Palatal Area Research Articles

Fit Accuracy of Complete Denture Base Fabricated by CAD/CAM Milling and 3D-Printing Methods.

Digital complete denture fabrication can be accomplished by either milling or three-dimensional (3D)-printing approach in which minimal distortion during processing contributes to effective denture base adaption, which leads to good denture retention. The purpose of this study was to compare the fit accuracy of milled and 3D-printed complete denture bases. The reference edentulous maxillary arch model was scanned to generate virtual denture bases using computer-aided manufacturing software that exports as standard tessellation language files. Denture bases were constructed using a milling and 3D-printing technique using digital light processing method (n = 10). Intaglio surfaces of denture bases were scanned and superimposed on the reference model. The fit accuracy was quantified as root mean square error and evaluated statistically using independent t-test comparisons with a significance level of 0.05. Milled denture bases were significantly more accurate in adaptation than 3D-printed dentures in the overall intaglio area and primary bearing area of denture bases. 3D-printed denture bases demonstrated significantly greater accuracy in adaptation than milled denture bases in the peripheral/posterior palatal seal area. Milled denture bases fit better in the overall and primary stress-bearing areas than 3D-printed dentures, while 3D-printed dentures appeared more accurate in the peripheral seal area, which had a minor undercut that is not suitable for using milling technology.

Predictive Analysis of Maxillary Canine Impaction through Sella Turcica Bridging, Ponticulus Posticus Calcification, and Lateral Incisor Anomalies: A Retrospective Observational Study.

Maxillary canine impaction is an increasing dental anomaly and is often related to other dento-skeletal anomalies. The aim of this work is to support the clinician in evaluating the relationship between a displaced maxillary canine and clinical (the features of lateral incisors)/skeletal (ponticulus posticus and sella turcica bridging) anomalies through orthopanoramic radiographs, lateral cephalograms, and plaster casts to identify the parameters that best predict maxillary canine impaction. A retrospective observational study was carried out on the analysis of the medical records, radiographic findings (panoramic radiographs and lateral cephalograms), and plaster casts of 203 orthodontic patients divided into a case group, with at least one impacted maxillary canine, and a control group, without an impaction. A chi-square test and logistic regression analysis were used to analyze the data. A statistically significant association was found between the impaction of the maxillary canine and the female sex, the bridging of the sella turcica, the ponticulus posticus calcification, and the anomaly of the lateral incisor; a logistic regression revealed that these significant variables were found to be positive predictors of impacted maxillary canines, particularly in reference to the impaction in the palatal area. Finding one of these clinical and radiographic elements can represent a predictive sign of the possible impaction of the maxillary canine.

An In Vitro Study of Intaglio Surface, Periphery/Palatal Seal Area, and Primary Bearing Area Adaptation of 3D-Printed Denture Base Manufactured in Various Build Angles.

The objective of this research was to compare the adaptation in the overall intaglio surface, peripheral/posterior palatal seal area, and primary bearing area of the 3D-printed complete denture produced in 0, 45, and 90° build angles. A reference edentulous maxillary arch model was scanned to design virtual denture bases with computer-aided manufacturing (CAD) software with standard tessellation language (STL) files as output. Denture bases were fabricated by printing with a digital light processing (DLP) technique and divided into 3 groups according to build angles of 0°, 45°, and 90° (n = 10). To assess the adaptation, each STL file of the intaglio denture base was superimposed on the STL file of the reference model using surface-matching software. The adaptation was reported in root mean square error (RMSE) values and statically compared using one-way analyses of variance (ANOVA) and followed by the Turkey's test for multiple comparisons with a significance level of α = 0.05. Overall, intaglio surface adaptation of denture bases printed from three angles had no significant difference in adaption. In the peripheral/posterior palatal seal area, denture bases printed at a 90° build angle showed significantly better adaption than other groups. In the primary bearing area, denture bases printed at 45° and 90° had no significant difference in denture adaptation; however, they exhibited better denture base adaptation than the 0° group significantly. The build angle has no effect on adaptation in the overall intaglio surface area. The build angle of 90° provided the best adaptation in the peripheral/posterior palatal seal area. The 45° and 90° build angles provided better adaptation than 0° in the primary stress-bearing area.

Determination of the Frequency of Various Anatomical Forms of the Hard Palate for Complete Denture Fabrication

OBJECTIVE: To determine the frequency of patients with various anatomical forms of the hard palate for complete denture fabrication and to compare the mean distortion in heat cure denture base polymer in millimetres in different hard palate forms. METHODOLOGY: Informed consent was taken from total of seventy six patients and divided into low and medium hard palate forms. Dental casts were prepared from alginate impression and poured in type III stone and reference point R was marked on the deepest part of the posterior palatal seal area at the junction of hard and soft palate on each cast. After curing, the cast along with the cured denture base was retrieved from the flask. After 48h of curing cycle the distortion was measured in millimetres from R to R' via traveling microscope. RESULTS: Among seventy six participants the frequency of low palate forms was 45 (59.2%) and medium palate forms was 31 (40.8%). For each sample three readings were taken R1, R2 and R3. The mean distortion measured in low hard palate form was 0.52mm with a standard deviation of 0.18, the mean distortion measured in medium hard palate form was 0.76mm with a standard deviation of 0.27, which were clinically significant with a p-value of 0.0001. CONCLUSION: The hard palate forms has direct influence on retention of maxillary complete denture in posterior palatal area. KEY WORDS: Heat Cure denture base, distortion in hard palate forms, dimensional changes in heat cure, hard palate anatomy and denture bases

TUBERCULAR ULCER ORAL CAVITY MIMICKING MALIGNANCY-WONDER FACE BEHIND MASK.

Oral tuberculosis (TB), a chronic inammatory disease, can manifest as oral ulceration and mucosal erythema. This article presents a case of an oral ulcer on the right side's palatal area. Clinicians must be aware of TB while assessing a differential diagnosis for oral ulcers. A delayed diagnosis might have serious consequences for the patient.

A new perspective on the relationship between anchorage and palatal morphology: Three-dimensional digital model analysis.

The tooth movements were generally analyzed in two dimensions on cephalometric radiographs. Nowaday, 3D digital model analysis, which does not have any harmful effects on patients, can be used to evaluate the palatal morphology and coronal tooth movements in a very comfortable and easy way. To investigate the effect of palatal morphology on anchorage reinforcement during intraoral molar distalization with pendulum appliance using 3D model analysis. The material consisted of before (T0) and after (T1) dental plaster models of Class II malocclusion patients (17 females, 3 males) treated with pendulum appliance for molar distalization and Nance appliance for anchorage. T0 and T1 digital models were superimposed using the palatal area as a reference via three points and surface-matching software, and the changes in teeth movement were calculated for left and right central incisors, first premolars, and first and second molars. Palatal morphology was evaluated at T0 on digital models as palatal inclination, palatal depth angles, and anterior hard palate area. Wilcoxon test was used to evaluate the treatment results and Spearman's correlation analysis was performed to evaluate the relationship between palatal morphology and dental movement. The upper limit for the level of significance was taken as 0.05. Mesial movement of first premolars and distal movement of first and second molars were found to be statistically significant (P < 0.001). A weak negative correlation was found between the palatal inclination and the movement of first premolars (P < 0.045 and P < 0.003). Palatal depth angles and anterior hard palate area had no correlation with dental movements. Presented results supported that the mesial movement of premolar teeth decreased as the inclination of the palate increased.

Rehabilitation of Aramany Classification I Defect on a Completely Edentulous Patient: A Clinical Case Report.

Abstract: This clinical case report describes a prosthetic rehabilitation for a patient who had partial maxillectomy surgery following the diagnosis of maxillary squamous cell carcinoma in 1991. She was also previously diagnosed with parotid gland pathology on the right and required complete removal of gland along with facial nerve. Her previous prosthesis is 18 years old and claims it not as retentive as before. Intraorally there was a large oval shaped defect on the right side of the maxilla sparing the left alveolus. Defect extends more than 2/3rd of the palatal area with communication to the nasal floor. Presence of buccal frenal pull on the right side on the upper and lower jaws due to the wound contracture on that side of the face. The extraoral facial asymmetry and weakness of facial muscles in this patient may lead to improper denture border seal of the prosthesis. Patient was provided with maxillary acrylic obturator and mandibular acrylic complete denture as a definitive treatment with careful denture extension planning. She was reviewed multiple times till prosthesis stability intraorally was achieved. This improved the prognosis for this patient. The only option for retaining prosthesis in this case, without implants, is optimum engagement of the available soft-tissue undercuts found within the defect space and the non-affected side. Keywords: Completely Edentulous, Obturator, Facial Nerve, Prognosis, Case Report.

The study on the morphological changes of oropharynx in patients with complete unilateral cleft lip and palate after palatopharyngeal closure.

Cleft lip and palate can be treated as one of the most common craniofacial congenital malformations in humans. Such disease influences tens of millions of patients all over the world. Cleft lip and palate deformity affects many important physiological functions, including breathing, swallowing, speech, chewing, and aesthetics. This work focuses on investigating the morphology and airway volume of oropharynx patients with unilateral complete cleft lip and palate after palatopharyngeal closure. In addition, this work evaluated the similarities and differences between patients with cleft lip and palate and those without such an issue. The employed data, selected from the Department of Stomatology of Xuzhou First People's Hospital, are based on the conical beam CT images. The study sample was divided into two groups: the selected experimental group, who confronted the cleft lip, cleft palate, and velopharyngeal closure surgery, and the selected control group, who are healthy children at the corresponding age. The parameters, including the airway volume, the airway volume of velopharyngeal and oropharyngeal segments, the minimum cross-sectional area of the pharynx, the horizontal plane airway area of the hard palate and soft one, the horizontal airway area of the hyoid bone, and the vertical distance between the hard palate and soft palate, can be measured by Dolphin. These parameters were analyzed with a statistical approach. The analysis of the above-mentioned parameters reveals that the airway volume, the minimum cross-sectional area of the pharynx, the horizontal cross-sectional area of the hyoid, and the distance between the hard palate and soft palate tip in patients with complete unilateral cleft lip and palate show significant differences between the experimental group and the control group. Meanwhile, other parameters, including the horizontal cross-sectional area of the airway in the horizontal plane of the hard palate and the horizontal plane of the soft palate, did not show noticeable differences in the two groups. The patients, who confronted the unilateral complete cleft lip and palate, can improve with the velopharyngeal closure surgery. Furthermore, the length and vertical distance of the soft palate and the volume of each segment of the airway exhibit differences between the experimental group and the control group.

Vibration accelerates orthodontic tooth movement by inducing osteoclastogenesis via transforming growth factor-β signalling in osteocytes.

We previously found the conditions of supplementary vibration that accelerated tooth movement and induced bone resorption in an experimental rat tooth movement model. However, the molecular biological mechanisms underlying supplementary vibration-induced orthodontic tooth movement are not fully understood. Transforming growth factor (TGF)-β upregulates osteoclastogenesis via induction of the receptor activator of nuclear factor kappa B ligand expression, thus TGF-β is considered an essential cytokine to induce bone resorption. The aim of this study is to examine the role of TGF-β during the acceleration of orthodontic tooth movement by supplementary vibration. In experimental tooth movement, 15 g of orthodontic force was loaded onto the maxillary right first molar for 28 days. Supplementary vibration (3 g, 70 Hz) was applied to the maxillary first molar for 3 min on days 0, 7, 14, and 21. TGF-β receptor inhibitor SB431542 was injected into the submucosal palatal and buccal areas of the maxillary first molars once every other day. The co-culture of RAW264.7 cells and MLO-Y4 cells was used as an in vitro osteoclastogenesis model. SB431542 suppressed the acceleration of tooth movement and the increase in the number of osteoclasts by supplementary vibration in our experimental rat tooth movement model. Immunohistochemical analysis showed supplementary vibration increased the number of TGF-β1-positive osteocytes in the alveolar bone on the compression side during the experimental tooth movement. Moreover, vibration-upregulated TGF-β1 in MLO-Y4 cells induced osteoclastogenesis. Orthodontic tooth movement was accelerated by supplementary vibration through the promotion of the production of TGF-β1 in osteocytes and subsequent osteoclastogenesis.

Mini-Implant Rejection Rate in Teenage Patients Depending on Insertion Site: A Retrospective Study.

Mini-implants have undeniable advantages in Orthodontics. However, the use of mini-implants shows some limitations and disadvantages related to patient age, the quality of the bone tissue, the characteristics of the oral mucosa, implant site, the state of health of the organism and the quality of oral hygiene. The aim of this paper was to analyze the rejection rate of mini-implants in teenage patients, depending on their insertion site, and examine their stability up to three months after insertion. This retrospective study was conducted on dental charts belonging to patients aged between 12 and 17 years, from Oradea, Romania. The mini-implants were placed for various therapeutic reasons and were inserted in the following sites: buccal maxillary area, the infrazygomatic region, palatal area, buccal mandibular area and lingual area; they had a diameter of 1.6 mm (inter-radicular spaces) and of 2 mm (nonbearing tooth areas), and a length of 6–8 mm (mandible) or 8–10 mm (maxilla). The rejection rate was checked in the first month, second month, third month and after the third month from insertion. A total of 432 patients were included in the study, and they had a total of 573 mini-implants. Most implants were placed in the buccal region of the maxilla (27.7%), and most patients had one mini-implant placed (65.7%). The highest rejection rate was obtained in the first month (15.2%). The rejection rate between genders was similar. The mini-implants from the buccal mandibular region had a significantly higher rate of rejection in the first month (M1) in comparison to the mini-implants from the palatal region (24.4% vs. 8.3%). The mini-implants from the lingual region of the mandible had a significantly higher rate of rejection in the second month (M2) in comparison to the mini-implants from the infrazygomatic or the palatal region (10.5% vs. 0%/0%). Mini-implants are very useful for carrying out various orthodontic treatments, but their stability should be enhanced.

Risk of root damage after using lateral cephalogram and intraoral scan for guided insertion of palatal miniscrews

BackgroundGuided insertion of palatal miniscrews using a lateral cephalogram instead of cone beam computed tomography (CBCT) significantly reduces the radiation level for the patient. Till now no data are available on the risk of hitting the incisors in this regard, which is one of the worst clinical complications when inserting a paramedian miniscrew. Hence, this study aims to investigate the distance between the mini-implant and the roots of the central and lateral incisors.MethodsLateral cephalogram, an intraoral scan, and CBCT of 20 patients were superimposed. After a miniscrew (1.7 × 8 mm) placement based on intraoral scan and lateral cephalogram, the CBCT was used as control for the distance between the miniscrews and the roots of the incisors.ResultsThe mean value of the shortest distance between the miniscrew and roots of the incisors in the lateral cephalogram was 4.74 ± 1.67 mm. The distance between both miniscrews and the central incisors measured in the CBCT was 5.03 ± 2.22 mm and 5.26 ± 2.21 mm and between the two miniscrews and the lateral incisors was 4.93 ± 1.91 mm and 5.21 ± 2.64 mm. No significant differences between the distances in the CBCT and the lateral cephalogram could be observed. In one case, the CBCT control revealed the penetration of two palatally displaced canines after insertion based on intraoral scan and lateral cephalogram.ConclusionsThe use of an intraoral scan and a lateral cephalogram for guided paramedian insertion of palatal miniscrews can prevent incisor root damage. This may reduce the radiation since no CBCT seems necessary. The current investigation focuses on the anterior paramedian area of the palate. Outside that region and in complex cases with displaced teeth in the palatal area, a CBCT might be indicated.

Correlations of palatal surface area with anthropometric dimensions of the head and face

PurposeSaliva distribution over the palatal surface plays an important role in the perception of dry mouth. It is envisaged that non-invasive estimation of the palatal surface area by anthropometric measurements of the head and face can be useful in the assessment of oral dryness. For this purpose, the relationship between the palatal surface area and anthropometric measurements of the head and face was investigated.MethodsThe palatal surface was measured in 51 healthy volunteers using an intra-oral scanner. The distances between anthropometric landmarks of the head and face were determined using an anatomical sliding caliper. Correlations between the palatal surface area and the anthropometric landmarks were investigated.ResultsThe median palatal surface area for the total study population was found to be 2120.6 mm2. Virtually, all anthropometric measurements showed significant differences between females and males. Various head and face measurements had a significant correlation with the palatal surface area. However, these correlations disappeared when the participants were stratified based on their sex, with the exception of mandibular length and palatal width in females.ConclusionThe surface area of the palate correlates with nearly all anthropometric measurements of the head and face included in this study. Yet, the clinical applicability seems limited to females.

Labial and palatal alveolar bone changes during maxillary incisor retraction at the Universitas Sumatera Utara Dental Hospital

Background: The fundamental concept of tooth movement during orthodontic treatment is the occurrence of bone remodelling accompanied by tooth movement in equal proportions. The thickness of the alveolar bone, which supports incisors, is important in estimating the direction of tooth movement. Purpose: The study aimed to measure labial and palatal alveolar bone thickness changes after maxillary incisor retraction using lateral cephalograms. Methods: Cephalograms of 40 patients (18.58 ± 4.2 years) with skeletal Class I bimaxillary protrusion after maxillary first premolar extraction for insisivus retraction had been taken before (T0) and after (T1) orthodontic treatment. Changes in alveolar bone thickness were measured in linear and angular directions and then analysed with Spearman correlative analysis. Then the samples were separated into two groups based on the type of tooth movement (tipping and torque), and then the data were analysed using Wilcoxon analysis to see differences in the bone thickness (p&lt;0.05). Results: There was a significant difference in the apical palate (p&lt;0.05) and a relationship between retraction and alveolar bone thickness in the midroot area. In the angular direction, there was no significant difference and relationship; however, there was a significant difference in the labial crestal in the tipping group. In the torque group, the difference in bone thickness occurred in the crestal and apical palatal areas. Conclusion: The retraction and the type of tooth movement difference influence the alveolar bone thickness.

NON-HODGKIN'S LYMPHOMA OF PALATE: A CASE REPORT OF A HIGHLY DESTRUCTIVE LESION

A 54-year-old female patient presented to a dental office with a chief complaint of pain in her palate. Intraoral physical examination revealed a 2-cm local swelling with a small, centered ulceration and dilated superficial capillaries in the left posterior palatal area. Cone beam computed tomography did not show bone destruction. An incisional biopsy was performed and the histopathologic exam was inconclusive. Immunohistochemistry was positive for Ki-67 marker; co-expression of CD45, CD20, BCL-2, and BCL-6 associated with a high proliferative index of Ki-67 established a diagnosis of diffuse large B-cell lymphoma. Positron emission tomography revealed the involvement of the hard and soft palate, palatine tonsil, cervical and axillary lymph nodes, and inguinal area. The palatal lesion showed very rapid growth, affecting the underlying bone, causing extensive destruction and leading to a buccosinusal communication in a short period of time. An acrylic palatal obturator was installed to improve the patient's quality of life during oncological treatment.

Salivary film thickness and MUC5B levels at various intra-oral surfaces

ObjectivesIn this study, we investigated the salivary film thickness and the MUC5B levels at various intra-oral locations in healthy volunteers, with a focus on the palate. Besides, measurements of the palatal surface area were included to explore the possible relationships between the palatal surface area and the palatal salivary film and MUC5B levels.Materials and methodsThe salivary film thickness was determined using filter strips, which were pressed to the mucosal surfaces of five different intra-oral locations; conductance was then analysed using a Periotron. After elution of the strips, the MUC5B levels at various intra-oral locations were determined using ELISA. The palatal surface area was measured using an intra-oral scanner. The surface area was subsequently calculated using the software.ResultsThe anterior tongue had the thickest salivary film and also the highest levels of MUC5B, while the anterior palate had the thinnest salivary film and lowest MUC5B levels. There was no association between the palatal surface area and the salivary film thickness of the palate.ConclusionThe salivary film and MUC5B levels are unequally distributed over the intra-oral regions of the soft tissues. The lack of association between the palatal surface area and the salivary film thickness indicates that a larger surface area is not associated with a relative thinner palatal salivary film.Clinical relevanceThe results of the current study increase our understanding of saliva distribution in the oral cavity and could be used as reference values for future studies.

Three-dimensional evaluation of pharyngeal airway and maxillary arch in mouth and nasal breathing children with skeletal Class I and II

ObjectiveThis study aimed to investigate whether the subjects with mouth breathing (MB) or nasal breathing (NB) with different sagittal skeletal patterns showed different maxillary arch and pharyngeal airway characteristics.MethodsCone-beam computed tomography scans from 70 children aged 10 to 12 years with sagittal skeletal Classes I and II were used to measure the pharyngeal airway, maxillary width, palatal area, and height. The independent t-test and the Mann–Whitney U test were used for the intragroup analysis of pharyngeal airway and maxillary arch parameters.ResultsIn the Skeletal Class I group, nasopharyngeal airway volume (P < 0.01), oropharyngeal airway volume (OPV), and total pharyngeal airway volume (TPV) (all P < 0.001) were significantly greater in subjects with NB than in those with MB. Furthermore, intermolar width, maxillary width at the molars, intercanine width, maxillary width at the canines, and palatal area were significantly larger in subjects with NB than in those with MB (all P < 0.001). In the Skeletal Class II group, OPV, TPV (both P < 0.05) were significantly greater in subjects with NB than in those with MB. No significant differences in pharyngeal airway parameters in the MB group between subjects with Skeletal Class I and those with Skeletal Class II.ConclusionRegardless of sagittal Skeletal Class I or II, the pharyngeal airway and maxillary arch in children with MB differ from those with NB. However, the pharyngeal airway was not significantly different between Skeletal Class I and II in children with MB.

Misfit of Complete Maxillary Dentures' Posterior Palatal Seal following Polymerisation with Four Different Autopolymerising Resins: An In Vitro Study.

Background: The majority of complete dentures are still conventionally manufactured using a flask-and-pack technique. However, the polymerization process may introduce a distortion of the denture body. The aim of this study was to evaluate the three-dimensional fit of the posterior palatal seal of maxillary complete dentures with the original impression, and to give recommendations for scraping. Methods: Four autopolymerising resins were used to manufacture 40 palatal plates each for high, medium and flat palates (total n = 120). The misfit was captured by taking a reline impression with a highly fluid silicone, the dimensions of which were measured with a flat-bed scanner. Results: The shape of the palate had a significant impact (median p = 0.0435), but not the resin type (median p = 0.2575). It was largest for the flat palate and smallest for the high palate. The largest misfit was observed in the palatal midline area (flat-palate average median: 685 µm; high and medium palates: 620 µm) decreasing towards the lateral and anterior regions. Conclusions: The results suggest compensating for the palatal misfit that occurs with autopolymerising resins by scraping a postdam of an approximately 0.7 mm depth to the master cast, decreasing towards the anterior and lateral areas. In high and medium palates, the scraping could be less pronounced.

Favorable Transverse Maxillary Development after Covering the Lateral Raw Surfaces with Buccal Fat Flaps in Modified Furlow Palatoplasty: A Three-Dimensional Imaging-Assisted Long-Term Comparative Outcome Study.

The pedicled buccal fat flap has recently been applied to cover the lateral raw surfaces during palatoplasty as an attempt to mitigate scar-induced transverse maxillary constriction during growth, but with no formal long-term comparative analysis. This three-dimensional imaging-assisted study assessed its impact on posterior transverse maxillary development. Cone beam computed tomographic scans from patients with unilateral cleft lip, alveolus, and palate who received buccal fat flap (buccal fat group; n = 22) or Surgicel (Surgicel group; n = 32) for covering lateral raw surfaces during modified Furlow palatoplasty at 9 to 10 months of age and had reached the age of 9 years were retrieved for analysis. Patients with unilateral cleft lip and alveolus (nonpalatoplasty group; n = 24) were also included for comparison. Using three-dimensional maxillary image models, linear (U6T-MSP and U6J-MSP) and area measurements were calculated for cleft and noncleft posterior maxillary sides and for total posterior transverse maxillary dimension. The buccal fat group had significantly (all p < 0.05) wider dimensions compared with the Surgicel group for all transverse maxillary measurements on both the cleft and noncleft sides, except for U6J-MSP and posterior palatal area parameters on the cleft side ( p > 0.05). The buccal fat group had significantly (all p < 0.05) wider total transverse maxillary dimensions compared with the Surgicel and nonpalatoplasty groups. Covering the lateral raw surfaces with buccal fat flaps resulted in less posterior transverse maxillary constriction compared with the Surgicel-based covering procedure. Therapeutic, III.

Three-dimensional assessment of palatal area changes after posterior crossbite correction with tooth-borne and tooth bone-borne rapid maxillary expansion.

To assess and compare the three-dimensional treatment changes in palatal surface area and volume using either tooth-borne (TB) or tooth bone-borne (TBB) rapid maxillary expanders and to evaluate the long-term effects of the two devices and the incidence of the relapse between the groups. A total of 52 consecutive patients who met the eligibility criteria were recruited and allocated to either the TB group, mean age 9.3 years (standard deviation [SD], 1.3), or the TBB group, mean age 9.5 years (SD, 1.2). Study casts were taken before, directly after, 1 year after, and 5 years after expansion. Study casts were digitized, superimposed, and evaluated. Participants were randomly allocated in blocks of different sizes using the concealed allocation principle in a 1:1 ratio. Changes in palatal volume, palatal surface area, and palatal projection area within and between the groups up to 5 years after expansion followed the same pattern and did not show any statistically significant differences between the groups. Relapse was seen in 15% of the patients. It seemed that open-bite and a Class III growth pattern could be assumed as prognosis-deteriorating factors in regard to stability of the treatment. There were no significant differences between the TB and TBB groups in palatal volume, palatal shell area, or palatal projection area directly after expansion or at 1 year and 5 years after expansion, which implies that the two devices gave rise to the same immediate and long-term outcomes.

Surgical exposure and fix orthondontic combination for maxilla canine impacted treatment

Objective: Teeth that are buried in the jawbone or obstructed by gum tissue and fail to emerge from the typical occlusive surface, causing malocclusion, are known as impacted teeth. Canine teeth are kept for masticatory function strength, aesthetics, and malocclusion repair. Impacted canines can be retrieved using a combination of surgery and fixed orthodontic equipment to restore a normal arch and position Methods: An impacted maxillary left canine caused edema in the palatal area in a 22-year-old female patient at RSKGM-P UNAIR who was referred by orthodontics. The impacted tooth's position was determined using radiography, occlusal projection, and CBCT. The procedures included flap surgery with a full thickness incision, flap opening, orthodontic button insertion on the crown of the buried canine, ligature wire implantation, and flap repositioning and suturing. Results: Combined surgical technique and orthodontic appliance placement on impacted canines can place canines in normal arches and in the space available and in the occlusive position of the teeth, Surgical exposure combined with fixed orthodontic treatment of the affected maxillary surgery on the left maxillary canine was performed. Conclusion: In terms of the ultimate position of the canines in the normal arch and aesthetic appearance, a combination of surgical exposure and fixed orthodontic treatment of the impacted maxillary left canine produced good results.