AIM:To evaluate the relationship between third molar germ formation and three-dimensional (sagittal, vertical, and transverse) skeletal malocclusions to guide early orthodontic diagnosis and proactive treatment planning. MATERIALS AND METHODS:A retrospective study was conducted using the initial orthodontic records of 483 patients (58.6% female, 41.4% male; mean age 12.42 ± 2.26 years) treated between 2014 and 2025. Initial panoramic, posteroanterior (PA), and lateral cephalometric radiographs were evaluated to determine Sella-Nasion-Point A Angle (SNA), Sella-Nasion-Point B Angle (SNB), Point A-Nasion-Point B Angle (ANB), and Sella-Nasion to Gonion-Gnathion Plane Angle (SN-GoGN) angles, along with maxillary-mandibular skeletal widths. Sagittal classification used ANB angle thresholds (Class III: ANB <0°; Class I: 0°-4°; Class II: ANB >4°); vertical classification used SN-GoGn (<27° = hypodivergent; 27°-38° = normodivergent; >38° = hyperdivergent); transverse classification used PA cephalometric skeletal widths relative to age- and sex-adjusted reference norms. Third molar germs were scored utilizing the Demirjian method. Inclusion criteria strictly required the absence of systemic diseases and prior third molar region surgeries. RESULTS:In the early mixed dentition group, the germ formation stage of the mandibular right third molar (tooth 48) showed a nominally significant difference across sagittal skeletal malocclusion classes (P = .018; uncorrected). Skeletal Class III cases exhibited more advanced germ formation for tooth 48 compared to Skeletal Class II cases. However, following Bonferroni correction for multiple comparisons (corrected threshold P < .0028), this finding did not reach statistical significance and should be considered an exploratory observation. No significant differences were found regarding transverse or vertical skeletal malocclusions across any dentition groups (P > .05). CONCLUSIONS:(i) No significant correlation exists between maxillary/mandibular transverse skeletal widths and third molar germ formation stages. (ii) Skeletal Class III patients in the early mixed dentition period demonstrate accelerated development of tooth 48, likely reflecting advanced sagittal mandibular growth.
OBJECTIVE:To investigate the role of osteoclast-specific HIF-1α in orthodontic tooth movement and to explore the underlying molecular mechanisms. METHODS:A controlled experimental study was performed using a murine OTM model and osteoclast-specific HIF-1α conditional knockout mice (HIF-1αfl/fl; Ctsk-Cre). In vitro osteoclast differentiation assays were conducted using RAW264.7 cells under hypoxic or hypoxia-mimetic conditions. Tooth movement distance and trabecular bone parameters were assessed by micro-computed tomography. Histological staining (H&E and TRAP), immunofluorescence, quantitative PCR and Western blotting were used to evaluate osteoclast number and the expression of HIF-1α and transferrin receptor (TFRC). Small interfering RNA was used to examine the functional role of TFRC. RESULTS:Osteoclast activity increased during OTM and was associated with reduced local oxygen levels and HIF-1α stabilization. Osteoclast-specific deletion of HIF-1α reduced tooth movement distance, decreased osteoclast numbers and increased trabecular bone volume. HIF-1α upregulated TFRC expression under hypoxic conditions, and TFRC silencing attenuated osteoclast differentiation. Pharmacological stabilization of HIF-1α enhanced tooth movement in wild-type mice. CONCLUSIONS:Osteoclast-intrinsic HIF-1α contributes to force-induced bone remodeling and promotes osteoclast differentiation n through a TFRC-associated pathway. Modulation of hypoxia-responsive mechanisms may provide a potential approach to influence orthodontic treatment outcomes.
OBJECTIVES:This study aimed to predict hand-wrist developmental stages, the most reliable indicator of skeletal maturation, from panoramic radiographs (PRs) and lateral cephalometric radiographs (LCRs) using deep learning and to compare the two methods. The goal was to provide a rapid and objective method for growth assessment in orthodontic planning without additional radiation exposure. METHODS:A total of 3703 patients who underwent hand-wrist radiographs (HWRs), PRs, and LCRs prior to orthodontic treatment were retrospectively analyzed. HWRs were classified according to Björk's 9-stage system and reduced to 5- and 3-group schemes. YOLOv5 was used for automated reference point detection, and the extracted regions were classified using a multimodal deep learning framework. EfficientNet-B0 was used for 9-stage classification, and EfficientNet-B4 was used for 5- and 3-group classifications. Clinical variables (age, gender) were included, and hybrid loss strategies addressed class imbalance while preserving sequential stage relationships. Performance metrics included accuracy, recall, mAP@0.5, balanced accuracy, Cohen's Kappa coefficient, and detailed error analysis; 5-fold cross-validation and ensemble learning were used to improve robustness. RESULTS:YOLOv5 detected tooth roots in PRs (accuracy 92.5%, recall 93.3%, mAP@0.5 = 0.942) and cervical vertebrae in LCRs (accuracy 98.9%, recall 99.9%, mAP@0.5 = 0.995). In PRs, the standard accuracy in 9-, 5-, and 3-stage classifications was 0.3648, 0.5307, and 0.7520, respectively, while in LCRs, the standard accuracy in 9-, 5-, and 3-stage classifications was 0.4350, 0.6336, and 0.8975, respectively. CONCLUSION:Deep learning can reliably automate skeletal maturation assessment across imaging methods and resolutions. Appropriately optimized models provide valuable decision support in orthodontic treatment, increasing efficiency and consistency.
OBJECTIVE:The integration of temporary anchorage devices (TADs) to aid clear aligner therapy (CAT) represents an evolving strategy that has gained expanding application over the past decade. This retrospective cohort study aimed to investigate the treatment outcomes of CAT cases involving maxillary incisor retraction following premolar extraction, managed with assistance of various TAD patterns. SUBJECTS AND METHODS:Adult premolar extraction CAT cases were included in this retrospective cohort study. The maxillary central incisors (U1) were grouped based on the TAD pattern for their retraction: Non-TAD (n = 54), posterior TADs only (P-TADs; n = 50), or combined anterior and posterior TADs (AP-TADs; n = 46). Pretreatment and post-treatment CBCTs quantified U1 lingualization, intrusion, retroclination and potential side effects such as apical root resorption (ARR), pulp chamber reduction and palatal dehiscence incidence. RESULTS:P-TADs and AP-TADs patterns achieved greater U1 lingualization than the Non-TAD group. Vertical control differed markedly: AP-TADs achieved U1 intrusion (1.07 ± 1.64 mm), whereas P-TADs and Non-TAD showed U1 extrusion (-0.46 ± 1.12 mm and -1.51 ± 1.29 mm, respectively). U1 retroclination was over 10° in all three groups. AP-TADs exhibited greater ARR (1.31 ± 0.91 mm) and a higher proportion of Grade III ARR than the other groups. In regression analysis, the intrusion achieved was the strongest independent predictor of ARR. Pulp chamber reduction and palatal dehiscence incidence was similar among groups. LIMITATIONS:Residual confounding may persist due to the inherent limitations of retrospective study designs. CONCLUSIONS:In CAT cases involving maxillary incisor retraction following premolar extraction, P-TADs and AP-TADs patterns were associated with notable clinical treatment outcomes. These preliminary findings may provide prognostic indication for the management of such cases in the future.
BACKGROUND:Recent technological advances enable integration of digital dental casts or intraoral scans with 3D facial stereophotogrammetry. However, evidence on the accuracy of this integration remains limited. OBJECTIVES:To assess the level of evidence regarding the accuracy of the integration of a digital dental cast or intraoral scan into a 3D-facial image, in comparison to a full face CBCT scan in healthy growing and nongrowing patients. SEARCH METHODS:MEDLINE (PubMed), EMBASE, Web of Science, Cochrane Library were searched. A manual search was performed of reference lists of included articles. SELECTION CRITERIA:Inclusion criteria were studies investigating the integration of a digital dental cast or intraoral scan into a 3D stereophotogrammetric picture of the face, with a full face CBCT as a comparator. All study designs except case reports were included. DATA COLLECTION AND ANALYSIS:A pilot assessment was conducted, to synchronize the reviewers' criteria for data extraction. After data extraction, a Risk of bias (RoB) assessment was performed using the Quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Certainty of the evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. RESULTS:Four eligible studies were identified and two more after updating the literature search. All reviewed studies confirmed feasibility of integrating intraoral scans with 3D facial images. The QUADAS-2 assessment revealed a high risk of bias for all included studies. Certainty of evidence concerning the accuracy was very low (GRADE). Due to heterogeneity concerning registration procedures and anatomical landmarks between the included studies, a qualitative description analysis of the results was made. CONCLUSIONS:The accuracy of the registration of a digital dental cast or intraoral scan into a facial scan is clinically acceptable. Most, but not all outcomes met the 2 mm or 2 degree threshold, depending on anatomical region, image acquisition, and measurement method. A 3D image of the face with an integrated digital dental cast or intraoral scan may be a promising radiation-free method for orthodontic diagnostics and treatment planning. However, due to the inconsistency in different registration methods and small sample sizes, the accuracy is yet to be further investigated. CLINICAL TRIALS REGISTRATION:INPLASY (INPLASY202420038).
BACKGROUND:Artificial intelligence has been gaining popularity in all fields of dentistry. Orthodontic screening is needed to categorize patients for treatment eligibility and urgency of care in public orthodontic clinics. However, screening is time consuming due to high demand. This is the first study to investigate the use of artificial intelligence-supported teleorthodontics for orthodontic screening and triage. OBJECTIVES:The objective of this study was to investigate the validity of teleorthodontics and artificial intelligence (TAI) in orthodontic screening and triage in comparison to face-to-face (F2F) screening. TRIAL DESIGN:This study was designed as a single-centre crossover randomized controlled trial. METHODS:A total of 255 patients referred for public orthodontic treatment were randomized into two sequences: control, F2F triage first, and test, TAI triage first. A total of 178 participants completed the trial (age range: 7-38 years) with 95 participants enrolled initially to the control and 83 to the test sequence, respectively. For TAI triage, patients submitted intraoral scans using Dental Monitoring™ (DM™), extraoral photos, and an online patient history survey. After a 2-month washout period, participants were re-triaged with the other method. OUTCOMES:The primary outcome was the validity of TAI triage in referral acceptance or rejection based on a minimum Index of Orthodontic Treatment Need (IOTN) Dental Health Component (DHC) threshold of ≥3. Secondary outcomes were diagnostic validity of TAI for all IOTN grades, at referral acceptance threshold IOTN ≥ 4, and triage duration comparison. RANDOMIZATION:Patients were randomized using a permuted randomized block design (allocation ratio 1:1). BLINDING:Investigators and participants could not be blinded to sequence allocation. RESULTS:Referral acceptance or rejection at IOTN ≥ 3, TAI triage had a sensitivity of 1, a specificity of 0.67, and an overall diagnostic accuracy of 0.98, with three referrals incorrectly rejected by TAI. Artificial intelligence could not detect OB and OJ correctly for some patients and did not measure important traits, including crossbite, contact point displacement, and functional shift. Teleorthodontic triage duration was 2.9 times faster than F2F. LIMITATIONS:This study was conducted in a public orthodontic clinic, and results apply to this setting when using IOTN and the hybrid method used in this investigation. CONCLUSIONS:Teleorthodontics combined with DM™ is a valid and reliable tool for orthodontic screening of patients with mild and severe malocclusions but cannot be used to confidently assign IOTN-DHC grade for patients with borderline malocclusion severity yet. The duration of screening is significantly shorter using TAI. REGISTRATION:Australian New Zealand Clinical Trials Registry ID: ACTRN12623000327684.
OBJECTIVES:While current evidence suggests that dentofacial orthopaedic treatment neither increases nor decreases TMD signs and symptoms, corresponding data on treatment performed in adults are lacking. Therefore, the objective of this study was to assess the long-term (≥15 years) prevalence of signs and symptoms of TMD in adult Class II Herbst-multibracket appliance (MBA) patients including oral health related quality of life. SUBJECTS AND METHODS:All patients (Department of Orthodontics, University of Giessen, Germany) in which Herbst-MBA treatment had been performed during adulthood and ended ≥15 years ago, that could be contacted and were willing to participate. Records from before (T0) and after active treatment (T1) were compared with the recall data (T2). The DC/TMD and the Helkimo index were used for TMJ analysis. In addition, the participants filled out the oral health impact profile (OHIP) questionnaire 14 at T2. RESULTS:31 out of 51 patients with an average age at recall of 43.4 ± 7.4 years participated. The prevalence of patients free of TMD signs and symptoms (DC/TMD) was 50% (T0), 84% (T1), 75% (T2). The corresponding reduction in TMD prevalence went along with a decrease in TMD severity both anamnestically and clinically (Helkimo Index). Overall, signs and symptoms fluctuated and there was a trend towards improvement (T0-T1) and recurrence (T1-T2). None of the changes was statistically significant. The level of oral health related quality of life was very high (OHIP: median = 1). CONCLUSIONS:Adult Herbst-MBA Class II treatment does not seem to be associated with a clear trend regarding incidence/prevalence of TMD in the long-term (≥15 years). TRIAL REGISTRATION:WHO ID: DRKS00023022.
OBJECTIVES:Maxillary Total Arch Distalization (MTAD) with interradicular mini-screws (MSs) in combination with Completely Customized Lingual Appliances (CCLAs) is an effective concept for Class II correction in adolescents and adults which does not require any additional supraconstructions. The aim of this study was to investigate the failure rates of MSs after strictly following a defined insertion protocol. PATIENTS AND METHODS:From November 2015 to August 2025, a total of 958 interradicular MSs were inserted in the maxilla for MTAD in combination with a CCLA in one orthodontic specialist practice. The surgical procedures were performed by 8 different clinicians (6 orthodontist specialists/2 postgraduate students in orthodontics) on 283 patients (female: 199/male: 84) with an average age of 27.6 years, ±13.3. Premature loss was defined as any instance in which a MS required removal due to mobility or was lost spontaneously on a yes/no basis. RESULTS:Of the 958 interradicular mini-screws, 14 (1.5%) failed before schedule (palatal 13/buccal 1). No significant influence of the experience level of the clinicians (P = 0.394) on the mini-screw loss rate was observed. The highest loss rate was observed in the patients > 45 age group. LIMITATIONS:One limitation is the retrospective study design, but no patient meeting the inclusion criteria was excluded for any reason. CONCLUSIONS:Interradicular mini-screws used as temporary anchorage devices for maxillary total arch distalization can exhibit comparably low failure rates (1.5%) to those placed in the anterior palate, provided that a well-established clinical protocol is strictly followed.
OBJECTIVE:To analyze the compensatory characteristics and influencing factors of the maxillary arch curvature in the sagittal plane. METHODS:A total of 537 pre-treatment cases with cone beam computed tomography (CBCT) and digital dental model were included. CBCT images and dental models were registered and fused to obtain landmark coordinates of the integrated models. On the midsagittal plane, maxillary arch was fitted separately on each side using clinical crown center points, indices reflecting maxillary arch morphology were measured. Generalized estimating equations (GEEs) and additional statistical analyses were employed to examine the relationship between maxillary arch curvature and its influencing factors. RESULTS:The gingival-directional intersection angle between the anterior and posterior segments of the maxillary arch in the sagittal plane (AC/PC) was smaller in adolescents (162.42° ± 6.38°) than adults (166.09° ± 6.93°). Differences were also observed among patients with varying degrees of crowding, overjet, and overbite. In GEE analyses accounting for within-subject clustering, age demonstrated a significant positive association with AC/PC (β = 1.781, P < 0.001), whereas the maxillomandibular plane angle (MP/PP) showed a significant negative association (β = -0.902, P < 0.001). CONCLUSIONS:With increasing age, the sagittal curvature of the maxillary arch tends to flatten, whereas greater curvature is associated with a larger maxillomandibular plane angle (MP/PP). Age and vertical skeletal relationships appear to play key roles in shaping sagittal maxillary arch morphology.
BACKGROUND:The chin is a distinctive anatomical trait unique to Homo sapiens, with unclear origin and function. This study aimed to investigate chin morphology, describe shape variability, and identify potential sex differences. MATERIALS AND METHOD:The sample consisted of 95 CBCT images, from university archives. Inclusion and exclusion criteria were: age above 21 years, absence of craniofacial deformities, no missing or extracted teeth in the anterior mandibular area and no alveolar bone resorption. Raw DICOM data were converted into mesh surfaces. The following methodology comprised three steps: one manual and two automated resulting in coverage of the chin area by 640 landmarks. All landmark configurations were then superimposed with Procrustes Superimposition and the resulting shape information was reduced to Principal Components (PCs) of shape. These were used to describe shape variation in the sample. Sex differences were evaluated with permutation tests and allometry was assessed by regressing on the logarithm of centroid size. RESULTS:Symphyseal shape variation was primarily linked to its height-to-width ratio and to symphyseal thickness. Significant sex differences were found both in shape and size; male symphyses were 8.7% larger. Also, there were notable sex-related shape differences in mental tubercle prominence and mandibular curvature, however, these were minimized after removing the allometry effect. CONCLUSIONS:We suggest a fast and user-friendly 3D geometric morphometric method to assess chin morphology. We identified the main symphyseal shape patterns and sex differences, which were mostly related to size, indicating a strong allometric effect.
Background The benefits of powered toothbrushes (PTBs) over manual toothbrushes (MTBs) are well established. However, for orthodontic patients with fixed appliances (FAs), the evidence remains diverging. Moreover, direct comparisons between PTBs with different action modes and MTBs in terms of plaque and gingivitis control are limited. With new data emerging, an updated synthesis of the literature, including subgroup analysis by PTB action mode, is warranted.Objectives To determine the efficacy of PTBs vs. MTBs in orthodontic patients with FAs on reducing plaque scores (PS), gingivitis scores (GS) and gingival bleeding scores (BS).Search Methods PubMed-MEDLINE and Cochrane-CENTRAL were searched until November 2025, and the reference lists of eligible studies were manually reviewed.Selection Criteria Controlled clinical trials (CCTs) or randomized controlled clinical trials (RCTs); involving orthodontic patients with buccal FAs, toothbrushing performed by participants in good general health; comparing PTBs and MTBs; reporting PS, GS, and BS.Data Collection and Analysis From the included papers, data of interest were extracted, risk of bias was evaluated by RoB 2 or ROBINS-I, and a descriptive analysis was performed. Where possible, meta-analyses were performed with subgroup meta-analyses by evaluation index or/and PTB action mode, along with heterogeneity evaluation, publication bias assessment, sensitivity analysis and trial sequential analysis. The evidence quality and effect sizes were assessed, and, where appropriate, the strength of recommendations was rated.Results Twenty-three papers (including 39 comparisons) were eligible, with low-to-high risk of bias and considerable heterogeneity. Descriptive analysis found no overall difference in most comparisons for PS (64%), GS (76%), and BS (75%). Incremental-difference meta-analyses indicated PTBs had medium effects over MTBs on PS [standardized mean difference (SMD) = -0.77, 95% confidence interval (CI): -1.33 to -0.21, P = .007, I2 = 92%], large effects on GS (SMD = -0.82, 95% CI: -1.55 to -0.09, P = .03, I2 = 93%), and medium effects on BS (SMD = -0.51, 95% CI: -0.88 to -0.13, P = .008, I2 = 80%). All sensitivity analyses confirmed PTB benefits for BS, with RCT-restricted analyses supporting improvements for PS and GS. Publication bias could not be excluded for any incremental-difference meta-analyses, and evidence quality was low across all parameters. In subgroup meta-analyses by PTB action mode, counter-rotational PTBs (CR-PTBs) showed large effects on PS (very low-quality evidence).Conclusion For fixed orthodontic patients, low-quality evidence limited by methodological weaknesses and inconsistency suggests PTBs may moderately improve PS compared with MTBs, with medium to large effects on gingival parameters. Subanalysis by action-mode showed that only CR-PTBs provided large improvements in PS over MTBs, supported by very low-quality evidence. The findings observed in this systematic review are sensitive to a limited number of studies and should be interpreted cautiously, as true effects remain uncertain and may change with more robust randomized evidence.Registration PROSPERO (CRD42023480974).
Background This study explored the extent to which orthodontists experience work-related musculoskeletal disorders (WMSDs) and burdensome working conditions, assessed job satisfaction, and identified factors associated with job satisfaction.Methods Data were collected by means of a web-based survey comprising 64 items addressing general and professional characteristics, work-related musculoskeletal complaints, and five subscales addressing working conditions, stress, private circumstances, coping ability, and job satisfaction. Descriptive statistics, reliability analyses, and bivariate and multivariable linear regression analyses were performed.Results In total, 115 orthodontists participated. Almost three-quarters (73.0%) reported at least one WMSD, with the shoulders, neck, and lower back being the most frequently affected anatomical regions. While orthodontists reported a moderate burden from working conditions and private circumstances, most experienced low levels of stress, demonstrated high coping ability, and reported high job satisfaction. In bivariate analyses, fewer WMSDs, lower perceived burden from working conditions and stress, and higher coping ability were associated with greater job satisfaction. In the multivariable model, working conditions, practice ownership, and coping ability explained 25.2% of the variance in job satisfaction.Conclusion Greater job satisfaction was most strongly associated with more favourable working conditions, owning a practice, and higher coping ability. Although lower perceived stress and fewer work-related musculoskeletal disorders were associated with job satisfaction in unadjusted analyses, they did not remain independent predictors in the multivariable model. These findings suggest that both organizational and individual factors contribute to professional satisfaction among orthodontists. However, additional determinants not examined in this study are likely to play a role.
BACKGROUND:Extraction of mandibular primary second molars in patients with congenitally missing second premolars may influence oral health-related quality of life (OHRQoL), yet this has not been previously investigated. OBJECTIVE:To assess the impact of mandibular primary second molar extraction on OHRQoL compared with an age- and gender-matched control group without dental agenesis. DESIGN:Prospective, randomized, longitudinal split-mouth study. METHODS:Patients were recruited from nine public dental clinics in the Skaraborg region, Sweden (2017-2020) with bilateral congenitally missing second mandibular premolars. Each mandibular side was randomly assigned to extraction or hemisection. At the 4-year follow-up, the intervention group underwent a clinical examination and completed the Child Perceptions Questionnaire (CPQ11-14) along with a treatment recall and perception questionnaire, whereas the control group underwent a clinical examination and completed the CPQ11-14. RESULTS:The study included 80 patients, divided equally between the intervention group (n = 40) and the control group (n = 40). There was no significant difference in total CPQ scores between the intervention group (mean 8.5, SD 5.6) and the control group (mean 6.9, SD 5.6; P = 0.218), nor were any differences observed between sexes. The intervention group scored significantly higher in emotional (P = 0.018) and social well-being (P = 0.045). Hemisection was recalled as more painful than conventional extraction (P < 0.001). Despite 65% reported awareness of residual spaces, 82.5% were not interested in further treatment. CONCLUSION:Extraction of mandibular primary second molars in patients with congenitally missing second premolars did not adversely affect overall OHRQoL 4 years post-treatment. Hemisection was recalled as more painful than conventional extraction. Most patients were satisfied without additional treatment, indicating good long-term acceptance of residual spaces following interceptive extraction. TRIAL REGISTRATION:The trial was registered with https://www.researchweb.org/is/sverige, registration number: 967125.
AIM:To compare orofacial dysfunctions (OFD) in individuals with rare diseases, with and without open bite (OB) malocclusion, and to explore the associated symptoms. PATIENTS AND METHODS:In total, data for 788 individuals representing 164 different rare diseases, were collected from the MHC database for the period of 2013-2019. The inclusion criteria were having a rare disease and having completed the Nordic Orofacial Test-Screening (NOT-S). OB was categorized as anterior OB (AOB), lateral OB (LOB), and severe anterior OB (AOBS). The sample was divided into two groups: 142 with OB (mean age, 14.2 ± 13.0 years; 81 males, 61 females); and 557 with normal vertical relation (NVR) (mean age, 15.1 ± 12.9 years; 292 males, 265 females). OFD was compared between the groups. Items from the NOT-S test were analysed, and the Odds Ratio (OR) for OB was calculated. RESULTS:The OB prevalence was 18%, with AOB being the most-common sub-type (58%), followed by AOBS (15%) and LOB (13%). Nemaline myopathy was the disease with the highest prevalence rates for OB and AOBS. The OB group had a larger proportion of OFD than the NVR group in 6/12 domains of the NOT-S. Deviant tongue posture was most strongly associated with OB (OR 6.062). CONCLUSION:Two-thirds of the individuals had OFD, and OB was a common finding (18%). Rare diseases with symptoms of orofacial hypotonia, craniofacial abnormalities and macroglossia show a higher prevalence of OB. A deviant tongue posture showed the highest odds for OB in this group of rare diseases.
BACKGROUND:Dental crowding affects nearly half of European adolescents and can negatively impact oral health-related quality of life (OHRQoL), particularly emotional and social well-being dimensions. Orthodontic treatment aims to improve function, aesthetics, and psychosocial well-being, yet active treatment may temporarily impair OHRQoL due to pain, dietary restrictions, and oral hygiene challenges. Understanding how conditions affect patients requires both objective and subjective assessments, yet patient reported outcomes remain underreported in orthodontic research, especially when comparing treatment techniques. OBJECTIVES:To evaluate and compare OHRQoL, treatment motivation, expectations, quality of care and attention, and satisfaction in adolescents with dental crowding treated with two fixed appliance systems without extractions, and to explore factors associated with satisfaction with treatment outcomes. TRIAL DESIGN:Multicentre, two-arm, parallel-group, superiority randomized controlled trial, with pooled analyses of both treatment groups, sex-stratified comparisons, and analyses exploring associations. METHODS:Adolescents (n = 132), 12-17 years, with dental crowding were randomized with 1:1 ratio using computer generated random permuted blocks, stratified by sex, to receive fixed appliance treatment without extractions with either a conventional bracket system (CB; Victory) or a passive self-ligating bracket system (PSLB; DamonQ) at four orthodontic clinics. Primary outcome was Child Perceptions Questionnaire 11-14 (CPQ) score change. Two items were omitted; sensitivity analysis confirmed minimal impact on results. Secondary outcomes were patient experience and satisfaction questionnaires (10-point scale) assessed before treatment (T0), post-alignment (T1), and post-treatment (T2). Because of the nature of the treatments, only assessors could be blinded. RESULTS:Both the CB (♀39, ♂31) and PSLB (♀34, ♂28) groups reported improved OHRQoL (median CPQ score change T0-T2 for total sample: 4.5; r = 0.37, P < .001) with minor intergroup differences. Oral symptoms and functional limitations worsened at T1 then improved by T2 (median change T0-T2 for each domain: 1, r = 0.23, 0.27, respectively, P < .001), whereas emotional and social well-being improved throughout treatment (median change T0-T2 for each domain: 1; r = 0.28, P < .001). Median scores were high for motivation (9) and overall satisfaction with treatment outcomes (≥9), and low for regretting having started treatment (1). Correlations between treatment expectations and satisfaction were observed (ρ = 0.330, P < .001). Minor harms expected during orthodontic treatment included plaque accumulation, chafing and gingivitis. CONCLUSIONS:This study indicates that fixed appliance treatment for dental crowding leads to improvements in OHRQoL, with temporary declines during treatment, and high patient satisfaction in the studied sample. Patients reported satisfaction with the changes achieved, dental appearance, and did not regret having started treatment. The results demonstrate possible benefits of treatment, patient-centred care, and support the use of patient reported outcomes in orthodontic practice. TRIAL REGISTRATION:ClinicalTrials.gov (NCT05664282) 2022-11-24.
OBJECTIVE:We aimed to evaluate three-dimensional (3D) maxillary displacement and secondary mandibular changes following miniscrew-assisted rapid palatal expansion (MARPE) according to pretreatment skeletal subtypes, based on the identification of variables affecting site-specific maxillary displacement. MATERIALS AND METHODS:Sixty-three patients (mean age, 21.4 ± 4.3 years) treated with MARPE were categorized by sagittal (Class I, II, III) and vertical (hyperdivergent, nonhypodivergent) subtypes. Pre and postexpansion CBCT scans were used to quantify forward and downward maxillary displacement at the anterior and posterior nasal spine (ANS and PNS), and mandibular positional changes were assessed. Multiple regression analysis was performed to identify craniofacial variables affecting differential ANS and PNS displacement. Finally, maxillo-mandibular changes were compared between Class II hyperdivergent (CII-H) and Class III nonhyperdivergent (CIII-NH) patients. RESULTS:After adjustment for age, gender, and the amount of midpalatal suture split, downward displacement at the ANS and PNS was significantly influenced by pretreatment sagittal, vertical, and transverse skeletal subtypes, whereas forward displacement showed no differences among subtypes. The Class III subtype exhibited less downward ANS displacement than Class I and Class II. The hyperdivergent subtype showed greater downward displacement at both ANS and PNS than the nonhyperdivergent subtype. Regarding the mandible, the hyperdivergent subtype showed a greater increase in vertical divergency, while sagittal subtypes showed no significant differences. CII-H patients showed greater 3D maxillary displacement and subsequent mandibular rotation than CIII-NH patients. CONCLUSIONS:MARPE-induced 3D maxillo-mandibular changes were dependent on pretreatment skeletal subtypes. These findings highlight the importance of subtype-based strategic vertical control to optimize postexpansion orthodontic outcomes.
BACKGROUND/OBJECTIVES:Tooth segmentation remains the most time-consuming task during model preparation for digital orthodontic setup. This study aimed to assess the accuracy of AI-based tooth segmentation tools of four widely used orthodontic platforms, namely Medit LINK (©Medit Corp, South Korea), DentOne (©DIORCO Co, South Korea), BlueSkyPlan (Blu Sky Bio, USA), and ArchForm, using models categorized by specific clinical characteristics. MATERIALS/METHODS:A total of 270 digital dental models were retrospectively selected and assigned to nine groups: aligned dentition, crowding, spacing, ectopia, agenesis, gingival recession, tooth wear, orthodontic brackets, and attachments. Automated labeling success and segmentation quality were evaluated for each software. Mesio-distal (MD) tooth widths were calculated using Meshmixer software (Autodesk, San Rafael, Calif) and compared with unsegmented models (ground truth). All data were statistically analyzed. RESULTS:BlueSkyPlan consistently outperformed the other tested software in tooth labeling, surface segmentation, and mesio-distal measurements accuracy across all model groups (P < 0.05). Labeling errors were most frequent in models with ectopic teeth (≤12.2% success) and agenesis (≤53.1% success). Surface-specific errors increased with crowding (buccal/lingual errors), spacing (mesio-distal errors), gingival recession (buccal errors), and tooth wear (occlusal errors). All software overestimated MD widths compared with ground truth with the limits of agreement considered clinically relevant (>0.30 mm) in specific software-model combinations). LIMITATIONS:The software evaluated does not provide transparency regarding the AI technologies implemented. CONCLUSIONS/IMPLICATIONS:The accuracy of automatic segmentation of intra-oral scans is influenced by clinical and anatomical characteristics of the dental arches and still requires clinician supervision. BlueSkyPlan currently appears to provide the most reliable performance among the tested platforms.
BACKGROUND:Orthognathic therapy aims to correct severe maxillofacial deformities and enhance facial appearance. Certain orthognathic osteotomies may achieve gender-affirming changes, shifting a face towards a more feminine or masculine appearance. The objective was to develop a convolutional neural network (CNN) to quantify orthognathic therapy's effect on gender-defining facial features, in relation to malocclusion and osteotomy. METHODS:A computational algorithm combining a face detector and a CNN trained on >0.5 million gender-labelled facial images and further fine-tuned on dedicated 7591 face images to predict perceived gender was applied on 2164 annotated facial images of 146 orthognathic patients. Perceived gender was graded and post-treatment scores were compared with pre-treatment scores, differentiating between corrected malocclusion and performed surgery. RESULTS:Female orthognathic patients demonstrated a significant feminizing shift (P < .001) particularly evident in the Class III female subgroup. This feminization effect was also observed in female patients with vertical, transverse and retrognathic facial disbalances. Male patients experienced strengthened masculine facial features especially in the Class II subgroup (P = .029), while the correction of vertical and transverse discrepancies resulted in minimal change. The most pronounced gender-affirming changes were achieved when bimaxillary osteotomies were performed in conjunction with chin osteotomy (P ≤ .002). IMPLICATIONS:CNN-based models offer dependable possibilities to quantify orthognathic treatment's impact on gender-related facial features, underlining their value in treatment planning and patient education. The results suggest that orthognathic corrections can significantly alter gender-affirming facial traits, which must be considered when defining individual treatment goals.
