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    Analysis of the effect of maxillary transverse deficiencies on permanent maxillary first molar rotations using 3D digital models
    (Bmc, 2025) Ozden, Samet; Cicek, Orhan
    AimThe aim of this study was to evaluate the permanent maxillary first molar rotation (PMMR) angles in cases of maxillary transverse skeletal deficiency (MTSD) and to compare them with a control group. Materials and methodsIn this study, which included a total of 88 patients (50 females, 38 males, with a mean age of 14.98 +/- 2.14 years), consisting of 66 patients with MTSD and 22 patients in the control group, four groups were divided: Group 1 (MTSD without molar crossbite), Group 2 (MTSD with bilateral molar crossbite), Group 3 (MTSD with unilateral (right-sided) molar crossbite), and Group 4 (Control Group). Skeletal deficiencies were evaluated by measuring the interjugular, jugale right (JR), and jugale left (JL) distances on posteroanterior cephalograms (PACs), while occlusal relationships were assessed using 3-dimensional (3D) intraoral models. PMMR angles were measured using the 3D Slicer software on 3D intraoral models with the Ricketts Molar-Cusp Reference Line and the midsagittal reference plane. Statistical significance was set at p < 0.05. ResultsThe PMMR angles and JR and JL distances of Group 2 were significantly higher, while the interjugular distance was found to be the lowest (p < 0.05). There was no significant difference in the PMMR angles between the Control group and Group 1 (p > 0.05), while the JR and JL distances were significantly smaller in the Control group (p < 0.05). In Group 3, on the crossbite side, both the PMMR and the JR and JL distances were significantly higher than on the non-crossbite side (p < 0.05). A significant positive correlation was found between PMMR angles and JR and JL distances (p < 0.05). ConclusionIt was concluded that (i) mesiopalatal PMMRs are observed in the MTSDs with molar crossbite, (ii) molars with normal molar occlusal relationships have normal PMMR angles even in the presence of MTSDs, and (iii) early detection of MTSD enables timely interventions, preventing treatment delays and improving occlusal outcomes, particularly in developing patients, thereby optimizing long-term orthodontic results. Clinical relevanceConsidering the differences in PMMR angles between MTSD patients with and without molar crossbite, these findings should be taken into account when designing expansion appliances to achieve molar derotation in these patients.
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    Assessment of the Mandibular Osseous Architecture in Cleft Lip and Palate Using Fractal Dimension Analysis: A Pilot Study
    (Mdpi, 2024) Ozden, Samet; Cicek, Orhan
    Background/Objectives: Although there has been extensive research on the orofacial morphologic effects of cleft lip and palate (CLP), the effects of CLP on mandibular structures remain largely unknown. The aim of this study was to investigate the trabeculation differences in the mandibular osseous architecture of patients with bilateral CLP (BCLP) and left-sided unilateral CLP (UCLP) using fractal dimension (FD) analysis and to compare these findings with healthy controls without CLP. Methods: A total of 63 patients (27 females, 36 males) with a mean age of 9.69 +/- 1.5 years in the pre-peak growth stage were divided into three groups (n = 21 per group): the control group (CG), the BCLP group, and the UCLP group. The FD analysis was conducted on selected regions of interest (ROIs) from the mandibular condyle, angulus, corpus, and coronoid areas in TIFF-formatted panoramic radiographs. Statistical analyses were performed using the paired t-test and ANOVA for parametric data, and the Wilcoxon and Kruskal-Wallis tests for nonparametric data. Statistical significance was set at p < 0.05. Results: The FD values obtained from the ROIs of the right condyle were found to be significantly lower in the BCLP group compared to the CG and UCLP groups (p < 0.05). Conversely, the FD values for the left condyle were significantly higher in the CG group (p < 0.05), while no significant differences were observed between the BCLP and UCLP groups (p > 0.05). The FD value of the left condyle in the UCLP group was found to be significantly lower than that of the right condyle (p < 0.05). In the CG group, the FD values for both the right and left mandibular condyle and corpus were significantly higher than those for the angulus and coronoid regions; in the UCLP group, only the FD values of the right mandibular condyle and corpus were significantly higher than those for the same regions (p < 0.05). Conclusions: The reduced FD values in the mandibular condyle of CLP patients during the pre-peak growth stage suggest a loss of trabeculation and lower metabolic activity, while similarly, reduced FD values in the corpus region contribute to delayed tooth eruption timing, likely due to decreased masticatory forces during the intercuspal position and altered occlusal relationships. Clinical Relevance: In treating CLP patients, particularly with orthopedic face masks, the reduction in metabolic activities in these areas should be considered to achieve the optimal mandibular growth and development, and dental eruptions during the distribution of force from the chin to the corpus and condyle.
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    Distalization Methods for Maxillary Molars Utilizing Temporary Anchorage Devices (TADs): A Narrative Review
    (Mdpi, 2024) Oguz, Firat; Ozden, Samet; Cicek, Orhan
    Class II malocclusions, characterized by the mesial positioning of the maxillary molars relative to the mandibular molars, are among the most frequently encountered orthodontic issues. One of the widely adopted non-extraction approaches for addressing this malocclusion is maxillary molar distalization, which has been utilized for decades to create space within the dental arch. Historically, extraoral appliances such as headgear were commonly employed. However, with technological advancements, intraoral distalization devices, particularly those incorporating temporary anchorage devices (TADs), have gained prominence due to their compact size, not being visible externally, and improved patient acceptance. These appliances offer significant advantages, including being less invasive compared with extraction-based camouflage treatments, being more readily accepted by patients due to the absence of extraction spaces, and not requiring the complex biomechanical principles involved in extraction-based methods. TADs have revolutionized distalization techniques by providing superior anchorage control, reducing treatment duration, and offering a straightforward, patient-friendly application. The purpose of this comprehensive narrative review is to focus specifically on intraoral distalization techniques utilizing TADs, summarizing their efficacy and outcomes in the management of Class II malocclusions as reported in clinical studies over the past three decades.
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    Relationship between maxillary sinus volume and alveolar trabeculation at orthodontic mini-implant sites across vertical skeletal patterns: a cross-sectional CBCT analysis
    (Bmc, 2025) Ozden, Samet; Cicek, Orhan; Sobi, Elif
    Background This study aimed to evaluate the relationship between maxillary sinus volume (MSV) and alveolar bone trabeculation using fractal dimension (FD) analysis across different vertical skeletal patterns, and to assess its potential implications for orthodontic mini-implant (OMI) stability. Methods CBCT images of 84 skeletal Class I individuals (47 females, 37 males; mean age 20.08 +/- 2.25 years) were analyzed and categorized into three vertical skeletal groups (28 normodivergent, 28 hyperdivergent, 28 hypodivergent). MSVs were measured bilaterally using 3D Slicer, and FD analyses were conducted on alveolar bone regions of interest (ROIs) located between the roots of teeth #14-15, #15-16, #16-17, and #24-25, #25-26, #26-27. MSV and FD values were analyzed within and between groups using one-way ANOVA, Kruskal-Wallis test, paired t-tests, Wilcoxon signed-rank tests, and Spearman's correlation test at a significance level of p < 0.05. The effects on OMI stability were then evaluated. Results Both right and left MSVs, as well as FD values in the ROIs between teeth #14-15, #15-16, #24-25, and #25-26, were found to be significantly higher in hypodivergent individuals. The posterior increase in FD values was significant only in the normodivergent group. In hypodivergent individuals, right MSVs were significantly correlated with FD values at the 14-15 ROI, and left MSVs with those at the 24-25 ROI, while no such correlation was found in other vertical patterns. Conclusions In hypodivergent individuals, increased trabecular complexity between the maxillary second premolar and first molar may enhance OMI stability; however, the MSV, which correlates significantly with FD values in this region, necessitates caution due to the potential risk of sinus perforation during insertion.