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To compare the clinical outcomes and tendon integrity after rotator cuff repair combined with anterior cable reconstruction (ACR) using the proximal biceps tendon and patch augmentation (PA) using a human dermal allograft (HDA) in a large retracted anterior rotator cuff tear. Patients who underwent arthroscopic rotator cuff repair with 2 different augmentation procedures between January 2017 and December 2020 were enrolled. The inclusion criteria were patients who were treated by arthroscopic rotator cuff repair with ACR using the proximal biceps tendon (ACR group) or patch augmentation using a an HDA (PA group) and follow-up for at least 2 years. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) score, Constant score, and the number of patients who achieved minimal clinically important differences (MCID). Magnetic resonance imaging was performed to evaluate tendon integrity after surgery. A total of 92 patients were enrolled (ACR group = 55 patients and PA group = 37 patients). The mean ASES and Constant scores significantly improved in the ACR group (68.8 ± 15.3 and 58.4 ± 16.9 before surgery vs 91.4 ± 6.3 and 87.8 ± 6.0 after surgery, P <.001) and in the PA group (63.7 ± 16.7 and 57.9 ± 15.4 before surgery vs 93.1 ± 6.3 and 88.3 ± 6.2 after surgery, P <.001). Overall, 78 patients (84.8%) achieved the MCID with 81.8% in the ACR group and 89.2% in the PA group, with no significant differences between the 2 groups (P =.638). Ten patients (18.2%) had retear in the ACR group, and three patients (8.1%) had retear in the PA group (P =.174). In large retracted anterior rotator cuff tears, both augmentation techniques using biceps tendon autograft and HDA provided satisfactory clinical outcomes that achieved the MCID in 84.8%, range of motion restoration, and lower retear rates with no significant differences between the two groups. Level III, retrospective case-control study. [ABSTRACT FROM AUTHOR]

The biomechanical changes and treatment guidelines on acromial fracture after reverse shoulder arthroplasty (RSA) are still not well understood. The purpose of our study was to analyze the biomechanical changes with respect to acromial fracture angulation in RSA. RSA was performed on 9 fresh-frozen cadaveric shoulders. An acromial osteotomy was performed on the plane extending from the glenoid surface to simulate an acromion fracture. Four conditions of acromial fracture inferior angulation were evaluated (0°, 10°, 20°, and 30° angulation). The middle deltoid muscle loading origin position was adjusted based on the position of each acromial fracture. The impingement-free angle and capability of the deltoid to produce movement in the abduction and forward flexion planes were measured. The length of the anterior, middle, and posterior deltoid was also analyzed for each acromial fracture angulation. There was no significant difference in the abduction impingement angle between 0° (61.8° ± 2.9°) and 10° angulation (55.9° ± 2.8°); however, the abduction impingement angle of 20° (49.3° ± 2.9°) significantly decreased from 0° and 30° angulation (44.2° ± 4.6°), and 30° angulation significantly differed from 0° and 10° (P <.01). On forward flexion, 10° (75.6° ± 2.7°), 20° (67.9° ± 3.2°), and 30° angulation (59.8° ± 4.0°) had a significantly decreased impingement-free angle than 0° (84.2° ± 4.3°; P <.01), and 30° angulation had a significantly decreased impingement-free angle than 10°. On analysis of glenohumeral abduction capability, 0° significantly differed (at 12.5, 15.0, 17.5, and 20.0N) from 20° and 30°. For forward flexion capability, 30° angulation showed a significantly smaller value than 0° (15N vs. 20N). As acromial fracture angulation increased, the middle and posterior deltoid muscles of 10°, 20°, and 30° became shorter than those of 0°; however, no significant change was found in the anterior deltoid length. In acromial fractures at the plane of glenoid surface, 10° inferior angulation of the acromion did not interfere with abduction and abduction capability. However, 20° and 30° of inferior angulation caused prominent impingement in abduction and forward flexion and reduced abduction capability. In addition, there was a significant difference between 20° and 30°, suggesting that not only the location of the acromion fracture after RSA but also the degree of angulation are important factors for shoulder biomechanics. [ABSTRACT FROM AUTHOR]

Introduction: The study aimed to evaluate the morphologic changes in the pharyngeal airway after bimaxillary surgery in skeletal Class III malocclusion patients with or without asymmetry. We also analyzed the correlation between positional changes in the menton, hyoid bone, and changes in the dimensions of the pharyngeal airway.Methods: We included 32 patients with skeletal Class III malocclusion who underwent bimaxillary surgery. There were 16 subjects in the symmetry group (10 male, 6 female; mean age, 22.44 ± 5.14 years), and 16 in the asymmetry group (10 male, 6 female; mean age, 21.38 ± 4.62 years). Preoperative and postoperative (2 months after surgery) cone-beam computed tomography scans were taken and then analyzed by comparing postoperative changes in each group.Results: The anteroposterior lengths at the uvula level (P2L) and epiglottis level (P3L) were significantly decreased in the symmetry group. The P2L was also significantly decreased in the asymmetry group, and a difference in the P3L was observed. However, there was no significant change in the width at the uvula level (P2W) and epiglottis level (P3W) in the symmetry group. In contrast, in the asymmetry group, P2W and P3W were significantly decreased. The cross-sectional ratio was significantly decreased P2 (P2L/P2W) and P3 (P3L/P3W) in the symmetry group. However, a statistically significant decrease occurred only at P3 in the asymmetry group. Anteroposterior positional changes of the menton and P2L (r = -0.370; P <.05), P3L (r = -0.414; P <0.05), and P3L/P3W (r = -0.361; P <0.05) were correlated.Conclusions: Differences in the morphologic features of the pharyngeal airway after bimaxillary surgery was observed in both the symmetry and asymmetry groups. Bimaxillary surgery with a mandibular setback in patients with skeletal Class III malocclusion worsened morbidity of the elliptical structure of the pharyngeal airway. However, it worsened less in the asymmetry group than in the symmetry group. [ABSTRACT FROM AUTHOR]

Introduction: Controlling transverse discrepancies is necessary to ensure stable and functional occlusion. Altered molar inclinations can camouflage the transverse relationship. The purpose of this research was to evaluate the maxillomandibular relationship of the center of resistance (CR) of the arch form created by the CR of teeth and compare these CR arch forms by their skeletal patterns.Methods: Sixty patients with minor crowding and normal posterior overjet were divided into 3 groups according to ANB angle: skeletal Class I group had ANB angle between 0° and 4° (n = 20), skeletal Class II group had ANB angle >4° (n = 20), and skeletal Class III group had ANB angle <0° (n = 20). The 3-dimensional coordinates of the CR were estimated using cone-beam computed tomography images and projected on the CR occlusal plane to obtain the 2-dimensional coordinates. The CR arch forms were constructed and evaluated using Matlab (MathWorks, Natick, Mass).Results: On comparing maxillomandibular CR arch form widths, the maxilla was significantly larger than the mandible of the canine and first premolar. The mandible was larger in the first molar of the skeletal Class III group. The maxillomandibular CR arch form width ratios were between 0.97 and 1.35. On comparing maxillomandibular CR arch form areas, the maxilla was significantly larger than the mandible in the anterior segment, and the mandible was larger in the posterior segment. The ratios were between 0.86 and 2.25. In between-group comparison, the skeletal Class III group showed significantly greater arch forms in the mandible.Conclusions: CR arch forms had significant maxillomandibular differences throughout the arch. The maxillomandibular ratios could be a reference for site-specific transverse discrepancy analysis. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to analyze the treatment effects after molar distalization using modified C-palatal plates with and without second molar eruption and to evaluate the three-dimensional position of the molars during long-term retention using cone-beam computed tomography.Methods: The study sample comprised 74 third molars in 42 patients. Twenty-seven adolescent patients (mean age, 12.6 years) having 48 maxillary third molars were divided into 2 groups according to the eruption of their second molars: 15 patients with second molar eruption (group 1) and 12 patients without second molar eruption (group 2). Pretreatment, posttreatment, and long-term data (mean, 5.2 years) from cone-beam computed tomography were scanned and compared with control groups.Results: There was less tipping movement of the first and second molars (0.94° and 3.22°) and distal tipping movement of the third molars (8.91°) in group 1 than in group 2 (4.36°, 7.39°, and 3.08°, respectively), but the treatment time was shorter and the positional change of the third molars was insignificant in group 2. In the long-term, the second molars fully erupted after distalization in group 2, and there was no difference in the third molar position between group 1, group 2, and the control group, except for the vertical position of the third molars in group 1.Conclusions: In the long-term, the second molars fully erupted after distalization, and the third molars were in a favorable position. Therefore, these findings suggest that clinicians do not need to extract developing third molars before distalization in adolescents. [ABSTRACT FROM AUTHOR]

Introduction: C-expanders are tissue- and bone-borne maxillary expanders that are anchored by 6 orthodontic miniscrews, 3 on each side of the palate. The purpose of the study was to investigate the effect of C-expanders on the circummaxillary sutures and bucco-palatal axis of teeth in 3-dimensional finite element analyses when anchor screw vectors are different.Methods: Five expansion models were studied on the basis of the vertical positions of anchor screws on the palate. Anchor screws for models A, B, and C were placed symmetrically at 4 mm, 7 mm, and 15 mm below the cementoenamel junction (CEJ), respectively. Anchor screws for models D and E were placed asymmetrically at 4 mm and 15 mm below CEJ and 7 mm and 15 mm below CEJ, respectively. Stress, displacement, and angular changes of the bone and teeth were measured in elastoplastic behavior models using a static-nonlinear simulation in an implicit method.Results: Symmetrical and asymmetrical anchor screw placement with different vertical vectors were compared using finite element analyses on 5 models.Conclusions: Using different vectors of anchor screws for C-expanders does change the pattern of palatal expansion (null hypothesis was rejected). The current investigation presents a promising future of controlled asymmetric skeletal maxillary expansion when asymmetric maxillary architecture needs to be corrected for successful orthodontic outcomes without involving orthognathic surgeries. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the anatomy of the posterior palatal alveolar process, which is often used for placement of the orthodontic mini-implant (OMI), and to suggest simple guidelines for safe placement of OMI.Methods: Cone-beam computed tomography (CBCT) scans of 60 patients (30 men, 30 women; age range, 18-39 years; average age, 25.8 years) was used to measure the palatal interradicular distance, the palatal bone thickness, and the palatal soft-tissue thickness. Measurements were performed on the area from the maxillary canine to the maxillary second molar based on the vertical distance apical from the cementoenamel junction. The CBCT data were analyzed by Bonferroni correction for multiple testing and the multivariable mixed linear model.Results: The palatal interradicular distance was the widest between the second premolar and the first molar and the narrowest between the first and second premolars. The palatal bone thickness at interdental sites was the thickest between the first and second premolars and the thinnest between the first and second molars. The interdental palatal soft-tissue thickness from the canine to the second premolar was thicker than any other area. There were minor measurement differences between genders and positive correlations between vertical distance from the cementoenamel junction plane and all of the parameters.Conclusion: In this study, we evaluated the anatomy of the posterior palatal area using CBCT scans of adult patients. The data will provide guidelines to the clinicians before OMI placement in the posterior palatal alveolar process. [ABSTRACT FROM AUTHOR]

Nonmineralized cysts and cyst-like lesions that frequently occur in the mandible include ameloblastomas, odontogenic keratocysts, and dentigerous cysts. They have specific features of well-demarcated, unilocular, and radiolucent lesions that are often associated with tooth impaction. Although it rarely occurs, these cysts can become extremely large. Furthermore, cyst enlargement causes additional symptoms that can challenge the success of tooth recovery through orthodontic treatment. This clinical report presents the successful eruption of 2 impacted molars in a large dentigerous cyst treated with marsupialization and orthodontic traction using an orthodontic miniplate anchorage over a 4-year treatment period. [ABSTRACT FROM AUTHOR]

Recently, a newly designed lumen-apposing metal stent (LAMS) with a conventional delivery system was developed. The purpose of this study was to evaluate the effectiveness and safety of a newly designed LAMS for EUS-guided drainage to treat symptomatic pancreatic pseudocysts. This prospective multicenter cohort study included 34 patients with symptomatic pancreatic pseudocysts from 2016 to 2017. The patients underwent EUS-guided drainage with the newly designed LAMS (Niti-S SPAXUS; Taewoong Medical Co, Ltd, Ilsan, South Korea). Effectiveness outcome measurements included technical success rate, clinical success rate, successful stent removal rate, and procedural time. Safety outcome measurements included procedure and/or stent-related adverse events (AEs) and overall AEs. Patients were prospectively followed, and consecutive data were collected at discharge, at stent removal, and 20 days after stent removal. Thirty-four patients (mean age 51.7 ± 13.3 years, 26 men) were enrolled. The mean pseudocyst size was 9.23 ± 3.54 cm. The technical success rate was 97.1% (33/34). The clinical success rate was 94.1% (32/34). All stents were successfully removed. The mean procedural time from needle puncture to stent deployment was 10.3 ± 5.7 minutes. Four patients (11.8%) experienced procedure and/or stent-related AEs, including stent maldeployment (n = 1) and pseudocyst infection (n = 3). All patients completely recovered from the AEs. Bleeding caused by the stent or buried LAMS syndrome was not observed. No unplanned endoscopic procedures were required. This study showed that EUS-guided drainage using the newly designed LAMS is technically feasible and effective for the treatment of symptomatic pancreatic pseudocysts. (Clinical trial registration number: NCT02730663.) [ABSTRACT FROM AUTHOR]

Congenital absence of permanent teeth can be treated by means of dental implants and prosthetics. Tooth autotransplantation is an alternative in growing patients because continued eruption of the transplanted tooth and associated alveolar bone growth can be expected. This clinical report presents tooth autotransplantation in a 10-year-old boy with chronic maxillary rhinosinusitis, diagnosed by the department of otorhinolaryngology. The patient's mandibular second premolars were transplanted to a congenitally edentulous maxillary premolar region. There was insufficient alveolar bone during transplantation because of pneumatization, but normal root development with vertical alveolar bone growth was observed during a 3-year follow-up. Healing of the transplant in the right side without closing of the apex and without signs of obliteration after 4 years is exceptional. [ABSTRACT FROM AUTHOR]

A modified C-palatal plate (MCPP) is introduced as a treatment option for adolescent patients with Class I malocclusion and severe overjet. A boy, 10 years 11 months old, was successfully treated without extractions in 22 months. Indications for clinical application of the MCPP as well as procedures and biomechanical analysis of the treatment effects are described in detail. The MCPP was used to distalize the maxillary dentition. The results were stable 1 year after retention. Clinicians should consider the application of MCPP as a nonextraction treatment option for adolescents with Class I malocclusion and severe overjet when the patient or parent refuses extractions. [ABSTRACT FROM AUTHOR]

Carbon dioxide capture based on membrane separation process is one of the most promising methods to reduce greenhouse gases emissions. Many studies concerning economic competitiveness of membrane separation processes have been conducted. Heat exchangers can be effectively used to reduce the total energy consumption in the membrane separation process. The two-stage membrane separation processes considered in this work include heat exchangers with H 2 O sweep. The necessity of this work arose from the need to apply the heat exchanger network analysis in order to identify the optimal process configuration based on the process models. Typical multicomponent separation models for the counter-current flow pattern using hollowfiber membranes are validated with experimental data. Effects of the pressure ratio and membrane area to achieve a target CO 2 purity (90%) and recovery (90%) are investigated. Energy analysis including heat recovery and utility power are performed using pinch technology. The results show that significant amount of total energy (1.31 MJ/kg CO 2 ) can be reduced by introducing heat exchangers compared to the two-stage separation process without heat exchangers. [ABSTRACT FROM AUTHOR]

Introduction: Our aim in this study was to evaluate the effect of augmented corticotomy on the decompensation pattern of mandibular anterior teeth, alveolar bone, and surrounding periodontal tissues during presurgical orthodontic treatment.Methods: Thirty skeletal Class III adult patients were divided into 2 groups according to the application of augmented corticotomy labial to the anterior mandibular roots: experimental group (with augmented corticotomy, n = 15) and control group (without augmented corticotomy, n = 15). Lateral cephalograms and cone-beam computed tomography images were taken before orthodontic treatment and before surgery. The measurements included the inclination and position of the mandibular incisors, labial alveolar bone area, vertical alveolar bone height, root length, and alveolar bone thickness at 3 levels surrounding the mandibular central incisors, lateral incisors, and canines.Results: The mandibular incisors were significantly proclined in both groups (P <0.001); however, the labial movement of the incisor tip was greater in the experimental group (P <0.05). Significant vertical alveolar bone loss was observed only in the control group (P <0.001). The middle and lower alveolar thicknesses and labial alveolar bone area increased in the experimental group. In the control group, the upper and middle alveolar thicknesses and labial alveolar bone area decreased significantly. There were no significant differences in dentoalveolar changes between the 3 kinds of anterior teeth in each group, except for root length in the experimental group (P <0.05).Conclusions: Augmented corticotomy provided a favorable decompensation pattern of the mandibular incisors, preserving the periodontal structures surrounding the mandibular anterior teeth for skeletal Class III patients. [ABSTRACT FROM AUTHOR]

This case report presents the camouflage treatment that successfully improved the facial profile of a patient with a skeletal Class III malocclusion using bone-borne rapid maxillary expansion and mandibular anterior subapical osteotomy. The patient was an 18-year-old woman with chief complaints of crooked teeth and a protruded jaw. Camouflage treatment was chosen because she rejected orthognathic surgery under general anesthesia. A hybrid type of bone-borne rapid maxillary expander with palatal mini-implants was used to correct the transverse discrepancy, and a mandibular anterior subapical osteotomy was conducted to achieve proper overjet with normal incisal inclination and to improve her lip and chin profile. As a result, a Class I occlusion with a favorable inclination of the anterior teeth and a good esthetic profile was achieved with no adverse effects. Therefore, the hybrid type of bone-borne rapid maxillary expander and a mandibular anterior subapical osteotomy can be considered effective camouflage treatment of a skeletal Class III malocclusion, providing improved inclination of the dentition and lip profile. [ABSTRACT FROM AUTHOR]

This case report introduces a new approach of corticotomy-assisted rapid maxillary expansion for treating a severe maxillary transverse discrepancy in a skeletally mature patient. This approach uses piezo-bone perforation in conjunction with a fixed appliance and an expander. This report describes the treatment of a 14-year-old girl with a severe maxillary transverse discrepancy. She had a straight profile, severe maxillary crowding, a maxillomandibular transverse differential index of 9 mm, and a Class I skeletal relationship. The treatment protocol consisted of surgical intervention with piezo-bone perforation and active orthodontic therapy. Immediately after the piezo-bone perforation on the lateral buccal side of the maxilla, active orthodontic therapy was started with activation of an expander. The expander was reactivated weekly. Treatment duration was 5 months 2 weeks. Proper overbite and overjet, facial balance, and occlusion were achieved. The treatment outcome was stable at the 3-year follow up. This treatment approach considerably reduced the treatment time and gained bony volume. Additionally, it transformed the periodontal biotype in contrast to conventional therapy. This approach is a good alternative for treating a severe maxillary transverse discrepancy in a skeletally mature patient, especially for a patient who does not want surgical rapid palatal expansion. [ABSTRACT FROM AUTHOR]

Although 2-jaw orthognathic surgery is a typical recommendation for the treatment of facial asymmetry, another good treatment alternative is maxillary corticotomy with temporary skeletal anchorage devices followed by mandibular orthognathic surgery. The corticotomy procedure described here can achieve unilateral molar intrusion and occlusal plane canting correction with potentially fewer complications than 2-jaw orthognathic surgery. The approach allows movement of dentoalveolar segments in less time than with conventional dental intrusion using temporary skeletal anchorage devices. A 2-jaw asymmetry with occlusal plane canting might be corrected using maxillary corticotomy and mandibular orthognathics rather than 2-jaw orthognathics. Two patients with facial asymmetry are presented here. In each one, the maxillary cant was corrected over a period of 2 to 3 months with 3.5 mm of intrusion of the unilateral buccal segment. After the preorthognathic cant correction, orthognathic surgery was done to correct the mandibular asymmetry. [ABSTRACT FROM AUTHOR]

Introduction: This paper introduces a virtually planned and stereolithographically fabricated guiding system that will allow the clinician to plan carefully for the best location of the device and to achieve an accurate position without complications. Methods: The scanned data from preoperative dental casts were edited to obtain preoperative 3-dimensional (3D) virtual models of the dentition. After the 3D virtual models were repositioned, the 3D virtual surgical guide was fabricated. A surgical guide was created onscreen, and then these virtual guides were materialized into real ones using the stereolithographic technique. Results: Whereas the previously described guide required laboratory work to be performed by the orthodontist, our technique is more convenient because the laboratory work is done remotely by computer-aided design/computer-aided manufacturing technology. Because the miniplate is firmly held in place as the patient holds his or her mandibular teeth against the occlusal pad of the surgical guide, there is no risk that the miniscrews can slide on the bone surface during placement. The software program (2.5-dimensional software) in this study combines 2-dimensional cephalograms with 3D virtual dental models. This software is an effective and efficient alternative to 3D software when 3D computed tomography data are not available. Conclusions: To confidently and safely place a miniplate with screw fixation, a simple customized guide for an orthodontic miniplate was introduced. The use of a custom-made, rigid guide when placing miniplates will minimize complications such as vertical mislocation or slippage of the miniplate during placement. [Copyright &y& Elsevier]

Introduction: Registering a 3-dimensional (3D) facial surface scan to a cone-beam computed tomography (CBCT) scan has various advantages. One major advantage is to compensate for the inaccuracy of the CBCT surface data. However, when registering CBCT and 3D facial scans, changes in facial expression, spatial soft-tissue changes, and differences in the patient's positioning can decrease the accuracy of the registration. In this study, we introduce a new 3D facial scanner that is combined with a CBCT apparatus. Our goal was to evaluate the registration accuracy of CBCT and 3D facial scans, which were taken with the shortest possible time between them. Methods: The experiment was performed with 4 subjects. Each patient was instructed to hold as still as possible while the CBCT scan was taken, followed immediately by the 3D facial surface scan. The images were automatically registered with software. The accuracy was measured by determining the degree of agreement between the soft-tissue surfaces of the CBCT and the 3D facial images. Results: The average surface discrepancy between the CBCT facial surface and 3D facial surface was 0.60 mm (SD, 0.12 mm). Registration accuracy was also visually verified by toggling between the images of the CBCT and 3D facial surface scans while rotating the registered images. Conclusions: Registration of consecutively taken CBCT and 3D facial images resulted in reliable accuracy. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this prospective cohort study was to compute the clinical survival and complication rates of a miniplate with a tube device (C-tube) used for orthodontic treatment. Methods: From August 2003 to May 2012, 217 patients were recruited. They received 341 C-tube miniplates. Some C-tube miniplates were removed because orthodontic treatment ended. Others remained beyond the study period and were recorded as censored data. Survival was classified as a C-tube miniplate that functioned in the mouth regardless of any complications. Success was defined as survival without complications. From the data, the effects of these clinical variables on the survival of the C-tube miniplates were evaluated: sex, age, jaw, placement sites, oral hygiene, tube clearance, inflammation, miniplate shape, number of screws, and length of the fixation screws. Survival analyses using the Kaplan-Meier method and the Cox proportional hazard model were applied. Results: Of the 341 miniplates, 14 failed, and 32 had complications. Two-year survival and success rates were 0.91 and 0.80, respectively. In terms of the simple ratio statistic, this was equivalent to a success rate of 96%. The status of oral hygiene maintenance and the operators’ experience had significant associations with the complication rates (P <0.001). Conclusions: The C-tube miniplate has an advantage in versatility in terms of force application. When placing a miniplate, the most important factor is maintaining good tissue health by means of good oral hygiene. Even with good hygiene, the doctor’s experience in performing the flap surgery was the second most important factor for success. [Copyright &y& Elsevier]

Introduction: Facial convexity related to bimaxillary protrusion is prevalent in many populations. Underlying skeletal protrusion combined with increased dentoalveolar protrusion contributes to facial muscle imbalance and lip incompetence, which is undesirable for many patients. In this study, we evaluated the relationship between soft-tissue and hard-tissue changes in an orthodontically treated Asian population. Methods: Twenty-four consecutive adult Asian patients (mean age, 24 years), diagnosed with severe bimaxillary dentoalveolar protrusion, were evaluated using pretreatment and posttreatment cone-beam computed tomography. The patients were treated with 4 first premolar extractions followed by anterior retraction with either skeletal or intraoral anchorage. Serial cone-beam computed tomography radiographs were registered on the entire cranial base and fossa. Soft-tissue and hard-tissue changes were determined through landmark displacement and color mapping. Results: Upper lip retraction was concentrated between the nasolabial folds and commissures. Lower lip retraction was accompanied by significant redistribution of soft tissues at pogonion. Soft-tissue changes correlated well with regional facial muscle activity. Significant retractions (2-4 mm) of the soft tissues occurred beyond the midsagittal region. Use of skeletal anchorage resulted in 1.5 mm greater lower lip retraction than intraoral anchorage, with greater retraction of the maxillary and mandibular incisor root apices. Conclusions: Profound soft-tissue changes accompanied retraction of the anterior dentition with both treatment modalities. [Copyright &y& Elsevier]

Highlights: [•] Combination treatment with PT and 5-FU increase apoptosis-associated molecule expression. [•] The combination can inhibit the growth of SW620 tumors in a xenograft model. [•] The combination induces apoptosis through the mitochondrial pathway. [•] The low-dose of PT exerts a synergistic effect with 5-FU induction of apoptosis. [ABSTRACT FROM AUTHOR]

Vertical dimension control is critical for adults with Class II high-angle malocclusions. If the patient has a temporomandibular disorder, this requirement is exacerbated. When extraction is planned, the treatment challenge is further increased. This article reports on a new biomechanical design (C-therapy) appropriate for anterior segment retraction with excellent control of the vertical dimension, even in a Class II high-angle patient with a temporomandibular disorder. Maximum retraction of the maxillary anterior segment can be achieved with a lingual retractor and a palatal miniplate without appliances on the maxillary posterior segments. Mandibular anterior vertical height was well controlled by a second miniplate in the mental region. This device also contributed to mandibular anchorage reinforcement. A patient with temporomandibular disorder symptoms treated with this approach is shown. [Copyright &y& Elsevier]

Introduction: Our objectives were to evaluate the amount of decompensation of the mandibular incisors and the change of periodontal support around them after corticotomy with bone augmentation before orthognathic surgery. Methods: Before orthognathic surgery for 15 skeletal Class III patients, orthodontic treatment was combined with corticotomy and bone augmentation labially to the anterior mandibular roots. Lateral cephalograms were taken before orthodontic treatment and before surgery (completion of preoperative orthodontic treatment). The amounts of mandibular incisor proclination, alveolar bone thickness, and periodontal support (gingival margin levels and augmentation pattern) were evaluated. Results: Significant proclination of the mandibular incisors was shown after decompensation (P <0.001; incisor mandibular plane angle, 10.45°; incisor symphyseal plane angle, 10.74°). The incisor edge moved labially by 3.47 mm. The alveolar bone thickness increased by 1.56 mm at the root apex and 1.98 mm at the level of B-point (P <0.001). There was no gingival recession irrespective of the degree of proclination of the mandibular incisiors. Two types of bone augmentation pattern were evident. One was characterized by alveolar bone proclination proportional to the labial tipping of the mandibular incisors. Buccal alveolar bone at the cervical area was well maintained (60%, 9 subjects). The other showed greater increases in alveolar thickness at B-point than at the cervical area (40%, 6 subjects). Conclusions: The augmented corticotomy provided effective decompensation of the mandibular incisors in skeletal Class III patients while maintaining labial bone thickness and with no periodontal side effects. This technique reduces or eliminates the risk of moving the roots through the labial plate during decompensation with the associated risk of gingival recession. [Copyright &y& Elsevier]

Introduction: The purpose of this study was to use cone-beam computed tomography to compare mandibular dimensions in subjects with asymmetric skeletal Class III malocclusion and those with normal occlusion. Methods: Cone-beam computed tomography scans of 38 subjects with normal occlusion and 28 patients with facial asymmetry were evaluated and digitized with Invivo software (Anatomage, San Jose, Calif). Three midsagittal and 13 right and left measurements were taken. The paired t test was used to compare the right and left sides in each group. The Mann-Whitney U test was used to compare the midsagittal variables and the differences between the 2 sides of the group with normal occlusion with those of asymmetry patients. Results: The posterior part of the mandibular body showed significant differences between the deviated and nondeviated sides in asymmetric Class III patients. The difference of the asymmetry group was significantly greater than that of the normal occlusion group for the mediolateral ramal and the anteroposterior condylar inclinations (P = 0.007 and P = 0.019, respectively). Conclusions: The asymmetric skeletal Class III group showed significant differences in condylar height, ramus height, and posterior part of the mandibular body compared with the subjects with normal occlusion. These results might be useful for diagnosis and treatment planning of asymmetric Class III patients. [Copyright &y& Elsevier]

This report describes a novel concept of en-masse retraction with temporary skeletal anchorage devices in place of posterior bonding or banding. The patient was a Korean woman, aged 24 years 4 months, with a Class II Division 1 malocclusion with severe mandibular anterior crowding. Both molars showed decalcification of the cervical areas. Partial osseointegration-based C-implants and C-tube plates were placed bilaterally between the maxillary second premolars and the first molars and in the posterior mandible. These temporary skeletal anchorage devices were used as independent appliances for full retraction of the maxillary and mandibular anterior teeth 3-dimensionally without the assistance of posterior bonded appliances. The posterior occlusion was not changed during treatment, and Class I occlusal relationships with optimal overjet and overbite were achieved. The 7-year posttreatment records showed a stable result. [Copyright &y& Elsevier]

Introduction: This article introduces a technique combining corticotomy and orthodontic forces, or accelerated osteogenic orthodontics, for use in patients with a Class III occlusion and a thin alveolus who will undergo orthognathic surgery. Methods: Two adults with Class III malocclusion undergoing anterior decompensation for mandibular setback surgery were selected. The first patient was treated with accelerated osteogenic orthodontics and conventional decompensation. The second patient was treated with accelerated osteogenic orthodontics and decompensation with a temporary skeletal anchorage device in concert with guided tissue regeneration. Decortication of bone was performed to the mandibular teeth with a low-speed round bur and piezosurgery. After hemostasis, bone graft material was placed into the decorticated area. In the severely thin alveolar ridge, a rigid scaffold was applied for immobilization of graft material. After approximation of the flap, an immediate orthodontic force was applied to the teeth to initiate rapid tooth movement. Results: Rapid tooth movement into predetermined positions for orthognathic surgery was accomplished in all mandibular anterior teeth. Preoperative 3-dimensional imaging showed dehiscences on the facial aspects of the mandibular anterior teeth. Postoperative imaging demonstrated coverage of the denuded roots with radiodense material. Conclusions: The accelerated osteogenic orthodontic technique is a safe and effective treatment option for mandibular anterior decompensation treatment of these patients. When combined with a temporary skeletal anchorage device and bone augmentation, this technique facilitated the decompression of the mandibular anterior teeth in severely compromised dentitions. [Copyright &y& Elsevier]

Introduction: This article reports the use of an orthodontic mini-implant for a temporary crown restoration in a small edentulous space after limited orthodontic treatment. Methods: Two clinical cases are presented: a 23-year-old woman and a 14-year-old boy. In the adult patient, a 2-piece orthodontic C-implant (Cimplant, Seoul, Korea) was placed in a 3-mm wide edentulous space to build up a temporary crown restoration after a short orthodontic treatment to regain space for a missing mandibular right permanent lateral incisor. In the boy, a C-implant was placed in the space resulting from an avulsed maxillary right permanent lateral incisor to prevent aggressive alveolar bone resorption after dental trauma. Both patients were followed for more than 4 years of retention to evaluate the stability of the temporary crown restoration built up on the orthodontic mini-implants. Results: Both patients had successful long-term results, confirmed by clinical and radiographic examinations. Both were pleased with the results and plan to retain the orthodontic mini-implant temporary crown restoration until they are ready for a permanent restoration later. Conclusions: A 2-piece orthodontic C-implant system can be used to maintain edentulous space after active orthodontic treatment. [ABSTRACT FROM AUTHOR]

This report introduces an innovative treatment approach of selecting atypical and unconventional teeth for orthodontic extraction without compromising the quality of treatment outcomes by using temporary skeletal anchorage devices in patients with bimaxillary protrusion. Both patients introduced in this report had solid Class I molar relationships with bimaxillary anterior protrusion without facial or dental midline asymmetry. Their chief concerns were significant facial convexity, which conventionally requires the extraction of all 4 first premolars. However, 3 second premolars and 1 first premolar were removed in the first patient, and 2 second premolars and 2 first premolars were removed in the second patient. All second premolars extracted had previously had root canal treatment and large prosthodontic restorations, which resulted in a compromised short lifespan of the teeth relative to the natural dentition. To manage these cases of asymmetric extraction space in a symmetric dental and skeletal environment, 2 mini-implants were placed in the posterior maxillary interradicular spaces, 1 on each side. Despite the unusual asymmetric extraction of teeth, superimposition of the pretreatment and posttreatment cephalometric tracings shows excellent treatment outcomes of facial convexity reduction by asymetric maximum retraction of the anterior teeth with no change in the molar relationships. [ABSTRACT FROM AUTHOR]

Introduction: Our objective was to evaluate the factors that affect effective torque control during en-masse incisor and canine retraction when using partially osseointegrated C-implants (Cimplant, Seoul, Korea) as the exclusive source of anchorage without posterior bonded or banded appliances. Methods: Base models were constructed from a dental study model. No brackets or bands were placed on the maxillary posterior dentition during retraction. The working archwire was modeled by using a 3-dimensional beam element (ANSYS beam 4, Swanson Analysis System, Canonsburg, Pa) with a cross section of 0.016 × 0.022-in stainless steel. Different heights of anterior retraction hooks and different degrees of gable bends were applied to the working utility archwire that was placed into the 0.8-mm diameter hole of the C-implant to generate anterior torque on the anterior segment of the teeth. The amount of tooth displacement after finite element analysis was exaggerated 70 times and compared with tooth-axis graphs of the central and lateral incisors and the canine. Results: The height of the anterior retraction hook and the degree of the gable bend had a combined effect on the labial crown torque applied to the incisors during en-masse retraction. By using 30° gable bends and the longest hook, lingual root movement of the 6 anterior teeth occurred. By using 20° gable bends, the 6 anterior teeth showed a translation tendency during retraction. Conclusions: Three-dimensional en-masse retraction of the 6 anterior teeth can be accomplished by using partially osseointegrated C-implants as the only source of anchorage, gable bends, and a long retraction hook (biocreative therapy type I technique). [ABSTRACT FROM AUTHOR]

Introduction: When mini-implants fail during orthodontic treatment, there is a need to have a backup plan to either replace the failed implant in the adjacent interradicular area or wait for the bone to heal before replacing the mini-implant. We propose a novel way to overcome this problem by replacement with a miniplate so as not to interrupt treatment or prolong treatment time. Methods: The indications, advantages, efficacy, and procedures for switching from a mini-implant to a miniplate are discussed. Two patients who required replacement of failed mini-implants are presented. In the first patient, because of the proximity of the buccal vestibule to the mini-implant, it was decided to replace the failed mini-implant by an I-shaped C-tube miniplate. In the second patient, radiolucencies were found around the failed mini-implants, making the adjacent alveolar bone unavailable for immediate placement of another mini-implant. In addition, the maxillary sinus pneumatization was expanded deeply into the interradicular spaces; this further mandated an alternative placement site. One failed mini-implant was examined under a scanning electron microscope for bone attachment. Results: Treatment was completed in both patients after replacement with miniplates without interrupting the treatment mechanics or prolonging the treatments. Examination under the scanning electron microscope showed partial bone growth into the coating pores and titanium substrate interface even after thorough cleaning and sterilization. Conclusions: Replacement with a miniplate is a viable solution for failed mini-implants during orthodontic treatment. The results from microscopic evaluation of the failed mini-implant suggest that stringent guidelines are needed for recycling used mini-implants. [Copyright &y& Elsevier]

This article reviews several clinical applications of the C-type temporary skeletal anchorage devices, such as a C-Implant, C-Tube Mini-Plate, or C-palatal Mini-Plate that are used for camouflaging mild-to-moderate Class III skeletal malocclusions. The treatment strategy was established following the principles of biocreative C-therapy. [ABSTRACT FROM AUTHOR]

An orthodontic miniplate tube device, the C-tube, was designed for use in patients for whom a conventional miniscrew is not suitable, such as those with narrow interradicular spaces, extended maxillary sinuses, dilacerated roots, or severe alveolar bone loss. After local anesthesia, 2 parallel horizontal incisions are made in the area of placement, and the periosteum is elevated. The C-tube is slipped under the mucosal flap and fixed with self-drilling miniscrews (diameter, 1.5 mm; length, 4 mm). Because the screws are short, there is adequate retention in the alveolar plate, and the clinician can avoid the increased morbidity of anchoring to the zygomatic buttress. This makes placement possible with superficial anesthesia. A small rolled tube at the head part can act as an orthodontic tube and accommodate archwires or as a hook to attach orthodontic elastics. However, in some patients with pneumatization or systemic diseases, such as diabetes mellitus, or in heavy smokers, cross-type C-tubes with longer miniscrews are recommend for better stability. This new type of orthodontic miniplate can be an effective alternative to conventional 1-component screws or miniplates in complex situations. [ABSTRACT FROM AUTHOR]

This report describes a novel concept of relocating orthodontic mini-implants during dental distalization to provide unrestricted distal movement of the full maxillary dentition. The patient was an 18-year old Korean woman with a full-step Class II Division 1 malocclusion and mandibular deficiency. Mini-implants were initially placed bilaterally between the maxillary second premolar and the first molar. Sliding jigs were used to distalize the maxillary first and second molars. After the maxillary molars were distalized to a Class I molar relationship, the mini-implants were removed and immediately relocated distally to provide space for retraction of the anterior teeth. The occlusion was completed with Class I molar and canine relationships with optimal overjet and overbite. The 2-year posttreatment records showed a stable treatment with retention. [ABSTRACT FROM AUTHOR]

This article illustrates a new treatment system combining segmented wire and osseointegrated mini-implants for molar distalization without complex appliances. The procedures, advantages, efficacy, and indications for this method are discussed. Two patients whose treatment plans included distal molar movement and orthodontic mini-implant treatment were recruited. One patient required 1 molar to be uprighted, and the other needed molar distalization to regain space lost for the missing maxillary right second premolar. C-implants (diameter, 1.8 mm; length, 8.5 mm) were placed and, after 4 weeks of healing, were used as direct anchorage and indirect anchorage simultaneously for correcting the asymmetric Class II molar relationship. Few orthodontic attachments were necessary, and the teeth moved rapidly to the planned positions without detrimental effects on the occlusion. The combination of segmented archwires, minimum bonded attachments, and a partially osteointegrated mini-implant (C-implant) was a simple and effective treatment choice in distalization treatment. [ABSTRACT FROM AUTHOR]

Introduction: The purposes of this study were to determine factors favoring successful mini-implant placement and to evaluate root proximity as a possible risk factor for failure of osseointegration-based mini-implants during orthodontic treatment. Methods: Three-dimensional cone-beam computed tomography images were used to examine 50 sandblasted, large-grit, and acid-etched surface-treated mini-implants (C-implant, Seoul, Korea) placed in 25 patients. The images were analyzed for 3-dimensional position of the mini-implant (placement angle and depth) and any contact with root surfaces or maxillary sinuses. Results: There were no remarkable differences in horizontal placement angles in the axial plane and placement depths of the mini-implants, but the vertical placement angle was significantly higher on the left side (24.5° ± 11.0°) compared with the right side (11.8° ± 11.6°). The horizontal mini-implant placement angle had a greater inclination tendency toward the maxillary first molar, and 11 mini-implants with root proximity showed mesiobuccal contact with the maxillary first molar root. Only 1 failure in 15 mini-implants with root proximity and 1 failure in 35 without root proximity were observed on the images. Conclusions: Root proximity alone was not considered a major risk factor for osseointegration-based mini-implant failure. [Copyright &y& Elsevier]

Introduction: Survival analysis is useful in clinical research because it focuses on comparing the survival distributions and the identification of risk factors. Our aim in this study was to investigate the survival characteristics and risk factors of orthodontic mini-implants with survival analyses. Methods: One hundred forty-one orthodontic patients (treated from October 1, 2000, to November 29, 2007) were included in this survival study. A total of 260 orthodontic mini-implants that had sandblasted (large grit) and acid-etched screw parts were placed between the maxillary second premolar and the first molar. Failures of the implants were recorded as event data, whereas implants that were removed because treatment ended and those that were not removed during the study period were recorded as censored data. A nonparametric life table method was used to visualize the hazard function, and Kaplan-Meier survival curves were generated to identify the variables associated with implant failure. Prognostic variables associated with implant failure were identified with the Cox proportional hazard model. Results: Of the 260 implants, 22 failed. The hazard function for implant failure showed that the risk is highest immediately after placement. The survival function showed that the median survival time of orthodontic mini-implants is sufficient for relatively long orthodontic treatments. The Cox proportional hazard model identified that increasing age is a decisive factor for implant survival. Conclusions: The decreasing pattern of the hazard function suggested gradual osseointegration of orthodontic mini-implants. When implants are placed in a young patient, special caution is needed to lessen the increased probability of failure, especially immediately after placement. [Copyright &y& Elsevier]

This article describes the orthodontic treatment for a young woman, aged 23 years 5 months, with a Class III malocclusion and a deviated midline. Two orthodontic mini-implants (C-implants, CIMPLANT Company, Seoul, Korea) were placed in the interdental spaces between the mandibular second premolars and first molars. The treatment plan consisted of distalizing the mandibular dentition asymmetrically and creating space for en-masse retraction of the mandibular anterior teeth. C-implants were placed to provide anchorage for Class I intra-arch elastics. The head design of the C-implant minimizes gingival irritation during orthodontic treatment. Sliding jigs were applied buccally for distalization of the mandibular posterior teeth. The active treatment period was 18 months. Normal overbite and overjet were obtained, and facial balance was improved. [Copyright &y& Elsevier]