots.

Several procedures have been proposed as adjuvant treatments in orthodontics to accelerate orthodontic tooth movement (OTM). This review aimed to evaluate and compare the effectiveness of surgical and non-surgical techniques in accelerating tooth movement, ascertain the influence of different orthodontic appliances on the rate of tooth movement and analyze their clinical applicability as supportive approaches in orthodontic treatment. A bibliographic search was carried out in April 2024 across Pubmed, Scopus, Web of Science, and the Cochrane Library using combinations of keywords and Medical Subject Heading terms relevant to the topic. The search had no time restriction and was limited to studies published in English. A total of 76 articles were included in this systematic review. Corticotomy exhibited the highest acceleration potential among surgical techniques but is highly invasive and associated with considerable pain and discomfort. Among non-surgical techniques, vibration and photobiomodulation (PBM) showed the most promising results due to their non-invasiveness and effectiveness in accelerating tooth movement. This review provides a comprehensive overview of techniques for accelerating OTM. The literature remains limited in involving surgical and non-surgical procedures using orthodontic aligners, highlighting the need for further research. Considering all the pros and cons, PBM appears to be the most promising technique; however, its effectiveness is yet suboptimal. Future efforts should be dedicated to optimizing PBM protocols to stimulate specific remodeling phenomena, ensuring its establishment as a safe, effective, painless, and non-invasive acceleration technique.

Objective: To compare the pharyngeal airway size and area between Class III patients exhibiting optimal vertical growth direction and Class I patients at the MP3cap stage, considering gender differences.

Methods: This retrospective study analyzed pre-treatment cephalograms of a total of 180 patients with Class I (45 girls, 45 boys) and Class III (maxilla or maxillo-mandibular origin) (45 girls, 45 boys) malocclusions. Linear and angular measurements were conducted on lateral cephalograms utilizing the GNU Image Manipulation Program (GIMP 2.10.18, NY, USA; https://www.gimp.org/). The pharyngeal airway areas were computed utilizing AUTOCAD (Autodesk 2018, San Rafael, CA, USA). The Independent Samples t-test and Mann-Whitney U test were employed for comparative analysis of variables across groups. The forward selection method was employed in conjunction with regression analysis.

Results: No significant differences were observed in the nasopharyngeal area (NA; mm²) across the malocclusion groups and genders. In Class III girls, the oropharyngeal area (OA; mm²), retroglossal (RG; mm²) area, and superior pharyngeal space (SPS; mm) were significantly larger than those of Class III boys, and Class I girls (p<0.05). The inferior pharyngeal space (IPS; mm) was significantly larger in Class III girls compared to Class III boys (p<0.05). Girls with Class I/III malocclusions demonstrated a more pronounced head posture than boys (p<0.05).

Conclusion: The findings indicate the necessity of accounting for gender-specific variations in Class I and III patients, as well as evaluating pharyngeal airway characteristics in orthodontic diagnosis and treatment planning. In Class III girls, the OA and RG areas, as well as the superior and inferior pharyngeal spaces, were larger compared to Class III boys.

Objective: This study aimed to investigate the positional changes of maxillary first molars in patients treated with the hybrid hyrax-mentoplate and Cl III elastics combination using cone-beam computed tomography (CBCT).

Methods: Ten patients (7 females-3 males, mean age: 11.66±0.83 years) treated with hybrid hyrax-mentoplate at Marmara University Department of Orthodontics were included. Angular and linear measurements were taken from pre-treatment and post-treatment CBCT images, and changes in maxillary first molar teeth were examined using 3D SLICER version 5.0.2 (www.slicer.org). Statistical significance was set at p≤0.05.

Results: Significant increases were observed in all distance measurements except C16p-C26p in the coronal plane, and significant decreases were observed in angular measurements only at 16mb and 26mb (p≤0.05). All measurements in the sagittal plane significantly increased compared to the vertical and horizontal reference lines (p≤0.001). Angular measurements relative to the palatal reference line significantly increased only in P-16p, P-26mb, and P-26p (p≤0.05). In skeletal measurements, significant changes were observed only in V-A, V-ANS, H-PNS, and V-PNS measurements (p≤0.05). The expansion at the apical level was significantly higher than that at the coronal level (p≤0.05). Compared to the V line, more mesial movement was observed at the coronal level than at the apical level (p≤0.001).

Conclusion: The use of Class III elastics causes greater expansion at the apical level than the coronal. Molar teeth exhibit a mesial movement, but there could be multiple contributing factors. In molars connected to Class III elastics, extrusion occurs. When vertical control is important, appropriate safety measures are advised.