The primary role of buccal-shelf miniscrew implants (BS-MSI) in orthodontic treatment is to provide extra-alveolar anchorage that alleviates severe crowding and allows for distalization of the entire mandibular arch and may obviate the need for orthognathic surgery, particularly in patients with skeletal malocclusion. The stability of these screws is crucial to their successful function throughout orthodontic treatment. Therefore, this systematic review aimed to assess the success rate and various factors affecting the stability of BS-MSI. The databases were searched electronically using PubMed/MEDLINE, EMBASE, Scopus, and the Cochrane databases on 7th February 2025 and re-searched on 22nd February 2026. The reference list and additional bibliographic databases, including clinical trial registries and Google Scholar, were also searched. This review includes clinical trials published in English, comprising prospective randomised controlled trials (RCTs), non-randomised trials (NRCTs), and retrospective cohort studies (RCs) that described the success rate of BS-MSI for orthodontic anchorage in human subjects. Success rates and associated risk factors for BS-MSI were determined utilising a random-effects model. The determinants influencing stability were categorised into patient, mechanics, and implant-related aspects, and subsequently underwent subgroup analysis and meta-regression. The evaluation of study quality was performed using the Cochrane risk-of-bias tools for randomised trials (RoB 2.0) and non-randomised trials (ROBINS-I). This meta-analysis included nine studies: three RCTs, two NRCTs, and four RCs. A total of 2366 BS-MSI were aggregated in a random-effects model, revealing an overall success rate of 93% (95% CI 0.81-1.00; prediction interval = 0.39-1). In a sensitivity analysis, experiments using more than 100 screws exhibited a 91% success rate, comparable to those with fewer than 100 screws. A meta-regression study indicated an inverse relationship between age and success rate. A considerable heterogeneity was observed across all subgroups. Three assessments indicated a low-, two indicated a moderate-, and four indicated a high-risk of bias. BS-MSI demonstrated a high success rate and therefore can provide a reliable source of orthodontic anchorage. However, given the low certainty and high heterogeneity in the existing evidence, the results should be interpreted with caution. Although numerous factors appear to influence BS-MSI stability, most require further investigation due to inadequate data and data quality. Furthermore, future studies are necessary to corroborate the findings of this meta-analysis and investigate other critical factors, such as location, dental cleanliness, gender, insertion torque, and operator experience, which could not be evaluated due to insufficient data. Trial Registration: PROSPERO registration: CRD420250653597.
BACKGROUND:Tipped teeth are frequently managed by orthodontic uprighting, retention, and subsequent tooth-preserving or restorative care, but real-world pathways are heterogeneous. Evidence comparing coordinated treatment pathways with less standardised management remains limited, and observational comparisons require careful interpretation. METHODS:We retrospectively analysed 204 adult patients with at least one tipped tooth requiring clinical management at a single tertiary dental centre from January 2021 to January 2025. The integrated pathway group received orthodontic uprighting followed by standardised retention and coordinated preservation or restorative care (n = 127). The non-standard management group included patients treated by direct restorative treatment without orthodontic uprighting (n = 45) and patients treated orthodontically without standardised retention or coordinated restorative follow-up (n = 32). Patients were classified according to the treatment pathway selected at the initial treatment decision and index intervention stage. Outcomes were assessed at the patient level and included satisfactory functional recovery, occlusal stability, complications, retreatment, and an exploratory composite of overall treatment success. Baseline balance was summarised using standardised mean differences in addition to p values. Multivariable logistic regression was used only as an exploratory adjustment for prespecified pretreatment covariates; causal language was avoided. RESULTS:Of 242 potentially eligible patients, 38 were excluded, leaving 204 patients for analysis. Satisfactory functional recovery was recorded more often in the integrated pathway group than in the non-standard management group (89.8% [114/127] vs. 75.3% [58/77], p = 0.006). Occlusal stability was also more frequent (86.6% [110/127] vs. 70.1% [54/77], p = 0.004). Complications occurred in 13.4% (17/127) and 27.3% (21/77), respectively (p = 0.011), and retreatment was required in 8.7% (11/127) and 18.2% (14/77), respectively (p = 0.028). Exploratory adjusted estimates suggested higher odds of the composite adverse outcome with severe initial inclination and direct restoration without uprighting; however, the low events-per-variable ratio limited model stability and precluded confirmatory interpretation. CONCLUSION:In this retrospective cohort, integrated orthodontic-retention-restorative management was associated with more favourable functional and clinical outcomes than heterogeneous non-standard management. Because treatment selection was not randomised and some outcome definitions relied on routine clinical records, the findings should be interpreted as hypothesis-generating rather than causal.
OBJECTIVE:This retrospective study evaluated three-dimensional effects of hybrid hyrax-mentoplate (HH-M) orthopaedic treatment in high-angle Class III individuals using Cone Beam Computed Tomography (CBCT) images. MATERIALS AND METHODS:Pre-treatment (T0) and post-treatment (T1) CBCTs of 17 fully compliant high-angle Class III patients (7 males, 10 females, age: 11.7 ± 1.32 years, treatment duration: 12.62 ± 1.7 months) treated with HH-M were analysed. T0 and T1 CBCTs were superimposed from the cranial base using artificial intelligence-based AMASSS module of the 3D Slicer version 5.8.1 software (www.slicer.org). Linear and angular changes were analysed in the sagittal, vertical and transverse planes, alongside three-dimensional landmark displacements and volumetric airway measurements. Significance level was set at p < 0.05. RESULTS:Significant increases occurred in SNA, ANB and Occlusal Plane (OP) to Mandibular Plane (MP) angle (p < 0.001, p < 0.001, p = 0.001, respectively), while Sella-Nasion to OP and Palatal Plane (PP) to OP decreased (p = 0.008, p = 0.008, respectively). Vertical linear measurements remained stable (p > 0.05). All transverse linear measurements increased (p < 0.05). Upper Molar (UM) to PP, Upper Incisor to PP, Lower Incisor to MP and overjet have significantly increased (p < 0.001, p = 0.018, p = 0.048, p < 0.001, respectively). Overbite remained unchanged (p > 0.05). Nasopharynx (p = 0.008) and Middle Pharynx (p = 0.003) volumes significantly increased. CONCLUSION:Despite the significant alterations observed in OP and UM-PP, this technique effectively managed to maintain overall vertical skeletal dimensions without inducing a significant change in other facial height parameters and enhanced the airway volume. Significant expansion occurred across maxillary, nasal and zygomatic levels. HH-M represents an effective orthopaedic treatment approach for high-angle Class III patients.
PURPOSE:To identify independent preoperative three-dimensional (3D) morphological predictors for postoperative bone bridge formation in secondary alveolar bone grafting (SABG) using cone-beam computed tomography (CBCT), and to propose an optimal surgical strategy based on these quantitative indicators. MATERIALS AND METHODS:This study evaluated 100 patients who underwent SABG. Preoperative and 6-month postoperative CBCT images were analysed. Patients were categorized into three surgical stages: lateral incisor eruption (Stage 1), canine eruption (Stage 2), and the multi-bracket treatment period (Stage 3). Preoperative cleft dimensions (volume, area and width) and postoperative outcomes (bone bridge thickness, height, and residual defect volume) were measured. Multiple linear regression analysis was performed to identify independent preoperative predictors of surgical success. RESULTS:Multivariate analysis revealed that a larger preoperative cleft volume strongly predicted decreased postoperative bone bridge thickness at the mesial aspect (p < 0.001). Furthermore, a larger preoperative cleft area at the root apex was a significant independent predictor of decreased mesial bone bridge thickness (p = 0.019), and a wider preoperative cleft at the midportion strongly predicted decreased bone bridge height (p = 0.001). Volumetric analysis showed that patients in Stage 3 exhibited significantly larger preoperative cleft volumes. Consequently, while the absolute dimensions of the newly formed bone bridges did not differ significantly among the stages, Stage 3 patients were left with significantly larger postoperative residual bone defects. CONCLUSION:The preoperative cleft volume, apical cleft area, and middle cleft width evaluated via CBCT are robust independent predictors of SABG outcomes. To minimize postoperative residual dead space and optimise bone filling, surgical intervention is strongly recommended during Stage 1 or 2, prior to the severe morphological expansion of the alveolar cleft.
BACKGROUND:Patient safety, defined as the absence of avoidable harm, in orthodontics is still in its early stages of development. Knowledge on the subject is limited. AIM:(1) To conduct an incident analysis, (2) to measure avoidability, (3) to investigate the relationship between contributory factors and perceived avoidability of harm from orthodontic care, and (4) to suggest methods to mitigate potential patient harm incidents. MATERIALS AND METHODS:Data were retrospectively collected from consecutively filed orthodontic-related claims from the Danish Dental Compensation Association (DDCA) and included all approved-for-compensation claims from September 2019 to August 2024. Reason for filing the claim, harm category, and harm-causing events were recorded. Incident analysis was conducted for each claim based on the Eindhoven criteria and AI-assisted qualitative analysis. A large language model was used to identify and interpret the interplay between the contributory factors. Perceived avoidability of harm was based on a 6-point rating system. RESULTS:A total of 125 claims of approved patient harm were included and reviewed. Based on the Eindhoven incident analysis, the most frequent root causes were human related factors (monitoring, verification and clinical knowledge among others) followed by organizational factors (management priorities, protocols and workplace culture), illustrating complex interrelationships. The majority of claims (70.1%, n = 82) were avoidable harm, being rated as either probably avoidable in more than 50% of cases, high certainty of avoidability, or completely avoidable. While low-avoidability harm events were characterized by few contributory factors, high-avoidability cases were characterized by the involvement of numerous human and organizational failures. CONCLUSION:The analysis of 125 compensated orthodontic harm cases showed that 70.1% of the cases were deemed avoidable and most harms were multifactorial in nature, with human and organizational contributors playing the primary role. This multifactorial pattern provides new insights and forms a foundation for future patient-safety initiatives in orthodontic practice and research.
Artificial intelligence (AI) is increasingly integrated into orthodontic research and clinical workflows. Yet, the reliability and clinical value of these systems depend fundamentally on the quality of the data used to train them and the rigour with which their performance is evaluated. Continuing from Part 1 of this 3-part review, this article provides a practical, implementation-focused overview of data preparation and performance evaluation for orthodontic AI applications. Key considerations for AI models are highlighted to ensure that datasets are representative, reproducible, and clinically meaningful. Various strategies in data processing are presented to enhance generalizability while maintaining patient privacy. This review then focuses on interpreting model performance, detailing the strengths and limitations of common metrics for classification, regression, and segmentation tasks. Key concepts are discussed to guide researchers in evaluating model robustness across varied populations and imaging conditions. Finally, the article discusses the real-world utility of trustworthy, well-validated AI systems that can advance orthodontic diagnostics, planning, and research.
The rapid integration of artificial intelligence (AI) into orthodontics raises important questions about which methods are being applied, how they are being validated, and what barriers remain to clinical implementation. This study was conducted to inform orthodontic practitioners, researchers, and educators about the possibilities that AI could bring to orthodontics and to emphasise the need for increased collaboration among experts. The literature search was performed across four databases: PubMed, Scopus, Embase, ProQuest Dissertations & Theses Global (PQDT). All types of clinical studies involving the design and implementation of AI in all aspects of orthodontics published from January 2000 to August 2024 were included in this review. The search identified 1917 articles from the four databases (PubMed = 455, Scopus = 668, Embase = 554, and PQDT = 240). After 566 duplicates were removed, 1351 titles and abstracts were screened. Finally, 110 full text articles were included in this scoping review focusing on the following areas: diagnosis, treatment planning, practice management, evaluation of orthodontic devices, and orthodontic education. A thorough search across databases and relevant sources was conducted to gather a comprehensive understanding of how AI impacted orthodontics research. This scoping review carefully examined the existing literature on the applications of AI across various aspects of orthodontics. The findings provide insights into the utilisation of AI in this field, identify challenges faced when integrating AI-driven methods and uncover gaps in the knowledge that require further research.
OBJECTIVE:To assess the impact of baseline malocclusion severity on the number of prescribed, used aligners and treatment duration. MATERIALS AND METHODS:An unrestricted, independent search was conducted on the Invisalign ClinCheck database of a private practice for patients without any missing anterior teeth and whose treatment was finished between April 2021 and December 2024. Descriptive statistics were generated, and the feature selection Boruta algorithm (random forest algorithm) was implemented to identify important predictors for the number of aligners (prescribed, used) and treatment duration. RESULTS:A total of 404 patients were included (age: 29.57 [10.7] years). Mean numbers of prescribed, used and unused aligners were 72.21 (37.52), 65.63 (30.40) and 6.57 (14.09), respectively. Important predictors of the numbers of the prescribed and used aligners were relatively similar and included molar and canine relationships, maxillary crowding, overjet, presence and number of missing or extracted posterior teeth, overbite, presence and number of teeth in posterior crossbite and midline discrepancies. Treatment duration was associated with baseline maxillary crowding, molar and canine relationships, overjet, overbite, midline discrepancies and the presence and number of missing or extracted posterior teeth. CONCLUSIONS:Factors related to the baseline malocclusion severity significantly affect the number of prescribed, used aligners and treatment duration. This information could be used for informed practice and patient communication, including future evaluation of the biological and environmental footprint of aligners.
OBJECTIVE:This exploratory split-mouth randomized controlled trial aimed to evaluate the effect of a custom three-dimensional (3D) surgical guide on mandibular sagittal split osteotomy outcomes compared with conventional freehand osteotomy. METHODS:Patients undergoing sagittal split osteotomy (SSO) were randomly assigned in a split-mouth design to receive mandibular osteotomy performed with a custom-made 3D surgical guide on one side and without a surgical guide on the contralateral side. The primary outcome was the postoperative lingual split scale (LSS) of the mandible. Secondary outcomes were lateral osteotomy end (LOE), assessed using postoperative CT-based evaluation, and intraoperative inferior alveolar nerve exposure (NE). RESULTS:Fifteen patients contributed 30 mandibular sides for paired analysis. Guided sides showed more favourable LSS (p = 0.041) and LOE (p = 0.041) distributions compared with non-guided sides. No statistically significant difference was observed in NE (p = 0.763). These findings suggest that the use of a custom 3D surgical guide may improve osteotomy control and split predictability. CONCLUSION:The custom 3D surgical guide was associated with more favourable lingual split pattern and lateral osteotomy end distributions during sagittal split osteotomy. Given that the study population consisted predominantly of skeletal Class III patients, these findings should be interpreted primarily within the context of Class III patients. No significant reduction in intraoperative inferior alveolar nerve exposure was observed.
INTRODUCTION:Mini-implant placement has become a routine method for providing anchorage in orthodontic treatment. The stability of these implants is influenced by several factors, including implant design, bone quality, site preparation, insertion angle, and loading protocol. Among these, implant and bone quality are largely unmodifiable. Resonance Frequency Analysis (RFA) is widely used to assess implant stability. This ex vivo study aimed to evaluate the impact of immediate loading on the stability of orthodontic mini-implants using RFA. MATERIALS AND METHODS:This prospective animal study assessed the primary stability of 72 self-drilling stainless steel mini-implants of three lengths (1.3 mm × 6 mm, 1.3 mm × 8 mm, and 1.3 mm × 10 mm). A 2 N load was applied using nickel-titanium coil springs. Stability was measured by RFA immediately after force application (T0) and after 5 weeks (T1). RESULTS:Initial stability was comparable across all implant lengths. After 5 weeks of loading, all groups demonstrated a reduction in stability. The 6 mm implants showed a significantly greater loss of stability (5.31 ± 4.89) compared to the 8 mm (2.36 ± 4.08) and 10 mm (2.39 ± 1.64) implants. All lengths exhibited statistically significant stability loss post-loading (6 mm, p = 0.001; 8 mm, p = 0.009; 10 mm, p = 0.001). CONCLUSION:Variations in implant length did not significantly affect immediate stability following loading. However, over time, 6 mm implants experienced greater stability loss compared to 8 mm and 10 mm implants. Despite this, shorter implants exhibited slightly higher initial stability under load.
OBJECTIVE:This study aimed to investigate the structural associations between palatal morphology and upper airway dimensions in twins with completed craniofacial growth, while evaluating genetic and environmental contributions. METHODS:The sample comprised 53 twin pairs (27 monozygotic, 26 dizygotic; mean age 17.8 years). Palatal parameters were obtained from digital 3D casts, and upper airway dimensions were assessed using lateral cephalograms. Pearson correlation analysis was performed, and multiple comparisons were controlled using the Benjamini-Hochberg false discovery rate procedure. Heritability estimates were derived using structural equation modelling within the classical twin design (ACE model). RESULTS:Interpremolar and intermolar widths were positively correlated with the PCV-AH distance (posterior cervical vertebra to anterior hyoid) (r = 0.27-0.43, p ≤ 0.005), representing the sagittal distance between the posterior pharyngeal wall and the anterior hyoid bone. Palatal surface area (r = 0.30, p ≤ 0.003) and palatal volume (r = 0.29, p ≤ 0.003) were also associated with PCV-AH. Palatal height showed moderate correlations with PCV-AH (r = 0.29-0.30). CONCLUSION:Several palatal parameters were significantly associated with the PCV-AH distance, a measure showing substantial shared environmental influence. The environmental predominance of this airway parameter suggests functional plasticity within the maxilla-hypopharyngeal relationship. These findings indicate that structural maxillary characteristics may interact with environmental or functional factors and may be responsive to environmental or functional influences.
To map and critically synthesize the methodological approaches used for the CBCT-based evaluation of maxillary and mandibular impacted canines (ICs), with emphasis on imaging protocols, anatomical variables, and diagnostic frameworks. This scoping review followed PRISMA-ScR guidelines. A three-step search strategy was applied across PubMed, Embase, Web of Science, Scopus, LIVIVO, Cochrane Library, LILACS, and Google Scholar, using MeSH terms and free-text keywords related to ICs and CBCT. Data on sample characteristics, CBCT acquisition parameters, anatomical assessment criteria, classification systems, segmentation software, and examiner calibration were extracted and synthesized narratively. Forty-nine observational studies met the inclusion criteria. Substantial heterogeneity was observed in CBCT equipment, voxel size, field of view, exposure settings, image orientation, segmentation tools, and calibration procedures. Most studies evaluated maxillary canines, whereas mandibular impactions were rarely assessed (6.12%). The most frequently analysed characteristics were the impacted canine's position within the alveolar bone, its involvement in adjacent tooth resorption, and its spatial relationship to surrounding teeth. Major methodological gaps were identified in CBCT acquisition protocols, image orientation, examiner reliability, classification systems, and the assessment of follicular and impacted canine morphology, volume, shape, and anatomical relationships to adjacent structures widely used classification systems, particularly Ericson-Kurol, showed variable adaptations and limited standardization. Most studies evaluated maxillary canines, focusing on bucco-palatal position, root resorption, and the Ericson and Kurol classification, although CBCT methodologies were inconsistently reported. Standardized acquisition, orientation, and measurement protocols may improve diagnostic consistency and support more reliable orthodontic treatment planning and clinical decision-making for impacted canines.
OBJECTIVE:This study aimed to evaluate the impact of simulated obesity in rats on Receptor Activator of Nuclear Factor κB (RANK), Receptor Activator of Nuclear Factor κB Ligand (RANKL) and Osteoprotegerin (OPG) expression during orthodontic tooth movement (OTM). METHODS:Forty male Wistar rats 6 weeks old were allocated into non-obese and obese groups. Obesity was simulated by a high-fat diet for 8 weeks. After, the left maxillary first molar was moved by stretched orthodontic nickel-titanium coiled springs. The animals were euthanized after 7 and 14 days of OTM, and the alveolar bone surrounding the roots of the left and right maxillary first molar was dissected to gene expression by qRT-PCR. TaqMan assays for RANK, RANKL, OPG and GAPDH were used, and the values of gene expression were compared by one- and two-way ANOVA with Tukey post-test (alpha = 5%). RESULTS:RANK expression in OTM side at 7 days was statistically different between non- and obese rats (p < 0.01), but not at 14 days (p > 0.05). The RANKL and OPG expression levels on the OTM side did not differ between the groups after 7 or 14 days of OTM. CONCLUSION:The RANKL and OPG gene expression is not affected by OTM in simulated obese rats. The impact of obesity on RANK gene expression needs to be further studied.
OBJECTIVE:To evaluate the trueness and precision of Qlone Dental Pro 3D Scanner for smartphones when applied to indirect facial analysis of individuals undergoing orthognathic surgical planning. MATERIALS AND METHODS:This is a cross-sectional trueness and precision study. The study population comprised individuals with dentofacial deformities. A control group without dentofacial deformity was included for comparison. Direct facial anthropometry using a digital calliper served as standard-reference. 3D facial models in. OBJ format were obtained by Qlone Dental Pro 3D Scanner and imported to MeshLab 2025.7 where indirect facial measurements were performed. Trueness was defined by the proximity of indirect and direct facial measurements, while precision was assessed through comparison of indirect measurements from two subsequent smartphone-based scans. Statistical analysis was performed with Jamovi 2.6.26.0. RESULTS:The study included 40 participants, equally distributed between dentofacial deformity and control groups. In trueness analysis, mean differences ranged from -3.32 mm to 0.83 mm, with an overall mean difference of -1.47 mm. Systematic bias was statistically significant (p < 0.05) for all measurements, except for N-Sn. Precision analysis demonstrated mean differences < 0.40 mm, with an overall mean difference of 0.14 mm, without statistically significant systematic bias (p > 0.05). Comparison of trueness and precision between individuals with and without dentofacial deformities revealed no statistically significant differences for most measurements. CONCLUSION:Indirect facial anthropometric analysis using Qlone Dental Pro 3D Scanner demonstrated high precision but limited trueness compared with conventional direct measurements. The presence of dentofacial deformity did not significantly influence indirect measurement performance.
OBJECTIVE:This study aimed to determine the relative contributions of genetic and environmental factors to phenotypic variations of dental arch shape from the primary to permanent dentition stages. MATERIALS AND METHODS:Maxillary and mandibular digital models of 188 twin pairs (90 monozygotic and 98 dizygotic) in the primary dentition stage, tracked longitudinally through the mixed and permanent dentition stages, were examined. Dental landmarks were recorded at the incisal edges of incisors and the cusp tips of canines and posterior teeth in both arches in MeshLab. Arch shape variation was analysed using Procrustes superimposition and principal component analysis, then partitioned into genetic and environmental variance components using genetic structural equation modelling. RESULTS:The first three principal components were meaningful, explaining 42%-54% of the phenotypic variation in dental arch shape from the primary to permanent dentition stages. The arch depth-to-width ratio (principal component 1) greatly influenced arch shape in both maxillary and mandibular arches across all dentition stages. Other components included canine position, displacement and rotation of incisors and posterior teeth and the steepness of the curve of Spee. An AE model incorporating additive genetic (A) and non-shared environmental (E) components best explained the phenotypic variances in dental arch shape, with narrow-sense heritability estimates ranging from 0.60 to 0.84 for the first three principal components. CONCLUSIONS:The dental arch shape was predominantly influenced by additive genetic and non-shared environmental factors throughout development, with moderate to high heritability estimates across all dentition stages.
INTRODUCTION:This study evaluated the immediate skeletal and dentoalveolar effects of Minimally Invasive Surgical and Miniscrew Assisted Rapid Palatal Expansion (MISMARPE), comparing outcomes using two different appliance designs: tooth-bone-borne (TBB) and bone-borne (BB) expanders. METHODS:This retrospective comparative cohort study included 24 consecutively treated adult patients (mean age 35.9 ± 9.5 years): 13 in the TBB group and 11 in the BB group. Cone-beam computed tomography scans were obtained pre-treatment (T0) and immediately after expansion (T1) to assess skeletal and dentoalveolar changes. Generalized Estimating Equations analysis, followed by Bonferroni correction for multiple comparisons, was used to compare measurements between groups over time. RESULTS:The MISMARPE technique produced significant increases in all linear measurements except posterior maxillary basal width in the TBB group (p = 0.142). Both groups exhibited greater skeletal expansion in the anterior maxillary region, demonstrating a triangular expansion pattern in the axial view. The TBB group showed significantly greater increases in dental distances (6-6CR, p = 0.002; 6-6RT, p = 0.017) and posterior alveolar width (P-AM, p < 0.001) compared to the BB group. No significant changes in molar inclination were observed in either group post-expansion. CONCLUSIONS:The MISMARPE technique is effective for adult maxillary expansion, producing a triangular palatal expansion pattern in the axial view with parallel suture opening at the anterior nasal spine level in the coronal view. The TBB expander demonstrated greater transverse dentoalveolar expansion and stability of miniscrews compared to BB design, while both anchorage systems achieved similar skeletal effects.
OBJECTIVES:To evaluate eruption pattern, in terms of space closure and alignment of second permanent molars (SPM), following extractions of first permanent molars (FPM) and assess the effect of predicting factors including age at extraction, developmental stage of SPM, angulation of adjacent teeth and presence of third permanent molars (TPM) on the outcome. MATERIALS AND METHODS:This retrospective study included healthy children aged 6-12 years who had undergone extraction of one or more severely compromised FMPs and had complete pre- and post-extraction radiographic records until completion of the root formation of SPM and second premolar. Data on age, arch, extraction site, SPM developmental stage (Demirjian scale), angulation of adjacent teeth and presence of TPMs were collected from patients' records and pre-extraction panoramic radiographs. Space closure and angulation of SPM were evaluated via post-extraction radiographs. Descriptive statistics and logistic regression models were applied. RESULTS:Sixty teeth, from 60 patients (mean age at extraction: 10.4 years; mean follow-up: 32 months) were evaluated. Overall complete space closure was achieved in 75%, more prominent in the maxilla than the mandible (80% vs. 73%). Significantly higher closure rates were recorded in patients < 10 years at extraction (p = 0.01) and when the SPM was at Demirjian developmental stages E-F (p = 0.04). Upright angulation of SPM was observed in 78% of the cases, significantly more frequently in the maxilla (100%) than in the mandible (67%) (p = 0.01). Regression analysis identified the SPM developmental stage and the TPM presence as significant predictors of space closure, while the dental arch was the only significant predictor of upright SPM alignment. CONCLUSION:Spontaneous space closure and favourable alignment of the SPM occurred in most cases following extraction of compromised FPMs. The highest success rates were observed when extraction was performed between 8 and 10 years of age and when the SPM was at Demirjian developmental stages E-F, suggesting that these factors may represent the most reliable clinical indicators for optimal timing of extraction.
OBJECTIVES:To compare craniofacial morphology between individuals with isolated cleft lip (CL), cleft lip and palate (CLP), and a matched control group before and after the pubertal growth spurt. MATERIALS AND METHODS:Cephalometric data from before and after the growth spurt were collected from 71 anonymized patients, of whom 29 (40.8%) had CLP, 13 (18.3%) had CL and 29 (40.8%) non-cleft control patients presenting Angle Class I malocclusion. Data analysis included raw and standardized mean values along with comparisons using ANOVA and Kruskal-Wallis tests. The significance level was set at 0.05. RESULTS:At baseline, mean ages were comparable across groups: 8.24 ± 0.94 years (control), 8.24 ± 0.94 years (CL), and 8.33 ± 2.44 years (CLP). The cleft groups included a higher proportion of male individuals (CL: 76.9%, CLP: 62.1% vs. 48.3% for control), although not statistically significant. Patients with CL had significantly higher A-Nasion-B angle when compared with CLP and control groups. Individuals with CLP presented significantly lower values of Sella-Nasion-A and Sella-Nasion-B angles and significantly higher values of mandibular plane to Sella-Nasion and gonial angles when compared to the control group. Changes in the maxillo-mandibular relationship were observed in the CLP and CL groups, reaching Class III and Class I relationships after the growth spurt, respectively. CONCLUSION:Although normal prepubertal maxillary prominence was observed in children with CL, impaired sagittal maxillary growth was recorded in this group during puberty. Individuals with CLP or CL present significant differences in maxillary and mandibular morphology and growth, which should be considered in orthodontic planning and treatment.
This scoping review aimed to map the available evidence on clear aligner attachments, summarise key themes and identify gaps to inform clinical practice and future research. This review was registered in the Open Science Framework database. A systematic search was conducted across PubMed, Scopus, Web of Science and Embase databases in accordance with PRISMA-ScR guidelines. The search strategy was systematically constructed using Boolean operators to capture the core literature related to clear aligners and attachments. Searches were conducted up to 30 August 2025. Studies focusing on attachments in clear aligner therapy published between 1 January 2005 and 30 August 2025 were included without restrictions on study design, except narrative reviews. Both primary studies and secondary studies (systematic reviews) were eligible and mapped in this scoping review. Data were systematically charted using a standardised form capturing key variables including study design, year of publication, country of origin, research objectives and outcomes relevant to clear aligner attachments. A total of 115 studies were finally included. In vitro studies predominated, representing 72.1% of the total. Most research was conducted in China and Turkey, with a total of 23 countries represented. The United States, China, Australia and Italy led in international research collaborations. A noticeable increase in publications was observed from 2020 onward, reaching a high point in 2025. Five major thematic areas were identified: Biomechanics and tooth movement, bonding and debonding, attachment materials, patient-reported outcomes and adverse effects, and aligner retention. Evidence was concentrated in biomechanics and bonding/material studies, whereas patient-reported outcomes (comfort/acceptability) and safety-related aspects (e.g., material elution/exposure) were relatively underexplored. Current evidence on clear aligner attachments is mostly in vitro-based, leaving its actual clinical effectiveness unclear. More clinical, multicentre and standardised studies are needed to strengthen and unify our understanding of clear aligner attachments.
OBJECTIVE:To analyse and compare the craniofacial characteristics of patients with nonsyndromic, surgically repaired, complete unilateral cleft lip and palate, aged 8-14 years, treated at 10 cleft care centres. METHODS:Lateral cephalograms of 396 patients (mean age 11.2 ± 1.6 years; male: female ratio 1:0.64) with unilateral cleft lip and palate from 10 comprehensive cleft care centres across India were evaluated using NemoStudio cephalometric software. Cephalograms were anonymised, coded and digitised for unbiased assessment. Two orthodontists independently traced all radiographs at different time intervals. Eleven hard-tissue and seven soft-tissue cephalometric variables were measured on each radiograph. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). RESULTS:Cephalometric analysis demonstrated statistically significant intercentre differences for sagittal skeletal and soft-tissue parameters, including SNA, SNB, ANB, ANS-Me/N-Me, NAPog, nasolabial angle, N'A'Pog' and A'N'B'. In contrast, other parameters did not differ significantly among centres. Dental inclination variables Ui-PP and Li-MP also showed no significant differences. Inter-rater reliability was moderate to good, with ICC values of 0.51-0.85. CONCLUSIONS:Considerable intercentre variation was observed in sagittal hard- and soft-tissue craniofacial parameters among children with repaired unilateral cleft lip and palate. However, these variations cannot be attributed to any single component of the treatment protocol. Instead, it reflects the multifactorial nature of cleft care, including variations in surgical timing, technique, presurgical orthopaedics and patient-related factors.
