Accurate evaluation of facial proportions and soft tissue relationships is fundamental to orthodontic diagnosis and treatment planning. Although cephalometric analysis remains a standard diagnostic aid, it is primarily dependent on radiographic evaluation. With increasing emphasis on soft tissue esthetics and clinical facial analysis, the need for a simple, chairside, and noninvasive method for direct assessment of facial linear and angular parameters continues to exist. A structured clinical approach capable of translating cephalometric concepts into extraoral soft tissue measurements may enhance routine facial analysis, improve diagnostic applicability, and serve as a useful adjunct in orthodontic evaluation. Z-CLAM (Zadakes’s Clinical, Linear and Angular Measurement Analog for Facial Analysis) is a novel chairside clinical diagnostic analog designed for extraoral assessment of facial linear and angular parameters using standardized soft tissue landmarks. The system facilitates clinical evaluation of facial thirds, facial fifths, nasolabial angle, mentolabial angle, and mandibular plane inclination, along with other cephalometric measurements relevant to orthodontic diagnosis. Z-CLAM provides a structured clinical framework for facial analysis with potential comparison to corresponding cephalometric parameters.
Background Growing skeletal Class III malocclusion with facial asymmetry presents a significant orthodontic challenge, particularly when orthognathic surgery is declined. Case Report A 13-year-old girl with growing skeletal Class III malocclusion and functional facial asymmetry was treated in two phases. Phase 1 consisted of a removable posterior bite plane, rapid maxillary expansion, sequential bite plane reduction, and intermaxillary Class III elastics. Phase 2 comprised comprehensive fixed appliance treatment to refine the occlusion. Treatment was completed in 34 months. Results A positive overjet, Class I canine and molar relationships, improved facial symmetry, and a more balanced facial profile were achieved. The treatment results remained stable after two years of retention. Conclusion Two-phase orthodontic treatment using a tooth-borne appliance and intermaxillary Class III elastics may provide a nonsurgical treatment option for selected growing Class III patients with functional facial asymmetry.
Clear aligner therapy requires complete tray seating, effective engagement of attachments, and good patient compliance. Commercial aligner seating and removal aids are often expensive, less accessible, or prone to distortion, while the use of fingernails or sharp objects can damage the aligner and injure the gingiva. This article describes the fabrication and clinical application of a simple, multifunctional orthodontic safety tool made from 19-gauge stainless steel wire with helices, reverse S- and Z-loops, and angulated triangular hooks that permit locking and unlocking. The single or locked double hooks facilitate aligner removal from both arches and aid in intra- and inter-arch elastic placement, while the flexible helices assist in aligner seating through the biting forces. The tool is easy to fabricate, sterilizable, reusable, economical, and safe for soft tissues, and it minimizes aligner distortion. This multifunctional safety tool improves patient convenience and clinical efficiency during clear aligner therapy and can serve as a cost-effective alternative to commercially available aligner accessories.
The integration of three-dimensional (3D) printing technology has profoundly transformed contemporary orthodontic practice by enabling highly customized, precise, and efficient digital workflows. This review aims to provide a comprehensive overview of the evolution, principles, clinical applications, and future prospects of 3D printing in orthodontics. The transition from conventional plaster models and laboratory-dependent procedures to digital intraoral scanning, computer-aided design and manufacturing (CAD–CAM), and additive manufacturing has enhanced diagnostic accuracy, treatment predictability, and patient comfort while reducing chairside time and laboratory turnaround. Various 3D printing technologies, including stereolithography, fused deposition modelling, digital light processing, selective laser sintering, and PolyJet printing, are discussed with respect to their orthodontic applications, advantages, and limitations. Current clinical uses encompass printed study models, aligners, customized brackets, archwires, functional and expansion appliances, surgical splints, fixation plates, and presurgical nasoalveolar molding devices. Recent advances such as compliance-monitoring appliances, integration of artificial intelligence, and emerging concepts of 4D printing further highlight the expanding scope of this technology. Despite challenges related to material properties, cost, regulatory approval, and long-term clinical validation, 3D printing represents a paradigm shift toward fully digital, patient-specific orthodontic care.
Introduction Clear aligners are promoted as more esthetic and comfortable than fixed appliances, but how Indian parents choose between them is not well understood. Methods A cross-sectional mixed-methods study in two digital smile practices in Mumbai (Chembur, Lokhandwala) was conducted. Parents of 8-17-year-olds attending their first orthodontic consultation completed a questionnaire on sociodemographics, malocclusion, awareness and information sources, risk perceptions about at-home aligners, willingness-to-pay (WTP), equated monthly installment (EMI) acceptance, psychosocial concerns, and final treatment choice (clear aligners vs. fixed braces). Results A convergent mixed-methods design was used. Quantitative data were obtained from routine clinical records and structured questionnaires from 480 parent–child pairs treated at two urban orthodontic centers in Mumbai, India (January 2018-December 2025). The qualitative component comprised semi-structured interviews with 10 purposively sampled parents. Conclusions In urban India, parental treatment decisions for adolescent orthodontic care are shaped by a combination of esthetics, perceived effectiveness, comfort, and affordability. Transparent, evidence-based counseling and flexible payment options may help bridge the preference–uptake gap for clear aligners among urban Indian parents. Clinical Significance Transparent discussion of clinical indications, expected compliance demands, and structured EMI counseling may help align treatment decisions with both esthetic preferences and affordability.
Background Accurate assessment of root length, tip, and torque is essential for orthodontic diagnosis and treatment planning. Cone-beam computed tomography (CBCT) provides reliable three-dimensional visualization of tooth roots but is associated with radiation exposure. Recently, artificial intelligence (AI)-supported planning software has enabled virtual root reconstruction using intraoral scan data; however, the accuracy of such reconstructions compared with CBCT remains uncertain. Objectives To compare root length, tip, and torque measurements obtained from CBCT with those generated by AI-supported planning software (Maestro 3D) using intraoral scan data. Methods This cross-sectional observational study included 21 patients with existing pre-treatment CBCT records. Intraoral scanning was performed prior to orthodontic treatment. The maxillary left central incisor was selected as the reference tooth. CBCT Digital Imaging and Communications in Medicine (DICOM) data were segmented using 3D Slicer to generate STL files. Intraoral STL files were imported into Maestro 3D, where AI-based root reconstruction was performed. Root length, tip, and torque measurements were recorded and compared using paired samples t -tests and Bland–Altman analysis. Results CBCT-derived root length measurements were significantly greater than AI-generated measurements (mean difference = 5.01 mm; P < .001). The AI-supported software consistently produced a fixed root length value of approximately 12 mm with no variation, indicating a limitation of the algorithm and suggesting reliance on standardized templates rather than individualized root morphology. Tip measurements also showed a statistically significant difference between the two methods (mean difference = −0.85°; P < .001). Torque measurements demonstrated a small but statistically significant difference between CBCT and AI-generated models (mean difference = 0.67°; P = .045). Conclusion AI-supported planning software underestimated root length and slightly overestimated tip compared with CBCT, while torque measurements were comparable. CBCT remains the reference standard for root length assessment, whereas AI-based intraoral scan analysis may be clinically acceptable for torque evaluation.
Objectives To compare and assess hearing capacity between children with maxillary constriction and those with normal maxillary width. To evaluate the correlation between arch width and hearing capacity. Materials and Methods In this cross‑sectional study, 70 orthodontic patients in the late mixed dentition stage were divided into two groups. The experimental group ( n = 35) included individuals with maxillary constriction, defined by an interpalatal molar width (IPMW) smaller than 34.92 mm and an IPMW-to-intercanine width (ICW) ratio around 1.15-1. The control group ( n = 35) had normal maxillary dimensions and well‑aligned arches with no crowding or spacing, and with IPMW greater than 37.45 mm and an IPMW-to-ICW ratio near 1:1 ± 0.05. Maxillary arch width was measured on dental casts using a vernier caliper, and hearing thresholds were assessed using pure-tone audiometry in a sound-isolated chamber, and pure-tone air conduction averages were taken. Statistical tests were analyzed using unpaired t -tests and Pearson’s correlation. Results The experimental group showed significantly higher mean hearing thresholds (~28 dB) bilaterally compared to controls (~15 dB) ( P < .0001). A strong negative correlation was observed between maxillary arch width and hearing threshold in the constricted group ( r ≈ −0.49 left, r ≈ −0.44 right), indicating that narrower arches were associated with poorer hearing. No significant correlation was found in the control group. Conclusions Children with a constricted maxillary arch width demonstrated mild but significant bilateral conductive hearing loss. The findings support a strong relationship between transverse maxillary deficiency and auditory function, emphasizing the importance of interdisciplinary evaluation in orthodontic patients.
The Twin Block appliance is one of the most preferred functional appliances for the treatment of skeletal Class II malocclusion in growing children. Conventionally, the inclines of the Twin Block appliance are kept at a 70° angle, based on the angle between the hinge axis of opening, which is approximately 70° to the occlusal plane. But this angle is not constant for each individual and can vary based on individual cuspal inclines and condylar morphology. The present article describes a simple visual method for individualized Twin Block angulation based on the individual’s own cuspal inclines.
Introduction Torque control of maxillary incisors is essential for esthetics and stability. In clear aligner therapy, torque expression is often unpredictable due to material and design limitations. Finite element method (FEM) analysis offers insights into optimizing aligner biomechanics. Objectives To evaluate the torque mechanics of maxillary incisors during anterior retraction with aligners alone and in combination with auxiliaries, including skeletal anchorage. Methods A cone beam computed tomography-derived finite element model of the maxilla and dentition was constructed. Five configurations were simulated: D1—aligner only, D2—aligner with ellipsoid attachment, D3—aligner with power ridge, D4—aligner with labial elastic from a mini-implant, and D5—aligner with linguoincisal elastic from a mini-implant. A 100 g bilateral retraction force was applied. Crown and root displacement of maxillary incisors and von Mises stress distribution in cortical and cancellous bone were analyzed. Results D1 exhibited uncontrolled tipping with a crown-to-root ratio of 411.11. D2 improved displacement (ratio 3.57), while D3 showed limited root control (ratio 214.81). D4 demonstrated a favorable root-dominant translation pattern (ratio 0.20) with maximum root displacement and highest but physiologically acceptable stress values. D5 also achieved favorable torque control (ratio 0.31) with slightly lower stress compared to D4. Conclusions Within the limitations of a single-anatomy proof-of-concept FEM model, the study shows that clear aligners alone are insufficient for effective torque expression. The addition of skeletal anchorage with elastics significantly enhances root control, with labial mini-implant-supported mechanics providing the most favorable outcomes. This hybrid approach expands the biomechanical efficacy of aligners in complex cases.
Background Impacted maxillary canines are among the most frequent eruption disturbances encountered in orthodontic practice and are often associated with other developmental dental anomalies. Their prevalence and eruption patterns vary according to malocclusion type, influencing diagnosis, treatment complexity, and prognosis. Aim To evaluate the frequency, distribution, and positional characteristics of impacted maxillary canines and associated anomalies across different sagittal malocclusion groups in young adults from Western Bihar. Materials and Methods A cross-sectional study was conducted using pretreatment records of 1,000 patients retrieved from the archives of the Patna Dental College and Hospital. Based on sagittal malocclusion (ANB angle), patients were categorized into Class I ( n = 500), Class II ( n = 326), and Class III ( n = 174) malocclusion groups. Impacted maxillary canines and associated anomalies—including transmigration, transposition, and agenesis—were evaluated. Statistical analysis was performed using Statistical Package for the Social Sciences version 25.0, with chi-square and analysis of variance tests applied. A P value <.05 was considered statistically significant. Results A total of 332 patients exhibited impacted maxillary canines (frequency: 33.2% within the orthodontic cohort). While Class I contributed the highest proportion of cases (40%), the highest within-group frequency was observed in Class III malocclusion (47.7%), followed by Class II (35.6%) and Class I (26.6%) ( P < .05). Labial impactions predominated in Class III (75.9%), whereas palatal impactions were more frequent in Class I. Associated anomalies were significantly higher in Class III malocclusion. Conclusion The frequency and positional pattern of impacted maxillary canines vary significantly across the malocclusion types studied. Class III malocclusion demonstrates the highest relative risk within the group. Early screening is essential for timely diagnosis and individualized orthodontic intervention, potentially reducing treatment complexity and associated complications.
Background Obstructive sleep apnea (OSA) is a condition in which the upper airway narrows or closes repeatedly during sleep, interrupting normal breathing. To evaluate its trends and advancements, a bibliometric study examining the 50 most frequently referenced articles in dentistry published between 2002 and 2022 was conducted. Methods The Scopus online database was searched for relevant literature on OSA published in the last two decades. VOSviewer software was used for data analyzes, science mapping, and network analysis. A country-based correlation analysis and keywords based on bibliographic data were used to create a co-occurrence network. Results The top 50 most highly cited articles appeared across 17 separate journals, comprising 39 original research articles (78%) and 11 reviews (22%). The top three cited journals were the European Journal of Orthodontics (EJO), Journal of Oral and Maxillofacial Surgery (JOMS), and American Journal of Orthodontics and Dentofacial Orthopedics (AJODO). The bibliometric analysis revealed that the top 50 articles were authored by individuals from 20 different countries, with the USA contributing the greatest number of publications and receiving the highest citation count. Conclusions The 50 most-cited articles primarily focused on the diagnosis and management of OSA, with the highest citations from the EJO, JOMS, and AJODO. Practical Implications This research emphasizes the importance of diagnostic techniques, such as 3D airway imaging and sleep studies (polysomnography), for detecting associated morphological and physiological variations. Orthodontics, oral and maxillofacial surgery, and dental sleep medicine are all addressed in the most-referenced studies, highlighting the impact of craniofacial structures on airway patency and the need for individualized diagnostic and interdisciplinary treatment approaches.
Background Orthodontic force application induces an inflammatory response in periodontal tissues, resulting in bone remodeling. Gingival crevicular fluid (GCF) provides a non-invasive medium to evaluate these biological changes. With the increasing use of clear aligner therapy, it is clinically relevant to compare its biological effects with those of fixed orthodontic appliances. Aim To systematically review and compare biomarker levels in GCF among patients treated with clear aligners and fixed orthodontic appliances. Materials and Methods Electronic searches were conducted in PubMed, Cochrane Central, Web of Science, Scopus, LILACS, and Google Scholar from January 1, 2000, to June 30, 2025. Clinical studies evaluating GCF biomarkers during active orthodontic treatment with clear aligners or fixed appliances were included. Risk of bias was assessed using the Cochrane RoB tool and ROBINS-I. Meta-analysis was performed using a random-effects model. Results Ten studies (six randomized controlled trials, two non-randomized trials, and two observational studies) involving 380 participants were included. Clear aligner therapy was associated with higher levels of interleukin-2, interleukin-6 (IL-6), and interleukin-8, while fixed appliances demonstrated elevated tumor necrosis factor-alpha and IL-6 levels. Meta-analysis of IL-1β levels revealed no statistically significant difference between the two groups (SMD = 1.11; 95% CI = −2.54 to 4.77; P = .55). Substantial heterogeneity was observed ( I 2 = 98%). Conclusion Both clear aligners and fixed orthodontic appliances elicit inflammatory responses during active treatment, reflected by increased GCF biomarker levels. While cytokine expression patterns differ between modalities, current evidence does not establish a clear association with the rate of tooth movement. Due to the high heterogeneity, the findings should be interpreted cautiously, and further standardized longitudinal studies are required.
Background Orthodontic bonding materials are required to provide adequate adhesion throughout treatment while also permitting safe debonding upon completion. Recently, the incorporation of nanoparticles into composite resins has gained attention due to their antimicrobial properties and their potential to reduce enamel decalcification around orthodontic brackets. However, such modifications may influence the mechanical and physical characteristics of adhesives, particularly the shear bond strength. Limited evidence is available regarding the effect of zinc oxide nanoparticles on the bond strength of orthodontic brackets. Aim This study aimed to evaluate and compare the shear bond strength of orthodontic brackets bonded using an adhesive containing zinc oxide nanoparticles with that of a conventional orthodontic adhesive. Materials and Methods A total of 32 extracted human premolars with intact structure were selected for this in vitro investigation and randomly assigned into two equal groups ( n = 16). Stainless steel brackets (McLaughlin–Bennett–Trevisi (MBT) 0.022″ × 0.028″) were bonded to the buccal surfaces using two different adhesive systems: one incorporated with 1% zinc oxide nanoparticles and the other without nanoparticle addition, serving as the control. After 24 h, shear bond strength was measured using a universal testing machine (UTM). The collected data were statistically analyzed using IBM Statistical Package for Social Sciences version 24, and an independent t -test was applied to determine the significance of differences between groups. Results A statistically significant difference in shear bond strength was observed between the two groups. The experimental group demonstrated a mean value of 2.8 MPa, whereas the control group showed a considerably higher mean value of 16.28 MPa. Conclusion The addition of zinc oxide nanoparticles to orthodontic adhesives has a significant impact on shear bond strength, which may restrict its effectiveness for clinical use.
Objective This study aimed to assess the infrazygomatic crest (IZC) bone thickness and insertion heights at varying insertion angles in patients with different vertical facial growth patterns using cone beam computed tomography (CBCT). Materials and Methods The study included 48 healthy Maharashtrian Indian subjects (24 males, 24 females; aged 20-30 years) with no history of previous orthodontic treatment. Subjects were classified into three groups—hypodivergent, normodivergent, and hyperdivergent based on cephalometric parameters (Sella–Nasion to mandibular plane angle, overbite depth indicator, Jarabak’s ratio). CBCT imaging (Carestream CS 9300) was used to assess IZC bone thickness and insertion heights at insertion angles from 40° to 80°. The measurements were taken bilaterally, and data were analyzed for group-wise, gender-wise, and side-wise differences using analysis of variance and Scheffé’s post hoc test. Results Bone thickness increased progressively with an increase in insertion angles across all the groups. Hypodivergent subjects exhibited the highest bone thickness, followed by normodivergent, with hyperdivergent showing the least. Males and the left side measurements showed higher bone thickness generally. Insertion heights decreased with increasing angles across all the groups, with hyperdivergent subjects having the highest heights. No consistent gender- or side-based variations in insertion heights were observed. Conclusions IZC bone morphology varies significantly with vertical facial growth patterns. Hypodivergent individuals exhibited greater cortical bone thickness, whereas hyperdivergent individuals demonstrated greater insertion heights. Bone thickness increased, and insertion height decreased with increasing insertion angulation.
Introduction Smile esthetics play a vital role in orthodontic treatment outcomes. Different treatment mechanics can influence mini-esthetic and micro-esthetic smile parameters differently. Aim To evaluate the mini-esthetic and micro-esthetic components of the smile in extraction and non-extraction treatment cases. Materials and Methods The study was conducted on 50 orthodontically treated patients, which were divided into two groups: Group I (25 extraction) and Group II (25 non-extraction). Pre- and post-treatment frontal smile photographs were analyzed using Adobe Photoshop CC 2023. Mini-esthetic parameters assessed were maxillary incisor display (MID), gingival display (GD), smile index (SI), and buccal corridor ratio (BCR), while micro-esthetic parameters included crown width–height ratio (WHR), golden percentage (GP), connector height (CH), and gingival zenith level (GZL). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 18. Student’s t -test was used for intragroup comparisons, while intergroup comparison of change scores was performed descriptively. Results Both extraction and non-extraction groups demonstrated significant intragroup improvements in several esthetic parameters. Extraction cases showed a reduction in MID and BCR, while non-extraction cases demonstrated an increase in incisor display and CH. GP improved in both groups. Intergroup comparison of change scores revealed comparable esthetic outcomes between the two treatment modalities. Conclusion Both treatment modalities demonstrated improvement in smile esthetic parameters, though the pattern of changes differed between the groups. Extraction cases showed an enhanced width and height ratio and reduced buccal corridors, whereas non-extraction cases showed improved incisor display and CH. GP improved in both groups, highlighting the importance of individualized treatment planning for optimal esthetic results.
Objective To evaluate the inclination of incisors after retraction with double wire using double-slot brackets (DSC) versus single wire using single-slot brackets. Materials and Methods Twenty-four patients aged 18 ± 5 years with maxillary anterior proclination requiring extraction of upper first premolars were randomly divided into two groups equally. Group I utilized double wires for retraction in DSCs, whereas Group II received a single wire retraction protocol in single-slot brackets. Pre- and post-retraction cone beam computed tomography scans were compared to assess the changes in inclination, vertical position, anchorage loss, and root resorption between the groups. An independent t -test was done for inter-group comparison, and a paired t -test was done to determine significant changes within the groups. Results Group I revealed a significant reduction in labiolingual inclination by 5.59° ± 6.56°, whereas Group II showed a reduction by 8.02 ± 6.53. The central incisors in Group I showed a vertical change of −1.13 ± 1.34 mm, whereas in Group II, significant vertical changes were limited to the lateral incisors at −1.79 ± 1.35 mm. Inter-group comparisons revealed no significant differences ( P >.05) with respect to torque, anchorage loss, and root resorption. Conclusion The changes in the double-slot group post-retraction were comparable to those in the single-slot group, with no significant statistical difference.
Aim and Objectives The study aimed to evaluate the antibacterial efficacy of titanium dioxide (TiO 2 ) nanoparticle-coated stainless-steel orthodontic brackets and to assess cytological changes in the adjacent oral mucosa. The goal was to determine if TiO 2 coatings reduce bacterial colonization and biofilm formation while ensuring biocompatibility with surrounding tissues. Materials and Methods This split-mouth randomized controlled trial was conducted on a sample of 30 patients who needed orthodontic treatment, aged between 16 and 30 years. TiO 2 -coated brackets were bonded on one maxillary quadrant, and non-coated brackets on the opposite side, with sides alternated to avoid bias. Brackets were coated using a dip-coating method followed by the process of annealing. Plaque samples were collected at 30 and 60 days post-bonding and cultured on blood agar for bacterial quantification. Microscopic analysis was performed using oil immersion field counts. Buccal mucosa samples were collected before bonding (T0) and at 30 days (T1), in order to assess cytological changes via exfoliative cytology using Giemsa staining. Results The TiO 2 -coated bracket group showed a slight but significant increase in bacterial culture grading from 1 (interquartile range [IQR]: 0-1) at T1 to 1 (IQR: 1-1) at T2, whereas the non-coated group increased from 2 (IQR: 2-3) to 3 (IQR: 2-3). TiO 2 -coated brackets consistently demonstrated significantly lower bacterial culture gradings than non-coated brackets at both T1 and T2 ( P < .0001). Bacterial cell counts remained stable over time within groups, but were significantly lower in the TiO 2 -coated group [2 (IQR: 1-2) at T1; 2 (IQR: 1.25-2) at T2] compared to the non-coated group [3 (IQR: 3-4) at both time points] ( P < .0001). Cytological analysis revealed no significant increase in polymorphonuclear leukocytes or evidence of inflammation, degeneration, or malignancy in the TiO 2 group, supporting its biocompatibility. Conclusion TiO 2 nanoparticle coatings on stainless-steel orthodontic brackets have been shown to markedly reduce bacterial colonization and inhibit biofilm formation. Importantly, these coatings preserve the cytological integrity of the surrounding oral mucosa, indicating their biocompatibility. By limiting microbial accumulation, TiO 2 -coated brackets may contribute to improved oral hygiene during orthodontic therapy. This preventive effect has the potential to reduce common complications such as white spot lesions and gingivitis. However, further long-term clinical studies are necessary to validate these promising outcomes throughout the entire course of orthodontic treatment.
