OBJECTIVE:The study evaluates the impact of thickness and trimming geometry on the magnitude and distribution of transverse forces applied by thermoformed plastic aligners during maxillary arch expansion. METHODS:A randomised experiment evaluated 60 aligners fabricated from PET-G in two distinct thicknesses (0.03 and 0.040 in.) and three different trimming geometries (G1-scalloped margins, G2-straight margins with 5 mm width and G3-straight margins with 10 mm extension). Transverse forces in the canine (C), first premolar (FP), second premolar (SP), first molar (FM), second molar (SM) and third molar (TM) were measured in newtons (N). Three measurement repetitions (original data plus two replicates) were implemented to generate sufficient degrees of freedom for the sum of squares of the error. RESULTS:The maximum transverse force in the canine region was exerted by the PET-G aligner with a thickness of 0.040 in., with no significant difference observed between the G2 and G3 straight trim lines. However, the G1 scalloped trim line exerted significantly lower transverse forces. The G3 geometry with a 0.040-in. Polymer thickness consistently generated the highest forces in the premolar and molar regions. The average transverse forces decreased in an antero-posterior direction, with the highest force observed in the canine region and the least in the molar region. CONCLUSIONS:The thickness and trimming pattern of orthodontic aligners significantly influence force delivery during transverse expansion. Transverse forces during expansion with aligners progressively reduce from the anterior to the posterior region.
To summarise the scientific evidence from systematic reviews on the differences between fixed functional appliances (FFA) with and without skeletal anchorage for the treatment of Class II malocclusion in growing patients. A systematic search on six major databases was performed. Primary outcomes were changes in Co-Gn, SNB angle and the lower incisor inclination. ROBIS tool to assess risk of bias and GRADE instrument to assess evidence quality were used. Mean differences (MD) or risk ratios (RR) with their 95% confidence intervals were calculated from random-effects meta-analyses. A total of 10 systematic reviews were identified, six at high risk of bias, three at unclear risk of bias and one at low risk of bias. The meta-analysis with only RCTs studies indicated that FFA with skeletal anchorage did not produce a statistically significant increase in Co-Gn (pooled MD = +1.37 mm, 95% CI from -0.88 to 3.62; p = 0.23, I2 = 96%, three studies, GRADE low). No statistically significant differences were identified for SNB angle between FFA with and without skeletal anchorage (pooled MD = +0.31 degrees, 95% CI from -0.03 to 0.66; p = 0.08, I2 = 51%, three studies, GRADE low). FFA with skeletal anchorage showed a statistically greater decrease for lower incisor inclination (pooled MD = -5.03, 95% CI from -8.49 to -1.58; p = 0.004, I2 = 89%, four studies, GRADE low). Low evidence of findings from exclusively RCTs studies suggested that FFA with skeletal anchorage could reduce the lower incisor inclination with a greater percentage of complications. However, no significant differences were found for mandibular dimensions and mandibular protrusion between FFA with and without skeletal anchorage.
OBJECTIVE:To investigate postsurgical rotational flare between the proximal and distal segments of the mandible following mandibular setback surgery using three-dimensional analysis. MATERIALS AND METHODS:Cone-beam computed tomography scans from 30 patients who underwent bilateral sagittal split ramus osteotomy were analysed. To minimise the influence of bone remodelling, the proximal segment (PS) at T1 (post-surgery) was superimposed onto the T2 (post-treatment) PS using stable reference areas, excluding the osteotomy sites, condyle, and gonial angle, to generate a modified T2 model. The T1 and modified T2 were then superimposed on the distal segment (DS), which served as the reference. Displacements of the medial and lateral condylar poles, coronion, and gonion were measured with respect to the DS. RESULTS:When assessed using the DS as reference, the medial pole, lateral pole, and coronion showed significant posterior displacements (1.21, 1.57, and 1.24 mm; p < 0.001). Coronion also moved superiorly (0.74 mm, p < 0.001) and laterally (0.43 mm, p = 0.004), while gonion moved medially (0.65 mm, p < 0.001) without significant anteroposterior change (p = 0.468). No significant correlation was found with setback amount, vertical bony step, or its resolution. CONCLUSION:The PS exhibited counterclockwise rotational flare and anterior-outward/posterior-inward yawing in relation to the DS. Incorporating surgical compensation for anticipated rotational flare-related relapse may enhance the predictability of mandibular setback outcomes.
To compare the extent of root resorption, assessed via three-dimensional (3D) volumetric CBCT analysis, between tooth-borne and bone-borne rapid maxillary expansion (RME) devices. A systematic search of seven databases (PubMed, Cochrane Library, Embase, etc.) up to December 2024 identified eligible studies (randomised controlled trials, cohort studies, clinical trials) evaluating CBCT-measured root resorption in patients treated with tooth-borne, bone-borne or hybrid RME devices. Data were analysed using STATA 17.0, employing weighted mean differences (WMDs) and random/fixed-effects models. Heterogeneity, subgroup analyses and publication bias were assessed. Sixteen studies (525 patients, 2906 teeth) were included. These studies comprised randomised controlled trials and observational studies, predominantly enrolled adolescent and young adult patients, and directly compared tooth-borne and bone-borne RME devices. Tooth-borne RME resulted in significantly greater root resorption volume compared to bone-borne devices (WMD = -10.4 mm3, 95% CI [-13.9, -6.9], 95% prediction interval [-11.94, -8.92], p < 0.05; I2 = 98.8%). Tooth-borne RME also caused greater root length loss (WMD = -0.14 mm, 95% CI [-0.21, -0.08], 95% prediction interval [-0.20, -0.08], p < 0.05; I2 = 95.6%). Tooth-borne RME resulted in significantly greater root resorption volume (WMD = -20.7 mm3) and length (WMD = -0.40 mm) compared to baseline, indicating increased resorption. Three-dimensional CBCT analysis demonstrated superior sensitivity in detecting resorption morphology and localization compared to linear measurements. Bone-borne RME devices, which are associated with reduced root resorption risks, may be related to improved force distribution to bony structures. Three-dimensional volumetric CBCT assessment provides a more accurate quantification than linear measurements. Clinically, bone-borne expanders are recommended for high-risk patients, while tooth-borne users require close CBCT monitoring. Findings should be interpreted considering limitations of the included evidence, including heterogeneity in RME devices and protocols, risk of bias in some non-randomised studies, and imprecision due to limited sample sizes in subgroup analyses and lack of long-term data. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD420251018535.
OBJECTIVES:This study aims to investigate the effects of low-level laser therapies (LLLTs) with four different wavelengths (532, 650, 810 and 940 nm) on new bone regeneration during inter-premaxillary suture expansion in rats. MATERIALS AND METHODS:Sixty rats were divided into five groups (n = 12): control (Group A) and four laser groups (Group B: 940 nm, Group C: 810 nm, Group D: 650 nm and Group E: 532 nm). Each group was further divided into two subgroups (n = 6) based on the sacrifice day: Day 7 and Day 14. The upper incisors of the rats were drilled, and a 30-g force expansion appliance was inserted. The study lasted 14 days, with 7 days of expansion and 7 days of retention. LLLT was administered at 48-h intervals in groups other than the control group. Bone regeneration in the suture was assessed using micro-computed tomography and immunohistochemistry. Trabecular number (Tb.N), trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp) were measured by using micro-computed tomography. Alkaline phosphatase (ALP), bone morphogenetic protein 2 (BMP-2) and tartrate-resistant acid phosphatase (TRAP) immunoreactivity intensities were calculated in the immunohistochemically stained upper jaw sections. RESULTS:In Group B (940 nm), ALP was significantly higher on the 7th day (p < 0.001); ALP and BMP-2 were significantly higher (p = 0.002; p = 0.013, respectively), and Tb.Sp was significantly lower on the 14th day (p = 0.034) compared with the control group. CONCLUSIONS:The results show that 940 nm low-level laser therapy accelerates bone regeneration more effectively in the expanded inter-premaxillary suture.
OBJECTIVE:Mandibular retrognathism (MR) is a skeletal malocclusion in which patients have a deficient mandibular length, resulting in a more posterior position of the mandible. We aimed to investigate the association between Single nucleotide polymorphisms (SNPs) in Fibroblast Growth Factor Receptor 2 (FGFR2) gene and MR in germans. MATERIALS AND METHODS:Genomic DNA and lateral cephalometric radiographs were obtained from orthodontic patients. Patients were allocated into the 'Retruded' group (SNB angle < 78°) and into the 'Well-positioned' group (SNB 78°-82°). The rs4752566, rs10736303, rs11200014, rs1078806, rs1219648, rs2981578 and rs2162540 SNPs were genotyped using real-time PCR. Allele, genotype and haplotype frequencies were compared (α = 5%). RESULTS:A total of 142 patients were included, 93 (65.5%) allocated into the 'Retruded' group and 49 (34.5%) into the 'Well-positioned' group. The allele T in rs2981578 SNP was statistically more frequent in the 'Retruded' group in both univariate (PR = 1.22; 95% CI, = 1.02-1.47) and multivariate (PR = 1.55; 95% CI, = 1.07-2.25) analyses (p < 0.05). The CT + TT genotypes were statistically more frequent in the 'Retruded' group in univariate (PR = 1.58; 95% CI, = 1.03-2.41) and multivariate (PR = 1.59; 95% CI, = 1.11-2.26) analysis (p < 0.05). All studied SNPs were associated with MR establishment in haplotype analysis (p < 0.05). CONCLUSION:SNPs in the FGFR2 are associated with MR and have the potential to serve as genetic biomarkers to early diagnosis and prediction of mandible growth.
OBJECTIVES:To evaluate the influence of anterior bite turbos (ABT) on pulpal blood flow (PBF) changes in maxillary central incisors using Laser-Doppler Flowmetry (LDF). MATERIALS AND METHODS:Sixty-one patients with deep overbite were divided into two groups. Group I received 0.014 nickel titanium (NiTi) arch wire and composite ABT on the upper central incisors to correct the deep overbite; the second group (control group) received 0.014 NiTi arch wire only. LDF was used to measure the PBF at different time points (at baseline, 20 min, 48 h, 1 week, and 1 month after activation). The baseline PBF (without orthodontic force) was compared to the corresponding PBF measurements at the designated time intervals within each group. Changes in PBF between the two groups were compared to assess the impact of ABT on pulpal circulation. RESULTS:Complete data were obtained for 55 patients. PBF decreased significantly after force application in both groups and reached its maximum drop after 48 h. After 30 days, the average PBF values returned to baseline values in Group II but remained slightly less than basal values in Group I (0.4 mm/s). No statistically significant difference in PBF changes between the two groups at any time point. The overall change from 20 min to 48 h was greater in the bite turbo group than in the control group; however, this difference was not statistically significant (p = 0.078). CONCLUSIONS:Using ABT does not cause irreversible changes to pulpal vasculature.
OBJECTIVES:To compare skeletal, dentoalveolar, and dental changes following maxillary skeletal expansion using expanders of two different designs. MATERIALS AND METHODS:This was a 2-arm parallel trial with 28 patients randomly assigned by an independent data monitor to two groups namely Maxillary Skeletal Expander with 4 miniscrews (MSE) and Favex expander with 6 miniscrews (FAVEX), using block randomisation in a 1:1 allocation ratio. Eligibility criteria included transverse skeletal deficiency, incomplete midpalatal suture ossification and presence of upper posterior teeth. Primary outcomes were the skeletal changes (Nasal Width-NW, Maxillary Width-MW, sutural expansion-SEM). Dentoalveolar and dental changes formed secondary outcomes. A total of 33 skeletal, dentoalveolar, and dental parameters were evaluated using cone beam computed tomography (CBCT). Analysis was done using paired t-test to evaluate the intragroup changes and independent t-test to compare difference between the groups. RESULTS:Successful skeletal expansion was obtained in both groups. MSE demonstrated significantly higher changes in NW, MW, SEM, Buccal Maxillary Width (BMW) and Palatal Maxillary Width (PMW) (p < 0.05). Buccal inclination of posteriors was significantly higher in the FAVEX group (p < 0.05). CONCLUSION:Successful transverse expansion of the maxilla was obtained with both groups. Both primary (NW, MW, SEM) and secondary (BMW, PMW) outcomes were better in the MSE group. TRIAL REGISTRATION:The trial was registered at Clinical trials Registry (CTRI/2024/10/075097).
INTRODUCTION:Osteocytes express numerous G protein-coupled receptors (GPCRs) and mice lacking the stimulatory subunit of G-protein (Gsα) in osteocytes (DMP1-GsαKO mice) have severe osteopenia. We previously demonstrated that the severe osteopenia in these mice was mediated by increased sclerostin expression, which suppresses osteoblast functions. In this study we analyse both the craniofacial and tooth characteristics of these mutant mice. METHODS:A total of 28, 6-8-week-old mice were used (Gsα fl/fl or Control, DMP1-Cre;Gsα fl/fl or DMP1-GsαKO). Total bone mineral density (BMD), total bone mineral content (BMC), condyles' BMD and incisor mineralisation were quantitatively assessed by DEXA. Bone microarchitecture of the mandible and full head of mice was quantitatively assessed with high-resolution micro-computed tomography (μCT). For the condylar region, we assessed total BMD and bone volume fraction (BV/TV, %). Three linear measurements of the mandible were measured: mandibular length, condyle head length and condyle head width, and samples were assessed by histomorphometric analysis. RESULTS:DMP1-GsαKO mice have decreased total mandibular BMD, total mandibular BMC, condylar BMD and total tooth mineralisation as assessed by DEXA. μCT analysis revealed that condylar bone volume and tooth mineralisation were reduced in DMP1-GsαKO mice and showed that skull size and specifically the zygomatic bone were larger in control. H&E histological sections of the jaws of DMP1-GsαKO mice confirmed the osteopenic phenotype. Tartrate-resistant acid phosphatase (TRAP) staining showed that the number of TRAP-positive osteoclasts was increased in the DMP1-GsαKO mice compared to controls, suggesting increased bone resorption. CONCLUSION:Our studies identified Gsα signalling in osteocytes, mature osteoblasts and odontoblasts, as important in maintaining normal bone and tooth homeostasis.
OBJECTIVE:To evaluate the efficacy and efficiency of in-house digital software and fabrication of clear aligners. MATERIALS AND METHODS:This retrospective study analysed pre-treatment, predicted and post-treatment digital scans of 61 patients (42 females, 19 males) to assess the accuracy of predicted tooth movements. Planned and final scans were superimposed using best-fit analysis in Geomagic Design X (Hexagon AB, Stockholm, Sweden). Distoincisal (DI), mesioincisal (MI) and gingival zenith (Z) landmarks were measured perpendicularly from the mid-facial aspect, with differences < 0.5 mm deemed clinically acceptable. Data were analysed using repeated-measures ANOVA with logarithmic transformation, and clinically acceptable movements were compared between groups using generalised estimating equations (GEE). RESULTS:When evaluated individually, 91% of mandibular and 95% of maxillary landmarks showed clinically acceptable movement. When all three landmarks per tooth were below the threshold, 84% of mandibular and 88% of maxillary teeth met this criterion. At the case level, 48% of mandibular and 50% of maxillary cases achieved overall clinically acceptable movement. The greatest discrepancies were observed at the Z point on maxillary teeth (p < 0.05). Mandibular canine movements were more predictable than those of mandibular incisors (p < 0.05). CONCLUSION:In-house aligner planning and fabrication demonstrated effective and efficient outcomes for limited treatment cases. Tooth movement was generally more predictable in the maxilla than in the mandible, with canines showing greater predictability than incisors. Torque movements in the maxilla exhibited the lowest accuracy.
OBJECTIVE:To investigate and compare the accuracy of the automatic orthodontic tooth segmentation process performed by three commercial CAD software packages. MATERIALS AND METHODS:Three typodonts, representing different degrees of crowding in both arches (mild, moderate and severe), were scanned and the files imported into three professional CAD software packages (ArchForm, OrthoSystem and VISION). In addition, 28 removable teeth, used for construction of each typodont, were scanned and their STL. files used for reference purposes. After tooth segmentation, the STL. file generated for each tooth by each software was 3D-superimposed onto its reference, and measurements were analyzed for each tooth subgroup in both arches. Both 2D discrepancies at 13 different points (mm) and central mesiodistal width (mm), and 3D discrepancies in area and volume (mm3) were investigated. Tooth segmentation accuracy was compared with respect to the reference STL. files and among software packages. The amount of crowding was investigated for its influence on the tooth segmentation process. RESULTS:Most linear and 3D measurements displayed some degree of inaccuracy, with a general tendency to oversize segmented teeth. The degree of crowding did not appear to affect the accuracy of tooth segmentation, considering both arches and each individual tooth group (p > 0.05). Different software packages performed differently, though likely not to a clinically significant degree for most of the discrepancies found. In particular, OrthoSystem and VISION demonstrated better accuracy compared to ArchForm. CONCLUSIONS:Automatic tooth segmentation software presents variable degrees of inaccuracy, irrespective of crowding severity. The different software packages evaluated demonstrated varying levels of accuracy, with no clinically significant differences among them, except in a few cases. While most single-point discrepancies can be considered clinically irrelevant (< 0.1 mm), exceptions include the mesial, mesiogingival, and distogingival points. In contrast, discrepancies in central mesiodistal width often exceed 0.1 mm and tend to result in overestimated measurements. This overestimation can compromise the accuracy of interproximal reduction (IPR) during clear aligner therapy, potentially leading to excessive enamel removal. Regarding volume and area discrepancies, the automatic segmented teeth are generally oversized, without a significant clinical impact.
OBJECTIVE:The aim of this study was to assess the aesthetic judgements made by lay people and professionals relating to an asymmetric maxillary central incisors' gingival margin position. SETTING:Multi-center institutional study. MATERIALS AND METHODS:A high-quality intra-oral photograph of a previously treated case was manipulated (six images). Parents of children undergoing conventional orthodontic treatment (PCT), parents of children undergoing combined surgical-orthodontic treatment for a unilateral impacted maxillary central incisor (PI) and professionals (dental and orthodontic specialists) were asked to evaluate and rank the images in terms of aesthetics and provide free-text responses to support their rankings (least and most attractive). All data was analysed statistically with regressions at 5% and a thematic analysis of the free-text responses was performed. RESULTS:The responses from 120 participants (mean age 42.2 years; Standard Deviation [SD] 8.6 years; 62.2% female) were analysed (30/group). Image E (symmetrical gingival margins with the lateral incisor gingival margins 0.5-1.0 mm below both the gingival margin of the maxillary canine and central incisor which are at the same level in relation to each other) was ranked the most attractive (60.8%). The presence of an asymmetric gingival margin between the maxillary central incisors was rated the least attractive (Images D and F; 30.9% and 39.2%, respectively). The highest and lowest mean ranking scores (adjusted for gender) were Image E (5.12 points; 95% CI: 4.76-5.48 points) and F (1.83 points; 95% CI: 1.57-2.10 points) A similar trend was evident within groups. The PCT group scored Image D the lowest (2.17 points; 95% CI: 1.72-2.62 points). Gender influenced the ranking of the images. Themes to support the ranking of the most attractive image were related to the importance of overall symmetry. Themes to support the ranking of the least attractive image were based on overall asymmetrical (uneven) appearance (n = 117). CONCLUSION:An asymmetric gingival margin position between the maxillary central incisors negatively influences the rating/perception of attractiveness by lay persons and professionals.
OBJECTIVE:This study aimed to evaluate the association between upper airway obstruction sites and the morphology of lip and perioral soft tissues in paediatric patients. MATERIALS AND METHODS:Upper airway obstruction sites were classified into four categories using Fujioka and Baroni's methodology: nasopharyngeal obstruction (NO), oropharyngeal obstruction (OO), combined nasopharyngeal-oropharyngeal obstruction (NO + OO) and a control group (CG). Primary outcomes focused on quantifying upper and lower lip thickness, while secondary outcomes evaluated perioral soft tissue morphology and maxillary skeletal parameters. Statistical comparisons were performed using one-way ANOVA, Kruskal-Wallis H test and chi-square tests. A multinomial logistic regression (reference = CG) examined adjusted associations, including ANB and SN-MP as covariates. RESULTS:A total of 256 paediatric patients with pre-treatment lateral cephalograms were included, 64 in each group. Comparative analysis revealed the NO group demonstrated significantly greater upper lip thickness (p < 0.001) and eversion (p = 0.012) compared to the CG. Additionally, the NO group displayed a greater distance between the incisal edge of the lower anterior teeth and the uppermost point of the lower lip than the OO and CG groups. Regression analyses confirmed upper lip thickness was positively associated with all obstruction types, whereas upper lip length was inversely related to NO and NO + OO. CONCLUSIONS:Nasopharyngeal obstruction was associated with upper lip thickening and eversion, while oropharyngeal obstruction corresponded to lower lip protrusion. These findings suggest that distinct obstruction sites are linked to specific perioral and maxillary morphological patterns, emphasising the importance of airway evaluation in orthodontic diagnosis and treatment planning.
OBJECTIVE:The NLRP3 inflammasome is a damage sensor driving pyroptotic cell death during orthodontic tooth movement (OTM). Recent studies have revealed impaired one-week OTM in mice lacking NLRP3. However, the relevance of NLRP3 during long-term OTM remains unknown. MATERIALS AND METHODS:OTM was analysed after 7, 14 and 21 days of force application in mice lacking NLRP3 (NLRP3-/-), wild-type (WT) male and female littermates. Micro-computed tomography (μCT) was used to assess molar movement and bone quality. Tartrate-resistant acid phosphatase (TRAP) staining was used to visualise osteoclastic activity. RESULTS:We show here that after 2 weeks of force application, OTM was delayed in mice lacking NLRP3 compared to WT mice. Interestingly, OTM regained speed in NLRP3-/- mice catching up with the WT controls at day 21. Independent of NLRP3 expression, OTM caused alveolar bone loss compared to the untreated contralateral side. NLRP3-/- mice showed a diminished number of TRAP-positive osteoclasts than WT male mice 14 and 21 days after OTM induction. CONCLUSION:The results of this study suggest that NLRP3 is relevant during the early but not later stages of OTM.
ABSTRACT Objective To explore which effects of jaw orthopaedics in class II during puberty are related to daily functioning and family impacts. Materials and Methods Seventy‐one subjects in their pre‐pubertal and peri‐pubertal stages with skeletal class II and procumbent incisors (median age 12 years; 56% females) were treated with the Sander bite jumping appliance (BJA; N = 37) and Twin block (TB; N = 35). They were matched by the same number of untreated class II subjects. Lateral cephalograms before and after treatment (one‐year distance) were analysed. Children's and parental perspectives of oral health‐related quality of life (OHRQoL) were assessed by the Child Perceptions Questionnaire, Parental‐Caregiver Perceptions Questionnaire and Family Impact Scale Results The change in pharyngeal airway width in treated groups was not significantly greater than in the group without orthodontic treatment. Treated groups, compared to the untreated group, demonstrated an increase in mandibular length and a reduction in sagittal skeletal intermaxillary discrepancy ( p ≤ 0.002). Retroclination of the maxillary incisors, accompanied by a reduction in overjet, overbite and upper lip prominence, was observed in both treated groups compared to the untreated ( p ≤ 0.001). Parents of children in the TB group reported a reduction in impairment of OHRQoL when compared to BJA ( p = 0.003). There were no correlations between the change in the airway width, dentofacial characteristics and OHRQoL. Conclusion Treatment with both appliances stimulated mandibular growth, retroclined maxillary incisors and improved facial profile and OHRQoL. However, the changes in the airway were not greater than normal growth and were not related to alterations in other dentofacial characteristics or OHRQoL. Trial Registration ClinicalTrials.gov identifier: NCT03455634
OBJECTIVE:This prospective study aimed to evaluate the impact on oral health-related quality of life (OHRQoL) in skeletal Class III patients treated with the surgery-first approach using either orthodontic aligners or fixed appliances. MATERIALS AND METHODS:Patients were treated using the Surgery-First Approach (SFA) combined with either clear aligner (CA) or conventional fixed appliances (FA). A total of 20 patients (male and female) were allocated to the CA group, while 14 were included in the FA group. OHRQoL was assessed using the Orthognathic Quality of Life Questionnaire (OQLQ), the Oral Health Impact Profile-14 (OHIP-14) and the SF-36 at different time periods: (T0) pre-treatment, (T1) 1 week after orthodontic appliance installation, (T2) 4 weeks post-surgery and (T3) 6 months post-surgery. Data analysis was conducted using the Friedman and Mann-Whitney tests, with a significance level of 5%. RESULTS:No statistically significant differences were found in OHRQoL scores between the CA and FA groups at baseline and after 6 months of treatment. However, significant intra-group improvements were observed over time, particularly between the first and sixth months of treatment. CONCLUSIONS:Both ortho-surgical approaches, using either clear aligners or fixed appliances, resulted in significant improvements in patient quality of life. These findings highlight the positive impact of orthognathic treatment on dentofacial correction and overall well-being, regardless of the appliance type. TRAIL REGISTRATION:ClinicalTrials.gov NCT05822271.
OBJECTIVE:This study aimed to develop a deep learning model classifier capable of predicting the extraction/non-extraction binary decision using lateral cephalometric radiographs (LCRs) and intraoral scans (IOS) to serve as an additional decision-support tool for orthodontists. MATERIALS AND METHODS:The dataset was composed of LCRs and IOS from 617 patients (mean age: 18.2, 63.5% female) treated at the Indiana University School of Dentistry. Subjects were categorised into two groups: extraction (192) and non-extraction (425). Two sets of features were extracted from IOS: traditional arch measurements and novel tooth spatial features. For LCRs, features were derived using CephNet-based landmark detection (Land), a convolutional autoencoder (AE), and the dimensionality was reduced using Principal Component Analysis (PCA). Models were evaluated using accuracy, sensitivity, specificity, positive predictive value (PPV or precision), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and F1 score. RESULTS:IOS + Land model achieved the highest overall accuracy (77%) and F1 score (0.62), with strong specificity (83%) and PPV (62%). In contrast, the Land model yielded the highest sensitivity (82%), but at the cost of lower specificity (57%). McNemar's test revealed that the AE model was significantly less accurate than IOS + AE (p = 0.048), IOS + Land (p = 0.006), and IOS + AE + Land (p = 0.005). CONCLUSION:Deep learning models can predict the extraction/non-extraction decision using IOS and LCRs with high accuracy and diagnostic performance. Multimodal approaches, particularly those integrating IOS with cephalometric landmarks, demonstrate superior accuracy, sensitivity, and specificity compared to single-modality models.
This systematic review and meta-analysis aimed to evaluate the predictability of tooth movement, and clinical effectiveness of clear aligners in extraction-based orthodontic therapy. A comprehensive search of seven electronic databases (PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, CINAHL and ProQuest) was conducted up to April 19, 2025, adhering to PRISMA guidelines. Eligible studies included prospective and retrospective designs assessing clear aligner treatment in patients aged ≥ 12 years with premolar extractions. Primary outcomes encompassed predicted versus achieved tooth movement and root angulation/parallelism, with secondary outcomes including treatment duration and clinical indices (American Board of Orthodontics Objective Grading System [ABO-OGS], Peer Assessment Rating [PAR]). Risk of bias was evaluated using the Swedish Council on Technology Assessment in Health Care (SBU) grading system and Centre for Reviews and Dissemination (CRD) criteria. Random-effects meta-analyses were performed for homogeneous outcomes. Twenty studies (536 aligner patients, 173 fixed appliance patients) were included. Meta-analyses revealed significant discrepancies between predicted and achieved movements, including excessive mesial tipping of maxillary first molars (mean difference: -6.08°, 95% CI: -7.89 to -4.26). Under-retraction (-1.93 mm, 95% CI: -2.15 to -1.71), and increased vertical displacement of maxillary incisors. Root divergence and anchorage loss were prevalent. Compared to fixed appliances, aligners exhibited inferior root control and occlusal contact scores. Four randomised controlled trials provided high-quality evidence, but the predominance of retrospective studies contributed to a moderate risk of bias. Clear aligners demonstrate biomechanical limitations in achieving precise root control and bodily movement in extraction cases, necessitating strategic overcorrections and adjunctive mechanics. Trial Registration: PROSPERO (CRD42024613540).
INTRODUCTION:The purpose of this study is to compare the skeletal and dentoalveolar effects of the three types of facemask protocols in children. SUBJECTS AND METHODS:Forty-eight subjects were grouped into three groups: bone-anchored facemasks (BAFMs) (BAFM group, n = 16, mean age 10.77 ± 1.00), facemask with miniscrew-assisted rapid palatal expanders (MARPEs) (MARPE/FM group, n = 16, mean age 10.47 ± 1.43) and facemask with rapid palatal expanders (RPEs) (RPE/FM group, n = 16, mean age 10.45 ± 1.04). Lateral cephalograms were taken at the initial observation (T0) and after maxillary protraction (T1). Cephalometric analysis was performed, and significance was assessed between the three groups. For statistical analysis, 1-way ANOVA or Kruskal-Wallis test was performed. RESULTS:During maxillary protraction (T0-T1), greater maxilla advancement and greater intermaxillary relationship improvement were attained in BAFM (SNA: 2.28°, Mx. length: 3.13 mm, ANB: 3.41°, AB to MP: 5.31°) and MARPE/FM (SNA: 2.22°, Mx. length: 2.91 mm, ANB: 3.28°, AB to MP: 5.57°) groups than in the RPE/FM group (SNA: 1.09°, Mx. length: 1.46 mm, ANB: 2.08°, AB to MP: 2.77°) (p < 0.01). Protraction of the orbitale was greater in the BAFM (SNOr: 2.54°) group than in MARPE/FM (SNOr: 1.53°) and RPE/FM (SNOr: 1.28°) groups (p < 0.001). Also, the BAFM (PP to U6: 1.17 mm, U6 to VRmx: -1.18 mm) and MARPE/FM (PP to U6: 2.74 mm, U6 to VRmx: -2.80 mm) groups showed less maxillary first molar movement than the RPE/FM (PP to U6: 2.74 mm, U6 to VRmx: -2.80 mm) group. There was no significant difference in the mandibular variables and most of the vertical variables. CONCLUSION:The orthopaedic effects of BAFM and MARPE/FM were greater with maxillary protraction and intermaxillary relationship improvement than RPE/FM after protraction. Midface traction effects with MARPE/FM were less than with BAFM. However, MARPE/FM was more effective in preventing mesial movement and extrusion of the maxillary first molars.
OBJECTIVES:This study aimed to three-dimensionally analyse the effects of pre-surgical nasoalveolar molding (NAM) in patients with unilateral cleft lip and palate. METHODS:The sample consisted of 66 patients (with pre- and post-NAM casts), collected from three centres. Landmarks and measurements were identified on each cast, and the changes from pre- to post-NAM were recorded and analysed using a paired t-test. RESULTS:Post-NAM, we observed a mean decrease of 5.18 mm in 3D cleft width, a 1.78 mm decrease in the sagittal cleft gap, a 1.34 mm decrease in the anterior arch width and a 2.27 mm increase in the posterior arch width. There was a greater inward rotation of the greater segment (8.50°) compared to the lesser segment (3.09°), an increase in arch depth (1.74 mm) and internal flexion (9.20°) of the lesser segment. No statistically significant changes in the greater segment's arch depth and internal flexion were observed. The morphological changes between pre- and post-NAM therapy were visualised by the closest-distance colour maps and 3D superimposition assessments. CONCLUSIONS:This study demonstrated the significant morphological changes induced by pre-surgical nasoalveolar molding (NAM) in patients with unilateral cleft lip and palate through a three-dimensional analysis. There was a notable reduction in cleft width, inward rotation of the greater segment and changes in arch dimensions.
