Objective:This study aimed to compare the clinical outcomes of indirect- and direct-bonding techniques for bracket placement in orthodontic treatment, focusing on the influence of operator experience. Methods:A total of 153 patients were quasi-randomly assigned to the indirect- or direct-bonding group, of whom 124 were analyzed. Clinical outcomes in the two groups were compared and further stratified by operator experience (1-3 years vs. 4-6 years). The evaluated parameters included total treatment duration, chair time, discomfort during bonding (visual analogue scale scores), plaque control record, bracket failures, intentional reattachments, and post-treatment occlusal index (CR-Eval scores). Results:In procedures performed by operators with 1-3 years of experience, the indirect-bonding group demonstrated significantly shorter treatment duration, shorter chair time, fewer intentional reattachments, and better post-treatment occlusal outcomes than the direct-bonding group. However, bracket failure rates were significantly higher in the indirect-bonding group, regardless of operator experience. In procedures performed by operators with 4-6 years of experience, most parameters showed no significant intergroup differences. Conclusions:The indirect-bonding technique improved treatment efficiency and quality, with potential advantages for less-experienced operators. However, attention to technique is essential to minimize bracket failures. These findings support the incorporation of indirect bonding in clinical training programs.
Objective:To examine the associations of fixed orthodontic treatment with oral health-related quality of life (OHRQoL) and self-esteem (SE) in relation to sex and premolar extraction status. Methods:Adult patients undergoing fixed orthodontic treatment at a private orthodontic practice from 2010 to 2021 were included. Pre- and posttreatment OHRQoL and SE were evaluated using the Orthognathic Quality of Life Questionnaire (OQLQ) and Rosenberg Self-Esteem Scale (RSE), respectively. Outcomes were compared by sex and premolar extraction status. Results:A total of 358 patients (mean age: 26.98 years), including 250 female patients (69.8%) and 206 patients (57.5%) who underwent premolar extraction, were evaluated in this study. Before treatment, male patients had higher OHRQoL and SE than female patients (OQLQ score: 20.25 vs. 25.77, P < 0.001; RSE score: 31.99 vs. 30.06, P < 0.001). After treatment, OHRQoL improved in both sexes (P < 0.001) and SE improved in female patients (P < 0.001), although the between-sex difference was not significant. Male patients maintained higher OHRQoL and SE than female patients posttreatment (OQLQ score: 12.56 vs. 16.79, P < 0.001; RSE score: 32.44 vs. 30.94, P = 0.001). Pretreatment OHRQoL and SE in the extraction group were lower than those in the non-extraction group (OQLQ score: 25.82 vs. 21.78, P = 0.005; RSE score: 30.21 vs. 31.23, P = 0.018), but these differences became non-significant posttreatment (P > 0.05). Conclusions:After orthodontic treatment, OHRQoL improved in both sexes and SE improved in female patients, although the clinical significance of these changes was uncertain. In the extraction group, OHRQoL and SE were initially lower than those in the non-extraction group but showed no significant intergroup differences after treatment.
Objective:To compare the efficacy and stability of maxillary arch expansion using clear aligners (CAs) and slow maxillary expanders (SMEs) in growing patients with maxillary transverse deficiency. Methods:This prospective multicenter cohort study included 48 growing patients (mean age, 9.3 ± 1.7 years; CA group: n = 24; SME group: n = 24) requiring maxillary expansion. The maxillary arch dimensions at the crown and gingival levels, arch perimeter, and molar buccolingual inclination were assessed at pretreatment (T0), post-expansion (T1), and post-retention (T2). The primary outcome was intermolar transverse expansion. A predefined non-inferiority analysis was performed to determine whether the expansion achieved with CAs was non-inferior to that achieved with SMEs within a clinically acceptable margin. Secondary analyses assessed the magnitude, pattern, and stability of the expansion through intra-and intergroup comparisons across time points. Results:The average duration of the expansion phase (T0-T1) was 8.9 ± 3.4 months in the CA group and 6.3 ± 6.1 months in the SME group, followed by a retention phase (T1-T2) of 8.8 ± 5.0 and 8.3 ± 5.7 months, respectively. Both groups showed significant increases in the arch dimensions at T0-T1 and T0-T2. The SME group showed a greater bodily expansion pattern in the molars at T0-T2, although this difference was not statistically significant (P = 0.26). Significantly greater expansion at the canine cusp tip was observed in the CA group. Age was a negative predictor of expansion at the canine region. Conclusions:Based on a predefined non-inferiority margin, the maxillary arch expansion achieved with CAs was not inferior to that obtained with SMEs in growing patients.
Objective: To assess the adaptation and thickness of three-dimensional (3D)-printed and thermoformed aligners, comparing differences in relation to fabrication methods, inner-surface offset, and tooth region. Methods: Thirty maxillary aligners were fabricated: 3D-printed aligners (0.5 mm) with no offset (n = 10) or a 0.05-mm offset (n = 10) and thermoformed aligners from 0.75-mm sheets (n = 10). All aligners were fitted onto a dental model and scanned using micro-computed tomography. Gap distance and thickness were measured at five anterior and seven posterior tooth regions. Thickness ratios after fabrication were calculated. Group and tooth-region differences were analyzed using one-way analysis of variance with Tukey's post hoc test, or Kruskal-Wallis and Mann-Whitney U tests. Results: The no-offset 3D-printed aligners showed larger gaps (0.07-0.15 mm) than the 0.05-mm offset and thermoformed aligners (0.05-0.09 mm). Thickness was greater in 3D-printed aligners (0.68-1.08 mm) than in thermoformed aligners (0.47-0.70 mm). Thickness ratios exceeded 100% in 3D-printed aligners, particularly at the cervical and central fossa regions, whereas thermoformed aligners showed thinning (< 100%), most notably at the labio/buccocervical areas. In comparisons based on tooth region, no-offset 3D-printed aligners showed greater gaps at the buccal, buccocervical, central fossa, and palatal cusp tip regions (P < 0.001), whereas the 0.05-mm offset group exhibited no significant differences. Thermoformed aligners showed larger gaps at the palatocervical, palatal, and palatal cusp tip regions of posterior teeth (P < 0.001). Conclusions: A 0.05-mm offset in 3D-printed aligners produced gap values comparable to those obtained with thermoformed aligners and showed consistent adaptation over tooth regions. 3D-printed aligners tended to show greater thickness than their virtual design, whereas thermoformed aligners showed reduced thickness.
Objective: To investigate the prevalence and clinical characteristics of hypodontia among orthodontic patients in university dental hospitals in Korea. Methods: A total of 15,422 patients who visited the Departments of Orthodontics at 10 university dental hospitals in Korea between 2021 and 2023 were enrolled as the study cohort. Among these, patients with one or more congenitally missing permanent teeth (excluding third molars) were identified using panoramic radiographs and diagnostic records. The prevalence of hypodontia, number and location of missing teeth, associated dental anomalies, skeletal malocclusion patterns, and treatment methods were evaluated. Results: The overall prevalence of hypodontia was 11.9% (n = 1,835). Younger patients (< 16 years) showed a slightly higher proportion of hypodontia (13.2%) than older patients (11.0%). Most cases involved the absence of one or two teeth (68.7%), while oligodontia occurred in 10.6% of cases. Bilateral cases were more prevalent (56.6%), with 80.8% exhibiting symmetrical patterns. Mandibular second premolars were the most frequently affected (20.7%), followed by maxillary second premolars (14.7%) and lateral incisors (12.0%). Among patients with hypodontia, 37.8% had other dental anomalies, such as impacted teeth and microdontia. A Class I skeletal pattern was the most common overall (40.4%), but a Class III relationship was predominant in patients with oligodontia (42.6%). The most frequent treatments were orthodontic space closure (39.9%), observation (29.5%), and space opening for prosthetic restoration (27.5%). Conclusions: Hypodontia is relatively common among Korean orthodontic patients, especially in younger patients. Accurate diagnosis and individualized, multidisciplinary treatment plans are essential for effective long-term care.
Objective: The assessment of orthodontic treatment needs often involves subjective judgment, particularly when using esthetic indices such as the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). This cross-sectional diagnostic agreement study evaluated whether large language models (LLMs) could provide consistent and reliable IOTN-AC scores comparable to those assigned by expert orthodontists. Methods: Three experienced orthodontists (with 8-15 years of clinical experience) independently scored 147 standardized frontal intraoral photographs using the IOTN-AC at two time points (Time 1 and Time 2). Five LLMs (GPT-4.0, GPT-o3, Claude, Manus, and Grok) were used to evaluate the dataset. Agreement and reliability were assessed using intraclass correlation coefficients (ICCs), Pearson and Spearman correlation values, mean absolute error (MAE), and match analyses (exact, near, and group matches). Results: The orthodontists showed moderate inter-rater reliability (ICC = 0.649; 95% confidence interval [CI], 0.563-0.742). Among the LLMs, GPT-4.0 showed the highest agreement with expert scores (ICC = 0.771; 95% CI, 0.697-0.855), followed by GPT-o3 (ICC = 0.663). GPT4.0 also yielded the strongest correlation (r = 0.773; P < 0.001) and the lowest MAE (1.09). In the match analyses, GPT-4.0 achieved the highest exact match (28.6%), near-match (47.6%), and group match (66.0%) rates. The remaining models showed lower performance across all metrics. Conclusions: Multimodal LLMs, particularly GPT-4.0, demonstrated substantial agreement with expert orthodontists in IOTN-AC scoring. These findings suggest that LLMs may serve as adjunct tools in assessments for orthodontic treatment needs. However, clinical decision-making should continue to rely on expert judgment.
Objective:This study aimed to investigate the clinical characteristics of senior orthodontic patients. Methods:The cohort consisted of consecutive senior patients (age ≥ 60 years, n = 146) who visited the orthodontic clinic of a university hospital between 2020 and 2025. Host factors, treatment or referral motives, path of visit, orthodontic diagnosis and treatment acceptance rates, oral health status, severity of malocclusion, and treatment outcomes were evaluated using medical records and the modified discrepancy index (DI). Results:A higher proportion of females (65.1%) than males (34.9%) was observed. The primary treatment motives were improvement of anterior crowding or spacing (65.0%), followed by intrusion of supraerupted molars (9.6%) and space management for edentulous or hopeless sites (8.2%). Direct visits and referrals from other specialties accounted for 24.7% and 75.3% of cases, respectively. The prevalence of retaining 20 or more natural teeth was 94.9%. The orthodontic treatment acceptance rate was 70.9%, peaking at 84.6% among seniors who directly visited the orthodontic clinic for anterior alignment. Orthodontic treatment primarily focused on the anterior segment (83.6%), with a significant decrease in DI (P = 0.001). Conclusions:Seniors who visited the orthodontic clinic were predominantly females in their 60s with a high retention rate of natural teeth. Orthodontic consultations were driven not only by esthetic needs for anterior alignment, but also by recommended referrals as part of interdisciplinary care. The orthodontic treatment acceptance rate was higher when orthodontic goals aligned with the patient's intrinsic motivation for anterior alignment or edentulous space management. Orthodontic treatment in senior patients led to significant improvements in malocclusion.
Objective: To evaluate the influence of three gingival margin aligner designs and varying degrees of marginal tissue recession on aligner retention. Methods: Nine models were obtained for each marginal tissue recession Class (Classes I, II,III, and IV). Control models had no anatomical alterations. For each model, three aligners of each gingival margin design were fabricated (scalloped, scalloped extended, and straight). The aligners were placed on the models, and a hook was positioned in the buccal region at the level of the mandibular first molars. Pull-off tests were performed using a universal testing machine at a crosshead speed of 10 mm/min, and the maximum dislodgement force (N) was recorded. Each aligner was removed 10 times, and the average value was obtained. Results: According to the two-way ANOVA, the main effects of the gingival margin design factor (P < 0.001) and tissue recession factor (P < 0.001) were significant. However, the interaction term was not statistically significant (P = 0.105). According to Tukey's test, scalloped extended (52.3 N) and straight (47.9 N) margins demonstrated significantly greater retention than scalloped margin (33.1 N) (P < 0.05). The Class IV model (82.2 N) resulted in significantly greater retention (P < 0.05). The Class III model (54.4 N) exhibited the second highest retention value, which was significantly different from the other models. There was no significant difference in retention among Class I (25.6 N), Class II (33.2 N), and control (26.8 N). Conclusions: Aligner retention increased with increasing severity of marginal tissue recession. Aligners with scalloped margins provided less retention than those with scalloped-extended and straight margins.
Objective:To compare the effectiveness of acetaminophen and ibuprofen for pain control in orthodontic patients. Methods:Using the PICO strategy, studies were included without restrictions on publication date or language. PubMed, EMBASE, Scopus, Virtual Health Library (VHL)/Latin American and Caribbean Health Sciences Literature (LILACS), Web of Science, and Cochrane Library databases were searched, along with gray literature, up to July 2025. The methodological quality of the studies was assessed using the Cochrane Risk of Bias 2 tool. A meta-analysis was conducted using R software. Subgroup and leave-one-out sensitivity analyses were conducted for moderate or high heterogeneity. Results:Of the 1,139 studies identified, 13 were included. The ages of the participants ranged from 9 to 30 years. Most studies (n = 7) were double-blinded. Tooth movement was induced by fixed appliances or separators, and two studies had a high risk of bias. Pain control with the two medications showed no significant differences at rest at 24 and 48 hours or during chewing at 6, 24, and 48 hours (P > 0.05). Heterogeneity was low, except for pain during chewing at 24 hours (I² = 68.7%; τ² = 1.24; P = 0.022): for this outcome, the "before" subgroup showed no heterogeneity, while the "before/after" subgroup showed high heterogeneity (I² = 84.3%; τ² = 3.38; P = 0.012). The leave-one-out analysis did not change the combined effect but indicated one study as a source of heterogeneity. Conclusions:Pain control during orthodontic tooth movement did not differ between the two medications.
Objective:Plastics are widely used, including in medical applications. In dentistry, clear aligners (CAs) offer an alternative to fixed appliances, but their potential microplastics (MP) release raises health concerns. This study aims to investigate the detachment of MPs from CAs by analyzing the correlations between wearing time, manufacturing methods, and material composition. Methods:The following CAs were tested: Alleo (AL), F22 Aligner (F22), FlexiLigner (FL), Graphy (GP), Invisalign (INV), KeySplint (KS), Lineo (LIN), LuxCreo (LC), Spark (SP), and SureSmile (SS). One pair of CAs per group was immersed in artificial saliva, and the solution was stirred for 5 hours per day for 7 (T1) or 14 (T2) days to simulate mechanical friction. Saliva samples were subsequently vacuum-filtered through 1.6-μm pore-size membranes. Attenuated total reflectance-Fourier transform infrared spectroscopy was used to characterize the CA materials, and Raman microspectroscopy and scanning electron microscopy were used to assess the chemical composition, number, size, and shape of the MPs. The experiment was conducted in triplicate. Results:The release of MPs increased significantly from T1 to T2 (P < 0.05), especially those with a diameter < 5 μm. The mean size of the MPs did not significantly differ at either time point. MP release was associated with material composition at T1 and T2 (P < 0.0001). No significant correlation was observed with the manufacturing process, although GP, KS, and LC, which are three-dimensionally printed (3D-printed) CAs, released more uniform and spherical MPs. Conclusions:Replacing CAs after 7 days may help limit MP release, particularly smaller fragments; however, the clinical significance of this finding remains unclear and requires further in vivo investigation.
Objective:This study aimed to evaluate changes in oral health status and related oral habits in children undergoing adenoidectomy or adenotonsillectomy, focusing on dental indices and mouth breathing-associated symptoms. Methods:This prospective observational study included 52 children (mean age: 7.4 ± 2.1 years) who underwent adenoidectomy or adenotonsillectomy. Clinical evaluations included decayed, missing, and filled teeth for primary dentition/decayed, missing, and filled teeth for permanent dentition (dmft/DMFT) scores, plaque index (Silness and Löe), gingival index (Löe and Silness), and unstimulated salivary flow rate. Parents completed structured questionnaires assessing their children's medical and dental history, oral health-related behaviors, and symptoms. Oral health-related quality of life was evaluated using the Early Childhood Oral Health Impact Scale. Results:Statistically significant improvements were found in salivary flow rate (from 0.43 ± 0.21 mL/min to 0.75 ± 0.19 mL/min), plaque index (1.58 ± 0.48 to 1.06 ± 0.33), and gingival index (1.28 ± 0.55 to 0.70 ± 0.39) (all P = 0.001). Several mouth breathing-related symptoms, such as snoring, dry mouth, daytime sleepiness, and halitosis, also showed a significant postoperative reduction (P < 0.05). Conclusions:Adenoidectomy or adenotonsillectomy significantly improved periodontal parameters and reduced mouth breathing-associated symptoms in children. These findings highlight the importance of interdisciplinary management involving otolaryngologists, pediatric dentists, and orthodontists.
Objective:This systematic review evaluated dietary changes during the first 6 months of orthodontic treatment between multibracket fixed appliances and clear aligners. Methods:Five databases (PubMed, Web of Science, Cochrane's Database of Systematic Reviews, EMBASE, Scopus) were searched through January 2025 for longitudinal studies on healthy participants undergoing non-extractive orthodontic treatment with multibracket fixed appliances or clear aligners, assessing dietary changes. Data on diet change were extracted at baseline, 24 hours, 1 week, 2 weeks, 1-2 months, and 3-6 months, and descriptively compared with pain outcomes. Quality assessment was performed using Risk-of-Bias-2.0 and ROBINS-I; overall certainty of evidence was evaluated with GRADE. Results:The search retrieved 180 studies; 56 were screened, and 22 full-text articles were reviewed. Nine studies (671 participants, 58.9% females) were included. Despite no significant baseline differences between groups, 24 hours after appliance placement, all studies indicated significantly greater diet-related limitations in the multibracket group than in the aligner group, with differences of 0.1-0.9 points on a 0-10 scale. Trends persisted at 1 week (differences 0.7-1.8 points), 2 weeks (0.8-1.9 points), 1-2 months (0.1-2.0 points), and 3-6 months (0.8-3.0 points). Across timepoints, comparisons of pain intensity and dietary changes did not reveal consistent patterns. Conclusions:During the first 6 months, multibracket appliances may affect diet more negatively than clear aligners and this pattern does not seem to be explained by differences in pain. Given the low-to-moderate certainty of evidence and indirect diet assessment using items from broader oral health-related quality of life instruments, these results should be interpreted with caution.
Objective:This study examined the biomechanical properties of computer-aided design/computer-aided manufacturing (CAD/CAM) retainers made of titanium and nickel-titanium (NiTi). Methods:Four retainer types were tested: (1) twisted steel, (2) NiTi, (3) cut titanium, and (4) printed titanium. Longitudinal wires were manufactured (2-4) and subjected to a three-point bending test (3PBT). In a biomechanical bending test (BMT), retainers were designed from patient scans and applied to models in an Orthodontic Measurement and Simulation System, with the maxillary central incisor and mandibular central incisor loaded with deflections of ±0.2 mm and rotation of ±1°. Results:The 3PBT showed that NiTi wires exhibited a characteristic hysteresis loop, whereas the cut and printed titanium wires had different flow and yield strengths. The BMT forces during intrusive and extrusive movements were measured, and the findings revealed that in the maxilla, all CAD/CAM materials showed significant differences from the twisted steel, with NiTi differing from the cut and printed titanium. In the mandible, the forces were generally higher, with significant differences observed at 0.1-mm extrusion and 0.2-mm deflection. In addition, significant differences were observed in the mesial and distal deflections, particularly in the mandible, where the cut titanium generated the lowest forces. Twisted steel exhibited the lowest torque, whereas cut titanium exhibited the highest torque. Conclusions:CAD/CAM retainers differ significantly from conventional twisted steel retainers, with notable differences between NiTi and titanium retainers, especially in the maxilla. However, these differences may be negligible in the mandible due to the shorter interdental distance.
Objective:Since categorization of dental crowding is a crucial parameter in orthodontic diagnosis and tooth-extraction decisions, we aimed to develop an automatic system to categorize crowding levels on intraoral photographs without space analysis. Methods:The Dental Crowding Categorization Network (DCC-Net), consisting of segmentation, extraction, and categorization modules, was proposed and optimized by extracting regions of interest and crown centroids. A multicenter dataset including 1,351 maxillary and 1,253 mandibular intraoral photographs was divided in an 8:2 ratio for model training and internal testing, and an additional 100 photographs were collected for external testing. The ground truth was obtained through measurements by experienced orthodontists using intraoral scanning data. The accuracy, precision, recall, and F1-score of the categorization module were calculated, and heatmaps were obtained for model interpretation. Furthermore, a clinical evaluation was performed to compare the diagnostic accuracy of junior orthodontists with and without the assistance of DCC-Net. Results:For the maxilla, the categorization accuracy, precision, recall, and F1-score were 0.7232, 0.7447, 0.6793, and 0.6962, respectively, whereas the corresponding values for categorization in the mandible were 0.7352, 0.7506, 0.6723, and 0.7019, respectively. The heatmaps indicated that DCC-Net could identify the dental arches and regions showing malocclusion. In the clinical evaluation, the diagnostic accuracy of junior orthodontists improved with DCC-Net's assistance, increasing by 9.18% for the maxilla and 12.75% for the mandible. Conclusions:DCC-Net achieved accurate categorization of dental crowding on intraoral photographs. Its rapid predictions may offer insights for guiding tooth extraction in orthodontic treatment, providing valuable reference data for inexperienced orthodontists and improving doctor-patient communication.
Objective:Force application during orthodontic tooth movement (OTM) promotes oxygen depletion and bone remodeling. Deficiency of hypoxia inducible factor-1α (HIF1α) in myeloid cells accelerates OTM. Low-oxygen and high-salt conditions can stabilize HIF1α in myeloid cells. This study aimed to determine whether myeloid HIF1α levels influence OTM under low- and high-salt diets in mice. Methods:Mice with and without HIF1α expression in myeloid cells received a low-salt (< 0.03% NaCl, tap water) or an high-salt (4% NaCl, saline) diet for two weeks. One week after the start of the diet, an elastic band was inserted between the first and second molars. The expression of inflammatory and bone remodeling genes, bone density, and extent of OTM were determined. Results:Myeloid Hif1α expression did not modify high-salt-induced expression of the inflammatory genes interleukin-1β and interleukin-6. Myeloid-derived Hif1α and dietary salt levels did not significantly modify osteoblast responses to OTM. High-salt conditions and myeloid Hif1α deletion increased osteoclast numbers and expression of osteoclast-specific genes. This was paralleled by reduced bone density, which ultimately led to increased OTM. Conclusions:A high-salt diet and the absence of HIF1α both lead to increased OTM. In the tested OTM model, exposure to high-salt conditions was largely independent of myeloid cell-derived HIF1α.
Objective:This study aimed to compare extraction versus orthodontic eruption decisions for impacted maxillary canines made by three artificial intelligence-based chatbots (ChatGPT, Gemini, and Grok) with those made by orthodontist raters, and to evaluate the overall accuracy of these artificial intelligence-generated recommendations. Methods:Thirty-three patients with impacted maxillary canines were selected, and standardized case scenarios incorporating key diagnostic parameters were presented to the three chatbots. Their treatment decisions were recorded and compared with orthodontists' consensus decisions. Additionally, 10 general queries regarding impacted maxillary canines were submitted to the chatbots. The responses were rated by three orthodontists using a modified 5-point Global Quality Score. Results:The chatbots and orthodontists showed moderate agreement regarding treatment decisions (κ = 0.411-0.524, P < 0.05). Gemini produced significantly more discordant responses, frequently over-recommending orthodontic eruptions (P = 0.002), whereas Grok and ChatGPT received significantly higher scores than Gemini in the case-based scenarios (P < 0.001). Grok outperformed both ChatGPT and Gemini for general queries (P = 0.006). Conclusions:While Gemini showed lower clinical alignment with orthodontists for treatment decisions regarding impacted canines, ChatGPT and Grok demonstrated moderate agreement with orthodontists and produced relatively accurate responses. These findings highlight the potential of chatbots as supportive tools for orthodontic decision-making. However, their use requires careful supervision to avoid the risks associated with inaccurate or misleading recommendations.
Objective:To investigate the frequency of midpalatal suture separation with tooth-and-bone-borne (TBB) and bone-borne (BB) miniscrew-assisted rapid palatal expansion and to compare their skeletal and dentoalveolar effects in young adults. Methods:This retrospective study included 34 patients (14 male and 20 female) who underwent palatal expansion divided into two groups: TBB group (n = 15; mean age, 22.3 years) and BB group (n = 19; mean age, 21.7 years). Cone-beam computed tomography images were acquired before treatment (T0) and after a 3-month consolidation period (T1). The primary outcomes were the frequency of midpalatal suture separation (%) and skeletal and dentoalveolar changes after expansion. The secondary outcome was the dental expansion ratio (%). Results:Midpalatal suture separation was observed in 73.3% (11/15) and 73.7% (14/19) of patients in the TBB and BB groups, respectively. Both groups showed comparable increases in skeletal measurements. However, the TBB group demonstrated greater dentoalveolar expansion than the BB group. In addition, the TBB group exhibited greater dental inclination and a greater reduction in the buccal alveolar bone thickness than the BB group. Furthermore, the dental expansion ratio was significantly higher in the TBB group (65.0%) than in the BB group (35.7%, P < 0.001). Conclusions:Both TBB and BB achieved successful midpalatal suture separation in young adults, with success rates of 73.3% and 73.7%, respectively. Moreover, skeletal expansion outcomes were comparable between the groups. However, dental expansion was greater in the TBB group than in the BB group, with a greater increase in dental inclination.
