Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

Background The purpose of this prospective study was to compare adolescent and post-adolescent growth periods regarding the effectiveness of conventional activator appliance in patients with Class II mandibular retrognathia by using lateral cephalometric radiographs and three-dimensional photogrammetry (3dMDface). Material/Methods We enrolled 2 groups: 15 patients in the adolescent growth period and 17 patients in the post-adolescent growth period. All patients had Class II anomaly with mandibular retrognathia and were treated with conventional activator appliances. Lateral cephalometric radiographs and three-dimensional photogrammetric views were obtained at the beginning and end of the activator treatment of Class II patients. Maxillomandibular discrepancy, mandibular protrusion and lengths, convexity angles, facial heights, and dental measurements were evaluated cephalometrically. Projections of the lips and the chin and volumetric measurements of the lip and the mandibular area were assessed using three-dimensional photogrammetry. Results Conventional activator therapy resulted in similar effects in both growth periods regarding improvements in the mandibular sagittal growth and maxillomandibular relationship (ANB° and the SNB° angles). Mandibular effective length was increased (Co-Gn length) and the maxillary horizontal growth was restricted (decreased SNA° angle) in both groups following the treatment. Treatment duration was significantly longer in the post-adolescent group. Increases in the projections of menton, pogonion, and sublabial points were observed in the three-dimensional photogrammetric views. Total lip volume was reduced while the mandibular volume was significantly increased in both groups. Lower gonial angle showed a greater increase in the post-adolescent group. Conclusions Correction of Class II anomaly with mandibular retrognathia was achieved with a combination of dental and skeletal changes in both growth periods. Conventional activator therapy may be an alternative treatment approach in the late growth period as it led to significant skeletal and dental changes.

Ortodontik tedavide diş çekimi yapılması uzun süredir tartışmalı bir konudur. Çapraşık alt keser dişler için çekimsiz sabit tedavi, interproksimal stripping ile tedavi, premolar diş çekimli tedavi, bir veya iki alt keser dişin çekilmesi gibi çeşitli ortodontik tedavi yaklaşımları bulunmaktadır. Çekimli tedavilerde en sık premolar diş çekimi tercih edilmektedir. Ortodontik tedavi sonunda ideal oklüzyonun sağlanmasındaki zorluk sebebiyle alt keser diş çekimi yaygın bir prosedür değildir. Alt keser diş çekimine karar verirken çapraşıklık miktarı, diş boyutu uyumsuzluğu, patolojik durum, overbite, overjet, keser açılanmaları, iskeletsel büyüme paterni ve hasta yaşı gibi faktörler değerlendirilmelidir. Bu tedavi seçeneği anterior diş boyutu düzensizliklerinde, küçük üst kesici dişler ve/veya büyük alt kesici dişler nedeniyle oluşan problemlerin düzeltilmesinde endikedir. Literatürde tek keser çekimi uygulanan hastaların premolar çekimi uygulanan hastalara kıyasla uzun dönemde daha iyi stabilite gösterdiği bildirilmiştir. İyi bir posterior oklüzyona sahip olgularda alt keser diş çekiminin bazı avantajları bulunmaktadır. Uygun bir endikasyonla bu tedavi yaklaşımında istenen sonuçlar ve stabil oklüzal ilişkiler elde edilebilir.

Mandibular retrognatinin mevcut olduğu hastalarda, mandibular büyüme stimülasyonu için çeşitli ortopedik apareylerden faydalanılmaktadır. Herbst apareyi, bu amaçla kullanılan sabit fonksiyonel ortopedik apareylerden biridir ve farklı tasarımlarla kullanılabilmektedir. Bu tedavi yöntemi ile hastanın yaşına ve büyüme-gelişim dönemine göre farklı etkiler elde edilebilmektedir. Apareylerin tasarım ve uygulanmasına bağlı olarak tedavi süresince; bant kırılması, bandın kaybolması, teleskop parçasının kırılması, splint kaybı ve splint kırılması, vida gevşemesi, piston deformasyonu ve akrilik parçanın kırılması ve yumuşak doku yaralanmaları gibi komplikasyonlarla karşılaşılırken; tedavi sonunda ise aşırı alt kesici diş protrüzyonu ve spee eğrisinin artması gibi durumlarla da karşılaşılabilmektedir. Kök rezorpsiyonu ve kondiler rezorpsiyona yol açtığı konusunda ise bilimsel bir kanıt henüz bulunmamaktadır. Bu derlemenin amacı Herbst apareyinin çeşitli tasarımlarıyla yapılan tedavi sırasında ve sonrasında karşılaşılan komplikasyonları sunmaktır.

Background/aim To compare the outcomes of skeletally-anchored (SA) or face mask (FM) therapy in the management of patients presenting with maxillary retrognathia. Methods Forty-four consecutively treated maxillary retrognathic patients who underwent SA or FM therapies followed by fixed orthodontics were evaluated. Two micro-implants between the maxillary first molar and the second premolar and two mandibular miniplates were inserted to facilitate the use of Class III elastics in the SA group (23 patients). Facemasks with full occlusal-coverage acrylic appliances were applied in the FM group (21 patients). Lateral cephalometric radiographs obtained before treatment (T0), after orthopaedic treatment (T1), and after fixed orthodontic treatment (T2) were traced and 31 measurements compared. Results No statistically significant differences were found between the groups related to treatment duration and gender distribution. The mean age was significantly higher in the SA group (11.70±0.25 years) compared with the FM group (10.57±0.35 years) at T0. The mean ANB angle increased by 3.34° and 3.15° and the mean Wits value reduced by 6.16 mm and 4.13 mm in the FM and SA groups, respectively. Forward movement of the maxilla was similar between the groups. The vertical plane angle increased in both groups following maxillary protraction. However, it decreased in the SA group during fixed orthodontic therapy, which was contrary to what occurred in the FM group. The lower incisors were retracted/retroclined in the FM group and protracted/proclined in the SA group. Conclusions/implications Maxillary protraction was achieved in both groups and was maintained during fixed orthodontic therapy. Undesired lower incisor retraction and an increase of the vertical plane angle encountered with FM therapy were minimised by SA therapy.